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MARCS MARKET - ESTABLISHMENTS Mares 444f 10i 51 tigrber Strct� ftNIVERSALS UNV-12110 J MADE IN USA SUSTAINABLE MN pE�y.� FORESTRY CDNIF37f10%® l unnnnR C.tftd Rear Sm,cJOq �T mvw.ffipmorem aro fI u1:W Commonwealth of Massachusetts ` City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/19/2011 ESTABLISHMENT NAME: Marc's Market File Number:BHF-2004-000029 51 Harbor Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2011-0335 Jan 1, 2011 Dec 31,2011 $280.00 TOBACCO VENDOR BHP-2011-0336 Jan 1, 2011 Dec 31,2011 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l, 2011 Is 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 aI BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL F Ax(978) 745-0343 MAYOR DGRl_LNBAUM(fe7(SALL':M.CONI DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT / NAME OF ESTABLISHMENT 07) Le TEL# ADDRESS OF ESTABLISHIADNIT-eLl "96):! 5 -T FAY# 4-G ' MAILING ADDRESS(if different) EMAIL- Business': Website: OWNER'S NAME f CCV_k 7-0 .L f'4,0 TEL# 929 2( 2 J ZoYf ADDRESS 43 ft i kt C 16 ST 94 L ,4 GhI D 19 7D STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION° , - Monday u Tuesday;,_`; -zWednesday j :Thursday--; Fnda'= , Saturday HOURS OF OPERATION Pleasel For example 11am-11pm) �_7A,/D I' ,jf- to f 7Alqo !74 , 74- 10 74 ,lo.f. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. $ 7 1000-10,000sq.ft. 280 more than 10,000sq.ft. =$420 -- -----------------------•-------------------------------------------------------------------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$2.10) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO 5 '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 nd paid all state taxes required under t law 2 67 �/ S' afore Date Social Security or Federal Identification Number Revised lo/7/11 FOODAP201 Ladm Check#&Date I 6�� Commonweakh-of Massachusetts s City,of Salem 110"ofHealth-- Kirnbetiey Dtiscott 120 Washington Street,4th Floor Mayor SAL M,MA-,01970 FoodMetail.Establishment Permit- DATE PRINTED: . 01/1212010 ESTABLISHMENT NAME:" " Marc's-Market- File arc's Market-File Number.BHF-2004-09W29 - ...51 Harbor Street Salem MA 01170' LOCATED AT: SALEM, MA 01970 Permit Type Permit No: Perruit-Issued-Permit Expires.- Fee_Restrictions(Notes RETAIL FOOD BHP-2010-0316 Jan 12,2010 Dec 31,2010 $280.00 TOBACCO VENDOR BHP-2010-0317 Jan 12,2010 Dec 31,2010 $135.00 Total Fees: $415.00 i PERMIT EXPIRES ecetnber 31,201A- Bbarttof`ffes[lth_ This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beotre any revomatfow,-improvements;or equipment-ehanges are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS + s BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KRABERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRr•.EN6AUM@SA1,Em.COM DAVID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMITTOOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT44LW L" S, /,�el�>l TEL# .97 ADDRESS OF ESTABLISHMENT �Lr/E/¢iR�iOd ST: FAX# H. MAILING ADDRESS(if different) EMAIL- Business': 12 Website: K OWNER'S NAME JU-aK 7-0�^,ry4i`6 TEL#__Q7$-L/2!-bldQf ADDRESS 4/3 t,"ktLr(°P $ 7- -f4L660 ay14 D/ p STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday Tuesday Wednesday, Thulsda Fdday' Saturday Sunday HOURS OF OPERATION i Please write in time of day. Forexam ellam-17 m 7a- /0/ !7Q -/0 to i7 7 a- /P 74E 16 7 a /O ;] -CL 74 TYPE OF ESTABLISHMENT FEE (check only] RETAIL STORE YE NO less than 1000sq.ft. =$70 1000-10,000sq.ft. r28Q more than 1 0,000sq.ft. =$420 --- --------------------------------------------- ------------------------------------------------------------le-ris----------- ------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 --------------------------------------------------Y-------ES------id $---10-------- BED/BREAKFAST/ NO 0 CHILDCARE SERVICESMURSING HOME - - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $13 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. ///7//o 2,4�(4 v;! y 41 Signature Date Social Security orederal 1 ratification Number $ — --------------------------rr—��--}�--------- ----------- Revised 42 54/07 FOODAP2008.adm Check#&Date[V `,� CITY OF SALEM BOARD OF HEALTH Name of Establishment: Marc's Market Address: 51 Harbor Street Owner(s): Juan Toribio Phone: 978-745-8260 (c) 978-429-6099 The owner of this establishment presented floor plans for this establishment for review in accordance with the State Sanitary Code. The owner would like to include meat slicing as part of this operation. A three bay sink, a hand sink and a stainless steel prep table have been added to accommodate the meat slicer and the repackaging of meat products. PACKAGING AND LABELING Deli meats and cheeses may be sliced, the owner may start this operation effective 11/12/09. A scale, certified by the Sealer of Weights & Measures must be used to weigh the meat. The owner is hereby granted permission to re-package meats ONLY. There shall be no cuttingof meat such as chicken pork or beef. Th , p e packages for sale to h p g to public must have a label with the following information: type of meat, weight, price per pound, sell by date, name and address of the store. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station. 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". BARE HAND CONTACT WITH READY TO EAT FOODS There shall b n bare hand contact with any ready to eat foods in this establishment. Ton s, de ' p r, gloves must be worn. ),Z-o a id Greenbaum Date Acting Health Agent ii -Z1� JT ri io Date Translator Fr dy Guerrero ate S f2 C! U 'u C.aac i TS w M ----.- 2 1/Gx '72rr LA b.Xz 4&p X 2 ii k N a X � -cz CP y Qi zt, N aver. tlS�9� P�J-N �� I raza� r� �a�7 2 x x s1W v .'X� � k a2x�Baauv2 4 V14-1 R. M JC V V L? IMPORTANT MESSAGE FOR id ��77t , DATE y /TIME`S I T•5A.M M n�IACU 1 1c7T11�IO� IySDY11 OF.tY 11v1� (�Ul-y�t1 PHONE AREA CODE NUMBER EXTENSION O FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE PALL CAME M SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH u RETURNED YOUR CALL - WILL FAX TO YOU MESSAGE .rQJ �,_ I 4- SIGNED FORM 4009 MARE IN U.S.A. S310N �A IMPORTANT MESSAGE FOR 1v C. M Y (lW 0L(r2. OF Mcacs Mane PHONE AREA CODE NUMBER EXTENSION 'a O FAX O MOBILE k AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAMETO SEE YOU WILL CALL AGAIN "WANTS SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE 'IN i�lb SIGNED FORM 4009 1�1 MADE IN U.S.A. NCTFS -For CJ 6}6Y►tpto_gin��ezY.r_.avid c�t1'ih �'o_cCv��s(ic e._c�¢,ii_hc�-eta• C��c,l_eMetil�ually istti olnaawd�,��. F ORTANT MESSAGE S%e�PC,1tUrSI/, S/`/11 )0 TIME �P.M. Mj,��o,I((rCA _ OF ,L -7 p S 11� Z�� PHONE__..._. !& U 1- S� 1 / 1 k AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL, CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL WTO YOU _1 —d MESSAGE p`-,,,,'ins o2C-r1(i/\ SIGNED FORM 4009 ■■■■ter MADE IN I0 9 NOTES s Iiil1PORTANT MESSAGE FOR A.M. DATE }��U� TIME P.M. OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED . PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN s WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU R MESSAGEZ SIGNED �4 FORM U008 �ps NUTFS CITY OF SALEM BOARD OF HEALTH Name of Establishment: Marc's Market Address: 51 Harbor Street Owner(s): Juan Toribio Phone: 978-745-8260 (c) 978-429-6099 The proposed new owner of this establishment presented floor plans for this establishment for review in accordance with the State Sanitary Code. The proposed owner would like to include meat slicing as part of this operation. The floor plan calls for installation of a 3 bay sink to wash all equipment and utensils, hand sand and stainless steal prep table. Also to be constructed is a type of barrier to portion of the retail space from the prep space. ITEMS FOR SALE All food items displayed and offered to the public must be from an approved source permitted as a Wholesaler from the Mass Department of Public Health. FLOOR PLAN All surfaces must be intact, impervious and easily cleanable. All refrigeration units must have accurate internal thermometers. Refrigerated food must be held at 41 degrees Fahrenheit or lower, freezers at 0 degrees Fahrenheit or lower. EXPIRATION DATES All expiration dates on products must be clearly visible. Out dated items must be promptly removed from display. HAND WASHING All hand sinks must have wall hung soap and paper towel dispensers, and must be stocked at all times. TRASH There is an area for storage at the exterior of this building. At this time this establishment will us municipal pickup. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. Outside area of premises must be kept clean and sanitary. PACKAGING AND LABELING Deli meats and cheeses will be sliced. A scale, certified by the Sealer of Weights & Measures must be used to weigh the meat. The owner does not have permission to re-package meats at this time and there shall be no cutting of any meat. The packages for sale to the public must have a label with the following information: type of meat, weight, price per pound, sell by date, name and address of the store. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. Mr. Toribio is set to take the ServSafe course on April 4 and April 11. Once course is complete owner must provide proper documentation of this certification. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station. 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 3`d 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". The new owner also hopes to be able to repackage meats in the future. At time of review it was agreed upon that deli slicing of deli meats would occur. At three months a follow up inspection will take place at which time it will be determined if this establishment and owner can take on the responsibility of re-packaging meats at this location. BARE HAND CONTACT WITH READY TO EAT FOODS There shall be no bare hand contact with any ready to eat foods in this establishment. Tongs, deli paper, gloves must be worn. New owner plans to take over on Please call one week prior to schedule a change of ownership inspection. An opening inspection will be conducted a few days prior to opening. Janet Mancini Date Acting Health Agent Juan Toribio Date Translator Freddy Guerrero Date Commonwealth of Massachusetts ` City of Salem Board of Health Kimberley Driscoll IS QW, 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 04/09/2009 ESTABLISHMENT NAME: Marc's Market File Number:BHF-2004-000029 51 Harbor Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2009-0434 Apr 9,2009 Dec 31,2009 $280.00 TOBACCO VENDOR BHP-2009-0435 Apr 9,2009 Dec 31,-2009 .$135.00 Total Fees: $415.00 PERMIT EXPIRES December 31, 2009 Board of Health aiht This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4".FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR IMANCIN12SALEM.COM JANET MANCINI, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT-nar(,r5 A -r1� ' t TEL# 9 ]£� -7G5- 6?(00 ADDRESS OF ESTABLISHMENT IrAG r bcx- Sa FAX# MAILING ADDRESS(if different) EMAIL- Business': Website: OWNER'S NAME ,1 . \oribi 0 TEL# Clr)�) 42G - (.POgq'. ADDRESS 43 _PrIv)Cf <c1 s6ltyeyn "VA C)\q STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# ;DAYSOF'OPERATION . ' ':; Monda " '_ 'ry> TuesdayWednesday.­,,, Jhursda Frida '. .,' Saturday Sunda:, HOURS OF OPERATION Please write in tune of day. j (Forexample Ilam TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. =$280 more than 10,000sq.ft. $ -------------------------------------------------------------- ---------------------------------------------- ---------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YESNO $100 CHILDCARE SERVICES/NURSING HOM------------------------------------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE Y TOBACCO VENDOR Y1E NO $135 ALL NON-PROFIT(such as church kitchens) YES "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. X 1)iS7 `Z5Z- p Signature Date Social Security or Federa Idenfification Number ---------------------- 7�- -- - --------- Revised 424/07 FOODAP2008.adm Check#&Date $ Commonwealth of Massachusetts s e City of Salem Board of Health lGmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 0112712009 ESTABLISHMENT NAME: Marc's Market Fite Nuntff;BHF-2004-000029 51 Harbor Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-20030382 Jan 23,2009 . Dec 31,2009 $70.00 TOBACCO VENDOR BHP-2009.0383 Jan 23,2009 Dec 31,2009 $135.00 Total Fees: $205,00 PERMIT EXPIRES (December 31, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page t , h ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978)741-1800 KIMBERLEY I)RISCOLL FAX(978)745-0343 MAYOR lMJ\NC1N1 a-;AJ E i.COM JANET MANCINI, ACTING HEALTH AGENT 2009 APPLICATION FQR RM TO Q TEL# 4 /ERATE A FOOD ESTABLISHMENT ?�} �/ A/ " " v NAME OF ESTABLISHMENT--_���d---I—.•I ADDRESS OF ESTABLISHMENT r" IL hd�Y`�" FAX# MAILING ADDRESS(if different) l� EMAIL-Business': _Website: 7 OWNER'SNAMEC� TEL#1 ADDRESS �� 1S61 k STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous fois prepared) ^.��`���•f n n�� EMERGENCY RESPONSE PERSON x\ HOME TEL# WM-11PmJ RATION . =Mond Tuesd ,�Wednesd Thur ' �Frid ;'.Saturday. Sunday I w' a aY_� ERATIONS q A �(?� ne of day. I�d i —•----� "'� 1 /.. /// ' .1/( , TYPE OF ESTABLISHMENT j 1 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 NO $100 CHILDCARE SERVICES/NURSING HOM ••.................... ............... .......... .......... ... ............. ..........• ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE NO $25 TOBACCO VENDOR t NO $135 ALL NON-PROFIT(such as church kitchens) YES Q3 $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 Sta nitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to approved by the Salem Board of Health. Pursuant to MGL Chapfer 6 ion 49A,!certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax ret d paid all tate t fired under the law. 1�2- OZ5, -69- 02-1 Sign tore Date Social Security or Federal Identification Number Revrsed424107 FOODAP2008.adm Chmk#&Date ..—...-- EXAM FORM NO. 4436 CERTIFICATE NO. 6403618 AffSafe® Cert/f/Catl n O J�.U�A � a O 1 BTO , , ..: .. for successfully completing the standards set forth for the ServSafee Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI-Conference for Food Protection(CFP). 4/11/2009 DATE OF EXAMINATION 4/11/2014 _ DATE OF EXPIRATION ' Local laws apply.Check with your local regulatory agency for recertification requirements. NATIONAL RESTAURANT ® David Gilbert ASSOCIATION Chief Operating Officer, National Restaurant Association 80866 Executive Director, National Restaurant Association Solutions 02009 National aedaurentAssadadon Educational Foundation.All dghtc reserued.SomSale and the SereSsfe logo are registered tradematka of the Nagonal aemurentAecociallon Educational Foundedon, end used under Homes by National Rattsumm Asaoeladon Solutions,I.I.C.a wholly owned subsidiaryof the Nodonsl lieetauramAseociadon. This document cannot be reproduced or altered. ' 09121102 v.09M CITY OF SALEM BOARD OF HEALTH L Establishment Name: I Y 1 c-'fCS I V I CLQ �� l Date: L� // n k)c:i _ Page: of Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference "R-Red Item - - - Verified PLEASE PRINT CLEARLY Ah pale o ws Ind r pn Ci_ CJYI t fc..{P ( P:5 fCD h 15 i�tSLvI f S L ( u y\a Ln. 4Z� w I� aY� i ht t tn�f rj er a ( (S t e( + a l( rt'rr( I � t � �{'eeb�l5h fi � ( e -rl;•lu -f' �'a� 1 ' cuiti /5 iclvt� vv c tG1t✓�G I 9uvrt i ( 1 i I (1 ( KQc t LtrN rjU ,j/j+ V zh Cold iK- kit G ure 6 r m�� -e dzwo - � t� C 5� i tnc o - r Kk.�S �x.rS• `� 1 f saua v 1 <Dam c i I lesf-) 1- kaa c ni-fcWi an Discussion With Person in Charge: Corrective Action Required: ❑ No. ` ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont-) 41'F/4YF Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Calor Additives 19 PHF Hot and Cold Holding d- e --- 3501.16(B) Cold PRFs Maintained at or below 3-302.1 Adtectio* 59Q004(F) 41°145° F" 3-302-14 protection foam.Una roved Additives* 3-501.I6(A) Hot PHFs Maintained at or above IS Poisonous or Toxic Substances 140°F. * 7-101..11 Identifying Iufonnxtion-Ori fi nal 3-501A6(A) Roasts Held at or above 130'F. Containers` 7-1.02.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Se oration-Stontge* 3-001.19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence and Use 590.004(1!) Variance Re uirement 7-202.12 Conditions of Use- 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizees.Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.12 Chemicals for Washing Produce,Criteria" 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.74 Dr nn � guts,Criteria* Beverages with Warning labels* 7-205.11 Incidental Food Contact. Lubricants* 3-801.11(B) Use of Pasteurized E,,-s* 7-206.11 Restricted Use Pesticides-Criteria* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed S routs Not Served. 7-206.12 Rodent Bait Statrotts" 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and lYoniforing* CONSUMER ADVISORY T_I_MEITEMPERATURE CONTROLS 22 3-60311 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Foods That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate E'r rcvo 3-40'1-I1A(1)(2) Eggs- 155'FISSec. Pathogens.* rw2061 Etas-humediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.1].(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155°F 15 sec. 3-40 1.11(B)(1)(2) Pork and Beef Roast- 13(T'F 121 min" SPECIAL REQUIREMENTS 3-401.1'I(A)(2) Ratites, injected Meat's-155`F 1.5 59(),()()9(A)-(D) Violations of Section 590.009(A)-(U)in see. * catering, mobile food, temporary and 3-401.1,I(A,)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Red tes-165'F 15 sec.* above if related to foodborne illness 3-101.11(C)(.3,) Whole-ronMe,Intact Beef Steaks intetveutionsandrisk factors. Other 145`1^<: 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave ki5"F* Special Requirements. 340 1.11(A)(1)(b) All Other PHFs--145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and nun-critical violations, which do not relate to the Time" foodborne illness interventions and risk fo<tors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and LOS CMR 140'F* 590.000. 3_403.1I(E.) Remaining Unsticed Portions of,Beef _Tte_m­_T Good Retatl Practises FC 690000 ---- Roasts 9 ____-_, - FC-2 .003 .* ana ament and Personnel -_ _ Ig Proper Cooling of PHFs 24. Food and Fond Protection _ FC--3 _ 004 25 Equipment and Utensils __FC 3-501_14(A) Cooling Cooked PHFs from 140`F to 26__ Water.Plumbin and Waste FC 5 '' .008_ 70°F Within 2 Hours and From 70'F 27. Ph slcal Facility FC-6 +j-.007 to 417/450F Within 4 Hours. ` 28. Poisonous or Toxic Materials FC-7 ' .008 3-50L 14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 'Temperature'Ingredients to 4l`F/45°F a67-- Other Within 4 Hours* Denotes cr ow]item in the&deral 1999 Food Coda or IM CMP,590 000. Inspection of �! `.(� ((' .`v�fi ( fl I Date A 1� "� Time Name Address Owner r � r � 1+ , i Tel. No. i Type of Inspection '. -r - -�.'`�" ^,,c:VN o t 6Y' Inspector ( ' I Remarks and Violations are listed below: U ,rt .?4 c . fi( A -ri(0 Ct A-,)k 1 .-.'.I� Y) ,1 C i Jrl � J ;0 , A f ,�T I IC- J � 1 C..1 _c�«�C 'c� l�l dlv ,c r" )9ur( , Report Received by: 7 i CITY OF SALEM i g130 BOARD OF HEALTH ( Establishment Name: C S imaf [4 Date: U f6 /OG Page: I of t Rem Code C-Critical Item ''r ` ; x DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified A PLEASE PRINT CLEARLY A _�lwrfve QrsGf in�I P�fioN (., )as conduc -fPcI DlylrJ i o I hw i�G ul-c'A'e to �Pc �t Q �� v covers on ail 4z kfs (3 eX 4- S).rk)ico Dc f YCty CL a` Ih o P�cy h �1,5 ✓YL2v1 { O y� S Ct ��C.JJCa Q f, Cl .,�A �_ , o i' T - 1 Lt o t Vn_ K C��7 . <w rs ! c'o n ..Vo 11 Y 2 PVl rs-r7 r TF lJPS S Li t I - t rk *,II Ihel (o�nG, nG +n In�kal( �h� 51n r� 1ce.bl � ar�� ho tO COY bODL-kd 'Pa ltk f, 6 n r M r,I o Of. rye —in-) { 1 � I i i Discussion With Person in Charge: Corrective Action Required: ❑> No ' ❑ �Yes d 7 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 nd to Exclusion P p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understar}d that noncompliance may result in daily fines of twenty-five dollars pir ssuu4ppensloon/revocation of ❑ Embargo ❑ Emergency closure your food permit. /��77 �l ❑ Voluntary Disposal ❑ Other: v l PHFi;Peomed ai'rent ra urrN Violations Related to Foodborne tibias Interventions and Risk I At-:cording to L.aw Cooled to Factors(items 1-22) {Cont) 'I-F/45"F Within.4 Hour," -0-1-1-5 Coolio�,N4 e,thod s titPROTECTION FROM CHEMICALS PHF Hot and Cold Hole 1=4 Food or Color AdditivesL19 ing 3-50!�16(B) cold Plipi mainn6fled ,- 1-o'w 1�202 2 Addon�c,' 590,004(F) 3-302,14 -42!qeoclion firoEL��'-- 3-50 1,1 tr(A) I for PFI( Maintained at of above 15 Poisonous or Toxic Substances —i 140"F. be waiiol - 11"'a! -[0I.1 1 IderwiTying ow, 11114 3-50 L 16(A) en'Held at or bore't` 'a Cojiaaonrs' iF(me;as a Pubtir,Health Con t I.r 11 01 1- Ti 7 102,11 Cuormore Name. 11im,as a Nittic Health com,ov --- are 7-20t.I I as a Public 90.004(1-1) I RL�t;t,�ici*ie- Pvc,.�;cx and U,o* 7-202.12 Condftmn�of U W 0' LL)—1jREGUIREMENTS,FOR HIGHLY SUSCEPTIBLE 7"}311 Toxic Connlirici,-- Prohihcioll." POPULATIONS F7204.1i Seirlitizers,Criierizx-cfremicds' 3 - -'- - F 7-204-1G �fieriueiie,tot 'eZ,,Z e,'inctla' Beverevaes rvith Warning,1,abelt;* 7-204,14 D; in A cljo.Criter4- L!�4- - -: %--- - I 3-80!.Ilffl) I le;k�'(d pasleuri7ed El� '7-26�� I I hwidemal taxi con=t'1AIN icirms" 1.11(0) Raw or Pintially Corked Animal]'(xJ ane,H 20& Re,tricted Ser tuts svitioas, _ ( R tit Sr d S1rz,sats hat ilo ji.if 11(C Unopt�ned Food Pact,agc Not i Fe �� (1-11 06 1 , 1 Tracking Powdoe�. Control and Morehorm-4 CONSUMER ADVISORY T TIMEITEMPERATURE CONTROLS 3-60, 11 — nim, Proper Cooking Temperatures ForA Not Otherwise Pr(x:ersed to Einion,ar PRFs P Fg&'- 15517 15 s ,c- 3-302.11! P vteiq iiuf Eqe:Substitute fial Rain Shell 1-40IJI(AV2) Comminuted Fish, Meats& Gmw Aminals 13YT15 wc. SPECIAL REQUIREMENTS Zia 590,009(A)-(D) Viclartows of Section 590.00')(A)-(D) in +-x30'1.21�A)i7) csjnli(medticat� 155�FJS catering, mobi1c,food,temporary and 3-401 11(A)(3) Portltr),Wild Caine,Stuffed PITFs, rosident:al kitchen operations should be, I debited under the apincepriate w;eUions you lo�Ramrs-165'F 15 sec, above if rclatod to firodborne "[moss , Tne� twaci heof Swans intwvcritjon� and risk fiicbor� (xh(..r 1-461-T ')t31 Ire Wd fail .590.009 vhilafion�' relating to glokyl ik i"', Kiall ni It piai,fices should be debited wider #29 - ve 3-41�1.15-----LR fvhciowavr 16.S'F special 3-4 '- ,701,11(A�(I)(b) All T17 I Tse *- L17 -Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A3(A)&(1)) Iellf,s Itch' 15 wc, (lifelins 23-30) 3-403.11(B) c,owave 16577R9awr,-Snuidm, Critical and non-critical riolarrow, which do nor i elate;,r air Time" foraireorne illness inwrventlowaird risk jot rors IiWed above, rnn be? CommercccIN found in the jo/lem mg sectieenv of the Food-Code and 105 CUR 140'1* 590,(X)0, 'F ----:jLc --go,666-- I I(E I Roaawml,, Unsiiced Portions of f1cef -Tce;w e�Tenran FC.'2 0(13 2t Prolortio, Ft, 3 18 Proper Cooling of PHFs -H7-7 Equipin--------- �0(4 FC-4 al'� 3-Still l(A) Oxelhin Cookai PHYg ii-orn 14WF 17 ----------- --A 26 Water, -FC .006 acili!y FC-6 007 700F Wnhin 2 lfmlr�and From 70�il, -ii I Q09 i o'- to 4 I'F/45 F Ve'uhier 4 Hout 26, r Toxic Materials FC -7 008 Crer4inL PHF.,klidt Front Ambient 29, Speciii!Ray1rements 3-SOL 14(B) ------ Tcmperaoire lngvedieot ts to 41F/45'F 30. Other IMPORTANT MESSAG FOR Z A. DATE TIME i M Eced H of (�,�� PHONE q7R- S Q- S of AREA CODE NUMBER EMENBION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN`. WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU. MESSAGE i4ag , tQ rec -e/l QCc u — po.au �A)ner SIGNED .Q/L FORM 4009p MAOF,_jlyi,USyA. 1 � ��rf V NOTES CITY OF SALEM BOARD OF HEALTH Name of Establishment: Marc's Market Address: 51 Harbor Street Owner(s): Juan Toribio Phone: 978-745-8260 (c) 978-429-6099 The proposed new owner of this establishment presented floor plans for this establishment for review in accordance with the State Sanitary Code. The proposed owner would like to include meat slicing as part of this operation. The floor plan calls for installation of a 3 bay sink to wash all equipment and utensils, hand sand and stainless steal prep table. Also to be constructed is a type of barrier to portion otthe retails ace from the prep space. ITEMS FOR SALE All food items displayed and offered to the public must be from an approved source permitted as a Wholesaler from the Mass Department of Public Health. FLOOR PLAN All surfaces must be intact, impervious and easily cleanable. All refrigeration units must have accurate internal thermometers. Refrigerated food must be held at 41 degrees Fahrenheit or lower, freezers at 0 degrees Fahrenheit or lower. EXPIRATION DATES All expiration dates on products must be clearly visible. Out dated items must be promptly removed from display. HAND WASHING All hand sinks must have wall hung soap and paper towel dispensers, and must be stocked at all times. TRASH There is an area for storage at the exterior of this'building. At this time this establishment will us municipal pickup. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. Outside area of premises must be kept clean and sanitary. PACKAGING AND LABELING Deli meats and cheeses will be sliced. A scale, certified by the Sealer of Weights & Measures must be used to weigh the meat. The owner does not have permission to re-package meats at this time and there shall be no cutting of any meat. The packages for sale to the public must have a label with the following information: type of meat, weight, price per pound, sell by date, name and address of the store. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. Mr. Toribio is set to take the ServSafe course on April 4 and April 11. Once course is complete owner must provide proper documentation of this certification. to iiz sake1'1l T)ZAa of �1C0.t14�• SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station. 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". The new owner also hopes to be able to repackage meats in the future. At time of review it was agreed upon that deli slicing of deli meats would occur. At three months a follow up inspection will take place at which time it will be determined if this establishment and owner can take on the responsibility of re-packaging meats at this location. BARE HAND CONTACT WITH READY TO EAT FOODS There shall be no bare hand contact with any ready to eat foods in this establishment. Tongs, deli paper, gloves must be worn. I New owner plans to take over on Q d- Please call one week prior to schedule a change of ownership inspection. An opening inspection will be conducted a few days prior to opening. gPr1Y. y rbl oq '1 0 J no Mancini ate Ong Health Agent a T tibio /Dte J. Z �9 ranslator Freddy Guerrero Date 0� avd rq Ivolkcho,& o� a k 16 1 COO G•�^ 41d _ A�QU eeZ'e�• ,� �.TfRP �--Y' m „p 1907 J � m K .L f J CITY OF SALEM '. BOARD OF HEALTH � p y Establishment Name: Mw �s s M ax Ozt Date: GJ 13 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY cionn 0 mu-b.ne irspe_c, on arr( �eY da.�cu�s; wrr�r —,Smnne Sc-Sc1s P Fa_ b" i.5h vlt mcni �vt M-Oceckcsre n moat-to 5211 of c_Ot- lakly 46 C (20l,�p 'to zwft* ( "oe r c l It i es c:iri Ieswu l.O m mt to ij o s c, 5r { (Y r r h c)i' u j cc;I gA . [end ac is. Kon wac het cpr &?d CGw N ce r is eel h1i'5Am9*7-F s r e_rzJ to wc?,sP L tl , -00c, P Foc :Ie and uAfhnc, U cheese" aA (o -e_ Rci; vp_ "inln d cz�et)a a� mu st dis—I-1nr cY I( -on kc a cI nuNt tct d ' I IA dO (I Mqp, t Y1Cl. is UJ_Ct-2 1tq - Ci e. . i+ f<)+11611' QA4 6yLt k)U like fo dict Ik9 u, Ae cjcfi'i hies QU)hPr n-tust Lrn �-I (, )i -CGtu eca h {�ee� � r fJr rl r�na:nc,Ps t�r1c .Cui7Yti`�fi Alan -� in�allc�-h'�n � hecPcSary evui nw.n-� �a�( Ure. +) co rylD UL -1)is or 4 a trnc,.i r-e. p t-1- 'I r1 r e\ioc of*,-)n 9 _ 17 n a A CJ Sct n i tR,ti ao 1 n Required:£ Discussion With Person in Charge: Corrective Actio ❑ No ❑ Yes r 4Y I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ E cploye ee Restriction/ violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. i Q a� r�A I o n ❑ Voluntary Disposal ❑ Other: e 14(C) PHFs Rec,rvad at Temperatures Violations Related to Ferogronne fitness Interventions and Risk According i o Lao Cooled to Factors(item 1-;*) (Cont) 4 IT/45"F Within 4x PROTECTION FROM CHEMICALS Ctcoloig�klft,&In:PRFs7-1--- 19 PHF HCA and Cold Holding 1=4 Food or Color Additives 3 501.16(B} cold PHES Maintained at or below 590JKWFl 41 V45'�F� 3-30114 prowelion from Lj" 3-50LM(A) Hot PHFs Maintained at ow above is— Poisonous or Toxic Substances 140'R * 101.11 Identifying irto;manon-Ori�g ind I 3-501 16(A) Roasts Held at or aiz�l I—1011F—* Comahlcrs- Time as a Public Health Control 7 102_-_:_l 1 Conamon Name-- WorkinI��ainer,* LN———-—-- 7-201.1! Sa — 3-50 1.19 'rime as a Public ITChh—")..l V S90.004071) Vwiletce -202,11 Reqlicoon -po'stitce and Lse* �,1411 _.v...-_-. - ---- 7-202.12 Condition"of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20-1.11 Toxic ConnuncrProjnfh6o1e;* POPULATIONSHSP 7-204,11 sannizels,Cowie-ChculicaW 7-204. 47 _cliLclideals for Washi!�_e-L d t zS�- iitcria 21 I-SO IA (A) Ulqisteurized Pr -pacLiged Joic tsIud 7204,14 Dr Cro�ria &Vemcec with WLIBn�Sbvlsl � - 7-205,11 Inci&inal taxi3-80IAILB) Use of Pa,teurizc�d I 7-206.11 Restricted t T Se Pc. rt cloy.Cfiterja 7-206J2 RWM Ectil St:1110ns R�tv Sctd Sprouts Not Scrved. r---- �on I --tracking P,n�dt�r�,Pest Control and _LLmn-edh �120 Re CONSUMER ADVISORY 370:�, l FTF-cx),0sluner a iyisory Post for Consoulptif a roper Cooking Temperatures for oil TIMEMEMPERATURE CONTROLS k�dc) PHFs ;Vol Otherwiw Processed lo Elinimiae 3 401 11 A(I)(2) Eggs- 155'F 15 scc- horwAitic Scrvicv 145"F15sec, P stem rizA Egg Snbsunne far R Shell (A)(') 1 cononinuted Fish,Meuts& Came Am=ils- 1.5,5"F 77 sec ---­­-- -7, 40 1.11.(B)0}( SPECIAL REQUIREMENTS Pot I,and Beef loxist - 1304' 121 nun 590,009(A) (D) vicilatiow,oi,Section 590.(X)9(A)-(D') in .3-4101.11(A)(2) Xiintes, InJectcd Mckils -1-55 3F IS sec. catering,rnobilt:fixxL toiripxary and r�4( I I m Ir Game. Stuffed PHFs, redemlial kitchen opeiaflrtrs shovld he Poultry conlamixit"Fish, Mete, defined under the apprrpriatc see tions or knitiles-165-F 15 scc. aliuve if related In fixAborne.illness 7-401H 1(C)t ic",i 3) Whole Beef—Stoakk� interventions and risk factors. Offier - 1151, 590.009 violations relating to goal retal! 3 J2 Ra, Amurwi FeiZ Coilicc,In 11 pacticesAicadd be dcbitc(i under#29 sfie"'a",ouwave 165'F l Spuend Requirements, 3-401,11(,A)(10,; j Ali Othei Plws-1-45'T—15sec. *— L17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-463,11W)k(T)) PHi o 165'T i gee. (Items 23-30) 3403AI(B) Microwave- los'F 2 Minute Standing Critical and non-critical viotalunij, which do no;reiap,to the Tirvel, foodborne Hines inter vennonsand risk fixtors livied ahtu,e. can be -73-403 11(C) COMMOrCially processed RTE.Fixid- found at dwfolfiming ser ions of the Food Code and 195 CUR 14WF1 -.590,000. 3-403.3 I(H) Remaining Unsficed Portions(it*ffixf ------- 'c Roam,,* 2T managementand laerzonnel FC--2 --I �003 FC 1 004 Proper Cooling of PHFs 24 on _25�........Equip em and tnLb, -4 OWC n L JL FC -5()l I I/A) Inuz Cooke(filiFFs ftum`� 14(f r to 26 W ter jnj)�Jf , f� --------- ---------- --P 7WF Within 2 lniur�and Front 70' J hy-6L�q- 1Y--1-------.--- FC::�S_ .,W7 to 4PF/45°F Wilhin 4 Hour!;, Poisonous or To Materials I FC -7 1 008 1 3 501 14(b t Coolnig PHR Made Note Ambient 009 Temperature Ingredients to 4PF/45'F _Offier Within 4 IhAirs* I Denote critical gvi)m the leder,,! NI)q Food 0,d�a,765(MR 590 000, IMPORTANT MESSAGE FOR DATE `V b TIME P. M OF -Q j PHONE AREA CODE NUMBER EXTENSION U FAX 0 MOBILE AREA CODE NU ER TIME TO CALL TELEPHONED PLEASE:CALL. CAME TO SEE YOU [RUSH ILL CALL AGAIN WANTS TO SEE YOU ' RETURNED YOUR CALL ILL FAX TO YOU MESSAGE SIGNED M*ps FORM 4009 YYYY���v MADE IN U.S.A. NOTES r 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: T PROTECTION FROM CONTAMINATION 745-8260 Handwash Facilities FAIL Critical ❑d RED Owner Comment: Bathroom missing paper towels,and front sink missing soap.Provide soap and paper towels at both sinks at all times. Fred Guerrero - -7 Violations Related to Good Retail Practices (Blue Items) PIC:. i Food and Food Protection FAIL Critical BLUE Raymond Guerrero Comment:The following were removed,outdated: Inspector: I Elizabeth Salandrea 6 maizena corn starch 5 nesquick Date Inspected:Correct By: 1 frosted flakes p 12/9/2008 1 betty Crocker frosting r 4 Pillsbury pumpkin bread mix Risk Level: 4 pkgs bread crumbs - 3 pkgs bologna 1 kraft bbq sauce IPermit Number: 7 bags pork rinds BHP-2008-0094 L 3 cans green beans S Owner to closely monitor all expiration dates. SIGNED OFF e #of Critical Violations: Some items had price labels covering expiration dates. Do not cover expiration dates with labels. 2 Some personal items being stored in front counter fridge.Store personal items separately to prevent contamination. ¢Time W: Time OUT: ._ ( Some vegetables being stored directly on wooden shelves.Store all food on impervious,easily cleanable surfaces and containers. !Urgency Description(s): Equipment and Utensils FAIL Non-Crifical BLUE iBLLIE: Comment: Fan and ceiling above it in the walk-in fridge has some grime build up.Thoroughly clean these areas. Violations Related to Good :Retail Practices(Critical - Woods freezer needs general cleaning on shelves inside the door. ;violations must be corrected ;immediately or within 10 Ice cream freezer needs general cleaning. 'days)(Non-critical violations Milk fridge has some water in the bottom.Investigate for leaks and remove the water. }must be corrected immediately or within 90 days) Owner to notify the Board of Health within one week that violations have been corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 11,2008 ) Page I oft Item Status Violation Critical Urgency RED: Molations Related to 'Foodborne Illness Interventions Viand Risk Factors (Require ;immediate corrective action) I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 11,2008 ) Page 2 oft r 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency j Telephone: mr PROTECTION FROM CONTAMINATION 1 745-8260 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED ?Owner: Comment:Meat is cut and packaged for re-sale at this establishment.Proper sanitizer is not available;establishment uses a bleach Fred Guerrero v cleanser which does not have an EPA registration to clean cutting board. Knives used to cut meat are washed with dishsoap but PIC: not sanitized,and no knife rack is available-knives appear to be stored on cutting board. � f Freddie Guerro Aa� Establishment must make proper sanitizer and test strips available,and maintain a daily log of the concentration.Sanitizer must be Inspector: quaternary ammonium or chlorine bleach,and must have EPA reg.number.Concentrations must be 200ppm for quaternary ammonium sanitizer,and 100ppm for chlorine bleach sanitizer. 5 p(ci Y U4 EM Elizabeth Salandrea Handwash Facilities FAIL Critical ❑d RED -Date Inspected:Correct By: Comment: Hot water at front sink measured at 101°F.Turn hot water up to ensure that minimum temperature of 110°F is being met. cri CrA'(`etq 1RiskL v A ���In �mp� Risk Level: reaper towels not available at front sink;provide paper towels. S j rl hy7h m Ji,6,n,ld is ? ont sink had a metal container in it at time of inspection. Do not obstruct sink with any items. Jns-laflLn5 �> 104y, st'tl Permit Number: vp +a� i• .BHP-2008-0094 Bathroom missing paper towels and soap in dispensers;towels and soap were available at time of inspection.Ensure dispensers are stocked at all times. CIS -fO (�2- 1� �Jcxt� .t• U)N 4 lnX J AocLGet."Anka( 4A50-_rls . )Status: Violations Related to Good Retail Prac i (Blue Items) Open Food and Fo d Protection FAIL Critical BLUE F#Of CfItICBI Violations: ommant: Items including a children's bike being stored on top of cases of canned food in back room.Do not store anything on 3 top of cases of food. Time IN: Time OUT: :Meat packaged by establishment for re-sale has no sell-by dates on them.All meat being packaged for sale must be labelled Urgency Description(s): properly with sell-by/expiration dates. BLUE: 't>Tome price labels covering expiration dates.Do not cover expiration dates with price labels. Violations Related to Good 9 .Retail Practices (Critical ersonal drinks observed in front display case unit.Store all personal items in a separate area designated for employees only. violations must be corrected Equipmentan Utensils FAIL Non-Critical BLUE Immediately or within 10 mment: Mop stored in bucket in back room.Store mop hanging to air dry to prevent cross contamination. days)(Non-critical violations- ,must be corrected Immediatelycream freezer needs general cleaning and de-icing. or within 90 days) &4&- i - —Walk-in produce fridge readirk at 48°F.Adjust unit to ensure minimum temperature of 41°F or below is being met. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 12,2008 ) Page ! of + Item Status Violation Critical Urgency RED: Violations Related to Reinspection in one week, all violations to be corrected. 'Foodborne Illness Interventions and Risk Factors(Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 12,2008 ) Page 2 oj2 V 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-8260 Handwash Facilities FAIL Critical 0 RED I Owner: - Comment: Hot water at front sink measured at 101°F.Turn hot water up to ensure that minimum temperature of 110°F is being met. Fred Guerrero - Bathroom missing paper towels and soap in dispensers;towels and soap were available at time of inspection.Ensure dispensers PIC: _ are stocked at all times.PIC has stated that a new paper towel dispenser has been ordered and they have also ordered refills for i Freddie Guerro the soap dispenser. I Inspector: - Violations Related to Good Retail Practices (Blue Items) Elizabeth Salandrea_. - Equipment and Utensils FAIL Non-Critical BLUE Date Inspected:Correct By: Comment:Walk-in produce fridge reading at 45°F,Adjust unit to ensure minimum temperature of 41°F or below is being met. 5/16/2008 Risk Level`: Permit Number: BHP-2008-0094 Status: SIGNED OFF #.of Critical Violations: 1 Time IN' ' Time OUT: Urgency Description(s): BLUE: All other violations noted in the 5/9/08 inspection report have been corrected. Violations Related to Good :Retail Practices(Critical Owner to call the Board of Health and speak with the Health Agent when ready to present plans for proper violations must be corrected equipment and sanitization so that the establishment may resume selling re-packaged meat. A 3-bay sink is 'immediately or within 10 currently being installed in the front counter. .immediately violations ,must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 19,2008 ) Page! of 7 Item Status Violation Critical Urgency Violations Related to Foodborne Illness Interventions] .and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 19,2008 ) Page 2 oft �`.y...—..4.. A+«w•_ " f a a"" d ,+sww^ •W`".`m• 'T�'%"�„"ey".P w +Y•"'"°^..is j,Zt'+.m+e.:,sn4:« I y �'?'"'sri T�� tia^ .�c°•.:s vtie_ 47 .. q •• .� x« .+k:-Yom.:.-. .. of Massachusetts i e *K Clty of Salem • f - ~s - Board of Health 120 Washington Street,4th Floor Kimberley Drisooll Mayor SALEM,MA 01970 FoodBetail Establishment Permit DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: Marc's Market File Number:BHF-2004-000029 51 Harbor Street Salem MA 01970 LOCATED AT: SALEM,MA 01470 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2008-0084 Jan 3,2008 Dec 31,2008 $70.00 TOBACCO VENDOR BHP-2008-0122 Jan 3,2008 Dec 31,2008 $135.00 Total Fees: $205.00 PERMIT EXPIRES December 3l,2008 Board of Health This Permit is not transferable and must be-reissued upon change of ownership or location.The permit must he posted in - a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any.revonations,improvements,or equipment changes are made;-all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 46 . QTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TSL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ISCOTTna sAl EM.COM JOANNE SCOTT, HEALTH AGENT 2008 AP LICATION FOR RMIT T OPERATE A FOOD ESTABLISHMENT J� NAME OF ESTABLISHMENT t`�G L � (� TEL# �`� / ' v�61 ACGnESS OF ESTABLISHMENT � ' �a cSo V FAY-*, MAILING ADDRESS(if different) EMAIL-Business': Website: q OWNER'S NAME J U1? TEL# ( - — n' ADDRESS 2'd v STREET VCITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentiall hazardou/s'ff d eparech A EMERGENCY RESPONSE PERSON r��L/ A HOME TEL# DAYS OF OPERATION MondayTuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION pµ Please write in time of day ,p /A� ,p (For example 11 am-1 1pm) / /"r TYPE OF ESTABLISHMENT �.l FEE (check only) RETAIL STORES NO less than 1000sq.ft. dg 7s' 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------------Vl. ........N...O ------- ....l.ess... .than...... ............. RESTAURANT YES .. 25...sseats--.. =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - BEDIBREAKFAST/ YES NO $100 CHILDCARE ITISERVICES - .... ADDONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDORNO ALL NON-PROFIT(such as church kitchens) S NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitte t and approved by the Salem Board of Health. Pursuant to L Chapter 2 Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax s a pai all state to s quired under the law�� gnature Date Social Security or Federal Identification Number -------------------------_.____._--------------------` --J------------ - - ------—--------------------------------------- Revised 4/24/07 FOODAP2008.adm CheckN&Date L 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-8260 Handwash Facilities FAIL Critical ❑d RED Owner: ail Comment:There is no hot water in the restroom. Provide hot water at a minimum temperature of 110°F in the restroom Fred Guerrero immediately. PIC: Violations Related to Good Retail Practices (Blue Items) Nalda Guerrero Food and Food Protection FAIL Critical BLUE Inspector: Comment:There are price labels obscuring many expiration/sell by dates. Do not obscure any expiration/sell by date with price David Greenbaum labels. Date Inspected:Correct By: 10/15/2007 The following items removed from the shelf outdated: I 13-Parmesan cheese Risk Level: 7-Salad dressing 1 -Turkey breast 10-Tang Lemonade Permit Number: 2-Pancake mix BHP-2007-0361 Closely monitor all expiration dates. Status: Equipment and Utensils FAIL Non-Critical BLUE SIGNED OFF Comment: The front deli unit has a broken thermometer. Provide a new visible,accurate thermometer. #of Critical Violations: 2 The Hershy ice cream freezer needs a visible,accurate thermometer. Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 15,2007 ) Page 1 oft / Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 15,2007 ) Page 2 of rr 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 745-8260 Hot and Cold Holding FAIL Critical ❑d RED Owner: Comment:The Woods freezer has a temperature of 20°F. Repair this freezer to maintain a temperature of 0°F or below. Fred Guerrero Violations Related to Good Retail Practices (Blue Items) PIC: Food and Food Protection FAIL Critical BLUE Freddie Guerro Inspector: Comment:There are price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price labels. David Greenbaum The following items found outdated: Date Inspected:Correct By: 2-Taco Bell salsa 3/20/2007 4-Turkey gravy 1 -salad dressing Risk Level: 1 -peanut butter 1 -frosting 8-packages of cheese Permit Number: BHP-2007-0361 Closely monitor all expiration/sell by dates. Status: Equipment and Utensils FAIL Non-Critical BLUE SIGNED OFF Comment: The front deli unit has a broken thermometer. Provide a new visible,accurate thermometer in this unit. #of Critical Violations: 2 The Deep Freeze freezer needs a thorough cleaning. Time IN: Time OUT: i Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2007 ) Page I oft • Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2007 ) Page 2 oft COURT DOCKET NO. CITATION NO. CITY SALEM 6011 +01 q VIOLATION PD N NOTICE {11J 1 NAME I ST FIRST,INITIAL) STREETADDTSESS' CITY/TOWN STATE ZIP r /� c- L 666 LICENSE NO. LIG EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS Cl /TOWN STATE ZIP �bQa� ; {¢�trd yet G, G REGISTRATION NO. STATE EXP DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN RINFONAI ❑n PM AM ❑NO YES ❑ LOCATION OF VIOLATION Y/'4 5 / 'A+. ENFORCING(D'EPPT.T. ' OFFENSE L _ CHAP. SECT. FINES `J oti'7 YactY rQ'rA'r 7-¢ C -Yl OFFICER I.D.NO. TOTAL FIN DUE OFF ICER CERTIFIES COPY GIVEN TO VIOLATOR X HAND �„JA'�W/// BY MAIL DO NOT MAL CASH-PAY ONLY BY POSTAL NOTE,MONEY J?RDEH OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL RSM `✓c'x�w i'.y'�'^s y..^ i`355''^ C �n va A f'2 h� �- ��'�4 F, l C y�l o ;. \ ` '?3 - - +,cuuRTooclIErNo "' .: .-ORATION NO.�. CITY OF SALEM VIOLATION NOTICE�•.�� �. ro •�' e` (�~"+3' �`" p� NAME T,FIRST,INMAL) J r + C STR R CITVROWN STATE ZIP et r 0 w � ` 06 ack A O � � LICENSE NO. Q LI MTE ATE OF BIRTH oy D m OW ER'S NAM , S 113 n"I I °mom O Y !'C-Q- i• g � -AC STREET Ay1pRES /'1n- /SOWN �E ZIP O ;� � p�J�/J�ff``�JQ r Yf�/I Ola 6440 T REGISTRATIONTAT XP NO. STATE E .DATE AKET'PE YEAR COLOR . O 3I ( DATE OF VIOLATION TIMEff CITATION WRITTEN PERS Al- r \ O ❑ INNR X \\J YES � ❑NO .[] m LOC�j10NOVIOL(A�TION. ENFORNG ,,EOFFE SE CHAP. SECT. FINES J{� 3a �., B i U3 N; OFFICER I.D.NO. TOTAL FINE DUE OF CER CERTIFIES COPY GIVEN TO VIOLATOR I- N /�fHAND B MAIL DO NOT MAIL CASH-PAY ONLY POSTAL NOTE,MONEY ORDER OR 9V CHECK MADE PAYAA BLE TO: - �-� CITY CLERK N CITY HALL 93 WASHINGTON STREET ED iSALEM,MA 01970 1 s �- TEL.(503)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE ' I PAYMENT IN THE AMOUNT OF - i b_ CASE# i SIGNATURE I SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL X 1 *w`p`!x°�' yt � r .eNA-'+ M.ahne.� r � play ay. plc' +gym xx wr X >„`4a'ir'N + 4,tl- � t S ) 1 a d}F h � n� .�� . ♦.Fff A� n Y: Commonwealth Of Ma$SBCIIUSBtt§,+'?, City of Salem „.;. Board of Health IQmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 DATE PRINTED: 01/08/2007 ESTABLISHMENT NAME: Marc's Market File Number:BHF-2004-000029 - 51 Harbor Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2007-0361 Jan 8,2007 Dec 31,2007 $50.00 TOBACCO VENDOR BHP-2007-0362 Jan 8,2007 Dec 31,2007 $50.00 Total Fees: $100.00 PERMIT EXPIRES 'December 31, 2007 Board of Health Page 5 of 6 f - i 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMITjj',TO PERATE A FOOD ESTABLISHMENT x NAME OF ESTABLISHMENT aIC J�//111 W t TEL#�i U— ' r — Vt 6(J ADDRESS OF ESTABLISHMENT � , ()Q r7 n FAX# MAILING ADDRESS (if different) EMAIL--Business':' J/ Owner's: OWNER'S NAME c� V / ) TEL# /ADDRESS + Cr�} G C� C lINA STREET f ►/�+ Q��i�5(I,T,)Y STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) `'U�O ' " CERTIFICATE#(S) r� G0 5 9 /,kp. d1re /p-/6- 2.06 # 3 19 rDBO_ (Required in an establishment where potentiallyazaarrdous food ids prepared) Jj// [� EMERGENCY RESPONSE PERSON !MaF'&t7C1lr HOME TEL# �P�1 4r�41-3ll DAYS OF OPERATION Monday Tuesday Wednestlay ` Thursday Friday Saturday i Sunday HOURS OF OPERATION Q,jai YY C n to �p Please write in time of day. �.�� Say^ Sj ,�1G JdN+� �d.�•�� Iter example tram-1191W TYPE OF ESTABLIS NT FEE (check on RETAIL STORE Y NO less than 1000sq.ft. $_ 1000-10,000scI t. =$100 more than 10,000sq.ft/ =$250 RESTAURANT YES less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 -._... _.-....... VES- _ .... ....__..... .. --- -- .------------ $100 ... -- ......... ... . . .._ --.--- _.----- BED/BREAKFAST N ---- ------------ - - ......_ ...-_.....---- ...... ...... _......._---------._...----- ----- ..... .... ..... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVENO $5. TOBACCO VENDOR ALL NON-PROFIT(such as church kitchens) YES NO 5 '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 su h must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapt r C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, iie all tate tax r s and paid all sta taxes required under the law. S nature Date Social Security or Federal Identification Number - - ------------ ----------- -----_ -------- -------- . Revised 11113/06 FOOUAP2007.adm Check#8 Date_ ,'���j _ � $ �� 't 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 745-8260 Hot and Cold Holding FAIL Critical RED Owner: Comment:The ice cream freezer has a temperature of 30°F. Repair unit to maintain a temperature of 0°F or below. Fred Guerrero J Violations Related to Good Retail Practices (Blue Items) PIC: Food and Food Protection FAIL Critical BLUEi Freddie Guerro Inspector: Comment:There is food stored directly on the floor in the back room. Store all food at least 6-8 inches off the floor. David Greenbaum There is ulabeled pudding out for sale. All product for sale must meet all labeling requirements. Date Inspected:Correct By: 10/5/2006 The following items found outdated: 3-tomatoe soup Risk Level: 2-mayo 1 -BBQ sauce 34-macaroni&cheese Permit Number: Owner must closely monitor all expiration dates. BHP-2006-0146 Equipment and Utensils FAIL Non-Critical BLUE Status: SIGNED OFF Comment:The microwave needs a general cleaning. #of Critical Violations: There is a leak in the Fogel cooling unit. Repair unit to good working order. 2 Physical Facility FAIL Non-Critical BLUE Time IN: Time OUT: Comment:There a many broken/damaged floor tiles. Repair or replace all brokenldamaged floor tiles. Urgency Description(s): Ther are gaps around the screen door. Seal all gaps. Provide a sweep at the bottom. BLUE: Violations Related to Good The back door found open. All openings to the exterior must be sealed. Retail Practices (Critical GENERAL COMMENTS: violations must be corrected immediately or within 10 874:Owner to notify the Board of Health within one week that the above violations have been corrected. days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 05,2006 ) Page 1 oft 41 Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 05,2006 ) Page 2 oft 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephoner PROTECTION FROM CONTAMINATION 745-6260_ Handwash Facilities FAIL Critical Q RED Owner. Comment:The restroom is missing paper towels. Provide dusposable paper towels in the restroom at all times. Fred Guerrero Violations Related to Good Retail Practices (Blue Items) PIC - Food and Food Protection FAIL Critical BLUE Freddie Guerro _ det: Comment: There are many price labels covering expiration/sell by dates. DO NOT obscure any expiration/sell by dates with price Inspelabels. David Greenbaum Date Inspected: Correct By: The following items were found outdated: 11 -bottles BBQ sauce 4/12/2006 2-salad dressing Risk Level: 1 -popcorn 5-Coco 8-frosting Permit Number: 3-cake mix BHP-2006-0146 6-doritos 8-baby formula Status: Owner must closely monitor all expiration dates to insure no expired product is out for sale. SIGNED OFF = x �� Equipment and Utensils FAIL Nan-Critical BLUE #of Critical Violations: 2 Comment:The Hershy ice cream freezer has an accumulation of food spills and splatter. Thoroughly clean the freezer. .Time IN: - Time OUT: The Woods freezer has an accumulation of food spills and splatter. Thoroughly clean the freezer. Urgency Description(s): GENERAL COMMENTS: BLUE: 565:Owner must post the 2006 food permit for this establishment in a highly visible area. Violations Related to Good Retail Practices (Critical-' violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately, or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 12,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require .> immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 12,2006 ) Page 2 oft M. .... .. . ... ...4.y ver .. Commonwealth of Massachusetts s e City of Salem Board of Health g� 120 Washington Street,4th Floor "�M� SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Marc's Market File Number:BHF-2004-0029 51 Harbor Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2006-0146 Jan 3,2006 Dec 31,2006 $50.00 TOBACCO VENDOR BHP-2006-0147 Jan 3,2006 Dec 31,2006 $50.00 Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health �6 -x� -4–jr- This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 12 CITY OF SALEM9 MASSACHUSETTS o BOARD OF HEALTH - - 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 V� �eAp"s TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 nn C7 ' 0�,�q MAYOR wWw.SALEM.COM vO Ty _ . tlo JOANNE SCOTT, MPH, RS, CHO �9Q�p s HEALTH AGENT OiCS'T�� E9�y 2006 APPLiCATiON FOR PERMIT TO "PERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT dr / / / TEL# //y �✓�� V ADDRESS OF ESTABLISHMENT l < rs o Y MAILING ADDRES�ifferent) OWNER'S NAME TEL#%8— I V/O� ADDRES CITY q STATE ZIP y1 / � 1A CERTIFIED FO D MANAG R'S NAME(S)_r tt CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prfared.) Q EMERGENCY RESPONSE PERSON F-0 C/A HOME TEL# 9 HOURS OF OPERATION: Mond _3 Tue.aj I Wed.=Thu. 1-' Fri. Al Sat. Sun. TYPE OF ESTABLISHM T FEE check onl CRE,Al! 8 i GRE r"c NO less titan 1000sq.ff. - / morean 10, 00 =$100 more than 10,000sq.ft. =$250 ------------- - ------ - ----------- ........ -... le.sss. ,than-------25 se--- seats' .....------_$100---------------- ......- --------- -- RESTAURANT YES NO 25-99 seats =$150 more than 99 seats =$200 - ----------------------------------------------------------- BED/BREAKFAST YES $100 A.DDITIONAL PERMITS -----...----------------------------------------------------------------------------------------------------- MAKE_(not-just serve) ICE CREAM, YOGURT, SOFT S RVE0) $5 C . _.TOBAC_CO VENDOR E NO $� ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans or such must be submitted to and approved by the Salem Board of Health. Pur ant MGL C a er 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best Band ave filed all state tax returns and paid all state taxes required under the law. AAA 7Y' ®� Signature D Social Security or Federal Identification Number --------------- -------------------------- ----------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date 51 Harbor Street Marc's Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: T ^ '^"` Z "' _ FOOD PROTECTION MANAGEMENT 745-8260 PIC Assigned/Knowledgeable/Duties PASS ❑d RED Owner Non-compliance with: Fred Guerrero Anti-Choking PASS PIC. Freddie Guenro ` r Tobacco PASS Insrprtnr, , David Greenbaum EMPLOYEEIIEALTiI Date Inspected: Correct By: :; Reporting of Diseases by Food Employee and PIC PASS ❑J RED .11/18/2005 .a .. .ic Personnel with Infections Restricted/Excluded PASS RED Risk Cevel: - ^ FOOD FROM APPROVED SOURCE Permit Number - Food and Water from Approved Source PASS RED BHP-2005-0206 � Receiving/Condition PASS RED Status:=' SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS RED *of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS RED 3 Time IN: ^ , Time OUT Urgency Description(s): BLUE:` Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within,10 , days)(Non-critical violations' must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 18,2005 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to �, Separation/Segregation/Protection PASS Q RED rn Foodboe Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) Proper Adequate Handwashing PASS 0 RED Good Hygienic Practices FAIL 0 RED Prevention of Contamination from Hands PASS 0 RED Handwash Facilities FAIL Critical RED Comments:The owner must replace the wall hung soap dispenser and keep the wall hung paper towel dispenser full. Soap and paper towels available at tim of inspection. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures N/A RED Reheating N/A RED Cooling N/A 0 RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP N/A RED CONSUMER ADVISORY Posting of Consumer Advisories N/A RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 18,2005 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE Comments: Inspector removed 27 outdated items from the shelves. Owner must closely monitor all expiration dates. Some price labels covering expiration/sell by dates. Do not obscure any expiration/sell by dates with price labels. Equipment and Utensils FAIL Non-Critical BLUE Comments:The Woods freezer needs a visible,accurate thermometer. The counter reach in needs a visible,accurate thermometer. The Hershey ice cream has a broken thermometer. Provide a new thermometer. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 374: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 18,2005 ) Page 3 of R.J 1.1-75rz�e� i A f- I r i i -� CITY OF SALtum} .�, BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 gBOrrNgrr TEL. 978-741-1800 FAX 978.745-0343 rANLEY J. IISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT June 22, 2005 Marc's Market 51 Harbor Street Salem, MA 01970 gZ3 Dear Owner: On Wednesday June 15,2005 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17-year-old female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Marc's Market is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes,chewing tobacco,snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of (ONE Hundred Dollar fine)for the FIRST offense. FOLLOWING THE THIRD (3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$100.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven(7) days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders,and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please rail me at 741-1800. Sincerely yours, %Joanne Scott / Health Agent JSlmfp CERTIFIED MAIL: 7003 3110 0005 1992 1493 cc: North Shore Tobacco Control Program Christina Harrington, Board of Health Chairman and Members i I I w,aY} __.:-..... ... . ... ... ncrsvnxa.:. a•...W r---'", .. .—'_"`E'�-^te•Mi�tiaa:: y 4 g1xY@r'.gV SL { n'94t } dt to .t"l.'IFe»'t-^^"F"3'MIe' '.F3I'_' Mh14 Hh'T 'rR-YvS �• '� iF I^M"'.evT'AF+£m„t �`#.:- CITy .OF T SALEM, MASSACHUSETTS v BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Marc's Market Address of Establishment: 51 Harbor Street Owner's Name: Fred Guerrero Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 137-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 32-05 These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT, CITY OF SALE.M, MASSACHUSE 'UI' *r.]a BOARD OF HEALTH NODI 2 4 2004 120 WASHINGTON STREET, 4TH FLOOR 9 SALEM, MA 01970 CITY OF SALEM TEL. 978-741-1800 BOARD OF HEALTH FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION F R�PjECRMSIT Tp OPE,RAT A FOODEST �ru,1Mgoz(4 NAME OF ESTABLISHMENT 1A'nl�n �//�b, ADDRESS OF ESTABLISHMENT ��� UVv -Yg(� �Sz MAILING ADDRESS (if different) �% Q OWNER'S NAME J �/`—�/ TEL ' "�J3?' 6Z68 ADDRESS 99- AN�� CITY STATE Zip_ CERTIFIED FOOb MANAGER'S AME(S) CERTIFICATE#(s (required in an establishment where potentially hazardous food is prepared.) n 0 EMERGENCY RESPONSE PERSON hG/� � " HOME TEL HOURS OF OPERATION: Mon. -/Tue. ✓Wed. ✓Thu. y Fri.v Sat. \/ Sunk./ TYPE OF ESTABLISH PI' FEE check onlzoo)RETAIL STORE YE NO less than 1000sq.ft.1000-10,000sq.ft. more than 10,000sq.ft. =$250 RESTAURANT YES NO �/ less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YE TOBACCO VENDOR _5.2-05 oS NO $50- ALL NON-PROFIT(such as church .kitchens) YES NO 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 y2 , Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge d beli ve filed all state tax returns and paid all state taxes required under the law. Signature Date /1_23-0 Social Security or Federal Identification Number ----------- ! v ----------------r-a ' Revised 11/03/03 FOODAP2.adm Check#8 Date AO Wa' p 7 "� '4 CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Marc's Market Address of Establishment: 51 Harbor Street Owner's Name: Fred Guerrero Restrictions: Application Date: 1/22/2004 Permit for Food Establishment 226-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 11-04 These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT I :1 CITY OF SALEM, MASSACHUSETTyE'�^ v InJt ( + BOARD OF HEALTH V 1 120 WASHINGTON STREET, 4TH FLOOR IIWD'�. SALEM, MA 01970 - NOV 2 4 2003 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. lr�`-tri- 'E;� 041 QY/ JOANNE SCOTT, MPH, RS, CHO B(�J' -"Z' lrJ;= MAYOR '�f lnl r7 HEALTH AGENT 2004 APPLICATION FOFtPERMIT S�JOPERfTE A F�D ESTABLISHMENT ` NAME OF ESTABLISHMENT //JJ���� II��� /�/J'f�19��Nc f� TEL#1 �/ `/���J ��, ADDRESS OF ESTABLISHMENT 57 G l� ` OO C Jv ,� l(�* (A 6 MAILING ADDRESS (if different) M 6 q OWNER'S NAME YQ 4 (/ c / /n� TEL _ ADDRESS_ '207 �L _Jd`4F l _ _ CITYi_ -— — -- SPATE"— IJ --ZIP-- � - CERTIFIED FOOD MANAGE NAME(S) CERTIFICATE#(s) (required in an establishment where potentiallyhazp�rdous;oyold is prepared.) ILK �jJ (� EMERGENCY RESPONSE PERSON ) ✓ HOME TEL-# " J Tv UD A. ..,y�. ,/ HOURS OF OPERATION: Mon. L—Tue. ._Wed. Thu- L�Fri-_J, . _X_,—Sun. V TYPE OF ESTABLISHME T FEE check only RETAIL STORE NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES ' 1O O less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS YE ^ / MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE ES/`N.Q/ $5 TOBACCO VENDOR NO $50 ALL NON-PROFIT(such as church kitchens) YES ®/ $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuan t _ MG apter 62C Section 49A, I certify under the pains and penalties-of perjury that I to my, a e d belief a filed all state tax ret r."ns and paid all state axes r ui ed and ''the la Ft�xg t 1Ny ^ i aye! k a_.re rn , ! s id � a,r . re gnature 1 w Date Social Security or FederallIdentificat Number .N.n.. .. d_ "f J u. ♦ y(Jyry �y Revised 11/03/03 FOODAP2.adm Check#&Date �Ou� — �c�� T "3 40" /'/oo — JAN 2 2 2004 71 1�,I (Y OF SALEM BOARD OF HEALTH Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t' Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 NameDate T of 0 eration(s) T e of,lns ection MqR E's riRlt�r- (d Yt< LJd Service © outine Address3 Risk Retail ElRe-inspection Telephone Level EI Residential Kitchen Previous Inspection Al ❑ Mobile Date: Owner HACCP Y/N ElTemporary ElPre-operation /(6`f�0 lr'UQR v ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint Inspector 0A'J1 0 Gyt� & tl t� 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. FFOOD PROTECTION MANAGEMENT,,' ❑ 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties `EMPLOYEE HEALTH 13. Handwash Facilities ? ` " " i PROTECTION FROM CHEMICALS "r❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives El 15.Toxic Chemicals FOO[k,fROM APPROVED.SOURCE " ' ❑ *,,Food and Water from Approved Source .TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Pleceiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1Cooling `PROTECTION FROM CONTAMINATION '` ' ` :' ` '': X19. Hot and Cold Holding :_ ,•< - j ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ,'REQUIREMENTS FOR:HIGHLY SUSCEPTIBLE POPULATIONS(HSP) `, ❑ 10. Proper Adequate Handwasfiing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices :CONSUMER ADVISORY:'.' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 2 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C I N ,' 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations . Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 5 25. Water, Plumbing and Waste (FC-5)(590.005) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:5MnVWFoim6 UAW Inspector's Signature: f - Print: 1wR PIC's Signature: Print: , �• .- O Page of ZPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003tA I Ansi inuent of Res[ Iffy"' 3-302.11(A)(1} Raw Animal Foaxis Separated from 590.00�.rnonstral'ion of IGtowledge* Cooked and RTEFoods* 2-103 1 t Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Others` 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting byfood employces and 3-302.11(A) Food Protection* a �7tcants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Chat ,e'k Contamination from the Consumer 590.003(8) Re orcin b Person in Char e* 3-306.14(A)(B) Returned Fond and Reservice of Food* 3 590.003(D) Hxclusionsamd Restrictions`F Disposition ofAdukerated or Contaminated 590.(I03(E) Removal of Exchusions and R s actions Food 3-701.11 Discarding orReconditionineLvisafe FOOD FROM APPROVED SOURCE Food- 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A BI Compliance,with Food Law" 4-501.111 Manual luarewashing-Hot Water 3-201.12 Food in a Hermetically ScaledConnuner* Samlization'I'anacamres' 3-201.13 Fluid Milk and Milk Products* 4-501.1.12 Mechanical Wire-washinb Hot Water 3-202.13 Shelf Egos* Sanitization Tem teratures" 4-5o1.114 Chemical Saiutization-tem H, 3-202.)4 E9a?s,mit Milk Product,. Pasteurized" * p Concentration and hardness.. 3-202.16 Ice Made From Potable Drinking Ritter* 5-101.71 Drinking Water from an Approved Svstein* 4-601.11(A) UteEqUrvon Cleut ars d Contract Surfaces and Utensils Clean* 590.006(A) Bottled Drinking 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22D'x Contact Surfaces mad Utensils* Shelffish 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 E ui meat* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed Chemical Sources` to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regoiatory Authority 2-301.11. Clean Condition-Hands and.Arms'" 3-202.18 Shellstock Identification Present" - 2-301-12 Clearing;Procedure' 590.Ot)4(C) Wild Mushrooms* 2-301.1.4 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices $ Receiving/Condition 2-<t07.11 Eatin ,Drinkin caUsing Tobacco 3-202.11 PHFs Received at Pro er Tatn terat'ures* 2-401.12 Discharges Froin the Eyes.Nose and 3-202.15 Package Int'e it * Mouth'u 3-101.11 Food Safe and unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em lovees* Handwash Facilities Tags/Records:Fish Products 13 3-402.11 Parasite Destruction* Conveniently Located and Accessibie 3-402.12 Records,Creation and Retention" 5-203.1.1 Location and Ca Placement* 590,004(J) Labeling of ingredients' S-204.11 Location and Placement* q Conformance with Approved Procedures 5-205.11 Accessib li y,O eration and Maintenance IHACCP Plans Supplied with Soap and Rand Drying 3-502.1.1 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen tacka�ng,criteria 6-301.11 Iiandwashing Cleanser.Availability- 3-502.12 8-103.12 Conformance with Approved Procedur * 6-301.13 Band D ins Prov vino *Denotes critical item in the federal 1999 Food Code or 105 Ck1R 590,000. ' CITY OF SALEM .A BOARD OF HEALTH / Establishment Name: lflif/cC— M/wAarr Date: /D/y Page: 2 of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified - PLEASE PRINT CLEARLY - L,7 Ac- N(r tlN 6r IF A+✓A bJdd O I�l�7 � O�ci�' WA zck- c V 14 1_� ye t*M t1 0rEM d rU«2 g C /sus !cd Cef Y 04 F`Ves s&set__ A- fIC,M 0 d v•e-, q MIAC C)f o "f d,� r3az,� U" f r ,ova s Of 0-117A4% A • A4CO+� 0.s,V map L-'&4 . $ flanb&ja2t4 M CAN6— DIM", (��.� SMP � • Discussion With Person in Charge: Corrective Action Required: ❑ No C3 Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: F� a ', I 3-501.14(C) PHFs Received at'temperatures Violations Related to Foodborne Illness interventions and Risk According to law Cooled to Factors(items 1.22) (Cont) 41'F/45'F Within 4 tiorus. X PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PRFs 13 Food or Color Additives 19 PHP Hot and Cold Holding 3-202.12 Additives* 3-5013-501.16(B) Cold PHFs'Maintained at or below 590.004(F) 41'/45°F* 3-302.14 Promm Protection froUna t roved Additives* ove 15 Poisonous Toxic Substances - 140°F * 3-501.16(A) Hot PHFs Maintained at or ab 7-]01.11 Identify ug-Information-Original 3-501.1.6(A) Roasts Held at or above 130'F. CAtntainers' 7-102.11 Common Name-'Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora e* 3-501.19 Time as a Public Health Control* 7-202.'11 Restriction-Presence and Use" 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers -Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Saniti7cre.Criteria-Chemicals' 7-204.12 Chemicals far Washing Produce,Criteria* 21 3-80'1.11(A) Unpasteurized Pre-packaged Juices and Beverages with R'aruins Iabols* 7-204.14 Dying. ents.Criteria* 3-801..11(,B) Use ofPasteuuzed'GGess 7-205-11 Incidents]Food Contact.Lubricants* 7-206,11 Restricted Use Pesticides, Criteria* 3-801.11(I)) Raw or Partially Cooked Animal Foul and Raw Seed Sprouts Not Served.* 7-206.12 Rodc,nlBaitStations* 3-801.11(C) UnoenedFondPacka>eNotRe-served, * 7-206.13 'franking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or ' PHFs - Not Otherwise Processed to Eliminate _ err nos rnrzoai 3.401.11A(1)(2) Figs- 155'F 15 Sec. Pathogens.* 6 ins-hunmtiiatc Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec.'s 3-401.11(13)(1)(2) Pork,and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Ratites, Injected Meats-155'F '1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. "' catering,mobile food, temporary and 3-401.1.I(A)(3) Poultry, Wild Game,StuffedP1117s, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'17 15 sec. above if related to foodborne illness v 3401.11(0(3) Whole-mnscle,Intact 13ecf 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 1/29- Microwave 165°F Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Sterns 23-30) 3-403.11(B) Miccoumve- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Timer' foodborne illness interventions and risk factors listed above. can be 3-403.11(C) Commercially Processed RTP.Food- ,found in the following sections of the Food Code and 505 CMR 140°F* 590.000. _ 3-403-11(E) Rennamng Umliced Portions of Beef Item Good Retall Practices FC 590.Op0 --- Roasts' -I _ FC-2 .003 * ana amenf an _Personnel _ _. 18 Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 004 25. -Equipment and Utensils FC 4 .005 3-501.14(A) C oollog Cooked PHFs from 140'F to - 26. Water.Piumbin and Waste FC 5 .006__ 70'F Within 2 Hours and From 70'F 27. Ph sinal Facility__ FC-6 .007 to 417/45°F Within 4 Hours. .. 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29 Special Re uirem rats _ .009 Temperature Ingredients to 41°F/45'F 30 _Other Within 4 Hours" I or sats-z.do� °Denote,taitical item in the tedeial 1990 Food Cody or 105 CKIR 590,000. COURT DOCKET NO. S CITATION NO. CITY OF SALEM A 290 8 VIOLATION NOTICE L fl' NAME(LAST,FIRST,INITIAL) ! uerr�ro ed f filares 014arkt STREETADDRESS CITY/TOWN STATE ZIP 51 AgrhoQrSt ' !e r 61117tv LICENSE NO. LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS CITYaOWN STATE ZIP .6l k4 r r r S : So lett 1 MA 0l9 REGISTRATION NO. STATE EXP.DATE I MAKE/IYPE YEAR COLOR DATE OF VII�O(L)ATIOOWN'/ TIME ,.,. DATIE CITATION WRITTEC.N /. PNl 8ONAL T �G7'+ LJ`"� OL'OL4'rrn T 'pk�,0 ! ❑NOS LOCATIION{{OF VIOLATION 1 ENFORCING DEPT 51 17�V t�vY 5 h'P SOF I OFFENSE CHAP SECT FINES A Pw�epA tJ(� Datat� Irl 59 .oa t'6` B C OFFICER I.D.NO. TOTAL ( FINE $• Yj DUE v OFFICER CERTIFIES COPY GIVEN TO VIOLATOR i{�J/-}/Y' �yq / ❑ IN HAND X [3-97MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL , r COURT DOCKET NO, TATION NQ CITY �F SALEM VIoLAT�oN N ICE A2908 NAME(LAST,FIRST,INITIAL) 5 e C„ 109 rkl & a Y f g STR ET ADDRESS }, CITVMIWN TATE ZIP to a /�-�/�i ' W m LICENSE N0. LIQ EXP;DATE DATE OF BIRTH OWNER'S NAME(LAST,FIT,INITIAL)- d co W -'Q � 6 e ST EETADDRESSCIITY1,TO.WN STATE ZIP }}}T Y 4. I REGISTRATION NOuTYPE7 YEAR COLOR � y S FATE OF VIgLATI�O}N TIME DATECITATION WRIRE(N_( INJIU ONAI El YES LOCATION OF VIOL41 ATION ENFORCING DEPT.._. pn C -7 � iVU!>✓ -.f' �Fierrif r -w i OFFENSE CHAP. SECT FINES �.oys /q in i (` A 1. %'i /' 1L'- rn I s 0 p LTi 2 t OFFICER I.D.N0. TOTAL a0 ` OF ? R CERTIFIES COPY G FINE --' WE �j i3 `-- - DUE $ 35 GIVEN TO VIOLATOR �i0 9E d I _ ❑ IN HAND X .EMAIL ZZ > I DO N, T MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY go f w U ` a 0 ORDER OR BY CHECK MADE PAYABLE TO:, CITY CLERK w O¢ E CITY HALL l W m Q 93 WASHINGTON STREET a a¢ ' .a SALEM,MA 01970 If p.0 �' TEL.(508)7459595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON I REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL Salem Board of Health . ; Massachusetts Department of Public Health 120 Washington Street, 4th Floor Division of Food and Drugs ' Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Da 29 Type of Operations) Tvp Inspection A N C S ))7d elye ?' II V Food Service ❑i'-Routine Address Risk LJ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone 97� JI 'A�1 El Mobile Date:9- �?- 0 3 Owner HACCP Y/N ❑ Temporary ❑ Pre-operation T/2P W e iCp ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ElP HACCP Ins ecto �s v' /.�Lfiff'3 �1/. 77t/y/ 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 „ ❑ 1 . Prevention of Contamination from Hands F-11. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities i`.EMPLOYEE HEALTH - i. ' ' "". .,.,. a PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC ❑ ❑ 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE -. ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURECONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR.HIGHLY SUSCEPTIBLE POPULATIONS(HSP):_ El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP El 11. ADVISORY 11. Good Hygienic Practices ❑22. Posting of Consumer`Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): �- of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C '_N590.000/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 4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 6. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you _. 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 8. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: . S.5005pCIFOm 14,do s ector's g re: �71,��� �, Print: PIC's Signature: Print: Page/ of a Pages e Qv�NTT'�- Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ft Cross-contamination 1 590.003(A) Assignment of Responsibility'" 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration ofKnoe9edgc* Cooked and RTE Foods* _,_... 2-103 11 Person_in charp+e-duties Contamination from Raw ingredients 3-302.11(A)(2) RaAnAninul Faxis Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C-) Responsibility of the person in charge to Contamination from the Environment require reporting by&xxl employees and 3302.1 1(A) Food Protection* a nlicants* 3-302.1.5 Washin Fmit�bles 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Persson In Utensils* Charge* Contamination from the Consumer 590.003(6) Re Cortin b Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food" 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and RestrictionsFood 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood* L4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com nuance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures, 3-201.13 Fluid Milk and Milk Products* 4-50t.1L MechanicalWarewashing-Fiat Water 3=202.13 Shell Eggs* Sanitization Temperatures* 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ic.e Made From Potable Drinking Water* concentration and hardness * 5-101.11 DrinkingWater from an A Ut Approved System* 4-601.11(A) n sillils C food Contact Surfaces and UtensClean* , 590.006(A) Bottled DrinkingWater k 4-602.11 Cleaning Frequency�of Equipment Four]- 590.006(f3) Water Meets Standards in 310 CMR 22.Ot` Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4.702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment' ShellfisContact4-703.11 Methods of Sattitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical" Sources* to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arne't RegulatoryAuthortt 3-202.1.8 Shellstock Identification Present* 2301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Came Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401..11 EaYin ,Drinking or Usin Tobacco* 3-202.11 PHFs Received at Proper Tem eratures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* - 3-101.11 Food Safe and Unadulterated* 3-301.t2 Preventing Contamination When rastin L 6 TagslRecords:Shellstock ]2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-20312 Shellstock Identification Maintained* Enn loyees* Tags/Records:Fish Products I3 Handwash Facilities 3-402.1 1 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Caacities* 3-402.12 Rearrds,Creation and Retention* 590,00.4(1) Labeling of Ingredients" 5-204.11 location and Placement* 7 Conformance with Approved Procedures 5-205.11 Aa essibility,Q eration and Maintenance IHACCP Plans Supplied with Soap and Nand Drying 3-502.11 S ecialized Processing Methods* Devices 3-502.12 Reduced oxygen nacka ging.criteria* [6--301.11 Handwashin Cleanser8-103.12 Confomance with A) roed procedures301.12 Hand Drying Provision *Denoles critical item in the letlerd 1999 Fond Cate of 105 C641Z 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified 42 4 -PLEASE PRINT CLEARLY 6e vi e r91,1~1X191-' o-mN� a� � �ti 5T ti ie "/7 itiP/fv ,fit GL-O�) I Dom' r�duf _ ' oZV ,cC,PC1�.C3Ul,1.P'C/ /?�1 �:'•o�'� v.,/PS Pyl?/1 2J ;Jae ar _ i 1 i CdiPt', .S CJS Y r yell L iLe �e e7j 7>ov e ve- Sez ly_447 .s 6 � i N Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Ll Re-inspection Scheduled LI Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. Oil ^ ✓��e, ❑ Voluntary Disposal LIOther: t 3-501.'14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk _According to Law Cooled to Factors(Items 1-22) (Coni.) __ _ �41'F(45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 v Cliolina Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16JI) Cold PHFs Maintained it or below 3-202,12 Additives* 540.004(F) 41'/45'F* 3-302.14 Protection from t Ina aproved tlddttiresit 3-501.16(A) Hot PHFs Maintained at or above y g Poisonous or Toxic Substances 140'F. * 7-101.11 Identifying Information-Original -501.16(A) Roasts Held at or above '130'=F. Containers* 7-102.11 Common Name-Working CoContainers" 20 Time as a Public Health Control 7-201.1.1 Separation-Stort O 3-501.19 Time as a Public Health Control" 7-202.11 Restriction-Presence and Ilse'' 590.004(1-1) Variance Ron unement 7-202.12 Conditions of Use" 7-203.'11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Cheridcnls^ POPULATIONS(HSP) 7204 12 Chemicals for Washing Pratuce.Criteria* 21 3-801.1.1(A) Unpasteurized Prc-packaged Juices and Beverages with Warning Labels* 7-204.14 Drvinn Arcents-Qitetia* 3-801.11(B) Use of Pasteurized Fins* 7-201.1.1 hicidentai Food Contact,Lubricants* 3-801.1.1(D) Raw at Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 1-306.1.2 1 Rodent Bait Stations" 3-801.11(C) Unopened Food PackaLL Not Re-served. 7-206.13 Trackin_;Powders,Pest Control and Manitorinr CONSUMER ADVISORY_ TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Animal Foods That are Raw.Undercooked or Proper Cooking Temperatures for _PHFs Not Otherwise Processed to Eliminate Patlr(sgens 3-401.1JA(t)(2) Eyys las'F 1 Sec, H.ee';Pool Eggs-Imrnedi rte Service l 4fi'F15secx 3-302 13 Pasteurized F„gs Substitute for Raw Shell 3-401.1 i(A)(2) Comminuted Fish.Meats roc Game L gag* Anitnafs -155'F 15 sec. * SPECIAL REQUIREMENTS 3-4(1Lll(B)(1)(2) Pork and}3eefRoost- 130'F12-irnm* 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(I')) 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 Stuffim,Containing Fish,,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 scc.* above if related to foodborne illness 3-401.11(0)(3) Whole-muscte, Intact beef Steaks interventions and risk Factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked hr a practices should be debited under #29- Microwave 165'F" Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 14VF 15 sea 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3,03.'11(A)&(D) PFIFa 165'F 1.5 sec. * (Items 23-30) - 3-40111(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, evitich do not relate to the Time* foodborne ilbress interventions and risk factors listed above, call be 3-403:1l(C) Commercially Processed RTF Food- found in the follooinq sections of the Food Code and 105 CDIR 14WF' .590.000. 3-403.'11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices PC 590.000 Roasts" 23 Mane ement and Personnel FC-2 .003 �..__._-____-_ -----g- -^ 1 24. Food and Food Protection FC ----- --�� -- -- 3 004 3-501.14(A) Cooling Cooked PIJFs from 140'F to - ( ) a 4 26 Equipment ar do Uansils to FC 4 005_ ig Proper Cooling of PHFs r- Wat 25 E f FC_o 006 70`F Within 2 Hours and From 70'F (27, Physical Facility FC-6 .007 '� to a l'FI45"F kVithin 4 Hours. * 28. Poisonous or Toxic Materials FC 7 .008 3-501.14(6) Cooling PHFs Made from Ambient I�29 Spse(al Requirements .009 Semperature In,,,r edienas to 41'F/45'F 30 ether Within 4 Hours'* .<Denoto.,critical i ern in the federal 1949 1ood C.de or 105 Ci9R 590.000. f ' CITY OF SALEM, MASSACHUSETTS v��co r BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 �nnvs TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Fred Guerrero Name of Establishment : Marc ' s Market Address of Establishment : 51 Harbor Street Type of Establishment : RETAIL FOOD Application Date : 12/11/2002 Restrictions : Permit for Food Establishment 68-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 16-03 These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT ,' ce CITY OF SALEM, MASSACHUSETTS 1111 "� BOARD OF HEALTH Ivl� r_ • > 120 WASHINGTON STREET, 4TH FLOOR G-00 1 1 Lu�2 SALEM, MA 01970 TEL. 978-741-1800 L) I Y vi JHLEM FAX 978-745-0343 BOARD OF HEALTH STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR /j PERMIT TO PERATTjE� OOD E nABLISHMENT NAME OF ESTABLISHMENT N/ 4I-Cs JAXS ( TEL ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) r OWNER'S NAME 'k`I8A1A j ) TEL ADDRESSd c:,?v ST.gTF71P _ CERTIFIED FOOD MANAGER' NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous ood is prepared.) EMERGENCY RESPONSE PERSON/--rL�,I�DCJI I Z HOME TELV � ��� ' r -lm -�r� 1�,,(/j HOURS OF OPERATION: Mo - Tue. .J ed.LThu. ✓ Fri. j/ Sat. y Sun. L/ TYPE OF ESTABLISHMEbLT, FEE check only RETAIL STORE ES NO less than 1000sq.ft. $ 50 1000-10,000sq.ft. 0 3 more than 10,000sq.ft. =$250 RESTAURANT YES less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YDS` / TOBACCO VENDOR NO `6 Q� ($50 )ALL NON-PROFIT(such as church kitchens) YES NO V 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 bell have filed all state tax returns and paidall state taxes required d r the law. 025 - - �-0 Signature Date 'le IM&Social Security or Federal Identification Number ---- - ------- -------- ---------------------------- Rev iud 11 5/02 FOODAP2.adm Check#&Date F THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name / D to Type of Ooerationfs) Type of Inspection t Y //4��� Q� ❑ Food Service Routine Address _ Risk Retail ❑ Re-inspection Level E- -1 Residential Kitchen Previous Inspection Telephone >"i c _, _\ / Q O Q' V1 El Mobile Date: Owner HACCP Y/N ElTemporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) ,/�.�, , Time ❑ Bed&Breakfast ❑ General Complaint ✓ '� In: El HACCP Inspector c l CA )/ C- Out: Permit No. [I Other Each violation cch00ecked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH [12. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements Ll 17. Reheating V S. Cooling 9. Hot and Cold Holding El7. Conformance with Approved Procedures/ HACCP Plans PROTECTION FROM CONTAMINATION t ❑ 20. Time as a Public Health Control � 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) X 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) 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: . E t Inspector's Signatue,: Print: PIC's Signature: Print: Page,/- of 7pages V t.. v FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION -_8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1. 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 7-" 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P'P g8 Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.1 1(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* S Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* "'12' Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* ' -13. Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM `nn/)�� /^^�/� ARD OF HEALTH ° Page: of 3 Establishment Name: t'/ /'/ Date: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ■ PLEASE PRINT CLEARLY -7 �- c Sf / �5 !�c �Jt S72 Poor k Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunr�o9ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Emersion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14((') PHFs Received atlentperatures 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. 3-501.15 Coolieg Methods for PRFs PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-202.12 Additives=s 3-501.16(B) Cold PHFs Maintained of or below 590.004(F) 41'/45°F 3-302.14 Protection from Unapproved Additives" 3 Poisonous or Toxic Substances -501.16(A) Hoc PHFs Maintained at nr above 15 140°F. * 7-101.11 Identifying Information-Original 3-501.16(.A) Roasts Held at or above 130'F. _ Containers" 20 Time as a Pubic Health Control 7-102.11 Commonbune-Workin Containers* 3-501.1.9 Time as a Public Health Control* 7-201.11 Se aranon-Stor , 7-20111 Restriction-Presence and Ilse-'" 590.004(1-1) Variance Requirement 202.12 Conditions of Ilse" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20311 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitu^fs.Criteria Chemictls� 7-204.1.2 Chemicals for NVashang Produce Criteria* 21 3-801.11(A) Unpasteuriood Pre-packaged forces and Beveraees with Warning Labels* 7-204.14 Drying Agents-C 1 atria* 7-205.11 Incidental Food Contact.Labrieants* 3--801.11(5) Use of rPasteurizedPartially Cooked Bees* 7-206.11 Restricted Use Pesticides,Criteria's 3-801.1.7(0) Raw or Pm� pro s Not Animal Food and Raw Seed Sprouts Not Served. :,' 7-206.1.2 Rodent Bait'Stabonss' 3-801.t 1(C) Unopened Foal Package Not Re-served.a, 7-206.13 Tracking Powders,Pest Control and Monitorin4'` CONSUMER ADVISORY TIME(CEMPERATURE CONTROLS 22 3-603.11 Cons'urnf er Advisory Posted for Consumption o Animal Foods Than are Raw.Undercooked or 76 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs ., crave, 2uor Pathogens.- 3-401.1IA(1)(2) Etas- 155'F 15 Sec. Lt s-Immediate Service 145°F15su:* 3-302.1.1 Na1'emued Eg"s Substitute'for Raw Shell Eggs' 3-401.11(A)(2) Comminuted Fish.Meats&Game ' u pals- 155'F 15 sec. ' SPECIAL REQUIREMENTS 3-401.11(5)(1)(2) Poi k and Beef Roast- 130'F 121 min* 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 40 1.11 Poultry,Wild P Game,Stuffed HF,, residential kitchen operations should be Stuffing Containing Fish,'Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec " above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 14.5'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. 3-401.1I(A)(I)(b) All Other PRFs- 1,45°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES r3-4O3,1 1(A)&(0) PHFs 165'F 15 sec. * (Items 23-30) I(B) Microwave 165'F 2 Minute St'amding Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk{actors listed above, can be 1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CAIR 14WT 5,90.000. 1(E) Remaining Unsliced Portions of Beef item i Good Retail Practices �FC 590.000 Roasts'` 1-23. _Management and Personnel FC-2 .003 24 Food and Food Protection FC 3 .004 L 1S Proper Coaling of PHFs r-2-5 - - m .t- E gent and Utensils jFC 4 .005 3-501.14(A) Cooling Cooked PHFs from 14WF to 1 �8 Water Plumbing and Waste FC 5 .006 1 70`F Within 2 Hours and From 70'F ^27. Ph sical 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 1 PHFs;Made From Ambient 130. Other _ ___ _ _ 29 Special Re wrements 009 Temperature Ingredients to 41'F/45`F Within 4 Hours',, seeora:oda2 drc Denote:critical hem in the federal 1999 Foal Code or 10;CMR 590.000. q ' t, r CITY OF SALEM / BOARD OF HEALTH Y 's Establishment Name: (lr/�lC� y" /�C r� La Date: / �—� Page: 3 of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date f No. Reference R—Red Item PLEASE PRINT CLEARLY Verified i. t v i t :3 I I t k x J �t s * k Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled El Suspension comply with all mandates of the Mass/Federal Food Code. I understand that r noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 4 r 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Inness Interventions and Risk According-,to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs F-14 -----7FOod or Color Additives E19 PHP Hot and Cold Holding 3-501_I6(B) Cold PHFs Maintained at or below 1-202.12 Additives* 590.004(F) 41`745'F* 3-302.14 Protection from Una pin roved Additives' 3-501.10(A) Hot PHFs Maintained at or above 1=5 Poisonous or Toxic Substances 140'F. 7-101.31 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers' 7-102.11 Conanion Name-Working Containers* 20 Time as a Public Health Control 7-201 11rattel 3-501,19 Time as a Public Health Control* Se�o 7-202.11 Restriction-Presence and Use" 590.004(H) Vmiance Rcquu�jvnentt 7-202.12 Conditions of Use' 7-203.11 foxic Containers-ProhiliniOni"; REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Skinitizers.Criteria-Chemicals:, POPULATIONS(HSP) 7-204 1221 3-801,1 I(A) 7-204.14 Chemicals Jim Washing produce,Criteria* Unpasteurized Pre-packaged Juices and - I Beverages with Warning- Libels* I Incidental FoW Contact,Lubricants* 7-20��l Diving- Aggent�.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides, Criteria* 3-801.11(D) Raw or Partially Cooked Amaral Food and 7106 12 Rodent Bait Stations* - Raw Seed S�)uts Not Served. * 7-206.13 Trackin,Powders, Pest Control and 3-801.11(C) Unopened food Packa�� Monitoring" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Anarred Foods That are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3 Eglp- 155'T 15 Se, 1 A(U(2) Paflro�, ns.* E,-s-Immediate Service 145'F1.5scc:, 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11,(A)(2} Comminuted Fish.Meats&Game ER,s* Animals- 155°F 15 sec. * - 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 turn* SPECIAL REQUIREMENTS 3-401.11(A)(2) Raines, Injected Means- 155'17 15 590.009(A)-(D) Violations of Section 590.009(A)-(I))in sec. * entering, mobile food, temporary and 3-401..11(A)(3) Poultry, Wild Game, Stuffed PHP,, residential kitchen operations should be Stuffiiin,,Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, above if related to foodborne illness 3-401.11(C)(3) Whole-muscle. Intact Beef Steaks Interventions and risk factors. Other 145g-F* 590.009 violations relating to good retail 3-401.12 Raw Annual Foods Cooked in a practices should be debited under#29- Microwave 165°F Special Requirements. 3 �40 1.11(A)(1)(b) All Other PHFs - 145°F 15 sec. 17 Reheating for Hot Holding VIOLAVONS RELATED TO GOOD RETAIL PRACTICES 3-10111(A)&(D) PFIF, 165'F 15 sec. * (items 23-30) 3-403.11(13) Microwave- 165° F 2 Minute Standing Critical and non-critical violations, ivilach do not relate to the Time* foodborne illness interventions and risk,lacrois listed above, can be 3-401.1.1('C) Commercially Processed RTE Food- found in thefolloning sections qj the Food Code and 105 CUR 14WF- 590.000. 3-403-403.11(E) Remaining Unsliced Portions of Beef Item 1 Good Retail Practices PC 59-0-000- 1 Roasts' 23, Management and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection 1 FC-3 .004 25, Eguipment andUtensils FC-4 005 3-50L14(A) Cooling Cooked PRFs from 140'F LAI 2 Wateir.Plumbin andWaste ---- -FC 5----- .006. - 7WF Within 2 Hours and From 70°F I I FC-6 007 to 41'F/45'F Within 4 Hours. * 5�� 2=0UES'0C-r1Ti1cxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29 Special�Rmm�,t, .009 Temperature Ingredients to 41"F/45°F 30. Other Within 4 Hours* S 2 d-,- Denote,critical nern in the led-ral 1999 Food Code or 105 CMR 590o00, a,r'twMw-TR nHNF.•yfp�E:I THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name l �.� Date Type of 0 eration(s) Tvoe of Inspection �12C S / ��`��t // 6.3 ❑ Food Service � Routine Address / ,// _�- Risk K Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone 7(7 Kr (il/ T1 YY Y J d' 4So �.J El Mobile Date: Owner HACCP Y/N ❑ Temporary ElPre-operation ( � ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) �•---/�i�� Time ElBed 8 Breakfast ElGeneral Complaint In: ❑ HACCP Inspector va/ Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 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 FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ El 6. Tags/Records/Accuracy of Ingredient Statements 17. Reheating ❑ El 7. Conformance with Approved Procedures/ HACCP Plans 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El 20. Time as a Public Health Control El8. Separation/Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food ( 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. / 30. Other 1 DATE OF RE-INSPECTION: Inspector's Signatur� Print: PIC's Signature: Print: "Y Page/ofZPages FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charpe-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* k EMPLOYEE HEALTH Contamination from the Environment 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4!: Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* * p gg Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.1l(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* AL Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* '5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12> Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products 3-402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code'or 105 CMR 590.000. CITY OF SALEM t BOARD OF HEALTH Establishment Name: �'��C-Sy f l�(� ( Date: X116-3 Page: 2 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY - 44 " I I i I Discussion With Person in Charge: Corrective Action Required: Ll No ❑ Yes . I have read this report, have had the opportunity to ask questions and agree to correct all Li Voluntary Compliance ❑ Employee Restriction/ s inspection, to observe all conditions as described, and to Exclusion violations before the next ins P LI Re-inspection Scheduled 11Emergency Suspension comply with all mandates of the Mass/Federal Food Code. l understand that . noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I 3-501,14(C) PHFs Received at Terrilwratrues Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Horns. PROTECTION FROM CHEMICALS .5o 1.r-) CoolinE Methods lot PHFs L 14 Food or Color Additives Fig PHF Hot and Cold Holding 3-501,16(B) Cold PHFs Maintained at or below 3-202J2 I Additives" 3-501.16(13) 41'145c F* 3-302.14 Etoicction floor LTniTLrovetj Akddioe. ea% 3-501.16(A) Hot PHFs Maintained at above 15 poisonous or Toxic Substances 140°F. 7-101.t] identifying Information-Original 3-501.10(A) Roasts Held at or above. 130°F. Containers* 7-102.11 Cornirvii Name-WorkinContainers* 20 Time as a Public Health Control Sel2Storarauon- cl 3-501.19 Tinic as a Public Health Control" 7-202,11 Restriction-Presence and Use" 590-00_4(H) Variance Ree jnicer nt 7-202.12 Conditions of Use* 7-203.11 'toxic Containers-Prohibitiorrs'T REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Samti7crs,Criteria-Chemicals* POPULATIONS(HSP) 7-204,12 Chemicals for Washing Produce,Criteria* 21 3-801,11(A) Unpasteurized Prepackaged Juices and Catena". I I Beveraees with Warninci Lsbels" 7-204 14 Dirvim Agents.Cri cria ' ­_ '_ 7 -gs Incidental Food Contact, Lubricants- 3-801.11(B) Use of Pasteurized E, 3-801.11(D) Raw or Partially Cooked Animal Food and Restricted Use Pesticides,Criteria" I Raw Seed Sprouts Not Served. 2b 1-206.12 _'oo 12 Rodent Bait SUIL101i 3-801.11 C) Unopened Food Package Not Re-served. 6.1 13 7 206 _F Trackin'g Powders, Pest Control and Montrone, CONSUMER ADVISORY TIME[TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Proper Cooking Temperatures for Animal Forids That are Raw, Undercooked or 16 PHFs Not Otherwise Processed to Eliminate 3-401.11 A(1)(2) Eggs- 155'F 15 Sec. Patjlo�gens ""1/1"POOI .* - Plm,n-hirrmthate Service 145�1715sec;, 3-302.13 Pasteurized E,gs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish. Meats&Garric - Es, Animus- 155'F 15 sec. �' - SPECIAL REQUIREMENTS 3-401.11(fil)(1)(2) Pork and Beef Roast- 130"F 121 rrljn,' 3-401,11(A)(2) Barites, Injected Meats- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Sec * catering, mobile food, temporary and 3-401.11(A)(3) Poultrv,Wild Game..Sniffed PHFs, residential kitchen operations should be Stuffing Containing Fist),Medt, debited tinder the appropriate sections Poultry or Ratites-765°F 15 sec, 1 above if related to foodborne illness 3-401.11(0)(3) Whole-muscle.Intact Beef Steaks interventions and risk factors. Other 145`F* 590.009 violations relating to good retail 401.12 Raw Aninial Foods Cooked in a practices Should be debited under#29- Microwave 165-F* Special Requirements. 3-401.11 W(I) b) All Other PHFs-145'F'15 see, 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) Pt{Fs 165'F 15 see. 1: (Items 23-30) 3-403,11(B) Microwave- 165'F 2 Minute Standing Critical and non-crificul violations, which do not reline to the filliel: foodborne illness interrentions and risk factors listed above, cart be 3-403,11(0) C.onuncircially Processed RTE Food- found in the following sections q/'the Food Code and 105 CAIR 140°F' 590.000. 3-403.11(E) Remeanyro,Unsliced Portions of Beef Item Good Retail Practices FC 590,000 Roasts* 23. -Management and Personnel FC-2 .003 24. Food and Food Protection FC 18 Proper Cooling of PHFs - ul meat and Utensils L -3 -004 25. FC 4 .005 3-iOt 14(A) Cool in,,,Cooked PHFs Irani 140'F to 26 Water, Plumbil FC-5 .006 _i-wa��-------------------j 70-'F Within 2 Hours and From 70'F 7 Physical Facility FC-6 007 to 41OF/451F Within 4 Hours, li 28Poisonous or Toxic Materials FC -7 .008 3-501.14 From Arrancrit 29 SpecialeVlrernents _ .009 _ Temperature Ingredients to 41'177450F 30 Other Denotes crilical itern in the Sideral 1999Food Code oi MCNIIZ590000. COURT DOCKET NO. CITATION NO. • CITY OF SALEM 11 i d8 VIOLATION NOTICE r nD NfAM�(LAST,FIRST INITIAL) rI' �� G STREET AD�/ESS / CITY/TOWN STATE ZIP LICENSE NO. LIC.EXP.DATE- DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS f f CITY/TOWN STATE ZIP REGISTRATION NO. STATE I EXP.DATE MAKID7YPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN veasorvaL muny El EIYES 1 f rDvZ ®4F7 1 ❑NO LOCATION OF VIOLATION ENFORCING DEPT. r e 1 ryC�G//7�1 OFFENSE CHAP. SECT. FINES Al B id tJ /zc/i cIc' �1P 5 f3 C OFFICER •''' I.D.NO. TOTALFINE DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR +11 L y/ . X ^ ❑ IN HAND ,�„� .lirBV MAIL PONOT MAIL CASH-PAY ONLY BV POST L NOTE,MO EY ORDER OR BY CHECK MADE PAY,ABrLE TO: CITY CLERK !/ CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)748-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF - $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION - ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL � O SENDER: 1 -a •Complete items 1 andtor 2 for additional services. I also wish to receive the l o •Complete items 3,4a,and 4b. following services(for an l % •Pdnt your name and address on the reverse of this forth so that we can return this extra fee): 'f lard to you. ai j •Attach this form to the front of the mailpiece,or on the back if space does not 1, ❑ Addressee's Address Y permit. t' y -Write-Return Receipt Requesfed'on the mailpiece below the article number. 2. ❑ Restricted Delivery y -The Return Receipt will show to whom the article was delivered and the date ti Y C delivered. Consult postmaster for fee. 0 j 3.Article Addressed to: 4a.Article NumberIx i d Z 279 293 056 � I Y CL VELOUKAS 4b.Service Type «' f C/O MARIA'S PLACE ❑ Registered XEKCertified rnl W 10 JEFFERSON AVENUE ❑ Express Mail - 0 Insured 'C ¢o SALEM, MA. 01970 ❑ Return Receipt for Merchandise-❑,COD o o _ 7.Date of elive o 10 Jefferson Ave. VM JD 01 1 Ya. 5.Received By: (Print Name) S.Addresse 'Address(Only if requested it W and.(ee'is paid) i g 6.Signature:(Addressee or Agent) ~ T X PS Form 3811, December 1994 Domestic Return Receipt UNITED STATES POSTAL SERVIC�r��'� E SSF-{- 'FIr9hGlass� Mail 3 'Postagd`iFee 'aid l P M sus j r, o �F.s m+i oYhf"G-o R — l Print yourPy 69ad ss, and ZIP_' oc ode��F�Ftis h 4 'r „ I II `)SIA I AR 3 0 1998 Salem Health Department 9 North St, Salem, Mass, 01970 ITY OF SALEM EALTH DEPT. Illu�iiilil�Inln�111nuIII�I�Ii�ul�Ili�I�I1�uLlliinllll COURT DOCKET NO CITATION NO CITY OF SALEM A0931 VIOLATION NOTICE NAME(LAST,FIRST,INITIAL) !+/lam/e -'wa STREET ADDRESS CITY/TTO_W/NN �STATE ZIP p LICENSE NO./bn- /4 LIC.EXP.DATE DATE OF BIRTH ycq-- C? a OWNER'S NAME(LAST,FIRST,INITIAL) S,#m e STREET ADDRESS CITY/TOWN STATE ZIP REGISTRATION NO STATE I EXP.DATE MAKE TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATIONNWWjRITTEN IPrELU50NAL ' ��LI/ ` ❑'PM -�Ch '7 6 p-NOS LOCATION OF VIOLATION V��/jw' X2 Uhl Cr ENFORCING EP . 15 /�7R PGir.F/ 7 ✓ /kP�� OFFENSE yQ LSC :�,�Il/ CHAP.I SECT. FINES B/Lo77:t t� .�-i✓ GPl( /^'y gf71` OFFICER I.D.NO. TOTAL DIUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑IN HAND X (/ �-{./kl-/!f i 'Al-BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE!MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON. REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE. PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE - SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL R f a `I _+ ;,. �`M1✓•#Y .-+',.. I 4IRT DOCKET NO.: Y-. :s CITATION NO t L ICITY•OF SALEM p ( VIOLATIONHOTICE .I p - rrp�)y(LAST,FIRST,INITIAL)' CITYfrOWN STATE ZIP - LICENSEIG EXP.DATE DATE OF BIRTH { : S � 0ln r^ OWNER' .�-d1 ) >. ru mSTREETADDRE$S , CITVffOWN STATE ZIP REGISTflATION NO. - STATE P.GATE MAKEiYPE YEAR COLOR i E r O f s DATE�]¢' VI('}T TWN TIME , DATE CfjAHON KITTEN IE yoI AW /�f LI YES -+ M O ' LOCATION OF VIOLATION ENFOR TNG DEPT. -,] ! ,OFFENSE CHAP. SECT. FINES X U" 03 41176-, I / 5 D Ep OFFICER ID NO. 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X D� FINE $ DUE 'S5 :`OFFICE IFIES COPY GIVEN TO VIOLATOR z��l 03 T� IN , ;Z -,-, 51 MAILCASH-PAY_ fy TAI NOTE,.-MON Ln ONU 0:, WR AbE-PA �WTI ORBYCHqCKIA s I 's'CdY CLEAK 9. CITY HALL �-93 WASHINGTON STREET ZALEIM,MA 01 TEL.(508)-745­ Z I HEREt3V-.iLE6i�-fd.,E5CEOCISE.-rHEFIRST-OPTION-AS STATED A; PAYMENT TO THE OFFENSE CHARGED AND.ENCLOSE!,Q PAYMENT IN THE AMOUNT OF 0 $ CASE# IN FURTHERINFOAMATIC SEEOTH OTHER FOR ENCLOSE PAYMENT SEW N T