Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
HONG KONG KING - ESTABLISHMENTS
HCA9 kony kin y 2 NO�a�aVl s f( ftNIVERSAL® UNV-12110 MADE IN USA 0 m MN.NECYdID l"PrMrSOu � ® CeNdad pmgta Oro mvwffiPmaram and Yi nl'!111 MEMO Date: 8/4/2011 To: File From:David Greenbaum, Senior Sanitarian ) RE: Hong Kong King Based upon a complaint of improper cleaning of the Ansul system and the illegal dumping of waste oil in the alley Senior Sanitarian, David Greenbaum conducted an inspection at the above referenced establishment. At the time of inspection the following were noted: the Ansul is being cleaned on a quarterly basis as required by fire code. The cleaning company, A.S.A.P Fire & Safety of Tyngsborough, is licensed with the office of the State Fire Marshall. All waste oil is being stored in a grease barrel near the dumpster. There is no evidence of oil being dumped in the alley behind the restaurant. I was not able to see any grease or oil splattered on the house of the complainant. No health code violations were noted at this time No further action taken at this time. Commonwealth of Massachusetts ` e City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Hong Kong King Restaurant Fite Number:BHF-2004-000023 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0193 Jan 1,2011 Dec 31,2011 $t40.00 ESTABLISHMENT _ Total Fees: $140.00 PERMIT EXPIRES IDecember3l, 2011 � e Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 I • CITY OF SALEM, MASSACHUSETTS bis BOARD OF HEALTH 120 WASI-iINGTON STREET,4°1 FLOOR TEL. (978) 741-1800 KhNIBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAUMni SALEM.COD( DANTID GREENBAum,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT t.S>>� IfI(�� TEL# `11(�(�' �• �� ADDRESS OF ESTABLISHMENT ©S GA I/� n"� FAX# 4 u MAILING ADDRESS(if different) ` EMAIL- Business': ^-� y Website: f pp /�(� OWNER'S NAME J ill/\ t— 1(�� �( TEL# h�"�/t 0 0 � 011 1?C1 ADDRESS I R pi'm PN t IX vv�y-I 02-1 \ STREET PP ` ^ CITY� 'n STATE 6zl$? 79ZIP CERTIFIED FOOD MANAGER'S NAME(S) 7 'GAO 1 �( " \ CERTIFICATE#(S) // O O (Required in an establishment where potentially hazardous food isf prepared) P EMERGENCY RESPONSE PERSON HOMETEL# I'iDAYS'OF-;OPERATIOW +. Monday',,1."-Juesdayi<``j' _Wednesday >;;' .7husday..It') "Saturday-w-4. > = Sunday'' HOURS OF OPERATION Please write in time of day. �•� I-� — (For example llam-Itpm) loom '"-' IOvvv I�IPVN; t4 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -- - ------ ---- ------ R E STA UR ANT less than 25 seats $14 (Ou door Statlonan,, Ford Cert$21 25-9q seats = _ more than 99 seats =$420 --------------------------------------------------------------0-N--------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOM------------------------------------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES O $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be 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 fled all state tax returns and paid all state taxes required under the law. uN JJAW A*W&7 1 6 o Signature .41N A14 mwG.7. Date (Y /ypG(q Social Security or Federal Identification Number Revised ionli l FOODAP2011.adm Check#&Date -AT-/t-CA -- 1WM -1q ,TQ S A, ° City ®.f S'afem, Massachusetts Fire department pfflNF•t� 48 Gaffayette Street David'W. Cody 'Fire(Prevention Bureau Chief Salem, Massachusetts 01970-3695 29 Tort Avenue 978-744-6990 Te1978-744-1235 7e(978-745-7777 dcody@ialem.com rFaX 978-745-4646 `Fa)C978-745-9402 VIOLATION NOTICE Hong Kong King (Chinese Restaurant) Friday November 5, 2010 028 Norman Street Salem, MA 01970 An inspection of your facility on Thursday November 4, 203.0 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on Wednesday Nov. 10, 2010 at If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. , Violation Code Article Division Page Count 10.03.8 Commercial Kitchen Exhaust Systems and Maintenance 10.03 8 0 0 NON-COMPLIANCE WITH NEW 527 CMR 11 REGULATIONS AS ORDERED 3 TIMES. Commercial Kitchen Exhaust Systems and Maintenance . Commercial kitchen exhaust systems shall be installed and maintained in accordance with NFPA 96, 2001 Edition. On horizontal exhaust ducts, at least one 508 mm, by 508 mm (20 in. by 20 in. ) opening shall be provided for personnel entry. Where an opening of this size is not possible, openings large enough to permit ' thorough cleaning shall be provided at 3 .7 m (12 foot) intervals . Exceptions : (a) Cooking appliances located within a single family dwelling unit . (b) Completely enclosed ovens . (c) Steam tables . (d) Auxiliary cooking equipment that does not produce grease laden vapor, including, for example: toasters, coffee makers, and egg cookers . (e) Existing installations shall be permitted to be continued in service, subject to the approval by the head of the fire department. Inspection, maintenance, testing and cleaning within the scope of NFPA 96, 11/05/2010 10: 16 Page 1 1 .:drAll?% City ®f S'alfem, Massachusetts Fire Department 48 Gaffayette Street �DavuCZV. Cady Fire(Prevention Bureau Chief Salem, Massachusetts 01970-3695 29 Eort,4venue 978-744-6990 Te1978-744-1235 7ef978-745-7777 dcody@safem.com (Fax978-745-4646 Ea,X978-745-9402 VIOLATION NOTICE Hong Kong King (Chinese Restaurant) Friday November 5, 2010 028 Norman Street Salem, MA 01970 shall be performed in accordance with NFPA 96. Documentation shall be available for inspection by the head of the fire department. Xctorran, Jr. , Charles ROccupant/Owner CC; Chief Cody Building Inspector City Health Agent City Licensing Board File 11/05/2010 10: 16 Page 2 i a 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 740-8727 Management and Personnel FAIL Critical BLUE Owner: Comment:Within 3 months the owner must have at least one other full time CFM employed at this establishment. Jian Ming Lin PIC: Man Ming Lin Inspector: David Greenbaum Date Inspected:Correct By: 7/21/2010 Risk Level: 1 Permit Number: BHP-2010-0023 Status: SIGNED OFF #of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: All outstanding violations cited in the 7/12/10 inspection report have been corrected. 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®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 27,2010 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 27,2010 ) Page 2 of � � 4 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment: Dirty knives stores in a dirty bucket. Properly clean and sanitize all knives after each use and properly clean and Jian Ming Lin sanitize the knife bucket. PIC: Dirty buckets are being used to store food in both walk ins. All buckets must properly cleaned and sanitized after each use. Lin Han Ming Violations Related to Good Retail Practices (Blue Items) Inspector: Management and Personnel FAIL Critical BLUE David Greenbaum Comment:There is only one CFM at this establishment. The owner must have at least one other full time CFM employed at this Date Inspected:Correct By: establishment. 7/13/2010 Equipment and Utensils FAIL Non-Critical BLUE Risk Level: Comment:The rice barrel has an accumulation of food debris,spills and splatter. Thoroughly clean ad relable the rice barrel and relable the rice barrel. Permit Number: the door gaskets on the walk in are dirty,moldy and have mildew. Thoroughly clean the door gaskets. BHP-2010-0023 Status: PARTIAL COMPLY #of Critical Violations: Physical Facility FAIL Non-Critical BLUE 2 Comment:There are water stained ceiling tiles in th back hall. Investigate the source of the leak and repair. Replace all stained Time IN: Time OUT: ceiling tiles. Urgency Description(s): BLUE: All oustanding violations mustbbe corrected within one week. Violations Related to Good Retail Practices (Critical All other violations cited in the 7/12/10 inspection report have been corrected. violations must be corrected immediately or within 10 This establishment is hereby grranted permission to re-open immediately. 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®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 27,2010 ) Page 1 of 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®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 27,2010 ) Page 2 oft CompanyList (Hood Cleaning Companies with MA licensed employees (T)Pdaeed6123/2o1o ) I (Company Address City State 11 Call Ventilation 277 Washington St., Apt. 1 Weymouth MA I IA.S.A.P. Fire& Safety 90 Progress Ave. Unit#3 Tyngsboro MA I IA-1 Cleaning Systems 17 South Street Three Rivers MA IA-1 Hood 90 Mountain Road West Hartford CT IA-1 Restaurant Ventilation 145 Broadway Everett MA I (AAA Professional Cleaning 113 Concord Avenue Lexington MA (AAA Restaurant Fire Control 115 Chestnut Street Warwick RI IAddilex Fire Protection P.O. Box 5012 Bradford MA (Advanced Air Quality 333 East Columbus Avenue Springfield MA Advantage Hoodcleaning 19 Rawson Road Hanover MA (Affordable Duct Cleaning 80 Ramah Circle South Agawam MA I (Air Care Environmental Services 480 Neponset Street Canton MA I ]Air Cleaning Services 19 Rawson Road Hanover MA I (Air Duct Services 100 Messina Drive Braintree MA ]Air Duct Specialists, Inc. 239 Liberty St.,Apt.#1 Lowell MA (Air Quality Environmental 1 Harding Road Roslindale MA (Airways Cleaning& Fire Proofing 76 South St. Ware MA All Brite Surface Cleaning 51 Oak Knoll Drive Hampden MA All Types Vent Cleaning Co. P.O. Box 117 Somerville MA Allbrite Restoration 147 Maple Street East Longmeadow MA Allied Commercial Equipment 32 Spice Street Charlestown MA ]American Clean Air Inc. P.O. Box 475 North Pembroke MA IAmericlean 51 Harrison Avenue South Glens Falls NY IB&W Inc. 419 Hurffville-Grenloch Rd Sewell NJ (Bay State Exhaust Services 18 Madison Rd. Halifax MA [Blaze Em Hoodmaster 3100 Davis Road Mims FL (Borges Cleaning Pro 1005 President Avenue Fall River MA (Boston Hood & Duct 25 Cardigan Road Tewksbury MA ] (Boston Power Wash LLC 35 Norwood Street Boston MA I ]Brother's Hood Duct 4 Edinburgh Dr Bedford NH I (Brothers Kitchen Exhaust Services 571B Washington Street Boston MA (Brown Hood & Exhaust Cleaning 216 Pleasant Street Orange MA IBT Industrial Cleaning 639 Mechanic Street Leominster MA (Buchanan Cleaning/Exhaust 60 Robert Street Roslindale MA ]Casey Powerwash 65 Lake Street Braintree MA I ]Ceiling Pro of Rhode Island 802 Main Street Warren RI IChagin Pro-Cleaning Inc. 19 Porter Street Chelmsford MA [Chelmsford Pressure Wash 241 Groton Road Westford MA [Clean E Vent Services, Inc. 744 Flat Rock Road Athol MA [Clean Sweep North and South PO Box 649 South Yarmouth MA [Cochrane Ventilation 154 West Street Wilmington MA (Connecticut Steam Cleaning Inc. 440 John Fitch Blvd. South Windsor CT ]Continental Clean Air, Inc. 20 C Del Carmine Street Wakefield MA ICS Ventilation 67 Albion Street Wakefield MA [Custom Mobile Solutions 21 Winter Street Natick MA (Cyclone Cleaning Corp. 10 Wompatuck Road Hingham MA ICZ Exhaust Cleaning Corp P.O. Box 826 South Easton MA IDa Tong Cleaning 143 Third St. Cambridge MA IDean's Deli 894 Grafton Street Worcester MA (Delta Cleaning Service 39 West Street Ludlow MA Page 1 Companyl-ist (Dependable Ductwork 1192 Main Street Watertown CT ] Dependable Hood & Duct Cleaning LLC 62 Healey Road Candia NH JDJM Kitchen Hood Cleaning 46 Wilson Avenue Johnston RI jDunnwell LLC P.O. Box 1908 Garner NC (East Coast Fire &Ventilation 16 Kendrick Road Wareham MA JERS Enterprise 27 Brattle Street Worcester MA Eternal Cleaning 139 West Squantum Street Quincy MA [Extreme Fire Protection 14 Lincoln Circle Paxton MA [Eyies Electric Inc. 667 Westminster St. Fitchburg MA [Facilites 51A Western Industrial Drive Cranston RI Final Touch Commercial Cleaning 57 Dudley St. Medford MA [ Fire Extinguisher Services of N.E. 66 Main Street Putnam CT [Fire Fighting Equipment 2146 R Main Street Three Rivers MA [Fire Pro 233 Lexington Avenue Manchester NH IFirst Choice 137 Spring Stret Fairhaven MA [ IFleetwash Corporation 91 Maple Street Lowell MA lGeneral Fire Extinguishers, Inc. 12 Arthur Street Taunton MA [ lGreasebusters 16 Carpenter Street Concord NH �Hartman's Herb Farm 1026 Old Dana Road Barre MA Hood Masters 100 Governor's Drive Winthrop MA Hood Pro 49 Elmwood Avenue Holyoke MA lHurley Fire Protection 32 Woodland Road Malden MA lIndustrial Steam Cleaning of Boston 131 Steadman Street Chelmsford MA Ilnnovative Environmental 200 West Main Street Vernon CT Ilnsta-Brite Mobile Washing P.O. Box 148 Whitman MA ]Integrity Cleaning 9 Rosemont Terrace N. Providence RI Integrity Total Service 5 Pickel Way Forestdale MA jInterstate Fire&Safety 404 Willett Avenue Port Chester NY I [Island Fire Protection 550 Adams Street# 199 Quincy MA IJ and J Technology 52 Wheeler Avenue Brockton MA i+ [Jae's Spice 297 North Street Pittsfield MA IKelley's Hood & Duct Cleaning 511 Union Street Rockland MA lKitchen Exhaust Fire Protection, Inc. 7 Nancy Road Dedham MA lKitchen Exhaust Fire Protection, Inc. P.O. Box 33 Needham Heights MA I (Kitchen Klean Inc. 27 Black Hall Road Epsom NH IM and G Cleaning 17 Crane Avenue Peabody MA Magic Wand Services 80 Kristen Lane Wareham MA Martin Striker Services 8 Spring Street Webster MA IMastro's Powerwashing Service 337 Lake Avenue Worcester MA MD Cleaning Inc. 202 Moss Hill Road Jamaica Plain MA ]Medford Wellington Service 17 Locust Avenue Medford MA IMencia Fire Appliance Co. 15 Lawrence Street Lawrence MA [Monte Corporation 1156 Wood St. Swansea MA ] IMr. Hood Air Quality 170 Main Street Holyoke MA Nationwide Maintenance Service Inc. 444 Second Street Schenectady NY INelbud Services Group 7 Alice Court Pawcatuck CT INew England Exhaust Cleaning Co. 53 Rathbone Street Providence RI New Fire Services 599 Old West Central St. Franklin MA ] INisco Inc. P.O. Box 485 Windsor CT ] Noble Hood and Duct 51 Ellington Road Tewksbury MA ] [North East Fire&Safety 231 Pulaski Blvd. Bellingham MA ] [Omni Pro Inc. 165 Lavan Street Warwick RI ] Page 2 Companyl-ist IP Pressure 497 Silver Stret Manchester NH Pao Tsai Sim 277 Harvard Street Quincy MA Perfection Maintenance Co. 175 Ashby Lane Sheperdsville KY Power Metal Hood Cleaning 124 North Westfield Street Feeding Hills MA lQuality Hood &Duct 68 Glendale Street Revere MA IR&M Pressure Washing 11 Melvin Avenue Lynn MA Restaurant Hoods &Ventilation 16 Whipple Street Worcester MA Results Hood Cleaning 88 Franklin Street Lawrence MA Rice's Market 769 North Main Street Brockton MA IS&C Vent Cleaning P.O. Box 516 Uxbridge MA Shore Thing Cleaning 32 Sewall Drive Mashpee MA Sigma Kappa Sorority at Amherst Collegi 19 Allen Street Amherst MA Simplex Grinnell (NH) 35 Progress Avenue Nashua NH IStar Air P. O. Box 400 Bellingham MA Stones Cleaning Systems 1981 Memorial Drive Chicopee MA Straight Shooters Mobile Washing 67 Bedford Street Whitman MA Trans-Clean Corporation 45 Mayfair Place Stratford CT 1 Tri State Fire Protection 84 Lake Street Nashua NH U.S. Filter Corp. 45 Sand Creek Road Albany NY jUnder Pressure Hood &Exhaust 1 Apple House Road Lakeville MA United Power Washing 26 Beacon Street Burlington MA (United Power Washing P.O. Box 7101 Brockton MA ) Wachusett Country Club 187 Prospect Street West Boylston MA IYe Ole Commons 120 Northside Road Charlton MA Page 3 Served from 11:30 am to 3:00 pm 1-1-1-21 Served with Roast Pork Fried Rice L,1 - Pork Chow Mein, Chicken Fingers...- 425 L2. "Moo GooGai.Pan,-Chicken Fmgers...:...425, L"'3:" Subgum Pork Chow Mein; Boneless Ribs ...............I........... ... 525 L R." Egg Foo Young, Chicken-Teriyaki ..., ..4.95., L=5. -Sweet and Sour Chicken;',Egg Roll 5 25 L 6. Lobster Sauce,Chicken'Fmger...........:...4.50 ; L 7. -Teriyaki, Chicken Wings,, Chicken Fingers:.........:......................:.::.:.5.50 'L,8:`" Teriyaki; crab Rangoon, CHINESE R L S TA.0 RANT Chicken Fingers............... .5.25 We-use 100% Pure-Vegetable Oil L 9 -:Boneless Ribs, Chicken Wings, g .....5.25- DEI j` , Crab Rangoon ....................:............... L10.rft� Kung Pao Chicken, Chicken Teriyaki:..:,5.25 ` Call 15 minutes prior to closing for delivery: L11. Cashew-Chicken,-Chicken,Fingers:........5.25. Minimum Order$10:00`a$1;10 Delivery.Charge www.salemhongkongking.com L12.-&Hunan Chicken; Spring Roll ..:..:.....:. ..:...5.25. Ll 3.- Chicken with Broccoli, Crab Rango6n':::5.25 . Take Out'or_Delivrery Please Call L14 Beefwith Broccoli,'Crab'Rangoon... 550 i fy '5af ;.L15. - Beef with Mushroom, Crab"Rangoon......5.50 U.. (778)740-� �p G� _ L16.�Kung Pao Shrimp; Chicken Fingers: ::5.95 Fai.- 7 )74 Y0® �2 L17. Shrimp with.Vegetable;Crab Rangoon...5.95 'L18 r*- General Gau's Chicken, Crab Rangoon-5.50' GIFT CERTIFICATES AVAILABLE L19.r& Orange Chicken, Crab Rangoon .::..::::....5.50 L20. - Sesame Chicken,Crab Rangoon........I.....5.50 ' OPEN DAILY' L21.n► Spicy String Bean, Crab Rangoon .., 5.50 MON THURS.:11:30 AM-10:00 PM FRI.-SAT: 11:30 AM 11:60 PM_, . L22.. Vegetarian's Delight with White Rice,` SUNDAY.:NOON--10:00 PM Spring Roll....:. .....4.95 ; - L21-o-Bean Curd Home.Style, --_ 28:NI®[rnatl Street, Route 114, Crab Rangoon with White Rice......:.. 5.50 _ Salem, MA 0197®; , L24 a Hot_&Spicy ShrimpwithWhite Rice, E99-Roil ...... ..... ...5.95 ssetet L25 Pork or Chicken Lo Mein, Chicken Wings 4905 5 Hot&Spicy E i 54 za Mass Meal T V5%' Norman S vm :Not Responsible for Lost Articles'. cast 1Ce., I. _ _ _ _.,_ . .. y,. .. Sm. Reg. Sm. Reg. 1. Egg.Roll......................::...........'.. ...........::::.1.65 3.25 36. Steamed Rice........................................:.... 1.25 1.95 2. Spring Roll(no meat). ..........................::....:.1:65 3.25 37: Vegetable Fried Rice ..:... : 3.50 5:25 ................... .. 3. Chicken Wings ............................................ 4.30 6.95 38:` ' Roast Pork Fried Rice`....:.:.r..::,:.:..:.:........:::.3.75'5.75 4. Fried Shrimp Chips ..........:................:...................3.50 39. . Chicken Fried Rice-...............:....,:............... 37525.75 5. Chicken=Teri aki........... ::::.: 3.95 6.95 _ y _.;.... ........ 40... ,Beef Fried Rice .................................... 4.20 5.95' 6. Beef Teriyaki...........................................::..: 4.30 7.75 - Y 41. Shrimp Fried Rice....:::.I............................4.20 5.95 7.- Chicken Fingers............I............................. 4.25 6.25 42: House Special Fried Rice :::.::::.::...:....:.:::::'4.20 6.50 8. Crab Rangoon............,...........:....:..............:.3.75 6.25 43,. .-Young Chow Fried Rice:....................:.................:;6.50 9. Boneless Spare Ribs.........::.....:..............: :3.95 6.95 44. Ham Fried-Rice....................................................5.75 10., ,Barbecued.Spare Ribs :..:.:...:::. ... <3.95 6.95 � 11. Scallion Pancakes .................... ..............3.75 12. Fried or Steamed Dumpling...:.............................5.95 13. .- French Fries................................I......., , ... 2.50 - 46 .; Pork 3.95 5.95 47. Chicken.......................................................3.955.95. 14. Fried Wontons......:.:.::..::.:. ............................3.00 15. Fried Jumbo Shrimps...........................:...............7.25 48, Beef.................................................:...........4.25 6.25 16. Fried or Steamed Qumpling...............(1)4.25 (2)7.25 49. " Shrimp...............................:........:.........`......"4.25 6.25 17. Pork Strips,.........a+4y................................... 3.95 6.95 50. House Special: .;:::. :..................:.:.:::.....::`4.75-6.95 18. Vegetable Tempuras .......::.: ...............:................5.75 51._,_ Vegetable............... 3.955.95 ............._:,::.....:.:., ..,... 52. Garlic Noodle......................................... 3.50;5.25: g 19. Pu Pu Platter ...........•. ............ ... -ChickenfWrings - ),rigid Jumbo Fingers rir p(2),Feed 53 Sesame Cold Noodles ..... 4.75 54. Rice Noodles with Chicken or Shrimp.................6,50,. 20. Kid's HaPPY`Box..:...: ...:..:......:....:.::....................6.50 Crab Rangoon (4), Chicken Teriyaki(2), Chicken _ 55:r.*;Peking.Noodle with Hot,Meat,Sauce::.:...:...:....;6.95 Fingers(4,Spring Roll(2). - - 56.. ,Singapore Rice Noodle withGutry ............: .....6.95 ,- W5 ED,NOQ A, Beef Teriyaki,Chicken Forgers; 58. . . Vegetable.. P _.. 6.25 Spareribs,Egg Roll,:.`..........................7.50 . 57. _ Choice of Shrim ,Chicken,or Beef :. 7.25 Boneless Spare B. Chicken Teriyaki;Chicken Wings, Boneless Spareribs,Crab Rangoon .....................7.50 59. -,•Seafood.............,.....,............................................7.95; C. Fried Jumbo Shrimps, Chicken Fingers, 11yft Chicken Teriyaki;Egg Roil........... `.. ..7.50 """"' ' 61 Vegetable ..... .....6.50. D. Beef Teriyaki,Chicken Wings,Spring Roll, Crab Rangoon...........:........................................ .7.50 62 Shrimp or Chicken 6.95 CHOW ms 3d L � - 21. Hot&Sour Soup......- . 1.95 3.50 66• Beef or Chicken 6.75 , , 22. E Drop Soup................................................ 1.95 3.50 �� N gg P , ftf�ci I Old CIS H 23. Wonton Soup............................. 1.95 3.75 24. Chicken Rice or Noodle 'Sou 1.85 3.50 67. Vegetable ....... 3.95 5.50 ( -. = .=_ .. ) „ p..,::.: . 68: . , Pork....:.....,.,,::..,.,..,........:.._..............::..........3.95 5.75 25. Chicken Cofn`Soup : ,,..3.95 26. Tofu&Vegetable Soup ................................. 1 85 3.75 69. Chicken ..., ,. 3,95.5.75- 27. House Special Soup...........--..::.......::.........:.::..:::5.75 70. . Beef............................:.......:::.::.::......... ::..:::4.256.25 CSeafoodDeli ht Soup.....:..........................: . .: .6.25- 71: Shrimp "........`= 4.25 6.25 28. Delight .. . .. p.........:.....:.:..:.°...:.,:.....°..........:.. 73 House Special........;.:..:..,. 7.25-. (Shrimp,Chicken and Pork) 31: . Mushroom...:........... 5,50 " >, AnySubgumorGhicagoS OChowMeinAdd...0.30 0.50 32. Pork................................... ...-5.95 33. Chicken......................:::r:...............:.....::.........:....5.95 -""-�y- -�'!Consumer advisory warning for raw foods 34: Beef-..:..:...:.................... ::. :..::.... 6.50 0 In compliance with the d .............................................°..... - P. epattment of public health,we 35. Sllrlmp.:::. 6.50 advise that eating raw or undgrcooked meat poultry or sea food -,poses a tisk to yourself, Sm. Reg. Sm. Reg. - .. :...:..::..:.:::.r:4.257.25 . 121. -Pork withMixedVe 77. Chicken..........:.:::::..................:.:.........::.:.:: 4.50 7.50 122:_ Pork with Broccoli.............: .....................::.4.25 7:25 78. -Shrimp.............................:.:..:...:.:....::..........5.25 8.95 123. PorkwithScallions.'...>:;:.:.;:.,:.....................::4.95 7.50 W_ - 124.-Pork with;Garlic.Sauce .,:.. ........ ..... 4.9 -T50, 125;yMunanPork ................................,.,.....,....._..4.95.7.50: BEAN GU ,; :; 126.ra Double Cooked Pork ..... .......7.50 81.- Pan Fried Bea6Curd;withVegetable ...... r........6.75 82. Bean Curd and Black Mushroom ..............;............7.95:. 131. Beef with MixedVegetables-....:............:...... 5.25 8.75 84.e-4& Szechwan Tofu e... .e..,.... 132: Beef with Mushrooms.::.:. ::.::.::.:.::.:.::.:::....:5.25 8:75 85.ro Bean Curd with Garlic Sauce.................................6.75 133. Beef.with Snow Peas:...:::...........:..:...........: 5.25 8.75 ...........6.75 134. Beef with Broccoli.....................I.................. 5.25 8.75 86.^� Ma•Po Tofu(meat) ...... 135 Beef with Pepper&Onions:. ... ..... :5.25 8:75 STEAMED 136. Beef with Oyster Sauce .......:.. ..................... 5.258.75- 87. .258.75- 87. Steamed Mixed Vegetables........:....:.:..:. 4:50=5:95 13T. Beef with Ginger&Scallion .............:...:...:....:...:.9:25 88. Steamed Chicken with Vegetables .........,::..4.75 7.50 138. Kung Pao Beef .:...:.........:..... . . 5.25 8.75 89. Steamed Shrim with Vegetables,............... 5.759.25- 139: Hunan.Beef ......::.:::..::.................................5.25 8.75 ._ VEGETABLE_ 140.'&Beef with Garlic Sauce ..........................r..:: 5.25.8.75; 141.rv,Hot&Spicy Beef......................:..:.:............... 5.95 8.95 f 90. ........::.::.......................ia::.4.50 5.95 142: -Beef with String Bean .....::....................................8.75 Vegetable Delight 9+1 - _ =Stir Fried Bean Sprouts ......::............::.......:.:........4.95- 501- WIN 92 - .-,Stir Fried Snow.Peas..................... ....:...4.75 6.95 -` f93. Broccoli with Oyster Sauce .............,,..........4.50 6.25 146. Chicken with Mixed Vegetables..................:.4.95 7.95 .. - 94.rs Broccoli with,Garlic-Sauce.,...:...,...... .......... 4.50 6.25: 147: Chicken with Broccoli; .:.............................4:95-7.95 �5.ryp_Spic y String Beans ..... 6.25 148. Moo Goo Gal Pan ........:..4.95 7.95 96.-6:, Eggplant with Garlic Sauce..:.:.........`..................:6.50° 149. - ;.Chicken with Snow-Peas..........._..................4.95.7.95 150. Chicken.wifhGashewNuts.: 4.967-95.97.-97..- Green"Jade . . ...... ......... .. .............6.75. ...... Fresh broccoli,snowpeasandstringbeans sauteed = - - -- ' - in white sauce. 151.E Kung Pao Chicken...........................,...........4.95 7.95 - • _� 152.-!_-&Chicken with Garlic_Sauce 4.95-7.95 153 r&Szechuan Chicken...............................:. ......7.95 101. jShrimpwith,MixedVegetables..............:...... 595950 154 -►CurryChicken.... 7.95 ......... 8.50_ 102. . -Shrimp with,Broccoli:.: ...... .. 5.95:9; 156 Chicken with Ginger 50 155^� Hunan Chicken: .....................7.95 &`Scallion :.:...:. :: 103... ' :Shrimp with Snow Peas................ ..:b.95-9.50 i , 104.--- .-Shrimp with Cashew Nuts ............................. 5.95,9.50 157.E Unique Flavored Chicken......................:.:. :.........7.95 105.-4,Curry Shrimp .:•. . ................................9.50 158:.',' Chicken with String'Beans:....::.....:....:....:. 7 75 106.ry►Kung'P-a6Shrimp ... $% . 5 95 __I R 107: Hot&Spicy Shnmp :.:: ... 5 95 9.50` - 161. Stir Fried-Asparagus.............................................6.75 108..E Hunan Shrimp ............:..:..................::..: .:::5.95 9.50 162. - _Asparagus with Beef....:..................... ...................8.50 109.;, 'Shrimpwith-Green Jade:`:.....:.::::::...:.:.::.::.5:95 9:50 16.3. . Asparaguswith'Stirimp.............SM..............:::.:.. ....9.50 110.�Shrimpwith Garlic Sauce ...... .`:::.:;::: :5.95 9.50 ' 164. Asparagus with Chicken:::....:...............................7.95 111I.:_- •Lobster Sauce- 00 112. ' Shrimp with Lobster Sauce ...:.... 5.95-,9:50 I4 - 113._ Shrimp with Pepper&Onions .............;.....,..........9.50 Served with s Pancakes 166 Vegetable .:::... 6150 114.E Fried Shrimp Mild-Pe er Sauce 9.50 """""""" "' """' pp, ._ .: . 167. Pork-..:.......:......:....:...:......................:................:....695' .115. : Scallop with Vegetable .......................... 8.95 168. Chicken.....::....:...:..:..:. ::.:.:.......:......6.95 ....... .. 116..: _Scallop with Black Bean Sauce.... .... 8.95- 169. Beef: 6:95 ................... . 117. S uid wifh Black Bean Sauce ..... ..8.25 q i 170. Shrimp...:.:.....::....:. : 6.95 EWTVAe .- - .• ON SERVED ALL DAY :.H.: 1.. >' Hong Kong Crispy_$hrirnp:.::::5: :;::i:,10.50= Served with Roast Pork Fried Rice 'H-2.-. Seafood Delight .........:...............:..11.95 ' D 1 ,= .Chicken;Wings, Boneless Ribs,_ Lobster meat,scallop,jumbo shrimp,calamari with mixed vegetables in white sauce. -- Chicken-.Fingers...::.......................................6.95 H Ira.Shrimp&Scallop with Garlic Sauce:=10.65 -' D-2. . -Chicken_ Wings;Grab Rangoon, -`H 4 HappyFamily 1095` Sprmg Roll ........ ....,. ......6.75 Beef,chicken,lumbo shrimp,roast pork,Lobster meat and mixed vegetables in browns•auce. D 3. Boneless RIbS, BC@f T@riyakl, Egg R011..6.95 H;5.- 'Gai Poo Lo Mein;(3_boxes)`:.....:.:.:.::::.13.95 :- _ D 4. . B-B-Q Spare Ribs;Egg:Roll........ .:...r.,..::.7.50 Shrimp, chicken,beef and roast pork,sauteed 9 . with flesh vegetables-beddedbysoftnoodles D`5. Chicken Win s,Boneless=Ribs, H"s ;;Four Happiness :.....:.:;9.95 Beef Teriyaki ......... ......,.....................750 Chicken, shrimp, roast pork,-and tender beef blended into fresh garden vegetables and oyster D 6. " Chicken Chow Mein,-Bonel_esS RIbS,_ sauce: _ Egg Roll.. .... ..... ...;675 H-7 Dragon&Phoenix ... .................... 11.50: - Two dishes in one:hot&'spicyshhMpendchick-en D 7. Chicken-Chow olein, Beef Teriyaki, - with ginger&scallion Chicken Fingers........................................6.95 - H.8.r4&General Gau'sChicken. .. 895• Chunks of chl&ken deep fried until crispy and D 6. Egg Foo Young"Boneless Ribs, cooked with hot sweet andsourgingersauce: Chicken Forgers ..:. 6.95 H=9."&Orange Flavored Chicken.....::..:..:........8.95 ; D 9. Egg Foo Young, Beef Teriyaki, Egg Roll.6.95 Orange Flavored Beef:........................:..9:75. Crispy aromatic beef or chicken sauteed with_ D10. '.Lobster Sauce; Egg Roll...........:................6.25 chePsspecial orange flavorsauce D11. ` -.Shrimp. E 'Roll .:7.50 . H10. -. Sesame Chicken ......::.... ........8:95 P 99 _ Sesame Shrimp ....................................9.75 D12.�&Kung Pao Chicken, Egg Roll,.: :6,75 .`Chunks ofchickenor shrimp deep-fried until - D13.'�Hunan Chicken, Chicken Finger -:.6.75 crispyand cooked with sesame seeds and sweet &sourgingersauce;. D14. ` 'Chicken With - H11 a4un Pao Three Deli hfs .:.::...:..:.::::::..8.95" " Beef,jjumboshrimp,chickegn,peanutswithmixed, _ _ 'Mixed'Vegetables,Spring°Rolh.....:..:..:.:::6.75 : - vegetafi(esinbrown sauce. -D15. Cashew Chicken, Egg Roll :.:6.75 H12. = Lemon Chicken ....... ®16. Moo Goo-Gai Pan; Chicken Fin ers :...6 75 aso 9 - - -- Cubes of chicken coated�with water chestnuts- _ - - -. flour and egg,deep fried until crispyand cooked D17. Chicken With Broccoli, Egg--8011 - :6.75 with lemon sauce - - H13. Mongolian Beef.-. ..:...: . ..... 11.95 D18. --B@ef &-Mushroom, Chicken Fingers ....7,50 Beef with onionandscall(onssauteedwith chefs; - D19..- Beef-with Pepper&Onions;Egg Roll .....7.50 -"' _ speoialsauoe. D20 Beef.with Broccoli Grab Ran oon.........:7.50' ` H14. Fried Squid with Mild-Pepper Sauce 10 50 9 H15. Minced Chicken:w.Pine-Nuts.......:.....:9:95 - D21 General Chicken;Crab.Rangoon`7.75 `. with hoision sauce and lettuce leaves top w`rap= ®22 r*�Orange Chicken, Crab Rangoon ..,7. 75'- ping - H15A. Minced Shrimp with Pine Nuts-...:..'....-11.0.- D23. Sesame Chicken, Crab Rangoon ..:..7.75 H16:- -Lobster with Gin er_&Scallion ..;Seasonal D24.r%- Kung Pao,Shrimp;Egg Roll,..:.:......:,:....:7:50_;. . D25 Cashew Shrine E Roll ...: 7;50 _ H17 Lobster,Cantonese Style Seasonal p 99 t -' D26 .,..,Vegetarian's Deli ht E Roll 6.25--. 9 r ,D27.�Curry Chicken, Egg_Roll SERVED ALLDAY D26�.Double.Cooked-,:Pork ....7.50.--, Pick any.of 2 items below D29. Chicken with SnoW.Peas,Egg,R0[I ..c....7.50 'Served-with Pork Fried Rice or:Pork Lo-Mein - D30• :-:Beef or Chicken;o4ith Uparagus, , -E Roll.............::.:... .......... ....7.75 •.Spring Roll (1) .: _ Crab Rangoon(4). _ ° - 99 •••••�• Egg Roll(1): Fried Jumbo Shrtmpi(2) D31.- -Beef.or Chicken with SVirig Beans, ' Chicken Finger(4) Beef,Teriyaki(2)_ Egg Roll.: 6.96 ' Chicken Wings(2)' Chicken Teriyaki (2) = D32 •Sweet&Sour Chicken,Spring.Roli 6P Pork Strips(2) Boneless Spareribs 0028 Norman Street r\ _ S Z SQ �,^ Hong Kong King Restaurant l city of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 740-8727 PIC Assigned/Knowledgeable/Duties FAIL Critical RED Owner: Comment:The Certified Food Mangager does not appear to be knowledgeable in food safety and sanitation. The Certified Food Jian Ming Lin Manager must educate all personnel are educated in food safety and sanitation. PIC: PROTECTION FROM CONTAMINATION Lin Han Ming Separation/Segr tion/Protection FAIL Critical ❑d RED Inspector: C ment:There is only one pair of tongs for allbitems in the Beverage Air deli unit. Provide separate tongs for all food items in is unit to prevent cross contamination. David Greenbaum Food Contact Su es Cleaning and Sanitizing FAIL Critical ❑d RED Date Inspected:Correct By: 7/12/2010 Co mart:There is absolutely no sanitizing solution available in this establishment. Sanitizing solution of proper concentration ust be readily available at all work stations at all times. Risk Level: D' nives stored between equipment. Properly clean and sanitize all knives after each use. Store knives in appropriate knife LD Permit Number: BHP-2010-0023 knives stores in a dirty bucket. Properly clean and sanitize all knives after each use and properly clean and sanitize the knife �=ckets Status: VIOLATION are being used to store food in both walk ins. All buckets must properly cleaned and sanitized after each use. #Of Critical Violations: Prevention of Co tamination from Hands FAIL Critical ❑� RED 10 C mart:There are personal over the counter medications in the food prep areas. Store all personal OTC medications in a Time IN: Time OUT: ;ed.cal, area to prevent cross contamination. re ipersonal food stored in the front sauce refrigerator. Store all personal food in a dedicated employee refrigerator to prevent Urgency Description(s): oss contamination. BLUE: Handwash F ities FAIL Critical ❑J RED Violations Related to Good Retail Practices (Critical mment:The hot water temperature at all hand wash sinks was approximately 98°F. Restore hot water temperature to a minimum violations must be corrected temperature of 110°F. immediately or within 10 TASe be hand wash sink was found completely obstructed. Keep hand wash sinks clear and accessible at all times. days)(Non-critical violations V must be corrected immediately T hand wash sinks in the restrooms are missing paper towels. Provide disposable paper towels in the restrooms at all times. or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 13,2010 ) Page 1 of r Item Status Violation Critical Urgency RED: TIME/TEMPERATU E CONTROLS(Potentially Hazardous Foods) Violations Related to Coohn FAIL Critical ❑� RED Foodborne Illness Interventions Co ent:Sauce found cooling at room temperature in a pot approximately 6-8 inches deep. Cool sauce in pans no more than 3 and Risk Factors(Require nches deep to allow even cooling of sauce. immediate corrective action) 1. Fro chicken being thawed at room temperature. Thaw chicken in a refrigerator,under cold running water or in a microwave. of at room temperature. Hot and Cold Hold' FAIL Critical ❑d RED Co ant:At the time of inspection there was chicken and pork cooling or being held at room temperature. All potentially zardous food must be held at a temperature of 40°F or below or at 140°F or above. E and rice held at room temperature.All PHF must be held at 40°F or below or 140°F or above. Ther food in the walk in freezer that is frozen in a block of ice. This an indication of thawing and refreezing. Do not thaw and r eze food this increases the opportunity for pathogens to grow. REQUIRtMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP FAIL ❑/ RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 13,2010 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel FAIL Critical BLUE Comment:There is only one CFM at this establishment. The owner must have at least one other full time CFM employed at this establishment. Fo d a?secon� rotection FAIL Critical BLUE enta Beverage Air deli unit has uncovered food. All food in storeage must be covered. average Air deli unit has uncovered food. All food in storage must b e covered. The ar clo /rags being used to cover food throughout this establishment. Do not cover food with clothstrags use non porous ily cl able covers to cover food. T e is uncovered food in the walk in. All food in storage must be covered. D mgr ms uncovered. cover all dry ingredients. at all dry ingredient barrels. Equipment qnd Utensils FAIL Non-Critical BLUE j f Gobmme . he rice barrel has an accumulation of food debris,spills and splatter. Thoroughly clean ad relable the rice barrel. Zwbeverage Air needs a thorough cleaning inside and out. Ma 'c Chef freezer has an accumulation of frost. Thoroughly defrost and clean this unit. e�Garland grill has an accumulation grease. Thoroughly clean the grill. �secsecond Beverage Air unit needs a thorough cleaning inside and out including the door gaskets. �hherhe sensorlsmoke detector in the kitchen found taped up. Do not cover the heat sensor/smoke detector. e a unfinished wood shelves in the kitchen. Finish all wood shelves to impervious and easily cleanable. T prep tables need a thorough cleaning and replace the tin foil on the bottom shelves. T ood filters are dirty and greasy. Thoroughly clean the hood filters. e cano ener needs a thorough cleaning and sanitizing. T re is rash barrel in the kitchen that has an accumulation food debris,spills and splatter. Thoroughly clean the barrel. Th cooker has an accumulation of food spills and splatter. Thoroughly clean the smoker. Th is food debris in the sanitize bay of the 3 bay sink. The sanitze bay of the 3 bay sink must be used to sanitize all equipment d utensils only. dr 'n lines for the walk ins is draining into the sanitize bay of the 3 bay sink. Drain lines must drain into an approved drain. e walk in refigerator has unfinished wood shelves. Finish all shelves to be impervious and easily cleanable. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 13,2010 ) Page 3 of Item Status Violation Critical Urgency T es pl stic and cardboard on the racks of the walk in. Remove all plastic and cardboard to allow for proper flow of cold air. T ks in the walk in are dirty and rusted. Thoroughly clean all shelves. ` t door asks on the walk in are dirty,moldy and have mildew. Thoroughly clean the door gaskets. ( T floor of the walkin freezer has an accumulation of food debris and grime. Thoroughly clean the floor. ere is food debris in the back hand wash sink. Hand wash sinks must be used for hand washing only. Ter room needs a thorough cleaning. T dry ingredient area needs a thorough cleaning. he hall floor is dirty. Thoroughly clean the floor. Physical Faali FAIL Non-Critical BLUE C melt:There are water stained ceiling tiles in th back hall. Investigate the source of the leak and repair. Replace all stained eiling tiles. Other-See No s FAIL BLUE mment:This establishment is need of thorough cleaning of all floors,walls,surfaces including under and around all equipment. Due the large number of critical violations noted during the insspection on July 12, 2010 this establishment is immediately ordered to cease and desist operations. Operations cannot resume until all violations cited in this report have been corrected and the Board of Health has given written permission. P City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2010 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 13,2010 ) Page 4 of i ' 1 Commonwealth of Massachusetts i City of Salem Board of Health [Qmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01104/2010 ESTABLISHMENT NAME: hong Kong King Restaurant File Number:BHF-2004-000023 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions t Notes FOOD SERVICE BHP-2010-0023 Jan 4,2010 Dec 31,2010 $140.00 ESTABLISHMENT _ Total Fees: $140.00 PERMITEXPIRES December 31, 2010 Board of health This Permit is not transferable and must be reissued upon change of ownership or location.'The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. page 1 CITY OF SALEM, MASSACHUSETTS e BOARD OF HEALTH 120 WASHINGTON STREET,4"r FLOOR TEL. (978) 741-1800 ~ . KIMBERLEY DRISCOLL FAX(978) 745-0343 �x MAYOR DCREENnAOMOSALEIM.COM „'•: Ate DAN71D GREENBAuNi C O ACTING HEALTH AGENT' &a o7r DF?� O 9 14 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT(('' NAME OF ESTABLISHMENT H0001<V1`l0 ��iot TEL# g7�-74'd -b O ADDRESS OF ESTABLISHMENT = � (V�VVt ivi St- FAX# 10% 1�0 MAILING ADDRESS(if different) EMAIL-Business': Website: p OWNER'S NAME �/`� )jou/ NiwL17 TEL# 017/ 9>97`� / ADDRESS C9 oNZ- ST 3 kA 6 2-11 STREET / CITY STATE ZIP�/ CERTIFIED FOOD MANAGER'S NAME(S)lI�/ �I/ [ /"67 CERTIFICATE#(S) 6 `Z I L-0 0 0 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON Ztk -. 111Y PNN6 HOME TEL# �1QPYSOFaOP,ERATION: ?S{ (Mgntla1.aay6nedy; r`fy;" eW011, FgdayWIPM52tprdW*1411.1 m2 nTlzy HOURS OF OPERATIONHid Please write in time of day. III-3l)U ILJ III'=;dLtNrlOplvjl — IULAMpyyljIAS'— i9py>nll;3o IIpYv1i (I �Iv1 fZatM— It;i'�h (For example l l am-11 pmt �VY\ . TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES (1 0 1 less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 ------------------------------------------------ ----- ----------------------------------------------------------- --------------------- ------- ... `ES NO less than 25 seatsy49 (Outdoor Stationary Food Cart$21 O) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME---------------------------------------------------------------- -------------------------------- ---------------- ------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES ^� $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES N $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties 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. 1-14 >/,4u i(0Y(5 i2. 1 �l U � 60 Signature Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date I I /,I ()y—!7� $ i_�Lj �r 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: 12/29/2008 ESTABLISHMENT NAME: Hong Kong King Restaurant File Number:BHF-2004-000023 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0235 Dec 29,2008 Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH REL a�"'�E `��STEL. (978) 741HINGTON STREET, n1800FLOOR KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR NOV 2 6 2008 IDIONNIQlSALF-M.COM JANET DIONNE, CITY Oi S'L"I ' ' ACTING HEALTH AGENT BOARD OF Ti'c" .vi 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1—I tl fl U I�/l Vi I� I In r� TEL# "17D—��(J (,-z7.2-7 pp ADDRESS OF EST ABLISHINIENT1 Z5f IOyleom h S FAX# q7� -74Q 8 7Z0 MAILING ADDRESS(if different) EMAIL- Business': Website: Q OWNER'S NAME 4Y A AN N.iNC-f TEL# 167 ADDRESS PINS ST 3 g6Sfm mA 02 /I STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)11N )IAV talko CERTIFICATE#(S) 117�77 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# I'DAYS OF OPERATION. I . : Monday -Tuesday I 'Wednesday : .Thursday Friday ISaturday-... I,' Sunday' Ii HOURS OF OPERATION ql=3gh(Vl—Id 1TMq_70V}M Ik o) ,II AIyI 1070?ll Ir%NV1- lo-,00 tt Please write in time of day. !II-36��'�(J:L�; I�.:j O�)'}-��:�}� I�-3C��Y}-'L�()f'Il�� - � ; (For example I1am-11pm) TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT NO less than 25 seats $]40 (Outdoor Stationary Food Cart 5210, 25-99 seats =.,2 0 more than 99 seats =$420 --------------------------------------------------------------- -- --------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES - - -- RM ADDITIONAL PEITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pain and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all stat taxes required under the law. Gvu 1 i ii.r MNl7 ;I �73 /Q O 1 I g � .772-7 Signature Date ' Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date I/—s-0 5� $ '� w Massachusetts Department of PublicHealthSalem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name k l/ 1 Date Tyce of Ooeration(s), . Type of Inspection .1w /. /,1n . I ��74 )IA 1 op`I�l Ili Food Service Routine Address �atM n Risk Ll Retail ElRe•inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date:.�� ] El Temporary ❑ Prrop lati6n Owner -T' HACCP YM I I . I ❑ Caterer El Suspect Illness Person in Charge(PIC) -J Time ❑ Bed&Breakfast ❑❑ General HACCP Complaint _ In: fl,� Inspector / 1 �T Permit No. El Other �c f ;1� ,A� Out t Each violation cliecked 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Receiving/Condition El16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating F17. Conformance with Approved Procedures/HACCP Plans '9\8. 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 ❑ 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-3)( 90.00 ) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(990.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: SWf,� IFo, 14< /^ o�i6j2j Inspector's Signature: I\ I ��' Print: � (n 7 �J PIC's Signature: t �i v Print: ; -v`y" ` I Page Pages Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination . j 1 596.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from j 590.003(B) Demonstration of Knowledge* j Cooked and RTE Faxls* 2-103.11 Person in charge -duties i j ( Contamination from Raw Ingredients 3-302.11()%)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I 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' j applicants* 3-302.15 W'ashlna Fruits and Vegetables 590.003(F) Responsibility Of A Pisid Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In I Utensds* Charge'' j ( Contamination from the Consumer j 590.003(G) Reporting by Person in Charge' j 3-306.14(A)(B) j Returned Food and Reservice of Food'* j 3 590.003(D) Exclusions andRcstrictions* j ( Disposition ofAdulterated orContaminated 590.003(E) Removal of Exclusions and Restrictions ! Food l 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Ruud* 4 Food and Water From Regulated Sources ( ( 9 Food Contact Surfaces 1590.004(A-B) Compliance with Food law* j 4 501.11 1 Manual Warewashing-Hot Water 3-201.12 Foal in a Hermetically Scaled Container* ( Sanitization'reniperatures" - j 3-201.13 Fluid Milk and Milk Products* j 4-5.01.112 Mechanical Warewashing-Hot Water 3-202.13 j Shell Eggs* 1 Sanitization Temperatures* j 3-202.14 ( Eggsand Milk Products, Pasteurized* ( 14-501.114 I Chemical Sanifizabon-temp.,pH, 3-202.16 ( Ice Made From Potable Drinking Water- concentration and hardness. * l j 5-101.11 ( Drinking Water from an Approved System" 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* leiClean* 590.006(B) Water Meets Standards in 110 CMR 22.0"` ( I-F,02.1 1 Cleaning g Freauency of Equipment Food- 5 Shet9rsh and Fish From an Approved Source Contact Surfaces and Utensils* I 4-702.1 1 Frequency of Sanitization of Utensils and , -201.14 Fish and Recreationally Caught Molluscan Food m Contact Surfaces of Equipent*Shellfish' 4-70311 Methods ofSanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( Chemical" Sources* i 10 I Proper.Adequate Handwashing Regulatory Authority Game and Wild orityMusrooms Approved by 2-301.11 Clean Condition-Hands and Arms* j j 3-202.18 Shelistock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* - 3-201.17 Game Animals* j 11 Good Hygienic Practices j 5 Receiving/Condition 2401.11 Eatme,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and j 3-202.15 Package Integrity- i Mouth 3-101.11 Food Safe and Unadulterated* j 3-301.12 Preventme Contamination When Tasting" j 6 Tags/Records:Shelistock j j 12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification* j 590 004(6) Preventing Contamination from 3-203.12 Shellstock Identification Maintained'* I Employees* j 13 Handwash Facilities Tags/Records:Fish Products ( j Conven 3-402.11 Parasite Destruction- 3-402. estruction" j snW LocafedandAccess)bte j j 3-402.12 Records.Creation and Retention* j 5-203.11 ( Numbers and Capacities* j 590.604(J) Labeling of Ingredients" 5-204.11 ( Location and Placement* 7 Conformance with Approved Procedures j 5-205.11 Accessibility.Operation and Maintenance I /HACCP Pians I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing MDevicesethox)s* --- ( 6-301.11 Handwashing Cleanser,Availability j 3-502.1'_ Reduced oxygen packaging,crrteriay' -- ---- j 8-103 12 Conformance with Approved Procedures* ( ( 6-301.11` Hand Drying Provision 9 - Uenol�c critical item in ibe Ceder.d ll 79('Dort Cale a I0�CY1R 5)0.000, CITY OF SALEM 11 ( �, >/ BOARD OF HEALTH Establishment Name: F111� � . , A_c�_w r/r, �� Date: I e3 /�Id0 Page: of Item 'Code C—Critical Item �- DESCRIPTION OF VIOLATION/PLAN{OF CORRECTION _ . , Date No. Reference R—Red Item - - - Verified r PLEASE PRINT CLEARLY r� rill r{- C� Jr'Iprrj /`la. ,: 17 IcMMA„'L/AO �� K/!/ LOc( r✓ ,n Jl_ lIr, 1/1 /,,_�I/I I I.)r/� /In4_ Alf'17_rV d-I\ L ` i it - r ✓/ C.G— 1 �(7' 7 /0_t” - I I � A r � T�i�/ ( shy l-n _ rA'I" ' JY_l4/ .awo_� `�-�. Lo (:� �1.�1,�} � l -ifi/^,L_nL - ,c , r-( } OKLT., nn�1��i'l'A ../ t�1�t(J�/,t_� \_ lvr�l ! ._�-�.✓�, ..� /l]✓ t JI/_�f(f�n - -�- 1rr��l/_.cr.J r..� /,-ti,) -(fir L ir., 1. 1LI// V_'�JL � .�-ti,�� /✓ } , JI C r r,� n I v'�.n r n &� )/'r \_JiR ,n \ G/ / Il?r7 ^ vin.+ /A `7V C7'r (. , 'llp A .✓ +'1 .', I�C lM-� �!'� � H-1 or'— r--! 7ti . = A {'7.'_\ Jr. ri /.-{ l Lk'ti<a_✓ J/-� 1f � Y- IfM�1 �/ I r, -- /1.,� �I A� q3 N! n� r/n �-1 .,r.,n I/i S �e/_SG�� n/ 7. l rl1Vr {3 —� �LYna /Vl_ rM77/1� ��icf r t :� � r { ✓n�,i, n� l M - - ` l„ //) I ,venni 1Y1` h., \� _ fin✓ P—!n -� , CT - svl. �1� C)Vpr- 4, ' Discussion With Person in Charge: Corrective Action Required: ( El A Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee(Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I ❑ Voluntary Disposal ❑ Other: V, R::, / I I - IA " Ir V _ Violations Related to Foodborne Illness Worverrions and RIO to U-,l. (!a;lcd ii Factors(items 1.22) (Cont} :I'13/45=F Willml * How, PROTECTION FROM CHEMICALS tor Illil"s 14 Food or Color Additives 19 PKF Hot and Chid Holding 1 e(!;.16(6) COd pli's%iwra,,ined at•r L--it,w Adlo.ive!,4 - I I -Ifi froot Addifive,;' i 3-50 1,1 f;�'A) I ilit PUF%z i'laiwailled at', show is Poisonous or Toxic Sunstances ldtnfilpillg lnfolln.worl-- Orl"'ilal %,iisbIddator^bvle 1APF,' (7-mmoriNitme 170 Time as a Public Health Control S�rai z6'o -So i3agc,,i `01 I'I rim,as a Vuhlie I Icalth Control i c lividioll -VFviincc lod U:;^ 12 Uw, jREOWREMENTS FOR HIGHLY SUSCEPTIBLE ?-?03 it POPULATIONS(HSPj Criteria --O)C'mickilv Ti t-ill! H(A) ntn jwLiged Juices and 7-?0l.!2Ch,mvicak for Wwhuill,Viild4ice, Dn,ing Ali Cru,:rja (cv,ou>cfiwtth v""Iriloll. 7-245.7 t hicidimial f t-tiilf I i 0)o a,lv r K'al'all" C,X)kt,d ATj;In3( FkKid and Lj,iv Per�,Ilidci,,Cliteml, i St r'd Nici SCrvCd. 7--'06.12 Wkiew 13•14 Sualolv,- 7 206 13 flacklag Pol%dC(L;, (altiol gird3 itf), I I 1,ii,,riinielf ioxil Pai.I a,4, N,)s Ri:-i;er%cd CONSUMER ADVISORY WEITEMPERATURE CONTROLS 16 Proper Cooking Temperattm as for viinill Ilia, art. ki;,i. Under,. 1 PHFs -10 1 1 jAf 1;12� Fligt,- I��,F I'stx. F,eQs Imalk-t6ak:Sef,1cl: I 11'� 1%,;tcqf,/�Xt Fi.;I� f,31 k"m Shall CmImInw-d F-i'll, Wj::.& 6,1111v vet. ' SPECIAL RFOUIREMENTS, roili, t,x,i! tr,mporai,and ;1.1t.11l.Au it ll•tkfltv,Vk ild Smlle(i 1114F,, j rc;lkh'rr.:A kmhen cp�,;idiilv4 should Ile J ' obwd Luldel 13,Q Opt I ate sections abi,ve `.f cc-lali-d til lkvidbornk- illness 3-40d,j PCI,31 Whnl� fraw.-tv. Inrm lt,:J Si,,akF OLliff 1451; ,4)0.009 641, owl rolaiin� tol,m,,ij retail 1.12 ll;lw krihmii Folik Ciw.�ked in '11011161,iedchitedunder f29 Xfielo,valv lo" -1p-cial R;!ijmre-i,.vhm 3-40111(A)ltob) Ali Odiet 11141-, - 15 ' 17 Reheating tor Hot Holding j WOLAWNS RELATED TO GOOD RVAIL PRACTICES 3-403JVA)&{DZ Oil-, 165T ',� ;ec, (Items 23-36) IfB) Mwyotifwc, Io5` I, . Vlloll!e Siandin,, Cliwaf-aili do:,#t,.»+.. wi,evh do nut thr 11 tat... t ,!:i ,,!61 ll�s,Ine;ri,.,� in i,,rs 1;,Icif e&or'% C'm be fim,u��',,The i,i 4,11, lel 'i F,";d Code ewd/t}5{',6th' -40�.l jtr) Commkticially Pltxv,i,�J RTE hlod 140 F, Ik Remajaimi U101ced Portions of Bix:1 F,- 590000 :jagflln� and PSMYM-t t'C 2 003 i 004 Proper Cooling of PHFs 25_ 10 ,Wisil'i €C { 00� 50IJ4A) rom 14;YFIv Watel.Phir'bin" Tc----- I F -1� m ---------- c�!Facli:iy Ff, -r 007 Paiionou, FC-7 003 501.14411) Cooling PI IFs. 11.!dc Frola,lailble,a 29, �009 f, YFtna- T4 rapQrawre to WF;45 F Within 4 `-kali.,"' t CITY OF SALEM _.BOARD BOARD OF HEALTH J Establishment Name: , r(Y YI�fSC ��t✓tt KAP I r1�KLrn4 Date: (to a Page: of I Rem Code C-Critical ItemV.. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date F No. Reference R-Red Item a r Verified PLEASE PRINT CLEARLY C � C,C''I _ ik) —I,)')01S --+j I'Vo ,�.a , s�Pen �iA�� ue)crtalrO (-AVel,( ,4— II L n IJe Vfn-I'3 —�-n ,21r. hrs rn ( v.P; l.tr� � 4� 1o') ,JJr"- A)oonLl rinGn � 1 �� - A.)6:r Q,,,?17 o"C7 '7YJ VO/lli r.� f1�1 ('C�7(l�/�v:�.1/ QC/iK< 4nwt4 r�n-Ii 0, t• /lr<- �� !/ V ' _ - r i I,�/[_� .''l � . �1 I/ �s�1- lin C . �L. ✓Y� i .Srt'j"rS /LIn_0j 4-') cJ 1�4 rL-,.,0 xd -t - J Corrective Action Required: ❑ No I � Yes Discussion With Person in Charge: �— � [ { I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction ! p PP Y 9 9 \ / Exclusion r violations before the next inspection, to observe all conditions as described, and to � Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ^b dA Pill- ❑ Voluntary Disposal ❑ other: f Violations Rolaied to Foodborne Illness latervoritiorc and Rlsk ! :tcvorjin"to F.:tt' 0l,11,.d,:: Factors(item 1.221 (Cont) E 41:C.,'-iC:.2. llr'ktlrn ;Houri ' PROTECTION FROM CHEMICALS 41 i t t ,iioI..�i..I od>;o, P(iF. Pl Food or Calor Add,flves tf3 PHP Had and Good Holding !.lr;ft3} Col,;PHI'S"Maillf"llicd at til bAi,t;• ?-2}2.22 A kittit.:,* 1 13-30114 � Vrot,,c!.,at Fran tin.:prw.ed A(Witr c�,' 1 5=tt,ttt?-1:'1=; IS Poisonous of Toxic Substances ; .'.?: 16,A) I tn'. PHY, .1Yaintaiued at or above 1 7141.1? Id:ntit2n�inl:nmanrm -CYet�ia;z{ t #IJ'F 3 l b o ! 3-jtli.i^.(:? k,•a,t:.Hdd at or:fbo4e t'o`ll,If conf aiv9r.° i 21) Tire as a Public Health Controf i % 102.I1 C:otnntnnName--l4„rkirgCoatajat'r,` i-'?t)l.31 , Sepal:uan - St,nag.:,, i 3 `'S1 19 ( T=.'z;,•a5 a Pathic 2irai'h Contro 7-2t}7..11 Kc,i"icnon -Yrr•sin:.and i'•C` � s,ltil.;fnkEli j V;:rtancr� t:e,luircu;eat 7-'02.12 Condniqu' „f Us r' '-t?03 11 Tonic,C,nnainet^,- i'roi«brtl,m” REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 204.1! POPULATIONS(HSP) Chomic:l�- f're-}rad:.rge,i Imces and b?(54.1 t'htntit.zl5 Por�v'u,hta 2^, x ne ;Gitr.tta' j l 7-204.14 Di}ing Aec m,Criteria° -._-- }tetets�zes with 1iarrinI i,;tbois' of I"', ` i-2it5,?i YnCiriemsl h:xxl(vnlao Imil) won i' �.'_G6.11 Rt::tn,:led t';t Pe>niitie:: <:riEert;t' I „r i ail!sif:. C,� k•d Animal F,xd and S:, u ,})ro+ua Rt:, St:l vcd, 7-200.I2 PctKi,:nt B.,;i St:uu,tts, 7_�oi.l jr_} ulvm polled l4x,a Paci;ag, Not kc-senvl 106 1? Tracking Prnu?er<. Peat C onm i aa,,i 1 Mouit+Inn CONSUNOF€i ADVISORY TIME/TEMPERATURE CONTROLS .2 ' I:: i i i onsurn:t .fit?',im, Vt veil !in Ctnts,eanptitm of ,v�n,.,l I.'+r;J,7hm.ire lc;u. ttnden:utficd Ci f 16 Proper Cooking Temperik'nres forPHR tit;t S fi)? ',Y.lti:(2? Eigg,- 15i '.,3u2.;+ t:.rariln.�d E�• z,P,aNnnr fan kaer Shea i•h Li�i,gs-hlnnedt:Rc Ser,'tcr i, ' iis?c °�..', 1401.1tt:t)t1) �C„mnlinn±'d}i,h. .`•tc„r�A Cia;itc• Animal, 1,5 1: !;set.. .. 3401.11(B)(1/2) Pork and tint k0a<1 - i;()°l: 121 uun° SPECIAL REOUIR£MES°1T-S i-�til.I1'Aiitl 5 ti 5!:;t_l}t s:ll r;liU.� :,I:iII,7n�i,CS.:,•itt,n 5t)()W)lA',-(D) in j clacrinia tt=obil,axilla temp.,rai.v and , 3 401.I1(A), A;uln), Wild riatn�:, nulled Wleei � 't.•Id:•iit:ail kitchen op,,Aaiitais,Ilv[ld lw uCt'SI F.i inded'tiR'a'9t'i; Cllt2':CCtif}itfi St,ti4nle i:oath)=un:� I:i:.h. !tfea:. N? p Po+7iity r.r kat+us-I67'E' 15 s,:c. t'.?:Md to ict Ilflo nr il?itcs,. ?-401.211 f'i?;�, \Vh:•ie-naua:its 6tl rct Ii,',:I Sten4.e; i and ri:4, ta.tors. Cxbm 145'1^ t 590.000 viol:at „ns relating.to^ut:d r,twl 'i---Ut.12 Ran Awirut}'o•,d, Ctx)k•:tt ins 41oo!J he dehifi,°t, undrr h29 . I ;Uta„tiaoe l�S`F 1 5t1,'tz:ti It:cl!tiretttcttt': ?tA){t!t},) ,1i. CJtlttr VtiF� 9 t: 15 Sec I 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) VHY':. 165''F- 23-30'? A-403.1 1(H) Uiinn,avc- lf,Y,F-2 tf:,nnr smildinr {rrt,r:;,1 crd n.a;-= n;„rzt :,t,f,rtr,»,t, ,;;itch cl„rru; :p4lm't.1 tk,, Tlnx^ (rc;ttlr rttr i1bl s,. r:t�..t d,;nrn,re,:.,rr,i r,;,i jilt fors i„r,,,d aaborr. Eta?be 3 403.111(7) t-,,mmcr.iall,E'iree..cd R1 1•:vxi- ` for o;.!;rr 'k. Jrr;n::,, s r r::m. ,j th, Fo,:rt Cad,-nal 105£AIK 14ti'F` 516.0(e7. ltP:rr Card f{eta+t Pr3rtiCEs Fi: r590.tJOt) -- 3_10? I11 Remaining I ntlued Pr,riom(it t3rri R ,ast, 123 i Manat,cmeni ano Per=mnel_- FC -.2 005 Proper Coolln of PHFs i__'a r'm'':"0 fto l F'r:tic'Ct,:,:, , F£: 3 J_094 j ift g E : 25. c ui meal ar,8 Utenaiis FC-4 t tX75--�`1 t idir J Ct,,ain Cooked PHt:t ht,n, I: . 1'tt, 1 -' 1 1 ' .:F. ( 'r'1a'e! P!t:R� sn�r",r:G ay.^'fE_-_... ......i-FC-5,_ �. ...'a_.-_ 7U`F Within 2 Hours;,'td Front 7U`i- i ! 27 phy;:,ai Fa..itty E£,-6 1 407 I t,: 11"Ili-15'f' :Vit1•.v4 Hours ' ! 2L< ' r:NnT;^::s of lbs):- FA,.td--=:a!s iFC _' I .003 3 501 14BCcoting PHR,W& From Ambient i "9: Pe,:ia1 fs(wifemem: 409 Tclnfnv,a«rc ln}=redirntst,-41 1:/.15.4 a 'Si.nok.-initcat sten,6t ihr i,+4z.+! 19 P> WS C'lk 59000O z Massachusetts Department ,of Public Health 120 W Board SHealth Department 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 / ) L Date I Tyoe of Operation(s) Type of Insoection `r, K .' rY �iAr. bCo�y7r�ir..nl 1J.;i11c,.A © Food Service El Routine Address I ` III«` ) ` Ri's`k ' [I Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone k v+ ❑ Mobile Dateto'd-troy \ El Temporary ElPre-operation Owner \ I �( + HACCP Y/N 1 El Caterer El Suspect Illness Person in Charge(PIC) Time ElBed&Breakfast ElGeneral Complaint 1 In:'.4 S- E] HACCP Inspector w� n�nr,U 1 Out:, , ,-r Permit No. El Other Each violation check d requires art explanation on the narrative page(s) and a citation of specific provision(s) violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ' - ❑ 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties ❑ 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 ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements, a ,. ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATfON'. ' " " ❑ 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 SUSCEPTIBLE POPULATIONS(RSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing I CONSUMER ADVISORY El11. Good Hygienic Practices El22. 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 23. Management and Personnel (Fc-2)(550.003) by a Board of Health member or its agent constitutes an 1 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 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 -T 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 5801na IFom 14 dx ^ -. ' _ �• f/ \I Inspector's Signature: Print: PIC'sSignature:w(JPA/V Print:/-rr�r ��� it hln�� I Page�Aof__�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 ( Cross-contamination I d 590.003(A) Assignment of Responsibility' 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of KnowledgO I I Cooked and RTE F(x)ds* 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.t l(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other, 2 590,003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 13-302.11(A) Fes(Pmtecticm' applicants* 13-302.15 I Washing Fruits and Vegetables 590 003(F) Responsibility Of A Ftrxl Employee Or An ( 3-304.11 Food Contact with Equipment and Applicant To Report To The Pelson fn Utensils* Charge' I Contamination from the Consumer 590.003(6) Reporting by Person in Charge'" I 3-31)6.14(A)(B) Returned Food and Reservice of Food^` 3 590.003(D) Exclusions and Restrictions* Disposition ofAauN.erafedorContaminated 590.003(E) Removal of Exclusions and Restrictions I Food 1-701.1 i Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* J 141 Food and(Mater From Regulated Sources ( 19 Food Contact Surfaces I590.004(A-B) Compliance with Food Law* I 4-501.111 Manual Warewashing-HotWater I 3-201.12 Fwd in a Heretically Scaled Container` I Sanitization"leniperattves` ) 3-20L 13 Fluid Milk and Milk Products* I ( 4-501.1 t2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs' I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized` I ( 4-501.Ltd Chemical Sanitization-temp.,pH, concentration and hardness. 13-202.16 I Ice Made From Potable Drinking Water` 4-601 I ltA) Equipment Food Contact Surfaces and 5-101.1 I Drinking Water from an Approved System" 590.006(A) Bottled Drinking Watcr* � ( Utensils Clean" 590.006(,B t Water Meetq Standards in 310 CMR ( 4-602.11 Cleaning Frequency of Equipment Food- ' Contac Solaces and Utensils* Shellfish and Fish From an Approved Source I ( 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shell isM 4-703,11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemicaii' Sources* I 10 ! Proper,Adequate Handwashing Game and IMAd Mushrooms Approved by (_ I Requ)atoty AutnorHv ( 2-301.11 Clean Condition-Hands and As" 3-202.18 Shellstock Identification Present* I 2-301.12 Cleaning Procedure* ( 2-301.14 When to Wdsh*590.004(C) I Wild Mushrooms* ( I 3-201.17 Game Animals« 111 Good Hygienic Practices g Receiving/Condition I 12-401.1 1 Eating,Drinking or Using Tobacco* f 3-202.11 PHFs Received at Proper Temperatures* I 12-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity' Mouth" 3-101.11 Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* 16 TagsMecords:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.00.4(E) Preventing Contamination from i 3-203.12 Shellstock Identification Maintained* I I Employees* j Tags/Records:Fish Products ( 113 ( Handwash Facilities 3402.11 Parasite Destruction' I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* I 15-203.11 Nunbers and Capacities* 590,0040) I Labeling of Ingredients" ( 15-204.11 I Gxatian and Placement* 7 I Conformance with Approved Procedures I 15-205 11 Accessibility.Operation and Maintenance IHACCP Plans ( Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods" I _ a 16-301.11 Handwashing Cleanser,Availability 3-502.1_,, I Reduced oxygen packaging;criteria 18-103.12 Conformance with Approved Ptoc:edures* I 16-301.12 Hand Diving Provision Denotes critical Trent in the federal 1999 Foctd Code in 105 CNIR 590,000. CITY OF SALEM 'I �f ) BOARD OF HEALTH Establishment Name: Fl t)n% [•^l' Date: (��) /7f'j Page: DZ of nZ- Rem Code C-Critical lteml J ', DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION-, I Date No. Reference R-Red Item - Verified yy ` PLEASE PRINT CLEARLY i ID} <-(era !-�� .l� /1( � il�lCn ^)nocVn Irv) I,4_1A'YV/.' f Yr./1,✓1G t n_ ink aA .1P�C 4/�. �.� —h) ) �I. Ili l • \�e� �1 GrrcoAv f w(l' 1lA.,/ o l ! )o f JA 606/ iXt t 1 i 1 1 z I 1 i I f I 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No d.ot Yes I have read this report, have had the opportunity to ask questions and agree to correct all e 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 {Ploncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure L r food permit. / r� �-1/V ACG ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne fHn&qq Interventions and l"Ist, Factors(Items 1-22) (Cont.) WWvn I Hvuu�. PROTECTION FROM CHEMICALS 3 iii Mollrid�,tor PHF, PHF Hot and CoW Holding Food or Color Additives 3 50!.1611tt r_*l-!.!PFF�",NliiI1f::1ticd at fir 2u2,12 1 Adtiitiscs' 41,.,4Y F 1 501 1 6,A; Fol PHFs %laiplained at of alow 2.14 edkddili�es' Pomnaus or Toxic Substances 101.11 jdtmlilymit Iiiiii twt:iori- ougifla.1 kv;,,ts HOd at u shove I Containers' Time as a Public fifteen Central 7 K121! colmumNamc, 'A,wki1)1',(,iqwuw:rst IQ Viw�asa Punji�Health 7-201.11 1.•pa,.Iukm- 1.20,111 Rcqric6on and 7-2()2.12 Condtl;ow. ,fI Is,,' 7-�(),l I t To�,Cunmui�i, Probibi:mw REOOIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Chcmici,k- 21 t 80 1 Ilii? Vrc.p;ld,;,gcd jurces and 1 i`I::enagci,with Naraillk I; 7 201,14 Dr} Agmt>. I Iffit I "r P4,mniz-i Ea._,:<, lacidenial rxgl Ci,��I.m, J01 I it!)' R,m or flommk Animal Fmd and 7-20ti I I kc�tricted Cw 0,teivil k;ii% N,,t Srrvcl_ 7-106.12 R(Xiew Ban Stallorl" powdcr<, Peat("Introl anti CONSUMER ADVISORY 22 t 401} .1 Cwxumei Aa,:sor,, Po\,tl :,ir Cuitsumption(,I TiME/TEMPERATURE CONTROLS 16 Proper Cocking rempetatures for i lir it.:i 111,11 z,C ka,,% un&lukcd(n PHFS Pr, Uimmxe 3 40 1 1 IA(l)(2) I`> ?: I 9 sc�', Pathowa, lk;,w Shell Fx lmliwdiaac Set, Allitmik I 55T 15.:c;:. SPECIAL REQUIREMENTS lHltls ri 1 011.1 i i b0!-CN,_'i4 MLIA� 155 F Vitti,moo,,cq Stqwq '90.(X)9i A'i-(DI it) �,w. , I mohjl,: i;Kxi, wmpwai.v avid 3-}ti 1.111 Au;) PouitD,Nk ild Gime SwIfed PtIl"", I:ircher. opLi,tveins,hotdd Ila sluffilvContamin'. Fish. Raaf, &Nlcd w0cr tile apmcprimc iectlojl� 15.wc. rvjuled it.f,)(xjf%,mk: Illooss 3-401.INC),'3; Whole nlij,^!C, fatu,:l 130 Steaks j inlerwrmm-z a!!d :isle hik:torc Odiff 145"j. 51-40.009 vioLuow:r0atinc� to pokd rclail 3-4(11.12 R:iw Anirlbi I•"ads Cixiltcd m a i ices Jw;ild lx:dcHim! under #29 - Mmov_lw 165 F'` Ifal II(A,(Iiib) A!10mei Plfl:s-- 14YT i5scc 17 Reheating tar Hot Holding j VIOLAVONS RELATED TO GOOD RETAIL PRACTICES Pill-, 165 1 15'W( (11terils 23-A I I(d) Miriilvav,,, Cr i.V�11 wi.7 Wm.,filt"al vk,iiwows, wimh dr,pi,,); 1,) rhr 3-403.11.47) Commulcia-k,itrwe"'cd RTL RN"I in tke "ef IiOm V,the/,h),l t ode cfml 10('11IR I 40T 1-4t)3A IlEl Realamin�1.103'ed Pwtlolls officcl I ?m1m I Good RoNil PT?cticira i Niw�aaetric:,i wid Piii<onnej FC IN i i7c_�a wvj_�Euvl FC--3 004 Proper Coaling of PHFe PTIFk Irom 14(1-i�ic, I rc_�IoqleW and utefisi.!j FC- 4 j.Q5 _ [GFWater,"u.m6vt22111 cl'4 aete 1 FC- 006 701, W;llon 2 likiury wid From'10T 1 PIIIVs111at Faclliry Fi.— 26 of Tnxir M�Aefiai:i µ Fc 1 - I On '-Sol,144 H) ('00irlY,PHR Made Froill Amblew 009 -rcillpewoire Ithi n 41 I�mrs D:r,•to,i.fltj,.A iteir m hw I" F"),l K""i 105 L 141(590 ` Commonwealth of Massachusetts City of Salem Board of Health 1(hibefiey D(beoii 120 Washington Street,4th Floor Mayor SALEM,MA 01970 FoodMetail Establishment Permit DATE PRINTED: 04/17/2008 ESTABLISHMENT NAME: Hong Kong King Restaurant ReNumber,BHF-2004-MO23 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-MB-04n Apr 17,2008 Dec 30,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMTF EXPIRES cetnber 30,2008 Board of Health . This Permit is not transferable and must be reissued upon change of ownership or location.The permit most be posted In a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any remotions,improvements,or equipment changes are made,an Plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • • BOARD or HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FA-x(978)745-0343 MAYOR Is(:o•1,1r7sm,iz K.CoNf JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT My96�e /t i - TEL# 9V 7*11 f727 ADDRESS OF ESTABLISHMENT,.F &,Y1d4 JZ ,6AW1,0A FAX# ^)119 MAILING ADDRESS(if diff//A erent) tW Ai A'ki e EMAIL- Business': TT4/ Website: ''/1F) v OWNER'S NAME Je2r) AW ) rA TEL � V ADDRESS/' /ih2 tj6ty6lo fao 2/// STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) zqa 464-il)l CERTIFICATE#(S) -S117777 (Required in an establishment where potentially hazardous food is pry ed) EMERGENCY RESPONSE PERSON , / a4 4/ 1 Lh HOME TEL# I DAYS OF OPERATION Monday Tuesday j Wednesday Thursday Friday ; Saturday I Sunday I HOURS OF OPERATION Please write in time of day. (For example Ilam-11 pm) /I;, llm — /D TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------- ------ -----------------------------------------------1 ------------------------------ ---- RESTAURANT E NO less than 25 seats $14 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 BED/B-REA --------------------YES-----NO ------------------------------ ----------------- $100 CHILDCARE SERVICES - ------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES (� $25 TOBACCO VENDOR YES 1 $135 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be 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. - y19 J1�4 P4NGf 14/7101a�-,2�4789GI Signature Date Social Security or Federal Identification Number 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 740-8727 Owner: Jian Ming Lin PIC: Zheng Feng Zheng Inspector: Elizabeth Salandrea Date Inspected:Correct By: 4/14/2008 Risk Level: Permit Number: BHP-2008-0235 Status: Open #of Critical Violations: 0 Time IN: Time OUT: SII Urgency Description(s): BLUE: An opening inspection was conducted and the following were noted: Violations Related to Good Retail Practices (Critical Last extermination reciept dated 2/29/08. Owner must have establishment exterminated by a licensed pest control violations must be corrected operator prior to new food permit being issued. immediately or within 10 days)(Non-critical violations Owner has been given undercooked foods advisory for menu; new menus not printed yet. Owner to forward copy must be corrected immediately of menu with advisory to board of health for review. 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. Apr 18,2008 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 18,2008 ) Page 2 oft ( IMPORTANT MESSAGE ) I FDP /��� DATE � a TIME 0 onF l0/7 AREA CODE NUMBER EXTENSION 3iOB .tee `0 's7-aaa�-87aC� AREA CODE NUMBER TIME TO CALL / TELEPHONED I PLEASE CALL CAME T,0 SEE YOU WILUCALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE _ /J.CLv1f�/�O� �ALd-11W' '/wssL�Oi.{iix- � l.C.�y 7lw�rt.7a-Mi' e� ` SIGNED �) r Vi70C FORM 4009 ��w���r1���iiii MARE IN U S.A. 1 NOTES r ' 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 740-8727 PIC Assigned/Knowledgeable/Duties PASS ❑d RED Owner: Non-compliance with: Zheng Feng Zheng Anti-Choking PASS PIC: Tobacco _ PASS Zheng Feng Zheng EMPLOYEE HEALTH Inspector: Reporting of Diseases by Food Employee and PIC PASS ❑J RED Elizabeth Salandrea Date Inspected:Correct By: Personnel with Infections Restricted/Excluded PASS ❑d RED 14/1112008 FOOD FROM APPROVED SOURCE I Risk Level: Food and Water from Approved Source PASS ❑Q RED I Receiving/Condition PASS ❑Q RED I Permit Number: Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED 1 BHP-2008-0235 Conformance with Approved Procedures/HACCP Plans PASS RED Status: PROTECTION FROM CONTAMINATION Open Separation/Segregation/Protection PASS RED #of Critical Violations: Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 0 Time IN: Time OUT: Proper Adequate Handwashing PASS ❑d RED Good Hygienic Practices PASS ❑d RED Urgency Description(s): BLUE: Prevention of Contamination from Hands PASS RED I ,Violations Related to Good I Handwash Facilities PASS 0 RED Retail Practices (Critical t PROTECTION FROM CHEMICALS violations must be corrected Approved Food or Color Additives PASS ❑� RED 'immediately or within 10 'days)(Non-critical violations Toxic chemicals PASS ❑O RED 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. Apr 14,2008 ) Page I of Item Status Violation Critical Urgency RED: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Cooking Temperatures PASS (] RED Foodborne Illness Interventions Reheating and Risk Factors (Require , PASS © RED immediate corrective action), Cooling PASS U RED Hot and Cold Holding PASS �J RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED - CONSUMER ADVISORY Posting of Consumer Advisories PASS (_] RED Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils FAIL Non-Critical BLUE omments:Shelves of walk-in fridge have areas that are rusting.Reseal or replace shelving to make impervious and easily cleanable. -secure wash,rinse and sanitize labels at 3 bay sink. Physical Facility FAIL Non-Critical BLUE II0-- ments:Ceiling in women's room has large cracks in paint.Scrape and repaint ceiling. 9,9ne tiles missing in wall near sink In women's room and men's room;replace tiles. ;o rsweep on back door in disrepair.Replace doorsweep and seal all gaps to help prevent entrance of insects and rodents. ott�3 om part of screen on back screen door in disrepair.Replace screen. Water,Plumbing and Waste PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE A change in ownership inspection was conducted. Re-inspection 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. Apr 14,2008 ) Page 2 of3 y Item Status Violation Critical Urgency 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. Apr 14,2008 ) Page 3 of ' CITY OF SALEM BOARD OF HEALTH Date: April 7, 2008 Name of Establishment: Hong Kong King Address: 28 Norman Street Owner(s): Jian Ming Lin Phone: 978-740-8727 The proposed owner of this establishment presented an updated Floor Plan and Menu for review in accordance with the State Food Code. Jian Ming Lin was accompanied by Andrea Kor, Paralegal for Christopher Coleman who translated the discussion and this report. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. Mr. Lin has taken the class and is certified at this time. A "Person in Charge" or "PIC" must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. FLOOR PLAN A Hand Sink must be located in each food prep and service area. Therefore, there is a hand sink in the front prep area. The hand sink must have a wall hung soap and paper towel dispenser. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the basement. Storage must be at least 6 inches off the floor. A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes will be used. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. Fruits and vegetables must be washed prior to preparation. All food must be held at 41'F or lower, or 140°F or higher, at all times. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. At time of this review steps of receiving and the preparation through service of pork strips and chicken with mixed vegetables were discussed. UNDERCOOKED FOODS The advisory was given to the owner. An advisory must be added to the menu if undercooked food items are served. CUTTING BOARDS Cutting boards must be provided in good repair. If cutting boards are stained or scored they must be replaced. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. These must be clearly marked "sanitizer" in Chinese. Outside area of premises, including the dumpster area, must be kept clean and sanitary. TRASH Trash will be held in an outside dumpster. A grease barrel will be located in the same area. The dumpster must remain closed and the area must be kept clean. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. This establishment is scheduled to open in 2-3 weeks. Please call one week prior to opening to schedule an opening inspection. Application for permit to operate a food establishment and check were submitted at time of review. J net Tonne Date Senior anitarian -)�v ,AAI'4 F--i�C C-7 2-f Jian Ming Lin Date �i'71,?,o( ndYea Kor Date C6jciC - JJt- 0uJ/1��uP,�1��iUYi -Re ( IMPORTANT MESSAGE ) FOR r�-J�,o n SATE y'-/�_0 g+ TIME /D /F46A: M OF PHONE U AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII G AREA CODE NUMBER TIME TO CALL ff TELEPHONED ✓ PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN C WANTS TO SEE YOU RUSH 1 ` RETURNED YOUR CALL WILL FAX TO YOU MESSAGE �p-�'-�-�-«� , -L'D 2- ' SIGNED FORM 4009 MARE IN U.S.A. - LUNCHE0N SPECWy r OlK ' Served from 11:30 am to 3:00 pm L1-L21 Served with Roast Pork Fried Rice 044 L 1. Pork Chow Mein, Chicken Fingers..........4.25 L 2. Moo Goo Gal Pan, Chicken Fingers........5.25 L 3. Subgum Pork Chow Mein, Boneless Ribs ...........................................5.25 L 4. Egg Foo Young, Chicken Teriyaki...........4.95 L 5. Sweet and Sour Chicken, Egg Roll..........5.25 L 6. Lobster Sauce, Chicken Finger...............4.50 L 7. Teriyaki, Chicken Wings, 'Z Chicken Fingers........................................5.50 CHINESE RESTAURANT L 8. Teriyaki, Crab Rangoon, 'i Chicken'Fingers........................................5.25 We use 100% Pure Vegetable Oil !, L 9. Boneless Ribs, Chicken Wings, Crab Rangoon ...........................................5.25 WE DELIVER . L10.^► 6, Pao Chicken, Chicken Teriyaki .....5.25 Call 15 minutes prior to closing for delivery L11. Cashew Chicken, Chicken Fingers .........5.25 f Minimum Order$10.00•$1.00 Delivery Charge J 4 www.salemhongkongking.com � L12.' Hunan Chicken, Spring Roll ....................5.25 ; L13. Chicken with Broccoli, Crab Rangoon...5.25 ! Take Out or Delivery L14. Beef with Broccoli,Crab Rangoon..........5.50 I Please Call T L15. Beef with Mushroom, Crab Rangoon......5.50 Tel.: (978) 740-8727 11_16.ra• Kung Pao Shrimp, Chicken Fingers........5.95 Fax: (978) 740-8728 L17. Shrimp with Vegetable, Crab Rangoon...5.95 11_18.r►General Gau's Chicken, Crab Rangoon 5.50 GIFT CERTIFICATES AVAILABLE 11_19.ra►Orange Chicken, Crab Rangoon .............5.50 L20. Sesame Chicken, Crab Rangoon.............5.50 OPEN DAILY I L21.-& Spicy String Bean, Crab Rangoon ..........5.50 MON.-THURS.: 11:30AM-10:00 PM L22. Vegetarian's Delight with White Rice, FRI.-SAT:11:30 AM-11:00 PM SUNDAY:NOON-10:00 PM Spring Roll.................................................4.95 L23.r► Bean Curd Home Style, 28 Normals Street, Route 114 Crab Rangoon with White Rice................5.50 Salem, MA 01970 L24.ra- Hot&Spicy Shrimp with White Rice, Egg Roll......................................................5.95 Essex Street L25. Pork or Chicken Lo Mein, % -0 Chicken Wings ..........................................4.95 5/��7 4004 10th i r► Hot&SpicyIli4 Mass Meal Tax 5% Sum Not Responsible for Lost Articles post Office. .t�c,k-�+u.4 �. S k'P.F APPETIZERS �� _ FRIED RICI✓ Sm. Reg. Sm. Reg. 1. Egg Roll....................................................... 1.65 3.25 36. Steamed Rice ............................................. 1.25 1.95 2. Spring Roll(no meat) .................................. 1.65 3.25 37. Vegetable Fried Rice ...................................3.50 5.25 3. Chicken Wings ............................................ 4.30 6.95 38. Roast Pork Fried Rice.................................3.75 5.75 4. Fried Shrimp Chips ..............................................3.50 39. Chicken Fried Rice.... ............................... 3.75 5.75 5. Chicken Teriyaki.......................................... 3.95 6.95 40. Beef Fried Rice ...........................................4.20 5.95 6. Beef Teriyaki................................................ 4.30 7.75 41. Shrimp Fried Rice.......................................4.20 5.95 7. Chicken Fingers.......................................... 4.25 6.25 42. House Special Fried Rice ........................... 4.20 6.50 8. Crab Rangoon............................................. 3.75 6.25 9. Boneless Spare Ribs................................... 3.95 6.95 Young Chow Fried Rice........................................6.50 10. Barbecued Spare Ribs ................................ 3.95 6.95 44• Ham Fried Rice....................................................5.75 11. Scallion Pancakes ............................................... ; LO 12. Fried or Steamed Dumpling.................................5.95 13. French Fries.................... ....................................2.50 46. Pork.............................................................3.9i 5 5.95 14. Fried Wontons ......................................................3.00 47. Chicken.......................................................3.95 5.95 15. Fried Jumbo Shrimps...........................................7.25 48. Beef.............................................................4.25 6.25 16. Fried or Steamed Dumpling...............(1)4.25 (2)7.25 49. Shrimp......................................................... 4.25 6.25 17. Pork Strips ................................................... 3.95 6.95 50. House Special.............................................4.75 6.95 18. Vegetable Tempuras ............................................5.75 51. Vegetable..................................................... 3.95 5.95 19. Pu Pu Platter....................................(1)8.25 (2)15.95 52. Garlic Noodle.............................................. 3.50 5.25 Spring Rolls(2),Crab Rangoon(6),Boneless Spare- ribs,Beef Teriyaki(2),Fried Jumbo Shrimp(2),Fried 53. Sesame Cold Noodles .........................................4.75 Chicken wings(4),Chicken Fingers(6) 54. Rice Noodles with Chicken or Shrimp .................6.50 20. Kid's Happy Box ..................................................6.50 Rangoon (4), Chicken Teriyaki(2), Chicken Crab Ran 55.f+ Peking Noodle with Hot Meat Sauce ....................6.95 Fingers(4),Spring Roll(2) 56.^► Singapore Rice Noodle with Curry .......................6.95 " CEJ 61- ATION AFjrMZMUW E=21VAMAUED PIOODI, _ _ , A Beef Teriyaki,Chicken Fingers, 57. Choice of Shrimp,Chicken,or Beef .....................7.25 Boneless Spareribs, Egg Roll ...............................7.50 B. Chicken Teriyaki,Chicken Wings, 58. Vegetable..............................................................6.25 59. Seafood................................................................7.95 Boneless Spareribs,Crab Rangoon .....................7.50 C. Fried Jumbo Shrimps,Chicken Fingers, UWaIMLPA©:THAI N6061' Chicken Teriyaki, Egg Roll ...................................7.50 61. Vegetable..............................................................6.50 D. Beef Teriyaki,Chicken Wings,Spring Roll, g ............ 62 Shrimp or Chicken ........................ ........6.95 Crab Rangoon ...... 7 ' SOUF'1MM .CHOW FOOD .:� 21."► Hot&Sour Sou ..... 1.95 3.50 66. Beef or Chicken....................................................6.75 22. Egg Drop Soup............................................ 1.95 3.50 �QWMik Iri OR CIOPl&- 23. Wonton Soup...................:........................... 1.95 3.75 24. Chicken(Rice or Noodle) Soup................... 1.85 3.50 67. Vegetable.....................................................3.95 5.50 25. Chicken Corn Soup..............................................3.95 68. Pork.............................................................3.95 5.75 26. Tofu&Vegetable Soup ................................ 1.85 3.75 69. Chicken.......................................................3.95 5.75 27. House Special Soup.............................................5.75 70. Beef.............................................................4.25 6.25 28. Seafood Delight Soup...........................................6.25 71. Shrimp......................................................... 4.256.25 EGG FOO YOUNG 73. House Special......................................................7.25 (Shrimp,Chicken and Pork) 31. Mushroom ............................................................5.50 Any SubgumorChicago StyleChow Mein Add... 0.300.50 32. Pork......................................................................5.95 33. Chicken ................................................................5.95 34. Beef......................................................................6.50 35. Shrimp6.50 ss Hot&Spicy .................................................................. Mass Meal Tax 5% "= S S4U1� ;'PORK" --- WEET 8e Sm. Reg. Sm. Reg. 76. Pork......................................................................7.50 121. Pork with Mixed Vegetables......................... 4.25 7.25 77. Chicken.......................................................4.50 7.50 122. Pork with Broccoli........................................ 4.25 7.25 78. Shrimp......................................................... 5.25 8.95 123. Pork with Scallions......................................4.95 7.50 ` HEALTHY DIEM ' ' ? , ? 124.r4-Pork with Garlic Sauce................................ 4.95 7.50 _ _ 125.ra.Hunan Pork .................................................4.95 7.50 BEAN CURD 126.r4�Double Cooked Pork............................................7.50 81. Pan Fried Bean Curd with Vegetable....................6.75 g _ BEEF --p--- = 82. Bean Curd and Black Mushroom .........................7.95 131. Beef with Mixed Vegetables......................... 5.25 8.75 83. Bean Curd Home Style.........................................6.95 132. Beef with Mushrooms..................................5.25 8.75 84.n► Szechuan Tofu .....................................................6.75 133. Beef with Snow Peas................................... 5.25 8.75 E 85.ra. Bean Curd with Garlic Sauce...............................6.75 86.r& Ma Po Tofu (meat) 6.75 134. Beef with Broccoli........................................ 5.25 8.75 135. Beef with Pepper&Onions.......................... 5.25 8.75 STEAMED 136. Beef with Oyster Sauce ............................... 5.25 8.75 87. Steamed Mixed Vegetables.........................4.50 5.95 137. Beef with Ginger&Scallion..................................9.25 88. Steamed Chicken with Vegetables ..............4.75 7.50 138.r4�Kung Pao Beef ............................................5.25 8.75 89. Steamed Shrimp with Vegetables................ 5.75 9.25 139.r&Hunan Beef .................................................5.25 8.75 VEGETABLE 140.r+ Beef with Garlic Sauce................................ 5.25 8.75 141.nb�Hot&Spicy Beef.......................................... 5.95 8.95 90. Vegetable Delight ........................................4.50 5.95 142. Beef with String Bean ...........................................8.75 91. Stir Fried Bean Sprouts ........................................4.95 92. Stir Fried Snow Peas...................................4.75 6.95 �x .P. _CKICKEN, 93. Broccoli with Oyster Sauce .........................4.50 6.25 146. Chicken with Mixed Vegetables...................4.95 7.95 94.r+► Broccoli with Garlic Sauce.......................... 4.50 6.25 147. Chicken with Broccoli..................................4.95 7.95 95.ra. Spicy String Beans ...............................................6.25 148. Moo Goo Gai Pan .......................................4.95 7.95 96.ra. Eggplant with Garlic Sauce..................................6.50 149. Chicken with Snow Peas.............................4.95 7.95 97. Green Jade ..........................................................6.75 150. Chicken with Cashew Nuts.......................... 4.95 7.95 Fresh broccoli,snowpeas and string beans sauteed 151.r4►Kung Pao Chicken ......................................4.957.95 in white sauce. 152.r*Chicken with Garlic Sauce.......................... 4.95 7.95 N .vat -,.�� kSEAFOOD » = 153.r,►SzechuanChicken ........7.95 ....................................... 101. Shrimp with Mixed Vegetables..................... 5.959.50 154.ra.Curry Chicken.......................................................7.95 102. Shrimp with Broccoli ................................... 5.95 9.50 155.ra.Hunan Chicken ....................................................7.95 103. Shrimp with Snow Peas............................... 5.95 9.50 156. Chicken with Ginger&Scallion............................8.50 104. Shrimp with Cashew Nuts ........................... 5.95 9.50 157.r,&Unique Flavored Chicken...........................:.........7.95 105.�Cur Shrimp9.50 158. Chicken with String Beans....................................7.75 f ,_ (_....._._ - y 106.r�►Kung Pao Shrimp ........................................ 5.959.50 �,SP�,]�GUS SEAS41`�1�Gg�`` 107.r'►Hot&Spicy Shrimp...................................... 5.95 9.50 161. Stir Fried Asparagus.............................................6.75 108.ra.Hunan Shrimp ............................................. 5.95 9.50 162. Asparagus with Beef.............................................8.50 109. Shrimwith Green Jade.............................. 5.95 9.50 164. Asparagus wi h Shrimp 9.50 .... . . . . ........................... .<» 110.r&Shrimpwith Garlic Sauce ........................... 5.95 9.507.95 111. Lobster Sauce ..... . . . . . 4.255.75 � Asparagus with ........ Q MOO SHUT. . .:>.: , with Chicken.... .... ......... 112. Shrimp with Lobster Sauce ......................... 5.95 9.50 ,x�.» served with s Pancakes 113. Shrimp with Pepper&Onions ..............................9.50 114.-& Fried Shrimp with Mild Pepper Sauce .................9.50 166. Vegetable..............................................................6.50 167. Pork......................................................................6.95 115. Scallop with Vegetable .........................................8.95 168. Chicken................................................................6.95 116. Scallop with Black Bean Sauce............................8.95 169. Beef......................................................................6.95 117. Squid with Black Bean Sauce ..............................8.25 170. Shrimp 6.95 ' ' � �� MERCOMBO, 10USE SPECIALTIESIry - - SERVED ALL DAY H 1. Hong Kong Crispy Shrimp................. 10.50 Served with Roast Pork Fried Rice H 2. Seafood Delight .................................. 11.95 D 1. Chicken Wings, Boneless Ribs, Lobstermeat,scallop,jumbo shrimp,calamari with mixed vegetables in white sauce. Chicken Fingers........................................6.95 H I,6-Shrimp&Scallop with Garlic Sauce. 10.95 D 2. Chicken Wings, Crab Rangoon, H 4. Happy Family...................................... 10.95 Spring Roll.................................................6.75 Bee,chicken,jumbo shrimp,roast pork,lobster meat and mixed vegetables in brown sauce. D 3. Boneless'Ribs, Beef Teriyaki, Egg Roll ..6.95 H 5. Gal Poo Lo Mein (3 boxes)................. 13.95 D 4. B-B-Q Spare Ribs, Egg Roll......................7.50 Shrimp,chicken,beef and roast pork,sauteed with fresh vegetables bedded bysoft noodles. D 5. Chicken Wings, Boneless Ribs, H6. Four Happiness..................................... 9.95 Beef Teriyaki ..............................................7.50 Chicken, shrimp, roast pork, and tender beef blended into fresh garden vegetables and oyster D 6. Chicken Chow Mein, Boneless Ribs, sauce. EggRoll......................................................6.75 H 7 ti Dragon&Phoenix............................... 11.50 Two dishes in one:hot&spicy shrimp and chicken D 7. Chicken Chow Mein, Beef Teriyaki, with ginger&scallion Chicken Fingers........................................6.95 H S.-&General Gau's Chicken ........................ 8.95 Chunks of chicken deep fried until crispy and D 8. Egg Foo Young, Boneless Ribs, cooked with hot sweet and sourginger sauce. Chicken Fingers........................................6.95 H 9.'ll�Orange Flavored Chicken.....................8.95 Orange Flavored Beef........................... 9.75 D 9. Egg Foo Young, Beef Teriyaki, Egg Roll.6.95 Crispy aromatic beef or chicken sauteed with D10. Lobster Sauce, Egg Roll...........................6.25 chef's special orange flavor sauce. H10. Sesame Chicken ...................................8.95 Dii. Shrimp Lobster Sauce, Egg Roll .............7.50 Sesame Shrimp 9,75 D12.ra- Kung Pao Chicken, Egg Roll....................6.75 Chunks of chicken or shrimp deep fried until 1)13.^►Hunan Chicken, Chicken Finger .............6.75 crispyand cooked with sesame seeds and sweet &sour ginger sauce, D14. Chicken with H11 l►Kung Pao Three Delights .....................8.95 Beef,jumbo shrimp,chicken,peanuts with mixed - Mixed Vegetables,Spring Roll .................6.75 vegetables in brown sauce. D15. Cashew Chicken, Egg Roll 6.75 H12. Lemon Chicken..................................... 8.50 D16. Moo Goo Gal Pan, Chicken Fingers........6.75 Cubes of chicken coated with water chestnuts flourandegg,deep fried until crispy and cooked D17. Chicken with Broccoli, Egg Roll..............6.75 with lemon sauce. H13. Mongolian Beef................................... 11.95 D18. Beef& Mushroom, Chicken Fingers.......7.50 'Beef with onion and scallions sauteed with chefs D19. Beef with Pepper&Onions, Egg Roll .....7.50 special sauce. H14.^►Fried Squid with Mild-Pepper Sauce. 10.50 D20. Beef with Broccoli, Crab Rangoon..........7.50 H15. Minced Chicken w. Pine Nuts.............. 9.95 D21.-&General Gau's Chicken, Crab Rangoon 7.75 with hoision sauce and lettuce leaves top wrap- D22.r►Orange Chicken, Crab Rangoon .............7.75 ping H15A. Minced Shrimp with Pine Nuts.......... 11.95 D23. Sesame Chicken, Crab Rangoon.............7.75 H16. Lobster with Ginger&Scallion .. Seasonal D24.r& Kung Pao Shrimp, Egg Roll .....................7.50 H17. Lobster,Cantonese Style ............ Seasonal D25. Cashew Shrimp, Egg Roll.........................7.50 D26. Vegetarian's Delight, Egg Roll ................6.25 ISMSMCIAL C0r4B0.;$5 QI + D27.r►Curry Chicken, Egg Roll...........................6.75 SERVED ALL DAY D28.�&Double Cooked Pork.................................7.50 Pick any of 2 items below D29. Chicken with Snow Peas, Egg Roll..........7.50 Served with Pork Fried Rice or Pork Lo Mein D30. Beef or Chicken with Asparagus, Spring Roll (1) Crab Rangoon (4) Egg Roll......................................................7.75 Egg Roll (1) Fried Jumbo Shrimp(2) D31. Beef or Chicken with String Beans, Chicken Finger(4) Beef Teriyaki(2) Egg Roll......................................................6.95 Chicken Wings(2) Chicken Teriyaki (2) D32. Sweet&Sour Chicken,Spring Roll.........6.95 Pork Strips(2) Boneless Spareribs EXAM FORM NO. 1916 tervSa �� CERTIFICATE NO. 5117777 &r x � � ServSafe® Certification mac,- 7111 1 ' 1 f.• � for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafeo Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSA-Conference for Food Protection (CFP). Presented by the National Restaurant Association Educational Foundation 11/12/2006 DATE OF EXAMINATION 11/12/2011 DATE OF EXPIRATION Local laws apply Check with your local regulatory agency for recertification requirements. National Restaurant Association ••r Mary M Adolf EDUCATIONAL FOUNDATION < President and Chief Operating Officer National Restaurant Association Educational Foundation wwW nraef org ©2006 The National Restaurant Association Educational Foundation 05061402 v.0611 nevrsrons By Gv roe LER warCttiCT Js RFP 9q c�ewt�c, �,r,.. 0 k5aLf rz 4 ,� i N�-: r 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) .1740-8727 Food and Food Protection FAIL Critical BLUE f Owner: Comment:Some uncovered food in 2-door beverage air fridge.Cover all foods in storage to prevent cross cobtamination. Zheng Feng Zheng GENERAL COMMENTS: IPIC: Zheng Feng Zheng All other violations noted in 3/13/08 inspection report have been corrected. Inspector: a Elizabeth Salandrea 1 'Date Inspected:Correct By: i 3/20/2008 }Risk Level: t [Permit Number: BHP-2008-0235 Status: SIGNED OFF #of Critical Violations: 1 • . Time IN: Time OUT: a Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical ; violations must be corrected immediately or within 10 days)(Non-critical violations i must be corrected immediately or within 90 days) 6 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 24,2008 ) Page 1 oft / rl 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 24,2008 ) Page 2 oft 1 0028 Norman Street Hong Kong King Restaurant 7 , City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Separation/Segregation/Protection FAIL Critical Q RED Owner: 4womment: Small reach-in freezer had potentially hazardous food stored above ready to eat food.Organize freezer so that PHF is Zheng Feng Zheng below RTE foods to prevent cross contamination. PIC: 8,66me items in deli unit did not have serving utensils. Provide separate serving utensils for all items. Zheng Feng Zheng Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ RED Inspector: Elizabeth Salandrea L96 ment: Knives stored in dirty water.Store clean knives in sanitizing solution or in a knife rack. Date Inspected: Correct By: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 3/13/2008 Time As a Public Health Control FAIL Critical ❑d RED Risk Level: P_/'mrnent: Potentially hazardous food found out at room temperature. PHF must be kept either at 140°F or higher,or 41°F or lower. Permit Number: BHP-2008-0235 Status: VIOLATION #of Critical Violations: 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page l of 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 o ant: Large bowl of meat right beneath 3-bay sink. Keep food away from sink to prevent cross contamination. immediate corrective action) ncovered food in 2-door beverage air fridge and walk-in fridge.Coverall foods in storage to prevent cross cobtamination. Wegs of dry goods in storage open.Cover dry goods and store in a container. Equipment and Utensils FAIL Non-Critical BLUE ✓��Coo�mment:2-dooll beverage air fridge requires general cleaning. Whelving above and below soup requires general cleaning. Vrill area requires general cleaning. Wntire cookline requires general cleaning, including under and around all equipment. Veverage air deli unit requires general cleaning. Perowave requires general cleaning. oth food prep tables require general cleaning, including shelves underneath. (Ybrainboards at 3-bay sink require general cleaning. able rice cooker is on requires general cleaning. /elves in dry storage area require general cleaning. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. i U 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 r Commonwealth of Massachusetts a City of Salem Board of Health IGmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Hong Kong King Restaurant File Number:BHF-2004-000023 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0235 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31,2008 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 16 of 25 Q CITY OF SALEM MASSAC HUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4' FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR iSODTraSALEM.COM JOANNE SOOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT H0111 _ TEL#71!?'-Ao -5f72,7 ADDRESS OF ESTABLISHMENT /1 Gt Q Sl` FAX# 979--75"a - Ff 7z ;�' MAILING ADDRESS(if different) 2�f 119rM C4h7 'fW-- '�Ia�_e'K MA 0192-4 EMAIL-Business': Website: OWNER'S NAME )heq 7- e aol 7,h toi — TEL# ADDRESS ! � -aVl 0 >AJIC1-�, _- �-I t4 A,7y YL IMJ� Zt z 1REET r CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) __ Lhctty F¢N� 2t1en� CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared)IN EMERGENCY RESPONSE PERSON i)P J; ,O III P_1l HOME TEL#�T�- - 0 S DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION 1F30c%K 10306-tll1 /I=3n�t1vL' 1t =30aIN1 11 3oatv� , jl , 3titiwt lZ ���' Please write in time of day (For example llam-1 1pm) JPO '%Q =oopot -101ve,yw - l/=�� ^9 1.. -ll=moo 7121 Plk TYPE OF ESTABLISHMENT `/ FEE (check onlv), RETAIL STORE YES N / less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------- - - - - - - ------ -------------------- ------------ --- -- ---..-........--------- RESTAURANT NO less than 25 seats =$140 (Outdcor Stationary Food Cart$2101 25-99 seats =$280 more than 99 seats =$420 - -------------------- ------ ----------------------- ... ... BED/BREAKFASTI YES NO. $100 CHILDCARE SERVICES.._._. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 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 fled all state tax returns and paid all state taxes required under the law /a - r-- o 0 -) 07 Signature o Date Social Security or Federal Identification Number ----------- /��� ---------------------------- Revised 4/24/07 FOODAP2008.adm CheckN&Date O q{0 %2/3 07 $ r e 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 740-8727 Physical Facility FAIL Non-Critical BLUE Owner: Comment:There are water stained ceiling tiles in dry storage. The leak has beeen repaired. Replace or paint all stained ceiling Zheng Feng Zheng tiles. PIC: ( GENERAL COMMENTS: Zheng Feng Zheng i All other violations cited in the 7/11/07 inspection report have been corrected. Inspector: David Greenbaum Date Inspected:Correct By: 7/18/2007 Risk Level: i Permit Number: BHP-2007-0153 Status: SIGNED OFF #of Critical Violations: 0 Time IN: I Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 19,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Ll City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 19,2007 ) Page 2 oft 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM q NJTAMINATION 740-8727 Food Contact aces Cleaning and Sanitizing FAIL Critical d❑ RED Owner: — mment:The plastic tableware in front must be placed facing one direction handle side out to prevent cross contamination. Zheng Feng Zheng Good Hygienic Practices FAIL Critical ❑d RED PIC: Zheng Feng Zheng mment: Employee drinks observed in the food prep areas. Employees must eat and drink in a designated employee area or in he dining room to prevent cross contamination. Inspector: Handwash Facil�ies FAIL Critical ❑.� RED David Greenbaum Date Inspected:Correct By: C ment:The back hand wash sink found obstructed. Keep hand wash sinks clear and accessible at all times. 7/11/2007 Risk Level: Permit Number: BHP-2007-0153 Status: VIOLATION I #of Critical Violations: 4 i Time IN. Time OUT. 1 Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 11,2007 ) Page 1 oft Item Status Violation Critical Urgency • RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Foo rotection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require omment:The Beverage air deli unit has uncovered food. All food in storage must be covered. immediate corrective action) a rice barrel in front needs to be labeled"Rice" T re are open bags of dry ingredients in dry storage. Keep all dry ingredients sealed. Equipment and sils FAIL Non-Critical BLUE mment:The small Beverage air unit needs a general cleaning. — e/slicer must be cleaned and sanitized after each use. She wal flooring needs a thorough cleaning. VVV unfinished wood shelves in the walk in must be painted. L,We wa n freezer flooring needs a thorough cleaning. e front True reach in needs a general cleaning. ere is an accumulation of food spills and splatter on the shelves of dry storage. Thoroughly clean all shelves. T Garland grill and stove top have an accumulation of grease and grime. Thoroughly clean the grill and stove top. Physical Facility FAIL Non-Critical BLUE Comment:There are water stained ceiling tiles in dry storage. Investigate the source of the leak and repair. Replace all stained tiles. GENERAL COMMENTS: 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 11,2007 ) Page 2 of 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Food Contact Surfaces Cleaning and Sanitizing PASS Critical RED Owner: Comments: Dirty knives found stored in a dirty container. Properly clean and sanitize all knives and the container prior to storage. Zheng Feng Zheng PIC: The plastic table ware in front must be placed facing one direction handle side facing out. Zheng Feng Zheng The meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Inspector: Handwash Facilities PASS Critical ❑d RED David Greenbaum Comments:The soap dispensers at both kitchen hand wash sinks did not appear to be working. Repair soap dispensers to good Date Inspected:Correct By: working order or replace. 1/18/2007 RTheRISK Level: back hand wash sink found obstructed. Keep hand wash sink clear and accessible at all times. Violations Related to Good Retail Practices (Blue Items) Permit Number: Food and Food Protection PASS Critical BLUE BHP-2007-0153 Comments:A bucket of meat found marinating directly on the floor near the back hand wash sink. Keep all food at least 6-8 inches Status: off the floor and away from the hand wash sink to prevent cross contamination. SIGNED OFF Equipment and Utensils PASS Non-Critical BLUE #of Critical Violations: Comments:The canopener has an accumulation of grime. Thoroughly clean the canopener. TOime IN: Time OUT: The entire cookline line has an accumulation of food debris. Thoroughly clean the entire cookline including underneath. The Garland grill has an accumulation of grease. Thoroughly clean the grill. Urgency Description(s): BLUE: The dry storage area needs a thorough cleaning. Violations Related to Good Retail Practices (Critical The bottom shelf of the prep tables needs a thorough cleaning. violations must be corrected Physical Facility PASS Non-Critical BLUE immediately or within 10 Comments:There are some water stained ceiling tile in the kitchen and dry storage areas. Investage the source of the leak and days)(Non-critical violations repair. Replace all stained tiles. must be corrected immediately or within 90 days) Cit of Salem Board of Health 120 Washington Street 4th Floor SALEM MA 01970 978 741.1800 Y 9 ( ) GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 18,2007 ) Page I oft Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to All violations cited in the 1/11/07 inspection report have been corrected. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) G'7 -0 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 18,2007 ) Page 2 oft 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 1 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: mm nt: Dirty knives found stored in a dirty container. Properly clean and sanitize all knives and the container prior to storage. Zheng Feng Zheng PIC: a plastic table ware in front must be placed facing one direction handle side facing out. Zheng Feng Zheng T meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Inspector: Handwash Facilities FAIL Critical RED David Greenbaum Co menta The soap dispensers at both kitchen hand wash sinks did not appear to be working. Repair soap dispensers to good Date Inspected:Correct By: orkm order or replace. 1/11/2007 Risk Level: ack hand wash sink found obstructed. Keep hand wash sink clear and accessible at all times. Violatio:The elated to Good Retail Practices (Blue Items) Permit Number. Food a/Foodection FAIL Critical BLUE BHP-2007-1 A bucket of meat found marinating directly on the floor near the back hand wash sink. Keep all food at least 6-8 inches Status: r and away from the hand wash sink to prevent cross contamination. VIOLATION 1 Equipment and Utensils FAIL Non-Critical BLUE #of Critical Violations: ""ment:The canopener has an accumulation of grime. Thoroughly clean the canopener. $ Time IN: Time OUT e entire cookline line has an accumulation of food debris. Thoroughly clean the entire cookline including underneath. T Garland grill has an accumulation of grease. Thoroughly clean the grill. Urgency Description(s): BLUE: 7Tbottoo trage area needs a thorough cleaning. Violations Related to Good Retail Practices (Critical m shelf of the prep tables needs a thorough cleaning. violations must be corrected Physical Facility . FAIL Non-Critical BLUE immediately or within 10 days)(Non-critical violations Co ent:There are some water stained ceiling file in the kitchen and dry storage areas. Investage the source of the leak and Cr, air. Replace all stained tiles. 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 11,2007 ) Page I oft 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 11,2007 ) Page 2 oft N CITY OF SALEM, MASSACHUSETTS p..!` BOARD OF HEALTH RECEIVED`jED 120 WASHINGTON STREET,4TH FLOOR 9 9/ SALEM, MA 01970 DEC - 4 2Q06 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 N� 1�� �.�1✓L�I G TEL# 1 cI ZS '" 74 0 — `-�r 7 Z I ADDRESS OF ESTABLISHMENT 'I<-- IV/OYWOV14 7 5'C FAX#) CII ;' —7 `v v MAILING ADDRESS(if different) -2, /V� f�Y✓ eA. I`64111_ , /✓U}%f�y� 'o' yy ) EMAIL--Business': Owner's: L� Z IV 7&MG Z I�iz IV /—..—... M1 — OWNER'S NAME G —1 11~ TEL#-h 17-2A - I t� ADDRESS d 1 C4,V14L t W:,fl O( ' S IfJ(1`n L'�� Axx (1 Z i Z� STREET t CITY t STAIIP / TE ^�ZZ CERTIFIED FOOD MANAGER'S NAME{S} -- �j �, t� tgf—V ,_CERTIFICATE#(S) L f t G• (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON t Io „ }Vl 7� T,(V( HOME TEL �— DAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION 99 1 Please write in + [forexamoleltala-1ltual4 (� 39�aj.9tl 4f+`50 i�.Jn, I ZG—�/ �� i�. TYPE OF ESTABLISHMENT FEE (check onlvl. RETAIL STORE Y�jB' NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT NO less than 25 seats 100 25-99 seats =$ more than 99 seats =$200 . ..-- __ _ __ . ...... ....... . ..... $'100 BED/BREAKFAST YES ----- ----------------------- ---...----- ----- ..._._.. .. -- _-- ..... -- - ------------- ---------- ADDITIONAL PERMITS MAKE (net just serve) ICE CREAM, YOGURT, SOFT SERVE YES -No $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations. improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 620, 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 .order;he law Signatures ' Date Social Security or Federal Identification Number - - - el4 - ------ - -- Revised 11/13/06 FOO AP2007 adm SCh' d&Dale _ _ ow M �.Vlr 4 'V9 kormassach setts w WIN 'A 1 N- Saleim� z. ai AV,A.; ;g nbw -S Z120 Washington Street;4th I ';,"Ur e Yti a F- SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Hong Kong King Restaurant File Number:BHF-2004-000023 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP-2007-0153 Dec 20,2006 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 3l, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 16 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone; PROTECTION FROM CONTAMINATION 740-8727 Separation/Segregation/Protection FAIL Critical ❑d RED Owner: Comment:The front Magic Chef has meat stored with other products. Store all potentially hazardous foods separate from other Zheng Feng Zheng foods to prevent cross contamination. PIC: The walk in has chicken stored above sauces. Store potentially hazardous foods below ready to eat food to prevent cross Zheng Feng Zheng contamination. Inspector: Handwash Facilities FAIL Critical ❑d RED David Greenbaum Date Inspected: Correct By: Comment:The back hand wash sink found obstructed. Keep hand wash sinks clear and accessible at all times. ' 911412006inspe Violations Related to Good Retail Practices (Blue Items) Level: Equipment and Utensils FAIL Non-Critical BLUE Risk Comment:The front Coke True unit is not working. Repair unit to good working order or remove from establishment. Unit to be Permit Number: _ replaced by Coke. BHP-2006-0113 GENERAL COMMENTS: Status: 819:AII other violations cited in th917106 inspection report have been corrected. 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 14,2006 ) Page I oft J Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors(Require , immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 14,2006 ) Page 2 oft h .s 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Criticaf Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Separation/Segregation/Protection FAIL Critical ❑d RED Owner: Comment:The front Magic Chef has meat stored with other products. Store all potentially hazardous foods separate from other Zheng Feng Zheng foods to prevent cross contamination. PIC: The walk in has chicken stored above vegetables. Store potentially hazardous foods below ready to eat food to prevent cross Zheng Feng Zheng 7 contamination. Inspector: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED David Greenbaum co ent:The meat slicer has an accumulation of food debris and a dead fly on it. Thoroughly clean and sanitize the meat slicer Date Inspected: Correct By: each use. 9/7/2006 RISK Level: TheTpSFo sanitizing solution for wiping prep areas after food preparation. Sanitizer buckets for wiping food prep areas must be l._/or6wded at proper concentration at all times. Provide two buckets of sanitizer on labeled"sanitizer"and one labeled"Raw Animal Foods Only" Keep clothes in the buckets. Permit Number: Handwash Facilities FAIL Critical ❑d RED BHP-2006-0113 -e-, Comment:The back hand wash sink found obstructed. Keep hand wash sinks clear and accessible at all times. Status: VIOLATION TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) #Of Critical Violations: Time As a Public Health Control FAIL Critical d❑ RED 6 Coant:There is excessive amounts of potentially hazardous food being kept out at room temperature to be prepared. Keep Time IN: Time OUT: y small amounts of PHF out at a time to prevent contamination. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and FoEBrage lion FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comhe end Beverage air reach in has uncovered food. All food in storage must be covered. immediate corrective action) e air deli unit has uncovered food. All food in storage must be covered. e walk i as uncovered food. All food in storage must be covered. The is some.uncovered flour in dry storage. Keep all dry ingredients covered. Equipr�l�nt and nsils FAIL Non-Critical BLUE menta T e Beverage air deli unit needs a thorough cleaning. The nopener has an accumulation of grime. Thoroughly clean the canopener. T alk in freezer needs a general cleaning. Th o burner stove has an accumulation of food debris. Thoroughly clean this stove. Th arland grill has an accumulation of grease. Thoroughly clean the grill. ,,.—The front Coke True unit is not working. Repair unit to good working order or remove from establishment. Physical Facility FAIL BLUE t` C�rfi t:The flooring throughout the establishment needs a thorough cleaning including under and around all equipment. T ereis a aged wall near the utility closet Repair the wall. h are water stained ceiling tiles in dry storage. Investigate the source of the leak and repair. Replace all stained tiles. GENERAL COMMENTS: 786:Reimspection will be in one week,all violations to be corrected. J � City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006 ) Page 2 oft The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health State Laboratory Institute 305 South Street, Jamaica Plain, MA 02130 Mrrr ROMNEY GOVERNOR _ to KERRY HEALEY L9 I LIEUIENANr GOVERNOR TIMOTHY R.MURPHY `UN j 5 4�0$ SECRETARY V G PAUL].COTE,-JR, COMMISSIONER CITY OF SALEM BOARD OF HEALTH May 30,2006 Tracy Giarla, LPN Board of Health 120 Washington St.,4"Floor Salem,MA 01970 Dear Ms.Giarla: One sample, a manufacturer product,was received in our Laboratory on May 24, 2006, assigned a laboratory number and examined for the presence of bacterial contamination. The sample is identified as being obtained from the Hong Kong King,28 Norman Street,Salem,MA 01970. A summary of our examination follows. Lab. No.:06F-0067 Sample Description: Frozen,uncooked Wontons(5 pieces) Type of Container: Plastic tub Gross Weight: 120.3 grams Total Coliform/g:200 Fecal Coliform/g: <10 Standard Plate Count/g: 130,000 Bacillus cereustg: <100 Staphylococcus aureus/g: <100 Please let us know if you would like to pick up the remaining portion of this sample. If we do not hear from you within 15 days,we shall assume that you have no further need for it and it will be discarded. If you have any question,please do not hesitate to call the Food Laboratory at(617)983 —6610. Sincerely, Robert A. Goldbaum Laboratory Supervisor PC, Kim Foley i COURT DOCKET NO "� _ - - -- CITATION NO. CITY OF SALEM �� V VIOLATION NOTICE V 530 NAME(LAST,-FIRST INITIAL) A/C> A ESS j CITYJTOWN STAIE ZIP CO ca Salem -ha riv2J LICENSE NO /D OF BIRTH 4 4 Qt' 2 OWNER'S NAME(LAST,FIRST,INITIAL) �Ly '✓ t� STREETADDRESS CITY/TOWN STATE ZIP I --A . { o IHEGISTtjAT10N NO. I STATE DATE � MAKEtTYPE I YEAR ICOLOA� 7: i LIT E. DATE OF IOLABON TIME DATE CITATION WRITTEN CO co / -� � I9Q Am PM s- a 3,4- QNO ❑ LOCATION OF VIOLATION ENFORCING D6P�a"I i i01 11 ,dt i f /Y� I TL1 OFFENSE CHAP, SECT IFINESI V Eti lai 1, Z • p.- �6F A�' i'%:3�/'�71 : -= Q/J 1r_ ;'1 ir..0 I O i IN Q o �yq _ L I 'l { )t ~H Ori _ ❑ C .Y`� �=I .... i, ' I W Z o "4 ` LD OFFICER I D NO TOTAL d {k h I FINE I$ e," ':j + Z OFFICER��CERTIFIES COPY _rT O_VIOLATOR z o t i ff IN HAND ill GJ m ❑N4N X'.- :.: BY hPt.ZO DO NOT MAIL CASH PAY ONLY BY POSTAL NOTE,MONEY 'i Y Q ', al LIT II ORDER OR BY CHECK MADE PAYABLE TO: e, CTIi C- N CITY CLERK Z N CITY HALL 93 WASHINGTON STREET "+ = z,- (p SALEM,MA 01970 TEL.(508)745-9595 X 251 z0 I HERESY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON 3 Q _ REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF k $ CASE k SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 0028 Norman Street Hong Kong King Restaurant yk City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Separation/Segregation/Protection FAIL Critical RED Owner: Comment: The walkin refrigerator has raw meat stored over vegetables. Store all potentially hazardous foods below ready to eat Zheng Feng Zheng �'food to prevent cross contamination. PIC: Th are food dirty containers and bowls stored on top of the food in the deli unit. Do not store any containers or bowls on top of Zheng Feng Zheng od to prevent cross contamination. Inspector: - The erage air cooling unit has items stored directley on top of food. Do not store any items directly on top of food items to David Greenbaum vent cross contamination. Date Correct By: Food Contact Surfa s Cleaning and Sanitizing FAIL Critical d❑ RED Risk Level* Co menta The sanitizing solution in the cookline and at the front counter found too weak. Sanitizing solution of proper ncentr must be readily available at all work stations at all times. Permit Number: T hree bay sink is not being used properly. The 3 bay sink must be used in a three part system to wash,rinse and sanitize all I and utensils. ' BHP-2006-0113 Status: D' knives found stored between equipment. All knives must be cleaned and sanitized and stored in an appropriate knife rack. VIOLATION aront rice scoops stored in water only. Store rice scoops in sanitizing solution. , #of Critical Violations: 7 Th�cutti boards are badly stained and scored. Resurface or replace all cutting boards. Time IN Time OUT: Th eat grinder found with an accumulation of food debris and meat particles. The meat grinder must be thoroughly cleaned and anitized after each use. Urgency Description(s): Good Hygienic Practices FAIL Critical ❑J RED BLUE. Violations Related to Good Comon' There was evidence that employees were eating in the kitchen area. All employees must eat in a designated employee Retail Practices (Critical br, k room or in the dining room to prevent cross contamination. violations must be corrected Hand sh Faali s FAIL critical ❑/ RED immediately or within 10 days)(Non-critical violations Co ment:T hot water temperature at all handwash sinks was approximately 103°F. Provide a minimum hot water temperature must be corrected immediately 110°F all handwash sinks. or within 90 days) T wall hung soap dispenser in the men's room missing soap. Provide soap in the wall hung soap dispenser. Soap available at City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2006 ) Page 1 of Item Status Violation Critical Urgency RED: the time of inspection. Violations Related to TIMEITEMPERATUR CONTROLS(Potentially Hazardous Foods) Foodborne Illness Interventions Hot and Cold ding FAIL Critical ❑d RED and Risk Factors (Require immediate corrective action) C ment: There are no stem type thermometers available to check and keep track of food temperatures. Provide stem type ermometere to insure proper holding temperatures. Time As a Public Hea ontrol FAIL Critical ❑d RED Com nt: There were potentially hazardous foods thawung at room temperature. Potentially hazardous foods must be thawed in a re gerator or under cold running water. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Pro tion FAIL Critical BLUE Coent:There are food containers stored on top of uncovered food in the walkin. Do not store food containers on top of covered food to prevent cross contamination. T �,s covered food in the walkin. All food in storage must be covered. Thod stored directly on the floor of the walkin. All food must be stored at least 6-8 inches off the floor. �- Ther as uncovered food in the dry storage area. All food in storage must be covered. Equipmen and Utensils FAIL Non-Critical BLUE ,Com t:The walkin has an accumulation of food spills and splatter. Thoroughly clean the entire walkin. Ther s an accumulation of grease spills and splatter around the sink. Thoroughly clean this area. These trap has an accumulation of food spills and splatter. Thoroughly clean the grease trap. e corner sink"Food Prep Only" 14 ,T anopener needs a thorough scouring. e deli cooling unit has an accumulation of grime,food spills and splatter. Thorough clean this unit inside and out. The c line has a heavy grease accumulation and food debris. Thoroughly clean the entire cookline. Professional steam cleaning is �icrowave Thhas an accumulation of food spills and splatter. Thoroughly clean the microwave. T reach' ' ooling unit at the end of the counter not working. Repair this unit to good working order. The agic Chef freezer at the counter needs anew visible,accurate thermometer. Physi a acility FAIL Non-Critical BLUE C ment: There are many water stained ceiling tiles throughout the establishment. Investigate the source of the leak and repair. eplace all stained ceiling tiles. There w many items stored around the water heater. Remove all items from around the water heater,allow a 5 foot area per the Fire de. GENERAL COMMENTS: 627:Due to the high number of critical violations cited in this establishment the owner is required to attend a hearing at the Board of Health office on Tuesday, May 23, 2006 at 10:OOAM. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions Inc. Commonwealth of Massachusetts Rev. May 22 2006 Page 3 0 4 P � Y ) S l Item Status Violation Critical Urgency v City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2006 ) Page 4 of 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection g m CD o < HACCP: El N O Item Status Violation CriticaP Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Separation/Segregation/Protection PASS Critical RED Owner: Comments: The walkin refrigerator has raw meat stored over vegetables. Store all potentially hazardous foods below ready to eat Zheng Feng Zheng food to prevent cross contamination. 0 PIC: =iThere are food dirty containers and bowls stored on top of the food in the deli unit. Do not store any containers or bowls on top-of < Zheng Feng Zhengfood to prevent cross contamination. o O Inspector: ° :E T The Beverage air cooling unit has items stored directley on top of food. Do not store any items directly on top F food items to N David Greenbaum prevent cross contamination. -rm �t 11 W Date �6 Correct By: Food Contact Surfaces Cleaning and Sanitizing PASS Critical m 0RVDV m o o m Comments: The sanitizing solution in the cookline and at the front counter found too weak. Sanitizing solubfrd�em z 0 Risk Level: concentration must be readily available at all work stations at all times. D K m -4 -4 D W T 6 K cn A p 2 The three bay sink is not being used properly. The 3 bay sink must be used in a three part system to wash,WnA agtd�pnitiz�`wl m Permit Number' dishes and utensils. , p -4 (n BHP-2006-0113 W w o o er = y Status: Dirty knives found stored between equipment. All knives must be cleaned and sanitized and stored in an apprriate knife racy 2 SIGNED OFFThe front rice scoops stored in water only. Store rice scoops in sanitizing solution. O p N #of Critical Violations: m 0 The cutting boards are badly stained and scored. Resurface or replace all cutting boards. A LTime IN. Time OUT: N The meat grinder found with an accumulation of food debris and meat particles. The meat grinder must be thoroughly cleaned and sanitized after each use. Urgency Description(s): Good Hygienic Practices PASS Critical RED BLUE: Violations Related to Good Comments:There was evidence that employees were eating in the kitchen area. All employees must eat in a designated employee Retail Practices (Critical break room or in the dining room to prevent cross contamination. violations must be corrected Handwash Facilities PASS Critical ❑/ RED immediately or within 10 days)(Non-critical violations Comments:The hot water temperature at all handwash sinks was approximately 103°F. Provide a minimum hot water temperature must be corrected immediately of 110°F at all handwash sinks. or within 90 days) The wall hung soap dispenser in the men's room missing soap. Provide soap in the wall hung soap dispenser. Soap available at City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 25,2006 ) Page I of 4 Item Status Violation Critical Urgency REDthe time of inspection. Violations Related to . TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Foodborne Illness Interventions Hot and Cold Holding PASS Critical ❑d RED and Risk Factors (Require immediate corrective action) Comments:There are no stem type thermometers available to check and keep track of food temperatures. Provide stem type thermometers to insure proper holding temperatures. Time As a Public Health Control PASS Critical ❑d RED Comments:There were potentially hazardous foods thawung at room temperature. Potentially hazardous foods must be thawed in a refrigerator or under cold running water. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 25,2006 ) Page 2 of I� Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS Critical BLUE Comments:There are food containers stored on top of uncovered food in the walkin. Do not store food containers on top of uncovered food to prevent cross contamination. There is uncovered food in the walkin. All food in storage must be covered. There is food stored directly on the floor of the walkin. All food must be stored at least 6-8 inches off the floor. There was uncovered food in the dry storage area. All food in storage must be covered. Equipment and Utensils PASS Non-Critical BLUE Comments:The walkin has an accumulation of food spills and splatter. Thoroughly clean the entire walkin. There is an accumulation of grease spills and splatter around the sink. Thoroughly clean this area. The grease trap has an accumulation of food spills and splatter. Thoroughly clean the grease trap. Label the corner sink"Food Prep Only" The canopener needs a thorough scouring. The deli cooling unit has an accumulation of grime,food spills and splatter. Thorough clean this unit inside and out. The cookline has a heavy grease accumulation and food debris. Thoroughly clean the entire cookline. Professional steam cleaning is in order. The microwave has an accumulation of food spills and splatter. Thoroughly clean the microwave. The reach in cooling unit at the end of the counter not working. Repair this unit to good working order. The Magic Chef freezer at the counter needs a new visible,accurate thermometer. Physical Facility PASS Non-Critical BLUE Comments:There are many water stained ceiling tiles throughout the establishment. Investigate the source of the leak and repair. Replace all stained ceiling tiles. There were many items stored around the water heater. Remove all items from around the water heater,allow a 5 foot area per the Fire Code. GENERAL COMMENTS: 630:AII violations cited in the 5/18/06 inspection report have been corrected. Any future repeat critical violations will result in the immediate suspension or revocation of this establishments food service permit. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 25,2006 ) Page 3 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 25,2006 ) Page 4 of CITY OF SALEM BOARD OF HEALTH Name of Establishment: Hong Kong King Restaurant Address: 28 Norman Street Owner(s): Zheng Feng Zheng Phone: 978-740-8727 Date: May 23, 2006 The owner of this establishment was requested to appear for a hearing regarding multiple repeat critical violations observed at his establishment during an inspection on May 18, 2006 by Sanitarians David Greenbaum and Virginia Moustakis. This inspection was conducted because of customer complaints of illnesses after eating at this establishment. A sample of the implicated food, wonton, was sent to the state laboratory institute for testing and the required investigation by the public health nurse was conducted. The owner, Zheng Feng Zheng, and his son, Debin Zheng appeared. The son translated for Mr. Zheng. The Health Agent described the seriousness of the violations and that such violations increase the chane of foodborne illness. The Health Agent explained that if the critical violations are observed again, the establishment's food permit may be suspended or revoked. The owner is a Certified Food Manager. He agrees to have another full time, permanent employee become a Certified Food Manager. The Board of Health is issuing a $200 ticket for repeat critical violations. r� tf v{x,ati ,?3. 700(o Joanne Scott Date Health Agent Zheng Feng Zheng, Owner Date COURT DOCKET NO CITATION NO. CITY OF SALEM PD 053tJ VIOLATION NOTICE 1' V NAME(LAST,FIRST,INITIAL) A16 STREETADDRESS 7 CITY/TOWN STATE -�,"ZIP X lVd�n2?+ Sf >a �2A) /7!! 0/07,1 LICENSE NO LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) .?/7/611+,— t,c.,IV0 �.f�f:i✓!7 STREETADDRESS CITY/FOWN STATE ZIP iS r'.q�,rr11 Gl)ctr/.�4r,.rrf,`��strr� 7b1� REGISTRATION NO STATE EXP.DATE I MAKE/TYPE YEAR ICOLOR DATE OF VIOLATION TIME I DATECITATION WRITTEN PrvdeRs Wl- /� ivaOVES S I (t G Z PM Jf OZ�^QYJ ❑NO LOCATION OF VIOLATION ENFORCING DEP.TI '2R /✓e172-Gx'Sr d'or OFFENSE CHAP. SECT. FINES `` 5`w' B C fes` 61-nK -oo OFFICER ID NO!�'' YOWL � y/!l0L 57,fA/N DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ///[/}+y),� p' IN HAND BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL diACCP Risk Assessment City/Town of: Salem, MA G. � e . e _ Wonton Soup, Boneless Spare ribs and Chicken Fingers Establishment Name Hong Kong King : �: eY. a.;::�" - - Address ygfents Source 28 Norman Street Wonton Soup:Pork,Wonton Shell Agar Supply, Lun Fat Produce Person-in-Charge Boneless Spare Ribs: Boneless Pork and Sauce Agar Supply Zheng Feng Zheng Chicken Fingers:Chicken and batter Agar Supply Information for the Risk Assessment was obtained by: ❑ Observation of Suspect Food/Process S ❑ Observation of General Food Handling and Sanitation Practices a ❑ Interview with Food Employee Responsible for Preparing Implicated Food s ❑ Interview with Person-in-Charge or Other Employee WeightNolume of Suspect Food Prepared or Served: Dates of Investigation: 5/18/06 PLEASE PRINT CLEARLY ' - .FDescribeP_roduct Flow - Describe Environmental Data Collected to HAZARDS Describe Corrective and Preventive Date ^s,_!-�.°y't�'ff Verify Control or Lack of Control of Hazards -Contamination Measures Initiated Verified !(Preparation Steps)Who,What, -Survival Wh6ni,When''' -Proliferation (Include changes in food handling procedures,orders for correction,embargoes/disposals, food employee _�,� astrictions,food safety training,emergency _.�,{ t. - .. suspensions and closures,etc) OCCP Wonton soup is prepared on site. The pork is The meat is processed upon delivery. It appears C-Pork The proper cleaning and sanitizing procedures �jtical supplied by Agar and comes in a box of i approximately 50lbs The pork is processed that the meat is out at room temperature until such must be adhered to when cleaning all equipment Control time that it is processed. S—Pork and utensils , immediately upon delivery. A pork loin is cut Point) to the desired amount and processed through a There is a lack of proper cleaning and sanitizing of P- Pork meat grinder. It is mixed with scallions and wrapped in awomen shell. The prepared equipment and utensils,particularly the meat wontons are then bundled and placed in the grinder. walk in freezer at 00F. The wontons are {' removed from the freezer upon ordering and f boded in water on the cook line and added to the soup for service. j, N 3 Page: Number—of 3 ' RACCP Risk Aenpeament Report Form(Updated 09/05) The boneless spare ribs are supplied The meat is processed upon delivery, it appears C- Pork Pork must be placed under rein,geration until roby Agar. They are received in that the meat is out at room temperature until such such time that the chef will process the meat. approximately 5016 boxes and are time that it is processed S Pork OCCP processed upon delivery. The Sanitizing of knives, cutting boards and utensils 1� ` There is a lack of sanitizing=takin lace during the P-Pork must be done before changing from PH F to boneless pork is cut into the desired b g P € I portions and placed in sauce to processing of the meal. It does not appear that another. marinate for 7-8 hours in the walk in cutting boards and other utensils are being, ° at a temperature of 32�. They are properly sanitized between uses and when then cooked for about one hour and changing between PHPs. cooled at room temperature for one € ( hour. They are placed back in the { 1 walk in to finish cooling. The ribs 7 i are grilled to heat and then served to the customer. _ The chicken for the chicken fingers is The meat is processed upon delivery. It appears C—Chicken Chicken must be placed under refrigeration until supplied by Agar. Chicken is that the meat is out at room temperature until such such time that the chef will process the meat. delivered in 501b boxes. The chicken time that it is processed. S Chicken EICCP is either placed on trays in the walk Frozen chicken must be thawed in a refrieeration t "There is a lack of sanitizing taking lace during P-Chicken in freezer or processed upon delivery. b P 5 the unit or under cold running water. Chicken observed out thawing at processing of the meat. It does not appear that cutting boards and other utensils are being Sanitizing of knives,cutting boards and utensils room temperature. Chicken is cut g S y and place in baiter and partially properly sanitized between uses and when must be done before chan�ine from PHh to an thin between PHFs. another. cooked. The partially cooked changing tt , chicken fingers are placed in the walk mat a temperature of 37EF. They are 9 cooked completely in the hyolator and served to the customer. lit J, OCCP { t •t- Page: Number of • RAeCP Rick AsasaBmont Report Fa (updtod 09105) 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Separation/Se egation/Protection FAIL Critical ❑d RED Owner. C ment:The 3 bay sink being used for preparing food. The 3 bay sink must be used in a three part system of"Wash-Rinse- Zheng Feng Zheng anitize"only. PIC' roduce sink had rice cooling in it. Produce sink MUST be used for washing produce only. Zheng Feng Zheng Inspector: F�tion.tored under the cookline. Do not store food under cookline to prevent cross contamination. Food discarded at time of David Greenbaum Li spec Date Inspected: Correct By: c ning supplies stored near food prep areas. Store cleaning supplies in separate storage area to prevent cross contamination. 2/2/2006 Risk Level: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Co ent:There is insufficient sanitizing solution in the food prep areas. Sanitizing solution of proper concentration MUST be Permit Number Lr dily available at ALL work stations at ALL times. BHP-2006-0113 Di els stored on top of the meat slicer. Store dirty towels in appropriate storage area. Status VIOLATION Tmeat slicer needs a thorough cleaning and sanitizing. #of Critical Violations: Tod s stored on water pipe. Store tongs in appropriate storage area to prevent cross contamination. 5 Ton for raw potentially hazardous foods being used for other foods. Use separate utensils for preparing food to prevent cross Time IN: Time OUT: cttamination. Urgency Description(s): Tgs for grill have an accumulation of grime and food debris. Thoroughly clean and sanitize tongs at least once every four hours. BLUEHandwash Facilities FAIL Critical RED Violations Related to Good Retail Practices (Criticalment:The back handwash sink was found completely obstructed. Handwash sinks MUST be kept CLEAR AND ACCESSIBLE C violations must be corrected ALL times. immediately or within 10 The all hung soap dispenser missing at back hand wash sink. Replace wall hung soap dispenser. Soap available at time of days)(Non-critical violations pection. must be corrected immediately or within 90 days) The ladies room is missing soap. Provide soap in the ladies room at ALL times. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 06,2006 ) Page I of Item Status Violation Critical Urgency RED: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Hot and Cold Holding FAIL Critical ❑J RED Foodborne Illness Interventions and Risk Factors (Require C ment:There was food thawing out at room temperature. All potentially hazardous food must be thawed in a refrigeration unit immediate corrective action) r under cold running water. Shr' p found out at room temperature with a temperature of 53°F. Store all cold potentially hazardous foods at a temperature of °For below. Shrimp discarded at time of inspection. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 06,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE 74-Comment: There is uncovered food in both Beverage air cooling units. All food in storage MUST be covered. -y- The walkin In s uncovered food. All food in storage MUST be covered. A b et of fish was found stored on top of chicken in the walkin freezer. Do not store fish on top of chicken to prevent cross l c taminati on.. Equipment an tensils FAIL Non-Critical BLUE �.. mment:The canopener has an accumulation of grime. Thoroughly clean and sanitize the canopener. T icrowave has an accumulation of food spills and splatter. Thoroughly clean the microwave. T ront True unit has an accumulation of food debris. Thoroughly clean this unit. �.Same cooling unit not working. Repair cooling unit to good working order. e Magic Chef freezer in front has an accumulation of frost. Defrost freezer and clean. The Garland grill has an accumulation of grease and grime. Thoroughly clean the grill. �.. There is an accumulation of grime on the fan covers in the walkin. Thoroughly clean the fan covers. she ing beneath the canopener need a thorough cleaning. ( TIS an system hood and filters need a thorough cleaning. V Beverage air cooling unit needs a thorough cleaning. Physical Facilit/y FAIL Non-Critical BLUE tt C9ifiment: There are water stained ceiling tiles in the utility closet. Investigate the source of the leak and repair. Replace all Wamaged ceiling tiles. Th a are water stained ceiling tiles above the 3 bay sink. Investigate the source of the leak and repair. Replace all damaged ding tiles. All wal�oors,surfaces and equipment have an accumulation of food spills,splatter and grime. Thoroughly clean all floors, L�Is,suFfaces and equipment. T re is an accumulation of food spills and splatter. Thoroughly clean dry storage. GENERAL COMMENTS: 458:Reinspection will be 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 GeOTMSO2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 06,2006 ) Page 3 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 06,2006 ) Page 4 of g•2S .O!�:- ( IMPORTANT MESSAGE ) FOP Q DATE TIME - S � M' M OF j ARA C OE NUMBER EXTENSION FAX O MOBII F .e� E AREA CODE NUMBER TIME TO CALL i I'TELEPHONEO lZell ASE CALL ,CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I I RUSH RE URNEO YOUR CALL I 11 WILL FAX TO YOU MESSAGE ^'«-� -j�' SIGNED *PsFORM 400 MARE IN U 5 A 1-�0 -Kon _KinS-o�d.ered- __-- 1ti -- - Company --Crarne ou}-_ an-cl - c�eaned -- ve is - it - - -- - -S lhwhavi - ----Care_'- '-�' - - - -- - - ark IG -- dKt _k�av_P52 5. -- - - - - � i � I I I � � V i i I�' � ! I � � I I 1 � i I I { � � '� - -' - - II - I - I - I i { '� i �') � it I ' II l � i I l i ) � w r �I i I ' � ( I �� � i � i, I i I I t I i � i i a � I i { I i ' i j , I ! ISI � � 1 � � � i , j i i I � A l i 1 i Il I � l i i l I ' I I i � j i I � f � l � '� ; r �, I � � i I � i i � I I I � � � ' I � I i � s I I i, I l i i iii lilt � i j � � '; I I i I I '� , I I � I i �, , ', f 1 � I ii i I , � li � II i ( I �I 'I ` I ! 'I l ' �, I i I II � i �.- - - - T Page 1 of 2 r C� Joanne Scott From: Lynne Montague Sent: Thursday, June 02, 2005 7:13 PM To: 'mpmarcil@earthlink.net' Cc: Joanne Scott; Thomas Stpierre Subject: RE: Constituent Concern Sent From Salem.com Hi Michael, I'm forwarding this to Joanne Scott, Board of Health and Tom St Pierre, Building Inspector for review and response. Lynne Montague Executive Secretary to the Mayor Salem City Hall 93 Washington Street Salem, MA 01970 978.745.9595 Fax 978.744.9327 -----Original Message----- / From: mpmarcil@earthlink.net [mailto:mpmarcil@earthlink.net] Sent: Friday, May 27, 2005 7:54 PM To: LMontague@Salem.com Subject: Constituent Concern Sent From Salem.com Name:Michael Marcil Address:15 Crombie Street 93 I, City:Salem, MA 01970 IAddress:15 Crombie Street#3 Phone:(978) 745-4220 Email:mpmarcil@earthlink.net Comments/Requests: Regarding health concerns Address of Concern: Address:DeLeo's plaza, Norman Street City, State, Zip:Salem, MA 01970 Problem:Code enforcement The Hong Kong Restaurant in DeLeo's plaza at the corner of Crombie and Norman Streets is the source of two problems: 1 st, the eaves at the rear of the restaurant (facing our house) have rotted away and squirrels have been in and out of there all spring pulling insulation out and scattering it on the ground and using some for nest building. This has to be a health issue. I don't want to see the squirrels hurt,just the eaves repaired! Also, whenever the Hong Kong cleans it's noisy ventilators on the rear roof,black dirty grease ends up splattered on the side of our house. If you come and take a look, you will see numerous drips and evidence of grease which we have not bothered to clean off our house. This is not 06/03/2005 f Page 2 of 2 only disgusting, but cannot be healthy. 06/03/2005 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-8727 Handwash Facilities FAIL Critical ❑J RED Owner: Comment:The soap dispenser in the ladies room was not working properly. Monitor soap dispenser for proper operation, replace Zheng Feng Zheng if needed. PIC: Violations Related to Good Retail Practices (Blue Items) Zheng Feng Zheng Food and Food Protection FAIL Critical BLUE Inspector: Comment: There is uncovered food in both Beverage air cooling units. All food in storage MUST be covered. David Greenbaum Date Inspected: Correct By: The walkin has uncovered food. All food in storage MUST be covered. 2/9/2006 Equipment and Utensils FAIL Non-Critical BLUE Risk Level: Comment: There is an accumulation of grime on the fan covers in the walkin. Thoroughly clean the fan covers. Permit Number. The front True cooling must be plugged in and working to maintain a temperature of 41'F or below. BHP-2006-0113 Physical Facility FAIL Non-Critical BLUE Status' PARTIAL COMPLY Comment: Replace the one water damaged ceiling tile in the utillity closet. #of Critical Violations: GENERAL COMMENTS: 2 471:All other violations cited in the 2/2/06 inspection report have been corrected. Time IN Time OUT Urgency Description(s): BLUE' Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 13,2006 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 13,2006 ) Page 2 of '4}e:' 1--Comin6iiwealthofAiassachuset�� City of Salem' Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 1e Food/Retail Establishment Permit 440D DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Hong Kong King Restaurant File Number:BHF-2004-0023 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP-2006-0113 Jan 3,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES IDecember 3l, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,'beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 9 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 nwa TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT , 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT o!14, I cDV,�. 1Z.1 n - TEL# 7 7! -- / ADDRESS OF ESTABLISHMENT to MAILING ADDRESS (if different) Z 11 arIMGt( 4_. OWNER'S NAME –2–H'F-II/A T(A// 9 LM (' TEL# ADDRE S [ r 444 1Na)/ CITY t , Ve; -7A l STATE J&J/� ZIP CERTIFIED F D NIWAK-AGER'S NAME(S) TI -ICT #(s (required in an establishment where potentially hazardous food is prepared.) C/ 77 /C/ EMERGENCY RESPONSE PERSON J 7-W�-uudq 11 -r I HOME TEL#17 b '77�-ls o 7 HOURS OF OPERATION: Mon. �'Tue. k. ,Wed.�- Thu. 1l ri. Sat. k� Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ....... ........... - --- ---------- ...---- --------............--------------- RESTAURANT YE NO � �� less than 25 seats =$100 �0 25-99 seats $1 more than 99 seats =$200 BEDIBREAKFAST YES NO $100 ADDITIONAL PERMITS ---------------------------------------------------------------------------------..........--------------------------------- MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature ° Date Social Security or Federal Identification Number ----------------------------------------------------------------------------------- ---e --------------------------------------- 11/03/05 FOODAP2.adm Check#&Date v 1 (� PU °° / J 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 740-8727 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Zheng Feng Zheng Tobacco PASS ❑ PIC. - Zheng Feng Zheng FOOD PROTECTION MANAGEMENT Done Inspector:or: PIC Assigned/Knowledgeable/Duties PASS ❑ RED David Greenbaum EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS 0 RED 9/30/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS �/❑ RED BHP-2005-0234 Receiving/Condition PASS RED Status: Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED SIGNED OFF - #of Critical Violations: Conformance with Approved Procedures/HACCP PASS d❑ RED Plans PROTECTION FROM CONTAMINATION Done Time IN. Time OUT. Separation/Segregation/Protection PASSd❑ RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS Q RED 338: Proper Adequate Handwashing PASS Q RED r . Urgency Description(s): Good Hygienic Practices PASS �/❑ RED BLUE: Prevention of Contamination from Hands PASSd❑ RED Violations Related to Good Retail Practices (Critical Handwash Facilities PASSd❑ RED violations must be corrected immediately or within 10) -: days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 03,2005 ) Page I of 0028 Norman Street Hong Kong King Restaurant must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASS 601 RED RED: Violations Related to Toxic chemicals PASSd❑ RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS ❑d RED Immediate corrective action) Reheating PASS ❑J RED Cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑o RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE Provide sanitizing solution at any area where food prep will be performed. A bucket may be used as an insert in the sanitizing bay of the 3 bay sink if necessary All violations cited in the 9/23/05 inspection report have been corrected. GeoTMS®2005 Des Launers Municipal Solutions, Inc. ( Rev. Oct 03,2005 ) PaQe 2 o!3 0028 Norman Street Hong Kong King Restaurant GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 03,2005 ) Page 3 of 0028 Norman Street Hong Kong King Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 740-8727 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Zheng Feng Zheng Tobacco PASS ❑ PIC: Zheng Feng Zheng FOOD PROTECTION MANAGEMENT Not Done Inspector: PIC Assigned/Knowledgeable/Duties PASS RED David Greenbaum*, EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 9123/2005 Personnel with Infections Restricted/Excluded PASSd❑ RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS 0 RED BHP-2005-0234 Receiving/Condition PASS ❑/ RED Status: Tags/Records/Accuracy of Ingredient Statements PASS RED VIOLATION - Conformance with Approved Procedures/HACCP PASS 0 RED #of Critical Violations. Plans 2 Time IN (Time OUT. Notes: 320:Reinspection in one week. All violations to be corrected. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected Immediately or within 10 , GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Pa.Ve / of 0028 Norman Street Hong Kong King Restaurant days)(Non-Critical violations PROTECTION FROM CONTAMINATION Not Done / must be corrected immediately Separation/Segregation/Protection FAIL Critical ❑d RED �nployees observed drinking in the or within 90 days) Itchen area. Employees must eat and RED: drink in designated employee areas to Violations Related to prevent cross contamination. E ployees drinks stored in the Beverage Foodborne Illness Interventions ire cooling unit Store employee food and and Risk Factors (Require drinks in a designated employee immediate corrective action) refrigerator to prevent cross contamination. Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ REDpray bottle of sanitizing solution in the okline too weak Provide sanitizing solution of proper concentration at each work station at all times. Proper Adequate Handwashing PASS I] RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑/ RED Handwash Facilities PASS Q RED PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS RED TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASSd❑ RED Reheating PASSd❑ RED Cooling PASS ❑J RED Hot and Cold Holding PASS ❑V RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS 0 RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Page 2 of 0028 Norman Street Hong Kong King Restaurant_ Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE _ T&is uncovered food in the walkin All 416od in storage must be covered. Equipment and Utensils FAIL Non-Critical ❑ BLUET nopener has an accumulation of ime. Thoroughly clean the entire canopener. The elving,flooring and barrels in the dry n nedient area have an accumulation of d spills. Thoroughly clean all flooring, shelving and barrels There is a light fixture in dry storage issing a cover. Provide a protective cover on this light. Magic Chef freezer at the counter feeds a visible,accurate thermometer. Water, Plumbing and Waste FAIL Non-Critical ❑ BLUE T drain in the sanitize bay of the 3 bay nk does not work Repair drain to good working order. Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Page 3 of �—IMPGRTA�LNT MESSAGE a FOR DATE w ��c5� TIME 4 A.M. OF PHONE AREA COOE NUMBER EXTENSION O FAX U MOBN 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 WILL FAX TO YOU MESSAGE Iw Al l SIGNEC . + PSFORM 4009 MADE IN U.S.A. i I U-,"n ' - P ��/�/��///� v I i� �� - � � - - � - - !{ - _ : � _ i - _ j ` . �.. - - i --- - -- _ � � - �j - ---- -- -- � -- - - ?ID\8xDcHGBi735D>zLe Page 1 of 4 �1.y®iY'�I Sts1a{w�:l'i€tiSTtidr'fA�striii�.ys'1 i�iYM4+lii'rt�oYlCili'ii� Foo dbam Ike Safe ftO ,u (This document in English) http://www.foodsafety.gov/—fsg/bac/csbug.html 12/16/2004 ?ID\8xDcHGBi735D>zLe Page 2 of 4 I rq IR = fie Tt�q� � ° �'���t: 1 ��J'�'��7�: ��J�'• Fes]. A, 4qtmrpl�±- 7- 10T° 1S• i#QJf1�QQ ��A �Ct � 5t �8 8� ` l f ] �^7• F• 1X A J JJc 48- 72,1,90pL' i -�7,[��,`'�}��I,yL�• �R•,Q� '���� ani i Ih�LC�A.I=P J��G��N�YS, �G� ��:f� L/X�• 7C�,�,• g -},, 'I kL{ffi��iC]° '��° 'L'• pL^QL° ���ipl"J����Y7 A MPI:A, ±A, �15— A, AAAPITI�A http://www.foodsafety.gov/—fsg/bac/csbug.html 12/16/2004 ?ID\8xDcHGBi735D>zLe Page 3 of 4 - 711� J is i >A8- 12 Qa !J _ JRA. Y&{5. IfErf � JJft120— N14010C o I — — —----- — — f�it ill IF. M7-3M• rEV6 NO, )RAI 1413t. U q'I'I �'1'I I=YfJ � !JL, J TY�JQC ✓��A�J L7L]. I` f�1• 1S: i7]: /R1 - 7T jMLtim �%EM: o-+R9V• JN--moi- I tm-911911i—v M, RM flft, mu" ff31 `W`'1`�IY/J�T �� ���i�o I'd• �• ��jJ pC1. �'IL'� log 19R. A I ��o http://Nvww.foodsafety.gov/—fsgibac/csbug.html 12/16/2004 ?ID\8xDcHGBi735D>zLe Page 4 of 4 MfiT-:,:FAf*MlN,....ifi,� f IAJW; AF�3- 10 I AW HPAVVto,50,� Partnership for food Safetv I'ducation FDA Center Cor Food Safety and Applied Nutrition http://www.foodsafety.gov/—fsg/bac/csbug.html 12/16/2004 Organisms That Can Bug You Page 1 of 4 "ii Partnershia for Fond Safetv Education t.... �.,• �BACFightersE� � c:`.'Atedia �' Consume '� S Four Steps Organisms That Can Bug You Success Stories Foodborne Illnesses ;r � Store About Us Disease and Organism Links That Causes It Source of Illness Syml Bacteria I Home Botulism Spores of these bacteria Onset: Gen are wide-spread. But Ihours after c Botulinum toxin these bacteria produce Register to be a (produced by Clostridium toxin only in an Symptoms: BAC Hij� botulinum bacteria) anerobic (oxygenless) symptoms, i environment of little double visio acidity. Found in a to swallow, considerable variety of difficulty, at For More Information . . . canned goods, such as progressive corn, green beans, the respiratc USDA's Meat and Poultry Hotline: soups, beets, asparagus, 1-888-Wflotlinc(1-888-674-6854) mushrooms, tuna, and Get Medica liver path. Also in Immediatel FDA's Food Safety Information luncheon meats, ham, Can Be Fat Hotline: sausage, stuffed 1-888-SAFEFOOD(1-888-723-3366)24 hr I eggplant, lobster, and smoked and salted fish. lCampylobacteriosis Bacteria on poultry, Onset: Gen, cattle, and sheep can days after e, Campylobacter jejuni contaminate meat and milk of these animals. Symptoms: Chief raw food abdominal c sources: raw poultry, fever, and st meat, and bloody stool unpasteurized milk. 10 days. Listeriosis Found in soft cheese, lOnset: Fron unpasteurized milk, after eating, Listeria monocytogenes imported seafood symptoms h products, frozen reported 48- http://www.fightbac.org/bug.cfm 12/16/2004 Organisms That Can Bug You Page 2 of 4 cooked crab meat, after consun cooked shrimp, and contaminate cooked surimi (imitation shellfish). Symptoms: The Listeria bacteria headache, m resist heat, salt, nitrite, vomiting. Pi and acidity better than affects pregi many other micro- and their fet organisms. They newborns, tl survive and grow at people with low temperatures. those with ii immune sys cause fetal a death. Perfringens food In most instances, Onset: Gen, poisoning caused by failure to hours after c keep food hot. A few Clostridium perfringens organisms are often Symptoms: present after cooking pain and dia and multiply to toxic sometimes r levels during cool vomiting. down and storage of prepared foods. Meats Symptoms 1. and meat products are less and are the foods most mild. Can b( frequently implicated. serious in of These organisms grow debilitated f better than other bacteria between 120- 130° F. So gravies and stuffing must be kept above 140° F. Salmonellosis Raw meats, poultry, Onset: Gem milk and other dairy hours after c Salmonella bacteria products, shrimp, frog legs,yeast, coconut, Symptoms: pasta and chocolate are pain and dia most frequently sometimes r involved. vomiting. S, last a day or usually mild more serious debilitated F Shigellosis (bacillary Found in milk and Onset: 1-7 c dysentery) dairy products, poultry, eating. and potato salad. Food (Shigella bacteria becomes contaminated Symptoms: http://www.fightbac.orgibug.cfm 12/16/2004 Organisms That Can Bug You Page 3 of 4 when a human carrier cramps, diar does not wash hands sometimes N and then handles liquid and blood, f or food that is not mucus in stc thoroughly cooked afterwards. Organisms multiply in food left at room temperature. Staphylococcal food Toxin produced when Onset: Gen poisoning food contaminated with minutes-8 h the bacteria is left too eating. Staphylococcal long at room enterotoxin (produced by temperature. Meats, Symptoms: Staphylococcus aureus poultry, egg products, vomiting, m bacteria) tuna, potato and abdominal F macaroni salads, and and prostrat cream-filled pastries 24-48 hours are good environments fatal. for these bacteria to produce toxin. Vibrio Infection The bacteria live in Onset: Abri coastal waters and can Vibrio vulnificus infect humans either Symptoms: through open wounds fever, and/o or through prostration. consumption of are people v contaminated seafood. conditions, ) The bacteria are most (stomach) ai numerous in warm weakened it weather. systems. Protozoa Amebiasis Exist in the intestinal 'Onset: 3-10 tract of humans and are exposure. Entamoeba histolytica expelled in feces. Polluted water and Symptoms: vegetables grown in crampy pain polluted soil spread the over the cob infection. loose morni recurrent dig of weight, fi sometimes a Giardiasis Most frequently (Onset: 1-3 c associated with Giardia lamblia consumption of Symptoms: contaminated water. onset of exp May be transmitted by watery stool uncooked foods that abdominal c http://www.fightbac.org/bug.cfm 12/16/2004 Organisms That Can Bug You Page 4 of 4 become contaminated anorexia, na while growing or after vomiting. E: cooking by infected infects hikes food handlers. Cool, travelers, an moist conditions favor institutional .organism's survival. patients. Virus 11 Hepatitis A virus Mollusks (oysters, Symptoms : clams, mussels, Begins with scallops, and cockles) appetite los: become carriers when vomiting, at their beds are polluted by untreated sewage. After 3-10 d Raw shellfish are develops jai, especially potent darkened ur carriers, although cases can ca cooking does not damage and always kill the virus. Site design &development by NetStrategies http://www.fightbac.org/bug.cfin 12/16/2004 10 least wanted pathogens -- Chinese (Traditional) version Page 1 of 2 I *- TM T110 "Vow= 1 Foodborm O (This document in English) MI lam! {Fight BAC!) Nit o AIME s0 VjVffujMj—Mq[RrAMq3 ae fpm tAfM 0157 - H7 --41MM*-.SftRW*ffi MIN 7glR+1j**MA - Z—ate �� � f�9 • ����c��•B•]�� ka '�r���tl����.��l�J. ��A�� at��l�r���i��f�AS - - * SR�µ7L7/1y:,�TCaiNklkpf.y uJ'P4 yM ' VMMOM ' GG 11� &R,P V ' R&A ' http://www.foodsafety.gov/—fsgibac/ct101eas.html 12/15/2004 10 least wanted pathogens -- Chinese (Traditional) version Page 2 of 2 i�s��L�J71�'�—� ' � 5(�'�h300,D00'f����i�l • fi1��r'�'[� —�'�f�iW:R;i�iD`J� ' i��'t����f�a�pt � � �i.''�f;F�����A�F�19is�• �� ���at�i�—��� &`•]� '1!� � �I�f'd��i�`'J��{�tl 7'jffl ' �•f�`J�f�`Ja��a ' 7�fi�r�t}`171� • '� ' �'���t ��� 8191%7 - w • � A s tl - �� Digf l � — 4 7�( l in` 19@Alfa �sr7�µ§l�ltali�#MA`]kq�oG�yqyy�fi�'l.fi��fyy ,!► - � 6p � • o��yuf ' �n�I�3t�y • y�� �Al��it$9J7 %ffi 71C• �M1 � v �I 79� MGG ' /l��T�� i�: �B`•3��c�:�D`•] 'safe �ti°� � �. OWN , "Bad Bug Book" , int t L "http://vm.cfsa n.fda.gov/—mow/i ntro.htm l". Partnership for Food Safety Education FDA Center for Food Safety and Applied Nutrition http://www.foodsafety.gov/—fsg/bac/ct101eas.html 12/15/2004 Foodborne Illness: Ten Least Wanted Foodborne Pathogens Page 1 of 3 Partnership for Food Safetv Education _ !dCF#_�h r I ;MeAdlo �vnaumRnc Four Steps Foodborne Illness: Ten Least Success Stories Wanted Foodborne Pathogens Foodborne Illnesses Updated on April 10, 2003 Store About Us Links Home The U.S. Public Health Service has identified the following microorganisms as being the biggest culprits of foodborne illness, either because of the Register to be a severity of the sickness or the number of cases of BACFighterl illness they cause. Beware of these pathogens: Fight BAC! For More Information .. . LEARN WHERE THEY ARE AND HOW TO AVOID THEM USDA's Meat and Poultry Hotline: 1-888-MPHotline(1-888-674-6854) Campylobacter Most common bacterial cause of FDA's Food Safety Information * diarrhea in the United States; Hotline: 1-888-SAFEFOOD(1-888-723-3366)24 * Sources: raw and undercooked meat hr ,� and poultry, raw milk and untreated water A "t Clostridium botulinum •� This organism produces a toxin which causes botulism, alife-threatening s"„ [d�} illness that can prevent the breathing - . muscles from moving air in and out of the lungs. Sources: home-prepared foods and herbal oils; honey should not be fed to children less than 12 months old E. coli 0157:117 http://www.fightbac.org/l Oleast.cf n 12/15/2004 r Foodborne Illness: Ten Least Wanted Foodbome Pathogens Page 2 of 3 A bacterium that can produce a deadly toxin and causes approximately 73,000 cases of foodborne illness each year in the U.S.; Sources: meat, especially undercooked or raw hamburger, produce and raw milk Listeria monocvtoeenes Causes listeriosis, a serious disease for pregnant women, newborns and adults with a weakened immune system; Sources: soil and water. It has been found in dairy products including soft cheeses as well as in raw and undercooked meat, in poultry and seafood, and in produce 4 Norovirus This virus is the leading cause of i diarrhea in the United States. Any food can be contaminated with norovirns if handled by someone who is infected with this virus. Salmonella Most common cause of foodborne deaths. Responsible for millions of cases of foodborne illness a year; Sources: raw and undercooked eggs, undercooked poultry and meat, dairy products, seafood, fruits and vegetables ► 4 ,' "6a� to Stanhvlococcus aureus This bacterium produces a toxin that 1`-t��r+ causes vomiting shortly after ingesting; Sources: cooked foods high in protein(e.g. cooked ham, salads, bakery products, dairy products) Shigella Causes an estimated 300,000 cases of diarrhea illnesses. Poor hygiene causes Shigella to be easily passed from person to person. Sources: salads, milk and dairy products, and http://www.fightbac.org/l Oleast.cfin 12/15/2004 I � Foodborne Illness: Ten Least Wanted Foodborne Pathogens Page 3 of 3 • unclean water. Toxoplasma eondii fi A parasite that causes toxoplasmosis, a very severe disease that can produce central nervous system disorders ° particularly mental retardation and visual impairment in children. Pregnant women and people with weakened immune systems are at higher risk; Sources: meat,primarily pork Vibrio vulnificus Causes gastroenteritis or a syndrome known as primary septicemia. People with liver diseases are especially at high risk; Sources: raw or undercooked seafood For more information on these and other foodborne pathogens, check out the 'Bad Bug Book" on the World Wide Web at: httu://vm.efsan.fda.Qov/—mow/intro.htmi. Site design&development by NetStrategies http://www.fightbac.org/l Oleast.cfm 12/15/2004 Everyone Can Fight BAC!, Chinese (Simplified) version Page 1 of 3 E:lili� V�'fi( '•�'fYC�"��iT �I'1fltlYlili� �.- — pread the t00,919 (This document in En hah (Fight BAC0TM http://www.foodsafety.gov/—fsgibac/csfactsht.htmi 12/16/2004 Everyone Can Fight BAC!, Chinese (Simplified) version Page 2 of 3 i :-AIRi:-A 7J�P,-gW-9 �• ��Qf�l AAS) �� € A "EAC " (zm�) 7�GdIl �Ilym,, .1�'1J.,v-WIlL1'S�Ub'l'PJ_ t, �`I/i, �l'R;�pg1a VA �J• T iJ e itVxf0 ATFAQ4. FAA - 4 ren rAl. 1'. R �1���N'�A'a%QI"J�,f�'J 4� •ii Sy. : 1�)�C]C]PJ�T�o MT' , f7 'ttA4-)� J 1 Q -F Affi 7�, t9f� I� T ) , J� JmlRitrl'J WC[N A. EC�"Jx� AaIt XtAt&Mr! FIGHT BAC! Patinership for Food Safety Education http://www.foodsafety.gov/—fsg/bac/csfactsht.html 12/16/2004 Everyone Can Fight BAC!, Chinese (Simplified) version Page 3 of 3 r FDA Center for Food Safety and Applied Nutrition http://www.foodsafety.gov/—fsgfbac/csfactsht.html 12/16/2004 Community Activity Page 1 of 3 �hMD f . ; P'artnershin far Food Safety Education I NN �+�.°„�� �9ACFighterb! Atelia t t Consumers r Four Steps Community Activity Success Stories Everyone Can Fight BAC!TM Foodborne Illnesses THE INVISIBLE ENEMY: BACTERIA Store Despite the fact that America's food supply is among About us the safest in the world, the unappetizing fact is that sometimes, the food we eat can make us sick. Why? Links Because under the right conditions, an invisible enemy called "BAC” (bacteria) may be present on Home foods when purchased or get into food during preparation, cooking, serving or storage. In fact, even though we may not see BAC - or smell him or feel him- this creature and millions more like him Register to be a may already be on a sponge, a cutting board, or the BACFighteri food itself. Most cases of food-related illness can be prevented For More Information . . . if everyone who handles and prepares food learns how to Fight BAC!TM Although BAC is USDA's Meat and Poultry Hotline: everywhere, he can be stopped with a little know- I-888-MPIlot]ine(1-888-674-6854) how and such everyday weapons as soap and hot water, a refrigerator and a food thermometer. FDA's Food Safety Information Hotline: BAC:The FACTS 1-888-SAFEFOOD(1-888-723-3366)24 hr Scientists have been studying bacteria and other tiny organisms that cause food-related illness for a long time. They have learned these important facts: x Bacteria are a part of all living things and are found on all raw agricultural products; x Harmful bacteria can be transferred from food to people, people onto food, or from one food to another; x Bacteria can grow rapidly at room temperature; http://www.fightbac.org/factsht.cfm 12/16/2004 Community Activity Page 2 of 3 x Growth of harmful bacteria in food can be slowed or stopped by refrigerating or freezing; On n Food-related illness can produce symptoms from mild to very serious. Illness can occur from 30 minutes to two weeks after eating food containing harmful bacteria; x People who are most likely to become sick from food-related illness are infants and young children, senior citizens and people with weakened immune systems. FIGHTING BAC!: FOUR SIMPLE STEPS To Fight BAC!TM, food safety experts recommend that everyone think about food safety at each step in the food handling process - from shopping to storing leftovers. What this really means is always following these four simple steps: CLEAN - Wash hands, utensils and surfaces in hot soapy water before and after food preparation, and especially after preparing meat, poultry, eggs or seafood to protect adequately against bacteria. Using a disinfectant cleaner or a mixture of bleach and water on surfaces and antibacterial soap on hands can provide some added protection. SEPARATE - Keep raw meat, poultry, eggs and seafood and their juices away from ready-to-eat foods; never place cooked food on a plate that previously held raw meat, poultry, eggs or seafood. COOK - Cook food to the proper internal temperature (this varies for different cuts and types of meat and poultry) and check for doneness with a food thermometer. Cook eggs until both the yolk and white are firm. CHILL - Refrigerate or freeze perishables, prepared food and leftovers within two hours and make sure the refrigerator is set at no higher than 40°F and that the freezer unit is set at WE So, don't risk problems when these simple steps will help you reduce food-related illness. http://www.fightbac.org/factsht.cftn 12/16/2004 Community Activity Page 3 of 3 WE HAVE THE POWER TO FIGHT BAC! Site design &development by NetStrategies http://www.fightbac.org/factsht.cfm 12/16/2004 mya j -WRTDOCKETNO.-�, 0" k"I Oil W 01? tf?AI�l �."li4AME(LAST-MRST,,INMAL)��,-,-��lI KtV6 lesr�� or STAEETADDRESS CrrYrrOWN STATE Zip ST co o IUCENSEN�.y I EXP.DATE DATE ftFZIRTH f OWNERS NAME(LAST,FIRST,INITIAL) Ur. A 7j4tJ&- . ejr.#,J&-74194-� 3 STREETADDRES6 CITYfrOWN STAT ly"x, Sir d"t 15ormi r ZIP rQ M4 07/-I/ l REGISTRATION NO. STATE DATE � MAKErrYPE I YEAR ICOLORI TI VIOLATION M DATE CITATION WRITTEN DATE -2- it/6'f YES LD Z1,fA— 0 [I NO L13 LOCATION OF VIOLATION ENFORCING DEPT 0 1 ?91 Ifo* OFFENSE CHAP. C�r, FINES Ole- z c� or z 0 s ME V*i r" z Ir E LT.. I D NO. TOTA r 0 L INEJ$ 13 Lu z M< DUE 2< a Ox LU OFFICER CERTIFIES COPY GIVEN TO VIOLAT� El 13Y MAIL .5 �INHAND < w z DO NOT MAIL CASH PAY ONLY BY POSTAL NOTE,MONEY Ln 0 ORDER OR BY CHECK MADE PAYABLE TO: x Ln CITY CLERK a c- CITY HALL o 93 WASHINGTON STREET z SALEM,MA 01970 0 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON 0 c 0 REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO. CITATION NO CITY OF SALEM PD VIOLATION NOTICE r .i. .i�✓ NAME(LAST,FIRST,INITIAL) 16W6 141W6 /t,-- b Acs STREETADDRESS CITYrrOWN STATE ZIP 'le Ne4f'.4* l rr r4"QA4 044 611 cl j LICENSE NO LIC EXP DATE DATE OF BIRTH IhO rW�N.E�R{S NAMI E(LAST FIRST.IN,ITTIIIAL)) ME /_ STREETADDRESS CITYrrOWN STATE ZIP W Y`jl da Sr 'fIt / oonoa salt Cr "d REGISTRATION NO. STATE I EXP DATE MAKETYPE YEAR COLORI DATE tVIOLATION �M6® I DATE CITATION WRITTEN PEASOEl O YES ❑NO LOCATION OF VIOLATION ENFORCING DEPT. Tal Ifo*- OFFENSE, CHAP I SECT I FINES BI(747Zf- S(W .;r40I(kjl-'}r C aa . OFF�IER I NO I TOTAL FINE !""' T ✓7 `"'6_.._...�'" DUE J Q. OFFICER CERTIFIES COPY GIVEN TO VIOLAT:R/� IN HAND X ❑ BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name � Date Tvpe-of Operation(s) Type of Inspection Nd N� j" /s o"11- lelt,.;6- 2V*/,C RvrpFood Service ❑ Routine Address El q"� Risk ❑ Retail Cage-inspection Telephone Level El Residential Kitchen Previous Inspection 7Yd efW7 I ff ❑ Mobile Date: Owner7- fapd ra�� �� �� HACCP Y/N Tempor0 Caterer ary ❑ Pre-operation El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: I El HACCP Inspector o*,jr o (fA1'V BN r1oi-uh 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 El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [110. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions Q immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590 004) order of the Board of Health. Failure to correct violations 25. 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: S seomso crFo m 14 dx AA rl Inspector's Signatur (, MA� Print: I PIC's Signature: 7i 1-.!/yl✓� r�Jn h/�,l Print: 7 I-' i,w r�� I, �/ J Page ofPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 7-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT R j Cross-contamoat(on j f ( 590003(A) Assignmentot Respon.,,ibility" 3-302.11(,11)(1) Rae r,nimat Puxxk Separat,.d Tuan 590.OU3(R) Demmnsu',mon ui Rnowlcdge" I Cooked and RTF.Fund.," 2-103 11 Person in cictrrve--dutie> j Contamination from Raev Ingredients ? 302.1 1(A)(2) Paw Animal roods separated fiom Each j EMPLO"EE HEALTH I Other 1 2 590.003(C) Responsibility of the person in ch;a;e to j Co,aarmnatioc form the Environment require reporting by food employees and ;_;02.1 WV) Font Protean,I I applicants* j 3-302.15 Wanhmg Fruits and Vc.ctnb'.c; j 590 003(F) Responsibility Of A F�ad Employee Oi An 3-304.11 Food Contact with Equipment and Applicant To Report To The Perst in Utensils" Chs,ter" I Ccntan patron from 65e Consumer j 590.003(6) Repor-Lifo,by Person in Chases'' 3-306.14(A)(Ht Returned Food:4od Rcseadee of Food" j j 3 590.0030) Exclusions and Keshictionst j rkpe,ld.,of Adulterated or Con;amrnated 590.003(E) Removal of Exclusion;and Rearricttons ( Food 3-701.11 Discarding or Reconditioning Unsafe FOOD F IOM APPROVED SOURCE Fo xl.N q : Food and Water ,/-rorri Regulated Sources ( 9 Fcod Contact Surfaces 599 004(A R) Compliance with Find Law, 4-501.111 Manual Warewashmg-Hnt W'ate( 3-23Ll 1Food in a Herntetic 11v Sealed Container, j Sanmiaicn Tcngmrwros j ''01.13 Fluid Milkand Milk Products` ( 4 501.112 Mechanicai W'arewashin, Hol Rater g 3-202 13 Shell Egs* l ,Sanit,.uiun Tent>eratutes" j 3-202.1 d Eggs and Milk Products..Pasteurized" ( I 4-501,114 C hemual Saniti tion-temp.,pi 1, cuncettL conn and bardttcss " 3-202.16 Ice Made From Potable Drinking Water' I I ,t_ I f;;. j 5-101 11 Drinking Water from an Appb.oed System" ( fi(1.11(A) Equipment Fuxxl Centaer Sur cis and ' 1 Oirnsds.Clean' 590.006(A) LooW Looted Diinkine Water., 4-602,i I C'lesning Fo-queney or Equipment Fwx1- j 590.006(8) Plater Meets Standards in sl0M CR 22 U" j Contact Surfacesand Uten,ds`" She9flsh and Fish From an Approved Source ( 4-702 1 l Frequency of Sanitization of Uten_iis and j 3-20j.14 Fish and Recreationally Caught Molluscan 1 Fo"d Contact Surfaces ut Equipmenr* Shellfish" 14-703.11 Alcrhods ut Samti,ation - d Hot Water.m 13-2uLf5 Molluscan Shellfish from\SSP Listed I ( 0:emica!* I Sources" Game and whkl Mushrooms.Approved by 50 Propel,Adeguate Handwashing j Regulatory Aumority I i 2-301.11 Clean condition--Hands and Arun," 3-202.18 Shu llstock Identification Present' � j 2-301.12 Cleaning i'rcxedmr" j 2-3(11.14 Wlrcn to W'nsh* 59U.(()=t(C') Wildit4ushnxims"� I j 3-201.i 7 Game .AnrtnaLo'. j 11 iGood Hygienic Practices 2-401.11 j 5 Receiving/Condition ( H+one, Drinking of Using Tobacco' 4 202 11 Pl-IFs Received at Proper Trtnperatures j 2-d01 I2 Discharges Fran the Eyes,Nose and 3-202.15 Packaee Inteitrity" I Month* 3-101A I Food Safe and Unadulterated" j 3-301.12 Prevrrtuu Contamination When Tustim- j j 12 Prevention of Contamination from Hands 6 Tags/Records:Sheilstock j j 3-202.i8 Jbellsicx.k Identification' 590.00 (6) Pterentin Cvntannnntv,nfir,m ';-m3.I2 Shellso.lck Idennfication Maintained" j Entnlolces' Tags/Records:Fish Products ( j 13 Handvrash Facilities 3�tl?,I I Paasiie Drstmction* Conveniently Located and Accessible j j 3--102.12 Records.Creation and Retention"` i 5-203.i 1 Number,and Placemen s" i9U.0w(.1) Labeling of Ingredients* 5-20<}.l l Location aid Placement - I 1 5-205.11 Ae�assibi`.ily, On,crahun and.`. mmenmtre j i 'j i Conformance with Approved Procedures I IHACCP Plans I Supplied inih Soap acrd Maid Orvind 3-502.11 Spec iolized Pioce,,sing Methods'- j Dev,ces joxygen ' j o-301.11 Hacdwahtn;Cleanser.Availabity3-SU2.'2 Reduced o packaging.criteria., 1 6- 8-103.12 Conformance with Appimcd Procedutrs" j .3b1 12 f-I:u;d Drein�,Frmision I Dennie,toot,;nani m the 1,'(tof 1 c)9}:,.,r30,&,s-W5 CA9R 5W 0U i CITY OF SALEM L�t�A BOARD OF HEALTH Establishment Name: AJVNIf It-Wd- ilr06 Date: 2 /BXdC Page: 2 of Z Item code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I ✓�- a 1>/-c-es ►�- t//ecM'��nrs �/ArO� N 2/1r�6! i N�'/'e�C��N /4S /4s-+—' llrNr/1� �ts�rt✓ �o��-�- j I I � I I I I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: =• ?t:1.I-b C; PHh's Pecceived at-temperatures Violations Palated to Foodborne fitness interventions and Risk According h,1Aw Cooled to Factors(items;-22) (Cont.) 41'FJ45'F lti)thi❑4 Hours. PROTECTION FROM CHEMICALS I 3-.901.15 Cool aro Mcda„& !or PHFs I 14 I Food or Color Additives 19 PHF Hot and-old Holding 3-SO;.t678) (:n!d PRF,NI;iin:ained at of below 3 211?12 Aduun'e '" 59D,f!;)"4(F) 41`/•1S'F 3-302.14 Protecir.n) trout tinapprovcd Additives'' I ; 5p1.1(F) Piot PHF:Maintained at or ab<ae 115 Poisonous or Toxic Sul:stannes ! Wo,F. > 7-101.11 IdenlJyinglnti>rmation--Onginal � 3-50!.;61A) Roaw Held at or above 1300I7. '" Containers" Time as a Public Health Control j 7-103.11 Common Name--Workim,Containers" 17-201.i i Seriaration--S1a:ravc^ j -SUI 19 Time a a Public Health Control* 7-202.11 Re�tricnoo- Presrnce and Ilse" I 7`%U.UU4(Ht Variance Requirement j 7-202.17 Cvnd)tions of I iso' I 7 103 11 Toxic Containers-Prohibitions" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 ( Sanitizcr,,Criteria--Chemicnis- i POPULATIONS(HSP) r 121 P FillUA) Unp steurrzed Pre-pt kaged Mice:and j 7->_Od.12 I C:bemica,s for R'ashuCe f rorluce,Cite a" I BeNrrae:sih Na w � rt :ninC l.ab-.:Is° . 7-20414 I Drying Agents.Criteria' 3SO 1.1!(R) Use(if PactetFrized I �es" I 7-205_ii I blcidenad Food Contact.Lahr:cants^ ( - -- 7-200.11 Re,iricted Use Pectindes.Culerni" 13-301.11(1)} Raw or Partiall�.'C:x�ked.animal Food and Raw Seed Sprouts Not Scrsed. '° 7-20612 j t•:calenl Bran Stations'" 7-306.13 Tracking Powders,Pest Control and. ! 13-801.1 l(C! !!novened Fried Package 1Cot Re-served ' Monitor in„'^ j CONGUMEz2 ADVISORY TIME/TEMPERATURE CONTROLS ?2 3-603 1! Consumer Adlisory Poszzd for Consumption of Animal Ftwds iThat aro Raw. Clnder:ooked or ifi Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-101.11A(1)(2) Eggs- 155'F 15 Sec. Rith0;1cns.^ Eggs-Immediate Service 145"Fl 5se�_ 3-3.1)2.13 Pnsrc;;razed Fres Sub.,waste for Raw Shell 3-401.11(A)(2) Comminuted Fish. Meas&Gams L2"'* Aatittta!s- ?55=F 15 sec. ' SPECIAL REQUIREMENTS ! 3-401.11(13)(1)(2) Pork and Beal Roast- 130°F 121 min* 3-401.11(A)(,'-) Ratites, lajected Meats- 155'F 15 I 590-009(A)-(D) Violations of Section 590.009(A)-t D) in sec• catering, mobile food. temporary and 3-401.11(A)i3) P.aultry, Wild Game,Stuffed PHFs. restdentia' kitcher, operatious should be Slutling Cont:Ouiug Fish,Meat, debited under the appropriate sections Poultry or Ratites405 P i5 sec. ' ;)hove if relaid to Coodbornc i8ness 3-401.1 l(C)(3) Whole-nntxle,Intact Bzef Stcaks inter,,entions and risk factors. Other 145°F" ( 590 009 violations relatin`to good retail 3-101.12 Raw Animal Foods Caked in a pr.^rticcs should be debited under #29- Miciowwve 165F. Special Requirements. 3-101,111A)(i)(b! All (Phot Pd-IFs- 145"F• 15 sec. 17 Reheating for Het Holding I VIOLA77ONS RctA rEo To GOOD RETAIL PRACTICEs ;-403.11(A)&(D) PHI's 165'F 15 see. * I )Mona% 23.30) 3-403.11(H) Microwave- 165"F 2 59inute Siandin;l Griot al and non-critical c)olalions, ,Arch do not relntr m the Time" foodborne ;Ilncsv inteivennons and riskin(to,s listed above, tar be 3-403.11 Camtnercial!y Pimecsed RTE f=ond- i found in the j'oilowinx sections of the Food Codc and 11iS Cd•1R 140-17" 59ti.UUo. t 3403.11(F) Pcniain;ng Unshced Portions of Reef Im Good Retail Practices FC 590"000 Roaster I 23 Management and Personae! FC-2 .003 j 18 Proper Cooling of PHFs I 24. Food ano Food Protect on FC-3 004 _ 'F Equitanen1,tad Uteosi;s FC-4 .005 3-501 14(A) Cooling Cooked PHFs from 140'F to ( 26 Water Piumbinq and Waste eC-5 .006- - -_-� 70'F Within 21Iourti and From 70'F i 27. PhYs!ral Facility FG--6 ,007 i !0 41`F145'F Wrthm 4 Hours. " 128. Poisonous a Tows Malaria., FC - 7 : .008 ! 3-501.14113) Conlin*PEIFs Made From:\mb!ent 29, Brevia?Hornur<^men's --- -009 j "temperature Glgredientc u,41`F(45"F 130 Othe! Within 4 Hours" Denotes criucal it m,n it,, 6,dcral 191)0 Fo-,d C•odc or 105 Chin Sou Or,p, 44. "Vr CITY OF SALEM;.4 M A 7*SACHUSETTS BOARD OF HEALTH 120 WAS STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Hong Kong King Restaurant Address of Establishment: 28 Norman Street Owner's Name: Zheng Feng Zheng Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 124-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. - � =4� 4t� -'d HEALTH AGENT CITY OF SALEM, PIASl;ACHUSETTS BOARD OF HEALTH _ *y, 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT > NAME OF ESTABLISHMENT H.Ohqo �. TEL#J] ^ � ADDRESS OF ESTABLISHMENT 2IV,0 ld 5t, SCI eWL OAL 0177-0 1& t MAILING ADDRESS (if different) //-- 'Qr�tC OWNER'S NAME ZNIzW�r ��214hdy� TEL#SSS� -22Z'96Y3 ADDRESS CtCW -�/LhtZ St_ CITY w) f-oiw STATE I VVI ':P t1 _2 111 CERTIFIED FOOD MANAGER'S NAME(S) 2Hj7-W�T(A/(_ ff]4�ERTIFICATE#(s)4,S-- o (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 2J1EA4:j-T_IgG1 ZIf 1 1HOME TEL# - 72.2- HOURS L2-HOURS OF OPERATION: Mon. '✓ Tue. l/ Wed. "\/ Thu. v Fri. V Sat. Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO /�j less than 25 seats $10 b 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL MON-PROFIT(Such as church kitchens) YES NO `E25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownemiji i ust be posted in a prominent location in the Establishment. p u In accordance with the State Sanitary Code, before any renova �prove �r equipment changes are made all plans for such must be submitted to and rov a1em Board of 9 P pr Health. CITY OF SALEM Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and ��j� � �R,4nTat I, to my best knowledge and belief, have filed all state tax returns and paid all stat�t-axes required under the law. Signatur Date Social Security or Federal Identification Number ------------- ------ - - --- - - -- -------------II- // JJ - - Revised 11/03/03 FOOD P2.adm Che k#&Date S b fj �. 1 �' Z(�7�-Y � � Go I 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 Named j Date TyoeAYODeration(sl, Type of Insoection /Vodd llronrr /�llmd' � '/�/,6 J Food Service E]' outine Address '29 d&ko Hj r`, Risk ❑ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection 7 S/p r 072,7 k4_1 ❑ Mobile Date: OwnerEl HACCP Y/N E] Caterer ary ElPre-operation ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Ins ector 1 In: ElHACCP P n✓b✓r r/ ,V,Zef"A,,3vr,.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 El 1. PIC Assigned/Knowledgeable/Duties x-1"3. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded E] 14. Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 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 Lo 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 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 �G immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an ✓ _ 24. Food and Food Protection (Fc-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590 007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901nspe Form 14 eoo 0� Inspector's Signatutrl�yr �del Print: PIC's Signature:/ % A/ G'? ( r int: �,�,' /^ ! ✓ /���/`//jam"I Page of Pages dr Violations Related to Foodborne Illness I Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I K I Cross-contamination 1 790.003(-V Assignment of Responsibility" I i-302.11(11)(1) Raw Animal i'rxxls Separated f om � 590.003(B) Lou castration of Knowledge* I Ccoit ed and RTE z:n+d:,''t i 2-103 11 Person in charge-duties 1 j cootcminatbn;iom Raw Inogaoients j 3-30111(A)(2) w'RoAnimal Foods Separah-d from Each EMPLO"EE HEALTH I Other 2 590.003(0) Responsibility of the person in charge to Contam;natro n from the Emcournent requite reporting by food zmplopers and 3-302.1 t(A) Food Pruteuion' applicants* 1 3-302.15 W'ashh:L Fruits ane! Ver;erables 590 003(F) Responsibility Of A food Employee O:An ( =-304.',': Fns!Contact ,vitt: Equipment and Applicant To Repot To The Person In ! Utensils Chat,_e'r I Contamination frorn rhe Consumer S90.O03((;) Reporting by Person in Charge` 3 30(.14(A)(k) Returmd Fond and re.,cn-ice of Food. I 3 590.003(D) Exclusions and Restrictions^ D.'sposition of Aeutre,'aded or Contaminated I 3e0.003(F) Removal of Escia;ions and Restriction., Food j 3-701.11 Discarding or Reconditioning Ihisafe FOOD FROM APPROVED SOURCE Foe»1" 4 Food and Water From Reguisted Sources 19 Food Contact Surfaces 590 00=4(A-6) Cnmphance with Fond Law" 4-%L 1 i! Mwowl Warct,a:.hmg-flet Water Sanitization Temp..aatres' 13 201 12 hood in a Jlcnnztica0y Staled Container` 14-501.i 12 Mechanical Wt:r:�tashin--Hut Water I ;-701 13 Fluid Milk and Milk Products, 3.202.13 Shell Egos` Sanitization Tempc(`oures ( 14-505.114 CLrnucal 5auiti:atirr:;-tamp,pH, 4-2,'12.14 F,g u;and Milk Products, Pastemrized" ! cu ict-11fration and hard!:ess. 13-2o12.16 Ice Made From Potable Dr:nkuu R.ttrr` i 4-601.11(0.) Fyuipment FtKe;('anaui Surface,and 5-101.1! Drinkinq Water from an Appu}ved Svsiern'� L'twuds Clear.' 590.006:A) Bottled Drinking Water" 15.662,11 Cleaning Freq::eocv of Equipment Food- 59{),006ffti W:ae Meets Standards m 310 CMR 220" Contact Jurfaces and Utensils'' Shefifish and Fish Horn an Approved Sourc- {-702.I I F+eduencg of Sanitizauon„f L!tensils and 201.1_ Fish and Recreationalb_;Caught Molluscan ( ( Fnod Contact Surfaces of Equipment" Shellfish* ( I .4 703.1': A.euiuds of Sanitizahun -Hot Watet and 3401.19 Molluscan Sbztifi,h front NSSP Listed Chemical" Sources` 111} Proper,Adequate Handwashine Game and mid Mushrooms Approved by I I ? ,Regulatory Authority 501.I t Clean Crndition-- H:md;and Ano: 3-202.18 Shellsa,ck Identification Present` 12-'01.12 Cleaning Procoduiel' 590.OU9(C) Wdd Mus1nix)jm* 2-301.14 When to Wash"' • t-201.17 Came A,nmals" � 11 Good Hygienic Practices I5 Receiving/Condition 2-401.11 FatinL, Drinkini?oi LnngTobacur` 1-20-'.1 1 PER,Retched at Proper T?mperaturec', 1 2-40 i.12 Uischargec Prom the Eves,Nose and ILlow"I:": 202.15 Pa.kat•e lntct,itpx' ?-lULIng I Food Safe and Unadulterated 3-301.12 Pre,ention of Contamination fen'1'Hands 6 Tags/Records:Sheiistock I 112 Prevention of Contamination from Hands 3202.18 ShcHituck Identification I 5W0O4(E) Preventing Con6umnatien It cm 3-203.12 Shelktoak Identification Maintained" I F,np!oyees" 13 Handwash Facilities Taiasite ords:Fish Products Co •en:enthy Lered and Accessible 3-102.1! Pmasitc Dtstraetion* mx 5--!03 it Numhers and Capscincs' 3-402.12 Records.Creation and RetenhoWt 5()0.0')4(1) Labeling of Ingredients' I i 5-204 11 Lut.abon artd Placement" 7 Conformance with Approved Procedures Acccs^,haity, ;)peryticm and Maintenance /HACCP Plans I i Supp,io d u,,rin Soap and'nand Dryrn9 pr;BiCBS 3-50211 Specialized Processing Methods u,cr Availability ea ( C! 3-502.12 Reduced oxygen packaging,criterA.301.!1 fiand�rashing ia- ( 6-301.12 hand Drying Ciea ;nn 15-103.12 Coot brmance with Approved Pnxtedumc ' "Dcnoto,,nucel hum in the fulaal 001)Pond Cale ci F6 CNIR>911,011, f CITY OF SALEM BOARD OF HEALTH Establishment Name:1rf ,JS /fej&f X//Ar� Date: 7-1///dr Page: of 3 Item Code C-Critical item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY + J49/tAlf,R-e"14 tA,< COi&OZ-1 "Gr ejrr,r /lira .w s9f&-vee-AW �'7fXl�rr-fastw2t. K_ �tleu %� U/ rr cG�J,r4 tweL I . I t 1 2��' /• trr'N it /I-tif'-T -rd.-(Ir AA-_ r-AcA44£7. 13 r Nm-r• &rAs ti rafte /.r Gerocar4 eoTrr�a da. ,rte jAo. rOwe srI r4jV1'' I JAG' Q,.� G46.,'a-R hrr� r.Ie!'r�sSifiL-rr� .Otr .au-- vr�'-+e�s' I 2-5- �lC a CC. *44, &, MA_ rhA 5 4W r9 rc.r r t uurrnv of G)Gnea. . trt f,sr a/e ro4 Cu£AN r�Mr j 2V ( _ b A-C C r 1J 4A S 5-cu-4c t Irn/4*✓4Q4" C rer o e N r rrrJsr- I • I rcbo rrd-&O day GYts react, 01-a Aar'I/1 0--W rf- 14* I �s3�,�n r r t�c,rre GD . g a e�h�r^ ofd #,eZ - f r'" L arfG 0_zX ,#fd /3c3rr.iJ /S CGr*Ab0 14WV r0eriW-60. A&-C-dA4C,fC;4_� dell L.a49 lr�PfJNG /3ert +�q. Nt3 �. ce NA'? c.- - Discussion With Person it Charge: Corrective Action Required: I ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of El Embargo Ll Emergency Closure (y your food permit. /1j��"'I I�� LI) Voluntary Disposal ❑ Other: u ' �-50� i*FY:) PHFs t:et:eraed at'Pemper.ttures Violations Related to Foodborne fitness interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont) =U "r/4,311 Within 4 Hours. ' PROTECTION FROM CHEMICALS I ,15 Cooling Methods fo-I'1ll;s I 19 PHF Hat and Cold Holding 14 Food or Color Additives 3-203.12 Addtiives' 3-507.i(if E) Cold PHF, Maintainoci at or helow � 590.Ot!.I(F) 41 '/75' F' 3 302.14 Poitou+ion or lxic Substances Arldinvesk 1.501 l6iA) Hot PHFs Maintanteti at or above 11,5 Poisonous ar Toric Sutrstances 7-10:.11 40'F 13enLt5vic lnii•,nr.au:an-Unginat i INIA Roasts Held m or F.bo,e 130'F Caiiteiners" I t ' 120 Time as a Public Health Control'-ll2.11 Gtma:ou Name--'v1';+rkin;,Cattamers' 7-201.71 i Sc ation-Storaxe ( :90 l !9 TViamrii:a;ne7-202 Il RestrictionUse a RPauqbuli+croIni:eeauitd t Control --� -i'resence and ti gr` ( 7-202.12 Cenditions of Use 7-203.11 Toxic Container.;-Prohibition:.* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA'T'IONS(HSP) 7-^_04.11 Sanitizeu.Crircna-Chc:¢ictls* rtzcd 7-20! 12 Clr.,n;tade,nrVrasi:irg}'r.:+nicc t'ri;zria` 2I 3-8(}l.ii(^J topustcuswdr aruir:ageh,-F; e>.ind 7-204.14 Drving Agent.Criten a* Brve,::ces uuh W)u+n:re !abets^ - - 3-80!.11(B) Ils.�•.rf Pasteurize-1 Eggs 7-205.1 t Inridcntal Food Coutaa Lubncants^ ;�OI.I 11)) Rae, or Partially Ctvked Arimai Food and ---I 7-206.11 Restricted Use Pesticides Cnrcria" ! i Rau Seed Sprouts tint Ser '" ved. 7-206.12 Rodent Bait Stations* ,-SO1.11tCt I Unoeenrd Foci Padtage Nut Re-served. " 7-206.!3 Tracking Powd;rc,Pest Conoid aid ( -- - Monitoring CONSUMER ADVISORY TIMEITEMPER4TURE CONTROLS 1-1 3-603.11 Consumer Advisory Posted (1a CO tsmnption of Anklial 1 0KNIS That are Raw. Undorumked or 1fi Proper Cooking Temperatures for i Not Otherwise Processed to Elnninate PHFs 21; c`hutt,c 9;;pnp� ?-401.11.4(1)(2) F-,ggs- 155`F15Sec. �tuogroa-.. Eggs-lnuitediate Service 145'r l.5sec„ 3-102.13 Past.,_nred Eggs Subs6ttne Fon Raw Shell 3-401.110)(2) Comminuted Fich,Mcats r'e Game Egss,: Animals- 155'F 15 see. " 3401.) 1(111(1)(2) Pork and Beat Roast- 130`17121 min'° ! SPECtAL REQUIREMENTS 3-401.11(AH2) Ratites, Injected Moats- 155'F 15 590009(A)-(D) Violanons of Section '190.0'09(A)-(D) in SeL• I -at-rine, mobile food, temporary and 3-401.1 7(411?) Pouhri,Wild Crame,Stuffed PHF,a, residenl.al kitchen operations a.Itould be Stuffing Containntg Fish, Meat, dcbited udder the apntopriate sections Poultry of Ratites 169`17 15 sec. "' above if rclatcd to foodborn::illness 3-401.1ItC')(3} Whole-jutrwie, Intact Beef Steaks interventions and risk facto's. Oiler 145'h 590.009 viol;dions relating to gm,d tetail 3-407.1? Raw Anil Food.,,Cooked in a i practices should be debited under #29- Microwave 165^F* ( Special Requirements. 3-<tD1.11t.9t(1)(h; All Oche: PHFc- 1-i 'T 15 sec. '- 17 Reheating lot Hot Holding ( VIOLATIONS R.:LA'rED TO GOOD RETAIL PRACTiCES ?-410.11(A)&(1)) PHFs 165'1715sec. " tltents 23-30) 1 403.11(B) Microwave- Itis` F 2 Minute Standing Craiud arvi non-,t4 ica!v;,;k+t+„n s, n•hich do nil,re!are to the Time* I foodborne dlne.s::tnre'rvoilU.re;4wo riskJoeter,lived obovr ,on he 3-403.1 1(C) C'onnnerci,.!!t Prtxe,csed RTF Food- i found i„the J.-Mormk scrtione of the Fo,,,l Code am'1105 CMR 170.17'17 jy0.0i)D. 3-403.11(E) Remaining Unsliced Purtionsof Reef iItem Good RetsPi Practices FC 590.000 Roasts* 23. Management ar^O Personnel -C-2 .093 I, 24 Foot;enol Fo cl Protection FC-3 004 ! 18 Proper Cooling of PHFs ( 2 5. Equipment and Utensils FC - 4 .005 3-)01.14(.1) Cooling Ctx)kcd P}1171 from 140"F to ! 26 v'Vater,Plumbing and Wa6;C FC-5 006 701-Within 2 Flours and Fmml 70'F 27. Physic=d Fac!lit, FC--6 i OW to 41'-F/45'14 Within 4 Hours. " 28. Poreonous or Toxic Matonsls FC--7 .008 3-501.!4(B) Cooling PEIFs Made Froth Ambient 29, Sceaal Requirements 009 !� Teu:Petamre lngreditnts to 11 'F/45`F ?0. Otter -- Within 4 FEours'.: DenoreN critical item m ih. federal 1999 Food rude or 105 Ctvti:59n 000 CITY OF SALEM BOARD OF HEALTH Establishment Name: 14UY' /SONG K,tJd Date: 21,1140r Page: 7 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified i PLEASE PRINT CLEARLY r 2� n/k VT�e� !r � /6«fyCJlt'..F'rfa t✓ o>< f4r'��1 S�/L�r nem_ ✓I.�YS�S r N erg I \-�_/,.! sd o,4d-� .�rr�.sf.. ft�absat�,rrlfty cL�t,✓ O.s� sraic..sb-� .9,4£ r!- 4 I 7Y G �G✓St�sll O/>�s.c.rt� a.., �M-r3 l�mc. iP✓ �w�.o �,.//,� sttr�c- �ac�0 rv,JTf A-r- I.i.esb- 6 S? ..le/oIkk_T ntwF nou q c L! •' OCN rA,�s s 17 fes(;D /9� c3GJJi��tf►✓r /I t� t'NI 1/g S AwJs4" /3i S0F0"4 Of A LW6C c,1- ,a 6 ucoezw � r� S.►►t�R7,rllr sbe�rrdK 1 ? 3r .bljr-1OJ "0411-4e .4Lr#j&444C . S,AF1 #171"6 .t Wo 470/r of 1 P /i�.�. G�..c.�w(itknvn. �uvsf" �.� .r,�s,�o,�v a•+rittc,.,,3u .moi' �I-rt- t...r>>� r�Asr-.drs I il I ✓.f ,e7�L k4AC_ GL09- S"AVn _1&01K- Sewn.,..,! d'+fz_r .4,.o . .6k CA-M Oft�sv14--S ,r-.s /-�_ sNes�rr- _r.��i��- .tuo� uMv� rr✓i��[lT,� �,r /®.CeSpe�NO- j ,,•�� �,ulS I Discussion With Person in Charg;e'C Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Ll Embargo La Emergency Closure your food permit. I Qr1' l� t��� S r �� i Q �'�� ❑ Voluntary Disposal ❑ Other: 5-50 i;Cy FFit's Received at Temperatures Violations Related to Foodborne%Ines%'Interventions and Risk Auutding to Iain Cooled to Factors(ltems 1-22) (Cont,) F Within,I Hours. ' PROTECTION FROM, CHEMICALS C,�)bng R^etLods for i'iEps � 1� Food or Color Additives I4 PHF Hot and Cold Holding 3-SUl.ltil:t) -old PilFs Maintainod at n'bean% 320_'.12 Additivecr -402.14 Protection from Unapproved Adduives' ( 590 004(F! 41 145 F, 15 Poisonous or Toxic Substances 3-501.l ht A} Her PIIFs Maintained at or above i ; „F M 7-10 1. Identifywc Inlorm:non-Original ! 4O Container, ?-501 11,1 A) Roasts Held at or above 130'F ^ r Time as a Public Health Control ! COrttainei5" 25 ',- 02.1 I Comntcnt Name - K'orking --) j 59U.pU<(H) Variance Rrquucmen 7-201.11 Separation as,--StomI 13-St.'I.I`) Time a a Public nii th Corbel* 7-202.11 Restriction-Presence and Use' � t 7-202.12 G:ndmons of lice' 7-203.11 Toxic Containers-Pn:lnhirons ° i REQUIREMENTS FOR H;GHLY SUSCEPTIBLE t OPULATICralS(HSP) 7-204.11 Sanitizers.Criteria --Chemic;i}a:, i � .= 20-4.12 Owni cats for W"shnit-Producv.Criteria" � 21 1 SO I I I(A) lhtps:teurized Prepackaged Juices an,a ! N:,w1aii with Warning I.;ahcls 7-204.L". Erving:'>,geus.Crneria* � 7-205.11 incidents! Foia1 Contact.Lubricants' ( 1-ti0l.I !(B% Use of Pastea:izeo H"a's, 3-S01.1 (D) Rax or Paanafy Cooked Ananed Food and 7-206.11 Rct rricted Use Pesticide"s,Criteria% ka.e Sc :' iu:outs Vat Szrrcd. ` 7-206.12 Rodent$m Stations- i-sU1.-1,(C) IInopenedPoon Package Notke-served. "r 206 13 Tracking ftlwdrrs,Pi Gouraud and Monihorng" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 :1.603.11 C:msum�r Advisory Posted for Consumption of 16 Proper Cooking Temperatures for <5mnml Foodl, That are Raw. Lhtdewooked of PHFs I Not Otherwise Processed to Eiim:na!e 3-401.11 A(L)(2) Eggc- 155'F 15 Sec. I pathogens.*,-•;":.. ,,.door - - Eggs- !nimedia:c Sen-ice 1=1YFi5sec* 3-302.!j Pasteurized lsY.,Suhit:,urtr For tate,,,'shell 3-4(11.111 A)(2) ComminutedFish,A4eat,& Gante Eggkw Pal nods I i5'F 15 sec. 3-401.11(611,1)(2) Pork and Bcef Rata- 13WF 121 mins` SPECIAL REQUIREMENTS 3-401.11(A)il) R:nttes,Inje firleats- 155'F 15 590.0:)4(5)-f )) Violations of Section 590.009(A)-(ll) in sec .. catering, mo(iile food,temporary and 3 461.11(A)0) Poultry,Wild Game, Stuffed PHFs, resident;at kit(heu opelations should he Stuffing,Containing Fish, Meat, debited wader the appropriate sections Poultry or Ratites-165'17 15 sec " above if refitted to foodborne itlness 3-401.11(C)(3) Wh<le-muscle, Intact Beef Steaks interventions and risk raclor.,. Other 145'2 51 violations relating to good retail 3=401.12 Rain Animal Fo,As Cooked in a practices should be debited under //_'9- Microwa,e 165"FSpecial Requirerucnts. 3-401 A I(A)(1)(b) All Other Pl-IFs- 145°1' 15 sec. " j 17 neheating let Hat Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(:5)&i D) PHFs 165T ti sec. It (Items 23-3(1) 3-403.111`11) Microw.we- 165')F 2 Minute Standing Critical ural nnn--idt,al rmkttrans. which on not relate io the Time' - nodburae dbrese irtdi varhoes and risk,4re tura livr[l above, ran be 3-403 11(C) I CommecialN Pimessed RTE Food tnrotd it,ihe./oI1rwin,q secgw:s qr Jar F't,,ld Calc and 105 Ch1R 140'171 s1,%0.(1Ofi. 3--403.111,E) Elviowning Cnsliced Portions of Beef 1'1-ns Good Retail Practices it FC 590.000 23. Manaaeraent and Personnel FC tiastss I ! lg Proper Cooling of PHFs I . 04 Food and Food Protection ( FC - 3 004 25. Equipment and Uuaosils FC-4 005 I 3-5(11.14(A) Cooling Cooked PH Fe from 140`F to pg_ :Nater,Ph,r.;binq and Waste FG- 5 I 000 70"F Within 2 doors and From 70"2 27 Powe cal Fac lit ! FG--(3 007 1 to 41"F149'2 Within 4 flours. ' ( 29. Poisonous or Toxic Wateri=:Is j FC-7 .003 3-501.14-(3) Cooling PftFs Mado Front,Ambient 29 Special Requirements i .009 Temperature Ituredients to 41'Fi45`F I 130. Other Within 4 I-loui ^ Denote',critical item u1 thr I?deral 1994 Pond Cme,.r 1(li(SIR 590 000. r � :. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 ,pB TEL. 978-741-1800 Q' FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Hong Kong King Restaurant Address of Establishment: 28 Norman Street Owner's Name: Zheng Feng Zheng Restrictions: Application Date: 11/26/2003 Permit for Food Establishment 45-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Boar^d,of Health. , HEALTH AGENT IMPORTANT MESSAGE FOR / DATP TIME OF / PHONP 'AREA CODE LI FAX Ll MOBII AREA CODE TELEPHONED LirPLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEEN RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE MADE IN U.S.A �,��1' r e CITY OF SALEM, MASSACHUSETTS y��r�y✓y BOARD OF HEALTH 3 ® 120 WASHINGTON STREET, 4TH FLOOR V rr�, A t3 {y \VV/ SALEM, MA 01970 NOV 2 4 200 TEL. 978-741-1800 FAX 978-745-0343 U I Y (.}s•" SALEM 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 ESTABLISHMENTp✓t q 111 1 TEL# d Z �-_ 1�s-7�. -Ss7 7 ADDRESS OF ESTABLISHMENT a AIA- MAILING IAMAILING ADDRESS (if different) ' OWNER'S NAME?` cdi/����1'Us - Imo// - TEL# ADDRESSgIW Vy)_�/l�i'� - F— T CITY W STATEZIP ,0 2-11 1 CERTIFIED FOOD MANAGER'S NAMES) _ ERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 21 (%L0 7J fT/I:��nHOME TEL#�S HOURS OF OPERATION: Mon : 4 Tue.-4'_ Wed.k1 tPThu. OFri. ?:8at. l�Sun. Ll TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 pr more than 10,000sq.ft. =$250 RESTAURANT �/ES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. I1--rS(-0Z Sign atur C -Date - Social Security or Federal Identification Number Revised 11/03/03 FO DAP2.adm Che 08 Date f CITY OF SALEM BOARD OF HEALTH Establishment Name: et/ma �//1� Date: 5 Q Page: of Item Code C-Critical item J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY >� - /1/}�/J�i �i�Nt -fi, O i�/�r�i� {'! _c l�� irn �a -/�--a•y 44p '911I)IJInq 14 /0c TilnvJ __TNnnna I <-w - S") �,. /7f /V' _. huh rho nlicl �h�trrP nvl� GarJrl�i, i6 40 J�SJG�av ff�� � I 1 I I 1 1 , I 1 : I 1 ° I 1 I 1 r Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. —7t� r ji^ 0 Voluntary Disposal ❑ Other: 3:5^.11,10' PI Ifs Refer;ect at Tzniperatures Violations Related to Foodborne Illness Interventions and RhO According to L:;.v Cool-d to Factors(Items 1.22) (Cont.) a?--F/-5`F'Kithi a-1 Howl. ' PROTECTION FROM CHEMICALS Coaling Method'f�•.PRFs j 114 j Food or Color Additives 1 i PHF Hot rnd Cosd Holding 3-202.12 Adtfime.* ColdPIIPsM•intainciiai "rbclox 590 0041F; 41'145 F` 3-302.14 Protect;im fru:u Un::npro-,-ed Additivec'� 3-5FI Atii(A) i-tut F•HFs Maiataiued ar or abose 15 Poisonous or Toxic Substances 7-101.11 kiendtymglnfom:;ation-Oriina( I40'Frr. Container," 3-50 i.i.ic.k) Roast:. Held at or abate 130'h. 7-102.11 Common Nance - Workine Containet;." 20 ' Thne as a Public Health Control j 7-"_01.11Scpdratian-Slot age'" 3-501.:8 Time;as It Public Heald:Control* 7-202 11 Restriction-Ptdxnce_,nd Ucc, j i 5)0.004i H) Variance Requirement 7-202.12 Conditions"f Ui -' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prolubuions'- 7-204.11 Saaliiizers,Criterr,I--C'):emirds* POPULATIONS(FISP) 2. 4`u'01.111 A, Unnastcw'itcd Fac-nu-ka,cd Juices and 7-20-112 Chemicals for Washmc Produce,('nit:ria" r� .. 7-204,14 Drying Agents.Criteria.. I ULie A<eseuriedE, Labels j "-Sol,t!(ft) Cse of Pasteur!zed fier*.'' j 7-20.5.11 Incidental Food Contact.Luuneattts* I 3-�,nl.1 t(Di Raw-jr Partially Choked:kmmal Food and 7-1-06.11 Rest(ictcd Use Pe�ticides.Criteria' 7-206.12 Rixient Bait Stations` Rate orad Food Package e ved " ?-*01.11(C:) Unoper.ai P'<xu{Packa;;c tJot Re-sewed " 7-206.!3 Tracking Powd:rc,Prsi Control and ! Monitoring' CONSUMER AilVISORY 22 ? 603,11i C'^nsumer Advi:.or} P:.ted lot Consumption of 16 Draper Cooking TIME/TEMPERA7URE CONTROLS kinggTTemperatures inn Amoral Food. I'Itar arc Raw. Undercooked or em ( o! (itherwiae Pttu_ecsed to Eliminate u� j I PHFS Iv j 3-40:.11 A(I)(2) Fggs- 15;'F 15 &c. Pffiho9,mc,* Segs-himiediate Service 145'FI5.wcv 3-;02.i 3 Pzsieurtlec Fg�Substitute for Raw Shelf 3-401.11(.)(2) Cotmninuted Fish,Mea:,:&Gante Egg,, ` j Animalc- i55'F i5 sec. ?-401.!1(81(!)(2) Pork and Beef Roast- i30'F ?27 min;` SPECIAL REQUIREMENTS � 401.11(A 1(2) Ratites; Injected R1rat:.- 15j"F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in ' sec. I catering, mobile food.tc;opura;y and 3-401.1 I(A)(3) Poultrv,Wild Game.,Stuffed PHTs, residential kitchen ooerationc Aiould be Stuffing Containing Fish,Meat, debited wider the appropriate sections Poultr,-or Ratites-165-F 15 sec. ' about ifreiaied to foo-lbome illness 3-;01.11(C)(3) Whale-muscie, Intact Beef Steaks interventions and risk factors. Other 145°F` 590.009 violations relatin,to gond retail 3-401.12 Raw Animal Foeds Cooked in a practices should be debitrd under i/29 -- Microw.a'e 165"F " Special Roquireracats. 3401AI(Aglyb) All thherPHFc- ids'F15wc. * 17 Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES ;_403.11(A)&(D) PHF, 165'F 15.arc. * j (Rents 23-30) 3-403.118) Microwave- 165°F 2 Minute Standing I CrBir tri and nim-crincul vinLttarne, shic.h ua nn/ ,elate?o the Time" rnndborne illness frnerreniion.c and risr;Jia tons lir;ted above, can be 3--403.11(C) Commeruatty P;tx essed R'lb Fund- I roand in the ioas o1 the Fond(.-ode and 105 C'bIR 140FF' s9RUU0. 3-103.11(E) Remaia i.,w Unsitcecl Pardons of Be-eC hemdcIcId Retaii Practices FC 1 580.(700 koast," V 23 Manapement and Personnel FC --2 .003 Ig Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 <,5 Equipment anv-U!ens:ls FC-4 .OW 3-5(11 14(A) Crxryhnc Cooked PRFs from 140`Ptn ! 26. Water, P!mnbino and Waste FC-5 .0066 70"U Within 2 Hours and From 7U°F 1 27. Physical Fapd'ty FC-ti .007 to 41"F/45"F Within 4 Hours. " 28. Poisonots o,Jose Ivliecriahs FC -7 1 .003 3-501.14(B) C olinv,PHF,Made From Ambient 213, Special Reauirements nog Temperaiure fneredie.nis to 41'F/45`V Ott;ei Within -t Hours-1 4 DCaeteV cnucal acro tit tae ialei::! N94 l and Lode or 105 C NIR 5'+0 ui3O. CITY OF SALEM , __ /� BOARD OF HEALTH Establishment Name: 1-11,y-)a fC 6y?a )e/k)67 Date: Page: of D Item Code C-Critical nem % f DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified j _ / PLEASE PRINT CLEARLY kP-in IR �/-�, //1/7<' 1 )Ar lvl_ 14 61 -71A it o�fahl�chryla�r f h111 -J �irn� P S id l���Ytvio ti h� �iooil �'��S✓10 Gf��/�'. �� l///F�'G`�7Dvr S' `/�//�' l/_.6�1�.P /_ls�P/� G'Y1. . I /;:6 -)a-ovImle tialse he" l'!ll/J Y, ,IIIV6 YJ Z-/%';MO UI//I YAC/ll� �h onrf��� f�nas 1 _J// U� it I FDcussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ave read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restrictionlations before the next ins ection, 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 l your food permit. pg � �//L�'--"'ri Y''GlVl1�2�/�v� ❑ Voluntary Disposal ❑ Other: i 3-50;-; 'C, PHFs iice.e[Ve.t aT'1'entperatures Violations Related to Foodborne tilnese interventions?nd Rist. According io I-at,-Cooled to Factors(items 1-22) (Cont.) 4ITl45°F Within -IHowl. ' ! PROTECTION FROM CHEMICALS 3 `131.1.1 Coolin;;Methods for PHFs 19 PHF Hot and Cold Holding ,4 Food or Color Additives !302.12 Additive:d' 3-501.16.B i Cold PHF�, Maintained at or belov: 102, ,.i 590.uU-1tF) M1l`hq-.,i;:, 14 Protection front tom lrnapprot-cd Additives' 15 Poisonous or Toxic j I i-5n},lea q) riot FHFsbfavdz;redatorabov'c 7-101.11 Identifying Inform.mon-Origina, I 140'F. '' Container,.' ' 3-50 L 16(A) Furasts:geld at or above 13011 1 ',-1(1211 Common Nanie- Working Comniners" ! 20 Time as Public Health Cont=oI 7-161.11 Scparilinn-Sk>raye" i 3-:iOi 19 'Lime a:,a Fnblic Health Control* 17-202.11 Rest=iction- Preserve and Us,* I � 5';0.0G41H) Variance Rcquiren:ent 7-202.1'1 CondTcjxic Con i Ltci - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 ll 'folic C'onttineis -�Prohibition,= 7-204.11 Sanitizers,Criteria--C'hemic Ls„ j POPULATIONS(HSP) 7-2u4.I' 0etnicaL;for tiv'ushmg Produce,C121 '?01.11(A) Unpasteurifed Pre-packeged Juice.and rit=+ria" j , i7-204.1 } Dl} ig Af6115, 'rltetia , . l3cic;agzs with 6erm-ne I.abals- 7-_O5.11 Incidental Food Contact,Lahr wants* 3-S0!.1'(;) L7,eofPast-wizedE.-Its* j 3-30:.1 1(Ui Ra,,,or Patti 11i- 7-206.i i Restricted Ilse Pesticides:.Criteria" -v s o t S rved. ;i i':axl and - � , ( Rave Seed Jproutc Not Served. " j 7-_06.12 Rmlt rd Bail Station,,- yg61 11(Ci Unopened F„oil Package Not lic-served. " 206.13 Tracking Powders.Pc,t Control and p `' \lanitoi-iu"' CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.1 i Consumer Adv;sory Pasted for Consumption of lb Proper Cooking'f"emperatures for Anima! Po:as-1 hat are Raw,Undercooked or I i PHFs ( iSot Odterv;Ise Processed to Islitttinate 101. 1A(1)(2) ( Eggalis`F15Sec. j Eggs-bnmediatc seivice 145`F15sel• j =-:103.13 P.ateunzctl Fgdc SUN titute for Raw,Shell 3-401.11(A)('1-) Conaninuted Fish, Meats&Crone Animal,- 155'F I5 sec. 3-461.11(13)(1)(.^.) Park and Beef Roast - 1301E121 mi..* � SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites. Injected McaLs- 155"F 15 590.0-!Q(A)-(I)) Vio'a:ion;ol'Section 590,009(A)-1 D) in sec. "' ! catering, mobile food, temporary and 3-461.1{(A)(3) Poultry, Wild Gane,Shtffed PI Ws. resideub:;l kitchen operations ehould be :itufting Contmnur;rash,bleat, debited under the appropriate scchons Poultry or Ratites-165"F 15 sec " aloo'.e if refaced to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beefsteak,• mtervenhons and risk factors, Oche; 145"F^' 590.009 viola?ions relating to good retail 3-401.12 Raw Animal Foocls Cooked in:i pt l:tliccs should be debited under ft29-- Microwave 165^F< Special Requirements. 3-40i.t I(A)(Otb'I All Other PHF,,- 145'F 15 sec. I, 17 Reheating for Hot Holding VIOLA CIONS F LATED TO GOOD RETAIL PRACTICES 3-403.1I(A)&(D) PHI's 165`17 15 sec. ` !peons 23-30) 3-403.11(B) Microwave- 165'F 2 M utule Standi ng Cri;ir,o1,<ria'«an-r.ilical vgd-itiun s, wim h de not relate to fhe Time" ;uudN)rnr ilih ea.;btterveruiura and risk lactams tr,tted obere, call be 3 4W.I1 t C,) Commercially P.cm essed RTE Food- ,junnd in pre follmt all;So 110115 of tilt, vew,l Code and 105 C:111{ 140`F,. 590 Yet 3-}43.I1(E) Remaining Un:liced Portions o.Hecf item Goad Retail Practices FC j 530.000 Roasts* M. Manacemerr an^Pet son, =1 FC-2 .000 f 13 Proper Cooling of PHFs 1 124 Frog and Food Protection FC-3 :004 ! 25 Ecuior:ent and Urcnsas FC-4 605 501.i d(:1) Cooling Cooked PHP, floor 140 F to 1 - 26 Water,Plumbing and Waste Ft;-5 ! .(106 7WF Within 2 flours and Fngn 7W F 127, Phtsice;Facility FG-6 007 J to fl`17/451P Within 4 Hours. " 128. Pois,nous or Toxic Materials FC-7 ! .008 f 3-501,14(B) Cooling PHFs blade Front Ambient 129. Sorest Rewacrieras 1 009 j Temperature htgree ients to 41'F/45'F I 3o. Or! \Vilhin4Ilour,# Denov:s cnncal dem it ane Irde::.l 1999 FoM Cvde or 105:A1k 590 000. �r I IMPORTvAW MESSAGE FOR J90--pV0 i✓lU .. �� DATE?-/N-el 41 TIME M OF C�doe Fill'/ PHofn1F 3S-7 AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOEIII P AREA CODE, NUMBER TIME TO CALL V TELEPHONED , PLEASE CALL I CAME TO SEE YOU WILL CALL AGAIN I WANTS TO SEE YOU II RUSH I RETURNED YOUR CALL 1I WILL FAX TO YOU MESSAGE Q7c? -IV/?/ a(N" MM LUO.f//!S iRl_�i�l C,-, lIl9M f',�✓A^�'' YNP.✓1)- /liPL1 ,,/Pe.�/.vned /lrr_r/ �� P//rirSOBte ,� B SIGNEE),QyV7 Y 1T1cT�^1,4i M*ps ORM 4009 iii��� MARE W U.S.A. Massaclsetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division af'Folo' and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name " '/ 7 ate q Type of Ooeration(s), Tyge of Inspection Address �� C I tYl/) I q�" , In�') (� I ® Food Service ❑ Routine p �)VIo1V1(L V1 t t`1'JG� Risk ❑ Retail ❑ Re-inspection Telephonef � ' ^, (U l+j�yLeveEl Residential Kitchen Previous Inspection M (, J ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation /gyp Q � El Caterer El Suspect Illness Person in Chaige(PIC)) Time ❑ Bed&Breakfast jJ General Complaint In: '[� HACCP Inspector Tf))y)h 0 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 EMPLOYEE HEALTH E�/13. Handwash Facilities (a) El 2. FROM CHEMICALS 2. Reporting of Diseases by Food Employee and PIC < „ [13. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑/18.Cooling PROTECTION FROM CONTAMINATION Hot and Cold Holding6o n�, V8. Separation/Segregation/Protection ❑20. Time As a Public Health Control [�✓�. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑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 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)(990.003) order of the Board of Health. Failure to correct violations . Equipment and Utensils (FC-3)(590.005) cited in this report may result in suspension or revocation of 5 (a 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 59JMVMFOl 14d c l� g IIn�'ol A J'jjY nl Yure: Print: r,�}}11 s Si nature: , ,vn w �. Print: I Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 590.003(A) I Astgnmerit of Ruq)on,,,ibifitt 3-302. ItAi") P--'Vl Anu.tal F(jci& S,-puatcd tvan 590,003(B) Cjukd and krF. Rlvuls,* i 2 103 11 Petsonincharge-dutics 09,tan-,inavon from flaw lnyrvdivnlS 1 3302.:1(A),20 RjV, ADIT11al F,xsds Separated from Each EMPLOYEE HEALTH Oche:l 2 1 590,(103(0) Respormbil;JN of the riersovi in chaue to i Coirarvinarton f.°orr,the Eavxrnmert require rcportmg by fo,:yl en 3302.i i(A) Fv,(xl Prntectiow" -02. VV�ishinv Fruits an.:',Vegetables applicants* 3 �i I I 5900'03(F) Rcsponsibiliv,Of'A Food Or An 3-304.1 z Fool Contact •,tirtb Equipment aid APcjiCant rro Repuri To The Per-,on In I j Utenmlsx' Chance' I Cont,?nilratfnn from the Oonsumol 59n 003(G)- Reporting be Per,%-a, in Char--e' I 1-306JII(A)(3) !��od and -1- Retuned ,inNica�of Fooj* u J "t 59:i.CC3(Di Exclumonsaud Restrict!nns* Adu,116iate,fot Confarr131.1ted 500 003irill Reasn al of Exclusi,ns and Restrictions Food 3 DiscardIm-oi fiaeconihtiono�ll G111afe FOOD FROM APPROVED SOURCE F"wo'! il 4 Food and'Alater From Ficgu:.ited SourusS 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law' .4-5(`1.1 i. Manual Warewshnig- Hot Water 3-201.12 Foal in.) flernietically Scaled Cnntalrier" Tsoeerd I A 1.112 N�ajewashin,, lotK.atei 3-201.13 Fluid Milk and 1,401, Products" 1 Shelf F,,-St Sanirizui-1 Tvn!ociaturesl 3-202 14 Fg-Ils and Mill,Products.Paswoazed- Sri] 114 C"enfie"d S.,mtizAtwil-ielnp, PH, 13-202.16 ! Ice Made From. potable Driakino W-,,.ter* al':j'iventriqionand hardness. 5-101.11 4-"!A.I!(A Equipmunt Fool Cunta�U Sutfwi-�and ! Drinking from APpsred S�sfe;;,' U;enails Clean:. 590.006fAi r'o'deo Dri:Aing Water 4-61,)2.1 i Cleaning Frequency of Equk.-meat Kind 590 006(11) Wacr Meets Stand:-,r";in 310(INIR 22 01' Contact Surfaers and Utensils'' Shellfish and Fish Foni an Approved Source 4-7)-, 1 3-201.1-1 Fish ori! ReematioroIly Caught Molhiscan -,I I FrerIm,.c%,of Skutitiza-liorl o: and Food Contact Surfaces of Ec il,t i Methods cf'Sanh'&ition-Ho,Water and 3-101-19 Nfoltuseivi Shellfish frnm NSSP Listed chelificall! 15ouice-' 10 j Proper,Adequate Hand-nashing Game and Wild Mushrooma,4tvproved by Reauiatory A,thort!, 11 (71,an Hands and Arn)10 i 3-201!8 Slidistock Mentificaiton Prewiat j 2-301.12 Cleaning Proccdur,A 590.004(C) Wild Mushroorri,,-, -;ol.1.1 vken to Wash, 3-201.17 Caniv.eUriiva6s I t t. I Good HyginniaPrazlices S Receiving/Condition -4r)j I I Eatino.Drmki;i,of Usitilt Tobacco" 3-202.11 PHFs Received at Proper Temperatures* 2-401 12 Discharge, From th,--Eyes. Nose and 3-202 15 Package Integrity" lvatill' 1 3-i 01,11 Fund Safe and Unadulteralcol 3-30:.;2 Prerealijw Co:a.ruinattion V)T)^p Tati7n- 6 rags/Records:ShoUstook I 12 Prevention of Contamination from Hands 590.00"d-1) Prmentin,Cononpination fforn 3-202.18 Shellsto,:k Identificaoon * Emplovee, 3-203.i Sheflst(�,k Identification Ma'ritaine& Hindwash Facilities Tags;Rscords:Fish Products Conven,,entiy Located and Auce�,sjbfe 3-402.1! Parasit'!IXstructio::I I 3-402.12 j Records.Creation and Retention" I 5-2-03.11 I Numbers and Cavwlo:vs° 5-204,11 LA)cation arid Placement"590.0040) Labeling of Ingredients' I I Atco,,,;ibilny�Opa� ion and 7 Conformance with Approved Procedures S /HACCR Pians I surrloa with 3,'),.P and band Onjing I IDeiqce� 3-502.11 Specialized Processing Math+Js` ciitetia i b-301.: ! "laudivistone.---lcan:zer,Av�ilat-.Jitv 6, 301 12 Hand DryingProvizi,,n 8-103.i2 Confonntwe ivith Approved Pox-dures oeno:e., ,rnical sem in fix federal 1099 Foal(',&e o 105(,,%IIZ 571),0fl0. CITY OF SALEM BOARD OF HEALTH ( J Establishment Name: r�� y/,-Y�/i y f 11�� Date: Ia 14-6` t Page: of 7 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified • PLEASE PRINT CLEARLY € I v 41, A?o In/ vn_ 4r� Y tel,/!= h� � �oiP cni, h, rOrll/l!L 4/YIlJ - /7r/nQco 420 �JdTIr/YO _ P/ZIDe- 42 gni ;. Ci�>7�dhl/�a'�5�i "0 V< ne s1��P�/ham/ haJ� Sin�10 vsC 11A tnr: �/ 1h d/ r,l a I - �asl nl�f� all /!�c»nnfiiivt� G,nt ?"7n _ rfiar, Iv�lts� i f 0/r LIJO� C I ✓G /�/vi ! vl "�orar , �s✓ iso_ lrl/�t'Qlo/� .4 --•- -r j r c�< i . /f 12.J�l! {�O K /)!�/✓ //1/ /i7/• L 1134 i 0 7 o Y'S' (l�Cl. - dh� I T.► z�(� R�.1t) t10 10" and //S �L�/co�� im/y�.�hd Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I haue 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. s i O� ❑ Voluntary Disposal ❑ Other:- r. Ptil's Rxcejveo to Tchiperatiges Violations Related to Foodborne Illness Interventions and Risk .According I,1-i.Cooled to Factors(items 1-22) (Coat.) 4l`F/45'F %%ufelia 4 Hour;. PROTECTION FROM C14EMICALS Coaliftg Methods fa-PHFs 14 Food or Color Additives -,g P HF Hot arid Cole Holding 1-5o1.16(B) Cold PHC,.Nqoiniafned at or below 3202.12 Additu%ec" 1 �90.004i F'i 4 1 V45'F- 3-302.14 P,oe,I;on fro:1. 011ai.m. n.ted litd.dawes- I b(A) Hot F'Hj-; Maintained :,,or above 15 Poisonous or Toxic Substances 7 101.11 Identifiving Information- 011 1�q wal 140`F� 3-501.t(dA) Roasts-Held at or aboxe 130'1-. Cuntaincn.)' 7-10111 Common Name-Working Containers! 21) Time as a Public health Control 7-20 L I I Separation--Siciag,1� 3-��, 1.19 Time as a Public Health 7-202.11 Restriction-PrcIetwe and "ise* 5%.004(ft) Va6towc Rcqutreincrit 7-202.12 Conditions of Use" 7-203.11 'rrixc Containers, -Proitif,tiot, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-1204.11 Sunitizers.Cntun!- Chti-nicals, POPULAT;ONS(HSP) 7-204.1 22 Chemicals for Washina Pioducc,Criteria" 21 3-80 1.11(At unpactcuri/ett Pre-pack,:rect Ivices and 71-204.14 Driang Agents.Criteria� i - -i�vorages tvith Waimiril-,Labels" 7-205 11 Incidental Food Contact. Lubricants* -431A l(B) Use of i'wqcuriztd L-Im"s- 7(16.11 7Restrictrd Use Pccticrdes.Criteiwq* I(D) Rat, or Pet bully Cooked Animal Hind and I `-801.1 kaw Secd Sprouts Not Sorted. ' I 7-206.12 Rodent Bait Station(,' if 1-?uj 1,t I(C', Unopened Fooi!Pa2kaee Not Re-served 7-206.13 Tracking R,wders. Pest Control and Mollitorin, CONSUMER ADVISORY TIMEITEMPERikTURE CONTROLS 12 3-603.!i Consumer Adi,jsoiy Posted for Consumption of 16 Proper Cooking Temperatures for Animal luodsl'hat:i.c Raw.UKdciwoked or PI-Irs Not Otherwise Processed to hl,min-,ic r , , 3-401.1 1 A(l)(2) Eggs- Ln'F 13 Sec. J-t:ng wrl�- E111t., 1.1,ctif Pasteurized 5;,t`Substitute Fuc Rav;Shell Esies-mimediu;e Service 145'Fl.')�e, A-102 i3 P , 1 1, 3-4U1.11(A)l2) Comminuted Fish, Meals&Garne E,,,s' SPECIAL REQUIREMENTS 3-401.1 l0B(l)(2) Pork and Boct Ristat 130'F 121 riwi* 3-401.11(A)(2) R.itites, hijected Meat:,- 155'F 15 590 0rWA)-(J)) V;olaltons of Section 590.01 l9(A)4D) in sec. * catering. mobile food,ternporary and 3-401.1 i(A)(3) Poultry,Witd Game. Stuffed P111s, i-sidcritial kil-tion operations should be Stuffing Containing Pkh,lit-Ileat, debited under the appropriate sections Poultry or Ratites 165`F 15 sc,. 4: 1 above if related to fetodhorne illness 3-401A hC)(3) Whole niuscle,Intact Beef Steaks interventions and risk -.actors. Other 145"T* ', 590.0.09 violations rolalm,g to good retail 3-401.12 Raw Anim.,i Foods Cooked tit a practices Aiould he debited under//29- Microwave 165'F Special Requir-munts, 3,401 II(A)(1)(b) All Ctthert`IfFs- 145"F 15zec. 17 Reheating for Hot Holding VIOLA TIONSRFLA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(U) PHP:. 165'F 15 icc. (Herris 23-301 3-503.11(B) Microwave- 165° F 2 Minuto Standing C,ideal and non-criti,ai t wialirs;s, wh,,h do not re!ate to 11w Time` loodborne ilLfes.v in"".1 ventions and risk-Pezors lined above, can be 3 -403.11(C) Commercially Processed RTE Food- linind it,the it'if"'Iti Ing werion,% ufihz Food Code and lo5 CA4R 140-Ft 590 000. .03 11(E) Remaining L.n.0ced Portions IT Beef i itemGoodRc.aii Practices PC 596-0mi-I R,,astsl t 23. klanaciemeni and Personnel FC ? .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 004 -,i) Cooling Cooked PHFI,from 140'F if) Equiorr.curt and t liaisIs FC;-4 005 31-501 [4(,, 2P. I[Viner,Plumlin',and VVasta FC-3 006 70' F Within.1 hour,:a:-d From 70°F 27. i PhrIca: :a6ity RD-6 007 to 41'F/4.5-F Within 4 Hout-N. 28. 1 Poisonous of To=Mateaiiis FC - 7 .0-C8 3-5UIA4(B) Cooling PHFs Made From Ambient 2C. S-Pec-al Requarments 009 lenifirrature ingredients to 41'F/41-t, x", Othei Within 4 Hours* ani'di Item III al"Gdeud 1914 F,;,,d Code:.r 1115 CNIR 591)000, CITY OF SALEM ' \/ 1/ BOARD OF HEALTH /l Establishment Name: &)� 1—Ug h-(n1 G Date: ISD Page: 9D D of —/ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R-Red Item PLEASE PRINT CLEARLY Verified �9Mao cIn)c 1 F3n1�� �R l�Jgch K,n�c :�on�7`i�i/ ;>� �✓�a, IZVI1nS(�ch�m In hv�fn� Gh<vhr� �YIaI�_ Prnr�J�foo 1�iu,�ah� hl_nn 11% i n fn it a14 Sing - R, y ( a.iU-A ?inq = lIno 'r.P/�C(>/Ya I r i,as 4z t;ll A,z Dybim� Agm a/' J I t✓��' G �sd F�111 )Pato -.T1r�0fc ll2Jr ��, 1�im <,ne . -T)Iv Own /wn hwim l`ba" d iod-A_ f111)<-h JJ of b&#;6rn 0 /" <11) P S/nk Ave_dn fv 1e.., nlJ� av,�/ sah fir1 !�{1�907,u��Inih� S - Dwin9b��v had a(,AI)YY11) al ek) 617" /_T/// -qn)d Qmrl�jh/u I nLe cin ID toe 0_�4d lflyf? � L >rrl>'r me ! z 04el�f 2.< egY7)(!A .e hof if�nn 1 L6/S t,Q /rP1 . + a+ i2� �-P . �r� Sr�l-hn� nu t I Irk -lW-c_19)oe FITg hvfmZ /-IShiihl/ foo/ J I ✓Iq 1, - IltfnPo _ /q� SrFi, �uf � ��mm -�evu�. ay 4,0Phn/lc� )Inchess DA - -)K�"�e . 4 Discussion ith Person in Charge: Corrective Action Required: I ❑ No I ❑ res 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 LD Re-inspection Scheduled ❑ Emergency Suspension Jomply 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. --:2 1�_0' G���lic 11 Voluntary Disposal ❑ Other: n 1F("; PHFs Received at Te:npen•uu^i'e Violations Related to Foodborne fitness Interventions and R%sn According to Law Cool'd to Factors(Items 7.2%) (Cont.) -1"FI4.i`F I+ittrn 4 Hours. PROTECTION FROM CHEMICALS 3-50;.15 Looting Nlethtxi,, u)r PHFs 14 PHF Hot and Coid Holding 14 Food or Color Additives 3-,01.1613) Cold PI IF, Mam(amed at of li low 3-202.12 Additiaes` ( 59U 004(F) 4:'11;"F' 3-302.14 Protcclien horn Unapprovcd A.ddrtive31 ; IS Poisonous or Toxic Substances i 1 ',01J6(A) Hot PHF: Maintained!at„r above 7-101.11 identifying lnhinnation-0nginai ( i I41TF. °u Contained.', � 3-50i. .1) keastsHoldatorabo,e130'F. " 7-102 11 Common Name-Work-in',Containets* j 211 Time as a Public Health Control 17-201.11 Sco.naLon Ston/[;." 3 ^-51.19 Time os a Public liealth Control', > 7 k 1 590.004(H) v'.uianc:: (iryu,rd•ment 7-_011 1 Retldu:on"- Presence road Jsd 7-202.12 Conditions of i[w, � 7-203.11 Toric Containers-Prohibitions- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1-204.11 Sanitizers.Ctiterut--Chemicalc� POPULATIONS(HSP) 7-'04.12 ( Chemicas for t%asore reduce,Criteria- ( "1 -,01.1 PA) Unpa,lourtaed Pro-packaged juices and B<velm!es with Warnine Labels- Di( Diving Agents.Criteria' ?-so I Poo ofPaFtewiZedEees" 72{75.11 ( Iuaciental Food Conia.t.t::i:ncants` ( 13-30111(D) Raw or Patnal i v Cooked.animal Food and 7-206.11 Restricted Use Pesticides. Cutenr* ( 1 Raw S(,efl Sprouis :Not Served " 7-206:12 Rodd-in Bait Stations" 3-901.i If C) tinntiencd Fouts Package Nor Re served. " 7"'_06.13 'Ptackinla Po vders,Pest i:entrol and Monitoring,' COTiSUF11F.:Ft A®VSSORY 22 --(0; 11 Consumer Advtsory Posted Cot C'oucnmption of TIMEITEMPERATURE CONTROLS .annual Foods That src Raty. Undercooked or i6 Proper Cooking?emperatures Par PHFs Not 0111crwice Processed ro Eliminate 340111AO)t2) Fg�_t- Pathogens."c•t,xci.v;.".,, ., i 55`F 15 Se; i-302.1; Pas!euvi.ed Eggs Suhsfitule for Raw Shell hats-llmnediate Servioe i45'F15ccc- o 3=101.11(:1)(2) Co*;tninutedFish, Mears:9.fiiamr Eggs` Animals- :55'F 13 sec. :: 1 3-401.11(0)(1)(2) Pork and Heel Rost- 130`F 121 min" 1 SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injocted Akuts -- 155"F 15 590 009(A)-(D) Viulattons of Section 590.009(P.)-(D)in sec. d ',,tering, mobile feud, temporary and 3-401 11(A)(3) Poultry, Wild Game, Stuffed PH Fs, residential kitchen operations should be SIV'i ng Cotwi inm e Fish, Ivlmr (1eiii ted untic)'III, appt onrmle sections Poultry of Rurites-165=17 15 sec * above it ielared to ltxrdborne illness 3-401.11(C)(3) Whiole-nouns, Inafnt BrefSleaks I infertentions and risk: factors. Other i45'P* 540.()09 violations relating to good retail 3-401.12 Raw Animal Foods Cooked w a i practices should be debited under 1129"- Mictowave 105'F* Special Pequirententc. 3-401.11(A)(1);b) All Other PI-IFs- 145'F' 15sec. '' 17 Reheating for Hot liolding VIOLATIONS R:LATED TO GOOD RETAIL PRACTICES 3-401.11(A)&(D) PHFs 165T'15 cec. r ( (items 23.3€1) i--403.11 OB) Microwave:_'165'F 2 Minute Standing ' Cridrni and non-rriryral vmialua,.), ndrich draw relate r,,the Tiroc" : foodborne illness and risk fug tor,listed abate, can be 3-40111(C) Commercially Processed RTE Food- IOtllrr:iT:the A-Po',�org Codc,uui 105 Civil? 4WF 90.OfaS. 3-403.11(F) Retnaining Dnclteed Portions of Beef I Item I Good Retail PracticesFC 590.00!7 Knuct>" 23. Management a,,,,Personnel =C-i I .00(kl3 jay Proper Cooling of PHFs 24. Food and Food Prota,tioc FC 3 .0 3-5 `01.14',1) CooFng Cooked PI-I is from 14 0'F to "' Equipment and utensils FC-4 ! 005 i 26 Water,Plumbina and Was+e FG-5 I 006 _ 70'F Within 2 [tours and Front TPF 1 27 Physical Facility FC"-6 .007 to= R ' CITY OF SALEM \ L h BOARD OF HEALTH �1 ) ' Establishment Name:_ t'f DVl ��n i Date: o 4-) '-t Page: of `t Item Code C—Critical Item IIESCR,PT,ON OF VIOLATION/PLAN OF CORRECTION ' Date No. Reference R—Red Item Verified _ PLEASE PRINT CLEARLY --tv npwA-e a t �d Ish�m�n t S el Ct . �h1S ,i?s-a b I1 sh rrar i+ m a,y Y).b- re-o n I) wh 1 -itiw Pwi k-P o� -4ea-l+h has 1 sczed n (u y4L- t1- r;, Ye-I sued . I Dw u v of to r". a_4 t o i+k 4-2 H-k VA a 1 )cp inure Sco ft and / Sevu.6v2 c-ani-f a 12.1 Q.n- ,_In n v✓4 T)x i 1 �2 Iofrm on 1a- 15- v4 a+ IhrL � I 1 :4 I 1 Di cs ussion With Person in Charge: Corrective Action Required: I ElNo ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ P PP Y Q g Exclusion r violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension " 4somply with all mandates of the Mass/Federal Food Code. I understand that nonoampliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo Li Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: ;11 i x{f'J f HFs Rrc,zr,ed a;-tcmpuratuic3 Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors j Rents 1-22) (Cont.) :1'FI45`F 1Vit1tiu 3Y,aur.,. ' PROTECTION FROM CHEMICALS 3 Sr;I IS )Oling Methods for PHFs j 1 19 PHF Hot and Cold holding 14 Food or Color Additives ! j 3-)0!.16(l;) Cold PHF. Maintanrod at of below 3-2(12.12 Additives" 590.004'F J 3-302.ld Protection from 1 Tnappmved Additives* 3-501.)hi A) Hot Pl{Fs Maintain-0 at cr above I5 Poisonous or Toxic Substances l40 F. 7-101.11 Identifying Informal ur.,-0u;inizl . ! 3-501 N,t;i,} Ruaras Held at or ab•.;ie 130°F. ` i ContamC[s" ! 7-102 11 Common Name-Working CantainerO 20 Time ss a Public Health Control 1>r)1.19 Time a,a Public Ilealdt Cbntrnl* j 7-201.11 Separation-Stcrtge'' ( j 59(1.0040) VaianceRequirealem 7-202.11 Ritoricrion-Presence mad Use t j 7-202.11 Conditions of REQUIREMENTS FOR HIGHLY SUSCEPTIBLE Use- 7-203.11 Toxic Container.ei!; - Prohibitions^� - 7-2(9.11 Sai itizeis.Corens--Chemicals* POPULATIONS(HSP) 7?(14.12 Cheinicala for Washing Frnduce,Criteria" 71 3-801.t i rA) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria'" i � � Belei:ages -mth VVttning I.tbels 7-305.11 InCItlCmal Fond Contact.L.ibrreants^ j 3-8111 11(B) Use of Pasteurized 7=_'06.1 l Restricted Use Pesticides.Criteria" 3X01II(D) Kay.•urPmtrdlyCcxiked.AnimalFowland k.ra;Seed Sr,n>tits Not S,-nod. 7-206.12 Roden: Bait Soman° 1 3 S L 11(Cl) ( Unopened Fwd Package Not Re-served. 7-206.13 Track nig Powders.Pest Control and Monitoring CONSUMER ADVISORY TIME/TEMPERIATURE CONTROLS 22 3-603.11 CuTy;um..-r Adsisory Posted for Consumption of 16 Proper Cooking Temperatures for Arur of Foods That are Raw.Undercooked or PHFs Not Otherwise Pnoxes:;ed to Elim:nale j I 3-401.11A(l)(2) Eggs- l51`F' 1.5Sec. j Pnrhogen,. ?-?:J_.13 Pasteariied Eg_s Sube.thute for Raw Shed Eggs-luunediatc Service 14 i`Pl Ssee� � - 3-401.1 VA)(2) Comminuted Fish,Meat,&Game Eags Animals- 133'17 ,-cF 15 sec. ` SPECIAL REQUIREMENTS -401.1 UBy,I)(2) Pork and ftref Roast - t30'F !21 min' ' ( 3-401.11tAu2) lhnars,lnjectcdAfcat:•- 155`Fl.i 590.009(AJ-t D) Violations Ol'Secbop 590.009(A)-(D)in Sec. catering. mobile fond,temporary mid -101.11(-)(3) Partin Y,Wi1J Gam:, Snrffed Pflrs j residential kitchen operations should he Stuff,nc C:nlainmg Fish, Meat, debited undet the appropriate sections Poultry or RatitesIiil5:sec. i above if related to"Awrne illness ! 3.401.! liC)(3) Whole-naisvle. intact Beef Steaks inrervettione and rt:k factors. Other 145"I" I 590.009 violations relaimg to good retail 3-401.1:' Rao Aninw)Foods Cooked in a or'actices should be debited under k29- Microwave 165"F* I Special Requireructlts. 3=401 11(A)(10) All Other PHF;- 145°P 15•.ec * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ?-403.Il(X&(I',) PHFs 165'F 15 sec. ° (tte:m 23-30) 3-403.11(B) Microwave 165` F 2 !Minute Standing,, and non-rriiicat vioiations, aln(h do not tei.7r,•to tCe T7mc" foodborne Jhtese an,i ventruns ural riAkjutiory fisted above. ran be 3-403.11(C) Commercially Processed RTE Food- ! torrid ire the Julh,s we errriona of the Ford Code,,)0 105 Ch1K 140`F•" 590.0uu. 3-403.t ItE) Remaining U'nshced Portions or Recf ( Item Good Retail Practices ; FC 54D.000 j Ruasis' 23. tvlarragement ano Personnel FC - 2 .003 IR j Proper Cooling of PHFs I 24. 1and Food Protection FC-3 004 � : 25. Equipment aid Utensils FC -4 I _.005--_� 3-501.14(A) Cooling Cooked PHFs from 140"F to 26 Water Plombi-:q and`Neste EG-ii 006 7,0°F Within,2 Haas mrd From 70'l 27, P by^,feel Facili'a FC__6 i .007 to 41`F/45`l•Within 4 flours. " 28 Poisonous or Toxic Materials FC-7 .008 I 3-501.14fB) Cooling PHF:,Made Fpm Ambient29___neaai Re,uirements - _- 009 ! Temperatate ingredients to 41"F/45 F, 30. Other j Within 4 l lotu Ra .war-,..I'll,ra m,. UenoleS cancel nem:n 1110 1•',' :al 1999 Poi rcI Code or 105('Alk 5a"0011. CITY OF SALEM , / / -BOARD OF HEALTH Establishment Name: /,y' J<-r a Date: 3 -vim Page: / of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified �- PLEASE PRINT CLEARLY nn I �il �S 5�rn CY r>P-P&e t,4 Q KPa.r fC4 4V 4��u O ✓/ola f res obi-� eol c✓aio 1j_'f aoae 7Gt�5 k /meq w�5 fca ( l ih �ece I A// v io /�, �"*,nW s wv;'e w�. a c��� -fin PSS -A) I&A-We43 01 If /?w S t be, /W a /,I 1'f /KPS-( 17 AP-41 J.OSL - -7t -IC22 Ct Le 41.-V, 12a4,o 19.*- Div 6_'"-/�zt OV 4� � ` Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ as I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance C] 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 r your food permit. ❑ Voluntary Disposal ❑ Other: I� t .50I 1'1(C) PI IF%Received at Temperatures Violations Related to Foodboie: illness Interventions and P,isn According to law Cuulcd to Factors(items 1-22) {Cont.) 41'F(451TWithin,l Hollis PROTECTION FROM CHEMICAL$ ( 3-5()i.15 Cowling itilethods fie-PHFs j 14 - Food or Crier Additives j j 19PHF Hot and Cold Ho!d!ng j j 3-501.!6(11) Chid PIIFa Ma!ntamed at or below 3-202.12 Addit!N-es" 590.004(F) =1'145 F' 3-301 i4 Protection fttnu Gnappnrved Acidtnves* j 3-50!.!6(A) Hol MIE, Maintained at or abuse j 15 Poisonous or Tov1c S�.:ostances j 140'1: i 7-IO]A 1 Identifying Inforniiuon-Orl,ivai 3-501.16(A) Roasts Held at or above 130°F. C,%nbllners- j 7-102 11 Cumuwr: Name--%v rkm-,Containers' j 2(! Time as a Public Health Control j 7-?01.11 S:parati�;n-Storage" j 3:101.1'1 ,'i nig as a Public Health Comro!" j 7-202.11 RcstHc io,-P' i90.064li-I? j Variance Requirenuna t r �cseneeaudtse" j 7-201!1 C'ondi:ians of Use` 7- REOUIREMENTS FOR HIGHLY SUSCEPTIBLE '_OiToxic Col'taive[s-prohibidons�' 7-204.11 Seaitizeis-Crania-Chn:nnals` POPULATIONS(HSP) j 7 2.04.12 Chemicals for Washing llnojucc,Criteria"' j 1 21 3-SO i.1I(At Unpastew'tzcd Pic-paeka!ed Juices and BcserageswithWarningi.abclw- ! 7-204.1; Di yu:r Aye(us.C'riter:-A 3-80L I I(B) Use of Pasteurized l gcs'^ 7 205.11 hi,idetnal Food Contac'.Lubr,amtn` i ! 7?O6 11 Rer.tric:ed:Ise Fc aiades.Cnterta" j 3-801,11(D) Raw or partially Cooked Animal Food and kaw Seed Sprouts Not Served. :, 7-206.12 Roden?Blit Squor.a' j 3-801.11(C) j Unopened &r;d package Not Re-served. * j 1 "t-_'06.13 Tracking?usrders, Pest Control and MonitorinA," CONSUMER ADVISORY TIM EITEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of Amoral Fxxts,'hat ate Raw, Undercooked or ifi Proper Cooking Temperatures for PHFs Not Otherwise Processed to hhminate 3-401.1?..^,0;(2) Eggs- 155`14 15 Sec. - - Pathogens..,emir""' Egos- ln:mediate Service ;45`P 15:.ec• 3-302.13 Pnsteurried F,ygs Substitute for Raw Shell 3-401.!!(A)(2) Comtrunuted Fish,b9,_ats :C.Gate. Egps'p An mI&- 155 T 15 sec. , SPECIAL REQUIREMENTS 3-401.11(B I(11(2) pork .md Bcef Roast- ?30'F 121 min' j 3-=+01.1 t(A)f2; Ratites, injected Me:ils- 155'F 15 590 A)-(D) Violations of Section 590.(109kA)-(D) in ter. catering, mobile food, temporary and 3-401.11(,A?(3) poultry, Wild(.;nme,Stuffed MfFs. residential kitchen operations should be SlulTme Cont.Jr:ag Fish,Meat, debited under the appropriate sections Poaltrr or 15 sec. ' above if related to ibodborne illness 3-401.':!(C)(•=) ivhole-nntscle,htta_t Beef.C;:aks interventions and risk factors. Other 145°F" 590.009 violations relating to good retail 3 401.1? Rats- Animal Fo,MJ6 Cxrked in a ptactices should be debited under 1129- iviicro%ave 165,14* Special Requirements. 3-401.1 ':(.An;1)!t;) All C>iherPl-1Fs- 14:i°F t5se, 17 Reheating for Hot bolding VIOLATIONS ReLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) 1`1 Ms 165'F ?5sec. (Itents23-30) 3-403.11(B) Nlicrowace- Iff F 2 'O nn o Standing Ce'irrrnl and non-critical violanotm which do not r,lute to the Dime* foodborne illness Iwo venhons mrd risk Iiu tors liur'd abrme, can he 3-403.11([; Comm:nisLy Processed iYI F.Food- ,(uenrd rn the fnllon-Ing sectinnc nj the Food{'ode and If)'i C39K l4lr F- sro.onn. 3-403 11(E) Remainht=Uro' liced Portions(f Tie, F j Item Good Retail Practices FC 590.000 Roast'v j 1 23. Management and Personnel FC-2 .003 18 Proper Cooling of PHFs j 24 Food and Food Protection FG-3 :3n4 I 25. Equipmenl and Utensils FC-4 .005 _ 4-50i l4(A) Ce,ohng CJJSed PHF,from 140"F to ^6. Water, Plumbing and Waste FC-5 006 '0'I Within 2 ;lours and Flom 70T 27. Physical Facility FC-6 007 to-FF/45"F Within 4 Hours. ' 20. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHF:.Made From Ambient 29, Special Requirements .009 ! Temperature higredients ut 41"14!4>'F ! 30. Other Within 4 flows" ._•, ,r.de-z a. ----- ------- , ' Dcnotrs rwral itc m u�the Gd2ral 1999 F11L-d Cw:r 1 :+),CNIR 590^u0. r _ i CITY OF SALEM '' // BOARD OF HEALTH t- Establishment Name: w q �w9 h Gam'/ Date: P- 2 15-6)c/ Page: of Item Code C—Critical Item F DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY .- 4111 i �a�s//s Af'v ,� he, 10ro �P 1d /s w1Y46 Gt/s � I 1 I 1 � I ' I - i Discussion With Person in Charge: I Corrective Action Required: ( ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ 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. ( „t 1 � 11 Voluntary Disposal ❑ Other: 1 i 3-SQt.i-t;CS I PRFs Received at Temper.uuies Violations Related to Foodhorret Illness lr,terver.Nors and Risk According to t..rs 0x11ed to Factors(Items 1-2$) (Cont.) ( 41^F715`F\'iid'rin4 Huw s. " ?-501.15 C'oolinr Methods for PHFs PRorecrloN FROM CHEMICALs � 14 Food or Color Additives 19 f PHF Hot and Cold Holding 3-501.i6(B) I'a1dPEIFrMauuaineduo, be!rf% 3-2452.12 Addil:tec.` ! 590.0041F) I -4('/45` F' 3302.14 T'!vtce.i:on !;om Unanrno•:ed Ad;i�ure5" i 3-501.16(A) Hut PHFs Miiutained at or above 15 Poisonous or Toxic Suostances 140'F 1 .1 Identifying lni.,r:u.a:n,:-ori ging! ' Cunlainera" 3-501.16(A) Roasts Held s or abo e 130"F. 21) Time as a Public Health Control 7-012,1 I Coumu;n Name-1Yorkm;?Containers' j 17-'_UL I 1 Se(r codon-Shnaycs I j 3-501.19 Time as it Public 14ealth Control', 7-202 11 Resrriction-Rcaence and Use 5`i0 004tH) Veriance Requirement i 7-209,12 Conditi.,ns of 11on" 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-264.11 SLnl:izera,Critcr.::- Chcmir<ds" POPULATIONS(HSP) 7-204.1;1 Chemicals for\l%ash:ng'` 21 1 3$O 1.11(A) Unpasteurized Pre-packaged Juices and Produce,Ctita'ria' 7-204.1.4 Drvmr,:lgerts.Cn:erta^ ! BeveraS,eswuhW:uningl.thcls 3- 7-205.11 incidental Food Centao. Lubr=.cants ;0!.1 IIB) the of Pasteurized Eger= 7-206.1 I R:strr_led I;se P_stii ides.Criteria" - - 3-ROi 11(D) Raw or Partially Cooked Annual Fuad and 7-206.12 Rodent Bal[Sunir-ats^ Rain:Sccd Sprouts Not Srrt ed. 'A 7=106.!3 Tracking Powdd-s,Post C'or,;-ol ant j 3-801,1I1C) Unopened Food Package Not Re served. hkmina:-in;;^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Cnnsumet Advisory Posted for Consumption of Animal Fuo.:is That are Rate,undercooked Ur tb ! Proper Cooking Temperatures fee FHFS Not Odicrwise Processed to Eliminate Vathogens.* `""`""comae 3-401.IIA(Ir(?) Egga- 155`1 LS Sec. Eggs-hnmuJ'atc Settice 1 ''F:5t.e(, i +)2.13 Pasteunzed Eggs Subslitin� for Raw Shell 3-40'..11(:1)121 Comminuted Fish, Moats 8c Gan(: i Epps Animal:, - 155-; 15 sec. ; 3-401.11(11)(1 (2) Pock and BeefRoast 121 min* SPECIAL.REQUiREMENTS 3401.11(A)(2, Raritvs,TnjectuJ Meats- lis"F 15 590.009'A)-(D) N iolairons of Section 590.009(A)-(D) in Sec.- catering. mobile food, temporary and 3-401.11(=\)(3) Po(dtry.lVild Gnm�,S:uffe:l PHFs, j resldeutial kitchen operations should be Stuffing Conhuaing Fish.Meat, dehiied under the appropriate sections Poultry or R,tae, 165'F IS seI,. j above ii related to foodborne illness 3401.(1{C)(iS Whole-muscle,Intact Beef SteeSs I inietventions and risk factors. Other 1453F" I 590.009 violations relating to good tetail i 3401.12 Ray. Animal Food,Cooked in it ( practices should be debited under B39- V.-ic,owave I6, 'F` Special Requirements. +=40i.I 1(A)(1 ah) .all Other PI IFo-- 145'F 15 sec. ' 17 Reheating for Hot Holding VIOLATIONS RLLATED TO GOOD RETAIL PRACTICES 3-.403,11(A), D) PI-IPs I65'F 15 sec. (Items 23-30) 3-403.1 i(li) hlicurwove- 165` F 2 Minute St:mdine I Critir.v7 and non-rritirbl :iolutrbnv, which do not relate to Me Time' ,Jbndbnnte dlness iere mention and riskjacxbry listed above. con II 3-403.11(C) Commercially Pitwessed RTE Food- ,%bund io the Jbiiumin,g ve,livns q(thr I'II Code and 105 <'N, h 1.10"F-' 500.000. 3-403.I t(F,) Remaining Unsbced Portions of Rcef I Item 1 Good Retail Practices FC 540.0l 10 R„is;s" i ( 23. htanatiement and Personnel FC--2 003 E8 Proper Cooling of PHFs 24 Food and Food Protection FC-3 j .004 j , t t :, 25. Equipment and!Utensils FC-4 1 005 3-501(}1 4(;) Cooling Cooked I1-1sImia 140'F to P-6. Water Plumbingand Wa=te FC-5 j .006 I 7('FF Within 2 f-Eours artd From 70", ! 27 Physical Facaily FC-6 907 lu 41`F/45'F W ainn 4 Hours, 25. Poisonous or Toxic lvlateria's FC--7 .008_ 3-`'AGI.I-UB1 C;x9ing PHF,Made From Ambient 29. 1 Special Reouirements ---non ! 1 't'entperanue bu:redients to 4I`Pi45`F 30. Other Within 4 Hours' .•,^n:,.n,:�t.z,u. ' Denotes criu.al eem ai die federal 1990 Fond Cudz or 1(15 C%m 59(t 0I CITY OF SALEM k J I BOARDOFHEALTH t Establishment Name: TT i l�)Y1C' ��V I�PC1�a_)wi n F- Date: L4 Page: of / y ,tem Code C-Critical item ., •� DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified t PLEASE PRINT CLEARLY J -ice- ti cm /t t:0)u1010L41J 4. A'\n ik A IA)&i i i� I Ivin )an hrn� , , ,n� r Nr�rtlP�f -Tl�� �i�ilvwiv�r� Ilir�✓e v�v+� . - ani, , (:fna 0 Lor) has f_m�nS t) he_�' Sekve4 L')JA- f 11-yfS -tD /9"a l,�.etsl-,Pr( a�R22 !7c[ttr�L/�/c> �l Ci �2rrGv Cly./r�rn �,2 ��rr�. <�141,57) 7iiW oVo 1"S1WC h6 ID !�. / toVh Whm hakIlItkIl nMjJ raOdV tv -ec-� firvds . - I I .5U-%UD �nm 1I)Ii' 1 - 3 3 olr,l� hr�r /na �sPc,� (arr°^ I- I've. � 'Wa.Sh'" /Zis�cr ,h4 UA�"sils, -�Iil 1-11'�4 -,f F")-, Dhnf, h011d/fbr,l ry�,fll �o,�i fo lal--�ixi�s I i FI i I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion c p C] Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that = noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 1--I .. I -SUi J s({") PHFs Recened at Teuiperarnres i Violations Related to Foodborne Wness Interventions and Risk According-to Law Cnoled to Factors(items 1-22) (Cont) 41`F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS ?-°G1,15 Coohrg Media)& foo PFI's 19 1 PHF HM and Cold Holding 14 Food at,Color Additives I 3-501.16(11) Cold NIFi, Maintained at of below _i-202.12 Additive:" I 590 004(F) 41'!45° F` IS ( 3302.:4 Prutcetion tan Unapproved AdduiveS'� I 3-S0 1.16(A) Hot PHFs Maintained at or above Poisonous or Toxic substances 140'F. 7-101.11 ldentifcine hrforn:at+on-Oi;;ynal C I ;-5(Ll.lb(A) Roast;Held at orabu%e130'F. ' ! ,ontaineis' ( 7-102-11 Common Nino---i'r�oiki n,a l:•.m:.tiner.' I j 2U Time as a Public Health Control I 7-201.11 Separn,ion-Storaet' 3-501 19 Time as a Pubic Health Control- 7-202 11 Restriction-Pr_s�nce and Use' 1590,004(H) Variance Requirement 7-202.12 Conditions of U..a" 17-203,1 l im.ic Containers--Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I7-204.11 Jaiu:izers.Criteri..- Chemicals'. i POPULATIONS(HSP) 7=_'04.1_' Chetu:.aia for Wa&ism^ l'rc duce,Criteria'' 21 ;-XU 1.1 1 Gk) Lopasteur+zed Pte-packaged Juices and 7-204.1Beven{ces with Warning Lsbols' -t iJuving.Agents.Cater::.* 3-60 1.I1(B) Usauf Pasteurized limes^ 7-ZOS.it Incidental Food Contact Lubricants" 3-90?.E 1(D) Raw„ or ed So lv:iuo;Not Served. **Java and 17 "_06.1 I Ratr.�ted Lee Fesric::ies.Criterrr'- Row Seed Sprouts Not Served. 'x 7 206 12 Rodent B.:it Stations- ( 13-901 1](C) Unopened Fax]Package Not Re-served 71-06.13 Tracking Pawners,Pest Control nna I `Arauitutin.;^ CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 31603.11 C nsum i-Advisor} rusted for Con>umfitien of 16 ( Proper Cooking Temperatures for Animal Footc''hat aie Raw.Undercooked at PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155'Fi5Sec. i Pathogens.°'Erm.:o,�rc:no, Eggs-hiatraliate Service 14-3'Fl5se.c; 3-307.13 Pas!eurized F,ggs Substitute for Raw Shell 3-401 I1(A)(2) Commiuuteu Fish,Mcats&C111:m Eggs* Animals 1?5'F 15 sec. ., 3401.11(B)t i)(2) Pork and Beef Rost- 130-F i 21 moil SPECIAL REQUIREMENTS 3-401.11(A)i2) Routes, Injectcd Nicata -- 15q-'F 15 I 590009(A)-(D) Violations of Section 590,009(A)-(ll) in sec. ' catering, mobile food, temporary and 3-401.11(A)(3) Pouior ,gild Game. Stu ff d Pl-fFs, I residential kitchen operations should he Stuffing Comainir:g Fish,Ivicat, I debited under the appropriate sections Poultry or Ratites-165'F 15 sec. ' above if related to foodborne illness 3-301 11(C)(3) l;hole-uuucle, Intact Beef S':eaks ( interventions and risk factors. Other 45 F,"` 590.009 violations relatimr to good rotai I 3-401.12 Raw Aminal Fuods Cooked lt.a practices Should be debited under #29-- Mrctowave 105'F w Special Requirements. 3=101.1 i(A)(1)(b) Vl Othei PHFs- 145-F 15 sec. 17 Rehaating for fiat Holding I VIOLATIONS R.3LATED TO GOOD RETAIL PRACTICES 3-403.11(AAf Di YHIv 165'17 15 scc. „ ( (Reins 23-30) 3-403.1](R1 M;ciowave- 165'P 2 Mmwe Standing I Critical and nun-riitical vhrlalions, n•h,ch do nor relate to thr Time` fi+ndbome dhiecv irate)vennnns ancf risb-Jrr(tors li•+ted oixme, can he 340'1.11(C) Ccmmerci:illy Processed RTE Food- humid it the Jotlowing se,tions of the Food Code and 105 CSL}d !40114 590.000. 3-403.1 t( ) Remas:ng Unshed Portions of Beef I I Nem Good Retail Practices FC590.000 j Rusts* 11 23, Management and Personnel FC-2 003 IS Proper Coaling of PHFs 24. Food and Food Protection FC-3 004 ?-SUI 14(A) Coaling Conk-d PHFs front 14,Y17 to 25 Equipment and Utensils FC-4 ! .005 j =6 Wader,Piumbin4 and Waste FC-- 5 ! .005 7WF Within 2 Flours and From 70'1-1 ! 27 Phvsicai Facility FC-6 I, 007 � to 41`FA4'F Within 4 Hours. " ( 28. F'oisonoun or Totic Materials FC-7 I .003 3-501.14(H) Ccohng PHFs Made Fri.-a Ambien.; ( 29. Special Reauiremenls 009 Tetnperumre ln�redients :n 41`F145`1-1 30. Other j ! Within 41-lours'' *Denotee critical item in iIa federal Igoe F god Cod,,or lu5 CNIR 590 000 o a'rur�s pj(2Z-7n2—Y7�0 -?I y,,; �ch�I— 6unt�SUrac�sG�tc'L ' - c-��iy� s a_Lo� /_ , i // �/ / 3 y ,/' ` F ��� i� /moi L TYP M1 P v if-a. y 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/v/.,J Date Tvpe of Ooeration(s), Type of Inspection AJ/- leeJ od ettl t � Z_/Or mood Service El Routine Address n ��P �� Risk El Retail C14-4-inspection Level ❑ Residential Kitchen Previous Inspection Telephone Cyd �Z7 A( ❑ Mobile Date: Owner HACCP Y/N ElTemporary [IPre-operation Caterer ❑ Sus '�/p/�p/4- F�{r,I� Z/d�jJ� I ElpectIllness Person in Charge(PIC) C/✓.�/✓ Time El Bed&Breakfast El General In: ElHACCP Complaint Inspector /340 D j!y�A,,jaAtJM Out: Permit No. ElOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) 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 El2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. 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 ❑ 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 ❑ 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. C N 590.000/federal Food Code. This rep g ort, 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 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)(590.005) 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 (590009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5e01neoomFor -ra eoo Inspector's Signature:vi /fes Print: I PIC's Signature: ��/`/'` '� '' �/` ��9 /� I Print: .-7 I, 11/ /',� i/) / I Page r�of 2-Pages Violations Related to Foodborne Illness interventions and Risk Factors f/tens 1-22,) PROTECTION FROM CONTAMNNA"f ION FOOD PROTECTION MANAGEMENT ( S Cross-ccnta:mt'nacon j j i So;1.0;Y?tA) Assigmnen?of Respratsd,dity' 3-'402. I'A 1f: Faii,AvnmalFood,,Separawdfrom 590.00?(8) Demonstration of KnoWWloe"' Gu,ked and RTP Fno;ie". j 2-103.11 j Person in chane--duties !,`oriamin iron from Raw higYeidents j I ;3-30.1..1 l(^.)(2) R:w, Animal Fnotk:Jepa: ?ed tun)Each EMPLOYEE HEALTH I Odi,% 2 590,003;0) Reapunsibility ut the peison in .-hatge u, from the Emvronment i requin,reporting by ford emphr)ees and :i-iti2.1 i(:�) Na d Pt'iacctio;r` j applicants'' 1 ;-302 15 'h'a:hing Fruits and Vcge?:,bies 540 003(F) Rcypon::ibility Of A Foix)1=,:r:plo�re Or An 3--04.t i Frxtd Coata.t .;::h Equtpmen? and Applicant Tu Rcontt To i Ile Pcrson In Chat a.` ( CcntnrnMaitor trent the Cor!st,mer 500 0Ui t r) 1 Reporting by Pec;on in Charge" ! 3-"W' I l'A ff RLi;l'- "' F.�A And Rcsereic,rT 1,:,cd" 3 590.003iI3) Sxc:uvons and Resirit tion;" j 1 D:spcsdien oiAdultarrted or Crnta:r,inafed 590.001(17F) ROIDOAdl of EYClnsinns anti Reitricti,its ( f cow 3-70:,1 1 1;:scar aiiig ur Recoor i'tioning Uwafe FOOD FROM APPROVED SOURCE Food' ,y food and Water Fran:Ragularea Sot="t ' i 9 Food Centart Surfanvs 590.004(, 8) Comphnnee with F:xtd Late" 4-501.i i i PSanual`}iarewasF:mu,- Hct Water j 3-201.12 Sanitiz;1rion Food it,,a Her?nnicaliv Sowed Container* 1 3-20 t.13 ( Fluid Milk and Milk Products* I ( "-`i',IL712 A!vcha:n-.al Wareuashin Hot Water j -392 13 Shell Eggs* j Sanitization Tentperuures"" j202 14 E;--'and tulip:Pnxitiat, P,ste, ize& j ( 4-501.:14 Chemical Saniliiation-temp.,pH, j 3-20::.15 Oce:54a::e Pruitt Potable Drin6u;;r`rVater" ( cnuceninnion And haidneis. :` 11 Drinking Watrr h-ou,an Annrnved Systeut, j 4-60(1 I(r`,) Eions;k C Furxf Cunta,t �.::face,and 1 59;L(ti3l:i A) !;otticd Drinking Watei ( Uteanint(:dean' -}-602.1 Clramtr Freyue::cy of Fz}uir:nent!'oud- .590.005:81 1y':aer".leets Standard;in 310 Ctilk 23.01' j j Centaa Surface;:old Urenstlas SheiNish:nd Fish From an Approved So,:rca - :}-702.:! Frequc:Ect,of Sanrtizanon o;Llren::il;:and ? 201.14 Fish and Reacationall,i;anitht Ylot3uscatl ( ( Fotxl Counts Stlrf;IUS of Equipmeni" Shciitislt" '3..11 Methods.�f Sanitization-;lot Witter and :,-201 15 A4ultus:an She!tfis;; ro*u Ngcu l,gEad I C`hzr.;ical" Sources* j it) I .• Proper,Adequate Handwashing j 1 Game and W,Id,9dsshroems.Approved by ( , ! rRegowtcry Author ly, 1-3f)1.11 Cle:n Con:,ition-I :.ods,.n.. Ann,- j i-20215 Rhell.to.k Identification Preaeni* ( ( ==,01.17 Chanim''roeedute' j i90.004"Q Wild Dluahrooins" j 2-10;.1-' When:o�b'ash* ? 2CIJ7 Gant, Aminal,." i !i 1 430ed Hy_ienic Practices j 5 Receiving/Condition 2-401. f Etaiug, Dr inkinof Ueing Tubaccu" j 3 202.11 PHFs Rece:aed at Prope-TvnipetaturW 2-40!.12 D;achurgcs Pnmt the Eger. Nose and j 32021 N Pad:.r)te tntegNfouth*nt}' i j j 3-101.11 i Food Sale and L'aadulicr:ucd ` � 1 3-11.12 Preventing Contantinauon When Tasting' j j 6 Togs/Recorrim Sheiisiock 12 Prvirnfirri rf Contamination from Hands 12t)?.)5 Shellstva.ideutificano,t ' Sdili'h.I1G) Pre%-entingCuntamir"atienfro!n j ?103.13 Shc•ilstock luentification Vaimtined' j enpioyrec.` Tag:,lRecoros: Fish Products j i;l ( Handwash Facf6i=as Crnvenrev,tfp Located an,9 AccessiGle 3-407.11 Parasite Dcarnction° j :,_:.�.', 11 j CapauLes" 1 3-40'2. 7 Records, reauon and RetenE:ont - Nun;bercnwd 590.0040) labeling of ingred:ents' i 2h4 11 Lacaoor. and Place,::an* i Conformance with Approved Procedures I j 5-205 11 Acce, sibility. Operation and:blaintenanu /HAC^.P Plans I Saprliea n-th Scan and Nand Drying 3-502.11 SIX-Jalizcd Prneessinc kted:oth,, I Dukes 3-SU.!.11 I Reduced oxygen packaging,criteria` I b-3(11.11 ilandttushing Ctean:er, Availability -11'3.;: j Confu:-tnmce wnh Aprio%'ed 1'ro;rdu;esr b 301.1 Hand Drynl'Prm ts:oe " Denoter.rdcA n,m in the 1cdc,al 1090 Foal Cuda or !US CM(I .',90 )i0. CITY OF SALEM BOARD OF HEALTH Establishment Name: /Vil ke)"41 kWilf- Date:_� Z�ay Page: Z of 2 + I Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I V/U LAr,Ca✓i r i Il /Pr [y 4{/ /I !S'ptCCrr e'j j I i I i I I { I Discussion With Person in Charge: Corrective Action Required: Li No El Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ p p Y q 9 Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I i4t Ci PHP;Received lit'1'empetaturas Violations Related to Foodborne fitness Interventions and Risk According t;L ov Cooled to Factors(Items 1.22) (Cont.) 41=F/45`r Within 4 Hours. PROTECTION FROM CHEMICALS i i 3::01.!.5 Coolim,:bte:iwdsiorPHFs � Food or Color Additives i 19 RHP Hot and Cold Holding 19 3-50LIWFl Cold PF!Fs Maintained at or belov: 3'02.12 Additive` 590.')i)4:F) 41'14V'F• 3-302.14 Protection from Unapproved Additives* 3-501,I6iA) Hct --- - PHFs Mature�ned at or above 15 Poisonous or Toxic Substances 7-101.11 identifying identifying lnformatruu - Ouginai - - - ' 1 3-501.1F,!A1 koalas Held atorabu%e i30=P. '"- Ct,niainers" 1 7-102,11 Common Name -Working Containers" 2t) Time as a Public Health Control 7-i0 L I I Separation-Storaee' 3-?U7.1Q Time es a Public Health Contra!' 7-2(72 11 Re-trictior,-Presence and Use" i 590.004(H) 'dariancc Rryuirement 7-)03.12 Toxic tit Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE '7-203.1 1 Toxic Cies.Criteria a Chejnic k" POPULATIONS(HSP( 7-204.11 Chemicak firms i Cheroduce-` ! ` 21 3-801.11(A) Unpasteurized Pre-packiged Juices and ( ??04.12 Chcmmals for Washing Produce,Critcriat` ( 1 Beveraees with Wiaming Lilwls- 7-204.1.1 Drying Agents.CritetraT 7-205.11 Incidental Food Contact. Lubricants^ I(Br Use of Pasteurized Segs` 13-riOt.I lrii) IRaw or Patt:elly Cooked Aminal F<-aid and 7-206.11 Res,ric[ed Use Pesticides.Criteria* 7-206.12 Roder(Rail Stations" Raw Seed Surouts Not Served. 7-306.13 Tracking ( ;-861.1!(C) Unrpencdf':xxiPacka<_eNot Re-servecL " Powders.Pest Control and Monitoring* CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisor e Posted fi)r Consumption of Anonal Foods That arc Raw.Undercooked or (6 ' Proper Cooking Temperatures for PHFs Not Otherwise Proces:;ed to Flimrnare � ( 3-401.11A 1 Pathogens ( )(2) Eggs- I55"F 15 Sec. Eggs-Ltmrediute Service 145'Fl5sec^ 4-302.13 Pasteurized Legs Subndwte lot Raw Shelf 3-401.11(A)(2) Comminuted Fish, Meats&Game I Eger": Animals- 155-F 15 .sec. " SPECIAL REQUIREMENTS 3-401.1 I(B)(1)(2) Pork and Beet Roast 130'F !`'1 min� 3401.11(A)(2) R:mtes, Injected Monts- i55''F IS 590.009;A)-(D) Violations of Section 590J1g9(A)-lD) in see, catering, mobile fisod,temporary and 3-401.11(:1)(3) Poultry,Wild Game,Stuffed PHPs, rcsidenf gal kitchen operations should he Stuffing Containing Fish,Ment, debited under the appropriate sections Poultry or Ratites-165`F 15 ser. above if related to foodborne iilaess 3-401.11(()(3) Whole-muscle. intact Reef Steaks interventions and risk !actors. Other 145°F 590.009 violations relating to good retail 401.12 Raw Animal Foods Cooked in a practices should be debited trader#29-- Microwave 165"F* ( Snecial Requirements. 3-401A I(A)(1)(b; All Other PHFs-- 145''F 15 sec 17 Reheating for Hot Holding VIOLATIONS R.:LATED TO GOOD RETAIL PRACTICES 3-4J3.11(A)8t(D) PHFi, 165-F i5 sec. :, i (lie.afs 23.30) 3-403.11!B) Microwave- 165' F2 Moate Standing C,iticai arra non-critical viuianun,, Mush do not iclate to the Torre" foodborno illness inurrenri<:ns wed cis:laLWrs limed above, can be 3-403.11(C) Commercialh Processed RTF.Ford- 1 found in rhe jolt min, seeftnn+of the Ford Code a,ui 105 CNIR 14(1`F" 590.000. 1 ? .103.11(F) Remidnine Unshed Portions of Reef Item Good Retad'Pramices !. FC590.000 Roasts" - I 23. lvlanapement and Personnel FC-2 003 18 Proper Cooling of PHFs i ! 24. Food and Food Protection FC-3 .004 25. Equipment and(ilei siis FC-4 .005 isul.la(,\) Cooling Cooked PHFs from lu0`Fit) 126 Water,Plumbinoand Wasic FC-5 1 006 f 70`'F Within 2 flours raid From 70'F 1 27. FhVsicel Facile;t FC--6 .007 to 41'F/45'F Within 4 Hours. ' 2.8. Poisonous or Toxic Materials FC-7 I .008 r 3-501.14(8) G olingPHF,Mad, From lmbient29. Spemal Requirements 009 Temperature Ingredients to 41°F/45,F 30, Other Within.1 Ilours'r "•n;,, u,.,e.:.,K *Demxe.m ucar dein i,i the fsierd 1999 Food Cudv or N5 CtdR 590 600. nr+r -. .r.. ..." . ........ . ......✓, ....- .-..�- -..-.._�... ..at..-n rv,•.y., m •-.�.�a°^*vb�vrm' .�r,.%^..-..-..Ywtis.ru..... �»�.-- �...,...,- .�----•-...�.... * - 4. 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 NameD t T_voe of Onerationf� Tvoe of Insoeetion ld9NG 1kor4G k1NG w1r7lav ood Service IL,Rbutine Address Risk / 111 Retail ElRe-inspection te 140AMAO S` Level El ElResidential Kitchen Previous Inspection Telephone -wo a �,,,7 /-t ElMobile Date: OwnerHACCP Y/N ElTemporary EIPre-operation Z14IFN1- f jEiJj-' 2/4,6N6' ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP lnspectora . 10 ^ ��q�,H 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 Iter l Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Calor Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEl1 EMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating ❑ 18. ooling El 7. Conformance with Approved Procedures/HACCP Plans 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control p.1 e. eparation/Segregation/ Protection Lr^l/ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food Contact Surfaces Cleaning and Sanitizing 9. ❑ 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 L.--' 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 226Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you L,'0'27. Physical Facility (FC-6)(590007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.00e) 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� / 1, 2ao Inspector's Signature/ /ICA �/ __- ._ Print: PIC's Signature: - , �P/ .A����/� Print: --7 N ^/ --q ' /V Page ( of 9 Pages FORM 734A HOBBS&WARREN - BOSTON .n 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)(]) Raw Animal Foods Separated from 1 590.003(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 ' 13-306.14(A)(B)I Returned Food and Reservree 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 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 1 590.004(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 gB 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 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 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 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 I Tags/Records:Shellstock 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* 590.0040)' Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 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 Establishment Name: 140pff- le &e Kft* Date: t0la y Page: 2 of 3 Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE POINT CLEARLY cj C 4446- w+f,r ff c•-e ►eJV 6ejA40 t r se.PO4rlo aro I 8 C �,o y,.Asn n .>r Q,e�o e� 1W X. 0A.;ioue-e- siN/d T-0 eg I I I l IJPf�!✓C� - / S !kl`r AGL✓MdL/t f-/vN l�urJO �J���75 /iN� 1sr2ror,z c"7�oltOc�6l�t�f scvvK A"n 5',f�-N,a—rzc C,AN CP&kl6A/ AfJO AJ, t-'&-4YV Pttlit— C'�r - /1 f).rV3V' Rpt 7d UNIr7 -T- � MM" .d V9MO CIO LeAe ?�l C QW- , JdP-A901'&a 3 fPJ Q-iwx AS. r(�!U/ / NGt/LsDic�N6fs' I is X- 69.: S9 &A-9 � ,PJ e o Uf R•6 0 / ✓a r�� C�,.,b rt,� 1I Nf r1r t S S �b vtAx a— n NI-. Oo rjDr .T v niA4 /a-tjY feed 9 trn�Ps� ,T/r✓/est' SO�tt� fZodo �N M'P�oP�.,rRr� 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 o Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 7,47aM j� e ,2 Voluntary Disposal Other: e PHF.i R-eened of Tempetaturec Violations Related to Foodborne lilness Interventions and Risk Accet:?:ng to Lao,Cool;d to Factors(Items 1-22) (Cont.) 41`Ff45'F W Vhln d Hour.,. ' PROTECTION FROM CHEMICALS 5(.51.3 C'.,u;ins Methods for PHF., 19 PHF Hot and Cold Holding � ].1 I Food or Color Addi;wes I ' old 2 i , " 202.12 Alditiw� < ' i 1.16(B) C :1117,V:mtaijrcd a, or below ' lt> 3-302,14 Protection from Unaparuted A,cidunesr 54).0()4'R 41-A 5" j 3-50!.Ifii;\) (lot PHl=s Ma;ntamed at ur:tbnve 15 Poisonous or Toxic Substances ( f I401' i liti.11 Identitcane Information-Orgira1 =,3-501 16t t� I Ratets 0°f• Heid at or above 13 . Containers` ' 211 Time as a Public Health Control 7-10111 Common\atnc-W'o;gin;;Crnminers* i ? 501.19 Time as a Public Health Control 7-..02.1 1 Restriction-Prcre::cnc '' 7-20111 Separation- : nce and Usej .590.004(9) val w1we Requirement 7-202.12 Co,ndt[wns,rt Use't 7-201 It Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanuizecs,Criterut-Chemicals' POPULATIONS(HSP} - -- - e I '1 3 SUI I t(A) Untitmeurized Pte-packaged buses end 7-20-1 I,.v <:'hruuc:ds for W'ashmg Produce,('r!eria' � i Be•.ertges with Warning Iabcls^ 7-204.14 Dr0ng Aeents.Criteria" ! 3-RO1.11(R) Use of Pastcuized E; gsx 7-205.11 incidental Food Cuit,wt. Lubricant,* I ;.g0 i.i 1(13) Raw or Partially Cuokcd.4nonal Food and 7-206,11 Rrilncted Lae Pesticides,Criterut* -- - - Raw Secd Sprouts Not Served." 7=206.12 Rodent i3an Stations` ! 7_206 13 1)-acking Powders,Poet Cunirol and 3-60 t.I N(..i 'Unopened Fax1 Pacl:a;ee Not Rc-een-ed. " Monitoring^ CONSUMER ADVISORY TIMElTEPAPERAI'URE CONTROLS 22 id)t. 11 Consumer Acit;soiy Posted for Cmmimptiun of ma al Foods That ate Raw.Undercooked or t6 I Proper Cooking Temperatures for ( ,ohot Chherwtse Processed to Elitmnate PHFa 3-401.11.4(1)(2) Fgg+- 155°F 15 Mc. Yathugcns.^ ` Eggs-hrauediaic Service 14501715sec^ 3-302.1-1 P:,steurized Fg,s Sube,titute for Raw Shell 3-401.11(A)(2) CormmntAed Fish, Meat:&G:nie F,gcs�P .Animals- 155"1 3-401.1 t(B)t I 2) Po * SPECIAL REQUIRE141ENTS ){.- jl atul Beef Roast- 130'5 t' ] nun ' .590.0013(Ar(J 4iolah,tr.s `�r ' ,. ?-4ti1.1 !tA}(2) fZmtes; IujernxiMcat:- .555'17 IS ) v,SecUnn :Se0.009(A}-(D)in seC 1, catering, mobile food, temporary and 3-401.; I(Aft 3) Poultry,Wild Game, SiuRed PFIFs, residechal €citchen cperation�should be Stuffing Containing Fish,Meat, debited under die appropriate sections Poultry or Ratites 165'F 15 sec. * above if related to foodborne illness 3-401.11(0)(";) Whale-muscle, intact Bed Steaks inicrve.dtons and rite factors. Other 145'P,. 590.009 violation; telae,ing to good retail 3-401.12 Raw Animal Foods Cooked in a ptacticeS should be debited wader#29- Micioaave 165`1'' " Special kecluircmcnts. 3-401,1l(•4)t11)(b) All Othsr PHF -. 145"F 15 sec. * 1? Reheating for Hot Holding VIOLATfONS R,7LATE-0 TO GOOD RETAIL PRACTICES 3-403.11(.A,&(D) PHF, 165'17 15 sec. " ( (Items 23-30) 3-403.11(B) Microwave- Itis' P2 Minute Standing Critic al and non-critisal >m[,rtmr;, 1011chuuHot rc)ate!o!he '(tine hio.dburne i(hte.,a or„v carbons crus!ii k'o,tv:.s!iw;.d obto,e, can lx; ,403.11(C:) Commerrahy Pt'ocessed RTE Food- fotttul in rhr ju1G me sections<�f the F'rud!'oJe me/105 CM11k 140"F" ' `90.000. 3-403.11(P) Remaining Unsticed Portions of Beef I Item Geod Petard Fracfices 1 FC 590.000 Roasts" 23. h1anapement and Personnel ! FC - 2 .003 124 Food and Food Protection FC -3 .004 (:325. Cooling of PHFs I 25. Equipment and Utensils FC-4 ,005 I 3-501 14(A) ' Cooling Cooked PHF.from 14W F h, 26 Water, P:umbinq and Waste FC-S o06 70"F A thin 2 I Iuu;s and From U,F ! 27. Physical FacilM1v Ft'- 6 .001 ,o 4['Fl.SrT W!Thin 4 Hours. " 1 26. Poisonous or"toxic Mater!ala FC--7 ! .008 3-501 ld(W Cooling PHP:,Made From Ambient 29, Specia:Regwrements .009 Tenpeiatutelncredientsto41`t:Ws"F 30, Other Within 4lhnn,' �w•rm..n.,te.,x.. Denotzs cnucat item ai the teacrat 1999 Fund Code or 105 l',t4N 5W 000, CITY OF SALEM BOARD OF HEALTH Q Establishment Name: 1,16-fr_ le/7f,& lelf'j(- DateAS!lei u/ Page: 3 of J Item Code C-Critical item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item I t n PLEASE PRINT CLEARLY Verified 77 /42VSq ~ I& A0,6A- r,*, 4,C Pbr-f &/ Fv / I j I I I w �,1� 14L�f rCrOi^us 1&fl.M 'uc ,,A rO WArfl f t-4 rN/a 70A u*-S Way o-0 6(w ILODD S 1I - /�nefl i4tLSI N�r� ; r uSesV4 klv'k Il 1 I 1 I . I I . Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: F"AFs Received at Temncmtures Violations Related to Foodborne iliness Intermi tirrr,.e and Risk Ac•ardi n; :n Lr.ry Cuuled io Factors(Items 1.22) (Cont) ^-ff745'F Within 4'Homs. ' PROTECTION FROM CHEMICALS Coohn;;A':thcd,, for I:IIl-'s f ' IS' PHF trot rend Card Holding 14 I Food or Color Addlt=ves 3-501 16(R) Cold PF'F,A4,nniaiatal at or below 3-202.12 Additives` 3-302.14 Protccnou from t7 napproo-ed Adc ihve�r Poisonous or Toric Subsiam;es -iy')'�+t'4(Fi .a("i45°E" 15 1 3-501,1h(A) lint PH17s t4anitauted at or ab•�ve 1 7-101.11 Identifying InfornRtt!on-Original 1110'F. 1F Containers' Roasts Held at or abu,e 130'F. 7-10111 I Common Na*nc-W ort.ine Conut�ner�s" ( � 2O Time as a Public Health Control -201.11 Separation- - ) 3-501. t Tie as a Public Hcaith Cuenol': � storage" m ' 7?02 11 $ee;h fiction-Presence and I;sr" :190(el-illi) "Variance Requirement 7-202.12 Cwtddions or I.!x' 7-103.11 oxiccontaincrs--Pit:hthitv:ns" REQUIREMENTS FOPHIGaHL'fSUSCEPTiBLE 1 7-204.11 Sanitizers.Ciliaris -Chemicals'* POPULATIONS(HSP)I i7-204.12 Chemicals for W-asb�n! ;+ i,.,allied,O;icria ! if 3 SUI,I?(.v) Pnpi;dcu'izcdl§;-Pacl.agedJuices and � I i Revers<es midi`i+auric c 1_abcls^' ?-204.1-4 � Drym,>,!,vents.Critei::+' ' ' r i-801.;1(8) U.,e of Pasteurized hps 1-:.(15.1 t Incidental Food Contact. Lubricants- 7-206 11 kcr;trieted Use Pesticides.Criteria' 13-80:.11(1)) Rata u-Partially Co("):ed Aei.nal Fa Q and Raw seed Sprouts No;Sons d. ( 7-2(Ki 12 Rorenl Bah St. vu::" 7-206,13 'Nock mg Powders.Pest Control and i ' 801.11 i Ct Unopened Food Pa:•sage Not Re-served -- wlonitot CONSUMER ADVISORY 32 3-603 11 Causumer Ao iaaty Poston fi r Consumption of TIMElTEPAPER9TURE CONTROLS - + A ton;B 'F+-awls fliat are Raw. Undercunked or qfi I Proper Cooking Temperatures for _ PHFs I Not Other+*�i5e :7uceseed to E!uunrite Pathogens =.t,n••r :soar 3-101.1 l A(l r(2) F;t;gs- 155`F L5 Sec. Egos-]nmrediste Service 145°i°15sec' i 3i3'.13 Pnsreunied Eggs Substitute For Row,Shell 1-401.1I(A)(2) Comminuted Fish, Meats&Game Eg's .Animals- 155'F 15 scc. 3-401.11(11)(1)(2) Pork and Beef Roast- 130"F 121 min' SPGCEA:-REQUIREMENTS 3-40'..1 i(.A)(2) Ratites. In;acted Meats- 155"F 15 I 590009iA)-(D) Vioaadcns of Section 590.t)i19(Ai-(D) in sec. t j catering. mobile food, temporary and 3401 11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchci: operations �.hould be Sndfnw Contaurim*Fish,Meat, dehited under file appropriate sections Poultry or Raves-i65''F 15 see. * above if related to foodborne illness 1 3-401.11(C)(3) Whole-nmscle,hnm:x B?cf Steaksmr.rl went�uns and risk factors. Other 145'P 590.009 violalions ret.Ling to good retail 3-401.12 Raw Anunat Footis Cooked in a i practices should Ir._debited under#29 - Mitaowave 16.i"F* .Special Rvquirements. 3-401.11(AI(1)(b) All Ctther, PHFs- 14531. 15 see. : f 7 Reheating for Hot Holding VIOLATIONS RELATED-10 GOOD HFrAtL PRACTICES 3-403.I1(.A)&(D) PHFs 165'F 15 sec. (Items 23-36) 3-403.11(8) Microwave- Itis' F 2 Minute Suuicin!; C1 iGuti and non-rri!ical cioboiio!e, i ln�h do trot relate is the Time.' foodborne illness inter writions and risk fzir ran fiord above rmr be 3-403.11(C) Commercially Piocecsed RTE Foul- i hoard iii Ste f'llnn-mc vftcnrno q(the Final Code and 105 C'MR 1 140-F" 590.0t+o. 3-403.11(1'.) Remaining Unspced Portion;of Reel' I Item Gond Retail Practices FC 590.000 1 __ N1anapem;nt and f='e�sonnel FC-2 .003 Roasts" I4 1 fig 24 Food and Food Protection FC--3 .004 Proper Cooling of PHFs 25. Erman--ant and t.ensis FC - 4 A05_ t-501,14(A) Cooling Cooked PHFs from 140"F to 126. Water,Plumbing and Wads FC-5--- -006 7(Pl-Within 2 Hour;..rod From 7(1"'F 27, Physical Fac Iity FC-6 l 007 J to 41'F/457 Within 4 Hour,. "" ! 28. Poi-,ono:-.s or Toxic Matenals FC -7 .008 3-501.14(F) Cooling PHFs Made Proir,Ambient i 29. Spacial Requirements Temperattue higrediznts in 41"Ff45`F ( 31) Ulhor Within 4 Flour,* <<'IN n_,t.i m.. -Denotei,dunce]ilei in:he federal 19ny Fo+vl C,afe or 105 ChiR 590 ono, 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 Nameto Type-of Ooeration(s), Tyge of Insoection �%�p✓� /l aNG ��IN(} �/1�/(J I [Food Service ❑ 3joutine Address /yU�MAN Sr Risk E] Retail E]`Re-inspection Level ElResidential Kitchen Previous nsp ction Telephone Y" i El Mobile Date: lIZ91ea1 OwnerElTemporary ElPre-operation ZA1&N9 7f(�A/8 //tEd t HACCP Y/N I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)j�j,,,,., Time ❑ Bed&Breakfast ❑ General Complaint In: EIHACCP Inspector /&F) C) Gka£�£ ttQ,+,w 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 [12. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded E] 14. Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 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) [110. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Pasting 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. C N s re 590.000/federal Food Code. This signed below Port, when 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: S 5901ns dFo, -14d. Signature:' Ins ectors Si nat ^� ,��+`, n 6,,,//J' '• Print:^ P g ^ . W"��/J!'�6�-- I a91J11� �ti�F�`✓)llrU PIC'sSignaturRrp,{,/ (,� I Prim 1,4 �j��� / nPage�ofZ Pages aY I t 1 v , Violations Related to Foodborne Illness Interventions and Risk Factors(Items 142) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I A.,;signmicat of Rcsivinsitiflitv' I(A)(1) Raw Ajvm_,i f7o,ul6;ei,jivncd fioni 500.003(B) DeinotistintioiiofKn(iusled,,,,,* j CoAed and RTF Fntds Coi-,tanaration from Raw h7giodprits 3 302.1 I(A;(2) Raw An:nafl Food, SiTar,aed from Each EMPLO"IEE HEALTH tither` CunzamP7a.itm from.trip Frioron-iont requite ieportirug by fixid employees and i1-302,1 :(A) Food Protection am.,licarit" 3-30115 Washim, Runts and Vc,,eiables 590 003(F) ResponsibiNy 01 A Food Employee Or An 3-30.11 Fuod Cc`ili:,,m wili!_"quiPirent and Applicant To Report ToThe Person In uteniW Charge" Contamtbinio,,,from the Consumer )90.0:)3.,(;) Reporoirl-by Person in Charge' 3 306J,t(A,('B� ReWrticd Food and Reset vice 0 Foid* 3 59W;03('I)) Fxclu.ioni,and Restiictions* ? Dspositio,,i of Adutiteeated or Goritamdoated z9o.003(E) Removal of Exclusiciismid Restrictions Fix)d 3-701.11 Di,,cadinlg of ReconditioniiiF Cnsafc FOOD F IOM APPROVED SOURCE Fot,& t 1 ; Wood are Wates From Fpgarated Sources 19 iccd Contact Surfaces 590.004(A B) Compliance with Food LaWj -1-501.1 I I \1anual War.,,wtub:rig-Hot Wotoi 3-20!.12 Food in a I lei mfical ty Staled container" I1-501.1 I2 Nted!,mica' Waiewa�hing- 1fol 'Water 3-201,13 Fluid Nfilkand Milk Products* ;-20213 shc1l Egias.4 q 3-202.14 Hives wid Milk ProdtlCb,. P:1!,lZJrt/Cd' j 14-5'}1,114 Cheimcal Sanitization-tetup.,fil L ! 202.!6 ke Made From Potable IDrinking,Walcr'! cooc-entron atinud hmdties,t, 't I 1-601.1 LA) Equipment Food Contact Surfaces and 5-10i A I Drinking\N ater Irian as Approved Sv,;tcni* Uttri,fl.,Clean` 590.006(A) Bnttfrd Lniukinv,Witer' I I Cleaning Frcqwncy tit Equipment Food- Soo.006(.91) Water Wets Standard,,in 310 CMR 22 W Contact Surf&cs,ind Liten,tiW, She,fr.;h and Ffsh From an Approved Som ce 4-7, Frcqueucv ol'Sann*zatjo " n of and 3-201.14 Fish and kecreationallvCaught jklifluscan Fcayd Contact Surlaccs of F impineol* Shellfish-� 4-703.11 %Irthods of Sanjt:,ation--His Water and 3-201.1.5 Molluscan Shellli.h fri-an NSS11 LisIed "heinical"; SourcesSources^ j 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I 2-301.i; Cl_.ui0),.di6on Handsand Anini t Reqolwrrsry Authority 3-202 18 Shellsiock IticinificaLiori Present', 2-30!.12 Cleaning Procedure" 590.004(C) Wild Nlushioorn,' 2-301.14 \\11en to\Mash* 'A-20 1.17 Game Animals Good Hygienic Practices Receiving/Condition j 2-Au I.i Fatima,Drinking or U,,ing Tobacco' 3-202.11 PrIfs Tlc.cv, d at Proper T empritaturcit 240l.l2 I)1;Chj.,'hL;From the E)cs,lNtNc orld 3-202.15 Package integrity, Mouth" 3-101.1 I Food Safe and [Amdulerated 3-301,1' Prevcrniini Contamination Whcn Tasting* Tags,Records:Shell&tock i12 Prevention of Contamination from Hands 3-202.18 Shelki(vk Identification 590.004(E) P-.`.ventito,Contamination hum 3-203.12 Sheljs,Ock Ident'fication Nlainta,ne& j Emplovccs" 1ags/Recordi,:Fish Products j 33 handivart;Facili6es I Cvnvenjenh�locatisdaaro Accessible 3-402.11 Paias'rc Destruction* 5-203.11 Numberr.and Capacities"3-402.12 Recorck,crealli-al and Retention" J-204.II Location and. Placvnicril'* 590.0040) Labeling of Ingredients* Contoemance with Approved Procedures 5-205,11 Accessibility, Operation and Xl.im(Laance /HACCP Plane Suppled mth Sc,,p and Hdool Drying 3-502.11 Specialized Pruccsa in,-'Methods* covc's I -3-5102 12 Reduced uxvgen ltac�agine.criteria o "01J] I-landwoshing Cean�,er.Availability X-103 12 Conformance with Apnroved Pfooeduru�,` 6-101.12 Eland Eliyinic prm�sion r f f CITY OF SALEM G BOARD OF HEALTH Establishment Name: 14'7a /5/, C' A a Date: �- 7-0q Page: 02 of . Item Code C-Critical Item f DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date J No. Reference R-Red Item Verified PLEASE PRINT CLEF RLY 1 '- .`�4L U/oLrfi%uiVS` Cif ` 61 nn/ /Z9�ar1 ANf� �nnl 2,rnc7rL^ I � I I x I 7-J-194A `/0�/ r I 1 1 I I � j 1 j j 1 1 I I s Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑Yes j[ I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to comply Exclusion t with all mandates of the Mass/Federal Food Code. I understand that noncompliance may L) Re-inspection Scheduled ❑ Emergency Suspension i result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure v ❑ Voluntary Disposal ❑ Other S FORM 734B HOBBS @ WARREN - BOSTON 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 to1°F/45*F Within 4 Hours.* PROTECTION FROM 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 I Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 1 7-101.11 Identifying Information-Original 140°F* Containers* I 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 Samtizers,Criteria-Chemicals* 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.1 l(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7'206.11 � Restricted Use Pesticides,Criteria* � Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1](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/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Enec"e 1/1/2001 3-401.1IA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 1457 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- 1307 121 Min.* catering, mobile food, temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* 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 Rattles- 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) 3-403.1 l(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 folloli ing sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail PracticesFC 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(8) 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. Mas, .Usetts Department of Public Health Salem Board Health M 120 Washington S Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax (978)745-0343 1 Name '/ Date I j(oii of ODerationtsI. TT�yYp�e(of Inspection�`�l�?n A n,� A'/ /-c2¢pt/ ® Food Service WRoutine Address '� - I L Risk ❑ Retail ❑ Re-inspection VR /1�i�C7Y/�ua �! Level ❑ Residential Kitchen Previous In s91 7 echo. ( Telephone ❑ Mobile Date?-15Z M ❑ Temporary El OwnerHACCP YIN ' 171 caterer ElSuspect illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint S/ a In: ❑ HACCP PIVIolations nspector ?l l fly1�1 „t p/ S Out; Permit No. ElOthe ach violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.0as(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12* revention of Contamination from Hands [11. 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 - - - -- TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 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 U/8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions j L 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 N_ 23. Management and Personnel (FC-2)(590003} by a Board of Health member or its agent constitutes an - . order of the Board of Health. Failure to correct violations /,/�24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. if aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 59GlnspttlFpm6-14.tla' �' I1`7 Vot / /V7?'J"'ac.,dl Print: PIC's Signature: �. „�, aA y," Print: �^ I� !;n f ? I� !�� 1 Pagej of_ Pages T-- -- Violations Related to Foodborne fill'105S irtervetiltions and Risk Factors(111011's 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-co-amiration Assignmery 3-30:'-.'.1(A)(I i Raw ALnnia: FJils Separated from 590.003(B) Dcnionstr,tic,r,of KnoMed, Cooked an:!RTS Fox ds' Periotiindrarge duties -eritamatatatnfmm Fiaw,nyiectienrs 3-302.1 I(A'(2) i Raw Anuaal F,Wc Separated from Each EMPLOYEE HEALTH. 1 U. 2 590 00" Rcspinsibility of the poesOn"t,112179, W Cc,�tarriirmbr irrin the&nirc,mort require reporting lh} tool employee:aml i 13-302.11,A) Food Pp�tccuion' j applicants" .5-302.:5 Wahilw Fru:1;,in([LVretaoles Res ponsinilit) Of A Food Euiplocec Or 11111 3-304.1, ; Foci Coaiaact with F;jmpuiew and A,ppl scant Ti i Reparr To T it- ersoi, 'n Chanue, C-.ritaminatim from.ne 6on,,--mar 190.003(G) Repor ting bN Person in Chaip' i 3-306.1 1(,kyll) Renamed Food and Pcenice ,f Y-".x-d;` 3 590.001(1)) Exclusionsand R"Atictjonsl' F- 01sposlion of IdOeiated or Corvarmna-tcc�j' -,�l 54(Y()W(17: Rcrom a!uf Exclusions amt keetnctions i Fcod 3-701.i f -Oiscardi--Ipa Re,enditi,ning Ur,;we FOOL) FROM APPROVED SOURCE F,od 41 Food and Water From Regulated 50airco-,' 9 Food Contact Surla=s 790.00 k;A B 1xial Fcq--d Law:' 4-501.111 Manua': Warowashin,-,-I'lot NV.oci 3-201,12 c+:od in a Hermeitcalh '3ealcd Container* 3-2- 1.13 Fluid Milkar�,"VIiiie Products* 1-502.i i2 MecharicalWui-wasli:n�'-tint Waucr 3-'_02.13 Shell F'ggi* --501 fill Clietntia! sanitization-temp.,PH, 3-202.14 and Milk Prodiii,ts. PasteoAzed"' I couix-n1ral ton and hatch 3 292 If, ice Made Fioni Potable Dfinkin',Water' l(A) Eymplricnt Food Cuntact Surfaces and 5-101.11 Drink!ng'Y�tuei fioni as Approted Systera' i eaw' 590.0i)6(A) Bottled Drinki ng,Water' I A-6012 11 i-learirg Frequenc� ot'Equipmw Foo,,i- i 590oowfi) Wxei V, .cetq Slandaidq fit 310,CMR 220- _;-mU1 ens;Is* d Sheit.75)`i and Fish From an AppioverSource 4-702.11 I Frequency of Sanitiz,aion of Utensils and 3-201.14 Fish and Rect-cadoridiv Catight Molluscan i Food Contact Surfaces,of Equipa Shcfltish' -71j3'i i -xSaniuzatwn -Hot W,[cr and 1-01.15 Molluscan ShelifiJi from N"P IJ,,tod Sourcz.q* tit Proper,Adequate Handwashing Game and Wild Musnronms AooNved by 2-301 11 Clean Condifion-Ilands and Aurin'freyslafor,,4ulhorltv 3 2G2.18 ShellstoA Identfflcanon Prcs,nu" 2-301 1.1 Cicaning Prk'cAhircA Wild Muslitoorns' V)Iacii it,W,sb- 3-201.17 Gax.c Aiiitna6Good Hygienic Practices Feceiving!Conditien 24(11.11 Eating. DrinkingDrinkingor Using lobac;'O' 1-202.1 I PHr s Received at Pieper Terupwature,* i i 1-401,12 I Discharg,: Front the Fyrs Nose and 3-202 15 I Pw kage huegritv` 3-101.11 Fux)d Safe and Urrajulteiated -,0 1,12 Preventarl",Cn-aannnatirat When"ExamQ1 12 Prevention of Contamination iron Hands Tags/Benords:SlmiWock ;k'10.0011�14 I Pre%cuting Cintarilinatiolt from 3-2-,)',.13 She! stock identification - I I 1-203,12 Shellsteck ldwification VwmtaincP Emjdoycc-" li; Flandwmit Facilities Tags/Records:Fish Products Convemnntiv Located aridAccessible t-402.11 Pasite Dettcuctiou" 3-402.12 I Records.Creation and Retentioul --203 11 'N'tunbefs ind Cipactfies* 5-204.11 1 o�aticn arv"Plarorurfa* 50,C)01�!41 I Labeiing of Ingredients* iII 7 Conformance with Approved Procedu,es I j-205.11 Arcc";hility,01-enal,on nal cc 1HACCP Pians S:;cpkP �d with So6pand.Hand Drym Specialised Prritesmjig Nletha00 I i D(v'oos 3-502.12 Reduced ox vgen packaging. 76teria" 6-301 11 Haruhv,,shirii:Cli;au,ci,A,,ailalbifity 6-301.12 Hand Ppwif,at,r. 8-103.12 Conformance with Approved Pr.,)c,dures J)01,jq"3:rimai acne hi !,)QQ Pood Code oi IV,"*\IR 590,0110, f CITY OF SALEVM ::� --�_ BOARD OF HEALTH Establishment Name: Date: .9-`2-aL! �'� Page:---,3—_ of 7 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - `-. Verified PLEASE PRINT CLEARLY - _ �J f �Oe/iAin�-Nn/ 1,i1//l Qi-i n.GA-� ✓I /e +OOJn-..rn�a.�r.. !�.Y � ...n a '� rv• -f- A' n �//A G,o�D _ 1�n ,/!./" �o l/ia✓P AOS t�� y �.f��P 7/_ �ZJ.� /�ai/i�/i �/�f'Y�`�-d /J..✓l.� .,n nen-L- 7/.x...1 tfl..� 9/:nn.�uP o.0.1/ lam.> /Y. / //,'.'.'S/ /J/I!J 1 ..o !Y �i ,m/, q✓ er uL nor..✓�? ,n .V. ra ,.`.� 'V L�//.�.�,jn,P,a/)!'/oP �a Gn•.�o��.7,'J'� s--�/_Ju_o �e.a /G1iir_/ ��.(` t�o ./ .rn //_'",i✓�O ,:1_< � L/FYI,/"P.f,'/�•dP ✓_///i/�ii/iiJ7//�llliir/n din//Zc- f<�AA�/.✓,O/�(�•C-���s. �c.•jiY/�/filr_P_ I C`�-� � � /' /�/7/4ryo 7,///!-e /ap.o,0 /ll/ 1 � �S- ..^2 ,S'�rvoi/ /O✓T--�il�Z.nl�o�r,n. // ,�tJ�L1^f1 ��ES•I!'.F��� //.11t�fo J/n0 /�J/..l�J. .Zi 4/l!)ps.n i{.w3 �✓l c�.l��il elf /- '-A A �4w.//P �( .w/ `.- i /1!O /'i�/../ �. ,�,/..•,n n. //_N+ j K ,- .c �iJo �,; t. no ; 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/ solations before the next inspection, to observe all conditions as described, and to Exclusion f P ❑ Re-inspection Scheduled ❑ Emergency Suspension omply 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: 1 ) 3-50114iC ( PHFs ReceivedaiTeriper tvcs ! Violations ttelated to Foodborne afnoss interventions and Risk t Art<;r:!in b,I aw,Caticd to ! Factors(items 1.22) (Cont.) 41^Fi=IS"F li8ithin a(h,w s j PROTECTION FROM CHEMICALS Cotriiue P:loth:u)s for P}4F 14 Food of Color Additives j 19 PHF Hot and fold Holding i 3-5(jLhitO) Cold i'(-1Fa. .Ylamtainrdrn t; at clo•.c 3-201. iAdditives'( =90.(}04(P� {I')=15°mss 3-301.1+ Praection from Unappioved Additives' i t01.16L4) Hot F;iH;hlainiained at olahoy-e p g Poisonous or Toxic Substances ' 144YF j -101 I 1 Idennfirmg litfonn ltion-(anginal i j ;f11.16(A) h:o,:.;t;:Held at of above 130'F Containers" j 2,) ( Time as a Punk I;c-altn Con;,oi j � '.iol.11 Common N'atne-Working Cantainer.` i 3-5u 1.19 ! Tuue a;.a Pubu. Hr::idt Coutn:P' i-201 11 Sep.,rmwn-Siorige 7-202 11 Restriction-Presence anti Usc'F 590.0i)4(H) Vanau:e Re<nnr,r.n;nl 7-202_.12 Conditions of the' 7-203.(1 '1'oxicCoutainor,-Prohibitions" POPUEREMENTSrURRICaHLYSUSCEP?ISLE 7 201.11 Sanitia:rs,Criteria --ChetruLals^ 'OPULA'C}Uapa i u} `., 21 ;80..; i(.4) L'npatit-.ur�r.ed Pr,'i:aeksged June,and '-^_Oq 1: C!tekuir•:.tis flu Washur}r k nxluce.Criteria' j Bvve:;r;e±, sit:h Warnin,t Lahek* 1204.14 Drving Agens.Criteria' i ! 3-SC 1.;I(h) CseufPasteur:zed hrg,° 7-205.11 hu•ideubd Food Contact,Lubricants* 7-206.11 Resrnoted tine Pesticides, Criteria" 3-xt}A ;(i)) Raw u: P.uhnlfy Conned Amina! Fcxni and : Raw Seed Sprown Not Sewed. 7-206,12 Rodent Bait Statiom* i 1.11(C) Unopened F:vr�d Package DJot R:,served. 7-206.13 Tracking Powders, Pest Contrul and Mum urine' CONSUMER ADVISORY gy 26113,11 Con<utner Adiitoiy Potted for(:emaumn:ion o1 TIMEITEMPERATURE CONTROLS _ munal Food,,That are Raw.Un.fcrr•.±okrd or 1 16Proper Cooking Temperatures for j I PHFs ; ! Not Utbem tse Processed to Pli ninatc 1 Pad$igeP,,''Fro•rrva v%:"2• 3-40 L i i A(1)(2) Eggs- 155''F 15 Sec. - ! 3-302.3 I'asecurized Eggt Substituic fo:Ravi ShOl Eg;;s-Itnmedtare Service 14 S'F15sec' : 13-1(11.i I(A)(2) Comminuted Fish.Meats&Game ! Animals - 1.55'F 15 SPECIAL REQUIREMENTS 3-40 ( Po!kandRcefBoast- 130'F 121 mite` i 3-401.11(A)(2) ( Ratiter, infected Nkats- Ii3'F li I .5-40.009(A)-(0) Vinlatio:.: of Section 590.009(A)�(D) in sec. * ealerin2. mobile food, htnporary and 3-401.11(A)(3) Pouinr,, Wild Game. Stuffed PHF., residential kitchen operations should be Stuffing Containitw Fish,hfeat, debited wider the appropriate sections Poultry o,Ratites-165'F 15 sec, w bOP( if r.}ated to ioodborne ilste.,s 3-401A I(C)(3) Whole-muscie intact Beet Strain I interw9tions, and risk iactots. 00tct j 14�"F; 590.009 violations relating to,moil retail 3-10!.i 2 Raw Annual Foods.Cooked in a practice:: should be dehiled under,12c)- Microwave 165'F r" Spectral Requirements. 3-401.1 i(.A)(1)lb) ( AI I Othet PHFs - 145 F 15 sec. " 17 j ( Reheating for Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 1 3-403.11(A)&(D) PRFs 165-F 15 sec, (}teats 23-30) 1-403.11(Fs) Micunvave- 165`F 2 Minute Standing C'ritica!-:ne non-critiral vio!wkmr , actuch Co nor relate ter the i 'I'ikue° ioudhorue ilhtesa tater rentiox.r aro/rat,fuc"its lvfed ano:e can 5e 3-40.3.1 1(C) Commercially Piucessed RTE Foaad- bund rat the/ol7omLrg ,se(tmas ol'the Fond Curie+awd 105 C41R I 110'F' I 990.000. 3-403 1!(E) Reinalmng, Uushced Portions of Beef I item Good Retail Prartices FC ! 590.000 Roasl s,: 23. Management and Personnel FC-2 .003 In Proper Cooling of PHFs I 24. FooJ and Fuod Profeotion FC - 3 004 . 25 1 Frnnpment and Utensils PC-4 .005 -501 14(A) Cool mg,Cooked PHFs from 140"17 to ! „_ Warer.Plumbinq and Waste FC-5 .006 70'F Within 2 Hunts and From 702E 27 P"ys cal racimy FC --c 007 i-501.111.6) (Pu 1p ro`14176 Made romA tient F I 20 rechl Rlw Toric Vatenals 1 FC- % .00� . I )--y_._-�' i .009 ,: �� � n•tl F� uiromPns 1 S Within 4 Hours" "Drroa.rilic,l nam m die lederA 1,)99 Food Curie m 105 CMR>9u.0Un, CITY OF SALEM BOARD OF HEALTH Establishment Name: /err 9 Date: Page: 3 of-3 Item Code C-Critical Item f DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY . I 1 B�cs�tiprr�nf IVO 74 ea/c� �/�v�.�iU/ vq �Ge�' e /S�rc{� ` l�PP�r /PP S7n P P i v /v!P_ Zlt ,Ir PS 42//_47- 11 dee ''2 71 Zt/ II No = 1 �Iv.��'�`► /3 —ten /A' z-esG�eieru�m� 7>��z /�/P� � , zslzrBG/s��1et�` I aM� oar/Pede.� //JP PP u�.r�s Ski� �W kurlirvr K!9 uer r2 r•, 6CO i>7 e is I � s I 1 v good �as I S r�izi vq _ Le c% ,Pe to "Pla f ?r-day j 'gzAIA 19r�&'f ,ti P lex'7e' 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all 11 Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion lations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension ` mply with all mandates of the Mass/Federal Food Code. I understand that Fnoncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: ,L 3: .4101 ;01.14((') "11 Fs Re:.eirrd at Temperatures Violations Related to Foodborne Illness Interventions and Risk Aeccirding to t_aw Ccrled to Factors(items 1-22) (Cont.) 4I P%45'F Within 4 Hums. ' PROTECTION FROM CHEMICALS 3- 501.15 Choline Methods ibr PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.1: Ad:hoses'.. 3-561.16(B) Cold Pi-IFs :14atm%hied .d or bc!uw• X90.004T? 41'/45"i� ,-302.1 Prwrction from Unapproved additive,° Poisonous or Toxic Substances j `7(i 1. WA) Hot Pi-[Fs M1I:untain:d at or zUovc 15 W),i; 7-101.11 identibuielnforni,lion-Or,inal - = ;01.16(.>) Ros,ts 6IaL1 xt o; ab,::e !301P. ' Containers 7-102.11 l unanon Name-t4'utking Cnnlainers` Tire as a Public HeaRti Control z ',Ul 19 !iurr v;a Public I-i:alth Ckeatot" j 7:'.(11.11 Separation-Stora>'e" I 1590.00=l II) V;man : Re:uIienicni 7-20111 Restriction-Presence and Use* � t- 7204.1 Z Conditions of Use' � 7-20311 'toxic Containers-Prohibitions* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Sauitizeis.Criteria -Chemicals* I - 2 21 1 3-8o i.11(A) Unpaqem-ved Pre-packaged Junes and ! 12 Chernicuk fol Washing Produce. Cuternu^ 7-204 11 Di vino A„ems.Crit.ria* Bet ernizes trim wanting Labels': _ ,+,`_ 3-801.'I(B) Use of Yastvur€zecl Ee,s�` 5 11 hicidental Food Contact,Lubricant; 206 i1 Res1-rctrd Use Pesticides,CriteriX' 3-Vol 11(Er) Raw ca Partially Spns N(v.Cooked Antm:tl i=rncl and � Ra�r iced Sprouts No: 5cvrd. " 7-2016 12 Rodeni Bait Station, ( 3-8o1.11(C) 1 i)nop,ued Food PackaLe Not Rc-screed v, 2!)6.13 Tracking Powders, Pest Control at),.] P4cnitotuzg'" CONSUMER ADV!SORY TIMEIfEMpERATURE CONTROLS 22 3-603,11 Consumer 1cKi5ory Pusted tot I oncuntption of {� Proper Cooking Temperatures for I Animal Fooem id That arc Raw,Eliminate Undercooked or PHFs .."Jit OtherA tae Processed to Eliminate 3-401.1 IA(1IA(I)Q) F.eg5-F Patin-2eas." s- 15IS Sec {, • F.egs-Immediate Service 145'Fl5sec' ! )ir, 13 Risteunzud Fg^s Substitute hot Raw Shell 3-461 11(A)(2) Comminuted Fish. Mcats&Came ! F"'sa ; Animals- 155'1` 15 sec. " 3-461.11(@)(1)(2) Pork and Beef Roast- 130'F 121 num` SPECIAL REQUIREMENTS 3-461.1 i(1)(2 i Ratites, ht)ccted Meat:- I55'P I ,96.009(A) (D) Viulaiur.c of Section 590.009 A-i,D) to sec. m ialering. mobilc food; !rrnporarN'and 3-40 1.11(A)13) Poultry, Mild Game. Stuffed PHl^:, residential kitchen operations should be Stuffing Containing Fish,Meat. deh;,cd under the appropriate sections Pouhry or Ratites-11 15 sec. " abs,c if related io fog;borne illness 3-401A I(C)(3) Whole-muscle. intact Brat Steaks I inter;entlo)ns and risk factors (fiber I Is"F590.009 violations relating to good retail 3-401,12 Raw Anima! Ftxids Cocked in a practices shouid be debited under 1429 - Microi+ave 165"F^ Sp rtai Rcquircmenis. 3-401.11(A)(1)(b) ( All Other PHFs - 145°F 15 sec. 17 I ( Reheating for Hot Holding I VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3--403.11(A)&(D) PIIrs 165'P 15 sec. # I (Items 23-30) 3-403.11(B) Microwave- 165'P 2 Minute Standing I Criow!and non-critooi 1 ioiatious, which du not reline io the '('ince* firodhorne il(nees brte,veua:ores✓n,+risk foclut-3 bsted above, can he 13-403.11(C) Commercially Puxessed RTE Food- found in the f,limrin_g fu(ti<ma cj;he boon Codi and 105(;D-IR ( 140"F". J of).p0. 1-403 !I(E) Remaining Unshced Portions of Beef I item Good Retail Practices FC 590.000 Roasts* i23. __ PAanayemont and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Focht and Food Prolectton FC -3 004 I 25. Equipment and;Jtersi's FC-4 .005 3->01 14(A) Cuuling Cooled PF1Ps from No'F to26. e'Vater.?Imnbi:)q and`fv'2w^te FC-5 .006 70'F Within 2 flours and Fmnt 70'F 127. Physical Facilay Fc--6 .007 to 4l'F/45'F Within 4 Hours. ' 28. _Poisonous or Toxic Materialz FC-7 .008 3-;01.14(@) Cooling PHFs Made Fioni .Ambient 29. Snecia;Reauiremeuts 009 --- Temperature Iedientsto41`F/4.�F 1: 3U Other ngrI Within 4 Hours' *D moles:ntical nem in tha fedora]l999 F(.o:l(bdc of 105 CAiR>920U;? CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY - Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of u Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14tQ Phis Received ai Temperatures Violations Related to Foodborne Illness Interventions and Risk According to L,w Cooled m Factors(items 1.22) (Cont.) 41 F/45`F Within 4 Hours. r PROTECTION FROM CHEMICALS IS Cooling Methods for 11I-IF'E 14 Food or Color Additives 19 PHF Hot and Cold Holding ' 3.501.fo(6) Cold NIP,,Maintaincul til or helow 12 3-202. Additives' 590.004(F) 41145° F, 3;402.t4 Protection from Uuapprrned Additives* I 3-S01.INA) Hot PHFs Maintained;u or above lc Poisonous or Toxic Substances ( 140'F 7-101.11klentitymglnLirmation-Original -501.16(:A) Roasts Held at or above 130T. Containers' ?Q Time as a Public Health Control 7-102.11 Cmmnon Naruc-Working Containers* ( ( 3-50!.19 Time as a Pubfic Health Com,ol* 7-201.11 Separa[ion-Storage" 7-202.11 Restriction-Presence and Use" 590.(}U4f H) \hnnmce Requirement 7-202.12 Conditions of Use' ' POPULATIONS � Toxic Container<-Prohibitions* � REOULATI NS(HSP) FOR HIGHLY SUSCEPTIBLE 7-204.11 I Sunitizens,Criteria-Chenr.cals^ i-101.1'2 Chemicals for W'aehin�Produce,Criteria ( 21 3-80; 14A)(A) L'npasteunzed Pre-packaged Juices and 7-"204.}4 Devitt Beverage,with Warning Libels* g Agents.Criteria* _z_SO1,11(B) Use of Pasteutized Eggs* 7 205.11 ( Incidental Food Contact. Lubricants* 3-801.11(D) Raw or Partially C.kked Amm,d Foodand 7-206.11 ( Restricted Use Pestiudes. Cnleria* ' Raw Sced Sptonts Not Scrved. x 7-20(1.12 Rodent Bait Stauone* 7 206 13 Franking Powders,Pest Control and 3-801.11 i C) Unopened Ptxxi Package Not Re-sen pd. Monitoring" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of Animal ForAs I-hat are Raw,lindeicooked of 16 Proper Cooking Temperatures for Not Odterwise Processed to Eiiminale PHFs 1F2cre, :a0d, 4-401.11A(L)(2) Eggs- 1SSOF 15 Sec ,,i. I P:!!Icgr.ns. : ; 3-302.13 Pasteurized 13kgs Substitute for Raw Shell Eggs-Immediate Service 145'F15seo =' 3-401.11(A)(2) Comminuted Fish,Meats&Game j cg s", Animals- 153 T I S sec. 'x SPECIAL REQUIREMENTS i-40LiitB)(1)(2) Pork and Beef Roast-i30'F 121 nriu* 3-401.1 t(A)(2) Ratucs,Injected Meats - 155'F 15 590.009(A)-(D) Violations of'Section 590.009(A)-(D)in sec_ I catering. mobile tial, temporary and 3-401.i 1(A)(3) Poultry, Wild Game, Stuffed PHFs re,nfential kitchen operations should be Stut'liny,Cnntainnng Fish, Meat, ! debited under the appropriate sections Poultry or Ratites-1650F 15 sec. " above if related to loodborne iliness 3-401A 1tC)(3) Whole-nwscle, Intact BeefSteaks interventions and risk factors. Other 145'F * 390,009 violations rclatinr to good retail 3-401.12 Raw An:iruil Fouls Cooked in a ( iNatllcr's should be debited under 1129 - M,ciowave 165'F* Special Requi:ements. 3-401.11(.4)(1)(6) All Other PHFs- 145'F 15 we 17 Reheating for Hot Holding ! VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs, 165'F 15 sec.': I (I tents 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-crilieal violonnors, winch do net inlarc to!lie Time'' lundbonw illness intetventeor.,s and riskfuetoes tilted above, can be 3-403.11(C:) Commercially Processed RTE Food- found in the,+n/1te,ing�.ecleons r),rthr Foud Gude and 105 CAIR 140 F` 5x10.000. 3-403.11(5) Reomming L'nsliced Portions of Reef f ltern Good Retail Practices FC 590.000 Ro.:st,* I 23. 14annoement and Personnel FC -2 003 24 Food and Food Protection FC- 3 004 18 Proper Cooling of PHFs ! 25. Evuipn gent and Utensils FG-4 ! 005 3-501.W(Ai Calhne Cooked PHFs from 140'-F to , 28_ Water,Plum6inq and Waste FC-S 006 70`F Within 2 I fours and From 70'F 127. Physical Facility FC-n j .007 to 41`F/45"F Within 4 Hours. "' ! 28. Poisonous o; I oxic rtilaterials FG-? .008 3-501.14(6) Cooling PI-IFs Made Front Ambient ! 29 Special Reeti rements 009 ` Temperature Ingredients to 41'r/45 F 30, other Within 4 Hours* a„- Dowies critical item m iht(.doral 1999 Food('ode or 105 CNIR 590 000 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of tk. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified ; PLEASE PRINT CLEARLY J f I 1. Discussion With Person in Charge: Corrective Action Required: I El I ❑ les i I ' 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 o Embargo ❑ Emergency Closure your food permit. ❑ °,Voluntary Disposal ❑ Other: i-4-GLA(IC) ( PHFs Receives:at'renyleratures Violations Related to Foodborne if'.oe_<s Intel veminris and Risk According to Iw Cooled to Factors(items 1.22) (Cort.) 41'Fl45"r Within 4 H:nug. PROTECTION FROM CHEMICALS 3-501 15 j Cooling b'Iethuds for PHFe 1-0 I Food or Calor Additives 19 PHF Hot and Cold Holding 3-;-)(II IAi B) Cold PI-iFg Mico tained at or b,,low 3-2C^.12 Addidt-e.` I j 59U u04(F) t 1''/45°F' 3-302.14 P;utect:rat fr.,::: ;8uappnrved :1r:d;nves` 3-501.161(A) Hut PHFs Maintained at or above 115 Poisonous or Tox:c Substances I - 140'F 7-I01.17 ictrnidyinglntor??taLrr.:-- Chsrurai j I z.sill INA) iRuasrsHeld •ator,rbove130°F ' Container.;' 12 Time as a Public Health Control 7 102.1 I Cun?mcnf.'otkin);C.anainer'* i 3.50E i9 Time as a Public Health Control" 7-20L 11 7c P2raeori 1 90.004 H) Lanance Requirement 7-20211 Resf:fiction --Pte;enrc•-:gid Use" 7-202.12 C'onddions ut,-S- 7?(13 L,x: I REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 : : Comaincrs i'roha:ai°t:s` I POPULATIONS(HSP) ( ',-204.11 Sanit:?ers,Criteria-Cr:_micais' 7-204.12 `: Choc.ecalsforl'v' shmgPinduce,Criteria" I ( 21 3-Rt)I 11(A) linpasteunzedPre-packaged.kriczsand 7 204.14 j Dtvmg Acents.Cnte+ia'' j Beveralves anti:Waimina labels" ; i 205.11 3-Xcl II(B) Useof P:atetuizcd Ec2s' ; _ ri:orts' ( 3-501.t I(D) Raw or Partially Cooked Anmtal porno and 7-20611 kesU ua<•d L:;r Fedi x?es Cr:erlo" j 7.206 12 Rxient Exit Stations., I I Rut Sced Sprouts Not Served. : 7-206.13 Trackmg Yuwdera,PestControl and 3-ri0 i.;1(C) Unopened Food Package Nut Re-sererd. . Monitoring' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for ."mint,:: F.yids'I-h,:t arc Raw, Undercooked of PHFs Not O'hcrwise Processed l o clitmnate 3-401.11A(7)(2) figs,- Ii�°F :S Se:.. Yathorens.*ene,o•" "0" Fells-1»:mediate Service 14a`i'15sc-* 3-302.13 Po teurized Eggs Substitute for Kaw Shell 3-101.11 iA)l21 Comnnmtted Fish,7t4cat::@ Game Eggs Animalq - 1551; 15 sec. * 3-401.11(Bp,i It 2) Petit and Beef Retest 13WF 121 min* I SPECIAL REQUIREMENTS 9-401.1 1(Au2) Rattles. Injected Meats- 155"F 15 590.009(:1)-(D) Violations of Section 590.009(A)-(D) in sec * catering, mobile food, temporar),and 3-401.1;(A)(') R7::itry1 Wird O;ame, Stuffed P}!Fs, residential kitchen operations should be 5+::"ting Cvntamine, Fish Meat, debited cutter the appropriate sections Fouhry or tstitea-]O:5`F 5 set. t above I related to foodhorne illness 3-401.1!(C)(3) 11 nole-nu?scle- Intact]Reef Steaks interventions and risk factors. Other 145`F r 590.{)09 violations relating to good retail 3-401.12 Raw.An-:oal Foocll Ccx, ed in a practices should be debited under k29- Microwave 1t15'F* Special Requirements, 3-401.1 1(A)(I als) All Other PHFs- 1.15.;h !5 gee, n 17 Reheating:or flat Holding ! VIOLATIONS R�LATEO TO GOOD RETAIL PRACTICES 3-403.i1(A)d:(D) PHFs 155`F !5,ec. (IteF71523-30) 3-403.11(13) Ahicroway.- 155°F-L Minute Standing j Critical and non-rrinral violations. ahrch do not relate to the Time, foodhorne illness nrtc,'venhory and ri.s•k fiwtors listed above. (an he i 3-403.1 If C) Com llerculi v Proce;sed R'I L. Food- I ,iutind in the follo> ins.sections(If the Food Code and 105(+b1k 140'F:' 500.000. -------------------- 3-403.1 I(r:) 3euu.:iz:n;;Ungheed Purtionr of Reef item Good Retail Practices FC 590.000 Roasts+ 123. Management and Personnel FC-2 .003 Proper g I ( 24 Food and Food Protection FC-3 .004 j IS tin Cooling of PHFs 25. Equipment and Utensils FC-4 005 - 3-5t)?.!.,(,1) Cooling C',>-ked PHFs I'rnm 140`P to 26. Water, Plumolnq and Waste FC-5 .006 70'P Within 2 !uurs and From 70'6 27. Physical Facility TC-6 007 to 41"F/45`F Within 4 Hours. * 1 28 Poisonous or Toxic Materials FC-7 .008 3-..^.0 1.143133 Cuniing Pt lP��4ade From Ambient j 29. ;pedal Reawrements W5 TempeiaturehtgrediertgLr47`P/45`P 30. Other j Within 4 1 lours : •ou.„r.,-t,..:m. Uclwa"<om(al ismm the L•,4a si 099 Rs,d Code.010K Clll2590000. i 6��awur CITY OF SALEM, MASSACHUSETTS ♦ �)` fij BOARD OF HEALTH is 120 WASHINGTON STREET, 4TH FLOOR �+ t < 9 SALEM, MA 01970 TEL 978-741-1800 c FAx 978-745-0343 STANLEY 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 : Owner ' s Name : Zheng Feng Zheng Name of Establishment : Hong Kong King Restaurant Address of Establishment : 28 Norman Street Type of Establishment : FOOD SERVICE Application Date : 01/14/2003 Restrictions: Permit for Food Establishment 258-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET'. 41'H FI-OOR a 151 f� SILIM MA 01970 TEL 978-741- 1900 �F��MINS� F=.t 978-745-0313 STANLEY USOVICZ JR JOIHNE SCOT"r MPH RS CHO MAYOR HEALTH Al3E.11 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT � NAME OF ESTABLISHMENT Hoi�I 6a I<I iLc TEL# C0_ —W-A—�/pO7 f L7 ADDRESS OF ESTABLISHMENT Zn /V�JI�MGI(fI/I S!vl P l�I I� / + ✓/l / n MAILING ADDRESS (1f different) / OWNER'S NAME L�1'�[(/�yIC7� / f IIU/�U �7�/1fS/� ADDRESS 91 Cd TXL`P/K ZaCA4- CITY R'0<4---0 VL STATE MA ZIP_ -OZLV CERTIFIED FOOD MANAGER'S NAME(S) Z.H fAl r—E�l/(S 2 Ff R CERTIFICATE#(S) Z (required in an establishment where potentially//hazardous/food is prepared.) EMERGENCY RESPONSE PERSON 2H t A Ho 21 HOME TEL#k)- HOURS OF OPERATION: Mon. —� Tue. � Wed. � Thu ✓Fri. Sat. Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000s ft =$ 50 1000-10,000sq.ft. =$1�0 03 more than 10,000sq.ft =$250 RESTAURANT YES NO dp� less than 25 seats 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS { MAKE ICE CREAM, YOGURT, SOFT SERVE YES NU $5 f) TOBACCO VENDOR YES NO $50 o ALL NON-PROFIT(such as church kitchens) YES✓ NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 52C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. SignatureDate Z Social Security or Fe I entifica)i0 ----Number 1L - --�Zff� --------- --- - ---- --- - ----------------------- - -------------_-- - Revised 11/25/02 F OP2.adm ckA&Date_ _ &' t i �µ'• Ott t r•� • � �tgt'���1.. y 1'`+'}<, OD ',o 4���'.:�$'..'•,�;T', Q Q ; ��� 1y. 4Q tr(fR,rpps � �.f. ��g,��s4 '. y._!�c r.: '''� s •tRyklY e7� i�i' ` dip � ;C�' fit ik Qa'.�_: 'ry't,: ', =.t •i-f ° ' � Y' a . }y �' C fps` • ' 4`.l �,' CON =�ffo Sol R' ]'�,`f✓,F, c'� { F Y1! r1.E wit '. F' tat �R'., ... t r }f •�r ;.� .fes^• -_- - ........-..«. . . �.-.-. +.-� . ...-.-Y.,....-_....... .... ..�..-.-.-...,,,,..r.v3..,.r.�..+rR^'-..r-....-....:.-,.,.-..wv.r-q.E-.Mev.--..+a.�.... ...-..w�n.....�..rv.s+,,.,..w ,.--. .......--„_'.n9 THI 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 Date v Type of Oneratiori Type of Inspection - �C/ �""�,/ 7 �"' /� I 7y`/ 61 X Food Service W Routine Address Risk ElRetail ElRe-inspection Y7 ' 7G S-T Level A ❑ Residential Kitchen Previous Inspection (Telephone / 2? � to , c'2�� /!/i ❑ Mobile Date: Owner /,/�/ dd- /" „ �5 / [ HACCP Y/N ❑ Temporary ❑ Pre-operation l/ L/ El Caterer El Suspect Illness Person In Charge(PIC j ,✓�� Time ElBed&Breakfast ElGeneral Complaint In: ❑ HACCP InspectorOut: Permit No. ElOther (-) L�IE 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 El2. 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 p*3.. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection 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 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: PrimS „^?(n Yk )�/Ai (' PIC's Signature: -_ / - r 1- M' Print: V I"K / / y ( Page/ of Z Pages //ILYN� l/LP FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION4► 8 Cross-contamination • - FOOD PROTECTION MANAGEMENT 3-302.11(A)(]) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 1 590.003(B) Demonstration of Knowledge* Contamination from Raw Inqredients 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-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* 1 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* -- 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 11 Good Hygienic Practices 3-201.17 Game Ammals* 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* 3-301.12 Preventing Contamination When Tasting* JJII 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 61 Tags/Records:Shellstock 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 BOARD OF HEALTH r'CY/� ��✓! �/ ��� Date: �/ �3_ Page: of Establishment Name: ,! Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY z - �4 I I I I �X-��,.�, r» ��� � ✓ I I -7/F hr s - 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 El Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that nAncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure yolar food permit. ❑ Voluntary Disposal ❑ Other: f 3-501 14W,) Pius Received st Tin;pewtutes ' e. Violations Related to Foodborne Illness Interventions and Risk A.corain.,to I.-ow C(x,i.^(f u, \� 1 Factors(items 1.22) (Cant) a1':"a;-i4 Within I Hosts ^ PROTECTION FROM CHEMICALS I 501 t5 Ci oling Vteth(xls for PFiP: j 14 Food or Color Additives ! 19 PHF Hot and Cold Holding 3-501 1618) Cold P( s_N'aimainad at or below 3-2(12.12 Addititer* 59(IMIA(F) 41"745"F' '1-302,14 Protection from Unapproticd Additnes* j I5 Poisonous or Toxic Substances 3-5(11.164A) Hot PHFs Niamt.,uzd at ar ab;ive 7-101.11 hienttP,vig Information-- Co,uamen'" ( ; 50 I.INA) Roasts H?Id at of above 130'F ` 20 Time as a Public Hearth Control j 7-^0'.i I Cotrnnon Name--Rbrkin;;C;vtCtiners` 3-51i 1.19 1'nn..•as a Public Health Control" 7-_01.11 Separation-clolasiO j j 7-202.11 Restriction-Presence and Use'" 590.00,401) 1'ar lar.--z Reywtenxxd 7-202.12 Gaiditions4 Us.-,r 7 203 11 TexicContainers-Prohibitirl REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 204.11 Sanitizers.Criteria-Chemicals" POPULATIONS(HSP) 7-204 Iv Cheuucal;for Washm) Pnxlooe.Criteria' 2t ( 3-801.11(AI Unpasteurized Pre-packaged Juices and _ I Be%erages with R'eniin, Labels: 7<U•1.14 Dgdn_Agents,Cracrio` ( 3-901,11(13) Use of Pawtui7ed L-'._rs' 7-205,1 l Incidental Fond Contact,Lubricants* "' :_901.11;D1 Ra::or Pmttaily Cooked Annual Food and 7-206.11 Restricted Use Pesticides,Criteria Raw Seed Snrznits Not Served. ' 7-106.12 Rodent Batt Stations'� � 7-206.13 Tracking I'mvdcrs,Pest Control and I 3-801 11(C) Unopened Food Package Not Rc-served. " hlonitotinli ( CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted Co, Consumption of ;fi Prower Cooking Temperatures far j Animal Food,That are Raw, Undewc oked or PHFs Not Otherwise Processed to Eliminate `r, , .. YaOwgens. vin 3-401AIA(1)(2) Eggs- 155^F 15 Sec. - (,2 ; !• Eggs-immzdtate Service 145"FI$;zck ' -' 1_ Pas irrized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Nlzats&Game Eggs` Animals- 155"F 15 sec. * ! SPECIAL REQUIREMENTS i 3-=40i.i1(,Bl(iji2) Pnrk;mdRezfRoast- 130'F 121 min'^ j ,g0009(A)-(th 1 3-401.11(A)(2) Ratites,Lijecied bleats- 155'F I; Vso(ation.of Sectiatt :90.CJ0u- . Ai-(D)in ( sec. * catering, mobile Food. temporary and 3-401.11(A)(3) Poultry Wild("ame. Stuffed PHF, residential kitchen operation•;should be Stuffinpt Containing Fish,Meat, debited order the appropriate&edions Poullry or Raines-I65`F 15 sec. * above if related to foodborne illness 3-401 1 I(C)(3) Whole-muscle, Intact 0eef Steaks inlerventinns an(I ri,k;actors. Other 115, 590.009 violations relatinp to good retail 3-401.12 Raw Animal Foods Cooked in it practices should be debited folder#29- vfiuuwave 165`F* Special itequtreinents, 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec * j 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 i ItA)&(D) PHFs 165'F 15 sec. j (Items 23-30) 3-103.1 I(B) Microwave- 1650 P 2 Minute Standing I Critical and non-craicul ciolutiom which do not relate to the Tunes` i i7lns ierrerstionsand risk -s listed uhotw, err be 3-103 11(C) Commercially Pr(:essed RTE Food- ipr.md in the foll'ojing se(tiore+(+f li,e 14rod Cod(and 105 CAdR 1.10-17` 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef I Item Good Retail Practices FC 590.000 Roasts* 23,_ ;_Klanaeemeniand Peisonnel FC-2 .003 ' 18 I Proper Cooling of PHFs j 2°, Food and Food Piatection FC-3 004 1.25 Fgapment and Utensils FC-4 .U05 3-501.14(A) Cooling(' oked PHFs from !40`17 a. f 2;.--""" "'Jv'eter. Plumbinq and Waste FC -° 009 7WF Within_'Hours and From 70-F 27 1 Physical Facility IFC-i .007 rn 41"F/45'17 Within 4 Hour " I j 28 1 Poisonous or Toxic Pnateriais FC- 7 __.008 __� 3-501 14(B i Cooling PHFsblade Hour At 11bient j 20. Special Regwrements 009 'Temperature Ing7odients to 41'F/;5'F i 30. Other Within 4 Flours` --'- `Denote,ariliod item in the tedeul 1999 Fwd Code of 105 C6dR 590.0ol). NO. CITATION NO 0,CITY OF SALEM n 116 9 71;l 'VIOLATION NOTICE (LAST,FIRST, NITIAIy,�yZ,*j fwd&Ap /14 leiid�p-per N�'.v4 �f do // � rQ / ,/- / STREETADDRE95 CITV/90WN STATE P ��/Ib2 cSf So%n. �r� & LICENSE NO. LIC EXP DATE I DATE IRTH OWNER'S NAME(LAST,FIRST,INITIAL) �= G STREETADDRESS CITV/LOW�` A6l3 ZIP REGISTRATIO{4•(I NO. I STATE EXP�D`,AI f MAKE/TYPE YEAR(COLOR DATE OF VIO TION TI \'DATE fILDITATION WRITTEN PERS YESI !J wuR l-/OS PM /-0/ry^63 ONO LOCATION OF V TI I ENFORCING DEPT O ENSE a� e/51s�/ ((.�u'+ HA -SECT. FINES �e.Lo R� wd7tFi�.a� B OFFICER //�� //�� I.D. OTAL F NE INE (/u 7LYJY/S DUE I$�Q7 OFFICER CERTIFIES COPY GIVEN TO VIOLATOR /{�/ ❑ IN ND X (/.//J(( ,t0O�,� Y MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKEl NO. CITATION NO ` -» -• CITY OF SALEM PU +� {11 � •':*" "�s VIOLATION NOTICE r R{ � NAME(LAST,FIRST,INITIAL)/V%-"91/ J(�////yyy�;��•/�S + {,1(v' 47 ST EETADDRES6 /-'- ll YM♦WN STATE ZIP LICENSE e10 LIC.EXP OATEATE OF RTH OWNER'S NAME(I-AST FIRST, ITIA ) u STREETADDDR,XRE/�SS �CITV,//rTOWN �)4ATE ZIP REGISTRATION NO STATE EXP.DATE I MAKE/TYPE I YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN I RRRSONAL r� ❑AM INJURY ❑PM 7.-.O ❑NO LOCATION OF VIOLATION ENFORCING DEPT. J^r+'T7i�v ILRsl�7 Iti.t�JSr'�.Fh_tle �`•*-7 �f3 lt�n'�%1 OFFENSE'O(S°/jf^f'�J7LN+t A�.*�.k �%�'^ 'C`H`AP'SECT FINES ic OFFICER ✓ / I.D NC{:r}OUELI OFFICER CERTIFIES COPY GIVEN II�TO VIOLATOR ) `� j� Ll IN HAND X fig./%J(P[(,x�„Q. d/ - 19-BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)7459595 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 T CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL 4COURT_IbOOK_EETT NO CITATION NO. t ' CITY OF SALEM PD VIOLATION NOTICE NAME(LAST,FIRST,INITTI-AL).J `-.?q j�yi^)J Nf. � �+kS ay, . r STREETADDRESS✓ CITY?OWN STATE ZIP LICENSE NO. A LIC.EXP.DATE I DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDR�EJSS CITY,7OWN STATE - IP. REGISTRATION NO STAT\ E P.0 /1 4E/TVPE r YEAR(COLOR - DATE OF VIOLATION TIME DATE CITATION WRITTEN( PERSONAL AM 777 iNduRv ❑PM 1'� 7—C� a ❑NO LOCATION OF VIOLATION ENFORCING DEPT OFFENSE' l f�F'r'.T% +�J, .-'-"+` DCHHAP SECT. FINES 1;i-?' '444 leer C OFFICER (p 1.I D NO. TOTAL(` -r.'+'. ` J> FINE �'' I , 0-A ,fGY% OFFICER CERTIFIES COPY GIVEN TO VIOLATOR _ -❑ IN HAND } BV MAIL "J< 's DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK - 'i:x -" CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 [I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON "REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF 4 CASE N SIGNATURE _ SEE OTHER-SIDE FOR FURTHER INFORMATION -ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 'E REMOVE LINER J3NF 3AOW3U 3AIS3H 1V 3SOdX3 Ol TO EXPOSE AD' 3AOW38 3AISRHOV 3SOdX3 01 TO EXPOSE ADHESIVE REMOVE LINER tl IOLATION NOTICE s'amp Here Post Office T�Q OFFEliti will not deliver without stamp Q YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER(t)You may elect to pay,either by appearing in person between 8.30 am to 4.30 per, Monday through Friday,legal holidays excepted,before THE CITY CLERK-SALEM CITY HALL, or by mailing a check,money order or postal note to the City Hall WITHIN TWENTY-ONE(21) DAYS OF THE DATE OF THIS NOTICE This will operate as a final disposition of the matter,with no resulting criminal record (2)If you desire to contest this matter in a non-criminal proceeding, _ you may do so by making a written request to the above City Hall or Assistant Clerk will operate as a final disposition,with no resulting criminal record provided any fine imposed by that officer ! Jim.. F is paid within the time specified (3)If you fail to pay the imposed fine or to appear as specded,a criminal complaint will be issued against you CITY CLERK City of Salem CITY HALL 93 WASHINGTON STREET Q SALEM, MA 01970 COURT DOCKET NO. CITAI IO OF SALEM PD �{ 4 CA _ �ba'I VIOLATION NOTICE` 1.i.L7 7 NAME(MST,FIRST,INITIAL)/` ,7 Trope STREETADDRESS CITY/?OWN STATE ZIP LICENSE NO LIC EXP.DATE DATE OF BIRTH OWNERS NAME(LAST,FIRST,INITIAL) /,4-A,16-' tl=. G STEETADDRESS CITY/TOWN STATE ZIP REGISTRATION NO." i STATE EXP DATE I MAKE(TYPE YL°AR COLORI DATE OF VIOLATION TIME DATE CITATION WRITTEN I FwRSO 3 RAL �J ❑AM /�ry_oOYES 0 P / .J ONO LOCATION OF VIOLATION ` I ENFORCIN/IG DEPT SII � 7x Ally lti�v9 s''i[it��u��� l I�/4fi i/ed,A OF FENSEAa y/(f1pryJ A�r-�,.y..v..� / C�HA SECT FINES A !TJ/2UAF To6yw4't Q. t�VQ7 IB OFFICER I.OLN�TFINEDUEL $/�� OFFICER CERTIFIES COPY GIVEN TO VIOLAT��BYMAIL //�� a D X M !/.///LL��J DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK I CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL " Janet Mancini r From: David Greenbaum Sent: Tuesday, July 28, 2009 8:50 AM To: Janet Mancini; Elizabeth Salandrea Subject: FW: Code enforcement Janet and Liz, Can someone please look into this. yC��kf�'' Thanks V NN p Dave y _ K ►y David J. Greenbaum, Acting Health Agent Wk\,ip City of Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970 Phone 978-741-1800 1� Fax 978-745-0434 o-S vp \1�) FromOriginal Message----- From:: Jennifer Keough VVv Sent: Tuesday, July 28, 2009 8 :46 AM rr To: David Greenbaum Subject: FW: Code enforcement Jennifer Keough, Code Enforcement Officer v City of Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970 Phone 978-741-1800 Fax 978-745-0434 -----Original Message----- From: Michael P. Marsille, Esq. [mailto:marsille@earthlink.net] Sent: Monday, July 27, 2009 11:26 AM To: Jennifer Keough Subject: Code enforcement Hi, Jennifer: I live at 15 Crombie Street, Unit 3, and I have an issue with the Hong Kong Restaurant next door. Their cooking vents point at our house and I have noticed that over the past several years the grease accumulates on our tree leaves (and sometimes the house) . This has caused the death of two trees and another is great affected right now. You can see the black grease on the leaves and the leaves are noticeably dying. On certain days, you can see the smoke blowing directly onto the tree's foliage. If you come by the house, you will notice that our house is very close to the back of the restaurant and the vents are quite close to the front of our house. What are our rights? 1 Mich6,l Marsille Michael Marsille Checked by AVG - www.avg.com Version: 8.5.375 / Virus Database: 270.13.39/2268 - Release Date: 07/28/09 06:00:00 2 Janet Mancini From: Michael P. Marsille, Esq. [marsille@earthlink.net] Sent: Wednesday, August 05, 2009 12:55 PM To: Janet Mancini Subject: Re: Grease Issues Thanks, Janet. Also, it is very serious now because the grease is coating the leaves of our trees and our plants in the garden. I don't think just cleaning is the answer. I think they need a whole new filtering system. I don't know if you could also bring the building inspector. I think those vents are too close to our house (less than 20 feet maybe?) and the fumes settle on our property all day and night. It cannot be healthy to breathe. I have contemplated bringing a civil suit because the nuisance issues are so bad. We had to cut down one tree that died from the grease and now our pine tree is almost dead from it. Another tree, directly opposite the vent furthest from the street, has leaves absolutely black with grease and is sickly looking now. Please have a look for yourself. Something major needs to be done. Thank you. -----Original Message----- From: Janet Mancini Sent: Aug 5, 2009 12: 46 PM To: marsille@earthlink.net Cc: David Greenbaum Subject: Grease Issues Hi Michael, I wanted to let you know that I am planning to go by Hong Kong King and take a look at your property while out there. I had dealt with this issue a few years back and we had them clean their hood and vent system. I, again, hope to get out there by the end of the 1 ^� week and will keep you updated on my findings. Please let me know if you have any other questions or concerns. Thank you Janet Mancini Senior Sanitarian Salem Board of Health 978-741-1800 Michael Marsille No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8 .5. 392 / Virus Database: 270. 13.44/2283 - Release Date: 08/05/09 05:57 :00 2 ( IMPORTANT MESSAGE-� FOR Z-15-0, am, �.7AA�([If � DATE TIME/Jy . M OF �9 9 PHONE " O A' DE 521NUMBER n EMENSION ❑ FAX O MOBN F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN l WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU J MESSAGE Y SIGNED s� r' MADE 009 NOTES 15 Crombie Street Unit 3 Salem, MA 01970-3303 August 20, 2009 David Greebaum Acting Health Agent Salem Board of Health 120 Washington Street(4th floor) Salem, MA 01970 RE: Hong Kong Restaurant Exhaust Fans Dear Mr. Greenbaum: I have been a homeowner at 15 Crombie Street for the past 6+years. It has become apparent over the years that the exhaust fans of the Hong Kong Restaurant,which are located less than 20 feet from our building,are a health hazard and a hazard to our property. The exhaust fans emit fumes and greasy smoke from morning until late at night each day. This pollution has coated our trees with greasy residue,succeeding so far in killing two trees and leaving one with blackened leaves so that we fear that it may be next to die. At times the side of our building has also been the victim of grease splotches. In addition, both the smell and the noise are a nuisance in the legal sense and interfere with the right and enjoyment of the three unit owners in our building. We are also quite concerned with the health effects of the emissions which trespass on our property. If they are enough to coat and kill our trees, then certainly the air quality cannot be much better for the occupants of our building. I would respectfully ask the Board to investigate this matter. We find it hard to believe that the location and lack of filtering on these exhaust fans is proper in such a densely populated spot. I would encourage the members of the Board to visit our property to see just how close the units are to our building and to experience the noise and aromas firsthand. Thank you. Sincerely, Michael P. Marsille Owner, 15 Crombie St Unit 3 /mpm cc: Jean Pelletier Joan Lovely ll.,�lJ�.,�I�X�� ° �G.�.ln.���V_vt 1� ���-38�q�a_q 9 � _ �� � 11 �h� `� _ __✓ � -I �1��ci�- �` 1 �. �^ . 08/25/2009 15:19 FAX 6177280833 TAT ON AUTO SUPPLY 001 ' � I1� •. . �t.� RJ i ar PROTECTION CLEANING, INC. 552. Mass, Ave., #E Boston, MA 02118 Q .t tk Tel: 617-824-1199 Celt: 61.7-888-2728 We clean ovens,area sides&:btoottoms,.tmoke exhausts and fans i. Customera g. : C - H D:n tT kc;rL ; Address 4-3k : Ald rm QN ., -t SaIQV Tel z �-0.— ��)zz EI ACJ Dater-F---F-t o i QUANTITY DESCRIPTION 1 TOTAL RooC1 rl to.aYL : 4 �IfeF� i i I ;t SUBTOTAL ZQ Approved by. vj&.,� #R TAX 4K LESS DEPOSIT I i ReceivcA bv: iii X BALANCE DUE i CITY OF SALEM, MASSACH1JSETrS BOARD OF HEALTH 130 WASHLvGTON STREET',4'FLOOR PublicHe8lth Rnrnt.flramme.Prottet TEL. (978) 741-1800 F,\X()78) 745-0343 KIMBERLEY 17RISCOLL Itamdioasalem.com - 1,ARItY R;\N[UIN,RS/RI?I 1S,0110,Cl'-I;S MAYOR 1JEA RIAGENT 1- = This Form will be collected during your next Board of Health inspection. QUESTIONAIRE -GREASE TRAPS 2012 1. NAME OF ESTABLISHMENT: PAI-1 2. ADDRESS OF ESTABLISHMENT: 9' �JC�^( tin �^., , �yn_t I ✓� ti 4 l I J C 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? 4. WHAT,SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS " -Z� G( cn.11011 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? ,61 44ewcL, 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? V\ e. 'vt D e5 t, . 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? 8. WHAT 1S THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? {-,4 b0i v1- . REVISIONS BY X V T crer + �. �, o t-FETTAt. J:ru. CIL tic s+,mtC K-46k TiLAS - _ 5 tiv, 4j! — C PIK yj of, C? 'n o QUAPR)* r i.s T Lx K oV .p _ - 2 �� b . stvL 4 Y .fid T � r ; Kt Kkli"1� ' NAA (, CDM Pt- j W" TN � p Z DATEU LAW ON .-- `n - SCALE u Q DRAWN 8 JOB r SHEET 0 z i� 0 OF SHEETS J STOCKDRAFTM FORM NO JFT 52 REVISIONS BY 2vYZo F hV ki F Ta � ON �GOFL -- -(( - ` - fox20 dao REN°T� A Dol io-,c F— 2-o x I Co kl 51aro U 300 2ox0 2g ;Cw ,c�-car%5 UL t� � � rX'�t'&'"i� Y k �Ftcur wk-*,0LF— M W KLREASFp L-TI*ls 7h1fi} C� wlLLTPo#iFt`, 'ox24 kl-rCN�N � SADV�' I TO t�Mt- I C{AS RooF coo Q UIP � 0K _ _ EYFi, lrc ► : �/F.1iT'l- `O�� VU�'t" DA`u �r d !L- we c 54LL Com Ly u T4 L/t'�'r eflm4C)6 y M ASS. BulL-h K6 at:e Ai, b ,ALL L r-AL L.Ai,;s < ProF "� RP qU (.,47!-,0ky . t STAr1-I " Q r20 U f�k S S (o J rj�(S?t?*� SSU. C S 1 �, AND FT- ; J �3, r=F -1, -i , Gco C t'E" 1.40k1k, C -5. 2�P, > ITAY wZoAZ<., Sv F VALVE t�R 5rA'0LsS, STS l +►��t.0 �.►Jf�,; -� `. W' 1 — u� LAW" PVl_Y /SIR L^�� ,.� � s• �� DATE SCALE DRAWN Nic T- roe t^--- a SHEET z OF .�.. SIOCKp AFTING FORM NO dt r 1, ETISICHEON SPECIAL Koff, Served from 11:30 am to 3:00 pm L7 -L21 Served with Roast Park Fried Rice00%G L1. Pork Chow Mein, Chicken Fingers..........3.75 L2. Moo Goo Gai Pan, Chicken Fingers........4.95 L3. Subgum Pork Chow Mein, BonelessRibs..........................................4.95 L4. Egg Foo Young, Chicken Teriyaki............4.50 L5. Sweet and Sour Chicken, Egg Roll..........4.25 �� N L6. Lobster Sauce, Chicken Wings................4.25 L7. Teriyaki, Chicken Wings, C Chicken Fingers.......................................4.95 L8. Teriyaki, Crab Rangoon, CHINESE RESTAURANT Chicken Fingers.......................................4.50 L9. Boneless Ribs, Chicken Wings, We use 100% Pure Vegetable Oil Crab Rangoon.........................................4.50 WE DELIVER ! it L10. Kung Pao Chicken, Chicken Teriyaki .......4.95 L11. Cashew Chicken, Chicken Fingers...........4.95 Minimum Order $8.00$1.00 Delivery Charge YD L12. Hunan Chicken, Spring Roll.....................4.95 L13. Chicken with Broccoli, Crab Rangoon.....4.95 L14. Beef with Broccoli, Crab Rangoon..........5.25 Take Out or Delivery L15. Beef with Mushrooms, Crab Rangoon.....5.25 Please Call 0 L16. Kung Pao Shrimp, Chicken Fingers.........5.95 Tel: (978)740-8727 L17. Shrimp with Vegetable,Crab Rangoon...5.95 to L18. General Gau's Chicken, Crab Rangoon ...5.25 Fax: (978)740-8728 0 L19. Orange Chicken, Crab Rangoon..............5.25 L20. Sesame Chicken, Crab Rangoon .............5.25 GIFT CERTIFICATES AVAILABLE 0 L21. Spicy String Bean, Chicken Wings...........5.25 L22. Vegetarian's Delight OPEN DAILY with White Rice, Spring Roll....................4.75 MON.-THURS. 11:30 a.m.-10:00 p.m. 0 L23. Bean Curd Home Style, Crab Rangoon FRI.-SAT. 11:30 a.m.- p. SUNDAY Noon-10:0000 p.m.. with White Rice.......................................4.95 s 0 L24 Hot&Spicy Shrimp with White Rice, 28 Norman Street, Route 114 Egg Roll..................................................5.95 v� Salem, MA 01970 L25. Pork or Chicken Lo Mein, Chicken Wings........................................4.75 Essex Street S 110114 ftOp` W,Hot and Spicy e a " � r o rn < < E 4NIN4 4 E 3 0 0 .- Mass Meal Tax 5% � E o < .• r Not Responsible for Lost Articles " Norman Street 3 } Post Office APPETIZERS FRIED RICE Sm. Reg. Sm. Reg. 1. Egg Roll............................................. 1.55 2.95 36. Steamed Rice.....................................0.90 1.50 2. Spring Roll (no meat)......................... 1.55 2.95 37. Vegetable Fried Rice......................... 3.25 4.95 3. Chicken Wings................................... 3.95 6.25 38. Roast Pork Fried Rice........................ 3.50 5.50 4. Fried Shrimp Chips........................................3.50 39. Chicken Fried Rice............................. 3.50 5.50 5. Chicken Teriyaki................................. 3.75 6.50 40. Beef Fried Rice..................................3.95 5.75 6. Beef Teriyaki......................................4.25 7.50 41. Shrimp Fried Rice..............................3.95 5.75 7. Chicken Fingers................................. 3.95 5.95 42. House Special Fried Rice...................3.95 6.25 8. Crab Rangoon ................................... 3.25 5.25 43. Young Chow Fried Rice..................... 3.95 6.25 9. Boneless Spare Ribs.......................... 3.50 5.95 44. Ham Fried Rice.................................. 3.50 5.25 10. Barbecued Spare Ribs....................... 3.50 5.95 11. Scallion Pancake............................................3.25 12. Fried or Steamed Dumpling..........................5.50 LO MEIN 13. French Fries...................................................2.00 46. Pork ...................................................3.75 5.75 14. Fried Wontons...............................................3.00 47. Chicken..............................................3.75 5.75 15. Fried Jumbo Shrimps....................................6.95 48. Beef................................................... 3.95 5.95 16. Fried Scallops................................................6.50 49. Shrimp .................................... 3.95 5.95 17. Pork Strips......................................... 3.95 6.50 ..... 18. Vegetable Tempuras......................................4.75 50. House Speccialial....................................4.50 .95 5 19. Pu Pu Platter............................ (1)7.95 (2) 14.95 51. Vegetable.......................................... 3.75 5.25 Spring Rolls(2),Crab Rangoon(G),BBQ Spare Ribs(2), 52. Garlic Noodle.................................... 3.25 4.95 Boneless Spareribs,Beef Teriyaki(2),Fried Jumbo Shrimp(2), 53. Sesame Cold Noodles...................................4.25 Fried Chicken Wings(4),Chicken Fingers(8). 54. Rice Noodles with Chicken or Shrimp ..........5.95 20. Kid's Happy Box Chicken (.........................5.95 io 55. Pekin Noodle with Hot Meat Sauce ........... 5.95 Crab Rangoon(4),Chicken Teriyaki(2), g Chicken Fingers(4),Spring Roo(2). 10 56. Singapore Rice Noodle with Curry...............6.25 C=0OWINATION APPE_ TI'ZERI9- A. Beef Teriyaki, Chicken Fingers, NOUN FRIED NOOVILE Boneless Spareribs, Egg Roll ........................6.95 57. Choice of Shrimp, Chicken, or Beef..............6.95 B. Chicken Teriyaki, Chicken Wings, 58. Vegetable ......................................................5.95 Boneless Spareribs, Crab Rangoon...............6.95 59. Seafood .........................................................7.95 C. Fried Jumbo Shrimps, Chicken Fingers, Chicken Teriyaki, Egg Roll.............................6.95 I CHOW FOON; D. Beef Teriyaki, Chicken Wings, Spring Roll, Crab Rangoon............................6.95 66. Beef or Chicken.............................................6.50 SOVP 191 W MEIN or CHOP-10lE�l"'r 1 VP 21. Hot & Sour Soup............................... 1.85 3.25 67. Vegetable.......................................... 3.25 4.95 22. Egg Drop Soup.................................. 1.85 3.25 68. Pork ................................................... 3.65 5.25 23. Wonton Soup..................................... 1.95 3.50 69. Chicken.............................................. 3.65 5.25 24. Chicken (Rice or Noodle) Soup......... 1.85 3.25 70. Beef................................................... 3.95 5.95 25. Chicken Corn Soup............................ 1.95 3.75 26. Tofu &Vegetable Sou 1.85 3.25 71. Shrimp ............................................... 3.95 5.95 9 P ..................... 73. House Special................................................6.95 27. House Special Soup.......................................4.95 28. Seafood Delight Sou 5.95 (Shrimp,Chicken and Pork) g p............................•••••• Any Subgum or Chicago Style Add ..0.30 0.50 iEG�G FOO YOVN`G _ I 31. Mushroom........................................................4.95 32. Pork..................................................................5.25 33. Chicken............................................................ 5.25 34. Beef.................................................................. 5.95 0 Hot and Spicy 35. Shrimp..............................................................5.95 Mass.Meal Tax 5%. SWEET 6c SOUR, PORK Sm. Reg. Sm. Reg. 76. Pork..................................................................7.50 121. Pork with Mixed Vegetables............3.95 6.95 77. Chicken...............................................4.50 7.50 122. Pork with Broccoli ............................ 3.95 6.95 78. Shrimp................................................. 5.25 8.95 123. Pork with Scallions............................4.50 7.25 �t 124. Pork with Garlic Sauce.....................4.50 7.25 WS; MLQIVSE SPECIALT.MIRS-3 DINNER COMBO PLATES H1. Hong Kong Crispy Shrimp ......................9.50 SERVED ALL DAY H2. Seafood Delight....................................11.75 Served with Roast pork Fried Rice Lobster meat scallop,jumbo shrimp,calamari with mixed vegetables in white sauce. D1. Chicken Wings, Boneless Ribs, NA H3. Shrimp &Scallop with Garlic Sauce........9.95 Chicken Fingers.......................................6.50 H4. Happy Family........................................10.95 D2. Chicken Wings, Crab Rangoon, Beef,chicken,jumbo shrimp,roast pork lobster Spring Roll..............................................6.25 meat and mixed vegetables in brown sauce. H5. Gai Poo Lo Mein (3 boxes)....................12.95 D3. Boneless Ribs, Beef Teriyaki, Egg Roll.....6.50 Shrimp,chicken,beef and roast pork sauteed with D4. B-B-Q Spare Ribs, Egg Roll.....................6.95 fresh vegetables bedded by soft noodles. D5. Chicken Wings, Boneless Ribs, H6. Four Happiness.......................................9.50 Beef Teriyaki. 6.95 Chicken,shrimp,roast pork and tender beef blended """"""""""""""""""""" inrofresh garden vegetables and oyster sauce. D6. Chicken Chow Mein, Boneless Ribs, �t H7. Dragon & Phoenix...................................9.25 Egg Roll..................................................6.50 Two dishes in one:hot Pr spicy shrimp and chicken with ginger d scallion. D7. Chicken Chow Mein, Beef Teriyaki, 4 H8. General Gau's Chicken............................8.50 Chicken Fingers.......................................6.50 Chunks of chicken deepfried until crispy and D8. Egg Foo Young, Boneless Ribs, cooked with hot sweet and sourginger sauce. vh H9. Orange Flavored Chicken .......................8.50 Chicken Fingers.......................................6.50 Orange Flavored Beef.............................9.75 D9. Egg Foo Young, Beef Teriyaki, Egg Roll..6.50 Crispy aromatic beef or chicken sauteed with chefs D10. Lobster Sauce, egg roll...........................5.95 special orange flavor sauce. H10. Sesame Chicken......................................8.50 D11. Shrimp Lobster Sauce, Chicken Wings....7.25 Sesame Shrimp.......................................9.75 vh D12. Kung Pao Chicken, Egg Roll....................6.50 Chunks of chicken or shrimp deep fried until crispy to D13. Hunan Chicken, Chicken Fingers.............6.50 and cooked with sesame seeds and sweet&sour ginger sauce. D14. Chicken with 4 H11. Kung Pao Three Delights........................8.75 Mixed Vegetable Spring Roll..................6.50 Beef,jumbo shrimp,chicken,peanuts with mixed vegetalbes in brown sauce. D15. Cashew Chicken, Chicken Wings.............6.50 H12. Lemon Chicken........................................8.25 D16. Moo Goo Gai Pan, Chicken Fingers........6.50 Cubes of chicken coated with water chestnutflour D17. Chicken with Broccoli, Egg Roll ..............6.50 and egg deep fried until crispy and cooked with lemon sauce. D18. Beef& Mushroom, Chicken Fingers........6.95 H13. Mongolian Beef.......................................9.95 D19. Beef with Pepper&Onions, Egg Roll.....7.25 Beef with onion and scallions sauteed with chefs 9 special sauce. D20. Beef with Broccoli,Crab Rangoon..........7.25 to H14. Fried Squid with Mild-Pepper Sauce.....10.25 D21. General Gau's Chicken, Crab Rangoon ...7.50 H15. Butterfly Shrimp 9,25 0 D22. Orange Chicken, Crab Rangoon..............7.50 jumbo shrimp,pork and egg top on of the lettuce D23. Sesame Chicken, Crab Rangoon .............7.50 H16. Lobster with Ginger&Scallion ......(Seasonal) to D24. Kung Pao Shrimp, Egg Roll.....................7.25 H17. Lobster, Cantonese Style................(Seasonal) D25. Cashew Shrimp, Egg Roll........................7.25 D26. Vegetarian's Delight, Egg Roll................5.95 _ to D27. Curry Chicken, Chicken Wings................6.50 �r�-'IP'.7ECIAL COMBO $�5 3_5 to D28. Spicy String Beans, Egg Roll...................6.50 SERVED ALL DAY' . D29. Chicken with Snow Peas, Egg Roll..........6.95 Pick any oft items below, D30. Beef or Chicken with Asparagus, served with pork Fried Rice or pork Lo Mein. Spring Roll (1) Crab Rangoon (4) Egg Roll ..................................................7.50 Egg Roll (1) Fried Jumbo Shrimp (2) D31. Beef or Chicken with String Beans, Chicken Finger(4) Beef Teriyaki (2) Egg Roll ..................................................6.75 Chicken Wings (2) Chicken Teriyaki (2) D32. Sweet&Sour Chicken,Spring Roll.........6.50 Fried Wontons (8) Boneless Spareribs 0 ( IMPORTAW MESSAGE ) FOR tL51 .P A"r - DATE�J /� TIMEP.M OF 0,4 D�>r A�2� PHONE AREA CORE NUMBER EXTENSION U FAX U MOBIl F AREA CODE NUMBER TIME TO CALL TELEPHONEDf PLEASE CALL CAME TO SEE YOU ' , WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I I WILL FAX TO YOU MESSAGE /�/Jl-TJ�,P�✓ fi G ,Pis �' C1� I A&c'� �IWIf L3GQ.(Y �ll _hV. A.A ! n SIGNED O �Fn�orylfv J S A 4 NOTES ---�--obs-en}ed_ ��. . ��.�u� - ,, `� ,� ,� � k� +i \ , • «, t�' �', ;_ . ,�1. t� ' ��i ,� 3