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A TASTE OF THYME - ESTABLISHMENTS A TASTE OF THYME 122 WASHINGTON STREET k 1 r Commonwealth ofMassachusetts ti 'City of Salem Board of HealthKimberley Driscoll'. - - �s 120 Washington Street,4h Floor Mayor t _ - 3 SALEM,MA 01970 � � �_ •�a, Food/Retail Establishment Permit DATE PRINTED:' 01/03/20131' ESTABLISHMENTNAME-- : A Taste of Thyme Cafe c `. File Number:BHF-2004-000114 '_ - 122 Washington Street E .N - • - - Salem MA •01970 ' LOCATED AT: M x- e x •i •. u s9 .k R SALEM, MA 01970 Permit Type Permit No. I Permit Issued Permit Expires Fee Restrictions/Notes x e FOOD SERVICE BHP-2013-0295 Jan 1,2013 , Dec 31,2013 $280.00 a ESTABLISHMENT r = Total Fees: $280.00 . PERMIT EXPIRES IDecember 31, 2013 _ g Board of Ifealth. a 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; i all plans for such must be submitted to and approved by the Salem Board of Health. page 1 CITY OF SALEM, V MASSACHUSETTS PublicIie�4th BOARD O F FIFAI I I " 120 WAS]IINC1'ON S'11kU,'r,4111 FLOOR KIMBERLEY DRISCOLL Tlil..(978)741-1800 FAz(978)745-0343 LARRY RADIDIN,RS/tutl-IS,CIR1,CP-FS MAYOR Ixemdin(a0salem.com HF,ALTI I A( ISN'1' Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: /kk )�0 2) Establishment Address: [ 2 Z, � l/OSS 3) Establishment Mailing Address(if different): 4) Establishment TelephoneNc: I "� /—J �`i'"/ 20 1 5) Applicant Name&Title: 6) Applicant Address: 7 7) Applicant Telephone No: 24 Hour Emergency No: ALM -3 mail: 1 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address ,A- ro poratior An individual A partnership Other legal entity 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge, Supervisor,Manager,etc.) Name&Title: Address: Telephone No: Fax: Email: Emergency Telephone No: l� 13) District or Regional Supervisor(if applicable) Name&Title: Address: l� Telephone No: Fax: Email: Check#: a 6\6 Date: /XJI C/ Amount: Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: (if applicable) 16) Days and Hours of Operation: — (1 17) No. of Food Employees: 2 , 18) Name of Person in Charge Certified in Food Protection Management: Required as of 1011/2001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) ❑ Retail( Sq. Ft) ❑ Caterer Permanent Structure ❑ Food Service-( Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments---_-------------------- (check one) RETAIL STORE RESTAURANT Annual ❑ Less than 1000sq.ft. $ 70 ❑ Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 ❑25-99 seats $280 ❑ More than 99 seats $420 Temporary/Dates/Time: --------- ------ - - - - ._... ----------------------- ❑ Bed &Breakfast/Childcare Services/Nursing Home $100 - ------------------------------------------------------------ ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no timeRemperature controls required) (check all that apply): RTE-ready-to-eat foods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch.62C, sec. 49A, I certify nder the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. �j 25) Social Security Number or Federal ID: 07' 0T_I 7T2 -5 26) Signature of Individual or Corporate Name: Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4h Floor Division of Food and Drugs Salem, MA 01970-3523 �- Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of Address: FOOD EST LISHMENT INSPECTION REPORT Tel. Name �J Datp Typ f Operation(s) Type of Inspection m(, 1 I Food Service ❑Ro4ine Address '�i Risk ❑ Retail e- inspection Telephone 10 1 Level ❑ Residential Kitchen Previous Inspection P ( ❑ Mobile Date: Owner HACCP YIN [ITemporary [IPre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) J Tim •/tfJ ❑ Bed A Breakfast ❑ General Complaint f _) In: w I,HP ❑ HACCP ( Inspector \1 )p�}IA� Out .I Permit Inspector Each violatiorlt Shec ed requires a-i exp anation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.909(F) ❑corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) El FOOD PROTECTION MANAGEMENT ,_ , - ,� - - . ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH ❑ 13. Handwash Facilities •PROTECTION'FROWCHEMICALS , - _ ❑ 2. Reporting of Diseases by Food Employee and PIC _ - _ ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ I El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE_ _ _ _ _ ._ _ TIME/rEMPERATURE CONTROLS(Potentially Hazardous Foods) F14. Food and Water from Approved Source _ ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling -,PROTECTION FROM CONTAMINATION ., - _ __ ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR gIGNLYSUSC-EPTIBLE=POPULATiONS.(NSP)`- ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing _ ❑ 11. Good Hygienic Practices CONSUMERADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (ss0.0 order of the Board of Health. Failure to correct violations 24 ood and Food Protection (FFC-3XC-3X590.0044)) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (Fc-4x590.005) the food establishment permit and cessation of food 2 . Water, Plumbing and Waste (FC-SX590.006) 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 R ements (sso.00s) within 10 days of receipt of this order. 30. O DATE OF RE-INSPECTION: .. b�ddac Inspector's Signature: Print �. I PICS Signature: x-1`7 /-•-� -, I Print: "�'I IM L - a _ Page'of//�/�/=Pages Violations Related to Foodborne Illness Interventions and Risk Factors(gems 1-22) PROTECTION FROM CONTAMINATION I FOOD PROTECTION MANAGEMENT 8 1 1 590.003(A) Assignment of Responsibility" I 3-302.11(A)(1) Cross-contamination Raw Amal Foals Separated from Cooked and RTE Fools* 590.003(B) Demonstration of Knowledge" Contamination from Raw ingredients I 12-103.11 Person in charge-duties 13-302.1 I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 1590.003(C) Responsibility of the person in charge toI ; Fuad Protection applicants* 1 Contamination from the Environment I 02.11(A) i I replica reporting by fool employees and 1 3 3-302.15 I Washing Fruits and Vegetables J7 and a uipn 1 I j 590.003(F) Responsibility Of A Foal Employee Or An 3-3(1}.11 Food Contact with Eq J Applicant To Report To The Person In Utensils* Charge* I 1 Contamination from the Consumer I 590.003(G) I Reporting by person in Cbaree* i i 3-306.14(A)(B) Retuned Food and Reservice of Food* 13I 590003(D) I Exclusion and Restrictions* Disposition of Adulterated or Contaminated Food 1590.003(E) I Removal of Exclusions and Restrictions I 3 701.i 1 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE I I Fo`e, 4 Food and Water From Regulated Sources 19 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 Scaled Coniainer* I Sanitization Temperatures* I3-201.13 Fluid Milk and Milk Products* I I4-501.112 MechanicalWarewashing-Hot Water 13-202.13 Shell Eves* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized'k I 14-501.114I Chemical Sanitization-temp.,pH, I 13-202.16 I Ice Made From Potable Drinking Water* I concentration and hardness. * 5-101.11 I Drinking Water from an Approved System* 14-601.11(A) I Equipment Food Contact Surfaces and I Utensils Clean* 590.006(A) I Bottled Drinking Viater* ^ * 14-602.11 I Cleaning Frequency of Equipment Fold- 590.006(B) I Water Meets Standards in 310 CMR 2._',1, I Contact Surfaces and Utensils* SheAlah and Fish From an Approved Source 4-702.1 I I Frequency Sanitization of Utensils and I 3-201.14 Fish and Recreal.itmally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 MetholsofSanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP t.istcd I I Chemical* Sources* Game and Wild Mushrooms Approved by 110 I Proper,Adequate Handwashing Regulatory Authority I 2-301.11 1 Clean Condition-Hands and Arms* 13-202.18 Shellstt ck Identification Present' I 12-301.12 Cleaning Procedure* I 590.004(C) Wild Mushrooms* I 12-301.14 When to Wash* I 3-201.17 I Game Animals* I I it I I Good Hygienic Practices ISI Receiving/Condition I 12-401.11 I Eating,Drinking or Using Tobacco* 13-202.11 PHFs Received at Proper Temperatures* I 401.12 Discharges From the Eyes,Nose and 3-202.15 Package Inteprity* I I Mouth* J 3101.1 i Foal Safe and Unadulterated * I 13-301.12 I Preventing Contamination When Tasting* I 16 Tags/Records:Shelistock I 112 Prevention of Contamination from Hands 3-202.18 I Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 I Shelistock Identification Maintained* I Employees* Tags/Records;Fish Products I 113 Handwash Facilities 13402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.1215-203.11 Nmnbers and Capacities* Records,Creation and Retention* I I 1590.004(1) Labeling of Ingredients* I 15-204.11 Location and Placement* 15-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Y /HACCP Plans I I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices I 13-502.12 1 Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cleanser,Availability 8-103.l2 I Conformance with Approved Procedures* I 16-301.12 I Hand Drying Provision 'Denotes critical item in the faleral 1999 Faxl Cleric or 105 CMR 590 0M. CITY OF SALEM BOARD OF HEALTH /t Establishment Name: � Date: � � ll�C�l 1`Z-� Page:_ of 1 item I Code I C—Critical Item DESCRIPTION OF VIOLATION/PLANOF CORRECTION Date No. Reference R-Red item Verified PLEA E PFS NT CLEARLY s f I f I I I ).n _ h��n��i�n,r vr•� . I � ( q E;UL;A it�4 _ ' 41 I i I Discussion With Person in Charge: Corrective Action Required-TU—N-0 —To—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 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 twenty-five dollars or suspension/revocation of ❑ Embargo u Emergency Closure your food permit. �^ � 12 Voluntary Disposal ❑ Other: 1 ' 3-501.t4(C) PHFs Received at Temperatures t Violations Related to Foodborne(lines&Interventions and Risk According to Law Cooled to Factors f1mins 1-22) (Cont.) 41°-145°F Within 4 Hl PROTECTION FRO A CHEMICALS ( 3-501,!5 Coding Methods for PHFs I 14 I Food or Color Additives I lg PHF Hol and Cold Holding V 3-202.12 Additives* 3-50L16(B) Cold PHF; Mitinminedatorbelow i 590.404{F7t 41°145°F* 3-302.14 Protection from Una proved Additives* I 2 1g Poisonous or Toxic Substances I 3-501.16(A) Hot PHFs Maintained at or above t ( 140°F * 7-101,11 identifying Information-Original ( 3-501.16(A) Roasts Held at or above 130°F. Containers* 120 Time as a Public Health Control 17-102.11 Common Name-Working Containers* 1 r-201.l l Separation-Storage* 3-501,19 Time as a Public Health Control* + 590.004(H) I Variance Requirement ' 7-202.71 ,Restriction-Presence and Use I 17-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals fru Washing Produce,Criteria* I 121 3-801.!1(A} Ueverages wit Pre-packaged]vices and i 7-204.14 Drying Agents.Criteria* .Use of Pas with Warning Labels* 7-205,11 Incidental Food Contact,Lubricants* I 3-$01.11(6) Use of-Pasteurized C Eggs* 7-206.11 Restricted Use Pesticides,Criteria* f 3-501.11(0) Raw or d Sprouts Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Spnxns Not Served.* j 3-$01.11(C) Unopened Food Package Not Re-served 7-206.13 Tracking Powders, Pest Control and I Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFa Not Otherwise Processed to Eliminate Pathogens.* 3-401.11A(1)(2) Eggs- i55`F 15 Sec. Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game { Eggs* Animal's-155'F 15 sec. 3-401.11(B)(1)(2) I Pork and Beef Roast-130°-121 mio* I SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected A4eets- 155°F 15 - 590.009(A)-(D) Violations of Section 590.009(A)-(D)in ( see.* catering, mobile toad,temporary and f 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be t Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-I65'F 15 sec. * above if related to foodborne illness + 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to god retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 1657* Special Requirements. 3.401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.* I t 117 Reheating for Hot Holding I VIOLATIONS R 7LATED TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) ) PHFs 165°F l5 sec. * I (Itemis 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing I Critical and non-critical violations, which do not relate to the Time ` foodborae illness interventions and risk factors listed above, can he 3403.11(C) Commercially Processed RTE Food- jbund in the fallowing sections o/the Food Cade and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef I Item 1 Good Retail Practices FC 690.000 I Roasts* ! 23. 1 Management and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. I Food and Food Protection 1 FC-3 .004 I 1 25. 1 Equipment and Utensils I FC-4 .005 3-501.14(A) Cowling Cooked PHFs from 140°F to i a6. Water.Plumbing and Waste I FC-5 .006 1 70'F Within 2 Hours and From 70"F 27. I Physical Facility 1 FC-6 007 I, to 41`F/450F Within 4 Hours. * 128. ( Poisonous or Towc Materials FC-7 I .006 I 3-501.14(6) Cooling PHFs Made From Ambient 1 29. I Special Requirements 1 .009 ' Temperature Ingredients to 41'F/45°F 130. 1 Other ! I I Within 4 Hours* 'Dena%critical tvm in the federal 1999 Ford Cale w'105 CUR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,40' Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town of ��(0) Address: FOOD E TABLISHMENTTNSPECTION REPORT Tel. NameI Datel (7�ti(% Type ofOperationis) Type of inspection l7� OIL ood Service utine Address I Risk Retail ❑Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YIN ❑ Temporary El Pre-operation ❑ Caterer ❑Suspect Illness Person-in Carrge(PICT , I , � Tim ❑ Bed& rea, st 0 General HACCP Complaint �r��1111 In7 // (� J Inspector 1 Out:�ub "'" Permit No.7,)117,_0 ❑.Other Each viotatillori chec ed requires an explanation on the narrative age(s)and a citation of specific provision(s)violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.909(E) ElIVi Violations marked may pose an imminent health hazard and require immediate Tobacco 9 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) FOO OTECTION MANAGEMENT " _ _ _ �r vention of Contamination from Hands ��. PIC Assigned/Knowedgeable/Duties - - " - - - 3. Handwash Facilities EMPLOYEE HEALTH PROTECTION_ FROM'CHEMICALS� _ ❑ 2. Reporting of Diseases by Food Employee and PIC E] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE _— ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TmErrEMPERATUREC.t)NTROL'S(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION' _ _ -� - of and Cold Holding 92 Separation/Segregation/Protection El20.Time as a Public Health Control [ZX rood Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE=POPULATIONS'(HSP) E]21.Food and Food Preparation for HSP ❑10. Pamper Adequate Handwashing I GGood Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. C N 590.000/federal Food Code.This report,when signed below 23. Management and Personnel (FC-2X590.003) by a Board of Health member or its agent constitutes an 2 Food and Food Protection (FC-3X590.004) 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-4X590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC5X590.006) establishment operations. If aggrieved by this order,you Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.006) and submitted to the Board of Health at the above address 29. Special Re irements (590.009) within 10 days of receipt of this ord;;;eeer. I 30. Other DATEOFRE-INSPECTION: i I ��.r Inspector's Signature: I Print:UPah �'I /1 (� W PICS Signature: 17V"^� � Print: ,Il!_t ) Page jof&es 1 __ � t n Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 18 Cross-contamination ` FOOD PROTECTION MANAGEMENT 1 3-302.11(A)(I) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I I I Contamination from Raw ingredients 2-103.11 1 Person in charge-duties i 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH I I Other* Contamination from the Environment 2 590.003(C) Responsibility of the person to charge to I 13 302. i I I . 11(A) I Fund Protection require reporting by food employees and 3-302.15 I Washing Fruits and Vegetables applicants 13-304.11 I Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils*Applicant To Report To The Person In I I Contamination from the Consumer I Charge* 590.003((3) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated 13 590.003(D) Exclusions and Restrictions* I I Foo 590.003(E) Removal of Exclusions and Restrictions I 3-701.1: Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I I Food J q 1 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004iA-B) Compliance with Food Law" I 14-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed C:ontamer* I Sanitization Temperatures* .I 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Warewashing-Hot Water I3-202.13 Shell Eggs* I Sanitization Temperatures* J 13-202.14 Eggs mid Milk Products.Pasteurized* I 4-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 ice Made From Potable Drinking Water* I concentration and hardness. 5-101.11 Drinking Water from an Aeproved System" I 14-601.11(A) I Equipment Food Contact Surfaces and 1590.006(A) Bortled Drinking Water' I Utensils Clean* 1590.006(13) I Water Meets Standards in 3]0 CMR Z2.0* I ( 4-602'11 ( Cleaning Frequency of Equipment Food- Jil Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 14-702.1 I Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from vSSP L sled I Chemical* Sources* 110 ( I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I ReoulatoryAuthority I 12-301.11 I Clean Condition-Hands and Arms* f 13-202.18 Shellstock identification Present" + 12-301,12 I Cleaning Procedure* f 1590.004(C) Wild Mushrooms* I 12-301.14 ( When to Wash* 11 13-201.17 Came Animals* I I It I I Good Hygienic Practices ISI Receiving(Condition I 12401.11 I Eating,Drinking or Using Tobacco* f 13-202.1 1 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the E I I yes, Nose and 13-202.15 I Package Integrity* I Mouth* f 3-101.)i I Food Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* 6 I I Tags/Records:Shellstock I I 12 + Prevention of Contamination from Hands 13-202.18 Shellstock Identification* I 590.004(F) I Preventing Contamination from 13-203.12 ShetIstock Identification Maintained" I Employees* Tags/Records:Fish Products I 113 Handwash Facilities 13-402.11 Parasite Destructiou' I I Conveniently Located and Accessible 13-40212 I Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 1590.004(!) I Labeling of Ingredients' I 15-204.11 I Location and Placement* f 15-205.11 I Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Y /HACCP Plans I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices 3-502.12 I Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cleanser,Availability f I I i I I R-103.12 I Conformance with Approved Procedures* 6-301.12 Hand Drying Provision 'Denotes entiwl item in the federal 1999 170d Code ur 105 CMR 590-000. CITY OF SALEM s4c � JBOARD OF HEALTHEstablishment Name: Date: Page: C/ of 4 nem code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified IPLEASE PRINT CLEIRLY t t v �G� 1_IiC�f�I-ice i_A I 1 11011x 9��Pfo ---)ahe ��rfYa t ��,� � n;�� -I11'( )A IY� ^^ -v h. vr,6U- I fit, n` '10 ' Q in PAR oto k)�( r' lel n JA t hl_ k4r) Ivy _ L. t�lh P��cti't � Imo; Il f I � I Discussion With Person in Charge: Corrective Action Required: I ❑ No [V:es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance (3 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 ❑ Other: S 3-501,t4(C) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cant.) 41°F/45°F Within 4 Hous. PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PRFs 14 I Food or Color Additives ( 19 PHF Hoe and Cold Holding i 3-50L W(B) Cold PIfFs Maintained at or below 3-202.12 Additives* 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives' 1 3-SOl.lb(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101,11 Identifying Information-Original 3-501,16(A) Roassts( 140ts Held at or above 130°F. Containers* * 7-102.11 Common Name-Working Containers* 20 Time a Public Health Control 3-501.19 Time as a Public ment Control*7-201.11 Separation-Storage* 590.004(H) Variance Requirement 7-202.11 .Restriction-Presence and Use* I ent 7-202.12 Conditions of Use+ 7-203.11 Toxic Containers-Prohibitions* 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP} 7-204.12 Chemicals for Washing Produce,Criteria* 121 3-801AI(A) Unpasteurized Pre-packaged Juices and ` 7-203.14 Drying Agents.Criteria* { Beveras with Warning Labels* 7-?05.11 incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* I 7-206.11 Restricted Use Pesticides,Criteria* 1 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* I Raw Seed Sprouts Not Served. ( 13-SOl.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring'* CONSUMER ADVISORY TIMER EMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisary Posted fur Consumption of 16 Proper Cooking Temperatures for { Animal Foods That are Raw.Undercooked or PHFs I Not Otherwise Processed to Eliminate Pathogens.*"'""" 3-401.11A(i)(2) Eggs- 155°F 15 Sec. Eggs-Immediate Service 145°F15sec* 3-302.13 1 Pasteurized Egge Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E 4 Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) I Pod and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec * catering, mobile food,temporary and 3-401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F t5 sec.* above if related to foodborne illness ? 3-401.11(12)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. tither l 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.* I 17 Reheating for Not Holding I VIOLA770AIS R SLATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 165"F IS sec.* I (Items 23-30) 3.403.11(B) Microwave- 165`F 2 Minute Standing I Critical mrd non-critical violations,which do not relate to the 1 Time* foodborne illness interventions and risk factors listed above, can be I 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 1 3403.11(E) Remaining Unsliced Portions of Beef ( 1 Item Good Retail Practices I FC 1590.000 I Roasts* 123. 1 Manapement and Personnel FC-2 .003 I 118 I Proper Cooling of PHFS 1 24. 1 Food and Food Protection I FC-3 I .004 1 25. Equmment and Utensils FC-4 .005 ' 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 26. Water.Plumbing and Waste j FC-5 .006 I 70°F Within 2 Hours and From 70°F 1 27. Physical Fact& FC-6 .007 to 41`F/45°F Within 4 Hours.* 1 28. Poisonousor Toxic Materials ! FC-7 .008 1 3-501.14($) Cooling PRFs Made From Ambient i 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other 1 Within 4 Hous* s_aan,mm.ca.x r.: 'Ucnotes critical hem in the federal 1999 Food Cale or 105 CMR 390.000. i r CITY OF SALEM BOARD OF HEALTH Establishment Name:__j 6 Date: Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red RemVerified PLIAtSE RINT CLE lY t ILS_ ,?� I• s ` ' 1p A/l �/ - . l� 1 I I Z : ). ' i 1,10 Discussion With Person in Charge: _ ( Corrective Action Required: ❑ No I res I have read this report, have had the opportunity to ask questions and agree to correct all I ❑ 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 twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I i 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodbarn'e Illness Interventions and Risk According to law Cooled to Factors(ftems 1-22) (Cont.) ' 41'F/45°F Within 4 Hours. ' PROTECTION FROM CHEMICALS 3-501.15 CoolinI Methods for PHFs 14 ( Food or Color Additives ( j 29 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PRFs Maintained at or below j 590.004(F) 410145'F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above j 15 Poisonous or Toxic Substances I 1400F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1300F, Container* * j j 7-102.11 Common Name-Working Conminen* j 20 Time as a Public Health Control 6 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Storage" j 7-202.11 .Restriction-Presence and Use* 590.004{H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-203.11 'Toxic Containers-Prohibitions* POPULATIONS(HSP} 7-204.)1 Sanitizers.Criteria-Chemicals* j I I j 7-204.12 Chemicals for Washing Produce,Criteria* 1 121 1 3-801.1 I(A) Unpasteurized Pre-packaged luices and 7-203.14 Drying Agents.Criteria* ( 1 Bevemges with Warning Labels* Use of Pasteurized Eggs* 7-205.11 incidental Food Contact Lubricants* l 3-80t.11(B) j 7-206.11 Restricted Use Pesticides,Criteria* j 13-801.11{D) Raw or Partially Conked Animal Food and Raw Seed 7-206.12 Rodent Bait Stations* Food P Not Serve d 7-206.13 Tracking Powders,Pest Control and ( j 3-$Ol.li(C} Unopened txrd Package Not Re-served. Monitoring- CONSUMER ADVISORY i 1 TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of t 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or S PHFs Not Otherwise Processed to Eliminate Pathogens.,OWI.111 �1 3 40i.11A{i}(2) Eggs- 155 F 15 Sec. I Eggs-Immediate Service 145'FISsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Il 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'P 15 see.* SPECIAL REQUIREMENT'S 3401.11(B)(1)(2) Pork and Beef Roast-130OF 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec.* catering, mobile ford,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat. 1 debited under the appropriate sections Poultry or Ratites-165'17 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 Fords Cooked in a I practices should be debited under#29- Microwave 165°F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec.* j 17 Reheating for Hot Holding VIOLATIONS R 5L.ATED TO GOOD RETAIL PR4C77CES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3403.11(B) Microwave- 165`P 2 Minute Standing I Critfcal,and non-critical violations, which do not relate to the Titre* f foodborne illness interventions and ris&,factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Cade and 105 CMR 140*F* ( 590.000. 3-403.11(E) Remaining Unslic:ed Porticos of Beef Item j Goad Retail Practices FC 590.1100 i Roasts* 23. 1 Management and Personnel FC-2 .003 I 1g Proper Cooling of PHFs { 24. 1 Food and Food Protection FC-3 .004 ! 25. I Equipment and Utensils FC-4 .005 I i 3-501.14(A) Cowling Cooked PHFs from 140`F to 126 Water.Plumbinq and Waste j FC-S ON I 70°F Within 2 Hour and From 70T 127. Physical Facility i FC-6 .007 ! to 41`F/45'F Within 4 Hours. * f 28. j Poisonous or Toxic Materials FC-7 .008 ! 3-501.14(B) Cooling PHFs Made From Ambient 1 29. j Special Requirements .009 'I Temperature Ingredients to 41 OF/45°F ! I Other ! I Within 4 Hour* "Denotes critical ir.o in the federal 1999 Fuad Cale ur 105 CMR 590.000. l c CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Z Page: of nem Code C—Critical @em 1 DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY -Al j�6h �GY7 n k ��, wv—� �Get_ca��e�nVy �i �• U I I I r >e�VC; a I ' I in 1 f \"A� r J� (AN 'n� f U D I Ii l� i ,��(� ► - err �� ,- �i6ir?. • — Discussion With Person in Charge: Corrective Action Required: I ❑ No I IYYea 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 ❑ Other: f 3-501.14(0 PHFs Received at Temperatures Violations Related to Foodborne Illness.Interventions and Risk l According to law Cooled to Factors(Items 1-22) (Cont.) 41`F/45`F Within 4 Hous. PROTECTION FRO d CHEMICALS 3-50t.15 Cooling Methods for PHFs 14 Food or Color Additives I 19 I PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 4101450 F* 3-302.14 Protection from Unaporoved.Additives* I 3-50i.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I 7-101.11 Identifying Information-Original III 130 F.� 3-50I.16(A) Roasts Heid at or above 1300F. Containers* r 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control ` -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 7-02.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(NSP) 7-204.11 Samtizers.Criteria-Chemicals* 121 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* I Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact Lubricants* 3-801.L I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Cnteria* Raw Seed Sprouts Not Served 7-206.12 Rodent Bait Stations* 3-801AI(C) Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPER,�TURE CONTROLS 22 3-603.11 Consumer advisory Pasted for Consumption of g6 - Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or wi PHFs Not Otherse,Prot•essed to Eliminate 3-401.11A(i)(2) Eggs- 155`F 15 Sec. Pathogens,' n Eggs-Immediate Service 1450FISsec+ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155*F 15 sec. � SPECIAL REQUIREMENTS 3401.11(B)(1)(21 Pork and Beef Roast- 130OF121 min* 3-401.11(A)(2) Ratites,Injected Meats- 155*F LS ! 590.004(A)-(D) Violations of Section 590.009(A)-(D)in sea.* I catering, mobile food,temporary and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, + residential kitchen operations should be Stuffing Containing Fish,Meat, I debited under the appropriate sections Poultry or Ratites-I65'F 15 sec, * above if related to foodborne illness 3-401.11(0(3) Whole-muscle,Intact Beef Steaks I interventions and risk factors. Other 145*F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165*F* Special Requirements. 3-461.11(A)(1)(b) All Other PHFs- 1450F 15 sec. M j 17 I Reheating for Hot Holding VIOLATIONS R ELATED TD GOOD RETAIL PRAC77CES r, 3-A03.11(A)&(D) PHFs 165°F 15 sec. * I (Items 23-30) { ( 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403A I(C) Commercially Processed RTE 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 'I, Item I Good Retail Practices I FC 590.000 I 23. 1 Managament and Personnel i FC-2 .003 f Roasts' 18 Proper Cooling of PHFs 24, 1 Foal and Food Protection I FC-3 .004 � 125. Equipment and Utensils ( FG-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140*F to i 216. Water.Plumbing and Waste ; FC-5 .006 I 70*F Within 2 Hours and Frau 70*F 27. Phvsicai Facility FC-6 .007 to 41`F/45*F Within 4 Hours. * 1 28. Poisonous or Toxic Materials I FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient ! 129. ( Special Requirements ! .009 I Temperature Ingredients to 41*F/45*F ii{ 130. Other Within 4 Hous* "Dem scs critical iwai in the federal 1999 FooJ Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH C� Establishment Name: �r'�� Oh I Y �11iY V' Date: Page: l of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY h !Y� I - _ - . V-,z 1 b� Ob)- �_ f _ (�� 3 11nY.OX/� (/iY� GlC _ PM a )till i Alo -A4k� Vfl f,�- fix. le �A�x_ ;. I I 2 I s Discussion With Person in Charge: corrective Action Required: I Li I area I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: t r , 3-501.14(C) PRFs Received at Temperatures' Violations Related to Foodbarne Illness Intervent/ons and Risk According to Law Cooled to • Factors(items 1-22) (Cant.) 41°F/45°F Within 4 Hours. CHEMICALS 3-501.15 Coobng Methods for PHFs PROTECTION FROM CHEM 14 f Food w ICALColor Additives 1 19 PHF Hot and Cold Holding II 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(M 4101450 F* 3-302.14 Protection from Una proved Additives'y E 3-501,l6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances t - 140,E * 7-107,11 identifying Information-Original ( 1 3-501.16(A) Roasts Held at or above 130'F. " Containers* 120 Time as a Public Health Control ! 7-102.11 Common Name-Working Containers* 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Storage* 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* I 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 E 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 Ro-served. " 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERNTURE CONTROLS 22 3-603.11 Consumer Advisory Posted fru Consumption of 16 Proper Cooking Temperatures for E Animal Foods That are Raw,Undercooked or PHFa f Not Otherwise Processed to Eliminate Pathogens.*`�01ava rn2Pcr 3-401.11A(1)(2) Eggs- i55°F 15 Sec. Eggs-Immediate Service 145°FLSsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs Animals-155°F 15 see.* SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* ! 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590.009(0)-(D) Violations of Section 590.009(A)-(D)in r sec.* catering, mobile ford,temporary and ' 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be i Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec * above if related to foodborne illness 1 13-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other I 145°F* 590.009 violations relating to good retail 3.401.12 Raw Animal Forx).s*Cooked in a I practices should be debited under#29- Microwave 165F Special Requirements. 3:101.11(A)(1)(b) All Other PHFs- 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3403.11(B) Microwave- 165°F 2 Minute Standing I Critical and non-critical violations, which do not relate to the Titer* foodbonte illness interventions and risk factors listed above, can be ! 3-403.11(0) Commercially Processed RTE Food- found in the following,sections of the Food Cade and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef % Item 1 Good Retail Practices I FC 540.000 1 Roasts* � 123. i Management and Personnel � FC-2 .003 i l ( 24. i Food and Food ProtectionI FC-3 .004 1 18 Proper Cooling of PHFs 1 25. Equipment and Utensils FC-4 I .005 t 3-501.14(A) Cooling Cooked PHFs from 140°F to I i 26, Water.Plumbing and Waste ! FC-5 W6 1 70°F Within 2 Hours and Front 70°F11 27. Physical Facility FC-6 .007 1 to 41°F/45°F Within 4 Hours. * 28. Poisonous or Toiac Materials i FC-7 .om i 3-501.14(B) Cooling PHFs Made From Ambient ' 29. I Special Requirements .009 ! Temperature Ingredients to 41°F/45°F 130. i Other i ( Within 4 Hours* sani,m s:c: 1, Denotes criticat nem in the federal 1999 Food Cade ur 105 C.MR 590.000. { w "l . CITY OF SALEM BOARD OF HEALTH Establishment Name: kl�k . Date: Page: of Item Code C—Critical Item ` DESCRIPTION OF VIOLATION/PLA'N OF CORRECTION - Date No. Reference R-Red Item verified PLEASE PRIPJTCLEARLY Vt171 � ��eDlr� Otln InrYhl� n}rl�� i t,5 ✓ I nJPP�r,. �S�t�( 1 � � r x � raP iv-PJ . i��e CaliY� L� t. )tW1W�- i�� Discussion With Person in Charge: Corrective Action Required: I ❑ No t_,ter' 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 C3 Embargo El Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 1 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.) 417145°F Within 4 Horns. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 � Food or Color Additives 1 19 PHF Hot and Cold Holding ! 3-501.16(B) Cold PRFs Maintained at or below 3-202.12 Additives o 590.004(F) 41°/45"F* 3-302.14 Protection from Unaporoved Additives* i 3-50IA6(A) Hot PHFs Maintained at or above ) 15 I Poisonous or Toxic Substances 140°F. * 7-101.11 identifying Information-Original ( 3-501.16(A) Roasts Held at or above 1300F. Containers* � PuControl 7-102.11 Common Name-Working Containers* 20 Time as a Health 7-201.11 Separation-Storage* 3-50019 Time as a Public lic 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* I POPULATIONS(NSP) 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals far Washing Produce,Criteria* 1 21 3-801:11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning labels* 7-204.14 Drying Agents.Criteria* ( 7-205.11 incidental Food Contact•Lubricants* 3-8801.11(B)3- Use of Pasteurized 7-206.11 Restricted Use Pesticides;Cnteria* i 101.11(D) Raw or Partiallyy Eggs* Cooked Animal Food and C e ! 7-206.12 Rodent Bait Statism&* Raw Seed Sprouts Not Served, r ( 7-206.13 Tracking Powders, Pest Control and I 1 3-$01.11(0) Unopened rood Package Not Re-served. " Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 16 ( Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate EYte°eve aH2ar!i 3-40i.11A(1)(2) Eggs- 155`F 15 Sec. Pathogens.' Eggs-immediate Service 145°FL5see* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs� Animals-155°F 15 see. " SPECIAL REQUIREMENTS 3.401.11(B)(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.* catering, mobile ford,temporary and t 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHF's, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections j Poultry or Ratites-165°F t5 sec, * above if related to foodborne illness l 3.401.11(0)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F* I 590.009 violations relating to good retail f3401.12 Raw Animal FoolsrCooked in a practices should be debited under#29- Microwave 165°F Special Requirements. 3401.11(A)(i)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Not Holding WOLA77ONS R -ELATED TO GOOD RETAIL PRACTICES 3403A I(A)&(D) PRFs 165°F 15 sec.* i (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Mature Standing I Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-503.11(C) Conmrercialiy Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef I Item I Good Retail Practices I FC550.0w i Roasts` I j 23. 1 Management and Personnel ( FC-2 .003 i 18 Proper Cooling of PHFs 1 24. 1 Food and Food Protection I FC-3 .004 I 1 25. 1 Equipment and Utensils FC-4 ,005 3-50L14(A) Cooling Cooked PRFs from 140°F to 125, Water.Plumbing and Waste i FC-5 .908 70°F Within 2 Hours and From 70°F 27. i Physical Facility FG-6 007 i to 41°F/45°F Within 4 Hours.* 128. 1 Poisonous or Toxic Materials ' FC-7 .008 i 3-501.14(B) Cooling PHFs Made From Ambient 29. I Special Requirements Temperature Ingredients to 41°F/45oF 30. Other ! 1 1 t Within 4 Hours* "Denotes critical ism in the federal 1999 Fuad Calc w'105 CMR 590.000. CITY OF SALEM A � BOARD OF HEALTHEstablishment Name: �N�IC� Qi IC > Tlt Date: Page: of Item code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red item verified _ 1 A^') UI_�P �/11EASE PRINT CLEARLY � 6(_- VD- LI .AJ t RAC _ 101iV1ISA �r_A) Ur ffAk, .7( 6 C ' t(� Vyl - Yd'_ 04� �J I V j , r,� _ �. rAM �1 191 ' CL v mt , Discussion With Person in Charge: I Corrective Action Required: I ❑ No I pe'-fes 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 ail conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. Il �` - ❑ Voluntary Disposal ❑ Other: ! 3-501A4(C) PHFs Received at Temperatures r Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to r Factors(Reins 1-22) (Cont.) 41T-1457 Within 4 Haus. ° p PROTECTION FROM CHEMICALS I 3-501.15 Cocline Methods for PHFs { 14 Food or Color Additives 19 PHF Hot and Cold Holding f 3-50L16(B) Cold PRFs Maintained at or below 3-202.12 Additives* { ( 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives" { batenees 501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Su 740°F. 7-101,11 Identifying Information-Original ( • 3-501.16(A) Roasts Held at or above, 1300F. Containers* * { { 20 Time as a Public Health Central 7-102.11 Common Name-Working Containers* { { ' 590.004(H) Variance 3-501.19 Time as Requirement a equirirement Health Central* 7-201.11 Separation-Storage* { 7-202.11 .Restriction-Presence and Use* ( { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE { 7-203.11 Toxic Car -Prohibitions* POPULATIONS(HSP) { 7-204.11 Saniriurs.Criteria ia-Chemicals° ( { 7-204.12 Chemicals for Washing Produce,Criteria* { 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ` { 7-204.14 Drving Agents.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* 13-801.11(D) Raw or Partially Cooked Animal Food and { 7-206.12 (talent Bait Stations" Raw Seed Sprouts Not Served. * 3-801.11(12) Unopened Ford Package N 7-206.13 Tracking Powders, Pest Control and ( a Reserved. Monitoring* CONSUMER ADVISORY T1ME1i EMP.ER4TURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11 A(1)(2) Eggs- 155`F 15 Sec. Pathogens.*FH 1e on.roer Eggs-immediate Service 145'F15se& 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec. * SPECIAL REQUIREMENTS 3401.11(B)(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.* ( catering,mobile ford,temporary'and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat. I debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(12)(3) Whole-muscle,Intact Beet'Steaks interventions and risk£actors. Other 1 145'F* 590.009 violations relating to good retail 3.401.12 Raw Animal Faxh Cooked in a I practices should be debited under#29- Microwave 165°F* Special Requirements. y 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. { 17 Reheating for Hot Holding { VIOLATIONS R PLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165F 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing I Critical mrd non-critical violations,which do not relate to the Time* ` foodborne illness interventions and risk facrors listed above,can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3-t03.11(E) Remaining Unsliced Portions of Beef 1, Item Good Retail PraeNces , FC 580.000 I Roasts* 1 23. 1 Management and Personnel 1 FC-2 .003 { FC-3 004 I 1g Proper Cooling of PHFs 124. Food and Food Ptatection 25. 1 Equipment and Utensils I FC-4 .005 1 ( 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. I Vy�,Ptumb ria and Waste I FC-5 .006 1 70°F Within 2 Hours and From 70°F 27. Physical Fac Pity i FC-6 .007 1 ! to 41`F/45'F Within 4 Hours.* i 26. 1 Pasoncus or Toxic Materials 1 FC-7 .008 3-501.14(6) Cooling PHFs Tilade From Ambient 29. � Special Requirements 009 1 Temperature Ingredients to 41'F/45'F i 30, Other 1 Within 4 Hours* ll.ncxe,critical iv,m in the federal 1999 Fund Code a'103 CMR 590.000. CITY OF SALEM BOARD OF HEALTH I Establishment Name: Date: { I Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified jPLEASE PRINT CL- LV I ' ^ fbe Vx lA t 1C1 +U PirrS�f✓I° , n mit - I I I I I _ _ 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No Ti �:es 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 ❑ Other: I 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to b Factors(gems 1-22) (Cont.) 41'F/45F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50L15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50136(B) Cold PHFs Maintained at or below 3-202.12 Additives* } 590004(F) 4101450 F* 3-302A4 Protection from Unapproved Additives 15 I Poisonous or Toxic Substances 3-501,l6(A) Hot PHFs Maintained of or above * * t 7-101.11 IdentifyingInformation-Original I40F. � 3-501,16(A) Roasts Held at or above 130°F. Containers* ° ` 7-102,11 Common Name-Working Containers* ' ( 20 Time as a Public Health Control 3-501.19 Time&s a Public Health Control* 7-201.11 Separation-Storage* 590.004(H) Variance Requirement 7-202.11 .Restriction-Presence and Use* 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* V POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* ( 7-204.12 Chemicals for Washing Produce,Criteria' 21 ?-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria* ( 7-205.11 incidental Food Contact,Lubricants* 3-801.118) Use of Pasteurized e 7-206.11 Restricted Use Pesticides,Criteria* ( 3-801.11(D) Raw or Partially Cookedked Animal Food and 7-206.12 Rodent Bait Stations' Raw Seed Sprouts Not Served, ' I 13-801.11(0) Unopened Food Package Not Rn-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEMEMPERNTURE CONTROLS 22 3-603.11 Consumer Advisary Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise,Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. I Pathogens.*s`"1/1 't Eggs-immediate.Service 145°F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3.4M.11(A)(2) Comminuted Fish.Meats&Game 1 Eggs* Animals-155°F 15 sec.* 1 3401.11(11)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratios, Injected Meats-155°F 15 590.009(0)-(D) Violations of Section.tem temporary- and in sec.* i catering, mobile ftxxl,tempuran•and t 13-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-I65°F 15 sec, * above if related to foodborne illness 3-401.11(0)(3) Whole-muscle,Intact Beef Steals interventions and risk factors. Other } I 145°F* 590.009 violations relating to good retail t I3-401.12 Raw Animal Foals Cooked in a � practices should be debited tinder#29- Microwave 165°F* Special Requirements. 17 I 3-401.11(A)(1)(b) All Other PHFs- 1, 15 sec. Reheating for Not Holding VIOLA77ONS R MATED TO GOOD RETAIL PRACTICES t + 3-403d 1(A)&(D) PHFs 165-F IS sec. * ( (Items 23-30) t 3-403.11(B) Microwave- 165`F 2 Mmute Standing Critical and non-critical violations,which do not relate to the � Tito* foodborne illness interventions and risk factors listed above, can be { i 3403.11(0) Commercially Processed RTE Food- found in the folloning sections of the Food Grde and 105 CMR i 140°F* 590.000. 3-403.1I(E) Remaining Unsliced Portions of Beef 1 Item I Good Retail Practices i FC 590000 i Roasts" 1 23. 1 Management and Personnel ! FC-2 .003 1 I 18 Proper Cooling of PHFs 1 24, 1 Food and Food Protection ! FC-3 .004 1 128. Equipment and Utensils I FG-4 .005 3-54114(0) Cooling Cooked PHFs from 140`F to } 26, Water.Plumbinq and Waste FC-5 008 } 70°F Within 2 Hours and From 70°F I 1 27. Physical FaciBN FC-8 .007 I to 41'F(45°F Within 4 Hours.* i 28. 1 Poisonous or Toxic Materials FG-7 .008 3-50114(B) Cooling'PHR Made From Ambient 1 29. ( Special Requirements ,009 1 Temperature Ingredients to 41°Fl45°F 30• l Other ! i Within 4 Hours* s.cnmm. Dcmw critical ivm in the federal 1999 Foal Cale a,105 CMR 590.000. i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 NameQ D to Tvoe of OoeratlonUs Type of Insoection t - -fo, O' C l _(��A K7 R'1 Til0 Food Service LgRoutine Address1�a ( Uci1 OM , (`r-Io a�, Risk Retail El Re-inspection �7�� Level ❑ Residential Kitchen Previous Inspection I Telephone � R- A (n(� ❑ Mobile Date: Owner (� ^y'�� ' HACCP YM ❑ Temporary ❑ Pre-operation V. 1�.�;^"'VV` S /- D I ❑ Caterer ❑Suspect Illness Person in Charge(PIC)v 5% 4W .4j,4-, ❑ Bed&Breakfast El General Complaint v �n 0/1 VV/ ❑ HACCP Inspector �AR R �( . Permit No. [I Other Each violation checked requires an expfd�ation on the narrative pag§(s)and a citation of specific provision(s)violated. V Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco ,p Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 119 590.009(F) Luh action as determined by the Board of Health. 0I k vo FOOD PROTECTION MANAGEMENT'S" _ � El 12. Prevention of Contamination from Hand - ` El1. PIC Assigned/Knowledgeable/Duties �}� [,EMPLOYEE HEALTH ';- - - " ' " 0 13. Handwash Facilities y❑ 2. Reporting of Diseases by Food Employee and PIC L ROTECTION FROM CHEMICALS ❑ 14.Approved Food or Color Additives -`❑ 3. Personnel with Infections Restricted/Excluded El15.Toxic Chemicals L.FOOD FROM APPROVED SOURCE_ Q 4. Food and Water from Approved Source TIME/TEMPERAE CONTROLSPotentlallTURy Hazardous Foods L-�_ _ (« ).j ❑ 5. Fteceiving/Condition ❑ 16. Cooking Temperatures []-6: Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18•Cooling t PROTECTION FROM CONTAMINATION �� ❑ 19. Hot and Cold Holding 1❑ 8. Separation/Segregation/Protection El 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing I REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices �� ,ICONSUMER ADVISORY___ I Oi 1122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(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 r 1 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing VVV��, 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 S 5901nspeclF.m 14 x �_) - j I C� (,J) Inspector'sSignatui•e:� � �� Print: vJ�l 1 cxk✓ PIC's Si ature:./ Print: p / \ PaBe Bes / ��_! 1 1, ( . /✓r.'�� n,V� �� C/� ( 1 I oPa Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 8 FOOD PROTECTION MANAGEMENT I Cross-contamination 3-302.11(A)(]) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(6) Demonstration of Knowledge* f Contamination from Raw Ingredients J 12-103.11 Person in charge-duties J 3-302.11(A)(2) Raw Aminal Fouls Separated from Each I Other* EMPLOYEE HEALTH I l I Contamination from the Environment I 2 590.003(0) Responsibility of the person in charge to 3-302.1 I(A) Food Protection* J require reporting by food emptoyees and � 3-302 15 Washing Fruits and Vegetables applicants* J 590.003(F) Responsibility Of A Foul Employee Or An 13-304'71 Food Contact with Equipment and Utensils Applicant To Report To The Person in Contamination from the Consumer Charge* 3-306.14(A)(B) I Returned Food and Reservice of Food* 590.003(6) Reporting by Person in Charge* I Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590,003(F) Removal of Exclusions and Restrictions 3-70111 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE ( I Food* 4 Food and Water From Regulated Sources 9 I ( Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I ( 4-1111,111 Manual Warewashmg-Hot Water 3-201.12 Food ma Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 I Eggs and Milk Products. Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, I 13-202.16 I Ice Made From Potable Drinking Water* ( I concentration and hardness. 15-101.11 I Drinking Water from an Approved System" I 14-601'11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A:) Bottled Drinking Water* 14-602.11 Cleaning Frequency of Equipment Food-590 006(B) Water Meets Standards in 310 CMR 22.04 I S 9 Y el Shelf/ish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.74 Fish and Recreationally Caught Molluscan I Shellfish Food Contact Surfaces of Equipment* I ( 4-703.11 Methods of Sanitization-Hot Water and I 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources" Game and Wild Mushrooms Approved by 10 I Proper,Adequate Handwashing Regulatory Authority I ( 2-301,11 I Clean Condition-Hands and Arms* J 3-202.18 I Shellstock Identification Present* 2-301.12 Cleaning Procedure* J 590.004(C) Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 Game Animals* I if I Good Hygienic Practices J 5 Receiving/Condition 1 2-401.11 Eating,Drinking or Using Tobacco* J 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Lttepsity* I Mouth* 3.101.11 Food Safe and Unadulterated* 3-30(.12 Preventing Contamination When Tasting" 6 Togs/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 1590.004(F.) Preventing Contamination from 13-203.12 I Shellstock Identification Maintained* Employees* TagsfRecords:Fish Products I 113 , Handwash Facilities J 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 1 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) I Labeling of Ingredients' 5-204.11 I Location and Placement* 9 ( Conformance with Approved Procedures 15-205.11 I 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 ( Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 I Hand Drying Provision *Denotes critical item in the federal 1999 Fond Code or 105 C p1R 59000. :r BOARD OF HEALTH Establi hment Name: Uk inn b_ Date:. — g 7 Page: C;k of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Ia. Date No. Reference R tem I -Red _ PLEASE PRINT CLEARLY Verified y Red ll✓r! `!1/u ��,�4P/ Leh O n IJ GyY UAI4/�RL1Ap/rnf� J nr. rrQo /� ` linnonnA - I Lho 140/ I�i✓` ��n '` •� V_ 1 (p �n—,�/�,IrrI�Vi 1bL/�f' I n� I0 )�tcQ1nr, �� C�� Q�/� — �Do1061 .� l�` , — nal lUl4�t� �.►1JL\ j \(�' / LI'�d1�t-f'rI '✓ Ohs�+��(�Y_Lia(A\_. SI;t ^ . 01-X_ . .� ./(p�/1-ON ,v�to,,/644--J Y_q \ UAIl -4-1! # P �kick �J, +0A a�� I AA �� I 1O p,I,,A �Qo A,. - — I ( ,V0 P0A__ IP'PO —610AOO"_ � 1`'1 '1 .On .t� tPAAPO , /_KQ t'� tin_ — ' }. �3A0 O-Alf�— rfi> . lnAe I V(/.AAA — U Df I (IQ� ti F t' Discussion With Person in Charge: _ / , Corrective Action Required: ❑No'' LI Yes � ❑ Voluntary Compliance ❑ Employee Restriction/ to VOIA' tn 1A,4 ?�� Y_(�(�(_7 ")l 1 eG �' I Exclusion , 11 j ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure $ ` ❑ Voluntary Disposal ❑ Othei d••f FORM 734B (REV. 7/20001 HOBBS a WARREN, - BOSTON 4 Th-isForm Approved by[he Department of Public Health 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(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/45'F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140'E* Containers* 3-501.16(A) Roasts Held at or above 130'F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201 11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202 12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Samhzers.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 TIME/TEMPER'.TURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EHecly viaoot 3-401.11A(1)(2) Eggs- 155'17 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(6)(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.*1 residential kitchen operations should be 3-401.1 HA)(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* 3-401.1 I(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, a Inch do not relate to the 3-403.11(8) Microwave- 165'F 2 Minute Standing foodborne dlness interventions and risk finctors listed above, can be Time* found in the fulloni ng 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 70'17 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 nem in the federal 1999 Food Code or 105 CMR 590 000. CITY OF SALEM r� (� BOARD OF HEALTH Establishment Name: + t 'v, k. Ail cl�" Date: g-1 2 Page: 3 of Item Code C-Critical Item U DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PI FCRF PRINT CLEARLY u rnilcP In N' oo -c tim) w. J'r)oA <5ipcu r ,f:> c�6 trnyv-N � I � I I Pj "'v rrh v - h o�c)1� s-n I 0 n I Cr Y P PIvl --50 M I'm U 16 P (J I � 1 � , j 1 Discussion With Person in Charge: Corrective Action Required: O--Nb O fes 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-,i`spection Scheduled, ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that _ noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � � ' ❑ Voluntary Disposal ❑ Other: s - ' 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne 01ness lnter✓entions and Risk According to law Cooled ro Factors(!toms 1-22) (Cant.) 41'P/45`F Within 4 Horns. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives ( 119 PHF Hat and Cold Holding -501.16(B) Cold PITFs Maintained at or below 3-202.12 Additives*' 590.004(F) 41'145°F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFsMaintained atorabove � 15 Poisonous or Toxic Substances ( * 7-10111 Identifying Information-Original 140`F. 3-5U1.t6tA) Containers* Roasts Held atorabove130'F. 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers" 3-501.19 Time as a Public Health Cimino 7-201.11 Separation-Storage* !* 7-202.11 Restriction-Presence and Use* ( 590.004{H) Variance Requirement 7-202.12 Conditions of rise* I 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)aloes and 7-204.12 Chemicals for Washing Produce,Criteria* $everages with Warning Labels* 7-204.14 Drying Agents.Criteria* I - 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(11) Use of Pasteurized Eggs* 3-80IA I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Spratus Not Served * 7-206.12 Rodent Bait Stations* ( 3-80L II(C) Unopened Fwd Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEti EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate Pathogens."`°`rnnort 3.401.IIA(t)(2) Eggs- 155°F 15 Sec. Eggs-Immediate Service 145`Fl5sec* 3-302.13 Eggs'Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Z * Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3.401.11(11)(1)(2) Pork and Beef Roast-130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155*F 15 sec.* catering, mobile food,temporary and 3-001.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-1650F 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F"` 590.009 violations relating to good retail 3-401.12 Raw Animal Fads Cooked in a practices should be debited under#29- Microwave 165F* I Special Requirements. 3-401A l(A)(1)(b) All Other PHFs- 145°F 15 sec. 17 Reheating for Hot Holding 1 VIOLATIONS R LATER TO GOOD RETAIL PRACTICES 3-40341(A)&(D) PRFs 165'F 15 sec.* ([tetras 23-30) 3403.11(0) Microwave- 165°F 2 Minute Standing I Critical mrd non-critical violations, which do nor relate to the Time* foodborne illness interventions and risk factors listed above,can be 3403,11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140*F* 590.000. 3403.1l(E) Remaining Unsliced Portions of Beef Item Good Retail Practices I FC 590.000 i Roasts* ( ; 23. I Manaaement and Personnel I FC-2 .003 I 28 Proper Cooling of PHFa 1 24. i Food and Food Protection FC-3 .004 1 1 ( I 3-501.14(A) Cowling Cooked PHFs from 140`F to 25. Equioment and Utensils FG-4 .00526 Water.P)umbino and Waste FC-5 .006 I 70°F Within 2 Hours and From 70'F 27. I Physical Faculty FC--6 .007 I to 4I'F/45`F Within 4 Hours. * 128. ' Poisonous or Toxic Matenals I FC-7 .008 i 3-501.14(8) Coaling PHFs Made From Ambient 129. Spacial Requirements 009 Temperature Ingredients to 4VF/45°F i 30. 1 Other Within 4 Hours* Denorra critical tent in the federal 1999 Foci Cade or 105 C.MR 590.000. t Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'6 Floor Divisioh of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name((�� n Date Tv a of Operation(s) Tyge of Insoection N' �n [rhe. [T'C (�\NhP-c I0 4 n Food Service Routine Address , 1� ) onn �M SxA ox II Risk Retail �e-inspection Level ❑ Residential Kitchen Previous Inspection Telephone 61()R n 4� 4A(.-)q�q ElMobile Date: Owner t r' HACCP YM El Temporary ElPre-operation �Yl l--"- l � _ ❑ Caterer El suspect illness Person In Charge(P!9) Time Bed&Breakfast El General Complaint n�I ' ' �n I In :Q OwY, ❑ HACCP Inspector nb ( I Out: Permit No. ❑Other Each violation checked requiresZeplanation 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) E�K 590.009(F) action as determined by the Board of Health. MtAr tl P[FOOD_PROTECTIONMANAGEMENT __ _ _ 1 ❑ 12. Prevention of Contamination from Ha�nd.a 1. PIC Assigned/Knowledgeable/Duties ❑ ❑ 13. Handwash Facilities [EMPLOYEEHEALTH_ _ ) PROTECTION FROM CHEMICALS " ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El_ 15.Toxic Chemicals [:-FOODFROM APPROVED SOURCE I ❑ 4. Food and Water from Approved Source I 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 ,i ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic PracticesNSUMER ADVISORY Ox22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an I order of the Board of Health. Failure to correct violations l 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 V� 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 S S901nspscl 0m 14 Inspector's Signature: p ( � n, A _ ^Print;` PIC's Signature: Print: )i Q \ I Page ofa Pages =\ 1 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION I Cross-contamination FOOD PROTECTION MANAGEMENT I 3-302.11(A)(]) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Fords* 590.003(B) Demonstration of Knowledge* I Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH I Contamination from the Environment I 2 590.003(C) Responsibility of the Person to charge to 3-302.11(A) Food Protection* require reporting by food employees and ( 3-302.15 I Washing Fruits and Vegetables 1 applicants* 13-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Fant Employee Or An J Utensils* Applicant To Report To The Person In ( Contamination from the Consumer Charge* 590.003(6) Reporting by Person in Charge* 3-306.14(A)(Bl I Returned Font and Rted or e of Food* Disposition of Adulterated or Contaminated 13 590.003(0) I Exclusions and Restrictions* Food 590.003(E) ( Removal of Exclusions and Restrictions I 13-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 I Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I ( 4-501,111 I Manual Warewashmg-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Saniti72tion Temperatures* 3-201.13 Fluid Milk and Milk Products* 14-501.1 1 2 I Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products. Pasteurized* ( 4-501.114 I Chemical Sanitization-temp.,PH, concentration and hardness. 3-202.16 Ice Made From Potable Drinking Water 4-601 5-101.11 Drinking Water from an Approved System* ( .1 t(Ai Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* J 4-602.1 L 590.006(B) Water Meets Standards to 310 CMR 22.0* I ( Contact Surfaces and Cleaning Frequency of Equipment Food- 590.006(B) and Fish From an Approved Source I of]s* 4-702.11 Frequency of Sanitization tion of Utensils and 3-201.11 Fish and Recreationally C'auglrt Molluscan Fad Contact Surfaces of Equipment* __ Shellfish" 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 30 I I Proper,Adequate Handwashing Regulatory Authority I 12301.11 I Clean Condition-Hands and Arms* 3-202.18 I Shellstock Identification Present* I 2-301.12 Cleaning Procedure* I 590.004(C) Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 Game Animals* 111 I Good Hygienic Practices 5 Receiving/Condition 12401.11 Eating,Drinking or Using Tobacco* I 3-202.11 PHFs Received at Proper Temperatures" 401.12 Discharges From the Eyes, Nose and v 3.202.15 Package httegrity" Mouth* 3-101.11 Food Safe and Unadulterated* ( 13-30 t.12 I Preventing Contamination When Tasting" 6 ( Tags/Records:Sheflstock ( 12 I Prevention of Contamination from Hands 3-202.18 Shellsttxk Identification * ( 590.(H)I(F) Preventing Contamination from 3-203.12 Shelistock Identification Maintained" I Employees* TagsfRecords:Fish Products 13 I Handwash Facilities 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 13-402.12 1 Records,Creation and Retention* 5-1_03.11 Numbers and Capacities* 590.0040) 1 Labeling of Ingredients' 15-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance I lHACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 13-502.12 Reduced oxv2en packaging,criteria" I 16-301.11 Handwashing Cleanser,.Availability 8-103.12 Conformance with Approved Procedures* 16-301.12 Hand Drying Provision *Denotes critical nem in the federal 1999 12ood Cale or 105 Cil1R 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name:_ �n �_ o. _ Date: \0 — a 1--'_T Page: of Item Cade C-Critical Item U DESCRIPTION OF VIOLATION/PLAN OF CORRECTION v Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY �OMn yenl 0A_T' NI _ r� Yn �(T�}oi C 11 OIJP'✓ lrA �i CA 00�i 111 .r _ �_�U� Lk�ne _, rr._n)A 0n1 a %1111 �_I_n ' ., ,n A,) '1 �/I /A JAI ire _ �'`��-p/1/1nn/a�nnn r_r �n4//,_I '.'1- N� X1-�h� 1 -.�h I ® rP ,. 1,, ` 'IV 7' e j� YcY_,.�Pn/V„{.r)�i S� �� .fir�On I I r� VP_� T,-_ 1 _# I / )�tw A 1 ( /� _ �Vl R�r.)C m�/�Ir\ )A\ iUiM�.) \�e q�.ae . - 1�#n.o 10"1, A API n PA,' lr iA krA I / )A,in l )AA ID.. �- , kill �10(AI'l- 11/3XU ' tiIn H\D nn.I- ,-.. � 11 �_ 1/-; /1� . � . . -0 Il - K�1/VrlO+n.,Qaq J-1 /g/ I l p r' ^� J /7i I_> r, -n,l- ��0... }r- n D_i, ,� �N I> i \/ ? -4'OK',,.r, i�T I 1 1 is n_ .., U �AM_'Z'Lt t 0AA..6U I !T/foe-*I'1/'7� (T / - l/ f l na �Y ' 11 l�!' Gl r. , P e T7i r .n oX r, (LO,n n e I I �II �k2, F tn. t limn / Y'ln , N:()Y� (��lD, " ' _0 1_n_ inn, 0�—'��i/1 II )'L_ I/ l f' �r--r 1np, ., r.,.,. -,`, 1�rJJ Y"Ti1 �// trJvl . nnP I ti? S�IY/) min , . t A CC Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes i 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 ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that rioncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �/ ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions arta Risk According to Law Cooled to Factors(Items 1-22) (Cant.) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS I 3-501.15 Cooling,Methods for PHFs 114 Food or Color Additives I i 19 PHF Hot and Cold Holding 3-50IA6(B) I ColdPHFsMaintainedatorbelow• 3-202.12 Additives* 590,004(F) 41'/45°F* 3-302.14 Protection from Unapproved Additives* 115 Poisonous or Toxic Substances ( 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 7-101.11 Identifying Information-Original Containers* 13501.16(A) Roasts.Held at or above 130°F. 17-102.11 Common Name-Working Containers* ( 120 I Time as a Public Health Control 7-201.11 Separation-Storage* 13-501.19 Time as a Public Heitlth Control" 7-202.11 Restriction-Presence and Use* I 1590.004(H) Variance Requirement I 17-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toric Containers Crater-Prohibitions* I POPULATIONS(HSP) 17-204.11 Sanitiurs.Criteria-Chemicals* � 21 3-801AI(A)(.A) Unpasteurised Pre-packaged Iuices and 17-204.t2 Chemicals for Washing Produce,Criteria* I Beverages with Warning labels* 17-204.14 Drying Agents.Criteria* I 3-80L11B) Use of Pasteurized Eggs* 17-205.11 incidental Food Contact,Lubricans* 13-801.11(D) I Raw or Partially Cooked Animal Food and i 7-206.11 Restricted Use Pesticides,Criteria* I Raw Seed Sprouts Not Served. 17-206.12 Rodent Bait Stations* I 13-801.11(C) I Unopened Food Package Not Re-served. ' I 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pouted for Consumption of 16 Proper Cooking Temperatures for ( Animal Fee&,That are Raw,Undercooked or PRFs Not Otherwise Processed to Eliminate 3401.11A(t)(2) Eggs- 155°F IS Sec. Pathogens.*E"°"""t Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec. * 3401.11(B)(1)(2) I Pork and Beef Roast-130'F 121 min* I SPECIAL REQUIREMENTS 3401.11(A)(2) I Ratites,Injected Meats-155°F 15 I 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, I 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 I Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) I All Other PHFs-145°F 15 sec. 117 I Reheating for Hot Holding VIOLA77ONS R-GATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE 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 i Mem ( Good Retail Practices ( FC 1590.000 I Roasts" 23. Management and Personnel FC-2 .003 I 18 Proper Cooling of PHFs 124. Food and Food Protection FC-3 I .004 1 25. Eaulpment and Utensils FC-4 I .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. 1 Water.Plumbinq and Waste FC-5 006 i 70`F Within 2 Hours and From 70°F 1 27. ( Physical Facilitv 1 FC-6 .007 I to 41°F/45'F Within 4 Hours.* 128. Poisonous or Toxic Matsrials 1 FC=7 .008 I 3-501.14(B) Cooling PHFs Made From Ambient 29. 1 Special Reauirements .009 Temperature Ingredients to 41°F/45°F 30. 1 Other I Within 4 Hours* s:'""`"inAmr1r2 tl" *Ihnotes critical item in the federal 1999 Food Code or 105 CMR 590.000. T THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF � P,W Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name ^gin_ -0 I T pe of Ooeration(s) qr,e of Inspection t t 1�1� c �lit E �i (�I0q, Food Service Routine Address Risk Retail Re-inspection i as 1 1 Ln ,, �.� o� Level ❑ Residential Kitchen viou�s Irnspe-tion Telephone O T y 71 .l l4-.)r � ❑ Mobile Date: "'la -t ``ttlll��v ❑ Temporary ❑ Pre*46io� Owner YI L4 HACCP Y/N I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)( (� Time ❑ Bed& Breakfast El General Complaint 11 "- In: I z ,l ElHACCP Inspector !SSP n✓I / OuW, -1 ,- Permit No. ❑ Other Each violation cii6ckecil4equlres 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 correct `�1.0`'ive 590.009(E) [:] 590..009(F) ❑ action as determined by the Board of Health. V c J1G ) C cj I L' FOOD PROTECTION MANAGEMENT ❑12. Prevention of Contamination from Hands{' 1\ly� ❑ 1. PIC Assigned I Knowledgeable 1 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 FOOD FROM APPROVED SOURCE ❑15. Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)' ❑ 5. Receiving/Condition ❑16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control El 9. food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper AdequateHandwashing EJ21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items 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 Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report,when signed below C x 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)(59o.00s) 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: Inspector's Signature: � �� Print: PIC's Signature: ( � Print: jar Page4of Pages FORM 734A AM SULKIN CO CHARLESTOWN MA Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I I 1 1590.003(A) Assignment of Responsibility* j 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foods* 12-103.11 Person in charge-duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE 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* 13-302.15 Washing Fruits and Vegetables* I 590.003(F) Responsibility Of A Food Emplyee Or An 13-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* I Contamination from the Consumer 590 003(G) Reporting by Person in Charge* I 13-306 14(A)(B) Returned Food and Reservice of Food* I 3 590.003(D) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* I4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I 4-501.111 Manual Warewashmg-Hot Water 13-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 14-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* concentration and hardness* 13-202.16 Ice Made From Potable Drinking Water* I 14-601.11(A) Equipment Food Contact Surfaces and 15-101.11 Dnnkmp Water from an Approved System* I Utensils Clean* 1590.006(A) Bottled Drinking Water* 14-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* I Contact Surfaces and Utensils* Shellfish and Fish from an Approved Source I 4-702.11 Frequency of Sanitation of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I I Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 I Molluscan Shellfish from NSSP Listed I I Chemical* Sources* 10 Proper,Adequate Handwashing Game and Mid Mushrooms Approved by I 2-301.11 Clean Condition-Hands and Arms* I RegulalmyAuthodty 1 0 I Shellstock Identification Present* 2-301.12 Cleaning Procedure* 59 004( 12-401.11 2-301.14 When to Wash* I 1590 004(C) I Wild Mushrooms* I 3-201.17Game Animals* I 11 Good Hygienic Practices 5 I I ReeeivinglCondition Eating,Drinking or Using Tobacco* 13-202.11 I PHFs Received at Proper Temperatures* I 1Mouth* 2-401.12 Discharges from the Eyes,Nose and 3-202 15 I Package Integrity* ( 3-301.12 Preventing Contamination When Tasting* 13-101.11 I Food Safe and Unadulterated* I 16 I I Tags/Records:Shellstock I 112 Prevention of Contamination from Hands I 590 13-202.18 I Shellstock Identification* I .004(E) Employees* I EmpleContamination from es* 3-203 12 I Shellstock Identification Maintained* 113 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible I 3-402.11 I Parasite Destruction* 13-402.12 I Records,Creation and Retention* I 15-203.11 Numbers and Capacities* I 15-204.11 Location and Placement* I 590.004(J) I Labeling of Ingredients* 15-205.11 Accessibility,Operation and Mamtainance 7 Conformance with Approved Procedures IHACCP Plans I Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* I Devices 3-502.12 I Reduced oxygen packaging,criteria* I 16-301.11 Hand Drying Cleanser,Availability 16-301.12 Hand Drying Provision 8-103.12 I Conformance with Approved Procedures* "Denotes critical item in the Federal 1999 Food Code or 105 CMR 590.000. ' :�'lfi t:"'r-.e'[t�lr,�a� �la'i u �•'�,Rs`t�'+;, ,,e�,�•,..,^:,w=t';t'"�..,.-...,- ,.�•t�t•p�f4t P.P-;.,r./.mIR.,,.�,+iytl. a�tw+�. ;mow.._. ,. Massachusetts Department of Public Health Salem Board of Health Floor Division of-Food and Drugs 120 Washington Street,4'h Salem, MA 01970-3523 FOQD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ^^ \ Dat / Type of Operation(s) Tyge of Insoection /1 1 f j p� �lj r� I 4�6(0ood Service Routine Address ) li Risk Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone c., d_ a 6 4 ❑ Mobile Date: Owner1 D HACCP Y/N ElTemporary ElPre-operation I ❑ Caterer ❑ Suspect Illness Person in Charge!(PIC) L, Time ❑ Bed&Breakfast ❑❑ General HACCP o 'eV Complaint �e^ In: fi, 55-Inspector ! ��d I Out: I -i J 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) [:1 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties • ❑ 13. Handwash Facilities ' EMPLOYEE HEALTH ' PROTECTION FROM CHEMICALS 712. Reporting of Diseases by Food Employee and PIC - ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El_, 15.Toxic Chemicals FOOD FROM APPROVED SOURCE"'" x'; 'i TIMEJTEMPERTRE CONTROLS Poiernill rdousoo Fds E] 4. Food and Water from Approved Source AUba ( Y Haza ) ❑ 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 �❑/8Separatio n/Segregation/Protection ❑ 20.Time As a Public Health Control T . 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:,, , . _....,'_ [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 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (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)(5110.008) 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 S 590Ms,&Fo 14 da n 1 h I Inspector's Signature: _�. Print: PIC's Signature: ✓ Print:- ,c/ I Page of LPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1 590.003(A) Assignment of Responsibility* 1-302.11(Aa]I Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I 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 ()ther* 2 590.003(C) Responsibility of the person in charge to ( I Contamination from the Environment require reputing by food employees and 3-302.1 t(A) Food Protection* applicants* 3-.302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foots Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 59o.003(G) Repordng by Person in Charge* I 3-306.1 4(A)(B) Returned Food and Reservice of Food* 3 590.003(13) Exclusions and Restrictions* I I Disposition or Adulterated or Contaminated 590.003(E) I Removal of Exclusions and Restrictions Food l 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* _ 4 Food and Water From Regulated Sources ( 19 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* I Sanitization Temperatures* _ 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Warewashinn Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* I m PH, 13-202.14 Eggs and Milk Products.Pasteurized* I 4-501.114 Chemical Sanitization-temp., 13-202.16 Ice Made From Potable Drinking Water" concentration and hardness"14-601.i l(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System'" Utensils Clean" 1590.006(A) Bottled Drinking Water* 4-602,1 t Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* J Shellfish and Fish From an Approved Source 4-702.1 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* SheOfish* 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed SChemical* Sources* t0 Game and Wild Mushrooms Approved by I I Proper,Adequate Handwashing - 2-301.11 Clean Condition-Hands and Arms" Regulatory Authority I 3-202.18 Shellstock Identification Present* I 12-301.12 Cleaning Procedure* I 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 13-201.17 I Game Animals* I I1 Good Hygienic Practices I S I Receiving/Condition I 2-401.11 Eating.Drinking or Using Tobacco* 13-202.11 ( PHFs Received at Proper Temperatures* 12401.12 I Discharges From the Eyes,Nose and 3-202.15 ( Package Integrity* . Mouth' 3-101.11 ( Food Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* I 6 Togs/Records:Shellstock I ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(F,) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* Employees* Tags(Records: Fish Products 113 I Handwash Facilities I 3402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 15-203.11 Numbers and Capacities* 590.00401 Labeling of Ingredients' 15-204.11 i.ocation and Placement* 7 Conformance with Approved Procedures 15 205.11 Accessibility.Operation and Maintenance Supplied with Soap and Hand Drying lHACC�flans ( A ry ! 3-502.11 Specialized Processing Methods* I Devices 3--502.12 Reduced oxygen packaging,criteria" 16-301.11 Handwashing Cleanser,Availability 18-10.3.12 I Conformance with Approved Procedures* I 16-301.12 Hand Drying,Provision *Denotes critical nem in the federal 1999 Food Code of 105 CiMR 590.000. -- CITY OF SALEM BOARD OF HEALTH L Establishment Name: /+ 1r n .A Date: )(A,,0,1/)Cj Page: c� of Item Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION ,VCer fled No. Reference R-Red Item � Q �-y ( -PLEASE PRINT CLEARLY 11 t, 11,1 ��'��!' Mr,^YCw 114- -I ld AJO! �� ' cppo S,.n(_ nt DL A,)o �i7 4-1 � [Y �.,7C>•',, v .1.Lale r. 00 n I G- J�✓1I. '77� �.��_-� . v, Inn ^ �Do., t )gym i h � n �a�_ (� , / T,� ,, rM��kr-�. ( t 1 «� (Jn, f G/lr� �,��ai,_ ✓n� ,h,D cJ�. e144 �IL .S h� {r J i. / `, 1111.11 d- R � �_ nJ. IQ'%AtP �WCAC//l,ne IJ1.413 / hoclQci1 0, � CW Iv ,tel _i S� V Ir_, Wey'A17 71/ I l�eom 1 �9_C/9L/it �/vlyt!-/ `Si)17 �7710�, C_/ln. �n/ r�bfsor �e��' fYJ—D./(/1�[ 1_4 i /lh�n ,.,r / ra ✓14 CVn f_r / n r /l"_v) V"9f I) ..1N0 I G,n� /Jlvv , do I�v , .v1n4 ��-><i:Y`l..� �.,e✓%o V'C�� (�I ,✓Ig-�;/� i Ja.,t 4A� ',o) fs/l-h n/ lf.llO�rl 5 ,J,AnJ ( i ,' A (-I/nrlGM /)rh110 OA 1A Ci,i !/1/1 �. r.i/�X�Ip L r - r <--M-4 r--V1r -LNr J r kvt c-r„,m-. I/LJ4 / � Yes Discussion With Person in Charge: rt Corrective Action Required: I ❑ No I , I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ey 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. �-•_,b ❑ Voluntary Disposal ❑ Other: Violations Rotated to Foodborne fitness Interventions and Risk i-50 14(C) PHFs Received at'FemperatorasAccording to Lai+ Cooled to i Factors(Itehis 1.22) (Cont•) 41 T-/45'F Within 4 Hours { PROTECTION FROM CHEMICALS 3.501 15 Cardin;;P4ethods for PHF( 14 i Food or Color Additives 19 I PHF Hot and Cold Holding 3.2{)212 r`.dJi[;ves' 3-S0!.I6(6) Cold PHI-s Maintained at or Felim, � C90.()(}�(F) -}I`/�IS°F" i 3-302.13 � Procto,)n frons l lnai>nr(ned Additive i' � 3-y01.4(F) 410/45 Fs Maintained;+t o+'ataoer 15 ! Poisonous or Toxic Substances i Ifie P, '< 7 101.11 i kizialfyiugIntotirciuon -Urtyinal '_i-5()I.I6(A) Roasts Heldatorabove130`F, * 1 ConW.iners" 7 102,11 C ommou dame W oriine Coat;uner," 1.20 Time as a Public Health Control j 1-201.1 t Sepal anvn- Stnragca, 3-501 19 Time as a Public Health Comr il* { � 7-202.l i }{crniciivn -Preu.n,:c uxl F,;e' 590.0(kNH) Variance Rr,•9atrcnrurt 7-202.12 Toxt i On ineuo" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 1-oxt, fbntcritto.-- - chlblic+,N' POPULATIONS(HSP) 7-204.11 _ _ Samtizer._Ctstcrin - C'hesticdc' 7-2(14.12 C'henricak for W4r hinii t'rndn.:c. Cote( 121 I 1-801.11(A) Unposteurt/.cd Pre-packnged Juices and 7-204,14 Ur,ir:H Ai•enu.r'nre.^ia' •-- --`_- i I Heceraees with Warning labaia 7-205.11 incinental 1-•�.rl t_xmract-1a,hricams° ( 3-R01 11(B) Use of Pa iliallred bees` ;?-8(17.11(b4 Haw or Pattr,Jly GKi3.ed Aoiinal F+x,d and 7=206.11 Itc,tricted Cee Pesticides,Crrterm, Raw SuJ Spnnux Not Saved. 7-206.12 '1rI nt F3.ui a coon, 7-?06.13 Fri 3-gol.i)!C) Unopened Ford PacF.agr Not Re-scncd .tcktng Po+a�lcri,l'�5[C4mtr(i and 4lonitorinc, ( CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 31,03-71 ( Coosuruer Advisory Postod 14 Consumptioa of fwiutal F+'xxi,'that.ac Raw Ctndeiaxiked or 16 Proper Cooking Temperatures for ( ;Vol t)therwise Processed to tiliuuttaa: PHFs I >. ..rn,.r cess 3-401 1 JA(F;(2r (:gg�- 155.F 15 Gr.(;, •� 1 mhopons •-E_9, -lamredcue Srn,icr ( l5"f i5sec 3.302.13 ( Pa;tearved Fgg::Substitute lot Raw Shell 1-401.11(A)(2,) C_,tnnOm1 d F ii h, 14euts Fi Grow 1 Anitnuls- i S'F 15 se<:. SPECIAL REQUIREMENTS 401.11(6)(1)(21) Pore and Bec1Roast - 130'(' 121 mina 590.1N)91A}-(U) Violations of Section 590,n09(A)-(D) in 3-401.11(A}t 2) Ratites, In,1e.t�d heats - 155'F 15 * I catering. mobile"d,I,tetnp0rary and sec. 3-401I7(A)(3) Pnultr},Wild Game, StuCcd PHF, nsidenlial kitchen operations should he Stullnia Containing Fish; pleat, debited under the appnmrtate.Wt'6011a Poultry or Rantes-165'F 15 sec. " above it related to lixdbnrnc itlness 3-40t.1)X)0) Wbole-0111-OV,torso !?e.f Steaks intervention:and risk factors Other [45°F$' 590.009 violations relating to good rcU! 3-401.12 R;tw Animal Fiiris C o,wkcrt to a practices should be debited under d29 - 1 ;tlicrou,eve 16S'F* SPdctal R0,(µ1irc1l1et)ts. 3-401.11(A)(l i(b) A0 Other PHF, 149,1: 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.11(A)&(U) Ptih, 1651' 15 ser. 1 ((tents 23-30) 3-40111(H) +,TJC,oa'ave 1r15"P >RJQajjo Standing Criiieal and nun-rnUCRI vioialmai, x•lw h du rent relate re,the Pune' firodburne illness inferventiuns and risk fat tors lictcd above, (on be 3-103,1 i(C) Comma,-ialty Proeased RTF hxxl- (mind in the p4lowing ser riono of the Feud Code and 10i 0,11? 140 F' `W 1 o0a. 3-403 1 IfFi Reveom g Uncii,eJ Pvrtions of Beef' 1 Item Good Reta71 Practices FC ! fi_�-000 1«,ayt,�f 23 Management and Personnel FC -_2 I 00a 18 Proper Cooling of PHFs ' 124 Food and Food Protection I FC- 3 004 ! 25. Eg0morsnt and Utensils FC-4 005 I-501,14(A) I--2g-----`Ca,4:cJ PRFs from 141E F to I--2g-----`-water.Piumbin�and Waste FC-5 1006 f 70'F Wuhrn 2 hours a: 1 27, PhVsicaJ Facility _ 1 FC-G .007 _ to-li :/.75"F'tL'ifhtn 2Hnur-. ' 1 28. Poisonous or Toxic Materials- FC -7 I 0(J6 --- --- 3501.14161 Ctmling PHF,Made Hoak Ambient L '9 S octal Requirements Tcatperature lnercJ,ws,to 41'F/45 F Other^ Within 4 1I aor.'' 1km.os,nncat ucm m U,-tader.d 1C9v 1,,"IC k iU.`.cite 5441)000 L � e n Commonwealth of Massachusetts s ` City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 01/03/2012 ESTABLISHMENT NAME: A Taste of Thyme Cafe File Number:BHF-2004-000114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2012-0255 Jan 1,2012 Dec 31, 2012 $280.00 ESTABLIS184ENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment In accordance'with the State Sanitary 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 Y p �a BOARD OF HEALTH 120 WASHINGTON STREET,4"' FI <Ir Ott TEL. (978) 741-1800 htivfBERLEY DRISCOLL F_�x (978) 745-0343 I%L-�YOR Iraindin na salem.com LARIIYRANIDIN,RS/Iti:1 IS,CI10,Cl)-FS H I'.A I:n I AC i I'.NT 201_APPLICATIO FOR P RMIT TO OPERATE A FOOD ESTABLISHMENT �p NAME OF ESTABLISHMENT k�OSie 67 �TEL# 0) F �' �26J ADDRESS OF ESTABLISHMENT (0 t CG, 0 FAX# MAILING ADDRESS(if different) / EMAIL- Business': A Website: OWNER'S NAME I bYl ,C)CelTEL# ADDRESSI STREET Cc CITY 'StATE 7 ZIP CERTIFIED FOOD MANAGER'S NAME(7S) t/" J cl?� CERTIFICATE#(S) 4� ��O _t__ (Required in an establishment where potentially hazardous food is� EMERGENCY RESPONSE PERSON (l1iiwl HOME TEL# I DAYS OF OPERATION : 1 Monday Tuesday j Wednesday ,-Thursday' 1 -Friday: 1 Saturday 1 Sunday HOURS OF OPERATION Please write in time of day. — 2 "7--?J T-3 '� F -3_3 (For example Ilam-11pm) J i Q— ✓ t" TYPE OF ESTABLISHMENT FEE (check onlvJ RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------- ------------------------' ------ ----------------------------------------------Ie- ---------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Foos Cart$210) 25-99 seats =$2'.0 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICESMURSING HOME - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 52C,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. /2 - 2/1- JI-2S Signature Date / Social Security or Federal Identification.Number ---------------- ---------- - ' --------------- Updated 523/11 FOODAP201 Ladm ChmkN&Date/ Commonwealth of Massachusetts s " 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: rA-Taste=of Thyme Caf_e� File Number:BHF-2004-000114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0231 Jan 1,2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health l l A . 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 n 7. CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4""FLOOR TEL. (978) 741-1800 ICIb1BERLL'Y llRISCOLI F AS(978) 745-0343 KAYOR DGREENnAUNIOSALEnt.CONI DAVID GREENB.-Aum,RS ACTING HEALTH AGENT 2011 APPLICATION FOR _PERMIT TO OPERATE A FOOD ESTABLISHMENT / NAME OF ESTABLISHMENT f�W� �I/ri-f l TEL# QU d ADDRESS OF ESTABLISHMENT fZ Z C<�91/f BO' FAX# MAILING ADDRESS(if different) r EMAIL- Business': Website: OWNER'S NAME l� �CPXPR— TEL# v ADDRESS STREETpp CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) (*� �'�t <3f-Q.Cve CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# IDAYS'OF..OPERATION'i•T'l >Monday z, I :_:.Tuesday'711',-Wednesday `,Friday= :i'JT`, $aturday:i ,i Sunday`; 'I HOURS OF OPERATION Please write in time of day. (For example t lam-11 pm) ! TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------------------------------------------------------f4d--------------------------------------------ie-----------------------------------------..--- RESTAURANT YES NO less than 25 seats 40 (Outdoor Stationary Food Cart$210) 25-99 seats $28 more than 99 seats =*440 ----------------------------------------------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all slate taxes required under the law. l2 - L ©-6o Signature Date Social Security or Federal Identification Number Revised Iona l FOODAP201 Ladm ^Check#&Date i $ '`�tl 1 Commonwealth of Massachusetts City of Salem Board of Health lQmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: A Taste of Thyme Cafe File Number:BHF-2004-000114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0050 Jan 4,2010 Dec 31,2010 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 �1 CITY OF SALEM, MASSACHUSETTS * BOARD OF HaALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERL.EY DRISCOLL FAX(978)745-0343 MAYOR DGRERNRAUMnO SALEM.CONI DAVID GREENBAuM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 4 4's C0— (� nr QQ , LL TEL# ADDRESS OF ESTABLISHMENT 1 '2)- ,Yegkq EC 4 3 V FAX# MAILING ADDRESS(if different) ` EMAIL-Business': -f pp Website: OWNER'S NAME �I h'I CQJL(5? TEL# ADDRESS STREET Ulm- STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) I �Ul— CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# �YA.Y$OFOREiZ4TI0N lulgntlay G Tuesday i�',Wed_resday T;hursda'y," +a �`,Fiday Saturtlay Y°,' Siiidayt' I HOURS OF OPERATION 1 Please write in time of day. yF (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO less than_25 seats =$140 (Outdoor Stationary Food Cart$210) 25 99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties or perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. s 12- 02 - a 7+ 1�-2 Signature --- --- Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date $ bv`d/ .COURT DOCKET NO. CITATION NO -A CITY OF SALEM VIOLATION NOTICE PD 6 2 Z 3 NAME(LLAAS,TT FIRST,INITIAL) STREETADDRESS C /TOWN STATE ZIP Ila- ��S j'Nl�-� S` 56 5 !mom ^ C+ LICENSE NO LIC EXP DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) S�aL q S i t^i v I" I \ �. STREET ADDRESS' "CITYR�`,STA 2I� REGISTRATION,O. -s EXP ATE INIMAK\faTTYYPE YEAR COLOR DATE OF VIOLA b TIMO DATE(CITATION WRILTEN IPWRWNAL aAMZ _ ,,.G-sl nuuSY ❑PM i 'fTT []NO LOCATION OPIXIO- )ZZ V1( e14N S �I,Fl� NG DEPT b OFFENSE CHAP SECT FINES A OFFICER _ ID NO -tQtNE ` SINE dY DUE I$ OFFICER CERTIFIES/COPY VEN TO VIOLATOR `l�� J L IN HAND X ✓ j/I ❑ BY MAIL DO NOT AIL CASH-PAYIONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL MM■IIR Massachusetts Department,of Public HOafth Salem Board of Health I Washington Street,4 Floor Division of Food and Drugs Salem,MA 01,970.3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745.0343 Name y �1 Da o T of 0 er tions Type of Insoection t tL .Frok i Yt„�+({ �f. ! �f 1 Food Service ❑ Routine Address l� I R) � Retail NrRe-inspection Ir�g r` A Level ❑ Residential Kitchen PNvious Inspection Telephone [.,, J ❑ Mobile Date: 4� i? "��'�FFF ❑ Temporary ❑Pr er'�tioro Owner �1 d + t 4�1 HACCP YM ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In: ! ❑ HACCP Inspector �- Permit No. ❑Other 1 q 1 n Out: { . 7� Each violation`ctiecked reef unres 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. _ . . FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands El 1. PIG Assigned i Knowledgeable(Duties EMPLOYEE HEALTH "»"" ""' "' """ro El13. Handwash Facilities . ... PROTECTION FROM CHE%dcALs`.,........, . ❑ 2. Reporting gf Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Ad ditives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 4. Food and Water from Approved Source y ❑ 15.Toxic Chemicals . FOOD FROM APPROVED SOURCE o � �. .ourCe,:.,,._ � TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods)- "' ❑ 5. Receiving/Condition ❑16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION. "' .""" „. ,: ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ," ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing .'CONSUMER ADVISORY E] 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 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 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-s)(559090cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(5so.00a4)))oos) 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.56tlMspec40+m6f4dc (1 Inspector's Signature: �� {1 Print: PIC'sSignature: .� Print: � �f )[-` i 1i z Page of Pages J/ ' i r Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination I 1 590.003(A) Assignment of Responsibility I 3-302.1](Au]I Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw ingredients 3-302.11(A)(2) Raw Aminal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require reporting by faxl employees and 3-302.1 l(A) ( Food Protection" applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1 t Food Contact with Equipment and Applicant To Report'Fo The Person In Utensils* Charge* Contamination from the Consumer 590,003(G) Reporting by Person in Charge* I 3-306.14(A)(B) Returned Food and Reservice of Food* J 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 Food* 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* ( 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* J 3-201.13 Fluid Milk and Milk Products* I 14-.501.1 12 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 I Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. '� J 3-202.16 ( Ice Made From Potable Drinking Water* I 14-601.1 1(AI Equipment Food Contact Surfaces and I 15-101.11 Drinking Water from an Approved System* I Utensils Clean* J 590.006(A) Bottled Drinking Water* I 14-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.(1* Contact Surfaces and Utensils* l Shellfish and Fish From an Approved Source I ( 4-70111 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* ( ( 4-703.11 I Methods of Sanitization-Hot Water and 3-201.15 I Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 I I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by RegulatoryAutho* ( 2-301.11 Clean Condition-Hands and Arms* j 3-202.15 I Shellstock Identification Present* I i 2-301.12 Cleaning Procedure* 1590.004(0) Wild Mushrooms* 12-301.14 When to Wash` 3-201.17 Game Animals* I I it ( Good Hygienic Practices 5 Receiving/Condition I ( 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 13-202.15 Package integrity" Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* Hands 1 12 Prevention of Contamination from Ha6 Tags/Records:Shellstock I _ I 3-202.18 Shellstock Identification* I 1590.0(9(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Employees* Tags(Records:Fish Products I 113 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 1 3-402.12 Records.Creation and Retention* 15-203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients' 15-204.11 I Location and Placerrtent* -205,11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures 5 � Y _ I IHACCP Plans I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 Hand 6-301.12 Hand Drying P Provision g Cleanser,Availability 18-103,1 2 I Conformance with Approved Procedures* I 1 t< Denotes critical item in the federal)))9Food Cale nrr 105 CMR.S90A00. r CITY OF SALEM BOARD OF HEALTH / Establishment Name: t I ��l t llyMQ CG Date �aOl t� Page: �_ of Item. CodeC-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item ` " Verified _ ��, II PLEASE PRINT CLEARLY I C1 • \�- �1 v !T ll7l 7.n L.,rm�o 1.4�t.'I-' -S✓"�7 f-I 'I �1-S L� ✓� ltd 1 'r5� ,. - - 1 1 I 1 1 I � i I 1 I i r I 1 Discussion With Person in Charge: Corrective Action Required: ❑ No les I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Ll 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 ❑ Other: J s ' 3-5111.14(0 P}1Fs Keonved at Temperatures Violations Related to Foodborne fitness Interventions and Risk 1 Acct,rdiag to Laa Cooled to Factors(11ohm1.22) (Cont) ( 41'1714>"'f W-ithin4Houis r PROTECTION FROM CHEMICALS I 35(}1 1 i C,x,tin.t Mcthrals for PHF, ( 14 ( I Food or Color Additives ( ( 19 PHF Hot and Cold Holding 3-5{1{.16(6) Cold PHFs Maintained at or below f :1-2()Z.12 Adcittives't 159(;0o4f1-1 41`r45'' F` ( 3-302.14 Protection front IInapproved Additives' I 3 50 1. .A) lir a t'IIF.= Mairained at or above ( 15 I Poisonous or Toxic Substances f 7-101.11 I Identifying information - Original I +-5a1J6(At Rlststs Hcld at rx above 130°!', Containers` - f 20 Time as a Public Health Control j 7 102,11 Common Name-- Working Cowaincrc* I 01 I,) 1`itnc as a Publie health Control* 7-201.11 I Srpaurnon-Storage* I } - ( 7.202.11 I Restriction -Presence find Use* I "i(1.'){y}(}ii -_-. �'a:inncr Requirement f 7-202.12 I Condition..of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 I SanToxiti CxmtCrite -"PChib icoils° POPULATIONS{HSP) 7-204.11 3annizers,Criteria-C`hcnticuls* 7-2(4.12 C"hemicals for W'ashieg,Produce,C•titcriat' ( 21 3-SUi t tin) I l:npaeteurtzrd Psc-pacl:agnd Juices and i Laheis`" 7-204,14 Drink Acent�.Criteria' I ( ( I<e4'rrt„eg with Warning f 3-SOLI i(R) I:st of Pasteini Led Lugs` I 7 205 11 hicidental Food Contact. Lubticanis'' ^-$(H.V ItFJ} it,,w or Pan�:dly Cixiked Animal Foul and ( 7-206.11 Romricted Use Pcsrirides.Crtterr.i* ji Rav:Seed';prorate N,a Served. ' j 7-20(1.12 Rodent Bait Stations` I j 3 em 1.11(0, I unopened F.xxi Package• Not Re-serval j r 106.13 Trucking Poudvm Fist Control and ry I Aiuninxing' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 2: 3+.U? I I onsufn r At!,isorG-t',twd 1;,r C'unsomption of inim-4 F•xxis that arc Raw. Underux,kcd of 16 I Proper Cooking Tempelaturesfor ( 'Q„iOHatv.is PHFs cPrtrcrssedutLtiannae �_.__.. ! 3-•401 I lA(i r(G) tigy,�- I55'c. 15 S,�v. Pathor'n".. I 145"F15rce' t.3o?.3 i 3 P..::rettna°d t�rk.Suhs6vuv fol RAW Shell _h )!s-HmueduucSe)�ia 1-401.11(A)(2) Comminuted Fc'h, Meats k Glint I f`£'t;�� 1 Ani uals- Ii5'F' 15 sec. "4:)1.1SPECIAL REQUIREMENTS ( 3.40LI I(B)(i}i2) Pot!.and Beet Roast - L"(1 121 min* I gg0(}i19(Ai-U)) i Vivlairma of Secaitm 5'S1.009(A)-(D) in (A}t2) Ratites, lniectai A4eats- 155 5'F IS , cawring,, mohilc food,temporaiv and 3-40Lin t1(A)'3) Poul .Wild Game.Stuffed PHRs, I %.,Idem-al tit0en operations Should tx Smff}ng Containing Fish, bleat, tldaed ucdei the appropriate sections f Pouitry or Ratites-165`F 15 sec. ^ abw c if r;i;tte41 to Ioodtx,rnc illncsti 3-401AIfC)r3) Whole-mu.ac, intact BeJ Steaks I in?er,;entionm and risk Pastore CRhor t45"F <' 591).(x)9 V101ation9 relating to roixi retail 3-401.12 Raw Anutial Foxls C.,x,kcd to a },radii es ihofild be debited under #29- Mietowuve 10515p.a:in1 Rcgttiretu tits. 3401 11(A)(1)1b) All Other PIJF - 144"F 15*cc '* I 17 Reheating for Hot Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40311(.A)4(D) Pill-, 165'F 15 sm, * I (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing CrW'•a;,.WJ nor,rim:ol vwGtltoo c, which do no; relare to lire Tittle" ,foodhornr illnesi imet vrnt,m:and riet,jnctor., ligcd ak<me. unt be ;-403.11(C) C.ommctciatly Proses wd RTF:l-tod . fr,unu in tht Inll:n,-ink ae<'ti,rnn !1 talc Food Code and 10('1171t ` 14()"F' 5<10.00I. _ _ 3-403 11(P) Remaining Unshred Portions of Heel item Good Retail Practices- -(-FC T 59tLOt70 _ Ronan* 23 _ _1:Aanagemanf and_Pmonnw_ ( FG 2 I .003 �24_ F,-)d and Food Protection i FG--3 004 IS Proper Cooling of PHF$ r—:-- - - --{-=--"----� 2v- -E 4aP tCnt and()Lens's FC-4 005 3-50114(A) C`ading Cooked,Cooked,PHFs from 140'F to I-Zg - " Nater .Plumbinclood Nasse FC-5 006_ 70"F Within 2 Hours and From 70"i' e7. Pllcal Facdily FC-G .007 L„41"F145'F Within 4 H yriv�. ° 2H Pcvsono0s of 7crtc Matenals j FG-7 .008 3501.14f1t) Cooling P}iFa Made From Ambient '0 .�! Spacta!Ft�:cu;Sretnent> 009 I `= -- { -- Temperature hteredients to 4101745F L 39_ _other -_-"—_, -_-- - --_ Within 4 I Buns x `Duioitc rntte�H nen,in the rr:Nud 1999 Fax}C`,ale,r 105 CNIR 590( t Massachusetts Department, of - Public Health Salem Board of Health 120 Washington Street,4'"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name /q/�� ( � Duff Type of Ooeration(s) Tyge of Insoection T ( f�� h• 7\ l /��•MP (a (�� iF Food Service ❑ Routine Address �J 1 C Risg ❑ Retail 5d Re-inspection 1^ n r 2 Level E] Residential Kitchen Previous I "spection Telephone / _ El Mobile Date: QT(,�V� Owner HACCP Y/N El Temporary ❑ Pre-op t Illn n El Caterer El Suspect Illness (PIG,; Person in Charge Time ❑ Bed&Breakfast ElGeneral Complaint ElHACCP fT 1 In: 1 0s permit No. ❑Other inspector �czn� (olI Out: J Each violation checked Irequires 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) ❑ sso.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT " ❑ 12. Prevention of Contamination from Hands 7� 1. PIC Assigned/Knowledgeable/Duties , . •., „ ,- .,,, ,-,w • , „ _ -„ ❑ 13. Handwash Facilities EMPLOYEE HEALTH " PROTECTION FROM CHEMICALS J - ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El„_ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE „ .. - - TIMENEMPERATURE CONTROLS(Potentially Hazardous Foods) F14. Food and Water from Approveed Source ❑, 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)',;W ❑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 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 inspebtion 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 T N-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: Inspector's Signature: ( /1 t ��- Print: PIC's Signature:, Print: i 3('/nOr 1? - oz.Pages Pag U � J Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I I 1 590.003(A) Assignment of Responsibility* I 3-302.1 l(A)(1) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge" I Cooked and RTE Foods* J 2-103.11 Person in charge-duties I I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* J 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.1 t(A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590,003(F) Responsibility Of A Food Employee Or An l 3-3(W.1 1 Food Contact with Equipment and Applicant To Report To The Person In I Utensds* Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge` 3-306.14(A)(B) I Returned Food and Reservice of Food* 13 590.003(D) I Exclusions and Restrictions* j I Disposition of Adulterated or Contaminated 590.003(F,) I Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources ( 19 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 Scaled Container* I Sanitization Temperatures* _ 3-201.13 I Fluid Milk and Milk Products* I 14-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs' I Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteurized* I 4-501.114 I Chemical Sanitization-temp.,pH, concentration and hardness.1 3-202.16 Ice Made From Potable Drinking Water'" 14-601.11(A) I Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* I 1590.006(B) Water Meets Standards to 310 CMR 22.0" Contact 4-602.11 CFrequency of Equipment Foal- Surfaces and Utensils" Shellfish and Fish From an Approved Source I ( 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foal Contact Surfaces of Equipment* Shellfish* I 14-703.11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Lasted I Chemical* sources* Game and Wild Mushrooms Approved by 110 Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* I 12-301.12 Cleaning Procedure* _ 1590.004(C) Wild Mushrooms" 12-301.1.1 When to Wash* 3-201.17 ( Game Animals* I I If I Good Hygienic Practices g ( Receiving/Condition 12-401.11 I Eating.Drinking or Using Tobacco" 3-202.11 I PHFs Received at Proper Temperatures*_ I 2-401.12 I Discharges From the Eyes, Nose and 3-202.15 Package Integrity"` I Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting" 9 I 6 Ta s/Records:Shellstock 112 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 ( 113 I Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 1 I 3-402.12 Records,Creation and Retention* I 15-203.11 Numbers and Capacities* t Labeling of Ingredients* 15-204.11 location and Placement* 5)0.004(J) 9 9 I 7 Conformance with Approved Procedures 15-205.11 Accessibility.Operation and Maintenance I 1HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialised Processing Methods* Devices 13-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser, Availability 18-103.12 Conformance with Approved Procedures'' ( 16-301.12 Hand Drying Provision i Denoicc critical item in the federal 1999 Food Code of 105 CMR 590.000, CITY OF SALEM BOARD OF HEALTH Establishment Name: i _ fir_ CJ �� ` Cr,l/�, Date: ql+ 131/ coq Page: rr� of Item Code C-Critical item DE4C7 IR PTION OF VIOLATION/ PLAN OF CORRECTION Pate No, Reference R-Red Item . Verified PLEASE PRINT CLEARLY t �, -ITA ?0- . tv,. f� r3 = ! r_ ,\dl t, , C� I „� SSU _n1,1 1t � ��r�.,,.1 :rhe ( [a, .,I ,c�„ (h,n _ C �, J ! - t � i Discussion With Person in Charge: Corrective Action Required: I ❑ ;No I "Yes l } 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 toExclusion 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 twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ ether: k :}ol t4(i'1 PHFa Rccc•ived at'fentpernures Violations Related to Foodborne Illness Interventions and Risk According to Lay. Cooled to Factors(Hems 1-22) (Coot) 4 1`Fi4 5�F With;n.l Homs. 3-50i.15 Cwtin;, Memo&tot Ptfps PROTECTION FROM CHEMICALS , 1q i PHF Hot and Cold Hois(}itg 14 r { Food or Color Additives { I6(t3) C'oirt PF1Ps Maintained at or below -i-2')112 Addim(:0r , S}p.t)!}+,ft•) 11014V' FA E 3-302.14 I Protection from Unapproszd Additives' 3-501.l6(.�) }tor PFl)-s ittainrained at or ab•)ve 15 j Poisonous or Toxic Substances 1 140'F. � 7 10f.11 Idenfifying lnfonnauon - iAininal 1 3-501,llii A) koasts Held at or above 1300F. * Containers" { l0 Time as a Public Health Control 7-102.11 C'ummon Name -Working i'onoonera 7-201.11 Sepalauon-Sioage„ 1-501 } 'Neon as a PublicHoulth Control" 1 '-202.11 Restriction -Presence-,old tJ oc* 59+1.0(i,Ifi-t) VarianceReyuirentent 7-202.12 Conditiom of Usc' 7-203 t 1 Toxic Coniainci;.-ProOibi;ions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17204.1 t Sanhizers,Criteria--C'hendcals* POPULATIONS(HSP) 7-204.12 C'hcnlicals for Washing lh'r,dnce,GiA•.riar 21 ( 3-501 11tA) { Unpa+tcururdPre-potkagedJuic'eswill J 1 I Rei-races with N'<'aruing ixhrts' { 7204.14 Drying Ay-ene.Criteria '" j 3-80LIIt}3t ( U,cotPantewizedEs?ys" 7-205.11 Incidental Faxl Contact. I nhricants" ;-801 ;I(D) i Raw or}',,uuaiiv CttirKrtl Animal F,xd and 7-206.11 Restncled Usc PCItl OCS,C:rirerta" { Rau'ti,-•d titrnnrt5:4oi Served. " ( 7 206.12 Rodent Sart Srrnons" 1 _+.XU1 l 1f(l Unopened F,.xi Psr.kay;r tiw Re-served, t 7-"_06 13 [racking Powder;.Y^st Control and Monitoring- CONSUMER ADVISORY 22 140'.I 1 i Coneun:er -Wk iscrry Pca;ted [or C'ansnuiption of TIMET EMPERATURE CONTROLS vonta{ F',x 1s'1l at ate Rau•. Underwuked of 1 16 Proper Cooking Temperatures for )tit<°rm isr Pox 05501 to I%Iiminare PHFs , 7. ,;- r 5 ,. 1 Rwhkwmn ' d0i t i A(L(2) Figbs t55er I- bt t i-r01)3 Kmeonz sf Fgy,Subamute for Raw Shell Fees-hnmciluuc Set.la F45°i=lisec^ 3-401.11iA)(2) Comminuted Fch, Meats&G:3mc I t>Iras` Animals 155°F 15 sec. SPECIAL REQUIREMENTS f 3 401.11(H)(1)(21 Poik and Beed Rlmst 130't- 121 min'" ( 99l)0091 A)-t[)) Violation,c)f_Secoon590.(X)9(Al-(D) to ?-4WAI(A)(21) Raores, lojedod Meath 15.5 F 1S cat0ricatering. mollil.i'rxxd,teinporary and .sec. * 3-401.11(A)0) Poultry,Wild Game, Stuffed PIfFs, rc,idenlial kitchen operations Axoald be Suifitne('onruning Fish,Meat, dr+hued tinder the appropriate secttou.c Poultry o'Ratites-165F 15 sec. ' ahove if relao^d to ftxAborne 1111105= 3-401.111 C)(3i whole-mus1le,Intact beef SIVAS I inlerventioo5 and risk factors Oth(-r 145°F;` { 590.009 vioi:,tions relating to rood rani! 3.-401.1' Raw Ari n al Ptsxln Cooked or a Inactices ,hoold be debited under/129- 1 Microwate 165"F* Spacial Rtgoircnwnts 3-401 i1(At(10) All tRhei Pt%-- 145`17 15 see ` 17 Reheating for Hot Holding { VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 9-103.111.4)&(1)) PHI•. 165'F 15 sec. ^ I (Items 23-30) 1 i-703.11($) Microwfivc- 165'F.' Minuie Standing I Critirai meed runt-r,im.at e•tu[almor, which at)no; reiarr to tier Time, Foodborne Pln.se iwo ventiow cert nsk ja,turd ti,rtrd above, (an be 1-403.1)(C) Commetciall}•Prcxessed RTF Ftsxl- fottnix'ie, the fol;,nt-ille tet tune,,f th,Food Poste wed 105 C AIR 140"F° Sr/Qttgp. __ _ 3-4013 1 l(E) Remairow, Unshced Portions of Heel I item Gnad Rerait Praohces FC 590,000 _ j Roast,' � 23 Manacternent and Per UnnN,, TFC �2 1 003 -11 Proper Coolln of PHFs _24._ Frond and Fand Proration FG-3_ .004 1 18 rope g i - -- L I ---_{ 25. - ( cqulumeni and Utensils J I FC-4 ,005 3 501 11(A) Comline Cooked PHFs homy 140-F to -. _ �f. Water,PlumGinind Waste FC-5 i 006 70°F Witten 2 Hours and From Ph Y 70`F 27 _ Vs.ral Fadlit Fr--6 .007 ---- _ to 41"F/45 F'WFtiin4Hnuts. ° � 2S— tjFonanrnls or't axle Ma'enain- � FG-7 i OOFI ( 3 501.14(13) Cooline PHF>Made Front Ambient 29 I Special P,-gr:IrnmenL. - . ., .009 ,30, f Other Tcrnperatrtre hteredients to 41"F!4$'F -- Within 4l(tnrrs* "•x.�.n.;,r:r. P<nuie"rmcai rent In 1hr ladeud 1904 Fo+l Code or 105 CMM 590 000 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 _ ((� DI! ( Type of Operation(s) Type of Inspection 3Q (nc ,-� r�, G, ki- #p(,i�U� [� Food Service �] Routine Address S� RiskL ` ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone (f ❑ Mobile Date: C, A-)LA ❑ Temporary ElPre-operationOwner 1) _S 14 L,4 HACCP YM ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint in: ( E] inspector �� I Out(�.r ), 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 A 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH——"' ' ; f 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 - - TIMEITEMPERATURE CONTROLS(Potentially Haiardous Foods El 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 J�/18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing .REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) . ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices i CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related j Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediate) or within 10 days as determined b the Board Y Y Y 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 r of Health. 590.000/federal Food Code. This report, when signed bel W., 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 X 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: avow' Inspector's Signature: J t�f Print: PIC's Signature: /�j j/ Print: sTT(1��i L9� `l (0� I Page-ofg Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT i 8 Cross-contamination I I 1 1596.003(A) Assignment of Responsibility* 3-302.1((A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Caked and RTE Foals* 2-103.11 Person in charge-duties I I 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 I Contamination from the Environment require reporting by food employees and 3-302.1](A) I Food Protection- --_ applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility OCA Foal Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge* I 3-306J,I(A)(B) Returned Fond and Reservice of Food* 13 590.003(D) Exclusions and Restrictions* I Dispos@ion of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions _ Food 1 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 Warewashtng-Hot Water 3-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* - 13-201.13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 1 { 13-202.1.4 � Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, i 3-202.16 I Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 ( Drinking Water from an Approved System* 14-601'I I(A) I Equipment Food Contact Surfaces and 590.006(A) I Bottled Drinking Water* I Utensils Clean' 590.006(B) I Water Meets Standards in 310 CMR 22.0* I 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* J Shefifish and Fish From an Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( F(yo Contact Surfaces of Equipment* Shellfish* 4-703.11 I Methods of Samtizalion-Hot Water and 1-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* to I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 12-301.11 Clean Condition-Hands and Arras* 3-202.18 I Shellstock Identification Present* ( 2301.12 Cleaning Procedure* - 590.004(C) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 I Game Animals* 111 I Good Hygienic Practices g Receiving/Condition 12401.11 Eating,Drinkimt or Using Tobacco* 3-202.11 ( PHFs Received at Proper Temperatures* ( 2-401.12 Discharges From the Eyes, Nose and 13-202.11 Pcad Safe and Unadulterated Mouth* Package ity* * 3-301.12 Preventing Contamination When Tasting* � 3-101.11 and I 6 I Tags/Records:Shelistock ( 12 Prevention of Contamination from Hands 3-202.18 I Shellstock Identification * I 590.004(E) Preventing Contamination from 3-203.12 Shellstock identification Mamtained'' Employees* 13 Handwash Facilities Tags/Records:Fish Products I 1 - 13402.11 Parasite Destruction' ( Convenientty Located and Accessible 13-402.12 Records,Creation and Retention* I ( 5-203.11 I Numbers and Capacities* 540.004(J) ( Labeling of Ingredients' I 15-204.11 I Iixation and Placement* 7 ( Conformance with Approved Procedures I 15-205.11 ( Accessibility_Operation and Maintenance /HACCP Plans I ( Supplied with Soap and Hand Drying * Devices 3-502.11 Specialized Processing Methods 13-502.12 I Reduced oxygen packaging,criteria* D 6-301.12 Hand Drying 16-301.11 I Hardwashing Provision g Cleanser,Availability 8-103.12 I Conformance with Approved Procedures* I 1 I Denotes critical nem in the federal 1999 Forel Cade of 105 CMR 590,000. 1 CITY OF SALEM 7 BOARD OF HEALTH f Establishment Name: Ai/ r . , L ice,,-A .4r �. . �� Date: (jPage: of Item Code C-CFltical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dare No. Reference R-Red Item <: Verified ( ^� // r1}� ,}f, I PLEASE CLEARLY (e) r/j- Ii j d, I1 �.�I 11� - l/1'� /[ 'GL �(M Y1.7 .CY �fJSI Y �/R / .,�f CUl��./7 o�ki x,12 / 1 t .stbn� ne n_ '_t- I j_,cA t\k).A C'1(A^E •- 3 I / 3 V On sh,e(J4 4o `l e.(��u 4 ✓ u�, � -I�, �r> ,ro �.�,r ti/P� 1 f L— 1 .. (��_ac '4 - I - n!� !n. �! Kdti(e.�nPC+ r "� C -3ARr-. _-uAi' tP_ Q\(1_1 . li- 49 C_� __�.UP �� ._1/lC7ir t'� - la 'i�,l-1 jA CoAnAYz_-l-u trn 'Pf, 4- _",9 _".9 iL kiOAA r 4', bi d- j,7 ,�- I I��-C��1.t,a.. ✓ Cl�� -�{ I,� para�.� -M�-(w�-+-G2�� 1 ��c- G/'-��e �:r� :�� . ,� � f ` 6 (ep �� P r h Cl.c/}�e/L �Dc- l a�n J'dNto'Z A�-c r f Discussion With Person in Charge: Corrective Action Required: :3 No `I` � Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance L) Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. � Voluntary Disposal ❑ Other. I i Iaill s Rr;u•ned at Temperatures Violations Related to Foodborne Illness Interventions and Risk Io Lay. Cooled to Factore(Items 1-22) (Cont) 3I'F14'-,F Within a Hants. n PROTECTION FROM CHEMICALS ( 3-501 15 C',xdinc AArU ndc for PF1Fs ( 14 Food or Color Additives ( 19 ^THF Hat and Gold Holding 24)2.12 Adcbtives'r 3-501.16(6) Cold PHFs Maintained at or below 54t;.0(r:(F1 141 /15"F- ( 3-34214 Protecoon from Unapproved Additives" � 't.5gL1ofA) Ilotl'F{hmt sltaamedatorabove ( F5 I Poisonous or Toxic Substances ! 140,P 1 7 101.11 identifying Information -Original I 3-M?L IN A) Rth,sis Hell st of above 134- 1 Containers' ( 7 102.11 Common Name- Working Conrainera* ( 1 20 Time as a Public Health Control 7-20t.I I Se a aeon-storage 1 '-501 19 fimo,,,a Pubhe Health_C'onu•of' ( D'i' g•,. ( .`•0t1.t144tFi) ( 7-202.11 Restriction-Presenceand Use' ( VartxnceRr.ouiremcin - ( 7.203.H Toxic Cons i Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-103 04 11 Toxic Crs,Crieer-Prohibition+ ( POPULATIONS(HSP) 1 7-204.11 Sanitizers,C'ritt:ria-l'hentieak^ ( ( ( 21 ( 3-8"1 t I(A) Unpaatcurircd Pre-liad:aged Juices wid 7.201-l2 Chcnucals for W'ashuag Yrrxh«.r,<:uteaia" ( I Hcveraees acid: Warning 1.2001s, 7-204 14 Ur3vig Agents.Cntcria" S-KO! ll(B) Lsc of Pasteadnd Y:ggs' ( 7-205,11 incidental I'.xod Curtact,Lullteams' I z-3Ut.!1(.>} R:ow or Paria'l'r Coxok-d Animal Food and 7-206.11 ( Restricted Use Pesticides.Crnteua' ( ( Rain Seed Spnnnt Not Served. ' , 7-206.12 ( R(Ae01 13mt Smoor s" ( ( 3-W! 11'C) IIII Un<}pc ned F4xxt Package No Re.served. ` 7-106 13 I Trucking Pmodera.Pest(ArnrUI and Monitoring' CONSUMER ADVISORY TIMEiTEMPERATURE CONTROLS 22 34,03 11 Con*umor Arttiisory Pouted 14 Consumption of 16 Proper Cooking Temperatures forI Anin;,A F��od�'Ilw arc Raw. UndercookedIII f "orrttber•�iso Processed h,13timinate 3 401 11 All)(-') Eggs- 155'F 15 Sec. E'.Pn-fmmedtale service 145'F I5sec, -307,i i p,:<icurn;u i ex, Subsiiiair fur Raw Shell )-401.11(A)(2) Comtntnuted Fish, Mews& Gaine Animals 1151` 15 sec. - r 3-401.11 401.I1(A)(2) R:nne<, hojedcd Meats IS$'F i(B)(I)t2) Pork and Beet Roast1 t0"Y 121 nun SPECIAL REQUIREMENTS - 59J.tNIP(A)-(€)) I Viraatl,ota�of Seclioq 5o0 009(A)-(D) in 5 I see. catering.. rlwhdC 6NxI,temporary and 3-401.11(A)(3) Poultry, Wild Gante, Stutted 111-fFs, I IcMdent:•d Litchca operations should be sw(fing C'onnaimng Fish, Meer, 4 dthtted under the appropriate sections Ponitie ur Ranted-165'F 15 scc. ° I above tt lcj:l,d to S:x>dhorne:Illness 3-401.11(C)(3) Wlwle-muscle, Intact Beef Sicaks Interventions and risk factors. Other 145"P 590.000 violation;relating to good retail 3-41)1.1'_ Raw Animal Foixls Cooked in a pratticcs slio'lld be debited under /129 - ,Micrawave 165"F* Sp.'clal Reyuircnicnta, 5-401.11(A)(10) All Other P1lFs-- 145°F 15 sec " ( 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-I03.ti(.A)&(DI PHK 165'F 15 wc. I (Items 23-30) 3143.1 l(ts) Microwave- 165"F2 Minute Standing Cnacal and nae-rno,ui vwfa wo%, which do nal refute io the 71me' ,fnodhorne linos., iIIINTCah0I4,y,utd rt:d Jar tors li,ted above, carr Lr 3-403.11(C) Commercially Picvecsrd RT'E F'ti,od . I (trend in tfu:Jolt;oto-urg sectimo of M,, Food Cade rued 10 C'A/K 140'F' 90.(')(](1 3-403 1!(1:) Remannw, Unsllr•ed Portions of Boer llem _Good Retail Fraclioas FC 53d.fX)0 23, Mansoamert and Per:onnE _ FC_ 2_ 003 , Roasts 4 _ ----__ _ ( lg Prosper Cooling of PHFs 124 Faxi and Fond Ploieciion -�FC 3 ---004 L- '5. uy Iprrir:nf and Ultosils FC-4 .005 3-541.14(A) Cooling Coked PHFs frama 140'•7 to 26. - Water,Plumt;inn and b7este FC-5 006 70°F Within 2 flours and From 70"I' j 27. P`a;sicai Fwn lly FC-6 .007 to 41^F/45'F Within 4 Hours. _ ( 1 26. Poisonous or Toric Matea813 _--_ ( FC-7 008 3-501.14iB) Cooling PHFs Made From,ambient 29. ' :.'ger_:a!Raauafafients ______ 1 .009 �----{-- ..._ ---- TemperatureIngredientsIo41"F/45'7 i. 0_ -_Other T Within 4 Hairs* 'De11,10 Lot<al neat III Ihr li,lerIII 19'19 Fwxi('tile or 105 C54R 590(100 CITY OF SALEM BOARD OF HEALTH Establishment Name: /,t —_ <I- �_rk— I V1vM� �� Date: <:-IIG)0Q Page: of oer Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - - - verified (-, PLEASE PRINT CLEARLY r - Y�-.1re (�,r nr\,l► r�� p n��,/ �X, ^-r� i I v cj ,X tJe v� —1a c�\ fn/ a s1�,nt2 G/9� hWA _1,) -6, �l2ren Ot�l C,/yy LZ .�d1 M vG 41/1 ' orC� C 10C /I,�ta I I / ✓ ! ��I- �o�. ►,, - l� ter,. (,�A� Lt�� (hl �u, ► .. i , ,� n� �r l� I !�t—. r,v_r, cP� SClr.n�(o �)n , 6 � { . ror cc}�t v r r _ [ II�� Sk-rr Ice SC��(>r �a ho r��t r � , -P n,4- ��. J� {n t7.� t)r C((n M, 5 +_ QV T")r] r),t-H Jun!Le rZ.0 !! 1 j j / Q�7- �_.`S� 1.1,tI C_ �'"" Cllr �e,-kG 71-- drL)(Vjn I.lAA0 /1.�Kc1 nn Y�'�l-h ).n nc i--•-( k, IJvef-) h� c -1 (". I r �Fvtn. C c�tJ } SGn- ��o� en�Z9 GncL. V 'Ur_ j j� 31 I C) C) I J.a I - - II 1 / Inr k, "7-3-\-1 I , c� ' I lk Sir _1 Jr, �1X) nn ,v,a ,�U r� r ��,� l� _G/J. _ .5(InA�/ �c.rJeL'✓Ivlyd an of .t n.. ()mn �-�4lt_,�- c � ��_/,' I _ �,r�/l.(�C✓t�� S�� ,j` �(.{G�C�!r/t1L J c�,ULf/Y� f-- �IOG�- 'E Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ "Yes 4 I have read this report, have had the opportunity to ask questions and agree to correct all I ❑ Voluntary Compliance ❑ Employee Restriction/ Emersion violations before the next inspection, to observe all conditions as described, and to P 13 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that • noncompliance may result in daily fines of twenty-five dollars or.suspension/revocation of ❑ Embargo — ❑ -Emergency Closure i your food permit. ❑ Voluntary Disposal ❑ Other: s r 3-5,+1 14i'Cl PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Ac;cordmg to Lan-CooW t. Factors(items 1.22) (Cont) I I11`1`41�5"FWithin-1 Hours. PROTECTION FROM CHEMICALS I 1 S-5Ut 15 CtM@ine 9-fethod"for PHFs I 119 PHF Hat and Cold Holding 14 Food or Calor Additives 1 501.16(B) Cold KIF,Mamunned at m'below 1 3-202.12 Adcbt6w* ( 590.(410-? .11-!450 1,, 1 ,-302414 Protection from Unapproved Additives' 3-SOI i6;.A) H:Kt>Flt;c ?.fainramedaturabove 1 I H5 I Poisonous or Toxic Substances ( E4t1'P. ' 101.11 I Identifying Intunnatirn-OnBinal 3-501.16tAi koasis Hold at of above 1301"F Containers` I7 10� 1 1 20 j Time as a Public Health Control I ��Common Name- Wnrkin„,Canrunars" , 7-201.11 Scpa,attun-SHrcage'' i-5U3 t'7 1 rirp� as a Public Health ComroV 202.11 Restriction -Pw,&nce and Use" 5`)O.004tH1 Variance i eytaremcnt I 17-202112 Condition:,of USu" 7-203 11 I 'Toxic Cuntamea.-Prohibnioos* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE i 7-204.11 Sarinizefs,C'rileria-chernic;iW POPULATIONS(HSP) 7-204.12 Chemicals tot Washing,Produce,C'titeria, I 121 "-sol i 1(,\2 l'npasteuriccd f're pact aged luices and Beveraees with 1M1'arning 14b.:lti" 7-20414 Frying.Agent.Criteria" ?-SU(.l Us:e:I"Yastc`wized i:J;es° I 17 205.11 incidental Food Contact,lubricants" ( 1.802.1 I1fn 1%iw or Paittally Cooked Abimal Food and 7206.11 Restricted Use Pe,ticides.Criterin* I ' i Rte:Send Spn,niv Not Ser sed. ' I 17-206.12 Rcxtent licit Suctions'` ( ( 3.8(;1 11!('a Uwlri tied FLxxi Ps(kagc Not Re-served . t 206 13 Traekmg Po,%der..Pest Control and - Munitnriog^ CONSUMER ADVISORY TIMEREMPERATURE CONTROLS i 22 3 4l03 11 t oatwoer Wd iw y Piot�d for Conanmpciun of 16 Proper Cooking Temperatures for I Anivao( F'atd.'Chnt arc Raw, Underaxoked of PHFs ( got Otherwise llox%-ssed to Btinnmcte 3-401 11 A(i)(=) I €Bs' 155`14 15 Sec. Pwhoieom Eggs-Immediate Service 145"F15sec. ( s'3t1?,0 Kr tekmt A Fgi: Substitute 1"or Raw Shelf f 3-401.11(A)(2) Colon inuled 17,h.A4eat.&(rater -- f Animals 155'F 15 sec. " SPECIAL REQUIREMENTS . 401.11{!3)(1)('2) Pull,and 13cei Roast - 130'F121 min^ ( ? 401.12(,Ur2) Kautes, Lnje.red 14cxta- 155,F15 590,0011(A)-ti)) Viuiuu,rn,ofSection 5')11(0)(.A)4D) in SeC . I catering. mobile loxt-temporary and 3.401.11(A)(3) Poultr),Wild(lame. Stuffed PHR, residenb.d kitchen operations should be Stullme C'onc filling Fish.Meat, dchited imder tho appropriate eecdous Poultry or Raines-165'F 25 soc. '' A),,,ve if relaie.d to foodborne illness 3-401.111(7)(3) Whole-muscle, Intact Beef Steaks I Intel ventlona and risk factors Oilier 14501;" 590.009 violations relating to good retail l ,i-401.12_ 16w Animal Fids Cooked in a •,� practict'. .,bonld be debited under/129 - Nlicrowaoe 165"F* I Spacial IL:quircmcnts. -401.11(A)(I ab) I Alt Mier PIIFs - 145"F l5 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.112.A)R(F) PF(Fs 165"F 15 scc. ^ (Iterras 23-30) 3.403.1 1(B) Microwave- 165"F-1 Minute.Standing Ciawal and non-ccrilwal ovlol wee,which do tear snit•tai Me Tme' (nudlewnc:db,vct uu,-i i,eno.'nrts.vtat risA-fa?c wrc licwd ubnrr, can be 3-403.11(0) Comrnercialiv Proecscd RTF I-ood fi,und in rht.f%tU,=>,mg sec^mm ,!l AG Foil("ode olid 115 CAIR 140"F° Sc ).tiOrJ. 3403 1 I(F) Remaimng Unshced Purdom of Beef ' Item Good Retail Practices - ---- FC 590;000 { Roosr>* 23 hAananemani and Personnel- FC2 L003,,_- 18 I Proper Cooling of PHFS 24, r-ond and Fad Protection FC—3 I .004 _..__ 13-501 14(A) Coding Cooked PHFs tomo HOOF to ' 25 watet,:ent and Utensils`_.--___ _- FC_4 _005 26. VJxtet,Ptt,mbtna.ond V J ante FC-S - 70'F Within 2 Hours and From 70'1' 27, PnYsical Fac:lity _ _ FC-6 .007 1 to 41"F/45"FA,ithin 4 Hums. ' 26 Potannou>c t T-iet(Mate,45 FC- 3501.14(1]) Cnnliug PI{Fs Made Front Arrtblrut 29. - —SpKiai Fic-nulretnervs A,9 -- ` Temperature htgredicnt,eto41"i'idS:F _30.--- 7 Gthet_..---,- - -- —_----� Within 4 Hous'" Lennie"Critical ueni m the I,,irud i4't9 Poul C,xJe„r 10( Mt2 590 000 f i CITY OF SALEM 1k BOA//RD OF HEALTH Establishment Name: t� 3T3-' �_ ti GtP C��r" — Date: qIt- /l)-0, Page: of Item CodeC-Critical Ite DESCRIPTION OF VIOLATION/PLAN'OF CORRECTION Date :I 1 No. Reference R-Red Item Verified 11 {It \ l PLEASE PRINT CLEARLY A � /r, l ,n Ac-A //,S�Ca� ��wl , (ICA �_'�l)� r !/PG rK > �t� o ` o tom) so 4rl) I - o�h4 c;f j r,,-7 ,rp �i�� 1 � r J�1, ( Irn s k.� kp,;r f= � Rjr! aaG�I n�r /I 4— �_�rcdr✓�n . cs` jps� tss.�� hD � ;,� 1 Lj_ �f r nC`!�L I � 1 � I I � 1 1 Discussion With Person in Charge: Corrective Action Required: ❑ No Y b Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Re friction 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 1 your food permit. .- .\ _J--��•��' ❑ Voluntary Disposal ❑ Other: ?-:S()l.i4fC,s PHF'�Ree>�ned at l-entpertture< Violations Related to Foodborne fitness Interventions and Risk i,,ccording to Lai+ Cooled iu Factors(Itetns 1.22) (Cont) ( 4l"F145`F Within J Hows j 13-sol Is C oltlir,-1lrthods for P1iFs j PROTECTION FROM CHEMICALS j 19 PHF Hot and Cold Holding j 14 ' Food or Color Additives j 3-50!.Will Cold PIIFs Mranctined at or helow j 3-202.12 Add 0vcs" ( i40 oola t -41''1-15"F` 3-302.14 Protection from Unapproved Additives" 3-501 16,A) tl:K PHl s i:timaired at to above i Ig j Poisonous or Toxic Substances 1.10'F 7 101.11 Identifying lntnnnaoon - Original I 1.51r1.1>5(A) koesta Heid at,a allove 130'F. Containers* 20 Time as a Public Health Control 7 10211 1 Common Name Working Cuununers* ( '4_501 0 Tim+•as a Public Ilealth Cumrri j 7-201.11 Sdparauon-Storage` j j 7202.11 Restriction-Presence and Use" � ")0.R@4(H) Vtmianu:keatnremem j 7-20,'..12 Condition.,of Use" REOUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7.20311 Toxic Containers-Prohibuions* POPULATIONS(HSP) j 7204.11 Sanitivers,Cnteria-Chenucnk" j 7-204-12 Chemicals for W'u�hinfi Produce,Cdteua' j � 21 i 3-801.11(A) j t'npasteutrzc:d Sm-put-}:aged Juices mol _� Bcteraacs with W'arnutg labels° j 7-204.14 Uryittfi A4!cnts,Criteria" � 3,801,11 ti.c of Pasieurizcd k•:e,as a j 7-205.11 Incidental Food Contact.Lubricants' '-XOi.!I IID) ' Rav ur Pott+ally C'otk�d Animal Ford and 7-206.11 Restricted Use Pe,ncides,Cntena' R.rw Seal Clrroats Nut Srrved. 7.206.12 j Ro cient Bait SntOons" j 1 3XL(!tC1 Unopened Tkxxt Pacl st c Not Re-served * j 1 7 2_06 13 Tracking Powders.Peat Control and Monitoring' CONSUMER ADVISORY TIMEREMPERATURE CONTROLS 22 34,0., 11 Con,mnu.Adtisor} Poited for Consumption of rUmil'l F,tod<'filar arc Raw-, t)ndercarked ea 16 Proper Cooking Temperatures for `:ot Other N ise I'nx:essrd to Flintinate 1 PHF6 3401.6 1 A(I)(2) r;gg.•.- 155`F 15 Sec. i Eggr-hnmedtate Set vice 14.5"F15se. 10:.13 Pastcunt,A Egl,> Suhsututr fur Raw Shell :t-4pl.l l(A}(27 Comminuted Fish,Moats& Gar F""', Animals 155'F 15 sec. " 3 406.1I(8)(6}(2) Pork and Bcct Roast - 130°F 121 mink SPECIAL REOUIREMENTS t.4t IIA)(2) Ratites, Injected Meats- I55'F 15 590009(A)-(D) Viu!attrx!,of Set.lion 5'X f009(A)-(D)in )l.l sec * catering. mobil, k>,ut.letup Crary and 3-401.I1(Ali 3) 110111try,Wild Clause, 3tuftetf PHFs rc:si&nl.al l.itshen operations should he Stuffing C'orrtanung Fish, blear, dehileoi undei Ilio appropriate ecfions Poultry or Raines-165'1, 15 sec. " aho\c if related to fatdhvrne !Ihress ?-401.111(7)(3) Whole-musele, Intact Beef Steaks I inletrventions and risk tactors, 0iber 14501;a i 50t).009 vlolatione relating to gold reltui 01.12 Raw:animal Foods Cooked to a I practices.iliould he debited under 1129 - Micnneave 165"F* Special Retiuircmcnts. ' 401.31(Al(i)(b) All Other PHI's- 145`F15sec " j 17 Reheating for Hot Holding VIOLATIONS R.=LATED TO GOOD RETAIL PRACTICES 3.403.11(.AWD) Pli}., l65"F 15'cc, (Itenu.23-30) ?-103.11(8) Microwave- 165'F 2 Minute.,Standing Gifu+tc`:zxr7 nr!rrt rilicai violalo,n,, wrath do,rat relut7•inlift- m Tie" fuedhrrrta•titles oiler ru.k)<utuci luted above, con fir 3-403.11 W) Commercially Picleecsed RT'F Foist- I (,cold ire.du J%,t 4,c,anr;'ser•ti,ms of tilt /•'foul t bde raid 105 CMJ{ 140',' 3-403.1 i(F) Remaining Unshred Portions of Beef I I Item Good Retail Practices FC. $90.000 Roast,* i 23. Management ivid Pers.gnniFC 2 403 j IR Proper Cooling of PHFs j 24 ,nod and Focrd Frotecton FC-a __0004 ---� 25 Equipment and Utensils IFC- 4 t7()5�� ? 501 14(A) Codut Cooked PHFs from 14(1`1,to s -" I--"-"-' --- g �_2_n" W atel.Pli.?nbina acid •Waste I FC-5 006 -- 70'F Within 2 flours and Front 7041t- j 2"t .� . Ph1Jsh,a;FaalEtY. ._____.. ._ __ FC-6 6 007 _ Lo 41^1,745 ,Wiflnn4floors. ° ! 28 Pcxxonou,orToxic Matenals FC-7 .DOS __, { 3-501.14(B) Coaling PHF: Made Font Ambient (i 29 1 Special Po:cuiremant, - I .009 I Temperature htgrediews to 41°F/45`F j_30.-- - y_Omer Within 4 flourR Uenoteti cnncat riem in ihz Irder el icily Palet C,xie„r 105 CNIR 590000 +� Commonwealth of Massachusetts ` F City of Salem Board of Health Kmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: A Taste of Thyme Cafe File Number BHF-2004-000114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0305 Dec 30,2008 Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2009 _ i Board of Health 11-YU 141,71q A/171 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,e'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR IDIONNEOSALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT A . (A5 t OF 1 GYM Cr WE TEL# � 4-B .4ql `426 ADDRESS OF ESTABLISHMENT 12t- VJ -f/A) 6-QA) St SkA�,M FAX# MAILING ADDRESS(if different) EMAIL- Business': Website: OWNER'S NAME ci0� l n1 SAL k TEL# ADDRESS X r, Q>ZakNwAY ni0fyh "Q11(i:e STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) R CERTIFICATE#(S) (4-�5—T (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON T Ere. &14- HOME TEL# '329-- 369 DAYS OF OPERATION :'Monday1.,,'F,Tuesday. Wedoesdav? .j=::'.Thursday L Friday• �`: Saturday: � ' ` Sunday HOURS OF OPERATION j �gryl (�qm +AM i }Am i 4- A/V :AM Please wdle in time of day. ! i j (For example 11 am-11 pm) 3t'�J TYPE OF ESTABLISHMENT FEE (check onlv). RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - ------------------------ --------- ----- ------------------------------------------------------ ----------- --------- ---------- RESTAURANT ES NO I s than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 sea =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES .............................................................. .................................. --------- ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax retums and paid all state taxes required under the law. Signature Date --- Social Security or Federal Identification Number ---- -------------------- Revised 424/07 FOODAP2008.adm Check#&Date�"_,, � ��/•,Zy $ f � Integrated Pest Management • s "r �_` Wood Des!roying Insects is NEPMQ Residential&Commercial > $ss CUSTOMERj�C Q / �7�l✓! -E .: flcensed&insured '� �— « g/ MEMBER ADDRESS�/ tw1G��irvf /1v Sf = 4 Water Street,Amesbu MA 01913 4E0.ED Neu; CITY/STATE �i l r "'NATraNAt m'�medtm6 978388-4589 - 800.371-4589 PAST DATF ASSOCIATION NT ASSOLUT PestcoNTRo( AaaOC1AT(ON rn PEST CONTROL f METHOD CeeMICALSIFRooUCrs USED OF AREAS TREATED TARGET PEST STRUCTURAL DEFICIENCIES YES NO' APPL. t Lot clean,free of harborage/burrows? 7,-) 4 t ''� � C�C ti-- ��C�✓ Bldg.free of holes,cracks,openings? Doors rodent proof? S/6 f�� Windows screened? n 7" Dumpster area clean&well drained? x Gi err fl d` Sr7�rr rrt{ )!n!^ I �. S 1 rlO Trash area away from building? / Receiving doors clean&secure? ?�- Other Storage 6-12 In.from walls? - — - - Storage area clean,free of harborage? Damaged products stored separately? >-- Svc. Svc.Room&kitchen clean? Jz Soiled clothing&towels property stored? x Clean.equip.(mops,etc.)properly stored? GarbageArash cant.clean? Floors well drained&dry? Y- Open drainage traps or lines clean? `Other areas needing cleaning? `Comments/Recommendations: Yrl K p 401. GENERAL SANITATION CONDITIONS Comments: sx Ltr�tG ch oU 11 q TECHNICIAN'S SIGNATURE CUSTOMER'S SIGNATURE _ . . , WORK ORDER/INVOICE Invoice Number , 28128 - 6+6ucriri'9nedbmb � t - . ABSOLUT FEST CONTROL 4 Water Street Amesbury, MA 01913 978 388-4589 - 800'371-4589 BIWNG ADDRESS- SERVICE ADDRESS j y,i'n4;.. 'Ef,ESCR�YFTlON�vTkR�ET?E$T: z �+ �` �, �sr"P "�US�fljs'�rER NU}YSBE,R:�R'-``� q' i ! i i i _'CgqNEMICAI:'USED:�y<b';.��,f°�/A/�l;A•CJWNT,'"��'-.,c .�,'AP�P„uT.YPE/w�?t�' - � ! TOTAL CHARGES ; k �x� rOr A/Y�Gc lis (G(.ruy ERViCE nn1oUNTi ,TOTAL INV04CE - ! I AMOUNTPAID . . . .a BAPANCE'nUE! = SERVICED By�. ''� ! t t.1rl � 7� :5g-2,-ir TIME IN 1 •'. TIME OUT - CUSTOMER SIGNATURE i DATE SERVICEF]_ r- � f—Z t ttt Thank you for your business! While-Office Copy Yellow-Customer Copy ”" Pink-'Please Remi TERMS NET 3a DAYS I .y 00 00 Commonwealth of Massachusetts r City of Salem Board of Health lQmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: A Taste of Thyme Cafe File Number.BHF-2004-000114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0290 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 11 e QTY OF SALEM, MASSACHUSEnS BOARD OF HEALTH r , 120 WASHINGTON STREET,4" FLOOR TEL.(978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR TSCOT IaSALEM.COM JOANNE SCOTr, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ik T RS I E' of- ` R I m E CAtC C- TEL# �9 $ ) 4-41 -4 2,o ADDRESS OF ESTABLISHMENT 12L \N S NI N C,1—oN cS 1✓ FAX# �34R ) -T� I — 4/13 MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'SNAME S"PIPTIm SM-N TEL# ADDRESS 3S6 0MIZ\1)LLG /)) 1� Od►�� STREET CITY p STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) T- CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 6`1015kt M SRIF- HOME TEL# 6 I (o V o.Z6 , DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunday I HOURS OF OPERATION Please write in time of day (For example 11 am-11 pm) }AM-6 PlYj IAM- 3PM'Urn-SPM •:401-WM440)-317x17 14-AM-3PM ; +AM I Pn TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than I000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - - - RESTAURANT ------- -------- E NO lessthan 25 seats =$140 (Outdoor Stationary Food Cart$210) X?5799seats =$280 more than 99 seats =$420 --------------------ES§ NO $------ - -------------------------------------------------------------------------------- - ..100...... BED/BREAKFAST/ Y 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 Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax returns and paid all state taxes required under the law (a7 Signa t Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date Iy40 0 $ , u� NQV-21-2007 09 : 16 AM WHEN SECONDS COUNT P.02 I I I ht I Choke Saving Course Registration #'o 00,j,; Each attendee must complete a Registration Form ' r To reserve a span:in the Choke Saving Course Registration Form,please complete and retuisi ,i ., Registration form to the Salem Board of Health. Course provided by When Seconds Count, o .' 'Class size is limited and will be on a first come first serve basis. *Registration Fee is Non-Refundable •Registration Deadline is Friday,December 28,2007 at 4:00 p.m. !^ " Date of Registration: Form Form Completed by:—y�� f?f �iA �f j!:_•; _. �1 ✓ I` Name ✓,, OA �r Restaurant: A e_ -C. Business Address: /L2AQ /alep // / City/Tow�n/_f j "1 :" Business Phone: 9 7 '"� "1a t �i sf `15 s _J_.tate&zip .l P l J t a. Email: f T understand that the information provided to the City of Salem&When Seconds Confit,itt p. 31�b0: 50t- confidential and I herebyattest that the information supplied on this Course Application is PP Pp �T�; accurate. Cost: Choke Saving Class $5.00 per person Course Date: Wednesday, January 16, 20011 Q l Time: 2 p.m.to 4 p.m. Location: City Hall, 120 Washington Street, Floor 3, Salem, MA Z T have read and understand the above registration form,its requirements. I ' Student Signature: Date: !, Return the completed application and payment to: Salem 8oa>; of eaul01 I i 120 Washi4on pialk �' Salem,MA 019701 R Y 1'. t Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4269 Handwash Facilities PASS d❑ RED Owner: Violations Related to Good Retail Practices (Blue Items) Shpetim Sala Equipment and Utensils PASS BLUE PIC: Shpetim Sala Comments: McCall unit not in working order.Remove equipment not in use from establishment. Remove doors from unit to ensure not in use.This piece of equipment to be removed by next routine inspection. Inspector: Janet Dionne Physical Facility PASS BLUE Date Inspected: Correct By: 12/4/2007 Comments: Produce sink had no hot water at time of inspection. Per conversation with Health Agent because sink has only cold water all produce must be washed thoroughly do not cut down wash time because of cold temperatures when washing/rinsing Risk Level: produce. GENERAL COMMENTS: Permit Number: All repeat violations noted in the next routine inspection will be subject to fines of$25 for each repeat violation. BHP-2007-0185 Status: All other violations cited in the 12/04/07 inspection report have been corrected. Open , #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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2008 ) Page 1 oft ti Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors(Require immediate corrective action) wn" v 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. Jan 17,2008 ) Page 2 oft 1.22 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4269 Food Contact Surfaces Cleaning and Sanitizing PASS Q RED Owner: Handwash Facilities FAILd❑ RED Shpetim Sala PIC: Comments: Back handwash sink paper towel dispenser not working properly.Repair or replace dispenser to ensure in good ,,working order. Inspector: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Janet Dionne Hot and Cold Holding PASSJ❑ RED Date Inspected: Correct By: Violations Related to Good Retail Practices (Blue Items) 12/4/2007 Food and Food Protection PASS BLUE Risk Level: Equipment`and Utensils FAIL BLUE ;Permit Number: V ments: McCall unit not in working order.Remove equipment not in use from establishment.Remove doors from unit to ensure BHP-2007-0185 �ot in use. Status: , omens and mens restrooms both did not have toilet paper placed in dispensers.Owner to ensure that toilet paper is placed in Open Wtoilet paper dispensers and that dispenser is in good working order. #Of Critical Violations: Physical Facility FAIL BLUE 1 Vlo�mments:The steps leading to hallway have loose tread covers.secure to prevent trip hazard. Time IN: I Time OUT: Bioduce sink had no hot water at time of inspection.Per conversation with Health Agent because sink has only cold water all Urgency Description(s): Vproduce must be washed thoroughly do not cut down wash time because of cold temperatures when washing/rinsing produce. BLUE: GENERAL COMMENTS: Violations Related to Good Retail Practices (Critical All repeat violations noted in the next routine inspection will be subject to fines of$25 for each repeat violation. violations must be corrected immediately or within 10 All other violations cited in the 12/04/07 inspection report have been corrected. 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. Dec 17,2007 ) Page I oft Item Status Violation Critical Urgency RED: - Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 17,2007 ) Page 2 oft 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 741-4269 _ PIC Assigned/Knowledgeable/Duties PASS N❑ RED Owner: Non-compliance with: Shpetim Sala PIC: Anfi-Choking PASS Shpetim Sala Comments:staff to be certified through board of health training being offered in December. Inspector: Tobacco PASS Janet Dionne EMPLOYEE HEALTH Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS d❑ RED 12/4/2007 Risk Level: Personnel with Infections Restricted/Excluded PASS ❑d RED Permit NumberFOOD FROM APPROVED SOURCE : BHP-2007-0185 Food and Water from Approved Source PASS ❑d RED Status: Receiving/Condition PASS ❑d RED Open #of Critical Violations: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED l 5 Conformance with Approved Procedures/HACCP Plans PASS ❑d RED Time IN: I 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. Dec 04,2007 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSJ❑ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing FAIL Critical J❑ RED immediate corrective action) v Comments:Cutting boards stained and scored. Resurface or replace. Proper Adequate Handwashing PASSd❑ RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities FAIL Critical ❑d RED it/Comments: Front handwash sink missing soap and paper towels. Provide soap and paperowels at all times. Back handwash sink paper towel dispenser not working properly. Repair or replace dispenser to ensure in good working order. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS d❑ RED Toxic Chemicals PASSd❑ RED TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures eratures PASS d❑ RED Reheating PASSd❑ RED Cooling PASSJ❑ RED HoXandCol olding FAIL Critical J❑ RED ents: Small Continental unit at 56.6 degrees fahrenheit.All food in unit discarded at time of inspection.Unit to be serviced ust be maintained at 41 degrees fahrenheit or below as mandated. Pancake batter at 56.5 degrees F, Mayo at 52.6 degrees F. There shall be no food stored in this unit until proper temperature requirements are met. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASSd❑ RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑d RED 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. Dec 04,2007 ) Page 2 of Item Status Violation Critical Urgency ' Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection FAIL BLUE ' mments:crutons uncovered at time of inspection.all food in storage must be covered. T ere was a large hotel pan of cooked bacon at room temperature at grill area. If bacon is held at room temperature it must all be used within 2 hours.Any pieces of bacon not used and that have been held at room temperature and have not been served must be discarded. Equipmenta , Utensils FAIL Critical BLUE omments: Provide visible accurate thermometers in the Snapple unit at front counter and also in the Pepsi unit and small Continental unit in back prep line areas.Cooling units to be maintained at 41 degrees fahrenheit or below as mandated.Units were holding acceptable temperatures at time of inspection.Temperatures taken with inspectors thermometer. ,,-'Fhe Pepsi,True and microwave all need general cleaning.clean the interior and tracks of these units. IIs in back prep area need general cleaning of grime buildup. Ices am chine in basement had accumulation of grime and mold buildup on inner panel and sides of machine.Machine to be cleaned ad sanitized to remove buildup.Clean and sanitize on regular basis to prevent buildup and accumulation. McCall unit not in working order.Remove equipment ppno�tpi�n use from establishment.Remove doors from unit to ensure not in use. .�yyomens and mens restrooms both did not have toilet�p�laced in dispensers.Owner to ensure that toilet paper is placed in toilet paper dispensers and that dispenser is in good working order. provide"Employees must wash hands"sign in womens restroom. Physical Facility FAIL Critical BLUE �.Comments: The steps leading to hallway have loose tread covers.secure to prevent trip hazard. Produce sink had no hot water at time of inspection.Repair and provide hot water at produce sink. Water, Plumbing and Waste PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: All repeat violations noted in the next routine inspection will be subject to fines of$25 for each repeat violation. 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. Dec 04,2007 ) Page 3 of Item Status Violation Critical Urgency k AI AOL 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. Dec 04,2007 ) Page 4 of F 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4269 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: —Comment:Cutting boards are stained and scored. Resurface or replace boards. Shpetim Sala PIC: Handwash Facilities I FAIL Critical ❑d RED Shpetim Sala menta Bach handwash sink obstructed. Sink to be clear and accessible at all times. Inspector: John Gehan ,S6r'a sink has no soap. Provide soap. Date Inspected:Correct By: wont handwash sink has no soap in dispenser. Provide soap. 4/25/2007 Risk Level: SII Mena restroom sink has no soap in dispenser. Provide soap. Permit Number: BHP-2007-0185 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. Apr 25,2007 ) Page I of f 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 and Risk Factors (Require Comment:There are personal drinks stored where food prep is done. Personal items to be stored in designated employee areas. immediate corrective action) jftilr�e are personal items stored where food is store. Personal items to be stored in designated employee areas. Equipment and Utensils FAIL BLUE omment: Pepsi refRigerator doors and tracks require thorough cleaning. e,refrigerator next to Pepsi refrigerator requires thorough cleaning. same unit has missing handle or broken handle. Repair handles to proper working order. icr ve flow requires general cleaning. Dual w oven requires general cleaning. <,, ag-continental refrigerator requires general cleaning. /Ansul system has accumulation of dust and grime. Have vents professionally cleaned. a.Ihe er are shelves beneath the grill that are covered with cardboard. Cardboard has accumulated food spills. Replace coardboard %with surface that is impervious. Shelves next to stove require general cleaning. Montague oventstove requires thorough cleaning. anitizing log not up to date. Log to be maintained daily. —MSster-bilt freezer requires general cleaning. at slicer requires thorough cleaning. Shelves above can opener require general cleaning. Syappie refrigerator requires general cleaning. Physical Facility FAIL BLUE mment: Floor beneath mixer requires general cleaning. GENERAL COMMENTS: The 2007 food permit needs to be posted. 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. Apr 25,2007 ) Page 2 of Item Status Violation Critical Urgency 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. Apr 25,2007 ) Page 3 of e 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4269 Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑d RED Owner: Comments:Cutting boards are stained and scored. Resurface or replace boards. Shpetim Sala PIC: Handwash Facilities PASS Critical Q RED Shpetim Sala Comments: Bach handwash sink obstructed. Sink to be clear and accessible at all times. Inspector: John Gehan Same sink has no soap. Provide soap. I Date Inspected:Correct By: i Front handwash sink has no soap in dispenser. Provide soap. 5/2/2007 Risk Level: Mens restroom sink has no soap in dispenser. Provide soap. Permit Number: BHP-2007-0185 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. May 02,2007 ) 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:There are personal drinks stored where food prep is done. Personal items to be stored in designated employee areas. immediate corrective action) There are personal items stored where food is store. Personal items to be stored in designated employee areas. Equipment and Utensils PASS BLUE Comments: Pepsi refRigerator doors and tracks require thorough cleaning. True refrigerator next to Pepsi refrigerator requires thorough cleaning. Same unit has missing handle or broken handle. Repair handles to proper working order. Microwave requires general cleaning. Dual flow oven requires general cleaning. Small continental refrigerator requires general cleaning. Ansul system has accumulation of dust and grime. Have vents professionally cleaned. There are shelves beneath the grill that are covered with cardboard. Cardboard has accumulated food spills. Replace coardboard with surface that is impervious. Shelves next to stove require general cleaning. Montague oven/stove requires thorough cleaning. Sanitizing log not up to date. Log to be maintained daily. Master-bilt freezer requires general cleaning. Meat slicer requires thorough cleaning. Shelves above can opener require general cleaning. Snapple refrigerator requires general cleaning. Physical Facility PASS BLUE Comments:Floor beneath mixer requires general cleaning. GENERAL COMMENTS: All violations from 4/25/07 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. May 02,2007 ) 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 02,2007 ) Page 3 of 1 t CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978.745-0343 Kimberley Driscoll WWW SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENTJ, NAME OF ESTABLISHMENT 1-1- ?_ ste � '1"�el(f / NC TEL# 7-2 ��4/ `�2i'T ADDRESS OF ESTABLISHMENT I2 2 t�f oShi a J'� S�pek FAX# �/� o ( `t� 153 MAILING ADDRESS (if different) 02 ��S,4l it 51— S Q r/Z✓l �/�- G f`� EMAIL--Business': �// / {' Owner's: r OWNER'S NAME C7 e ifkkt SCS--- TEL# ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) K C7 f`I 1v IF" CERTIFICATE#(S) -T�/ct C7 �90 (Required in an establishment where potentially hazardous food is prepared) �qI /� f� EMERGENCY RESPONSE PERSON 1';'t G2 C t1i� HOME TEL# 61r L 9 3 �aQf DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. 7 /r�i� ,.,,—(c074(& —tG9y�.." r9�,.— (c��,,,,r u�•,—lc7/r., tFerexample It— TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000scI t. =$250 _... - - - - . .. _...._..... ...._......................... ... - RESTAURANT YES NO iess than 25 seats 25-99 seats $150 more than 99 seats =$ - -... .... ... ----- - ........... - .. ----..--- --_ ...._ ..-- --- --- -----$40- ...__---- ......_.---- -- --- -- BED/BREAKFAST YES NO $900 - ... ... -... .....-.. --- --- ---- --- -- ----- - -- ...... ....... ..._,..._ ..--...... ..._.. ADDITIONAL PERMITS MAKE (riot just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $25 *Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge ,.Ind belief. have filed all state tax returns and paid all state taxes required order the law. 12 - 4, - 6 Dz v -74-/ Signaturp, Date Social Security or Federal Identification Number ---------------- -------------------- ---------------- --- --------------- ----- ----- ---------- ---------- ------ "----------------- ----- ----- ----------- ------------------ ---------- ----- ---- Revised -Revised 11/19/06 FOODAP2007 adm Check#&Date //37�'_ _ /, /per/Q6 _ S1+i"Q,O r, r,'.yRyw�ti ",�y"i�u.,.s.� ;.k , , :Y.'�T �; , -i—ommonwealth of Massactiu'setIs , i f ''at4 � 1 let • g #<Rp to CI of Salem; , gra. , y ty, � '" S-� '] } l i�� SVI.i1^.�e � t R � �f Iia. • ''t 4 p R t.,� s�R_i'�r-$'`. si '5�. d�'S1�B08Cd Of Health'�;j Klmbedey Driscoll 1120 Washington Str;e"4th Floor :w 1 . .Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: A Taste of Thyme Cafe File Number,BHF-2004-000114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0185 Dec 20,2006 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 18 ..'122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4269 Handwash Facilities PASSd❑ RED Owner: Comments: Back hand wash sink requires general cleaning. Shpetim Sala PIC: Shpetim Sala _ Inspector: John Gehan Date Inspected:Correct By: 11/14/2006 Risk Level: Permit Number: BHP-2006-0457 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 21,2006 ) 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:Ice machine has accumulation of grime and mold. Thoroughly clean and sanitize ice machine. immediate corrective action) Spoons on side of soups need to be handle side out to protect from contamination. Equipment and Utensils PASS BLUE Comments:General cleaning of the true unit required. General cleaning of the peps!beverafe air unit required. Microwave requires general cleaning. McCall refrigerator requires general cleaning. General cleaning beneath shelves is required. Utensils being stored incorrectly on oven. Utensils to be stored in designated area. Master Bill unit requires general cleaning. Pepsi true unit requires general cleaning. Mop stored incorrectly. Mop to be stored so that it can air dry. Snapple refrigerator in front requires general cleaning. Sanitizing log not up to date. Log to be maintained daily. Sanitizing strips incorrect type. Correct type to be bought or on hand at all times. Spice rack area requires thorough cleaning. White freezer downstairs requires thorough cleaning. Strong odor coming from inside. Unit should also be running as designed. If not being used,discard. Walk in shelves require thorough cleaning. Shelf protection in basement requires changing. Physical Facility PASS BLUE Comments:There is a water stained ceiling tile in the kitchen. Find source of leak and repair. Replace tile. GENERAL COMMENTS: All violations have been 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. Nov 21,2006 ) 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 21,2006 ) Page 3 of 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4269 Handwash Facilities FAIL RED Owner: omment: Back hand wash sink requires general cleaning. Shpetim Sala PIC: Shpetim Sala Inspector: John Gehan Date Inspected:Correct By: 11/14/2006 Risk Level: Permit Number: BHP-2006-0457 Status: Open #of Critical Violations: 2 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 14,2006 ) Page 1 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 and Risk Factors (RequireL-Cmt: Ice machine has accumulation of grime and mold. Thoroughly clean and sanitize ice machine. immediate corrective action) ,—spoons on side of soups need to be handle side out to protect from contamination. Equipment and.Utensils FAIL BLUE "-Comment:General cleaning of the true unit required. neral cleaning of the Pepsi beverafe air unit required. LIVjw wave requires general cleaning. arefrigerator requires general cleaning. ,-,�ereral cleaning beneath shelves is required. LW,fsilt being stored incorrectly on oven. Utensils to be stored in designated area. L_Masfer Blit unit requires general cleaning. (fpsi true unit requires general cleaning. stored incorrectly. Mop to be stored so that it can air dry. pple refrigerator in front requires general cleaning. j_Sanitiiing log not up to date. Log to be maintained daily. nitizing•strips incorrect type. Correct type to be bought or on hand at all times. pice rack area requires thorough cleaning. .t/hite freezer downstairs requires thorough cleaning. Strong odor coming from inside. Unit should also be running as designed. If not being.used,discard. nhelves require thorough cleaning. elf protection in basement requires changing. Physical Facility FAIL BLUE �ornment:There is a water stained ceiling tile in the kitchen. Find source of leak and repair. Replace tile. GENERAL COMMENTS: Owner to have readily available the last three months of extermination or fax them to the board of Health. 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. Nov 14,2006 ) Page 2 of Item Status Violation Critical Urgency C O City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 14,2006 ) Page 3 of qui 10 � S�bKe Cu i 4-Ci fi wn eve Zls� o.F �Prna��ti Ili volu ,74-a;11y u9i// SfvP v �i�y all .5 pma etr e t 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone' - - PROTECTION FROM CONTAMINATION 741-4269 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 0 RED Owner: Comment:There was no sanitizing solution available in the cookline. Sanitizing solution of proper concentration must be readily Shpetim Sala available at all work stations at all times. PIC. The sanitizer in the 3 bay sink found too weak. Sanitizing solution of proper concentration must be used in the 3 bay sink to Shpetim Sala properly wash, rinse and sanitize dishes and utensils. Inspector' The cutting boards are badly stained and scored. Resurface or replace all cutting boards. David Greenbaum Date Correct By: Violations Related to Good Retail Practices (Blue Items) MI&JO16 Physical Facility FAIL Non-Critical BLUE Risk Level: Comment:The basement storage area does not have finished floors,walls and ceilings. The basement storage area must have finished floors,walls and ceiling. Permit Number: The floor in the basement storage area needs to be repainted. BHP-2006-0457 There are water stained ceiling tiles in the kitchen. Investigate the source of the leak and repair. Replace all stained ceiling tiles. Status' SIGNED OFF NOTE: These violations must be corrected by the next routine inspection. #of Critical Violations: GENERAL COMMENTS: 1 636:AII other violations cited in the 5/23/06 inspection report have been corrected. Time IN Time OUT: All other requirements to operate a food establishment have been met. 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. Jun 01,2006 ) Page 1 oft J Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 01,2006 ) Page 2 oft 122 Washington Street A Taste of Thyme Cafe 4 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone' PROTECTION FROM CONTAMINATION 741-4269 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 0 RED Owner: coo rrfiint:There was no sanitizing solution available in the cookline. Sanitizing solution of proper concentration must be readily Shpetim Sala —%Svailable at all work stations at all times. PIC: The sanitizer in the 3 bay sink found too weak. Sanitizing solution of proper concentration must be used in the 3 bay sink to proper) wash,rinse and sanitize dishes and utensils. Inspector: ere were dirty knives stored between equipment. Knives must be cleaned and sanitized and stored in an appropriate knife rack. David Greenbaum Date Correct By: The cutting boards are badly stained and scored. Resurface or replace all cutting boards. 1W2T&@d6 Good Hygienic Practices FAIL Critical RED Risk Level: Com : Employee drinks observed throughout the kitchen area. Employees must eat and drink in a designated employee break r or in the dining room to prevent cross contamination. Permit Number: BHP-2006-0457 Prevention of Contamination from Hands FAIL Critical ❑/ RED Status: Co ent: Employees observed not wearing gloves when handling ready to eat food. Employees must use didposable gloves, VIOLATION g or deli tissue when handling ready to eat foods. There is to no bare hand contact with RTF. #Of Critical Violations: ' Empl a jacket observed hanging above the produce sink. Employees personal items must be stored in an appropriate storage 8 kjLM to prevent cross contamination. Time IN. Time OUT: Handwash Facilities FAIL Critical RED Urgency Description(s) Com nt:The kitchen hand wash sink missing paper towels. Provide disposable paper towels at the hand wash sink at all times. BLUE: ThItchen hand wash sink found obstructed. Keep hand wash sink clear and accessible at all times. Violations Related to Good Retail Practices (Critical The are items stored around the counter hand wash sink. Keep hand wash sink clear and accessible at all times. Do not store violations must be corrected a Hing around the sink. 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. May 25,2006 ) Page 1 of Item Status Violation Critical Urgency RED: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Cooling FAIL Critical RED Foodborne Illness Interventions and Risk Factors (Require corn nt:There was a large container of chowder cooling on the kitchen floor. Cool foods in containers no deeper than 4"and d should be cooled in a refrigeration unit. Employee iced and put chowder in smaller containers at the time inspection. immediate corrective action) CONSUMER ADVISORY Posting of Consumer Advisories FAIL RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 25,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) _ Food and Food Protection FAIL Critical BLUE Comme here is food stored directly on the floor in the basement storage area one case showed evidence of water damage. Sto all food at least 6-8 inches off the floor,discard water damaged product. There is n stored directly on top of lettuce in a container. Do not store any pans over ready to eat foods to prevent cross con ination. The s food stored directly under a waste pipe. Owner must relocate food from under the wast pipe. Equip ent and Utensils FAIL Non-Critical BLUE omment: T e microwave has an accumulation of food spills and splatter. Thoroughly clean the microwave. The is accumulation of food spills and splatter at the waffle iron. Thoroughly clean this area. canopener needs a thorough scouring. LTPw0'e`psi cooling unit near the dishwasher needs a thorough cleaning. Th me ' needs a new visible,accurate thermometer. The me it needs a cover on the light. The ay sink must be relabeled"wash-rinse-sanitize"fom left to right with the sanitize bay nearest the drain board. Thee ' e cookline has an accumulation of grease and grime. Thoroughly clean the entire cookline. refrigerators and freezer units need a thorough cleaning. rigedaire freezer in the basement needs a visible,accurate thermometer. The Ik i has an accumulation of food debris. Thoroughly clean the entire walk in. T e are pots and pans hung over the 3 bay sink. Remove all pots and pans from above the 3 bay sink to prevent cross ontami on. mop was found improperly stored. Mop to be rinsed and cleaned and hung upside down not touching any surface to air dry. Physical Facility FAIL BLUE Cc ant:The Ansul vent system is due to be cleaned. The last cleaning was in May of 2005. This system must be cleaned at least ce per Kyear. Salem Fire Prevention Bureau will be notified regarfing this matter. g7eeading to the hall are in disrepair. Repair or replace the stairs and treads. re unfinished shelves in the basement storage area. All shelves must be impervious and easily cleanable. The basement storage area does not have finished floors,walls and ceilings. The basement storage area must have finished floors,walls and ceiling. 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. May 25,2006 ) Page 3 of Item Status Violation Critical Urgency loo.The floor in the basement storage area needs to be repainted. There are many water stained ceiling tiles throughout the establishment. Investigate the source of the leak and repair. Replace all s stained ceiling tiles. Special Requirements FAIL Critical BLUE Com t:The owner had no extermination invoices. Owner must have a monthly extermination crontract with a licensed pest co of operator. GENE L COMMENTS: 629: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2006 Des Launers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 25,2006 ) Page 4 of -- 1 . w .,»�yya.'^ ..pp".�':>� .+s.: w. ..1 x . ew...n.+x. .v .-.«. ._.v�..___. ,W't...•.` t - Commonwealth of Massachusetts v City of Salem Kimberley Driscoll k k Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01470 Food/Retail Establishment Permit DATE PRINTED: 04/19/2006 WHO'S PLACE OF BUSINESS IS: A Taste of Thyme Cafe File Number:BHF-2004-0114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions t Notes FOOD SERVICE BHP-2006-0457 Apr I9,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES (December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit most be posted in A prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonatious. ingmovcments,or equipment changes:u'c mule, all plans for such nurse be subutiited to and approved by the Salent Board of Health. Page 1 of t Alla Pr A CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 0N6 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT rA�_k vhf TEL# Ol&$ ADDRESS OF ESTABLISHMENT \I a- wv��h•wS�v� D� �w�ew, MAILING ADDRESS (if different) //� y� OWNER'S NAME Sl ��ravll;', p cS��—+T TEL# 67 628--1/63 ADDRESS ly((//eS'&4; J ( � 3 CITY STATE ✓-1'4 zip O2/4S CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON SPZ# HOME TEL# 964 HOURS OF OPERATION: Mon6"°'/94fue. -6=-/cured. C- -Thu. 6 --/0Fri0–eoSat. 6—/vSun.Ba� o^ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 --------------------------------- _----------------------------------- ---------------------- RESTAURANT ES NO less than 25 seats $100 25-99 seats 1 0 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. Si� Date Social Security or Federal Identification Number --------------------------------------------------------------- ----- ---- -------- - ------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date CITY OF SALEM BOARD OF HEALTH Date: March 24, 2006 Name of Establishment: Taste of Thyme Address: 122 Washington Street Owner(s): Shpetim Sala Phone: 978-741-4269 The proposed owner of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. An updated Floor Plan must be submitted. CERTIFICATION Mr. Sala will be the Certified Food Manager who will work full time at this location. He has enrolled is a CFM class. A current employee of the establishment will also be the CFM. A "Person in Charge" or "Pie' must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. FLOOR PLAN A Hand Sink is located in the front service area and in the rear prep area.. The hand sink must have a wall hung soap and paper towel dispenser. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the basement. A dishwasher and a three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes will be used. The dishwasher must have a final rinse temperature of 180 degrees in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENU/FOOD PREP Reviewed preparation of a soup item. All food must be held at 41"F or lower, or 140°F or higher, at all times. Therefore, soup and other hot items should be brought to boiling before being held hot. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. .. � i There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKED FOODS The advisory was given to the owner. If no undercooked food items are to be served, then the menu must state that. If undercooked items are to be served upon request then the advisory must be followed. CHOKE SAVING A person trained in choke saving techniques must be available whenever this establishment is open for business. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Outside area of premises, including the dumpster area, must be kept clean and sanitary. This establishment is scheduled to open in early to mid April. Please call one week prior to opening to schedule an opening inspection. Mr. Sala submitted an application. No check was received. J nne Scott Date Health Agent Ownef/J Date i A TASTE OF THYME CAFt CHEF KEN'S SPECIALITIES 122 WASHINGTON STREET 1. EGGS BENEDICT-Two Poached Eggs Served SALEM, MA Atop Two English Muffins with Country Ham and 978-7414269 Topped with Creamy Hollandaise Sauce Served BREAKFAST with Home-fries $6.50 Served Monday-Friday 6:00 AM-11:00 AM 2. EGGS FLORENTINE-Two Poached Eggs Served Saturday 7:00 AM-12:00 Noon,Sunday 7:00 AM-1:00 PM Atop Two English Muffins with Fresh Steamed Spinach EGGS YOUR WAY! and Fresh Grilled Mushrooms Topped with Creamy Hollandaise Sauce. Served with Home-fries $6.50 Served with home-fries or homemade beans and toast ( $.30 Additional for each Egg Beater) 3. THRILL OF THE GRILL-Stack of Pancakes or Texas French Toast,Two Eggs Any Style with ONE EGG TWO EGGS Bacon,Ham or Sausage,Toast and Home-fries $6.95 ANY STYLE $2.50 $2.95 With: Bacon,Country Ham,Or Sausage $3.50 53.95 4. CAPTAIN CRUNCH FRENCH TOAST-Texas Toast Grilled Kielbasa $4.30 $4.95 Coated with Chef Ken's Special Crunchy Coating Corn Beef Hash. $4.50 $5.30 Topped with Butter $5.50 Angus Sirloin Tips $6.50 $7.50 (Additional Eggs$.60 Each) PANCAKES -THREE HEARTY PANCAKES HOMEMADE FROM SCRATCH OMELETS Buttermilk Short Stack $3.00 $4.00 Three Eggs $3.95 Blueberry Short Stack $3.50 $4.75 Three Eggs,Tomato&Cheese $4.50 Chocolate chip Short Stack $3.50 $4.75 Three Eggs,Mushrooms& Cheese $4.50 Banana Short Stack $3.50 54.75 Three Eggs,Broccoli&Cheese $4.50 (Served with warm whipped butter) Three Eggs,Spinach&Cheese $4.65 Three Eggs,Garden Veggie $4.95 FRENCH TOAST (Tomatoes,Peppers,Onions,Mushrooms,Broccoli,Spinach) Three Slices of Texas Style Bread $4.75 Three Eggs,Bacon&Cheese $5.25 (Served with warm whipped butter) Three Eggs,Sausage&Cheese $5.25 Three Egg,Western With Cheese $5.50 Strawberries and Cream-Fresh sliced Strawberries, $5.50 Three Eggs,Hash And Cheese $5.50 Whipped cream Served with home-fries or homemade beans and toast Red,White and Blue Strawberries,Blueberries and $5.95 BREAKFAST SANDWICHES Whip Cream Fried Egg In An English Muffin $1.95 Banana Chocolate Chip-Fresh Bananas and $5.50 With Cheese $2.25 Chocolate chips With Ham,Bacon Or Sausage $2.95 With Cheese,Bacon,Ham Or Sausage $3.25 Banana Walnut- Fresh Bananas and Walnuts $5.50 Western-Peppers,Onions,&Ham $3.25 Eastern-Peppers&Ham $3.00 BELGIAN WAFFLES Additional Items $0.30 This delicious large,light and airy waffle is made with our$5.50 homemade batter. SUBSTITUTIONS Red,White and Blue-Strawberries,Blueberries and $6.50 BAGEL ADDITIONAL $0.50 Whip Cream ENGLISH MUFFIN $0.35 Apple Cinnamon-Apples,Cinnamon,Powdered Sugar, $5.95 Whipped Cream SIDE ORDERS Homemade Muffins made Daily $0.95 Strawberries and Cream-Fresh sliced Strawberries, $5.95 English Muffin-Grilled Or Toasted,Butter Or Jam $0.85 Whipped cream Bagel $0.95 Bagel With Cream Cheese $1.35 Banana Walnut- Fresh Bananas and Walnuts $5.95 Toast With Butter Or Jam $0.85 Bacon,Country Ham Or Sausage $2,25 BEVERAGES Cornbeef Hash $2.50 Coffee/Tea $1.25 Bee $1.30 Iced $1.50 Homefries $1,75 Flavor Coffee/fea$1.35 Homemade Baked Beans $1,75 JuicelMilk Sm $ .95 Med $1.25 Lg $1.50 Hot Oatmeal with Fruit Cup$1.25 Bowl $1.75 Fountain Soda $1.15 Bottled Soda $1.35 Assorted Brands of Cereal $1.50 Hot Chocolate $1.25 f WRAP & POLL 7 Pick your wrap - Italian, Plain, Sundried Tomato, Lo Cal Wheat, Spinach and be prepared to roll out of here! Served with French-fries, chips and pickle or tole slaw Santa Fe Chicken Wrag-grilled strips of fajita chicken,melted Jack cheese,Mexican rice,spicy black beans,sour cream and chunky salsa $6.75 Chicken Finaer BLT Wrap-hand battered chicken fingers topped with lettuce,tomato,crispy bacon and mayo $6.50 Chicken Caesar Wrap -our classic Caesar salad topped with fresh grilled chicken $6.50 Veaaie Wrap-fresh spinach,broccoli,fire roasted peppers,red onion,marinated Portobello mushrooms topped with aged provolone cheese $6.25 Buffalo Chicken Wrap -boneless chicken tenderloins,seasoned with Ken's hot sauce topped with lettuce, tomato and Blue Cheese $6.50 Ranchero Wrap-lean strips of sirloin of beef saut6ed with roasted red peppers, roma tomatoes,onions and tossed with Jasmin rice and sweet teriyaki sauce $6.50 Greek Salad Wrap with Grilled Chicken—lettuce,tomatoes,red onions, black olives,cucumbers,feta cheese and seasoned grilled chicken $6.75 California Wrap- fresh roasted hummus topped with fresh baby spinach,artichoke hearts, roasted red peppers,havarti cheese and portabella mushrooms, $6.50 Southwestern Wrap—Grilled spiced chicken, bell peppers,onions,Jack cheese,salsa and sour cream $6.50 Chicken and Eaaolant Wrap—grilled marinated chicken and roasted eggplant,sun-dried tomatoes,spinach, Harvarti `cheese and pesto mayo $6.75 IQ�i I ENTREES - Lunch shouldnt be this good -Don't blame us if you cant eat dinnerl Chicken Finger Plate—Strips of fresh tender chicken tenderloins deep fried to a golden brown served with French-fries and tole slaw $6.95 Chicken Quesadillas-fresh grilled seasoned chicken served atop a crispy tortilla wrap with onions, tomatoes,mushrooms,melted cheddar cheese served with salsa and sour cream $6.95 Marinated Anpus Sirloin Steak Tips—grilled to your liking with choice of teriyaki, BBQ,or honey mustard sauce served with French-fries and coleslaw $7.95 Fish and Chips-8 o/z of fresh haddock hand battered and deep fried to a golden brown served with French-fries and cote slaw $7.50 Grilled Atlantic Salmon—8 oz. salmon fillet grilled to perfection served with rice pilaf and fresh vegetable $8.50 Fresh Bakedl3oston Scrod-baked in lemon butter toppedwith homemade seasoned cracker crumbs served with fresh mashed potatoes and vegetable of the day $7.95 Chicken. Broccoli and Ziti—saut5ed chicken,crisp broccoli and zits in a rich creamy alfredo sauce $7.50 Chicken Parmiaiana —(House Favorite)-boneless breast of chicken baked with a homemade tomato sauce dripping with mozzarella cheese served over choice of pasta $7.50 Bruschetta Chicken-fresh roma tomato-basil salsa tossed with angel hair pasta topped with sliced chicken breast served with garlic Ciabatta garlic bread wedges $7.50 Tomato Basil Cheese Ravioli-fresh raviolis smothered with tomato/basil sauce dripping with cheese served with garlic ciabatta bread wedges $7.50 'Thyme" for Lunch Served: 11:00 AM Monday - Saturday A TASTE OF SOUP- You've heard of the Godfather of Soul, well,we have the Godfather of Soup. Our soups are made daily using fresh garden vegetables, herbs, meat and poultry. CUP BOWL Soup of the day $2.25 $2.95 Ken's award winning chowder $2.75 $3.75 Homemade thick spicy chili $2.50 $3.25 (served with crackers or rolls) IWSALADS - 'Tony the Produce Man" picks up our fresh vegetables every morning at the produce market in Boston. Blame him if we dont have it today) Small Large Our Garden-greens,carrots,cherry $2.75 $4.25 tomatoes,cucumbers,onions, black olives, Bell peppers, homemade croutons Garden Salad with grilled marinated fresh chicken $5.95 Tuna salad-White Meat Tuna $5.50 Chicken salad-Made with Fresh Baked Chicken $5.50 Greek salad $5.50 Caesar salad $5.50 with grilled marinated fresh chicken $6.50 with grilled ponabella mushrooms $5.95 Chef salad-Made with freshly baked roast beef,ham and turkey topped with cheese $6.50 Grilled Sesame Beef Salad-Thinly sliced sirloin of beef tossed In a light sesame teriyaki sauce served over a large house caesar salad $6.50 Taco salad-an edible taco shell stuffed with lettuce,tomato,onion,cheese, chili,topped with cheddar cheese $6•50 Southwestern Fiesta Chicken Salad-sliced grilled chicken, salad greens tossed with grilled peppers,onions,shredded cheddar cheese,roma tomatoes topped with black bean salsa and sour cream $6.50 Choices of salad dressings: Lite Italian,Creamy Italian,Caesar,Greek,Balsamic Vinaigrette,Wandell Vinaigrette, Raspberry Vinaigrette,Blue Cheese,Russian,Parmesan Peppercorn, Honey Mustard and Oil And Vinegar SOUP OR SALAD OR HALF-SANDWICH - Select any two Cup of soup,a small garden salad OR One-half of any cold sandwich listed under"sandwiches" $5.25 Substitute Chowder $ .50 Substitute Caesar Salad $ .50 I� - "THE SANDWICH BOARD" Eat healthy for a change) We season and bake fresh chickens, hams, turkeys and roast beefs every morning in our ovens. All of our sandwiches come with choice of crispy French-fries, tole slaw or chips and pickle or whatever else the chef feels like making. Grilled cheese $3.00 Grilled cheese and tomato $3.50 Grilled ham and cheese $4.75 BLT(bacon, lettuce and tomato) $4.50 Imported ham and cheese $4.50 Fresh baked turkey $4.50 Tuna salad(all white tuna) $4.50 Chicken salad(fresh all white chicken breast) $4.75 Smoked turkey $4.95 Roast beef $4.95 Any sandwich can be made into a triple decker for an extra $1.50 Lettuce,Tomato or Onion $ .15 a "THE CHEF'S CREATIONS" Chefs get blamed for a lot of things but they cant be held responsible if you fall in love with thesel Served with French-fries, tole slaw or chips and pickle. Bulkie Burgers- Fresh black anjus beef 1/2 pound burger grilled to your specifications topped with lettuce,tomatoes and cheese served on a grilled bulkie roll $5.95 add bacon $6.50 add peppers,onions,mushrooms $6.50 Fancv Charlie- this all white meat tuna melt is dressed up with roasted red peppers,artichoke hearts And swiss cheese served on grilled dark rye bread $5.95 New Yorker -grilled lean fresh corn beef grilled and topped with Sauerkraut,Russian dressing, Swiss cheese served on grilled rye $6.50 " Mommie Dearest'-Lean black pastrami, fire roasted peppers,grilled onions,Swiss cheese and Honey Dijon sauce served on a grilled bulkie roll or fresh focaccia bread $6.50 Grand Slam-fresh baked turkey,country baked ham,Swiss cheese,home made coleslaw,Russian dressing served on grilled ciabatta bread $6.50 Henney's Gone Italian-grilled fresh chicken smothered with marinara sauce and mozzarella cheese served on a bulkie roll $5.95 Garden Patch-grilled fresh spinach, broccoli,fire roasted peppers,red onions,marinated portabella mushrooms topped with provolone cheese served on grilled focaccia bread $5.95 "The Taste of Thvme"-boneless chicken breast topped with baby spinach,roasted red peppers, artichoke hearts,honey dijon sauce and Swiss cheese served on grilled focaccia bread $6.50 'CONSUMING RAW OR UNDERCOOKED PRODUCTS COULD INCREASE YOUR CHANCE OF CONTRACTING A FOODBORNE ILLNESS ^.W. "A«` Y'i ft'31a'4'�$ryaT3`N'�' ' .•^ 'T s•a $ #�.N � , -' u ..y. F %4; r3. ° ffi ' • : •,- -, ' CommanweaiW of Massachusetts �� Ll��'�j. �^J..,t h ,- .. : . City of Salem Board of Health +� 120 Washington Street,4th Floor SALEM,MA 01970 Fes " Food/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: A Taste of Thyme Cafe Fite Number:i3HF-2004-0114 122 Washington Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes FOOD SERVICE BHP-2006.0025 .Ian 2,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 ` Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in 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 i of 26 CITY OF SALEM, MASSACHUSETTS D BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR .�.... SALEM, MA 01970 +<s!! DEC TEL. 978-741-1800 0 �o FAx 978-745-0343 C 6 2005 STANLEY J. USOVICZ, JR. �Ty MAYOR WWW.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO- AOPE�RATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT X Tsfe CTr CV qM _ TEL# 9 V Tell- 542-6-n/ ADDRESS OF ESTABLISHMENT /v2oZ �J/J<Sffiitlhfr 7t • MAILING ADDRESS (cif different) —� OWNER'S NAME I_ eJ.P C(-LI rrLa-AJ)Lz. TEL# ADDRESS CITYBc6*4 -emA STATE ZIP 03933 CERTIFIED FOOD MANAGER'S NAME S} e`K CERTIFICATE#(s) '17S 3 SIV l S.PO (required in an establishment where potentially h zardous food is prepared.) EMERGENCY RESPONSE PERSON KC4 n ?I� ;F6AuJP(1 HOME TEL# )X '4(P1=00x2 HOURS OF OPERATION: Mon )-(0 Tue.7-" Wed.7.-"Thu.�" Fri..7'rySat.7:" Sun. 7-'4'O 2:M Q:Qo a: av 2•'6-0 2: , o a.v� /.-&-o 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 ............ ... . ..N.O............... ........------------------- ---t-h-- a--n- -- --5...s.ea... ------------=--$10---- ----------------- RESTAURANT YES" le-ss -2--5 0 690 —0� more seats =$150 ' more than 99 seats =$200 - ----- ------------------------------------------------------------------------------------$-10-0- -10----------------- BED/BREAKFAST YES NO 0 - .....----------------------------------------------------------------...------......------------------------------------- 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. A-/'arr� o 113 -5-1Y o3 y S,,nature r Date Social Security or Federal Identification Number ---------------------------------------------------------------i;15'73 Revised 11/03/05 FOODAP2.adm Check#&Date -i L------/- a- - -7---------------------------------------- l50 Massachusetts De artment of Public Health Salem Board SHealth h 120 Washington Street,41h Floor Division of Food and Drugs Salem,MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978)745-0343 Name D j I Tvoe of Ooerationts) Type of Inspection Tj ,,Lyf ��,��_ �r/n�, ® Food Service ❑ Routine Address "! 7 i Risk' (� Retail [0 Re-inspection Level ❑ Residential Kitchen Previous Inspection { Telephone �L, I��j/Gr ❑ Mobile Dateajyf,yG Owner HACGP YiN ❑ Temporary ❑ Pr -operation K�i L� f V o 1 r� ❑ Caterer ❑Suspect Illness Parson in Charge{PIG) � Time ! ❑ Bed&Breakfast ❑General Complaint �,.,r ''�''J In: e Ip it ❑HACCP Inspector t } �M K P(. IC Out:/* , n Permit No. El Other Each violation checkedirequires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Nan-comptiance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 5e0.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH _ PROTECTION FROM CHEMICALS ❑ 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 TIMEtt EMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation!Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices [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 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 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 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: 5$Wffi a fh.a -14 d. lei Inspector's • atu e: } a , Print: o,:;o ¢\lI PIC t,s*�� - - I Print �� t,z� v. R- �� 4`-� 1-•�..�\_Vt`Page�..oV0.Pakes Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 1 590.003(A) I Assignment o1'Responsibility* I 3-302.! :(A)(1) Raw Anima! Foods Separated from 590.003(6) ( Demonstration of Knowledge" I ( nuked aunt R17,Fmi, 2-103.11 I Person in charge-duties I Contarnrnaton hzm Raw ingredients Raw Animal Foods Separated from Each EMPLOYEE HEALTH O flet 2 590.003(C) Responsibility of the person in charge to Contarrination from the Environment require reporting by food employees and 3-302 1 It A` Food Protecnon" applicants* ( 3-302.15 W'a;hin Fruits and Vegetables 590 003(F) Responsibility Of A Fond Employee Or An 13-304.11 Food Contact with Equipment and ,Applicant To Report To The Person In (]tem:ih* Chame* I I Contamination from t+,e Consumer 590.003(G) Reporting by Person in Charge* I ( 3-306.14(,1)(€1) Returned racxl and Reservicc of Food* 3 590.003(1)) Exclusions and Restrictions" I Disposition ofAd,rltaraledor Contaminated 59(1.003(0 Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fes" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law-* ( 4-501.111 M..nual Wwtvw-ashutg-Hot Watet 1 o * Sanitization"temperatures"3-201.1_ Food m il Hermetically Scaled Container* 3-301.13 Fluid Milk and Milk Products* 4 501.1 !2 Mechanical Warewashm.-Hot Water I 3-202.13 Shell Eggs* I Sanitization Temperatures" 3-202 14 Eggs and Milk Pt ducts. Pasteurized* ( 4-501.114 Chemical Sanitization-temp., pH, concentration and hardness. 'r 3-202.16 Ice Made From Potable Drinking Water` 4-601.1 I(A) Equipment Food Contact Sudaceq and 5-101.11 Drinking Water hom an Approved System* I utensils Clean" 590.006(A) Bottled Drinking Water" 1590.006(B) Water Meets Standards in 310 CMR 22.04' ( 4 t>02.11 Cleaning Surfaces eu y of t Equipment Fad- ( Shellfish and Fish From an Approved Source I Contact cy of Sanitization and Utensils` 4-702.1 I Frequency of Sanrizatien otlltensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Egtdpnrent Shellfish* F-703.11 :Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources" 110 ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( 2.3011! Cl. rm Condition-Handsand Arens+' Regulatory Authority I I 3-2021& Shellstock Identification cation Present* 2-301.12 Cleanme Procedure* I 590.004(0) Wild Mushrooms" ( 12-301.14 When to Wash" 3-201.17 Game Animals* I I It ( Gond Hygienic Practices g ( Receiving/Condition I 2-101.; I Eatma.Drinking or Using Tobacco" 3-202.11 PHFs,Reserved at Proper Temperatures" ( 2-401.12 Disthrrzes From the Eyes, Nose and 3-202.15 ( Package httegrity* Mouth* 3-I(11.11 I Pani Safe and Unadulterated* I 3-301.12 Preventing Contamination When'rasting* 6 112 Prevention of Contamination from Hands Tags/Records:Shellstock 3-202.18 Shellstock Identification^ i90.001(13) Preventing Contamination from 13-203.12 Shellstock Identification Maintained" mployecs` 13 Handwash Facilities TagslRecords:Fish Products I 1 Conveniently Located and Acces3ible 3-402.11 Parasite Destruction* 3-402.12 Records,Creation and Retention" 15-203.11 Numbers and Capacnies" 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placerucnt� 7 ( Conformance with Approved Procedures 5-205.11 Aceessd tot).Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* I Devices 1ri-301.11 HandwadtingC!canscr, Availability 3-502.12 Reduced oxygen packaging,criteria 8-103.12 Conformance with Approved Procedures" I 6-301.12 Hand Drying Provision *Denotes enttcsd acnt in the ledu'al 099 Food Code in 105 0:1112 590,000, i CITY OF SALEM _ ff �[ BOARD OF HEALTH . Establishment Name: (Gs�r r�F I /Ic.b1,_ r"l Date: r2�,110 C Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date -No. Reference R—Red Item Verified LEASE PRINT CLEARLY i �r G 0,) 13 !6)* 0 �f�oor�i� nl050., - - - -- . r -,A4d/IL / 0Lh rl cs- C L2 .n O 1 vx / ! I I {�i7f�r.�� 1.�, � {�/' �-M�9C_ llG � �in�9' � /� 9 1-77 7�!�/bn A ��,,� r,✓l� I lf,,n, iii[ C ,/•nl ed {f.� !'P o,✓.no./ ' P rr J CA-0 GJ J,Jz J/ 19ef IILt"_J� K-1. I 1 - I 1 ` I 1 1 I I I I I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No l Yes 1 have read this report, have had the opportun' sk qu tions nd agree to correct all '�—Voluntary Compliance ❑ Employee Restriction / y Exclusion Al violations before the next inspection, to observe\ II cnditi ns as d `cribed, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Fo Cod I understand tat � 1� noncompliance may result in daily fines of tw ` ty-fl doll rs or suspennsl n/revacation of ❑ Embargo Ll Emergency Closure your food permit. �� — 0 Voluntary Disposal ❑ Other: 3 50' 1;-C:'- PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accciding to Law Cooled to Factors(items 1.22) (Cont.) .I I F/45'F-Within 4 Howl. " 11 PROTECTION FROM CHEMICALS I '-c•u:.1 5 Cooling Methtxls for PHFs 14 Food or Color Additives 119 PHF Hot and Cold Holding 3-203.12 Additives3-501 16(B I Cold PHFs M,lintaittell at or below '" 540 ftl-4(�t 41'!1>° F" i-302.14 Protection from Unapproved Additives" _i-501.4l") Not PHFs M:unto;ned az or above 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original I 1-twy. Containers' 3-501 INA) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Ccrutainers* I 20 Time as a Public Health Control 7-201.11 Separation-Ski ugu` 3-i0l A 9 Time w n Public Health Control* 7-202 11 Restriction-Presence and Use 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203 11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(A.I IPOPULATIONS(HSP) � Saititizeis,Critervt-Chemicals" 7=204.12 Chemicals for Washing Produce,Criteria' 21 3-801.11(A) ( Unpasreiir;zcd Pre packaged Juices and 7-204.14 Diving Agents.Criteria" Beverages with tiN arrant,Labels r 1 3-g0i.11{B) l Use of Pasteurized Eees* 7-205.11 Incidental FooUse Contact, Lubaertal' 13801 111I)I Raw or Pattialt Cooked.Animal Food and 7-206,11 Resected St Pesticides.Catena* Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations �, j 3-801.11(0) Unopened I?",' Package Not Re-served 4' 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60111 Consumer.Advisory Posted for Consumption of Annual Foods That are Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs ErMcb,I;:1.10111 3-301.1]A(]l(2) Eggs- 155°F 15 Sec. Padrigens.^' Egos-hnmectiate Service 145'F15scc^ 3-30'-.13 Pasteua reel Eggs.Substitute for Raw Shell 3-401.1l(A)(2) Comminuted Fish,Meats r@ Game Eggs! _- Animals- 155'F 15 sec. " 3-401.11(6)(1)(2) Pork and Reef Roast- 130°F 121 nein* SPECIAL REQUIREMENTS - 3-401.11(A)(2) Raines, Injected Meats-155°FIS 590 009(A)-(D) Violations of Section 590.009(A)-(U)in sec, * I catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Studied PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'P 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 I Raw Animal Foods Cooked in a practices should be debited under#29 - Microwave 1650F* SPecial Requirements. 3-401.11(A)(1)(b) All Other PHFs- 1.15°F 15 sec. 17 I Reheating for Hot Holding f VIOLATIONS RcLA TED TO GOOD RETAIL PRACTICES 3-303.11(.A)K(D) PHFs 165°F 15 sec. * I (Items 23-30) 3-403.11(B) I Microwave- 165'F 2 Minute Standing Citi(al and non-critical violations, •.shirh do not relate to the Time* ,foodborne illness interventions and risk jo(tore listed above, (on be 3-403.11(C) Commercially Processed RTE Fcwd- found in the follna-ing scrtdons qJ the Food Code and 105 C7Y/k 140°Ft .590.(_16.0. m . 3-10111(E) Remaining Unsliced Portions of Reef Item Good Retail Practices FC 590.000 Roasts" 23. Management and Personnel FC-2 .003 IR ( Proper Cooling of PHFs 24 Food and Food Protection FC-3 .004 1 25. Equipment aid Utensils FC-4 .005 J 3-501.14(A) Cooling Coked PHFs from 1407 to 26. Water.Plumbing and Waste FC-5 .006 1 70`F Within 2 flours and From 70'F 27. Physical Facility FC-6 .007 to 41°F/451F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 1 29Special Requirements 009 Temperature Ingredients to 41°F/45"F 130. Other Within 4Ilours'i s •oa,,,n.an �.. Denotes critical vent m Ihr federal 1999 Pond Code or 105 CMI2 590 000. ry, n§'PI.z�,YM:�M M�''^' ^nY•.•r•L'r-,GI..••M•'4,z..Nv.r-.M.P �. - i F•F'd' K+ f•. 4s h iA..l Y...^ fiy. T - .�r rMP,,yr Salem Board of Health Mass* usetts Department of Public 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 t { DFe Type of Operation{s1 Tv of inspection //`ii !J rN� � I�( � � ��Food Se vice Routine Address 0 � RRetail ❑ Re-inspection 4 _ Level ❑ Residential Kitchen Previous Inspection 1 Telephone L,� ❑ Mobile Date: Owner HACGP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person in Charm (PIC) Time ❑ Bed&Breakfast ❑General Complaint -� Time ❑ HACCP Permit No. ❑Other inspector out -'0,-r Each violation checked n6quires 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 590r009{E} ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands El1. PIC Assigned/Knowledgeable/Duties " Handwash Facilities C u{V•peoIj j EMPLOYEE HEALTH PROTECTION FROM CHEMICALS d ❑ 2. Reporting of'Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded RA.Toxic Chemicals FOOD FROM APPROVED SOURCE EITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source IR k. Receiving/Condition �ti,syP 2-l [116.Cooking Temperatures 716. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION \QA9. 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 t ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22, Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1.22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C NJ 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)(590A04) 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 j26, Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you V27. Physical Facility (FC-6)(590.o07) 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: 1p / �W f l Inspector's Signature: Print: Prin1, _ PIC's Signso ' � Page of Pag es , Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S Cross-contamination 1 590.003(A) Assignment of Responsibility* 3--,02.11(A)I 1) Raw Auinwl Pnots Separated from 590.003(B) Demonstration of Knowledge" Cooked and.RTE Foods' T 2-103.11 Person in charge- duties I I Contominalion from Raw Ingredients 3--,02.11(A1(2) Rao Animal Foods Separated from Each EMPLO"EE HEALTH I Other' 2 590,003(C) Responsibility of the person in change to I Gontamination from the Environment require reporting by fool employees and 3-302.11(A) Fool Protection` applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of'A Food Employee Or An 3-304.11 Ford Centtct web Equipment and Applicant TO Report To The Person In ULmtsih;* Charge* I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 3-306.14(A)(B) 1 Relurued Fo,KI and P.eserviLe of Food;' I I3I 590.003(D) Exclusions and Restrictions* I ( Disposition orAdulterated orContaminated 590.003(E) Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Eood" 1 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* ( 4-501.111 Manual Warovashing-I-lot Water 3-201.12 Food in a Hermetically Sealed Container" Snuirization Temperature., 13-201.13 Fluid Milk'and Milk Products* 4-50!.112 Mechanic;!Warewashir Hot Water 13-202.13 Shell Eggs* Sanitization Temperahrres* 13-202.14 Eggs and Milk Products.Pasteurized* I 4-50i.114 Chemical Sanitization- temp., pH, 3-202.16 lee Made From Potable Drinking Water* cone:nation and hardness. " 4-601.11(A) ! Equipment Fom!Contact Surfaces and 5-101 11 I Drinking Water from an Approved System" Ctensila Clean, 590.006(A) Bottled Drinking Water* 14-602,11 Cleamnn Frequency of Equipment Food- 590.006(Ii) Water Meets Standards in 310 CMR 22.0" Contact Surfaces and Utensils k Shellfish and Fish From an Approved Source I 4-702.11 - Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foul Contact Surfaces of Equipment* Shellfish' I 4-7n; I I I Modiods of Sanitization-Ilot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical"` Sources'" 110 iProper,Adequate Handwashinq Game and Wild Mushrooms Approved by Rego/atory Authority 2 301:1 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 ( Cleaning Procedure*- I 590.004(C) Wild Mushtooms^ 12-,01.1.1 ( When to Wash* 3-201.17 Game Animals* I 111 Good Hygienic Practices 5 Receiving/Condition I 2-401.11 ( Eating. Drinking or Using Tobacco" 3-202.11 PHFs Received at Proper Temperatures* I I 2-401.12 Discharges From the Eyes; Nose and 13-202 15 Package Integrity* I Month 3-101.11 Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When'fasting* 6 TagslRecords:Shellstock I 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.00N(E) Preventing Contamination from 13-203.12 Shellstock identification Maintained" I Employees, Tags/Records:Fish Products ( 113 3402.11 Parasite Destruction* Handwash Facilities 1 Conveniently Located and Accessible 13-402.12 Records,Creation and Retention* 15-203.11 Numbers and Capacities* 1590.0(I41J) Labeling of Ingredients* I 5-204.11 lxxu ation and Macetnetn* -__ I 7 Conformance with Approved Procedures 5-'_'05.11 Accessibility Operation and Maintentmce /HACCP Plans Supplied with Soap and Hand Drying 3-502.1' Specialized Yrocessmg Methculs* 6-301.11 He d Devices Cleanser.Availabnhty 3-502.1_ Reduced oxygen packaging,criteria 18-103.12 Conformance with Approved Procedures" I 16-301.12 Hand Drying Provision Denotes critical item in the(edeial 1999 Fmd Cole of 105 CMR 590.000. k CITY OF SALEM / rr Jr BOARD OF HEALTH Establishment Name: it osK -T-t,"'_ I Ir Dater )fa Page: of y Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date !' No. Reference R—Red Item Verified i .•f y/ C / J / PLEASE/PRINT CLEARLY l_ J /.fi.QsC6'✓0�Pe/ �Gn rl ren sho w. JA S M � r �lcnr•p,,,�o.�,„� 7 5;0. linD/� U�� ((� r S45z)I 1�1rk�� 1�i� (f Ct 1441,4— f r�C � �i -A CYn.�7aJ PC,,xAIM O'eQJA � Vir, r) _ :t s � r�.vf� . , n N �—�-� Sin. ��P Py� 5A�(.Y„� r/ �,rf:!f•� P h.) )A 'M(51%/7 ;AI— + - r - r / dej- J�( r ✓ 'c Discussion With Person in Charge: I Corrective Action Required: I LI No I _ Yes I have read this report, have had the opportunity to ask questions and agree to correct all I L' Voluntary Compliance Ll Employee Restriction/ -� �p lations before the next ins described, d t inspection, to observe all conditions as escre , ano tExclusion Vf p p Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/FederaWood Code. I understand that noncompliance may result in daily fines of twenty-five dollarsor suspension/revocation of Li Embargo ❑ Emergency closure your food permit. /\/� ❑ Voluntary Disposal ❑ Other: v - l - 3-501 PHFs Received at Tuaperatures 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 3-50-.15 Cxilimp Methods for PHFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-501 1hiB I Cold P1hts Msmtained at or below 3-202.12 Additives" 590 004F) 41°/451F' 3 302.14 Protection from Unapproved Additivev°' IS 1 Poisonous or Toxic Substances 3-501,16(A) Hui PHFs Maintained at or above 7-I01.11 Identifying Information-Original I I _ 501.16as Containers' (.,) Roast Neid at or above 130`F. 7-102.11 Common Name -Workin;,Cwi[ainers* 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* ( 500.U04(14) I V.irianx RBan(rCnlent - - - 7-202.12 Conditions of Usc. 7-203,11 Toxic Containers-Prohibitions" REOUIRE41ENTS FOR HIGHLY SUSCEPTIBLE 7-204 11POPULATIONS(HSP) Sanitizers,Criteria-Chemicals* 7-20-1.12 Chemicals for Washing Produce,Criteria4121 ( "3-301.1 I(A) I Unpa;tem'nzed Prepackaged luxes and 7-204.14 Dying Agents.Criteria* 6ever:.necs with W:u'ning Labels* r 3-so!.II(B) ( Use ofPusteutizudEggs` � 7-205.11 Incidental Food Contact,Lubricants+ - - 3-80LlI(D) Raw orPmliallyCookedAnun:dFood and 7-206.11 Restricted Use Pesticides.Criteria'k I. I ( k,,w SccdtSpr<>uts Not Served. 7-206.12 Rodent Bait Stations" :Y-w I.1 l K') Unopened Fcxxt Package Not Re-served 4` 7-206 13 Tracking Powders,Pest Control and I -- ------- Monitoring* CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.11 Cowminer Advisory Postal for C'onsuniption of Annual Foods`Mat are Raw,Undercooked or 16 I Proper Cooking Temperatures for I Not Otherwise Processed to Eliminate PHFs a eav,_.n,r I'll 3-101.115(0(2) Eggs- 155°F IS Sec. � Pathogens.'� Eggs-tr mediate Service 145°Fl5sec* ( 3-302.13 Pasteurizer;Eggs Sebntiloic for Raw Shell 3-401.11(5)(2) Comminuted Fish, Meats&Game Eggs* Animals- 155"F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(6)(1)(2) Pork and Becf Roast- 130°F 121 min* _- 3-401.11(A)(2) Ratites, Injected Meats-155"F 15 590 NOW-(D) Violations of Section 590.009(A)-(D)in sec, " catcrinc, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFe, resideatial kitchen operations should be Smff'ing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. "' above if rel:ted to foodborne illness 3-401.11(C)(3) I Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations,relating, to good retail 3-401.12 Raw Animal Fptxls.Cooked in a practices should be debited under 1729- Microwave I6fioF* Special Requircnicitts. 3-401.11(A)(1)(b) All Other PHFs- 145`F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.4)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) I Microwave- 165°F 2 Minute Standing Ctitkal and non-critical tdolaumm which do rot relate to the Time* ,l✓udlmrne itbiess mtrrventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Faxl- ,(✓tnrd in rhe follni,-bag arrr&,ns u/the F✓ad Code and 105 C',t7R 1400F' 590.000. 3-40111(E) Remaining Unsliced Portions of Beef I � item Good Retail Practices FC 590.000 Roasts* ( 23. Manammert and Personnel FC-2 .003 18 Proper Cooling of PHFs I 24 Food and Food Protection FC-3 .004 25.__ Equipment and Umnsils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140"F to 26. Water,Plumbinq and Was!(., FC-5 .006 70'F Within 2 Hours mid From 70"F 27. Physical Facility FG-6 .007 to 41`F/45"F Within 4„4ours. * 28. Poisonous or Toxic Materials FC-7 .008 f 3-501.14(13) Cooling PF1Fs Made E Mni Ambient 29 Soernal Requirements 009 Temperature ingredients to 41°F/4-5 30. Other Within 4(lours" ,'-OP .,:,<+„-:r.. 'penoter:cnucal item in the feclend 1999 Fond Code or 105 CMR 5901 000. CITY OF SALEM B ARD OF HEALTH Establishment Name: _ _ �,�.4.., Date: l��o G Page: of r Item Code c-critical Item - DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified �- - EASE PRINT CLEARLY r'_ l 3 G.:raJ� k/ td-I �'o �i'I.CJI/(./ll(.fF�/ C a(v�.- LIZ, (_'7 C2 SS.J/2 r*T (iwrd� A 've-,�n � F.� ' / n;"4 /17�l 7f IiI1 t b n f� : u� ► (�I fah4tow aw n4-A _Op 1: S?> �_ I�PY + nIA Lj— h �h �f Mf (�"f/ c/pj- (�IQ,�Cfc/E�� v ' G4 n� 4C( 7Or- �nJSc ._ /1<7On r *' c / !_ t /"fGr•n. 4Q,O r L FG Sal �� AAf'GCG� �. -k-Os A)wck Y !/,o� / L(I pn)'J f � PT/r-�1 IAIOWO t�iJ', .n- S�rifl�2dl / f I . t `�- . !f l� �► �[��', bt)W4-, C1 �cr c CIJ � 04—i AJ(AM) -� , ri7"'.41, rrit4.'n j� f _ I f t'JJ��I'DC`t l)5.c� cli PU��l t,10,1` 9- -fes (r,-,A a �?'I c , J, f Discussion With Person in Charge: Corrective Action Required: ❑ 11 .es 9 Ihave read this report, have had-the opportunity-to ask questions and agree to correct all ❑ oluntary Compliance ❑ Employee Restriction Exclusion / r ; Violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled L3 Exclusion Suspension _ comply with all mandates of the Mass/Federal Food Code. I understand that poncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: f , 21 3-501.14(C:) PHFt Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to J Factors(Items 1.22) (Cont.) ]$t '45'F within 4 Hours. = PROTECTION FROM CHEMICALS ( 3-501.15 C,xtting Method~ for PHF,: ' Food or Color Additives ( 19 PHF Hot and Cold Holding 14 3-202.12 Additives') 3-JOLI,s(B) Cold PHN 4aintained at or below 3-302.14 Protection from Unapproved Additives* 41''/45°F' 15 � ----- 15 Poisonous or Toxic§ubstances i 3 501.16(A) ( Hot PHF:Maintained at or above 7-101.11 Identifying Information-Original- -- - 140'F, Containers" 13-501.16(,+) Roasts Held at or above 13097 7-102.11 Common Name-Working Containers* 20 ( Time as a Public Health Control 7-201.11 e S-�Ol Irl Time as a Public Health Control* � Separation-Storage 7-202 It Restriction-Presence and Use* 590A04fH) ( lrrrci;mcc Requimivcnt 7-202.12 Conditions of Usc" 7-203,11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801 �DA I Unpasteurized Pre-pacIaged Juices and 7-204.14 Drvmg Agents,Criteria" Beverages with W'arnine Labels`7-205.]1 Incidental Foal Contact. Lubncants* 3-SOL1(B) Use of Pasteurized F,,gs* 7-206.11Restricted Use Pesticides.Criteria* 3-501.1'(D) Raw or Partially Coo 1•:ed Animal Food and Raw Scat Sprouts Not Served.,x 7-206.12 Rodent Bait Stations„ 3-801.1 l(C) U'nopentd Foots Package Not Re-served. 7'206.13 Tracking Powders.Pest Control and Monitoring,* CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Raxle Char are Raw. Undercooked or 1fi I Proper Cooking Temperatures for I tiot Otherwise Processed to Eliminate PHFs 3-401.11 A(1)(2) Eggs- 155°F 15 Sec. i yarhogens.,` Eggs-humediate Service 145°1715se& 3-302.13 Nisicurize.i Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game F,egs"' Animals- 155°F 15 sec * SPECIAL.REQUIREMENTS I 3-401.1l(B)(I)(2) Pork and Beef Roast- 130"F 121 min* � 3-401.11(Al(2) Rattles,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in ec.- catering, mobile Rod,temporary uid 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHPs, revidential kitchen opetations should be Stuffing Containing Fish, Meat, debited under the appropriate sections - Poultry or Ratites-165"F 15 sec. * above if related to tilodborne 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 x{29-- Microwave 165"F* Special Requirements. 3401.1l(A)(1)(b) All Other PHFs- 145`F' 15sec. * 17 Reheating for Hot Holding VIOLATIONS R,.LATEO 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 I Critual acrd lion-cribra(violations, n•ini-h do nat )elan to the Time* ,foodborne illness interventions and riek f is tors listed above, can he 3-403.11(C) Commercially Processed RTE Food- ,found in the tollnu-bag.sections c1t t4u Ford('ode and 105 CMR 140"F* 590.000 3-103.1 HE) I Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 1 23. Manaoement and Personnel FC-2 .003 tg Proper Cooling of PHFs 1 24. Food and Food Protection FC-3 .004 25. Equipment and Utensils FC-4 .005 3-501 141'A) Cooling:Cooked PHFs from 140'17 to 26. Water,Plumbinq and Waste FC - 5 .006 70°F Within 2 1-tours and From 70°F 27. Phvsical Facility FC-6 007 to 41"F/45"F Within 4 Hours. * 28. Poisonous or Toxic Materials FC--7 .008 3-501 14(B) Cowling PFIFs Made From Ambient ( 29. Special Reauirements .009 Temperature Ingredients to 41`F/45"F 30 Other Within 4Flours r Denol,s critical item/inn he Wesal 1994 Fix%[Code or 105 CNIR 590 600. I z s CITY OF SALEM - (' rBCARD OF HEALTH / ,t r Establishment Name: I G s�c .i— rfn F �c d Cf Date: aZ IN I o 6 Page: 4— of Item code C-Critical Item DESCRIPTION OF VIOLATION/PEAK OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY r I' � -fel �/�GYO /M�./r .•,.r—f JP /2 f 7i n ILS i /i G�i�L,S,A c—A F 1 j 1 i4 f I { I f "r I 1 # - 1 1 ` ll � Discussion With•Person in Charge: Corrective Action Required: ❑ No - Yes r f / I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion tjjolations before the next inspection, to observe all conditions as described, and to /Re-inspection Scheduled L3 Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that «`alll ` noncompliance may result in daily`fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: H L —_ i4(C') PI-IFz Rc-en ed at'Temperatures Violations Related to Foodborne Illness Interventions and Risk ?,cording to(auCooled to Factors(Items 1-22) (Cont.) SPF/-3.5`1'Within 4 Hours. PROTECTION FROM CHEMICALS 3->O1 15 Coolm,Methixls for PHFs 14 Food or Color Additives 19 Col Hat and Cold usedHolding i 3-SU L 16tL'i Cold Pf IPs Maintmnat or below 11 3203.12 Additocs,* 590.004(F) 41'/.15"F< }` 3-302 14 Protection from Unaktproved Addihves* 3-`.Ot.15tAi 4PI'F; A9.:iuhunect at or above IS Poisonous or Toxic Substances � 140(i"F * 7-101.11 Identifying Information-Original Containers' I +-501.10(A l Roasts Held at or above 130°F. 7-10211 Common Narne-Working-Containers* 20 Time as a Public Health Control 7-201.11 Separation-Shn;tge" 3-501 IU "lime as a Public Healdi Control* 7-202.t I Restriction-Presence and Use* ( 59(1.(IOd(H) bin dance Requirement 7-202.12 Conditions of Usc" 7-203.11 Toxic Containers-Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-243.11 Saititizers,Criteria-Chemicals* POPULATIONS(HSP) 7-_03.12 Chemicals for W'ushms!Produce,Criteria' I 21 3 501.1 I(A) Unpasteuri?ed Pre-packaged Ruses and � a Bevcr.:y-es wah Warning labels' 7-204.14 Drying Agents.Cnteria'" 3-801.11(B) Use of Pasteurized EeesT 7-205.11 Incidental Food Contact.Lubricant�s* 3-801,l 1(1)) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* I r Raw 5-ed Serums Not Su'ved. 7-206.72 � Rtxicnt Bait Stations" , ( 7-206.13 Tracking Powders,Pest Control and ( 3-80 I.11(C) Unopened Food Package Not Re-served. "' Mvnihxing* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of Ammar Foods'Fhat ate Raw.Undercooked or PHFs 16 I Proper Cooking Temperatures for ( Not Otherswisc Processed to Eliminate 3-401.1 IA(I)(2) Eggs- 155'F 15 Sec. pathogens- `'r >•. c::zon, Eggs-Immediate Ser%-ice 145'Fl5sec* 3-302.13 Pasteurized Ergs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&GameI Eyrs' a Animals- 155"F 15 se 3-401.1l(B)(I)(2) Pork and Beef Roast- 13WT 121 nun* 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.m catering, mobile focw, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operraions shot.dd he Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. above if related to iix)dborne illness 3-401.11(C)(3) Whole-muscle,Intact Beet Steaks interventions and risk factors. Other 1450F" 590.009 violations relatimo, to good retail 3-401.12 Raw Anirnal Foods Cooked in a practices "should be debited under 1129- Microwave 165`F* Special Requirements. 3-401.1 1(A)(1)(b) All Other PHFs-- 145'F 15 sec. " 17 Reheating for Hot Holding VIOLATIONS R.LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) ( PHFs 165'F 15 sec. a' (Item.;23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and nun-r'ritical I."Icaron r, which rlo not relate to the Time* ,fondhorne illness niter!:entionv and iiAjo(tors bAzed above, can be 3-403.11(C) Commercially Processed RTE Food- fowid in the following sec tions o/'tire Food Code and 105 C,f4R 140"F' 590.000, 3-403.11(E) Reniauung Unsliced Portions of Beef I ( Item Good Retail Practices FC 590.000 Roasts* 23. Management and Personnel FC-2 .003 l8 ( Proper Cooling of PHFs 24. Food and Food Protection FC,-3 .004 25. Egwpment and Utensil; FC-4 .005 3-501.14(A) Cori Cooked PHFs from 140'F to 26 Water Plumbinq raid Waste FC-5 .006 70"F Within 2 1-tours and From 70'F 1 27. Phvsical Facility FC -6 .007 to 41`F/45'F Within 4 Hours. " 126. Poisonous or Toxic materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 1 29 Special Fara erronts 009 1 Temperature Ingredients In 41`17/4i`F 30. Othei -_ Within 4 Hours* >swi,::a.rz a„ *DCnUles trmcal item at the federal 1099 Fond Code or 105 C Mk 590 000. lri-'1?".�Gi :`&'"�Gb'�:+::a•+°,' e`�+�•' ' `h-A.fr`� v�xn'Fghxw.. cu„rra.,...i:,u'.. °n`�."'�L""�'. " '��r,"� •ar"!i Y .e�.,_., .K41"-'s?t7, *Ae-'x' r :' d1; .;q�8. ;�nk4<_�r5-r•ik; . q :"��:^ " f" 's,:'>� :r ,•:+Itr :�i '�v,�r{e-"t'.'?s�"'": b A' � '.a n .�"isB+ -�iL-..,,e.,«r.w qea. a..,,",1:rtw'. '•,t::^vv;e:.' r7 120•WASHIN RE4TH FLOORm CITY OF ALEM, MASSACHUSETTS „• ' BOARD AD OF AF HEA LTH " 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: A Taste of Thyme Cafe Address of Establishment: 122 Washington Street Owner's Name: Beverly Trueira Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 146-05 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 ink 'CITY OF SALEM, MJXSSACHUSETTS BOARt OF HEALTH 120 WASHINGTON S-�REET, 4TH FLOOR i SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FORS PERMIT TO OPERATE A FOOD ESTABLISHME'N/T� NAME OF ESTABLISHMENT -ra + < .C � TEL# q7S--W1 Y'��// 21oq ADDRESS OF ESTABLISHMENT I,D,-2� UA9611-15-3 ^ / `T— — MAILING ADDRESS (if different) /�, f• t—/�yl 0� /_.1 /�2 OWNER'S NAME! Vt��Lx/ l JZI e�IY(. TEL# 663 ADDRESS CITY"'}-P_!1't-!.L'X�C`�(] STATE_ /UY�" ZIP CERTIFIED FOOD MANAGER'S NAME(S e CERTIFICATE#(s)._ $;LJeeP J f1 1�1 tea (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE , ERSAN&0F_tWW (tAI132HOME TEL#J1)t)5-'3`)-1— oo(p tD '-ra -5 m i '14m— HOURS OF OPERATION: Mon.--Tue.—Wed.—Thu.—Fri.- ) SaPPm �1 Sun. - tAin— 1 .p TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 f more than 10,000sq.ft. =$250 ,yCYJ 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 $5 TOBACCO VENDOR YES $50 ALL NON-PROriT(such as church kitchens) YES iJ0 $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. Signatur Date b� Social Security or Federal Identification Num er -------- -- -------- ` I-- �---[-�--,----------- g3 - Revised 11/03/03 FOO 2 adm Check#& Date 3-7 9�� ' �oZF(�`" ! �� d 4 � iia 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 741-4269 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Beverly Trueira Tobacco PASS ❑ PIC: Ken Rothwell FOOD PROTECTION MANAGEMENT Done Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑J RED Janet Dionne - EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS 0 RED 9/14/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number Food and Water from Approved Source PASS RED BHP-2005-0202 Receiving/Condition PASS ❑o RED Status: - Tags/Records/Accuracy of Ingredient Statements PASS 0 RED FULL COMPLY Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done Time IN Time OUT: Separation/Segregation/Protection PASS RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS RED 290' Proper Adequate Handwashing PASSd❑ RED Urgency Description(s): Good Hygienic Practices PASS ❑d RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASS ❑/ RED Retail Practices (Critical Handwash Facilities PASS ❑/ RED violations must be corrected immediately or within 10 days)(Non-critical violations GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 19,2005 ) Page I of 122 Washington Street A Taste of Thyme Cafe must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASS ❑d RED RED: Toxic Chemicals PASS ❑� RED Violations Related to Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS ❑D RED Immediate corrective action) Reheating PASS RED Cooling PASS ❑d RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL ❑ BLUE walkin floor needs to be sealed to make impervious.seal floor.owner stated floor to be completed and installed within a week or two. owner to contact board of health office once completed. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE all other violations cited in 09-01-2005 report have been corrected.Thank you. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 19,2005 ) Page 2 of 122 Washington Street A Taste of Thyme Cafe GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev Sep 19,2005 ) Page 3 of s 122 Washington Street A Taste of Thyme Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: j Item Status Violation Critical Urgency Nature of problem or correction 741-4269 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Beverly Trueira Tobacco PASS ❑ PIC: Ken Rothwell FOOD PROTECTION MANAGEMENT Not Done Inspector: PIC Assigned/Knowledgeable/Duties PASS (] RED Janet Dionne EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASSd❑ RED 9/1/2005 Personnel with Infections Restricted/Excluded PASSJ❑ RED Risk Level. FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS ❑J RED BHP-2005-0202 Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED Open •• Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations: Plans 11. PROTECTION FROM CONTAMINATION Not Done Time IN: I Time OUT. Separation/Segregation/Protection PASS RED Notes: Food Contact Surfaces Cleaning and Sanitizing FAIL RED ,fitting boards stained and scored. 262 resurface or replace. Proper Adequate Handwashing PASS ❑d RED Urgency DesCription(s): Good Hygienic Practices PASS ❑d RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASS ❑/ RED Retail Practices (Critical' Handwash Facilities PASS ❑ RED violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Laurlers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 1 of 122 Washington Street A Taste of Thyme Cafe must be corrected immediately PROTECTION FROM CHEMICALS Not Done or within 90 days) Approved Food or Color Additives PASSd❑ RED RED: Violations Related to Toxic Chemicals PASS RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action) Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 2 oto 122 Washington Street A Taste of Thyme Cafe Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Critical ❑ BLUE ✓many sanitizing buckets and spray bottles throughout establishment that did not have proper concentration of sanitizing solution sanitizing solution shall be maintained at proper strength of 100-200 ppm label all spray bottles and wiping buckets.two buckets to be used one labeled raw meat cleanups and the other for all other cleanups PcCall refrigerator had temp of 50°f at time of inspection. refrigerator unit to be maintained at 41"f or below as mandated service unit to ensure proper temp is maintained psi fridge had temp of 52°f service unit and ensure proper temperature of 41°f or below is maintained. Vfce scoop at ice machine stored incorrectly ice scoop to be cleaned and sanitized and placed in a container that is able to be cleaned and sanitized and labeled ICE SCOOP ONLY. ite freezer in basement missing thermometer. provide visible accurate thermometer maintained at 0°f or below as mandated. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL ❑ BLUE �t cover in back food prep area missing cover. provide light cover. er stated that there was a water leak in t/ceiling some ceiling tiles stained find source of leak and repair and replace all stained and damaged ceiling tiles. walkin floor needs to be made impervious. seal floor Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 3 of 122 Washington Street �� A Taste of Thyme Cafe Other-See Notes FAIL [:1 BLUE tl4p stored incorrectly store mop mophead up touching no surface to air dry. GeOTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 4 oro CITY OF SALEM BOARD OF HEALTH J Establishment Name:/ /CfS-le C04L Date: Page: of i Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ,pv_-/ns'Drcfie was COnI z1n-1e / 17 / 7/1"7/s �sfiS/i h n�fr n s rt fes"//a uj Ufa /a /c1ph2 no Xed. 1 @ G ��inC� ho��' S�ra�/�,�r� / �ii1,�/.+�' ✓��/a,�� - ��+ G'}r�p�' 1 QIP rn� ori` -. 1?e'li t' a,17' /s Vn ialf'?Q :2 l.tloa.e oo r . (,t 1-), 6H ' 1,Ajk4t: -tom ar-e_ 1 1,tit � I / 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es 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 Ce. I nderstand that noncompliance may result in daily fines of tw nth-five of s or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. Q ❑ Voluntary Disposal ❑ Other: r. 3-5(i1.;4(Cl F HFs Recei,ed at Tcmperatures Violations Related to Foodborne fitness Interventions and Risk According(k)Law Cooled to Factors(items 1-22) (Cont.) 41`'F/45"u Within 4 Hours. PROTECTION FROM CHEMICALS I 3-501 1.3 Coniine Methods for PHFs 14 PHF Hot and Cold Holding 114 I food or Color Additives 3.501 I6(B) Cold PHP,Maintained at or below 3-202.12 Additives 590.004(F) 41V45'F` 3-302.14 Protection from Unapproved Additives' ;_SOL Iti(A) i{ot PHFs M19aintawerl at or above ---- 15 I Poisonous or Toxic Substances - 14(i''F. 7-101.11 I Containers information-Onnrinal I 3_501 l6(A) Roasts Held at or above 130"F. 4' -- --� Containers'" I I �7-102.11 20 Time as a Public Health Control Common Nxtne-Working Containers* 7 OLI1 Senara[ion-SRnagc"` ( 1 3-501.10 Time as a Public Health Control* 7-202 It Restriction-Presence and Use's ( 1590.00k4(H) Valiance Rtymrcment 17-202.12 Conditions of Use' 7-203.11 I Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 I Sm»tizers.Criteria-Chemicals* I POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria"' 121 1 3-80 L 11 I t:npasieurir:ed Pi -packaged Juices acid 7-204.14 Drvi rig Agents.Criteria. Bevel with W:unin*I;ahels* 7-205.11 ( Incidental Food Contact,Lubrican3-801.17(6) Use of Pasteurized Eo.es' ts* � I --I o n* 13-SOI 11(D) Row or Partially Cooked Aminal Food and 7-_06.11 I Restricted Use Pesticides,Criten I Raw Seed Sprouts Not Served. 7-206.12 ( Rodent Bait Stations' ( 3-801.11(C) Unopened Food Package Not Re-served. " 7-206.13Pracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-(103.1 1 Consumer Adroisory Posted for Consumption of Auunal roods that are Raw, Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3401.11A(L)(2) Eggs- 155°F 15 See. Pathogens.* Egos-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comrniuuted Fish, Meats&Game Eg"T Animals- 155"F 15 sec. 3-401.11(6)(1)(2) Pork and Beef Roast - 130"F 121 min* SPECIAL REQUIREMENTS 3-401.1I(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 3-401.11(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. 4` above it related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations rotating to good retail 3-401.12 Raw Amoral Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.1l(A)(1)(b) All Other PHFs-- 145°F 15 sec. 17 I I Reheating for Hot Holding VIOLATIONS R-LATER TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) I PHFs 165°F 15 sec. 4 (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Ctin(al and nor-(r itncal violutruns, which do not relate to the Time* jaudhorne illness interventions and risk fa(tors listed above, con he 3-403.11(C:) Comtnercialty Processed RTE Food- found in the follawie,g sections of the Food(.'ode and 105 CAIR 140°F* 590.000 3-403.11(E) Remaining Unsliced Portions of Beef I I Item Good Retail Practices FC 590.000 1 Roasts* 23. Management and Personnel FC-2 .003 1g Proper Cooling of PHFs 24 Food and Food Piotaction FC-3 .004 25. Equipment and Utensils FC-4 005 3-501.14(A) Cooling Cooked PHFs from 140"F to ( 26 Water.Plumbing and Waste FC-5 .006 � 70'P Within 2 Flours mid From 70°P 27, Phvsical Facility FC-6 .007 to 41"F/45°F Within 4 Hours. * 28 Poisonous or Toxo;Materials FC-7 .008 3-501.14(3) Cooling PHFs Made From Ambient 29, Special Reauaements 009 Temperature Ingredients to 41'TASOF 30 Other - -- Within 4Ilours* ."'IF °'°'°-2d", Denotes cnucal nein in the federal 1999 Pool Code or 105 CMR 590 000. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH o _ 120 WASHINGTON STREET, 4TH FLOOR �a 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: A Taste of Thyme Cafe Address of Establishment: 122 Washington Street Owner's Name: Beverly Trueira Restrictions: Application Date: 12/17/2003 Permit for Food Establishment 210-04 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/. O _ HEALTH AGENT o CITY OF SALEM, MASSACHUSETTS �F �';c� 1 BOARD OF HEALTH • i 120 WASHINGTON STREET, 4TH FLOOR '` SALEM, MA 01970 DEC 17 2003 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ck--V z (-P,',!� TEL# �i�a BVI-yJ C,q ADDRESS OF ESTABLISHMENT la-tZ, +��vv� S� • MAILING ADDRESS (if different) OWNER'S NAME `WU� e � TEL# ADDRESS CITY SnTA'T, E,,^' ZIP CERTIFIED FOOD MANAGER'S NAME(S) konQ�Ah".o CERTIFICATE#(s) t1Uo ,%%,� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# 978 "3 la-S 775 Q. joD HOURS OF OPERATION: Mon Tue.b 3� �� 3�Ute 30 � 3oU lDa Wed.�F' Thu. Fri. Sat. Sun. 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 RESTAURANTS NO V less than 25 seats =$100 25-99 seats _ 15 more than 99 seats 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. Pur to L apter 6 , S tion 49A, I certify under the pains and penalties of perjury that I, to my b st d nd beli , have fil all state tax returns and paid all state taxes required under the law. IJ ( - 01> h(S - (eb 4d 3/ Sif nature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------ Revised 11/03/03 FOODAP2.adm Check#&Date 3 07a ' 1 °3 Massach,Vsetts Department of Public Health Salem Board of Health 120 Washington Street, 4" Floor Division of/Food and Drugs Salem, MA 01970-3523 r� FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameI / Date Type of Ooeration(s). Tyoe of Insoection /� A TQS'fc OC �11�1�11 co'ce )o1"I4-64r1 � Food Service ❑ Routine Address t�1 Risk LJ Retail [ Re-inspection 1 at r�• � l '(I'� h 4 . Level El Residential Kitchen Previous Inspection Telephone q�� 1 M 'OQ 1 •' ❑ Mobile Date: /a-(/G'Oe{ Owner �,( () I (_ HACCP YM El Temporary Pre-operation 1 e,I'1 I (4 YI ay A ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) C Time ❑ Bed&Breakfast ❑ General Complaint � In: El HACCP Inspector/�, t Al n 11A� I 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 ❑H�3. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116. 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 Q 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ®"e9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP [110. 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 2� immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): J of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C x 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an '24. Food and Food Protection order of the Board of Health. Failure to correct violations (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 (,FSC-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 ssa�nsp/ec/rFo,ms IC d. K n ff IVIn�s�f ° xy An6llYr/ _ Print:--Bev --r" lrra/1Y / I) d . A I (PI s Signature: Print: Pagel o/'�Z'ages Violations Related to Foodborne Illness W-- Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross--contamination 1 590.003(A) Assignment of Responsibility" 3-;02.1 1(A)(l) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and R1 E,Fraxls'" 2-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302,1 If A)()) Raw Animal Fonds Separated from Each EMPLOYEE HEALTH Otlar"' 2 590.003(C) Responsibility of the person in charge to Contarninaton from the Enwronment require reporting by food employees and 3-302.11(A) Food Protection" applicants* 3-302.15 Washuac Fruit: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 Rc,et,ice of Food* 3 590.003(D) Exclusions and Restrictions* I DispnsllronofAdulterated orContaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Rewnditionmg unsafe FOOD F IOM APPROVED SOURCE Food" d Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law't 1-501.111 Mainral Warewashing-Hot Water 3-201 12 Food in a Heinietically Sealed Container* ( Sanitization 1•emperattires* 3-201,13 Fluid Milk and Milk Products* 4-501 112 Mechanical W'arewashing;Hot Water 3-202.13 Shell Eggs Sanitization Temperatures 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" 14-601.1!(A) Equipment Fri d Contact Surfaces and yst 5-101 11 Drinking Water from an Appioved Sem" Utensils Clean` 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Focd- 590.006(R) Water Meets Standards in 310 CMR 22 0* ( I Contac Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702 I 1 Frequency of Sanitizatirn of Lhensils and 3-201.14 Fish and Recreationally Caught Molluscan I 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" to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2301.11 Glenn Condition- Hands and Arne* 3-202.18 Shellstock Identification Present* 2-30 1A 2 Cleaning Proccdme' 590.004(C) Wild Mushrooms* ( 2-301.14 When to WaSW 3'201.17 Game Ammals" � � 1( Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating„ Drinking or Using Tobacco* 3-202.11 PIIFs Reserved at Proper Temperatures* 2-401.12 Discharge;Front the Lyes,loose and i 3-202.15 Package Integrity* Murth* 3-101.11 Food Safe and Unadulterated" 3-301.12 Prevennne Contaminaa ton When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Piecenting C.OriCilmuali0n from 3-203.12 Shellstock Identification Maintained* Eniplu}ees^ 13 Handwash Facilities Tags/Records: Fish Products ' I Conveniently Located and Accessible 3-402.11 Parasite Destruction" 3-402.12 Records,Creation ;and Retention* I � 5-1-03.11 Numbers and Capautte 5-204.11 Location and Placumont* 590.004(7) Labeling of Ingredients* 1 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operationand Maintenance /HACCP Plans I Supplied with Soap and Hand Drying es d an 3-502.11 Specialized Processing Methods"` 3-502.(2 Reduced oxygen packaging,criterta* � � 6-301.11 llHanwashht,Cleanser.Acsi(abdity 8-103.12 Conformance with Approved Procedures" I (i-301.1'_ llmad Dn�ine Pro.-isn�n :'Denole,dnncal rent in the federal 1499 Food Code ut 105('AIR 500,000 q CITY OF SALEM �j BOARD OF HEALTH Establishment Name: Q Tn l7C 1-k( tM_ l A f- Date: 19 - 14-6) q Page: 02 of c� Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ! No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 40 -{;-)l j0tA)1VY4 •. 1 ✓) 3 h n -QM (`c�� 7A r 0 T\n l n t Aee� �b 0 . (hinge �t°n �2as 0lAJP.( ( �Ir.� I�all( ral -h) ��ii trq i) yvv -v l ,lhcvia I n r a� ihnS��P r_ div A VZ 1)4 Cpm �412 Im i 05 r7��! ( LH ,r ��na s Ski �20�1 �� nr�°(E �er�icr �. I -01 L) . tv �)YZ- b i,) --t'v, 14 n (mllPj- r}t-ph rn q1;w0rae_ I ✓S" Sri , �, ,�p li r n ��n�oh fi-ccfrar� rr{�i�rn h �r Ch (1) ('/1110 a _'4jVuh17 M at orop�,/L op m . .4��le �ipr�orrcF ��- Vnc�� tzi��iet[ ----- - ri�nsnnrrf /'�,fs slrih��/- -10av) 4SCc`u_�i ire niavid.0 (11 s1 ate CL vll� river os2 �n ar tai�.nl a D°F u y �e l ,.ct C_� Q,2PAA hOCl -YVJ a t4 <:*W d V14 V �OhPn (4 - -_Snpn)/Afie, �a rn t t� yu �f� E;n Cy, �l u >nP�-I A oaf JgnLk -IV biy_L ee j- I cm's t �V1+MtM lh(( f)t)n a <7-" rt V10 f In } „o lafirni,\ ,>,' mori { clt jsq «n i�4 C-Uo n ` Jtf I IA-0k- 'V1 (1 f1476 l ('j fT(I • _ �].Pl� 11 (.t�_1_/_Vl°.P*�-Pn� • �Tit/kc Vl .�� .dT(I) _ _ c Discussion With Person in Charge: ( 'Corrective Action Required: ( ❑ No I ❑ Yes N I ve read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ ` viCations before the next inspection, to observe all conditions as described, and to Exclusion P Li 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 Disposal ❑ Other: i J r 13-50; u(;•} ?HFs Rscorved at'i'emperVe es Violations Related to Foodborne Illness interventions and Risk .Accord,ng it)Law Cooled to Factors(items 1-22) (Cont.) .I I`F/45'P Within 4 Hrur�, PROTECTION FROM CHEMICALS 501.15 Cooling Method;for PHFs ) 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-5(11.168) Cold PHP( Maintained at or below 3-202.12 Additive.' 590.004(F) 11145"F-" 3-302.14 Protection from Unapproved Additives* 3-501.Ifi1A) Ilei PRF: Mamtamed at or above 15 Poisonous or Toxic Substances _ 14017 ' 7-101.11 Identifying Information-Original Containers* 1-501,I INA) Roasts Held at or above 130'F. 7-102.11 CommonNatnc-WurkingContaincrs* ' j 20 Time as a Public Health Control 7-201.11 Separation-Storage": ( ( 3-iO1,19 Time as a Public Health Control* 590.0041H) Variance Requirement 7-202,11 Restriction-Presence and Use* 7-202.12 Conditions of Use, 7-203.11 1 'toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 1 Sanitizers,Criteria-Chemicals` POPULATIONS(HSP) � I 121 3 801.1 1(A) Lhnpnsteurized Pre-packaged Juices and � 7-_04.12_ � Chemicals for Washing Produce,Crrcria' Beve;a;e with W':nninI1.tbels� 7-204.14 Drving Agents.Cnteria"" 3_g01.11(B) Bev of f,Pasteurwith cF rnin- 7-205.11 Incidental Fcaxl Contact.Lubncants* 1os 3-301.111 D) Raw or Partially Cooked Animal Hind and 7-206.11 Restricted Use Pesticides.Criteria* _ k:nv Seed Sprouts Not Set'red. 'x 7-206.12 Rodent Bait Stations* 3 801.111 C) Unopened Food Package Nm Re-served "` ) 7-206 13 I Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Adnisoiy Posted for Consumption of Aninrd Foods 11oat are Raw. Undercooked or 16 I I Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs ne•en„<,:bpm 3-101.11A(1)(2) ( Eggs- 155'F 15 Sec. i'athu;tens.^ Eggs-Immediate Service 145'F15sec- 3-302.13 f asteuri:.ui Egg<Substitute for Raw Shell 3-401.11(A)(2) ( Comminuted Fish, Meats&Game Eggs Animals- 155'F 15 sec. '" SPECIAL REQUIREMENTS 3-401.11($)(1)(2) Pork and Beef Roast - 130'F 121 min* 3-401.11(A)(2) Ratites,Injected Meats- 155*F 15 590OOq(A1-(D) Violations of Section 590.009(A)-(D) in sec. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PIfFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 see. 4' above it related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145°F* 59{1.0(19 violations relating to good retail 3=101.12 Raw Animal Foods Cooked in a practices should be debited under #29- Miciowave 1650F* Special Requiterneats. 3401.11(A)(])(b) All Other PHFs- 145`F 15 see 17 ( Reheating for Hot Holding _ VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) ( PHFs 165°F 15 sec. (I tents 23-30) 3-403.11(6) I Microwave- 165'F 2 Minute Standing Critical and non-critical-nidations, which do not relate to Nm Time' foodborne ilii,ess anervenfiirns and rind/actors listed above, can be 3-403.11(C) I Commercially Processed RTE Food- found In da•fot/iu-ing srrli,ms of the Food Code and 105 Ch1R 140'F* .594(X10. 3-403.11(E) I Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* ' 21 3. Management and Personnel FC-2 003 Proper g 24. Food and Food Protection FC-3 004 LA � p Conlin of PHFs � - . 3-501,1,1(A) 25 Egmpment and Utensils FC- 4 0051(A) Cooling Cooked PHFs from 140`7 to 26. - Water,Piumbine and Wast: FC-5 .006 70'F Within 2}-tours and From 70'F 27 Phvs,cal Faculty FC-6 007 J to 41 014/41nF Within 4 Hours. * i 21 Poisonous or Toxic•Materiels FC- 7 .008 3-501.14($) Cooling PHFs Made Froin Ambient 29, Special Recoremerts 009 Temperature Ingredients 1o41`T/45'F 130. Other -- J Within 4 Hours'x •...r.,„n.,,:.;.��,. 4 Denotes cnucal nem in the(xle;al 1999 Fond Code or 105 CMR 590 000. bas`sachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor 161vision of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name{ -r- ( / - n Date Type of Operation(s). Type of Insoection ft 1 �1 Ii- of 1 1 luf��/) 1--�. j Food Service )[n] Routine Address 7 C I "-� I cHi§R `� f ❑ Retail ❑ Re-inspection � _ Level y� El Residential Kitchen Previous Inspection Telephone }k _ �U U��9 /�/ El Date: � // '' ! HACCP YM El ElPre-operationOwner V,;'//-7. �n4bfJY-_�l I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)- Time ❑ Bed&Breakfast ElGeneral Complaint A-9- In: ElHACCP Inspector Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties r2.' i3. Handwash Facilities EMPLOYEE HEALTH hd' - ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives [:115.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMElrEMPERATURE 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 E?1'9. Hot and Cold Holding PIE. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control M/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): C of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C eaNh. 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 order of the Board of Health. Failure to correct violations (I) v 024. Food and Food Protection (FC-4)(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)(550 Dos? 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 5901nsp troy -10 a« 'a -/ 3_ G L) 1I 1 ' �� Prink I PIC s�gnature: Print: '�L�� \el � � I Page / of .J Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I s Goss-contam;naton 1 590.0030) Assignment ofResponslbility" 3-302.11(A)li) Raw Animal Foode.S;paretudhorn 590.003(B) Demonstration of Knowledge* Cocked and RJ E Fo,ds'. 2-103.11 Person in charge-duties Contam;nation from Raw Ingredients 3-302.11(A)Q) Raw -lnimal Food;Separated from Each EMPLOYEE HEALTH Other' 2 -,90.003(C) Responsibility of the person in charge to ( Contamination from the Environment require reporting by food employees and 13-302.1 t(A) Fax1 Protection, I applicants* I 3-302.15 Wash:ne FILILs and Vegetables 590 003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact w ith Fquiprnent and Applicant To Report To The Person Iu Utensils k Chat ge I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 3-306A,I(A)(13) Returned Food anti Reser ice of Fool` 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions ( Food 3-701.11 Disc.trding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fond' 4 Food and Water From Regulated Sources ( 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law' I 4-501 111 Manual Warewa,hmg-Ilot Water 3-201.12 Food to a Hermetically Sealed Container* I San,llzatiUn Tempv,attires i 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Wart-washing-I-tot Water 3-202.13 Shell Eggs* Sanitization Temperatures" 3-202.14 I Eggs and Milk Products.Pasteurized" 4-St)1.119 Chemical Sanitization-temp. pH, cunc:nuation and hardness "` 3-202.11 I tee Made From Potable Drinking Water' I 4-601 11(.a) Equipment Food Contact Surfaces and 15-101.1 l � Drinking Water from an Approved Svstem" ( 590.006(A) Bottled Drinking Water* I Utensils Clean* 4-60'_.1 1 Cleaning Frequency of Equipment Food- 540.006(B) I Water Meets Standards in Approved CMR 22ce Contact Surfaces and L!tensils" Fish Food- Shellfish and Fish From an Approved Source I 4-702.1 1 Frequency of Sanitization of Utensils and .i-201.14 I Fish and Recreationally Caught Molluscan I Food C'on'tact Surfaces of Equipment* Shellfish;, ( 4-703.11 Methods of Sanitization -Hot Rater and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical^ Sources* Game and Wild Mushrooms Approved by I 110 I Proper,Adequate-H ands a hung Requlatory AuthorM 2-301.1 1 Clean Condition--H:uxis and Anus* .. . - - - _ _e t - -- 12-301 12 Cleaning Procedure* 3202.18 Shellstock Identification Present* I 590.004(C) Wild Mushroorns* I i 2-301.14 When to Wash" 3-201.17 Game Animals" I 111 Good Hygienic Practices I5 Receiving/Condition I I2-401.11 Eating,Drinking orUsing Tobacco,' 3-202.11 PFIFs Received at Proper Temperatures* ( 2-401.12 Discharges from the Eyes.Nose and 3-202.15 Package Intevnity* I Mouth* 3-101.11 Fond Safe and Unadulterated'" I 3-301.12 Preventing Contamination When Tasting* ( 6 Tags/Records:Shellstock I 12 Prevention of Contamination from Hands 3-202.18 Shellsto k Identification* I 590.DU4(E) Presenting Contamination from 3-203.12 Shellstock Identification Maintained' andwash Facilities Tags/Records: Fish Products 113 Handwash 3-402.It Parasite Destruction* Conveniently Located and Accessible 3402.12 Records.Creation and Retention* I I 5-203.11 Numbers and Capaei tie:" 590.004(1) labeling of Ingredients` I ( 5-204.11 Location and Piaccment* 7 Conformance with Approved Procedures 5-205.11 Ac(,essibility, Oper.dicn and Maintenance MACCP Plans Supplrod wdh Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3502.12 Reduced oxygen packaging,criteria" I 16-30).1 1 1-laudwashim,,Cleanser.Availability 8-103.12 Conformance with Approved Procedures" ( I 0'101.1_ Maud Diving Pros-ismn I 'Denote,craa al dein in the fedet a) 1999 Raid Code or 105 CMR 590.000 CITY OF SALEM BOARD OF HEALTH / Establishment Name: f I TQSre or 711 u me ( F2 Date: Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date t No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I mo)-7-hne,_In. 0_bm nip e5gknbllshv rif ry -Nno - P)l101k) InO I -f Mph � ��r In�•PR - I !A� c3nn to hp F-jj)nvAt_n Nfr'� o Dirt nQ In t <'fe n � `, I Gt lnl h4r/1 (nr11711V1OYT n�01o� "fro .QP/mp nv i111 (L'Q �x)(J� tG ln� lit —)evue- 4 �o . J ✓� C n..ti-17,�cyl LA )l p .nn hnc h,o --arivt -;2ee ) lac ) 4 dv� clniprv,r�I�ucice.E 1-v lrnI>P orbtr �rrrn� I��rrXn ` irrnr� c C _ 4n nA lk <,h -_zjn)C hl) h,4I-AAtiw vy\,nAn 1 (yt(A I_I / _ cL KnA Mme Sfi a _ ,¢ 1 l )rii;Qvin )l 4 ower hn ,csll�, fhov�b�nimo �- �/}I,�rlc \/r��i�iQ �ii�;� �r� tp 4ornnnm^no-�er2 "YlA( lIrlflY) 0(1 (_) 4 (3 --ei)l �? L�Plrw)- �✓o� C_nmo \)nl k l�r,rt �c�tv�t t)n�r�u�trli �n��l 1�Ii m�_1 f l� �i7� iQe iY)cr! !an IAU . 6# GT5eOz-Z-4 hn0QP NNln o oC °i 'EtiYltatnlr� Mkt 4�ni D a�' 41 ()F I 6Y 1et.0(4) nS I-V) G1t9/l tv(� . ' � / - � �ac I_Is. I E vv-,h lex' rPlVPv--PA A (I ( � AinxoD, � Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ les Af / I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance L] Employee RestrictionExclusion ` 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 C90w. I understand that noncompliance may result in daily fines of twent e dollars e sr ensiu . cation of ❑ Embargo ❑ Emergency Closure �your food permit. .�I / ❑ Voluntary Disposal ❑ Other: kyt 3-50! 14(C) PHF;Reserved at Tcmpciatures Violations Related to Foodborne Illness Interventions and Risk A,.cording to law Cooled to " Factors(Items 1.22) (Cont.) 41-Fi45`F Within 4 Hums. 3-501.15 Cooking Methods for PfiFs PROTECTION FROM CHEMICALS � 14 Food or Color Additives I 19 PHF Hot and Cold Holding a J 3-501.I6(B) Colo PflFs Maintained at or below 3-202.12 Additives 3-302.14 Protection from Unanproved Addiuveg* 5-501 4(F) =1' /45° ; 15 � 3-50! Ih(A) lfol PHP; Maiuuunetl at or above Poisonous or Toxic Substances IAO"F. 7-101.11 ( Identifying Information-Ori�mnal 1-501 )6( \) Roasts Held at or above 13017 - Containers 7-102.1 I Conunon Nance-Workin,Containers* ( 20 Time as a Public Health Control 3-501.!9 Time as a Public Health Control* 7-20211 Restriction- PresStorence 590.00A(H) Variance Reaw rement 7-202 I 1 � Restriction-Presence and I)se�" � - -- 7-202.12 Toions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 � Toxixicc Containers-Prohibitions'' � 7-204.11 Smitizers,Criteria-Chemicals* POPULATIONS(HSP.) 7-204.12 Chemicals for Washing Produce,Criteria* 121 3-801.1 1(A) Uupasrcunred Pre-paclagcd Juices and 7-204.14 Drying Agents.Criteria' Be-vetai.es wnh Warning Labels': 7-205.1 I Incidental Food Contact. Lubricants* --801.1l(B) Usc of Pastetuized hr gs* 3-80IAI(D) Raw�orPwniti1vGwkedAnnualFoodand 7--206.1 I Restricted Use Pesticides.Criteria* kaw Seed SpruuLc Not Served. * 7-206.12 ( Rodent Bail Stations- 3-801.11(C) I Urtopened Food Package Not Re-served. * f 7-206.13 I Tracking Powders,Pest Control and Moninxing* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60'A I Consumer Advisory Posted for Consumption of Aunnal Food.That are Raw,undercooked ia lfi I Proper Cooking Temperatures for Not OffiervIse Processed to Eliminate PHFS 3-401.11A(I)(2) Eggs- 155'F 15 Sec. I l adnu;;rns° Eggs-hmuediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(4)(2) I Comminuted Fish,Meats &Game Eggs* Animals- 1557 15 sea " 3-401.11(13)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles, Injected Meats-155'F 15 590.009(A)-(D) VoCtiXions of Section .590-009(A)-(D) in see. ` catering, tnmbile food, temporary and 3-401.1 I(A)(3) Poultry,Wild Game, Stuffed PHFS, residential kitchen operations should be Stuffing Containing Fish,Meat, (icbited under the appropriate sections Poultry or Ratites-165'17 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145'17* 590.009 violations ieiating to good retail 3-401.12 I Raw Animal Foods Cooked ma practices should be debited under#29- Microwave I65`F* Special kequircntents. 3-401A l(A)(1)(b) All Other PHFS- 145T 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40111(A)&(D) PHFS 165'F 15 see. * I (Metas 23-30) 3-403.11(B) Microwave- 165° F 2 Minute Standing Ct anal and nun-critknl violations. which do not relate to tire Time" ,foodborne dinesv arte,-venlions and risk lot tors listed above, can be 3-40111(C) Commercially Processed RTE Food- ,bound in thr jnl/nn-inc sections o{the hood Code and 105 OUR 140°F" 590.000. 3-403.1 t(EI Remaining Unsliced Portions of Reef ( Item Good Retail Practices FC 590.000 Roasts* 23. Management&nd Personnel FC - 2 .003 ( 24 Food and Food Protection FC-3 004 18 Proper Cooling of PHFS 3-SO1.lA(A) 25. Equipment and Utensils FC -4 _405 Cooking Cooked PHF's from 140`17 to 26. Water. Pmmbinq and Waste FC5 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 _"0_�S ��a..Regw'emmnts 00L_� Temperature Ingredients to 41`F/45017 30. Other Within 4 Ilours'k *Denotes cnucal item m thr I'edrral 1999 fond Code or IUS('bIR 59(1000. CITY OF SALEM /� t /� �B�OARD OF HEALTH 2 Establishment Name; t��St� Ut I Y IIY�� ( C7 f f'_ Date: a "CD -O� Page: J of ¢ nem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified X PLEASE PRINT CLEARLY U ( u,f F h cc»n I In ( n VAP._ rn ns- ��hrx..( I 01A) CrAin � Com r4'. , h�_AA 0 ! Y i t� -t-U h rrPn� �,crvf i �. o i Til( )P tin r}(fie Ara A (rji r114 )�I -MA-inn DC _ A - 11101 l�� 0_0110/4,a S slyv I_Ivlt-f c_ ,nn_o iunrnwI . -1 v)j . N1 Viw-1 in �,varw mie+1v /i7, �1 1 nA o ( )Y)U -A'Pn 0 vw,rvm n� Q "D,� w ti o T'A , n f.0ta n , � %� ` �I �(lt.ln n� LII OF dr VPinlA C. -•_*�it(t) rNAKin_ N(n P1w-v la,-e0 V 9k7YPAinn-h>0 /-k (�-1-k-17('p 1 V. re 1 c �a �t n,1 orr fs -sA"k) rt a �m( 1 �o eaIf -G ris t7) Dvp v-F tt S-- I Slar^ (Q T� 0 nrA<, rotooitn 1 r0on nA_n(.I, � ✓� �' - ren Irf7 )),riI O n 0q, AS rX0Ag t ,n 4 r0`*'CIlM Ln 1 S�re� ' �' r✓�� - raln�� nn� i �e.�C4�, l )na I- hrlrC!_ �-f�'Y�Q 17!1^(11hPM($ �zJl>r� �1 -��n� �✓�c� Mo CaA fv_- - !lnr� c.-)Veno ( IR of"oe reel 4iZA. M ) t DrrS ( n C. Fz Yana / Y�flt S� 4� (t�11P 4 Pr v morino _oru : Y\oo.AS nPV\ 0AAS r000KenQ _n YX\1 ttos u) rnI �> liNr _� "r((4 n .C(.( if"YYi' ((rhan o� +'Z�I t 6Q 6m, A)r)Y7)nn)V) ( (n o o n a <Za V1I -h-�e c - 'C nt ves ttDlrfrA no o rAo v ,)eo 1 w o l, mrn Wmi . M1 H)?xj i n SfiRoole mn + he C,!letf&- `s Discussion With Person in Charge: Corrective Action Required! I ❑ No I ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food ode. I un stand that noncompliance may result in daily fines of twenty f e dollars r s spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: w , Y 1 I rHFsReceivedat'i'emper:ieures -� Violations Related to Foodborne Illness Interventions and Risk Ac,eiding to Iaw Cnalcd to Factors(items 1-22) (Cont.) 41"F7451F W dhin 4 Hours. PROTECTION FROM CHEMICALS i 3 i01 15 Coulimi Method;for PHFs PHF Hot and Cold Holding 3-2(12,12 Additives 19 t1 Food Color Additives 3-501.168) Cold PHFs Maintained at or below Additives* ( 3-302.14 Protection from lJnappnrved Additives 590.004(P) 41 /45"F' ivess ( 13-501.INA) Hct PHF.Maintained at or above 15 Poisonous or Toxic Substances l40'F 7-101.11 Identifying information-Original 3-50I 16(.-'s) ,Coasts Held at orabove Li(I`F. ' Containers* _ _ 7-102.11 Common Name-Working Containers"` 20 Time as a Public Health Control 3-501.19 Time an a Public Health Control" 7-201.11 Separation-Storage" ( - Se10.0(!`i(H) Variance[requirement 7-202.I1 � Restriction-Presence and Use:' � - - 7-202.12 Conditions of LJsc* 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-.,04 o .12 Chemicals for V1'ushmg Produce,Criteria' 121 3SO1.11(A) LMp-!steunzedPre-packaged Juices and � Bevei.tees with Warning labels* 7-204.13 Drying Agents.Criteria* 13_801.E 1(B) Use of Pactenuzea b19a' 7-205.11 Restricted Food Contact. .Crit era* � 3-80 1.11(D) Raw or Partially Ctvked Annual Frexl anti 7-20611 Restricted Use Pesticides.Corona* Raw Seed Spigots Not Served. ; 7-206.12 Rodent Bait Stations* 3-S01 11(C) Unopcn:ed Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and - ---- Monito ing' CONSUMER ADVISORY TIMElI'EMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of +,nima(Foods'lliat are Raw, Undercooked of 16 I Proper Cooking Temperatures for PHFs Nut Oiacrwuse Processed to Elinunatc =n " rr oro 3-401.1IA(1)(2) Eggs_ 155°F IS Sec. lathe„ens.' - Eggs-Immediate Service 145`1715sec* 3-302.13 Posteun/ad 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 Beet Roast- 1303E 121 min' SPECIAL REOUIREMENTS 590.009(A)-(D) Violations of Section 590.009 A)-(ll) in 3-401.1 I(A)(21 Ratites, Injected Meats- 155°F 15 ( sea® I catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operatiuns should he Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165"F 15 sec. * above if relined to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beet Steaks interventions and risk factors. Other 145"F* 590,000 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 A I(A)(1)(b) All CRher PIFs- 145"F 15 sec. 17 Reheating for Hot Holding _ VIOLATIONS R.SLATED TO GOOD RETAIL PRACTICES 3-403.1](A)&([)) PHFs 165°F 15 sec. * ( (items 23_30) 3-403.11(B) Microwave- 165° F 2 Minute Standing Colica/raid non-rritG:til i fohoiwns, which do not relate to the Time* ,foodborne illncrs ieten entions and,iskjurtors listed above, can be 3-403.11(C) Commercial ly Processed RTE Foal- ( .found in the fu(lowioc vection of the Feud C'odc and Ill CMR 140"F' 590.000. 3-403.1 1(E) Rentaimng Unsliced Portions of Beef Item Good Retail Practices FC 590.000 J Roasts* 23. Management and Personnel FC-2 .003 J l8 ( Proper Cooling of PHFs 24. Food and Food Protection FC- 3 .004 J 25 Equipment and Utensils FC -4 .005 3-501.14(A) Cooling Conked PHFs from 140"F to ------I 26. Water, Plumbing and iNaste FC-5 .00ti 70"F Within 2[[ours and From 70°h 27 Phvsical Facts v FC--6 .007 J to 4 t`F/45'F Within 4 Hours. 28 Poisonous or Toxic Materials FC--7 .008 3-501 148) Cooling PHFs Made From Ambient 29 Spocial Requirements 009 J Temperature Ingredients to 41°F/45`F L 30. .....__Othe. --- -- _- ----I -- Within 4 Hours` Denows enucai item in the.falerai 1999 Fond Code w 105 CMR 590 000. r i CITY OF SALEM A BOARD OF HEALTH f Establishment Name:f l� i�c�Co , Date: I Z-1,9 -Ozf Page: � of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified �. PLEASE PRINT CLEARLY , k�,PA ra1thnr. hMI raq ) iso oY Vvi`- V001 . \ �c� 1�, 1rn. �ralv��'inil,rrl r�t�� — ir c -y�, ,, AAino. had n_1li^r )lr,iA,/o-Hny) ny-VIA-Pr{ (rn IV)rior-nn_n( . ro --nA n C_ .h_I V, o hra nl n, nA Int►I'lr� (,.( ori tt on l + 1 min/�1 n1 irc �rnn7,x ni�irar4 4ir`c�c1tosin6 1 ,n , I,n iso n)p ru , 19_ 1 rl orp In oc� c/0 t�I I r ' lla,u,err n C1.Q 1 n 1 x�I a rt I ''14:e_ <7zz?" /mill " �/aS— - Ir�n7urub�� l , o. �YaS , �S11 >I� tonlr . IAbi� � vii�i ✓!l�( f rm r= o?)Q _ VP�aly . —�_c:-17,v\PA ism Cirv7 -fit i P»c( 7IA I Al Ip root 'T i (_o�a�l (o R 1 it In n� - IAXI ( Il ( h - i n)V IHe- IlcMn iI)COAD vinnr,,m0, vp �- r) <� s-in\nDA - Moan Ywrm )lamhnsls:,. I * Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes ❑ voluntary Compliance ❑ I have read this report, have had the opportunity to ask questions and agree to correct all Employee Restriction/ Exclusion s 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 tenoy t fiv o ars�sion/fev�n of Ll Embargo ❑ Emergency Closure your food permit. `fl-/�' ❑ Voluntary Disposal ❑ Other: v. 1. ! 1-50i.i4tC) PHFs R.rct Ved at t'emper'atures Violations Related to Foodborne Illness Interventions and Risk Acunsiing to{.aw Cooled to Jf Factors(Items 1-22) (Cont.) ( 41`F/41 'F W'ithi n d Hour s. * PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFs 19 PHF But and Cold Holding 14 Food or Color Additives ;-5t)i f ri(B) Cold.PHFn Maintamcd at of below 3-202.12 Additivcrr ( 5901104(F1 41'i45'F'° 1 3-302.14 Protection Crow unapproved Additives* 15 1 Poisonous or Toxic Substances 3-50LINA) 1101 P9Fs Maintained at or above � !40`F. 7-101.11 ( Identifying Information-Original Containers" 13-501 16(A) Roast,Held at or above 130'F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control ' ( 3-501.19 Time as a Public Health Control* 7-20211 estrction-Storage" - 500,004(H) ValianceRequircmont 7-202 11 Restriction estriction-Presence and User 7-202.12 Conditions of Use- 1 7-203 11 'Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE f 7-204.11 Sat»tizers,Criteria (HSP) -Chemicals* I 7-204.12 i Chemicals for Washing Produce,Criteria* 21 13-801.1 i(A) Unpasteurized Pre-packaged Juices and es with Warnow i.{bels' 7-204.14 � Drying.Agents.Criteria* Bevcrag 3-SOI l l(B) Use of Pnntcut'ized Eeps' 7-20(i.l I Restricted Use Pesticides,Criteria* 7-205.1 1 ( Incidental Food Contact.Lubrteri13-MI l 1(D) Raw 0t Partially Cooked .Animal F,xd and � ( a" 7-206.12 ( Raw Seed Sprouts Not Ser:ed. Rodent Bait Stations" l 3- 7-206.13 Tracking Powder.,Pest Control and 1801.11(0) Unopened Food Package Not Re-served ' Monitoring,* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consamer.Advisory Posted for Consumption of Animal Foods"That are Raw. Undercooked or 26 Proper Cooking Temperatures for PHFs rwNot Otheise Processed to Eliminate 3-401.1]A(])(2) IEggs- 155°F 15 Sec. Pa[hugcns.* ` ° "'0' _ 3 - Eggs-Immediate Service 145"F15sec* 1 -30'-•1 Pasteunzed Egg=Substitute for Raw Shell Eggs" 3-401.11(A)(2) Comminuted Fish, Meats&Game Animals- 155"F 15 sec. ` 3-401.11(13)(1)(2) Pork and Beet Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.1 I(A)(2) Raines,injected Meats- 155'F IS 590.009(A)-(D) Violations of Seclton 590.009(A)-(D) in sec, "' catering, mobile foal,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 secitons Poultry or Ratites-165`F 15 sec. $- above if related to Ibodborne illness 340L11(C)(3) I Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violation,relating to good retail 3-40{.12I Raw Animal Foods Cooked in a praeticcs should be debited under#29- Microwave 165'F* Special Requirements. 3401.1 I(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * I (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Crilira/and nun-rritical vioiatiorn, slush do not relate io Ike Tone* foodborne illness aoci vcnkan.�and risk fac tors listed more, ran be 3-403.11(C) Commercial lv Processed RTE Foal- found in the follori unit sernonc n(the Food Cade mul 105 CMR 140°F" 500.00o. 3-403.1 1(E) Remaining Unsf iced Portions of Beef Item Good Retail Practices FC ! 590.000 Roasts* 23. Manaqernent and Personnel FC-2 .003 l 18 Proper Cooling of PHFs ( 24 Food and Food Protection FC-3 .004 25. Equipment and Utensils FC-4 005 3-50I 14(,1) Canine Cooked PHFs from I4U"F to 26 Water, Plumbinq and Waste FC-5 .006 70"F Within 2}lours and Front 70'F 27 Physical Facility FC-6 .007 f to 4tcF/450F Within 4 Hours. '" 28 Poisonous or Toxic 1Aaterials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient -- Special Regtarentenrs Temperature Ingredients t041`F/45"F 30 Other ! - Within 4(lours` e:numu,r,.�o Im„ * Denote.,critical item in the federal 1999 Food Code or 105 CNIR 590 000 Y CITY OF SALEM I BOARD OF HEALTH / Establishment Nam' sTtS Date: I I � � 'U�1 Page: 5 of Item Code c-Critical Item s DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. RefereAce R-Red Items Verified ^ � PLEASE PRINT CLEARLY I @/��I ��q�}<`rnn 1.rn)V_(/ vl o hA I »rah ow n 4 vm-m- -e 1�,� . 4A 1 C 1+F -i n h n 1 n6 !Lf t.# 1 0 F . I I - 11'lon h) ,l0 StD e t Yvwr horn( I )P - � I . I I ; I 1 :. Ij'0�}'/, �`n. n � 11 Iof XYl Y1 III11Q If17� 7tiwi , I („n + .� I 1 \ P&DSUUel?' IlAA"+,A AI e _ ,i'�(--nr;l u m 'Prf � N I lk pri0<,-() t� - 1 5 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Ye� I have read this report, have had the opportunity to ask =,; and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all Condit as desc`rib� and to Exclusion t P ❑ Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food Code. I undbrstand that f noncompliance may result in daily fines of tw r�ty five dollars orsusp si n/revocation of ElEmbargo ❑ Emergency closure your food permit. LlVoluntary Disposal ❑ Other: 1 r PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accorchas to Law Curled to Factors(Items 1.22) (Cont.) 41"F/45'F Within 4 Hours. ' PROTECTION FROM CHEMICALS 3-501.15 Cool In-,Methods for PHFs f 14 1 Food or Color Additives 19 PHF Hot and Cold Holding 3-203.12 AdAdditives* 3-501.16(B) Cold PI IFs Maintained at or below 59n.004(F) 41°)45`'F" 3-302.14 Protection from Unapproved Adel3-501.16(A) I lut PHFs Maintained at or above 15 Poisonous or Toxic Substances (4i)'F. 7-101.11 I ktenuf}i ng Information-Original I r- st I .. 501 16(A) Roams Held at ur;,bove 13U'P. Containers* 7-102.11 Common Name-Working Containers" 20 Time as a Public Health Control 7-201.11 Separation-Storage"` 3-50 1.19 Ti are as a Public Health Control* 7-202.11 Restriction-Presence and Use - I i90.004(H) VviotnsRector remcnt f 7-202.12 Conditions of Use' 7203 11 'Toxic Containers-Prohibitions"' I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals' POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 121 ( 3-801.1 I(A) L'np.eacunzed Pre-packaged Juices and Beverages wain Aarmng Labels°. 7-204.14 Drying Agents.Ca' 3-801JI(B)i(B) Ilse of Pasteurized Eggs* 7-205.11 Incidental Foal Contact.Lubricants* 13-80L l I(D) Raw ur Partially Cooked.Aniriml 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 rood Package Nut Re-served " 7-206.13 'tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603,A 1 ('onsumer Adsi,aty Posted fur Consumption of Animal Futods That are Raw. Undercooked or 16 Proper Cooking Temperatures for I PHFs Nut Otherwise Processed to Eliminate I 3-401.1IA(1)(2) I Eggs- 1.55'F 15 Sec. 1'aihogvns.'rh Eggs-hunneale Service 141°F1-Ssec* 3-30'_.1 i Pasteurized Eggs Substitute tot Raw Shell 3-401.1I(A)(2) Comminuted Fish, Meats&Game Eggs', Animals- 155'F 15 sec. * 3-401.11(13)(1)(2) ( Pork and Beef Roast- 130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-1.55'F 15 590009(A)-(D) Violations of Section 590.009(A)-(D) in see, " I catering, mobile fxid,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 3401.11(C)(3) Whole-muscle, Intact Beef Steaks Interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 I Raw Animal Foods Cooked in a ptactices should be debited under#29- Microwave 165'F* Special Regnilements. 3-401,11(A)(1)(b) All Other PHFs- 145'F 15 see. * _ 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)8c(D) PHFs 165'F 15 sec. * ( (Items 23.30) 3-403.11(B) Microwave- 165' F 2 Minute Standing Ct anal and nun-erincal violations, ni ich(ln not relate to the Time* foodborne illness i,rerrennoru and risk fag two listed above, can be 3-403.11(C) Commercially Processed RTE Food- f(urnd in the%allowing se.Iinn,t ill the Food Code and 105 CLIR 140"F"' I 590.000. 3403.1 t(E) Remaining Unshced Portions of Beef ( Item Good Retait Practices FC 590.000 + 23. Management and Persrnnal FC-2 .003 Roasts 1 I 24. Food and Food Protention FC- 3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 J 3-501.14(A) Cooling Cooked PHFs from 140°F to 26Water Plumbing ard Waste FC-5 .006 70'F Within 2 Hours and From 70°F 27. Physical Facility FC-6 007 a-t 41`F/45°F Within 4 Hours. ( 28. Poisonous or Town Materials FC -7 .008 3-501.141 B) Cooling PHFs Made From Ambient 29 Special Ronulremerts .009 f Tempetatare Ingredients to 41'F/45'F 30. , Other - Within 4 Hours" °irn .•'" a'° Demme,critical iimn m the IAlerzl 1999 Farad Code or 105 CMR 590 000. le— 1 PORTANT MESSAGE ) FOR n J DATE`6 1 ?JI I 0 TIIvME1 3L . M sod,, l OF PHONE AREA CODE NUMBER EXTENSION O FAX O MORA F AREA CODE NUMBER TIME TO CALL TELEPHONED J I PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I I RUSH f RETURNEE)YOUR CALL( WILL FAX TO YOU MESSAGEyll-f' M Y Q -A i-eA4YK+ rkrA2. iV'\ft�k -e1 PNCAJW fw� cu m lv- q f cm Take of T�mf,s -1 fCk& n IcY1( as SIGNED N.QArA ISTOPa FORM 4009 MADE IN U.0 CITY OF SALEM Establishment Name: IQS O ��a rn� BOARD OF HEALTHDate: I i� y Page: ( of r r Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ` Verified.NoReference R—Red Item .^ PLEASE PRINT CLEARLY ( n, � I t^Y �P/� �1�1 �i �nt�A ,��/1• i,� F 1rP/t011 }P� Q ��Otik �ftll-�- 1�IU1n /'iln _ Il� IL) f)C4 IkJlerP_ (I 1)✓ cd 1 - n� r�n LrY��O /)h�GNIP� tl0/Y� lvink ovr�✓r/r( o - PiP/M6Xi nlnylc✓ ct7fYlq ",57Q IW17- /lerrs. b�n. � 1-wA4'o'l . 7h1124/7' rir/Le _ ' n f�n� rf Yo (Jr.�v //Stc �rla�l mrtll 1-i 0144, Ma(Ili_rjc r a: aifiiGilco is, hilel? ohol( (417dil. also JAW",-' Cor.,,kAr. lash 2oraa�fi�� lc a ``l(a��iaW /ii/i., ,�/s4�G a-Icy I'lyzat " -T��rn�fn>z ch/cr�c�/�' ta, l�lP�rG. /tPlc rle'jI'0 �Gr.ken—lu r 7irvn >f�j 1k, '71 i Cie a wo- - -> 00 Maahr�o ti�r� �;n�rlel�r,lafim f �� rY9�ili( - 71/i�wl//�hlri s'I�lnad Y ro.cur-ar-a are r" places_ - i Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes t' ❑ Voluntary Compliance ❑ Employee Restriction/ ' I have read this report, have had the opportunity to ask questions and agree to correct all ry p Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food Code. I understand that — k noncompliance may result in daily fines of t enty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. l�10A�J/ a c_J1_-v. ❑ Voluntary Disposal ❑ Other: 3-501.I'I(C) PHP,Received at Teruperatures Violations Related to Foodborne Illness Interventions and Risk .4ccerdina to I,aw Cooled to Factors(items 1.22) (Cont.) -11 'F45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coo!irw Methods for PHFS 19 PHF Hot and Cold Holding Food or Color Additives 14 I 3-501.16(6) Cold Pt IF,Maintained at or below 3-202.12 Additives'* I 590 004(F) _ 41'145: F' 15 1 3-302 14 Protection from Unapproved Additrves k I 3-501.16(3) H:» Phi Fs 67aintamed at or above Poisonous or Toxic Substances 7-101.11 Identifying Informal um-Original I IdiYh * , Containers" 3-501 16(A) Roasts Held ;u or above 1300P . 7-102,11 Condition Name-Working Container'" I 120 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Storage', 590.004(H) Valiance Requirement 1 7-202 11 Restriction-Presence and Use* 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-^_(13 11 Toxic Containers Prohibitions* I POPULATIONS(HSP) 17-2(Yl.i 1 Sanitizes',.Criteriaa-C'hemicalsm I 7-204.12 Chemicals for Washing Produce,Criteria' 'I 3-801.IIfA) UnpasteunzedPr,.-packaged.Juice-,and 7-204.14 Drying.Agents.Criteria• ( Beve.aees with N ammo i.,hels 3-S01.11(B) U;:e of Pasteurized lees' 7-205.11 Incidental Food Contact, Lubricants* I 3-80L 11(f)) Raw of N;uually Cooked.Animal Food and 7-ZU6.11 Restricted Use Pesticides. Criteria'' ( Raw Seed Spimas Not Served. ,; 7-206.12 Rodent Bait Stations* I 3-g01.11(C) Unopened Food Package Net Re-served. " 7-206.13 Tracking Powders.Pest Control and -- Monitoring*" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60_.11 Comforter Advisaty Posted for Consumption of 16 ( Proper Cooking Temperatures for I Animal Fords liiat are Raw. Undercooked of PHFS Not Other"Ise Processed to Eliminate 3401.11A(1)(2) Figgs- 1ss°FlsSec. I'atho,�cns Eggs-s Immediate Service 145'F75sec; 3-3(1'-.13 Pasteur,ed Hges Sutbstrtute for Raw Shell kt.,- l 3-401.11(A)(2) Comminuted Fish, Meats&GameEgXs* Anmtals- 155'F 15 sec. .t SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130"F 121 nein* I 590M09(A)-tD) Violations of Se('tion 590.009(A)-(D) in 3-401.11(A)(2) Ratites, Injected Meats-155'F 15 I sec ` catering. mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFS, rdeidcntial kitchen operations should he Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165`F 15 ser. above if related to foodborne illness 3-4011t(C)(3) Whole-muscle,Intact Beet Steaks interventions and risk factors. Other 145'17;. 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices ahotdd be debited under#29- Miciowave 165"F* Special Rcquiremeuts. 3-40LlI(Arf bb) I All Other P1fFs- 145'F 15 sec 17 Reheating for Hot Holding I VIOLATIONS III TED TO GOOD RETAIL PRACTICES 3-403.11(A)8t(D) I PHFS 165°P 15 sec. " ( (items 23-30) 3-403.11(6) Microwave- 165°F 2 Minute Standing Critrctd and nun-rrilmol violations. oho h do nor relate to fire Time* ,Jondborne illness interventions una iW /actors listed move, can be 3-403.11f C) Commercially Processed RTE Fund- loud in the f dlonvic sections q the hood Codc azul 105 CNIR 140017* 59(.000. 3-103.11(E) Remaining Unsliced Portions of Beef I item Good Retail Practices FC 590.000 Roasts* 23. Manaffen:ent unit Personnel FC-2 .003 is Proper Cooling of PHFS I 24 Food and Food Protection FC-3 004 2.5. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFS from 140'F to 26. Water,Plumbinq and Waste FC-5 .006 70'F Within 2 Ilours and From 70'F 1 27 Physical Facility FC--6 .007 I to 41'F/45'F Within 4 Hours. " 1 28. Po sonoos or Taxic Materials FC-7 I .008 ,-501 14(B) Cowling PhIFs Made From Ambient 29 Special Requirements 009 Temperature Ingredients to 41'17/45`F 30. Other Within 4 Hours' pennies critical item in 010 federal 1999 Fond Code or 105 CNIR 590 000, Massachusetts Der. S artment Of Public Health Salem Board Health M 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 j Name Date Type of Operationtsli Tyce of Insoection 4 &� _ n f VYY1e 5 , �7 •0 )-9ood Service ❑ Routine rAddress� � l �- Risk E] Retail 0'Ra-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneA q ❑ Mobile Date:S• �5 Oq HAGCP YlN ❑ Temporary [:1 Pre-operation Owner IRI /v TrIjPiRGi r ❑ Caterer ❑Suspect illness Person in Charge(PIC) f Time ❑ Bed& Breakfast El General Complaint err) �/34"Yt1.tiaCif( In: I ❑HAGCP . 1 (lrrrn H n ,/ M ql��h Out:t Permit No. El Other Inspector 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 PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEtTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HAGCP Plans ❑, 18. Cooling PROTECTION FROM CONTAMINATION p� i9. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1.22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR cf Health. 590.000/federal Food Code.This report, when signed below C TN 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 SWfnp arnrm6 14 nw Insp ct$s$1'gxni� re: „ Print: 1 NI'C' Si t e. f I Print: ( Page_of_ ages r n Y! • Y Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 590003(\) ( Assigtun6nt of Resuonsibility* 3-302.11(x)(1) R„w Antn•d Fruits Separnled lion 590.003(B1 Demonstration of Knowledge" C(wked and RTE Foods'- 2-10311 ods'-2-10311 Person in charge-dunes Conlammatien from Raw fngrodrenrs 3-30111(021) Raw Animal Fails Separated from Each EMPLO"EE HEALTH Othcri 2 590.003(0 Responsibility of the person in charge to Contaminanon from the Environment require reporting by forxl employees and 3 302 11(A) Foot)}'rmc�tion* applicants* .3-302.15 Washmc Fruits and Vegetables 590.003(F) Responsibility Of A Focxl Employee Or An I 3304.11 Foal corLrct with Equipment and Applicant To Report To The Person In Utensils* Cha]ue k Contamrnefrbn from the Consumer 590.003(C) Reporting by Person in Charge* 3-306.1-1(A)(B) Returned Fond and Reservice of Frxxh 3 590003(D) Exclusionsand Resuictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning unsafe FOOD F IOM APPROVED SOURCE Food' 41 Food and Water From Regulated Sources 19 ( Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501,111 Manual War washing-flot Water 3-201.12 Food in a Hermetically Sealed Container* ( Sanitization'I'emperan.ues' 3-201.13 Fluid Milk and Milk Products* 4-501 112 Mechanical Warewashing Hol Water 3-202.13 Shelf Eggs* Sanitization Tenperauues' 3-202.14 Eggs and Milk Products.Pasteurized' 4-501 114 Chemical Sanitization-temp.,pH, 3-'02.16 ice Made From Potable Drinking Water'" Equpmntconcentration and hardness, s" d-601.i l f AI Equipment Fail Contact Surfaces and 5-101.11 Drinking Water from an Approved System" Utensil,Clean' 590.006(A) Bottled Drinking Water* 14-602,I1 Cleaning Frequency of Equipment Foal- 590,006(8) Water Meets Standards in 310 CMR 22 0' Contact Surfaces and Utensils' Shellfish and Fish From an Approved Source ( 4-702.11 Fi cyuency of'Sa itizahon of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of liquipment" Shellfish" 4-703.11 Metboxls of Satntimlion--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical Sources" 10 ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I 2-301.11 Clean Condition Hands and Anns* Regulatory Authority 3202.18 Shellstock Identification Present* 2301.12 Cieeiung Procedure* 590.004(C) Wild Mushrooms" 2-301.14 When to Wash" 3-201.17 Carne Annuals' 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco° 3-202.11 PIIFs Received at Proper Temperatures* 12-401.12 Dlscharccs Frorn the Eyes.Nose and 3-202.15 Package Integrity* Month* 3-101.11 Fuad Safe and Unadulterated" 3-301.12 Preventing Contanmation When Taslin�* i 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellsux:k Identification Maintained* Employees" 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 3402.12 Records.Creation and Retention'' 5-?03.1 t Numbers and Capacities" 990,004(p Labeling of Ingredients' 5-205.11 Ac atinn and Placement"' nn" 7 I Conformance with Approved Procedures 15-205 l t Aa;scibility, Operation and Maintenance /HACCP Plans I Suophod wah Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen Packaging,criteria* 6-301.11 Ilandwashing Cleanser.Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 flaud Dning Provision "Denote,critical ileal io the fedei al 1999 Food Code of 105 C6-iR 591,100 11 CITY OF SALEM BOARD OF HEALTH _ Establishment Name: TASTE /1F ��1?F ��/ E Date: Page: of 0 Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified - PLEASE PRINT CLEARLY !i a� re>h_c ��ior� � /�'Ilrrwl //��e 46�w : 1 9 C — ` r,.v Fwil v " lvnl -/enc o • / q5,* &-r/ - /lee 7WOr• _[ a v r n'• n v, aS N /e. - SIS S 44 �Y�� /n/c -v 1-.�e rP/ora14P4_ _ I 1 l �7Qv-h Pen.(-0 I ��/-✓�t-6C�ruGsl��rr //'' 1 4 ttt 41 ad �X'I•'ei' /W/--LC/7Q`�6�?_ " riltlltQ.C'O,pFi2 ✓j,Pp0 It j 4n p0f -jCj' / re locriTed rov-(Wnis bA 11114 0(31 w4 o ✓Ad w s8au (ry' u-) t I b 4 ` Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 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 Fp9d%ode. I understand that r noncompliance may result in daily fines. f t nt ve dollars or suspension/revocation of ❑ Embargo Ll Emergency Closure ` your food permit. ❑ Voluntary Disposal El Other: t _ s-SOI ;J{C'; PI1F's Recened u Temperatures Violations Related to Foodborne Illness Interventions and Risk IAccording to Law Cooled to Factors(items 1-22) (Cont.) i 41'F745'F Witi,in 4 Hours. ' PROTECTION FROM CHEMICALS 3-501.15 Cooling Methcc.s for PHFs 14 Food or Color Additives I 19 PHF Hot and Cold Holding y n „ k ?-5(17 I6(6) Cold I'f1Fs R1ain[aincd at i1i below 3-_02.12 Additives 590-004(F) 41'145" F- 3-302.14 Protection from Unapproved Additives* 3-501.16(„) tioi PHFs Mautainect at or above _-- IS � Poisonous or Toxic Substances � 1401F, , 7-101.11 Identifying Information-Original 3-5(11.14(A) Reims Held at or above 13U'F. Containers" 7-10111 Common Natne-Working Containers* � � 20 � Time as a Public Health Control 7-201.11 Separation-Storage* 3-901 it) Timc as a Public Health Control* f 7-202,11 Restriction-Presence and Use" i90.004(1-1) Vami:mc'c Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204,11 Smtitizers,Criteria-Chemicals' POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteuuzed Pre-packaged Juices and Beverages with Warning LabeW'- 7-204.14 Drying Agents,Criteria" 3-8f11 1116 Use of Yasteu.�zeJ Fens" 7-205.11 Incidental Food Contact. Lubricari 3.801.1 I(f71 Raw of Partially Cayked.4ninral Faai and 7-.06.11 _ Restricted Use Pesticides.Criteria Raw Sceri Sprouts Not Served. " 7-206.12 Rodent Bait Stations* 3-801.1 IW) Unopened Food Package Not Rc-served. 7-_06.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer A&iso:y Posted for Consumption of Animal Foals"I'hal arc Ra*.Undereool or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs Fascave v,'Poo, 3-401.11A(I)(2) Eggs- 151'F 15 Sec. Pathogen:..' Eggs-bunlediate Service 145°1415sec* 3-301.t? Pasteurized Eggs Sabstimte ffn Raw Shell 3-401.1 I(02) Comminuted Fish,Meats cS.'Gams Eggs Animals- 155'F 15 sec. * _ 3-401.11(6)(1)(2) Pork and Beef Roast- 130'F 121 min* ( SPECIAL REQUIREMENTS 3-401.11(A)(2) Rallies, Injected Meats- 155°F 15 590.009(,\)-(D; Violations of Section 590.009(A)-(ll) in sec, ro ( entering. inobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations.should be Stuffing Containing Fish, Meat, debited ander the appropriate sections Poultry or Ratites-165°F 15 sec. " above if related to foodhornc illness 3-401.1I(C)(3) Whole-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'F* Special Requireinelits. 3-401.11(A)(1)(b) All Othel'PHFs-- 145'F15sec 17 Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 16.5'F 15 sec. * L ( (Items 23-30) 3-403.11(6) Microwave- 165' F 2 Minute Standing Critical and uca-critical vtohuimis, i0 ich do not relab•to the Time* foodborne illness into i-enlions and rill/hrtors lisled above, Can he 3-403.11(C) Commercially Processed RTF Food- found in the/idlowii,g sections of the Food Code and 105 CMR 140°F* I 590.000. 3-403.11(E) Remaining UnsbcedPortions ofBeef I Item Good Retail Practices FC 590.000 Roasts* 23. Management and Personnei FC -2 .003 18 ( Proper Cooling of PHFs 24 Foal end Food Protection FC-3 004 25. Equipment and Utensils FC -4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water,Plumbing and Waste FC-5 .006 70"F Within 21lours and From 70'F 27. Physical Facility FC--6 .007 to 41°F/45'F Within 4 Hours. * ( 28. Poisonous or Tnx,c Malerials FC-' .008 3-501 14(6) Cooling PHFs Made From Ambient ( 29 Special Requirements .009 1 Temperature Ingredients to 41"F/45'F 1 30, Other Within 4 Hours;y *Denotes cuncal dem m iha Weral 1994 Fond Code or 105 C NIR 590 000. ( IMPORTANT MESSAGE ) FOR Nil DATE i'S��y7�9�DY TIME ZZRI ` M OF PHONF AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBP F AREA CODE NUMBER TIME TO CALL TELEPHONED /'i 'PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU f RUSH RETURNED YOUR CALL f WILL FAX TO YOU MESSAGE Q "4zzZao --��-e'��/� SIGNED ��Pcc FORM 4009 MAN IN U S.A NOTES - Wssachusetts De arthient of Public Health . Salem Board of Health p 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 Date ++ Tvpe_of ooeration(s) Tyne of Inspection A v dry or Y#S/M� ( d. SIC` 15"a ErFood Service 0Koutine Address Risk ❑ Retail ❑Re-inspection / 7_2 /a/Ardim&rt'" Sr- Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: qw- --744/-U 2C9 ❑ Temporary ❑ Pre-operation Owner HACCP YIN I ❑ Caterer ❑ Suspect Illness f.01114211'4 Person in Charge(PIC) �J � ,JJTime ❑ Bed&Breakfast El General Complaint nP� l2n'ti'i/tMl� In; ❑ HACCP Inspector ( �nnp /'/ h�nr«�a6k Il�•t°arWrrtfYl uYx I Out: Permit No. F-1 Other Each violation checked requires aniexplanation 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 j313. Handwash Facilities EMPLOYEE HEALTH - «, PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source TIMEtTEMPERATURE 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 [�K9.Hot and Cold Holding(01) ❑ 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 El11. 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 immegiately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (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.o05) 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: SI5.901nsP�'IFomi644.tloc /Vir V ' Print: i,•.r:<. •r tit P� �Signature: �1 r r C �-t It'.S l �. Print: �� ', �-- U-U, !-1�� I Page of Pages Violations Related to Foodborne illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contaminaton t i590.003(A) Assignment of Responsibility" ( 3-302.11(Aa I) Raw Animal Nxxls Separated from 590.1103(6) Demonstration of Knowledge* Cooked and RTF:Foods' 2-103.11 Person in charge - duties Contamination frorn Rao,ingredients 3-302.1 I(AL(2) Raw Animat Fonds Separated from Each EMPLOYEE HEALTH Other" 2 390.003(C) Responsibility of the person in charge to Contamination horn the Environment require reporting by food employees and 3-30111(A) Food ProtectionT applicants* 3-301.U Wastuoo Fruits and Vegetables 590 003(F) Responsibility Of A Food Employee Or An 3-304.i i Food Contact w.;n 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)(6) Returned Food and Resercice of Food^ 3 590 003(f)) Exclusions and Restrictions* Disposition of Adukerated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Rcconuttiomng Unsafe FOOD FROM APPROVED SOURCE F(wd'" 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-6) Compliance with Food Law* 4-501.111 Manual W.rewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container' Saninzatiun Temperatures* 33-201,13 Fluid Milk and Milk Products* 4-501A 12 Mechanical Warewashiuc Hot Water 3"202.13 Shell Eggs* Sanitizatiou Tempe!atur, 3-202.14 Eggs and Milk Products,Pasteurized'" 4-501 114 Chemical Sanitization-temp.,PH, concentration and hardness. " 3=202 16 Ice Made Front Potable Drinking Water14-601.11(A) Fh'rluipment Food Contact Surfaces and 5 101.11 Di inking Water from an Approved System* Utensils Clean- .500.006(A) Bottled Drinking Water* 14-602.11 CleaningFFrequency ofEquipment Food- 590.00603) Water Meets Standards in 310 CMR 22 W. � Contact Surfaces sid 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 I Fo.,d Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization -Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemicar. Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I Regulatory Authority 1-301.11 Cleat Condition--Hands and.Army" 3-202.18 ( Shellstock Identification Present* 2-301.12 Cleaning Procedure' 590.004(C) Wild Mushrooms' 2-301.14 rNhen to Waslt* 3-201.(7 Gaine Animals* 11 iGood Hygienic Practices 2-101.11 S Receiving/Condition ( Facing, Drinking or Using Tobacco^ 3-202.11 PIIFs Received at Propet Temperatures" 12-406-12 Discharges From the eyes,None and 3-202.15 Package Integrity* Mouth:: 3-101.11 Food Safe and Unadulterated* ( 3-301.12 Preventing Contamination When Tasting" 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands 3 02.18 Shcllaock Identification* 90.004(E) Preventing Contamination from 3-203.12 Shellsto k Identification Maintained* Emphiydes^ Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Desh'uction* I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention'' � � 5-303.11 Numbo s and C,pacifier^ 590.0(}1(,1) Labeling of Ingredients' 5-204.11 Location and Placernent* 5 7 Conformance with Approved Procedures -205,11 Accessibility, Operation air] Maintenance /HACCP Plans I Sucplkd w:ih Soap and Hand Drying Oev'ces 3-502.11 Specialized Processing Methods* 6-30)A I Handwastnng Cleanser.Porailabllity 3-502.12 Reduced oxygen packaging,criteria" 8-103.12 Conformance with Approved Procedures^ ( 6-301 12 IImcd Chying Provsiun 'Deraft,critical dem in the federal 1999 Fond Code or 105 CNIR WOO)() CITY OF SALEM BOARD OF HEALTH Establishment Name:/4 7 Srf- nF Tf1Vj)96- (7,r}PE Date: 5 Page: °2 of Hem Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE/PRINT CLEARLY 7(�nr5/irt� CA'Sbnn-1i/-nn hn�r1 �Q A01)ZOin 1 0// IG-ed n m rnus-F he t l Cvvere� . _ 4- / 4 True frit%." A41� a 4&,f-k7 '0- a ' *$oF: On ,F O?U'41 Ae Macn4a l ed � .((� Ybllssln�i Chao/iP Ina "' C'on&VYU tf vvu-f-. JnO/a,'� I-i t!�`liva�G,/,v/ slink had no sma Ownee rnr,sf eupplu soccer_ of a1 /ylaan4n/l7jed al a 4enla or 6o ov geIntc..I — ('7nrea Crjk' 0hp -'P- mn rr)1-0I)ted a -v R4fY)(p ar UI OF oy AeJauu - Uh Its tvius� har.-P I/rs/hl� otc�t„rI��._7° -N�ovrrrorna�e�,/eS . ��- 197 �'_ PeQSt Chas/ 17vhI wlor,n�,2 )Y/� Q 4en4�!}'t OF QM MISSI,-1 a "� Cove fnv -Plvn�-P_5non f h Ai-. . Terries rnusn4 he macn -kiined a_� n 4prwr) n•f' 4l or arbPl,91. reo)aC1t. ./Josh' c'OlrPrr aln Owif''sul' �- )/ h4. r 1, -h6o a-r W- rlyims • elerrv) < < carr47f `3) vtc fv, �ha�( _Sln)c �'Gr, � Sfra-t- " l�l//S(1 , i IY)� I nlx-Mx-�lPr{ hi.i 1Y�� . �'Ich� Y)Oorl � hP rr � rlorry 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 dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your.food permit. El�., �- t 1 Voluntary Disposal 0 Other: 3-5(11.14(C) PHFS Rec iwd it Temperatures Violations Related to Foodborne Illness Interventions and Risk Acta;rdmg w to laCooled to Factors(Items 1-22) (Cont.) al`FP:5'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50!.:5 Cookie,Method;for PHF's 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501 1613) Cold PI IFs Maintained at or below 3-20'_.12 Additives* 59U,n04(F) -Ii"/Y'"F - 3-102.14 Protection from Unapproved Additives* � 3-501,16(A) ifor PHF. Maintained at or above 15 1 Poisonous or Toxic Substances 140'F, 7-101.11 Identifying information-Original ( 3-501.16(A) Roasts Held at or above 130°F. * -------) Containers- 7-102.11 Common Nance-Working Containers` 20 Time as a Public Health Control 7-201.11 Separation-Storage" 3-501.19 Time a:.a Pabiiv Health Control* 7-202 11 Restriction-Presence and Use 590.004(H) Variance Requirement . 7-203.12 Conditions of Use- 7-203.11 se" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1 1 ToxicSancti Containers Criers-Prohibitions* POPULATIONS(HSP) 7-204.11 Samtitizers,Criteria-C'hemicvls* � - 7-204.12 ( Chemicals for Washing Produce,Criteria"' 121 ( 3-801.11(1) L',irnsteurized Pte-paekagcd huces and Be4era es a,rth W�arrnna Iahels* 7-204.14 Diving Agents.CriteriaT ( 3-801.i 1(B) Use of Pasteurized Ege"s^ _ 7-205.11 Incidental Food Contact,LubncantsT 13-801,11(D) Raw or Partially C.-vked Annual Food and 7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts Not Set ved. 7-206.12 Rodent Batt Stations* 3-801.11(C; Unopened Food Package Not Re-served. 7-206.13 'tracking Powders,Pest Control and -- - Monitorrm+T CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1! Consume;Advisory Posted for Consumption of Anunal Foods That are Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFS _ ., "y., r-r anar I th „ens.*"" '° -401.1 to{U(2) Eggs- 155'F 15 Sec. an Eggs-humediate Service 145°Fl5see� 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Eggs* Animals- 155"F 15 sec. I` 3-401.11(13)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Routes,Injected Meats- 155°F 15 590009(A)-t D) Violations of Section 590.009(A)-(D) in sec. It catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFS, residential kitchen operations should be Stuffing Containing Fish,Meat, dchxed under the appropriate sections Poultry or Ratites-165'F 15 see. °' above if related to foodborne illness 3-401.11(00) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145"F* 590.009 violations relating to gond retail 7-401.12 Raw Annual Foods Cooked in a practices should be debited under 1{29 -- Microwave 165`F* Special Requirements. � .3-401.11(A)(1)(b) All Other PHFs- 145°F 15 see * 17 Reheating for Hot Holding VIOLATIONS RZLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFS 165'F 15 sec. * (Metas 23-30) 3-403.11(B) I Microwave- 165'F 2 Minute Standins Ciiticad and non-critical vralatrons, ivin.h do nut relate to file Times ,foodborne ilbnsa intevv ntions and risk j,,e tors 1WW above, can be 3-403.11(C) Commercially Processed I2TE Food- ,found in the follrmang sections ccf die Food Code and 105 CMR 140"F* 590.000 3-403.11(E) Remaining Unsltced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 123. Managcri and Personnel FC-2 .003 18 Proper Cooling of PRFs 24. Food and Food Protection FC-3 .004 25. Equipment and U!eos:ls FC-4 .005 3-501.14(A) Cooling Cooked PHFS from 140"F to 26. Water,Plumbinq and Waste ( FC-5 006 70"F Within 2 Hours and From 70"F 27. Physical Facilitv FC-6 007 to 41'47/45"14 Within 4 Hours. It 28. Poisonous or Toxic Mater!als FC-7 .008 3-501 14(B) Cooling PI-IFS Made From Ambient 29, Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours . „s,� `Denotes cancel item In the toderal 1999 Feud Code or 105 C NIR 590 000. CITY OF SALEM BOARD OF HEALTH Establishment Name: A Ti4Sr6 ,OF T(-}V/YIL CA FT Date: 5'•x5.05/ Page: v� of %3 Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified PLEASE PRINT CLEARLY It a C'_ nfoma)d( -)h7hljtxP lvnn Y2Ce)IMIY nh�uf Unrn/e/-ed rmp4gir)S an �nr�nlP� C`I( /w hohrs . 0 A)11,9 k- /OlC /cCfS /d Dhbud oce lnr> eir /I kid ns ort +n ooueY rvru,n�, nc. I ��_'o}rl��irntn �pPYYhi�' 1 N� v�r1lu�.sl7,nG� Eu-lPv�,lnafi� � I _ Food '�Prnr2S � vopl /G' ' P _ 1 1 I � 1 Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes 4 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 r. noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑, Embargo ❑ Emergency Closure ? your food permit. EL, �V/ ❑ Voluntary Disposal ❑ Other: 1 Siil.!d,C,! Violations Related to Foodborne Illness Interventions and Risk PHFs Recewed.0 I eiperaturesAccording to Law Cooled to Factors(Items 7.22) (Cont.) ' 1 i'F1=t5`F Within 4livurs. PROTECTION FROM CHEMICALS ( 3-50!.! I Cootinrtdrthodsfor PHFs 14 I Food or Color Additives 119 I PHF Hot and Cold Holding 3-202.12 Additives'« I 3-501.16(B) Cold PRFs Maintained at or below 0 004(F) 41'/45 F" 3-.302.14 Protection horn Unapproved Additives* 319 IS Poisonous or Toxic Substances 3-501.16(A) Hut PHFs Maintained at or above � ( 7-101.11 I fdentifymg infonnatinn-Orig4(i"F.inal 13-501.16(A) Roasts Held at or above 1300F. Containers- 7-102,11 I Common Name-Working Container" ( 20 I Time as a Public Health Control 3-501 10 1Time as a Public Health Contr'o'.*7-`_'01.11 I Separation-Storage* I ; ( 7-202,11 Restriction-Presence and Use* 159(.(104(11) Variance Re.luiremnnt 7-202.12 I Conditions of Use* 7-203.11 I Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � 7-204.11 I Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)7-204.12 ( Chemicals for Washing Produce,Criteria' 21 3-80 L 11('.+) U:tpasleurircd Pee-packaged Juices and Beverte2es with Warning Labels 7-205.11 7-204.14 I Drying Agents.Criteria'' I 3-801.11(B) Uwnl'PasteurizedEeek' - --___- Incidental Favi Contact.Lubricants' 13.801 11(D) Raw or Pertain Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* Rae:Seed Sptouta Not Served. " 7-206.12 Rodent Batt Stations* 13-801.111C:) Unopened Food Package Not Re served. 7-206.13 Fnackmg Powders,Pest Control and - 'Monitoring^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603,11 Consumer Advisor} Posted for Consumption of Anneal-Foixts ]'bar are Raw.Undercooked or (6 IProper Cooking Temperatures for ( PHFs Not Otherwise Processed to Eliminate t"""""" i 3-401.1 I A(I)(2) Eggs- 155°F 15 Sec. Pathog`0s'�+ Eggs-Immediate Service 145'F15sco 3-302.13 Pasteurised Fggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meals&Game Eggs* Aninsils- 155'F 15 sec. ` SPECIAL REQUIREMENTS 3-401.11(B)l1)(2) Pork and Beef Roast - 130"F 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 590 009(A)-(D) Violaiuns of Section 590.009(A)-(D)in sec, * caterine, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under die appropriate sections _ Poultry or Ratites-165°F 15 sec. * above if related to foudborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations ielaling to good retail 3-401.12 ( Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) ( All Other PHFs- 145'F 15 sec. 17 I ( Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)X(D) PHFs 165°F 15 sec. * (items 23.30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Orilicrd and nun-*ritual violations, which do not relate at the Time* Jondborne illness mecrwalions ra:d tisk Jb,uwi lined above, can be 3-403.11(C) Commercially Processed R'CE Food- found in rhe jofloi-nig secrion.s or che Fond Code and 165 CMR 1400F* 590.000. 3-40111(E) Remaining Unshced Portions of Beef I I Item Good Retail Practices FC 590A00--.1 Roasts*. 23. Management and Personnel FC-2 ,003 18 I Proper Cooling of PHFs I 24 Food and Food Protection FC - 3 004 I 25. Equipment and Ulonsiis FG-4 005 3-501.14(:1) Cooling Cooked PHFs from 140`P to 26. Water, Plumbinq and Waste FC-5 006 70'F Within 21lours;and From 70'F 27. Physical Facility FC--6 007 to 41'F/45'F Within 4 Hon s. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(8) Cooling PHFs Made From Ambient 29, Special Heauirements 009 Temperature Ingredients l041"F/45°F 30, Other Within 4 Hours" Denotes meal item In 1110 COderd 1999 Fond('ode or 105 CMR 59(1000.