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MANDARIN SUPER BUFFET - ESTABLISHMENTS MANDARIN SUPEk BUFFET 400 HIGHLAND AVENUE i I r a Q- l `U q y � 4 �� 1 a C M P d i I i .o _ � © 6 F . o oa. .sa .^'^c - � � r7 - may- a m � �- .-:aC =4 � o `�.�� _'-- �Z'"p � �- �- b � — � � � .. � �. ., -^ 111 �� —_ :�_ - __._ =n _ - ...r - •�-..= ��caec-- �- �. .. w..-=a o s� �cix :^r---- �=Ca =�-x- s.« --...^�-w�-- 3-+'== c�� v��c =_.. �.. ��o c s„-."•� 0 t f c 4 i o 7 a s 6 i, o � r c �:�c nq{j , E. ;4, y Massachusetts Department of :Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4t" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 NameY n Date Type of Ooeration(s) Type of Insoection -A� /T V�/o n r nil �r .; -a/I f� A F-+ �� SCS I� Food Service RRoutine Address nAp fj(J Risk ❑ Retail Oke-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneQ�uv ElMobile Date: Owner ) l) HACCP YM ❑ Temporary Pre-operation ( vnn ,�1 ( ��,��(/ I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) I Time ^ ElBed&Breakfast ❑ General Complaint n n�J lJ( t.t �`1 Z�y� In `��/ jY( q ❑ HACCP Inspector Out: I 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. _ n �/'FOOD PROTECTION MANAGEMENT �-n„.;" 12. Prevention of Contamination from Hands f---�� 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH `C PROTECTION FROM CHEMICALS ' ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives _ ❑ 3. Personnel with Infections Restricted/Excluded O [ 15.Toxic Chemicals ',FOOD FROM APPROVED SOURCE ,.1�� , � , ,- TIME/TEMPERATURE CONTROLS Potentials Hazardous ) ❑ 4.P Food and Water from Approved Source ( y Hazardous Foods ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION' . -' ` IJ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control i- 9.4Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),'-z E]21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing 11. Good Hygienic Practices CONSUMER ADVISORY e r ' ; (� 0 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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 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: ( (-(b_ i d !,- Q-1 0 C VS sloulp(�rFo�m-tPe.tlu,o /L" c � n1) �C � C,AC,(k f&.1 , Inspector's Signature: {� V Print:` ..�.b-CT•CJ-�-C�� .ltd/ Y�/1 V11"�� / rlti n PIC's Signature: Print: _ Page-L oll`�Pages v li C G l 1( � 4! ti�o4/ Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I 596.003(A) Assignment of Responsibility 3-302.11(A)0) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.1 I(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Other' 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Fond Protection- applicants* 3-302.15 Washing Fruits and Ve_etables 590.003(1;) Responsibility Of A Food Employee Or Alt 3-304.11 Food Contact with Equipment and Applicant To ReportTo The Person In Utensils* Charge* I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) ( Returned Food and Reservice of Food' 1 31 590.003(D) Exclusions and Restrictions* i I ( Disposition of Adulterated or Contaminated 1 590.003(F) Removal of Exclusions and Restrictions Food _ 3-701.1! Discarding of Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.0(14(A-B) Compliance with Food Law" 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* - J 1 3-201.13 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashine Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* ( 14-501.114 ( Chemical Sanitirttion-temp.,pH, 3-2(12.16 Ice Made From Potable Drinking Water'" concentration and hardness. 5-101.11 Drinking Water from an Approved System" ( 4-fi01.11(A) Equipment an- Contact Sm-Faces and 590,006(A) Bottled Drinking Water* Utensils Clean- 590,006(A) _ 590 006(13) Water Meets Standards in 310 CMR 22.01' 4-602.11 Cleaning Frequency of Equipment Food- _ Contact Surfaces and Utensils* 1 ShefNish and Fish From an Approved Source ( 4-7102.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 s of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemic ( Chemical* Sources* 10 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Rands and Arms* 3-202.18 Shellstock Identification Present" 23 112 Cleaning Procedure* 590.004(C) Wild Mushrooms* ( 2-301.14 j When to Wash* 3-201.17 Game Animals* t t Good Hygienic Practices S Receiving/Condition 2401.11 I Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 12-401 12 ( Discharges From the Eyes.Nose and � 3-202.15 Package Integrity" Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.i2 Preventing Contamination When Tasting"' 6 Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained' Employees` TagslRecords:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* ( Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures i 5-20.5.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-.50...1_ Reduced oxygen packaging,criteria'" 6-301.11. Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision Denotes critiud nem in the federal 1091)Foal Cale or 105 CMR 590.000. y � CITY OF SALEM r n BOARD OF HEALTH Establishment Name. D-P-1_ Date: ci - 15'— 1 Page,:_ C19N of f Item Code C-Critical Item U DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ': Date No. Reference R -Red Item, r Verified,; _ PLEASE PRINT CLEARLY \ -P.Mn(Y\'L� � � •,'- I I✓tly A )C t-1rarn ' YZ( 111X_eA ,r I\)o y)'l�,',,'�i1 t .I A,:L/'[nnrl:� — r�17/ALI 111 � '1/ .n-,/n, I�'.0.(i,._7@ ly(�Cl �Y�. C IY'l )Ai /21 i.t901' 'C 0 (N�EJl I ate' 1 Mn nilA"' 1' t�1A IIrr)PAil f I v \ t X /.c //\.11rt -1v/ nt bI:?sn /��^o 1,( 1 YJn'��t�J�`C/n.-/��i ,COQ �� — : rl.n),ln_ \ f)M^�.t7,, Y �!✓��1�I� ni�/�•/ Iv k1 t t �4P 1 - ( ��J l7Y \'l 9 YS' `) T 1./A6: ( .r,t,r 1 //. 0AI - ��..l�nn OO.0 ��tq) -k �`)'_ kJ 0x-4R ie su— �0 �/1T /V\ \IWAA j Inn A i 'Jz �XtP_ 1�i1AP 1/� It(K (/ �j� (��_l{` /,� ��}- _ � "� NU st f Q�/1/ P (f /,n rin W 17_x. �ti 1/ i n�J t z' �, F a v - �t I PAQ__t l , 1P i4l �7l V),o ,\µ` �j c•,ti,}A o{I p �� j/�� 7/.�.�,I o-�`--�_�n! --�!l;_St /� _ e _ Sd �' I )�y 0 i^t lyd�:vD :_��:,, ,K JI,V 1,1,IX NA ' NO III kn,7Yl/ ,n 10 xA,)+- UJB, Nt�A Discussion With Person in Charge: Corrective Action Required: I ❑ No ;I ; ,Yes F I have read this report, have had the opportunity to ask questions and agree to correct all IVoluntary Compliance EJEmployee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure ' your food permit. r I '! l , ❑ Voluntary Disposal ❑ Other: C, -501 W0.) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk I Au:ording to Lot+ Cooled to Factors(Items 1.22) (Cont.) 41`F/45'F Within a Hours. PROTECTION FROM CHEMICALS 3-501.15 Coling Methods for PHFS 14 PHF Hot and Cold Holding 14 I Food or Color Additives 3-501.16(6) Cold PHFs A7aoiLiined at or below -203.12 � Aticbtites" I 59Ct(t11a(FI 11`/•45`F' 3-302.14 I Protection from Unannrv'.ed Addtti+es' i 590 0,int ) 41a('HP,c Maintained at or above 1.5 ' I Poisonous or Toxic Substances 7 Ibl.l( ick:nt;fyme tnfi:rmation t)ug,n:d t 140 F. I kiosis Hrld at or.tbot'e Iip`9 ' E l om inlets` i-2 —_r_._�-__.—.�`__-� 7 102.1 1 1 t„Inmou Name -- N„rkf,a C'nu4tm rr X21! !! —_-_-.—_- Time as a Public Health Control W 1'itra•as;a Public liealrh_ Control, _ 1 ttiN:un -Pr•'�t.n,_:ru'J t,.:" - —'-- ! 7=202.12 f Cuteftunn.of Us - 7 2O3 If Toxic f'auttinzl: -Prnh:br.vt„= REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 1 Sano 7teis,Crilerw -Chctnic.,l.._ --_----- ___POPULATIONS(HSP 12 21 t-S111.I HA) Unpasteunn�d Pr&pal-,gcd lwces.,nd 7-_rte Chrau'rals fot N'a•ht>�.r P!nd,f._C.'t i±cn.i^ i 7-704 14 Dnine.Auenn.Cot.:ia'-�—_ ---- �._— Revera:tns tctt(a 4t'„rnn?e taha�' — 205 I1 h?.id.ntai !-,>,x1 t1mt:ct < Rc'. n(B) L:,e of Pa>teu6,:eJ { Z-I,njj Itkr} K.,I'-r or P;oinik Amami Fot d an ( 7.216.11 {2�.0 itteci l"s<' Pe.f;udc> Cr.rri:.: 7-2061^ -- � . < R,><k+n: B:n Ninoi"i:,- --'________.. Kau 5c od tipinut. h,;t Sova:.� f _ -___.. ___ • 1;t' I1'C; 1 i lln0:•ted F.Kaf t'x;edr,, ti.n 'Y.' t.at'{, I — i 1 :dnnitcttn�, CONSUMER ADVISORY Tt9UtElYEMPERATURE CONTROLS 2 t.O; 1. ( t or,'tnutt Ad aa.n t'i'rns,d!,IT ,tit"atr,f:,In i,.i 16 _--�- _- Proper Cooking:emperalt,tes fns— 1 I PHFs delirl' �•s-Imo, SIT:.rL; S ------- -- - -------. _ __ _-- - -- -- - :•PE`:I,RL RECaJiREtN;:,�7'y 401.11113!(1),aI r'•' t a,";i H -el k,,.a !t•;2 1!' €.}in' �7a;N'l)n -+:11.11(Altil hear ii.i.c: d ?i.it. 'atertite, n;ni't!: t:.exi. tcntt:;,ra,} aeo 1 ;: 4oLN(.Ai t, I Pnyftrt, Glt13 f1_a': °;ut,'cd i,f'ry f';nnl''w al t,:k'h,�n. oi',a,;iipP.¢..tvitid Slic 3a,tTt,�t i+4rr .ti iiO;i1 , if r a , 't' TIC i,t,:} _ '7 'PAS 'ti rT �t — - . i1 tj t'.{Ren:'.}r ti'.'t. � ; i.�:' .[�r�.J.a.rY i;"::.Atli... 1�. :.t_'4}L' .RF i`�"Ff. Pr)A¢:, :!)3.11,:1 t.'.t!S.. ( 3'i it . ,r•'.^, I, ..Z. ilftt3tri 27.311; f; ?.`.t. .:U: .- I, - _ .'a u,ptr;,i:'.'.i:❑:: ( 'u „ a1., r,. . -:.i4:4! < .J7 0';. .,i'u h:fyr :;ri ',iIt'I 4tt 1,r:`. 1I h :n.11 i-•;1,3.1 i t<', t'"n': rct:i.,iie i',c, ,'i Y b '.t i„',r;,<at: r ;:': 'it::ig '., ,:n: e tV F jrtt;!)!i+', , :403 11,Ei Fc,tt:,:r InL't':'+r::, i't<t,<,ns.,j}3;x� . herr, : '..god He.:tit Praruces _ FC ' 1,30 G-00 2a :t?anagrrn=.'nt anq Pwc 1g Proper Cooling of PHFs r"`_.- y Fa_(7 wind-Fxxt P'oterT.on .2S _i'qu�„mcnt_ono Uten,_:a ' Si!1 14,A> PH f'iwbn:'G>,d;�`d P> tr�•n. Hi%i'h• 1 :. �- . - _ -_ r_ F _ ' f S:. __ '_°:''In5?; F.,.nl Lig,il'G'"7+I2E<8 �l c(^ _ (`{•._ 7:i Y Wotan 2 i kxrr:<•,a From ; "i '• p-, ;;y„�:.,,,,f I;,,. - __ ._____-i_c_,- Cd`;' fo !1'1/-1' Pts-'rti'm t H,•,w, 1 np ' .- _„ -_ i- r d: zt•- • :.p.lD,:� Ip Jt'.^Y.k ,3if ti C:i t'{' r 3S,)I I.4(hl fbrling PHF:.Mi;lt� From ltOwnt i °— . i_F1 C.ra'?:::_,roar•<;r_.-.__ - a:, `!',ml:erttnre In�'rc,i{,:n„tI1 a°11.15 }. - - - -' --- ----`----- -- — -- . . _- . _ \l morn 4 l l'nu,, 'Irux,ir cnnCai r,,,•,ni in r .i.. : :•':b t .:•:' ;';` : ...,:•H„if CITY OF SALEM F BOARD OF HEALTH (/ Establishment Name: YX V�P'\ Oo A AAAA_ �R, , rcn I. h_, r D Date: )>—( �'�l �� Page: of d 1 ItemCale C—Crltical kem U L DESCRIPTION OF VIOLATION/PLAN OF CORRECTION " '` Date" No. Reference R-Red Item Wrlfled ..I P1 PPSE PRINT r1 EARI V - I�"11'��Y- }Y/M ' t/ _A � 0 d r /I/- 1' . 1/ P -- - - J.II _On /l",in . —AAAA an �7Q 1 I I ��tn�.t-�nM ' � r1�r/�6(n �4 _ l /xuo ;_ `t'7� DaA_ - 0_ \ 1 t_n .� I� 1 A,,rn : 1 \ P, n 12XIl IT 1 A- V. 1A, .4 64" 11rnaA. h.-� ".\ Cl, !_A, (--CO rTA�-r/A� 47) . /� 1 \fin I \ / 1` f-411 na 1,�(�) /"WU 'f _/;.A On A\ 0/10 N, I� N^ 1 b0/7 17 -A1) /nA 10-,� A ) o,, IA bl-ki ' 2121 3-501 14(0 PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to haw Cooled to Factors(Items 1-22) (Cont) 41'F/45'F Within 4 Hours PROTECTION FROM CHEMICALS ( 3-501.15 I Coolin;Method.rix PHFs 19 I PHF Hot and Cold Holding 114 j Food or Color Additives ?-203 12 3-501.16(B) Cold PHFs Maintained at or helnw - -- -Arlchtices" I 3-702,14 Protectirmfrom lJnappm.edAdditives` I 590(Nlrt(}) 41`'/45"P^'i_5r)i.loiA) Ilot PHFs Maintaiuedatorabove 15 i Poisonous or Toxic Substances ( 7 I identifying Intin"matinn - gj 14O'P. 101.11 Ouinal i � _t'I7htA) RtxtstaHeitl,at,x.tiwc'e130'!'. I ! i.ontaioere' I Time as a Public Health Control 7-102 It Countion Name - N,�rk rr�,t_,nu.tmer+' 20 j i 7-201.11 _' I'im:'a.,t Public i iealth Conur,!'Srpa,a4,m--Shn age" - - r{r'tturtll V::nanccRrentre:nen+ 17-202.1 t kc>uiPreun ctiun-- tc"old 4„r' 7-202.i2 C'nnoi uc,n.of l iso` ; 17-'03 11 Tcxic Cumameu.-Prohibi:;on ” ! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-20.4.11 Sannizet+.i'nte'ia -ihemiaPOPULATIONS(HSP)d+' - --i 7-204 12 C'brnticals for Wa^hing t'indnt ,Cuten,N I 1 7 ?Od.14 U 21 ";-it�)l,lli,lt 1'npadcunn:d Eke-pa�I:eudlutcce.md Kevera:•e,,will, lt'arnin?:lal,rls Di rin,;.4t'ctlt.Cntc.'u)' _ --T:_fi,t:_l_:ii31 ti..t' Paaru:i,:ed -7 2105"11 lncidvnia) Hod Cuniact. tnMiaal"s, i(i)i It,v, or Paitisif:.Cr,^i:rJ antmnl Ftuj aa:i ` 7-206.(1 Rcant led Vs, Pe>b.ader C';;tene' Rao Sc ru Snn w'f+ui SCrVk:'i. i 7-206.12 1 Rodrnt B.,:t\,:Hums` i,,:9.1 1 .,{ Gna.creel Fix ki Pay.k;t::r itis; R,: erne 1 _ f ._..�' CONSUMER_ ADVISORY TIME/TEMPERATURE CONTROLS22 u1; 1 i T: o:;+uetex -k::+•n: i'i,stet', I•'r Cnn:iunyltioa __.�. ._. ! ! :'u:innl f ' I y( I Proper Choking Tempel atutns.tot_-� i `td+7"ha;ere Rav', i i PHFs �q( 'l(It•t..ISP)'Tw:c'A:.\1'"�" 1 'a:hoytzn. .T. _;�..t; 155..E }rh ` .. t'� =l:.. maly ) ' `FEC9ALF?EQUt'9EMENTS'i )t' §T ,i,l , r,+mrtnt,. :nohtl; Aer,t. tei:tpoiat a:td 411t.i ii 4PouIir, W lel;i.,r*m.. Sba'.'e,i pl'L; I rc>tcicn;:.tl k.ilchcrl i I C:,:ftrtz i'•,astra*+; tichdc:d under the 1porift-:,ak: ;Lc'iUtf< n::, :"-'ra' S1'ik%'a':,i`V3..11. 'i i` ini°• 9:.. ., . 21 21 ?i'iil .n , in . . . 17 ! R::11e31;r`<4 toi i401.:i,;ar'U 4't LA7;..'fvfi t)E'it>fi?6 D i,3 testi t~'" a i-403"ilt4)o.t U) I I"id, iC1"i- 1'; ,c:. " , ilfent'; 23.30) 3 .403,11(h • hou; :nt'- i"'- 1'< `st"at. �Stan•1in, C'awa coal 111.r:-OW"!2i no:,r{:..r, ." .. _ tai:C i.n.,?IA"rtr 'i;",•, 'J'w' .ntti.ni., rdri)"i:1. ?Oi lt('t I Corm's 1.1!1% 1:'1,, ,, "_.. ,.n:.;:'r;rr j•• : ,i,.,.a 'Cr:mr:. 'r:h" 1'a)d('nttt,;a' ?':i ,' Vii 110 F T?emainmr.Ln<{rea Rk'oor<,^t is rc; ttem Gucd Retm?F:acfrces ,-F4 �30.00ru l+Hast>` 3 j_'Aanayrner,!and Per--onn:A _i_FC-_._J ..... .`0t (fS i Proper Coa;ing o4 PHFs _2'-__ _' Ftv+tf:�r d Ft><i t'ratt„:a.on -rc t - rn,4 , - _ .. ---- 2 _ _- 5" - ErIlrMIent_�nd Utenars F:,- 1 U_J,. ' S01 larAi I C'ixduu;C.a,l,rci P?li'.r nnm t :+i { ti' ' ,- - -- -- '— - ' -`- -_-. 2°. FC-5 -'- - __ __ 47a±:r,P?�� n g:utd ;Jt'•:r� _. {K':. ' I i 7,)-F Within ni 2.tiour:':!'d Fra %'! i- r r c..; .,-), -- - ---- P_C-t_ Fri? C u'itl'ni 1 u }tau,:. � 22 'xir. t.1T49rJs E'{' . 7 ^ -tXiB.. +-So 1.!4i61 (-tali k,,PIIF:"!kbde ::9, :rx:'alEv.ae,an-e!tt:'. i - r 3u O:orr - E.m}),;auite 9t�'rrc=leap is,=„„'1 i,ti"1� - " -- --- --- j Within» I lcnii'+' d•., P; ')i,,,.'i- .' li• +(.<^ .., .-_'_ CITY OF SALEM BOARD OF HEALTH Establishment Name f71tb/r A' in,t'13p / x�OA V'\ , Q 00 1 Date:� —lk —1 n Page: of Y' I Item Code C-Critical Rem u DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- j No. Reference R-Red Item PLEASE PRINT CLEARLY - � '� Verified*' - - 0 � d�n$I kt.,nn _ e✓1. n _ ��1 /�O� nv /� 1! Jo_ 'Avtc�r�r \ 0 )A1� l DA- _tO Ann n -In A � �n tf �iQJI Y'10IJn J u D . f(Q c tP.M�:X\D � O1 :i /� �� _ e 0 0 Un n :EQ r a/ P. � A A"1 ,t I.n /°,al oa-7 -^�- t � )•�� n1 PYK'n /1n (K) ,RN, nn_J X'/ � / 7�1 ]J�� n, �'//�,t.t�i-.nom/�y\!_l/1 !.J 1 kid V ` — 0 P 0 ---r�/�{/ _-A ,12 Q /�.-l:f A 0 -� 7) V)/�_ (AA y}. (�� 1�l ,t�J -.f� -\t_I�J_�.I ,_/�.�_-n_V M_ ��n.�-b1 0J I A- . 't X)-t7D AA fA r)l /11 �e �.Q� /YXA A ��_� 7/' �.'e-A�� in ,a_r_ \�e�J� '/0/� 0 .�_ tt'S, 1�,AI 1J n )I /1 /AJ P-11! --r1�� / I X e�A'�l�, n �i�/I/� - /i%I �,l, ilia �! - Nl/1/�/n n A n �/ 0,;` I liO_1A 011 �iAa WIPO J . Wit _ 2 - ' s Gl A . f`,✓r�/�.�rtt.�1;L`1/O�Lr /�CA �f-�P�/ K� Y. I ' (-_D 'A (i1 C,� \7J 'l' ? �r_ '1�( o_-�JLc.� pts �7r' - �3�C,�y,� ,('�/ir .�_1_,"U Il _ Discussion With Person in Charge: Corrective Action Required: I ❑ No yes I have read this report, have had the opportunity to ask questions and agree to correct all q/ Voluntary Compliance ❑ Employee Restriction/ V� Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension S comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure i your food permit. —.---- ❑ Voluntary Disposal 0 Other: 3.501 140(1) PHF,Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accxvding to Lau Cowled to Factors(11eMs 1-Y2) (Cont) 41`F/45"F Within 4 Hours, PROTECTION FROM CHEMICALS j {-5(11.15 Clxdin•;Mctho&for PHFs j j 14 j Food or Color Additives j j 19 PHF Hot and Gold Holding j 3 5()1.16(B) Cold PHFs Maintained at or below 3-202.12 j Addtdvei* 590 OW(F) j 3-302.14 I Protection fronn Unapproved Addirves` ( 3-501 WA) I Int I'FiFa Plainlained;u or above 1 1S Poisonous or Toxic Substances I 7 101.11 j I(Icnufying info nnution - Ort�,nal t-SPI i6(,l) Roast; Had at or above 130°P. Containers' r 'r0 I Time as a Public Health Control 7 102.11 Common tater R't,rkit. Cootmnrr ' — ---- __--- -- t atJ; !'_ t'inr ,� Pubtic)(raldtConvxri' i-ZO t.l l S�pai.0 i'n-sw;tna r" j ;!t!ict:on- Pr.'u Dec Md L.,c' II )(!.'1(1.1!}i) V^riaere,Ra,—K 11 t 7-202.11 R, 7-202.12 C'ondmon•of U.w- 7-303 11 j Toxi( Contameo, -Probibr;'iD'* REOU&REMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 j Saniti Zell,Crnernt-Ctu'miC:'W j 7-204.12 21 ( 7-1,01.1(A) Unpatteunecd t're-pac,:o:,ed Jim,"and ! Chcnuvals t;n tt'a�ht�:9.k'rutt+cc.(.Hiro:' j j 7-204.1: Ur _ -- firvet aces wit) Waraing t:rl:att'j »rr' Aueoa Cntran' ---- -� -I-=— : Paaroti,:cd}:QI r7 ZU5.11 j Lretd:nt.tl F,etf{'vn;au. [zdmeanh` S-Silt,l li lt) i�,tu or Portt.d),:cl ol,.d Aunnad BRd and i •7-206.!1 Regn'th.d t:sv Pe.n.ader. it;1v ti,cd 5{;Hari, Not Serrr•i. ' 1 76 12 R(xtew lint S':niorn- L_.__ +'!ui 13 i Pi;.r>rned_I LX"i Far[';i lc h,n Rr-:,crier). ^ ! ilmr„Iand , �- I "1 `U6 i` frdCi:n,;,1'':,t,.iC!__t_.'L-_.__--____�____._ .__.---_..__ , � _. ---'- CONSUMER ADVISOR" 7—.t — .-- TiMElrEMPERATURECONTROLS , <y,t,. 1i , !lmnannrl(i,i,oipPnst.dit,'Cou uoptiun. 116 ' roper Cooking Tempe,atu' s foo .a 1 1 min e : .(01.11A(i u,:; ( ----- ------- F r , l ?:rte.. r�.} 1: r. .1,::i �_ _ _ �1'u(4iC ._.._�.. ;. _'d_:ite Ser:'ir, 1X5'1'1. „i" • t 1 ie•'• 'i !; Sha„ . 1.,kL Si,•'il _, lou u, `t ^ 401, t(•1)(:, , . An-:tr:d-aec _S_ •E-CIAL REWREMENTS i .:Ki IAI(A1e R"oc , ii•i'o ,i t}r,ttn `5 i' i` _. ;,ii q,.,3% i hlt�`..It.�4:. 41�S:,_it:ra t ) • , ii+1Q. te! tIP;Aaly and trO.t i x _j t'tCfl{;t7 ',.'rdi:D:Y.:>tt04itl tic rE.1 i(A}+ � (nit; rt, \t:ad r::in:' Siitii: !i 4i1' i ,lie;.: dehn:;d twldc1 tl:r atmrupr'iax eeiat)us j : ,, ,ar;�. „. !it .,. ,-!•,; � . .:1�: .: ,t ,�'.t.;,t ' ,roc'+ !b ; ._U11.i.t._ ... ,., .. ., iu:'a ir, ..1.3�. � 1 •C. ., , ,:as:. '1 1, ..i(: .,, .ni.• (�'tt .. . {: t )ii'i'J i': _,, •a`,SY;i 2ti i,}2 ',i£O.•," ., i ,} .:., ._V, P l7 Pchtat�:t'ltor'ri5i1'c(,s„v b•OLl 1ONSRELA E1' Tt)GOQi RE7'Al,. r'.rA.1-•7F."t:S 1403.11(A)&,.. i'(i( . i<i, i- ?` .r:. i t€teen;_. •, t ? 403.1I(b) \1rtt"R:!ti- if•"'1'2N'i'nwe' St:uidn' L-I,i1,"'!' :Jr7nr64r'1r1,fjtL••t11hALhllir}i,11,',te1J 'liUl<': , F:tYt' > of/, r!II ,I:'F,`f+ (vhr'/t,riL J't1 •dN:>"i:t, kl(iUY:( , r'rl iii P , r„ )i,^ 3-403.1 It C.) ma: ) Comar., h tCtn:.s:d t"1 i_F+, , in:ii: _ j .;40.. 1 I'1F, Rcoiautin:� L'So :a'd 1,^( t•oS )! i.cc. -.. i>nod Retail Practices FG §JJ,Oft(t Proper Caoitn a9 PHFs 2: a I( h.,as., , t.am ` ,l,_mflgeme_ii and Perrarntr'_. rC -? 00- j l8 t.ro',tl anal Food FrOitrt:u.-- _ F{. -S G.IS _nam Utensos ` F� - 4 i)i)5 ._ _- ' j j 2c i Y;+a!r_t,P!i.r,tbtrnCy_Ind 1`/_,,r<r ! _{;-5 pt)t^ 11'�t' K51btn 2 Utwre�.ni1 From.'0'€ '' , a F _ _ _ -. - t;,.:I F lt'tl)tn» ;-1ntn• Ii '8 1 00,s.;n.,ds nr Towr. P^„tena:s FC -7 1 008 3-501.t4(I3) C`,+din P({F: Rt;tdc I'ww Arnrirnt !.•'`3--_t_�'p'%ra'Fp.'aU•rerre;,k - -- _-.- .._ Term crate to iredicm, n,-11`i AS }: 3J _ . _C,nre: - - --- -----.' - - --- -- A rib:n d ?f^vi rIUcel 1:1,� ..6;:..: '. r' i, CITY OF SALEM n / BO-ARD OF HEALTH Establishment Nam '' If `e'N\ AnI)e _ n # A a`,i a "A '.�,1 A �(0 JT" Date: Page: Gi of Item Ccde C-Critical Item ` DESCRIPTION OF VIOLATION/PLAN OF CORRECTION f Date r No. Reference R-Red Item _ Verified -- —____ - /� PLEASE PRINT-CLEARLY . ' — - +.�- A\n ��,),-6A_kV (zA VOA4 �_ A,Jf 0ZIA— bn vyf IXC)-'1+ — ` � / lqn ,n .I.oA_a � )CkMA\ Y/��nl/_inJl) 1�( (fJ Gl�/t� l C� a: cf, 0n0 x �- D hi �( , �� - AA %1 n , ' P- __ (a /�nM onn,f ,til /. LOWNL inn XU" I J Jnrf �J1� � J — J 04 J It) !3 n S� 4i) (a /'A,\- F—MnM n n n 4-te Al , S � ((vPln/ — (_f ,9nfPn ^A , , 1� 0Q-P1), —\vmrjCroAMJOA4,JO — i 1J o I f I I i i 'L I s — — tDiscuss!an 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 f inspection, to observe all conditions as described, and to Exclusion before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension 't comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or sus_.ension/revocation of ❑ Embargo ❑ Emergency Closure 1 your food permit. ❑ Voluntary Disposal ❑ Other: i - v -5u1.14(C) PHY's Rec'ivcd at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lau CooW to Factors(/left 1.22) (Cont) 31'045°F Within 4 Hours { _ PROTECTION Fi;OM CHEMICALS I 3-501 15 I Coolol Wthod,for PHFi, 19 PHF Hot and Gold Holding i 14 Food or Color Additives 3-50!.1hB} Cold PHFs Maintained at m'below f 3.202,12 - -[ AJ hfi%cs ------ - - - 1590()(9(F) 41`'/45",1" I 3-302.14 I Protection from L'naplinived Addilitec' 3.501,1b(A) i-lot ["Ilk ;Maintained at or above I 15I j Poisonous or Toxic Substances ' ( 140'F( ' 1(11.11 I Idt:ntif}'mg tnh,rmanon Original Ruaats Nt•Iti al of .thole I3Q'(�, a Time as a Public Health Control + 1(}2,1(_ ' _ -;+i L' I Pini'ak a Public I I"Ith — �20t.1i � Srpaiauun-�i�ta}�e` � --._+ � 7-202,11 ka�t:iet,on-Yr:'senu`.wdh�•.^ 7-202.12 T x icCo3, it t, - REOUiREMENTS FOR HIGHLY SUSCEPTIBLE 7 '_03 11 Toxic f'o,xameo - Prolabnion.*` 1 POPULATIONS(HSP) 7-204.11 1 Sanit,zer<,Criterir-Clivo cats' ( 7-204.72Chenucalsfor r'ka,hoi} i1•,odi: ,Ciiler?a, -'[ ( +,St)7ILAj lterteuncedP -ra�}.agedlaite�muI Betera^es n'ith Warning taLrlr I} 7 104,14 Urtin;;.Accor`.Cnrtrnr <-ri0! I:118) Itt ;I 105 11 ' S(;L I Inti ! Raw or i'',utis7P:C+Kti,.d anuna} Ftu:d s?d i F7-lt)ti.(I 1 R,:,irir±cd ['4c Pe.r,Li,j :JCutetia' i I Hoc:Stoll tips kot %k" Sct tr•l. 17-M106.1:: iR,xl:tn_Bnt S::!tion:.' -_--- ?,tit;, t'"-_ -`,',nc•d R,er: Fa,lNot k'-://yell r-`06 1° I \4(au{ounw_ CONSUMER ADVISORY _ F§'rt1E)TEMPERATURE CONTROLS 16 or,'.tonet hth wort F'n.,V.d h,r('tnrmtnption ro f----- iMEITE ----i 1 Proper Cooking Temperatures tot PfiFs __ ,.I.i h.it.'nn;e6 lsa� S.''nsv;ua• Iia Rsu'She11.. c:,•ds-,;u,r:d:.nc Ser-'F.r i +5'rli.t•, , SPECIAL REQUIREMFW,S L_—___. __ _ __ _ _ 4 _ '_. ; ct.'.r•: :q _ •,� \r101.Ei l+;±i. U; .t:,-.!i'! -�'ti'.Ea,?..v "1-`i-. { )L.11 Ai( .' ka';t, Gn�._�•i i,cta }'S }� ± . I Citit'rkti�� !ilt,itk G:;J^'I, iClliQ4dai i nttrl -1 011!(A -i_, lloolo,, 1t' r' , . i -i___.__, tcstu:'tri;:tlt,;i.henons;tion ,hvn[,11': ? � h1e ' ' flCt;tU^U' tl.,tlt'i 147. ?.itKp}yrs.t'i •�'C'i0i:7 {T , _ ! i ' n `4"f .v.v„ ,,•i:. .tiiyl+lk,"i:.:;�', ,. is ... . t 1'+. :... .li ...:::c' l±`,i .:h\♦ k.': ..li;r'al� „ .,i ria.. ,.,,`IP°<. /int`., ' . , . '111:: C:tSd!;J;. .:±'l:::h. •, '{., r : :•" aPn ( iol ! Vtil _1 "11 .. ..�"� .. v ,. tid;i::3lt�+ i {?Ft t1,i._a.7�;,. .*3 ilE i...hlt:f' TO lit. „) i^'et:'•.'i1fL lfi )tCttt52Z3i}; ? 40?,11;b; ! ',.tiav'.tavz- in'' . , tl:na.::'S�;oatu;; C;r.;. �1. -. , rr1..a! no a:.,a s. a'nrct.Jo•or, :.'4ra . I 11we i,+U:iri..rng r . 'c, . , 1„rn L, h1 rnr,l t,q fa.'i 1,v,iJ tY:. r'(,•: {' 9[i- F^,at :ft;f.', : .- .':4r, 1Y •(•::Y,u j;; 7;A•r; "Jf,v,i 1"` r 11./11 ;4ti F` -4h? ilf1:, Rcrtalmn,i L'n,nre,? P.'t C.<'tc„f der: item ucod Reral?i'raC.mes FC'- 59tiR3L 123 �'i?79at•mcr'•anc:Psn;ntnnl !Fltoleclio, _FC _ OU: ( t3 I Proper Coating of PHFs �- t�j -tx`'-tc� - - - ------ Ft. -- I s 501 I I(A) ' C\n+)ina ' .G bozo 1.91 FI,; - _C:xmrd I Nl, ' 2" _,-4:'1?`a`t_FN_:::',',anny:u,d',V i-,'c 1trFWillis 2llo ,i..,!di-P.uil "l.,( ! ,. -�,:,7=:�_a,F,t_::ip,`- - - -- -----!-FC-r�- ,- - � -- r _ _ _ _ •' { � 1• .:, :! inxlr- iv""1;r,:n 1 i-C - 7 '_c7GP 501,W(B) Crr!in_PHF: ."its+}e Fro„t vaFt os i ;S :`£•r,.:,,n 4j.,;,ire'rnrs:-,- -- -' - --,--x„- ---' I ( T,•at}:rrumre !n;:re,ii,:rt�t,•;;'3.+_ty}: ikl ltitinn4 H,w ' i,r.: .ni' k , CITY,OF SALEM t BOARD OF HEALTH l Establishment Named Date: l4-- 116 -,_QylI /) Page: of Item Code C-Critical Item V DESCRIPTION OF VIOLATION/PLAN OF CORRECTION oaten.,,. L No. Reference R-Red Item t✓(� - , Gv..�2�,r_ J(/\'\ Q,i V 1� r� � rifled PLEASE PRINT CLEARLY 0An D - Q1 h ( A) ci � Ae `� A D 40 ,., 10 C-A (gl )-} -r Al, 1Q„�tly ( 46-.LLrru •; 1 al;.YA tkn3 (d n n M , I n�r� D� ��n.k C61,JA nn,.-. Win` nn/AO.c J 01 0, (0) 6 0: V t 2 p (0 fP. n D -4) . (_1/1 n�1_1..� tiQ e-7, O)A U.n SDA D n Carr Q , �[L /�MVIA -- II'� Lt ! .. ;nl• A,\ , O/ AA .rn �tlu/. /�/ (X'\ U, N � p 1 ( U .! -k'Ch ono () n0(�- fe7.r7r (' ILiI(,'D.nV i il,,( f !;/! i �n1 .�. Yre11 �t.t �n�t � —•�(YlAnr✓� \ OM, 1� "f7X) ( n�� m n Jfl ��-w✓"" _ 1 nnn c� _1•a_r.n i1,�0, .Sir'le A\- gip nnesn,�, DD�rtJ � O �(\-Zi /J J(k-h v` ('.�,� 'V/➢qn A/U `I'(A nM t ./1 kr! Q n 3) VA C A \i' M -A S Y•f'nn/1 R/lr f-0 I Y cr IQ t7) PA Ot'erD — ' ! -ten n„ n0:� I /�\a)-n n .--, -VA P_I-D_0n1 r_�n_n nn .,C7:1- 91 -0! Ann�� lr^_IJ n_ t' nn o X_ - - ©I t-t-'A PAA'. / AAn n J, A-1 /� 1 / !r v 1N /eb4 n >'P1 cn Y N'" .I'�sO ()1 V •••wYa vA �4 limit rl/1/11 /1 YG/ .fl .Q ll-. h/�r.:n w /1-`A•"`f:^n n.. P'ln /� /-' Yn I -r A.'��\nnn \I - n �/n •-> /i D1_'/n t_ n_r9! -M e_ y(z LnS� L1n Jc,U /1 n_n �4J l"nn.V'� nn� 1 v „rn_n_nrnna fl Af. A r, f! rnA) r.nn F'�/� /'I 'P (� 1, rrn . \ _ _ - - - ' - t)� I fLo _n 9 ,41 _nn ((''� j 'T_`i vD_v�; .'1'l o` 1 /_l, /tn`\ n� �'A /t r'� �2F' i or,:i1 an O-k- C �O.R nnn Vnnn�n.b fn Oof /�Y!_.Q(%\. A o '� o.n.rn. s. y--�nP ,� n cJ! _ ion Discussic n With Person in Charge: Corrective Action Required: ❑ No I ❑ res 1, I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ It violations before the next inspection, to observe all conditions as described, and to Exclusion t P € comply with all mandates of the Mass/Federal Food Code. I understand that Li Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: r t 3-Sill 14f'Q PHFe Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lau Cooled to 1 Factors(IteMs 1-22) (Cont) 41'F/45'F Within 4 Hours. ° PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFf, 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below j 3-202.12 I Additives' I 590(N)4(F) 410/45'P` 3-302.14 Protection front L`nappm:ed Additives' j { 13-50 L I(i)i:`.) 1 lot PHFs Maintained at or ahnvc 1.5 i Poisonous or Toxic Substances I 140T. '. 101.11 Ic1;:nufym�t tnAtrmahnn -Original t_9('1 11)t•ll Roasia Hr}d at or above. I301' " ! ("ont2ietec' til 1 Time as a Public Health Control 7102.11 i C.uintunll?7na:e u„rla:nc(�ongana•f>` .___ .;_. .___.. ._._-- I rim-a>a Public Ikalth Coralnl' 7-70t.i1 is{ru.mon- 5aa'af:::- �._:__�..:_-._._._ - 7-202.11 i ficst:i+a:ov --Yrs st nri and 1 -�-- ----- iUsel j 7-202.12 Cutuhtion:of Toxic C'+r,»»in.c - 7 203 t1 Prohiht:um,+ REOUIREMENT5 FOR HIGHLY SUSCEPTIBLE � i I -1104.11 I Saniu;et,.C'riwru, -Chemicals, i POPULATIONS(NSP) ?-'.04.12 Chtnucth.f.+ �a>hn:t t'radnce.Clitcn.t' 121 '+-S'i'.I I(A) Unpa,icurtred Pr;l-pael.aged Jmcea mol i ��.�.------ 7-_20414 ' Urtit�Avinnn,.Crim ia-l-----v.--' I � I ltr>•<e!a^.e.t�'nb \\rarnin„fab.:is• U,.(4 Pa>tt'wized Ell"'," 2{!5.11 lucid:ntal h.,.�I Cont>i�t_Lubllrxn�s' : ;.SGL I itit) ! H',u. +m Yautnlh:C,u>V..•:I Alaimo! Food old 7-_206A 1 � ke,un I"d U” ('e.t,ader' clitet:a' 1 ___vG .. R.;ri. `+e-`_d- S nu, \+a Srnei 7 _06.1^ I Rollrm B,,t r_ , ' I - lI,i 111( ) ' l_Su I,x+SNo7 oa itr' -..rated I _ ''a"t ="c-_--- .— __ —_----_--- - CONS;UMERADVISORY TIMEIrEM PERATURE CONTROLS �22 3+(G II 1Con,u: icr!bt;t,n:o Po';trd Tor Cotno!np:iun of -r-- ------ --t .�t'ur. ad, that dre flaw Cnrierct+,lcd s ' 16 Propel Cookrr,g Tempe;atwes for -'-- ---"— ti0i (ttl1,r t,its.'I7,n"c` $lt'd in LIatdn.Ce i iii} 1- + t;ddurii'alt(?�' Sd}1J1.O17 ri:'haw$t,t'fi P:; Ll t:1ii:.` C, Till ti?:.; Pr>it. ; r _7 ._�_-___________ .__._; -41(11.1 IB)(1: 2 : '1,.1 an-i 1, :t iia t , .( .' i2. t:,in' ' 1._____._1_F 77_REQUIREMENTS - ------_ :, 1, 147/fr.; Moh7 t" lie Li, k`n;¢ut a[ nlrl 441-11(AV+: i'ot ',,R id ti:m::. S1 of IT, Ill IF, r'r:,:ut'ri•;ti l,ilChra ot:ct i1(rVS ';Int:Ir rt I ! ii':'. - - t .iv ,,: :' _....�'i :,'i.,:x(i';1:':. is•:. t S 17 i Rsr:e.t:in7 !or H,� tiolo4 n9 WOLA2? }fc,; PELA TED .`O GtiOD FtETA!i +RAz ,7>E`:':t 1 3-4131i(Al,,,Dii ? !'Ill I^^`z" 1� ; : flfetaS?3-30 i I ._103,1 i b1 t.Pr:st.t 1!:,.' t-L dLnu:�:,r,!it.ltn;: I (.�+ii:"^' :r,;.r r<,.n�;•t;r(ti r,<•6rt..e,:. .a:nY do:r;z; 'd,or.;..;•;r 1 3-403.11t(') jr,wn e:.`hi:it: ; m.or x•,m:n. ;r it<'? '<rizna+ is Z i 7 , ' lt*:h! I GOAiI RC7:11f/''Y3C.1tC`C'S I FC .._ '� r:7(I U'6G _ IU. t 1ih1 I c.lu:::lzasx� 1.•..,;red I c'rnom oi'!s?c' I __. _.__..- _ _ ._ 23 __. : t4ana_yc:neni avid P=iso;_"l,'_ 18 i 1 Proper Cooling of PHFs 3 _24 .�FC,X1:Inti F"F'zoitN:tum 004 1 + 1(11 l I(A) r• i `_'['� :OPOit all and U(widLS _ _ Fr,_- _ , {Y(17- .. . . n41nr C',:t:'d PHP: trod.: i ar f to r - '-i __ ..._. - 1 _ - I ," 1 tJac:=t,�i::mhn^.v^U':Vdata_ pC - 71r'f 1\;6nr, ” (hull 1 1`.i" i :•id From c 4Facliq_-' i 1 tt:.};'Fi--:� ° Within,! }{:,a,', 2i Pnwa:7oo5 0!71xlr Ca'er:,t'o t 3-501 14(13) J t.'+,'tt:_('HF, %Ladd Fnsu:it,ihtcnt .' - -�5'^�:,a(R•. _ --- -- - - v _ 1 i I.nup"I.isne hcrzdiew,t,. 41+,'4S P -'U 1 Omer r CITY OF SALEM f - BOARD OF HEALTH Establishment Name:tr^YAa,1. -7r A,,n,\ � p/L JI_J 0.04- Date: L�--I h- a 0 l (� Page: � of l P - - i Item Code C-Critical Item v DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item .r ` ,Verified _P4_EASF.PRINT CLEARLY ()V_ \� on tnn (').� n�-s.a (.\.� ;, �-��;�;J,� ti n.;.JQ_- ()/i V.t ZL I .P Il d` l> .M< 1)' kin < n C--}(/l- n — -- J j �, *`P 'A_/�'. 1<n/ 4 1iL n /7+ e n fl, n n P-iyK� p *11WIAf AA ) '�I/')!A;.. )A.' C_�Yl i�< ��C_ -P_ o i X ,i�(M__��l 11}—p Opt.\.: _.1 A (y1X o_ ` 1, -4 9t ��n a� _ /T nn. , , l ,1 pQ� r/V\ /41-1 _T7)1 /)-PYl1� — 1.1 ImA) F)i A 0 _ t ).OAJ �f�•-f rX�n�1.�� /_A, StL APA Aek�t)/� _/� _ J _ /"iL op) (-3) �G cA P �a' .A l0 A, i,_nnn, �) � P/_lo - (_� D_0 A;,APA, inn 1wn.nnr-E-Qj — '`` •I `,f ,1, V v^ fit"_c, \ (_`nn v_ n _-4_ "eX — `aA aw,1 Qn in , o_ h/;1C -PlL ,_nn JAr_ _ .I X nA v a _''kl /.,)SVA �_�.,� ?_ — \ X\/J ,.�.. l 1 /_� Inn , I nn,. (� _' p f� /� pp - 1- `� ( - r�,i�(\ hV <Ct` , D S i�E.pi�-Yn o n A .+ ,_N_ 7L"\\9 — ' ' /(e 14.! rt '�.in �n A! n. tn__ II) t-Xn- j �Onl On �I V't t) ;R'•. `I VC1 (', � Q -�(^\Of, /J� -s� \�P —\/�([ynA P.IY_� �Ji�l I Corrective Action Discussion With Person in Charge: Required: I ❑ No ❑ , fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p P ❑ Re-inspection Scheduled ❑ Emergency Suspension . comply with all mandates of the Mass/Federal Food Code. I understand that 'r noncompliance may result in daily fins of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure r -your food permit. \\ c� �Z/� �,� �__ ❑ Voluntary Disposal LIOther: r , -5+1i [4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk .According to Lau Cowled to Factors(itents 1-22) (Cont) ;I'F/45"F Within 4 Hots. PROTECTION FROM CHEMICALS 3-Stlt.?5 Q cling Mrthods for PHFs 19 { PHF Hot and Hold Holding { 14 Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 3-202,12_ _Additives'r 590 0(?-;i F-; 4P/45-'F- 3-30114 Protection from Unapproted Additives' 3.501.16tA) I-lot ['HF's htainlained at or above Is i Poisonous or Toxic Substances i 1409' ` 101.11 !Ki:;nufytng Infounatmn - Du,inal _ Rimm. Held ar,or abot'e 13011 i t`ontataers` � —'—102,11 _ 1 conivi,vs lanr - t\' rhi,;c' um.n;n:r..' ! L20 � Time as a Public Health Control {- ^..— —.----{ :_±_:! P; ma sa a Public Hf;llth Corar;,[. _ i r-20[.[i ( JrpA,ath%n- Sloraki': �. q t _`.—__ -_._. _ --. 3 tie uircnsy! 7-20:.1! 1 Fca;ici:on-Nrs;:ncc acJ t",:' ------ `' i7-202._12 C,,;uirt;on,t,f U,c' 7-'_t)3.[1 1,+zit Contamett -P{ohibI!om,I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE { 7-204.11 SJ1mietti,Cmr;ie--�C=hrm-i—u'—e-';----- 1 POPULATIONS(HSP) 7-204.12 Cliuicals tot 'IN 21 40111+Ar Unpimcuti,l.d Pre- c ni't cdmc cs iu)d Beeuues aith jarnin, ahelr7'04d i I Dr)in2Acents.('ntrrta _---- _----- i 7 205.1 t ?-Fti: 1 RU± U,;u! pit,willwd Lr,c," 1 t htrid:oUa) l o t h-Lvitd1,( I_ubu L7-206.11j }ta>i,itir.i i:.r Pe.riuder tatt�i r,' _ 3-i,dLI ltir) I Rata or Padinll_, C,eokcd Ali Fv,d .,ad I ` f Rav S.od Imouu, Nta S,atvvd, 7-206.12 Rctieni 13,-11 s mwn>^ `Gi:,±�rt':I (Vh..i Pat!'aei 5.,: � , _On 1? � Prark:'tc R;.tdt •.Yea:'. :nGr,. ,,;a -- -..-'- ---- '— -- 9,rai(ooin CONSUMER ADV_iSORY_ TIMEtTEMPERATURE CONTROLS ,unint ir+ isnry i't,.t,,i 1 16 I Proper Cocking Tani:e+atuies for PHFs 101 As± Rd,,k Si;t11- i is _h:nn.diatc Set'+;: 1i 15.e, 1 ! - .-q,t[,; Cort. Air _ t•aht 4`•f a,.. .. , ct.,- 1 , . 'Yh Fl ii: 1 _ lUt.i!r8sr1) 2r ro b,C! t{Iia,, !"I nuit` SP%E41AL REQUIREMENTS iV76'gjc.i,'. tii Sk"tli'a oI i c•aicrinfl. a.\,hd�t.a;; terutn,rar, a'id 1 i 40(.1+(fiy 3> ! I°,,ti i!Tt,lfi Iia Cr:Ittt J!n(le.i I :: r tm t• ' i + 6Cbllcd umli17 t1h;8Oit,s;Pi ia'r ' liths fl , JiG_.`:it:rr,:: -TU-1A'TED i-.u 7 ti REipa- ";7C_4 __, .103ANA;itiP? :1T, Ifi' i_ 1, ,r;: i (11ewg23'34i ,SU?,t ir<i; 5,hu:a=a, - 1,:'+,I": ,•.bona•.`."tndnv C;r;;trtG nn":;ir+o:.tp.,»,. ui.,+h.do IIRt .arc)v r!!„"h y"q rr(h4t„+L,,p, jif prti •"'r?:!(. ?, -Y?3.Uif`) CaRHiI,;Xid:lro Pu:., ..,;d 'Ili i•"..tl %retard i+t: rJ<• .'it„r;. .i; ?"n:n7 i'n:i:'.a:'%,.:l"i7P• 14t) F' 7tetn iced Rete:t l'racbces - ---_' FC- - ' 5d(1 OCnt :-ifi33!\Ll Rr_^.etnet,t i,n,n+'et; __.-_.--- _ _ - -. ' d Per,ornm FC .2 0U.- . 1}{ Proper Cooling of PHrs 21 F wIli:Ind`oyl Proiftctm_: Cn: ';�_. i1 i 501 4(A) PHrFF font i4l i ii' YUnn ? ifo : Frr»•t i _� ![JA,e, r tAPinI-f:mdKtti.tai xt'l_l-ut_Ctid:N»_,_,_r-; F�f C,.,_--.`5.?--.--jCMK:;"j%F,ya;,_xFa: 6.; _ 1 h:.; 'Fd-i, F1t96n)t i7 3-501,i4(8) Cnrdit=:;PHF: Mitkic Fn:tn Amhtcnii L.'•'A. 5)ati_al Rrjlt;r v:,ietl?^ -- - �--__ _- _Mv,?` _ Toni:raaneingtnEsr:,• todi';:45`F 'I:cno+r.rnpril ems•,.a:"t.. ,... .' +ioo f,., 7 , ,, ,,, , , ,,,,,, CITY OF SALEM BOARD OF HEALTH Establishment Name:'i�Aar?,•(tl.,r,1 P.l�..�,\ t,tx)P A- Date: 4-1 (o-10 Page: �3 of z Item Code C-Critical Item v ,Dete; DESCRIPTION OF VIOLATION/PLAN OF CORRECTION t No. Reference R-Red Item ,Vedfled';ql PLEASE PRINT CLEARLY " ' .. •- r - �7 11),'\ I P)JOn.Pn �r�.Jonri,"/.G �IvD_,1 `: y�- ) l,ej �rt �tJis r /t; .Y..trpL e �'CA AC' 'T,1A) _ , • . S O . J U I �p � e9 0 "V' 0JQ D' A AA- PJVv\� l, t�P OAA n��r�r,r� � pn� (x I � o nn' _0.1 , `n 1\^Ann OA �M me / \ /'fit I 'I A kAA PJ1 ."0 64) i I "-A )A 1 0 I J olinn V( 0 '- tlA ) "9 ' +' - IC/V\I V-A r,XP0n Ari f O 1'vrn_0_ - -q_ /) YA I 10 C14 ADO/j,1,1 017 e1 I l9e_,p A \PireC- I lJtJn VVIP N aJNenS t� .�nrr� r,Lqrl in. t'1 a Gln I �I PDQ �. e� cam-/ u,dK 0Vna,, x o n u a - �,� ; ray- *6 ()r7nA 4 &-v k-1 P'�_v.P? 8 —I LI-I 1 S<CUv _ Discussion With Person in Charge: Corrective Action Required: I ❑ No Cl, 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 ' noncomp!iance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. C c _ ❑ Voluntary Disposal ❑ Other: t 3-5171.14{(:) Violations Related to Foodborne illness Interventions and Risk PHFs Re6nved at TemperaturesAccording to Law Cooled to Factors(Ifelins 1-22) (Cont) -41'F/45`F Witbin a Hours PROTECTION FROM CHEMICALS 3-501.15 Cuolinn Method,,for PHFs ( 11 y PHF Hot and Cold Holding 4 Food or Color Additives -A-501.16(B)3-2{)2.12 Additives' -A-501.16(B) Cold PHFs Maintained at or below Syp(NITf1 I 141"!4i"F- 3-302.14 Protection from Unappro':ed Addihvec° ( 1.501.16(:1) (int PHFs Maintained at or above i 15 { Poisonous or Toxic Substances 140,(' W[A 1 ( Womifyme Inion mat+nn -Ortgmal ( I ;-5111.16(A) j Rlst+(>Held at or above. 13011. I Comiiners` ! j 7 1 U2 11 i Cointoon Naar;• Nark i';�i'•+:uau+:a ` {} ! Time is a Public Health Control : "--'---._---'-� _ -- ,.;C'; i s 'Pimp•ac;a Public!{ealth Control' I '-2UL :v I1 ( Srpa! ik'n- Str;age" Ni Var;amc Reyuin ntrnt r ':-202.1 I 1{catriunon -}'lostnu vol l,•r' +_._� 7-202.12 C'+mdnuxt,of ke' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Containe, --Prnh!b:dnn.'" POPULATIONS(HSP) 7-204.11 Saniuza'ti,Crue;ia-Chemicals, 7-203.12 Chemicals for W'a,,hing,,i"odnc'e,( iitcua> ' 121 1-S101 I I(A) Unpx:(eurv.ed t'r::-pa�}.ugal Juieas mill � 7 204.44 Uratnr.Atrentc,Crit,-Iia' _ _ I Reverazes with N'arninr i abrin'' ?-Rt:' I1ii3r licr of� Pa�Raui::rd f:8c•,'305.11 httidIntal Frx.d c_rrntact. Lub;!ca;;a' A-� t._A_�..__�__ —, 17-206.!! ! 1tr�.tnc:z,i 1'sr Pe.ric:tic;.Cnr:a;,--� I ?-501.11{i'7) H,+w or F'a:Us(ly<_l a>t.:d:lau7tal Ftx.d and I F.- + 5t.d r•itu:ut.\,r 4cr4.�i. " i 7 306.1= Rotiol:t B.m S:3oon„ ' __-._—_._. —__- _ r' nt Red h,st,Pa(_<a s Rc a <,� tit i tT+• tai I -_.,,. 1_ ht.ti:!ng Pu:t di?•. :':b;t „m':d ..:.1 -_L.. .__.,_ -�_ %ioriii, Jl^ i - - - GONSUN_+ER ADVISORY TIME/fEMPERATURE_CONTROLS 22 ,SC ii i Coo iwwrAti•u=.n' i'rnted iuC,nt,u }:ti,'n"I Pre. g”, P 'tNoiil t'�,w. lira=. .iC R:;v�, i'.n:ierax:{.e_'. .: 16 ' Per Conking rim erotwes for 7 ,)I r ! PtiFc Not ' .+e,%.!i c i401 !!A(t a-:: 17'1-, 1�ii • {�Sri. ---_ .. '-- -III:--' hoer, _ ` 2 + P .reartnsi h,:g Sar?I at, ra. Raw Sh,ll i ,'+'1=1Sser ;'.It,:RSi.. i 7l'`' if 5cZ - Ruast I''J I 1:=1 n+tr,- , `lira ri.3AL RECaLt!31:tv'[C:TS .' `ttJ q; :, -.';. 14'•,.i.I L= ''^ ! ' ! i Cul.Noy- n'•..hii,:hx1a. tr>.a{`arra:-r at:J 1 ; 4tti-i i'AY;�__. --'..'i`�.�i:rj tv ild;kiv;c r+n'•i.;l i>1�,;, , — retiuion(: Il,itint:n i+pcs.J ie.!,salt<a,hi !f: C: w:q!.nit;!'i0i, hlvc: ' : tlti'+it:'ti L':R'::a 1%t aitlt:r!ti:dot' :Ct'I r,9Yr: i 1 , , , „ t; {'(11'.:(11;11.{at:?rtSa!1;��e�l:q.. -v'-fJi..rt',.:4':x i±=;?;F�Ctf. C- U R.:t. r:%>.i. ,. , r. .-.r!t z.i li.•li.�Y lt_- Yf{3 •, !t:� i l� +rr _ _ _ _. (itPtt;•� ?? Xtj i-403.11'tif^ �� \tita=n. iw Ir.`..P: Sao: Slari inl_ C:,:i! .f ar,d e , run al ^r: 5, err. nl:::{,du•:rrr • ...;ti .:t., 1 lwe' .1,:,,,r'I, 'I1,,'i..:>: '1101 riat',on,(110..:,l:JO(for r A. ;.i.n•' t,'nt'._ ,..,ifA ..,:P.,,,d'..,.., 5-403 11(1:) t L Lamm,i;,i,h,•;=d P.=r't,ac of l?,.! item CLL)d Retail Practices ir" 97ir 00W - _ _ rope — --------- ! za _: -F(,)ow "I Proi(.,,uor, FC :•_ (>r;__ Proper Cooilnp o4 PNFs --- -._ -- - - -- _—-- - - - s, iPt 11(A) ( (•tx•i u+e Ciy t6rti['HP: tr,:n, La:ri i:• '-- -"-__..._.____--_"_ -- - - - + 2,1 . 'lra'e!.mit.^+b�nC !r:d v^J_¢!c ' FG- " 7 W ith'r ' Hou':.., -..i. . -- v 007 - - - . haian 4 i;nu., i :'< '-Pcf or�t•ox�c M14'itr-r,.rls "r{; , 561.14!H} t',slit�,PHF: ! "it Front `.;:•x_aI�R.>:u31ar+,w L- - .iii O(I:Pr itr:IF�xat,lr, Iltrr:dk;,;" t,.41'};.ti'F _ -_-- IMPORTANT MESSAGE FOR !Y\ GATES/ TIME EES�; �'\,-�2/ P.IVB. M Qcy VJ �X.s OF ( h I PHONE \ 4� I) W7q - G h I,I / AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBP P AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNEE)YOUR CALL WILL FAX TO YOU/� may) /MnnnE��SSAGE � ((�� /cu -�-inot (-At b(A UilC�h V-c�f, t of Y ecS t reS ( 7-� hoi— Ytcai(C In IthLc� - n �c.� �)C Cr+ (-- n n5+n's Y SIGNED FORM 4009 Won MADE IN U.S A. NOTES , k CITY OF SALEM BOARD OF HEALTH / Establishment Name: i1V\CSI Ir1_A.( 1V) `�C A? e 4 Q_t,r9� 'Pt Date: c� Ia/C�� Page: / of a Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data No. Reference R-Red Item Verified 11 PLEASE PRINT CLEARLY YecQ_t n1- n vttn1 a lri l rw_c.OA, 1t'rK- -fes (0 �Y114P�lf IrIP(Y1G c �lcl OvJ k;)U tk',KS (` ( 0r)I' YlCt( f_S'jI'h 017,12ca an t\1� vy'Pc4t,>1 tkn-1 c ) 1� vc T�.tn1 tnp r r Q t�We.5 -lit L-en r v t bjq:�?t I oe'v e Cis -to(10(,q-)S ; - I I ,hSlec `'n�.)cQ C �'O�jf) - 15� C. �rev C11 - i1Cff- ( I At -kin(_,Q_ oli� i ns necft"n, Pst-�t 0_i-�h m o iv�t Vna4 k/ V�N_un c)&ert -R' r I aom,'ri t `t-nr1' 011 �-E-,tw 4-,-rF4 k-ld nn W hPon tk st-P,C'- -McIf,T I (*I(-, lizif (-1-' 1-c n4e-f cc-(- (-I .-k )ry , o--P, 1Y-FCl'P rA Dt ct I( -('inrotd ,97"( of +\O i5li')m 'vitt "A Q- �- bce ' 'n (e 41 _VltocDjc t( tjrQ I o_c' -Gc ce 3;/.� op,ir r L MP5 W1 t lv� kQ t tQC ,�( tivj )UTj �t \rl tVtSL. YVt Ot n i11� , c c t 1 el �a ! c� k �cs I v1 cel C� P5 h I_ Bch 1U�'�� cch�=tiv�to rnt die d ihMrhxdict ,E Discussion With Person in Charge: Corrective Action Required: I ❑ No 10, ;Yes f 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 C] Re-inspection Scheduled Ll 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. l/ ( ❑ Voluntary Disposal ❑ Other: s Violations Related to Foodbortiv Illness interventions and RISA j Akxordinj!to Cat'. Called io Fartors(Iletyrzi 1-22) 070-90 f 41 tt;NS"I Within 4 Cwting,Methods for PHM,' PROTECTION FROM CHEMICALS 14 Food or Color Addiltives 1'tPHF Hot and Cold Holding 202 I't 3 5w.1('(B) Cok!PHF,Mitimairrel:11 at,ir b7lilu tiwl ot)4(I-) 4V/4i' F" 3-102.14 Pckatzcivin front UnuctlirwxoAtWiLve:' I 15 i Pononovi at Tana 140T, ' 101A I id"miltvilig l'o(Illikalon- orl'in't, kio,n,Hdd;it w above 130 It, Time as a Public Health Control 7-if)2 it Ucnton-Narvt- Wort ttv, V S("1, ic, a Nbli, I lVallit(*("Pit o; It "'equirenrclit 1.202,11 s Rc'Illclwq -Foti.1tw'Llid 7-202.12 1 I (ondit;otj,of 12,,,` !()3 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE --' POPULATIONS(HSP) 4 1! 1'r 21 3-Y) 1 (Al Unpactcurwd Ilr-pad,atnd Jeke,s will -------I 8�vek with Wall-wilia I Di N i it I'.Aatlit�.Cm,!is 7 204 1.4 -80 1 (B) I e of jr"idVillal 1% .'i- Rav, or IlaiunlN "narol Fixj and Rav, Sual Sprooli hot See vuki. 7 20(02 Rcl'ivn: Ee'q ltlam'ct,- -i;(; t IQ- UIt')P'nvd F'Xxi Packillat Not lo- 3 TrJ&iTLi:Pll"j Pau Ullttlro! ;wj "lertil ti.i It a CONSUMER ADVISORY 22 14"), 11 Consutu�,r ItatVisol v po';l,tj ;'r' owkw'Pti"t"k'f TIMEITEMPERATURE COWROLS Aitniol f"Kul, Ilia" are Raw, Underc�)kcd,i 16 Proper Cooking Tempgratures tar I(01111c IV�ifV IlR,1cNScd itl t:I i all 11,14' PH.r,ii' Pathtl;rcn,,.' lnJi tt t4 T! 11.'t,oltz"d fol R'4'v Stell 3-40 1.11(A)i I') jimiqlWed Fi"Ic 6a"Ir 401 1 103),!;Q) fllli!, a.,e, kkait�t Vt("'F I'! mist` SPECIAL REQUIREMENTS i.11 reVit 2 R.tw�" jltwct�-"t kt,m� I,,, i- Viv!anon,,0 Section >00,Wt)(A) iD.1 in 5 -a i a r i i i g, rrwbfle foitd. tempoi-aa and 40t II(Ar) i Forder,, tkod Gmoc, ;�twrecj Plff`', rcmdvIjJ;at titchul upol;!lions thoul(j I't- si"llpw k-,mu,:v iril;Fi;.il Meiif' I dellwal under 11w appr')JItrate^;eklioll, alxwc !f roLved In fitx1florrir ('v krva,r itaci veution.and rjst. facies, 00iff r•`40,009 vnllaiirxlc relatino ill tto:xi ,Cu6l I 1-401 ;2 I1';"v %%ttaa! Ftyw!'% 'll he dettiacd under #29 1-101 1 I(Al(!,�Jl j .10! Otoct PHI:, i5 lei 17 Rerwantig for Hot Hc4dmg VIOLATIONS RELATED To GooD RETAIL PsucncEs ',-303�1 IlAI&W) i P1 ii- t@5•} !.1'cv ' i I Item,;23.,4(t) ffhJ ahn". nut b" 3-303.11(C) C twol'ir!all., P FF F-'K'd 1 fi,iind in thely;lPowurq rerrinn,of:he lid Codo elud 105 CUR 14',; F- 3403 11(E i RV;Ilanona 1,10wVlA 11k)(tiolsof Roof I Item Good Retail Practices Ff" 590,OW.- 1',aaI, E j ".1wvqcMrn1 andPpmonnell- ___ I FG -P 0l) 18 Proper Coating of PHFs 24, RxA and Food Protection FC J !-,004 2il 1 FC-4 A 501 O(Al (:4K)kt-APffFV ftont i4(rFn, -Watal.Plurnarxi Waste I FC-5 -;(!,F W itiml 2 1 iwr�4!ld From"91 _717- I FC-6 007 t„ IJ T/45 F-`,k;oast,I Howt, I or Tamr Matenal, I FC- 7 003 PHF-, Mitf!,,Floor Ambitwttri S nurfer'lRits 0(,,4 F i 30 othor Wt0lut A I l',ur'I mll A ' CITY OF SALEM n BOARD OF HEALTH Establishment Name: )\.kunh \uttri c;_ADer Date: a �2 IC1G Page: a of o2 Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ;��—sc�bli�,l ��tt Ylt. «1 men -t�i�.c.r*,oc ' Ji C I��S I ,� 1—� ice � �xl ;cl Vr .� e nU4vi �t ,,cf� lct b1� F3( ir�J,InPr tars cl„r,v in /)�.C- rQ.-kPcx-kPJ oft-h'mo i n�nEr-k�,�n j I `� I Fx nlc�iv�cd in; nocicf rxo � rncik�r�c 5r ,I� et,�c nl.ve� r�r� a�b�c-�Ic it 1 cxal C,c5Ln tAtLn;r 1^�,kl -LS �h� v�.,—I c ��r) t>c �t ' nCi I !I r��rii� nc ` J ar�ll� ;n <,il� ,�,lQA in I I _ I f I 1 i , 4 Discussion With Person in Charge: Corrective Action Required: ( No I.❑ Yes � ❑ 4 i ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion - f violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I } `t•S.t:1tt Ptif'sRea',vrdatTa;"SPtrr¢arc< { Violations Related to Foodborne Iftlless t„te,'vcndfora and AisA Accn,diog{o l.a,,:Crx)led'n j Factors(Items 1-22) {Cor,;.) i .11 €714Y F W iihin•1 Me urs ' PROTECTION PROtrI CHEMICALS 3-so 1'!5 Ccx,1}n:,N1,11ikiM for PHF, IS ; ; Food or Color tar dr:3?+Ysu- i � 19 3 PHF Hof and Cold Holding '-5WA6iR; Coid PHFs A9nintaines]at or bet,,;v 110112 ! .,.4610:0 i no 3-3(;'_A4 Pnxtc't;,ni from'•;,t;,,,;,; ' 7{'%;,t3„}.< .it5t:1! Ilott'HFs4fain€ainedatorab;,ve 15 � P^}ttunaus at lax?r St,tstances { ! 7 tt)3.1i S,k'zwilvtn}t tni.,rt::.,,,,m -t'•ri;zna, «;r+i ., I X51;1.1: Rants!Kid at ke above 130'0. ! ZU Time as a Public Health Control i j 7 102.1) Common N_rc Wori::rc�,:nt;tine•r+'r f 1 ? Sul t') 'i'inn�as a Public l;eai;3,.'ornrni° 7-2!3!.31 � S�pe,.:tton -SE,.t: e°ici l � f 17-25}2-}i R,:,trn c: r,renwe j `'aU.`ztU1Hl 1'a "Ce Re uin•nxttr 7-202.12 Condition•,+t i T4,.' 7-2!131.1 rOC17011s•:t, -1'n,:nb;'niu ,; REOWREMENTSFOR HIGHLY SUSCEPTIBLE i 7 WA I Namnac i' wris-.Clu,,:ic..ic' POPULATIONS(HSP) .__. , - _ i E 21 E '-M 1 i til? l:,lpas5eurr,ctt t'reyts,}agcd 1uSts and ( 7-�(}'j.1? {)b'S?liCa}:.fyF 'i'Y�htnr.t''f,d4:e t.RlCtL,x -i E 7-701.1# 01vittnAierts.Cricriu^ -_.. tierer: ea'.a'irhW`crninglat„�ts' ? ?; t r., i _.._._...._—..._.-� ; gilt hill) j Ln of Pasteunud Lys' i CSiI Ine€d::niu. F,xxi nr;:ct..•wlnuts� 3_,n1,W) ' P.n,� o'P; { 7-2!)6.51 kcIli,:i,dt'te1'e.rim st.,iusm” 1 z .atla3i`.C:txwk,•iI,At7iinaif=,xhl,tld I?nr: tnkcd Sa:T+:ars h.a Sertrd. ” 7--.06.12 R.<(,:a; {,.nt tir,n,n;' i E i ! '-o !ltr,r t lapipsned 3�ex+d Scoop Nw Rcourvull i 7^or; 1.+ `rr-irking P„wdvr:. €':,; ('awsw and .`.t mumg.. i CONSUMER ADVISORY T1MtIl'EMPEI§ATURE CONTROLS k22 3 600 11 t ''.nannier 'ld,iso,y Aiswi for C onsumpthn0 Pr,t r rookm Tem er'tuies to, t I AnnnA F,xxi- 'lora! <nc IZ%w. £.'ndero,oStd o16 j P` { ti t}thrtw5s< !'Fu;r•ssczi:n l: i ninate 3.. W 11.1{1!{a 111. ON a: ; sa' '=�tl2.13 hasir❑rvrd E�,y:..S;tbs,±tLk• itis Rn,`. Sh0i j }�,,U..lntn,<'d ,tc'r:e,.Zt'c 4 :4"1:,i.rC� a � i-A5.l.1• 1 +<, fcntn.intos, F n, Mew,& £ifltuk. - in,n,al:- 1 XV 15 sc•<:, � SPECIAL RES�U$REMENTS dQi.I ttII}€112) -Put and W! ! Mln - 004' 121 551 RT(1)AD) Viufafio!N of Sec:lioS 59{}tMltlt=.}-(k)1 in � '-•ifi€.i 1C,i}'..'' Rat i.,-, it '+,€"<': }.;:.,tt }:S�F' 155 E catcrtng, rncbilc: iuitd, temporary and 13vt5f-IVAlff:: Sz,,ultrs tYiidi:ure. 4t;,.stsd lifx, rc:,iklettl;all:iuhenoponl:litaiG h,add la, WNW f zlit-:in"Fi<I:. how, 1 cichited wider the al>propriatk <c•citons Poultr:krliatnnl-Io^'1: �5,;.n ahue'e if'1.:(tuwS tnf xldhtmnc 0h1r !'S< l ) 4( , I1 ' t, h rea;, , In•rI Hot Soaks u,d TIs€: taste re. {?fllcr i»'+'€• 59(1,J)09 Violwions relatnfa tc, ;otxi rani! j 3-4Ci.}2 k_,w A.in"i F,rxr:Co,4m'n,;, l {ir.tttic:v should be deb meld under 0-19 - j -._I Sp,'.cutl kc`(;nirernCnts 17 1 1401 IVA7 IPW ( rll;rkhw I'llFs - l-rT F N ser - i i neltnating tar Hae:folding j VIOt.,rt TIONS R_TLATED TO GOOD RETAIL f'R,4C77CES j Will l i;Wf D) 11 1h 165'F t i tic•,: ^ ! (!tents 23.38) IF 2 d'bmttr 5!,mdir, i Cris ai.arid rimy,rilv:ai vio+,' ...o. which do noi ,clua';o o+,- ! foodhow.ell!:rrs• r,na.v,aunn6P.rrt,lri.4jo wrrVwe.rinhnar c,,at„ 349.11,C)S,C) C•aazmrrciAl; i'"Ws3.'d Re vast . I f nK in lite fi M'SSS' ,crtioro'("i!the Furxl Code awl)')`(,IR i 34M 3 t{1iz 7 T{rnt.n wq C nrll vd Portions„f€scel 1 i Item T(Mod fdataft Practices _.. .�. FC �r9tt0 0 { ! 1 Sam& � F. � P•Aaaapeme�n!c,,d,_amino !, 18 Pruner Coaling at PHFs Foorl and Food Protection FC- 3 003 J _�5 ( Eaugpmont and U_ensds _. FC: -,t 065 4 4Within,' { 1 ' Mpsal FaciiB i FC--� i__..-.-.. 3 SUl.19tr1} io 41t`H,1. xF ti41 PFin a hnur i 1i5' t t' ,B. Pasonous of T air Ma.er,zfs --l-TC:7 00k } , 25, s W�':t.Pn,mGin Ind Na&is � FC ' i.!'i'W't(},,tr .' I IOuri and'From�'- s `^' t ' i=---i.. ..._ _ out, _ -t 150.10H) y C.`c,„fin:, l'tii: ?vl:ttlr €tune neni+rrnt Sp, .lai 1?cr�nnemau,:_^ -- (�a I' 3� : .ro he Withm4 tlou:s` 'Dcm,a.+m¢.aI item i,;•,. 1,:!er:d Y"�9 N;;,d r :..i,.c 7'.0, `.Sk:"i+:0'x9 CITY OF SALEM p� BOARD OF HEALTH / Establishment Name:\Y \ G �r� tX to �_5 i(l�� I'l c A �P� Date: o� 15/0 q Page: f of Item Code c-Critical ItemDate DESCRIPTION OF VIOLATION/PLAN OF CORRECTION No. Reference R-Red Item T "" - Verified l PLEASE PRINT CLEARLY 'i A- yP � 'Yl� PPc7h(M r),)(-,('S C-,n 7I (AC ed' CC Md �Gn -Pu//�c�+n� C. ) +` I 1 - CYP-0 7n—� �CcTS (ICX �u�c. ��t ( �li7+a alto. W(tgiIn��Yn�ih'c+t �fv 1� I nlSr favi QJC ,nrA i�• T!�'Xi ' I hY�f )t )GVtI I11 -": -T-LtQ C)Lfk �1 �N°uy' �I vv)L'(.< nJ k Pcc'St"� �cX V 0 1 I �p111at n PuC�o�\1tfJ I< 'lh\.1l e NES ��o is t I f I I r7 1 1 1 Discussion With Person in Charge: ^Corrective Action Required: I ❑ No I ❑ Yes I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ 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'fZ ❑ Voluntary Disposal ❑ Other: Violations Rotated to Fondborne ttinrss Fni•,rventions and Rigg ( 1rcotdinr to Lav Cos}1:d to Factors(Ifems I-V) {Coot) `-4'ithin ! f•?;;tus ' PROTECTION FROMCH[CHEMICALS Ctxttinf!`,lcth0 fur VHF: I € 14 I ' Food or Color Atdtt#vas i `} 1 PNF Nos and Cold Holding I E 14E71.wBi Colo PEED.Malm,tinci at or bJct„ 3 if 1 11 1 1 '59100!11 t i -41-!3:i` F: 3-3C32.E-i Pt131eCt;:1n iit;n;Utwppm-�r+q Add.p,sI t ,Ol 1NA1 Ilol fli-IFL"Mailn:iiwd at'), a}.*:,se I tS I l Poiscr+ous of Texic Sabststta#•n ( I ? $40'F." ( IMAM ; i0cn;!h's;g to 4i.,i,a..:'ur, l)rS�sr,::: ? i Sit !r,{':'i) R„este HOd at of abwi, }t{YV + I i jq} Time as a Public Hatrtlit Control ;.11!-, t{ i 201,11 Sisuspc` - _Tim. �is.a_._Put#li,)tealth t;rtrol' 7-22 11 Pr;•s:+ r Yar;ance Ri_=neW i 7-20:.}2Coedit{„n.otiaw- i 7-'`0.} #t T"• Jc'C'ontaimt,-rYo (Lt'(,at,' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -2(74.t! Saui:i ce+a.+,rncr+..--Cht,nit.,,h; I POPULATIONS(HSP) �� ,• + i t' + . t;upxsteu:(<x�d Pre-pit”!::tett Jultrs wx€ 3 u ,unit V,'arotug ',-?ilt 1lL'rit t3r_.rrc;Af=rr+t,. ��ria' _..... ......... ! , € f 11(b) F<e tv Pdw stet::ed Lxi!„ . ^.2t}ti 7 1 Inruiert•+} t;r>t)C,tnlact t rshtits i 11;I)t Raw or{'.,rtt.tE};, C(>„c,l-$Dunaj (vxnl 0)"1 j 7-206.11 riode”Crit::'i n' i Ha;v 5rtd S#tn,ut„ "a Scra.:•i. ' 1 i 206.E^ i #?(A,1�'rt {4n,t ir,tn•na' 8t;l.i UCi L'nnpenetl Ptxxl Pa::4.asr No, "tree}.+nm );P ,:.irr;. P•rs {- : onnt,i xnt { - CONSUMER ADVISORY TIME/TEMPERATURE C:ONTRO:.0 `• 22 A-t)01,.1 1 C on,u,ucr At;isor•. h-t;t:d for i ntt..umptu`n of Ai,€ tial r,x>3;'11,at an• Raw, torn#er x.,l;ed e: Ifi Proper Cooking Ten;Pet loures for f "::t 0tix;r:;ire !'rt>'.t•s>ed!ui•:tirtinare ' Pius .> 101 1IA(i:t.:) F;tt' :�",`_- (.`. •.:. ( i'a+hoean;: `` -" I Fza; iaerndram Set,:cs i-•'+”F 3-.;ec• I .i 3 Pa;troniat F.t!c:: S;,l,ad(uir I K:rs Shell j E i.*gs, 3-dr)E.1 ti A)(.: C,,,rrrinu.':d F%.}t. :,ica:s 4, 4i:t3tr , r'.nru, n ti4 t� Hca. SPECIAL REQUIREMENTS -#Qi.l;(P._u} r'1', 1!+;P4 ane !x;'tt Rtr+,i - i�i7-} i2i Eton' -- cyp_{}lVIA.t)-t77i Yu}19F,'Sth,)sSccaort590.rx}9(r4) ;E-l} t:? ii,11s:) ,.,. . can>rine- m„Eid�itnxl,tetnpcxat-,' and 1 r __,,.._. dasat:,il i:i#chtn o.uaticu!c,it<:t:IdE,e 3 �4tii.1ltAi: tj � 1 n,t.rry, Wild C..:;:::', t;tv,!'et€ :rii•4, l' e,,trine t"nta:tun•; , t:€,. Mec:, jA!hk1cd undo Eli: appr(glriatt ,e:tttnis i Iroldto •,r K'in i::s-t f•; (' t 'ec. ` :tlx)ve !t'r::E2ui d to{ixkibonic z_gC,l.ilt(';,:? `,v},:,senn;',Jv n,a,+ t; .fs}ea >, E iutc#tention; and rl,kiactiva. crhe-r i,a.�}• ' I 54ti.r}U9 vioiationa relit€in- to reiut� Aa:nod i”, ,# :,l it ! E,ra,tite. shoilld he dchircd under i"29 - '.ti.,,,:,n„ Sp,: ml Regr!ircntenta. 401,,I!A)(1!,i+,) ; At! it-f;et l•iif,-.- —,:.t^7;;4,_ i 11 Reheating to, at Holding i VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3-303.:1t R).0t 0' Pill lbs r15 se'.. " j (Ifeulti 23-,194) loi"F:Nl,wv'r Sl;tndiv Criw-ii, and non-,riHcrl q,,1eq;od.i, ahich do itnt relan•:,,the favilhorne illa,As im.-watt„us...d tisk1a,tr,rr h.att aLcvc .+.n).:, p1F F•,a+d bund b,:tic julh»,-+rrh,ser ri en, t4:1w Foad Code, d/Gi{h)P, _{tem .r Good Re#air Practices FC - `-- - 401.}I(l:) Rr::taitti:t UIIJI,edt',, 60reortictq #t;,a=t.,' r 2:i. _ k4onaueins-cl aro per:ianrtel FC -= (t13 ti and FC 3 004 Ig Proper Cooling 54 S*HFs i 1_24, Food!^nd Food Ptot _ - 25. Ec{_u,pnu,nt and t;ler,sila _}-C`4 .00,1. Si}i I1(r',) {'ttt,iiuvC.wtS:ett i't{is tn,ul l ?f}`t tt, � _Water.Piumbinq and Waste FC-S.- .ont-.�--_t F 4Vi#h,n 2?i tr:,nt€Pnun l'.t`7 7 P1t sic,!Fa,14v �._.. - } t,•$7`}-;'it�F '.v:4}*m4H„tl:� r ' gin. Pasonous:r roxtc Atater�u!; "rC- 7 00£, Sri; I'!F',,Sktde,Ft.mnu)btrrt - TymP_raturc ite;rcdicttt�+,:47'}i..� F I-.. - Other I `liea,,.r„nnx ai ucnmit.•,,;kn:' #C•y,>('.,,><:ti,,'<,.: h+j, t?tc i'3(:o,kl 1 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: ` 1 PROTECTION FROM CONTAMINATION 740-0306 - "JI Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED 'Owner: Comment: Dishwasher rinse temp still only reaching 177°F. PIC states replacing the booster is too expensive,and that she will be Binh &Chau, Inc. having a sanitizer feed installed for the rinse cycle.This must be completed within 3 days; if not,all dishes are to be washed, rinsed&sanitized in the 3 bay sink until the sanitizer feed is installed.Invoice for work to be forwarded to the Board of Health,and PIC: inspector will return to check dishwasher upon completion of work. Nancy Truong 1Inspector: 1 wooden brush still in use at grill,and several cloths also in use.Cloths may only be used if stored in bucket of sanitizer;brushes may not be used. Elizabeth Salandrea Date Inspected:Correct By: 1 1/412 0 0 8 i Risk Level: Permit Number: BHP-2008-0205 Status: PARTIAL COMPLY #of Critical Violations: �1 a Time IN: i Time OUT: _! Urgency Description(s): BLUE: All other violations noted on the 10/28/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical ¢ violations must be corrected immediately or within 10 clays)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 05,2008 ) Page / of? jI Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 05,2008 ) Page 2 o(2 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Separatio egregation/Protection FAIL Critical ❑J RED Owner: omment: 2-door True fridge had meats and shellfish above vegetables and other ready to eat items.Properly organize this fridge Binh &Chau, Inc. to separate PHFs from RTE items. t PIC: Food C�on/t�Et Surfaces Cleaning and Sanitizing FAIL Critical ❑�/ RED Nancy Truong Vc mment: Bottles of sanitizer too strong at 400+ppm.Provide sanitizer of proper concentration(200ppm)at all times. Inspector: ce scoop at bar laying in the ice.Store scoop in ice with,handle extending out,or in a separate clean,sanitized container. I Elizabeth Salandrea ��,�� p lX 011 herlh-SCUfh_() Date Inspected:Correct B Dishwasher rinse t p reac a 7°F.Se ice dishwasher to ens re nnse to perature is 180°F. g P Y NUJ. 1 10/28/2008 —Wooden brushes being used to clean woks in between uses. Brushes may not be used;all equipment and utensils musy be I Risk Level: gl��Q ervious e�nnd easily cleana e. L p �Y`Ila byos I.� 5byKa. Cto' 1s bL Vb4 In �Qhtit Wi j l os�vr� cb`Yhg,y,.°St 8t, ,h 5rftit,r @cell ;Permit Number: I BHP-2008-0205 #Status: a VIOLATION #of_Critical Violations: 3 Time IN: Time OUT: ,Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected I .immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 29,2008 ) Page I oft i Item Status Violation Critical Urgency RED: 4 r Violations Related to Good Retail Practices (Blue Items) ,Violations Related to Food and 50od Protection FAIL Critical BLUE Foodborne Illness Interventions{ omment:2-door beverage air fridge had a cloth covering eggrolls.Cloths may not be used to cover food; provide covers for all and Risk Factors (Require 1I fo d that are impervious and easily cleanable. immediate corrective action) of of onion ring batter being stored uncovered on a bottom shelf along cookline.Cover all food in storage to prevent cross con amination. V everage'air deli unit,delfield deli unit,and walk-in fridge had some uncovered foods in them.Cover all food in storage to prevent crcontamination. &2-W-11-of shrimp in walk-in fridge had a cover directly on the shrimp.Covers may not touch the food;provide properly fitting cover for shrimp. Equipment and Utensils FAIL Non-Critical BLUE _vomment: 2-door beverage air fridge missing thermometer.Provide visible,accurate internal thermometer for this unit. rill,fryolators and wok area need general cleaning. Lotri�pare rib oven has accumulation of spills and splatter.Thoroughly clean this oven. & bay sink must be labelled"wash", "rinse"8"sanitize". YDry ingredients barrels need general cleaning. , 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 29,2008 ) Page 2 oft I HACCP Risk Assessment City/Town of: Salem, MA RUM, • - Establishment Name—Mandarin Super Buffet Address—400 Highland Ave ,In dir: IN; Pork dumplings I Chinese Spaghetti Factory I Person-In-Charge—Nancy Truong Shrimp cocktail I Baystate Seafood Express Corp. Cream cheese I Baystate Seafood Express Corp. Celery Information for the Risk Assessment was obtained by: I Solo Produce,Inc. El Observation of Suspect Food/Process Imitation crab I Baystate Seafood Express Corp. 0 Observation of General Food Handling and Sanitation Practices Crab rangoon shell I United Foods Inc. El Interview with Food Employee Responsible for Preparing Implicated Food. Pastries I King's Pastry JZ Interview with Person-in-Charge or Other Employee WeightlVolume of Suspect Food Prepared or Served: I Dates of Investigation: 1/26/09 PLFAS.E PPY�rr CLFARtY 4. Describe Product Flow, �il; JD crib6�c6�re��-in"d'�'Pr'ev4e-n'ti"V'e'� -4 to.'�il* AHAZARDS-' �V, oftonfroll6fHaizaeds, !�-�Cpntamihafion %Measures-initia c1`1 gl efff yCbntrol�or-,ka6k�"' (Preparation Stipp) H! I 'd' -Proliferation oraers ;,Who,',What:',,Wo,ero�Wheii,�,,�� F V�posals,f�ddt P Alo� pirrectunt;prgbark9e -`etti ?yee,,, t r, ety-trauningemotg5ni; T', �restncticins;tbodsaf S, so yspensmns 0 iV� EICCP Pork dumplings:pork dumplings are delivered Refrigerator the boiled dumplings are held in prior (Critical frown once a week from Chinese Spaghetti to ftying and service was 42°F at time of Refrigerator must be adjusted to ensure Control Factory.Upon receipt they are put into the inspection. temperature of 41OF or lower is met. walk-in freezer at-10017 in original packaging. Point) When needed,they we taken out of the Geezer, Dumplings at the buffet were not being held at boiled according to manufacturer's Dumplings at the buffet were at a temperature of the proper temperature.Potentially hazardous instructions in a wok,and put in a covered 101.80F at time of inspection. items must be held hot at a minimum plastic container in small refrigerator at the temperature of 1400F.Dumplings were cook line at 42"F.When needed for the buft a small amount of dumplings we taken from discarded at time of inspection. the fridge,fried in a wok,and put out at the buffet immediately for service.At time of inspection,dumplings at the buffet were at a temperature of 101.8°F. Page: Number_of HACCP Risk Assessment Report Form(Updated 09/05) r Shrimp cooked:shrimp is delivered frozen 1 once a week from Baystate Seafood Express t Corp.Upon receipt it is put into the walk-in ACCP freezer at-IO°F in original packaging.When needed,shrimp is put into the walk-in fridge at 40PF to thaw,and when it is thawed,taken and boiled in a wok.Atter boiling shrimp is placed in a dean,sanitized shallow plastic container to cool,then put on ice and put out at the buffct At time of inspection,shrimp at the buffet was at a temperature of 38.4°F. Crab mngoons:cream cheese,celery,imitation The cream cheese mixture for the crab rangoons is Wood may not be used as a food contact surface; crab,shells. mixed with a wooden spoon. all equipment and utensils must be impervious ❑CCP Cream cheese is delivered once a week from and easily cleanable.Do not use wooden spoon. Baystate Seafood Express Corp.Upon receipt, it is stored in the walk-in fridge at 40°F.When needed,it is taken out of the fridge for immediate use. Celery is delivered twice a week from Solo produce and stored whole in the walk-in fridge at 40°F in original boxes.Small amounts are taken out as necessary,washed and chopped for use. Imitation crab is delivered frozen every two weeks from Baystate Seafood Express Corp, and upon receipt is stored in the walk-in freezer at-10°F.When needed,it is put into the walk-in fridge at 40°F to thaw in a covered plastic container.When thawed,it is taken out of the fridge,chopped,combined with the cream cheese and celery,and mixed together in a large plastic container. The shells used for crab rangoons are purchased 1-2 times a week from United Foods Inc.They are stored in the walk-in fridge at 40°F.To make crab rengoons,the ere=cheese mixture is put into the shills with a clean,sanitized butter knife,and they are folded and placed on a tray lined with wax paper.The tiny is put into the Beverage Air refrigerator at 38°F,and as needed,small amounts are taken out,fried in the&yolator, and put immediately at the buffet for service. At time of inspection,crab rangoons at the buffet were at a temperature of 154.9°F. Page; Number of_ 0 HACCP Risk Assessment Report Farm(Updated 9105) Pastries;pastries delivered every 1-2 weeks as needed from King's Pastry and stored in their original box in the walk-in freezer at-]0°F. ❑CCP They are taken out as needed,put in a small refrigerator at the desert bar at 37oF to thaw, and when thawed,pastries are put out as necessary. Comments: Some knives stored in plastic knife container had accumulation of food debris on them. All knives must be properly washed, rinsed, and sanitized prior to being put in storage for use. Sanitizer reading too strong at 400ppm. Ensure sanitizer of proper concentration (200ppm) is available at all times. Page: Number_of_ HACCP Risk Assessment Report Form(Updated 09/05) 1 Commonwealth of Massachusetts • r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Mandarin Super Buffet File Number:BHF-2004.000039 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-2090-0096 Jan 4,2010 Dec 31,2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES jDecember 31, 2010 Board of Health 1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r CITY OF SALEM, MASSACHUSETTS • , BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM OSALEM.COM DAVID GREENBAm,i, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT MANDI)tIN SLIPb ✓IZ TEL# r0 6 )21 --7�� -03 ADDRESS OF ESTABLISHINAENT 4PV 1'l1'011 Lc't�01 FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME >, JAlk IaIAILI lNe7L CHAD �%JJ2u0l�l TEL# �qh�5 42-?-1 7 o ADDRESS �/ - bs -/ D.� ' 6- 91 Vi -e-(-% k4 C/�//� STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CHAV CERTIFICATE#(S) �-27172-GI Q I (Required in an establishment where potentially hazardous food is prepared) �/ EMERGENCY RESPONSE PERSON )?%nl/1- 1Z/NH (k*) /IZ/JO/YG-HOMETEL# 6779((-'�- /a�/'J-72?,r) 1,-'DAYjS,10FOPERkT,,ONai= l",&rtday?MI Tt esday ! N!eay" 197tif rsd"ay . j` Fnday i" S_`aturday !!,;,,�'.Synday I HOURS OF OPERATION j Please write in time of day. f (For example I1am-11 pmt I - TYPE OF ESTABLISHMENT FEE (check onlv), RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 ----------------------------------------------- - ---------------------- ----------------------------------------------------------- RESTAURANT I YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats < $420 ------------------------------------------------...-------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem'Board of,Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. , Signature Date` w0,°p ,j ,Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#Bc Date �7 Sq2 Zo 1 f rnonnwmn 1' 11Y9fW'laM Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Mandarin Restaurant Mandarin Restaurant 400 Hiqhland Avenue 400 Highland Avenue Salem, MA, 01970 Salem, MA, 019'70 (978) -740-vJUo x (978) -740-0306 x i Nancy or Ben Type: Emergent Routine /°�Z��r�t Cesspool: No Yes (7Tank: No Yes= Date of Pumping: I / D Quantity Pumped: Gallons l ' System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: S.E.S.D. Salm ,-MA. Date: Pumper Signature: - A�/ _ i Condition of System/Other Comments I Dep Approved Form- 12/07/95 v r — � rnv�nnq��d IORfY1006 Commonwealth of Massachusetts Form,4--System Pumping Record Massachusetts System Pumping Record r r � MAY :5�oolj System Owner System Location � ', ' OF SALEM Manatr-in P.o -taus ant Man<i.erin kesr.�irr 2nt BOARO OF HEALTH 400) glcniand Avgnuu 4oU High Land Ac,anue aaT. ,a, 4A, '71Yfo Salem, PIA, o14'11' �- tu✓N � - 140 -Usvn (y7$)-74V—V3[so x Nancy or Hgn Type: Emergenc Routine SO Greqse- Cesspool: No `C ' Yes 5eptie-Tonk: No = Yes Date of Pumping: �3 —�� Quantity Pumped:1O(�)(Z Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: S.E.S.D. SaterrrM�►. Date: Pumper Signature: Condition of System/Other Comments Dep Approved Form-12/07/95 Commonwealth of Massachusetts City of Salem Board of Health 1Gmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISHMENT NAME: Mandarin Super Buffet File Number:BHF-2004-000039 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-2009-0270 Dec 29,2008 Dec 31,2009 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLLFAX(978) 745-0343 MAYOR pp��@p��ee 515 IDIONNE6SALF.Nl.COM JANET DIONNE, 0 ACTING,HEALTH AGENT �oV Ch U� �N�y'C1'I 130 0 OF 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT /l NAME OF ESTABLISHMENT il/1/AAAI�Q l� 6A -�t TEL# f_GJ�f3 / ADDRESS OF ESTABLISHMENT 40 D d El lll_AU 4 AJ.LP_ FAX# MAILING ADDRESS(if different) EMAIL-Business': (kDM.P Website: 4"aA„2-- OWNER'SNAME R I - ��la,e f �.w,( C,WA-1 - -TR-k�1/ONCrTEL# 57j - CJ27- -�- 71 0 ADDRESS 12- I�A (J l9 1 S� STREET CITY U STATE q ZIP CERTIFIED FOOD MANAGER'S NAME(S) CN A U- 721i n cl if- CERTIFICATE#(S) � 7 /q 2( 8/ (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 9 /dw, li/;Z HOME TEL# l/� /�7?- "!27- ,�7 7,0 I DAYS OF OPERATION I Monday I Tuesday' -Wednesdayr { : ,Thursday• I, `Fdday j Saturday I Sunday, HOURS OF OPERATION Please write in time of day. //A)✓- I�`�Ati (For example 11 am-11 pm) 7d� IIL1dr..-il (1/fg,�-11 a�i 11 flnv.-llpdru l) .-11 Dnp 11 A'"� `11 TYPE OF ESTABLISHMENT FEE (check onlvj RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - ---------------------------------------------------------------......--------------------- - less than 25 seats =$140RESTAUAT----------------- YES (Outdoor Stationary Fend C� t$210) 25-99 seats $2 more than 99 seats =$420 B---E--D-/-B---R--E--A---K--F--A---S--T--/---------------------Y-ES------146----------------------- ------------------------------------$1-0-0-- ------ CHILDCARE SERVICES - - ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code;cbefore any renovations,improvements,or equipment changes are made,all plans for such must-be submitted to and approved by"tfje,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 return nd paid all state taxes required under the law. Signature ------date- Social Security or Federal Identification Number ---------------- - — - Revised 424/07 FOODAP2008.adm L i Commonwealth of Massachusetts Form 4--System Pumping Record GA7 Atcue t..,, ?1-'-' 'Massachusetts " ' "` - tank and tnvert in front of Urea,.'• end 'n..cx t i.rer betted Inlet and loutlet line, until FUEL CIW,::r System Pumping Recordalord hvald Kiev invert cleaned out 3 tiw�u . yea,, or All t.ui Wingi6 will block up System Owner System Location Mandarin Restaurant Mandarin Restaurant 400 Highland Avenue 400 Highland Avenue Salem, MA, 01970 Salem, MA, 01970 (978)-740-0306 x (976)-740-0306 x Nancy or Pen Type: Emergent Routine Cesspool: � e N Cess ool: No Yes 'Vo ink: No Yes Date of Pumping: GQv 'a�/ stondard Quantity Pumped: /450Z) Gallons Montldy•Specific System Pumped 8y: Wind River Environmental,LLC 07/26/2008 Permit#: tine Contents Transferred to: Twh Nam— '..Wd:1R:1 t.Lr'1 •t�Y.'t1 Ui':•1.. .. 1 � • ..V J ` •J( ' ).UV 1hIR aeiiAeil` Ibinet L�YJ Contents Disposed at: r v Date: Pumper Signaturey � � � "-- f• i Condition of System/Other Comments Due on Receipt Wind River Ft,vicorut�nr -n3 Wu turn A, .lt.ucv�t-t, `SA 01913-0 (978)-562-4500 I V Dep Approved Form- 12/07/95 i i i i i I i i i i I i R CB4�D DEC - 82008 GI IY OF SALEM BOARD OF HEALTH 0222022946 9N?fY?IkNi Commonwealth of Massachusetts Form 4--System Pumping Rec Massachusetts System Pumping Record System Owner System Location Mandarin Restaurant Mandarin Restaurant 4UU Highland Avenue 4v0 Highland Avenue Salam, MA, 01970 Salem, MA, 01970 (978) -740-0306 x (978)-740-0306 x Nancy or Ben Type: Emergent Routine ✓ G7«L Cesspool: No Yes Septic Tank: No E71 Yes Date of Pumping: `7- ooI b- 01 Quantity Pumped: Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: ° S.E.S.D. MerlMerl n ,��ir.A Date: Pumper Signature: \ - Condition of System/Other Comments u ---_-- Dep Approved Form-12/07/95 AUG 13 2008 CITY OF SALEM fBOARD OF HEALTH Establishment Name: I V 1r��t�u r rl _l' 7 ( >PN R) 1 Date: I 1 I �C�� Page: of I j nem Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY { I cr)p,dtrch/-W innrj I t t 4i';0 4 ,i� _ r V�r) - I 1 I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I o 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 j noncompliance may result in daily fines of twenty-f,ive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. / /' _- S f LiVoluntary Disposal ❑ Other: 1 i t I Y I j 3.501 14W.) Piths Rt:oelced et'fentpar:tiurev Yiotstions Rntatrrd to Foodbatn^tineas tntcrventions er:f to Uiv, Factors(ttems1.22) (Corot} i i!'ft-l 'E wilhin•ill,�Ws ° --�I31M14 CooNl"Method.: itlrPiths PROTECTION FROM CHEMICALS i9 I � PHF Hot and Cold Holding Food od or Color Admlives 1 z 5111 I6(B) PC td PHFs?vlmianned at+tr belle%, j 3362,14 1 ProtuctonWin Wa{nr,,,edAddihve<' i +00€ iCti:ii i-1,a ('!€I=v1t:rnidtnPdaturabove i j 1S Potsarr=us or Toxic Substaa+;es _-.� A i €WWI V:'ntif,initlrt<,rsn:,tinn c)rl;:nsS ( , Rtr.+sS<1-10d at ci arove :i(1•I . k ! ! Coi:tainer+ i tfi Time as a Public Health Control I7 ,ti2,li `. cc:amr.INcmc '„r3•.lr,�i'ou,;na�r: ` ! 19 'Fiau: as a€'ukii:;i[e:tith l,:nuxtl" i-Z(}t.l i Srpa+a;ic,a- .GY„,Rre"u.- i i I + =all+Y- V::ri•tnee Frytarcr.=este 2!72.31 I kea;;r:r,nn � F'r^xrcr. NA i...c` i '—.-- - --- " REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) i 12MAI SMWi>et•, ('rtiL"i; .t_t,Ctnt.W ! + �.�r ( ZP ( *5u'.(itAF tnpa:mnr':zedt'm-poi.agc.dfu,ctcwa! i -)-t,i2 t'tttnul�:t11I�,rtt'Y.ltii+l',t':'�Xti,C2.C.2}t, i.it -_ �--__ ( i ttc.eea:'e: with 1Varnint:tai.-1s" j 1 7 204.14 i.2t+S.kt livid::ntai }-cutlr:t•r:t:,c+_S»tbr';;:antti' ! : L'<r,tPaeteauizedt:t�,.'` 7-206.1! tstr+<<t:i Lw Pe,hartes Crnera' ]AOL k!ON R.av„r'itt gall;:{.rv:I:,d %nal lived anti ttay.SLcd ` prl u1,t R't:i Srry-.I, 7-206.12 R<.arr. 2.tt e:tt,mw I ( 0H l IQ UrvTowd tr.wd PSc:'aW No Resuve,{ i 'I r:tct,ins' P,rt,lrr<,3'",t f.\mtir E antl ! ".ft't:,ioiinn' CONSUMER ADVISORY f 2 345 11 i t�,K,gowr Addams hand rur: '� f1rJ9nJfIQ1� IQ12fXM Commonwealth of Massachusetts Form 4-- umping Record Massachusetts System Pumping Record C System Owner�� —" System Location Mandarin Restaurant Mandarin Restaurant 400 Highland Avenue 400 Highland Avenue Salem, MA, 01970 Salem, MA, 01970 (978>-740-0306 x (978)-740-0306 x Nancy or Ben Type: Emergenc Routine (9('PR8'G Cesspool: No 1>0 Yes {epfirTank: No Yes Date of Pumping: /y 0� Quantity Pumped: IDOD Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: rV Contents Disposed at: �� I Date: Pumper Signature: Condition of System/Other Comments RECEIVED i 4N 6 2006 CITY OF SALEM BOARD OF HEALTH Dep Approved Form-12/07/95 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,0 Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax-(978) 745-0343 Name 11 Date TYDe of Operation(s), Type of Insoection M(71Y11] (�(IhOP ( �,U �t l }��3� ❑ Food service ❑ Routine Address I ��' 1�1 1. ��)�U1 L� Risk ❑ Retail ❑ Re-inspection i " �Yt (1 /T Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: OwnerHACCP YIN ElTemporary ElPre-operation Now/ 1 Y'(. ono I El Caterer Suspect Illness Person in Charge(PIC) Time ElBed&Breakfast ElGeneral �a � HACCP inspector P; �jqj1HTja I Out: Permit No. El Other Each violation checked regWlfes 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 ' El12. Prevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities --. EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC r ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source - TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 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 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 4 - Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-z)(9 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(5500.004).004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 50lns ft14 dx Inspector's Signature: Print: Y-T�/1Y1le��nc�fl2ci'- PIC's Signature: r "��% /L� Print: 1(7 /'%/% --'// // 19 S/1"7 I Page-L of 3 Pages v• Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S I Cross-contamination i 1 59O.003(A) Assignment of Responsibility° I ( 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(61 Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge- duties I I Contamination from Raw Ingredients 3-302A I(A)(2) Raw Anumd Foods Separated from Each EMPLOYEE HEALTH I Other* J 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employee"and 13-302.11(A) Food Protection- ---- applicants* 13-302 15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An ( 3 204.11 Food Contact with Equipment and Applicant To Report To The Person in Utensils* Charge'- Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservtee of Food* I 3 590.003(D) Exclusions and Restrictions* � I 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* J 4 I Food and Water From Regulated Sources ( i 9 Food Contact Surfaces 590.004(A-B) I Compliance with Food Law* 4-501.111 Manual Waiewashing-Hot Water 3-201.12 I Food in i Hermetically Scaled Container" Sanitization'fettt eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashim< Hot Water 1 I I3-202.13 Shell Eggs* Sanitization Temperatures* 1-501.114 Chemical Sanitization-tem -1 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 P"pH 3-202.16 Ice Made From Potable Drinking Water* ( concentration and hudness. 5-101.11 Drinking Water from an Approved System" I 1-601.11(A) Equipment Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean- 590,006(B) l I Cleaning Frequency of Equipment Food- 59i).DU6(B) Water Meets Standards in Approved CMR 22ce I Contact Surfaces and Utensils* Fish ash and Fish Froman Approved Source 4-702.11 ( Frequency of Sanitization of Utensils and 4-201.14 Fish and Recreationally Caught ivtoliuscan Food Contact Surfaces oi'Equipment* Shellfish" 4-703.1 S I Methods of Sanitization-Het Water and 3-207.15 Molluscan Shellfish from NSSP Lssted Chemical" Sources* 110 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( Regulatory Authority 12.301.11 Clean Condi tion-Hands and Arms'' 3-202.18 Shellstock.Identification PrescidT ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 12-301.t4 When to Wash* 3-201.17 Game Animals* I I I II Good Hygienic Practices 2-401.1 1 g ReceivinglCondition I Emting,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Propel Temperatures* 12-401.12 Discharges From the Eyes,Nose and 3-202 15 Package Intearrv* Mouth* 1 Unadulterated* 3-301.12 Preventing Contamination When Tasting* 3-101.11 � Pcwd Safe and Lnadtilterated I � 6 Tags/Records:Sheilstock ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* l Tags/Records:Fish Products 113 Handwash Facilities ( 3-402.11 Parasite Destruction" Convenientiy Located and Accessible� ( 3-402.12 Records.Creation and Retention` 15-203.11 I Numbers and Capacities* 590.0040) Labeling of Ingredients' 5-204.11 I Location and Placement* ( 5-205,11 I Accessibility,Operation and Maintenance? Conformance with Approved Procedures I Y� I 1HACCP Pians Supplied with Soap and Hand Drying 3502.11 Specialized Processing Methods* ( Devices 13-502.12 Reduced oxygen packaging.crdetia* I 6-301.11 Handwashing Cleanser,Availability 8-103,12 Conformance with Approved Procedures- Denotes critical item in the ledend 1999 Food Code of 105 CMR 590000. r i j CITY OF SALEM (( BOARD OF HEALTH �/ { Establishment Name: MQ nA n c I h ' .J lre6 k U f4 _ Date: 1-I/Q_ '-)S? Page: of ( Item; Code C-Critical itemDESCRIPTION OF VIOLATION!PLAN OF CORRECTION Date i No. Reference R-Red Item - - Verified PLEASE PRINT CLEARLY " f in�nPr{inA reln< r--iy irfPd_ Tlno 4} ) outlnc. lternc I, hI Y1rtA'fe r.L_ ren In P r n I (- n'.; C I(%. v) t-lnicken t- rr,ccoli r pr_15-ctle 1 Anp�v, I I ' I I Ian 4nilntf11n� ca inn V)�+i0c4 .. _ -1-t �t 0 < ,t5t ct- - t nr)m -i-a w, re r f- 10 Pit i nr -to heinc,nc, t e) I`1 T U xt r n a +t ) Vnn --(~-f I er� kp rr e,,J� 11n1� I Cn✓-41`IIn Srl Dt�e t h . l A\�nt/c,�, IS Or4l? V&, rti�J > t11GG _P�<_ -P_ar_rn <nr_ocP rih . cabcace CPIPfv_1 I11l, cekn by Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / 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. i ❑ voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk i Act u!ding to U, Cclot,,d to Factors((Pears 1-22) fconf) I +I C W ltliin a Wzur,. * j j0 t 15 PROTECTION FROM CHEMICALS C%li'likl-, WI�As lot VHFs 14 Food or Color Additives 19 PHP Hot and Gold Holding 135;11 lfiilia CoN I'llFs Mallit"me:1 at.'ll:I'cloW 2 Addhliv-�' 1 590 004 0;) W/4V I;- 3-30224 i Protection from tiriappoped Addinves4 1. KIF"' Poisonous or Toxic Substances -1 loi.11 idIcIAl!"Ving Inumil'ititin -Ou"irall Comainm— �I-'5111 'A iji),F, 2f) Tims,as a Pubim Health Canty o3 allvIr'l, 3-im 7 102,11 0,mmoTiNanIt I Mill,I i SIparauon-Slot agt 7-202,11 Rc!lticoon 7-'_02.12 Ctladiiiomof(Jso' I-?03 [I Comajn':I; REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20-1.11 sallili"eN.Criteria cbelnic;'W POPULATIONS(HSP) 7-'()4.12 Clmwllcal�for Nli a,zhow ll'odiwe I CI im;,I, iiA) I 111 r'"I C irizi,d PoI-pad::q"ril Jul cts at(! T'204,14 Dning 4�eut,.Criteria- ,i nit Wilmin'r, 7 205.11 Invid.-IIIAl 1-(XA Cora am 1-1111)waills, il!P P two flirti:div IA,,k_d Allim-0 Foodend 7-206A) kc>mcle,l Llw Pe>ticides,Cnterili' 7-',On.12 kac'Stud:; NO S 3 HWl iird PkxA Pad,:I,ic N,Ii Rsvrcd ?-"06.1, Tricking llov%dcr:, PCs[('ontrol and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS t 22 a rU3 t 1 i:kllmimor An'iI,or' iIoa.:j li'r I"-iusujIIpw'n I,( Proper Cooking Tempa( for Aniic�l j-,lod,z Thal no, Rain, Uni-M,A,olied I.I ltr PHFs 3 101 I I A(I FL9:,- I55 s: 15 Src- l'3W.1 SI'hl;I�Iilo- tor RAW Shell Immediate senicr 145"Fl5wQ 1-410 1 1(02, Comminwed Mi;ats e, Gantt, Animals J,;:i F L� sr(- I SPECIAL REOU!RFMFNTS 101.l l(B)a Ili'11) [,,111,1)rd I"VC1 Ruilsi !"&F IZJ nuo j D) I- it)I 11(A)(��i R�mt,:,, McAt - 14�5 IF 1.5 s,c. " *zilorv;,n mobil- 3 4,t I I(A)0 I Poultry,Xi,ild 6ame. Suit red PH F,, c,1.11 liIal Kifchcvt openiliol's c.hovId Fc Swilling Cony-.wrung Fish.Mew, kh"I"Icd umd;'r the apprcprla"e ;Kil;AIS !'Ssec. " 'Wil'III" to I,Kx5rnt: ilfilcs� _3-401.11{() ,} Whol?-mooch. Intco Rcf Steaks Intel,. nt oTI,,and risk fitc-t(,m (Abor 145'F I 590.0(0 viol;auolit rolounlto luokid vct;61 q 401.12 11.)w !ijorikld Food+Cooked In a llraklic'N 'ho Ild Ik;11-hitcd wider b;?9 - Nlico)walr 165`14 Ali Otliet I"111 i-- 135'€' 15 sec. 17 j Reheating for Hot Holding WOLA PONS fIELATED TO GOOD RETAIL PRACTICES 3-401!1 iA),`i I D) llfil-i t(,5"F 15 sec. 4 Illems 23-39) 103,111 B) "livrowaw10,F , Nlmllw siandhlg r, .'wlldvph' ivoit'it Lto qo: ,"I'Ite;';I)a- mle, MW,vv•:!'...1)•(IndriAjou r,Ira it,!nl aia,vp, (an tr (C) ("hullo orad-,plixz;srj FTV I-I'KNI !uunri,),:h.Jro,!nu1:y helo,,d Coal,iIial P) f Ilk 140'P" Uii,lj�ed lloftiv -FC- 5-90,000- ns Pp. I FC 2 OW H, 3 W4 Proper Cooling of PHFS 4 Fcwl lliA, x)d Frolkcit,)n ?5, .'.-501,;4A) Coolitig C;lohI%I PKFr f'Iilu 144N to Wale.,r4.1nrIng Irid 701:Wiffint"floll,`��a!lil FW111'191 27, Pnili-,al Fa': F(-.'-- i$)7 1 2e F 008 w A 17145 F Wiann 4 How'. or'r�xz� 3504.i kl:} 1`14Ft.Madr,Rom Ambient -- i Tonipmolre III 41'F,145 0,6 , - -------J Within 4 Hour food Cw!,,r WSI,Alit5960;)i) + CITY OF SALEM ,� /� BOARD OF HEALTH (�� Establishment Name: It ICtridn r Ih �Unec P'o rt-'e t Date: 46'3(nR Page: of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Vete No. Reference R–Red Item - Verified PLEASE PRINT CLEARLY y Chicken wines czf w k ff-�-1- of I 1 'voc, rc�llS at + ono k 'Ie p f — 0-1-t'gk1+'(-f (1}� k0l,-7 GJ_d-)i,A i-rm_, m u log I ,off H e Irk t�1 I L 1 O'F clt v v;�I IS t vn nv or� tri- j " + 1 I I 1n�necl�C toi11l_ r, ,rt Ictc� Esta tiIi hrvtevtliv4��am�af�n i� NeedjA ��t-11,ef is�tAQs c�.ci�e. - 1 `- SaA'Vih_er CY+ 4r,or:,. C� 'S �I41.-)n J � Il6OhPf (-')1roil-�Yc�li ,r, } USanitcaian Caoo non, 64' c 11 bliwt.ps. 1 1 1 I Discussion With Person in Charge: Corrective Action Required: I Li 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. ✓ i l ` ��/��/''—� ❑ Voluntary Disposal 0 Other: -o 1,14(c PlIF's Re"lycd al Violations Roirted to Fofidborno 11loost;interventions and Risk to t cot'I'd t� Factors(Items 1-=) fiCortj i 41-045"T Within', Wuj� 3 ctiolin."WIllodN for PHP, PROTECTION FROM CHEMICALS 14 Foad or Color Additives 19 P 10,HF and Cold Holding oj, i CdIpHFS or h;it,k li4c) al`/41v F. 3-30114 j Vwpxkt,,i,) From � �)J �bj jj�'j PUI a %J',ljnlaikjed.t of ,- Po;, nous or Toxlc Substances 1401-, 7 101.1i tieunrville into,nl:itior, 0"ijmi,1 Ro'l,t: Held at or lbnvv i lvi• Collc&nler,- 1 Time as a Public Health Contra! 7.20 11 3-301 10 Timt, ,,s a Public lieaJdt Control' 7-202,11 P ,oktc)n 'al'i I— Requilcillclit 7-2112.12 condilioll,fli,Uic, 7-2w if Toxit,Cunn'mcl: - ploilthvilloO4 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) i-204.1 OictnicL,W 21 I'ap:mcurizt d Pro-paa.aged juice,;luv] 7-204.12 ChenliG?;s tor VVI'hng Clvoi i,l, with Walcille 7-2t},6.14 01�Jlw Agent,.Crm-list" Ci.;K(d jild RiKicni liw Rini.St"d Sjn01ltL`i Nut Ser FIA. lr.vllnd Fig,ij llackagv No R'! iv f 7'_06.1= fr,4ckina Po,,dz,�,l',,q Ctnaf0 and CONSUMER ADVISORY 21 3.60-;.11 (urlxujywv Ate vot v P(x;tod for i ouinniptnnt of TIMEIrREMPERATURE CONTROLS 16 1 Proper Cooking Tfarpotaftvai;;for Adliln,tl F 4 1 Filar il't kllw, 0t1dcrCx&vJ ul PHF& iia('411tir"se if)!_�.Itnlilww o4yfio, 3 401 11 A"1)(-, F�, �, ;5 i'i: 15 Sc.h j Subt,tina,- tci Rn",Shellaw� i�qv St., lc�, , i5�1 ),I�ec 3-40 1.111 A'i co,ulllniw ,%' f:, h, Mcw;& (tainu i-401.1 IiB)i!zi?; Poll,ant ll!vt ltfmm }'(#..(= ?<'s din` SPECIAL REQUIREMENTS I I(A)t 2) Roloie, lri!c;:tcd W:e, - 15S F E, 590009(A)-(t)f viollmoll"of Section Sr)(f(KNA)-R)t Itt cantrioF. mobic klod,tivpwary anj 3 40t.1 I(At`i l rem&nlifil kitchen opefationi;sinwic 1-c Fifin,Rfartt, dchlt'd under file apprupowc ieotollN P,.uttry c r kwicir,-165'1- 15 arc. abi've if V:hu,:d to frKxlIxwrfC illj,ps� 3-401,11iiO3) At: Intact flc.r inter,iontion,,and visil, hjctorr Other t4,-,I vlolation,,relatino to-okxj fvtai! 2 Raw An:nev Folf C,ok,:d to ti puwticox "Lliould be debited uitticr .41'rim,aw spovial 3.401 ll(Ai2 vb) Ali Olf"Iff Pill I %ti I. i, vei I 17 Reheating for Hot Holding j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3 -03.11(A}' (v) vIll- lo ; "I I (Iterus_13-30) 16' '.1"IQiaul,:Siliadir.g cri&.ai it;;(!non,o ron.01 vnilnp,inl, 'whicIz(I(,fill; reran If,nnr fodhorne i1F»nss but-,venoons evid KkA 116(turs ii,feJ ra-m", wi Lf, Comlll�16%lix,Pim RTE Iixi I foluld in tilt It'iblunkc �owto(ij dic Food I'lli C1,11, ;4WFt Ronxmn,LI!F11"nd Pnqfxp,of uce.l item T000g 4eaubructices iFC, 2-00.00-0 23 hAanagemeni and Peconnel FC 061 18 Proper Cooling of P"Fs 24 Fcoaana F000 Protection FC 3 604 IK- Equipre"ll and ulensi!s FG-4 605_- i %j J�llpc) Cwhrn�Cflk,,,d PHP- inini 140 t 'w6. Water.Pkmooq,nd Waste I FC-5 clon ?WT:Ntiiihm 2 14,lur.iay.l Frl,;n'H)-F 27 povs,"o Mliilv FC--G 00, O M to 4 1 Ti_15 F-W;tFwin A Ho , I r p(q-()no'js or ,r0fic: aterials Fc, - oe ' 350lA4(B1 Coolui,,PHF>%Vldc Front Ambient C30cther %\nhin4 ii�pjzl' Mr,,tee crit,it lmn,ina,wdvi;0 %It,5njj 1 i;ji) r 07?2019713 lor161m Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location III Mandarin Restaurant Mandarin Restaurant 40u Highland Avenue 400 Highland Avenue Salem, MA, 01970 Salem, MA, 01970 (978)-740-030+5 x (978)-740-0306 x Nancy or Tien Type: Emergent Routine f Cesspool: NA ' Yes b (,(e u� Septic Tank: No YesFVA Date of Pumping 6 6r Quantity Pumped: Gallons_ System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: Salem, MA. Date: U .a " Pumper Signature: /I Condition of System/Other Comments i RECEIVE® .APR - 4 2008 CITY OF SALEM BOARD OF HEALTFI Dep Approved Form-12/07/95 - 0222013830 aazarzoos Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Mandarin Rr+staurdrit M»,ndarin Restaurant 40u Higr,iand Avenue 200 Highland Avenue Sal*^+, MA, 01970 Salem, MA, 01970 19781 -740.0306 x (978) -740-0306 x ,, Ndncy or Ben Type: Emergenc Routine K9S"�_ Cesspool: No Yes No Yes Date of Pumping: Z/j� quantity Pumped: "c) Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: i Contents Disposed at: Date: Pumper Signature: r Condition of System/Other Comments bQ r RECEIVED � IJAN 5 2001 CITY OF SALEM BOARD OF HEALTH Dep Approved Form- 12/07/95 .HACCP Risk Assessment City/Town of: Salem, MA • . • Establishment Name–Mandarin Super Buffet j Ingredients Source Address–400 Highland Ave 11 Mussels Ipswich Shellfish Co., Inc. Person-in-Charge–Nancy Truong J Chicken Agar Vegetables(carrots,peppers,onions, broccoli, Solo Produce,Inc. cabbage&celery) Information for the Risk Assessment was obtained by: Eggroll shells Sun Hing Noodle Co. ❑ Observation of Suspect Food/Process Noodles United Foods Inc. ❑Observation of General Food Handling and Sanitation Practices Pastries King's Pastry E] Interview with Food Employee Responsible for Preparing Implicated Food. Sherbet I ❑ Interview with Person-in-Charge or Other Employee I Garelick Fars Weight/Volume of Suspect Food Prepared or Served: I Dates of Investigation: 4/23/08 PLEASE PRINT CLEARLY Describe Product Flow Describe Environmental Data Collected to HAZARDS Describe Corrective and Preventive Date " Verify Control or Lack of Control of Hazards -Contamination" Measures Initiated Verified (Preparation Steps)" , . Survival -Proliferation (Include changes in food handling procedures,orders ' Who,What,Where,When . - , for correction,embargoes/disposals,food employee - restrictions,food safety training,emergency suspensions and closures,etc.) ❑CCP Mussels.Mussels are delivered fresh every 1-2 PIC did not have tags for any shellfish on hand at Shellfish tags must be saved for 90 days from (Critical weeks from Ipswich Shellfish Co.Upon time of inspection. receipt of product;owner must save shellfish receipt they are put into covered buckets to the p Control walk-in freezer at-5°F.They are thawed in the tags for proper amount of time. Point) walk-in refrigerator a[32117,taken out& steamed in a wok,and put out at the buffet.At time of inspection,mussels being held at a temperature of 142.5°F. Page: Number—of_ HACCP Risk Assessment Report Farm(Updated 09/05) Curry Chicken:chicken,canons,peppers& Some whole vegetables in the walk-in refrigerator All food in storage, including all vegetables, onions.Chicken is delivered twice a week were uncovered. must be covered to prevent cross-contamination. from Agar.Upon receipt it is chopped into ❑CCP small pieces and put in a covered container in the walk-in freezer at 5°F.It is thawed in the walk-in refrigerator at 32°F,cooked in a wok with the vegetables&curry powder,and put at the buffet immediately.At time of inspection, it was being held at a temperature of 141 oF. The vegetables are received once a week from Solo Produce Co.,and stored in the walk-in refrigerator at 32°F in either their original containers or covered plastic containers.They are taken out as needed,chopped,and cooked in a wok. General Gao's Chicken:chicken is delivered twice a week from Agar Upon receipt it is cut &fried immediately,and stored in covered ❑CCP containers in the walk-in refrigerator at 32°F.It is taken out as needed,cooked in a wok with vinegar,sugar&salt,and put out at the buffet At time of inspection,it was being held at a '.. temperature of 151 8°F Chicken&Broccoli:chicken is delivered twice a week from Agar Upon receipt it is chopped into smaller pieces and put in a ❑CCP covered container in the walk-in fridge at 32°F When needed,it is taken out&placed in a small refrigerator at the cookline at 38°F in a covered bowl,then cooked with the broccoli in a wok and put out at the buffet At time of inspection,it was being held at a temperature of 145 8°F Broccoli is delivered once a week from Solo Produce and stored whole in a covered container in the walk-in fridge at 32°F It is taken out as neeed,chopped,and cooked with the chicken. Page: Number_of HACCP Risk Assessment Report Forth(Updated 09105) Chicken wings:the chicken wings are Chicken wings out at the buffet measured at Chicken wings not being held at correct delivered twice week from Agar and smreed container in the walk138.5°F. temperature;potentially hazardous items must be ❑CCP refrigerator at 32°F.When needed,they in their original container mum temperature held hot at a miniof 140°F. tkaen out of the walk-in and put in a covered Chicken wings discarded at time of inspection. bowl in a small refrigerator at the cookline at 4IT,and fried in the fryolator. After being fried,they are put directly out at the buffet.At time of inspection,wings were being held at a temperature of 138 5°F Eggrolls:eggroll shells,spare rib,cabbage,& There was a large amount of eggrolls out at room Eggrolls may not be held at room temperature celery.Shells are delivered once a week from temperature waiting to be fried. while waiting to be fried;they must be put into Sun Hing Noodle Co.Boneless spare rib refrigeration and held at 41°F or below. ❑CCP delivered 1-2 times a week from Agar in large The eggrolls at the buffet were at a temperature of g pieces,and upon receipt are cut into smaller pieces and stored in covered containers in the 137.4°F. Eggrolls not being held at correct temperature at walk-in reftigerator at 32°F.For the egg rolls, the buffet;potentially hazardous items must be spare rib is removed from the walk-in,ground held hot at a minimum temperature of 140°F. in a mixer,and combined with chopped cabbage and celery to be rolled into eggrolls; Eggrolls discarded at time of Inspection. eggrolls are then fried in the fryolator. Vegetables delivered once a week from Solo Produce,stored whole In the walk-in refrigerator at 32°F,and as necessary,taken out&chopped to be combined with the spare rib for eggrolls.The eggrolls are put out at the buffet,at time of Inspection,they were being held at a temperature of 137.4°F. Lo Mein noodles,green peppers,onions, carrots.Noodles are delivered twice a week from Untied Foods Inc.,and stored in their []CCP original bags in the walk-in refrigerator at 32°F.They are taken out as needed,boiled, and held in a small refrigerator at the cooklme at 33°F until cooked in a wok with vegetables. Vegetables delivered once a week from Solo Produce,stored whole in the walk-in refrigerator at 32°F,and taken out as necessary,chopped and cooked in the wok with the noodles. Page: Number_of_ HACCP Risk Assessment Report Fenn(Updated 09105) • Pastries;pastries delivered every 1-2 weeks as needed from King's Pastry and stored in their original box in the walk-in fieezer at-5"F. ❑CCP They are taken out as needed and put in a small refrigerator at the desert bar at 40PF,and pastries put out as necessary. Orange sherbet:delivered from Garehck Fames once a week.Stored in original containers in walk-in freezer at-5°F until needed,then taken ❑CCP out and put in ice cream fieezer at 0°F. Comments: Some knives stored in plastic knife container had accumulation of food debris on them. All knives must be properly washed, rinsed, and sanitized prior to being put in storage for use. Sanitizer reading too strong at 400ppm. Ensure sanitizer of proper concentration (200ppm) is available at all times. Page: Number_of HACCP Risk Assessment Report Form(Updated 09/05) RADIO � ` SERVICE REPORT -DISPATCHED Gtt! WAREWASHING Coyle Detergent Services N 200 Weymouth St. Rockland,MA 02374 781-741-8080 9 Fax: 781-741-2525 Commercial Detergents, Cleaners and Sanitation Products 4 /� CUSTOyrF'a } ' i i7ATR ADDFFee l T12MY Ili: E it .Ll . ----- CITY&STAmF r.-.. I 1 PREVENTATIVE MAINTENANCE SERVICE MACHINE IN USE 'LOW-TEMP.MACHINE u j EMERGENCY SERVICE NEW INSTALLATION G COUNTER# I — WAREWASHING OPERATION, MACHINE& DISPENSERS — MACHINE MODEL ',,{�., 1-fi ALKALINITY " MAKE ' .3�. la,r' &SERIAL# ; �, CONCENTRATION PPM PRE-WASH WASH �, RINSE FINAL RINSE 'CHLOR tt�� TEMPERATURES: TANK '^'""""" �F TANK!GvFTANK ._..,...-. �F RINSE �F PRESSURE -'' PSI _RINSF "�'" PPM I LOCATION I CH- AZ'V$1 CLEAN RIPS ' CHECK AJJ)I TiCLEAN REPAIR I RESULTS i 1 Detergent Control 18 Wash Arms I ITEMS i GOOD cF OTHER 12 Rinse injector i i9 Rinse Arms � 151 Cups l i 13 Pumofsl 10 Scr?ens 16 Glasses I 14 Motors 111 Switphea 1 �17 j Dishes 15 Valves 112 Conveyor (_ 18 Flatware" ! 16 By-Pass Water Go]/Min I 13 Doors 8 Safety Switch, ,,, !19 Racks- 17 Drain I 114 Curtains i - ( •20 Pot-Pans - I 1 COMMENTS ON OPERATION: I21 Employas Training 1 WORK PERFORMED : C L _/ a':. ,.. _ 22Operating Chart 2311 Racking _ -, - 4, 1 - - (24 I Pre-Scrapping I' c:. '`'r, �. 77. 12,. Cleaning of EDT I j ti>} r:T:' 126 { CUSTOMER SERVICE TECHNICIAN Name j r 1-„ . # q Date I� CLEANING SUPPLIES INVENTORY I MATERIALS USED OR STOCK DELIVERED I I TYPE PRODUCT r�" NR,NaII ORDER QUANTITY PART.NUMBER & DESCRIPTION PRICING I Machine Dateroent I Rinse Agent - i II Pre-Soak Pot 8 Pan Sanitizer Floor Product MISC. - i It i /r Service DATE TO RECEIVE ORDER customer ❑ Signature X Total rI I_ � I 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:The dish washer has a final rinse temperature of 173°F and an alarm sounds between cycles. Dish washer must be Binh & Chau, Inc. serviced to insure a minimum rinse temperature of 180°F is reached and to determine why the alarm is sounding. PIC: Inspector will inspect the dish machine and review the repair invoice on 3/31/08. Nancy Truong - GENERAL COMMENTS: Inspector: David Greenbaum All other violations cited in the 3/20/08 inspection report have been corrected. Date Inspected:',Correct By: 3/27/2008 Risk Level: Permit Number: BHP-2008-0205 Status: PARTIAL COMPLY #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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page ] ort i Item Status Violation Critical Urgency i 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 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Apr 02,2008 ) Page 2 oft 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 1740-0306 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED !0 wrier: Comment:The dish washer has a final rinse temperature of 173°F and an alarm sounds between cycles. Dish washer must be Binh $Chau, Inc. serviced to insure a minimum rinse temperature of 180°F is reached and to determine why the alarm is sounding. IPIC: Good Hygienic P actices FAIL Critical ❑d RED Nancy Truong mment: Employees drinks observed in the food prep areas. Employees must eat and drink in a designated employee area or in I Inspector: he dining room to prevent cross contamination. I David Greenbaum Handwash Fad"es FAIL Critical ❑d RED Date Inspected:Correct By: 13/20/2008 - mment: Employees observed washing pots in the hand wash sink. Hand washing sinks must be used for hand washing only. iRisk Level: TIMETTEMPERATURE CONTROLS(Potentially Hazardous Foods) Time As a Pu Health Control FAIL Critical RED j Permit Number: mment:Chicken wings out at room temperature at 63°F. Hold PHF at 41°F or lower or T 140°F or higher. Chicken wings BHP-2008-0205 iscarded at time of inspection. Status: 1 VIOLATION #of Critical Violations: 4 I Time IN: Time OUT: 9 Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected g immediately or within 10 days)(Non-critical violations ; must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2008 ) Page I oft Item Status Violation Critical Urgency RED: I Violations Related t cod Retail Practices (Blue Items) Violations Related to Equipment an tensils FAIL Non-Critical BLUE Foodborne Illness Interventions! and Risk Factors (Require mm Delfield#17 unit needs general cleaning. immediate corrective action) } 7he Sout nd grill has an accumulation of grease. Thoroughly clean the grill. Ito Shamm warmer needs thorough cleaning. evge air reach in needs thorough cleaning. T dry ingredient area has an accumulation of food debris. Thoroughly clean this area. gaurds in the walk in have an accumulation of dust. Thoroughly clean the fan gaurds. e walk' freezer floor needs thorough cleaning. e dining room ice cream freezer has an accumulation of food spills and splatter. Thoroughly clean the ice cream freezer. PhysicalLFadl� FAIL Non-Critical BLUE There are water stained ceiling tiles in the back wait station. Investigate the source of the leak and repair. Replace all iling tiles. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. L/ City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2008 ) Page 2 oj2 Commonwealth of Massachusetts s � City of Salem Board of Health 120 Washington Street,4th Floor IGmbedey DriscollMayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Mandarin Super Buffet File Number:BHF-2004-000039 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-2008-0205 Jan 4,2008 Dec 31,2008 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the SalemBoardof Health. Page 16 of 24 3v� t CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL.(978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 �� MAYOR ISCOTfaa SALEM.COM AEFO JOANNE SCOTT, a C1 Nov2 72007 HEALTH AGENT 0A�O111�4-OF M 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD/1 ESTABLISHMENT NAME OF ESTABLISHMENT JNJATI �1+ t �,I` SV D� d r--Ff TEL# ADDRESS OF ESTABLISHMENT yD8 /11 is R) JNA VE— FAX# MAILING ADDRESS(if different) SA M�-7. EMAIL-Business': Website: VAP OWNER'S NAME HAD lRvo/k/G-- TEL# �V429-SV,') ADDRESS /2 �.LLia(T S T 916V,519L11 MA dx/S STREET CITY STATE ZIP �y CERTIFIED FOOD MANAGER'S NAME(S) (HAI) - 7ZU vl&- CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON V� INS-/-T11NN Amd (1. � 1 P-ubNG HOME TEL# 9�� 92�S 7b� DAYS OF OPERATION I Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION . Ili—/pp" IlAyh-loplv7 IIAM~IoPM IIAM-l0'PM IlNM- 12%M 11A M- /2?M IIpM Please write in time of day. (Forexample Ilam-11pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 __ RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats more than 69 seats ytitu BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES ------------------------------------------------------------------------------------------------- ------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. t,:, , This Permit is not transferable and must be reissued upon chir_rge,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 Boats of;Hedl lfh:i%r. � Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains 1ndpenaltibs df'perjury that I,to my best knowledge and belief,have fled all state tax returns and paid all state taxes required under the law. Signature Date �� Social Security or Federal Identification Number bL � ----- �O 1 ,j ----1--------- - Revised 4/24/07 FOODAP2008 adm Check#&Date 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Separation/Segregation/Protection PASS Critical RED Owner: Comments:The top of the Delfeild#17 unit has uncovered on top of each other. Repair unit to separate all food items to prevent Binh & Chau, Inc. cross contamination. PIC: Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑d RED Nancy TfUong Comments:The sanitizer fo the dishwasher sounded at the rins cycle. Dishes do not appear to be being sanitized properly. Inspector: Dishwasher must be serviced to insure proper sanitizing. Repairs must be made immediately and the 3 bay sink must be used to David Greenbaum wash, rinse and sanitize all dishes and utensils. Date Inspected:Correct By: Dirty knives and utensils found in the knife holder. All knives and utensils must be properly cleaned and sanitized prior to storage. 9/20/2007 Risk Level: Permit Number: BHP-2007-0180 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS@ 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:The Beverage air vegetable unit has uncovered food. All food in storage must be covered. immediate corrective action) The walk in freezer has food stored directly on the floor. All food must be stored at least 6-8 inches off the floor. The walk in freezer has uncovered food.All food in storage must be covered. Equipment and Utensils PASS Non-Critical BLUE Comments:The True reach in needs a general cleaning. The shelving in the walk in has an accumulation of grime. Thoroughly clean all shelving. The Delfield#17 unit needs a general cleaning. The grease barrel has an accumulation of grease spills and splatter. Thoroughly clean the grease barrel. The canopener has an accumulation of grime. Thoroughly scour the canopener. The ice machines need a thorough cleaning inside. There is an accumulation of food spills at the dry ingredient barrels. Thoroughly clean this area. Physical Facility PASS Non-Critical BLUE Comments:There are gaps around the back screen door. Seal all gaps. The flooring throughout the kitchen needs a thorough cleaning,including under and around all equipment. Other-See Notes PASS BLUE Comments:A complaint was received regarding a customer possibly being bitten by fleas. Owner must contact the licensed pest control operator and have the establishment inspected for fleas. Owner must comply with all recommendations of the pest control operator to abate any ties infestation. GENERAL COMMENTS: All violations cited in the 9/12/07 inspection report have been corrected:' City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2007 ) Page 2 oft 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM NTAMINATION 740-0306 Separation/Se gation/Protection FAIL Critical ❑d RED Owner: C mment:The top of the Delfeild#17 unit has uncovered on top of each other. Repair unit to separate all food items to prevent Binh & Chau, Inc. cross contamination. PIC: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Nancy Truong Comment: The sanitizer fo the dishwasher sounded at the rins cycle. Dishes do not appear to be being sanitized properly. Inspector: !/ Eliishwasher must be serviced to insure proper santizing. Repairs must be made immediately and the 3 bay sink must be used to David Greenbaum XDn' nd sanitize all dishes and utensils. Date Inspected:Correct By: nd utensils found in the knife holder. All knives and utensils must be properly cleaned and sanitized prior to storage. 9/12/2007 Risk Level: Permit Number: BHP-2007-0180 Status: VIOLATION # of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 13,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related t9 Good Retail Practices (Blue Items) Violations Related to Food and Food.Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Cgmmenl The Beverage air vegetable unit has uncovered food. All food in storage must be covered. immediate corrective action) ( Tti�e m freezer has food stored directly on the Floor. All food must be stored at least 6-8 inches off the floor. 1V7 walk in freezer has uncovered food.All food in storage must be covered. Equipment and yltensils FAIL Non-Critical BLUE ,Cgm�me t:The True reach in needs a general cleaning. VT shelvi g in the walk in has an accumulation of grime. Thoroughly clean all shelving. field#17 unit needs a general cleaning. T e ease barrel has an accumulation of grease spills and splatter. Thoroughly clean the grease barrel. The canopener has an accumulation of grime. Thoroughly scour the canopener. T i e machines need a thorough cleaning inside. ( /T�{e/ref is a/ry�ccumulation of food spills at the dry ingredient barrels. Thoroughly clean this area. Physi IC3 Facilit/ FAIL Non-Critical BLUE , 7m nt:There are gaps around the back screen door. Seal all gaps. e flooring throughout the kitchen needs a thorough cleaning, including under and around all equipment. Other-See Notes FAIL BLUE C menta A complaint was received regarding a customer possibly being bitten by fleas. Owner must contact the licensed pest ontrol operator and have the establishment inspected for fleas. Owner must comply with all recommendations of the pest control operator to abate any fles infestation. GENERAL COMMENTS: 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 13,2007 ) Page 2 oft Page 1 of 2 Joanne Scott From: Joanne Scott Sent: Tuesday, September 04, 2007 9:16 AM To: Tom Watkins Subject: REGeneral Comments about Salem Hi Tom: We require all food establishments to have the services of a Licensed Pest Control Operator monthly. We will follow-up with this complaint and have their Pest person determine if there is a problem and then handle it appropriately. Do you want me to let the complainant know what we find out? Joanne From: Tom Watkins Sent: Tuesday, September 04, 2007 9:12 AM To: Joanne Scott Cc: Jason Silva Subject: FW: General Comments about Salem Hi Joanne— I was hoping you could help out with another email inquiry I recently received (please see below). Thanks in advance for any help/insight you may be able to provide. I was not sure the best course of action, if any, this individual may be able to take but thought you might be able to best assist her. Tom From: [mailto:jrock9781@aol.com] Sent: Friday, August 31, 2007 1:46 PM To: Tom Watkins Subject: General Comments about Salem Request From:Jennifer Rockwood Email: irock9781 naol.com Address: 28 Eden Street City: Salem State: Zip: Phone: 978.239.2116 Organization: On Wednesday,August 29,2007,1 visited the Mandarin Super Buffet,located at 400 Highland Avenue in Salem. I had dinner with a 9/4/2007 ` Page 2 of 2 friend and atter 20 minutes of dining,we both started to itch immensely. After another 10 minutes we decided to leave and when we walked out of the restaurant our ankles and lower calves were covered it what appear to be flea bites. I do not know how to file a formal complaint as I am only a visitor passing through Massachusetts,however,this has ruined my long weekend as my ankles are covered in about 10 bites. They could be mosquito bites however,we were indoors and they only appeared on our ankles,feet and lower calves. I hope that this complaint does not go unoticed. Please contact me or my friend if you need any further information. Thank you, Adrianne Cherpak 631.384.1798 acheroaka vahoo.com 9/4/2007 � I i a IMPORTANT MESSAGE ' FOR OATF TIME .M. OF //��..� PHONE_ZX 7 � y AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE MBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU:" RUSH RETURNED YOUR GALL WILL FAX TO YOU., MESSAGE .71 i n d NEDj��)� i FORM 4' 9 1/ Y MADEINUSA ` r NOTES i . I . 1 { IMPORTANT MESSAGE ` FOR DATE 5--6 /:L�07 TIME o M OF PHONE ��n " "7! 11--0964 AREA CODE NUMBER EXTENSION O FAX ❑ MOR IF AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE ALL CAME TO SEE YOU WILL CALL AGAIN x WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE ;14 Ct' Y SIGNED SFORM 009 MADE I 5 A NOTES I IMPORTANT MESSAGE FOR DATE M � OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBU F AREA CAME TO SEE YOU coo VLEASE OAS A6 ER TIME TO CALL I TELEPHONED L S L AIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU ME ;SAG r ia/ ti Y SIGNED MYWFORM 4009 MADE IN U S A NOTES V P 0222014543 tB2N200s &7� Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Mandarin Restaurant Mandarin Restaurant 4010 Highland Avenue 400 Highland Avenue Salem, MA, 01970 Salem, MA, 01970 (9716)-740-0306 x (978)-740-0306 x Nancy or Ben Type: EmergentRoutine G r�Rk Cesspool: No / Yes Som Tank: No F7 Yes ' Date of Pumping: 3 J6 0 7 Quantity Pumped: /401) Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: �� " /y" 7T6 Date: Pumper Signature: 'Condition of System/Other Comments r .:r RECEIVED MAY 7 1001 CITY OF SALEM BOARD OF HEALTH Dep Approved Form-12/07/95 ti } 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Handwash Facilities PASS RED Owner: Comments: Bar handwash sink has containers stored in it. Sink to be used for handwashing only. Binh & Chau, Inc. PIC: All hand wash sinks require new signs. Provide signs. Nancy Truon9 Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection PASS Critical BLUE John Gehan Date Inspected:!Correct By: I Comments:Walk in unit has uncovered folds. All foods must be covered. 2/112007 Walk in freezer has uncovered foods. All foods must be covered. Risk Level: Equipment and Utensils PASS BLUE Permit Number: Comments: Inside ice machine panel has accumulation of grime. Clean inside panel. BHP-2007-0180 Status: Walk in shelves requires general cleaning. SIGNED OFF Pepsi refrigerator requires general cleaning. #of Critical Violations: 0 Shelves that hold plates in kitchen require general cleaning. Time IN: Time OUT: Wait station in back corner drawers require general cleaning. Urgency Description(s): Physical Facility PASS BLUE BLUE: Violations Related to Good Comments: Back door has visible air gap. Provide seal to prevent entrance of rodents/insects. Retail Practices (Critical Emergency door has visible air gap. Provide seal to prevent entrance of rodents/insects. violations must be corrected immediately or within 10 days)(Non-critical violations GENERAL COMMENTS: must be corrected immediately All violations froml/25/07 have been corrected. or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 01,2007 ) Page 1 of? ' 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. Feb 01,2007 ) Page 2 oft 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Handwash Facilities FAIL RED Owner: Comment: Bar handwash sink has containers stored in it. Sink to be used for handwashing only. Binh & Chau, Inc. PIC: -'All hand wash sinks require new signs. Provide signs. Nancy Truong Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE John Gehan Date Inspected:Correct By: —Comment:Walk in unit has uncovered folds. All foods must be covered. 1/25/2007 ,Walk in freezer has uncovered foods. All foods must be covered. Risk Level: Equipment and Utensils FAIL BLUE Permit Number: I'e ...Comment: Inside ice machine panel has accumulation of grime. Clean inside panel. BHP-2007-0180 Status: ,..Walk in shelves requires general cleaning. Open 'Pepsi refrigerator requires general cleaning. #of Critical Violations: s 2 _,SWelves that hold plates in kitchen require general cleaning. Time IN: Time OUT: Wait station in back corner drawers require general cleaning. Urgency Description(s): Physical Facility FAIL BLUE BLUE: Violations Related to Good Comment, Back door has visible air gap. Provide seal to prevent entrance of rodents/insects. Retail Practices (Critical violations must be corrected __,Emergencydoor has visible air gap. Provide seal to prevent entrance of rodentslinsects. 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. Jan 25,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) i , 1 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 25,2007 ) Page 2 oft CITY OF SALEM, MASSACHUSETTS g^+ �@ S BOARD HEALTH RECEIVED 120 WASHINGTON STREET, 4TH FLOOR DEC ! �2006SALEM, MA 01970 EC TEL. 978-741-1800 CITY OF SALEM FAX 978-745-0343 BOARD OF HEALTH Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Jt4IV� I P j �LD7JZ 8&",, TEL# M-740 - 016,4' ADDRESS OF ESTABLISHMENT 460 HIGH ND Aklr2- FAX# 117 .QUI - 576f2 MAILING ADDRESS (if different) � A_dnH_ A61)I � _ EMAIL--Suslnes� n : t5wua„P Owner's: &tba -Q_-_ _ OWNER'S NAME l7 /11TH '��11�I'1 TEL# ADDRESS �rlZ LI 1 l(' , 4 f Ub 7 PIA 11- STREET CITY STATE Z{IP//;; CERTIFIED FOOD MANAGER'S NAME(S) CHAD '" TP-015N6- CERTIFICATE#(S) / 0 f f i4 t<i"1 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 13 NAq I p-"Nlq 4 �N y 'T"P N(�HOME TEL# q71- q'127' 3�-?yt` ARTS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday POURS OFOPERArite Ineloday. I/AM-tD�rR tt�`-`!�'tjdi` 11A4ti-1op9K- ttQan-IDS IlhaK- Il�u.«.; I(A+n-ting-,._ IIA4l,.— flrase � (for example iiam-iinm) 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 25-99 seats more than 99 seats =$200 _.... _ .._........... - -- - - - -- ---- $ .-$,1-0-0,", ,- - ...._. .. --.- .. _ _ . ----...--- BED/BREAKFAST YES NO $100 ---- ----......-.... ...... ---- -... ......... .... --- ----- ._- ..... .... .... .. ._. ..... ...__..._ ....... -- ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the'paIiins and perialties of perjury that IJ to my best knowledge and belief, have filed all state tax returns and paid all state taxesr quired under the law 1112 Signature Date Social Security or Federal Identification Number --------- ----------------------------- ---- - -, - - -j - - - - - - - - Revised 11113/06 FOODAR2007.adm Check#& Date . (Z _] � //7�jF i�-0 Imo" hN' --M1.4-It -fiq;' 4ZI I Ssa jlgs) SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Mandarin Super Buffet File Number:BHF-2004-000039 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-2007-0180 Dec 20,2006 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2007 Board of Health U This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 8 w f Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to 767:All violations cited in the 8/16/06 inspection report have been corrected. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) '7 / 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. Aug 28,2006 ) Page 2 oft c 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency 'Telephone: PROTECTION FROM CONTAMINATION 740-0306 Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑J RED :Owner: Comments:The plastic silverware in the kitchen must be placed going in one direction handle side up. Binh &Chau, Inc. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) PIC: Hot and Cold Holding PASS Critical ❑d RED Nancy Truong Inspector: Comments:The right Beverage air cooling unit has a temperature of 50"F. Repair unit to maintain a temperature of 41"F or below. David Greenbaum Violations Related to Good Retail Practices (Blue Items) Date Inspected: Correct By: Food and Food Protection PASS Critical BLUE 8/28/2006 Comments:There are dirty pots in the produce sink.Produce sink to be used for produce prep only. RISK Level: The left Beverage air cooling unit has uncovered food. All food in storage must be covered. Permit Number: The right Beverage air cooling unit has uncovered food. All food in storage must be covered. BHP-2006-0150 The Beverage air vegetable unit has uncovered. All food in storage must be covered. Status: SIGNED OFF There are paper goods stored directly on the floor upstairs. Store all paper goods at least 6-8 inches off the floor. #of Critical Violations: The dry ingredients in the cookline must be kept covered. 0 Equipment and Utensils PASS Non-Critical BLUE Time IN: Time OUT: Comments:The Auto Shaam oven needs a general cleaning. Urgency Description(s): Provide a new sign for the back hand wash sink indicating where the sink is. BLUE: Violations Related to Good There is an accumulation of food debris near the flour and rice barrels. Thoroughly clean this area. Retail Practices (Critical violations must be corrected The Pepsi True cooling unit needs a thorough cleaning. immediately or within 10 days)(Non-critical violations The entire cookline is in need of a thorough cleaning. must be corrected immediately The knife holder in the prep line has an accumulation of food debris and grime. Thoroughly clean the knife holder. 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. Aug 28,2006 ) Page I oft 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Food Contact urfaces Cleaning and Sanitizing FAIL Critical J❑ RED Owner: omment:The plastic silverware in the kitchen must be placed going in one direction handle side up. Binh & Chau, Inc. TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) PIC: Hot and Cold Holding FAIL Critical (] RED Nancy Truong Inspector: Lpdfnment:The right Beverage air cooling unit has a temperature of 60'F. Repair unit to maintain a temperature of 41°F or below. David Greenbaum Violations Related to Good Retail Practices (Blue Items) Date Inspected: Correct By: Food and Food Protection FAIL Critical BLUE 8/16/2006 C ment:There are dirty pots in the produce sink. Produce sink to be used for produce prep only. Risk Level: ee Beverage air cooling unit has uncovered food. All food in storage must be covered. Permit Number: t Beverage air cooling unit has uncovered food. All food in storage must be covered. BHP-2006-0150 T e Beverage air vegetable unit has uncovered. All food in storage must be covered. Status: VIOLATION Th a are er goods stored directly on the floor upstairs. Store all paper goods at least 6-8 inches off the floor. #of Critical Violations: The ingredients in the cookline must be kept covered. 3 Equip t and tensils FAIL Non-Critical BLUE Time IN: Time OUT: C men t•The Auto Shaam oven needs a general cleaning. Urgency Description(s): r id new sign for the back hand wash sink indicating where the sink is. BLUE: P Violations Related to Good ere is an accumulation of food debris near the flour and rice barrels. Thoroughly clean this area. Retail Practices (Critical violations must be corrected T e7 i True cooling unit needs a thorough cleaning. immediately or within 10 T en cookline is in need of a thorough cleaning. days)(Non-critical violations must be corrected immediately a knife holder in the prep line has an accumulation of food debris and grime. Thoroughly clean the knife holder. 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. Aug 17,2006 ) Page / of f Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to 750:Reinspection will be on 8/28/06 all violations to be corrected. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 17,2006 ) Page 2 oft 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone; PROTECTION FROM CONTAMINATION 740-0306 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑Q RED Owner: Comment:Cutting board on True unit stained and scored. Resurface or replace the cutting board. Binh & Chau, Inc. PICViolations Related to Good Retail Practices (Blue Items) Nancy Truong Food and Food Protection FAIL Critical BLUE Inspector, Comment: There is uncovered food in the Delfield cooling unit. All food in storage must be covered to prevent cross David Greenbaum contamination. Date Inspected: Correct By: GENERAL COMMENTS: 2/14/2006 482:AII other violations cited in the 2/7/06 inspection report have been corrected. Risk Level: Permit Number: BHP-2006-0150 Status: SIGNED OFF #of Critical Violations: 2 Time IN, Time OUT Urgency Description(s): BLUE. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 15,2006 ) Page 7 oft 1 Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 15,2006 ) Page 2 oft 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-0306 Separation/Segregation/Protection FAIL Critical ❑Q RED Owner: j/Comment: Bowls stored directly on top of other food products. Do not store bowls directly on food to prevent cross contamination. Binh $ Chau, Inc. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Q RED PIC. Nancy Truong Comment: Cutting board stained and scored. Resurface or replace the cutting board. Inspector. ✓ Dish washer has major leak. Repair dish washer to good working order. David Greenbaum Date InspectedCorrect By: ✓The interior panel of the left ice machine has an accumulation of grime. Thoroughly clean and sanitize the entire ice machine. : 2/7/2006 Handwash Facilities FAIL Critical RED Risk Level: iAllComment: The right side employees restroom missing soap. Provide soap in this restroom at all times. TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) I Permit Number: Hot and Cold Holding FAIL Critical ❑d RED BHP-2006-0150 ✓ Comment: Eggs found stored out at room temperature. Store all cold potentially hazardous foods at a temperature of 41°F or Status: below. VIOLATION #of Critical Violations: 5 Time IN: Time OUT: Urgency Description(s). BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 08,2006 ) Page I oft Item Status Violation Critical Urgency RED. Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Y Comment:there is uncovered food in the walkin, Delfield and True cooling units. All food in storage must be covered to prevent immediate corrective action) cross contamination. Equipment and Utensils FAIL BLUE Comment:The rice utensils stored in water. Store rice utensils in a clean,sanitized container labeled"Rice Scoop" ✓The vent fans in the walkin have an accumulation of dust. Thoroughly clean fans. V The racks in the walkin have an accumulation of mold and grime. Thoroughly clean all racks. V The floor of the walkin freezer needs a thorough cleaning. There is cardboard and rags attached to the Ansul vent hood. Remove all card board and rags as this is a fire hazard. The microwave needs a thorough cleaning. /There is a blocked floor drain near the back handwash sink. Thoroughly clean this drain. (,There is an accumulation of food spills and splatter on the dry ingredient barrels and rack. Thoroughly clean barrels and rack. Physical Facility FAIL Non-Critical BLUE VComment: Grease barrels to raised off ground. V The lights under the bar missing covers. Provide protective covers on bar light fixtures. GENERAL COMMENTS: 465: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. Feb 08,2006 ) Page 2 oft Commonwealth of Massachusetts sr 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: Mandarin Super Buffet File Number:BHF-2004-0039 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-2006-0150 Jan 3,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES IDecember3l, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 12 e CITY OF SALEM, MASSACHUSETTS g;2 BOARD OF HEALTH <" 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 "0N8 TEL. 978-741-1800t(�� 0//-), �� oee 0 O -745 STANLEY J. USOVICZ, JR. FWWW.3ALEM-000M3 vO'1/��Q ®?0os MAYOR JOANNE SCOTT, MPH, RS, CHO OoFHA<<c' HEALTH AGENT ��4f 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTXAm'pAlQ;N OPUL TEL# ADDRESS OF ESTABLISHMENT NOb HI O N-A,,A MAILING ADDRESS (if different) A OWNER'S NAME �� iT)�j )TYINI-J_ CH�' �RildllCT TEL#(_Ut7B� �2�-��S(j ADDRESS '� 12 k- P-TT S CITY 1Z-LV'(^'v2 -o STATE MA ZIP 0 Ill I / CERTIFIED FOOD MANA(3ER'S NAME(S) C,H/ill - X21/D-AI erg- CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON C H All - TP-Li D Nlr HOME TEL 447 9) 92,:7-S IS 0 HOURS OF OPERATION: Mon.&JLTue.If 10 Wed. No Thu. 11- /0 Fri./1-// Sat.11- 11 Sun.jQ- 1 r7 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - - ...................................................-------...------------------------------------- -------------- RESTAURANT YES NO less than seats =$100 D 25-99 seatsis =$150 more than 99 seats <Z- 2:0:0 - - ................................-----------------.....-----------------------------$-10--.......-------- BED/BREAKFAST YES NO 0 ------------------------------------------------------------------------------------------------------------------------------------------------------------ ADDIT!O":AL PERMITS - MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO .- $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. �I:�iL✓ \ ,2lylo s`;� ` � ' � IN � r71- 068��181 Signature _ Date Social Security or Federal Identification Number ------------------------------------------------------------------ ----------------------------------------------------------------- Revised 11/03/05 FOODAP2 adm Check#&Date ?la-�� and p'��/I�_, �C y Fro"- e t f �y a\1 h f b t \� � � � "�� N e i1 '�l � t \ � r , \ 1 , ♦ \ � \ \` 1 \L ( � � � \ � \\ � ` � �� / !r jf. /�� x� iNwv, .r1�u1��fi 3"a/1.tiFs 't % #J Aa,.j-r oo s I 7 q I �. 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 740-0306 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Binh & Chau, Inc. Tobacco PASS ❑ PIC: Nancy TfUOng FOOD PROTECTION MANAGEMENT Done N I ancy T g PIC Assigned/Knowledgeable/Duties PASS ❑d RED David Greenbaum EMPLOYEE HEALTH Done Date Inspected: Correct By Reporting of Diseases by Food Employee and PIC PASS ❑d RED 10/3/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASSJ❑ RED BHP-2005-0104 - Receiving/Condition PASSd❑ RED Status: Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED SIGNED OFF #of Critical Violations: Conformance with Approved Procedures/HACCP PASS Q RED Plans - PROTECTION FROM CONTAMINATION Done Time IN: - Time OUT: Separation/Segregation/Protection PASS ❑d RED Notes: - Food Contact Surfaces Cleaning and Sanitizing PASS 0 RED 341: Proper Adequate Handwashing PASS 0 RED Urgency Description(s): Good Hygienic Practices PASS 0 RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASS ❑ RED Retail Practices (Critical Handwash Facilities PASS O RED violations must be corrected immediately or within 10 y days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 04,2005 ) Page 1 o!2 0400 Highland Avenue Mandarin Super Buffet must be corrected immediately PROTECTION FROM CHEMICALS Done or Within 90 days) Approved Food or Color Additives PASS RED RED: Violations Related to Toxic Chemicals PASS RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS /❑ RED immediate corrective action) Reheating PASS �/❑ RED Cooling PASS ❑Q RED Hot and Cold Holding PASS ❑Q RED Time As a Public Health Control PASS ❑Q RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE All violations cited in the 9/26/05 inspection report have been corrected. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 04,2005 ) Paee 2 of 2 ( IMPORTANT MESSAGE ) FORM/ I ,Sd A. DATE TIME ) M 6S4.N / rJnA OF PHONE L 7 7S(z AREA CODE NUMBER- EXTENSION ❑ FAX ❑ MORil G AREA CODE NUMBER TIME TO CALL TELEPHONED f PLEASE CALL it CAME TO SEE YOU f WILL CALL AGAIN WANTS TO SEE YOU f RUSH RETURNED YOUR CALL k �I WILL/FAX TO YOU MESSAGE Q.� .P �G�� Q R � SIGNED f NOTES 0400 Highland Avenue Mandarin Super Buffet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 740-0306 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Binh & Chau, Inc. Tobacco PASS ❑ PIC: Nancy Tr'UOn9 FOOD PROTECTION MANAGEMENT Not Done Nancy tOr: PIC Assigned/Knowledgeable/Duties PASS ❑d RED David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 9/26/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS ❑Q RED = BHP-2005-0704 Receiving/Condition PASS ❑Q RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED VIOLATION '` Conformance with Approved Procedures/HACCP PASSd❑ RED #of Critical Violations: Plans 2 ,: 0400 Highland Avenue Mandarin Super Buffet days)(Non-critical violations PROTECTION FROM CONTAMINATION Not Done must be corrected immediately Separation/Segregation/Protection PASS ❑Q RED or within 90 days) RED: '. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑Q RED V Cutting board on end reach in is stained Violations Related to and scored. Resurface or replace cutting board Foodborne Illness InterventionsV Knife stored between tables. All knives to and Risk Factors(Require be cleaned and sanitized and stored in an immediate corrective action) appropriate rack. — Ice scoop stored in sanitizing solution. Store ice scoop in a sanitized bucket only. Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑Q RED Prevention of Contamination from Hands PASS ❑Q RED Handwash Facilities PASS ❑d RED PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑Q RED Toxic Chemicals PASS ❑J RED TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS RED Reheating PASS ❑J RED Cooling PASS ❑d RED Hot and Cold Holding FAIL Critical RED v True reach in had a temperature of 46°F. repair unit to maintain a temperature of 41'F or below. "Delfield freezer had a temperature of 20°F Repair unit to maintain a temperature of 0°F or below. 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 ❑d RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Page 2 of 0400 Highland Avenue Mandarin Super Buffet Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE dThere were some pots and containers directly on food in some cooling units.Do not store containers in cooling units in ✓ direct contact with food The walkin freezer has food stored directky on the floor All food to be stored at least 6-8 inches off the floor. Equipment and Utensils FAIL Non-Critical ❑ BLUE V The toaster oven has an accumulation of food debris Thoroughly clean the toaster oven. ✓Wiping clothes to be kept in two buckets of sanitizing solution one labeled"Raw animal food only",and one labeled"Sanitizing solution." ✓ Remove cardboard from the floor of the walkin. Water, Plumbing and Waste FAIL Non-Critical ❑ BLUE One stall in ladies room is out of order. Repair the stall immediately. Physical Facility FAIL Critical ❑ BLUE VProvide a sweep on the back screen door. Clean all spilled oil in back of establishment. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Page 3 of 3 1 Massachusetts Department of Public Health Salem Board S Health Department 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax (978)745-0343 Name Dat � T�Ae.of OperatioMsE Tyne of Inspection /GI�AlJA.4A/r✓ SrLYst£�f Qa'Jfi+af I / A d5 � "Food Service t�7 R}�tine E]Addresi Risk Retail id Re-inspection 41AJ �f�/�/,Or" V AV,,X- LevelN ❑ Residential Kitchen Previous Inspection TelephoneCyd d?D.f , E] Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation /3jI�iN rt C/`,Its /n/� ❑ Caterer ❑Suspect Illness 1 Person in Charge(PIC T Time ❑ Bed& Breakfast [-IGeneralComplaint i ❑ HACCP In: Inspector f2fjt^n 4,0 �z(NrSat IM Out. Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties MA<Hndwash 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 TIMEREMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [: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) [121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices, Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003} order of the Board of Health. Failure to correct violations _ 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5POIns OF�m 14,&c '^ � / ) � � I Lrspector's Signature;?(_ Print: r H XN __rl "r OA1 PIC's Signature: Print: `+. ,1�dge of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINAT ION FOOD PROTECTION MANAGEMENT 8 j Crus-Contam-i n+ton j 1 590.003(A) Assignment of Responsibility' j 3-302.11(.Av!) Rw,e Animal Fonds Separated boot 590.003(B) Demonstration of Knowledge" ( Cooked and RJ c.Foods- j 2-103 11 j Person in charge--duties j Gontammation from Raw ingredients 3-302.11(5)(2) Raw Animal F wds Scp'aratrd from Each EMPLO`rEE HEALTH ( Other' 2 590.003(0) Responsibility(it the person in charge to ( Contaminavon'rom the Environment j require reporting byfkxxteinploveesand j 3-302.1l(A) Food Protection, applicants* j 3-302.15 Weshing Fruits and Veget blcs j 590.003iF) Responsibility Ol A Food Employee Or An 13-30.4.11 Food Contact wolf Equiptnerd ::nd Applicant To Report'To The Person In utensils (Clue ge* Contamination from the Consumer j 5140 003(0) Reporting by Person in Charge`" 3-306.14(A)(W Returned Food znd Rcsetvicc of Foo& j 3 5901)03(D) Exclusions and Rerdtictions-` 1 ! Disposition& adulterated or Gonternmated 590.003(E:) Removal of Exclusions and Restrictions 1 ! Foca 3-701.11 Discaubng at iteastditirmag tI safe FOOD F-?OM APPROVED SOURCE Food- 41 Food and Water From Regulated Sources ( j 9 Food Contact Surfaces ! 4-501.111 Manual Ware,..vasltmc-FIut`+t'n:cr ! 590.004(A-B) Compliance with Food Law'' 1 3-201.12 Food in it Hermetically Sealed Container• Sanitir�t:on'Fcn.i-cratur.s 3-20 1.13 Fluid Milk and Milk Products'" 4-5(11.111 Mechanical Wanevrashing-Hot Water 3-202.13 Shell E^_qs' Rannizat on Terlperalul: j 3-202.14 Pegs and Milk Products,Pasteurized" � 14-501.114 Chemical Sanitization-temp..pH, j concentration and h:udness. :i-'?02 16 fee Made krum Potable Drinking Water' j " 4-601 f 1(.A) .:ifuipmznt rood Contact Sitriaees and 5-101.11 Drinking Water from an Approved System' j Utensils Cican" j i9i),00((A) Bottled Drinking Water` j 4-602.i I Cleaning Frequency of Equipment FuoO- 1 590.006(8) Water Mretc Standards in 310 CMR 22 0s: Cnntaa Smi:are:and I,'tensils' j Sheli ish and Fish From an Approved Source i ( 4-70? 11 Frequency of Smtitizahou of Utensils and 3-20 t.i'4 Fish and Re.Teatianaliy Caught Molluscan Food Contact Sin faces of Equiument" Shellfish 14-703.11 Methods of Sanitization -Hot Water aid 3-20!.15 Molluscan Shellfish from NSSP Listed I C'h.;m cal^ Sources' j ip ' Proper.Adequate Handwashing j Game and Wild Mushrooms Approved by 2-301,11 C'It:an CnnrHuoa- H;uxls and Ar::as" Regulatory Authority j 3-102 IR She0etock Identification Presciat --301.12 Charing PtocrdLuc" 590-OOuc) Wild R4tt4troom;* 2-301.14 Whin to Wash'' 3=201.17 Game Ammak" j 11 Good Hygienir Practices 0-401 11 Eating. Drinking of Usinp fooicco' j ( g Receiving/Condition ! 1 3-2011,11 PIIFs Rece vvd at Proper T-tnperatures x j 2-401 12 Di;et;arges Fount the Eye,,. Vose and mouth*' outh" ! j -iP =102.15 1':ngage 6nesn'i ty" I 3 1(1.11 aL k iafe and Iinadulteratcd, 3.301.!2 Prev=ntnrrka:n*Co,tamination Wlaen Tas:mp' ( hellstock ( 12 Prevzof Contamination from Hands 6 Tags/Records:Sj 3-202.13 ShelktockIdentification'' j 590A04(F.I Pre+entbwContamination f:our j 3-203.12 Shellwock Identification Maintained' j Emplotee,' ( j 13 Handwasfl Facilities Tags/Records:Fish Products Qmvemertty Located and ACCeSSible j j 3-402.11 Pat'asitoDeshuetionx j ?-203.1 i ymnbc�;and Capause:" 3-102.12 Records,Creation and Retenti,ei* I c j 5afn/)04(.11 Labeling of Ingredients' 5-204.11 +xation acrd placement'" j Ili Conformanre with Approved Procedures l 5-205.11 accessibilih-,Operation:aid Mimitmtan'e j /HACCP Plans ( Suppl*eo mth Sonp and Hand Drying 3-592.11 Specialized Processing Methods" Devices j 3-502 12 Reduced oxygen packaging,criteria' j 6-301.11 l-landwiohn%C'!eansa.Availabilay j ;-ityl.I Conformance with Appowed Priced rres" 6-301 1' Hand Drying ProA!" :n "Den0(c,cnu«d nem to the federal ]Q(19 Food CnJe or 1(15(Nit 590,0001 CITY OF SALEM BOARD OF HEALTH /��rf Establishment Name:M#4afJ o /a .J'LV4 o- d dorofa FG Date: � 9/oaf_ Page: 2 of 2 ` Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY '.. /13 W/C ^4o49 n se6-0 '1"Aq&1erYs ri'nfK 4y I—F"a 141aly I I, I i9t�C- t/td�+�-lt�ws �r �lJ.. �+✓ . /2s��% i..(J'sr��cr.� ,.� rc��i'�.ti-- �r�z�_r � II I � I � I � 1 I � I Discussion With Person in Charge: Corrective Action Required: I ❑ No res 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. /, �v? / _ Ci 0 Voluntary Disposal ❑ Other: l 3-5W.i 4 C! PHFs Received at-lemperatur Violations Related to Foodbortfe iimess L?terveni:ons and R;sk According to Law Cooled to Factors(gems 1.22) (Conti 4I'F/45'F Within 4 Hours. " PROTECTION FROM CHEM€CAIS 3-501 15 C,)oiin_;Methods for PHFs 14 wood or Color Additives ' 119 PHF Hot and Cold Holding j , 3501.16(6) Cold PHFs,Maintained at or below 3-202.12 Additives I 590.00 t(F) 41 V45'F" 3-302.i, =omUnapprovedASdi?Ives" 3-50!.I6(A) Hot PHFs Maintained at orabove 1.5 Pcsonoue n:Toxic Substanc^s identtt3vu jmormdtion-O,igowi .16Ga) Roasts Held at or above l t0"i'. 7-t02.1I Common CommonrN:uu..-}xrctkm^-C:nntainers'" � °II Time as a Public Health Control � 7-?f�l.l l S,•p�r:ttion-Storaec'" 3-501 19 Time as a Public Health ControP j 7-8,211 Rett:iction--Po:scnccw idilne." 190.004(H) Variance Requircment I 7-203.1? Conditions of liee" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-21)3 11 Toxic Containers Pn>hibitirms" 7-204.11 Sunri:ereC'ritert. Che:ri:cals" POPULATIONS(HSP) 7-2UM,12 Chemic+: s for Warkw;l YnducC.Cr,trna4' I 21 3-801.1 I(A) L'npastem':zed Pre-packaged Juices and 7-204.14 Drvn�r ( Beve:a!_es with Wnrnine labels^ 1gzn.s.cnier: r 1 3-s0!.i 1(R) Us..of Pasteurized Eegs' _I 7.205.11 Incidental Food Contact. Lubricants' I 13-301.1 I tD) Raw or Partially Cooked Aninud Feuxl anti 7-,06.1! Resir:cied it- veil. 'x 7-' 1 06.! Roc J!Cl t 3n:t St:aicuc ! 3-Y.O1.1llC) Unopened Fcxxi Package Not Re-served ' 7-_06. 3 T,::ckmg Fre*Jdr:.?eA C:.ntroi and tvtonitorio;;' j CONSUMER ADVISORY TIM /TEMPERATURE CONTROLS 22 13-603.11 Consumer Advisory Posted for Consumption of 16 Proper CoroKmg Tern,eratures for I Animal FlxAs"Pkat are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate Frm,.ere vr.rom 3-&uLIIA(L)(2) tathugens'.' I b'c+'s-hmnsdia,e Serv6te 145-F15secx i 3-302.13 Pasteurized E 414 Substitute for iRaw Shell 3-401.11(A)(2) Com:mnated Fish, IvIcat: &Game E vs:1 Arontals- 155"F I i ;ec. 3-401.!108)1 ){_.I 1 o „ * SPECIAL REQUIREMENTS Pork zd$raf Rrasr - L'�0-F I:.. n»r, ?-401.11(.%)(2) Rante-.. Lt)ected RIzaL,- 15S°F 15 590.000(A)-(D) Viuluuons of Section 590.009(A)-(D) In sec. " catering, mobile food,temporary and 3 4U I.11(A)(3) Poultrs, Wild Gamc. Sotted PHi s, residential kitchen operations should be Stu(i ac Containing Fish.Meat, debited under the appropriate sect-1011S Poultry'of Ea.ite, 165°F 15 sec. I above if related to foodborne illness 3-401.)I(C)(3) t'.hole-muscle,hdaet Bccf Stvaks Interventions and risk factors. Other 145°F 590.009 Nriolations relating to good r:tail 3-01.12 Raw Animal Foods Conked in a ( praaicc:;should be debited under //29-- Mi:-rowave 165`F * Special Requirements, 3-401 A I(A)0)(b) All Othei PIF:. - 145'F 15 ver 17 Pe eating to Hat Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3 403 I I(A)&(D) PHFa 165'F 15 sec. (ItetnS 23-30) 3-403.11 3.11013) Micr:,xave 165"F 2`rlinute Standin_ CiiNrat anrt norrr'ritiral ciulunan::, trhich do xot rrGete ter tlec 'rime* (oodhorne Illness(ntervcniions unci riskfa<sois lived nbove, can he 3-4o3.!i(t^I Comtuciva!1y Prxecged K"IE Frs�<I- I lound in the fedInning sections ql the Food Code and 105 CMR 14017" 590.0(N). i 3-.1O3.11(L) Reinaiain,l Ung1tced Portionsof Heel' I Item I Good Retail Practices FC 590Atto---� eowt" 123. Management and Personnel FC-2 .003 18 nroper Cooling of PHFs i 24 1 Food and Food Protection FC--3 .004 Coniine Cooked PEiis from 140`P to 25. Equipment and Utensils FC-c _005_ 2B. Water Plumbirm and Waste FC-5 Cob 1 70'F Within 2 Hours and Front 70'F `7 - ,_ Phvs:cal Facility r,417/45'F NVithin 4 Flora. T 20 Poisonous o:Toxic Materials FC-7 1 .00E 3-:41.14("') 000nil,PFEF Made From Arnbtent29. ( Special Requirements 009 Tctuper.anre htgrediens to 41`1/45"F 30 , Othe: Wit"hot.1 Hotlrs,f Uernnr:rnac:i ileo:m:h::?dela: :NO curd i:,dc or 10;CniR 590 000 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat$ ) Tvpe of Operation(s), Tyge of Insoection E� )dn!(1r i .. l S'rll�rFit �J>`i4F/ IIAIArr J ❑mood Service Routine Address Risk ❑ Retail ❑ Re-inspection Telephone I Level.AA ❑El Residential Kitchen Previous Inspection �7 yli] -n/\�J/ 9'` Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation AlmlA' f cit,.t,l I t(e I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint I El HACCP Inspector O Permit No. ❑ Other .2 AYr 4 /f'rt..r rF,./iS..r.J.w Out: 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 3. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC E] 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE F] 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [:116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control [91'97 Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E] 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 3 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 C 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 _ 5. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you X27. 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: 1/28 //O f S BWMSp crFor -14 dx Inspector's Signatur" /Y Print: PIC's Signature: r . J g ,�,� f-" Print: IL 1 Page of Pages r Violations Related to Foodborne fitness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT Z3 Cross-connminutic n 1 590003(A) Assignment of Responsibility" 3-302.11iA)(1) Raw Awmal Fonds Separated f, )in 590.003(B) Demonstration of Knowledge* ( Cons ed and Rl'E Food'` j 2-I(r311 Person in charge--duticc Contamination t`um 4avinfuodients 3-302.11(A)(2) Kam--�ttinml Fords Scpaiated from Each EMPLOYEE HEALTH I Other' 7 51)0.003(C r Responsibility of the person in charge to Contamination from the Environment require reporting be hood employees and ( 3-302.1 t(A) Food Pi o1c,'to n' applicants^ 3-302.15 W;,;huty Fruit,and Vegetables 590.003(17) Responebility OlA Food Employee Or An ( '-301 11 Food Contact with Equip.aeot and Applicant To Report To The Person lu Urensds* Chin ge'= I j Contamination from the Consurner 590,003(Gi Repuiting by Person in Charge* 3-306.1a(A03) Returned Rx:d and Reser v;ce of Food 3 590 0,03(l)) ESL'InSionsand Resnictions' ( Disooston of Adulterated or Contaminated 590.003(E:) Removal of Exclusions and Restrictions Food 3-701.11 Disc.oc!ngorRecoadit9oningl"nsafe FOOD FROM APPROVED SOURCE Foul` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) j Cumpiiance with Food Law:: 4-501.11; Manual W'arewashing-Rol Water i 3-201.12 Fond in a Hermetically Sealed Container` Samuzatiun'1'crnl)eratures' 4-501.112 Mechanical W'areNvashin Hot Water 3-201.13 EhMilk and Milk Products* I Sanitmition Temper-sures' 1-202.131-202.13 Sheoll ll Etas" I 3-20'..14 hggs and Milk Product,,Pasteurized'' 4-501,114 Chemical Sanirizanun-temp pH, 1-202.16Ic, Made From Potable Drink o,Water" conczntr"'6on and hardness. ,; ' 601 11(A) Equipment Fixxl Contact Surfaces and i 5-I01.II Drinking Water from an Approved System" Lltcnsds Cleat['" 590.006(.A) Bottled Drinking Worer" 1-602.11 Cleaning Frequency of Equipment Food- 590.O06(H) Water Meets Standards in 310 CMI:22.0" ( Coniact Suriacec and Utensilti* Shellfish and Fish From an Approved Source ( )_707 I i 1`requen y of Sanitization of Utensils and 3-201.14 Fish and Reueationally Caught Molluscan I Food Contac[Surfaces ut L•.yuiptnent* Shellfish" 14-703.11 Metbods of Sanitization -Hot Water and 3-2Ul.13 Molluscan Shellfish limn NSSP Lister) j Sources Chemical^ Game and Wild hfushrooms Approved by to Proper,Adequate Handwashing '- Re9uietort,AuthoritAuthority � -301.71 Clean Ccndiuon- Hands and At ms': 3-20'_.18 Shellstnck Identification Present' 2-30i A2 Clea^an,Procedure` 590.004(C) Wild Mushrontns" 12-301 14 When to WasW; 3-201.17 Game Atnn als'. ( 11 Good Hygienic Practices I g Receiving/Condition 2-401.i 1 Faiing. Drinking o: Uong'rnhacco` 3-''02.1 1 PHFs Received at Proper Temperatures* I 2-40 L 12 Dischergec From the Eve,. Nose and 3-202.15 Package hue)nity* j Moutn* 3-101.11 Fund Safe and Unadulterated'' ( 3-301.12 Preventing Contamination t4Tren Tasting' ( h Tags/Records:Shellsiock ( 12 i Prevention of Conta-mination from Hands +'202.18 Shellstuck ldeniilication" Sat0.001iE1 Yre4.4nting Contaroinatinn is um 3-205.12 Shellstuck Identification Maintained" fauplovee;^ Tags/Records:Fish Products ( ( 13 Handvoash Facilities 3-402.11 Parasite Destiuction* j Conveniently Located and Accessib/e j c � 3-402.E 2 Records.Creation and Retention' 21-!3.11 Numbers and Ca p`.tbes" S90.0011M Labeling of Ingredients' 5-204.11 Location and Placement' 5-205.11 AccesaibiErq,Operation and Mainteuame Conformance with Approved Procedures I Suppled with.Soap and Nano Drying ^ iHACCP Pians 3-5:12.11 Specialized Processing Methocls" De.�ras j 3-502.12 Reduced oxygen p;+ekaging,criteria" 6-301.i 7 Handwa4jul C(eanscr. Axailabihtc 8"1(:3.12 Conformance with Approved Procedures" 6-30;,i 2 Hartel Drying Yrnris:un `r)enoter enucil nevi in rhe federal 1999 Food Codc or 105 CT9R 500,000 CITY OF SALEM BOARD OF HEALTH _ Establishment Name:,'L/�a4 A. W S'cA0X1(- l ef'—' ASV- Date: //�✓!e i� Page: 2 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I C_ /N /hs l�a+f' Gr/ Gr4rvWac �c,s �w4r�J3n�er ��s�r .r+J .��cv.r�d�.Mi fe✓ f _ F71 o rc.,cX3�+X�i'" C-e-a it'K I / / f o/ >< Vi f tt/AntYJ arri r� St►/!� i /,r r✓e.r,r.,✓a /2c� sretit /f.f f^"�++�'t 19 f r�1V cs04rf� Ui1�� N»f7 ,a+ Dnp o� �1B'�, ftc�/.b,t aa, t%� .^'wy.✓rwKl .4 MAP c< cf/aF dLt tz. I /� — /� v un+s� r.�A� ✓3�I cen�<.c.� f s o�sc�w !t ya, r�#-fX n 041, 1 /J( .3A9W 1�icr-L) j I � 1 2 g If�C r dr h/tc Eo W -Te 6 tcz. er~e- i nfr-;nCA ✓.rL (Z�2f� Mt�ME/r{�CeZ I �/� i-- n r*f(' mac.•�i �d rrs f>✓� rzaf �-cz r -ni J'e,04 C_c"rtnre_, da .T"s u-c-acr rc."144 4040 Sr?flWiLV. e.�sSfA-.e-A,e, I i c� r4L Pc�-e.� �'rfZrfe- fSo.e+v� Discussion With Person in Chargee: Corrective Action Required: I ❑ 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. / /,l G�j� _/� 0 Voluntary Disposal ❑ Other: t 3-50!. °:'C'i PHFs Recei"d at Tempu•umes Violations Related to Foodborne illness k:tervertions and Risk Accord:ug to Lasa Cooled to Factors(Items 1-22) (Cont.) 4FF/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 1 3-501.15 Cooling Methods,for PHI-s f 14 1 Food or Color Additives ( 19 PHF Hot and Cold Holding 1 3-501.16(B) Cold PHFs Maintained in or below 3-202.!2 Additives° 590 004(8 ,IIV-15"F" 3-302 14 Priaection frtin: !'nannros-dd .Addil;ies* 3-501 L•it.Al 1PRFs lviainteined at or above 15 Poisonous or 1 exit Substances I40 40'F 7-101.11 klenutyntL lnfoi r,::nam-thiginal Roasts field at or above 13WR " 1 Conta nvu•" j 1 7-102,t I Cotumon Name-'Working 1 20 Time as a Public Heafth Control 1 _Cutiainer," - - 1 7-201.11 Separstix:-S;o:-agz-: 1 1 501.19 Time as it Public Health Control* 1 7-202.11 Zc't t anon-Presence,utd Use* 1 1 590.004(H) Variance Requirement= 1 7-202.:2 Conditions of U::c:: 1 7 203 11 T+ Contain;-,-oicintntions"' 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(M.11 Sattitizer,,Criteria-Chemic..;10 POPULATIONS(HSP) 1 7-204 i2 C!hCn:t:caln for Washrin Pirducc. Criteria" 121 3-801.1NA) Unpasteurized Pre-packaged Juices and 7-204.1=« Diving.ker,afs.C:itowl Bevetapes with Warning labels'- 7-205 11 Incidem J Food Contact,Lubmenis4 '-301 ll(B) Use of Pasteurized Eggs* � j 7-206.11 Restricted 17:e Pct-m ales.Cri4---ria° 1 3-501 I i(D) Raw or Pittlially Cooked Animal Fowl and Raw Seed Sprouts Not Serred. .k 7-206.12 Rodent F.vt o otatiou;" I ( 3-101.1If C•) Unopened Food Package Not Re-served 7-206.13 Trach tng Ptevurn,Fest Control and ( --- A?:aohrring' CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-003.11 Consumer Advisory Posted wf C'onstnnptien of 16 Proper Cookinq Temperatures for animal Foods 19iat are Rae,, Undereool ed or PHFs Not Otherwise Processed to Eliminate 3-101.1 I AI I)(2) Egg.- I i;°p ;`i Sec. Pathogen.T Eggs tion»(hate Srivire 145"Fl5;,em 3-302.13 PasteunMi Eggs Substitute tin Raw Shell i-401.1 I(A)(2) Comminuted Fish, Meats&Game Eggs' animals 155`'F 15 sec. '" 3-401.1ttB)(i)(2) Farr ndPc Roast 13h'Fi--Amin> 1 SPECIAL REQUIREMENTS 3-401.1 I(Al(2) Fanics,Fnjccten kte at,- 155'F 15 590,009(A)-;"D) Violations of Section 590.009(A)-(ll)in seL. catering, mobile fend, temporary and Ii401.1 i(A)(,) Poultr„Wild Game,SiutfcdPI-1Fs, residential kitchen operations should be Stuffing Corttt:iri;:?,Fish,bleat, debited under the appropriate sections i';4s;rv:,r sautes-Io5"F 15 sac. a above if related to foodborne illness 3-4101.1110(3) ''Whole-muscle, Intact R,cf Steaks interventions and risk factors. Other 1158* f 590,009 violations relaimg to good retail 1 3-401.13 Raa::`,1 Ponds Cooked in a ; practices should be debited under N29- Rlmrowave 165"F Special Requirements. 3-401.1 i(A;(•))(h) pit 0th.-;'PHFs-- 145"r 15 sec. 17 Reheating for Not Holding 1 VIOLArioNs RELATED TO GOOD RETAIL PRACTICF_s 3--103.11;'A)&(t)) PHF: !65'F19sec ' 1 (items 23-30) 3-403.11(11) Mic,owi ve- 165' F Z f0inute Standing l Critic a!and non-rrih<.u[virla,inns, which do not relate in the Tinte4 loodbome il/haeec'imei,iewiorr,s and risk"/a,iors li,sied abore, can be 3.403.1 l(C) Commercially Processed RTE Food- ( ,found in ilii jul/owing sections of the Food Code arra 1115(.tIR 40c Ft 590.000. 3-40111t F.) Rctuauting Unsliced Portion;of Beef I � Item Good Retail Practices Fc 1 590.000 I Rtnsts:: 23 Management and Personnel FC-2 .003 13 Proper Cooing of PHFs 24. Foal and Food Protection FC--3 004 2.5 Equipment and Utensils FC-4 ,005 3-501 14(:1} Cooling Cooked PHF; from 140'5 to j -------- - -0 -------J 26. i Wafer, r lumblrq and Waste FC-; ,006 i Wiih;:t 2 I lours and From 70'•r i 27 - Physical Facirly FC-6 007 1 v)"l I"Fµ5017 W iLhm 4 Hours. w 1 28 Poisonous or Toxic Materials FC-7 .003 3-501.14iB; Cooling PfIFs Made hroniAmbient Special Requirements 009 Temperatureingiedienr:;to4:`F/d 5`F 30. Other Within 4 Hour.` •...in.::,n,.io-z��K .Delmar;cr4c,-d nein in ire'?chid 10,1)Fond Cade or{O5 l'R7IL S90 000. 1_ CITY OF SALEM BOARD OF HEALTH Establishment Name: ✓Lfrin//1_A0'Az Date: /�2//os� Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item ,� Verified t' PLEASE PRINT CLE/ArR�LY� /fl.I/ F�irJA,.Li l`rri- /ACL C� OS ✓t ��/�' V�Cfrt a-<i All��K�' �J✓G.L✓fir r✓� (1�M�� N'r+�° 2l7 N/! m rr6d,,nr i n r t>�A►. frf NtL n S f ,�t .•�.A,o r� /ruP�luv., S I 217 1 14 v/.1e f Jr n T.I fe S /ry e7jf / Srd A4nrrf .20 /01c M cf r&O)t .t9_ I I � .r .0 r setrt,✓ I 'I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ` ❑ Employee Restriction/ 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: B-501,! liC;i PFIFs Received at Pemperatures I Violations Related to Foodborne Alness tnierventions and Risk Accordin,to I aw Cooled to Factors(Items 1-22) {Cont.) 41`Fi45°F Within 4 Hours. PROTECTION FROM CHEMICALSi 3-501.1` CWtina Methods for PRFa I ( 1 t4 PHF Hot and Cold bolding 14 Food o-Color Add:uves 3 0'.r2 1:Iditive ' '-50 1 16(H) Cold PI1Fs M-aijn fined at or below 590.00-1t F) -tl"J45°F•` 3-302.1.3 Protection tr,-,i Unappimc d Additives" 3.501.161 A) Hot PHFs Maintained at or above15 Poisonous or Trxic Substances 140'17. 7-101.11 lde.nt:fyun:Information-Original :' - 3 501 16(A) Roasts Held at or above 1.',0°F. Otltamrra.' ! 7-1 02,11 Common Raine--tiv orking 20 Time as a Public Health Control Containers" 3-501.19 Time as a Public Health Control* 7-201.11 Seoaration- Siora,e' ,is.,. 1590.004(H) Variance Requirement 7-_0_.I I Reatrictinu-Prestnce W:d �, '' 7-20Coxi,: i ons nUse' 7-203.3.i I Turin Container<. -?:uhibitionc* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE fPOPULATIONS(HSP) 7-204.11 S.uruzel::,Critcr:.t-Cherncals". 7-204.12 Chentictis for Washing,Pn,ducc,Crtsia"' { 21 ! 3-801.1 i(A) Unpasteurized Pre-packaged 3u,ce�and 7^04.14 i)ryir!�Agent.C'niet^a' ( Beverages with Waming I abcls^ - 3-8W.11'B) Use of Pasteurized Eggs` { 7-205.i I incidental Food Contact. 1_utnicant,`' s 3-80i.11iD1 RawP:u proCooked AnnnaL Food and 7?06J i Resin,not lis: f•esticules.Catena" Raw Raw Seed Spn>uts Not Served. " I 7-206.12 Rateni Sail Stations' 3-801.11(0) Unopened Food Package Not Re served. " 7 206.13 Tracking Polydor.. Prat Control and ` Monitoring'" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3 603.11 Consurrwr Advisor} Posted for Consumption of 16 Proper Cooking Te,nparatures for I Attend d Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Etminate 3-dCLIIA(U;2) F„gs- 155"r" IS Ser.. Pathogens.:Eneco:.e a-v:oca Fz}s-6nmeuiate Sen;ce 14'PiSsec+ -'-30'.13 Pasteurized Fgga Substitute tar Raw Shell I3-401.14(A)(2) GnniroutedFish, Nleato- Game I Egos., Ammons- eai sac SPECIAL REQUIREMENTS 3-40 1.l !(!i)ti)(2: Pork and Beef t Roast - L 0°i" 121 mitt 3-=L(U.11(A)t_t Ranter. tnjcct:dbteats- 155°P i5 i 590.009(A)-(D) Violations of Section 590.009(A)-(l.)) in sec 1i catering, mobile food,temporary and 3 401.11(A)(.3) poultry, W11d Game, Stuffed PHR, residential kitchen operations should he Surfing C•antaunng Fish.Meat, debited under the appropriate sections Foultry of Ratites-1 65-F 15 sec. .: above if related to foodborne ilinecs 3-401.111^;(3) Cti :de-nursde. faatet Beef Steaks interventions and risk factors. Other 145-P * 590.009 violations relating to good retail 3-401A2 Raw Animal Foods Cooked in it I practices should he debited under 4'29- Nlicrowa%e 16ti^F s. Special Requirements. 3-d01.1i(A)(INb,, All Other NlFs- 145'F' ;5cec. ' 17 Reheating for Hot Holding VIOLATIONS RicLA TED TO GOOD RETAIL PRACTICES 3-101.111A)S:(D) Pi'n's !65` 13 sec. " ' (Item.C23-30) 3--103.11(B) A^:i:,rarrn�c- 1653 P 2 h11n1ne Standine Critical and nun rrilical violations, n•lnch do not ielare m the Tooe" /oodborrm Illness interventions and rind f actors leaved above, (an be 3-403.1 1(C) Cununoiciaily Pio essed RTE Forid- (ormd in the fWIon ing.sections of the Fond Crude raid 105('4411 1.111-F" 590.000. 3-403.11(13) RentaminnUnslicedPoruomofBeef Item Good Retail Practices FC5,00.000j Roast:,': y 23. Management and Personnel FC--2 .003 98 Proper Coo?Inc r4 PHFs 24. Food and Food Protection FC-3 .004 ! 25. Equipment and Utensils FC-4 005 3-501 14(",) Coohie C.00l:ed PHPs from i,*F to I--....-- -- _ 26. Water,Piumbinq and Waste FC--5 006 70cF Within 2 flours and Frooi MT 27 Physical Facility FC-6 .007 v,4!"F74a1-'NVithin 4 Hans. 28, Poisonous or Toxic Materials FG-7 li 003 3-501.1403) Ct oli^L, PHF:, ^✓hole From Ambient 129 Special Reouirements .001) Temperature u,411'FW'F 130. Other Waiun 4 l lours^ Denot 'mucA i@rr,in Ili, h deal 1990 Puod Cute" UU CMR 5i)o()::o. CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 qqQ 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, III Section 5 of the General Laws tooperate a Food Section 305A and Chapter , Se Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Mandarin Super Buffet Address of Establishment: 400 Highland Avenue Owner's Name: Binh & Chau, Inc. Restrictions: Application Date: 11/22/2004 Permit for Food Establishment 54-05 Frozen Desserts/Ice Cream 03-May Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT f • �II I CITY OF SALEM, MASSACHUSETT Ymp+ ��l# [� jl .� BOARD OF HEALTH 1 Y 120 WASHINGTON STREET, 4TH FLOOR NO / 9 20 a SALEM, MA 01970 C/ OQ JOANNE FAX 978-745-0343 78 7 5-0 RS, CHO OARD OF ALq M STANLEY J. USOVICZ, JR. CTy MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT/1 A /4a, S>�j r ��TEL# ( �l 1 J 7yD - b ADDRESS OF ESTABLISHMENT 406 I�ILLOIn�-O[_ Avt- MAILING ADDRESS (if different) OWNER'S NAME AjH --F (HAV 'I NIL TEL#(9)�� Z7"57� � ADDRESS 12 -ELLI o)-t. �;T CITY R -b n P STATE Trl q Zip 0 1 9 1 CERTIFIED FOOD MANAGER'S NAME(S) TILtNCti 7 RU ON& CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) / 7 gO 'O�ON EMERGENCY RESPONSE PERSON NAV C-/ N Cr HOME TEL HOURS OF OPERATION: Mon.11- 10 Tue.A�10_Wed. !I-10 Thu. ( /0 Fri.) -IZSat. l -12 Sun. II-l2 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 65 less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$20 BEDIBREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 _ Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kgAwledge and belief, have filed all statte tax eturns and paid all state taxes required under the law. d yr��P �C Jl/�� Signature J date Social Security or Federal Identification Number ------------------------------------------------------------- ------------------------)-------- ------------------------------------ Revised 11/03/03 FOODAP2 adm Check#&Date S.S )�J I 1l 5�1Dc 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. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Mandarin Super Buffet Address of Establishment: 400 Highland Avenue Owner's Name: Binh & Chau, Inc. Restrictions: Application Date: 11/14/2003 Permit for Food Establishment 14-04 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. �HEALT A G CITY OF SALEM, MASSACHUSETTS'*' BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 NOV 13 2003 TEL. 978-741-1800 FAX 978-745-0343 UTY OF SALEM STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT � �p�Qf�y✓L TEL# ��7�I �Ilffl -O S O 6 ADDRESS OF ESTABLISHMENT 4-067 / MA 01910 V MAILING ADDRESS (if different) ' ga OWNER'S NAME TEL#(178) gZ7'�7 ADDRESS CITY 2PV&L-L J STATE 14A ZIP D 1'7V CERTiFiED FOOD MANAigER'S NAME(S) CERTIFICATE#(S; (required in an establishment where potentially hazardous food is prepared.) 7 EMERGENCY RESPONSE PERSON SLI./vHOME TEL#(17S � HOURS OF OPERATION: Mon./Ll—Tue.)Ll--Wed.-L—T-Thu.rr"5 Fri./),/0 Sat.&10 Sun.�� TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO / less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 1 more than I0,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats 20 BED/BREAKFAST YES NO 100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 PleasepaY 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 knowledrand lief, have fled all sta a tax returns and paid all state taxes required under the law. W. _C /00/02; 6IN rel-o68�u8/ Signature ate Social Security or Federal Identification Number ----------------------------------------------------------------pp-----I-'-'---------- - ---- -------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date t 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 / T f i Type of Inspection /t'IIA$04021N SSdPkR 19uf1" -V' F1127 iq ® oodService ❑ 5outine Address , AA) I��AMQ AOC Risk El Retail Re-inspection 7 Level Ll Residential Kitchen Previous Inspection Telephone -7'/6 -0304 o304 M ❑ Mobile Date: Owner /� HACCP Y/N Ll Temporary ElPre-operation (31N9 / ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ElHACCP Inspector 0AVi0GQcsrc[N�A�M Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (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 El13. 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 El 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEJEMPERATURE CONTROLS(Potentially Hazardous Foods) F-1 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Q 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 o 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 2�. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you �` 7. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Print: PIC's Signature: T Print: ��Pae of z-Pa es FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contarhination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 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* I Contamination from the Consumer 3-306.14(A)(B)l Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH. 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 I 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* � 6 � � Tags/Records:Shellstock � 12 Prevention of Contamination from Hands 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 I 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: MArMAIW SW'bt- lSuPi6T" Date: Page:`j�A/N Page: L- of Item Code C-Critical Item DESCRIPTION OF VIOLATION J PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I ALL c�v'Mc � VJl�t riD rJS r^.r�(r7 i r/ ;14C -7 bfzlew /ri jraCsi o►j a"40A- I,&VIE R <r. Are 1-ur0 1 Crda-,�a ydv i �, • I j I 1 1 1 1 I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes r I have read this report, have had the opportunity to ask questions and gree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as desk bed, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fede-at-Food Code. I underst# that noncompliance may result in daily fines o twenty-five Ilars or suspension/revocation of ❑ Embargo ❑ Emergency Closure y your food permit. ` I _ ,(� ❑ Voluntary Disposal ❑ Other r 3501.14((') PHFs Received at Temperatures Violations Related to Foodborne illness tete::ventions and Rist: At coding tri Law Cooled to Factors(Items 1-220 (Cont.] 41'Fh15 T:A'ithin 4 Hours. PROTECTION FROM CHEMICALS 3-501.1 Coohng k'icthods for Pi?F. j 13 Food or Color Addiu cs 19 PHF Hot and Cold Holding :r-202.12 :\ddaives' 3-50!.16(6) Cold PHF;Maintain• it or below 590.0041F) 41°t45`F* 3-30'.14 Fromaticn 1r)m Unappio,,d Addifi%c,' l ' 3-501.16(A) Hot PHF:,N airdnined ai or alio,,:; I S Po;a^cos or Tax:o S:,bs!arces I 7-101.11 Wennt3;ne in(urm.:hon_C�r�oin:*i 3-501.1o(A) Roaats Held at or above 130.:1 : (;oataiuen' 7-102.11 Cotntnon Nmnc-W,r'_ C 20 Time as a Public Health Control j xtna,Containers ! 7-201 11 Sep.ir;iti.+:=.-St.use" ' :i-5101.19 Time as a Public Health Control- 590.064011) Variance Reyuu+anent j t-102.1 I ke:.triction--Yteerncc and Use" 7 202.12 Condvion;of Ilei 7-203.1 1 Toxic C`),imincrs-Prrhibitiu+ns' � REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -204.!1 Sanitizert.Craerm-C'heducals^ POPULATIONS(HSP} 7-204 12 Ch-111:Luls for Washing Produce;Criteria' 121 1 3-801.11(A) Unpasteurized Pre-packaeed Juices and Beverages with.Warning Labels* 7-204.14 Dryinp Aggaois.Criteria' -� n3-811 ) Use Pai 7-205.11 iaeideuwFoodContao i.ubriatS3-3017IiDv Raw or PartiallyCooked Amnni F-nct and 7-206.11 R,<imed Ue Pe;ucde:;,Criteria.r Rate Seed Sprouts Not Sened. * 1 7-106.12 ,Kodwii Bait Stations* 3-301.1](C) thwpened Ford Package Not Re-served, 7-206.13 Trackh:; !'undris, Pest Crvroi anel i lonitor i ne' CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603,1 I Consuinuz Advisory Posted for Consumption of 16 I 1 Proper Cooking Temperatures for 1 Amoral Fouds'lli a are Raw, Undcr�ouked of ! Not Otherwise Processed to Eliminate 1 PHFS f'v'u:m:rnaonr Pa[o„ecns.* 3-401.1 IA1,1)(2) F,g ;- 155`F 15 Ser' i-302.13 Pasteurized E-,>,Substitute lot Raw Shelf i L= us-1n:med)e::e Set Vice l�7s T 15 sec` ! .b' 3-101.11(A)(2) Conm:inaled Fish, [meats& (,time E*,Iss ! ! :,,linin:- 155'F 15 Sed. ( 3-401.11(61(!1(-1 � PorkandPeelRoast- !30"F121min' SPECIAL REQUIREMENTS 3-101.11(A)(2) Raiius, lnjerrdMeats,- 15_'F 15 ! s90.0091 A)-(D) Violations of Section 590.009(A)-(D)in caret mg, mobile food, temporary and i--1O1.11(A)!3; Pualtri. WildC1ama. Scoffed YaI-s residential kitchen operations should be Stuf Int,Contanunz FWi, ^rat, debited under the appropriate sections Poultro or Ir.i6 'F 15 sec. " above if related to foodhurnc illness 3-401 11rC)+3) Whole-mus-b_,hutact Bect Stc:dis interventions and risk factors. Other 45-F 4 590.009 violations relating to good retail 3-401.12 Raw Acowd Ponds Cooked in a practices should he debited under#29- Nl;erowawe 165`F' Special Requirements, 3-401.11iA)(1)kb) A!ICthcrPl4Fs-- 145'F15sec. ' 17 Reheating for Hoz Holding VIOLATIONS R kA TED TO GOOD RETAIL PRACTICES 3-103.11(A)&iD) PflFs 16.5°F '.5 sec. ' I (Iterns 23-30) 3-401 11(13) Microwave- 165°F 2 Montle Stand.im, I Ciiliral and iron-critical viatatiam, which do mot re?ate to the Tinie" joadhorne rline,ry inferventions and r W facion lister(above, um be 3-4013 111 C) Conuneiciatly Processed R'fF Food- ,found in the follo�,dog set 1,wee of!lte Faad Coyle and 105 CMI? i40,r SVQOOo. 3-403.1 ltE) Remaining Unsliozd Portions of Bert' I I Item I Good Retail Practices li FC 591.000 Raacr�': 23. Management and Personnel FC -2 .003 18 24 Food and Food Protection FC-3 Proper fooling of PHFe. � �-- � - .004 l 25. Equipment and Utensils FC-4 .005 ! 3-501.14-,A) Caalin,tC,:oLr:1YHr;fmm ?d0`Pt, 1-6. --FWatacPlumbinoand Waste FC-5 GG6 I 70'14`Within 2 Hours and Frim 70'14 127 Phvsical Facility FC-6 .007 to 41'1414:5"Fl*iition4 Hours * 2E. Poisonous or Toxic Materials FC-7 .008 3-501.14(6) Coding PHFs 1&6e From Ambient 1 29. _---LSpecial Requirements .009 Tempera;mrr in;:r:,bents in 41'F/45 30 I Other I j Within 4 Hours- 'I-en-AC,cut izaI,� nr m the Iederai 1999 Fi,od Ode a; !!15 C;MR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpe-of Operation(s) Tvpe-of Insoection MAdg&&W '] i Food Service 4 'Moutme Address Risk El Retail El Re-inspection j Mle-fiLVir) /�tkf Level ❑ Residential Kitchen Previous Inspection Telephone 7 yd_ du M ❑ Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation &I Y /' AJ Ad IW_ I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP I Inspector OA-0-10 (rr"&NA40M I Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties V13. Handwash Facilities EMPLOYEE HEALTH " PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1Cooling 19 , PROTECTION FROM CONTAMINATION . Hot and Cold Holding 08. Separation/Segregation/Protection El20.Time As a Public Health Control 21*9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. c N p g 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 5. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of ' the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you _,x'-27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590 008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: -- 5 5 7/r,7XV 901n5pecfForm6-1J tiv[ Inspector's Signature /. Print: X�' t PIC's Signature: Print: V n P' P,.^ Page I of 3 Pages Violations Related to Foodborne fifiripss Interventions and Risk Factors(Items 1.22) PRom-'eriON FROM CONTAMINATION FOOD PROTECTION MANAGEMENT t t 590MW(A) -1AI(A11:10 Rnv Aiimul Foods Separated from ,J).003(B) Cooked and. RTE Foods* 2-103A I I Person incharge duties Comarntratitcr,from Raw log-edionf!; 3-302 1100) Rei: Annual FoodsSepar.iled fi orn Each EMPLOYEE HEALTH Other 2 590.003tC) Responribiliiy N the person in charge to Cortioasnationi',cm dit,Lrrwrcninent require mporting by food employees and 3-302.1 it,%) I I voll Fpji=cfioji- opplicant.," 302.: ',vasIbut- I FrudtsanL!Veuetables 590 003(F) Re:,ponsibility OJ'A Food EITIDIONee 01 An 3 Food Coaia,t wide Equilml-!,tmd Applicant"Po Report To The Person In Ul"md's* ChargoaT I Ponta nation from iho Cojsunta, J90 003(G) kcokadn�by Person in Chin,,e" _'0Q_lr 3 590.003(D) Exclusions and R(,,lrictiom0,spocNon&Ad,itqvanqd o,,Coniamila,"Fd 59p.ow(11') Reruo,al of Exclusion.,_,aid Restlictiortt Fcnd 3-70:.1ng Unsafe FOOD F 1010 APPROVED SOURCE 1""d4. 141 Food and Mitor Front Regulated Sources 9 Fond Contact Surfaces 4-501 1 i i Nlkuiva'�Warewk,,,hino-riot 590.00-11'413) Compliance will) l-ood Law I Skwitizato)n 201.12 Food in a licrrnetical;y Sealed Container*:' ( 4-5(i1.1 12 Mcch..n.:1-kil �asz�;n,_;_Aid Water -,?ul 13 Fluid Milk and Milk products' 1. '202.13 Shull Eggs* Sanitization Tenip,azurest 4-501.114 ChmM.ml Samtiv,tiortemp.,pH, 3-202 11 Eggs and Milk ProkfiCb,Pa�teuri�-ed� 3-20116 ice I Made Frost potable Dr'aking Witter" concentrancri and fidxdnqs. 4-60I A loo Ey,;paicvt F,�,d Contact Surfaccsoird it 5-101 11 Drinking Water Coln an Approved System" tUtens";Clens' 590.006(A) Bottled Drinking Water* 590.006(P,) )Vater Nleet3 Standards in 311)CMR 2? 0earling Freqimcy of Equipment Food- Shellfish and Fish From an AppiovedSource i'ontaSurface!: -d Utellsdsr 20).14 Fish acct Recreationally Caught Molluscan Fie(juc;t,,y of Sauifiz�iw�l of Ulemdls kind Shellfish' FoulContact S,;rfaces of Eciui�,rn 4-_,13.11 Nletho&of Sail;fization—flotAater and :x201,I S Nlolhiscan Shellfc,li frorn NSSP J i.;tvd I ch.mwal* Sources'" Proper,Adequate Handivashing Game andours Approvedb� Regulatort,Authority 2-30i.1 I Clean Condition—Hands.,n�l Anni` 2-m].12 1 3-20118 ShLINtock Identification Present, 590.6104(C) Wild Mushrooms" 1111.1.1 When to wash* Cond 4yqi2nic Practices 3-201.17 Gone Animals* Receiving/Condition it Fatiny,.Drinking of U.,;,w Tobacco)" 2-401 12 Difcllktrgcs Fnjli;the Eyes, N'se".-od :i-202J I pills Received at Proper Tvnipcialuies 3-202 15 Fackage filte;n liy' 3-30!.12 3.ioi.1 1 Food Safe and Uicidultera;cd1 6 12 Hands I*aqsiR,?cords:Shelislock Lo 3-2dl.le, Shellsiock identification an ijj _-l-203,I Shelhinck Identification Maintained Tags/Records;Fish Products Hs.-Owash racllfth,s 102.1'1 Pulttsite Desirts:tion' 1 3-402 1-2 Records.Creation and Retention* ku;llhels and czpacitiesT 1 5-204.11 localwc arid Plact;itsentl 590.004(1) Labeling of Ingredients* Conformance with Approved Procedures 5aii5.l 1 "O-essibilim Operallon and ivialfileflaricc Sup6ud with Soap and Hand Drjmg 1HACCP Plans 3-502.11 Spcoiidizcd Processm:2 Nlethojs* ["ovic"s 1 Handuxdtua,Clvan.ei,Availability 3-502.1 Reduced ox ken packaum.g.cro et i:il o 301.12 F-i'mid Diving Prcvis;oii 8-103.12 Ckwi*1narance with Approved Proceduce," I Du:otes irincil u:m.in:he feJr�al 1994 Pond Crate or 305 CSCR )o CITY OF SALEM BOARD OF HEALTH Establishment Name: MAN0.4A/N SUA6X 6U1`0ii:A ' Date:_I)��ny Page: 2- of 3 Item Code c-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R-Red Item Verified 11 i PLEASE PRINT CLEARLY I � / (JIB+NK ICA 32',i»0 [_AF r' n,N V—A &-&. /4F 51111 q e l; /3d' C' GgAtJ6r> A/vrJ 3'itw/r�iz,�v /4-4�0 Pu/testi ,rJ /C6 1VOW1101r;' SY016 6444' Of in/ A— Sn41rmrAvn < t tAif— L,q.dz9U_A l � /ee£ se-__1_,i " �n 2y G "' f/�2a�Gt£ A-ijf JC L/Cr.Ci�.4lrid►✓ 11N if- N� �. /lf✓Cef/K,Cv jzm)n . A4� `GXA0 254 � -- �y�n ss-�,..�n ,..r c..�s�g,,,a..o mss_ .�,u. �a„� .•��Jf- ,�� .�d,•g,� 1 ! J9 0.0 AAU9r' ISX- r"A_49 /.4-f k rAkAIP 6iC L-A t 1. - 1� 2S h►�� M�t/YiJ4t_ QKACo ir4 i,Nif .at/ss. r/G C1VFA1A46jndI1i /0e6u14AtS iA- I 2� / atit� tfN,r /M.7 a*rc,^tAC tsn FddO. A[/ r-&W If,/ .3 OX,4ig I :� I � Mt1Tf' �� CBVtE�C-rst0. t Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ !es 4 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 Fo90 Posle. I derstand that noncompliance may result in daily fines Of twent �t liar r suspension/revocation of LlEmbargo ❑ Emergency Closure your food permit. / LiVoluntary Disposal El Other: 501.1'1:C') PHFs Received at Temperatures Violations Relai?d to Foodharne/!mess Interventions and flisk Ac:,nding to Lase Cooled to Factors(items 1.22) (Cant.) -41"F/45F Within 4 Horns. " PROTECTION FROM CHEMICALS S0l.l5 j Cool's:;Dlediod, for PHFs 14 ( Food or Color Additives I w I PHF Hot and Cold Holding 13-501.l6fB) told PIIFI,Maintained at:t belwx 3-20'".12 Ad:hr�es" i 590.001(F) ( 41"1.45` F" ! 3302.1} Prote.li.n:f oat Unaoprw.ed A,4r'iri csr I 3-50LINAI Hot PHFs Maintained at orabove 15 Poisonous or Toxic g:lestarcos ( 140'F. 7-101.11 Identifying lrfin':)st:on-Chigiod 3-SOI 161,A) Kunsts Held at ur above 130'17-* Container:," 7-102.11 Gr:::non None-Working C rtitainers" 120 Time as a Public Health Control I 17-201.I1 Sep,:ratioa-S'foragc' 3-501.19 Time a,a public Health Conhol' 590590.0(9(H) Variance RegnirC111CAt I 7-202.11 Restriction-Pa Scru�and [Ig;` , 1 7-202.12 Conditions of Ute" j 7-203.I I '_-oris Containers--Prohibitions" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smn,verz.Critan:: - Chemicals POPULATIONS{HSP) j 7-21,4.1 2 Cheun.ais for Wash:^aCr F.•: '!criV, 21 3-801.11(A) Unpasteurized Pre-packaged Juices and nit:cc; , i 7-204.14 Di Yin,-Apcttts.Criteria. Beveragc,umh Warning Iabels'. 7-205-I t incidental Food Contact. L,ibrrcnnts' 3-501.11(R) Use of Pasteurized&_gs� ted tt t e� r r.n j +-fOL I i(D! Raw or Partially i:uol,ed Anima Food and 7-206,11 R,itri I ke Fess C ;;;r.4 Raw Seed Sprouts Not Setwd. 7-2(16-12 Rtxient$z:: Burdon, 13-SO i.11(C) Unopened Pan{Package Not Re-served. 1-206.13 Tr.:ekutg Potcders,Pesi Control and ' 'vh:nimrir.,,1 CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 1-603,11 Consumer Acltisory Posted for Consumption of "units!F><xln Fliai are kaw,Undcr.00ked in Ifi I Proper Cooking Temperatures for i PHFs Not Otherwise Processed to Eliminate 3..101.1iA(i)(2) f>gg,- i°5�F1:i5rc. t§tthn;,enn.^` Egg,- Immediate Serving 145`FI Sse.^ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3=101.111 A)(2) comnntanrd Fish.ft9rdil: Eegs Aninmis- 55 1 ! sec. 3-;'01 IIQ3)(;'(?) fcrk and B•< 'b; a � t I SPECIAL REQUIREMENTS u ant 1 Lt F I_1 rots 3-401.11( f):2) RaOr,a.Jnjcred Mrats- 155"FIS 1590 009(A)-(D) Violations of Section 590.009(A)-(D) in nt. - catering, mobae food,temporary mid 401.11(A)(i) Poultry,Wilcl Came,Stnft22d 1'HFs, residenttal kitchen operations should be :uit;rg Co^ ainiag Fish; Pdear, debited under the appropriate section; Foulo :,r Rafites-M-, I, 15 sec. * 1 above if related to foodborne illness 3-i01.11(C)(3) \"hole-nmsc!, Beef Steaks interventions and rick factors. ()Ilicr 45°F* j 590.009 violations relating to good retail 3--4(:1.12 Ra,v A..^..uta! Finds Cooked in It practices should be debited under#29-- 1 65'F* Special Requirements. 3-40i.ii(.A)(1)(b) ai! O1hcr^H s-- I=5'F' ;5sec. 17 :tebea;dng for Hot Holding I VIOLATIONS ReLATED TO GOOD RETAIL PRACTICES 3-403.i U-1),Q.t i?I PF11's ai5'F 15 scc ' (Itemrs 23-30) 3-403.11(8) tjN^.urm:ave- 16531-2 Minute Standing Criiueof anal tion-rrifical violanons. which do not relate to the T:wefoodborne illness hrrcrrenlions wad riskJiutors lia;ed above, tarn be 3-403.!1(C) Comtnerciallq Plot V';fled PTE Food - foand in the f illnnagq sertiom of I&Food Code and 105 CMR 401 F" 5()0.000. 3-1it3.l i(P.) Remaining Casliced Parsons of Bcef I Item Good Retail Practices FC j 590.000 Rant::* 23. Manaciement and Personnel FC-2 .003 18 Proper Cooling o4 FI-We 24. Food and Food Protection FC-3 004 J 3-501.141 A) Coo':::r Cooked PHFs front l atf to 25. Equipment and Utensils FC--4 .005 26. Water, Plumbing and Waste FC-5 .006 70°F t4ohut 2 Hoar.,and From 70"1• 27. Physical Facilav FC-6 007 =' 41'RN!4'F U?tile,w Hous:. * 28. Po!,onous ur Towc Materials FC-7 .008 ! 3-50i.14(I3) Cu„Iing,PHF,Mwde Froni Ambient 29, Special Reuu!rements 009 Tempa"i Iare trtgredienN 1:,41"F(45 P ( ! 30 Other 'Within 4 1luurrz * 9p 000.10. De, cr.::c,,sem In rLr(:,,:�.::.� i 89° � N .d C.d_or 105 lMR 9 l CITY OF SALEM BOARD OF HEALTH // /1 Establishment Name: It N()A AItJ _PVII&A- l3dFF£f Date: "7/ule.� Page: J of 3 Item Code C-Critical nemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 21 660 AAYAAP 6nr1.4- /*-*rd &1*1� /" 13 U9F)111-$1J,8F*y A414- /*sw! 2� rr�!✓ P91 A&Ae-4 .N 11141 M/St/N6 �tit�dMeH�re£/�. t�/�dIROJr VI5/144 &��-- I 2S/ c a oW/s,f-e�.r�� AACk /4*0 Ft�b>, AWO A"ke 0461610u-s Srd"O d,If 1 \Q�E „tF r h'a FiAa,c. j rr N k s fr* Stu,,._r& AFF 0 -i%kL. PR-~�v 1 �S�cJ,tll; Oevnt 57NMs rrl refs urnu.. sOtATW-� A+'o 0*64A circ sLa.s W*"- nUo4dldS441 C'&OSA-K I , - I 9,6 n//C. C �tuPSt-��s �evrr4 rr� rs��K /��6/�.eN /lg�P �c�InaJ�ft�s",c-d' CLofKQ. y GrQ%AX /J * CAO +C 60rro a ef- il SIt-C�JcrJ arc. A&AZA46 ruA!&ecR v�L,�.r, f.rcartC I/16itrlrf 11 r �c►xDw�3 rd r NG �g/�0�I SAS �'�( t�A.nA,nf,�rnrJ !F !l JYSrs� N 1vt LPE5.0 V*AA ' �dY !'osf rr� CIerF/a,rFr� Discussion With Person in Charge:PW'f eU144- Kd;rual1T Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 F ode. I understand that noncompliance may result in daily fines of twen fiV dolJrar or suspension/revocation of LlEmbargo 11 Emergency Closure your food permit. 0 Voluntary Disposal 0 Other: 1-SOLI W") PHFsRecetvedatTnrperatures Violations Related to Foodborne Illness tntrrventions and Hick - according to Ianv Cooled to Factors(Items 1-L') (Cont) 141'F745'F Within 4 Hours. '' PROTECTION FROM CHEMICALS I 3-501.15 j Cta)tiu„i Inhod;forl)HrIi � j j j 19 PHF Hot and Cold Holding 1"u *aldi v Color Fdditives 3-501.16(3) Cold PI IFI, Maintai tied at of below 3-202.12 ,=ulditicea k 3-302.74 Pru cciion frotrtj 590.004(F) 41'V-15" F, LlnaPpiu':Cd rltoi tCrSF j 15 Poisonous ori xis S:;bsran es f 13-501.10(.4) Hut PHFS Maintained at or above 7 101.11 Identityute lnfertr.;)lion-Ori8inal Containers- j 14:) F. " 1 3-5;01.16!M Roasts Held at or above 130°17. " I � j 7-1 U2.1 I Coutnion Naine-Working Cowainers' j 20 Time as a Public Health Control 7-''!11.11 Saparadon-Stotaee`I 1-501.19 Titus at,a Public Health C'onu ol* 7-2(:2.11 Restriction --Picaen-e mn U` -7.C-' � � 5`>0.004(H) j Variance Requirement j i � 7-202. 12 Condniorr,of 1 c;: 7-203 11 Toxic C'ontainer,,-Ptohibition,� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 1204.11 Samniel s.C_rter:.�-Che:niealsm ( 7211-1.12 Chemic:7ls for R%aslvmz Produce Crites is I2C 3-80i.17lA) UupasteunzcdPte-pacl:aged3u:cesand 7-204.14Drlir,^,A¢cuts.Ctiter:a'' Beverages with Warning Labels" 3-801.11(13) Use ofPastemized EeeI," 7 205.1 1 incidental Food Contact i.ub+tcant;^ j j 7206.11 Resiricred_Ise Pestir:d,ti,Criteria" - ! 3-801A 1(D) Raw or Pa)t)ally Cooked Aminal Food and Raw Seed Sprouts Nol Served. j 7200.!2 Antiznt Bait Mations„ - j 3.501.11(C) Utmpened Food Package Not Rc-served ( 7-'_'06.13 T'nr-king Pored:rs Pst CAll:o1 ami Bio^..tr.m.,° CONSUMER ADVISORY TIMEITEPAPERATURE CONTROLS .. ..... I i Consumer Advisory Posted six Consumption of Anonal Foods'lliat are Raw.Undetcooked of Ib I Prager frn?king T'amprratur?s for Not Otherwise Processed to Eliminate PHFS Frrern:e nc:oar 3-101,11A(1:(2) Fgs- 155`!' 15 Sec ! lathog.ns.^ Eggs-bumed'u7tt'Ser,ice 1.15"P15,ec" ip2.13 ( Pasteurized Eggs Substitute tot Raw Shell 3-401.11(AIQ) Cammn7utrd Fish,s4eats tic Game ! Eggst An:n7alt, - 155'F 15 se... ,. SPECIAL REQUIREMENTS 3-401.1 i(!3)(1)(2) Pork and Becf Rrast- 1'WF 121 nen' 3-401.11(A)(2,) Ratnrc t;:j_cted [.teats- 155'17 15 I 590.009(A)-(D) ViolaitonsofSection i00.009(A)-(D) in catering,. mobile food,temporary and 3-401.1 t(A>?3) Pr.t t ry,Wild Game, Snuffed PHf's, residentia! kitchen operation;,should be Sn_fting Containing Fish. :iMcat, debited under the appropriate sections Poultry or KIvites-165017 15 sec. above if related to foodbarnc illness 3-401.1;(Cx,3) 1):7:ote-,7nts..ia,Intact Bect Steals Interventions and risk factors. Other 1>> 1 ' 590.009 violations relating to good retail 3-401.12 Raw animal Food, Cooked in,- ( practices should be debited tinder !{29- \4icrowa„e 165'17 Special Requirements. 3-401 ll-,a.)(10)) All Othe: PHF,- 145`F 15 se.. 17 Peceating far Hat Holding j VIOLATIONS ReLATEO TO GOOD RETAIL PRACTICES 3-403.11(.r1)&0)) PI-11,s 16.5'F 15 sec. - (Items 23-30) 3-403.11($) IV,:, 165°F2 Rfinute Sumdin2 Cridca7 mr<1 non-critical rioiuhun e, which do not relate to the Tir--c" foodborne illness baervemions unit tisk- iutars Bated nhose, can he 3-403.!i(C) Commorc Call} Pra:ecsed R-1c. Food- I ,(uund in the f lb,r,-orq.serrions of the Food Code and 105 Cblk 141)'17- 50+0.000. :y-403.11(E) Remainint Uushted Portionsui Hccf j Item Good Retail Practices FC 59o,00o j 123. Manaclanent and Personnel FC -2 003 I j 18 Proper Ceoling of PHFS _- - 24 Focr3 and Food Protection FC- 3 .004 j 25 Fgoirment and Utensils FC-4 005 3-501.14A) Coolim,CookedPHPsiroa714o`Fto 20. Water,PlumbingandWaste FC-5 .000 --- -1 76';Within 2}-sour,and Front 7C)"F 27 Phvsical Facility Ft: -6 .007 to l`P14:i'F' t4'ithtn4 Hours- ^8 Poisonous or Toxic Materials FC-7 .00E j 3-501.14113) Cooling PHF;blade Hour Ambient 29. I Special Regwiernents 009 J Pemperature h7gredienrs in 41`P/45'F 30 Other I - W ithin 4 I(car;;' i DCA(ACI eneeal i(em m 11),,Ldaal 11)u9 E,m!Cud: , 10`(-'psi?;90 000 T an r-.: - r..-nY--.-....,...+,.ti.+n+rr� .��-+'++w..d..-r.r.r«y«r.'.�r.+-,«-+w-'¢..+Y,y.w, w..+'++wl.-w+a+w.'r."-�w^-vn+wn`.ar^=h.+.wa''+n✓'�mi^r-..:,w+..w'....-v-..'.r... .vf-r .vxLL�.. 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 Tvae Qf r i n Type of Inspection 1/i.74Z'IdA lAl ya.6 &, Fe-r- a- �/-(:7,v Food Service I,�,�/Routine Address ' / ! ��, Risk ❑ Retail L Re-inspection �00 �`f/phf � /A:X� Level ❑ Residential Kitchen Previous Inspection/ Telephone ) `/SAO-03610 - ❑ Mobile Date: Owner / / HACCP Y/N El Temporary ElPre-operation /A,/� yt (7`j//uj /,VC ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) f�UbN� Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector 'la11W&W / 7 4n1/Z 7-17I'W 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 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ El 16. Cooking Temperatures ❑ 5. Receiving/Condition ' - El [� 17. Reheating 6. Tags/Records/Accuracy of Ingredient Statements s El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling 1:1 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 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)(590.000 have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-0(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 REINSPECTION: n�r n�Mf'e: Print:..i"v�o�,.G�.... PIC'sSignature: Print: D 1�1 Jne .� -� Page�of Pages FORM 734A HOBBS&WARREN - BOSTON _ 1 Violations Related to Foodborne Illness - 41 Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(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 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 I 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 Contamer* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601 11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* ]1 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* - 6 � � Tags/Records:Shellstock � 12 � � Prevention of Contamination from Hands 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 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 11 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: Date: a /7-UPage: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY r 'ape" G�/.��f . .v o`l - I��l1� //✓S,1J�C �7�i'1 � /.,n,e 1' /7�L trla I r I I I Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I, have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension i1 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: +-�4111.14(0 PH Fskceervedat I ciuperaturs Vreiatiors PBlared fo Faod+bome Nlness tnteiventions and Risk Accorditf,,io Low Cooled to Factors(items 1-22) {Con:) 4 i'F,145'`Within 4 Homs " 3-501.13 CUeilna Methods lit PHFs PROTECTION FROM CHEMICALS ( io PHF Hot and Cold Holding 14 Food or Cour Additives j Z20�.i2 ;Lddiutest 3-�Ult&,B; Cold P[11,sMalnlaht:'ddloihelow j 590.004(F) 41'R5'F"., i-302.14 Piotecoon from Unappro,ed Additives* ;-501.16(.1) Hot PHF:,it4ain:pined an u; abase i g Poisonous or Toxic Substances ( 140'1,, i-10:.; t ldentnh?Inc hihxm;liun-Ori gimd I ( 3-501.16(At Roasts Held at of above l 3WI, ih L o;ti ainei ti„ 1-002.t 1 Common Name-t4'orkirw Containers-" ZO Time as a Pao!;c Health Control � 7 2Gl 11 Sop;nation-Storsec^ j 3-501.19 fungi a:It Public i lea th ControP j 7__07.11 Rt,strictioo-F:=sertean ise't 590.004(H) 4 at'iance Requirement j 7-2J2.12 Conditions of t'sc' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE r-203 11 'Cox is Cnn[nn:rs-Pr,AiibitionsA POPULATIONS(HSP) 7-20=.11 Sanir;zers.Criteria-Cheimc ls^ 7V4.12 Chemicals lot 1n'ashmg Pioduce.Criteria'° 121 3801 1 i�A) Unpasteurized Pre-packaged incus and 7-:04.14 Beverages with Warnir a I-,abel0 Drone Ageeta Criietia' j j. 7-105 11 hi(idenud Fnou Gn ?-g01.11tt) Uie•uf Pasteurized Eggs* dact. 1.t:hricant:,r' j 7-206.11 Restricted Use Pcsticid,s,Chet ia' 13-$1)1 I I(D) Raw or Partially Cooked Anneal Food and Rat'.'Sced Sprouts Not Staved. ^' 7-206 i 2 Rodent Bait Stati'ms" j 3-801.11(C) Unopcn,d Food Package Not Re-servz([ 206.13 Tracking Po.vdets,Pest Cooirol art, ! Isfommaim' ( CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consunxr Advisory Posted for C'onsumptcn of 16 Proper Cooking Temperatures for i Annual Foods That are Raw, Undmu;uk=d or PHFs Not Othertc ise Processed to Eliminate Pathogens.* s,�.,:-.,,;.rm,r =103.' EA',I)(7) Eggs- 15:3'`, I5 pec . E Fr;r,-Immcdrac Service 1 45'F;5sec' 3-302 l3 Yasteun.:e(t Eggs Substiurtr for Ra�r Shell 3-401.1?;A)(2) Comminatcd Fish.Meat.:K Game Animals- 155''F I5 sec. SPECIAL REQUIREMENTS 31(Yi.11(RH1)(2) Puil:and bcefRO"t- 130'F121inin' 3-411.1 RA;(2) Ratitc,. In;ectal l4mr:- 155'` 15 500 009(.=1)-(D) Violations of Section 590.009(.0-(U) in e, catering, mobile food, tempotarpand 3-401.!1(A)(71) Piaiity, W141 Gam..Sudfed PHF,, residential kitchen operation,Should be Staffing Containing Fish,�4eat. ! debited tinder' lite appropriate sections Pouhry-or Ratites-16�'f 15 cee 4' lb'v'e ii telated to foodborne, dhness ',01 11(C)(3) `who;=-tuusc!c. in::ict Bcct Steaks ! interventions and risk factors. Other 1-15'F 590.009 violations relating to good retail 3-40 1.12 Kay, lnirnal Foods Coked in a ! practices should be debired tinder 1/29 -icro«ave t6°-1' Special Requirements. 3-40!.11000 l (b) All Othet FHE. - 14:'F' 15 cee 17 ( Reheating for;lot Holding VIOLATIONS R.LA TED TO GOOD RETAIL PRACTICES 3-40.3 1I(A)S(1`- PiIPs 165'115 sec. j (items 23-30) 3-403.11(13) 64icruwave- i'.6'F 2 Moiate Standing Critical and con critical violations, olich Bio not relate u)tie! lime' (w,!a or'nt dhwss inter voaioux and risk lactnrs lisic l abate, Bae be 3-403 1_(Ci Commercially Powe ted RTE Food- Pound r,;rite follna iog sertioin nl the Food Code and 105 CWR 140'?' 54(:.000. 3=03 i l(E) R-ominin g Unshcc(i Portions of Bcef I Item Good Retail Practices FC 590.000 RoastO j 23. Management and Personnel 1 FC--2 003 ! t3 Proper Cooling of PHFs _24._ _Fred and Food Protection -_ FC- 3 004 _ 25. � GquiGment and Utensils FC-4 .005 3-501.1 zl(A) Cool inCooked PTTFs from l JUT to j 26. Water,Plumbinq and Waste FC-5 .006 70'F W.ilhau 7 Hours sad Pr;.tai 70`F 27, Physical Facility FC-6 007 to_11 TN 5-F Within a F,�ucs. ` 3,3. -_ _Poisonous or Toxic Materials FC--7 008 3-501.14(B) Coling PHF:; Made From Amrbient Special Requirements 009 letupzraturetn'rulcr.[:tu=,I-F;•}>"p Other Wo h:n 4 Hour-,° 'Dtno!c•cdtiaai U` Ct.ts l f i Massachusetts Department of Public Health Salem Board SHealth M 120 Washington Street.4'" Floor Division of Food and Drugs Salem,MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978)745-0343 Name I Date I Dpe of ODeration(s) Tvpe of Insoection �/7 �/ je „ii)v �F ter �-/1)-Otf ©'Food Service ❑ Routine Address h n I Risk ❑ Retail ❑ Re-inspection 2 a,oa 1/nn Grp up . - Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Dateg-/ &C3 ) 7,1(-)- G'.3/ C, ❑ Temporary ❑ Pre-operation 1 Owner 4/n r! 7 of Nn,Chn u HACCP Y/N I R/ vy v r A/Ju. Tric rk veN6 ❑ Caterer ❑ Suspect illness Person in Charge(PIC)'- Time ❑ Bed&Breakfast ❑Genera�Complaint TES/)N , (d Ln,i /v.rnrc P In: ❑ HACCP , / Out: Permit No. ❑Other Inspector /-)1 reG,r3r, v -/ If 7;,�st rn/FIS Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS - ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE �, - TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ' ❑ 19. Hot and Cold Holding Separation/Segregation/Protection 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) . ❑21, Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 3 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction:.Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2}(590.003) order of the Board of Health. Failure to correct violations 4. Food and Food Protection (FC-3)(590.004) �`Z cited in this report may result in suspension or revocation of r�c5. 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 ___,Z-21 2 . 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 5901nspecll M1 6 14 do I, Print:SivK%6 ` , . Print: ge�of_ Pages PIC'sSignature: / 4 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) P801 EC Y;WN FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I 8 I 0 50 .003tA'� i I i i I",%f(1,: Ri,iv animal To;uh, 59'0003(B', Demonstration of Knox ledg,, Ciei4ed and f1,TEFouls* 2-103.11 I Person fit charge-conies i I Cantanwnatioq from hian,fngt-aio,its 302 i 1;.11=') K,:v, Annual FoodSepirzot-d lionFach EMPLOYEE HEALTH Other- 2 590.003(( ) Responsibility of the person in charge t;l fron,''ho Errviranft;:nt require reporting by food employees and 3-02.1 (A) ; u,d 1,njluctivn- applicants* 1-3Q2.i.,-) Wasit,;t; Fruits and\'eeetables 200 003(r) lksponsibilily Of A RKKI Eoiptovc,Or.kn 3-304.! 17,311-d Cont::-..t lith: Equilinrei-tand Applicant To Rcporl To The Person In i Utensils* otainont,en from're Corsuei,,,� fi90 fjA(,G.) Reporting by Pelson in Cluffiae* 3 1�1:6 14(A!(W 'R1111ned Food an"!Kecl vicr,of Food, 3I 590 00?(D) Exclusion;and ResiTic t nu,,.sT 0,,soosMon of AdC,terated cr Coeaminattscj 500.003(F; xerni,,al of Exetusionsand Restrictions II Food 761.11 DL,rardingo.Reconditioning Uu,afe FOOD FROM APPROVED SOURCE Food'. i 4 Food and Water From Roguiated Sources 19 Food Coninct Surfaces B) Compliance with Food L:w" -1-50IJ 11 Manual War:waslhine- Hr.t'Wat,r 1-201.1 2 Food in a Hermetmilly Sealcil Container* Sauid:%oor. I elnpe,� 3-201 13 Fluid Nfilk and Milk Products" '1-501 IK, M-ehiiwcal VV,reAashing-H.-Viater 3-202.13 Shelf F"'g,", I Saniozatio[I Tenlpriai 3=207..:4t 4-50!.I I Chi::,utal Sanni/ation-letup.,pH, Einzs and'Milk Pioduo's.paqeurizcd,� conventrolinnand Inudrim, 11 i 3-2C2.16 kc Made From Potabk Drinking Water" 4-6U:.:I(R) Equilianpry F.cd Contact Sail'aces und 5.101,11 Drinking Water from.:n Approved System" ',90.006/ Bottled Drinking Waiui,� kA 1002.1 i Clear,i r.-, Frecp,,.ency of 590 00603) Water Meets Sixidards in 310 CIVIR 22.0* Contact siwfacCs aA Sholifish ad Fi3ii From,,?t?Appri:ivad So-ice 4-701.:I fIl-Uy-ellcN,Vi, ,iinoz.ation,of Utensils and 3 20 1.14 Fish;in([Recreatik-nalh,Caught Molki.scin OnWIJ SlnfaWOS Of E(Itlipole! 4-103.:1. INA dht,Li s of Sanitization-I lut Water and 20L 15 Molluscan Sh,11fu1i 1',oin NSSP Listed sources` Chemical* Proper,Adequate F.3ndwashinj Game and Wild hfushroorrisApproved by Y)1.1 i --lean Condition--hands anti Arins Roguiaiory Authority i-202.15 Shelku.cl:ItIcittiflication Piret.ent" -10 Clcnnin2 Procedure* 590.ou41C; Wild Mushrooms* 2-30i-14 When to Wash* 3 20;.17 Chante Animals* 111 Good H.vqienic pfactirmt; 5 Receiving/Condition 1 2-4u L 1 Eating,EInnking or Using Tuba"o' I i Pfif-i;Received at Pi oiler Tenipetatuues* 2-4:1.12 Di,ch:,rLN Fv�ni the E,,e,,, Nose and 3-202 15 PaLkage Integritv- Mouth`_ I ?_=1)1.11 I F(K)d S,ife and Unaduil,rated l3r.,,eiaing Contaurinettvir, When Tasting" rdri Ion from Hands Prevention of Co minati Tagsj.ReCoeds:Sh,,Ilgtmk 12 3.209..15 Shellstock Identification E) Prot-eating COntalinnatioll Iron; 3-203.19 Shellstrick liki,i;Fication Maintair:,d' Tap/Records;Fish Products Handwash Facilities 3-A02.,; pai"Isite Conv&,7ien%qy ucaft-rd and Accessible 5-20111 Nan-ibers and calj-.Cities* Rek ui ds,Ccation and Retention' 590.00401 LaWing of Ingredients' I 1 5 4u 1.11 Locati"o and plaienie.u* Conformance with A.pproved Prcredures 5--, A-ctssibilitv, and Nlaintejian�e i ( i 7 MACCIP Plans S'ppkedSoap and Hand a Drying Processing Methods* -51)2.12 Reduced ovygen packalting.criteria" 16-:;DLI "Hai6%asInnp Atailability T)r-vin,,,Provision 12 Conforrnirix Nyidi Approved Froedure,," 6-301 1I I Duioicseriii,:;d itum in the fudmal 1994 Food Code o, oi;CNIR 590 000, CITY OF SALEM BOARD OF HEALTH / Establishment Name: Date: 2�°/° Page: J, of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY ) i T/l Cele C//rp Z - /•l�rG/�/�i— �i�oia /rE.n< s tz iP°d P� zu air / �/r>� — ✓� a a l G�� S �5 c'a 9P 9 C - G//aG!�rN! tet/ mvaf Clrli ,co /A o'u/e Ps Guile ur, f' 2S Pl-ec 77 C_ niJc XC - .S 7'7,1//trod - A '`ea-y) 1iaA?0r_A:;fi //j ,,/ a C- ?"-,/1/0/AVC/ &Z' 1 S"�YuST � ' )3 e A/ Cee- /rr/ sa4-r /= Ste/ 72iA/ g to LU 7e7eW ,&A7-zleeF fir/crc s�X/ot ' 7`731.eS, Lf-7` . d.P, \S;4 n71i ran �- c�dr. _ v / � /r✓ �e e 2/,Se� Fv,e C'us t�7rrs,,a� / �.e/,I,rrs ''� Discussion With Person in Charge: Corrective Action Required: I ❑ No �❑ Yes 3 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �'177 G �Ti��—�f— -❑"-'V616ritary Disposal ❑ Other: �T - 1 3-501.14(C) PHFs Received 6t Tenil,ervinres Violations Related to roadbon%r-illness intervenr;;,r..c and Risk ,%ccordin-�in I,a.r Cs,;ha{to , factors(Items 7.22) (•:onl.; -:I'FMJ4 F Within S Hams PROTECT)ON FROM CHEMICAL � 1-501.15 ( t,,sling �tethcxls for PliF. 14 Food or Color Additives 19 PHF Hot and Cord Holding 3-501,Ifi(B) twill HiF5 Nfainlaloed at o' 3-"u--,.12 Additree''' 590.004(F) 4i`145^F- I J potent:o:, :routttn npr;r.ri; lid;t:,es:' -501.I6(,A; Hot PHFS Maintained at or above 15 Poisonous ar Toxic Substances 140'1' " 710II1 Iden:•ty:ncln'onm,tion-Oroe:nal ( 3-501.16(A) Roasts Held atorabote130` i 7-102.11 Cou n on Same.-t$urk:rc Cue tz.ncv ' ! ' 20 Time as a Public Hearth Control 7-''01.1 ISc;).u-.¢F.;a- 3-501.19 'lime as it Public Health Control j i-::02.11 Rer[Jiehnfl-fte�,rnce.vol L<r, 590.00<!(H, Variance P.equiretneat I 7-2u) .12 Conditions::t t.;c'' i 7-20s 11 1'o:ic i:rnnain:r< -?roiii ,tio ;' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-201,11 Sanitizer;.Criteiin-Chemical,;_ POPULATIONS(HSP) 7-20= 12 CEteutic;:f< for 14a41r.^ Pi""!'Ice' Cuiieta' 1 21 3-901.11(A) Unpasteurized Pre-packaged Juices and ' Beveraces with Warnim,,Labels* 204.14 Divine flgeutn Ctnzua` 3-901.1 t(B- Use of Paeteutized ;S* '' 205.;I Uu:d:)til Fund C;,;:fnct,1 jibu,aur.:= 13-301 1 I(D) Raw of Partially Cooked Animal Food and 206.11 Reeroctcd Use Peabcidcs Critojia" 7-.'.Ob.i'_ ILs. j Raw Seat S1x,uns Not Served. dent Bait S:al:uis 7-706.13 ?racb:ing Pu„detn,Pest Couilrol a,i;; I 3-80L]I(C) Unopened Food Package Not Re-sen-ed Nt,mitorunz, CONSUMER ADVISORY 22 3-603.11 Consumer Ad}icnr Posted for Con uni Winn of TIME(TEMPER iTURE CONTROLS AnimA F,,ods'11-t are Raw. Undercooked sr lb Proper Craking Temperatures for PHFs Not(Jther�aise Processed to Eliminate 3-401.11 At 1)(2) Eggs- f55''F1`' Ser Pathtwem.* ecr.,00 lmmechzte 5:.:crce i d5-SI5sec, 3-302.13 Pasteurved Eggs Substitute foe Raw Sliell 3-401.i i(.4)(?) Comntimued I`^e:ns Y:(;nine Fit,,.,, Animals-155`F ;5 scc " SPECIAL REQUIREMENTS 3-401.11(1:)(I)'2) Pot L:md Bce1 Roa_t - 130'F 121 min' 3-401.1 i(An2) Ratites, injected Meats- 155-F 15 590.009(.4) (D) Violations of Section 590.009(A)-(D) in seg-. catering, mobile food, temporary and 3-401.11(A)(3) P,:n11r, W1111 Gam,, Stuffed P1 T.1, ( residential kitchen operations should be j Stuffing Containing Fist,D4eot, Jehited raider the appropriate secnons Poullryer Ratites-155'F i5 sec ` aho.c if related to foodborne illness 3_401,11(0(3) Wh,,:e.m:r;cle intact BrefSteaks interventions and risk factors. Other 14';'F" 590.009 violations relating to u0od retail 3-1f11.12 Ras,Anand Foods Cooked ;it it practices should be debited under#29-- Nl:clowavz I55`F' Special Requirements. i-4'1.1UA)(l,itb) All Other PHFs - 1.15':' 15 eec. 17 Reheating for Hot Holding VIOLATIONS R-LATER TO GOOD RETAIL PRACTICES ' s-403 1!(A)K(D) PIIFt; 16.5'F iii sec. "' (Items 1-3-30) 3--:03.1 i(Br A9ic,o•.va,•,- 155°F 1.I gVntrie Standing Critu al and non-crriicul violations, which do not rr•fnte to the 1 Tube" Invdbori a itiaess inters entionc dna/rick(morn(s !mled above, can he i 3-403.1 `(C) Co�mercholy P:c:essed RTE Foos- found in the fell,,),trig s,:c�tinrn�o the Food Code and 10=CN,R !40-F+ 590.000. 3-403 11(E) Romaininc Lncticed Por:+nns of Beef I item--- Good Retail Practices FC 550.000 Rsast,,: 23. _ Management and Personnel 1 FC- 2 .003 tg Proper Coaling of PHFs 24 Food and Food Protection FC - 3 '004 25 Equipment and Utensils FC-4 ; .005 i-:JOL4(Al Coating CookcdPHPsfuom140'F10 2E. 1 Watet. Plumbing and Waste FC-5 .005- ---- 7WF Within 2 Hour,and Front 7h'F 27 ! Physical Facility FC-6 .007 In,!]'F/45'•F Within 4 Hoa:,. ^ 1 28. 1 Poisonous or Toxic Materials FC--7 I .008 3-501.11(B) Cooling PHFs Made From AraLient 1, 24 _Special Requirements 009 'teinperature ingrcdi iat tv,41:Fv'.75"F 30 Other Mitt:;o.4 Hour` •,, Drnuro,;aitirai nim u;the fedmil 199+1;'nod Coda ut PH CSMR X90,000. 4 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: 3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I �k�t,c'iae J I 2-7 - �o/—X '_PC11_n 6e h�cr>�f } 27 )' I 64i Y_2�—n/ /.4 i OJMT 071, //l'e . 1-_rt7 - 6e1"� ¢. c,-/dem -/0 I ✓pza'0L1-1i. �� A/ow NQpIl �o /0 rcPP CT/"!/f'S ,y i2 2/SG Z/ SILs Ck /)�L/ 77 /vl�q A&(vra6eeI/ F GIv-E d✓ I k l I I ✓ I I I I I I 441:(5n') , vt"L_�O_ ` Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I I ❑ Voluntary Disposal ❑ Other: 3-%l.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk Accurdine to Law Cooled to Factors(items 1-22) (Cont.) 41017/45"F Within 4 t-lonrs ' PROTECTION FROM CHEMICALS 3-501.15 Conking Metho(Is for PHF; 14 Food or Color Additives ( 19 PHF Hot and Cold Holding 3-501.16(B) Cold PliFs Maintained at of below 1 3-202.12 ,iddnives' 590,004tF) 41 '45'F- -302.11 Protection funn Unuppnnrd Additheo- ( 3_S0 L 16(A) Hot PRFs Maintained at or ahnte 1g Poisonous or Toxic Substances TWK 7-101.11 Identifying Information-Original I 1 ci j 3-501.I6.A) Roans Held at ri above 30'F'. " Con[ainers` 'r-1021 I Currurun Nam: -Working Containers* 20 Time as a Public Health Control 201.11 Sepxruion-Storaee'�' j 3-501 19 Tinto as a Publi( Health Central* 7-20111 Rc.;trietlon-PresenceaedUse590.004(4) VarianceRequinornent 7-202.12 (Andih(In;uI Ilse' 7-203 11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-20-}.11 Sanitizes,Criteria unp Produce, 121 3-801 1 NA) Unpasteutiyxd Pre-packaged.luices and 7-204 12 Ci,,ing lr.for.Cut vii Pnxlu�e,Criteria* Beverages with Warning 1..Ibels* 7-204.1A Drying Agents.C�itecia' � 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact, Labrteants 7-206.11 Rc,tricted Use Pesticides. Cr eria" 3-801 11(D) I Raw of Partially Cooked Annual Food and Riot Sued Sprouts Not Served. s 7-206,12 Rodcnt Bait Stations" ! 3-801.11(C) Unopened Food Package Not Re-sc•rv_d. " 7-206.13 Tracking•Powders, Pest Qmtroi wid ibiomtocingCONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consu[ner Advisory Posted for Cons[unPGon of 16 I Proper Cooking Temperatures for Annual Foods That are Raw. Undercooked or PHFsNot Otherwise Processed to Eliminate 3-401.11A(I)f.'.) Eggs- 155`F 15 Sec i Pathogens." r,,.,,:.-ovum E;;gs-Immcdt:ueService l•t3'FISse." 3-302.13 Pasteurized Eggs Substitute fur Raw Shell 3-401 1 I(AI(2) Cbimninuted Ptah. bleat.,K G[une Eggs` Animals- 155-F 15 sec. " SPECIAL REQUIREMENTS l 3-401.1 (A)(2) Ranter, Injected lllcats- 155'F 15 3-401.1 (u)(1)(2) Pork and Beef Roast- 130`F 121 min'^ 590.009(A)-(D) Violations of Section 590.009(A)-(t)) in sec. * catering mobile food, temporary and 3-401.11(A)(3) ( Poultnp,Wild Game. Strafed PHI7:. I residential kitchen operations should he pStc., Stut�mI -ontainmg Fish,Meat, I ll under the appropriate scctioas Poultry or Ratite-:165'F 15 sec above if related to foudhoute illness 3-40 Ll 1(C)(3) Whole-muscle,lutad Beef Stceks interventions and risk factors. Other 115'F " 590,009 violations relating to go(A retail 3-401.12 Raw Anunal Foods C(xtkcd in a practices should be debited under#29- Miavwase 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 j 3-403 1l(A)h'r(D) PHFs 165`F 15 sec. * ( (lterns 23-30) 3-403.11(B) Microwave- 165'F 2 Mumu Standing I Critical and non-enlistl violations, which do not relate to the Time" (oodhorne Illness inierrenrions anti risk faclory listed abate, can be 3-403 11(C) Commercially Processed RTE.Faxl- 11)in the follon in,g.rel tions of the Food Code and 1t>5 C. R 14417' 540.000, 3403 1 l(E) Remaining timbeed Portions of Beer j Item I Good Retail Practices I FC 590.000 Roasts" 23 I Manaqement and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25. Equioment and Utensils FC--4 .005 3 501.14tA) Cooling Cunked PHFs iron) 1400E to 26. '�i Water,Plumbinq and Waste FC-5 006 _____ _ 70'F Will,,,2 Homs anti Front 70`F 21 Phvsical Facility FC-6 007 to 41"F/45'F Within 4 Hoary. " 28 Poisonous or Toxic Materials I FC-7 .008 3-501.14(B) Carting PHFs Male From Ambient 29 1 Special Requirements 009 Tanperature Inin-edients to 41'F/45`F 30. Other ------------- Within 4 Hours` ""'"""""""'e, Denolcr+critical nein in the(cderal 194+9 Frw,d 0ade.of 105 CM It 14)0.000. r ca CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ms 120 WASHINGTON STREET, 4TH FLOOR ` * SALEM, MA 01970 gB TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, -P .JOANNE SCOTT. MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to : Owner ' s Name : Binh & Chau, Inc . Name of Establishment : Mandarin Super Buffet Address of Establishment : 400 Highland Avenue Type of Establishment : FOOD SERVICE Application Date : 12/16/2002 Restrictions : Permit for Food Establishment 92-03 Frozen Desserts/Ice Cream 5-03 Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS vQ1 BOARD OF HEALTH 2 � 120 WASHINGTON STREF_T, 4TH FLOOR SALEM, MA 01970 DEC 13 2002 '>B "•" TEL. 978 74 1-1 800 FAX 978-745-0343 ` -SALE /��y..l i[ry�p�Lii' STANLEY USgV(G2, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT )`4X)j h V-11+ CUPe'r- R U e*TEL# C fl 0 74V" D�D4 ADDRESS OF ESTABLISHMENT 1400 MAILING ADDRESS (if different) ( s a �..� OWNER'S NAME IN" -f C-HAV F N e- TEL A002-) 01 -7`S')70 ADDRESS j-- --L� o TT '&T CITY I� F _p L i STAT= "A ?!P C i `i t.("— CERTIFIED FOOD v1ANAG'c�S NAME(S) e-P ) - `)R 1.t 6 til ff CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) r } Q EMERGENCY RESPONSE PERSON 17,f+ NA)- t ZW 0 N 6'- HOME TEL# �1�I`� / qL? -�0 P 1111a,ta 111.1040 ?i13atr:3 i1 Ia–tr 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 qq more than 10,000sq.ft. =$250 RESTAURANT YES NO /a less than 25 seats =$100 25-99 seats 410- more than 99 seats -$20 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS _ MAKE ICE CREAM, YOGURT, SOFT SERVER NO Yo 3 $5 TOBACCO VENDOR YES NO 0 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!, to my best knowledge and belief, have filed all state tax returns and paid all state taxes reu ed under the law. Signature iDate Socia! Security or Federal Identification Number Revised 11/25/02 FOODAP2 Check#&Date 7�a�— 4 1 IMPORTANT MESSAGE ) FOR JOSC�� DATE � �'' `� TIME 11,'16 P.M. M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII P r AREA CODEAll NUMBER TIME TO CALLTELEPHONED 1PLEASE CALL CAME TO SEE YDU ' WILL CALL AGAIN WANTS TO SEE YOU I RUSH f RETURNED YOUR CALL ) WILL FAX TO YOU MESSAGE SIGNED �✓✓ YYM'49. on o IM 00 NOTES I �' ( IMPORTANT MESSAGE ) FOR DATE�1 /91 /0 '_TIME d �.M. M OFF'YL 4iv-.eC^A/1 ///c� PHONG C7 1.� �TU _ 03nC, AREA COOE NUMBER EXTENSION O FAX O MOBIl F AREA CODE / )NUMBER TIME TO CALL TELEPHONED I /It PLEASE CALL CAME TO SEE YOU J .� WILL CALL AGAIN WANTS TO SEE' 'rY ( RUSH RETURNED YOUR CALL f ( WILL FAX TO YOU MESSAGE + SIGNED MbPS. MADE I'NU.S.A. NOTES .,.,�,�,„ .. Y-...,n.-w:.n--.... .. w.s,.-c..,•�...ww.c..a....�..��,��.-.Mah^�-ewro»�vb♦"....++,.w•Fr�.,.-..� t..,.,.e,.-......w. �, THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name J cDale roTvog of Ooeration(r Type of Inspection 7/w r�✓//1 7r/ L'i17-' ls �iS� ElVP Food Service 0ElRoutine Addr s�s /// / Rr k Retail 12 -inspection (2/ W/Je - Level ❑ Residential Kitchen Previous Inspection Telephone '.. ❑ Mobile Date: Owner �/� / L / HACCP Y/N ❑ Temporary ❑ Pre-operation ir, f __ _ jai -7/�� • El Caterer El Suspect Illness Person In Charge(PIC) j// Time ❑ Bed&Breakfast general Complaint _! In: [I HACCP Inspector_ /HJT Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating El6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ B. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24: Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above-address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature:�� / �\ r Print: PIC's Signature: (��'%?/7v � Print: ' Pagf� e oPages FORM 734A HOBBS- WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person to Charge-Duties 3-302.1 l(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 13-302.15 Washing Fruits and Vegetables Applicants* - 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 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 €g � Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 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(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashmg 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: fAl7i..7 �e, fC X51 j/)Pv 1� p Date: _R /,,S '1 Page: of Z Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I I I I • I I I I I I I I I I I I I I I I I I I I I I I I I I I I lI I I I I I I I i I Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion " comply with all mandates of the Mass/Federal Food Code. I understand that ❑ Re-inspection scheduled ED Emergency suspension noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: . I . 3-50114(() PHFs Received:u 'Feltiperature.s Violations Related to Foodhoure tones:irtsrvanero;ts and Risk According to Law Cowled to Factors(ltems 1-22) (Cont) 41"F/45`F Within 4 Hnura. 3-501.!5 Cowling Methtxls for PRFs PRO i EC TION FROM CHEMICALS dorColor A ( 19 PHF Hot and Cold Holding la Food or color Additives 3-501.16(B) Cold PHFs [Maintained at or below .02.12 ,:lditt`r k 590.004(F) 41'/45` F* 3-302.14 Pi,acclion t o:n U:;appror.d Adduive:� j 15 Poisonous or Toxic Substances 3-5(1 1,16(A) Hot PHFs Maintained al of abusa 7-101.11 identifying in4;vuuirion --0,I it l 3-5U1.16(A) Roast:Fleld it on ebme 130"r. '^ Cuutamerv" j 7-1 )) 11 Cummam Nsrne- '7-301 Il Repar:r.on- Time as a Public Health Control g,Cunhnr:ers' 3-501.14 Time as a Public I lealth Control'" 4:ora^e+' � '7 2U- I 1 Restriction-P'rescncr and Ilse" 591"W04(H) Variance Requirement 7-''_fi2.12 Conditions of G�e:: 7-20'.11 Tunic Containers-Prohibitions` ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 S:autiz::,.C rater a-Chz:r,�cats' POPULATIONS(HSP) 21 3-801.11(A) Unpasteurized Pre-packaged.Juice;:at,,,' ; "1-201.12 Chemicals ti�i' yaltiil;n,' P:nCuCe.iCl i�rie' 7-20.4.14 DlA;,ents Cl with Wal Labe.s* j 3-801.1 1(B) Use of Pasteurized Egg's'° 7--^_(15.11 hicidcntal Food Cuniact.Lubr'icants� ( 3-801 11(D) Rat".'of Partial1v Cooked Animal Foul and j 7-206.11 Restrided Ur.e Pe,,tic.ides, {Sizer; Raw Seed Sprouts Not Served. ' 206.!2 Rodent Ban Stations'" ( ! 1 1(C)-801 3 . tiro used Foo 7-2U(i.13 Trae.kinr F'uwders. rest Centrtl and I - p' d Package Net Resrrred. Mo-al CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temp-ratures for Animal Fo ods Than are Raw. Undercooked of PRFs Not Otherwise Proce:;.wd to Eliminate Shell Pathogens. rs�.r:.:,.•+.>w 3-10L11A!1 t(2) Lees- 155'F Ii See (}2. 'txcd Eggs Substitute lot Ran' Leps-lmmeili:to Set vice l-4i"FiSsec" ;-302.13 13 Pnslem �' Epps. 3-401 11lA)(2) Cot'I:n nutrd I^sh, Meals X Game j and n 3-4nL11(B)(;)t_I Pat kdBceof Ruast-i 30°FI:?Imull, SPECIAL REQUIREMENTS� 59t7UU9(A (D) c c 13-9U1.l VA)(2) Roues. lnjec+ed Mears- 155'F 15 )- Violations of Section 590.00)(A)-(D) in e, I catering, mobile fool; temporary and 13 401.11(A)(3) P„ult,v, Wild Game, Sarrfed PHFS, residential kitchen operations should be ,QpftulL O-inaining Fish, kicat, debited tinder the appropriate sechous L>rattrrg::r Ratites-165"F 15 sec ' above if related to foodbot ne illness i1 401,111C')(3) Whole-muscle. In,act Reef Steaks i interventions and risk factors. Other 145'F'c 590.009 violations relating to good retail 3-401.12 Raw Annual Fonds Cooked in a practices Should be debited under #29- vticrotrave 165`F Special Requirements. j 3-401.1 l(A)(Ulb) All Other PI-iFs - 145'F 15 ser. " 17 Reheating for Hot Holding VIOLATIONS RLLATED TO GOOD RETAIL PRACTICES i 3-103.11(A)R(D, PIIF; 165-F 15 sec. = (Items 23-30) 3-403.11(13) Microwave- !65- F 2 Mmule Siandinl, Crinrul and non-orifice(violations, which do not reiate to rhe -Lme" j loodhorne oluess intervearions and risk laefars hsfcd abate, can he 3-403 1 i(C) Commercially Processed RTL- Food- found in the following sc<'tionx a(the hoot(Code and 105 011? 140017" 59J.000. ! 3-403.1 i(E1 Retruk"ing Un>iicecl Portions ul'Bcer Item Good Retail Practices FC 590.000 Roads'' ( 23. I Management and Personnel 1 FC--2 .003 18 Proper Cooling of PHFs 24, 1 Food and Food Protection FC--3 004 3-501,14(A) Cowling Conked PHFs room 140+to 25. Equipment and Utensils FC--4 ,005 26. Water,Plambinq and Waste ; FC-5 ,006 10T Witton 2 Hunts and Frow 70'F i 2.7 Physical Facifty I• FC-6 007 � to d I"F/4i F Within 4 Hours. 28. Poisonous or Toxic Materials FC-7 .605 3-501.1-bB( Cooling PHFs Made From Ambient 29, I Special Requirements .008 temperature ingredicacs to 4i'17/4541' 30 Other •; Wil 4 Fkmrs" ' IRnrdea rriLc•I itn,t in in, Cede.Al 1990 1 u•d'ode o 105 CMR 590000. .. -. ._ .__-.w.-..-....,.. .....-.-...., ew.-... .. .. ...-...�rc...N .! ® w.....,... • •'4 -vr...,. .«. .yMMN+KrMAWuwv-•s--.,....w^.�.-.....-...., w .+n _ ..... 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 / Dat `� TTvvo�e of Operation(s) Tyne of Inspection _®9_i rs�fP �` �y/Q3 t Kood Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone `/ Ai 7 ❑ Mobile Date: 74iD- i1 fin/ Owner / / HACCP Y/N ❑ Temporary ❑ Pre-operation I ❑ Caterer ❑ Suspect Illness Person In'Charge(PIC),, Time El Bed&Breakfast General Complaint /_'-hi/� T✓i//lig 6 In: ElHACCP Inspector `-,/'�� %�-�/,�� \/ Out: Permit No. L1Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. I 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 ❑ FO0 PROTECTION MANAGEMENT EI 12, Prevention of Contamination from Hands [t] 1. PIC Assigned/Knowledgeable/ Duties [�13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating [� 6. Tags/ Records/Accuracy of Ingredient Statements ❑ 18. Coaling ❑ 7. Conformance with Approved Procedures/ HACCP Plans 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 ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories / Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related 3 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 o 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 6. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you y 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days-of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: ��; ��'� Print 1 PIC's Signature: j/', 71 L, >/ / // Print: Page-/of 3 Pages FORM 734A HOBBB&WARREN -BOSTON l Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590 003(A) 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 J Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* I Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products, Pasteurized* P'p gg � Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 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: oOYiw� lliirin �'./QRv �i/�.fe -7/_ Date:_1 Z'8 Page:Page: of � Item Code C—Critical Item / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY -/ All /_J C _//�fJl,n /�i1jtPG/,//iJn l/�T� �19'LI�i�Sh/JIIP� � �hC'/2 H-C1'/d it .,eA—At- //� ergIk t� J3 C �ff_i...diLfJ/tfilsa/lJ/ij.F //7 y i�s'ilJ .Lf/.!s✓ /d��r �iJGuJe�. G»� 9JI>L.IS� /S4lJ� G/ I •� � �,rJG//��L�s�� G6i c1/.�.OQhSer. I � ��1llLJS7" f!P �G!//G/�_h��Gi� P�C�i !,/�/rd•�dsfr � �!�CI�/f/fi I rj. Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ 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 I noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure youf food permit. 0 Voluntary Disposal ❑ Other: 3501.14(0) PHFs Received at l emperanorec Violations Related to Foodhorne Illness interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4I'F145'F Within 4 Hauls. ' PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods For PHFs 14 Food or Color Additives I 119 PHF Hot and Cold Holding 202,12 .'idtfoptes ( 3-501.16(6) Cold Pl-fFs Maintained at or below 3-302.14 Plotec:ticnt from (hrapptuved Adduracs" I 590.004(F) 41'i45`F° 3-50LIb(A) Hot PHFs Maintained ator abotc 15 Poisonous or Toxic Substances I( 140'F.'-10 L I I k entthrmg Information-Original 3-501.16(A) Roasts Held at w above 130T. * Containers:` 1 1 20 Time as a Public Health Control 7-102.11 Common V'atnc- �Yorking C:ontainrr<:` I 1 7-201.i 1 Separaivn-Shxttec ( 13-501 19 Time as a Public Health Control" 7-202.11 Restriction-Ptescnce and I iscii I I 590.004(Hi Vat since Requiretnerit j 17-202.i2 Gaxhtions of 7-203 if fozic Containvti:-Prohibtticins I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizecs.(Titer?, -Chenuc.&- I POPULATIONS(HSP) 7-204 12 Chennca!N La Washing Produce. Crileria ' ( 21 3-801.1 I(A) Unpasteurised Pre-packaged.Juices and I 204.14 Dryim .Agents.Critefiz' I Beverages miih Warning Labels* 3-801.11(6) Use of Pasteurized 7-205.1 I hrcul�auat `road C.an.te[,Lnbucarasr 13-801 1 I(D) Raw or Partially Cooked Annual Ftwd and 17-206.11 Restricted Use Pesticides.Criteria" Raw Seed Sprouts N,d Sewed. 7-206.I G Rodent Bait Statics` 7-206.13 '?lacking Rrsdets,Peat Control an,-' I 13-801.1 l!C) Unopened Food Package Not Re-served. Ivhminrring' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Cancumptiou of Amutul Faxfa That are Raw,Undercooked or I6 I Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs I ,nror: 3 401.11 A(0(2) Eggs- 155'F 15 Sec. Patboeens.;:r-seg,. E,gs-lmmnediaur Service 145'Fi5.cc° 3-302.13 Pasteurized Eggs Substitute for Rata'Shell I 3-40 ,,. hgga 1 I ItA)t ) C�ntminuted f•tsh. Moats S,Gamic Anunals- 155T 15 ser. " 3-401.11(6)(1)(2) I Pork and Beef&oast- 130'F 121 nrim` SPECIAL REQUIREMENTS 3-401.11(A;(?) Ratite:., h3lcaed Mitats- 155'F 15 51)0.009(A)-(D) Violations of Section 590,009(.3)-(D)in we, T catering, mobile food, temporary nod 13-401.1 I(A)(3) Pouit p,Wtld Game.Stuffed PIIF;. I residential kitchen operations should be Jtatttng(.+-attaining Fah. Poteitt, I --)it*t, ..adetthe _�r�-;+ i.h >... -,, lloulrry or Ratifies-]65F 15 sec. " above if related to Foodborne illness 3-40LL1(C)(3) Whole-muscle, totter Beef Steaks interventions and risk factors. Other 145`F* 590.009 violations relating to gond retail 3-401.12 Raw Animal Fonds Cnoked in a ' practices should be debited under#29- A4icrmvave 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 3-403.1 1(A)&(D) Pf IFs 165'F 15 sec. r (Items 23-30) -1403 11(B) Microwave- 165'F 2 Minute StandingCritrcul and non-critical vio/alions, which do not rrlatc ti,the Time" f walborne illness inierrentions and risk facmrs lister(above, can be 3-403.11(C) Commjiecualiy Processed RTL Fund- found in the fblimrin,q sec uon,t of dee hood Cl+de and 10.5 CAdR 140'Fx 590.000. 3-40311(E) Rematm tie CnOwed Portions of Beef I I Item I Good Retail Practices j FC 590.000 Roams" 23. Management and Personnel FC L,003- 18 Proper Cooling of PRFs 24 Food and Food Protection FC-3 004 25. Equipment and Utensils FC-4 005 3-561.14(A) Cowling Cooked PHFs from 140'F to 26. Water.Pannonia and Waste FC-5 --.00-06---- ---- - , 70'FWiih,n2Hours and Front 70,1- ! 27 PhysicalFaciiity FC-6 1 .007 to 41'F/45'F Within 4 Hours. * 1 28. Poisonous or Toxic Materials FC-7 .008 ; 3-501.14(6) Ct,olinwPHFsMade From.4mbtegl29. Special Requirements .009 j Tcnuperavire, Ingredients to 4PF/- 30. Other Within 4 Hours.: ..I,..� -2 n:.. Uenotu,crif cal arm to the federal 199')Food Code m 10f CNIR 190.000. CITY OF SALEM ' BOARD OF HEALTH Establishment Name: �h/ �/.� _�,/)o �3_�,.,e�P� Date: S' 14-43 Page: 3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item 4 Verified PLEASE PRINT CLEARLY J / .ZS /c1�L II GcyiJe,v,/ C /JVP AAW/P 7,/J AAJsl 1//1, P _.Z H/ �Ji�li �_v O�lAii •114 S 1n /]/i/ !_� �7PQliCS f-d �P_ .L �ilsi�/ �.ii�>/.�i/i �GrlS Gtf/el�C .S�i�.�F�/9l�/J✓ � 4 Ale, IV I : ,L I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes .1 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: 3-501.1410 PHFsReceivedat'I'eroperatures Violations Related to Foodborne Illness Interventions and Risk Accurdim,to f.aw'Cooled to Factors(ttems 1-22) (Cont.) 41''F/45'F Within 4 H(Ims. '< PROTECTION FROM CHEMICALS j 3-5t)1.15 Cooling Methods for PHFs j 14 Food or Color Additives ( j 19 PHF Hot and Cold Holding 3-202.12 Additives3-501 16(B) C,ld PHFs Maintained it or below ` j 5yq.004(F) 41'/45'F* -i-'402.14 Protection from UnspPRAed Addtuaes's j 15 Poisonous or Toxic Substances ( 3-501.16(4 Hot PHFs Maintained at or above id0`P. * 7-101.11 Idenhfvwc Information --Ongmai Containers' 3-501.16(A) Roast, Held at of aboi,e 130'F. 7-!02.11 Common Nana -'WodJug Containers'" j 20 Time as a Public Health Control j 7=20 L 11 Separation-SUn;rgc* j 3-501.19 Time as a Public Health Control* j j 7-202.11 Restricti .n-Preserucoamd I T,e" j 590.(10{(HI Varlanco Requiromen( j j 7-262.12 Conduionc of USC` I 7-203.11 'lash:Contain:r_-Pr)l:ibitions^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizens.Criteria-C'hemrcals^ POPULATIONS(HSP) j 7-204.12 Chemicals fur Washing Produce.Criteria* ! ( 21 13-801.11(A) Unpasteurized Pre-packaged Juices and Bevera<_es with Warning Labels* 7-204.13 Doing Agent's C'riteiia" j 3-801.11(B) Use of Pasteurized E.--Is' 1 7-�f,; I I I::eideutal Food Contaci, Lubrieam;" I 1 3-801( 1 t(D) Raw or Partially Cooked Anrmat Food and 1 7-206.11 Rectirecd Use Pesticides,Crite:ia� i Raw Seed Sprouts Not Served. '° j 7-206.13 Rodent Baitder!.,Stations' j 3-801.11(C) Unopened Food Packapz Net Re servers ` 7-206.13 Track,e.,ft,�.vtiers. Pest Control and Monitoring CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Adrisury Posted for Consumption of 16I I Preoer Cooking Temperatures for Annual Foods:Thai arc Raw, UralCIeooked or PHFs Not Otherwise Proeessed in Eliminate �r� j 3-4f)LIIA(l)t2) Eggs- 155-FI See Pathogens,' "d>v„1,'2001 Eggs-lmmcd,ate act vice 1.7 i"F15:ec• eun'ic3-302.13 P.Wd Eggs Substitute for Raw ShdI g' 3-401.1 l(A)(2) Colo neinmed Fish,bleats dY Game Eggs" Amma!, 1.55'F]5 sr: * j 3-401.1 l(Bul u2) Pork and Beef Roast- 130`F 121 min" ; SPECIAL REQUIREMENTS 3401.1 PA)(2) Rrucs, Injected Meats- 155'P IS 590.009(A)-(D) Violations of Seaton 590.009(A)-(D) in ! sec .. catering, mobile food, temporary and j 3-401.1 I(Ar(3j I PR)ultiy,Wild C;zme. Stuff-,d Pll residential kitchen operation,should be ')tumnC t..ontaimng Fish,Meat, I .+-.u�i, ..;ldetthe _.y,r •Fcr�h .,�.,,.,.;,. 1)0111hY or Ratite;165'F 15 sec. above if related to foodborne illness 3401 1 I(C)t`3) tkhole-muscle, tntacr Beef Steak, interventions and risk factors. Other I45'F"' 590.009 violations relating to good retail 3.101.12 Raw Animal Pon&Couked in a I practices should be debited under f}'_9- Micitwase !65-F " Special Requirements. j 3-401.1 I W(1)(b) All Other PHFs-. 145'F 15 sec ' j j t7 j j Reheating For Hot Holding j VIOLATIONS R.FLATED TO GOOD RETAIL PRACTICES j 3-403.11(,A)&(D) PHFs 165"F 15 sec. ` j (Iterns 23-30) 3-403.1](13) Mici evaze- 165' F 2 Minute Standim, Criltx.al and non-critical violations, which do not relow rn the Tm,e.•` foodborne tllnes.+ interventions and rick actors luted aboi e. cr:n be 3-403 1 1(C) Commercially Processed RTL Food- foand in the follon•ing se(tions of die Food Code and 105 CAIR 1400F* 590.000. 3-303 11(E) Remaining Unsliced Portions of Beef ( I Item 'I Good Retail Practices ( FC 590.000 ' 23. Management and Personnel FC- 2 .003 18 Proper Cooling of PHFs j 24 Food and Food Protection FC-3 .004 25 Equipment and Utensils FC-4005 3-501A-I(A) Cooling Conked PHI" 26 Water,PWmbmq and -s from 1401'to ( __-- ----------- Waste 70=F Within 2 Hours and Froin 70"F 27, Physical Facility FC-S .00E FC-6 .007 to 41'17145'F Within 4 Hour.,. " 28. Poisonous or Toxic Materials 1 FC-7 .008 ! 3501.14(B) Cooling PHFs Made From Ambient29. Special Requirements009 Temperalere Ingredients to 41'F/45'F 1 30 1 Other Within 4Hours ` Denolr.;rreieal itrm in the feder:J ]0A)Fund Code o, 105 CMR X90 000. CITY OF SALEM �DBOARD OF HEALTH " Establishment Name:�/>>i>��ri.� �i�f r /� /_»` Date: _Z��3 Page: of Item Code C-Critical Item / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY -w J.-.A 4' JI - 'l I I �P_ /.J////i�[i��/GI/1 7r /Ea/i I I I I y� i t I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes .I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: s 3-501 I-o C) PHFs Recene(I:t Temperatures Violations rPoiated to Foodborne lilness interventions and Risk Arvin ding in I aa-Cooled Lo Factors(hems; (Cont.} d I"F(45`F Within d Fl:,w; ' PROTECTION FROM CHEMICALS � 3-501.15 Goofing Methods for PHFs � 19 PHF Hot and Cold Holding ' 14 I Feud or Color Arid!t!ves 3-501 16(H) Cold Pr[Fs, Maintained of or bel.,w i 3-20111Additiver' =,9(},0(}4(F) 41=/Ili'F* 3 301 Id Plotc�imn taxa Unappro,cd rldditivrt'* ( 3-%)L Io(1A: I-Ito PRFs Maintaimvd at or above 15 1 Poisonous or Toxic Substances 14U�[' 7-)+iL1J !dens;ytau lrnxm,ttiort-Original ( 3-501.16(A` Roasts Hello(of above 130"F ' Containers' 2 i I Common Name--Vvork�av Contumem" ( 20 Time as a Public HealthControl 3-501.19 Tow as a Public Health C:mh-d" 7-201,11 S..rarat, a-Stw'acc` ( � 5901041-1) Vatiawit Requnentem 7-202J I Res tricnon-Presence and U>c" � '-'0'.12 Conditions of Use" 7-203,11 `!oxic Containers-ProhiMtion,,,. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7204.11 Snn;tizcc,Cnr tei:-cher:mals* ( POPULATIONS(HSP) 7-204.12 Chemics'a fix W;r,h::r- Prodnce, 'Titeria" j 21 3-901.11(.A) Unpastcuriied Pre-packaved Juices and 7-204.14 Drvirnp A,teuts. C'rn.em;* Bevera¢e>with Warning Lohels* 1 i htc:denial Food Contact,Lnbn cant* ( 3-801.11(B) Use of Pasteurized Eggs* j 7.206.11 Restricted Use Pc.ticides,Criteria"' 3-801 1 I(D) Raw or Partially Cooked Animal Fuod and j Rsv Seed Sprout:: Not Served. * 7-206.12 Rodent Exit Starums'* ( ( 3-801.11iQ Unopened Fund Package Not Re-servud, 7-2U(i,13 Tracking Powder,,Fest,'(aauto! and CONSUMER ADVISORY TFMEtfEh7�ERATURE CONTROLS 22 3-603,11 Consumer Adsisory Posted for Cmrsuml+ti:11 of Ammal Fo::ds'I hat aro Raw.Undercooked e, 16 I Proper Cooking Temperatures for ( Not Uthenu ise Processed to EliminateNIPS Grerme::coo: 3-401.1;A{1)(2) Eggs- 155°F 15 Sc.- Pathogens. Eg n-I!onnediatc Scn^cc i41'Fliwi:1 3-30-213 Fasteurved Egg.Substitute for Rau Shell 3-40ii i(Aa2) Comminuted Fide. Bleats d.Game Aninials- 155'F 1:3 SPECIAL REQUIREMENTS R,:kancl3txfRloaot- 130T !21tmn'R 3 401.11(A)(?) Ratites, !nlected 64ems-- 155'F 15 I 590 Un9(A)_(I)) Violations of Section 592009(.x)-(D) in car,ring, mobile food, lernporary and 3-401.11(5)(3) P:,nifly, Wild(;ami,Saiffe:!PUT,',, residential kitchen operations should he ttOff r Containing Fisi, "cut i debited under the appropriate sections P:arltr),(.r Ratites-1 65'F )5 e.ec, " I above if related to Foodborne illness 3-401 I I(C)(3) Whole-m acic, lntact Beef Slcaku interventions and risk factors. Other 145`F n` 590.009 violations relating to good retail i 3-401.12 Raw Auinnd Funds Ccrktal in,, practices should he debited under #29-- 165 F!: Special Requirements. I3-401.11(A)(I)1b) All Other Pl-fFs-- 145'1' l` sec, j 17 Reheating for Hit Holding VIOLATIONS R.ELATED TO GOOD RETAIL PRACTICES 3-4031IrA)X:(D; PiIFs I65 T 15 sec. '0 (Items 23-30) 3-403.1](13) Microwa,,;- 165`17 2 Minute Standine Critical and non-critical violations, which do not relate to tire. Ti mr I loodhorne illness intervention and risk,latero r bsted abate, call Le 3-403.11(C) Cn*nmerciatly Prre=:ped I2TE Food- found in the fnilmring set tions of the Food Code told 105(INR 140`F* 590.0u0. 3-403.; 1(b) Reirsoning 1 rMwed Portions of Bccf Item Good Retail Practices I FC 590.000 Roast,"' j 25. Management and Personnel ( rC-2 .003 1g Proper Cooling of PHF> '24. Food and Food Protection FC-3 004 25 Equ pment and Utensils FC- 4 ,005 3-50i.i4(A) C,-olirtgGn-kedPHFsfromIdo'Fto --- --- -------------- o -6. Water, Plumbinq and Waste i FC-5 .006 70-P Within 2 flours air([Front 70'F ! 27. Physical Facility I FC-6 .007 to 411745'F W e:hut +Hours. 1' 28. Poisonous or Toxic Materials I FC-7 .008 i 3 SOI.i4(B) Cooling PI-1Fs Made 1-run,Ambieni �9, _ _Special Requirements � .009 Tc mperature Fngred:eau:u, 11"F/.15'F 20. --- Other Within 4 Fbzurs' r Den,ae4,riti:al arm in t ua-ed,ra! 19)`)Feod Ctale o: !US C:17R 595000. THE NATIONAL REGISTRY OF: .. FOOD SAFETY PROFESSIt3Iii�:�S,� ,t r ct) + a y` CERTIFIES d�3 DEC 11 2 CEW,H IED VINH TRIM BOP iD OF HEALTH FOOD SAFE1Y3tA V.AGFR HAS SUCCESSFU"LY,SATISFIED THE REQUIREMENTS FOR',':- ss' THE FOOD SAFETY MANAGER b' > CERTIFICATION EXAMINATION . DEVELOPED BY PROFESSIONAL TESTING, INC. Chartered PRESIDENT: --- r August 18, 2003 FOOD ESTABLISHMENT COMPLAINT: Mandarin Super Buffet—400 Highland Avenue, Salem. Our office received a call on 8/18/03 from Maryann Williams (w)781-599-3119, stating that she had eaten at the Mandarin Super Buffet on Saturday night(8/16) at about 6:00 PM. She had just about finished a plate of chicken and broccoli when she noticed a band aid. When she confronted the manager with this she stated the manager said "it must have fallen off the cooks finger". Ms. Williams was concerned about possible diseases and called our office to tell us what happened. An inspector from the B.O.H. went to the restaurant on 8/18 and conducted an investigation. Our office was in contact with the State Lab food division(Roy) and was advised that the only real threat would be staph. Which would cause a response within 6-12 hours of consumption. We also contacted the Beverly Health Director and the same response was given. JV rales '7"'1 pl �,•�"7 � - � I � I �a / I I ' C� J _ i C-2 - it- ...:.w^ql..�• d`f^.u-o»-r.n ..ron....-...-r.,_ w.'W ar�p,.....,rr.0 ,y -.+n, I =' THE CO-MM'ONVVEALTH 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 T - f Operation(s) Tyne of Inspection fvl✓� l i�� 5�� 1F� � /� Food Service en Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection / Telephone XJ � k ❑ Mobile Date: Owner /` r f(///O/ 6 HACCP Y/N El Temporary ElPre-operation J y 1..�d 0 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ElBed&Breakfast El General Complaint In: ❑ HACCP Inspector ..SCA t /w- Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/Duties 13 Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE E-1 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El 20. Time as a Public Health Control XO8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (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: r Print: Signature:Inspector's Si P g <__ PIC's Signature: //� - Print: I PageZof ages FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Inqredients 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)l Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I 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-I tem Eggs and Milk Products.Pasteurized* p..PH, 3-202.14 I gg I Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* I 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ' Regulatory Authority _ 301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes.Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products 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 I 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* 0 Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: QV C r<-1 SJ/� a Date: /�3 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ____PLEASE PRINT CI FAIRLY uSi'c� �,n-�cl5iillc_S 1=1C� r2Qr h�-,r-alJ�tsh. n C�c/�>�S � can -!-h F_ I E CQr�sn �! KC� _Os v-)C I--.n\ nr,<-- c x) �'► . y lvr-t�/1m�t c��l �/'� Psi,.' fir, sem- �<�<vl - — aS - _ 2 Discussion With Person in Charge: C� Corrective Action Required: I ❑ No I ❑ Yes ! have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance 13 Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P LI Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that y noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: l.hC,, PHFs Rete)Ved Ps T'lliperritiles Wohithim;Related to Fvvd'orrro e6,!Pss and Pack Acca nine to Lim to Factors(itams ,41S) (C;onL't I'F/4j-F Within 4 hom e, PROTECTION FROM CHEMICALS 'I", Cooling Nlethwis Pre PHF,, 14 Food ol Color Additives t9 pff."101 and Cold Holding 11-5,"11,JOB, Colki oliFs Main%iorA at or below 3-2C-,.1< Additi,es 4j"/,a5'F* 2,';21-:14 -oql Uoappi—ed VidjL",es' 1P(A) Hot PFFS Maintained s or abo,- 15 Po!zor=s or Toy'c S ,halr:ncps - -,-5o 1.1 MA) Rvisu,Held q or above F40YF. 2o Time as a Public Hoa-ai Control 7-102 11 Coullnop Name-Wofli<:�l.'T('0111 e.: el s' f 7- 1 11 S.:,paraiicni Slojahc" =-501.19 Tinw as a Public Health ControPe "r. vllee and La 51)0.004(H) Vaciaoce Rectununwro 7-=0,2.12 7-2,-:; 11 '1 Pr.,!,; 11EQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2i A.I I Jallouev; POPULATIONS(HSP) 7 ono1 21 1 1!(A) lhipasteuiif�d P,c-ps:1,aged juice,,and Ch-iiw"ih,lot NN'jnhins,Prfiduc�,Criteria 7 1A Bcvenige> with'>t jinin-I 214 Drhe,A�eiivq.(-citvJa: 7 N')-, II Useof Pasteurized En s, 3 ;;til I I(D) Raw(-f Patinfly Cooped Animal Food eo,,u,,ido!;, Crt[,,m' Raw Send Sprouts Not Se:vcd. 7-^tv'. I Roicn! Bait statiollO, 3.801.11(C) linopened Fixed Packuoc NLO, Re-served. 7-2or. u Ira.mn�,, Vo.,,deis, Pt;t Controi mid "Ooni toring" CONSUMER ADVISORY 22 i 603. Consumer C.osncr Advisoiv Posted for Con,;uiuptjoo of TINIEri-EferPER ATUnE CON rqo:_s AnimalFood.,'Phar are Raw, lsuiercoolwd or 16 Pi op--,,Cooking Tempermures for PHFS Not Otherwise Proveseed to EFilaaate 3-401.11 A(1):-!1 F?g,- 15�5�F 15 Fel-S Itairr"drat.Sorvi(c 145'F I�so: 3-30`L.1 11 P.�,;lcuriz�d Egg,,Substitute lot Raw Shell 1 1 - Nloms - Garro Ll I(A)(2) '�nallilvltvd Fi�" Eggs' SPECIAL REQUIREMENTS 31-40IAI(B)R 1)(2) Peal:and lhre(`P,�asi - 13;1-17 !2L nun' Rdh(c!. ll(j,cwd Meat,- I iVF 15 .590.00WA)-(D) Violations of Section 590.004)lAPP) in entering, mobile food, temporary and residential kitchen operations shoal,be 3-401.1 :(A;('it PoiO,rv, Wilti Gain-- Stuffed Pt-It:., �;;-vlfrng C,Aitzeioing Fish. Mea; I debited under the appropriate sections poulify,4 Ratites-!6^+ l'i sCC, above ifIC10ted LO loodborne illn,�ss 3-401 11(C9(.3) Whole-muscle, liniact interxi:nlionsand risk lfactors. Other 145'-F 590.009 violations reloling to good retail 'Raw Anomd Foods Cooked it o practices should be debited under P29 - 1iiL^aw.tve Lis F' Special Requirements. 101.11'Aalv[)) ,`,11 Oth:i PRIF, - 145'F 15 SCL, [7 Reheating for Hot Holding j VIOLATIONS Ra LATED TO GOOD RETAIL PRACTICES 3-40',.11(A)&(D) F!Ik ]�,'F 15 sea. ' (fiterrias 1-3-30) 3-403.11(13) NI:ci-wav- lbs`F I tylisine Staudfiv'�, crituol an'i i't'll-ciltica" violatiom, 1"hic4 d"1101 1-1'a"to tile, fooelbon,e illness bele,i,eniolus"Isd r;5kfia(-o,r5 hste.d abuee. can he 'i-103 1 1(('. 0,runierciall) P1 o�ssed RT-Food found in the f41,,rime se(e;(um q1 the hood Code and 105 01P iio F, -5')0.000. 3-401 I I(b: Remaining Urisfic-d Pord.-vis of Bca I Item Good Retail Practices FC 590,000 Roasis' 23 Management and Personnel FC-2 003 24, Food an(]Forld Prolection FC3 .004 18 Proper Cool!cc-to PHFr, i 2,5'----L-F2uiPrrrsa and Utensils FC-4 .005 --iO I 4(A) C IP dn F 11) 11 R, i W ater,Plumbinq and Waste FC-I -ooline, Cooked P� .; itoln r 7(,'F W�0iin 2 qcnis-io.Frou,70'F 27 1 Physical Faciliv F, 6 ro 41 'F/JL 1'w'ithni 4 Hosis, 28. Poisonous or Toxic Materials FC-7 AnInent 29, Special RequirementsRequirements T,iayeiatuie Ingwd%:nt,;to-1IT-/45'F 'o. 1! Other Within 4 hoirs;1 CITY OF SALEM t I BOARD OF HEALTH Establishment Name: 14.41ki_,0 •I , �Il/IS/I ,/I()/� Date: 7��/C23 Page: of Rem Code C-Critical Item "DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY - 9 - 1 1 . 1 1 _ 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ les I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal 0 Other: 1 3 :if)! j Iii 1) PHFs Received at Temperatures WOL-?iorE Re.aied it.,rvodborri-Wre.-;!; 1lccordln'w Law(7coled:9 Factors;"emrs 1-22) ,Cent.; 41'F/45'F Wqhun.1 HoLio, PROTECTION FROM CHEMICALS 3-51!1 15 O'ding Methods for PHFs 39 PHF Hal,and Cold Holding Fr-oc ov Color Additives 3 ',-591 1603) Cold PHFs Maintaincil at or boioll -20 11 'WditkeF 41 I- f':ot-,-ot,on i-oat Unapinwed 3-501 1(,iA) IlotPHFs N",Uilt:ill)eL[atro above 15 Poisonous or Toxic Substances 140-F, li)1.11 klenviyn- i4orma,ion--0riginal I 3-501.161A1 Ro�sts Held af oi atmv I 1WR Contatric-'), Time as a Public Health Control -102.11 C ounuon N::tx-W,n'kiflg 7-101.1 1 Separaiew 3-501.19 Time as a Public 14calth Control' 7-2011 i Restriction-presfnco Usr' (194(Hi Variance RequilcuWal 7-202.:2 (',,j I r,o,,; if IJT , 7-203,! i 'loxic Crmtainers-Prohibitions" i REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(,,4.11 Sanitize,�,.Ci:ierut Chviukal-,' POPULATIONS(HSP) 21 3-801.1!(A) Uripmteurwd Prc-pick,,gcd Juices and 7-2u'4 J2 Clu:r�als ic N%ash-ug Prockwe.Criteria* 7-2('14.1-1 Di}mI2 A��--uts.C-ir,,;ia: I Beverages with Warning Labeler' 3-S01.1 l(B) Use of Pastetu i7ed E-.s* 7-,'D; 11 rq,identai Fond Contact, Luocic,oits^ 7-206.11 Pestr;,-ted Use Pe��:jc:de:% C-11,2t1tiat 3-0� i(D) Raw on Partially Cooked Anima!Foott and Raw Seed Sprouts Not Sen,tJ. 17-16h 12 Rodcol Butt Statiow 7-20(..13 Track;u�� Powders. Pat(-oal �roand3 i�0 I(C) Unopened F(xKJ Package Not Re-scr-,ed. klonqciruw� CONSUMER ADVISORY TIME'TEMPERATURIE.CONTROLS 22 3-603.11 Consumer Advisoraminalal Foods That arc Raw.-v Posted for Cousumption or 16 Protter Cooking Temperatuyet.for AUndercooked or Not Qihetwise Processed to Eliiuwale PHFS Patho: 3-,Ml 11 lvj)(2) LggE,- 15-`,-F ! Se,- �rons.' Eog -Imm,&ate Service 145"F!5se,- :1-302 13 Pasteutized Eggs Substitute for Raw Shell 3 101A1EA)(2r connnii-nuted Fish. "'Icali Az Garrie Eggs. Anirr'ial;s- 155'F 15 Ne- t 3 101 111 B)(!)t 2) Pot K,and Pevt Roast- 130'F 12 i min' i SPECIAL REQUIREMENTS 3f)Lll(A)(21� Injocled lk'.'ats- 15�,"F �1)0.009(A)-(D) Violations of Section 590.009(A)-([)) in sec. catering, mobile food, temporal V in,! 3-11 0 1.11(AK") Pouln-,Wild Game.Stutf.-'d PHFz- residential kitchen operations should be SnWlng Comm )in Fish,Moat, dehited under the appropriate sections Poultry or Fntiics-165T 15 sc_. above if related to foodborne illness 3-40L 1400) Whcte-rnus:e. Intao Be,,! Stc,,.ks interventions and risk factor s. Other 145-1- ' 590.009 violations relating lo gOodl rctail 3-•101.12 R�lw Aruniii Frrsls CO:)1�,td in a I practices should be debited wider//29-- Nliernwqvc 165`F A Special Requircincrits. 3-401.1 Ak CitGer PHfs 14; k Li acv 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 11(A)&;'Fo PI-IFi, 165''F 15 so:. - (Iterris 23-30) 3403.1 t.(It Microwave- 165" F-'* Minute 1;ti1ndin,, Tnue� Cri;i,aiand non-ctaical violations, al-dch do not relate to the fiiodbotize illness intra-:rurioas and risk,facloi+ listed above, can he 3-403 1 I(C) A fiound!n tific,lollow;fig se(oans(y the Foul Code and, 105 (-'I-.4R RTE Food- I i 0°F" 590 000. 1-403.111 E) Rcivatuair tAisliced Porli-:ns,,FBccf Item Good Retail Practices FC 590w0 23 Management and Personnel FC-2 .003 18 j Proper Coo:;ng of PHFis 24. Food and Food Protection FC-3 004 14(A) J'11'oo�uili Ccokco PRFs front 1401-to 25 Equion-ent and Utensils FC-4 .005 3-50;. �'6. 1 Walter, Plunibinq and Waste FC-5 '006 7W FWithin 2 Hours F-con,70'F 27 Physioni Facility FC -6 007 1- 1, 41'1-145 Ffthnn 41-tour'31 28 J Priqopous or Toxic Materials PC -7 .00'3.00'3-51)1.14(13) Cooley PHFs Made From j�mhient 1 n- j Spec al Requirements .009 leniptralur.Inpredic;iLs to4l 17/45"F R-0�0—. Othet Within 4 Hours' CITY OF SALEM �n BOARD OF HEALTH Establishment Name: I V �(� n �� J> JK/ Date: A IU I��i Page: / of j Item Code C—Critical Item _ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION � yer if { No. Reference R—Red Item - E PLEASE PRINT CLEARLY 171 di? I 1 U� l�vinaa �)i��r�o,e �.><' ��_4 PS-frihl�Shrnrr� f ,Sy7j�ta �L i'Y)lr/'l� / 6 I `pPP7'i1 /S c /l� f/z �cii'7`z/ Mu/7�r G1�lry[o. c cervi/c/ h x c c z _ UP dv, /M a `� -fill p t l n�a fit) /'rr�.L �)�r�n� � - }1�� _ f� - ) �I? xv? 'r ( .i;✓1� l� >_>�7`7l� , �` �D� i/1/rfi�-fi d�S �_�,� �/� �/ 1 i n D � {' 1 r t _ � 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/ i Exclusion violations before the next inspection, to observe all conditions as described, and to P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that oncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo.r ❑ Emergency Closure your foodermit. l ' r 4 � p �i� / ❑ 'Voluntary Disposal ❑ Other: Z < t_j,}! ;,ut'} 4'ttd��Ret+'ierd.a"d'esnperatorc� Violations Related to Fondbornr tltreess fritctwcnt orm and Risk ;lc.tading to!„t k ;_'•xiiut ns ! Factors Items t-22) Cont) ! ( ! tI�F(45`F Within ? Hi+u+� PROTECTION FROMCf CHEMICALS Ccxthw, M thM� t;,( VHFf, PHF Hot and Cold Hoiding 14 � ` Food or Color Additives C l.%!.Ih($} f-uirl PI IF. Wia;;:i„rt,ccl atoe'"ctt+w I €_ 1t€ltitr.; 59r0()4t}l 4)cW' F:,, ?-3t)2.F�z ( F';v:et.t;;,n.ronri!naunra,xaxl +�tiditzvr:' z5()l.ihi:\j Hot t'Fi?-:, ?xfsans.tit:ecl.:ttxabowc ! y 15 i Po!sancos or Task SoGsfancas I !. ,. 71dE.ii !x'.entifya nif%,::nal'on tkl ^aa, r ,- 3-5:1 16f k.1 Rtmsh Hdd at or above i WT ! Cont:uner�I i n i Time as a Pubisc Haa!th Cnsrkro! ! 7-IU211 (utamlopNin,e--N':+rkia„�C:vetan<r:” 1 j 3-50i 0 Time at:a Potdi! !&::tlrtt Cuatrol . E 7-201 1 i ti.�par:awn- 7-202.11 SteStrict:c,n-I-'rxunc�at:,tt'xr' jI s 4t1)0.!}tWHE VariauteeReyatremelit 7-202.12 t urditit a:,of?€w' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ? 7-24I; POP ULA- IONS(HSP S _ 7-204.!.'. C'h..nu.;tis;:,t l�a�h++:f,t' .+il+:,;e C:t,tzris'. j 21 i z.hQi 1 ii+.) i'npasicurr.rd Pte-pact-a,ted So:cos wi(iT 7-204.14 Diyirzs; ekoxnt•.C'nierr,+' ftcter.tL.Bg with Wal-lang I,aEx•I� --v ! S-No 1.1103) d;s�tit P4>t:•arii',A i�—i-{}41i _ Inciu:, : tta! F:rtl;Cunt,ttt,l t+hl;v;,ate' ! .l liD) Raw or Pait+,,,1€'+Ctws4,-AAnimal K- ,,J o,id c ( t-2t36-1 I Ririteri;, :ed t se l,v rit ii7t'a (hr ' ! 7-206,12 RkxltPt 3 R01.1 I'iaxi Paxl;,tze N.+t kr. ai rt'c:t i 7 2_06 1 i '1P"o.ders.i>..,t t+:ntrol and CONSUMER ADVISORY _ TIME/TEMPERATURE CONTROLS s 122 3+,0?.1 I Cor, amet Ait,txnry Pthct:d 14 C,nisim+ptiiin of it I!xid� Mat.trc if,w' U'ndrr,,,okol 16 j Proper Cooking Temperatures for I Not tttlzrrl ise Pro'cess(-:to Eiiuun:Lw ! PHFS 310111 AiIg',) ;5” 'p' 1"St:x'. j[z1.1 3 f i:wurvt;d 179y,Suhatitui,•nv Raw ShOl 't-AC)t.i1t�.N s L'ommlintr.'d t i,h. :4ea•,:R(utu, !: 'r•" <Anium!:;- ;S 'F 1? " 3di3Lt!(Hhli�^-s Pu.a ar,dE>:•c# Ituaf itq°i'i?: a�dn+ SPECIAL REQUIREMENTS t- tj-- i— - %9W)09(A)-f,D) Vi:,1311on,of section 590.((}9t,\;-(I>t in 4 1.1 ltAIQ' #utile, n a+ xs 's'1( +t;. I.`'� F 15 t'ateruig, rntdnic kwhi,tetmt,iai.v in l s , r ri,:,tdirii+al Wchen op 7lioli�.,€1"uld Ile, E ?-Stit PitA{�3z Snrt;try, tliir.;,ssti:. SrnftcudE,l•:,, � F''rrt ! C,nftuse C.+nt arunf:F:;;+: Niv i. ' tk+iwd under the approltriatc sc:truaa I'J:ilErx'Ut'12',t,tes In5'P 15.x „ aliuvo if re:lai,d to fovdh,'+rne ilh,cc� 3-401.11W)tz+ T'h:4e-n,oa+.l:. Intact 1"+ef SWa}., i nitcrventitm aad rick f ctnrs. {nhtr (45T T ` i 5140.009 Violation¢reiatini_ to good tt:tail { Jl.d2 R.,,e •ti:t+;u,.t F'o+ s 04ik,xi is a pt:tc:tic i;ho+Etd be&bitu71 wider h29 - t1;•:rn,navr 165 f` Sp.x.z;st Requircin,nts. -40 LI ISA)(!l+hs .Vt:('a liev N IFS-- 145'}: ':^sc - � ! 17 Rehcafing far Hot Holding } VIOLAT IONS RELATED TO GOOD RETAIL PRACTICES 3-103.11 2U4S 154. Uietus23-30) '401.11(ft) hiss;+itt::tr- 16; ' F Z'Mcfaii Sttndiug Cridew;,ad twa-(riIii'al rioutli,u+s, is-if if,l,de)f?, r•'1+,:tr:4);1:c 1line' food7x,rne itiaese 1410lrnti,,m•rind r;zi,jot nre G, ,,,f ahe,e r<+n be 3-403.1 I(C+) f,tmnr::,tt•i,xtiv Paxe<;':d RTP:Fik'd- (,crud in the ja(!monk evrtieene of Me Foud rode,wi=i Rei ("'14R 14ti F, 3-403 11 it:! P.rsnalninit Uli�' cd ft,rtivct of lit [ Item 1 Good Retatl PtacHms rc 59Qrm 1 F+,,ass,* 23 1 Ma_nagemcniantl,F"eisonnel - FC'._?.... _6ii) -T...- 1S ! Proper Cooling of PHFs I^i_ Forx€and fined Proter:tion F(':_3 ,p(i, _ -5{7,.I4(At °5. �_eg_uinnun€ann UtHisas _ ...._.. FC- 4 ! C'xrc+iingL:�,i.cdPFIV: rr•,rni4f F14, I_�_- ._..i III ` 26, W atet,Ptamtina.ind`�MaSre !�fiC-5 f 'O-W 7C+`t ir,'illnn 2 Hnur3 and From"'}`t' 27 Ph✓s ce!P ac.l tb• EC-=' M7_- I io 41 Ti:i ,'P k it€dzk 4 Rojw, onnw or To:uc M,.tenais I FC - CH}o ( 35i',d.t•4/Hr• � Cnuiin_ - � 1�ea:iaiRutrrernw'+ts f}06 ' .PHF:,'�O,tde F?nttt htzihtrt,t s 'g. _ ! _ ------ lun*er::tate 6r:rex!icnts t,,.}t'I l45'F 11�gi+inti l4xn>� t ..v,xU:... +1)enntte.'ta.: lt!rc:i�,in•Iad::::' i'*µ,€'nrn'.C:.,i• ein�t Not:49ii'+i;fi a 1 BE FOR LIbALOANT��MESS DATF Il-'e71'-l�? - 7 TIME,//--, M OF V PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODEMBER TIME TO CALL TELEPHONED PLEASE CALL ' I CAME TO SEE YOU WILL CALL AGAIN f WANTS TO SEE YOU I RUSH RETURNED YOUR CALL I I WILL FAX TO YOU MESSAGE LGA 00 SI NED ol FORMMAOEIN9 MARE r U S 5 A. f (VOTES 1�J914 i i K11 --i �,y - MF OW ( a .0 t . rr p IR i I � t� nde�a R..a 111 •N i• arm l +1w+ ^^^TTM ♦�� :. � Sys �y, k i x • t At e $� 1 { 'Y �V 140 a �y. Z . x a r r 1 � v Y { r � 1 .�. r. , tip r s y c i 6 N r j[Ty e s + 4 l i i