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LOBSTER SHANTY - ESTABLISHMENTS [obStef s�w,Ty 2� 40Stn�p ftNIVERSAL® UNV-12110 MADE IN USA SUSTAINABLE MN.pECyCLED FORESTRY FORESTRY Elf 10% Cebfed Fiber Souabp PDSTtONSNR eewefiprogrem.ory 41u mk rt i Commonwealth of Massachusetts .� City of Salem r Board of Health 120 Washington Street,4th Floor Kimberley Driscoll SALEM,MA 01970 Mayor Food/Retail Establishment Permit DATE PRINTED: 03/11/2010 ESTABLISHMENT NAME: Lobster Shanty File Number:BHF-2004-000013 25 Front Street Salem MA 01970 , LOCATED AT: SALEM, MA 01970 i Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0388 Mar 15,2010 Dec 31,2010 $280.00 ESTABLISHMENT e 1 . Total Fees: $280.00 Y` PERMIT EXPIRES December 31, 2010 Board of Health 4 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 Small Tastes jS Lobster Stuffed Pierogis $6 Corn Dog $3 M Vegetable Hush Puppies $5 Y Eating raw or undercooked meats Fried Mac &Cheese $4 may increase your ,21 Sweet Fry Bread with raspberry honey $3 risk for food borne Pickled Beets $4 illnesses .0 Fresh baked Pretzel $2 d Vegetarian m Gluten-free Baskets i� French Fries, Al &� Sweet Potato Chips, 36 Fresh Onion Rings $4 Starters Chicken Tender basket$7 Grilled Lobster tail over crispy polenta $10 Pan Seared Scallops in coconut broth marketprice Wicked Spicy Crab Cake $11 -- M Nachos $7 Bearer Add Chill for$3 or Pulled Pork for$4 BBQ' Hot& a, Steamed Mussels marketprice Sweet, Creamy Maple, Honey With white wine&fresh herbs Mustard, BuRalo Fried Calamari $9 .Served with lemon-garlic molt Pan-seared fresh mozzarella $7 with our own fresh marinara sauce Soups & Salads 8 Smoke Black Bean &Corn Chili —� y Make your salad a meal! Add: New England Style Clam Chowder $4 Cup or$6 Crock Chilled Lobster Meat $7 Grilled Chicken $5 Caesar Salad or .40 4, House Salad Steak Tips 1 $7 $4 side or$7 regular Dressings Caesar, Balsamic Vinaigrette, Crtrus Herh, Blue Cheese or Ranch Pizzas M Classic Cheese pizza $9 Gorgonzilla pizza $10 A white pie with roasted garlic spread, caramelized onions, blue cheese&mozzarella Margherita $10 Fresh mozzarella, basic&tomatoes Nan Alcoholic Beverages Flat Sodas $2.50 Coke, Diet Coke, Ginger Ale, Sprite Shantastic© Blend Coffee$2.50 Roasted locally atJaho Coffee Roasters iced Tea (unsweetened) $2.50 Weak Tea $1.50 Root Beer or Ginger Beer $3 Tepid Juices $3 Cranberry, DJ, Pineapple, Grapefruit, Tomato, Moo 0Wicked Howl Enterprises.Inc Sandwiches Each is served with our home-made pickle of the day&your choice of one side dish Y Shanty Burger $8 Our hand-packed Boz burger Y Scary Uncle Sully Burger $9 Topped with bacon, Pepperjack American, Swiss&Jalapenos O Clyde Burger $9 Crusted with sesame seeds&black pepper then topped with blue cheese M Seville Burger $7 Our home-made vegetarian burger, served with olive&orange relish (A vegan Boca burger is available as a substitute) Traditional Lobster Roll Market Price Our house speclaltyrfl Y Steak &Cheese Wrap $8 With sauteed mushrooms, onions&peppers Fried Haddock Sandwich $9 Grilled Marinated Chicken Sandwich $8 M Grilled Cheese $5 Your choice ofAmerican, Pepper Jack or Swiss Cheese Hot Dog $5 Pulled Pork Sandwich $9 Sloppy Joe $8 Entrees These served with your choice of one side dish These served with a choice of two side dishes t Fisherman's Stew $13 Boiled Lobster Dinner Market Price Shrimp Etouffee $13 Fried Shrimp Market Price r1 �b Seasonal Vegetable Risotto $9 Fried Scallops Market Price Lobster Mac & Cheese $15 Fried Whole-Belly Clams Market Price Lobster Pie $15 Fried Haddock Market Price Jambalaya with Shrimp &Sausage $12 Y Guinness marinated Steak Tips $17 Baked haddock with lemon crumbs Market Price r Pulled Pork Platter $13 Side Dishes Available a la carte for$4 each French Fries Sweet potato Chips Onion Rings Mashed Potatoes Cole Slaw Wilted spinach &bacon Sandwich & Burger Toppings Tortilla chips Roasted red bliss potatoes 75¢ each Pickled Beets Side Salad Bacon, Caramelized Onions, Jalapenos, one Side Chili Side Chowder Fried Egg, Pulled Pork or Chili Cheeses: American, Swiss, Pepper-Jack, Fresh or Shredded Mozzarella, Shredded Cheddar Jack or Crumbled Blue Cheese ©Wicked Howl Enterprises,Inc. Fine Print, FAQ and other stuff you want to know �• Before placing your order, please inform your server if anyone in your party has a food allergy. This is especially important if someone has an allergy to shellfish—this is the Lobster Shanty after all. s. We reserve the right to refuse service to anyone at any time. v- The Lobster Shanty was featured on an episode of Diners, Drive-ins& Dives hosted by Guy Fieri on the Food Network. Our show was tided Wings, Dogs& Claws, The menu items featured were the Pulled Pork, Guinness Marinated Steak Tips &the Lobstertini. " Please use our main entrance at all times; climbing over the patio ropes is strictly forbidden. " For groups of 6 or more, for your convenience, we will automatically add 18% gratuity. yr We are a seasonal restaurant because we have a seasonal liquor license. We close on January 15"' and re-open on April 1St. We're closed for 10 short weeks a year. Yes, we are open after Halloween. .� Our patio chairs are brittle; some are quite old. Don't tip in them, you may get hurt. u. As a courtesy to our adult patrons, no one under 21 is allowed to sit at the bar. v. Once our kitchen is closed, the Lobster Shanty is strictly 21+ -P. We follow McSorley's golden rule "Be Good or Be Gone". v. Yes, dogs are welcome on our patio, There is even a dog menu and water bowls available. However, dogs that are aggressive, bark too much or are off-leash will be asked to leave. w. Please visit our web page at lobstershantysalem.com. 0WIcked Howl Enterprises,Inc. �f r CITY OF SALEM, MASSACHUSETTS • _ + BOARD OF HEALTH 120 WASHINGTON STREET,4O.FLOOR TEL. (978) 741-1800 KIIv1BERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREE.NBAUM&ALEN1.CONI DAVID GREENBAUM, - ACTING HEALTH AGENT 2010 APPLICATION ,FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT (�/meq NAME OF ESTABLISHMENT 1 r 101Q1*f jQ}kAj TEL# q 3y qt ) ,sI ( 1 ADDRESS OF ESTABLISHMENT-c 5r NVtA 5 1 ^ FAX# MAILING ADDRESS(if different) B)Qck�e f' 6.I_�I I O " EMAIL-Business':�4QIJ"�NJ4'j90QAfi1INK•NQt Website: tQJ*rstia �lkt Sgtem CUM OWNER'S NAME �/�N2 C - 1L(,�� TEL# /S(��LtA3 OOS ADDRESS L L7CC�C� I 5� � JffIC�/� MA- O(q �0 STREET - CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) 'biAN _ l • QO I-� CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) �I EMERGENCY RESPONSE PERSON I N2 G lJD HOME TEL# S� C/93O5 DAYS OF OPERATION i Monday Tuesday 1 Wednesday:- I Thursday Hday Saturday Sunday HOURS OF OPERATION r4fo N j i Noone to 1 I�(OOn( f D N don M i Noor( to; NOON +-D r1�vn to Please write in time of day. ! 1 A 1 For example 11am-I1pm) ! f}A^ R'Nt `rr�- I /�/t/L (r4/✓� ( �rt/l , f}AA, TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT ES NO less than 25s eats =$140 (Outdoor Stationary Food Cart$2 25-99 seats =$280 more than 99 seats =$420 --------------------- ----------------------------------- ------------------------------------------------------------------------------------------ BED/BREAKFAST/ YES O $100 CHILDCARE SERVICESMURSING HOME-------- - - ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES I > $25 TOBACCO VENDOR YES aO7 $135 ALL NON-PROFIT(such as church kitchens) YES d9D $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Purs t t MGL Chapt C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax retu and p id'all stat axe requir under the law. � c to -;L7"5 � Signahme Brate Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date VIPORTANT MESSAGE FOR DATE �U�73�00 IME 113 .M. M OF PHONE AREA CODE NUMBER EXTENSION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL . TELEPHONED PLEASE.CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU FRUSHRETURNED YOUR CALLLL AX TO YOU MESSAGE w'ti`C SIGNED , 1 MOPS. MADE IN U S,A NOTES --- - -- �+ i IMPORTANT MESSAGE FOR DATE _Z &Z/0 TIME P.M. M ! n OF PHONE A EA CO E NUMBER EXTENSION U FAX U MOBILE / AREA COLE NUMBER TIME TO CALL y TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH. " RETURNED YOUR CALL WILL FAX TO YOU MESSAGE I ' SIGNED -- FORM C MADE I .S.A. I NOTES i 0 i i i i IMPORTANT MESSAGE FOR 7..�{" DATE ✓ TIME M \Cil. Qi� OF�A ' PHONEI AREA CODE NUMBER EXTENSION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED _ PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUST{ RETURNED YOUR CALL WILL FAX TO YOU MESSAGE LA lee ecOC P cSPRSu1 Qn �(� 2Z""a' SIGNED FORM 400s LMAGE Jrf U.S.A. r SlON Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name �^ --� Date a of 0 erasion s ,T of Inspection C�� IL CY l�h 4n A, . �- / Food ServiceRoutine Address�� n ^ fl Risk 'Retail 1k Re-inspection Level li ❑ Residential Kitchen Previous Inspection Telephone y)p _ G�^ JC L� ❑ Mobile Date: Owner 1' 17 1 El Temporary ElPre-operationHACCP YIN��(�v�oc� ` ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time � ❑ Bed& Breakfast El General Complaint Inspector ,-) l// Out:,In: ,L�j/ Permit No. ❑ Other Each violation checked requires-en-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) [3' 590.009(F),E] action as determined by the Board of Health. „FOOD PROTECTION ,,, t El 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties �. � ❑ 13. Handwash Facilities EMPLOYEE HEALTH ,6 , - �'PROTECTION FROM CHEMICALS`"-'gym " El2. Reporting of Diseases by Food Employee and PIC :.mom �,a -m= r, x-..� a El 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded El15.Toxic Chemicals FOOD FROM APPROVED SOURCE ar =ii°:,b�r�Rr i':TIMF.fI'EMPERATURECONTROROLS Potentlall Hazardous Foods F E] 4. Food and Water from Approved Source '5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans' ❑ 16.Cooling PROTECTION FROM CONTAMINATION".` " I. �'J!" El 19. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY'SUSGEP,TIBLE POPULATIONS{NSP)` El 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices ;-CONSUMER ADVISORY,,,„ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-4)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 9 9 q 9 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:/fn`ylr, (y S:sso�nwe fFom ia.ex 1 1 l��w•`r- Inspector's Signature: p Print: v G r�eP�� t-( � Do VIS Cd, 1 PIC's Signature�/�Lt G� C( I „ �.� ( Print: >` I ,\ 1. , �„ _Jr,'l Pagel of�Pages �- l r--uwc Y Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT $ Cross-contamination 1 I 590.003(A) Assignment of Responsibility*_ 3-302.1.1(A)(]) Raw Animal Foods Separated from 590.003(B�Demonstration of 1Sno ,ledge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by tract employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fax)Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,003(0) Reportingby Person in Charge* 3-30614(A)(B) Returned Food and Resetvice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces _ 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 _Fend in a Hermetical) •Seated Container* Sanitization Temperatures* - 3-20113 Fluid Milk and Milk Products* 4-501112 Mechanical Warewashing-Hot Water 3-20213 Shell Eggs* Sanitization Tem eratures* 3-2011.4 E sand Milk Products.Pasteurized* 4-50 t.114 Chemical Sanitization-temp.,pH,- concentration and hardness. * 3-20216 Ice Made From Potable Drinking Water* 5-101.11 ,Drinkin Water from an Approved System* 4-GO t.t I(A) Equipment Fad Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 590.0t)6(}3) Water Meets Standards in 3 10 CMR 22 4-602.11 Cleaning Frequency of Equipment Food- Shellfish e Sheltrsh and Fish From an Approved Source Contact Surfaces and Utensils' 47021 L Frequency of SanidzPttion of Utensils and 3-20114 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arens* 3-202.18 Shellstock Identification Present* 2-301.-12 CleaninaProcedure* 590.004(C) Wild Mushrooms* 2-301J4 When to Wash* 3-201.17 Game Animals* , Good Hygienic Practices 5 Receiving/Condition 2-401..11 Eating,Drinking or Using Tobacco* 3-202.11. PI-IFs Received at Pro er Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-20115 Package lite it•* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting" 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-20112 Shellstock Identification Maintained`% Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-40111 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(.)) Labeling of Ingredients' 5-204.11 I ocation and Placement* g Conformance with Approved Procedures 5-205,11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processin Meibo<is* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser, Availability 8-103,12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision `Denotes critical item in the federal 1999 Ford Code or 105 CMR 590.000. I CITY OF SALEM BOARD OF HEALTH r Establishment Name. wti 1 r1 rX Date: f — /) b Page: of Item Code c-Critical Item 71 1 DESCRIPTION OF VIOLATION/PLAN OF CORRECTION „ ' Date,_ No. Reference R-Red Item _ `•�> - a _ !!! � z � Verified ^, � PLEASE PRINT CLEARLY � I vi 4l�nu, h1�1 MQ/ AIJ 0A 04 W(Y& 0A, Gn.nt � oA AM , (n)/(�f.P/ h t e a 0/L 0M /n,l.n,r,fXY��/'t'l�0/)AIA(A'YA nYOn. )n �a� �B/1 pian u U A0.vin n �/ F 7fu u h7iVL P� ^Oe -1 Ax a �r�,Y u —' �f cl f� C ()n,�..� ��-s r.r paL � /1/�0 � - U Q 41 own�_ ©X ' V)-e Q,`"n o-,fit, (IU _ v j� } Discussion With Person in Charge: Corrective Action Required." ❑ Noel ❑` ;Yesy' •• -ol 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 l 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. ( ,I � ❑ Voluntary Disposal ❑ Other: 3_"I l.14O PHFl;Received at Temperatures Violations Robilou to FoodborneIllness Interventions and Risk According to Law Cooled to Factors(ftems 1-22) {Cont.] i5 coofifl'>'Mlhods for PHFs� PROTEC'nON FROM CHEMICALS PHF Hot and Cold Holding 4 Food or Color Addilof es 1-202,12 Adifirivc'�� 3-50!AO(B) Cold PRFs Nlaintan"i at or b,4ow 590.004(F) 41°/45"F' 3-302,14 proteeli on frrna�� 3-$0l.16(.'�) TRA pfil-�Mainuiluell it or above IS Poisonous or Toxic Substances 140T. Id,raifyin"Inho ination � Original ITT]l- a.50116(A) Roa�vRdd at ot above EIVT, container r-. Time as a Public Health Control 102-I l 1 Conation Name, Work;im'Con, LL_ 3_��01 19 :i"�a Publa;Health Conhol —7�2F)f,IT _�7LIlwn-Sea a"e. 7-20111 ll��Suic,lion-pru:ace and Ue* .004(H) Varirmen R_eq 7-202.12 curshwers of REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1-204,11 POPULA IONS(HSP 21 Uripasteuriz.cd Plcpackaged Races and 7-104A 2 Chenucajs fiat Wir�ha�w 11r"2cluce'�Tlt_�nw_ flc"wraRes Ivilb Warual.lah"js* T05 04,14 D Criieria 1 3-801-1_1(B) lj�c of-Pasttaaii zed Epp T hu;ideaufl P("Contact,Lobficairas* 3 �01 I iaw r Painall" Cixik'd Animal rf)cyj 01, T06 1-1 _71-71 11ird_se Pe'u,5dt_1'1_T1r1un—MI '-Ou Rodew Fmsi�nlioa�* � — 1R 1lvt�j )TArini 4 ot,avc( 7-206.12 L3 80'1' ZL)' _LETeucd irasd Par.4 age 'NZ, Wsen'T- 7-206,11 Tracking pot%(lerPert Control and CONSUMER ADVISORY 22 0o,I I Corraimer Advisor ov Posted lbr Crvuoiptiotr()I TIMEITEMPERATURE CONTROLS 34i Animal F�nit flea are Raw, Llndoirowk�d v; 16 Proper Cooking Temperatures for No(Odre(wise Pr(weqSed L - Pahts toPHFs 'e"'1 1 3 401 1 IA(lr(2 ", - 155,F 15 Sec, '9� 1--,(2.13 Piiste�irizcd foi Raw Shell Fi�h' Arruvali 15VF, 15 sec. --t_ SPECIAL REQUIREMENTS 3-401.11(B)s I)(2) Pork ar�d Beef Roast - 1301712f ri 3-41)1.11(Aft Rautes,tiiieci��d tdcate- 15 F 15 '59d009G*A)(D) Viol lions oi'secti()a . catering. mobib, ft)od,temporary and residential kitchen operations, Aiould be IT( 1.111 AT _ _ STUTICkTliT F's — �oofhng("valnuis FiO,Nicia, I debited under the appropri nte siections poultry o.kafacs-16 "'F!65°F 15 SCabove if r laced to ftx)dborneIdt xis 3-40JANC)!3) whole-armole. la"'ICT Ret1 Sleaks interventions and rist, factors, Odiff 1451; 59Q009 violations relating to flood retail 7 40 1.127 Raw Aninut F(,od,Cooked in a prlwticcc should be debited under 1129 - Nbciowave 10'F SpeCial kcaluiTC11wi-as. At,Other PHFs - NTT 15 sec. 3-401�II(A)(1)( l7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES NIF> 165'F 15 s'e c, (Items 23.30) 3-403.1liB) Microwave- 10"F 2 Minnie Siandhig. C4twalavd trvn-rfia(:al violatimis, which no are relate to rhe I inle' foodhorne ilhwss flacp venuonv and ri.kjhm tors Mile aboi,4, ext be 3-403.11(C) ComuaeMallv lhix.-Ssed RTF I"rod- finaid in of the Food Code and 10,5 C'MR 140"Fr 5oo.00(t 3-403.1 4(E} Renlanan"unsliced Pt rtions of Beef actions F S80 000 23� ;A artaq errLei t and ,(Innqi 003 Roast,* Per �T__ _Fwdand Food Protection PC 3 004 1=8 _Coollnq_Tt PRFS _ -----------— _,_ ----I 25, E_Tufp FC -4 '00� 1 3 50 1.14(A) a?Cooked PHFr fi oin 14Y F 14) 20 _yVq!qrjj1Lmbin2_a-go Waste FG-5 .006 i TjF Within"Jfoarl�nod From�O'F Physical Facility PC --0-07 -1 Lo 41'F/45P Wifbin 4 Homr. Po�lwn"�ui"or Toxic Malonals PC -7 W8 - 1 29, �01 i4lh) Cooling P14Fs Made Front Ambient Spn'Ll Tcrtiperaikirc logredunits o,410F/4YF 20 Other Crithat Ilkin S* CITY OF SALEM, MASSACHUSETTS RECEIVE® Kimberley Driscoll Mayor MAY 14 200.9 May 11, 2009 Mr. Clay Colarusso 141 Washington Street Salem, MA 01970 Dear Mr. Colarusso: Thank you for your follow-up email with regard to the outdoor entertainment at the Lobster Shanty. I appreciate hearing from you on this matter once again. I understand your concerns as expressed in your former email and in your latest one. As I wrote in my previous correspondence, the Licensing Board is responsible for issuing permits for live entertainment in restaurants in the City. If you believe by issuing this permit, the Licensing Board is allowing the Lobster Shanty to violate the City's Noise Ordinance then I would encourage you to let them know, as well as the Police and Health Departments both of which are responsible for the enforcement of the Ordinance. In copying the Licensing Board, et al on my response, I am attempting to come to a resolution to the problem as presented by you. I am not responsible or able to enforce the City's Noise Ordinance or issue entertainment licenses. However, this does not speak to the validity of your complaint. I have been notified that the Licensing Board is planning to put the Lobster Shanty on an upcoming agenda to discuss this issue. Again, thank you for your email. If I can be of further assistance please do not hesitate to contact me at (978) 745-9595 ext. 5600. Very -truly yours, r '^�� k14 k Kimberley Driscoll Mayor cc: David Shea, Licensing Board Chair Melissa Pagliaro, Licensing Department Sgt. Harry Rocheville, Police Department Janet Dionne, Acting Health Agent Salem City Hall—93 Washington Street—Salem, MA 01970-3592 Ph. 978-745-9595 Fax 978-744-9327 i CO� m RECEIVER CITY OF SALEM, MASSACHUSETTS 'APR 232009 RECEIVE® Kimberley Driscoll CITY OF SALEM Mayor BOARD OF HEALTH APR 2 3 2009 April 21, 2009 Mr. Clay Colarusso [ - 141 Washington Street Salem, MA 01970 Dear Mr. Colarusso: Thank you for your recent email with regard to the outdoor entertainment at the Lobster Shanty. I appreciate hearing from you on this matter. As you know, the Licensing Board is responsible for issuing permits for live entertainment in restaurants in the City. With respect to your request for me to issue a cease and desist order to the Lobster Shanty, I do not have this authority. Under the City's Noise Ordinance, Section 22, the Police and Health Departments are charged with its enforcement. Thus, I would recommend you share your concern with the Licensing Board, Police and Health Departments for their review. Your implication that the Lobster Shanty receives special preferential treatment because they rent from the City is completely false and unfounded. When making decisions to attract new businesses, issue liquor and entertainment licenses and construct new residential units in our downtown the City needs to be mindful of the impacts each have on both our commercial and residential sectors. I know I've written this before but I really feel that the activity in our downtown is what attracts most residents to it. That said, this activity needs to stay within our control so that both residential and business sectors can co-exist. In an urban downtown such as Salem's it often feels like we are "walking a tight rope"to ensure that we maintain an environment that is welcoming to businesses and residents who both are critical to the success of our downtown and each other. Again, thank you for your email. If I can be of further assistance please do not hesitate to contact me at(978) 745-9595 ext. 5600. Very truly yours, Q/"'vrq Kimberley Driscoll Mayor cc: David Shea, Licensing Board Chair Melissa Pagliaro, Licensing Department Sgt. Harry Rocheville, Police Department Janet Dionne, Acting Health Agent Salem City Hall—93 Washington Street—Salem, MA 01970-3592 Ph. 978-745-9595 Fax 978-744-9327 t CITY OF SALEM i BOARD OF HEALTH Establishment Name: t t: 2 5 WCC mJ;�i Date: Page: 1 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item ' PLEASE PRINT CLEARLY _ Verified li k ')LL, V1 o ti17A 71 a N S C.13 r, 1 v 1 L) 3 1 z- 4 iv S n C.t "n cJ c?o l IN T f l t `6 Discussion With Person in Charge: Corrective Action Required: ❑, No ❑ Yes " N 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 t0 U Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/F deral Food Code. I understand that snoncompliance may result in daily fines�of twenty-five f/i II\rs or suspension/revocation of ❑ Embargo U Emergency Closure your food permit. Ll Voluntary Disposal ❑ Other: f z 14(C) PHFr fteceiwd ml`emr; ralurcs Violations Related to Foodborne Iftress,Interventions and Risk According to Lav, Cooled to Factors(items 1-22) (Cont) 4 I"F/45'F Within 4 Hours, 3-501.15 Coolie-Methods for PHFs PROTECTION FROM CH-EMICALS--,—,--- 19— Food or Color Additives PHF Hot and Cold Holding 3-501.I6(B) Cold PRFs Maintained at or btlow 202.12 Add tttUs k �90.004( ) ^4I V45'F� 3-31)2.14 Protection irow I in It Addillyc's, -501 16(A) Hot PHF,z Mainciined at or above 15 Poisonous or Toxic Substances 140'F. 16(,\) Roasts Held at oi above 13WF, I )LI1 Identify np Lqft)i inanon - Original Conw'cersx =26 I Time as a Public Health Control I Common'Name Workin,Coauni 1'imo as a Public Flealdi Coranol' 7-20L 11 -1: — 1-20111 Resuiction -Pr,,,scnoe and t,le- 590R)4(H) V4riancc R 7-202.12 Condinow of Use, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-10,3AI ,T -� POPULA ION§ xic Conlainea�- 7204.11 Saruuwns, 3-801A I(A) he(W 7-254 12 chenlicaiI,for Wash -J� 7F--04 14 -ic."Cra0e,"Vith esand LIL�-r-ia�, 3-80 1.11(B) Us c of Pa�lcurizcd 7-205,11 Incidental RaXl Contact, Uibi icanW: Wi.11(1)) Raw or Parijalli Cook-d Animal I-(x)d and '7-i266.I I Ross icted UT.,e Pedcides.Ciinerin', Raw Sv.(A S - 2 Rmlent Bait Stauons� nis I Served. -7 206 11 T-1-- 3-90 1.11(Q� T�m1ned Fixxt Packa"'. Not Re-, cl 1-206 1-- L-1� I ni-knIg P"W'dCri Psi C'Unn ol and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 11 360• I I llon,u...ct-A&iso,y Posn,d for C.......nt�tion of ivimal FIK)&That are Raw. LjnderoIxtkvd or 16 Proper Cooking Temperatures Not(Itheiwise Processed folilialinate PHFs P th I A(7)(2) Fgg,,- i55 c 15 Scc. 302.13 N;qeuri7zd Sibsbtinv io7p—a"fi-c-ll -110--hunc—�dlatc—Scrllil� L—Irll 1401communced Fish, Meats&, Gans: — Annuals� 135�F I i sec. � — SPECIAL REQUIREMENTS 130"i' l2inrinT 590,0(9(A)-(f Vioiariofc;of Section 590.(k)9(AT(73) in 1-401.11(A)Q� 16iites, funwri Me v3 - 155�F 15 seceateringmobi1cfooti,temporal V and rcmdent'al kitchen operations,;hould he I 3-401.1](A)13) Pouliry,Wild Game,Stuffed PHFS', sluffing,Containing vlsh, Meat, debuted under iliv appropriate sek-tions Poultry yr xatn 165'1 11 sec. above if related to foodborne illness Intact Beef steaks Interventions and risk factors, Other 590.009 Violations relaturlo to rood retail Riu �ia' Rds Cooied Ina pi actices Miould be debited under#29 - 7I401.12 165"F Special Requiremoim. 3-401,11(,k)(17(b) k2,QtlierPFll, 145"F 15 sec. 17 Ra,h of If for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-�0 3.1-1 7-A T&I-(f)-) HF> (Items'F 15 sec. * (Items 23-30) ..g 16V F "rlinive, Sctrafia,, Critical wwj non-(rilical violaPons, 11loch do 1101 rebate to the Tinle, be 3-403J)(C) I Commer-ially Pioc�ssed RIF Food - hand in thej�llowwg secisons sy'rhe Ford Code and 105 C.441? 00, 3-403.1 1(F) 1 Remaimm, Unsficed PoTtions of Beef 590000 r"-- 4 23 1 Mans Person Roas!'4 Itement and nel FC 003 Fond rnd Feed Protectwn Ft Ig Proper Coo24 ling 3- g of PHFs — _j_,�tb4___j Lf�uipinTlnd-ll!e-osis- JFC -4 1006 Neater, 70�1`Whom 2 Hours and From 70111-1— 27, Phisical Facillfir QFC 6 007 sonous or Toxic Mater ars ( FG-7 1 008 3-50I.14(B) Coolin,PHF�Malt Front Ambient -29 _j if��IrIa f»ts069 Temperature hir,,redients to 41'1`745 —--—-- °F _SO.__�� Ober Within 4 Hours S��,'r f,,'K Z',?" J)enotz CrIc"Al Item In the feIleral 1949 Foci('Oe or 105 CMM 590 000. s CITY OF SALEM # ( ( <:::I, BOARD OF HEALTH / Establishment Name: I,nk<�P( �c'aVt'kX Date: �_ ( ��_1 lr)Cl Page: of } Item Code C-Critical Item ' DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY _ / PC 1 Pi F) PpIn Unca t n �� i t�Y\ c �uA C O n ,��Ames r-i IA d _TttQ_ aDap Ji -p-Q( stf nr-o n- nr t'e n Qr-n i , UI- Il alp .<11'nk a5 -(b (,)SC, in PrvCh P. ' t, -t Ic�A 1r CDI '1;1 fU�` Q.C( /192Q. X10 cx CIA Cc7hn tvl� l�✓i�r-�,'K>rr k�-cls ,, 1 �. t c cane ung vtn,H �<ec�l (-1W'y ll� ( 9Y�CQc Y .�Rr �rP r�r1a74_� � roi �rh� - - 11C0'J�c� -F?�c AGi,i�- 2,x�PXYh�VICt�l�l1 C�.r,nt �� ii�«eC�khll - b (i_llCror•n � � n Discussion With Person in Charge: Corrective Action Required:, ❑ :No ❑- Yes S I have read this report, have had the opportunity to ask questions and agree to correct all CD voluntary Compliance ❑ Employee Restriction 1 ,3 inspection, to observe all conditions as described, and to Exclusion t p ❑ Re-inspection Scheduled ❑ Emergency Suspension violations before the next ins 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. � ,,,,t4 t ❑ Voluntary Disposal ❑ Other: i 14(C) PIfFs Received at Temperatures Violations Related to Foodborne Iftness interventions and Risk According to Law Cooled to Factors(Items,1-22) (Cont) IPF/45IF Within 4 How s. PROTECTION FROM CHEMICALS 1-5 Coolun,Methods for I'HFs L—iA Food or Color Additives PHF Hot and Gold Holding Li9— 3-5O+ 16(B) cold PHFs Maintained at"M below 3-202,172 590,004(F) '11°145`F 3-302.14 1 Peocaa)on fr;xjLjLiia)i —i _LLrcwed Addifives !-5— Poisonous or Toxic Substances 3-501,166k) I int PHI s Maintained at or abwvc ---t Idents I I'ving infra ca unai on- Origi nal 140'R� 7 [1)t 11 —-------- 1 Car iasiier ` mets h6dat or above 13011, 50 1.16(A Time as a Public Health Control 7-201,11 --er, 3-j07—19 Tiinu as a public 11"tit Control 1-202.11Reshicuop -Pvnwnce and Uxe590Xv)4(H) varinLC—R -202.12 coradi I Ion,of Use, 7-203 11 prolubinon17— REQUIREMENTS FOR HIGHLY SUSCEPTIBLE - -7--- —I---,— POPULATIONS(HSP 1-204.1 rlria_ct - 21 3-80EII(A) Umxmcurizcd ple-1cwTIged—Juicts and - 7-1,04.12 Chemicals for�Va'�hi la�2cLllcc;Clitoria'I 7-2-04,14 DrAic Aizcnt�.Criteria Beveraazes With I I I'll) JQof p,,Tt,,-LC _j_ d 7-205,11 1 Incidental tel Contact.IAII)MarnS 1-801 Hill) Raw or Paioafl,,0K)kQdAritrail Niod and 7-206.1 R��Irivied U�e Pesticides,Criteria, 7-200.12 1 RkX10in Bait ScI00TIS' S"-� 7306.13 pracking Prader,.P"�S[Control and T--11 -LY12ET—( CONSUMER ADVISORY Consumer Ad�isory TIMEITEMPERATURE CONTROLS —i2 63.11 T"7)std r"r(:01tounpti,n of — Animal Fxsls'tliat are Raw.Undercooked c, 16 Proper Cooking Temperatures for Not Otherwise Pr<x-egsed to Ellininatte PHFs 7�11� P -401 IIA(1)(4�aI Eggs- 155'F 15 S,,c. h Tf di ate 9c.rs•iCc ( i5 isec, L302.13 Pa:staunecd Eq.:Substinov for Raw Shell 1-401,11(A)Q) Coni nnnut�Lvb Meats& 6ante Animals 155"F llstc. SPECIAL REQUIREMENTS 3 40 1.I I(B)f 1)(2) Pork and Beef Roast 110117.1 rmnx 3-40 1.11(A)(2) kAitCS,h1(Wd MLAte 1r�S+ 15 '595,009(Ai4k)) Violanon.oi Section 590,009(A)-(D) in " - , caw.rmpmobi1cfoml,vinportov and Waal kitchen operation�shovld be 3-401,11(A0) poultny,Wild Game, Stuffed PliFs" residenth stufflaa,conlaining Fishc Meat, debiied under the appropriate sections poultry<ir Ratites-165'I 15 wa if related to fo(Aborne illness 3-40LINC)(3) cLhsk muss 1v invwBecf Steaks interventions and risk factor , Other 1450F 590.009 violatonis relating to=xJ retail 3-40i.12 Raw Anonwi I z i»1 cooked In 11 practices should be debited under#29 - tviliciowave 165'F-* octal Requirements- '�hi()hlti-PHF� - 145`17 15 sec, Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 165t)F 15sec. (Items 23.30) 403.13(B) Microwave- 165'F 2 Nlmwc !Standing CrWrai and ran-criiwal riotajton,v, which do notrelate to tile Time, foodborne diness iWoventionswul riskjoe tors IrIted above, con be —3'-40311 Connnff(`IailF lafoces'sed RTE KxId- fiaind bt chejolhro ing sediorc;qf the Foad Code ota'105 CUR 140'17' 14 ---—-—- )3 1 I(B Rentainin, Unsiked portions of Beef Rojsts* 23 FC -9 3 F �004 i Proper Cooling of PHFa —--- Equip d Utensils FC-4 005 FC LieRtarL 75(7114(A) Cooked PHF, fio� 140'F to ------ 26, Watec fily"I FC-5 006 Poai�!�t� 70'17 With it2 Ifours and From 701 Physicai Facilitv FC-6 007 -i! 14(1�, Coolin�,,PHIPs Made Front Ambi SP2c1009 Tempffature Ingredicats 1(,41'1`/45`F Other I Within 4 ljouj-0 nem a)the fe,laral IMPORTANT MESSAGE FOR p o DATE TIME J/�: � i M OF PHONE J A CO NUMBER EXTENSION D FAX D MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL. CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH: RETURNED YOUR CALL WILL FAX TO YOU MESSAGE l 51 C� SIGNED 2 ®p M�DE ° - IP4 NOTES Commonwealth of Massachusetts e City of Salem Board of Health IGmberley Ddsooll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/12/2009 ESTABLISHMENT NAME: Lobster Shanty File Number:BHF-2004-000013 25 Front Street Salem MA 01970 LOCATED AT: SALEM, MA. 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0394 Mar 12,2009 . Dec 30,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 30, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASI4INGTON STREET,4"r FLOOR TFC,. (978)741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR JMANCINI([t�SAf FM.COM JANET"MANCINI, ACTING HEALTH AGENT 2009 APPLICATIONFOR PERMIT TO OPERATE A FOOD ESTABLISHMENT _1 NAME OF ESTABLISHMENT i knnt�C�/ 442Cy�lf tCQ{ Q TEL# ��C )/4a3O��` ADDRESS OF ESTABLISHMENT Ctl 4-7S)t f FAX# MAILING ADDRESS(if different) �� f��3T _ �)� �Id� J ((iqm 0 19 2 EMAIL-Business': ZD �CSIn�A} 2Gi({17!l��.�v� Websife: `t �°t� � f1�� r �7�t/j OWNER'S NAME L�y TEL# 70f�Io�J CSr� ADDRESS GL i y�/VL / 411 010}G STREET C Y STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) )�thj e � CERTIFICATE#(S) r7r` 0I S19, (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON ;71)' IgP— HOME TEL# DAYS OF.OPERATION Mondays- i'...Tuesda , .':, ,.Wednesda ,t1,> :Thursda . F.rida :'Saturday, `-:€ ' Sund*14, HOURS OF OPERATION I I i i � iIAM— 7 Please write in tans Forexampiellam-tipm TYPE OF ESTABLISHMENTFEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 1 0,000sq.fL =$420 --- -----------------*-------------------- RESTAURANT YE NO Tess than 25 seats (Outdoor Stationary Food Cart$210) 25-99 seats = 280 more than 99 seats =$420 ---------------------------•------- -------------- -----------•-----•------ BED/BREAKFASTI YES NO $100 CHILDCARE SERVICES/1VURSIN HOME. ------------- ---------------- ------------------------------------------------.--------------------- ----------- ADDITIONAL PERMITS MAKE(not just serve)ICE CREAM,YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROW(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. P u t to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perl'ury that I,to my best knowledge and belief,have filed all state tax r ums a d paid all stat t par ed under the law. �� o a089T,5-�1 Sign lure Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Chak#&Date �I �Q/ q $ rTa wd Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 745-5449 Handwash Facilities FAIL Critical ❑d RED Owner: Comment: back hand wash sink obstructed at time of inspection. Sink to be free and accessible at all times. Dave Driscoll PIC: Back hand wash has no soap. Provide soap. David Driscoll Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE John Gehan Date Inspected:Correct By: Comment:White refrigerator has uncovered foods. All foods must be covered. 812312007 Risk Level: Equipment and Utensils FAIL BLUE Comment: Samdwich unit requires general cleaning. Permit Number: Vulcan unit requires gemneral cleaning. BHP-2007-0450 Status: Same unit in disrepair. Repair unit to proper working order. SIGNED OFF United freezer requires a defrosting. #of Critical Violations: 2 Physical Facility FAIL BLUE Time IN: Time OUT: Comment:Screen doors in disrepair. Repair doors to proper working order. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 23,2007 ) 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. Aug 23,2007 ) Page 2 oft { CITY OF SALEM ! BOARD OF HEALTH 1 Establishment Name: Date: Page: of S, Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item ,. - - - Verified PLEASE PRINT CLEARLY l IPJ 6'' C.L—a W 1.-1 i I +u 1"a _v�1L�L_ h c Q�,G�v� '�-i:.Yr-�c$C1 } } { Sty\raa� + a-� F i. Z e k , f ( Corrective Action Required: ❑ No',, Yes"❑ Discussion With Person in Charge: / I have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure 7 your food permit. ❑ Voluntary Disposal ❑ Other: V IA F,7513I_14(C) P1iFs—R — eoerred at7fcmperaturas Violations Rolarsd to Foodborne Illness Interventions and Risk AccoFdi ug to Law Cooled to Factors(fteres 1-22) (Cant) t FF/43'F Within 4 Homs_ ik)! 15 coalm"'MeLhocis for 11HIPs PROTECTION FROM CHEMICALS 9 DE PHF Not and Cold Holding 1=4 Food or Color Additives A 501 16(Bi Cold PHFs Mointoned at or 2-02 12= It`145°F, ro"S" '�Llillln-I-o _T30j 14 Me- on Irian ljq�2L r 15 Poisonous �tot!il��111Inllro'lli I I 3-501,16(A) I lot PHI Maintained at or above L-E- Poisonous or Toxic Substances—___ 140T. 101.11 infoi ination-Orialme 3-501 16(A) Poasi,�Held at of a�-"e—13c)" I containers. a -Ti—me as it Public Health C=ntroi 7-10 .11 Common Name- -Workk , L-110— 7-2{;1.25 1 3-�{}1.19 Time as a Publiu flealrb Control, BEL—__ S90,00,41-1) vari 'e Requirement 7-20211 R��triciiori--Preskocc and (;so* F7-20E2 jjsj REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Contannu,-Prolabinom'e POPULATIONS HSP 1204.11 aZvTer� Criteria-C'e nicat%* Ll 21 SO 1711(A) 'ninu,aeurized Pec-pachqgcd Ruo"and 1-20412 cltnnlcan�for --- Bevvunes with Warlitne I'Abzb;° 1730_4.14 14 D % iiq�' S-,1101.11($) U o'of Pieteurized Eina;' Lura tial Foocl Cvteao.1,ulnicams� 7-206.il 3-�;O 1.11(D) Raw or Pailiativ Coalaal Auirred RxA mat flsc Pesficidio,Crittarat, R a- �d Sprouts Sot Ser vctl 7-206.12 R(atent Biit Siad 7 Stallone, r_1 --* 206 13 11 icking Pe�dery, Control and CONSUMER ADVISORY 22 310 1 I consulner aaivisory flost4d for("UMoin .on of TIMEITEMPERATURE CONTROLS PU Armin[RAW Bar arc Raw, Undercooked vi 16 Proper Cooking Temperatures for Not Othef v,ke ProK!e'qSCd to Eliminate PHFs 3-401.HA(l)(2) 1-bV- I55 F 15 1-301.1"1 pi;,acuri/cd FAIg';subsbtute tor R'aw slnejt Comminuted 1-1th'meaty&(aulit Aphn-als i - SPECIAL REQUIREMENTS 3-401.1 Pock, 133 aid Bee Roast-110'F 121 ram* F - — 7 757;�17()la Zrins o SycTi7()n7)0.009(A)-(_D)—ini 3-4')l.11(A)('' ItAuie,, fnietcd Mt ais - 1WF 15 catering, rnobW fiyod, temporary and �Tl 14�( 1.1�Jf A)(j7— re.�klential kitchen operations 4iould be Pou!iry,'kkild Game,stuffed PHFs' Stuffni-e Containing Fish,Meat, debited coder the appropriate iecilons plAiltry ot,Rafitea"165°F 1,5 sec. ' abtwe if rchuedni ferAliorric Hinols -401ANCK3, A`helcnra lc, himitBeof interventions arid tisk lucb)rs Oth(T 1451; 590.009 violatioos relatin,q togood r-tal'! 3-401.12 Raw AniTrial Foixis Cookad in a frac should be debited under#29 - Nfictowave 165'F Special Requircrucam, 3-40L 1 W17 Chines PHI 145'17 15 sec. Reheating tor Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(D) Pf i1 165'T 1 5 wc. Utenas 23.30) 3-401.11,B) _'Microwave- ](I-T'P 2 Nlimn'c standing Critics,'and nim-iridial viokdwns' which do nit relate to Me I Time, foodborne illness anoventionvtind risk factors listed above. con be 3-403,I I(C) found in iheft)1nnwngse.-none q/the hiod Cod(,m 105(11)? 3-403A I(Et Rejoajning,U;nticed Portions of Beef Roam,* nagtTeai and 23, _ML 'I FC - 2 1 003 1 _E.emi�nne W�Por-Cooling of PHFi 24, Food and Food Protection FC-3 004 18 n t site F_ 045 14(A) Cooling Cooked PHF� �Iro" 1'rolfr to -Water.Plumbing and�Waste_ FC-5 '006 7W1 Within 2}Tours and From 701: 2 Ph, ir, Facility FC-6 1 007 to 41 F/45F Within 4 Hoar^ or Coni Materials FC -7 1 008 Ccliug;Pk Fs Medc Front Ambient 29 Special ants !."009 Temperature Ingredionis to 41'F74SF 'Denl,IC�LrihCal incl,M the 1999 I'(XXI C(oV105 Collt 590 000, R •1, r 'c..iaF�.+�' ha7.;.... tnw iX +4+ ,[q,' `c }o ♦ I'M * la ws `nofMassa.�A',N Ya m Commonwealthchusetts:� x CftyofSalem� � � >w�k'x �� s Board of Health _ . IGmberley Driscoll "x 120 Washington street,4th Floorg Mayor SALEM,MA_01970 Foo&Retail Establishment Permit DATE PRINTED: 03/19/2008 ESTABLISHMENT NAME: Lobster Shanty File Number.BHF-2004-000013 25 Front Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0427 Mar 19,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember 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 s. 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 t ;r QTY OF SALEM, MASSACHUSEM • } Ire' BOARD OF HEALTH t 120 WASHINGTON STREET,4' FLOOR 'ISL.(978)741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR JSODTTna SALEM COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION lFO,,R PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT tLe to63 of �SkaAA4� TEL# '"I�8 M5q /7 ADDRESS OF ESTABLISHMENT a 5 FLON -9a leaf Mf) FAX# N/} MAILING ADDRESS(if different) l EMAIL-Business': L��S+2�S�lry� !(� QQ �F1I ��• �e7 Website: LO6STer,SLIAA)4j , f le*t • COM OWNER'S NAME QiOV-e� 140w( &A+egDfib,eS fl`J TEL# SDI �a30OS2 Cel)) ADDRESS I a Becit e+ S+r Su;�e a- SA(eM Pyy Ol q�O STREET /� CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES)�IFlN� w� f CERTIFICATE#(S) (Required in an establishment where potentially/hazardous food is prepared)pa /� �t p s? EMERGENCY RESPONSE PERSON Lee- W O t HOME TEL# `"l 78 �Y I L{86E) DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION i )IAM II1 T7 Please write in 6me of day. I CIAkMgfi.��PCzDU'^ �FF � `( For exam le 11 am-11 rnM= 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$2 25-99 seats =$280J more than 99 seats =$420 -------------*._._ - - ------------ -----------------------------------------------------------* ... BEDIBREAKFAST/ YES N $110000 CHILDCARESERVICES ---------------- -.....----------------------------------------------.-...--------.....-.... ------------------- ADDITIONAL PERMITS �1 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES 40) $25 TOBACCO VENDOR YES $135 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 s must be submitted to and approved by the Salem Board of Health. ursu nt 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 returnstd-paid sta xes r q ired under the la . Signaure Dat Social Security o Federal Identification Numbe ---------------------------------- —--- -------------- Revised 424107 FOODAP200 dm Checkq&Date S 03/10/2006 09:46 7813563960 EASTERMAS PAGE 01 To caj&ro aa.PS46 1p/ `�llMCC1 E From: Cindy Rice 1�iAA% Re: Foodhaaidler Certification Class FOOD Date: 3 -/d- 01 SAFETY This letter is to verify that • ServSafe Certification classes is registered en • Re-certifications ;' • Consultations the foodhandler certification class and examination • Basic staff trainings on-site scheduled for 3 -/S-o in AaoUX'y-- Results of the examination will be available in approximately 4 weeks from that date. Wyou have arty Q questions, please feel free to call me at any time. Respectfully, 70 Christina Drive Braintree, MA 02184 /6'. Z<-. / �i 781-356.1467 Cindy A. Rice,RS,MSPH Fax: 781-356-3960 cindy aeeasternmassfoodsafety.com www.eastermmassfoodsafety.com o CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 120 WASHINGTON STREET t b SALEM, MA 01970 CASE _ TEL. 978-745-9595 ExT. 5648 DAVID J.JOHN H.SHEA. CHAIRMAN �mna FAX 978-744-6775 RICHARD C.LEE ROUTING SLIP BARBARA A.SIROIS KIMBERLEY DRISCOLL CLERK OF THE BOARD MAYOR The Salem Licensing Board requires each applicant to have the appropriate Departments sign this Routing Slip and return it to the Licensing Board Office prior to the issuance of a license. BUSINESS NAME Corporate name: LOCATION: -* F(7-om " S�I 2A Tele. # �� TYPE OF LICENSE: 132asCMCjl- �AQ � APPLICANTS NAME: L.Q.Q 00( Residence Street: �C� Inc S I#� Home tele. # �i f( qo&?) City: �cl�,tl State: ; tll Zip: TO ALL CITY DEPARTMENTS: your signature on this form is notifying the Licensing Board that all requirements of your department have been met, ateStreet g Board will issue a license. 0 Salem ATE 120 W Sign Review/Planning Dept. DATE 120 Washington Street v1C ct 9- Ag-Z)8- S em Health Department DATE 120 Washington Street ' 1 ( t I�..r�� k,- 2 r 0 � 4C m Fire Prevention DATE p k�ashIngton vee. --I—V 30% nspector A h� Stre yepartmeqf o ublic Services AT (Water Dept.) 120 Washington Street routine slip `A CITY OF SALEM BOARD OF HEALTH Name of Establishment: Lobster Shanty (Wicked Howl Enterprises) Addres§`.' 25 Front Street Proposed Owners: Diane & Lee Wolf Phone: 978- 749-2980- sL/g9 The owner of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. This establishment is seasonal. u0. FLOOR PLAN The Hand Sink will be located within the food prep area between the grill and dishwasher. Hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. All floors, walls and ceiling must be intact, impervious and easily cleanable. All exterior windows and doors must be intact with no space for rodents or insects to enter. All equipment must be intact, properly finished, easily cleanable. MENU/FOOD PREP Fruits and vegetables must be washed prior to preparation. 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 at least 180°F before being held hot. Reviewed the procedures for preparing clam chowder, pulled pork and chili. Food items may not be held at room temperature for more than two hours, cumulative, including cooling time. Food may not be added to containers in hot or cold holding units. 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. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. Ms. Wolf has an expired certificate and will take the exam again. When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. 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 2- 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. Please call two days before requesting an opening inspection. anne Scott Date He gent c a .s Og Diane Wolf 'Date (/I U cke-&� l 1r / /M iY �� a/ LOUSY F®®© a ® Me SOUPS Woifie's Clam Chowder Vegetarian Chili Soup of the Day Traditional Creamy New Spicy chili with grilled Ask your server for todm/s England Style vegetables and beans selection Cup $4.50 Bowl $5.75 LIMP SALADS Caesar Salad $5 The Wedge $5 House Salad $5 Crisp Romaine, seasoned Iceberg lettuce, diced Fresh greens & veggies croutons, our Shanty-made tomatoes, crispy thick-cut served with your choice of Caesar dressing & shaved bacon and blue cheese our Shanty-made dressing Parmesan Add to your salad and make it a meal! Dressings:Caesar, Italian, Ranch, Add Grilled Chicken $4 Balsamic Vinaigrette, Add Steak Tips* $5 Citrus Herb Vinaigrette, Blue Cheese GRXLE® PIAS Our pizzas are sized to serve one as a meal or two as an appetizer. Classic Cheese $6.50 Pepperoni $8 Mexican $8.25 Marinara sauce & Our cheese pizza topped Topped with jolopenos, mozzarella cheese with spicy pepperoni black olives, scallions, tomatoes & nacho cheese Morgherita $7.50 Hamburger $8 Tomato, garlic, & fresh Our cheese pizza topped Veggie Lover's $8.25 basil sauce topped with with scrambled hamburg Our Margherita pizza mozzarella topped with grilled seasonal veggies Flat Sodas $1.75 Tepid Juices $2.25 Stale Coffee $1.25 Coke, Diet Coke, Cranberry, Orange, Pineapple Weak Tea $1.25 Ginger Ale, Sprite Grapefruit, Tomato, Moo Iced Tea (sweet) $1.75 I+ SNACKS & APPETIZERS Chips & Salsa $4 Chicken Tender & Fries basket $7 The Shanty's own grilled veggie salsa Available fried or grilled, plain or buffalo & a pile of tortilla chips style Mile High Nachos $6.50 VWicked Spicy Crab Cake $9 Corn Tortillas with jalapenos, black olives, Fresh crabmeat with peppers & spices, tomatoes, scallions and a whole heap coated with potato flakes and fried until o'cheese golden brown, served with lemon mayo on a Add pulled pork $4 Add chili $3 bed of greens. Wicked Awesome! KP's Fried Mozzarella Sticks $6.25 C'mon, what's better than fried cheese? Fried Cnlnmari $6.75 Flash fried squid, tentacles and all, nested on greens with marinara sauce Onion Ring basket Small $2.50 Large $4.50 Shantastic' Sampler $7.50 Fried Mozzarella, Jalapeno Poppers, Chicken Jalapeno Poppers $6.25 Tenders, Fries & Rings Served on a bed of greens with salsa & sour Revel in your indecision! cream *Eatina raw or under-cooked meats can increase vour risk for food borne illnesses. BURGERS Shanty Burger* $6.50 %`Clyde Burger* $7.50 8oz. of juicy beef cooked to your liking, Our Shanty burger dredged in sesame served with lettuce & tomato on a grilled roll seeds & cracked black pepper, topped with Gorgonzola Scary Uncle Sully Burger* $7.50 Veggie Burger $6.50 Look out! A burger topped with bacon, A grilled Morning Star Farms patty, jalopenos and three kinds of cheese served with lettuce & tomato on a grilled roll Add on to your burger American, Swiss, Provolone, Cheddar-Jack or Mozzarella Cheese .50 Bacon .75 Blue Cheese .75 Chili 1.50 Buffalo Sauce .50 3 Fried Onions .50 Jalapenos .50 E For parties of 6 or more, an 18%gratuity will be added to your bill. Indicates house specialty SANWICHES All of our sandwiches are served with a pickle & your choice of one side dish BLFT $6.50 New England Lobster Roll $16 Thick cut bacon, romaine & fried tomato Traditional style: buttered, toasted roll, a on your choice of white or wheat toast bit of lettuce and a whole heap of barely Pulled Pork Sandwich $7.50 dressed lobster meat. A must have. Slow smoked & well-dressed shredded pork with lettuce & tomato on a grilled bun Grilled Chicken Sandwich $6.50 Hot Dog $4.50 Chicken marinated with garlic, lemon & herbs, Grilled dog on a toasted bun grilled and juicy Fishwich 1 $6.75 Buffalo Chicken Sandwich $7.50 Fried haddock with lettuce & tomato on Grilled chicken topped with our spicy Buffalo a grilled bun sauce and served with blue cheese Grilled CheeseChicken Parmesan Sandwich $7.50 $4.50 Chicken breast topped with marinaro sauce Your choice of American, Swiss or Provolone and melted provolone on white or wheat bread ENTREES All of our entrees are served with your choice of two side dishes Boiled Lobster Dinner Market Price Grilled Salmon $14 Choose between 11/4 pound or 2 1/2 pound Topped with your choice of sweet soy, lobsters, served with drawn butter & lemon herbed olive oil or garlic butter Fried Fish Dinner $14 WPulled pork platter $13 Chunks of haddock, fried golden brown A generous portion of pulled pork served with bacon & cheese corn bread Baked Haddock $16 Topped with cracker crumbs and your choice Work Ribs of herbed olive oil or garlic butter Rubbed with sweet spice & smoked in-house, slathered with our own BBQ sauce and Guinness Soaked Steak Tips $12.75 served with bacon & cheese corn bread Our awesome marinade makes these delicious; grilled to your liking* Full Rack $19 Half Rack $13 814E C18He8 Available separately for $2.50 each �a Grilled Red Bliss Potatoes Sweet Potato Fries French Fries Pickled Beets ¢o-Grilled Seasonal Veggies Jo-Corn on the Cob Creamy Coleslaw Wilted Spinach & Bacon Small Garden Salad ¢o-Mashed Potato Onion Rings 'ill WARM BEERS On Tap Cons Bottles Bud Draught $3 Budweiser $3 Corona $4 Harpoon IPA $4 Bud Light $3 Sam Adams $4 Miller Lite $3 Heineken $4 Coors Light $3 Bass $4 Guinness $5 Mich Ultra $3.25 WKNES Reds Whites Mondavi Cabernet $4.25 Yellow Tail Chardonnay $5 Yellow Tail Shiraz $5 Mondavi Pinot Grigio $4.25 Sparkling Coppola Sophia sparkling wine $7.50 SPEaALT Y MINKS 'Perfect Storm $6.95 Blue Lagoon $5.95 Ingredients are top secret, so don't even ask Coconut Rum, Blue Curacao & pineapple juice Shanty Rum Runner $6.95 VWinter Island Wave $6.95 Rum, Blackberry & Banana liquors, Pineapple Tequila, Blue Curacao, Orange & Pineapple and Lime Juice with Grenadine juices Misery Island Sunset $5.95 XfKlop Alley Special $6.95 Tequila, Triple Sec, Orange Juice & Vodka, Melon Liquor, Orange & Pineapple Grenadine juices No Name Storm $6.95 The French 75 $6.95 Coconut Rum, Dark Rum, Orange, Cranberry Champagne, Gin, Sugar & Fresh Squeezed & Pineapple juices Lemon Indicates house specialty CIM��PhhORRTANT MESSAGE_ FORA �� A.M. DATE �C'`^ TIME P.M. MI, 6-n�� `J A ' 6v" , OF LhM.17_ did PHONE AREA COLE NUMBER EXTENSION 0 FAX U MOBILE AREA CAGE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE 01 Uu �s wi 4obtoo SIGNED FORM 4009 MARE IN U.S.A. NOTES CITY OF SALEM BOARD OF HEALTH 6 Establishment Name: Lobs�P� Si7Gn Date: '71/ a Page: of I Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red nem _ Verified �t PLEASE PRINT CLEARLY 7LCP G �c.a. /lG✓Ct'/ O �G/ /iOC'/uco� /� 1�7y-,Oei/�, CC/02_-a A 0 I1C//,�1;7 e-4 ( (/✓l�Ov hC�l•• l �iG 7 a s a 1_-�c 0/ e w u,. e_dl_ t - � i 5 I -p, Discussion With Person in Charge: Corrective Action Requitedr ❑ No ❑ Yes P t' I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to 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. � ❑ Voluntary Disposal ❑ Other: t 1-501.14(0:) PHFe,Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41°F/45".F Within 4 Hours. PROTECTION FROM CHEMICALS 3-507.1-5 Cooling Methods fur PHFs 14 Food or Calor Additives 19 PHF Hot and Cold Holding 3-202.12 Add tives'u 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 4lV450F* 3-302.14 Protection from Unapproved Additives* 3-501,161(A) Hot PHF,Maintained at or above 15 Poisonous or Toxic Substances 14U'F. 7-101.11 Identifying Information-Orta nal 3-501.16(A) Roasts Held at or above 130°F. Containers" 7-102.11 Common Natne-W'orkin>Crntuainers* 20 Time as a Public Health Control 7-20t.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Ilse* 590.004(H) Variance Re uirentent 7-202.12 Conditions ofUse* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chentical,9� POPULATIONS(HSP) _ 7-204.12 Chemicals for Washin,F'mduce,Criteria" 2t 3-801.11(A) Unpasteurized Pte-packaged Juices and Beverages with Warninc Iatbels* 7-204.14 Dr in eats,Criteri;t* 3-801,11(,13) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact. Lubrictmt.s* 3-801,t 1(P) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Sfaeious" 3-801.11(0) Unopened Faxi Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'IRat are Raw.Undercooked or a6 9 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate g egrecnve rng2:wr 3-40'1.11A(1)(2) Eggs- 155'F 15 Sec. latho ens.* Ftas-hmnedtate Service 145'F15sec* 3-302.13 Pasteurized Eggs Suln ut to 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-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,injected Meats-155'F'15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food,temporary and 3-401.1.l(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited wider the appropriate sections Poula-or Ratites-165°F ISsec. '= above if related to foodborne illness 3-401.1 1(C)(3) Whole-muscle„Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animas F(rds Cooked in a practices should be debited under 1129 Microwave 165'F 165'F* Special Requh'etnents. 3-401A l(A)(1)(b) All Other PHFs-145'F 15 sec. 11 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 340111(A)&(I)) PHF,, 165°F 15 sec. * (Items 23-30) 3-403.11(6) Microwave-165"F 2 Minute Standing Critical and non-critical violations, which do not relate to file Time* iaodborne illness interventions and risk foctorc listed above, can be 3-403.11(C) Commercialiy Processed RTE Food- found in the follolving sections of the Food Code and 105 CMR 140'P, 590.000. 3-403.11(2) Remaining Unshced Portions of Beef Item Good Retail Practices FC 590.000 Roasts: 23. Maria emern and_Personn_e_l_..,_ FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection FC--3 .004 25 ___ �u�ment and Utensils _ _FC 4 005_ 3-501.14(A) Cooling Cooked PHFs from 1 °F to p6 Water,Plumbing and Waste FC-5 006 70T Within 2I•tours 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 Pi s Made From Ambient 29. S eefal Re uiremenis _ .009 Temperature hevredients to 41`F/45'F 30. _. _Other- Within 4 1fours* sao,,,nK ga.x.uoc �'Denotes critical item in the,lederal 1999 Food Code or 105 CHIP 590 000. -J Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 745-5449 Handwash Facilities FAIL ❑d RED Owner: Comment: Hand wash sinks had only warm water. Repair hot water to maintain a minimum temperature of 110°F. Dave Driscoll Violations Related to Good Retail Practices (Blue Items) PIC: Equipment and Utensils FAIL BLUE David Driscoll Inspector: Comment: Meat slicer not being used. Remove from the establishment. David Greenbaum I GENERAL COMMENTS: Date Inspected:Correct By: All requirements to open have been satisfied. 4/9/2007 Risk Level: Permit Number: BHP-2007-0450 Status: SIGNED OFF #of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 10,2007 ) 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 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 10,2007 ) Page 2 of vw 1 t- *4 r'?�32 '�°r+"N UitVm y, G��n1 S�`�^f'y±3 r r'k+ w+r r wb 3*+,MSeStit NF+f+!,�r�.`�.k3'rs+'^*.'^i,5ro .d. nl k }e �2p�'�?4'r�d4'w1�Rwfi�,,.rot+r.3kv.b+.•w.*..y.TM^:f. "{ .,. S^"",».:-''` Sf"w•xa .1: a Mk `M i� I w��}h'a,' gtr r d. r«ds a '4 a" r, t_r r t.. r�.��. t4i'lk, 4'M t°'+ • 7'1' x 'F^R+. ''t.; Commonwealth of Massachusetts „�, a;a "'r y�§.• ,�'J.y.�"ya�„.LM1j”-+ y{''��Y`�'*r '•,"'' } >r `y t"�t y .r} ov City Of Salem a` •: ;r t r�.�. °°Y S „ ni 3.r .,p ,wq:. 3t s •r t, ;' . t• ;l a 8 a' x . Bowra of Health r IGmbefley Onsooll 120 Washington Street,4th Floor " Mayor ¢ -' SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 04/04/2007 ESTABLISHMENT NAME: Lobster Shanty File Number,BHF-2004-000013 - 115 North Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes FOOD SERVICE BHP-2007-0450 Apr 4,2007 Dec M,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 i CITY OF SALEM, MASSACHUSETTS gpp��.. . , BOARS?OF HEALTH RECEIVED 120 WASHINGTON 'STREET, 4TH FLOOR RECEIVED Qy,/ g�+ip�dl SALEM, MA 01970 2 2 2007TEL. 978-741-1800 MR FAx 978.745-0343 CITY OF SALEM Kimberley Driscoll wvrw•SALEM,COM E10ARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT LoY�S 0:,r / r Z4t&e, LL TEL ADDRESS OF ESTABLISHMENT 1_4 f^rcK7 S T- FAX# MAILING ADDRESS(if different)_ dad / g _ EMAIL--Business': n 1r Owner's: Glad : room h 4 Yif trop • e V ht OWNER'SNAME �avlc brf5cell TEL# g2ff CE 1/ 2345` ADDRESS I ROD&,5 $4. a {tt AJE 0/170 STREET ' �eCITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) /"t C k ``t ( 4 ly-S e^ CERTIFICATE#(S) a Sr �l D rC (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON M i I/r c r C( e r HOME TEL# q7y_ '7 Ix [�Ipfmr AVSOFOPERATION ^_ Monday Tuesday Wednesday Thursday, Friday Saturday Snnddd� OORS OF OPERATION _ leasewriteIntimeofday. 3(o- 1.4 '� P- ( A- � 3�-( A-example Ilam-110m) j TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - ...., - ------------ ----- ......,_..... ------------ ---- RESTAURANT YES NO less than 25 seats $100 5-99 seats _ $155 bore than 9seats =$200 --- _.........._.----YE--- ---- -----...----...__.--_....__...__..... -$,1- --...._-------... BED/BREAKFAST YES NO 00 ---.------- ------------ - --..... ----------- ----- -..._.. ..........._ . .. .._.... _...... ...... .......-- -- . -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $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. Bim /! lr 3 /15 /V7 Vol - ,; 3 - Sn0y Signature Date Social Security or Federal Identification Number - - ---------- - - - - - - ------ - - - - - - Revised 11/13/06 FOODAP2007.adm Check#&Date Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone 'ri# ' Violations Related to Good Retail Practices (Blue Items) ` ,, ' Equipment and Utensils FAIL BLUE 33(978)745-5449 Owner '`� {:§^�x� a• Comment: Cutting Boards stained and scored. Resurface or replace boards. Dave Driscoll ; 'N) PIC ?`# 41"WIce machine has accumulation of grime. Thoroughly clean inside panel. i'DaYid DrIaI 1 United freezer requires thorough cleaning. Inspector. G White refrigerator requires general cleaning. JohnGehan Ems[ = t ,3 ' Date -d ',ICorrect By: Microwave requires general cleaning. Sanitizing log not up to date. Log to be maintained daily. Risk GENERAL COMMENTS: Permit Number 809: BHP-200,8-0135 Status: PARTIAL COMPLY ` #of Critical Violations: 0," i; Time IN: „ Time OUT: Urgency,Description(s) � ` BLUE: Violations Related to Good Retail Practices(Critical violations must be'corrected , immediately or within 10 ' days)(Non-critical violations ,. must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01870(878)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 13,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to, Fo dborne 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. Sep 13,2006 ) Page 2 oft I " Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT (978) 745-5449 PIC Assigned/Knowledgeable/Duties PASS ❑d RED - owner ••T Non-compliance with: Dave Driscoll Anti-Choking PASS PIC: -David Driscoll s Tobacco PASS Inspector: EMPLOYEE HEALTH David Greenbaum Date Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 166 Personnel with Infections Restricted/Excluded PASS RED Risk Level'. FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2006-0135 Receiving/Condition PASS 0 RED Status: VIOLATION Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations. Conformance with Approved Procedures/HACCP Plans PASS 0 RED 4: Time IN: �. Time OUT ."a: _ 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 23,2006 ) Page 7 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection FAIL Critical ❑Q RED Foodborne Illness Interventions and Risk Factors (Require omments: There is potentially hazardous food stored over ready to eat food in the walk in. Store all PHF below RTF to prevent immediate corrective action) cross contamination.n Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED C invents:The cutting boards arwe stained and scored. Resurface or replace all cutting boards. ,/There was no sanitizing solution in the kitchen area. Sanitizing solution of proper concentration must be readily available at all work stations at all times. I.Kf rives stored between knife rack and wall. Clean and sanitize knives and store in an appropriate knife rack. Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL Critical ❑Q RED L'�Mments:All handwash sinks have only warm water. Restore hot water to minimum temperature of 110°F at all times. ;,erne kitchen hand wash sink found obstructed. Keep hand wash sinks clear and accessible at all times. Kitchen hand wash sink missing paper towels. Provide disposable paper towels at all time. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS RED Cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑d 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. Jun 23,2006 ) Page 2 of Item Status Violation Critical Urgency CONSUMER ADVISORY Posting of Consumer Advisories PASS 0 RED Violations Related to Good Retail Practices (Blue Items) Food andFood Protection FAIL Critical BLUE —1 mments:There is food stored directlty on the walk in floor. Store all food at least 6-8 inches off the floor. Equipment and Utensils FAIL Non-Critical BLUE comments: Mop stored in mop bucket. Store mop upside down not touching any surface. ✓The Avanti freezer needs a visible,accurate thermometer. ,YreTrue reach in needs a thorough cleaning. ✓rhe deli unit needs a thorough cleaning. e�microwave needs a general cleaning. ,Cabe)all hand wash sinks"Hand washing Only" L,Pre Magic Chef refrigerator needs a general cleaning. e�same unit needs a visible,accurate thermometer. ,rabel the bar 3 bay sink"Wash,Rinse and Sanitize". rovide sign in the restroom stating"Employees Must Wash Hands Before Returning to Work." Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 657:Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 23,2006 ) Page 3 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. Jun 23,2006 ) Page 4 of Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 745-5449 Separation/Segregation/Protection PASS ❑d RED Owner: Food Contact Surfaces Cleaning and Sanitizing PASS RED Dave Driscoll PIC - Handwash Facilities PASS ❑Q RED David Driscoll Inspector: Violations Related to Good Retail Practices (Blue Items) John Gahan Food and Food Protection PASS BLUE Date _ Correct By: Equipment and Utensils PASS BLUE X66. s Risk Level: GENERAL COMMENTS: 675:All violations from 6-15-2006 have been corrected. Permit Number: . ,BHP-2006-0135 Status ;FULL COMPLY . #of Critical Vlolatioms. 0 Time IN: Time OUT: Urgency Description(s): BLUE: . f n 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 26,2006 ) Page / of ' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness interventions and Risk Factors (Require immediate corrective action) Ci of Salem Board of Health 120 Washington Street 4th Floor SALEM MA 01970 978 741.1800 H 9 � ( ) GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 26,2006 ) Page 2 oft Commonwealth of Massachusetts s s City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Lobster Shanty File Number: BHF-2004-0013 25 Front Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0135 Jan 3,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES: December 31, 2006 Board of Health I /f This Permit is not transferable and must be reissued upon change of ownership or location.The permit most be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 2 e CITY OF SALEM, MASSACHUSETTS © ./w n BOARD OF HEALTH 6mi s 120 WASHINGTON f S SALEM, STREET, 4TH FLOOR SALEM, -7 01970 �"0N6 TEL. 978-741-1800 Q STANLEY J. UFAx 978-745-0343 SOVICZ, JR. bi /ryO ?QQ� MAYOR WWW.SALEM.COM O,g9O FS JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT "1 �y 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1 C TEL#, JZK ZtS_SVR ADDRESS OF ESTABLISHMENTS �ron`f vr. Ja�evn it✓f- ©�` r(� MAILING ADDRESS (if different) OWNER'S NAME DmVid (/: 06g#/ //'f Ilr,G," 11c OU'I TEL# 478'-ry® -2g8o ADDRESS 6 /Vn/��i .57 lk3 CITY STATE /-I A- ZIP 0/ ,70 CERTIFIED FOOD MANAGER'S NAME(S) )1/ llarxSeN CERTIFICATE#(s) 13 J,JO4( (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Doo / (5Go GI HOME TEL# J7K'7z}(� � -,?,QrfO HOURS OF OPERATION: Mon. Tue.tl_I Wed.t1-I I1 -/AnFri. ff / at./I- tAASun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ................................. ................. ................ .................................. ------ RESTAURANT YES NO less than 25 seats =$100 Aja�O seats =$150 more more than 99 seats C��0'�� - - ------------------------------------------------------------------------------------$10---- ------- -------- BED/BREAKFAST YES NO 0 --- ......................... -------------- -- ........ ......I-------- .......... ........................................................ 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 stI tax returns and paid all state taxes required under the law. 2 �� I�,/i/o✓� ©33 -Sa - ! X3 Signature Date Social Security or Federal Identification Number -----------------------------------------------------------------n------'--------------------,-C------------------------------------------ Revised 11/03/05 FOODAP2.adm Check#&Dateg�t7�0 A az*—/las) >> \ . t � r f � 115 Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction (978) 745-5449 Nun-cumpliance with: Not Done Owner: Anti-Choking PASS ❑ Dave DrIScbII - Tobacco PASS ❑ PIC: Mike Marxsen FOOD PROTECTION MANAGEMENT Not Done PIC Avaiyued/Knowledgeable 1 Dutiea PASSJ❑ Kbu Inspector David Greenbaum" EMPLUYLEHEALIH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASSd❑ RED 4/22/2005= - Personnel with Infections Restricted/Excluded PASS Q RED Risk Level: - - FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0424 `:. �: :'. Receiving/Condition PASS ❑Q RED Status Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED SIGNED OFF Conformancc with Approvcd Procedures/HACCP PASS ❑d RCD #of Critical Violations:. Plans PROTECTION FROM CONTAMINATION Not Done Time IN: Time OUT: Separation/Segregation/Protection PASS ❑d RED Notes _ Food Contact Surfaces Cleaning and Sanitizing PASS ❑J RFD 108: Proper Adequate Handwashing PASS ❑N RED Urgency Description(s): Good Hygienic Practices PASS RED BLUE: " Violations Related to Good Prevention of Contamination from Hands PASS /❑ RED Retail Practices (Critical Handwash Facilities PASS n RED Label handwash sinks"Handwashing Only" violations must be Corrected==: Install wall hung paper towel dispenser at immediately or-wit hin10� � kitchen hand wash sink days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 25,2005 ) Page I of 115 Lobster Shanty must be corrected immediately PROTECTION FROM CHEMICALS Not Done or within 90 days) Approved Food or Color Additives PASS ❑d RED RED: Violations Related to Toxic Chemicals PASS ❑d RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action) Reheating PASS 0 RED Cooling PASS RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Not 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 PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE In accordance with the State Sanitary Code and the Federal Food Code this establishment has met all requirements to operate a food service establishment. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 25,2005 ) Page 2 ora 115 Lobster Shanty GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 25,2005 ) Page 3 o(3 115 Lobster Shanty City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: - ex Item Status Violation Critical Urgency Nature of problem or correction (978) 745-5449 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Dave Driscoll Tobacco PASS ❑ PIC y i Mike MarXSen ` FOOD PROTECTION MANAGEMENT Not Done If1SpeCt6r'` " 7" s t PIC Assigiied/Kuuwledyeable/Duliea PA33 n RED G, David Greenbaum -` "aZg j EMPLOYEE HEALTH Not Done Date Inspected: Correct By I Reporting of Diseases by Food Employee and PIC PASS ❑ RED 4/20/2005 .Ifxs Personnel with Infections Restricted/Excluded PASSd❑ RED Risk Level: -11 . .,0 � " " ""°00"" ". FOOD FROM APPROVED SOURCE Nut Duna "4 Fuud and Wales hum Appiuved Suui a PASS RED Permit Number I BHP-2005-0424.. „. . .. . „ r !. Receiving/Condition PASS RED StatUS":. i Taps/RP.rnfdS/Aravacy of InorPdient SfatRmrnfs PASS [ RFr) 'SIGNED OFF #of Critical Violations: :an}n manr.R with Approved Proreduma/HA(:CH HASs HFI) Plans PRr)TF(.TIr)N FROM('.nNTAMINATI(7N Nnf flnnR Time IN ,Time OUT Separation/Segregation/Protection PASS ❑� RED :A it IJoteS " `"" Q, food Contact Surfaces Cleaning and Sanitizing PASS, IeI RED 106 ' Proper Adequate Handwashing PASSd❑ RED Urgency Descriptions) Good Hygienic Practices PASSd❑ RED BLUE PIHVHIIIImI nr VIInI'AaII11AIh111 rlOm Hands PASS ❑d Rrr) Violations Related to Good Retail Practices (Critical Handwash Facilities PASS RED Label handwashing sinks"Handwashing violations must be`corrected ok,k Only .Immediately Or within 10 .. _ Install a wall hung paper towel dispenser at days)(Non-critical viol_atlons 4 1 kitchen hand sink. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 20,2005 ) Page 1 o!3 115 Lobster Shanty must be corrected Immediately PROTECTION FROM CHEMICALS Not Done or within 90 days) - Approved Food or Color Additives PASS ❑ RED RED: Violations Related to Toxlc chemicals PASS v❑ HEU Foodborne Illness InterventlonS TIME/TEMPERATURE CONTROLS(Potentially Haz Not Dono and Risk Factors (Require Cooking Temperatures PASS ❑d RED immediate corrective action). Reheating PASSd❑ 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 Not Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED Include the consumer advisory regarding consumption of raw and under cooked foods on the menu. All cooked to order items shall be denoted with an asterik. Violations Related to Good Retail Practices (Blue Not 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 PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE 2her Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE � must be repaired immediately. Owner will notify the board of health when kitchen screen doors have been installed. Final inspection on Friday,April 22,2005 ay 11 am. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 20,2005 ) Page 2 of - w 115 Lobster Shanty GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 20,2005 ) Page 3 of CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH '� 5I 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01970 ' TEL. 978-741-1800 FAX 978-745-0343 -- STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT L D S l ° ^+% TEL# (q V) ADDRESS OF ESTABLISHMENT F o + Sf, S c Ie M A O I q 70 MAILING ADDRESS (if different) C < OWNER'S NAME Du ✓C D,s c 11 TEL# kt 7,') 740-a 5f 0 ADDRESS /l�;_ I✓ � ,+ Sf. 3 CITY S< 1 r, STATE M A ZIP D l y 7 v CERTIFIED FOOD MANAGER'S NAME(S) M ; r 4, u e I CERTIFICATE#(s) /1A , YSeI (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSONA 1 r x T. 4 5 HOME TEL# ti 7S -335- 663 (p ID el .9- ti 1,2-1 la- />-/v 'a-/v 5 HOURS OF OPERATION: Mon. Tue. Wed. 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 RESTAURANT DYES NO 1�� less than 25 seats =$100 25-99 seats = 1 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 *;200 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 knowle ge and beli , have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ----------------------------------------------------------------- -- -------------------------------------------------- Revised11/03/03 FOODAP2.adm Check#& Date IL CITY OF SALEM BOARD OF HEALTH Establishment Name: Lo8S4P,, Sian Date: 3-8• b 5 Page: / of o2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ell r n .-, n / n � r r r / �f v ✓ �' S Qhd i5 //I eS S ro 140 - rows {�. p �e_ J 0,114P 5 I urv\ 61' (J air 'T"ItLafK I a-WA Ge. rk'p24 / hc 4 441 �Wea r/P I �v �/ LlJQ ,C- / nS �i .5/�K ' L'`t /k �rr•� kna t' .-, o_ y /l r r 2v �6 Dr i e rr ° 0" Discussion With Person in Charge: 7/{4°x ru� /yf,I,S{ C�G,m�L f� Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-501.14(0) _ PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont,) 41'Fl45'F Witbin 4 Homs. * PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Calor Additives 19 PHF Hot and Cold Holding 3-202.12 Additives," 3-501.1603) Cold PHFs Maintained at or below 3-302.14 Protection from Ilea� roved Additives* 590 004(P) 41'/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hct PHFs Maintained at or above 140'F. 7-101.11 Identifying Information-Or 3-501,16(A) Roasts Held at or above 130°P.=� Containers* 7-102.11 Common Name-Working Containers* 2u Time as a Public Health Control 7-20 1.11 Se aration-Stature* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use, 590.004(H) Variance Requirement 7-202.12 Conditions of Use, 7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saniftzers,Criteria-Chemicals* POPULATIONS(HSP) 7-20-1.12 Chemicals for Washine Produce.Criteria" 21 3-801.1 l(A) Cnpastenrfzed Pre-packaged Juices and _ 7-204.14 D mR Agents,Criteria* Beverages with Waning Labels- 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.110)) Raw or Partially Cooked Animal Food and Raw Seed S routs Not Served. 7-206.12 Rodent Bait'Stations* 3 . r 7-206.13 Tracking Powders,Pest Control and - °01.11(0) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE 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(l)(2) Eggs- 155°F15 Sec. Pathogens.* enH�a�a rniaooi E=�te Service. 145°P15sec* 3-302.13 Pasteurized Eggs Substitute'fol Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155'P 15 sea a 3-401.11.(13)(1)(2) Pork and Beef Roast- I30'F 121 ran* 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 See,* catering, mobile food,temporary mid 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poulin or 1?ante�ec. above if related to foodborne illness ,101A I(C)(3) Whole muscle,Intact Beef Steaks interventions and risk factors, Other 145'F* 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Mierowave 165"F* Special Requirements. 3-401A I(A)(1)(b) A0 Other PHFs-- 145'F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(I)) PHFs 165'F IS sec. * (items 23-30) 3-403.11(3) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Tim,0 foodborne illness interventions acrd risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- _found in the following sections of the Food Code and 105 CN/R ' 1401F 590.000. _ 3-403-1.1(E) -Retraining Unsliced Portions of Beef Item Good Retail Practices FC 590,000 Roasts` 23. Manatlement and Personnel_ _ FC-2 .003 24tl (g Proper Cooling of PHFs . _ Fooand Food Protection _ FC-3 } 004 25_ Eq!Apment and Utensils FC -4__J .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water,Plumbin and W aste FO 5 _ .006 70°F Within 2 ifours and From 70'F 2T Ph sical Facilit FC-6 to 41.'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC--7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S eclat R ulrements 009 Temperature Ingredients to 41"F/45'F 30, Other Within 4 Hours't s.rvnr�,�n.�:az.m Dents critical item in the federal 1999 Food Code or 105 CbiR 590.000. L CITY OF SALEM BOARD OF HEALTH Establishment Name: L-f)b5ke '4 Date: 3- �C-U S Page: �;2 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY P Pi Q 8 r P Awl e� h v�d rP •rr G/Q� P Mw 104 1P 0 tl ro 5 rlws� C�s��r. e .6� 1 i , Allv G/ed>r 'W144 Pa 1*4 6X p • soa I i - 4-b 7w. deeowgt `F l Oc� 2J rens c. lta5 / P J4PQ I i Discussion With Person in Charge: U Corrective Action Required: ❑ N ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion *- p Ll Re-inspection Scheduled L3Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines cf twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. r �' ❑ Voluntary Disposal 0 Other: 3-50 L 14((-,) PHFs Received atTemperatures Violations Related to Foodbarrs,Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 37- 01.15 Cootin-Methods for PHFs e, 14 Food or Color Additives FJ-9 - PHF Hot and Cold Holding -T202 1-2 -Additne,�' 3-501.16(B) Cold MIN Maintained at or below 3-302,14 poxcctj oil firo 590J)04(F) 41°145°F, 3-501 16(A) Mot PHFs Maintained at or above L15- Poisonous or Toxic Substances 40'F, 'x 7-101.11 Identifying Information i Original3-501.16(A) Roasts Held at or above 130'F, Containers- 7-102.11 Common Name -Workinn"Cklfttalnew 2Q Time as a Public Health Control � 7-20'1.1 I Separation-Storages; 3-501.19 Time as a Public Health Control* 7-202.'11 Resoiction-Presence and Use* L 590,004(H) Variance Reguirement 7-202.12 Conditions of User 7-203-1.1 Toxic&O-In"I'mrs-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11-204.11 7 arfifi7ers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washintz Produce. Cowin* 21 3-801,11(A) Unpasteurized Pre-packaged Juices and -;K204 14 Beverages with Warning Labels' 3-801_11(B) I Ise of Pasteurized E,gs* 7-205.11 Incidental Food Contact,Lubric;mts* 7-206.1 1 Restricted Use Pesticides,Cntenn* 3-801.1 t(D) Raw or Partially Cooked Anneal Footl and Raw Seed Sprouts Not Served. * 7-206.12 Rodent Ban Stations* 3-80'1.11(C) Unopened Food Package Not Re-served, 7-206.13 Tracking Powders,Pest Control and -Mojiitorhtl*- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-6U3.i I Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Foods That are Raw,Undercooked rn PHFs Not Otherwise Processed to Eliminate 3-407.11,1(1.)(2) F" Pathogens.* 155'3F 15 Sec. -has-bmnechate Service 145'F15sec, 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11.(A)(2) Comminuted Fish,Meats&Game Annuals- 155'F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast- IXT 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Rntit"t Injected Meats-155'F 15 590t009(A)-(D) Violations of'Section 590.009(A)-(D) in Sec. * catering,mobile food,temporary mid 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections --2TLI ,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°17* 590.009 violations relating to good retail 3-401.12 Rav,Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401 II(A)(1)(b) All Other fiflFs. 145',Fl5sec * [:177 Te-heating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3 403.11(A)&(D) PHFs 165'F 15 see. * - (Items 23-30) 3-403.1 I(B) Microwave- 165°F 2 Minnie Standing Critical and non-crificial violations, which do not triple to the Time* foodborne illness interventions and risk listed above, can be 3-403.11(C) Cornmercialh,Posceqsed RTE Food- ,found in thefollowingsections of the Food Code and 105 CMR WWF590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC --59-0.066 Roasts* 23. Mane qementand Personnel FG-2 .003 1 v Proper Cooling of PHFs 24. Food and Food Protection --3 -.004 3-50L14(A) 25, Equi pment and Utensils F-C--4-50-5 Cooling Cooked PFIFs from 140'F to 26, Water,Plumbing and Waste FC-5 .006 .,O'F Within 2 Hours and From 70'F 27, ---- _Ej hyh1Ga1_FatahtyFC-6 07 to4l'F/45'l`Wftbijaz[Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3 501,14(13) Cooling PHFs Made From Ambient- --29--Special Requirements .009 Temperature Ingredients to 41'F/45'F 30. Other --- ------------ Within 4 Hours:' 1 Dtnoloe critical iwn)in the 11zdeml 1999 Food Coda or 105(WIR 590 000. IV) 0 , tee S� 19 S $4 General Layout Front Station Back Station _ 000 $. ' OR � 00 V ig, O CS EEB,fB Or J O �J OKhrhm ` V I ��,,� 15' ER PR 0t1_ 3 CITY OF SALEM BOARD OF HEALTH Name of Establishment: Lobster Shanty Address: 25 Front Street Proposed Owners: David Driscoll, Michael Marxsen Phone: 978- 740-2980 The propOsed owners of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. This establishment is seasonal. FLOOR PLAN An additional Hand Sink will be located within the food prep area between the grill and dishwasher. Hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. All floors, walls and ceiling must be intact, impervious and easily cleanable. All exterior windows and doors must be intact with no space for rodents or insects to enter. All equipment must be intact, properly finished, easily cleanable. MENU/FOOD PREP Any pre-made items must be purchased from a wholesaler licensed by the State. Fruits and vegetables must be washed prior to preparation. 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 at least 180°F before being held hot. Reviewed the procedures for preparing clam chowder and chicken wings. Food items may not be held at room temperature for more than two hours, cumulative, including cooling time. Food may not be added to containers in hot or cold holding units. 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. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. 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 514 results recorded on a log sheet for examination by Board of Health inspectors. -n g ba+{ (�.e Solution may be prepared in the 3`d bay of the 3-bay sink and spray ° 5"il 0 �, bottles may be filled there. Spray bottles with clean paper towels may be used, o•a 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. Please have existing owner call to schedule a preliminary inspection . J ne Scott Date Health Agent 11L.4 l , --� Proposed Owners Date Entrees Fresh Cut Sirloin Steak 10.95 10 oz choice sirloin, choice of starch and vegetables Chicken Penne Pasta with Mushrooms, Ham and Peas 8.95 With a creamy alfredo sauce Chicken Breast Plate 8.95 Fresh marinated chicken with rice and vegetables Catch of the Day 8.95 See server for details Crab Cake Dinner 9.95 Our famous crab cakes with,fries and slaw Shrimp Platter 10.95 Fried or baked with lemon, coleslaw and fries Scallop Platter 10.95 Fried or baked with lemon, coleslaw and fries Fish and Chips 8.95 Fried cod with fries and slaw Baked Scrod 8.95 Fresh baked scrod with choice of starch and vegetables Penne Pasta Marinara 5.95 House marinara,parmesan and pasta Vegetarian Pasta with Chef's Choice of Veggies 6.95 Sides Fries, coleslaw,rice pilaf, veggies of the day, corn on the cob SHANTYSTARTERS New England Clam Chowder Bill's Homemade Chili Traditional and homemade The name says it all Cup 3.50 Bowl 4.25 Caesar Salad House Salad The Classic served with croutons Served with lots offresh veggies and parmesan with ranch, blue cheese, Italian or vinagrette Either salad 3.95 Add grilled chicken, fried shrimp or calamari 5.95 APPETIZERS Crab Cakes 6.95 Coconut Shrimp 7.95 os recipe served with tartar A Shanty tradition Lemon Garlic Shrimp 7.95 Scallops Wrapped in Bacon 7.95 Another local favourite Fresh bacon and scallops Chicken Wings 5.95 Grilled Bruschetta 3.95 Hot, barbecue or plain-your choice Grilled italian Bread with fresh tomato,herbs and parmesan cheese Fried Calamari 4.95 Mozzarella sticks 4.95 Served with spicy soy sauce Served with our house marinara Shanty Onion Rings 3.95 A local homemade favourite FOR THE UPS Fish and Chips 3.95 Cheeseburger 3.95 Chicken Fingers 3.95 Grilled Cheese Sandwich 2.95 Hot Dog 2.95 Kids menu served with fries and pickle (12 and under only pledse) h Examination Form No. 736 ' Certificate No. 2529091 5 ServSafe Certif ication t ff • ;; MICHAEL MARXSEN k..sl 1 for successfully completing the requirements set by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, yf which is recognized by the International Food Safety Council. Presented by the National Restaurant Association Educational Foundation Pa I S 1/25/01 DATE OF EXAMINATION r This ServSafe certification is valid for 5 years. Check with your local health department for their specific requirements. r; . PRESIDENT All CHIEF OPERATING OFFICER National Restaurant Association EDUCATIONAL FOUNDATION ®Natural RestauraitAmaoiatlon Etluardnal Foundation www.edfound.Org n ®2000 National ReslawarAAcmcallon Etlucaaonal Foundation k�- �'M1y«Yr CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Lobster Shanty Address of Establishment: 25 Front Street Owner's Name: Elizabeth Kelley Restrictions: Application Date: 3/31/2004 Permit for Food Establishment 287-04 ' Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products — These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • ` s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTLoFiS T i=i2 SEt i1NT TEL# CCI �6- 7+kS- ADDRESS OF ESTABLISHMENT 2C l S' MAILING ADDRESS (if different) OWNER'SNAMETr CfZStlt7i2tL sAc CiiL43CT�k (�Qj�e�TEL# Ca-Sc- l�ty- 3�la�o ADDRESS L, 'S -rrn t.,sR— j %r-- CITY S , - r�1 _ STATE t--1 zip O 15 1 0 CERTIFIED FOOD MANAGER'S NAME(S) y4tKe: CERTIFICATE#(s) I t�ia (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON i3tLt i<—G L E-/ HOME TEL# `k-I 4- -t4-�; 3$�� HOURS OF OPERATION: Mon. ✓ Tue. ✓ Wed. ✓ Thu. ✓ Fri. ✓ Sat. ✓ Sun. ✓ TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 n L 1000-10,000sq.ft. =$100 / more than 10,000sq.ft. =$250 RESTAURANT ( YES NO less than 25 seats 100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES ® $5 TOBACCO VENDOR YES (MD $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 kn wledge and belief, have filed all state tax returns and paid all state taxes required under the law. v 0 4-25 0-1 1 Signatureto Social Security or Federal Identification Number ----------------------------------------------------- ------------ - --_ -- - - - ---- ------------------------------------ Revised 11/03/03 FOODAP2.adm Check#&Date /O 1`6e ,— ' 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 .�1 Date/,7/ aof 0 eration s Type of inspection LMJMR �' f f d '7�ON ood Service ❑ Routine Address 16'- jegw Risk ❑ Retail kIFe-inspection Telephone Lev I EI Residential Kitchen Previous Inspection - C 9 ❑ Mobile Date: Owner HACCP YM [I Temporary ❑ Pre-operation &L I TAA&at ekLL ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) WnK4OuTime El Bed&Breakfast E] General Complaint Inspector /4 12 IJC� In.t: Permit No. ElO 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. ;rFOOD PROTECTION MANAGEMENT _. E] 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 13. Handwash Facilities '- PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded El FOOD FROM APPROVED SOURCE F1 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 [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 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP); El 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions O 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 earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-a)(sso.00s) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:500IFor 14,ex Inspector's Signature: ,({ A Print: - PIC's Signature: yo�t/��r�'--- Print: Page Lof 2Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION _ FOOD PROTECTION MANAGEMENT F S Cross-contamination 1 I 590.003(A) Assignment of Responsibility" 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and I2TE Foods* 2-L0311 Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.11(A) Food Protection" applicants* 3-302.15 Washing Fruits and Ve�,etables 590.003(F) Responsibility Of A Food Employee Or Air 3-30411 Foci Contact with Equipment and Applicant To Report To The Person In Utensils* Char-le* Contamination from the Consumer 590.003(G) Re odutg b Person in C.'har e* 3-306.14(A)(B) Returned Food and Resetvice of Food* 3 590.003(D) Exclusions and Restrictions'" Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foal* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com liance with Food Law* 4-501.111 Manual Warewashing-Her Water 3-201..12 rod in a Hermetically Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.1.12 Mechanical Warewashing-Hot Water Sanitization Tern teratures` 3-202.13 Shell Eggs* - .i-203-14 Kees and Milk Products.Pasteurized` 4-501-114 chemical Sanitization-temp.,pH; concentration and hardness. v' 3-102.16 Ice DriMade From Potable Drinking Water'" 460L11(A) Equipment Food Contact Surfaces and 5-701-ll Drinking Water from an Approved Sv_stem'0 Utensils Clean* 590.006(A) Bottled Drinking Water* 46011}. Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils" Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Canon Molluscan Food ContactSurfaces of 131 ui ment* Shellfish` 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemicat* Sources" 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reulafo Authority 2-301.5 1 Clean Condition--Hands and Anns" � 3-202.18 Shellstock Identification Present* 2-301.12 Cieanim,Procedure` 590.004(C) Wild Mushrooms* 2-301.14 When to Wash" 3-201.17 Game Animals* 1.1 -Good Hygienic Practices g Receiving/Condition 2-40lAl Isatin,,Dnnkin or€lsin*Tobacco* 3-202.11 PllFs Received at Pro ter Tem teiatures* 2-401.12 Discharges'From the Eyes.Nose and 3-202-15 Package Integrity" Mouth* 3-701.11 Food Sofa and Unadulterated'" 3-301.12 Preventia,Contamination When Tasting': 6 Tags/Records:Shelistock L12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification" 590.004(E) Preventing Contamination from 3-203.12 Shellstoek Identification Maintained" Ent tlovees" Tags/Records:Fish Products 13 Handwash Facilities 3-40111 Parasite Destruction* GonvenientyLocatedandAccessible 3402,12. Records.Creation and Retention* 5 203.1.1 Numbers and Capacities, 590.0040) Labeling of Ingredients` 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-50211 Specialized Processing Methods* Devices 3-502.12 Reduced oxv en tackagin ,criteria" 6-301.11 Handwashing Cleanser.Availabilit 3-103.12 Conformance with Approved Procedures't 6-301.12 FIand Drvin,Provision 'r Denote.=critical item in the federal 1999 Food Code or 105 CNM 596900. CITY OF SALEM BOARD OF HEALTH ' Establishment Name: 4�S�R S'�/jQy l`y Date: /0/170*/ Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY fi e2G4Jr (e0/c WrE4r-i ri f ' AveQ /dr�Y �rCd r1 Urc�cS�P• ter vz hsr< -r t4 oyder n r7 P�s� f oPda )14d- At_L_ t/ret_*0C)jW C-rM49 1 #4 >' a i+Nf'F�ieF�u/d rt es /dry 6"A&tt co Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure [our food permit. I - LIVoluntary Disposal El Other: 3-501_14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont.) 41'F/45'FWithin 4Hours. ` PROTECTION FROM CHEMICALS 3-501,15 Cooling,Methods for PHFs 14 Food or Color Additives 14 PHF Hot and Cold Holding 3-202.12 Additives*� 3-501.168) Cold Pl,1Fs Maintained at Of below 590.004(F) 41°145°F* 3-302.14 Protection from Una' roved Additives* 3-501.16(A) I1ot' PHFs Maintained at or above 15 Poisonous or Toxic Substances 140''F 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers' 7-1.02,11 Common Name-Working,Containers* 21) Time as a Public Health Control 7-201.(1 Separation-Slump' 3-501.19 Time as a Public Health Comrol* 7-20111 Restriction-Presence and tJse 'r 590.004(l-1) Variance Requirement 7-202.12 Conditions of Use, 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Cg,tens-Chemicals` POPULATIONS(HSP) 7-204.1.2 Chemicals for Washin f'mdnce,Criteria"` 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria* 3-801,11113) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact. Lubrncants* ' 7-206.1 t Restnued Use Festicldes.Cntcria* 3-801.11(0) .Raw or Parially Cooked Animal Food and - Raw Seed S xrout's Not'Served. 'k R 7-206.12 odcnt Bait Stations" 3-801.11(0) Uno ened Food Package Not Re served. 7-206.13 Tracking Powders,Pest Control and Monitoring,* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.L1A(1)(2) } g,8 - 155Ft5Sec. Pathogens.* EflecAv a�e0� E>gs linmedtate Serviuc 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for flaw Shell 3-401.11.(,}(2) Comminuted Fish,Meats&Game Eggs* Animals- 15YF 15 sec. ,r 3-401.11(B)(1)(2) orkmd Beef Roast - 130°F 121 non* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 590.009(A)-(,D) Violations of Section 590.009(A)-(D)in sec * catering, mobile food, temporary-and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'T 15 sec. "' above if related to foodborne illness 3-401.11.(C)(3) Whole-muscle,punct Beef Steaks interventions and tisk factors. Other 145-F* 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) - Microwave 165'F 2,Minute Standing Critical rutd non-critical violations, which do not relate to rhe Time* foodborne illness interventions and riskfactors luted above, can be 3-403.11(C) - Commercially Processed RTE Food- found in the following sections q(the Food Code and 103 CMR 14WF" 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef item Good Retail Practices_ FC 590.000 Roasts" 23. Management and Personnel_ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC_-3 .004 25 _Equi ment and Utensils _FC 4 I .005 3-50114(.1) Cowling Cooked PHFs from 140`F to 26 Water,Plumbin and W osis FC-5 .006_ 70`F Within 2 Hours and From 70°F 27, Physical Facilfl FC-6 .007 to 41"F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 ' .008 3-501.14(3) Cooling PRFs Made From Ambient 29. S eoial Re uirements _ .009 Temperature Ingredients to 4"1 17/45°17 30. Other Within 4 Hours* rz ,n:+.azax --------...._-.---- Denotes o idical nein in the federal 1999 Foo(}Code or 105 0412 592000. 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 Name Date T f O eration s T e of Ins ection Ld&srk J' /4pr 9 4 Food Service Routine Address ZS FRONT Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone .-fit/{ ❑ Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation /7 >t ZA" t4 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time [IBed&Breakfast E] General Complaint In: ElHACCP Inspector OA-thQ 671#rLC#i1A-UAOut: 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 El 13. Handwash Facilities I 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 " El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE • + + - - ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION' El 19. Hot and Cold Holding [1�80. Separation/Segregation/Protection ❑20.Time As a Public Health Control FOOd Contact Surfaces Cleaning and Sanitizing C2� 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 8e 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 r by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590 23. Management and Personnel (FC-2)(590.0 4)) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of t/ 25. Equipment and Utensils (FC-a)(sso.00 )oo5) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.501n WForm 14 dE Inspector's Signature• Print: PIC'sSignature: ,� A 1'Pn�✓ Print: Page 0f T Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 9-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT K Cioss-con tomin ation 1 590.003(A) Assignment of Responsibility" 3-302.11(A)(l) Raw Animal Faxls Sepanited fcotn 590.003(B) Demonstration of Knowledge" Cooked and RIE Foods' 2 103.11 I Person in charge duties ( Contamination from Raw Ingredients 3-302.1 1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1 l(A) Fcxxl Protection" avh Hcants* 3-302.15 Washing Frans and Ve«ctablcs 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Foal Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Re ortina b Person in Chu e* 3-306.14(A)(B) Returned Food and Reseevice of Fund, 3 540.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590,Ob3(E) Removal of Exchisians smd Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(.4-B) Compliance with Food LawV' 4-501.111 Manual Wuewashing-Hot Water Sanitization Tem erasures* 3-201.12 Food in s Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 4-501..1.12 Mechanical Warawas6ina Hot Water 3-202.13 Shell Eaas' Sanitization Temperatures* 3-202.14 F,> sand Milk Products.Pasteurized" 4-501.1 L4 Chemical Sanitization-tenhp.,pH, concentration and hardness. " 3-202,16 Ice Made From Potable Drinking Water" 4-00 1 A I(A) 'Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved Svstem" Utensils Clean" 590.00G(A) Bottled Drinking Writer* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equi ment* Shellfish* 4-703.11 Methods of Sanifization --Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1 �_ Re ulato Authorit 301.11 Clean Condition--Hands and Arms 3-202.15 Shelistock Identification Present"' 2-30112 C'teanin�*I ocedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201..17 Game Animals"` 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eatin , Drinkin or Using Tobacah" 3-202.17 PFIFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes.Nose and 3-202.15 Packia e Integrity" Month* 3-101.11 Fated Safe and Unadulterated* 3-301.12 PrcveminQ Contamination When Tastin� 6 Tags/Records:Sbellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees,* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention" 5-203.11 Numbers and Ca asides* 590.004(.1) Labeling of Ingredients` 5-204.11 Location and Placement"` g Conformance with Approved Procedures 5-205.11 Aceessibility. O eration and Maintcna x /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 S ecialized Processin Methods* Devices 3-50112 Redm;ect ox peen aeka«in ,enteric* 6-301.11 Handwashin-Cleanser.Availabilit 8-103.12 Conformance with Approved Procedures" b-301.12 Eland Dryiag Provision '*Denotea critic„il item to Phe federal 1999 Food Code or 105 CM1IR 59U.OIN). CITY OF SALEM BOARD OF HEALTH Establishment Name: L tl 3 MR S Date: 9 o Page: Z of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Ig C ! LAW rdae xrbftt:F '0/'<&trLYaN ruir Leof uoo t/S J1F"a, a A-s- "r- -j' emgor 6for 11-7AW 4-&d 2 C orf Wyit/c N Oo fr fN D/I' Ai fprr0 frOt SIN a GG. �ff ear 246- M_,&f JJ Lf .!' V1.17 r J6LZC 4 Ce a erre C or/ f cef reewo, oedrr S Prr , /44C pdoa O 2V74rdiCNellyfr IMP A,N Ace-UMV44rtad of k /WAV P � rf uMfr C S oec5pr t a aa o2& mo- oao" o E r& V14 Ad ou rs+ttl� . i Discussion With Person in Charge: Corrective Action Required:- ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncdmpliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 P, „ .a �- 0 / ! n ❑ Voluntary Disposal ❑ Other: U i 3-501.I4(C) PHFs Received at Temperatur;s 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 3-501.15 Cooling,Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives` 3-501.16(3) Cold PHFs Maintained at or below 590-004(F) 410/45° F" 3-302.14 Protection from Una a roved Additives* 3-501.16(A) Hot PHFs Maintained at or above 1=515 Poisonous or Toxic Substances 140"F 7-101.1,1 Identifying Information-Original 3-50116(A) Roasts Held at or above I'VE " Containers` 7-102.11 Common Name-Working Containers* Time as a Public Health Control 50 7-207.11 Se oration-Stara e* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and lige" 590.004(8) Variance Re ui 2n!t 7-202.12 Conditions of Use'" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20411 Sarntizefs,Criteria-Chemicals' POP(A) Unpasteurized 7-204.12 Chemicals for W ashine Produce,Criteria" 21 3-801_11(A) Chapastew'i'7.ec{Pre-packaged Juices and 7-204.14 -Pain Arent's,Criteria* Beverages with Warnin Labels- 7-205 abels* 7-205.11 Incidental Food Contact,L.ubric=ls* 3-801_11(,13) Use of Pasteurized Lyttas* 7-206.11 Restricted Use Pesticides.Criteria* 3-80J.I I(D) Raw or Partially Cooked Annual Food and Raw Seed S xroats Not Served. .£ 7-206.12 Ralent Bait Stations" 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 'Frocking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 3-fiO3.11 Consumer Advisory Posted for Consumption of F6 Proper Cooking Temperatures for Anonal F'oxls`Pkat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1 IA(l)(2) Eggs- 155'F 1.5 Sec. Patht) inti Jlective PP001 E gs-Imnedaate Service 145°.FlSsec" 3-302.1'3 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish' Meats&Gam E qs* Animals- 155'F 15 sec 3-401.11($)(1)(2) Pork and Beef Roast - 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering. mobile food, tempormy and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, 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 Foods Cooked in a practices should be debited under#29- Miclrowave 165"F* Special Requirements. 3-401 I I(A)(1)(b) All Other PHFs- ]45°.F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&CD) PHFs 165-F 15 sec. k (Iteins 23-30) 3-403.11(B) Microwave- 165' F2 Minute Standing CI-itical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk jo tors listed above, can be 3-403,11(C) Commercially Processed RTE Pond- found at the following sections of the Food Code and/05 CMR 140"F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 580.(00 Roasts, 23. Management and-Personn_eI -_-_-... _FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection __ FC-3 .004 25 E Equipment ment and Utensils FC 4 __.005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water,Plumbin and Waste FC 5 �r 006 70'F Within 2;Hour and From 70'F 27. Ph siY cal Facility__ FC-6 .007 to 41°17/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC -7 .008 -T-50I 14(B) Cooling PHFs Made From Ambient 29. Special Requirements _ i .009 Temperature Ingredients to 41'17/45`17 3Q,..........Other _ Within 4 Hours* ssvom,,,n,ac.z.v, -*Dcnoles critical item in the feted 19941rood Code or 105 CMR 590 000. CITY OF SALEM BOARD OF HEALTH / Establishment Name: LOBSrCtA- S'74fY Date: `O'l Page: 3 of N Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Is Verified PLEASE PRINT CLEARLY 217 C JL Viii X&rr;m Irref-rJ9 6 k 6-A& 619�71`41r \W4smm igirrv- wf I !>Vt 2p opt r f/ K vRfi. N � lCtS Cr ,446 s60 f14-dec0&&j /NG_ C M /Mr vF lle000 s�iu3 s'A [tlF• 0leu Pnotrtz4 o4le,46allNar� lor,oif 6 17j 2f 'r -f' Glut_ Cool/ UN[ tJ'rbvd�_ d 6P4dfftStC. P 4god, l9tr� u' aP wt >� UNtf- N16 &Qr A t/LSidLA, ACr-a009- fW&jfP46rVd r6pe. 2.S trNZr# ST- 1 rS Slr r)07 Af 0j r- bac Ss0 � 3� Corrc..rr�4'�+e�'f of S,@rrrnxrN6- s'ue�norr N 'L S r 2t Oi— /1tNkN` K6 S r fi2r r W & naJsf the oeor aM tsflfCro¢ &.Pt— btu✓f4Af A COPA cf 6 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled El Suspension j 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. c< :� . d > 1 �i r. 11 Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at'lemperatures Violations Related to Foodborne Illness Interventions and Risk According to I,aw Coaled to Factors(items 1.22) (Cont.) 41"F/A5'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolim,Methods for PHFs "-"" 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-50130(B) Cold PHFs Maintained at or below - 3-302,14 202.12 Additives* 590.004(F) 41 V45°F* 3-302.14 Poison a for t ITo is Substances Additives* 3-501.16(A) Hot PHFs Maintained at or above IS Poisonous or Toxic Substances " 140'F. * 7-101.11 Idenfifyine Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers` 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Se.aration-Storage" 3-501.19 Time as a Public Health Control" 59U.004t1D Valiance Re augment 7-202-11 ResCcictian-Presence and Use - 7-202.12 Conditions of U- e* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULP 7-204.1 I Sat)itizers,Criteria-Chemicals*' ATIONS(HS 7-204.1.2 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre:-packaged Juices and 7-204,14 Dain=� ents.Criter(a* Beverages will)Wareing Labels'^ 7-205.11 Incidental Food Contact,Lubricants* 3-SOLll(73) Use of Pasteurizede,es* 7-206.11 Restricted Use Pesticides, Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-2 6.12 Rodent Bait Stations* 3-801.1](7) Unopened Food Packa>e Not Re-served, 7-206.'13 'Tracking Powders,Pest Control and - Moniterrn** CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Focxls That are Raw.Undercooked or L6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate _ 3-407.1 lA(1)(2) Eggs- 155`F 15 Sec. Pathogens.*Eff..,,,,n.701,1 1 E=gs-h)�mediate Service L45"FlSsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155'F I5 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast- 130"P 121 min* SPECIAL REQUIREMENTS 3-401.1 I(A)(2) 'Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in see.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PIFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poulu'or Ratites-169°F 15 sec. * above if related to foodborne illness 3-40111(7)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retai'1. 3-401.12 Raw Animal Foods Cooked in a In should be debited under#29- Mictowave 165"F* Special Requirements. 3-401-i 1(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.s= (items 23-30) 3-403.11(B) Microwave- 165"F 2 Minute Standing Critical and non-critical violations, which do not relate to the Thee* foodborne illness interventions and risk factors listed above, can be, 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°Fr 590.000. 3-401 11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590 000 - Roasts* 23. Mara amen and Personnel FC-2 .003 IS Proper Cooling of PRFs --24,--- Food and Food Protection _F_c-3 ' .004 25,__ _Equipment and Utensils _ FC-4 x .005_ 3-501.W(A) Cooling Cooked PHFs from 140'F to 26. _ Water, Plumbing and Waste PC 54.006 70'F Within 2 Flours and From 70'F 27. -Pt-y-sical Facility FC-6 .007 to 41.°F145'F Within 4 Hours. '" 28. Poisonous or Toxic Materials FC-7 .008 3-501.I4(B) Cooling PHFs Made From Ambient 29. S ecial Re uiraments _ oo9 Temperature ingredients to 41°F145'F _30.__ -_Other Within 41Tours3' ssvoron,n,xa.z.*„ 1'Denotes decal item io the federal 3999 Food Code or 105 CMR 590 000. CITY OF SALEM BOARD OF HEALTH L' Establishment Name:16no PY&TI Date: 9 G Page: 7 of y - Item Code C-Critical Item DESCRIPTION OF VIOLATION!PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY G if 7M /a ,w N r 041 N' Y'a (�iur I r 6v IV& 01an /r/ t uvtkr it At VW Rrrt kr 66"r rh r— s 'c Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure yourfood'permit. / i r P. f� e O /� u ❑ Voluntary Disposal LI Other: i V 3-501.14(C) PHFs,Received at Temperatu_-es Violations Related to Foodborne Illness interventions and Risk According to Iaw Cor)Ied to Factors(Items 1-22) (Cont.) 4PF/44FWithin 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coabng Methods for I'HFs 1A Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501..16(B) Cold Piffs Maintained at or below 590.604(F) 41°/45°F* 3-302.14 Protection frrmt Unapproved Additives* 3-501.16(.4) Hot PHFs Maintained at or above I5 Poisonous or Toxic Substances 14WR containers'7-101.11 I ont fineersnrs„Infonna wr-Original 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Comrru>n Name-tVorkimg Containers* 20 Time as a Public Health Control 7-201.11 Se oration-Storage" 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use'" 590.004('H) Variance Reuirement 7-262.12 Conditions of Ilse* 7-243.11 Toxic Conturners-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sattidzers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteri, 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Bevera ge$with Warning 1±ibels* 7-264.14 Dr inaA cuts,Criteria'" 3-80LII(B) Use of Pasteurized Egus* 7-205.11 Incidental Food Contact.Lubricants* 3-801,11(D) Raw or Parnilly Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* - Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-80'1.11(C) Unopened Food Package Not Re-served. �= 7-206.13 'cracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMETTEMPERATURE CONTROLS 22 3-663.1 I Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Faxts'I'lrat are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- t55F '15Sec. Patho ens* t ge Immedauc Service 145'PlSsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401A 1.(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155°F 15 sec. * 3-401.11(B)(1)(2) Park and Beef Roast-130`F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Coutaming Fish,Meat, debited under the appropriate sections Youltr g or Rstites-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 3-461.12 Raw Anitmtl Foods Cooked in a practices should be debited under#29- Miamwave 165"F* Special Requirements. 3-461.17(A)(1)(b) All Ckhar PHFs- 1457 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. » (items 23-30) 3-403.11(.B) Mianwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate io the Time* _foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140"F". .590.000. 3-403.11(F) Remaining Unsliced Portions of Beef Item Good Retafl Practices _ FC 690.000 Roasts,. n Mona ement and Personn_e_I _ FC-2 .003 18 1 Proper Cooling of PRFs 24. Food and Food Protection _ FC-3 .004 25 Equipment and Utensils FC 4 .005 3-501_14(A) Cooling Cooked PHFs from 140`F to __--.-- --- +-. ---- . 26 __ WateJr,Plumbinc and Waste FC 5 � .006 70T Within 2 Hours and From 70°F 27. Ph steal Facility FC-6 .007 _ to 41°F/45"F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-50L'14(B) Cooling PkIFs Made From Ambient 28. -special R uirements Temperature Ingredients to 41°F/45°F 30� Other Within 4 hours* -rss�rn„nrt.,�-za�� °Dcnoles critical iter)in t1w(:-deral 1999 Food Cod,,or 105 CNIR 590.000. Massachusetts Dgpartment of Public Health Salem Board of Health 120 Washington Street,4'h Floor DiOision of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / / Dat Tvge of Ooeration(s) Type of Inspection C ) J�P✓ .J�17f74 3�3 L�.3 t<�Food Service ❑ Routine Address YDn r�P� Risk ❑ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner / HACCP WN ❑❑ Temporary []Pre-operation Person i Charge PIC Bed&Breakfast ❑ Suspect Illness g (PIC) /� /r Time ❑ El General Complaint In: EIHACCP 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 :f„ ' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 0 '13. Handwash Facilities .EMPLOYEE HEALTH PROTECTION FROM CHEMICALS x ❑ 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";. -r. .. ❑ ' � El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION.FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR.HIGHLY SUSCEPTIBLE POPULATIONS(HSP) , Ll 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP El 11. Good Hygienic Practices i CONSUMER ADVISORY_ . ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions / immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 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-a)(Sso.00s) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.005) 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: 5:5001nsWfFom 14.d. Inspector's Signature: Print: PIC's Signature: / �`�'1� n Print: Page of ages Violations Related to Foodborne Illness e ' Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION . FOOD PROTECTION MANAGEMENT_ S Cross-contamination 1 590.003(A) Assignment of Responsibility' 3-302-t1(A)0) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.l 1 Person in char e-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other` 2 590.003(C) Responsibility of the person in charge to - Contamination from the Environment require reporting by food employees:rod 3-302.11(A) Food Protection* a plicants* 3-302.15 Washing Fruits and Ve etab1es 590-003(F) Responsibility Of A Faxl Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Thensils* Charge- Contamination from the Consumer 590.,003(G) Re cortin b 'Person in Charge* 3-306.14(A)(B) Returned Food and Reservicc of Food* 3 590.003(D) Exclusionsand 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 1 Food and Water From Regulated Sources } Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11 Manual Warewashing-Hot Water 3-201.1.2 Foci in a Hermetically Sealed Container* Sanitization Tem reratures* 3-201.13 ,Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 Drinking Water h-om an Approved System' 4-601-11(A) Equipment Food.Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* r s 4-602.11 Cleaning Frequency of Equipment Food- SI0.006(B) Water Meets Standards in CMR 22Contact Surfaces and Utensils* Shellfish and Fish From an Approved oved Sourccee 4-70111 Frequency of Sanitization of Utensils and 3-20114 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Anns* 3-20218 Shellstock Identification Present* 2-301-12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201-17 Game Animals* 1..1 Good Hygienic Practices g Receiving/Condition 2401.11 Eatin ,Drinking or Using Tobacco* 3-202.11 PHFs Received atProper Temperatures* 2A01,12 Discharges From the Eyes„Nose and 3-20215 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated * 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification Maintained" nt Elo'ees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conventently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers acid Capacities* 590.004(!) Labeling of Ingredients' 5-204.1.1 Location and Placement* '7 Conformance with Approved Procedures 5-205.ll Accessibiht .O aeration and Mttintenance lHACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processin Metlxxls* Devices - 3-502.12 Reduced oxygen packahg-criteria* 6-301.11 HandwashmE Cleanser,Availabilit 8-103.12 Conformance with Approved Procedures* b-301.12 Hand Drng Provision *Denotes critical iter in tine federal 1999 Food Code of 105 CNIR 590.000. CITY OF SALEM // / BOARD OF HEALTH Establishment Name: G U�S�P✓ ,ii, T// Date: 3�> I Z Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY T Discussion With Person in Charge: Y- Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / /, ❑ Voluntary Disposal ❑ Other: .-1I� � y 3-50114(C) PHFe Recei ved at Temperatures i Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4l°F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Coolin*Methods for PRFs Food -------------- - -di 19 PHF Hot and Cold Holding lq Food or Color Additives 3-501.16(B) Cold PBGs Maintained at or below 3-202.12 Additives* 590.004(F) 41'/45°F°` 3-30114 Protection £rout Unapproved Additives'( 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140'F 7-101.(1 ldentdt ling Information-Original 3-501.16(A) Roasts Held at or above 1.30°F.'* Containers" 20 Time as a Public Health Control 7-102.11 Cornmon Name-�Vorking Containers" 7-201.11 Se aralion-Stora¢e* 3-50119 Time as a Public Health Controls 7-20111 Restriction-Presence and Use* 590-004(H) Variance Reguirement 7-202.12 Conditionsoi'Usc" 7-203.1.1 Toxic Containors-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204-12 Chemicals for Washin,Praluee.Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvin-Agents,Criteiia` Bevei nes with Warning Libels* 7-205.1.1 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized E1-gsa. 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1.1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 7-206.1.2 Rodent Batt Stations* 3-801.11(C) Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitornw, CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Fatds That are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- I55"'.F to Sec. Pathogens' Fr „A ^ooi h"-s-Immediate Service 145"FI 5sec+ 3-302.13 1 Pasteurized Fggs Substitute for Raw Shell 3a01.11(02) Comminuted Fish,Meats&Game Eggs* Animals- 155'F 15 sec. ,3-401.11(B)(1)(2) Pork and Beef Roast-130'F121 unit 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 sea * catering, mobile fax{, temporary and 3-401.11(A)(3) Poultry,Wild Game.Shifted PHFs, residential kitchen operations should be Stuffing Conteiniug Fish,Meat, debited ander the appropriate sections Poultr-or Ratites-165°F^15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145�F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foals C(K)ked in a practices,should be debited under#29- Microwave 165°F" Special Requirements. 3-401.11.(A)(1)(b) All Other PFIFs--145'F 15 sec. * p Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(D) PFIFs 165'F 15 sec.a° (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not reline to the Tirne" foodborne illness interventions and risk fiactors listed above, can be 3-403,11(C) Commercially Processed RTE Food- found in the follotming sections r f rhe Food Code and 105 CMR 14W17, 590.000. 3-40311(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590-000 Roasts'` 23. Management and Personnel FC-2 .003 I ig Proper Cooling of PHFs '�24_ _Food and Food Protection _ FC--3 .004 25. Equipment and Utensils __FC 4 005 3-501.14(A) Cooling Conked PHFs from 140'F to � ------and Waste -- - -- 26. Water, Plumbin FC-5 .006 I 70'F Within 2 Hams and Front 70"F 27. Physical Facility FC-6 .007 7 to 4J,'F/45°F Within 4 Hours. * 28- Poisonous or Toxic Materials FC-7 .003 3-501.14(B) 1 ooli ngPH I Madecnc Ina 4'Fent 3 24 0------ al Re Otherquirements _ ----`_-- ,009 -i Within 4 Hours*` "Ilenotes Critic:(itern in the lateral 1999 Food Code or 105 Ck9R 594000. V THE COMMONWEALTH OF MASSACHUSETTS CITY�OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name ,+ Date Tvoe of Operation(sl I=of Inspection D Z , S �f/L / L Food Service 9<outine AddressRisk 'B' Retail d Re-inspection ,aT Z(Z Level in/) ElResidential Kitchen Previous Inspection Telephone 7L �( / )P) ❑ Mobile Date: Owner ' / ` HACCP Y/N ❑ Temporary ❑ Pre-operation _ ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint [IHACCP O Inspector _ Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) [14. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements L-17. Conformance with Approved Procedures/HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing El❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) 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: P 'nt: / PIC's Signature:///r -{� / n R �� Print: PageLot_Pages it r?-crew,..- 1. A FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FRO Iu} CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from - 1`1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2, 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 1,3, 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces>.4'. Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-30!.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* ` 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* ``12` Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM /- BOARD OF HEALTH Establishment Name: T Date• G Page: of Item- Code c-critical Hem DESCRIP( ION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item. Verified PLEASE PRINT CLEARLY a Discussion With Person in Charge: Corrective Action Required: Li 'No ❑ Yes 9 - 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. <f ❑ Voluntary Disposal ❑ Other: • n 3-501.14(C) PHFs-iteceived at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cowled to Factors(Items 1-22) (Cont) 4I'F145'F Within 4 Hoare. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below= 202.12 Additives'" 590.004(F) 41'(45°Fr :302.14 Protection frorrt tlnatiLoved_Additive," 15 Poisonous or Toxic Substances 3-SO1.I6(�A) [lot PHFs Maintained at or above t40°F, 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. s Containers 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.1.1 $e.aration-Storaee^` - 3-501.19 Time as a Public FIealth Control's 7-20211 ,Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers-kP'ohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers. Criteria-Chemicals* POPULATIONS(HSP} 7-204.1.2 Chemicals for Y✓aghin g Produce. Criteria' 21 3-80L l I(A) Unpasteurized Pre-packaged.Juices and 7-204.14 Drying A-eats. Criteria" Bevel tees with Warningg Labels, 7-205.11 Incidental Food Contact,Lubricants" 3-801,11(B) Use of Pasteurized Eggs* 7-206,11 Restricted Use Pesticides,Criteria* 3-801.1.1(D) Raw or Partially Cooked Animal Food mid Raw Seed Starts Not Served '* 7-206.1.2 Rodent Bait Stations" 3-801.11(C) Unopened Food Package Nut Re-served.?' 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY _TIMEITEMPE_RATU_RE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooidng Temperatures for Animal caul. That are Raw, Undercooked or L PHFs Not Otherwise Processed toEliminate 3-001.11X(1)(2) Eggs- 155°F 75 Sec. Pathogens. 1s- Immediate Service. 145'F75sec* 3-302.13 Pastcwt ed Fags Substitute f'or Raw Shell 3-401.11(A)(2) Comroimtted Kish,Meats&Game Em:s* Animals- 155`F 15 sec. ': SPECIAL REQUIREMENTS 3-001.11(B)(1)(3) Pork and Beef Roast-130'F 121 min's 3-401.11(,A)(2) Ratites, Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering,mobile food, temporary and 3-401.11(A)(3) Poultrv,Wild Game.Stuffed PHFs, residential kitchen operations should be Sfuffmg Contafiing Fish,Meat, debited under the appropriate sections Poultry or Pntit'es-165'F 15 sec. * above if related to foodborne illness 3-401.11('0(3) Whole-muscle,Intact Beef Steals interventions and risk factor. Other 145-F x= 590.009 violations relating to good retail 3-401.12 Raw Animal Fcxtils Cooked in a practices should be debited under#29- 'Microwave 165°F, Special Requirements. 3-401.11(X)(1)(6) All Other PHFs--145°F15sec. '= 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(X)&(D) P1IFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minute Standing Critical acrd non-critical violations, which do not relate to the Tune* foodborne illness interventions and risk factor 4 listed above, can.he 3-403.11(C) Coiaunercially Processed RTE Food- fonmd in the following soetiomqf the Food Code and 105 CD4R 140°F' 590.000. 3 403.1.1(E) Remaining Unslieed Portions of Beef Item Good Retail Practices FC 590-000 Roasts` _2_3.___1 Management and Personnel FC-2 .003 1S Proper Coolingof PHFs 24. Food and Food Protection FO-3 .004 r25 Equipment and Utensils ___FC 4 ,005 3-501.14(X) Cooling Cooked PHFs from 140`F to 26 Water Plumbin and Waste FC 5006 006 70'F Within 2 Hours and From 70'F 27. Physical FacilityFC-6 .007 to 41 01-745'F Within 4 flours, x 228. Poisonous or Toxic Materials FC-7 .008 p 3-501.14(B) Coding PHFs Made From Ambient 30 Spheral Re unements .009 Temperature Ingredients to 41'FJ45°F -.-.---- --...--.- Within 4 Hours* s+•�ao�oi,a:..-.z a� Denotes criccaI iter)in the federal 1999 Foix!Code or 105 CNIR 590.000, rtrol F+ F sg.., �`tSi ..• �� V�' ¢1�, � 4d3; �} °��,, ,R +��Y vvb� r� S , � 3'a:�R� �3`� ri�t "r_s�SSv��'J :x,{a� -n � 't +'ar4_kaRi, � i 1 ,, .�- z!,, Y. r" sa�'� '$h �;' 3 .r I ir^,r�` f 3, R4*' A •�R" ^SF„tr r"`�w' v;• mM1r•t v r+h ^r ,r,� "'ar' :� v ,o-{ ` • ' 1. _J_. va i .':. " a .mss*^zy, '� tier ry3t *�vi�H rro x"H4r%w,g �J�T� N „�,-a{ ,, '� , `4 x .t(f x.A � ,±d' �: B c` P s.. Y+b't,✓;1�x� n,y;< p�, d}�'. !�,,, ''.}x� �,.�`�,,�; A S � ';�,n �M 1 �z,, r�r,�+��i area. T f• °'� �wg'I � ��#� �x a �� r��P�B � .'Grov: )M� y�� ;is %* � , d .,- ,�R, f"R ak. :°z� t ta,' o-^ %' r $ ^.;: � & xy r + rw 11 u t.� ,.>1 * s a: e 6k ; d;�J2 rt"h A5 Y fn rrkr fair rvr, R T E ` kA •�. 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Off _p"�dgb '"a'�Wtrr�.�"r x'. 1.4 , x n ur7i e4 "z,. °''kt'M"„ *~ � .rW S y °„ ... _ 1 `u ;S' y;,yrc G*wk�,,{ ,�+YiJyk,�:Ifv s ” . .r .�^ u•x,” 4, o a W n .Z X :� X4 z ,"H N d m u „ pmt r ; x + % rwed' •x M1 r Jct V' x '8%g t1` zk r d r Vre ,i+. v^ Y + rrYF•� r Y a m ' r .F '� ;d° rRY xr Ir'$'4 h^ Y m Lpr ztE,3t. kFu Yob yT axe,{ nn°Fi:�+ 3 �'b` r r4iH,+w"s *S�l e $ br r z °` .d+� 4v3 ;,�aa^ : u '.++ >'6�N .3na`d;Rh«.«,e��lC CITY OF SALEM, MASSACHUSETTS P, Ith BOARD OF HEALTI'I 120 WASHINGTON STREET,4' FLOOR KINIBERLEY DRISCOLL 'TEL.(978)741-1800 FAx(978)745-0343 LARRY RANIDIN,RS/REI4S,CHO,CP-FS MAYOR lmmdin@salem.com HEAL Tq AGENT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: �Q 2) Establishment Address: 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: � q-is l5 5) Applicant Name&Title: bipiAJt C 6) Applicant Address: I �- 7 Applicant Telephone No: 1SVIM�300�i/n�,24 Hour �Emergenc�Y No:- j-5Pjo S")MS ( Email:LS4e(-S fy 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 cork T \ n m rvidual 1�1q't l W� 1 reAsvter, cleflL a I A partnership Other legal entityl C, W01 616r4 54VM MA-0/4--+0MA-0/4--+04 � 12) Person Directly Res onsiblle For Daily Operations Owner, Person in Charge, Supervisor, Manager,etc.) Name&Title: O`P g e C ouuer Address: rC S� �� Telephone No: 4{ ,S v '� Fax: Email: WVJJ (��tQa t Emergency Telephone No: Q S 3Qj Y�K��I/tt 1 lel( , 1g4e� 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: Date: Amount: Food Establishment Information 14) Water Source: ` 15) Sewage Disposal: 7 DEP Public Water Supply No: (if applicable) I �I kc 16) Days and Hours of Operation: I'AM /�M lily S 17) No.of Food Employees: (� t V �� 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): XYes No 20) Location: 22) Establishment Type(check all that apply) (check one) ❑F3etail( Sq.Ft) ❑Caterer Permanent Structure fdFood Service-(�f3-1(0& 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) ...................................................... .............ANT........... .......... ......................... RETAtL STORE RESTAUR Annual✓ ❑Less than 1000sq.ft. $70 ❑Less than 25 seats $140 Seasonal/Dates: ❑1000-10,OOOsq.ft. $280 ❑Residential Kitchens $140 ❑More than 10,OOOsq.ft. $420 ;115-99 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 ❑ALL NON-PROFIT` $25 *Including, church kitchens, state funded childcare&private club 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no time/temperature controls required) (check all that apply): RTE-read to-eat foods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to OrderHot PHF Cooked and Cooled or Hot Held / Pre-packaged Non-PHFs i/ for More Than a Single Meat Service I/ 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 V/ 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 ojAealth 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 o r applicable law. ave been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food C /1 24) Signature of Applicant: m Pursuant to MGL Ch. 62C, sec.49A, I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required requiredd under law. Q 25) Social Security Number or Federal ID: (7 0 V ��J l 26) Signature of Individual or Corporate Name: _.W�a e2 1 �Vw� I_-`Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 Clty/ToWn of (X t Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Dat Type ofOperation(s) Type of Inspection bobnS ' Food Service ❑ Routine .Address Risk Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection P ❑ Mobile D te: Owner HACCP YIN ❑ Temporary Pre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) Time ❑ Bed&Breakfast ElGeneral Complaint In: ❑ HACCP Inspector [3 1 Out: Permit No. ❑.Other Each violation checked requir4j an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance wlth: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) ❑ Items) Tobacco 590.009(F) ❑ Violations marked may pose an imminent health hazard and require immediate Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOD;PROTECTION MANAGEMENT._. _ - [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties r EMPLOYEE HEALTH E] 13 Handwash Facilities tPROTECTION'FROM'CHEMICALS _ ❑ 2. Reporting of Diseases by Food Employee and PIC - - ❑ 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded _- - _._._ .y..,.__- e-_ --1 ❑ 15.Toxic Chemicals FOOD:F.ROMAPPROVED SOURCE_ _ __ _�...._._�.-_ - -- ---- - -. -- --F1 4.4. Food and Water from Approved Source JIM EREMPERATURE:CONTROLS(P.otentlalp HkAi dous Foods) _1 ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy.of Ingredient Statements ❑ 1.7.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling -'" - 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION . _ - � , - � 9 ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing eREOUIREMENTS FOR,HIGHLY4US.CEPTIBLE=POPULATIONSf(H.SP).' j El 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good 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. 590.000/federal Food Code.This report,when signed below C N 23. Management and Personnel (FC-2x590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3x590.004) order of the Board of HealthFailure to correct violations 25. Equipment and Utensils (Fc-4x590.005) cited this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FCS)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.008) 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-INSPECTIO S: 3eavc // Inspector's Signature: Print: rh- "/f PICsSignature: - V Print:Ag-f/4- 'i PageLofo�Pages _f{ Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assn ment of Responsibility* 3-302.1 l(A)(t) Raw Animal Foals Separated from Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge" Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 - FoodContactwith Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report'To The Person In Contamination from the Consumer Chun e* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* DispositMnofAdulteratedorContam!Hated Food 590.003(E) Removal of Exclusions and:Restn'etions 3-?Ol_11 Discarding or Reconditieming Gnsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4501.1,11 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Seated Container* Sanitization Temperatures* 3-201.33 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* - Sanitization Temperatures* 3-202.14 Eggs and iMilk Products.Pasteurimd* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Potable Drinking Water* concentration and hardness.* 5-101.11 Drinkin Water fiom an A roved S stem* 4-601..11(A) Equipment Food Contact Surfaces and 390.006(A) Bottled Drinking Watery` Utensils Clean* 4-602.11 Cleanin Frequency of Equipment ment Fond 590.006(B) Water Masts Standards in CMR 22.0" Contact Surfaces and Utensils* Shellfish and Fish From an Approved Some - r 4-702.11. Frequency of Sanitization of Utensils and M - 3-201.14 Fish and Recreationally Caught oliusean Shellfish" Food Contact Surfaces of E ui ment* 4703..11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from vSSP L steel Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild A�fushrooms.Approved by Raculatory Authority 2.301..1 I. Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present' 2-301.12 Cleaning Procedure* 590.004(C) N ild Mush wms* 2-301.14 When to Wash* 3-201.17 1 Game Animals* 11 - Good Hygienic Practices I; Receiving/Condition 2-401.11 Eatin ,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges.From the Eyes,Nose and 3-202.15 Package Integrity' Mouth* Fool Safe and Unadulterated * 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 -Shellstock Identification* 590.004(E) Preventing Contamination.from 3-203.1.2 Shellstock Identification Maintained" Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruaiou* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(!) Labeling of Ingredients' 5-204.11 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. S cialized Processing Methods* - Devices 3-502x2 Reduced oxygen packaging,criteria" 6-301.11 Llandwashin Cleanser,Availability 8-103.!2 Conformance with Approved Procedures* 6301.1.2 Hand Drying:Provision *Dentes critical item iathe federal 1999 Ford Code or 10i CMR 590.0(10. CITY OF SALEM ^�,�' , C( _ BOARD OF HEALTH Establishment Name:--� �1;1Y Date: Page: of 91 Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PRINT CLEARLY -nQf 7h lC O r _t o a6 i A( a 1 fl a6 aaq Discussion With Person in Charge: Corrective Action Required: a No ❑ 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 O 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 1 Y S a j 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to ` Factors{Hems 1-22) (Cont.) 41'Fi45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolie Methods for PHFs g4 Food or Color Additives 19 PHF Hot and Card Holding 3-50116(B) Cold F1117i Maintained at or below 3-202.12 -rAdditives* 590,004(F) 410145'F* 3-302.14 Protection from Unapproved Additives* 3-50L16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140T. * 7-101,11 Identifying Information-Original 3,501.16(A) Roasts Held at or above 1300F. S Containers* 7-102.11. Common Nam-Working Containers* 20 Time as a Public Health Control 7--201.t.1 Separation-Stora e* 3-501.19 Time as;f Public Health Control* I 7-202.11 Restriction-Presence and Use* 590.004(H) Variance R uiremant 5 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204,11 Satudzers.Criteria-Chemicals* POPULATIONS HSP P 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pse-packaged luiees and i. 7-204.14 eels.Criteria* .Beveraees with Warning labels* a 3-801.11lB) Use of Pasteurized Eggs* ( 7-205.11 Incidental Food Contact,Lubricants* 3-801..1 I(D} Raw or Partially Costed Animal Food and iS 7-206.11 -Restricted Use Pesticides,Criteria* Rao Seed S its Not Served- 7-206.12 erved7-206.12 Rodent Bait Stations° 3-801.11 C Un ned Fvod Pac Not Re-served. 7-206.13 Tracking Powders, Pest Control and ) Monitoring* CONSUMER ADVISORY TIMEti EMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Fixxls That are Raw,Undercooked or PHFs Na Otherwise Processed to Eliminate v Tens.*srrxe s inamr 3401.11M I)(2) Eggs- I55`F 15 Sec. PaU H as-Immediate Service 145°F15sec+ 3302.13 Pasteurized Ems Substitute for Raw Shell _ E I 3.401.11(A)(2) Comminuted Fish.Meats&Game - Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 3.401.11(13)(1)(2) Pork and Beef Roast-130-F 121 torn* 590.009(A)-(D) Violations of Section-540.009{A}-@)in 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 sec.* catering,,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness ry 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145T* 590.009 violations relating to goad retail . 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165OF* Special Requirements. 3401:11(A)(1)(b) All Other PHFs-145'F 15 sea 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403:11(,4)&(1)) PHFs 1657 15 sec. * (Items 23-30) 3-403.11(B) Microwave I65`F 2 Minute Standing Critical,mid non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed ATE Food- found in the following sections.of the Food Code and 105 CMR 1400P 590.0010. 3403.11(E) Remaining Unsliced Portions of Beef item 1Good Retail Practices FC 590.000 i t Roasts* 23. 1 Management and Personnel FC-2 .003_) h18 Proper Cooling of PHFs . Food and Food Protection FC-3 .004 24 1 25, l Equipment and utensils _ FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 126, 1 Water.Plumbing and Waste FC-5 A06 70'F Within 2 Hours and From 70*F 27. Physical Facility i FC-8 .007 to 41'F/45'F Within 4 Hours.° 28. Pasonous or Toxic Materials FC=7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Spatia R uirements .009 Temperature Ingredients to 41'F145'F 30.__ i Other �- Within 4 Hours* s:sseroma.ara c: 'Denotes critical item in the f-deral 1999 Food Cade a 105 CMR 590.000, Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 / Tel. (978)741-1800 Fax (978)745-0343 City/Town of �If'w- Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name D e Ty a of Operation(s) Type of Inspection Ia Food Service ❑Routine Address Risk U Retail V Re-inspection Level ❑ Residential Kitchen Previous Insp lion Telephone El Mobile Date: /�)CJ Owner HACCP Y/N ❑ Temporary Pre-oper ❑ Caterer Suspect Illness Person-in-Charge(PIC) Time ❑ Bed&Breakfast El General HACCP Complaint 1ALIn: Inspector Out: Permit No. ❑.Other Each violation checked requires an a lanation 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 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) ,FOOp;PROTECTION MANAGEMENT--_ _ _„__ -__ _ __ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 'ENIPLOYEE HEALTH - - ' ❑ 13. Handwash Facilities _ PROTECTION FROM`CHEMICALS!__--_-� w. _ _ _ ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM�APPROVED SOURCE. ❑ 4. Food and Water from Approved Source_ -....._ _ __ _ . '.TIM&FAPERATURE.CONTROL_S(P.otaMfallYHazardousFoods)- ❑ 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 El 9. Food Contact Surfaces Cleaning and Sanitizing .REQUIREMENTS FOR-HIGHLYSUSCEPTIBLE.POPULATIONS((HSP):,3 ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices 'CONSUMERADVISORY ,_ __ . __ _� AEl22. 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): LJ of Health. Noncritical (N)violations must be corrected Official Order forConection: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 106 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-2X590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-sXsso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4X590.o05) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) 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 b.I.dac Inspector's Signa Print: Z PICS Signature: Print: �yG / - Page�-/ of-gPages Violations Related to Foodborne illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION g Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 I 590.1103(A) Assignment of Responsibility* Cooked and RTE Foods* 590,003(B) Demonstration o£Knowledge Contamination from Raw Ingredients 2-103,11 Person to charge duties 3-302A I(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibiiity of.the person in charge to 3_302.11(A) Food Protection* require reporting by food employees and 3-302.15 Washing Fruits.rod Vegetables applicants* 3-304.11. Food Contact with Equipment and 590.003(F) Responsibility Of A Fund Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3-306.14(A)(B" Returned Food and ReserviceofFood* 590,003(G) Re t n b Person in Charee* Dispassion of Adulterated or Contaminated 131 590.Q03(D) Exclusions and Restrictions* Food 590.003{E} Removal of Exclusions and Restrictions 3-701.1 1 Discarding or Reconditivafig Unsafe Fot-,d* FOOD FROM APPROVED SOURCE 4 Food and Water From Regulated Sourced _ 9 Food Contact Surfaces - 590.004(A-B} Cc•m butie with Foa3.l,aw* 4-501.111. Manual Warewashing-Hot Water _- Sanitization Temperatures?' 3 201,12 Food in a Hermeticall°Scaled Container* 4.501.112 Mechanical Warewashing-Rot Water 3-201.13 Fluid.M.ilk and Milk Products* Sanitization Temperatures* 3202.13 Shell E- s* 4-501.11.4 Chemical Sanitization-to H, 3-202,t4 E sand Milk Pnducts.Pattenriud" "P Vdatar* concentration and hardness. j 3-202.16 Ice Made From Prxable Ddn�cane 4-601.11(A) Equipment Food Contact Surfaces and 5-101.1 t Drinkin Water from an A roved System* - Utensils Clean* 590,006(A) Bottled Drinking Water" _ 4-602.11 Cleaning Frequency of Equipment Food 59Q.006(B) Water Meets Standards in;41.0 CMR 22.0* Contact Surfaces and Utensils*. Shellfish and Fish From an Approved Source 4-702.1 L Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Mailuscaa Food Contact Surfaces of Equipment* - Shellfish* 4-903.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSF Listed Chemical* Sources* 10 T Proper,Adequate Handwashing Game and Wrrd Vbshmoms.approved by 2-301 1 1 Clean Condition-Hands and Antis* Requiatoty Authedty f3-202. 2.1$ Shellctcxk Identification Present* 2-301.1'2 Cleaning Procedure* C) Wild Mushrooms* 2-301.14 When to Wash* .17 Game Animals* 11 Good Hygienic Practices Receivingtcondition 2401.11 Eatin ,Drinkinor Usin Tobacco* .11 PHFs Received at Pro er Ten atures* ''401.12 Discharges From the Eyes,Nose and Mouth* 15 Packa¢e-lute it'* 3-301.12 Preventin Contamination When Tastin * i.11 Foal Safe and Unadulterated* 13 Prevention of Contamination from Harris MoflngredlenW ords:ShelWock 3-20118k Identification* 590.004(E) Preventing Contamination from Em to s* 3-203.12k Identification Maintained'k 14 Handwash Facilities ords;Fish Products Convenienny Located andAccessrble :s02.11Destruction* 5-203.11 Numbers and Ca acities* 3-402.12 . Creation and Retention* 5.204.11 Location and Placement* 590AQ4(1) of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Acceseibilit , tiara and Maintenance lHACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* ... 6301 11 Handwashin Cleanser„Availabilit 3-502.12 Reduced ox men acka ppm criteria* - b-301.12 Hand DryingProvision 8-103.12 Conformance with Aoproved Procedures* v LYenwes ei3tical item[n.the fedec-a1 14991"�xi Elate ar tt25 CMR 5,9q.gtit3, CITY OF SALEM r ^ BOARD OF HEALTH Establishment Name: l�J Date: � 14Page:_ of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date•. No. Reference R-Red Item Verified PLEASE.PRINT CLEARLY i t t b I IsV1 AM Scut 1� [your scussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ave read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ olations before the next ins ection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension mply with all IT of the Mass/Federal Food Code. I understand that ncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo u Emergency Closure food permit. ❑ Voluntary Disposal ❑ Other. `[4 i 3-i01.14(C) PHFs Received at Temperatures ` t Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(itetne 1-22) (Cont.) 41°F/45°F Within 4 Hours. ' PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs ' 14 Food or Color Additives 19 - Col lilt and Card fined at 3-202.12 Additives* � 3-501.4(F) Cold PHFs Maintained at or below 3-302.14 Protection from Una roved Additives* 590Ab4(F) 410145°F* - 3-50L16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1 40GR 7-101.11 Identifying Information-Original 3.501.16(A) Roasts Held at or above 130'F. i Containers* 7-102.11. Common Name-Workiu Containers* Time as a Public Health Control 3-501:19 Time as a Public Health Control* 7-201.11 Separation-Storage* 7-202.11 .Restriction-PresenceandUse* 590.004H) Variance Requirement 1 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanidzers.Criteria-Chemicals* POPULATIONS HSP 7-204.1.2 Chemicals for Washi Produ Criteria* 21 3-801.11(A) Unpaeteutiraci Pre-packaged Iuices.and t n A ats.Criteria* Beverages with Warning labels* 7-204.14 3-801,11(B) Use of Pasteurized Eggs* 7-245.11 Incidental Food Contact,Lubricants* 11 3-801-II(D) Raw or Partially Codted Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* fly 7-2C)6.I2 Rodent Bair Stat ons° Rea Seed Sprouts Not Served 3-801.11(r-) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and a Monitoring' CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of f TIMEtTEMPERATURE CONTROLS Animal Foods That are Raw.Undercooked or + M Proper Cooking Temperatures for PHFs Not Othetwise-Proc�essedtoEliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. PathogPathogens"o. *gft' ,. 11 Eggs-Immediate Service 145°Fl5see- 3-302.13. 1 Pasteurized Eggs Substitute for Raw Shell E 3-401.11(A)(2) Comminuted Fish.Meats&Game Animals-155°F 15 see. 3-401,11(B)(1)(2) Pork and Beef Roast- 130°F'121 min* SPECIAL REQUIREMENTS 340IA l(A)(2) Ratites,Injected Meats-155gF 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering,mobile fcwd,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 y Poultry or Ratites-165'F 15 sec. * above if related to foodborne 'illness 3-401..11(0)(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 Fowls Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements, 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Hoiding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403:11(A)&(D) PI1Fs 165OF 15 sec. ' (Itettts 23-30) 3-403.11(B) Microwave I65=F 2 Minute Standing Critical,mid non-critical violations,which do not relate to the Tithe* foodborne illness interventions and risk factors listed above,can be f 3-403.11(C) Commercially Processed RTE Food- found in the following sections-of the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portion=s of Beef item I Good Retat7 Practices FC 59D.Wo i I Roasts* 23__ 1 Manatiament and Personnel FC-2 .003 ! 24..-� Foal and Food Protection FC-3 .004 j Ig Proper Coaling of PHFs 25. Equipment and Utensils FC-4 .005 1 • 3-50L14(A) Cooling Cooked PRFs from t40°Fto Water.Plumbing and Waste i FC-5 '006 70°F Within 2 Hours and From 70'F 27. Physical FacliftyFC-8 W7 to 41°F/45'F Within 4 Hours. * 128. Poisonous or Toxic Materials ! FC=7 .008 3-501.14(8) Looting PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredicnts to 41°F/45°F i Other Wit1uR 4 HraRs* SsnCfnm�rti-'<C: "D:nores cnfica:hent in the federal 1999 FwJ Cate of 105 CiMR 590.000. t