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IMPORTANT MESSAGE
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DATEEll O TIME �I�S P.M.
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PHONEa39 411S
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
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MESSAGE' O
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SSIIGNED
VNIVERSAL 48005 MADE IN U.S.A.
NOTES
IMPORTANT MESSAGE '
FOR ( +
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DATE TIME P.M.
M � r
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OF�1
PHONE
AREA CODE NUMBER EXTENSION
❑ FAX
❑ MOBILE
AREA CODE NUMBER TIME TO CALL
TELEPHONED PLEASE.CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS M SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
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SIGNED
FORM 4009
MARE IN U.S.A.
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Massachusetts Department of Public Health Salem Board of Health
Division of Food and Drugs 120 Washington Street,4'" Floor
9 Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Name ate T e of 0 erasion s Type of Inspection
IS 1Z (�) Food ServiceRoutine
Address Risk Retail Re-inspection
Level ❑ Residential Kitchen Previous Inspection
Telephone ci (1 I / CD /n/D [I Mobile Date:
Owner !1 i lLl HACCP YM El Temporary ElPre-operationC (� A ❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) t Time ❑ Bed&Breakfast El General Complaint
l n�7i 0 11( � In:' 10 [1 HACCP
Inspector �( a (�� Out: Permit No. ElOther
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) vn 590.009(F)
action as determined by the Board of Health. A CIA
PROTECTION MANAGEMENT, ° us �., n n„� •, ;',»,» ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
❑ 13. Handwash Facilities
`»EMPLOYEE HEALTH--""
+ _ ;_ - „�„ „,,,.„,,;,„r,, t »,g,3 „k, 1�_PROTECTIONFROMOHEMICALSi"' E' p'
❑m2. Reporting of Diseases by Food Employee and PIC =m _• m - - µ � "•
A❑ 14.Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded
❑ 15.Toxic Chemicals
P FOOD FROM APPROVED SOURCE" .. .�. „._..
❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Polemlalty Hazardous ds)77011
❑ 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'""" El19. Hot and Cold Holding
s�
El 8. Separation/Segregation/Protection El 20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing r REQUIREMENTS FOR HIGHLY SUSCEPTIBLE=POPULATIONS
❑21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing CONSUMER/IDVISORY,'�,
El11. 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
Cm by a Board of Health member or its agent constitutes an
23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-4)(590.0044))) cited in this report may result in suspension or revocation of
25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5>(5so.ocs) 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. �1
30. Other DATE OF RE-INSPECTION: -Y a_^p S( y
s 5so1ns IFum 14.x 1 f.e U L CA Xb:i-✓.am
^� \\
Inspector's Signature: R AjD N-O Print:
'�I n l
PIC's Signature: SEMI,a ��u.)v� Print: c)(,v 0,u- Page of2-bges
Violations Related to Foodborne Illness
Interventions and Risk Factors(Items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT F g Cross-contamination
1 I 590.003(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*
2-103.11 Pe son in char<e-duties Contamination from Raw Ingredients
3-302A I(A)(2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 59UO3(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11(A) Foal Protection* -
a plicants* 3-302.15 Washing Fruits and Ve.*embles
590.003(F) Responsibility Of A Faxl 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(6) Reporting by Person in Charge*
3-306.14(A)(B)_ Returned Food and Reservice of Food*
3 590,003(D) Exclusions and Restrictions* - - Disposition of Adulterated or Contaminated
590.003(F.) Removal of Esclasions and Restrictions Food
3-701-1'i Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE
4 Food and Water From Regulated Sources �) 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 Hermetically Sealed Container* Sanitization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.1.3 Shell Eggs* Sanitization Temperatures*
3-202.14 E< >s and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,-
3-202.16 Ice Made From Potable Drinking Water*
concentration and hardness. *
5-101..1.1 DrinkinE Water from an Approved System* 4-601-17(A) Equipment Food Contact Surfaces and
590.006(A) Bottled DruLmg Water* Utensils Clean*
590.006(B) Water Meets Standards in 310 CMR 22.07` 4-602.11 Cleaning Frequency of Equipment Foixl-
Shel ish and Fish From an Approved Source Contact Surfaces and Utensils*
3-20114 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-HotWaterand
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 10 Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms*
3-202.18 Shellstock Identification Present* 2-30112 Cleaning Procedure*
590.004(C) Wild Mushrooms* 2-301.14 When to Wash'
3-201.17 Game Animals* 11 Good Hygienic Practices
S Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco*
3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and
3-202.1.5 Package Integrity* Mouth`
3-101.11 Food Safe and Unadulterated* 3-30112 Preventin Contaznination When Tastin
6 Tags/Records:Shellstock L12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(F.) Preventing Contamination from
3-203.12 Shelistock Identification Maintained" Employees*
Tags/Records:Fish Products 13 Handwash Facilities
3-002.11 Parasite Destruction*
Conveniently Located and Accessible
- 3-402.12 Records,Creation and Retention* 5-203.11. Numbers and Capacities*
acities*
590.004(.1) Labeling of Ingredients` 5-204.11 Location and Placetnent*
7 Conformance with Approved Procedures
5-205.11 Accessibility,Operation and Maintenance
/HACCP Plans Supplied with Soap and Hand Drying
3-502.11. Specialized Processing Methods* Devices
3-502.12 Reduced ox enacka h ,criteria* 6-301.11 Handwashipf Cleanser, Availability
8-103.12 Conformance with Approved Procedures* 6-301.1.2 Hand Drvin Provision
*Denotes critical item in the federal 1999 roal Cade or 105 CMR 590.000.
(T1 R JJ
BOARD OF HEALTH
Establishment Name: `���h Date: r'/n �� ��(/Pt Page: Of
Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
No. Reference R-Red Item >,'
PLEASE PRINT CLEARLY / /{ Verified
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Discussion With Person in Charger Corrective Action Required: � Nci ❑Yes
❑ Voluntary Compliance ❑ Employee Restriction/
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
r » ❑ Embargo ❑ Emergency Closure
. � ❑ Voluntary Disposal ❑ Other
c - FORM 7348 (REV. 7/2000) HOBBS &WARREN, - BOSTON I This Form Approved by the Department of Public Health ,
! I
Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures
Factors(Red Items 1-22) (Cont.) According to Law Cooled to
41°F/45*F Within 4 Hours.*
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
14 Food or Color Additives 19 PHF Hot and Cold Holding
3-202.12 Additives* _ 3-501.16(8) Cold PHFs Maintained at or below
3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F*
15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F.*
Containers* 3-501.16(A) Roasts Held at or above 130°E*
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP)
7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.12 Chemicals for WashingProduce,Criteria* Beverages with Warning Labels*
7-204.14 Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.*
7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.*
7-206.13 Tracking Powders,Pest Control and
Monitoring* CONSUMER ADVISORY
22 3-603.11 Consumer Advisory Posted for Consumption of
TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or
16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate
PHFs Pathogens.* Effective 1/1a001
3-401.11A(I)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
Eggs-Immediate Service 145"F 15 Sec.*
3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS
Animals-155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.1l(B)(1)(2) Pork and Beef Roast-130°F 121 Min.* catering, mobile food,temporary and
3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F*
3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the
3-403.11(6) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be
Time* found in the following sections of the Food Code and/05 CMR
3-403.11(C) Commercially Processed RTE Food- 590.00.
140°F* Item Good Retail Practices FC 590.00
3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003
Roasts* 24. Food and Food Protection FC-3 .004
18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005
3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006
70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007
to 41°F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008
3-501.14(8) Cooling PHFs Made From Ambient 29. Special Requirements .009
Temperature Ingredients to 41*F/45°F 30. Other
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Commonwealth of Massachusetts
City of Salem
Board of Health
120 Washington Street,4th Floor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 05/05/2008
ESTABLISHMENT NAME: Josh's Place
File Number:BHF-2003-000050 72 Wharf Street
Salem MA 01970
LOCATED AT: 0072 WHARF STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2008-0021 Jan 3,2008 Dec 31,2008 $70.00
TOBACCO VENDOR BHP-2008-0047 Jan 3,2008 Dec 31,2008 $135.00
Total Fees: $205.00
PERMIT EXPIRES December 31, 2008
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
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 ,L/ Date T e of 0 eration s T e of Inspection
l i�25 ri Food Service outine
Address 77 G✓hl/6 ST Risk ' ❑ Retail El Re-inspection
Level ❑ Residential Kitchen Previous Inspection
Telephone ❑ Mobile Date:
El Temporary ElPre-operationOwner / / HACCP Y/N 71 ❑ Caterer ❑ Suspect Illness
Person in Charge(PIC Time ❑ Bed&Breakfast ❑General Complaint
IL
In: ❑ HACCP
Inspector N)j-A_) �> Out: Permit No. ElOther
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.
F006PROTECTIONMANAGEMENT w
J,�`� -' �"k
m _ _ -. ❑ 12. Prevention of Contamination from Hands
❑ 1 PIC Assigned/Knowledgeable/Duties
❑ 13 Handwash Facilities
= EMPLOYEE HEALTHY,
nr����. i tl ,n fir,
❑ 2. Reporting of Diseases by Food Employee and PIC k
[114.Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals
,FOOD FROM APPROVED SOURCE _. .
El 4. Food and Water from Approved Source 'TIMEITEMPERATURE CONTROLS(Potentially Hazardous Footls). {p
[15. Receiving/Condition ❑ 16 Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1 B. Cooling
fi PROTECTION FROM CONTAMINATION f' ':s 3 '""r r '' jai t ❑ 19. Hot and Cold Holding
El 20.Time As a Public Health Control
[]iB. Separation/Segregation/Protection
0/9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR-HIGHLY SUSGEP,TIBLE P{PULATiONS
❑21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices "CONSUMERADVISORY;�
❑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 7
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 TRI by a Board of Health member or its agent constitutes an
23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations#
✓' 24. Food and Food Protection (FC-9)(9590.090.0 044)) 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)(51o.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,5001nsp ror 14.do
Inspectors Signature: Print:
t PIC's Signature: 'V.:� � Print: �C -CL_t�-G Page of�Pages
�. ��%
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT F 8 Cross-contamination
1 I 590.003(A) Assignment nfResponsibility* 3-302.11(A)(1) Raw Animal Foods Separated from
590.003(B) Demonstration of Knowledge* Caked and RTE Foods*
2-10311. Person in charge-duties Contamination from Raw Ingredients
3-302A I(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 3-3021.1(A) Food Protection*
a plicants* 3-302-15 _Washmg Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils*
Charge' Contamination from the Consumer
590.003(G) Reporting by Person in Charge* 3-306.14(A)(.B) Retuned Food and Reservice of Food*
31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003(E) Removal of Exclusions and Restrictions Food
J-101.I I Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 1Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501.111 _Manual -Hot Water
3-201.1.2 Food in a Hermetically Sealed Container* Sanitization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501112 Mechanical Warewashing-I-lot Water
3-202.13Shell Eg s* Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 ChettrtcaL SanifizaCion-temp.,pH,-
3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. "
5-10111 Drinking Water from an Approved System* 4-601.-I I(A) Equipment Food Contact Surfaces and
590.006(A) Bottled Drinking Water* Utensils Clean*
590,006(B) Water Meets Standards in 310 CMR 22.0"' 4-602.11 Cleaning Frequency of Equipment Food-
Contact Surfaces and Utensils*
Sheldish and Fish From an Approved Source 4-702.1 1. Frequency of Sanitization of Utensils and
3-201.1,4 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment*
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
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms*
3-202.18 Shellstock Identification Present* 2-301.-12 Cleaning Procedure*
590.004(C) Wild Mushrooms* 2-301-14 When to Wash*
3-201.1.7 Game Animals* 11 Good Hygienic Practices
g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-20211 PHFs Received at Proper Temperatures* 2401-12 Discharges From the Eyes,Nose and
3-202.1.5 Package Inte it * Mouth*
3-101.11. Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting*
Tags/Records:Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* - Employees*
Tags/Records:Fish Products 13 Handwash Facilities
3-402.11 Parasite Destruction* Conveniently Located and Accessible
5-203.11 Numbers and Capacities*
3-402. R Creation and Retention* 5-204.11 lAication and Placement*
590.004(4(7) Labelingbeling of Ingredients'
g Conformance with Approved Procedures 5-205A1 Accessibility,Operation and Maintenance
/HACCP Pians Supplied with Soap and Hand Drying
3-502.11
Specialized Processing Methods* Devices
3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability
8-103.l2 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision -
Denotes critical item in the federal 1999 Foal Code or 105 Ct4R 590.006. -
CITY OF SALEM
- BOARD OF HEALTH
Establishment Name: /GS/ ICQ Date: `r � ' Page:_ of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY.
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Lt 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
's your food permit.
Li Disposal ❑ Other:
l
Y
3-5(3t_14(C} PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to I.aw Cooled to
Factors(items 1-22) (Cont.) 41°F/45°F Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Coolie Methods for PHFs
14 Food or Color Additives 19 PHF Hot and Cold Holding
3-202.12 Additives_`
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/45°F�
3-302.14 Protection fram'Unapproved Additives*
15 Poisonous or Toxic Substances 3-501.1(i(A) Hot PHF,Maintained at or above
4WF. *
Co
7-101.11 Idecontainers*ntaInformation-Original 3-50116(A) Roasts Held at or above 1300F.=`
containers-
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Storage" 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use*
590.004(H) Variance Re nlrement
7-202.12 Conditions of Use"
7-203.1.1 Toxic Containers-Prohibitions'` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11, Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Was hin,Produce,Criteria'` 22 3-801.1](A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents.Criteria*
_ Heveraees with Warning labels*
7-205.11 Incidental Food Contact, Lubricants* 3-801.11(13) Ilse of Pasteurized Eggs,
* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.11 Restricted Use Pesticides. Criteria Raw Seed Sprouts Not Served.
7-206.12 Rodent Bait Stations* 3-801.(1(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
t6 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or
PHFs Not Otherwise Processed to Eliminate
Pathogens.r
3-401A IA(i)(2) Eggs- 155'F 15 See. '
ErfeL'""e v+am�
E ccs-hmnediate Service 145-'Fl fixer- 3-302.13 Pasteurized Eggs Substitute for Raw Shell
3-401.11.(A)(2) Comminuted Fish,Meats&Game
Animals- 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 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
sec. * entering.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
Poultx or Kadtes-165°F 15 sec. * above if related to foodborne illness
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and tisk 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 PHFs--145'F '15 sec.
17 Reheating for Hot Holtling VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.11(A)&(ll) PHFs 1650P 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 interventions and riskfactors listed above., can be
3-403.11(C) Commercially Processed I2TE Food- found in the following sections of the Food Code and 105 CMR
140'F* 590.000.
3-403-1.1(E) Remaming Unsliced Pa dons of Beef Item Good Retail Practices FC 590.000
Roasts` 23. Mona sment and Personnel_____ FC-2 .003
(g Proper Cooling of PHFs 24 Food and Food Protection __ FC-3 .004
3-5(11.14(A) Coolie r Cooked PHFs £rum 140°F to -5 E uipment and Utensils FC_-4 005
26, Water,Plumbing and Waste FC-5 _.006_
70'F Within 211ours and From 70'0 27 Ph sical Facili FC-6 007
to 41.'F/45'F Within 4 Hours. ` 28. Poisonous or Toxio Materials FC-7 .008
3-501.14(B) Cooling PHFs Made From Ambient 29. 9 ecial R uirsments .009
Temperature Ingredients to 41"F/45`F 30__----Other __------`--------
Within 4 Hours:'
°Denotes critical kern in iha rAci al 1999 Food Code or 165 CMR 590.000.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: ;o4 S ���i�P Date:_107 C-16`7 Page: of 3
Item•I' Code' C—Cntical Item 1 - r DESCRIPTION OF VIOLATION!PLAN OF CORRECTION x:' "� "? ' Date '
No!'j.:, Reference R=Red Rem i ' �y,"`a� p ro rte. _yy �.,, i ;� � �_ - e/ Verified
',� t %' "% `'; z PLEASE PRINT CLEARLY F Y a'`x ""+ af'".,fv"3
Z � 'Jl�� [ �; � !✓vr r r r^ �l/G � �D/t .� vC�r/r vt �'ii�wa� � oii� i<�c
• J J
2� ✓ IAI— "P �kl-I <, W4ivo vPrd / bo . , q (v14c/e- ccvow )
y r�i kl�/ 0,7I bai; 60//
(( r rr tt cc �T Vy
l W v ) U--P b - 1 NV C'Ke dT t d t- -2 1 o 6C
3 I
�t ,1J ,J
` W G ::&(C �- ro o xn IVP ' J ✓2 S Ci V(/I r ✓Al J C GI 2 c� ins �'t:\/S ✓fi-- AY!
r
i I VOFeC� (, �C �/-fir(.✓ -a.-� �L`. -tUb r� S 1'v� (.� ✓�C�.f._�e � t 'l�p4CI\
V1 O (c C"/C�v� S Irl Lk COY de C-(-7J
F Y
-F-HF
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
i
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.
0 Voluntary Disposal ❑ Other:
F a-507 PHFs
Violations Related to Foodborne fitness Interventions and Risk Accordin,
Factors(Itters;I-V) (Copt) to La� Cooled to
I I rFi45'F Within 4 Hours.
PROTECTION FROM CHEMICALS
19 PHF Hot and Cold Holding
E4 Food or Color Additives
3
Ad Ti N,c,' }1.16(B) Cotrl PHFe f lvmt�urmd at or below3-202,12
590 oxcl'a
3;_30214 Protection front tLna)pro% d
1,1 6(A) Hot PIIF� %xiinained at or above
FIT Poisonous or Toxic Substances
:7101.11 1 liientitywg moll ircluon -kniginal 140'F.
I7 I Cotuan ens 3-501,16,A) Rousts Hold at or above 130'V,
My
f-I-Tl Conamon Name- 'Alorkinx,Conwulers* Time as a Public Health Control
i "7-2fil11 50;'N Time as a-i;;bfic Health Eni 110
�
7-202.11 Restriction Presence and Use* 90.9044f) Variance
Re ttireruent
7-202.12 Conditions of Usc�
'103 11 Toxic f iintainM klrolhhi:ions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE
sarxilorer�'crileri:x...Chculic'ils�
7 .04 POPULATIONS{HSP}
s for!V'L1�lh1V1lrx)dj t Q it t I(A) Urnpamernriz-A Pre-pac",l)ged Jmot�Will
"(4 12 htocill [-2
—— iE Bc.voiages leith Warit Labclii�
204 14 1),V, xiteria��
-1 f
s 11
hicidemill Full]Contact lilbi wayns,
Raw or Partially Cook-ed Animal Food and
?-206.11 Retri dea Ust lle�heides'Crnvriu� Rav,,SeodSpnints Not Served,
7-206.12 Rodent Bmt statioic,' 7x-
7-346.13 'I'l-aalng Dluxde!&S', Contra) and
CONSUMER ADVISORY
22 0
-�T, 1 1 (013
TIMErrEMPERATURE CONTROLS F. 7
Anhaal '11ca are Raw, Undercooked or
1 16 Proper
PHFs Not Othem isc Prrxl!ex�,sed to E'lipuruve.
3-dOtltAtl i(2, rg&�- 15i'F 15 Path"welo,
�5'F I 5gxu�' --302 11
fiorueLT' "�e±vic� 'g� Subsuitine for Raw Shell
-kh-MeWs
—1 ZOI-f I(A)I 4) Conhointlied F , &cenDt
Arxima-1s 1551-' Ifisec. '
3' 4 SPECIAL REQUIREMENTS
01.1103NW2) Porr and 11cel Ruitil- 1301' 121 oi0 -FS—ection .590.009iA)-(D) in
-740 1.11(Ah 21 Rulne ' lllicol�d McdN 1-55 F 1559 0
sec. caterine. rnobilc tood,tellipural v and
rcmdeul7al-kitchen cipenitiorosshoald Be
401AI(Ah3) poultry, )A�lid
SluffillgConlaininy Fish, Meet, dchired tander the appropriate sections
Poukry v katnes 165"F i 5 sec. anue if rcjai;d to floliborne illness
'laFllmi�c)(I) Whole-mus,:1a; Intact Beef Sneaks mint vent ons and risk factors, Other
1451, 1 590 009 violations relating to goal retail
I 3-40i.12 llaw Arxuia�T Ford,Fxxk7d in firacticeshould be debited under#29 -
Miciowaw 165'F
Special Requirements-
3-401A I(A)(l 1{b) {vii Otbei P14F, - 145`3 15 sec.
L l7 _Pchealing lot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-103.11(A)&,(D) Plll;; 165tT 15 icx', (Iterns 23-30)
-1— —7�i
--403-11(B) rolvave, 165-'T, 2 klima, Standing Critical andnon-,,diral riol,,awnx, which do trot relate to the
thor", 'S
PlOdbrxroe illruis�alleivenliomy undn 41,olors 1i-V tcdahove. we be
3-40111(C- Comyrierciaif, Processed RTEForsd-
firund in the,fiiik>n-wg tecdocs oIxtre Fund Code and 105 CkIR
--------------
3-1103.11(F
Reatainiro, Ujirfir-ed Portions(if Beef FC 590.0w
Personnel f oaiIg ! -
-- -iTra—percooling of PHFs 24, 1 Food!and Food Prorecnon FC--3 004
3 501.14(A) Coolim,Cooked PHF� filim 140' -
I F to 26 t Ntatot Pil.manriandWeste i FG-5 006
700F Within 11 Mows and From 701 --j
2" Phrelcal Fae�!!N, FC-6 007
in 41 J-145'1-Within 4 Hours
Poisonous or Tlnur Materials FC -7 OOB
3 S'
loliag Plifis Made Front Ambi
56TI4(B) cut
II Temp-'fature Ingredunas to 41'F/45'F 1 30 i Other
Within 4 llouis�
Bono es vein ill lhr Estero;1994 Forel C'Ae of 165 CMR 590 000
.. CITY OF SALEM
BOARD OF HEALTH
{{( Establishment Name: Tsi/-< 4 C-e! Date /612/6-7 Page: / of
4 item Code C-Critical Item - s ea Tr DESCRIPTION OF VIOLATION/PLAN OF CORRECTION '= a x 4 10, Date
{
No. ; Reference, R-Red Item _ t �, - - n.'� „. , - verified
�` PLEASE PRINT CLEARLY ” '
i
i
v c , ✓♦ Cn I �2G S �X Un / C
_ s
l ;
I
Y
T
t
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
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. ! \ `=
\� o ❑ Voluntary Disposal ❑ Other:
Vialattorts Related to Foodborne Illness Interventions and Risk According to Law Cooked to
Factors(herd;1-22) (Cont)
WF'i45'F Wfthin,l Hours
PROTECTION FROM CHEMICALS coolue,Methods for IIHF�
L-14 Food or Collor Additives PRF Not and Cold Holding
)-202 12 1 Addinivo�`� '3-501.16(g) Cold PHF,,Maintained at or below
3-302.14 -�F
590 004(1`�
Protection froul Unapproved Addifi"es
EEPoisonous or Toxic Substances -T.-5M) 7T6(7A) ll,,t PHF,Mailonined at of above
140'F.
IN 11ldealt�,7,8 Intc...w7wn70nmai
Containers -501.16(A) I Ramlas Held at or above 130,"F
Time as a Public Health Control
102,11 anL 112
--�. J�,ajth(-om,7oll
T CorwaoriName- Wo6in—(�— T1-- 1 , 5012)—
--tTjw�a
'S2a'X k 11 u)1a e 1
R-sLtricflon U€o* 590JI04(11) Variance R
-202-1? ("Ondiflom of Use*
7-202.11
7-?03.I1 Toxic Coniaincis-- Prohibito)m* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULA IONS{HSP
FT204TI Savrico,Cwerja -Chemic lv
-Z fi�nu for W h 13
-204.12 21 3-S01 H(A) Uripaqteurizcd Pce-pactaged Juices and
7-?04 Bev'ra"e""th War
1 3-S0 1 11(B) ii Uw of Pasteuiiz<d E....
;-20,5,11 hui&mal F�xxl CornactlAtin icant S,
L�-2t�() I Restric(ed Uw Pe�tn,ides,C T�w.I I(D) Raw or Partialiv Coof�d Animal Food and
7 206 12 -R B art S loo�' Rav,st'('d SproulsiNot Scived.
L(C! 21na ned 1tcod Packa ,IL Not Re-served.
06.13 Trtckinfi P.111 Control ontrol and
CONSUMER ADVISORY
"u, n lod�'Hca arc Raw, Undcr"x)loed
35 Proper Cooking Temperatures far TIMEITEMPERATURE CONTROLS -�2T�F Consumer Actyisory Nvaed 14 Consuniptio
PHFs III Not Otherwise flr(we5sed to Eliminate
Patho on
Egg�� 155'F 15 Sla��
It"k(l)(
haus drite SeLvicv 145'F 1 5sec, ll'.teary d Eggz'suhmi"itute fol Raw shell
3-4011-- UA)(,) comnonwe'd Fieh'Mcat,& Gallic
Animals
3-461.11(N)d 92) Poik and Beet Rixtsi - 1301- 1-)I mii)4 SPECIAL REQUIREMENTS
590'00q(A)-TF)j --
590—�i)%A)-(D)in
3-40 1.11(A)t 2) llafites, hijeoai '%lkals - IS5 3F 15
sic x caterwsi. mobile"al, tearkporarvand
111-fiFs, reside qWal koclitti operations should be
so)(file,Containing Fish,hlhl t t debtd under the appropriate sections
l"athr, Sec ohuve if related to fbxAlx)rne ifhws5
3-401ANC (3) aYhsle mug le,Intact Beef Steaks inter enttons and risk factors Other
145'T '1 590.009 violations relating to good retail
1 3.40L F2 Raw AretrW i7od,—Coljke',Ill a praefices, should.he debited under i29 -
Mfco),Aave 165*F
461,11(A)(1)(b) Mi Other PRFs - 145"F 15 sec Special Requirernont%-
--7 Reheating for Hot Holding VIOLATIONS RELATED To GOOD RETAIL PRACTICES
x103.1 i(A)&(F)) PHI-s 765'T 151 (Ithn'ts 23-30)
3-403,11(H) -Microwave- 165°F2 Nlinuia Slarefin,, Ciihkwl wul tlon-crol(wi wulahons, which do not relate In the
— Tillie, foodborne ilInass haet ventiow and riA jot sort listed above, (on be
anti in nhejnwoiwig sectiorls of thc Rlod(ode and 105 041?
,403A I(C) Commercially Processed Rf't-',Fxxi-
140'P 590600.
3-403.1 I kE) Reastvaal� Unslk'ed Portions,of Bml' Item Good Retail Practices FC 590000
Roast,* I r-
_LaDL
'i sy�nnd -4-F q--
IS Proper Cooling of PHFs 124 Food and Food Protection FC--J 004
FC -4 00-5
3-501.14(A) Cooling
C• ooked PRFs Rom 1401,to
70'F Wition 2 Hours and From 70'F L 27 Phy��ral Facilit
L_ FC-6 007
o,41'F145'F Within 4 Hairs.
7 008
3-501 14(B) Corlhug PHFs Made From Ambient 21.), 009
i—her
Temperature InInredietu�to 411 i45`F Other
Within 4 Ifour�
llanklles Iritil:Al nem in rhe itkra! N99 Fooa Cook or I Of C MR 590(4)(1,
/ 0072 Wharf Street Josh's Place
City of Salem
RETAIL FOOD - Food Establishment Inspection
HACCP: ❑
Item Status Violation Critical Urgency
I Telephone: PROTECTION FROM CONTAMINATION
745-6659 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED
Owner: mment:Ice scoop in slush freezer stored on top of a bag of ice.Ice scoop must be stored in ice with handle out or in a clean
Joshua & Kimberly Gray . dedicated container labelled for ice scoop only.
`PIC: - amtizer not reading at any ppm,and log not up to date. Provide sanitizer of proper concentration at all times,maintain daily log of
t Dave:Doucette sanitizer concentration,and record ppm on log. -
alnspector: - Violations Related to Good Retail Practices (Blue Items)
Elizabeth Salandrea Equipment and Utensils FAIL Non-Critical BLUE W
Date Inspected:Correct By: mment•. GE freezer in back needs general cleaning.
15/6/2008 10(ush freezer needs general cleaning.
Risk Level:
_ Vft pizza cooker needs general cleaning.
jPermit Number: cream freezer needs thorough cleaning.
BHP-2008-.0021
Status:
VIOLATION
#of Critical Violations:
�1 i
Time IN: ' Time OUT:
E
'Urgency Description(s):
BLUE: Reinspection in one week, all violations to be corrected.
Violations Related to Good
'Retail Practices (Critical Owner to have last 6 months of extermination receipts available upon reinspection.
violations must be corrected
.immediately or within 10
iays)(Non-critical violations
must be corrected immediately
or within 90 days)
I j
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)747-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 07,2008 ) Page 1 oft
Item Status Violation Critical Urgency
RED:
,Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action).
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 07,2008 ) Page 2 oft
i Commonwealth of Massachusetts
City of Salem
Kimberley Driscoll
Board of Health Mayor
120 Washington Street,4th Floor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/12/2010
ESTABLISHMENT NAME: Josh's Place
File Number:BHF-2003-000050 72 Wharf Street
Salem MA 01970
LOCATED AT: 0072 WHARF STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2010-0265 Jan 11,2010 Dec 31,2010 $140.00
ESTABLISHMENT
TOBACCO VENDOR BHP-2010-0266 Jan 11,2010 Dec 31,2010 $135.00
Total Fees: $275.00
PERMIT EXPIRES December 31,2010
Board of Health 1.
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
CITY OF SALEM, MASSACHUSETTS
• BOARD OF HEALTH
120 WASHINGTON STREET,e FLOOR
TEL. (978) 741-1800
K NIBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DGREENBAUMnOeSALEM.COM
DAVID GREENBAum,
ACTING HEALTH AGENT
2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT �YO S V 3 e IG C.(_ -:Enc- TEL# Cl -78 "1 4 S- "59
ADDRESS OF ESTABLISHMENTyl h St FAX#
MAILING ADDRESS(if different) Sc\m e
EMAIL- Business': 'iGShSrlac :ncC��ahGO • Col Website:
OWNER'S NAME SOShua i1 K'.n1 G a.l TEL# O _7�- -7q5- 3(yJq
ADDRESS 0A \rJhct l SV Salt' M(I o 19 76
STREET ,, // CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) Kl rr-)bD of % j C `C' CERTIFICATE#(S)L�-5 39
3 /
(Required in an establishment where potentially hazardous food is p epared) /-
EMERGENCY RESPONSE PERSON 30SV1va 9 V%^) HOME TEL# G 13 - 7q5- 3 SP/
QAY51Q OPERA710N ( Monday Tuesda'� wWed_nesday Th7lrsdayF dCyWfl W- Saturdaye# I Sunday €
HOURS OF OPERATION I
Please write in time of day. C', 5
For example Ilam-11pm
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO Tess than 1000sq.ft. =$70
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
-
RESTAURANT YES NO less than 25 seats $1
(Outdoor Stationary Food Cart$211P 25-99 seats = 280
more than 99 seats =$420
---------------------------------------------------- - -
........... 1�
BED/BREAKFAST/ YES NO $100
CHILDCARE SERVICES/NURSINGHOME .................... �'�
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR 4� NO
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
rKetyms and pai all state taxes required under the law. ZO 3 S0 S 0 3 S
�a T''^� \2J& I o 9
Signature Date Social Security or Federal Identification Number.
Revised 424/07 FOODAP2008.adm Check#&Date $
LIMFOR_TA NT MESSAGE
Zr(lFOR� /DW)
A.M.
DATE LI/3% TIME P.M.
M5t�
OF��S ti IQCR--
ry
PHONE ARE
AREXCODE NUMBER EXTENSION
itJ FAX
r� tl
MOBILE �I - 6� / Jr►�
AREA COO. NUMBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN'
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TC YCU
MESSAGE
V_..
��GGhCYwtC�l yy�kf(1r�
u
SIGNED
WipsFORM 4009
MADE IN LLS.A.
NOTES
Josh's Place
72 Wharf Street
Addendum to the menu
Lobster Rolls
The meat is distributed by our current wholesaler Shaheen Bros.
The meat comes pre- cooked and frozen in an air sealed bag. The meat is defrosted over
night in the refrigerator in a large container on the bottom shelf. The meat is kept for up
to three days in a clean container that is labeled with the throw away date. The lobster
roll is made to order(mayo or celery can be added). The mayo (in a squeeze bottle)
and/or celery are added to the individual serving of meat in a throw away styrofoam
container(ice cream cup). The meat is served on a hot dog roll and is served in a
styrofoam hot dog container. Gloves are worn during the process.
Chicken Parmesan and Chicken Cordon subs
The chicken patties are distributed by our wholesaler Shaheen Bros.
The patties come pre- cooked and frozen and go from the freezer to the microwave for 3
minutes. Jar sauce, provolone, and parmesan cheese are added during the heating
process. Chicken Cordon uses the patties with ham and swiss cheese served on a sub roll.
All the sauce, cheeses, and ham are stored in the sandwich unit.
Any questions please feel to contact me.
Thanks, Kim Gray
I
Commonwealth of Massachusetts
« e
City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 05/04/2009
ESTABLISHMENT NAME: Josh's Place
File Number:BHF-2003-000050 72 Wharf Street
Salem MA 01970
LOCATED AT: 0072 WHARF STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
TOBACCO VENDOR BHP-2009-0263 Dec 29,2008 Dec 31,2009 $135.00
FOOD SERVICE BHP-2009-0452 May 4,2009 Dec 30,2009 $140.00
ESTABLISHMENT
Total Fees: $275.00
PERMIT EXPIRES (December 30,2009
Board of Health, Q(',
�KGErG�
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
v
CITY OF SALEM, MASSACHUSETTS
` BOARD OF HEALTH -
120 WASHINGTON STREET,4""FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR IMANCINI&A1.EM.CONI
JANET MANCINI,
ACTING HEALTH AGENT
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT / /
NAME OF ESTABLISHMENT J OS 1'1 S `Q Le- TEL# � —I O -7 S " l9lD 5 I Q
ADDRESS OF ESTABLISHMENT -72 Wham Skree.} FAX#
MAILING ADDRESS(if different)
ca iYI
EMAIL- Business': t(3ShSD1QC2 .hc�. \IQh&y Website:
OWNER'S NAME70Shua�t 1�'.lr,b_r ,� G ra fi TEL# g 1� -7H5 - 3 58
ADDRESS \ Osq wy-\w � SAreei 5ate_rn MA 01170
STREET ,,// CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S)_ V.%M be-r \�4 CERTIFICATE#(S) 95 -73937
(Required in an establishment where potentially hazardous food is preps/ )
EMERGENCY RESPONSE PERSON_aO Sh U CE1, K '^ b e r tY HOME TEL#—q -7 $ " 7 (-I S' 3 EE
DAYS OF,OPERATION Mond 1 Tuesda_y Wedhesd Thursday,,"s;. . FriA Saturday Sunday
HOURS OF OPERATION (� S�f.n9
Please write in time of day. Ol C ,_6 94
(a 1 ` ` 1�oJc,SJ
(For example 11 am-11 pm) l
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$ 70
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
-------------------------------------- ------------------------------------------------e-s"s'----------------------------
RESTAURANT YES NO less than 25 seats =$14
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
BED/BREAKFAST/ YES � $100 (
CHILDCARE SERVICES/NURSING HOME
------------------
ADDITIONAL PERMITS
MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES 10b $25
TOBACCO VENDOR (a) NO $135
ALL NON-PROFIT(such as church kitchens) YES $25
"Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax
returns nd paid all t e taxes required under the law.
returns
-Jlglo 7 012 - 52 - 09?/
Signature Date Social Security or Federal Identification Number
Revised 4/24/07 FOODAP2008.adm Check#&Date
IMPORTANT MESSAGE
FOR t-l-A �
DA
T
E TIME
OF
PHONE
AREA CAGE NUMBER EXTENSION
O FAX
O 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
FORM 4009
MARE IN U.S.A.
NOTES
5hc�heell 13S6S. C�',S�r �'>.� aes
� rte- ��•• ��.� m� a� s
1C:bJ -, 2C
IM434M AiM kmewwmf e
as 0AW&V 0-Al~tsP
•
40"POP - ce"M ropSODA rc►v
Speelalty Sandwiches Your Choice Of Bread:;White,Wheat, Spetlalty Not loft Dogs
Add Chips,Cale Slaw and 20 oz fountain soda for 1.75 Marble, Lite Rye, Pita, Wrap Make it a 1/4 pound Hot Dog for a$1.25
Veggies: Lettuce Tomatoes Pickles Hot Hot Dog...............................2.75
Big Josh............................7.50 Chili Do ..3.50
Josh's favorite, triple decker of Ham,Roast Beef, Peppers, Onions, Black Olives tided Ch ddar Ch ese
p Chili, Shredded Cheddar Cheese
Turkey, Swiss Cheese,Coleslaw and Russian Southern Do 3.75
DressingDressin • Ketchup, Mustard Mao Hone gnion................
g• P> Y Y Chili, Slaw and Onions
Mustard, Russian, BBQ, Thousand Island, Southern BB Do 3.75
Haile ..........6.50 French, Oil & Vinegar BBQ Sauce,Baked Beans, Slaw and Onions
A small version of the Big Josh Chicago Do .......3.99
Cheese: AmericanSwiss Provolone. Mustard,Onions,Relish,Tomato Wedges,Dill
Kimberly..........................6.50 Pickle, Sport Peppers&Celery Salt
Kimberly can't complain about this one! Tuna on a r New York Dog .........3.25
Mustard& Kraut
Pita Bread with your choice of Veggie's and Cheese Sangwit'`eS Set S
I1 / � ,
with Thousand Island or Russian Dressing Add Chips,Cole Slaw and 20 oz fountain soda for 1.75 Rueben Dog..........................3.25
Sandwich Sub/Wray Melted Swiss,Mustard&Kraut
The Dave........................:.6.99 Roast Beef 5:25 5.99
Triple Decker Club Sandwich with your choice of Turkey Breast 5.25 5.99 fesh Salads
Roast Beef or Turkey Breast with lettuce,Tomato,
Bacon,Mayo Ham 5.25 5.99 Served with your choice of Salad Dressing and Pita
Corned Beef 5.50 5.99
Garden Salad.......................4.50
Nathaniel Hawthorne.....6.50 Pastrami 5.75 6.50 Mixed Greens,Tomatoes,Cucumber, Red Onions,
Triple Decker of Roast Beef, Turkey Breast, Corned Tuna 5.25 5.99 Carrots,Green Pepper
Beef Swiss Cheese Coleslaw Russian Dressin
g1
Chicken Salad 5.25 6.25 *Add a scoopf h'
o Tuna or Chicken Salad 1.75
Veggie 4.25 4.75 Chefs Salad.........................5.99
Salem Comwich,mon H...Pastrami o B.L.T 5.25 5.99
A wicked sandwich, Hot Pastrami on a Sub Roll, Garden Salad topped with Roast Beef, Turkey,Ham,
Coleslaw,Swiss Cheese,Russian Dressing Grilled Cheese 2.00 Bacon, Provolone
With Tomato 2.50 Greek Salad.........................5.99
The Friendship..............5.99 Extras Garden Salad Topped with Feta Cheese and Olives
A sub as big as the ship. Salami, Antipasto Salad...................6.50
Mortadella, Cappicola, Provolone, with your Cheese .60 Garden Salad Topped with Salami,Ham, Mortadella,
Coleslaw/Sauerkraut .75
choice Of Veggie's Cappicola,Provolone,Peppers,Hot Peppers,Black
Bacon .80 Olives,Onions, Fresh Mozzarella and Basil
IMORFAA01
MlIIARDfON'!1!E!IlEAM �� -JOSH'S PLACE I0AW"Y"
Vanilla - Chocolate- Strawberry ^ Fes- - Goe t PC*
Coffee - Mint Choc. Chip Cookie Dough ON
Choc. Chip- Green Monster- Butter Pecan PICKERING WHARF M .LOCATION
Maple Walnut- Moose Tracks Pickering Wharf
Cashew Turtle Josh's Place on Pickering Wharf is centrally 72 Wharf St
located in the heart of Salem. Known as' Salem, Ma 01970
RROZEN YOGUEIT Salem's gateway to seafaring activities. WHAT YOU CAN RIND AT
Purple Cow- Coffee Heath- Mint Pa This exciting market place is the past ` IOsll!PLACE
urp Patty ,
Oreo Cookie - Pistachio - Choc. Almond recreated. A harbor side village of shops
with elegant gifts from ItichRichie's Ice Cream
g g around the world,
1UGAE!99EE&Now RAT boutiques featuring the latest trends in Soda's Slush
Black Raspberry fashion, exquisite restaurants, and a marina Soda
catering yachts up tc 120 feet long. This Sandwiches
10CM=RUlil seaside getaway is surrounded by the true Salads
Lemon- Cherry - Watermelon essence of American History., With Hot Dogs &Pizza
Blue Raspberry historical sites such as Salem's Custom Muffins &Pastries:
House,National Maritime Museum and the Breakfast Sandwich's
House of Seven Gable located with in steps Smoothies
Regular Cone......................:. 3.35 of the wharf, and having Salem's largest Frozen Lemonade
Large Cone...........................4.00 industrial park, famous museums, and most Assorted Candies
inspiring restaurants in town brings a wide Ye Olde Pepper Candies
Add Waffle Cone.......................... .75.: Winfrey's Fudge &Chocolates
Sundae....................................5.50 variety of patrons to the area.
I Massachusetts's Mercury Soda
Brownie Sundae.....................5.95 Boston's Real City Soda Fountain Soda
At Josh's Place we pride ourselves to make
Create Your Own Sundae...:`. 6.50 New England Coffee
your visit a pleasant one. If you are lost or
Frappe.......:............................ 4.50 e .Lottery ;
Extra Thick Frappe................ 5.00 have questions on historic Salem we will . Magazines
Malts...................................... 5.00 gladly help. Please stop in and say hello to News Papers
Smoothies....:......................... 3.75 Josh! Cigarettes
Mercury Soda Floats..............4.00 ATM
Richie's Slush Sm................:.3.00 ICE
Med................4.00 & More
•Lg...................5.00 ' Spring Hours
Frozen Lemonade..................4.00 Monday - Friday 9:00 a.m. -6:00 p.m.
Josh's Special.......................5.50 Saturday- Sunday 9:00 a.m.-7:00 p.m.
A Triple Layer of Slush and Ice Cream Telephone: 978-745-6659
CITY OF SALEM
BOARD OF HEALTH
Name of Establishment: Josh's Place
Address: 72 Wharf Street
Owner(s): Kimberly & Joshua Gray
Phone: 978-745-3884
The owners of this establishment presented a new Menu and floor plan for
review in accordance with the State Food Code.
This establishment is primarily a sandwich shop with a small food prep area.
MENU/FOOD PREP
Frappes, scooped ice cream, hot dogs and pretzels. Deli sandwiches and salads
are being added. Breakfast sandwiches may be added in the future. These will
consist of frozen egg patties and frozen bacon micro waved and put on a bagel,
English muffin etc. Please notify the Board of Health prior to adding these items.
A Hand Sink must be located in each food prep and service area.
Hand sinks must have wall hung soap and paper towel dispensers. These must
be stocked at all times. Hand sinks must be used for hand washing only.
A 3-bay sink is also be located in this area to wash, rinse and sanitize all dishes
and utensils. The sink must be large enough to accommodate these items.
All floors, walls, and ceilings where food, utensils, paper products, etc, are
stored, prepared or served must be intact, impervious, and easily cleanable.
Any pre-made items must be purchased from a wholesaler licensed by the State.
Shaheen Brothers and BJ's and Costco will be the wholesalers.
All ingredients must be maintained at a temperature of at least 140 degrees F.
Also reviewed holding temperatures of 41 degrees F or lower for any cold items.
Reviewed rotation of holding bins in deli unit.
There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or
tissues must be used when handling such food.
CERTIFICATION
Kimberly Gray is a Certified Food Manager. Certificate number is 4573839
FLOORS and WALLS
All floors, walls and ceiling throughout the establishment must be intact,
impervious and easily cleanable.
RESTROOMS
Restrooms must have a sign stating that employees must wash their hands
before returning to work. Restrooms must be clean and sanitary. The woman's
room must have a covered receptacle.
EXTERMINATION
Monthly services of a Licensed Pest Control Operator are required. Please keep
receipts for inspections.
SANITIZING SOLUTION
Sanitizing Solution must be accessible at the food prep area and for the patrons'
tables.
Test strips corresponding to the kind of sanitizer, must be on hand to check
concentration of solution. Solution must be made daily, tested, and the results
recorded on a log sheet for examination by Board of Health inspectors.
Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles may
be filled there. Spray bottles with clean paper towels may be used, as well as
wiping pails with wiping clothes always held in the solution in the pail.
Trash will be stored in the complex's trash holding area. This and the outside
area of premises must be kept clean and sanitary.
A new food service permit reflecting the change to food service will be issued
upon receipt of the difference of$70.00 from the original retail food permit.
The menu and floor plan are approved as presented. Upon issuance of the new
food service permit the establishment is granted permission to resume serving
the items listed on the new menu.
Any further changes in the menu or floor plan must be approved by the Board of
Health.
44 � S- a
David Green aum Date
Sanitarian
�4 A—�, S✓ZI-la
Owner Date
(&PORTANT MESSAGE
F
R TE V7---ca TIME
OF q /
PHONE C' 9 '6 I
AREA CODE NUMBER PENSION
0.
O FAX
U 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
FORM 4009
MARE IN U.S.A.
NOTES _ �-
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Commonwealth of Massachusetts
City of Salem
Board of Health lQmber(ey Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 1212912008
ESTABLISHMENT NAME: Josh's Place
File Number.BHF-2003.000050 72 Wharf Street
Salem MA 01970
LOCATED AT: 0072 WHARF STREET
SALEM,MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2009-0262 Dec 29,2008 Dec 31,2009 $70.00
TOBACCO VENDOR BHP-2009-0263 Dec 29,2008 Dec 31,2009 $135.00
Total Fees: $205.00
PERMIT EXPIRES IDecember3l,2009
ti 1 „._..
Board of Health
`f— '
OT
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
in accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4""FLOOR
TEL. (978)741-1800
KIIv13ERLEY DRISCOLL FAX(978)745-0343
KYOR IDIONNI.`,@SALEM.COM
JANET DIONNE,
ACTING HEALTH AGENT
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT c p
NAME OF ESTABLISHMENT J OS K S G C L TEL#
ADDRESS OF ESTABLISHMENT -72 W 1"1 G(-` S3 f s z4 FAX#
MAILING ADDRESS(if different)
EMAIL-Business': Website:
OWNER'S NAME V' rnlbC( l� 0 0 S hw c, G( r,. TEL#
ADDRESS Uu8 WhGvf St- SGllzm 1MA O1 �i70
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) ', ,r GmCERTIFICATE#(S) I45 73 $ 3 9
(Required in an establishment where potentially hazardous food is prepay d)
EMERGENCY RESPONSE PERSON K; m5 2r L f HOME TEL# cj -71-16 3 �?,ff
DAYS'OEOPERATION ' Monda 'Tuesday. Wednesda ,;:-Thursda :; '• •Frida I aturday, Sunda
HOURS OF OPERATION I l
Please write in the d day.
i
(For example 11 am-11 pm
9 _ ! I
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft.
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
RESTAURANT YES io less than 25 seats $14-0 /
(Outdoor Stationary Food Cart$210) 25-99 seats =$280 /3 5
more than 99 seats $420
�J
BED/BREAKFAST/ YES ® $100
CHILDCARE SERVICES
ADDITIONAL PERMITS
MAKE(notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES Q $25
TOBACCO VENDOR *0 NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
"Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax
retums an paid all staA taxes required under the law.
/2/i'�Otf 2o3 - So. So 3 s—
SignatureT Datei
nn'' Social Security or Federal Identification Number
Revised 424/07 FOODAP2008.adm Check#&Date a(1) Imo)alUj2j $ &Y
0072 Wharf Street Josh's Place
City of Salem
RETAIL FOOD - Food Establishment Inspection
HACCP: ❑
Item _ Status Violation Critical Urgency
Telephone: Violations Related to Good Retail Practices (Blue Items)
745-6659 Food and Food Protection FAIL Critical BLUE
Owner: Comment:Ice cream scoop fountain not running at time of inspection.Fountain must be on at all times ice cream is available to
Joshua& Kimberly Gray order.
}PIC: Equipment and Utensils FAIL Non-Critical BLUE
Josh Gray Comment: Ice cream freezer needs general cleaning.
j Inspector: Slush freezer needs general cleaning.
Elizabeth Salandrea
,Date IrlSpected:COrreCY By: Pizza freezer in back room needs new visible,accurate internal thermometer.
Date Insp9 Physical Facility FAIL Non-Critical BLUE
1 Risk Level: Comment: Screen door has gap at top.Seal any gaps around screen door to prevent entrance of pests.
I
Other-See Notes FAIL BLUE
t Permit Number: Comment:Establishment has started selling sandwiches and has a small True sandwich unit being used.Owner must submit new
Floor plan to the Board of Health with any new equipment,and may be required to meet with Health Agent regarding changes to
4 BHP-2009-0262 activities conducted at establishment.
i Status:
Establishment is also re-packaging candy to sell.Candy is purchased from Metro Candy and bags are heat sealed and labeled with
' Open store name,address,ingredients and nutrition facts.Inspector to call owner if any further labeling information is required on bags.
l#of Critical Violations:
11
Time IN: 7Time OUT:
Urgency Description(s):
BLUE: Owner to notify Board of Health within one week that violations have been corrected.
;Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 30,2009 ) Page I oft
Item Status Violation Critical Urgency
Violations Related to
Foodborne Illness Interventions i
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®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 30,2009 ) Page 2 oft
0072 Wharf Street Josh's Place
City of Salem
RETAIL FOOD - Food Establishment Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
745-6659 Separation/Segregation/Protection FAIL Critical Q RED
Owner: Comment:Two of the freezers in back room had hot dogs stored next to bread products.Properly organize freezers to separate
Joshua $ Kimberly Gray PHFs from RTE items.This was corrected at time of inspection.
PIC: Violations Related to Good Retail Practices (Blue Items)
''Dave Doucette Food and Food Protection FAIL Critical BLUE -
L Inspector: Comment:Approximately 12 sugar free red bulls and 2 packages of cheetos were removed,outdated.Owner to closely monitor all
expiration dates.
Elizabeth Salandrea
Equipment and Utensils FAIL Non-Critical BLUE
Date Inspected:Correct By:
1111812008 Comment:Mop being stored in bucket.Mop must be stored hanging to air dry.
Risk Level Slush freezer needs general cleaning.
Entire ice cream freezer has build up of ice cream inside and needs thorough cleaning.
Permit Number:
BHP-2008-0021 Sanitizer log is behind-sanitizer log must be maintained on a daily basis.
Status: Physical Facility FAIL Non-Critical BLUE
SIGNED OFF Comment: Front screen door has gaps at top and bottom. Provide door sweeps to seal gaps.
#1of Critical Violations:
2
Time IN: Time OUT:
Urgency Description(s):
BLUE: Owner to notify Board of Health within one week that violations noted have been corrected.
Violations Related to Good '
Retail Practices (Critical Please also fax or email October and November extermination invoices to the Board of Health within one week.
violations must be corrected
immediately or within 10 y
days)(Non-critical violations l
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 25,2008 ) Page I oft
v '!
r
Item Status Violation Critical Urgency
RED:
Violations Related to
Foodborne Illness Interventions.
and Risk Factors (Require
immediate corrective action)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 25,2008 ) Page 2 of
Y
0072 Wharf Street Josh's Place
City of Salem
RETAIL FOOD - Food Establishment Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone:
745-6659
Owner:
Joshua &Kimberly Gray
4PIC:
Dave Doucette
Inspector:
i Elizabeth Salandrea
Date Inspected:Correct By:
15/13/2008
Risk Level
,Permit Number:
BHP-2008-0021
9 Status:
SIGNED OFF
J#of Critical Violations:
10
Time IN: Time OUT:
Urgency Description(s):
.BLUE: All violations noted in the 5/6/08 inspection report have been corrected.
Violations Related to Good
Retail Practices (Critical Please fax February and March extermination receipts to the Board of Health.
violations must be corrected
,immediately or within 10
days)(Non-critical violations
'must be corrected immediately
or within 90 days)
I
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 14,2008 ) Page 1 oft
;r
Item Status Violation Critical Urgency
RED:
Violations Related to
Foodborne Illness Interventions
`and Risk Factors(Require 7
immediate corrective action) I
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 14,2008 ) Page 2 oft
0072 Wharf Street Josh's Place
City of Salem
RETAIL FOOD - Food Establishment Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: Violations Related to Good Retail Practices (Blue Items)
745-6659 Equipment and Utensils FAIL BLUE
Owner: Comment:White freezer requires general cleaning.
Joshua & Kimberly Gray
: Same unit missing thermometer.Provide visible and accurate thermometer.
PIC
_Kim Gray _ Tropicana refrigerator requires general cleaning.
Inspector:
John Gehan I Brown refrigerator freezer has accumulation of ice. Find source of leak and repair. Remove ice.
Date Inspected:Correct By: Sanitizer to be made daily with proper ppm as mandated. Log to be maintained daily with concentration level.
2/26/2007 GENERAL COMMENTS:
Risk Level: Owner to call BOH upon completion.
Permit Number,
.
BHP-2007-0066
Status:
SIGNED OFF
#of Critical Violations:
0
Time IN: Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 26,2007 ) Page 1 oft
Item Status Violation Critical Urgency
RED:
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
City of Salem Board of Health 120 Washington Street,41h Floor SALEM MA 01970(978)741-1800
GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 26,2007 ) Page 2 oft
CITY OF SALEM, MASSACHUSETTS
+ s 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 0 Sh 3 r,CL( --Q TEL# - I L _ tV lV Sq
I
ADDRESS OF ESTABLISHMENT �I 2- \r1 \lO f i FAX#
MAILING ADDRESS (if different) ea m-Q— t.
EMAIL--Business':-- Owner's: ,m�0 ( k o t-k c e- � e00
OWNER'SNAME 30Shvo, £A �',m�Zf �� G(Q�i TEL# G -l�- �H S- 3 �3 lj
ADDRESS �98S W,1QY S�C2e�t SA\em rnn- 011 -7o
STREET CITY STATE pZIP q
CERTIFIED FOOD MANAGER'S NAME(S) V • m 40er`*) G(a u CERTIFICATE#(S) 1.4 5-7
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON O w n F-,r 5 HOME TEL#
OAYSOFOPERATION Monday Tuesday Wednesday Thursday_ Friday Saturday Sunday
HOURS OFefutur of .
ON
Please write future of tlay.
flor example llam-tlnml
TYPE OF ESTABLI_ FEE check o
RETAIL STORE YES NO less than 1000sq.ft. 15
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
--- -------- -----------------_....-._...-- - --- - ...-..-... - ----- - - ...
RESTAURANT YES NO less than 25 seats =$100
25-99 seats =$150
rnore than 99 seats =$200
...--.,---_----._...-- - ._....._ --
_..-...-.. -- ------- ------ -----*-_-------...--
BED/BREAKFAST YES NO $100
__........... ----------------- ------------ -- --- -_. .. . . __.....,-..-_....... .-_...._.......-. .------- -....... .... ----. -
ADDITIONAL PERMITS
MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE NO
TOBACCO VENDOR NO
ALL NON-PROFIT(such as church kitchens) YES $25
-Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a
prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are
made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief,
have filed all state tax returns and paid all state taxes required under the law.
Signa ure Date Social Security or Federal Identification Number
------------------------------------ --- --------------------- ------ -----..----------- ------ ------------ ---------------. -------------- ------------ -----
Revised 11/13/06 FOODAP2007 adm /Check#a Date_1551_i?s2�o6 __ $ _Z 0 5
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`4ba • • s �..st 8rdOf Health
120 Wash ingt on Street,4th Floor IGmbe�Cy DaSeoll
.�: Mayor t
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 12/19/2006
ESTABLISHMENT NAME: Josh's Place
File Number:BHF-2003-000050 72 Wharf Street
Salem MA 01970
LOCATED AT: 0072 WHARF STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2007-0066 Dec 19,2006 Dec 31,2007 $50.00
TOBACCO VENDOR BHP-2007-0088 Dec 19,2006 Dec 31,2007 $50.00
Total Fees: $100.00
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 24
F0072 Wharf Street Josh's Place
City of Salem
RETAIL FOOD - Food Establishment Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
745-6659
Handwash Facilities FAIL Critical CI RED
Owner: Comment:The front handwash sink found obstructed. Keep hand wash sink clear and accessible at all times.
Joshua & Kimberly Gray Violations Related to Good Retail Practices (Blue Items)
PIC: Equipment and Utensils FAIL Non-Critical BLUE
Kim Gray
Inspector: Comment:The Pepsi Beverage air reach in needs a visible,accurate thermometer.
David Greenbaum The Tropicana reach in needs a general cleaning.
Date Inspected:Correct By:
10/5/2006 The ice cream freezer has an accumulation of food spills. Thoroughly clean the ice cream freezer.
Risk Level: The slush freezer needs a thorough cleaning.
The counter with the syrups needs a general cleaning.
Permit Number-
BHP-2006-012'0 GENERAL COMMENTS:
Status: 880:
SIGNED OFF
#of Critical Violations: l
1
I
Time IN: Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 06,2006 ) Page ! of
Item Status Violation Critical Urgency
RED:
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 06,2006 ) Page 2 of
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Commonwealth of Massachusetts
City of.Salem
Board of Health
sr
120 Washington Street,4th Floor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/03/2006
WHO'S PLACE OF BUSINESS IS: Josh's Place
File Number:BHF-2003-0050 72 Wharf Street
Salem MA 01970
LOCATED AT: 0072 WHARF STREET
SALEM,MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FROZEN DESSERTS BHP-2006-0121 Jan 3,2006 Dec 31,2006 $5.00
RETAIL FOOD BHP-2006-0120 Jan 3,2006 Dec 31,2006 $50.00
TOBACCO VENDOR BHP-2006-0122 Jan 3,2006 Dec 31,2006 $50.00
Total Fees: $105.00
PERMIT EXPIRES December 31, 2006
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 6
Y CITY OF SALEM, MASSACHUSETTS ?8�
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR ��
SALEM, MA 01970
TEL. 978-741-1800 QFC ® �C o
OF
STANLEY MAUOR VICZ, JR. FAx 978-745-0343
y WW.SALEM.COM eOq o�. 200,f
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
D
"1` h
2006 APPLICATION FOR PERMIT TOOPERATEA FOOD ESTABLISHMENT'
NAME OF ESTABLISHMENT ( Sh
� `, fS C 'QCQ TEL# q-IS.-
-7 W `IS- �U15 I
ADDRESS OF ESTABLISHMENT 12. IN4 S�rCG� Sa�et 1
MAILING ADDRESS (if different) `/ r n p vp l'
OWNER'S NAME3051nQI0.a h. rnbe0� Gro. „ TEL# 91$-IHS-,3M
ADDRESS 66$ X whOA SNQe }
CITY STATE rnq zip 01110 q
CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) H S S 3$ 3 1
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON �,rnbtf kn GCO HOME TEL# CI 18-1 y 5_ 38sq
HOURS OF OPERATION: Mon. A-5 Tue. S•SWed.$-S Thu.�Fri. &,1�7Sat. $ ^(a Sun.
TYPE OF ESTABLISH l FEE (check only))
RETAIL STOREYES NO less than 1000sq.ft.
=$100
more than 10,000sq.f.
=$250
- - ..... - - - - - - ------- -.....
RESTAURANT YES NO le-ss than 25 seats $100
25-99 seats =$150
more than 99 seats =$200
- -------------------------------------------------------------------------------- ----------------
BED/BREAKFAST YES NO $100
AD.DITIOt L PERMITS .00(o�,0(/
MAKE just sere ICE_CREAM;YOGURT;SOFT SERVE YES NO (19D
gTOBACCO VENDOR 51-0(f C53 NO 5l]`
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.
Q � IZIS/OS 012-SZ-09� I
Signature e Social Security or Federal Identification Number
------------------------------------------------------------------------------------------------------------------------------------
Revised 11103/05 FOODAP2.adm Check#&Date M 7(p 18." 5-65
� io-6 -
F.
CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
4 120 WASHINGTON STREET, 4TH FLOOR
�. SALEM, MA 01970
TEL. 978-741-1800
ane FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
COMMONWEALTH OF MASSACHUSETTS
PERMIT TO OPERATE A FOOD ESTABLISHMENT
In accordance with regulations promulgated under authority of Chapter 94,
Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food
Establishment in the City of Salem is hereby granted to:
Type of Establishment: RETAIL FOOD
Name of Establishment: Josh's Place, Inc.
Address of Establishment: 72 Wharf Street
Owner's Name: Joshua & Kimberly Gray
Restrictions:
Application Date: 9/27/05
Permit for Food Establishment 324-05
Frozen Desserts/Ice Cream
Permit for the Sale of Tobacco Products 71-05
These Permits Expire December 31, 2005
This permit is not transferable and must be reissued upon change of
ownership or location. The permit must be posted in a prominent location
in the Establishment,
In accordance with the State Sanitary Code, before any renovations,
improvements, or equipment changes are made, all plans for such must be
submitted to and approved by the Salem Board of Health.
HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
f 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978.741-1800
FAX 978-745.0343 -
STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHC?
MAYOR HEALTH AGENT
2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT Z26b:S lq ��_^ _TEL
ADDRESS OF ESTABLISHMENT -12 Wh`-AY£ 5JG:&J
MAILING ADDRESS (if different) 2 {Tpy S�Y'eea
OWNER'SNAME ;�OShQ '.rm erl TEL# 1LJS5-Wf
ADDRESS�_WI1f1GC
S
CITY )4yn "STATE m(- \ zip7# -1-
HOURS
CERTIFIED FOOD MANAGER'S NAMES) VneSNe ��'m -nran ER T(required in an establishment where pofegtially hazardous food is prepaEMERGENCY RESPONSE PERSON M 1 G>rC HOOF OPERATION: Mon. 9-5 Tue.2j_5Wed. Thu.S-5 Fri. -& Sat. Sun. Ypr;r�b(e�
dve b
TYPE OF ESTABLISHMENTFEE check only $tQSd�i
RETAIL STORE ES NO f less than 1000sq.ft. = 50
1000-10,000sq.ft. =$100
(10 more than 10,000sq.ft. =$250
✓Ill
RESTAURANT YES NO (1 � less than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $
6?
TOBACCO VENDOR �), (r E�j NO
ALL NON-PROFIT(such as church kitchens) i YrS NO $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made, all plans for such must be submitted to and approved by the Salem Board of
Health.
Purs nt to MG Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
b kgowl and belief, iled all state tax returns and paid all state taxes required under the law.
Signature
9 Date Social Security or Federal Identification Number
----------------------------------------------------- ---- -
Revised 11/03/03 FOODAP2.adm Check4&Date, �✓�___
J
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
.� TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
T
NAME OF ESTABLISHMENT :&2hs lace. _fn C. TEL#
ADDRESS OF ESTABLISHMENT 12 \AV%O,Y J p 5�reCJ
MAILING ADDRESS (if different) _1`2,, A\ud S�SQ_J
OWNER'S NAME _S0Shy4 a VN%mbCe`ri) GrM TEL# QL1$-Jy5-388'
ADDRESS Ut$ (a 1t��1Q`f SA''e4
CITY '50ikyn STATE rnl -) ZIP (019'70
CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON 1f,,iv162,Y17 Gfw, HOME TEL# Q1$" 14S _ " Y
HOURS OF OPERATION: Mon. 9-3 Tue.L,,5' Wed.8-S' Thu.,?-5 Fri. -& Sat. Sun. VaY;4ble)
dve to l
TYPE OF ESTABLISH ME FEE check only $CRSdo
RETAIL STORE ES NO less than 1000sq.ft. = 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
RESTAURANT YES NO less than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $$ .
TOBACCO VENDOR E S NO C�59 5
ALL NON-PROFIT(such as church kitchens) 7rS 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.
Purs nt to MG Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
b krlowleQp and belief, iled all state tax returns and paid all state taxes required under the law.
/Signature Date Social Security or Federal Identification Number
----------- -----------
Revised 11/03/03 FOODAP2.adm Check#8 Date
IUO Ckje'(C ✓eeld_
CITY OF SALEM
BOARD OF HEALTH
Name of Establishment: Josh's Place
Address: 72 Wharf Street
Owner(s): Kimberly & Joshua Gray
Phone: 978-745-3884
The owner of this establishment presented a Menu for review in accordance with
the State Food Code.
This establishment is a convenience store with a small food prep area.
Any change in the menu or floor plan must be approved by the Board of Health.
MENU/FOOD PREP
Frappes, scooped ice cream, meatball subs, hot dogs and pretzels are
planned at this time. Sandwiches may be added.
A Hand Sink must be located in each food prep and service area.
Hand sinks must have wall hung soap and paper towel dispensers. These
must be stocked at all times. Hand sinks must be used for hand washing only.
r6
A 3-bay sink is also be located in this area to wash, rinse and sanitize
Paw9s and other service items. The sink must be large enough to accommodate
these items.
All floors, walls, and ceilings where food, utensils, paper products, etc, are
stored, prepared or served must be intact, impervious, and easily cleanable.
Any pre-made items must be purchased from a wholesaler licensed by the
State.
Reviewed preparation of meatball subs. All ingredients must be
maintained at a temperature of at least 140 degrees F.
Also reviewed holding temperatures of 41 degrees F or lower for any cold
items. Reviewed rotation of holding bins in deli unit.
There may be no bare hand contact of ready-to-eat foods. Gloves, tongs,
or tissues must be used when handling such food.
CERTIFICATION
I
Kimberly Gray will become a Certified Food Manager.
In the meantime, either a CFM from the existing establishment will be
hired full time or no potentially hazardous foods will be prepared and served.
FLOORS and WALLS
All floors, walls and ceiling throughout the establishment must be intact,
impervious and easily cleanable.
RESTROOMS
Restrooms must have a sign stating that employees must wash their
hands before returning to work. Restrooms must be clean and sanitary. The
woman's room must have a covered receptacle.
EXTERMINATION
Monthly services of a Licensed Pest Control Operator are required.
Please keep receipts for inspections.
SANITIZING SOLUTION
Sanitizing Solution must be accessible at the food prep area and for the
patrons' tables.
Test strips corresponding to the kind of sanitizer, must be on hand to
check concentration of solution. Solution must be made daily, tested, and the
results recorded on a log sheet for examination by Board of Health inspectors.
Solution may be prepared in the 3rd bay of the 3-bay sink and spray
bottles may be filled there. Spray bottles with clean paper towels may be used,
as well as wiping pails with wiping clothes always held in the solution in the pail.
Trash will be stored in the complex's trash holding area. This and the outside
area of premises must be kept clean and sanitary.
Please call one week prior to opening to schedule an opening inspection.
PI Pam �b�+r � a Flo-7� Plan
Oanne.Scoft Date
Health Agent
—/,, Zj pJ—
Owner Date