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MANDEES PIZZA - ESTABLISHMENTS Mand=c'! �iuu 4ag cjk�t +�trtc� ftNIVERSAL® UNV-12110 MADE IN USA SUSTAINABLE MBI FFMC<ID FORESTRY C INITIATIVE DNTENT10% C.ft.d Fber Sa.,&2 POMONSUM 91 wvw. 10%mare m nirro Commonwealth of Massachusetts a 4 ` City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Mandee's Pizza File Number:BHF-2004-000066 408 Essex Street Salem MA 01970 LOCATED AT: 0408 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0198 Jan 1,2011 Dec 31,2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health lie This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENOAIhb(&ALL-N COINI DAVID GREENBAuM,RS ACTING HEALTH AGENT 2011 APPLICATIO FOR PER TO OPERATE A FOOD ESTABLISHMENT I� NAME OF ESTABLISHMENT- �e�s -1-aTEL# 2 ADDRESS OF ESTABLISHMENT_�O S$! �IJLFAX# ' _ 2TA2 MAILING ADDRESS(if different) /y� P EMAIL- Business': /d Q Aff /1P/ Website: l� m Cy� 2 .ap� OWNER'S NAME h ��// nnCgs vGd TEL ADDRESS 3 11i;4lecr7 �i�.( E3L ,ter 0- OLgC3V STREET CITY STATE ZI CERTIFIED FOOD MANAGER'S NAME(S)a?4i1 :4Cd"AA CERTIFICATE#(S) a n-cq3 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 0? ✓, 263eQ HOME TEL# DAYS'OFOPERAT,ION •,Monday ? ', ,Tuesday` ! ' Wednesday, .' =?Thursday ';> ,,,�dday: ,, j 'Saturday . s• .4=Sunday' " " HOURS OF OPERATION �� x},y �( �4 i �y/ `C eq /( Pt 44V Please write in tone of day- (For ay For example 11 am-11 m // �'� j {( �� (y�/Y, i ( ( � ( �!� ) //►7 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 YE NO less than 25 seats (Outdoor Stationary Food Cart$210) 25-99 seats =$280 mer than 99 scats =$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 stale tax returns and id all oe taxes requiTd under the law. Si ure Date Social Security or Federal Identification Number --------------------- - Revised 10n1I I FOODAP201 Ladm Check#&Date $ /i/i1 Commonwealth of Massachusetts ` r City of Salem Board of Health Kimberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Mandee's Pizza File Number:BHF-2004-000066 408 Essex Street Salem MA 01970 LOCATED AT: 0408 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0031 Jan 4,2010 Dec 31,2010 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2010 Board of Health '. -04 4f 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 DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM&ALEM.COM DAVIDGREENBAUM, DEC )2009 ACTING HEALTH AGENT /,EAL7-H 2010 APPLICATION OR PERMIT TOr OPERATE A FOOD ESTABLISHMENT (f NAME OF ESTABLISHMENT TEL# -/ ]Z�l �'�G ADDRESS OF ESTABLISHMENT_,._ _5,6,�" .___ FAX#�j�3 - MAILING ADDRESS(if different) ` `a� - �'/—y EMAIL-Business': M,1 n / PC' � �16,G�I/✓!&ASS ,OWebsite: i / OWNER'S NAMEZZ' 'J ///nkg, # � ID C�� TEL sl,,�I/ `c�,�� ADDREss- STREET l/ CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) y�T1 X""161"(A 1"(A CERTIFICATE#(S) O (Required in an establishment where potentially hazardous,food is prepared) EMERGENCY RESPONSE PERSON iS 44 /Gt to,(�ti( �L L(,� HOME TEL# y QF Batu ay'yr Sun ay AYS'OOPERA7(ON� Ov1, dayTues,ay��W,etlnesd ;;iThurstl - _' Fn9ay HOURS OF OPERATION Please write in time of day. 'For example Ilam-11 pm TYPE OF ESTABLISHMENT FEE (check only) RETAIL ORE YES PCr- less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 -------------------------- --- -`-------------------------------------------------------------..--------------------- -- --- RESTAURANT � NO less than 25 seats -x$1407 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 — -------------`------------ES�ffd---- ---------------.---------------------------------- ------ BED/BREAKFAST/ Y �}0r $-1-0-0- CHILDCARE SERVICES/NURSING HOME ADDI ----------ITS TIONAL PERM ----------------------------------------------------------------------------------------------------------------------------------------------------- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NCr $25 TOBACCO VENDOR YES N6 $135 ALL NON-PROFIT(such as church kitchens) YES W $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 Chapte 6 C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns p all stat s required under the la_w.n/ o� tj 01 S' ature ate Social Secuity or Federal Identification Number. Revised 424/07 FOODAP2008.adm Check#&Date .ti i :r.. .:a+..c 7a 1 ,,. r.. e�. s r , pL,p,.�,t,,,r•.r � . .l"`J ro•F. -T 1•ra � -. .u,..*. Massachusetts ;Department of �Public.Healtft Salem Board of Healtlt4 120 Washington Street,4th Floor « Division of Food and Drugs Salem, MA 01970-3523 / FOOD ESTABLISHMENT INSPECTION REPORT Tel (978) 741-1800 Fax (978) 745-0343 S Name iDate I T e of 0 eration s Type of Inspection �S rP. 2, (-�- ' -n Food Service ( ❑ Routine Address C Risk ❑ Retail , ❑ Re-inspection Level ' . ❑ Residential Kitchen 4 Previous Inspecttioo' Telephone C1,f� f� f1 I ❑ Mobile Date: .f , Owner 7 O 1 F �l HACCP'YM ❑ Temporary ❑ Pre-operation X> ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) l(} y Time ElBed&Breakfast ❑ General Complaint PJibiu ElHACCP inspector p A pPermit No. El Each violation checked requires an exp anation on the narrative pages) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) /590.009(F); action as determined by the Board of Health. "FOOR PROTECTION MANA EMENT €'n G` " ' """ P G ❑ 12. Prevention of Contamination from Hands 1 PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH �u a..m �mo-Kr,� 6 � , ,�� , � 13 Handwash Facilities .,„ ` PROTECTION FROM CHEMICALS �;� 1::� ❑ 2. Reporting of Diseases by Food Employee-and PIC ❑ 14. Approved Food or Color Additives ❑ 3: Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals f•FOOD FROM APPROVED SOURCE p ;; ; �' ,.��on. .rs�,-. F ,.ii' []-4r Food and Water from Approved Source 9,TIMEITEMPERATURE CONTROLS(Potentially Harardous Foods) ;i bua3} fReceiving/Condition ❑ 16. Cooking Temperatures Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling .,., PROTECTION FROM CONTAMINATION i " r�x,"" w ` �` 19. Hot and Cold Holding .._ . . .._ El8. Separation/Segregation/Protection 20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing - 96REGUIREMENTS FOR HIGHLY 11 SUSCEPTIBLE.POPULATION$(BSP);,�I, ❑ 21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing I OOFI$UMER ADVIS E] 11. aZ';. � "`.„"' �u- ::-^.:�,��`��S.r_• n ,m*v_ 11. Good Hygienic Practices T(L1(�' 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 s immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below. N ` by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(5590.090.0 ' 23. Management and Personnel (Fc-2) 4)) order of the Board of Health. Failure to correct violations 0 ) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.os) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.005) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: I('_ -3-09y/� 5:5901nspettFo m614.tloc I��t 3, - Inspector's Signature ! nye Print` PIC's Signature: � � X (, Print: �`�, Y J Page-1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination '1 591).003(A} Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* &103.11 Persat in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Anirnal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11.(A) Food Protection* aplicatus* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* j Charge* Contamination from the Consumer 590.003((3) Reporting by Person in Charge,* 3-306.14(A)(B) Returned Food and ReseZice of Food* 3 590.003(D) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food", $ 1Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501_Ii I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* - 3-20't.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Slrcll Eggs* Sanitization Tem eratures* 3-20214 F j re and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp., pH, concentration and hardness. 3-202.16 Iee Made From Potable Drinking Water* ki 5-10tH DrinkingWater from an Approved System' 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.0)6(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Fowl- 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 Saiutization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ig Proper,Adequate Handwashing Game and WildAut Mushrooms Approved by 2-301.1 L Clean Condition-Hands and Arms" Re Mato Authorit 3-202.18 Shellstock Identification Present* 2-301..12 Clea2m Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Nash* 3-201.1.7 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.'15 Package line it * Mouth* 3-101.11. Food Safe and Unadulterated* 3-301,12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 1.2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained' Eir to ees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca achies* 590.0040) Labeling of Ingredients" 5-204.11 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Pians Supplied with Soap and Hand Drying Devices 3-502.11. Specialized Processing Methods* 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-3(11-12 Hand Drying Provision °Denoles,critical item in the federal 1999 Food Cade or 105 CMR 590.000. t ------ CITY OF SALEM AAA BOARD OF HEALTH 'i Establishment Name: �1Nn AAA p P t 012�7��/ Date;�P��v___Gi A_Cr_ Page:_ of} _�item:, Code C-Critical RDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dat Item w e No.' Reference R-Red Items - '' , f Verified 7 _ (� � � PLEASE PRINT CLEARLY kr'AP./,t.Cl1/�-/t n) -AA-0-41N I o_ . per" ' � �.tin., a,A A7� I Q.4.�' � 1 M��i-t-nnn RV,� % O An rs..a 't'l/1 On nn.In,, ,,nxR/J V Uu 'y07 1(V) E /�^ n „ o� Mnon� — L e if )I r nA I X Al/7 A DIY A C_I V !n. �n.t I n I - 11//1, AA .,7t` /k P vt^r"C'NO t 0. Jn �Uh1J �?P/�tv fAF 1 n (? D C rnn �vw/ A v _ WIMP /2Jl r )"'j) V)(L4AD- AA / D.(/ .-401 Dn n�l� inn s 1�.� — � W� __ ii a 1 ti . -n A a,�,P, � `-� I,, ,� rnn:.e�.P2, ; Al q[t I A ,j� /� f n o A r1... IL '/X, n / i,.-- P ( ..(i� en.,., ;1"/) ) s nt t Xo_t L/\ 1 t n,-,4 Pe ." 01 ,1,��:lOaAp \ .h1n nP .�llA Y- )O n nA A !r' ( �/n ,n .a,c`t/i,i ,: —A,\inA o, -+ hn. A/ Discussion With Person in Charge: f� �� L,� J. , Corrective 1 1,Action Required j ❑tt No°:f ❑ ^ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑.,,Employee Restriction/ }t Exclusion violations before the next inspection, to observe all conditions as described,, 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: Violations Related to Foodborne fflness Ardenvereflons and Rtsk According to Lmv Coolul to Factors(Itterts 1-22) fCont) 41 F/45 C Wifbin 6 175 —C-1 x�I—io k[—(L I it 3'd,E--1"o r P H F PROTECTION FROM CHEMICALS LL4 LL9 PHS Hot and Cold Holding ------LFood or Color Additives 3-202,12A-A 150t 1'6(B) Cold PfIFs Mainuin-axi at or btiow I - - - Protection from IiiLiaLroved Addi------ 590,004 okve,L— Poisonous or Toxic Substances3�501,16(A) lit PRF c Mainiamed it os aNw� Riteit-itvi—m, ln—fonniimr 14l,-F. IOLII s, container -3 �61—k) — Kixis Held at or above i 30�1 P;7b-1lcHeatlh Control f I OT,I Common N'4ra- - Worki owiia,r,,' 3 W.0 Tirrio as a Public flealth Control- 7-201 90,0(01-1) vad 7-20111 Rc��tdctioo-Pr once and LNC* 7-202.12 ("oridi on,of U 0* !-,Int�—, HEOUIREMENTS FOR HIGHLY SUSCEPTIBLE iy-7 Toxic Contaimx�-Polqbviou�* POPULATIONS HSP 204.1717— [Tt —julces ancl—I 7-210412 ChQnn�als for'Nalin"lloditce,Ciinoia�, ] r7-204,14 20 205 IT 111cidentfl F(Xx)Cornitt."oficareq I(LO 20 w or Pait oill,,Covk-d An f tRTII 1-1 XTI-111-1 7-M6 H Reiei us a t C,,,tc lNol set 7-206.12 62WO(11 13 la S'UOD F—206.Iz Cracking FtlwPestdtri, "�i Control and CONSUMER ADVISORY 'nME/TEMPERATURE CONTROLS 22 3-601.11 !Wao)] Fxxlsmat aie Raw Undor"Aed or F16 raper Cooking Temperatures forE tion PRFs 0them isv pr(A:eSsed o)1-Jinninve 3-40L 1 (2) Fgg�� 155'F 15 st,c. as, "n,Oho Ons _T11—un—It,—flaka�Thl-b— fcdFig��7SU ion -401,tl I{_,}(1) rrsmrnut l7jeh,Meat.& Conic SPECIAL REQUIREMENTS 3 4TI-11(13) 1)(2) Pol k,an d T,7WR tast I-10,F, 121 Ini 11 590,0090k)-J)) Vial if of'Section 500 3-4()1.11(A)(2) 15�F15 Txjq(T) ))in ie catering, mobile.tood, temporary and 3 401-1 i(A)13) Poahry,Wiid,41111", stuffed PF s, resident"al kitchen operadons, Aiould be -- -t i SfuffingCcevaining Fes?. Wei, I debited under the approprinte qeelouis abtwe if related to fty)dhornc illness Fouttry or katn�s-165"'T' 15 se 14-0 1 1 7lC)(-I) limo BeJ Sleaks, Other 14,514 590.009 violations relatino (opxxi 34OL12 Raw Arnoial Fuxb Cfx)kcd ins iv debited under#29 - Special kequirenleflts. -401.I I0;i([)tbi Ah C3t12er FFIR-- I.5'1 15 nec =7 -keheatung ter Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-#0 3.tf(X TZ D) Pl-lf�, 165'-F 15 sec, * (I tents 23.30) 3-403.13—ii) o s"—r��Ni-m aa7i nt, crid"'wand non-rrawaz violaiwn,, whith domn relan,v,Me Tone, V,T nuet veraiwey curl risk factors bsied at,ove, can be filodhorne 111ne coagoerriallv pvkvessed RTF FWKI found in the jrrlffmurg wt-iion%ql the Food Code and 105 ClIR 1400 �90.11)w Remanim- Un�lweul Portions of limf Ttirw-T FC 59ftow 3403A I(Ej 1, - 213, gin ---poa ±rt�nelfer,,onne 24 Food Farxi Prole4i' 1=8 Cooling at PHIs FC �3 004 25, E9uip nent and Utensils Ste FG-5 �006 -T)OLWA} 0,,llap 0,,lv:,d PH1,F finno 14W�-T, --- I--,' -- n -?-§ Haste 701F Within 2 hours�and Frena 79 2-1, Kzh�!!;L-�Vt[Faoifity 6 007 c 1k, C-7 o)4J'I/45FWdJnn4 Houe,, I Fr -- - --- ------ ------- -008-1 it t, 00 Cooling PHF,�Made From Arnbici ---132-7-4�os T�awratore lnincdicot�io 41°F/45�F ------ ........ wifllin&t IRM10 mthe ioivr;,! 1949 Foml('dr or lkh CMR5901X)0. S - sk CITY OF SALEM BOOD OF HEALTH"`4 �( n1 a 9 Establishment Name: n l 2{ 7 ( Date:,g� A � �rY�J Pa e: of E Item Code r . C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORREC ION Date, j No. Reference R-Red Item - - - I{{ PLEASE PRINT CLEARLY r - - Wka (a _ T � ► n lO vn in, .t,n rr /)�) v `{ Q . 4� A_s A ro k/G ,(1/h w Dr, _ 4 � h1 A�p/1 YA A>1 \ nn I� ". OYAX_ ) 0,1p),i i 2 /1 Bnn J rn� r .\` 1 .\ lls lLrn A(9,/—.-' - AA (Wq I �1y(�),/� Il I �4�ft 0A M\ fA(Y% 0� Dn /V (I/\d3 k) LYS A 0,0 0,9 OA n (\C.4 Jel 4_1 1 1 A Yt a 4 AA A /, o , 11 4 n.✓7 ApAn'Q\Yk',-Y Al ho (-)1/n ,_� �t)p�P �/,O..Q\.LF 17_._�a nen10/P — �r �(1l ( f� _4?A YAAnn - Y'AL) tf�finnn riVl.a A Discussion With Person in Charge: _ , Corrective Action Required: ❑ No ❑ Yes , I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described;'and to �.. ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that. noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r.7 ❑ Voluntary Disposal ❑ Other: r � 7.5 F)l 77114(0 fl,s Received at Tenrperatmes Violations Related to Foodborne illness interventions and Risk According to Um Cooled to Factors(items 1-22) (Cont.) I'F/45"F Within 4 Hours, PROTECTION FROM CHEMICALS LHolding 14 ___ I Food or Color Additives Lut- G-rar Txi F2 Cold PHF,Maintained at or bekav 590,004(1,) 4045"F* 3-302,14 Proiection froth i'LlIalj)mwed _q75()j 16,A) Hot PHFs Maintained at or above Lis— _4 Poisonous or Toxic Substances ldfaarfymInformation - Orig"inal 3-,�OIJ6(A) Roasts Held at orabove 13WT, Coraairlert;�, I L!L Time as a Public Health Control —IOZ-1 I -CInnnion Name Worki.E�C(Ifnainerr* —------ 7-201.11Se3-1;01,19 Time as a public Health Corur,ol' —-_ l)_ar I` ;-201F Restriction Pretwncoaud U90.004(ft) �e* Variance R _rInl—ent 7-202.12 Condition,of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7.20311 7— �F,)xt,(-,_oonanz�f"prolt I nor on S,t POPULATIONSHSP 7-204,IT Snifl?,Js,Criteriachcnlickls* 7-204-12 21 3_801,I I(A) l ripsmerarized Pre-packaged Ruces and 7-204.14 Drtm At.ence_Criter_inl lqr,ser tees with W aunt l,ab 1s` 7-205.31 11(R) _!,��Ioof�astcalj�7Li Incidental F,NX1 contac��Iola icarls3-8ol li( ' — I '401.11(D) Raw or Parliall,,0K*ed Amaral Food�i nd [:7�206 it Rz�aridod" se Pe'liciales,Cyiterin, Raw Sc td �7 206AStau 2 Pxlern Bait wir,' 7 206.13 Tracking Powdor,,Psi C'narol and 3-80 1.1 N.-lorouvin" CONSUMER ADVISORY 22 TIME/TEMPERATURE CONTROLS 3b0Animal f(Kids Mar arc Raw. Underckx)kt�d or Proper Cooking Temperatures for 16 PHFs Not Otlierv,ew processed to Ninurrar —3-i)I I I A(l)(-'i Fgg,- 155'F 15 vie, 145`Fl5sec, t-301 13 Fcg�!:Sobstiont:lot Raw Shen comyroilar'd Tih,Mead,&(illne Aroivaln- 13-1,F1 5 sc�:, t_(H)(l_,Q;_7 IurR—a SPECIAL REQUIREMENTS -401.1 ir�2_T , nd BQd Roast 1:101, 121 a it* - ',-401.21(A)( 1' Ratire, hoccled kl(4tr I 590.009(A} (I)) Violaniorm off'Section 790,009(A}-(1.1) in 19 catering, inobilcftxxl,temporary and 3-401-l1(A)(3) 4Poultry=,Wild Game,Stuffcd PI-[Fs. I residential kitchen operations Should be Sruffing,COntanoria- Rsht Meat, debited ,n,lc,,the ap,oprialeseatorts Poultry or Ranter 105F 15 scc. above if related to IIaodberne illness 3-40111f(7)(3) Intact Beef Steaks interventions and risk lactor-s. Other 145"l; 590.009 violations reltaing to szood retail- 3-401,12 etail3-401,12 _Raww Anneal FoIxii,Cooked in a prat heel should be debited under #29- Mici owave 165'F Spacial Requirements. 3-401,11(A)(1)(b) ,,Vl Other 11iFs.- 145`1- 15 sec. I7 -Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1-403,1 l(A)&fD) PrIEs 165'F 15 %e(,. (Items 23-30) 3-40711(B) Microwave.- 165°F 11 Nlmmta Standing Critical and ram-i rilwal violafiont, inloch do not relate in the Tuve" can be 3-403.1I(C) finord in therfolloning sectioto qf dre Food Code an,1105(.'AIR 140 F 3-403.31E( ) Regaindrn, Unshced Portions,of treat' Item, 18 FC -2 1 003 ---TProper Cooling of PHFS 24, Food kind Few Protection 25_ _Eq_Wp njils I FC-4 005 Cookvd PFIR front 1 0-66- 3-501.14(A)— 26, P�ater,Plumbing and IN aste FG-5 Igm to FC-6 007 P Facility it an 2 flou6 taid From Fifilt,11 ;___hpLq�tl to 41^F/45�F W-ithin 4 Hears. 28 Poisonous or Toxic Materials FC-7 D08 , 009 5-01 It 4,('1W) Cooling PRFi,,Made Front Ambient 2, Tempaittare Ingredients,to 411�M:51 Within 4 il,srr�' "'lien rtes criucat ituv is the lode,,id 1994 105 CNIR 59900(1. �o him -�O i'z-z v e low vz� T -.. ry f j y c I = fr fr 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-6400 - Separation/ egregation/Protection FAIL Critical Q RED Owner: omment: New walk-in fridge has a shelf with meats above items like pastas and dressing.Properly organize fridge to separate John-Theodorakopoulos i potentially hazardous items from ready to eat items. PIC: ,- Food Cont t Surfaces Cleaning and Sanitizing FAIL Critical ❑Q RED Joe LeBlanc Vt%omment:Slicer has accumulation of food debris.Thoroughly clean and sanitize the slicer between uses. IDSpeCYOr: �nppener needs thorough scouring. Elizabeth Salandrea �// Date Inspected:COrreCY$y: anitizer log is not being kept up to date.Maintain sanitizer log on a daily basis. Handwas Facilities FAIL Critical Q RED 112/912008 Risk Level[ omment: Handwash sink behind front counter had food debris in it.Handwash sinks may not be used for anything but e hhaandwashing. Permit Number: ✓Soap dispenser at handwash sink at grill was empty. Provide soap at all handwash sinks at all times. BHP-2008-0246 Status: VIOLATION 1#of Critical Violations: 4 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. Dec 11,2008 ) Page I of r� r •'' Item Status Violation Critical Urgency lRED: Violations Related to Good Retail Practices (Blue Items) Violations Related to - Food and Food Protection FAIL Critical BLUE 'Foodborne Illness Interventions � 4 GComment:There were platters of chicken fingers at the pizza oven directly on top of each other.Do not store anything directly on and Risk Factors (Require food. ;immediate corrective action) mm I freezer across from the fryolators had some uncovered food.Cover all food in storage to prevent contamination. ttge white frigedaire freezer downstairs had some uncovered food.Cover all food in storage to prevent contamination. Equipmen and Utensils FAIL Non-Critical BLUE CComment: Pizza ovens need general cleaning. Vsmall pizza topping unit needs general cleaning inside. '- -Same unit has a broken gask t at to of fridge door,causing a gap when door is closed. Repair gasket so fridge stays closed and Zpled properly. r5�.e� nY�,d - v5Cafe unit does not have an internal thermometer. Provide visible,accurate internal thermometer for this unit. VLarge pizza topping unit needs general cleaning. rue deli unit needs general cleaning. alls in area of the handwash sink near the grill have some splatter in them.Thoroughly clean the walls. ereezer across from the fryolators needs general cleaning. 7Altar er meat station needs general cleaning. Zsink needs to be labelled"wash","rinse"and"sanitize". F or and general area near the doughmaker needs general cleaning. - he below table the slicer is on needs general cleaning. 7/o r to the old walk-in does not latch properly.Repair latch so door closes properly. LMeat containers in the walk-in need general cleaning. - ottom shelf of prep table in the old walk-in and the old can opener on the table have some rust1grime build up.Thoroughly clean th ottom shelf and remove the can opener. ar hila frigedaire freezer downstairs needs general cleaning. hirlpool freezer downstairs needs general cleaning. Physical Facility FAIL Non-Critical BLUE Comment:There are many areas of the floor throughout establishment that have cracked or missing tiles.Replace tiles/repair floor to ensure good and impervious condition. Y� 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. Dec 11,2008 ) Page 2 of .r Item / Status Violation Critical Urgency 7h re is what appears to be an open panel on the hood above the grill.Repair or cover panel. hts above the grill area do not appear to have covers.Provide protective covers for all lights. Reinspection in one week, all violatio�ts to be corrected. Owner must submit updated floor plan with new walk-in to Board of Health and meet with Health Agent for review. 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. Dec 11,2008 ) Page 3 of 1 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency gTelephone: Violations Related to Good Retail Practices (Blue Items) 1745-6400 Equipment and Utensils FAIL Non-Critical BLUE j Owner: Comment:Small piva topping unit has a broken gasket at top of fridge door. Repair gasket so fridge stays closed and sealed 9.John Theodorakopoulos properly.PIC states gasket has been ordered.Monitor unit to ensure correct temperature of 41°F or lower is maintained until repair PIC: is made;temperature was below 41°F at time of reinspection. } Bruce Irving jInspector: I Elizabeth Salandrea Date Inspected:Correct By: 112/17120 !Risk Level: 1. j Permit Number: 1 BHP-2008-0246 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: .Urgency Description(s): 'BLUE: All other violations noted on the 12/9/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical 'violations must be correctedOwner submitted updated floor plan with new walk-in and will be meeting with Health Agent for review. immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) I w 1 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. Dec 17,2008 ) Page ! of Item Status Violation Critical Urgency Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) i City f Salem Board of Health 120 Washington Street 4th Floor SALEM MA 01970 978 741-1800 �I C tyo Sae g ( ) GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 17,2008 ) Page 2 oft Commonwealth of Massachusetts City of Salem Board of Health IGmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISHMENT NAME: Mandee's Pizza File Number:BHF-2004-000066 408 Essex Street Salem MA 01970 LOCATED AT: 0408 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0226 Dec 29,2008 Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember 31,2009 Board of Health Lj This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH " % 120 WASHINGTON STREET,4`FLOOR�F^ TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 DEC MAYOR IDIONNE'g-SALEM.COM �700g 1. JANET DIONNE, 130ARO Ul. ACTING HEALTH AGENT hill R 2009 APPLICATION FOR P RMIT TO OPERATE A FOOD ESTABLISHMENT_ (/ NAME OF ESTABLISHMENT 1h12,A tgc Ii2e_, TEL# �/ 4:�� ✓& "0 0 ADDRESS OF ESTABLISHMENT y© 4F55euL S;t-- FAX# J MAILING ADDRESS(if different) EMAIL-Business': 2ha�err1e` e�CM < Website:J�nrldPe��12 �T rJ/J OWNER'S NAME O� r , TEL# G 7 b ADDRESS r'�!� vel Q STREET CITY STA E ZI /�, n CERTIFIED FOOD MANAGER'S NAME(S) 1 )j.(�(C� Y11W A CERTIFICATE#(S) l o (Required in an establishment where potentially haz]]ar�us food is prepared) EMERGENCY RESPONSE PERSON_ �I A :&o HOME TEL#_/yy �J-C4Z2 DAYS OF OPERATION 1 :':Monday , ; Tu sda Wednesd Thursda Frida l`. SaturdaySunday, ' HOURS OF OPERATION Please write in time of day For example Ilam-11pm) i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - _-------------- -------......................... ---------- RAN RESTAUT YES NO less than 25 seats (Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats =$420 BED BREPKFAtiT/ yEc NO $100 CHILDCARE SERVICES------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter C,Section 49A, I.certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns an stat as requi oder the law. D ;Z1967)5-6 Signatur Da Social Secun y or Federal Identification Number --- --------------------------------------------------------------------- —------------------------ - ,/ - ------------ Revi 424/07 FOODAP2008.adm Check#&Date J w 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency I Telephone: Violations Related to Good Retail Practices (Blue Items) 1745-6400 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment:Small pizza topping deli unit has accumulation of water in bottom.Investigate for leaks and remove water from this unit. John Theodorakopoulos Same unit missing internal thermometer.Provide visible,accurate internal thermometer for this unit. PIC: Physical Facility FAIL Non-Crifical BLUE Bruce Irving Comment:Wall behind 3 bay sink has peeling and chipping paint and is in general disrepair.Scrape and repaint wall to ensure 'Inspector:- good condition;this to be completed by next routine inspection. Elizabeth Salandrea Date Inspected:Correct By: 5/15/2008 Risk Level Permit Number: BHP-2008-0246 status: SIGNED OFF I#of Critical Violations: 0 Time IN: Time OUT: r Urgency Description(s): BLUE: All other violations noted in the 5/8/08 inspection report have been corrected. Violations Related to Good .Retail Practices (Critical r violations must be corrected I ,immediately or within 10 days)(Non-critical violations ,must be corrected immediately or within 90 days) ' i City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 19,2008 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions; and Risk Factors (Require immediate corrective action) i City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 19,2008 ) Page 2 oft 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency iTelephone: PROTECTION FROM CONTAMINATION { . 745-6400 Separation/ egregation/Protection FAIL Critical 0 RED : i Owner ' omment:Walk-in fridge has meats above vegetables.Properly organize so that potentially hazardous items are below other items John Theodorakopoulos to prevent cross contamination. d PIC: Food C�ontt I Surfaces Cleaning and Sanitizing FAIL Critical 0 RED Bruce Irving 1�omment: Few knives found in knife rack with some food debris on them.Properly wash,rinse and sanitize all knives prior to - - Inspector. storage in racks. �� Elizabeth Salandrea a tting board at pizza station stained and scored.Resurface or replace cutting board. Date Inspected:Correct By: 0 5/8/2008 Risk Level: 6Permit Number: BHP-2008-0246 Status: VIOLATION ''#of Critical Violations: 3 1Time IN: Time OUT: Urgency Description(s): j BLUE: t Violations Related to Good Retail Practices (Critical ;violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 08,2008 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and F Protection FAIL Critical BLUE Foodborne Illness Interventions, mment:Some uncovered food in small freezer below fryolators.Cover all food in storage to prevent cross contamination. and Risk Factors (Require i immediate corrective action) I ;/11nit across from grill had some personal items in it.All personal items to be stored in separate employee-only area to prevent cross contamination. Equipment d Utensils FAIL Non-Critical BLUE Wment: Mops being stored on floor in corner next to dough machine.Store mops hanging to air dry and away from food prep areas. ice needs thorough cleaning. n opener needs thorough cleaning and scouring. ring freezer in basement and fry freezer in back room missing thermometers.Provide visible,accurate internal thermometer fort ese units. ry/fr�ezer in back room needs general cleaning. �feezer beloQww ff�rvolators needs general cleaning. Deli unit acrifss from grill and small pizza topping deli unit have accumulation of water in bottom.Investigate for leaks and remove 'water from these units. Small pizza topping deli unit missing thermometer. Provide visible,accurate internal thermometer for this unit. Physical Facility FAIL Non-Critical BLUE Comment:Wall behind 3 bay sink has peeling and chipping paint and is in general disrepair.Scrape and repaint wall to ensure good condition;this to be completed by next routine inspection. t ere is a pipe above grill with loose insulation hanging out of it.Secure insulation. Reinspection in one week, all violations to be corrected. Tease have March and April extermination invoices available upon reinspection. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 08,2008 ) Page 2 oft HACCP Risk Assessment City/Town of:Salem • , _ 10"Veggie Pizza w/eggplant, mushrooms,broccoli Establishment Name Mantises Pizza Steak Tip Dinner w/side salad,creamy Italian dressing Italian Sub Ingredients Source Address 6 Boston Street Dough Mandees Person-in-Charge Brendon Eggplant, broccoli NATCO Cheese NATCO Information for the Risk Assessment was obtained by: Steak tips NATCO ❑Observation of Suspect Food/Process Salad Tony's Produce ❑Observation of General Food Handling and Sanitation Practices Interview with Food Employee Responsible for Preparing Implicated Food. Interview with Person-in-Charge or Other Employee Weight/Volume of Suspect Food Prepared or Served: 1 Pizza,l Steak tip dinner, 1 Italian Dates of Investigation: 215108 sub 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 Who,What,Where,When -Proliferation (Include changes in food handling procedures,orders . for correction,embargoes/disposals,food employee restrictions,food safety training,emergency suspensions and closures,etc.) ❑CCP Veggie Pizza with eggplant,broccoli,and All temperatures were good. The freezer had a temperature of (Critical mushrooms. Pizza dough is made at the 10°F. Unit must be repaired to maintain a temperature of 0°F or establishment Eggplant and broccoli are below. Gloves are wont while preparing pizza. Proper Control received frozen and goes directly into a freezer. sanitizing is being done of all work areas and equipment and Point) The freewr temperature was approximately utensils. 10eF. These items are supplied by NATCO. Mushrooms are received daily from Tony's Produce and go directly into the walk in at 4I-F. The eggplant stays frozen until it is cooked in a fiyolator for 2 minutes. It is sliced and added to the pizza Broccoli is thawed in the walk in and held in a refrigerator unit at 38°F. Mushrooms are received pre-sliced and washed and stored in the same unit as the broccoli. These are then added to the pizza. Page: Number of -11 HACCP Risk Assessment Report Form(Updated 09/05) Cheese is supplied by NATCO and goes Gloves are worn while handling cheese. All time and directly into the walk in and then stored in the temperatures controls meet the requirements of the food code. same pica mit as the other ingredients. ❑CCP Cheese is delivered 2-3 times a week. Salad ingredients are all received from Tony's Cheese is supplied by NATCO and goes directly into the walk Produce. Lettuce is washed in a colander and in and then stored in the same pizza unit as the other prepared by hand. Peppers are washed and ingredients. ❑CCP sliced on a slicer that is cleaned and sanitized after each use. Onions are also sliced on a slicer. Cherry tomatoes are used in the salad. They are washed and added directly to the salad. Carrots for the salad are received from NATCO and are pre shredded. All ingredients are stored directly in the walk in at 41°F. Steak tips are delivered 1-2 times a week in Steak tips are supplied by NATCO and go directly into the 12-15 pound bags. They are stored directly In walk in and then stored in a refrigerator and are cooked to the walk in at 41°F. They are in strips and= order. ❑CCP cut to tip sin for the dinner. The steak tips are placed in a marinade consisting of BBQ sauce, vinegar,worcteshire sauce and salt and pepper. Freezer should be repaired to maintain a minimum temperature They are stored in a refrigerator unit and 30- of 0°F or below. 40 pounds a week are used. The dinner comes with a side salad and French fries and onion rings. French fries and onion rings are stored directly in freezers at 1W. Page: Number of 3 HACCP Rlek Aexsement Report Form(Updated 091051 Describe Product Flow Describe Eri4ironmental,Data C611beted'to HAZARDS Describe Corrective and Preventive Date Verify Control or Lack of control of Hazards. -Contamination Measures-Initiated Verified (PreparationSteps) Survival •},i . - - - ( s in food handling e Include than9 procedures,orders s ` Proliferation ' _ Who,What,.Where,When - for correction,embargoes/disposals,food employee restrictions,food safety training,emergency suspensions and closures,etc.) Italian sub is made to order and consists of All product is prepared using gloves. All food is held at the salami,pepperoni,mortadella,and provolone proper temperatures. Proper sanitizing of all equipment and cheese. Vegetables and seasonings are added utensils is done. ❑CCP at the customers request. All deli meat and cheese are delivered by Agar and NATCO and are stored in the walk in at41°F. The meat and cheese are sliced into approximately l lb packages and stored in a refrigerator unit at 38T for use. Comments: Many cutting boards are stained and scored. Resurface or replace all cutting boards. Provide visible,accurate thermometers in all refrigerators and freezers. Page: Number 3 of .3 HACCP Risk Assessment Repoli Form lUpdated 09105I Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Mandee's Pizza File Number:BHF-2004-000066 408 Essex Street - Salem MA 01970 LOCATED AT: 0408 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0246 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31,2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 21 of 25 I , QTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL. (978) 741-18008 E C E NE D KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR TscoTTna SALEM.COM DEC 6— 2007 JOANNE SCOTT, CITY OF S;'LEM HEALTHAGENT BOARD OF HEALTH 2008 APPL^ICATLON FOR P WIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT / ' tAY!/�T t?� I /ZZ/e TEL# � ADDRESS OF ESTABLISHMENT �O ��S�s��,7"' FAX# .�7� .� MAILING ADDRESS (if differe ) Inil�Z`R��EMAIL-Business': dt°P � 1 "�Nebsite: ffllo OWNER'S NAME ! � / TEL# ADDRES °,'/ STREET CITYC� D_{. STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) h /t._,,/ o LGGGf 24yJ rCrERR'TIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday T day Wednesday Thursday Friday Saturda Sunda HOURS OF OPERATION /7 �jj/Q�7 Q(/�m / Please write in time of day �( , �� For example Ilam-Ilm 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 R-ESTAURANT YES less than 25 NO--------------------------------------------------------- seats p—� r rmoor Static-nary ry Fd Cart$2t 25-9seats =V)80 more than 99 seats =$420 - - - ------ �-- ---------------------- ----------------*--------------------------------------------------------- - ------ .......--------- BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES------------------------------------------- ------- ---------- ----------------- ---------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM,YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 2C, Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax retu id II st s required under the I w. sus S' nature Date Social Security or Federal Identification Numbdr --------------------------------------------------------�-------- -- -'-----------'----- ----------- ----- Revised 4/24/07 FOODAP2008.adm Chcckft d Date ! $� i ! Massachusetts Department of� PublicFaNHealth Salem Board of Health -� 120 Washington Street,4r"Floor Division of Food and Drugs Salerp,.MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvoe of Operation(s) Tvoe of Inspection d / ®--Food Service Q Routine Address Risk ❑ Retail Re-inspection Level ❑ Residential Kitchen Previous In/Sp;ection Telephone , ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary El Pre-operation yp. ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In:.J,% ❑ HACCP Inspector04,eOu6?' - 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 „'�.�,„ „,� ,,,,,�[ ;,,,,:_�. El 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities "EMPLOYEE HEALTH- PROTECTION FROM O#fEMICAt.6--�� - �❑ 2. Reporting of Diseases by Food Employee and PIC - ,�r -u�`=� eau - •- - "CAKU m _.LA - �&_ [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals FOOD FROM APPROVED SOURCE�' �,,,..,,,, F14. Food arrnd Water from Approved Source TIMEITEMPERATUREOONTROLS(Potemrally Hazardous Faods) w E] 5. Receiving/Condition El16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements -E] ❑ 17. Reheating + El 18. Cooling i ❑ 7. Conformance with Approved Procedures/HACCP Plans l PROTECTION FROM CONTAMINATION �- ' " El 19. Hot and Cold Holding ' ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing El 21. Food an FOR d Prep SUSCEPTIBLE POPULATIONS(HSP)Wim` I ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El 11. Good Hygienic Practices / ` =CONSUMER ADVISORY;y` [:122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical N violations must be corrected immediately or within 90 days as determined by the Board Official Order for Correction: Based on an,inspection Health. today, the items checked indicate violations of 105 CMR of H e alt 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure tocorrect violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of �c 25. Equipment and Ute�sils (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 i 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 orrd-e/rnrA , 30. Other DATE OF RE-INSPECTION: S:5WIn5 IFO�-ra.d o Inspector's Signature: Print: PIC'sSignature: Print: C- vtN Page ofZPages l Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination , 1 5590.003(A) Assignment of p( 3-302.1 3-302.11(A)(1) Raw Animal Foods Separated from 1590.003( 0 Demonstration of Knowledge* Cooked and RTE Foods* F-2-1-0-3.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4501.111 Manual Warewashing-Hot Water 3-201.7.2 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell hgs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized'* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-'t01.t 1 Dunkin Water from an roved System* 4-Ci01..11(A) Utensils Cl Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Fcwd- 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source Contact Surfaces and Utensils'« 4-702.1 t 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-HotWater anrl- 3-201.75 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1p Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Author 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301..12 Cleaning Procedure* 590.004(C) Wild Mushrooms* - 2-301.14 When to Wash* 3-201..17 Game Animals* 1.1 Good Hygienic Practices Receiving/Condition 2401..11 Eating,Drinking or Using Tobacco'; 3-202.11 PHFs Received at Proper Tem eratures's 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tastin a, 6 Togs/Records:Shellstock 12 Prevention of Contamination from Hands 3-20218 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained' Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11. Numbers and Capacities* 590.004(7) Labeling of ingredients' 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11. Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision Denotes critical item in the federal 1999 Fwd Code or 105 CMR 590.000. - S CITY OF SALEM f{ BOARD OF HEALTH 1 = Establishment Name: Date: l 1 a, /it Page:_ of "Item =Code =e„ C Critical Item ' _ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION �, ;: Date, No. Reference R-Red Item " Verified PLEASE PRINT CLEARLY w ' f Fac 0 ¢ J horn t�� r r 4 v r-Pa a Sly, 6 c D57 r�P1 Discussion With Person in Charge: Corrective Action Required: ❑ " No I have read this report, have had the opportunity to ask questions and agree to correct all k❑�Voluntary Compliance ❑y 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 I your food permit. ��- / tc'��. 9 - ❑ Voluntary Disposal ❑ Other: I 4(t--p HFs Received iW�Fmiratures Violations RmcW to Foodborne illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) 4VF/45'FWdhm4Houm + PROTECTION FROM CHEMICALS 1501,15 Coolim, MAW&for PHFs PHF Hot and Cold Holding L14 Food or Color Additives LI 3-501.16(B) Cold PHI-s mtaiflu6nud at(it beftni, 9-201E Adainve,-* 590JA)4(F1 410,145`F� 3-302.14 Protection frin 3-501,16(A) Hot PHEe Maintained at or above 15Poisonous -- Poisonous or Toxic Substances 101 11 Idenfifying,Info;inaflon-Orig,prial -----------------4 containers* 15 A) Pua�aslleldatoi above130'F, * Time as a Public Health Control 7-10111 Common'Name- workin C —IT 1111"LTM1 —.-- 3-5111.19 'rime as a Nblic I leafth Control 7-201.11 Sonat aLion-Still, 7 —a��— 90.004f H) Variance �it 1-201 T R,,nictio, -llwswuce and Use* 7�1 7-202A2 Conditions of 115c* -.............. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 Toxic(Aqnainct,-Proliibi'ion,, _ POPULATIONS jq8PL 7 204.11 Sallitizers.Criteria -C'ernioN* 7-21 --- 121 3-801 11(Ai Pre-packaged hn�es and �4.12 Chouicals for'ftshik"is 11rojace,("riterW 7 Reve les with Wa -0414 -80 I'l I(B) UW ot Pa'tturized Eews' 1-205,11 Incidental Gyri Contact,IAi '�t' --- F-w 11(D) Raw or flailiall,,Oxikod Annual rood and 1 7-206.11 Rc�nicf�d Use pe�ticidcs'crjterla�' 2ijMoaitodn 12 Suitiolls Re'le"t Bili! 1-8ril o _-T—— 1-801 11(E� fracking 1`�EE C'oiuml aid"' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS I fiO3 IT ),,7.....sr Ao,i,,,,,v Posted 14 Cousilloption oi foimal f,,o&That are Raw, L7ndescx":ct:l',n'c1 16 Y Proper Cooking Temperatures for Not Otherwise flr(x!essecl to Eliminate PHFs 3 401 11 A(l)(2) Fgg., 155'F 15 S"'C. ry,u 1451-l5sec- .3-302.)3 74 ZtIVAO) Conmarruied 11A, Mew,& Game Animals- 155"F 15 scc. ' SPECIAL REQUIREMENTS ' ,B.10F121rain, 34C�Ll I(11)(I)t2) 1-401,11(02) i R�alue,�' Weo'�Xl. %al,� - 155 115 Violations ofSection 590.N)9(A)-(D)in . ........... soc, catering. mobilc food, temporary and 3-401.11 CA�fT, Pcinitrlv'Wild(Janje-Stulfc.d IIHFS, rcsidetjlat kitchen operali.onsAxadd lie Sniffing Oavnining FishMeal, I debited under the appropriate sections Pouftry or Ratites 165'F t5 see. alcove if related to ftxAborne illness 3-401.11'c)( NN'hole-musclo,Intact Beef Sicaks interventions and risk fectors. Other 1451- 4 590.009 violations relating no good retail _RTZ9turnaFF,,k C.(,uad in a practiecs should be debited under#29 - Mioowave 165T* ecial Requiremonts- 3-401,11(A)(1)(b) All()thet I'BI'S-- 14TT'15 sec, F17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.103.11(A)&{D) PHF, 165'F I n wc, I --I (items 23-30) 3-403.1 1(B) ti cmv ac- 105'F 2,Minute Standing Ctilb-a't anel non-critical violaiwiti, Ouch do noz retrace to the TinIC4 foodborne illness nuet venliorcy and roklm tors listed above, (on be found in trwjniloiwng xef tions of tht!Food Code and 105 CI-IR 3-403.11(C) Cofflrcio:,iafl� (,essediWT��- 14WF" 3-403.1 1(F-) Remaining 6-11*11—ced'T"rinIns—of licv—fFC 00 MahagQmenf and Par exon_.,., —FC -2 �00 and 3 4 1 18 Proper Cooling of PHFs Food aFood!Protection FC 3 004 ---�L4 7 1 EqUilinient all len'%s -4- 7 3-501,141A) Cixling Coolaxt PHI-'s re � 1X15 40,r 1, 26 tt Water.Phumqiqq��d'�Nnsfe i FC-5 006 TPF Within 2 Ilourq and Fran-Iff, . ........Phys alfacjli FC-6 007 4 1'1`145�F Within 4 Hmirs. 28 Potsonouc or Tow Materials 008 h—s T-I z(ii—) - C'Ooolifig,PHIRs Made Fron0antnial -29, so li='R_72T—'2E121 Tenilwonore likqedivics 1(410F'/4-5�1, 'joOther Within 4 khxrrs* ae'r in the ledenO 1?90 Food C'Aie or 105( NIR 59it 04)(1, Massachusetts Deparmnt of Public Health Salem Board of Health 120 Washington Street, Divisioneof Food and Drugs Salem, MA 01970-35234 19 0-352341h Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DateType of Operation(s) ype of Inspection HO�0 oI� 4_ Food Service outina Address 0 I Risk I Retail 0 Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone r El Mobile Date: , 'oP� Owner VV HACCP YM El Temporary Prera!on ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ElHACCP Inspector _ A Out: y 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 EIEMPLOYEE HEALTH - 13. Handwash Facilities ' '"`PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC -_ � - a ,,� . .-`_� • �.,. sa, ❑14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals I,FOOD FROM APPROVED SOURCE ' �„ ,,,, @® '.TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) til ❑ 4. Food and Water from Approved Source µ Mk LM b rm j _W5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 17. Reheatin ❑ 6. Tags/Records/Accuracy of Ingredient Statements g ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 118. Cooling p PROTECTION FROM CONTAMINATION��b� "` �' i�'�� ' '"�',� `s i,i � LAS i9. Hot and Cold Holding - , El 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing - ,REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices G CONSUMER ApVISORY' , ` & ❑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 i immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection of Health. today, the items checked indicate violations of 105 CMR 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)(550.003) 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 S. 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'59JIn5pectPomiE14.tlac n ,00. Inspector's Signature: _ Print: PIC'sSignature: / - Prink - tiJLKI IZ �lpa,J7-, Page of r c Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 gn 590.(K)3(A) Assiment of Re`�nsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demanst atnon of Knowledge* Cooked and RTE Faxls* 2-103.1 I. Pelson in charge-dupesContamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) - Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Fond and Resctvice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions - Food - 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4-501.1.11. Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization'feni eratures* - 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Ears rs and Milk Products,Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, - 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101..1.1 DrinkingWater from as Approved System. 4-601_I I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 5 * 4-602.1 I Cleaning Frequency of Equipment Food 90,006(B) Water Meets Standards in 310 CMR 22.0 - Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4-702.11. Frequency of Sanitization of Utensils and 3-20.1.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.1.1. - Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* - 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or UsinE Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package hnte it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting* 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.0(A(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to gees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 3-402.4( Records,Labeling Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients` Conformance with Approved Procedures 5-205.11 -Accessibility.Operation and Maintenance 7 Supplied with Soap Drying /HACCP Plans P and Hand ry 9 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11. Hindwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.1.2 Hand Drying Provision "Denotes critical item in the federal 1999 Foci Code or 105 CMR 590.000. t CITY OF SALEM BOARD OF HEALTH Establishment Name: a� r� Date: / c> �� /01 Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ;Date No. Reference R Red item` ,` - za y Verified PLEASE PRINT CLEARLY 2d f2 �-� // 7A �AMC.J r I '4 C" L3n - 14 Q �- Ugq00 , ( - _l �C��CA Ir vl�r c,Y)71 / h �C� � , (I' n. / o J / J/ (' �A/ �1(�61 fir" 11 nn ' /1 1 1 r 1azC� r _ _ �I n-�/-�C.a�, 0f no r rI S - m K �iL{D, f ; r i FP A f l f 11 r, 7n d r �l l— Cir — r Y �n7 (A o� � r c r I X \(O Ii, I d Discussion With Person in Charge: Corrective Action Required: ❑ . No "'l Yes have read this report, have had the opportunity to ask questions and agree to correct all o 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 Qnty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ��---T� �' A ❑ Voluntary Disposal ❑ Other: PHFs Received it Too�psratur;,T'— Violations Related to Foodborne fitness interventions and Risk According to Lao Cooled to Factors(item 1-22) (Cont) 4 1�F/45'F Within 4 Hows, PROTECTION FROM CHEMICALS 3- ()1.15 (00"11" h](Kit,for PHFs ANF Hot and Cold Holding Food or Color Additive's E,4 7�,— L-t—, 3.5(31 16(B) 1,11 PI-If�Mirimained at or trelt, 590JX)4(F1 41`"I45"F- 3 302.14 Protceboufrom�Lfl ves' Poisonous or Toxic Substances ;-50 1,16,A.) I lot PHFq Maintained at or above —infol ina i i on -—Ori'i nal 140T. 101.11 z-5W.16(,�) Roasts Hold at or above 13 FIF 1 corrwicms --A��—W—orkin---,— LTime as o Public health Centro I I621 1 1 Common Nam _4 2) 3-iol 1-11 —Timc as TaNblic—11cald)cow)OV 7-201.11 590.0(k4(fl) Variance,Requ] toein -201 Rrid ostion-11r,"'Wnce wid Use* 7-202.12 Condition;of tjse* 7-303.11 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE :oXic("ontairroo,- 7-204.11 Saniozerti,Ctieyri ClCIMIC4S POPULATIONS(HS R 7-201.12 ChemicaR forh�ljloqlrcc,Cfitob7- 21 3-801,t I(A) Revetarte's with Waruh%j lb,-W 71-04,14 Drtins,Avcnts,Crfteria�� 3-&01.11 Q3) Use of ry Pa�teriztA 6c s 7-205,11 -ryIncidental foorl Corow.Lubricrrpti, -- 1 7-20&11 Re�liwed Uw critekia+ 3- 0 �I I(D) Saw or franja][N C(.K)kd Annual RxyJ end Raw Sef:j.�prr)tits Not S4�rwd. 7-206.12 -801 17(C) Unopened Fioti Packagc Nor Re-scrved. 206 '13 lot king Powder.Pest C.ontrof arel CONSUMER ADVISORY TIMEfrEMPERATURE CONTROLS 22 3-6W I I Consumer Ailvisory Pant d for('011,111;DPEADO Of Proper Cooking Temperatures for Animal F,:KAsTbru are Raw. Undencxxrked or 16 PRFs Not Odwre ise flvwe�,sed to Flinurtare -TIT I gips 155'F 15 Sec. t—P- 1 I Pasteurizof Egg.,Subsiiunr for Raw Shell 3-40 fTl(A) Cumminuied Fisb,Nleats&, Gatir, Animals 155'F, 15 sec. , SPECIAL REQUIREMENTS -,-401A 1(Ifit 1�Q) Nuk and Beef Rossi - 130'1- 121 min* - I 1 -0- -T- 3-40 1.11("W") Rlalite,,, inreoed lM 590,009W-il)) viola ions of Section 590.009(A)-(D)in se" carcrinit. Mobile firx)d,terriporanr and uld 3 40 1-11(Ay 31; Poultry, Wild Gaule, $tuffed PFrend(FS, remr.al kitchen opelitionss[to N., stuffingConlaining FishMeru, debited under the appropriate secliolls Poultry or Ranes-165115 sea above if related to foodbonic illness �3-467t i i-(,)5 1 hww; fieul interventions ai)d risk taclors, Other 590.009 violations relating to good retail 3-401,12 Rax Anmhtl Foxk Cwked m a practices hould be debited under 1129 - Mier owave 16s F Special Raluncalents, 1-401,11(Abl)(b) All Olihei PifFs-- 145'T 15 sec Reheating for Hot Holding '—VO—LATONS RELATED TO GOOD RETAIL PRACTICES 3-103,1J(4)&fD) PIIS x 165'r- t sec (Iterns 23-30) 3 403.I -TI-i TmwvZ 155"F 2 Nl—iqcio Sianding Ciim a"and nvn-t rhh:al vwkdwns, wirkh door n ebae i,)rhe Time' foodborne illness imervewiony and rLkJa4 too,lived above, con be 3-403.1 l(C) Commercially Processed RTE'Frxid- found in theft)l1ruving, teetioruof lie Food Code a0 105('MR -590,(.()0, -.. I 3-403,1 1,E) Renlauum"Unsb,,ed Portion 590,0w 1, -s of Beef ---- -�q— —, RoasO 23� and per FC -2 I 003 T4, Fuad rail Food Protection IS proper Coong Of PHFS FC 3 t .004 25, Equipment aritiyLe�wls FC-4 001 3-5tH.WA) ctolinit cookid PHPs frow 1,9)'F to ---- --------4 Water Ph;mbir;(Land IN rite l FC-5 '006 i 27. Physa al FactlitV FC-6 .p071 �F W'ulun 4 How!�� o lott PHFsMadc Form Ambient 1 29, __�f-Sptxaal Raurremrail� 9 T T vniperawre Ingredieras lo 411`/45 --2I Within 4 1 lryurs' Denot,cralcal twill 61 the(ilder,! CITY OF SALEM I BOARD OF HEALTH Establishment Name: Gin(IPC 1 Z7c,-t Date: (c7/ J Page. _ of Item, Code - C-Critical Itemr TDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ({ No. Reference R-Red Rem Y Verified_PLEASE PRINT CLEARLY I I n n 0 9 SOAe,tt-2)tiele/ cty4_(,,L(e /-jL -4)4,\ e crkyo ra2rT! i (9---7- Y . to ajr �,1� U tih A)0,2 A4 Q I h,e o + ( or r ;z, rK, ,Y, , ieit,os CA5 ^s� h, Nps - h� � r ate ( I d )(� sr)�g dec"'? CC.n , 0X + '�:_ZiC Do .qv i 7 �t.n�P ✓Q !f nllr",_t I Lt.I Q n r (. - •i��..1-Y I Tenn I/ f.� Discussion With Person in Charge: Corrective Action Required: ❑ No t�/Yes nx*�i." ;v' ytis " ,� �w '%4,; '„:., •r''M,'F., .Gz-ire 4$t , 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. V / /1 � ) ❑ Voluntary Disposal ❑ Other: k r — S PHFs Received at"Temperatures Violations Rol~to Forsdiblarne Iffness Interventions,and Risk According to Lave Cooled to Factors(fleft 1-22) lCont) 11IF/45"'F Within,,Houis, —Cwfiw,?s-4v,.(hod PROTECTION FROM CHEMICALS for PHFs 14 Food or Color Additives L!9 PHF Hot and Gla�d!Haldino 59().f)f)4('f l 4P1450 F, 7202 12 Cold PHF.�NhnnLimed at or beh)%v 3-02EI 4:��- P�oecctiofi—J'wnLl�naM I—veddditw�,V' L_�'L_ P ()fW. lint PHFs Maintained at or above L-15--7—iPoisonoto;or Toxic Substances 140'F. �,O,.,, Identitying Irfonrocion- Original Containers* 3-501 16(A) RAxists field at or abive 130-F. R "as He' L20 +T'nue Ra-"as ,P'ubfic Health Control 7 102,11 CommonNarce Salation- Firne as a Public liealth C enrol, wil T Re67ictloD-P7r(,Zn(V and U<e* varianw Reymtrentent 7-202- -7Coadii7jo-i�,of 7-203.11 Toxic Containoi, - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA IONS HSP 204.1' Sallitiwfs'Criteria-cheloicafs,* ry 1 1-80 1,11(Al Unpaitcutti.ed Pre-paclaged Juict.s LIT---� 7-204.112 Chollicak for tN usho�tlx" 04.1; W 7-' 1F73cv to t;.with 7 2�)4 114 U'we of'Pa,tcurized FlIl's* E�S I Incidental Food contoct,Imbricaols- r= L5 P72 I l-801.1 Ill)) Raw or Partial1% Col)U.d Apimill Food and L7106.i LPostiided Us,Pcq4ide,�.,Criteria, Raw [!2 lrnt—lts -206.12 RoIlew B,it Stations� -7 2-LnM�Lned�,00d flackE��= r.7� hnt Sea tea i 2106'11l 'I rac'kiligg Powdem PesL Control and L -monhorin- CONSUMER ADVISORY T'IMErrEMPERATURE CONTROLS 22 3 lim 11 It Onsol Adr isory Posted lor Cme;l"llption(IT 16 ProperCooking Tempelatures for Allimel Fxlds That are Raw.UndtiewLtd cr Not Othcr�isc Pr(x!essed to Eliminate Eggs- t'5'5'F 15 S'�c. Y. ---2L jlnjw'�I'ae lier"loc 1451"1 5stc" 3-3010 Piliteuriyed Fgg,;:Substihne fill Raw Shelf I I(A)(1 X' colommuled cAme Aarfoals 4� SPECIAL REOUIREMENTS 1.11(h 2) Polk and Roast - 130,T, 121 Vain — ---- —1 -�90-009W)4D) Viol of Section 590A09lAIl-(D)Jn jnjecleIi Wall,-- 175'v 15 caterine. mobile".)(1,temporary and it FA) -K tn7—T icsidenlod kitchen operation,should be itel, FiYs� solfbil",Containing Fish, Meat, debited .oder Ile appropriate sections Ftmivv or lllnmejL16�51-' 15 s about if rotate d to foodliorric illness �5-401—11(c)(3) Whole-muoic Way heef Steaks inteiventions,and riskfacton, Other i i--- 145 l s 1 590.009 violations rclatino to goad retail 3A01,12 Raw Ainfriet Fe"As Cooked its a practices 3hoold be thmitcal under#29 - Micio,,%ave 165'FSpecial Requirements. 3-46571A)Wlflb) All Other P 1-fFs-- 145"F 15 sec. I L17 Reheating for Hot Holding VIOLATI&kS-AE-LATED—TO GOOD RE—TAIL P—RACTWES W'T 15 (Wrts 23-30) 3-403A I(B) Miciowave- 165°F 2 klinule Shirldm�" C�airal and rion-Irwricd violahl)IIY, which do ww relate to yhr Time" 4foodhorne Woe,"imeovenliunv and riAja4tors livfvdaborr, um be 3-403.1 JiC) fins in of the Food COde,and 1325(.,WR 14l)'F 51 90000, 3-4f)3.3 IP Reelanlin", Uiishced Portions of licer Item Goad Retail PracL Ices Roast,* -23Management and Pecorind 7�--2 -663 , -I -—�rFo� eclion FC--3 004 1=8 Proper Cooling of PHFs -14, ain�rx!FPm1-- 1 10 1.14(A) ClXjiogCook edPHF3 Flom nt and Utensils .FC 4 .....00� --------- 1 26, 70'F Within 2 lfouc. and From 70'1' 2--7- Phystoal Faciiiy. FC-6 '007 1 -I--- - ----- - ' 7-1 � to 41�F/45'F'Wihurt 4 Hones, ou�_qr ic.Materiws-- 7 008 _�g�eL _1,,)L —Cmiling P----- ..P��, . ..-gltremarll- 1 5-w i PHFs Ishole Nom Ambient RI, 006_ 1 Tcmpofmorc Ingredients to 41'F145'F =t--------------- -- Within llioljrO CITY OF SALEM /n� BOARD OF HEALTH / Establishment Name: G/I � C�O_eii 1/7274- Date: w� �/ O� Page:� of Item Code C-Critical Item a 3 DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION s' . - oaten= - -11" 1 verified! No. Reference R—Red Item 3' PLEASE PRINT CLEARLY'' t '' i o Ir 5e leJJ ,I_11 JZ, n �y i t y� - i 1 r i i Discussion With Person in Charge: Corrective Action Required: ❑ No Yes 17, sP.,.. 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 1 S comply with all mandates of the Mass/Federal,Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars oil suspension/revocation of ❑ Embargo Ll Emergency Closure your food permit. ❑ VoluntaryDisposal LIOther. 4 _ i itT 14(0'} -- PHFs Received at'FeoiN_raLures Violations RalaW to Foodborne Illness Interventions and Risk According to 1.,,m Cooled to Factors(items 1-22) (Coto) - Wilbut 4 Maur.;. PROTECTION FROM CHEMICALS Coofia,Nutho&for PHFs L14 as L 19 PHF Hot and Cold Holding td PHFs Maintained at or lt�lock 9-202.1-2 1 Aldrin s* 590,004(F} 3-30114 Protcelvai fronjjj!Epr�t� Additives 3-501,16�A) Inti PFIFS NIamts,ueAat orkb,,n7, —_4 15 Poisonous or Toxic Substances 14WR [4L'11 1 Identifying Info mat on z)'—"�;.'i --------------A R(Kists Held at or above 130 F. 7-102,11 (,narnon Nnate, 'Norl< 1 20 1 Time as a Public Health Control 7_201.1 i S.°oaaeon 3-501 ig Tinto as Public flealth ControP — f_� 7-202.11 lt(�q'iction-Presence and U�c L90.004(H) variance,pequireluent l, ...... 7-20'2.12 Emdu..n,of 1,Ise. ...... 7-203.11 Toxic Containci,,--P(ohildnon,* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 SaailiMS,CtitCroi -C!X'OuOPOPULATIONS(HSIS� . 7-204.12 _Tiw_nu,,cit for W a—,hll��_Pf c Clltao--ae, 21 1 11(A) Uapatcuriecd Pre-pat Laged Juices and 7-204.14 L Soweto es Ivith Wannq I 7-205.11 liUs�of,Pasteurized E"'S" cidcntal Fo�xl Com"Im blivicants", 7-206.11 Critmol* 1.1 I(D) R�jw or Palliall"Cooked Avinv] R,7,nd aw St'('d 7-206A2 Rodent finit SUOJOM' Tf�otckin Pwdcri�Pest Cowrol a (I T-206,T I;� 81;11)1 Llt_(_)_LLa()2_eTte_(I r _j Nlonilonn CONSUMER ADVISORY TIMEff22 EMPERATURE CONTROLS ,qo i are Raw, Ljn&rcxx&eJ(,i 16 Proper Cooking Temperatures for "a trot()djvrj� Mind I PHFa e 11(wegsed to jqjInulau, 135 6 E'�Lt�-Inumchaw SefAct, 14S'Fl 5�ec, 1-302.13 Pzstrorizod Eg,-�z Substitute lot Raw ShOl 3-401.11(A)(17(A)(2) Comminot(n]N11Meas&Gallic L Anuvais- 1 ')�'F I sec 1-4{}7.12{$}(t)(21 Pod, and 13ccf Iowa - 130'T 121 rnjn� SPECIAL REQUIREMENTS _T Violatjon,�rd-Seclion 5 -(D) in _T401.I I(A)U) _iizute,, In ccr,,d W4ts 155 F 15 (,,awrine. tuohi1c.food.ternporary slid TTEWAY, lloaltrp5 ilildliarnC'_S ulteci PJF_ rcsidomW kitchen opeiations.4bould be 'intdnlc contaillin"Fish,Moat, debited LInder the appropriate sections t P=oult or Ratite,.165T 15 secal-love if related to ftxAborne i llnes 3-401.1!(C)Q; Whole-it"u-1111, ln',JT�_�IiSteaks inter ventioni and risk factors, Other 590.009 violations on� rclaunto"ood rotal( Ras t k Ano9a,11111�, in J'cooked a pray tices.ihould lx.debited under#29 - j lio owave 165,F L Sped u( Recpuueruents HA)fl)tb) Ni Othes PHFf - J451; IS sec, I L17 -Reheating for Hot Holding^ VIOLATIONS RELATED TO GOOD RETAIL PRAcnicEs 3-403.1 l(A)&fD) Pf fl,s 165"S 15 sec_ (Items 23.30) i-4©3.13(ii-)- -M_icro wn-v'e-169°F 2 k1 i m oe Sutinfing, Critical and non-nitinol vo),Wfioob, o4fich do no; re'a te In ihe I TimO 'foodhorne diner nln'rVenliolv and nstjmtors liviedabove, (an be 3-403.14-1 C. mm omealiv Processed RTF Food 'found in the Joil,nvingovions of the Food Code mid)05 CMR 4014* I(E) Rtrnamun, llnqwed Portions of Beel' i Stem Good RataiI Practices FC 590Wo 23, lAartagurner"an�d pwsoroe( FC -2 - _ ----------- - ----------- Food and Food Protection 25, E and Utensils FC-4 1 �005 Proper Cooting at PHFa i FG 3 p04 5cil'14A) Crx4ing Cooki�d PHF,�front 1,10'F to FG 5 ------- 70'F Within 2 Hours and From 70"'1 2T I P cal Facifitv FC-6 1_oo? to 41 T!45�F Within 4 Houm.� j±q_-7 L008 [:!It 14�il) Coolnig PHF�Made FroinAmbient 29 itpa Temperatere InLzredierus to 41 0 H45 30, Other _ i W-thin 4 llours�' Dell"te,initial Itemtheem in �["'IenO 1999 P�Ino'Gxl�or 105('141t 590 6(;(3 .i 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I PROTECTION FROM CONTAMINATION 745-6400 Food Conta t,Surfaces Cleaning and Sanitizing FAIL Q RED Owner: Comment: Cutting boards stained and scored. Resurface or replace boards. John Theodora kopoulos PIC: Handwash Facilities FAIL ❑d RED Bruce Irving menta Front hand wash sink obstructed. Sink to be clear and accessible at all times. Inspector: John Gehan track handwash sink missing handwash only sign. provide sign. Date Inspected:Correct By: Employee restroom and patron bathroom paper towel dispensers appear to be dispensing slowly. Maje any coreections necessary 4/3/2007 to ensure paper towels dispense properly. Risk Level: Permit Number: BHP-2007-0328 Status: Open #of Critical Violations: 2 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food otection FAIL BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:There are missing light covers on various bulbs. Provide covers for any bulbs that do not have covers including immediate corrective action) downstairs storage area. Equipment and Utensils FAIL BLUE C ent: Small whute storage freezer by walk in unit requires thorough cleaning. -S lbfinlog not being kept on a daily basis. Log to be maintained daily. 3 bay-sink missing proper labels. Relabel sink. Beverage Air unit not in use requires thorough cleaning. Unit to be repaired to proper working order or discarded by next routine �spection. C ental unit has accumulation if water on bottom. Find source of leak and repair. Remove standing water. zen foods unit requires thorough cleaning. aw meat continental unit requires thorough cleaning of shelves. ack coke unit requires general cleaning of bottom. ell-Jnit by oven not being used requires general cleaning. Unit to be repaired to proper working order or discarded by next routine inspection. tco unit requires general cleaning of bottom. argee w-hiit, freezer downstairs requires defrosting and general cleaning. II white freezer downstairs requires defrosting and general cleaning. Physical Facility FAIL BLUE — ofnment:There is a visible air gap on back door. Provide weather stripping to protect against entrance of rodents and/or insects. then has accumulation of spills and splatter on walls. All walls to be throughly cleaned by re-inspection. alk in floor in disrepair. Floor to be repaired by next routine inspection. I� n is a missing vent cover over the cookline. Repair or replace cover. ,,'GENERAL ENG ERAL COMMENTS: Last three months of extermination to be on hand at re-inspection or faxed to BOH. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page 3 of t 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-6400 Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED Owner: Comments:Cutting boards stained and scored. Resurface or replace boards. John Theodorakopoulos PIC: Handwash Facilities PASS - ❑ RED Steve Carpenter Comments: Front hand wash sink obstructed. Sink to be clear and accessible at all times. Inspector: John Gehan Back handwash sink missing handwash only sign. provide sign. Date Inspected:Correct By: Employee restroom and patron bathroom paper towel dispensers appear to be dispensing slowly. Maje any coreections necessary 4/3/2007 to ensure paper towels dispense properly. Risk Level: Permit Number: BHP-2007-0328 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 GeoTMSO2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 11,2007 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:There are missing light covers on various bulbs. Provide covers for any bulbs that do not have covers including immediate corrective action) downstairs storage area. Equipment and Utensils PASS BLUEi, Comments: Small whute storage freezer by walk in unit requires thorough cleaning. Sanitizing log not being kept on a daily basis. Log to be maintained daily. 3 bay sink missing proper labels. Relabel sink. �, Beverage Air unit not in use requires thorough cleaning. Unit to be repaired to proper working order or discarded by next routine inspection. Continental unit has accumulation if water on bottom. Find source of leak and repair. Remove standing water. Frozen foods unit requires thorough cleaning. Raw meat continental unit requires thorough cleaning of shelves. Back coke unit requires general cleaning of bottom. Unit by oven not being used requires general cleaning. Unit to be repaired to proper working order or discarded by next routine inspection. _ Front coke unit requires general cleaning of bottom. Large white freezer downstairs requires defrosting and general cleaning. Small white freezer downstairs requires defrosting and general cleaning. Physical Facility PASS BLUE Comments:There is a visible air gap on back door. Provide weather stripping to protect against entrance of rodents and/or insects. Kitchen has accumulation of spills and splatter on walls. All walls to be throughly cleaned by re-inspection. Walk in floor in disrepair. Floor to be repaired by next routine inspection. There is a missing vent cover over the cookline. Repair or replace cover. GENERAL COMMENTS: All violations cited in the 4/3/07 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. Apr 11,2007 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 11,2007 ) Page 3 of � �� r '� � �� " � 11•w �~�a�7� �x ,S'+ Y��S 7:�'d�F� r�"��. Commonw�ealthafMassachusetts � `c "�' #. i aka^"' ti ` �L • a�, +, f ^ G}a SY'nS., '1 City Board of Health IGmbeftey Dnscoll 120 Washington Street,4th Floor " . .:Mayor . SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2007 ESTABLISHMENT NAME: Mandee's Pizza File Number:BHF-2004000066 - 408 Essex Street Salem MA 01970 LOCATED AT: 0408 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0328 Jan 5,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES (December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 11 CITY OF SALEM, MASSACHUSETTS o e BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741.1800 Fax 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION OR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT yY lCl4 C e S / (Zt�_tF TEL# � �✓�(� tl0 C;) ADDRESS OF ESTABLISHMENT l7/O SS Lj� `J� FAX# MAILING ADDRESS(if different) EMAIL-- Business': Oa6jf P e S— (a ,foof{'uwner's: f S OWNER'S NAME (70G/v,?J am', r� ,��,///��c S L# ADDRESS STREET J ITY / STATE / ZIP-T CERTIFIED FOOD MANAGER'S NAME(S) �'/�I 7d1C��d��Oa4 G¢ '`� CERTIFICATE#(S) I/ (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON � NOME TEL# UpYSOFOPEO6TtON Monday Tuesday Wednesday_ Thursday Friday Saturday Sunday HOURS OF4PEOATlON J � � � �� f f. /.j-ts7 !�- ✓�. ^ /(- r4-+� Please writeindmepfdaV. � � ! lt'—/r�-0'� !(—B�sN TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT E NO less than 25 seats $100 25-99 seats =$150 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 s ch must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Ch r 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief. ha I e 1 turns and paid a0 state taxes required under the law- - Si ture Date Social Security or Federal Identification Number -- -- - ------------------------------------------ -- - ----------------- -----_ ---- - .- -------------- Revised 11113/0G Foo Check#& Date ,,, .(-_/_/'*/-"-✓— S . COURT DOCKET NO. CITATION NO. SCITY SALEM PD f 0 VIOLATION NOTICE r NAME(LAST,FIRST,INITIAL( f r .Go L L>5 ' D? 17 STREETADD/REESS t CITV/TOWN /STATE ZIP O'k , /f?f�(i'l,Ft/ ��1iG ty13.G'Grrc�ll� LICENSE e %P.DATE DATE OF BIRTH D _ �ftY(.rFi'G,�G>3 c�GS � VOh (j STREETADDRESS CITY/TOWN STATE ZIP //1Crirli_, C�'cc„cjc,� REGISTRATION NO. STATE EXP.DATE MAKE/TVPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL ❑AM wuRy 'El PM 11 YES [-]NO LOCATIONTT/ION OF VIOLATION t 'C,IliOUG ,ZC&, ENFORCING tt D/E�P,T. OFFENSE CHAP. SECT. FINES Y_ c� A f6 j C f 1 4 fn 2 B �•17 pc r^ a e , OFFICER I.D.NO. TOTAL Is Jf DIUE /o X O E- [ IFIESOPY GIVEN TO VIOLATOR ED IN HAND `- r BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL •il ?l i, G N p ��OWHfOOCI�TNO..�� _a ,- _ kj1 �, m$tF r Q •q CITY OF SALEM crranoN No O VIOLATION NOTICE PD 0 010 , 'p; 0 K�C¢' a ' AW NAME(LAST,FIflST,INITIAL) o mo * o + W STREETADDRESS CITYfTOWN STATE ZIP . ^ _ t s H 3 w LICENSE S � hSa� OLI P.DATE DATE OF 81RTH LL „ 0 OW NAME(LAST,FIRST,INITIAL) C^. 1 J SIRE11€T A9D�RESS /! CITY/TOWN STATE ZIP C \\ I REGISTRATION NO. STATE EXP DATE MAK6'iYPE YEAR COLOR I - DATEOFVIOLATION TIME DATE CITATION WRITTEN PERSONRL Cl AM rwuRb I ao [IPM YE$ O LOCATION OF VIOLATION 'G Y y- Q I ONO FORCMG D T.j( C O/ g ( oaQO E CHAP. FINES A -"40 SECT. ff car 7 O-..'o rf PexO a s B �ym S2 oW -� UOLn a ir OFFICER LD.NO. TOTAL ! Ip and a O6 .� ! FINE $./�ry%i DUE t/ OFIICER CERTIFIES COPY GIVEN TO VIOLATOR _ 1 ) � 1 /JO d/ ❑�/BY MAIL IN HAND ❑ X DO NOL CASH PAY ONLY BY POSTAL NOTE,MONEY Q ORDER OR BY CHECK MADE PAYABLE TO: N CRY CLERK N_ — L` CITY HALL S 93 WASHINGTON STREET a rm SALEM,MA 01970 y C TEL.(508)745-9595 X 251Do W ? p I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON W cn m- REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE c 0 Z o7 E: cc PAYMENT IN THE AMOUNT OF Z z o I o O iX m. m Q 0 o O ;_ 5 CASEa U 5 z Q� O z� O I SIGNATURE w'wo p Q iJ < WI - C NOO:m g D o SEE OTHER SIDE FOR FURTHER INFORMATION Fr C) fO v .'��-' < ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL V waw< 4 Z , Q Www w avua Z O O d v rt `o TIT 0 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 745-6400 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment: The shelves in the walk in have an accumulation of grime and debris. Thoroughly clean all shelving units in the walk John Theodorakopoulos in. New shelf units have been ordered. PIC: The small Beverage air reach in in the kitchen not working. Repair unit to good working order or remove from the establishment. John Theodorakopoulos Owner is looking into having this unit repaired. If it cannot be repaired it will be removed. Inspector. The small pizza unit door gasket is in disrepair. Repair or replace the door gasket. Anew door gasket has been ordered. David Greenbaum Date Inspected:Correct By: 10/30/2006 Risk Level: GENERAL COMMENTS: 943:All other violations cited in the 10/18/06 inspection report have been corrected. Permit Number. BHP-2006-0253 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 31,2006 ) Page 1 oft • Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) V�P" 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. Oct 31,2006 ) Page 2 oft s 0408 ESSEX STREET Mandee's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-6400 Food Contact aces Cleaning and Sanitizing FAIL Critical [I RED Owner: mment: a cutting boards on the deli unit and pizza unit are stained and scored. Resurface or replace the cutting boards. John Theodorakopoulos PIC: T, he pf stic tableware in front to be placed in one direction handle side up. Glenn Davis Il// Inspector. David Greenbaum Date Inspected:Correct By: 10/16/2006 Risk Level Permit Number: BHP-2006-0253 Status: VIOLATION #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. Oct 18,2006 ) Page I of Item Status Violation Critical Urgency RED: Violations Related tgGood Retail Practices (Blue Items) Violations Related to Food a7mment: Irotection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require There is food stored directly on the floor of the walk in. Store all food at least 6-8 inches off the floor. immediate corrective action) Tho reen World freezer has uncovered food. All food in storage must be covered. he C tinental reach in has uncovered food. All food in storage must be covered. Equipment and Utensils FAIL Non-Critical BLUE Cent:The mixer has an accumulation of food debris. Thoroughly clean and sanitize the mixer. The sh s in the walk in have an accumulation of grime and debris. Thoroughly clean all shelving units in the walk in. The freezer in back needs a general cleaning. Tneeds a visible,accurate thermometer. he gh achine has an accumulation of food debris. Thoroughly clean and sanitize the dough machine. T can -pener has an accumulation of grime. Thoroughly clean the canopener. T Fri ' aire freezer in the basement needs a thorough cleaning. Th a unit needs a visible,accurate thermometer. �Tma freezer inthe basement needs a thorough cleaning. Tnit needs a visible,accurate thermometer. Frigidaire freezer in the back of the basement needs a visible,accurate thermometer. c...... The small Beverage air reach in in the kitchen not working. Repair unit to good working order or remove from the establishment. T Green World freezer has an accumulation of grime. Thoroughly clean this freezer including all shelving. L.T,Ivedell unit has an accumulation of food debris. Thoroughly clean this unit. T same unit needs a visible,accurate,internal thermometer. e Continental reach in needs a general cleaning. T e same unit needs a visible,accurate thermometer. The small pizza unit door gasket is in disrepair and has an accumulation of grime. Repair or replace the door gasket and clean thoroughly. Tame unit needs a visible,accurate,internal thermometer. T rue Coke unit needs a general cleaning. Cityf 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. Oct 18,2006 ) Page 2 of Item Status Violation Critical Urgency Physical Facility FAIL Non-Critical BLUE ` Gbmme :The walls in the back prep area have an accumulation of food spills and splatter. Thoroughly clean the walls. V / I walls near the single bay sink have an accumulation of mold. Investigate the source of the moisture and repair. Thoroughly clean and sanitize the walls. Th loorhe walk in has many broken/damaged floor tiles. Repair or replace all broken/damaged floor tiles. Th asement is in need of a thorough cleaning an organizing. Remove all items not pertinent to the business and repair or move all equipment that is not working. GENERAL COMMENTS: 902: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. Oct 18,2006 ) Page 3 of CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT i COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Mandee's Pizza Address of Establishment: 408 Essex Street Owner's Name: John Theodorakopoulos Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 142-04 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. IJP HEALTH AGENT A a CITY OF SALEM, MASSACHUSETTS • '� BOARD OF HEALTH 120 WASHINGTON STREET 41H FLOOR � — SALEM, MA 01970 DEC 3 -2003 TEL. 978-74 1-1800 CITY OF SALEM FAX OTT, MPH, RS BOARD OF HEALTH STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION ,FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT T/(X/f'l/ t ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) A OWNER'S NAME �lT��{g�ND/L.t�,BoPL �e S TEL ADDRESS315 /X11`! CITY�('tye/an0 — STATE [��rrr ZIP D/ CERTIFIED FOOD MANAGER'S NAME(S) SaN1, CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON l HOME TEL# ue. HOURS OF OPERATION: Mon. TWed. Thu. Fri. Sat. Sun. v. 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 YE NO 7 less than 25 seats =$100, 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check ' payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Cha ter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bes I ge lief, have filed all state tax returns and aid all state taxes required under the law. 3 �r s s� �l Sig tui-6 - Date Social Security or Federal Identification Number - ------------------------- --------------------------------------------------- ----------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date 17-7 3--03 lov S/_ Massaehusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Namei ( ) Dae/ Tvoe of Operations) Tvoe of Insoection _'0/LSI P 0 JZZG U VFood Service Routine Address U - ? o Risk ❑ Retail IVI'Re-inspection - - Level ❑ Residential Kitchen (Previous Inspection Telephone EIS( Mobile Date:3/a .>G E] Temporary ❑ Pre-operation Owner I l ^ 1 HACCP YIN( � �� ,�- � � ❑ Caterer El Suspect Illness Person in Charge(PIC) 4 Time ❑ Bed&Breakfast ❑General Complaint _ In: ❑ HACCP Inspector A� p Out: T, t Permit No. El Other Each violation checked refiuires an explanation on the narrative`lpage(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",r`,"„� „._.�,=�mm , �:„,„�:„ �� ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties a EMPLOYEE HEALTH "t" ^k �� mii! mITn rI �- ❑ 13. Handwash Facilities . .:. ,... ,;„,., o a.m ..«,� m.. .�.�� ,PROTECTION FROM CHEMICALS ❑�2. Reporting of Diseases by Food Employee and PIC S �.- �� ..... »� �•� =��m4. m��< =- f,'i El 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals FOOD FROM APPROVED SOURCE e El 4. Food and Water from Approved Source ourc"'` 'r (`TIMEIrEMPERATURE CONTROLS(P6temrafly Hazardous Foods) k _ � r n»ia C] 5. Receiving/Condition EI 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ' ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing �F OOUIR21. Food and OR,HIGHLY ood Preparation l �or HSP POPULATIONS(HSP)7I ❑ 10. Proper Adequate Handwashing El11. Good Hygienic Practices m CONSUMES ❑22. Posting of Consumer Advisories kms. 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)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food ' 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility O (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.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:SBJlnspectForm6-ia.mc "-I- , Inspector's Signatures9: Print: PIC's Signature:�w�j_/ Print: {� / •-�-^-'-" Page_lof,2Pages T // / � '- Violations Related to Foodborne Illness o Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 596.003(A) Assignment of Responsibility* 3-302.1.1(A)(]) Raw Animal Foods Separated from 590.003(B)TDemonsuittion of Knowledge* Cooked and RTE Foods* 2-1031 I Person in chargee-duties Contamination from Raw Ingredients 3-30211(A)(2) Raw Anirnal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590:003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1.1(A) Food Protection* applicants* 3-302.15 Washing Fruits and Ve atables 59(t003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* D(sposklon of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food.Law* 4-501.1.11. Manual Warewashing-HotWater 3-201.12 Food in a Hermetically Sealed Container* Sanitization Ten eratures* - 3-20'LI3 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Fa s* Sanitization Temperatures* 3-202.14 Fggs and Milk Products.Pasteurized* 4-501,114 Chemical Sanitization-temp.,PH, 3-20216 Ice Made From Potable Drinldn Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-60 L I I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 59(1006(B) Water Meets Standards in 310 CMR 22.0* 4-60211 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Sfrellfish 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* 4-703AI Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from:NSSP Listed Chemical* Sources* 16 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11, Clean Condition-Hands and Arms" 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* -590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tasting* 6 Tags/Records;Sheiistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.1.2 ShellstockIdentification Maintained* Em to ees* Tags/Records: Fish Products 13 Handwash Facilities 3402,11 Parasite Destruction* Convenienty Located and Accessible 5-203.11 Numbers and Capacifies* 3-402,12 Records,Creation and Retention"` 5-804,11 Location and Placement* i 590.004(J) Labeling of Ingredients' _ 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashin Cleanser,Availabilit, 3-502.12 Reduced ox genpackaginge-criteria* 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dryingv Provision 4 .y ' t *Denotes critical item in the federal 1999 Foal Code or 105 CMR 590.000. - CITY OF SALEM - BOARD OF HEALTH Establishment Name: G �P YrZZG� Date:/!T G _ Pager of o2 ? Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified. PLEASE PRINT CLEARLY (} la f' ( Ica C - , x S m r v` 1 kDiscussion With Person in Charge: Corrective Action Required: -.❑ No Yes have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. !/' 0 Voluntary Disposal ❑ Other: ;-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Iatw Cooled to Factors(items 1-22) (Cont.) 41'F(45`F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202-12 -Additives* 3-501.16(13) Cold PHFs Maintained at or below 590.004(F) 41°145°F� 3-302.14 Protection from A �na roved Additives* 3-501.16(A) Her PHFs Maintained at or above 1$ Poisonous or Toxic Substances 40'F. 7-101.11 cont Identifying Information-C)riginal 3-501.16(A) Roasts Held at or above 130°F. Containers` 7-1.02.11 Common Natrte-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora*e* 3-507.19 TimeasaPub(icHealthControl" 7-202.1.t Re-_sPrictic,�n-Presc.ncs and Useie 590.004(H) Variance R@"nlrement 7-202.12 Conditions of Use* 7-203.11 'foxicC'ontmm-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Samnzers,Criteria-Chemicals' POPULATIONS(HSP) 7-204.12 Chemicals for&ashineProduce Criteria' 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Devin ATents,Criteria' - Beverages with Warnin*l,abels" 7-205.11 Incidental Food Contact.Lnbrieants* 3-801.11(B) Use ofPacteurizedEggs* 7-206.7] Restricted Use Pesticides.Cxiteria* 3-801 A I(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.'r 7-206.12 Rodent Bait Stations* 3-80'1.11(C) Unopened Food Package Not Re-served. 7-306.13 'Tracking Powders,Pest Control and Monitoring`' CONSUMER ADVISORY _ TIME/TEMPERATURE CONTROLS 22 3-663.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'Phat are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate 3.401.11A(1)(2) Eggs- 155'17 15 Sec. Pathogens ErL s turned rare Servicef45'F15sec* 3-302.13 Posteunred Eggs Substitute for Raw Shell 3-401.I I(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155'F 15 sec. 3 d01.11(B)(1)(2) Pork and Beef Roast - 130"F 121 min* SPECIAL REQUIREMENTS 3-401.1 l(A)f2) Ratites, fnjected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. ' catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11.(C)(3) )')hole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F r 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All tither PHFs-1.45'F 15 sec. 11 Reheating for Hot Holding V10LAT10NS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.A)&([)) PHFs 165'F 15 sec. " (Items 23-30) 3-403.11(8) Microwave-165°172 Minute Standing Critical and non-critical violalions, which do not relate to the Time" foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR '140°F* 590.000. 3-403.11(E) Remaining Iinshced Portions of BeefItem Good Retail Practices FC 530 000 Roasts' 23. ona ement a Mn_d Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 _ .004 3-501 14(A) 25. Equipment and Utonsils __FC 4 ___.005____ ( Cooling Cooked PHFs from 140`'F to g6. Water.P_lumbin and Waste FC-5 .006 70'F Within 2Ifours and From 70'F 27. Physical Facility..._ FC-6 .007 Lo 41°Ff45'F Within 4 Hours. " 28. Poisonous or Toxic Materials --FC---7 -T0-8 3-501.14(B) CoolingPHFs Made From Ambien[ 29 S octal R uiremoMs 009 Temperature Ingredients to 41°F145'F 30 _ .Other Within 4 Hoursa ssr�,naa+:z:x,r Denotes mucal Stern in the.tedeml 1999 Food Code or 105(Wk 590.000. L e Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameI � Date Type of Operation(s) Type of Insnection cjr, LS 02 %JT&4Food Service ®.Routine Address �U Rik Retail LJ'Re-inspection Level [:] Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: j ifs Owner i HACCP YIN ❑ Temporary ❑ Pre-o er tion O(p t f ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) 1\ �, Time E] Bed&Breakfast El General Complaint __ In:(I, ❑ HACCP Inspector Out: a Permit No. ElOther Each violation checked req iris 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',11 1 ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ( y h ❑ 13 Handwash Facilities I"EMPLOYEEHEALTW � ,,,.r,« �d,1 4-�7 _ ., _ ...... "s-e`- ��.Q.�.,,.,d.-m_ ..��..�.-.a,,.�,�.., �:. ,-,.., .� ��o�,�.�� 7'.PROTECTION FROM CHEMICALSi�w I ms ,i it r G moi. ❑ 2. Reporting of Diseases by Food Employee and PIC _ t 1 ; ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded t 1 ❑ 15.Toxic Chemicals ,,FOOD FROM APPROVED SOURCE , ,.„.s:77eN, . j, g.`TIME/TEMPERATURE CONTROLS F+otanUall�Ha;ardous foods gn ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition 016.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling t Y`PROTECTION FROM CONiAYtA1NAT10NE� � ' " �` El 19. Hot and Cold Holding �❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing krzodiRoMENFSFOR HIGHLY SUSCEPTIBLE P'0PULATiON Q4SP)�;; ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing E] 11. Good Hygienic Practices CONSUMED 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 immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection of Health. today, the items checked indicate violations of 105 CMR ,, 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food ^26 Water, Plumbing and Waste (FC-5)(550.005) establishment operations. If aggrieved by this order, you 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: 5:5901rupeclFo,m61d me Inspector's Signature: Print: PIC's Signature: / Print: i"' Page!of�Pages G2 t Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 596.003(A) Assignment of Responsibility* 3- 002.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge*" - Cooked and RTE Foods* 2-103.1 t Person in char e--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Eacb EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1.1(A) Food Protection* a rlicants* 3-302-15 Washing Fruits and Vegetables 590.003(F) Responsibility OYA Food Employee Or An 3-30411 Food Contact with Equipment and Applicant To Report'ro The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A) Retuned Food and Resetvice of Food* 3 590.003(D) Exclushms and Resvicti ons* - Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell E s* Sanitization Temperatures* 3-202.14 F.>is and Milk Products.Pasteurized* 4-501..114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water- concentration and hardness. * 5-1.01..11 DrinkingWater from an roved System" 4-601.11(A) &luipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean" 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 21F - Shellfish Contact Surfaces and Utensils*sh and Fish From Approved Source 4-702.1 t Frequencyof S 3-201.14 Fish and Recreationally Caught Molluscan Con r faces aces oof Utensils and f Foal CSurfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authorit Game and uMushrooms Approved by 2-301.11 Clean Condition-Hands mid Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning,Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11. Plirs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes, Nose and 3-202.15 Package integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock L12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Emloees* Tags/Records:Fish Products 13 Handwash Facilities 7402.11 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 5-205.11 1 Accessibility,Operation and Maintenance /HACCP Plans - Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 1 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with A roved Procedures" 6-301.12 Hand Drying Provision *Denotes ciitfcil item in the federal 1.999 F<xx1 Cale ur 105 CMR 590.000. f CITY'OF SALEM BOARD OF HEALTH i Establishment Name: U /'Z-Sot Date: f v Page: of_7?=) Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY r. ( cCA OT A is ,r�C r Lt c P s f 1 a if �J3a�� 1 n/ 0 1 l D . j2 / t C ( OI it rt ) r, c� a na ✓ d li e . !te r Rr , 00 =Ih J ' jal y, Discussion With Person in Charge: corrective Action RRequired: ❑ No Yes r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the:next inspection, to observe all conditions as described, and to Exclusion p I e inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars or suspe io /revocation of ❑ Embargo ❑ Emergency Closure your food permit. 11 Voluntary Disposal ❑ Other: 3-501 14(C) PHFsReceivedat"1"emperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) "(Cont.) » 41'F/45''F Within 4 Hans. PROTECTION FROM CHEMICALS 3--501.15 Cooling Me hods for PHFs 1=14 Food or Color Additives 19 PHF Hot and Cold Holding 4 3-501.16(B) Cold PHFs Maintained at or below 3202.12 Addthres" 590.004(F) 41V45'F* 3-302.14 Protection from Unaj)proved Additives`* 3-501.16(A) llat PHFs Maintained at or above 1g / Poisonous or Toxic Substances 7-101.11 Identifying information-Original 3-501.16(A) Roasts Held at or above 130'F Containers* 7-102.11 Common Name-Workim>Containers* 20 Time as a Public Health Control 7--20'1.1 1 Se aration-Stora=e* 1 3-501.19 Time as a Public Health Canhr7i* 7-202.'11 Restriction-Presence and use* 590.004(H) Variance:Re mrernent 7-202.12 Conditions of Use* 7-203.1.1 'toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.71. Sanm7ers,C'yiteria-Chemicals- POPULATIONS(HSP 21 3-801 11(A) Unpasteurized Pre-packaged Juices and 7-204.1.2 Chemicals for Washin¢Produce,Criteria` � 7-204.14 Diving Agents.Critetia* Beverages with Rarning Iitbels* 3-801.11(B) Use of Pasteurized Ergs* 7-205.11 incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.1l(D) Raw or Partially Cooked Animal Foodand Raw Seed Sprouts Not Served. a 7-206.12 Rodent Bait Stations- 3-801,11(C) Unopened Food Package Not Re-served. * 7-206.'13 Tracking Powders.Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLSConsumer Advisory Posted for Consumption of Animal Foods That are Raw. Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate Pathogens.3-401.L]A(1)(2) Fgg, --1.55 F 1.5 Sec. 22 3 603.11 *enec""111/20,11 6 gs hrrmedrate.Service 145°F15sec* 3-302.13 Pasteunzed Fggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&( aure Eggs* Anirnals- 155'F 15 sec. * 3-401.11(13)(1)(2) Pork.and Beef Roast-130'F121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-401.1101)(3) Poultry,Wild Game, Stuffed PFTs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Paultr or Ratites-265�F 15 sec. above if related to foodborne illness 3-40 A l(C)(3) Whole-muscle, Intact BeefSteaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Corked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401-1l(A)(1)(F) All Other PHFs-145'F 15 sec 19 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 16YT 15 sec. * (heats 23-30) 3-403.11(B) Microwave-165° F2 Minute-Standing Critical and awn-critical violations,which do not relate to the Time" foodborne illness interventions and risk factors listed abode,, can be 3-403.11(C) Commercially Processed RTE Ford- found in the following sections of the Food Code and 105 CMR 14WF` 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retain Practices IFC 590.000 Roasts` 23. Management and Personnel FC-2 .003 (g Proper Cooling of PHFs 24. Food and Food Protection _ FC--3 .004 25 _Equipment and Utensils FC 4 .005 3-501.14(A) Coaling Cooked PHFs from 140`F to 26. Water,Plum6in and Waste FC-5 .006 70`F Within 21fours and From 70'F ZT Physical Facill ____ FC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S eeial R uirements .009 Temperature higredie-nts to 41°17145'F 30_ Other_ _----- Within -Within 4 llours'bS sat m,0 1,-2,r,< *Denotzs critical rem in tha tderal 1999 Food Code or 105 CMR 590 000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Pager of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY It r n ��L E -7 2CPIoJ ani "T 7«h-b., l c� 49 f L 2 \Yrt ( s S r k - 4 1� its Discussion With Person in Charge: Corrective Action Required: ❑ No s ❑ Voluntary Compliance ❑ Employee Restriction/ have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and toRe-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 s pen ion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-591-14(C) �PHFs Received at'remperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41�FIAYT Within 4 Homs. PROTECTION FROM CHEMICALS3-501.15 Coolin3 1=4Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(13) Cold PHFs Maintained at or below 590.004(17) 41°/45°F" 3-302.14 Protection from Una roved Additives* 3-501-16(A) I{ot PHFs Maintained at or above IS Poisonous or Toxic Substances 140'17. 7-101.11 ldeCont isle'sarig Information-Original 3-501.1.6(A) Roasts Held at or above 130°F. " Containers" 7-102-11 Comrnon Name-Workin^Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora e* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590(004(H) Variance Re airement 7-202.12 Conditions of Use* _ 7-203.11 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washnw Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with 0.n-nins,Labels* 7-204.14 Dain t� ents,Criteria* -g01.11(B) Use of gejith'Pasteurized Eggs- 7-206,113-S01 Incidental Food Contact. Lubricants* 7-206.11Restricted Use Pesticides, Criteria* 3-801-II(D) �RAw or Partially Cooked Animal Food and Raw Seed S orouts Not Served. 7-206-12 Rodent Bait Stations' 3-801.11(C) Uno ened Food Pucka>e Not Reserved. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS ;t3 0311Consumer Advisory Posted for Consumption of Animal FaxlsThat are Raw,Undercooked of PHFs16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-101.1.lX(1)(2) F=gs- 155 F 15 Sec. Pathe ens "e"moa E>es-Immediate Service 145°.Fl feec* 02.13Pnsteuriud Eggs Substitute for Raw Shell 3-401.11(X)(2) Comminuted Fish, Meats&Game Eggs* Animals-155°F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food,temporary and 3-401.I I(A)(3) Pruitty, Wild Grupe,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-165°F 15 see. �= above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and tisk factors. Other 145-17* 590.009 violations relating to good retail 3-401.12 Raw Animal Fotxls Cooked in a practices should be debited under#29-- Microwave 165°F* Special Requirements, 3-401.11(X)(1)(6) All Other PHFs- 145°F 15 sec. * I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. "= (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and ii.ekfactors listed above., can be, 3-403.1I(C) Commercially Processed RTE Food- found in thefollowing sertLms of the Food Code and 105 CLI2 140'F* 590.000. 3-403.11(E) Remaining Unsitced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Mona ement and Personnel_ FC--2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 X04 25. _ Etc uipment and Utensils FC 4_ .005 3-501.1.4(A) Cooling Cooked PFIFs from 140`F to 26. Water,Plurn and W asie FC 5 .006___ 7WF Within 2 Hours and From 70°F 27. Ph sical Fa !Ky__ FC-6 .007 to 41'Ft45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 750L 14(B) Cooling PHFs Made From Ambient 29. Special R uirements -009 Temperature Ingredients to 4,1°17145°F WT `_ Within 4 llours'' Sswr�,w,xPzo-e Denoa s critical itenn in the federal 7999 Food Coda or 105 CMR 590.000. 0408 ESSEX STREET Mandee's Pizza City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 745-6400 - Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ John Theodorakopoulos - Tobacco PASS ❑ Plc: - r John TheodorakopOUl05 µ'. FOOD PROTECTION MANAGEMENT Not Done Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑Q RED David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑Q RED 5/5/2005 Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Level: Q FOOD FROM APPROVED SOURCE Not Done Permit NUmber: Food and Water from Approved Source PASS RED BHP-2005-0299- Receiving/Condition PASS ❑o RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑ RED SIGNED OFF Conformance with Approved Procedures/HACCP PASS RED of Critical Violations: F Plans 2 PROTECTION FROM CONTAMINATION Not Done Time IN: ' Time OUT: Separation/Segregation/Protection PASSd❑ RED Notes: Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ RED Cutting boards are stained and scored. 130:Owner will notify the Board Resurface or replace cutting boards. of Healthwithin one week that � ' Proper Adequate Handwashing PASS d❑ RED the~noted ViolationS have been Good Hygienic Practices PASSd❑ RED corrected. " ' .. Prevention of Contamination from Hands PASSd❑ RED Urgency Description(s): Handwash Facilities FAIL Criticald❑ RED Front handwash sink is obstructed. Hand BLUE: wash sink must clear and accessible at all Violations Related to Good times. Retail Practices (Critical GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 06,2005 ) Page 1 of 0408 ESSEX STREET Mandee's Pizza Violations must be corrected PROTECTION FROM CHEMICALS Not Done immediately or within 10 Approved Food or Color Additives PASS Q RED days)(Non-critical violations must be corrected immediately Toxic chemicals PASS ❑D RED orwithin90 days) r TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done RED: - Cooking Temperatures PASS RED Violations Related to Foodborne Illness Interventions Reheating PASS ❑D RED and Risk7Factors (Require immediate-corrective action) cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASSd❑ RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Non-Critical ❑ BLUE Canopener needs a thorough scouring. Continental cooling unit has an accumulation of grime. Thoroughly clean entire unit. Coke unit has an accumulation of food debris. Thoroughly clean unit. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non-Critical ❑ BLUE All thresholds need to be repainted. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 06,2005 ) Page 2 of 3 0408 ESSEX STREET Mandee's Pizza GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 06,2005 ) Page 3 of y R•,Sok A.. -...1f fY LJSa. P +� ...r.. . -.F{.rw+...an m:« +.a r... -..: ..-«.-w-.a p...-g..a ...r.amNY .. A .- m CITY OF SALEM9 MASSACHUSETTS -t. BOARD OF HEALTH 4 - 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA O 1970 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: RETAIL FOOD Name of Establishment: Mandee's Pizza Address of Establishment: 408 Essex Street Owner's Name: John Theodorakopoulos Restrictions: Application Date: 12/7/2004 Permit for Food Establishment 205-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETj�� C%gy� a]L BOARD OF HEALTH ��++++++ o " - O 120 WASHINGTON STREET, 4TH FLOOR 3 2004 o. SALEM, MA 01970 DEC TEL. 978-741-1800 C'TyO FAX -745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, BOARS �FHE T, MPH, RS, CHO SALEM Fi MAYOR HEALTH AGENT 2005 APPLICATION FOR PE MIT TO DRERATE A FOOD ESTABLISHMENT Gf /� NAME OF ESTABLISHMENT MQII ee S / /1ii� TEL# l L�v ADDRESS OF ESTABLISHMENT02 jk, MAILING ADDRESS (if different) rye, OWNER'S NAME U�t`'� e-©�'�" °�P`�� s TEL A-/ ��f- _-�,�� CITY ADDRES ( STATEy yT— —i ZIP_ U(�V Z� CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON-� M' HOME TEL# jj�k—570)- .6-?&'? HOURS OF OPERATION: Mon//Alr�Tue. ed. Thu. Fn 'Sat.—Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 v more than 10,000sq.ft. =$250 RESTAURANT YE NO (� +' less than 25 seats =$10o-- 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my b w e and belief, have filed all state tax returns and paid all state taxes required under the law. _ natu e 1, Social Security or Federal Identification Number ------------------------------------------------------------------------------ Revised 11/03/03 FOODAP2.adm Check#&Datei ao q'T tl- 16 Commonwealth of Massachusetts City of Salem s x Board of Health 120 Washington Street,4th Floor "+rte W SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Mandee's Pizza File Number:BHF-2004-0066 408 Essex Street Salem MA 01970 LOCATED AT: 0408 ESSEX STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0253 Jan 3,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 10 CITY OF SALEM, MASSACHUSETTS ; BOARD OF HEALTH j a 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 nNe TEL. 978-741-1800 STANLEY J. LISOVICZ, JR. Fax 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AG ENT 2006 APPLICATION FOR 1 PERMIT TO O RATE A FOOD ESTABLISHMENT Ij t/, c_ NAME OF ESTABLISHMENT t / me S d ( TEL f ?�( ADDRESS OF ESTABLISHMENT L09 MAILING ADDRESS (if different) 1f Q . , OWNER'S NAME CrVI f!i CvOC1a/�G� f°^GCl7 TEL# ADDRESS ��/ �� ZIP P/ `a I CERTIFIED FOOD MANAGERS-NAME(S) 6f7 I _CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON O�)111 C9 HOME TEL# 7 HOURS OF OPERATION: Mon�Tue. ^ Wed I ; Thu./ —b Fri. / Sat. ^ ! Sun. /^ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ------------------------I--------------------I-es.s. t-h-an--- ..s.e. a-ts----------- -$--1-0---0- --------------- 25-99 seats =$150y—/ r/ more than 99 seats =$200 .............................................. .......................... ------......... ------......-- -.......... .......... ..... ---..... BED/BREAKFAST YES NO $100 --- i ........- ........ ---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Cha ter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kno n have filed all state tax returns and paid all state taxes required under the law. Si ture Date Social Security or Federal Identification Number - -------------------------------------------------------------------------------------------------------- --------------- Revisedll/03/05 FOODAP2.adm Check#&Date /D/Ql - /�_, J,'� l.—G�i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name�A I Date T of O eration s T e of Inspection MAi4dicc.S' 1' Z�'/\ o /5i a Food Service ❑ utine Address „ Risk ❑ Retail e-inspection �� ! SSE[ a �- Level f ❑ Residential Kitchen Previous Inspection Telephone 7 t1�3 �N6U / l � [1 Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation �JO,tfrl �1 4a�AK� OAt01 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: El HACCP Inspector 67/L"(v VM Out: Permit No. ElO herr 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 El3. Personnel with Infections Restricted/Excluded E] 14. Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 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 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR„ of Health. 590.000/federal Food Code. This report, when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-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 50MS,UFO/ te.orc Inspector's Signatur -Print: PIC's Signature: Print: Page of Z Pages . . ,t Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-corzaminaticn 1 590.003(A) Assignment of Responsibility* 302.11(A)(1) Raw Animal Foods Sepamated front 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods" 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-30211([1)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH other" 2 590.003(C) Responsibility of the person in chaibe to Contamination from the Environment require reporting by focal employees and 3-302.1 i(A) Food Protection- a lica nts* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Food Contact with Fquipment and Applicant To Report To The Person In Utensils* -21a]�Re* Contamination from the Consumer 590.003(G) Re oiling b Person in Char e* 3-306.14(A)(B) Returned Food and Reservice of Focal* 3 590.003(0) Exclusions and Restrictions* Nspositton of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-70LI1 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food' 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590,004(A B) Compliance with Food Law* 4-501-111 Manual Winces ashing-Hot Water 3-201.12 Food in a Flemtetically Sealed Container'" Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501..1.12 Mechanical Warewashing-Hot Water 3-202,13 Shell Eggs* Sanitization Temperatures* 3-202.14 E gs and Mitk Products,Pasteurized* 4-iO1-114 Chemical Sanitization-temp.,pH, 3-202.'16 Ice Made From Potable Drinking Water`" coneenAation and hardness. 5-101-11 Drinking Water from an Approved SvsteTn* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* cy of Equipment Food- 590.006(B) Water Meets Standards in CMR 220* Contact Surf4-602.11 Cleaning Frequency and Utensils* Shellfish and Fish From an Approved oved Souree 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Su faces 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 2-3QI-11. Clean Con3iiion- Hands and Arens* 3-202.18 Shellstock Identification Present" 2-301..12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 Wheat to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2-401.11 ._-_ Eating,Drinking or U mg Tobacco* 3202,11 PHFs Received at Proper Temperatures 2-401.12 Discharges'Frotu the Eyes,Nose and 3-202.15 Packagelnte it * Mouth* 3-101.11 Food Safe and Unadtihcrued* 3-301.12 Preventing Contamination When Tastier''* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellsttick Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em tovees* Tags/Records: Fish Products 13 Handwash Facilities 3-102.11 Parasite Desh notion' Conveniently located and Accessible 3402.12 Records.Creation and Retention* 5-203.11 Numbers andCapacities' 590.001(7) Labeling of Ingredients` 5-204.11 Location and Placemento' 7 Conformance with Approved Procedures 5-205A I Accessibility,Operation and Maintenance /HACCP Plans ISupptied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen uackaging,criteria" 6-301.11 llaudwsshnw Cleanser.Availabilit &-703-12 Confocmance wilt Ap)rovedProeedures* 6-301 12 Mand Drying Provisiim Denote,critical item in the federal 1999 Food Code or 105 CbIR 590900. CITY OF SALEM BOARD OF HEALTH Establishment Name: /' 0qj)& k Date: /41JI16 f Page: Z of Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY - AIL L"oL407evs' C4 raw rN 16&Lo JY eW&t — Nitres Otf-rlr� Y Discussion With Person in Charge: Corrective Action Required: ❑ No '- ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. ��C dI ❑ Voluntary Disposal ❑ Other: s v 3-501 J 4(C:) PHFS Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41°F/45 F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 CoolinL Methods forPHFs 14 19 Food or Color Additives PHF Hot and Cold Holding 3-202.1.2 Addra�ecK 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 41°/45°F* IS Poisonous or Toxic Substances 3-302.14 Pfrom Unapproved Additives" 3-501.16(A) Icor PHFS Maintained at or above t40'F. * 7-I01.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130`F. Containers* 7-102.11 Compton Name-WorkimyContainers* 20 Time as a Public Health Control 7-201.1 I Se anion-Stoiaee* 3-501.19 Time as a Public Health Control* ' 7-202_'11 Restriction-Presence and Use* 590,004(H) Variance Re uirement 7-202.12 Conditions of tJse* 7-203.11 Toxic containers-Prohibitions* REQUIREMENTS ION (HSP) HIGHLY SUSCEPTIBLE 7-204.11 Sanitizer's,Criteria-Chemicals" POPULATIONS(HSP) 7-204.12 Chemicals for Washine Produce, Criteria* 21 3-801-11(A) Unpasteurized Pre-packaged Juices and 7-204 .14 Dnm A*ents,Cnteria* l e4 rages with Warnme Labels* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(,3) Use,of Pasteurized EL,s* 7-206.'11. Restricted Uis Pesticides.Criteria" 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 3-801.11(C) Unopened Feard Packw,c Not Re-served. 7-206.13 Tracking Powders,Pest Control and YSonitorin** CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw. Undercooked or PHFS Not Otherwise Processed to Eliminate 3-40'1.IIA(1)(2) Eggs- 155-C15Sec. Pffihogens-*Enacm�e riv2oar P ts-Lrmredtate Service 145"F75sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.Lt(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155°F 15 sec. 'r 3-401.1l(H)(1)(2) Pork and Beef Roast-130`F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-I55'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3 401.1.1(A)(3) Poultry,Wild Game,Stuffed PHFS, residential kitchen operations should be Stuffing Containing Fish, Meat, debited ander the appropriate sections Poultr,,or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,'intactBeefSteaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under 1/29- Micnowave 165'F* Special Requirements. 3=#OL.11(A)(1)tb) All Other PHFs- 1,45°,'15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 1651E 15.sur. * - (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Sumdimn Critical and non-critical violations, which do not relate to the Time" foodborne illness interventions and risk,factars listed above, can be 3-403.11(C) Commercially Processed RTE F'uod- found in the foliowiug sections of the Food Code and 105 CMR 1401,* 590.000. 3-403.i.1(E) Remaining Unsliced Portions of BeefHem Good Retail Practices FC 590.000 Roasts* 23. Manu ement and Personne_I _ FC-2 .003 IS Proper Cooling o4 PHFS 24. Food and Food Protection_ - -FC-::-3- .004 25. ___ Equipment and Utensils _ FC 4 .005 3-501.14(A) Cooling Cooked PHFS Prom 140'F to 26. Water, Plumbing and Waste FC 5 .008 70°F Within 2 Hours and From 70'F 27, Physical Facility_____ FC--6 .007 to 41°F/451F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 _ ----------- 3-501.14(B) Cooling PHFS Made From Ambient 29. S ecial Requirement,. __ i .009 Temperature ingredients to 41`F/45°F 30 Other 1.............._-. Widrin 4 Hours'w bsanmmda,kc-ze„ '`'Dents critical item in the fcaeral 1999 Food Code or 105 CMR 590,000. Massachusetts Department of Public Health Salem Board SHealth M 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 Name Date T of 0 eration� Type of Inspection M r / /d d y Food Service ® Routine Address Risk 171 Retail (� Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephoner F1Mobile Date: �YL ZVdO ❑ Temporary ❑ Pre-operation Owner r t014 40M G74a-a 041110XA Pv HACCP YIN ❑ Caterer [I Suspect Illness In: ime E] Bed& Breakfast [I General Complaint Person in Charge(PIC)5A�� ❑HACCP Inspector 014ylo -AWe4 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 k /3 Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE m -- - TIMENEMPERATURE 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 ❑ 8. eparation/Segregation/Protection ❑20.Time As a Public Health Control V9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) , ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY i ,... ❑ 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 2 immediately or within 10 days as determined by the Board and Risk Factors (items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below 0 N# by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.0 4)) order of the Board of Health. Failure to correct violations 4. 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 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)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this or er. P q 30. Other DATE OF RE-INSPECTION: ! � d t S:5901nsp fFom -Mdoc Inspector's Signature:' Print: t PIC's Signature: Print: Page/ of-_Pages Y Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 592003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(13) DemonstratlonofKnowledge* Cooked and.RIFFoods't 2-_103.1.1 Person in char-c-duties Contamination from Raw ingredients 3-302.11(A)(2) ' Raw Animal Foods Separated frau Each EMPLOYEE HEALTH Others, 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by'focxl employees and 3-302.11(A) Food Protection- ap hcants* 3-302.15 Washing Fruits and Ire=�etables 590.003(F) Responsibility Of A Foci Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Cltarae'# Contamination from the Consumer 590.003(G) Re orpn'by Person in Char e" 3-306.14(A)Q3) Reati ned Fax]and Reservice of Food* 3 590.003(D) Exclusions and Restrictions" Disposition of Adulterated or Contaminatod 590.003(1-) Removal of Exclusions and Restrictions Food _ 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Footle 4 Food and Water From Hegutated Sources 9 Food Contact Surfaces 590.004 A-B) Com liance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201-12 ri_od in a Hermetically Sealed Container* Sanitlzation'I'am eranRes* 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashina Alit Water 3402.13 Shell E^nss Sanitization Temperatures* 3-202.14Eggs and Milk Products,Pasteurized* 4-a01.1 14 Chemical Sanitization-temp- fill, 3-202.111 Ice Made From Potable Drinking Rater" amcenhation and hardness. 5-101.11 Drinking Water from an A troved Svssem* 4-601,11(A) Equipment Fail Contact Surfaces and 590.006(A) Bottled Drinking Water" Utensils Clean" 4-60111 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 F47 '11 Frequency of Sanitization of Utensilsand 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of 131 ui ment*Shellfish* 11 Methods of Sanitization -Hot Water and 3-201.15 Molluscan Shellfish bolo NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Lgutatory Authority 2-301.11 Clean Condition-Hands and Arens" 3-202.18 Shellstock Identification Present* 2-301.12 , Cleaning Procedure'~ 590.004(C) Wild Mushrooms` 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2-=401.1] Latin . Drinkin.or Using Tohacap* 3-202.1 1 _ PHFs Received at 1''ro per Tetn erasures* 2-401.12 Discharges From the Eyes.'Nose and 3-202.15 Package Into itv+' Month* 3-101.11 Food.Safe and Unadulterated'k 3-301.12 Preventing Contamination When Tastia=s` 6 Tagstnecords:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590.004(E) Preventing Cunkamination from 3-203.12 Shellstock Identification Maintained* Em pLpvees* Handwash Facilities TagslRecords: Fish Products 13 Conveniently Located and Accessible 3-402.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.1.1 Numbers and Ca acities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,O erasion and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-30'1.11 I-landwashina Cleanser.Availabilit 8-103.12 Conformance with A raved Pmcednres" b-301.12 Hand Drn�Provision *Denotes critical Sem in the federal 1999 Pond Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: MA4- 0C£SC!r p/zZA- Date: le,)& dy Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY /3 ts�L fl�M' nt✓r4r/o s►/�ic ` `/ td+@sH f'/NA- -OWLY � C .Sr A" o/N/f'- /r Bio t4f.fiac6 ex x&eAg," car/Nd- Ifo,-- g 26 c /N fL edX 0s' id K C C rrti/u /&d a vaA 00tEIISA/S. 6/s 0400 C-e c frJ_dfa'ff 7✓ar N Wait k, /N F�O�✓ �o►SLI IV**%:- W Acc rt LfL,#410 o4" 0US r d#td d Ce vtf`r .4- 7-37 Fitto/wc! ce_g,,+Ar/ntG r/Gc dirt U- UNPA ZY G /9 fit_ PNG,�.O/�N� CoNi rfdt S 7.9 141k. 14W AV AC0_-UMtJ444-ed14 of <od,0 ryLts r-A-# c1L- � Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all con5itions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension J+ comply with all mandates of the Mass/Federal Food0.dde. I understand that noncompliance may result in daily fines of twe ty f Ilars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: l 3-50 t14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to taw Cooled to Factors(items 1-22) (Cow.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-507.15 Cooling Methods for PHFs 14 Food or Color Additives 1y PHF Hot and Cold Holding 3-50(.16(11) Cold PFIN Maintained at or below 7202.12 Additives" 590.0()4(F) 41'/45° F" 3-302.14 Protection from Una i roved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1.40°F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. * Containers" 7-102.11 Common Narne-Working Containers' 20 Time as a Public Health Control 7-201.1 1 Se oration-Storas�e" 3-501.19 Time as a Public Health Control* 590.004(H) Variance Ke uirement 7-2011.1 Restriction-Presence and Ilse* 7-202.12 Conditions of Usc* 7-203.11 Toxic Containers-Prohibitions*` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satritizers,Criteria-C.lhemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria" PF 3-801.1 I(A) Unpasteurized Pre-packaged Juices and Beverages with Wamin¢L3bels'* 7-204.14 Dtvin�A eats,Cr7teria` 3-801.17(B) Use of Pasteurized Eggs* _ 7-205.11 Incidental Food Contact.Lubricants* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 RodentBait Stations' 3_SOLll{C') Uno enol FoodPacka=eNotRe-served, 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMENEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annul Foods'l'hat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1 IA(1)(2) F).g>- 155'F 15 Sec. Pathogens.*en" ,-poi E es-Inmedtate Service 145°FlSsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell _T10 1.11(A)(2) Comminuted Fish,Meats Fc Game E 1s Animals- 155'F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Raines,Injected Meats-155°F 'i5 590009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food, temporary and 3-401.1.1(A,)(3) Poultry,Wild Game, Stuffed PIFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultr-or Ratites-165�F 15 sec. * above if related to foodhorne illness 3-401.11(C)(3) Wlaole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal,Foods Caked in a practices should be debited under#29-- Microwave 165'F* Special Requirements. 3-401.11(A)(I)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.13(0& D) PHFs 165°F 15 sec. (Items 23-30) 3-403.11{B} Microwave-165°F 2 iLTinute;Standing Critical and non-critical violrrlions, which do not relate io the Time* foodborne illness interventions and risk factors fisted above can be 3-403.11(C) Commerciaily Processed RTE Food- found in rhe following,sections of the Food Code and 105 CMR 140'F* .590.000. 3-403.1.1(F..) Remaining Unsliced I'ortians of Beef item Good Retail Pract ces FC S80 000 Roasts* 23. Mang ement and Personnel_ - FC-2 .003 18 Proper Cooling of PHFs _24. Food and Food Protection FC-3 .004 25 __Equipment and Utensils __ FC 4 .005 3-501.14(A) Calling Cooked i'HFs from 140`F to 26 Water.Plumbing and Waste FC 5 006 70'F Within 2 Hours and From 70°F 27. --Physical Facility FC-6 .007 ut 41'F/45'F Within 4 Hours_'" 28. Poisonous or Toxic Materials FC-7 .008 3 501.14(B) Cooling PHFs Made From Ambient 29 Specia Requirements 009 Temperature'lugredients to 41 F,/45"F ,_30_____ Other _) _ Within 4 Hours* Denotes critical item in the federal 1999 Food Cod,,or I M CMR 590,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: rpt ia/Y�/s 4'r P/ZZ,n Date: l0�5116V Page:_5 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY mm lt4 0 Pf Nsirro e� /rte. o JSr, a w,4 ce< oe VA//r lotd4a. s r /S / ,s PbfiS.r I ' PSA+N tmw sN A-p/r P.r L �tF i"b 6A-r Foa4S tf/Js .r 6R�3e�r� /✓ �fMs6 I "t a r Discussion With Person in Charge: Corrective Action Required: LlNo ❑ Yes t I I have read this report, have the opportunity to ask questions and to ntary Compliance 0 Employee iiition F violations before the next in the Mass/Federal al Food conditions as dtandbhaeand Correct all ❑ Re-inspection Scheduled ❑ Emergency Suspension t comply with all S noncompliance may result in daily fines o7ft fiv tlars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 1-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41°F45`FWithin 4 Hours. PROTECTION FROM CHEMICALS 3-50'115 Coaling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501 16(B) Cold PHFs Maintained at or below 3-202.12 Additives*s* 3-3(Y114 Protection front Una>>rovedAdditives* 590.004(F) 4P/45°F" 15 Poisonous or Toxic Substances 3-501 16(A) /lot PI-IFs Maintained at or above 140°F. * 7-101.11 Identifying Information-Original 3-501.16(A) I Roasts Held at or above I'AWP. Camtainers" y0 Time as a Public Health Control 7-102.11 Common Nemo-Working Containers" I, 7-201.11 Separation-Suattee" 3-501.'19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* S90.004(H) VarianceRequirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Sanitizeis.Cc3teria-Chemicals' -- 7-204.12 Chemicals for Washine Produce,Criteria* 21 3-801.1 I(A) Unpasteurized Pte-packaged Juices and Beverages with Warning Labels^ 7-204.14 Dt m3 A eats,Criteria* 3-901,11(}3) Use of Pasteurized ELLS* 7-205.11 Incidental Food Contact, Lubric nls' 3-801.1 l(D) Raw or Partially C.Not Animal Poo<t and 7'206.11 Restricted Use Pesticides.Criteria` Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations` 3-901.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME7TEMPERATURE CONTROLS 22 3 E 03.1 t Consumer Advisory Posted for Consumption of 16 Anbnal Foods That are Raw.Undercooked or Proper Cooking Temperatures for PHFs _ Not Otherwise Processed to Eliminate 3-40'1-1.lA(1)(2) Eggs 155'F 15 Sec. Path2E2 * E'L ' -zrnr E des hrvuedrate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(X)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155"17 15 sec.* 3-401.11(B)(1)(2) Pork and Beef Roast - 130".F 121 min* SPECIAL REQUIREMENTS _ 3-401.11(A)(2) Ratites, Injected Meats- 155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PFIFs, residential kitchen operations should be Stuffing,Containing Fish, Meat, debited under the appropriate sections Poultr,or Kat�5 sec. * above if related to foodborne illness 3-401.11(C)(3) Whale-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Ccxrked in a practices should be debited under 9129- Microwave Itis°F. Special Requirements. 3-401.11(A)(1)(b) All Other PFIFs- 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.I](A)&(I)) PUFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can he 3-403.11(C) Commercially Processed RTE Food- found in theJ677oerirng sections of the Food Code and 105 CAIR 14W17, 590.000. 3 401 11(B) Remaining Unsliced Portions of Beef item Good Retafl Practices FC bS0.0A0 Roasts* 23. Management and PersonnelF,C-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection __ FC-3 .004 25 _ Equipment and Utensils FC-4 .005 3-501.14(.6) Cooling Cooked PHFs front 140'F to 26 _ Wer,Plumbin and Wasie atFC-S .006 70°F Wlthnr 2llours and Froin-70'F 27- Physical Facility FC 7 6 1 .207-- to 07 _to 41°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Coofing PHFs Made From Ambient 29. S aeial R ulremenis .009 Temperature Ingredients to 41°F/45°F 30._____ ,-- Within 4 Hours'r '.5r1n,,,na:e.zvo, Denotes critical item in Qra federal 1999 1ood Code or 105 CNIR 590.000- Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'h Floor ' Division of Food and Drugs Salem, MA 01970-3523 ., • `,E' FOOD ESTABLISHMENT-INSPECTION REPORTA T I. (978) 741-1800 Fax (978) 745-0343 Name Date a of O eration s Type of Ins ection. �r r S /22cP y n Food Service ,y�/R6utine Address D9 G Risk El Retail Wy e-inspection SGX S/ Level ❑ Residential Kitchen Previous Inspection Telephone ,', g41S_ G</OG /tj F-1 Mobile Date:3-31-6fL Owner HACCP Y/N ❑ Temporary El Pre-operation �7D�f ✓ nUcKo D GGS ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) .4 MS Time ❑ Bed& Breakfast ❑ General Complaint. El HACCP Inspector O Permit No. ❑ Other-_J/ �s.QWP�/�C�NrI V �/: /k.,�GO 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 ,F ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties fCJ 13. Handwash Facilities EMPLOYEEHEALTH ,„ -' ' --_4 PROTECTION FROM CHEMICALS e E] 2.2. Reporting of Diseases by Food Employee and PIC11 -- ❑ 3. Personnel with Infections Restricted/Excluded E] 14. Approved Food or Color Additives FOOD FROM.APPROVED SOURCE ❑ 15.Toxic Chemicals El '�TIMErrEMPERATURECONTROLS 4. Food and Water from Approved Source i (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 t PROTECTION FROM CONTAMINATION " `- '"i El19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing E_REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices ',,,CONSUMER ADVISORY_- W .) ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions �G 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 Boartoday, the items checked indicate violations of 105 CMR-C earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(550.003) by a Board of Health member or its agent constitutes an 4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-4)(590.005) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.005) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you ✓ 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:S901n dFom 14tlo in ecto 's Sr ature• iJJ Print: pp PIC'sSi nature: Prmt�Tq W Yo 0/ �� Page-LofZ- Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.1l(A)(1) Raw Animal hoods Separated from 590.003(B)_ Demonstration of Knowledge* Coked and RTE Foods* 2-103 I 1 Person in charge-duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foals Separated from Tacb EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1l(A) Food Protection* applicants* 3-302.15 Washing Fmu is and Vegetables 590.003(17) Responsibility Of A Fool Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In - Utensils* Charge* Contamination from the Consumer 590.003(6) Re porting by Person in ChargO 3-306.14(A)(B) Returned Food and Reserviee of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F) I Removal of Exclusions and Restrict ons Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(0-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water Sanitization Tem erahnes* 3-20112 Food in a Hermetically Scaled Container* 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 She1I Eggs* - - Sanitization Temperatures* 3-202.14 F.Us and Milk Products.Pasteurized* 4-501.11.4 Chemical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness s 5-101.1.1 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 1. Bottled DrinkingWater* Utensils Clean* 4-Fi02.1 L Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 3 t0 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-20114 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical" Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms" Requlatory Authority 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* Il Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco" 3'202.11, PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity- Mouth* 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tasting* b Tags/Records:Shellstock 92 Prevention of Contamination from Hands 3-20118 Shellstock Identification * 590.004(E) preventing Contamination from 3-203.12 Shellstock Identification Maintained'" Ha douses* Tags/Records: Fish Products 13 Conveniently Facilities Conveniently Locafed and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Ca acities* 3-402.12 Records,Creation and Retention" 590.0(}1(,)) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibili .Oseratimr and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3 502.12 Reduced oxygen tacka 'ng-criteria* 6-301.11 Handwashin Cleanser,Availability 8-10312 Conformance with A. roved Procedures* 6-301.1.2 Hand Drying Provision Denotes critical item in the Wert] 1999 Food Cote or 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name nPc hS1 2-/O Date. ,9 q Page: c of ''- nem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ' No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 13 U o T / Z19d /S e .PJ -e�. -'t/ / C 7-eP f Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance ❑ Employee Restriction/ s 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 CA-e. I understand that noncompliance may result in daily fine ent 611ars or suspension/revocation of L] Embargo ❑ Emergency closure r your food permit. LIVoluntary Disposal ❑ Other: F � / 3-501.14(C,) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to Law Coaled to Factors(Items 1-22) (Cont.) _ 41"F/45'F Within 4 Hours, PROTECTION FROM CHEMICALS 3-501,15 Cciolinx IMedulds for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(B) Cold PI1Fs Maintained at or below 3-202.12 Additives* 590.004(F) 41"(45°F* 3-302.14 Protection from Unar rived Additives* 3-501.16(A) [lot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140°F.* 7-101.11 Identifying Information-Original 3-50L16(A) Roasts Held at.o,above I30`F. Containers* 7-102.11 Common Name--Working Containers' 20 Time as a Public Health Control 7?Ol.11 Separation-Stora e" 3-501.1.9 Time as a Public Health Control* 7-202.11 Restriction-Presence and Ilse' 590.004(H) Variance Requirement 7-202.12 Conditions of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Cinttainers-Prohibitions* 7-204.11 Sanitizers.Criteria-Chemicals POPULATIONS HSP 7-204.12 Chemicals for Washing Produce-Criteria* 21. 3-80111(.0) Unpaskwrirx:d Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Davina Agents,Cuter t` 3-801.11(B) Use of Pasteurized Ea-s* 7-105 11 Incidental Food Contact,Lubricants* 3-SQL 11(D) Rau or Partially Cooked Animal Food and 7-20Ci.11 Restricted Use Pesticides,Criteria Raw Seed S xrouts Not Served. 7-206.12 TraRodci g Po Stations* 3-801.11(C) Unopened Food Package Not Re-served. " 7-20fi.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY _ TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Faxls,rhat are Raw. Undercooked or PHFs Not Othentidse Processed to Eliatinate 3-401.11.0(1)(2) Rs,gti 155'F IS Sec Pathogens Eggs-Immediate Service 145`F1.5sec* 3-30213 Pasteurized Eggs Substitute for, Raw Shell 3-401.1 t(A)(2) Comminuted Fish.Meats&Game Animals- 155�F 15 sec.* 3-401.11(B)(1)(2) Pat andBcefRoast- 130°F 121 infix SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,htjected Meats- 155'F 15 590-009(A)-(D) Violations of Section 590.009(A)-(D)in sec . catering, mobilee f'Wd, temporary and 3-401.11(A)(3) Poulhy,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Ment, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. above if related to foodboit ne illness 3-901.1 t(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factor's'. Other 145"F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#79- Microwave 165'F Special Requirements. 3-401.1l(A)(1)(b) All Other PHFs--145'F 15 sec. " 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 I(A)&(D) PHF, 165°F 15 sec. *= (Items 23-30) 3-403.11(B) Microwave-165'F 2Minute Standing Critical and non-critical violations, chick do not relate to the Tithe* ,foodborne illness interventions and risk facama fisted above, cae he 3-403.11(C) Commercially Processed R'PE Food- ,found in the following sections of the Food Cotte and 105 CA9R 140'F' 590.000. 3-403A 1(E) Remaining Unslic:ed Portions of,Beef Item Good Retail Practices FC 590.000 Roasts*` 1 It Pfanagomenl and Personnel FC-2 003 24 Food and Food Proteot+on FC-3 004 ' Lo Proper Cooling of PHFs (- --- - -- + 25 E m meat and Utensils ___ FC 4 005 3-501.14(.0) Cooling Cooked P}{Fs from 140°F to 26. Water.Plumbin and Waste i FC-5 .006 1 70'F Within 2 Hours and From 70'F 127. 1 Physical Facility 1 FC-6 .007 to 4'1'17/45'F Within 4 Hours. * 128. Poisonous or Toxic Materials ( FC-7 .008 3-501.,14(B) Cooling PIFs Made From Ambient 29 Special Requirements _ .009 Temperature Ingredients to 4PF/45'F L30. Other -- - -- Within 4 Hours* ' 'Denotes cat icxt item in the rederel 1999 Food Codc of 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs ;•. Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvde of Operation(s) Twfe of Inspection eve S R2=2 3. 3/ dY F1 Food Service LvJ Routine Address OS _SS f f Risk El Retail ❑ Re-inspection-I/-IA-' Telephone LeveElResidential Kitchen Previous Inspection 998) 7 - l 6gOd ❑ Mobile Date:)/-6-03 Owner HACCP YIN ❑ Temporary ❑ Pre-operation l N Y�On�O U r/O ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint t e 1n: ElHACCP Inspector 7�to i ,ra,/lair-r /r/1%/iiaS /is Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT •,,, .. ❑� �12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties 3. Handwash Facilities EMPLOYEE HEALTH " "' ` `.- (pJ 1 4'PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC iEl14.Approved Food or Color Additives f ❑ 3. Personnel with Infections Restricted/Excluded ` FOOD FROM APPROVED SOURCE n_' E] 15.Toxic Chemicals IJ E] 4. Food and Water from Approved Source -TIMErrEMPERATURE CONTROLS(Potentially Haiiardous Foods) `" E] 5. Receiving/Condition ❑ 16. Cooking Temperatures fi i ❑ 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 V9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) F-1 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP El 11. ADVISORY 11. Good Hygienic Practices _ .......... LL� it El22. Posting of Consumer Advisories P, 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 C ealNth. 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 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 / �93rder. 30. Other DATE OF RE-INSPECTION: l/ /7 o� p S5: Inspe Wom -14 X // 1 A or's 'gi ay r r Print: K_v N Wil, /rR//r/r�•IY,/✓.: PIC's Signature, Print: Page of-3Pages W, Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT K Cross-contaminaton 1 590.003(A) Assi u amt of RespomtbiIity* 3-30211(A)(1) Raw Animal Foods Separated from 590.003{B} Demonstration of Knouledgel` Cooked and RTE Foods* 2-1 f)3.11 Person m charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Cather* 2 590.003(C) Responsibility of the-person incharge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* a rlicauts* 3-302.15 WashitiFruits and Vegetables 590.003fF) Responsibility Of A Food Employee Or An 3-344.11 Food Contact with Equipment and Applicant To Report To The Person ht Utensils* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reser'cice of Food* 3 590.003(D) Exclusions andRcstrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclasions and Restrictions Food 3-701.1 t Discarding or Recouditionh:g Unsafe FOOD FROM APPROVED SOURCE Ftea 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Cornrliance with Food Law* 4-501.111 Manual Warewashine-Hot Rater 3-201,12 Food in a Hermetically Sealed Containers` Sanitization Tem�erahnes* 3-201.13 Fluid Milk and Milk Pioducts* 4-501.112 Mechtmieai Warewashin;-Hot Watei 3-202.13 Shell E-s* Sanitization Tem eratures* 3-202.14 E is and Milk Products,Pasteurized* 4-501..114 Chemical Samtiration-temp., pH, 3-202.16 Iee Made From Potable DrinkinaWater* concentration and hardness 5-10111 DrinkingWater S(,)in an Approved System 4-60L 11(A) Equipment Food Contact Surfaces and Utensils C1een* 590.006(A) Bottled Drinking Water 4-602.11 Cleaning Frequency of Equipment Food- 590,006(B) Water Meets Standards in 310 CMR 22.01Contact Smfaces and Utensils* SheN/ish and Fish From an Approvsd Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 11 Methods of Satritization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed 4-703. Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2.301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301-14 When to Wash* 3-201.17 Game Animals* Vi Good Hygienic Practices g Receiving/Condition 2-401.11 Eatin ,D nk n or Usin Tobacco"' 3-202.11 PI-Ws Received at Proper Temperatures 2401.12 Discharges From the Eyes, Nose and 3-202.1.5 Packin,e Ince rit�* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin 1` 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Comaniination from 3-20112 She]Istoek Ide_nti fication Maintained" EmMcNees* Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3-402.11 Parasite Destruction* �� * 3-402.12 Records.Creation and Retention* 5203.11 numbers and Capacities 0 5)0.004(1) Labeling of Ingredients5-204.11 Location and Placement*" 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialiMl Processing Mcthafs* Devices 3-502.12 Reduced oxygen packa he.criteria" 6-301.11 Handwashin Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand D dug Provision " Denotes critical item in the feera11999 Ponta Cale or 105 COIR 590,000- CITY OF SALEM n BOARD OF HEALTH Establishment Name: Date: Page: Of `3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 6U-h.Pa �oa )Pt't�/ e /.✓ ,O�C/ld'�7 iLd �le r✓Gl, si ��. � — CLr! irn.S ^✓ Siyk �n '_ /. L P ' '-� ,Gt°u.(Js//(4/ CJ�7 i ar A.vr,� — �P,O.C/C e- '5W(/X"' Sf7!/^✓Pt /1Pf rt dC e. Y P Oi1j2P�! OL 7c%vp ovForz i✓E l G?r'P.t°S. eo 9, ov7' c# 127 a 7 - �pr - ✓sig li.v�i 7Ji7,f o;PSPd 6,1 4(xs 7 -PCS 02 J�9rJ9 �u(f7/N[' �PPr�S `tYJO.FOdCi /' lfin/�/ of — �LGAQ/mss Ct'EGCr / (1 h 7�kGC r/,2P iJPP/�S Gtcya C �av7rn/9 i✓ E5ke'6a/K— Ae OGS / �S - .17eGFiel� �/tii-f- PPc/S q �v y� i S � /7P.Prrldr�eZe,� OS "--DarLr/ is /i l? �Pii�i�l7 P� - ®' at cue. GGDc / ✓ tea/ !(�, ,a /tiSi��c sr sr�r nuu e A& SrL�fi ,e 6 a-Yiok c" 5r e aky '4'0-1 !n 8e /&SPd / g /3 61C e La6rG Az'cD✓e. eowlr,�l c A/�k E t i "r Discussion With Person in Charge: Corrective Action Required:, ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ 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. j� ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Tdntperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41"F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling;Methods'for PHFs - - --- I9 PHF Hot and Cold Holding 1q Food or Color Additives 3-202.12 Additives,* 3-501 lo(B) Cold Pill-s Maintained it or below 3-302.14 Protection from Unaepioved Additives* 590.004(F) 41"/45°F; 1,5 Poisonous or Toxic Substances 3-501.16(A) Hot PIJFs Maintained at or above 1401,. 7-101.1 I I ontain ng Information-Orifi nal 1-501.16(A) Roasts Held at or above 130'F. Containers,* 7-102.11 Common:flame-Working Containers* 20 Time as a Public Health Control 7-201.11 Se.ara6on-5ta�a e* 3-501.19 Time as a Public Health Control*' 7-202.11 Restriction-Presence and Use" 590.004(H) Variance Rec uirement 7-202.12 Conditions of Use- 70203,11 se*7203.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.1' Chemicals for Washing Produce_Criteria* 21 3-80'1.1I(A) Unpasteurizecd Pre-packaged Juices and Beverages with Warning Labels* 7-205.14 Dr Ina al Fos. ContaCriterin* 3-901.11(B) Use of Pasteurized E-Os* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted B Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 7-20612 Rodent Bait Stations* 3-801.11(() Unopened Food Package Not Re-served *" 7-206.13 Tracking Powders,Pest Contra)and Momtarut CONSUMER ADVISORY _ TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'Phat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs 155'F 15 Sec. Pathogens,*r ' a¢oor E� s-Immediate Service 145QFI 5sec* 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3 401.11(A)(2) Cotmninuted Fish.Meats&Game Lms* Animals- 155'F 15 sec. * 3-401.11(8)(1)(2) Pork and Beef Roast-130'F 1.21 mitt SPECIAL REQUIREMENTS 3-401.A I(A)(2) Ratites, Injected Meats- I55'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(I)) in sec-* catering, mobile food,temporary and 3-401.11.(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-1651,15 sec. * above if related to foodborne illness 3-401.11(()(3) Whole-muscle-Intact Beef Steaks interventions and risk factors. Other 145`F" 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under;#29- Microwave 165'F* Special Requirements. 3-401.11(A)0)(b) All Other PHFs - 145''F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A I(A)&(D) PFIFs 1651E 15 sec. * (Items 23-30) 3-40111(B) Microwave-165°F 2 Minute Shardin.g Critical and non-critical violations, which do not relate to the Tinto* foodborne illness interventions and risk factors listed above, can be 3-103.1.1(C) Commercially Processed RT'E Food- found in the following sections of the Food Code and 105 CMR 1401F* 590.000. 3-403.11(E) Retraining Ureficed Portions of Beef Item Good Retail Practices FC 580.000 Roasts* aa Management and PersonnelFC-2 .003 24, Food and Food Protection FC-3 .004 1g Proper Cooling of PHFs -- -- -- - --- �I 25 E�ment and Utensils _ I FC 4 .005 3-501 14(A) Cooling Cooked PHFs 26 Water Plumbing and Waste tram 140'F to - - - - t-FC'" .006 -5 70'F Within 2 Hours and From 70'F 27. Physical Facility i FC-6 .007 to 41'BJ45'F Within 4 Hours. * 28. Poisonous or Toxic Materials I FC--7 .008 -- 3-501.14(8) Cooling PHFs Made From Ambient 29 S ectal Requirements .009 TemperaYun Cngredients to 41°,145°F . 30 Other _ _ :-___.--_. -------- -----. Within 4 Hours* Denote,critical item in the federal 7999 Ppod Cate or 103 CMR 590 000. CITY OF SALEM BOARD OF HEALTH Establishment Name: I-e S , =2rz Date: 3- 31-oil Page: 3 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 4 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY `, kt Z — ZV1 Ge� J 11/ a<Os Y/G/v "C/u L121/9( vs &Skl' 0.2p / ,Y P J ve T 6&0.P/'( ;r NO .PP an,V fie Alrl'(/O 6-35 ACQCP, o t- ra ybe' ' creme D s q i +s .Pn'J! nJnj 7o..tl T�,PMI ry e X od s 'x gafFddPs ffez De G1 -7iss✓e- C?X L. ( / V '62,4,5 //t CPicc c¢..-' Q�P'r/nS o.E•y �,Ivea T L T 1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes / EEE I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension ' comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines off twenty-five dollars nsion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. N ❑ Voluntary,Disposal ElOther: 3-501.14(C) PHFs Received at:Idmperatures Violations Related to Foodborne Illness Interventions and Risk According to'law Cooled to Factors(Items 1.22) (Cont.} 41°17145°F Within 4 Hours, PROTECTION FROM CHEMICALS3-501.15 Coolie Methods for PIFs 14 Food or Color Additives 19 PHF Hot and Cold Holding - - - --- 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives r 590.004(F) 41°/45°F* 3-302.14 Protection frotn Unapproved ddnrocs* 3-501.16(A) Hot PI-IFs Maintained at w>above 15 Poisonous or Toxic Substances 140°F. * 7-101.11 Identifying infarmtttion-Orilrinal 3-501.16(A) Roasts Held at or above 130'F. Containers"` 7-102.1 I Common Name-Working Containers"' 20 Time as a Public Health Control 3-501.19 Timeas a Public Health Control*7 20111 Separation-Storage* 7-20211 Restriction-Presence and Use" 590.004(H) VarianceReduirettwnt 7-202.12 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 Toxic Containers-Prohibitions* 7-204.11 Saniti7.ers.Coterie-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning labels"' 7-204.14 Diving Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.I1 Incidental Food Contact,Lubricants* 3-8U1.1.1(D) Raw or Partially Cooked Animal Fond and 7-206.11 Restricted Use Pesticides,Criteria" Raw Seed S routs Nitt Served. 7-206.12 Rodent Bait Stations'* 3-801-II(C) ileo.coed Food Package No[Re-serval. 7-206.13 'tracking Powders, Pest Control azul Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal F'oods'Ihat are Raw. Undercooked or 1G Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Fgss- 155715 See. Padtogens a er"'1?101 L s-Immediate Service]45°F 15seck 1-302.13 Pasteurized Fgbs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Esc gg'* Animals- I s5'F 15 sec. " 3-401.118)(1)(2) Pork and Beef Roast- 130`F 121 mut* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-([)) Violations of Section 59(.).009(A)-(D)in sm * catering,mobile food, temporary and 3-40t.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential.kitchen operations should be Stuffier Contauung Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.1t(C)(3) Whole-muscle,intact BeefSteak3 interventions and risk factors. Other 450E 4 590.009 violations relating to,,()oil retail 3-401.12 Raw Animal Foods C(x)ked in a practices should be debited under##29- Mticrowave 165'F* Special Requirements. 3-401.1 UA)(I)(b) All Other PRFs----145FF 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PRFs 165'F 15 sec. - (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute St'aru int, Critical and non-critical violations, which do not relate to the 'tune* foodborne illness interventions and risk factors listed abave, can he 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code.and 105 C,VIR 14WF` 590.000. 3-40-3 11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.090 _Manment and Personnel FC- age2 .003 24 Food and Food Protection ' FC-3 .004 1g Proper Cooling of PHFs 1 ------E- --- ----- 25. uipment and U_tenstls _FC 4 .0055 3-501.14(A) Cooling Cooked PHFs from 140°F to 26 Water Plumbinq and Waste QFC 5 .006 70'F Within 2 Hours and From 70'F 27. Physical FacilityFC-6 _007 to 41'F145'F Within 4 Hours. * 28. __Poisonous or Toxic Materials FC-7 .008 3501.14(6) Cooling PHFs Made From Ambient 29. __ _Oth�erecial Requirements Temperature 1ngtedienLs 30 to 41°F/45'F Within 4 Hours* "Denotes critical item In thetedernl 1999 Fawd Cale or 105 CMR 590.0011. e - Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4tb Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT f Tel. (978) 741-1800 Fax(978) 745-0343 N\amme Date T s e of O eration Type of Inspection 1 L�- 0- Food Service Routine ) Address vs C p Risk Retail KRe-inspection v Level ❑ Residential Kitchen Previous Inspection Telephone �] /� I _ �o�( "'t 1 lU El Mobile Date: OwnerHACCP YM ❑ Temporary ElPre-operation Nt. 2 \a�U 0 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) 0 wv� Time ElBed&Breakfast ElGeneral Complaint Inspector µ� �� . Iy 14� Permit No. ❑Other HACCP Each violation checked requires an ekolanation on the narrative page(s) and a citation of specific provision(s)violated. t 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) R action as determined by the Board of Health. �l n 4� L j), l�-rJ�-�1 G{(�)�l�171 FOOD PROTECTION MANAGEMENT__ _ ❑ 12. Prevention of Contamination fro Wands -t- 0ri Y PIC Assigned/Knowledgeable/Duties �'` --- El_ 13. Handwash Facilities �MPLOYEE HEALTH _ .. PROTECTION FROM CHEMICALS �_❑"_2'-_�eporting of Diseases by Food Employee and PIC "e ❑ 14.Approved Food or Color Additives ❑ 3gPersonnel with Infections Restricted/Excluded El15.Toxic Chemicals FOOD FROM APPROVED SOURCEx.>�-""'I ❑ d a 4. Foond Water from Approved Source TIME/TEMPERATURE CONTROLS_(Potentially_Hazardous F_o_ods)_ ❑;5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ,[]_7. Conformance with Approved Procedures CP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION * _ El19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection F ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing rREQUIREMENTS FO 0 R HIGHLY SUSCEPTIBLE POPULATIONS(HSP) vv El 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP �i ❑ 11. Good Hygienic Practices CONSUMER ADVISORY r[ 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 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 O 25. Equipment and Utensils i (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:590InapecfFomKl4.tloc V o /rb9 rM�r - \ i�t/)� Lr✓ Inspector's Signature: int' V)(7 hkA PIC's Signature: PrintT-dn tY u a ej -Pageof �4ages F t 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-30111(A)(]) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Folds* 590.003(6) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11. Person in charge-duties 3-302.1l(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(0) Responsibility of the person in charge to 4-302.)1(A) Fowl Protection* require reporting by food employees and 3-302.15 1 Washing Fruits and Vegetables applicants* 3-304.11. Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An * Applicant To Report To The Person In Utensils Contamination from the Consumer Charge* 3-306.14(A)(B) Refurned Food and Reser-vice of Food* 590.003 G) Ke ortin b Person in Chv>e* Disposition of Adulterated or Contaminated- 3, 590.003(D) Exclusions and Restrictions* Food 590,003(E) Removal of Exclusions and Restrictions 3-70L I I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law'' 4-501.1.11. Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Teu eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202..13 Shell Eggs* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products.Pasteurized'* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.1.1 Dri AmE Water from an Approved System-tem- 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.04' 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source 4-70211Contact Surfaces and Utensils* . 3-201.14 Fish and Recreationally Caught Molluscan Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Shellfish* Food Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 30 Proper,Adequate Handwashing Regulatory Authority Game and MidMushroomsooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Presem* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Usi22 Tobacco* 3-202.11 PHFs Received at Proper Tem eratures* 7401.12 Discharges From the Eyes,Nose and 3-202.15 Package rote it V* Mouth* 3-10L11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.1.2 Shellstockldentification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently located and Accessible 3-402.12 Records.Creation and Retention* 5-20.3.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients= 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. S ecializad Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand D Provision 'Denotes critical item in the tedend 1999 Foal Cage or 105 CMR 590.006. zrv1,) Y u U SC `rV'01 \ 42 Zv� ire �6UA QtiC8 A2A' I CITY OF SALEM r BOARD OF HEALTH Establishment Name: M Y Date: - - Page: of Rem Code C-Critical Item DESCRIPTION OF VIPOLATION/PLAN OF CORRECTION Date- No. Reference R-Red Rem Verified ��,tt p r� / LEASEP(nRINTCLEARLY 01 oI � tatzYD�� - Vn'(( )fir 51 1 L 9 � , ti /)1 \ U 04 n za �`{'m o 14 6 C) I .,�S d - 4L50Al o (AL JT u U n�ff C.,(A ,ills �_ (:0, Q l V ,t. ,� C" 1 ZZ C� �17,t" �. IP XA.O \ Y\ /YU.� V (.v/iV� ,�.(.r �P UXSO�CL br, AaA ", CJ T i ( of CM;t. t'-. �-AUDY D�L� S-E ULfivr dS� lJr) i / p,, �.p 21�Y( �� ,1a. [�.uzX 1�VIX.d Discussion With Person in Charge: U / Oorreetive Action Required: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and toExclusion Cd' Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal ood Cod . understand that noncompliance may result in daily fines of twLs-rit fiv dol r or suspension/revocation of o Embargo ❑ Emergency Closure your food permit. C ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness interventions and Risk According to law Cooled to Factors(terns 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 - Food or Color Additives 19 PHF Hot and Cold Holding --- 3-501.16($) Cold PHFs Maintained at or below 3,202.12 Additives* 590.004(F) 4i'/45'F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501;16(A) Hot PHFs Maintained at or above I40°F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 7-102.11. Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storae* 3-501,19 Time as a Public Health Control* 7-202.11 .Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 ToxicContainers-Prohibitions* 7-204.11 Sanitizes.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for WashingProduce.Criteria° 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 d encs.Criteria* 3-801.11(8) Use of Pasteurized Eggs* 7-205.11 incidental Food ContaPesticides, ,urticants* 3-801.11('D) Raw or Partially Cooked Animal Food and 7-206.11 -Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.11(C) Uno ned Food Packa Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of 16 Proper Cooking temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate Path 340i.11A(1)(2) Eggs- 155F 15 Sec. Pathogens.* Eggs-Immediate Service 145'F15sec* 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec. * 3401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section.590.009(A)-(D)in sec.* catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Paul or Ratites-165'F 15 sec. * above if related to foodborne illness 3401 AI(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145'F i° 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3401:11(A)(1)(b) All Other PHFs- 145'F 15 see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A 1(A)&(D) "PHFs 165F 15 sec.* (Items 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing Criticaland non-critical violations,which do not relate to the - Time* foodborne illness interventions and riskfactors listed above, carr be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400P 590.000. 3403.11(E) - Remaining Unsliced Portions of Beef - It Good Retail Practices .FC 590.000 Roasts* 23. Management and Personnel =FC-2 .003 .I Ig Proper Cooling of PHFs 24. Food an5Fo�od otection FC-325. E ui mieensils FC-4 R053501.14(A) Cooling Cooked PHFs from 140'F to 26. Water.Pand Waste FC-5 .006 70'F Within 2 Hous and From 70'F 27. Ph sisalto 41°F/45'F Within 4 Hours. * " 29. Poisonoc Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ectal etts .003 Temperature Ingredients to 41'F/45'F L 30- 1 Other _ Within 4 Hcxvs* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. � 13''�«.r�','�+�4.'ra.=,��-Se'Yi�i.ntssaw+nns''`y�.+�.�:�'".�t.7},er-.IS;„:�w�,reiran-.e�,..�+sna�„� �nl':.r .,,d*.t•r-.i..;Kv��"".hk+.•.. � 1 ,Massachusetts Department of Public Health ;,., Salem Board of Health 120 Washington Street,4 th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800°Fax (978) 745-0343 - Name AD , �F Date Type of 0 eration(s) Type of Inspection f/ /l� - i -D Food Service L rRoutine Address)_hk �ia�PA� l Risk C] Retail Ea Re-inspection _ Level ❑ Residential Kitchen Previous Inspection Telephone /� l l' n ��DO ❑ Mobile Date: HACCP YIN ❑ Temporary ❑ Pre-operation Owner U Q� i� M �� ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) U Time ❑ Bed&Breakfast ❑ General Complaint J �l Ply. In:i 15 p- ❑ HACCP Inspector �j Z�A�At�� / �/ Out: i d�( 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) p action as determined by the Board of Health. FOOD PROTECTION MAN/1GEMENTM_,_1--T"'_ u® ,6 _@m) El 12. Prevention of Contamination from Hands C ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH jly m,.PROTECTIGNFRGM CHEMICAL$ ij1,041 j ❑ 2. Reporting of Diseases by Food Employee and PIC �� " .� ..» �� s,= ��a'= -• El 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 111 15.Toxic Chemicals � ".� w� Cad' dare. ivi was G;wt m'" FOQD FROM APPROVED SOURCE 3 :b„tea �r� r.;.. ".TIMEIfEMPERATURE CQNTROLS Poterteall Haler pus Fgilds 5j-o ❑ 4_ Food and Water from Approved Source Ld-li� „ iA 7gL. ( »up - Yr ."d ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑•6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION " 27 El 19. Hot and Cold Holding [18. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control P - 1 REOUIREHIENTS FOR HIGHLYSUSCEPTIBLE POPULATIONS'(HShj„®@ 9. Food Contact Surfaces Cleaning and Sanitizing El 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ®"CONSUMER ADVISORY' „•a -"�;� ❑ 11. Good Hygienic Practices �j ao. I 22. Posting of Consumer Advisones 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 �s' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.090.0 044))) 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)(59o.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,5801nspecfFom 14.d. Inspector's Signature:; Print: ri h bi P, PIC's Signature: _ // (\ Print: flPage of Pages v - e'- Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT_ 8 Crass-contamination 1 I 590.003(A) I Assignment of Responsibility* 3-302.1](A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590:003(,C) 1,11,11s'Pquire eonsibility of the person in charge to Contamination from the Environment reporting by food employees and 3-302.11(A) Food Protection* licamts* 3-302.1 ..Washing Fruits and Vegetables 590,003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge` 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures- 3-20 en eratures*3-20 L 13 Fluid Milk and Milk Products* 4-501112 Mechanical Warewashing-Riot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-501,114 Chemical Sanitization-temp.,PH, 3-20216 Ice Made From Potable Drinkin.-Water* concentration and hardness. * 5-101.11 DrinkingWater from an-A roved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0` 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* ShelNish 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 Reaulatory Authorit 2301.11 Clean Condition-Hands nn and Asi` 3-202.18 Shellstock Identification Present* 2-301._1.2 Cieanim,Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* t.1 Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202,15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records;Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacifies* Labeling of Ingredients* 5-204.1.1 I-ocation and Placement* 590.004(1} 9 g Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance 7 /HACCP Plans - Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Hindwashing Cleanser,Availabilit 8-103.12 Conformance with Approved Procedures* 6-301,t2 Hand Dr ins Provision *Denotes critical item in the federal 1999 Faxl Code or 105 CMR 5901W. CITY OF SALEM , i BOARD OF HEALTH I U Establishment Namei-�M\�i n , P o n Date: it L7—In Page:_ of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item PLEA\SE,,PRINT CLEARLY \ I � _igOA , A �e.c .Qo, YG . 11e —,��1a1 O r, Von,.�c�il Lo di Ll X v u _ lkll#A e ( d d In 6y'-�IAI-v A n 0AA)_I OrnA 0 0— j�)_ 1 . 9 1n n R P &A /'n.� M XIR ri a A ( ,)P,n -P.K- i ,1 of LAI '{,J/��',r.� _ t `�r _ zti `C — 1 YI 0,1,171 ?� — tin N� _�� 7P� InP�' F: � Discussion With Person in Charge: Corrective Action Required: ❑ No $$ O/: Yes Exclusion I have read this report, have had the opportunity to ask questions and agree to correct all voluntary Compliance C1 Employee Restriction 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 I noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure re your food permit. - ❑ voluntary Disposal ❑ other: i {( , .{oI,14(c) PHFa Received at Temperatures Violations Related to Foodborne illness Interventions and Risk ` According to Lain Carted ax Factors(items 1-22) (Cont) _ _ _ 4 i`:F/A5`F Within 4 Howl. } PROTECTION FROM CHEMICALS - 3-501,15 Ctxtlin l JMetho&for PHFs r14 Food or Color Additives i l9 PHF Hot and Cold Holding 202.12 Additives" 3 50T 6(B) Cold PHN Maintmnul at or below 596 f g(F) 410/450 F' 3-302.14 Protea on front Unappro ed Additives__ a W ) — -- ! .16(A Hit PH,F Maintained it or above 15 PoisonousorToxiCSubstences _ i4(/,l, 7 ( )1.11 , Identif mg Infomatun-Ou mal --- IContuter 1 t )eii l_(A) kwmx Hold at or above 13VIl.'"__.._ +- — 120 1 Time as a Public Health Control , )' 11 C creno n N am w Ab l,. t-C nm n r+ z -�- ©1.17 ��, tta rt 5tn�_ _---- �0 tvt}if}i) IS t sten rtii uercmeaE_ .r iJ2.1' Pc. tnu cn Fr uncc wid l v 7-'02A2 l oncha» ofe'S cxe( otREQUIREMENTS FOR H IGHLY SUSCEPTIBLE 7-22G4.11 Sumuvetti.,crile -Chennc lls POPULATIONS(HSP) --!7-204.12_ Chin+u ai+tot Lq ivht� t,rxl,u f❑tvr ai' � 2l SO1 1 1fA) i)np,uedri�ed f r 1 ad al-ed Jwt cs and 1 7'04.14 U�nn. Arenu< Cnte ia. I L Br vett:e.Mill i'.at ui i,af> lti" 1 1?{(5.11 hr.«i nta' t. x1 Contact. Cx�b jcany 801 I l(B7. Uv i' Pa temiz d t t "_ _ tiJirite)) kay. orPvtiall f�u�1, AnttntlFiXK1md ti J6.1 Re- ni i US Pe nude..Cr t t+ ' 11 f n 4r .i :matt 'v<i S vc ru 206.12 1 Rcxie 13,1;1 S':rtt<Tii, — I--- t--- - .f ,1.{.i f i Uilo n tl Tw.><xi t't tt. R surcad _..._.__ N.._,..._.� .._...,_.� _ -..� CONSUMER ADWSORY t 2 t�*_' t t t.nstuuct tL -miv ' ct 1 Ibr£rnt art,ption�t , TIME/TEMPERATURE CONTROLS f � �._ _.. Tee mper aturas_ .. _.- v.un t I ora Sha i e ka Undefuxtkc. u l 7(r T— �� Prape noa,cmg to� c t x<101.Ls 1 ,r, c x. ! ( 't t �< t>tt cs, :: t to t.. } '' 3 r tc,lir i i t ti d»t( ft toe R;lw S1101I r 6n,z d sit x is 15 t t 7:e�- Me:sa. c nt SP =L REQUIREMENTS rt C l Ru t- ) 1 ni _ i SI 4)t.? h),_2 .,, c i 7 �Su E) ttA;=- Vi(A r on u 4<t e u '�ilC}fthr'1 (e)j,r. ( K na, . 6.i , a , �u i c L 1 S - r n d;i n hih fixrLt + inporai.v ,ori .i 4t)1.11�A1'3} 1 P it rry bti Id Game, StaffPI{t�s, 1 1 cLsin n tt kitciicr op i l ,iot 1t ttihi i'l Coi:i,ii.Iq„Fi>t At„�., 1� 1 i.:.t)t1,o tri{ti)r(Itt l2ti)FI 17;3at1 LCi:Qat+ , r w , cr I t tv n5°f ' . j i alro: e , _f;,!<r<# lxhxun .1.tes tLtaMa'l 10 - -'.17 f eheatiri tnr tint r n!a�n ,. . i/}C1.,..-+. _. . . .. 9 9 _ f27'fri�s 5 t?r:.L..�XTG.t.3 1'f} VJ[./C>5 £{Et�rfl. t"Ptix2z t''I{,2_:i *.i s.11lS r 2 1r 1ti if "'t i i 1 103.1l(B, I lln uvv iw- 10, 1 l klinul. smilding � C) 11,11 .r i f,n tr ?nt < r t a.r, ty ch do?lw t _ t t lith t"lbws', u i veva, n i ul r: t}rt t },wed i r. "m b" (C; £,in t�ctcia ly P.L...vs�a !ZDJ,xxi-� u.u<. t.r;a; r >iu S =hr ro<•l c nzla iu 111 '"y9#{ I 403 i i(F i tRvl i t in;, T nolcvd Pomo n�of Ii,cej I i_rrenT x',ond Rerad Practices Fc? b9(l.Ott0 - [ a 9anny mEr+andPer n -! IFC l (zQ3 L24 r,,]d �cl (xxi F_rol<tru, �-G f u.4 Ytopar Cooling of PHFs - - -1- �_.__ .�. t * 5(i1.k14V? Cinaav Catkd PHfs fT xtx 140"F to r _ ! ci, 4e cies P� mbin�v'C N, .,_ I FC-1, ptr;'( 17 tvrtht;t 1 1't>U ";:nJ From 791 y �? :i` l Ft its QFC r , 007 1 to 4 il 1-I 15'F N ti j n 4 How- ° 1 28. ' s>> is of rtis, Utter_t. -- i C- 7 , ,X} 501.1.4B, ! Coo1w,,PHF M da From AffiHent � 1 °;, tt;t alh tic rerrfvn _ 009 ( T nl rawi Tt rec..a.:,io4hS/WF �'tG Ofhcr . .,.._._ '. With w.1 H.@IT> . � LI m . CITY OF SALEM, MASSACHUSE'ITS BOARD OF HEALTH 120 WASHINGTON STREET 4"FLOOR PUb.1CHC81t}t. o Prevent.Promote.Pml[m. TEL. (978) 741-1800 FAX(978) 745-0343 IUMBERLEY DRISCOLL - kamdin e salem.com LiARRYIZAAN41)IN,RS/Ri_ns O-io r_>>-l�S MAYOR :qA. . This Form will be collected during your next Board of Health inspection. QUESTIONAIRE — GREASE TRAPS 2012 1. NAME OF ESTABLISHMENT: ir�Prt, 2. ADDRESS OF ESTABLISHMENT: Vag 4L2� 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? (lP 5 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE?-. CAPACITY IN GALLONS ' 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? 4Meo &40Ae/---D 8. WHAT IS THE DATE,OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? G