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IHOP - ESTABLISHMENTS
lno� rabJJ we ( ftNIVERSALO UNV-12110 MADE IN USN SIJSTAR M Mph, �+� FORESTRY CCNl1E>V(In@ 1N ITIAPVE [�`+PTiWY�� P0MOF!$:IMER Cmrofied fiber So. 9 mrw'fipmayrem.ary 7 M Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41" Floor Division of Food and Drugs t I&Iem MA 01,970-3523 FOOD ESTABLISHMENT INSPECTION REPOI#T" t Tel. (978).741,'-1.800, Fax(978) 745-0343 Name Date T gof O eration s Type of Inspection 7 1 i 1 0 Food Service [M}Routine Address �, Rik ❑ Retail ❑ Re-inspection ,. rro c�7rS Level El Residential Kitchen Previous Inspection Telephon' nl � � El Mobile Date: Owner � HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ElBed&Breakfast El General Complaint In: ElHACCP Inspector ( Out// l� Permit No. El El Each violation checked requires an explanation on the narrative age(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT;° a� i ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties q ❑ 13. Handwash Facilities EMPLOYEE HEALTH r ,- ,..,„. v. '� per,..,, ..,,.ice �„...>,: ,:"t-'m.a .PROTECTION FROMCHEMICALS r��� „ ..,7 t1 E3.., _�. Q.u� El 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded k �s� ern xceayai�n;g ❑ 15.Toxic Chemicals ,FOOD FROM APPROVED sOURCE „, TIMEREMPERATURE CONTROLS PotentlaFlRezardousFoods °"m) El4. Food and Water from Approved Source 1 y ) `LY,_.,I 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 17.,REiheating ❑ 7. Conformance with Approved Procedures/HACCP Plans . Cooling fl PROTECTION FROM CONTAMINATION;""1'7 - `""I�.. m "�"`_ E] 19.Hot and Cold Holding kE18/Separation/Segregation/Protection ❑20.Time As a Public Health Control . Food Contact Surfaces Cleaning and Sanitizing A _QUIRE EN FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),;„,( ❑21. Food and Food Preparation for HSP [110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices [CONSUMER ADVISORY A,e,,,�,�, .a�:»,��,s,�� `�,.:�,�� �,.0�, [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C' P 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-5)(550.004) cited in this report may result in suspension or revocation of Equipment°and Utensils (FC-4)(590.005) 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)(590.067) 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: A#A( s:5901ns fFoi taex /^� I Inspector's Signature: ( _Print: _ r PIC's Signature:/U Print: Vr)NCk. J (J7C PageL V o Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F 8 Cross-contamination '1-t-590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from f 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in char e-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anitnal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1.l(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char*e* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A) Returned Food and Reservice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(H) 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 590A04(A-B) Compliance with Food law* 4-501111 Manual Warewashing-lot Water 3-201.12 Food in it Hermetically Sealed Container* Sanitization Ten eratures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical WarewashinUg--Hot Water 3-202.13 Shell Eggs" Sanitization Temperatures* 3-202.14 E>>sand Milk Pmducts,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. 3-202.16 Ice Made From Potable DrinkingWater" 5-101.11 Drinking Water from an Approved System*tem` 4-fi01_t i(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drink n Watet Utensils Clean* 4-602.11 Cleaning Frequency ul'Equipment Fo 590.006(B) Water Meets Standards in 310 CMR 22.0" Contact Surfaces and Utensils* od- Shellfish and Fish Froman Approved Source 4-70111 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreacionally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-70311 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1p Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reulator Authorit 2-301.1.1 Clean Condition-Hands and Arms* 3-202.1 S Shellstock Identification Present* 2-30112 Cleanim,Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices $ Receiving/Condition 2-401.1'1 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package hite i[ * Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock Lj2 Prevention of Contamination from Hands 3-202.15 Shellstock Identification* 590k04(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-40111 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacifies* - 3-402.4( Records.Labeling Creation and Retention* 5-204.1.1 Location and Placement* 590.004(J) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced os gen acka ho,criteria* 6-301.11 Handwashin Cleanser,Availability 5-103.12 Conformance with Approved Procedures* 6-301.1.2 Hand Drying Provision '''Denotes cciticid item in the tetlend 1999 Fsxxl Code or 105 CMR 590.000. - _ CITY OF SALEM ` BOARD OF HEALTH I Establishment Name: ' :;Q/-)n Date: _ Page:_ of Item Code C-Criticril Item ° - DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ;- No. Reference R-Red ltem Verified ..: S n PLEASE PRINT CLEARLY y r � , n n S 4 IQr I � i � mss`, Ib n l i S, n ?/ Cz �o i i //tt Discussion With Person in Charge: Corrective Action Required: ❑ No O: Yes I S 14 y. 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 LI Emergency Suspension E 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. �n r" ilVlc�,l� ❑ Voluntary Disposal ❑ Other: i ' t �:-501.141C) PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to' Factors(ItaMs 1.22) (Cont) _ _ 41°F/45`F Within.#How s. * PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods frx PHFs 14 rA(" or Color Additives 19 PHF Hot and Cold Holding -- 3-501.16(B) Cold PHF.Maintained at or below 3-202.12 ves540.01(1`)3-302.L4 tion tion UnapprosedAdddivts' 3-501.16iA) I lot PHSL Maintained at or abovenous or Toxic Substances40' (0111fying Wool nation-Oto,mal slil 1rr(�) Rk ,ts Held at or above 130°F. Time as a Public Health Control 1-102 t 1 ' (,ommnu Naw( t"4 7rhin to is a Public Health Control' — r '01.11aiau<n—St,na� 1-202.1 Pe_tI ict on -Prt.,ancc and l,,c'" _ t 6_Is04 r}q7 _��t ..ar cti t? ircwctit .� r7'02.12 C'oldition ofUw REQUIREMENTS FOR HIGHLY SUSCEPTIBLE _ 7 203.11 Toxic C ant tine ProMbitiom' J -„— t— -- POPULATIONS{HSPS_ t 04.11 SonChemi cati for W; , Chunicals 21 a b01 l h�t L'nPtcteatircd Pre l act ged ltnces teal ( °(14.12 Chcnu nht<rc�k a,hu 1 <ulucc Cnrctia_" 7-204,14 D;}sn Aents.Criteria, !3r oPt s e.last! �i m tv7 F tills- hQ' t' S Up of Pa tcmi d F21Psy c 2117 11 Fnctdtnttl t nod Contact laiMican s' t K: or Paillall clooked Annnfll Fexsl and 7.vOb.1 112etiu i i a t c< t'e nc tde�. Cntei n 1 i tic d `t�n,u1 he t Sene.o _ 4� >OFi.t2 I & nait13,61 St'morn _----� (._!. r� 'n Frgx ' oz� FacNo R d. scrve " i "1061 r. 'Cru, .n!1'rwd;r,.P_s,(i:oirmul>tod \4enharir,�' I CONSUMER ADVISORY __ T FIKFITEMftERATfSR6 CONTROLS '2 rG0' 1 l sc nt rA,'%sw ti t3sicrl C'artattulptian ot- -'—� i S o i i l F KJ.1� hide rc R' UndercuiA v:1 t. Proper Cooking Ternperaturas tnrtiniln in.ue 1 - _ 0 d.,..J. hii �. 17 n5 ' 175-c.. Ih.y n _. .,_.+ __.- i rrs snw:uh tic Ott�ia ( 7 #'i'ssev - ' 1 t . Ir it (,_(call jut. Sir e.11 IIIc L IF ilY ) t 1 Kut,t i '} t 1 SPECIAL REOrJFR FrEla''S ,_J, .,.i� rt __� __ { t-_ . ' i 's ;.i,f'nAr i�7 � L�uElwlo c `sem btu 9('.t-kU('t) C +,in e1 i fL 1 , j itc:rt itr l ilii:1�)Od, lemporin,, and a(.1.i.+'At {} Pats trp. l3'ud Ccanlc.£Turk« .: t j i I rts,�l tz> ai st..-hc>t opaLtions dicildld be j fllae C'�nt utin",nisi rte.+t. dct i;elJ un<lr illi ai>IxoF ri,tte ceetiota � I rtrr star is �C7'1 .:-" ' � •._.:c �R s.�te> � .7t:.. �> �Il.,'�f. ; in scr[3c t,`� ,e-.:: .,,,u: ;.... 0lt�;ors. Olhc= 1 t,.,:;at� .rciatist Io OnU; F, xl:i'.;-7ti.d . .a 1 y s a i i j t (tt'e 't I 1 c I R heating tar Her Holding WOLATIONS P L.TELL TO GOOD RETAR PHACTWES PHI1, 105,11, t ce ._j (I tern,23 3(}1 r 103.1 i`k) 1411 use sxe 165 C Millow Stan=fing 1 C+ < < t:.i+etc r �..I r< t i s htr h do am elwe 1 sre i fn ldhumc tl , t rr + told t uwre om be t 3.i l i i t n mtitcia l} Pt<x.s cd 1 I,'F1uu1- Olen t b: ;1;,sr ti y a€, ,':h<,,,4+ad c'urlc z td 1'J� ("IM t,u unmet Lnt,hced Po:a M of t3._c l ( herr Good nstar!PracLeen FC 50-000k k asc>' 1 to ^ viana(1 rsa , >a F c J9 'I FC ? i is-, >-Ig - Proper Cooling of PHFs _Pt rax( ed Food ill etc to _ 1`4 s ry.u- . �F?b (' ntdilliUIPno ._ Z 3-501.14(A) KAiw2 Cxrk A IdiF, from I tF to torrc t S_ .{ Nlo, s IPC b aPo Wahin 2 1 fours tInd F tt nl i!}"t' ? 1`h r iu' t ?i F 145°�L4 thin? is rt c7 '''ti>i s.t orfI C r (X78 - 3-541.I.1(Bj C r uud PHF M11�d<From �m i . t 1 mpelawle httzedu;xts „ 1.45'1 36 Oihr `ithm A Hcnst,* .' °,Dev, _s kxitical vet. ., 1 7 Q, _ i=):S C �'i �rl(> L CITY OF SALEM BOARD OF HEALTH Establishment Name: /-Y2 Date: / Page-._? of _ Item Code C-Critical Item. Date DE$CRfPTION OF VIOLATION/ PLAN • F CORRECTION No. Reference R-Red Item , jam' i Vedfled ..Z 1 PLEASE PRINT CLEARLY r r O f1-7 n D D i /4 / 0 f P !j _ Itin eAT O /!r / _ nd Ira 11-1 1 Q G n14 iiI A' Q =,� )If,bn ' Yom 10 O Y ( 0 1f _ . 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 esfrictibn/ o 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 Q noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. , ❑ Voluntary Disposal ❑ Other: r r} )01 ;4((:) PfIFs Re,eived at Temperatures Violations Related to Foodborne ffirross Interventions and Risk ACvordiri.to Law Corned to Factors(Items 1-22) {Cont) 4 1 .F/45'F Within 4 Hours, Amm Ckx4iii-,Methods for PHFs PROTECTION FROM CHEMICALS , 19 — PHF Hat and Qofd"ding 14 d or Color Additives 3-50!.16(B) Cold PHRs Maintained at or below.1-202, t47111 ivcs* 590,004(1} -11 ,451°F- 3-30214 IARACO,W)from tA2yMX0d OAKYN' Poisonous or Toxic Substances3-50LWA) 1-01 Pffl��Ntainfarited at or above 10T. 7-L01.11— WQ" 1 tylifying ImIlion -Original _LRy, Hdd ^ao, 1 Time as PrARJ&Ph Control _L'yL..nL, ------------ , "m 19 P�u-,aF I PubliC I fealth control' Soowauklr, -st'nLAA E- --- --- ----------- 70mil ( Rottman -14mvee and the* 7 202J2 cmdolor b d UW* REQUiREIVIENTS FOR HIGHLY SUSCEPTIBLE Comanwf ------- POPULATIONS 7 ,0 i'm 1 21 1101 110) Unponeurizad Wo1mckaged imm aud IL 7 �0414 0;-An2 Armav WTI' Warnin,, Lai 15 Iuk id,-MIA i�->J 1-0hiWall!A' ofP�,,malh boKCA Amm"al Ftxd And 717----771 7-206�1T -1 1 Ili"--2d � � _7, Lo!, , oS�; J.W Rwe;, ------ "v—S --4Tittit - so-OIL A i "n-T L---------- r1Q% TWESTEMPERATIIRE CONTROLS FIT j 01:1-i 1-T(Nlu - 7- i Fiat , KGtF '_t[1.i 16 for ! EN"mm: ------------- til-,11t k phCjj 7-1 1 '.'32.;.iAW Womm RA. sows coml- 10-F I Zi r . _,fFZQQ REWMEMENTS .,1.i gran RNW- WC:A MCA. - 151 F15 i Vii ! P, Qi rrl'9�At (,D) in 3 PFF's; v-, X tl�, T 'CC if nir Hot Ho'.;uk7 RKA Th� TO "TAT I-A-A,-No i 1 00 W! ------ Owns 2XQ i V I� &Aa 11(ti) I "ImoCo"n 1650 v 2 Nimme swoding Ch QWj Man MWi I 4A 14 M11Y �nl I hQ &M.LMA! Amami R-[F hs'd w,� CC e C 4am Rosa,' F Proper CooHng of PHFs I I I 2)�; I--, �1-t,- 4 44_4 (Mljjjjt(%:X)jao J'�Jf-'F iron I MI Fhl 2'l 7t l! pt�Jrl�)IoQ mW Thav- '01- Within ? FIou- From 719 C-61 1 oof a i .i RKAditl, U ting Pit! M & FF,mAmbi�m 30 Wun j I Emus' )6 i CITY OF SALEM BOARD OF HEALTH Establishment Name:_ Date: c/ Page: 44 of Item Code C—Critic al Item / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION '•„` Date No. Reference R—Red Item - t r, Verified PLEASE PRINT CLEARLY 1/ 1 uI w l - ,� = 2� o o Yl . c o C [ "re- - Y` C ��r c %N t a i I I lL� r,A A 7S Discussion With Person in Charge: Corrective Action Required: ❑ No Ye t I have read this report, have had the opportunity to ask questions and,agree to correct all ❑ Voluntary Compliance ❑ EmployeesRestriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p J 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 doll rs or suspension/revocation of a Embargo ❑ Emergency Closure yntir food permit. (�/ / ❑- Voluntary Disposal ❑ Other: I -Sfl I.14(C) PHFs Recowd at Temparatums Violations Related to Foodborne fitness Interventions and Risk Am)Tding to Law Cooled to Factors(Ifema 1.22) (Cont) _ 41'F/45"F Within 4 Haus. PROTECTION FFIOM CHEMICALS 3-501.]S Conlin Afethods for P}iFs --- 19 PHF Hot and Cold Holding 1q Food or Color Additives— 3-50' 16B) Cold PHFv Maintained at or below 3-202.12 Addtuves" W,(jf)4(F) 3-302.14 Prottclion korn Unapproved Add tiles` }5 P -- ;-�M WA) Hot PFli. ccfaanlaineditorabove t Poisonous or Toxic Substances (01.11 ldentityinglnfi,maurn -Qn m { ?-501_{6(Al ' Rw tsField ator above 130CF, Container,: — -- --. -o -- as n Public Health Control toion pante v1 nr6i ee f uui t tars ? t- ------. — 1._._..� �...._ "- - �' 1) Cir i t m, is a -alaic Health Cr nU'ai' r 301J1 Seim attcn SAna -- ' 203.11 Re trill on Pr once and t, t iS ..nu,Jittnreni. -� 7-202.12 Condition- of Use —� 7 ?03.11 Toxic C o 1)t finer Prohihi!imW: REQUIREMENTS FOR HIGHLY SUSCEPTIBLE P -- — — __ POPULATIONS(HSP) i .04A I —{t Sannvel, ldre i ChuluC S 121 i 3_801 11 A) L � icurir,:I Prc lacca ed Juices a:id � 204.12 t 't nuc ah for v ithm. k litce C iloda" P b -- — _ I &veti es aritby'a mt Lal i�-- �1704.14 Di%imAt rw.Crntuta' + --� - — -- hlii 11($1) li of Patio„inrvd i t x- '05.11) I tn,xd atal t N)d r uni t(t IAtt1) tc t s= t ---�-- '�— ------i -- -- —. -.--.- . J Set w !{i n R,tty or 1'vi+.aL {t,x>i,•dtu+ai Fcx:d and >Mi 11 1 iztctii t i t'+c Pr rude C: :ret 3 Pi8 5[ d + tt a SCI" x �.... ._. _.._ _........... .� tat:'. 11 i i L 1. 14 11 S''"t c:d ' t. td''-,n+ r ac a' � CONSUMER >~e:3o,tSt}f'£Y f 2° -003' ' a :m u t ai r t i l l :r t rn atn uvn t f TtFE1TEIrrPEitATURE CONTROLS I atut.i r c r 1`ti ¢c l�PrnPrr Cooking TenYpa3 atve fur a ! t i ( t ""f I PYt{a1) )9.E: St v i F fC' 5 — >�.�_ _ . . -SU _ F"'IS,- ucu:It e,4cnh t.,1) ,tc?.ai r t� aac.c' '. ._. _ ._t,u.itr i —! S?'ECIr°+at_FzELir Mx.� C.,(r k -- Ru i i I rY':t 1) _ ..x -I wIt,',?t A; 71i I V4": ±, J4. t.�a. , ;.Ct J an 1.i:ata 1'� t t i i 7 „c 01.WAi t) I I p ti iy lapid r:dt-ad.Stt3 .,,1 I a. :".'s' t. . Y6. a • a.� a . Z f t _ t i i;t1 ! i351) � t'C S i _ '. Rc.1 eatir:y tut I .t.in4ui>.c, 1,??OLATIt7.PVS RELATE t:.+ rfl.Ji`i P><IAIL IW ri£;r::S i o t .iiiZ u): lftl,, F ( c - - I ikews233i1 lU:'_i Ktt9 41i ,w arc- lr4 [•zil9t 1)u b�andin>_ Cta '_t„iar c,: t t = :o th 'oa.a a f. 1a,lu' � l�OUr__JIC6r � i +c_c'rsz t a w lac+r>rsl- .t e roof(Ur ltCl i {ow n:.r,ia h4 l'i ax. `Z'['j 1e>if- /,ruin 11:i,G » .... :�; :acr ,ar.C_+:fa: ce 10 t k +y 00i em Unor4e-ar ----Pacric,, _ FC 690,000 T oa !; 1 j ' }rr'faf�Jr'r1)f f am”P t rrel _ F 7_ VC, t i Proper Cooling .— �,. Yl5 ..r f + Ralvn ' lrou cttr�r - a OP6 I l rmp F a + �. i 0c,f3 — 311!.14(6)_ .._. (An),-,Pi MI& Freit -J h iii'in 4 Hour CITY OF SALEM ' BOARD OF HEALTH '+ Establishment Name: Date: / Pa 9e: of t Item Code C-Critical Item V DESCRIPTION OF VIOLATION/PLAN OF CORRECTION �k Date No. Reference R—Red Item t `� .i Verlfled�.e 'r - ' PLEASE PRINT CLEARLYif i i _ In -,Plga U 1.1 i 7 / - a l / A / C n ..1 ttr / r - o 'r y _ l Discussion With Person in Charge: Corrective Action Required: Li 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 tokKe--inspection Exclusion P 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 CI Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501.14(Q PRFs Received at Tewperalures V7olations Related to Foodborne Illness Interventions and Risk According to Law Cooled Factors(Harris 1-22) (Cont) 41`Ff45`F Within 4 Hnws. * PROTECTION FROM CHEMICALS -Sill 15 Cooling Methods for PHFs 19 - PHF Hot and favid Holding C4 pFcwd or Color Additives WIWI I Coid PHFs Maintained at or below ? 202.12 tives* 540.GI1w{Eh 41"J45`1"3-302,14 c ion front Lfnappro ed Additives" j ;_jg} ifil%; }Inc PHE>�Saintained at or above LIS Poisonous or Toxic Substances -i -� ---� 140'17 �- �TAI0ILI1 1 hlcnlitying infoma on-Otv.int. --'- ---_ -.— '• SttE ih ,) Ro sts Hold at or above 130`F. 1.01t4dti Cts _ - '^+ i Public Hoaflh£ontro3 tiai ut<n -S& int a,a publw H at h t_ontral:° _ _._ LAS —41 ist.kt .an -"we and Lw' t-7-202.12 1 Coa drt ot" of list: - - - '" j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i Contain,-t nmh brio I-- r) ? Toxic r -- POPULATIONS(HSPS s ^tai i - Sawn els Cr was lhmd is 1 - - c 7-204,r7 E'h�iiu�als kir th a�bu 1 ztL 2 C r tt,in'- :)-: r 11` ) i;np rcc i«d F r p c.xKed R icac wul _. —. �__ j = 1 4c e.with at ,=Hart- 'ab;,k 7 °")4.14 Dain,, 5t nae.r nt� Fa' i -�--`-- ' - - ---i TWA KBilN c Pate, :d1 L- F ..-- -t-.-= — - ..__--{ h::i I ria} i.,i tr"�a�iiik a r a>•, 1.launal irx,, and� i 'OCi_I i rte. t a �c Pc i tic .G,'en'' . Ofi 1 ��.x ni H t 1:nun - --� fZa Sud atrr"aci 1 tic Sciwct I —' i�ih , 10r tdc KFi1 } till �r ScnCi ' a J' t Tr..l. ny aS..etisr . ... (e,=`rc3 d,.a --} =-- ----,---_ . -J CONSUla9Es't ADVISORY TIMETEMPCRATURE CONTROLS �' � "t>Qr ( t t r std rnr n z lar ri TRn3pt°,�afurer+for ' t " PHFs ii t C>" a i c 'ri. ss i .,, in°ur rq 55T z5 - - --_.. rliV sAwme by ho h1 ,1 j i � 1mi do as 4c r; I 5115�ec - 40.I1t,A, .."t & t.aa,)c Ji i 'df.l Q L1, 1 PQ sed Qwf too - 1 .` F } . hair'-'t ,.W... EMAL R. Eyd it ` i.NT' __ WREVENT'--� - I -- -- _ ___- , t VIA r i �,�i . 41 _.P.,.. )t;x�}YAlt� : t ' 5)r 1; 00-70-0--TT :, t.J-5- r 1> I � > Cnti'.i ti t [nli`ia icna .)Aa2rc "Ic' . ;- ,l Ac '';j� 1V'ni" .. 1Viit C�.z.t. St4 , ,}'YF�� icaxi si r ` r t.rc r t�.64�s sh<i,iti he i � � S" ftt�"}f C�} t „ta.Fish,, h'tici- � ' s,�[:it_.c i.c,�•.. ;ls ,.x v�ri.tr 1.1:0:15 j ) "f 5 0 i rt 4C' } `_ . . P fA6 7 q T _-- r -3{ly 903.1 UN !Sric,t w:tc- !+ i ' R4 we S_:,adin; I t " r:arre m , ,r,.�zz , ,}<.,_. n u f.K 4W a,. . a`�-. I A r,r , ., q owe ,at zitM pa,; CMR et " "tern Gcoti r e Fractrcx _ FC 5�9.LiDL ,,f, _ K, 1g Proper cooling of pHFs 25 v 1_ MH i-VA) �. I S exui to CNA d t'Hi'< I i ph, t t�"I'Within_ iiow:avid From `T`I- a t � c•n: ".,., ...� __ - �"C r, ✓`�'_� — t 9 }745, Ll b n h n F d =s i r �s h cS [`. s ._.-_.. _. -,-561.ia Bi ( Cti.itng Pilf- 41,.11. Frcni,ln"aiertt 1 7 n r cure_In cec ie>?-s ii +-?`Cid{'N- i � 4✓ ` 016 _.__.- - _-_--_ _ ._._. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name to Tvoe of 0 eration(s) Type of Inspection /l I[Yi ®_Food Service ❑ Routine Address �G Risk 'El Retail -© Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone a�� �a ❑ Mobile Date:(0 v py HACCP YM ❑ Temporary ❑ Pre-operatidn Owner Pt I r t/ - G e ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑❑ General HACCP Complaint In:� Inspector Our Ro Permit No. ❑Other Each violation checked requires_an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 1590.009(F) ❑ action as determined by the Board of Health. ((a� g / ( ' C `3/ FOOD PROTECTION MANAGEMENT,� k „m El 12. Prevention of Contamination from Hand's y� / ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities e EMPLOYEE HEALTH amEeJ'.a; '�du..� P'PROTECTION FROM CHEMICALSa' � q El 2. Reporting of Diseases by Food Employee and PIC f` "w���= mow« ��' �a� _ .i� ' r= � • ��� "04 a ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals ;•°FOOD fROM'APPRDVED SI)URCE t6N"�` ' '`;'!+nrafQvep�iaa7!?m s.-�wp T .I -- at�...,aw..au 11 a� `ax+'�li ,< TIME/TEMPERATURE CONTROLS(Potentially Hee ardour Foods) ❑ 4. Food and Water from Approved Source � _-„ ❑ 5. Receiving/Condition ❑ 16..Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION F11061 CONTAMINATION, " I`i" �K, 713 ❑ 19. Hot and Cold Holding • sae" x ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing L REOUIRENiENTS Fok HIGHLY,SUSGEpTIB,L€PQPULATtONS(HSp) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices pCoNSUMER ADVISOR`(; ..5,.,..�' `:w I e ", . M �",.»y�e, ,. ..0°', ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected , To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below aC ' Ns 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-4)(550.004) 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)(590.108) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: �/ 5:5WInsp&Fo m614,dx Inspector's Signature: C Print: KPc ct/ PIC's Signature: Print: l Pageof�Pages �c�J4/� £• �ee� n r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F& Cross-contaminafion '1 590.003(A) Assignment ofResponsibility' 3-302.11(A)(1.) Raw Animal Foods Separated from 590.003(B_).._ Demonstration of Knowledge" Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Arnrnal Fouls Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by foal employees and 3-302.1 l(A) Fiord Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foal Employee Or An 3-304.11 Foal Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590 003(cl) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 5()0,00-1(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's 4-501..111 Manual Warewashing-Hot Water 3-201.12 FatB in a Hermeticaliv Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-HotWater 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, _ 3-20116 Ice Made From Potable Drinking Water* concentration and hardness.* 5-101.11 Drinking Water from an Approved roved S stem* 4-601_I I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-70311 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Ae Mato AAut Game and ut hor"Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* ].1 Good Hygienic Practices Receiving/Condition 2-401.11 Eatln ,Drinking or UsinE Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes, Nose and 3-202.1.5 Package lute it y Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting* 6 Tags/Records;Sheiistock I2 Prevention of Contamination from Hands 3-20218 Shellstoek Identification* 590.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records,Creation and Retention'* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans - Supplied with Soap and Hand Drying 3-502.11. S ecialized Processin Methods* Devices 3-502.12 Reduced oxygen packalging,criteria* 6-301.11. HandwashinE Cleanser,Availabilit, 8-103.12 Conformance with Approved Procedures* 6-301.1.2 Hand Dr v Provision Denotes critics]item in the federal 1999 Food Code or 105 CMR 590.000. ti e Commonwealth-of Massachusetts City ofsalem' Ktft1 0 }(1 -- I3oard.of Health 120 Washington Street;4th-Floor- SALEKjMA 01970_.._ Food/Retail=Establishment Permit DATE PRINTED: 01/12/2010 ESTABLISHMENT NAME: HOOP"" File Numb:BHF-2007=000055 " .` Tiad=l Way-- SALEM MA 01970 ; LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit issued-Permit ExpiFm- Ree-Restrictions l.Nutes . FOODSERVICE BHP-2010-V94 Jan12,2010 Dec 31,1010 $495:00 ESTABLISHMENT FROZEN DESSERTS BHP-2010-6295 Jan-12,2010 Dec 31,2010 $25.00 Total Fees: $520.00 PERMIT EXPIRES �Decettther 3IY 201D - - Board of Health, This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominentiocation hr the Establishment. In accordance with the State SanitaryCede,beofi e'attyrevmmtium54ngnvvemenks;or:equlpment changes ammade,.aI1 plans for such must be submitted to and approved'by_the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAUM@SALEM.COM DAVID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT lJe.tn Q 5 T)7C 3V&TEL# ADDRESS OF ESTABLISHMENT o? &5JO <i! SQk /77,9,015`70 FAY,# n Jn MAI LING ADDRESS(if different)� AL)hurV KIY 6;6'100 /�tyi62hyr✓ 2,ce 0,A 7/..30 0 EMAIL-Business': (2� Website: OWNER'S NAME �1 ./ G/1 P�. L ! _TEL# 927 ADDRESS J T1-a0..eP's W&V , &l m Z�I/� 61,970 s i KEEI" _/ STATE ZIP p CERTIFIED FOOD MANAGER'S NAME(S) [� >4ecr/Q.1_) CERTIFICATE#(S) 659990' (Required in an establishment where potentially hazardous food is prepared) - Q r n n EMERGENCY RESPONSE PERSON ��4j"el7&1i ) HOME TEL#. 925, �i 7—�0�Cl .„,,. ©9YS„;©F,OPER4TIQN�� . . Monday,, T,uesdW ff ed_npsday Thu_rsda Fntl�y�, y � � � y= � "� ��� . 'Saturdsy"'w HOURS OF OPERATION I �rdm R/Y) l4rh �� pori �Avh �m Please write in time of day. Forexam ellam-ll m I /o pm. I /0)0/,P7 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE `YES ) NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 -------------- RESTAURANTYES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats = 420 3.02 Sea,45 BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES/NURSING HOME----------------------------•----.............................. .............................................................. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES to $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, Improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns a9alipaid /t axe required under the law. � �o,�i< v ia�as�o9 ao-ssy9��8 Signature Date - Social Security or Federal Identification Number. Revised 424/07 FOODAP2008.adm Check#&Date / 7% $ V _. ,-,-...,e��„rav �:�:.,..�.nw :. .sw.:.�a+-..r.r.•�,.-;-._ t,�„ ,.: .,:.r..-.. y -.,.:...�. - .rte.. 1 Massachusetts Department of Public Health Salem Board of Health 120 Washington Sreet, Division of Food and Drugs Salem, MA 01970-t35234 1h 190-35234'"Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Da(e Tvoe of Ooeration(s) Type of Inspection Q ('0/�/�I ®.Food Service [a Routine Addressi f G���� ( Q Risk ` ❑ Retail [IRe-inspection I C) Level ❑ Residential Kitchen Previous Inspection Telephone _ ga t gnj0 ❑ Mobile Date: %g( 1jil ElTemporary ElPre-operationOwner r f HACCP YM El Caterer El Suspect Illness Person in Charge(PIC)_ Time ❑ Bed&Breakfast ❑ General Complaint In:d: 4< ❑ HACCP Inspector �� Out:4-3-"> Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate,corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. mFOOD PROTECTIONMA) EME(Tm® ',` rr,� :,�y';,-1znmpt s'�'a`�_'�� ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El` ® 13. Handwash Facilities F EMPLOYEE HEALTH � � "' `-jm � ' .a... .- ,: a��a � PRO TECTiON FROM CREMICAL fi`: . iara�� V a�r '�)�('. �u�,�.a ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals . a Fs4FOOD FROMAPPROVED SOURCFj� rja T � X-0 - ❑ 4. Food and Water from Approved Source 7,TIMEITEMPERATURE CONTR0IS(PoteMlally Hazarttoue Foods) IN 7 i „ o-,. , ,i r�.,.�� sI= ' ...�..11 wl3lxr:. P3-5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling F F'PROTECTION FROM CONTAMINATION.p r.�,g " � " � �# E] 19• Hot and Cold Holding r ep /Segregation/gatio /Pro ecti i ' " ❑20.Time As a Public Health Control ❑ 8. Separation/SegregatioN Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ;REpUIftWN'rb FOR HCOMLYSUSGEPTIHLEPQt+IJtiAT10N (HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices aCONSUMERADY1St'CRY„��ax�rn�eriPl-� aifi ? r� a�{{"�" � ���t, ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations �.25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:590ffi p Fo 14tl n I Inspector's Signature: Print^-' PIC'sSignature: ' / Jf A� Print: ( h l Page- or-7 Pages f Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590 003(A) Assignment of Responsibility* 4.302.1 (A)(]) Raw Animal Foods Separated from 590.003(B))) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person tocharge-duties Contamination from Raw Ingredients 3-30211(A)(2) Raw Aminal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3302.1 W% Foci Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An .11 Foal Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Ra Orting b Person in Charge" 3-306.14(A)(B) Returned Foal and Reservice of Food"' 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(13) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFcod* 4 Food and Water From Reoulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with.Food Law* 4-501.111 Manual Warewashine-Hot Water 3-201.12 Fcwcf in a Hermetically Sealed Container* Sanitization Tem eramres* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13Shell Eggs* Sanitization TerijoraturreO 3-202.14 Eg�s and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp_,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 DrinkingWater from an Approved System* 4-601.1I(A) Equipment Clean* Contact Surfaces and 590.006(A) Bottled Drinking Rratcr* Utensils Clean" 4-60211 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact surfaces and Utensils" SheO€rsh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ceE men Shellfish" FoxContact Su 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Re MatoAu€hart Game and AutWild Mushrooms Approved try 2-301.1.1. Clean Condition-Hands and Anns* 3-202.18 Shellstock Identification Present* 2-301..12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2 401.1 t Eat n ,Drink n or Usin Tobaceo* -T-202 1-1 PHFa Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Pucka e Irate it-* Mond'* 3-101.11. Food We and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock I2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(,13) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained" Employees* TagxlRecords:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 3-402.12 Records,baling Creation and Retention* 5-204.11 location and Placement* 590.004(;f) Labeling of Ingredients' Conformance with Approved Procedures 5-205.11 Accessibilit,3 0 teration and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processin Methods* Devices 3-502.1.2 Reduced oxygen packaging criteria* 6-301.11 Hindwashing Cleanser, Avaitabilit 8-103.12 Conformance with A roved Procedures" 6-301.12 Hand Dr ing Provision Denotes critical item in the federal 1999 Food Code or 105 CMR 590000. - CITY OF SALEM BOARD OF HEALTH EstablishmenYName: Date: (3(3g Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified fPLEASE ,PRINT CLEARLY Q / [[ I i -sv I Uiu UnV, �Jo _novi e r e P— iJ0_ , n f I UoqjLL oncdN (= IL > 21 C T 1 (cz4z 1 "-,W— t0 n/� —3r Yi -r / _ s . 1 , r S. — JC !� 1 S 7192 fAll a _ n c i 9— G t Discussion With Person in Cha ge: Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction/. have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to 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. ( Int /�� ❑ Voluntary Disposal 0 Other: 3-501,l d(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 CHEMICALS 3-501.15 Cooling tvlethods for PHFs 14 Food or Color Additives _ 1y PHF Hot and Cold Holding 3-501.16(B) Cold PEIFs Maintained at or below 3-20212 Adduiv�,* 590.004(F) 41"145'F" 3-302.14 Protection from Una>.roved Additives*li5_ Poisonous or Toxic Substances 3-501.1 ii(A) I for PHFs Maintained at or above 40'F. 7-101.11 Ideon t}'ing Information-Ori Original Cnntamers* 3.507,16(A) I RoaH sts eld at or above 130°F. * 7-102.11 Common Name--Working Containers* 21) Time as a Public Health Control 7-201.11 Separation-Sl.Ll u9CL 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use" 590.004(1-[) Vatiamcc Re uiremein 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smitizers.coteria-Chemicals°` POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 2I 3-801A I(A) Unpasteurized Pre-packaged 7o1ce5 and 7-204.74 Drvin>. ents.Criteria* Beverages with Warnmg I aabels* 7-205.11 Incidental Food Contact.Lubricants" 3-801.11(Bj Use of Pasteurized Eegs* 7-206.11 Restricted Use Pesticides, Criteria* 3-801.11(3) Raw or Partially Cooked Animal Fail and Raw Sced S Trouts Not Served. F77-206.13 06.12 Rodent Bait Stations* 3-801.11(C) Uno erred Fano Pscka>e NoC Re-served. x Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMENEMPERATURE CONTROLS 22 3-60' 11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods Ifiat are Raw.Undercooked or PRFs Not Otherwise Processed to Eliminate 3401,1 lA(1)(2) C gs- 155'F ]5 Sec. Pathogens . E cs-Imrnedi ate Service t45'F15sec* 3-302.t3 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats &Game E *s* 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) ViOlati0115 of Section 590.009(A)-(D)in set. * catering, mobile food, temporary and 3-461.11(A)(3) Poultry, Wild Game, Stufted PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165017 15 sec. * above if related to foodborne illness 3 40111{C)(3} Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145`F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Micmwave 165'F* Special Requirements. 3-401A l(A)(1)(b) All Other Nits- 145'F 15 see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.A)&(D) PHF,,165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and rick factors listed above, can be 3-403.11(C) Commercial Iv Processed RTE Food- found in the following ser.tions of the Food Code and 105 CMR 40'F* 590.000. 3-403.1.1(E) Remaining Unsliced Portions of Beef I Item Good Retat7 Practices_ FC 580000 Roasts* 23. Mana einem and Personnel FC-2 .003 1g Proper Cooling of PHFs 24. Foga and Food Protection ____ FC_3 .004 25 E ui mart and Utensils FC 4 _ .005 3-501.14(,x) Cooling,Cooked PHFs Prom 140'F to 6. _ - --- 26. _Water. Plumbing antl Waste FC-5 .006_ 70'F Widr n 2 Hours and From 70'F 21. Ph steal Facility FC-6 007 to 4t'FI=45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(13) Cooling PHFs Made From Ambient 29, Special Requirements .009 Temperature hreredients to 41'F145'F _30_ L Other Within 4 Hours* s=vor�nwn,:za�� *Uenoles critical item in arc tsdccd 1999 Food Code or 105 CMR 590.000. "y CITY OF SALEM BOARD OF HEALTH `Establishment Name: S 03� Date: �I3 /0 9 Page:___ of f .r DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION 1 Date :Item T Code'' C Critical Item No a Reference '` RRed Item{ ✓�, �'z&vrs'..r'..�` rySc'j. a 'h, ,,f;j %;'. K" °o`' P EASE PRINT CLEAR DJ —f Z i Q mo'ler, d re c� PL2t4)6..jnc/ �. 2� n Sol. I� r Cc u n c'G r LJOAJM< 024 ')A A — Oil ) r / r 1 f� Cin, . r_ �" (" _-O' o fl , r i 1 s" I Discussion With Person in Charge: Corrective Action Required: ❑ No as 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 I P I '�Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that 1 nonHood ance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure youermit. � 1_. � � � � � �� f1C 4 ❑ Voluntary Disposal ❑ Other: F 14 i C-1 Violations Related to Foodborne fitness Interventions and Risk AccordingOto Late Cooled to Factors(item 7-221 {Cont} 1 41 F/45'F Widilin 4 Hours, PROTECTION FROM CHEMICALS '-K')1, 5 --- Coe lin,Mei ods for IlliFs L-L9— PHF Hot and gold Holding 14 Food or Color Additives_ 7�—(B) Cold PHN Majolained at m belown-202.1? AiLli I i vas 590)(4fln, 4P/4�' F� -Ti62 14 protection from 1'nar roved additives* -- 11.50 1,16(A) Hot PHF,Nitarnamed;it or abovc LL� Poisonous or Toxic Substances 140T lof if Iderififying,information - Original Rcmlits Heidat ornative 130'0- cornahlers'l L20Time as a Public Health Control i FaimionNams - wakin,cootainers j Sol T I� as a public Health Comrol� 7-20 1.11 1 SWpalation54 I 'o - n40R cywrunenC �02�11 - 7-202,12 Condiiions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE _7_261 I I Toxic Clanirrinrr�,-Prd,�v7i�_)ns' POPULATIONS 7-204.11 Saniii7ers,Crheria -Orinuical%* 7-204.17— (7he_1111Z—for W_at��Ed1-iTTTw-)��-if np—a ste—ur-i zed Pre-pack aged juices Wild 7-'04,14 Dim iwtia' or pa'teu 7-205,11 Incidental Food Contim Lubricturts" 1 3-801A l(f)) Raw or Parliah,;Cooked Animal Food And _7 i erY ci [2-206�IT �'Ilrnnai Ille lae�Eiradel;�Cnterui� Rsv, St,,d Spro-riel Not Strved. 1 7 206:12 Raters, Brit SVAi0nS* 77 124-6E,_J'i — Tracking Powders 'esCvmrol—.i,, TEE' L CONSUMER ADVISORY 2 2 360', 11 CoConurywr An%isory fIrraed lor Cmeauription la of TIMErrEMPERATURE CONTROLS Ntliwal Kaa&That are Raw. UTrlurax)ktd vj 16 Proper Cooking Temperatures for bot Othem ase Pro�,Ossed to Elorrinake PHFs xr 15,5'F 15 5,,e. p Is 1130113 11-igtelinz-d Feg.<Subawiste m3 Raw Shel _301.]I(A)(2) Comminuted Fish, Meats&Ginne Annuals I55"F 15 gec. SPECIAL REQUIREMENTS 3-401.11(13)(4 Y(2) Pirfli and Btlef Roast 130"f 121 rain 74—oi—I i Ratites, hii-ct"d Meats - 1�5 F 15 of Section 5140 9fA)-(f))T catering. mobi3 toad,tercipurta v and s fit 401,11(AI(3) Pouhry, Wild Game,Stin FieJpjj-f,71 restdimhal kitchen operations hola he Sueffing, Containing Filill, Mori, debit Under the appropriate sections lamfirvorRinites,165,1i 15 scc, j alxve if relawd to ftxxlborric ithress ,401 11tC}13} Nve'4-masele, bttact13ecfSneaks inter ventfsnand tisk factors. Othcr 145'T l" 590.009 violations relining to igoocl retell II 3-401J2 Raw Amoral Foilds Cooked in practices should I.v dehitcd under#29 - 3401 A Microwave 165'1-'* S pecial Roqujrernorax. I(A)(1)(1)) All Other P11B- 145"17 15 sec. L_17 -Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A 1 f A)&(D) PHF, 165'F 15 sec. ' (Items 23-30) _7_4Jq_l I(B) -Microwave 165°F 2 Mintill,Standing # Cripren anIkon-(riucal viola ions. o-hich do ria relare io the L_ 'firrO, 1 /oadborne iflnesr auervenoonx,nzd risk jarrors lived above, (an be 3-403.I I(C) Commercially Pivessed R i oT finund inthe following o,roori of Me Food Cade and 105 CUR 140)F F,C 1 590,00 340111 kE) Remaining Unshced Portions of licef � Good Retell Practices I M and person, PC -2 '003 1 -_ Roasts 24, Food and F(M Prclertion PC 3 004__ Proper Cooling of PHFs Cook�at PHFs from 140l F to FrIa!2n -1 Ltaorl RL,�sjtsa F0-4 005- _____t 2 6 'T3 'i6l 146k) 70'F Within 2 lfoursand From 70111 5 006 PC-6 007 - ---- --Rhoycicci �LFqciflty in 4 I'F/45P Within 4 Hraas� pe Prilsonocs PC-7 .008 H301 14(Bi Cooluiv PHFi;Made Front Aniscan ocit Temperature Ingredicias to 4PF'14i`F L-39Other Within 4 llours' Denows omen Asin in rhe federal 1999 vora Curie(zf l05 c' "IR 5el 000. -.:. � ,.,. .W 1. �,. , •.herr... .. _.. *._, .- ;.,,;+e.wi"":w'.�./r'u*r'r".1'`". -,: ,.:;�;_ . ;, �. , .. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4`" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel.'(978) 741-1800 Fax(978) 745-0343 Name Da Tvoe of Operation(s) Tvoe of Inspection / O ood Service ❑ Routine Address �( Q( t f R sk° LJ Retail �] Re-inspection Cq W Level ❑ Residential Kitchen Previous Inspection Telephone ��l ❑ Mobile Date: I i)),,/u Owner ^ HACCP VI El Temporary ElPre-operation (j.r (( � ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint No. In:4:r�'4/ [IHACCP Inspector \ f Out:4134 Permit ❑Other Each violation-checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate co recti; s90.009(E) [:] f$9b/.009(F) ❑ action as determined by the Board of Health. y10 G.4r did `I yv� i z/hj_q FOOD PROTECTION mANACEMENT! w„_•� J1' � m� � �T EJ 12. Prevention of Contamination from Hands 11'r°° ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities 'EMPLOYEEHEAILTH.....`"'w"" T :�� ,d1'€i��= „� wti .� r�qr , _„,„„„,,,,„d., :.„,.,z, 1� V,PROTECTIQN FROM CHEMICALS > �3w�r „€ ❑ 2.lkepon66 of Diseases by Food Employee and PIC �.. . • -- ��� m• ��•m �m ❑ 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals FOOD FROM ❑ APPRO EDSOURC ., '- ' � , . ITIMEEMnPmEmRATUR�ECONTROLS PteMialli-1--E 4. Food and Water from Approved Source Hazardous Foods) 4 ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling = PROTECTION FROM CONTAMINATION- " ""` =� �' El 19. Hot and Cold Holding � n ��E � � � El8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning.and Sanitizing E REOUIREMEE,NT$FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)-,,,€ [-121. Food and Food.Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices "'CORS-UMERADVIS IRY-,� : i- r y a m �a ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ❑. Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044))) 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.Oo8) 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 REINSPECTION: ssso�nspec�Forrrsia eoc - n nn ..-- Inspector's Signature: _ ._ Print: - ./ PIC's Signature: �rrr� Page of / PagesA/ r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination -590.003(A) Assignment kit Responsibilhy* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* _ Cooked and RTE Foods* 2-103.J 1, Person in charge--duties _ Contamination from Raw ingredients 3-302.1.1(.4)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food enhptoyees and 3-302.1 L(A - Food Protection* ahhlicauts* 3-302.15 !N'ashin Fruits and Ve etables 590.003(F) Responsibility OPA Food Employee or An 3-304.11, Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,003((3) Reporting by Person in Char Vie* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(1)) Exclusions and Retrrctionstrict onss* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and ReFood 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fcxrd+' 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.Ot}4(A-B) Compliance with Food law* 4-501.1,11 Manual Warewashing-Hot Water 3-203.12 Food in a Heretically Seated Container* Sanitization Teni eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13Shell Eoos* Sanitization Tem eratures* 4501.114 -Chemical Sanitization-tem H, 3-202.1.4 Eggs and Milk Products,Pasteurized" p'+p 3-202.16 Ice Made From Potable Drinking Wafer* concentration and hardness. 'h 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- ShellfishContact Surfaces and Utensils'"and Fish From an Approved Source _ 47P2.11. Frequency of Sanidzanon of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foal Contact Surfaces of E n ment* Shellfish* 4703.11 Methods of Sanitization-Hot Water and Shellfish 3-201.15 Molluscan from NSSP Listod Chemical* Sources* f0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Recularon,Author" 2-301.1 t Clean Condition-Hands and Arms" 3-202.18 Shellstock Identification Present* 2-301.12 Cleanin Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-20117 Game Animals* 1.1 Good Hygienic Practices 5 Receiving/Condition 2401.11 Ending,Drinking or Using Tobacco` 3-202.11 PHFs Received at Proper Tent cratures* 2-401-12 Discharges From the Eyes, Nose and 3-202.15 Pada e tette it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tastin Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible - 5-203.11 Numbers and Capacifies* - 3-402.12 RecLabelingds,Creation and Retention* 5-204.11 Location and Placement* 590.004(7) Labeling of Ingredients' - 7 Conformance with Approved Procedures 5-205.11 Accessibility, operation and Maintenance IHACCP Plans - Supplied with Soap and Nand Drying 3-502.11. Specialized Processing,Methods* Devices 3-502.12 Reduced oxygen packaging,criteria` 6-301.1 t Handwashin Cleanser,Availability 6-103.12 Conformance with A roved Procedures" 6-301.t2 Hand Dr n Provision Denotes critical Item in the federal 1999 Paxf Cale or 105 CMIt 590,000. - Massach-usetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name D tg T e of eration s Type of Inspection 2407 1�'U pOod Service 14 -Routine Address a -N- C Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone �a�_ J ElMobile Dater��7� Owner r- HACCP Y/N El Temporary ❑ Pre-operation (Lc ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Tim ❑ Bed&Breakfast ❑General Complaint // In.4*-,� E] HACCP Inspector Out: 4 Permit No. ❑Other Each violation checked requires an explanation on1he 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) [:1 action as determined by the Board of Health. i x,FOOD PROTECTION MANAGEMENT„7, ='1 "" re'-7=21", ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities r EMPLOYEE HEALTH'" "`' r� ` •M1_;`,` " �;.dE�t:; mi ;. .,» .i ;;„,„ PROTECTION FROM CNEMIGA4s,. "` y '�;E re F] 2. Reporting of Diseases by Food Employee and PIC ��•� x�=�__�_� ���t ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals f FOOD FROW APPROVED SOURCE 're= 7=T`g"�'°°� :rere. i °a+a ' """ '_'��'°°`"�' " .-ism taF"`"" TIMEREMPERATURECONTRfSIS(PbtenfWity'H4xe1'd4usFp6ds)" ` �❑, 4. Food and Water from Approved Source � . AT " •- roten�� a ps _ �1 l,y Receiving/Condition ❑ 16.Cooking Temperatures a6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. ooling PROTECTION FROM CONTAMINATION 7' 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing URE QUIREMENTS FOR H,QHLY-SUSCEF�IBL,E7©PULATtONS(HSP);A ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices - QONSUMER:ADVISORVp a ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 3 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below ' by a Board of Health member or its agent constitutes an 23.Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(sso.004)) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(990.009) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: v Inspector's Signature: , Print: g PIC's Signature: Print: e((P V Q Paget- of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contaminaton 1 1 i90.003(A) I Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated-from 590.003OH Demonstration of Knowledge* Cooked and RTE Foods* &103.11 Person in char e-duties Contamination from Raw Ingredients - Raw Animal Foods Separated from Each 3-302.11(A)(2) EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Foal Protection* applicants* icants* 3-302.15 Washing Fruits and Veetables 590.003(F) Responsibility Of.A Fad Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char*e* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A}(B} Returned Food and Reservice of Food* 3 590.003(D) ExclasionsandRestrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.12 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* 4-501.13 t Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetically Sealed Container* Sanitization Temperatures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temper cures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-1.01..1.1 Dunkin,Water from an A roved S stem* 4-60 1.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Bets t Water* 4-602.11 Cleatuu Fre uenev of Equipment Food- 590.0(16(B) Water Meats Standards in 3 10Approved CMR22.04Contact Surfaces and Utensils* Food- 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 E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10Proper.Adequate Handwashing Game and Wild Mushrooms Approved by Re ulafo Autharit 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301_12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices Receiving/Condition 2-401.11 Eatin ,Drinkin or Usrn Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes,Nose and 3-202.15Packa e hite it y* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting 4c 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 - Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers mud Ca acifies* 590.004(f) Labeling of Ingredients' 5-204.1 t Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation andMaintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialize Lrocessjn ,Methods* Devices 3-502.12 R�en acka rina.criteria 6-301.11 Handwashin Cleanser,.Availabilit 8-1031.2 Conformance with Approved Procedures'k 6-301.12 Hand Dr in Provision 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 1 CITY OF SALEM - i BOARD OF HEALTH J 1 Establishment Name: I�I C))) Date: 0 (�/ Page:-- of j f jl nem Code C-Critical ItemPLEASE PRINT CLEARLY DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item - - Verified r 1/1 s 'c C ,� &k'(_e Aon (1'1 1 ,� • � Z /acl I1 4� 0 fhn r2 tot L 4h r,,� s ' I �_0_ . o S n �>l-_d, u✓ I ezu 4- !hJ(51t J 17rf p I V-2 52P CALr G x f III ^^LLf-- �� 1i } �• 5�1 (!. D t/)eI/LQ k,d-- r/�f V4 �/ kcjr 4 La'j a t�'1 '�JJ . C'tP Irl 7Y�lC•�/ r L CJn , C Wr Ih�l + f A UtL� 5,r7 . In, A4,It,-, p � P, 1x r�. c�SI„0 t � � '�Ur• �� °� rler" kjAAK-,n rte( S �Lc �F JA, hWQ6 4-il tg":� 2v(/,;,,J- Discussion With Person in Charge—{o 4-%Ja/k�;- ©' Corrective Action Required' ❑ No I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P � Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars o.suspension/revocation of ❑ Embargo L] Emergency Closure your food permit. ry I � t.C/rK,C l ❑ Voluntary Disposal ❑ Other: I , 4( "e PHFs Received 11 Temperaluret's Violations Related to Foodbarne illness intervenlionse and Risk According to Lav Cooled I* Factors(Ile?"1-22} (Cont) 4 1�FA5'F Wilkie a Hours 1-501.15 for MIR PROTECTION FROM CHEMICALS 14 L 19 PHF Hot and Cold Holding --7,561.16(il) Cold PffFs Moultairied at or bcltaw 3-202,12 i Addiuvct;* 590,004(F) 4I"t45°F, F-7--71�-�ZJ4 1 kivowctl�qll�kroal till =d Additives*—1- -3--50-1,161—A) flot—PHF�' Mami7lined—at ,,arov'-11 Poisonous as Toxic Substances 11), it 1 identifying trifol mao'lif -Orit�ma! 3-501,16tA) Roasts Held at or above 130"F 20 Timeasa Public Heafifiz—ontwi 7Time as a Public Health Conuro[Ir l-10211 Complore Name, - �7-201,I 1 eldork-Stol 1 7-202.11 Romi ction -Preselict and Uso* 590,004(lill vari F— —7,od 7-202�i 2 rlition,(IfLU k�' '——,-- 1—' -- ASQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 Toxic Collamet"--Prohibitions 7-2()4.11 POPULATIONS(HS Sallilct >-»0£ 11(A) Uriplmeloizied Por-packaged Juices arid -tn'Criteria -Cheiqic�tk* _Z:204 12 C° sols :fiteeia'for Nir'4'hI!T1 7 20414 - — '5-SO!,II(B) 1c if past ,-205T Incidental Food Conirecr, Lkilio icawv4 -11--( --,L Ciiteihe3-801,(1(D) Raw or Pavredl,,Cooked Aminal Food mat ' I Rem SL",d �'trouts Sc Served. 7-206.12 TZOderlt Beat`=t,tei0r� 3,8WAI(C) I' 7-206.'13 Tl-ackmp fees,—control Monnorim," CONSUMER ADVISORY 22 3.00 I E Crerlaniter!Vt4isory flowd for Consenniareon la TIME(TEMPERATURE CONTROLS Anincil Fttods That are Raw, Undercooked I,; 16 Proper Cooking Temperatures For- PHFS Not Otherwis-e rrrowel"""ed to Fliminerte, 3 40i I IA(1)(21Elll:- 155'F 15 Sec, diatcService I 1,302.13 Pl:stn abred FggSubstitun,-foi Raw Shell -174 1-11(A)t2) ------ — Animals SPECIAL REQUIREMENTS -401.11s,11)tl/t2a I Pork and f3cof koloei 110"t-121 mine' 3-401.11(A)0) Satins, IlIject�-,d Meats 1' F 15 � tijalatt an,of tion 5ZWOfA�(r )) in catering� inobilc food, tempea-ary and -T'eiultr,,,IX ild GarW,-,'�Ta fccTiq F", -i 461 11(A),�) 7� 1i rerideul'al kitchen operations should be Pulov or komcs165�f15 s-c Svoffnig Conlainin" F�Ish� t1 at, debiled lndcr the aplropriatt."'ecilesns alxve if I elened to flKAhornt illaoss o whok,-P.rul'-fic.Intact Beef sterelks l avei ventions and visk factors, Other 90 009 1 --flo"k cll,.�C-d In 1-3 h debited under I pedal Requirements. Mlcrowavc 105'F —1W1 I I(Aglj(b) All Other Pffs -- 14ITT t5 sec, L7 Reheating for Hot Holding -VIOLATIONS RELATED TO GOOD—RETAIL PRACTICES 3-4()3.1l,A;&(D) 111* 165tT 15'qec (Item,;23-30) 140111(tf) Microwavc- 165°F2 Nlinuw Siandin, Critical unel nori-traical violanteal, which do eun relare to oelc Tirrie" filtaittionew Illness iaurventoines and risk jbrs rors RIeei above, (,III be, 3-203.I I(C) l Commercially Processed RTE KAO- fillied in the, ection I of lhe Food Code.and)05 CAIR 14('Fr 3-40 3A 1(F I Rertainin Uraliced Portions of Serf w jj� do pivary Fc 590,00 23 management and Peonqnsl 24 1 FcrA and mood Protection, I FC 3 004 18 r at Cooling of PHFs --- -25' FC--4 005 qyip erj�Li�s_ 3--501.14(A.) Cciovagcookv.dPHF's from 14(frito 26 I Water,PicribinjandNaste 5 006 y i 'O'F Wiihin 2 111 slid From 70"I' 27, te)41 -45 P Within 4 How,- 1 1 26, Poisonous or,roxic Materials I rO -7 1 3501.14M) Coolhw PHI s Made From Ambi(all Peal R,--RtLireane.n Temperature Ingredients o,41'F"15'F 30 Other Within 4 Hews' crarcell vlern e4 the I 949 I'llod coda'e'105 1,MR 590 fli)0' CITY OF SALEM BOARD OF HEALTH Establishment Name: Lt-Ni"' Date: Q Page: a� of item-4 Code,3 c-critical item Date,.,,�,, DESCRIPTION VIOLATION/PLAN OF CORRECTION ,-7, Verifl;ci��i 'Red Item A ,, #,� PLEASE� No., Reference R L 4 CLEARLY 2-ic r ko b. A�f C4, S A '11 fA bl //1 0, \j t/ --)n) Ale, (_Ler,17i Y1 IF t1i\lee 5 f), Irl] li2 11 ep A� vroLw vl(�Iec. 41,' SlWy -A -A_1A G r/to I loon/ J Z4 L lcf 3-5-V(-lo* AL 5�2 GC4r4J9 AJ-) OX)AA —L.IA12 . 17 r, �L r cle,VA41dod 4-,.� �,-, I- &),e-) o,=_ Rf_f1__ ,C"p, Z, 0 F:7 U7 4L Discussion With Person in Charge: Corrective Action Require N Ll Voluntary Compliance El Employee Restriction ect all Exclusion I have read this report, have had the opportunity to ask questions and agree to corr violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled U Emergency Suspension,-- comply with all mandates of the Mass/Federal FoodCode. I understand that ' noncompliance may result in daily fines of twenty'five dollars of suspension/revocation of Li Embargo., U Emergency Closure your food permit. n711-YVA �i U Voluntary Disposal' o Other: PHFs Ree ived at Visomovins Rolarils!to Foodborne ffirsista;linaNivithers and Risk I Accordi Ell,to Ltnr Cooled in Factors(item 1-22) (Coal.) 41'F45°F Wilbin al How s. ydirl,�14ethoqs fir 11 Fs PROTECTION FROM CHEMICALS _L PHF Hot and Cold Holding 4 Food or Color AdditivesElsa. Edd PHFr Mtornamed at or below 3-2 0 11-2 1 11-1 s`1'_ 590,0 3..(F) 4i"/4 F' 3-30114 Protora,•oll Iranied Additives" 3-�l)iN IN,A's or PFIF�Nfabifaiiied at(,it rlbove� , Politractits or Toxic Substances L —------------------------------ 1f}t.11 IdorittNing,Islas makittri -06�'olnri Rtsist�Held at of atictie 130'T. Containers, 1 20 Time as a Public Health Control I 0_1 i I I Coqunon Nart,� - %Kork;q,�('�,aonner s, Ids conn-OV Lrsslanosl -son C 7-�O 1. 9 1 Tww as a Public Heas Itmet Racuirstttent and Use" 7 1-202.12 I Coadnionof REOUIREMENTS,FOR HIGHLY SUSCEPTIBLE 7-203,11 Toxic(arolalseE,, POPULATIONS HE?L 7�_�4.11 Sant vets ("'ittrits 0ennicats, _L 2— -5e,iii—eakfor 1_2i_7_380-1-1-k—AF U-njilimcurized Pre-paclaged liners add C ocfial d 7 '04,14 !=vcvwE�With `lYariJal&,1-illi-L '401AI(B) Uc in,Parleurized i, 7-205,11 fir6dontd i-oad cornict,FlinlinurW _) ____- ( 3-801.11(D) a6 1 Ra�i,it:icdl t"t critelv), i S N111 S'Asee _1�11��d_Tlotlls_11 'Flackirk Psmdam pt,sl C'EntrA and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 60' rigurnor Ad%isory Posted air(Irmouaption of A i cre Raw, Undercooked la wim') F�Xxjs,rlla Proper Cocking Temperatures for �(at Other,ilafloy:e'si;wd,to 1-Annuare 116i.1-Fk I', in i,i Feg S,sbsulule ka Row StellElco- Inalledr=Set vicr IIST15t 1-40LINA)Q) fen donned Fi,", Me"Its&(,airs Arnucuk -ii'T isec. ' SPECIAL REGUIREMENTS 11 i Po4 said lite( Roast -I�Wf` 12 j Jilin — _T - df_ __F__ — --i P - 1__,_______�_____------ 59J),009�,T)J)) T �el (Its _196 is)I�11(A)(2) Raiiw,, InjcotA %1,riti, - 15.5 F 15 scc csderwairibik fricis, ientiokwary and _-401.11(Al 'l) 1 Pclflsry, VNIld(itvr,a�. Stuffril PFFS, rcradixiLid known operation,' should be nSfr r2 Csaid pril, Fith, Mese, deboed under the 1 pollity or kawts-IWls 1,;�wc '° tdxwe if relawd tit firrAbonte illness whoblnusvleIn Ici BJ�et S�101Z utefs anst risk foclori, Otbcr 14,19, J� 5a0.()09 votlationa rclatino (st-gi)(id retail loacticesshould he debited tinder #29 Microwavc 10f- spimal Rquireamits IllAflp(b) All Otriti illl`, -- 145'1 15 sec. 17 ighentmet for Hot Holding VF01A55N§-AtE44YED TO GOOD RETAIL PRACTICES H-11 1651 17ce, (Iterms 23-30) I _21Mutt to_Sr,indi El", Citir-q!and non-r saos,al vi0i'mostli, alsith do iiw relatein flar favirshone ahcM wrei)enriorlv,end and finairs lweat ahove, can bis 3.,401.1](C) Cornalcyci;d1v RTEFood listed in'he lolin,isikaee rionv of na, Food Code avid 105("11IR °.901(30+1. 3-40;3 3-40,3A I'El Undirad portions of Feel tem, I Good Retail Practices 5_00,000 Roasi<l FC c) 003 Inv�tWFW Food!and Food Protcrlilo'n 3 004 _25 1 E qil rrassit and Uteri, c FG-4 , 71,5 1.11(A) fin hair Coolant PTIFs Irons 144)`F to ----------- 26 Prornoirig--arid Wasle I FC-5 1 006 A)CF,isvialin 2 Hours,rid From cry-c, P11 fity t FC-6 �007 ol!1VIIF Willan 4 Howt, FC 7 008 Cisaing flf[Fs Wdo F"au Ambient Tsorip,ittoire iot�,rcifcrrts to 4VFi45`F ...... Within 4 Ilkisturss' clutcal ilon sn she iokn,! MIr Far(ode or 10 Ctort 591)Oor� �iilo HACCP Risk Assessment City/Town of: Salem, MA ee a Establishment Name—IHop '�' ';^t , 's z , Address—2 Trader's Way Ingredients Source fir,, a.,, Scrambled eggs Glenview Farms Person-in-Charge—Luke Raphael Eggs Glenview Farms Pancakes [hop Information for the Risk Assessment was obtained by: Potatoes Ihop/US Foodservice Pancake Syrup Ihop El Observation of Suspect Food/Process ❑Observation of General Food Handling and Sanitation Practices ❑ Interview with Food Employee Responsible for Preparing Implicated Food. ❑ Interview with Person-in-Charge or Other Employee Weight/Volume of Suspect Food Prepared or Served: Dates of Investigation: 2/10/09 PLEASE PRINT CLEARLY Describe Product Flow.. Describe Environmental Data Collected to =HAZARDS Describe Corrective and Preventive h i Date 1, Verify Control or tack of Control of Hazards Contamination Measures Initiated, (Preparation Steps) it .fl Verified '. ° -Survival" .. , ;,* Who,What,Where,When Proliferation *` (Include changes in food handling procedures orders ry for correction,embargoes/disposals food employee restrictions,food safety training,,emergency . .;:'!. w �+• ,r , t, •.:;: s';r , s,;. . i°� 't z. ,,;v„. suspensions and closures,etc.) "CCP Scrambled eggs:liquid scrambled egg is (Critical delivered every 3 days from Glenview Farms. It is stored in original packaging in the walk-in Control fridge at 36T.As needed boxes are placed in a Point) reach-in at the cookline at 39°F.When needed, one box is taken out and put into a container in ice at the cookline and ladled onto the grill with a ladle kept in the container.The container and ladle are replaced with clean, sanitized ones three times a day minimum,and the egg is refilled approximately every half hour.At time of inspection,scrambled egg at the cookline was at a temperature of 39°F. Eggs:eggs are delivered every three days from Glenview Farms.They are stored in original boxes in the walk-in fridge at 36°F,and when ❑CCP needed,trays of eggs are removed from a box and put into a reach-in at the cookline at 39°F. Eggs are put in a container in ice at the cookline for use;container is re-filled as needed from the fridge. Page: N umber_of HACCP Risk Assessment Report Form(Updated 09/05) Iv Pancakes:pancake batter is composed of dry pancake mix,water,egg,and liquid butter alternative.Pancake mix is delivered once a ❑CCP week from Ihop in 451b bags,and stored on racks next to the mixer.One bag at a time is used for mixing batter.Liquid scrambled egg is used for the pancake batter;see above for information on scrambled egg.Liquid butter alternative is delivered every 3 days from Ihop, and stored on racks in dry storage.No refrigeration is required for this product.One jug at a time is used for mixing batter. Pancake batter is made every two days. Ingredients are combined in the mixer,and put into covered,dated buckets for storage in the walk-in fridge at 36T.One bucket at a time is taken out and stored in a reach-in at the - cookline at 35T.Batter is poured from the bucket into a pancake dispenser when needed and dispensed onto the grill for cooking. Potatoes:potatoes are delivered once a week from either Ihop or US Foodservice frozen, and put directly into the walk-in freezer at- ❑CCP 10°F in original boxes.As needed,one bag is removed from a box in the walk-in freezer and put into a container in a freezer at the cookline _ at-5°F.When ordered,potatoes are taken out, fried in the fryolator,and served. Pancake symp:symp is delivered every two days from Ihop in Igal jugs,which are stored on racks in dry storage.Onejug at a time is ❑CCP taken to the waitstation in the kitchen and used to fill individual pots for customers'tables. Comments: Page: Number_of HACCP Risk Assessment Report Form(Updated 09/05) Commouwealth'of Massachusetts r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2009 ESTABLISHMENT NAME: IHOP File Number:BHF-2007-000055 2 Traders Way SALEM MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BNP-2009.4280 Dec 29,2008 - Dec 31,2009 $420.00 ESTABLISHMENT FROZEN DESSERTS BHP-2009-0345 Jan 2,2009 Dec 31,2009 $25.00 Total Fees: $445.00 i PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIMBERL.EY DRISCOLL FAx(978) 745-0343 MAYOR 1DIONNE S LFNI.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT lHOP - NAMEOFESTABLISHMENT SACCM PANCAkCS _ TIVC • TEL# 6978 ) 9QS- 90z0 ADDRESS OFESTABLISHMENTA JAA.669S lJflyISALCMO MA FAX# C97S) 5.-125- 10 22- MAI LING MAILING ADDRESS(if different) EMAIL-Business': a�CLCUOLW%WY Til rC • CO7- Website: IV A OWNER'SNAME ALCM PANCAtCS TNC • TEL# 660 J-2F -8S7 -2 ADDRESS 025060 PFVE• 61FAnNFOIAA #a00 VAC.En1CtA CA- 9135S" STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) OSCAR Ay6NA✓ENY--URA CERTIFICATE#(S) 3 FS 8' S•_3A 6 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL#C6 /-7)8 /9 ' a�O ' DAYS OFOPERATION Monday Tuesda Weilnesda Thursda F e Frida -' Saturda Sunda HOURS OF OPERATION ,SAM_ 10 PM' -7AM- 10f�u 7AM-)DPS Please write in time of day. j �'1A M- i0 PM' (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. - J - 1000-10,000sq.ft. t1WO more than 10,000sq.ft. =$42„ ---------------------- - --------------------- -- -- - --------............................................ ---------------' RES c AUPAN i YES- iJ0 less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and ai all state taxes d under the law. •�, // •20 . 20,01 40 - 5,806 ,19 Signature Date Seel 4.9esm;4ror Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date 1104 9 1 1i Z 1 1 D 1 , $ _y'ttxil•0 0 . 2 Traders Way IHOP City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 825-9020 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:Dirty knives found stored in the knife rack. Properly clean and sanitize all knives prior to storage. Mark Justice PIC: Violations Related to Good Retail Practices (Blue Items) Hugo Buenaventura Food and Food Protection FAIL Critical BLUE Inspector: Comment:The Traulsen unit has uncovered food. All food in storage must be covered. David Greenbaum' Date Inspected:Correct By: 6/5/2008 Equipment and Utensils FAIL Non-Critical BLUE Risk Level: { Comment:The back stairs need a thorough cleaning. Permit Number: i BHP-2008-0220 Status: SIGNED OFF #of Critical Violations: 2 Time IN: Time OUT: Urgency Description(s): BLUE: all other violations cited in the 5/28/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2008 ) Page 1 oft --•' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2008 ) Page 2 oft 2 Traders Way IHOP City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency iTelephone: _ '� PROTECTION FROM CONTAMINATION ..(978)825-9020• - Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED 2GWneC - .:E ,\�Comment:,Dirty knives found stored in the knife rack. Properly clean and sanitize all knives prior to storage. Mark Justice s Th slicer needs a thorough cleaning and sanitizing. 1PIC: I Nikki Albright a cutting board on the end True unit is stained and scored. Resurface or replace the cutting board. IDSpQCfOr: I� Violations Related to Good Retail Practices (Blue Items) David.Greenbaum Food and Food Protection FAIL Critical BLUE :Date Inspected:Correct By: Com/mQnt:The Traulsen unit and the end True unit have uncovered food. All food in storage must be covered. {5/28(2008 :There are paper products stored directly on the floor upstairs. Store paper products at least 6-8 inches off the floor. Risk Level: Equipment and Utensils FAIL Non-Critical BLUE Comment:The ice cream freezer needs a thorough cleaning. Permit Number: BHP-2008-0220 a Traulsen unit needs a thorough cleaning. `Status: S rue drawer unit has an accumulation of food debris. Thoroughly clean this unit. PARTIAL COMPLY same unit needs a visible,accurate thermometer. 1#of Critical Violations: �T )2e end True unit needs a thorough cleaning. Time IN: Time OUT: I th ack food prep sink"Food Prep Only" Urgency Description(s): T walk in needs a general cleaning ofd dsh Iv BLUE: �� .,Violations Related to Good ! Lam"walk in freezer floor needs a thorough cleaning. .Retail Practices (Critical violations must be corrected The back stairs need a thorough cleaning. immediately or within 10 days)(Non-critical violations Reinspection in one week, all violations to be corrected. ,must be corrected immediately 3 Pr within 90 days) g9 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 29,2008 ) Page ! of2 Item Status Violation Critical Urgency RED:. Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action): .. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 29,2008 ) Page 2 of Commonwealth of Massachusetts City of Salem a Board of Health 120 Washington Street,4th Floor IGmberley DriscollMayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: IHOP File Number:BHF-2007-000055 2 Traders Way SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0220 Jan 4,2008 Dec 31,2008 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31,2008 Board of Health (iz.Lv 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 13 of 24 CITY OF SALEM, MASSACFIUSEM BOARD OF HEALTH 120 WASHINGMNSTREET,47H FLOOR TEL,(978)741-1800 KIMBERLEY DRISOOLL FAX(978)745-0343 MAYOR asmnT&sAU ODM JOANNE SOOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT„-„,1."O P * Ur .'d_6 TEL# l l g M-90010 ADDRESS OF ESTABLISHMENT FAX#9lg Qas- q0 as MAILING ADDRESS(if different) EMAIL-Business': CQSe r A Website: OWNER'S NAME SA/-Cn PfNC0rk6S j ,[- /nr C • TEL# 46.J1 _&_7k -88 -77 ADDRESS , CZ5060 AV NIL) STAN FQR4 4.200 VALCIVclA� CR 91355 STREET 1111 CITY �L STATE 1 ZIP CERTIFIED FOOD MANAGER'S NAME(S)4j j 0 a UeBgVt1� u1g0Q kt�FRTIFICATE#(S)�JF�SJ`L - 4��4540 (Required in an establishment where potentially h3zqous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday 1 Tuesday—, Wednesday Thursday Friday t Saturday Sunda NOURSOFOPERATION (Fore wdmnlwAloay. (Forexanpb 71ao-11pmi ' TYPE OF ESTABLISHMENT FE (check only) RETAIL STORE YES NO less than I000sq.ft. =$70 1000.10,000sq.ft. =$280 more than 10,000sq.R. =$420 .............................................. ........ ................................................................... ...I......-------_.......... RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats more than 99 seats =$420 ................ ................ . . .................... .......---------------------.....-----......--- BED/BREAKFAST/ YES NO $100 Cttt4l?CAt?�.$,ERY.tQE6............................................................. ..... .................-... ADDITIONAL PERMITS MAKE (not Just serve)ICE CREAM,YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church Kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit Is not transferable and must be reissued upon change of ownership.The Permit must be posted In a prominent location In the Establishment. In accordance with the Slate Sanitary Code,before any renovations,improvements,or equipment changes ars made,all plans for ouch must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I tartly under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Qo - 5g�961 8 signature ,L Date 0 //-�/-•Zo/rn-�- Social Security or Federal Identification Number Revised 4124107 F DAF2 6.adm Cheeklf&Date g fF Commonwealth of Massachusetts City of Salem s • Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 10/29/2007 ESTABLISHMENT NAME: IHOP File Number:BHF-2007-000055 2 Traders Way SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0683 Oct 29,2007 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31,2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 R'{qatR;rrime 75`2412007 ^-q;,n o>,: ^.j - .. • 4rA T^�... - rz.- - Cal PM ;i:_ - 745 rl9y2 .I v CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOn _ SALEM. MA 01970 e TEL 978-741-1800 FAx 978-745.0343 Kimberley Driscoll WWW.rALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT 10 OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 176 p �SY�EEGs� TEL#��0„_. �',S�pi n ad ADDRESS OF ESTABLISHMENTO — ajeol FAX# 15 ' oC�/T MAII.INr AnnRFSS(if different). .. .....__ - / EMAIL--Business'': Owner's: OWNER'S NAME + �-,/ TEL H1 y8�I�7p� ADDRESS O U iUe. .] is," I 1O Iy�.IP.lICiQ O /VSS STREET CITY ` STATE ` 21P CERTIFIED FOOD MANAGER'S NAMES) I(..P-F-P1 ot'QS CERTIFICATE#(S) l , (Required in an establishment whew potentia Iter l foo is r agd� l HOME TEL# ' N Y RESPONSE PERSON €�J C.e EMERGE �/� C /{'! �-7 OAYSBFOPENatIAN Monday TtlesdaV Wednesday Thursday Friday Saturday ..SUUddY NOUK-0FOPERATION Fleasewrite lnUnleolday. /�''1' 7m / / Yn 741,_/fen /44M-(a mr�.2r IFor 110111010 11aa1.1111911 TYPE OF ESTABLISHMENTj FEE (ch✓✓eck only) RI_I AIL STORE YES NO/ less than 10003q.ft. _$ 50 1000-10,000sq.fl. =$100 more than 10,000sq.It. =$250 RE5TAURANT /GES NO less than 25 seats =$100 25-99 scats =$150 more than 99 gnats =5200 BEDIBREAKFAST YF:S NO>� $100 ADDITIONAL PERMITS MAKE (riot just serve) ICE CREAM, YOGURT, SOFT SERVE YLS NO✓ $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO✓ $25 -Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the Slate Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans r such must be submitted to and approved by the Salem Board of Health. Pursuant t GI Chaplet li2C,.'Cellon Ci:rllly under the pains and lienalliCs ill pullury Vial 1. to illy busk knowledge and bchrf. Ila,e III all stall: Nix �UIUi n-•u pd .II:I Ir. lurv9!enwred w"dCr Iho law. ---_ - Rn,>�5310 . _. ... _6 0 - bar N J Signa t�re Date Social Security Or Federal Identification Number -------- ..... . ................ ..................................... ....................... ..-------------------`---------------- f7r:vivcd I V I31oG r 001)AP711n7 adpi Ch0ckd g DOW . (i 1 j i CITY OF SALEM { BOARD OF HEALTH Establishment Name: -C//o t! Date /O--a-D 7 Page t of } :nem : :Code t C-critical Itemx ri R DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION " Date j $ No. :Reference a R `-Red Item TT xy e ra".. V +.3 p .' ., *' =` ." _. `5" c " ' ` Verified - ""^ �` ��' "��' � " "'�' � PLEASE PRINT CLEARLY - ° - � - f1 ?e 0Penf l7c/ I� S I�o� �irr� 04L -//;5 CO21,h),4ed ,'? 6011% -fAe' Shu l� oval �'ud� �avr� 5inr5 : All are GUP// /DPdlP� t I Tvh 5 !/5°F - ©e 1 - Ex 7 D/M l n d't/vyl CC e) / — b C t JIS111 - OKE 1-4/'11!!z7F's Q Q C edcA JW-P. y �Cp C✓P `!Dl� r , U�114 Jf A QfOoF d/ �07uPv 4 /2n �om�s CflrJ e��� ✓P � P4 /v�'d /h Gu0�-eW 5 ?W � - � �.� ��c��-l�rrs � a%t�uo✓i� i,4 � dui �— �t/�.- _�Ha/s 2fa f J ra /a�� Y//va✓� 'Jve 40 Able 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/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure i your food permit. I ❑ Voluntary Disposal ❑ Other: f a t 1-1 PHFs Received at T i ,ratureq Violations Related to Foodborne f1friesis Interventions and Risk Acording to 1,aw Coaled to Factors(Iterml 1-22) (Cont) I'F/45'F Within 4 Hi turs. 3_501 1 s Coolirr,NIcUrods for PRFs PROTECTION FROM CHEMICALS L19 I _FH_F Hat and Odd Holding 14 Food or Color Additives --—' - "'-, I I S{Fl 16F87 Cold PRFs mainuJited at or bell'ay 3-202Ane ___T 59frNO(F) 41 /450 F LL 3-302,14 piriteehou firolaL��_ 1-50i,16iA) Hot 111112'Nbinntitied at or above Poisonous or Toxic Substances !40"F. � ?-101.11 1 identifying dilainatiop-Oil..Dal 'Z.5VlA6(A) Roasts Held at of above 130'4' Colltajner�j' r_1 Time as a Public Health Control 7-102,11 cowlion Name-workirr �raloaijlortl L-20 7-201.11 Srpraation - 512L!�+e 3_5Gl 19 7-202.11 lictriction -Prestreco and U,,e* ?-202.32 Cotaditiont (if)Lhse- REQUIREMENTS FOR HIGHLY SUSCERTIBLE ?-3{}3.1Y Toxic Crtaharrcis-Prolabvion, ` POPULA IONS(HSP 7-204.11 saniti7erq,crilel6 -chellvictils* 3-401.11(Ai Pre-pric"'Sged Jtfic�s and _7-204 12 Chenlicak for wash"T,llnlacc�cjheria'� Bevera"'es, 1�ibols� I wid"Wiit� 7-204,14 Drdrut Aitentt.Criwrial a 11- _801.11f1t) U�c of PaNnqn-twd /_2_05 1—1 �hwidemal F'o(X_J Contact,1-uhricanni' 1-801.1 [(D) R or Ptroialb,Cwk,,d Animal Food and E7::2:06�i I hese ioed ase pelicides'cvivalaRaw 206.12?06.1 —il — _�:_ Stu .a �)r xas Not Stryed ode i B 'wtlwns� GI fi - _�_ P �rs t and _06 '4oiaj or" CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 16 Proper Cooking Temperatures for Aniawl F�"ods Dial tri,Raw, Undervookcd of L. PHFS Not Odvr,�iSe flroce_sserd to Eliminate _' 401�I lA(l)(2) Fggs- F5� 2 th( 5sec, 3-30113 i Pt'teaiwod Eg�;Substlonfor Row Shelf 1-401II(02) Comminuted Fi<h, Meals&Gmry SPECIAL REQUIREMENTS 7441.11{H)Q,(2 JLl:rk turd Beef Roast �j 10"l121 mdl* —LL Vioinflons of Section 90,0}9(A)-(D)in 3-401.11(A)t'')1i Ratito,lnjeod sAt ivts - 155 F 1S110,10mi-07) crrtering, mobil-tool,icrapKafy and 3-401AI(A)(3) i—Poultry,Wild Game, Stuffed PF(Fs, romdent at kitchen operations should he Shiffing Containing Fish, Nicol, oebued under the apprr)pnateie%:tiows rrcc. f anuve!f related hi ftKAborrie, illnoss scle. bract B�o leaks 3-401.1 lic)(3) whole-inu.scle. bract B�o interventions and risk factors Other 145""F* 590.009 violrltionn relating to good retail 3-405.12 W_ la acticos Awidd be debited under#29 - i , k Miloowave 1651 Rerjldrelllonts. -401 It('T 1),b) ltmrn Fo rl� RawkCooked in a All Other fllil`, -- 145°F 15 sec, 1=7 Reheating for Hot Holding VIOLATIONS RELATED?_T0 G00' D—RETAIL PRACTICES -_I OTIl(A Fw T) __FliI-, I T5 Sec. (Items 23.30) Miconkaw- 155°F Z Nliall-w Standing Cr o,wl and raor,rincal vim'artum,,, which do not reiate ro the Time, fttodhorne illness oaenewiow and KA-fin tors licwd (an bo 7:53_5(c) Commorcialiv Piocesiad RTE�Frxxi- fi'lvid in iheft'lourng sections q,'rhFood Code and JOJ CAl IR 1401P oll,(X4' 7Z.3 31(S) Rernaijam Umhoed Por iiiong7of cer T 23 Ig 1 T4 Foodand Food ProlcTflon 1 FC--3 004 Proper Coolingdt PhFs —------ — �25, LEeviand Uensili FC-4 005 3-5{)1.34(A) cvolirloo -ckud Plif-'s Naar 1-40-F to ------ 2Waterd '9L W6 � ' 7(!*F Within 2 If vers,and From'11PI r26�7. r, blrlvlrd007 W`4 1-1`145F W'iflan 4 Hrno,, Poisonous or Tonc MaterlalsFf L008 7501.14Qi) Cooling PHF�Made Front Ambiew Sp al Temjx�navvre to 41'F/45 F 30: Other --_Wdhun 4 J)oiroies auroal etir,in hie f,,denfl 1999 Food(Axly or 105 CMR 59'U(0), CITY OF SALEM BOARD OF HEALTH Establishment Name: �/hJ/� Date: /D o 7 Page: of_-2- Code,, 2Code,, C Critical Item g . r DESCRIPTION OFVIOLATION/PLAN OF CORRECTION ; Date -; No ; Reference R Red Item ,,. 'a''`t . '. � ", ,."' ..,_ e, ,,, , -�.. Verified f - f 4-= PLEASE PRINT CLEARLY- �• r 4 x . x "� �'lP✓1f12_ / / t&,,// .50P /y h /r �!'LY� ,_Ae r' l>!! G✓COD.1101 -/T�d 5 t { / 054 hd-oOUCA 14/e_ SDIu7'1" 1 0t7k'1 p lP CA u.i4,,r 0 e-xe /oto rt J - 13 51 r - SC�,r/ /�/✓ — Q✓N yu,r,+/ tu��.. C'vyrr � - Gvi// � � -�i-cP.�. A�e Q-f � -� .5/'1r� f(✓� � 1/.Pv/�t u>/� �QSf S-/ri/ Qj Q !/S-F s 1 F � I C Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes j ' I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P El Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that h noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I ❑ Voluntary Disposal ❑ Other: ]4(C) PHFs Received iitTemperaftnes Violations Relattat to Feedborne Illness Interventions and Risk According to L. Cooled to Factors Itte"er I-v) (Cont) 77 41'Fi45'F1hnhin4Hciir:s , sit M,thuds�for PHFs PROTECTION FROM CHEMICALS 1=4 -KZC-f-0rCoJor Additives F19 PHF Hot and Cold Holding 3-SO? 16(1l) Gild YHF,Wintemed at or below 202 Adthdw 3-541 16iA) flot PlIfs Mainrained at or abov,� 3502 14 protection fircuuE2��� --- Poisonous or Toxic Substances 14UT, 7-101.11 idenfifyinglifoiawflon - Ola mm —Hold at or above 130'F. — cuiradhers" L16 Tithe 1-102,11 Common('lame- Time as a Public Health Control 7-101.11 41 ah, variance etoent I ()21 111 ReNtniction-Premncc and Ike, '-202.12 Condition of Usv REQUIREMENTS FOR HIGHLY SUSCEPTIBLE [I Toxic Coillainco, -Prohibition'` POPULATIONS HSP r 7 204.11 1E 7-204�12 11riahtec'Cluefial frevero?'es with Warin - 7 204,1 0n,riaL-47 I.T(BT 7-201,11 Incidental Use of EaiwonLcri J:' 3-81,1 1 d)) Saw or Pawaltv Cc-)kcdAaiajaI Fuad and 2007i 1 Rear ted Ue Pteticides,Clitetia* Rat 54 d SI itak Nor Scuved. 7-206.12 Rociefil fair statiom� 206.13 1 Tracking P'ovdem P�'sl Control and _L�yi�eucd'fkx!i PacltaL, but Re-served.,L CONSUMER ADVISORY 3Postal for Cousumption of TIME/TEMPERATURE CONTROLS 16 Fr��rCookingTempecatunrsror' Aninini Foto& Mat art Raw UnderetIuked ul PHFs Not Othcrmse fr(wessed to lKholfraw ae, 3--401.11 A(l)(2 Figgs- 15,5'F 15 Sec. Irat latlac(hare Ser to I Of 15,111 5sec' �iO2.11 P ,'teuriiod Fgg::SLibsunne f6i Ravw Shell —1-I F)-I I_I(A) conallinuied fib' Meas& (eant, 1 mss` Amin ccls-1s51 15 sec Poik and fleet Roast - 130"1' 121 rinn' 4jL 1](8)(1) 2 SPECIAL REQUIREMENTS 3-401.11(&)(2) Ratites,hvjecd Wav,-- 15,S,F 15 590009W (D) Violabcni, of Section 59(009(A) (D)Jn soc. catori n g, mobilo f(W, temporro v and -T4-01—1 I{A}1 3 1 Poultry,Wild L,arise, Stuffed PHFs, E recideril'al kitchen operations should be Stuffing Containing Fish,Nfina, kictaccd under tits appropriate sections loultr•or kadws-165"T 15 scc. above.if retaiccl to foodbonic illness Intact Boel'Steaks Interventions and risk fiaclorsOther 145"T590.009 violations relarrn.v to Q(K)d retail 7:T0-1-12 Raw Anum—il F—,Kk C'uxluxi In a practices should be debited under#29 - .Mioowave lrd"F" Special Requirements, -�vv—001ti—PTIf-'s-- 5 1— I Reheating for Hot Holding ^i VIOLATIONS RELATED TO GOOD RETAIL PRACTICES -s10111(A)&(17} PRFs 165"F 15 wG. (Items 23-30) 3-403.11(R) Microwave- 165'F2 Minute Staratim, ctifiral and non-"Kiical vioualiont, which do no rehge;o the Tjrve,� foodborne dutess eIRIf VCsh0MV,ou1 rkjottors Rved tit mn'e, (on he 1—(C) Commercially Processed RTI-.'Focx1- found In uheltIltow[ng secdons of the Food Code and 105 C.RR 140'P J 9atH Item T- 3-403�I I(E) Remaining unhelad pornsitut of Hcof Good Retail Practices FC 590,066 R(xea'0 Ig 2n, I Manafipj�entanq_ 24 Ford and Food Prouactio-n FC 3 004 -�rW7o—ollnq�t—PHFS - 26, �2Watei�Plurvatniq'crid Waste -5 006 _[_E p -!IttarIq eac;jI 005 501 i4ij") Cooling Cooked PFIFs front 1401,le ---qui mit, 70'F Within 2 Hours,and From 791' 27. Physical Faclil)i a K'-6 .007 28 -HPoson(yjx�r Toxic Mater&si P.0-7 '008 I 14(B) Cooling PRIPs Made From Ambient t 29: 'Yaal pa, tarts Goo Ferritaffature Ingredients to 411'/451F 36 Other llouW iiiihtie,teral 1919 Voo,!C,Aor 165 CMR590000, IHoP For Me=" Dellrroses absence,pato Is geniegre mlAo at mn mo de mreahidialas bio se a ocked, Cart,Conscious Fewer Fat Gra ms Cum gYour Cala nes i Great All Around Choices Less than 15 Mam L true is ga so((at L N 6N wlorig Les Nan l5 gram of rarbobydmhs, of<arb M1yd tee,s Pam Lmmmde Gmso CuganOo lm Calodm ¢grams of fat and avalones BOM M COtbaM1idrmm Men.de 11 Arctic,de 9mm Menet de 6rN morin On ....l9ual Minas Ee Ispanm Se", I"'nowde m2Mi9dm demrtWAay "'now mbaar � Big Breakfast Combo A m eat to-, dlghtTh st'p f b three pork r Osagelis th ee�fledh tp �f ga 999 mPill W �Buttermilk Tno A hon stack I famer,b ft mlk Panakes topped with mprga eeand l w giip429 � � a^". 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O ` rel F p co^Too,.sakhrhos 5e^iev Nuevo Revnreda y Panque,azi IN and 6W carries Meed,ISgromn:eegenrny6wmlams A shop Senor Buttermilk Pancakes bisect[ -. • rommsfihre,of our cStr winning buverrri lk pancakes 399 Ads Frush Fruit For Mewsee reg demmondmrm rsgmmosde -. 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Other Juices Available Iply. Chocolate Milk 199 vegetable,choice of potato and art c bread 699 xlld tome roe Gaolote Pemuga de Polls Asada Senior Apple,Tomato,Cranberry or Gmmfrut Rg r2.39 Curare 569 219 Hot Chocolate 229 Onsslugss Odponibks oke',Spot' Root Bee. Uockwe Calente Hol Tea 1.99L¢mOndde 219 TP Caliente reactors, Senor COW ilaplp fWUndaix Unliw,iFed.eccllr a"all bNe•nyes Milk Shake 3.49 40 Neve•Ewcl CoPke Pette Icooducce while or wawbem) Regular or Coat 199 porr poison/ &aide de Lech, Sorry,no coupons or discounts On senior items. In CN&em Nun[a 8Ve✓moa sell('nwming now or uMx[ooke i miau,paltry,beaked,sell an W may I— 'Notice'Corrulming mw or undersock[d mays,poultry,seakidd,blanch or eggs may rage spoof SM up your rhk of foodborne Braes;aper Bynu have anain Imdml mMidolis put ink of foodbome ilk,;apfoalty Mpu here[ecan medical mndinae. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Type of Operation(s) Type of Inspection ❑ Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP Y/N El Temporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. .. ;'FOOD PROTECTION MANAGEMENT,„,.,,,, .m,.,,,_„�,,,,�a„,,„„� �,,,�� ❑ 12. Prevention of Contamination from Hands F11. PIC Assigned/Knowledgeable/DutiDuties _ � 3�„ El13. Handwash Facilities EMPLOYEE HEALTH 5 , s3 PSE »m swrw�gu 5tyn%wP 'Pcr=t `ti R"trA _ _ _ n. m ❑ 2. Reportng of Diseases by Food Employee and PIC -� � w ='-a'�' � - w•- wm �ti� e t� �• ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals (FOQD FROM and Water SOURCE ov d �¢,� . w�r�k F TIME/TEMPERATURE CONTROLS(R4terrt1a11y Hazardous Fonda) t ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling `-PROTECTION FROM CONTAMINATION" _ El 19. Hot and Cold Holding A, ;ena n b AJ- ❑ µ8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing - %REQUIREMENTS FOR IflGHLY SUS- -- - - PQPULATIONS(RSP);1 ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El 11. Good Hygienic Practices g CONSUMER ADYISOHY;„ „� ,x e_ a+ °2'SDE ❑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 by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-a)(5so.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)(59o.00s) 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:5WMm rFo�14e Inspector's Signature: Print: PIC's Signature: Print: Page_of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 I 590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foals Separated from 590.003(B) Demonstration of Knowledge* Calked and RTE Fonds* 2-103.11 Person in drarge-duties Contamination from Raw Ingredients 3302.1.1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in change to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection* applicants* _ 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Re orcin b 'Person in Chu!e* 3-306.14{A)(B Returned Food and Reservice,of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated - 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" 4-501-111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eratureo, 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashino Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-501,114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water- concentration and hardness.* 5-101,11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinkin Water* Utensils Clean* F 590.U(16(B) Water Meets Standards in 3 LO CMR 22.0 4-602.11 Cleaning Frequency* q y of Equipment Fund- Shellfish ShelNish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contac[Surfaces of Equipment* Shelllish* 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 Regulatoty Authority 2-301,11 Clean Condition-Hands and Arms* 3-202.18 Shellstock.Identification Present* 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 1 When to Wash* 3-201..17 Game Animals* 11 Good Hygienic Practices y Receiving/Condition 2401.11 Eatin ,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes, Nose and 3-202.15 Package lute it-* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records;Shellstock 12 Prevention of Contamination from Hands- 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstoek Identification Maintained* ..Employees* Tags/Records: Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11. Numbers and Capacities* acities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.1-1 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced ox en packaging,criteria* 6-301.11. Handwashing Cleanser,Availability 8-103.12 Conformance with A roved Procedures* 6-30IA2 Hand Drying Provision 'Denotes critical item in the federal 1999 Ictal Cate or 105 CMR 590.000. L {Ti%.(':'r, - �.. y,.1^'sy.t;_.lr.ra�vr.r.•=.rv+. s..x.n.v+.y'y't.w•--m .-.r .f _'._^4.�.C...!LS ..n;M}. Q '}�.F#2:.rpY.T,' "tvt�'r-•6 .:. - . Massachusetts Department of Public Health 120 W Board Street, 4n He Division of Food and Drugs Sals Sal Washington 4'" Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name DateTvoe of Operation(s) Tyne of Inspection ❑ Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP YM El E] Pro-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint ` In: ❑ HACCP InspectorOut: Permit No. E]Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action-as determined by the Board of Health. FOOD PROTECTION MANAGEMENT,'," „ "'' El12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities e EMPLOYEE HEALTH ' ' €_ „•. er- ® a PROTECTION FROM CHEMICALS,G�1. j,'kw_ a sk mn 4 ( a ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ,,FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source 'TIM&TEMPERATURECONTROLS(PoleMialry Hazardous Foods)?", ,,,=iia,u. i:r.u..m.a:��.. .2pa: m a,aok'.....k#%�=�I,.w.ktwsw.a..•m.,.eeiW,�.::..r� ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [:117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling �PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding r 9 ^ `' ...�m + , ^.e �...- �.� �'-x a.m�.....uw.m ae,m. s�sR•4xJeti r j ,..- . 'm916AA ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 9l#QulAEMEN1rS FOR HIGHLY SUSCEPTIBLE POPULATIONS ❑21. Food and Food Preparation for HSP 17110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER A()UISORY, -„�i '.,�a "i=1 :..� ".Y,m%^,'.ai.;-apv, [122. Posting of Cocsumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N 23. Management and Personnel (Fc-2) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(5590.0 4) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(590.00 )o.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 ry29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:5901nsPostFormB-f 4 Ea Inspector's Signature: Print: PIC's Signature: Print: - Page_of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination rI I 590.003(A) Assignment ofResponsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demons ration of Knowledge* Cooked and RTF Foods* 2-103.11 Person in char e-duties Contamination from Raw Ingredients 7302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.11(A) Food Proteetian* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Cdhsumer 59R003(G) Re orcin b Person 3-306.14(A)(B) Returned Food and Rescrvice of Fund* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food .11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanifization'Pent rahues* 3-20113 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-I-lot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.* 5-1.01.1.1 Drinking Water from an Approved System. 4-601.11(A) Equipment Food Contact Surfaces and 590,006(A) I Bottled Drinking Water* Utensils Clean* 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 Regulatory Authority Game and Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-202.I5 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PI-IPs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and - 3-202.1.5 Package Lite it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tastingic 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* )kl Em ces* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca achies* 590.0046) Labeling of Ingredients' 5-204.11 Location and Placement* q Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying _ 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packer hg,criteria* 6-301.11 Hindwashing Cleanser,Availability 9-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Proiision *Denotes criucd acm in the federal 1999 Foal Code or 105 CMR 590.000. - CITY OF SALEM BOARD OF HEALTH Date: May 31, 2007 Name of Establishment: IHOP Restaurant Address: 2 Traders Way Owner(s): Mark Justice Phone: 661-294-8877 Terrence Case, VP Operations East ( 661-294-8877) and Terry Abner (770-426- 8383), Construction Manager, for this proposed establishment presented a Floor Plan for review in accordance with the State Food Code. CERTIFICATION The IHOP corporation requires at least one Certified Food Manager per shift. Certificates must be posted in a prominent location. FLOOR PLAN A Hand Sink must be located in each food prep and service area, this includes the Service Area, Food Prep Area and the Dishwashing Area. Proposed locations (drawn in pink on Plan K-1 by Mr. Abney) of those three sinks are approved. Hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the basement. A dishwasher for washing, rinsing and sanitizing all utensils, equipment, dishes is proposed. It must have a final rinse temperature of 180 degrees in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENU/FOOD PREP The Menu will be reviewed at a later date, prior to opening, with the establishment's on-site Manager UNDERCOOKED FOODS An advisory must be included on the menu regarding undercooked foods. CHOKE SAVING A person trained in choke saving techniques must be available whenever this establishment is open for business. f 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 3rd 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 and grease holding area, must be kept clean and sanitary. Trash disposal methods have not been finalized This establishment is scheduled to open in October. A comprehensive review of food preparation must be conducted with the establishment's Manager. An application was received. Awaiting the Federal ID Number. No check was received. S- 3/--07 J ne Scott Date HeaMAgen Terrence Case Date