The URL can be used to link to this page

ADRIATIC RESTAURANT AND BAR - ESTABLISHMENTS A�figtit 1Qcttgdfunt qni lea/ 5 � t✓a�,�py�'a n St�ccl' miversal one www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA 0 � 1 1 1 1 1 1 I 1 1 1 1. opal Commonwealth of Massachusetts r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/28/2011 ESTABLISHMENT NAME: Adriatic Restaurant and Bar File Number:BHF-2010-000037 155 Washington Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2012-0124 Jan 1,2012 Dec 31,2012 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December.31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,. all plans for:such must be submitted to and approved by the Salem Board of Health. Page 1 • j �yj� CITY OF SALEM, MASSACHUSETTS �'• � BOARD OF HEALTH 120 WASHINGTON STREET,4°1 FLOOR TEL (978) 741-1800 KIN03ECR1.HY DRISCOLL Fax (978) 745-0343 MAYOR IearndinCwsalem.com LARRYR NI[DIN, IS,CI lo,C11-1;S 1-11;\1:171 ;\(;IiN'r 201_APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTLC 2> Sciatl2rWi 3R2 TEL# G ADDRESS OF ESTABLISHMENT 199 U)/�-SI4i OGIVAJ ST- FAX# — MAILING ADDRESS(if different) S/4-A4 g- EMAIL-Business': (Q qdf av'cres AOL(%CDuit Website: kdf'<Jto _rCSA Jfg0al44ar.C-OW7 OWNER'S NAME iel_4N166 I� Of2ii /Age�,aFIG 6e0df CLC ) TEL# ��t' 7t�t°Z SG F t e4 J C&4-91— ` ADDRESS (.t�FtFFJ-P ST. STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)1"L09".w CKfA-, "6e�l tui (wQTi CERTIFICATE#(S) 6k3OKdo 6,?61 94 Sr (Required in an establishment where potentially hazardous food is prepared 5 06 905 EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION 1 MondTuesday Saturday -i Sunda LHOURSOFOPERATION 4ease e in time of day. i 0>PlA 11:40 0H ' 12'ne fltN �(L:oop .l2:onV" AZ,'a�n orrexmplell m-11lpm) �f:n� ?H ,tl :D� aN ✓-t; �(�:arP� �(Z:oA44Y1 �t1:.�;>f,7H 4:JJ h TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES .NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 ^_5-99 seats =R� more than 99 seats =$420 ----- ------ ---- ----- /----------------------ES-- -- - - -------------------------------------- ---------------------------- ------------0 CHILDCARE YES 'NO $100 CHILDCARE SERVICES/NURSING HOME-------------------------------------- ---- ------------------------------------------- ------- ---- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES k4W $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location In the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid a I state ta/es required under the law. �zizz zo�i2 7 ,13,13 49 9 Si ature Date Social Security or Federal Identification—Number --------------------------------------------------------------------------- pdated 523/11 FOODAP201 Ladm Check#&Date_�C4 g AZ1 ZL�.// S Lr 2 U. L 163890 `_ - - Service Lo®Hon: 163840. ADRTAnc RESTAURANT ADRIATIC RESTAURANT V44 KURTI vim KuRTI 155 wASM[NGTON STREET - 155.WASHB9GfON-S'TREtT SALEM,MA 01970 - BARCODE @ REAR DOOR SALEM,MA 01970 customer Signature. Tedmloon.Signatum Lkenses/ � MA-0625-030 r//af+i�i -7( WMA:-33671 . .Thee In: ... .09/18/2011 11:18;51 AM - PEDRO MALDONADO lput: 0MAW2011 11:39:42 AM imo Order#./Fnvoim Service Data Service Description Service Amount Tax Total 931653 '04/18/2011 .- T coCare.SUver Program- $70.00 $0.00 $70A0 brand Toiale ;`$70.00 Amount Due: $70.00 Purchase Order. Terms NET 30 Open Defidencies/Observations A'one'AbtOd. Pest Summary Device Summary wit wu,wt l Toni Device Exfimis : .Pat Activity, ..Quardity ..Device Type Activity Ad�vity In d Replaced Removed Sidpued N�Natml MULTI-CATCHRoDMT :0 7 ! 7 :. 0 Totak . 0:. Z': 7 i. 0 0; 1. Add#runa/pe�flAA smayhavebeena/xiriwed Please see ddidenawar�O Lskrmwed�s Material Application Summary EPA# Mater®t Applied Quardr7Y UOM Nene Noted Genera 4Comm eids Service Instructions:4 MULTDTTCH Tedi Comment:SEFMCED ALL STATIONS.REPIAcED GLUEBOARDS AS NEEDED.FOR PEST MONITORBVGNAVE AHICE DAY_YEDRD. fbr moreinfometion on Devices and De kkWes please go to:http://wwwstodernpestcom and select ClientAtcess. wwwrnod_ -e_..__m i C!eglt: 163840 - :service Location; 163840. ADRIATICRESTAURANT - - ADRLATIC RESTAURANT VINI KURTI - .. VINI KURTI 155 WASFONIiTON STREET.- - 1S5 WASFffNGMN-STREET SALEM;_MA 01970 : - : BARCODE D REAR DOOR . SALEM,MA 01970.-. CuaOonry Slgeature: :TerJmWan Stoagrre: - - Licensee/Cerli"imfbns O MA 38936 _- `/^ -� Ti®eln: 03/31/2011095436AM Thee Out 03/31/2011 10*09:58 AM CHANCE srRANDELL Order 4./Invoice Service Data Service Description Service Amount Tax Total 919705 .03/31/2011. TmCare Silver Program-. $70.00 $O.Im. -x$70.00 - Grand Tomk, x.$70.00 Amount Due: $70.00 Purcliuse order. Terme: Open Deficiencies/Observations Abw Aar: Pest SummaryDevice Summary. WithWithout Total Dedce Liiep" Pest ActivKv' Quarolr Device Tvpe Adlft ' Actift Inspected Replaced Removed Sldpped AkneA6fed.` Minn-c=HRODFNT o - 8 - 8 .0 . 0` 0., Totals 0 - 8 8 -0 0" 0 AmoralPed�iWmayhambeenohowd Maw see daftmm Md ommaro Iprmmedata& Material :Application Summary EPA# Material Applied - - -EPA# ` Applied�n�UOMUOM NaeeAtted Generai C61 merMs -Tech CMTnwt:INSPECRON AND SLR WCES RENDERED s9LVi®ALL STATION WITH NO PEST x mTrIES NOTED For more in mragon an Devices.and.Ddidarrm please go to Mtp.//wtwj4odempest com and select ass Access. www.modernpest.com Cllr,rt 163840 Service L xa. 16.9840 ADRIATic RESTAURANT ADRIATIC RF37AURANT WIG KURR VIM KUKII 155 WASHINGTON STREET 155 WASHINGTON STREET SALEM,MA 61970 BARCODE @ REAR DOOR SALEM,.MA 01970 -. CusEomer Signa ure: Technidan.5igoaiure: l+imnseslCertiflradorrs � 33671 0) 11 MA-31671 Time In; 05/20/2011 11:45:37AM :PL3)RO MALt)ONADO T6ne Our -;MrAl201112:26:18:PM Order#/:Invoice Service Date Service Description;' Service Amount Tax Total 996888 O5l20/Zpli EcoCareSliver Pro gram -_-: -$70.00 $0.00 $7p.00 era rrd Tatak '$70.00 Amount Due: $70.00 Purchase order: -Terms .NET 30 Open Deficlencies/Observations 3 Low ti Medium dPest Summary Device Summary wan wdnwt Total Device Exceptions. -:Pest ActivitY:_ Oumfih -Device Type -Activity asttvity LsPecteclReplaced "Removed Sidpped -NoneA�i.d muLn-cA7CH RODENT 8 80 3 i „ 0 -Totals 0 8 8 0 3 p Ao awlpestmo%.t�mayI'm been observed obeaoe see dem andmmments formare dttYaibc Material Application Summary EPA# Material Aided Duantity " ' UOM None Noted) General Comments Service InMxbons:SERVIPID ALL STATIONs.REPtACED ALL KTICIIEN STATIONS WITH KET(MU.SADDED SNAP TRAM 'Io UNDER OVEN AREA WITH GLUEBOARD.SSEALED HOLES IN BAR STOCKROOM AS WELL AS BACK DOOR SIDE ROOM:UNDER SINK.PLEASE NOTE RODENT DROPPINGS NOTED AT BAR ST00(ROOM UNDER BAR .: ,El2UIPMBYTAT BRICX OVEN AREA AS WELLAS UNDERNEATH.HAVE:A MCE DAY.i:PEDRO. For more infomeBon on Devices and Deficiencies pleese go to http-//www.ModernpesLc6m and select Client Access. sa � a s ? _ v v .modernpest.com t Massachusetts Department of Public Health Salem Board of Healthry Division of Food and Drugs 120 Washington Street,41" Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name 5 2 Dat Tvee of Operation(s) T e f Ins action �- M Food Service Routine Address /S 5 ^ Rik I ❑ Retail [jr].Re-inspection (� _ Leve, ElResidential Kitchen Previous Inspection Telephone - 7 J ❑ Mobile ' Date:,,, Owner ISI tO HACCP Y/N caterer ❑ Pre-ope atlon L 1 ❑ Suspect Illness Person In Charge(PIC) /r Time ❑ Bed&Breakfast ❑ General Complaint �a�/1LI (J 'iC 20In: f.�J ❑ HACCP Inspector Out Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. / ►,FOOD PROTECTION MANAGEMENT_,� _. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _- ❑ 13. Handwash Facilities EMPLOYEE HEALTH , , < • '_' El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El__ __..____ 15.Toxic Chemicals F000 FROM APPROVED SOURCE _ TIME/TEMPERATURE CONTROLS Potential) Hazardous Foods ❑ 4. Food and Water from Approved Source �m� (Potentially Hazardous _) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing - LREQUIREMENTS FOR.HIGHLY SUSCEPTIBLE POPULATIONS.(HSP)' 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ T _ El 11. Good Hygienic Practices CONSUMER ADVISORY __ t[122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an f 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water,Plumbing and Waste (Fc-5)(550.005) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(390.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: /y /[ s:S9ulnspectFornKla.tlx '/-"' Inspector's Signature: Print:,- / PIC's Signature: Prink �R S i rA�J9 Page lof (Pages �r v Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)Q) Raw Animal Foods Separated from 1 590.003(.0) Assignment of Res onsibilitY* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge" Contamination from Raw ingredients 2-103.11 Person in charge -duties 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3-302.15 1 Washing Fruits and Vegetables applicants* 3-304.1 L Food Contact with,Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003 G Ke tin b Person in Charge* 3 590.003(D) Exclusions and Restrictions* DispositionoiAdulteratedorContaminated Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Forod* 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 3-201.1.2 Food in a Hertneticall Sealed Container* Sanitization Teniperaturw 3-20113 Fluid Milk and Milk Products' 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* 3-202.14 E 2s and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH; - 3-202.16 Ice Made From Potable Drinking Wates* concentration and hardness. * 5-101.'1 1 DrinkingWater from an Approved System* 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 22.0" 4 602.11 Cleaning Frequency of Equipment Pond Contact Surfaces and Utensils* SheiBish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Mollusc m 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 Ra ulato Authort 2-301.11 Clean Condition-Hands and Arms* 3-202.1.8 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* 1.1 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-20211 PHFs 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* 3-301.12 Preventm�Contamination When Tasting* 6 TagsfRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 1 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) labeling of Ingredients' 5-204.1.1 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.1.2 Reduced ox men acka 'nom,criteria* 6-301.11. Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.t2 HandDrying Pror'ision *Uenotegcrnicai item in the federal 1999 Food Code or 10 CMR 590.000. PERKINS FOOD SERVICE REPORT Check one: ❑ Preventive Service ❑ Emergency Service ]-Other- 26992 Warewash Laundry Team Chain TM 01✓� MonthNear Customer RECAP 4'7 i- Ship to Acct.No. Address _�J- SM Corporate Acct. ❑yes City,State AVP 1.Machine Manufacturer 2.Type 3.Model CONDITION FOUND ACTION TAKEN 4.Electronic Controller 5.Feeder Water Softener 6. ❑yes 7.O no Code; WARE CONDITION OK OPERATOR PROCEDURESNot oK- OK Action re 'tl 8. Glasses 33.Racking A I V I fi e 9. Stem Ware 34.Prescrapping A 10.Plates/Saucers 35.presoaking A A&V 11.Cups/Bowls 36.Deliming A 12.Flatware 37.Curtain Cleaning AAA ,}1 13.Other 38.Tank Water Changing A r V A A, PRODUCTS OK 39.Scrap Tray Cleaning A 40.Equipment Cleaning A 14.Detergent . 141.Manual Warewashing A 5.Det.concentration r 42.Wall Charts A 1¢.Ainse- dditive IY 7.Sanitized 43.MSDS Sheets Posted A .� t ip 8.San.c ceniration _o .or - 44.MSDS On File A I / *MEC ANICAL OPERATION L Not OK- 45.Right to Know Station Installed A OK Action req'tl 46.Spray Bottles A 19.Fill Value VAor TEMPERATURES Current/OK Adjusted to: 20.Prewash 21.Wash Arms 47.Prewash _ ___ 22.Rinse Arms 48.Wash Tank23.Final Rinse Solenoid 49.Power Rinse24.Freshwater Feedback Rate 50.Final RinseOK AaonoKgtl 25.Drain Value 26.Rinse Saver A 51.Final Rinse Pressure A 27.Conveyor Belt/Pegs/Dogs A 52.Fresh Water Bypass A - 28.Curtains/Racks % 'A or B 53.Water Hardness grains A or B 29.Screens JA30.Motors A 800-733-5718 X31.Pum s t A 32.Door Switch PARTS INSTALLED AND DURATECH ORDERS f Part Number Description Quantity P.O.# Truck-Stock art# Qty Signat Customer Signature Date FOOD SERVICE ITEM STANDARD RESPONSE IF ITEM STANDARD RESPONSE IF ITEM STANDARD RESPONSE IF ITEM CHECKED "ACTION NEEDED" ITEM CHECKED "ACTION NEEDED" ITEM CHECKED "ACTION NEEDED" DUALITY 27. Conveyor TM repaired/replaced conveyor.This will 39. Scrap Tray Cleaning TM held inservice training to review scrap improve efficiency of dishmachine. tray cleaning procedures.This will ensure 1, 8-13 Would depend on other checked items to cleanliness and results. affect change in results 20-53. 28. Curtains& Racks A.TM presented Duratech rack program to As an example: Glasses-poor results manager. Replacing worn racks will ensure 40. Equipment Cleaning TM held inservice training to review overall would equal 24-solenoid which was non proper machine efficiency and results. equipment cleaning.This will ensure operational-removed and replaced. B.TM presented Duratech curtain program cleanliness and results. to manager. Replacing worn/missing MECHANICAL OPERATION curtains will ensure proper machine 41. Manual Warewashing TM held inservice to review benefits of efficiency and results. changing sink water and checking for 19.Fill Valve A.Repairediieplaced due to leak.This will proper sanitation level. save water,utilities r& Chemicals. 29.Screens TM recommends repair/replace B.Service agency'called"repaired/replaced; bent/missing screens to improve results. 42.Wall Charts TM replaced and updated wall charts to this will save water, utilities&chemicals. provide instructional aids for the staff. 30. Motors A.TM cleaned cooling fan and lubricated 20. Prewash A.Arm;-clogged.TM-cleaned and gave motor as required for proper operation.This 43. MSDS Sheets Posted TM reviewed/updated MSDS sheets as training to operator.This will ensure will ensure long motor life. required to ensure OSHA compliance. proper results. B.TM replaced burned out motor.This will B.Ann broken.TM replaced/called service ensure proper operation of the entire 44. MSDS on File TM reviewed/updated MSDS on file to agency.This will ensure proper results. dishmachine. ensure OSHA compliance. C. 0 ring was ruptured,causing splash over into tanks.TM replaced.This will ensure - 31. Pumps A.TM cleaned/repaired pump.This will 45. Right to Know TM installed/updated Right to Know Station proper results. ensure proper pressure and results. Station Installed as required to ensure OSHA compliance. B. Intake screen missing.TM has suggested 21.Wash Arms A.Arms clogged.TM cleaned and gave ordering a replacement.This will ensure 46.Spray Battles Spray bottles were not labeled properly.TM training to operator.This will ensure `•.,� - proper wash pressure and results. checked/instructed personnel on labeling proper results. r procedures. B.Arm broken.TM.replaced/called service 32. Door Switch TM repaired/replaced door switch.This will agency.This will ensure proper results. ensure safety of employees. TEMPERATURES C.0 ring was ruptured, causing splash over into tanks.71,9 replaced.This will ensure OPERATOR PROCEDURES 47. Prewash TM adjusted temperature to °F. proper results. TM repaired/replaced components to ensure 33. Racking TM held inservice training to review proper proper temperature and results. 22. Rinse Arms A-TM cleaned final rinse jets and made racking procedures.This will improve adjustment/replacement for proper results. efficiency of operation. 48.Wash Tank TM adjusted temperature to °F. B. Rinse arm was bent.TM repaired/ TM repaired/replaced components to ensure replaced for proper operation results. 34. Prescrapping TM held inservice training to review proper proper temperature and results. prescrapping procedures.This will improve 23. Final Rinse Solenoid A.TM repaired/replaced solenoid-this will results and efficiency of operation. 49. Power Rinse TM adjusted temperature to -F. ensure proper sanitizing rinse and results. TM repaired/replaced components to ensure B.TM adjusted/repaired rinse activator 35. Presoaking TM held inservice training to review proper proper temperature and results. switch.This will ensure proper sanitizing presoaking procedures. Proper presoaking rinse and results. will ensure one pass results. 50. Final Rinse TM adjusted temperature to °F. TM repaired/replaced components to ensure 24.Freshwater TM adjusted for proper operation. 36. Deliming TM held inservice training to review proper proper temperature and results. Feedback Rate deliming,procedures..This will ensure cleanliness and results. 51. Final Rinse Pressure TM repaired/replaced components to ensure 25. Drain Valves A. Drain leaking.Tm repaired/replaced drain. proper temperature and results. This will save water,chemicals and utilities. 37. Curtain CleaninG TM held inservice training to review curtain B.TM cleared debris from drain.This will cleaning procedures.This will ensure 52. Fresh Water Set at 1 gallon per minute.This will save save water, utilities and chemicals.. cleanliness and results. Bypass water and chemicals. 26.Rinse Saver TM cleaned rinse saver pan because it was 38.Tank Water TM held inservice training to review 53.Water Hardness grains. , overflowing into wash tank,wasting water changing the water at 2 hour intervals. A. Checked softener, out of salt.This will and chemicals. This will ensure cleanliness and results. affect results and detergent concentration. B. Checked softener. Service needsto be called. T r, ! Massachusetts Department of Public Health Salem Board of Health r 120 Washington Street,0 Floor Division of Food and Drugs r ,l ' Salem;MA`101970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (g7,$) 741-1800 Fax(978) 745-0343 Name ° Dat T e of O erasion s Tvoe of Inspection P M oed Service L-&Routlne Address �+ R k ElRetail ❑Ple-inspection + 1Level ❑ Residential Kitchen Previous nspe>tion Telephone V q 3V ling- ❑,Mobile Date:5Zy y Owner �� HACCP YIN ❑❑+✓Cat�ereary ❑ Pre operation ❑Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint Inspector In: El(� Permit No. El Other Out: f 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 ElEMPLOYEE HEALTH ---� 13. Handwash Facilities PROTECTIONFROMCHEMICALS T ❑ 2. Reporting of Diseases by Food Employee and PIC `�� ❑ 14.Approved Food or Color Additives 1 3. Personnel with Infections Restricted/Excluded . _ T . . _ __ - �_ El 15.Toxic Chemicals ,.FOOD FROM APPROVED SOURCE ---� \ ❑ 4. Food and Water from Approved Source i:11 /TEMPERATURE CONTROLS,(Potentially Hazardous Foods) }❑ El 16.Cookin Temperatures S..Receiving/Condition 9 p ,. ►` ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling 'LPROTECTION FROM CONTAMINATION • _' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control . Food Contact Surfaces Cleaning and Sanitizing (REQUIREMENTS FOR.HIGHLY SUSCEPTIBLE POPULATIONS.(HSP)I ❑21. Food and Food Preparation for HSP El10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related I Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations "24.-Food and Food Protection (Fc-3)(5550.090.0 044)) 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)(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;kp . 30. Other DATE OF RE-INSPECTION: `t,ti� � 1, d-a r� s5HOlnspecfFomKi<.tlac 1 Inspector's Signature: Print: �C6646 Vo • PIC's Signature: (NAIVPag '4 Print: Y �' e of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1} Raw Animal Foods Separated from 1 590.003(A) Asia meat of Res onsibilit * P Carked and RTE Foods* 590.003(B) Demonstration of Knowledge" Contamination from Raw Ingredients 2-103.11. Person in charge-duties 3-302.1.1(A)(2) Raw Animal Foals Separated from Each Other` EMPLOYEE HEALTH Contamination from the Environment 2 590.003(,C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Fail Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3-306.14(A)(B) ,Returned Food and Reserviee of Food* 590.003 G) Reporting b Person in Charge* Disposition of Adulterated or Contaminated 31 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources FT Food Contact Surtaces 590.004(A-B) Compliance with Food law* 4-501..1.11 Manual Warewashing-Hot Water 3-201.12 Foci in a Herinctically Scaled Container* Sanitization Te erafures* 3-201.13 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products. Pasteurized* 4-501.114 Chemical.Sanitization-temp.,PH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101..11 Drinking Water 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 22.0" 4-602.11 Cleaning Frequency of Equipment Food Contact Surfaces and Utensils* ShelNish and Fish Froman 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 Authorrt 2-301.1.1. Clean Condition-Hands and Arms* Re u/ato 3.202.18 Shellsttx:k Identification Present* 2-301.12 Cleaning Procedure* 590.004 C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1.7 Game Animals* i.l Good Hygienic Practices' g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1.1. PHFs Received at Proper Temperatures'* 2401,12 Discharges From the Eyes,Nose and 3-202.1.5 Package Integrity* Mouth* 3-101.11 Foal Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* i 590.004(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* _ Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11. Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placernent* 1 Conformance with Approved Procedures 5-205.11 Accessibilit ,0 reration and Maintenance IHACCP Pians Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Redu01.11 ced Ox gen packaging,criteria* 6-3Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-30]..1.2 Hand-Dr Provision 4 Denoles,critical item in the federal 1999 Food Cale or 105 CMR 590.00. CITY OF SALEM BpARD OF HEALTH / Establishment Name: f ,V�rr >> r >� f rko�� ✓fit Imo( - Date: -/ / Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified . L PLEASE PRINT CLEAR/IV . 1 Q2vlrC_ ItN �•� �1P r11� _ C�C� lx��C' t K / G. r It<. / c e L..no . ,Li rS'c. — prth� c IJtI �S c 'T SPI Ul rule GnJ Cr 171/r✓1l� C� ; Gn1 cQ '5 . - 67 . S t -� 1 n�crlr Q �IS Ll l)gj- —(`o a a'R i C ao,r.l ( Ddr, 1 fin/ ,s C a inn w ,t,t nu a (7 Discussion With Person in Charge: Corrective Action Required: o No _ g Xes - I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance El 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 yqur food permit. /� ❑ Voluntary Disposal ❑ Other: � • ,� _ M 3-501,14(C) PHFs Received at Temperatures Viot Brans Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 4l'FI45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 CoolingMethods for PHFs 14 - Food or Color Additives _ 19 PHF Not olid Cold Melding 3,242.12 Additives* 3-50 L 16(B) Cold P11Fs Maintained at or below � 590.004{F) 4i°745'F* 3-302.14 Poisonou or T Unappxic Substances Additives" 3-SOL 16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140`F * 7-101,11 Identifying Information-Orriginal 3-.501.16(A) Roasts Held at or above 130°F.* Containers* 7-102.11. Common Brame-Working3-501:19 Time as a Public HContainers* 20 Time as a Public f HealthControl Contras* Control 7-201.11 Separation-Storap* Rego 7-202.11 .Restriction-Presenceand Use* 590.U04(H) YarianceRe irement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanitizets.Criteria-Chemicals* 21 3-80j.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warring labels* 7-204.14 cots.Criteria*ctee Food Canted Use Pesticides;Criteria" 3-&01.11(6) Use of Pasteuriml Eggs* 7-205.11 Restricted td Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-246.71 RestricriRaw Seed Sprouts Not Served * ,-206.12 Rodent Bait Stations* 3-801.11(C Unopened Food Packs Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitorin * - CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of 16 Proper Cooking Temperatures far Animal Foods That are Raw,undercooked or P - Not Otherwise,Processed to Eliminate 3-401.11A(I)(2) Eggs- 155°F 15 Sec. Patiro * nxe ulna r Eggs-immediate Service 145°FlSsec* 3-302.13. Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs! Animals-155°F 15 sec. 3.401.11(11)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3401.11(A)(2) Ratites,Injected Meats-155`F 15 590.049(A)-(D) Violations of Section 590.009{A}-(B)in see. * 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 udder the appropriate sections Poultry or Ratites-165'F 15 sec. * above.if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F 4, 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3401:11(A)(1)(b) All Other PHFs-145°F 15 sec.# 17 Reheating for Mot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A I(A)&(D) PHFs 165-F 15 sec. * (Items 23-30) 3-403.11(B) Microwave--165`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the 'rime* Joodbome illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- fqund in the following sections of the Food Code and 105 CMR 140°F, 590.000. 3-403.1I(E) Remaining Unsiiced Pardons of Beef { Item Good Retail Practices FC 590.000 Ro astO' 23. 1 Management and Personnel ! FC-2 .003 24 1 Food and Food Protection I FC-3 .004 1g Proper Cooling of s f from 14U`F m 25. Equipment and Utensils 1 FC-4 .005 3-501.14{A) Cowling Cooked PHWFs (26. Water.Plumbing and Waste i FC-5 .006 70°F Within 2 Hours and From 70°F 27. Physical FacifltyFG-6 007 to 41`F/45°F Within 4 Hours. * 1 28�s or Toxic Materials ! FC-7 .008 3-501.14(6) Cooling PHFs Made Fmm Ambient 29. S acral Requirements - .009 Temperature Ingredients to 41°F/45°F i 30. I Other Within 4 Hours* s:sver,.,ms.ac *Denorea eritieat rwra in the federal 1999 FLW Cale a'105 CMR 590.000. CITY OF SALEM /� BOARD OF HEALTH Establishment Name: AJ ( I A�l f SPS �1��0� r d Date: `? / Page: 3! of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- _ r No. Reference R-Red Item Verified i PLEASE PRINT CLEARLY �� n✓L IS /tfL. � ^ � T. � � �C - ,-r h.Ctrl c I�f awn�J, VN 4 Discussion With Person in Charge: Corrective Action Required: ❑ No es 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 rtL _ Exclusion t[e=inspection Scheduled LiEmergency 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 suspension/revocation of ❑ Embargo ❑ Emergency Closure R your food permit. Q 4 ❑, Voluntary Disposal ❑ Other: Y 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors Mems 1-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding ---- 3-50L16(B) Cold PHFs Maintained at or below 3-202.12+ Additives* 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PRFs Maintained at or above 140°F. * 7-1011 11 Identifying information-Original 3501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11, Common Name-Working Containers* 20 Time as a Public Health Control 7-20L l I Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 .Restriction-Presenceand Use* 590.004H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) I Unpasteurized Pre-packaged Iuices and 7-204.14 Drying Agents.Criteria* Beverages with Warning Labels* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Lubricants* 3-801..11(D) Raw or Partially Cooked Animal Foal and 7-206.11 Restricted Use Pesticides, s,Criteria° Raw Seed Sprouts Not Served. 7-206.12 1 Rodent Bait Stations* 3-801.11(0) Unopened Foal Package Not Re-serval. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 1 Consumer Ads Posted for Consumption of 16 Proper Cooking Temperatures for Animal Faxds That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.11A(1)(2) Eggs- 155F 15 Sea Patho ens.*EfBeOv*+n oor Eggs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game E s* Animals-155°F 15 sec. * 3401.11(B)(1)(2) Pork and.Beef Roast- 1.30°F 121 min* SPECIAL REQUIREMENTS 3.401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(1)) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.409 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) Ali Other PHFs- 145°F 15 sec. 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 1657 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical,and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above,can be 3-403.11(0) Commercial ly Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef Item I Good Retail Practices FC 590.000 'Roasts* 23. Manatesnent and Personnel FC-2 .003 1g Proper Cooling of PHFe 24. Food and Food Protection _ FC-3 .004 25. E ui m and Utensils FG_-4 .005 3-50L14(A) Cooling Cooked PHFs from 140'Fto 26. Water,Plumbing and Waste FC-5 .006 70°.F Within 2 Hours and From 70'F 27. P ical Facility FC-6 .007 to 41°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 130. Other Within 4 Hours" 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Administrative tOffices STATEMENT 100 PET 'RS SERVICES Brunswick,ME 04011 v, r 1, . a -j 163840 F77 IIIIIIIIIIIIIIIIIIIIIIIIIIUII •_ ': , ,., :, -, r , � YOU CAN NOW PAY ONLINE AT MPS STMr9 091311ba MODERNPEST.COM. CALL US FOR YOUR LOG 15 ADRIATIC RESTAURANT IN AND PASSWORD! ATTN:VINI KURTI 155 WASHINGTON STREET SALEM MA 01970 Billing Questions, 1-800-894-8800 - Service Questions, 1-800-323-7378 For account access amd online payments,please visit US at www rnodernpest.com ADRIATIC RESTAURANT 155 WASHINGTON STREET, BARCODE @ REAR DOOR SALEM MA 01970 6/30/11 959142 EcoCare Silver Program 70.00 70.00 7/25/11 975237 EcoCare Silver Program 70.00 70.00 8118/11 989951 EcoCare Silver Program 70.00 70.00 9/13/11 Finance Charge 2.24 2.24 72.24 70.00 70.00 0.00 212.24 PLEASE RETURN THIS SECTION WITH YOUR PAYMENT. ADRIATIC RESTAURANT 163840 9/13111 (V)CHECK ONE . .:ten . � A IASA I EXP.DATE 212.24 Modern Report Card-Take a few moments to grade our performance. Ona scale of 1(Worst)to 70(Best) El rAt� AMOUNTPAID t. Howwould you ratethe Quality and Effectiveness of our service? EI 3❑ 4❑Os ©❑i © 9❑to 2 How would you rate the Knowledge and Attitude ofour ACCOUNT NUMBER team members? 11D DE1 ©00 9❑10 3. How would you ratetheOveralivalue ofourservice? 0[ ❑3 ® s❑©❑ s❑Q©o EFT from bank account and check by phone available. 4. How likely are you to recommend Modem Pest services to a friend or colleague? t❑ 2❑❑3 ® s❑©� a❑ 9❑to SIGNATURE Client: [NEW] Service Location: 163890 ADRIATIC RESTAURANT ADRIATIC RESTAURANT 155 WASHINGTON ST 155 WASHINGTON ST SALEM,MA 01970 SALEM,MA 01970 Customer Signature: Technician Signature: Licenses/Certifications MA-0625-030 '7 MA-33671 Time In: 08/18/201103:08:38 PM PEDRO MALDONADO Time OuC 08/18/2011 03:32:58 PM Order#/Invoice Service Date Service Description Service Amount Tax Total 989951 08/18/2011 EcoCare Silver Program $70.00 $0.00 $70.00 Grand Total: $70.00 Amount Due: $70.00 Purchase Order: Terms: Open Deficiencies/Observations None Noted. Pest Summary Device Summary with weuut Total Device Exceptions Pest Activity Quantity Device Type Activity Activity Inspected Replaced Removed sapped Noire Noted. Now Noted. Additional pestWiings may have been observed Please see dafrtknaes and mmmentr tormae details. • Material Application Summary EPA# Material Applied Quantity UOM Now Noted. General Comments Tech Comment:VISUALLY INSPECTED ALL STATIONS,PDA COULDN'T SCAN FOR REASONS UNKNOWNADDED/REPLACED GLUEBOARDS AS NEEDED FOR PEST MONITORINGAO RODENTS CAUGHT THIS VISIT.HAVE A GOOD DAY....PEDRO. For more information on Devices and Deficiencies please go to http://www.Modempest.com and select Client Access. i'm Service Remit To: 1-800-323-PEST(7378) 100 Pleasant-Street Billing Brunswick, ME 04011 PEST 1-800-894-8800 CIknC 163840 Service Location: 163840 ADRIATIC RESTAURANT ADRIATIC RESTAURANT VIM KURTI VINI KURTI 155 WASHINGTON STREET 155 WASHINGTON STREET SALEM,MA 01970. BARCODE @ REAR DOOR SALEM,MA 01970 Customer Signature: Technician Signature: Licenses/Certifications MA- 0 33671 MA-33671 s Time In: 07/25/201103:11:23 PM PEDRO MALDONADO Time Out: 07/25/201103:32:06 PM Order#/ Invoice Service Date Service Description Service Amount Tax Total 975237 07/25/2011 EcoCare Silver Program $70.00 $0.00 $70.00 - Grand Total: .. -. $70.00 r. Amount Due: $70.00 Purchase Order: Terms: NET 30 Open Deficiencies/Observations 1 Medium Pest Summary Device Summary With Without Total Device Exceptions Pest Activity Quantity Device Type Activity Activity Inspected Replaced Removed Skipped MICE 3 MULTI-CATCH RODENT 3 6 9 0 0 0 -Totals 3 6 9 0 0 0 Additional pest Andings may have been observed please see defrcierxl and comments for more details. Material Application Summary EPA# Material Applied Quantity LOM None Noted General Comments Tech Comment:TODAY WE INSPECTED AND-OR TREATED THE INTERIOR OF YOUR ESTABLISHMENT AND SERVICED ALL INTERIOR STATIONS.3 MICE CAUGHT IN KITCHEN.THANK YOU FOR CHOOSING MODERN PEST SERVICES. -.. For more infomraton on Devices and Deficiencies please go to http://www.Modempest.com and select Client Access. www.modernpest.com j Remit To: Service 100 Pleasant Street 1-800-323-PEST(7378) Brunswick, ME 04011PEST SERVICES 1-800-894-8800 i Client 163844 Sanded Location: 163840 ADRIATIC RESTAURANT ADRIATIC RESTAURANT Vim WWII VINI KURR 155 WASHINGTON STREEI I55 WASH94GTON STREET SALEM;MA 01970 BARCODE @ REAR DOOR SALEM,MA 01970 i customer Signature: Technician Signature: Llcemes/Certifications MA-0625.030 MA-93671 Y�.•..1�./ `+ (�• Time In: 06130/201102:24:21 PM PEDRO MALDONADO Time Out 06/30/201102:54:42 PM Order#/Invoice Service Data Service Description Service Amount Tali Total 959142 06/30/2011 Ecocare Sinter Program $70.00 $0.00 $70.00 Grand Tetah $70.00 Amount Due: $70.00 Purchase Order: Temps: NET 30 Open Deficiencies/Observations 1 Medium Pest Summary Device Summary With We"A Taal Device Exons Pest Activity (' landty Dema Type Activity Activity Inspected Replaced Removed Skipped MICE I MULTI-CATCH RODENT 1 8 9 0 0 0 -Totals 1 8 9 0 4 0 Addift7alpirstfrnaftsnay Ravebeen observad.Peasesea daribeecies and comensatsfor mevedebris. Material Application Summary EPA# Material Applied Quantity UOM None Mohd. General Comments Order Instruuctions:Your next moah`s invoice may refla t a rube adjustment to cover various increases in Moder Pest Services costs.Thank you for your continued patronage. Service instructions:4 MULTIKETCH Tech Comment:SERVICED ALL STA17ONS.NOTED SEVERAL RODENT HOLES HOLES SEALED.2 MICE CAUGHT UNDER PIZZA OVEN AND b IN KTTCHEN.HAVE A GOOD DAYJWRO. For more information on Devices and Deficiencies please go to h4.,//Www.Modempest.com and select Client Access. �. . www.modernpest.com /i Commonwealth of Massachusetts " s City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Adriatic Restaurant and Bar File Number:BHF-2010-000037 155 Washington Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes FOOD SERVICE BHP-2011-0214 Jan 1,2011 Dec 31,2011 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTII 120 WASHINGTON STREET, 4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRJ,,ENB,wNAlVSAJ FN.COM DAVID GREENBAIIM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ESTABLISHMEZ/NT NAME OF ESTABLISHMENT RS21eTC 2EW1t - ADDRESS OF ESTABLISHMENT_ 11511,'nIGr W S-f -.A -At x114- FAX# MAILING ADDRESS(if different) SY+A-t / 1 EMAIL-Business': t_4QLQe2a!fi0.�tCreclowr'A4gvJbpr C_ Website: IQ•ArIaNcriasWur4y�Qvulbdf COM OWNER'SNAME F4061AAJ CC(-14 TEL# -4$ A - W-?,4q'L ADDRESS 2.6 PEW bezt`t cytew *407- S191-e-.4 Ain- 04170 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) roei l;n) C(SC.4 .N rZUIN eJeh CERTIFICATE#(S)6 e a 0a(JbS (Required.in an establishment where potentially hazardous food is preps ) EMERGENCY RESPONSE PERSON HOME TEL# 494- 988- 2t-gl DAYS OF OPERATION Monday Tuesda Wednesda t 1. Thursday Friday 1 Saturday HOURS OFOPERRA OPERATION Please write in time of day. M J �zmO g7t1. �fl oo �� ,ao IFMFor exam tram-11 /ZPo p� a2. , ,.r2d�0 'C.�� TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than I000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 .........--•-•.-----•...................................... .................... ................... RESTAURANT E NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats ( $ ------------ --------------------yb .... ----•-------------...----...-----------...........---............................$-1--0-0------- BEDIBREAKFASTI YES O $tfl0 CHILDCARE SERVICE$/NURSING HOME. .................................. ....... . ADDITIONAL PERMITS " MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES O $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment In accordance with the State Sanitary Code,before any renovations, Improvements,or equipment changes are made,all plans for 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 1,to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law- Signature Datat-e'er Social Security or Federal Identification Number Revised 1017/11 FOODAP2011.admCheck#&Date /�� $ ullenee 163890 Service location: 163840 v ADWATIC RESTAURANT . . ;ADRiAnc RwAl1RANT VIM KURTI VIM KURn 155 WASHINGTON STREET - -155 WASIgNGTON STREET SAIFM;MA 01970 - -SALB9;MA 01970 CustINIVer Members: TeecbnklonSkpud we: Lweosmlcwtmcadom MA4 Wf/• � al— oIn: e Tune n: 08/16(2010 11:32:22 AM rare Out: 08/16/2D10a1i47:21 AM ROGER CARON Order#/kwoke Service Data Service Description Service Amount Taos Total 822881 - 08/16/Z010 EcoCare New Start - -. $70.00 $0.00 ::$70.00 .-Grand Total: 4$70.00 Amount Due: $70.00 Purchase Order. Terms: 'NET30 -r Open Deficient/Observations Nave Anted. Pest Summary Device Summary Withwdlro d roan Device Pest Activity :Quantity= Device Tvce Acth* Activity Impacted Replaced Removed Sldpped None Ablad. Abw Nadad. Add'tiara/pestrffxV s_mayhavebeenobselmdPlaceseeddiderrdesandmnu»enlsfornaredetails. Material Application Summary EPA# Material Applied –. Qus" UOM None At>ted. General Comments Sar UP restaprant for initial service placed rr bitch in bar area and three m Idtdet and inspected besemeartno activity seen For more infomration on Devices and Defidendes please go to hUp://www.Modempestoom and select Client Access. �. �Yw hom.mcdornpest.com CITY OF SALEM BOARD OF HEALTH Establishment Name: f I Ol {1T c 510t L; 0'nt Date: Z/07 0 Page: of _ item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date.. No. Reference R-Red Item Verified PLEASE PRINT CLEARLY cU IY1c i of L1,�I _ 't o s c r (' u G Y +0 t -�7CQ4v 25�. I5 to r-villt � Discussion With Person in Charge: Corrective Action Required: ❑ .No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Emersion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twen y-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. d ❑ Voluntary Disposal ❑ Other: l 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Hems 1-22) (Cont:) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50 L 15 CoolingMethods for PHFs 14 Food or Color Additives 19 Col Hot and Cold ineHoldat 3-501.16($) Cold PHFs Maintained at or below 3-202.12 Additives* 590.OD4(F) 4101450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(0) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140 Containers* 3-501.16(0) Roasts cc Held at or above 130'F. 7-102.11, Common Name-Working Containers* 20 Time as a Public Health Control 7-201.1.1 Separation-Stora 4, 3-501.19 Time as a Public Health Control* 7-202.11 .Restriction-PresenceandUse* 590.004(H) Variance R uirement 7-702.12 Conditions of Use* 7-203.11 Toric Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for WashingProduce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with alantin°Labels* 7-204.14 Drying Agents.Criteria* o 3-801.11(8 Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or PartiallyCooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PRFs_ Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 1557 15 Sec. Patho ens.* Eggs-Immediate Service 1450F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E Animals-155°F 15 sec. * 3401.11(8)(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 Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11((2)(3) Whole-muscle,Intact Beef Steaks 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#29- Microwave 165F* Special Requirements. 3.401.11(A)(1)(6) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(D) PHFs 165-F 15 sec.* (Items 23.30) 3-403.11(B) Microwave 165'F 2 Minute Standing Critical,mid non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Cotttmercially Processed RTE Food- found in the following sections of the Food Code mid 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portiints of Beef Hem Good Retail Practices .Fc 590.00 Roasts4: - 23. Management and Personnel _ FC-2 .003 18 Proper Cooling of PHF® 24. Food and Food Protection FC-3 .004 25. Equipment and Utensils 'FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water Plumbing and Waste FC-5 .006 70'F Within 2 Hours and From 707 27. Physical Facility FC-6 .007 to 41°F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC 7 .008 3-501.14(B) Cooling PHFs Made Fttnn Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Omer _ Within 4 Hours* .rsvainc�rxax. *Denotes critical item in the federal 1999 Food Cale or 105 CMR 590.000. o Commonwealth of Massachusetts e City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 DATE PRINTED: 08/05/2010 ESTABLISHMENT NAME: Adriatic Restaurant and Bar File Number:BHF-2010-000037 155 Washington Street SALEM MA 01970 _ LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0473 Jul 12,2010 Dec 31,2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31,2010 Board of Health Page 1 F CITY OF SALEM, MASSACHUSETTS t t BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIIvfBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAUNI&ALEnt.COM DAVID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT J%ei r1c l2EST<We^r1QY)W 1V-TEL# !q4s - :594,402- ADDRESS '94- 4832ADDRESS OF ESTABLISHMENT ,ISS W aSh'l;WrOA1 Sl FAX# MAILING ADDRESS(if different) — 5tDL 04 e EMAIL-Business': IY)�D100116r1CM5161(d4M&r' Website: ��/ 3,h t1ra t4a I,A Qcow OWNER'S NAME F-L.IOMiL# y e-0Rri TEL# SSA— ��S- 'R2Yi ADDRESS JS"O LErt)1s 3T 1,y4/V MA- 0/I902- STREET CITY STATE /ZIP CERTIFIED FOOD MANAGER'SNAME(S),QF///l) leap i , CZ0RIj9AJ CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepay ) EMERGENCY RESPONSE PERSON AWL//A-) k0krl Ce'tje/-17S0122- OMETEL# -..p o�(,7YO.C'16�6 DAYS OF OPERATION Monday j Tuesday Wednesdff I . Thursday Fddq Saturday Sunday HOURS OF OPERATION 4A•-SoaAl 11,3D +4"r j W4 3,;�AN 14304,1 Aa. 10 ' Aas� ati( Please write in time of day. (For example Ilam-tlpm) i 42.490414 j 47-0094 42 -,"1" 42-MM ,i 42,W,4M j 42, 301" 'p.,09 9/4 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ----------------------- RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ------------------------------------------------------------- ----------------------------------------------------- ---- BED/BREAKFAST/ YES N $100 CHILDCARE SERVICESMURSING HOME - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES N $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. €'Go r 0 z/off/z0j0 2 ��13i13 �f99 Signature Date //�� Social Security or Federal Identification Number -----_ ------------------ 4 f�'�} - - }ty------------- ------------------------- Revised424/07 FOODAP2008.adm Check#&Date / V ✓� $"I C,�.�IJ EXAM FORM NO. 4503 sevus� e CERTIFICATE NO. 6863060 TO --FL"ORIAN CELA for successfully completing the standards set forth for the ServSafesi Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection ICFP). 1/12/2010 DATE OR EXAMINATION 1 /12/2015 DATE OF EXPIRA'f10N Local laws apply.Check with your local regulatory agency for recertification requirements. NATIONAL "t RESTAURANT ® David Gilbert ASSOCIATION® Chief Operating Officer, National Restaurant Association V #0655 Executive Director,National Restaurant Association Solutions 01009 National Restaurant Association Educational Foundation.All rights reserved.ServSefo and the Servsafe logo are registered trademarks of the Netional Restaurant Association Educational Foundation, and used under license by Nabonal Restaurant Association Solutions,LLC,a wholly owned subsidiary of the National Restaurant Association. This document cannot be reproduced or altered. 08111101 v.0911 EXAM FORM NO. 4503 W � ." CERTIFICATE NO. 6863065 C ° car�0?QC&OT,Va in _ To MERVIN KURTI. for successfully completing the standards set forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). 1 /12/2010 DATE OF EXAMINATION 1/12/2015 DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recertification requirements. t2 NATIONAL l RESTAURANT ® David Gilbert ASSOCIATION@ Chief operating Officer, National Restaurant Association #0655 Executive Director,National Restaurant Association Solutions 02089 National Restaurant Associates Educational Foundation.All rights reserved,SeN$afe and the SewSale logo are registered trademarks of the National restaurant Association Educational Foundation, and used under Home by National cherished d Association Solu vas.UC,a wWty mmed subsidiary of the National Restaurant Assocladem, This document cannot be reproduced or altered. 08721102 v.gatt CITY OF SALEM BOARD OF HEALTH Date: January 26, 2010 Name of Establishment: Adriatic Restaurant & Bar Address: 155 Washington Street Owner: Mervin Kurti Phone: The proposed owners of this establishment Mervin Kurti presented a Floor Plan and Menu for review in accordance with the State Food Code. The floor plan and menu are approved as presented. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. Owner has expressed a desire to have retractable windows for open air dining. Owner must apply for and receive the appropriate variance for such windows prior to installing them. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. A "Person in Charge" or"PIC" must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. Owner to forward copies of all Serve Safe Certificates to the Board of Health FLOOR PLAN A Hand Sink must be located in each food prep and service area. Hand wash sinks are centrally located in the prep areas. The hand sinks must have wall hung soap and paper towel dispenses. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes is available. If a dishwasher is going to be used it must have a final rinse temperature of 180 degrees in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENUIFOOD PREP All food must be purchased from a wholesaler licensed by the State. Fruits and vegetables must be washed prior to preparation. All food must be held at 41°F or lower, or 140°F or higher, at all times. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKED FOODS The advisory was given to the owner. An advisory must be added to the menu. CHOKE SAVING A person trained in choke saving techniques must be available whenever this establishment is open for business. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3rd bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. These must be clearly marked "sanitizer". Outside area of premises, including the dumpster area, must be kept clean and sanitary. TRASH Trash must be kept in appropriate trash receptacles and a grease barrel must be used to hold discarded food grease. The trash area must be kept in a clean and sanitary manner. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. Application and a check have not been received. Please call one week prior to opening to schedule an opening inspection. David Gre nba m Date Acting Health Agent r ` Mervin Kurti Date CITY OF SALEM BOARD OF HEALTH Date: December 7, 2009 Name of Establishment: Adriatic Restaurant & Bar Address: 155 Washington Street Owner: Mervin Kurti & Florian Cela Phone: The proposed owners of this establishment Mervin Kurti and Florian Cela presented a preliminary Floor Plan and Menu for review in accordance with the State Food Code. A final floor plan must be presented prior to construction of the kitchen. The owners must present a final floor plan and a final review with the executive chef must be conducted prior to any operations at this location. Please call the Board of Health to schedule a final review once the final floor plan is c plete. -c7 David Greenbaum Date Sanitarian CIC A,1�a, � I Mervin Kurti Date '11>-c� %2 ZZ l f2-7 Florian Cela GLI SFIZI PARMIGIANA DI MELENZANE $9.00 (E40-plant ParrniQian) FRITTURINA DI POLIPO E CALAMARI $11.50 (FriEd baby octopus and calamari) CARPACCIO DI MANZO Al CARCIOFI $11.50 (BEEf carpaccio with juliEn artichokEs shaved parmesan) SFORMATINO DI SPINACI IN SALSA TARTUFATA $11.00 (Spinach flan with walnuts in tPUfflE parmEsan saucE) FAGOTTINO D'ARAGOSTA IN SALSA DI ASPARAGI $11.00 (LobstEr puff with aspara4us saucE) ZUPPA DI LEGUMI $6.00 (Farro-basEd soup ) It. TAGLIERE $11.50 (MixEd cold cuts) FRUTTI DI MARE $11.95 (MUSSEls and clams sautEEd) CALAMARI ALLA GRIGLIA $11.00 (Grillad calamari on bEd of mushrooms and IEmon saucE) LE INSALATE., INSALATA DI ARUGOLA $7.50 (Aru4ola salad served with applE and pEcorino) MISTA CON POMODORINI ALUACETO ROSSO $6.00 (MixEd 4rEEn salad with chErry tomatoEs) ROMANA AL PARMIGIANO CON OLIVE $7.50 (Caesar salad with OWES) PASTA FRESCA PAPPARDELLA IN POLPA D'ASTICE $19.00 (HomEmadE pasta with IobstEr mEat in fra diavolo saucE) TAGLIATELLE ALLA BOLOGNESE $16.00 (TaP-liatEllE Pasta with mEat saucE) SCIALATIELLI GAMBERI E RADICCHIO $17.50 (HomEmadE hand rollEd pasta with shrimp and radicchio) SPAGHETTI CHITARRA CON CALAMARELLE $18.00 (HomEmadE spa4hEtti with baby calamari cErrY tomato ) LINGUINE POSILLIPO $17.00 ( iAulni with clams in a frEsh dicEd tomato) RIGATONI SALSICCIA E FUNGHI $18.00 ( Pl4atoni with sausagE, mushroom, 4arlic & olivE oil ) RAVIOLI Al CARCIOFI, PANCETTA E SALVIA $16.50 ( artichokE ravioli with crispy bacon, saA-E and buttEr saucE ) LASAGNETTA DI MELENZANE $16.50 (crispy bakEd E44plant lasa4na stuffEd with mozzarEla, chErrY tomato and basil) I RISOTTI RISOTTO NETTUNO $19.00 (MIXEd sEafood risotto) RISOTTO ASPARAGI E GORGONZOLA $17.00 (Risotto with aspara4us and 4orgonzola) RISOTTO ALLA ZUCCA $16.00 ( buttErnut squash risotto ) If You haVE ally SpECial PEgUEStS, pIEaSE fEEI EPEE to ask. WE also offEP OWED frEE pastas DAL MARE TRANCIO DI SALMONE GRIGLIATO $22.50 (GrillEd salmon with IEmon saucE and aromatic hEPbs) FRITTURINA DEL GOLFO $25.50 (FPIEd baby octopus, calamari, mEPluzzo and shrimp) HALIBUT IN SALSA DI ZAFFERANO $26.00 (halibut in saffron saUCE ) CARNE E POLLO AGNELLO AL FORNO $26.95 (Brick oven roasted rack of Iamb with aromatic OlIVE Oil) PICCATINA DI VITELLO AL LIMONE CON ZUCCHINE FRITTE $19.00 (VEal ScalopinE with fPiEd zucchlnE in IEmon saUCE) FILETTO DI MANZO Ai tPE pEpi $25.00 (GPIIIEd filEt mignon with thPEE pEppEPCOPn saUCE) PETTO D'ANATRA ALLE FRAGOLE $22.50 (Par) PoastEd bPEast of duck with strawberry balsamic saucE) FORMAGGI SELEZIONE DI FORMAGGI IMPORTATI CON MOSTARDE DI FRUTTA MaPKEt priCE (A SEIECUOn Of impOPtEd ChEESEs and fPUlt) II form us Of any food alIEP4iES that You may haVE SO WE may pPEpaPE YOUP dish accOPdin4IY. SEPMA You is OUP plEasuPE. LE PIZZE MARGHERITA $12.00 (tomato saucE bufala mozzarElla frEsh basil) SALSICCIA E FRIARELLI $16.00 (bufala mozzarEla, broccoli rabE and sausaW CAPRESE $13.00 (bufala mozzarElla frEsh chErry tomato) ARUGOLA $16.00 (tomato saucE bufala mozzarElla prosciutto aru4ala shaVEd parmi4iano) DIAVOLA $13.00 (tomato bufala mozzarElla spicy salami basil) QUATTRO STAGIONI $16.00 (tomato,bufala mozzarElla,mushroom,ham,oliVEs,artichokEs) MARINARA $10.00 (tomato Garlic orE4ano Extra Virgin oliVE oil) FUNGHI $14.00 (Tomato saucE bufala mozzarElla mushrooms) CAPRICCIOSA $ 16.00 ( Tomato saucE, bufala mozzarElla, mushroom, ricotta & salamE) SORRENTINA $15.00 (SmokEd mozzarElla, frEsh chErry tomato, EeP-plant, basil) Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Dat ' I T e of Operation(s) Type of Insoection Mr, c_iS T1 Food Service ❑ Routine Address I �_ f_ Ri ElRetail 'ORe-inspection n� a Level ❑ Residential Kitchen Previous Inspec)ion Telephone 5 ❑ Mobile Date: 6/ Owner HACCP Y/N [I Temporary ElPre o�rati n(� ( kJ177 I ❑ Caterer ❑ Suspect Illness Person in Char§6(PIC) / Time ❑ Bed&Breakfast ❑General Complaint InP(,d5 ❑ HACCP Inspector a Outh-Z��, 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 Illiesslnterventionsand Risk Factors "A , Anti-Choking _Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) E?� s9o.009(F) ❑ action as determined by the Board of Healtt - t FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH- _ --- -- -- - PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC -" ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ ❑ 15.Toxic Chemicals 'FOOD APPROVED SOURCE TIMFJTEMPERATURE CONTROLS(Potentially Hazardous Fooda)� ❑ 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 [118. Cooling PROTECTION FROM CONTAMINATION ^r k.. j _ _ ❑ 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.(HSPji ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER ADVISORY 0 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-z)(ss0.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(5so.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: / s:s&o�nspecrFomia'-ta.oa /V� Inspector's Signature: Print: PIC's Signature: Print: (n Q Page)of CPages Violations Related to Foodborne Illness , Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I I 590.003(A) Assig ment of Res onsibili * 3-302.1.](A)(i.) Raw Animal Foals Separated from Corked and RTE Foods* 590.003(B) Demonstration of Knowled e* Contamination from Raw ingredients 2-103.11. Person in charge-duties 3-302]1(A)(2) Raw Animal Foods Separated frimzEach Other* EMPLOYEE HEALTHContamination from the Environment 2 590.003(0) Responsibility of the person in charge to 3-302.11(.A) Foal Protection* require reporting by ford employees and 3-302.15 Washing Fruits and Veg applicants* stables ------ 3-304.1.1 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Char r e* 590.003 G Reporting by Person in Charge* 3-306.14(AILBL Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* DisposdionofAduUeratedorContamieated Food 590.003(E) Removal of Exclusions and Restrictions 3-70111 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE _ F� 4 Food and Water From Regulated Sources -� 9 _ Food Contact Surfaces 590.O01(A-B) Compliance with Food Law* --{ 4-501.111 Manual Warewasbing-Hot Water 3-201.12 Food in a Hermeticall •Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products' 4-5011 t2 Mechanical Warewashing-Hot Water 3-202.13 Shell E gs* Sanitization Tem eratures*. 3-202.14 Eggs and Milk Ptuducts,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 4-60 L I I(A) Equipment Ford Contact Surfaces and S-IO.I.'L l DrinkingWater fmm an Approved System- Utensils Clean* 590.006(0) Bottled DrinkingWater* 4-602.1.1 Cleaning Fre uenc of Equipment Food- 590.(H)6(B) Water Meets Standards in 310 CMR 22Contact Surfaces,and Utensils* Shelttrsh and Fish Froman Approved Sourcece 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 Re MatoAuthorrt 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* 3-201.1.7 Game Animals* It 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 ince rit * Mouth* ;3-10'1.11. Food Safe and Unadulterated* 3-30112 PreventingContamination When Tasting* 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from. 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11. Numbers and Capacities* - 590.004(f) Labeling o1 Ingredients' 5-204.11 Location and Placement* � Conformance with Approved Procedures 5.205.11 Accessibility,Operation and Maintenance tHACCF Plans Supplied with Soap and Hand Drying 3-502.11. Specialized processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301..1.2 Hand Drying Provision *Denoues critiad item in the federal 1999 Food Cate or 105 CMR 590.000. CITY OF SALEM f BOARD OF HEALTH Establishment Name: d r, n , l� <., cf _� Date: Page: of vZ Rom -Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date, . No. Reference R-Red Item Verified n PLEASE PRINT CLEARLY } /J Discussion With Person in Charge: Corrective Action Required: ❑ No Y60— I have read this report, have had the opportunity to ask questions a ree to correct all Voluntary Compliance ❑ Employee Res 'ction inspection, to observe all conditions a�described, and to Exclusion violations before the next ins P El Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I ffderstandlb noncompliance may result in daily fines of tw,' y--five.dollars or suspension/revocation of Ll Embargo El Emergency Closure your food permit. // ❑ Voluntary Disposal ❑ Other: 3-501,14(0 PHFs Received at Temperatures Violations Related to Foodborne fliness interventions and Risk According to Law Cooled to Factors iltemsY-22) (Cant.) 41'F/45'F Within 4 Hours, PROTECTION FROM CHEMICALS 3 501..15 CoolmE Methods for PRFs 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(M 410145'F* 3-302.14 Protection from Unapproved AdditivesiQ 3-501.16(.0) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances _ 140` * 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1WR " Containers* 20 Time as a Public Health Control 7-102.11. Common Name-Working Containers* .3 7-301.11 S araiion-Stora * 3-501.19 Time as a Public Health Cnntnai* 7-202.11 .Restriction-Presence and Use* - 590.004(Hj Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) - 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for WashingProduix,Criteria* 21 3-801.17(A) Unpasteurized Pre-packaged Juices and 7-204.14 Agents.Criteria* BevrraLes with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(6) Use of Pasteurized Eggs* 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 Rodent Bair Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 14 Proper Cooking Temperatures far Animal Foods Thar are Raw,Undercooked or Not Otherwise Processed to Eliminate PHFs Proper Pathogens.'`"°'"°'"''ten 3401.11A(1)(2) Eggs- 155°F 15 Sec. 3 E *s-immediate Service 145'F15sec* -302.13 Pasteurized Eggs Substitute for Raw Shell E 3-401.11(A)(2) Comminuted Fish.Meats&Game " Animal's-155'F 15 sec.* 340LI I(B)(1)(2) Pork and Beef Roast- 130°F 121 mit* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see.* catering,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3401.11(C}(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145*F* 590.009 violations relating to goal retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401a(A)(1)(b) All Other PRFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRACTICES 3-403:11(A)&(D) PHFs 165*F 15 we. * (Items 23-30) 3-403.11(B) Microwave 165`F 2 Minute Standing Critical,and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above,can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections.of the Food Cade and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef Item I Goad Retail Practices 19FC 590.000 Roasts*: LP3._ i Ma adamant and Personnel -FC-2 .003 18 Proper Cooling of PHFs 1 24, 1 Foal and Food Protection I F-C-3 .004 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PIFs from 140'F to 26. Water.Plumbing and Waste T i FC-5 .008 , 700F Within 2 Hours and From 70'F 27. Physical Facifi FC-6 .007 to 410F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FG-7 .008 3-501.14(6) Cooling PHFs Made From Ambient 29. --Special Requirements .009 if Temperature Ingredients to 41'F1456F 130' I Other Within 4 Hours* s:nvne:,ma..ua.c. "Dmites critical hem in the federal 1999 Food Cade or 105 C-MR 590.000. 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 NameAd D t Tvoe of Ooeration(s) T e f Inspection _ �U 144 It ood Service Routine Address ) ,S l� Risk El Retail Re-inspection Level [IResidential Kitchen Previous Inspection Telephone ❑ Mobile Date: Ownerl T �Y HACCP W ElTemporary ElPre-operation C G ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) f 7 Time ❑ Bed&Breakfast ❑General Complaint In: yaJ ❑HACCP Inspector Out Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Chokin Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E))2 590.005(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT "� El 12. Prevention of Contamination from Hands [11. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EwOWYEE HEALTH,_ - g- FROM CHEMICALS ElPROTECTION 2. Reporting of Diseases by Food Employee and PIC --`-"" El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives LFOO.D FROM APPROVED SOUREl 15.Toxic Chemicals CE s_ ❑ 4. Food and Water from Approved Source TIM EMPERATURE CONTROLS(Poterdlally 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 B. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control - - i__ �9. Food Contact Surfaces Cleaning and Sanitizing CREOUIRE_MENTS FOR HIGHLY SUSCEPTILILE_POPULATIONS.(HSP}' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices [CONSUMER.ADVISORY ❑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 x 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 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: 5:5901nspeclFamb-ta.aa r'l�h./ �K a �( ( Inspector's Signature: Pri `PIC's Signature: }�wwl (LEP-120 Page- i of /Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION $ Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)0) Raw Animal Foods Separated from 1 5911.003(.0) Assignment of Responsibility* Cooked anti RTE Foods* _ �J 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in char e-duties 3-302.1.1(A)(2) Raw Animal Foods Separated from Each. Other" EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Fiord Protection* require reporting by food employees and 3-302,15 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Foal Employee Or An Applicant To Repot To The Person In Utensils* Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Foal* 590.003(G) Re orcin by Person in Charge* 3 590.003(D) Exclusions and Restrictions* Disposdiono/AdulteratedorContaminated Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 . Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.0(9(A-B) Compliance with Foal Law* 4-501.111. ManualWarewashing-Hot Water 3-201.12 Food ma Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.,13 Shell Eras* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 Donkin Water from an Approved 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 Foal= Contact Surfaces and Utensils* Shelrsh 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 SanirizaGon-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild b1ushmoms Approved by 2-301.11 Clean Condition-Hands and Arms* Re Mato Authork 3-202.18 Shellstod,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 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and . 3-202.1.5 Package Inte rite* Mouth* 3-101.11 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* i 590.004(E) Preventing Contamination front 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destructiot* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of ingredlents` 5-204.11 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility, Operation and Maintenance /HACCP Pians Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices- 'k 3-502.12 Reduced ox Qen acka �ng,criteria* 6-30f.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301..12 Hand Drying Provision '*Denote,,critical item in Phe federal 1999 Fond Cale or(0i CY1R 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: =� 6 �o ,/�t Date: r (I Page:_ of 3. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data No. Reference R-Red Item Verified / ��ll (( 1 i ) PLE°APSE PRINT CLEARLY 1 Cscmo+4 au .`JJ I G7 eA 1r,-4l JJ /n� .Se11 �e LIQ \/°n IS GI Q CQ. 11 ,A Cl 4— Lr n L .Q¢ i^ vS /i Ktn CvYI /.fir d(Aa6 s.nc t' Gc n iG. L 2 G-lip - n la— 000 G1�2e �- v� J t7 A C_ OKi 1. } i S�vl It?S� 1lQl I1� gz, Discussion With Person in Charge: Corrective Action Required: ❑ N Rcr Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ v untary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and Emersion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Cie. I undersea Ind that_ noncompliance may result in daily fines of two,, lv�ollars or us e sion/r ocatiori c ❑ Embargo ❑ Emergency Closure ' your food permit. ❑ Voluntary Disposal ❑ Other: F 3-501,14(C) PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors{hems!-22) (Cant.) 41'17/45°F Within 4 Hoots. PROTECTION FROM CHEMICALS 3-501..15 Coolin Methods for PHFs C6t 14 Food or Color Additives19 PHF Not and Cold Holding 3-50L16(B) Cold PIiF*Maintained atorbelow 3,202.12 Additives* 590.004(17) 41 3-302.14 Protection from Unapproved Additives" 145°F • 3-501.l6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1400E * 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F." Containers" 20 Time as a Public Health Control 7-102.11. Common Name-Working Containers* * 3-500 4( Time ac a Public me nth Control* 7-201.11 Separation-Storage 7-202.11 .Restriction-Presence and Use* 590.004{H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for WashingProduce,Criteria* 21 3-801.11(0.) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria' .Bevm,ges with Warning Labels* 5.11 Incidental Food Contact Raw or Partially Cooked Animal Food and Lubricants* 31MLI1(B Use of Pasteurized Eggs* 7-20 7-205.11 -Restricted Use Pesticides;Criteria s 3-801.11(D) Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.11 C Unopened Food Package Not Re-served. 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of ]6 Proper Cooking Temperatures far Animal Foods That are Raw.Undercooked or PHFs Not OtherwiseProcessedto Eliminate Pada*ens.* 3-401.11A(i)(2) Eggs- 155017 15 See. t e ere orae r Eggs-Immediate.Service 145°Fl5sec* 3-302.13. Pasteurized Eggs Substitute for Raw Shell 3-401.i 1(0.)(2) Comminuted Fish.Meats&Game EggO Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 3.401.I1(13)(1)(2) Porte and Beef Roast- 130'F 0121 min* 3-401.11(A)(2) Ratites,Injected Meats-155OF 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 under the appropriate sections Poultry or Ratites-165017 15 see, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145'F 15 sec, 19 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.I I(A)&(D) PHFs 165"F 15 see.' (Items 23-30) 3-403A I(B) Microwave--165'F 2 Minute Standing CHricul,and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections-of the Food Code and 105 CMR 140017"` 590.000. 3-403.11(E) Remaining Unsliced Portim of Beef Item 1 Good Retail Practices FC 590.000 I Roasts* 1 23` I Management and Personnel -FC-2 .003 1 Fo 18 Proper Cooling of PHFs 1 24.. Food and Food Protection FC-3 .004 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140OF to 26, Water.Plumbing and Waste FC-5 .006 70'F Within 2 Hours and From 70'F 27. 1 Ph real Facies to 41'F/45'F Within 4 Hours.* 26._ Poisonous or Toxic Materials ! FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41017/45°F 30 i Other 1--- Within 4 Hews" "Denotes critical iwm in the ledcrsl 1999 Foci Cate or 103 C.MR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: lr�f/ 7r KeSUnF C.�c� IW41r- Date: Page: 3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date" No. Reference R-Red Item Verified t � P ASE PRINT CLEARLY I 1/ I I . L 1A 04,J f'OC4 ✓1(`2 N . S (CLcw lQ (? — �v fes' Go r S _ r ?; q r 1;,7 /--CI A1C AYE. 2 r ¢n J �f G PS ri t7 . I lr CL c !cC ( /nG� D c-rN sv C Q of Discussion With Person in Charge: f 1 Corrective Action Required: ❑ No Y I have read this report, have had the opportunity to ask questions and agree torcrectall ❑ Voluntary Compliance ❑ Employee Restriction I P PP Y q 9Exclusion violations before the next inspection, to observeall<c3nditions as described, aninspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Foo ode. I undersj ndzMat I noncompliance may result in daily fines of t Inty-f', ' dollars or snspension/revocation/of C3g Embargo Ll Emergency Closure j� ,your food permit. �' ❑ Voluntary Disposal ❑ Other: d r 1 3-501.14(C) PHR 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 Hours. PROTECTION FROM CHEMICALS 3-5O1.15 Coolie Methods for PHFs 14 Food or Color Additives 19 PNot and Cold fid 3-SOI..i 6(13) Cooll d PIIFs blainU»nened at or below 3-202.12 Additives* 590•004(F) 410/45'F* 3-302.14 Protection from Unapproved Additives" 3-50IA6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140�F 7-101.11 tdentif}ing Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* - 7-162.11. Common Name-Working20 Containers* Tuna as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 .Restriction-Presence and Use* 590.p04(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals' POPULATIONS HSP 7-204.12 Chemicals fere Washit Produce,Criteria* 21 3-801.11(A) Unpasteurized Pte-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning labels* 7-265.11 Incidents]Food Contact.Lubricants* 3-801. Use of Pasteurized Eggs* 7-205.11 Restricted Use Pesticides;Criteria*' 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served 7-206.12 Rodent:Bait Stations* 3-801.11(C) Unopened Food EaekaE Not RL-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-617.1.11 Consumer Advisory Posted for Consumption of Animal Fonds That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 16 Proper Cocking Temperatures for 3-401.11A(i)(2) Eggs- 155F 15 Sec. Pathogens.*�nw,nrzaer E *s-Immediate Service 145'Fl5sec* 3-302.13. Pasteurized Eggs Substitute for Raw Shell 3-0Ol.I I(A)(2) Comminuted Fish.Meats&Game E * Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3.401.11(13)(1)(2) Pork and Beef Roast-130'F 121 mm* 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 Poultry or Ratites-1650F 15 sec * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3.401.12 Raw Animal Foals Cooked in a practices should be debited tinder#29- Microwave 165'F* Special Requirements. 3401 I UM(1)(b) All Other PHFs-145 F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) PFIFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165`P 2 Minute Standing Critical.and non-critical violations,which do not relate to the Tisa* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- }'bund in the folloning see,tions.gf the Food Code and 105 CNR 1400F* 590.000. 34012.11(E) Remaining Unsiiced Portions of Beef Item I Good Retail Practices FC 590.000 Roasts* 23_ 1 Management and Personnel FC-2 .003 .t e 18 Proper Cooling of PRFs 24.. Faxl and Food Protection I FC-3 .004 25. Equipment and Utensils J FG-4 =5 3-501.14(A) Cooling Cooked PRFs from 740`F to 26, 1 Water.Plumbing and Waste 1 FC-5 406 70`F Within 2 Hours and From 76'F 27, I Plasicai Facitiry FC-8 .007 to 41`F/45'F Within 4 Hours.* 28__-t Poisonous or Toxic Materials I FC-7 .008 3-56LM(B) Cooling PRFs Made From Ambient29. S ectal Requirements .009 Temperature Ingredients to 41'F/456F 30 1 Other Within 4 Hours* *Denotes criticat item in the Lderal 1999 rc d Co&or 105 CMR 590.000.