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LUCIANA PIZZERIA - ESTABLISHMENTS Lvt,ir4+4'�s X17.7 i� u { lrl tl u 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 Citi /Town of Address: FOOD ESTA ISHMENT INSPECTION REPORT Tel. Name a at Type of peration(s) Typr,,ef Inspection Gl - d Service Woutine Address Risk Retail ❑Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection P Mobile Date: ❑ ate Temporary Pre-operation Owner ❑ P N ❑ P V-PAVAHACCP YIN ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) Tim El Bed&Breakfast [I General Complaint In;� g,1 ElHACCP Inspector " Permit No. ❑.Other Out: Each violation checked requires an pla ation 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 To590.009(F) ❑ Allergen Awareness 590.009(G) ❑t�/ 'n corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT' _ _ ❑,�1.2. Prevention of Contamination from Hands F-11. PIC Assigned/Knowledgeable/Duties a,r13. Handwash Facilities - EMPLOYEE HEALTH - - .. '_ _ -� •PROTECTIONFROM'CHEMICALS _ ❑ 2. Reporting of Diseases by Food Employee and PIC -E] 14.Approved Food or Color Additives ~- r E] 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD'FROM APPROVED SOURCE e ❑ 4. Food and Water from Approved Source TIMEREMPERAT.Ultt COkTROES.Ooteritlally kuatdous F..ggoo) _ ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy.of Ingredient Statements [117,Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling .PROTECTION FROM CONTAMINATION El19. Hot and Cold Holding El 8. Separation/Segregation/Protection ❑20.Time as a Public Health Cont rol �� _ _ _ _ 019. Food Contact Surfaces Cleaning and Sanitizing REOl11REMENTB FOR HIGHLYSUSCEPTIBLE-POPULATIONS'.(HpP)'.l ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMERADVISORY. ❑22. Posting of Consumer Advisories Y 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 inspecti n 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-2X580.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-aX59o.o05) cited in this report may result in suspension or revocation of 25.Water, Plumbing and Waste (FC-5x590.005) the food establishment permit and cessation of food 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 daysrof receipt of this Qrder. 30. Other e DATEOFRE-INSPECTION: S suauc `I O r nspector's 'g afore: Pri PICS Signa Print: X41 Page of Pages w Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination 1 590.003(A) Assi ment of Responsibility* 3-302.11(A)(0 Raw Animal Foods 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 3-302.1.1(A) Food Protection* require reporting by food employees and 3.302.15 WashinE 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 Repon'Co The Person In Contamination from the Consumer Char 3-306.14(A)(.B Returned Food and Reservice f Food* * ) u Foal 590.003E Reporting b Person in Charge* Disposition of Adulterated or Contaminated - 31 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrict ons 3-701 A 1, Discarding or Reconditioning Unsafe _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* 4-5111.111 Manual Warewashing-Hot Water 3-201.12 Foci in a Henueticall y Sealed Container* Sanitization Temperatures* _ 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* - 3-202.14 Eggs mid Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101..11 Drinking Water from an Approved System* 4-601.11(A) Equipment Fad Contact Surfaces and Utensils Clean* 590.006(3) mottled Drinking Water* , 4-602.11 Cleaning Frequency of Equipment Food 590.006(B) Water Meets StaFish From in ppr CMR 22re Contact Surfaces and Utensils* Shellfish and Fish Fron an Approved Soui�e 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught MoHu=,can - _ Food Contact Surfaces of Equipment' Shellfish" 4-703.11 Methods of Sanitization-Hot Water and - 3-201.15 Molluscan Shellfish from NSSF l istad Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authority Game and uMushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* - 3-202.13 Sheilstoc lc identification Present* 2301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 7301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Praotices 5 ReceivingrCondition 2-401.11. Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Tem eramres* 2401.12 Discharges:From the Eyes,Nose and 3-202.15 Package line.rit * Mouth* _ 3-10i.1f Food Safe and Unaduleerated* 3-301.12 Preventin Contattunation When Tasting* 6 Tags/Records:Shelistock 12 Prevention of Contamination from:Hands 3-202.18 -Shellstock identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock.Identification Maintained* Employees* _ - Tags/Records:Fish Products 13 Handwash Facilities - 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3.402.1^_ Rcoorda,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(!) 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 Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced bx en acka in&criteria* 6-301.11 Handwashing Cleanser,.Availabdit 8-103.!2 Conformance with Approved Procedurc.0 - 6-301.12 Hand DrLingProvision 'Derai s critical item inthe federal t999 Foixi Code ur 105 CMR 590.00), Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4a' Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Citi /Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Nameate Type o Operation(s) TYppof Inspection -a -) ood Service [y'Routine Address M /l. Risk El Retail ❑ Re-inspection lX � Level ❑ Residential Kitchen Previous Inspection Telephone n J� ❑ Mobile Date: x HACCP YIN [I Temporary [IPre-operationOwner VN e-YA J V)kI ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) --Time 11 Bed 8 Breakfast El General Complaint Inspector (gyp Out Permit No. ❑Other Each violation checked requires anxpla ation 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) ❑ Viq Tobacco 590.009(F) Violations marked may ❑G y pose an imminent health hazard and require immediate Allergen Awareness 590.009(G) ❑ .y corrective action as determined by the Board of Health. U,} FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties3. 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 !. _ 4 [115.Toxic Chemicals FOOD;FROM APPROVED SOURCE E] 4. Food and Water from Approved_Source TIMEITEMPERATURE.CONTROLS(Potontfatty Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures $ ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating < ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling .PROTECTION FROM CONTAMINATION ❑ 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-$USCEPTIaLE=POPULATIONS':(H-SP)! ❑ 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMERADVISORY... _ .' E:122. 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 P 9 23. Management and Personnel (FC-2X590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (Fc-3Xsso.o0a) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4X590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-5X660.006) 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. �Other DATE OF RE-INSPECTION: ( l G_ s: n /O LlV� ( \ .vt.� !,_ Inspector's SiOature: V Pri> (, N � 'C t,�.v i PIC&99111¢ure: Print: rr/e ^\ .�R/ Jd� 7i (/� Page_of Pages r ' Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination 3-302.1.-](A)(]) Raw Animal F 1 590.003(A) Assig went of Responsibility* - Dods Separated from 590.003(B) Demonstratiou of Knowled e* Conked and RTE Foods* 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 I Washing Fruits and Vegetables applicants* 1-3(AA I Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charze* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions 3-^,01.11 Discarding or Reconditioning Unsafe _FOOD FROM APPROVED SOURCE Food* 14 1 Food and Water From.Ragutated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Fa)d law* 4-501..1.11. Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Seated Container* Sanitization Temperatures*' 3201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eons* Sanitization Temperatures* - 3-202.14 em ratures*- 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 Drinkin Wnater from an Approved S tem" 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water' Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source Contact Surfaces and Utensils« 4-702.17. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreational iv Caaght Molluscan Food Conrad Surfaces of Equipment* Shell ish* _ 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shel'Jfish from NSSP Listed Chem cal* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Authority 2-301.11 Clean Condition-Hands and Arms* Re Mato 3-202.18 ShellstockIdentification Present" 2^301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* y 2-301.14 When to Wash* ni 3-201.17 Game Amals*` 11 Good Hygienic Practices 5 ReceivingtCondition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Tem ratures* 2-401.12 Discharges.From the Eyes,Nose and 3-202.1.5 Package tette grit.*. Mouth` 3-I0i.11 F,�od_Safz and Unadulterated* 3-301.12 Preventina Contamination When Tasting* 6 Taus/Rerords:Shelistoek 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained*' - Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Dcsrrurinn* - Conveniently Located and Accessible 3-402.12 Records.Creation and Retention*` 5-203.11 Numbers and Capacities* 590.004(f) Labeling of Ingredients' 5-204.1.1 Location and Placement* F7 Conformance with Approved Procedures 5-205.11 Accessibilit .Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processing Methods* Devices 3-502.1.2 Reduced ox gen acka 'ng,criteria* 6-30L11 Handwashing Cleanser,.Availabilit 8-103.t2 Conformance with A. roved Procedures* b-301..L2 Hand Drying-Provision 17enotes critical acro in.the Weral 1999 Pail Code or 105 CMR 590.000, �, • i I I �� I/ r i� � I � - r r . . - !► . .tea `, i. , • � .- • • - i� • • • • . • • • R-Red Item "Roorp W. M NO 11-1 ME rArt-m RE 1 MHMSHAA rl L� rf:Gl�liflfi]f��MINOR• Im, ri • . .r ��.�.:i.. ��s . .•�. J •. d ... �ii.�.. �..�• I .n• a �i • � �r _.. � � E t Y t 3-501.1.4(C) PHFs Received at Temperatures Violations Related to Fdodborne Illness interventions and Risk - According to Law Cooled to Factors(ttemsY-22) (Cant.) 41°F145°F Within 4 Hours. r PROTECTION FROM CHEMICALS 3-501..15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF!tat and Cold Holding l 3,202.12 Additives*' 3-501.16(B) Cold PHF*s Maintained at or below l 3-302.14 Protection from Un moved Additives* 3-50L16( 41 (45°F 1 15 Poisonous or Toxic Substances 3-501.16(A} Hot PHFs Maintained at or above 140 ° 7-101.11 Identifying Information-Original Roasts Containers' - 33-501.16(A) Roassts Held at or above 130 F. 7-102.11. Common Name-WorkingContainers* 24 Time as a Public Heath Control 7-201.11 Separation-Sto * 3-501.19 Time asa:Public Health Coatrot* 7-202.11 ,Restriction-Presence and Use* 590.004H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204,11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 1 7-244.1.2 Chemicals for 4Vashht Produce,Criteria* 27 3-4341.11(A} BeverUnpasages wit Warning ad Juices and 7-204.14 Agents.Criteria* :Use of s with lamino labels* 3-$41.11(B) Use of Pastemizeci Eggs* 7-245.11 Incidental Food Contact,Lubricants* 3-801.11(0) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Raw Seed Sprouts Not Served 7-206.12 - Rodent Bait Stations* 3-$01.11C Unopened Food Par Not Ra-served. 7-206.13 Tracking Powders, Pest Control and Manitctin * 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 Pathogens,*rrexevs onrmai 'r 3 401.11A(I)(2) Eggs- 155°F 15 See. i E gs-Immediate Service 1450F15se& 3-302.13. Pasteurized Eggs Substitute for Raw Shell ? 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Aaitnals-155°F 15 sea. * SPECIAL REQUIREMENTS 3 401.11(B)(iM2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section.594.009(A)-(I3)in 3-401.11(A)(2) Ratite,Injected Meats-155°F 15 � �� * catering,.mobile Food,temporary and iresidential kitchen operations should be 1 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, 1 Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 see. * above if related to foodborne illness 3-401.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. (Rher 145°F* 590.049 violations relating to good retail l 31!01.12 Raw Animal Fonds 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 Not Holding WOLA77ONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165T 15 sec. * (Items 23-30) 3-103.11(B) Microwave--165`F 2 Minute Standing Criticai,mrd 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 RTE Food- faund in the following sections-of the Food Code and 105 CMR 140"F* 590.0010. ,t 3-403.11(E) RzmainingUnsiicedPortions ofBeef item I Good RetailPracBces .FC 650.CV0 t Roasts* 23__ MnagnmentandPersonnel '-FC-2 .003 18 Proper Cooling of PHFs 24. I Food and Foci Protection FC-3 .004 i 125. E ui ment and Utensils _ _1 FC-4 .005 3-501A,I(A)4(A) Coating Cooked PHFs from 140°F to ! 25, Water.Plumbing and Waste F FC-5 .006 70`F Within 2 Hours and From 70T 27. Ph s sal Facility FC-8 407 1 to 41°F145'F Within 4 Hours.* 128. Poisonous or Toxic Materials FC=7 .008 3-501.14(13) Cooling PHFs Made From Ambient 29. S ectal Requirements .009 f Temperature Ingredients to 41°Fl456F 1 i--- cI Within 4 Hours* `"°r' r 'Denotes critical iwm.in the federal 1999 Food Cade uiSUS CMR 590.090. r S CITY OF SALEM BOARD OF HEALTH Establishment Name S Date: '\ Pager of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Vete No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1 Discussion With Person in Charge: Corrective Action Required: ❑ No es I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction i Exclusion violations before the next inspection, to observe a �ll conditions as described, and to / P Re-inspec ion Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal F d Code. I understand that t —4—I noncompliance may result in daily fines oft ty-f' Ilars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other. 1 3-301,14(C) PHR Received at Temperatures - Violations Related to Foodborne Illness interoentlons and Risk According to law Cooled to Factors(Items;1-92) (Cant.) 41TF/45°F Within Horns, PROTECTION FROM CHEMICALS 3-501,15 Cooling Methods for PHFs 14 Footl or Cntor AddK ver 19 PHF Hot and Cold Holding 3-50L W(B) Cold PHFs Maintained at or below 3-20112 l Additives*' 590.004(F) 4101450 F* 3-302.14 Protection from Una roved additives" 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101,11 Idemifyinginformation-Original 140°F * 3-501.16tA) Time as at of aboveF. Containers* r 7-102.11. Common Name-WorkingContainers* 2® Time as a Public Health C oT of 3-501.19 Time as a Public Health Cnnioat rat* 7?01.11 Separation-Storage* 590.004(H) Variance Requirement 7-202.11 Restriction-Presence and Use* 7-202.12 Conditions of Use* 7-20311 Toxic Containers-Prohibitions* RE6IUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPHSP 7-204.12 Chemicals for Wishing Produce,,Criteria' 21 3-f301.17((A)A) U Unppaa steurized Pre-packaged]rices and .BemaLes with Warning labels* . 7-204.74 eats,Criteria 3-801,11(B) Use of Pasteurized Eggs` r 7-205.11 Incidental Food Contact,Lubricants* 3-801..11(D) Raw or Partially Cooked Amaral Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served, * 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Foci Package Not Re-served, i 7-206.13 Tracking Powders, Pest Control and Monitonn * CONSUMER ADVISORY i TIMEIPEMPERATURE CONTROLS 22 3-60111 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate, PRFs 3-401JlA(l)(2) Eggs- 155°F 15 Sec. pybo egs,* E -immediate Service 145°F15sec* 3-30113. 1 Pasteurized Eggs Substitute for Raw Shell r 3-401.11(A)(2) Comminuted Fish.Meats&Game E Animals-155°F IS sec. " SPECIAL REQUIREMENTS 1-401.11(b)(1)(2) Pok and Beef Roast- 130°F 121 min* 1 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 54C}.t 9(A)-(D)in sec.* catering,.mobile food,temporary and 31101,1 f(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec, * above if related to foodborne 'illness 3-901.11(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- 4 Microwave 165F* Special Requirements. 3-401 A I(A)(1)(b) All Other PHFs-145'F 15 sec, j 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403A I(A)&(D) PHFs 165-F 15 sec. * (Items 23-30) 3-403.11(B) Microwave 165°F 2 Minute Standing Critical,and non-critical violations,which do not relate to the !} Timc* foodborne illness interventions and risk factors listed above, can be 3403.H(C) Commercially Processed,ATE Food- found in the fallowing sections of the Food Code and 105 CN.R 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef t' Item Good Retail Practices .FC 1.690.0001 Roasts* 23.1 Management and Personnel FC-2 .003 18 Proper Cooling of PHFs . E 24. 1 Food and Food Protection FC-3 .004 25ui ment and Utensils I FC-4 .005 i 1 3-50L]4(A) Cooling Conked PRFs from 140`F to 26, Water,Plumbinq and waste FC-5 7008 { 70`F Within 2 Hours and From 70°F 27. Physical Facility i FC-6 .007 to 41`F/45°F Within 4 Hours.* 28. Pdsonous br Toxic Mated& ' FC-7 .008 3-501.14(B) Cooling PHFs Made Froin Ambient 29. Special R uiremems .009 t Temperature ingredic-nus to 41°F/45aF L30. i Other 1 Within 4 Hours* s:syorm w�s.x c: t ^Denotes critical iwal in the federal i 999 Foul Cale a 105 CMR 590.000. t 'r CITY OF SALEM ! BOARD OF HEALTH Establishment Name: t��CI�kVYv 5 Date: (-a � 5 I r� Page: , Of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN CiF CORRECTION Com` No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1 ClCari �'ic rtl�Yl 6� �� !a(�I•I D ��l ur)nlc i1� �)UX-1 Lk-` e C3� 1WC.O: 'i C j Discussion With Person in Charge: Corrective Action Required: ❑ No o 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 J�- l ,�-� ❑ Voluntary Disposal ❑ Other: I I 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45°F Within 4 Haus. PROTECTION FROM CHEMICALS3-501..15 Cooling Methods for PHF5 14 Food or Color Additives 19 PHF Not and Cold Holding 3-20_2.12 Additives*' 3-50116(B) Cold PIiFs Maintained at or below 3-302_14 -- _-e.....,..n f 590.004(M 4101450 F Protection from Unapproved Additives" 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original 14p°F. 3.507.16(A) Roasts Heid at or above 130°F. Containers* 20 Time as a Public Health Control 7-102.11. Common Name-WorkingContainers* * 3-501:14 - Time as a Public Health Control* 7-201.1i Separation-Stora 7-202.41 .Restriction-Presence and Use* - 590.004(H) VarianceR airement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Tonic Containers-Prohibitions* POPULATIONS HSP 7-204.71 Santrizers.Criteria-Chemicals' 7-204.12 Chemicals for Lirash%n Predair,Criteria* 21 3-801.1](A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* Beverages with Warnin*Labels* 7-205.11 Incidental Foal Contact,Lubricants* 3-801.1I(B) Use of Pasteuriml$ °s* - 7-206.11 Restricted Use Pesticides;Criteria* 3-80]..11@} Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Rodent:Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitixm * CONSUMER ADVISORY - TIMEPFEf RPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of lb Proper Cooking Temperatures for Animal Foals That are Raw,UndEliminate PHFs Not Otherwise-Processed to Eliminate 3-401.IIA(l)(2) Eggs- 155`F 15 Sec. pathogens.' Segs-imtnediate Service 145°F15sec* 3-302.13. Pasteurized Eggs Substitute for Raw She11 3-401.11(A)(2) - Comminuted Fish.Meats&Game E * Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(B)(I)(2) Park and Beef Roast- 130'F 421 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'1715 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,lona Beef Steaks interventions and risk factors. Other 145OF r` 590.009 violations relating to good retail 3-401.12 Raw Animal Foals Cooked in a practices should be debited tinder#29- Microwave 165°F* Special Requirements. 3-40LI I(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 31103.5I(B) Microwave 165`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3401.11(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 Unsticed Portions of Beef i-Item , Good Retail Practices FC 1 590.000 i Roasts* `L23. _ I Man ement and Personnel FC-2 I .003 - .I 1S PCling of PHF$ T 24._ Food and Food Protection FC-3 .004 25� Equipment and Utensils _. FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to ! 26, Water.Piumbi and Waste FC-5 .006 70°F Within 2 Hours and From 70`F 27. Ph gicat Faci 1 FC-6 .007 to 41°F/450F Within 4 Hours. * L28. ' Pasanous ar Toxic Materials FC-? .008 3-501.74(6) Cooling PHFs Made From Ambient 29. Special R uirements .003 Temperature Ingredients to 41'F/45°F 30. j Otfier 1 Within 4 Hours* "Den«tes ctiticat nein in the federal 1999 FavJ Cale or 105 CMR 590.000. Commonwealth of Massachusetts City of Salem f n Board of Health Kitnber!4 Driscoll ` f 120 Washington Street,4th Floor IMyOr I itj SALEM,MA 01970 it ' Fofi&Retail`Establishment Permit 5 i r yY •n} l- p DATE PRINTED: 12/11/2012%t. x , 1 i a �1 tt E ESTABLISIIMENT NAME: .. Luciana-s Pizzeria File Number:BHF-2005-000006 400 Highland Avenue s . a - Salemt MA 01970"' , O LOCATED AT --,0400 HIGHLAND AVENUE a Y .c SALEM, MA 01970 �= , Permit Type Permit No.. Permit Issued Permit Expires f Fee Restrictions/Notes. '1 FOOD SERVICE BHP-2013-0119 a Jan 1,2013 ' Dec 31,2013 $140.00 " ESTABLISHMENT ' °.. ,r v Total Fees: s $140.00", b w ` 4 na _ els ` F[ } x9 r C P _ A.3 .i• t. . Y i 4 L r y PERMIT EXPIRES. December 31 2013; z ' - . Board of Health This Permit is not transferable and must be reissued upon change.of ownership or location The permit must be posted in a prominent location in the Establishment: a • _ Y In accordance with the Slate Sanitary Code;beofre any revonallons,improvements,or equipment changes are"made, F all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 pM1 ad.y awasr.«.. FRjDH, : KEVINCLRNCY PH0HE NCI. 15752823116 Dec. 08 20112 10:03RM P2 CE'VE®r,,,�, O SALF I ' 012 MASSACHUSETTS 1 D 2 rrwucxeau>i DEC Cil Y OF SALEM 13CIAuu(W I Ili.AIIIII BOARD OF HEAL11141�� "l ura(,n Irl S'ner:cr,4'111 Pl c)OR I,[;l.. 978 - 978 745-0343 •,- ;• it1Mi3I�,R1.T�.YURItiC,<>LT., ( )7411800 FAX ( ) T.ARILYRAi�II)IN,ItS/Iil(IIt,CIIU, .I( I5 114AY'Olt Lrundin V i lcm com Mr,wri I AGISN'I* Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: e-- 14/P� /s /��sT. }.'/dA�✓T [� V r ZZ 4 c 2) Establishment Address: y�D 91611-t,44,;6 ,411F 11L- /le 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: Sl S) Applicant Name& Title: �(L NNc�Tf� ,44P-77,1 Nr] 14, '—A , 6) Applicant Address: 7) Applicant Telephone No: 7ffs 7732 24 Hour Emergency No:97S—�77;,ZEmail: 8) Owner Name& Title(if different from applicant): lYf4f<44P 4,C,4Ue,4NAPe45zC 9) owner Address(if different from applicant):�jgp [QUiQN�7�M L.Q/cC9S` plf #20( 13r7V�✓loNcrVc-e( rL ELO 42jb 10) Establishment Owned by: 11) If a corporation or partnership, give name,title and home address of officers or partner. An association Name Title Home Address Acorporation ✓ / 6-466 6,-.2&L`Aft. An individual ( f/tD S4✓�?NW A partnership Other legal entity d S v i4�0 ✓P R-0e4jc,,.Vt�44172$ 12 Persion.21rectly Res onslble For Daily Operations(Owner, Person In Charge, Supervisor, Manager, etc.) Name&..Title: C I- N i/'ro ,� 114,612 Address: Telephone No: 77,32 Fax: yT Email: Emergency Telephone No: f�7732- o-Jf 4! 7 733 0. 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Checktljo�a - Date: .. Amount: 41 i FROM KEVINCLANCY PHONE NO. : 19782823116 Dec. 08 2012 10:041;M P3 Food Establishment Information 14) Water Source: 15) Sewage Disposal, . DEP Public Water Supply No: (if applicable) 16) Days and Hours of Operation: 17) No. of Food Employees: r1 11l) 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): iP'Fes No 20) Location: 22) Establishment Type(check ail that apply) (check one) ❑ Retail( Sq, Ft) 0 Caterer Permanent Structure v @'Food Service-( 2-Y Seats) 0 Frozen Dessert Manufacturer Mobile 0 Food Service-Takeout 0 Residential Kitchen for Retail Sale 0 Food Service-institution ❑ Residential Kitchen(or Sed and ( Meals/Day) Breakfast Home 0 Food Delivery 13 Residential Kitchen for Bed and 21) Length Of Permit: .......I........ ........................................... - ........ ----- ........ (check one) RETAIL STORE RESTAURANT Annual ✓ 0 Less than 1000sq.ft. $ 70 :ETA than 25 seats $140 Seasonal/Dates: O 1000-10,004sq.ft. $280 0 Residential Kitchens $140 0 More than 10,000sq.ft, $420 1125-99 seats $280 13 More than-99-seats -$420 Temporary/Datesfrlme: - - - ❑Bed&BreakfastlChiKdcare Services tNursin -{-lorn ---------------- ---------------------- ......***----1­1----------I------- - -,------------------------------------------------------ -------- --- ------_..,----............ ADDITIONAL PERM#TS 11 MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATiON $25 0 TOBACCO VENDOR $135 0 ALL NON-PROFIT $25 Includln% church kitchens, state funded childcare&private clubs 23) Food Operations: Definitions: PHF-potentially hazardous food(trmelfemperature controls required) Non-PHFs-non-potentially hazardous food(no Bmaltemperatura controls required) check all that a RTE-ready-to-eat foods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order J Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility De#Ivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of CommerciallyCustomer Self-Service Use of Process Requiring A Variance Processed Foods for andlor HACCP Plan(including bare hand Service Within 4 hours ✓ contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares FoodtSing#e Mea s for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF In Bulk Quantities -� To be comnleted h,� the Hoard_ 4 Hoalth Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment Is due with application k,the undersigned,attest to the accuracy of the information provided in this application and i affirm that the food establishment operation will comply with 105 CMR 590,000 and all other•applicable law. 1 have been instructed by the Board of Health on how to obtain copies of 105 CMR $90.000 and the Federal Food Code. 24) Signature of Applicant: IrY/Liat � lr Pursuant to MGL Ch. 62C, sec,49A, I certify under the penalties of perjury that 1,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Securlty Number or Federal ID: Y, {frj Jr j f f /J 26) Signature of Individual or Corporate Name: o Mil s lzlllie l - F f xe LUCIANA'S 400 Highland Ave. #16 Salem, MA 01970 December 7, 2012 Board of Health 120 Washington St, 4`h fl Salem MA 01970-3545 Re: Luciana's Restaurant & Pizza, Inc. 400 Highland Ave. #16 Salem, MA 01970 Dear Sir or Madam: I am enclosing: • Food Establishment Permit Application • Food Establishment Information • Check for$140.00 Please process. If the amount is different, or if you have any questions, please contact us. -- I Kenna h Santiano, Mgr. Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/07/2011 ESTABLISHMENT NAME: Luciana's Pizzeria File Number:BHF-2005-000006 400 Highland Avenue Salem MA 01970 LOCATED AT: 0400 HIGHLAND AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0366 Mar 7,2011 Dec 31,2011 ESTABLISHMENT Total Fees: PERMIT EXPIRES IDecember 31, 2011 Board of Health l This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r CITY OF SALEM, MASSACHUSETTS • * BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOI.L FAx(978) 745-0343 MAYOR DGREENBAUM&ALEM.COLI DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FORP MIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT G..-UG 1 c n� S ! ( Z Z P rl c, TEL# ADDRESS OF ESTABLISHMENT f(uU �� ��ca�X �� e 'l�D FAX# MAILING ADDRESS(if different) ? A EMAIL-Business': Website: OWNER'SNAME rr US 's // S c yLO /__ ADDRESS /,I bvhS tJt,*1-! :21," STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) CERTIFICATE#(S) (Required In an establishment where potentially hazardous food Is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OFOPERATION I Mond T Wed Thu F Satu Sun HOURS OF OPERATION Please write In time of day. !) �C) (.!k�.ti A^ F•� �"'� 1 Forex 11an•ll t + j r -j IV 1 r -` TYPE OF ESTABLISHMENT FEE teheck only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.fL =$420 _.-... _..................... .... ... ... .. RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$ 25-99 seats =$280 more than 99 seats =$420 ---------------- --------- .- ---- -------- ----------------- -•-------- ---...._-...-..---------**----,.... ..-..•60" HI BEDIBRERKFASTi YES 0 $100 .... CHILDCARE-�SERVICE^�fNURSIN ,11 ... . --_••-„,,,,,,,,,,,,,••.,._---••.-----,•------., .-. ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES N $25 TOBACCO VENDOR YES $135 ALL NON-PROHT(such as church ktfchens) YES N $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. r=anPursuant to MGL Chapter 62C,Section 49A,1 certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax pall all state taxes required under the law. Llsign—ature Date ' �� , Social Security or Federal Identification Number ODAP2011.adm Check#&Date-,�y� C _„—�• I C�AV Eastern Ban Lam ' ` CITY OF SALEM GENERALACCOUNT-ZBA C/O TREASURER'S OFFICE Date: 04114/2011 f PO BOX 528 SALEM MA 01970.0528 Account: 9123881 Weare charging your account for items \ 1 returned unpaid as listed below. t Returned Item Notice Account Amount Description 9123881 150.00 Chargeback Item 80066105 150.00 Returned Deposited Item 9123881 280.00 Chargeback Item 9243280792 280.00 Returned Deposited Item Summary of Account Charges Number Amount Debit Total 2 430.00 Account Debt Total 2 430001 *011301798* 04/14/2011 18044604 a ry This is a LEGAL COPY of your C check. You can use h me -a ti same way you would use the M1 original check. p RETURN REASON-A JOSEP1fC COS1'At¢O 1294 NOT SUFFICIENT FUNDS ti o MOMAImuls 61 WO N p a sw.11u FO #J �j,�{ n� N E� s��� 1 � 1W.I t� :1' L M r aw ® ® ' �ra�wr'00i231.,, i34— 0�07i, 4,2- 039.ia n'00 L 2 31, 41:0 1, 14000 7 L1: 9 24 3 28079 2E "00000 28000.1 195 Market Street• Lynn, MA 01901-1508. 1-800-EASTERN 132776376) •www,easternbank.com EGF-1176 OEastern Bank CITY OF SALEM GENERALACCOUNT-ZBA — C/O TREASURER'S OFFICE Date: 04/14/2011 PO BOX 528 SALEM MA 01970-0528 Account: 9123881 We are charging your account for items returned unpaid as listed below. Returned Item Notice Account Amount Description 9123881 150.00 Chargeback Item 80066105 150.00 Returned Deposited Item 9123881 280.00 Chargeback Item 2 792 280.00 Returned Deposited Item Summary of Account Charges Number Amount Debit Total 2 430.00 Account Debit Total 2 430.00 -z3 - - v' " Mu sT `*011301p98s �. 1 , r 4 a � • 04/14/2811-� r •wr` . r "' 4"'-.i `�",,» .., : It This,saLEGALCOPYofyourx� a 1�3t � T £ e " check`'Youpnuse.itihevr -aN - r h same way you woUki use the , rlgmal CtiedC i O O; >t a z c: ' j RETURN REASON A ` .IOSEPHGCOSTANLO, p 7 -' 1234 NOT SUFFICIENT FUNDS � o • � 4 }pitwx ti `� �� � ¢ Wmuo. �" n? `, ��` n sz r � +kj/ -�rn� 1.,,gk... D.� t e . 1r + '" 'T , -..� '" �.t"''- e i=•. fir + Y ORIGI S. �� fw�5, ''' � .. t �- wo e'H ���` 'c°b 1i �'C�Gr �.. r�" �4✓'" a � a1. ��€- % 77 11'00123411' 4401140007it: 9 24 3 280 79 2 V .19 00000 28000,0 195 Market Street• Lynn, MA 01 901-1 508 • 1-800-EASTERN (327-8376) •www.easternbank.com EBF-W5 CITY OF SALEM BOARD OF HEALTH Establishment Name: 1.-.\I f,l Date:_a_ Page: / of Item Code C-Critical hem No. Reference DESCRIPTION OF VIOLATION/PLAN OF CORRECTION nate R-Red Item Verified PLEASE PRINT CLEARLY I i i i 1 Discussion With Person in Charge: Corrective Action Required: ❑ No CI 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 L3Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twen o ars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i t 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness interventions and Risk According to law Cooled to Factors(MOMS 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.)6(B) Cold PHFs Maintained at or below 590.004(F) 41'145'F* 3-302.14 Protection from Unapproved Add lives* 15 - Poisonous or Toxic Substances 3-501,16(A) Ho[PHFs Maintained at above 140°F.* 7-101.11 Identifying Information-Original. 3-501.16(A) Roasts Held at or above 1307F. * Containers* 7-102.11, Common Name-WorkingContainers* 20 Time as a Public Health Control 7-201.11 Se aration-'tora * 3-501.19 Time as a Public Health Control* 7-202.11 .Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP 7-204.11 Sanitizers.Criteria-Chemicals* * 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for WashingProduce,Criteria Beverages with Warring Labels* 7-204.14 n encs.Criteria* 3-801.11(B Use of Pasteurized Eggs* 7-205.11 Incidental Foo Contaa Lubricants* 3-801..11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* y 7-206.12 Rodent Bait Stations* 3-801.11(C) Seed Sprouts Not Served 3-801.11(C) Unored Food Package Not Re-serval. 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 3-401.1IA(1)(2) Eggs- OFF 15 See. Path° ens'* Eggs-Immediate Service 145°F15sec* 3-302.13 PEasteurized Eggs Substitute for Raw Shell 3-4Ql.ti(A)(2) Comminuted Fish.Meats&Game Animals-155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 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 sec.* catering,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Staffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. " above if related to foodborne illness 3-401,11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3101.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401i11(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above,can be 3-503.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef rte Good Retail Practices _ .FC 590.000 Roasts* - 23. Management and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Foul Protection FC-3 .004 25. E uiprneM and Utensils . FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water.Plumbing and Waste Fr'-5 .006 70'F Within 2 Hours and From 70'F 27, Physical Facility FC_-6 007 to 41°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials I FC-7 .008 3-501.14B) Cooling PHFs Made From Ambient 29. S ectal R uirements 009 Temperature Ingredients to 41°F/4.5°F 30. 1 Other Within 4 Hours* 'Nmotes critical tem in the federal 1999 Foal Cafe o, 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: J_y c ) QJ�S 7-2t 21 0, Date: � 3 - I Page: ) of 1 Rem -Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date, No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1-" Ga.^A t2uPLn L: sao Cn.P LR —ra N 1`1:%-' 761 5 'Z' rL A Discussion With Person in Charge: Corrective Action Required: o 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 ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twent - " e ollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(Rams 1-22) (Cant.) 41'F/45'F Withia 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-50L16(B) Cold PRFs Maintained at or below 590.004((' 41.°/45°F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-50116(A) Hot PHFs Maintained at or above 140°(. 7-101..11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* - Time as a Public Health Control 7-102.11. Common Name-Working Containers* 20 * 3-501.19 Time as a Public Health Central*7 X01.t 1 Separation-Stora 7-202.11 .Restriction-PresenceandUse* 590.004(H) Variance Re uirement 7-202.12 Conditions of Lise* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTSFORHIGHLYSUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for WashingProduce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Labels*, and 7-204.14 in Agents.Criteria* Use of a with Warning Labels*. 3-1f01.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria*' Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-8D1.11(C) Unopened Food Packs Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMET I EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Ani mal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(L)(2) Eggs- 155°F 15 See. PCO ns'*F e** runt Eggs-Immediate Service 145'F15,wc- 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) - Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sea * - 3-40L11(Bxl)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Rallies,Injected Meats-155°F 15 590.004(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering, mobile foot, temporary and 3401A UA)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3.401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to goad retail 3401.12 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 see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403,11(A)&(D) PRFs 165'F 15 sec.* (Items 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing Critical,acid non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above,can be 3403A I(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item I Good Retail Practices I FC 590.000 Roasts* - 23. MananementandPersonnel _ 'FC-2 _003__ 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25. Equipment and Utensils i FC-4 .005 3-501.14(A) Cooling Cooked PRFs from 140°F to 26Water Plumbing and Waste I FC-5 .006 70'F Within 2 Hours and From 70'F 27. - Physical Facility FC-6 .007 to 41°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. 1 Special Requirements .009 Temperature Ingredients to 41°F/45°F 30, I Other Within 4 Hours* s:svotoma,Y�tza: ' L\-notes critical item in the federal 1999 Food Cade or 105 CMR 590.000. IMP`^OR,TAWT MESSAGE FOR W""" d ` DATE `� TIME A.M.� P.M. M �SP�I� � CPMLp OF PHONEI,,� aa� - Lf a AREA=E NUMBER EXTENSION ❑FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL i TELEPHONED PLEASE:CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED 1 YOUR'CALL WILL FAX TO YOU MESSAGE kL d' OV S. hffJ k 0r.77 onId � VLQXd7 r-z �lX17n n�v�ww. SIGNED ONNERSAL. 48005 MAGE IN U.S.A. NOTES Award Winning Italian Pizzeria 7'LZZerLA 27 FRESH RIVER ROAD EPPING,NEW HAMPSHIRE (603) 679-9900 Dine In or Take Out r ALL OCCASION CATERING Delivery - "Fresh" Beer & Wine New England Style Seafood ."-�-We are so much more than gust Pizza: Appetizers - Salads Sandwiches - Dinners Your choices are Endless... HOURS: Sunday to Wednesday 11-9 -- Thursday to Saturday 11-1.0 APPETIZERS AND EXTRAS Fried Calamari................ .............................. *Buffalo Wings or BBQ(10)in a order..........7.95 Bowl of Soup or Chowder of the Day............3.95 Bucket of 50 Buffalo or BBQ Wings..............22.95 Potato Skins cheese,bacon&Sour cream.....5.95 *bleu cheese or ranch dip extra French Fries....................................................2.99 Fried Mozzarella Sticks....................................5.95 Chicken Fingers..................(6)_6.95.......(10)9.95 Fried Mushrooms...............................................5.95 Sweet Potato Fries............................................3.95 Buffalo Chicken Fingers......(6)7.75.....(10)10.95 Loaf of Garlic Bread.........................................1.95 Cole Slaw or Potato Salad..............................1.95 Loaf of Garlic Cheese Bread............................3.50 Pepperoni Rolls w/garlic&Mozzarella......... .95 Meatballs .........................................................3.1.5 Macaroni&Cheese Bites(8).........................4.99 Onion Rings battered and deep fried.....................3.95 Sausage ..........................................................3.15 Zucchini Sticks(15) Jalapeno Poppers(6) Breaded from the garden to your plate................._...4.99 Breaded and stuffed with cream cheese............A.99 Garlic Knots warm toasted bread with a hint of Brushetta ........................................................4,25 Olive oil and arlic 3 er order .1.25 Take them to Work or Home by the dozea................4.35 Extra Sauce or Dressings...................... ................. .50 Marmara,Ranch,Fat Free Ranch,Bleu Cheese,House,Creamy Italian,Greek,Caesar,Sweet NSour,BBQ Buffalo SALADS BURGERS AND MORE CHEF SALAD harp,turkey,American Cheese...................6.25 ANTIPASTO salami,ham,provolone.................... ............ TUNA SALAD scoop of tuna on house salad......................6.25 1/4 Ib.Cheeseburger w/fries...................4�..95— GREEK GARDEN SALAD..................................................6.25 1/4 Ib.Patty melt w/fries......... .........5.25 CAESAR SALAD.................................................................6.95 1/4 Ib.Bacon cheeseburger /fries........5.55 GRILLED CHICKEN CAESAR SALAD.............................7.95 .yam GRILLED CHICKEN GARDEN SALAD............................7.9,-S�Hot-dog w/fries......................................4.50 GRILLED STEAK CAESAR SALAD.......................-- 7.95 Toasted BLT w/fries..............................4.95 BUFFALO CHICKEN SALAD................... ............7.95 Fried Haddock Sandwich w/fries..........6.95 SCOOP OF CHICKEN SALAD OFIOUSE SALAD.........6.25 Tuna Melt..............................................6.24 GENERATION>1OUSE SALAD..1....................................4.95 TOMATO AND FRESH,MOZZARELLA SALAD Grilled Cheese w/fries...........................4.50 ,w�Over Romaine Drizzled with Olive Oil and Balsamic Vinegar............6.25 DINNER SALAD..................................................................2.55 CALZONES CHEESE ZONE ricotta,mozzarella,provolone,romano...................................................................6.95 MEATBALL ZONE meatballs,mozzarella&ricotta cheese...........................................................7.95 EGGPLANT ZONE breaded eggplant,fresh tomato sauce,ricotta&mozzarella...................................7.95 HAM ZONE ham,mozzarella,ricotta&Provolone cheese.................................................................7.95 PEPPERONI ZONE pepperoni,mozzarella&ricotta cheese............................................................7.95 SAUSAGE ZONE fresh sausage,onions,green peppers,mozzarella&ricotta cheese............................7.95 SPINACH OR BROCCOLI ZONE choose from either vegatable,sliced tomato,ricotta&mozzarella....7.95 Combination of both vegetables together in the above calZone..............................................................8.95 STEAK ZONE rib-eye steak,green peppers,onions,ricotta&Mozzarella cheese...................................8.25 BUFFALO CHICKEN ZONE buffalo chicken,ricotta&Mozzarella cheese.....................................7.95 CHICKEN PESTO ZONE pesto,onions,grilled chicken,sun-dried tomato,mozzarella,provolone..........7.95 "SUPER ZONE"sausage,pepperoni,ham,salami,onions,mushrooms,ricotta&mozzarella...................8.95 VEGETARIAN ZONE assorted veggies provolone&roman..:.......................................................8.95 STROMBOLI ham,salami,pepperoni&Mozzarella cheese.................... ... ....... .................................7.95 All Calzones are served with a 4 oz.Cup of fresh tomato sauce,Extra sauce SO each ROLL-UPS .....all roll-ups are prepared on lavish bread CHICKEN MEDITERRANEAN ROLL-UP grilled chicken,feta cheese,black olives, Lettuce,tomato,onion&pesto mayo.............................................................................................6.95 BUFFALO CHICKEN ROLL-UP buffalo chicken,lettuce,tomato whanch or bleu cheese..................6.95 TURKEY CLUB ROLL-UP turkey,bacon,lettuce,tomato&mayo..................................................6-95' VEGGIE ROLL-UP vegetarian sandwich with lettuce,carrot,tomato,onion&green peppers.•i 5.75 ROAST BEEF ROLL-UP roast beef,provolone,lettuce&tomato with horseradish`&Z ..................6.95 ITALIAN ROLL-UP salamik ham,cappicola,provolone,lettuce,-to m GRILLED CHICKEN CAESAR marinated to.Pe fo[ on...................................6.95 eeti .........................................................6.95 DRINKS of Coca-Cola products from the fountain free refills.................................1.75 i Iced Tea,Iced Coffee .............................................................................1.75 Hot Coffee(bottomless) ........................................................................1.50 20 oz.Bottles of Coca-Cola products ....................................................1.75 2 Liter Bottle of soda .............................................................................2.25 SANDWICHES *COLD PITA OR SMALL LARGE TOASTED VEGETARIAN......................................................5.25 ......................................................5.80 ITALIAN...................................................................................5.25 ......................................................6.25 HAM&CHEESE .....................................................................5.25 ......................................................6.25 PEPPERONI&CHEESE .........................................................5.25 ......................................................6.25 TUNA........................................................................................5.25 ......................................................6.25 CHICKENSALAD...................................................................6.25 ...............................................,......7.25 ;. TURKEY....................................................................................6.25 ......................................................7.25 E, HAM,TURKEY&CHEESE....................................................5.55 ......................................................6.25 BUT.............................................................................................5.25 ......................................................6.25 ROASTBEEF............................................................................5.55 ......................................................6.25 GENOA SALAMI&CHEESE..................................................5.55 ......................................................6.25 SEAFOOD SALAD(seasonal)..................................................6.25 ......................................................7.25 We will gladly toast any sub upon request *HOT SMALL LARGE SHRIMP PARMIGIANA ... ......... 6.25 ... ....... .... ... .... ... ........ .........7.55 VEAL CUTLET PARMIGIANA. . ... -1-.77-6.25 ....... ... ... .... .�.yop .. ... .........7.25 '. CHICKEN PARMIGIANA ... s! 6.05 .. .... .. ... .... I t . .....6.80 EGGPLANT PARMIGIANA } 5.80.......... 6.55 MEATBALL PARMIGIANA'av,... .3 5 80 ... .. ... .�..+. 6.55 SAUSAGE-PARMIGIAN A 'r 5 80 '�' "'�'°.. 6.55 ,�STEA'�IC&CHEESE.. ". . .. .}5 25 � �--� 6©5. STEAK&ONION/W/CFE SEs!... q. . ...� 5.�y � 6.55- STEAK&PEPPER/W/CMSE. F ...�.. 5�:... �..: �«-S .... ..6. 5 STEAK,MUSHROOCHEES ., ^ ... .. 5 55 � .sem' .... ...6.55 STEAK,JALAPENO&'CSM SE ...............5.25...... ... 6.55 STEAK,EGG&CHEE E .... ... 6.05 ..... ...... ................. ....7.05 PEPPER&EGG.. ..... A7.1� '� .. 5 25 t I. .........................................6.55 WESTERN. .... ... .. . py, -, 55 �� ;,.. '........................................6.25 SAUSAGE&EGG yyg'. —�T y A... 5 55�'f..'� ......6.55 SAUSAGE,PEPPER <NI'ONS " .. ... 5.55 � .. 6.55 CHEESEBURGE B 1. ., -.,ems ��.h..,t4 80 .. ....6.25 HAMBURGERS- B� .. a.`.... ....'`1E.. 5-5'x, . . ... .. . 605 SAUSAGE, ASL-+ CHE.SE...........................�^..y..l 9.80................. ... ..,. , 6.80 ITALIANH ,. ........................ .era.... .55............. ........ .... ...............6.55 Additional ice` s on s s ir'ecludEl tri�c re�are.S,Q If you do what wa p( ase-a�k � SCI �13 ............ STEA B. MB ...................... ....... ... 6 50 ...... !.. 0 Stea) rt* rooms,onions,green peppers,salarm `cheese HA BOMB ............ ......P.Ppe�!'.'.'.'..:�s...- ................. 'P"...... .:OS ....„............... Ham `uslh, o s,onions,green peppers,salami,cheese ,�1+f,1 CHI s E vTE IYAKI ...................jj ........... ......... . .25.."..6 ' �.j................... ...7.25 Chic ,Iled green peppers,onions ice_. CHI SUPREME............. .,... . 625 . ....................... .7. 5 Chic e�t Sre Iw/peppers,onions,mus hPSoom�o�teedd}w/. ozzarelIa� PIZZS ..............................1..........y,gl............5.80...!" ......1I!n.... `!..6.55 Split subk topped with tomato sauce&Ivfq�zarell cheese o +v--�� O BLT STEAK&CHEESE....... I .......................6 25....... .. rn. .,,,..6:95 Steak,cheese,bacon,lettuce,torfi to&mayoo, ZA-- t Buffalo Chicken -Grilled Peppers and Onions it homemade hot sauce,fresh tomatoes and Mozzarella....20.95 Grilled Chicken Fajita-Grilled Peppers O ns,Mouarella and Hot Peppers......................................20.95 Chicken BBQ-With Onions and Mozzarella.....................................................................................................20.95 Eggpint A With Peppers,Onions,Tomatoes,Mozzarella,and Ricotta.................................................................20.95 �Chick'en Ranch- With Bacon,Fresh Tomatoes,Mozzarella,and Ranch Dressing.............................................20.95 ChickenParmesan...............................................................................................................................................19.95 Steak Bomb- With Peppers,Onions,Mushrooms,Salami,and Mozzarella.......................................................20.95 Spinach Pie-With Mushrooms,Fresh Tomatoes,Ricotta,and Mozzarella.........................................................17.95 Meat Pie-Ground Beef and Pork,Onions with Mozzarella and Romano.............................................................19.95 Create Your Own-Your choice up to five toppings............................................................................................20.95 *Please note extra preparation time is required for all stuffed pizzas due to all that goes into them. DESSERTS HOMEMADE CANNOLI (chocolate chip)..........................2.95 ea. (3)for 7.95 ........... NEW YORK CHEESE CAKE................................................3.95 TIRAMISU.............................................................................3.95 ITALIAN TREAT ZEPPOLIS(fried dough treats) (6)for 1.50................(l2)for 2.50 FRESH HOMEMADE ITALIAN DINNERS CHICKEN PARMESAN freshly breaded chicken covered in tomato sauce&mozzarella.............................................................9.95 VEAL PARMESAN we only use freshly breaded veal covered with mozzarella...................................................................10.95 VEAL DISICILLIAN veal,eggplant&ham,layered with ricotta&mozzarella......................................................................12.95 EGGPLANT PARMESAN ' freshly breaded eggplant covered in tomato sauce&mozzarella............................................................9.95 EGGPLANT ROLATINI eggplant stuffed and rolled with ricotta cheese topped with sauce and mozzarella.................................10.95 SHRIMP PARMESAN fresh breaded shrimp covered in a tomato sauce and mozzarella...........................................................11..95 CALAMARI MARINARA fresh calamari sauteed in marinas sauce over pasta......................................................... Above dinners come with your choice of'pasta,a dinner-salad&garlic bread. PENNE ALLA ROSSINI a chicken breast,mushrooms,spices,pink cream-sauce...........................................................................10.95 FETTUCCINE ALFREDO flat egg noodles in a-sauce of romano cheese,cream&butter.................................................................9.95 add grilled chicken.......................10.95 add broccoli....................................10.50 , add shrimp(may we suggest a touch of garlic in this one!) SEAFOOD ALFREDO ' sea scallops,shrimp&haddock,lite garlic alfredo sauce......................................................................14.95 SHRIMP SCAMPI tender shrimps sauteed in butter,oil&wine served over linguini .........................................................10.95 j PENNE with BROCCOLI broccoli&penne sauteed in garlic&oil&roman cheese .....................................................................9.95 CAPPELLINI MARECHIARO shrimp sauteed in a garlic&oil with a splash of marinara....................................................................10.95 BAKED CHEESE RAVIOLI (with or without meatball)............................................895 STUFFED SHELLS four jumbo shells filled with ricotta covered with tomato sauce and mozzarella......................................8.95 SHRIMP PARMESAN fresh breaded shrimp covered in a tomato sauce and mozzarella...........................................................11.95 SPAGHETTI CARBONARA bacon&onions sauteed in butter with romano&cream.........................................................................9.95 BAKED ZITI ricottaand mozzarella..........................-...................................................................................................8.95 BAKED ZITI with MEAT SAUCE same recipe as above but with meat sauce added ....................................................................................9.95 BAKED LASAGNA with meat sauce,ricotta&topped with tomato&mozzarella.................................................................8.95 MANICOTTI pasta rolls filled with ricotta topped with tomato&mozzarella ...............................................................8.95 SPAGHETTI with tomato sauce OR garlic,oil&basil ............................................................................................:.....6.25 SPAGHETTI choice of MEATBALLS or SAUSAGE LINKS or MEAT.....................................................6.95 CHEESE TORTELLINI choice of MEATBALLS or SAUSAGE LINKS-or MEAT SAUCE ........................................................8.95 PASTA MEDLEY�r stuffed shells,manicotti and lasagna........................................................................................................9.95 SEAFOOD EXTRAVAGANZA ;'shrimp,haddock,scallops in a red or white clam sauce over linguini...................................................15.95 All above served with a dinner salad&garlic bread. GRILLED CHICKEN-(Your choice: Salad or Fries) ............................................................7.95 STEAK TIP DINNER- (Served with Fries and Salad) ..........................................................9.25 CHICKEN LAROSA breaded chicken with broccoli,tomato,and basil,topped with melted mozzarella................................10.95 CHICKEN OR VEAL MARSALA. tender cuts of veal or chicken sauteed with onions and mushrooms in marsala wine sauce topped with melted provolone served over penne..............................................10.95 "HOUSE FAVORITE" GENERATION'S ITALIAN PU PU PLATTER (for 2).............................................18.95 includes eggplant,chicken and veal parmesan,with 2 sides of pasta,garlic bread and salad NEW YORK STYLE HAND TOSSED PIZZA Our Pizza Dough&Sauces are Made Fresh Daily on the Premises No Pizza is Prepared until it is Ordered! TOPPINGS AVAILABLE Jam" A Anchovies,artichokes,bacon,black olives,broccoli,Canadian bacon,mushrooms,eggplant,extra cheese, fresh garlic,fresh green peppers,green olives,ham,jalapeno,meatball,onions,pepperoni,pepperoncini, pineapple,roasted red peppers,salami,sausage,s�tomatoe pinch,sun dried tomatoes WE ALSO OFFER GRILLED CHICKEN OR-STEAK-THE COST COUNTS AS TWO TOPPINGS Garlic butter crust.35,side of-garlic butter dipping sauce .75,side of crushed red peppers.75, _Side of Pecorino Romano ground cheese$1.00 TRADITIONAL CHEESE .............Large 16" 9.95..........Extra Large 20................. add 3.50 yeaeh extra topping(unless specified)..................2.00...................2.50 ISICILIAN 16"X16...................12.95...........Toppings 2.50 each f MINI PIZZAS.................5.95 MINI TOPPINGS............... .75 M GOURMET PIZZA SPECIALTIES Large 16" Extra Large 20" SUPERCOMBO .......................................................14.95 ..........................................add 3.50 Pepperoni,sausage,fresh green peppers,onions,mushrooms,mozzarella(no substitutes please) PPIZZA BIANCA....................................................... 10.95............................................add 3.50 Extra virgin olive oil,fresh garlic,onions,mozzarella TRADITIONAL VEGETARIAN.............................. 13.95............................................add 3.50 Mushrooms,fresh green peppers,onions,black olives,mozzarella t CALIFORNIA VEGGIE............................................14.95............................................add 3.50 Sun dried tomato,fresh garlic,broccoli,spinach,onion,roasted red peppers,mozzarella SPINOCCOLI ...........................................................13.95............................................add 3.50 Spinach,broccoli,sliced tomato,garlic butter crust,mozzarella F STEAK BOMB PIZZA..............................................15.95............................................add 3.50 Steak fresh green peppers,onions,mushrooms,salami,mozzarella BACON CHEESEBURGER PIZZA.........................13.95............................................add 3.50 Bacon,hamburger,onion,topped w/mozzarella BUFFALO CHICKEN PIZZA...................................13.95............................................add 3.50 P Buffalo Chicken&Sauce,mozzarella BBQ CHICKEN PIZZA............................................ 13.95............................................add 3.50 RGrilled Chicken,BBQ sauce,bacon,red onions,mozzarella MEATLOVERS PIZZA............................................17.95............................................add 3.50 Pepperoni,salami,ham,bacon,meatball,sausage,extra cheese fHAWAIIAN PIZZA...................................................12.95............................................add 3.50 Ham,pineapple,mozzarella EL GRECO PIZZA....................................................13.95............................................add 3.50 t Feta cheese,Romano,mozzarella,fresh garlic,black olives,pepperoncinis hRMEXICAN PIZZA.....................................................1.4.95............................................add 3.50 Taco beef,refried beans,black olives,jalapenos,onions,mozzarella WHITEPIZZA...........................................................13.95.. .........................................add 3.50 Ricotta cheese,topped with mozzarella,garlic butter crust MAY WE SUGGEST ADDING SLICED OMATO.BROCCOLI AND FRESH GARLIC FOR A DELICIOUS-UNIQUE FLAVOR TO THIS HOUSE FAVORITE add$2.75 kPIEZONEEPPIZZA(his one has tomato sauce)...................14.95............................................add 3.50 fDollops of ricotta cheese,topped with mozzarella cheese,sausage,garlic butter crust EfROMANO RANCH PIZZA.......................................14.95............................................add 3.50 (Looking for something different?This is it!) Ranch dressing,Romano cheese,fresh garlic,spinach,mushrooms,¢esh sliced tomato,mozzarella BRUSCHETTA PIZZA..............................................14.95............................................add 3.50 Fresh basil,mozzarella,garlic,sliced tomatoes PESTO PIZZA SPECIALTIES j (NO TOMATO SAUCE) CHICKEN PESTO PIZZA.........................................15.95............................................add 3.50 { Homemade pesto sauce with grilled chicken,fresh garlic,and onions topped w/mozzarella SHRIMP PESTO PIZZA............................................15.95............................................add 3.50 Homemade pesto sauce with shrimp and garlic,sliced tomato topped w/mozzarella I, TESTAROSSAPIZZA...............................................14.95............................................add 3.50 Pesto sauce,sun-dried tomato,fresh garlic,ricotta cheese,roman&mozzarella 20"SIZE AVAILABLE FOR ONLY$3.50 ADDITIONAL LOW FAT SPECIALTY PIZZA 16" Fresh tomatoes,tomato sauce,green peppers,mushrooms,onions,and broccoli on this cheeseless treat.........13.95 CHICKEN BROCCOLI ALFREDO Says it all..........................................................................13.95 GRILLED CHICKEN ALFREDO With fresh tomato and roasted peppers...................................13.95 ROASTED PIZZA Roasted Pepper,spinach,fresh tomatoes,mozzarella,and seasoned with our Garlic Sauce..........................13.95 MARGARITA PIZZA Fresh tomatoes,fresh basil,fresh mozzarella and brushed with garlic sauce..............................................13.95 SHRIMP SCAMPI fresh shrimp,w/garlic oil and spices ..............................................................13.95 i FRIED & BAKED SEAFOOD FRIEDCLAM ROLL .......................................................................... .........................10.95 FRIED IPS WIC ELLY CLAM DINNER ............................. ................................14.95 FRIED BELLY CL BASKET .......................................... .....................................10.95 FRIED BELLY CLAM HADDOCK COMBO D ......................................15.95 FRIED BELLY CLAMS & GALLOP COMBO DI ER......................................15.95 FRIED OR BAKED SEA SCA OP DINNER 13.95 SEASCALLOP BASKET ............................... ..............................................................9.95 FRIED OR BAKED SHRIMP D ....................................................................13.95 i SHRIMPBASKET ............................... ..... .....................................................................9.95 FRIED OR BAKED 1/2 LB HAD CK D NER....................................................12.95 FRIED OR BAKED 4 OZ.H OCK BAS T ......................................................8.95 .i FRESH LOBSTER ROLL ....................................... ..............................................9.95 SEAFOOD PLATT Includes haddock,sea scallops,shrimp&Ipswi belly clams 17.95 ULTIMATE SEAFOOD PLATTE Includes haddock,sea scallops,shrimp,belly clams&calamari 18.95 ALL THE ABOVE SERVED WITH FRENCH FRIES,SUBSTITUTE ONION RINGS .75 EXTRA COLESLAW OR POTATO-SALA&TARTAR SAUCE CHICKEN FINGERS 6 served with'french fries and cole slaw ...........................................................................8.95 CHICKEN FINGERS BASKET (4)served with french fries ..................................................................................................6.95 OUR DELICIOUS SPAGHETTI SAUCE IS AVAILABLE TO TAKE HOME pint..........3.50 quart.........5.50 KID'S MENU (12 and under please) CHEESEBURGER &FRIES ........................................................................................4.50 CHICKEN FINGERS (3) &FRIES .............................................................................5.95 GRILLED CHEESE&FRIES ......................................................................................3.95 HOTDOG&FRIES .......................................................................................................3.95 SPAGHETTI &MEATBALL ........................................................................................4.95 WE OFFER A LARGE CATERING MENU Ask to take one home! We do offer parties,family gatherings,showers,etc. All of our foods,calzone,pizza etc.are prepared to order, we hope you will allow us the time to prepare each item to perfection. Come in and check out our daily assortment of Pizza's,Stuffed Pizza's Baked Italian Specialties,Stromboli's,Calzones,and other mouth watering treats on display,all made with the finest ingredients and made fresh throughout the day. Check out our Daily Selections of Dessert_P-izza's and other Italian Treats IT IS OUR PLEASURE TSERVE YOU.THANK YOU!! Prices-on- menu subject to change.State of NH g%meals to not included. Please refrain from smoking. 15%gratuity added to parties of 6 or more. WE OFFER DELIVERY SERVICE"7 DAYS" 11 A.M.-CLOSE $10.00 minimum It is customary to tip your delivery driver;THANK YOUP CITY OF SALEM BOARD OF HEALTH Date: February 18, 2011 Name of Establishment: Lucianas Pizza Address: 400 Highland Ave Owner: Joe Costanzo Phone: 603-205-4112 The proposed owner of this proposed new establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. The floor plan and menu are approved as presented. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. A"Person in Charge" or"PIC' must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. Owner to forward a copy of the Serve Safe Certificates to the Board of Health. FLOOR PLAN A Hand Sink must be located in each food prep and service area. The hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. The 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. A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes will be used. MENU/FOOD PREP All food 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. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKED FOODS The consumer advisory must be posted on the menu. The advisory was given to the owner. ALLERGEN AWARENESS Allergen awareness information must be posted on the menu, menu boards and posted in the employee area. Information given to the owner. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. The owner must have an initial service and provide documentation of a monthly extermination contract prior to opening. 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 3rtl bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. These must be clearly marked "sanitizer". Outside area of premises, including the dumpster area must be kept clean and sanitary. TRASH Trash must be kept in appropriate trash receptacles and a grease barrel must be used to hold discarded food grease. The trash area must be kept in a clean and sanitary manner. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. Please call to schedule a change of ownership inspection. An application and check have not been received. David Greenbaum Date Acting Health Agent 6T ACostanzo Date Owner