MARINAS NEWSTAND - ESTABLISHMENTS /I/la(�ga44 n`�Itu�b 2t� ner�^•n SO#
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Commonwealth of Massachusetts
City of Salem
Board of Health 1Gmberiey Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/03/2011
ESTABLISHMENT NAME: Marina's Newstand
File Number:BHF-20064)00010 24 Norman Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No Permit issued Permit Expires Fee Restrictions!Notes
RETAIL FOOD BNP-2011-0031 Jan 1,2011 Dec 31,2011 $70.00
Total Fees: $70.00
Ii
I
PERMIT EXPIRES December 31, 2011
Board of Health —f ✓ —
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,
all plans for such must be submitted to and approved by the Salem Board of Health. Page 1
CITY OF SALEM, MASSACHUSETTS
' BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DGRerNBAUM(a�s,= ALCM.CONI
DAVID GREENBAUM,RS
ACTING HEALTH AGENT
2011 APPLICATION FOR PERMITS TO OPE ATE gr FOOD ESTABLISHMENT
>
NAME OF ESTABLISHMENT_ r"/G�/� i71 ,/ i,m 77,,( TEL#
ADDRESS OF ESTABLISHMENT 7 FAX
MAILING ADDRESS(if different) Gf�D . G`� b CiD n
EMAIL- Business': 11 Website: y
OWNER'S NAME I �� L� ) TEL# /? v�J
ADDRESS f� r Gr/�h� ✓9 !' "
STREET (? � CITY STATE - ZIP
CERTIFIED FOOD MANAGER'S NAME(S) SO /'I `-r � CERTIFICATE#(S)
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON HOME TEL#
;DAYS`OF,OPERAiIONx ; ';Monday :''Tuesday ' ,Wednesday�' (;W Thursday, j ,Fritlay_ ;,3 Saturday Sunday"
HOURS OF OPERATION 1A9
Please wdte in time of day.
Forexam eltam-ltpm
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. _$ 70"
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
-------------------------- ---------------------------------------------------------.....----- ----------------------------
RESTAURANT YES NO less than 25 seats =$140
Outdoor Stailona, Fooder $2 �3
( y Cart i 0)
9
seats ==J200
more than 99 seats =$420
BED/BREAKFAST/ YES NO $100
CHILDCARESERVICES/NURSING HOM---------------------------------------------------------------------------------------------------------------------------------
ADDITIONAL PERMITS
MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax
returns and paid state axesrequired u er the I w.
Signature Date _ Social Security or Federal Identification Number
Revised 10/7/11 FOODAP201 I.adm Check#&DW4,2
Commonwealth of Massachusetts
00 City of Salem
Board of Health lQmberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED:. 02/05/2010
ESTABLISHMENT NAME: Marina's Newstand
File Number:BHF-2006-000010 24 Norman Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2010-0347 Feb 1,2010 Dec 31,2010 $70.00
Total Fees: $70.00
PERMIT EXPIRES December 31, 2010
Board of Health Av
t
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,4m FLOOR
TEL. (978) 741-1800
ICIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DGREENBAUMQSALEM.COM
DAVID GREENBAimt,
ACTING HEALTH AGENT
2010 APPLICATI FOR PERMIT TO ER TE AFOOD ESTABLISHMENT
NAME OF ESTABLISHMENT � - , /� TEL# 77��u /,d 2.S
ADDRESS OF ESTABLISHMENT FAX#
MAILING ADDRESS(if different) � L� �/�� �)
EMAIL-Business`. Website:
OWNER'S NAME_ � ��-r TEL# �t911O-
ADDRESS 4
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#
Monda Tuesda� �, � _es , +,Thursday -'=,w ntla"" "�- ;Saturday_,,, , ;� Suntlay
HOURS OF OPERATION
Please write in time of day.-
(For example 11am-11 m ( -
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE Y S N( less than 1000sq.ft. 4
'
1000-10,000sq.ft. 80
more than 1 0,000sq.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
CHILDCARESERVICES/NURSING HOME-------------------------------------- -----' ...................-- ----
-----------------
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax
returns and paid all state taxes r ired er the law.
D�2G38 /�Z
Signafure Date �/ _ /� Social Security or Federal Identification Number.
— - — --- f-�`--------- - - -
Revised 424/07 FOO 08.a heck#&Date ^v. $ y
.y.. < : ..M1-:�.� ;;r>r•S!h'_ ty�:•.�.>t�'h'sM�...>R++l:*+'^�'.A''r++m " x'r`I"�"e_�i�+:. "3..r� ._
.Y 7
Massachusetts Department Of Public Health l Salem Board of Health
Division of Food and Drugs 120 Washington Street,4'"Floor
g Salem, MA-01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Nam Date Type of Operation(s) Type of Inspection
( k U )5 Qin r_ 0 ❑ Food Service Routine
Address Y\oAh 1CP/v� C Risk (®,Retail 'Ne-inspection
Level ❑`Residential Kitchen Previous Inspection
Telephone (1 { ' �J / + I ❑ Mobile Date:
Owner / t' HACCP Y/N ❑ Temporary ❑ Pre-operation
'�(� � ❑ Caterer ❑Suspect Illness
Person in Charge(PIC) _ Time nnn uuu��t ❑ Bed& Breakfast ❑General Complaint
Ind or7 1 ❑ HACCP
Inspector � ��� I Out: ` Permit No. ❑ Other
Each violation checked require vexplanation 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_�obacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(EY❑ 590.009(q Lj
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT, ; f u ❑ 12• Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
EMPLOYEE HEALTH """"` '"`' - ��I ❑ 13. Handwash Facilities
- PROTECTION FROM CHEMICALS
RepoingofDias,easesbyFoodEmpl_oyee, .a,nd PIC �� ,., -
��_€❑ 2a
❑ 14.Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded
❑ 15.Toxic Chemicals
;,FOOD FROM APPROVED SOURCE',' T
71MEITEMPERATURE CONTROLS P6temlall n Hazardous Foods ``
E] 4. Food and Water from Approved Source , j , I < < ,y ) [
❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling
EPROTECTION FROM CONTAMINATION r, - ❑ 19. Hot and Cold Holding
_ sl
:'��.-. w,rol
E] 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing t REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)k`h
El21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices $CONSUMER,ADVISORY,n
❑22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report, when signed below
C iv` by a Board of Health member or its agent constitutes an
23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-3)(sso.004) cited in this report may result in suspension or revocation of
25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this or er.
30. Other DATE OF RE-INSPECTION:
S'S901nspeclFo.m61a me "tf-- _
Inspector's Signature:
PIC's Signature:�� n ��� Print: G ^ n r^Sp�, Page of 2-Pages,f
Violations Related to Foodborne Illness
Interventions and Risk Factors(Items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT. S Cross-contamination
1 1 590.003(A) Assignment ofResponsibihty* 3-3011UA)(1) Raw Animal Foods Separated from
590.003(B) Demonstration of Knowledge* Cooked and RTE Foods*
2-103.11. Person in charge--duties Contamination from Raw ingredients
3-302.11(A)(2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590:003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by fait employees and - 3-302.11(A) Food Protection'
applicants* 3-302.15 Washing Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-3(A.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils*
Charge* Contamination from the Consumer
590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Foal*
31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003(E) Removal of Exclusions and Restrictions Food
3-701.1.1 Discarding or Reconditioning Linsafe
FOOD FROM APPROVED SOURCEFood*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501..11 I. Manual Warewashing-Hot Water
3-201.1.2 Fund in a Hermetically Sealed Container* Sanitization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-20213 Shell Eggs*
Sanitization Tem ocratures*
3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. *
5-101.1.1 Drinking Water from an Approved System' 4-601_11(A) Equipment Food Contact Surfaces and
Utensils Clean*
540.006(A) Bottled Drinking Water"
4-6021.1
590.006(,B) Witter Contact Surfaces and Utensils*
Meets Standards in 310 CMR 22.01' 1 Cleaning Frequency of tensiils'le* Food-
590,006(B)
and Fish From an Approved Source
4-702.11. Frequenoy of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sarutization-Hot Water and
3-201-15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 10 Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authoq 2-301.11 Clean Condition-Hands and Arms*
3-202.18 Shellstock Identification Presents 2-301.12 CleaningProccdme*
590.004(C) Wild Mushrooms* 2-301.14 When to Wash*
3-201.1.7 Game Animals* ].i Good Hygienic Practices
S Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and
3-20215 Package Integrity* Mouth*
3-101.11 Food Safe and Unadulterated* 3-301.12 1 Preventing Contamination When Tasting*
6 Tags/Records:Shellstock L12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-20312 Shellstock Identification Maintained" Employees*
Handwash Facilities
Tags/Records: Fish Products 13
. Conveniently Located and Accessible
3-402.11Parasite Destruction*
3-402.12 1 Records,Creation and Retention* 5-203.11 Numbers and Capacities*
590.0040) Labeling of ingredients' 5-204.11 Location and Placernem*
7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance
/HACCP Plans Supplied with Soap and Nand Drying
3-502.11 Specialized processinMethods* Devices
3-502.12 Reduced oxygen packa hg.criteria* 6-301.11 Hindwashing Cleanser,Availability
8-103.12 Conformance with A. roved Procedures* 6-301.1.2 Hand Drying Provision
*Denotes cririu"d item in the federal 1999 Fond Code or 105 C-1MR 590.000 -
6
CITY OF SALEM
B/OIARD OF HEALTH
Establishment Name: T n A "ri J Q c �S T vI �V Date: \O –1 —� Page: ;:D, of
Item Code C-omleal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No, Reference R–Red Item .Verified
PLEASE PRINT CLEARLY
as Ox Q () — CJCJ OIV
- -
�I
t
t
f'
F
I
i
Discussion With Person in Charge: Corrective Action Required: yil o ❑ Yes
T 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.
�j ❑ Voluntary Disposal ❑ Other:
F -
t
1
i-SOIJ4(C) PHFs Received at Temperatures
Violations Related to foodborne Illness Interventions and Risk According to Law Cooled to
Factors(Iletns 1-22) (Cont) 41`F/45`F Within 4 Hours.
PROTECTION FQOM CHEMICALS 3-501.15 Coolim.Mcthods for PHFs
--- 19 PHF Hot and Cold Holding
14 Food or Color Additives_ 3-501.16(B) Cold PHFs Maintained at or below
3-202.12 Additives" 590.(N)4(F) 41°/45°F-
3-30114 Protection from Una t roved Addnivesr 16(A') lint PHFs Maintained at or above
15 Poisonous or Toxic Substances
7-WIJI Identifinglntinmanon-Ou ioal td(l'F- *`
3 sill 16(A) ��Rva+ts Held at or above 1300F.
Cont.uner,�
102.11 Common'Name Ao hniFl anrrin ra" I-��--� — Time as a Public Health Control
7 "30L11 i(II IS rlas i Public If alrh Control
Se mtu<n Sunagc' ` f � — ----i m� ---
�-' 90.-`-01,10 V a mi,e'tiuynuc aianC
7 202.11 P.e-tttt'an Pr stnCe wd L.c< — -__—_ - —---- --_ -----
7-202.12 Condition;of llse'
'-209.11 Toxic f om tinct P ohibiiwny –1 REOUiREMENTS FOR HIGHLY SUSCEPTIBLE
04.11 Sanni/er. Cri ria Chu nc is' _ POPULATIONS(HSP)
7-204.12 _ Ch nni ids for Rhu.
a t rwu < ( ilolia" } °L ( 501.1 i(A; Unpn tcu ivcd Pri pact t,cd Jaices wed
7-v04.14 Dim Ai cuore,(nut� with l�ainui�ahv4s,.
`'-RU' II(i3) I Li, otPu.tcmtrvdt
los I i _ horn xl[vial t xvntlu t.ah c u: s -- —
rze _d ca Pe n idc: Grtei t -- t fi01 I Iti)t �t aw of PailWl C isrl.ul Aannal Fixe and
-- -d--- - — — Rin Sod Sproat "Sof Serval
7 06 1 Roil"111 R t 5:mon, — — —
�--, —'I
— -- -- - -- ty's0 I:(C:.. .1.!r r(_nul l_a>l Pacia iSoi 4 -ser vCtL "
hit..k.ny.towdv-r. Ps:t:orarid and � � ------
) CONSUk;ER ADVISORY
— --- --- -- — --
�< I i-tN_ 1 i imsumcr lrty 5u v Post d liar( cmxempliva of
TIMEITEMPERATURE CONTROLS
i t Rac L.nderCr of ed i s
1!r Proper Cooking Temperatures for 1 'r
PHFs. — ( <',t f)ih<re isc t ri,.ctiv d o i_`h it ttre i
,.sOttllni(-1 1 � f� 155 35i. 5h
t _— ..l ---
v,� Raw Shell
-101A% l)( J G ;n nailed 1;"h' art s ti 2 C;tu.c
nn iia r» ! se SPECIAL REQUIREMENTS
1 Pod i 3 li t Ro ,t t 7 i t ' nvn
ttcfallol ra 'Sect ?t).Ck}3tr-1iii�l
i 402.111, 1,<� � ores. tni.a �i ?4cats 15 F 15 � � ion In —�
— v -- t ntcrntt in lite 1 air temp,l a:i mid
_ 4iii.1}{Alr3) t'ou n�,�`ill'i,i e,Stuffed PHF,; rv5idi n al}:,tthc rp utt3cn dttld 7t
oeh icd under the appronrratc aakms
i
i i � i ){i.ta ) c ti tri ts1 tct t r z , n 2J,t
a
_ —I '' 1 _ i app' ni ,e ct. r i at
it --
47 Rehz ating for tial Hraoing VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
+ I HIE, 16o" x _ (lftn523-3i})
3-403.11(H) �.�Yir uw at-c lfj 1 ' i9i.iu.- Si,;adan' ( C,ut �n<'nr x n111uu`uu tt ..e. ;+r tth ao oat
i I i'Lt- )edh' me,.% s' niarverif mo rrru u d tat t,rr li+fx f ire c n cl+rr tjr
3-40'4 11 X!t f h tato?., ri a-;: r tl n,mg Ter .,. � '%nr/ Sud t'oac a,.d l i t r.b.R
L40'1:' { IUCJIeu
-401",1 l r1.-f 1 Ra of using L,id ted Poh t t s >f ficcl _Item : Good Retail Practices _ FC i 590,000
h last:*: 3i ^lanagrme t and Per onri'__., r('_ 1 ui i
Proper Cooling of PHFs �_24 Food sod Fax?Protection 4 FC i W
�!
i 20 Fqui�men�ant;Vten ds F� s +oF
C:wk d PHI s Don 141 F to _ - _ _
{ 26 Water Pit rtioi_q and W r FCQCio
t a f Wit 7 1 fours.!i(I Crum 1) 1' 1 27 F`r}_ ca.Fa atv `-FC_i 607
_ t< 4t 1i15'F 44ti+m4fin, 2ca a Pcxionois orTorcM rias -- 1 FC-7 OC3
PHF.M de Fan n Ambient ° Spm. RrgtaremPtl6('?
--
T int-erasure I grediew,a41 1=r'45'F 1 tc� Oi ntr fi--
Win!in A I
+p Commonwealth of Massachusetts
City of Salem
Board of Health lQmbedey Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/22/2009
ESTABLISHMENT NAME: Marina's Newstand
File Number:BHF-2006-000010 24 Norman Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2009-0379 Jan 22,2009 . Dec 31,2009 $70.00
TOBACCO VENDOR BHP-2009-0380 Jan 22,2009 Dec 31,2009 $135.00
Total Fees: $205.00
PERMIT EXPIRES December 31, 2009 f
Board of Health T
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
ICIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR WANCNI&ALEnt.COM
JANET MANCINI,
ACTING HEALTH AGENT
2009 APPLI ATION FOR PERMIT TlOP RATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT TEL
ADDRESS OF ESTABLISHMENT FAX#
MAILING ADDRESS(if different)—ey //I/e� +��S zi Jgl�
EMAIL- Business': Website:
OWNERS NAME �� TEL
ADDRESS
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 , "= Mond Tuesda . '_.:Wednesday Thursdays` l ., ;F.dday ',Sated ' `:+ .. Suhda -
HOURS OF OPERATION
Please wore in tone d day. ,
(For example Ilam-11pm) I '
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.fL
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
----•----...----•------••-------------------•------...-------146----------------•--------------------------•- -s"I'--..-••-......------------...------------
RESTAURANT YES NO Less than 25 seats =$140
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
---...----..EA - ---•------------ --------------------------------------------•-----...------------------•------...-----•------
BEDlBREAKFAST! YES NO $100
CHII-DPARE SE RVICES/NUKl!NQ HOME.......... ---•------------- -------- ...... ------—--------------------.------------•----------
ADDITIONAL PERMITS
MAKE(not just serve)ICE CREAM,YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO C
ALL NON-PROFf7(such as church kitchens) YES NO $2
*Please pay total with one check payable to the City of Salm.
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 a submitted to and approved by the Salem Board of Health.
PursuYanttMG}C apter 62C,S 'on 49A, Icertify under the painsand penaltiesof perjurythat I,tomy best knowledgeand belief,have filed all state tax
air,all ate taxes r uir der the law.
Sign a Date Social Security or Federal Identification Number
$
Revised 424/07 FOODAP2008.adm Check#&Date —
Commonwealth of Massachusetts
x ° City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 10/03/2008
ESTABLISHMENT NAME: Marina's Newstand
File Number: BHF-2006-000010 24 Norman Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2008-0401 Jan 29,2008 Dec 31,2008 $70.00
TOBACCO VENDOR BHP-2008-0611 Oct 3,2008 Dec 30,2008 $135.00
Total Fees: $205.00
PERMIT EXPIRES IDecember 30,2008
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"'FLOOR
'IEL. (978)741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR IDIONNr: s,vcrrl.COM
.JANET DIONNE,
ACTING HEALTH AGENT
2008 APP (CATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT �I rlv')/G,S Al _h;✓)Ck TEL#
ADDRESS OF ESTABLISHMENT C( 7 ./VCYY/!G n S�
FAX#
MAILING ADDRESS(if different) 'A
EMAIL-Business': p Website:
OWNER'SNAME / )ICl/ TEL# ! 7Y GfJ�� � l() z7
ADDRESS
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S)
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON HOME TEL#
DAYSOF.OP.ERAT.ION Montl . . h ,Tuesd""" Wednesda Thursda,W;;f - , Fnda ' - ; -.iSaturd
HOURS OF OPERATION
Please write in lime of day. I. j
(Forexamplellam-llpm)
i
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. Q�$ 71000-10,000sq.ft.
more than 10,000sq.ft. =$420
– – ; ----•- ---- - - - -----
less than 25 seats =$140
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
----------------- --- -------------------------------------------------------------------------•-------------------
BED/BREAKFAST/ YES NO $100
CHILDCARESERVICES -------------•--------------------------------------------------------------------------------------------------------------
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
*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.
Purs hap r 62C,Section 49A,I certify under the pain7an penalties of perjury that I,to my best knowledge and belief,have filed all state tax
rs required under the law.
�
Signature Date Social Security or Federal Identification Number
------------------- ----- --- —*------ – —-----------------------
Revised 424/07 FOODAP2008.adm Check#&Date $
�l
0 o^p*vFy Form CT-3A 07123
pT Massachusetts Department of Revenue 2008 - 2010
Cigarette Excise Unit
Retailer's License for Sale of Cigarettes
DOR
This license must be posted and visible at all times. Sales to persons under 18 years of age are prohibited by law.
Application Number: 62275 License Number: Date of Issue:
Federal Identification or Social Security Number: 026-38-1727 07123 0912312008
Mailing address for license: Cigarette sale location(if different than mailing address)
MARINAS NEWS STAND MARINAS NEWS STAND
24 NORMAN ST RILEY PLAZA
SALEM, MA 01970 SALEM, MA 01970
This certifies that the taxpayer named above has paid the required license fee and is licensed to retail oigarettes at the address shown above
until June 30,2010. This license is not transferable,and is subject to suspension for failure to comply with the law.
Commonwealth of Massachusetts
City of Salem
Board of Health lGmbedey Driscoll
120 Washington Street,4th Floor Mayor
SALEM MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/29/2008
ESTABLISHMENT NAME: Marina's Newstand
File Number:BHF-2006-000010 24 Norman Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. . Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2008-0401 Jan 29,2008 Dec 31,2008 $70.00
Total Fees: $70.00
PERMIT EXPIRES IDecember3l, 2008
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1
___--
can
b�,wrd b�e�"7�
QTY OF SALEM, MASSACHUSETTS
j a BOARD OF HEALTH
t 120 WASHINGTON STREET,4'H FLOOR
TEL.(978) 741-1800
KIMBERLEY DRISCOLL FAX(978)745-0343
MAYOR ISCM(&SALEM GOM
JOANNE SCOTT,
HEALTH AGENT
2008 APPLICATIO FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT /L� /�I f /t/Ou�f %�� oJr� 1/01 J
ADDRESS OF ESTABLISHMENT FAX1#
MAILING ADDRESS(if different) /7?T �7 6�e�1_�✓/ /' /�
EMAIL-Business': 0 Website:
OWNER'S NAME TEL# G2
ADDRESS6aL� 1�7 721
STREET I 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 1 Monday Tuesday Wednesday 1 Thursday Friday Saturday Sunda
HOURS OF OPERATION
Please wdte in time of day.
(For example 11 am-11 pm)
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than I000sq.ft. _$70
1000-10,000sq.ft. =$280
more than I0,000sq.ft. =$420
- - - - —' ............ ..........---------------------- - . .. .
RESTAURANT YES NO less than'- ...25..se..ats =$140
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
---------- ------------------------------ -------- -------------------------- ---------..
BED/BREAKFAST/ YES NO $100
CHILDCARE SERVICES -. ------ -----
ADDITIONAL PERMITS
MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax
returns and paid all st a to s wired u r the law.
Signature Date Social Security or Federal Identification Number
-------� - - -Cr --- -° - - ---- -
Rcviscd 4/24/ 7 FOODAP2008.adm Chcckq&Dalc S
'�a+a"�sc "e# •a� mgpry �- aY�Cr�"rF ka '"=s�Cs�- k �"° b*{ +n#y�^ r+' �"�'A.' i"S�„�"'v
r "T' '�'} % :'v i J � �'R._ r ";� s..,e`LsC' x• � i a i �E x a � a �' J+` j -
y +, a t< �'aw N a a t � u ?3 'r 'a,; r �•
'F°^s�,' " � , 'Y ,,,,=.;Commonwealth of Massachusetts�a a�.�,,�ar•"�,a��ra�l,�+� a �'6s� r ��}b « v.
. � ♦ ... Clty Of$elem. . .�-'i a e ,. se" ':� ..a. n rxs.. ..
soard of Healch IGmberley Driscoll
120 Washington Street 4th Floor Mayor
SALEM,MA. 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/08/2007
ESTABLISHMENT NAME: Marina's Newstand
File Number:BHF-2006-000010 24 Norman Street _
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2007-0373 Jan 8,2007 Dec 31,2007 $50.00
Total Fees: $50.00
PERMIT EXPIRES December 31, 2007
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 4
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR - -
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
2007 APPLICATION FOR PERMIT TOOPERATE
�TTEEA FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT � �� ' TEL#
ADDRESS OF ESTABLISHMENT FAX#
MAILING ADDRESS (if different) / -,4–
EMAIL--Business': Owner's:
OWNER'S NAME / G G% % oy�rt�f 7 I + TEL#
ADDRESS !)/P/K —, f
G' rj ice, 1�J7
STREET CITY —SATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S)
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON HOME TEL#
I
AYSOFOPERATiON Monday Tuesday Wednesday Thursday Friday Saturday SunO OAS OF OPERATIONease write in time at day.ar examale Ram-110m) _
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
.............YES-----NO --....---
......---
..-...---
._.---
..- ----I less---thaa"n 25- s-- ..eats.---- -----=$100- --
RESTAURANT
25-99 seats =$150
more than 99 seats =$200
- - -...--......_. VIES _
. -NO ----------------- ---------- -- -----
---- --
_
. .......... -
.._ ---- ......----
.
BED/BREAKFAST YES $104
- ---------------- -------------..---....-....._.-..._......... ----- - -- ...... ......._. ..... .. __.._._. ...._ .
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5
TOBACCO VENDOR YES NO $50
ALL NON-PROFIT(such as church kitchens) YES NO $25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a
prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are
made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursuant to M L C ap A62Cc on 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief,
have filedal tat a r ti all state taxes required under the law.
Signa re Date Social Security or Federal Identification Number
-------------- --------- ----- ------------ --------- ---- - ------ -------- - - ----------------------------------.-----.. ----- ----------------------
Revised 1 V1 106 FOODAP2007.adm Check#&Dale �� $
r
.. .... .. ♦ w Tn: f w �',.- 3 x ..re 'r s M wig. r�x 4 �N +S�t.
Commonwealth of Massachusetts r
City of Salem Kimberley Driscoll Aq:
»� Board of Health Mayor
120 Washington Street,4th Floor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 03/28/2006
WHO'S PLACE OF BUSINESS IS: Marina's Newstand
File Number:BHF-2006-0010 24 Norman Street
SALEM MA 01970
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2006-0433 Mar 20,2006 Dec 31,2006 $50.00
Total Fees: $50.00
PERMIT EXPIRES December 31, 2006
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a.prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
f -T 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745.0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT aiI a'qI /J" I PG/�P (y¢ TEL# 9,9d� y ®�
ADDRESS OF ESTABLISHMENT
MAILING ADDRESS (if diff nt)
OWNER'SNAME 1 dd /t fT %/ / TEL#
ADDRESS YA1?,VX 4
CITY 'E4lelwh STATE ` 1Z zip
CERTIFIED FOOD MANAGER'S AME(S) CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON HOME TEL#
HOURS OF OPERATION: Mon.J Z_Tue.1 ) Wed. Z.Thu. 4-2. Fri. ,-Z.Sat. Sun:=?
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
--------------YES NO----------------------------------------------------------------- --than- -----25 s-------eat----- =$100 ------
RESTAURANT less s
25-99 seats =$150
more than 99 seats =$200
---------YES------NO- -------------------------------------------------------------------------------------$---10-------------------
BED/BREAKFAST 0
--------- --. --------------------------------------------------------- .---------------.......................------
ADDITIONALPERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5
TOBACCO VENDOR YES NO $50
ALL NON-PROFIT(such as church kitchens) YES NO $25
*Please pay total with one check payable to the City of Salem .
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes
are made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursu to GLhapter C, Section 49A, I certify under the pains and penalties of perjury that I, to my best
kno ge nd lief, ve it d all state tax returns and paid all state taxes required under the law.
Z
re Date Social Security or Federal Identification Number
---------------------------------------------------------------------7-�----------- ----- --------------------------------------------
Revised 11/03/05 FOODAP2.adm Check#&Date 1._-�T
456
`• ww
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
meq' 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: Marina's Newstand
Address of Establishment: Washington Street
Owner's Name: Nicholas Padouani
Restrictions: Soda and Candies
Application Date: 7/11/05
Permit for Food Establishment 310-05
Frozen Desserts/Ice Cream
Permit for the Sale of Tobacco Products
These Permits Expire December 31, 2005
This permit is not transferable and must be reissued upon change of
ownership or location. The permit must be posted in a prominent location
in the Establishment,
In accordance with the State Sanitary Code, before any renovations,
improvements, or equipment changes are made, all plans for such must be
submitteda b the Salem Board of Health.
to and approved y
HEALTH AGENT
~ CITY OF SALEM, MASSACHUS 1
BOARD OF HEALTH 11,11
u 9'. 120 WASHINGTON STREET, 4TH FLOOf JULy
SALEM, MA 01970 UL 0 6 2665
TEL. 978-741-1800
FAX 978-745-0343 CITY OF SALEM
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH
MAYOR HEALTH AGENT
2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT ( /dJj$r3 �n TEL#
ADDRESS OF ESTABLISHMENT /Z 47e' /�1 Dopa
MAILING ADDRESS (if different) 2? .y // /0,P"J w"P S'/ 60/'r
OWNER'S NAME �C�d� X✓ 40aI -W, TEL R as�poj�
ADDRESS �D�/J'Id ,� X14
CITY_ ,Ga/ STATE ZIP D/J'JD
CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON I-P" /! y/np��HOME TEL# 9�8 ✓S3J 'f6fps/
HOURS OF OPERATION: Mon! 'a Tue. `S"-2 Wed.S-1 Thu 5?-Z Fri.-'47-.Z Sat. Sa Sun.-5-1-7-
TYPE OF ESTABLISHMENT FEE check only
RETAIL STORE (SES NO less than 1000sq.ft. _$ 50
/ 1000-10,000sq.ft. =$100
Omore than I0,000sq.ft. =$250
RESTAURANT YES NO less than 25 seats =$100
4V 25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5
TOBACCO VENDOR YES NO $50'
ALL NON-PROFIT(such as church kitchens) YES NO $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made, all plans for such must be submitted to and approved by the Salem Board of
Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
best know
le ge nd belief have filed all state tax returns and paid all state taxes required under the law.
4 G 3 /7
SigId -V
Dat i Social Security or Federal Identification Number
-------- �
RevDAP2.adm Check#&Date
r: DEWS THE ?EST CONTROL.
I-800-579-3028 TOLL FREE
r
DATE I TIME
IN OUT
❑�❑ LT/IME ❑RES. ❑COMM. ❑INDOOR ❑OUTDOOR
. NA...�✓lY'S h�:..�r Ur: t7j �UiG,G.ii'C..��.' '
ADDRESSf- l
CITY,STA, -:0 PHONE -
rJ /
i SERVICES PERFORMED { Ti�
ARGET PEST S) APPLIC TION METHOD
❑ INSPECTION
❑ TREATMENT
1 CHEMICALS USED AMOUNT % EPA NUMBER
t .
DESCRIPTION/REMARKS AMOUNT
i
seRwceo sy, f LIC.NO. TOTAL -
:OM .
CUSTOMER 'NATURE '
SERVICE REPORT
g g� � -7- yoa �
l ORTArdt MESSAGE
FOR - �O
DATE - O TInME
M � zrCs�t�-
OF
PHONE
AREA CODE NUMBER EXTENSION
❑ FAX
❑ MOBILE
AREA CODE NUMBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU ILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE
SIGNED
FORM 40
MAGE IN U.S.
PRIM mmpp�
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C3 t GL. ULauf
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CITY OF SALEM
BOARD OF HEALTH
Name of Establishment: Marina's Newstand
Address: Washington Street
Owner(s): Nick Padovani
Phone: 978-257-4027
The owner of this establishment presented plans for review in accordance with
the State Food Code.
ITEMS FOR SALE
This establishment is a newsstand selling papers as well as wrapped candy and
energy bars purchased from BJ's Wholesale; and coke and water from the Coke
Company.
All food and drinks will be stored on site. No food or drinks may be stored in an
unpermitted facility.
HAND SANITIZING
There is no food handling or preparation, therefore a hand sanitizer may be used
and must be at the establishment.
TRASH
Trash will be taken to the owner's home daily for disposal.
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.
Please call prior to opening to schedule an opening inspection.
a6,.X�� 4co-�*— G-/0 -d5'
Idahne Scott Date
Health ent
��er Date
i�-P! � �G�-E��� � C�CL� /17t ✓eee.tu �d