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7-11 FOOD STORE 22763 - ESTABLISHMENTS fee) Stow #11763 , '26 Nefhh fl�c<� universal oneTM f _ UNIVI6162 MADE IN USA G J Commonwealth of Massachusetts ¢ ' City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 04/11/2011 ESTABLISHMENT NAME: 7-11 Food Store#22763 File Number:BHF-2004-000113 126 North Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2011-0420 Jan 1,2011 Dec 31,2011 $280.00 TOBACCO VENDOR BHP-2011-0421 Jan 1,2011 Dec 31,2011 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 I � a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH r�tP" 120 WASHINGTON STREET,4...FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 KAYOR DGREFT411AUM rni ALEN1.COM DAaID GREEN&wNi,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I-: (I A- aa.-, Lo'3 TEL# ADDRESS OF ESTABLISHMENT Iat-& 1VL912\H Si- Szxkcw MA FAX# to MAILING ADDRESS(if different) N,b EMAIL- Business': N�A Website: N10, OWNER'S NAME N"36,A C NA�f Q�i{�y� TEL# ADDRESS \'S \ C �� AL pe r.� 2� C�CJ-I\)hn wl (1\A STREET `� e CITY STATE ZIP , / CERTIFIED FOOD MANAGER'S NAME(S) A rel \ C-."x G�� `�\ �`1� CERTIFICATE#(S) 1�l 5-6 7 (Required in an establishment where potentially hazardouFfood is prepared) -1,LA 4a a Og,q EMERGENCY RESPONSE PERSON A m %C A Ck-a-kN-4 HOME TEL# PSo�- y 34 - poa3 jDAYS;OFOPERATION- .,'.MondayTuesday ;_; ' Wednesday IIhursday. '..i, `?'i ;Fridays::;:''.:p'. Saturday.. ;' ;'s: Sundays. HOURS OF OPERATION Please write in time of day. .0A %Lr It l 4%4ry d o (For example Ilam-11 pm) ! 'd TYPE OF ESTABLISHMENT FEE (check onlv) RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. more than I0,000sq.ft. .................. ............... ....... ........................................... RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 .,.om!han 99 seats =$420 BED/BREAKFAST/--------------------YES--------- ----O-- ----------------------------------------------------------------------------------$---10-------- N0 CHILDCARESERVICES/NURSING HOM-- -------------------------•---------------------------------------------------------•------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES (00 $25 TOBACCO VENDOR ® NO Ir 135 ALL NON-PROFIT(such as church kitchens) YES NO '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 plans4or such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state tAgA required under the law. is/8 /10 An 413— o9a 3a� Signature Date / Social Security or Federal Identification Number Revised 10/7/11 FOODAP101Ldm Check#&Date 1+6JILtI4o!4-$11) slyo- DATE_ J )3 ► 1► 1 _ RECEIPTN U M B E R :. Q cV RECEIVED FROM / (''') C , r n �^ ' ADDRccc ( 1� �'1�(�- Y�li_t��1 �/UI�-'�� )r C' //!11 ' r1 DOLLARS$ _� z W '2 FOR ' 3a ACCOUNT HOW PAID / U �$ I BALANCE BEGINNING CASH r AMOUNT PAID CHECKBALA DUE NCE ORDER BY t Salem Board of Health Massachusetts Department of Public Health 120 Washington Street,4tb Floor Division of Food and Drugs Salem, MA 01970-35rax FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800978) 745-0343 Name Datg Type of Operation(sl Tee of Insoectlon 1114 /lo I ❑ Food Service Routine Address 'a6 i/ / Risk ' ' Retail Re-inspection ofth t °� Level Residential Kitchen Previous I spa tion Telephone G�y �J �/ I TU _' [W -11030 I El Mobile Date: I r (5 /,J o Owner aton Aµ'I cr� C 11ia rl k r I/ HACCP YM ❑❑ Caterer Temporary ❑ Pre-o t Illness Suspect Illness Person in Chargefft) I Time ElBed 8 Breakfast ❑ General Complaint "//�� In: e ❑ HACCP Inspector `nSP7)1 I�J[ n� I Ouh/ ?� Permit No. ❑Other Each violation checked requires a'n explanation on the narrative age(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. LFOOD_PROTECTION MANAGEMENT-_ �1 E] 12. Prevention of Contamination from Hands 1. PIC Assigned/Knowledgeable/ ❑ Duties _ 13. Handwash Facilities [EMPLOYEEHEALTH ') , [:12. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ _ 15.Toxic Chemicals LFOOD FROM APPROVED SOURCE T 0 4. Food and Water from Approved Source LIIMEITEMPERATURE CONTROLS(Potentially Hazardous Foals)( ❑ 5. Receiving/Condition [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 CREOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)! El 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices LCONSUMER 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 today,the items checked indicate violations of 105 CMR ofHealth. 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)(ss0.00s> the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5 SBOln (Fo 14,E () f/�1 Inspector's Signature: I, Print: , PIC's Signature Print: � I� FFF(YY' YY I Page oabes , Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 1 3-302.11(ANi) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility" Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I j Contamination from Raw Ingredients 12-103.11 Person in charge -duties I 3-302 11(A)(2) Raw Animal Foods Separated from Each herT OtContamination EMPLOYEE HEALTH ( ( from the Environment I 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection* require reporting by food employees and � 3-30115 Washing Praire and Vegetables applicants* 3" 590 003(F) Responsibility Of A Fant Fraployee Or An '1O4' Food Contact with Equipment and 1. Iiort To The Person In I Utensils Applicant To Report I I Contamination from the Consumer I Charge* 13.306.14(A)(B) Returned Food and Reservice of Food* j 590.003(G) Reporting by Person in Charge` Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) I Removed of Exclusions and Restrictions 13-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.11- I Foot inn Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* j ( 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* I 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice blade From Potable Drinking Water* concentration and hardness. 5-101.11 Drinking Water from an Approved System* I 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 14-602.11 Cleaning Frequency of Equipment Fool- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source j 14-702.11 Frequency of Sanitization of Utensils and 3 01.14 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* Game and Wild Mushrooms Approved by 110 ( Proper,Adequate Handwashing j Regulatory Authority I i 2-301.11 CleanCondition-Hands and Arms* 3-202.18 j Shellstock Identification Prescnt* 2-301 12 Cleaning Procedure* 590,004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* I I if Good Hygienic Practices j g Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* j 3-202.11 PHFs Received at Proper Temperatures* j 2-401.12 Discharges From the Eyes,Nose and 13-202.15 Package Integrity' Mouth* 3-IOL I t Food Safe and Unadulterated 3-301,12 Preventing Contamination When Tasting'' 6 Tags/Records;Shellstock I 112 Prevention of Contamination from Hands__I 3-202.18 Shellstock Identification" ( 590.004(E) Preventing Contamination from l 13-203.12 Shellstock Identification Maintained* j I Employees* Tags/Records:Fish Products I 113 I Handwash Facilities 13-402.11 Parasite Destruction* I ( Convenientty Located and Accessible 3-402.12 I Records.Creation and Retention* I 15-203.11 Numbers and Capacities* j 590.004(]) I Labeling of Ingredients' I 15-204.11 Location and Placement* j q Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging;criteria* j 6-301.11 Handwashing Cleanser,Availability 18-103.12 Conformance with Approved Procedures" I 16-30# 12 Hand Dryin Provision j *Uenutes critical item in the federal 1999 1'Ood Calc or 105 CMR 590.000. CITY OF SALEM _ '1 BOARD OF HEALTH Establishment Name: - � ' F—pra� ice T�- ___�> Date /0 Page: (9 of Item Code C-Critical nem I DESCRIPTION OF VIOLATION/P,CAN OF CORRECTION I Date No. Reference R-Red Rem verified r� PLEASE PRINT CLFA � ) 1 / 6-R , 11 M9 ' /C� �Y I I It�)Q�7�� /-'WG//k SS �(l/i!✓G!/- n)', Ja J-7 Y�'1 S77I�G r-�l ��\1(.�9 6-R 1 alt J . c c4-�3/ja v—n.),44 IL,d l.a,— -l��n _ Y31 I �,�►Z�a.�- C' �or✓�, �u �t�aQ �oo/ -;t,T W �e Sj'l� /�.�,s �-- G✓u r!� -,.� w� ; n I I I I I I Discussion With Person in Charge: ( Corrective Action Required:TO No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ 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. ( e �� ii� Q- Li 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.) I 41'F/45"F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives _ I 19 PHF Hot and Cold Holding I 3-50L16(B) Cold PHFs Maintained at o r below 3-202.12 Additives* 04(5) °145°F* 3-302.14 Protection from Unapproved Additives* 3-501 H 115 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140 7-101.11 Identifying Information-Original I Roasts 3501.16(A) RaasLc Held at or above 130°F. Containers* 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* I 1 I I 13-501.19 Time as a Public Health Control* --201.11 Separation-Storage* 7-202.11 Restriction-Presence and Use 590.004(H) Variance Requirement 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Satdtizers.Criteria-Chemicals* 17-204.12 Chemicals for Washing Produce,Criteria* ' 121 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria' I Beverages with Warning labels* 7-205.11 Incidental Food Contact,Lubricants* ( 3-R01.11(B) Use of Pasteurized EPs* 7-206.11 Restricted Use Pesticides,Criteria* t 13-301.11(D) Raw or Partially Cooked Animal Food and Raw Seed 7-206.12 Rodent Bait Stations* I 7-206.13 Tracking Powders,Pest Control and 13-R01.11(C) Unopened Food ood P PNot Served.Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERS.TURE CONTROLS 22 3-603.11 I Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for f Animal Foods That are Raw,Undercooked or PRFs ( Not Otherwise Processed to Eliminate 3-401.i1A(i)(2) Eggs- 155°F 15 Sec. Pathogens.*EWeedve f/rlXgl Eggs-immediate Service 145'Fl5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game ( Ems* Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 155 3-401.11(B)(1)(2) Pork and.Beef Roast- 130°5121 in* I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food,temporary and 3401.11(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 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F t° 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a ( practices should be debited under#29- Microwave 165°F* Special Requirements. 117 1 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec. * I Reheating for Hot Holding VIOLA770AIS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PRFs 165'F l5 sec.* I (items 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- f found in the following sections of the Food Cade and 105 CMR 140°F* I 590.000. 3403.1I(E) Remaining Unsiiced Portions of Beef i Item I Good Retail Practices FC 540.000 Roasts4: i 23. 1 Management and Personnel f FC-2 .003 18 Proper Cooling of PHFs i 24. Foal and Food Protection FC-3 .004 j 25. Equipment and Utensils FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to I 1 26. Water,Plumbinq and Waste 1 FC-5 .006 ! 70'F Within 2 Hours and From 70°1 127. I Physical Facility 1 FC-6 .007 to 41'F/45'F Within 4 Hours. * 128. Poisonous or Toxic Materials 1 FG-7 .008 i 3-501.14(B) Cooling PRFs Made From Ambient 129. Special Requirements .009 Temperature Ingredients to 41°F/45°F I 130. 1 Other ! I Within 4 Hoa s* *Denotes critical rent in the federal 1999 Foal Code N 105 CMR 590.000. 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 r Q r Dat jyoe of Ooeration(sl Type of Inspection //1/rl/j I ❑ Food Service ® Routine Address /a6 a I/�r j �e,, Rihk Retail El Re-inspection t►) T Level IJ Residential Kitchen Previous Inspection Telephone q-1tk wq 610a [IMobile Date: Owner /nCr1QJ f HACCP YM El Temporary El Pre-dperation AM ) *J ❑ Caterer ❑ Suspect Illness Person in Charjle(PIC) I Time ❑ Bed&Breakfast ❑General Complaint ff; In:3 aJ ❑ HACCP Inspector 'rrcY� Out:L(S Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisfon(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. ❑ / I (FOOD PROTECTION MANAGEMENT El_ _ ' I 12. Prevention of Contamination from Hands 1. PIC Assigned/Knowledgeable Duties ❑ 13. Handwash Facilities [ -- P ., EMPLOYEE HEALTH ";'' i (PROTECTION FROM CHEMICALS ', ❑ 2. Reportingof Diseases by Food Employee and IC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals LFOODFROM AP_P_ROVEDSOURCF t - ❑ 4. Food and Water from Approved Source I TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)J ❑ 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 1 ❑ 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_(NSP)I El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices (CONSUMER ADVISORY - El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-z) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(9590.090.0 044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION C, S 5WMgp�14 ^ Inspector's Signature: , `, Print: PIC's Signature: �� V �„r� I Print: U�p S C I Pagel of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)t 1) Raw Animal Foals Separated from 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Fools* 540.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in charge --duties 3-302.11(A)(2) ( Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(0) I Responsibility of the person in charge to 3-302.11(A) Foal Protection* I require reporting by fool employees tmd applicants* 13-30. 75 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foal Employee Or An 13-304.11 Food Contact with Equipment and Applicant To Report To The Person In I Utensils APP P � Contamination from the Consumer I Charge* - - ---- 590.003(G) Reporting by Person in Charge* i i 3-306.14(A)(B) Returned Food and Rted or C of Foci* i Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions I 13-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE 4 Food and Water From Regulated Sources 9 I Food Contact Surfaces 590.004(A-B) C01,111omphance with Food Law* I ( 4-5Manual Warewashing-Hot Water 3-201.12 Focif in a Hermetically Scaled Container* Sanitization Temperatures* 1 4-501.112 Mechanical Warewashin Hot Water 3-201.13 _Fluid Milk and Milk Products* � g' 3-202,13 Shell Eggs* � Sanitization Temperatures* 4-501.114 I Chemical Sanitizatitem H, 4 3-202.14 Eggs and Milk Products,Pasteurized* on- p'°P 3-202.16 I Ice Made From Putablc Drinking Water* ---- concentration and hardness. 5-!01.11 Drinking Water from an Approved System* 4-601.11(q) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* ( Utensils Clean* 1540.006(B) Water Meets Standards in 370 CMR 22.04" I 4-602'11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source _ Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscum Foal Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* Game and Wild Mushrooms Approved 4v ( 10 � Proper,Adequate Handwashing I Regulatory Authority I 2-301.11 Clean Condition-Hands and Arms* 3-202.19 Shellst.xk Identification Present'" 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I 2-301,14 When to Wash* I 201.17 Game Animals* ( 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating.Drinking or Using Tobacco* I 3-202.11 PHFs Received at Proper Temperatures' 12-401 12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity' Mouth* 3-101.11 Food Safe and Unadulterated* 13-301.1.2 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock ( 12 Prevention of Contamination from Hands_ � 3-202.18 Shellstuck Identification * ( 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products ( 13 I Handwash Facilities I 3-402.11 Parasite Destruction* I ConvenientyLocated and Accessible 3402.12 Recorda.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* I 7 I Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance IHACCP Plans ( i Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* ( 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced oxygen packaging,cnteria* 8-103.12 Conformance with Approved Procedures* � 6-301.12 Hand Drying Provision <Denotes critical nem in the federal t999 Food Code o; 105 CMR 590,000. CITY OF SALEM • _ i g, (v� t BOARD OF HEALTH ' Establishment Name: 77--11 , aaar. A Date: If 14 Pager of ri Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - verified 1 ` > l PLFAR P PRINT CI FART Y C if any h VrlIto- ,k_n. 1/. /1/1r. .Ir/i �e-y � rn. .�es_) �8 i-ml� i L Ge_A �,l�va �. .. (!wn �'•-1 1;11,1;11,/a ✓.74k4 / 4-r/- ✓�{�/ r T Ora ;A:)//) -t- -2, , t- {\.l l/J 6 �/. tTK.I_�n r� o � -]-41 Qt , r? I w,i l/v '�A�. w 7CA/�/ �71 ! 4—/ Iy 1a-� .9ni. G1 -A2,1 ( UILe OTYA rL1.AM� -rte 172Q I'Ze A«ca-, Z rZX. I-V J a ?h-4 /'A,,tre- I-Aew M ( Q7,." ; r lt.*A.�c,.l / t`i�,fi a nC, J-1/./iaz�r o I � C A,.�p .Pd4 �,//7 U &116- .r-(,,I r �knnr� ��ti, , r-.,A-4O AvzJ aP n 4 J t I -a�1_ra ✓ cV%C- �^v�� Ql (P',�/� i(� (JA�Lj �tnr.,,�a Ut.s,(,�� h.� &- ( .. I (;)1— 41 13 ...n 4 '1 It Ar 4,4-- c..vAa _ 46✓ 50 /-C/'0cu .f- AtrK A s r �• la �� 2or,n � .L/ /�l �JY`P�7� -r�✓tid'r S�ru, i ��,.. r�2R�i �/� ✓+ ,..'T lI rl /�f �yl z, cY�' "ri V�✓n i` �c7lcrl �il� J4,) ..� Discussicn With Person in Charge: Corrective Action Required: ❑ No IaaYes' " I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ V � Exclusion violatio,Is before the next inspection, to observe all conditions as described, and to �r Re-inspection Scheduled Ll 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. a -moi 0 Voluntary Disposal 0 Other: a f i#(') PHFS Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Amwifing to Law Cooled to Factors(list"1-22) /ConQ _ 41`fd45`F Within 4 Haws- z PROTECTION FROM CHEMICALS +-501 15 i Cxdiw,Methods for PHFs 19 ! ' PHF Hot and hold Holding 14 Food or Color Additives - - 3 5{±t.16(13) Cold PHFs 44amtainect at or haloes ?-202 12 I A("tilCcr 590.004(1) -11 1#; F* 3-302.14 Protection front Hnapprot�ed Addiltver, 3-501 Ih:.`,i ilex['HFe 3lainiauted:tturahove 15 Poisonous or Toxic Substances { ! 7 !(11.11 Idmofymg intilintaliun Ung�nai id0^} T-_--,5t_i Iht,h _- fi'o.•at>Heid at of alwvc i311`H. * i ContauieW I Tt1 Time as 7 Public Health Control Cwmunn Vam:- tCnrklna+.nut..---- ...1 t._ -__._ - ___.__ .__.-_-..._.�.--.-.________ r i '-30Lti $a^;nanan--Sint ago" .�J� != __ __. $__- uh t.,er tuntl,tl i --- _..._..-_. n v u fa } 1AY h '-2U2.1i Et c:.t:it't:on-Prc+:nutanti L•:'' _----_.t_= H'- - 1�- . j 7-202.12 Co;tciu ion,of 7-'Q3 t t Tois t_<mnewi;I -Proh;hi:I3no' REOUiREMENTS FOR H*HLY SUSCEPTIBLE - i POPULATION�...HSP 7-104.11 S:13InL[ell•t_(IICI'3i1 -t.heu)IC;,iq, _ �_-_-.- - ,� <' i 7.] +-i+P? i ILl) Tl:n(iaaifurt.cd S"m-t�oil:.icd!tulle wtd I 7. h.nticaB.int 1',hahtoF t':,ablcaC:itctrrt' J 1 _ -.. . _ _ Rct;t`stnawnhtl`,luink ahols^ 7-.'.04 la I I Ur':u!sAccnh.Cnte:ra'" _ _ --+;-S+i: 11dAl 1's, 7 ?(75 it _ Lti td:alai i:�al Cvnt.3it. nI No :fl } Ct+H.cd Animal FtxJ arm 7206.11 Hr irirl::vi t'>r Pe niidr. Crttct:,:' r F 7-06A?2 i Rtdtn; 6ni15'::ua*!=. ___ -__ _.�._,..__'_ \I,: 'trot R a:•:i — i i Y.t ; 7 � .a ret't'r,el t'�• t . ,z. (. l�r.lC.:*^:oadCr^ 1'••a. '• t:IFT<1.tsi:, t ,,t r•e:it nJnr rre } ( �„ R .._.... . X4NSUFYti'..F• -'.ESYt.V X TIME/Ti ECIPERATURE CONTROLS :{' : i i t't>,: :,n.•t :i;'..;r:r';. i'r a,:t1 :.:r{'oit<E;n;rni..n t•' z------ ! i :i.•!a '1 E<rd• .r:..t.,c ii.,,. !'tlilc;w'a<ti:. 1 PrttPArcooking Yytnpurstir+e>re•t I _, 401 f 1.1+i:i.:, j } ;�:- 1 Fi ;: t<•c. :. � - -_ i ti : ..:'7 .o 1 '<l.t,1..'d i'. T'r.tt�•.I'r34:•iP;'i2 w t:E ell 1 - --------------- i 1 .:.:3 t, .v•r r. � }:<,,r, 1tbtP: - i - r i -.. ._.�t...... ... --.. _..._. _.. r � i t ' ndwa . t3 5 ' r'}l b .t ., r 'SS�lti."• :.).'ki^r• 1. fLt ,. ) . „ 3O;'l:. (•y,'d, :C*t},,!i 8. it... r�,i 3:i IF. � 1 :ttv .o< a; '.rr., o:n :)(:3:,^fsi.. •h�',:'.: . ^ i r St1.:J'1" tiihP.i.ly 1... !91e i � r't"e . .. < - ?:i ir:'R• tpdR' ;f-:' t'� , 1 it t.. `.:etit..� 'tii ti4t a'7tcil:n.r r . .�, r ._ .0 ;r t•„y5 __ _. S k:ILFt t^l.+a,., tl �._.- a., }�.. til.'nip 2i.,{lit -7:',-.I ll b: � `hit do ai.i Ir.•,' I'? L6,tu' :v;,ndl:^.,: Cr:.. .. .,.!r.or. r ..: o) . ,;,r,. . . .., .:'(.a'o."<C ::lot!.r 1'l0<: • ar,; i!,I. isr nu;at^ u:� item ocd FN 'r �'r,^ i•c. _: _ .`,9;:n3gjrnrc't<v�C t',:.•,ay,:•,"- 6aj Fix,$i`Die•aPr 4(' .i L✓:1 RR Proper Cooling of PHFs _ . . .._..--_a-.. _ . 501 i_.:1' i ;lhvntt!(':wk'd C'HPe I"un If I I - - PL� Ln,,.:fi( ',V • -_ _-- �*.__ - %t�,; -, W4 liI;it !L•or<;:9fl Frc:l:: t ___ ..a. ' -.--_ _- _.- -_ _ __ _ : .r.;i"t-1-l. It F kite::'. ' f - _ ',,::.:� ,-.e.,x• :T -- .-_q) t•'t iii i t iridin:;('ti :+5..:!e F,t•nt At+:lnrnt .'__ - 3_S: ---ii.= 1n.1 CITY OF SALEM BOARD OF HEALTH Establishment Name: H)a( add 6 f Date: /(�/��n Page: of tem Code C-Crttleal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I . N Reference R-Red Rem r'L'G�� PI.EAFF PAINT C;PARI v VerMed "--�-,Y' S(" nee, //3./, r,,,17 r /V OD . I I ��Ci/Iih<i Imo " �u�.l! I I I � 5r(lirnSI ,�tJ�� Ioc i olPl rQ C hrncT! I- dl'�� - c�r.r KCr �r,?w Grz,.rn��, il/l dn. 3` Y-0 4A Vk�d 14,�)r (DO /Q - T E I ��AJvr;rtA& r r�i eA4, 3 a c 7 ,J -0 -n L) i )+ c I `I'§kr�I -+A9 iC / ->t/7 11 a,� I /_/ i >-r(, I I i I t"Kcl9 �1) 6njord --ruit- G L (,)N4 rC4'X. IOrj, --y)lJvA�/ / 1,.A I I �.e�e.ci- � / -�� '�. /9r/1✓74.( %�//t�C C)7�J �-' f��Je12r ! '_'2oriT�l�v r �`r�l, ., JYI,e= I ca d Lem'(n T7 r n tT4 0 Y rQA__ r / �,M r r ((9? P _ rtie S'� A4 --I 'C c>[— Z,✓t5lb -r--�. Discussion With Person in Charge: Corrective Action Required: ❑ 'No �<6 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 11 ne - Exclusion a -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that �� noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. — .,\��_ ❑ Voluntary Disposal ❑ Other: 3-501.t4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness.Interventions and Risk According to taw Cooled to Factors(ftems 1-22) (Cant.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS { 3-501.15 Cooling Methods for PHFs { { 14 I Food or Color Additives I { 19 PHF Hot and Cold Holding { 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41'/45°F* 3-30114 ,I Protection from Unapproved Additives* 1 13-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances ( 7-101.11 Identifying Information-Original I 1403501.16(A) Roasts Held at or above ' I Containers* Lc 20 Time as a Public Health Control 7-102.11 { Common Name-Working Containers* I { 7-201.11 { Separation-Storage* 3-501A9 Time as a Public Health Control* { 7-202,11 ,Restriction-Presence and Use* { { 590.004(H) Variance Requirement { 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* 7-204.11 Sanitizers.Criteria-Chemicals* { POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* I 121 13-801.11(A) Unpasteurized Pre-packaged Juices and { 7-204.14 Drying Agents.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Fwd Contact I ubricants* 3-801.11B) Use of Pasteurized Eggs* { { 3-801.11(D) Raw or Partially Corked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened F 7-206.13 Tracking Powders,Pest Control and I Food Package Not Re-sensed. ' Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooling Temperatures for I Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 340111A(i)(2) Eggs- 155°F 15 Sec. Pathogens.*`"°` " Eggs-Immediate Service 145'F15sec* I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.i l(A)(2) Comminuted Fish,Meats&Game j Ems* Animals-155'F 15 sec. * I SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) Por):and Beef Roast- 130°5121 thin*1 3401.11(A)(2) Ratites,Injected Meats-155`515 590.009(A)-(D) Violations of Section.590.009(A)-(D)in sec * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks I interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12I Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165°F* Special Requirements. 3-40111(A)(1)(b) I All Other PHFs-145°F 15 sec. 117 Reheating for Hot Holding ( VIOLATIONS R,eLATED TO GOOD RETAIL PRACTICES 3403.tl(A)&(D) I PHFs 165'F 15 sec.* I (Iteins23-30) 3-40311(B) Microwave- 165'F 2 Minute Standing f Critical and non-critical violations,which do not relate to the Time* I foodborne illness interventions and tis&factors listed above, can be 3403.11(C) I Commercial ly Processed RTE Food- f found in the following sections of the Food Cade and 105 CUR 14005* I 590.000. 3-40111(E) Remaining Unsliced Portions of Beef I Hem I Good Retail Practices FC 590.000 i Roasts* 23. Manaqement and Personnel 1 FC-2 .003 I 118 Proper Cooling of PHFs { 24, Food and Food Protection I FC-3 .004 I 3-501.14(A) Cooling Cooked PHOaten, Fs from 140'F to ( 25. tem and Utensils I FC-4 .005 i 126. Water,PlUmbinq and Waste IFC-5 006 f 70'F Within 2 Hours and From 707 1 27. Physical Facility FC-6 .007 I to 4l'F/45'F R'ithin 4 Hours. " 1 28. Poisonous or Toxic Materials 1 FC-7 A08 3-501.14(B) I Cooling PHFs Made From Ambient 1 29. 1 Special Requirements j .009 Temperature Ingredients to 41'F/45°F f 36. 1 Other I Within 4 Hours* s:""""""""` "Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �w+,`7y' ,,. ..,.,,r*++r,<+n wl'»fin ✓'y`r.-rvlry �1r.trit. .,y�:w.-.'.p.�..- ' rys-,5,v new\. ,,i. wt,wk,b.+aP'+��S.qe'!"� p Y rT` �y'p,, "1 r^ ' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name `` Date Toe of Ooerationfsl, Type of Insoection I- l l ��)rr� S�YCa . tea 7�0 'A-a^M Food Service Routine Address /n _0oI/ �1 Risk {ir]'Retail I_I'Re-inspection l U( Cin o o Level ❑Residential Kitchen Previous Inspection Telephone Gj tlCA/ fl 44 6 7 El Mobile Date: Ownernn HACCP Y/N [:] Temporary ❑ Pre-operation //�� ( ?M,� \ /A.. , , a _ I ❑ Caterer ❑ Suspect Illness Person in Charge'(PIC) /1, (�M O Time ❑ Bed&Breakfast ❑ General Complaint ElHACCP I'� Inspector f �AJ>AR 0 �J aJA I O`Ut:,qh41 Permit No. ❑Other Each violation checked requires,an,ezplanation on the narrative p ge(s) and a citation of specific provision(s)violated. VNon-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 IF) action as determined by the Board of Health. / FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH - ❑ 13. Handwash Facilities , 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/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ` ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedure`s/HACCP Plans ❑ 18• Cooling s, PROTECTION FROM CONTAMINATION '` ' •. -. '- > ' r❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaningand Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9 EI21. Food and Food Preparation for HSP El 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 p g 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 cited in this report may result in suspension or revocation of (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:,--"to n S 50IW.tFUr 14 d. I r l,� Inspector's Signature `,� � //1 Print: /r��ri ,.tom I PIC's Signature!y_�- l 1 I Print: �' ��/�� G°f i�lX�/rJ Pagel of_Z7Pages �J Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination . I I 596.003(A) Assignment of Responsibility'" 3-302.11(Ahl) Raw Animal Foods Separated from 590.003(5) Dem=*nshation of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Aninatl Foods Separated from Each EMPLOYEE HEALTH Other= 2 590 003(C) Responsibility of the person to charge to I Contamination from the Environment - require reporting by food employees and 3-302.11(A) Food Protection"` j applicants" 13-302.15 Washing Fruits and Vegetables j 590.003(F) Responsibility OCA Focal Employee Or An 1 13-304.11 Focal Contact with Equipment and ApplicanE To Report To The Person In I utensils* Charge" i j Contam;nation from the Consumer 590.003(G) Reporting by Person in Charge` i ;-306.1 VA)(5) Rehumed Food and Reservice of Food'* 13 1590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(8) Removal of Exclusions and Restrictions I Food 3 701.?I Discarding or Reconditining Unsafe FOOD FROM APPROVED SOURCE rte' 4 Food and Water From Regulated Sources I y Food Contact Surfaces -- -- - 590A(µ(A-5) Compliance with Food law* j 4-501.111 Manual Warewashing-Het Water 13-201.1'2 1 Food in a Hermetically Scaled Container* I Sanitization Tentperattres* 4-501.1 12 Mechanical Warewashin� Hot Water ( 3?01.13 ( F1uid Milk and Milk Products* 4-501.112 r j 3-202.13 I Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milo:Products,Pasteurized* j 14-501.114 Chemical Sanitisation-temp., pH, concentration and hardness. * _ __ 3-202.16, Made From Potable Thinking Water* 14.601 11(A) EgUipment Food Contact Surfaces and j 5-1011 11 Drinking Nater from an Approved System" Utensils Clean" 5o0.01)((A) Bottled Drinking Water* j ' - _ j 590.006(8) Water Meets Standards in 310 CMR 22.0" i 4-60-.21 Cleaning Frequency of Equipment Mood- _ Shellfish and Fish Froman Approved Source i Contact Surfaces and Utensils*4.702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recrmdonally Caught Molluscan I - Fvcu!Contact Surfaces of Equinment* Shellfish" 4-703.11 Methods of Sanitization-Flot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ChemicaP" Sources* 110 .IProper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2.3111,7 1 I Clean Condition-Hands and Arms" j j j 3-202.18 Shellsto k identification Present" I 12-301.12 Cleaning Procedure* j 590.004(0) Wild Mushrooms* j 1 2-301.14 When to Wash" j j 3-201.17 Game Animals* I 111 Good Hygienic Practices 51 Receiving/Condition I 2-401.11 Eaun£. Dunking,or Using Tobacco* 3-202.11 PITFs Received at Proper Temperatures" 12401.12 Discharges From the Eyes, Nose and 3-202.t5 Package Integrity- Mouth* 3-101.11 Food We and Unadulterated* 3-30L12 Pieventing Contamination When Tasting* j j 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands j 3-202.18 Shelistoek Identification* I 590.004(2) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* j Employees* - -- Tags/Records:Fish Products I 113 Contlwash Facilities I Conveniently Located and Accessible 3-402.11 Parasite Destruction" j 3-402.12 Records. Creation and Retention* I 15-203.11 Numbers and Capacities* 7 1 590.0f9(1) Labeling of Ingredients* 15-204.11 Location and Placement* Conformance with.Approved Procedures ( `2x)5.11 Accessibility,Operation and Maintenance I /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Ivtethods* Devices 3-502.12 I Reduced oxygen packaging.,criteria" 16-301.1 i Hand washing Cleanser,Availability_- 8-103.12 Conformance with Approved Procedures, j I 6-3301.12 Hand Drying Provision Denotes critical nem in the federal 1999 Faxl Code nr 105 ChiR 590.000. a t" € CITY OF SALEM BOARD OF HEALTH i Establishment Name: r7— I I �__r), 1 1_6 -2� Date: Page: c of Item Code C-Critical itemDate No. Reference R-Red Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION ,- Verifled /� PLEASE PRINT CLEARLY NVIRI c. Lf n XD �QS�P�3C l,0A—ita—(4 - 16 1 013V 1/'�M(f'f\ ,> l I 6V,1 �� rA L+O' -44 f € 1 4A �rAN A-4 OVA-)I, , {Viii I /On/vl lY_�/4lPll._ A�. `01 � .�, a.//)y�, 1-� ��Q,'k^orA 0.nn 't ✓u it __ I _ _ -In-1��, (, n � pn � �� _ //_��- //1� (\,t� n�.l 9%? P-[ n.p ,e#A AA n (�,I J:�¢Gn�w 11) wQ 0,A.Xxft-0"-. �. rA� �rn An rV +, , iI , /� 1 wff / /1 dAw. � 1 Jwfl/1 ri o �U a; - „� � ham= „ n ., -\;a -�� - (00CA C , e I IOA.1A0 U / r , n0�� 1 bo4J 11y - 1 �C A .� (�4`/ 12 r1 mn /1 n yr 1 J nlnt1�nirv1 (�orrn-ten Q CA/IA, rICDA ', aAA-0, ()AO,. . ORA \ Oh^A' IA. A 1 ✓f��l_rY FDiscussion With Person in Charge: v (J / I Corrective Action Required: I ❑ No iC I a' Yes F 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 O 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 t your food permit. t V I I ❑ Voluntary Disposal 0 Other: 3-501 #4(l') PHFc Received at Temperatures l) Violations Related to Foodborne Illness Intervent/ons and Risk According to Law Cooled to I! Factors(hells 1.22) (Cont) 141°F145`F Within_4 Homs. ' PROTECTION FROM CHEMICALS ( 1-501,15 Qxding Methods for k'f1Fs 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(B) Co#d PHF,Mainwined at or below 3-202.12 Additivcx'" ( 540 t311w(f-') 410/45"F- 3-302.14 Pnnccluai from Una3mr(r ed Additives` 3-501,16(i1) 1 fill PHF<Maintained at or above 1; 1 Poisonous or Toxic Substances 140 F. 1-101.11 Identifying Intcainatinn - lhirinal I 16(A) R,:a,tt.field a(or ibocc 130'F, C'nntainers• 1 Time as a Public Health Conti of 7-i 0_7..t 1_ ! Common Namb'r e - Worlg i :11 � Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/29/2010 ESTABLISHMENT NAME: 7-11 Food Store#22763 File Number BHF-2004-000113 126 North Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2010-0183 Jan 4,2010 Dec 31,2010 $280.00 TOBACCO VENDOR BHP-2010-0184 Jan 4,2010 Dec 31,2010 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l, 2010 Board of Health 1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS Y j BOARD OF HEALTH 120 WASHINGTON STREET,4T FLOOR TEL. (978) 741-1800 I{IMBERLEY DRISCOLL �, ,;. FAX(978) 745-0343 MAYOR DGREENUAUM&ALEM.COM DAVID GREENBAU1i, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (Y hGr,A S'1 o DJ.') (a-i TEL# Ci-1 Li L( 30'7 ADDRESS OF ESTABLISHMENT 1 ZLU P1G R-\N- S t- C�iv1&,.b, Md FAX# MAILING ADDRESS(if different) w)I� EMAIL-Business': Nl r) da Website: Vl1 OWNER'S NAMEC' V\ANI-IA ky�k3 TEL# x1.41 - -tLALA • lc30"- ADDRESS 1 K\ '� 1 Q� �' �a mlik `6 �,`� 'O o a 3 STREET ll 1 CITY STATE Qts •} ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) U ao A D 31(00 (Required in an establishment where potentially hazardous f_o is prepared) EMERGENCY RESPONSE PERSON HOME TEL# '1��1 U1�a 881 g I D'A.YS',.OFQRERATIgN ';( twfoutlayR'r; Tugsda'y�; l Nle`duesday71iu,'rsdayaFndayitrSat�frdayw $iintlay- `� HOURS OF OPERATION Please wMe in t6ne of day. Q1{ \v", a+ (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. � more than 10,000sq.ft. =$420 ------------------------------------- - ------ ----------------------------------------------------------------------------------4----- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ------------- _ - ------------------------------------------------------------------------------ - BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSIN1--1 OM---------------------------------------------------------------------- ----------- ........................------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO TOBACCO VENDOR YE NO r$135 ALL NON-PROFIT(such as church kitchens) Y NO *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state to s required under the law. Signature Date / Social Security or Federal Identification Number Revised 424/07 FOOD A 008.adm Check#&Date aL S ,:a> T�. �.' Msnro-,"'+t..A'3.`.a '�.' /„t-r�-+ n; r...�*,4ti- •� '• � . .... .,.yy�� (y� tM+f"• � C0/M i�Yg J4A�'.�y� .�, Y.wMh. 4.'.FYI Yn� '�i"{r..cJl / 1 f Massachusetts Department of Public Health ; Salem Board of Health 120 Washington Street',OlFloor Division of Food and Drugs Salem, MA 01970-3523 . FOOD ESTABLISHMENT INSPECTION REPORT 1 r' e � Tel. (978)741-1800, Fax (978) 745-0343 NameDae Type of ODeration(s) Type of Inspection -7 - 1 I h�Ij SLrn �IL- a �z? ►aj�l01t ❑ Food Service ❑ Routine Address ' 1� A j fir / `\ _ A jL RisK Retail P-Re-inspection , Level Residential Kitchen Previous Inspection � Telephone ❑ Mobile Date: n .�r '�k-mil- Owner r HACCP YM ❑ Temporary ElPre-operation A� � r �,� ��c I El Caterer El Suspect Illness Person in Charge l(PfGt� ' Y ^ / Time ❑ Bed&Breakfast ❑ General Complaint In:/:4 ElHACCP inspector A I Q Outr7 .)7 Permit No. ❑Other Each violation checked r ulres 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 ElEMPLOYEE HEALTH_ ' - -"" 13. Handwash Facilities 2.'R _ -. , PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE" ' ❑ 15.Toxic Chemicals ' ❑ 4. Food and Water from Approved Source TIME/rEMPERATU9E CONTROLS(Potentially Hazardous Foods) _ ❑ 5. Receiving/Condition. ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [:118. Cooling PROTECTION FROM CONTAMINATION' - - ❑ 19. Hot and Cold Holding [18. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIaLE POPULATIONS(HSP) ` E]21. Food and Food Preparation for HSP El 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 cf Health. 590.000/federal Food Code. This report, when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-s)(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 417. 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 5901nsp tFo, 14 ^ Inspector's Signature: -/- Print: /1 PIC's Signature ��' Print: �� --��5� Page.of,2P ges Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S ( Cross-contamination I " I 590.003(A) Assignment of Responsibility' I 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foals* 2-103.11 Person in charge-duties I Contamination from Raw ingredients 3-30211(A)(2) Raw Anincll Foods Separated from Each EMPLOYEE HEALTH Other'` 2 1590.003(C) Responsibility of the person in change to j I Contamination from the Environment require reporting by food empktyecs and ( 3-302.11 LA) Food Protection- rpplicants* 3-302.15 Washing Fruils and Vegetables 590"003(F) Responsibility Of A Food Emplovee Or An j 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge" Contamination from the Consumer 590.003(C) Reporting by Person in Charge I i 3-306.14(A)(B) Returned Food and Resetvice of Food'' 3 590.003(D) ExctusiousandRestrictions* l Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I , Food i 3-701.1 i Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 41 Food and Water From Regulated Sources 9 Food Contact Surfaces - 590.004(A-B) Compliance with Food La w* 4-50t III ManualWarewashmg-Hot Water 13-2-01 12 Food in a Henuetically Scaled Container*, S:mitizution Temperatures" 4-501.112 Mechanical W'arewashin Hot Water 3=2(11.2-3 Fluid Milk and Milk Products* I Sanitization Temperatures* 3-202.13 Shell Eggs* 3--'_(52.14 Eggs and Milk Products,Pasteurized" 4-5{}1.114 Chemical Samtiration-temp.,pH, 3-202.16 I lee Made From Potable Drinking Water- I concentration and hairiness. 4-601 1 1f A) i Equipment Food Contact Surfaces and 5-101 11 Drinking Water ttnm an Approved System' Utensils Clean- 590.006(A) bottled Drinking Water* " ( 4-602.11 Cleaning Frequency of Equipment Food- 590,006(B) Water Meets Standards in 310 CMR 22.0` I Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I ( 1-IO2l 7 Frequency of Sanitization of Utensils avid 3201.14 Fish and Recreationally Caught Molluscan I Food Contact Surfaces of Equipment" Shellfish' 4-703.11 I Methrsk,of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* 110 I I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Requiatory AuthordV ( 2-301.11 Clean Coudiuon-[lands and Arms* ( 3-202 IS Shellsux2301.12 Cleaning Procedure*k Identification Present- I I 590.004(C) Wild Mushrooms* ( 2-301.14 I When to Wash* 3-201.17 ( Game Animals* I I I1 I I Good Hygienic Practices - - 5 ( Receiving/Condition 12-401.11 ( Eating,Drinking or Using Tobacco* 3-202.11 PIIFs Received at Proper Temperatures* I n--401.12 I Discharges From the Eyes,Nose mid 13-202.l5 Package Integrity" Mouth' 3-101.11 I Food Safe and Unadulterated"' ?-301.12 Preventing Contamination When Tasting* 6 I Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.1$ Shellstock Identification* I 590.004(E) Preventing Contamination from 3-203 12 Shellstock Identification Maintained" I Empkrvees' Tags/Records:Fish Products I 13 Handwash Facilities " Parasite --- - - --- - Conveniently Located and Accessible t 1-4w-1 1 Parasite Destruction- I - 3-402.12 Records.Creation and Retention* I 15-203.11 Numbers and Capacities* - - 590.0040) Labeling of Ingredients. 15-204.11 Location and Placement* - g IConformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying Devices 3-502.11 I Specialized Processing MethodProcessing 3-502.12 I Reduced oxygen packaging,criteria* 16-301.11 Handwashiug Cleanser,Availability I 19-101.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision *Denolec critical nem in the(odes 099 Fryid Cale of 105 C:41R 590.000, l CITY OF SALEM _ BOARD OF HEALTH a Establishment Name: -1 ( (-b-A 54,)� t:�--»-J�-..`> Date: /:7f A /� i Page: _� of� Item Code c-critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date I No. Reference R-Red Item ,� . . . ,Verified • "3' l (( PLEASE PRIINT CLEARLY - - rVJA-k� (ZV", Lb6 r- f �wn-I-I < ✓t om —,Nn-JAr 40 n, f no, .1�_ I _ _ - ,C�.'.S`O 1�'fn ��_n.�J�.[M�n/yP.�.fl IwL�A rn�llAAad 1-' /gin h/nom a` o .� !'f/ •lrJ .�7 � .,. div � inn ve.�5�✓1 V, r�_ l�v�f,Y^ ✓b,,ra;�fr>•o� - - t I • ,C rC � P 'Discussion With Person in Charge: I Corrective Action Required: I ❑ No ILL�- Yes / I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance C] Employee Restriction it violations before the next inspection, to observe all conditions as described, and to Exclusion P comply"with all mandates of the Mass/Federal Food Cod�,l=understand that L3 Re-inspection Scheduled ❑ Emergency Suspension e d 1 noncompliance may result in daily fines of twent -fivollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure t your food permit. -, ❑ Voluntary Disposal 0 Other: 3-)U1.14(CS PHFs Rectfwd at Temperatures Violations Related to Foodborne Illness Interventions and Risk Aaordiag to Lav Cooled to Factors(IteMs 1-22) (Cont.) 4I'Fl45`F Witl»n 4 Hows- PROTECTION FROM CHEMICALS 3-501.15 Conlin.,titeihad:, for PHFs j 19 I PHF Hot and Cold Holding 14 ( Food or Color Additives ' — 1-202.12 Addid%c,.x ' 590,() 168) Cot/PHFs Maintained at or below 3-302.14 Pnxcnum from L'naunruved Addfhves' WA) I lot PHF:ltaintaiued at or atxwe is 1 Poisonous or Toxic Substances , 140F " ' !(tl.lt k?e:ntifI Iinfc::metinn -Urt;;tn,d z_5„1.161 ) Rami+Heid at or.tbove13U'F, ” 1 ! Cont.nt:er a• _ 20 Time as a Public Heatth Control j 7102.11 ' Common Nail-- A',rrki n�t,Cowa:.icr,"--_ a �-- — --.----..-- _ i s a Public lleallb ControV ! j 7-201.11 � Srpau;atm-Stunit.' -_—._ V j wot202.1? yettrietum - uwd U'C' -___ _j 7-20-3.12 j 7-201.12 Coidni(m, 'ifUsc- 'z 103 t I Toxic Coniameit - Proh,h):wc,` REOUIREMENTS FOR HIGHLY SUSCEPTIBLE i _'-204.i I Sanraer;,C noon-ChrfniuJ.^ j POPULATIONS(HSP 7_� o litrl'r i ldfp:rieurvcd Pre-i:at. ;:ai leu ce wed j j 04.1_ ('hrfitical>Ila W'.hrJx k':,•.ir:. Ca it.•na' I 1+'enan• !ate?Is- A----` 7.'.04.14 . :,f)S.It ;In.'id;:'a? t.kx!ft•n:au Luh:.:a=a,^ t ;.SU).t lii)) j iz.iv>,rr i'anctl!" C,-,k"t %rimai Fn,v .md t _. — "�1.Uf1.12 III, I4Cti :'.xo� i'9ti �Lrai .r;v � � -- - - m_ C rua<ara ♦ Viso P•/ wf. ., +'omwlpd,n o TIMElTP,SPERATIJRE CONTROLS Aui.r,t? t re>3. Cha:arc ;ts•.�. 4n:n:a o.x•i.,d r: 16 1 .-_._.i ProPr.; GU6Kin07en'.petacu,es for r I •:-a fltttrr+',i:e Pn^ra'::'.'1-t;r.,t:..:i _T = t•,i 114ti.c_' ' 1F_d .' i,`•�., :_ _I __ _ ___t_ Y_ _ v r i r ' ):'±.i?:Fltt' ,'• ? i=,�:4�, �. I:,tt };:,.,,t i � uE"2: oat:' ! _ _ _"`.>.�'[_ __C t+riv?(t kfr-F_;V75 __. _ - .-__. __. •-'t•''.r ;,':., i,)t:):,, ,.:,: r, n , 'C. ,?, '(: {: i 14y: �h?•.( `t:'.):Li ;'i� r . .. 'P±: ., <i ./r Hi :it; .. :oo , ,rii i: ., i ?,, R" i f':?'•r.��.•. ,. i t t,i. ,. _.� ' . ,,.''i;l 7? , - -- -- ..-- .- _ tta1i[ tr1)` 4TF )U s < ; fp:r" .•, '•:` ( 11wttl;i23-30) Muiw' S'::adia;a :),; •o>n-,;tr,.'.0 i'ro:,..,,.,rr. rnri,,k . , . :'l . . t__ ?.-f• -_ Jrr„f;:, •x.' (;r inr.rrrrrt:. •r, retJ.r•F. t:r<;r..< I, ,',t t:... ,. .,.;1 r 1 "J.1):f') � t�.t6::C�1:1.,Ii*i's O.,..aa° ':?. t"u<? RP:rI.:iH: .:rJn r!4':c .,..... rj .r.c i:, r. .�<_.... .'t" ,rr f•' R,i%ta;im,L'' si-ol; Pwtwl'of 1;711 IreiGood Retari Practices Fr' Or* _ r �--'-'- 2a P,,n:md Fact_Pt'otc,:Got� [8 r Proper Cooanq of PHFs _. - 2S.__ i:qu,nment and Utwfsds__ ___ _' Ci; - •i UOri ____ 7(:? E !(A, f',x•Lo_(':wi.`d F'Fi Fs Fau: I i7;`F L• W;jgy Fic.mhm v'.d tNa3tp Fr _ n!'p: t _- .,.._ __. _ �.-___- _ _-__._ t__ --- -_ ---, � 7:"F ,t?6::n 7. 16ntn.:nJ Fres �;`.!'i' o;, P,.,.:_•,�,Facda. p� .� ;g7; ' clVithtn 111„e:'. 7- t ^ ! Made F1^nt,luhii .t .'�' S"a.°I Fir{tLnvmfR i'' t},:• . . .,, . 5 } "+C Ol i F�u;..�r.,o:ee (use.F.•r:r:tr -:, f,.t • ' Per a ' Massachusetts t Department of Public Realth- � ' Salem Board of Health ! Public I` 120 Washington Street,'4t' Floor Division of Food and Drugs � , ' Salem, MA 0197,0-3523 ' ' ' I FOOD ESTABLISHMENT INSPECTION.REPORT 3 in ,,( Tel. (978) 741-18001 Fax:(b78) 745-0343 Name �' // ` I_ ; Da / Tvpe of Ooerationlsl, Type of Inspection �( txl ❑ Food Service ® Routine Address ' �r t h� ./^ �1 D fitsk Retail `❑ Re-inspection iXl rIA/ li �nP Level Residential Kitchen Previous Inspection Telephone yy / ,/ El Mobile Date: 7 Owner `, � / HACCP YM El Temporary r,. ❑ pre-operation t ( .h CVViLid f _, -I ❑ Caterer ❑.SuspectIllness Person in Charw(PIC) / Time ❑ Bed&Breakfast _ .❑ General Complaint In: ❑ HACCP Inspector �'j y�n� �hr,1Do I Out: zp;�- Permit No. ❑Other Each violation checked requires an explanation onRRe narrative page(s) and a citation of specific provision(s) violated. V _ 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. 11 ,FOODPROTECTION MANAGEMENT _., 4 ,- '" ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH "-' El 13. Handwash Facilities 'PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded El 14. Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE"-I -,,..:� „ ,, . .. ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potemlally 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 [1 9. Food Contact Surfaces Cleaning and Sanitizing • REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY "" ' ' ' - " ,,; "'• ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected I 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 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(sso.004) cited in this report may result in suspension or revocation of ZZ 25. Equipment and Utensils (FC-a)(sso.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: Nolo u� S 5001nVecffo m-14 lac V v Inspector's Sign ure:'' fI I /� j/ - Print: - PIC's Signature: �,,, J1L�� c Print: 1/- /rc�Qc...�F' Pa e_4 Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S ( Cross-contamnation I 590.003(A) Assignment of Responsibility* ( 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge' I Cook-ed and RTE Foods* 2-103.11 I Person in charge-duties I I I Contamination from Raw ingredients j 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Otherr 2 590.003(0) Responsibility of the person to charge to I I Contamination from the Environment require reporting by food employees and 13-302.11tA) ( Food Protection" applicants* ( 3-302 15 I Washing Fruits and Vegetables 590,003(F) Responsibility Of A Fivd Employee Or An 13-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge' I Comamination from the Consumer I3I590.003(6) Reporting by Person in Charge* 13.3,06.14(A)(B) Returned Food and Resetvice of Food* 590.003(D) Exclusions and Restrictions* i I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701 It Discarding or Reconditioning ITTnsafe FOOD FROM APPROVED SOURCE Food* 14 ' Food and Wider From Regulated Sources j ( 9 Food Contact Surfaces - 1590.004(A-B) Compliance with Food Law* i 4-501.111 Manual Warewashing-Hot Water 1 +-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures' 3-201 13 Fluid Milk and Milk Products* 14 50I 112 Mechanical Warewashing Hot Water imI I3-202.13 Shell Eggs* SanitizationTemoeratures* 14-501.114 I Chemical Samtizaiion-temp.,pH, i 13-_02.14 Eggs.mil Milk Pnxlucts.Pasteurized* j 13-202.16 ice Made From PotableDrinking Water" I concentration and hardness. * 5-101.11 Drinking Water froin an Approved System- 601.11(AI Equipment Food Contact Surf aces and Utensils Clean- 590.006(A) Bottled Drinking Water* i ( 4-600 11 Cleaning Frequency of Equipment Food- ( 59t},0(16(B} Water Meds Standards in 310 CMR 22.0" I Shellfish and Fish From an Approved Source I I Contact Sur faces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan4-702.11 Contact Surfaces of Eouipmer Shellfish* ( Molluscan Shellfish from NSSP Listed 4-703,11 Methods of Sanitization-Hot Water and 3-201.15 Chemical* - - Sources* j Ig ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 12-301.11 Clean Condition-Hands and Arms:_ 3-202.18 Shellstock Identification PresenN ( 2-301.12 Cleaning Procedure* I 590.004(0) Wild Mushrooms* I 12-301.1.9 When to Wash* 3-201.17 Gnmc.4nimuts* 111 I Good Hygienic Practices I I $ Receiving/Condition j 12-401.11 Eating,Drinking or Using Tobacco* 3-202.11 ( FHFs Received at Proper Temperatures* I 12-401.12 I Discharges From the Eyes, Nose and 13-202.1.5 I Package Integrity I Mouth* 3-101.11 I Food Safe and Unadulterated* ( 3-301.12 I Preventrny Contamination When Tasting* ( 12 Prevention of Contamination from Hands ti Tags/Records:Shellstock 1 I 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Mamtained" Entplovees* I Tags/Records:Fish Products 113 I Handwash Facilities 3-402.11 Parasite Destruction* I I Conveniently Located and Accessible i 3-40'_.12 I Records,Creation and Retention* I 5-203.11 Numbers and Capacities* 590.004(T) I Labeling of Ingredients' j 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-2-05.11 Accessibility.Operation and Maintena ce /HACCP Plans I Supplied with Soap and Hand Drying j Devices 3-502.11 Specialized Processing Methods* j 3-502.12 Reduced oxygen packaging.criteria* I 16-301.1 1 Handwashing Cleanser, Availability j 18-103.12 Conformance with Approved Procedures* ( I b-301.12 Hand Dr ng Precision j °Denotes critical item in the tWerd 1999 Folxl Cale or 105 CM R 590.000. / �CITYJOF SALEM � ! BOARD OF HEALTH Establishment Name: -7 /t f-,�n.Q � `P / E?�-�G Z Date: _// Va Page: 9 of Item CcG: C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date: No. Reterence R-Red Item Verified IIn PI FASE PRINT 04- 10 CLEARLY &-J')1 / ,,/� ! 9, - ' II � dl ) �P/2�0//!A_J^ rvpll6 "'f'1 . ./ /_/'/) G�nthn n� jl � I i � 7 ,G 1 Il .Q nn..,7-��{ \l. F nnr• �IIf71_T I' \Ai/I n,4w�ij l— 1 Nn CNiii lS f l -�( JOK4'�, 1rllna Dt" Xn , o A_li,„ )t rf i c-�!/+`R. L^- / ]/� 1IV� ��71- j�l �I� �- _ 1r N)bc /t r-P/) r_/1 ..�� In /fin_ JYfr �r.ln.nn/L .. C�.1�� r- DIrP r1`14- r ( V V i ♦ �' alJtiCiJ ti II'� r, � / ,yy, �t /J ,L^ �1 /� 1 -+--r' /'/114 it �Jrr_F_V` Ill'tc�,ir QY�n./L �_ IY CJw_W1DJnT l fOry t r.{>,Oo&7_n S!3-2- cJYI I -r oAA,) c/en_I /�A 1/ s r? -2f Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑11 Y"s I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Re//s((triction/ 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 P your food permit. ❑ Voluntary Disposal ❑ Other: sl j IViolations Related to Foodborne Illness Interventions and Risk -501 WC) PHFt,Received at Temperatures I ! Ac rdiag to Law Cowled to Factors((tents 1-22) (Cont) i 11 91'F/45"F Within 4 Haws, PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHF 1 14 i i PHF Hot and fold Holding ]4 j Food or Color Additives 15 t 3-202,12 Adlh!o'CO I (1 10((8) Cold PRFs Maintained at or helnw ! 590 4Hl-r(t-) � ;(`'t-ti`F" 3.302.14 Pioteclxm front Unapproved Adddivas' j -;.;?ti Iti:.`;t ( Ilot PHFc;ttaintainedaturabove IS ' Poisonous or Toxic Substances I 101.11 i Id::ntitwt' Information - Orinsn,d 140'1: r i 6 - --? >tti I'"_1i— • Rr>_t,rs Haid a.or atrove 19{11. s i onlainet.' ! ZU Time as a Public Health Control 102.I t j C amnion Nam: N t,rki':c_ 0g1i.un1;r1' i -� ------ t i 'i-2f12.1i itrctiiuon -i'lrunccan,lt ,r„ 7-_'()2.12 i C'audnion:of t',c" i 7-303 i I o.ic r',nttaincu -.Prniutnula„' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE --- - — i POPULATIONS{HSP ! 20-4.11 Sann'zer,.C rllerii' -l'llrmic::h' —_�--.--. T __ .._.�—_-- 7 204.12 � t'h 'ai,tot 4N`il.tr.i;tl t':n,: x',_ a i+I a`-� I till i'np.:=teurrred Prc-pa�t.a_c3 Jvuc,a and i --'-- - - - - i !il`e.^ra ee 'x•ttl: ti"tu.ne�ial.,'.Is. 7 'ti 3.14 Ur vne Arrrt,.Cr!tr'cl- l i i B t 1_,:of Pa trtri::cd is �y� _ 7 205_1� i bn id:nial F;xKI Cor,lna, [AIN ncan'a 1 + Iin P :;'. or P.uua?:', :knitnal Fix'd sn3 ! I-_iiti 1_6.12 1 15.nf CONSUME"ADVISORY TiMEITEMPERATURE CONTROLS .._.�-._ iv'ir::; t t't«4, l ii.it.ac !";:r�'. L n.)ct'.,x,kt d•,: ! i .-. 1 Proper Cooking Peniperatut"s frrr --; I I `,.., �tt!,;:.„i•'c ?'n:'t:>`.1 r;::Gr.i's;a:e . 1 2 r -- r, 1'(13',3 _ tp „t of tr ru1R' S,• t: t i i � i C.:1Ctta P, :ri•:1`if: kk`... l:i'.XS+ di^. , t : i S LT'.,,!{ rlai.::i:.: . 1q;' ” ! t � ' :!ii•(t,. YiL` .'L. ... 11 tr;nhtali[,p.9� n.r: . _ rky? F:(J(-A,r0iti:i.k,..:n /5'a' ;r','t. Di ! 1H!". 16` i. (I tIiews 23_,5;7' iQ'.i I($1 -- +d t,rrn,av; It, ' i ' S11nu:e Si'mlin;; t%,4. . a,t, tot.,-t :,'r•tir i'it:::,. '. is .. . , :eFa.< ..t 1 1:31:3' •r,!//': rt4 1'..'S' 'rF:i.:'etit,ni, ,.. a .,: LYL t,.r;;,,tc rG r;,r;I,P '-403.'14C:} ("'r, ...: {,'I!- (t_„ f tw'!i'l :h, ,rr;qe et aoP•.. :h _.. _ - . .- ''-40' i I(Li R,n,.n;ii„�', t.:, i•t.ro i'R•itions of lt,•i herr. Good Retai?Pracfrces FC _ �9G'.C6li _ I 2,i F id'ta4f'nt_.•:1 and Poti.Y,f,y: ?-0 t-:v.n:md CthAi P'O:td'i;o', 4 ± tjnd 14 1 Proper Cooling of PHF5 _.. _ _._._. ___ _- .._- .. —{-- � _Flit,nn U 3 501 L;(:\} I Crv4lae Ct",S''t1 I'HI'. F,nn: tx(P('L' 2,C -da'.er Pt,nt,t - 1i 7: 'F 4l uiar, Z dour<and(-nun i!)'I F,.„it} j Io `- - -- - -- - - - - - - - --- ' .1:'F"/,; F 4kifi'm- H,ai ^;;: �C. - 7 :$iD 501.i-l(b f--olive 4'ifF M:Je Foin Avl1 wnf , '_ : - `"r;•i':.`i i,r:�(:_.`Er-HI_ _. ._ _._.._____ .__.__ �'_._ .._ ! ('em rt..e Ine'md;Cnt= t,�454• t' ?the- ' 1 d::1,-; ,,t i.,r'r". :t1- t %,iN 'X•"N. ` CITY OF SALEM 7 _ I BOARD OF HEALTH Establishment Name: 7- / r, , Chirp / as�!-<� Date: Page: �3 of — item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION - Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY - I I C)4%,r 1k, , e� h�eI^n/< Or-y l foa.,vr/ %-&C- 17 CX)ovF- r, OS) (C I r1r .i a�r)ci 5C� �d�i � I f 1 } (11.Ic In taC/ Y�r'• o?l ��- _' nAA. '? ( � „7 [/#n - s OP) 4 (tv]aAP ( 'JL-r la oc, - I-f JfAAo 1.4_0�1 - CIA , JO,,/) 1 A/-LV0a, rlTl/ fO felA�ir 'j R.-j- —,)A-)f 1 1. 2j_)i ��( I r-e,i 1,, /}y A_n S-A lk-f-\ r�TIA r ff $A l,ia .'e �'-r J C)�' - (��C; 11 n �.i /�,r` �� 9/t>=�Tinr�vtin div IAJ (Ju(l�In (.,,ala fi— pA l - AeJA I_s�,/v�f l�� '�S �� i�L.9✓ tJl /�a i=ap.�rar,( �� !� 5�(. lam/ ��it / � c ✓r� �AIJ10 0-,\)j' (—,r� <•ICeok liJ>k � DIsc ssion With Person in Charge: Corrective Action Required: I ❑ No g Yes Q . - 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, �� 0 Voluntary Disposal ❑ Other: ?-5,11 i4:C'} PHF!.Recciwdat Temperatures Violations Related to Foodborne Illness Interventions and Risk According to LauCooled to Factors(items 1.22) {Cont) 41'1"/45`1"Within-1 Hours. PROTECTION FROM CHEMICALS ( 501 is Ctn ling Methods for PRFs { 1 ( 114 PHF Hot and Cold Holding 4 Food or Color Additives; 3-2(}?.12 AddttiwO 3 5M 16B) I Cold PHFs Mainwined at or beh,w 590.004(1-} -41'!4,5,,,I: i 3-302.14 Protection front linappro%edAdditive~' I i.ig1.1611) Hot('H}-e Maintained atorabove c 1 Poisonous or Toxic Substances ! ' 101.11 luentiti'imz tntiontalirn Original I I !d0`P ' .(t!AN'A) F„a+t:,Hrld at orabove 1300F. * toinsirers` - - -- -------- ------------- �(}~ Time as n Public Health Control 10'.t I ( C,,nunon Nam: "- K'„rkm,C•ow,wwr.-' t Cia;,as a Public Health Control` -; I 7-317tJ3 1 Se�anuon- Saeartc` ' -j-=J---- ”?t. anx ?-21}2.i! I Jictu'icbon -Yrruno;uxJ t.'r" —- � `------- ----. j 7-202.12 � C.`„ndmorr.of!)Sc" 1 ------` 7-''w if 1,nic C`on!ain.t• --P1nitM: u1:'„ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE — _ POPULATIONS(HSP) ! 7-204.11 SaniuuiS.C'riwrw-C_hewic:'k { — -- _ --- ? t'ix'nn,.d,tat 'Aa,how ri t4.ti't:, Cul a' -'' ! ^_1n1 IIt•1) f L;nj::,ac:mes:dPre-nau.s:cdlun,ec;,eod I 'f,)4.! -_`_---_ -_ t;-. ' ilerer,we:,willtha:,n•te iahc(ti i 7.704.14 _ D;arw .Arena.Catt':ia"_ _ -}-- -- ` -. -'ni 11 — In �'n idad att 1_ f-:wxl C orntNwatd. "�--- _=S0!_t'tilt aotunz.�Ece:,` -_ i ':y8! i ltih i<,n: „r Pan::d:. C,•oi::ri Anunnl t=t><xJ nrd Imo-_-'06. I Kr.irlUrd'.'Sr hr•ryctder Caltrl:a'^ � i ! 7 :06.I , 4„x!cr.l F',:i S:at wn>_ '06 1: 1':ackoo,i'„�tder.. P:s.Conn', I and ”-i-_ _ __ 1 uei P. (.ate. ti.n-k-,=n=l- -- i ,1„n,rotir;; ___._.___:......... ... . .. _. --- C-.NSO' EPAC4Yii:GFl _ 4411E TEMPERAt URE CONTROLS 22 +n, „r «utt Po'f-! i.x C'on oo=p'wn'a ?d 1 Prurmr Conking Temperatures k>r 3 I 1 PHFS u I r -. nrun:d..ln:Srr:ux 1 .51:i (',•narnnn.u}",:h. titc.:'. ,4 t•astr ...._.... __........._._. . . ___._--_...,.__ _.. _: t � `'IL',A - . . Y rax_ en;. ;UI li,r.}: !";A*;"i P({..• ._ ...:'i;,::, ii %. ," �.,: I :^t d:Y lo.t .r 'i.i.:•. ' `. i tib -• :t IC :IliC:i hce'; • '::'. , .. .. . ' RehEcono;..: Hoir!oki,n” b'iacAiIONS {tet.:: °j"'Amts._:„�,;=r:7.,:f. . ••'1`S.1!iA)lt;it, i Nt}., tb`'i. 1 tleiiati .tU?.J It h} :il::i;d: Cw'r41• s+rr n:,r:-. .1”-c. ,-'J'. r'. n%r,kn. •:r :, '.:ro . ' n . i--i"i3.ii{C'} Cnm: :ri'i•ch. l4c...,..cd ;"I}=b�•a "win, ','c t+tFr< ' •::'�:, .. :o� , 'it: :40,F. 34f:a110Gt Remamin LnJw,,jP,eacne,,:"11;5, : Item GoodNeradpracvicea FC.__ -. 5vo_wo j_*,AoaC+`nr, t srd Per.-.;er,r''. .__... .:_K, >_ 60.. _ r— ^4 U",ax1('Jtl-boo F(: -"_-j__ ' C,<:.: . Fo•?d n•. . ' .. I IN i Proper Cooling of PRFs ,� - -- -'_1 -- --- --- -- -' - --- -+- - n;_ - ------ 21,; !-cq,a;_m:;r.'.ma S01 11CAJ iim!C<xt ?d PH7 x Iroir. I Uti I'b' `r' := -- - _ - a.ze, r l-^:r_?y'_sd'r:9diy!-�_ , FC__•' ! -Ar P \vuhln ? I kwr<.,nd From - • 007 i :o S;-}-/-4, F Within.t Hoot, j ;--..,� ,._ _ - -r..� - -- . i5U1,1.JiIf' CF:. ,.o4iuePRM.,dcFEom:\tnF:.rr r ` ,-Mra __- _ ' 'ternparawre fni reti-w,Ic 41'l :{'}: "+u : Otor, .. _ .. : ... U'11 ti Rt-I li'mu,' " • I¢a,.:;+,.r,+:'a: -. .. ,.^t+(n,"'Cl.,� ,In 1 '.r;. �'n. CITY OF SALEM _ BOARD OF HEALTH ff Establishment Name: �� f�J,.Q < L' �a'�-�2 Date: l-(1.'/,tc. Page: f�— of �- Item Code C-Critical Item l - Date DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION No. Reference R-Red item . .Verified PLEASE PRINT CLEARLY _ Z1,Ai ��/ G(r- �1t6✓r � �!)� ��.� _C �M n � i v / • _N j . ✓/ If A114�f}y ) t,Aj ( on illi ec) n�rJ_ _ rYt/C� �� '� V • yl 1 ) ��. f�. _C n e�i i�',/ljr -I•— . l').. I .i' n W_nlr /�l r4.. �_r_,y�� l"(C .cam /"'.f/J�.n n �. �t�ei.� I . i� _ .n� •�.1�,/{ �^l RA Gf/7 r 'ln✓t .l� 4.{/) r4f I/Pn�r,t/1h,1� E I / At IIA; 4v lv t4t4�- n -(�ro¢ Ot AJ GP S�1rLJL1 I V�v c '1 r asc fjk F Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion k¢ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Codes 1-understand that noncompliance may result in daily fines of twenty=fi .e dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _ �� ❑ Voluntary Disposal ❑ Other: }Eel.l alt) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to LaoCooled to ` Factors(Iteft 1-22) (Cont) r J- -__ 41'Fl45`F Within 4 How s. s PROTECTION FROM CHEMICALS i :3-Sttl ]5 C.xdinoY N1etho&for PHFs ' 14 j food or Color Additives ( 19 PHF Hot and Cold Holding - ' 3-501,16(B) Cold PHFa Maintained at or below 1-202.12 .Addltirc.'x 590 0040-; 41'145"P" 3-3011} � Protectam from Unapproved Additi4et � I 3.y)I ib±rlj lint PH F:Alaintained at or above j 15 i Poisonous or Toxic substances M hi:ntufymg iniiama,urn - (?uginai 1 2 5 id0'F= 7-161.11 c # E i til 16i,i? ko•s!n Held at Or Jbuve IiU P. I Contaittec>` i —_.��_.____�_..�.--Time as ti a Public Health Conti I 7-102,11 ( ,.ram+,n \amt - R,`r6 i•}r Cine•.Is a Public l leatdt Control' ! 1 7-1ta.17 Sr7;v ation- . il.t 1 t:r.picfloa - 1'rrs;:ar ?-20'1 is Coudttiutt`ofE:�e" ! REOUiREMENTS FOR HIGHLY SUSCEPTIBLE ------ POPULA_TiON_S(_NSP 204.11 j lenmze[ .Criten: --t'hctnico,ls^ — -- ------- --..-- '64.1? ('hauti�.d, t„i 21 ( '-SII. I'(A; Pn:pJcl aica Jauac anil j j 7 fA 14 Dnine A;.ut`. Crnwriw U! I Llit 1.:"c' I Pa`tt:Eri;'`d t; ! _(`5.11 hl.id.not� l:'�Yl ia,rtari Lubli au;s' _� :---'--- '- ! 1 ?-bt`1,11!I)} P.ea or P'wlail•. Ct`oFal Animal Ftx�i a;:d ' ! 7-'Uo.:I _ Re'i I_tc!r.l ,'se i'r.'It uics.('nre!ln � f' kq'.: ! :U(02 '. it it: l,,t`r\u:(Eom^ _._- -__._ .i::-_�_____� _._{ ; X{;' ;nt t '`:;tai iv.ci F;1( .:!`:t No Fz-a.�•d], i r ^r:6 19 t h zckmc'•1.a,lrr< P-�:Cuutr:,l .nu2 '.____�_. __.:._. 11MEITEk,•_E_P_trnATU_RE CONTROLS ", i_; !! 1 ` r't;`u;::c t .1rt::s�:. Ih,.;,,i ;.tr t'nit t;:r:},tit•n r'i •_-•_--- •• ! .,!d Ui.t l 'Y'ai� 111:4:Jt. 11. ,t t BaerYtp+LlC.1. }G i groper Cooking Yempat attues for i -- ---'-' SPECIAL PEG,Ul;?`c'"k-e•- _ k C ,rr, i ail.: C i .. .;. '..' :7=•:. ., :. ` ;•Itilz: i .,.r' ' .., :'r,❑ IIF;'; i:. .., ! I .iCi'ti`.', lS'i,l'1 lb" :iiv ,',i`C„r .:!.,•q`' i . tl .. ;7 'nior,s'ttin.:?o4tq '4 viLtL.?Yic:''fiSHE:Ld'c`:. :v '".1Gt?r:`=:a;i. �T,r?{"i:i-'C. {1tCt17r^ :3,,{rt) ALamC StM(11111 � ;,�t"": .,r+, v- "r::,'af +. . +L : :r•r 1:,?�.::,•: :tr: , t ____ }"t.'. ;,n<.'ht•rnr:,i;, aY;R•1H,� .",, '; r,,i itt.:O.l :, ,, i4: I t.. 7(•' ___6i'.41tCr .3 'I:a at''} }',o..',_,.d i�it }. �i ' r:•un. !a:'•, Jr,'r nt . �,... . :k' h nd s',nts :..1/':i :'.11i; (';`!"t-.. + Pt<UOnh of Bcr: <.'. :`.San:iwh'--'net71 p:.d 1'e!"^r[,<': FC 14 . 1 Proper Cooling or PHFs ry - -- -- ^ - - - - 701 I3(A! t"'tm,i::.,}. 'd PHI:g It"tt IA^Fi,. — — - - - ! Vt:+ter p{.,.�tr.� v�tt'h„ro_ _ ". .m'' Fa::irtr.. __. _- RC - CCi r ., - - .— (..4 t 1'i-t,`. F `,1 ai m d Flow iYiibpnpn::^t 'GAr'` .:rF: .'.. _.... _t.�-y_ Vii. 1 3 701.id(ti) t-,(i:❑z i'HF. Nll,dr From Ambient ""_- ! 5p:l,;lal F,-;bi,gn-,n: _ _6'_. - E lore, .si•G"�S-� ,,. ,k.. .-.'r.�aa�„�,�..+?C$"t+'4�7v'°+,R+4,�*,,.-,../r��.,,.,1.,� �y '+l�ini•,.k',9 J�n°F�+) ��„�i�.�r�+t«'w.. `k. tiq,.sa,,� . ,Massachusetts Department off Public Healthl .,. salemBoardofMeahh j 120 Washington Street,4 Fl/ or of Food and Drugs 1 /4 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name r� r ) -2r Date Tyoe of Ooeration(s), Tvpe of Insoection ?- (( r�[1 D <LL Q /l • /fli ❑ Food Service ❑ Routine AddressA' �„ 51 _ RaW VI Retail [?�Re-inspection /1 I�t n riw Level ❑ Residential Kitchen Previous_Inspection Telephone ��_ ❑ Mobile Date: CLIA 63.E �/(3/(r7 Owner /� I1 HACCP YM El Temporary ❑ Pre-operation M IAI) Ck Jc4r1 I ❑ Caterer ❑ Suspect Illness Person in Cham(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: /.rf ❑ 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 ElEMPLOYEE HEALTH 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 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 [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16.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) El21. Food and Food Preparation for HSP [3 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER ADVISORY - •y _ - _ ❑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 cf Health. 590.000/federal Food Code. This report, when signed below C NI by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-8)(sso.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S50M�,dFo�,, NOO)AIVA Q3A�Dj Inspector's Sigpat> _ Print:T � / I '•''� PIC's Signa re: Print:• �/U�� I Pfge�of;Pages i Q- Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination . i I I ( 590.003(A) Assignment of Responsibility` 3-302.11(A)(1) 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 Contamination from Raw Ingredients 3-302.1 I(A)(2) Raw Anin¢d 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 to employes and 3-302.11(A) Food Protection* applicants* 13-302.15 Washing Fruits and Vegetables 590 003(F) Responsibility Of A Fax!Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 13-306.14(A)(B) ( Returned Food and Reservice of Food'' 13I 590.003(13) Exclusions and Restrictions* I ( i Disposition of Adulterated or Contaminated i 590.003(E) Removal of Exclusions and Restrictions I 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" ( 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sardfi-ration Temperatures* 3-201.13 ( Fluid Milk and Milk Products* ( 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteurized* 14-501.114 Chemical Sanitization-temp.,pH, 13-202.16 I Ice Made From Potable Drinking Water* concentration and hardness. 15-101.11 Drinking Water from an Approved System* I 14-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* 1590.006(6) Water Meets Standards in 310 CMR 22.0* ( ( 4 602.11 Cleaning Frequency of Equipment Foal- ( Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Food Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 114 I Proper,Adequate Handwashing Regulatory Authority 12-301.11 Clean Condition-Hands and Arms* I 13-202.18 Shellstock Identification Present* I 12-301.12 ( Cleaning Procedure* i 590.004(C) I Wild Mushrooms* I 12-301.14 When to Wash* I 3-201.17 I Game Animals* ( ( 11 I Good Hygienic Practices I g Receiving/Condition I 12-40L11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I I 2-401.12 I Discharges From the Eyes, Nose and 13-202.15 Package Integrity* I Mouth* 3-101.11 I Food Safe and Unadulterated* 13-301.12 Preventing Contamination When Tasting* 6 I Tags/Records:Shellstock 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 113 Handwash Facilities 1 3402.11 Parasite;Destruction" Conveniently Located and Accessible( --- 3-402.12 _-3-402.12 ( Records,Creation and Retention* I 15-203.11 Numbers and Capacities* 1590.004(7) I Labeling of Ingredients' 15-204.11 Location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging.criteria* 16-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision _ 'Denotes critical nem in the federal 1999 Foal Cale or 105 CMR 590.000. k CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 1//�)U4 Page: of Item Code C-Critical Item ^ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION 'Date No. Reference R-Red Item I \ t Verified PLEASE PRINT CLEARLY (n,,,�eLe AA r.,, a/A-� /Wce,1� s,Aw r,,,e 1 In_'Gi `K r. 1 r^1lly:r✓1 ,�i= .— R+-!Xl1 L 1 oq _ S-�u .may— '-t2 ✓h'/� P(,1..,I... ✓.,t<.0 A((-) 1U) 6- PJ)%�lr-1 0 '�l 6v ":AA)7- -,1-J0C -/flLle �J,a„ 6n, 4 , �� ab.44 AJ I rnja c,o ` C AkA,J Cw(a. D,� e I ` I ,om,l f, ,M,n.x r� f •.f Un/I�w- .rn J I (moi _ j1e i �/t�� 1 < A�OD(Dn l`1 44- .�cY1n.DAJ p� 1 Cv-t/�S/In i�-✓� t.�\ '�I l'1 Jr if .�;l .� 17 4� - - 7J1 >_n✓1,4 mool -4z 6 f(o p4— r-h II'l/'ne ril,U/)-a. 4,(4~-1 Si/t— F I I � I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I d�2 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 toExclusion Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Cod 1-understand that 7 noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: :-SUIJ4(C} PHFs Recrrved at'Pemperatures Violations Related to Foodborne illness Interventions and Rlski 1N�Awording to LaCooled to Factors((tents 1.22) (Cont) I 41-F/45"F Within•1 Hours. PROTECTION FROM CHEMICALS I 3-5011.15 Cooling Methods for PHFs 14 ( PHF Hot and f7ofd Holding ( 14 I I Food or Color Additives ( 3-202 12 Addtlives' 'A-501.16(B) t (y 5 l -- -- 16B1 Cold PHFs Maintained at or helow � S90t}i}+IFi 3-302,14 I Pt'otectlon front Unappro"'ed Addiht•c>' 1 IS I -- Poisonous or Toxic Substances ! 3-501 INA) I l int PH4=s..^.Ssintained at or abnvr i 101.11 ldcintifym,>- Information - Un;:ina; 14{, F _ --- ' S!:t 161 Al Rc'ant>Ht'!d:H ur.rbtx'e t i6°p, + I Container.,' � --- -- ,h Time as a Public Health Control 7 102.11 I Common N'.imt• - N,vkln;.{'11111,ntar> n i 7-201.11 Sdpat.w 11- Stvtapc" r i!r�as a Public lie,dth('omr,)V ---1 F�:at).'it+d�H? S',r'ar;c P,e.yui«•min! --� 17-2(}Z.I 1 k?c,uichon - P«srncc;w'k i 1 f 7.202.12 (\,adnitm,of Uwo j 7-".:113 11 I -ftv.ic C;oni:tnct; -Pn>lntn:ita;,' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -- --- POPULATIONS(HSP) } .C1-:,"j-77-S01 -- �_-_ 1 it.}r-( I np:,aeu1',cd Pre-rao uk''cd Jutcc,;4nd 1 720-4.12 l'honlieal,fit LVa,hn�t^',P,k'+<ttLu^r,t.n'L'ri a' i 7-?114.W Or,m;'Acentc.Cnteria'_ ---. t_-- -'----- 1;V 4erares tvith Watumy` 1'il.,.tl;., i 1 --, Hilit 7 3'S 1 r:idtaI CnhM talhna{ � r---------- "Qi,I W-), kare or Pa,ualla. C'4K-d Aniaill Fts:d&id C lne:!3° 1-. PAV Su•LS Spnnu.Nct Scnri. 1 7::66.12 Roc!en: But -- -----. -__ . �.._--_.._....___ {t„ ;it{_: (;,Im .1-d 1't><><i Pat'atr Not Ra:-scr}ed . i- lob t3 }7.u!.:ng P,•mda';<. !'pett,mr,t,nr] - 1 ____.____:__ _ _ t - t ' �'tJn0011;:9 t C'X45i2MERADVi3ORY TIMEITEMPERATURE CONTROLS = C',v7 u1*1'.t 's:of 5, t>? i,w i'aat<nu:I „n rf I Ili 1 I Propei Cooking Tempe,r,twes ior— I a.�u(.,t I : ... ,., . n c .sx < 3 G z wt', Mat "t F' L• u 'k' i 1 F>ttFs I ' t .•, . .. _ _::,tc i:_'r.u._L_Iiv'y.t G-.. � '.. .Al . . .. . r._ , , , t.. .,. :{d P:`,ih:;i I L"f it vt"r?.14a}�. � t ','4PPBi".ICI;I':',h, 1!i'::' i:.>lla ;iJ'} !:7?t I f ! '`,+.t it,:l t;'r( 12u.+,i t .1.._ i. ;";n' SPECIAL RECii31i7.EMICNl_k 1 .•:i.: -et:.. N_v;+C, !.Pi+.':�t ";':at, i i � tL.',1i..x,i> 1 l., i <„ J'1? ( . . 1 40:.1 i!.0.i' ,`, . .. .• .,'u::?t... ,,::^.`CG i>{,r ,.,. .,Tu:". e 7.' :fl�_.: <tP.'Ld�.e> "I"I a I i f ' e'i i � f•.C',Cauit(;tJ: i}u.i ip;dtE4 I Ytr{./'?Y},ifttd'r!i;: ,Ft 1�}:(� f i, ii:,}[,Li "t'�.f$:1. i-`:i,y: Cjf^3-�i.. t01AIiAtat... iF-!!I it,; ;. ,r.: i ilt'inw2i-31!1 101.1 1(b) tb6um::n:- 1111' = \'antt:r,5!.:n•hn; C''. ..f. .. .'r,+.a' .11•11ar :., .,,.. ,'t i. n• n_.,, •:a , :arta . . � i,lit✓' li,c[in, ' a i�'t. •.1'i'Y,.�n r..'ttt .., i:n M1tt:Jft . �'Q1:U:.n., t:..!., -40?, It(.i .—_____' i. gnu 9CRId:Iv P:'t>" •i .`?t I- 1 a,',1 .a ,:n:. is p, 'i,t, ,.5.. - ''tr x.4'11{:.tr uf_i itarn ! i.lnoo Ratan FrrcGcas --_--._FC- - SBi1.(nh:+ I y4{!i ii;t'i i i�K:n.111litt�1.n5'iCe t! 1'ttt ift'a5»; t'Pt" :_ _ _ -_-. _- _ __ _ -t _ k.innayerTi, 1 d'ji: i IN i propel Cooling o4 PHFs I 2t-_ - -Fc YI_'.nd',xx7 F'�7t'r':c•" t -_. - __- cgmpmet*! 3ofl G1e,is,s ' F C_- g _ up5 f ! 561 !l(A) I C',ndur>C'a>r:}rt{PF{P> i1'ar I -- - - -- - F-C j 7, F Willun 2 !tour aad Front 27 _ F^;',';a. j- ±r �; --{�; -- t - - - - -- - -- - --- - - - W ithni' ti:gl;. -. i 28 ?ory a.t'L.tr,:rat..,�s FC -7 Ly',- - - - - - - - - 3501.?�tB: C',.t!inePiIF: N'i,ticF(".iii oni,leat -='?_- --Sp:a:1.u!= <r.:ia;,,•aL`'--- - ----- - - CCS;_ i '1-:,rq.ct.liare !Ia'rn!�ent;t,•�iFt .K'}: � I ;0 t `r:r.: - - -- .-_- '_--.-.___. .- - .-. - • i;a,artt.Lnbcal Y.0±' :,'.,�: .' .; ,a..�u;.,.,;I,',;;c a.1 i s",l"',i:,�^,r.',,,t t r" jlf 'A 9•4 f`4g& ti Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800`Fax (978) 745-0343 Name [ ( ry ate n Type of Operations) T,�iee of Insoectlon �17t ISD �)( I ;Food Service N(S Routine Address 1 A6n A (\ I (� C�(,�� Risk I �Retail ❑ Re-inspection i A �" _ Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: OwnerHACCP YM El Temporary El Pre-operation AAA 14 A f`/�jt t ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) // (( \\ Time ❑ Bed&Breakfast ❑General Complaint 1 I �t 1m q9/) l l In: E]E] HACCP inspector ��1��(� �i77A Out: Permit No. ❑Other Each violation checked requires an`eicplanation 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)u 590.009(F) I� 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 ; ,_" -•------ TIMErrEMPERATURE CONTROLS Potentials 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. 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 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 FNI 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)(5so.00a) 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: C 7K 7 � S 5001nsp&FOm 140oc Inspector's Signature:6-LA�j 041, Print: P_k ( )I,,, CA A l �I PIC's Signature: /'��nne/"-a...i� / ` Print: r_�^ir_�v A� _��a J �� Page 10f'2Pages U H v 11 k l� Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I I 590.003(A) Assignment of Responsibility- 3-302.1I(A)(1) Raw Amma1 Foods Separated from 590.003(B) Demonsb ation of Knowledge* I Cooked and RTE Fcxds* 2-103.11 Person in charge-- duties I Contamination from Raw Ingredients 3-302.11(A)(72) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' l 2 590.003(C) Responsibility of the person in charge to Conraminarion from the Environment require reporting by food employees and 3-3021 I(A) I Food Protection'" applicants" 3-302.15 Washing Fruits and Vegetable; 590A03(F) Responsibility Of A Food Employee Or An 13-304.1 1 i Food Contact with Equipment and Applicant To Report'ro The Person In Utcmils* Charge* Contamination from the Consumer 590.(H)3(G) Reporting by Person in Charge" I 3-306.14(A)(B) Returned Food and Resemce of Fund* 13 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590 003(F,) Removal of Exclusions and Restrictions Food 3-701.1 I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 41 Food and Water From Regulated Sources q Food Contact Surfaces 590.004(.A-B) Compliance with Food Law* j 4501.11! Manual Warewsshing-Hot Water 13-201.12 Fiord in a Hermetically Scaled Container* Sanifization 1-entperatures" 3-201.13 I Fund Milk and Milk Prcducts* I ( 4-501.1 12 Mechanical W'arewashing-Hot Water 13-202.13 Shell Eggs* I SanitizattonTemperatures* 3-202.14 Eggs and Milk Products.Pasteurized* I 14-501.114 Chemical Sanitization-temp.,p1l, concentration and hardness. " -202.16 Ice Made From Potable Drinking Water* 4-60!.11(A) Equipment Food Contact Surfaces and I 5-t01.I 1 Drinking Water from an Approved System 590.006(A) Bottled Drmknng Water* Utensils Clean Food- 590.006(B) Water Meets Standards in 3 10 CMR 220" 4-602.11 Cleaning Frequency of'Equipment Ford- Shellfish and Fish From an Approved Source I Contue Surface_ and bonUteof Utensils 4-702.11 Frequency of Sanitizanon of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish" 4-703.11 Methods of Sanitization-I-IotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed I I Chemical* sources* I 1fi I Proper,Adequate Handwashing Game and Wild Mushrooms.4pproved by I Regulatory Authority 2-301.I 1 Clean Condition-Hands and Arms" 3-202.18 Shellstock Identification Present* I 12-301.12 Cleaning Prtxxdurc* 590.004(0) Wild Mushrooms- I i 2-301.14 When to Wash* ' 3-201.17 Came Animals* ( I I1 I Good Hygienic Practices I g Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* J 3-202.11 PHFs Received at Proper Temperatures e I 12-401.12 Discharges From the Eyes,Nose and 13-202.15 Package Irnegrity' ( Mouth* 3-101.11 ( Food Safe and Unadulterated'" I 3-301.12 Preventing Contamination When Tasting" S TagstRecords:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained;' Empiovecs* Tags/Records: Fish Products 113 ( Handwash Facilities 13-402.11 Parasite Destruction' I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* ( 5-203.11 ( Numbers and Capacities* - 590.0040) Labeling of Ingredients' 5-1.04.11 Location and Placement* i 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans ( Supplied wtth Soap and Hand Drying 3-502.11 Specialized Processing Methods" Devices - - 13-502.12 I Reduced oxygen packaging.criteria* I b-301.11 Handwashing Cleanser,Availability 8-103.12 ( Conformance with Approved Procedures" I 6-301.12 Hand Drying Provision 'Denolcs critical rtes in the federal 1999 Fa Cale of 105 0OR 590.000. 1 C.� 0'IV BOARD OF HEALTH € ((j; Establishment Name: ` PXDI 4,1 Date: rV) -(`?O Page: '9. of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date { ( No. Reference R—Red Item ,., � o �,y112�'�(' < Verified If PLEASE PRINT CLEARLY V..taK�)\ A , I _U,_V ar1V_Q� _ NA ➢ — lel tC aeii im0% t OK7y1'�.4^/)-1�A7LC..Y' r-i,00V 'P l_I_ n4, (�'f/fd.1Y /.alj I; J_A `() • bl&A"64 ( IAyanr/) Nix •,_A U�AA piGleno,1 �/r^)/,�lADS, n��ll ' 1,1r�n�D_�-1}7-! V:G_ /I0�7n,(�,, ew Dt N AA � 1 +?''I 'S/�C 1 o.fM I i�/1nn I Vn (14-AI A O� ('/Ir� ,�_/ D�i n , a/. l/I �t/��V :aA oPM i -A .f .1A I /.l�n It AA --►� i=n ao,�d� — — ,� U — 10 " 4--iz 0 3 0 1 + (J, IUP ) 0AOO `aIXnDO/1 ADl) ()P AA .0 -S_PniiM,�_ "f 1� A" Vi/-0 I P1 �2 to - ,� �v( A. I (II n wOY) o (� � 3 n K �( /2 : AX A(V ( 7t /t f(�M _- /t,l..!L4' Lp /n i f \p0 'OA) ('1AIPJ) � �'1:'\ A-)LnIOf•rz _)_A'LAAV . Discussion With Person in Chargeah/ t1 v borrec�Action Required: I ❑ No & Yes L /Voluntary Compliance ❑ Employee Restriction / Exclusion f ❑ Re-inspection Scheduled ❑ Emergency Suspension 9 ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B (REV 7/2000) HOBBS & WARREN, - BOSTON This Form Approved by the Department of Public Health i T � Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to Factors(Red Items 1-22) (Cont.) - 41"F/45'F Within 4 Hours.* PROTECTION FROA CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 11 3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Addiives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 1 7-204.14 DBeverages with Warning Labels* Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206 It Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and -- Monitonng* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Erfecbe 11112001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* - 3-401 I1(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 Min.*j catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401 11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(I)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and not-critical violations, which do not relate to the 3-403 11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the follon ing sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70*F Within 2 Hours and from 70°F 27, Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41*F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. (� BOARD OF HEALTH Establishment Name: Date: -�; -aU -nq Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red Item / 0 Verified PLEASE PRINT CLEARLY P nnOA).o �-'l I10 � ) AP AjOOe' y -, K A� A_ AmA , AD,, > n /6t t r/V'1 r14� -ten n�Ef�i C,r \ 0oc��i��".L1, IA1.-.PYX �Jl1P. -FO��i' I t i I Discussion With Person in Charge Corrective Action Required: I ❑'Ve I Wes ❑ Voluntary Compliance ❑ Employee Restriction/ x 7 Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other .d FORM 7348 (REV. 7/20001 HOBBS &WARREN, - BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41*F/45°F Within 4 Hours.* PROTECTION FRO JI CHEMICALS 3-501.15 I Cooling Methods for PHFs I 114 Food or Color Additives 119 PHF Hot and Cold Holding I 3-202.12 Additives* 3-501.16(6) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 115 Poisonous or Toxic Substances 3-501.16(A) Hat PHFs Maintained at or above 7-101.11 Identifying Information-Original140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°E* I 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 I Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590 004(H) I Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 17-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 17-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Cnteria* -- 1 I 3-801.11(6) Use of Pasteurized Eggs* I 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPER9TURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Etrecnve 11112001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.1l(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.*I catering,mobile food,temporary and 3-401.1l(A)(2) Ratites,Injected Meats- 155°F 15 Sec.*I residential kitchen operations should be 3-401.1l(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors.Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401 12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 117 I Reheating for Hot Holding I (Blue Items 23-30) 13-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item ( Good Retail Practices FC ( 590.00 3-403.11(E) Remaining Unshced Portions of Beef 23. I Management and Personnel FC-2 .003 Roasts* 24. I Food and Food Protection FC-3 I .004 I 18 I Proper Cooling of PHFs 25. I Equipment and Utensils FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70*F 27. I Physical Facility FC-6 .007 to 41*F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 I 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ` BOARD OF HEALTH Establishment Name: `l-lI �dc4 SAZVC 10.3 Date: 3 ^ao —no7 Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION I Date No. Reference R–Red Item PLEns9 nmrrr cienaLY Verified Al f A J I I I I 1l I V.Nn nn AAA 5_0 I^JA on — 7 P 11 nnA P n/-Y)t a /n i �cJ 0- 19X II�0(_A_�.o_i.r\„f1 4110 r— q-O c) F— I V/ L \_�bMOAA _n/�n —�tv M U� i I I ✓ I �. 1- C . I I I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑No I ❑Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FARM -IiAR IRFV 7/1ll()(ll HnRRS r Commonwealth of Massachusetts r City of Salem Board of Health IQmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: 7-11 Food Store#22763 File Number:BHF-2004-000113 126 North Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2009-0186 Dec 23,2008 Dec 31,2009 $280.00 TOBACCO VENDOR BHP-2009-0187 Dec 23,2008 Dec 31,2009 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l, 2009 Board of Health /,/I 47 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 I • � A4 s]! • CITY OF SALEM, MASSACHUSETTS rBOARD OF HEALTH 120 WASHINGTON STREET,4O1 FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR [DIONNHOSALEnt.COM .JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT •/- j/ Ft Cd S+OfE# UL-1 G 3 TEL# 97& , 7q4• ('036 '7 ADDRESS OF ESTABLISHMENT /o4 (4 N0/2-F# Sd&n FAX# x_14 MAILING ADDRESS(if diffr"rent) '/VIA / EMAIL-Business': p A/1.4 Website: A1J� OWNER'S NAME l�\m A-b � TEL# - -14 - Li ADDRESS IS C.lth_ e t+ R,4 C tl-E.4�t` Ol'i M lot- STREETCITY STATE ZIP //�� Ab CNAPR - Pa 3�3l6p2 CERTIFIED FOOD MANAGER'S NAME(S) T1M) .� 1 CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOMETEL# S ZZ -Ll3UQCT ,l I DAYS OF OPERATION I Monday -"! ': Tuesday `" Wednesday- la:':Thursday ,I Friday I.' Saturday I" Sunday I I HOURS OF OPERATION j i i Please write in time of day. opt �_✓ a� '�`� �k a'~ ! at!Uw a4v"Csv-r (For example 11 am-11 pm) Ikoo,0- V,�O VY TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. _$280 more than I0,000sq.ft. 4420 - ------------------------------------------------------------------------------------------ ----- ---------- RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES----- ------ - -_-_-.- . --------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDORES NO $135 ALL NON-PROFIT(such as church kitchens) ES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is no.transferc5le and must be reissued upon change of ownership.The Permit rwist 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 perjurythat I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes requir ' oder the law. a4 Signature f^ Dale Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008 adm Check#&Date tl (� / Q zliCrCe1 $ t i 1t `Massachusetts Department of. Publlc Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4`" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name D to Tyge of Ooeration(s1, Tvpe of Inspection 1 ❑ Food Service ❑ Routine Address 11 `' Risk ❑ Retail ❑ Re-inspection -_� ^ hf',I^ Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: a -3 Z /e/3/u0 ❑ Temporary ❑ Pre-o era ionness Owner �t� HACCP YM ❑ CatererN�J ("Yj� I El Suspect Complaint Person in Charge(M- ) Time r ❑ Bed&Breakfast ❑ General Complaint /J In: ❑ HACCP Inspector j sop� r�(/� �'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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding -_ ❑ 6. 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 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)(590A03) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590 006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to'the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. /1 30. Other DATE OF RE-INSPECTION: S seoiosp dForm-14 coo ,.n Inspector's Signature: ) / Print: PIC's Signature: / /` / Print: �/v, �" Page of raPages r a Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S Cross-contamination I 1590.003(A) Assignment of Responsibility' 3-302.11(A)(1) Raw Animal Foals 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 Animal Foods Separated from Each EMPLO"EE HEALTH ( Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by fad employees and 3-302.11(A) Foal Protection* applicants* 3302.15 Washme Fruits and V,getables 590.003(F) Responsibility Of A Ford Employee Or An 3-3(A.1 I Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contaminatton from the Consumer 590 003(G) Reporting by Person in Charge* 3-306-14(A)(B) Returned Fool and Reservice of Food' 3 590.003(D) Exclusions and Restrictions* i Disposition of Adulterated or Contaminated ..I 590.003(F) Removal of Exclusions and Restrictions Food 3-701,1 ! Discarding of Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces - 590.004(A-B) Compliance with Food Law" 4-501.111 Manual Warewashine-Hot Water 3-1.01.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-20 I3 Fluid Milk and Milk Pniducts" 14-501.112 Mechanical Warewashing-I lot Water � '• 3-20213 Shell Eggs* Sanitization Temperatures'" 3-202.14 Eggs and Milk Products,Pasteurized* � 14-50L114 Chemical Sanitization-temp.,pH, ! concentration and hardness. 3-202.16 Ice From Potable Drinking Water" 14-601,11(A) Equipment Food Contact Surfaces and � 5-101.11 Dunkingnking System'from an Approved Sys[e ' Utensils Clean* 590.006(A) Bottled Drinking Water* ^ 4-602.11 Cleaning Frequency of Equipment Food- 590 006(B) Water Meets Standards in 310 CMR 210* Contact Surfaces and Utensils" Sheffish and Fish From an Approved Source I ---- 4-702.11 Frequency of Sanitization of Utensils and 3201.14 Fish and Recreationally Caught Molluscan Foul Contact Surfaces of Equipment* Shellfish" 4-103.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( Chemicals Sources" to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Author@y 2-3ill 11 Clean Condition-Handsand Awns" 3-202.18 Shcllstock Identification Present" 12-301.12 Cleaning Pro cduro' 590.004(C) Wild Mushrooms* ( 12-301.14 When to Wash' 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition ' 2-401 11 Eating,Drinking or Using Tobacco* 3-202.11 ( PHFs Received at Proper Temperatures* 12-401.12 Discharges From the Eyes,Nose and 3-202.15 Packase Integrity* Mouth* 1-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Sheiistock ( 12 Prevention of Contamination from Hands 3-202.18 Shellsto k Identification * 590.004(13) Preventing Contamination from 3-203.12 Shellstock identification Maintained* Employees* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 ParasiteDestmction* 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* I Labeling of Ingredients* 5-1-04.11 Location and Placement* 590.004(7) 9 8 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance I /HACCP Plans ( Supplied with Soap and Hand Drying 3502.11 Specialized Processing Methods* i Devices 3-502.12 Reduced oxygen packaging,criteria" 6-301.11 Handwashing Cleanser,Availability _ 8-103.12 Conformance with Approved Procedures* ( ( 6-301.12 Hand Drying Provision Denoes,critical item in the federal 1999 rood Corte of 105 CMR,590.000. CITY OF SALEM �t BOARD OF HEALTH Establishment Name: 1"U Jc\� c 1T �--c-:z Date: q1/o Z ln.G� Page: of Rem Code , C-Critical Item DESCRIPTION OF VIOLATION/P`LAN OF CORRECTION Date No. - "Reference R-Red Item , Verified (PLEASE PRINT CLEARLY _l.A/, C1n Jnr lJos irfG)/n �PGnlVlr I� )))yu")� e� 4-0 (NUIn cc» [ tr 0OC14 rr� lv,r �rn r�La(llA�/N'. C�hstb� �:�SQ ,a� r �.Y,c��,ru L/\ fG,✓n� l r� t��1�1a f��L A'� - - I I 1 1 r I 1 I I 1 I I I I 1 I Discussion With Person in Charge: Ci're tive Action Required: I ❑ No <1 Q Yes t D Voluntary Compliance ❑ Employee"'IIRLstriction / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension r comply with all mandates of the Mass/Federal Food Code. I understand that j noncompliance may result in daily fines of twenty-five dollarsVsuspen ion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. St ❑ Voluntary Disposal ❑ Other: a Rec"Iv"'d:if Violations AtAualged to Foodbarne illness Interventions and Risk 'VxordinA'in i'.-A,Aed z"' Factors(Iforiss I-Z4) (Coot) —J Co lint for PHT-, PROTECTION FROM CHEMICALS IA) PHF Hot and Cold Holding 14 F id or Color Additives -50! (11B) Cold PHI's Mttiw."rxd at or tid"w �-202 1-1 ,-302,14 Plotoomil firolik Adkfifivn' j INA) Jim i Poisonous or Toxic Substances 101.11 id--mu tying lnfA,i inmion- Ouxinal ki,tsi,Held at orib-Ave 13(11�' 20 Time as a Public Hoafth Conti of A 3-�01 il� FiIw a!;4 pablic Ilt-allh Control, Sepaiall 7-202.11 Rc�tjwiion -Pwtcricc and 1,u Reqtarcwent 7.20112 con0h i„u'of rice' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE T"Xic Contaimu' Prohihii;Am! POPULATIONS(REP) -,,04.1 21 F rSOI 1!t Unpv,Acw i?ed Julie:anal7-104.12 C 11CIInC31i f(Ir WX 111111t l"(KhtCe Clit'!J, qt•,Aml e,ii,111, V%aliAing Lakel4` Drying 14 Di� Agent.,,Cr1writi., U,c v! Pw,?enn -d 7.205.11 Incidental F kxo Comm.i Atli)wants' 3-SOL14(Di Raw or ilaiti.fflv C;4k-,A kinaril FAxd and 7-206 11 - Cnteiia- 7-206.1 11 1 oaI<W.'Sc rd 'InT0111, "�oj Served. I Rodcat Bail Skm � 206 17 TrAzlking Pi-iderc,11e&i(Aintf,land CONSUMER ADVISORY 22 3 i)u_ I*A C0n'UZQ"r alt'¢:A)ti POACd Iter Cowunaltion of TIMEITEMPERATURE CONTROLS mI'IA.A lhmIrSaw. Urkde.raxlked i'l !6 Proper Cooking Temperatures for PHFs KI Cttlwrv,it,: I'liniinate '-,10 1 H Ak(1;(2r .g,- 155,E 15 iu2j'i F.A!,!!2 S01*111MV fire R41W Shell L -.J c(munnitn"d uwx Ariitn:ds 155'F 15 Istc. - 1 I'Bit1),2) P(Atkand lf'k�ei Roast 130T Ili SPECIAL REQUIREMENTS -- --- --- , I Sett�k f4i A, (f)f :;j 4etqjcqj in T 41,1 A. I 1,A)F1 Rallies,J'.iedtA 1 1'� (.iiieritig, mobi--kwxl,telopk.ru',, and hkAuld bc� 3-461.1 i,Ali 3) Pt itil rrN.NIA i I d i;wne, Stu hc f 1 111-1 F A ioic:n or-miun:3 SnAtbinf Onv ]?IuI8 Nsh. va`tAg the approprime ;t,ctioss poultry'or t5 sec. if to fA,A!iorin- iil!wi, 3 401,11 t Whol-inu>vlo. ldinLt J;ej Sl,:jkicoel-ejltn:,Inc uAd tisk faclom (ah(Ar (45"1" 590.00'0 Mlatin" 0)2,Uld NIUJI 1-40 1.12 IUw Antiftal Void,Cch)kcd In a pi i,cf i cv ,hould' he deN zed L,odti #29 - Mic"m a%e 16i-F:* I 1 1-401A HA)} !I(b) M'Othtl Plff,; - 1-15"F 15<e,: 17 Reheating for Hot Holding VIOLATIONS BELATED AD 0000 RETAIL PRACTXES 1 3-403.11(.4),k-(0! Plit-, 165"F 15 sc, j (Iten-is 23-399 4.403.11!8) %fioowavc- lf?' F , kfiaut-"Slandinv wi'Ack f"O)w; retfi:e to lk' Time foodig,me 0"a F Viwf v0d;Amy md to., bsted,4 ove t,,n le ?-403.1 J(C.) Connnom"liv R'[F hmnn;yt ti,,nI (,,�rnv PoA;d Cod''-and]?)A OtIR 140'Ft ' 140:A RLnnaminl" uns;I(ed Portion.,>f tita:< I T FC 2 1 103 Proper Cooling of PHFa L F<Axj prt-4u'V 0 FC 3 F0 -4 00,S 3-501,14IA) ClAiding CNAh!'d PH"-'g (min 1'1(1`r to --z�- ------ Ln , I,'A?1!m-pt',, Ino 1,14;;Fta I F" 00n 70* Within 2 1 fows and From'10-1 -1- L 27 Phys-a:FAI�;Jity FC'-C 0(,,7 i to 4 1�1-145,F AVithin 4 Houn, i F,- 7 008 Cooling PlIFI,Minit Flom"Unbirm Ilrement, 1411") to Within 4 1-1,mr Z Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name99 ( Date'I Tyke of Ooeration(s) Tyge of Insoection T i ( rt�X ,C �., 4��a�� C( It SJ � I ❑ Food Service ® Routine Address !1t J � Risk C-3`Retail [] Re-inspection } Level nResidential Kitchen Previous Inspection Telephone ❑ Mobile Date: 3 t ❑ Owner A^ A �/ HACCP WIN ❑ Caterer El Temporary [I Pre peration Suspect Illness Person in Char g (PIC) lll��GGGWWW v� f //_ Time ❑ Bed&Breakfast El General Complaint �� /C(< (L¢ I?JnJu/Y1 CX.7 In: 3�l r ❑ HACCP Inspector `�� G I Out:ti _<:D Permit No. ❑Other Each violation checlted 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. 1 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 ' - ❑ 4. Food and Water from Approved Source TIMElrEMPERATURE 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 11 ❑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)(590.0 order of the Board of Health. Failure to correct violations _T 24. Food and Food Protection (FC-3)(Sso.004) cited in this report may result in suspension or revocation of X 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 F_ 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- PIC's Signature// � L Print: �� .,,lvvv��000�ev�w Z I Pace_of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination . I I I 590.O03(A) Assignment of Responsibility* i 1-302.11(AM) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge--duties Contanvnation hmm Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO`+EE HEALTH Other, 2 590.003(C) Responsibility of the person in change to I I Contamination from the Environment require reporting by food employees and 13-302.11(A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility OCA Food Employee Or An 1-304.11 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)(B) Returned Food and Reservice of Food' - - -� 3 590.003(f)) Exclusions and Restrictions* i I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701 It Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* d Food and Water From Regulated Sources 19 Food Contact Surfaces .r 4-50;.111 Manual Warewashm6 Hot Water 590.004(4-B) Compliance with Food Law - 3 01.12 Food in a Hermetically Sealed Contamer* I Sanitization Temperatures` 3-201 13 Fluid Milk and Milk Products* I ( 4-50i.11_ Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitizatinn-temp.,pH, 3-202.i6 I Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 ( Drinking Water from an Approved System- 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean' 590.006(A) Bottled Drinking Water* 14-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils" Shellfish and Fish From an Approved Source I 4-702,11 Frequency of Saint ization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I FoNal Contact Surfaces of Equipment* Shellfish, 4-103.11 MerhodsofSanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( 10 I j Regulatory Authority 3ull I. Clean Condition-Hands and Arms* 1 13-202.18 She(lekxk Identification Present, I 2-301 12 Cleaning Procedure, 1590.004(C) Wild Mushrooms* I ( 2-301.14 When to Wash* 3-201.17 Game Animals* ( I if I Good Hygienic Practices g ( Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* I 12-401.12 Discharges From the Eyes,Nose and Mouth* i 3-101.11 I Package hated ity' I 3-301.!2 Preventing Contamination When Tastin ' 3-lUl.l1 I Food Safe and Unadulterated' ( R gc I 1of from Hands I ( ( Tags/Records:Sheiistock � 12 Preventionf ContaminationfHdI 3-202.18 Shellsto:k identification * 590.004(E) Preventing Contamination from 3-203,12 Shellstock Identification Maintained* Employees' 1 I I Tags/Records:Fish Products I 13 Handwash Facilities I3-402.1 L Parasite Destruction' I Conveniently Located and Accessible 3-402.12. Records,Creation and Retention* I ( 5-203.11 I Numbers and Capacities* t90.004(J) Labeling of Ingredients' ( 15-204.11 Location and Placement* 7 Conformance with Approved Procedures ( 15-205.11 I Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Metheds's I Devices 3-502.12 Reduced oxygen packaging;criteria* I ( 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformaiwe with Approved Procedures* I 16-301.12 Hand Drying Provision Dmote<critiad item in the federal 1919 Foal Cale or 105 C'MR 540.000. CITY OF SALEM -y BOARD OF HEALTH / Establishment Name: �t �7) `s,A,-,e 'fo- 3 Date: Ct �c�' a "� Page: a of �Y Item Code C-Critical Nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION nate No. `� ,Reference R-Red Item - - - i. ' Verified J, ,PLEASE PRINT�"CLEARLY vl - vnc,Q LjC^J-i 5,,� 'rte, ^4A aYc4 �' C.�to- � o� �4�, C � ��4 ?• 30�. 1� 1 �U /a� fq�y� � �c�� i 'G� r S�,v �s <LS u� 4 f� p tis �7 ak:jL1_ a.»s I� 1 - v -3-- Ser GLDJJ CZk/Lr FK,7- cJc hes I,- J, c SIc�L _ Cteor\ (>15,6 Cu�^ rinol _ kP/1171-A kl� 14 ^c.,ln /IC • � 1� r7,�l. la- e�tnr, ,yn 5(_rfkr AJstet1,4 CGr,11-1, r ( IaS 46�a.(f V2, 0 11c1yt6_ cnc(� 4y� � aFMe � Jr� JI.irOP, /t�Gcshc�,t AM�o�J CX9G�i, y,� V �in�/NJ� IY\.) (�v n jZ�_As c^ 'I1YL'n''_Qi,4r,(_ 1 afi E)'C5Z)(. 16 J K/r/ J 'f �p 40 —{„ A r, M c-)4 -_O�ec- Cw)"-rn. 'v-,A (t-,- - I - i V 01A— Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes k 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-fiv/dollars orsuspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / � �0 Ej Voluntary Disposal ❑ Other: r• I :.5=f! i=<t.;•. Plfi=a Ke<xired ai Ten(peraitu'c. in^.:anions R¢tafad to Faodbotnn Inness tate:ver tions and Rlsx j Acuttdic"to Law..=x,icd?n Fatlors pfems 1.22) (Cont.) �i }'-,`t-:5`F Wi;Ifia'� Ho=ds jJ ? z.4;!t i5 C.ik:Itu31-?etfitxi ;ix PtiPs PROTECTION FROM CHEMICALS 19 i PHF trot and Cold Haidi F4 14 Food or Calor Additives ! , 5}•. r:'€t} ^ "' Y }( { E t CO'l PH€• Mainteirtc.i nt nr l:elow I i 2L2 I2 i .4cltii!tt�� 1 c, i 3-302.14 Prutcct;on front€;nap,rw.ed Ad htivc:i- i s=a !'H€; '`iainiaenecl at of a}rtve { is j Poisonous of Toxic Substances ( , 1 41,0F }(halt , Wend{}'ingini'omi'l ort Oeif'ina€ Container", 21) i rime as a Pubfi,.He;dth Cc;atrol 7-iU' 12 Cotnnton Name- t\'nrkitts i•.tnt:nn::rn"' E ' LS a Pu€:Sii i 4-�s€fh('.,arid" 201.1i !irPw-Lion...slowie" I i 'zu::?t)•1'Iil .'art,mu Regis:tt'mc:u 7-?t1"_.l; Rzrasichon--Frt`s:.nce all,] €. ?-202.1; C"falitfon,of Ilae` (;r.ic funtatnct=- t'Yohilrriuu,' I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE T ' ( POPULATIONS(HSP) I 7 Od.l i Sanitize err{;rw-Chemic-,Is' i i.€ i j-\fli lir'.}....'1:iip,mcurocft€ c-j`n !aged Sun.ea aa€ 7-104-ICiuec2s for i :hit, .1'�rJtct,t•t item'' I 7 201"I•t Drymr;.hl:.ertc,Crinin- ...... 1 R"-"Pamir:wish R'a{16118i,iibds' 7 :Oral! hx'idrntai 4=+xxl i'vntact dt!bt,.:ant.' 3 ` <.3Us.€itH, tar of Pa>icun,_ed t:qc.'`.. i .(I(I)t R.:w"r Paitl-Ah (.lok:d Animal Fot ,,nd ( 300.11 Raanded t'.;e Pe<'icnlcs C:rttet;;r' 1 f t?$LL=Srrd bprtlttiS Not :)PI Y<d. ' 7-206.12 Ktxicnt H;it �Suturot " I 3-n{;t.1;tQ Uw,pt.ned Fox P,c;.ag. N,i Re.L ncd j "r'-_Ori i< 'i r.3ck!ng Potcdrr..k':°<t(.'lural ;nd 4Ic»titnr,np CONSUMER ADVISORY ttc"kokY Pex;led i,sr Cowumptiun of j TIME/TEMPERATURE CONTROLS ' rias!::tt i-=v;d�'IIsat arc• i;,i�- it ndt'iva'krd is I ({ I Draper Cooking Temperatures for PHFs Pxt>t:.ssei 3 €i)€ 11 All t-.gg;._ 155`F 15 it-.:. . .ti'.1 z )':, a unr= : k', SC=hsrtut:;iv to v Shell ! iannrdi:ac Se.t"ae. t i5'FtSser � } � a`, I -461.€Ita}t•21 Ccfun:nutr•dii;h. htru.:tit;�tni ! ' <" anitnal,'s- i5?'t' 15 set:. ' } i-d(tl.l'.(I3)i 1}C2) ;'ut4 .(rad €3:ci Ka::ini - 1101" i:k win, SPECIAL REQUIREMENTS 51:i?kt"tt/Ll-tri) L'iC'I:It."ti�tii54it1i7,15'#ti.{}{?`;}r\}-{i)} jn 7;A}(_" Rrllitel, lniti'::,d itik.tti I55'F' I-` :1t•`Yt{3G tell�=,1IC iiY,:i. ICt1i(JS r{;xfV 8114 t 3 Pnuttrt.�4'iid Ciau!c. Stufte;t PHFe rt:stdittt,sl i-in-hcn o,'eiativnF Arould Ile -i 40i.i1.AP..j 4l,.btted tind,ti ti)i' a rt;:tr3.tts::^f'4t(tt;l1 Cunmft,tn,' Tisb M1feat, } €P P,v[Ittv(a'Rnnics i65'It [S';ec. ' } alx'vc ll,td€aled to i;xnddlinrl,.f1lnr5=1 3-401.4!t0t3t 'd'ht,le otusttle. ht:,tcr lir.•f:ite:u',s ;ut:.`rt•enl {tu:a:d risk facture thher W501. 4z fatal)009 viodilrioite relatutlo io t)C i t^tat? i 401J2 Raa ,anile!Paul,4.txtkcd ma t}rRt.iicr2s .hCrt{ld R;°debitod under rt_><J - E } :�4iit,nva{r 1651, x S;9t•{:t:tl €tt'{lutr::ttt'.Fttf. ; t 2-401 II(A)(I)th7 Ut Other Plik - 145`F €5 cc j 17 ( Reheating for Hot Holding V10LA TIONS RELA rEU TO 6000 RETAIL PRACTICES 1.•i0;s.t h A)-(D) j I'11F, ln5'€� If,tCl, I (7Y0nts 2,;-x!€) "-40111(b) � itilicroicatc- Ib)"('2 Nim"le Standing j cmwat sed ran rur,at vwio n„t,. wbif 4 do'lo. c4t41, to rile I llre•' I f lvdhoole On,Ss rn!+-rr;atitrrri.....i rok.'la,tors lt,ted ah011e, ("ll be A. 1!3',.i I(`2 ICnn,tttete taih•Prtx.'c=„td RFT I=nktfr"rF+ttl it,file=i•'+':'eory C+rt.,"T6C the h fud Codeand Pi-5 CUR '1.40i,1 1(L Remaining Ln>I!:ed Portions ni ifeei Tera--'T G(<r;7 ftotuf;Prac:ic'esFC 57ie-fit10 �i.4a,'aC,_=:x'.,r+,c-ta.pct;{x= FC ? ! OC,_-- €>; Proper Cooling o;PHFS 24 F(,rt aad'ext Arotacl=nn F{. T _00,t _.--- t ?5. cr ti rtant hnr:!1fFns:!s _ FC -4 005 ' 50i.14W Ctuliae�Ccr>kedPTIFS hon, 1.9) rl') '--'�---� { - - -_-- .--- `- --- -_-__._ ._'-- Zo, ! `Nniet,Pltr,ain+.t aid`IJG"sFe FC-5 1 O0t _ 70'F 1Vithm 211our::Lilt] Frim;"FI' _ �.-P. - -- --- T --- ? 2'i -: t'h•,`4ea:FaC!I::Y FC-6 .0077 I w 4 i F.'15 CatE'in-t Hom, ' i 2t<. Pusnnoas t^r'i:^etc P�t_tecals_ FC._7 . .OM ! 3501 €•i,};t ("(*hIll,Ptiirr 'MadrEl, wAutb[ent 1 T:fnprruutrc invred;crt,tt'41"hi4S F .mesal r:-rn i:!the 3,de:c i i':.ry Foo, Y\:S:or 10"t Sot{5q(i gra) l E CITY OF SALEM BOARD OF HEALTH Establishment Name: ( � 1'll1 Q a6 Date: 1 at! Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION .; ,. Date No. Reference R-Red Item / ..,. .. C PLEASEPRINT CLEARLY Verified 1 n2 :d'1N. (,L / N.�.l( !/� �1�CCl�� X7:1 (�/. T(/1 I /!/�Q �c �i�fl/ �.Ifrn� Srl ��Qac{ . her hvm�, G. �� (J bio�n�, , �r )N, /1s, i,.- � I � �-�-ni.�/; J Vrn,.'li•I� <��,��,a�d IJn"5Q �'�c��l. --llama ��:� G 4-5v11 / l0IIP,, h(,rdS v)t I Jam,,l r?.,((.dsJ— `" f10 Ntl /Y_ fl( ( ir mo I j I �i` Stern. 1I�/• l /ll��_. /�I.Qs-� E7, 17o 1:. I ✓ ;7r, �d 9�< 1 : 5 -I 1,\I'�a (' ��4- S-ae "'i I ' k, '.d, n . v GP�J.n �3p,-h. n ,)4 4 , t,e va <�-{,e Iv )e- n Q ttt i1 J, l(�.Zj h. ISI-" ,n - - I tIQo . i h er G,��-E , +� I.lui r-,/-) "(J(/ 11;_14CeCz_t1r r11 � i Discussion With Person in Charge: I Corrective Action Required: ❑ No �/ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ 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 twenty=fivedollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure •your food permit. / ❑ Voluntary Disposal ❑ Other: } E i.`ht7: 1410.1 PHF{ Rl,• elved:•l't:'ntperag'ireC Violations Related to Foodborne Illness Interventions and Risk ! Ac; ,rditw to l zv.. (oolod ti Fartors(Items 1.22) {Coot) ^,)`H'14,5 1 1'r it},i*, 1 H:ruts i PROTECTION FROM CHEMICALS ^ '! ` Caxrlind M.LiliuI.!itt, P}if's I 1y i PHF itof and Gold Hotding 14 ii Food or Color Additives 1 3 50! 16(H: Crf.t pffi, i ,-202 12 AiltLttt;c'r' ! iW I 3-302,14 Pr,,n-0ion front Urnipp ir;rd ldditsvc�" , Ot It;;.1s !int Ytt:'` 1t;tin!'tttred of i,;nitmc { is Poisonous or Toxic Substances i 7 10(.11 Idcrnityhtg 1nformatson 06,inai i it) P. i-`atl Yti;.it kw. t,Hk.Id tt or above i ,{t't• coinainers' „!f! T}r.,c as a Public Haigh Control ! 7-10 11 Consmon Same- Workinc C'onnsincrn'" F r 7-24[.1; 3rtr,,t:uk.n-.�,insarc°` l t f me a:a Putrlit .teal(}t Control, ' ! `I,1000 4,1€) Varinirtx:l;ec{ztircn.enr j i 7 X47.1 f RQitrictuw-Preernce acrd L>c" f 7={rZ.i2 Cundru,=n:-ofUw' j 7-2(t? I1 ToKk C'untain,'t: - Prolsihition,`. RE.f,UIREMENTS FOR HIGHLY SUSCEPTIBLE 7 204.t! 5annizerc,Criic ri, -Chewic.,Is- aOPULATiONS(HSP} r - - - it i :yrtt.11( ) Lnf:r�teurtnd £'re-!,:t:.i..i:*rdlatice>wid Ch::nncsts for t4ashtn(:I's:xlr:c:c,t.ritotw' ! t (}4.14 Linin 4>� 1 rv;t!r t',trnn�!ahzts` 7-2 —� � 5-:;Oi.!7(13} t'„•t:; Pariru„t,:ri 'eery' 7 2{)5,I! 1a;tdemt.il t'�+xxl x,nta��t.Lan]mwil'' :'-;;O 1.i i(1)} Ko,kir Patt:tli: C,><Yt ,d A9iinal Fite d vud 17-2p@.I i Rosiiwied lkr Pe<riantes Qitertn*� t kliw Srk•a �ptrn,t,w ti,rt 'Wivrd. ; 'r 200.12 i Rrr.icnt Bari St;vtinrta` i I �:W! I j((r�r t;n<;�.ned I"'Xid 1'a.1:re: Not }tr �crvcd. ;.2061' f:ncatog P,ru,l:;ra. Prat C.'„ntn�1.Fnd � - ��- 41Omn:rin CO4NSUMPR ADVISORY TI FJTEMPERATURE CONTROLS -!1 (ovgit:w r 4st,;u`r'r i'„at:d ! ,r c'ttstwtjtinn r.; t6 Proper Cooking Temperatures tat f'hat.i,C kww, Um;Qrux>krd PHFe •'kit tttlu;rt..tst t'tt"e setI to H� F it:tt: � xm .€4€ I f A(l)(:.i I FgIf:._ 155,, 15 i u,rr.:,_k�;=� 1 ,. f.i: ;,j,,,L,oue tot 12am Shelt Invo-&Ito Ser-1t ; , 6 1-l:i;ec -tts(,1it:1)(2t <'rmns:inun•ti Dish. :,1e.:°..;K t-,:sure - ' nlnwf li 'P 15 ccc. SPEC?AL REQUIREMENTS -40f n;.tl(H)(I!i2) NiA, and ('Seel 1}U`t l2} nuts° I t�•t i 5v0.tt{)4r:Si tl7j 'iuialr,ut. 4 .etc t 54£t.(Ki�i'll-tC})tr. i If :)i.4)t_r t K:rttte<, hrie.tcd '+ir.ris i55 T' t5 of WC r ( vrsnx.. mtr!t)1, "%:C1, ttoiporiin sod -4t}1.11(A),3) C Pcultn,Vd ild 6.twe, $titled t HN, r,:.,drut nl r,tic.?ten oj,t:rntion.•,�.ttvtld oc j Ctufftuet onf:ulliv, r"11, ht-at ! 6k!hiLi;d the a,,j`rt•fiMite WC:1011. 111,tit'y rr ttotita, l65,T 0 s,-c. i' ,atvre it rcl:dC€i tc„iarl},(;rne !!Ines”: I -4(if.i ltC)!i} _ •',i'hk,le nrurl'le, tntflct I3eui W:Iks E Iitt'l Vefltlona 3t)d 6' ,: : (actor, Odw..' 145'1` 590,009 i+'I:,u,t .rclaiing i a--t,)).1' R:ra' Amino! F'kkxi,0s okct}to A ( i•r.;eis(t•. 'ftotr€tx lie dci>€ter( u•tder#29 - tlic:km vc i45"F I ,.401 thA)(10)i ' .all Oihet fi ff a- I-t5 1, E4 ic,: i 17 Reheating tot Hot Holding VIOLATIONS R£'LO TED TO GOOD RETAIL PRACTICES 3-.141•,I Ai34i)) PIIF, 165'F li sec. I f ((tents 23-311) >40'%11(8) MicruWtive- 16 ”r NLIIL;e Si tndinp; I 04P!u!::n.t a:;rr-<ri:}rai t•rn!st;rt,, xhr,:h to,;a, rri tc:,,ih< 'irate' r ?"ndf,rov,r iII=tcs., un;r••,n::�•re:✓a;l ti,.',7dt:o+:"tilt.,!sl:,:ro. ;an Cr• � 3-403.11iC) unnmcrrt:t1h,pr(xe: dK"lF_ Hxx{- � fi,rm,i,>;:q;roi'•n,,,rgs,":.�.,r:r:;r'rti, tt•u.lt'�,cicr,n7tt7�Cdtt•' !di) _•4442.!! 1:t Reinainml•,1:110w,d l>s,rin,ivI of linea � r.Item I Good Retail Arnrtims -- FC 5.40.9(90 ryr„Perstrrn£;: _ FCC � ? )0-'.1'._�._I`-- _-. _._.... ' pt; Proper Cooling of PHFs ! t 24. Fitt rn,s fond Prw>e Von?,-. '� VC-,') ON, i ' t 2;i. Fwi^_tern? ind rJtcrtc,'n ! #'G- 4 i0'• 50114(A) Ctritlir,}c(xk�ifPHI-" lornI-I(N:tkt :v:cS't:t:fn 74'0 Within 2 Hours WA from")'I' 2 7 � _... ._-. ...r 4 t . Ph;r=.;^.ai Fa;11t'p F 0t,i. ' to�41'F/17'F Within.:l-inn.:. i 28 Pa;L,nc:w 00',,^,.tc hik,tk rQa!;; _.___.. ,;_7 t'N)H i i 50i.14t131 C':xYtine,PFIF: Made Hoot Arnh:eot 29 _.��Sc-Ftr r H•:t<•"rement; -_ . ' .(k•9 `FcoipvraorehwrednF; 44'44- itxtR ,41'F/#S. j err >�J;r,=:. 7� 1 i Within 414{,#31.1.1 t>cn .,%,nQcal den.its,(;t,:k•t a: 1 iq Foe.di,:ric or 105 t %t!:$41;fit);r CITY OF SALEM _ J BOARD OF HEALTH I j/O� page: 4- ofd Establishment Name: ' f f—v {} � PQ azo Date: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION nate .. : ' . , . , , 1_ - Verified No. - Reference R-Red Item - !'` PLEASE PRINT CLEARLYt ! I Mt ( �� iN �� n,ns . hlttt: s F PART1 Cr �(r Lei, i E I C a r ( t cvzn aG) J1-�0� , exn o4,0� 04001- 4-(Loa, 408-`"-(Loa, W4 4-v-r µQ (7�7Y1G �(Z(/tr5 tvjuct GT�V i )ff)�P J *i�3u ( As az3 M _ t '171ee( . rar> U - � d 0 V Ov ocv, ' _5p" 'P'I t 1.)201 jtb OU, I t c �c HA ?r 't (s J tkCp D' & -)l_i Fri., �- -r(U)k? " ¢ ski (om' 2 - (, ./' t7ejT- r 1 46 U7- A)_U -, �v U Jnr MW 4_:�P- D44-e6. j � r�S-Flr1,��t�-. (,�� h.21� I(�vf= ��s s�� I< I-I� c,�/• �i /v�.�- CsfNtyb I {� R� C�c (/f540VL%-- U,�. Discussion With Person in Charge: Corrective Action Required: I ❑ No I [tit}Yes } I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion Re-inspection violations before the next inspection, to observe all conditions as described, and to P Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that snoncompliance may result in daily fines of twenty-five/dollars or suspension/revocation of El Embargo LI Emergency Closure your food permit. "�Gif29 `i ❑ Voluntary Disposal ❑ Other: Violations Related to Fandborne fffross Intementions and Rlsk j A,:c,,,dinatoLjv Coo!,,dni Factors(items 1-22) (Cont) oaten•i niikja," PFfFs PROTECTION FROM CHEMICALSI9 1 far PHY,H;and Cold Holding 14 Food or Color Additives 5,,)!.16 Cold PHIF , Nlaulzani"I ator f.,iletv Protoolon trunk Unappro%Cd Addillle,.' PHF, Poisonous at Toxic Substances 146 101.11 I identifying infot imoon-- Onglaal lti,Iltll Held at 01 AbOle 130'`T, (iontain--rit Time as a Public Health Contra! 7.107 ,11 C owillon Maar--- W�,rkiog k ,ILI taln�r, l j �U! I" Tini-t as a Ptltjic hearth Control f L -1 lion -Pelt��ncc and L,C� '04 P�i,n (. I 7.20112 Cwvfldonr of ljqo, 7 '03 i i 1"Xic Cowaincrl - Plollibi:ioni,4 i REQUI44EMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS{NSP} 21 ai:l I I(A) Un'p:,Itetll i!Vd PIC Ila,11-igt7d AfteSWId 7-1()4.12 ('��wnncaN frill Ilrodor, Iit;�ti,il mlg Agein,.Critcna' flu,' 17('61 !J, t ,I pe\tutin,.d locid-enol F;"YJ ('vntIm.I ktbtictiol. i !,5w 11fi)) iza��or flaaual;,�O�I!,d Atimel Fod and ?--206.11 kc,ttidl'd t ,k PC,fiCi&1 CIACIO i I I 7-206.1.1 Rollellt liil:t Stan,41s_ I 7 "06 I31 3 ilt;1 1 JfCt Vnovoleu PaLkata' Not P.ador,z.Yrct Cow,l unit CONSUMER ADVISORY 22 {,G i 11Ao%i,,,t� tylcJ TIMEfTEMPERATURE CONTROLS P � Wlt,0� 16 t Proper Cooking Temperatures for y Not f rthcl,, l� i Pro;r s,z,td Z,l LhnunaT� PHFL �', i�', 3 ,101, l-L, - l5iFI5,1�,.C. A'� I' l't!f0t:1r)7;_'J F;g>S,IhEtiltlli 101'tUW Sitell 40 1.11 l A)(2,I i comminot-'d Fi,h, lleats ti", (Iom A[14111k- 155'F 15 stc. ' SPECIAL REQUIREMENTS lfflal;;2l i Port, and 11,.0 R4wst 12 1 wie'- 3-40IJ Injecl,"i NlLat\ - !i5 F1` in .'...101 11 Ay 3) 1 Pntflrn,Wild 6aille, siolICd I,Hi',s, n; Itchca or::raliopi,,!Iooid be Containint. FiQi.ll feat, J'!hkt:,d It, Rjuji,, Y F 15 wt,. illncs,, "Illtly ot .-I o aix,vu i"I ta If -40 1.111 C 71:3) "Wolt-rouscIc tnoaj livef5wjt,l; talei ven"on,and faC!klrq 011tcr 590 001� violallk,os rolajla� [,)Fcx.i r<j:jji Rim Anorml Fultd: ata .should N,-&bitoi uadcr_#N - lo 'F�7-1--"F 15 ,ei; sp,icial I(Atki)(1)) 'Vl 001e1 PH , , Plr I I 17 Reheating for Hot Holding VIOLA TIONG RELA TED TO OOOD RETAIL PRACTICES 3-.1,03.11(Aa (D) PI-IF, 165T I sek- ^ I (Itenis 23-30) which do Ito! i elae:'t lb" linin` 'atibe J-403.11(:') ClInIM01OWN P1lXr33l`iJ RIF}Illld fiwr,: f;h. 1,,),,d (X,4R 14011 ("),0w 34031 tfll) RQ111aillim, Porli(as(if licel i Item catraRilani ptactives IF& F 59_0_. .3 kkinaqiirl,�r!o-d I. Peo,00ne! I FC -2 fX'3 18 Proper Cooling of PNFS F�,)d wo Fxd FrWk,cbof: ,CC I G'04__ 1_2�1 Eq0P.men1,,,UIlJteol;d7_ FC-4 '.05 litao 1401,It, : 29 Wato Pi,imt:,ifai-,net Vjato FC-5 I GO'� 701:Wi:lran 2 flours iind Froni'iTP . .... F%ci!ifv F( -r 007 t(,4l^F115iP tt'.tiunafinutr. ° 1L ?.501.14(H) Cooling PHR,,ado Front Ambient inq.�ralIvc Jn,,rCdicrw,,i,,411-,P�'F 53T i 'N001"t 126 North Street 7-11 Food Store #22763 City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744 6307 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Q RED Owner: , Comment: Sanitizing solution found too weak Provide sanitizing solution of proper concentration at all times. Amjad Chaudhry Handwash Facilities FAIL Non-Critical ❑Q RED PIC: Felipe Fernandez Comment: Front handwash sink had loose roll of paper towels at it.Paper towels must be wall mounted. Inspector: GENERAL COMMENTS: Elizabeth Salandrea All other violations from 3/3/08 inspection report have been corrected. Date Inspected:Correct By: 3/3/2008 Risk Level: Permit Number: t BHP-2008-0011 Status: SIGNED OFF #of Critical Violations: 2 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions` and Risk Factors(Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page 2 oft 126 North Street 7-11 Food Store #22763 City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency .!Telephone: FOOD PROTECTION MANAGEMENT 1 744-6307 PIC Assigned/Knowledgeable/Duties FAIL Critical ❑Q RED I Owner: LComment:At time of inspection,there was no employee on duty designated as a person in charge.A PIC must be on duty Amjad Chaudhry whenever food is being served in the establishment. PIC: PROTECTION FROM CONTAMINATION Christina lovita Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 0 RED }Inspector: —Comment:Sanitizing solution found too weak and no.test-strips-were available. Provide sanitizing solution of proper concentration Elizabeth Salandrea at all times,and provide test strips to ensure proper concentration. Date Inspected:Correct By: Prevention of Contamination from Hands FAIL Critical ❑d RED g i 3/3/2008 Vmment: Personal items found stored in condiments cooling unit.Store employees personal items in a separate designated J Risk Level: refrigerator to prevent cross contamination. Handwash Facilities FAIL Non-Critical 0 RED Permit Number: BHP-2008-0011 , —Comment: Front handwash sink had loose roll of paper towels at it. Paper towels must be wall mounted. [Status: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) VIOLATION Hot and �Cold Holding FAIL Critical ❑� RED #of Critical Violations: J t6comment: Back ice cream freezer had a temperature of 15°F.Repair freezer to maintain temperature of 0°F. 6 ;Time IN: Time OUT: Urgency Description(s): BLUE: I 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2008 ) Page 1 oft r Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE '_Foodborne Illness Interventions and Risk Factors(Require Comment:The following items found outdated: 4 Breyers yo-crunch yogurt immediate corrective action) i 2 pkgs orange hostess cupcakes 4 bags sunkist fruit snacks 7 Oscar Mayer turkey variety pack 1 pkg Oscar Mayer ham 4 cans enviga green tea 6 Tropicana orange juice 12 Sobe green tea 5 Lipton white tea 5 vanilla coke 7 cherry coke 1 diet dr pepper 15 Vault soda 8 red vault soda 7 diet coke plus Owner to closely monitor all expiration dates. Equipment and Utensils FAIL Non-Critical BLUE omment:The walk-in/reach-in cooler was missing a thermometer.Provide a visible,accurate internal thermometer for this unit. cream bar freezer requires a thorough cleaning. "/Mop stored in the bucket.Clean the mop and store upside down not touching any surface to air dry. 1L. < reach-in freezer in back room requires general cleaning. 7he same unit missing a thermometer.Provide a visible,accurate internal thermometer for this unit. GENERAL COMMENTS: GOwner to forward extermination reports to Board of Health within one week. Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2008 ) Page 2 oft Commonwealth of Massachusetts City of Salem s r Board of Health Kimberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: 7-11 Food Store#22763 File Number:BHF-2004-000113 126 North Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 _ Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2008-0011 Jan 3,2008 Dec 31,2008 $280.00 TOBACCO VENDOR BHP-2008-0031 Jan 3,2008_ _ Dec 31,2008 $135.00 Total Fees: $415.00 PERMIT EXPIRES (December 31,2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 28 r QTY OF SALEM, MASSACHUSEM ' fro BOARD OF HEALTH "ft> 120 WASHINGTON STREET,4"m FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR JSCOTTO SALEM.COM JOANNE SOOTT, HEALTH AGENT 2008 APPLICATION 'i FOR PERMITTO OPERATE A FOOD ESTABLISHMENT LI NAME OF ESTABLISHMENT ' I = 11 Fo c 4 `Aare * ZXI63 TEL# CT-YR ADDRESS OF ESTABLISHMENT 12 U Mv)(IL INA 'AJC ShcPw FAX# MAILING ADDRESS(if different) b EMAIL-Business': ryry�� N Website: OWNER'S NAME W Y�l '� C Y10.�V�r� TEL# ADDRESS 15 1 �� l7e�,� ChaYl�-01.1 STREET CITY STATE ZIP / CERTIFIED FOOD MANAGER'S NAME(S) NM ARD CNAu_O��CERTIFICATE#(S) / -�o ' ok6ZO 3 (Required in an establishment where potentially hazardous food is prepared) WftD EMERGENCY RESPONSE PERSON Lath 1e-A C". HOME TEL# .5b$ - A DAYS OF OPERATION Monday Tuesday Wedn Thursday Friday Saturday Sunday HOURS OF OPERATION Please vmle in time of day a 4 �{ a4 N ak N \A �,y K a4 H ay 14k. (For example l lam-11 pm) o TYPE OF ESTABLISHMENTFEE (check only) RETAIL STORE YES NO less than 1000sq.ft. -$70 1000-10,000 sq.ft. 2$0 more than 10,000sq.ft. 0 -------------------------- ----------------- - -------------------------------------------------.........--...-------------........... RESTAURANT YES NO less than 25 seats =$140 (Outdecr Stationary Fuod Cart$210) 25-99 seats -=0 more than 99 seats =$420 --------------------- -------....... - BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YESNO $25 TOBACCO VENDOR ES $135 ALL NON-PROFIT(such as church kitchens) Y 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 a pproved by the Salem Board of Health. Pursuant to MGL Chapt ecti n 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid a e taxe r quir d under the law. 4a6-/b? o13- (o?- LACI 5S Signature DateSoci�all Security or Federal Identification Number __ Revised 4/24/07 FOODAP200L adm CheckH&Date S -t'72��()�/� $ /✓r7 l )-J T 126 North Street 7-11 Food Store #22763 City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: i Violations Related to Good Retail Practices (Blue Items) 744-6307 Food and Food Protection FAIL Critical BLUE Owner: ! Comment:There are many price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price Amjad Chaudhry labels. PIC: The following items found outdated: Rejane Tavares 1 -Smokehouse grill house sandwich Inspector: 2-The bomb burritos David Greenbaum 1 -Macaroni R cheese poppers 1 -Egg and cheese sandwich Date Inspected:Correct By: 1 -Portugese roll with butter 8/16/2007 3-Drakes apple pies Owner must closely monitor all expiration/sell by dates. Risk Level: Physical Facility FAIL Non-Critical BLUE Permit Number: Comment:The bathroom sink is loose and falling off the wall. Repair and resecure the sink to the wall. BHP-2007-0046 Some light fixtures are missing covers. Provide protective covers on all light fixtures. Status: GENERAL COMMENTS: PARTIAL COMPLY #of Critical Violations: Owner to notify the Board of Health within one week that the above violations have been corrected. 1 Time IN Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 16,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 16,2007 ) Page 2 oft a IMPORTANT MESSAGE , � I FOR I �_ T7 e- -, e) DATE Q�/�is TIME2-tP.M. M OF �t PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBV F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE J " (9C,k"b dr.S r0 ? , v_ ` SIGNED/, ^ -- FOiyp✓i 4009 0 IN U S.A. E W 0 z ' � No Violation Notice February 8, 2007 An inspection was conducted at the following address: 7-11 Food mart North Street Salem, MA 01970 No violations were observed at time of inspection. John Gehan Sanitarian CITY OF SALEM BOARD OF HEALTH Name of Establishment: 7-11 Food Store #22763 Address: 126 North Street Owner(s): Amjad Chaudhry Phone: 978-744-6307 Date: January 26, 2007 During a reinspection by Board of Health Sanitarian David Greenbaum, several violations observed during the initial inspection had not been corrected. There was also a concern that a Person-in-Charge was not on site. Hot dogs were not being held at the proper temperature and there was no sanitizer at the hot dog station. These conditions may be critical and increase the risk of foodborne illness. Therefore, the owner was asked to appear before the Health Agent to discuss these violations. David Greenbaum attended the hearing. The owner is the Certified Food Manager and works at the establishment early in the morning and in the evening. However, many of the duties he described are administrative. The owner explained that he works with his corporate office putting in work orders to correct some of the violations. These corrections may take some time to process. Therefore, he made some of the corrections on his own, such as installing a paper towel dispenser in a restroom The owner agrees to have a full time, daytime employee trained as a Certified Food Manager. to-at Amjad Chaudh 1 Date anne Scotf Date Owner Health Agent It 126 North Street 7-11 Food Store #22763 City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-6307 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:There is no sanitizing solution available at the hot dog area. Sanitizing solution of proper concentration must be readily Amjad Chaudhry .W, available at all workstations at all times. PIC: Handwash Facilities FAIL Critical 0 RED Rejane Tavares Comment:The restroom is missing paper towels. Provide disposable paper towels in the restroom at all times. Inspector: 1 ' David Greenbaum The bathroom had a hot water temperature of 104°F. Restore hot water to the restroom at a minimum temperature of 110°F Date Inspected:Correct By: i Q--'immediately. /7 1/17/2007 a The counter hand wash sinal .has no hot water. Restore hot water at a minimum temperature of 110'F to this hand wash sink Risk Level: immediately. /Vy Violations Related to Good Retail Practices (Blue Items) Permit Number: Food and Food Protection FAIL Critical BLUE BHP-2007-0046 e, Comment:There are many price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price Status: labels. PARTIAL COMPLY #of Critical Violations: Equipment and Utensils FAIL Non-Critical BLUE 3 1 Time IN Time OUT: -'"I Comment:The walk in/reach in cooling shelves and tray need a thorough cleaning. Urgency Description(s): The mop stored in the bucket. Clean the mop and store upside down not touching any surface to air dry. BLUE: GENERAL COMMENTS: Violations Related to Good Final reinspection on Friday, January 19, 2006. All outstanding violations to be corrected. Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2007 ) Page 2 oft I1 126 North Street 7-11 Food Store #22763 City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-6307 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑j RED Owner: Comment:There is no sanitizing solution available. Sanitizing solution of proper concentration must be readily available at all Amjad Chaudhry work stations at all times. G ddb y. PIC: Handwash Facilities FAIL Critical 0 RED Rejane Tavares Comment:The restroom is missing paper towels. Provide disposable paper towels in the restroom at all times. Inspector: F. Restore hot water to the restroom at a minimum temperature of 110°F David Greenbaum The bathroom had a hot water temperature of 103° Date Inspected:Correct By: immediately. 1/10/2007 W iWhe counter hand wash sink does not work. Repair this hand wash sink to good working order immediately. RISK Level: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold Holding FAIL Critical RED Permit Number: ment:The hot dogs had a temperature of 118°F. All hot potentially hazardous foods must be held a temperature of 140°F or BHP-2007-0046 igher. Status: Violations Related to Good Retail Practices (Blue Items) VIOLATION Food and Food Protection FAIL Critical BLUE #of Critical Violations: 4 Comment:There are many price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price labels. Time IN: Time OUT. The fo Ing outdated items were removed at the time of inspection: Urgency Description(s): 1 - nchables turkey stackers BLUE: Tomatoe Basil soup owner to closely monitor all expiration dates. Violations Related to Good Retail Practices (Critical Equipment and Utensils FAIL Non-Critical BLUE violations must be corrected �z Comm nt:The walk in/reach in cooling shelves and tray need a thorough cleaning. immediately or within 10 days)(Non-critical violationsa walk in floor needs a thorough cleaning,including under all racks. must be corrected immediately or within 90 days) `A, The mop stored in the bucket. Clean the mop and store upside down not touching any surface to air dry. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2007 ) Page I oft a Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to Reinspection in one week, all violations to be corrected. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2007 ) Page 2 oft 126 North Street 7-11 Food Store #22763 City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: i PROTECTION FROM CONTAMINATION 744-6307 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Q RED Owner: Comment:There is no sanitizing solution available at the hot dog area. Sanitizing solution of proper concentration must be readily Amjad Chaudhry available at all work stations at all times. PIC: Handwash Facilities FAIL Critical RED Rejane Tavares Comment:The wall hung paper towel dispenser missing paper towels. Provide disposable paper towels in the wall hung paper Inspector towel dispenser in the restroom at all times. Paper towels available at time of inspection. David Greenbaum The bathroom had a hot water temperature of 105°F. Restore hot water to the restroom ata minimum temperature of 110°F Date Inspected:Correct By: I immediately. 1/1912007 Risk Level: The counter hand wash sink has a hot water temperature of 105aF. Restore hot water at a minimum temperature of 110oF to this hand wash sink immediately. Violations Related to Good Retail Practices (Blue Items) Permit Number: Food and Food Protection FAIL Critical BLUE BHP-2007-0046 Status: Comment:There are many price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price PARTIAL COMPLY ' labels. #of Critical Violations: 3 Equipment and Utensils FAIL Non-Critical BLUE Time IN, Time OUT: Comment:The walk in/reach in cooling shelves and tray need a thorough cleaning. Urgency Description(s): The mop stored in the bucket. Clean the mop and store upside down not touching any surface to air dry. BLUE: GENERAL COMMENTS: Violations Related to Good Retail Practices (Critical Owner has failed to comply with inspectors order and therefore may be required to attend a hearing in front of the violations must be corrected Health Agent. immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 19,2007 ) Page 1 of? Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) %lVbl . I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 19,2007 ) Page 2 oft A� 14� Fit a° �,N �jr,'. A, 4" rpt Al UUWea1th�o1;Mass1fchUpetA3- 'A g; -7, 4:z gtv�P- Z., Board of Health7 4 1, mbefley DlisIGcoll 120 YVashington Street,4th Floor a ay0i ' SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED. 12/19/2006 ESTABLISHMENT NAME: 7-11 Food Store#22763 File Number:BBF-2004-000113 126 North Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes RETAIL FOOD BHP-2007-0046 Dec 19,2006 Dec 31,2007 $100.00 TOBACCO VENDOR BHP-2007-0028 Dec 19,2006 Dec 31,2007 $50.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 29 CITY OF SALEM, MASSACHUSETTS • s BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC — 7 2006 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM Kimberley Driscoll WWw•SALEM.COM BOARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 7" /1 Fhi9Z) TEL# 478 - 1�4/LI- 6367 ADDRESS OF ESTABLISHMENT �e2LO, lVPleFlf- 9-1- FAX# N�xT MAILING ADDRESS(if different) Y✓/h4 EMAIL-- Business': e-'14 Otaner's:AN 31 Ab Q,!A—k- !�;A t:2.,.L{ OWNER'S NAME AM.* MITD �tcZ`� TEL# -1911 --1Q 45 'S ADDRESS IS 1 CI �� '�4cit C,ta A,KCI OA/ MN Q 1Soq STREET CITY` STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) A1v�Gtd C1riQtt�Avlwy CERTIFICATE#(S) -ab30 ►SODA (Required in an establishment where potentially hazardous food is prepared) `.J EMERGENCY RESPONSE PERSON QMJ AD C tAA(-L H (C`t HOME TEL# ZiVR• u 8Q a3 I DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday I Saturday Sunday _ HOURS OFeIntim of aLAv) c-k 1 � � IA vl ` ) Please writetntimeolday. aL► �i a4 (for example Ilam-Ilom) TYPE OF ESTABLISWAENT FEE {check onlvl RETAIL STORE YES)) NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - -- _.. . RESTAURANT YES O less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 - - -- ... - _. ..... ...._ _.... _....- ------ ---- ---.............. ....... - BE6MREAKFAST YES NO $100 _-... ----------- - ------ - - -- ----- . ........... - .. ..... .....- ....- ----- ._-............._...._._.. -_.-.-..... ADDITIONAL PERMITS MAKE (riot just serve) ICE CREAM, YOGURT, SOFT SERVE Y NO $5 TOBACCO VENDOR YE 0 $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Ser.tion 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all stale taxes required drrder the law SignaturDate Social Security or Federal Identification Number ----- ------------------------ --- ----- ----- ----- ----- ----------------- ----- ------ ------------- ------ --- - - - Rcvised ll/13/06 FO()DAP2007,a m !Check#& Date &?' -Si 93311 s —t1 ;S--- -6c) I Massac-husetts:.Department of Pi blit Health Salem Board of Health f ( r a t 120 Washington Street, 4'h Floor Divis'sh of Food and Drugs _ Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Datg ( Type of Operation(sl Tyge of Insoection �%([._J 2t� I El Food Service t Routine Address �( Risk detail �] Re-inspection ` Level F Residential Kitchen Previous inspection Telephone -44 1" t� l ❑ Mobile Date: - ❑ Temporary ❑ Pre-operation Owner A � �1 � HACCP Y/N �� tl1 r �,xV� �� El Caterer El Suspect Illness Y-k Person in Chargee /� Time I El Bed&Breakfast El General Complaint In: la:IT3 ❑ HACCP Inspector i C) I OutO,, ,) Permit No. ❑ Other Each violation checked Fe�ire 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 PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals „FOOD FROM APPROVED SOURCE.. - ... _ - TIMEITEMPERATURE CONTROLS(Potentially Haiardous Foods) " ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑� 18. Cooling VI PROTECTION FROM CONTAMINATION 9. Hot and Cold Holding .§ El 8. Separation/Segregation/Protection El20.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 (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(990.009) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 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. M 30. Other DATE OF RE-INSPECTION: 5 5901nspeclPo,m6-14 P �i IVi i% 05-4;0L, Inspector's s Si tore: Print PIC's Signa re: G / Print: �' Page, of 3Pages �cst..c �C iU/jrlc�D C Z Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S Cross-contamination I 1 590.003(A) Assignment of Responsibility' 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(13) Demonstration of Knowledge" Conked and RTE Foods* 12-103.11 Person in charge-duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Ani trial Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by flood employees and 3-302.11(A) Foal Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-3(A.11 Food Contact with Equipment and Applicant To Report To The Peron In Utensils* Charge* I Contamination from the Consumer 590.003(6) Reporting by Person in Charge* 13-306.14(A)(B) ( Returned Food and Reservice of Food* _13 590.003iD) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 1 590.003(E) I Removal of Exclusions and Restrictions Food 3-70 1.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Focus* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces -- 590.004(A-B) Compliance with Food law* 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* Teutperatureo ner* 3-20 1.13 Fluid Milk and Milk Product-e* I ( 4-501.112 Mc.:hanical Warewashing-Hot Water I3-202.13 Shell Eggs" I Sanitization Temperatures* i 4501.114 I Chemical Sanitization-temp.,pH,3-202.14 � Eggs and Milk Products.Pasteurized* concentration and hardness. " 3-202.16 I Ice Made From Potable Drinking Water" 14-601.11(A) Equipment Food Contact Surfaces and 5-101.t 1 ( Drinkiug Water from an Approved System" 1590.006(A) ( bottled Drinking Water* Utensils Clean" 590.0(}6(B) I Water Meets Standards in?10 CMR 22.0* 4-602'11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* J 4-702.1 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* _ Shellfish* ( 4-703.11 I McthodsofSenitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 11Q proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Anns* 3-202 IS Shcllsttxk Identification Present* ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 12-3U1.!4 When to Wash" 3-201.17 Came Animals* 11t I Good Hygienic Practices g ReceivinglCondition I 12401,11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 2 401 12 Discharges From the Eyes, Nose and 13-202 15 Package Integrity* I Mouth* 3-101.11 Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When'Casting* 6 TagstRecords:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification' I 590.004(E) Preventing Contamination from 3-203.12 Shellste>ek Identification Maintained* I Employees" Tags/Records:Fish Products 113 Handwash Facilities 3-402.11 ( Parasite Destruction* Conveniently Located and Accessible 3-402.12 I Records.Creation and Retention* 15-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 15-204.11 Location and Placement* - T Conformance with Approved Procedures 15-205.1 1 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices _ 1I 3-502.12 Reduced oxygen packaging.criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures" 6-301.12 Hand Drying Provision ------ ( 'Denotes critical item in the redetal I094 Food Code of I(t5 CMR 590p00. t A CITY OF SALEM t t—� I BOARD OF HEALTH Establishment Name: f - ( � j-„_� �A3 ,.n Date: /n� /Y- Page:1j of Item Code C-Critical Item v DESCRIPTION OF VIOLATION/PLAN bF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY c �JI v v JC. rt rwl3ueJ i a I ✓A ,. r��Q E 11 .12I Co Pf -.I,cc/ y �/v (. I (�vC,� _ I y �-1��1,If � I rx tr_.tu� J () nawt-o,9 C.'C,� k-v-, �4- L ._(4 .0 I iF. C'�" r-, n...1c� /`\o l P rA r n J �I-o ),A �l t I n{�Sr,o rv✓ 14 C,(11A �r I114- /rt� r 1 N .rJt cl l�a—L 4� t oefu r L., r41s�, n D p, 40 hum sr }i r- 1 I.AA n:t� _- A0 1 N_,1�--tCi .r: G ��_U- v -C5w11�.� � J1- rC'� ,Qik aSe2Ui. Lo ,n lv„ I,r -f ^,'_1, } .A lNii Afu �.M�In/t r11 �Ka r z_&?c/LDN Wi LAS / 5�9c 'All un, it 40e e_IcScc�i� Q2 ?roil-jt Gt �s—� �—� fi ✓ Nu�� ,, s_ei.,�� _,4_4 ✓- i t Discussion With Person in Charge: Corrective Action Required:�No les) I� � I I ❑ V tary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion , violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency-Suspension ccenply with all mandates of the Mass/Federal Food Co e. I understand that noncompliance may result in daily fines of t e�-fiv � ollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: E <iii irI i ` L ' f' PHF1 Rei et,ed a Tempe.attnes• - Violations Related to Foodborne Illness Interventions and RisA ,Accuedl ag,o La' Coaled to Factors(Items 1.22) (Cont.) 1'Fr45`E tVitl;ia-1 flows. ' 3 51)115 Co•uinp ;Methods for Phis PROTECTION FROM CHEMICALS 3 I 119 1 FHF Hot and Gold Holding a Food or Color Additives 3-50LIO(E) C.;id PflPs sl:tintained at or helot- _-202.12 r`,dditi"es" 590 001iF) 3-302,11 Protection from unapproved Addittvcs* ( _1`145, F:: -501.1bIA) Hut P9 F;A'laint;uned at o, -ahnve Ig Poisonous or Toxic Substances 140'14. 7-101.11 Identifying Information-Original 4-301.I6(A) Roast:Held at or abovei?0 7 102 11 Comtuon name - Workia Containers' „Containers` ( 20 Time as a Public Health Contras 3501.!9 Tinto as a PabLc'rleahi,,Control* 17-201.11 Separation-Ston age I 51)0.00-,(H) '1-202.11 4-2(!2.11 Restriction-Presence and Use'k 7-202.12 Conditions of Use,- 7-103 se"7-?03 i i Toxic Containers - Prohibitions' I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criten.--Cheiniai!s;;, I POPULATIONS(HSP) I7-201.12. > ( 21 3-801 IPA) Lhtpasteunied Prc-packaged Juices and Chemicals for Washing 1--,duce,Criteria" I !obeli;:. 17-2!1:1.1.3 Drying AgF�,:ett.ces with Wa'ame Agents.Criteria' I I a 7-205.11 Incidental Food Contact.e LubricantsDn of Pa,aeut:zed Eggs* ^ I ( •;-g;';1.1;(1)) Raw or Patt;all• Cooked Anima Fond and 7-'_06.11 Re:.trieted lis- Pesticides.Cnterci'" Raw Seed Sn n o t,s Nol Setved. " 7-705.12 Rodent Bait Stations' I =-S01.11(C Unn coned F. 7-206.13 Track mg Powders.Pest Control and I I - ) t � xx1 Pac6 age Not Re-sereed. " ( Moninning"' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 : Censmnor Advisor) Puste.d for Conntimption of Canal hands'I'hat:::n Raw. Undercooked oi' 16 Proper Cooking Temperatures for PHFS 1tiw.Otherwise Processed to Eliminate -- Pathuaens.;, dercrm+.sin; 3-401.1 15(1;(2) I:ges- 155`F 15 Sec. 3-302.1--, Pasteunzai Eg,,Subatitut, for Raw ShellEggs-ImmediateServtce 145`Fl5sec� 3-41)1.11(5)(2) Comimnuted Fish,Meats,k Gamy' Eggs Animals- 155'F 15 sec. ': 3-401.11(101)(2) Pork and Beef Roast- 130'F 121 min'' I SPECIAL REQUIREMENTS � 3-401.11(5)(2) Ratites; Injected Meats- 155"F IS I 590 W9(A14D) Violations of Section '.)90.009(A) (D) In sec.. ` catcrin;*. mobile foul,temporary and 3-401.11(A)(3) Poultry, Wild Game,Scoffed Pt H's residential kitchen ope,ations should be Stiffing Contait:ing Fish,Meat, debited tinder the appropriate sections Ponitiv or Ratites-Hi5`F 15 sec. above fl'related to ibcdborne i Ilness 3-41.11(C)(13) W9wle-muscle,Intact Beef Stcaks iraervent;ons and risk factors. Othet 145°F* 590.009 violations te!ating to good retail 3-401 12 Raw Animal Foods Cooked in a practses should be debited under f 29- Micru•wave 165`F* Special Requirements. 1 a01 11(A)(I I(b) All Other PliFs- 145"14 15 sec. ` Iq Reheating for Hot Holding 'VIOLATIONS R.FLATED YO GOOD RETAIL PRACTICES ? 403.11(5)&(D) PHFS 1650F 15 sec, * (Items 23-30) ' 3-403.11(B) Microwave- 165'F 2 Mtnwe Standing Critical marl,tun.:',-iNr.;!wnlo!io;:s, ah,Ji u'n-tut relate to die T illic, keodhurne illness imef vc;Wons and rill-;"ba[o: hwod above, ,an be 3-403.11(C) Counuercially Pi twossed RTE Food- found in the johnin aig.se'rhom of the FuuJ Code and 105 CLIR 14017" 590.000. 3-40111(F) Remaining Unsliced Portions of Beef I . Item Good Retail?ractrees FC590.000 � Roasts' 23. Manamment and Personnel _ =C-2 .003 I 113 Proper Cooling of PHFS I ; 24 Food and Food Prrtecno FC-- 004 25 Equipment art,Utensils FC - 4 .005 3-50114(A) Coofin Cooked PHFsfrow140`Fit) 126. `Nater,Pitaminciand'Waste ' FC-5 i--006 7C 5 rY;ehnt 2 Hours and From 70'0 27 Pnys;ca:Falsity Fc- 6 I .0.07 to 41"5'1-45"14 Within 4 Homs. " 26 Poisonous or Tonc Materias - - FC-7 1 .008 3-501.14(B) Cooling PI IFs Made From Ambient 129, Special ReClU:rements 009 Tempel attire htgredients 1n 41`Pf4i'F 130. Other Within 4 1 fours `Dcoo;rt critical item.a the iM okl 1990 Farad Coeie or 105 CNIR 590 000. r` CITY OF SALEM BOARD OF HEALTH f // 3 ji Establishment Name: q -II �-I) ,r-9 C�r� Date: q/Z(i)1 Page: of Item code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I' No. Reference R-Red Item Verified '_'// I PLEASE PRINT CLEARLY } I� _/� (� --1!7 nl Ilf r r te'\ I1, lo, iA r r L/C/`� 'f f- ata +y) /r C - - � / (f 11,M r.. �f- �v -�.U.AO OC TA �i T' ' r�,�� I 1 T(/� r I hS�9r'� I� lr^�'�O/✓lJ HD �' � . / , s 1- tCnrrrn Hina.( ( 055ir �fr,n,tls ( L .� :�J C111 Ale rCyn�o II S "IN/ v� uL12 'A A-n0 1/, fjr.Jj, Orr, I f0•A '7vvS /-r I; Cx o,.r P_ f- torn 1/t f,..n o n7dr'�"� J/Ly -1 ( 1vt y,I,C i--_R/I _c.( �G .C._ � f �/ff,[7// (^ �r� �!. U r A`J C7T(n F01/17v�G.� /q / )`t '� ` �r�-� tz' �, �� IGa l .acs rrf n. � �: �---►�li,,�Q G,.�,o ._ s,� >�- � r 1 ii _ ��f12J�� .tY.n�l.%,��' � v✓� ,-.�t�T�Di /i,. � � ,'1 :,an7vt�.4r-. , 4 ,F3p Ik Discussion With Person in Charge: Corrective Action Required: I ❑ No I le !es I have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to �7 Re-inspection Scheduled ❑ Emergency Suspension icomply with all mandates of the Mass/Federal Food Code. I understand that F/ - noncompliance may result in daily fines of twenty.Jiv rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure yourfood permit. �, ❑ Voluntary Disposal ❑ Other: i PHFs ReLenedar re::nreruurcS ! Violations Related to Foodborne Illness Interventions and Risk According to I.aw Cooled to Factors(Items 1-22) (Cont.) I`F/45`F`%virhin a Hour: ' PROTECTION FROM CHEMICALS 3 501 15 Cooling Method,S,r PHFs: 14 ! Food or Color Additives I 14 PHF flat and Codd Holding 3-50i.!6(B) Col:1 P1;F,Mugs via.(:,:al at or b:-low, � 3-202.12 Additives` 590.00i(F) 41`/45,P,: 3-302.14 Protection from U-;approved Adclitrves* 3-50: !NW) i I{nr PIj(s Manrt:,hted at or abs-we 5 Poisonous or Toxic Substances j I 7-101.11 Identifyinvinformalion-Original" 3.511115(A) RoaslsHeld AtoraboveliU'F. ' Containers' 7-102,11 Common Name-Worlong Containers" � � 20 Time as a Public Health Control 17-201.11 Separation-Snxage t' 3-S;)Ll % -rime as a Puhlic Heal:.':Control' i 7-202.!I Restriction-Presence mid Use" 590.0041}1) Variance Requirement j 7-202.12 t_'or d tions of Use" 11 Toxic Container.,-Proh:hoi(as" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20 .1 I Sanitizes,Criteria-C'hemic-ds° I POPULATIONS(HSP) 7-204.12 ( Chemicals for Washnc Produce,Criteria" I ..1 -Su I IT(A) L::r;rwcw-tzcd Pr.-packaged Juice,and 7-2114.14 DrymlpAssents,Criteria' : Beveiu;�es with 1\"arnin;Labels^ ! 3-Xti1,11(B) t'sen'PactemfzedEs+_s^ j 7.X5.1 1 Incidental Food Contact.Lubncnnrs^ 3-801L i i(D) Raw r Partially Cooked Animal Flxxl and 7-206.11 Recirictcd Use Pesticides. Criteria* 17-206.12 Rodent Bait Stations" I Raw Sced Sptouis N,)t Se:ved. " 7-206.13 '17:Ickino Po,vderc,Fest Control and ( 3-901.11'CI I Unop,ted Food Parka;;: Not Re-served Monitoring'' CONSUMER ADV?SORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for j Animal Foods"Pham are Raw, (lndercouked or PHFs Not Otberw-e Processed to 2linunate 3-401.1141 1)i2) Eggs- I55`F IS Sec. Pathq:;eM..*`("COPY""'00' Eggs-Lumediate Service 145'1315sec 3-'02.;3 Pastcunzed Eggs Subatibne for Raw Shell 3-401.1I(A)(2) Commur(tted Fish, Meats&Ganne I Eggs* Aniniats- 155'F 15 sec. :' SPEC?AL REQUIREMENTS ItBh l)(2) Pork and Beef Roast- 130"F 121 rnie* 3-401.1l(A)(2) Ratites, Injected Meats--155-F 15 590 0091,{)-(D) Violations of Section .590.009(A)-(D) in sec. catering. moNle toed temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed Pl-1Fs, resideotral kitchen operations should he Sni ting Containing Fish,Meat, debited unlcr the apptepriatc sections Poultry or Ratites-165'F 15 sec. ' allow !f related to foodborna illn-ss 3-40L1 I(C)(3) Whole-nuiscle,Intact Beef Steaks interventions and risk factors Other 145'17 590.009 violations relatins to ruod retail 3=; 11.12 Raw Animal Foods Cooked in a ( practices should be debited under#29 - M!cruwi ve 165`F"' .Special Reguitemerts ( 3-401.1,(A)(lhb) I All Other PHFs- 145`F15sec 17 Reheating for Hot Holding VIOLATIONS RuLATED TO GOOD RETAIL PRACTICES 3-403.11(A)K(D) PHFL, 165'F 15 sec. * _I (items 23-30) --403.1 I(B) Microwave- Itis'F 2 Minute Standing Critical and non-criti,al vvulatvons, h inch c7n nor relive in the Timet' loodborne illnesv in;o venttan.s and rick ja(tors listed obore, can be 3-403.1 1(C) Commercially Processed RTF Food- found n,the Jbllowing sec vistas o1 the Food Code en+d 105 C'67.4 140'F* l 590.000. 3-403.11(F) Remaoung Unsliced Portions of Beef I F Item Good Retail Practices FC . 590.000 Roasts* j 23. 1v1aoage:Tmrit end Persons,, FC--2 .003 j 18 Proper Cooling of PHFs I 24. Food and Food Protection FC-3 - .004 j 25. DiOpman+,and Utersit= FC-4 005 _---j 3-501 14(!{) Cooling Cooked PHFs from 140"F to 2G. Water, Piumbinet ani..Waste PC=5 -- --.006 70"F Wahm 2 Flours and From 10"F j 27" Phvsical Fard!ty ( FC- tt .007 to 41"F/45"F Within 4 Hours. r ! 28. PDr;urmus or Tout.tchiterims j FC-7 1 .008 3-501 14:,B) ! Cuof n,;PHFs Made From Ambient ( 29. Snecia!Requirements ! l 009 C Temperature Ingredients to 41'F145"F 30. Other Within 4 IIours= s�.wn,�.r:,i 6-2m. - ---- --------- Dcnat,c cnucai item in thz fzdcral It.+'iq Food Code or Ills CMR 59O 000. ° I4 t Massachusetts DepartmentiWA Public Health Salem Board of Health 120 Washington Street, 4" Floor Div lion of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ( / - D t¢ Tyne of`Ooerationfsl, Type of Inspection Q Service Routine Address r�( t ( rte( ca Risk / © Retail [ Re-inspection r ' " '� l Level ❑ Residential Kitchen Previous Inspection Telephone ��J ��, -�7 ❑ Mobile Date:y�,t(p p _ T Owner HACCP Y/N ❑ Temporary, ❑ Pre-operation / ) r CJI f ❑ Caterer + ❑ Suspect Illness Person in Charge(PIC) _/ Time ❑ Bed&Breakfast ❑ General Complaint In: 1 J.'.40 El HACCP Inspector \ nv� K o Out:H :, a h. 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 F1 2.2. Reporting of Diseases by Food Employee and PIC P i• - .. + El 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/rEMPERATURE 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 - > ❑ 1%9. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing p 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 f C N ""µ •- 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 1c 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food ,�C-26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you i 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 (590.0o9) within 10 days of receipt of this order. 30. Other j DATE OF RE-INSPECTION: S 5901nspecfFom610 acc ��ryl � �j`~/ Inspector's Signa t/e -k _J / Print: PIC's Signature':'r�_, Print: ��i'�'<r KKK... '� I Page_!�_of 7-Pages ei - - Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) "4 PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination i 590.003(A) Assignment of Responsibility" 3-302.1I(A)(1) Raw Annual Foods Separatedfrnm 590.003(B) Demonstration of Knowledge* Calked and RTE Foods* 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' J 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by to employees and 3-302.1 1(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* l Charge* ( Contamination from the Consumer 590 003(G) Reporting by Person in Charge' 3 306.14(A)(B) Returned Food and Reservice of Food* � 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Foo l 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 1 Food and Water From Regulated Sources 19 Food Contact Surfaces _ T ti iti 590.004(A- zaonentB) Compliance with Food l.aw* 4-501.111 Manual Warewashmg-Hot Water � 3-201.12 I Pond in a Hermetically Sealed Container* � Sanperatures` 3-20 1.13 Fluid Milk and Milk Products* 4 501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202,14 Fggs and Milk Products,Pasteurized* ( 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water` concentration and hardness. 5401.11 Drinking Water from an Approved System' 14-60].1 t(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water` Utensils Crean' 1 590 006(B) Water Meets Standards in 310 CMR 22.0" ( 4-602.11 Contact Surfaces of ten i ls* Fail- Contact Surfaces and Utensils* SheP/!sh and Fish From an Approved Source 14-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment*Shellfish* 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I Regulatory Authority 2-301.11 Clean Condition-Hands and Arms- 3-202.18 Shetistock Identification Present* 2-301,12 Cleaning Procedure* 590.004(C) Wild Mushrooms" 2-301.14 When to Wash* 3-201.17 Game Animals* 11 I Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating.Drinking or Using Tobacco* 3-202.11 ( PHFs Received at Propel Temperatures* 2-401.12 Discharges From the Eyes.Nose and 3-202.15 Package Integrity- Mouth* * 3-30(.12 Preventing Contamination When Tasting* _ 3-101.11 � Food Safe and Unadulterated � 6 Tags/Records:Sheltstock 12 Prevention of Contamination from Hands- 3-202.18 Shellstock Identification * 590.4O4(E) Preventing Contamination from 3-203.12 Sheltstock Identification Maintained k Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' ( 5-2(Yl.l t Location and Placement* 7 Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance_ /HACCP Plans ( Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* ( 13-502.12 Reduced oxygen packaging,criteria* 6301.11 Handwashing Cleanser,Availability 8-103 12 I Conformance with Approved Procedures* 6-301.12 Hand Drying Provision Denotes critical item in 16e federal 1999 Pond Code of 105 CZAR 590.000. t CITY OF SALEM I BOARD OF HEALTH Establishment Name: Fz)a t &k-rr Date: �9/�I�o Id Page? of � Item Code c-Critical Item DESCRIPTION OF'VIOLATION/KAN EOF CORRECTION Date '. No. Reference R—Red Item I Verified i N G( PLEASE PRINT CLEARLY T I � �r7� .t7- KQ(13r� Lour` 4ci,^ :7P rnP i. + )&,CX Sr✓J�.- Jo N�_W ,J_V C-)OrAld re«k c-ae ,'l «4y)' 1 47J'ti, jv. .,o Ic 9 (' A 1 P/F�sP/,v" don 4y/71 JL r ✓ N c` r ' C t I I iLA I K �_ , tO�flSe� �n�r �acJ c _Alter Cis)M 1 6-� 1U) r✓I t i S 4F-. n Ho,.,fi��, a.� r,f— 11&+ C,tvYl�,,I ,(-a4(1AP_Jr- � /�P(-I ),2Pc, 4 r � � Discussion With Person in Charge: Corrective Action Required: I ❑ No es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ I ' 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 f noncompliance may result in daily finesof�twe ty-fie oil pension/revocation of ❑ Embargo ❑ Emergency Closure youfood permit. 0 Voluntary Disposal ❑ Other: 3-iW :q(C) PHFs Receirrd:it Temperaturts 1 Violations Related to Foodborne illness Interventions and Risk Accordin,t to Lan Cooled to Facfors(items 1,22) (Cont.) 41`Ft45'F 4xn6rin a Hours. PROTECTION FROM CHEMICALS ( 501 I Coo!in*v Methods i;�rPN1-'s 19 ( PHF Hot and Card Holding I� Food or Coffer Additives ! 3.j0I,160a) C,:d P11Fs M:inmined at or helow ! 3-202.12 Additn-ec" 590.ofh&P' 4i'Fl5' F` 3-3021-7 Ptorcciion from Unapproved Additives r ( I i"507.l5i A) Ifut PlIis Maintained at nr^beee .5 1Poisonous or Toxic Substances j 141 i R ! 7"101,11 ldentifyinglntormsuon-Ori;arnd ! I '-5;)IANA) i?naste Held 9t of above 130`F. 'k Conta hers' 7 102.1 ' Common Name.- Working Containers" ( 20 :free as a Public Health Control . i-5 e a 01 !q Tit^ +a Public Health Connai* 7-201.1Separation--Slant$' j � i90.g0-b(li)' ( !i,trmncc i?ry;rrcn:en[7-20111 Re>trictton-Presence mid Use" - 7-202. 12 Condidons(if tlse' 7?0..1 l 151,.ie Container.-PrnNhiti„as* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizeis,Criteria-C'henriutls� POPULATiONS(FISP) 7 2ib4 12 Chetuicals for Wash;rg Produce,Crtaria' 121 3-SOL 1!f?.) Unpa,,tovri',ed Pre-packaged Mice:aid I 7-?U4.1-t Carving Aaents.Cniei'ifi° I Revefages with`,`w'.;rrime Labels, 7.,a, t. 3-801.11(B) Use ut Fasteutized E!_us^ 05.1 1 inciden al Food Contact,Lnbricants� ! 13-801.I 1 t D) Raw or Pat'tiall) Caked Anim�! 1700dand7-206,11 Rcgricted Usr Peaicicks.Criteria* 7 206.12 Rodent Bair Stations,* R.nti Sca! ,G%to:is D:ot Setaea 7-'06.13 Tracking Powders,Pest Control and I -3-Wl-I i(C) Unopened Food Package Not Rc-paned. Mi"llituting- CONRUMER ADVISORY TIit1EREMPERATURE CONTROLS 22 3-603.1 i Consmner A&icer) Posted for C'onsamption of - ( ifi Proper cooking Temperatures for Anunal 1-taxis'1'h.:t are Rzw, Undercooked or !,ni otherwise Pn)ecsvwd to Elimmate PHFs i ( Paf hngens." f 3-1OL17Atll(2) Lggs- L55°F 19 Sac. I Eggs-Immediate Sernicc 145'F75sec� 3-30? 13 Pa;+enm7cd I'jgs J¢hstii nt�' i:wr Raw ihct! i3-401.1€W(2) Comnunuted fish, lvl=s&Game I E"s* Animals- 155'F 15 sec. SPECIAL REQUIREMENTS 3di>LlI(B'.(V)(2-) York and Beef Roast 130'F )21coir,'" I(A)(2) RnOtes.Injected Mears- 155'F 15 590'000'A)-0f Viol mons of Section 590.009(A)-(D) in sea "' c•a.ering, nn.bite foul. temporary and 3-401J 7(A)(3) Pou!try,Wild Game,Siufied PFfFs, rcmdcnUal kitchen operations should he Stuffing Containing Fish,Meat, debited under the;appropriate sections Poultry offRoutes-16YT 15 sec. " ahc"Ve rt rclaldd to IC•CnlbornC dhtesi 3-4101.11t•^.r(?) Whole muscle,Intact Beef Stcaks intca—Vcj ions and r;sh faclors. Other 145`1'" I 590.009 Violations relating to good retail '-40),02 Raw Animal Food,Cooked in a practices should be debited under #29-- Microwave i65-F* Special Requirements. 3-401.11(,)(1)(b) AI! Other F'HF, - 145'F 15 see. 17 Reheating for Hot Holding j VIOLATIONS R.:LATED TO COOL)RETAIL PRACTICES 3-403.1 IfA)K;D) 111-11is 1ti5'17 15 sec, A' (Items 2.3-30) 3-403.1It B! Microwave- 165°F 2 Minute Standiirc Cr(hrrl and non-,rirRul vmiuuae.r, nfarh no not ieial,to file Time' ,f,odhorne i(iness interrwnhon,, and ok-jawn-5 lWed nlv112, tun hr 3-403.t 1 f C) Coni mercially Pi a-essecl RTE Rod- found in the,,•i iln tap sections of the Fvod Cod,and 10 i C7r?/f 140'F" I 5c+0.000. 3-4(:?.i I(F1 Retnainin_e Unshced Portions of Beef Item Good Refail Practices FC 550.000 j Roasts' ' 123. R4arallement-and Personnel FC -2 .003 j IF. Proper Cooling of PHFs ' 1 2d. Focx:and Food Prot-ctn;n FG-3 .004 3fit Confine Cooked 125 Equpmenfand'Utersi!s F7-4 .005 ! 2E. Water Pa!mb:cu and Waste ri:- GO6 1 701F Within 2 €fours and From 7(PF i 27. Physical FaetlAy F -6 ! 007 Lo 41"F,i45"F)3(thin 4 Hours. ", ! 28. Poisonous or Tonc fJtaierials i, FC- 7 ! .0o3 J 3-50LA(B) Cooling PFIFs Made From Ambient29 Seecisl Fequ remoras ! 009 i Tempera ire Ingredients to 41`F/4 i:F 1-30, Other ! Within 4llourg# `:-cm ae,a:tical ncm ui nv U,,al 1994 Kwd Cods,r 10'`CNIX 59(1(100. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4 Floor Salem, Division of Food and Drugs Salem, MA 01970-3523 POt ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name r'� L�- (^1, Date TYoe of Ooeration(s), Type of Insoection 9 Na/OG, ❑ Food Service ❑ Routine Address (�� ^ )`r f Risk 25 Retail .19,Re-inspection i Level ❑ Residential Kitchen Previous IPKe�� Telephone /I i ! C El Mobile Date: l ❑ Temporary ❑ Pre-operation Owner �' ' HACCP Y/N El Caterer ❑ Suspect Illness �e C) ❑ Bed&Breakfast Person in Charge(PIC) �fN Time El General Complaint In: (/- ❑ HACCP Inspector f c75rz0� P0.�o Outy r 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 .- ' [114.Approved Food or Color Additives F-13. Personnel with Infections Restricted/Excluded .. El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE °, ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potenfially 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) El21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. 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)(sso.0 order of the Board of Health. Failure to correct violations )C 24. Food and Food Protection (Fc-8)(590.0054)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-5)(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 10 dac (^, Inspector's S jgnature: /_•\ Print: ( D r PIC'sSignafure:� _ Print: ��./,�/.' ��" i�/iaer..��!G I Pageot Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION - FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility 3-3011](A)(]) Rau Animal Foods Separated from 590.003(6) Demonstration of Knowledge* I Cooked and RTE Foods, - _l2-103.11 Person in charge-duties � Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other, 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection' applicants* 3-302.15 Washing Fivmsand Vegetables 590.003(F) Responsibility Of A Food Employee Or An 13-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.(H)3(G) Reporting by Person in Charge* 3-306.14(A)(B) ( Returned Food and Reservicc of Food'* 3 590.003(D) Exclusions and Restrictions I I Dsoosition of Adulterated or Contaminated 590.003(F.) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foix!* 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.11! Manual Warewashin_-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 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* I 14-501.114 I Chemical Samtization-temp.,pH, concentration and hardness. 3-201 16 Ice Made From Potable Drinking Water' 4-601.11(A) Equipment Food Contact Surfaces and 5-101 ]1 Drinking Water from an Approved System"` Utensils Clean° J 590.006(A) Bottled Drinking Water* 4-602,11. Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0 Contact Surfaces and Utensils* 1 Shellfish and Fish From an Approved Source 4-702.1) Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* _ Shellfish* 4-703.11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical' Sources* ( 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms^ 2-301.14 When to Wash' 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* f 3-202.11 ( PHFs Received at Proper Temperatures* I 2-401.12 I Discharges From the Eyes,Nose and 3-202.15 Package hitegrity, ( Mouth* i 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting*- ds 12 Prevention of Contamination from Han b � Tags/Records:Sheiistock � 3-202.18 Shellstock Identification * 59004(E') Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* J Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible � 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 15-204.11 Location and Placement* ? Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging criteria 6-301.1 t Handwashing Cleanser,Availability ; 8-103.12Conformance with Approved Procedures" 6-301.12 , Hand Drying Provision f 'Denotes critical item in the fedend 1999 Foul CWc of 10C11R 590.000. CITY OF SALEM .r� Date:BOARD OF HEALTH 7s 1 t Establishment Name: -// L l. r ff Page: of � Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLS4N OF CORRECTION Date No. Reference R-Red Item _ verified' c PLEASE PRINT CLEARLY .y ��_ryryry 12VA ..,ow I atw_/k. r �r n { 1 /� II On C,),le,,d UL, P /7)A C_(4rT_4 � , jc-1 F a I r Cro, 4, c „ F ,Gt I t I n usP sysfi— T 1 1j /�- M/l (`LL_ Cly l,eif!'_SP.,,' A,_"Tr- r,n /jr c _'� C7.r' " 6e'(40 0 - *011 12_1SJ �,Sf\' j� �/,(�i !r k /I --le CA--Q , u'-" 1^�e �?-r+ �1 _r �fv t it sn�f� I�t - I .Ll ✓1 C/YJr ✓� I\P 7,1�1._.u,_il_.!� //IC G'V\9.PP � V! r /wl f I w a � iF I 1 r I � Jt 1 ' Discussion With Person in Charge: Corrective Action Required: I ❑ No 'Wyes „t 1 have read this report, have had the opportunity to ask questions and agree to correct all X 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-d tars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your ftod permit. / ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness interventions J-S')1.1'li PHFs Kee ejve(: it'lenipecnore:s and Risk Acc,.,ru:ng:o; !w Cooled to I�. Factors(items 7.22) (Cont.) 41`F14.S'F W itl,in.J Homs. " PROTECTION FROM CHEMICALS 3-.101.15 Coot ne S4ethcak 1:r PIiF, j lA ( Food or Color Additives I I) FHF Hot and Cc!d Holding 3-50:.16,1s) Grid Ptli?;\1:iniamed at oe below 32117,12 Ad.(iuvcs'P 590004(F) t-ids°Fx 3-30214 Protection thin Unapproxed Additives` j ?_5;31.INA) Hot PHFs Mai:[t.tned at or above 15 ( Poisonous or Toxic Substances Ido'F. " 7-101.11 Identifying lnformabon-Original I i 3-5o 1.tti(A) Conuuners" Roasts Held at or above 130"F. 7-i U2.i I Can ime Vanle-Working, Container.` 20 ' Time as a Nabl:c Health Control age" ( ( 3-50i.19 Time ac a Fuhli:I-leai(h Contiola 7201.11 Separation- is 7-202 11 Rc,triction-Presence and Use* ( 511'1 004(H) \r.:r!anu•Requirement 7-202.12 Toxic Conditions of Usc* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-303.11 Tonic Cnnncinzr�'-Pr,thihitu+ns* i 7-'704.11 Sanitizers,Criteria-Chemicals' i POPULATIONS{HSP) 7ti-1.12. Chemicals for Wahinet Produce,Criteria! I 2,1 3-SU 1,i](A) l:npasu ¢ m- cd Prt-patkagcd luiccs and '_ Beve,a.:eswah Watmnglnbel3'. 7-205.1.1 IdAgents.Conan " ti-801.11(13) Use of Pasteurized Em-s' ! 7-205.11 Incidental Fold Cor.[act.Lubricants' 7-206.i i * 3-801,110)) Rau or P,nfially Cooked Ani!nal F(ssl and Rod n t Bin,St Pesticides.Criteria* _ Raw Seed Sprouts\ot Served. 2011.12 Rodent Brit Stations" i-801.11(C t i)nonmed Food Package \r t Re-sen ed. " 7-206.13 'Tracking Powders,Pest Control and St �•� Ytoni[orinr,* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for('ons:nnption of Api;u.d Foods'lhat are Raw.Undercooked or lfi Proper Cooking Temperatures for PHFs No Otherwise Processed to Ehnnrste 3-401.I I X1)(2) Ei7&s- 155'F 15 Sec. Eggs immediate Service 1{i"Fl Ssee+ ---102•1 3 Pasteariz.d Eggs Suher.tute fo: Raw Shell 3-=10!.l l(A)(2) Comminuted fish,Meat k Game Bgas" Animals I S5'F 15 sec. I SPECIAL REQUIREMENTS 3-401.11(B)�1)(2) Pork and Beef Roast- 130'F 121 nein* 590.U09(A)-([)) Violations of Sectio n 59Q.OU9{A)-t G} in 1 I(A)(2) Raines,Injected Mcats-155'F 15 sec. uncring, mobile food,ten:poratry and l I(A)(3) Poultry,Wild Game, Stuffed PHFs, resian:dad kitchen operttions should be Studios Contmining Fish, Meat, debited antler Ole apptopri re sections Poultn.or Ratites 165°F 15 sec. " above if related to foodbn;nc illness 3-161.11(C)(3) Whole-muscle, Intact Beef S1cal,9 interventions and risk ?actor,. Other I45°17 590.009 violations relating to good retail 3401.11 Raw Animal F(xxls Cooked in a practices should be debited under#29- Microwave 165'F* Specird Requirerac-tits. ,i-401.11(A)0)(b) Ali Other PHFs- 145'F 15 se( '= 17 Reheating for Hot Holding VIOLATIONS R.LATED TO GOOD RETAIL PRACTICES 3-403.1 NA)&fU) Ptit's 165°F 15 se.:. * I (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing C,0ifal,.ml non-rr,'tio) vo,hd(n;u, rn'rt,h do not relate to III,, Time' Jcndb„rne ithres,, inrervaitcrns and riskimiars'i(r.,d above, ran be 3-403.1 IiC) Commcrcially Processed H'I'I: Food- ,found in the f.;dlot,'me sections of rhe F od ibdr aru11(1.5 C AIR 140`F* 500.000. 3-10311(11) Remaining Unsliced Portions of Reef I )tem Good HetaR Practices FC 590.000 1 Roastsm 23. Management and Pei sonnei FC-2 .003 IF Proper Cooling of PHFs 124. Food and Food Fretectlon FC-3 004 25. Eruio-rent and U:ensis FC-4 -,005 3-5111 141A) Cooling Cooked PHYS from 140'F u, 25. - -----' ; Water,Plurnbing and Waste FC-5 .006 70`F ''Within 2 ilo:us au(! From 701F 127. Physical Facaiiy FC -6 .007 to 41`F/45'F Within 4 Hours. ' 128. Poi=onous or Tom Materials FC - 7 .OU8 3-50L Idi H) Cooling PI-IFS Made From Ambient 129, Snecial Requirements ' 009- -- -� Tempeiatutc Ingredients to 4!`F/45`F 30. Giher Within 4 Hours """.,- Denow• ,uncal item m the federal 1999 Fond Cade or 1115 CC6IR 591)001), f .+.'ar.. .,.r .•-.. �.+-n+l'a, �,e az� y '`` S e` fs"Yu "Y ; CITY.SOF.SALEMpSMASSACHUSETTS-�,,',a" , .F- ' i§....�+ ' ..- x pt�a w� i'wY,>kF "�'MwIK.:.B�. in '•k°_-•w�t'.t'` .ra"9^�'r r y� �1 p ^r ra rnr -� a a� .q .� ' {{1r�',g • • S ,. �yr� .t: +,t., rtBOARD OF'HEALTH 120 W ril�ioN�SrREE74,ni,FtooP � �•-r;.,� SALEM,'MA 01970 b { s TEL 978-741:1800 . . FAX 978-745-0343 u`ues e_ Kimberley Driscoll WWWSALEM.COM �3oa oa Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Apri124,2006 Seven Eleven 126 North Street Salem, MA 01970 Dear Owner: On Wednesday April 12,2006 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17-year-old Female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Seven Eleven is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes, chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of (Three Hundred Dollar fine)for the Third offense. FOLLOWING THE THIRD (3RD) OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore, you are ordered to pay a fine of$300.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing If you have any questions regarding this notification please call me at 741-1800 Sincerely yours, /Joanne Scott Health Agent JS/mfp CERTIFIED MAIL 7003 3110 0005 1992 2308 cc North Shore Tobacco Control Program Christin,i I-1,mington, Bo,ird of I-Icnllh chavm:in 'Ind Mcnibur'� .''e. t�'�:� ,:rfixR '�.�,�....• �.,. :� Gt.;�.'..Ji"!a:s�'n:.fvx`'+,..�rli�„�'�,'.;.'c,,,..A�^.:. -,.Yt,.'.�':>"'zl '2��..r.�:�;?�'.L�T.. .�l.a,y }•h.fr i'�:! ;:t-x;-.+-.;'i' ...,t � �sh'`Y., :'P".w-;:n�i.�'= �' �: :�..r„ - :�trd?� si::.�,:::.r . n,�� r� =*>•.^ -:-.c.i ti��^:_ .. ..r,-,�.Qs:.,+�..aPt.Nt., n.•v .,,• J >c::.l:fi":-�.us:,' ':>r: ..,.>•.... _ - si... +.va v:?��.'� 't!'ru?'li:e:i;r�;�1::�1':;�: �'v"Y�c '�,*al,�"A'i'.Y%..� 'v'�4 iC.�» ! :::1" '.rt": ;vii:;. :';n::�'n`t,.�i: '.-`-G•�.`C-:huiu..s ra -:�f• w>.'�.�,.d�: ,`ib• "'�R,p:.!r�`..�. - 1..: 4: �+:;.D-.".£� Y'.. ,nt::r,.: cif`. .>•: - - �:.a•:.a ...�R T.+"-. . -:EL'S.- .Y}•.4sv.-1.. L��.r . ,Y 'K.'tt�..�:ut' ��•. :.�" j%`P.. - _:�y� Cr ,- ..._.,... ._:..ter:.... .... :..._., ..0 � - . .. n. _... /. . . s... ..+�\.. .. .. r: ..r .... >. _.-...• ...... � .. •.may.:. _.` i:' +-v..:. � J,....i:.�..:... r.:. .....r-....,...:,.....?... . 15..4. J-n«- t .-.. ...:.... - .r,k:.. .. ,'fig,->r •.c;G..,.:.c `..:... ..�__ � . ... ..f.h, M ..:.�.'t:": - - -- - R s.. p W.S _ a...R..�-. ..._.n...::-..✓:is ..}....1:.Y:.pGuq �.r _ - - . � 5 `f�f` 1`I Sr��j?°ST S` /Y1r..s t�.v _ �„�- ->>__ r .r r;�-,l \ \ \ \iN/\i`,N, N/N j\ iRp bb N Wn�`v, ` NrN ftirNr`l�l�j�,�/�/�/�/�/�'1 l ++��3�r�1 r I 'r \; ` ��' �� nw VI ra��`��Nc� �',// rl;f l i�'\2 INVOCEN0.i li` / \ ze . i TAUNTON MA�02780 `,��i\ •;,,,' ',.>.'-. ' i \�,.',.;*/`DATE > 9( ` '- s„• PAY TO THE : '% ORDER OF/ ` \` .:' /Cjw, O-� ",SCJ F A+ •: o oh 't,,'Xe IAA+ 4 ` '.f$ 360. 4t>0 �',o S.f\.�`.�..�`L��_'�,/�\�i�' %�f.,%`�= ♦ ,'�. �ti. `;?�l�l`. �. J�j',\�i,VI�S J�''�i� %, i �\\� �� DRAFT:'.TO BE USED FOR PURCHASE OF-BEER,WINE AND NEWSPAPERS ONLY NOT VALID AFTER 180 DAYS t'��'\ - ':" . �; �.', /� ,'/, /,`. •\i' - ''i..NOT VALID OVER$3',000:;.: .'BANK ONE;NA-0710- .',,`i;, J, \ ' \'i,•cricnco,a':'; AUTHORIZED SIGN PAYABLE ATURE • ' THROUGH FIRST USA BANK,'NA- ' -'9� • FOR I , 2466i2323?11& 1:03 ,11002831: 09 4054211' aa..- � raw a-.4aw.. ,S ' 4 .. _ � "qMM .. .h+ .�..'.. . n • . � �� r 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 Tyoe of Ooeration(s), Tyqe of Insoection ol�p�r-16Z ❑ Food Service ❑ Routine Address % y A // L Risk ®-Retail R1 Re-inspection Level ❑ Residential Kitchen Previous,Inspection Telephone /, / � ❑ Mobile Date&7(r Sc Ham+ f� ❑ Owner ( I ( HACCP Y/N Tem pora ry ❑ Pr -operation f a1 r !� _, , r I t✓ ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) \` ^ `� dL I Time ❑ Bed& Breakfast ❑ General Complaint 1 In:/0'/) ❑ HACCP Inspector �� Out: D it 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 E] 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS E:1 Reporting of Diseases by Food Employee and PIC E] 14 Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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): 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�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 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 SWMre nFom 14 da Irl 0✓I{ Ac Inspector's Signature: / ! / Print: /( A PIC's SignatL kv1V _ Xt/� f��_ Print: ,�1 MA 11\ OJ ��A('f JA A�_A Y v� I Page < of_ZRages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT $ ( Cies.,contam;nattan i 1 59(1.01)uA) Assignment of ResponsibilhN'" 3-302.1 i(ANI) Raw Anunal Faris Separated hour 590.003(11) Demonsh anon of Knowledge" ( ( Cnoked and RTL Foods* j 4103.11 , Person incharge -duties Contarrinahon from Raw tnyteaients i 3 3022 11(A)(2) Raw Annual Food.+Separated fu::, Etch EMPLOYEE HEALTH Other, 2 590.003;C'1 Responsibility of the person in rh>o 1,e n> Contrnnimdon rrom the Environment require rcprrtme by fool employees mrd 9 302.11(A) ' Fcxxl Protection" applicants" 3-302 15 vv s1;i - Fruits and Vpget,bles 590 003(F) Responslb,hty Of A Food Fimpluyee Or An 13.3n4.11 Food Cor.:nct with Equipment and Appliram To Repo,#To The Penson In 1Jtensi;<" Charge' j Contamnlaiion No.^;the Consumer S 90.003(6) Reporting by Person in Cham ae* I 3 306.14LA B) Returned Fo.)J:nid Re:,^rl,re of`'•-«I` l 1 3 590.003(D) Exclusions and Reetrictions" I Disposaion crAckiketated or Cornaminated 590.003(F) Renurenl of Exclusions and kestrictions Food 1 3-;U1 I l Iisscard:ngor Reconditiumng unsafe FOOD FROM APPROVED SOURCE Foal"` l q ! Food and Water From Regutated Soutees ( 9 Food Contact Surfaces 50[.0(14{A-H; Cuatphanc:,with Food Law" d:`+OI 111 h4anaai!z*arcs+•shmt:-Hot Water 3-201.12 Food in it Heimetieal!y Sealed Container" Sttni:i:.atiun'Cemperatures' 3-201.13 Fluid Milk and Milk Product;* 4-5(}1.11= I irlechaniee.: Ware,x,,,diina Plot Water 3-20'.13 ShcII H-Rs'' Sanitizat',n'cmperatures* 3-202.14 Eggs and Milk Pnxlucts,Pasteurized* ' 4-501.1 1 d C wnticai S"11::'align-mmp.,PH, C•onccntratuer and haldne,". :° 3-2(!2.16 Ice Made Fiom Potable Drinking Water- i 4"601,1 ItA) rA uipntrnt Pond Ccntact Surfacus and i 101.I I Drinkinp Water from an.Approved Svsteut" 5901)06 1 &;ted Drinking 4atcrt : Utnsils Clean- 4-6t)2.!1 Cleaning Frequem.y of Ftijiupment Food- 590 006(B) Water Meets Standards;n 310 CMR 22.01' Shelton and Fish From an Approved Source COntaCt:itlifIIleB and Umnsils" -1-70?.i I Frequet,cy ut Sanitization of Utensils and I -201.11 fish and Recreationally Caugh:Molluscan Food Contact Jurfa.es of Fquipctent" j Shellf'ish1 I : 4-103.!1 Methods,-.f *'. ! 3-201.15 Molluscan Shellfish front NSSP Livted l'heai:': _aniuzativn--1-k,:dater and : nu ! Source:;" Gane and Wild Mushroom 3 Approv.>d by I1j Proper.Adequate Handwashing Ragutffiory Authority 2-3t)!.i 1 Ocan C'v::dnwti-- Rand:and Aim:." 3-20218 She(tst,Kk Ideatiiication Present" '--0(11.12 CLauing Pn;c.durc"� ' 59U.t103(i:r Wild R4u<h:voms^ 2-301-13 Wft.n to W-esll" 13-201.17 Came AtumaL'" it Good Hygienic Practices 5 i ReceivinglCondition 2-100.!1 E:um;,, Drinking or U-:u4 Tobaceo* 3-202.1 1 PHFs Received at Proper Temperaures' i ' '-401.12 Dischatyes From the Eyes' Nose and 3-202.IS Packs,>rhtteprity< - j t�luutn' ' 3-1 0L Rr d Sate and Unadulterite.t * j ?-3'�1J2 ?re+enhntt Cnntmninatitm P.d�n`halting* u 1 Tags/Records:Sheilstock ( � 32 ( ?reveni:or,of Contnmina;ian from hands ` (.A04(L) f'lecenLng Contmninahon from 1 3-2u2.13 ShellstockIdentification 1Eiiiplo}ee 2(i 3.12 Shellstock Identification Maintained, ( : ' TagslRecords•Fish Products I M 13 Handwash Facuihes 3-307 11 Parasite Destruction' Cerrvenienry:seated and Accessible 3-402.12 Records.Creation and Retc•niton 5-20111 I Nuaibets and Capacities` 590.0040) ( Labeling of Ingredients' 5-20•±.11 laic.0:cn and Placement` 'T Conformance with Approved Procedures ( ''its 11 Aci::Nstntiity.Operation and Maintenance ' /HACCP Plans ( I Supplied with Soap a^a Rana Dying 3-50"_'.11 Specialized Processin Methods* l7cvicrs ! 3-502.12 Reduccd oxygen p2ckaging.criteria' ( 6-;(11.1 I Hend•,+•a>hing Cb.;anser, A9allabiht% S-H)>.12 � C;,nforrnmice with Approved Procedures.` ` 6-301 L% ( fizad Dtyiug Pu.cisinn Denote,vm^ ci:l item in tlT federal 1999 Pard Code o: 105 CNIR 5900001 CITY OF SALEM . (.� BOARD OF HEALTH Establishment Name: t Date: Page: 7_ of 2;- Item item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified J I PLEASE PRINT CLEARLY 0t_•� Ai-,r?; AkA !./ O✓�i , �{ PC`! l/ -/c� 1 ��(7n�ln h ncc .. 'h_v� /1� i_w1lYQ To s ' ) _ I ! I 1 1 I I - 1 - I Discussion With Person in Charge: Corrective Action Required: I ❑ No as - + I have read this report, have had the opportunity to ask questions and agree to correct all YVoluntary Compliance ❑ Employee Restriction/ P PP Y Q 9 1 Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension l 4 comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspensi n/ ocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: v w� yN A' 1. j =. °dQ 111::.: PHFs i2c:rrve�!.rt'I'empertmres I Violations Related to Foodborne Illness Interventions and Risk 4cioF:i:n to Le:a'Cooled to JI Factors(Items f-22) (Cont.) 4 I'F/-15"F Within a Hours. PROTECTION FROM CHEMICALS oolia r Method','V PH Ft � !q i Food or Color Additives � i I PHF Hot and Cold Holding F9 3-202.12 Additi�cs" I, 3-501.10(B) Col: PTIF,Nl!a;me:fncdat(it belnu 5901),,4tF) I41'1.4s*F- 3-302.14 PoisonuntrrT xicSubsta Addrttves° ; 3-501 IP.(A) ( H.IPHFsMuntaint:datorabote 15 Poisonous or Toxic Substances ( ' 1401F 7 101.11 Identifying Information--Original 3.501.16(A) ! Rousts Held at or above 130`F. Cunminers^ 7 102 11 Common Name-W orki ng Com ainers` ( 20 Time as a Public Health Control j 3-50i,i19 Tine as a Public Health Conhol* 7-201.11 Sepmetion-Storage 'I-2o2'! I Restriction-- Presence and Use'" j 591)t'udlti) V,rianev Requirunent 7-20'_.12 Condttionc of Use- 203 11 Toxic Containets -Prohibitions' REQUIREMENTSOPLATISj FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Ctiternr,-Chemicals* Pt7PULATIt7NS(HSP} 7-'_0,.12 Chemicals for Washing Produce.Criteria% 21 ?.x01.1:(A) Unpasrew,iied Pre-packaged Juices and i 7-204.1-1 Drying,Agents,Critetia'" Bever.cesWith \5'ainingLabels* -801.11(13) Us_�,f Pasteurized Eges* 7-205.11 Incidental Foot)Contact, l.ubnettnts` 13-80,,1 I:D) Raw or Partially Crooked Anin all F:NxI and 7-206.I 1 Restricted Use Pesticides,Cnrertn" 7-X7(,,12 Rodent Bail Stations" 12aw Seed Sprouts Nut Serked. 1 7-206.13 Tracking Powders,Pest Control and Unopened Food Pad:at?e tint Re-served. " f Monitoringj CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-C,03.I I Consmner Adt;soty Posted fur Consumption of ,4imrm:!Fuad,That xtc Raw,Urtderc tx,ked or lb I i Proper Cooking Temperatures for ( Not Othertvisr Processed to E!imanate PHFs _• Patho_eus 3-301.1 LA(I)(,-n) Eggs- I55`F 15 Sec. Eggs-hnnmdiate Service 145'1715,w" 3-302.13 Prr.,teuvzed Fgg,Substitute for Raw Shell 31-401.111A)(2) Comminuted Fish,Meats&Game ( ggs,. Animals- 155°F 15 sec, 3-401.11(-4)(1)(2) Pork and Beef Roast- 1301E 121 min" SPECIAL REQUIREMENTS 590009(A)-(D) Violaous ofection S54E1.0O9(A -!Dj in 3-4(11.4 i(A)(2) Ratites, Injected Moats- 155°F 15 I tt ) Sec. catering, mobile Food,tcmporar aitd 1-401,11(A)(3) Pnuliry,Wild Game Smi'fed YKfs, res:dernial kitchen oncrativos should be Stuffing Containing Fish,Meat, dchitcu under the appropriate sections Poultry yr Ratites-165°F 15 sec above if related to foodimrne illness 3-401.1IW (3) Wholk-nutscie,Lttact Beet Stesrks interventions and r•sk factors. Other 145"F a I 500.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should bE deb$ed under&29- M:ciowave 165`1' " Special Requirements. 3-401,11(A)(])(b) All Other PHFn- 1.4;"F 15 Sec. " 17 Reheating for Hot Holding _ ( VIOLATIONS Rrt.ATED 70 GOOD RETAIL PRAC17rES 3-403.11(A)&0)) ( PHFs 165cF 15 sc•_. " ( (Items 23-311) 3-403 111 B) I Microwave- 165°F 2 Minute Standing I Crai(ai and nor.-en!i;til vwkwors, which do nol relate to th•, Time* brodhn.ne illnrn ;:urrr>nnuns and riskjo(4orc Psied above. ^an be 3-4M.11(C) Commcreially Processed RTE Food- fount,'&r?h:Jolurwiu,k sec>iom of oi,?Food trade and 105 0,11? 140'F- _190.000. 3-403.11(3) Remainin,Urinbced Portions of fteef item Good fietaif Practices FC � 590.000 I Rnastsx 23. Management and Personnel FC-2 .003 I 13 Proper Cooling of PHFs 24. Ford and Foci Protection FC--3 ! 004 25 Equ!pm8ni and Utensils ( FC-4 .005 3-50114(:1) Coolurg Cooked PHFs from 140`F to 128. Wnt,r,Pumhno and Waste FC-5 ( .006 I 70=1-Within 2 l Iours and From 70'F 1 27 Ph'vsical FeciNY FC-- 007 to 41"F/45"F Within 4 Hours 28 Pasorous or Toxic Materials FC-7 � .008 1 -- --------- --3-501.14(B) Cooling PRFs Matte From Ambi ent i 29 Specid Requirements I 009 Tentpermure Ingredients to 41'F(45`P 30. Other j Within•7 Hours' ' i)enures cune.al it m litht federal 1999 Foos(wile or los CMR 5900i)01, • s � ,P7+^ �' h Y'. '" ...q,� r r r'j.:51P r�Tde. .. ..M' r i. .. -. ., f. . .� . J.-:. , ( 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 NameDat TYDe of Ooeration(s), Type of Insoection f Qf1110f I El -Food Service X Routine Address Risk r M, Retail ❑ Re-inspection Telephone ) An Level ❑ Residential Kitchen Previous Inspection [IMobile Datelo/W,)) Owner 7 ' HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Cherie(PIC Time ❑ Bed& Breakfast ❑ General Complaint Inspector In:/o_-ISS ❑ HACCP Permit No. ElOther 1i> A ✓nr,�o Out: Il.l� Each violation checked regluires 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 ;'-- `e ❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION 71Q. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing E]21. 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 o_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 25. Water, Plumbing and Waste (FC-5)(590.005) 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: ��/ S 5soi Vs (For -Ndoc 1 � ;2-f r IK as / Inspector's Signature: , Print: PIC's Signature: Print: l� r`�I I1�, ' ! Page of,,P4 Pages c Violations Related to Foodborne Maness Interventions and Risk Factors(items 1.22) PROTECTION FROM CONTAII".iNA`ION FOOD PROTECTION MANAGEMENT I S Cross-Contamino'fOn I 590.003(A) i kt.signrne:tt,,rResponsibilitvT 3-302.1!(A)(]'! Rae; Arun,! Fo-uisSeparated from 590.01114 Dennmgbation of Knowjedgc4 Cooked anti P lE Foods* 2-103.11 ( Perst,n in charge--dobe, I j ontsrrunanon Loin Rrw tngtedients j 3-30.21 !1A)0) Na,, Anima!Foods Separa:;d frons Each EMPLOYEE HEALTH ( Other", i 2 590.003(0 Rosponsrbddy of the person m.hater to I Corfamins6on from the Environment require reporting by food employees and 3-30?.1" I(^,) Fr,a3 Prnterion' app!ic:uR;.'s i 3-302.15 Wa;hingFr•-drsandVegetable, 590 003(f) Responsibility Of A Food Employee or An 1 3-304.1 ; Roc¢l Cootwi«'ith Fgmtpmmnt and Appi tcant To Report To The Person In Urens:!5 Charge, :cntommarrm from rhe Consumer 5t10.003i(l) Reporting by Pet stn,in Charge* I 1":06.1-1(A'd,H;: Returned Fond and R::se,t:ce of f,cci 3 590.0030)) ( Exclusions and Reltriciioos* ( G,saositon of Aft iteratec or Contaminate) 590.003(F) I Rentor-al of Exclusion;and Restrictions j Food 701.11 Di,carding or R.?conditioning lir,;ate I FOOD FROM APPROVED SOURCE P'-'od" 4 Food and Water From Regulated Sourcos ! 9 ; Food Contact Surfacos 590.004;,A-Hl Compliance with Ftod Law'" ( 4.501A 11 �vheival Wwcwa;lnnc-Hvt Water a-qt, S+nitizationTemperatures' tele.n Po�.,u ut a ,F,ermelically Boated Containers � j .5-2)1.13 Fluid hlilkand Milk Products r 1-5u1.i!2 MCinanicllWatewashing-tfotwater j 3-202.13 Shelf Eggs* j Sanitization Tcn:oeraturzs'e r FJI ( 'S01.11d Chemical PH. i 3-_n0_) ,,.4 ,.s and Alilk Product:.Pastetuizrd" 3-202.10 fee Mode From Potable Drinking Water` I vow outs tion aqui hordne;+s 1r 4-601,11(A) i Etfuipment?'oedC•antactStn-h;ecsmtd 5-101 11 I Dmiking Water from an Approved Svtem" 1 5,in,lifi(,(Al Bottled Drinking Watci : Utens!kcte.^.n" 590 006(H1 W.aer Meets Standards;in 310 ChIR 22 01` ( 1 02.i i Cle;uune, Frequeaev of Equipment Food- Costae! and Utensils. Shellfish and r=ish Fran ar,Approved Source u '^ ,�c)> t I Frequc,tey of Sa:Jtiza!run of Usils tenand 3-201..14 r:ish and Recreationsi 1p C':mght Molluscan I I I Fo,ui Contact Surfaces of Equipment" Shellfish'" ( 4-70±.11 ( Methods of Sanitization-I-Tut Water and 3-201,15 Molluscan Shcl75sh from NSSP Listed Chen;seal" Sources* III) ( Pelpr;,Adequate Handwashing - -I Gamy,and Wild Mushrooms Approved by 2-30;.i 1 Clea)Cbtu'aium --H.mds.,:nd :\sins* Regulatort,Authc my ! r i 3-202 1S _ Shelt_stt eek IdcntrGcnhon Present" ! --30!.12 Clen:i::i;Pr.1CCde[C' i 590.00-I(C) 'Id Mushrooms` 1 2-301.:4 Whe,:to Wash" 3-201.17 Carne.Animals* 111 Good Hvglenic Practices Receiving/Condition I 12 -101.11 Eatius. Drinking or Using Tobacco` 3-202.11 PHF;Received at Ptopor Temperatures" I I - ':)1 12 I Di chargzs Form the Lyes, Nose and 3?J? IS I Package Integrity* I hloully" 1 3-!01.1 I Food Safe and Unadulterated _!.3(11.1'2 ( Freventinr('ontaniin:nion Wlten'i-asting 15 � Tags/Records:Shellstxk 12 Prevention of C'ontammation from Hands 3-703.15 Shellstock Idenaticauon, 'i90.0(Jit E) ':Cventint'Cnnhuninatiun from 3-203.12 Shellstack Identification I Idnrs aiued" Tag:RecordisFish Products Handwash Facilities ?-402 i l Parasite Destruction' I I Canveniemiy ta:atod and Arcessirk^ 12 Records,Creation and Retention* I I _-203.11 I':umbers and Ca;ravities° 590.0040) Labeling of Ingredients' I 15"204 It I I ovailon and Placernen!* 7 Conformance with Approved Procedures I I -`'^`3=' 11 A.ce ib:iihC Ooeiati,m and Mai raenauee /HACCP Pians I aupplred oath Scat?and Hand Dtyr'ng Oe'vres 3-Si)2.11 Speciafize.:i Processmp' \4rth,rtls* I tt 100 I r i 3-:102.1:. Reduced orp en packaging criteria` ' I Hzndmanhnm Cleanser. Axai,alnlaa g 4. .. ki i 6-30 1.i? Hared Dr mat Froriaiou ti-103J2 Confiaimance with Approved Procedure.'' 1 ) I ouiores critical iD•m in rhe tede:.d 190)Fond Cale in 10>Csn2 590 000 CITY OF SALEM BOARD OF HEALTH 7., Establishment Name: _ Date: Page:Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified j .PLEASE PRINT CLEARLY n ,. 4-0 11. 1 A f"/- n fo 04 he /I eon �Gi�so IG �-501_` G r{/ C7r7A' Al �(J /,,A, n_I ��1� Al, le r/ �� Y.1-J-Tl / ` t o�P,n)Pli o.4 rhod&J 1 ' , (✓IZ�l�� vr� ;,�J y�IP/t1�H0.�i �a/I V refillboR/ 1, °i r � L -,It ai— X- Sin to r i2col- is /x,D jzl rg. ,YRJ . '�lYl/'[n 7- '\ /'no D /r4� /rPA Vit. 'An C_< , I 4 AIA IIS In�O�l �� /lVr�2Cr S,✓10. J fh;✓��O/ / I� RA d/ roil� t/�r nt)10s� DS— r ( I rnl►ov (All � ilbfi0rek4 jle4 11A k1(5,n l;,A.a / o- �, -0,44,1 a J I) � f r � -�.o �Or-1-0t'e\ !'il t K Son1-,Y:;- Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes / I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance C3 Employee Restriction Exclusion I. 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 under .and that noncompliance may result in daily fines of twenty-five dollars or slcspe�vocation of ❑ Embargo ❑ Emergency Closure your food permit. I ❑ Voluntary Disposal ❑ Other: R II _ 1 — C !1(C) i PHFs Received at IL mperaturca Violations Related to Foodborne Illness Interventions and Risk According to[am Gwled to I Factors(items 1.22) (Cont.) I 'F/45'1• %Vitlap 4 H(urs. PROTECTION FROM CHEMICALS 3-50!.15 ('ooi'n!_:Meduldifor PH'P; 14 Food or Color Additives it) j PHF Hot and Cold Holding 3-20..12 Additives;" 3-i01.16ili) Cuid1=lIFsMaintained atoihelow 5,30 r0_47. ) 3-302.14 Protection front Unappro,:d Additives" I ;.$i�1.I6(1) 11145]F Maintained a:or above 15 Poisonous of Toxic Substances j 7-101.11Identifying Information-0nginai I 40'Ir. * j 13-50'.16(A) koast,Held at or above 130°F. r Containers- 7-i 02.11 Common Name--Wnrki ice Coaruiners': ( 20 -rime as a Public Health Control 3-501 19 Time a,a Public Health Ccntnol" 201.11 Restriction-Storage` 590.004[8) Variimce Kcquircnlent ',-202.1 l Restriction-Yrc•ecncr and Ilse" 7-202.12 Conditions of Usc^ 7-203 11 Toxic Containers-Prohibitions' REOU ( FOR HIGHLY SUSCEPTIBLE 7-204,11 Sauitizers,Criteria--Chemicals'* POPULATIONS1.tI(AUnpa(HSP) 7-204 12 Chemicals fir Wash;ne Pn�xlucc. Culeria,; 21 3-801.11(A) Unpa.,tenr:red Pte-packaged Juices and 7-204.14 Drying Agents.Criteria, Y,eveiages with Wming I libels- 7-205A 1 Incidental Food Contact. Lubricants^ 3-801A I(B) Use of Paxetuized E,,es� 3-B0L1l(D) Raw tit Fartialf Caaked Animal Food.and 7-206.11 Restricted Use Pesticides Criteria* j } 7-20b.12Rodent Bait Stations Raw Seed Sprouts Not Served. i7 206 13 Tr;iJ ung Powders.Pest Control and ( 3-80!.i!(C) Unopened Food Package Not Rr,-served. =° Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Contiainor Advlsoiy Posted for Cnnsumption of Aninnal Fmxls'rhat are R-avw.Undercooked or PHFs; .r- I6 ( ( PHFProper Cooking Temperatures for Nut Oth.rn ise Processed to Eli nunatu_ •- 3-401.11A 1) 2) Eggs- ' - - Fath:rtens." ( ( €li_ 155 F LS Sec. I E);es-Inmediate Servict 145°Fl5aec„ 3-3011 Pa,teurized Eggs Submit- 1'(;r Raw Shell 3-401.11(.1)(2) Comminuted Fish. Meats&Ginn Egg.0 . Animals- l55°F 15 sec 3-401.1 I(B)(1)(2) Pork and Beef Roast- 130"F 121 mI-in* SPECtA&:REOUVEMENTS - n 5 90 009(A(D) violations of&action 590.009(A)-iD) in ? -1(,Li l(p}i_3 Ratites;Inj.dedMeat,- 155°F IS see, catering, mobile food,temporary mid 3-401.11(Aft3) Pouhr;l,Wild Game,Stuffed PHFs, ' res;dential kitchen opefatiors should he Stuffing Containing Fish,Meat, dehitcd under the appropriate sections Poultry or Ratites-165°F 15 sec. ' above if relater to fauuborne illness ,-401.11(C)(13) Whole-rrmscle,Intact Beef Cteaks inrzrvenLons and risk factors. Other 145`'F* 590.009 violations relahag to good retail i3-401.12 Raw Animal Foods C.OoKed in a )n aCitCes shouldbe dehiled undo:/!29- Microwave 165`F" : Special Rquirculvats. 3-401.1 I(Ahl)th) :MI other PHFs- 145`F Ii sec l; Reheating for Hof Holding VIOLATIOP/S R._LATED TO GOOD RETAIL PRACTICES 3-403.11(A,)&(D) PHF, 165'F 15 sec. * (items 23-30) 3-403.11(B, Microwave- 165°F 2 Minute Standing i Critical and non-n rt&,ai violahnmx, winch do not ieiair to tine Tune' ton borne:tritest intent entions nerd risk fire tars liste,4 above (on be 3-403.1 1(C) Commercially Pruce,scd RTE Fold ( found io!'W futlnu-%ns sections or the Food C'uue and 105 C'OIk 14WF` j 590.000. - 03.1 11 E) Remaining Unsiiced Portions of Bcef i item wood fratalt Practices IFC 53U.0U0 Roasts' 1 23. Manaclernent and Pemnnnei - -_ FC-2 .003 iR Proper Cooling of PRFs ' 24 Fooci and Foed Protection FC- 3 004 25. Equipment au;l themils FC-4 .005 3-501 14('1) Cooling Cooked PHFs from 140`F to 126. Water. Piunnb-nq and Wsre FC-5 .006 701-Witton 2 flours and From 7W F 27. Physical Facility F;--6 .007 to 41`F/451F Within 4 Hour,. "' �26. _ PNso,ous c.Trx.c fvlatechs FC -1 L,008 3-501.14(13) Cooling PHFs Made From Ambient .. 21 9, S.Fciai RequaFmerdi 009 -� Temperature Ingredients to 41°F/45`F 1 30 _ 0the, W rihi n 41[our,;" Denots c"iue"t ram 111,110 fvdeod 79119 Poi d Cod:or 105 C Nik 599000. 1 ° CITY OF SALEM '. BOARD OF HEALTH / e� Establishment Name / / Date: K? Page:Page: of : Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN F CORRECTION _ Date 1 r No. Reference R—Red Item n R _ _ PLEASE PRINT CLEARLY • Verified f 1 ' <),U_ �� f7/loi,l; ..c�-�� r)y /I /PM,��,l�.� �r 7 '<�.uAvTa.�-1� jk .._k tS�JlA„II.Inr�-..� � rp�7 opt/ I - 1 �, I -- n�� r1 _ 4- 4-e-ci- 4� , I, !rvn ,(�o r yn f�� l�c�/�2 �i .1� -4\) C fitQv�c 3 I S-r?. , �� y,i la F- `f�1ron l�u,zDrf�.�� S,✓) � c.Y � !/Icy Lx 1 I I ` I I j 1 Discussion With Person in Charge: Corrective Action Required: ( ❑ No IA/ Yes J} Emloee _ I have read this report, have had the opportunity to ask questions and agree to correct all :3 Voluntary Compliance ° Exclusion Restriction/ r violations before the next inspection, to observe all conditions as described, and to a�Re-iinspection 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 ox pens on/revocation of ❑ Embargo ❑ Emergency closure your food permit. N ❑ Voluntary Disposal ❑ Other: 3-56! :4,Cy PIFs Recc;ced n;Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled lc Factors(Items 1-2P) (Cont) 4l'F145"F Ccithin 4 PROTECTION FROM CHEMICALS I 3-501 15 1-oohn;;Method, for PFJPs ! 114 Food or Color Additives I 13` PHF Hot and Cold Holding 3-501.i6Qi i C",!d PFF,M titic;;riccl at of below 3-20212 Additives* 591Or)'4iF) 41'145"F" 3 302.14 Protection{corn (in.<ppruved Adddnes* I 13-50i.I5(.A) Hot PRFs N4a;mmned at or chow 115 Poisonous or Toxic Substances I r+ 7-101.11 Identitwng Information -"Of mina( I Containers" ! 3-50L16(A) Roasts Held st or.fiove 130°F. i .l 1(12120 Tims as a Public Health Control 11 Common Name-WorkinpC'rntmincrs' I 3-501-19 Tim:as:: PUhlie F-Ieaid Control r 7-20 L11 Separation-Storaget' 590.0N(H'! Varianecke uireu cmt 7-202 1! Restriction-Presence and Use ! 7-202.12 Conditions of Use` j 7-203.11 Toxic Containers-Prohibitions" I REOUPOPULLATIOA:riO NTS FOR HIGHLY SUSCEPTIBLE NS(FISP) 7-2(4.1 I Cheri callsors.Criteria Was i Chenii als Produce, 21 ;.8p1.111 A) Un searizcd Pre-3 ,ka cd Juices and ( -204.12 Clhemieals for W'ashimt p)�nduce,Criteria" j P"' 1"- �8' i 7-204.14 I Drving Agents.Cnteria`' Bevoiages with Warnine i LaF,els'' 7-205.1 I I Incidental Food Contact, I_nbri�.ants^' I - ?-501.31(3) Us:-r'Pastewizell;ts* 3-30 .1 t(ll) P.aw,-r Partially Cooked Aminal good sold 7-_G6,t! Restricted use Pesticides.Cricera* ( - Kav:Sced SitWrhs ,}•.,i Ser%et 7-206.12 Rcxicm Bait Stations* ;-801.11(0. Unooened Food Packagv Not Reserved. I 7-M&!3 Tracking Powdorc,Pest Control and Monitoring^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 1 NIP,I I Consumci Ads;sory Posted for Consumption of :minial Fuo,ls That are Rase.Uadercooked or 16 Proper Cooking Temperatures for ! PHFs Not Otlterwsr Processed to Elhnivate c<sseense 3-701.1 l A(l d2) Figgs- 155`17 15 Set,. Patho_,-rn,T Eg!ts-Immediate Sen+ice 1.15'F15scc, 3-302.1' Pniteurized Eg_S Substitute Fat Raw Shell 3-401.1 ItAi(2) Comminuted Fish,Mean:&G:une Animals- 155'F 15 sec. :` 3-401.1 413)(1,1(2) Pork and Beef Roast- I30"F 121 min* i SPECIAL REQUIREMENTS 3-400!1(A)(2) Ratites,In}ectcti Meats -- 155"F 15 590.009(A)-tDi Vbalaticne of Section 590.009(A)-(f)) in sec. : catering, niobile fivxi, temporary and 3-401,11(A 0) Poultry,Wild Game,Stutfed PHFs, rc,dewial kite':---n operations s!iould sic Sluftine Containing Fish,Mea!, debited under the aoptonriatc sections Poultry or Ratites-165`17 15 sec. * above if related to !'oodhorne, illi--Ns 3-401 11(C)(3) Whole-muscle,Intact Beef Steaks in(et'vcntions and risk factors. Other I45'F' >?0.(N)9 violations ielatin__T to gond rctall 3-101.12 Raw Animal Foods Cooked nt n xacnces sholad be debited ander It29 - Micomave 165"F` is ci.d Requirerocots. 3-401.11(A)(1)(b) A(1 Other PFIFs - 1.75'F 15 sec. * j 17 Reheating for Hot Holding ( VIOLATIONS 17LATED TO GOOD RETAIL PRACTICES 3-403.1 l,A)&i D) PHFs 165"F 15 Sec. 4 (Items 23-30) 3-403.11(B) Microwave- 165" F 2 Minute Standing I Critirtd unit n,.n-rriiu al v,nl.ntow- nvhich do no!relate!o tine Time" foodborne ltln.;¢c inter renoonc and rind/actors lis.rent ah,me, can In, 3-403.1 It C) Commercially Processed RTE Food- fours„r!Ire fid/ntriag se(. Frns of tire Food('cde aad tri;CbIR 14WF"' I 590.00_0. . 14)3.1 UE) Remaining Unshc•ed Portion;of Beef i Item Good Retail Practices FC 590.000 j Roast<, 123. fdm anaoeeni and Pe-scnnel FC- 2 003 18 Proper Cooling of PHFs I 24 Food aced Foor,'Protection FC--3 .,004 i 25. Epulpn@M ano Utensils FC-4 _.005 j ;-501 14(A) Cooling Cooked PHFs from 140`'F to 26. /Nater i ---�� Plumbing:and tNaste I'G-� ( .UOti 70"F Within 2 Hours and From 0cF 27 r'h,/seai Facility FC-6 007 to 41�'F/45`F Within 4 Homs. ' 128 PG!SOMIS or Tow. lJ;aterials FC-7 .008 3-501A4(B) Coolim,PHFs Made From Ambient 1 29 Specai Reacniemerts 009 'rcmperatute hir.edients to 41"F/4"F 30, Other Within 4 Iloure; Denorvv CiWCal item m the fcdcrd 1999 Fond Code,-r 1115 CMR 590000. . ......... Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2006 WHO'S PLACE OF BUSINESS IS: 7-11 Food Store#22763 File Number:BHF-2004-0113 126 North Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2006-0001 Jan 1,2006 Dec 31,2006 $100.00 TOBACCO VENDOR BHP-2006-0003 Jan 1,2006 Dec 31,2006 $50.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 18 I CITY OF SALEM, MASSACHUSETTS Jia R c (d rt v p o ,. ry BOARD OF HEALTH !i/Ill °� V s 120 WASHINGTON STREET, 4TH FLOOR DEC SALEM, MA 01970 Ll' 5 2005 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. USOVICZ, JR. BO WWW.SALEM.COM ARD OF HEALTH MAYOR JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 7= kl Ffr)ek e'VO a-0 TEL# G-1$ --I -k -k - X30 Z ADDRESS OF ESTABLISHMENT kala Nbt2\\! 5�- ��-q\cv� MpkSS on-)o MAILING ADDRESS (ifdifferent) \ aI/a UVVNER'SNAME {� V%A1`Oa CvtAs11 r TEL# -t%\- '1(400-St4Li ADDRESS 11 CITY IPlobn0K) STATE C A%V s ZIP okVe©l CERTIFIED FOOD MANAGER'S NAME(S)_Av.� L°�, L, CERTIFICATE#(s) 4a4a3o3tQt'� (required in an establishment where (( potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON A m3LM �Y" y/6 HOME TEL# 918 Bks �3a S"' HOURS OF OPERATION: Mon.__v-Tue._7A.Wed.__L hu. �Fri. Sat. TYPE OF ESTABLISHDAF�Tj FEE (check only) RETAIL STORES YES NO / 1ss than 1 0 than t 0 0000010 q.fft. =$2b ------------------------ -.................-----------/---------.....--- -.----- ----seais . RESTAURANT YES NO less than n 25 seats $100 25-99 seats =$150 more than 99 seats =$200 - - - ----------- - --------------------------------------------------------------- $..iGG . ---------------- BED/BREAKFAST YES NO ----------------------------------------------------------------------......-------------------------- ------------------- ADDITIONAL PERMITS MAKE_(noyust_serve} iCE CREAivI, YGGURT, S rT SERVE YES NC [TOBACCO VENDOB, ES NO 50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. \l.IN•0ll�- e -:�3 - 4&9a , 3*Z.4 Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------- Revisedll/03/05 FOODAP2.adm Check#&Date // .C4 ! bd • _y ..y,?.,..'+r.,R r•t r 4^A ... K .. . ..+ns� h,s t, r ' e 4~ MaSSp120W ae usetts Department of Public Health Board SHeahh !� 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 I Date/ Type of Operation(sli Type of Inspection 1 In/��os") ❑ Food Service ❑ Routine Address ) �� Risk 9 Retail [t�7,Re-inspection 7( _ 0 ' Level ❑ Residential Kitchen Previous Inspection Telephone I ❑ Mobile Date: CjJ�}3�p5 ❑ Temporary El Pre-operation Ownert HACCP YIN ( ❑ Caterer [I Suspect Illness Person in Cha(ge kL l� CI J Time ❑ Bed& Breakfast ❑General Complaint In: v ❑HACCP Inspector , tip Joh wo,�op ( Out:, Permit No. ❑Other Each violation checked requires an expYanation on the narrative 4ge(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 mareed may pose an imminent health hazard and require immediate corrective 590.00%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 E] 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) - ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17, Reheating 11 ❑ 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(NSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1.22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel {FC-2)fs9o.Do3} 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 28. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you X27. 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 S.WllnspecrtVrmb-ia.doc /-ti Inspector's Signature: ( � ^-.^ Print: ,1, PIC's Signature: // I I Print: ��./� n Page_l...ot�^-Pages ' 1 Violations Related to Foodborne Illness r Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ! 8 I Cross-cont+mina bon I I 590.0031A) As�ignment of Respowibility". 3-302.11(Ay l R.nv n:rn;l Focu's Sepwaied fi:.m 590.(I(t3r13) I Demo r,aralioo of Knowledge* I Cooked and RTF i kq-&'� 2-103.11 Pcrcon in charge- duties I I Conta,rrrnition from Ram Ingredients 3-302.11(A)(2l Rcic Animal Feeds Separated Irani La.h EMPLO"EE HEALTH I Othcr" 2 59U.003(0 Responsibility of the person in charge to Contaminaaon!rom the Environment ! require reporting by food employees and 13 302.1 I(A) Food Pr•:,tectioa" applicants* ! 3-302.15 k'os'I ..uts;ual Vc�=etables 59ii 003(F) Responsibility Of A Food Emplocee.Or An 1 3-301.11 Food Contact v,i:L EgUipment am9 Applicant To Report To The Person Lt I U,ensi(s Charae,t Contamma3on from the onsumer ! 590.002)(G) Reporting by Person in Charger I ! 3-306.14(A)03) Rattited Food and Resera-ice of F,XYI 1 3 590 0030)) E5Lltsioas and Restrictions' ! ( Disposition of Aouiteratod or Contamrneted 590.003(b) Removal of Exc!unious and Rcarictiors Food 3-701.11 U!scaiding or Rstmditiommt Unsafe FOOD F'1OM APPROVED SOURCE Fo`""' Food and Wafer From Regulated Sources ! 9 Food Contact Sir, aces ! -i 1 A-501 111 Manzi a Wareo-w1 the-Hot Water 590,004(A-11" Compl.:mcc with Food Law"" 13-7.01.12.. Food in a flennetically Scaled Container" Sanitization TenrpertureO 4-501.117 Mechanical W-,rewasib +in g-Hot Water 1 3 201 I i Fluid Milk;mel Milk:Ynxluc4s* I 3 202.13 Shell Eggs'" 1 banttizatioa Temper.uures" 4-501114 Chetnical Sanitization-temp, pH, 202.14 Fags and Milk Products.Pasteurized" cnrcea.arion:nd badne> : 3-2102,16 Ice'Made From Potable Drinking Watcr^ ! 4-601 I1(A) Equipiru ni Food Contact Surfaces and 5 10111. Drinking Water frum an Approved%}acm' 590.0061 A) Bottled lltinknuaWritert:*ens:L.('lca�r " 4-601 11 Cleaning Frequency f Equipment Food- ; 590.006(13) Water Meets Stat dards in 310 CAIK 22(P" Contact Suri;;e.and d L?[cnsiic" Shelffem and Fish From an Approvod Source I ( 4.702.i i Fugue of Sanitization of l Item ik,= and i ,'.til.Jt Fish and Recreetunally fMol oilu:can ( Foocl Conttci Surfaces of Equipment* Shellfish* -1-703.11 Methods of Sant:zatinn--Hot Water•md 3-20115 Molluscan ShelttiAt from NSSP Listed ! Chemical* Soarces" I i 10 ( proper,Aeequate Handwashing Game and Wild rMushrooms Approved by I I Regulatory Authonw .r-301 l l Clem Conn!tion--F!culs and Aima' 202. 1 S SheiNtock Identification Preaent" 2 '01.12 Cleai:mg Po.:cede:r' 590,004(0) Wild MuAnooms* ! 2-301 Id i�lieu rn Wash" 3201.17 G:nne Animals' ( 111 Good Hygienic Practices g ! ReceivingfCondltion I 12.401.1 l Eating,Drinking or tlsi r i Tabacc, - ! I 3-202.11 P1fFs Recetvcd at Proper Temperanutes°% ?-401.!2 ll:,,ch:urges Penn the Eye..Nose mid j 13-202.15 Package e anilhtnuth- 3-101.11 Ftxx3 Safe and ity"t:naduherated ! 3-301.12 Preventing ,ntamination NNIun Tasting` ! O. 6 Tags/Records:Sheiistock 12 Preven•ron of Contamination from Hands I ,-20?.13 Shcllstock identification 590.00-1(E) Preventing Contamination from i-2(13.12 Shellstock Identification Maintained* I''ap"'•yeei% Tags/Records:Fish Products I 1 i Handwash Facilities ! Conven,eni'y L 3-102,11 Pmasite Destruction* n,;atad and Accessible ! 402.12 Records.Creation and Retention"' j 15-201 11 Numbers and Canacities- I ,90,0040) Labeling of Ingredients' I ( 5 '01.11 Location and Placcmcatt" ! q Conformance with Approved Procedures 15-20' if Acces,ibi lily, ())eration and Maintenance 14ACCP Plans I I Suppii,xl two Scxtc and.H ind Dryio,g ' 3-50).lI SpecializedProcet. ingMeth+d,,,^ Dvores I " ( ! 6-301.11 Handtcashme Cltn,asm.Acai!abilay 3-502.12 Reduced oxygen packaging,criteria ! 6-30!.1'_ hand Div,rc?Prr.4xem 8-!03.12 Conformance xith Approved Procedun:s" i 'Do:ol�rr me"d ilem:a me federal 1449 Food(Hock or 105 CR1R 54fl fop). CITY OF SALEM BOARD OF HEALTH Establishment Name: �t - r' Date: /(3/1/o'5 Page: of r? Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R-Red Item Verified PLEASE PRINT CLEARLY i JJr ll ' �b SDI I1r r J U leo F -fi- ( I ✓! �l 1 r.I 1 I � c �Pr C -) x..anA l OJ n n - r fl C., A� _ (rn{ � I '�+c D n r- t L l 6'0,>),V 1 Ln)OG ym/-c`h'ip N _4z"J r1I r,11(05 GT' �J HJ Sw 1� -?svLI(, A'_r0 , 1 or,., hS,e�,`'hIs ��1 ��G�L 1 _�rA/rl - 1 �Yn �. ) VAC Lf(�rn"117t.ne'�L Ci� �). , aro. LP !1 itG7� )�II�� ✓Y� l�Sc� ^t9 /LICA,n� n �✓t��[�r� �P�l - I P I I • I a I I 1 Discussion With Person.in Charge: Corrective Action Required: I ❑ No /as I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ ations before-the next inspection, to observe all conditions as escribed, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension i=mply with all mandates of the Mass/Federal Food Co U. I understand that Npncompliance may result in daily fines of twenty-five d 1;rs,or suls�{iension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. \J ❑ Voluntary Disposal ❑ Other: I _i �M �;-fit): i•!(i't PHF, +te..etved ar'1'auperatnn�: Violations Related to Foodborne Illness Interventions and Risk ,According to Law Cunled to Factors(Iterns 1.22) (Cont.) »FF/I:i F Within-? Hours. " PROTECTION FROM CHEMICALS Ut IS : cnr!:ua Methods for PfIFs � 14 Food or Color Additives I 19 PHF Hot and Co'd Ho!d:ng 3-50;.1603i Cold Pfl''s Sl.,;:dained atm belo.v 3-202,12 Additives' 590.004 17) -'.I"i45°F ?-302.14 Protection from Unapproved Additive: i-501 IP,iA) Ff+a PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'F. 7-101.11 Identifying Infor1allion-Orininal 501 161:U kuastsHold zinr.ai."vei3(t°F "� Containers` 17102,11 0)(11111Wl Name-Workingg Containers'° 2U -lime as a Public Heahh Control ' 1-5111 19 Trrrc as a Public Health Contiol" 7-201.11 Separation-Stouu!c* 7-202 !1 Restriction--Presence mid tlse'` I !`)0.004(H) Variance Rrqurrenlc'at 7-202.12 Conditions tit Usc'" 7-203.11 Toxic Containers-Prohibitions' 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals" POPULATIONS(HSP) 180 1.11(A) Pre-Packaged lin,s:,:rartzcd ged juices and 7-204 12 Chemicals for R'ashmc Produce,Criteria"` 21 3- I I i 7-204.14 Drying Agents.Criteria: Bever:+ees witi": Warning Labels� I3-SOi.I1(B) Us,ofPasteuriredFees* I 7-205.1 ! Incidental Food Contact,Lubrtcau!g- - i3-301.i I ID) Raw of Partially Cooked An trial Foxl and 7-206.1! Restricted Use Pesticides,Criteria. ( q;.w d Sinouts Not Srrtvd. .;Se,, t 7 206J2 2 Rodent Bait Stations" 3-901.I 1(C) tJnupered Foxt Package Not Re-served r, 7-206.13 'I7;+cking Powders,Pest Control and Monitarim�* ! CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-61)3.11 Consumer Ad4ismy Posted t,rr Consumption of ..iiia:! Feeds than are Raw. I Indcrcooked or 16 Proper Cooking Temperatures for N.,t C..cr�.ts:. Processed to h'hrainale ,., ..: . PHFs 3.101.11.4(1)(2) r-1,gK- 151'F 15 Sec. Eggs-hi mediate Scrv;cc 145'Ft Ssec" 3-302.13 Pagteun ped dig+?s St&titute for Raw Shc11 3-101.1 i(A)t7..I Comminuted Fish,Meats Nc GattV. '%gKs" Animals - 155T 15 sec. ` 3-401.1 t{L31C1)(21 Pork and Bccf Roast - 130"F 121 nein. SPECIAL REQUIREMENTS :- (11.7 ilA}t2) Raines,]eject e#lyteats-155°F 15 590.009(A)-(D; Violatieng of Section 590.009;A)-(D) in See, cateri un,. mobile food, temporary and j 3-40 IA I(A)(3) Poultry,Wild Game, Slotted PHFs, r ridential kitrj;._a operations should be j Stuffing Containing Fish. Meat, debited under ilio anptt,nriaG_ sections Poultry or Ratites-1650P 15 sec ab0w it reh?ted to foodborne illness 3-401A 1(C)(3) Whole-nmscle, intact Beet Steaks intet Tuitions and risk factors. Other 145°F s I 590.009 Volations relating to good retail 3- t`t.l_> Rain Anumtl Fonds Cooked in a Prances;houid be debited under#29 - Microwave 165`F t Special Requirements. 3 40 1.1 1(A)(1 Hb) All Other PHFs- 145"F 15 gee. 17 Reheating for Hot Holding VIOLATIONS Rr'LATED TO GOOD RETAIL PRACTICES � 3-10.4.1i(^,)&(D) PHFc 165'F ISsec. * I (Itetn523-"i(l) 3-1 03.1 I(E) Microw.:ve- 165"F 2 A4iawe Standing Critical and non-crilical cinh-r ions, which do nol relate!o the Time'' i londburne dhiers huei,,ew ons Witt KAkfiutor'a fitted above, can he 3-403.11((:) Commerually Processed RTE Food- lmu7d in doe folLn+i;rg,iertu:ns:;f ch,�Food Code arcd'105 (WR 140°FT SY(i.1N)0. 3-403.1 I(E; Remajoon ,Unsliced Portions of Beef I item Good Retail Practices FC ( 590.1704 Roasts* 23. l/anatann, and-'e,suunzI FO-2 .003 !: 24 Food?nd Food Protecton FC- s 004 18 Proper Cooling of PHFs � 125 -_auiprr:ent:md Utvnsar, FC-4 ('105 f 3-501 14(.,1) C'uobn,Conked PHFs from 140'F to °6 Vv aloe,Pbtr~:bino and 4Naste FC -5 .006 _ I 70`F Within 2 1-iourti and From 70'F 27. ! PhVs+ca!Facility FC-6 ', 007 to 41`F/450F)l"ithm 4 Hours. " 128 Polsrno,is or Toxic nnatwiais FC--7 _.008_ 3-SOL Idl3; Ctmding PI-IFs,Made From PonMent 12R. ! Sut;cial Reuuiremaots pny iTenlpri attire hlcredients todiT/45'F ! �_30. ! On,ri i Witlun4 flours'( Denotes a r,cal itan nt the Rdera' !999 rood('ode or )",)5 CM]"590 000. . . "' -t+.. r..w.r-...r�ww+......,r•r d.�'w+rr.-^.r r... . .-...,n-. .� _,.•' 1a-, +.f +. ..- ..,.:-:..+.,,M.,,.T, ' ' .. 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 i Name - ' I t Tyne of Operation(s), Type of Insoection s f f2 ❑ Food Service Routine Address ' Risk Retail Re-inspection Telephoner o Level Residential Kitchen Previous Inspection Lj7L, ��1 ❑ Mobile Date:,;�(;/,C)F, Owner : HACCP Y/N ❑ Temporary ElPre-operation A-'pV1 p� ( �,,,,r(I / I El Caterer ❑ Suspect Illness Person in tharge(PI ) -t Time ❑ Bed&Breakfast ❑ General Complaint lnlEl HACCIP Inspector -(-T �� I 0 ac Permit No. ElO herr 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 X13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC E3 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 ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION '119. Hot and Cold Holding c'►- ❑ 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): 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 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 1 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 5901nspectFo,m6-10 Dac r-�j Inspector's Signature: ' Print: ; .Io PIC's Signature: A ) int: C\ J) (((��IXXXVVV I Pake_of77Pages r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S Cress-tontamca tion 1 590001(A) Asi�tnmentotResponsibiliq" 3-302.11(An 1) tine AoitnnlFoaisSen.u:aedfirm 54171103(11h i Demonuraon of Knowledge" ( Cook-,A and RT12. Fruxis' ?- 10 3 1 1 , Person in charge --duties Conaamrnatrbn t.am Raw h gi xiients 3-30111(A)(2) Raw Animal Foods Separated front Each EMPLO"EE HEALTH I Other'' 2 W(1.003(C) Responsibility of the person in charge to I Contamination from the Environment j requiro reporting by food employees ead 1 3-3172 1 1(A) Fond Pru::ctien" applicants`^ 1 3-302.15 Washing Frvitc and Vc.vetables 590.00`hF) Responsibility Of A Puud Employee Or An i3-304.1 1 Food Contact:vin;Equipment and Applicant To Report To The Person In Ute nsils* (Ilia Let Comamrnacon f,,rn the Consume; { 590.003(G) Reporting by Person in Charge` 3-300.1^-(A)(B) Returned Frmd and Resetaice of Food' 3 590.0031D) Exclusions andReshictions* I Disposition ofAdc,teratedorCon'arninated 190.(703(E) Removal of Exclusions and Restrictions Foud 3-701.i I Dizcarding or RecoudiUoning Cue,d'e FOOD F IOM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces f590 C'0=!(.4-B) Contphann;faith Food Law 1-501.11! Manual lVareHaalnne,-Hof Water 'i 201 12 Food in a Hennetically Sealed Container" Sanitization`('emperanrres" ( --2 t71 13 Fluid Milk and Milk Prruhicts" 4-501. ; 12 ibTechauical Warev:ashing-tiro Water ?-2t 2.13 Shell EggsT I Sanitiztuior:Temper.nures'� 3-202.14 Egga and Milk Products, Pasteurmzod" ( 4-501 114 Chemical Samuzatiun-tetnl;.PH, i-202.16 Ice Made From Potable Drinking Water* a;ncentradon and hardne.s. ' II Drinkiri- Water from:ut Approved Syafem 4-601 II(.4) Equipment Raid Contact Surfaces and Utensils Clcan- ! 590.0061 A) Bottled Ddnkine Nater" ?96.006(B) 1'vater Meets Standards in 310 CMR 22 0* 4-602.11 Cleaning Frequency of Equipm.rnt F'oW I Ccmtact Surf-aces and L:4ensilr" ' Sheifise,and Fish From anApproved Source I4-702.!! Freaaenc} orSaaitiza0onofutensils and 3-201.14 Fish and Recreational lv Caught�Mol Iuscan i Food Coniact Sud:u:es of L?quipmenr* Shellfish" 14-70x.11 Methods of Ssrn.; tion-Hot VFa_r and 201.15 Molluscan Shellfish from NSSP Listed Chemical* 1-20 sources Came and Wird Mushrooms Approved by it0 Proper,Adequate Handwashing Requiatory Authority 2-301.11 Clean Condition - Hands and Arm:" 3?02 18 Shellstock Idetnification Present* 2-301 12 Cle.uting Pnxecure* 540-004(C) Wild Mushrooms- 2-301.14 When to Wash, 9r „1 (lame Amntais"` 11 Good Hygienic Practices 17 � , 5 Receiving/Condition '_-401.11 Fating,Drinking or Usine Tobaceo 3-202.11 PRFs Received at Proper Temperatures:;. 12-401.12 llische:rge:;From the 6yc�, Soso and -102.15 Packaee Integrity* I Month, 1-101.11 food Safe and Unadulterated 3-301.12 Presenting Cunnmination W sten Tastiuy'� � 6 j Tags/Records:Sheilstock 12 Prevention of Contamination train Hands 3-202.13 Shellslock Identification" 590004(E) Prevemirn;C0Wi11innati:rn hon 1-203.12 Eniployee�' 3.12 Tags/ ock Identification Maintained'` I 14 Handwash Facilities I Tags/Records: Fish Products j 3-'02.11 Paia.6� Destruction-! Com:enienfy Loc?.fed and Arcessb(e 3-402.12 Ret meets.Creation and Retention"' , 5-201 11 Numbers and Capacities" 590.001,+)) Labeling of Ingredients" 5 204.1 I Location and Pl.:cemcat` 7 Conformance with Approved Procedures I i 5-205 I 1 Acce<sibiliiv,Operation and NCUnienance fHACCP Pians SuophadSoap and Hand Dry:n9 Devices 3-50'2.11 Specialized Processing 4lethrxls* ' 6-30!.11 ,landsvashu,p,Clea,,ser.:lv,;i!abilit3 .3 502,12 Reduced nx}'gcu packaging,c '" [eria16-301 P_ Eland Drying Pori:.ion j 8-.03.12 Cunt'ormanee with APprcocd Procedures" I1'n de,cutic.d l,aa io th;led:ral 19++9 Pa:d Code or 105 i'p1t2,i9U 0(0 CITY OF SALEM BOARD OF HEALTH Y Establishment Name: 1 t Date: Cf I�-3/c�� Page: '2 of 2 e at Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ' 1 VDerified No. Reference R-Red Item PLEASE PRINT CLEARLY 40 d,)A-f05-W_ tae L16fT '21_�s Akrcl "/ 4 bridl -5 UurQl, r K (_5FHIIiC tJOOJ c IOC,/? AC M. IQGAIJ � � :I�I-,.on��r � ✓ ° r-2., 3:)1. 1�1 12 !)/)Q, A 4'01 An { �'�- (�^o��l � I)6-I�U.� I,JQa�'lIL7� - --f � �Or.�C r,n0•i],.ni �. l ' Y2'��l,li/ r�T •^1�1a/"' �� "'I�"�7G° P " - - / 1 � 'J v� `C� �OIA( !•U llc-I�St2on /0 '1�.NV� r_1hp n,.rwJ r'_tn�i ..n n/ car 11J—�St/2 Jv c' I r IJ,IP J AOP/MI1AO�i ��1� nA lll`Jddd3`�i- + Lirtv/— �/Piti1 '�` 7.rfYn71� �l hr�7rr�1 s �-�/ �.�ci- /L� �UG<.. '?i�n eel G?�.4� ��-=r2�r.( /A s•n "/�•v �fs,�r' J n �I LCL I � ,a!h'1r,.ftKtZ I / i/t IhlGrrArJrt�,nj ' X r Tin I �c n-� z...' . , - h � (�rri,-t-f Discussion With Person in Gfha'i Corrective Action Required: I ❑ No I Yes r ' I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance C] Employee Restriction/ v)olations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food C I understand that (((lc y noncompliance may result in daily fines of twe ty ive olla s or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: C - ,y 3 3r; 4(C) 1':"IF� Deceived at Temperatures Violations Related to Foodborne Illness hitementions and Risk Avco;ding,to I-aw Ca Aral to Factors(items 1-22) (Cont.) ?1+45"F ithin 4 Hours. ' PROTECTION FROM CHEMICALS I 3-Sol 15 I Cooling tdethods for PW�s 14 Food or Color Additives { i9 I PHF[!or and Coir,'I ioiantg 3-501.161 B; Cold PI-IF-,, Mamlained at or below ?-202.12 Additives' 590.004tF11"145°F. 3-302.14 protection from Unapprosed Additives' 3-50 Lt.4}1fiHot PHF,Mmintancd it or snout 15 Poisonous or Toxic Substances ( 14WK ., -101.11 Identifying Information-0:wival 3-SOt.I{:iA1 N.uast:,Held at or r�brre i30`F Containers* 7-102.11 Common Name-Working Conlainers" 12t) Tose as a Pebiic Hezith Control 1 7-201.11 Setrrration-Storage '-5'!1.[9 Tinxas,tPublic He_ddnCrai!& I7-202.11 Rcctricr,nn-Presowe and ihe* 590.004(H) Vat iance Requirement 7-202.12 Conditions of Use, I REOUIREMENTS FOR HIGHLY SJSCEPTIBLE 203"11 Tonic Containers-ProbibitionsI POPULATIONS(HSP) 7-20411 Sanitizert.Crirers-Chciniad,a^ I - 7-204J2 Chemicals for Washing Produce.Criteria" I ( 21 3-SOL II(A) Uupnsteurizca Preepackaged Juices and Beverages v;i yk,tr:ing Label!; 7-X04.1.1 Drying- al Foo.Criteria' I ;-801.111W C{se of Pasteurized Le)_n^ ( ',-205.11 Incidental Foul Cenlaa. Labncants^ ! 7-206.11 Restricted Use Pe.ctitides.Cnterin* 3-301.1 I(D) Raw of ,Animal Food and Rmv Seed;;orow s;vol Se:ve d. ,x 7--206.12 Rodent Bait Stauous" 1.I!(C) C r,penes a,d c acks;c icon Re-nerved 7-2106 13 Tracl:ittg Puwdrr�, Pest Canu�t,I and I Monirixing* CONSUMER ADVISORY 22 1 3-603 11 Consumer Ads isory P:,sted for Con<umption of TIMEJIEMPERATURE CONTROLS Aainwl Fonds"Phar are Raw. Undercooked or tfi I Proper Cooking Temperatures for ( PRFs Not Otherxice pr n.etsed to Eliminate 4-401.'.1Ail)(2) fag 15S'F i5 Sec. -g`i Eggs Immediate Stn-ice 145"F15sec� .1 13-302Yssteurirad} SUI)AAute for R.aw Shcll E e�`"3-401.1 1(1)(2) Comminuted Fish,Meats 8c GamEe ' ggsy Animals - 153T 15 sea * SPECIAL REQUIREMENTS 3-401.1I(B):1i)(2: Pork and BeefRuast- l3WI- 121 nim* ( 5,p.009(.1)-([;i 590.(`,09 kA)-(D)Ratites, Injected Meats- 155°F 15 V:olaticns of Section 5>O.OIi)CA)-(1?) in Sec.- I catering, mobile fiktd, tempo: d 3-401.11(A)k3) Poultry,Wild Game, Stuhecl PHFs, r-,nidential kit�heu operations should be j Stuiling Containing Fish,Meat, debited under the appropriate sections ! Potdtry ur Ratites-165017 15 sec. * above if related to ;oodborne ilhtess 3-401.11:C)(3) Whole-ruuscle,Intact Beet Steaks interveetions and risk flJorr,. Oti or 145"F'` 590.009 violations relating to rood retail 3-401.12 Raw Animal FoWs Cooked in a ( practices should be debited under/129- Microwave 165`F' Special k:;r,uircments. 1-401A I(A)(I)( )) All Other PHFs 145"F 15 sec 17 I Reheating for Hot Holding ( VIOLATIONS R._LATED TO GOOD RETAIL PRACTICES 1-403.1 I(A)&(D) PHF,, 165'P 13 sec. * I (items 23-30) 3-403.t 1(k) Microwave- 165' F 2 Minute Standho! C%tiload and non-criticai violations, ,,hich do no;i"e!ate to the 1 Tnm0- I Jnndhorne illness inten,erttions and risk fm tors listed above. can be 3-403.11(C) Commercially Prom sed RTE Food - Jerold irr!I!&)irllotvirg sec tinr..c of the Food Cone ini,l 1(A t'A7K 140'FT I 590.000. 3-403.i I(H: Remaining,U nsliced Portions oi'Beef I item Goon Retail Praetfres FC 590.000 Roasts' 123. Managorrent end Personnel Fi:--2 903 18 Proper Cooling of PHFs I 24 Food and Food Protection FC-3 004 25. Equ omen!and Utersils FC" 4 _,005 '3-501.14(A) Conning Cooked PHF. from 140'F h, 26. Nater. Piunnbinp a:a Waste F%,-5 006---- 70°F Within 2 1 luurc and From 70'F 1 27. Physical Facility C-6 007 ---_ to 41"F115"F Within 4 Hours. " 28 Poiso:.cut,or Trxic Materiels FC--7 008 j 3-501 I4iB) Couling PHIFs Matte From Ambient 29 Special Rrouiremerits 009 ! "1'emperatute ingredients io 41'17!45'F 30 Other Within 4 lloara'^ i,,rvrr Denote:;anneal iwm in the f Aerial 1999 Fond Code.,r I o5 CNIR 590 000. G CITY OF SALEM BOARD OF HEALTH / Establishment Name: T d Date: ( v,c Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R-Red Item Verified PLEASE PRINT CLEARLY r ��, �tnnT)QIM�, 9Ae F1.�r� A ,s �GcW .nc U �,�}v �. �1 c�s r��l�1 1_ s>Pr of r Qom! -in i cF, r rlr " IG / I �Q-P/ . US�/l -1T1iQM4aL-ta4rs CAi Pn �1�1Jnr {fro b -t- Q. IQUCcY�L2 . mist41A�1.2 � I ��: 1� vN n�0-a,.➢� c� ! L�_'let�tit ,n c._'�5'� A,)P o cl a� � f C'-I �ro c��ir J.4 LL � roc,-arr�,W artlL / . 1 I 1 j 1 1 1 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 L3 Voluntary Compliance LI Employee Restriction/ vinspection, to observe all conditions as described, and to Exclusion violations before the next ins i P -k----Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I understand that 45 noncompliance may result in daily fines of twen y"ive doll rs o suspension/revocation of El Embargo ❑ Emergency Closure your food permit. Li Voluntary Disposal O Other: .i. �54 ;_;n!.; I(<:) i 'HFt,iL'.c;_iwect rt'I'emperaIDres Violations Related to Foodborne illness Interventions and Risk l According to Law Cooled to Factors(liems 1-22) (Cont.) 4!'F/^^-5=(=-Wdhin 4 dour.,. x PROTECTION FROM CHEMICALS i 3-50':. 5 f Crxtlin;?L1c,i:,,ds for PHFs 14 Food or Color Additives i 14 I PHF Hot and Cold Holding 3-2{11,1.' A:ISitive." 3-501. below (`old PHFs Maintained at of beloI *IF^ 'i45° 3 302.14 Protection from Unapproved Additive;'" 13_SUI,If-.(4) Hol PRFs Rtailtaincd at or abgve 15 Poisonous or Tuxic Substances 140_z17x 17-I O l.1 I {eld at ur above 130' Identifying Information--Onglinal Ko;zts ;( ! '; ' + ( ) f. Containers' ! I 7-102.11 Comnn,n Name -Work.rnp Containers' 21p ( -imus a Public.Heahh Con?rol 1 3-50!.19 T'1,91e ac a Public Health Core,)°7:rOLii Separation-Stuff age" I ' 7-202.11 Restriction-Yneseuce and Use" 5'-11UU3tH1 b.n:ance Requireme:;l 7-20112 Coi.ic C n:, i Us.` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-'_03.11 'fu>.icCbntaincrs-Pn,hihitions'' I 7-204.11 Sanitizers,Criteria --Chemi:::+ls^' ! POPULATIONS(HSP) 4_$O : r- 7-104.(2 Chemicals for WashuteProduce,Criteria'' 121 - 1.11iA, Unpas.cuiredPre-packaged)u,cesand 7-204.1-1 Dr}ing:4gents.Criteria Bee:4t;,ges wltb WaningL.abels'r 3-$01,1 i(B) List-it l'aacutized Epp s` 7-205.11 Incidental Food Contact.Lubricants' 3.3{;,1.!I(D; Rrm nr Palially Ccx,ked A t:rndl mood and 7-206.11 Resnir ted Use Pesticides.Criteria%' I Raw Sxd Spmms A'ut Sec+•:d. " 7-206.12 Rodent Hart Stations` I - 7-206.13 'clacking , ltCi Unope,:ed F(xtd Package•N:•t Re-s'er.e(i. " Pov:ders. Pest Control ant. Monitoring, CONSUMER ADVISORY TIMEITEMPERATURE CONTI ROLS 22 3-603.11 Consumer Ath^sort'Posted nor Consumption of •Animal Foods"1'hat arc Raw,Undercooked of L6 Proper Cooking Temperatures for I I tRhcrwise Pn;cesscd to Elinunate PHFs 3--101.11 AI l)(2) Fggs- 1557 15 Set:. -3ir2.13 t'ar ieuri-red E,, e Jubstitute for Raw Shell Egcs-huntediateSenv-ice 145"F75sec* � I s. 3-401.11(A)Q2 mFsY Comminuted Fish, Mears&Gae I 1 Animals- I55'F 15 sec. ' SPECIAL FiEQU1REMENTS 3-401.1118)(1)(2) Fork and Beef Roast 130"F 121 min" 3-401.11(1,)111 P rotes,Injected Meats- 155`F 15 590.009(A) (D) Violarions of Sec-lion 590.009(A)-(D) in sec.,: catering, inobile food, tempo:ar} and 1 3-401.1 !(A)(3) Poultry,Wild Game, Stuffed PHFs, residernial kitchen open&tions,.hould he Stuffing Containing Fish, Meat, debited under tie;pplopriate sections Poultry or Ratites-165'F 15 sic. _' above if rotated to foodborne illness 3-40111(C)(3) \bole-muscle, Intact Beet Steaks interventions and risk factors. Othcr 145°F* 500.009-isolations relatim;to good retail o 1.12 Raw Animal Foods C<x+k ed in a ( practices should be debited under 1129 -- Y Microwave lu5`F " Snuciai Requiremcuts. 3-401.1 l(.A)(Itb) All Other PH'r's- 145"F 15 see. x 17 ? Reheating for Hot Holding ( VIOLA77ONS RELATED TO GOOD RETAIL PRACTICES 3-403.11tA)&(D) PlJFs165'17l5.sec. ;. ( (Iterns23-31)) ?-403.11(8) Microwave- 165° F 2 Minute Standing I Gtilt(al,ata non-critical vtolunons, ouch do rot relate to the Time" %oodhnrne ilhre.+c iMervenrtona urd rrsk./uttors tinted abo rz. (urn be 1 3-403.11(C) Commercial Processed RTE Fooel- I jound ip the joke,+-ir/q ow;ions q1 the Fond Cc•dc(nod 105 Cifflt 140"F` -590 000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC590.000 Roast,* ( 23. Manaperr,ent and Personne!-- -_ FC--2 .003 -coon -- 18 I Proper Cooling of PHFs ( 24 Foal and Food t'ro?st:un FC--3 ! .UU4 25. Equitemen+.and L tersi!s FC-4 005 3-5i)1 14(n) Cooling Cooxed PHFs from 140'F to 26,_ �t mhinQ argil 4'a=te FC-5 i .00b ----i _ Water,: I � •' 70'F(1,l titer 2 Hours and From 70'F 27 Physics!Fa-^ihor FC--6 007 to-11"F/45'F Within 4 Hours. " 28. Poisonods or 1 oxic Materials FC-/ .008 ,-501,14(f) Cooling PHFs Made From Ambient _29 -- Special Require^encs 909 'I'emperaUtre htucillcnts.0 4t"F/(IS'Fi_-_-_----� 30. G?her Within 4 Hours:` '1?onoter cruicc.1,tem m itis[.•decd 1999 Fool Code or 10S CM S9U OO). ..,,A A+-.,.aAn i.f.` - ..•�,f. ...•t } k Massachusetts Department of Public Health Salem Board of Health p 724 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name I Date f Type of Operation(sl Tyoe of inspection "7-1tFAI/I ,A„C /1r ;yg G��//f I ❑yoodService gyp-Routine Address Risk L E"Retail ❑ Re-inspection I /24wvarrw rF-' Lev I ElResidential Kitchen Previous Inspection Telephone 4 ' / ❑ Mobile Date: �vym<367 ❑ Temporary ❑ Pre-operation Owner I HACCP Y/N ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time 1 ❑ Bed&Breakfast ❑General Complaint In: I ❑ HACCP Inspector I rpv4a f 13 h�j,,f Out: Permit No. C]Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Mon-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 [:114, 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 TIMEfrEMPERATUREOONTROLS(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 0419 Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 0Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) _`S ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11.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 , 4 Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of � 5 Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.-Water, Plumbing and Waste (FC-5)(590.008) 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 SJUlnspecfl orm614 Joc Inspector's Signature w`,'} ,( ! Print:Print: ` t 1 Pager of 4 Pages PIC's Signature: �, I A f f)0 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamrhabon 1 590.003(A) Assignrnent of Responsibility' 3-302.)1tA)(I) Raw Animal Fonds Separm;d$ern 59Q.ut7sB) Dzmonstralion of Knowledge* I Cool=ed and R"1':= F,xxls` ( 2 10111 Peron in charge--duties Contamination from Hary Ingredients I 3-302.11(A)(2) Rai, Anima! i Separated frunt Each EMPLO"EE HEALTH I Other,t 2 590.0G 3(C! Responsibility of the person in charge w I C'entam.habon from the Enexonment j require rerordng by fed employees and 3-302.1 !(A) i cn:d PrntCCf oTjT ' applicants* j 3-302.15 Wash!ne Fruits end Gege!obles 590 00-YF) Responsibility Of A boot!Employee Or An 13-3(11.11 Food Contact tvnh Iryuipment and Applicant To I2rport To The Pet son In Uten::ilr" Charee r Gontamrna?ion from tlta Consurorr j 590.003(1 Rcportif;g by Person in Charge", 3-306.1 VA) [3) Ren::nod Fo,,d and Res,ivicr o Food^ I 3 590003(D) Exclusions and Reshictions* j I Disposition of Adutterated or Contaminated 500.003;_E) Rennnal of Exclusions and Restrictions j hood 3-701 A I Discardme or Reconduiumne l:n,,ak FOOD F 90M APPROVED SOURCE Fcv-d.. Food and Water From Rsguleted Source; ( j 9 Food Contact Surfaces j 99(},004(,1-H) Qnulrhance with Frwtl Lay." ( 4-501,111 S4anual bi'arewattn r,.1-Hot\Vater j 3-20;.12 rood in a I Icrutetically Sealed Container" j Sanitizau:»n f"nircrat 3-201.13 Fluid Milk and Milk Product.* 1-51!1.1 12 Mechanical Warewashing- [lot Water 3-?.(12.13 Shell Euw' S:unt;urtton TemperAmes': 4-50!.1 Id Che:mral Sanitize*ion-tewp., pH, 3-202.14 Eggs and Milk Products.Pasteurized" I concentration and hardoess. " j 3-202.16 lee 'clade from Potable Drinling Wter" I -6tH.1!(A) hynipmer.:hrKw;CcnCtct Surfacra and 5-101,11 Drinking Water from an Approved System° Uten!.il.Clean" ! 500,0061 Al Bottled Drinking!Vater" 4-602.11 Clean!ag Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CN1R 22 W Conlert Surfueuc and Iitencils j Shel'hsh and Pr'sh From an Approved Source 4-702,11 Frequency of Sanitization of Utensils and 3-2(1 L14 Fish and Recreationally Caught Molluscan ( ( Fo-.vu Canteen Surfaces of F:r,uipment Shellfish* 440.3.11 Methocls of Samtization--Hot\Vater and 3-201.15 llnlluscanShell fish hom:VSSPListed Cherrdc.d` Sources" { t0 ( Proper.Adequate Handw=_shing Game and Wild Mushrooms Approved by ( ^_301.1 1 Chan l'undiu"n Hand,,arid:`,rine'' Regulatory Authority j 3202.i tS Shellsux.k 1dentifieatiou Pre Sent= 2 201.12 I'nxedme,' 590,064(0) 'Wild Mushrooms' I 2-301.14 W11en to Wash' 1 3-2 J1.17 (Ian:enals� r I Ila Goad Hygienic Practices Anu * 1 S Rece?vingfC'ondiVon 1 2-401.11 Eating,Drinking of Usrn}_Tobaec r 3-202,11 PIIPs Reeci sad at Proper Temperatures* Discharges From the Eyes.Nose and 3-21,12 l5 Package lntecrity.a. 3 101.11 Food Safe and Unadulterated i 'A-301.11 Preyentirw,Contamination W9nen Tasting', 6 Tags/Records:Shellstock 1 ( 12 Prevention of Contamination from Hands j 590.004(E) Pre+'ening Cogronlination from j 3-202.15 Sf.ellstock identification' EmpioyeesA j 3-203.12 Shellstock Identification Maintained' 13 Handwash Facilities Tugs/Records:Fish Products 1 Conveniently located 13=!02.11 Parasite Destruction* I end Accessible 310212 Records,Creation and Retention` I 21 i I Numbers and CbpaciBeS' 590.00+1.!) 'Labeling of Ingredients' I 5-204.11 L:x.ffiialt and Placement* j 7 Conformance with Approved Procedures I J-205,11 Accessibility,Ope;a!ton colt Mam[enat:cr MACCP Pians I Supplied w th Soap and Hand D.rytog ,-502.11 Specialized Prcnes,mg Methods* ( I Devices 3-502.1'2 Reduced oxygen packaging,criteria" j 6-30!.11 liandwn:hinc,:leanser.Availatrilib+ 16-301.12 lt: d rin R-10 .12 Conforrnanee with \ppro,,cd Pocedures Provision f r.-n,4c,cntLal hem in the I-dc,al 1994 i C'cde or 105 CNIR 590 N10 CITY OF SALEM BOARD OF HEALTH ` Establishment Name: W1 /02r) 4x22 7s3 Date: �/ 4/� Page: Z of nem Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY V •" V 7hF G d 64/tNWtN&4- r taii..•t4 IeJ`A41O atal�/K2�Q: I -t— AfAJ I Zr G 6_&�0,%.or r I ?- ars ( % Af ./ Gkc . Fm of 2 �-! Irr�i^ - 6ik+eq [,�-�a�,s oisr�.a�.�a- abfl�*+ON VSs'; Gf7r�ur— o.G�l'cu,c� .rv2c-iSry I moon-, "Aw A+."h re erra ItoeL4-619 wr-r1.✓4-- 2.� Irli' - rlarax o,c .+s'P4+r$ �n-,�,•1,:f�'.r.- „ter Ir4,J!.�-t.,.r Cret,,,,�.1 �/✓s+,�' I Z 5_ t^-- 6 ALL' A,10.A f ,,lid 04r .6 ✓fA&, f I C /sept- OJGr /t„t;l .r vzifMl' dK- 12,ecl e . tIG't p P MK tv.J o a„A T At tart L,4ea?04) ra,ApJ I iL,r.A.r,adz f f✓d I 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/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ' noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. ❑ Voluntary Disposal LIOther: 3-50 .<,(C.) PHF:.Rec�ioxl ar T'eniperaturer+ Violations Related to Foodborne Illness Interventions and Risk According to Lary-Cooled to 1 Factors(Items 1-22) (Cont.) 11`F145'F Widtin 4 Hours. PROTECTION FROM CHEMICALS "' 11 3-51J I J 5 Cadin�Methods for PH Fs 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-50;.1 o"13 r Cuid Pf iFb Nl inhimcd at or below 1 3-20112 ASSitnes 3 30114 PIOLe6ltan from Uaapproted AddihvW 3-50j(116, l4ol 4c.F. 3-SOI.Ifii,9? Heil PHFs P.9mmaine-1,;t or above � ]g Poisonous or Toxic Substances � 1-10;.i 1 Identifymc Information-OrO,iind - -1.16( Roads I .,id at or above 13WE Contdiuers" 7-102 If Common Name-Working Containers" � ( "t(1 time as a Public li2alth Control 7-20111 Sepzration- 5trn.age.: ( 1 3-50'..19 Timc as a Public Iledhh Cori ' ( _i00.p04(Ht `dariancc R_•yuirement i 7-202,11 Restriction-Presence and Use 7-202.12 Conditions u! tier* 203 11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1 I S.mititats.Criteria-Chemicals' POPULATIONS(HSP) ( ',-204.17 Chemieals (01'Aashing Pl'OCILWC,Cn6sia' 1 2.1 ; 3-301.1 1(4) Lmnasieurizrd Pre-packaged Juices and Beverace;:with N araing,Labels^: i-204.14 Drying Agents.Criteria's � I i3-8'0;.:1(13•) Usetri('asteutizedEgis' 7 205,11 Incidental Food Contact. Lubricants* I 3-801,11 iD) Rave or Partially Ctkiked Ammal Food and 7-'_06.11 Restricted Use Pesticides.Criteria* 7-206;.12 Rodent Bait Stations" I2nai Seed 3ptt;uts?vt Served. " i 1 .06.13 hacking Powders,Pest Control and 3-Z{Ul.I 1 Unopened Food Pachag, Not Re served " i Monitoring'^ CONSUMER ADVISORY TIME)TF.MPERATURE CONTROLS 22 3-603 11 Consumer Ad\'isoty Posted b,r Cansualp6on of I Animal Foods Th.tt arc Raw-Undercooked or 1 16 ! Proper Cooking Temperatures for Not Oiherstise Processed to Eliminate Ee9SPHF ( 3-401..tA(I)(2) Eggs- 155,.E 15 Sec. Pathogens. I Eggs-htmrediate Se ice 1 ti5'F15sect 3-302.1 3 Paaeunied Eggs Substitute lot Rav, 15heli 3-401.11 W12) Comminuted Fish,Meats k Game Animals- 155'F 19 sec. s 3-401 l l(B)t l)(2) Pork and I3eet Roast- i 30'F 121 min* j SPECIAL REQUIREMENTS 5')0(1091 A) (D) Violations of Sectio, 590.009(A -(D) in -d01.tItA)t2) Rartes, htjectedMcats- 155"F' IS � ) sec, catering. mobile- food,temporary and 3-401.11(Ali 41 Poultry,Wild Game Stuffed PHFs, reside,^•tial kitchen operation;should be Stuffing Containing Fish,Meat, debited :meler the appropriate 5ecrinns Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 1 3-401.1 ItCl(i) ��'hole-muscle. Intact l3ecf Steak, interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Ru ds Cooked in a I pt acuces shca ld be debited under d.'_9 -- Microwave 115'F* Special Requireruents 31'01 I I(A)(I)(h) All Other PHFs- 145 F 15 sec. ;? Reheating for Hot Holding ( VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 1403.1 I(A)&,(DI PHFs 165'F 15 sec. ° I (items 23-3€)) 3-403.11(B) - - Mcrowave- 165'F 2 Minion Sfandima l Cri;i.,(d red non (ridcnt i iulanonv, hick do net relate to the Tmm" (oodburre W,vs.s iturrrervwnt and r.rk Jn<tars li,ru'J above "an be 3-403.11(C Commercially Ptucessed RTE Fail- i Jourd in die(ollmrigg seuinos ol'me Fo,,J C ode at;d 105 CAIR 140"F'' .590.000. 3-403.11(F) Reutaiuing Uushced Portions of Beef Item Good Retai/Pn<etices FG 590.000 j 23. Mana iemera and Personnel FC-2 003 Roasts'' � -- 18 ( Proper Cooling of PHFs 24 Fccd ural Food Prolectlon FC--3 004_ 1 25. Equipment and Jcns'rs F(': - 4 .005 3-501.1d(A) Caahng Cooked PHFs from 140"17 to 26. Wa`er,Flunih:nq 2^d Waste FG-5 1 006 7C'F Within 2 Hour,and From 70°F 2 - a. 7. 7Ys,r, Facility FC--5 ' 007 to 4!'F/45"F\dlan 4 Hours. 28. Poisonous or Toxo Materials FC-7 .008 j 3-50 L I4(B) Cooling PHFs Marie From Ambient 1 2i) SlDe,ial Reotarements Orly j Tempeiaturebtgredicrasto4l`F/45'F ! 30. Other - --- Within 4 Hours` *Denote,err.wvt item m th;,Weral 999 Font Code nr 05 C IR 590 000 c CITY OF SALEM, MASSACHUSETTS Kv BOARD OF HEALTH :9 120 WASHINGTON STREET, 4TH FLOOR l �to SALEM, MA 01970 9q = TEL- 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR, JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT June 17, 2005 Seven Eleven 126 North Street Salem, MA 01970 Dear Owner: On Wednesday May 25, 2005 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 16-year-old female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sate. Seven Eleven is in violation of Section lil(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section, the sale of cigarettes,chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of (ONE Hundred Dollar fine)for the FIRST offense. FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$100.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney- Please also be informed that you have the right to inspect and obtain copies of ail relevant inspection or investigation reports,orders, and other documentary information in the possession of this Board,and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 741-1800. Sincerely yours, i ' u J'aanne Scott Health Agent JShnfp CERTIFIED MAIL: 7003 3110 0005 1992 1417 cc: North Shore Tobacco Control Program Christina Harrington, Board of Health Chairman and Members t CITY 'O'F- SXL'EM9`lMIA'S'S'AC1HUSF-.TTS' BOARD OF HEALTH gf 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 111, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: 7-11 Food Store #22763 Address of Establishment: 126 North Street Owner's Name: Amjad Chaudhry Restrictions: Application Date: 11/29/2004 Permit for Food Establishment 84-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 23-05 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. vHEALTH AGENT y +ryry, CITY OF SALEM, MASSACHUSETT m2! BOARD OF HEALTH Il, + 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 IJOV 3 2004 1 FAX 978-745-0343 ±�' ¢ STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO 8 C�I / QF MAYOR HEALTH AGENT 0ARD orskM 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT HEALTy NAME OF ESTABLISHMENT 7-// /,:r2ad S4t9'P�e, TEL# '17F - 751V- 13© T ADDRESS OF ESTABLISHMENT /a6 61' &c&, l A1*6-5 01970 MAILING ADDRESS (if different) t4lA OWNER'S NAME A ,11�014 Gka"A) e� TEL# '191 - 9 3 d -,5731, $ ADDRESS A$ - 'S11�e+ CITY wabd2N STATE IMRSJ ZIP aA %Z) I CERTIFIED FOOD MANAGER'S NAME(S) Aw �s( e_ n\ rlkvg CERTIFICATE#(s) toe-0-$023/40 2- (required (required in an establishment where potentially hazardous food is prepared.) +i EMERGENCY RESPONSE PERSON ce q A 6r\wAArV a� HOME TEL# -1`' A- a S31 HOURS OF OPERATION: Mon.—Tue.—Wed.—Thu.—Fri.—Sat.-`T Sun. odL\ bu 92S TYPE OF ESTABLISHMFNT FEE check only RETAIL STORE YE$ NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 Q more than 10,000sq.ft. =$250 RESTAURANT YES ( less less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BEDIBREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT S RVE YES NO $5 TOBACCO VENDOR (� ES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge e of a filed all state x eturns and paid all state taxes required under the law Signature DYte Social Security or Federal Identification Number --------- -------- - ------ ----- -- - ---- ( n Revised 11/03/03 FOODA adm Check#&Date 7y) ids �")'� sz% Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name�/ Date// __ Tyt a of Ooeration(s) Tyge of Insoection / -/f F"nA A .Stf d/L� l l'1�5,tt01 ❑ Food Service ❑ Routine Address y6 I�A�r H Risk tail ®-R'inspection Level ❑ Residential Kitchen Previous Inspection Telephone ,7qq_`307 El Mobile Date: Owner HACCP YM - [:1 Temporary ElPre-operation /)-Mr-AD G1.W.C4 I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: [I HACCPI Ins ector O Permit No. E] O herr P �/�r�i(1 /rLrS-,cK19A...M I Out: Each violation cfiecked 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 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling '; PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 99 Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 21. Food and Food Preparation for HSP El 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 r_ Health. 590.000/federal Food Code. This re ort, when signed below C N 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 5. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 25. 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 a4 the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. - 30. Other DATE OF RE-INSPECTION: S 5001ns OF.l6-14 dx Inspector's Signature:-„- , ,.,,% „A / Print: p PIC's Signature: -ter .i w !✓'^ Print: CA F 10A P Page�of Ages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g C+nss-conta,ain.tion i 590003;A) I .4ssigntnentofReeponsihifity 3-302.11(_P)t-I) RnwA i;;alFoodsSeparated !Yom 590.003(13) Demonstration of Knowledge* j Cooked and RTF:Bx-ds- 2-103.11 Person in charge--duties j Contain radon from Raw Ingredients j 3.302 11 WA t?) Rat, Animal Foods Separated from Each I EMPLO"EE HEALTH Other' 2 590 00'2(C) Rriponsibility of the person in charge to Confamlydtion from the Envirom-nent requite reporting by Food employees and j 3-302-.11 tA) Eaod Prolccnon" j applicants^ 3-302.15 l'rashma Pruitt and Vegctafifes 590 UO3(F) Rceponmbilily Of A Food Employee Or An 3-304.11 Food,Conttct with Equipui-m and I Applicant To Report To'Che Person It ( Utensil.'" Chat„e� Contamination'mm the Consumer 590.003(6) Reporting by Person in Charge" I 3-306.14(A)(B) Returned Food and Reseteice of Frn& j 3 590003(,0) Eeclusionsand Restrictions* Disposition of Aoulte+ated or Contaminated 59200?+F) Removal of Exclusions and Rcstriction., ( Food ,i-70111 Ufscardiug nr RcconJitimm�g unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water Fcorn Regulated Sources I 9 Food Contact Surfaces 590.004(;1-F1) Compliance with Fond Law" O-Sul.! !I Manual 1\'arewashme-Hot Warer "; 201 12 Food;n a I-Icrmetically Sealed Comainer' Sumi)zation-ietnperatures' i - 4-56L11.? Me::hauiud lA'arrwasbing-Hot \Vater 1 3=201 13 Fluid Milk and Milk Pioducts* Sauitizanon Temperatures' 3-201.13 She]! Ergs' - o. 3 2t)2.!4 Eos-,and Milk Products, Pastcarizsd` j 4-50;.1 14 C}iznuccl „anitizatinn-taup. pit, j j t;,nccr'a:ation ;nd ttardne.;. " i 202.16 Ice Made Froin Potable Drinking-W inni" 1-601.11(A) L-quipmenr Fond Contact Scrfa(es and j i-101.11 Drinkurn Water from an Approved System" I UtenstL Clear* i90.006f A) Bottled Drinking Water" ( ( 4-602.11 Cleaning t-'r c.yuencyot Equipment Food- 590.006(8) \Pato Meets Standards in 310 CMR 22 0` Contact SurPsdes and tltzn>tls' .4neBish and Fish From an Approved Sootoe - d?172 11 i'requenc}of Saniaz.nicm of Usenti L,and 1 3-201.14 Fish and Recreationally Caught Nlolluscam Prod Contact Surfaces of F,quiprnenr^ j Shellfish* 1 4-703.11 1-rerhods of Sanurzatrun-- Hot Water and 2UL15 Molloccan Shellfish floor NSSP Listed 1 Ct:mnicalT Sources I , try ( Proper.Adequate Handwashing Game and Wild Mushrooms Approved by ( Regula/cry Authority j 2-301.11 Clean Condition -H nits and Arm>� j j 3-201 18 Shellctock Identification Present* --'01.12 Cleaning Procedure'" ! 591)i'04t C'} Wi!d Mtic}vpnmsT 2-3UL14 %N lien ro Wash;: 3-211] 17 Cr.nue Ammak^' Good Hygienic Practical j g Receiving/Condition 1 2=101.11 Laing,Drinking or Usme Tobacco* 3-?(12.11 PBfn Received it Pr,,pet Temperatures" ( 2-401.12 Di.schnrg_s From the Lyes. tips_and Mouth*3-20'_.ii Yacka¢e htugrity* ( 3-301.12 Preventing Contaminatiirn When Tasting"' 3-101.11 F,wdRafc and unadulterated'" j fi Prevention of Contamination ficin Fiends Tays/Records:Shellstock 12 3-201.18 Shellsa>ek Identification' j 590.004(E) Preventing Contamination from 1-20.3.12 SheP,tock Identification Maintained* Hand-wash TaoRecords:Fish Products l•' Hand-wash Farilitiea 3-41}2.1 Ps'ae.ite Desnvction' Conveniently Locared and Accessible j 3402.12 Records.Creation and Retention"' i ( 5-203.1 I Numncis and Cap.:oine,," 5-204.11 Locahcn and Placunent"' � 590.001(j) Labeling of Ingredients" j , i ( 5-205 11 Acoacsib,!ity, Operation and :Plaintenance i i ) Conformance with Approved Procedures I I Supplied with Soo{u ano hand Drying lHACCP Plans Devrc:es 1 3-502 11 Spectahzed Procesaug Methods' x hi,> Availability 3-503.12 Reduced oxygen packs;; enter : 6-.01.1 I Nandt,as. ,t-Clezmscr. ,. }� mg, ia" 1 6-101 A2 f{.�-d [;- 3-103.i 2 Conformance with Approved I tocedurel n Yrm.. s;ix: "Ps11wfu>ennead item in thy,L(tial 1 11,)9 loud Code or 105(WR 50,1010 CITY 0i7-SALEM BOARD OF HEALTH Establishment Name: Ir-d049 CrA`llg� Date:- 6�Z3�a/ Page: Z- of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I I ✓ 1,[__ eJr_ -,C,i o/f A ( A47-7 t) -9 C__4CT n I � ,ai!�. Putvr ,4*4'c 13 g:14z; r4 Cv(Kr' Cris 1 CIdAf04 old Cl I ; I j L 1 I � I Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled El 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 1 ❑ Voluntary Disposal L3Other: r 1.1 If I PHFc Ro_ened at I eni Violations Related to Foodborno illness interventions and Risk ptrature,; Accorlt'n-1 t�, _m Corded to Factors(Items 1-22) (Cont) 41 T/451 F Witillir,4 Hours. I PROTECTION FROM CHEMICALS 1 3"7(1:.'5 CoohroAl Methods for PH Fs Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B,, Coid PHT`s I'launwried t vL belov, 3-202.12 AdditiNes 3-302.14 Protection fromUnappooed Additives" _90,if 04(F) 41�145' 4'W 3 5C.,I INA) !lot F`4f`� Maintained;�r nrabwo� 15 Poisonous or Toxic Substances i ' i I 140"F . I 7-101.11 Identifjing Intointation-Original 3-5M I("(A) koastc Held at or aboxe 130"F. Containers- 20 ':'time as a Public Health Control 7-102.11 Common Name-Workin-,Containers' 7-201.1 Scoaration-Stonaze! j-501 19 Time a Public 14�,alth Cla�!zo'v 590.00,41H) Variance ReqUirCluCilt 7-202 11 Restriction-Prest-rice and Use* 7(13.12 Conditions of I Jso' 7-203 11 Toxic Contairwrs-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sarnivers,Critern,-Chenocals* POPULAT5ONS(HSP) 21 3-801.1 IIA) Uapas,cunzcd Pie nackaged JWLeS 811d 7-2(ei�12 Chemicals for Washine Produce,Criteria' Beverages with Warning Labe 7-204,14 Diving Agents,Criteria 7-7-05.11 incidental Food Contact. LubrfcamW 3-801.1](B) Use of Fanttunized Lt,�slz Cook 7-206.11 Restricted Use PestiLides.Criteria* WI 11(D) Raw of Paiti,11 %, -,(,' Annual Frioll and I3- 12 1w Seal Sprouts Vol Sol wd. " I 7-206.12 Rodent Bait Stations" l !-,SO 1.11(C) I U�-orwned F'o,.)c Packwz,�Not Reserved. C 7-206.13 Tlack Ing powders.Pest Control and klonit(ain',O - CONSUMER'ADVISORY T(MEfTEMPERATURE CONTROLS 221 3-603.11 CongllWir Advisory Pt,sted lot Consumption of 16 Proper Cooking Temperatures for Animal Foods gnat are R�4w. Undercooked or Not Cthltrvice Processed to Fliminate PHFs I'll"00, 1-401.1 IA(I)f2) Eggi- 155�17 1:5 See. EL,,�,_s-Ininiccliate Sei,.icc 145'F153ec� 3-102.13 Pa!oeurized E,89t Substitute vol Raw Shell 3-401.1[(Aa21 Comminuted Fish; Wais&Game EPI-st AaiTflals- 155-F 15 sec. 3-40 1.11(Ii);;a 2) Pork and Bed Roast- 130"F 1 11 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, iniccied Meots- 155'F 15 590 001)(A)-(D) Violations of Section 590.009(A)-(D)in sec. catering, mobile food, temporary and residential kitchen operations should be '01.1 I(A l(3) Poultry, Wild Game,Stuffed P?-tis. Stalling Containing Fish, Meal, do hited un",;-the appropriate sections Poultlycal Ratites-165`F 15 sec. :ibovc ifreiu!td to f(y,)d'bor; illness 340,LI;((')(3) NNTtole-muscle,Intact Beef Steak. interventions and risk factors Other 145`F'- 590009 viijla1iow;rcla:in-2 to good retail 3101.12 Rail Animal Foods Cooked in a praCLICCS S11011W be debited under(29- Miciotvzoe 165"F:"- Special Requirements. 3-401 lliA);I)ft) All Other PHFs- 145'F 15 see, 17 Reheating for Hot Holding VIOLATIONS RtILATED TO GOOD RETAIL PRACTICES 23-3 3 ( lril; 0) ,-4113.11(AWD) PHFs 1650F i5 sec. * 11 tei 3-40111(H) Microwave 165"F2 Minute Stcualing Clittral ondnon-ciltical n;9'f(rmwv, whR.h do not re!aie to the Ti mc'` foodborne iflne8s inr(,rveniwms and risk.ht(cors liyfcd above, (rn be 3-403.1 Commercially Processed RTE Ford- fourd ifr, the foliotf inq switom oftb.:Food Co&-andlu-5 CWR 140'F- 590.000. 3-403A 1(F! Remaining Unsliced Portions ofBcef i item —doext P,,tsuracticos FC 1 590.000 Roasts` I 23. Manademeni an,'Personnel FC CO3 tg Proper Cooling of PHFs 24 Food @fill Food Protection FG-3 .004 25 Equipment and Otonsils FC-4 005 Cooling Cooked PHFN Imin 140"F to 26, W ater,Pluabinq and Warta FC-5 006 7(,t'F Within 2 Heart,;)fill From 70`F 27 Phvsicsl Far!lity FC-6 007 5 to41'F/45'FWithin 4 Hours. 1 —pol 7 0;0�US or Toxic matei:ais FC -7 008 -501,14(B) Cc)oiin,,,PFIFs Made Flout Ambient _ieouwemfalts 005Tcnipetature hi&Tedients to 41"F!45 F jo, ler Within I I lours* Den,ae%�:rnitalilcni in lh:f&ral 10119 Food''ode or 105(AW 590 000. r . 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 Datep Tyne of Ooeration(s), Type of Insoection ?-It r-000 .Twvl& Date Tyne [❑� ,�F9odService &R�ne Address �� A�AF Risk 8-Retail ElRe-inspection Telephone Level El Residential Kitchen Previous Inspection auy, &lw7 / 4 EI Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation Atw 9'AO C,IlA4j6 Al ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP Inspector LUtA ~,CNAAIA Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Ir V 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 [3 1. PIC Assigned/Knowledgeable/Duties 3 Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS E] 2. Reporting of Diseases by Food Employee and PIC E] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals d['hn ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentially�F?a£ardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans E�l, 18. Cooling PROTECTION FROM CONTAMINATION - L&VI9. Hot and Cold Holding ,( eparation/Segregation/Protection El 20.Time As a Public Health Controlrt Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY �rY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 3 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board 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 01 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation-of` (FC-4)(590.005) the food establishment permit and cessation of foo� � (�t 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this oral r, yo 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must b�i fit n 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the a ove abdr s 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S svoinsMe'rFomb-io em Inspector's Signature:i -�-A A..�� ` Print: .A�f�_ %rt/ 'I PIC's Signature: f 4�1r� Y _ r J" g Prink `�A F tD,(1 �yr� I Page of a es 7Jt17 1y ici �,` Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECT ON FROM rONTAMINATION FOOD PROTECTION MANAGEMENT i 8 :"Wss-Gonf:lmb la ton Ass,u�tnrent of Rcspnisibililv' :1-302.11(A)(Y) Ran 'Anirn�: Foolls separartd eon i 590.003113) Cooked and RTE Foods Y .��d M-3.1 pe7s��Ji in cfiar"e duties Cxy,'arni- ft,7 Irum 3-302.;1(A)(2/ Rxw Annnl F.rods Sep-,raic I from Etch EMPLOYEE HEALTH Othcr 2 590.003(0 Responsibility id the person fic-hate.to Con.-ami,-:aiion from rhe Enllimr,,,cnl require toporling,by four}mriplo)eei'An., 3-30'.-I(A A protecdo:' 3-302.15 Wahine Fruits sod V,,,tabics 590.0103(F) Responsibility Of A Fo,>,J Employee Or.,kn 3-304.11 17•:•nd C:-.note: and ."Pphcant'ro Rcp(rn'ro r1w person In uqens;l'-: Chance" froin!he Consumer 00316; Keportitie by Person in ChafLe* 3-3a)6.14(A"-i 011 Peturned Fou-: trod R,.,sej-Jc- r,�Fa,1j 3 59000.3(D1 Exclumons and Rcsrrictions* Dispositon of AdultarEled or Contaminated 590.003(11; Renunal of Ekclusv,--s, and Re^,trwlmus Food JLI I Discarding or FOOD FROM APPROVED SOURCE I Food, 4 Food and Water From Regulated Sources 9 Food Contact Surfaces I 5,'N0 01A(A S) Coninlinvice wit)) Food La%\ Eot Wat-,r 3-201.1 Food in it ni Heretwaily Scaled Cont,�!ncr�� r.iti7ation Tem p,,ratures 4 ;01.1 2 Nfeclinnic,0 Wniewa.shing-Ilot NIVatet 3-201.13 ��Itiid Milk and Milk Frodnct�� 3-202.13 Shell Eg-110 1 1 5u LH 4 Cherinic'! terrip., IFI,3-2-02.14 F'Tsand Milk Products Pasceunzed' I-2t112.16 Ice Made Fruit Potable Drinkin,,Water" cvnccali'raoion and hadness. ;'' n 5-11(01.1 I Drinkin�f Water front an Anprnved`�yscmi' 1-601A((,At ELlaipment Food Contact:-,tutficu+and Ljtcr,-,ils cioan- :iX).!1)06tA) Butle"i Dr:;1kjngWu1Crr -1-602.11 Clc:w;-2 Frequency.)i Ir'l(upmena Food- :i%006fB) Wawr Meets Standards in 310 CMR 22.04 She,'Ifsh aid Fish Froman App,o,od&,�,rco -ortact S�irface,, aid Utcn�fls�' 4-702. F*caocncc,,1,'S4-izatjcn of Utensils and 3-2()1.14 Fish and Recreationaliv Caught MOHLISC311 Food Con;qct Sur'l-evs Of&JUIDDIel 4 il)3 i Mc;hxc;LA Sanitization-B,l Water and 3-7(1 15 Molluscan Sliciffish from NSSP Listed fieultcal-* sourcdO Proper,A-2equate Handwashing t�crro and WildMushrooms Approves by Regulatory Authoritt, Clean Condition--Hu.6;and Arms" 3-202 IS ShelWwck IdIcnt'jication Pmsnitf -leaturl'. Pm-'01111'2' 30 1.14 Wbtrn to Vva�V 590.0,340 Wild Mushroori,s^ 3-101.1'r Game Animals" Good Hy3ienx Practices Receiving/Condition 2-401 11 FatimK,Drinking or tl,,ing Tobacco"' 3-^02-i i 1111Fs Received at Psojlcr'rennpetatutts* 2401,12 Dbchacgzs Fion:Jhe Eyes. Nona.rnd 3-202 115 Package Integrity' Ml'uth� }-101.4i FW)d Sate;;rad Unadulterated ;;-301.12 Pr-,.entaig('Culmurnatiou When'I istint0c 6 Tags/Records:Shellstock 12 Prevrrifirr.of Contamination from Fiends "102.i's Shellstock Id-zinill,.ation 590.00 1(E) "f-'enting Contamination 1]011), 12 Shell oo ldenfifi,ationMairnaincdl Tags/Records: Fish Products Ha-dwash Facilities 1 � 1 -;onvm7i, and Arcps 3-4W 11 PafaE'tc Destruction" 3-40112 Records,Cteat;,ai and Rfrertinn* 590.0:)41,1) LabeHng of Ingredients' F'ocalion""ng • 5-103A 1 ACcesjjji, CI, jjUlation and Mainlemin.x 7 i Conformance with Approved procedures supph-11 Soap 30d Hod Dr�lrly /HA(,C.P Plans 1 3-502.11 Specialized Processing Method]* I I H.,indwa;hring C 3-5u2.12 Reduced oxygen packogim, cnteri-� l;anser, Availability I�I Pm'd Drving Prc,ision 03 12 Conferinance with Approved Prouedurcs;' fienoic,umical tt,ni in;!:e tedeiA 1999 Food C.&oi [()>I-Alk 590,0W, CITY OF SALEM BOARD OF HEALTH Establishment Name: '7^ 11 KOvR 5'ibkog- Date: G1iSAV' Page: Z of Rem Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONDate 1 No. Reference R-Red nem Verified PLEASE PRINT CLEARLY C7z - Feu�,w,,.c /,-�N+r y. �s �., .,rn vas.- rte. r.�i, ,�✓ vers: 2 . M,A40 c6. WWI P. d tr{'64 - MUIT- C.G.e9S6rt/ r4df41Fh& A-lk/'i A&r- .dv raillmr . I I Is /3Aoty rt;A411f&0 A+rD t tt,erAr r �,� rG�Pt.Fc.E 6t�ri7'/+✓li~ /5aa�tlkJ_ \ 1er__r,ifs rcd t.e u.,.t t s e�,c i" tnN-s r j I ?� n/�C. ��O,nt6rrg— UNt1" M�rs.e�ra rel�-Mp.v16`aC,C.. t�KalA�]<� .UIQI�LcC-� 3 r•, _ .r ta 9I4t 4F �.�.t W0&,ntsd rjt1A• sv,a�rtyuUs - Ag1 tJ atlf/3, ..4-.— wt1,& rdAtfotArAr rt S'r Kx A-f+ At lf- i-wik S Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled L3Emerrgency Suspension c comply with all mandates of the Mass/Federal Food Code. I understand thaty ' noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other If S �� r t.', , t I � FHR, Res era ed at'I eml,eatures Violations Related to Foodborne Illness Interventions and Risk Au• ,,dint,to Law CM&d to Factors(items 1.22) (Cont.) ;1-F/aS`F'Within 4 Hour.,, PROTECTION FROM CHEMICALS - "IS Coolim,,Method,,for PHFs ;.t Food or Color Additives 19 PHF Hot and Cold Holding 3-30L,o(B) Cold PfiF,Yl,;:olz;nedatorhelow i 3-202,12 Additives°` R'14(17) 3-302.14 Protection from Unauproved Adidmvea* 3-501.1(11 A) lin, PI?Fs iWaimm aai at or abuse � 15 Poisonous at Toxic Substances 140'F ' 7-101,11 ldentifyme Information-Origiea( -501 16Uh) Roasts Hehi at or nhovc 130"1 Containers' 7-102 11 Common Name-Woikin^Containers"' 2{i Time as a Public Flealfh Control 7-.'.01.1 1 Separation-Storage' 'forcas :PuhlicHe:lthContr,v',* j 5o0.OGU H) I Varancc Rrgvircment .. 7-_02 i Restriction-Prscncc and Use'r - 7-202.12 Cond!tions of Ise' 7?03.11 Toxic Containers-Prulnbaions" REOUIRE MENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 ( Sanitizers,Criteria--Chemicals, POP ULA CIONS(HSP) 0 1 21 3-SC!.::L4) U::pasieunzed fare packagedJ aces and 7-_04,1_ C'hemicais for Wishuie Produce;Criteria Bever:tyr,wrth R'arninglahrla 7-204,1-4 Crying.Uents.Critcric.'" 2 ;-80LI I(BI 111te M Pas:euri7er "apS` 7-..05.11 ! o,;1rinta! Food Conlan.LCriteia' 13.801.1111?) ! Raw or Patusih•Cwkod Animal Food and "_'06.11 Restricted Use Pectic¢les.Criteria' Rdw Seca Sprouts Not Sorted. 7-206.12 Rodent Ban Stations' '-206.13 'I'rackmg Powder:,Pest Control and 3-801.111 C; Unopene:; Fcrd Pucka,=,c Not Rc served. ?W4unitorin;:* CONSUh",EP,ADVISORY TIME/TEMPER ITURE CONTROLS 22 1 603.11 C,msumr Ad nsor} Posted for Ceusumption of Anlnml `rood, Mat are Rau,. Undercooked or iii Proper Cooking Temperatures for Not Otherwi!c Processed to Eliminate 3-401.11A(1)(2) Eggs- 155'FIS.`iec. PHFs Pflih gellti^'011 mw vs .20111 Eggs-Immediate Scrvice 1 d5°i'15sec, 3,-302.1 l i?nsteurimd F,gga Substitute for Raw Shell 3-401.11(A)(2, Comminuted Fish,Meats&Garlic I Animals- 155'F 15 sec. + SPECIAL REQUIREMENTS i-401.11(B)(i)(2) NA and Beef Roast- 130'6 121 min* _x01.1 I1Alt2) P.�anrs, Injected Meats- 155"F 15 590.009(A)-(D) Vooiations ol'Securin 590.009(A)-(D) in It .. catering, mobile feud, temporary and 3-40IA1(Ay'i) Poultry,Wild Game, Stuffed PHFs, t.sident:a! kitchen operations should be Stirling Oa taining Fish,,Meat, _ debited unuer the appropriate sections Poultry or Ratitcr-165017 15.crc. ,ibove if rel.)tcd to foodborne iP,n:•vs 3-401.111(')(3) Whole-muscle, Intact Beef Steaks inter,enuons and risk factors. Other 1 450 a- - t)O.OU9 W-io{ations relating tc f>wyd IT 3-401.12 Rats Animal Foods Cooked in a practice,should be,debited under N29 - Microwave 165"F* Special Requitentents. 3-401.1 1(A;(l hb) .alt Of icr PHFs-- 14�'F i 5 sec. " 1; Reheating for Hot Holding VIOLATIONS RcLATFD TO GOOD RETAIL PRACTICES 3-403.11(A)&CL)) PHF, 165`F 15 sec. '' (€tains 2'-30} i 3-403.11(B) Microwave- 165°F 2 Minute Standma Cwical and,ann-triecul wf,la ums. wbich du not relote:o the Torte* foodborre iilroas.; and risk 1a;!ors listed above aan be 3-403.11(C) Comtnen.ially Ptaccssed I2TE Food- &Wad in rite tenon lag s:rtionr^f the rood<ode raid 105 (MR 140''F" 90.1100 3-403.11(E) Remaining Unsliced Portions of Beef Item I Good Retail Practices FC 590.000 ; Roast," 23 blanaaem—t anC d Personnel PC--Z .003 ---� N. Food ar;ti Fond Protection F^-3 tiff Proper Cooling of PHFs .0'14 25, Equpmrnt and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PFIFs front 140`F to 26, Wafer,Flumoinq and Waste I=C-5 606 70`F Within 2 Ffourc and From TOFF ! 27 = Phls:cal Facility FC-6 007-- _j to 31`F/45"F Within 4 Hours. " 25 Poisonous er Toxic llate,ials FC--7 ''i .003 3-5UL 14(B) Cwhn PHFs Made From Ambient 129, 1 Spacial Requawnents Oo4 'I empet'alme Ingredients to 41`F/45"F L 30 __1 Within 4 Hours" .:•o:, .,nK ,..:. Dwoie>int cal irzm in the Ieueml 1999 Fac*1 Code or 105 CNilt 590,into. CITY OF SALEM JJ BOARD OF HEALTH Establishment Name: 7- L / 11110 s)f"ettllc Date: 414,�I15a Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item Verified 11 PLEASE PRINT CLEARLY 2� � -' A s�Mtr.Z-+/�.RI— sv�•�Am !✓ oI¢ !-�i��!°a�- cCarle5Nri4K-r dl✓ ,�Ao�Y'7�4��[�S� r"rfoll/T A-tr w-w .1#4x - t ,z _ cA v;tA .Q I✓o 1f• t+ r- r ifmo-t A,- CvF`&& _Twwzsl✓ 6 or nm." r-il wdt1 rC i G4r t9 M u or A& L .k- �.,Jli CA/6 F op- Aga-a • I � — Q A v-o"old,ii — Frena cG,041li — AX-Aa v vn &J-r r-afor 1 i Discussion With Person in Charge: Corrective Action Required: ❑ No I El 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 Z3 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 dd Ilars or suspension/revocation of ❑ Embargo s' ❑ 'Emergency Closure your food permit. /J // ❑ Voluntary Disposal ❑ Other: i�— 3561111. PHFs Recel4ed at'i'empetatures Violations Related to Foodborne fitness Interventions and Risk According to law Cooled to Factors(items 7.22) (Cant.) 11'17/15':'Within 4 H:;urc. PROTECTION FROM CHEMICALS 3-SOi.,S C1o:; ncMcl';odsfor PHF� 14 Food or Color Additives i 14 PHF Hat and Cold Hoiding 3-501 Cold P111-s Maintained at or blow 3-2,02,12 Addidws* 590.)0 ( 4) 3-302.14 Protection from Unapproved Addjtivrs`" 3-507.161. ) Hot PHF:A4ai:ttained;tt or abo e is Poisonous or Toxic Substances � 7-101.11 Identifying lntorm.aion-Original ;-5(il.K,(AI Roasts Heid at or above 130'17. " Cnmainers" >t) Tim--as a Public Health Controa 7-102,1! Conunon Narue-W'nrking Container."' : ' :1-501.17 7-im::.:.:a Public Health i_oni:o:'" i 7-201.11 S.patation-Storage" 594;,004(1-1) Varianec Revateutem 7-202.11 Restruawn-Presencc and Use* 7-202.12 Conditions of I ase` 7-'_ :3.I 1 toxic Containers-P oiuhtl,un:," REOUi NTS FOR HIGHLY SUSCEPTIBLE 7-204.11 San;tizeis, Critcria-C'hcrincalsa` POPULATIONS(LV- U (vuni 7-202. 12 Chemicals for Washing Produce,Cnicria ! 2g 3-?SU I 11(-t Urpastc^a:-ved Pie-packaged knees and I Heve:nges ti ith Warning I.nbeis* � 7QUd.l-1 Drvmg.'-vg.ents.Criteri:t"" ' ( 7-205.11 Incidental 3-801 t i(K) Use or PasteunzeIncidentalFo,xl Contact.LuMreants• ( 3 SM l i(Dt Raw or Ya,ti:81v Cv&ed Ainpial Food and 7-206.11 Restricted Use Pes6cules.Criteria* ' Raw Seed Stn rnis Kna Burred. 7-206.12 Rodent Bait Station;" 7-206.!3 'tracking Powders.Pest Control and I `-Sill I1(C) U::epened Pa>rx{Packs„n.NoRr-sen•ed a Monitor:r-, CONSUMER ADVISORY TIMEITEPAPERATURE CONTROLS 22 3-603.11 ' Consutncr Adtiisory Posted for Consumption of 16 Proper Cooking Temperatures for -'r'ituai h;"'cs'i'hat N.aw.Undercooked or PHFs Not Cuh:x,•,isc Processed to El;oi^ate Poi h,n+.: ?401"I 1A(U(2i Eggs- 155IS Sec. Egg)-hnnnediate>ervice '•45°P75sec^ 3-302,13 Pa.teur:'rdg' g E g,Substuute for Raw Shell i n-401.11(.1)(21 Comuunuted Fist:,A4,ats A Gante Eels" Animals- 155F 15 see. SPECIAL REQUIREMENTS 3-401.11(B)(1)(21 Pork and Beef Roast- t30'F 121 men* 540 o04(A)-t D) ViOICIUCUIS of Seeglon :590.009(A)-(D) in 3-401.11(A)(2) Katttes, Injected Meats-155'17 15 sec. ': catering. rnnobile food- temporary and 3-401"i i(A)(3) Poultry,Witd Game,Stun'cd PHF's, esid..,atial kitcucu operations should be Starting Cornauiing Fish,Meat, debuk-d under tate a?plopriate sections Poultry'of Ratib;s-165'17 15 see. "` above If relalcd to Wdborne ilhic.s5 3401.1!(C)(3) Whole tnoscle,httad Beef Steaks mtetwritions and rick factor,;. Other 145TF* 590.009 violations relating to good retail 3-401.12 Raw Animcd Foods Cooked in a piav ices should be debited under 4i29- Microwave 165"1- * Special Rcgctiremems 3-101.1 I(A)00) All CRhcr PHFs-- 145"F I S gee. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.i I U1)K(D) PHFs 1650F 15 sec. '* (items 23-30) 1 =-103.1!(B) Microwave- 165°F 2 Minute Standing Giin•.rti i and ac !•'n-c riLcat t•io, r,rnr.;, rid,;,_h Jr riot relate to the Time* ,frodh.,rnr inter rewiaas and rick(h,,ur•,listed above, ran he 3-403.1 i(C) Commercially Processed RTF Food- frentd in the following seeiluns of the Ford Undo and 105 CbIR 140'F" S9U.000. 3-103.11(17) Remainine Unsticed Portions of Beef I Item Good P,r- i practices FC 1 390.000 Koasis" V 23. 5nanacement ane;Peasornel FC -2 1 .003 Proper Cooling of PHFs 124. Food and Food Ptotectioa FC-3 : .004 gg 3-501 1 dtrl) Cooling Cooked YHN front 140°F to 0.25. Egwpment and Utensils FC- 4 005 2Water,Plumbinq and Wasp,.. FC-5 .(103 70°F Within 2 1four;and From 70'F ( 27. Physical Fariidy FC-6 007 u)4 I"F/d5"F Within 4 Hours. ' 28. Poisonous ol''i oac tAafetiais FC- 7 ', .008 3-50t.14(B) Cooling PHFs Made From Ambient 29. Special Regwremeni. .009 TempeaatureIngredients todl`F/45`'g 30. tither Within 4lionr0 Dtwat r enuc3l icon in the arder:al 1999 Fond Cade or 105 CMR 590 000. ELEVEN �o 500 Myles Standish Blvd Taunton, MA 02780 April 19, 2004 Joanne Scott, RS, CHO MPH, Agent 120 Washington St, e Floor Salem, MA 01970 To whom it may concern, r -- --p As Quality Assurance auditor for 7-Eleven, Inc., I am Inquiring about your standards of keeping coffee condiments (cream, light cream;'milk) at a temperature of 41 degrees or below. Please provide any information concerning the requirements in your city/town regarding milk/cream displayed on the coffee bar. The information you provide will assist 7-Eleven in taking`the necessary steps to be in compliance with state and local ordinances. k - __-® - ' Please send or e-mail the information to me by,May 15, 2004;as I would-like to transition any ofou y to fes that are not in compliance as quickly as possible. ill 11' }'t ��4l _Thank you, 'y MIA- Nicholas Weston Quality Assurance auditor Phone(800)242-2505 Ext#680 Email Nwesto0l@711.com 7-Eleven Stores/Great Lakes Division 22 Christy's Dave/Brockton,MA 02301 /508-586-0474 Fax: 508-588-4787 Page 1 of 1 Joanne Scott To: Nwesto)!@711.com Subject: Coffee Condiments Dear Mr. Weston: The Salem Board of Health enforces the Massachusetts Food Code. Therefore, regarding the keeping of coffee condiments: • items must be stored separately from raw animal products; • in clean and sanitized containers; • not in direct contact with water or ice; • protected from contamination; • and held at 41 F or lower. Please contact me if you have any questions in this regard. Joanne Scott Salem Board of Health 120 Washington Street Salem, MA 01970 978-741-1800 iscottesalem.com 04/30/2004 P1ea� �b nod �oo �' lab �u o -F e .5 0 u 'e- cL I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA O 1970 .� 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: RETAIL FOOD Name of Establishment: 7-11 Food Store #22763 Address of Establishment: 126 North Street Owner's Name: Amjad Chaudhry Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 122-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 51-04 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. q�p�,100;I4� HEALTH AGENT 4 j u CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH IS�1 120 WASHINGTON STREET, 4TH FLOOR t/ NOV 17 2463 SALEM, MA 01970 TEL. 978-741-1800 CITY OF SALEM FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT,_ MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 7: // Anbd SI-oke TEL# 979 - 7e/f'- 367 ADDRESS OF ESTABLISHMENT 42L, 1\jnY,711 S-F Salw„ JyiASS o /�r20 MAILING ADDRESS (if different) --,,/,,4A OWNER'S NAME ' P, �cs,cA CI Gt 1.c1�1.t Y a TEL# ADDRESS '\g1- �cQ�c� 5\- CITY W Db,N-1L.\ STATE fY\Y1Sl ZIP 0 \'8o I CERTIFIED FOOD MANAGER'S NAME(SCERTIFICATE#(s) C,a i ?; o?, L(+O 'a. U (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSONA C�.L�t dL\r� HOME TEL# -1'R l - S-R1. :S3 Ii HOURS OF OPERATION: Mon. Tue. Wed. Thu. Fri. Sat. Sun. ilheuv5) TYPE OF ESTABLISHMEt FEE check only RETAIL STORE (YES) NO 0 less than 1000sq.ft. =$ 50 02 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE TOBACCO VENDORYES $50 ALL NON-PROFIT(such as church kitchens' -o SNO Please pay totai with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature LLv\n( C--&/ Date Social Security or Federal Identification Number -- ----- - -- ---- ---------- � �0 a3-------------------------------------------------------- Revised 11/03/03 FOODAP2.ad Check#&Date IWO- 1 a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR + „ SALEM, MA 01970 TEL. 978-74 1-1 800 FAX 978-745-0343 STANLEY USOVICZ. JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT f COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name: Amjad Chaudhry Name of Establishment : 7-11 Food Store #22763 Address of Establishment : 126 North Street Type of Establishment : RETAIL FOOD Application Date : 12/10/2002 Restrictions: Permit for Food Establishment 49-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 11-03 These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. '/ HEALTH f \ ` .Co CITY Y QF SALEM, MASSACHUSETTS t\4> BOARD OF HEALTH 3 ° 120 WASHINGTON STREET, 4TH FLOOR DEC q 91102 SALEM, MA 01970 GU L TEL. , 978741 1800 Gl 1 '1 FAx 979-745-0343 BOARD OF HEALTH STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO ' MAYOR HEALTH AGCNT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT /f.-// sfn ro- TEL# 979- 74'V- x0.307" ADDRESS OF ESTABLISHMENT 1,24 /t,/p,E//f 674 MAILING ADDRESS (if different) /t1/Lf OWNER'S NAME n1`' , ,ck C° TEL# ADDRESS_ 1`t31 - Givu�p-N S_l- - k*2I e _ ren 4s ss CI i L e,b�2ti STATE rtt ra ss ZIP_ thRQ t CERTIFIED FOOD MANAGER'S NAME(S) 1 ie it [ G, �tt.ws CERTIFICATE#(s) &L?034)3/4p<).� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 'A•M -4 Lis At r NOME TEL# 'I g i - ?(o o --Io $to HOURS OF OPERATION: on. Tue ed._ hu. fi' Sah (S _ ti h ou rs TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES') NO less than 1000sq.ft. =$ 50 J �3 1000-10,000sq.tt. more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR (YE3> NO JI-o3 $50 ALL NON-PROFIT(such as church kitchens) YES $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. c743-- to-50Q -3,214 Signature CA"A/ Date Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm I HCheck#&Date ` ^Y cf 70 r36 602, /gid, I • THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT / Tel: (978) 741-1800 Fax: (978) 745-0343 Name 7/j/11-4 ate / Type of Service Ty .@gt.lD�ggction `�� >�/� � / G23 7�a'f Food Service Routine Address /� / h/�!7/� S� Risk ❑ Retail Re-inspection 6 1V6e-( / Level ❑ Residential Kitchen Previous Inspection Telephone !,"1(y 2 %{, {�G ❑ Mobile Date: Owner j�/�/,,/Q '\ /� [/(9!1 HACCP Y/N ❑ Temporary ❑ Pre-operation f4P �/q 3 (�'(' f✓ �i� ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) 11-7 L j 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 (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local law ❑ FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties 13. Handwash Facilities EMPLOYEE HEALTH ROTECTION 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 El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements ❑ 17. Reheating El7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ El10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related / Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR oHealth. 590.000/Federal Food Code.This report, when signed below 7-7- by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 1. Inspector's Signature: Print: ':q (?e PIC's Signature: Print: / PageofQ--Eages FORM 734A HOBS aARREN -BOSTON 1 Violations Related to Foodborne Illness ' Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.1](A) I Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contac[with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in -- Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 4 I Food and Water From Regulated Sources 9 Food Contact s 4-501.111 Manual Warewashing shing--Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501 114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products, Pasteurized* P gg � Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* - 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 I Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 11 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 6 I Tags/Records:Shellstock 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* "Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM pc ` �B.O"ARD OF HEALTH ` Establishment Name: _�LU�\ � ` Date: ��3 Page: of 2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I - - I cls /2 fzt1 (� 1 I c� l� rel,•, 5�� - .>,a ��.�� .s�-� �i rc�� I Jy G I I l I I r� 7— �cb� -c-- Discussion 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 C3 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 I aw Cooled to Factors(items 1-22) !Cont.) 41'F/45"F Within 4 Hours. PROTECTION FROM CHEMICALS ?-SUl.IS Cooling Methods for PHFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-501,16(B) Cold PHFs Maintained at or belom 3-202.12 :-kdditkcs 590.U04(F) 41"/45'F°' 3-302.14 Protection Dorn Unappnn ed Additi%cs* 3-501.16(A) Hot PHFt,Maintanied at ui abode 15 Poisonous or Toxic Substances 140`F Containers"iners^ IdentifyiDiz I 3-501.16tA) Roasts Held at or aboveI-,0'F. ' 20 Time as a Public Health Control 7-102.11 Common Name-WorkingCantmnerc' 7-201.11 Separation -Stortgc" 3-501 19 Time as a Public Health Control' 7-202.11 Restictton-Presence and ttse', ( 590 004(H) Vat ance Requirement j 7-202.12 Condition;of I isel 7-2U3.1I Toxic Container:. -Pohibniuns POPULATION ( FOR HIGHLY SUSCEPTIBLE i 7-204.11 Saniti7ers.Criteria-Chem:,als^ POPULATIONS I(A) IONS(HSP} 7-2_04.1_ Chemicals for Washing Produce,Criteria' 121 13-301.I I(.4) Unpasteurized Pre-packaged sluices and 204.14 6rvmp;Agem;:.Criteria Beverages with Warning Labels* 7-205 11 Inetdemai Few,]Contac(. t,uhricantO 3,W 1.11(131 Use of Pasteurized Eggs' 7 206.11 Restri,led Use Fesucir.:es,Criteria` 3-301 I 1(U) Raw or Partially Cooked Annual Frxxl and j Raw Seed Sprouts Not Served. 7-201, 12 Rodent Flat Sraticns' 3-801.11(C) Unopened Fnid Package Not Re-served. " 7-206.13 Tracking Powder.,_ Pest Congo:and R"surto"ng CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Gmsumer Advisory Posted 1'or Consumption of 16 ( Proper Cooking Temperatures for Animal F+wds"That are Raw. Undercooked of PHFs 1 Not Otherwise Processed to Eiuninate 3-401.11A(1)(2) Ees's- 155`F 15 Sec. E,S`9s- Immediate Service 145"Flisec� 3-302,13 Pasteurized Eggs Substitute for Raw Shell 3-401.1 I(A)(2) Cunuainuted Fish.Aleats&GameI Ergs" F .\r iniak- 155� 15 tec. " SPECIAL REQUIREMENTS 3-401.11(B)(I)(2) Porkand Beet'Roast- I30"F 121 min" 3-401.11(A)(2) Ratites, igjecied Mean- 155`F 1.5 - 590.09(,4)-()) Violations of Section 590,009(A)-(D)in SCe catering, mobile Brod, temporary and 401.1l(A)(3) Pnuitm, Wikl Game.Stutfied PHFs, residential kitchen operations should be Stul'ling Cont"ning,d=ish,Meat, debited under the appropriate sections Poulhy or Rattles-165=F 15 sec. " above. if related to foodhorne illness i 3-101 1 i(C)(3) Whole-muscle.Intact Beef Steaks I interventions and risk factors. Other 145'F+ 590.009 violation; relating to l(xxt resat! 3-401.12 Raw Animal Fowls Cooked in a practices should be debited under#29- Microwave IA5`FSpecial Requirements. 3401.11(A)(I)(b) ,ill Uther PHFs - 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES ' 3-403 11(A)&tEo PHF> 165'F 15 sec. "' (Items 23-30) . 3-403.11(B) ( blicrowaye- 165'F 2 Minlut Standing C,incul and non-crrlicul violations, it inch do not relate to the Tiine4 fi,odhorne illness interventions,Ind ask(actors listed above, can be 3403.11(C) Commercially Processed RTE Food- funnd in the following sertinns of Me Pood Code and 105 LAIR 140'1F 590.000. 3403.11(E) RemaircU m_ n<hced Portinnsof Beef item Good Retail Practices FC 590.000 Roasts*' 23 _Management and Personnel ( FC-2 003__1 1R ( Proper Cooling of PHFs 124 Food and Food Protection FC--3 004 3-5U 1.14(.4) C+w1in Cooked PHhs from 140°F to 25. Equipment and Utensils FC-4 005 +: 26 Water.Plumbing and Waste FC-5 .006 70'F Within 2 Hours and Frani 70'F 1 27 Physical Facility FC-6 007 to-11'F/45`F Within 4 HOVS. * I 28,- Poisonous or Toxic Materials FC-7 .003 3-501.14(8) Cooling PHFs Made From Ambient ( 29. Special Requirements .009 Temperature Ingredient, to 41`17/45`F 30 Other •', Within 4 klourss^ "°.:' ""`;•:"`.` 'Denote:eriti,01 rt,.in m the tcdrm 199a+Fuod(oat:,n 105( \iR j90.1)p0. y ., -/' THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name / Dat Type of Operation(s) T In i /J �r✓ u��ArC # .�1�.�3 / ❑ Fyod Service outine Address r/ I /) / Risk Retail ❑ Re-inspection 1,4 /1//)r�� C r T Level�/y�yy El Residential Kitchen Previous Inspection Telephone 7 /ii� ❑ Mobile Date: Owner /1 / /� / /� HACCP Y/N ❑ Temporary ❑ Pre-operation //JfY / -h_ii El Caterer El Suspect Illness Person in Cchdrg€(PIC) // %/ Time ❑ Bed&Breakfast ❑ General Complaint In: Inspector �l ❑ HACCP ��•2.- )�G Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS [:12. 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 TIMUTEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control V❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing ❑ El10. Proper Adequate Handwashing 21• Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: /// / Print: PIC's Signature: Print Page/-of-12?--Pages FORM 734A HOBBS&WARREN . BOSTON q Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 4 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 1590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition o/Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501 112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* 11 Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash 3-201.17 Game Animals* 11 _ Good Hygienic Practices 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes.Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity*1 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 3-101.11 Food Safe and Unadulterated* 6 1 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 13 Conveniently Facilities � Conveniently Located and Accessible 3-402.11 Parasite Destruction* 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility.Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. L CITY OF SALEM 'i BOARD OF HEALTH Establishment Name: *Y—// ,2,7'1/.k Date: / Ala _�s3 Page: Z of 1 Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R-Red Item PLEASE PRINT CLEARLY Verified t �_l R.)/e /rJY d /,r7 =JP FR- _ham_"I C !1 �/J Lie el Iii/P - . /-. _/1�✓.d_/_ .fir i .lP .h/1 A/"d/pis./ Ssi-1A 4-�d/�iir i ,g I I � I Discussion With Person in Charge: Corrective Action Required: I O No I ❑Yes ? I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ tviolations before the next inspection, to observe all conditions as described, and to comply Exclusion / with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension } result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure l ❑ Voluntary Disposal ❑ Other k , FORM 7348 HOBBS &WARREN - BOSTON l Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs According tReceived o Law Cooled to at Temperatures Factors(Red Items 1.22) (Cont.) 4I'F/45'F Within 4 Hours.* PROTECTION FRO N CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives _ 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 I Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 13-801.1](A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 l(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Critena* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Batt Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effective 111/2001 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145'F 15 Sec.* -- - "- 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 Min.*1 catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish. Meat, above if related to foodbome illness Poultry or Ratites- 165'F 15 Sec.* interventions and nsk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F` 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165'F 15 Sec* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165'F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 f 3-501.14(A) Cooling Cooked PHFs from 140*F to 26. Water, Plumbing and Waste FC-5 .006 70'F Within 2 Hours and from 70'F 27. Physical Facility FC-6 .007 to 41'F/45°F Within 4 Hours.* pg, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41'F/45'F 30. Other Within 4 Hours* *Denotes critical item to the federal 1999 Food Code or 105 CMR 590.000. f CITY OF SALEM;^MASSACHUSETTS 10#1 v`6� '� BOARD OF HEALTH ♦ 'i, 120 WASHINGTON STREET, 4TH FLOOR_ SALEM, MA 01970 ; - d. , TEL. 978-741-1800 FAX 978-745-0343 - r STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT r P • e f COMMONWEALTH OF MASSACHUSETTS . 1 . . r PERMIT TO .'OPERATE A FOOD ESTABLISHMENT Ir /r - In accordance with regulations promulgated -under authority of �Chapter 94, Section 305A and Chapter III, Section',5iof the General Laws, -to operate a Food Establishment in thehtCity of Salem is hereby%granted°'to': = Owner' s Name : Amjad Chaudhry Name of Establishment : 7-11 Food Store #22763 Address of Establishment : 126 North Street Type .of Establishment : RETAIL FOOD -r s Application Date: 11/26/2001 - _: a Restrictions: _fx Permit for Food Establishment' . "• , ;19-02•. Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 18702 These- Permits -Expire December 31; 2002. This permit is not transferable and must be- reissued upon change 6i, 5- ownership f5 .ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEMy MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01970 {� TEL. 978-74 I-1800 ® E�� "„ FAX 978-745-0343 STANLEY USOV ICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 1190441 2 6 2001 CITY HEALOF H DEPT 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 7: // #f La76 S' TEL# ADDRESS OF ESTABLISHMENT /-24 Am47111 5-;0'- -SCl/0"w '*4ss 6 070 MAILING ADDRESS (if different) A 1A OWNER'S NAME Awe\o 6v)(ov�t"-1 TEL# 1$t lCoc? l0"d� ADDRESS I%\- t CITY lx)Abv LII STATE rvw s5 ZIP 0 t PO 1 CERTIFIED FOOD MANAGER'S NAME(S) Amy" C tw.�1 2� CERTIFICATE#(s) ('402c.3/402- (required to3c3/601- (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON'Aw�l C"("r'1 HOME TEL# 161 3/S DAYS/HOURS OF OPERATION: Mon._Tue.___-Wed._Thu.—Fd._Sat._Sun._.. 2e67 1 TYPE OF ESTABLISHMENT FEE check only DD RETAIL STORE ES NO (�.() $40 RESTAURANT S NO $40 BED& BREAKFAST YES NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR q* NOe'-Oot $10 NO CHARGE FOR NON-PROFI (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXE"APT FORM 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 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. �Aix�n/`t ttluEtn Iva - C'9 y95� Signature JC Date Social Security or Federal Identification number Revised 11/1/01 foodap2.adm Check#&Date ) 7,(>— ¢ Sd- 0 jY}Yi...ti h�N.w+Y.w�+. +'+.'ilrfr,•� 'xTYi�YrsYf'."#""�q?V"^4�`+iii{°+VW.+T+7e"�^°r8v1i++€e�w'*"�. - _ _ - �..�-•_...+"�',^!'vw`.,F'�+T.'+c'."M'-. J , y THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name �y Date Tvoe of ODeration(sl T In i /�� .S�Ore #I.Z yG3 � /^y❑ Food Service ["Out (Address [ Rsk R"Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone yy„ 10.3 Q �, o�W ❑ Mobile Date: Owner / // HACCP Y/N El Temporary ElPre-operation /wv"el (//,0 L,WOX v// ElCaterer ElSuspect Illness Person in Charge(PIC) / Time ❑ Bed &Breakfast ❑ General Complaint In: ❑ HACCP IInspector_�T-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 (Red Items). Anti-choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature:^� ! l �� I Print: / 'J PIC's Signature: ( [/ I Print: Page�of#Z Pages �/� 'Y FORM 734A HOBBS&WARREN/-BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION B Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B)l Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501 111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products" Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH. 3-202.14 Eggs and Milk Products, Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) I Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 10 2 Proper,Adequate Handwashing* Regulatory Authority 301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* +1 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Dunking or Using Tobacco* 5 I Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 _ Conveniently Facilities Tags/Records:Fish Products nvenientlyCapa Capacities*and Accessible 3-402.11 Parasite Destruction* Co 5-203.11 � Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging.Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH A r Establishment Name: // Ae0e ,�.1_iJrG �' Z-7 Date: '11;'A /4-2 Page: 7 of'-7- V IIF Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red ItemVerified PLEASE PRINT CLEARLY I>f I I = it 1 I .IPS/I/. . ),a /�, I t I � i I j r j Discussion With Person in Charge: Corrective Action Required: I ❑No I ❑Yes Com o / I have read this report, have had the opportunity to ask questions and agree to correct all LI Voluntary Compliance ❑ Employee yee Restriction violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure k r, ❑ Voluntary Disposal ❑ Other I, b FORM 7348 HOBSS &WARREN - BOSTON r Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41°F/45*F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 1 3-202.12 Additives* 3-501.16(6) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances _ 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original140°F.* Containers* I 3- 01.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Samtizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* - 3-801 11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contac[,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(0 Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Ekech a 1/12001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145*F 15 Sec.* 3-401.11(A)(2) Comminuted Fish.Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.1l(B)(1)(2) Pork and Beef Roast- 130*F 121 Min.*I catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.*I residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish.Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.1 I(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 _.003 Roasts* 24• Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005___ 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* _- *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. e ( IMPORTANT MESSAGE ) FOR DATF (,,_-a 9 -o TIME P.M. M ) J^ OF P'� �F 617- AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED C/,rPLEASE CALL (� CAME TO SEE YOU ( WILL CALL AGAIN I WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU I MESSAGE SIGNEDFORM 4 4wops MADE IIN lrA f , NOTES ORT_ NT MESGE ) FOR _ DATE= ,/�/J � �,� , /`! T�LWM. M OF PH 0F 0 .J1 -AR A CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED P/LEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESS SIGNED �.e !/ FORM 9 MADE INU U S A 7/ \ ') L5 _. . f I . i ' I ;? ( IMPORTANT MESSAGE ) FOR n ,/ DATE vI t 2 2" L TIME 91�S P.M. Ili OF p p p ✓ PHONE ! 70 ^ .�3 p • 3 boo ❑ FAX /� oZ�'I AREA CODE NUMBER E NSION/ iO MOBII F AREA CODE f)NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE ,)).e f '/—// I SIGNED r_ FORM 4009 MADE IN U 5 A ,'-- .., � 2 `, O t � i \ \ ` l y � �, ,_ \ � �` �� i � � \ � h `� `� � t \ � ', �` � , � 1 ti \ ,` y '` 1 � \4 � 1 i (IMPORTANT MESSAGE J ) FOR o5e , . 2 3 0. �� A.M. DATE � TIME �i P.M. M OF PHONIC AREA CODE NUMBER EXTENSION O FAX O MOBIL F AREA CODE NUMBER TIME TO CALL TELEPHONED /� PLEASE CALL CAME TO SEE YOU / I WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL X WILL FAX TO YOU MESSAGE 1 I Y SIGNED N}ED BFORM 4009 ��II FOR IN U 5 A � �; � � � 1 � m U7 � !` v _ ' i i i ` t ! 1 �' '� � � � ' j ��. i � � 1 i ., , � �, i � , l �, I i '�` '� t � , �` ' I i I � � i � - - i � --- 4 \ ( IMPORTANT MESSAGE ) FOR�O i DATE TIME ' P.M. Mho 62-x OF r PHONE-C REA/[ ] / T r) ( JL3 /\( / I AOOE NUMBER EXTENSION ❑ FAX * MOBILE AREA CODE / NUMBER TIM O C LL TELEPHONED J PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNEE)YOUR CALL WILL FAX TO YOU M SSAGE 1 17, - lx3n- rmrr�rA SIGNED FORM 4009 MADE IN U 3 A NOTES I , I .a/Y+w'•'d.V'�ati-�M.Y�w+"^�+�1'^a.1t'�".n"RIA'GYQ+#.+nhnl%1�'+9M�ItYi'abi •�•s-•.r..%we'lPw•-sdH;,,vl1.,f.ai.w:ti.i•a60a•0'•eCf.•+nT.Witi.Y0...r'JM1lavy'::.':d-.a\.-'-.nine-d�:J-�..�n-l THriE COMMONWEALTH OF MASSACHUSETTS' CITY OF SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 740-9705 Name Date Tvoe of Oneration(sli Tvoe of Insoection -x�g.27f,'3 r �//GLZ eFood Service Lo'Routine (Address �Z�D NG��I /rhe / Aisk [KRetail ElRe-inspection f T Level ❑ Residential Kitchen Previous Inspection (Telephone fyy 3 Q ,, f ❑ Mobile Date: OwnerElTemporary LlPre-operation HACCP Y/N ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ElBed&Breakfast El General Complaint ❑ HACCP Inspector In: ❑ Other Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: RED Violations (1-221 Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E)❑ 590.009(F)❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 1?<. 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(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures El 5. Receiving/Condition [117. Reheating t�1',/6. Tags/Records/Accuracy of Ingredient Statements .3 ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control NK8. Separation/Segregation/Protection`3) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [121. Food and Food Preparation for HSP E110. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations (23-30) Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Immediately or within 10 days as determined by the Board and Risk Factors(RED Items 1-22): 7--3 of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection -f Health. today,the items checked indicate violations of 105 CMR C N 590.000/Federal Food Code.This report,when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-6)(660.006) 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 59010"UFw 14 dw Inspector's Sig ature: /rte) Print: PIC's Signat fe: ��" // Print: Page_L of-7, Pages r y Violations Related to Foodbome Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT _8_ Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* :.4 Food and Water From Regulated Sources 9, Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,- 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.1 l(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensilsand Shellfish* Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integrity* Mouth 1 -6 _ 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 I Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* '7 Conformance with Approved Procedures - 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. l • - THE COMMONWEALTH OF MASSACHUSETTS Establishment Name /,jp 61' P „?� ��3 Date Address /„?/,o lve),-7q Page-7— of Item No. In the spacebelowdescribe all violations checked on front page. r 2/q,-j / Z _ . zr � �f0 ASF/.l h_ /i //s�.r.f F JJi>P/Jsz� -//i�s.� .iii i .rl,..!/ dw_.✓-,� Mo O /ilk (::7> Discussion with Management. COURT DOCKET NO. Q CITATION NO. CITY O SALEM A2 9 6 4 VIOLATION NOTICE NAME(LAST,FIRST,INITIAL) llilliz STREET // IXDV?OWN STATE ZIP LICENSE NO. T' EXP DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS CITY/TOWN STATE ZIP REGISTRATION NO STATE EXP DATE MAKETYPE YEAR ICOLORI t DATE/9FVIO TION TIME DATE/CC TATION WRITTEN PERirv�ua,-.gL /_� ONO LOCATION OF VIOLATION ENNF_ORCING DEPT. OFFENSE CHAP SECT. FINEST ,OAC—, a 50 ✓flra�u o 3ci�•�' B i � OFFICERietJP�.S I D NO. TOTAL NE ij - "-q/CIZ 3.�ZVr DUE OFF' CERTIFIES COPY GIVEN TO VIOLATOR IN HAND ❑ R MAIL O OT MAIL CASH-PAY Y POSTAL NOTE,MONEY DER OR BY CHECK M AYABLE TO CITU RK CITY HALL 93 WASHINGTON STREET SALEM,MA)701970 TET.(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 e CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE;PEEL AND SEAL r + COURT DOCKET NO '7 - CITY OF SALEM VIOLATION NOTICE NAME{ ST,FIRST,INITIAL) STREETADDRESS C OWN STATE 'ZIP w p w /,y7jl /?J/J �� - r 1.: LICENSE NO. LIC F.%P.DATE +DATE OF OWNER'S NAME(LAST,FIRST,INITIAL) - - N /y /4�� ,,a�",�,pd .�-f✓iC' '°''`��fLo _ ;` 'y,Y', b" "'a�.. :x STflELT ADDRESS-' ZiP, � .`2 � -�'y'w�.0 � °w i'I qg�({p, d `Sb'd!'xi .a r REGISTRATION NO. STATE P. 1 YEAR COLOR h � ;ygti. ``,�a-x,,,.,y(:y&r,"„ �"•�"� �* ,� 65 DATE'0 VIOLATION TIME 1)ATECI ATION WATTEN: oM / a. r t1? LIYES 70 PM �//fj 31��+eZ - " 17NO'.I � =�w� ry LOCATION OF VIOLATION - ENFORCING'DEPT.•G /-�jo 2Ji�r�� .Sty "c t �3.�i _�/ . ;:,s w ;, `: Lnj OFFENSE CHAP s/E/c F NEsY S c6vo _ cp' I03 L a L CDI B r.f - �{! I •jam 1� WE. P g _ ..+p.- //are Jt Gf! flI ,�31 cpl y . .°41 ,amOj ;i OFFICER_. - -I.D.NO.{TOTAL - . .0 . _`:' 4-- , .E O /G2 3 S':Z. V FINE- 3 U. iI'll ` aF s � Ya •J DUE I �r1': OFFIJ CERTIFIES COPY GIVEN TO VIOLATOR -' .W W NHAND .o�', 17=. { fi, . � ;.- 'o soQ X ��/// :..Y....ri• !�.-C/?_"�-� r� - - O`CMAIL=.:ii I -,.-_. " '"` ::_" X13 .7 b0 k'O'T MAIL CASH-PAY N Y POSTAL NOTE,MONEY. : -a` `Z,Z'� < .r'-� t, O ORDER OR BY CHECK M AYABLE TO: O c 1 �y CITY HALL X _ 1 ..�,.ZJ; ` •;, o �,vzNI - 98 WASHINGTON STREET -.`: `W 'a+ , a o �i� ' ; 0 SALEM;MKO1970 - - r; ' . .w •,' lKu O TEL IWO)745.9595 X 257 I HEREBY ELECT TO EXERCISE:THE`FIHST OPTION AS STATED ONC J. - i 4y` ,meq?5 "�•1 T REVERSE;CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE- - PAYMENT IN THE AMOUNT OF $ CASE.# SIGNATURE (:4 SEE OTHER SIDE FOR FURTHER INFORMATION '`a ENCLOSE PAYMENT INTHIS-ENVELOPE,PEEL AND SEAL .4i il s: l COURT DOCKET NO CITATION NO CITY OF SALEM r} VibLATION NOTICE A 2 4 NAME(LAST,FIRST,INITIAL) /� r`7 nw fel!/ STREETADDRESS //� / J CIy�V/TOWN STATE ZIP LICENSE NO LIC EXP DATE DATEOFBIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS CHY/TOWN STATE ZIP REGISTRATION NO STATE EXP.DATE MAKE/TYPE YEAR(COLOR DATED VIOLATION TIME DATE CITATION RITTEN PEFSONPL /yj/' > may' /IKM / IW,,YOYES ONO LOCATION OF VIOLATION / ENFORCING DEPT JZ/ /LJ�Jr��i 57 r �t f3•G •/fir OFFENSE CHAP SECT FINES A B OFFICER � HD NO TOTAL J.ZS DUE I$ S�.DJJ OFFICER CERTIFIES COPY GIVEN TO VIOLATOR/ N HAND /f // fl"\ � �y�y' > L:J{I X }/l ' /T• f✓✓rfUi�- / ❑ BY MAIL j SDC NOT MAIL CASH-PAY ONLY'EfY POSTAL NOTE,MONEY ORDER OR BY CHECK MAq�E•PAYABLE TO L/ 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 S CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO t, ^T'°-CITATION NO. l; - . .. - 61w of SALEM "'j .a VIOLATION NOTICE NAME(LAST, FIRST,INITIAL) y) - _ ._._ ./I STREETAPDRE! STATE ZIP LICENSE NO. LIQ EXP.DATE -, OWNER'S NAME(LAST,FIRST INITIAL) Z a o g STREET ADDRESS'. T�O ZIP. Lu REGISTRATION NO. STATE DTF YEAR(COLOR ' HI { moi ' DATE OF VIOLATION TIME DATE Cl ATION WRITTEN w .(/f�/I/�7 �1 YES �' wLn LOCATION OF VIOLATIO J ENFORCING DEPT ' I" -L FG_� ,moi fY CC.'f'" r✓ '!`j '/�1-' � t 'U6 C(A :J" L 1 (77 OFFENSE- .CHAP. SECTT-FINNES '�k i `F 'C.°�y 'k r �3 rj< Do K.'MQ toy (.(T :> .I=., r 1C �,`"IJnIJP�.s sedb�.�rf�i,�.r-e 7 ,:,y, g* ,; OFFICER -I.D.NO.�T-OTAL� _O FINE J DUE" S ^',, }$ OfFI CERTIFIES COPY GIVEN TO VIOLATOR 0 .�. rs HAND o- _" ' O X B?MAIL ' #piLa t0,XbT MAIL CASH-PAY ONV4Y POSTAL NOTE,MONEY '� z�_'; - '+ � -81 O is ORDER OR BY CHECK M AYABLE TO - 'cO ul trry CL CITY HALL _=:.j - .N'7. �4� �. J'O++w"', ='•y'.= "� 93 WASHINGTON STREETW SALEM,MN01970 3',y., '.:,`.W$,4w`. O TEL(508)745.9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON.-=.'3 REVERSE,CONFESS TO THE OFFENSE'.CHARGED,AND ENCLOSE_ ;V PAYMENT IN THE AMOUNT OF - $ CASE# SIGNATURE ! SEE OTHER SIDE FOR FURTHER INFORMATION r ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL �;v Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-35 Tel. (978) 741-180 Fax(978) 745-0343 i City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name *� ( //II tel/ D e e of Operation(s) Type of Inspection '( # �P�r}�o� 2-fle.It? Food= ❑ Routine Address �1 � 1 _ Risk [❑rRetail ,�Re-inspection Telephone Fr T/��•f Level Residential Kitchen Previou Inspection p C/ �{/(�_ h� ElMobile Date(41- I 1"' - �' 1 [I Temporary ElPre-op ration Owner HACCP YIN I ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) " Y Time ❑ Bed&Breakfast ❑General Complaint r'�/_ ❑ HACCP Inspector -1 hwl-�1 1t(d A)h Out `s Permit No. ❑Other Each violation checked requires an explanation on the narrative pag�eand a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) El Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ElAllergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. OOD PROTECTION E] 12. Prevention of Contamination from Hands t. PIC Assign /Knowledgeable/ uties - - ❑ 13. Handwash Facilities EMPLOYEE HEALTH - " PROTECTION FROWCHEMICALS' ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded - ❑ 15.Toxic Chemicals [1 4Food Rod and Water from Approved Source APPROVED SOURCE - - TIMEITEMPERATURE'CONTROLS(Potentially Haiarck us Foods) ❑ 4. ❑ 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 HIGHLYSUSCEPTBLE-POPULATiONS'(NSP). , E] 21. Food and Food Preparation for HSP E] 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMERADvisORY, ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N 23. Management and Personnel (Fc-2)(550.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (Fc-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4X590.005) cited this report may result in suspension or revocation of the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FcsX590.006) establishment operations. If aggrieved by this order,you 1 27. Physical Facility (Fc-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7X590.008) and submitted to the Board of Health at the above address 134. 9. Special Requirements (590.009) within 10 days of receipt of this order. 0. Other DATE OFRE-INSPECTION: Inspector's Signature: lr_I�C /�._. Print•/i_ �� ,/,� (� PICS Signature: �,/ I Print:`�'�r Page�of�Pages 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination I 1 590.003(A) Assignment of Responsibility* I 13-302.11(Al(1) Raw Animal Foods Separated from Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I Contamination from Raw ingredients 2-103.11 Person in charge-duties I : 13-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Otho* 2 590.003(C) Responsibility of the person in charge to I I Food Protection* rotei ti from the Environment I 1330.. 11(A) { Food Protection I require reporting by food employees and � 3-102.15• ( Washing Fruits and Vegetables applicants* J 590.003(F) Responsibility Of A Food Employee Or An 13-304.11 Food Contact with Equipment and I Applicant To Report To The Person In Utensils* J I { Contamination from the Consumer { Charge* 13-306.14(A)(B) { Returned Food and Reservice of Food* 590.003(G) I Reporting by Person in Charge* { Disposition of Adulterated or Contaminated 13 590.003(D) I Ezelusions and Restrictions* � I Food 590.003(E) I Removal of Exclusions and Restrictions { 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I fad* 4 Food and Water From Regulated So,rces ( 19 Food Contact Surfaces j i 590.0041A-B) Compliance with Food law* I 4-5(11.1 I I Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanifization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 4-501,112 Mechanical Warewashing-Hot Water i 3-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products. Pasteurized* --- 4-501.114 ( Chemical Sanitization-temp.,pH, 13-202.16 Ice Made From Potable Prinking Water* I concentration and hardness. 1 5-101.11 Drinking Water from an Approved System' 4-601.1 1(A) Equipment Food Contact Surfaces and{ Utensils Clean 590,006(Al Bottled Drinleng Water' - I 14.602.11 Cleaning Frequency of Equipment Food- 540.006(B) Water Meets Standards in 310 CMR 22.0" { e 9 Y eit Shellfish and Fist Fion an Approved Sow,e I Contact Surfaces and Utensils" r 14-702.1 i ( Frequencq of Sanitization of Utensils and I 3-201.14 Fish and Recreationally Caup-,r n Moliuecan Foal Contact Surfaces of Equipment* Shellfish* 4.703.11 I Methods of Sat»fization-Hot Water and 3-201.15 Molluscan Shellfish from NS5F f.i:.trd Chemical* Sources* Game and Wird Mushrooms Approved by 110 I Proper,Adequate Handwashing Repulatory Authority 12-301.11 { Clean Condition-Hands and Arms- J 13-202.13 Shelloock identification Present* I 2-301 12 I Cleaning Procedure* 590.004(C) Wild Mushrooms* ( 12-301.13 When to Wash* I 3-201.17 Game Animals'i I 111 I Good Hygienic Practices I $ { Rece!vingrCondition 2-401.11 Eating,Drinking or Using Tobacco* 13-202.11 PHFs Received at Proper Temperatures* I '-401.12 Discharges From the Eyes,Nose and 13-202.15 Package Integrity* I l y I Mouth* J 3-10 i.1 1 Food Safe and Unadulterated" I 13-301.12 + Preventing Contamination When Tasting* { { 6 Tags/Rerords:Shellstock I 112 I I Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 1590.004(E) Preventing Contamination from { 3-203.12 Shellstock Identification Maintained* I I Employees* J { { Tags/Records;Fish Products 13 I Handwash Facilities 1340"2.11 { Parasite Destruction" I ( Conveniently Located and Accessible I 13-402.12 Records,Creation and Retentiun* { 5-203.11 Numbers and Capacities* 1590.004(/) I Labeling o1 Ingredients' 15-204.11 Location and Placement* J Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance /HACCP Plans I ( I Supplied with Soap and Hand Drying I 13-502.11 Specialized Processing Methods* I Devices 3-502.12 I Reduced oxygen packaging,criteria* 16-301.11 Handwashing Cleanser,Availability J 18-103.!2 I Conformance with Approved Procedures* 16-301.12 Hand Drying Provision 'Denotes critical teem in the fWend 1999 Poo xi Code or 105 CMR 590.0(N). CITY OF SALEM BOARD OF HEALTH Establishment Name: ( 14� ��_ �f Date:�(o /1_-K Page: `L of- 2- Item f2- Item code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRIN CLEARLY IU �e 0 —112U-0' lr �M1cV � � Y Jac 11 f' >7 I I � 1 1 Discussion With Person in Charge: Corrective Action Required: I (3No 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. b � ❑ Voluntary Disposal ❑ Other: 3.501.14(0) PHFs Received at Temperatures Vloinflons Ae)ated to Foodborne Illness.Jnferaentiona and Risk According to Law Cooled to Factors(ftems 1-22) (Gant.) 417145°F Within 4 Hours.'" 1 PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PHFs I I Sq ( Food or Color Additives I i 19 PHF Hot and Cold Holding 3-202.12 Add lives* 3-501.16(B) CoPIFs Maim tined at or below 590.004(F) 41°id 145"F* { 3-302.14 Protection from Un rraved Additives' 3-501,lfi{A} Hot PHFs M;uatained at or above { 15 Poisonous or Toxic Substances 1400F. 7-101.11 Identifying Information-Original � 3-501.16(A) Roasts Held at or above 130'F. Containers" ' I 7-102.11 Coimnan Name-Working Containers* { 20 Time as a Public Health Cartrol I '-2n 11 Separation-Storage* I 3-501.19 Time ac a Public Health Control* j f ! 7-202.11 .Restriction-Presence and Use* ( ( 590.004(1) Variance Requitement I ( 7-02.12 Conditions of Use* I 7-203.11 Toxic Containers-Prohibitions* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.31 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* I 21 3-801.1](A) Unpasteurized Pre-packaged Juices and I .Beverages with Wandng Labels" 7-204.14 Drying Agents.Criteria° 7-205.11 Incidental Food Contact.TarbricanLS* I 3-801.11(B) Use of PasteurizedBAes* 3-801.11(0) Raw or Partially Cooked Animal Food and 17-206.11 Restricted Use Pesticides,Cnreria* 1 Raw Seed Sprouts Not Served 7-206.12 Rodent Bait Stations* 13-801.11(C) Unopened Food Package Not Re-served. ' I 7-206.13 Tracking Powders,Pest Control and i Monitoring" i CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of Animal Floris That are Raw.Undercooked or 16 Proper Cooking Temperatures for y PHFs Not Otherwise.Proeeased to Eliminate Pathogens.'�" 3 401.11A(1)(2) Eggs- 155'F 15 Sec. Eggs-immediate Service 145°F15see^ 3-302.13 Pasteurized Eggs Substitute for Raw Shell g 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* i Animals-155°F 15 ser,. * SPECIAL REQUIREMENTS 13 401.11(B)(1)t21 Pork and Beef Roast- 130°F 127 miv* I 590-009(A)-(D) Violations of Section 590.009(A)-(D)in i' 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 sec.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish.Meat. 1+ debited under the appropriate sections Paul"or Ratites-165°F 15 sec. * above if related to foodborne itlness 3-401AI(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145°F* 590.004 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165°F x Special Requirements, 3-401.11(A)(1)(b) All Other PHFs- 145`F 15 sec. 17 Reheating for Hot Holding I VIOLA77ONS R-L4TED TO GOOD RETAIL PRAC77CES 3-913.11(A)&(D) PHFs 165"F 15 sec. * (Items 23-30) 3-103.11(B) Microwave- 165`F 2 Mande Standing Criricat and iron-critical violations,which do not relate to the Time* foodborne illness interventions and risk.factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- jcund in the following sections of the Food Code and JOS OUR 140°F* 590.000. 3-4t13.71(E) Retraining Uas[iced Portions of Beef % Item Good Retall Practices FC 590.000 123. Management and Personnel Roasts* FC-2 .003 9 18 I Proper Coaling of PHFs 1 24. i Food and Food Protection FC-3 .004 1 25. 1 Equipment and Utensils i FC-4 .00U 3-501.14(A) Cowling Cooked PHFs from 340`F to ! 26, 1 Water.Plumbing and Waste I FC-5 .406 700F Within 2 Hours and Front 70°F 27. Physical Facaitu FC-6007 t to 4l`F/45'F Within 4 Hours. " 128. Poisonous or Toxic Materials FC=7 .008 3-501.14(73) Cooling PHFs Made From Ambient ! 29. Special Requirements i 009 Temperature Ingredients to 41'F/45 I, Ili 30. 1 Other Within 4 Hours* ' Dm,fe.ctiricat item in the f.-deral 1999 Fwd Cale ur IV CMR 90.000. lj Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'h Floor Division of Food and Drugs Salem. 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT ---WTel. (9781741--1800 ax(978) 745-0343 Name ( 11 �3 Datg' Tof OosrationUs] Tvpe of Inspection -MF I G/�( ype�t� I eM Food Service Routine Address ' a� } Q Risk Retail �Re-inspection C Level Residential Kitchen Previous In pecti Telephone 1 - ififu.- gh 930 5-�25 '� 1 _ El Date: 99 ddno Owner HACCP YM ❑ Temporary ❑ Pre-op rata M t 1 7 Ch u,J A�) ❑ Caterer ❑Suspect Illness Person in Charge(PIC), I Time ❑ Bed&Breakfast ❑ General Complaint ^� �1 In:�f'�] ElHACCP Inspector �� l/p I Out:, : r-)5 Permit No. El Other Each violation checked re uir San explanation on the narrative pages) 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 El 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives W115.Toxic Chemicals LFO01D FROM 4. Food W t'eD SOURCE om ❑ Approved Sour ( Ce 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 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION � �� 9 [1 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing t REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices I CONSUMER ADVISORY E]22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions ® . immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 4. Food and Food Protection (Fc-4)(9590.090.0 044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: I� S S Inspe Fan 14.E 13 Inspector's Signature: oyPrint: PIC's Signature: I Print: I Pagel of ages s siy4�... -.._i..._ • +.. .-.+•�f "YtT ..c. .. ..�H,� ,.r � i ..f._�-r +Yr�'r�`r•,.. �1 r r ..... �. I� Violations Related to Foodborne Illness interventions and Risk Factors(Hems 1-22)- PROTECTION FROM CONTAMINATION 8 I I Cross-contamination FOOD PROTECTION MANAGEMENT 13-302.11(A)0) Raw Animal Foods Separated from I i 590.003(A) Assignment of Responsibility* i Cooked and RTE Foods* 590.003(B) I Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in charge-duties I 13-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH J I Contamination from the Environment I 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and � 3-30.. 15 Washing Fruits and Vegetables applicants* I 590.003(F) Responsibility Of A Foul Employee Or An 1 3-304.11 Food Contact with Equipment and liTo Report To The Person in I Utensils Applicant Po I I Contamination from the Consumer I Charge* 590.003(G) Reporting by Person in Charge* I 3-306.14(A)(B) I Returned Food and Rd o lCe Food* i Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food f 590.003(E) Removal of Exclusions and Restrictions I 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE rte* 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food law* I 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* ( Sanitization Temperatures* 3-201.13 I Fluid Milk and Milk Products* ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 13-202.14 Eggs and Mill,Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water° concentration and hardness. 4-601.1 I A Equipment Food Contact Surface * ( ) Ey p sand 15-101.11 Drinking Water from an Approved System I I ( Utensils Clean* 590.006(A) Bottled Drinking Water' I 14-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* She/Hish and Fish From an Approved Source ( Contact Surfaces and Utensils* 4-702.1 I Frequency of Sanitization of Utensils and 3-201.14 Fish and-Recreationally Caught Molluscan Food Contact Surfaces of Egaipment* Shellfish* I 14-703.11 I Methods of Sanitization-Hot Water and I . 3-201.15 Molluscan Shellfish front NSSP Listed I Chemical* Sources* Game and Wild Mushrooms Approved by I 110 I I Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 I Shellstock identification Pre�cnt* 12-301.12 Cleaning Procedure* 590.004(C) I Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 Game Animals* I 111 I Good Hygienic Practices 15 I Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PRFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.15 I Package Integrity' Mouth* 3-101.11 I Food Safe and Unadulterated* 13-30[.12 Preventing Contamination When Tasting* I 6 Tags/Records:Shellstock ( 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * I 1590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained`" Employees* Tags/Records:Fish Products I 113 I Handwash Facilities 3402.11 Parasite Destruction* I I Conveniently Located and Accessible- 3-402.12 ccessible3-402.12 Records.Creation and Retention* I 15-203.11 Numbers and Capacities* 590.0040) Labeling of Ingredients' 15-204.11 I Location and Placement* 7 Conformance with Approved Procedures I 15-205.11 I Accessibility,Operation and Maintenance I IHACCP Plans I I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cleanser,.Availability 18-103.12 Conformance with Approved Procedures* I 16-301.1.2 ( Hand Drying Provision 'Denotes critical item in the federal 1999 Fail Cade or 105 CMR 590 000. CITY OF SALEM —1 BOARD OF HEALTH Establishment Name: -7= �_ ��- � Date: 119511111-3 Page: of item Code C-Critical Item DESCRIPTION OF VIOLATION/FLAN OF CORRECTION D No. Reference R-Red item Verified _ PLEASE PRINT CLEARLY o -4( f 0'!Pn oir -flc/2� �t 400 _ O-_ r /1 S/aoc rf\ i I 1 I I I � I I I I I I Discussion With Person in Charge: I Corrective Action Required: I a No fes I have read this report, have had the opportunity to ask questions and agree to correct all I o Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P e-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: o. �r ' 3.501,t4(C) PHFs Received at Temperatures t Violations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs I 14 Food or Color Additives 29 PHF Hot and Cold Holding 3-501.16(B) Cold PHFsMaintained at or below { 3-202.12 Additives* � � 590.004(F) 41°145"F* j 3-302.14 I Protection from Unapproved Addicives" , 501,i6(A) Hot PHFs Maintained at or above i 15 Poisonous or Toxic Substances 140` 7-101,11 Identifying Information-Original r Containers* 3-501.16(A) Roasts Held at or above 130'F. x $ M 20 Time as a Public Health Control { 7-102.11 Common Name-Working Containers* 3.501.19 Time as a Public Health Cannot* I ! 7 01.11 Separation-Storage* g 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement l 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(NSP) 7-204.11 Sardtizers.Criteria-Chemicals* 7-20412 Chemicals fcrr Washing Produce,Criteria* i 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning labels* 7-204.14 Drying Agents.Criteria* 3-$Ol.l l{B) Use of Pastemizetl Eggs* i 7-205,11 Incidental Food Contact.Lubricants* 13-801.1 l(D) Raw or Partially Cooked Animal Food and 4 7-206.11 Restricted Use Pesticides,Criteria'' i Raw or P Sprouts Not dernier 7-206.12 Rodent Bait Stations* 1 3-801.11(0) Unopened Food Package Not Re-served. " 7-206.13 Trucking Powders,Pest Control and 1 Monitoring' i CONSUMER ADVISORY TIMEITEMPER4TURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal F'aods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate tw��nrew�r 3-401.IIA(1)(2) Eggs- 155`F IS Sec. Patlogens Eggs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Animals-155°F 15 see. * SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Port:and Beef Root- 130'F 121 into* 3-401,11(A)(2) Ratites,Injected Meats- 155`F 15 ! 590.009(A)-(D) Violations of Section 49@.11<}9(A)-(D)in see.* I catering, mobile food,temporary and t 3-401.1 t(A)(3) Poultry,Wild Game,Staffed PHFs, residenuai kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections ' Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness } I3-401.11(C)(3) Whole-muscle,Intact Beef Steaks { interventions and risk factors. Other 145°F* i 590.009 violations relating to good retail 1 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. j 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165T 15 see. * (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Mout,Standing Critical and non-critical violations, which do nor relate to the Time* I foodborne illness interventions and risk factors lister)above, can he 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 90.000. 1 3403.11(E) Remaining Unsliced Portions of Beef item ! Good Retail Practices FC 540.000 Roasts" j 23. 1 Management and Personnel I FC-2 .003 1g Proper Cooling of PHFs 1 1 24. 1 Food anti Food Protection ' FC-3 .004 i 125. I Equipment and Utensils ; FC-4 .005 r 3-501.14(A) Cooling Cooked PHFs from 140'F to 1 26. ! Water.Plumbinq and Waste FC-5 .006 70`F Within 2 Hours and From 70`F 27. i Phvsical FaciNty FC-6 .W7 to 4l°F/450F Within 4 Hours.* ! 28. ; Poisonous or Toxic Materials FC=7 .008 3-501.14(B) Cooling PHFs Made From Ambient ! 29. Special Requirements .009 1 . Temperature Ingredients to 41°F/450F . 30. I Other ! ! Within A Hours* i Denores critical acm in the federal 1999 Food Code of 105 C-MR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: �- ( �Z Date: Page: a of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY _ `IcG r 1 .>!1wc;rn/ '11s�' Qc' lel PC'_ CG(�,M l— „Ql! r _SBZ✓1 ro t . 170 IAQ ar� 25Canti 147) 7 clpL� L lel r�!Q �1`CMa \/ le< t u '` d- 13m'r �s.+>e t'�sP(.� -� .n�r �� n o-� rill r ( ,'� ( - o lv�l0 Ff/ (� /� C I t� u`,/�,,. nn! AtotitG�P.t `— F i'11�7 { (I 1la/ ti�a�Llrr � I � tN I (K Al n� �Ivin (Ar ti o-oL Discussion With Person in Charge: L Corrective Action Required: ❑ No — r� es I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p gl/rte-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that O noncompliance may result in daily fines of twenty-five dollars or s spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ; /A 0 Voluntary Disposal ❑ Other: i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness.Interventions and Risk According to Law Cooled to Factors(teems 1-22) (Cont.) 4I'F/45°F Within 4 Homs, PROTECTION FROM CHEMICALS 3-501,15 Cooling Methods for PHFs { 14 I Food or Color Additives { 19 PHF Hot and Cold Holding 3-501,16($) Cold PIJFs Maintained at or below 3-202.12 Additives* I 590,004(F) 41°/45°F* 3-302,14 Protection from Unaporoved Additives* 3-50116(A) Hot PHFs Maintained at or above { 15 Poisonous or Toxic Substances 140cF, * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above t30'F, Containers* { 20 Time as a Public Health Control 1 7-102.11 Couninon Name-Working Containers* { { 7-201.11 Separation-Storage* ( 3-501.19 Time as a Public Health Control* i 7-202.11 .Restriction-Presence and Use* { 590.004(H) Variance Requirement I 7-202.12 Conditions of Use* I 7-203.11 { Toxic Containers-Prohibitions* { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* I POPULATIONS(HSP) 7-204.12 Chemicals for washing Produce,Criteria* I 1 21 3-801.11(A) Unpasteurized Pre-packaged Juices and i { 7-204.14 Drying Agents.Criteria* 1 Beveraees with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* i 3-801A J(B) Use of Fastetnizerl Eggs* { { 7-206.11 Restricted Use Pesticides,Criteria* { 13-801.11(D) Raw or Partially Cooked Animal Food and { 7-306.12 [cadent Bait Stations* ] Raw Seed Sprouts Not Served * 7-206.13 Tracking Powders, Pest Control and ( 13$Ol.li(C) d. Unopened Food Package Not Re-serve * I { Monitoring* CONSUMER ADVISORY TIMEIFEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of Animal Foods That are Raw,Undercooked or 26 Proper Cooking Temperatures for PHFs Not Otherwise-Processed to Eliminate 3-401.IIA(1)(2) Eggs- 155°F 15 Sec. Pathogens'"" Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell t"t 31401.11(A)(2) Comminuted Fish.Meats&Game Eggs* 1 Animals-1550F 15 sec. { { 3.40111(13)(1x2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 1 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sea.* I catering,mobile food,temporary and 3-401.1 t(A)(3) Poultry,Wild Came,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections ° Poultry or Ratites-165°F 15 sec * I above if related to foodborne illness i 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other S 145°F* 1 590.009 violations relating to good retail t 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec, ° I { 17 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-903A I(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165"F 2 Minute Standing Critical acrd non-critical violations, which do not relate to the Time* foodborne illness inten,entions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Fecal- found in the following sections of the Food Code and 10S CMR 140°F* 590.000. 3-403.1I(E) Remaining Unsliced Portious of Beef 11 Item i Good Retail Practices FC 590X00 i Roasts* 1 23. i Maaagament and Personnel FC-2 .003 ! 18 Proper Cooling of PHFs 1 24, i Food and Food Protection FC-3 .004 1 25. i Equipment and Utensils FC-4 ,005 3-501.14(A) Coating Cooked PHFs from 140°F to I ! 26, Water.Ptumbinq and Waste FC-5 X006 " 70°FWidiin 2 Homs and From 70°F11 127. ! Physical Facility FC-6 .007 to 41`F/45'F Within 4 Hours." 1, 28. Poisonous or Toxic Materials FC-7 .008 i ) 3-501.14($) Cooling FHY's Made From Ambient 29. { Special Requirements .009 ) Temperature Ingredients to 41'F/45°F ! 30. i Other ! '• i+ Within 4 Hours"' °Nnotes critical mra in the L-deral 1999 Fuad Code car 105(:-MR 590.000. c. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4s'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name D Type of Operadon(s) Type of Inspection --4-( ( 'l? ® Food Service Routine Addressy �� 1 Mak Retail Re-inspection (2r^ " of m Level ❑ Residential Kitchen Previou InVection Telephone (� �jJP� l 7 h ❑ Mobile Date:f 3 Owner l ff HACCP YIN ❑ Temporary ❑Pre-ope ation J"I J�( (1? (7��n .,J d ('V ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) / Tim ❑ Bed&Breakfast El General Complaint In:J X0.1 ❑ HACCP Inspector Out: -CL.3_ Permit No. ❑ Other Each violation checked I*equires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ��l'=l 13. Handwash Facilities EMPLOYEE HEALTH l��"�' PROTECTION FROM'CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC _ [114.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded _ _ - X15.Toxic Chemicals FOOD FROM APPROVED SOURCE_ _ _.. -- - 4. Food and Water from Approved Source TIMEfritMPERAT.URE CONTROLS(Potanttelly 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 HIGHLYSUSCEPTIBLE=POPULATIONS'(HSP)' 21. Food and Food Preparation far HSP El 10. Proper Adequate Handwashing ❑ ❑ 11. Good Hygienic Practices CONSUMERADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C1 N 23. Management and Personnel (Fc-2X550.003) by a Board of Health member or its agent constitutes an _ 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-aXSso.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 (FC5X59o.ow) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7X590.008) 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 OFRE INSPECTION: � Inspector's Signature: ( kv, Print- I PICS Signature: ' Print:\ n , 1� 4-1-R �( ' Paged ofPages I / F_•. ....-.v• 'wJ'..-.. . ^`..,.� 4,,.,.;a ....•s...-. 'v..+r `. •�s... -.-.^"'*..._ «..s`....a....ww--.*+-r•.4.�.+a^w.. 4w.w ..a.,.-. -r.,1._..v Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION ( g Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(]) Raw Animal Foods Separated from I ( 1 590.003(A) I Assignment of Responsibility* ; J Cooked and RTE Foods* 1590D03(B) Demonstration of Knowledge" Contamination from Raw Ingredients ( 2-103.11 I Person in charge-duties ( � 3-302.1 1(A)(2) Raw Anima]Foods Separated from Each I Other* EMPLOYEE HEALTH f Contamination from the Environment 2 590.003(0) Responsibility of the person in charge to I ( 3-302.1 RA) Food Protection* require reporting by Aral employees and 3-302.15 W ashing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of AFc,)d Employee Or An I utensils* Applicant To Report To The Peraon In j Contamination from the Consumer i Charge* 1 3-306 14(A)(B) Returned Food and Reservice of Food* j 590.003(0) Reporting by Person in Change* f t Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions'* I Food 590.003(E) Removal of Exclusions and Restrictions j 3 701 it Discarding or Reconditioning Unsafe C Food* FOOD FROM APPROVED SOURCE 141 Food and Water From Regulated Sources 9I Food Contact Surfaces { 590.004(A-B) Compliance with Food taw'* � 4-501.111 Manual Warewashang-Hot Water V 3-201.12 Food in a Hernteticall Scaled Container* j Sanitization Temperatures* 4 j3-201.13 Fluid Milk and Milk Products" j 1501.112 MecfianicalW'arewashing-HotWater ( 3-202.13 Shell ERggs.,* j Sanitization Temperatures* 4-501.114 Chemical Sanitization-temp.,PH, ( 3-202 14 Eggs and Milk Products.P�tstenrized* concentration and hardness-* ( 3-202.16 Ice Made From Potabic Driaking Nater* � � 4-601.11(A) Equipment Food Contact Surfaces and ( 5-101.11 Drinking Water from an Approved System"' i Utensils Clean* 15a(),006(A) Bottled Drinking Water` ( (M 4-60_'.1 t Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CNIR 2 0* _ j Contact Surfaces and Utensils*. Shellfish and Fish From an Approved Source j 4-702.11 Frequency of Sanitization of Utensils and I 1 3-201.14 Fish anti Recreationally' Cnught'ololiusca;a I Food Contact Surfaces of Equipment* Shellfish* 1 4-70.3-I1 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish f-ort NSSF I,ested I Chemical* Sources* j lq Proper,Adequate Handwashing I Game and Wild Mushrooms Approved by � 2-301.11 ( Clean Condition-Hands and Arms* Requlatoy AuNrcdty ( 3-202.1.8 Sheltstock Identification Prescm'" ( 2-301,12 Cleaning Procedure* 590,004(C) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 I Game Animals"' I ( it Good Hygienic Practices q I ReceivingiConditlon ] 2401.11 Eating,Drinking or Using Tobacco* j ( 3-202.1 t PHFs Received at Proper Temperatures* j 1 2101.12 Discharges From the Eyes,Nose and j Mouth* ( 3.202,15 I Package ixtkegri[)" I ( 3-301,12 Preventing Contamination When Tastin-* ( 3-I;)i.1 t j Food Safe and Unadulterated* 11'T Preveniion o}Contamination hum Hands ( b j TaysfRecardtifie590.004(&) Preventing Contamination from I 3-203.18 I SheOslnek Identification* 1 Employees* 3-203.12 Shellst xk Identification Maintained* j ( 13 Handwash Facilities I I Tags/Records;Fish Products j Conveniently Located and Accessible ( - j 3-402.11 Parasite Cxrstructiou* t *� ( 5-203.11 Numbers andtaaacities* 3-40^.t2 P<c or3,.,Creation and Retention j 590.004(1) Labeling of Ingredients* j 5-204.11 Accessi and Placement* I 7 Conformance with Approved Procedures ( 5-205.11 Accessibility.Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods" 6-301.11 Handwashmg Cleanser,.Availability ( 3-502.12 Reduced oxygen packaging.criteria" j 16-301.12 I Hand Drying'Provision 18-103.12 I Conformance with Approved Procedures* 4 Den t&s caticirl"sten}in the Federal 1999 pnsad Code or 1015 CMR 590.(3(71). L CITY OF SALEM BOARD OF HEALTH c/ Establishment Name: / ( �a � Date: t Page: of ( r•y Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date / No. Reference R-Red Item Veriflel.�l PLEASE PRINT.CLEARLY _ n 0.7r L�1g ° flJ - I VJ7�� I Q-� A o,0-31ri e_.- �Y r '�� 6n-��-�----t—r-cA /inek _ u S, ne ,) /J"-AC`�2c�rnL. I j1 . .. or 4C � - j rn �. -)\10 6 h.n� �t } r .I ( 1 f �7JLP �(2 r'�C Q t5_ nenngr�i Gv f{ i�� ram n. - N �q2 chi �(3 LZA Discussion With Person in Charge: 1 Corrective Action Required: I ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 11 Voluntary Disposal ❑ Other: , 3-501.14(C) PHFs Received at Temperatures Viotaflons Related to Foodborne Illness infermnflons and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41F145°F Within 4 Hours. ` PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFs ! 14 I Food or Color Additives ! { 19 PHF Not and Cold Hefting { 3-501.16(B) Cold PHFs Maintained at or below•3-202.12 Additives* ! 590.004(F) 43°145°F-- 3-302.14 Protection from Unapproved Additives* ! 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I i 7-101.11 identifying Information-Original ( 740 fyF. ' 3-507.16(A) Roasts Held at or above 130'F. Containers* { 7-102.11 Common name--Working Containers* I { 20 Time as a Public Health Control tCf , 201.11 Separation-Storage* I 3-501.19 Time as a Public Health Control* I f ^ ! ii 7-202.11 Restriction-Presence and Use* I 590.004(H) Variance Requirement { 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-203.11 Toxic Containers-Prohibitions* ` POPULATIONS(HSP) 17-204.11 Sanitizes.:.Criteria-Chemicals* I 7-2tk4.12 Chemicals for Washing Produce,Criteria` I 21 3-801.11(A) Unpasteruimd Pre-packaged Juices and { 7-204.14 Drying Agents.Criteria* ! Beverages with Warping Labels* •' 17-245.11 Incidental Food Contam Lubricants* � 3-901.1I(B) Use of Pasteurized Eggs* { 17-206.11 Restricted Use Pesticides,Cnteria* 13-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served-* 7-206.12 Rodent Bait Stations" 3-801.11(C) ! Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and ` { Monitoring* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Pasted for Consumption of 1g Proper Cooking Temperatures tar Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Piomssed to Eliminate 3-40LI1A(1)(2) Eggs- 155°F 15 See. Patltak'ens.*ta«e+s rn;za±f Eggs-immediate Service 145'Fi5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.1I(A)(2) Comminuted Fish.Meats&Game Eg Animals-155F 15 sec. 1 13.401.11(6)(1){2) Pork and Beef Roast- 130'F 121 min* I SPECIAL REQUIREMENTS 3.401.11(A)(2) Ratites, Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in sec.* catering, mobile food,temporary and 1 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Aleut, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.1I(C)(3) Whole-muscle,Intact Beef Steaks ( interceptions and risk factors. Other 145T* I 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under k'-9- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs--145'F 15 sec.* I ! 17 Reheating for Hot Holding { VIOLATIONS R SLATED TO GOOD RETAIL PRACTICES 3-103.11(A)&(D) PHFs 165°F 15 sec.* I (Items 23-30) 3-103.11(B) Microwave- 165'F 2 Mande Standing Critical and non-crituai violations,which do not relate to the Time* foodborne illness interventions and risk,*rors listed above, can be 3-403.11(0) Commercially Processed RTF.Fowl- ( found in the following sections of the Food Code and 105 CMR 140°F* ` 590.000. 3-403.11(E) Retraining Unsliced Portions of Beef ( j Item i Good Retail Practices FC 590.000 i Roasts" ` 123. I Management and Personnel I FC-2 A03 1 i 18 Proper Cooling of PHFs i 24. Food and Foal Protection ! FC-3 .004 i 125. Equipment and Utensils I FC-4 .005 3-501-14(A) Cooling Cooked PHFs from 1400F to 26 Water.Ptumbin4 and Waste ! FC-5 '008 1 70°F Within?Hours and From 70 F 27. Physical FaciiBy 1 FC-6 .007 to 41`F/45'F Within 4 Hours.* i 28. ' Poisonous or Toric Materials FC-7 .008 i 3-501.14(6) Cooling PHFs Made From Ambient 29. Special Requirements ,003 i/ Other Temperature Ingredients to 41'F/45'F i I Within 4 Hours" t 'D nous critical ivm in the federal 1999 Food Cede w'105 CMR 590.000. i CITY OF SALEM BOARD OF HEALTH Establishment Name: - ( 1 �� ,� Date: g�2oL,7 Page: 3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONDat'e. No. Reference R-Red Item n PLEASE PRINT CLEARLY I verified A Or X12 I _ I I I Kra �/ A orL G ,o f r✓ r1•.e.f.� , L I l 1V-J vel �I I t I ,�r Iw n I JW A1 Cass ►J -4 1-,� sh1 �,, � -rvbQs yl— QIP_ ) k 1 t K n , � moi' n✓ C4- 4/ D1^ or 45L.X-Z4 - r i cz C i4 eZMEI ' _ L't- 3y nnil 4 ct n,n;_ n !S 'f, l .� R°9.�c nc�K : 1C�ue 1>r!t rr i n! rllusci:t� 1, J . � I�I W']. C��Ii A �Ze I✓.r Discussion With Person in Charge: Corrective Action Required: I ❑ No i)-o'-_30's 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 e-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. „�Ja� ❑ Voluntary Disposal ❑ Other: t 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accordirm to Law Cooled to Factors{(terns 1-22) (Cont.) 41'FJ45'F Within 4 Hours. PROTECTION FROM CHEMICALS I 3-50L15 CocluiR Methods for PHFs I 114 I I Food or color Additives j 119 PHF Hot and cold Hoiaing } I 501.16(B) Cold PI3Fs Maintained at or below j 3-202.12 Additives*' i 590.004{F) 41'145°F* 3-302.14 Protection from Unapproved Additives* y 590. 16(.0} Hot 450 F Maintained at or above i 15 ! Poisonous or Toxic Substances 7-101.11 IdentifyingInformation-Original ( • 1400P. Containers* 3-501.16(A) Roasts Held at or above 130'F. ° 1 i 2t1 Time as a Public Health Control 1 17-102.11 Common Name-Working Containers* j ( j 1 7-201.t I Separation-Storage* � 590,00 4(H) Variance 9 Time as a Public e ReyniremeHealth nt Contra!* I 7-202.11 ,Restriction-Presence and Use* 590.00 17-202.12 Conditions of Use* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-203.11 Toxic Containers-Prohibitions* i POPULATIONS(HSP) ( 7-204.11 Sanitizers.Criteria-Chemicals* j 7-204.12 Chemicals for Washing Produce,Criteria* ! 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ( j .Beverages with Warring Labels*7-204.14 Drying Agents.Criteria" 3-801.11(8) Use of Pasteurized Eges* 1 7-205.11 Incidental Food Contact.Labticams* I 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria( Raw Seed Sprouts Not Served 7-206.12 Rodent Bait Stations* ` 3-801.11(C) Unopened Ford Package Not Re-served * I 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Fords That are Raw,Undercooked or PHFs Na Otherwise-Processed to Eliminate 3-401.IIA(1)(2) Eggs- 155'F 15 Sec. Pio ns.*eR°n*,nrzc t Eggs-immediate Service 145'Fl5sec+ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155'F l5 sec. " 1 3.401.11(B)(ix2) Pork and Beef Resist- 130'F 121 m%n* I SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see.* catering,mobile food,temporary and 3-401.11(A)(3) ' Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-1650F 15 sec * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef.Steaks ( interventions and risk factors. Other 1450F590.009 590.009 violations relating to goal retail 3-401.12 Raw Animal Fools Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3-401A I(A)(1)(b) All Other PHFs-145'F 15 sec.* I j 17 , Reheating for Hot Holding j V)OLAT/OAIS R SLATED TO GOOD RETAIL PRACTICES 3-103A 1(A)&(D) PRFs 165°F 15 sec. * ) (Iteans 23-30) 3-403.11(B) Microwave- 165'F 2 Minute StandingCritical and non-critical violations,which do not relate to tine I Time* 111foodborne illness interventions and risk frurors listed above, can be 3-403.11(C) Commercially Processed RTE Food- I found in the fallowing sections of the Food Code and 105 CMR f 1400F* ( 590.000. 3403.11(E) Remaining Unsliced Portions of Beef hent ; Goad Retail Practices FC 590.000 Roasts* j i 23, i Management and Personnel FC-2 .003 i 1 1g Proper Cooling of PHFs j 1 24. i Food and Foci Protection I FC-3 .004 1 1 25, 1 Equipment and Utensils I FC-4 .005 3-501.14(A) Coating Cooked PHFs from 140`F to ! 26. 1 Water.Plumbinq and Waste I FC-5 006 70'F Within 2 Hours and From 70'F ( 27. i Physical Facility FC-6 .007 to 41`Fl45'F!i rthin 4 Hours.* 128. ' Pasoncus w Toxic Materials FC-7 .008 3-501.14(8) Cooling PHFs Made From Ambient � 129. � Special Requirements ,003 Temperature Ingredients to 41'Ff45'F 30, I Other Within 4 Hours* s`*""'""•`.'�: 'fienMec critical nem in the federal l999 Fwd Cale ur IW C-MI,590.000, i f CITY OF SALEM BOARD OF HEALTH i Establishment Name: �"= ( l [ 2 2 r� Date: �� Page: tI of `/ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Pr'i3UC-� °T'7 ( r>wt oW,d , '- ud oa u , a:)IT 6i C`- l�� CSL,s 11.01)6 olt df-lq ( fbx.1<' Wa4r-�� sem 3.0 ka-- I QU&C L "\V( ".w � ,��rR j r��t c yl4 "'IS —204-Ry 6 s �3 ar dD✓L�� a r� I P I ��,.. i�}.r� i�,+•- �� SP_P ��i3 �— ��1 —ri��a,r- 13., �1L �3. 2� r 3 I 5(i AA`- Aj iYao J-7- y 'q ru vvul J , . JAJ I.s �i: ter. 'j jr9A4 �,.vd 'P, -r r3L T)� I ah 6,111L. ' 13 I I U&n kE-5-T R n -IW L zyo-�&- cimr R rll �'I3 a1�_ 1-3 1 ? - oYa9 (? � ,�� . i- ate r_rvlolcu (��/� 63 as t J4jr f o ped . Ir ctwAna.�a�.rlV_ IZ- Iia S,-tl"C r� / f�l2o%'� I ✓S 12� Discussion With Person in Charge: Corrective Action Required: ❑ No �) �--ales 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 Emersion violations before the next ins P e-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. 1 � I 0 ❑ Voluntary Disposal LI Other: �Wct; -9A-..t y S "771 CJS N sw 4, h-e ro r .�Jla nl c «,x�r�n•�ce "� ✓'T �� "i?'c,-,d a �v(.e`-1,4j .1 3-507.14(0 PHFs Received at Tempendures Viotations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Hems 1-22) (Cont.) 41'F/45'F Widan 4 Hours. PROTECTION FROM CHEMICALS I 3-501.15 I Cooling.Methods for PHFs � 114 1 Food or Color Additives t" 119 PHF Not and Cold Holding { 3-501,t6(B) Cold P11Fs Maintained at or below 3-202.12 Additives*- I 590.004(F) 410745"F* / 3-302.14 Protection from Unauproved Additives" 3-501,16(A) Hot PHFs Maintained at or abuts 1 Poisonous or Toxic Substances �17 7-101.11 Identifying Information-Original 140 F. Containers* 3_501.16(A) Roasts Held at a above 230'F. I 1 I 120 Time as a Public Health Control 7-102.11 Common blame-Working Containers* 3-501-19 Time as a Public Health Control* 1 7-201.I I Separation-Storages` ! 7-202.11 Restriction-Presence and Use* 1590.004(H) I Variance Requirement { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) E 7-204.11 Sanirizers.Criteria-Chemicals* i 7-204.12 Chemicals for Washing Produce.Criteria' 121 3-801.11(A) Unpasteurized Pre-packaged Iuices and 7-204.14 Drying Agents.Criteria* ( .Bevemnes with Waring labels* 7-305-i1 incidental Food Contact,Lubricants* 3-80LII(B) Use of Pasteurized Eggs* I 17-206.11 Restricted Use Pesticides,Criteria* 13-801.11('D) Raw or Partially Cooked Aninwt Food and 7-206.12 Rodent Bait Stations* I Raw Seed Sprouts Not Served 7-206.13 Tracking Powders,Pest Control and 13-801.11(C) Unorrened Fuel Package Not Re-served. " Monitoring* CONSUMER ADVISORY TIMEti EMPERATURE CONTROLS 22 3-603.11 Consume''Advisors'Pasted for Consumption of 16 I Proper Cooking Temperatures tar Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.IIA(1)(2) Eggs- i55`F 15 Sec. Pathogens.*a"°`'* r Eggs-immediate Service 145°Fl5sec^ 3-302.13 Pasteurized Eggs Substitute for Raw Siteil 3401.I1(A)(2) Comminuted Fish.Meats&Crane Em* Animals-155'F 15 sec. " 13 401.11(B)(1)(21 Pak and Beef Roast- 130°F 727 mitt* SPECIAL REQUIREMENTS 3-401.11(A:)(2) • Ratites Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)In sec.* catering, mobile food,temporary and 3.401.1 t(A)(3) Poultry,Wild Game,Staffed PHPs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145T* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Coked in a - practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. * I I Y7 Reheating for Not Holding VIOLA77OAIS RkATED TO GOOD RETAIL PRACTICES 3-103.11(A)&(D) PHFs 165'T 15 sec. * I (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and Leon-critical violations,which do not relate to the Titre* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the foilowing sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.11(1:) Remaining Unsticed Portions of Beef Hem i Good Retail Practices FC 590.000 l Roastsr' 123, 1 Management and Personnel ; FC-2 .003 ' ( lg Proper Cooling of PRFs I i 24. Food and Food Protection I FC-3 .004 1 25. ( Equipment and Utensils i FC-4 .COs 1 3-501.14(A) Coling Cooked PHFs from 140'F to 26. Water.Piumbinq and Waste ! FC-5 .Win 70*F Within 2 Hours and From 70`F j 27, Phvsical Facility i K-6 .807 � to 41`F/45'F Within 4 Hours. ° ( 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Annbient 29. ( Special Requirements + .009 I Tempexamre Ingredients to 41'F/45'F 1 W i Other ' Within 4 Hours* Dmote.,critieat imm in the federal 1999 Food Cmie w1W C.MR�90.000. , f 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 Namen p ate T e O eration s TYoeAR Inspection I t�C 4WAA, _'' nn �l - -�n � I UPod Service (�outine Address Risk IM Retail ❑ Re-inspection 1 Level [I Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP YM El Temporary ElPre-operation El Caterer El Suspect Illness Person in Charge(PIC) I TI ❑ Bed&Breakfast ❑ General Complaint ElHACCP Inspector I'5,,,WI I OInuu Permit No. ❑Other Each violation checked requi an xplanation 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 _.____d�_ �__ .��.1 Prevention of Contamination from Hands gable/Duties CC�� 1122 13 Handwash Facilities ❑ 2. ReportingpLof Diseases b PROTECTION FROM 1. PIC Assigned Knowledg TH Il - - -- ''Y M CHEMICALS y Food Employee and PIC [114.Approved Food or Color Additives EJ3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals L FOOD FROM APPROVED SOURC , - „ t � [14. Food and Water-from-App-roved Source I TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) I ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [:117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling I PROTECTION FROM CONTAMINATION a ❑ 19. Hot and Cold Holding ❑ 6.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [REQUIREMENTS_FOR HIGHLY-SUSCEPTIBLE POPULATIONS-(HSP); El 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices LCONSUMERADVISORY . ) [: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 r1 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 cf 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 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-a)(sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: f S InepectFamS-ia tice l A co PQ �. ,Ice dw,s Inspector's Signature:( Print: PIC's Signature: l - �7 f Print: //ice -� I Page ov Pages �oY haeme /�a�C l-I- ._ sv. ♦ _ __• .. � /\.'�'• n i .. u. ♦e yam.-a.✓. . .. .. ♦ -• N\{1-4 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION B Cross-contamination FOOD PROTECTION MANAGEMENT I 3-302.11(A)(1) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* ( Cooked and RTE Foods* 590.003(6) I Demonstration of Knowledge* I Contamination from Raw Ingredients I 2-103.11 Person in charge-duties 13-302.11(A)(2) Raw Aminal Foods Separated from Each Other* EMPLOwEE HEALTH I Contamination from the Environment � 2 590.003(0 Responsibility of the person in charge to 3-302.1 I(A) Food Protection* require reporting by food employees and i 3-30.. IS Washing Fruits and Vegetables applicants* I 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person in Utensils ( I Contamination from the Consumer I Charge* 13-306.14(A)(B) ( Returned Food and Rted or Contaminated e of Food* 590.003(G) Reporting by Person in Charge* StlOn of Adulterated or 13 590.003(D) Exclusions and Restrictions* I ( I Food 590.003(F) Removal of Exclusions and Restrictions 13-701.11 ( Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources ( ( 9 I Food Contact Surfaces 590.004(A-B) Compliance with Food law* ( ( 4-501.111 Manual Warewashing-Hot Water 13-201.12 Foal in a Hermetically Sealed Container* 1 Sanitization Temperatures* ( 320t.13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell Eggs* Sanitization Temperatures* 13-202.t4 Eggs and Milk Products.Pasteurized* 14-501.114I Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* I concentration and hardness. 5-101.11 Drinking Water from an Approved System' ( 14-601.11(A) Equipment Fad Contact Surfaces and Utensils Clean- 590.006(A) Bottled Drinking Water* I 14-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* ( 1 Shellfish and Fish From an Approved SourceI Contact Surfaces and Utensils' 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Cau t Molluscan �' Fad Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization-Hot Water and 3-20115 Molluscan Shellfish from NSSP Listed ------I - Chemical* Sources* Game and Wild Mushrooms Approved byI 110 Proper,Adequate Handwashing Regulatory Authority 2-301.11 I Clean Condition-Hands and Arms* 13.202.18 I Shellstock identification Present* 12-301.12 Cleaning Procedure* 590.004(0 Wild Mushrooms" I 12-301.14 ( 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 PHFs Received at Proper Temperatures* I 12-401 12 Discharges From the Eyes,Nose and 13-202.15 Package Integrity* I Mouth* l 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* f 16 Tags/Records:Sheiistock I 112 Prevention of Contamination from Hands .. 3-20118 Shellstuck Identification* I 590.004(E) Preventing Contamination from 3-203.12 Shelistock Identification Maintained'' Employees* Tags/Records:Fish Products 113 I Handwash Facilities 13-402.11 Parasite Destruction* I I Conveniently Located and Accessible 13-402.12 I Records,Creation and Retention* I 15-203.11 Numbers and Capacities* I 590.004(1) I Labeling of Ingredients I 15-204.11 Location and Placement* 9 I ( Conformance with Approved Procedures 15-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supp/'led with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* Devices 3-502.12 I Reduced oxygen packaging,criteria* I 6-301.11 Handwashing Cleanser,Availability i 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Feat Calc or 105 CMR 590.000, CITY OF SALEM BOARD OF HEALTH c� Establishment Name: �.�o�Pte_ Date: 0-1 Page: U�nf Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION onto No. Reference R-Red Item Verified , PLEASE PRINT CLEARLY ----�"/)/YY� I 0 tin° I1,:), 3-301 .12, _�h C��1 ?' — 'L . ennA nit Zj,, r ie 1- -- M A/ I (gyp -I rA�_ i� �ra �,00 Amt c�.0^, �-P�i o ny Discussion With Person in Charge: Corrective Action Required: ❑ No `�'es I have read this report, have had the opportunity to ask questions and agree to correct all m/Voiuntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-ins�tioQ Sclied� ❑ Emergency Suspension cpmply 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 mbargo -I_l� ❑ Emergency Closure your food permit. MM pl ` 13 ❑ Voluntary Disposal ❑ Other: -_-- a f� t r 3-501.t4(C) PRFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk According,to Law Cooled to Factors(items 1-22) (Cont.) 49.'F/45`F Within 4 Hours. I PROTEC71ON FROM CHEMICALS 3-501.15 Cooling Methods for PHFs I 14 Food or Color Additives I 19 PHF Hot and Cold Holding 3-50L16(B) Cold PIIFs Maintained at or below 3-202.12 Additives* 590.004(F) 410145"F* 3-302.14 Protection from Unapproved Additives* I 3-50L16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances * 7-101.11 Identifying Information-Original MOR3-501.16(A) Roasts Held at or above 130'F. Containers' * i 20 Time as a Public Hearth Control 7-102.11 Common Name-Working Containers* ` 1-201.11 Separation-Storage* f 3-501.19 Time as a Public Health Control* 590.004{H} Variance 7-202.11 .Restriction-presence and Use* I � � 7-202.12 Conditions of Use's � REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP} 7-204.11 SanChemicals.s firr W a-Chemicals, � � 21 3-801.1](A) Unpasteurized Pre-packaged Juices and 17-204.12 Chemicals fru Washing Pr«hrtx,Criteria* � f 7-204.14 Drying Agents.Criteria° { .Beverages with Warning Labels* 7.205.11 Incidental Food Contact,Lubricants* Use of Pastemazetl Eggs* 3-801.1 l(D) Raw or Partially Cooked Animal Food and r7-206.11 Restricted Use Pesticides,Criteriat Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 1 3-841.11(C) Unopened Food Package Not Ro- ervcd. 7-206.13 Tracking Powders,Pest Control and i Monitoring-, CONSUMER ADVISORY t 22 3-603.11 Consumer Advisory Posted for Consumption of 71MErrEMPERATURE CONTROLS Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate �ER«ays rn.7M!I 3-40t.11A(t)(2) Eggs- 155'F 15 Sec. Pa t bogens. Eggs-ImmediateServic:c 145°Ft5sec^ 3-302-13 Pasteurized Eggs Substitute for Raw Shell t 3401.11(A)(2) Comminuted Fish.Meats 8c Game Ems* } Animals-155'F 15 sec. " 3.401.I1(B)(1)(2) Pork and Beef Roast- 130'F 121 min+ SPECIAL REQUIREMENTS 1 3-401.11(A)(2) Ratites,Injected Meats-155`F IS 590.009(A)-(D) Violations of Section 590.009(A)-(D)in i Sec * catering, mobile fond,tempararp and 3401.111A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be I Stuffing Containing Fish,Meat, debited under the appropriate sections r Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(0)(3) Whole-muscle,low Beef Steaks interventions and risk factors. Other 1 145F 4' 590.009 violations relating to goad retail 3-40LI2 Raw Animal Foals Crooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145°F 15 sec. j 17 Reheating for Hot Holding VIOLATIONS R.LATER TO GOOD RETAIL PRACTICES - a 3403:1100&(D) PHFs 165F 15 sec. * (Items 23-30) { 3-41)3.11(B) Microwave- 1650 F 2 Minute Standing Critical mrd non-critical violations,which do not,elate to the Time* foodborne illness interventions and risk factors lisied above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400P 590.000. 3-4012A I(E) Remaining Unsliced Portions of Beef Item 1 Good Retail Practices FC 590.OW Roasts* 23. 1 Management and Personnel 1 FC-2 .003 ]g 1 Proper Cooling of PHFs f 1 24. i Food and Foal Protection ! FC-3 .004 1 25. Equipment and Utensils i FG-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 1 26, Water.Plumbing and Waste ! FC-5 .006 1 70'F Within 2 Hours and Front 70F 1 27. i Physical Facility FG-6 .007 I ( to 41`F/45'F Within 4 Hours. * 1 28 ' Poisonous or Toxic Materials FC-7 .008 t 3-501.14(6) Cooling PHFs Made From Ambient ! 129. Special Requirements .009 ; { Temperature Ingredients to 41'F/45'F II( 30. l er 1 ' Within 4 Hours* 'Demmq critical m-ni in the federal 1999 Food Cale w103 CMR 590.000. 4 r CITY OF SALEM (� BOARD OF HEALTH Establishment Name:fl (O1 0JWAA Date: ()—f2'IP5 Page: �_-5 of -'Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY t/ O�c@3 rCOOAA !} n t'C n _ J ` /.A__A�Oa 4r t I 0 I I - � iOJaI I (� �1c�'�//11 1991��_�..tlJ_�� L1 .i• __� AA "A 0_ 'tJl Ai0 I"�DAAVo i.tfic �G� ash i�'Y\ A, A O/Ac(.�77�J1 I I Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all 6KIVoluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe aconditions asescr , an all ditidescribed, to Exclusion p Re-inspection Sghecled ❑ Emergency Suspension cgmply 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 o /Embargo r ❑ Emergency Closure your food permit. / C= ❑ Voluntary Disposal ❑ Other: J tr t l4 3-501,l4(C) PHFs Received at Temperatures 1 Violations Related to Fdodborne Illness.Interventions and Risk According to Law Cooled to Factors{hems 1-22) (Cont.) 4PF/45F within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs ( 14 Food or Color Additives ( 19 PHF Hat and Cold Holding I 3-501.16(B) Cold PIJFs Maintained at or below 3-202.12 AddiFood ti 590.00 3-302.14 Protection from Unapproved Additives* ( 3-50116(A) 41 Hott F* ( g5 Poisonous or Toxic Substances ( (f PHFs Maintained at or abets i+ 7-101.11 Identifying Information-Original ` 140 * I � 3-501.16(0) Roasts Held at or above 130'F. Containers* 2D Time as a Public Health Control 7-102.11 Connotes Nam-working Containers* ( I ( 3-501.4(H} VarianceRequiremem Time as a Public Health Control* 7-201.11 Separation-Storage* 590.tI0 4( 7-202.11 .Restriction-Presence and Use* ( ( ( 7-02.12 Conditions of Use* ( ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* POPULATIONS(HSP) i ( 7-204.11 Sanitizers.Criteria-Chemicals* I ( 7-204.12 Chemicals for washing Produce,Criteria' ( 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ( .Beverages with Warning Labels* ( 7-204.14 Drying Agents.Criteria* ( 7.205.11 Incidental Food Contac.Lubricants$ ( 3-801.11(B) Use of Pasteurized Eg„as* ( 7-206.11 Restricted Use Pesticides.Criteria* 13-801.11{D} Raw or Partially Cooked Animal Food and Raw Seed Spnxrts Not Served 7-206-12 [rodent Bait Stations* 3-801.11(C) Unopened Food Package Net Re-served. ° 7-206.13 ( Tracking Powders, Pest Control and MonitrntingM CONSUMER ADVISORY ' T1MEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of Animal Foods That are Raw-.Undercooked or 116 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate ( PHFs 3-401.11A(1)(2) Eggs- 155`F IS Sec. Pathogensd `ggs Sof°" Eggs-immediate Service 145'Fl5see. 3302.13 Pasteurized Eggs Sabstimte for Raw Shell P 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs' Animals-155'F l5 sec. iSPECIAL REQUIREMENTS t ( 3401.11(6)(1)(2) Pori:and Beef Roast-130'F 121 mis* ( 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 1 3-401.11(A)(2) Ratites,lnjected Meats-155`F 15 ( sec * i catering, mobile food,temporary and 31401.1 i(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 sec. * above if related to foodborne il mess jjJ 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks I interventions and risk factors. Other ( I 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a { practices should be debited under#29- Microwave 165F* Iii Special Requirements. ( 3-401 A I(A)(1)(b) Ail Other PHFs-145'F 15 sec.* l ( 17 Reheating for Hot Holding ( VIOLA77ONS R PLATED TO GOOD RETAIL PRACTICES 3-030 I(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) t y 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violation,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the foilowing sections of the Food Code and 145 CMI? 140°F* 590.000, 3-403.11(E) Remaining Unsliced Pomoas of Beef i Item 1 Good Retail Practices 1 FC 590.WD Roasts* ; i 23. i Manaosmentand Personnel FC-2 003 i 1 24. 1 Food and Food Protection FC-3 .004 1g Proper Cooling of PHFs 1 25. 1 Ecluipmemand Utensils i FC-4 .065 1 3-501.14(A) Cooling Cooked PHFs from 140'F to 1 96. Water.Piumbinct and Waste ( FC-5 .006 t 70'F Within 2 Hours and From 70F 127. Physical Facility j FC-6 .007 1 to 41`F/45°F Within 4 Hours. * ( 28. Poisonous or Toxic Materials FG-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. I Special Requirements .009 1 Temperature ingredients to 41°F/15°F 30' 1 Oma ' Within 4 Hours* 5_xs,m �.L< 1 'Denotes critical item in the federal 1999 Fuad Cmie or 105 C.Mk 590.000.