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KINGS ROAST BEEF AND SEAFOOD - ESTABLISHMENTS k;ayl f691f b"ef 441 tevf•e� irt5 nelfA ,frf,4t ftNIVERSAL® UNV-12110 MADE IN USA O�l� INITIS M®LPEGYCIIDIrnnnmr Geifiae Fbi erSwcfnY P0674ONSM® w %fiVmYrom.oq 4i ni.-M ` 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: 01/06/2011 ESTABLISHMENT NAME: Kings Roast Beef and Seafood File Number:BHF-2004-000331 145 North Street Salem MA 01970 LOCATED AT: 0145 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0194 Jan 1, 2011 Dec 31,2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS a-r•�"rr/ BOARD OF HEALTH 120 WASHINGTON STREET,4"-'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAa(978) 745-0343 MAYOR DGIZEENRAUM(Ct)SALEM.CONI DAVID GREENBAUm,RS ACTING HEALTH AGENT 2011 APPLICATION FORPERMITTO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT11�I hQ S,/Y�OCt,)1�( t}1 t Sp 1I0� TEL# ADDRESS OF ESTABLISHMENT Nr N up--( J T FAX# MAILING ADDRESS(if different) EMAIL- Business': \ �/ Website: OWNER'S NAME__ JAV-%1 111QAA)+Zt7 'S br� TEL# 9TS 9,6tF W ADDRESS 34 hk-t kq 5� L. Vvk, mr9 0/90a STREET -2, CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) XE,20-3se 3�_ (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON �ZIAV ,5 fY�q G�� HOME TEL# 9-)8 a65 -4I $$ Y4AYS-0F'OPERATION ., ,Monday,. s aTuesdayi; Wednesday_ ' ,Thusdayx i , Friday ^j�y z; i; y ,,Sunday _;:;• HOURS OF OPERATION )) / II Please write in time of day. ;��'t"' - )�y�" ))kn'I/p^^ lam -)/p,- jl/hM 'I�pM /pm- /gym A41n - Uprn ' N001✓" )Opr� For example Ilam-11 pm ( i 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 S 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 CHILDCARESERVICES/NURSING HOM-- ------------------------------------------------------------------------------------------------------------------------------- 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 s b fitted to and approved by the Salem Board of Health. Pursuant t GL h ter 62C,Section 49A,I certify underthe pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns a poi t taxes required under the law. i//8/v 039-58-C?"3 Signature Efate Social Security or Federal Identification Number Revised 10/7 FONDI Ladm Check#&Date rR�{+ 'v"'+e''Y§"Y'rfT.'t'Ei,N"-a' _ J...rsu...'�P ;«w}++*'�'r•y'..:dw .:..Y+i�+r.dtil�7'f J r Massachusetts Department of Public-Health Salem Board Health Division of Food and Drugs SalSal Washington S Street,4th Floor em, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Ems) Q Date Type of Operation(s) T e of Ins ection hnn C\I)(?. Y lJ� 11- Food Service Routine •Addre s 0© Risk Retail Re-inspection - Level ❑ Residential Kitchen Previous Inspection Telephoner,;-1</ El Mobile Date: Owner wl HACCP YIN ❑ Temporary ❑ Pre-operation l l )An n (3 iA ❑ Caterer ❑ Suspect Illness "Personin bu ^ 0arge(PIC) Time EI Bed&Breakfast [I General Complaint In:I,` E] HACCP inspector vA lA tJ t _p Out: 1 Permit No. ❑ Other Each violation checked requires n 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-Chokings Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) �i 590.009X 1:1action as determined by the Board of Health..11 C Ft?OO PROTECTION MANAGEMENT, ,��Y t.,u.n(. u a ?�-5! ❑ 12. Prevention of Contamination from Hands 1 PIC Assigned/Knowledgeable/Duties 13 Handwash Facilities U �IEMPLOYEEHEALTH i G� si„ `Em . ,a..� ', `.`),�.3... .» , PROTECTION FROM CHtMICAL87:�;."m'"`�o-wu= mI El2. Reporting of Diseases by Food Employee and PIC .m'33.�r.:u. 62 k5, JJ'j ❑14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals FOOD FROM APPROVEb SOURCE sz�im ❑ 4. Food and Water from Approved Source 71MEJTEMPERATUREOONTROLS(Potertially Hazardous Foods) E% �a �=;;?,daii L� -w.u L c. ,e'o.f».k�.��.•:kL�.�C,,,,.� ,.�a�.m ❑ 5. Receiving/Condition Li'l 6.Cooking Temperatures - a ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating `" ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling ep® ❑ PROTECTION FROM CONTAMINAT{ON"� r`�-�2,=,. d `;E 19. Hot and Cold Holding n i E �'/ r.t, _ 8. Sepaarn atioo n/Segregation/Protecti_conw` ❑ 20 Time As a Public Health Control O`1j 9. Food Contact Surfaces Cleaning and Sanitizing ':REQUIREMENtS FOR HIGHLY SUSCEPTIBLE PdPull. N3(WSP)+ , ❑ 21. Food and Food Preparation for HSP ti 10. Proper Adequate Handwashing ^+ ^"W IB Es 3 -S Y�p.M1 �p 11. Good Hygienic Practices t: OriSUMERADVISORY �N,� .,, e, ,,m ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below G 23. Management and Personnel (FC-2)(550.005) by a Board of Health member or its agent constitutes an C� 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-a)(sso.00s) the food establishment permit and cessation of food 26. Water;Plumbing and Waste (Fc-5)(550.005) establishment operations. If aggrieved by this order, you r1' 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing U 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 1 DATE OF RE-INSPECTION: sasamsoecrFormsm.eoc Y -- (�/y l[ J Inspector's Signature• �1 Print: U EXAe.�7 n 1x:2 &N "PIC's Signature: �j/ Prink �A. / e Pagt7 04e of�Pages i . �a F 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) AssignmentofResponsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.00303) 1 Demonstration of Knowledge* Cooked and RTE Foods* 2-103.1 I Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from.Each EMPLOYEE HEALTH Other* 2 590M03(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302 15 Washing Fruits and Vegetables 590.003(17) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.(X)3(0) Reporting by Person in Chin Vie* 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 FoodAt 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 Focxi in a Hermetically Sealed Container* Sanitization Temperatures- 3-20t.13 em eratures*3-201.13 .Fluid Milk and Milk Products* 4-501.112 Mechanical Warewasfdng-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-1.01.11 DrinkingWater from an Approved System 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590,006(B) Water Meets Standards in 310 CMR 22.0* 4-602.1 I Cleaning Frequency of Equipment FM- Sheldish and Fish From an Approved Souroe Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Re utato Authorit Game and Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Aut 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* r 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices 3 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Inteit * Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* h Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-20118 Shellstock Identification* 590.0(9(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacifies* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibilitl,Operation and Maintenance iHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.1.2 Conformance with Approved Procedures* 6-301.1.2 Hand Drying Provision 'k Denotes critical item in the redetul 1999 Foal Cade or 105 CMR 590.0(10. CITY_OF- SALEM BOARD OF HEALTH Establishment Name: n> A— — Date: I�-_�—/I Pager of Item Code C-Critical Item - U DESCRIPTION OF VIOLATION/PLAN OF CORRECTION "'` Dates No. Reference R-Red Item .,✓ .Verified. PLEASE PRINT CLEARLYT /fin Ir. .. .msµ, ,._.-..o 0 00.c x vl n G-'i I U l? Ifs 0,iJ;_ i //U.\. MA, l' �n..• - An. n9 / n ,n - \A 11 0 �G In_ O, n0 Ilk o , G ate_ CO%n e . , �+.'Jy�V��, vl _oa0 /An�y.-YI o `.i ()-,,r !'Nr. AA PA. �'�r n/\f n A J .--.d X.(_fn `J 0 n t nn,c.a`— >n) U.,\o it ) 1, 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 'y&voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P 13 Re-inspection Scheduled ❑ Emergency Suspension I comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure i your focd permit. / i ❑ Voluntary Disposal ❑ Other: 3-501,14(0) PHF«Received at Temperatures Violations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(!tents 1.22) (Cont) 41'F/45'P Within 4 Hours- PROTECTION FROM CHEMICALS 3-501.15 - C ri ing Methods for PHFs 19 PHF Hot and Gold Holding 14 Food or Color Additives g_90; (13) Cold PH1 c Maintained at or below 3-202.12 1 Adtbtoe,4 590A04(F) 41°/45°F 3-302.14 Protccbon from tlnappro,led Additives" ?-- 15 Poisonous or Toxic Substances 01 I h(A) Ilot 1.Hf,Maintained at or above 1 140'F_ 7-101.11 : lc, Ic ntr vm Iotc Illationtn-Ou inn! Cor tato rs 3.501,16(A) Rost6 Held at or above I30`b_"--, -- +- '-- -- rp Time as a Public Health Control r 10211 ' Common 1 nme 1i ar6i Cunt (in -f- - ,01Ir as tPubli HealthContiol- —j 73O1.IImuttn $Pu aR< " - ---.-. -- >0.MA1tHt v an;t T2< ui rc nient 7-202,11 Pestntt on �Pr ,tnu�.u;d LSO - -- --_-- � --�-- --- -- 7 ?0'2—, Coldruon ofI_I "_ _ 203.11 2u r4Cor t iine�r eltibi'-ivm+,` REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 n 63.11 Samut, Croc ui Cher tiu Is POPULATIONS(HSPS — 21 -3-SM,11(A) Unpicicu hod Pic. pat' agedlun,ecwill 7-"04,12 _Ch,nu ai,for U c hire C t rodocc rte r a' 1 7-204,14 vif ,Attntc_ __- - v06 WT nmiL_I &"W of Pu teen l-)0S_11 htunatlt >oE1L,Am)Ct [xrbrrcann; ttitll ll(i)) Pailifilk Ofok1 dAnimtdFoodand- 7 306 (I Tta_nct I , Pe tide .Crteu t _ r 7-206 12 2cnlct 13 ,t 1 mon,` - �-- foe `, d Sprout,No Servo a 1 o �N oo Paco a; ot Rr se <.,d. 06.'13 �T F` ati.^r,ALlc 1_at Contr„1 alld - - — - --. - ( tr n CONSUMER ADVISORY TWE)TEMPERATURE'CONTROLS22 Jbb_ II I ('oriculowl V isot io';T'A ori (1o.uan)baano;' i -- in ur.11 ata chit at It iw t.'ndect aka '+ 36 _-� draper Cooking Temperatures for PHFS Not 0th t i iss c Vrc, tic i 1.a �Iil un ra t L� _ > tDI.Lt A(i ( , - r`C ,� i S �'athrn ' t tc,u u d t S i S,bit a.r IA,r R.tu Shell l I � tarn dr in x.r fu 1,511,_et� i 1 , a ri r SPECIAL REQUIREMENTS 401 1'113)0 2r : Pf,t lrR> t I -ntN -- - --- --- 590IAit)(A� l�l Vjtl «Fxq r- 5:. ttCn )G.(')El?rile tt)! ut r 14Ji.i(Ati)t. 1-�. 155 F15 - ti ( caterine m abilf, 1 o i uolyl,faj A a:.L, a - ( csicl tl lk.htno) ttumi lxrt i a40Lli 4}<3} 3 1 vara tYrl (loot 5tti edlllFs, -� i o- ( (d he i St `{ r. C'trn a[m Poll W3 at, dctbil U ! td;a tho apprt Pt iM ,et110175 t t r ! mrd .. I isF faclara 01hC 4 03.i H•1 t<+t)i c\ tort#at Holding ViQL lTiONS RffIAIEV t 0 GOOD RETAIL FE50.0 f(;�;� t_?.7 _. ft he 2.-.. _ - ___ .. :rg - ) E (ltenrs >3-3tk 1{u3,t rftii _._ t! sA .tc li to 1 - e tit anding� C+at r .!P 'ir, n r i i..at r rt .ur. w rli ',o ft;tel A 'A.r ti Inurtbr rile f?b f [n'_rii'np ».i id,t t lm+ort lieud ro an, curt br, 3 403.1 l,r? ( Amni,uial} (4ta,..cu 21F FsxK{- 1 jc!«ttr m whe/ t n r rq See' n ,'.hA loud t nae ezr..! N CM1fR _ 1 , l 3 ftem I Good Retail Practices rFC 90.0_00 �';-00311{1 )..� ,e t u urn_,9 tee red lot twn,of ti�i r_ _ - ,. J r M nagt mi nl a rd P r ar nr i f(.. 00� ; 24 Foxt and Foal ProlerAroo FC 1 004 I Ig Proper Goosing of PHFS = - - - + - r E9�0121cnt an'Yt.. eu !n _ A7 501.)4(A) Ccllow CioRa d PHPs from 14 '1;in �c dJset PIA mk,ng .rr) ac ' FC a 0 Within 2 Hours and(num %'t ----- u.not5h_ - FC } 1A 41111y F Within 4 Hoa. ' I �_7d inns ar ors ori�xr, F^ilenris C'_-7 008 i e'b01.14(B) ( (At htPHF_ Madc Front Ambient I9. _�5�3a ( "1 r I rttiRe In red eras to 511-1451" L ^ ' Other _ �_----------1 Wo ri d Ilona:, I c c 1. !:gal tic `r In tail, I 'a9 6„Aur C ldrir i(li( "R�f 6t;(J CITY OF SALEM / c BOARD OF HEALTH Establishment Name:K / 6 kk)o 1 Page: J- of Item Code C-Critical Item'-' �, DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION gate No. Reference R-Red Item Verified PLEASE PRINT CLEARLY IY/ \h !,X-' _+Y� A .rJ Y4'\Gl.f A� 1 V7/J I A.. Yi/(1 A�A_ � •f �H� .A+rh If� �f J>Y A: :' n :Y/ /pY P/G N_ 1A r ( I'v.-in; A2 M1 Al 0.0. �7Y�>�dC�O�II� 0 the XCI J i/}i,_ka — P:a4 tM /� O'/yktAl �/�l— �fl/�//'1�T.l�.tPO 1 A,�/r`ynyf X )L_/D . Zr K--) orrn A.rAII i n ZIA 1_n, -.f'—\I�!.. � ��A A /V1 G/i.,,^✓ � .-rP /Yrnn Ai -all N\�/ I J,'lA AXl �N(i O�l rFr 4 �1``Q A 'F.ar..n P 2 /SOA AA J2A�AJe�7, � -17I/) /I/lAI Al— ) )p�,7�ns�� ) /ane 9 t7 n. A(n I n. :J `L""ti_� �'Jn.. �1T) I V ,AMS '-(V Llan,.01 n ren \ XX—eA—. (n r A I r �V fi � C l r,A V r I u5� G 1 VI P �n Pnn _ r! p 'MAO-A ' Dnnn r ) /VFv,a-�� (? • kn C t,t_11,C- ,t � ' � � �� l ;.�� `V /Y�-P/Y � anti E-D� �1! I t)(Yn_.�l1.hn„-) C, UA,;-AQ` \ ,v+ + _WA\ . V)t - a rtr Vl Discussion With Person in Charge: Corrective Action Required: ❑ No 9�es I have read this report, have had the opportunity to ask questions and agree to correct all 71voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p 1i 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. t� p Ynn 0 Voluntary Disposal ❑ Other: 4u 3S61 )#C) PHFsReecivedat' emperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(Itents,1-22) (Cont) _ _ 41=F/A5F Within a Hours. * _ PROTECTION FROM CHEMICALS l-St11.15_ Cooling Methods for PHFs �9 PHF Hot and Cold Holding 14 Food or Calor Additives 3-501.16(B) Cold PHI s Maintained at or below 3-2(72.12 Adthti�es" 590.004(F) 410/45°I 3-302.14 Protcwnn from Unapproved Additives' 3.50116{�) Hi)T PHI 15 Poisonous . nous or Toxic Substances Maintained at or above 140 7-101.11 ldenti]in,.tnfoima+ion-Orioiaal I Y r --:+-501.1 6(A)(6(A) Rotsts�ts Held at ar above 130'F. e _ l container x- 2 (0211 ' (:ommon'Vtme Worki. Cnor m r;. L� Time a� sa Public Health Conti of tint-,as as a Public Health Cont t tnmceReq, cmutt 7-202-11 Ret 01031- 1'r SCav- cand LSO - _.. _ .._..._ ._._... 7-202.12�(Cozdlt on of Uri 7-20311 Toxic Connnea F'rohl6Lioo REQUIREMENTS(H$P) HIGHLY SUSCEPTIBLE 204,11 Sannvus Cttti 1t Chunk 15 POPULATIONS�HSP} 7-204.12 ChtmlalsfnrNnhn k-rxluu0t.nt'aiat` 2t 3-SUL11(A) Unpoltemizcdl'tc. pacragcdJnicasand -L--- — licvec r te+with) auun l.at Is'. 204-14 D in 1etotsCriteria L ---- -----� . — 5 8t1! 1103) l.'•.c t I Pa teoiixed F n _ , (0511 hx3dtatallxxl( unlitlllhr ais `,bill(0) l vorRalial C1ei dAnimalFokdand 11-7-206.11 r{ex11 t d l s0.Pe tit ides Ciiteu t -�---- Iia SttJ 5}?[, utv loott Ss,nOd 1 7 Ob-12 1 Rales 13 1 S 1 n 1 -- - -f _._.-_ _ ...__ ..__ . _._..-- ;+ r,{c l I C, ll )cn d l xxi V t0 i Not R :z 1 hsc.{,n g 3 outlet' P s,CVnirvl,lied ----' cont c nn CONSUMER ADVISORY 360 1, TIMElfEMP_ERATURE CONTROLS _ _- ___.�� '� - 71 I lvrh JtpRr 0 Pat'01C4ra o'1 ir)ar uxlr !Yn ar 16 ��. Pro ....r CookingSLTemperatures for 1 _ PHFs ,61 Imnxdi,ic 5u to. 1 t5-F15<ec i lU2 ; F tout i F i M 5 tY 1 we fv+ Raw Shell I 401AUA) a C R2 14U: r, Mci k*Hint qe "(lt t'C13} + ��i r , t r d Eltt kr « - 1 d t i SPECIAL REQUIREMENTS _ 1 -W viclullon� (a Section .90.0,69fA) (01 .6 t uv. inTc tr o 't10 ." t 5 1 1 ' �. ! , c 1tC! t 3! tnobil: fix),! t Flip ,rat r 1 tC - - rd m t1 k ichcn o 3 3 ,tLot 'x t ld Sit i 3 4ftLIFfAl�3j I nt3 W;la C tr1 Sftt e 113'1-.: l : 1 S 3 lt3 1 sot ai z 3 Fish Meal, c1013i1 d a id r tilt al Pru slat ,t. 1.3115 1 ...41;<,t To f 1ih:c,r ,-i✓1.I. C'. t t 1 .411! hl"S( 13+. ° "b'fin'i ..: yr 1 1a..,i. t 1 uc l 1�o rt l ime l o 17 1 Lal 3 t t5+�1�Ftt � i reheatln_ tar Fiat Holding VIOLATIONS RELATE„ W GOOD BETA 1 -01.1 i+'t3 t33> PHI l6 '1 1 t ' I (Items 23-30) - 44:�'-.tl.tsi Miuou ,,nc Iii F2M1eut" St"md:ng Grruaiandrun rifi,ai r< rt +-s. which do.wi 4r h , 1 �4 1 303 foodbo nc iflizess iawi voozow rad n C tnctarr 7r=cd r< ,r- < rr Gr 1 yt)3,i l tt'} r )n nor`ia h Pu ccetn #2 I t I fxl f<un 4x1 ho Jrir'» tit ,: rt>1he F ant( rte a1:4115 / VK 1 443 F �_ 01c2 Mann nmun a 3d Pet orn<a� P . l 4f'3-1 (I) 1 r2 to unmgl.nc, ,eo PO>rt r<ns 0l lSttl I 3m I Good Retail _ Item FC 690._000 C- J ow, 1 lvait 1 9 '-'-" --t- — T4 haxi Ind Fa3d Proit,"Uon G i 4 L✓t, rIg Proper Cooling of PHFs r- - --- - -- r_._. �. _ 1 25 F.qulpment and Uten 11s F 4 M ; 4 501.1?fA,t 1 C sx:.tin�Catk_d PHFs b m1 14W 1:to F - - -- -------- W 1 - • - 1 on y a`or.Ph 7 ny"Jid,W i to 1 FC S °Os _ 1 1 Within )Rcwrs and Front ';>✓i' ?r 1 P:)y it f Fac if ty_ ' FC tr. 607 1 .1F 'rltln nur �.28 t �Po1son R3sorToxWolof coal _ rC-- 7 Bo 5019 eOC34{ri) C-oolirP :Madonmbieiotor 5P te ,L ;vr( l i );,v Commonwealth of Massachusetts s i City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Kings Roast Beef and Seafood `- File Number:BHF-2004-000331 145 North Street Salem MA 01970 LOCATED AT: 0145 NORTH STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0028 Jan 4,2010 Dec 31,2010 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2dl0 Board of Health l This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 I • c CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"{FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 -MAYOR DGREENnAUM&ALEM.COM DAVID GREENBAuM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ///Q S or,Sl °�g{ P,p Oc/D TEL# 97Y 5'yS J � � g ADDRESS OF ESTABLISHMENT /•7r NOR!k 54 FAX# MAILING ADDRESS(if different) / EMAIL- Business': WSJ) I✓1GSoG. 1°P� ( D✓✓/ Website: q OWNER'S NAME JO)l n n��9ti�Z(S TEL# 9�1y A57Y?, �; c elD ADDRESS 5V O)h 141 n n vl M4 0/ 90) STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) Jo7Jl ,2 �1,4/l 1 41 /126 CERTIFICATE#(S) xF a o3s33sa (Required in an establishment where potentially hazardous food is pre/pared) 1 EMERGENCY RESPONSE PERSON �G/i9S �5 /q�f)H1jZ/S HOME TEL#_ 9VaG54_/7iJr DAYSTOOPERATQON;P= -P. Montlay ;; r Tuesda', , '�WeG'riesday T,Mursday`,, Frtla r ,j Satdrda.. Suntlay HOURS OF OPERATION 1, Ar 10 AM 1 IOAm IO Am 10 Am tOArn nJoea/ Please oexam lellaam-me llpm '/D 11 Prn ; u Fr7 11 Pm i. II Pm II pm TYPE OF ESTABLISHMENTFEE (check only) 'Oj RETAIL STORE YES less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YE j0 less than 25 seats =$140 (Outdoor Stationary Food Cart$210 `/ 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES 0 $100 CHILDCARESERVICES/NURSING HOME ------------------------------------------ ADDITIONAL PERMITS - - MAKE (notjust 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 sub fitted to and approved by the Salem Board of Health. Pursuant to M C ter,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 Pat Mtaxes required under the law. is o oma -5-;9 9y�Z3 SignaturePi1A Date Social Security or Federal Identification Number. --- - ------=------- a Revised 424/0 OOD 00 .adm Check#&Date I I a 7=T $ r,,t",40, A , �,w.y ^..R..,.+-.,+v.rr."/:!?-Rw.e -k'ai...y;'Sh�,+:A.j.w•�-d„rnw Y- . . Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name G� �� Date T of 0 eration s ate-inspection (V1CnS �'� Foed Se vice utine Address 414 � ) �� Risk I ❑ Retail ❑ Re-inspection n �� Lever.' ❑ Residential Kitchen Previous Inspection Telephone Ot 1( _ ✓1 `/ _ (1 � /l 1 ❑ Mobile Date: Owner �- l J i HACCP YM ❑ Temporary ❑ Pre-operation (J�) ,t Z S ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) rl { Time ❑ Bed&Breakfast ❑ General Complaint Inspector ( ) 00 Permit No. [IOther 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)-If_ 590.009-(F)-E:] action as determined by the Board of Health. OOD PROTECTION MANAGEMENT,�s'!,`, " mT,�,„__,,;� El E0 Prevention of Contamination from Hands 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH 112T f� 2. Reporting of Diseases by Food Employee and PIC V{^ AhPROTEC710N FROM CHEMICALS r sM rt G! ssta y F #i IIVJI��IVVV��I�� m I ! ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excludad 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ,x'';„F,�4'. ..,, m� . d,:TIMEREMPERATURE.CONTROLS Potentla)I'HezerdousFoctls ❑ 4. Food and Water from Approved Source ( Y ) �. ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures r\V N' 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17• Reheating E] 7. Conformance with Approved Procedures/HACCP Plans 0 k118. Cooling /i TTECTION FROM CONTAMINATION 1, �'" ° - ' r 1`"` 6419 Hot and Cold Holding _' lL® 8 Separation/Segregation/Protection [120.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and,Sanitizing .REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS{H$P)r ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing 11. Good Hygienic Practices CONSUMER ADvt80RX,.'-' -'_ '� °,e � }K',?mk ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C p 9 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 5. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) 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: �3 sssomspecrFomre-ia da� �//,`�'/e , \ 1,tv Inspector's Signatu�e: Print: PIC's Signature: ( \ Print: O iu w 2 k f Page of Pages ' J � r Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assigument of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11. Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 590.003(C)590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by fool employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washin Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304A t Foot Contact with Equipment and Applicant To Report To The Person In Utensils* Char e* Contamination from the Consumer 590.003(6) Reporting by Person in Charge' 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Ftp* 4 e Food and Water From Regulated Sources 9 Food Contact Surfaces 590.0(A(A-B) Compliance with Food,,Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Fund in a Hermetically Sealed Container* Sanitization Ten eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashina Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-60L l I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean- 590,006(B) Water Meets Standards in 310 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Foxl- * Contact Surfaces and Utensils SheiHlsh and Fish From 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 Regulaton,Author' 2.301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* ll Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Packa e hate it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification Maintained* Em to gees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients" 5-204.1.1. Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,O teration and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11. Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision '"Denotes critical item in the(federal 1999 Food Cade or 105 CMR 590.000. i } CITY OF SALEM BOARD OFHEIALTH Establishment Name: 1M G n. / 1 4 i��n r IJ aA,�.,Q `�OYOA rtDate: t — O GI Page: of T Item Code C-Critical Item ( DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. _ Reference R-Red Item ;r "• '� Wim' '^` '� • -Verified ` k. PLEASE PRINT CLEARLY s f li A1LLt IAA �ti.y�. n.�" �07, Alt AA-t 1. +Al nc �v n / /e (it.� f! i;r/ 19 o., ..r'rti„� /n, �:n li6ll.t yr/'lA OA '�.n .nn rnnti n ,_e rk� , I/�t��. .+�sL ill��nn ✓ton r' t� "� � 1 G} ��l . _ Q�� V j� II ��))�� ( /) y �j l!.7 iP_tl_ /�� .t-'.' (-AA—y1 E� f_✓_k H. A. 'i \A ,n.t Inn `�1_4-t-) (M1 00 /1 1) a,n,. n_ All _e AAnn .�n_ /b Il aAA /_A �A3 nAY) 1'� ('oo-V V'T6i1 iA a )1-4, r� . J X"/Vin o-�, �� , J ' in ._t rn.t ,q %b.. t .c/ r //� .., AP rnn J /A 'X n /1>'1 A-%/10 r0 NA si\', � A:�' 1X 0 � T> (b 1n JJ - �� O �A �N1 ni A n A A ) , )Ar AICI 1/.4-1 ioQ r"nnn 0 a .La a t (Van n1) 11.1 G,^ P.r:vt_N, 1 a .!1v �/. I . Discussion With Person in Charge - Corrective Action Required: ❑ No es ” 7 ~ ❑ untary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all _ �°1 Exclusion violations before the next inspection, to observe all conditions as described, and to t P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ' noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo- ❑ -Emergency Closure your food permit. ❑ Voluntary Disposal LI Other: 5 PIIFsReceived at'f;q>7em a to Law Cooled Violations Related to Foodborne Illness Interventions and Risk According Factors(item 1-22) (Cont) 41�F/45'F Within 4 Howc. j Fil 1�5 Cooling Methods for PHFs tg PROTECTION FROM CHEMICALS PHF Hot and Gold Holding Fcatd or Color AAditores Fj-�-- - Cold PH17s Maintained at or IeAow 3-202.12 A(Iditives* F* — 390 0(90-i 410/45' T�il—14 —PtlEco(a) E 3-501,1 NA) Hot KlFs' Maimained at or above 15 Poisonous or Toxic Substances 140'F. 101.11 1 Iderrot'vile'. tntblqrmion -Original -50L 16(A) Rwtas Held a[or above (30`F. I L2!L Time as a Public Health Control 7-102-11 Common N4 Working('o y 7-2()I.11 aree, % arconerl* 3-W,19 Time as a Public health Coian)P _�:S mL__ 590.004(1-1) Variance,Requitement 7-202.11 Rawlct�mi--Presence and (J'e* ---- 7-202.12 Conditions of UINO'° REQUIREMENTS FOR HIGHLY SUSCEPTIBLE F-7-M-3,1-1-Toxic(smnamev - POPULATIONS HSP) F-77-204 11 S,niu7ers.TriiTne- Chcmrc�ds* 2t I-S01.11W Unpa,aeurinxi Pre-packaged Juices and ri an 7-204,12 ("fiemrcAlv to; wash!��L(�)Ls'Cute.t - - fieverae-es with 7-204,14 Di i�i�etarts'Craera' -ie�s 7T-2 3-561.11(B) Use of 3-SUI I hwidetual Foxl Contact,Lubi ictrrWl (U} Raw or Partial! C�s7kcd Aunnal Fust{and 7-206.1 Raw Sc"'LlSprnaty het Sersc el 7-206.12 Rodent B'Irt Statiom, X01AJ(C)_ 7-?A613 F3 ck �' ed�r � CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS )0- 22 i Consumer Ad%iscry 14con'sualfaron of Animal Foods'flort are Raw, Undercooked or I Proper Cooking Temperatures for PHFs Not Other"itie f1r(K!egsed to F.lkrarcvv II 3-i671,I Ali 1,(2, f 5y -TF) F 15 S,c. _!'Lt t h_og(m� J- !L�-jooLi:r nuc Service IWT 15sec, T�— T 01.11(A)(2) Comminuted FiA-Meals&- Gann Animals 155"F 17sec. ,4C Pori, and 13NI Roam 1101' 121 min SPECIAL REQUIREMENTS 590,00r)(A)-(D) Violatrof Section 590.W9(A`t-(D) in 3=101.11(W:1) totes, In eoud bleats 155'F 15 ons 1 ecc- cateringmobile tood,temporary and 3-401JI(A)(3) Poultry,NI,ild Gaine, Stetted l'IfFs' rteadenflat kitchen oltorations Awtild be 1 Srolffiltz Contarnjnj"�Fisfi, Meat, debited under tire ppropfiale see s i;'afltry'oi Ratnes-165"'T15 sec. aliuve if related to foodborne i lhicss 7101 1-1 rouscle.intact Beef Steaks inter ventions and ri.sR factors, Other _ 1451 w 590.009 violations relating, to good retail 3-401J2 Raw Animal FoodCorked in a practices should 1-c debited under#29 - Microwave 10517 Special Requirements. 3-401,11(A)(1)4b) All 00w PHF, - 145'F 15 sec, I7 __ Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.103.1](A)&,(D) PflF's 765"F 15 sec. (items 23-30) 3-403.!.1(8) Microwave- 155°F2 Minute Standing. Ctitiral and nary-(rnical violairorm, which do not relare to the 'ritne, foodborne illness intet venliow and rokfirctors lictcd above, (on bc :3-403.11(() Commer,iailv Pj ocessed lrlF K-d- found in the jail orringser eons o1ilu;Food Code and)05 i"l-IR 14(t'F 5,90.00r), I--- - - - - --- r- item T S of lie - ------------ J-`) Rcinailim, nshQ Por tion el iariPret FC 590000 Rcvas* 23, _Maja -menu and -2 '003 24, Food and Food Protection FC--3 004 Ig Proper Co-xtlltngot _.j 2b Epment and ;i-50t.14(A) �26 - ----- , C( v,,dPHFsfromJ40`Fto _yl�tter,,Pl robinand V006 70'F Within 2 tfrarrs and From 701, 27.�" Utensils-6 007 -—-------------TF-'� -7 P sonous or Toxic Materials C 7 X01.14 8) ('001mV PHF�Made Front Ambient '009 Temperature ingredients to 41'N,15:F 30Other Within 4 Hours* [,)en,res cra cif stem in che fv<rec'l 1999 Food Calc'or 105 CMR 590(XX) CITY OF SALEM �l BOARD OF HEALTH / Establishment Name�A ' n VV)/-, n;11- Y: o �nrAnd In .. 19.r,j Date: Page: of Item Code C-Critical Iters DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION = Date No. Reference' -R-Red Item d°;'. � �" m "*' r�a - �" °-�"�_ �s 4 a� Verified P i �3 •q < • PLEASE /JPRWTcLEARLT'` "- z ,r �,� LL. N ��o ,li r'-��, I/�, -' �_.l�_i AA rs \-T/l ,,n n.n.v l`//inn Otd �_-�}_A�✓Y 0 7_) )A / .��1 ��V O/�nn(� y /- nnn .,t71 ��l. 0;-A �l Di1 n_ n:XA)P.�O 1�"A/_RTi/I OA n A� n/\"-I f/)1,(P /) -�-r /1_ ane „1 _n it 0101) Ar-r, INAr). kJnk f )F) D!v � 1n..A-) Q_ ann � n �A x" ' / � � 4 AA .i, ? ASA .K/.! - cf �'VPP /�� '� \7� 7�r�_.r r1/ nom,n,n Ornn . n \ 11\.x. Q�--rn��-n J' 011A- ��/\ o L� /I z nnl VnA n a .2, (�0/9 .r_ nit iOAA 'I ' } 1k -) 7 P ') 0( 5 '-6 A, L , 5-71 0 n r'e-6-- A7)ri n �/n nA.(/o\v�I l x On .t/o li rO A- JAM Win. - v } - + y, DrAd, I��f.t i7/v = 0;41re.a n l �l �n '3 tt 11//b n 0A � A,I ft- 'C (_0an_o 6N.� — L�r'00'PAo �� , �D (�a•9 n�R l_l r �1 0 p d Cll Poi re f c C I�tn O- i ! n n (� t �t/t />nn: Un _ -- - 1 Discussion With Person in Charge: Corrective Action Required: ❑ No esu I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: I, AT PI-IFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Lau Coulcol to Factors(items 1-22) (Cont.) 4 IF/45'F Wilbinl Houls, 115 Conlin-lrlcthods for PHR PROTECTION FROM CHEMICALS 14- Food or Color Additives F Lj-9- PHF Hot and Cold Holding 75- -- 3-50LI6(B) Cold PRI-S Maintained at or btloa, 202.12 j AZIti, 590.004(F) 4P/45" F' 3-30214 _ Proteciiou 3-50 1.16(A) IRA PHFs Maintained at or above IS Poisonous of Toxic Substances 140'K * ldentityiiig Infiourseion - OrigirutJ —-------- 3-501,16(A) R(Kists Held 4t or above 13WT, Container'�' 20 Time as a Public Health Control 7-102,11 Common Name knjj�eC'cnnuunos* __Y� _ -- 3-501A9 Time as a Public I leafth Control, 7-20 L I I Se at Sion a 590fg)4(11) VarianceR IL nell 7-20111 Restrict on -prc'��-rwc'and Use* 7-20112 TT'o—wjjt,7(-g;s of `Forte C(�(- 7-203, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 'iorls� POPULATIONS 7-204.11 sanilizers,Criteria -chcinicnls --111412 chcnii('ajs for Wash 01ce,Colin iter 21 1-8,01AI(A) Unpavtcurjtzd Ne-pacltoged Juices and JE04 1:4Rever"Qes k-20511 In $8zk jjLB) Use of Pastem ZC J , cidental F�X)d CMMdlo' OlAcauts' 1,205 11 Ill.)) Raw or Pailuiltv 0,oked;�TjiinaiToodani 7-206- 0-11rid",uw Pesticides. Criteria' Raw Sced Sproul%Not Served, 1 7.206.12 Rodent B uon�� Ti�ck rig P4�,tdere,feet Control and n, t�e� s, _L Mollitocino, CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-00�� 11 1 I — p� --- il Foods'I'lituarc Raw. Undercooked is Proper Cooking Temperatures For Anioll PHFs Not Othti wise Pro�cssed to Firronate Patholsms. 3-401.11 A70T(T Fg�s- 155'F 15 9145�Tl5sec' 1-302. IMM EggsSubinoriv for Raw Shell —------ _hanrd -7 Orauninwed Fish, Nfc�,us&Gaffit Pastin I I(A)(2,, Animals- 1 0 sec. SPECIAL REQUIREMENTS Porf ai)d Beef Rossi - 130 t 121 min* - -- 590,00')(A)-(D) Viujqlioj)s()i Section 5,90.109(A)-(L7) 67 3 3-4()1.11(A)(2) Raines, Iniectod vt�dt'� 155 F 15- 1 catering. mobile froord,temporary and W1.1 1(AV 3) Poultry,;W� lolled 'Iffs" residential kitchen operations sliould ive Siinfun"Conlithiing Fish, Meal, debited under the appropriate actions atruve if related to f6odborne illness 640-1.11tcpl) Whole-nam.-lc, intact BeJ Steaks interventions and risk factorsOthff 1451; 590.009 violations relating to zoo-retail 1 3-401.12 Rt w Annual FoiKk Cooked in a practices should be debited under#29 - Nficiowavc 10'F* Special Requirements 340 1A I(A)(l)(b) -All Other P1 fEs-- 145c F15 sec, L--i— IT Reheating for Hot lioldmi, VIOLATIONS RELATED TO GOOD RETAIL PRACTICES -3-•T151iT'A;K(D) PIIF.s 165`F 15 sec.'s- eG. 3, -- ([terns 23-30) 3-40111(B) icrowavc 165"'I"21NfirouteStanding Critical and non-critical violocino, a-rich do nor relate m Me Thile, canbr 3-403.11 C) Comnsavialiv Procassed RIE.Food - fintool hi the following sin lions of the food Code me11117 CAIR - --------- ---- -- m Good Retail Piscil FC 590,000 3-403,11(F) Remaijuna Unsficed Portions of fic�l I 23 -FC---2 1 -50--3 Roast'* 24� F�Aand Food Proliection 111 1 Proper Cooling of PHFS FC -13 00 -2 uipment and Utero-S-113 FC-4, 005 561 TZ,5 to ---------- 501 14A) C(s-4 in-Cooked PHFs h orn 14Y F 26, V, ter.,tiumbinciand Waste FC-5 -+iva --- 006 ------------ 7WI: A''ilhin 21-fours and From'19' 2! Physical FacilitlL —F(,'-- 7 3 5(11 41:1) -noling PHFs Made Frorn Aii�—Ielu r "n re Temperature Ingredients to' 1'1--/45�F 30 Fhr,,�a- j( ----- ------------------- Within 4 flourz' Den"te"mw:al nein in the 1�dera3 I94+)Food Ggle or 105 C"IR 590 C07. s _ ( CITY OF SALEM BOARD OF //HEALTH j Establishment Name i �r c )Yam R � Pd -�Z2JrtDate: Page: of �V Item Code C-Critical Item✓: + V DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Yate No. Reference PL R=Red Item, _ y'= �;; '` �-�EASE PRINT CLE' R A-� Verified -q '4 Ys� x+56" LY - -' "` : '^�°^"�- a� ! 1 r\ t�J) _VV rAnn f I (� J 7 'A- NN �i,..�I o �71V)l1.4 a7 /,_ l I 9 A 1( 1:0_/1 (�-t' 17Y i �" _ei��7• D Xi f ~�sl� '\ F� ;J�/`, r7 a'� /J '\M ,.'��i_ e.�O o r :ne rvt r /Jn, 10A Q_)IOA A I A9 i ^A ,,n --hi O oe'4.if )a, IJn /1n n/Jn A Q . AA 0 n i �- CV 1 6'V(Z 1 JA O Viso n x o� Discussion With Person in Charge: Corrective Action Required: ❑ No '" ,, ❑ Yesz :dfi,:yvw ffil s ,^moi N 21 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. ❑ Voluntary Disp6sal - ❑ Other: i 3601A4W) PflFs Recxived at-temperatures Violations Related to Foodborns,fliness interventions and Risk Acv)rdnig to Lim Coo)M to Factors(item 1-22) (Copt) I I'F/45'F Wilbin d Hours. 5jLJ5 Coolfro,Methods for 11 PROTECTION FROM CHEMICALS -I--- - F, PHIF Hot and Cold Holdi—ng— i4 Food or Color Additives 3-50!,16(B) Cold PHFsMaintained at or ft1tiw 3-202,12 AdZli,,,` 190.004(F) 410/45" F* 3-302,14 Prole tion fro4LInal io,,!�d Addjhvi�_ —3-507.I(�,.A) Hot PTIFs Maintained cit or above Is 1 Poisonous at Toxic Substances 140'F. 101.1 Odgioid 3-561.16(A) Roasts Held at or alawc 1301% 'orawners 20 Time as a Public Health Control 7-102,11 Common Name - Workin,Cowaincra* 3-501�j�7 7 as a Public I leakh Control' 1-20(A 1 S�paradcin 7-202.11 Roettictour-Pr.es, nco and U%�e* Ratnrcrnerit 7-202.12 coridlooti",cif ITe REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Tirkis Coatairiei,,,-Prohibition i* POPULATIONS(HSP) -7 204.1 t Saniu7tn' Crieeria Cirunii .Is -- 7 Chorricals for Wa,hu c tnxiace.Ciiiiiaia' 21 3-liol.11(A) Unpica L Bevelaces with Wrrjtl __04,1± 1-801�I I(B) Use,of pastein izcd Ec.'s o"( 1-7-1 Tna i ,-2o.5.11 Inci&'rual F(xXl(.'vniact'Lulaicapos� 13-80 .11{A)1Raw or Pailvilly Cooked Amund Foxe!damd 1[7::206 11 kesirictcd L.,w Ptticide,�.Criteria* _L�aw�SL�,Ld Sprouts Not Served IL_ seftiolls, r__ 1 3-801.I I Unopened Foxiq 7-206.12 _!acL�Nol Re-scrved, L7 106.13 'r3acking Powdcrs,r-S,control and -(,—no o I r1L CONSUMER ADVISORY T TIMUTEMPERATURE CONTROLS 22 3 4)()-" t I uonstrnria Advisory Posted for Consumption of 1"hual F-tiods That are Raw.Undercox)ked or lb Proper Cooking Temperatures for Nom- t Otheise Prowc„ssed to Eliminate PHF5 t oac!il a(jT I FlZg�, M'F15&,,c. 2=_—, 3-302.13 flastenrized Fg o Subsulul�,,for Put Shell (A)(2) Comminuted Fish, Meals&Game Anillaii 155"F 15 sec. ,1 _i5j—iipot 4 SPECIAL REGUIREMENTS 3-401.10111(,X)( Ranrc� (nice d Mats 155'F 15 .590.M90) M) Violations of Section 59()11M(A)-(D) in 8tic. $ caterineinobilic,foxyd, icinporin v and 74( Sturfed PI-irs” residential kitchen typetations should be Sio(biwConfainnibFish,Meat, debited tinder the appropriatc.<ectioais Pouftry�or kaotet-1 65"1 1 15 roc. above if related to ftx)dborne illness 3-401A NCK3i NV%0e-rT)wscicWart Becf Steaks inlet ventfcins and risk factors, Other 145"T 590.009 violations relating to lati-od retail 3-491,12 Raw Anpnukl Foi)&Cooked in a practices, should l.v debited under #29 Microwave 16" F S I Requirements- �)kbj Ali Other PHF� - 145'F 15 sec. -Reheating for Hot Holding VIOLATIONS RELATED ID GOOD RETAIL PRACTICES 3-4413.11(,4)&(F)) PHFa 1691E 15 sec, (]tents 23-30) 1-403,11(H) Microwave- 165°F 2 Minnie Standing Crawal and non-critical viotalion,i,which do nor relate to the Time, ,foodborne illness inierventionyand nskjactors livied above can be -ing.ioctiotiv of I rhe Food Code�u;d 10.5 CXIR 3- D3ConioicrJilly FrZoecSsed RI fiound in the ft)l1ou 140'P 590.090' item—' 33-403.11(F)JRemaining Unsliced Portions of—Beel Rojsi"4Management and Personnel OM 24 Food and Food Protection FU 9 18 Proper Cooling of PHF$ -- -4- �E------------F r�rn��lnc�t,� FC -4 14(A) t ooling Cookcd PRFq from 14WF to 26, Vlator,PlLmils_qj,*(1 1��ast oi FC-5 0J;Within 2 flours and From 70'1' 27. PhVsiccal Facility FC 6 007 41�F145 F Within 4 Horus, 28 Poisonous or T,,)Yjc Materials 8 3-501 14(B) Cooling,PHf�*Made Front Ambient S P2a.a_R n_ul rerrifT Tenriperatore. ingredient,lo 4l1_-/45'F Other Within4 Denotes anical tion in the ri'loon 1999 Foxl Gxre or 105 C NIR 590 6(00, BOARD OF HEALTH Establishment Name.l�kll Aa<2 Date: Page: ___L_of Critical, - ��I# Item Code;, ,R ESCRIPTION OF VIOLATION/,PLAN OF CORRECTION . Mate NO- W--'�,,R a d;Item'Reference" V Verified'' PLiAsEPMWCt.EAaLW.' 41\ A1VLCAr)0FAA (-AA,4� L6-2) 0 E, V\A V' r36,12\ S rLA Un� ADL Discussion With Person in Charge: Corrective,ActloritRe ulredl:, _q Ci No 0 Voluntary Compliance 0 Employee Restriction Exclusion Q Re-inspection Scheduled U Emergency Suspension Ck Embargo U Emergency Closure Q Voluntary Disposal L) Other rnp. 7I.R IPPV lllnnM n.RliY WARREN . ._. . .. ..._. Commonwealth of Massachusetts • r .City of Salem Board of Health lQmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISHMENT NAME: Kings Roast Beef and Seafood File Number:BHF-2004-000331 145 North Street Salem MA 01970 LOCATED AT: 0145 NORTH STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions t Nates FOOD SERVICE BHP-2009-0238 Dec 29,2008 Dec 31,2009 $140.00 ESTABLISHMENT _ Total Fees: $140.00 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 r r i CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IDIONNE&ALEM.COM — JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT c1 NAME OF ESTABLISHMENT ✓ /h�1 S O 3� FSS °0� TEL# /F7g 'V / ADDRESS OF ESTABLISHMENT �l.5-- /!/Oezh 5�� FAX# 97Y ?TS61'S'T MAILING ADDRESS(ifdifferent) 1 / EMAIL- Business': AS 117( JS by�7 ,rel C4 9010 Website: OWNER'S NAME JOhn XAII"J'Z/5 TEL# ADDRESS 39 Wh/f/nq JSL Lynn lng STREET— -�f // �/ �) CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) < /G h/7 1W+A)i'L6S CERTIFICATE#(S)_. 35306 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON R/195 K9IA4)4Z<5 HOME TEL# 97y a`S 7/ FS— DAYS OF OPERATION.-, I Monday ' Tuesday Wednesda . , Thursda Enda .'.!- Saturday.' ' Sunday, HOURS OF OPERATION Please write intime ofday. 1114, - 10304. /la07 -/0907- /lAm-1030p yOAm I/)Atn-/O?°?^' (For example llam-71pm) 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$21 25-99 seats =$280 more than 99 seats =$420 --- ---------- kl-- ------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE 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 Ch ter 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 p Mtaxes required under the law. // / - Signature V Date Social Security or Federal Identification Number - ---- $130 - ------------- Revised 424/07 FOODAP2008.adm Check#&Date Z 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-7779 Proper Adequate Handwashing PASS ❑J RED Owner: Prevention of Contamination from Hands PASS ❑J RED John Kalantzos Handwash Facilities PASS ❑d RED '`PIC' Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE :.Inspector: Janet Dionne Equipment and Utensils FAIL BLUE Date.Inspected: Correct By: Comments: knives in knife rack had dried food on them. knives to be thoroughly cleaned and sanitized before being put into knife rack. 5Nl2008 Risk Level: Physical Facility PASS BLUE Permit Number: BHP-2008.0237 Status: Open #of Critical Violations: 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2008 ) Page I oft Item Status Violation Critical Urgency READ: Violations Related to Foodborne Illness Interventions and Risk Factors(Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2008 ) Page 2 oft Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor g Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Dat T of 0 eration(s) Tvoe of Insoection o Food Service LJ49outine Address N Retail '❑ Re-inspection �Y Level ElResidential Kitchen Previous Ins,PP action Telephone El Date: �� //�� Owner HACCP Y/N [ITemporary ❑ Pre�operaiion t ❑ Caterer ❑ Suspect Illness Person in Cha a(PIC) t� ,` Time ❑ Bed&Breakfast ❑ Gene'ral Complaint In: ElHACCP Inspector Ua I Ou°? Permit No. ❑Other Each violation checked re4uired an explanation on the narrative 0age(s) and a citation of specific provisions) 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. r FOOD PROTECTION MANAGEMENT � az- ;;,; fl✓ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties T� El13 Handwash Facilities EMPLOYEE HEALTH i :resp ' ,f£� 1'PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PICm El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [3 r _ fM n ❑ 15.Toxic Chemicals FOLD FROM APPROVED s0`.4RCEx" ,,, „2J,.�. y: , �.a,w�a.�,� .,�.�.a' ;'1[MEIfEMPERATURECONTROLS Roterrt121I-Hazardous Foods -;-�j ❑ 4. Food and Water from Approved Source ( y 3 f° { ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling G PROTECTION FROM CONTAMINATION _ ) ❑ 19. Hot and Cold Holding A t� v .. I ] �mmiNpemP v mmF` Er n+,a6ry gaIX ePle)xh aedeN A P•, P1a i� El 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing - [REQUIREMENTS FOR HIGALVSUSCEPTIBLE POPULATIONS(HSP) "g El21. Food and Food Preparation for HSP E] 10. Proper Adequate Handwashing 11. Good Hygienic Practices r,,CONSUMERADVISORY;, ❑ _ - � �r •w�- ❑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 Correctiow 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)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food ' 26. Water, Plumbing and Waste (Fc-s)(5so.00s> 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,50�=10Fo, -,a.da o Inspector's Signature: ` �_ Print: �- O PIC's Signature: Print: A d) ? t Page�of3 Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Crass-contamination I 59().003(A) Assignment of Responsibility' 3-302.11(A)(1.) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cwked and RTE Foods* 2-103.11. Person in chargee-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anirrwl Foods Separated front Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables, 590.003(F) Responsibility Of A Food Employee Or An 3-304.11. Fund Contact with Equipment and Applicant To ReportTo The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* .31 590.003(1)) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1 t Discarding or Reconditioning Unsafe. FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11. Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetically Scaled Container* Sanitization'fent eratures` 3-201.13 Fluid Milk and Milk Products* 4-50'1.11.2 Mechanical Warewashing-HotWater 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-501.114 Chenueal Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.'" 5-101.1.1 Drinking Water from an Approved System* 4-601..11(A) Equipment Food Contact Surfaces and 590.006(A) I Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 220* 4-602.11 Cleaning Frequency of Equipment Food- ShellfishContact Surfaces and Utensils"and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E tri ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ig Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 - Clean Condition-Hands and Arms* 3-202.18 Sbellstock Identification Present* 2-301.12 Cleaning Procedure* 590,004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 Package In e it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Ern to ees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* Location and Placement* 590.004(I) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand DrmProvision c -Denotes critical item ll99 in the federal Foix]Cale or 105 CMR 5)0.000. CITY OF SALEM j ''// BOARD OF HEALTH Establishment Name: 4�I�,GCJC1 Sfp� 1 �_ Y f Date: r �� _� Page: of� Item Code C-Critical item• DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date I �, �x i No. Reference R—Red Item � � - PLEASE PRINT CLEARLY Verified Cl0firiz 4 Jo a A pj JY11. ,, 0 L.Jr)I [ �rt1 .� 1� Gf. dt Ajo-PL njrj � ..w f clrr,n, Ar i r 5 1 - r. 4 4 1 Discussion With Person in Charge: Corrective Action Required: ❑ No O ` Yes I I have read this report, have had the opportunity to ask questions and agree to correct all d' Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion comply with all mandates of the Mass/Federal Food Code. I understand that ❑ Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of-twehty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. a�/ ❑ Voluntary Disposal ❑ Other: Received at I Re lbo' 1 4(j) PHFs Recrived,,,,tTempev Violations Related to Foodborne Illness interventions and Risk Accordin,,,,to Law Cooled to S" Within �F/4 Factors(Ifents I-Z?) (Cont) ]74 Ic F14-S'F Wittin Hows. 3 1.15 C001111.�,M Lbods for PUFs PROTECTION FROM CHEMICALS 3-50 PHF Hot and Cold Holding � - Fi-g--- LL4 Food or Color Additives _--;- 3-50!,16(B) Cold PHFs Maintained at or below 202 12 Adcutive'* 59004F) -T-302 14 Protection fironi;napprto;e I llddives* 3-501.16(A) Hoc PRI Maintained at or above J I 15 Poisonous or Toxic Substances 140'F. * I -7-10111 identifying Irdbi inafion- Original ---------------------------- 3-501.16(A) Ruasts field at or above 13VF. * Time as a Public Health Control I Common'Name Working- Conounars* 7-20,.1= 3-501.'19 Time as a Public -�S��aluoa-Stns a eI 7.202.11 Restriction -Presence and Use* �.90,0()4(11) Variance Regoir 7-202.12 Conditions of UweREOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 1 Toxic CcndanunProhibiiorW POPULATIONS(IH§D_ 7-204.11 "alln"ell. 7-204.12 Chemicals for that ie odnec.Criteria"' 21 3-&0I A I(A) UnpaitcurixM Pre packaged Juices and 7204 14 neveluaes will} Warniq,l'abzIsl —T .5-80I A I(3) Use of Pa,tellni-7e F-7 206.11 Res'llided Use,Pu nudes.Criteria* 3-801.11t17) Raw or Partiath,Cwked.Anim8l Food and 7-20b.12 Rodent Bill stations* Raw Sct.A'Sj!EoI�o Served�' � 3-801 1-1((T 77 ?•06.1 Tracking Powdori.Pest C'nurol and CONSUMER ADVISORY 22 ' " (Aa;,ailaor Advisory posted for Consumption of TIMEITEMPERATURE CONTROLS 0- Psi)imal F�K)dsfflai are Raw, Undercooktd c; 16 Proper Cooking Temperatures for Not Otherwka�Processed to l4litillflate PHFs -7,10 L I I A(1)(Z) F.gg,- 1,55'F 15 5,,c. It 145"F 15secz. 13-300 3-401.11(A)(2) Comminuted Fi1h, Meals&Game Aniurds 155'1 15 stc. I -- SPECIAL REOUIREMENTS 3 -401.11(B)(1)(2) Pork and Beet Roast - L 'F 121 sun* _T401,11(Ai2) li,�uecs, lnjecicdtv!Lat�- 155�F 15 590,009(A)-(f)) Violations ofsection 590W}9TA;-(D) in et.. catering, mobilc food,temporary and -T-40T I I(AT(T) lloultry,Wild(Jarne, Stuffed PlITs, residential kitchen operations should be Stuffnit, J Cont lining Fish.Meat, debited under the appropriate Sections Poultry(n*Ratites-i65"T, 15sce. alyive if related to RKAborne illness 3401.11lCl(3) Whole-mor lo,Intact Beef SICA's interventions and risk factors. Offi(,r 145"T* 590.009 violations relating to qtA)d retail 3-40112 Raw Amt;;l Fcods Cooked in a practices should be debited under#29 - [- Miciowave 165'F Special Requirements. T4]' Il(A)(l)(b) All Other PlIfs . 145'T 5—sec LILL- - -- Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 34011)(AT&(5) Pflf, 16TT l-',Seca (Itentis 23-30) -T 403.11(B) Microwave- 165'F2 Vfium,.Standmg Crittrai and non-critical violations, which do nor rehire to the Time" foodhorne illness twee ventions ant risk joctors listed above, (an be --T - - (51 1(C) commercealiv 17xcssedRTE F-Ij- found in the fallowing sections of the Food Code mod 105 CMR 14WF1 590.00U 590,60 fern Rejoammi Eniilceyportlon�(If Beef tem, oolTRitiaFfrecin�s ------- -23—-ManageaentandPemonnei 003 RoasL- ....... Proper Cooling of PHFs -24, --Food and Food Protection FC 3 �004 25� Equipment and Utensils FC-74-- A00`5 3-501.14A) Cotling Cooki;d PHP,from 1,40-F to 26, Water,PLurnbjqq.�d �wLTU--5- 70'F Within 2 Hours and From 7TT' —277- Ph_ callFacil![V to.4 4 Houm. 28 z or c�L�t E A Fs 4(B) Cooling PHMade Front Ambictit _Special plralj��t 009 ...... ------- , Temperature InVedlents u,410F/45'F 0. Other L Werhm 4 flours* 'Jsenoles.ntjcal x[em is the 1,Mnfl 1999 Fo(xIC,0rof 105(MR 590000. CITY OF SALEM V ( BOARD OF HEALTH Establishment Name: K /�c C_ J- c�' t�'�c -4-J Date: 1, 1 41 n__q Page:_ of Item Code C-critical Item xs "'" :DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item r ` -P Verified. x,F`£r ^'i .,. r ,rnk✓s:% ° --" :PLEASE PRINT CLEARLY y_ :. _._. 1->q (.'1 -. I n[P 1"/11 l/O ) GT �6nr0t` n t I )I (t Lr lir S- 4 CI,/a1 1 t�,)r? V-0 , l" r nr�D 0,7,11 A)00./19 rtn11,1"11r rYnr�O / n^Y"'o (Xs-vArX, i - --I / ,7 r �._ ...' ��✓1--Lt `1P h, �k Cl t7. it /U oro nle rGnz),/1f ( Gin �_I,., /�-,i✓l /1.�. c� cN1 dL / a C 3� t I l �r -Gr,�llA I�. r r i7r ,r -f-Y, dot (rn.% n�p0�t lO�11612 .( G I � \ 0 , C^e- m.c. o r.r 1/ ine /",A�,,nrD . "T AJQ�J.4 rtQonln(_ .44 v It r" z IIrff LL // / 1L Re w ❑ No: ; ' ❑ Yes Discussion With Person in Charge: Corrective Actionq ired: 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 ¢o) Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food ,Code.4l 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: /w1 • I/ � PliFs Received Violations Retated to Foodborne fitness Interventions and Risk According,In Lxm Coriied in Factors(item 1-22) (rorit) 4 1'Fi4S'F Within 4 Hours, -Coolin,� Mcthrids f'(,)r PHFs PROTEC'nON FROM CHEMICALS Aft�Hotan;�;�Idti��Q — Eli— Additives— --------- 19 3-501,16(B) Cold PHbs k4aintaiund at or be t,w 590,0(P(F) 11°145°F` 3-302.14 Protection L rom 3-501.I 6(A) I-lot PI'll's k1amnalled at or above Lis— Poisonous at Toxic Substances 140'F. 101,11 T Identifying Infolinalion-- Original 3-'%l'16(A) I Roasts Held at or above 1301111, Time asoPublic—He—afth Control -- 7 102,11 Common Nam--- Workin,Cowairieir�* — ---4---—"" 3-561 19 I'mic as a Public Health Control' 7-201.11 i 'Se2aiauon-sforapc* 7720111 Rcs`rliction -—Pr".Wnceand UFe* 590.00411) _j,yar apce R Ilent 7-20112 Condkion.of Use, 7 20111 Toxoc Confainci, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP) 7-204.11 Sannizti,,Criterio,-chemic kds� 7 3-80 LIIIA) Unpoqicurmcd Pre-packaged Joices and -204.12 Ch'mlicak fis WushiLi�gj�, acc,0itenia —7 llevetuzes with WaD-i2lL!-,�kel�* Use of Pa' --- S0I1UB) "t 7-ioi,I I hiciden al ContContact,lmhricarrW� —el I I 12 C ; 3-80 1.1 (D) R,ovor Patlialk,OK)kedAwmid Fk �o� -206.11 fro�trioed V e Pe, iii Cnnnial -- - L' --, Raw St t 7-206.12 1 poil(ml Bolt Slatiom, —��Irrout�No Serwil '-80 I,I I(C) Unopcned F(X)d Packa�j�ol Re served_ 7-206,1'� 1 'I'lacking powdef;'ptsl(Aaltrof and CONSUMER ADVISORY 22 34)01 IT Consumer Artv;sory flosted lor("mmuntition 01 TIMEtTEMPERATURE CONTROLS AmmA F,,(KIN''Chat arc Raw. Undercooked of Proper Cooking Temperatures for PHFS rdcirwisc Pro�cess'ed to I'linimate ff-- 01,1111 1.11.1WI: 3—t 2 01 6A(I)(2�' Eigg"- ;5�'F 15 Sc2�t da ac Sci vice 1451f155ec, Pasteurized Egiq;,Subsntuis &a Raw Shelf 7T Z 1,11 t A)("; Cmiminruied Fish, Game k__ -Ardinals." 1551i 1 51 see. I SPECIAL REQUIREMENTS 1 11-401 11 Porl, and I')ecf RAxist I 10"F 121 min 1-� —z— — .—I-..-.-- 590.009(A)-if)) vivlatnx)'�of Sectioll 590.(X)9(A)-(D)in 3-40i.11(A)(2) Ratite�,lincoed Mc,iP, - 155'F IS I I se.{ i catering. in,ibilv.foxxtto i purtu y a rd Iff- rmderalal kiwhen opoiations sbould[it" *i 1,11 W(i; Pointr),Wild`!ante. $tulfed 1) s� u swfflng Cowaining Fish, Nbiat' debited under IhQ appropriate-wvtions Pool-v or Rautes-1-651' above if related to ftxxlborne illness interventions and risk factor�, Other �3-403.11 irract Beef Storks t45"'F 590.009 violatione relating to o retail 31441,12 Raw Aninial Foixls Cooloxi is practices should he debited under N29 - -— Mioosiave 1651�* — sp'-Cill Requirenlemi,- ' 3 45T5(A�(I)ib) All Other PHFS - 15 sec Iy Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3,iFA3e 11111- 165t)FI5'%ec 11 (Items 23.30) 3-4011.17(13) Mici'o"ave- 165°F2 klinuie, SuaidinIg Critical and non-critical violations, which do nor rvlane to the foodborne illness innoventioror iind KAjortors hard above, con be Coirnieteialiv Procosied RTF Fixed- found in the frWou-Ing ser rioto of the Food Code and 105 Chtk ;40'F 5(V.000.. Good Practices -4031 11(F) Remaining I'nslb�ed Potiong(if Beel' ------ — ------ Romt'* 23, FC -2 1 003 and Firorl Prolertion 00 4 1=8 Cooling of PH—Fs--- FC---) 25, E wip—rnPnLin!J9 Len ail 9,,-- FC ..4 '005 6�,vYj 'ookcd PhiFs f,orn 140'F to 26, Within 2 flour�and From 70'1' P!�;ial Faolliy F�nt,>_vnd N tsie�_ C-6 007 in 4 PF145'P Within 4 thnus. 28, Poisonous or Toxic Materials f FC-77--tlbs- 501 14B) Cooling 1`141,sMade From Ambient �Special R�- uiren2ribi Tonperawre Ingredicitts to 41 1--745`F Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Dat g T e of 0 eration s Type of Inspection AQQ ' I !r, �.� Food Service ❑ Routine Address Risk I ❑ Retail 4-Re-inspection _ Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: IO�,4 o y Owner t 1 I r HACCP Y/N [I Temporary ElPre-opration �I h Y t ❑ Caterer ❑ Suspect Illness Person in ChaYge(PIC) ,. r Time ❑ Bed&Breakfast ❑ General Complaint ^ In: 1-3:�) ❑ HACCP Inspector r 4 ( �n 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 PROTEC710NMANAGEMENT,a m ._„ ... _ El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned%Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE H€Al.TW {'PROTECTION FROM CHEMICALS ❑ 2. Reportrting_of Diseases by Food Employee and PIC �, .�� 4w ». El 14.Approved Food'or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals " FOOD FROM APPROVED SQJURCtI ❑ 4. Food and Water from Approved Source 'TIMErtEMPSRATURE CONTROLS(Potanfially Hazardous Footls) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling N PROTECTION FROM CONTIIMINArwN-- �`m°` ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection wrn ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PQPULATIONS(H Pi--a El21. Food and Food Preparation for HSP [1 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices rCONSUMER',ADVISORY" ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical C violations marked must be corrected ( ) To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0so.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)(590.000) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5'S901nsp Wcl -i4. A n /-) � Inspector's Signature: ') _ Print: PIC's Signature: 114 ,�f! Print: ,_7iil v ' PagegoL�2Pages r! �i C Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F 8 Cross-contamination 1 596.003(A I Assignment of Responsibility* 3-302.11(A)(]) Raw Anined Foods Separated from m 590.003(B) Deonstration of Knowledge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302A I(A,)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foot employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting 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(F) movReal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Ftp* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590A04(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tcni eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-I-lot Water 3-202.13 Shell Ea s* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products.Pasteurized'* 4-501.114 Chemical.Sanitization-temp., pH,- 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 'k 5-1.01..1.1 Drinking Water an an Approved System*tem* 4-601.1[(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* utensils C(eau* 590 006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils'' Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 - Molluscan Shellfish from NSSP Listed Chemical* Sources*Gam10 Proper,Adequate Handwashing Regulatory Authord and Wild Mushrooms Approved by 2301.11 Clean Condition-Hands and Arms" Re u/ 3-202.18 Shellstock Identification Present* 2-301.12 Cleanin Praeedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201..17 Game Animals* 1..t Good Hygienic Practices Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PRFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Package Inte it * Mouth* 3-101.11. Food Safe and Unadulterated'* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 - Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Mammined'* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11. Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients' 5-204.11 Location and Placement* ry Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availabilit, 8-103.12 Conformance with Approved Procedures* 6-301 12 Hand.Dr by ffovision i *Denotes critical item in the federal 1999 Pond Code or 105 CbtR 590.000. CITY OF SALEM V �^ BOARD OF HEALTH Establishment Name: 1� 1�4s � c�`e� � + Date: / n/A�( -)(f Page: of Item�,, Code .- C-Critical Item - DESCRIPTION OF.VIOLATION/PLAN OF CORRECTION,, Date No. ,. Reference R-Red Item`}� ra'^ =' s. x ✓ . `"' .. Verified r .� .e err '' 'eP. PLEASE PRINT CLEARLY ` i c2 1 [n , � ( � ,� 17� v� A.I:G�„n l., �. I rf � 1l<ni�+ _(_� IBI I ��S �/ . 7) -&,/— / r\Qfi( Is fll.OBrI.rJ-, VL 0 � 03 /� ' _ a �a ¢ .,�AAd 6 aop O�Plvrn � I-- �I.�/ rN� �a ( — I -F„z I/ r 1 �,� ,�— I or,nn. cr��;vo�1 67 Nze, r._ss.:n.�r. J kv r r 10r ,Pr 5- A'i J- �A s1,r'n J Gn G/# r, I ,_✓d �r.7�> - J 1 l 1 VX o s�CICA N o a r� �1v �S�re.r� a 4k v, - A ( P� t,�rl��, ar. ✓ � _ Discussion With Person in Charge: _ Corrective Action Required: ❑ No i7 Yes ! u_ !t �. 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 1 Exclusion p b 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-fivedollars or s,, uspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / �{�� ❑ Voluntary Disposal ❑ Other: i _T�01 74(C7) PHFs Rewiwdl in Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(11shis 1-22) (Cont) 14 VF/45"'F Within l Hcrux. 'I PROTECTION FROM CHEMICALS ;_5F_f _ Coolin,M .Lhrxls for f`HFs Q 1=4 �ood or Color Additives 19 PHF Hot and Gold Holding 3-501 A6(B) Cold PHF,,Maintained at or below 'V"nVc0 202 f2 I 590,004F) 410145�'F' -T-302714 Protection from Untip rovml Addifives* Is Poisonous or Toxic Substances 3-501.16(A) lint at or above 140'F, 7-101.11 firtuifyingkittonnation -Ori,ginal 501,16(A) ficasts Held at or above 130°F, Colaainers' 120 Time as a Public He [�� a""Con"of 7710211 Common In )ne _ _L 3-501 19 rime as a Public.licalth Comrol+ 7-201.11 _.Sgio.�lron-Still' (I n( .90 ixgait) Vari�!iec 7-202.11 Reettiction -Pf"Icneo and Use* 7-202.12 Conditions of?Fs REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 Toxic ConiaineiProinbiGonv POPULATIONHP) 7 Ilicals, an 20,L 11 ria-Ch 7-2(.12 12 Chinuicak for Wush ce,a i; 21 3-801A 1(A) Unpaiteurizeif Pre-packiged Juices and 04,1 Beveraees with Warnill_!_11_21s# 7-21)4.14 4 _!Lyi� Criterial 3-801.1 I(B) Use of Paszl� I Incidental FofyJ Contact,ladnicantsl� 1 I(D) Raw or Paritally Cookcd Animal FWA and 7-206.f_1__ kawstedSproule 7-206.12 1 podury Bail Statiom, 7 006A T7,-- 3-901.11(c) lino need hex Pac1<aFe hot Re.crved 3 oC,111� ,po,&�, l",si Control and lacking laowder�'P'�'u Co CONSUMER ADVISORY 22 3-003 11 isory Posted for FmTlkoup�ti,n Tot TIME/TEMPERATURE CONTROLS Anitual FIxtds'Chat are Raw, Undercookcri III 16 Proper Cooking Temperatures for PHFs Not Offierwise Pr(rcessed to ltloninau-. J;t — IIL12ns 15,5'F 15 S�'c. 2— __ 3-30113 Kisteurized ELV:SObStione lot Raw Shell 3-40 1,11(Art") cumloquin'd rish' Meats&(itnue Animals 155"F'15sec SPECIAL REQUIREMENTS 3-401-1103)((1)(2) Pork,and Beef Roast - 130'F 121 rithi* 3-401.11(A)(2) Rautes, ftijcociilvleats-1 155`F 15 590,009(A)-(D) Violutions of'Section 590.009(A)-(D) in catering. mobile.".)d,temporary and 3-401.1-1(A),T) Porr;u!'Wild Cialne, Stuffed PKI's, residential kitchen operations4rould he Stuffing Containing Fish,Meal, debited under the appropriate sections �Poultry or RaoteI;-1651t5 sec. above if related to ficiodborne Illness '3-40' 1', whofe-mus Iv,Int act Beef'Steans tract ventions and risk factors, Otht-r 145"1;11 590.009 violations relatinC,g togo( )d retail 3-401.12 Raw Aivrria�l Food,C:ookW I,,a practices should be debited under#29 - ___,%fictowave 165"F Special Requircroonts- 3-401,11tA)(1)(b) All Othei Pill's--145`F 15 sec, I I E17 ___ Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL_PRACTICES 3-.103.11(A)&(D) PHFN 165'F 15 sec;. I (Items 23-30) 3.403.17(ii)7 �4Ijcmwav,- 165'F 2 Murtao Standing Ctilo-aland non-critical violtileons, which do not relate,to Mr. Tine"' ,foodborne illn(crt ifflep ventionvand risit-Jin tors lined abore, (on be 3-403.11(C.) Cornutei,ially Processed.RTF Fix"- found in the'lollowing sections of the Food Code acid 105 CMR 14()'F' 90,000. —6— -p-cTr� -— _740T I(F) Remaining n1liTid ton, of B"i 3 _Menaqjtr!jenl and Personnel 003 Roasls* ftc� Proper Cooling of PHFs 24� Food and Food Protection j FC 3 004 1=8 Eg��tprrien tensils.. FC -4 005 25,__.__ _, Land q_ 501 14(A) Ccoling Cooked PHT-s from 140°F to Witten 2 flours and From 70'1 _27. PhAa:al Facility QFC-6 '007 r Toxic_91aie 3 501.W(11) Cooling PHFs Made From Ambient Temperature Ingredients to 411,145°F _9:........ Other ---------- Within 4 liocvs Den('!eI,critical Re'll III lha[",ic'ed 1999 Food Cale cr 105('144 594)O(K), 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency 'Telephone: PROTECTION FROM CONTAMINATION x 978-745-7779 Proper Adequate andwashing FAIL ❑� RED i Owner: C ment: Hand wash sink in front prep line area loose from wall.secure hand sink. }John Kalantzos Prevention of Contamination from Hands FAIL Critical ❑J RED )PIC: Co ent: Employee observed handling vegetables being used for salads wih bare hands.Single use gloves,paper or tongs to be John Kalantozos s d when handling all ready to eat foods to prevent contamination from hands. Inspector: Handwash acilities FAIL Critical RED Janet Dionne omment: Provide paper towels in mens restroom in basement. Date Inspected:Correct By: 5/1/2008 Risk Level e 'Permit Number: I BHP-2008-0237 I Status: Open #of Critical Violations: t5. Time IN: Time OUT: Urgency Description(s): BLUE: I :Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately 'or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 09,2008 ) Page I of Item Status Violation Critical Urgency RED:_ Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions I and Risk Factors (Require V/mment:food observedbeing stored on floor in back prep area.All food to be stored at least 6-8 inches off floor. .immediate corrective action the was a box of chicken that was being held out at room temperature.Chicken mus not be held at room temperature and shall e hel .at 41°F or below as mandated. rge ba.rets in basement for flour to be cleaned and sanitized. W e freezer in basement(right side of storage area)had accumulation of ice.defrost unit and remove buildup of ice. Equipmentand ensils FAIL Critical BLUE mment:sanitizer at back prep area not reading when tested wih test strips. provide sanitizing solution that is at proper parts per million that is readily available at each work station. rst deli unit on line behind counter needs thorough cleaning of food debris. ,,Srf'iall white freezer needs general cleaning. L,Z�maII white freezer chests provide visible accurate thermometers maintained at 0°F or below as mandated. �G smaller deli unit near stairs-provide visible accurate thermometer maintained at 41°F or below as mandated. Oaffie used for fish area needs to be thoroughly scoured cleaned and sanitized. � knives in knife rack had dried food on them.knives to be thoroughly cleaned and sanitized before being put into knife rack. Tr reach in on right...internal thermometer reading at 60°F. Inspector took temperature reading with digital thermometer and a emperature of 42°f was obtained. Provide visible accurate thermometer maintained at 41°F or below as mandated. Physical Facility FAIL BLUE Co -ent: Some ceiling tiles not in proper position in back prep area.resecure ceiling tiles to ensure proper placement to seal all 'Toles and gaps o help preven entrance of insects and rodents. water stained ceiling tiles were observed at time of inspection.find source of leak and repair.replace all stained ceiling tiles. 11 Oe6vicle li t covers and sheaths for all light fixtures in basement. M restroom provide toilet paper holder/dispenser. ront screen door not closing propely.ensure door latching properly. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 09,2008 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 09,2008 ) Page 3 of Commonwealth of Massachusetts City of Salem • r Board of Health IGmbedey Driscoll 120 Washington Sheet,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Icings Roast Beef and Seafood File Number:BHF-2004-000331 145 North Street Salem MA 01970 LOCATED AT: 0145 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0237 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES lDecember 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 20 of 25 a 3v� CITY OF SALEM, MASSACHUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4T FLOOR 'TEL. (978) 741-1800 KINMERLEYDRISCOLL FAX(978) 745-0343 RECEIVED MAYOR ISCOTTna SALEM.COM JOANNE SOOTT, DEC 4- 2007 HEALTH AGENT CITY OF SALEM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT(TSO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 00/1L5/ POGS�,��Pt�_I F J C��oS� TEL# 978 9 SSS 779-2/ ADDRESS OF ESTABLISHMENT /9_5- N©R711 ST FAX# MAILING ADDRESS (if different) EMAIL-Business': II �/ 1 Website: OWNER'SNAME JOiIY1J ALAN ZAS TEL# 978a�SS�9s— ADDRESS 3y uA l4l oq ST L y nn STREET 11 '/WCITY STATE .ZIP CERTIFIED FOOD MANAGER'S NAME(S) dAn wt) zl S CERTIFICATE#(S) 3.353636 (Required in an establishment where potentially hazardous food is prepared) �y y EMERGENCY RESPONSE PERSON ,ELl A S /S/AZA� 'Cell2/� HOME TEL# 7/�/y p9 c`bs," 7J8.�' DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOUR SOF-OPERATION Oy /JAM 10-19k, //a,n /0� ilJAm /Opp �� /aro /d�� A/OOYI-/Opp Please write in time of day //Am- /03 ^ (For example t tam-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 - ----------------------------------------------- ---------------------- RESTAURANT YE NO less than 25 seats =$140 'Outdoor Stationary Food Cart$210, 25-99 seats =$280 V more than 99 seats =$420 ----�-- - - � --- - -------------------- --------- -...---------------------*-------------`---------- ------- BED/BREAKFASTI YES NO --------------$--10---0 CHILDCARE SERVICES - ADDITIONAL PERMITS MAKE (notjust 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 subirpitted to and approved by the Salem Board of Health. Pursuant to MGL C ter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all slate tax returns and to taxes required under the law. a / o Pia s8- 9 V 9 3 Signat e e Social Security or Federal Identification Number ----- _/_12 - --- -'----------------'--------------------------------------- - r--- --------- ------------------------- Revis 4/24/07 FOODAP2008.adm Check#&Date�/�7 H /�� $� IMPORTANT M1ESSAGE FOR. �/ l J✓ � 7 �. DATE / r�� /C JD / TIME AM M o/Xnnn Adp)0--s OF PHONE AREA CODE NUMBER EXTENBION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH. RETURNED YOUR CALL - WILL.FAX TO YOU MESSAGE kllyl -444c SIGNED TbhFORM 4009 MAOI U.S.A. _ NUTES ---- �T 5�o�Ly,_ic��T11�i_�ats?R _off k��i. �3 _Qgbr. 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-7779 Food Contact Surfaces Cleaning and Sanitizing PASS Critical RED Owner: - Comments: Knives found with accumulation of food debris in knife rack. Knives to be washed and sanitized after each use. John Kalantzos PIC: Handwash Facilities PASS Critical 0 RED John Kalantozos Comments: Back Handwash sink in disrepair. Repair sink to proper working order. Inspector: John Gehdn There are no paper towels in the mens restroom. Provide paper towels. Date Inspected:Correct By: 7/23/2007 Risk Level Permit Number: BHP-2007-0156 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 06,2007 ) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: Employee observed using bare hands when preparing ready to eat foods. Employees to use gloves,tongs or paper immediate corrective action) when preparing RTE foods. Trus units in back has uncovered foods. All foods must be covered to prevent cross contamination. Kings unit has uncovered foods.All foods must be covered to prevent cross contamination. Ice scoop at drink dispenser stored directly on ice. Scoop to be stored in ice with handle exposed or in designated tabled container. Personal drink stored on drink dispenser. Personal items to be stored in designated employee area. Italian ice stored in freezer. Personal items to be stored in designated employee areas. Ice scoop downstairs stored directly on top of machine. Ice scoop to be stored in ice with handle exposed or designated tabled container. Equipment and Utensils PASS BLUE Comments: Back true refrigerators require general cleaning. Shelf beneath meat slicer requires general cleaning. Shelf next to fryolators require general cleaning. Shelf beneath mix requires general cleaning. Front Beverage air unit requires general cleaning. White Kenmore freezer with bread requires general cleaning. Potatoes kenmore freezer requires general cleaning. Other-See Notes PASS BLUE Comments:There is a Bud Light in the back True unit. Alcohol is not permitted unless proper license is obtained. GENERAL COMMENTS: All violations from July 23 2007 have been correctewd. 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. Aug 06,2007 ) Page 2 of Item Status Violation Critical Urgency I L/ 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. Aug 06,2007 ) Page 3 of 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-7779 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: ent: Knives found with accumulation of food debris in knife rack. Knives to be washed and sanitized after each use. John Kalantzos PIC: Handwash Facilities FAIL Critical ❑d RED John Kalantozos �� , c Handwash sink in disrepair. Repair sink to proper working order. Inspector: John Gehan There are no paper towels in the mens restroom. Provide paper towels. Date Inspected:Correct By: 7/23/2007 Risk Level: Permit Number: BHP-2007-0156 Status: Open #of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 23,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Foo 'tection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment: Employee observed using bare hands when preparing ready to eat foods. Employees to use gloves,tongs or paper when preparing RTE foods. immediate corrective action) rus units in.back has uncovered foods. All foods must be covered to prevent cross contamination. gs unit has uncovered foods.All foods must be covered to prevent cross contamination. eoop at drink dispenser stored directly on ice. Scoop to be stored in ice with handle exposed or in designated labled container. ersonal drink stored on drink dispenser. Personal items to be stored in designated employee area. It ice stored in freezer. Personal items to be stored in designated employee areas. e scoop downstairs stored directly on top of machine. Ice scoop to be stored in ice with handle exposed or designated labled container. Equipment and Utensils FAIL BLUE ent: Back true refrigerators require general cleaning. i �telfbe eath meat slicer requires general cleaning. elf next to fryolators require general cleaning. Shelf beneath mix requires general cleaning. l/ Front Beverage air unit requires general cleaning. White Kenmore freezer with bread requires general cleaning. I,Potatoes Kenmore freezer requires general cleaning. Other-See Notes FAIL BLUE om nt:There is a Bud Light in the back True unit. Alcohol is not permitted unless proper license is obtained. �L City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 23,2007 ) Page 2 oft 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-745-7779 Food and Food Protection PASS Critical BLUE i Owner: Comments: Seafood unit has uncovered foods. All foods must be covered: John Kalantzos PIC: Seafood unit has fish being stored directly on ice. Seafoid to be stored in clean designated container to prevent cross contaminaton. Discard fish. John Kalantozos Inspector: Beverage air unit at end of food prep line has uncovered foods. All foods in storage must be covered. John Gehan All knives in knife rack found with accumulation of food debris. All knives to be washed and sanitized after each use. Date Inspected:Correct By: 1/25/2007 _ Personal items stored where food is being stored. All personal items to be designated employee areas. Risk Level: Ice scoop stored incorrectly in front. Scoop to be stored with handle outside of ice or in sanitized labeled container. Meats being stored on floor atbroom temperature. Meats to be refrigerated at 41'F, in a freezer at 0°F or below as mandated and 6- Permit Number: 8 inches off of the floor. BHP-2007-0156 Equipment and Utensils PASS BLUE Status: SIGNED OFF Comments: Kings refrigerator requires general cleaning. #of Critical Violations: Sandwich unit requ res general cleaning. 0 Mops stored incorrectly. Mops to be stored so that they can air dry without touching any surface. Time IN: Time OUT: Shelves on cookline require general cleaning. Urgency Description(s): BLUE: Utensil bucket in back requires general cleaning. Remove,wash and sanitize all equipment in container. Violations Related to Good Beverage air unit at end of food prep line requires general cleaning. Retail Practices (Critical violations must be corrected Both true units require general cleaning . immediately or within 10 days)(Non-critical violations Same units require cleaning behind handles. must be corrected immediately or within 90 days) Entire cookline requires general cleaning. 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 01,2007 ) Page 1 oft ~ Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions Physical Facility PASS BLUE and Risk Factors (Require immediate corrective action) Comments: Basement requires organization of shelves. Other-See Notes PASS BLUE Comments:There is a strong odor of cigarette smoke in the downstairs mens restroom. Smoking is prohibited in any work establishment. GENERAL COMMENTS: All violations from 1/25/2007 have been corrected. 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 01,2007 ) Page 2 oft 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-745-7779 Food and Food Protection FAIL Critical BLUE i Owner: ,Co ment: Seafood unit has uncovered foods. All foods must be covered.' John Kalantzos PIC: .Seaf' ood unit has fish being stored directly on ice. Seafoid to be stored in clean designated container to prevent cross contamin don. Discard fish. John Kalantozos Inspector: —Beverage air unit at end of food prep line has uncovered foods. All foods in storage must be covered. John Gehan �All•kni eV s in knife rack found with accumulation of food debris. All knives to be washed and sanitized after each use. Date Inspected:Correct By: 1/25/2007 ,Personal items stored where food is being stored. All personal items to be designated employee areas. Risk Level: scoop stored incorrectly in front. Scoop to be stored with handle outside of ice or in sanitized labeled container. , Mel being stored on floor atbroom temperature. Meats to be refrigerated at 41'F,in a freezer at 0°F or below as mandated and 6- Permit Number: 8 inches off of the floor. BHP-2007-0156 Equipment and Utensils FAIL BLUE Status: - Open Gomment: Kings refrigerator requires general cleaning. #of Critical Violations: _Sandwich unit requ res general cleaning. Time IN: Time OUT: c Mop's stored incorrectly. Mops to be stored so that they can air dry without touching any surface. Shelves on cookline require general cleaning. Urgency Description(s): BLUE: Utensil bucket in back requires general cleaning. Remove,wash and sanitize all equipment in container. Violations Related to Good Retail Practices (Critical --Bevefagea r,unit at end of food prep line requires general cleaning. violations must be corrected ,Both true units require general cleaning . immediately or within 10 days)(Non-critical violationsSame units require cleaning behind handles. must be corrected immediately or Within 90 days) „entire cookline requires general cleaning. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 25,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions Physical Facility FAIL BLUE and Risk Factors (Require immediate corrective action) CO—M'ment: Basement requires organization of shelves. Other-See Notes FAIL BLUE ,,omment: There is a strong odor of cigarette smoke in the downstairs mens restroom. Smoking is prohibited in any work establishment. 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. Jan 25,2007 ) Page 2 oft '4�i r",f;. ¢il' ` CommonwealthofMassachusetts T�r s �`' Sr�# �. # • • �� ti£y, 4l ily 3�pl+,r„ •'•`e 5+'� t}a'f m A't .i l i a� + }c ac ,"F' +�y'"`%`��.,v° t 120 Washington Street,4th Floor-ii1 . J` O iGrobefley�nscoll � SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED:. 12/20/2006 ESTABLISHMENT NAME: Kings Roast Beef and Seafood File Number:BHF-2004-000331 145 North Street Salem MA 01970 LOCATED AT: 0145 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Nates FOOD SERVICE BHP-2007-0156 Dec 20,2006 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 Board of Health ! L This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 10 of 16 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH RECEIVED E`��" E IVE D 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC - 4 200fi - TEL. 978-741-1800 FAx 978-745-0343 CITY OF SALEM Kimberley Driscoll WWW.SALEM.COM BOARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT IS1 NAME OF ESTABLISHMENT ngS ?0kS+T-CtJE S�<L�oo� TEL ADDRESS OF ESTABLISHMENT 1/5 NO9T11 S�' FAX# MAILING ADDRESS (if different)______, _ EMAIL--Business': 1 ! ), Owner's: ,/ _ OWNER'S NAME CAO Kr9IAK)4Z1-5 TEL# IBJ S ADDRESS '3y Wk,l In,St Lyn,.1 A4 0/170) STREET t 1 1 ITY STATE :� ZIP CERTIFIED FOOD MANAGER'SNAME(S) d0k N R�IANTZIS CERTIFICATE#(S) 3,kAIr ' (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON Fb"15 k AIVII71 S HOME TEL# 972 ,?K5-- 7/B.; OAYSOFOPERATION Monday Tuesday Wednesday_ Thursday Friday Saturday Sunday HOURS OFOPERATION AM (f Am it AN it Am 1!- Hr>7 i—_0 100111 Please write in time of day. (for azamdieltam-itaml 10.30 PM 10€30 PM t0.30 PM w3o PM 10;30PM 10'.3o PM /Opn1 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 _ _ .._ -- - - ----- ------------- -------- ---- - --- ---- _ .... .--------- . RESTAURANT ES NO less than 25 seats F0" 25-99 seats =$150 more than 99 seats =$200 ------ O - - -- -------- --- - -- -- - --- -- - - --......-_...00_- ......-.---- ---- ..---- ----..-- - BED/BREAKFAST YES N $1 - -- -- - - - .-......... - - .... - ..... .... . ................ ..... ..................... ADDITIONAL 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 MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that i, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. _ _ Signature Date �eW), �Social Security or Federal Identification Number ---- ----- ------ - _--------- ------- ---- - ----------------- ----- Revised 11/13/ 6 00 7.acm Check#B Date_ •= ///2,.Cf s t 7� R` 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HIACCP: ❑ Item Status Violation Critical Urgency Telephone- PROTECTION FROM CONTAMINATION 978-745-7779 Separation/Segre nl Protection FAIL Critical ❑d RED Owner: Co ment:The small white Frigidaire freezer has potentially hazardous food stored with bread products. Store PHF separate from John Kalantzos. E food to prevent cross contamination. PIC: Food Contact Surf s Cleaning and Sanitizing FAIL Critical ❑� RED `�tri C ent:The sanitizer at the front found too weak. Sanitizing solution of proper concentration must be readiy available at all Inspector: _ ark stations at all times. David Greenbaum Di niv found stored in the back knife rack. Properly clean and sanitize knives prior to storage. Date Inspected: Correct By: 9/7/2006 0-rIfInive and in the fish and at the back sandwich unit. Properly clean and sanitize all knives. Risk Level: The i scoop found stored on top of the ice machine. Clean and sanitize the ice scoop and store in the ice handle side up or in a as !zed container labeled"Ice Scoop Only" Permit Number. The ck meat slicer needs a thorough cleaning and sanitizing. BHP-2006-0127 Good ienic Pr ices FAIL Critical ❑J RED Status: VIOLATION Com ant: Employees observed eating in food prep areas. Employees must eat and drink in a designated employee break room or #of Critical Violations: in dining room to prevent cross contamination. 5 Hand sh Facilitie FAIL Critical 0 RED Time IN:. Time OUT: Com ent:The front hand wash sink missing soap. Provide soap in a wall hung dispenser at this hand wash sink at all times. Urgency Description(s): v 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. Sep 07,2006 ) Page 1 oft Item Status Violation Critical Urgency RED: t7k- Violations Related to Goo Retail Practices (Blue Items) Violations Related to ,.,_.,,ta Food and Food P action FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require',,;�in Cc m Th small Beverage air sandwich unit has uncovered food. All food in storage must be covered. immediate corrective action) The ri True cooling unit in back has uncovered food. All food in storage must be covered. O ions sto directly on the floor. All food must be stored at least 6-8 inches off the floor. The gs ach in has uncovered food. All food in storage must be covered. Equip and nils FAIL Non-Critical BLUE Cc ant:The f t Beverage air deli unit needs a general cleaning. T brea elves have an accumulation of food debris. Thoroughly lean the shelves. Th ano er needs a general cleaning. True ach ins in back need a general cleaning. T mi ave needs a thorough cleaning inside and out. e Frigi ire freezer in the basement needs a thorough cleaning. T smal rigidaire freezer in the kitchen needs a visible,accurate thermometer. Physical Facil FAIL Non-Critical BLUE in t:All gaps at the front screen doors must be sealed. e entire establishment is in need of thorough cleaning including under and around all equipment. GENERAL COMMENTS: 787:Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006 ) Page 2 oft Item Status Violation Critical Urgency RED ' ''° u °�"" Violations Related to Good Retail Practices (Blue Items) Violations Related tor ; A,,.� Food and Food Protection PASS Critical BLUE Foodbome Illness Interventions' and Risk Factors(Require Comments:The small Beverage air sandwich unit has uncovered food. All food in storage must be covered. immediateeorrective action)_# The right True cooling unit in back has uncovered food. All food in storage must be covered. Onions stored directly on the floor. All food must be stored at least 6-8 inches off the floor. The Kings reach in has uncovered food. All food in storage must be covered. Equipment and Utensils PASS Non-Critical BLUE Comments:The front Beverage air deli unit needs a general cleaning. The bread shelves have an accumulation of food debris. Thoroughly lean the shelves. The canopener needs a general cleaning. Both True reach ins in back need a general cleaning. The microwave needs a thorough cleaning inside and out. The Frigidaire freezer in the basement needs a thorough cleaning. The small Frigidaire freezer in the kitchen needs a visible,accurate thermometer. Physical Facility PASS Non-Critical BLUE Comments:All gaps at the front screen doors must be sealed. The entire establishment is in need of thorough cleaning including under and around all equipment. GENERAL COMMENTS: 820:AII violations cited in the 917106 inspection report have been corrected. 1A u I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 14,2006 ) Page 2 oft 0145 NORTH STREET Kings Roast Beef and Seafood City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone ' m `, PROTECTION FROM CONTAMINATION yt,e w 978445-7779 sa Separation/Segregation/Protection PASS Critical ❑d RED Owner. :, -.., Comments:The small white Frigidaire freezer has potentially hazardous food stored with bread products. Store PHF separate from -John Kalantzos RTE food to prevent cross contamination. PIC: - 7 Food Contact Surfaces Cleaning and Sanitizing PASS Critical RED Comments:The sanitizer at the front found too weak. Sanitizing solution of proper concentration must be readiy available at all Inspector: work stations at all times. David Greenbaum Dirty knives found stored in the back knife rack. Properly clean and sanitize knives prior to storage. Date Inspected: Correct By: 9/14120i Dirty knives found in the fish and at the back sandwich unit. Properly clean and sanitize all knives. Risk LEVBI: The ice scoop found stored on top of the ice machine. Clean and sanitize the ice scoop and store in the ice handle side up or in a 3)= sanitized container labeled"Ice Scoop Only" Permit Number: The back meat slicer needs a thorough cleaning and sanitizing. BHP-2008-0137 Status: Good Hygienic Practices PASS Critical - [Jl RED SIGNED OFF Comments: Employees observed eating in food prep areas. Employees must eat and drink in a designated employee break room #of Critical Violations: ...e or in th dining room to prevent cross contamination. 0 Handwash Facilities PASS Critical ❑J RED L Time IN: - Time OUT: Comments:The front hand wash sink missing soap. Provide soap in a wall hung dispenser at this hand wash sink at all times. 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. Sep 14,2006) Page 1 of 'L�' .. .. ..... a.....w ti .,.w..r-R....,r. -:rr ,..:. F C ... .. ,_, • n. ''n�', s n e v'e- ` Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / Da T of 0 eration(s) Type of Inspection �( 1 " ' " L{ k� Food Service ❑ Routine Address ' Risk ❑ Retail 0 Re-inspection Telephone Level ElResidential Kitchen Previous Inspection � / El Date:-3 0 � Owner 1- HACCP Y/N ❑ Temporary ❑ Pre-operation I S ❑ Caterer ❑ Suspect Illness Person in Charse IC)^\ 4 Time ❑ Bed& Breakfast ❑ General Complaint Inspector ^ p OuIn:t: E]Permit No. ❑ HACCP 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 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 - - El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives F-000 FROM APPROVED SOURCE - ❑ 15.Toxic Chemicals ❑ 4'.- od and Water from Approved Source TIMENEMPERATURE CONTROLS(Potentially Hazardous Foods) El5. Recei%AQg/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/RecoroA!A curacy of-Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with A0pr_oy acedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS El 9. Food Contact Surfaces Cleaning and Sanitizing (HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices - CONSUMER ADVISORY, Lj 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number o;Violated Provisions Related Critical (C) violations marked must be corrected To FoodbornC 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.aN590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s>(5so.00s) 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 8. 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'S901nsPP�'tFPmr6-14 tloc �� 1 1 Inspector's Signature: \ Print: PIC's Signature: Print: of Pa e� g `Pages II Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT_ S Cross-contamination 1 I 590.003(A) I Assi mment of ResponibitiLyt` -� 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Dcmanst t0on of Knowledge* Cooked and RTE loxxls$ 2 103.1 i Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A 1(A) Food Protection* applicants" 3-302.15 Washin�Fruits and Ve,,etables 590,003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To RepotsTo The Person In Utensils* Chaise* Contamination from the Consumer 590.003((3) 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 W0.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" 4-501.111 Manual Wares+aching-[Iot Water 3-201..12 Food in a Hermetically Sealed Container* Sanitization lun aratnres* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell E,,s* S mutilation Temperatures* 3-202.14 i 's and Milk Praluc[s.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. Y` 3-202,16 Ice Mace From Potable Drinking Water" 5-101.11 Drinkin'Water from an Approved System* 4-ti(11.11(A) Equipment Ford Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4.602,11 Cleaning ofE ui�, 590.006(B) Water Meets Standards in 310 CMR 22.0* b Frequency 9 nen(Food- Shellfish and Fish From an Approved Source Contact Surfaces and ll`tensils* 4-702.11 Frequency of Sat:iunion of`(Utensils pad 3-201.14 Fish and Recreationally Caught Molluscan IY'0t1_U)-ntad_,S urfaces of Equi ment* Shellfish* 4-703.11 Methods of Sanitization -'Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources" 10 Proper,Adequate Handwashing Re mato AAuthor' Game and utild Mushrooms Approved by - 2_301.11 --Clean Condition Hands and Arms` 3-202,18 Shellstock Identification Present* 2-301.12 Clearing Procedure` 590,004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-20(.17 Gonne Animals' �l Good Hygienic Practices g Receiving/Condition 2401.11 F..atina, Drinkingor Clsing Tobacat* 3-202.11. PHFs Received at Proper Tem te-(tures° 2-40L12 'Discharges From the Eyes.Nose and 3-202.15 Packaee Integrity* C Mouth''= 3-101-1I Food Safe and Unadulterated* 3-301.12 Preventing,Contamination When Tastin>* 6 TagslRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Enthrvees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction" Conveniently Located and Accessible 3402.12 j Records.Creation and Retention"' 5-20311 Numbers and Ca *cities* 590.004(.1) Labeling of Ingredients' 5-204.11. Location acid Placement" 7 Conformance with Approved Procedures 5--205J 1 Accessibility, Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying 3-502.1.( Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria" 6-30L11 Ilandwashin t Cleanser. Availability 8-103.12 Conformance with Approved Procedures" O-30112 Mand Drying Provision Denote,critical item in the federal 1999 rood CoJe or 1(15 CMR 590,000, CITY OF SALEM 4 BOARD OF HEALTH ill Establishment Name: 91 r z `f � G��n(-I Date: / Page: Off, of r Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ,. No. Reference R—Red Item Verified PLEASE PRINT CLEARIbY.. Mi. A R` n r Trz)� F — c Cit Q U l/ j v C 1 i 1 { s P j € Discussion With Person in Charge: Corrective Action Required: ❑ No Yes r Voluntary Compliance ❑ Employee Restriction/ i 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 ❑ Re-inspection Scheduled ❑ Emergency suspension ;F comply with all mandates of the Mass/Federal Fo Co•e. I understand that } noncompliance may result in daily fines of twent fi a oll s or suspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. ❑ Voluntary Disposal ❑ Other: r . 3-501,14(C) PHFs Received at'renrperauures Violations Related to Foodborne illness interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont.) 41`�F/45`F Within 4 Homs. PROTECTION FROM CHEMICALS _ 3-501,15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50LI6(B) Cold PIlFs Maintained at or below 3-202.12 Additives* _ 590.004(1) 4P/45"F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501,16(A) Hot PHFs Maintained at or above 140'F. * 7-101.A I Identifying Information-Original 3-50L16(-A) Roasts Heid at or above 130'F, Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control m 7-201.11 Se oration-Storace" 3-501.19 Time as a Public Health Controls` 7-202.11 Restriction-Presence acid Use* 590.004(H) Variance Requirement 7-20212 Conditions of Use 7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE _ 7-204.11. Satiitizers,Criteria-Chemicats" POPULATIONS(HSP - 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning labels* 7-204.14 Dr in outs,Criteria* 3-801.11(B) Use of Pasteurized Euas* 7-205.11 Incidental Food Contact- Lubricants* 3-801,L 1(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 Foal Package Not Re-served. 7-206.13 'T'rack'ing Powders,Pest Control and Monitartng" CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'rhat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401,t1A(1)(2) Eggs- 155'17 1.5 Sec. Pathogens.* EMecero r^i:mai E ts-huinediate Service 145°Blisec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401,11(A)(2) Comminuted Fish, Meats&Game Eggs* Animals-155'F 15 sec. * _ 3-401.11(13)(1)(2) Pork and Beef Roast - 13V 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 see. * 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 Pot�es-165".F 15 sec. :. above if related to foodborne illness 340111((-)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors, Other 145"'F* - 590.009 violations relating to good retail 340112 Raw Animal Foods Cooked in a - practices should be debited under#29-- Microwave 165°F* Special Requirements. 3-40 Ll I(A)(1)(b All Other PHFs--145'F '15 see, * 19 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PF1Fs 165'F 15 sec. r (items 23-30) 3-403.11(B) Microwave.-165'F 2 Minute Standing Critical and non-critical violalians which do not relate to the Timet' foodborne illness interventions and risk factors listed above, can be. 3-403.11(C) Commercially Processed I2TE Food- found in the following sections of the Food Code and 105 CMR 140°F% 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef item Good Retail Practices FC 580.000 Roasts* 23. Mane ement and Personnel-.- FC-2 .o03 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 PHBs 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 I .007 _ to 41'F/45cF Within 4 Hours. . 28, Poisonous or Toxic Materials FC -7 .008 3-501,14(B) Cool mg PHFs Made From Ambient 29. -special Requirements _ .009 Temperature Ingredients to 41'F/45'F _30.___ Other Within 4 Hours'p "s"0r°"""""*2s« "Denotes raiticai item in the iiaeral 1999 Food Code or 105 CNIR 596.060. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name y Date T e of O eration s Type of Inspection ( I l� 0� Food Service to Routine Address r r n /� Risk ❑ Retail ❑ Re-inspection ry Level ElResidential Kitchen Previous II spection Telephone --y, El Mobile Date: 9/d4/a 5- �t f ❑ Temporary ElPro-operationOwner J 'C G�rJQ Z IS HACCP YM ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) a Time ❑ Bed&Breakfast ❑General Complaint In: 3,T�i�1a ElHACCP Inspector Q 0 t: . Permit No. El 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 ool PROTECTION FROM CHEMICALSr"" ." __ ❑ 2. Reporting of Diseases by Food Employee and PIC (�- �m=�" w :.u„ .MU_ �'_AK : a� k �Vr »» • ' a •:.i ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 TOXIC(',hemlCdlS EFOODFROM APPROV)rDSOURCE�+a„,�,,.,�,i-� „;,,�,#,�;,,,�,„„�,�„�.,_,�,,;,,;�,) � ❑ 4. Food and Water from Approved Source U TIME/rEMPERATURE CONTROLS(Potentially Hazardous Fiords) o ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling i'PROTECTION FROM CONTAMINATION `� 1 y +�' �` "�""' ""'i"i ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and SanitizingREOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)*j '[121. 2Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices fCONSUMERADviSORY�" ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 4) order of the Board of Health. Failure to correct violations 425. 24. Food and Food Protection (FC-4)(590.005) cited in this report may result in suspension or revocation of Equipment and Utensils (Fc-5)(990.009) 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)(59o.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: 1 Vj,a� sseomspecrFomu-1a.aoc Inspector's Signature: ` Print: r1 ddC / PIC's Signature: A / Print: ,JUk Paget of Pages �l Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT li Cross-contamination I 590.003(A) Assignment of Responsibility* 7302.1.IWO) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* - Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Annual 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* a rlicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) 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 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11 Manual Warewashing-Hot Water 3-201.13 Food in a Hermctically Sealed Contuner* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.7.3 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-'L01.'11 DrinkingWater from an Approved System* 4-60L31(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0"' Sheigish and Fish Froman Approved Source Contact Surfaces and Utensils*4-702.11. Frequency of Sanitization of Utensils and 3-20.1.1.4 Fish and Recreationally Caught Molluscan Foal Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 MoDuscan Shellfish from NSSP Listed Chemical* Sources* IO Proper,Adequate Handwashing Regulatory and Mushrooms Approved by Re Mato Authority 2-301.1.1 Clean Condition-Hands and Anns"' 3-202.18 Shellstock Identification Present* 2-301.12 CleaningProcedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1.7 Game Animals* 1,1 Good Hygienic Practices Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package bite it * Mouth* 3-101.11. Food Safe and Unadulterated* 3-30'L12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3.402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* acities* - 3-402.12 LabeliRecorng of ingredients' e and Retention* 5-204.11 Location and Placement* 590.004Q) Labeling of Ingredients' q Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Hindwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand D n Provision -Denotes critical item in the federal 1999 Food Code or 105 CivtR 590.000. 1 I CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 1 Page: of C/ Item Code C-critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item I Verified PLEASE PRINT LEA LV t IGS I G i f� i Corrective Action Required: ❑ No b�Ves Discussion With Person In Charge: y I have read this report, have had the opportunity to ask questions and agree to correct all elc voluntary compliance ❑ Employee Restriction i 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 t, noncompliance may result in daily fines of twenty-five d_ tars r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. (/ ' ❑ Voluntary Disposal ❑ Other: s ' 4 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`F745`F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Conlin,AVlethals for PHFs 14 Food or Color Additives 14 PHF Hot and Cold Holding 37202.12 Additives'" 3-501.I6(B) Calci PHFs Maintained at or below 590.004(17) 41'145°F* 3-302.14 Protec ion from Urua r roved Additives'" 3-501.16(A) Hot PHFs Maintained at or above 1.5 Poisonous or Toxic Substances 140°F. * 7-101.11 Identifying Information-Original 3-501.16(:4) Roasts Held at or above 130`F Containers* 7-102.11 Common Name-Workimr Containers* 20 Time as a Public Health Control 1-201.11 Se araiion-Stage* 3-501.19 _ Time as a Public Health Control* 7-202.11 Restriction-Presence and Use" 590.004(H) Variance Re unetneaa 7-202.12 Conditions of Ilse* 7-203-1.1 'Toxic{'ontainers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sartitizers,Criteria-Chemicals°` POPULATIONS(HSP) 7-204.1.2 Chemicals for WashineProduce,Giteria'; 21 3-50'L11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dr rna e teems.Criteria* Beveiaaes with Warnin;labels* 7-205.11 Incidental Food Contact,Labicants* 3-90L11(13) Use of Pasteurized ELI, 7-206.1 l Restricted Use Pesticides, Cnieria�� 3-901.111D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* 7-206.12 TraRodci Bait der,o, s* 3-801.11(C) Unopened Food package Not Re-served, r' 7-206-'13 Tracking Powders,Pest Control and • Mbnitorrnn* CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS Consumer Advisory Posted for Consumption of Animal Foods That are Raw. Undercooked of PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-40'1.1IA(a)(2) Fags- 15SF15Sec. 22 3-603.t I Pathogens.*ene"1/1"0" E es-'hnmuh uc Service L45'F15sec* 3'303.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats &Game E ,s!r Animtils- 155°F L sec. * SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) Pork and Beef Roast-130'F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in sec. I catering, mobile food, temporary and 3-401-1.l(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165`1"75 sec. " above if relaeito foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventionsand risk factors. Other 1459F"' 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited under N29- Microwave 165°F* Special Requirements. 3-401-1 I(A)(1)(b) All Other PHFs-I4 F 15 sec. 17 Reheating for Hat Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (items 23-30) 3-403.11(8) Microwave- 165'F 2 Mhmte Standim, t Crilical and non-critical violations, which do not relate to the Time" foodborne illness inter vinmions and risk fhctors listed above, can be 3-403.1 1(C) Commercially Processed RTE Food- ,'found in the following sections of the Food Code and 105 CMR 14WF- .590.000. _ .r+►.. 3-403.11(F) Remaining Unsliced Portions of Bcef Item Good Retail Practices. FC b80000_ Roasts" 23. Mana ement and Personnel FC--2 .003 18 Proper Cooling of PHFs 24._ Food and Fond Protection __ FC--3 .004 25 _ Egmpmeni an tensiis FC-4 .005 3-501.W(A) Cool ine Cooked PHFs from 14WF to -- 26 Water,Piumbin and Wasfe FC S .006 70'F Within 2 Hours and From 70°F 27. Ph slcai FaciiFG-6 -- w 41°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC--7 .008 3-501.14( 3) Cooling PHFs Made From Ambient -T9--Special Requirements .009 Temperature Ingredients to 411`F/45-F 30 -Other --- - --- --------..-----............ Within 4 Hours* Denores critical item in the radial 1999 Food Code or 105 CMR 590 000. 4 rwnT*� '�, r4 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/27/2005 WHO'S PLACE OF BUSINESS IS: Kings Roast Beef and Seafood File Number:BHF-2004-0331 145 North Street Salem MA 01970 LOCATED AT: 0145 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0127 Jan 3,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 9 r CITY OF SALEM, MASSACHUSETTS • 3 ,; BOARD OF HEALTH I'll 120 WASHINGTON STREET, 4TH FLOOR IYSY DEC 0 5 2005 SALEM, MA 01970 TEL. 978-741-1800 CITY OF SALEM STANLEY J. USOVICZ, JR. FAX 978-745-0343 BOARD OF HEALTH MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTJ20 S+ Bi°et� �Sea 9 TEL# 97B 7 yS 799 9 ADDRESS OF ESTABLISHMENT 1 q$7 Noety S->' MAILING ADDRESS (if different) OWNER'S NAME J06 KA1AtAZ-IS TEL# 973 o?�S-S�9S-veil ADDRESS 34 UI�t� ln4 S-- CITY L STATE M A ZIP 0190-7 CERTIFIED FOOD MA AGER'S NAME(S) 24n kW14u4z+S CERTIFICATE#(s)33S-36B6 (required in an establishment where potentially hazardous //food is prepared.) EMERGENCY RESPONSE PERSON LD 01E HOME TEL# JAI -S3/-l3IY HOURS OF OPERATION: Mon.//4/076Tue. 1-ID3DWed.11- iD'OThu. /I -IU70Fri.1/-IDJ`8at. J /0J0Sun. la - D TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 .............. ....- - ---..........------------------------------- --- --...... ---- - ------ ......--------------- RESTAURANT ES NO /O ( l 25-99 seats ess than seats $100 =$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 YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. 6d9 DS 0y3 57t/ 6oa- Signatur Date Social Security or Federal Identification Number ----------------------------- ----------- --------- --------- Revised 11/03/05 FOODAP2.adm Check#&Date )��--+j' -- - ------- ----6-------------------------------------- i ,k-3r4.,. . '; _.- .wy.:�..... -....w.,;'1..,....+.,,.'RN�ri...h4.'.^+,+h)+$r-r .moi. .1'f...rzm* ..-,a..1.+.JYr'^,y're.w,-..=4 '.fr_`a+.4...«,+�s.<,.r.`w*."T.'^x• - -. ♦ .. Massachusetts Department of Public Health Salem Board S Health Department 120 Washington Street, 4tb Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DT e of Operation(s) Type of Inspec attion } p1' Food Service ❑ Routine Address ' - RIA 771Retail /E Re-inspection Level ❑ Residential Kitchen Previou Inspection Telephone71Mobile 44410 1—- :117 1 Owner HACCP WIN ❑ Temporary ❑ Pre-operation G �� 21S ❑ Caterer ❑Suspect Illness Psrson in Cha IC) , - Time ❑ Bed&Breakfast ❑General Complaint *v In: /!:IJ ❑ HACCP inspector Ou Permit No. ❑Other Each violation checked requires an explanation on the narrative pages)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. �-�Rm5 FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities ��g/�S `EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE --- - TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source El 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. Hct and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY - ❑ 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22p 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 N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(990.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: rwn5:59::nsyee.FaemEl4 Jpc Inspector's Signature: Print: PC,PIC's Signature: Print:t. i Page of�_Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590003(A)Assignment of Responsihilit?'" 3-302.11(Ad) Raw Animal Foods Separated from �590003(B) Demonstration of Knowledge* Cooked and RIF.Foods" 2 103.1.1 Person in charge--duties Contamination from Raw Ingredients 3-302.11.(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A I(A) Food Protection* applicants* 3-302.15 Washing Fruits and Ve�et'ables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils" Charge* Contamination from the Consumer 590.003(G) Re outing b 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 Four]* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manutal Warewashing-Hot Watar 3-207-12 Food in a Hermetically Sealed Container* Sanitization`pem erutures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warawashing-Hot Water 3-202.13 Shell Egos* Sanitization Tem eramres'r 3-202.14 '131Z*s and Milk Pralncts.Pasteurized* 4-501-114 Chemical Sanitization-temp.,pt I, concentration and.hardness. * 3-202.16 Ice Made Front Potable Drinking,Water* 4-601.11(A) Equipment Fond Contact Surfaces and 5-1.01-i 1 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) Wacr Meets Standards in 310 CMR 220* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source F Frequency ofSanitization ofUtensits and 3-201.14 Fish and Recreationally Caught Molluscan Fool Contact Surfaces of P ui ment* Shellfish* Methods of Sanitization-Hot Water and 3=201.15 Molluscan Shellfish front NSSP Listed Chemical* Sources'" lg Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reoulatow Authorit 2-301,11 Cleem Condition-Rands and Arms* 3-202.t9 Shellstock Identification Present* 2-301-12 CleaningIrrocedure* 590-004(C) Wild Mushrooms* 2-301.14 When to Wash' 3-201.17 Carne Animals" 11 Good Hygienic Practices Receiving/Condition 2-401.11 Fatin , Dritilcin or Usin*Tobacco* 3-202.11 PHFs Received at proper Temperatures* 2-401.t 2 Discharges From the Eyes.Now and 3-202.15 Package Into ity" Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstockldentification 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently located and Accessible 3-402.12 Records.Creation and Retention* 5-203.1.1 Numbers and Ca amucs* 590.00401) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,O eration and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methk)d%,* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 lisrahv china Cleanser-Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Band Davin g Provision *Denotes critical hem in the federal 1999 food Code or 105 CMR 590.000. am 'n,:r.-..-.,t.,a ."f^r'... M.-r, ...�...:w(+r,v:'rx•...r,+n*.-�..nZ..SMe... TMr.,..n?�`,.:�+.r '+.-.. :.,*,,.�..:..._. . .ro. wit.. h,... lr"+s.... -xyyn.r.. ..�,-;�;.A.�...-,.,. Massachusetts Department of Public Health Salem Board S Health Department 720 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel, (978)741-1800 Fax(978)745-0343 Name / Dat Type of Operation(s) Type of Inspection �O� ,© Food Service ❑ Routine Address Risk ❑ Retail '[I Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone _� 1-71 Mobile Date: - HACCP YIN E] Temporary F-1Pre-operation Owner El Caterer F1 Suspect illness Parson(n Charge(PIC} Time 2)6 In ❑ Bed&Breakfast El General Complaint 1, [IHACCP Inspector I i Out3 do 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.,,. ..' �2. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH l PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diselases by Food Employee and PIC ` ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded R15.Toxic Chemicals FOOD FROM APPROVED SOURCE " - TIMIETEMPERATURE CONTROLS(Potentially Hazardous Foods) ' ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures 716. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19.Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20,Time As a-Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP), ❑21, Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices [122, Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 2 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below N t 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)(s90o04) 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 \/I 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: 0 C r � Pow-_. 01n 5:6 VWFomSKdw +ro Inspector's Signature: Print: PIC's Signature: Prink l I Page ofzoPagcs f Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT A Cross-contamination 1 590.003(A) Assignment of Responsibility" 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowled 'e* Cooked and RTE Foals$ Z-103.(1 Person in chane-duties Contamination from Haw 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 foal employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foal 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(6) Re orting b Person in Charge* 3-306.14(A)(B) Returned Food and Reset vice 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 Fboc1* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 4-501.111 Manual Warewashing ot Water 590.004(0-B) Compliance with Food Law* - d-HI 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 ShelLEggs* Sanitization Tem peratures 3-202.14 Eggs and Milk Products.Pasteurized" 4-501.114 Chemical Sanitization-temp.,pH, 3-202,16 Ice Made From Potable Drinking Rater'^ concentration and hardness. * 5-101.11 Drinking Water from an Approved Sdstem* 4-601.11(0) Equipment Fail Contact Surfaces and 590.006(A) Bottled'Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 220* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of P. vi meat* Shellfish* 4-703.11 Methods of Sanifl7ation-Rot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources" 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.1 1 Regulatory AuthorityClean Condition-Hands and Arens* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash` 3-201.17 Came Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 1=.uin Drinkin or CJsing Tobacco 3-202.11 PHFs 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 Preventing,Contamination When Tasting* 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification 590.004(E) Preventim,Contamination from 3-203.12 Shellstock Identification Maintained* 8m plovees* Tags/Records: Fish Products 13 Handwash Facilities 3-002.11 PmasiteDestruction°` Conveniently Located and Accessible 3-402.12 Records, Creation and Retentions, 5.203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients` 5-204.1 t - Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, C7 enation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S uialized Processing Methods` Devices 3-502.12Reduced oxy en paokagin ,criteria* (1301.11 Ilandwashing Cleanser.Availabilit 8-103.12 Conformance with A xoved Procedures* 6-301.12 Band Drvin>Provision Denote,critical item in the federal 1999 Food{lode or 105 C Mid 590,000- ' 4. i CITY OF SALEM (BOARD OF HEALTH Establishment Name: 1 T I �d X�u Date: 9 10 1 Page: C�z of t Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ` Verified -4 No. Reference R—Red Item _ PLE SE PRINT CLEARLY '4 1, 2 0 ! a01•t l (_ n Ci no 0S -, G tJv d J�t9. Oo l✓ 4M V 2 ! o f S(,ra lz d0a,t ar C leqr ws,cL SGQ qcicA,le t� ` N / 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 ❑ Employe astriction/ violations before the next inspection, to observe all conditions as described, and to I Exclusion t P Re-inspection Scheduled ❑ Emergency Suspension 'comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twe t fiv o or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. — �- ❑ Voluntary Disposal ❑ Other: f 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk _ According to I.aw.Cobled to Factors(Items 1-22) (Cont) 41"F/45'F Within 4 Homs. PROTECTIO N FROM CHEMICALS 3-501,15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding ---du 8-501.16(6) Cold Pl1Fs Maintained at or below Addtttves'r r 590.004(F) 41`/45° F' 14 Protection from Una J,,,--d Additives* 15 Poisonous or Toxic Substances 3-501.16(A) HofPHFs Maintained at or above 14o'F ' 7-101.11 Identifying Information-Original 3.50L 16(A) Roasts Held at or above 130'F. Containers" 7-102.11 Common Name-Working Crnitainers* 20 Time as a Public Health Control 7-201.11 Se araLion-Stora c'' 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Ilse* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* - 7-203.11 Toxic Containers-Prohibitions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smuuzess,Crucrie Chemicals* POPULATIONS(HSP) •i, 7-204.1.2 Chemicals for W tshing produce,Criteria* 2'i 3-801_11(A) Unp tstewized Pre-packaged Juices mid 7-204.14 Drvin*A ants;Criteria' Beverages with WarninJLabels* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(,6) Use of Pasteurized Eggs* 7-206.11 RestrictedUsePeSticides.Criteria* 3-80LlI(D) Raw or Parti a]Iv Coked Ani mal Food and Raw Seed S trouts 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 TIMEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal FixAs That are Raw.Undercooked or PHFs _ � Not Otherwise Processed to Eliminate, 3-401.1 I A(1)(2) Eggs 155"F 15 Sec. Pathogens."FIMO"""�00 Fees-Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E s* - Animals- 1.55'F 15 sec, 3-401.11(6)(1)(2) Pork and Beef Roast-13WF 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 3-401.1.1(A)(3) Poultry,Wild Game, Stuffed PHFs, residential.kitchen operations should be Staffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165' '15 sec. * above if related to foodborne illness 3-401.II(,C)(3) Whole-muscle;intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 1#29-- Microwave 165'F* Special Requirements. 140 1.11(A)(1)tb) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1-403.I1(A)&(D) PHFs 165'F 15 sec. "` (Items 23-30) y 3.403.11(6) Microwave 165 F 2 Minute Standing Critical gild non-critical viotationsl iAich do not relate to the Tmie'' _ foodborne'lllness interventions and risk factors listed above, can be, 3-403,11(C) Commercially Processed RTE Food- ,found in the fallowing sections of-the foot!Code and 105 CMR 140°F* 590.000. _ 3-403.1.1(() Remaining Unsliced Portions of Beef Item Good-Retail Practices '- FC 580.000 Roasts* t 23. Management and Personnel, 'FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 4 25. Equipment and Utensils .. FC-4 .005 3-501.14(A) Cooling Coked PHFs from 140'F to 26 *Water,Piumbin and Waste FC-5 .006 70'F Within 2 Hours and From 70'F 2'7.-, . 'Ph sical Paeilily FC-6 .007 to41.'F/45°FWithin4Hours-* 28. x., Poisonous or Toxic Materials _ FC-7 .008 3-501.14(B) Cooling PHF.,Made From Ambient 29- - S eciai Requirements - .009 Temperature Ingredients to 41°14745`6 30. Other Within 4 Hours* r>oio,,e.k*eam ,i Denotes critical item in the&deraj 199Y Pond Code or 105 CMR 590 000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4r"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name I Date T e.of 0 eration s Type of Inspection 1�/nl&-.` /'dd Pv'YJt3a S"eLA 2 /6 04� 'Foodservice ❑ Roo tine f Address/4 Na Risk LJ Retail Ve-inspection Telephone 55 Level,q 1 A' ElResidential Kitchen Previous Inspection 7 57 ❑ Mobile Date: Owner HACCP Y/N El Temporary ❑ Pre-operation ✓d/ t7/t ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) f+064W. Time ❑ Bed& Breakfast ❑ General Complaint In: El HACCIP Inspector 04/1-0 a rga&m, M 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 / Handwash Facilities �13. EMPLOYEE HEALTH _ PROTECTION FROM CHEMICALS E] 2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE [115.Toxic Chemicals._ ❑ 4. Food and Water from Approved Source ' TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [110. 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 / immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): t of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food i 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 5WInspeclFom 14.Ooc Inspector's Signatur . Print: PIC's Signature: Print: A ZtPage/ ofA- Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 I 590.003(A) I Assignment of Responsibility" 3-302.11(A)(1) Raw Animal Foods Sepa ited from 590.003(B) Demons¢ation of Knowledge* Cooked and RTF Foods" 2-103.11 Person in charge-- duties Contamination from Raw ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting byfood employees and 3-302A I(A) Food Protection* a t Locants* 3-302.15 Washow Fruite and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To ReportTo The Person In Utensils* Charge* Contamination from the Consumer 590.009(G) Reporting by Person in Charge" 3-306A4(A)('B) Returned Food rind Reservice of Fred* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590-004(A-B) Compliance with FoodLaw* 4-501.111 Manual Warewashing- ]lot Water 3-201.1.2 Fond in a Hermetically Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13Shell Eggs* Sanitization Tem eratnres* 3-202.1.4 Li gs and Milk Prov ticts.Pasteurized" 4-50,1.114 Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Potable Drinking Water" concentration and hardness.* 4-60111(A) Equipment Food Contact Surfaces and 5-1O1.11 Drinking Water from an Approved Svstem* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Pregnancy of Equipment Fcx'd- 590.006(B) Water Meets Standards in 310 CMR 220* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensits and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui iment* Shellfish* 4-703.11 Methods of Sanitization---HotWaterand 3-201.15 Molluscan Shellfish front NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatoty Authority 2-301.11 Clean Condition--Hands and Arras* 3-202-18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2-401.11 Hating, Drinkin or Using Tobacco* 3-202.11 PI Fs Received at Proper Temperatures* 2-401.12 Discharges Front the Eyes.Nose and 3-202.15Package lntegrit * Mouth" 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin�* b Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 She0stock Identification* 590.004(E) Preventim,Contmninadonfrom 3-203.12 Shelistock Identification Maintained* Em tlo yees� Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3-402.11 Parasite Destruction' 5-203.11 Numbers and 3-402.12 Rccords.Creation and Retention" Ca acities* 590.004(1) Labeling of Ingredients' 5-204.11. Location mid Placement, 7 Conformance with Approved Procedures 5-205.11 Accessibilit O eratlon and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.1.1 Specialized Processin,Methods* Devices 3-50112 Reduced oxygen packaging,criteria* 6-301..11 flandwashing Cleanser.Availability 8-103.12 Conformance with Approved Procedures' 6-301.12 Maud Drying Protision t "`Denotes critical item in the federal 1999 food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: e'[ o`N�S" /_OWAE7 r.� r _Apsg5 Ao Date: 2/�� Page: 2 of '/ 2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ! 1 zCt J7 NK e f wrbr G 2 / r X5 rV9-&A- CAc£ /!ZL- �fltr3lr' 91WZ44 iI`0 ' C-eFWR CN 2( / S' �et7�v✓ /�cf 6fr 0— Discussion -Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twent - ue II rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal LIOther: i 3-50 t.14(C) PHFS Received at"Pemperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41`F/45`F Within 4 Hours. * PROTECTION FROM CHEMICALS 3-501.15 Coolies Methods for PHFS 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PEIBs Maintained at or below 3-202.12 Additives* 590.004(F) 4IV45°F' 3-302.14 Protection front Unapinoved Additives* 3-501,16(A) Mut PHFS Maintained at or above 15 Poisonous or Toxic Substances 14WR * 7-.101.1.1 IdeContainers*nfonnation-Original 3-501.16(A) Roasts Held at or above l30°14. Containers' 7-102.11 Common Name-WorkingContainers* 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'k 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) _ 7-204.12 Chemicals for Washin¢Produce,Criteria* 21 3-80'1.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 D •inggets.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact, Lubricants* 3-801..11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides, Criteria* 3-801A I(D) Raw or Patualty Cooked Animal Food and 7-206.12 Rodent Bait Stations' Raw Seed S routs Not Served. 7-206.13 7]acking Powders,Pest Control and 3-801.11(C) Uno geed Food Packa>c Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of Annual Foods`That are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFS eeecn�e*naoni - 3-401.I.IAft)(2) Eggs- 155`F 15 See. Pathogens.- E yes-htmoediate Service 145'FI5sec* 2.1-1 Pasteurized Eggs Substitute for Raw Shell Game 3-401.11.(A)(2) Comminuted Fish,Meats& 3-30 E gs* Animals- 155"F 15 sec. * 3-401.1 I(B)(1)(2) Pork'.and Beef Roast- 13WF 121 win* 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 see, * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFS, residentialkitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. t' above if related to foodborne illness 3-401.1I(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 N29- Microwave 165`F* Special Requirements. 3-401,11(4)(7)(6) All Other PHFS- 145'F'15see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFS 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, winch do not relate to file Tune* foodborne illness interventions and riskjo(tors listed above, can be 3-403.11(C) Commercially Processed RTE Food- ;found in the folloeving sections of the Food Code and 105 CMR l4WF* 590.000. 3-403 t 1(E) Remaining Unslieed Portions of Beef Item Good Retail Practices FC 590.000 Roasts, -- _Fer...................._...----i 7- Roasts" .003 .* 23. Mona ement and Personnel 18 Proper Cooling of PHFS P4. 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, Piumbin and Waste FC-5 .006_ 70"F Within 2 Flours and From 70`F 27. Ph sical Faculty_ _ FC-6 .007 to 41.'F/45`F Within 4 Hours. * 28. Poisonous or Torjc Materials FC-7 .008 3-501,14(6) Coatig PH[Fs Made From Ambient 29,. - .009 Temperature Ingredients to 41'F/45°F 30 Other Within 4 Flours* ssvaro�..a�zrv, `Denotes critical dean in the Federal 1999 Food Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax (978) 745-0343 Name Dae T e 01`0 eratioon s) Tvpeaf Inspection /� er e<<JA$F tfdf f ffrAtae/7 ® pod Service �i'Routine Address /v9 ()� Risk El Retail ❑ Re-inspection Telephone Level El Residential Kitchen Previous Inspection 744f - 7774 ❑ Mobile Date: Owner J� K HACCP Y/N El Temporary E] Pre-operation N Z✓ S ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector ",Jr t Out: Permit No. ElOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12/Plevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties (�]A; Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded E] 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) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTIONFROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. $ephration/Segregation/Protection ❑ 20.Time As a Public Health Control hEr 99.. Food Contact Surfaces Cleaning and Sanitizin �� ❑REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): 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 7 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 t/ 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. p 30. Other DATE OF RE-INSPECTION: S:590rnVo rFon14,dc Inspector's Signator Print: PIC's Signature: J Print: a Page of Pages' J � / Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contomination 1 I 590.003(A) I Assignment ofRes)onsibility* 3-302.11(A)(1) Raw Animal Foods Separated Som 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-105.11 a Person in charge--duties I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Others= 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by Food employees and 3-302A I(A) Food Protection* applicants, 3-302.15 Washin z Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Fwd Contact with Equipment and Applicant To Report To The Person In Utensils* Charge'* Contamination from the Consumer 590.003(6) Reporting b•Person in Charge* 3-306.14(A)(B) Returned Food and Reserviee of Food* 3 590.003(D) Exclusions and Restrictions* Disposition ofAdutterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food:' A Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-llot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eratures* 3-201,13 Fluid Milk kind Milk Products* 4-501.1.12 Mechanical Warewashing-IIotWater 3-202.13 Shelf Ees* Sanitim ion Temperatures" 3-202.Ld Eggs and Milk Products.Pasteurize& 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. * 3-202.16 Ice Made From Potable DrinkingWater* 5-101.11 Drinking Water from an A roved System'' 4-601-ll(A) Equipment Food Contact Surfaces and 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 220* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-7021 I Fi ccluency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui anent* Shellfish* 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources' SO Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulato Authority 2-301.11. Clean Condition--Hands and Arms 3-202.18 Shellstock Identification Present* 2-301..12 Cieatinp*Procedme* 590.004(C) Wild Mushrcxims* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PIIFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes.Nose and 3-202-15Package Irate ity* Mouth* 3-101.11 Fold Safe and Unadulterated'* 3-301.12 Preventin Contamination When Tastin,4; 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 ShelMock Identification* 590O04(E) Preventing Contamination from 3-2(13.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records.Creation and Retention* 5-203.1.1 Numbers and Capacities i 590.0040) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-50212 6-301.11 Plandwashing Cleanser.Availability 8-103.12 Confo mance with A roved Pfocedures" 6-301.12 Hand Dying Pro rsinn '%Denote;critical infra in the federal 1999 Food Code or 105 CMR 590-060. CITY OF SALEM BOARD OF HEALTH Establishment Name: /eenlGJ• .44r'fder"/ r- s"cf11,JF~ Date: ZA4 Page: of Item Code C-critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY r 2b C dee o.f! u++. e � r<,sr.,-fb F7rf✓�,�te.� raJc _ ,�sr� 2a` C J' Ad re•✓ . 6 5 SAwl TF ruusre� c►� .� P F S'• 7 /lN/�/ T A6 J' �rl1s iai�t7i.[- itUd �J3� SPL�dE iN J/x V4-K f-7ze . /C 3 1"i �/nr c! � Ne✓sS ,t+�r rtn r Zr IA(- eo 1,•r&x S 4/(,§�eVO XA_ N 4r,eC 9 id JY S1464,1,c Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ 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 doll rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. n/ ❑ Voluntary Disposal 0 Other: 3-50LJ.4(C) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According,to Law Cooled to Factors(items 1-22) (Cont) 41°F745`F Within 4 Hours.'" PROTECTION FROM CHEMICALS 3-SO1.15 Coming Methods for PF1F's 13 Food or Color Additives 19 PHF Hot and Cold Holding 3-20212 Additives" 3-50116(B) Cold PHFs Maintained at or below 590.004(F) 41'145°F* 3-302.14 Protection from Una>prp oved Additives* 3-501.16(A) 1-tot PHFs Maintained at or above 15 Poisonous or Toxic Substances Hot P 7-101.11 Containersfying information-Original 3-504,16(A) Roasts Held at or above 130°E Containers" 7-102.11 Common Name--Worklne Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501-19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence and Usc* 590.004(1-) Variance Requirement 7-202.12 Conditions of Use" 7-20311 Toxic Containers-Prohibitions'` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washine Produce,Criteria" 21 3-801.1 I(A) UnpasteurizedPre-packagedJuices and 7-204.14 Beverages with Warning Labels, cots,Criteria* 3-801_11(B) Use of Pasteurized Eggs* 7-205.11 Incidental ental Food Contact, Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Ure Pesticides.Criteria* Raw Seed Sprouts Not Served. ,r 7-206.12 Rodent Bait Stations* Raw Unopened Foal Package Not Re-served. 7-206-13 frackmb Powders.Pest Control and Monitoring-* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 303.11 Consumer Advisory Posted for Consumption of 16 Propar Cooking Temperatures for Animal Foods That are Raw. Undercooked or PHFs Not Otherwise Processed to Elimtinate 3-101.1IA(1)(2) Eggs- 155-F 15 Sec. Pathogens.* E"�cdb 1,1,2001 Eggs-hinnethate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 401.11.(A)(2) Comminuted Fish,Meats&Game E gs* Animals- 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast-130"F 121 imn* SPECIAL REQUIREMENTS 3-401.1 t(A)(2) Ratites,Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec,* catering, mobile food, temporary and 3-401..11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections 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 7629 -- Microwave 165"F* Special Requirements. 3-40111(A)(1)(b) All Other PHFs- 145°F'15see. 17 Reheating tar Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165° F'12 Minute Standine Citical and non-critical violations. which do not relate to the Time' foodborne illness interventions and risk factors listed above,, eon be 3-403.11(C) Commercially Processed RTE Food- ,found in the following sections of the Food Cade and 105 CMR 140c'F` 590.000. 3-403.11(F) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.00_6_ Roasts, 23. Mama ementand_Personn_el FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection _ FC_3 .004 25 __ _Equipment and Utensils FC 4 _.005 3-50t.14(A} Cooling Caked PHFs from 140°F to 26 Water,Plumbin and Waste FC 5 .006 70`F Within 2 Hours and Front 70'F 27. Physical Facility_ 7C-6 .007 to 41°F1457 Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Coaling PHFs Made From Ambient 29. S eclat Re uiremems ____ .009 Temperature ingredients to4l°Fl45°F 30, -Other ----.__-- Within I llo irs's s mn,nxeaxa« "'Denotes critical item in iho rederal 1999 Food Code or 105 CMR 590000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 11�/NGir r/fM air /Ce ll s r gL 0'5&AFCr.� Date: �5 Page: 3 of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item _ Verified PLEASE PRINT CLEARLY 2 C W+� S J Fwa ,'A!Ez� e->w A-6 2'� i•I ,Ir Ud � rJ/s r .! rrsu�r ASc� pwi rtw rG s cr rAr-f1DVsfA is Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / !� ❑ Voluntary Disposal 0 Other: 3-501.14(C) PHFs Received 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'H'ours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cott]PRFs Maintained at or below 3-202.12 Add590.004(F) 41V45°F* Poisonous or Toxic t toned 3-302.14 Protectionction from ixAdditives* 590.004(F) Hot PHFs Maintained at or above FS c Substances - 7-101.11 Identifying Information-Gtig40"F *nat 'F- Cmttainers" 3-501.7.6(A) Roasts Held at or above 130'F1 " 7-102.11 CommonName-WorkinvCOutainers* 20 Time as a Public Health Control 7-201.115e rotation-Storage", 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Rc uirement 7-202.12 Conditions of(Ise* 7.203.11 Toxic Containers-Prohibitions` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals'" -- 7-204.1.2 Chemicals for Washing Produce,Criteria* 21 3-80117(A} Unpasteurized Pre-packaged Juices unci 7-204.14 Drying Agents.Criterium Beverages with Warning labels* 3-801,11(B) Use of Pasteurized Eggs* s* 7-205.11 Incidental Food Contact. ,Criteria* 3-801.11(D) Raw or Partially Cooked(Animal Food and 7-206.11 Restrletedit St Pesticides.Criteria* Raw Seed Sprouts Not Served. * 7-206.12 FniRoccnt Bait dtrs,Pe 3-801.11(C) Unopened Food Package Not Re-served. " 7-206.73 'frackingFowdars,PestControl and Monitoring** CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of lfi Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate Patho ens 3-401.1.1 All F g,- 155,1F 15 Sec. t:rrear� r7.aooi F>gys-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11.(A)(2) Comminuted Fish,Meats&Game Eggs* - Animttls- 155°F 15 see. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 min* SPECIAL REQUIREMENTS o-40 1.1 I(A)(2) Ratites, Injected Meats-755`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. catering, mobile food, temporary and 3-401-1I(A,)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165°F 75 sec. above if related to foodborne illness 3-40L11(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 N29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. Ll 7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. '° (Reins 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* ,foodborne illness interventions and riskfactors listed above, can be 3 403.1.1(C) Comrnerciahy Processed RTE Food- ,found in thefollowing sections of the Food Code and 105 CMR '140°F* 590.000. 3-403.1.1(B) Remaining UnslicedPortions ofBeef Item Good Retail Practices FC 580.000 nu ement an Roasts* 23. Mad Personnel _ FC-2 .003 FS Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25_ E ui meni and Utensils FC-4 .005 3-50L14(A) Cooling Gawked PHFs from 140°F 10 p6. Water,Plumbin and Waste FC-5 .006_ _ 70"F Within 2 Flours and From 70°F 27. Ph deal Facility FC-6 .007 to 47.°F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PIFs Made From Ambient 29. S ecial Requirements .009 Temperature Ingredients to 41 F/45°F 30. Other Within 4 Hours* ss�oe„,nKFsa.ax 4 Denotes critical item in the tedesal 1999 Food Code or 105 CNIR 590.000. r TM CITY OF SALEM, MASSACHUSETTS ..� BOARD OF HEALTH qj 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Kings Roast Beef and Seafood Address of Establishment: 145 North Street Owner's Name: John Kalantzis Restrictions: Application Date: 11/22/2004 Permit for Food Establishment 52-05 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, MASSACHUSET _ C 9 L' V �Ihtl��'I'' BOARD OF HEALTH I/ U O 4 _ p 120 WAS INGTOSTREETSALEM,MA 01970TH FLOOR NOV 19 2004 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR I HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT XingS g»G Rft- 8S -TEL# ADDRESS OF ESTABLISHMENT N,57 NoQTN <S+ SA(Zft rnk o 14 R MAILING ADDRESS (if different) �p 1 OWNER'S NAME J06 IQA 1/�N f ZI S TEL# g1�als�S9s ADDRESS 3Y Wh) f"' St CITYL n STATE r1714 _ ZIP 0170J,CERTIFIED FOOD ANAGER'S NAME(S) hn ERTIFICATE#(s) .33_rJi?1 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON EZi s, KAIArifus HOME TEL# 97$ d0-& 7/Br- I9j0 0 _10a HOURS OF OPERATION: Mon.11 10 1 to i Tue.11} Wed. 4I Thu.11• Fri. Ir � Sat. 11 Sun. 4 D 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 ES NO �a-06 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 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 C pter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kn e a belief, have filed all sta to returns and paid all state taxes required under the law. / /c� 0 b3� v8-9y�'3 Sign e ate Social Security or Federal Identification Number ------------------------------------------------------ [ ------- ----------- ---- Revised11/03/03 FOODAP2.adm Check#&Dat€ Sr>13 IIlj S/d ' _. , ' , t a .y � 7 ni5 Aa�IQ GOA 09 A aoCt N ,3 o o o uj �:¢ 0 CITY OF SALEM BOARD OF HEALTH Establishment Name: K1'19 _s &-O f f sea LA( Date: P - S/ Page: / of / 4 Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY /, P ha dr a_ // >< ' az&//'/ ' aY d s aPCi� i l /S vu �u ✓P�s aLJP �(tJcQ/ 6-,-/ HOs h7v a r s WAAi ( 0D / Ya+' e4 -7 ee U 4 't 's Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ •" inspection, to observe all conditions as escribed, and to Exclusion violations before the next ins > p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food ode I unde stand that ` noncompliance may result in daily fines oftw my-fi dq so uspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: a 3-S1)1.J4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Hours. " PROTECTION FROM CHEMICALS 3-50L15 Cooling Methods'for PHFs t9 PHF Hot and Cold Holding 14 Food or Color Additives - ----- -----_-- 3-501.16(B) Cold P1iF's Maintained at or below 3-202.12 Additives* 590.004(F) 41°/45'F* 3-302.14 Protection froth Unapproved Additives' 3-501..16(A) Hot PIFs Maintained at or above 15 Poisonous or Toxic Substances 14('F. 7-101.11 Tdenti y mg Information-Original 3-50L 16(A) Roasts Held at or above 1.30'F. - containers'° 7-102.11 Cornmon Name-Working Containers* 2g Time as a Public Health Control 7-201.11 Se.aranon-Stora et` 3-501.1.9 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re uirernmit 7-202.12 Conditions of Use" 7-203-1 1 Toxic Containers-,Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Samitzers,Criteria-C'hemieais` POPULATIONS HSP r-204.1.2 Sanivicals for Washing Produce.Criteria* 2t 3-801,11(A) Unpasteumed Pre-packaged.Juices and 7-204.12 CherniDhvin6 al eats.Criteria* Beverages with Warning Labels* 3-801.11(B) Use otPasteurizedLp'*'s* 7-205.11 Incidental Food Contact,Lubricants* 7-206.11 Restricted Use Pesticides,Criteria" 3-801.11(D) Raw of Partially Cooked Animal Food and 7-?(16.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. ng Powders,Pest Control and 3-801.1.1(C) Unopened Food Package Not Re-served. 7-206.13 Tracki Monitoring" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal P'axls That are Raw.Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.71.0(1)(2) Eggs- I55'F JS Sec. Patho,,enti*r' "`•""'ram Eu--,-Immediate Service 145oF15sec* 3-302.13 Pasteurized Fbas Substitute for Raw Shell 3-401.1 I(A)(2) Comminuted Fish.Meats&Game Eas` Animals- 155`F 15 sec. SPECIAL REQUIREMENTS_ 3-401.11(B)(1)(2) Pet aiidBecfAoast- 130"F L2't min" 3-401,11(.0)(2) Ratites,Injected Moats- 155`F 15 590.009(A)-(D) Violations ofSection 590.009(A)-(D) in see. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Starring Contahi9ng 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) Whale-muscle,intact Beet Steaks interventions and'risk'Factors. Other 145"F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under #29- Microwave 165'1- * Special Requirements. 3-401.11(Al(I)(b) All Other PHFs-- 145'F 15 sea 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sea. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk'(actors listed above, can he 3-403.11(0 Commercially Processed R'Fb Food- /imnd in the follou4ng se(tions of the hood Code and 105 CA'IR 140'F* 590.000. 3 a03.11(E) Remaining Unsliced Portions of Beef Item I Good Retail Practices FC 590.000 Roasts" 23. _Management and Personnel j FC-2 1 003 tg 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 front 140'F to 26. ' Water, Plumbin and Waste 1 FC-5 .006 70'F Within 2ours and From 70`F 27. Physical FacilityFC-6 .007 to 41'F/45'F Within 4 Hours. ` 28. Poisonous or Toxic Materials FC-7 .003 3-501 14(B) Cooling PHFs Made Front Ambient 29, Secial Re uirements 009_ Temperature ingredients to 41'F/45'F 30. Other --- f----_ ..._.. .... _ Wiihln 4 HouTS"` s:+nno,nwct2z ro "Denotes critical item in the federal 109 Food Code or 105 Ca911 190.000. #4 L S a 12 311/2 X 11 7/ DER BEAM 8 X 12 0 P 0 '- 10" SISTER 2 X 12 , ....I ' . .. J .... .... I' .... . ..... p ! I #4 HOR I @ 12" SUPPORT 00 EQAXP �. TO � I j ( # ) , ! #4HOP IZ ,( 1OF7 EOU - SPA .) ;3" CLR - I ll F'C=4000 4 -0 II FY=60000 TYPICAL FOUNDATION EPDXY COAT. SECTION REBAR 2 '-011 0 - 101, I 3 1/2" X 11 7/81 -- - - ! ► I ! PSL HEADER 2 X 12 D .F . RAFTERS BEAM @ 16" 5/8" EXT - PLYW SHEATH ; RUBBER COAT .._.i."..-.. .--_.i__.....-------- �. I.. { -2 X 4 STUD FRAPdE— ._...." !....._1..._...�........i....._.{"...__ ..." ._ ... _.- ...j ;... { % WAL_ X16" 5 8 + � 1 EXT . PLYW SHEATH + ! ! 1 ! ! ! SIDING ROOF FRAMING 121 EXIST. BLDG. Lu { I ! 7 2 -00" i \•� I j i o 0 _ - i EXIST SILL GR — — I — — ---� EX IST GND - - (APPROX . 0 .75/ 12) j EXIST FLR. GR. PROP. FLR. GFR. AAA t11CFMgg 1 1 9 .00" 2 9 .00" � 22 '-0'' — dry oyc 0 .0O" ANDREW INSKY 4 0 -00, 8 0 •00'1 FRAMING ELEVATIONS & PLAN KUCH STURA �I( \ FOR PROP. ADDITION AT S�69 yli \ _ RE I NF - P .0 . CONC . KING'S ROAST BEEF 8 SEAFOOD �! FOOTING ,WALL-TYP . REAR ELEVATION RFs 7 RIGHT ELEVATION RESTAURANT,145 NORTH ST.,SALEM,MA. I/4°-I, � p �d (LEFT ELEV.-OPP. IN KIND) SCALE: AS NOTED MARCH 5,2003 1/4°=1' AK STRUCT. ENG. PEABODY,MA. CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .�, TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. 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: King's Roast Beef and Seafood Address of Establishment: 145 North Street Owner's Name: John Kalantzis Restrictions: Application Date: 12/2/2003 Permit for Food Establishment 66-04 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 CITY OF SALEM, MASSACHUSETTS 6 '� BOARD OF HEALTH ley y 120 WASHINGTON STREET, 4TH FLOOR VV NOV 2 12003 — SALEM, MA 01970 r TEL. 978-741-1800 CI1Y OSALEM FAX 978-745-0343 BOARD �� HEALTH USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT " TO {OPERATE A FOOD ESTABLISHMENT 2 NAME OF ESTABLISHMENT ��/J5/ Dug V51`/ �C'ICnCI TEL# m�I7�- ADDRESS OF ESTABLISHMENT I�/s /VnOETt7 ST S1( 111�CM, A d/C�CII MAILING ADDRESS (if different) q OWNER'S NAME �dArfa'1�� IZ(S TEL# ADDRESS .37 W h I i l+ cS-6 CITY nG n V STATE P7 ft ZIP9 l 0 Da- CERTIFIED FOOD MANAGER'S NFiIVIC(S) c CATE#} (s)337-3686 vS (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON ZZ145 l�ala��zl S HOME TEL# I31 -57141V HOURS OF OPERATION: Mon.II -10g0rue./I-/030W ed.0- 1030Th u.I I-10OFri.1I-103Sat.I I-103D Sunl a-10 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 1 0,000sq.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 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 MGLUYI a Pi er 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kno d d f, have filed all st tet x returns and paid all state taxes required under the law. 1X403 03, - s-yV�3 Signatur ate Social Security or Federal Identification Number ---- -------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date Massachusetts De artment of Public Health Salem Board Health S p 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 DateT e of O stations TFsAf Inspection t k.VD em e . �Orl� 1-13-09 Food Service Routine Address Risk ❑ Retail [I Re-inspection S Pf Level ❑ Residential Kitchen Previous Inspection Telephone n ❑ Mobile Date: 7'7 9 ❑ Temporary ❑ Pre-operation OwnerHACCP Y/N Q caterer [ISuspect Illness NT)A/Al ry-Bh`N S Person in Charge(PIC) Time ❑ Bed&Breakfast E] General Complaint n In: ❑ HACCP Inspector, ppm f/ Vim„c his Out: Permit No. ❑Other Each violation checked requirers 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 590.00%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 R-11'3. Handwash Facilities EMPLOYEE HEALTH PROTECTION.FROM CHEMICALS ' ❑ 2. Reporting of Diseases by Food Employee and PIG Q 14,Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded Q 15.Toxic Chemicals FOOD FROM APPROVED SOURCE '. - -- -- t TIMErEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16. Cooling PROTECTION FROM CONTAMINATION [119. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below CTN__1 by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:5901nwp Form-14.o In pton's at 77at�A * Print: PIC's Signature Print: �j r Page of PF]Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination G 590.003(A) Assignment ofRespon�ibili� 3-302.11(A)(1) Raw Animal Foals Separated from 590.003( 1 Demonstration of Knowledge* Cooked and RTS Foods* 2-109 t t Person m chane- duties Contamination from Raw Ingredients 3-302,11(,A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1 t(A) Food Protection* a� 3-302.15 Washut Fruits and Vegetables S90.Ot13(F) Responsibility Of A Food Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char*e' Contamination from the Consurner 590.003(G) Re rortin b Person n Chores* 3-306.14(A)(B) Returned Food and Rescrvice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition ofAdulterated,,orContaminated 590.003(F.,) Removal of Exclusions and Restrictions IFood 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Fooda' 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-6) Compliance with Fad Law* 4-501..1.11 Manual Warewashing-Hot Water 3_201,12Food in a Hermetical) Sealed Container* Sanicizxtion'Cem erarirres* 3-20'113 FhtidMilkandMilk.Products* 4-501.112 MechanicaiWarewashing-flotWater Sanitization Temperatures* 3-202.13 Shell Eggs* 3-202.14 .Eggs and Milk Products.Pasteurized* 4-501114 Chemical Sanitnd hardon-temp., pH, concentration and hardness, 'k 3-202.16 Ice Made From Potable Drinking Water* 4-601_11(A) Equipment Food Contact Surfaces and 5-IOL 11 DrinkingWater horn an A roved S stent* Utensils Clean" 590.006(A) Bottled Drinkin Water* 4-602.1 t Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfa e and Utensils" Shellfish and Fish From an Approved Source 4_702.11 Frequency of Sari dzation of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of F q ui went* Shellfish* 4-7W3II Methods of Sanitization-IlotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1p Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Anns* Regulatory Authodt 3-20218 Shelistock Identification Present* 2-301..1.2 Cleanine Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash- 3-201.17 Game Animals* 11 Good Hygienic Practices 15 Receiving/Condition 2-401_11 Eating,DrinkingorUsin Tobacco* 3-202.1 t PHFs Received at Pro er Tent craunes* 2.401.12 Discharges From the Eyes, Nose and Mouth` 3-202.t5 Pack�* 3-101.11 Food Safe and Unadulterated* 3-30'1.12 Preventing of Contamination When Han 6 TagslRecords:Shellstock ]2 Prevention of Contamination from Hands 590.004(B} Preventing Contamination from 3-20118 Shellstock Identification* 3-203.12 Sheltstock Identification Maintained" Em rlovees* Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3-40111 Parasite Destruction* 3-402.12 Records.Creation and Retention` 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.O aeration and:Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processin Methods* Devices ced ax en 3-502.12 Reduacka ing.criteria* 6-301.1 t Hand 6-301.12 Hand Drying Dryin g Provision Cleanser, Availabilit- 8-103.121 Conformance with Approved Procedures'` 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH EstablishmentName:4j c P41,f.gf titi , Date: Page: 62 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 1rF�N�. /�. ..c [� .C77 � /riD✓fi� a �/if✓n/ i� f r n2 3 G/ e. s a P eLs ftp e a/la/� ' f _ T o x I/ r) ? Pirr7�y� D/LP 2' ,t-�/!ls CA, g tl � ✓ Ste/ N$i' rso�f - OOS1�� / Y / k. Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to ! Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code I un erstand that noncompliance may result in daily fines of twe y-flu d f✓ars r suspension/revocation of ❑ Embargo L3Emergency Closure your food permit. + / ❑ Voluntary Disposal ❑ Other: a.i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45"F Within 4Hours. .* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs I4 , Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(B) Cold PHFsMaintained atoibelow 3-202.12 _Additives', 590.004(F) 410/45"F* 3-302.14 Protection train Una roved Additives* 3-50f.16(A) [lot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140'P. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1.30'F. Containers` 7-102.11 Cormnon Name-Working Containers" 20 Time as a Public Health Control 7-201.1.t Se araGion-Stora e" 3-501.19 Time as a Public Health Control* I 7-202.11 Restriction-Presence and Use* 590-004(11) Variance Requirement 7-202.12 Conditions of(ise" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizem Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Washing Pnxluce,Criteria* ZI -;-gO1.I 1(A) Unpasteurized Pre-packaged Juices and 7-204.14 Diymo Agents,Criteria' Beteraies with Warning labels* 3-801.11(6) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,CCriteria*7-205.J Incidental Food Contact, teria"`eria * 3-801.1.1(.0) Raw of Partially Cooked Animal Food and * Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.1.1(C) Unopened Food Package Not Re-served. * 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'Chat are Raw.Llndercrmked w PHFs Not Otherwise Processed to Eliminate 3-40Ll IA(L)(2) Eras- 155715 Sec. Pathogens.*e.r r�« reooi Eggs-Immediate Service 145'F15sec 3-302.1.3 Pasteurized Eggs Substitute for Raw Shelf 3-401.1 i(A)(2) Comminuted Fish.Meats&Game hg r'* Annuals-155"F 15 sec, 42 3-401.11(6)(1)(2) Pork andBectRoast- 1.30°F 121 min'K SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, hrjecfcd Meats- 155°F 15 590.009(A)-(I)) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.1l(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. '= above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F s' 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) Ail Other PHFs-- 145°F '15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1.1(A)&(D) PHFs 165"'.F 15 sec. * (Items 23-30) 3-403.1.1(B) Microwave-165'F 2 Minute Standing Critical and run-critical violations, which do not relate to the Tune" foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the follon ing sections of the Food Coyle and 105 CMR 140'F% 590.000. 3-403-II(E) RemainingUnslicedPortions ofBeef item Good Retail Practices FC 590.000 Roasts 23. _ Management and Personnel FC-2IF .003 tg Proper Cooling of PHFs 24.-----_Food and Food Protection_ FC-3 .004 25. E ui ment and Utensils FC-4 .005 3-50IA4(A) Cooling Cooked PHFs front 140'F to -""--"-- -- 26. Water Plumbin and Waste FC-S .006 '. 70'F Within 2 Hours and From 70'F 27. Physical FacilityFC-6 .007 to 41'F/45'F Within 4 Hours. "` 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PRFs Made From Ambient 29. Special Requirements I ( _ .009 Temperature fngredients to 41".F/45°F 30. Other ------------ Within 4 Hours* *Denotes critical aem in urefeder2l 1999 Fwd Code or 10i CN1I't 590.000. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(PI e se Print any) R. Date of Delivery item 4 if Restricted Delivery is desired. 73 ■ Print your name and address on the reverse so that we can return the card to you. C. igna re ■ Attach this card to the back of the mailpiece, Agent or on the front if space permits. ❑Addressee 1. Article Addressed to: D I e a s d' renf m item 1? ❑Yes If Yes,enter delivery address below: 11 No King's Famous Roast Beef & .SeafW c/o Mr. John Kalantzia 145 North Street Salem, MA 01970 3. Se I e Type OOertified Mail ❑ Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. ✓ 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) 7099 3400 0009 4093 2683 PS Form 3811,July 1999 Domestic Return Receipt 102595-00-M-0952 UNITED STATES POSTAL SERVICE �F.�`�ESSFa- ,.��.. . ..First Glass-Mail....-- P M _P.ostage-&-Fees Paid. Jo -US__S —. Permit No. G-10 lI wt .i .,aro.__,,. _. ^' • Sender: Please print your , address, and ZIP4"66 this box Health Departma,A th St. h1AR 1 4 2001 se'e'p, M 'ss. 01970 —3q28 CITY OF SALEM HEALTH DEPT. I �� ? ILL,,,,IIIIJ„L„ill„„,ILLI,,,,I,IL,IJL„I,L,,,LII 6��o CITY OF SALEM, MASSACHUSETTS ., ' �)` '� BOARD OF HEALTH c 120 WASHINGTON STREET. 4TH FLOOR a , � SALEM, MA 01970 ,p�, TEL. 978-74 1-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT. MPH, RS. CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to : Owner' s Name : John Kalantzis Name of Establishment : King ' s Roast Beef & Seafood Address of Establishment : 145 North Street Type of Establishment : FOOD SERVICE Application Date : 12/20/2002 Restrictions: Permit for Food Establishment 112-03 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 exo V CITY OF SALEM, MASSACHUSETTS 13 RT a BOARD OF HEALTH I'll 3 +. 120 WASHINGTON STREET, 4TH FLOOR I141N r� ^r�q�q a SALEM, MA 01970 DE0 16 �JUUL TEL. 978-741-1800 FAX 978-745-0343 L:i I ( l 1' :.riL.EIVI STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS. CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT y/ NAME OF ESTABLISHMENT 71 I t10 5 90Z+ Bee f B Sec t TEL#��$ ADDRESS OF ESTABLISHMENT fq$- IV ORI h S+ MAILING ADDRESS (if different) SAM X. OWNER'S NAME IArt 61AQ4L1S TEL# 1315XA31Y ADDRESS I A 1lm+ ST CITY LAhn ST^^-.TE mot ZIP 0190) CERTIFIED FOOD M NAGER'S NAME(S)9 cK1?AD�T14o5 CERTIFICATE#(S) 6",90303—J700. (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON FtI A S K AJA V1 -ti 5 HOME TEL# ID wo HOURS OF OPERATION: Mon 11-1C3° Tue a 0 Wed.III jD�� Thum )00Fri.±1 !_ Sat. a 0a� Sun.ta TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 n A 3 more than 10,000sq.ft. =$250 RESTAURANT ES NO // OZ less than 25 seats 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to L a e 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best k e el' , have filed all st to ax returns and paid all state taxes required under the law. 1B % 02- 6 SB- Signa e fbafe Social Security or Federal Identification Number Revised 11125102 FOODAP2.adm Check#8 Date1�� IMPORTANT MESSAGE FOR A.M. DATE �` Z'S' O 22TIME P.M. r � / M OF �12c.P[�-Gi--lQ�,bd�\ - PHONE AREA CODE NUMBER EXTENSION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE.CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL'. WILL FAX TO YOU MESSAGE// L� U YE SIGNED FORM 4009 77k YYY�� MADE IN U.S.A. pfd 6 \ NOTES 4 14 :.� 4,.. , '�•a$ �+i q�;r.It j�. k. - d •ii°Ax 1� L ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH .e 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 - e TEL. 978-741-1800 - - FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS; CHO - MAYOR - - - HEALTH AGENT - COMMONWEALTH OF MASSACHUSETTS PERMIT. TO OPERATE A. FOOD ESTABLISHMENT e, In accordance with regulations promulgated under authorityof 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 'grantedMtd: Owner' s Name : John Kalantzis , Name of Establishment : King' s Famous Roast Beef & Seafood Address of Establishment : 145 North Street , Type of Establishment: FOOD SERVICE a Application Date; 11/26/2001 ae' Restrictions: - a Permit for Food'EstabTishmentAS`16-02 .`' ° F n*k y , Frozen Desserts/Ice Cream Permitfor the Sale of ;Tobacco Products These Permits ,Expire December_. 311: ;2002, ;¢z &°` This permitisnot transferable and must be reissued upon changerof':; 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. V HEA TH AGENT�� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ° 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1$00 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO P IL 2001IYU� MAYOR HEALTH AGENT U CITY OF SALEM HEALTH DEPT. 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT tS/ NAME OF ESTABLISHMENT /nQ s 14-m&5 A&S-1Oe tsiJ1914EL# ?72 TY-5� 2231,- ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'SNAME I`l Ate IrU }ZIS TEL# 7SJ'SBI-1,3/Y ADDRESS 3y LW LJ'i!q $ F CITY ZIP 000')- CERTIFIED < 0')CERTIFIED FOOD MANAGER'S NAME(S)_ F1,4S Ka#i godzi S CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON EG a 5 V-q 1q'047 Is HOME TEL# -7S1-SBl IP/f/ DAYS/HOURS OF OPERATION: Mon.(1=t Tue. LL1JWed.1:JJ-Thu.�-I Fri.i1-! Sat. i�l/Sun.h-/0 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO /k '�Od- $40 RESTAURANT ES NO $40 BED& BREAKFAST NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $10 NO CHARGE FOR NON-PROFIT(such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPT FORM 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 pians 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 belie , h ve filed all state tax returns and paid all state taxes required under the law. y- 3 Signat Date Social Security or Federal Identification number Revised 11/1/01 foodapZadm Check#&Date t%d av // a..,r.;:.y,.-.�-y-�.�owar-�r`i....'.,-r•�.b-:,:o.^w+r'+^r'+�•yYbW.i...--�.-�-^-.-rv-.^"---. .:,-,v.......-..-.__...,.�. 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 Type of Oneratlonlsl Tyge of Inspection /f(/N S t B y. LD �, /a-/7-r�L ��Food Service © Routine Address 3 S n72�� C -,� Risk ❑ Retail ❑ Re-inspection J Level ❑ Residential Kitchen Previous Inspection Telephone / 7yS� �_90D t� ❑ Mobile Date: Owner ' 440, - HACCP Y/N El Temporary ElPre-operation 4 A//C 40, a Z./i,ec S ❑ Caterer ❑ Suspect Illness 'Person In Charge(PIC) Time El Bed&Breakfast El General Complaint '/ In: ElHACCP Inspector V Out: Permit No. ❑ Other U.S 1s 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 ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ' El 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE' TIMElTEMPERATURE 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 ,,�,/ L?� 18. Cooling El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION E:1'19. Hot and Cold Holding � ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection �� f REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) IJ 9. Food Contact Surfaces Cleaning and Sanitizing ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP i 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 n✓ immediatelyror 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 p by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations J' 4.1 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of / 10 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: r .. PIC's Signature: 4 �y� Print: Ale e �CJ�c,f /ten /N N{y r�S Pageof 3 Pages v 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 lqe 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(8) 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 2E 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 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"A'. 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 Foodin 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* 4501.114 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 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* 13 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(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. d CITY OF SALEM BOARD OF HEALTH Establishment Name: A/ A,,os iYct ea f AI n �r sea/�d -77r- Date: _/„2—/7^0.�2- Page: y of -3 Item Code ' ' < C Critical Item > DESCRIPTION OF VIOLATION /PLAN OFDate 'CORRECTION No.3 r, .Referrence RL Red Item .a ,# F -�PLEA(S(,E,PRIM"CLEARLY n Verified Z0,11-,4 — ' ` y - 42 17 6A: ,v 67 f A /-�P a P F 0�i irr �s r <A,IPrPe�f 74-4 /� e 6Pi Pte' K S 0,,P 2f D_C 92 e _ i-/ .A 1,K) A°l� Ile, /S /,/,/3'/ A/fs' /I,e nI iln _ 2,a .6 C2 O /i7 Rrrv9 /I�Pduc y ni,7L M-a .S 400 XIA'2 liCP .7�ir/1/ i/lL!) .(7� isL6 /�7"' Discussion With Person in Charge: Corrective Action Required: : ❑ No ?` ❑Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to comply Exclusion 3 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 E FORM 734B / HOBBS &WARREN - BOSTON 4 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 Food or Color Additives 19 PHF Hol 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* 1 15 r 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 Drying Agents,Criteria* 3-801.11(6) 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.* Enective"'1200' 3-401.11A(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 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food,temporary and 3-401.1l(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 3-403.1l(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18,;;, Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70*F 27. Physical Facility FC-6 .007 to 41*F/45°F Within 4 Hours.* 28, poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Sp 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. CITY OF SALEM BOARD OF HEALTH C Establishment Name: /61v 9 S ®T a&IS-7 " 9 Sctf�d3iB Date: 1A — r/' �a Page: 3 of Item Code , 'C Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date ? No. Reference A Red It", - � "` • ' PLEASE PRINT CLEARLY Y ? Verified s 4 *v .OGPo c /T/OJ svot t - // � l gF /-`�9"nJX1N.CTcS/1I N9 d �, ,� S u,�, ttt a A ems/ 14 1 y ✓ �Q� �. _ NG�JpII� � I ' i 2 iP J w6 ch� 1 I i Discussion With Person in Charge: Corrective Action Required � ❑,No ❑Yes . :a r 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ s j 2 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 FORM 734B HOBBS &WARREN - BOSTON c Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PRFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to - 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs ,14'4 S Food or Color Additives 1119 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* �L 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 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.* Enectim 11112001 3-401.11A(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 3-401.11(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 47 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. 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 .006 707 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. 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. 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 fOperation(s) Type of Inspection C 2 V vG7Food Service ��❑,, Routine Address y / / c---� Risk7❑ Retail I� Re-inspection Level El Residential Kitchen /Previous Inspection Telephone _ 2 ❑ Mobile Date: Owner / HACCP Y/N E1Temporary F-1Pre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed 8 Breakfast ❑ General Complaint In: ❑ HACCP Inspector 12j) C' �2 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 ❑ 1. PIC Assigned/ Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 0,2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating El6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling ❑ 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 El[:1 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 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 Signatur : yl, C PIC's Signature: Ck1 Print: Page /of L. Pages 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 ll 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 3-302.11(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 Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 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 Surfaces4= 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-temp., H, 3-202.14 Eggs and Milk Products,Pasteurized* pP 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* 101, 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* -'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 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(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. CITY OF SALEM ? BOARD,—OF/HEALTH Establishment Name: ,��rl S /27Si f7� Date: /dam Page: of I Item Code -C—CritiCal Item ' ' DESCRIPTION OF VIOLATION/.PLAN OF CORRECTION - Date tNo. ? Reference R—Red Item �� .� s ;, , , - ,,, ,,, ,f }� •� •, s .... � � � . ., � F �VLEASEPRINL CLEARLY .:. � - Verified 1 v - I it - i i Discussion With Person in Charge: Corrective Action Required: :^ ❑No ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension P result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other J FORM 7346 HOBBS B WARREN - BOSTON . 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 X14" 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°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* L2_0 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* REOUIREMENTS 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 r7-206.13 06.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 06.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 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.* Effective v12001 3-401.11A(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 3-401.11(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 3-401.1I(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. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18'' Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70*F Within 2 Hours and from 70*F 27. Physical Facility FC-6 .007 to 41*F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(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. 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 TI r i n Type of spection ( i Food Service RoutinIne Address ( gyp// / Risk ❑ Retail ❑ Re-inspection _ Level /� El Residential Kitchen Previous Inspection Telephone q� // _ `7-'� 7 /// El Mobile Date: Ownert - / HACCP YIN El Temporary ElPre-operation Z,r: Z ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) / J Time El Bed&Breakfast El General Complaint L. In: El HACCP Inspecto� //J/� -7 i /l �y /n 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 ❑ 0D PROTECTION MANAGEMENT El12. Prevention of Contamination from Hands 1. PIC Assigned/ Knowledgeable/ Duties HEALTH El13. Handwash Facilities E9MPLOYEE 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 El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements [1 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 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 / El21• Food and Food Preparation for HSP 10. Proper Adequate Handwashing / CONSUMER ADVISORY ® 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N,, by a Board of Health member or its agent constitutes an i\23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food / 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: I I Inspector's Signature:( / Pr int 5 �h? PIC's Signature: \-/ r V Print: C. Page/ofzpages 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 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 Char e-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2,• 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in 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 g Food Contact Surfaces Food and Water From Regulated Sources 5 _ 4-501.111 Manual Warewashing-Hot Water 90.004(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* it 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* 12 Prevention of Contamination from Hands 6Tags/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(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 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. CITY OF SALEM F BOARD OF HEALTH Establishment Name: /e 76 T 126')_S �� Date: 1� 3 Uz Page: Z of s item ' Code C-Critical Item g - DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R-Red items; .,;. - "_,� !." %i,,:a�Edse.aamr aEaRa �' Verified 'i . St'-A P lJw-' cL, VeG c V-' )'�- f ' Id-II` -f-L-2—L Cb/Df Z Gig 5G Pce, \ S Tc-'(-�,'L P�E bv\c�c r-ras Cr'G? U - $ ..25 Qj - As c - X lJ Discussion With Person in Charge: Corrective Action Required: ❑ No ❑Yes ,r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 L11 Re-inspection Scheduled L11 Emergency Suspension r result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure i ❑ Voluntary Disposal ❑ Other j FORM 7348 HOBBS &WARREN - BOSTON L Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) RHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41'F/45'F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14. . Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(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 Se aration-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* °2f- 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 TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effective 1/1/2001 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 1457 15 Sec.* 3-401.1l(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, 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 foodbome 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 3-403.1 l(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 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. 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. Y.•rn'rv-.vrr'n,✓'�wavro--n-..�.+v1lwM:k'.n-+.�....--� :..-ar=.r-•.-�.......-.---`.rr.:.�ir..-..}r-..4 ;-.i.,:1i�......... -.... ...,,,y 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 �1 Date T fr I n Tyoe of Ins ection rVI Food= ood Service ,E Routine Address /�/ Ris ❑ Retail ElRe-inspection �(/ Level ElResidential Kitchen Previous Inspection Telephone Gi 2 b_ ,, 1 o / l / El Mobile Date: Owner ff// HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time El Bed&Breakfast El General Complaint , In: El HACCP Inspector /^ '2 C�v(n s 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 ❑ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. 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 El 5. Receiving/Condition El6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 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 ElEl 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 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 (FC4)(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: 1A A Inspector's Sign ture. Print:. PIC's Signatur :' Print: /( /1 A.. C Pa�oPages / n rl Tl ) FORM 734A HOBBS&WARREN - BOSTON!V 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( 590.003(A) Assignmentof Responsibilit * 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 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated S 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 g 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, P.P 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* I 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* 12 Prevention of Contamination from Hands '. G 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. v CITY OF SALEM BOARD OF HEALTH `! Establishment Name: �� S ��_ /�- Date: �G�UZ Page: Z of 4 ' Item Code a . "C-Critical Item DESCRIPTION OF<VIOLATION ! PLAN OF CORRECTION Date I o. Reference R,—Red Items - ' < s Verified R x s-: ..PLEASE PRINT CLEARLY "+ X �(rF nd L 1 i f '4 t 1 IV } 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 1:1 Voluntary Compliance 1:3 Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may 1:1 Re-inspection Scheduled ❑ Emergency Suspension `s result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure j ❑ Voluntary Disposal ❑ Other F FORM 734B HOBBS &WARREN - BOSTON 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 iL Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(6) 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 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* 3-801.1](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 PHFsPathogens.* Effective 11112001 3-401.11-A(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 3-401.11(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 3-401.1l(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. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 ;A 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 41017/450F Within 4 Hours.* 28, poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From AmbientS ecial Requirements .009 Temperature Ingredients to 41°F/45°F 30.29. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �f- -n,+.+.�.�:r.F's-e�....7J»ii.�r+✓`Na.-`.a-1 P�F:A:'^+Ws;.�w.1+.++,-'^"s- .a..K.✓i::�....; ..^erw'h�"F.1.-.,.rr*'-^t..t'"�+.w'+,Y'w.'w�'«. ..-... . _ 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 "Ae - Date 9ae_ Type of 0 eration(s) Type of Inspection /61f � - 3 s / ❑ Food Service ❑ Routine Address /��^- ,n v,�l- % Risk ❑ Retail ❑ Re-inspection .J vl�.�-7 Level ❑ Residential Kitchen Previous Inspection , Telephone 9'�f 277 El Mobile Date: Owner / 0 / /' ,/ `` - HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector -� / Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific 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 13 Handwash Facilities EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. 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) ❑ 16. Cooking Temperatures [15. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling, ❑ 7. Conformance with Approved Procedures/ HACCP Plans - ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ B. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing 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 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 3. 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: j. A Inspector's Signature: Print: PIC's Signature: Page-Zofc�Pages _ .. ..rte Pit FORM 734A HOBBSJ 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 L1590.003(A) Assi nment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowled e* Contamination from Raw-Ingredients 2-103.11 Person in Char e-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 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 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'' 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-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- or 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 :PHFs Identification Present* 2-301.14 When to Wash* 590.004(C) rooms* 11 Good Hygienic Practices 3-201.17 als* 2-401.11 Eating, Drinking or Using Tobacco* 8` /Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 ived at Proper Temperatures* Mouth* 3-202.15 egrity* 3-301.12 Preventing Contamination When Tasting* 3-101,11 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 TrioLocated 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 p Y g 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. CITY OF SALEM BOARD OF HEALTH Establishment Name: / ✓7 ,J /Z64 Date: S— �/2 Page: of Z t Item Code C-Critical Item DESCRIPTION OF.UIOLATION / PLAN OF CORRECTION Date 4n ` No. Reference ..R—Red Item. ` S R =.� ,PLEASE rRwr CLEARLYVerified` p _ r C(Z- Z — I ! s S J`76Z 4 i r U i — G Z c �n 4ez) 14 GC tom: YF�. do urs h —t S 7 i c3 _ t t !' Discussion With Person in Charge: Corrective Action Required: ❑No l ❑Yes Emloee violations befoI have read lrereport, have the next inspecthe tion,on, topportunity observe all ask conditions asdeons scribedeand� oto correct comply ❑ voluntary Compliance E elusion Restriction/ with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension r result in daily fines of twenty-five dollars or suspension/revocation of your food permit. !, a ❑ Embargo ❑ Emergency Closure i ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS & WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41°F/45*F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14' Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15- Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°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* ?213-801.11(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* 3-801.1 I(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 TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or r16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effective 11112001 3-401.1IA(I)(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 3-401.11(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 foodbome 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. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18d i 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 Ambient29. 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. S CITY OF SALEM BOARD OF HEALTH s Establishment Name: t4 .f � Date: —.5��152 Page: of Item Codec C-Critical item a DESCRIPTION OFVIOLATION / PLAN OF CORRECTION $ p Date PLEASE PRINT CLEARLY No. Reference R x Red Iterii<'� " - •_ Verified ;'re, i —t— S_ -f`zrM' ri L S F r Discussion With Person in Charge: Corrective Action Required: ❑ Nos ❑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 w r ❑ Voluntary Disposal ❑ Other `' FORM 734B HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PRFs 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 L14-; 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* iL 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 WashingProduce,Criteria* Beverages with Warning Labels* 7-204.14 Drying A ents,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 r7-206.13 6.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 6.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 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.* Eriective 11112001 3-401.11A(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 3-401.11(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 s 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 3-403.1 l(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 X18, 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/450F 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. 'tilti'v.o[F`W,nYAK(N"�Y°M.stS• RY'YA:[�'[YAywY'('�IAkYM�.t,W�....•.r•-- THE COMMONWEALTH- OF MASSACHUSETTS CITY OF SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (9,78) 741-1800 Fax: (978) 740-9705 Names�- Date T e of O eration Type of Inspection J L 6� Food Service Routine Address Risk ❑ Retail Re-inspection A10Level ❑ Residential Kitchen Previous Inspection Telephone /� _ / El Mobile Date: Owner 7 El Temporary LlPre-operation _ HACCP WN ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint El HACCP Inspector In: [I Other C � Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) Violated. Non-compliance with: RED Violations (1-22) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE 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 ❑ 18. Cooling ❑ 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 ❑ 21. Food and Food Preparation for HSP E110. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations (23-30) 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(RED.Items 1-22): of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR C N' 590.000/Federal Food Code.This report,whensigned below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-9)(990.009) the food establishment permit and cessation of food establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6)(590.007 have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10,days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.5901n tFw 6-Md. ) Inspector's Signature: Prin: ` PIC's Signature: ' / Print: /O / J� Page/ of Pages 7 Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENTS Cross-contamination 1_ 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.1 I Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Chare* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* F3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* l..4 Food and Water From Regulated Sources _9__ Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensilsand Shellfish* Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization -Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by 10 " Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 1,5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Pro er Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Packa e Inte Rei * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing'Contamination When Tasting*' 1 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance a _ /HACCP Plans 3-502.11 Specialized Processing Methods* Supplied with Soap and Hand Drying Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision - *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS Establishment Name ' ^ tt� Date Address /!/ �� S Page of—L Item No. In the space below describe all violations checked on front page. v ly_ r Y k" rjJr (-y - 6 JN Y: 6�rY�- .`l\ -� U Z V tl tll m m S f X i . Coo - Discussion with Management s CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(@,,SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: C� Time: 1, dq Received By: Complaint Number: 0322 Complainant o 4c � Address: Phone: (io2z 001 L� (4 C"S� Z&n!1NN �0 r Q,) r C12 ywVn c�- Investigated By: Date: Property Owner/Occupant Name Telephone#: •