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ICE CREAM ALLEY - ESTABLISHMENTS ICE CREAM ALLEY 131 ESSEX STREET y 9 li n 1 i u i ipyi} V t� a q . 3-C04 ,5dA>Vj/on 0,1Pho.0 101 ,l}{ii W9244* +v add PeA $queezA te.,k6sjt4l S4v44.•ed -64 6QJ& C140.,, Plied a6 VII- o[d Aj-n �esh "VmZed /en�oyadt ho{ S cve' PHFjs t of hpwe 3 b"41 5i-ft Co-n AAA.,4 C;du- ct- )Pje. L CA.At fke baC&- CITY OF SALEM 1 BOARD OF HEALTH / Establishment Name: ` �J f�Q/Y� i/� Date: Page: ` of Item Code C Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified r PLEASE PRINT CLEARLY - �e v � / ' ( � ,114nX��/ r� o - Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-f,ive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i� 3-541.kI(C:) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45-F Within 4 Homs. PROTECTION FROM CHEMICALS3501.15 Conlin,MethodslotPHFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 595004 (B Cold P 3-202.12 Addin%es'" 3-501. Cold P '16tB) PHFs Maintained at or below F* 3-302.14 Protection from Unalrprosed Additives`" 3-501.16(A) l lot PHR Maintained at or above 15 Poisonous or Toxic Substances 140°F. 7-101.11 Identifying Information-Orin nal 3-50116(A) Roasts Held at or above 130°F. Containers 7-102.11 Common Name-Working Containers` 20 Time as a Public Health Control 7-201.11 Separation-SiciaEe* 3-501-19 Time as a Public Health Control* 7-20111 Restriction-Presence and Use* 590.004(H) Variance Re tdrement - 7-202.12 Conditions of Use* 7-203.11 ToxicContainers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-21)4.12 Chemicals for A-'ashin¢Produce,Giteriav` 2'1 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 D °in t encs.Criteria* Beverages with Warning labels* �.,e 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteudze<IEges* 7-206.11 1 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations" Raw Seed Sprouts Not Served.'x 7-206.13 Tracking Powders,Pest Control and =-80L 11(C) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 1fi Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Blilninate 3-40'1.1.1A 1 2 Egg- Pathogens_": ( )(� ) r 1.55°F i5 Sec. E rKs-ltnmediate Service 145°FS Ssec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.1 t(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 1.55°F 15 sec. * 3-401.11(11)(1)(2) Porkand Beef Roast - 130°F 421 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155`F'15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food,temporary and 3-401._11(A)(3) Poultry,Wild Game,Stuffed PHPs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. " above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beefsteaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 1129- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-1.45°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15sec. * (Items 23-30) 3-403.11(13) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, a-hirh do not relate to the Time' foodborne illness interventions and riskfa(tors listed obove can be 3-403.11(C) Commercially Processed RTE Food- .bund in the f)flowing sections of the Food Code and 105 CMR 140`14 590.000. 3-403.11(E) Remaining Unsliced Portions ol'Beef Item Good Retail Practices FC 590.000 --- Roasts* 23. b/ana ement and Personnel FC-2 .003 1g Proper Cooling of PHFs 24 Food and Food Protection __ FC--3 .004 25 Equipment and Utensils FC 4 ,005 _ 3-SOL 14(A) Cooling Cooked PHFs from 140`F to 26 Water. Plumbing and Waste PC 5 006 70°F'Within 2 Hours and From 70°F 27, Physical FacilityFC-6 .007 to 41`F/45°F Within 4 Hours. * 29. Poisonous or Toxic Materials FC-7 i .008 3-501.14(13) Cooling PIIFs Made From Ambient 29. S ecial Requiremenis _ .009 Temperature Ingredients to 41°F/45°F 30_ , Other Within 4 Hours'x v ,mrev-aao< Denotes crincal item in the fMeral 1999 Food Code or 105 CMR 59o,000- CITY OF SALEM BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MASSACHUSETTS 01970-3523 Ice Cream Alley 131 Essex Street Salem, MA 01970 4'35, +.��K.,ffiY"_-=*'�""•�°"ti:'.�r:" �,,,�. eu'r" "$C`.3R" .#f'E�"x.,..% _ n', '�,�„nr^n'�'�A"'rMy +y. t,.,'` .x ; M s•'? -7a"r"„a .y," i "w ,�Erj ` :�, �'' `f T -r "�k ' i -t s5K -,f'.'....... . vY�+3�rsr`L,s ♦ r } �' i i�-"1a+' f'�':Ls � Commonwealth of Massachusetts` p ^$„„ City of Salem • ° Board of Health tGmbeliey Driscoll120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 09/26/2006 ESTABLISHMENT NAME: Ice Cream Alley - File Number:BHF-2004-000020 131 Essex Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0620 Sep 26,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health Page 1 of 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR A MOBILE FOOD SERVICE PERMIT A Fee $150 payable to The City of Salem, No Cash p Name of Applicant /`'� VQ.NII Telephone# 781 -?oG-3/SS Address 131 Erre* Str«r Certified Food Manager A4elr Va,L ty Certificate # Name of Business Lc-c cora xll�, Telephone# 7P-To6- 3/6'S Address 13/ Errref s1-r-Qzr Manufacture Frozen Desserts? Yes No X Type of Vehicle AV12 _Registration# Location of Operation Name & Address of Licensed Food Service Establishment Serving as Base of Operation A11A sq%c Telephone# s•".0 Location of Toilet & Handwashing Facilities 131 IFrfu Sr-r* t Menu Fr1'�,/ Dvc,34 Dr4kt Type of refrigeration: Ice Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gases Other Method for Sanitizing: Chemical_ K Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law �/ /I �� OX7- CC- yy2/ 7/JC/4,` Signature Social Security# or Federal ID# Date --------------------------------------------------------- -- --------- ---- ------------------------------------ Revised: 2/7/03 Permit d Checkd&Date 131 Essex Street Ice Cream Alley City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephoner Item Status Violation Critical Urgency Nature of problem or correction 978-745-7073.- Non-compliance with: Done .Owner., - Anti-Choking PASS ❑ Mark VanDell Tobacco PASS ❑ PIC� = % Mark Van De I F4 FOOD PROTECTION MANAGEMENT Done PIC Assigned/Knowledgeable/Duties PASS RED Inspector David Greenbaum_=`_ EMPLOYEE HEALTH Done Date Inspected Correct By a 1 Reporting of Diseases by Food Employee and PIC PASS RED 6/16/2005 Personnel with Infections Restricted/Excluded PASS [] RED Risk Level ` FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS ❑J RED rBIIP-2005 0462 s Receiving/Condition PASS RED "$[atUS "u �" Tags/Records/Accuracy of Ingredient Statements PASS ❑� RED SIGNED OFFrk 5, Conformance with Approved Procedures/HACCP PASS ❑d RED #of Critical Violations: '. Plans "'- PROTECTION FROM CONTAMINATION Done Time IN:, ` Time OUT ` 1.4 Separation/Segregation/Protection PASS RED Notes. r .,- _ -4 Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED 4% A L1. Proper Adequate Handwashing PASS RED Urgency Description(s): ;F Good Hygienic Practices PASS RED BLUE *-1 w :1 Violations Related to Good B - Prevention of Contamination from Hands PASS ❑d RED Retail Practices (Critical q Handwash Facilities PASS RED violations must becorrected a immediately or within;10, days)(Non-critical violations) GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) Page 1 o{3 131 Essex Street Ice Cream Alley must be corrected Immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASS ❑J RED RED: Violations Related to Toxic chemicals PASS ❑D RED Foodborne Illness Interventions t. TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require , , Cooking Temperatures PASS ❑d RED immediate corrective action)- Wz Reheating PASS ❑d RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE Establishment has met all Board of Health requirements to open. A temporary permit will be issued pending the decision of the Building Commissioner regarding zoning issues. This permit may be revoked based on the decision of the Building Commissioner. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) PaQe 2 of 131 Essex Street Ice Cream Alley h GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) Page 3 of "'"�`sr lr d 1�..�v"y:!..rµ ..:x �c-6 s e.F1 o- we r� Y* ::r ✓..i...,k A 'c . 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. 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: Ice Cream Alley Address of Establishment: 131 Essex Street Owner's Name: Mark VanDell Restrictions: Pending Zoning Decision. Application Date: 5/18/05 Permit for Food Establishment 306-05 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 $ 120 WASHINGTON STREET, 4TH FLOOR �a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343. STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT .ice ey`rg,41 Q(Iay TEL# NJ) ?0C-?/5'G7 ADDRESS OF ESTABLISHMENT I3I FfSeX Pr, Sg le. . ., i 019 70 MAILING ADDRESS (if different) ) 3( 1--'PPc,1- S-r- 4e r 9--3 OWNER'S NAME ✓�4rlT (diet TEL# 78 ?`(5=707 ADDRESS Sr- R PI' )-3 UITY �v(eh, STATE iL1,/ - - - QIP °'14176 CERTIFIED FOOD MANAGER'S NAME(S) ✓U4,/-r yQ4,6II CERTIFICATE#(s) E 6'00o(3957/ (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON A4,kr U"Oejl HOME TEL HOURS OF OPERATION: Mon.(o=(o Tue. to-1a Wed. (oIoThu..(0-10 Fri. to-IoSat. l0-10 Sun. IO-!O TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO _I less than 1000sq ft. =$ 50 v SG 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT (TE) NO less than 25 seats100 25-99 seats more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $2.5 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature e�/J�Q Date ocial Security or d ral Identificat'on Number -------------- _ �-"^ '�� /_05-S---------- S --------- Revised YY_T�--------- 11/03/03 FOODAP2.adm Check#8 Date ((39 / tZ(C',�05— IMPORTANT MESSAGE FOPa��nr� DATE TIMEP.M.. OF ii PHONa'XIQC1 ARE CODENUMBER E ENSgp� O FAX S a �W ❑ MOBILE 44 / AREA CODE NUMBE TIME TO CALL TELEPHONED y PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL', '! WILL FAX TO YOU MESSAGE wftizi + SIGNED FORM 4009 CITY OF SALEM ` BOARD OF HEALTH Establishment Name: 'CP ( 'i3Oa, Q / Date: `f/ _0 Page: / of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference "R-Red Item Verified , / PLEASE PRINT CLEARLY "e',.//... 15 stP -7 e5z e rLw�� e S Q vdvlcl - 0't 0a 7�vt J -fes 6uv k' rl A 4-z> �;1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 twen y-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure yoyrfood permit. / �,/, ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to lAw Cooled to Factors(Items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-5 0 1,15 Cooling Methods for PHFs F Food or Color Additives-u Fig- PHF Hot and Cold Holding 3-202.1 3-501.16(B) Cold P1 IN Maintained at or below- 590.0040 4V/450 Fs 3-30114 protection from Unapproved Additives* 3.501.1 I lot PHFs Maintained at or above 1-5 -Poisonous or Toxic Substances 7-101.11 Identifying Information-Original 14WE iin � 3-501.16(A) Roasts Held at or above 130'F. -'F Containers. H ` 1 -1 7r 102,11 Common Name-Working Containers' ��20 me as a Public Health Control Is Public Health I Time ' Ic 'a t Control*7-201.11 Separation-Stoj age1 3-501.19 Time a.,I Public Health Contra,. TIT a Publ 0c c, ",!,lent 7-202.11 Restriction-Presence and Use 590.004(l4i) Variance Re wretuent 7-202.12 Conditions of Use- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 'toxic Containers-Prohibitions* 7-204.11. Sanitizers,Criteria-Chemicals': POPULATIONS(HSP) 7-204.t2 Chemicals for Wushing Produce,Criteria"' 21 3-801,11(A) Unpasteurized Pre-packaged Juices and 7-204.1-1 Drying Agents.Criteria _!Le� Beverages with !'amine - f a b e I s 3-901.11(ft) Use of Pasteurized E, 7-205.11 Incidental Food Contact.Lubricants* 7-206.11 Restricted Use Pesticides.Criteria* 3-801,11 Raw oPartially Cooked Animal Food and 7-206,12 Rodent Ban Stations" - Raw Seed Synouts Not Served. :' - 7-206,13 Tracking Powders,Pest Control and 3-80'1.11(C) Unopened Food Package Not Re-served. CONSUMER ADVISORY TIME/TEMPERATURE CONTROLSConsumcr Advisory Posted for Consumption of 16 i Proper Cooking Temperatures for Animal Foods'Pkat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1 Uk(l)(2) Egg;- 155°F15 See. P,th T3-302 13 Pasteurized Eggs Subsfinrte for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meals&Game Eggs* Annuals- 155°F 15 sec. 3-401.11(11)(1)(2) Pork and Beef Roast- IXT 121 rom* SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles, injected Meats- 155'F 15 590.009(13)-(D) Violations of Section 590.009(A)-(D)in sec. * I catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed Plfrs, residential kitchen operations should be Staffing Containiq Fish,Meat, debited trader the appropriate sections Poultry or Ratites-1651F 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 4; - 590.009 violations relatingto good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- -- Microwave 165'F* Special Requirements. 340 1.11(A)(1)(h) Al Other PHFs- 145'F 15 see. 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) THE, 165'F 15 sec. (items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to file Time* foodborne illness interventions and rislftarors listed above, can be 3-403.11(C) Commercially Processed RTE Ford- found iir the,jollocing.sections of the Food Cade and 105 ClIll 1401-1 590.000. 7 - -T--RetaflPr----,-FC 590.000 3-403.11(E) Remaining Unsficed portions of Beef Item Goo Good Practices "00 *5g Roasts' 23. Marra ament s9dPersonnel FC-2 .003 lg 24. Food and Food Protection FC-3 O�04 Proper Cooling of PHFs 25. Eqw�ment and Utensils FC-4 .005 3 -501,W(A) Cooling,Cooked PHFs from 140'F to -26 WaltrPhumbi K-5 2-7. Physical Facilittv FC-6 00 70'F Within 2 Hours add From 70°F _j ooe to 41'F/45'E Within 4 Hours. FC - 7 1 .008 3-501.14(B) Coolin,PHFs Made Front Ambient 29. S acral R uirements .009 Temperature Ingredients to 41'17/451F 30, Other I Within 4 1 lours* Denotes critical itern in the rederal 1999 Food Cale or 105 CNIR 590000. IMPORTANT MESSAGE FOR M. DATE —2L �a TIME Mv- OF PHONE AREA CODE NUMBER EXTENSION O FAX U MOBILE AREA CODE N MEER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL ArAIN WANTS TO SEE:YOU RUSHr RETURNED YOUR CALL WILL FAX TO YOU MESSAGE -Fie sGt 5 9.>.e2o, 14.w L�'r cf.L,i ire SIGNED FORM 400 MARE IN U.S.A. :..H ... t r - S310N Ce// CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • � 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 MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Mark VanDell Name of Establishment: Ice Cream Alley Whose Place of Business is: 131 Essex Street, Salem, MA Date: 7/23/2004 To Operate a Mobile Food Server in Salem Restrictions: Permit#: 13-04M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 31, 2004 HEALTH AGENT i CITY OF SALEM > BOARD OF HEALTH Establishment Name: Date: 23 Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Az i . ��• �ez c i II I Discussion With Person in Charge: Corrective Action Required: ❑ No - ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ 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-fivers or suspension/revocation of LI Embargo L3 Emergency Closure 14 your food permit. ❑ Voluntary Disposal ❑ Other: -507 A(C) PHFs Received utTenificratureq Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4 l';F/45''F Within 4 Hours. Y PROTECTION FROM CHEMICALS501,15-T-- Cooling Methods for PHFs L14 Food or Color Additives Fig- PHF Hot and Cold Holding 3-501 16(B) Cold PHFs Maintained at or below 3-202.12 Addifincs* 590.004(17) 41'145°F* 3-302.14 protection from Unapproved Additives'' s-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140"F. * 7-101.11 Identifying Information-Original 3-50116(A) Roasts Held at or shove 13WR Containers' 7-102-11 Common Nainc -Working Container,,',' 20 — Time as a Public Health Control 7-1201.11 Se artuion-Stora c' 3-501-19 Time as a Public Health Control 7-20111 Rcstrictk)n-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) 7-2047 Sanitizeis,Criteria-Chernicals- 7-204-12 Chenucals for Washing Produce,Criteria"` 21 3-ROI.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Divine Avents,Criteria* I Beverages with Warning labels, 7-205.11 Incidental Food Contact.Lubricants* 3-901.,11(B) Use of Pasteurized Eggs` 7-206,11 Restricted Use Pesticides, Criteria* 3-801,11(D) Ra" or Partially Cooked Animal Food and ff Ti(_ Raw Seed Sprouts Not Served. -10612 Rodent Bait stutions� — Trucking Powders,Pest Control and }801.11(C) Urropened Food Package Not Re-served, _06 1 73f torCONSUMER ADVISORY N_romlll� TIMEMEMPERATURE CONTROLSConsumcr.Advisory Posted (It Consumption or Proper Cooking Temperatures for Nnfirral Foods That are Raw.Undercooked or PHFs16 Not Otherwise Processed to Eliminate 3-401.t1A(1)(2} Eggs- 155F 15 Sec.. 7 Pathogens. . PW�,� Evas-firimediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11.(A)(2) Comminuted Fish, Meets&Came EgEs:? Anneals- 155`F 15 sec. SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) Pork and Beef Roast- 130"F 121 min* 3-401.11(A)(2) Raines, Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section 590_009(A)-(D) in sec. r entering, mobile food,temporary and 3-401..1.1(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Sniffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 see, above if related to foodborne itlness 3-401.11(C)(3)(C)(3) Whole-muscle, Intact Beet Steaks interventions and risk factors, Other — 145`17* 590.009 violations relating to good retail 12 1-401 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-40 1A I(A)(1)(b) All Other PHFs- 145'F 15 see. 1 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(I)) PHFs 165'F 15 sec. * (Items 23-30) 3-403.118) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk fa( listed abo4, can be 3-403.11(C) COMRICITiall's Processed RTE Food- .found in the follows ng sections of the Food Code and 105 CMR 140'F" .590.000. 3-403.1.1(E) Remaining Unsliced Portions of Beef it Practices FC 590.000 Roasts* 23. ManoadqRerenteM and Personnel FC-2 .003 Proper Cooling of PHFs -_7-C-_3 -.004 24 Food and Food Protection — 2a ____ Equipment FC-4 005 3-501.1.4(A) Cooling Cooked PHI's from 140'F In --Water, FC-5 1:_.006 707 Within 2 Hours and From 70'17 —27. Ph sisal Facility FG-6 1 .007 to 41.°F/45'F Within 4 Hours. 28_. Poisonous or Toxic Materials FC-7_Tdw 2-9,_ Special—Requirements--- 1 .009 3-501.14(B) Cooling PHFs Made FrotaAmbient Temperature ingredients to 41'F/45°F 30, -Other Within 4 flour" Denotes mficai item m the rMeral 1999 Food Calle or 105 CMR 590.000. CITY OF SALEM, MASSACHUSETTS +� BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Mark VanDell Name of Establishment: Ice Cream Alley Whose Place of Business is: 131 Essex Street, Salem, MA Date: 7/23/2004 To Operate a Mobile Food Server in Salem Restrictions: Permit#: 13-04M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 31, 2004 HEALTH AGENT ~ CITY OF SALEM, MASSACHUSETTS / _p S� BOARD OF HEALTH } • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fee $150 payable to The City of Satefn, No Cash Name of Applicant Ark Ijnu oat Telephone# (y7* -7o73 Address 131 Ess�x Sr 4pr x-3 So jc y /t4,4 of 170 Certified Food Manager YeJ Certificate # EFOOO131531 Name of Business 16c Cr{4�, A//ex Telephone# 97a Y 5�7497 Address 1 31 Efrtx S f f SU!<,x, A4 a1970 Manufacture Frozen Desserts? Yes Na X Type of Vehicle Registration# Location of Operation Name &Address of Licensed Food Service Establishment Serving as Base of Operation Telephone# Location of Toilet & Handwashing Facilities 13) it r�-x Sr �ra;1 S>uve Menu Tc1 CrZ441 C4yr a Sado Bot9lw ��l�r Type of refrigeration: lee Dry Ice Gas Other E(11r',Z- Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical X Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law Signature Social Security#or Federal ID# Date --------------------------------------------------------------------------------,-J-------------------------------- - Revised: 2n103 Pemtit p Chccka&Date—, / j!1 — 7--r Ad Page IMPORTANT MESSAGE FOR OATE?�� , � OS�- TIME P.M. M OF / c� �/�7G �,L,� PHONE / it / Y-�- ` / s6 AREA CODE NUMBER EXTENSION ❑ FAX O MOBILE AREA CODE NUMBER TIME TO CAL TELEPHONED- PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE OG7 J G'om re hoz ,4) r� � SIGNED 01 MADE IN EiN u NOTES __ Business Plan for Ice Cream Alley Business Discrintion Ice Cream Alley will be an ice cream stand located at 131 Essex St. It will serve Richardson's ice cream, fraps and soft drinks during the spring and summer months then add fried dough,hotdogs and hot apple cider during the month of October. The latter was the menu from 2003. Menu -Ice Cream Alley will serve Richardson's Ice Cream in cups and cones. -Fraps -bottled soda Cleaning and Sanitation -Ice cream scoops will be stored in a container of water and bleach kept at a ph of . This will be monitored and changed as needed. -Servers will have three ways to keep their hands clean. 1. Hand sink " 2. Hand sanitizer 3. Poly gloves ! -Counters and equipment will be kept anit¢ed using degreaser and a water bleach solution. �G -Xio PP, s4n,:nZeo� - Frap mixing cups, spoons, ice cream scoops;etc will be efearied using the three bay sink method . Marketing 4X5 STORAGE SHED L/,,041, Col/, - tri dJGP SELF CONTAINED ° FRAP STATI✓ON -HAND SINK -3 BAY SINK ° - ° 1 1 SCOOP STORAGE lm,1 BOTTOLED SODA FRIDGE r, 1 J' ICE CREAM CHEST dow� Ja Www TOPPINGS WRAPAROUND ELECTRIC HOT FUDGE WA R SNEEZE GA JARD Sili� tnra(� ICE CREAM ALLEY V CITY OF SALEM BOARD OF HEALTH Establishment Name:` Q A Date: S 7- O Pager of i Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY ( ✓ P /r 7 J .S v1Q d. c}�(+❑ lir - �� I / " / / n&74 AP-1k D _ � ' A'-)a v Ce lyd D b 1 d l ' /(1 12.1 97907,17 r O-� JL44e Discussion With Person in Charge: -vlo e�(� t D�G�y/�/� l�j e�/ Corrective Action Required: ❑ N ❑ Yes {� - 1, 1141 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. -e8 ui�-v 11 Voluntary Disposal ❑ Other: V� 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Carm) 41'F145"F Within 4 Hours. PROTECTION FROM CHEMICALS 3-567.15 Colim,Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501_16(5) Cold PI Maintained at or below 3-202.12 Additives' 590.004(0) 41'/45'F" 3-302.14 Protection frorn Unapproved Additives" 3-501,16(A) Mot PHFs Maintained at or above I F Poisonous or Toxic Substances 140°F. * 7-101.11 Containerst'prig Information-Original 3-50116(A) Roasts Held at or above 130'F. C.r�ntainers*' 7-102.11 Common Name-Workinv Containers* 20 I Time as a Public Health Control 7-201.11 1 Separation-Storage- 3-501.19 Time as a Public Health Centro.* 7-202.t I Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use, 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.51. Sattitizers,Criteria-Chemicals' POPULATIONS(HSP) _ 7-2@1.1.2 Chemicals for Washing,Produce,Criteria* 21 3-80'1.tl{A) Unpasteurized Pre-packaged Juices and 7-204.14 Orving.Agents.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11{B} Uce of Pa�� 7-206.11. Restricted Use Pesticides. Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-20(1.72 Rodent Bait Stations* Raw Seed S trouts Not Set'ved. 7-206.'13 Tracking Powders,Pest Control and 3-8(11.17(C) Unopened Food Package Not Re-served. Mordtorine* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.110(1)(2) Eggs- I55`F 15 Sec. Pathos* aL er7�a',e 4Va=Jnr E gs-linmedt itx Service 145°P15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats &Game E gst Animals- 155°F 15 sec.* 3-401.11(B)(1)(2) Pork'and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats_- 155'F 15 590.009(A)-(D) Violations of Section .590.009(A)-(D)in sec,t catering,mobile food,temporary and 3-401.1,1(A)(3) Poultry,Witd Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Paultr of Rstites-165�F 15 see. " above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Swaks interventions and risk factors. Other 145'1`* 590.009 violations relating to good retail .1401.1.2 Raw Animai Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Regniretneuts. 3-401.11(A)(,i)(b) All Other PHFs- 145-F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.4)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave.-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time-` foodborne illness interventions and riskfactors listul above can be 3-403.17(C) Com ercially Processed RTE Food- ,found in the f6 lorving sections of the Food Code and 105 CAIR 140°F* 590.000, 3-403.1 I(Ii) Remaining Unsiiced Portions of Beef -1tern Good Retail Practices _ FC 7 590.000 Roasts* 23. Mona ement and Personne_IFC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection 25. E w at em and Utensils FC 4 .005 3-501 14(N) CoolingCook'edPHFsfront140'Fit) 26. Water, Plumbin and Waste FC-S 006___ 70`1`Within 2 Flours and From 70'F 27, Phsical Facility_____ FC-6 .007 to 41'F/45°F Within 4 Hours. ` 28. Poisonous or Toxic Materials FC-7 .008 3-507.14(8) Cooling PHFs Made From Ambient 29. S eeial R uirements _ .009 Temperature Ingredients to 41"F/45°F 30_ Other _L Within 4 flours* S=vornenacidz:xm *Denotes critical item in the federal 1999 Fool Code or 1'15 CMP.590.000.