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KINDER CARE LEARNING CENTER 668 - ESTABLISHMENTS k;Adrt tgle tc4ln►'aJ tw(r #-w, (OZ belay Ayt. RNIVERSAL® UNV-12110 /yQ�\ MADE IN USA FORESTRY MN.PECY(%EI 1 IrnnATNE 1® Cerifed nmr Soumine rosTca AER my WogmmanJ Yrtn:+A _ r I Commonwealth of Massachusetts " City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/09/2011 ESTABLISHMENT NAME: Kinder Care Learning Center#668 File Number:BHF-2005-000013 602 Loring Avenue Salem MA 01970 LOCATED AT: 0602 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011.0360 Jan 1,2011 Dec 31,2011 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRE.ENBAUM/7SALEM.COM DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT hl TEL# ,. BEReARE LEARNING CEINIIEK #300668 ADDRESS OF ESTABLISHMENT FAX# q '79 - 74LI'LI(4qa �a0� LCIRING h\I€Nla€ SALEM, MA 01970 MAILING ADDRESS(if different) a73-7"_58nn EMAIL- Business': KIn)r12 [cm Website: �liYl�O/Q�P •�cr � OWNER'S NAME Jjf)ad j Ai - Le_nelnir u "ior�. TEL# ADDRESS *4D A/C 1-kY c{dti pz/*� /_%P STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 'R/-;b/n Pie-rr- HOME TEL# DAYS OF OPERATION 1 Monday Tuesday 1 Wednesday I, Thursday Friday Saturday Sunda HOURS OF OPERATION j (prjA 1p R Gj /9 Please write in time of day. ! cv� I `/A vI ` (For example 1lam-11Pm) 1�to i �� to ��� P 1 Znw n i ! �e 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 -------------yi�i�..... --- - --------------4-140----- (Outdoor -- ------ RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 --------------------------------------------------------------------------------------- ------------------------------------------------------- �ED/BREAKFAST/ YES NO -Tp,� $100 CHILDCARE-SERVICES/NURSING-HOME ------- t ' f '--------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state lax returns and paid all state taxes required under the law. Signa re ----Date- Social Security or Federal Identification Number ----------------------------------------------------------q---7-----------r-7------------------------------------------------ Revised 10/7/11 FOODAP2011.adm Check#&Date IO7 /L $ 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: 0110512010 ESTABLISHMENT NAME: Kinder Care Learning Center#668 File Number:BHF-2005-000013 602 Loring Avenue Salem MA 01970 LOCATED AT: 0602 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions t Notes FOOD SERVICE BHP-2010-0129 Jan 4,2010 Dec 31,2010 $100.00 ESTABLISHMENT Total Fees: $I00.00 PERMIT EXPIRES ecember 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAUM&ALEM.COM DAVID GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT KINDERCARE LEARNING CENTER TEL# ADDRESS OF ESTABLISHMENT 802 LORNAVENUE 6ALFA4I -- Fax q78 70y- Ol70 978-744-5800 MAILING ADDRESS(if different) EMAIL-Business': Website: &r'-xd,0rLAoe-f_. l OWNER'S NAME t_eLVi1 in4 C6Y4- TEL# ADDRESS STREET ��uu CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)UM'►hA. A)Aytylt(L3 CERTIFICATE#(S)/o5(X 3 (Required in an establishment where potentially h rdai�' ous food is prepared) EMERGENCY RESPONSE PERSONDhln HOME TEL#_��17g yLYv/Sym! DAYSFOF TF,— I9N y Mpnday i Tuesday zWednesda, Tihursday 'n �Enday `,'j, Salurda Sunda HOURS OF OPERATION I i Please write in time of day. j For exam lel lam-11 m) 11 /414 _&_L4P_19AA 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 - -------------------------------------------------------ie------------------------------------------ ----- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - --- BED/BREAKFAST/ YE NO $10 CHILDCARE SERVICES/NURSING HOME--------------------------------------------- ADDITIONAL PERMITS -------- ----------------------------------------------------------- ----------- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES 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 and paid all state taxes required under the law. Sirnkure Date Social Security or Federal Identification Number`. ... _ _ .- _... . Revised 424/07 FOODAP2008.adm Check#&Date 1T� t 0602 LORING AVENUE Kinder Care Learning Center#668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 744-5800 Owner: Kindercare Learning Center PIC: Cindy Mavroules Inspector: Elizabeth Salandrea Date Inspected:Correct By: 3/6/2009 Risk Level: Permit Number: BHP-2009-0011 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: All violations noted in the 2/27/09 inspection report have been corrected. Violations Related to Good Retail Practices (Critical 3 employees will be taking the servsafe exam March 20th (see attached emails). Please forward copies of violations must be corrected certificates to the Board of Health when obtained. 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. Mar 09,2009 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Cityof 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. Mar 09,2009 ) Page 2 oft Message Page J of 3 . Elizabeth Salandrea From: Baez, Jennifer[JBaez@klcorp.coml Sent: Wednesday, March 04, 2009 11:29 AM To: Elizabeth Salandrea Subject: Salem KinderCare Serv-Safe Hi Liz, Please see below regarding our sery-safe exam. We will take on March 20, Thanks, Cindy KinderCare Learning Center-Salem Center:978-744-5800 FAX:978-744-4442 NOTICE: This communication may contain privileged or other confidential information. If you are not the intended recipient,or believe that you have received this communication in error,please do not print, copy,retransmit,disseminate,or otherwise use the information. Also, please indicate to the sender that you have received this email in error,and delete the copy you received. Thank you From: Baez, .Jennifer Sent: Wed 3/4/2009 11:24 AM To: Kevin Brown Cc: 'Krissy Murray' Subject: RE: Serv-Safe Test Hi Kevin (and Krissy) We would like 3 exams, please. This will be charged to our corporate account, correct? Yes, our center number is 300666. We already have a book, so no need for that. I will use this email as verification that we will be taking the exam and forward it off the to the Health Dept. Thank you, KinderCare Learning Center-Salem Center:978-744-5800 FAX:978-744-4442 NOTICE: This communication may contain privileged or other confidential information. If you are not the intended recipient,or believe that you have received this communication in error,please do not print, copy,retransm it,dissem in ate,or otherwise use the information. Also, please indicate to the sender that you have received this email in error,and delete the copy you received. Thank you From: Kevin Brown [mailto:kevin@thurstonfoods.com] Sent: Wed 3/4/2009 10:14 AM To. Baez, Jennifer Cc: 'Krissy Murray' 3/5/2009 Message Page 2 of 3 Subject: RE: Serv-Safe Test Cindy Yes it should as once you are done it will confirm if you passed or failed. After that it is about 2 weeks until your official certification arrives in snail mail from NRA in Chicago. Please reply to all with the number as exams you want to take ($50 each) and if you need a book ($75.00) sent out to your center prior taking the exam. 8y the way is this your center # KLC 300668 if so then Krissy this is our account # 21441. Thanks Kevin :) -----Original Message----- From: Baez, Jennifer [mailto:JBaez@klcorp,com] Sent: Wednesday, March 04, 200910:05 AM To: Kevin Brown Subject: RE: Serv-Safe Test We would like March 20th if possible for the test. We need confirmation as well for the Dept. of Health. I would assume your email back would be sufficient? Thanks, Cindy KinderCare Learning Center-Salem Center:978-744-5800 FAX:978-744-4442 NOTICE: This communication may contain privileged or other confidential information. if you are not the intended recipient,or believe that you have received this communication in error, please do not print, copy,retransmit,disseminate,or otherwise use the information. Also,please indicate to the sender that you have received this email in error,and delete the copy you received. Thank you From: Kevin Brown [mailto:kevin@thurstonfoods.com] Sent: Mon 3/2/200911:45 AM To: Baez,Jennifer Cc: 'Krissy Murray' Subject: RE: Serv-Safe Test Yes What day would you like to take the exam? I need 2 days notice to set it up 3/5/2009 Message Page 3 of 3 Thanks Kevin -----Original Message----- From: Baez, Jennifer [mailto:JBaez@klcorp.com] Sent: Monday, March 02, 2009 11:28 AM To: kevin@thurstonfoods.com Subject: Serv-Safe Test Hi Kevin, We would like to go ahead and order the test for Sery Safe. Is it possible to order 2? Thanks, Cindy Mavroules Assistant Director KinderCare Learning Center-Salem Center:978-744-5800 FAX: 978-744-4442 NOTICE: This communication may contain privileged or other confidential information. If you are not the intended recipient,or believe that you have received this communication in error,please do not print,copy,retransmit,disseminate,or otherwise use the information. Also,please indicate to the sender that you have received this email in error,and delete the copy you received. Thank you 3/5/2009 0602 LORING AVENUE Kinder Care Learning Center#668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-5800 Separation/Segregation/Protection FAIL Critical ❑I RED Owner: yComment: Large GE freezer has meat stored above bread products and vegetables.Organize freezer to properly separate Kindercare Learning Center potentially hazardous foods from ready to eat foods. PIC: Food Con ct Surfaces Cleaning and Sanitizing FAIL Critical � RED Cindy Mavroules Comment:Sanitizer is too strong at approx.400ppm. Provide sanitizer of proper concentration(200ppm)at all times. Inspector: w1ganitizer log must be maintained daily. Elizabeth Salandrea Violations Related to Good Retail Practices (Blue Items) Date Inspected:Correct By: Food and Food Protection FAIL Critical BLUE 2/27/2009 comment: Employee items being stored in GE fridge. Employee items must be stored in a separate employee-only area to prevent Risk Level: cross contamination. Equipment and Utensils FAIL Non-Critical BLUE ,Permit Number: V61mment: Large GE freezer needs general cleaning. BHP-2009-0011 V<relezer compartment of fridge needs general cleaning and defrosting. Status: VIOLATION All dry ingredients not stored in original packaging must be labelled. #of Critical Violations: 0410andwash sink in bathroom next to office must have"employees must wash hands"sign. 3 Time IN: . Time OUT: Urgency Description(s): BLUE: Reinspection in one week, all violations to be corrected. Violations Related to Good Retail Practices (Critical Please have December andebruary extermin,7tion receipts available at reinspection. }- violations must be corrected Q_ C �� �h o ¢n 11 o>vDh lrt 4�IYtf —l�fou �eh,MerAQ.�''1 — 1 immediately or within 10 Xook has not obtained servsafe certification yet. Cook must be registered for servsafe course within one week; days)(Non-critical violations please forward proof of registration to the Board of Health. 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. Mar 05,2009 ) Page / oft 1 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®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2009 ) Page 2 oft +� Commonwealth"of Massachusetts r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/18/2008 ESTABLISHMENT NAME: Kinder Care Learning Center#668 File Number:BNF-200,5-000013 602 Loring Avenue Salem MA 01970 LOCATED AT: 0602 LORING AVENUE SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009.0011 Dec 18,2008 Dec 31,2009 $100:00 ESTABLISHMENT Total Fees: $100.00 M PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"r FLOOR ^� TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR IDIONNIE(G7SALEM.COM JANET DIONNE, �-. r 0 ACTING HEALTH AGENT O9Rp OF yqi M Thl 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT KINAI Rt ARING CEMR TEL# c F . #300888 n ?fy2� i7 f - ADDRESS OF ESTABLISHMENT 602 LORING AVENUE FAX#v1 /p `r� SALEM, M 0 A. MAILING ADDRESS(if different)c� 978-744-5800 EMAIL-Business': �CXXO�D S Q k CQ)rp•fes_Website: Yl i rYQP 1�F1�'e . C6� OWNER'S NAME �YnL:&)1P� PjA / Ar i t� COYP. —TEL# /- � -/3.3` /On J r ADDRESS STREET �+ 1 CITY STATE ZIP 92-2d'4 CERTIFIED FOOD MANAGER'S NAME(S92-2d'4Ill ^� CERTIFICATE#(S) la7 t4O (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON hni J'e ► D HOME TEL#-78 C5!& 'O2425' DAYSOF-OPERATION - i -: Monday Tuesday' Wednesda Thursda FrWay 7 Saturday Sunda HOURS OF OPERATION Please wdle in time of day. I (For example Ilam-llpm " � 011 60 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -- -- ----- - - - ---- RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - ------ BED/BREAKFAST/ ES NO $100 CHILDCARE SERVICES -- - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES 0 $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax rel s and paid all state taxes required under th W. Sign tore Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date,0 16�/,O3_ lam_$,' $ L f03 73& J$63 1 Y 0602 LORING AVENUE Kinder Care Learning Center#668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-5800 Separation/Segregation/Protection PASS Critical RED Owner: _ Prevention of Contamination from Hands PASS Critical ❑J RED p Kindercare Learning Center Handwash Facilities PASS Critical RED @PIC: Violations Related to Good Retail Practices (Blue Items) Jennifer Baez Equipment and Utensils FAIL Non-Critical BLUE Inspector: Elizabeth Salandrea Comments:All dry goods not in original packaging must be labelled. Physical Facility FAIL Non-Critical BLUE Date Inspected:Correct By: 4/7/200$ Comments: Dry storage room has missing ceiling tiles.Replace ceiling tiles. I Risk Level: - Food being stored directly next to one of the water heaters.A 5-foot clearance around water heaters is required; move all items 84 from directly around the heater. Permit Number: BHP-2008-0169 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: i All other violations noted in the 3/31/08 inspection report have been corrected. Violations Related to Good I Director to fax extermination reports to board of health within 3 days. Retail Practices (Critical .violations must be corrected Cook to obtain servsafe certification within 6 months. Please forward copy of certificate to board of health when immediately or within 10 obtained. days)(Non-critical violations 1 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. Apr 14,2008 ) Page I oft i 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. Apr 14,2008 ) Page 2 oft 0602 LORING AVENUE Kinder Care Learning Center #668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-5800 Separation/Segregation/Protection FAIL Critical ❑d RED Owner: Wem'*`ment: Large GE freezer in storage room has potentially hazardous foods stored above ready to eat foods.Store PHFs below Kindercare Learning Center RTE foods to prevent cross contamination. PIC: Prevention of Contamination from Hands FAIL Critical ❑ RED Jennifer Baez Wmm ent: Employee drinks in GE fridge in kitchen.Store employee drinks separately in designated employee fridge to prevent Inspector: cross contamination. Elizabeth Salandrea Date Inspected:'Correct By: Handwash Facilities FAIL Critical RED 3/31/2008 _ W-9ment: Handwash sink in kitchen missing handsoap.Provide soap in soap dispenser at all times. Risk Level: ne toddler handwash sink missing paper towels.Paper towels to be stocked in dispenser and available at all times. Permit Number: mp`/ stairs employee restroom missing paper towels.Paper towels to be stocked in dispenser and available at all times. BHP-2008-0169 Violations Related to Good Retail Practices (Blue Items) Status: Equipment nd Utensils FAIL Non-Critical BLUE VIOLATION --- o nt: Microwave needs general cleaning. —#of Critical Violations 3 freezer in storage room needs general cleaning. Time IN: Time OUT: Van opener needs thorough cleaning/scouring. p Urgency Description(s): I./tove top needs general cleaning. �fik slu.l-Y vf� BLUE: o Violations Related to Good All dry goods not in original packaging must be labelled.C.�n-�,rj,ii2vt Retail Practices (Critical Physical Facility FAIL Non-Critical BLUE violations must be corrected immediately 1 O mComment: Dry storage room has missing ceiling tiles. Replace ceiling tiles. oritu ) days)(Non-critical violations —Food being stored directly next to one of the water heaters.A 5-foot clearance around water heaters is required;move all items must be corrected immediately from directly around the heater. 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. Apr 02,2008 ) Page I oft Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to Reinspection in one week, all violations to be corrected. Last 3 months extermination receipts to be avaiilable at Foodborne Illness Interventions time of reinspection. and Risk Factors (Require immediate corrective action) Cook to obtain servsafe certification by next routine inspection or within 6 months. rs-� 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. Apr 02,2008 ) Page 2 of Commonwealth of Massachusetts City of Salem • a Board of Health Kimberley Driscoll 120 Washington Sheet,4th Floor Mayor SALEM,MA 01970 FooWRetail Establishment Permit DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: Kinder Care Learning Center#668 File Number:BHF-2005-000013 602 Loring Avenue Salem MA 01970 LOCATED AT: 0602 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0169 Jan 3,2008 Dec 31,2008 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2008 Board of Health — This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all- plans for such must be submitted to and approved by the Salem Board of Health. _ Page 6 of 9 f v � 1 CITY OF SALEM, MASSACI IUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4h'FLOOR TEL. (978) 741-1800 KIMBERLEYDRISOOLL FAx(978) 745-0343 MAYOR ISCO f a RECEIVED SALEM.ODM JOANNE SCOTT, DEC 17 2001 HEALTH AGENT CITY OF SALLM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL# ADDRESS OF ESTABLISHMENT w;NDeRe ARE LEARNING CENTER FAX# q75 ,7 gL1_gqq a. e02 LORING AVENUE MAILING ADDRESS(if different) CAI FM MA n1A7n 22,�.�� �� 978-744-5800 EMAIL-Business': 0t;&&l 49 fz/av-P .COrt Website: OWNER'S NAME h ✓ TEL# ADDRESS KINDERCARE LEARNT G CENTER STRE ' CITY STATE ZIP 2 CORING AVENUE T �1l � � � CERTIFIED FOOD MANAGER'S� 1970 J�1 JII CERTIFICATE#(S) la7Llo�!/o (Required in an establishment where poten is ly fWgr ouus/s'�food is prepared) cc EMERGENCY RESPONSE PERSONTCFIn;, et- 940_`2 HOME TEL#-7 O a 'aG7S DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION Please write in time of day 2^ (For example Nam-11pm) ,30/9' 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 ---0 ---­---­------------------- .- -- ---- -- RESTAURANT YES ----NO less than 25 seats- '............-=$140' ---- (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - ------------------ =- - -- - - ---------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 �}IILDCARE SERVICES -------------------------------------------------- - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax ret=said a#state taxes required on the law. l /0J/,y/0? &3- 4y�9� _ Sigilature Date Social Security or Federal Identification Number ------------------------------------------------------------------------ ----- -------------------------------------------------- Revised 4/24/07 FOODAP2008.adm Check#d Date I 0602 LORING AVENUE Kinder Care Learning Center #668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-$800 Handwash Facilities FAIL Critical RED Owner: Comment:The children's hand wash sinks on the first floor missing soap and paper towels.Provide soap and paper towels at all Kindercare Learning Center hand wash sinks at all times. PIC: Violations Related to Good Retail Practices (Blue Items) Jennifer Baez iPhysical Facility FAIL Non-Critical BLUE Inspector: Comment:The kitchen base cabinets are in disrepair. Cabinets are in need of replacement. David Greenbaum GENERAL COMMENTS: Date Inspected:Correct By: 2/13/2007 All other violations cited in the 2/6/07 inspection report have been corrected. Risk Level: Permit Number: BHP-2007-0134 Status: SIGNED OFF # 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. Feb 13,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) v 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 13,2007 ) Page 2 oft 0602 LORING AVENUE Kinder Care Learning Center #668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-$800 Separation/Se regation/Protection FAIL Critical ❑J RED Owner: mment: The GE freezer in the kitchen has potentially hazardous food stored above other food. Store all PHF below other foods Kindercare Learning Center o prevent cross contamination. PIC: Go Hygienic Practices FAIL Critical ❑d RED Jennifer Baez Co ent: Employee drinks observed in the kitchen. Employees must eat and drink in a designated area to prevent cross Inspector: contam' fion. David Greenbaum E loyee drinks observed in the GE refrigeratorlfreezer. Store employee drinks in a designated employee refrigerator to prevent Date Inspected:Correct By: ross contamination. _2/6/2007 Handwash Fac'lities FAIL Critical ❑d RED Risk Level: y��/m/mient: The kitchen hand wash sink missing sopa and paper towels. Provide sopa and disposable paper towels at this hand C/wash sink at all times. Permit Number: _BHP-2007-0134 The children's hand wash sinks on the first floor missing soap and paper towels. Provide soap and paper towels at all hand wash sinks at all times. Status: VIOLATION #of Critical Violations: 4 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 07,2007 ) Page 1 oft • Item Status Violation Critical Urgency RED: Violations Related to Good/Retail Practices (Blue Items) Violations Related to Food and Food Pro on FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require C ment:All dry ingredient bins must be labled. immediate corrective action) EqLJV<ent and Utensils FAIL Non-critical BLUE C m t:The GEfreezer needs a thorough cleaning. T e cano ne and rack needs a thorough cleaning. T GE frigerator/freezer has an accumulation of food debris,spills and splatter. Thoroughly clean this unit. T refrigerator compartment of the GE unit needs a visible,accurate thermometer. T mi wave has an accumulation of food spills and splatter. Thoroughly clean the microwave. e oven needs a thorough cleaning. Shet kn walls have food spills and splatter. Thoroughly clean the kitchen walls. Physical Facility FAIL Non-Critical BLUE Comment:The kitchen base cabinets are in disrepair. Cabinets are in need of replacement. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. v 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 07,2007 ) Page 2 oft �t�a. b .� a,w.w +It 4✓,n a 'rF s < ac at ..�N1 t� Y m&�y� rhe i r"ar.{' Wt. 5£ p;Commonwealth of Ma�s,sachusetts �� ♦ ,i .'3' t fi-'` �` ;'x#"Yfv .t a"+ • ,.�� a f:, • a,5 h.3,s .�`t% ., dux Board of HealthN",,q'*- "' +,r `+,% > K.:fi x{ rx , +�..'?eey FGmbeiley Dn �s t„ k X120 Washington Street;4th Floor „t w r• t SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Kinder Care Learning Center#668 File Number:BHF-2005-000013 602 Loring Avenue Salem MA 01970 LOCATED AT: 0602 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0134 Dec 20,2006 Dec 31,2007 $100.00 ESTABLISHMENT 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 4 of 8 i I CITY OF SALEM, MASSACHUSETTS o a BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC 15 2006 TEL. 978-741-1800 Fax 978-745-0343 CITY OF SALEM Kimberley Driscoll www.SALEM.COM BOARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT - 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL# ADDRESS OF ESTABLISHMENT KINDERCARE LEARNING CENTER FAX# R Ifs 7 L/11 I-/UUa, #300668 602 LORING AVENUE MAILING ADDRESS(if different) SAL FM A4 W970 078-744-8800 EMAIL--Business': F(' L�yS 1C�sr _Owner's: OWNER'S NAMEt_Y�tlijrcy}p j � jar , �Y TEL# •� ,1,. 'S- tLt tr ADDRESS� D N C—N—L71-`14 tjog V/)r-J/0fnA to R STREET CITY STATE rT ZIP CERTIFIED FOOD MANAGER'S NAME(S).-.ay.,u Y(r(Q! CERTIFICATE#(S)_Za t t-Io?0(o (Required in an establishment where potentially hazardousfoodis prepared) �+ EMERGENCY RESPONSE PERSON slenn% het- 'B" 7— HOME TEL#—'78( ' ��Jo� �707s DAYS OFOPERATION Monday i Tuesday Wednesday Thursday 3Saturday I Sunday HOURS OF OPERATION Please write in time of day. , [For example Ilam-llpmi Irl a 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 YES NO Tess than--25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BEDIBREAKFAST YES NO -10 0 � .-�Ye .......... ... ...... - . ADNTIONAL PERMITS .. MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $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 MGI-Chapter 62C,Section 49A. I certify under the pains and penalties of perjury that I, to my best knowledge and belief. ha IIs to tax returns and paid tate tax s required under the law. L Si nature Date —social—Security—or Federal identification Number --`----------- ----- -------------- --------- --------------------------------- -------------/----- ------- ------------- -------------------- ---- ------ ------------ Revised 11113146 f-OODAP2607.adm Y Check#8 Date 0602 LORING AVENUE Kinder Care Learning Center#668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency --Telephone: Violations Related to Good Retail Practices (Blue Items) 744-5800 Equipment and Utensils FAIL Non-Critical BLUE Owner: - - Comment: The stove and burners need a thorough cleaning. Kindercare Learning Center -PIC: Physical Facility FAIL Non-Critical BLUE Jennifer Baez Comment: The flooring throughout the kitchen needs a thorough cleaning. Inspector: David Greenbaum There is a hole in the kitchen floor near the dishwasher. Repair floor. Date Inspected: Correct By: NEW:There is a leak coming from the kitchen sink cabinet. Investigate the source of the leak and repair. 4/412006 Risk Level: GENERAL COMMENTS: 553:AII other violations cited in the 3/28/06 inspection report have been corrected. Permit Number: BHP-2006-0395 Status: PARTIAL COMPLY #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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2006 ) 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2006 ) Page 2 oft 0602 LORING AVENUE Kinder Care Learning Center #668 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-5800 Handwash Facilities FAIL Critical ❑v RED Owner: Comment:There is only warm water at the bathroom handwash sinks. Provide hot water at a minimum temperature of 110'17. Kindercare Learning Center PIC: There is no hot water at the middle handwash sink on the first floor. Restore hot water to this sink. Jennifer Baez Violations Related to Good Retail Practices (Blue Items) Inspector: Equipment and Utensils FAIL Non-Critical BLUE David Greenbaum Comment:The freezer in the back room of the kitchen has an accumulation of food debris. Thoroughly clean this freezer. Date Inspected: Correct By: The GE refrigerator/freezer needs a thorough cleaning. 3/28/2006 Risk Level: r The stove and burners need a thorough cleaning. Permit Number The microwave needs a thorough cleaning. - BHP-2006-0395 Sanitize the water bubbler frequently. Status: Physical Facility FAIL Non-Critical BLUE VIOLATION — Comment: The flooring throughout the kitchen needs a thorough cleaning. #of Critical Violations: 1 Remove all stored items from around the water heater. A minimum 5 foot cleareance is required per Fire Code. Time IN: There is a hole in the kitchen floor near the dishwasher. Repair floor. Urgency Description(s). V The kitchen walls have an accumulation of food spills and splatter. Thoroughly clean all walls. .BLUE: Management and Personnel FAIL Non-Critical BLUE Violations Related to Good Retail Practices (Critical GENERAL COMMENTS: violations must be corrected 543: immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90days) 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. Mar 28,2006 ) Page / 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 28,2006 ) Page 2 oft -000M DOCKET.NO 07ATION NO • * ' <' CPTY OF SALEM PD M " • `I'ry��a :7R I VIOLAnONNonCE PD 0388 o O = Q7 NAME(LAST FIRST,INITIAL)ve [C[f3 Of LnG", $ �v G O w 3 STREETADORESS CITY OWN STATE ZIP ru J f� m W x m- H H p,qe,.� .B �1 Zoe 3-1 (z3 H D �. l �iy LICENSE NO. UC.EXP.DATE ATE OF 8IRTH z Ctp l W Qy w 111 tQ .Q O tv, O mt`I_' OWNER5 NAME{LAST,FIRST,INITIAI) 0 0 H z a r^ � 31 1 4 DvL¢,$ Alo . y STREETADDRESS CITY WN STATE zlP m REGISTRATION NO. STATE EXP.GATE MAKE/TYPE YEAR COLOR r p �< a •gym O r p [ �. ^IS DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL RRR 6 t YES _ i AM INIVAY m e.=:� t3 se�o � !' .p� ❑PM f~j OG^ � p gi ax O LOCATION OF VIOLATION ENF •• C +k T-,(O I ORCING rT m � ' C,D,Zlis/2/ gi� ,h,1112 l3�of, r1J * e p I :,,}Z, OFFENSE CHAP, SECT. FINES ' m; 43 (5zoo� S q IL� AM,7' ru # GS' x 4y� ... I C 1 ' ;Cy jjQ OFFICER TOTAL @@ oc 10 v DIUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ' O, • R8.,1� /lf .� �.,. ❑ IN HAND X f'/.fI, 14.x- ❑ BY MAIL 4 o DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY . 9 s Q�.�ym ORDER OR BY CHECK MADE PAYABLE TO:• m' ,O I g n % Z 10CITY CLERK a' s A ;r ;'- Q CITY HALL �9 93 WASHINGTON STREET x a i o SALEM,MA 01970 m s p a - TEL(508)745-9595 X 251 C N "�0 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE,CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE y Ly i PAYMENT IN THE AMOUNT OF CASE# L � Fx O ���i� I SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION - o `};)o ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL i A to Commonwealth of Massachusetts 3 City of Salem Kimberley Driscoll < <Z s Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/06/2006 WHO'S PLACE OF BUSINESS IS: Kinder Care Learning Center#668 File Number:BHF-2005-0013 602 Loring Avenue Salem MA 01970 LOCATED AT: 0602 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0395 Feb 1,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES IDecember3l, 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 t of 5. v *. CITY OF SALEM, MASSACHUSETTS / 1,55lerillqhr m BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR Kin SALEM, MA 01970 rcaro f+CTRdde reare TEL. 978-741-1800 G/L 0 300888 STANLEY J. USOVICZ, JR. FAX 976-745-0343 $ �� MAYOR W W W SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT AP roval Signature Approval Signature 200eAPPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT KINDERQARE LEARNING C 602 LORING AVENUE ADDRESS OF ESTABLISHMENT sAt FAA AM 01970 978-744-5800 MAILING ADDRESS (if different) OWNER'S NAME Ce:Xrrhlnq (�OYf� TEL# I-900-1e33 •/(a$k ADDRE,,$sS_fP9.) /1/e-r W CITY STATE U ZIP a as CERTIFIED FOOD MANAGER'S NAME(S),T/?,di i1rd CERTIFICATE#(s) log ? Q124& (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON �rlrni(-Cr ✓ 0e'eini HOME TEL# HOURS OF OPERATION: Mon jpN" Tue,4L •- Wed.kl-_Thu.G'�-&Fri.�at. -- Sun. TYPE OF ESTABLISHMENT FEE (check onlyl RETAIL STORE YES NO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ----- ------------------------------- -------- 6.. ................------....................le's....._..-- ...---- ------------- -- -- ----........... RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more then 99 seats =$200 - ---------- --- ------- BED/BREAKFAST YES NO $100 care t�� bLi , 6t.--- --vc5......00)-o...........................o ..........Jr' -........... AIONAL PERMITS MAK£ (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $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 knwledge and belief, have filed all state tax returns and paid all state taxes required under the law. ia/� 7Ax i'o -t` l03 �iV lq�G Si nature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------- Revlsed 11/03/05 FOODAP2.adm Check#&Date UO /!n V COURT DOCKET NO. CITATION NO. CITYSALEM PD 038,8 3 N NOTICE NAME(LAST,FIRST,INITIAL) n/J ,{!l.T)VJ-'rccf&-- �� /r; ClM JZ STREETADDRESS CITY OWN ST/ATE ZIP LICENSE NO. LIC.EXP.DATE DATE O RTH crj AM OWNER'S NAME(LAST,FIRST,INITIAL) 44"r euLe,S. var STREETADDRESS CITYEFOW S e— REGISTRATION NO. STATE EXP.DATE MA. E YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN wRUaoNAL El AM lam© � ❑VES ❑PM / NO LOCATION OF VIOLATION ENFORCING DEPT. 06f 6rj- OFFENSE CHAP. SECT. FINES AFT aBtai v o200� — osz C OFFICERTOTAL 1'11'aTr�Xs DU OFFICER /�• OFFICER CERTIFIES COPY GIVEN TO VIOLATOR 7 ttaam�� ❑ IN HAND X /�A � jc,AC. ❑ BY 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 IMPORTANT MESSAGE FOR DATE A23 TIME M OFit'-if' PrP PHONE AREA CODE NUMBER EXTENSION U 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 1 �Q SIGNED VIEWSFORM4 9 MARE IN U. A. 9 NOTES i Gv/7 �e DRQ 7e- //N-GG j Cl�h l/P PSCI TG Z ale, oexl-e m I / 74- AR LAaq ���y °fie G��P✓�ct�il D/ase Seo lvvrzc��? '�' _ L . oy _ or ©ti 45Zs7- _i i ' ..f 1 I 't ++ �4 ' I CITY OF SALEM, MASSACHUSETTS 0� 3 BOARD OF HEALTH ( „ a 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 Cindy Mavroules Kindercare Learning Center 602 Loring Avenue Salem, MA 01970 Dear Cindy Mavroules; With regard to 1/12/06 phone conversation we confirm the following: You stated that a completed application form and check was brought to this office and you faxed a copy of the application that we had no record of either. Please stop payment on your check. Any fees for canceling the lost check can be deducted from the amount owed to us for the 2006 Food Service Permit. Thank you for your Cooperation. Virginia Moustakis i I HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem BOH 978 745 0343 Jan. I8-2006 3-:45pm_. Last Fax Date 'rime !.We Identification II is ion PPago - esult Jan 18 3:44pm Sent 919787444442 1:11 2 OK Result: OK - black and white fax CITY OF SALEM, MASSACHUSETTS o ; BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR WWWSALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Facsimile Transmittal Fax# q� `d ggy RE: Lzoy) �!i� A4a� Date : l z Page(s): including this cover# Message: Board of Health News -------------- -------------- - -- -- ----------For o r Information OFFICE HOURS: 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 ? — Applications for a permit to remove exterior paint are required by the Salem Board of Health. No fee for permit and electric sanding is not permitted. Regulations for home owners and painting contractors are available. I JAN-11-2006 03 : 15 PM P. 02 i CITY OF SALEM, MASSACHUSETTS 1>L ye y'1 j'At BOARD OF MEATI+ 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 Khtder are TEL. 978.741-1800 p� CTR N 3M11 STANLEY ,J, USDVICZ, JR, FAx 9,78=745.0343 MAYOR WINKSALEM,COM JOANNE SCOTT, MPH, RS,CHO" - HEALTH AGENT roval Blpnat^uro �! Approval Ignaturs 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT KINDERCARE-LEARNINOC ___ so ADDRESS OF ESTABLISHMENT ' GOeuRLNGAVE .NUE" 976 ?44-a00o MAILING ADDRESS(if different) OWNER'S NAME k�<1060IC e_ _TEL# .#J-900-( 3 -lNFf ADDRESS CITY /L!/t/1 ST. U � ZIP Ci7a aa CERTIFIED FOOD MANAGER'S NAME(S)_1/gi 5h24diged CERTIFICATE#(s) /d7 Ua;?QG (required In an establishment where potentially hazardous food Is prepared.) EMERGENCY RESPONSE PERSON�nr1%ref' Mdeeir% ' HOME TEL# HOURS OF OPERATION: Mon(Orb.Tue;&?ai.Wed, Thu.G =L.Fri.fiat. Sun. -- TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.fl. _$ 50 1000.10,000sq.ft. =$100 more than 10,000sq It 4250 RESTAURANT YES NO less than 25 seats 5100 25.99 seats =5150 more than 99 seats -S200 . BED/BREAKFAST YES NO $t00 CgtC_ �yhbr.iah-r*.Ne+y ..... ._, C ..........._... .. ............ ... ...._.._.... ._)Lt7-__....... O R IT MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $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 EstabOah"rit. In accordance with the State Sanitary-Code,before any.renovations, Improvements, or equipment change& 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', 1 certify under the pains and penalties of perjury that I, to my best knkn l�belief, have filed all st to tax returns and paid all slate taxes required under the law. SI nature Date _ Social Security or Federal Identification Number .........—..............---........ - .................................. ..................................... Revised 11/03105 FOOOAP2.adm ChadkR.S Dale.. JAN-11-2006 03 : 15 PM P. 01 11 A Kinderc-aw Pax Cover Sheet , KinderCare Learning Canter #300668 602 Loring Ave. Salem, MA 01979 978-.744.-5800 Fox number: 978-744-4442 Jennifer MdcclM Director Cindy Mavroules Assistant Dfrsoor TO: Gi( 101 FROM: LZI RE: l b t tLI 3b ate . _. Pages: (including cover sheet), ��*ml -c """" %+-MS' - �kV ,-" . s n ;OFiSALEM� MASSACHUSETTS . THgOBOARD,OF HEALu"r Xpi„za. ..,,. r:• y.. 120 WASHINGTON STREET, 4TH FLOOR G e;r, A,•, SALEM, MA 01970 TEL. 978-741-1800 FAX 9_78-745----0343 .. STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Kinder Care Learning Center#668 Address of Establishment: 602 Loring Avenue Owner's Name: Kindercare Learning Centers Inc Restrictions: Application Date: 1/6/2005 Permit for Food Establishment 258-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS Do�l�B BOARD OF HEALTH 3� 120 WASHINGTON STREET, 4TH FLOOR � SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT QQ����b NAME OF ESTABLISHMENT Ki OX( r ( ra w C+r. TEL# R 7p' �LILI-5 � 11 ADDRESS OF ESTABLISHMENT rLCJYI� �lJ'L-• LSCC P�IY) InG� U(q 7v MAILING ADDRESS (if different) �M 22 p OWNER'S NAME i1 it:)L 6fl-re— I�YTEL# ly�� J✓ 0 ADDR SS C ��1 CITY W r Q/7 STAT ARM&IO ZIP �/} CERTIFIED FOOD MANAGER'S NAME(S (xL1 �' CERTIFICATE#(s) /a�J�oCI(o (required in an establishment where potentially hazardous food is prepared.) �} /JI EMERGENCY RESPONSE PERSON Y J-e-S HOME TEL#9 /W 9 I N HOURS OF OPERATION: Mon(pf-&Tue 4!1-�Wed.&JJ- Thu(o�Fri.!k�- Sat. � Sun. — TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 J more than 10,000sq.ft. =$250 RESTAURANT YES NO 5�,t� less than 25 seats =$100 �. 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YFS NO $50 ALL MON-PROFIT(such as church.kitchens) ES 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. Signatur11 Date Q/j/04Social Security or Federal Identification Number ------------------------------------------------------------------------�----q------------- -- -- Revised 11/03/03 FOODAP2.adm Check#&Date�5`e-7-03' /aIBIr�/ a� v S- h C. ------------- to �- L41L4 LLL'4N 4S: 2 £6, 4L/ZL INSPECTORS PLEASE NOTE: AS OF 2/26/003, PLEASE FORWARD COPIES OF ALL DAY CARE INSPECTION AND REINSPECTION REPORTS TO: M.J. BURNS, GROUP DAY CARE LICENSOR OFFICE FOR CHILDREN 66 CHERRY HILL DRIVE BEVERLY, MA OL915 FAX # 1-617-727-2533 Alo7'e .b Gza..vY �.oT�v_`T�ZS.} Jfib.�3T_�cr•�, IMPORTANT MESSAGE FOR A.M DATE M / OF PHONE AREA CODE NUMBER EXTENSION 0 FAX ❑ MOBILE AREA CODE NU BER 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 Qo�wPi/ti +d� �OL!- 1 SIGNED ops FORM 4009 7/I YY MARE IN LLS. NOTES -- - - - - - -y Massachusetts Department of Public Health Salem Board of Health w 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 �l r d✓y ( t�.6 -t� R.Prr +J Q f+3 uta 2(��/�� ❑ Food Service ❑ Routine Address.,.y fix dL 4,rg Risk ❑ Retail !❑.inspection Level ❑ Residential Kitchen Previous Inspection Telephone .) .r-,/ /q ❑ Mobile Date: Owner/,,, HACCP YM 1-1Temporary ElPre-operation (,<A-n-rt, N r-4,+,4-91( s ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time El Bed& Breakfast [I General Complaint r- Inspector 6kt��k!;0 h Aj �, f!, (r+vr+cF Out: Permit No. ElO her 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. Pr""evention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties ; ."3. 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 TIMEITEMPERATURE 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 ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE(POPULATIONS(HSP), ❑ El 21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing " El 11. 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, signed below, when C`r'Nt P 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 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S'59 Jnsp clFom IG.tlm f Ins top 's igr(a(f� Print: ff r 11 / /j -IC's Signature: Print: ,x l.g h �.- Pagel ofC Pages I � z Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 59(1003(A) Assignment ofResponsibility" 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103,11 Person in charge--duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Others 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Re orti rig by Person in Char e" 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) I 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 Bance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitir2iion Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell E,,gs* Sanitization Tem peratures* 3-202.14 Eggs and Milk Products,Pasteurizcd* 4-501,114 Chemical Sanitization-temp,pH, concentration arid hardness 202.16 Ice Made Front Potable Drinking R Stet* 4-601..1 1(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an A u-aved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency 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 5arutization of Utensits and 3-201,14 Fish and Recreationally Caught Molluscan Foal 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 Regulatory Authority 2-301,11 Clean Condition- Hands and Arms$ 3-202.15 Shellstock Identification Present* 2-301.12 Cleaning Procedmfe* 590.004(C) Wild Mushtnoms* 2-301.1.4 When to WasW 3-201.,17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2401-ll Eating,Drinking or Using Tobacco* 3-202,11 PRFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes.Nose and 3-202.15 Package Integrity* _-_ Month* 3-101.11 Food Safe and Unadulterated* 3-301.12 Pre vantin2 Contamination When-pastin>* 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590,004(E) Prevenring Contamination from 3-203.12 Shellstock Identification Maintained* Employees* TagstRecords: 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 Ca acilies* 590.004(7) Labeling of Ingredients* 5-204.11. Location and Placemenft 7 Conformance with Approved Procedures 5-205.1,1 Accessibility, Operation and Maintenance IHACCP Plans Supplied with Soap and Nand Drying 3-502.11. S ecialized Processim>Methods* Devres 3-502.12 Reduced ox en acka«in ,criteria* 6-301.1.1 Handwashine Cleanser,Availabilitv 8-103.12 Conformance with A [ovsd Ynicedrncs* 6-301-12 Hand Drying, Provision Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000. CITY OF SALEM BOARD OF HEALTH / Establishment Name: (,Ct"A -ter rdr' 4sDate: 2- f tr �a� Page: 7_ of Z- Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 0c) t#4n W r4 F7A 9 t K 2-l-,kof- 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 r' your food permit. /Y� ` n ❑ Voluntary Disposal ❑ Other: 9 3-501.14(C) PHFs Received at'I'emperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(items 1-22) (Cont.) 410FI45'F Within 4 Howl. * PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PFIFs 14 Food or Color Additives 19 PHF Hot and Cold Holding P ° 41°/ 3-202.12 Additives* 45 3-501.16(B) Cold PHFs Maintained at or below " 3-302.14 Protection from >Una roved Additives" 3-501,16(A)-590.004(F)4(F) Hot 450 F Maintained at or above l5 Poisonous or Toxic Substances 7-101.11 Identifying lnfonnatiwi-Orig.nal 1400F, Containers 4, 3-501.16(A) Roasts Held at or above 130'F. 7-t02.11 Common Name-Workln r Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stoiae* 3-501.79 Time as a Public Health Contra]* 590.004(H) Variance Requirement uirement 7-202.11 Restriction-Presence and Use* 7-202.12 Conditions of Use` 7-203,t 'Toxic Containers-Prohibitions` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saiitizets,Criteria-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Vs'ashin Product,Criteria"` 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Beverages with Warning Labels* 3-80L11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact.Lubricants* 7-206.'11 Restricted Use Pesticides.Criteria* 3-80111(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-20612 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 Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3Pathogens.** -4021 IA(71(2) Eggs- 155`F l5 Sec. E ges-Lnmediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Sheol Fg s* 3-401.11(A)(2) Comminuted Fish,Meats&Game 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 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 Ponitr or Ratite�ec. * alcove if related to foodborne illness 3-401.11(6N3) Whole-muscle,Intact Beet Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Anitrul Foods Coked in a practices should be debited under#29-- Microwave 10'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)&(D) PHFs 165°F IS sea s, (Items 23.30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and rick factors listed above, can be, 3-403.11(C) Commercially Processed RTE Food- ,found in the following sections of the Food Code and 105 CHK 140'14* 590.000. 3-403.11(F) RemauHng Unsliced Portions of Beef item Good Retain Practices FC 590.000 Roasts* 23. Mana ament 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) CohnL Cooked PHFs from 140`'F to ------- ------ - -- -- 26. Water.Plumbinet and Waste FC-5 __.006 70'F Within 2 Flours mid From 70°F 27. Ph sisal Facilit __ FC-6 .007_ to 4PF/45°F Within 4 Hours.' 28, Poisonous or Toxic MaterialsFC-7 .008 ____ 3-501.14(B) Coolin,PHFs Made From Ambient 29. S ecial Re uiremenis _ .009 Temperature ingredients to 41'F143'F ter Within 4 I lours* a 11W cul "Denotes critical item in Iha a�deral 1999 Food Code or 105 CMR 590.600, f Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name/,/,,,, Date Tvoe of Ooerationfs) Type of-Inspection ©'Food Service ©'Routine Address Risk ❑ Retail ❑ Re-inspection Telephone Leve fC El Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation (!:r,4r Ifi e-, ❑ Caterer ❑ Suspect Illness Person in Charge(PICT Time El Bed&Breakfast El General Complaint C. r t?M NtNxr d!/ J In: ElHACCP 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 .a PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ - E] 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE '- ° . ❑ 15.TOXIC Chemicals ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ M. Cooking Temperatures [3 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 E] 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control P4"Food Contact Surfaces Cleaning and Sanitizing ' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) d El 10. Proper Adequate Handwashing El21. 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 y 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 ofCHeah. 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 7 order of the Board of Health. Failure to correct violations ✓ 224. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 2 n Inse or' it '04, �/ Print: PI``C's Signature/ _ Print: r /.' /r]� , i4f pS Page / of Pages oajw& I e Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) ` PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 590.003(A) Assignment of Responsibility" 3-302.11(A)(1) Raw Animal Foods Separated fom 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge duties Contamination from Raw Ingredients 3-30111(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* at licants* 3-302.15 Washing Fruits and Vegetables 590.003(17) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report Tune,Person In Utensils* Char�e'w Contamination from the Consumer 590.W3(G) Reporting b Person in Charge* 3-306.14(A)(11) Returned Ford and Reservice of Food* 3 590.0033(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F) Removal oT'Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foci* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590-004(A-B) Compliance with Foci Law' 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Henneticall Sealed Container* Sanitization Tem eratures* 3?01.1.3 Fluid Milk and Milk Products* 4-501..1.12 Mechanical Wa-ewashino tfot Water 3-202.13 Shell Eggs* Samhzation Tem graters" 3-202.14 13 gs and Milk Products.Pasteurized,k 4-501-114 Chemical Samhzation-temp.,PH, concentration and hardness. * 1-202,16 Ice Made Front Potable Drinking Rater* 4.601.11(A) Equipment Food Contact Surfaces and 5-101.11. Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602-11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meet%Standards in 310 CMR 22.01" Contact Surface.,and Utensils* Shellfish and Fish From an Approved Source 4-702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment, Shellfish* 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authorityy301.11 Cagan Condition--Hands and Annss' 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure` 590.004(C) Wild Mushrooms* 2-301.14 When to Wastes` 3-201.17 flame Animals* 11 Good Hygienic Practices g ReceivinglCondition 2-401.11 Ealing,Drinking ar Using Tobacco* 3-202.1 1 PHFs Received at Pro ter Tem teramres'a 2-401.12 Discharges From the Eyes,,lose and 3-20115 Package Integrity* Month* 3-101.11 Food Safe and Unadulterated* 3301.12 Preventing Contamination When Tustin>" Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing C.ontatnination from 3-203.12 Shellstock klentifictttion Maintained Ent iterees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11. Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5.20311 Numbers and Capacities i 540.004(3) Labeling of Ingredients` 5-204.11 Location and Placement* - 7 Conformance with Approved Procedures 5-205.11 ' ccessibi liry,O eration and Maintenance /NACCP Plans Supplied with Soap and Hand Drying 3-502.1 I S ecialized Processin> Methods* - Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301..1 HandwashSng Cleanser-Availa a't 8-103.12 Cat@xmance with A moved Procedures^` 6-301.12 Hand Drying Provision '�Denotes critics)item in the federal'1999 Food Code or 105 CNIR 590,000. CITY OF SALEM �J � --// BOARD OF HEALTH u All 2 / Date: A-33 Pae o� of 7 Establishment Name: 9 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Na. Reference- R—Red Item - Verified PLEASE PRINT CLEAR � LY /orvir��` u N/r• x �,�i r l h R /aCI 1_ch' �V! r i� Z) . ' 1j)/1% _4� r D LSI C 1'CGS / 3 G l K t'0)ssiSoa �� �z ' ' . _61)shmrn l Musk rye_ _ rimula 7i �/ 412d d� z v ' All ) A) a > lea y;" �'- k ILIC s 1;tY 2-q- ZmeI2 WLI hdd 0.I1-e)f)IUZO-h6n r-' d de thou a CY��c `Z C /! <9 I' ifs 1h IYIa'f Ha_( CU)TldZ l",eS MUS4 e_ v . `/ /a 6P/ r 8 d/IJ i A44V d , nla11W1es' o , . aA o ' . to haL*- Scd &del L51 C -/a"l 2$ ,r r C 7/ _ VA D _ S (3P litL4 L _it 1,04 • Discussion With Person in Char of )/19,4 F v of- Corrective Action Required: ❑ No ❑ Yes 57 ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to 13 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 dollarsorsuspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. x �ra�� � . ❑ Voluntary Disposal ❑ Other: 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41°F/45"F Witten 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for Pl-[F's 14 Food or Calor Additives 19 PHF Hot and Cold Holding 3-50'1.16(B) Cold PI IFs Maintained at or below 3-202.12 Addatnec* 590.004(F) 41°/45'F' 3-302.14 Protcetion from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 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* 2A Time as a Public Health Control 7-201-11 1 Separation-Sl'oraee' _T501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Ose'" 590.004(H) Variance Requirement 7-202.12 Conditions of Use'" 7-203.1.1 'Toxic Containers-Prohibitions*' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11, Sanidzers,Criteria-Chemicals" POPULATIONS HSP) -- 7-204.12 Chemicals for Washine Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning,Labels* 7-204.14 Dr'in encs,Criteria* 3-801.11(13) Use of Pasteurized E".S. 7-205.11 Incidental Food Contact. Lubricants* 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.t2 Rodcnt Bait Stations* 3_801,1,1(C) Uno ened Foal Packa No Not Re-served, 7-206.13 Tracking Powders,Pest Control and Monitorinn,* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Anunal Foods 19iat are Raw.Undercooked or - 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs 3-40'Lt1A(1)(2) Eggs- 7.55 F is Sec. I$thu e-ns e'rocnrc rr;aoor Eels-Iumediatc Service 145"Fl5sec* 3-302.13 Pasteuriu,d Eggs Substitute for Raw Shelf 3-401.11(A)(2) Cormninuted Fish,Meats&Game Eggs* Animals- 1.55°F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130"F 121 min* SPECIAL REQUIREMENTS 340L11(A)(2} Ratites,Iryected'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 PffFs, residential kitchen operations should be Stuffing Containing Fkb,Meat, debited under the appropriate sections Poultry or Retires-I65°F 15 sec. * alcove 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 gimd 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)(O(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A 1(A)&(D) PHFs 165'F 15 sec. * (items 23-30) 3-403.1 I(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time" firndborne illness interventions and riskfactors listed above, con be 3-403.ti(C) Commercially Processed RTF Food- ,found in the following sections of the Food Code and 105(AIR 140"F* 590.000. 3-403.1.1(E) Remaining llnsticed Portions of Beef Item Good Retail Practices FC 5H0 000 Roasts"` 23. Mani ement and Personnel------ ____ FC--2 .003 1g Proper Cooling of PHFs _24 Food and Food Protection FC_-3 ,004 25. _Equipment and Utensils _ FC_-4 _.005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26ter, . Wa , Plumbin and Waste FG-5 .006 70"17 Within 2 Flours and From 70°F 2-7 Physical Facili FC-6 .007 to 41.°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-507.14(3) Cooling PRFs Made From Ambient _29. S ecial R ulrements _ .009 _. Temperature Ingredients to 41°F/45°F -.30, Other..............-_ Within 4 Llours' S1war-n-b,o6 2 d- "Denotes a'itical item in the.fcaerd 1999 Food Code or 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH / Establishment Name: A WAC,0+Gf- Date: 2 Page: � of__ Item Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 3 e �lC n 7G `to _,cJQsh MShvs . D / )r_ n/ J I&C S 1? elf7111 1 a d /d � � hl; SIS ,4 • -�� nd "�o`e 11 N n F Lo >ti pQ 4z, Kp d an Savr) a aossi66 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 RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension j f 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/re vocation of ❑ Embargo ❑ Emergency closure your food permit. �. 3 ❑ Voluntary Disposal 0 Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1.22) (Cont.) 41"F/45'F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Coolin�Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHRs Maintained at or below 3-202.12 Additives* 590.004(F) 41"/45°F" 3-302.14 Protcwon from IInar roved Addi Ives* 3.501.16(0) Riot PHFs Maintained at or above 15 Poisonous or Toxic Substances - 140'F. 7-101.11 Identifying Information-Original 3-501.1.(i(A) Roasts Held at or above 1300F. Containers* 7-102.11 Common Name-Workin Containers* 20 Time as a Public Health Control- 7 201.11 ontrol7-201.11 So aration-Stonre* 3-501.19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use 7-203.11 Toxic Containers-Prohibitions"' REQUIREMENTS ION (HSP) HIGHLY SUSCEPTIBLE 7-2(k3.i1 Saoitiuss,Cri retia-Chomicaltr* POPULATIONS(HSP) 7-204.12 Chemicals for Washine Produce.Criteria* 21 3-80'Ll 1(A) Unpasteurized Pse-packaged Juices and 7-204.14Din*A encs,Cnteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* ?+-8(11..11(B) Use of Pastautized'Ea^s" 7-206.11 Restricted Use Pesticides.Criteria* 3-801A 1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. '9 7-206.12 Rodent Bait Stations" '3-801.11(C) Unopened FoodPacka�e Not Re-served. 7-20fi.13 'Cracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Kaw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1 1All 1(2) F'".bs- 7.55 E"15 Sec. Patho Inti tte,m'v r-rrami f es-]mmedtate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(0)(2) Comminuted fish,Meats&Game Eggs* Animals- 155'F 25 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 ruin* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Mantes,Injected Meats- 155'F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec, y. catering, mobile food,temporary and 3-401.11(0)(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 3=401.12 Raw Animal Foods Cooked in a practices should be debited under i{'29- Micmwave 165°F* Special Requirements. 3401I1(A)(1)(b) All Other PHFs- 145"F15sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A I(A)&(D) PHIS 165'F L5 sec. * (Items 23-30) 3-403.11(B) Microwave- 165"P 2 Minute StandinIg Critical and non-critical violations, which do not relate to fire Time' foodborne illness intervenJion.s and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140 IF, 590.000. 3-403.11(E) Remaining Unsliced Portions of,Beef Item Good Retait Practices EFC-7 590.000 Roasts' 23.23. Mang emenl and Personnel .003 18 Proper Cooling of PHFs 24. Food and Food Protection .004 25. Equipment and Utensils __.005 3-501.14(A) Cooling Cooked PHFs from 140"17 to -26 Water,Plum bin and Waste .006 'WF Within 2 Hours and From 70'17 27. Ph sical Facilit .007 Lo 41.'F/45'F Within 4'Hours.* 28. Poisonous or Toxic Materials .008 3-501.14(B) Coolim, P11Fs Made From Ambient 29. S ectal Re uiremems _ .008 Temperature'htgrcdients to 41"F/45"F 30___ _Other Within I ldours'k ssnro,"c.ctM1.z.uw ''Uenotrs�Titicil item ns tha Federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM / BOARD OF HEALTH Establishment Name: �h��YCQ/ (.P��1/i�lil i71/( i1 Date: a 3 -D Page:_ of 7 9 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified -.-. PLEASE PRINT CLEARLY T) /i� �pPlYy7 L 'Aal 1 Discussion With Person in Charge: Corrective Action Required: `❑ No ❑ Yes ee I have read this report, have had the opportunity to ask questions and agree to correct all El Voluntary Compliance ❑ ExcpusEmlo�on Restriction/ 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 r noncompliance may result in daily fines of twenty-five dollars or suspension/ oca ltlt on of ❑ Embargo ❑ Emergency Closure your food permit. L C� -e� lGJ7 +. _❑_ Voluntary Disposal ❑ Other: 1 + 1 , 3-501.14(C) PHFS Received at'femperatures Violations Related to Foodborne Illness interventions and Risk According to law Cooled to Factors(Items 1-22) (Coni.) 41':F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PH Fs Food otl 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) 41°/45° F* 3-302.14 Protection from Unapproved Su Additives* 3-501.16(A) Hot PHFS Maintained at or above 1$ Poisonous or Toxic Substances 4W 7-101.11 Identifying Information-Original3-501.1.6(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* 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" 7-203.11 Toxic Containers-Prohibitions ' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals" POPULATIONS(HSP) _ 7-2(4.12 Chemicals for Washing Produce,Criteria" 21 3-801_I I(A) Unpasteurized Pre-packaged Juices and 7-204.13 Beverages with WarmilL L.iti Drin A guts,Criteria" 3-801.11(B) Use of Pasteurized Eons* 7-205-11 Incidental Food Contact-Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Ford and 7-206.7 1 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 7-206.13 Tracking Powders,P 7-20(1.12 Rodent Bair ersnPest Control and 3-801A1(C) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of Antmal Foods`lliat are Raw,Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFS enncave rnpuot 3-401.1.1A(l)(2) Eggs- 155'F 15 Sec. Pathogens.* Ti s-'Immeda uc Service 145'F15sec* 3-302.13 Pasteurimcl Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meati&Game Eggs* Animals- 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Becf 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 3-401.1.1(A)(3) Poultry,Wild Game, Stuffed PHFS, residential kitchen operations should be Stuffing Containing Fish,Meat, debitedunder the appropriate sections Pou!taor Ratites-165°F 15 sec. * above if related to foodborne illness 3-101.11(,C)(3) Whole-muscle,Intact'Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401-12 Raw Aninml Fowls 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 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFS 1650F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 1(15°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk}acurrs listed above, can be ,403.11(C) Commercially Processed RTE Food- found in thefollowing sections of the Food Cade and!OS CMR 140°F* 590.000. _ 3-403.1.I(E) Remaining United Portions of Beef Item Good Retain Practices FC 580.000 Roasts* 23. Mane ement and Personnel_ FC-2 .003 18 Proper Cooling of PHFS 24. Food and Food Protection FC- 3 .004 25 _ 3-5(}t.L4(A) Cooling Conked PHFS from and Utensils _FC4 .005 om 140'F to 26 Water,Plumb!n and Waste FG 5 .006 70"F Within 2,Haurs and From 70"F 27. Ph deal Facilit _ FC-6 .007 to 41°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-50.'14(13) C,.00lin,PHFS Made From Ambient 29. Special Requirements _ _ .008 Temperature Ingredients to 41"F/45"F Q: Other _..._._...._..._ Within 4 Hourss,, Denotes critical item in IN,tedecal 1999 Food Code or 105 C'NIR 590 0W CITY OF SALEM9 MASSACHUSETTS �. BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR r7 o SALEM, MA 01970 TEL. 978.741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Kinder Care Learning Center#668 Address of Establishment: 602 Loring Avenue Owner's Name: Dana Watford Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 175-04 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. HEALTH AGENT t CITY OF SALEM, MASSACHUSETTS � Il l' o V � BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR A SALEM, MA 01970 DEC 5 -2003 TEL. 978-741-1800 FAX 978-745-0343 C OF C,. M STANLEY USOVICZ, JR. CITY VI HEALTH JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO�O�P�ERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT�� u _(Yl iEL# g1H144 5800 ADDRESS OF ESTABLISHMENT tDoa Loring AL.)e 5oZ(!em - n-)o-. dICl ICD MAILING ADDRESS (if different) r' _J OWNER'S NAME L)9nQ ��CL TT 1�C71 TEL# ADDRESS CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)� C-Ar-ri CERTiFICATE#(s)Ia 14a9-1 o (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON CYT rnA HOME TEL#a JSDu&f 30 3: 30 P 3 HOURS OF OPERATION: Mon.le- oTue.lL_bWed.l0 (nTh .(e-�Fri._o� Sat.—y -Sun. X 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 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 $5 TOBACCO VENDOR NO $50 ALL NON-PROFIT(such as church kitchens) I�J,O7 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 1, to my est knowled� gee��and� belief, have filed all state tax returns and paid all state taxes req fired under the law. xca Is�.t?�F�2d 11(lRloa (0 glgln!� Signature WDate Social Security or Federal Identification Number ----------------------------------------------------------------------- - ------;;0---7-�---"-�----`5 Revised 11/03/03 FOODAP2.adm Check#&Date oZdOo '�:17 "— Massachusetts Department of Public Health Salem Board S Health M 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 DateTvpe of Operations) T e of Ins ction < N C &_ 6- CIA ' I1-0 { PoodService outine Address 2 r N 6- 1r Risk ❑ Retail ❑ Re-inspection Level/ ❑ Residential Kitchen Previous Inspection Telephoneda !� FlMobile Date: 4 HAGCP YIN ❑ Temporary [:1 Pre-operation Owner/y� W �J � ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint fr C'11v uryiLn V t-L ) In: ❑ HACCP Inspector ra ?QIV 11}ft t n R !i e 7A a f y;t' - Out; Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Mon-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) ❑ 690.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - , . . ❑, 12. Prevention of Contamination from Hands E31. PIC Assigned/Knowledgeable/Duties L?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 E] 4. Food and Water from Approved Source =TIMEREMPERATURE CONTROLS(Potantialty 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 ❑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 1. 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): El 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 105'6MR of Health: 590.000/federal Food Code.This report, when signed below N 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 2 ,,Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (Fc-a)(sso.00s) 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)(590.003) 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 5M)Inspecl4omb-09.tloc I ector'5ign re: - ,� Printf IC=B, i to e: `9 e- Print: I ��t !�'��^�t- L �1 + Page of Pages f Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination I 590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Annual Foods Separated from 540.003(B) Demonstration of Knowledge" Cooked and RTE Foods* 2 103.t t�erson in charge-duties Contamination from Raw ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(Cf Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-3021 UA) Food Protection* applicants* 3-302-t5 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Repot9 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(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fond* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111. Manual Warewashine-Hot Water S imtization'Cem eratnres" 3-201.13 Foci in il HermeticallyProdu is Containers' 4-501.112 Tvlec.hanical Warewashin* Hot Water 3-20'Lt3 F1uidMilkandMifkPmducas* b- ' 3-20213 Shell E--s21 Sanitization Tem eratures* 3-202.14 Eg>sand Milk Products,Pasteurzed* 4-501.11,4 Chemical Sanitization-temp., PH, concentration and hardness '* 3-202.16 ice Made From Potable Drinking Water* 5-101.11 Drinking Water b-om an Approved System* 4-601.1f(A) Equipment Food Contact Surfaces and Ltcnsils Clean^ 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequen�yolEquipment'F'oocl- 590.006(B) Water Meets Standards in'310 CMR 22.0* Contact Surfaces and Utensils'* Shellfish and Fish From an Approved Source 4-702.1 1 Frequency of Sanitization of Utan ensils d 3-201.14 Fish and Recreationally Caught Molluscan ,Food Contact Surfaces of E ui stent* Shellfish* 4-703.1 1 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources'" 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulatoAuthori 2-301.11 Clean Condition-Hands and Arms* 3-202.18Shcl1sfock.Identification Present'* 2-30L12 Cleatrin"Procedare* 590.004(0) Wild Mushrtpume* 2-301.14 When to Wash* 3-201.17 Garne Animals* 11 Good Hygienic Practices g ReceivingfCondition 2-401.11 Eating,Drinking or Usin g'robaccos` 3-202.11 PHFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes, Nose and 3-202.1.5 Package luteit y* Mouth* 3-101.11 Food Safe and Unadulterated" 3-301.12 Preventing Contamination When fasting* 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shelktock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shelhaock Identification Maintained" Ent !ogees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records. Creation and Retention* 5-7.03.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients* 5-204.11 1 I-cication audPlacement* 7 Conformance with Approved Procedures 5-205.11 Aecesslbilit Operation and Maintenance fHACCP Plans Supplied with Soap and Nand Drying Devices 3-502.11 Specialized Processing Methods* ti-301.11 3-502.12 _ Reduced oxygen packaging,criteria'" . Handwashi • n Cleanser,Availabilit 8-103.12- Conformance with Approved Procedures* b-301.12 Hand Drying Provision Denoles critical item in the tedend 1999 FoNl Code or 105 Cil1R 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 1t/IJO£!txc APKit 4_E0milrA&; c17'zDate: an_ IB —(7 Page:_ of_ 2 _ m Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY S e ed e �' a e ssi v.e let T POl � L V � , -Ai; 4F- /'/ it%f/S (U),P41 AJ a ,I J R Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion f+ 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 ❑ Other: 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accordini to Law Cooled to Factors(Items 1.22) (Cont.) 41'F/45°17 Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold Plif s Maintained at or below 590.004(2 41`Y45°F' 3-302.14 Protection from tJnaT roved Additives* 1.5 Poisonous or Toxic Substances 3-50 L 16(A) Hot PHFs Maintained at or above 140°F. * 7-101.11 Identif}fitg Information-Original 3-501.16(A) Roasts Held at or above 1.30'F. Containers* 20 Time as a Public Health Control 7-10211 Common Nan1e-Workina Containers'" 7.201.1.1 Separation-Storage, 3-561.19 Time as a Public Health Control 7-202.11 Restriction-Presence and Use" 590.004(H) Variance Ria uncruent 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 'foxicContainers-Prohibitions* POPULATIONS HSP 2204.11 Sanidzers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dtnina:aa vrds.Criteria` Beverages with Warning Labels* 3-801.11(B) Use of Pasteurized Ears* 7-205.11 Incidental Food Conrad,Lubrieants,k 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw S Partially Cooked Animal Food and Raw Seed Sprouts Not Screed 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 TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked of PHFs Not Otherwise Processed to Eliminate 3-401.14A(I)(2) Eges- I55'F In Sec. Pathogens.* """Pool ",'Poor F s-Immediate Service 145'FL5seo* 3-302.13 Pasteurized Eggs Substitute'for Raw Shell - 3-401.1 I(A)(2) Comminuted Fish.Meats&Game Ha gs* 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 3-401.1 i(A)(3) Poultry,Wild Game.StutTed PHFs, residential kitchen operations should be Stutffmg Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.1.1(C)(3) Whole-mnscle,Intact Beef Steaks interventions and Tisk factors. Other 145"F* 590.009 violations relating to g00d retail 3-401-12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401.17(A)(1)(b) All Other PHFs-145'1' 15 see. 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PI 11' 165`F 15 see. * (Items 23-30) 3-403.1.1(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which ria not relate to the Time* f r alborne itbtess interventions and risk factors listed above, can be 3-403.1.1(C) Commercially Processed RTE Food- towed in the following sections of the Food Code and 105 C1fR 14WF'* 590.000. 3-403.1((E) Remaining Unsliced Portions of Beef Item Good Retail Practices 1 FC 590.000 Roasts* 23. Management 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) Cooling Cooked PHFs from 140'F to . 26. Water.Plumbing and Waste FC-5 .006 70'F Within 2 Homs and From 70'F 27. Physical FacilityFC-6 .007 to 41'F145'F Within 4 Heins. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Speaai Requirements _ _009 j Temperature Ingredients to41'F/45'F 30. Other _ _ Within 4 Hours* s+arto111�1,le,7 nog *Denotes critical iters in the federal 1099 Food Code or 105 CMR 590.000, Y �v� ,�� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH '� + 120 WASHINGTON STREET, 4TH FLOOR 3 SALEM, MA 01970 TEL. 978-741-1800 0 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 : Dana Watford Name of Establishment : Kinder Care Learning Center #668 Address of Establishment : 602 Loring Avenue Type of Establishment : FOOD SERVICE Application Date : 01/02/2003 Restrictions: Permit for Food Establishment 201-03 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 I CITY OF SALEM, MASSACHUS BOARD OF HEALTH IO ® i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC 3 0 2002 TEL. 978-741-1800 FAX 978-745-0343 Gil1 —IVI STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD •. I-iLAUH MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO PERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT r1 ) ELe # g7'iC-- LiLA 5 t Ob ADDRESS OF ESTABLISHMENT ©a UZ)fl MAILING ADDRES (if different)��C",l 15pily—)� 7 ::ASS OWNER'S NAME C�� 1OC1 , �5�( TEL# ADDRESS CITY STATE =1P CERTIFIED FOOD MANAGER'S NAME(S) '1 CERTIFICATE#(s) \'2--NL4-a Lo (required in an establishment where potentially hazardous sffood - is prepared.) EMERGENCY RESPONSE PERSO<� ').A�i Jl�r� HOME TEL# k,3oA..,TU I,6Lp IAf HOURS OF OPERATION: Mon.—/ Tue.-,el Wed.__,,/Thu. ✓ Fri.-,"" Sat. Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YESNO� 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 $ more than 99 seats =$2 BED/BREAKFAST YESNO $100 ADDITIONAL PERMITS ..MAKE tC REAM, YOGURT, SOFT SERVE YES NO $5 :...YYJBACCU.VENDOR YES NO $50 ALL Nb20*PR0FIT(such as church kitchens) YES NO $25 .... ••„•• Please pay total with one cheek ••• .. payable to the City of Salem •• `111is Permit is not transferable and must be reissued upon change of ownership. The Permit must be postenjn a prominent location in the Establishment. ... In ac�ror.dance 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 an beli f, have filed all st-te tax retur s aq�}d paid all state taxes required under the law. ignature Date Social Security or Federal Identification Number -------- 2 FOODAP2.adm -----Chedc#&Date ---_--p---^-- �--------_- Revised 1112510 o2l 3 / ��� /2 ?I a00-- �. '^.-�-ti+a'.....�..1.-....--,;.w-Y.ti+r.d4w^•w,w„rr..'--.N var-.....-.+n9.•.-..�-..✓:.,:,a.�Y++'^...*°.`*-Ati+'�.^+.H�--.,:ww...-�.r�`++..n-.•m��"w-"'-'^-.^"`..' r �. .. THE 1'-_OMMONVVEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH � I Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name -}- Date -T - r i n T l In i niOC P n 62. )-/9-0,3 Food Service /Routine Address Risk El Q Re-inspection Level, ❑ Residential Kitchen Previous Inspection Telephone �. ❑ Mobile Date:a-//-Q.3 Owner / HACCP Y/N 11 Temporary ElPre-operation �,.i, .p C! /,- 40_ ' ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed& Breakfast x El General Complaint >Lrn,!' In: ❑ HACCP InspectorOut: Permit No. ❑ Other C c Each violation checked requires an explanation on the narrate page(s) and a citation of specific provision(s) violated. ,,= Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking 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. Local Law ❑ 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 El 3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures n El 5. Receiving/Codition & ❑ 17. Reheating .❑ 6. Tags/ Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/ HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION , ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing x - ❑ El10. Proper Adequate Handwashing 21• Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Goad Hygienic Practices ❑ 2,2�., Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Nl tuber of Violated Provisions Related Items) Critical (C) violations marked must be corrected /!To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board ° and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-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)(590.006) 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: Inspector's Signature: Print: PIC's Signature:(;^�_. / "1 Print: T--�,.,r, ` /Q I p Page of Pages �] n c / t/c W t T tl FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness a Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION -8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assi nmentof Res onsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.1 I(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contac[with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, Concentration and Hardness 3-202.14 Eggs and Milk Products, Pasteurized* P'P 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package In 3-301.12 Preventing Contamination When Tasting* 3401.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands -6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(!) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7" Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying a„ 3-502.11 Specialized Processing Methods* 6-301.11 HDevices evices hing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r CITY OF SALEM BOARD OF HEALTH Establishment Name: /(Nni��irAf ZFt AI.14/0 I1sI/v„ Date: '15?W- 03 Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION s i ,', Date No: References R-Red Item r .� ` € � ''' _ Verified PLEASE PRINT CLEARLY f �r 1 } e /S /u e SiN z< . zo' 'Fle /(/a s / / :C' 'V c, 0% F A _L.` 7/r P.C_ .0 12 ,Yi / df Alp' �i-✓Il 7/.S//i s/:L�,,4h�.?,n. E / 2.144 S l r z)e/ �- ,,/r Q P i.0 //li %/.ri i 7Y//I S ,tC5, P11C/ %/4, IV 7C / d� _is // /J ..Cis S/_r, / '1�17//VP, '!Z4/ ! _ r � Ai9 Crr��-f'/o-K TG o P �7LiP Ssl Y&-i4' /9i)T..0 / .,bi 4 I 1A T775 SP/` + , <� i -1�1 //1/O !70 P L(/ 4sv Tis SYx"i ,+r a� �:.tr /aP ,f) e,o a rrns 7�e�.ryC ru.�iari '/P l Yf_`/�75 n/n/ai� .V ate"//_//3 //✓S/-��"C�i.v�_ �P/fin r�- /�i,(6/� Y P.,,i n r��Y.Kra 1S"':,ia , y i i I i Discussion With Person in Charge: Corrective Action Required: IrUiNo --. ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all L11 voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ;e k-4?f20L. ❑ Voluntary Disposal ❑ Other i _ FORM 734B HOBBS&WARREN BOSTON r 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 !L Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) 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°E* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 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 Washing Produce,Criteria* - =z. Beverages with Warning Labels* 7-204.14 Drying 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 11112001 3-401.1IA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 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-1557 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(B) Microwave- 165*F 2 Minute Standing foodbome illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 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 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(B) Cooling PHFs Made From Ambient 29. S ecial 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. THE CQMMONVVEALTH OF MASSACHUSETTS ' CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Tv7pe of ODeration(s) T f In i M e2 LP iN4 2F v�-/,<03 rFgood�ervice Routine Address Risk ❑ Retail ❑ Re-inspection G•02 //✓ YC Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date:,,2-/,9-002 DO ' Owner . HACCP Y/N El Temporary El Pre-operation A / p yam, /,tiN1-.q tl& ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) _ Time [I Bed&Breakfast El General Complaint /.v J NOUGPS In: El HACCP Inspector // D k� Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands pr 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition 17. Reheating , ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ El 7. Conformance with Approved Procedures/ HACCP Plans 18. Cooling 19. Hat and Cold Holding PROTECTION FROM CONTAMINATION El20. Time as a Public Health Control' ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions y C immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-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 77 25. Equipment and utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: / Print: ;)n 7- rte. PIC's Signature: a'Yf�, ,Yo- / Print:4! m'( UroicLOS Page-1-of-aPages FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) _PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from .1(t 590.003(A) Assi nment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2. 590.003(C) Responsibility of the Person in Charge to 3-302.1](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 Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated i9 3''1 590.00Exclusions and Restrictions* Food 590.003(E)3(D) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces6a'4' Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P"p Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Ho[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* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 11 Good Hygienic Practices 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* -'12Prevention of Contamination from Hands s6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products 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* 590.004(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. a CITY OF SALEM ZBOARD OF HEALTH Establishment Name: r of�Tle Date: 3 Page: of \3 Item; Code' :,' C;—Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION' r Date _ No. Reference R—Red Item? y e :q Verified ,PLEASE PRINT.CLEARLV n 47 Ae- /A/O o / / // r.aL.- /7!>Air l(/P .P(//J4x2 _ �y r - d� /�/(-°/X///J Jc iti e /I1100il0 SCd ,.OI✓r3 ,_01 ./ 9e r 073 GrLr��i ,: f �drt,P ii�i//i' J �1//�i� s , <n/ G /ha a r-Af al (I. AIA, . �%7/'A ,,b0 ///Z10 /!-7e-AI Le 7-/Al fg LP r L 7�C ilk P .R� /Na iU&PIJA ( C7eom,,w, / v — /.7 Ag.,7_ f n C Pik rr 1 k t/R r n Ef• R -srs,..vo 7e 7i�cs _ .F „/ � ,r ,4� r a. .,-,-�, _r. 1%1c es { Discussion With Person in Charge: v 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 comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other a FORM 734B HOBBS a WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temp£iatures 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 14Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) 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°F.* 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 Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 D 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* 3-801.1)(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.* EBecsv 11112001 3-401.11A(l)(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 14501`* 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 ;.171 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(B) 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 Cade and 105 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 41017/45017 Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) 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. CITY OF SALEM BOARD OF HEALTH Establishment Name: 7jikr11P2/h t�t�. Pin roA,r.vn (�uT�,a Date: ,2-/f d 3 Page: 3 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION n a� Date No. Reference R-Red tteh 'A• //�:,,.. . ,may_.- --- --._,,. PLEASE rRirrr CLEARLY a '>. ;� ,, Verified 4 L" ITir/GP 1t�6'drly 5 O/ - (� �S 02./ P STA., /.(/ // � A,4 /I �U, P O /JO F P /l.P1', .2-71F.�.,fr CrOrt✓ PP 4;17` /CG. 2n, a'o0/i /J-24 Q(-- Lir ih xl o d,4zi /�: A __✓ Ai-47/�/4 / <YPlfrl,�>dC ( � /�iu6!•/r p�np. DF k/.rim �>?-i�, rzrV Cl� ,r ,c ��,�r�i f / z k v K S fT � / lnt /sxGL/?. f [ 7/c A%vPJ✓oA -/"�u /l7 <s apt S v/i k- AeX7- ' >. y 141 .[,7 7 - — /Qz� G ,'>7'/�. 11 -�- iN� a4701u / u2t P o t� Nynpuq's6i tiq � / - - = jC� 2m/� G7�/Dn 1m/rvex-779 (ye "Or /verc -- 5A/ 1f//y7 Z/ti y n t� -, - X,dfiC � A IV//I' fl �Z f 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 comply Exclusion f with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. f ❑ Embargo ❑ Emergency Closure F �'titl 1�C_C/4� ��/_f /f9c X •t � --... ❑ Voluntary Disposal ❑ Other FORM 7348 HOBBS &WARREN - BOSTON t 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 44 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) 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 1400F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 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 Washing Produce,Criteria* .,, Beverages with Warning Labels* 7-204.14 Drying 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 TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16;; Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Etlecnve 11112001 3-401.1IA(1)(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(B) 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 105 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. Manatlement 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 410F/450F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. So ecial 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. HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem BOH 978 745 0343 Feb 26 2003 11:50am Last Fax Date Time T)Te Identification Duration Pa es Result Feb 26 11:47am Sent 916177272533 3:14 6 OK Result: OK - black and white fax CITY OF SALEM, MASSACHUSETTS a 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 Facsimile Transmittal To: /YIyAve vs, 6,2eo.eCdQe4Censafi OFFiee P4 rlG AC-n Fax # RE: /f va e e Cag e Geaca�< v f Date : L< e� aeo3 Page(s): including this cover # Message: a`�.t� ou.0 a�d6�o 4 P�7rne Pvnd�Rbsofien Board of Health News ----------------------------------------------------------------For Your Information Office Hours: Effective September 3, 2002 through June 27, 2003 ; Monday, Tuesday, & Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 4:00 PM Do Salem Residents Know ? — Applications for a permit to remove exterior paint are required by the Salem Board of Health. No fee for permit and electric sanding is not permitted. Regulations for home owners and painting contractors are available. THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street,4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name Date TygP of Operations) T f In i n /� QRA4Ukq o p - �-!���3 J Food Service Routine Address Risk ❑ Retail ❑ Re-inspection 6C'z �v ✓� Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: , Owner n HACCP Y/N ❑ Temporary ❑ Pre-operation A!,/ -C� ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time [IBed&Breakfast El Complaint - *1 In: El HACCP Inspector V 4• ; Out: Permit No. EJ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT El12. Prevention of Contamination from Hands k 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ ED 3. Personnel with Infections Restricted/Excluded 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ El 16. Cooking Temperatures ❑ 5. Receiving/Condition 17. Reheating El 6. Tags/ Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/ HACCP El 18. Cooling Plans r7� 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION Q0 ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing El❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY , ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions C immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-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)(590.006) 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: Inspector's Signature: i' :� �� Print: PIC's Signature: a'-Y�� ,,,�� _ ..' Print: if 11 1 IJOIL(c s' Page-,L-ofy�Pages Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1•-i 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.1 I(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment :'2' 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and Applicants 3-302.15 Washing Fruits and Vegetables 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 Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated e'3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 'd4''. Food and Water From Regulated Sources 4-501.1 11 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container" 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products, Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* -1j7 Prevention of Contamination from Hands 6' Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(]) Labeling of Ingredients 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Demotes critical Item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH _ Establishment Name: AIOels?"C' Z le_& ;4'��Te.e- Date: o?-/��-3 Page: of 3' � lierti 'Godo C Critical item DESCRIPTIO.IJ 0F,,V10 ATI OW,PLAN`OKC0RRECTION % nDato No`s, -fi8ioreri6 !R Red Item . . ' ` `'. e . N..,,,. - • Ri r e. - - _ P _ - P /. zq P E 1A10 JIdW11 _ t 'c n ' d5 de O CO .9 - "' S/40 - x a� „ e _ ^.. - B e ti _ k �I 71� S � T=� ` I 04 — C 'AIX, fi Discussion With Person in Charge: ryCorrectiv4� ctlon RegW�ed;� �I Na ' `C?Yes 3 s. Iviolationsveread this before the nextinspection,adhe opportunity to observe all ask conditions asdescribed,and agree to correct all O Voluntary Compliance ❑ } E cPusion restriction p1 with all mandates of the Mass/Federal Food Code.I understand that noncompliance m_ay Re-inspection Scheduled ❑ Emerge,cy Suspension result in daily fines of twenty-five dollars or s uspension/revocation of your food permit. 1 ❑ Embargo ❑ -;Emergency Closure . M-t.�' h?�- ��` ❑ Voluntary Disposal ❑ Other Cn." 1WI-1 WARPS 0.WGgRCN - BOSTON 1. 3-501.14(C) PHFs Received at Temperatures x e atm to Foodborne IllnesstInterventions and Risk According to Law Cooled to x' ,�. 9. �• rJtenlB f12) (COWL) 3 * x- e. -.x-_ 41°F/45°F Within 4 Hours. ECTIO..N;FROM CHEMICALS 3-501.15 Cooling Methods for PHFs # I Food or Color Additives Y9 PHF Not and Cold Holding 3'202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3m202.14 Protection from Unapproved Additives* 590.004(F) 41°F/450F* io ;cr a Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101AI, Identifying Information-Original 14WE* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-101 11 Common Name-Working Containers* '12C' Time as a Public Health Control 7-201.1 t 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) 7-204.1 T Sanitizers,Criteria-Chemicals* "'21 3-801A I(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for WashingProduce,Criteria* ref Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(8) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Parially 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 ; TIMEIfEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or lfi Proper Cooking Temperatures for not Otherwise Processed to Eliminate . PHFs „ _= Pathogens.* E"""m""200' 3-40I,11A(1)(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 E • 3401,11(B)(1)(2) Pork and Beef Roast-130°F 121 Min.* catering,mobile food,temporary and " I 3401:11(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operations should lie P r 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections-' 'elStuffing Containing Fish,Meat, above if related to foodborne1llness" ? Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors.Other 3-40111(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* 4 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) i 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the . 3-403.11(B) 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 105 CMR , 3403.11(C) Commercially Processed RTE Food- 590.00, f is 140°F* Item Good Retail Practices f FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel I ,} FC-2 - .003 r Roasts* 24. Food and Food Protection , t FC-3 .004 ]8 ;' 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 ( c FC-5 .006 70°F Within 4 Hours and from 70°F 27. Physical Facility i i *i FC'-6 ( .007 to 41°F/45°F Within d Hours.*i 20. Poisonous or Toxic Materials I F&J : .006 3-501.14(B) Cooling'PHFs Made FromaAmbient; i 29. S I R u'irements{ I I ) o ' .009. 4 { Tetnperaturi4rigrsdiedts[d 41. 30. Othai 4 #i Within d Hours*I " �. . o Ik * notes cntical•ttem in the federal 1999 Food Code or 105 CMR 590.000. k 1 8 j{ t. i �` i i • CITY OF SAC"_M - y.. BOARD OF HEALTH r f.. + Establishment Name: Date: _f1--d_3 Page: 3 ' ' of Item Cq�d . C Crlticat Ttem - •H DESCRIPTION OF VIOLATION 1, AN OF�CORRECTION Dete s= •r; No Reterence ,.,R—Red Item 1 RiRr. ,. : Verltled •., ✓. .,� oeli ZAI ' A ✓ a -- g+ a D24 _ E w' PXT ' v �x m�NC7 d�z. IAI e -.7a e: _ -5119 AlIX7z� Discussion With Person in Charge: Corrective oqui Actin Rered ; ❑ o q ark I have read this report, have had the opportunity to ask questions and agree to correct all ' ❑ Voluntary Compliance ❑ 'Employee Fiestnction violations before the next inspection, to observe all conditions as described, and to'comply Exclusion .: with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ ..Emergency Suspenswn: result in daily fines of twenty-five dollars or sus pension/revocation of your food permit: LI Embargo ❑ ,Emergency,Glosure ❑ Voluntary Disposal ❑ Other � FORM 7348 HOBBS 8 WARREN - BOSTON M m o{ 1 - 3-501.14(C) PHFS Received'at TemperaturesN. � 4 Violations Relatedtto Foodborne Illness Interventions and Risk I According to Law Cooled Factors(Red Items 1-22) (Cont) 1 - L, r .._._...__ _ 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFS 14;,., ¢ 1 " ; i Food or Color Additives X19„ PHF Hot and Cold Holding 3-202.12= 'Additives* 3-501.16(B) Cold PHFS Maintained at or below 3-202.14 .Protection from Unapproved Additives* 590.004(F) 41°F/45°F* UL Poisonous or Toxic Substances 3-501.16(A) Hot PHFS Maintained at or above 7-101..11-. Identifying Information-Original 1400E* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* i 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* 7-204.12 Chemicals for WashingProduce,Criteria* 21 3-801.1 l(A) Unpasteurized Pre-packaged Juices and i �" Beverages with Warning Labels* 7-204.14 Drying 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 r 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 Pathogens. PHFS 3u; * Effective 1112001 ;iy 3-401.1IA(1)(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 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporaryand 3-401i1d(A)(2) i Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operationsshould be + 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFS, debited under the appropriate-sections i Stuffing Containing Fish,Meat, ty , g 8 above if related to foodborne'illness" Poultry or Ratites,- I65°F 15 Sec.* interventions and risk factors.Other 3-401.I1(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail . r 145°F* practices should be debited under#29-- - 3-401:12 Raw Animal Foods Cooked in a Special Requirements. -,? Microwave 165°F* - s 3-401.11(A)(1)(b) All Other PRFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES Reheating for Hot Holding (Blue Items 23-30) - 3-403.11(A)&(D) PHFS 165°F 15 Sec.* Critical and non-critical violations, which da not relate fa the 3.403.11(B) 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 105 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 d Lit 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'46 '; .007. - to 41°F/45°F.Within 4 Hours.*; 26, Poisonous or Toxic Materials 8 Fd.- ! .008: 3-501.14(B) i Cooling'PHFs Made From Ambient 29. 1 Special Requirements $ I ' (. .0092 =+ 'Temperature Ingredients to 41°F/45°F '} 1 ',30. 1 Other - t I_ I Within 4 Hours*; I 1 1 m •Denotes cnucal 1' in to the Yedeml 1599 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name Date ir l inspection Food Service 0,Aoutine Address Risk ❑ Retail Iq Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone , 4. , ❑ Mobile Date:62-j%-(�3 Owner ' f.- HACCP Y/N ❑ Temporary ❑ Pre-operation . 1.v ' 4P .• q d ry ❑ caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed 8 Breakfast ❑ General Complaint e14 99ki % /2=4o Pt" Win_% .„ �.c: In: [__1 HACCP ILZZLC Inspector f- Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ElEMPLOYEE HEALTH 13. Handwash Facilities PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15. Toxic Chemicals El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) C] 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 17. Reheating •❑ 6. Tags/Records/Accuracy of Ingredient Statements ' ❑ 7. Conformance with Approved Procedures/HACCP Plans [1 18. Coalino PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding El8. Separation/Segregation/ Protection El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing {,. ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22 Posting of Consumer Advisories �r Violations Related to Good Retail Practices (Blue'` Ter of Violated Provisions Related Items) 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 (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-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)(560.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: /; Print: PIC'sSignature: Print: -Dar, a Page-.O/ Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION -8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from rPI 590.003(A) Assignment of Responsibility* 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 Animal 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 Applicants e: Fruits and Vegetables 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 Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3;` 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9' Food Contact Surfaces - 4-501.111 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.1 12 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Ho[Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* `i104" Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* `11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* .5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* ' Prevention of Contamination from Hands Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical Item In the federal 1999 Food Code or 105 CMR 590.000. i CITY of SALEM BOARD OF HEALTH Establishment Name: /L Date: 1!y-/9. 03 Page: �_of 100 ecode x C Cddcal Items DESCRIPTION OFYIOGATION J PLAN OF°CORRECTIONS NoReterence -R Hed Item, u' •;, � , T •, - y, E:. Y ,•. a /NS a o - � Y m Y.$ VQ e 500&44 r 1 cr s e — l �tiaw e 7', n 'e ' _ qN q'- o `1 1 l; Dlscussion.With Person in Charge: h Corrective Action equlred:. ❑No fetes a ❑ Voluntary Compliance ❑ "Employee Restriction./ E ;I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion ! <violations before the next inspection, to observe all conditions as described, and to.comply a with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. `r u' ❑ Embargo ❑ ' ;Ern rgencyClosure hzm ck ❑ Voluntary Disposal ❑ ' Other 1 FORM 7148 HOBBS a WARREN - BOSTON Violations-Related to Foodborne Illness Interventions and Risk 3-501.14(() PHFs Received at Tempera¢ures r Factors(Red Items 1.22) (Cont.) J f i According to Law Cooled to y .- .. 410F/450F.Within4Hours.*' s 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(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* • 590.004(F) 41°F/450F* 15 k Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11, Identifying Information-Original 1400E* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* F 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* 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for WashingProduce,Criteria* : Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(8) 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 TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked,or Proper Cooking Temperatures for i '; not Otherwise Processed to Eliminate_ I",` PHFs n,>',: Pathogens.* Effecew 111t2001 3-401.I1A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* _ 3-401:1l(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS r Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporaryand `5 ! 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operationsyshoulI bE I 3 3=401:11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropronse,secuons' S% tuffing Containing Fish,Meat, above if related to foodbome`illness" • " Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors.Other 3-401.11(()(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.`.. J ...' i Microwave 165°F* t 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1Tr' Reheating for Hot Holding ( Blue Items 23-30) r m 3-403:11(A)&(D) PHFs 165°F IS Sec.* Critical and non-critical violations, which do not relate to the I' 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors lis-ted a6bve, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) - Commercially Processed RTE Food- 590.00. 1 - . 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel I ' FC-2 .003 Roasts* 24. Food_and Food Protection FC-3 .004 1t Proper Cooling of PHFs 25. Equipment and Utensils ' FC-4 .005 3-501.14(A) Cooling,Cooked PHFs from 140°F to 26. Water, Plumbinn and Waste ; n FC-5 .006 70°F Within 2 Hours and from;70°F 27. Physical Facile ( i FC.-6 .007 i f i [0 41°F/45°F Within 4 Hours.*1 , ;28. 1 Poisonous or Toxic Materials t FG'7 .008 3-501.14(B) I Cooling PHFs Made From Ambient ,29. Special Requirements; F m c .009. v Temperature4Ingredietitsto{4l°F/45°F : 30. Other '� k °' 0 . .i - �W-it�h-in.1Hours*� f i t 'v t� I 1 m g *Denotes tridcnl:item m the the federal 1999 Food ode or 105 Cl 4 R 5a+ m C