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IN A PIGS EYE - ESTABLISHMENTS (2) �„ q �%9J �y{ ��b .➢e�pal 5ti�.,<t ftNIVERSAL® UNV-12110 MADE IN USA l IMtIAtM D �� Com dSb.,SWICft xxw dprogrem Oro 'YIIO:MI it I IMPORTANT MESSAGE FOR DATE I/ a.3/ 62 TIME M �n ✓S OF 'Ln Q 7 S ?? PHONE ZFi' 9"/, AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED FdVIM 4009 E IN U.S.A. NOTES _._ 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 Food and Food Protection FAIL Critical BLUE Owner: Comment: Can opener has accumulation of food and grime. Thoroughly clean and sanitize opener. Jennifer Reardon PIC: Staff observed eating in food prep area. Staff to eat and drink in designated area away from food prep areas to prevent cross Jonathan Mitchell contamination. Inspector: Downstairs meat slicer found with food debris. Thoroughly clean and sanitize after each use. John Gehan Date Inspected:Correct By: Equipment and Utensils FAIL BLUE 1116/2007 Comment: Microwave in back requires general cleaning. Risk Level: Sanitizer reading below mandated ppm. Sanitizer to be reading at 50ppm. Permit Number: Sanitizing log not up to date. Log to be maintained daily. BHP-2007-0197 Status: GENERAL COMMENTS: Open Owner to fax over certified food mgr certification to BOH. #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. Jan 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. Jan 16,2007 ) Page 2 oft r American Heart Association. Learn and Live., Healthcare Provider ---- - -- ._. This card certifies that the above individual has successfuRY completed the national cognitive and skills evaluations in accordance with the curriculum of the American Heart Association for the BLS for the Providers(CPR&AED)Program. Issue Date RerAmmended Renewal Data Cert No. 5143799 $wvftW CertirCBtbn TO LL for su xesFNFY ampMtlW the ttimhia ds aet faith by tae NatMnal Aesburent Awodatw Edu Foundation for the Se eah®Food FroleWon Manager CuatMOtbn Eidalydnation. Date of Examination: 12/6/2006 Date of Expiration: 12/6/2011 Local lemepply DMaF aiN wml«al ntulNorYwwa Nwo.ua NALFOUNDAV L roc rBter4licYddireaa^eTYa4 EDUUTIONAL mUNDAmON• Exam Farm No.4299 CWL NS, 9143799 SffV$ 'CertN JOn N for sxl..mrh ca*Ww tM gaww Sa tate tw tta Naaaw aemarmt AR 00-Edu Fomaplorl for the SnvSsta®Food Fldtamm IYmaer cWbtlan 6ramlmeon. Date of Examination: 12/6/2006 Date ,of�Expiration: 12/6/2011 � pllaMN rM�w� eao'W enuu•.manoara.• Imn<aNfiav«reW�^dEDUUmONAl F9UNOAltON• CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1 /4 / ji &C (, ADDRESS OF ESTABLISHMENT FAX# , MAILING ADDRESS (if different) EMAIL-- Business': _ , nr's:48 '_ 7 � , (1- / OWNER'S NAME TEL# q 1 )?qWg I ADDRESS 57- ff4L tk 14A (51Q19A STREET �...-n 7 e CITY STATE� ZIP CERTIFIED FOOD MANAGER'S NAME(5) �}�d}11i4L-hAA.F-6UZGr<'ffil.L CERTIFICATE#(5) I (Required in an establishment where potentially V(ially�Yl h'lha—zarrd�ous food is prepared) i EMERGENCY RESPONSE PERSON f h.t( HOME TEL# t gg ?�y to L! 7 t BAYS Of OPERATION _ Monday Tuesday WednesdayA_ Thursday _ Triday� Saturday Sunday HOURS OF OPERATION t For example llam-11nm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YE NO less than seats =$100-� 25-99 seatsis $15 more than 99 seats - .._kF -... - ...._."N _ - ----- -- ----- -- ---- - ... ------- -------- ...... ..._....- BED/BREAKFAST YES NO $100 --- ---- _ - --- -- .... ...... .............. ...... ..... ...... ..... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES CMD $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Sign Lure �. Date Social Security or Federal Identification Number --------------------------- - -- - Revised 11113/06 FOODAP2007.adm - Check#&Dale��� --------- -----.---- ----------—� 1 ��'�i` * wM 4F'd i �-'t y yv�} , F•: K N„ �{�M.' } 0444" 1 ,.Y ✓� «x. �'a°4 {5 M+r +{w �22 � �yT�'Z -* YCommonwealtlt of Massachusetts $ Vs �iY'&dsia wr �aYL�.Ci` s �.t, '"xts a�,� • �¢ r a � r� d fi ty k>r "y x ' Bo8`rd Of H¢81th+w't''�""`�x�r°ix+s "`��'y�k+ `���{ � � �-'9"�+ ��,y�Y��': ` " Pix* �' 120 Washiu too Stree 4th Floor,+ �, IGmeedgy Dnsoollm SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 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-2007-0197 Dec 20,2006 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES !December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 10 of 18 148 Derby Street In a Pigs Eye Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone-'O, , FOOD PROTECTION MANAGEMENT 747 4436 r, I6 _ 6 PIC Assigned/Knowledgeable/Duties FAIL RED OWner}w, ,h4„ ` . expired certificate. CFM to Pd- •. Comment:CFM has ex fiupdate certificate. Call BOH for information if needed. Jennifer'Reardon PIC ya` ;i?P Violations Related to Good Retail Practices (Blue Items) '( 3�MA Jennifer M. Reardon Food and Food Protection FAIL Critical BLUE Inspector.`,' ,�. Comment:Cook observed handling ready to eat foods with bare hands. Cooks to wear gloves when preparing foods. John Gehani. 4: Date x` Correct By: Magic chef unit has uncovered foods. All foods in storage must be covered. , I I True refrigerator has uncovered foods. All foods in storage must be covered. Risk Level: "- +,i .„ w. Equipment and Utensils FAIL BLUE Permit Number: Comment: Can opener had accumulation of grime.Thoroughly clean and sanitize opener. BHP-2006-0360 Status: Southbend oven requires thorough cleaning. SIGNED OFF Utensil bucket requires general cleaning. #of Critical Violations: 2Utensils in bucket require cleaning and sanitizing. Time IN: Time OUT: ice machine inside panel has accumulation of grime. Thoroughly clean panel. Urgency Description(s): Ice scoop holder requires general cleaning. BLUE: Knife stored incorrectlt at bar. Knives to be stored in proper designated rack. Violations Related to Good Retail Practices(Critical Sanitizing log not up to date.Log to be maintained daily. violations must be corrected GENERAL COMMENTS: immediately or within 10 days)(Non-critical violations 846:AII violations from 9/12/2006 have been corrected. must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2006 ) Page I of . Item Status Violation Critical Urgency RED: Violations Related to k Foodborne Illness Interventions and Risk Factors(Require,,',, immediate corrective action)"d " City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2006 ) 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 Food and Food Protection PASS BLUE Owner: Equipment and utensils PASS BLUE Jennifer Reardon PIC:-„ _ Comments: Shelves above hand was sink found with chipping surface. Properly repair shelf so that shelf is easily cleanable and °•^ `^"T impervious.(3/13/06) Inspector.,- GENERAL COMMENTS: John Gehan Date Inspected: Correct By: „ 502:Owner states that floor will be done on 3/12/06 and 3/13/06. 2/16/2006 Beer Walkin which has leak to be done on same date at above. Risk Level: All violations cited on 2/16/06 have been corrected unless noted. Permit Number: BHP-2006-0360 Owner to call Board of Health upon completion of floor. Status: FULL COMPLY # of Critical Violations. 0 Time IN: Time OUT: .,, Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical m violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 28,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action). T—� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 28,2006 ) Page 2 of I s +� V ��'� . �� � . 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- Jennifer wnerJennifer Reardon. Non-compliance with: PIC: Anti-Choking PASS Jennifer M. Reardon Tobacco PASS Inspector: John Gehan s EMPLOYEE HEALTH Date Inspected: COrr2Ct By: Reporting of Diseases by Food Employee and PIC PASS d❑ RED 2/16/2006 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS ❑Q RED BHP-2006-0360 Receiving/Condition PASS ❑J RED ,Status: - Open Tags/Records/Accuracy of Ingredient Statements - PASS ❑d RED #of Critical Violations: - Conformance with Approved Procedures/HACCP Plans PASS RED 2 Time IN: - Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMSO2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 16,2006 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSd❑ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED immediate corrective action) Proper Adequate Handwashing PASSd❑ RED Good Hygienic Practices PASSd❑ RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑J RED Reheating PASS RED Cooling PASS 0 RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS 0 RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 16,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE �ments: chef at time of inspection seen not using gloves while preparing foods. All employees must wear gloves when preparing foods and change accordingly. —11,16�covered foods found in freezers downstairs in basement. All foods must be covered and labeled correctly in storage. Mayonaise in kitchen holding at 50°F at time of inspection. All Potentially hazzardous foods must be at 41°F or below when in cold holding. ✓ Outdated milks found in true refrigerator at top of stairway. Disgard milk. L'�C—Overed bacon on shelf. All food being stored must be covered and stored in appropriate areas. Equipment and Utensils FAIL Critical BLUE ments: Produce sink has dispensing soap bottles in it. Sink must be used for produce only. 11�eat grinder found with accumulation of food debris. Properly clean and sanitize grinder. ,/Fridge air freezer running at 3°F. Freezer must be holding at 0°F or below as mandated. tit point freezer running at 5°F. All freezers must be holding at O*F or below as mandated. E,-Tfi—ree freezers downstairs had accumulation of ice. Remove ice and properly clean freezers. Repair freezers if needed. rue refrigeration unit has broken handle. Repair or replace handle. C g boardbeneath fryolator stained. Properly clean and sanitize cuttingboard. If stains do not clean up,resurface or replace cutting board. 1 nives in kitchen had accumulation of food debris. Thoroughly clean and sanitize knives. `�- Shelves above hand was sink found with chipping surface. Properly repair shelf so that shelf is easily cleanable and impervious. an opener had accumulation of food debris. Clean and sanitize can opener. izer in spray bottle running above 200 ppm. Sanitizer must be at 200 or as mandated. scoop in bar area not in appropriate area. Properly store scoop in designated area or container. ,4Ce—bucket near stair way found with accumulation of grime. Thoroughly clean ed and sanitized at time of inspection. (/Magna Chef refrigerator in kitchen missing thermometer. Provide visible and accurate thermometer. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 16,2006 ) Page 3 of ' Item Status Violation Critical Urgency Comments: Floor tile in kitchen still not repaired from last inspection. Tile needs to be repaired to prevent accidents. Inspector spoke with office Sr.Sanitarian Janet Dionne and floor needs to be corrected immediately. Leak in walk in refrigerator that holds beer. Have leak repaired by plumber. )� f 3 condensation dripping from upstair ice machine to downstairs basement. Seek corrective plan to prevent accident. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 482: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 16,2006 ) Page 4 of CITY OF SALEM, MASSACHUSETTS ® BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT January 26, 2006 Jennifer Reardon In A Pig's Eye 148 Derby Street Salem, MA 01970 Dear Jennifer Reardon: You are currently operating your Food Establishment, In A Pig's Eve located at 148 Derby Street, without a Food Permit. This is in violation of the State Food Code, 105 CMR 590.000, section 8-301.11. In order to receive a 2006 Food Permit, you must: • Pay outstanding tax bills, if any • Pay outstanding tickets from the Board of Health • Pay for your 2006 Permit • Submit a completed 2006 Food Permit Application You are hereby ordered to obtain a 2006 Food Establishment Permit forthwith. Failure to do so by Monday, February 6, 2006, will result in a Board of Health Order to cease all food operations at your establishment immediately. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. An attorney may represent you. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Sincerely, gJo�a�nott Health Agent 4 NtakµA'a \� • Commonwealth of Massachusetts City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor i SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/01/2006 WHO'S PLACE OF BUSINESS IS: In a Pigs Eye Restaurant File Number BHF-2004-0272 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-2006-0360 Jan 30,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES .December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in it prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 5 CITY OF SALEM, MASSACHUSETTS o� BOARD OF HEALTH _ l a 120 WASHINGTON STREET, 4TH FLOOR ���jjjff411 ... SALEM, MA 01970 ij,/(Ir d TEL. 978-741-1800 QFC 0 D STANLEY J. USOVICZ, JR. FAX 978-745-0343 e C/� BZ00S MAYOR WWW.SALEM.COM Oq9 O/: JOANNE SCOTT, MPH, RS, CHO �OFSkF HEALTH AGENT HFq/M 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ` 7 NAME OF ESTABLISHMENT LRI }) '1P)��S 9,�(I . t>?irGZQ(f"&Jf TEL# q1 4L- Yq3G, ADDRESS OF ESTABLISHMENT 4� b�0h7 MAILING ADDRESS (if different) OWNER'S NAME,A ffar[1,l TEL# 9 5� co nj ADDRES CITY hAlfm STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S 1 Z CERTIFICATE#(s 3D N (required in an establishment where potentially hazardous food is prepared.) n_ EMERGENCY RESPONSE PERSON J4WWJ fed' 19. Re&K A611 HOME TEL#'T�� HOURS OF OPERATION: Mon._y/_Tue._)I;--LWedk--Thu.xFri.-�,, _Sat. >C Sun.p X� Ik30 - M�CIni9Y+F 0 � IIt30 -lo wt TYPE OF ESTABLISHMENT FEE (check only) P RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 RESTAURANT NO less than 25 seats = 100 25-99 seats = ( o C J more than 99 seats =$200 ....------------------------------------------------------------------------------- ---------------------- BED/BREAKFAST YES NO $100 ------------------------------------------------------------------------------------------- . ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Q4A44-yk. eoa -� I a15106— 6q.;Lq 0-2.76 q S Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------ -------- //--1,-,-r----------------------------------------- Revised ll/03/05 FOODAP2.adm Check#&Date '0 or !� b/W / 6p -....yam ';+ /. nW • n n} 'r ♦.erg., e S 'e:Y% }..(^..^ ,.n .=a •Y' -*�IbiH`4..-�:... Y T A^... �+'�/r'.✓t. i.;,rr. , � .nv j{jv$f ♦ , Massachusetts Department of Public W120W S Wealth 120 Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name Dat T of Operations) Type of Inspection Food Service ❑ Routine AddressRisk ❑ Retail rR Re-inspection 14 Level E] Residenflal Kitchen Previous inspection Telephone W112E] Mobile Date: '1/305 - Owner HAGGP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Ail Person in Gti rge{PIC) Time ❑ Bed& Breakfast ❑General Complaint In: 3- [IHACCP Inspector Out; L� Permit No. ❑Other_ Each violation checIted requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-comptiance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ , action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned!Knowledgeable/Duties ❑ 13. Handwash Facilities -EMPLOYEE HEALTH - PROTECTION FROM CHEMICALS El 2. Reporting of Diseases'by Food Employee and PIC [] 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - -- - TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18, Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY .. ... _. ❑ 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 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 e r , by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health, Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements {590.009) within 10 days of receipt this QrN 30. Other DATE OF RE-INSPECTION:: / S.s301nspecrFtl�6-r4.tloc N in Inspector's Signature: Print: PIC's Signature: �j �� Print: Page+of Rages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 190.003(A) Assignment of Responsibility" 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RIF.Foods* [:2:-1:0:3::l 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* 3-30215 Washing Fruits and Vegetables -59(003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils'r Chal ee* Contamination from the Consumer 590.003(G) Re ortinR by Person in Char e" 3-306.14(A)(I3) netiii'ned Food and Reservice of Ford* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701..12 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law` 4-501.111. Manual Warewashing-Ilot Water Suniuz ..__, 4-501..1.12 Mechanical� ar eashin - 3-201.12 Food in a IIenneticallv Sealed Container* Varewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* � i - 3-202.13 Shell E gs" Sanitization Temperatures"' 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.11,4 Chemical Sanitization-temp.,pH, concentration and hardness ` 3-202.16 Ice Made From Potable Drinking blit atet* 4-601.,1(A) Equipment Fax,Contac Surfaces and 5-101.11 DrinkingWater from an Approve,,Svst'eni* Utensils Clean" 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Egwpmcnt Food- 590.006(B) Water Meets Standards in 310 CMR 22.0 Contact Surfaces and C,tensils* Shellfish and Fish From an Approved Source 4-902.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of 11ui ment* Shellfish'" 4-703.11 Methods of Sanitization--Hot Water and 3-201115 .Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulator Authorit 2301.11 Clean Condition-Hands and Arms"` 3-202.15 Shellstock identification Present* 2-301.12 Cleanin-Procedure" 590.004(0) Wild Mushrooms* 2-301.14 Wlren to Wash` 3-201.17 Game Animals'; l l Good Hygienic Practices 2-401.11 Eating,Drinkin or Using Tobacco* Receiving/Condition -.� ..,-. 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes Nose and 3-202.15 Package I teeritv,* Mouth* 3-101.11 Food Safe and Unadulterated'0 3.301.12 Preventing Contamination When Tastin i* 12 Prevention of Contamination from Hands 6 TagsiRecords:Shellstock S04( Preventing Comamnation'from 3-202.15 w90500 3-203.12 ShellstockIdentification Maintained" Em lovees* TagslRecords:Fish Products 13 Handwash Facilities 3-40211 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* < Labeling of Ingredients* 5-204.11 Location mid Placcoatat* 5J0.004t.1) 9 9 Conformance with Approved Procedures 5-205-11 Accessibility,Operation and Maintenance 7 (HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecializedProcessiniMethoAds* Devices 3-502.12 Reduced oxygen >aeka,nnR,criteria* 6301.11 Handwashing Cleanser.Availabilit 8-t03.i2 Conformance withA>>rovedProcedores"` 6'301.12 Hand Diving Pro cion 'h Denora critical item lit!he federal 1999 Food Coda or 105 CENT 594000. ' CITY OF SALEM r— 'tBOARD OF HEALTH Establishment Name: G I L Lr �1 /0 _ Date: Page: a of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date t - Verified No. Reference R-Red Item F r - r 9LEASE. RI � CLEARLY,, I 5 L- J C040,1./ lOsv !1 � � . � r n v � IJ44 I / ✓ Q eL e� n 4 r� Gp3 : Y t. i- t1 r S1 r ,P Y r Discussion With Person in Charge: Corrective Action Required: ❑ No Yes have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance El Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion •� p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure a yourfood.permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to taw Cooled to Factors(items 1-22) (Cant.) 4t°F745,,F Within 4 Homs_ PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs '19 PHP Hot and Cold Holding 1A Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 3-202.12- Additives* 590.004(F) 41"145°F* 3-302.14 Protection from Unapproved Additives* 3-501.16(.A) I lot PHFs Maintained at or above Jg Poisonous or Toxic Substances 40°F_ 7-101..11 Identifying Information-Original 3-501.1.6(.x) Roasts Held at or above 130"F. Containers" 7-10111 Common!Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-siolai"C' 3-50Li9 Time as a Public Health Controk's 7-202.11 Restriction-Przsence and Use* 590.004(FI) Varian,,Re airement 7-2022.12 Conditions of Use- 7-203 11 se*7-203.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sattitizet s,Criteria (HSP)a-Chemicals* -- - 7-204.1.2 Chemicals for Washine Produce,Criteria"` 21 3-81)1A I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying. ents.Criteria* Beverages with W amine I-abets* 7-205.11 Incidental Food Contact.Labdcants* 3$01.13($) UFc of Pasteutrzed Y,gss* 7-206.'1 1 Restricted Use Pesticides.Criteria" 3-801.11(ll) Raw or Partially Cooked Animal Forxl olid - Raw Seed S grouts Not Served. 7-206.12 Rodent Bait Stations" 3-801.11(C') Unopened Foci Package Not Re-served. 7-206.13 'Pracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS :; 22 3-603.11 Consumer Advisory Pasted for Consumption of Animal Foods'19iat are Raw.Undercooked.or I6 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs tie""' rivzom 3-401.1 IA('U(2) Eggs- 155`F 15 Sec. Pathe ons.'' e )i s-Immediate Service 1.45"1-"lSsecu 3-302.13 Pasteurized Eggs Snbsdarte'for Raw Shell 3-401.11(A)(2) Contaminated Fish,Meats&Game - Es* Animala- 155°F 15 sec. * 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590 009(A)-(D) Violations of Section 590.009(A)-(D) in sec. * catering, mobile food,tempormy and 3-401.11(A)(3) Poultry;Wild Game,Stuffed PHPsi residential kitchen operations should be Stuffing Contanting Fish, Meat, debited under the appropriate sections Poultry or Barites-16511F 15 sec. * .abovc.if related to foodborne illness 34011I(C)(3) Whole-muscle,Intact Beef Sie:alcs interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.1.2 Raw Animas Foods Cooked in a -practices should be debited under#29- Microwave 165°F* Special Requiretnerits. -1401 A 1(A)(1)tb) All Other PHFs=145"F 15 sec. I7 Reheating for'Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. #` (Items 23-30) 3-403.11(B) Microwave- 165"F 2 Minnie Standing Critical and non-critical violations. which do not i elate to the Time" foodborne illness anei ven ionm and risk factors listed above, can be 3-403.11(C) Commercially Processed F 3fE Food- ,found inthe following sections of the Food Cade and 105 CMI: 14WF* _ 590.000. 3-403,1.1(G) Remadurva Unsticed Portions of Beef item Good Retail Practices _ FC 590.000_ Roasts" 23. Management and Personnel_...__ FC-2 _.003 I,y Proper Cooling of PHFs 24. Food and Food Protection_ FC-_3 .004 25 _Equipment and Utensils _ FC 4 .005 _ 3-501..14(A) Cooling Cooked PHFs from 140°F to g6 Water,Plumbinlji2rdWaste . FC-5 006 -- 700F Within 2.Houcs and From 70°F 27. Ph sical Facili FC-6 � .007 to 4FF/45F Within 4 Hours.t 28. Poisonous or Towc Materials_ FG 7 .008 3-501.14(13) Cooling PHFs Made From Ambient 29 S ectal Re uiremants _ .009 Temperature Ingredients to 41'F/45'17 K. Other Within Hours* orU%b,W- d, *Denor'es cr[iiczl irem in the federal 1999 Pond Code or 105('MR 590.000, �,.". _ r 4 t... . . .r+,T+,..-.w,,+., y :•.v.n4.W+.7.+.+w.:..,r..r.�,..�..r^.-h,..+.-.... ..4... ,. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpe of Operation(s) Type of Inspection C_ G OS Food Service ;&3 Routine Address Risk ❑ Retail ❑ Re-inspection Level [:1Residential Kitchen Previous nsp ction Telephone ❑ Mobile Date I ? p� Owner HACCP Y/N [-ITemporary ❑ Pre-oper ion G„-� ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑General Complaint El HACCP Inspector O. .'. Permit No. ❑ Other Each violation hecked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.006(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT " ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH "` - - - -- ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC F13.,personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives . ❑ 15.Toxic Chemicals , FOOD FROM APPROVEDIOURCE _ ❑ 4. Food and Water from Approved Source „TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) (fi]5. Receiving/Condition ❑ 16. Cooking Temperatures `❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [:118. Cooling PROTECTION FROM CONTAMINATION "" -- `! ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20. Time As a Public Health Control Q79. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY.SUSCEPTIBLE'.POPULATIONS(HSP) / El 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing�' -�� , ' ❑ 11. Good Hygienic Practices CONSUMER ADVISORY;, -1, El 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 of Health. today, the items checked indicate violations of 105 CMR C N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 1�24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations <y 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-6)(660.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:5WnsadFo,�,4.d� Inspector's Signature: Print: . PIC's Signature- Print: ° - Page of Pages { �AW Violations Related to Foodbome Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590-003(A) Assignment ofRear tonsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTF..Foods* 2-103-11 Person in charge--duties Contamination from Raw Ingredients 3-302.11(,VK2 Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in chatne to Contamination from the Enwronment regnire reporting by food employees and 3-302.11(A) Food Protection* applicants*licants* 3-30215 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person hr Utensils* Charge* Contamination from the Consumer 590.003(6) Re oiling b Person in Char=e"` 3-306.14(A)(1i) Returned Food and Reseivice of Foodi FTI Exclusions and Restrictions* _ Disposition otAduiterated or Contaminated 590.003(E) 1 Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fax]` 4 Food and Water From Regulated Sources °) Food Contact Surfaces 590.004(A-B) Com haute with Ftxtd Law* 4-501111 Manual Warewa0mg-Hot Water 1p Sanitization Tetn>zramrzs* 3-201..12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 4-501112 Mechanical Warewashino Hot Water 3-202-13 Shell EggsSanitization Tem eratmes't 3-203.1.4 E es and M k Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,. 3-202. ,16 Ice Made From Potable Drinking,Water* concentration and;hmdness. 5-101.11 Drinkina Water from not Approved roved Svstem* 4-601.11(A) Equipment Food Contact Surfaces and 590,006(A) 'Bottled Drinking Water* UtensiIs Cleats* 590.006(B) Water Meats Stan4-502.11. Cleaning Frequency of Equipment Food- dards in 310 CMR 22.0' Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-20 L 14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Wafer and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources" 1g Proper,Adequate Handwashin9 Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clem Condition-Hanids and Arms" 3-202.18 Shellstock Ideutif[cacion Present* 2-301.12 Clemnim,Procedure* 590.004(0) Wild Mushroo ns* ! 2-301.14 When to Wash* 3-201.17 Game Animals* 11. Good Hygienic Practices g Receiving/Condition -t 2-401.11 Eating,Dri nk int or Using Tobacco- 3-202.11 PIIFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes.Nose and 3-202.15 Package hntetul t•` Mouth* 3-101.11 Food Safe and Unadulterated 3-301.12 Preventing Contamination When Tastin " 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.13 -Shellstock Identification^ 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to gees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* S-203.1.1 Numbers and Ca acities* 590.004(.1) 1 Labeling of Ingredients" 5-204.11 Location and Placement" 9 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance iHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen Packaging,criteria* 6-301.1,1 If andwashin g Cleanser.Availability- 3-103.12 Conformance with Approved Procedures" 6-301.12 Rand Drying provision *Denotes critical item in the federal 1999 Ftmd Code or 105 CMR 590,960. CITY OF SALEM BOARD OF HEALTH Establishment Name: -4-70CA Date: Page:_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date -- _ No. Reference R—Red Item Verified. f PLEASE PRINT. LEARLV 1 .J / V Kir JJ V ' 1 r n �a In,ems c QG rrh- 0 L( t t t t o , 4 ) Sv/,l l so t odej I j kl, P -t, n� i Discussion With Person in Charge: — Corrective Action Required: ❑ = No " Yes / r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion ' violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food-Code. I understand•that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 1 ❑ Voluntary Disposal ❑ Other: S 3-501.14(C) P Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk .According to Law Cooled to Factors(items 1-22) (Cont.) 4FF145°F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Coolinv Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50 t.16('B) Cold PHFs Maintained at or below 3-202.12 Additives" 590,004(F) 41 V45°F 3-302.14 Protection oi o nou Prom.Unapproved Acs vest 3-501 16(A) Hot PHF-Maintained at or above ij Poisonous or Toxic Substances 140"F. * 7-101.11 ktenti)jling information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-1.0211 Common Name-Workin^Containers* 20 Time as a Public Health Control 7-201.11 Se station-Storage* _ 3-SOL 19 Time as a Public Health Control : 7-202.11 Restriction-Presence and Use 090.o(kl(H} Varitwce Re uirement 7-202.12 Conditions of Use" 7-203.11 Toxic Con ain�W ohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11. Sanmzers,ltYitd t Chenac da* t 7-2O-1-1.2 Chemicals for Washine Produce,Criteria c - 21 3-801.11(A) Uapastees wit Pre-packaged.aged Juices slid 7-204.14 Dtyin r guts,Criteria* Beroer�ges with Waiving(abets* 7-205.11 Incidental Food Contact,Lubricants* I I(B) Use of Pasteurized h- s* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 7 206.11 Restricted IIsa tionPests ides.Criteria* Raw Sced Sprouts Not Served. 7-200.12 Rtxi�nfBaitStxnons* 3-SOL11{C) 'UnoenedFoodPacka<r• 7-206.13 Tracking Powders.Pest Control and �' cNot Re-served. Monitarin�* CONSUMER ADVISORY TIMENEMPERATURE CONTROLS 22 3 603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or PHFs Proper Cooking Temperatures for Not Otherwise Processed to Eliminate - 3-401.1 1A(i)(2) F'Qgs- 155'F 15 Sac. - Pathogens,*Els q.o in:zom',. Eggs-homediate Service 145'1715sec* 3-302.13 Pasteurized Eggs Substitute'l;or Raw Shelf 3-401.11(A)(2) Comminuted Fish,Meats&Game E"sr Animals- 155'F 15 sec. * 3-401.1 l(B)(1)(2) Park and Beef Roast - 130'P 121 min* SPECIAL REQUIREMENTS 3-401.1 l(A)(2) Ratites,Injected Meats- 155'F 15 590-009(AND) Violations of Section 590.009(A)-(D)in sec * catering, mobile food, temporary and 3-401_1.1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Pouitx or Ratites-165°F 1S 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 -T401.12 Raw Animal,Foods Cooked in a practices should be debited under#29- Microwave 165°F* S,pecial Requirements. 3-401-11(A)(1)(b) All Other PHFs-- 145'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. " (Itettus 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-cri&cat violalions, which do not relate to the Time* foodborne illness inserventions and risk factors listed above, can be 3-403.1.1(C) Commercially Processed I2TE Food- found in the following sections 0.1 the Food Code and 105 CMR 14WF* 590.000. 3-403.1.1(E) Remaining L-❑sliced Vortions of Reef� Hem Good Retail Praetfcas _PC 590000 « Maria sment and Parsonnel Roasts -_,___ __ FC-2 .003 , .._--__- 1g Proper Cooling of PHFs 24. Food and Food Protection -_--- FC_-3 .004 25 _Equipment and Utensiis _FC _4 _.005_ 3-501.1.4(A) Cooling Cooked PHFs from 140`F to 26 Water,Plumbin and Waste FC-5 .006 70"F Within 2 Hours and From 70'F 27, Physical Facllltv_ FC-6 .007 to 4 t'F145'F Within 4 Hours. * 28. Poisonous or Toxic Materials F-C 7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29, S ©sial Re uiremsnts ' .009 Temperature higredients to 41'17/4501F 30 _-- ..Other _ -_.... -- Within 4 Hours* s 511F -n.,rr-xdo' `Denotes critical item in the teller l 1999 Food Code or 105 CMR 590 000. CITY OF SALEM B ARD OF HEALTH Establishment Name: _ Page: 3 of r Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date k No. Reference R—Red Item Verified PEASE. RINT LE LYA2p t IF i � • Y `F /y r � �l • � C '1 P r i k _sJ J Discussion With Person in Charge: , �. Corrective Action Required: ❑ No Yes r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Res rpensi / 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 1 ' noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure * your food permit. . "p voluntary Disposal ❑ Other: i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41°F/45`-'F Within 4'Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling 1,11%hods for PHFs 14 Food or Calor Additives 19 PHF Hot an& pill Holding 3-501.16(12) Cold Pl IFs Maintained at or below 3-302.14 Protecl 3-202.12 Adectio'k 590.004(F) 41''/45°F* 'lon from Ilna r roved Additives* 3-501.1.6(.A) Hot P14Fs Maintained at or above 15 Poisonous or Toxic Substances 7-10t.1 L Identifying lnLormation-(Jriginal 3-50l A 6(A) Roasts Held at or shove 130°F.* Containers" + 7-102.11 Common Name-Working`Containers'" 2U Time as a Public Health Contra)r 3-501.19 Time as a Public Health Cottrell 7-201.11 Separation-Storage" 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re iurement 7-202.12 Conditions of Use* - - 7-203.11 Toxic Containers-Prohibitions` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Satntizers,Criteria-Chemicals* POPULATIONS{HSP} 7-204J12 Chemicals for Washing Produce,Crit'erial` 2;t 3-801 11(A) Unpasteurized Pre-packaged Juices mid 7-204.14 Di •in eats,Criteria* Beverages with Vanning labels' 7-205.11 Incidental Food Contact, Lubricants* 3-801.1i(B) -- Use ot-Pastennzed Hees* 7-206.11. Restricted lire Pesticides.Criteria* 3-801-11(D) Raw or Parially Cooker!An teal Food and 7=206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Ung cued Food Paeka�e Not Ke-screed. * Monitoring DVISORY CONSUMER A TIMFiTEMPERATURE CONTROLS 22 3-60111 11 Art rudFo rse Processed to or Consumption of onsumer Advisory Posted I 15 " Proper Cooking Temperatures for Am mal Fixxtc Phut rrc Raw.Undercooked or PHFs Eliminate 3-401.11A(1)(2) Eggs- 155'F 15 Sea Pamo ons*e`r'a"� E --hnmediate Service 145gP15sec* 3-302.13 Pasteurized Pggs Substitute for Raw Shell 3-401.11tA)(2) Comminuted Fish,Meats&Gmne Eggs* Animals- L55°F 15 sec. 3-401.11(13)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food, temporary and 3-401_11(A)(3) Poultry,Wild Game,-Stuffed PHFs, residential kitchen operations should he .. Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-1650F 15 sec. above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'T* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under x#29- _ Microwave 165°F* Special Requbearents. 7401_II(A)(1)(b) P,11Other PHFs-145°F't5sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL,PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. :: (items;23-30) 3-403.11($) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate In the Time* foodborne illness interventions and risk factors listed above, can be. 3-403.11(0) Canatnercial{y Processed I2TE Food- {areal in the,foltpwiag suctions of tke Food E'pde and 105 CMtt 140'F* 590.000. 3-403.1.1(F) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Management and Personnel FC-2 .003 lg Proper Cooling of PHFs 24. Food and Food Protection F,G 3 .004 25. E ui ment and Utensils _%PC 4 .005 3-501-14(A) Cooling Cooked PHFs from 14WFto 26 Water,Plumbing and Waste' FC 5 006 70"F Within 2 Hours and From 70'F27. Pn sloes Facili FC-6 .007 to 41.'F/45"F Within 4 Hours. * 28. Poisonous or Toxic Materials __ _FC -7` .008 3-501.14(13) Cooling PHFs Made From Ambient 29. S ecial Re uireni a " '.00g Temperature Ingredients to 41°F/45°17 3e Other Within 4 Hours)) 4s9ominn,:46a.m� "Denotei critical iter)in Inc fQderal 1999 Food Code or 105 CNIR 590000. Massachusetts Department of Public FOODBORNE COMPLAINT • WORKSHEET Hease Complete and Send or Fax to: Questions? Ca/1: Date: �/Z 1�/� MDPH Food Protection Program Food Protection Program: (617) 983-6712 305 South Street,Jamaica Plain, MA 02130 Division of Epidemiology: (617) 983-6800 #: Fax: (617) 983-6770 1 Enterics Laboratory: (617) 983-6609 � � I r PERSON COMPLETING INFORMATION o7S) 00 Name: Affiliation: Loca BOH (town): Sam ❑ State DPH (division): ❑ Other: rnl �� EPQRTER / COMPLAINANT p� Name: 1 ' 1 LOf Orl}O(� I\ x: 40) A00 70�� Affiliation: XConsumer specify: -a /` ^ ^l ❑ Laboratory division, q0-3 L-00rCQ.-s+e-r �ll ❑ Local BOH facility, 1 ( I ❑ Medical Provider address, ❑ State DPH town, etc. Q� n ❑ Other qI ILLNESS INFORMATION # Persons ill:a Symptoms: (mark if reported for anyone): Diarrhea Vomiting Nausea Abdominal cramps Fever Bloody stool Headache Muscle aches Chills Loss of appetite Fatigue ❑ Dizziness ❑ Burning in mouth ❑ Other symptoms: ......... .................................................. ... ...... Onset: -a : Earliest Date: Time: J ❑AM PM E Latest (if > 2 ill) Date: / 15 /5 Time: ❑AM�PM %...................................................... ........................... ...... ...... . Duration: ❑ Less than 24 Hours ❑ 24-48 Hours More than 48 Hours ❑ Ongoing ❑ Unknown III Persons: Age Name Addressrrown S (yrs) Occupation Med. Provider/ o t ❑same as reporter(above) 2 �i�I I Le dose I r l B�I r�o+ton Are &8&S Yeache< U) 3 New Pfatalp C 4 \/ Medical attention received (by anyone)? Yes ❑ No ❑ Unknown -+ If Yes, specify above: T Stool specimens submitted (by anyone)? , \ Yes ❑ No ❑ Unknown -4 To SLI '? ❑ Yes ❑ No ❑ Unknown Medical diagnosis reported? ) UDd n FOOD TORY — Obtain history back 72 hours prior to symptoms, or, if organism identified, b/n min and max incubation periods (see p.2) - If > 2 ill, follow above time frame for common meals(foods)only # Restaurant/ store where 2 Fxn3 138 En a Imo-1 5 £ C D Same(as left) 13 Home dune 15+h L • Wd�loo— ShAr Cr d15� Y ❑Other(specify): ish 1 State laboratory Institute,305 South St.Jamaica Plain,MA,02130 - (617)522-3700 Sept 1999 (99SeptForm.doc) 2 Always record Time H possible;otherwise,choose B=breakfast,L=lunch,D=dinner Discard Previous Version 3 Total#persons(both ill and well)who consumed indicated food(s) �wormp.nc6t�— �+aY�d -� IVIDPH Foodborne Illness Complaint Worksheet Page 2 of 2 FOOD HISTORY (continued) # Restaurant/ store where Date & Time Exp a Food(s) consumed urchased (name, town) Place consumed 08 ❑Same(as left) D Home D L ❑ Other(specify/: 0 O B ❑Same(as/eft) ❑Home 0 L ❑Other/specify/: 0 D ❑ Same fas left)—[]Home D L ❑ Other(specify/: 0 D B ❑Same fas left) D Home O L O Other(specify/: DD O B ❑Same(as left) ❑Home 0 L ❑Other(specify): ❑D NOTES FOOD TESTING Food(s) available for testing? ❑ Yes �No ❑ Unknown --4 Sent to SLI '7 ❑ Yes ❑ No ❑ Unknown /f Yes, specify foods) & sources: Product and Manufacturer Information for Commercially-Processed Food(s) -�c Product name: Code/lot # U Expiration date: / / Package size/type: (j Manufacturer: W: ( ) - /1 Address: I Incubation Periods for Selected Organisms Min Max Min Max Min Max -{-� 2 B. cereus (short) 1 hr 6 hrs E. coli 0157:H7 3 days 8 days Staph. aureus 30 min 8 hrs 4 Q B. cereus (long) 6 hrs 24 his Hepatitis A 15 days 50 days Shigella 12 his 96 hrs Campylobacter 1 day 10 days Salmonella (non-typhi) 6 his 72 hrs Vibrio cholerae few hrs 5 days Cyclospora 1 day 14 days Salmonella typhi 1 wk 3 wks Viral GI 12 hrs 48 his C. perfringens 6 hrs 24 hrs Shellfish poisoning minutes few his Yersinia 3 days 7 days 1 State Laboratory Institute,305 South St.,Jamaica Plain,MA,02130 - (617)522-3700 Sept 1999 (99SeptForm.d0c) 2 Always record Time if possible;otherwise,choose B=breakfast,L=lunch,D=dinner Discard Previous Versions 3 Total 0 persons(both ill and well)who consumed indicated food(s) I f Massachusetts DepartmentofPublic FOODBORNE ILLNESS COMPLAINT WORKSHEET Please Complere and Send or Fax to: Questions? Calk Date: /Z /� MDPH Food Protection Program Food Protection Program: (617) 983-6712 305 South Street, Jamaica Plain, MA 02130 Division of Epidemiology: (617) 983-6800 #: Fax: (617) 983-6770 1 Enterics Laboratory: (617) 983-6609 _� PERSON COMPLETING INFORMATION (� Name: tc ^ f �0 Affiliation: Loca BOH (town): � 3IC7" L ❑ State DPH (division): ❑ Other: tI / COMPLAINANT Name. �u� � Affiliation: Consumer Specify: —� ❑ Laboratory division, k ❑ Local BOH facility, ❑ Medical Provider address, ❑ State DPH town, etc. ❑ Other ILLNESS INFORMATION f/ Persons ill:a Symptoms: Imark if reported for anyone?: Diarrhea Vomiting Nausea Abdominal cramps Fever Bloody stool Headache Muscle aches Chills Loss of appetite Fatigue ❑ Dizziness ❑ Burning in mouth ❑ Other symptoms: .................................................................... ...............................v..............\/..... \V Onset: > : Earliest Date: / 15 / OYj Time: ❑AM Id PM v Latest (if > 2 ill) Date: / I j / Time: ❑AMPM ..................................................................................................................... .......... Duration: ❑ Less than 24 Hours ❑ 24-48 Hours I1 More than 48 Hours ❑ Ongoing ❑ Unknown 111 Persons: Age kName Address/Town Fs (yrs) Occupation Med. Provider/ ^n �� ❑same as reporter(above) V J 2; l� 3 4 Medical attention received (by anyone)? .1 Yes ❑ No ❑ Unknown — ff Yes, specify above: T Stool specimens submitted (by anyone)? .10 Yes ❑ No ❑ Unknown — To SLI '? ❑ Yes ❑ No ❑ Unknown Medical diagnosis reported? FOOD 14T�TORY — Obtain history back 72 hours prior to symptoms, or, if organism identified, b/n min and max incubation periods (see p.2) — If > 2 ill, follow above time frame for common meals (foods) only # Restaurant / store where Date F, z ❑ B / — �-cT777r (as left) ❑Home rryyLIspecilyl: 7l ' \-�'L>;'-S Vic_❑ D 1 State Laboratory Institute,305 South St.,Jamaica Plain,MA,02130 - (617)522-3700 Sept 1999 (99SeptFomixoc) 2 Always record Time if possible,othenvise,choose B=breakfast,L=lunch,D=dinner Discard Previous Versions 3 Total#persons(both ill and well)who consumed indicated food(s) n MDPH Foodborne FOOD HISTORY(continued) # Restaurant/ store where Date & Time' Exp a Food(s) consumed purchased (name, town) Place consumed 08 ❑Same(as left) ❑Home 11 L ❑ Other(specify): 0 D O 8 ❑Same(as left) ❑Home O L ❑ Other(specify): ❑ D 0.B ❑Same las left) ❑Home OL ❑ Other(specify): 0 O B ❑Same(as left) ❑Home 0 L ❑Other(specify): 0 D 6 ❑ Same las left) ❑Home 0 L ❑Other(specify!: 0 NOTES � I FOOD TESTING L Food(s) available for testing? ❑ Yes qp No ❑ Unknown -� Sent to SLI '? 11 Yes ❑ No El Unknown ff Yes, specify foods) & sources:/ Product and Manufacturer Information for Commercially-Processed Food(s) Product name: Code/lot # Expiration date: / / Package size/type: Manufacturer: Address: Incubation Periods for Selected Organisms Min Max Min Max Min Max B. cereus (short) 1 hr 6 his E. coli 0157:H7 3 days 8 days Staph. aureus 30 min 8 hr n B. cereus (long) 6 his 24 his Hepatitis A 15 days 50 days Shigella 12 hrs 96 hrs Campylobacter 1 day 10 days Salmonella (non-typhi) 6 his 72 hrs Vibrio cholerae few hrs-5days \i y Cyclospora 1 day 14 days Salmonella typhi 1 wk 3 wks Viral GI 12 his 48 his C. perfringens 6 his 24 his Shellfish poisoning minutes few hrs Yersinia 3 days 7 days 1 State Laboratory institute,305 South SI..Jamaica Plain,MA,02130 - (617)522-3700 Sept 1999 (99SeptFonn.doc) 2 Always record Time if possible:otherwise,choose 8=breakfast,L=lunch,Dinner Discard Previous versions 3 Total#persons(both ill and well)who consumed indicated food(s) IMPORTANT MESSAGE FOR M OF PHONE AREA COLE NUMBER EXTENSION A ❑ MOX 47,/ 7 BILE _ app`-'- 1 27D AREA CODE NU BER TIME TO CALL TELEPHONED PLEASE.CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOURCALLWILL FAX TO YOU MESSAGE (,..,��j���� u SIGNED FORM 009 MADE IN U.S.A. HP Fax Series 900 Fax History Report ort for Plain Paper Fax/Copier Joanne Scott-Salem BOH 978 745 0343 Aug O1:2005 9:01afu Last Fax Date Time T= Mentification. D r ` n_ Paces A,ug 1 9:01am Sent 916179836770 0:51 2 OK Result: OK - black and white fax , 4 i HACCP RISK ASSESSMENT FORM ESTABLISHMENT NAME-In a Pigs Eye FOOD ITEM: Wahoo Fish PERSON IN CHARGE: Jennifer Reardon `� j .401T ' U..3REDIENTS: Wahoo fish, pineapple salsa: cilantro, CONDUCTED BY: DATE: 06'/23/2005 tomatoes, onions and canned pineapple Janet Dionne { j r � V. IGHTNOLUME: J INTERVIEW AND ON SITE INSPECTION E] PREPARATION OBSERVED SAMPLES COLLECTED:No ¢?I C_:RTIFIED FOOD MANAGER: E N82/10/2005 D ,TE OF LAST ROUTINE INSP ON: }y PLEASE PRINT CLEARLY +"�'t ITEM PLAN OF CORRECTION Verified ILENTIFY EXPLAIN HOW SUSPECT FOOD WAS HANDLED AT EACH HAZARDS # A&" P;:EPARATION STEP. (Who,What,Where) No. -Contamination – Date1'-�' -Survival Include changes in procedures,embargos, disposals,food IMIS !EPSt D..ie IDENTIFY ANY UNSAFE FOOD HANDLING PRACTICESMR6� -Growth/Toxin worker restrictions,training, emergency suspensions and'IN CK` IDENTIFY closures, and regulatory samples collected. ,) T„ne ( Violation of 105 CMR 590.000) CCP . f Wahoo fish s was e were on 6 15 2005 and elivered on according to CFM was placed in walk–in fri ge 6/15/2005 upon delivery. There was no wahoo fish on h nd {I ` at time of inspection.The Welkin located in the basement had a temp. pf 32 degrees F. Fish ere EE stored in buckets ontop of ice inside walki . The fish _---' 39 degrees.F. All produce held in walkin. Fish is then moved upstairs to True refrigerator. This unit had a temp of 42 degrees F. at time of i spection. '• Fish are then cooked onggtill. Pineapple ss, sa is then added. Salsa is also held in trud f idge u it . the salsa is made up of cilantro, onions, c nn_ed neanu� t : oes. ary �� � a All produce is prepared downstairs in produce are ” Salad was also nerved with this dish and is preps, ed and held ing,C tC refrigerator whish is maintained at 40 degrees F. „ • i ; No Sanitary healdh code violations weresse n at time of inspe tion. 0. IER OBSERVATIONS/EMPLOYEE HEALTH/ACTIONS TAKEN: .� / '� '� ° —. Page No.40f ,' .�o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01 970 ggG��p' TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT Facsimile Transmittal To- r �� kjUM S Fax # �nf�03- 6 RE� (— Date : /, Page(s): including this cover# Message: p''W,L -Q 'C hOVJ 4 L//q1/ ,Ap Board of Health News ----------------------------------------------------------------For Your Information Office Hours: Effective September 12, 2003 Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON Do Salem Residents Know ? — The Board of Health meetings are held the second Tuesday of the Month. L f Memo- Send to File 06/23/05 In A Pigs Eye Based on a complaint received of possible food borne illness an inspection was conducted on June 23, 2005. The following were noted. Fish name "Wahoo"was delivered by Patriot Seafood, on 6/15/05. When fish is delivered it is placed in walk-in refrigerator in basement. Walk-in had temperature of 32 degrees F. Temperatures of fish be held at time of inspection indicated that the fish were being held and had a temperature of 39 degrees F. Fish are in wrap and are iced down daily. Fish are then moved upstairs to the True refrigerator on prep line. At the time of inspection, this refrigerator had a temperature of 42 degrees F. The fish is then placed on the grill and grilled. Once ready to serve pineapple salsa is placed on top. The pineapple salsa consists of cilantro, canned pineapple, tomatoes, and onions. All these ingredients are held in walk-in downstairs,which again had a temp of 32 degrees F and are then prepared at the produce station. The dish also came with a salad. All ingredients are held in walk-in. and prepared at produce station in basement. Along with carrots and green beans. No Violations were seen at time of inspection. JMD -T< .."Ka.'; � _ -__. r •. ;! ka- 'F W.<.. nµ.(�,y.vw..,.MM'o. N.ie.�A°'.: .M . . .. t, - . .� ' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4" Floor Division of ;pod and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name // Date T of 0 eration(s) Tvpe of Inspection l S % °S7�UGeQ/Lf �'/� -GS ©'Food Service ❑ Routine AddressJ Y Risk E] Retail Z] Re-inspection Telephone Level,/It E] Residential Kitchen Previous Inspection y� _ 3� Level,/ "✓ E] Mobile Date -/e, -6S- Owner HACCP Y/N ❑ Temporary ❑ Pre-operation /J Y - !( Y GAJ ❑ Caterer El Suspect ral El &Breakfast ❑ General Complaint Person in Charge(PIC) Time P InIIt) Out: Permit No. E] O herCP spector Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTIONS FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - ❑ 4. Food and Water from Approved Source TIME/1-.EMPERATURE 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 [118. 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 ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices -CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions �G immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 2 j Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 7. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:5Mnsp cffom6-14,dw Ins ecfr' Cr 'ature: Print_� I P nun 0 ,� PtC', Sig �iaturei Print: ,n r �d Page of ages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) r.r PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT R Gross-contamination 1 1 590.0030) 1 Assignrnent of Res ronsibilig-* 3-302.11(A)(1) Raw Animal Foods Sepanred from 590.003(B) Demonstration of Knowledge' Cooked and RTE Foods" 2-103.1.1 Person in charge--duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other' 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by focxl employees and 3-3021.1.(A) I Fcxxl Protection* a licants' 3-302.15 Washing,Fruits and Venetables 590.003(F) Responmbilhy Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(0) Pe of ting by Person in Char 3-306.14(A)(B) Returned Food and Resert:ice of Fail* 3 590.003(I)) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal i Exclusions and Restrictions Food 3-701..11 DiscardingoiReconditioningUnsafe, FOOD FROM APPROVED SOURCEFood:, 4 Food and Water From Regulated Sources 9 Faod Contact Surfaces 590.004(rl B) Cont lip mcg with Food law's 4-507.I11Manual bVareuashing-Hot Water 3-20L12 Food in a Hermetically Seated Container* 'uanitization-lem�erutnre-L 3-201.1.3 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell E--S* Sanitization Temperatures'" 3-202.14 Eggs and Milk Products.Pasteurized, 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Matte From Potable Drinking Water" concentration and hardness. 5-].01.11 Drinking,Water from an A nvvad SvAern* 4-001.1It,A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinkin Water* 402.11 Cleaning Frequency of Equipment Food- 590.006(B) Witter Meets Standards in 310 CMR 22.0" Contact Surfaces and Utensils* Shel ish and Fish From an Approved Source 4-702.11 Frequency of San tization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of 13c ui ment* Shellfish* 4-703.11. Methods of Saaitizatlon-HotWaterand 3-201.15 Molluscan Shellfish from NSSP listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by �, Re ulato Authorit 2-301.11 Clean Condition--Hands and Aims 3-202.18 Shetlstock Identification Present* 2-301.12 Cleanimr Procedure"' 590.004(C) Wild Mushrooms* 2-301.14 When to Wash'' 3-201.17 (lame Animals* Lit- Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eatin ,Drmking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes.Nose and 3-202.15 Package Ihtevxlt s Mouth* 3-101.11 Food Sate and Iinadulterated 3-301.12 Preventing Contamination When TitA n>* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202-.13 Shelletock identification* 590.004(E) Preventing Contamination from 3-203.12 Shelklock Identification Maintained* Em In gees* Tags/Records: Fish Products 13 Handwash Facilities Conveniently Located and Accessible. 3-402.11 --ParasiteDestruction* 3-4-02.12 Recorda.Cremation and Retention" 5.20",11 Numbers and Ca acities* 3-402.1(7) Labeling of Ingredients` 5-204.11 Location and Placement" 9 mance with Approved Procedures 5-205.11 Accessihility, Operation and Maintenance ConformIHACCP ance Devices Supplied with Soap and Hand Drying 3-502.11 S eciced oxygen alized Process Methods*aoka�in^,criteria" 6-301.11 Handwashing,Cleanser,Availabilit 3-502]2 Redu 5-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dryin r Provision "Denotes critical item in the federal 1999 Food Codc or 105 CMR 590-000. CITY OF SALEM BOARD OF HEALTH Establishment Name: r �I 01 Date: a'/ "BS` Page:. of �— Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY t Y D ''))-- - 5;7) cY A 4 I S l n i <P d S o f rl - All pneho / i v s Discussion With Person in Charge: Corrective Action Required: ❑ No LlYes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines cf twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your fobd permit. 0 Voluntary Disposal ❑ Other: 3-501-14(C) PHFs Received at'1'emlre�+.,n'ires Violations Related to Foodborne Illness Interventions and Risk According to l.aw Cooled to Factors(items 1.22) (Cont.) 4l'F/45`F Within 4 Hours, PROTECTION FROM CHEMICALS 3-501.15 Coolim7 Methods for PHFs 14 �.. Food or Color Additives ]9 PHF Hot and Cold Holding 3-202.12 Addiuves* 3-501,16(B) Cold PIIFs Maintained at or below --._..-. 590.004(F) 41°/45'F* 3-302.14 Protection oisonou from txic Substances Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 4WEA 7-1{)1.11 Identifying Information-Original 3-501.16(1 Roasts Held at or above 130°F. Containers' 7-102-11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11Se araiion-Stw�a e" 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use's 590.004(H) Variance Requirement 7-202.,12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criterin-Chemicals* POPULATIONS(HSP) 7-2,04-12 Chemicals for Washita Produce,Criteria" 21 3-80117(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dtying r eats.Criteria* Beverages with Warning Izbels* 7.205.11 Incidental Food Contact, Lubricants* 3-801-11(B) Use of Pasteurized Eggs* 7-206.11. Restricted Use Pesticides. Craerin* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. s 7-206.12 Rodent Bait Stations' ;-801.11(C:) Una rend Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603-11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate _ 3-401.111(1)(2) Eggs- 155°F 15 Sec. Patho ens ="Je ,moor Eves Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Figs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats F Gyne Eggs* Animals- 155'F 15 sec. * 3-401.11(B)(1)(2) Pork.and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(1)(2) Ratites,Injected Meats- 155'F 15 590109(1)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.1.7(A)(3) Poultry,Wild Game,Smiled PHFs, residentialkitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-165°F 15 s� above if related to foodborne illness 3-401A 1(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited under #29- Microwave 165"F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs--145'F 15 see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(ll) PHFs 165°F 15 sec. ` (Items 23-30) 3-403.11(B) Microwave- 165° F 2 Minute Standing Critical and non-critical viokrtions, which do not relate to the Time" .foodborne,illness interventions and riskfaciors listed above, can be 3-403.11(C) Commercially Prricessed RTE Food- .tound in the following sections of the Food Code and 105 CMR 14WF' 590.000. 3-403.t1(E) Remaining UnslicedPortions ofBeef Item Good Retail Practices FC 590000 Roasts* 23. Mona ement and Personnel __ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _ +_ FC-3 .004 25 ___ Equipment and Utensils FC 4 .005_ 3-501..14(A) Cooline Cooked PHFs from 140°F to 26 Water,Plumbing and W este FG 5 .006 7WF Within 2 Hours and From 70'F 27. Ph sinal Fac16t __ FC-6 4 007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(6) Cooling;PHFs Made From Ambient 29._ eoiai Re uiremen s S 009 Temperature Ingredients to 41OF/45'F 30 _ Other _ L Within 4 Hours�s ss�oro,„ex�e.z.a, 'Denotes mucin item hr dV I,Ideral 1999 Food Code or 105 CMR 590.0oo. Massachusetts Department of Public Health Salem Board of Health �, c 120 Washington Street, 4M Floor Division.�r Food and Drugs ( n Salem, MA 01970-3523 F066 ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ' c ' Date Tvoe of Operation(s) Type of Inspection 40 * 't7 ,® Food Service 0 Routine Address /Lj ) Risk ❑ Retail ❑ Re-inspection Telephone qLevel ElResidential Kitchen Previous Inspection ❑ Mobile Date: HACCP Y/N ❑ Temporary ElPre-operationOwner n �p v [I Caterer El Suspect Illness Person in Charge tiltTime ❑ Bed&Breakfast ❑ General Complaint 0 n♦M tf. J In: ❑ HACCP Inspector I I Out: Permit No. ❑Other Each viola Ion checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded [114.Approved Food or Color Additives FOOD FROM APPROVED SOURCE - m - [:115.Toxic Chemicals ❑ 4. Food and Water from Approved Source ', TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures M __ ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION' " ' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control QJ9. Food Contact Surfaces Cleaning and Sanitizing r�1 REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) l El 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY. ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 5G immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): J 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�eaNh. 590.000/federal Food Code. This report, when signed below r 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations .25. Equipment and Utensils (FC-4)(990.005) cited in this report may result in suspension or revocation of �3 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 7. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:ssomspe Woom -14.tloc Insp to ti i gn u'e: Print: / PIC' igna[ure: Print Pv PageL of?pages UC t, Violations Related to Foodborne Illness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination _ I 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Rim Animal Foals Separmed from 590A03(B)_ Demonstration of Knowledge* Cooked and I2T1 1 a>ds, 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) ResPonsibi lity of the person in charge to Contamination tram the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 1 Washing Fruits mud Vc..etables 590.003(F) Responsibility Of A Food Employee OrAll 3-304,11 Foal Contact with Equipment and Applicant To Repots To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Chare" 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(17) 1 Exclusionsand Restrictions* Disposition of Adulterated or Contaminated 590.003(11) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com lumce with Food Law- 4-501.111 Manual Warewashing-Hot Water 3-201.12 Fond in a Hcnneticall Sealed Contaiuer Sanitization Temperatures* 3-209.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 ShullE­Is* Sanitization Temperatures* 3-202.1.4 Y sand Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. * 3-20216 Ice Made From Potable Drinking,Waters 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an A roved System" Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.13 Cleaning Frequenev of Equipment Foal- 590.006(B) Water Meets Standards in 310 CMR 22.0" Contact Surfaces and Utensils' Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils trod 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 2301.11 Clem Condition-Hands and Alms* Re u(ato Authorit 3-202.18 Shellstock Identification Present* 2-30112 Cleauim,Procedure* 590.004(0) Wild Mushrooms` 2-301.14 Willett to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 _,,.. Eating, Drinkingoi Using Tobacco* 3-202.11. PFIR Received at Proper Temperatures" 2401.12 Discharges From the Eyes hose and 3-20215 Package lntegrit°* Mouth* 3-101.1.1 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin>" 6 TagslRecords:Shelistock 12Etl Prevention of Contamination from Hands 3-202-18 Shel,lstock Identification* Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to gees* Tags/Records:Fish Products 13Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessibie 3-402.12 Records.Creation and Retention* Numbers and Ca.acities* 590.0040) Labeling of Ingredients' . Location and Placemenf' ry Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance (HACCP Plans Supplied with Soap and Hand Drying 3-502.11S ecialized Processin Methods* Devices 3-502.12 Rcrluced oxy cn mekaRin ,criteria* fi-301.11 ffandwashing Cleanser.Avaihrbilit 4-103.12 Contixmance with A roved Procedures` 6-301.12 Hutd Drvin Provision Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000. CITY OF SALEM i BOARD OF HEALTH Establishment Name: /f !�, S Cc 2e5 Date: r "�Q �QS Page: of 1 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified .PLEASE PRINT CLEARLY, L�SD�cfiG v� f e ;o/ �w/i�G '4 N I C, CLL J D L D - rP ' -;1 /1)(i 1 A !1 ed . `SQ zi 5610b/r ) �U ✓ aS- c fi sr11 i� ' f 124 41nv, 0a' /ns cfJon . S'c kL-1L . h r �l owr,��n�' astl�- C C S s L r strv{zrce, a� �PolCl<` _ "a 'stet ' 4 a G� n ar l� d d -rP ur 6)2 f�rcvmul(rh1j-n 61 r 4 =` s J01 0 6Y) 66 l( -&b L'e / cel :t Wo l f 1 S / OvtP. a S N - la/;GZf 1 izr a./°r/J r l tf7l 7n U� dYl �i7 �i P - /vl0 �u h /.l�S1 c►z 1e.0 e_ y / / s h ' r l 1� o1a-17&-n m lel, s' Discussion With Person in Char e: CorrectiveAction Required: . L3 No ❑° Yes g D PU lCvi bClS 1 I have read this report, have had the opportunity to ask questions and agra to correct all ❑ voluntary Compliance ❑ Employee Restriction/ � Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension ° comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of t. enty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure F your food permit. ❑ Voluntary Disposal ❑ Other: / r , t U � s 3-501.14(0:) PHFs Received at Temperatures Violations Related to Foodborne Inness Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41'.F/45'F Within 4 Hours. * PROTECTION FROM CHEMICALS 3-501.15 Coolim,Methods for PHFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-50 t.16(b) Cold PHFs Maintained at or below 3-202.12 Additives" 590.004(F) 41"/45'F° 3-302.14 Protection front IIna i roved Additives* 3.501 16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances - tot F 7-101.11 Identifying Information-Original 3-501.1.6(,) Roasts Held at or above 130'F. Containers* 20 Time as a Public Health Control 7-102.11 Common Narne-Workinn Containers* 7-201.11 Se *ration-Stmxge,,, 3-X01.1) Time as a Public Health Control* 7-202.11 Restriction-Presence and User 19O.004(H) Variance Re uirennent 7-202.12 Conditions of else* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 1-303.11 `toxic Cmnainers-i'rohibitians* 7-204.11. Samtizers,Criteria-Chemicals* POPULATIONS(HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-?(A1.C2 Chemicals for Washing Produce,Criteria" Beverages with Warning*Labels'" Div 7-20ll Incidental 7-204.14 maid eats,Criteria* 3-801,11(B) Use of Pasteurized&wsM ental Food Contact,Lubricants* 3-801A 1(D) Raw or Partially Cooked Animal Food and 7-2066..1 1 Restricted Use Pesticides.Criteria* Raw Seed S urians Not Served. 7-20C>.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 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Faxes"1'hat are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1 I A(1)(2) Egg- 155-F 15 Sec. Pathogens "ecov "' F cs-Im�vice 145°P15see* -1-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Figs* Animals- 155'F 15 sec. 3-401.11(B){7)(2) Pork and Beef Roast-130'F 121 mints SPECIAL REQUIREMENTS _ 3-401.11(,)(2) Ratites,Injected Meats 155`F 15 590.009(,)-(D) Violations of Section 590.009(A)-(D)in see. x catering, mobile food, temporary and 3-401_1.1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under die appropriate sections Poultry or Ratites-16VF 15 secabove if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions mid tisk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 7129-- Microwave 165'F-* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-'145'F15sec * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(,)&(D) PHFs 165`F 15 sec.* (items 23-30) 3403.11(B) Microwave-165'F2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness internentions and risk factors listed above,can be _3-403.11(C) Commercial ly Processed RTE Food- hound in rhe followbtg sections of the Food Code and 105 CMR 140'F` -590.000. 3-403.11(Ii) Remaining Unshced Portions of Beef Item Good Retail Practces FC 590.000 Roasts': 23. ManaQsment and PersonnelFC-2 .003 is Proper Cooling of PRFs 24. Food and Food Protection____FC-3 .004 25. Equipment and Utensils FC 4 .005 3-501.14(,) Cooling Cooked PHFs from 140'F to ---- - -- ------- 26. Water,Plumbing_and Waste FC 5 1 .006 _ 70'F Within 2 Flours and From 70'F 2/. Physkcai Facility __ FC-6 007 to 41'F/45eF Within 4 Hours. ` 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Codin,PbIFs Made From Ambient 29. S ecial Re uirements 009 - - TemperatureIngredients to4l°F/45'F _30,, _ Other Within 4 Hours" ^'Denotes glucal item w 1110 fedexat 1999 Food Code or 105 CMR 590.000- r CITY OF SALEM BOARD OF HEALTH Establishment Name:-T] t KJ- Date: I U 'lI Page: of _- Hem Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified r .. PLEASE PRINT CLEARLY !lU 1/r 6h1 S 2f/L-A-0d o °f L11i rfi -�` ✓ _ - ;vo s-� � ii . (� -t�, � l � 1,�-fi '�r; cry � - � �r�l� rf Y, v�2� dS rn r �,fA v Ti . � U 1 u�ly� Ln 1�v ha-N _ 4 n i u I n 16 ke 01( . L / c n /7 ✓ ice/ / �n / �Y .eh Ik/nanlh G h PCCJ Y �1 f Discussion With Person in Charge: Corrective Action Required: Ll No 4 Yes 4 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion 6 violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of o Embargo ❑ Emergency Closure your food permit. 7C1 �J Voluntary Disposal 0 Other: U '-501-Ld(C) PHFs Received aY'I'empera ures Violations Related to Foodborne Illness Interventions and Risk According to I art Cooled to Factors(items 1.22) (Cont.) 41'F/45°F W(tljin 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 13 Food or Color Additives 19 PHF Hat and Cold Holding 3-202.12 Addunc�^ 3-501.16(B) Cold PflF,Maintained at or below 590-004(F) 41�14PF- 3-302,I4 Protection from UnaiLrroveed Additives* 3-501.16(A) Hot PHFs Maintained at or above ].5 Poisonous or Toxic Substances 4017. * 7-101.11 IdentiTying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora e" 3x01.19 Time as a Public Health Control` 7-202.11 Restriction-Presence and tlse* 590.004(13) V:'iriaoce Re uirennent 7-202.12 Conditions of Use' 7-20"3.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-207.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204-12 Chemicals for Washin¢Produce.Criteria* 27 3-80t.'11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Bever ages with Warning Labels* Davin Agents,Criteria* -- 7-205.11 Incidental Food Contact.Lubricants* 3-$01.1 i(B) fisc of Pasteurized Eq s* 7-206.11 Restricted Use Pesticides-Criteria* 3-80L l I(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Set ved. 7-206.12 Rodent Bait Stations* 3_g01.11(C) Unopened Farad Pru:ka�e Not Re-server!. 7-206.13 'Cracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 7.55 F 1.5 Sec. Pathogens.*Erreon�a trozcei Ii >s-'hnmediate Serr�cc 145°F 15sec* 3-302.13 Pasteurised Eggs Substitute for&3w Shell 3-401.11(A)(2) Comminuted Fish, Mears &Game Eggs, Animals- 155'F 15 sec. * 3-401.11(13)(1)(2) Park 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 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under die appropriate sections Pooltr or Ratites-165'1'IS sea ^' above if related to foodborne illness 3-40.1.1.l(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'7* 590.009 violations relating to good retail 3-401 12 Raw Animal Fonds 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 VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(DF PHF, ,165°F15sec. '` (items23-30) 3-403.1l(B) Microwave-165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk fnciors listed shore. can be 3-40-3 11(C) Commercially Processed RTE Food- found in the fallowing sections of the Food Code and 105 CMR 140`F* 590.000- 3-403-1.1(E) Remaining Unslieed Portions of Reef Item Good Retail Practices FC 590.000 Roosts* 23. Mena emeni and Personnel FC--2 A03 I8 Proper Cooling of PHFs 24. _ Food and Food Protectio_n_. _FC-3 .004 25 _Equipment and Utensils FC 4 .005 3-50'114(A) Coolie Cooked PHFs from 140'9 to 26 Water,Plumbing and Waste FC 5 1 .006 70'7 Within 2 Hours and From 70'F 27. Ph sical Facility _ FC-6 j .007 to 41.'F/45'F Within 4 Homs. * 28. Poisonous or Toxic Materials FC-7 1 .008 3-501,14(B) Cooling PHFs Made From Ambient 29_ S eoial R uirements _ .009 Temperature Ingredients to 41°F/45'F 30.------DAher Within 4 Hours* r,'Wo�1,66 2d,� Denotes critical item in the Federal 1999 Fiord Code or 105 CNIR 590.004 c CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH - 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: In a Pigs Eye Restaurant Address of Establishment: 148 Derby Street Owner's Name: Jennifer Reardon Restrictions: Application Date: 12/8/2004 Permit for Food Establishment 217-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. EA LTH AGENT 1 CITY OF SALEM, MASSACHUSEjk�<V' BOARD OF HEALTH Y 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 CC f1 TEL. 978-741-1800 FAX 978-745-0343 C/?-), 62004 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO e0gQFS MAYOR HEALTH AGENT C0 '11 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTAEILISHM&N , 4 y NAME OF ESTABLISHMENT�v A 1'11is `s f5r�t;Q�' TEL# ADDRESS OF ESTABLISHMENT �'4 TI I MAILING ADDRESS (if different) OWNER'S NAME2 (j1/h l /L/� ly1 TEL# ADDRESS J,�Liu S I 6AI CITY n STATE MIA zip CERTIFIED FOO ANAGER'S NAME(S), IOta�Mli L119t.1. CF,RTIFICATE#(s)) �•n/�II�51L (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL HOURS OF OPERATION: Mon. �Tue�WedW Thu.)<L_Fr�4- Sam! Sun. I <3o - I20C) CL41 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT NO less than 25 seats =$100 Y - 25-99 seats >_9L1591 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES ZN_ $5 TOBACCO VENDOR YES $50 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 b t knowledge and belief, have filed all stat tax ret ms and paid all state taxes required under the law. �a � C) �/ 5�1 �)y � l Signature �e Social Security or Fe eral Identifica ion umber --------- -------- - ------ -- -- --- ---- -- Revised 11/03/03 FOODAP2.adm Check#&Date 4 miD r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA o 1970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT t COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: In a Pigs Eye Restaurant Address of Establishment: 148 Derby Street Owner's Name: Jennifer Reardon Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 159-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. xzl.. HEALTH AGENT I • 'O 1' r;� it 111\6,/P CITY OF SALEM MASSACHUSE � ' "Via ' BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR ' DEC 4 -2003 SALEM, MA 01 970 TEL. 978-741-1800 CITY OF SALEM FAX 978-745-0343 STANLEY USOVICZ, JR. BOARD OF HEALTH JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTS/I PICS rT(a� �STEL# L ��k ADDRESS OF ESTABLISHMENT (Yo ��/bLl tIl/iV��l MAILING ADDRESS (if different) OWNER'S NAME 1 -044 J/ Cy e'-�Y-zl/l_ TEL# PJ B ADDRESS St>lO�� cS7 CITY STATE LI , ZIP_ CERTIFIED FOOD MANAGER'S NAME(S CERTIFICATE#(s) ) C�oinp (required in an establishment where pote itiallyfhazzardous food is prepared.) .# EMERGENCY RESPONSE PERSON 1�L�G4 �P� HOME TEL# HOURS OF OPERATION: Mon.--k—Tue.,;,4 WedX Thu. >d Fri. .1 Sat.>(j_Sun. L TYPE OF ESTABLISHMYES NOENT A'4-4 the- RETAIL STORE less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 ' 9(j.B more than 10,000sq.ft. =$250 RESTAURANT YE NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES (3N $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES N $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signa �� Date1 . Social Security or Fed rah Identification Number -------------------------------------------------------- Revised 11/03/03 OODAP2.adm Check#&Date 6 — 02�ro� I Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4" Floor Divisidri of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat T e of O orations Type of Inspection (J � 8 1 pod Service ❑ R tine Address Risk F-1Retail We-inspection Telephone Level ►�/► ❑ Residential Kitchen Previous I spection _ /r + ❑ Mobile Date:�/a/ov Owner HACCP Y/N El Temporary ❑ Pre- pera ion ❑ Caterer ❑ Suspect Illness Person in harge(PIC) h Time El Bed& Breakfast ED General Complaint inspector In: El HACCP P Out: Permit No. ❑ Other Each viola Ion checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - """" ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El-- "" - --- 13. Handwash Facilities EMPLOYEE HEALTH .. '- PROTECTION FROM CHEMICALS -� El2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded - El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source - `TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures E] 6. Tags/Records/Accuracy of Ingredient Statements E] 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control V. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' ❑ ❑ 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 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): e 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 ofd earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) 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 590MVp tFom 14.do � � E I sp ct 1js i n e: Prink i P rgn u e: Print: 'P94-of ages e Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Crosscantamination 1 5 :11 i ) A�simunent ofRcs o ib.lin* � 3-30111(A)(1) Raw Animal Foots Separated from 590.003($) Demoaso ition of Knowledge* Cooked and RTE Foods* 2 103.11. Person in chac�-duke, ��l Contamination from Raw Ingredients 3-302.1I(A)(2) Raw Annual:Pools Separated from Each EMPLOYEE HEALTH _ Other* 2 590.0(13(0 Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and3-30111(A) F'uoct Protection" applicants* 3-302.15 Washin^Fruits and Ve•*enables 590.003(F) Responsibility Of A Fool Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Repot[To The Person In UtensiA* Cher?e* Contamination from the Consumer 590.003(0) Reporting by person in Charve" 3-306.14(A)(B) Returned Food and Rcservice of Food* 3 590.003(D) Exclusions and Resuictions' Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701,11 Discarding tx Reconditioning Unsafe FOO_D FROM APPROVED SOURCE -Food" 4 ' Food and Nater From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) C'nnpliance with F xx L zev4-501 111 Manual Wa ewashing-Hut Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures, 3-201.13 Fluid Milkand Milk Products" 4-501.112 Mechanical WarewasYting-Hot Water 3-202.13 Shell Eoos's Saonizahon Tem eratures* _ 3-20114 lies and Nlilk Pnidnets.Pasteurized'" 4-501.1 i4 Chemical Saruhzation-temp., pH, 3-202.16 Ice Made Front Potable Drinkrn,Water* concentration and hardness. 'K Drinkin Water fr(nn an A .roved S•stem* 1 4-601.11(A) Equipment Food Contact Surfaces and 5-1D1.11 590.000(A) Bottled Drinking14ater Utensils Clem 590.00603) Water Meets Standards in 3 LO CMR 22.0"' 4 602.1 t Cleaning Frequency of Equipment Food- §h and Fish From an Approved Source Contact Surfaces and Utensils* 4-7102,11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreatianaily Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 _ Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical" Sources* 10 Proper,Adequate Handwashing ComeRegulatory Author Rul and Wild Mushrooms Approved by ty 2-301.11. Clean Condition-Hands and Arrns* 3-202.18 Shcllsfock Identificthon Presci*1 2-30112 Clean3n"Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals," 11 Good Hygienic Practices 5 Receiving/Condition 2-401.1'1 Eating,Drinkin�or Usin Tobacco* 3-202.11. PHFs Received at Pro er Tem eratures* 2-10,1.12 Discharges From the Eyes, Nose and 3-202.15 Packa,Qe Ltte it * Month'" 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastinn* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.1 S Shellstoek Identification* 590.D04(E) Preventing Contamination from 3-203.12 Shelhrock Identification Maintained" Ern lovees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 ParasiteDestntctian* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca aammit* 590.004(7) Labeling of Ingredients' 5-204.11 Location and Pla ement* Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized processing Mehaods* Devices 3-502.12 Re�n aacka dng, criteria* 6-301.11 Handwashin Cleanser, Availability 8-103.12 CUITFAU ante with A a roved Procedures* 6-301.1.2 Nand Dr in,Provision 'Dentes critical item in the federal 1999 Food Code or 105 CYIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: I Date: Page: of _ Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified EASE PRINT CLEARLY - s rQ le-1 mnob-0 a s/ P (ir CGCG vfz - rue r_ c sem`, k Ilah Z /191 19 P l ar 8•� .Q �� �h arse / " �iC.e f o U / C - z i ft 2 c �P / Ji If n jrL Gh / O Orf O Discussion With Person in Charge: CorrectiO 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 ❑ Re-inspection Scheduled LlEmergency Suspension comply with all mandates of the Mass/Federal Food Code:-I understand that noncompliance may result in daily fin es_of_tw my-five dollars or pension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. "'--=-- .� ❑ Voluntary Disposal ❑ Other. -a`.. 3-501 I4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk - According to law Cooled to Factors(Items 1-22) (Cont.) 41'Ft451 F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Nat and Cold Holding 3-202.12 Additives' 3-501.16(B) Cold Flips Maintained at or below 590.004(F") 41`{45°F* 3-302.14 Protection froze Una r roved Additives'" 3-501,16(A) Hot'PHFs Maintained at or above 15 Poisonous or Toxic Substances 40°F. * 7-101.11 Identifying Information-Ori nal 3-501.16(A) Roasts Held at or above 130°F. Containers'" 7-1.02,t t Common:Name-Workins Containers* 20 Time as a Public Health Control 7-201.I I Separation-Storage* 3-501.19 Time as a Public Health Control* 7-20111 Restriction-Presence and Use* 590.004(1-1) Variance Re uirement 7-202.12 Conditions of Use`" 7-203.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1 t Saritizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 ChenticaN,for Washin Pmdncc.-Criterias` 21 3-80'1.'11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying,Agents,Criteria* Beverages with Warning Iabels* 7-205.11 Incidental Food Contaet.Lubricants* 3-801.11(B) Use of Pasteurized was* 7-206.11 Restricted Esc 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(0) Unopened Faxl Package Not Re-served It7-206.13 'Cracking Powders,Pest Control and Monitodnc* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisors Posted for Consumption of Animal Foods That are Raw, Undcrcooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed in Eliminate 3-401.11A(1)(2) Eggs- 155'F 15 Seo. Pathogens.`6'"20" Eggs-Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell )(2 ( 3-401.11 A- ) Comminuted Fish, ,&'Meats Game Eggs* Animals- 155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast- 130`F 121 min* SPECIAL REQUIREMENTS 3-401.1 l(A)(2) Ratites, Injected Meats- 155'F 15 590A09(A)-(D) Violations of Section 590.009(A)-(D)in see,* catering, mobile fond, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PFIF•s, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Moult 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 3-401.1.2 Raw Animal Foods Cooked in a practices should be debited under fl29- Micmwave 165`-F* Special Requirements. 3-40 Ll I(A)(1)(b) All Other PHFs-145°F'15 sec. 1? Reheating for Hot Holding -VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.,A)&(D) PHFs 165°F 15 sec. * (Steins 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 into ventions and risk fo(iors listed above, can be 3-403.11(C) Commercially Processed I2TE Foal- found in rhe following sections of the Food Code and 105 CAIR 140°F* 590.0100. 3-403.11(Bal ) Remnimg Unsliced Portions of Beef Item Good Retail Practices FC 580.000 Roasts°` ____ 3. Mona ement and PersonnelFC-2 .003.....- lA Proper Cooling of PHFs 24. Food and Food Protection FC-3_ .004 25. E ui ment and Utensils FC-4 .005 3-50114(A) Cooling Cooked PIiFs from 140"F to -- --- ---- - 26 Water_Plum and Waste FC 5 .006 70`F Within 2 flours and From 7U`F 27. Ph sical Facill _ FC-6 .007 to 41.'F/45'F Within 4 Hours. `• 28. Poisonous or Toxin Materials FC-7 .008 3-501.14(B) Cooling PHFs Made Front Ambient 29. Special Requirements .009 'temperature Ingredients to 41`F45`T .30. Other Within 4 Hours* vsvor..,.n.,at-z.�� Denotes critical item in the[ccaA l 1999 Food Code or 105 CMR 590,000. -r Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name L Date T of O eration s Type of Inspection S U T - p Food Service L&_? outl Address Risk ❑ Retail ❑ Re-inspection Level ElResidential Kitchen Previous Inspectio El Mobile Date:07-/0-04 Telephone Owner HACCP Y/N ❑ Temporary ElPre-operation / ❑ Caterer ❑ Suspect Illness Person m Charge(PIC) Time ElBed& Breakfast ElGeneral Complaint ti O In: [_1 HACCP Inspector Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated- Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH Mf. PROTECTION.FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE -,k ❑ 15.Toxic Chemicals= - A ,, *TIME/TEMPERATURE CONTROLS Potential) Hazardous Foods ❑ 4. Food and Water from Approved Source (Potentially ) ❑ 5. Receiving/Condition . ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements i ❑,•17. Reheating El7. Conformance with Approved Procedures/HACCP Plans ( '❑,,..,/T8.-Cooling Irl PROTECTION FROM CONTAMINATION `!!! �, 19. Hot and Cold Holding/U\ 1--_ ,. -_ Le /y 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control [ 9. Food Contact Surfaces Cleaning and Sanitizing �a� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP �10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices a CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Q immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): / G of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an I 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address FTI29. Special Requirements (590.009) within 10 days of receipt of this ord r. 30. Other DATE OF RE-INSPECTION//Gp p S,5MnsctFo m 14AM / / sopsylvaAnT _ Print: PIC 1 rgnature: 11, PrintN�l i�C/Z- N( O��R��A /' Page ' of Pages i Violations Related to Foodborne Illness r -y Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT $ Cross-contamination 1 I 59UO3(A) I Assignment of Res on�ibility* 3-302.1 (A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knov led O', C(x)ked and RTE Foods* 2-103.1] Person in charge--duties ( Contamination from Raw Ingredients 3-362.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(0 Responsibility of the person in charge to Contamination from the Environmoof require reporting by food employees and 3-302.,11(A) Foal Protection"` a plicams* 3-302.1.5 Washin=Fruits and Vegetables 590.003(F) Responsibility 01'A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Urensils* Charge'" _ Contamination from the Consumer 590.003(6) Re ortin by Person in Charge` 3-306.14(A)(B) Returned Food and Rcseivice of Food' 3 590.003(D) Exclusions andRcsvictions* Disposition of Adulterated or Contaminated 590.003(1) Removal of Exclusions and Restrictions Food 3-70I.I1 Discarding or Reconditionme Unsafe FOOD FROM APPROVED SOURCE Fund* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501..1.11. Manual Warewashine--Hot Water 3-201.12 Focal in a Hermetically Scaled Container* Sautitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-Hot Water 3-202.13 Shelf Eggs` _ Sanitization Tem eraturcO 3-202.14 F<>,s and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness-;' 4-601.1 I Equipment Food Contact Surfaces and 5-1D1-11 Drinking Water14om en Ar roved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency ot'EquipmentFood- 590.006(B) Water Meats Standards 3n 310 CMR 22.0* Contact Surfaces and Utensils', Shellfish and Fish From an Approved Source 4-702.11. Frequency of Sanitization of Uteusils and 3-201.14 Fish and Recreadonally Caught Molluscan Foal Contact Surfaces of E ui ment* Shellfish* 4-703.11 Methrxh of Sanitization-FIot Water and 3-20L15 Molluscan Shellfish from NSSP Listed. Chemical* Sources* 1g Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2_301.11 Clean Condition-Handsand Arms* Recufafo Autharit 3-20118 Shellsta:k Identification Present* 2-30L12 Cleaning Procedure* 590.004(0 'Tld Mushrooms* 2-301.14 When to Wash* 3-201.17 GarneAnimals* it Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacut* 3-202.11 PEIFs Received at Pro er Tem eratrues'6 2-401.12 Discharges From the Eyes, Nose and 3-20215 Package Integrity- -_ Mouth* - _-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tastin>* 6 Tags7Records:Shelistock 12 Prevention of Contamination from Hands 3-202.1'3 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification Maintained* Ein�k>vaas* TagsJRecords:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3-402.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients" 5-204.11 ,taxation and Placement* 7 Conformance with Approved Procedures Accessibilit-,O aeration snd Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing�Melfi(xls* Devices 3-502.12 Reduced oxygen packaging,criteria"' 6-301.11 73�andwashin Cleanses,Availabilit 5-103.12 Conformance with Approved Procedures* 6-3t11.12 Hand Drvin,,Provision *Dcuoles critic l Item in the federal 1999 Food Cale or 101 C k4R 590.006. CITY--OF SALEM a, BOARb OF HEALTH Establi h enfName:3/7 19— 101aS e )eeS7�rU Date: AA0 Page: of s Item code c-critical Item DESCRIPTION OF VIOLATION/PLA OF CORRECTION Date No. Reference R-Red ItemVerified. -.- - PLEASE PRINT CLEARLY , -P/rT/9 xzwew moi, 4 X1'C if Ike F ZZ P IPvS7 8e (fo%°a q/ air 6910. /1lG T Aef c�5 — vlve r°"f 42l-Elci4Ca l C Y 7- C' a CP 410 AA&M70V )U at v� era r� ,e, s S ° e a t v a Z-4k� A1/411z/ o.c� S v 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 ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that no may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. i ❑ Voluntary Disposal 0 Other: T-, 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk - According to Law Cooled to Factors(Items 1-22) (Cont.) 4i'F145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501,15 Cnotin*RSethodsforPHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3 202.12 Additives* 3-501.16(B) Cold PIIFs Main Tuned at or below 1-302.14 Protection from Unapproved Additives* 590.004(F) 41°/45°Ft' Poisonous or Toxic Substances 3-501..16(A) Hot PHFs Maintained at or above l5 140°f+. 7-101.11 Identifyinglnforuurtion-Oziginal 3-501.16(A) Roasts Held at or above 130°F- ' Containers* 7-102.11 Common Name-Working Containersm' 20 Time as a Public Health Control 7-201.11 Separation-Storage" 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of(T 7-203,11 'FoxicContainer.,-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Samttzers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washin�Produce,Criteria' 27. 3-M1.11(A) Unpasteurized Pre-packaged.Juices and 7-204.1$ Dty3nn Agents.Criteria* Beverages with W aurin*Labels* 3-801.11(B) Use of Pasteurized Eg-ls* 7-205.11 Incidental Food Contact.Lubricants` 3-801.1.1 D' w I Ra or Partially Cooked Animal Foal and Restricted Use Pesticides 'riteria* ( � y 0 i IX C Raw Seed Sprouts Not Served. * Rodent Bait Stations Tracking Powders,Pest Control and 3-801,1 ..1(0) Unoened Food Packa>e Not Re-served- 7-20fi.13 * Monitorine* I CONSUMER ADVISORY _ TIME/TEMPERATURE 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 P =n 5'1/1""' 3-401.11 A(1)(2) Eggs- I55°F 15 Sec. Padua<..ns " ` I �s-immedi ate Service 145'Fl ssec' 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals- 155°F 15 sec, "' SPECIAL REQUIREMENTS 3-401A I(B)(1)(2) Pott,and Beer Roast- 130'F 121.min* 3-401..11(A)(2) Ratites,Injected Meats- 155 F 15 590.009(A)-(I)) Violations of Section 590.009(A)-(D)in SCe * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Urine,Stuffed PHFs, residential kitchen operations should be .,,,o.�w tsderthe ,r-„rY,e.a4 aw,..,:m Sturnng Containing Ftsh,Meat, e' ,-- Poultry or Ratites-165'F 15 sec. * above if related to foodborne.ilhtess 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F It 590.009 violations relating to good retail 3-401.12 Raw Anhnal Fis Crooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs--145°F15see. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PIIFs 165'F 15 sea * (Items 23-30) 3-403.1.1(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk,factors listed above, can be 3-403.11(C:) Commercially Processed RTE Food- ,found in the following se(ticros of the Food Code and 105 CMR 140°F* 590.000. 3-403-11(E) Remaining Unsliced Portions of Beef hem 1 Good Retail Practices FC 590.000-1 �. 2� Maria emeni and Personnel FC 2 .003 Roasts• - --- tl Ig Proper Cooling of PHFs 24 11 Food and Food Protection I FC 3 .004 25 Equipment and UtensilsFC 4 _,005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. 1 Water Plunnonq and Waste FC-5 .006 70`F Within 2 Hours and Front 70'F 27. Physical Facility FC 6 .007 to 41°F145°F Within 4 Hours. * 28- Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 -- -�'i'enaperature htgic(lients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical iter)in t6e'rederul 1999 Food Code or 105 Chart`90.000. CITY OF SALEM /� BOARD OF HEALTH Establishment Name:��l/ C/ /, 4 5 �Ve- Date: Page: C3 of Item Code C-Critical Item_ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 9 C — /dee 0 ice e � — /n i L e ti o 6e 2 S L J / // ®t. /S/ e Ph�is� ; 9 C — e Ce / a e L�_ S'/OP W_� o s ke. :s i v 7 P_/1 ' / c� e uIre . G t �i ho 0 a E/ e / c • N .v �n. tii .� Discussion With Person in Charge: ✓ Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _ ���� ❑ Voluntary Disposal 0 Other: 3-501.14(C) PHFs Received ah Temperatures Violations Related to Foodborne Illness Interventions and Risk According,to Law Cooled to Factors(items 1-22) (Cont.) 41'F745 F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Cooling*Methods for PHFs 1=4I4 79 Food or Color Additives PHF Hot and Cold Holding 3-202.72 Addifives'k 3-501,16(1;) Cold PHFs Maintained at or below 590.004(F) 41"f45°F* 3-302.14 Protection from Unar roved Additives* 3-501.4fF) Hnt PHFs Mai unlined at or above 15 Poisonous or Toxic Substances 140°F. 7-101.11 klentitynig Information-Or 3-501.76(:x) Roasts Heid at or above 130`F. Containers" 7-102.11 Common Name-Working*Containers* w Time as a Public Health Control 701.11 Separation-Storage" 3-50119 Time as a public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re ❑Irement 7-202.12 Conditions of Use* 7-203,11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS HSP) 7-2(4.1.2 Chemicals for Washine Produce,Criteria" 21 3-801.11(A) Beverages with Warning labels*Unpasteurized Pre-packaged Juices and 7-2041 m 4 Drtid A suis,Criteria` - - 7-205.11 Incidental Food Contact.Lubncants* 3-s01.11(B) Use of Pasteurized Eees* 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 gait deers, -801.I((C) Uno ened Foci Packa>e NotRe-servcd. * 7-..06.13 Tracking Powders,Pee st Control and 3 Mon-rtorin�' CONSUMER ADVISORY TIMET TEMPERATURE CONTROLS 22 3 b03.11 Consmner Advisory Posted for Consumption of Animal Foods Tliat are Raw.Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. I1tho�ens.*Ee" "�v;.Pon' E s-'Inmredrate Service 145°.F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats v&Game Eggs* Animals- 155°F 15 sec. 3-401.1](B)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155`F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering. mobile food,temporary and 3-401.1 l(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containine Fish,Meat, debited under the appropriate sections Poultry or Ratites-1659, 15 sec. a. above if related to foodborne illness 3 401LI I(C)(3) Whole-musele, Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3401..11(A)(1)(b) All Other PFIFs-1,45°F 15 sec. * >? Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)r&(I7) PHFs 165°F 15 sec.* (Itetms 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standine Critical and non-critical violations, which do not relate to the Time' oodborne illness interventions and risk factors listed above, can he. 3-403.11(C) Commercially Processed RTE Faid- found in the following sections of the food Code and 105 041? 140°F" 590.000. 3-403.11(F) Remaining Unsliced Portions of Reef Item Good Retail Practices FC 590.000 Ronists* 23. Management and P_ers_onnel__ FC-2 .008 Ig Proper Cooling of PHFs 24 Food and Food Protection _ FC-3 .004 25 Equipment and Ufensiis _ FC 4 .005 _ 3-50L14(A) Cooling Cooked PHFs from 1d0°F to 26 Water,Plumbinq and Waste FG-5 006 70"17 Within 2 Hours and From 70°F 27. Ph slcal Facilk _� FC-6 1 .007 to 41.°F/45"F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) C<x>ling PHFs Made From Ambient 20. S eeia Re ulremaots 009 Temperature ingredients fo 4l`F/45°F 30 Other _ Within 4 Hours' s-srnn,,,m,ns.as," Dentav� critical item in the&.literal 1999 Food Code or 105CM 590.000. r t€k 'CITY OF SALEM ' BOARD OF HEALTH a Establishment Name: 1 Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY C l i F/ ale w w -,am 0rto x 1 Moi 4k) r r3.i �iz✓ti � 4a� - l �/,Ps al Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ti I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Wiolations 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 t noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: -501.I4(C) PHFs Received ae Temperatures Violations Related to Foodborne Illness Interventions and Risk Accordin,to Law Cooled to Factors(Items 1-22) (Cont.) _ 41"F/451F Within 4 How's. PROTECTION FROM CHEMICALS3-501.15 Coolmo tilethods for PHFs 14 Food or Color Additives S9 PHF Hot and Cold Holding 3=202.12 Additives'" 3-501.16(B) Cold PEIFs Maintained at or below 590.004(F) 41`145° N* 3302.14 Protection frown Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) tiot PHFs'M'aintamed at or above 140E * 7-101..11 ldeContainers Information-Oniginat 3-501.1.6(A) Roasts Held at or above 130`F. * C.��nteiners" 7-1.02-11 Common Name-Working*Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storag ' e 4 3-50L 19 Time as a Public Health Coru rot* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re ttirement 7-202.12 Conditions of Use' 7-2013.1.1 Toxic Containers-Prohibitions"` REOUIREMENTSFORHIGHLYSUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals'' POPULATIONS(HSP) 7-204.12 Chemicals for Washing.Produce,Criteria* 21 3-HOLT I(A} tha isteurized Pre-packaged Juices and 7-204.14 Drying ems,Criteria" Beverages with warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pastenrnzed Bags* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.11(D) Raw or Partially Cooked.Anhnal Food and Raw Seed S moat's Not Served.*' 7-206.12 Rodent Bait$tenons°` 3-801.11(C) Una ened,Foul Package Not Re-served. 7-206.13 Trucking Powders,,Pest Control and Monitoring* CONSUMER ADVISORY TIMFJTEMPERATURE CONTROLS 5 fiO3.t 1 Consumer Advisory Posted for Consumption of Animal Faads'Flon are Raw,Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Elitninate 3-401.11A(1)(2) Elms- 155"F 15 Sec. Path o cm* ''eLs...r roof 1: s-Iuuuedr tu.Service 145`rl-5 e * 3-302.13 Pasteurized Eggs Substitute for Raw,Shell 3-401 11(A)(2) Comminuted Fish,Meats &Game Eggs* Animals-155°F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast- 130`F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Rapues-165°F 15 sec. * above if related to foodborne illness 3-001.11.(0)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F^ 590.009 vio bions relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165"F*" Special Requirements. 3401.11(A)(1)(6) All Other PHFs- 145°F 15 sec. 177 Reheating for Hot Holding VIOLATIONS 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 St'andins= Critical and non-critical violations, which do not relate to the Timcv' foodborne illness interventions and risk fiu'tors listed above, can be 3-403.11(C) Commercially Processed RTF Food- found in the following sections of the Food Code arut 105 CMR 140°F' 590.000. 3-403.1 I(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Mena ement and Personnel __ FC -2 .003 ig Proper Cooling of PHFs _24. Food and Food Protection - FC_3 .004 25 __. .Equipment and Utensils _ FC---4 __ 3-501.14(A) Cooling Cooked PHFs from 140°F to 26 Water,Plumbincl and Waste FG 5-+ 006 70°F Within 2 Hours and From 70"F 27 Ph seal Faeili FC-6 .607 --- - ---- to 41°F/45°F Within 4 Hairs. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(3) - Colin);PPIFs Made From Ambient 20- 5 eeiai Re uiremenis _ _ .005 Temperature Ingredients to 41°F/45°F 30_ _Other Within 4 FIours* °Denotes critics{item in the ledend 1999 Food Code or 105 CNIR 590-000. Delande Lighting PAGE: 1 22 NEW DERBY STREET TEL. (978)744-2609 ** PICK. TICKET *** 4 S: 2 SALEM, MA 01970-3696 FAX (978)744-0405 B S I IN A PIGS EYE RESTAURANT H IN A PIGS EYE RESTAURANT � CHESTNUT ST. INVESTMENTS a CHESTNUT ST. INVESTMENTS T 148 DERBY STREET T 148 DERBY STREET 0 SALEM MA 01970 0 SALEM MA 01970 JOB NAME: ATTN: CUSTOMER NO. CUSTOMER PO.NUMBER DATE ENTERED SHIPPED VIA DATE SHIPPED SLSMN. SALES ORDER NO. 383141 08/19/0 PU AJM 2018793-00 MFG.I.D.NUMBER QUANTITY BALANCE QUANTITY UNIT u DESCRIPTION LOC ORDERED DUE SHIPPED PRICE MF EXTENSION 1 LOL56946 6 6 E 50ES16120V LAMPS FOR'MINI RECESSED-120V 2 MCG2260 2 2 E MCG2260 4F'T 'l-rP`CLR'-SL t _ z- rl ox ,T REMARKS: IMPORTANT: SEE TERMS AND CONDITIONS ON REVERSE SIDE. TRANSPORTATION $ / WE DATE 08/10/04 PICKED BY: PACKED BY: I CTNS BY: ERRORS:ADVISE IMMEDIATELY ��' � � i�t , 71 i ATTORNEY'S FEES In any suit or action brought on this sale to enforce the provisions of this sales agreement the losing party agrees to pay the prevailing party's reasonable attorney's fees to be fixed by the trial court, and on appeal the prevailing party's reasonable attorney's fees to be fixed by the appellate court. NO DISTRIBUTOR WARRANTIES Our Company makes no warranties or representations express or implied as to WORKMANSHIP, PERFORMANCE, QUALITY, DURABILITY, FITNESS FOR A PARTICULAR PURPOSE OR MERCHANTABILITY with respect to these articles or any modification of these articles requested by the customer. The only warranties applying to the articles sold hereunder are those specifically provided in writing by the manufacturer. Our Company shall not be liable in contract or tort or to persons or property or for incidental or consequential damages or for commercial damages or for any other loss or damage. NOTICE — When goods are received check carefully and promptly, if any differences are noted return the packing list of shipment with your claim. Claims cannot be considered unless made within 5 days after receipt of goods. Make all claims on the delivering carrier for damages or shortages on delivery. i Returned Material Procedure—Please do not return merchandise without first obtaining our consent, furnishing your order number and our invoice number and date. All returns may be subject to a handling charge. Credit for the return of specialty non-stock items will be in accordance with the terms of the manufacturer or supplier, and may bear additional restocking charges. A FINANCE CHARGE OF 1112% PER MONTH (18% PER ANNUM)WILL BE CHARGED TO ALL BALANCES OVER 30 DAYS. I� I i a.Jr Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date/ T e of O eration s 7 e of Inspection ir. n Cy Food Service Routine Address Risk ❑ Retail ❑ Re-inspection ' ° ;' `�f Level ElResidential Kitchen Previous Inspection Telephone El Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint El HACCP Inspector O Permit No. El Other rA /1/x'7 �!� /J�A/lc ,ir -/s Out: Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT F] 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH "" ❑ 13. Handwash Facilities .. PROTECTION FROM CHEMICALS ' ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection El 20.Time As a Public Health Control VFood Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP _ ❑ ❑ CONSUMER ADVISORY 11.Good Hygienic Practices C - - ❑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 ofCFN1-. ) 590.000/federal Food Code. This report, when signed below .. .. .... .. . 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations (FC-4)(590.005) cited in this report may result in suspension or revocation of 25. Equipment and Utensils the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s svomsce�Forms14 d. ecto SiPrint P1IsSignatur : y -V. Print: ��NI 1 PageL of Pages / J Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT i Cross-contamination 1 I 590.003(A) Assignment ofResorsibility* 3-302.11(A)(1) Rim Animal Po(AsSeparatedfrom 590.003(B)_ Demonstration of Knowledge* Cooked and RIE Foods* 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-102-11(A)(2) Raw Animal Foods Separated front Each EMPLOYEE HEALTH Ocher* 2 590.003(0) Responsibi lily of the person in diaige to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection' applicants* 3-302.15 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Food.Employee Ot An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In _ _ Utensils( Charge" Contamination from the Consumer 590.003(G) Re ottin b Person in Char e* 3-306.14(A)(1i) Returned Food andReservice of Fcxxl* 3 .590.0030) Exclusions and Restrictions" Disposition ofAdoiterated or Contaminated 590.003(E:) Removal oFExclusions and Restriction, Food 3-701.11. Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* Food and Water From Regulated Sources `) Food Contact Surfaces 4 _ 590.004(A-B) Cam�liance with Food Law" 4-501-11 1. Manual Warewashing-Hot Water 3-201..12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.1.3 Fluid Milk and Milk l roduets* 4-501.112 Mechanical Warewashing-Hot Water 3-20213 Shell Eames* Sanitization Temperatures* 3-202.1.4 Eves and Milk Pr(r<tucts.Pasteurized* 4-501.114 Chemical Sanitization-temp.. pH, 3-202.16 Ice Made From Potable Drinkine Waters concentration and hardness. M' 5-101.11 Drinking Water from an A roved Svstern"` 4-601-11(A) Equipment Fad Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Wates* 4-602.11 Cleaning Frequency of Equipment Food- 590.006()3) Water Meets Standards in 310 CMR 220* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sairnizat3on of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Fad Contact Surfaces ofEquipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical'* Sources* Proper,Adequate Handwashing 1p Game and Wild Mushrooms Approved by 2-301.11 1 Clean Condition-Hands and Arms* Regulatory Authority 3-202.15 Shellstock Identification Present" 2-301.12 Cleaning Pr(xedm'e,* 590.004(C) Wild Mushrooms* 2-301.14 Wheuto3Vash` 3-201.17 Game Animals* It Good Hygienic Practices 5 Receiving/Condition 2-401.11 F-aNng,Drinking w:Using Tobacco, 3-202-1 I PHPs Received at I'ro ser Tem�eramres," 2-401.12 Discharges From the Eycs,Nose and Package lntesrn'it°y` Month* 3-202.15 3-101.17 Fard Safe and Unadulterated* 3-301.12 preventing Contamination 4h}ten Tastin>^' Tags/Records:Shalistock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590.004(E) Preventin,R,Contamination from 3-203.12 Shellstock Identification Maintained* IEmployees* TaWRecords:Fish Products t3 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible. 3402.12 Records.Creation and Retention* 5-03.11 Numbers and Capacities* 590.0040) Labeling of Ingredients" 5-204.11 Location and Placement` 7 Conformance with Approved Procedures 5-205.11 Accessibility,O ernian and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502-11 Sriecialized Processin,Methods*, Devices 3-502.12 Reduced oxy¢en acka«inv,criteria* 6-301.11 Handwashing Cleanser.Avarlabilit 3-103.12 Conformance with Approved Procedures* 6 301-12 Flood Drvin�Prmtision "Denotes Critical item in the fedora]1999 Fcw d Code or 105 CMR 390.000. CITY OF SALEM BOARD OF HEALTH i Establishment Name: A g s `i'F Date: a/ !U 4 / Page: 2 of Item Code C-critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY. ,.. 0. . -JL•P 7`JDO? P-' %/.� i YY7/97I % SP/� � Gd .� . ..i.. ::'. i �✓ � �,/,S �i/CJ Ii ,� �f r4 nLG - S oo _�� 'r G ,a �./ur. Z 05 Ar o J c r 7i< S /I 2 ,n`r' r, /7V l 7^ v ef-77 r, <'�/' ?riJ //Y]J/ CI e/ LSPnJ�n7` G,"'e L - � 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 ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / f 7'� r ❑ Voluntary Disposal ❑ Other: 1 � j 3-301.14(C) PHFs Received at Xcinperatures Violations Related to Foodborne Illness Interventions and Risk According lo Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45'FWithin 4HOWS, PROTECTION FROM CHEMICALS 3-5 F)J.15 Confing Methods for PHFs i4 Food or Color Additives PHF Hot and Cold Holding _ E19 3-501 16(13) Cold KfFs Maintained in or below 3-202.12 Additnes* 590f004(F0 41 i45"F* 3-302.14 Protection from Unapproved AdditneO' 3-501.16(A) Hot PHFs Maintained at or above LF- Poisonous or Toxic Substances 140�F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 7_102 11 Common Name-Working Containers" 20 Time as a Public Health Central 3-501.19 Time as a Public Health Conto+' 7-201,11 - . 7-202,11 Restriclion-Presence and Use* 590,004(fl) Variance Re ❑irement 7-202.114 Conditions of Use,7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 POPULATIONS(HSP) 1-204.11 Sanifizcrs.Criteria- Chemicals* 7-20412 Chemicals for Washing Produce,Ctilcria" 21 3-801.11(A) Unpasteurized Pre-packaged luices,and 7-204.14 Drying Agents.Cnteir,0 Bevejaue, with Warnin"�f_lbels 7-20511 Incidental Food Contact,'Lubricants` 3-801.11(B) Use otPastaurizedE s* 3-801.J I(D) ked Animal Food and Raw Seed S trouts F206 11 Restricted Use Pesticides,Criteria* a Served. 12 Rodent air Stations* ,-206.1 3-801.1.1(C)_ J [ ,,,p, ,d Food Package Not 7-206.13 Trucking Powders, Pest Control and .. ..,,...... ........... Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-601.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods Mature Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11 A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*"""" Final-Inursediate Service 145`F15sec':' 3-302.13 Pasteur ed Egg.,Substitute for Raw Shell 3-401.1.1(A)(2) Comminuted Fish.Meats&Came Animals- 155"F 15 see. I 3-401,11(6)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401-11(A)(2)(A)(2) Ranics, Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffina Containing Fish,Meat, debited under the appropriate sections above if related to foodborn-,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 Annual Foods Cooked in a practices should he debited under#29- - Microwave 1.65°F* - Special Requirements. 3-401.1 I(A)(1)(b) All Other PHFs 145+ 15yec. ' I 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40311(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the 'fillre, foodborne illness interventions and risk{actors'listed above, call be 3-403.11(C) Commercially Processed RTE Food- ,found in the following sections of the Food Code arld 105 CMR 140°FM 590.000. 3-403.11(E) Retraining Unsficed Portions of Beef item I Good Retail Practices 1 FC 59it000 Roleas'� _�O_ _�3.�- Man ment and Personnel FC-2 03 aq�___ Proper Cooling of PHFs �24. Food and Food Protection FC-3 .004 25 - Equipment and Utensiis ---,.--- '006I__FC_-4 005 3-501,14(Al) Cooling Cooked PHFs from 140'F to 1 26. Water,Plumbs ng and Waste 70'F Within 2 Hours and From 70"F 27. Physical Facility i, -6 .007 to 41�1`145°1`Within 4 Hours. 28 Poisonous or Toxic Materials FG-7 60-8 3-501.148) Cooling PHFs Made From Ambient 29, Special Requirements 009 Temperature Ingredients to 41"1/45"F L39 )ther Within 4 Flours- Drmilie,chiral item in the teder3l 1999 Food Code of 105 C.MR 100.000. f a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. _JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner ' s Name : Jennifer Reardon Name of Establishment : In a Pigs Eye Restaurant Address of Establishment : 148 Derby Street Type of Establishment : FOOD SERVICE Application Date : 01/13/2002 Restrictions : Permit for Food Establishment 256-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. ( HEALTH AGENT } (;:s RilIn1 6�col+om,� CITY OF SALEM, MASSACHUSETTS - O ry 'Qi BOARD OF HEALTH 120 WASHINGTON STR F_EI. 41H FI_OOfi JAN 13 2003 X11 SALEM. MA 01970 >� a ✓'q�,;� TEL. 978-741- 1800 FAX 978-745-0343 BOARD OFHEALTH S-IANLGY USOVICZ. JR. JOANNE SCOT']'. MPH, RS. CHO MAYOR HEALTH AGEN-i 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT tiq / S E{l��ti.�qR�ScT/y9U)� TEL# ADDRESS OF ESTABLISHMENT IYO MAILING ADDRESS (if different) /� OWNER'S NAME � IW&A Y41 /ZZ4_4,A1%/ gTEL# MJVq` X)4 ADDRESS T CITY_ STATEea . ZIP Irl-3n CERTIFIED FOOD MANAGER'S NAME(S)cNfJT1r4.10 kERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON SEA/A[YFrf 2, AEAR4,Sf AME TEL# R39 //:30•/0;00 :> //.3o -&:do HOURS OF OPERATION: Mon. 11Tue.�Wed.�Thu.? Fri. X sat. >< Sun. AC TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less tha OOsq.ft. 50 1000-10,000 =$1 m an 1 3 000 q. $250 v3 RESTAURANT YES NO a5� less than 25 seats =$�� 25-99 seats <:2 � more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES el'IT-) $50 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 nowledge and belief ave filed all state tax returns and paid all state taxes required under the law. Cb � />/29/03 �i ;II 2Q.0� 7/v y i Sig ture 7, Dateourlty or Federal Identification Number -------------------------------------------------------------------------------5-------------------------------------------------------- Revised 11/25/02 FOODAP2.adm Check#&Date /lo `30`' 1.;2 - a q-O 3 i�� - COURT DOCKET NO. CITATION NO. CITY OF SALEM p �+� 70 VIOLAI'iON NOTICE ,L V NAME(LAST,7ST,IN DA'7L') STREETADDRESS I OWN STATE ZIP Q,R' T)!/ 3 t '�'.T �- �. t a (�f��:fit!• LICENSE NO. LIC.EXP.D DATE OF BIRTH OWNERS NAME(LAST,FIRST,INITIAL) STREETADDR S TY/TOWN ST TE ZIP Olr /c REGISTRATION NO. TATE P.DATE MAK PE YEAR COLOR DATE OF VIO TIONTI E DATE CITA ON WRITTEN PERSONrvJURAL AM 1-h1- r �n El PM I / J_� ❑VES LOCATION OF VI LATI Ni E+�, EN FORCING DEO.NO fs /`/y_ZP' �V,1 Sf_"SCI4P, .7?ikt- h.J. d.�hR:L7Li OFFENSE frT!GE- ^SS fL. L-�6 fiy'. v-f CHAP. SECT. FINES A gI/?[ 3 r :. 8lprNml 1� ns B C OFFICER I.D.NO. TOTAL / �- V /'fi'7/.CSYt7kic DUE $ hlt OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND X BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET' SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL - m na. `n'.!b4•ti$.st °..ra5a�'�i`:>' r : a x >t � d PT DOCKETt4 ''F '# ' "'yw,.,,a'S TION NO S '-., -.tn.... .. t a S �L+1.�her ,"'' I 4 W r TT r ° r e F e P AFI t 4 r CIT®r . SALEM°_PD��. VIOLATION NOTICE( L`t ?ra• F 'a a� w li ft \ mayF lj � S � F f 61AMEjLAST FIflST INITIAL) �4 O. Q OrC NM F STREETADDRESSuj V , CENSE NO. OC EXP.DA DATE OF BIRTH - Rj - 0 2, rn�(n LI O R'S NAME(LAST FIRST,INITIAL) r-loz . mOCZ SiREETAODRESS :':�.:�./'q— (^�jCITTYfrOWNSTATE '::= IZZllP./ r .' V/ J✓/�/}7 r�/LY' B [ !� rvtt - D�=m'/F REGISTRATION NO STATE EXP.DATE MAKERYPE L' VEAR COLOR s !p r J r o 9 O SE �. kLfI. S l *(L enz DATE OFVIOIATION TIME x: DATE CITATION WRITTEN, WnUwV, DAM F ElVES c A m ❑PMk Jlkm OSn` DNO. s 0� F 1 L m1 LOCATION OF VIOLATION .- ' Q #9s ENFORCING DEPT ; ; OFFENSE !d ,8 / i L.. CHAP. .PPFJNES. x�� A4.0 TJ k } �(h t 3 �-F .. s r-...'.,C If,F{, i OFFICER LD.NC TOTAL. L I/ �F(�(' OFFICERCERTIFIESCOPY GIVENTO VIOLATOR ' ; f f-'.2 DO//////NOT.�MAIL CASH 'PAY ONLY BY POSTAL NOTE MONEY :Ls t 2222 1F j� i(a, t ; ,t(_ . ..ORDER OR BY CHECK MADE PAYABLE TO.^ ` b _ .i k �eee�j rCITY , CITY HALRK. '•` flail .�f��. rI ��r G r 93 WASHINGTON STREET O, s - SALEM MA01970 p ♦ },`-^ }�( )) r.II 11 , <D " "•: ;''' TEL(508)745-9595X251 1' Q 11 •I yEREBY ELECT TO EXERCISE THE FIRST OPTION bS STATE ON S t ' .i1EVERSE,CONFESS TO THE OFFENSE CHARGED-,AND ENCLOSE - epAYMENT INTHE AMOUNT OF v$ + CASE#' .,S Y - -- ' IGNATURE c '~ I •r•+,SEE OTHER SIDE FOR FURTHER INFORMATION " - ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL r b_ N z t Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date T of O rations T of Inspection Qli G N �:1� r Y - - Food Service 16 Routine Address l Risk r 1 Retail Re-inspection ^ Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) O(ATime Time ❑ Bed& Breakfast El General Complaint CP Inspector Ou{. 0 Permit No. O Otth r Each violation checked requires an planation 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) LK 590.009(FY❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities C EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentlally Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved ProcedurWHACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS{HSP); ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices C NSUMER ADVISORY d 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 --?747- by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations O 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food GV-, 26. Water,Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order./ 30. Other DATE O"F RE-INSPECTION: 1 l l S.59JInspecfFom.814 Ex naI 111. CA a`ll`I, „vl'l. � I ��i�'' l�lX-'V +�✓V J- Vv/VV� ttff// 7 Inspector's Signature:' ,fa _' Print: 1 ( PIC's Signature: ��r Print: Page ofges Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(]) Raw Animal Foods Separated from I 590.003(A) Assignment of Responsibil * Cooked and RTE Foods* 590.003(B) Demonstration of Knowled e* Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302.11(A)(2) Raw Aima l Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) - Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3 590.003(G) Reporting b Person in Charge* -306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated Food 590.003(F) Removal of Exclusions and Restrictions 3-701.11 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* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 _Food in a Hemtctically Sealed Container" Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-1-fot Water 3-202.13Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.* 5-101.1.1 Drinking Water from an Approved System* 4-001.11(A) Equipment Food Contact Surfaces and 590.006(A,) Bottled Drinkin Water* Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food 590.006(B) Water Meets Standards in 3 CMR 22.0* Contact Surfaces and Utensils* ShelrYSh and Ftsh From an Approved oved Source4-702 11 Frequency of Sanitization of Utensils and - 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP lasted Chemical* Sources*- Ip Proper,Adequate Handwashing Game and bVild;vlushroom Approved s A o ed b PF Y Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present" 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms- 2-301.14 When to Wash* 3-201.17 Game Animals* Ln Good Hygienic Practices g Receiving(Condition 2401..11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Po er Tcm eratures* 2401.12 Discharges.FromtheEyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 _ Fcad Safe and Unadulterated * 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.1.2 Shellstoek Identification Maintained* Employees* TagslRecords: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently located and Accessible 5-203.11 Numbers and Capacities* 3-402.12 Records.Creation and Retention* 5-204.11 Location and Placement* 590904(1) Labeling of Ingredients' Conformance with Approved Procedures 5-205.11. Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processin Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with A ,Dyed Procedures* 6-301.12 Hand D Provision '*Denotes critical item in the federal 1999 food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH �(� I Establishment Name._'_�2,T Date: �7 Page:_�'of Item Code C-Critical ItemY\ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION (/ Date No. Reference R-Red Item , PLEASE PRINT CLEARLY 0A, V' -' Vetlfled d=ni -I nV_/I/Vti'1/�.'!•�pL_ q-`� 72��( ( ..�-/��/� 11 y',� .�/ne'. 'f_� i�Sl,�t�`(,'�r•'tll:��y1IC1P �/yyam�/ i�AL9/ G��1i I J ''Wo tL..1k..L� j_nre•1/. ./ � � .h,t '� `'' 9:,i',rCiuJ �Q ;D �'Y \ 1� �FS� k%�?:-YI;, ,e ;�"'I ( ( ✓ S L7b n —0 0✓fin n T1J 1 p O/1r -- o,,, -o,,,aa Ale i_.�nA In el/4 _H.,, i : ),✓ � .`''•r ^a .7i \�1 P,r.� J\��,Oa�J 1 ..11/ l !((��� �i ,��.� n I Io')_P_ 4-A n/ I (0'�7/� Discussion With Person in Charge: Corrective Action Required: ❑ No es I have read this report, have had the opportunity to ask questions and agree to correct all 4 Voluntary Compliance ❑ Employee Restriction Exclusion Re-ins violations before the next inspection, to observe all conditions as described, and to •j p coon Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ll� 1Xi� 4� noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Y �3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne 111ness interventions and Risk According to Law Cooled to Factors(fMms 1-22) (Cont.) 41'F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(33) Cold PRFs Maintained at or below 3.202.12 Additives* 590.004(F) 3-302.14 Protection from Una roved Addidves* 590.004 i PF* Poisonous or Toxic Substances 3-SOi.16(6(A} Hott PHFs Fs Maintained at or above 15 140°F. * 7-10111 Identifying Information-Original 3-501.16(A) Roasts field at or above 1300F. Containers* 20 Time as a Public Healtb Control 7-102.11. Common blame-Working Containers* 3-501:19 Time as a Public Health Control* 7-201.11 Separation-Storage* - 590.004(H) Variance Requirement 7-202.12 .Restriction-PresenceandUse* - 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP - 7-204.11 Sanitizers.Criteria-Chemicals* - 3_ a Pre-packaged forces and 801.11 A U 7-204.1.. Chemicals for Washing Produce,Criteria * 21 _ ( ) Unpasteurized packag :Beverages with Warning Labels* 7-20414 Agents.Criteria* ",-802.11(33 Use of Pasteurized Egos* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.31 Restricted Use Pesticides;Criteria Raw Seed Slimuts 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 Momtorin * 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 Processed to Eliminate Pathogens,' 3-401.1IA(1)(2) Eggs- t55°F 15 Sec. rro rn,m t Eggs-Immediate Servic:c 145`F15sec+ 3-302.13. 1 Pasieuriztd Eggs Substitute for Raw Shelf 3-401.11(A)(2) - Comminuted Fish.Meats&Game E * Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 3-041.11(13)(1)(2) Part:and Beef Roast=130°F 121 min* A-D 3-401.1 i(A)(2) Ratites,Injected Meats-155`F 15 590.0091 )( ) Violations of Section 590.pQ9(t'<} {]�)in sem * catering,.mobile food,temporary and 3-401.1 t(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 15 sec. * above if related to foodborne illness 3401.11(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 Foods Cooked in a practices should be debited tender 4'39- Microwave 165'F* Special Requirements. 3-101.11(A)(1)(b) All Other PHFs-145'F 15 sec,x 17 Reheating for Hot Holding VIOLA17OMS RELATED Tia 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 mid 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 sections of the Food Code and 105 CMR 140°F* 5.9o.Dt10, 3-403.11(E) Remaining Unsliced Portions of Beef i item 1 Good Retail Practices FC 1530.000 i Roasts" 23. Managamanf and Persenn-el , FC-2-[ .003 - .i 18 Proper Cooling of PHFs 24.. Food and Fcai Protection TFC-3 [ . 5 1 1 25. { EquiAmaM and Utensils 1 FG-4 .00005 1 3-50L14(A) Cooling Cooked PHFs from 140'F to W atet.Plumbing mod W ante IFC-5 '006 70`F Within 2 Hours and From 70°F 1 27. 1 Physical Facil FC-6 .007 ! to 41`F/45'F Within 4 Hours.* x_2_6_ ' Poisonous or Toric Materials FC 7 .008 3-501.14(6) Cooling PHFs Made From Ambient 29. Speciaj Requirements 009 Temperature Ingredients to 41-F/45°F ' 30 ! Other Within 4 Horns* Denotes critical iwav in the feder2i 1999 Favi Cale w'105 CMR 590.000. a � Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Nam� e 11 _ n ' ✓/�� �- -} Pate T e of O eration s Type of Inspection "�\ C. �'. T ye Cfi4.,] l/- Q Food Service IKRoutine LJ I, Imo, Risk Retail Re-inspection 175 Level ❑ Residential Kitchen Previous Inspection Telephone 7 ❑ Mobile Date: Owner ^ ( ) HACCP YM [I Temporary ❑ Pre-operation \Onn n�. Olt hC ❑ Caterer ❑ Suspect Illness Person in C Urge(PIC)U Time �j� ❑ Bed&Breakfast ❑General Complaint [I HACCP Inspector �� �1Q Permit No. ❑Other Each violationl checked requires an exp lanation on the narrative page(s)and a citation of specific provision(s)violated. Cl Jl Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Chokin Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) � 590.009(F)�( action as determined by the Board of Health. FOC PROTECTION MANAGEMENT R. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS - ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD.FROM.APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentially Hazardous Foods)_ ❑ 5. Receiving/Condition I ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑A ,17 eheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION 1 ❑ 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)I El 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing �� Q _ ✓ % - O 5 MEU RR ADVISORYa 11. Good Hygienic Practices '�2. Posting of Consumer Advisories L Violations Related to Good Retail Practices Number of Violated Provisions Related S! Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 1 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): oL of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(510.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-s)(5so.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(511.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:ssornspecr�o.uia eoo O Inspector's Signature: Print: 1 P PIC's Signature: ( Print: /- Page ofges U ♦ 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION _ FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assig ment ofRes nsibilit * 3-302.1 RAY0 Raw Animal Foods Separated from --- Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw ingredients 2-103.]1 Person in char 'e-duties 3-302.11(A)(2) Raw Anirn al Foals Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(0) Responsibility of the person in charge to 3-302.1 L(A) Food Protection* require reporting by taxi employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11. - Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3-306A4(A)(E) Returned Food and Reservice of Foal* 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* Food Non of Adulterated or Contaminated 590.003(E) Removal of Exclusions and RestriM ons 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources FOK Food Contact Surfaces - 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermeticall •Sealed Container* Sanitization Temperatureo, 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.)3 Shell Eggs* SAnitization Tem eratures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.1.1 Drinking Water from an Approved S ,tent* 4-601,11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Wates* 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* ShelMtsh and Fish From.an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish' 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.1.I Clean Condition-Hands and Arms* Re u/oto Author8 3-202.18 Shellstrick Identification Present* 2-301.12 CleaninR Procedure* 590.004(C) Wild Mushrooms* 7301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges.From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventin>Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" - Employees* - Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance' /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. S ecializmd Processing Metbods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleamer,.Availabilit 8-103.12 Conformance with Approved Procedures* 5-301.L2 Hand Drying Provision *Denotes critical item in the federal 1999 F(W Codc or I05 CMR 5900.000. CITY OF SALEM } BOARD OF HEALTH EstablishmentNam" ,_' 0 Date: 0-10 Page: C), oZ Item Code C-Crtticar Item V DESCRIPTION OF VIOLATION/PLAN OF CORRECTIO NO. Reference Reference R-Red item Verified PLEASE PRINT CLEARLY 1 `,11 11 �a P, — Lj 1 .! t A L __Q4 Le Q U 4o the GO N L ,1 C .PO o s' n� Nn I , r JL U t 6 - 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 cQr7ditions as described, and to Exclusion / ,< Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal F WUllhrs nderstand that ¢A 6` goncompliance may result in daily fines of twent or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. X - ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness.Interventions and Risk According to Law Cooled to Factors(item 1-22) rCont.) 41'F/45°F Within 4 Hours, PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Not and Cold Holding 3-50L16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590,004(F) 41°/45°F* 3-302-14 Protection from Unapproved Additives' 3-50 L I6(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 1400F. 7-101 l l Identifying Information-Original 3-501.16(A) Roasts Heid at or above 130°F. Containers* 7-102.11, Common Name-Working Containers* 20 Time We a Public Health Control 7-201.11 Separation-Storage" 3-501.19 Time as a Public Health Contra!" 7-202.11 .Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Wishing Produce.Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and Beverages with Warning Labels* 7-205.1 l Incidental Food 7-204.14 oo Criteria* Cnntact,Lubricants* 3-801.11(B) Use of Pasteurized E gs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders, 7-206.12 Rodent Bait eers * 3-801.11(C) Unopened Food PackageNot Re-served. ,PPest Control and Monitcrin * CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3401.11A(1)(2) Eggs- 155°F IS Sec, Pathogens.,Erre"rnnoor Eggs-Immediate Service 145°F15sec* 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food, temporary and 3-401.11(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 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 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401;11(A)(1)(b) All Other PHPs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS 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,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403AI(C)(C) Conmtercial ly Processed RTE Food- found in the following sectionsof the Food Code and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef - item j Good Retail Practices "FC 590.000 Roasts' 23. Management and Persamd FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 _004 and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140° 25. Equipment F t0 26. Water.PlUmbing and Waste i FC-5 F .006 70' Within 2 Hours and From 70°F 27. P ical Facility rials FC--FC-6 .007 to 41°F/45'F Within 4 Hours.* -28. Poisonous or Toxic Mate7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements i .009 Temperature Ingredients to 41°F/45°1 C 30. j Other Within 4 Hours* ssym«ms.:r-x , *Denotes critical item in the federal 1999 Foci Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name !� (� f Date T e of O eration Type of Inspection TN T )�TS G 1 2(o s Food Service Routine AddressRisk Retail Re-inspection �� ` ��� LevelL1 Residential Kitchen Previous Inspection 1n^ Telephone -�[t _ 4 3 V Y l ❑ Mobile Date: OwnerHACCP YM ❑ Temporary ElPre-operation �- VA d ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint Inspector sa,+ ,Q- In. �S Pe6r 0 No.26,11009 ElHACCP Lc out:�j:�o I S Other Each violation checked requires an explanation on the narrative page( ) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT- E:1 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities q EMPLOYEE HEALTH .. FROM CHEMICALS E] 2. Reporting of Diseases by Food Employee and PIC �.� �� •-• � �E+_ » -r •n� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE„„„, , w! �, u . ,,,_�� ,,, ,F„;,,,„ )r TIME(TEMPERATURE CONTROLS(Potentlally Hazardous Paads) 7 E] 4. Food and Water from Approved Source y ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling a PROTECTION FROM CONTAMINATION r " $49. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑,20.Time As a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing (,REQUIREMENTS FOFf HIGHLY SUSCEPTIBLE POPULATIONS(HSP)m4 ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El 11. Good Hygienic Practices I'CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Foz)( order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5990.000.00 4))) 25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.067) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(e9o.00s) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S ssoios (Foo -ra.eoo Inspector's Signature: , Print: PIC's Signature: Print Nor agel of Z Pages r a Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F 8 Cross-contamination 1 596.003(A) Assignment of Responsibility* 3-302.1.1(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-}03.1 t Person in cha ge-duties Contamination from Raw Ingredients 3-302.t I(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.On3(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Ve embles 590.003(F) Responsibility Of A Foal Employee Or An 3-3(M.1 I Food Contain with Equipment and Applicant To Report'fo The Person In Utensils* Charge* Contamination from the Consumer 590.003(03) Reporting by Person in Charge* 3-306.14(A)(B) Returned Foal and Reservice of Food'* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food.Law* 4-501711 11 Manual Warewashing-Hot Water 3-201.12 Foal in a Hermetically Scaled Container* Sanitization Tent eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eg s* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Wafer* concentration and hardness. '" 5-101..1.1 DrinkingWater from an Approved System* 4-60111(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* 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* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui ment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Re ulafo Authority Game and Wild Mushrooms Approved by. 2-301.1.1 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Clearing Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinkin�or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shelistock l2 - Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction"` Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca achies*5-204.1.1 Location and Placement* 590.004(1) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Accessibility.O tcration and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen taeka 'ng.criteria* 6-301.11 Handwashi ng Cleanser,Avid[ability 8-103.12 Conformance with Approved Procedures* 6-301..1.2 Hand Drying Provision 'Denotes critical iteor in the federal 1999 R"I Code or 105 CMR 590r)W CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Z D Page: of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION! PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY D . C. 2 (� Grp rX a 01,t G(. .ex� w rsY DoT c SL..� v 5,eV 2 bt-r Sv Discussion With Person in Charge: Corrective Action Required: ,❑ _,>No Yes I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily s of twenty-five dollars or suspension/revocation of ID Embargo ❑ Emergency Closure your food permit. fi ❑ Voluntary Disposal ❑ Other: F;-501.14(C) PHFs Reu.rv€d at Temperatures Violations Related to Foadbarne Illness Interventions and Risk ! According to Lae Cooled to Factors(items 1-22) (Cont) _ 31 Ft45F Within 4 Hours. 3-51 PROTEC71ON FROM CHEMICALS 11 35� Cwlinc btethods for PHFs IT- Food or Color Additives ._...._-.-� L 19 PRF Rot and Cold Holding -56� #6fBt Coid PHl s Nlaitttaine t at or below 3_'262.12 Adthuv ti 590.tHk(P) 41°l45a F. 3 ,(2.14 �T Pmtcet ext from Ln r Droved Add[ttti i 1-,5i)1.j6(A) Hnt PH} . }tntained At otabove 1 { 7s Poisonous or Toxic Substances 1401' 7-101.71 -l entifying lnfurniatiun -0rigina' 3.501.15{A) Roasts field at or above 1300h Containers - - Time as a Public Health Controll 7-162-11 l CommonName Workinm( retainers* - - �---� 3-Sol-19 - Timo as a Public i{earth Control- 1-20 L I I 7262.17 Rs [ct t'on-Yrsence-andt c _ L5,90.01x1(14)___I_VariaoeeRaterenteot 7-202.12 co ditiols"of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,1 Texts(onto:nes Pool abi on,, -- POPULATIONS{HSPS r204.71 Sam=[rens Criteria Chcnuats- - - ---.- 9 104.1 ChwYit ale fur W ache >P cad�i c crittviar 2t 3 MOI,t 1(A) Lnpesteunu f P c pae}aged Juices and ,204.14 Drytn A ent .C.rtter[ �- Beterases with l�atntt tabnas 80E ittB� lscctPasttu7redbt, s _ 7-20,9,11 Iur olio nial Frxx3 Contact,f uhrtt,ants �'3-h0 1 1 t(D) R iw w Partia7l Coo�d Ao[mal Paxl and 7-2206.1 i R,S rtc;e3 Lei:Pe hcides Cnte[tn -- ----- Raw he rdt,[rrut lot Serkud 1-206.12 Rrrrent R,t SttusYns 2-9.01 I IfC Luo tied Foal PauFag. Lot Re served_ 7 206.13 - `£racLtng Powders,Pest Control and -"_ -- -- ---`-- CONSUMER ADVISORY 122 3 b0 I IlConsumer Atlsisorc NxA d ttir(:owoulption of . TiMEtFENiPERATURE CONTROLS ( ZAnjool t xxl< Phot ore RAW. Undercwked or L 7.6 PPropper Cooking Temperatures for ( Not Otherwise Processed to E1117ln"tw 3-401.'1 I A(l)(') F } tth t-ns )('1) Ft(. - l5S ISS.e. _ _ t;,rs-lixun�dt ttx.4er�ie 195PISseo° 1-3U'o ll istt tete fFsgs Subst€tuir for Raw Shelf 3-40l.lit 1)(2; Cowutdnnted f t,h Meats k Ciatne Aminrls- 155'T 17 se SPECIAL REQUIREMENTS i3-401.1l(B)(J A2) Pork and Is of Roast-t 4o 1121 ruin` --- ---a 590,009(Ai (i7) Violdh rns of Sutton 590.00%At-(D)in ' 3-401.1I(A)(2) Raines,Inject d l,Seats i 5 F'15 � ' � catering, ouobile flot)d tetnputarvand 3-- 1.11(A)(3) Pouhrv,Wild Game,Stuffed KIN, remdentaal kitchen operati,ntrs should be Sluffint,Cont ening Fish Meat, dehiled under the appropriate ,tenons - i'Ytdtnr or Ratints-J65`F 15.sr c.* Above if related to f?odborns illness �i 401.11[C:)(3) Wbole-mus Ie Intact fief Steaks interventions and risk factors Chher a5 F 590.009 violations relatiwQ to good rete l 3-401.12 Raw Annual Vol&Cooked in a ( practices should be debited under#29- _ ( Microwave 165 1 , _ � Spacial Requiretucmts. 3-A61.11(A)(1)(h) AlOtheiPlfl 145`, 1-5s- 5 sec_" U7 Reheating for Hot Holding --^ VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11tA)&:(7)) Pith.,, 165°F 15 sec_* (Rents 23.30) 3463.17173) Microwave 165'F 2 7vlinue Sanding, CtliSPal and non-crilvol viotal±ons, which do not relate to lite Time" foodborne illnet"interventions and risk factors listed cbove. can be 3-403.i 1(C) Commereiatlt Prrcessed R'TP:Food- Hund in the fa1Tt>t,irrt; sect nets of the Food Code and J65 CiY7X 140"F' 590000, 3-403.11(E) Remaining Cirdiced Portions of Beef item Good Retatl Praeeces -_ FC 59p 000 ! 1 , ( a3 -1 Mana nment and Per onnei FC 2 I 00^ } R oast,." g .-- -- -- _-} i 24 _ Fond and Food Protection FC 3, +-.__. t8 Proper Cooling of PHFs - } Q04 l -- 25 L-1-Equipment and Utensils _ -� FC-4 3175 3-501 14(A) C+xrlingC<xaksdPH's from 14 Fto 2B Mater Pitmbin -UWa co w F_C S i .006 70`F Within 37ou s and Prom'10 T` 27 Phps ra FacilEt� --{i FC-6 007 _ u lt`F745 °k5tiL9n 4 Haru[s_* 28 Poisonous or Toxic Materal_s (3 7 ' 3---_-�-- _ _ 068 T9 nt 409301,:4(1) Co fsg PFEFs Made From Atnhtent iaR a 1 Tolipffae re Ingrcaicnts to 41",745°F r_30. -- O-- ------ Within 4 - __Within4 tburs`r Denotes cntwal iter;ill Ale ro<km t 1999 Food 0"le cr 105 Cbftt 59[160(1.