HOUSE OF THE SEVEN GABLES SETTLEMENT PRE-SCHOOL - ESTABLISHMENTS Houk I.vtn 6 �i6(e) 1�HHtm �n�
iniversal one,
www.myuniversaloP.cam
phone:1-800-756-4676
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Commonwealth of Massachusetts
City of Salem
Board of Health IQmberiey Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
FooWRetail Establishment Permit
DATE PRINTED: 01/03/2008
ESTABLISHMENT NAME: House of the Seven Gables Settlement Pre-School
He Number:BHF-2004-000019 114 Derby Street
Salem MA 01970
LOCATED AT: 0114 DERBY STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2008-0162 Jan 3,2008 Dec 31,2008 $25.00
.ESTABLISHMENT
Total Fees: $25.00
PERMIT EXPIRES December 31,2008
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 9
1
CITY OF SALEM, MASSACHUSEM
c BOARD OF HEALTH
120 WASHINGTON STREET,4' FLOOR
TEL. (978)741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343 ��� �!� A g,
MAYOR ISCOTTO)SALEM.COM �€ 8J
JOANNE SCOTT, NOV 3 0 2001
HEALTHAGENT CITY OF
BOARD OF HEALTH
2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT �ylG Nousa o� { G SWen &LbIC6 �Et q?S`f$'�906I
ADDRESS OF ESTABLISHMENT I IH Derb 5+ree-F FAX# '1701-740-.7,443
MAILING ADDRESS(if different)
EMAIL-Business': Website:
of -rhe SWrn btes
OWNER'S NAMEw►-1.Q. em at _51S ate» TEL# 1
47$• 74 ^6g91
ADDRESS 11 ;J VT erbu S+me+ "Ardem ��t�/f� 01110
TREET /� CITYSTATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) CaAex-;vier 5+0 CERTIFICATE#(S)37z F409
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON KQ_V-CYI Te le I I cr HOME TEL# 978' TrI4I^$3o.Z.
DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunda
HOURS OF OPERATION 'P- S:30 9-5:30 $-6.3D $'S 3o S1 S: 3o
Please write in time of day.
(For example 11 am-11 pm)
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES less than 1000sq.ft. _$70
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
- ---------------- ---------
AN ----------
RESTAURT YESO less than 25 seats =$140
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
-
--------------------------------------------------- ------------
-------------------
BEDIBREAKFAST/ YES NO $100
CH��ERVICE+- ----------------------------------------- ----- -------------------------
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25
TOBACCO VENDOR 1 $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
`Please,pay total with oris dhdck payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
I Establishments,
In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made;all plans for
such must be-submitted to and approved by the Salem Board of Health.
Pursuant to'MGL Chapter 6'k,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,'have'fled all state tax
returns and paid all state taxes equired under the law.
1� �, —A - ��Dd :� !l-�6- a� o*-- aro -3;Z
Signa u e Date Sse+aH88Ctttlt9�t Federal Identification Number
----'-'------------------7--
--------- -----
Revised 4/24/07 FOODAP2008.adm CheckN&Date 3�� i//- ,J7 S AVE
0114 DERBY STREET House of the Seven Gables Settlement Pre-School
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: Violations Related to Good Retail Practices (Blue Items)
74$-$909 Physical Facility FAIL BLUE
Owner: Comment:There are water damaged walls a nd ceiling the restroom.Investigate the source of the leak and repair. Repair and
The House of the Seven Ga repaint the walls and ceiling.
PIC: There are water stained ceiling tiles outside the restroom. Replace all stained tiles.
Cathy Diffin GENERAL COMMENTS:
Inspector:
David Greenbaum No other health code violations cited at this time.
Date Inspected:Correct By:
7/10/2007
Risk Level:
i
Permit Number:
BHP-2007-0104
Status:
SIGNED OFF
#of Critical Violations:
0
Time IN: Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800
GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 10,2007 ) Page I oft
Item Status Violation Critical Urgency
RED:
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800
GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 10,2007 ) Page 2 oft
0114 DERBY STREET House of the Seven Gables Settlement Pre-School
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: i PROTECTION FROM CONTAMINATION
745.5909 Good Hygienic Practices FAIL Critical ❑d RED
Owner: Comment: Employee drink observed in food prep areas. Employees must eat and drink in a designated employee area.
The House of the Seven Ga I Violations Related to Good Retail Practices (Blue Items)
PIC: Physical Facility FAIL Non-Critical BLUE
Cathy Diffin I
Inspector: Comment: There is water damage on the ceiling of the men's room. Investigate the source of the leak and repair. Repair and
repaint the ceiling.
David Greenbaum
Date Inspected:Correct By:
1/10/2007
Risk Level:
Permit Number:
BHP-2007-0104
Status:
SIGNED OFF
#of Critical Violations:
1
Time IN: Time OUT:
i
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
GecTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2007 ) Page I 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. Jan 10,2007 ) Page 2 oft
I
CITY OF SALEM, MASSACHUSETTS � ��`�9� �
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 DEC 15 2006
TEL. 978-741-1800 CITY OF SALEM
FAX 978-745-0343 BOARD OF HEALTH
Kimberley Driscoll www.sALEM.COM
Mayor ,JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT Nbu3t epTEL# 99f'- 74f5- i
ADDRESS OF ESTABLISHMENT !1 t} ,p � s >1� FAX#
MAILING ADDRESS (if different)
EMAIL--Business': . p4rI ie&ne Owner's:-7ya� es.p�"�
HotiSs Fho «`3evart Qci bFtts ✓ —
' OWNER'S NAME 59.�t, 'ag,F��gY d�,�®w � TEL#
ADDRESS 115 Verb 2t+nee {- -Sgdei+�+ A�l,�_, b ;to
STREET Y CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) L.rA4kw Tiffin CERTIFICATE#(S)(e, ,j_J0,? 17A-Z
(Required in an establishment where potentially hazardous food is prepared) t-
EMERGENCYRESPONSEPERSON Karen *9.Teilrek'er- HOME TEL# 47t?-7�t -330 .
DAYS OF OPERATION Monday Tuesday—Wednesday Thursday _Friday Saturday Sunday
NOURSOFO rutin ON
r,easewdtelntimeotuay. r-6' 30 P'" .13d
[For eyamole llamdlem) _
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES (D) less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
----- .... ---------- -------- ------------ ------ ------- --------- ...
RESTAURANT YES less than 25 seats $100
25-99 seats =$150
more than 99 seats =$200
-- .R..E._A_...--- -- ------ - - - ...._.... ... . ------ --- - - - -
---------- .------------ --
i BEDtBKFAST YES NO $100
- ... ----------- ..._...__.... ... ..__.... ...- ...._. .......__... -
ADDITIONAL PERMITS
MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YESNO $5
TOBACCO VENDOR Y N $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.
Sign re Date Social Security or Federal Identification Number
- -------------- ------ ------------- ----- -------------------- ---------------
�------ 5,--0----------- ------------ -----------------
Revised 11/13/06 FOODAP2007,adm Check#&Date_ Jp / $
THE F'OUSE OF THE SEVEN GABLES 5677
^SsTI ENT ASSOCIATION
City of Salem 12/5/2006
Date Type Reference Original Amt. Balance Due Discount Payment
11/30/2006 Bill 25.00 25.00 25.00
Check Amount 25.00
a %
x 5 4
%, Checking-Sovereign.
25M ,
^ip, �ii�p+ sx +,Frw,'?atdsa3 'snnfia,�14: fv#'P Y'`" 4 "� t4' eP
w+r
wCommonwealm',oi
Massachusetts
W7 e City Of Salem' WV
` <"�+s +r'
hF�.b .. • a M .fir. ,� # {, �i +� d-d- I �.1� 'i
s Fw `r Board of Health,! f 4> y tP
ip.
a 120 Washington Street,4th Floor ; iQmbedl y Ortscoll
"'=.a '". - x G=..- R"x{'a { i.-I rS• .�: ' '"' :o-iMayor,
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 12/20/2006
ESTABLISHMENT NAME: House of the Seven Gables Settlement Pre-School
File Number:BHF-2004-000019 114 Derby Street
Salem MA 01970
LOCATED AT: 0114 DERBY STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2007-0104 Dec 20,2006 Dec 31,2007 $25.00
ESTABLISHMENT
Total Fees: $25.00
PERMIT EXPIRES December 31, 2007
Board of Health
t.�
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any 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 23
t�
'r
0114 DERBY STREET House of the Seven Gables Settlement Pre-School
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone d rs Violations Related to Good Retail Practices (Blue Items)
745-5909;
Item Status Violation Critical Urgency
RED: rt
Violations Related to
Foodborne IilnesS lnterventions'
nd Risk Factors{Require`
immediate corrective`action)
I
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(979)741-1800
I
GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 01,2006) Page 2 oft
-+r
s
�^ 0114 DERBY STREET House of the Seven Gables Settlement Pre-School
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
'HACCP: ❑
Item Status Violation Critical Urgency
Telephone: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
745-5909 _ Time As a Public Health Control FAIL Critical ❑J RED
Owner: Comment: Hamburg thawing at room temperature. Thaw potentially hazardous foods in a refrigerator or under cold running water.
The House of the Seven Ga GENERAL COMMENTS:
PIC:
Cathy Diffin 480:No other health code violations cited at this time.
Inspector
David Greenbaum --
Date Inspected: Correct By:
12/14/2006
Risk Level:
Permit Number:
BHP-2006-0301 '
Status:
,SIGNED OFF
4 of Critical Violations-
1
.Time IN: Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 15,2006 ) Page 1 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. Feb 15,2006 ) Page 2 oft
(
Commonwealth of Massachusetts
City of Salem
` Board of Health
120 Washington Street,4th Floor
cd' SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/04/2006
WHO'S PLACE OF BUSINESS IS: House of the Seven Gables Settlement Pre-School
File Number:BHF-2004-0019 114 Derby Street
Salem MA 01970
LOCATED AT: 0114 DERBY STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2006-0301 Jan 4,2006 Dec 31,2006 $25.00
ESTABLISHMENT
Total Fees: $25.00
PERMIT EXPIRES LDecember 31, 2006
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 20
�C���r� 0
" CITY OF SALEM, IVIA&SACHUSETT D
BOARD OF pHEAL114 � 005
10�-mm
, -STREET.4TH FLOOR NOV`2 9 2
E4 WASHINGTON ca.
f... SALEM; NFA 01970
TEL.878-741,1400 CITY OF SALEM
rAX ?378.745,0343 BOARD OF HEALTH
STANLEY J. LIS VICZ, JR. JOANNE ScOTr; MPH, R5' Gt-10
MAYOR HEALTH AGENT
20Myoo5
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
The House of the Se-Ln &able-Y
NAME OF ESTABLISHMENT SelJ{lment flS5ou'ah4;1 TEL
# e/7P-7Y5.5905
i
ADDRESS OF ESTABLISHMENT
l/Y Vei -Ay SJYtLt
MAILING ADDRESS (if different)
OWNER'S NAME 7Ae fiavSe of-tk Se✓a1 Gr.6/ts !;f*1emtn�t Agog . TEL
#_Q7E- 7Yeh095 I _
ADDRESS SY Tvrn6� Sr1eGfi
CITY 51 /en-1 _ STATE M A
ZIP 0/970
CERTIFIED FOOD MANAGER'S
NAME(S) Cathv Llin CERTIFICATE#(s) ba0303 /70a
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON Karen B. yelleher' HOME TEL
# 978-7Y4-,530
HOURS OF OPERATION:
Mon.84:30 Tue.8d.30 Wed.B-S.'30 Thu. V-5'30 Fri.9-1:90Sat. Sun.
TYPE OF ESTABLISHMENT FEE check only
RETAIL STORE YES less than 1000sq.ft. =$ 50
/ 1000-10,000sq.ft. =$100
1 lJ more than 10,000sq.ft.=$250
RESTAURANT YES !O less than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES 10 $100
ADDITIONAL PERMITS (J/
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5
TOBACCO VENDOR YES NO $50
ALL NON-PROFIT(such as church kitchens) 01�2 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. 1,4
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 y� y/���p Date Social Security or Federal Identification
Number fJ /1�G�
Revised 11/03/03 FOODAP2.adm CheccW&Date
i
0114 DERBY STREET House of the Seven Gables Settlement Pre-School
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Urgency Item Status Violation Critical Ur
Telephone: s v Nature of Problem or correction
745-5909 _ _ Non-compliance with: Not Done
Owner: „ Anti-Choking PASS ❑
The House of the Seven Ga Tobacco PASS ❑
PIC. " "
4c FOOD PROTECTION MANAGEMENT Not Done
Cathy Diffin PIC Assigned/Knowledgeable/Duties PASS ❑d RED
Inspector: _
David Greenbaum m - EMPLOYEE HEALTH Not Done
Date.Inspected: COrreCt By: ` " Reporting of Diseases by Food Employee and PIC PASS ❑d RED
9/29/2005 " Personnel with Infections Restricted/Excluded PASS RED
Risk Level:
FOOD FROM APPROVED SOURCE Not Done
"e Food and Water from Approved Source PASS RED
Permit Number:
BHP-2005-0352 = Receiving/Condition PASS RED
'Status: a �. Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED
VIOLATION Conformance with Approved Procedures/HACCP PASS RED
#of Critical Violations. _ i Plans
2
L Time IN: Time OUT:
Notes =
332:
Urgency Description(s):
BLUE:'
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 29,2005 ) Page I of
0114 DERBY STREET House of the Seven Gables Settlement Pre-School
must be corrected immediately ; PROTECTION FROM CONTAMINATION Not Done
or within 90 days) Separation/Segregation/Protection PASS RED
RED
Violations Related to Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑Q RED The dishwasher does not reach the
Foodborne Illness IrlteNentlOrlS mandated wash temperature of 150'F or
... the mandated rinse temperature of 180°F.
and Risk Factors (Require-1 Repair the diswasher to maintain these
immediate correctiveaction) mandated temperatures.
Proper Adequate Handwashing PASS ❑J RED
Good Hygienic Practices PASSd❑ RED
Prevention of Contamination from Hands PASSd❑ RED
Handwash Facilities FAIL Critical ❑d RED There is only warm at all handwash sinks.
Restore hot water to a minimum
temperature of 110°F.
PROTECTION FROM CHEMICALS Not Done
Approved Food or Color Additives PASS RED
Toxic Chemicals PASS ❑J RED
TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done
Cooking Temperatures PASS ❑d RED
Reheating PASS RED
Cooling PASS RED
Hot and Cold Holding PASS RED
Time As a Public Health Control PASS RED
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done
Food and Food Preparation for HSP PASS RED
CONSUMER ADVISORY Not Done
Posting of Consumer Advisories PASS 0 RED
GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 29,2005 ) Page 2 of 3
0114 DERBY STREET House of the Seven Gables Settlement Pre-School
Violations Related to Good Retail Practices (Blue Not Done
Management and Personnel PASS ❑ BLUE
Food and Food Protection PASS ❑ BLUE
Equipment and Utensils PASS ❑ BLUE
Water, Plumbing and Waste PASS ❑ BLUE
Physical Facility PASS ❑ BLUE
Poisonous or Toxic Materials PASS ❑ BLUE
Special Requirements PASS ❑ BLUE
Other-See Notes PASS ❑ BLUE Please notify the Board of Health within
one week that these violations have been
corrected.
GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 29,2005 ) Page 3 of 3
CITY OF SALEM
BOARD OF HEALTH
Name of Establishment: Gables Settlement
Address: 114 Derby Street
Owner(s): Karen Pelletier, Director
Phone: 978-745-5909
The Director of this establishment presented a preliminary Floor Plan for review
in accordance with the State Food Code.
This establishment serves breakfast and lunch to children and elderly.
FLOOR PLAN
A Hand Sink must be located in each food prep and service area.
Therefore there must be a hand sink in the prep area used exclusively for hand
washing. Awl7Ac
Hand sinks must have wall hung soap and paper towel dispensers. These
must be stocked at all times.
If the hand sink is located close to a food prep area, a splashguard may
be necessary to prevent cross contamination.
All floors, walls, and ceilings where food, utensils, paper products, etc, are
stored, prepared or served must be intact, impervious, and easily cleanable.
A two or three bay sink next to the dishwasher is allowed if all dishes, etc.
are sent through the dishwasher.
EQUIPMENT
All new equipment must be NSF (National Sanitation Foundation)
approved.
The dishwasher must wash, rinse and sanitize all dishes, utensils and
food equipment. Sanitizing in the dishwasher may be by 180 degree water in the
final rinse or by an automatically fed chemical sanitizer in the final rinse. There
must be an alarm with the chemical sanitizer to indicate when it is running low.
MENU/FOOD PREP
Any pre-made items must be purchased from a wholesaler licensed by the
State.
Fruits and vegetables must be washed prior to preparation. This may be
done in a bay of the sink. This bay must be sanitized before and after washing.
All food must be held at 41°F or lower, or 140°F or higher, at all times.
Therefore, soup should be brought to boiling before being held hot.
There may be no bare hand contact of ready-to-eat foods. Gloves, tongs,
or tissues must be used when handling such food.
CERTIFICATION
There must be a Certified Food Manager working at this establishment full
time. Information regarding upcoming classes was given to the owners. Both will
become certified.
When a CFM is not onsite there must be a Person-in-Charge (PIC) who is
fully trained in sanitation techniques and has a thorough understanding of the
operation.
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.
Outside area of premises, including the dumpster area, must be kept clean and
sanitary.
Please submit a final drawing of the planned renovations prior to construction.
G-� -o
ne Sc tt
Date
Health Agent
Ile
Dire dor Date
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!(!(LCCCFINE CM CABINETRY
DESIGNFA "TE REVISED SGLE NDMGEH
SGLEEACHS EEOWLSB- O •/ %L�
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,4'h Floor
Division of Food and Drugs Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Name Date/ Tpe of Operation(s) T &of inspection
rsSAL Ir d'N 'rr rw &re 2-//f• a- , 0 Food Service Routine
Address by 4dAev 43r
rA'A- rOW isk ❑ Retail ❑ Re-inspection
Telephoner Level, El Residential Kitchen Previous Inspection
7!264f 9 ❑ Mobile Date:
Owner HACCP Y/N [I Temporary ElPre-operation
/f/dD .{ �t/IF✓ ElCaterer El suspect Illness
Person in Charge(PIC) CM ^ Time ❑ Bed&Breakfast ❑ General Complaint
Inspector IOut:n Permit No. ElO herr-
Each violation ch cked 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 Ami-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
El13. Handwash Facilities
EMPLOYEE HEALTH
[:12. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS
E] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives
FOOD FROM APPROVED SOURCE E] 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 El21. Food and Food Preparation for HSP
❑ 11. Good Hygienic Practices CONSUMER ADVISORY. -"-
❑22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of lc'Health. 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of
26. Water, Plumbing and Waste (FC-5)(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,5900VFo -Nrloc
Inspector's Signatu' : Print:
PIC's Signature: Print: Page-/ ora---Pages
` 4 /
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT S Cross-contamination
I 590.003(A) Assignment of Responsibility" 3-302.11(A)(1) Raw Animal Foods Separated from
590.003(13) Demonstr doo of Knowledge* Cooked and RPL Foods"
`' I D311 Person in huge--duties Contamination from Raw Ingredients
3-302.11(A)(2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590.003(0) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11(A) Food Protection*
applicants*" 3-302.15 Washing Fruits slid Ve�etables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Fw.xd Contact with Equipment and
Applicant To Report To The Person Is Utensils*
Charge'" Contamination from the Consumer
590.003(G) Re orting by Person in Char e` 3-306.14(A)(B) Returned Food and Reservice of Food"
3 590.003(D) Exclusions and Restrictions" Disposltlon of Adulterated or Contaminated
590.003(E) Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 1 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501111 Manual Warewashing-Idot Water
3-201-12 Food in a Elennetica ly,Sealed Container*
Sanitization lam eranrzesY
3-201.13 Fluid Milk and Milk Products' d-501-1.12 Mechanieat Warewashing Hou Water
3-202.13 Shci(Eegs* Saninzation Tem meratures*
3-202.14 figs and Milk Products.Pasteurized" 4-�OLl14 C Concenternicalration
coni and
hard temp.,pH,
concentration andhudness.
3-202.16 ice Made From Potable Drinking Water" 4-601.1 h A) Equiptnent Food Contact Surfaces and
5-1.01-11 Drinkinn Water from an A raved System* Utensils Clean*
590.006(A) Bottled Drinking Water* 4_60211 Cleaning Frequency of Equipment 590.006(8) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils*
Food-
Shellfish and Fish From an Approved Source 4-702.1 t Frequency of Satutization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Waver and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 1p Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Reaulaton,Authoritv 2-301.1 1 Clean Condition-Hands and Arms"`
3-202.16 Shellstock Identification Present* 2-301-12 Cleanim, Pnxedure-
590.003(0) Wild Mushrooms* 2-301.1,4 When w Wash*
3-201.17 dame Animals* 11 Good Hygienic Practices
g ReceivinglCondition 2-401.11 Fntim, Drinking or LJsing Tobacco*
3-202.11. PI-IFs Received at Pro mer Tem meratuces* 2-401.12 Discharges From the Eyes.Nose and
3-202.15 Mouth*
3-101.1.1 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting*
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
3-2,02.18 Shellstock Identification" 5, .004(E) Preventing Contatnination from
3-203.12 Shellstock Identification Maintained' Ha to ges'"
Tags/Records:Fish Products 1.3 Condwasfi Facilities
Conveniently Located and Accessible
3-402.11 Parasite Destruction'
3-402.12 Records,Creation and Retention' 5.203.11 Numbers and Ca acities*
590.0040) Labeling of Ingredients' 5-204.11. Location and Placement'
7 Contormance with Approved Procedures 5-205-1,1 Accessibilit ,O ration and Maintenance
1HACCP Plans Supplied mm Soap and Hand Drying
3-502.11 S ecialized Processin>Methods" Devices
3-502.12 I Reduced oxygen packaging,criteria- 6-301.11 Ifandwashing Cleanser.Availability
8-103.12 Connimance with_A a roved Procedures* 6-301.12 Hand Drving Provision
*tknotefi mural ileirk in tine irderni 1999 Food Code u 105 CMR 590.000.
CITY OF SALEM
BOARD OF HEALTF,4hJo�
Iw� , ,�
Establishment Name:/Ptt��dUSti Qf Sdiawow4ws- rdq-�s hfj7 Date: !off Page: 2 of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION bate
No. Reference R—Red Item - Verified
PLEASE PRINT CLEARLY
/ICJ Aj_rl( r o e UfOL, F!7 sN riC*_W jAr:: 17#47S 17^4e_,--
Discussion
7iuDiscussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
Exclusion
violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of 13 Embargo L3 Emergency Closure
your food permit. /G'/`�1
C ❑ Voluntary Disposal ❑ Other:
i
'e i
r
3-501.14(0) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to
Factors(items 1-22) (Cont.) 41'F145°F Within 4 Homs.
PROTECTION FROM CHEMICALS 3-501.15 _ Coolins Methods for PHFs
19 PHF Hot and Cold Holding
Iq Food or Color Additives 3-501.16(B) Cold PHFs Maintained at of below
3-202.12 Adihnies" 590.004F) 41V4511 F*
3-302.14 Protection from Unapproved Additives* 3-501,16 1(A) Hot PHFs Maintained at or above
I5 Poisonous or Toxic Substances
140°F
7-I01.I1 Tdentifging Information-Or7gi,nat 3-501.1.6(A) Roasts Held at or above 130'F.
containers'
7-102.11 Common Name-Workinm Containers* 20 Time as a Public Health Control
7-201.11 1 Separation-Storage* 3-501.19 Time as a Public Health Control*
590.004(fi) Variance Requirement
7202.11 Restriction-Presence and Use* -
7-202.12 Conditions of Use°
7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Samtizers,Criteria-Chemic ds* POPULATIONS(HSP) _
7-2(}.1.12 Chemicals for Washing Produce,Criteria* 21 3-80'1.11(A) Unpasteurized Pre-packaged Juices and
Beier ties with R n�mg atbels*
7-204.14 Dr m A*eats,Criteria" 11-801,11(B) Use of Pasteurized E .s*
7-205.11 Incidental Food Contact, Lubricants* oll
3-801.1 1(D) Raw or,Partially Cooked Ammal Food and
7-206-1 Restricted Use Pesticides.Criteria*
Raw Seed.Sxoats Not Served.
7-206.12 Rodent gait Stations" 3-801.1I(C) Unopened Food Package Not Re-served
7-206.13 'Pracking Powders.Pest Control and
Monitcrin•**
CONSUMER ADVISORY _
TIMEfrEMPERATURE CONTROLS 22 3 603-11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Focxls'1'hat are Raw_Undercooked or
PHFs Not Otherwise Processed to Eliminate
3.40'1.11 A(1)(2) F.vs- 155'F 15 Sec.
Pathogens. ENxu�e r e noel
Eyes-Immediate Service 145°FlSsec* 3-302.13 Pasteurized Fggs Substitute for Raw Shell
3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs*
Animals- 155°F 15 sec. ,v
3-407.11(BSPECIAL REQUIREMENTS)(I)(2} Park r---
3-401.11(A)(2) ttafites,Injected Meats 155`F 15
590.009(A)-(D) Violations of Section 590.009(A)-(D)in
sec.* catering,mobile food,temporary and
3-401.11(,,)(3) Poultry,Wild Game,Stuffed Fl s, residential kitchen operations should be
Stuffing Containing Fish,Meat, debitedunder the appropriate sections
Poultry or Ratites-165°.F 15 sea. #` above if related to foodborne illness
3-401.11(C)(3) Whole-muscle,Intact Beat Steaks interventions and risk factors. Other
145°F* 590.009 violations relating to good retail
3 401.12 Raw Animal Foods Cooked in a practices should be debited under 7129-
Microwave 165°F* Special Requirements.
3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.
I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.11(A)&(D) PHFs 765°F 15 sec. * (Items 23-30)
3-403.11(B) Microwave-165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the
Time* foodborne illness interventions and risk factors listed above, can lac
3-403.11(C) Commercially Processed I2T5 Food- fnind in the.f'allowing sections of the Food Code and 105 CMR
140'F" 590.000.
3-403.11(5) Remaining Unsliced Portions of Reef Item Good Retail Practices FC ( 590.000
Roasts" 23. Mann ement and Personnel._. FC-2 .00
lA Proper Cooling of PHFs 24. Food and Fcod Protection _ FC--3 .004
e _ .005
3-501.J.4(A) Cooling Cooked PHFs from 140`F to 26. Equipment and Utensils FC 4 Water, Plumbin and Waste FC 5 .006
70°F Within 2 flours and From 70°F 27. Ph sical Facility FC-6 .007
to 41"F/45°F Within 4 Hours 28 Poisonous or Toxic Materials I FC-7 1 .008
3-501.14(B) Coohng,PHFs Made From Ambient 29 S eaial Re utrements -_ __ ; .008
'temperature Ingredients to 41°F145°F -30___ Other T-
Within 4 Hours* savor,,,,�.ao.aav
Denotes critical item in the federal 1999 Food Code or 105 CMR 590000.
y^ ; ^'n3}r1,of .4. Sk h ry7 ti•n+v.. ic:L't 2.t`%L X.,i+ �y'G,.. t4",+- ..n, n #" s4, r '["`
"K IV, 'k' i4 -4 m ynA lyt -`b•4 .F v. "$ ) w<.
.a. ? .a :'� e, Yse:.• xi w� ; a { t�...�;r-••b"S�..a� -Ys n' r;n+u,+ +�' �rcr'�.•��,m:,+
--t,,gFiaUC1TY40F,4SALEl%9 ,MASSA_ CHUSETTS -
.� wt ' eBOARD
-1 µOF HEALTH
m l . .
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01470
•
.-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: House of the Seven Gables Settlement Pre-School
Address of Establishment: 114 Derby Street
Owner's Name: House of the 7 Gables Settlement
Restrictions:
Application Date: 12/16/2004
Permit for Food Establishment 238-05
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.
HEALTH AGENT
CITY OF SALEM,, MASSACHUSETTS
BOARD OF HEALTH
'i I ZO WASHINGTON STREET, 4TH FLOOR
SALEM, MA 4197D
.Mar• TEL.876-741.1606
FAX 47&745.0383
STANLEY J. LI'SOVICZ, JR, JOANNE SCOTT, MPH, R$, CIAO
MAYOR HEALTH Acu"T
2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
7ht HouSt of -fhcSe%ltn Gab Ks
NAME OF ESTABLISHMENT TEL
# 978-7ys�55o5 ,
ADDRESS OF ESTABLISHMENT
!1 r{ 7]3�hv SrrttT
r
MAILING ADDRESS (if different)
OWNER'S NAME_#V/JrJ1V di -4\�rC `fn6kbks &,ftll»enffhSOC• TEL
# 978-7y9-o%il
ADDRESS 5Y Tv✓h 6l- shYne r
5i
CITY )Gm STATE /soh
ZIP W7o
CERTIFIED FOOD MANAGER'S
NAME(S) 6eo•�,iv Fim
eon CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON KG�6n B Pclk,fit/ HOME TEL
# 97fi-7'W-53oo
HOURS OF OPERATION:
Mon.$-5_30 Tuef-S3dWed.Es:S Thu.T--5=3a Fri.V6-30Sat. Sun.
TYPE OF ESTABLISHMENT FEE check only
RETAIL STORE YES O less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft.=$250
RESTAURANT YES NOless 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 Y NO $50
ALL NON-PROFIT(such as church kitchens) E 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.
i 4
•i
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 11073-6 V-Social Security or Federal Identification
Numb79
OwJ�dy3ay
Revised 11/03/03 FOODAP2.adm ChecW&Date _
w �
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
�= SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
COMMONWEALTH OF MASSACHUSETTS
PERMIT TO OPERATE A FOOD ESTABLISHMENT
In accordance with regulations promulgated under authority of Chapter 94,
Section 305A and Chapter 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: House of the Seven Gables Settlement Pre-School
Address of Establishment: 114 Derby Street
Owner's Name: House of the 7 Gables Settlement
Restrictions:
Application Date: 12/30/2003
Permit for Food Establishment 239-04
Frozen Desserts/Ice Cream
Permit for the Sale of Tobacco Products
These Permits Expire December 31, 2004
This permit is not transferable and must be reissued upon change of
ownership or location. The permit must be posted in a prominent location
in the Establishment,
In accordance with the State Sanitary Code, before any renovations,
improvements, or equipment changes are made, all plans for such must be
submitted to and approved by the Salem Board of Health.
HEALTH AGENT
CITY OF SALEM$ MASSACHUSETTS
ou
((DOD-
HOARDOF HEALTH 120 WASHINGTON STREET, 4TH FLOOR DEC �� ���
SALEM, MA 0197
TEL. 97877410-1600
43
FAX 978-745-0343 Ci(lY O SALEM
STAN LEV USOVICZ, JR. BOARD
JOANNE SCOTT, MPH, ft5, CHO BOARD ��= HEALTH
MAYOR HEALTH AGENT
2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT {{082 }}se$gym tssc6{{i Se++tzm Grin TEL # �Q1ff)74S—SRQcf
ADDRESS OF ESTABLISHMENTI{Ll bfX�tl 5bet�
MAILING ADDRESS (if different)
OWNER'S NAME 11 5e+tit�ltpli �$
�e F{ 0� �+C to [,a6IvS TEL#(gl8)74U-LJ (
ADDRESS 54 Tyrmer Stint*
CiT`f SaitM STATE M ZIP Q1s}�Q
CERTIFIED FOOD MANAGER'S NAME(S)6cor�jne f7elmo n CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON_Q( 6,QtI1G}i$( HOME TEL# + $)?yq-53(Ja
HOURS OF OPERATION: Mon.".5, 1•S30Wed.$$: Thu.6_ S!.3Fri.!-mat. Sun.
TYPE OF ESTABLISHMENTFEE check only
RETAIL STORE YES L.%) less than 100osq.ft. =$50
1000-10,000sq.ft. =$100
more than 10,000sq.fL =$250'
RESTAURANT YES NO less than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR �! YES $50
ALL NON-PROFIT(such as church kitchens) ! ES O $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made,all plans for such must be submitted to and approved by the Salem Board of
Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my
best�knowied e a belief, have filed all state tax returns and paid all state taxes required under the law.�•
r,.�i
Siglhature Date Social Security or Federal Identification Number
--------- — ------__----------------- ----------------------/ -------------------ala-)ori-32y
Revised 11/03/03 FOODAP2.adm Check#d Date
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 T of 0 eration(s) Tvoe of InsDection
e /> .SE I/f J7 �l b Sr t//� u r/ oL-S.U` [�} Food Service 0 Routine
Address / Risk [I Retail ElRe-inspection
// P?�4 Level t El Residential Kitchen Previous Inspection
Telephone /
El Mobile Date:
Owner HACCP YM ❑ Temporary ❑ Pre-operation
/f-V,SeOh �rl/Pe % S Se -Env ,f S ❑ Caterer El Suspect Illness
Person in Charge(PI C�p Time ❑ Bed&Breakfast ❑ General Complaint
In: ❑ HACCP
Inspector 7 AeOCW VZ4i v -rn?_ee xL Out: Permit No. ❑ Other
Each violation checked requiies an explanation on the narrative page(s) and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
El- - - - 13. Handwash Facilities
EMPLOYEE HEALTH
"PROTECTION FROM CHEMICALS ?.
❑ 2. Reporting of Diseases by Food Employee and PIC
[:114.Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded
EI 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE -
❑ 4. Food and Water from Approved Source ! TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) T
❑ 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
[:1 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing : REOUIREMENTS 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
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 ' xJ P 9
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
25. Equipment and Utensils 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:ssoIn p&Form 14 doc
t,s ector' Sig ure: ✓) ��/ ,%EL.✓ Print:
PIC's Signature: /v '� / Print: / Page_/ of QPages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1.22)
PROTECTION FROM CONTAMINATIONP
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
1 590003(A) I Assignment ofResponsibility* -� 3 '02.11(A)(1) RawAnimidFo(AsSeparated from
590.003(B) _Demonstration of Knowledge" Cooked and RTE Foods*
2-103.11 Person in ehuee--duties � Contamination from Raw tngredients
3-30111(A)(2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other"
2 590.003(0) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.7 I(A) Food Protection"
applicants* 3-30115 Washine Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee 01 An 3-304.1.1 Food Contact with Equipment and
Applicant To Report To The Person In Utensils''
Charae" Contamination from the Consumer
59Q.003(G) Re ortin-by Person in Char e* 3-306.14(A)(B) Returned Food and Resef vice of Food*
,3 590.003(D) Exclusions and Restrictions* Disposition ofAduiterated or Contaminated
590.003(E) Removal of Exclusions and Restrictions Food
3-701..11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) _Compliance with Food Law* 4-501.111 Manual War ewashing-Hot Water
3-201.12 Food in a Hermetically Settled Container* Sanitization Tem aeranttes*
3-201.13 Fluid Mill,andMilk Products* 4-501..112 MedianicalWarewashing-Hot Water
7202.13 Shell Eggs* Sanitization Tem teramres"
3-2D?-14
4-501.114 Chemical Sanitization-tem H,
1.'s *s and Milk Products.Pasteurized" p"p
3-20116 fee Made From Potable Drinking Water* concentration and harchtess
d-601,11(A) Equipment Food Contact Surfaces and
5-101.11 1'arinkinn Water from an Approved System* Utensils Clean*
590.006(4) Bottled Drrnkin Water 4-602.11 Cleaning Frequency of Equipment Food-
590.006(B) Water Meats Standards in 310 CMR 22.0`" Contact Surfaces and Utensils*
Shellfish and Fish From an Approved Sourco 4-702.'11. Fv-equency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment*
Shellfish* 4-703.11 Methods of Sanitization--HotWaterand
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 10 Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Reoulaton,AlthOri 2-301.11 Clean Condition-Hands and Atns*
3-202.18 Shellstock Identification Present* 2-301-12 Cleaning Procedure*
590.004(0) Wild Mushrooms* r
2-301.14 When to Wash*
3-201.17 Game Animals" L1 _ Good Hygienic Practices
Receiving/Condition 2-401.11 Eating,Drudrmg or Using Tobacco*
3-202.11 111IFs Received at Proper Temperatures" 2-401.12 Discharges'From the Eycs.Nose and
3-202.15 Package'httegrit y* Mouth`
3-101.11 Food Safe and Unadulterated'" 3-301.12 Preventing Contamination When Tasting*
6 Tags/Records:Shenstock 12 Prevention of Contamination from Hands
3-202.13 Shelklock Identification* 590.0(14(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Enl lovees*
Tags/Records:Fish Products 13 Handwash Facilities
3402.11 ParasiteDestruction'0 Conveniently Located and Accessible
3-40?12 Records,Creation and Retention"
5-20311 Numbers and Capacities*
590.004(7) Labeling of Ingredients' 5-204.11, Location and Placemen"
7 Conformance with Approved Procedures 5-20511 Acceesibllit , Operation and Maintenance
lHACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502-12 Reduced oxygen paekeaing,criteria* 6301.11 Handwashing Cleanser-Availabifit
8-103.12 Conformance with Approved Proceduress; 6-301.12 Hand Dr'vin,>Provision
*Denotes critical irem in rhe federal 1999 Food Code or 105 CMR 590,000.
CITY OF SALEM
i' / BOARD OF HEALTH
Establishment Name:11,-, � �'� Date: ,y -S- e_-'. el Page: oZ of C�2_
DESCRIPTION OF VIOLATION/PLAN OF CORRECTION
Item Code C-Critical Item Date
No. Reference R-Red Item. - Verified
'r -- - - -- - PLEASE POINT CLEARLY
IV(f i�� Srpvrc rusr% ch✓rn 4 ye 71a
,
�5 Spade OU�2 - 2Gtc�rc ✓ti, r/>e.
627 tiL/.i,�+ jLuekPSCPrif chf �i Tib e il/?P�fS Pc �?r7✓ ( i) as
t v
i
t
✓ e a �f �imer7:��s 's Ad Gvi � ja/JM/t
� ✓ fid tin��s�i�-ro}�r ✓ � �
r t,/ e 1�?`,e.elnl ,U4/G-e — GAG/s"iCLf'r� ��/'JP�+� ��Gy/I`7GL11
� v Food�7ri s
I/ SH-ry/'f7zr +U� - .� P�� c cqf .5c�eoG
v �Au te ere 7, 'Xov _� �?GorieS title n/ `
s, [
✓ P/QSCr77 /N c'Lid�' Y�
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
11
I have read this report, have had the opportunity to ask questions and agree to correct all.- ❑ Voluntary Compliance ❑ Employee Restriction/
violations before the next inspection, to observe all conditions as described, and to Exclusion
p ❑ Re-inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revoc6ation of ❑ Embargo ❑ Emergency Closure
your food permit. (� I —_ �
�e/(2 ❑ Voluntary Disposal ❑ Other:
i/ /
3-501.1.4(0 PHFs Received at Temperatures
Violations Rotated to Foodborne Illness Interventions and Risk Accerdim,to Law'�Cooled to
Factors(items 1-22) (Cont) 41'F/45'F Within 4 Houts.
PROTECTION FROM CHEMICALS 3-501.15 C x>]in Metho s Tor PHFs
14 Food or Color Additives 1g PHF Hot and Cold Holding
3-501.16(8) Cold 11111'sNlaintalned at or below
3-302.14 Prelection 3 202.,12 Additives*s`s 590.004(F) 41'145'F*
on from Una r.awed Additives" 3-501.16(.4) Hot PHFs Maintained at or above
g Poisonous or Toxic Substances
40'F. *
7-101.11 Identifying Information-Original 3-50L16(A) Roasts Held at or above 130`F.
Containers"
7-102.11 Cornmon Name-Working Containers*
20 Time as a Public Health Control
7-201.L I Separation-Sto tea"
„1-501.19 Time as a Public Health Control*
i
7-202.11 Restriction-Presence and Use`" 590.004(H) VarianceRecuiretnem
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HS
7-204.12 Chemicals for Washing Produce. Criteria* 3-801.11(,A) Unpasteurized Fre-packaged Juices and
7-2 2104.14 Dryuc, Aoents,Criteiia" Beverages with warninv Labels*
7-205,11 Incidental Food Contact,Lubricants* 3-801.11(13) Use of Pasteurized Fc-s"
7-206.11 Restricted Use Pesticides,Criteria* 3-801.110) Raw or Partially Cooked Animal Food and
Tracking Raw Seed Sprouts Not Served.
7-206,12 RodTracBait Stations* 3-80'I.11(C) Uno aened Fol Parka re Not Re-served."`
7-206,13 cki ng Powders,Pest Control and
Monitoring*
CONSUMER ADVISORY
TIMElTEMPERATURE CONTROLS 22 3-603.11 Consmner Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or
PHFs Not Otherwise Processed to Eliminate
Pathogens.sre=attar ;egad
3-401.114(1)(2) Eggs- li5°F19Sec
L 3. 0213 Pasteurized rs Immedi rte Service - �' gs Substitute for Raw Shell
3 401.11(A)(2) Comminuted Fish.Meats&Game
Animals-155'F 15 see.
3-401.11(13)(1)(2) Pork and Beef Roast- 130'F 121 nue* SPECIAL REQUIREMENTS
3-401.11.(A)(2) Ratites, Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(I))in
sec. * catering, mobile food, temporary and
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be
Stuffing Containing Fish,N4eat. debited under the appropriate sections
Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness
3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other
145°F* _ 1 590.009 violations relating to good retail
3-401.12 Raw Animal Foods Cooked in a practices should be debited under#t29-
Microwave 165`F* Special Requirements.
3-401.11(A)(1)(b) All Other PHFs - 145'F I5 sea
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.1.1(A)&(D) PHFs 165°F 15 sec. * (Items 23-30)
3-40311(8) Microwave- 165'F 2 Minnie Standina Critical and non-critical violations, which do not relate to the
Time" foodborne illness interventions and risk factors listed abore, canoe
3-403.1.I(C) Commercially Processed RTE Food- found in the following sectioi s of the Food Code and 105 CMR
14WF* 590.000.
3-403.11(E) Remaining Unsliced Portions of Beef Item I, Good Retail Practices FC 590000
Roasts* 23 �Managemi t and Personnel I FC-2 .003
24 Food and Food Protection FG 3 .004
1g Proper Cooling of PHFs - - -- _065
--�
3-501 A,I(A) Coottne,Conked PlIFs from 140°F to �6. W ter Plumbing and W ante FC-5 006
25 E til merit and Utensils _ _ FC 4 00
70'F Within 2 Hours and Front 70°F Physical Facuit FG 6 007
to 41"F145'F W rthin 4 Hours. * (28 L Poisonous or Toxic Materials FC-? 008
3-501 14(B) Cooling PHFs Made From Ambient 4 29 Special ftequlrements 009
_. _-
TemperatureIn�,ied(enLsUr41°FJ45°F 30 Other ;_
Within 4 Hours, s ' """'*"
*D rome,crural iters in the federal 1999 Frwd Code or 10i CMR 590.000.
. ..�..,......a..-..Pvu..:�.+,;.,.e.,...ebv'i%...+i.�tRi.s`A'�,..A�M4'..�:^r+A.""v� `w..yM,..,^'"""„w•rr"...
- *HE 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 ,/ T fOperation(s) T f In i n
/VddS Of wu.S Ivat P s, i' 7 jnr L NO/ ood Service Routine
Address Risk ❑ Retail ❑ Re-inspection
11 rr Levelq ❑ Residential Kitchen Previous Inspection
Telephone "I Sr - 96
_ EMobile Date:
Qwner HACCP Y/N ❑ Temporary ❑ Pre-operation
/ !>< E Wr rrr rroe- ❑ Caterer ❑ Suspect Illness
Person In Charge(PIC)
'nf �! Time ❑ Bed 8 Breakfast ❑ General Complaint
In: ❑ HACCP
Inspectors � .J� ✓ uK� Out: Permit No. ❑ Other
Each violation checked re ires an explanation on the narrative page(s) and a citation of specific provision(s)
violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health. Local Law ❑
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/ Knowledgeable/ Duties
❑ 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El2. 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)
El 4. Food and Water from Approved Source
El 16. Cooking Temperatures
[15. Receiving/Condition
Eq 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
D 7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling
El 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION
❑ 20. Time as a Public Health Control
❑ B. Separation/Segregation/ Protection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 21. Food and Food Preparation for HSP'
❑ 10. Proper Adequate Handwashing
CONSUMER ADVISORY
❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related
Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/Federal Food Code.This report, when signed below
C N by a Board of Health member or its agent constitutes an
23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of
25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
AN
n ect- s Sign re: , L / r f Print:
PIC's Srgnature� A Print: Page or LPages
0 � .
FORM 734A HOBBSa WARREN - TON
Violations Related to Foodborne Illness
Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION
I'8 Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Sepa'ated from
,1''• 590.003(A) Assignment of Responsibility* Cooked and RTE Foods*
590.003(6) Demonstration of Knowledge* Contamination from Raw Ingredients
2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each
Other*
EMPLOYEE HEALTH Contamination from the Environment
2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection*
require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables
Applicants
3.304.11 Food Contact with Equipment and
590.003(F) Responsibility of a Food Employee or an Utensils*
Applicant to Report to the Person in
Charge* Contamination from the Consumer
3-306.14(A)(B) Returned Food and Reservice of Food*
590.003(G) Reporting by Person in Charge* Disposition 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 g; Food Contact Surfaces4l Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water
590.004(A-B) Compliance with Food Law* Sanitization Temperatures*
3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water
3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures*
3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,PH,
3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness*
3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and
5-101.11 Drinking Water from an Approved System* Utensils Clean*
590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food-
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils*
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*
`.'SQ_ Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms*
2-301.12 Cleaning Procedure*
3.202.18 Shellstock Identification Present* 2-301.14 When to Wash*
590.004(C) Wild Mushrooms*
3-201.17 Game Animals* 11 Good Hygienic Practices
2-401.11 Eating, Drinking or Using Tobacco*
5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and
3-202.11 PHFs Received at Proper Temperatures* Mouth*
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting*
3-101.11 Food Safe and Unadulterated* 12. Prevention of Contamination from Hands
5• 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(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance
7% Conformance with Approved Procedures Supplied with Soap and Hand Drying
x : 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: Mat/, W of PSfgg f 64&6&S Date: T ()q Page: � of O�
Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R Red Item Verified
' PLEASE.PRI T. LEAR
- l Dl• !J
e' -b itch b
-y _ olc
i
EXE �
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
violations before the next inspection, to observe all conditions as described, and to Exclusion
p
comply with all mandates of the Mass/Federal Food Code. I understand that ❑ Re-inspection Scheduled ❑ Emergency Suspension
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure
,pur food permit. C�
❑ Voluntary Disposal ❑ Other:
i
3-50L14(C) PHFs Received at Temperatures
Violations Related to Foodborne fitness Interventions and Risk According to I�aw Cooled to
Factors(items 1-22) (Cont.) _ 41'Ft45'F Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
I4 Food or Color Additives 14 PHF Hot and Cold Holding
3-501.16(13) Cold PI-IFs Maintained at or below
Add
3-302.1,4 Protection 3-202.12 Prot ctian on P590.004(F) 41°145'F*
rom Uua roved Additives"
IS Poisonous or Toxic Substances
3-501.16(A) Hot PHFs Maintained at or above
40'F.
7-101.11 Identifying Infbnnation-Origintd 3-50L16(A) Roasts Held at or above 130'14.
_ Containers*
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Slot aRc'* 3-501,19 Time as a Public Health ControPt
7-202.11 Restriction-Presence and Ilse'" 590.004(H) Variance Rec uircment
7-202.12 Conditions of Use"
7-203.11 Toxic Containers--Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce-Criteria'* 21 3-801.11(,A) Unpasteurized Pre-packaged Juices and
7-204.14 Drvin_>Aoents.Criteria" Bever ages with Ru'nm�Labels'
7-2g5.1.i Incidental Food Contact,Lubricants*
3- 801.11(B) Use of Pasteurized F as*
7-206.11 Restricted Use Pesticides,Criteria* 3-301 11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* RawSeed S xouts Not
3-801.]1(C) Uno ened Food Package Not Rc-served-
7-206.13 Tracking Powders, Pest Control and -
Rloniforin
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisort Posted for Consumption of
16 Proper Cooking Temperatures for
Animal Foods That are Raw.Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-001.11r1(1)(2) Eggs- I55'F li Sec
Pathogens.': e"acme vr;aom
Lu s-Immedi ate Service 145`F15sec* 3-302.13 PasteurF,ed Fags Substitute for Raw.Shell
3-401-11(A)(2) Comminuted Fish, M", is&Game gnos*
Animals- 155`F 15 sec.>,
3-401.,11(13)(1)(2) Pork and Beef Roast- 130°'F 121 min* SPECIAL REQUIREMENTS
3-401.11(A)(2) Raotes,Injected Meats-1.55'F 15 590'009(.A)-(D) Violations of Section 590.009(A)-(ll)in
see. * catering mobile food, temporary and
3-401.11(A)(3) Poultrv,Wild Game.Stuffed PHN, residential kitchen operations should be
Stuffing,Containing Fish,Meat, debited under the appropriate sections
Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness
3=101.11(C)(3) Whole-muscle, tmact Beef Steaks interventions and risk factors. Other
145-F* 590.009 violations relating to good retail
3-401.12 Raw Animal Foods Cooked in a practices should be debited tinder#29-
Microwave 165`F*- Special Requirements.
3-401.11(A)(1)(b) All Other PHFs- 145'F'15 sec.
I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403-11(A)&(D) PHFs 165'F 15 scc. * (Items 23-30)
3-403.11(13) Microwave- 165°F 2 Minute Standim� Critical and non-crilieal ablations, which do not reline to the
'rime" foodborne illness boen,eruions and risk factors listed above, can be
3-403.1.1(C) Commercially Processed I2TE Fail- ,found in the following sections of the Food Code and 105 CAIR
14WF" 599.000.
3-103.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000
Roasts* 23 _ tAana�ement and Personnel FC-2 .003
Ig Proper Cooling of PHFs 24 _._Food and Food_Protection _ FC-3004
25 E_gmpment and Utensils „_ FC 4 0005
06
3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water Plumbin and Waste _ FC-5 1
70°F Within 2 Hours and From70'F 27. Ph sical Facila FC-6 .007
to 41'F145'F Within 4 Hoors. * 28.28. Poisonous or Toxic Materials I FC-'7 .008
3-501.14(B) Cooling PHFs Made From Arnbient l 29 Special Rem, uirements i .009
- --
Temperature ingredients to 41'F145F LM. Other
Within 4 Hours* •"i10'°"'"" ""`
*Do mes crincat iters in thefederal 1999 Food Code or 105 C.\4R x90.000.
I CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
3
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
.� TEL. 978-741-1800
FAX 978-745-0343
STANLEY LISOVICZ, JR! JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
COMMONWEALTH OF MASSACHUSETTS
PERMIT TO OPERATE A FOOD ESTABLISHMENT
In accordance with regulations promulgated under authority of Chapter
94, Section 305A and Chapter III , Section 5 of the General Laws, to operate
a Food Establishment in the City of Salem is hereby granted to:
Owner' s Name : House of the 7 Gables Settlement
Name of Establishment : House of the Seven Gables Settlement Pre-School
Address of Establishment : 114 Derby Street
Type of Establishment : FOOD SERVICE
Application Date : 12/24/2002
Restrictions:
Permit for Food Establishment 150-03
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
r
Is,
o CITY OF SALEM, MASSACk1USETTS
3
BOARD OF HF.:ALTH [�r.1 n(y
$ ` 120 WASHINGTON STREET, 4TH FLOOR Gt1✓ L U LnnnUUZ
3
SALEM, MA 01970
TEL. 978-741-1800Ij
FAX 978-745-0343 SOAF..-i '„ w.. .-I rJ
f
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO Vt'1
MAYOR HEALTH AGENT
2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMEWThe House of the Seven Gabl(T!EL# 978-745-5909
ADDRESS OF ESTABLISHMENTtlement 114 Derby Street Salem MA 01970
MAILING ADDRESS (if different) Same
OWNER'S NAME The House of the Seven Gables Settleme9ftL#978-744-0991
Association
ADDRESS54 Turner , Street
CITY Sal -- STATP __ ZIP 01970 __
CERTIFIED FOOD MANAGER'S NAME(S)Georgine�e on CERTIFICATE#(S) 714162
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON Stanley Burchfield HOME TEL#378-744-3577
HOURS OF OPERATION. Mon. X Tue. X Wed. X Thu. X Fri. X Sat. Sun.
TYPEOFESTABLISHMENT 7: 30 a.m. - 5: 30 p.m. 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 less than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5
TOBACCO VENDOR Y NO $50
ALL NON-PROFIT(such as church kitchens YES NO /A-63 $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made, all plans for such must be submitted to and approved by the Salem Board of
Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
be:t knowledge and belief, have filed all state tax returns and paid all state taxes required under the law.
84 ' 8432.4
Sig ature Dae Social Security or Federal Identification Number
Revised 11/25/02 FOODAP2.adm Check#8 Date w os-73 - 5 L5•
1:2'z5-,
i�
_... VCO `MONVVEA,LT'H
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 //'' _ ,q� Date ` Type of Ooeration(s) Tvoe of Inspection
t0 - S Uv ) Z r7 X TZ] Food Service Routine
Address �/ i / Risk ❑ Retail Re-inspection
Level ! ❑ Residential Kitchen Previous Inspection
Telephone G'1 '7 (-�_ �l�v r
J / El Mobile Date:
Owner y,� _r /'' �- HACCP Y/N El Temporary El Pre-operation
`� L ❑ Caterer ❑ Suspect Illness
Person In Charge(PIC) j �. I Q ` :�•\Q P-` Time ❑ Bed&Breakfast ❑ General Complaint
l�-✓'TCI 1 , TC In: ❑ HACCP
Inspecto- rC-&'\L_-7�>c Out: Permit No. ❑ Other
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 (Red Items) Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health. Local Law ❑
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/ Duties
❑ 13. Handwash Facilities
EMPLOYEE HEALTH
❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS
El3. Personnel with Infections Restricted/ Excluded ❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE
'
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
.
❑ 16. Cooking Temperatures
?" ❑ 5. Receiving/Condition
❑ 17. Reheating
❑ 6. Tags/ Records/Accuracy of Ingredient Statements
[17. Conformance with Approved Procedures/HACCP Plans El 18. Cooling
El 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION
❑ 20. Time as a Public Health Control
❑ 8. Separation/Segregation/Protection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ,
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
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: / Print:
PIC's Signature: /1 /` T� Print: - Page/ OZ Pages
g g g
FORM 734A HOBBS&WARREN -BOSTON
r
Violations Related to Foodborne Illness
Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION
8 Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from
1 590.003(A) Assi nment of Responsibility* Cooked and RTE Foods*
590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients
2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each
- Other*
EMPLOYEE HEALTH Contamination from the Environment
2: 590.003(C) Responsibility of the Person in Charge to 3-302.1 I(A) Food Protection*
require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables .-
Applicants*
3.304.11 Food Contac[with Equipment and
590.003(F) Responsibility of a Food Employee or an Utensils*
Applicant to Report to the Person in
Charge* Contamination from the Consumer
3-306.14(A)(B) Returned Food and Reservice of Food* -
590.003(G) Reporting by Person in Charge* Disposition o/Adulterated or Contaminated
II"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 SOURCEg' Food Contact Surfaces
'4r 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'P
Sg 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*
-10L Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms*
2-301.12 Cleaning Procedure*
3.202.18 Shellstock Identification Present* 2-301.14 When to Wash*
590.004(C) Wild Mushrooms* .,11 Good Hygienic Practices
3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco*
5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and
3-202.11 PHFs Received at Proper Temperatures* Mouth*
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting*
3-101.11 Food Safe and Unadulterated* ' 12, Prevention of Contamination from Hands
<6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from
3-202.18 Shellstock Identification* Employees*
3-203.12 Shellstock Identification Maintained* F1_3 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` 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
/�
Establishment Name: C9S :LS �MZA.Q BOARD OF HEALTH Date: � a3 Page: of
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
<� No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
S—
ri1C i d� cc:b -
u
t
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
inspection, to observe all conditions as described, and to Exclusion
violations before the next ins
P ❑ Re-inspection Scheduled ❑ Emergency Suspension
C, 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
?ur food permit. d
❑ Voluntary Disposal ❑ Other:
3-501.1.4(C) PHFS Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk Accgrdin,to Law Cooled to
Factors(items 1-22) (Cont) 41.'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
3-501.I6(B) ColdPHFs Maintained at or below
3-202.12 Additives* 590.004(F) 41g/45'F'*
3-302.14 Protection train Unapproved Additives'r 3-50L16(A) Hot PHFS Maintained at or above
15 Poisonous or Toxic Substances
40°F. *
7-101.11 Identifying information-Original 3-501.16(A) Roasts Held at or above 130'F.
Containers*7-102.11 Common Name-Working Containers:x �� Time as a Public Health Control
7-301.1.1 Se.aration-Stora e*
3-501.1.9 Time as a Public Health Control"
7-202.11 Restriction-Presentee and Use'' 590.004(11) VwiauceRe ulrernent
7-202.12 Conditions of Use*
7-203.11 'Poxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sauidzers.Criteria-Chemicals* POPULATIONS(HSP)
7-204.13 Chemiels for Washing Produce,Criteria* 21. 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Revert acs with Waruing Libels*
3-801.11(}3) Use of Pasteurized Eggs*
1-205.11 Incidental Food Contact,Lubricants* 3.801 11(D) Raw or Partially Cooked Animal Food and
7-206.11 Restricted Use Pesticides,Criteria*
Raw Seed S gouts Not Served
7-206.12 Rodent BaitSa6ons" 3-801AI(C) LJno.ened Foor1 Pucka e NotR -served.
7-206.13 Tracking Powders, Pest Control and
Monitoring" CONSUMER ADVISORY_ _
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
Animal Foods That are Raw. Undercooked or
1.6 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate
PHFS . =net Processed
3-401.11A(1)(2) Eggs- 155'F 17 Sec Pathogens `
Ea s-Immediate,Service 115`1715sec+ 3-302,13 Pasteurized Eggs Substitute for Raw Shell
3-401.11(A)(2) Comminuted Fish, Meals&Game F'g''*.
Animals- 155'F 15 sec. * SPECIAL REQUIREMENTS
3-401.1I(B)(1)(2) Pork and Beef Roast- 1.30'F t2'1 min" 5�0.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.11(A)(2) Ratites,Injected Meats- 155'F 15
sea * catering, mobile food, temporary and
3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFS, residential kitchen operations should be
mumns Containing Fish,Meat, ... hw,a ,.ader the 'rr ol:
Poultry or Ratites-165'F 15 sec. * above if related to Foodborne illness
3401.1 I(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other
145'F* 590.009 violations relating to good retail
3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-
Microwave 165'F* Special Requirements.
3-401.H(A)(I)(b) All Other PHFs- 145'F'15sec. *
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.1.1(A)&(D) PHFS 165°F 15 sec. * (Items 23-30)
3-403.1.1(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the
Time* foodborne illness interventions and risk facrots listed above, can be
3-401,1.1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR
1401;* 590.000.
3-403.1I(E) Remaining Unsliced,Portions ofBcc Item I Good Retail Practices - FC 590.000-71
Roasts* �23 Mamgement and Personnel FC-2 .003
ig Proper Cooling of PHFS 24. Equipment___ Food and Food Protection FC-3 004
'F to
3-501.14(A) Cooling 7t)'F V\i hin 2cHpu runci Fros Item ut)70`F 26. hate aPlumbi 4 and Waste FC 6 00
_ 05
Facilit
to 4101-/45°F Within 4 Harris. * 1 28. Poisonous or Toxic Materials FC-7 .008
3-501.14(B) Cooling PHFS Made From Ambient i25-�I Special Requirements _ .009
1
Temperature Ingredients to 41"F/45`F 30. ; Other
Within 4 Hours*
Denotei ediicat i[em in the federal 1999 Foal Cale or 105 CMR J90.000.
.n,.... .. .-....J.. ...... ... .............. ...-..�-. �...• .. �.�....�.... ..n...JM MM.QY1N '-.wm-M+e-.r'.r.rv...-.+�v"-•-'^�-e�w�"^.T-� �.l^'tv""o+..-..i..�.-..�..r-YN..'�.....- .... ni-
Y
. THE,COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM Address: 120 Washington Street, 4th Floor
BOARD OF HEALTH Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343
Name Date Tvne of Onerationta) T f In i
j� OF r�drM o rtL 1-�;,-Q 3 [Food Service Routine
Address t Risk ❑ Retail ❑ Re-inspection
/U 79P0 A s Level ❑ Residential Kitchen Previous Inspection
Telephone ❑ Mobile Date:
i-aY03
Owner HACCP Y/N El Temporary ElPre-operation
/J i P r P p �/c Ar1'7 G ❑ Caterer ❑ Suspect Illness
Person in Charge'(PIC) - Time ❑ Bed&Breakfast ❑ General Complaint
i P .O 3rd n l� d In: El HACCP
Inspector 1 '
V d 6( 7-n tic Out: Permit No. ❑ Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)
violated. Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items)_ Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health. Local Law ❑
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/ Knowledgeable/ Duties
❑ 13. Handwash Facilities
EMPLOYEE HEALTH
El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS
EJ3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 16. Cooking Temperatures
El 5. Receiving/Condition
El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating
El7. Conformance with Approved Procedures/ HACCP Plans E] 18. Cooling
PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding
❑ 8. Separation/Segregation/Protection ❑ 20. Time as a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related
Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/Federal Food Code.This report, when signed below
C N by a Board of Health member or its agent constitutes an
23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of
25. Equipment and Utensils 1(FC-4)(590.005) the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
Inspector's Signature: Print:
PIC's Signature: Print: P `,� f Page-Lof �±Pages
FORM 734A OB65&1WRRREN -BOSTON
(/
. i
Violations Related to Foodborne Illness r'
Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION
8 Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from
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 3-302.1 l(A)(2) Raw Animal Foods Separated from Each
Other*
EMPLOYEE HEALTH Contamination from the Environment
'2`> 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection*
require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables
Applicants
3.304.11 Food Contact with Equipment and
590.003(F) Responsibility of a Food Employee or an Utensils*
Applicant to Report to the Person in
Charge* Contamination from the Consumer
3-306.14(A)(B) Returned Food and Reservice of Food*
590.003(G) Reporting by Person in Charge* Disposition 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 Surfacesq; 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,
P.P
3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness*
3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and
5-101.11 Drinking Water from an Approved System* Utensils Clean*
590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food-
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils*
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* a.:12Prevention of Contamination from Hands
G- 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:` 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:Au cp /7r AiPr k Date: 7'2-off Page: J of CZ
Item„ Code C-Critical Ite DESCRIPTION OF VIOLATION PLAN OF CORRECTIONDate
No -Red Ito
Reference R M ;�OLIEAI.EA'INT CLEARLY Verified
X4
�4
'0,00/)-7 4/2 4,1,5e-
9 9C
7r7/"_-4- 6�
'10k x- (Ul- Xe _21CaW
Z,- -,wr OA,102,c
Odell 17-Z-As 01AW
I-Aj 3 7_/VS,0/- v e a,mg
0?,,P eZ C V,211P
Discussion With Person in Charge: Corrective Action Required:' Lj No
U Yes
I have read this report, have had the opportunity to ask questions and agree to correct all L11 Voluntary Compliance U Employee Restriction
inspection, to observe all conditions as described, and to comply
violations before the next in , Exclusion
with all mandates of the Mass/Federal Food Code. I understand that noncompliance may Ll Re-inspection Scheduled EJ Emergency Suspension
result in daily fines of twenty-five.dollars or suspl?nsion/revocation of your;food permit. U Embargo U Emergency Closure
Voluntary Disposal LI Other
FORM 7348 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 to
41'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/450F*
15"` Poisonous or Toxic Substances 3-501.16(A) Hot PRFs Maintained at or above
7-101.11 Identifying Information-Original 140°F.*
Containers* 3-501.16(A) Roasts Held at or above 130°F.*
7-102.11 Common Name-Working Containers* ` 20. Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP)
7-204.11 Sanitizers,Criteria-Chemicals* .21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels*
7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.*
7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.*
7-206.13 Tracking Powders,Pest Control and
Monitoring* CONSUMER ADVISORY
22 3-603.11 Consumer Advisory Posted for Consumption of
TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or
16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate
PHFs Pathogens.* EnecOve vvzoor
3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs*
Eggs-Immediate Service 145*F 15 Sec.*
3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS
Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in
3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and
3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites- 165*F 15 Sec.* interventions and risk factors. Other
3-401.1l(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F*
3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the
3-403.11(B) Microwave- 165*F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be
Time* found in dee following sections of the Food Code and 105 CMR
3-403.11(C) Commercially Processed RTE Food- 590.00.
140°F* Item Good Retail Practices FC 590.00
3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003
- Roasts* 24. Food and Food Protection FC-3 .004
18,t Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005
3-501.14(A) Cooling Cooked PRFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006
70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007
to 41°F/45*F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008
3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009
Temperature Ingredients to 41*F/45°F 30. Other
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
--THE COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM Address: 120 Washington Street, 4th Floor
BOARD OF HEALTH Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343
Name /� !/ � Date T. f r i n Type of Inspection
,tSC ,C 3-W 6178 Sb7'TGB 1" Axe-�/fiO L. &9/-03 X Food Service X Routine
Address / Risk ❑ Retail ❑ Re-inspection
Level ❑ Residential Kitchen Previous Inspection
Telephone /g7rQ� NS^ S go9 ❑ Mobile Date:7-PP-aa
Owner HACCP Y/N ElTemporary ElPre-operation
ffaUSP OFr✓vn /S_PS Se �Q�SB� ❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint
/E U� jrizrLSCkt/ C ? .'In: ❑ HACCP
Inspector 1/A/>
N /'/� t Out: Permit No. ❑ Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)
violated. Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health. Local Law ❑
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/ Knowledgeable/ Duties
❑ 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
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
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
16. Cooking Temperatures
El 5. Receiving/Condition
El 17. Reheating
El6. Tags/Records/Accuracy of Ingredient Statements
"
El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling
.j' u ►LI, 0 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION o'; as a'^5�.
E) 20. Time Public Health Control
El 8. Separation/Segregation/ Protection �1z�
' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
EJEl 10. Proper Adequate Handwashing 21• Food and Food Preparation for HSP
CONSUMER ADVISORY
❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related c,
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
P/ 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-0(590.008) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
Inspector's Signature: - Print:
i 'Ii
PIC's Signature: �i ,� nPrint: % e P n Page-Lof�_ Pages
FORM 734A '`HOBBS 8 WA/EN - BOSTON ' '
Violations Related to Foodborne Illness
Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION
8 Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from
1&*j 590.003(A) Assi nment ofRes onsibilit * Cooked and RTE Foods*
590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients
2-103.11 Person in Chaz e-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each
Other*
EMPLOYEE HEALTH Contamination from the Environment
2'
590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection*
require reporting by Food Employees and
3-302.15 Washing Fruits and Vegetables
* Applicants* 3.304.11 Food Contact with Equipment and
590.003(F) Responsibility of a Food Employee or an Utensils*
Applicant to Report to the Person in
Charge* Contamination from the Consumer
3-306.14(A)(B) Returned Food and Reservice of Food*
590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated
's3') 590.003(D) Exclusionsand 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
4t 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*
YO Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms*
2-301.12 Cleaning Procedure*
3.202.18 Shellstock Identification Present* 2-301.14 When to Wash*
590.004(C) Wild Mushrooms* Il 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 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
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
F BOARD OF HEALTH i
Establishment Name: cP a,4 eon Qz� s Date: /— a/—/)A Page: ,V of -1) f
,Item t 'Code - C-Critical Item Y DESCRIPTION OF VIOLATION / PLAN OF CORRECTION , ' Date .
Y 'No: Reference R-Red Item ; ,,,, r „a E - � Verified r'
ac ,PLEASE PRINT CLEARLY -
t -.
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Discussion With Person in Charge: Corrective Action Required: : ❑ No 3a O Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction i
violations before the next inspection, to observe all conditions as described, and to comply Exclusion
$ with all mandates of the Mass/Federal Food Code. I understand that noncompliance may \ ❑ Re-inspection Scheduled ❑ Emergency Suspension
e
i result in daily fines of twenty-five dollars or su nsion/revocation of ur food permit. ❑ Embargo ❑ Emergency Closure
x �� `���'�'���• ❑ Voluntary Disposal ❑ Other
S
FORM 7348 HOBBS 9 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 to
41°F/45°F Within-4 Hours.*
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
414', 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*
X15; Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F.*
Containers* 3-501.16(A) Roasts Held at or above 130°F.*
7-102.11 Common Name-Working Containers* '''.20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP)
7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.12 Chemicals for Washing Produce,Criteria* " Beverages with Warning Labels*
7-204.14 D inL A ents,Criteria*
3-801.11(B) Use of Pasteurized E s*
7-205.11 Incidental Food Contact,Lubricants* 3-801.1 l(D) Raw or Partially Cooked Animal Food and
7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.*
7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.*
7-206.13 Tracking Powders,Pest Control and
Monitoring* CONSUMER ADVISORY
22 3-603.11 Consumer Advisory Posted for Consumption of
TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or
16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate
PHFs Pathogens.* Effective 11112001
3-401.11A(1)(2) Eggs- 155*F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
Eggs-Immediate Service 145°F 15 Sec.*
3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS
Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food,temporary and
3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F*
3-401.11(A)(1)(b) All Other PHFs- 145*F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the
3-403,I1(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be
Time* found in the following sections of the Food Code and 105 CMR
3-403.11(C) Commercially Processed RTE Food- 590.00.
140°F* Item Good Retail Practices FC 590.00
3-403.1l(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 41017/45°17 Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008
3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009
Temperature Ingredients to 41°F/45°F 30. Other
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
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