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IN A PIGS EYE - ESTABLISHMENTS IN A PIG'S EYE 146 DERBY STREET p �I �h 3 n 6 i. u r e � w a e M i I { o L. �i 6 �I ...�.. - � GI i � Y K A 1 Q I 1 0. 5 4 Y ` o �bNorT, City.of Salem, Massachusetts a,4 i Board of Health 9 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 health@salem.com Kimberley Driscoll Larry Ramdin, MPH, REHS, CHO Mayor Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2016 Permit Number: FM-16.351 Permit Type: Food Establishment 25-99 seats Goods&Services: Food Service: 25-99 seats Name of License Holder: In a Pigs Eye-Jennifer Reardon Name of Food Establishment In a Pig's Eye Address of Food Establishment 142 Derby Street Salem MA 01 970 Restrictions: This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2016 unless sooner suspended or revoked. Permit Fee: $380.00 Effective: 1/1/2016 Larry Ramdin, MPH, REHS, CHO Health Agent . CITY OF SALEM, lu MASSACHUSETTS ii!eaith BOARD of HIM],'rH •.`..",.'."'",.."",.". 120 WASHING]ON S MAr I'r,4111 Ft,00it KIMBERLEY DRISCOLL TEi..(978)741-1800 FAX(978)745-0343 LARRY RADIDIN,RS/RIiHS,CHO,CP-FS e MAYOR health s4em.com 1-I:IiS:\1:I'I-I AG'ENT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: In Ar �t s 2) Establishment Address: t t$ 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: 5) Applicant Name&Title: 6) Applicant Address: qq w S� 7) Applicant Telephone No: I7.rJ51 .5557124 Hour Emergency No: Email:JtmgactdtS r 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address A corporation �ua t -c - part7C nership Other legal entity 12 Person Directly Res onsible For Daily Operations Owner, Person in Charge, Supervisor,Manager,etc. Name&Title: ✓ Address: s} End Telephone No: $ — QST Fax: Email: L H.W )�� Emergency Telephone No: It J 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: G/�] Check#: / Date: Amount:' Food Establishment Information 14) Water Source: 15) Sewage Disposal: Pubbe-. DEP Public Water Supply No: (if applicable) t/ 17 16) Days and Hours of Operation: F•(Oa-$uN• IC•'3p I'LA ) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) &I(h. 19) Person Trained in Anti-Choking Procedures( if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) 0 Retail( Sq. Ft) ❑ Caterer Permanent Structure ❑ Food Service-( Seats) ❑ Frozen Dessert Manufacturer Mobile 0 Food Service-Takeout ❑ Residential Kitchen for Retail Sale )V Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments,,,• (check one) RETAIL STORE RESTAURANT Annual ❑ Less than 1000sq.ft. $70 ❑ Less than 25 seats $140 Seasonal/Dates: 0 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 O More than 10,000sq.ft. $420 25-99 seats $280 ❑ More than 99 seats $420 Temporary/DatesMme: ---------------------------------------------------------------------------------------- ----------------------- ------ ........... ❑ Bed& Breakfast/Childcare Services/Nursing Home $100 ---------------------------------------------------------------------------------------------------------------- --------- ...........--- ADDITIONAL PERMITS ❑MAKE ICE CREAM,YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑ALL NON-PROFIT'* $25 *Including, church kitchens, state funded childcare&private club 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no time/temperature controls required) (check all that apply): RTE-read -to-eat foods Ex.sandwiches,salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec.49A certiQ under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 03 4- '3 7 IbS 2 26) Signature of Individual or Corporate Name: \ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS. LRAMDIN(@,SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM L� J l Date: � Time: �/ ��_ Received By: / Complaint Number: 1844 �1 Complainant �, G✓�� I Address: s Phone: tx Investigated By: Date: Property Owner/Occupant Name Telephone #: City of Salem, Massachusetts 6 �$ Board of Health �pa 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 health@salem.com Kimberley Driscoll Larry Ramdin, MPH, REHS, CHO Mayor Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2015 Permit Number: FM-16-350 Permit Type: Food Establishment 25-99 seats Goods&Services: Food Service: 25-99 seats Name of License Holder: In a Pigs Eye-Jennifer Reardon Name of Food Establishment In a Pigs Eye Restaurant Address of Food Establishment 148 Derby Street Salem MA 01970 Restrictions: This License is granted in conformity Wth the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2015 unless sooner suspended or revoked. /} Permit Fee: $380.00 +< Effective: 7/22/2016 Larry Ramdin, MPH, REHS, CHO Health Agent • CITY OF SALEM, MASSACHUSETTS >ixeatt>i BOARD oFHeAL FI 120 WAST IING'rON S9REriT,4"'FLOOR KIMBERLEY DRISCOLL ' i L.(978)741-1800 FAx(978)745-0343 LARRY RAb1DIN,RS/REAS,CI 10,( P-PS MAYOR Iramdin([er)salem.com HuAlxm AGENP Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: Ln 1'1 2) Establishment Address: — S� - 3) Establishment Mailing Address(if different): p 4) Establishment Telephone No: "1 p r 711 1 - Li 5) Applicant Name&Title: �J1v+ 6) Applicant Address: J,0CZ WkrtA 7) Applicant Telephone No: 24 Hour Emergency No: S II Email: I da 8) Owner Name&Title(if different from applicant): 4 r do ✓l ' 9) Owner Address(if different from applicant): '-�— &.1 10) Establishment Owned by: 11) if a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address A corporation An individual ® �J A partnership Other legal entity 12 Person Directl Res onsible For Daily Operations Owner, Person in Charge,Supervisor,Manager,etc. Name 8 Title: JQ l--,& Address: 7 Telephone No: —63qJ'S¢ Fax: Email- lme'4 A L5 Lee rr% Emergency Telephone No: / '33S 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: /�3 Date: Amount: X t r` Food Establishment Information 14) Water Source: CI 15) Sewage Disposal: DEP Public Water Supply (if applicable) i 16) Days and Hours of Operation: - 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: _ Required as of 1011/2001 in accordance with 105 CMR 590.021A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): 9/Yes No 20) Location: /y8 I>7 22) Establishment Type(check all that apply) (check one) [3Retail( Sq. Ft) ❑Caterer Permanent Structure TCLFood Service-( 51 Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑Residential Kitchen for Bed and 21) Length Of Permit: ----------• •-----••-•• __ _ Breakfast Establishments-------------------„ ........................................... ................................ . .. . (check one) RETAIL STORE RESTAURANT Annual ❑ Less than 1000sq.ft. $70 ❑Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,OOOsq.ft. $280 ❑ esidential Kitchens $140 ❑More than 10,OOOsq.ft. $420 A 25.99 seats $280 More than 99 seats $420 TemporarylDates�me: . -- . ❑ Bed&Breakfast/Childcare Seryices INursing Home $100 . ---------------------------------------------------------------------...-....... ..-... ----------------- - ......-- ADDITIONAL PERMITS ❑MAKE ICE CREAM,YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑ALL NON-PROFIT" $25 `Including, church kitchens, state funded childcare&private club 23) Food Operations: Definitions: PHF—potentially hazardous food(time/temperature controls required) Non-PHFs—non-potentially hazardous food(no time/temperature controls required) (check all that apply): RTE—ready-to-eat foods Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retnil Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information providgd in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR - 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch.62C, sec.49A,I Ltify u at the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: AM CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDM,RS/REHS,CHO,CP-F'S LRAMDIN(@,,SALEM.COM HEALTH AGENT q COMPLAINT INTAKE FORM Date: .L1J�02/20_1Time: Received By: • Sy Complaint Number: 1319 ComplainantAh�Vs Address: Phone: = T D f `7 e.. SeeN 1 f"- tQS Cve, (`niI is vnyn��00CA o_+l I��InoV-me' In I Ar1apT l q ik' o food- ;11 Yl emen�Pw in Ls, n` L�EoJ 'n daS� wa S I ti I� ro t H Ce.l l i Lj n r 0c l fil3ny' � , 0n� 4y4y '�Gv��✓»nLn f • J Investigated By: Date: Property Owner/Occupant Name Telephone #: • I_ g `. 14 `. " (,'On11110IIW@alUl Of M88saehUaettS r h � �' ''� '' +' s � a City of Salem , �� t we 1- 7 a s Bonrd ofof H alth ��IGtTIb8Il8Y DtISCpII w ` ° s 120 WasWngton Street 4th Floor_ ? M8y0f i SALEM, ig MA�01970 �� ' x K� 7 71W b a � Wd Fb6d/Retail Estabbsliment Permit �� , DATE PRINTED` ' � "vt�.Ra 3 '�' �' : fi � �` '.� 3 s"a :� it'�u. *Tr.e ¢' ' � rc=£.5 � -;F *+v •ae,'�r aa� im 2�,Y.°4 '- [ �n ,�� '�-, —��k'��."''-moi # `.�"M s. %✓ +l.•�1 a ,ESTABLISHMENT NAME . ° In a Pigs Eye Restaurant �-Re Numlkr BHF 200004-000272 o �§ sX, AWO Salem SMA01970 �LOCATED AT � �TA-' g < - 'WESALEWMA 01970,"` ' jv -Permtt Type Permit No, Permit Issued R Permit Expires Fee Restricdous/'Notesr FOOD SERVICE BHP 2014-0302 , Jan 12014 Dec 31 2U14 $280 00 ESTABLISHMENT € � ` w s ��MMM w � Total Fees IV,. $280 00 'ex c- `. r -`w- €_�� - M '�...g ,c a� ,� 3' 46£L ��' .�Y'F'c."« �,3t�'g y�` fi # � I w—w U` A "R d s: .< t 3t,*#x � r .'+ p .� - � �`�' 2v'3t".� �„L,-' x '&ham a `a, r +. '.zp#e -: f -,5"^.� d ` ^dam ;'x sax. 'area` `�- _^.'+ MWW s.'-_'a 4' `+'v 3,«+�' VzK `'k' t +"'"s r✓ .. su u. �.' `3 `>'�'8' z-e��i r `' air 3" i7*• m� 'tu x,t" " r �"` �°�. � -Y' ''�IA mz.# l * �Lw . m d-5. - 'f ?. f les ° "e,f '- 5.'x '`•* `�y v« �,.�`•", 'r+ "z��`-' .`t'{ ;t, 'v"'°. U' +✓ �.' f" "� PERMIT EXPIRES",:4.,3. ecember 31 2014 r y x Board of Health]ams- 0- � .� ;mss c r ��,�°� �r �,�;, sr � � �. - � �sv'� x .� �xar �„ '`• �� . a 4-illw, ' 2' m ,`�'S`u` " 9 s `r" m •"., '. '",r a a� _ it,AI ,� ` _ Tlus Permit is not transferable and must be reissued upon change of owneraWp or location'The peinut moat be posted Ana prominent-location in the Establishment 5 � IN! � In accordance with the State Sanitary Code,6eofre any revonations,improvements or egwpment changes are made, 1 sB:pinns for su"llch must be submitted to and approved by,the Salem Board of Healthp e 1 K .. `0 c} r F. . ' CITY OF SALEM, MASSACHUSETTS rewicxeatdi BOARD OF HisAulli 120 WASHINGTON STRLzr,V,FLOOR KIMBERLEY DRISCOLL THL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,ILS/RENS,CHO,CP-FS lramdin@salem.com MAYOR � _ HrAIfi'H AGENT Food Establishment,Permit Application (Application.must be submitted at least 30 days before the planned opening date) 1) Establishment Name: jq 2) Establishment Address: "1 V ci 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: � 5) Applicant Name&Title: �� ) 6) Applicant Address: 7) Applicant Telephone No:a g� [bg 24 Hour Emergency No. 07'yEmail:(y)a i j n Vet dN L 8) Owner Name&Title(if different from applicant): ci 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. Anciation Name Title Home Address corpora An in v ua A partnership Other legal entity tit �� m •6Q CL -71 12 Person [Drectly Res onsible For Daily Operations Owner, Person In Charge,Su ervisor,Manager,etc. Name&Title: U QI P Address: 35 WSt n V 1 Telephone No: Fax: Email:16 a i Se 4f) �eled k- Emergency Telephone No: I ' 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: Date: Amount: /� Food Establishment Information ' 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: (If applicable) CH LA 16) Days and of 4eration:1I:30 a/ r 17 No.of Food Employees: C I I06, i-vbn wcA 5fa 18) Name of Person in Charge Certified in Food Protection Management: Required as of 10/1/2001 in accordance with 105 CMR 590.003(A) 19) Person Trained In Anti-Choking Procedures(if 25 seats or more): Yes No 20) Location: 22) Establishment Type(check all that apply) che®k e ❑�� 1j�eetail( Sq. Ft) ❑Caterer Permanent Structur (1(Food Service-( jj0 Seats) ❑Frozen Dessert Manufacturer Mobi e ❑ Food Service-Takeout ❑Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery 1 ❑Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments (check one) RETAIL STORE RESTAURANT nua - ❑Less than 1000 ft. $70 ❑Less than 25 seats $140 Seasonal/Dates: 131000-10,000sq.ft. $280 13 Residential Kitchens $140 ❑More than 10,OOOsq.ft. $420 2A5.99 seats $280- 13 More than 99 seats $420 Temporary/DatesMme: ----------------------------------------------------------------------------- ❑Bed B Breakfast/Childcare Services/Nursing Home $100 .................................... ..................................................................................................... ADDITIONAL PERMITS ❑MAKE ICE CREAM,YOGURT/SOFT SERVE $25 13 PASTUPJZA71ON $25 ❑ALL NON-PROFIT` $25 *Including, church kitchens, state funded childcare&private club 231 Food Operations: Definitions: PHF-potentially hazardous food(tima/tempereture controls required) Non-PHFs-non-potentially hazardous food(no dmaltemperature controls required) (check all that apply): RTE-rea to-eat foods iEx.sandwiches,salads,muffins which need no furtherprocessing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PRFs for More Than a Single Meal Service Said of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PRFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum PackaginglCook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1,the undersigned,attest to the accuracy of the information provided in this application and 1 affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. //. 24) Signature of Applicant: ,L Pursuant to MGL Ch.62C,sec.49A,I certify under the penalties of perjury that 1,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 15-0 rsoc)q 26) Signature of Individual or Corporate Name: Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 rrr111 t Tel. (978)741-1800 Fax(978) 745-0343 City/Town of €7 nA Address: FOOD ESTABLISHMENT fNSPECTION REPORT Tel (1 -7c'11 1 RO/T Name Type operatfon(s) Type X inspection 'EJ/Food Service uline .Addre-sl Risk ❑ Retail Re-inspection Telephone Level El Residential Kitchen Previous Inspection TV ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person-in-Ch a(PIC) Ti ElBed&Breakfast ElGeneral Complaint In. ❑ HACCP Inspector Ou Permit No. ❑.Other Each viola n checked requires an expl ation on the narrative lodge(s)and a citation of specific provision(s)violated. Nomcomplfance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobaccn Awareness 50.009.009(] p corrective action as determined by the Board of Health. „ 0FOOJD PROTECTION MANAGEMENT '�❑ 12. Prevention of Contamination from Hands 4Ntl1. PIC Assigned/Knowledgeable/Duties /I / 4�ir13. Handwash Facilities 'EMPLOYEE HEALTH U ❑ 2. Reporting of Diseases by Food Employee and PIC PR 14.Approve O veal Fodor C for ❑ 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 TIMEREMPERATURE"CONTROLS(Potentially Hazardous Foods,) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans 18. Cooling PROTECTION FROM CONTAMINATION - / /C/ IM19. Hot and Cold Holding El8.Separation/Segregation/Protection 4411 �❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSUSCEPTieLE-POPULATIONS,(HSP)' El 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical (N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an N 23. Management and Personnel (FC-2x 90.00 0) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-0x50.00a) 25. Equipment and Utensils (Fc-axsso.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 (FC5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (r-c-6x590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. an 30. Other DATE OF RE-INSPECTION: �� - (L� 1�� s: o-14.eoc r Inspector's Signature. Print: 1 PICS Signature: Print: V 60 Le Page l-uf�Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION $ Cross-contamination FOOD PROTECTION MANAGEMENT 3.302.11(A)(1) Raw Animal F(xxls Separated from 1 590.003(A) Asci�rnment oY Res onsibility* _ C(x)ked and RTE Foods* 590.003(6) Demonstration of Knowled a°' Contamination from Raw ingredients 2-103.il. Penson in char*e duties 3-302.11(A'(2) Raw;Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(,C) Responsibility of the person in charge to 3302.11(A) Fund Protection* require reporting by fexxl employees and 3-302.15 Washing Fruits and Vegetables a t tlicauts* 3-304.11 Food Contact with Equipment and 590A03(F) Responsibility Of A Food l:vrrployee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Chark`e* 3-306.14(A)(6 an Returned Food d Rescrvice of Food* 590.(N)3 G3 Re orfin b`Person i,n Char le* - Disposition of Adulterated or Contaminated 3 590.003(1)) Exclusions and Rns dions I t Food 590.003(F,) Removal of Exclusions and Restrictions �� 3-70L1'1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food.* 4 Food and Water From Regulated Sources ) Food Contact Surfaces 590.004(A-B) Crnn r�lianca with Food faw'F - 4-SOLI F1 Mama)Wazewashi,ng-Hot Water 3-201.1.2 Food in.a Hermetically Sealed Container* _ Sanitization Temperatures* 3201.13 Fluid MilktmdMilk Products* 4-501.112 MechanicalWarewashina Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Produets,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 System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Ddnkin Water* Utensils Clean" g 590.006(B) Water Meets Standards in 310 CMR 22.04' 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* Sheflfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Retrcationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfifront NSSP lasted Chemical* Sources* 1p Proper,Adequate Handwashing Garda and W8r1 Mushropms Approved by = RequIatoryAUtbarfty 2_301.11 Clean Condition-Hands and Anus* 3-202.18 Shellstock Identification Present* 2-30L12 Clearning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201..17 Game Animals* _ 1.t Good Hygienic Practices g ReceivinglConditfon 2401.11 Eating,Drinkin or Usin Tobacco* 3-202.11 PRFs Received at Pro er'I'em ramres" 2.401.12 Discharges From the Eyes,Nose and 3.202.15 Package Integrity* Mouth* 3-101.11 Food Safe mud Unadulterated* 3-301.12 Preventing Contamination When Tasting* Togs/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identilication Maintairned* Ent nhwees* TagstRecords: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Reanrds.Creation and Retention* 5-203.11 Numbers and Capacities* Labeling of Ingredients* 5-204.11 l"ation and Placement* 590.004(1) 9 g 5-2CIS.L1 -Accessibilit ,OterationandMaintenance q Conformance with Approved Procedures IHACCP Plans Supplied'wif7 Soap and Hand Drying 3-50211. Secialized Processin Methods* Devices 3-502.22 Reduced,omen acka -n*.criteria* 6-301.31 Handwashin Cleanser, Availability 8-103.12 Conformance with A. roved Procedures" 6-30).12 Hand D `Provision *Denotes cBtical item in the federal 1999 Pard Code or 105 CMM 590.000. �t'pl� , a... I_ ll�_�, •.. ►� ��5' • =��Ml��..._�,00■AMA RAI RIM AW L �� SL i .�� . � I _ .! a / 1. _ _ �Lr i_I�.. %I "� •ice ii.�,�= MIN 1 3-501.14(C) PHFs Received at Temperatures watations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F145°F Within 4 Hoars, 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS 19 PHF Not and Cold Holding 14 Food or Color Additives 3-501.16(11) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 4101450 F* 7302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PRFs Maintained at or above AS Poisonous or Toxic Substances 1400F. 7-101.1t Identifying Information-Original 3-501.16(A) Roasts Held at or above 13WF. Containers* TiTime as a Public Health Control 7-102.11. Common Name-WorkingContainers* 3-501.19 me as a Public Health Control* 7-201.11 Separation-Storage' - - 590.004(H) Variance Requirement 7-202.11 Restriction-Presenceand Use* 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS H 7.204.11 Samtizers.Criteria-Chemicals 7-204.13 Chemicals for Washing Produce,Criteria* 21 3-801.11(.4} Unpasteurized Pre-Packaged Juices and Beverages with Warning Labels* 7-204.14 DryingAgents.Criteria* 3-801.11(B) Use of Pasteurized E mac* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Raw Seed Sproms Not Served.* 7-206.12 - Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. * . 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY T1ME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercook--d or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFa *Ukc 1'"Wr 3-401.I1A(1)(2) Eggs- 155`F 15 Sec. P� � EM,-immediate Service 145°1`15sec* 3-302.13 Pasteurized Eggs Substitute far:Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E * Animals-155T 15 sec. * SPECIAL REQUIREMENTS 3.401-11(B)(I)(2) Pori:and Beef Roast- 130'F 121 ruin* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3.441.11(A)(2) Ratites,Injected Meats- 155°F 15 catering,mobile food,temporary and sec.* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fists,Meat, debited under the appropriate sections Poultry or Ratites-165°F 1.5 sec.* above if related to foodborne illness 3-401.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F a 590.009 violations relating to good retail 3.401.12 Raw Animal Fonds Cooked in a practices should be debited tinder#29- Microwave 165°F* Special Requirements. 3401:1I(,A)(I)(b) All Other PRFs- 145'F 15 sec,* d7 Reheating for Hot Holding VIOLAT70NS RELATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical,mid non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-303.11(C) Commercially Processed RTE Food- found ui the folloa4ng sections of the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Porti ns of Beef item 1 Good Retail PracticesFC 590.WO Roasts* 23. Manassement arxi Personnel FC 2 .003 Proper Cooling of PHFs 24. d Food and Food Protection FC-3 .004^� 25. E ui ment and Utensils I FC-4 .005 i 3-501.14(A) Cooling Cooked PRFs from 140'F to 1 26 Water,Plumbing and Waste_ FC-5 .006 70'F Within 2 Hours and From 701T 27. Physical Facility FC-6 to 41°F(45'F Within 4 Hours. * 288 Pasonous orToxic Materials FC-7 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements _ .009 i Temperature Ingredients to 41°Ft45°F 30 ( Other -� .Within 4 Hours* *t)rnov,critical iwul in the le&rai 1999 Foai Cade or 103 CAM 590.000. S r s ® Mu ®� ' 11 Till 111 j • • • • • • " • ie •lIYiv i. �� • �I �_ IL7I,�SL!l.L�� Y�I '. I�I�' J ��• �• �� FAWAGMPOWINIM 'il. A.._. W Z/ - wi�ir�lL'�!I__ i. sr* �! ♦/! i.% S. .VA - &"WZRX11 ` <<• Lim Mol -_�M_ i1 •1 ..%W W. OVAWMA L / . -M I . ... /ate _ •• • s: Warow --�L�'1l'+�� 1l ♦�c�� fi � r��1I � i . 1 .l�ir�!� Llri" L!��_ ra ■ • • •• ■ • - 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodbarne Illness.Interventions and Risk According to Law Cooled to Factors(items 1-221 (Cont.) 41.'F/45'F Within 4 Floors, PROTECTION FROM CHEMICALS Cold PHFs Maintained Coolin Methods for PHFs 14 Food or Color Additives i9 CHot and Holding 3-501.16(B) olat or below 3-202.12 Additives* 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic substances 140 F. * 7-101.11 identifying Information-Original 3-50L16(A) Roasts Held at or above 130'F. Containers* Time as a Public Health Control 7-102.11. Common Name-WorkingContainers* 20� 3-501.19 Time as a Public Health Cantron* 7-201.11 Separation-Storage* 590.004(H) Variance 7-202.11 .Restriction-Presence and Use* e Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1I Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11. Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-$OLll(,A} BeveUnparages wit Pre-packaged els* and 7-204.14 Drying Agents.Criteria* Beverages a with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 3-801,11(D) Raw or Partially Conked Animal Food and 7-206.1.1 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served 7-M6.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-se'rved, 7-206.13 Tracking Powders,Pest Control and Moattarin * CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 for Animal Foods That are Raw,Undercooked or Proper Cooking Temperatures PHFs - Not Otherwise Processed to Eliminate 3 401.I1A(t)(2) Eggs- 1557 Pathogens.'. '" � 55`F 15 Sec. E gs-Immediate Service 145°FlSsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E * Animals-155'F 15 see. * SPECIAL REQUIREMENTS 3.401.11(8)(1)(2) Pork and Beef Roast- 1309F 121 min* 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590,009(A)-(D) Violations of Section 590.049(A)-(13)in sec. * catering,mobile food,temporary and 31401.11{A)(3) Poultry,Wild Crane,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited udder the appropriate sections Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness 3401AI(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Otber 145°F ' 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-40111(A)(IMb) All Other PHFs-I45'F 15 sec. 17 - Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4)3.1I(A)&(D) 'PHFs I65°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave 165`F 2 Minnie Standing Criticat,and non-critical violations,which do not relate to the Time* I.n foodborne illness interventions and risk factors listed above, can be 3-403A I(C) Commercially Processed RTE,Food- found in the following sections of the Food Cade and 10.5 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsl�red Poiticros of Beef l (tem Good Rsfatt Practices FC 550.000 Roasts* _ 23. 1 Management and Personnel I FC-2 .003 18 - Proper Cooling of PHFs 24. I Food and Foal Protection FC-3 .004 ( 25. Equipment and Utensil FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140*F to 26. 1 Water,Plumbing and Waste F0_6 .006 i 70°F Within 2 Hours and Front 70'F 27. Physical Facility FC_-6 .007 i Io 41°F/457 Within 4 Hours. * r2B. Poisonous m Toxic Materials ` FC-7 .008 3-501.14(B) Cooling'PHFs Made From Ambient 2R• Special R uirements .009 i Temperature Ingredients to 41'17/45°F 30, l Other .-_.�.._�...�...__ Within 4 Hours* 'D nou e critical izem in the federal 1999 Fewd Code or It)5 CMR 590.000. -Masisachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax(978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name' D �Ty,Qa-of Operadon(s) Type of Inspection I C� �4 �d�F cold Service ❑ outine Address y� Risk' "I_I Retail qRRe-inspection Telephone Level ❑ Residential Kitchen Previous Inspection P ❑ Mobile Date: ,/,3),Y Owner HACCP YIN ❑ Temporary ❑ Pre peration d✓ ❑ Caterer ❑Suspect Illness Person-in-C urge(PIC) Ti ❑ Bed&Breakfast ❑ General Complaint In ❑ HACCP Inspector OU& Permit No. ❑.Other Each violatiorf-cheeked violation-checkedrequires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Vipose an imminent health hazard and require immediate Tobacco 590.009(F) El marked may P q Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. -- ----� OOD:PROTECTION MANAGEMENT; _ j ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowedgeable/Duties EMPLOYEE HEALTH - `-'- �-` ` `- - ❑ 13. Handwash Facilities ----N F - ._ -'- _ . ._ _ _ _ . _ _. _ _... ._. PROT_ECTIOROM'CEM_H_ ICACS.. . ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded .-' ❑ 15.Toxic Chemicals ,.FOOD2FROMAPPROVEDSOURCE- ...._ ,.. . .s _ . .. - ... _.. TIMErrEMPFRATURE:CONTROCS.PotentliI ❑ 4. Food and Water from Approved Source .__. ( - tyHarardous Eoods) ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy.of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18.Cooling --- ""-'-"' " 19.Hot and Cold Holding PROTE_CTION FROM CONTAMINATION � _ _I 9 ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR,HIG►1LYSUS.CEPTIBLE=POPULATIO_NS'tHS' ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY _ [122. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22): of Health. Non-critical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3x590.004) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4x590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC5x590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.008) and submitted to the Board of Health at the above address 9. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: bf4rtoc no Inspector's Signature: 'nt PICS Signature: Print G A Page o�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION . FOOD PROTECTION MANAGEMENT 8 Caw Animal Foodn 3-302.1.1(A)(L) Raw Animal Foods Separated from I 590103(1) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Parson in charge-duties 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* Contamination from the Environment 2 590.003(C) Responsibility of the person it)charge to 3-302,1 l(A) Food Protection* - require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 Foal Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report'Po The Person In Contamination from the Consumer Charge* 590.003 G Reporting by Person in Chorea* 3-306.14(A)(B) ,Returned Food and Resenice of Food* Disposition of Adukerated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701..11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* q 1 Food and Water From Regulated Sources 9 Food Contact Surfaces - 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashmg-Hot Water 3-201.12 Food in a Hermetically,Sealed Container* Sanitization Temperatures* _ 3-201.13 Fluid Milk and Milk Products* 4-501.1 l2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* - - Sanitization Tem ratures* 3-202.14 Eggs and Milk Products.Pasteuri?ed* 4501.114 Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Potable Drinking Water* concentration and hardness.* 5-101.11 Drinkin Water from an Approved System*tem* 4-601..11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water' Utensils Clean* 590.006(B) Water Meets Standards in 3 iD CMR?-2.0* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and - 3-201.14 Fish and Reaea onaliy Caugat Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-70311 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSS^r Listed Chemical* Souses* 10 Proper;Adequate Handwashing Game and Wild Mushrooms Approved by Reculatort,Authorft 2-301..1.1 - 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" Ii Good Hygienic Practices - 5 - Receiving/Condition 2-401.11. Eatin ,Drinking or Usipj Tobacco* 3-202.1.1 PHFs Received at Pro r Tem Lxraiures* 2-401.12 Discharges:From the Eyes,Nose and 3-202.1.5 Package Lnte it y - Mouth* Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 7ags/Reco;ds:Shellstock 72 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock ldentifrcationMaintained* Employees* Tags/Records;Fish Products 13 Handwash Facilities 3102.11 Parasite Dastructioe* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acities* 590.004(1) Labeling of Ingredients* 5-204.11 L-ocadon and Placement* ? Conformance with Approved Procedures 5-205.11 Accessibilit ,Operation and Maintenance iHACCP Plans Supplied with Soap and Hand Drying 3-502.17. Specialized Processing Methods* Devices- 3-502:12 .Reduced ox en acka"ng,criteria* -6-301.11 Handwashing Cleanser,Availability 8-103.!2 Confoimance with A roved Procedures* 6-301.12 Hand Drying Provision Denotes critical item inthe federal 1999 Pond Code or 105 CMR 590.000. M.q MIN MEMN MR ., mil �► � �_ 7! ,. . ,1 .01.4, ;. .4�.��I nel IN �. a ,-110w .�11�!. - :rl�!1�l'- ,,WA !�l1f�!�/��- - ��fv . _ „L►'�1!�. _ t:.� .%.� . . :, , .yl ., ate= Fr s t 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne lltness.Interventions and Risk According to law Cooled to Facfars(hers 1-22) (Cont.) 4t'F/45`F Within 4 Room°PHFs - PROTECTION FROM CHEMICALS 3-501..15 Coolie Methods for 14 Food or Color Additives - 19 PHF Hot and Card Harding 3-501-16(B) Cold PIJFs Maintained at or below 3-202.12 Additives* 590.004(F) 410/450 F* 3-302.14 Protection from Una xoved Additives"` 1g Poisonous or Toxic Substances 3-50L16(A) Hot PHFs Maintained at or above 7-202.11 Identifying Information-Original 140 i 3-501.16(A) Roastssts Held at or above 130'F. Containers* - Titre as a Public Health Control 7-102.11, Common Name-Working Containers* 20 . 3-501: raaPublic Health Control* 7-20111 Separation-Smra + 590.004(H) Variance Requirement 7-202.11 Restriction-Presence and Use* 7-202.12 Conditions of Use* REQUIREMEMS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Coru dicers-Prohibitions* 7-204.11 Sanitlurs.Criteria-Chemicals* POPULATIONS HSP 7-204.1.2 Chemicals for WashingProduce,Criteria* 21 3-801.I1(A) Unpasteurized Pre-packaged lsees and 7-204.14 ents.Criteria* :Beveraees with W'arrrina Labels* 7-205.11 Incidental Food Contact,Lubricants* 3801.11{6) Use of Pasteurized Baas* 7-206.11 Restricted Use Pesticides,'Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw,Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food EKILaE Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TiMEtFEMPERATURE CONTROLS 22 3-603.21 Consumer Advisory Pasted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked a PHFs Not Otherwise,Nricessed to Eliminate 3-401.21A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*eft"s'ni E .lmmediate Service 145`Fl5sec+ 3-302.13 Pasteurired Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game E * Animals-155`F 15 sec. 3401.11(B)(1)(2) Pak and Beef Roast-130`F 221 min* SPECIAL REQUIREMENTS 1 3 401.11(A)(2) Ratite..,Injected Meats-255`F 15 590.009(A)-(D) Violations of Section temporary and in ? Sec.* catering,,mobile food,tetttporary and i 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 1.5 sec, * above if related to foodborne illness 3401_11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other f 145OF r' 590.009 violations relating to good retail i 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- ? Microwave 165;F* Special Requirements. 1 3401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES y 3-4003.I I(A)&(D) PHFs 165°F 15 sec.° (Items 23-30) 3403.11(B) Microwave 163`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* - foodborne illness interventions and riskfactors listed above, can be 3-403AI(C)1(C) Commercially Processed RTE Feral- found in the following sectionsof the Food Code and 105 CMR 140°F* 590.000. 3-403.12(E) Remaining UnsiicedPortions ofBeef t Ilam 1 Good Retail Practices J .FC 590.000 Roasts', (_23i 1 Management and Personnel 1-FG-2 .003 Proper Cooling of PHFs i 24. Ford and Food Protection i FC-.3 .004 18 ) 125. Equipment and Utensils , FG-4 .005 I 3-501.14(A) Cooling Cooked PHFs from740`Fto 26, 1 Water.Plumbinq and Waste FC-5 Ms i 70°F Within 2 Hours and From 70`F 27. i Physical Faci6ry FC-B 007 to 41`F/45°F Within 4 Hours.* 28. `Poisonous or Toxic Materials 1 FC-7 ,008 3-501.74(6) Cooling PHFs Made From Ambient 29. 1 Special Requirements .009 Temperature Ingredients to 41°F/45°F ' 30 I Other Within 4 Homs* 'D:rrotrs aincal iranx in the fcderel 1999 Facd Cale a'105 CMR 590.000, l -Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4"'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Names D JT&e of Operation(s) T e of Inspection I= t Kl Food Service online Address Risk ❑ Retail Re-inspection Telephone Level ❑ Residential Kitchen Previous In pe 'on ❑ Mobile Date: Owner HACCP VI [I Temporary [I Prep rati ❑ Caterer ❑Suspect Illness Person-in-Charge( I ) Tirt) ❑ Bed&Breakfast ❑ General Complaint In: !1 ❑ HACCP Inspector Out ';�0- Permit No. ❑.Other Each violation check d r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) ❑ Items) Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) El Allergen Awareness 580.009(G) ❑ corrective action as determined by the Board of Health. -- - - _- - -...- _. '�FOOD:PROTECTION MANAGEMENT._-- _ __ _ s 1 ❑ 12. Prevention of Contamination from Hands - ❑ 1. PIC Assigned/Knowledgeable/Duties __ ,_-___w .r. ❑ 13. Handwash Facilities EMPLOYEE HEALTH ,PROTECTION FROM'CHEMICALS-- _-..- 1 El 2. Reporting of Diseases by Food Employee and PIC - - _ - El3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives �� D SOU - -_ -- -� ❑ 15 Toxic Chemicals F..00dFROM APPROVERCE_,�_ . . - __ J. s EM _.... .^„ ❑ 4. Food and Water from Approved Source ,TIMErrP.ERATURE�CON*=(P.iiao taujHaxerdousF_ood_ ❑ 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 w' - __ j ❑19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing IREOUIREMENTS_FOR,HIGHLYSUSCEPTIBLE=POPULATIONS(HSP);,J E] 21. Food and Food Preparation for HSP ❑10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices 'CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. C 590.0001federal Food Code.This report,when signed below N 23. Management and Personnel (Fc-2X59o.o03) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4X590.005) cited 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)(59o.om) establishment operations. If aggrieved by this order,you 27. Physical Facility (Fc-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Requirements (660.006) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s: o-rae: .-rJ, Inspector's Signature: Print: 1 -77 PICS Signature: Print: r Page!of Pages 7 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Raw Animal Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(l.) Raw Animal Foods Separated from Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw ingredients 2-103.11 Person in charge-duties 3-302.1I(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination tram the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employ=and 3-302.15 WashingFruits and Ve Eta a licants* 3-3(4.11. Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The person In Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003 G Reporting by Person in Charge* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions 3--707.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-50]_11 t Manual Warewashing-Hot Water 3-201.12 Food in a Hermeticall •Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* - Sanitization Temperatures*. 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.,16 ice Made From PotableDrinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved S' tem* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water- Utensils Clean* Fre Equipment 590.f106(Bl Water Meets Standards in 31.0 C,MR 22.0"` 4-602.11 Cleaning Frequency y ofFA PpmentFew- Shatltish and Fist From an Appraved Source Contact Surfaces and Utensils*" 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreadonaily Caught Mollusca Food Contact Surfaces oPEquipment* Shellfish* 4-703.11 Methods of Sanifization-Hot Water and 3-201.15 Molluscan Shellfish horn^JSSF T stall Chemical* Sources* Game and Wird Arlushruoms Approved by 10 Proper,Adequate Handwashing Re ulato Authorit 2-301..1.1 - Crean Condition-Hands and Arms* 3-202.13 Shellstock identification Present" 2-301..12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* - it Good Hygienic Practices " 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11PHFs Received at Proper Ten eratutes* 2-401.12 Discharges:From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-IOLI1 Food Safe and Unadulterated * 3-30 L.12 Preventing Contamination When Tasting* 6 Togs/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products - 13 Handwash Facilities - - - 3402.11 Parasite Destruction* Conveniently Located and AccesssNe 3-402.12 Records.Creation and Retention* 5-203.11. Numbers and Capacities* 590.004(:1) Labeling of Ingredients' 5-204.11 Location and Placement* F7 Conformance with Approved Procedures 5-205.11 Accessibilitv.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying " 3-502.11. Specialized Pra_essin Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* - 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301..12 Hand Drying Provision Denotes critical item inthe federal 1999 rood Code or 105 CMR 590.000. 1! i . • rl f . � • . - e ..'� 1.:...� ■ r� •-i Q.Ii�� 1/� ;iii •rrs�..�r ' E�� •a11',r _.J:ii_i.�i_��_,i�1 ��ti�!OI/7�a1 ��.f(I�F�1� ��..� �� ,�lU!�'1./��_ • • •t• • - / t3-501.14(C) PHFs Received at Temperatures a: violations Related to Foodborne 111ness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont. 41'F/450F Within 4 Homs._ PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food w Color Additives 3-501,16(B) PHF Hot and Cold Holding 3-501,16(B) Cold PHFs Maintained at or below 3-202.12 Additives*' 590.004(F) 410145'F* + 3-302.14 Protection from Una roved Additives* 3 501.1 fi(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I40`F. t 7-10L1l Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. o Containers" 20 Time as a Public Health Control 7-102.11. Common Name-WorkingContainers* � 3-501:19 Time as a Public Health Control* 7-201.11 Separation-Storage* - 590,004(H) Variance Requirement 7-202.11 .Restriction-PresenceandUse* - - ;% 7-202.12 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanirizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 2i 3-801A I(A) Unpasteurized Pre-packaged Juices and :Beverages with Warning Labels* 7-204.14 encs,Criteria' 3-801.I1M Use of Pasteurized Eggs* 7-?05.11 Incidental Food Contact Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and ]. 7-206.11 Restricted Use Pesticides,Criteria" Ran Seed Sprouts Not Served, 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. a 7-206.13 Tracking Powders,Pest Control and F Monitoring* CONSUMER ADVISORY I TIMFti EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fru Consumption of t AT Foods That are Raw,Undercooked or 16 PHFs Proper Cooking Temperatures for Not Otherwise Processed w Eliminate l 3401.11A(1)(2) Eggs- 155715 Sec. Patho=ens.*E"°""1 E *s-Immediate Service 145'Fi5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E 8 Animals-155'F 15 sec. " 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS + 590.009(A)-(I3)in 3-401.11(A)(2) Ratites,injected Meats-155`F 15 590.009(A)-(D) Violations of Section sec. * catering,.mobile ftxrd,temporary and 3 401 I I(A)(3) Poultry-,Wild Game,Stuffed PHFs, residential kitchen operations should be Stufliing Containing Fish,Meat, debited under the appropriate sections Pani or Ratites-165'F 15 sec. * above if related to foodborne illness 3-101.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F t' 590.009 violations relating to good retail 3-401-12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 1657* Special Requirements. 3-40LI I(A)(1)(b) All Other PIFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS RELATE?TO GOOD RETAIL PR4C77CES 3 403A l(A)&(D) PHFs 165"F 15 see. * (Items 23-30) 3-403.11(B) Microwave-'165 F 2 Minute Standing Critical mrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Fool- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.1 I(E) Remaining Unsliced Portions of Beef ` ftm I Good Retall Practices FC 580.0m Roasts* i 23. 1 Man agament and Personnel 1-F0-2 .003 - .I lg Proper Cooling of PHFs i 24. Foal and Food Protection , FC-3 .004 1 25, 1 Equipment and Utensils l FC-4 .005 1 +, 3-501.14(A) Cooling Cooked PHFs from 140`F to I 6. ater.Plumbing and WasteIFC-5 .008 1 70'F Within 2 Hours and From 70'F 27. Physical Facility i FC-8- .007- 1 to 41`F/45'F Within 4 Hours.* 1 28� ' Poisonous or TO)dc Materials ! FC-7008 ' 3-501.14(B) Cooling PHFs Made From Ambient 29. eoia}Regvitements + - .009 Temperature Ingredients to 41'F/45°F 30, I Other Within 4 Homs i "Den<Hes critical drew in the loderal 1999 Food Cade w 105 C141R 590.000. 4 CRL7.f'• •Jr- _ _ • .L►i �.� i � A ��.J . Sm MW FILAM Cr�► �_ �.� IF1W,:�weNowN 1020 a 3-50I A4(C) PHFs Received at Temperatures •■ Violations Related to Foodborne fliness Interventions and Risk According to Law Cooled to ' Factors(ftems-1-22) fCont.) 41'F145'F Within 4 Hours.* ' , PROTECTION FROM CHEMICALS 3-501.S5 CoolingMethods for PRFs 14 Food or Color Additives 19 _ PHF Hot and Cold Holding 3 20212Additive es* 3-501.16(6) Cold PRFs Maintained at or below 3-302.14 Protection from Unapproved Additives" 590.004(F1 41'1450 F* 15 Poisonous or Toxic Substances 3-501.16(4) Hot F. * Maintained of or above I 7-101.11 Iilentifyihil Information-Original 146`ts 3.501.16tA7 Roasts Held atarabove 130'F. * Containers* i 20 Time as a Public Health Control n 7-162.11. Common Name-WorkContainem* 'j - 3-501:19 Trttte as a Public Health Canirat* 7-201.11 Separation-Storage* - .. I 7-202.11 ,Restriction-Presenceand Use* 590.{104(Hj Variance Re uirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-SO1.71(A) Unpasteurized Pre-packaged elites and _ 7204.14 � encs.Criteria' Beverages with Warning Labels* 3-801.11(6) Use of Pasteurized Eggs* 7-205-I1 Incidental Food Contact,Lubricants* 3-80LI l(D) Raw or Partially Cocked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria' Raw Seed Sprouts Not Served 7-206.12 - Rodent Bait Stations* 3-80L I I(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitarin '^- CONSUMER ADVISORY TlMF1I EMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 1g Proper Cooking Temperatures for Animal Foods 14tat are Raw.Undercooked or PHFS rop - No Otherwise-PocessedtoEliminate Pat4to*ens.*FMcnre+nr2Wrr 3-40i.IIA(1)(2) Ecus- 155`F 15 Sec: Eggs-Immediate Service 145'Fl5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw ShellE 3407.11(A)(2) � � Comminuted Fish.Meats&Game , Animals-155'F 15 sec. 3.401.11(13)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS Violations of Section 3-401.11(A)(2) Ratites,Injected Meats-155'F IS 590.009{4)-{D) Yioiatitms of Section 590.009(4}-(IJ)in sec.* catering,.mobile food,temporary and 3-401.1I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Pout or Ratites-165'F 15 sec. * above if related to foodborne illness i 3-401.11(C)(3) Whole-muscle,Intact Beef Steals interventions and risk factors. Other 145OF* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3-40LII(,A)(1)(b) All Other PHFs- 145'F 15 sec. ° 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.41(A)&(D) PRFs 165F 15 see.* (Items 23-30) L 3-403.11(B) Microwave--165`F 2 Minute Standing - Critical..mrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3.403.tl(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400P 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef /fain I Good Refail Practices .FC 59 cow i i Roasts* 23. I Maroc and Personnel -FC-2 .003 - ! 1g Proper Coaling of PHFs 24.- I Fcod and Food Protection - FC'-3 .004 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PRFs from 140`F to ! 26, Water.PiUmbing and Waste FC-5 .tX76 7WF Within 2 Hours and From 70'F 27. Physical Facility FC-6 007 ! to 41`F/45'F Within 4 Hours.* j 28. Poisonous or Toxic Materials I FC'-7 ,008 3-501.14(,6) Cooling PHFs Made From Ambient .29. Special R uiremeits ! -009 Temperature Ingredients to 41'F145°F 30 - Within 4 Hours* 'Denotes critical item in the federal 1999 Food Code w 105 C.MR 590.0!)0. 51 5 Commonwealth of Massachusetts City of Salem,,, - r- tia J 4 d Board of Health - Kimberley Driscoll " 120 Washington Street,4th Flo62, or y 6'xMayor iL y: 4 SALEM,MA 01970 :a Eb +t> FOod/Retaii EstaUshment Permit DATE PRINTED:K 01/03/2013 ' L ESTABLISHMENT NAME: A; w , Ina Pigs Eye Restaurant, * y { - File Number BHF-2004-000272 mak,, " .: 148 Derby Street - - iz. 4 lk- Salem 01970 - z ¢ -LOCATED AT: . SALEM, MA� 01970x � _.�„ Permit Type Permit No. Permit Issued: Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2013-0315 Jan l;2013 Dec 31,2013 $280.00 ESTABLISHMENT <_ Total Fees: n' $280.010 3 yee > -Sb it TP a 0. 41 -3 i Y . 14 _ -.. '-Fug• ``i2 Jk.�«: '. 0 PERMIT EXPIRES ecenber 31;2013 - .' g _ YA IN z Board o_f Health' .� This Permit is not transferable and must be reissued upon change of ownership or location The pertmt 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 t v p a ,, CITY OF SALEM, 1P r MASSACHUSETTS rCw��xeaarh BOARD oP HP.AI:rl-i . 130 WASHINGTON STRt±cr,411+FLOOR KIMBERLEY DRISCOLL TG:L.(978)741-1800 EKY(978)745-0343 LARRY'RAIDIDIN,RS/Itf a is,Clio,CP-BS MAYOR Iramdin(t_salem.com F1F'ALni A(;ENT' Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: f )L 2) Establishment Address: LV 3) Establishment Mailing Address(if different): t 4) Establishment Telephone No: *la / 5) Applicant Name&Title: `,/L' JA)iPfk x-11&D 6N 6) Applicant Address: 36 CheStn�A Y, ,(eiyy YM . a 9 g � 4 7) Applicant Telephone No:'Th Ip �a`' pYI 24 Hour Emergency NoQ -5 q i Email:/YI�Ix 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An-asamclation Name Title Home Address corora i individual A partnership Vi It Other legal entity 12 Person Directly Responsible For Daily Operations Owner, Person in Charge, Supervisor,Manager, etc. Name&Title: �.0—�'36- GgiA Address: L (iHX Sf//l// UL R �3 � � .`lel iSG.ae as no Telephone No: Fax: (� Email: G,�(J✓L. Emergency Telephone No: y TJ Y�� G�� 7 C11� { �U 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check* 0�6f �" 00 Date: ��" 1 ` 'a'oj Amount: 1N21U6,-6D Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) y 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) ❑ Retail( Sq. Ft) ❑ Caterer Permanent Structure ❑ Food Service—( Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service—Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service—Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑°Residential Kitchen for Bed and 21) Length Of Permit: ----------------------------------------------------------------- ---------Breakfast Esta_blishments-----------.------------ --- - (check one) RETAIL STORE RESTAURANT Annual ❑ Less than 1000sq.ft. $70 ❑ Less than 25 seats $140 Seasonal/Dates: 13 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 ❑25-99 seats $280 ❑ More than 99 seats $420 Temporary/DateslTime: __- ---- ----------------------------------- ----------------------------------------------------------------- ❑ Bed R Breakfast/Childcare Services/NursingHome $100 ------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (including, church kitchens, state funded childcare&priva tubs) 23) Food Operations: . Definitions: PHF-potentially hazardous food(timeRemperature co ols required) Non-PHFs-non-potentially hazardous food(no timelterature controls required) check all that apply): RTE-ready-to-eat foods(Ex.sandwiches,salads, muffin which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A, I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name r - k Dat Type of Operation(s) Type of Inspection >= = i R-Food Service ❑Routine Address Risk ❑ Retail (4 Re-inspection Der "ILL Telephone Level El Residential Kitchen Previous In ection _ ❑ Mobile Date: p� Owner HACCP YIN ❑ Temporary ElPreq e atfon ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In:a• �- ElHACCP Inspector Out: Permit No. El.Other Each violation checked reliquires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors-(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. F0.00 PROTECTION MANAGEMENT .. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑.13. Handwash Facilities EMPLOYEE HEALTH ,PROTECTION{ROM'CHEMICACS' El 2. Reporting of Diseases by Food Employee and PIC - '11 _ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ .. _, _ , . , -115.Toxic Chemicals FOOD.FROMAPPROVEDfrom _timErrEMPERATUitiC..ONTROLSiOotentlall HazardousEgods.) ' ❑ 4. Food and Water from Approved Source Y ❑ 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 ❑ 8. Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY4USCEPI IBLE.POPULAriONS':(H8P)' j ❑10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER`ADVI$ORY. ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2X590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3X590.0044)) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4X590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5X590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-8X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INS�PECTION: - Inspector's Signature• Print: PICS Signa wv J� Print• 1 !`� Pagef Pa /r�`.'.�!-•`s..,......-r.J...�''h--.�'t�'1..-,'ti,..��y.-.-�-�'.•.^�--^+.w...'-^-^ti..+•�"'r1..wwm-i.-..�.r..+.'.�-.'+`.�'+...�... .._-..-r.-;"-," � r,^":: Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination . 1 590.003(A) Asia ment Demonstratiof Res 3-302.11(A)(1) Raw AnimalFoods Separated from neibilit * Cooked and RTE Foods* 590.003(B) on of Knowledge Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302.1.-(A)(72) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3-302.15 WashingFruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An i a pon3-304.1.1 Food Contact with Equipment and Utensils* Applicant To Report To The Person In Contamination from the Consumer Char * 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003 G) Reporting b Person in Charge" Disposition of Adulterated or Contaminated 31 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restr coons 3-70i.i1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE _ Food* q 1 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing- ,Hot Water 3-202.13 Shell Eggs* Sanitization Tem L * ratures*- 3-202.14 Eggs and Milk Products-Pasteurized* 4-501.11.4 Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Potable Drinking Water* concentration and hardness. * 5-101..1.1 Drinkin Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 4-602.11 CleaningFrequency of Equipment Food 590.006(B) Water Meets Fish From in App3 10roved CMP.22.0* Contact Surfaces and Uensils* Food- Shellfish and Fish Fror,r an Approved Sem�ce 4-702.11 Frequency of Sanitization of Utensils and - 3-201.14 Fish and Reci emionally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* _ 3-201.15 Molluscan Shellfish from:^1SSF Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* 30 Chemical*Proper,Adequate Handwashing ReGame and y rooms Approved by 2-301..11 - Clean Condition-Hands and Arms* Mato Authority 3-202.13 Shellstock identification Present* 2-301.1.2 Cleanm Procedure* 590.004(C) Wild Mushrooms* 1 2-301.14 1 When to Wash* 3-201.17 Game.Animals* - 11 Good Hygienic Practices g Receiving(Condition 2-401.11 Eatin ,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Tem eratures$ 2-401.12. Discharges:From the Eyes,Nose and 3-202.1.5 Package integrity' Mouth* 3-i0i.li Food Safe and Unadulterated* 3-301.12 Preventin ContaminationW9teaTasting* 6 Tag'19ocords:ahelistock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification" 590.004(F) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* _ Ent to es* Tags/Records:Fish Products 13 Handwash Facilities 302.11 Parasite Destrur.;on* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients* 5-204.11 Location and Placement* � Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Metbtxls* Devices 3-502.12 Reduced oxygen packaging,criteria* dwashing Cleanser,.Availabilit 3-103.12 Conformance with Approved Proceduresd Drying Provision *Denotes critical;tem in the Weral 1999 Pax1 Code or 105 CMR 590.000, CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Pager of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN ORRECTION Date No. Reference R-Red Item Verified M PLEAS PRINT CLEARLY IA 10 G(✓i S. J S -fir14) 4W U G S s S� kl - Qt go2Y J 1 (— �t7 IJ Discussion With Person in Charge: Corrective Action Required: ❑ No s I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ 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 en five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. c tiA A ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures - t Violations Related to Foodborne lanes&Interventions and Risk According to law Cooled to Factors(itelnsY-22) (Cont.) 41'F145°F Within 4 Hours. t PROTECTION FROM CHEMICALS 19 CoolingMethods far PHFs 14 - Food or Color Additives I9 PF1F)tot and Cold Hording 3-501-I6(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41%45°F* 3-302.14 Protection from Unapproved Additives* 3-50lA6(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 7-101,11 Identifying Information-Original t Containers* 3-501.16(A) Roasts Held at or above 1300F.7-102.11. Common Name-Working20 Containers* Time as a Public Health Control T 3-501,19 Time as a Public Health Control* 7-202.11 Restriction r 7-201.11 Separation con-Stns *-Presence and Use* 590.004(H) Variance Requirement -. � 7-202.12 Conditions of Use* i 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTI®LE 7-204.11 Sanitizets.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Washin Prcx3uue,Criteria° 21 3-801.11(A) Unpasteurized Pre-packaged Juices and .Bevcra>es with Warnin*Labels* 7-204.14 eats.Criteria* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(D) Raw or Partially 3-801.118) Use of Pastially Cocked Animal Food and l Eggs* 7-206.11 Restricted Use Pesticides,Criteria'* - Raw Seed Sprouts Not Served 7-206.12 Rodent Bait Stat ons* 3-801.11(C) Unopened Food Package Not Re=served. i 7-206.13 Tracking Powders, Pest.Control and Monitoring* CONSUMER ADVISORY TIMEIi'EMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Na Otherwise-Proessedto Eliminate 3-401.IIA(I)(2) Eggs- 155°F 15 Sec. Pathogens.'mxsrernav:r Eggs--Immediate Service 145'F15sec* 3-302.13. Pasteurized Eggs Substitute for Raw Shell ' E " 3-401.11(.0)(2) Comminuted Fish.Meats&Game Animals-155'F 15 sec. * SPECIAL REQUIREMENTS l 3.401.11(8)(1)(2) Pork and Beef Roast- 130'F 121 min* 3 401.71(.0x2) Ratites,injected Meats-I55'F I5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in ,4 catering,,mobile food,temporary and sec.* i 3-401.1.I(A)(3) Pou)try,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate Sections Poultry or Ratites-165'F 15 sec * above if related to foodborne illness 3.401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foxls Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 340LI I(A)(1)(b) All Other PHFs-145 F 15 sec. i7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRAC77CES 3-403:11(AWD) PHFs 165F 15 sec. * (Items 23-30) 3-403.11(B) Microwave 165`F 2 Minate Standing Critical,mrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the following,rections.of the Food Code and 105 CMR f 140^Fs 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef ' Kem Good Retail Practices .FC 590.000 i i, Roasts" - 1 23. 1 Manaqernent and Personnel FC-2 .003 18 Proper Cooling of PHFs 24.. 1 Food and Food Protection FC-3 .004 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 26, Water.Plumbino and Write FC-5 .006 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 4I'F145'F Within 4 Hours. * t 28._' Poisonous or Toxic Materials I FC-7 .008 3-501.14(0) Cooling PHFs Made From Ambient 29. Special Requirements .009 ,S Temperature Ingredients to 41'Fi45'F 30. i Other Within 4 Hours* stacrr, :c.a c: 'Drn<xev ccitieat mom in the£^.decal 1999 FwA Cate wr 105 C vtR 90.000. - I � L Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,a Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town Of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name r Da Type of Operation(s) Type of Inspection JAP c S L✓L -CI F nd Service ®_Routine Address Rik `❑ Retail Li Re-inspection M7 art,Telephone Level ❑ Residential Kitchen Previous Jnsp ction ❑ Mobile Date: /1/(,_ Owner HAI YIN ❑ Temporary ❑ Pre-operatirr ❑ Caterer ❑Suspect Illness Person-in-Ch a(PIC) t_ r Time?�`'�--� El Bed&Breakfast El General Complaint 3A Inc LlHACCP Inspector Out: � - Permit No. ❑.Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) ❑ IViolations marked may Tobacco 9 590.009(F) ❑ y pose an imminent health hazard and require immediate Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. : FOOQPROTECTIO.NMANAGEMENT. . _ t _ ..-__. _ _- ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties rEMPLOYEE HEALTH "- ` - -; E] 13. Handwash Facilities ` ` ' iPROTECTIONFROWCHEMICALS- ❑ 2. Reporting of Diseases by Food Employee and PIC EI3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ _TtmErrEMPERAruRE.CONTROLS(potintialryHaiardousFoodi)-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 19. Hot and Cold Holding _PROTECTION FROM CONTAMINATION � , . _ 9 ❑ 8. Separation/Segregation/Protection ❑20. Time as a Public Health Control _- 4 �9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR.HIGHLYSUSCFPTIBLE=POPULATIONS(HSP); I ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP - ❑ 11. Good Hygienic Practices ,CONSUMERAOVISORY. ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order forCorrecdon: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X order of the Beard of Health. Failure to correct violations 24. Food and Food Protection (Fc-0X5990.000.00 0)4) 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 (FcsX590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7X590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION:I ' a� 13 ffl,4� Inspector's Signature: Print: PICS Signature: Print: - - Page Of Pages ... �.�.✓tv.�_w�'�.r-.�.-.^--..r........Y.�.+.^r-w..:r�'-=;.:�'r^�-.'y""^�.-3-*7.r^r"...-.y..t*'w-" -�`y-.-..i-t., i Violations Related to Foodborne Illness Interventions and Risk Factdrs(items 1-22) PROTECTION FROM CONTAMINATION g Cross-contamination FOOD PROTECflON MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.W3(A) Assi�tment of Res�nsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw ingredients - 2-#03 11 Person In charge-dupes 3302-1#(A)(2) Raw Animal Foods Separated from Each Other'•` EMPLOYEE HEALTH Contamination from the Env amment 2 590.003(0) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting,by food employees and 3.3172.15 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A flood Employee Or An Utensils* Applicant To Report,ro The Person In Comaminawn from the Consumer Charge* 3-306.14(A)(.B) ,Returned Food and Reservice of Food* 590,003 "k Re orcin by Person in Chare_e* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 540.003{E} Removal of Exclusions and Restrict ons 3-70111 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE A Food and Water From Regulated Sourres 9 Food Contact Surfaces 590A04tA-B.) Compliance with Food Law* 4-5(11..111. Manual Warewashing-Hot Water k---- Sanitization Tem ratures* 3-201.12 Food in it Henneticall y Sealed Container' 4-501.112 Mechanical W'arewashin* Hot Water 3=201.13 Fluid Milk and Milk Products* Sa[titization Temperatures* 3-202.13 Shell B ns* 4-501.114 Chen-deal Sanitization-tet H, 3-202.14 E.>s and Milk PrednCts,PaSterl'rVed* 'P concentration and hardness. 3-202.t6 Ice Made From Potable Drinking Water* 4-601.1 I(A) &luipment Food Contact Surfaces and - 5-101.11 Drinking Water from tm A roved System* Utensils Clean* 590.006(A) Bottled Drit'xW4.602.11 Cleaning Frequency of Equipment Food 590.006(13) Water Meets Standards in 310 CMR 22.41" Contact Surfaces and Utensils*. Shelt7ish and Fish From an Approved Source 4-702.11. Frequency of Sanitization of Utensils and 3-20IJ4 Fish and Recreationafiy Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-'Hot Water and 3-201-15 Mobuscan Shellfish from NSSF listed Chemical* Sources* 24 Proper;Adequate Handwashing Game and Wild Mushrooms Approved by 2-301..11 Clean Condition-Hands and Arms* Re utato Authc+rH t t 3-20'2.1$ Sbellstock identification Preseni` 2-301.1'2 Cleaning Procedure* re* _ 590.004(C) Wild Mushrooms* 2-301.14 Wheno Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Rsceivin%(Condltlon 240131 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Dischargees.From the Eyes,Nose and 3-202.15 Packa-e hire,it'* Mouth* 3-161.11 Food Safe and Unadulterated* 3-301.12 PreventingContamination When Tasting* 6 Tagslsiocords:She etoclt 32 _ Prevention of Contamination from Hands 3-202.1$ Shellstock Identifccatic�n* 590.004(F,) ,Preventing Contamination.from 3-203.12 Shellstoek.IdentifieationMaintained'* Em-lo es* N11 gsJRacords:'Fish Products -- 13 Handwash Facilities Conveniently Located and Accessible rasite Destruction* 5-203.11 .Numbers and Capacities* cord.Creauon and Retention* j_204,ll Locationand Placement* beling of Ingredients'nformance with Approved Prireedures 5'205.t 1 -Accessibilit , ration and Maintenance nfor Plans Supplied with Soap and Hand drying Devbes 6.301,11 Handwashin Cleanser,,Avaitabiliteduced os en acka .nn triter a* 6-301.12 Hand Drying Provision $-103.12 Conformance with Approved Procedures* i �I Denotes efltkal item in.the Weral 1999 Rod Cods m 103 CMR 590.010. C—Critical Item '• • • •• ••� • •ww�161 d 1011! R-Red Item .lw;j2mi Mill! Ai: NEI NO LIMP ON M�011,kvfflsv�jr , rap o -- - - r 3-501.14(C) PHFs Remived at Temperatures - Yiolations Related to Foodborne Illness interventions and Risk According to Law Cooled to i Factors(HemsY-22) (Cont.) 41'F/45'F Within 4 Homs. 3-501..15 Cooling Methods for PHFs t PROTECTION FROM CHEMICALS F19PHF Not and Cold Holding I 14 Fnatl or Color Additives t 3-501.16(13) Cold PRFs Maintained at or below 1 3-202.12i Additives* 590.004(0 4101450 F* 3-302.14 Protection from Un troved.Additives* ' 15 Poisonous or Toxic Substances 3-501.16(X) - Hot PRFs Maintained at or above t 140°F. * 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1300F. ° 1 Containers" 7-102.11. Common Name-WorkingContainers* 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control' 7-201.11 Se -'on-Storage* 7-202.11 .Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of rise* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanidzers.Criteria-Chemicals* POPULAT10N5 HSP i 21 3-801.11(A) Unpasteuri7zed Pre-packaged Juices and fire 7-204.12 Chemicals re Washi Produce,Criteria 7-204.14 Dryingencs.Criteria' .Beverages with Wanting Labels* 7-205.11 Incidental Foal Contact,Lubricants* 3-801.11(B) 'Use of Pasteu11Ml Eggs* I 3-801.11(D) Raw or Partially Cooked Animal Food and 11 7-206.11 -Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. * 'r 7-206.I2 Rodent Bait Stations* 3-801.11(C) Usuppened.food Package Not Re-served. / 7-206.13 Tracking Powders, Pest Control and Monrtorin * CONSUMER ADVISORY s TIME/TEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 26 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs - Not Otherwise:Processed to Eliminate ') 3-401.11A(t)(2) Eggs- 155°F 15 Sec. Patho f E gs-immediate Service 145'Fl5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game E Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) Pork and Beef Roast-130'F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in i 3-401.11(A)(2) Ratites, Injected Meats-'155°F 15 see.* catering,.mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Sniffed PHFs, residential kitchen operations should be Staffing Containing Ash,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3401_11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3 d0I.12 Raw Animal Foals Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOL.A77ONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave-165`F 2 Minute Standing Critical arid non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-40111(C) Commercial ly Processed RTE Food- found in rhe following.rection of the Food Code and 105 CMR ' 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef j item i Good Retail Practices -FC 530.0w i Roasts" { 23. i Management and Personnel 1 FC-2 .003 i 1 24. � Foal and Food Protection I FC--3 X04 t 18 Proper Coaling of PHFs r25. 1 Equipment and Utensils � FG-4 .005 3-501.14(A) Cooling Corked PHFs from 140`F to ! 26, 1 Water.Plumbing and Waste i FC-5 .006 E - 70°F Within 2 Hours and From 70'F 27. Physical Facility i FC-6 .007= to 41`F/45'F Within 4 Hours.* X28. Poisonous or Toxic Materials '. FC=7 .008 3-501.14(13) Cooling PHFs Made From Ambient 29. -Special R uirements X-- Temperature Ingredients to 41°F/45°F 130• ! Other - - Within 4 Hours" r � *D:notcs critical izzm in the federal 1999 FecW Code ai05 C-MR 590.00p. �e ,_.�� a :��!1� �i�: ►w , v= , ,.„ M�119- z ` I 3-501A4(C) PHFs Received at Tetnperatmres Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to D Factors(Item;1-22) (Cant.) 41'F145`F Within 4 Hours, 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS 29 PHF Hot and Cold Holding 14 Food or Calor Additives t �- 3-501.16(B) Cold PHFs Maintained at or below t 3202.12 Additives*_ 3-302.14 Protection from(In iroved.Addidves" 590.0044{F(17) 4107450F* ) Hot PHFs Maintained of or above d 15 Poisonous or Toxic Substances 3-501. 1400F * F` 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F.' Containers* t 20 Time as a Public Health Control 7-102.11. (common Name-Working Containers* 'on-Stora * 3-501:19 Time&,c a Pttblie Health Control* 7-201.11 S 590.004(Ii) Variance Re uiremeM 7-202.11 .Restriction-Presence andUse' 7-02.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals° - POPULATIONS HSP 21 3-80t.it(A) 7-204.12 Chemicals for WashingProduce,Criteria' Unpasteuuized Pre-packaged Iuices and 7-204.14 encs,Criteria* [Beverages with Warning labels* 3-$01.11(B Use of Pasteurized Eggs* l 7-205.11 Incidental Food CuntacC,Lubricants* 3_gp1.13{p) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Rau Seed S ins Not Served- 7-206.12 erved7-206.22 Rodent Bait Stations* .3-801.11(C) I Unopened Food Package Not Re-served. 7-206.33 Tracking Powders, Pest Control and j Moadtorin * CONSUMER ADVISORY _ TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise.Processed to Eliminate PHFa 3-401.1IA(1)(2) Eggs- 155F 15 Sec. Pathogens.* jE, -Immediate Service 145°Fl5sec* 3-302.13, Pasteurized Eggs Sabstitute for Raw Shell EggO 3401.11(A)(2) Comminuted Fisb.Meats&.Game Animals-155'F 15 sec. { SPECIAL REQUIREMENTS 3.401.11(B)(1)(2D Port:and Beef Roast- 330°P 121.mm*_ i 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Sec.* catering,.mobile food,temporary and 3401.1.1(,A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish,bleat, debited under the appropriate sections f Paultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(0(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F+ 590.009 violations relating to good retail 3-401.12 Raw Animal Fowls Cooked in a practices should be debited under#29- Microwave 1657* Special Requirements. 3-401:11(A)(1)(b) All Other PHFs-145'F 15 sec. i 17 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRAC77CES p 3403:11(A)&(D) PHFs I6ST 15 ice. x (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* - Joadborne illness interventions and risk factors listed above,can be 3403,11(C) Commercia ly Processed RTE Form- Jound in the following sectionsof the Food Code and 1 05 CMR 140°F* 590.000. 1 3403.1l(E) Remaining Unsiiced Portions of Beef item j Good Retail Practices J ,FC 590.000 ( Roasts* 23_ 1 Mana ement and Personnel , FC-2 .003 ,t 1g Proper Coaling of PHFs 24. i Food and Food Protection I FC-3 .004 1 25. i Equipment and Utensils I FC-4 DOS I 3-501.14(A) Coating Cooked PHFs from 140`F to 26. Water.Plumbing and Waste v iFC-5 .006 70°F Within 2 Hours and From 70T 27. Plivaical FaciN i FC-6 .007 to 41`Fl45°F Within 4 Hours. * 28. Pa.sonous or Toxic Materials FC-7 .068 .! 3-501.34(B) Cooling PHFs Made From Ambient 29. -�jpecial R uiremems .009 Temperature Ingredients to 41°F145OF 30 I Other - --Within 4 Hom* - ° 'Denotes critical w-ni in the fedeml 1999 Fuad Cale W'105 ChiR 590.000. r ! c r. _�� moi• l'/1/CiCa/_ a� 1 G■ I .. .�J / P a iR� _ D MOr Al W- 12 -� .r ►]R i.Ir_ MWI�I_ iia< . r '•.. •_ n �.1� WK Ia1�ii!/�JtIJJ�� a� ' _�_ �==� • WAVALam. -•w_' � —� _ Flora i• 1 .L.r � I r rAW74 -WMPMAWWPFO • -• • • • •• • • • • • • • • • • ••• • • n •- • -• -• ■ - •- •- • ••• WON "Mil- li ■ • . •• ■ • �� - — { 3-501.14(0 PHFs Received at Temperatures >, Violations Related to Foodborne Illness.Interventions and Risk According to Uaw Cooled to ` Factors(Items 1-22) (Cont.) 41TF145°17 Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.35 Cooling Methods for PHFs PHF Hot and Cold Holding 3¢ - Food or Color Additives 19 3-501 3-501..16(B) Cold F* d PHFs Maintained at in below 3,202.12 Additives* 590.00 3-302.14 Protection from Un roved Additivesi4 16( 4i !- A) Hot PHFs Maintained aloe,above i 15 Poisonous or Toxic Substances MT. * j 7-101,11 Identifying Information-Original 3-501.16(A3 Roasts Heid at or above,. 1300F. Containers'" - 20 Time as a Public Health Control _ 7-102.11. Common Name-Working Containers* 7-201.11 Separation-Storage* 3-501,1.9 Time as a Public Health Control* 7-202.11 ,Restriction-Presence and Use* 590.004{HI Varianceuirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTISLE POPU 7-204.11 Sanit ur ,Criteria-Chemicals* LATIONS MSP t 7-2(14.12 Chemicals fire Washin Produce,Criteria* 23. 3-801 .11(A) Unpasteurized Pre-packaged Juices and �t 7-204.14n Agents.Criteria* :Beverages with Waning Labels* 3-801.11(B) Use of Pasteurized Eo-as* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served, 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Fond Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring CONSUMER ADVISORY TIMErfEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 36 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or F6 Proper Not Otherwise Processed to Eliminate Fs 3-401.1 IA(1)(2) Eggs- 155°F 15 Sec. Pathogens.' Eggs-Immediate Senile 145°Fl5sec+ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Crane Eggs* Attinuis-155'F 15 ser. 3=401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-461.11(A)(2) Ratites,Injected Meats-155`F 15 590'004(A)-(Dl catering, of Section temporary and in see * catering,mobile[lel,temporary and 3401.I1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Most, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-101.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F t` 590.009 violations relating to good retail 3401.12 Raw Animal F«xls Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-40'I:I1(A)(I)(b) All Other PHFs- 145°F 15 sec.° 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs I65°17 15 see.* (Items 23-30) 1 3.403.11(B) Microwave-'165°F 2 Minute Standing Crificai,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403,f i(C) Comtrennal ly Processed RTE Fond- found in the following sections of the Food Code and 105 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef ` Item 1 Good Retail Practices FC 590.000 Roasts* 1 23_ i Maria eat and Personnel -FC-2 ,003 { 1g Proper Coaling of PHFs ' 24..1-Food and Food Protection FC-3 .004 1 1 25. i Equipment and Utensiis FC-4 .00s 3-501.14(A) Cooling Cooked PHFs from 140°F to 26, I Water.Plumbinq and Waste FC-5 .006 70'F Within 2 Hours and From 70'F 27. i Physical Faci' FC-6 OD7 to 41°F745°F Within 4 Hours.* f 28. ' Pasonous or Temic Materials F FC-7 008 3-501.24(6) C wling PHFs Made From Ambient Monts 009 1 Temperature Ingredients to 41 OF/45'F 30 ! Other �---- - Within 4 Hours" �) 'Denotes critical imm in the federal 1999 Feed Cale a'105 CMR 590.000. f . Commonwealth of Massachusetts w r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2011 ESTABLISHMENT NAME: In a Pigs Eye Restaurant File number:BHF-2oo4.000272 148 Derby Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHF-2012-0234 Jan 1;2012 Dec 31,2012 $280.00 : ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance,with the State Sanitary Cale,beofre any revonations,improvements,or equipment changes are made, all plans for such must be:submitted to and approved by the Salem Board of Health. Paget. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH § 120 WASHINGTON STREET,4...FLOOR TEL. (978) 741-1800 KINI[B ERLEY DRISCOLL FAX(978) 745-0343 MAYOR lramdin@salem.com LARRY RANHAN,RS/REI IS,CHO,(:P-FS HF..\1:1'11 AGkNT 201_APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OFESTABLISHMENT 1 A P145 rLIA .g11f,5M OT' TEL# 916 -W'4q!2g, ADDRESS OF ESTABLISHMENT-45 AF✓{OU )T �)t��QYYI. Ml(fWAX# MAILING ADDRESS(if different) r EMAIL- Business':1 fJ 1 BS hJ `��)t 0-6 Website: 4UIMLJ. 1✓1a (Sfi X12.C OWNER'S NAI TEL 4� 7q(4 ,,69 / ADDRESS 35 04v5tmft a� - Sajaryl {/rid , Q4413 STREET - CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)11!" )IySO, P—fA&f)aJ CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON `I`WtJJ#V RtiAkbvtl"" HOMETEL# 91'6 Wif`16%9 DAYSOFOPERATION Monday Tuesda -.Wednesday vThursda `I -"'.Frida Saturday 1 - Sunday HOURS OF OPERATION `�;30 GHv1 I, Please write in time of d ; —7 —'tel -------- ay. ---� T--_� (For example 11 am-11pm '- /r 00 40r , _TYPE OF ESTABLISHMENT FEE check only) RETAIL STORE YES less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------ ----- - - RESTAURAN? NO Less than 25 seats =$140 (Outdoor Stationary Food Cart$21� 25-99 seats =$2 more than 99 seats X420 BED/BREAKFAST! YES $100 CHILDCARE SERVICES/NURSING HOME ------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. � Re'6� 101/al I"II �Na 9 X16 4 s Signature Date I Social Security or Federal Identification.Number ----------------------- �7 ------ ----------------------- Updated 523/11 FOODAP20I l.adm Check#&Date Mbissachusetts Department of Public Health Salem Board of Health 120 Washington Street,4h Floor Di $sion of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel - Name ate Typ f Operation(s) Type o.Inspection Food Service online Address Risk ❑ Retail Re-inspection Telephone Level El Residential Kitchen Previous Inspection ❑ Mobile Date: OwnerHACCP YIN [ITemporary ElPre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) TI ❑ Bed 8 Breakfast ❑General Complaint InEl HACCP Inspector , Out: Permit No. ❑.Other Each violation checked requires anxpla ation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red O Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and re uire immediate Tobacco 590.009( El q Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. ,FOOD.PROTECTION_MANAGEMENT_ � ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowedgeable/Duties - / r�13. Handwash Facilities �-EMPLOYEEHEALTH i )PROTECTION_FROM'CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14 Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded 15. Toxic Chemicals FOOD FROM APPROVED SOURCE ,� _ TIMF1rEMPERATURtCONTROLS(PoteMla9ytyFlaxardous F.00d;;)_4_� F1 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling P OTECTION FROM CONTAMINATION ��"� ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time as a Public Health Control -- - -, T -C',-- 9. Food Contact Surfaces Cleaning and Sanitizing 1REQUIREMENI•S_FOR HIGHLY+$U7 EPTIBL-P_OPULATIO_ El 10. Proper Adequate Handwashing ❑21.Food and Food Preparation for HSP X11.Good Hygienic Practices CONSUMER ADVISORY _ �1 ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(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-2X590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4X590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5X590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order,you OL 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: I a S \&d.ba L lospecter's Signature:' Print: PLCs Signator : Prin[: (� )F Page of Z�ages R . Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT B Cross-contamination 1 I 590.003(A) Assignment of Res onsibili[ * 3-302.1.1(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* 590.OD3(B) Demonstration of Knowledge'; Contamination from Raw Ingredients 2-103.11. Person in charge-duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3302.11(A) - Food Protection* require reporting by food employees and 3-302.15 WashmE Fruits and Vegetables applicants,* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Chat * 590.003(G) Reporting 3 b Person in Charee* -306.14(A)(B) ,Returned Food and Res'ervice of Food'* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701_i t Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE FoW* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces - 590.004(A-B) Compliance with Food laws 7501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell ERs* - Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114. Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Pctable 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 Drinking Water" Utensils Clean* 590.006(B) Water Meets Standards in 31.0 CMR 22.0* 4-602.1.1 Gleaning Frequency of Equipment Food- SheitfGsh and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and - 3-201.14 Fish and Reaea onal,y CauphY Molluscan4-702A Contact Surfaces of Equipment* Shellfish_ 4-703.11 Methods of Sanitization-Hot Water and S 3-201.15 Sources*scan Shellfish from NSSF listed Chemical* Sourc10 Proper,Adequate Handwashing Regulatory Authority Game and Wikt orityMusooms.4pproved by 2-301.11 Clean Condition-Hands and Arms* 3-202.18 She!lstcck Identification Present* 2-301.12 Cleaning Procedure* 590M04(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 ReceivingtCondition 2-401.11 Eating,Driulcing or Using Tobacco* 3-202.11 PHFs Received at Proper TeniTHatures*. 2-401.12 Discharges,From the Eyes,Nose and 3-202.15 Package Irate,it-* Mouth 3-1O:i.,l Frnd Safe and Unadulterated* 3-301.12 -Preventing Contamination When Tasting* 6 TagsfAecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock-Identification* 590.004(E) Preventing Contamination.from 3-203.1.2 Shellslock Identification Maintained* _Employees* Tags/Records: Fish Products - 13 Handwash Facilities .3-402.11 Parasite Desttveticm' Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 . Numbers and Capacities* - 590.004(1) 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. Sp ecrallZed Processing Methods* Devices 3-502.12 .Reduced ox men acka nom,critera* 6-301.11. Handwashin Cleanser,�Availability 8-103.!2 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision 4 Denotes critical item in.die federal 1999 Food Cade or 105 CMR 590.00). �! !�iM. ■�'� .. ��'� iil1 �� .I�i1lI�e �. _ . �L• ,.• Fin ESMa" ./ •, �i 1- I�ilyfL' ��71r�� S I� ��.. IR Ill.-MM.< .1 res 1 • . : Ir��61'Ida W. oil a MI111.1_`. ■ • . •• ■ • 3-501,14(C) PRFs Received at Temperatures Violations Refatetl to Foodborne Illness interventions and Risk According to Law Cooled to " Factors(lfes;1-22) (Cont.) 4171457 Within 4 Hous PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Hofdtng 3_501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives*' 590.004(F) 410145'F* 3-302.14 Protection from Unapproved Additives* 3-50LI6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140`F. * 7-1 Ol•i 1 Identifying Information-Original 3.501.16(A) Roasts Held at or above 130°F. * Containers* 7-102.11. Common Name-Working Containers* 2® Time as a Public Health Control 7 201.11 Separation-Storage* 3-501:19 Time as a Public Health Control* 7-202.11 ,Restriction-Presence and Use* - 550.004H) Varianceuirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP 7-204A I. Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Uninsteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* .Beverages with Waning Labels* 3-80IAI(B) Use of Pasteurized E 7-205.11 Incidental Food Csti cid Lubricants* 3-801,11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Raw Seed Sprouts Not Served. * ,-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3.603.11 1 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs - Not Otherwise Promssed to Eliminate 3-401AIA(t)(2) Eggs- 155 F 15 Sec Patho*ens.*E"m a n,n.7a c Eggs-Immediate.Service 145'F15see* 3-30113, 1 Paste Aird Eggs Substitute for Raw Shell '" 3-401,11(A)(2) Comminuted Fish.Meats&Game E ggs Animals-155'F 15 sec. ! 3401.11(B)(1)(21 Porta and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section-590.009(A)-(D)in sec.* catering,.mobile food,temporary and ti 3-401.11(A)(3) Poultry,Wild Game,Staffed PRFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Paul or Ratites-165°F 15 sec, * above if related to foodborne illness 3-401.11((Z)(3) Whole-muscle,Intact Beef Steals interventions and risk factors. Other 1450F 4' 590.009 violations relating to good retail 3-401,12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. I 3401.11(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403:11(,4)&(D) PHFs 165"F l5 sec. * (Items 23-30) 3403A I(B) Microwave--165`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* - foodborne illness interventions and vis&,factors listed above, can be 1 3403,11(0) Commercially Processed RTF.Fowl- found in the following sections.of the Food Cade and 105 CMR 1400P 590.000. } h Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions;of Beef t Roasts* L23_ i Mmaggment and Personnel 1 FC-2 .003 1g Proper Cooling of PHFs 1 24.. 1 Foci and Food Protection FC-3 .004__ 25. I Equipment and utensils I FC-4 '005 3-501.14(A) Cooling Cooked PBR%from 140'F to ! 26, 1 Water,Plumbing and waste FC-5 .006 70'F Within 2 Hour:,and From 70'F 27. 1 Physical Facility FC-6 007 to 41`Fl45°F Within 4 Hours.* L28_ Poisonous or Toxic Materials FC=7 .008 3-501.I4(B) Cooling PHFs Made From Ambient 29. "�aeiat R uiremertts 1 '009 1 Temperature Ingredients to 41'F/456F 30 1 Other - Within 4 Hours* ssw:r,:,ns,.o.x c: 'Denotes critical liesin the federal 1999 Foo!Cale a'105 C.MR 590.000. y Salem Board of Health Ma '�^sachusetts Department of Public Health Division of Food and Drugs 120 Washington Street,4"Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Nam Date Tvoe of 0 eration(s) Tvoe of Inspection a2bzjj ,r. ,,+. `� - r Food Service ®JRoutina Address Risk Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone q, ❑ Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation p p , ❑ Caterer ❑Suspect Illness Person in CK rge(PIC) 10A Time L ElBed& Breakfast El General Complaint In:Inspector Out: Permit No.� 'I IJ ❑OtherHAC[1r Other Each violation checked requires an 6planation 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)M 590.009(F)/© action as determined by the Board of Health. ��St FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contaminationfrom J Tl GG ( �( ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPALT ELOYEE HEALTH-- _.- PROTECTION FROM CHEMICALS _ El 2. Reporting of Diseases by Food Employee and PIC -'`- -❑ 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives El 15.Toxic Chemicals FFROM FOOD FM APPROVED SOURCE�m a __ _ ___ __ a El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods), ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection, ❑20.Time As a Public Health Control '' _,❑'�9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) \\ ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing _ El El11. Good Hygienic Practices CONSUMER ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(es0.0 4order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-a)(sso.00a)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water,Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007] have a right to a hearing. Your request must be in writing [4E] 28. Poisonous or Toxic Materials (Fc-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:59Jlnspec�m614 Erc `'V1o Umss- Inspector's Signature: Print: PIC's Signature: Print: NNI�_ /7 f� Page ores Violations Related to Foodborne Illness , Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION Cross-contamination FOOD PROTECTION MANAGEMENT 1 590.003(A) Assig mens of Res nsibilit * 3-302.11(A)0) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods*i Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302.11(A)(2) Raw Annual Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge m 3-302.11(A Food Protection* require reporting by food employees and 3-302.15 WashingFruits and Ve*etables applicants" 3304.1 I. Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 31 590.003(D) I Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Res rict ons 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 1Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501. I I I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 MechanicalWarewashing-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 fee Made From Potable Drinking Water* concentration and hardness. * 5-101.1.1 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 Contact Surfaces and Utensils* ShelNish and Fish From an Approved Source 4-70111 1. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1p Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ReutatoAuthort 2-301.1.1. Clean Condition-Hands and Arms* 3-202.19 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 4 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and . 3-202.15 Package Integrity* Mouth' 3-101.i 1. Food Safe and Unadulterated* 3-301.'12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 32202.1$ Shellstock Identification* 590.604(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Employees* TagslRecords:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located end 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* � Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Pians Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,.Availabilit 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand-Drying Provision 'Denotes eiitical item in the federal 1999 Fa>d Code or 101 CMR 590.000. CITE( OF SALEM \ ( , BOARD OF HEALTH Establishment Name. Lynn (L P� n r_e Date: 17 l�— a— / Page:_ of _ Item Code C-Critical Item U V DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item — Verified PLE SE PRINT CLEARLY �) x PA 1A �1 I —A 1 A,.o I i� .?A ANii trIa :��,:i Pu ��,. -'19n.., r,un.. , /�L .IAO l(Iori„ ,. P/VwYi. I& U �i �� 21 1, AYJltit.2'G/tf rh� �(�l 109 40 �� CCS nn �Jr1Jt' C _fiY 7:,v I J n /( - 4 (S9(a ` �/; 'AA =Lj.r-.�` G r �i,n�o,r�) f1 tea n010t7.A ,i" _ � 'l IP N A - V;��(�c, 11) I U D.. `�4 acs ' . i n (0'A to M — h Al rU, n � vl .fie inni �ON in n� 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 pi Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that n-A-W �NUti,45f-?1-(e noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of C3Embargo Ll Emergency Closure hour food permit. \ l ❑ Voluntary Disposal ❑ Other: �U ' 3-501.14(0) PHFs Received at Temperatures - Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items1-22) (Cont) 41'F145°F Within Haus, PROTECTION FROM CHEMICALS3-501,15 Cooling Methods for PHFs 14 - Food or Color Additives 19 PHF Not and Cold Holding 3,202.12 Additives* 3-501..16(6) Cold PRFs Maintained at or below 590.004(F) 411450 F" 3-302.14 Protection from Unapproved Additives" 3-50 L O(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1400E * 7-101..11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers 7-102.11, Cman=Name-WorkingContainers* 20 Time as a Public Health Control - 3-501:4( Time as a Public Health Control*Separation-Storage* 7-202.11 .Restriction-PresenceandUsee* 530.064{H) VarianeRequirement 7-202.12 Conditions of Use' 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* - POPULATIONS HSP 7-204.1.2 Chemicals for WashingProduce,Criteria* 21 3-801.11{A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* 3everageswith Wan»naLabels* 7-205-11 incidental Food Contact.Lubricants* 3-801.11(6) Use of Pasteurized EaaS* 7-206.11 -Restricted Use Pesticides;Criteria* 3-801.I 1(D) Raw or Partially Cooked Animal Foal and Raw Seed Sprouts os Not Served. * 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-205.13 Tracking Powders,Pest Control and Monitarin * CONSUMER ADVISORY____ TtMEtFEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisary Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,undercooked or PHFs Not Otherwise Processed w Elimurate 3401.11A(i)(2) Eggs- 155'17 15 Sec. Pathogens,'"B" Ev -Immediate Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggsv Animals-155'F 15 sec. SPECIAL REQUIREMENTS 3.401.11(6)(1){2} Pork and Beef Roast-130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites, Injected Meats-155`F 15 sec.* catering,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,&feat, debited under the appropriate sections Poultry or Ratites-165'1715 see, * above if related to foodborne illness 3-401.11(12)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Ammal Foods Cooked in a practices should be debited under k29- Microwave 165'F* Special Requirements. 3-401A I(A)(1)(b) All Other PHFs-145'F 15 sec.* 17 Reheating for Hot{folding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.11(A)&(D) PFIFs 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 imenendons and risk factors listed above, can be 3-403.1 i(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400P 590.000. 3-463.1 I(E) Retraining Unsliced Portions of Beef { Item 1 Good Retail Practices j FC 580.080 i Roasts" j 21 Management and Personnel�-FC-2 .003 18 Proper Cooling of PHFs i 24. Food and Food Protection 1 FC-3 .004 1 25, 1 Equipment and Utensils FC-4 .005 3-501-14(A) Cooling Cooked PHFs from W'F to 26, Water.Plumbing and West, i FC-5 .006 700F Within 2}lours and From 70`F 27. i Physical Facility FC--6 .007 to 4 VF1450F Within 4 Rotas. * i 28. Poisonous w Toxic Matena{s FC-7 .008 3-501.14(6) Cooling PRFs Made From Ambient ~29. -Special Requirements .009 Temperature Ingredients to 41'Fl45°F L30. J Other .- Within 4 Hours* 'Denotes crrucal iwm in the federal 1999 Foal Cale of 105 CMR 590.0110. r A, T�-;�,, y:-..- •f 1i 'F�i�,�t 'ii;'t�'T't4"M�.� '�1,�4 +.:.A,,,� ., ,,� r/. �•.... ( .��,: i h� •;�.:T'pt.�+.ki1'�.-w•`�,.d�"�7'R„�l tr it .. Massachusetts Department of Public HealthSalem Board of Health Division of Food and Drugs -120 Washington Street,4"Floor! I Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978). 745-0343 Name n - �y�1 �IIf Date Tvue of Ooeration(s1 Ave of Inspection F oar �� e `� e, iA� CC/wLi � Ttjk�()g R Food ServiceRoutine Address ( 1\ $� - Risk [I Retail Re-inspection ��J �vv Level ❑ Residential Kitchen Previous Inspection Telephone n �3 ❑ Mobile Date: Owner '\ ', 1 HACCP Y/N El Temporary ElPre-operation �(Yl ��y.n E�'Z(J ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)) Tim ❑ Bed&Breakfast El General Complaint 07. [IHACCP Inspector n 1 A 0 Permit No. ❑Other Each violation checked requires an explanation on the narrative p ge( ) and a citation of specific provision(s) violated. 1 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-choking /, Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 9 0.009(F) ❑ action as determined by the Board of Health. H FOOD PROTECTION MANAGEMENT�`;> _ , �„ „s., ,' E] 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties w ❑ 13. Handwash Facilities i EMV:hOYEE HEALTH�` �❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS '"�� *n ,��l ❑ 14.Approved Food or Color Additives 3: Personnel with Infections Restricted/Excluded Toxic Chemicals •' t FOOD FROM APPROVED SOURCE,a,„F.. �,,,,mm,_;,,„®,� E]74. Food and Water from Approved Source `TIME/TEMPERATURE CONTROLS(Poternrally Hazardous F&ihi)" 05: Receiving/Condition El 16. Cooking Temperatures ❑ ❑6_,Tags/Records/Accuracy of Ingredient Statements 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling ' PROTECTION FROM CONTAMINATION';, �:"""`" -.; ¢ ) ❑ 19. Hot and Cold Holding r , 8. Separation/Segregation/Protection r ❑20.Time As a Public Health Control ? ' a❑. 9. Food Contact Surfaces Cleaning and Sanitizing [REQUIREMENTS FOR HIGHLY SU§C TIBLE POPULATION$(HSP) y ,' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY,i Hca�xV q{-„ iI w �o-{a�. ;-:; '"^�7�t ��-'dk�ti� � `•.. ® 11. Good Hygienic Practices w r. ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related t I Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Lr� immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): 1 ' 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'i ) by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) i - _ order of the Board of Health. Failure'to correct violations 24. Food and Food Protection (FC-3)(590.004) - r cited in this report may result in suspension or revocation of 25. Equipment and.Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other f DATE OF RE-INSPECTION: S:501n�Foms14.000 tt � I Inspector'sSignature:A6,_O_� & t_ PIC'sSignature•. (1 Print:, CNhJIt= L-,�'!•�' c,t Do Pagel of-3PagestL � - al �r y Violations Related to Foodborne Illness Interventions and Risk Factors(items 9-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 78 Cross-contamination 1 590.003(A) I Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from -�590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* �2-103.11 Person in charge--duties Contamination from Raw ingredients 3-302,11(A)(2) Raw Animal Foods Separated from Each. EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An _7304.11Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 59Q003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Foal'* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Ford* q 1 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 Ford in a Hermetically Seated Container* Sanitization Tem erattues* 3-201.13 Fluid Milk and Milk Products* 4-501.1 t2 Mechanical Warewashing-I-lot Water 3-202.13 Shell Ea s* 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.`h 5-101.11 Drinking Water from an Approve I S tem* 4-6011 l(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish Froman Approved Source Contact Surfaces and Utensils* 4-70211. Frequency of Sanitization of Utensils and 3-20114 Fish and Recreationally Caught Molluscan Fax!Contact Surfaces of E ui ntene Shellfish"` 4-703.11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulatoAuthorit 2-301.11 Clean Condition-Hands and At7ns* 3-20118 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 2401.11 Eatin ,Drinking or Usui Tobacco` 3-202.11 PHFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes,Nose and 3-202.15 Package tette 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,)4(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* nt Eto secs* 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(1) Labeling of Ingredients° 5-20411 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria` 6-301.11 Hindwashing Cleanser,Availability 8-10312 Conformatme with A. Loved Procedures" 6-301.12 Hand Drying Provision Denotes critical item in the federal 1999. Food Code or 105 CMR 590.000. CITY.OF _SALEM �._. BOARD OF HEALTH s Establishment Name< Date: f 5 Page:__ of E nem Code C-Critical Item OF VIOLATION/PLANrOF CORRECTION Date _ r / No. Reference R-Red Item �, �U i . PLEASE PRINT CLEARLY Verifiedn� 'YF� i S 14 ; r .I 0 T:WOn, i n i A!onn j r.J J A0/� � h11D�A I MA I P4�� llM ti�/'✓1/nn�ot cn1,1 i,_A .1,(,iei �a ( AAno V Z7' �/e .� �11f/Jv <_f S2 /\ t y CJ 1 U/ 1 f r Y� Yom' # �A t v _ to --4- -p 01 Discussion With Person in C rge: 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 / �d that ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal,Food'Code. Lunderst F noncompliance may result in.daily fines of twenty-five dollars or s6spensi`onn/ievocfition of ❑ Embargo ❑ Emergency Closure $ your food permit. Jr ❑ Voluntary Disposal ❑ Other: ?-501.i.4(C) P}1Fs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(111 1-22) (Cont) 41'Fl45"F Within 4 Homs. ' PROTECTION FROM CHEMICALS 3-5111.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(13) Chid PHFs Maintained at or below ?-202.12 Additive.." 590.tNpfF) 41"'4<°F, 3-302.14 Protection from Unapproved Additives 3_50 1.16{,q} Hnt PHFs:wSaintained at or above 5 Poisonous or Toxic Substances iiiiii +- x 4o F. 7-(01.11 ldenvlymi.lnfoimauon -Oct mal t sG17EtA) RwasHeld atorabove 130"1 t'nntanaer 1 20 _ Time as a Public Health Cartrol 10111�Cornmon N arta R ;rhi t,C c ar rin r 31, C 191 as t Public Heal h Control' t 1-201.11 �� i tilt n St,x ag 4 3 t _..� °02.11 r Pe t coon-Pr otic<wd t,�r 1_1U')0.11Hi __ u_mc_h< utre nzene 7202.12 Condition, lfs - .- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 _03.11 Tt;. is( oni nner Prohtht.un POPULATIONS HSP) 7-204.11 Sau mler. Cnieti, Chemic Is ---� ?04.1.2 Ch niiak fo V„ehu L t cul is Ooelta' 21 ?-Apt 1 HAI UnItImeurw-A Pie pactaged Juices and &seta>osxvithttaunn fabism ; ?04,14 ll�dxm It ❑a.�C nix it t. r-- - - US i t nran tl 1 o,A t uNau tub i tnis' ' ? 801 I Itlll+R;,w e r II C,ah d Animal E7xnd and -k- - - - - LR tS e! Spri tit 1e Srrsetl 206.1" ri'xe 11 }j lj'Sti(x1t 1.t-; it i _ - (a-Ki e t t•e l` ! ke - u''x'.i1. C- I _ontA.z6�d ..� A4i;tciiafin'-'' CONSUMER ADVISORY _ TWEITEMPERAI'URECONTROLS__ _ 22 3-WU 11 t ,rsu Int t isoteP,m, ! , e toistimpti o1 vxaa.l 'z;Jc tP,xt e i cru r:,vr.,.r a er -,--P aper Conk nG Temperatu,es for E i F Not o_}a isc rirC ."Ni It, 'tt Em to 1 c� (Harr:due Ser r� 3 �s to -Pt.- ; +.4 i ) , z t ;�:5 1 #• r< x 4n.ar t• 1 {��11..f{1, . � ,tri uiuutlh tirttcn. t �.v; � t_ _ s i.11 ii i f c 8 ;Po u 1_9 i 1 1 til-r SPECIAL CKEf2E!'REC"EtSFS i ! i x att`1 tit Lit I1L: ' x1. 1;n It wrai and :401.11[4 P u rv.w'ila Lx + SL.11e it'HI.. 1 t rt Llt: a tl latctret Dial i.ttiots,rr `ci l3c. I j chiicd unticrthc ai,gto>priwc e.110'.1% 'IIId uI is,blv, > '; _ilh.es ' t ;.,t'Q To t:. "(!"or?ic tt..,,•4S 1..,.- tst-hlNoIrs 1,un", 'exf:.'.h rt�aitflr: e* is idt( .1 ` t . I s + IC '(I'931 !n, `.77 ...-t' Rey lung lot Hot flnl6n9 - VIOLA PONS RELATED TO OOOD TliTA.'!. d•'!r',4...?";.;,L',S 1't411651tic (Iteurs23 30,1 46'.11 t4i rlre ort x. 1,7 1 'l9�nt. Slatidin,, Ce ! r 4 rM,u; t < t1;1'195. xr tc r'olfol iP u 1+.r _�1 3403.11ff-'; i t.>n)na_iaftPux. sars92tll1<.xd !<,f,t.zIli.rG,r� In ,nhrr ,ticfortf.;u„n,, r ,, Chr.R 41-F F 60 Oct 4P3.11t1 Ralaminl Unshca Portio + of IFIc" tram 1Good Rete++Practices - FC 590.000 h ra, * �� 3 ' Aanagnmc t and P o vn r 1 PC 2 1 6013_ L.g �� T Proper Cooling of PHFs _24 ro, nd axi P 0 e. tar ., I PC t vC _ �._.__.__._-.�. 2 t-.1u�>m�, and Utens�s _ _-.. F(2 4 .h�5 t 1 z_5t)1.ta(A) 1, 'tx nin 0x)k A PHFs 1�if1 i 1t`P l�? -- -- - . ! ! ar 'Water,Pit rbin" U 1 s'o__ 1 FC OW ` j -")'F 1ithin 2 Rour, and Fr;rn 7{1"1' 2c f-� s a Fa R =_FC , OO' t 1 n 1145"F W h - H t " a 6 Z3 s Baa e ow 1 r is FC OC1d f .- -. 401.0 )31 r o f lu q PHRI MadcEront vni.lent 9 S.�c. al R o herr a _ OC 3 - Tem noun 6t reagents 1, rt.45`1% 0 # '?tt3s '--- �-� Vv ti`P. 1I,mrs* S r , a f CITY OF SALEM ' BOARD OF HEALTH Establishment Name ate: Page:_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION _ Date No. Reference R-Red Ile / \ Verlfled PLEASE PRINT CLEARLY 121 A )l L4 n -QAA n - 1 f Ido, �.o� t .t_ st a t r� 0/1,, o�T QA41 - t a, r 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 El Voluntary Compliance ❑ Employee Restriction/ i Exclusion i violations before the next inspection, to observe all conditions a s_described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code- that f i noncompliance may result in daily fines of twenty-five dollars or suspensid/k. evocation of ❑ Embargo ❑ Emergency Closure your food permit. , — t � -, ,�� .� LlVoluntary Disposal Ll Other: r r .i / r /Ilan i i n / f (/ w V 5i)l.ld(C� PHFs Received ai TernMatures Violations Related to Foodborne Illness Interventions and Risk According to Lau Cooled to Factors(!terns 1-22) (Cont.) 41'P/45`F Within 4 Hous. ° PROTECTION FROM CHEMICALS 3-5(11.75 Cxlim Methodst�rPHFs Fooddthor Color Additives 19 PHF Hot and Cold Holdi- ng 14 _- rddi 3 501.16BHF ) Cold P .Maintained at or below 3-2f)'?.12 Atnc;k 594.(H)4(F) _ 410/45'F* - _ 3-302.14 Protection from Unapproved Additises"' 3-501 16(A) 7-int PHF�Maintained at or above 15 Poisonous or Toxic Substances 101,11 Wonufyutc Info m,ttoOn--Ofinal 34{) _ 3-501 INA) Rwms Heid at or above 130°F >k Name R >rl.,n C uuc u�zr�* LSO _ Time as a Public Health Control7 102,11 Common -�-t �-- ---� 1-501 1 Tat r as a Pubhs Heal h Control" 720tJ7 ,S 1.1jtn -Sill'W - - - -- -- _ ---� >U.�4'1133 j t tarx 4' ni re meat_ .._ -202.11 Reaturtion -Pr_unc�vtd L>e` - --- - 1t 7-20-1.12^ Condition,of Usc' ' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE7 '03. 1 Toxic fo ntmo Pohtbt, o ' 0411 Sannvetti Criteria Chunit t POPULATIONS(HSP) 1t7 �t'npt5tcurizcd fr 1actgd Jules nti'Ot.(' Cttcnuctl+ Cc r 204_14 )r� Atrae,Criteria': rt es with +tam lat W _ t 1111) U.' ut Pacts mind r , -OS_i t Mata nt tl 1 vxl r tntict 1.nhn cants' 111 bisL 1 f(+)) plivor Puliaii f tak:d�Rmtnal V-7166'UC 11 12c^.:n�t rt t tc Pe tt do v.C * t t t- - 1 -- --j kw( S d >t,ttauts No:Scnv t-206 1: i rail t R n _ C 1� i 1 ,.. CONSUMER ADVISORY _ TIMEfTEMPERATURE CONTROLS i 22 1 3h0-' 11 lonsum r Ai i sorti fiostetl Ibr( ntsumudoo of Prope16 PHFsrWuo&ng Temp e 'ttusE for i 1 ti r ) e<rtlt^r Yrs+r it m t 1 _. t t -a, 3 t Yiu f t >'�Srn., a 5.;nal Six1E� -11110 d tte 5 z: t 5 z t�'•.e°' � � i A i i1 117 ` K _. -- SPG^IAL PEO IRCM.ENT 'tt( : rR)tr 2� r t tr ' 13i iLtr i ? ) t r ibzin - -- -- , .;Gist 3 Ct Scrtnt s:.!:4 J; erj i �atz`rttt 4, .tkvt�ilE'ltxr{.'.;.3i�,[dtr ..tt6. t i - , -- r tt -i( , tiltih ild1%, I 4{;1.7t .A nisi � Poultry, ',� td r :(ui i'ltr� and� � t n ceni(t � o ! ..nine! is n :lrujniatt t (ijon,[ to fio,Plorn i iol:=tiotttt ."TI to "'r,". .re.a,l S i ----- Reheating 3 for� .�f anal lir 7 _ VIOLA DONS P A TLL t.7 'TO r300D tier":1_.r'rtz" 3 t 7rS +"%",-11 (Steins 23301 1 .1 I 03IB -C o, tvr It 5Sf-m--LI 4:3t, 1 Grr r :r nrnrh(,0 rn; u v ' _ 7 t _ ao r r rn ii s, n t v�r3tr r+n e t n C J rttars 1wed r r con(It, I :. d 03A W-"). r t amillel.'ia.h F1(h.0� rd 2 fr i•�xet Wow in t3r�} -90.000 I 40'F —a -_ --- -. .._. { ) - tam Good and P oes FC u9D.J(tu 5C7.tslA. _�.�_ f tmkn�Ccxtk'd 7 H7_Yt.r tt 7�n [3 c: �_ x-4(13 7I t j Rcmutli ng L� ,tceu ,- r 9anag mt rt and nor )rai=l _ 1 , G l I Oo,_ L lti _ Proper Cooling of PHPs _ '>d r''d Faxt P o< no FG_ 3 Cit` _ 2'+ t) r+ n and iltets s f n f ' lion I 4)1-'tn 1 -2Cr 4tafur P4 rU ny_u C N o 1 FG 5 6GC WF f A4itntn t Hours:r.;d Fntt t r't1F 1 27, Phitcai Fx t r . ... '.. FC r 007 _ ( t 4 11,115,F At iftio n 4 a 1 2d ' s t rs or ,4C i" teoala :C -50 1,t4{iii Ccoltt g PHb ht do i rant 't I teat j ','9 St,r ai R t ,r,,n,ty .619 3CJ Otho TvmprratareL A�tonin 2 l'hvt:� •`'"" Commonwealth of Massachusetts s r City of Salem Board of Health lQmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: In a Pigs Eye Restaurant File Number:BHF-2004-600272 148 Derby Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions t Notes FOOD SERVICE BHP4009-0298 Dec 30,2008 Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2009 x Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 Kr YOR IDIONNE&ALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 0kh 'I# 'VT Cb11AM1�2�-r� f' NAME OF ESTABLISHMENT /G POl 5 `G CS7Y ELft 9-35 itt'I`lB VP ADDRESS OF ESTABLISHMENT t4brid FAX# MAILING ADDRESS(if different) )t�4) bpubu Jt. EMAIL-Business': 1/M) 5 CqP6 yP,2j&cm)-• Oe+ Website: Na Cafteni OWNER'S NAME rlA)1y 14 AEPiA00 TEL# 91y +H4-t-AH ) ADDRESS 36 Ct1`LS71�J )T- c5AUx4 � 002D STREET JONJ�Hfl IJ MkT- E&I ITY - / STATE CERTIFIED FOOD MANAGER'S NAME(S) V6TK -UL5orJ �T6r�Ni�S�2FAiCk�ail IFICATE#(S) CJ (Required in an establishment where potentially hazardous food is prepared) bb� �7 EMERGENCY RESPONSE PERSON- , 1Jl\,jjf%� R I�F.(�i2D6r.4 HOMETEL# 90hi1 ik;fO( DAYS OF.'OPERATION = Monday I Tuesday Wednesday: Thursda =; 'i'Fddff A k, ?"Saturday I Sunda ' HOURS OF OPERATION i`13l)—b� Please write in time of day. , ) (Forexample Ilam-11pm ' 3v� �� TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - - RESTAURANT YES NO less than 25 seats ^ (Outdoor Stationary Food Cart$2 25-99 seats28 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES --------------------------------------------------------------------•---------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES O $25 "Please pay total with.one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. �4 � li4'08' 6ga4 dqb Signature Datif Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Dated`t V 61 1 I q� -�---$ j-------------- ------ Commonwealth of Massachusetts T s City of Salem Board of Heath Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/25/2011 ESTABLISHMENT NAME: In a Pigs Eye Restaurant File Number:BHF-2004-000272 148 Derby Street - Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0345 Jan 1,2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH y 120 WASHINGTON STREET,4r"FLOOR TEL. (978) 741-1800 KINBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENu,%tJM@SALEnl.COM DAVID GREENBAum,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �t _TAAP(!54.(If TEL#gibl"41WN-7 NAME OF ESTABLISHMEN II /Zt$(�{��uQ 41/, , (�, ADDRESS OF ESTABLISHMENT I017P.Mq,c`St'��,A1.5�1 WA-M940 FAX#KJA MAILING ADDRESS(if different) EMAIL-Business': A PIS W 2- Q1r(RI LW.k1eC Website: �y1lWW,,L'tS A P4) f,{ ?l � OWNER'S NAME � IJAIb1 fR H• I'Z(=Ak176fJ c`_ TEL# T.l tIU iso ADDRESS�60jeff)&tS- ylium AM 019+0 STREET CITY , STATE ZIP ,Swig--ick.&AiRD>Sn1 [AVI D J7onset Ln.J CERTIFIED FOOD MANAGER'S NAME(S), NATi9 AI ►f ¢LL T[r1lA,�IJO i 1 CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON SfAA)i15,R M. 12-5ARDofl HOME TEL# 94?j q44 6Z31 DAYSAF'OPERATION w sl Monday rw --Tuesda ;'" Wednesda x7 r tThursd 3_I Fndz Saturda x x HOURS OF OPERATION yv Y 9 Y r.,'Sunday!. , Please verde in time of day I�x� I� 11136-J%V1 11:36-(uo 113 I%%) ! IE3o'I'cb (I-30 1IXC - IIZO--0w (For example 11 am-11 pm) ' ASM R� TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ( less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats 28 more than 99 seats - ------------------------------------------------- ------ ---- - ---------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES O $100 CHILDCARE SERVICES/NURSING HOME - ----------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES _ $135 ALL NON-PROFIT(such as church kitchens) YES $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 stale tax returns and paid all state taxes required under the law. Qevr n lJkZ&41A/o Signature 15ate Social Security or Federal Identification Number Revised 10/7/11 FOODAP2011.adm Check#&Date (?� �� ) TUT,I $ 1 Commonwealth of Massachusetts s p City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: . 01/29/2010 ESTABLISHMENT NAME: In a Pigs Eye Restaurant File Number:BHF-2004-000272 148 Derby Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0335 Jan 25,2010 Dec 31,2010 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 - r CITY OF SALEM, MASSACHUSETTS ♦ BOARD OF HEALTH 120 WASHINGTON STREET,4m FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAUM&ALEM.COM DAVID GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT (;H EOTIJ�r �r Tv L9_5TMew%s WC , c1 NAME OF ESTABLISHMENT 0 3•A• SnI A P14-3 f G TEL# ADDRESS OF ESTABLISHMENT �� Off/[/3U 7I FAX# 9T6 7 `lS- 9g1ob MAILING ADDRESS(if different) EMAIL- Business': fnI- lT r-1 Website: YJ A OWNER'S NAME �n✓ P1�e�.Lfi1-. TEL# 6 ADDRESS cab 11XaS n,,l , �� .. c'aLPw n M/. , C)L��f� STREET e CITY STATE ZIP TCNM' w A(00a51431R3— CERTIFIED FOOD MANAGER'S NAME(S)S�yWx CERTIFICATE#(S) 61 Y.319 Io (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# ?DAYSl©FOPEFtA+T,ION�? iMond'a`yj;�,Tues'day,' I�1Nednesday, .;�Thursday `�� aF„ritlay t°'SatuMay Sunday; HOURS OF OPERATION ! Please write in time M day. j Forexam ellam-11 m) Ii. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280' more than I0,000sq.ft. =$420 ------------- ----------------....-..- --------•---------------------------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280— more than 99 seats =$420 ------ ---------- - -------------------------------------------------------------------------------------------------------------------------------- -- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number. -----------------------� - 7- —�---------------------------- Revised 424/07 FOODAP2008.adm Check#&Date )� / / �r'!//6 $ t '148„Derby Street In a Pigs Eye Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: - FOOD PROTECTION MANAGEMENT 741-4436- PIC Assigned/Knowledgeable/Duties PASSd❑ RED Owner: Non-compliance with: Jennifer Reardon Anti-Choking PASS PIC:, ,. _ Tobacco PASS 'Jonathan Mitchell EMPLOYEE HEALTH l Inspector: Reporting of Diseases by Food Employee and PIC PASS ❑J RED Janet DlOnne Personnel with Infections Restricted/Excluded PASS ❑d RED Date Inspected:Correct By: 5/20/200$ FOOD FROM APPROVED SOURCE Risk Level: Food and Water from Approved Source PASS RED Receiving/Condition PASS ❑d RED °`Permit Number: Tags/Records/Accuracy of Ingredient Statements PASS ❑J RED BHP-2008-0307 Conformance with Approved Procedures/HACCP Plans PASS RED �Status: PROTECTION FROM CONTAMINATION Open - Separation/Segregation/Protection PASS ❑J RED #of Critical Violations: Z Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED Time IN: 71Proper Adequate Handwashing PASS ❑d RED Time OUT: Good Hygienic Practices PASS ❑d RED Urgency Description(s): Prevention of Contamination from Hands PASS ❑J RED BLUE: Violations Related to Good Handwash Facilities PASS ❑D RED Retail Practices (Critical Comments: label handsink in back prep area.handwashing only. Violations must be corrected PROTECTION FROM CHEMICALS immediately or within 10 Approved Food or Color Additives PASS ❑d RED days)(Non-critical violations must be corrected immediately Toxic Chemicals PASSd❑ RED 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. May 22,2008 ) Page 1 of r Item Status Violation Critical Urgency RED: r TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related t0 Cooking Temperatures PASS VJ RED Foodborne Illness Interventions' Reheating PASS RI RED and Risk Factors (Require immediate corrective action), Cooling PASS d❑ RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS - / RED CONSUMER ADVISORY Posting of Consumer Advisories PASS Vj RED 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 22,2008 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection FAIL Critical BLUE ,,Xomments:Tru reach-in uncovered food.All food in storage must be covered. t shelves with sugar etc needs general cleaning.any areas of shelves that are not sealed to be sealed to be made impervious and easily cleanable. Equipment and Utensils PASS Critical BLUE Comments:Small silver refrigerator at 527. Unit must be maintained at 41°F or below as mandated.No food shall be stored in this lrf/(04V refrigerator until proper temperature is maintained. \� /rowave needs general cleaning. C£n opener had accumulation of food debris.thoroughly clean and sanitize daily to prevent buildup. ZPf"'VVV Ovide stem type thermometer for chefs and cooks. icer needs thorough cleaning of food debris accumulation. pl ce small cutting board in basement.stained and scored. ,S Pr vide visible accurate thermometer in medium Frigidaire freezer unit. scoop at bar stored incorrectly.Store handleside up in ice or in a cleaned and sanitized container labeled ice scoop only. fgvide test strips for sanitizer at bar at three bay. keep daily log. mfe at bar to have proper knife rack or a container with sanitizing solution at 10-50 ppm to sanitize between uses. Physica Facility FAIL Critical BLUE X�omments:Tyvek in basement on ceiling in disrepair. repair and add to all areas with food storage. /There was an accumulation of water on floor in beer walkin.Find source of leak and repair. remove all standing water - 40412�lpi,o ns restroom floor to be rallied per conversation with owner Jennifer Reardon. , ing and Waste PASS BLUE / nous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE 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 22,2008 ) Page 3 of Item Status Violation Critical Urgency L� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1600 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2008 ) Page 4 of Commonwealth of Massachusetts • r City of Salem Board of Health IGmbeltey Drisooll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: In a Pigs Eye Restaurant File Number:BHF-2004-000272 148 Derby Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0307 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 12 3 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL.(978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR ISCOTTra SALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 1; NAME OF ESTABLISHMENT h2.S'I-✓JLI} 31Zd L7e5J17YLQA a,7A)C TEL# /c� 7 7Y/- L4Q3L ADDRESS OF ESTABLISHMENT A j 1 n6L FAX# 97 PIl JV5-%& 5 MAILING ADDRESS (if different) EMAIL-Business': Website: OWNER'S NAME�CeiUdJ1r:�r-,_/1,REAj!9n06 / TEL# ADDRESS T —5n LeA 019�b STREET CITY 61 STATE ZIP Ere.. RE�Ro vrJ 5143�3�' CERTIFIED FOOD MANAGER'S NAME(S)yUXV4taplJ H1Inch 4y/ CERTIFICATE#(S).n1Rr 9� (Required in an establishment where potentially hazardous food is prepared)C1L)5rfl l)a.-0L56A_) EMERGENCY RESPONSE PERSON\�))f?,2. 14' AeAXbOA/ HOME TEL# 7e/ 7t1L/&'0D1/ DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION i/t�� Please write in time of day �� 4 fin Forexam le Ilam-11 m + TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than I000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 .------------------------------------ ....-------------------------------------......----------------------------------------------- RESTAURANT NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 - 25-99 seats =$280 more,than 99 seats =$420 BED/BREAKFAST/ YESQD $100 CHILDCARE SERVICES. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES QN $25 'PleaseMaY total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ------------------------------------ ----------------------- --------------------------------- -------- Revised 4/24/07 FOODAP2008.adm Check#&Date A- Y/a 11�;i� ) - S 146f Derby Street In a Pigs Eye Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 741-4436 Food and Food Protection PASS BLUE Owner: - Physical Facility PASS BLUE Jennifer Reardon Comments:womens restroom floor to be retiled per conversation with owner Jennifer Reardon. By June 9. PIC: Jennifer Reardon Inspector: Janet Dionne Date Inspected:Correct By: 5/20/2008 Risk Level Permit Number: BHP-2008-0307 Status: Open #of Critical Violations: 0 .Time IN: Time OUT: Urgency Description(s): BLUE: Food Service Re-inspection Violations Related to Good All other violations have been corrected. Retail Practices (Critical Violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) I 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 03,2008 ), 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 GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 03,2008 ) Page 2 of 148 Derby Street In a Pigs Eye Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 1 Violations Related to Good Retail Practices (Blue Items) _- 741-4436 Food and Food Protection FAIL Critical BLUE Owner: C�nt:True unit has uncovered foods. All foods must be covered to protect from cross contamination. Jennifer Reardon PI,C: li — Employee observed eating in food prep area. All employees to eat in designated employee areas or in main seating area. r Jennifer M. Reardon Ma is ef-refrigerator has uncovered foods. All foods must be covered to protect against cross contamination. Inspector: John Gehan Equipment and Utensils FAIL BLUE Date Inspected:Correct 19Pmment: Magic chef refrigerator requires general cleaning. 71161200 7 Risk Level: C, n eKer requires general cleaning. __Microwave below shelf requires general cleaning. Permit Number: BHP-2007-0197 Status: Open #of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 16,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 16,2007 ) Page 2 oft '148 Derby Street In a Pigs Eye Restaurant City of Salem FOOD SERVICE ESTABLISHMENT FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 741-4436 i Food and Food Protection PASS Critical BLUE Owner: Comments:True unit has uncovered foods. All foods must be covered to protect from cross contamination. Jennifer Reardon PIC: Employee observed eating in food prep area. All employees to eat in designated employee areas or in main seating area. I Jonathan Mitchell i Magic Chef refrigerator has uncovered foods. All foods must be covered to protect against cross contamination. Inspector: John Gehan Equipment and Utensils PASS BLUE Date Inspected:Correct By: Comments: Magic chef refrigerator requires general cleaning. 7/23/2007 Risk Level: Can opener requires general cleaning. Microwave below shelf requires general cleaning. Permit Number: BHP-2007-0197 GENERAL COMMENTS: Status: All violations from July 16, 2007 have been corrected . SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 23,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Z(� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 23,2007 ) Page 2 of - --- STEPHEN A.GOR] ON y ^ HIC LIf:E.NSE# 147222 i ELITE. SERVICES "We Remove or Demo Anything" I± 978-317-5388 { RUBBISH REMOVAL DFMOLITIQN. ROOFING i w .eliteservicesonline.eoia vls�® CITY OF SALEM, MASSACHUSETTS 6 BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 RECEIVED Kimberley Driscoll WWv�.SALEM.COM !d I Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT APR '2 2007 C i. Y .}i= , .E2M SOAf ) 6- ALTH March 14, 2007 Dear Property Owner: The Salem Board of Health will assist in the enforcement of the amended City Ordinance, Chapter 36, "Solid Waste Management, " section 36-6 through 36-9. Some property owners have chosen not to participate in municipal trash collection. The Board of Health will be checking those locations to be certain that the trash is not placed out for municipal collection. Any excluded property, where trash is found out, will be subject to the fines as delineated in the ordinance. Thank you. Sincerely, ,��/ � <� cE.Z Joanne Scott b/g /LY � Health Agent CG1 % &4CV1LCS �� - `yg , e7 ,,6V S