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NIKOS PIZZA - ESTABLISHMENTS NIKO'S PIZZA 333 LAFAYETTE STREET A A �jl I _ � 4 7 i M 0 CITY OF SALEM, MASSACHUSETTS • BO.-1RD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 ICIMB17RLEY DRISCOLL FAX(978) 745-0343 MAYOR INIANCINIOSAI ENLC N1 ]ANI:;I'MANCINI ACTING HI_,Aun I AGENT May 19, 2009 Richard Kalaydjian, Owner Niko's Pizza 43 Nashua Street Woburn, MA 01801 Dear Mr. Kalaydjian: It has come to the attention of the Salem Board of Health that your establishment has closed for renovations. This office has not received nor approved any plan for these renovations. This is in violation of the Massachusetts Food Code, 8-201.11. Requirement for submittal of plans is printed on the bottom of your PERMIT TO OPERATE A FOOD ESTABLISHMENT. Therefore, in accordance with the State Sanitary Code for Food Establishments, 105 CMR 590.000 and the Food Code Annex, your Permit to Operate a Food Establishment is summarily and immediately suspended. All food operations at your establishment must cease immediately. In order to re-open your establishment, you must submit a floor plan indicating location of all equipment for approval of the Salem Board of Health. Once approval has been granted, a written request for a re-inspection must be submitted to the Salem Board of Health, 120 Washington Street, Salem, MA 01970, so that we may certify that the establishment is in compliance 105 CMR 590.000. 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 ten (10)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the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. An attorney may represent you. 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. Orders of the Board of Health may be enforced by an application to Superior Court. Sincerely yours, ,,/ aet Mancml, ting Health Agent CERTIFIED MAIL 7008 1140 0004 0940 1892 CITY OF SALEM BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR G - �° SALEM, MASSACHUSETTS 01970-3523 ONo e 7008 1140 0004 0940 1892 t pp o Fpr'artlr �tlCrpys O ,f 4o/`ems .. Ll O/tlf>r a G dim tp�'.1ua Qh! c gs�oa}'` :J O Apem Ptl -orpss -•UcLu „ c� ,�• N Spc ,yPRiclSaGd Kala an, Owner O rrPm " �, ,� o ti 1 aa ! N capt hT4a �14ko'p Pi O Nosy ° K t cn �MdiigOp/pa.�ANa a Street ON�ca°t ch r t �0 2 LN 403 a r !� O �7PSP� potdcp W n, IVIA 01801 QBcX LJdi�q� 6 0 °v m oQ Io Lu V O m m QPo td nPtlFP^YeyO of e`r �� o n,�1 P f -Ern v O f0 � ------------- z; .�- --- -It-�^ -- __ —_•. - -- - {'<iii3ai'i-�-'S"-�':�:ESaE:r. „w �"`^^,,., .,,..w""�,..,,..., p�-� ■ Complete items 1,2,and 3.Also complete gria'fur"e' ,w•^" "*:,,,* —„Y,w•'"'"-'^••,,,, � I item 4 if Restricted Delivery is desired. X0 Agent ' � I ■ Print your name and address on the reverse 0 Addressee so that we can return the card to you. B. Received by(Printed Name) I C. Date of Delivery ■ Attach this card to the back of the mailpiece, - !I t or on the front if space permits. _ I - D. is delivery address different from Rem 1? ❑Yes 1_ Article Addressed to: If YES,enter delivery address below: ❑ No iRichard Kal jian, owner Niko' s Piz 1 43 Nash Street Wobur MA 01 301 3. Service Type ❑Certified Mail 0 Express Mail ' 0 Registered 0 Return Receipt for Merchandise ❑ Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 13 yes 2. Article(Hans NumbAirier I 7008 1140 0004 0940 1892 I (flans/er fiom seMce label) 4 _ '� PS Form 3811, February 2004 Domestic Return Recelpt 10259502-nt-1540 � b CITY OF SALEM MASSACHUSETTS BOARD c Ir HEALTH 120 WASHINGTON STREET,4O'FLOOR TEI.. (978) 741-1800 KIMBERLEY DRISCOLL Fax (978) 745-0343 MAYOR INIANCwIna SALENIA 0\1 JANH I'MANCINI ACTING HP.AV;rH AGI?N'r May 19, 2009 Richard Kalaydjian, Owner Niko's Pizza 43 Nashua Street Woburn, MA 01801 Dear Mr. Kalaydjian: It has come to the attention of the Salem Board of Health that your establishment has closed for renovations. This office has not received nor approved any plan for these renovations. This is in violation of the Massachusetts Food Code, 8-201.11. Requirement for submittal of plans is printed on the bottom of your PERMIT TO OPERATE A FOOD ESTABLISHMENT. Therefore, in accordance with the State Sanitary Code for Food Establishments, 105 CMR 590.000 and the Food Code Annex, your Permit to Operate a Food Establishment is summarily and immediately suspended. All food operations at your establishment must cease immediately. In order to re-open your establishment, you must submit a floor plan indicating location of all equipment for approval of the Salem Board of Health. Once approval has been granted, a written request for a re-inspection must be submitted to the Salem Board of Health, 120 Washington Street, Salem, MA 01970, so that we may certify that the establishment is in compliance 105 CMR 590.000. 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 ten (10)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. An attorney may represent you. 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. Orders of the Board of Health may be enforced by an application to Superior Court. Sincerely yours, &, &1va/&( 4aet Mancini, g Health Agent CERTIFIED MAIL 7008 1140 0004 0940 1892 HRTIFIFIJ MAIL. RECEIPT Fr, (Domestic Mail 0I insurance Coverage Er CD o FNCI , L USE E"' Postage $ C3 CadI Fee Postmark Q Return Reeetpt Fee Nara C3 (rrsk semem RBQoire ) 0 Resore�Actetl Delivery Fee 1 C3 jEeaemem Rqulrem I= $ 'rR 7otei Postagoa Fees I� F l To `� ................_.......................,,....._,.......................... C3 atApt..stere,IIP+4 Certified Mail Provides: ■ A mailing receipt ■ Aunique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Remindens: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mails. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. • For an additional fee, delivery may be restricted to the addressee or addressee's authorized agant.Advise the clerk or mark the mailpiece with the endorsement"Restricted Dalrvery°. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an Inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000-9047 I Commonwealth of Massachusetts r City of Salem Board of Health Kmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/12/2009 ESTABLISHMENT NAME: Niko's Pizza and Roast Beef File Number:BHF-2004-000082 333 Lafayette Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0372 Jan 12,2009 Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 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. Paye t CITY OF SALEM, MASSACHUSETTS 4 BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR IMANCINI&ALEN1 COM JANET MANCINI, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT N11105 PIR&\ TEL# �I JR �4 q —9�5 Z ADDRESS OF ESTABLISHMENT 333 , (.uf aye+t e S t FAX# MAILING ADDRESS(if different) V EMAIL- Business': Website: OWNER'S NAME RiClW1 l�G�li�Id Civ TEL# ADDRESS LP WitAl Pll(l 01301 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) Oef ka Ven,d ef(q/1 CERTIFICATE#(S) �im Le6u (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON k6f L (C117(�(1t , HOME TEL# q)S- ?,f 4-9?s Z I DAYS OFOPERATION-t T Monday . ,!:'. Tuesday .a,--.�`,= Wedliesday i :Thursday. ''i" Friday ., �::. , Saturday.: -i Sunday >>. HOURS OF OPERATION Please write in Cone of day. i (For example l lam-11 pm) j TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YE�NO less than 25 seats =$140 (Outdoor Stationary Food Cart$2� 25-99 seats =$280 more than 99 seats =$420 BED/BREA- A --------------------YES------NO----------------------------------------------------------------------------------$-1--0-0-- ------ CHILDCARE SERVICESMURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES N $25 TOBACCO VENDOR YES O $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 I-Chapter 29;Section449A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns an atl I�slateto�/e�%,requiredwnder the law. Signature Date Social Security or Federal IdentificationPumber Revised 424/07 FOODAP.2008.adm Check#&Dare t +.*a'•" "k,..-_.a^w'.t`t*-'t••^s.t'.{+.-iffvw%"-i:.a,+;>e,1.1n- Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date? ),. Tyne of Ooeration(s). Tyge of Insoection A )iX i)( � 7�7/( - 2,,-Food Service Routine Address Risk ❑ Retail N Re-inspection 3 /7�/X- fJ�t�XX -0 2SY ' Level ❑ Residential Kitchen Previous Inspection Telephone ' r EIMobile Date: qT) 4� Owner �� )) / (n� / 1 T HACCP YM ❑ Temporary ❑ Pre-operation P� I r..N1(-m /X �A� ,L--I V I LY/t� ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)/V �f Tile ❑ Bed& Breakfast ❑ General Complaint ,, ^ ((/'7. P/(1 �I � in. "O , ❑ HACCP Inspector C17ti Y� 1 l t Q/�� (I( t� Out: : (S�/ r Permit No. ❑Other Each violation checked requires an exp anation 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)-p 590.009(F) [�] action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT . , . ❑ 12. Prevention of Contamination,([ Hands E] 1. PIC Assigned/Knowledgeable/Duties U EMPLOYEE HEALTH 13. Handwash Facilities -. . PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color ❑ 3. Personnel with Infections Restricted/Excluded 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ' - TIME/TEMPERATUREcONTROLS PotenUall Haiaidouii Foods ❑ 4. Food and Water from Approved Source ( y ) ❑ 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 [_1 20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP).." ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board s 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. ' ` p590.000/federal Food Code. This report, when signed below C x 'k 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 IDATE OF RE-INSPECTION: 0(,t)t.A PA 11 r� Inspector's Signatu/iePv1Y. A/Px� pntr P) >J -�k PIC'sSignature: A-)A f)dA-�A, (1 Pr1nt:/(_0,r/ KA,I U) / Pagel) of-'Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT j 8 Cross contamination ( l 590.003(A) Assignment of Responsibility* j 3-302.1 I(A)(1) Raw Animal Foods Separated from j 590.003(B) Demonstration of Knowledge=' Cooked and RTE Foods* 2-103.11 Person in charge-duties ( ( Contamination from Raw ingredients 3-302.1 I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other'` 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment ----) require reporting by foot(employees and :3-302.1 I(A) Food Protection" f applicants* j 3-302.i.5 Washing Fruits and Vegetables f 590.003(F) Responsibility Of A Food Firiplovee Or An 3-304.:I Food Contact with Equipment and Applicant To Repon To The Person In I ! Utensils* l Charge"' Contamination from the Consumer 590.003(6) Reporting by Person in Charge* 3 306.14(.-1)1T5) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* j Disposition of AauRarated or Contaminated 590,003(E) Removal of Exclusions and Restrictions I Food 3-7111.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Fuxi" J jai Food and(Mater From Regulated Sources j 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.i 11 Manual Warewashing-Hot Water j 3-201.11 Ftxxl in.v.. Hermetically Scaled Container* Sanitization Temperature" � 3-201.13 Fluid z MilkandNlilkPriductgx 4-501.1 i2 Mechanical Warewmiling-Hot Water� 3-202.13 Shell EMs* Sauittzation Temperatures* j 3=_'02.14 Eggs and Milk Products.Pasteurized* 11-501.114 I Chetnical Sanititatiun-temp., pH. 3-202.16 ( Ice Made From Potable Drinking Water* concentration and hardness. h01 I t 5-101.11 Drinking Water from an Approved System' ( 4- (A) I Equipment food Contact Surfaces and 590.006(A) Bottled Drinking Water* Cleaning Clean" _ 590.006(B) Water Meets Standards in 310 CMR 229" � -3-602.]1 Conta t Frequency of Equipment Food- 590.006(B) Shellfish and Fish From an Approved Source Contact Surfaces and tionUteof 1-702.1; Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Fond Contact Surfaces of E m merit* Shellfish* 14_;03.11 ( Methods of Sanitization-Hot Water and 3-201 15 ( Molluscan Shellfish from NSSP Iistr;d Chemical* Sources* 10 ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by j 2-301.11 Clean Condition-Hands and Arms* j Regulatory Authority 3.202.18 Shellstock Identification Present* i2-301.12 Cleaning Procedure* j 590.004(C) l Wild Mushrooms" 2-301.14 When to Wash` 3-201.17 Game Animals* j I1 I Good Hygienic Practices Receiving/Condition ( 2-40L11 Eating,Drinking or Using Tobacco* 3-202.11 PH Fs Received at Proper Tcnipmatures+ 12-401.12 I Discharges From the Eyes, Nose aid 3-202.15 Package Integrity* ( Mouth* 3-101.11 Foul Safe and Unad 3-301.12 PreventingContamination When Tasting* ti Tags/Records:Shellstock _ tock d* 12 i Prevention of Contamination from Hands j 3-202.18 Shellstock Identification * j 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Emplovecs* j Tags/Records:Fish Products j j 13 Handwash Facilities 3-402.11 Parasite Destruction* � I I Convenientty Located and Accessible j j 3-403.12 Records.Creation and Retention* j 5-20111 Numbers and Capacities* j 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures i 205.11 Accessibility.Operation and Maintenance fHACCP Plans 1 Supplied with Soap and Hand Drying 3-502.11 Specialized PrxessingMeffiDevicesods* ( i j 3-502.12 Reduced oxygen packaging. criteria* o-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures- j 6-301.12 Hand Drying Provision Denotes ccitivalitem an the federal 1999 Fai Cie of 105 C41R 500L000, i CITY OF SALEM I BOARD OF HEALTH Establishment Name: I I A ��)/ r> 7 Z/-! Date: In— n Page: of _ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN-OF CORRECTION " "' 00Date " No. Reference,, R-Red Rem; PLEASE PRINT CLEARLY Verified —4-7-0n.o n c C � l{ , �_vQ ,r. no /tn v1Q /_1„ ,t 00 AA,_ �.J ov — TVPn - ,t )r) X .� i �fnirn 7t)On �n t� 1 7 7r. . >..n � v, I ' o'oi .�. �) o 0_'9 � r,fir.. � ✓n r.n D�-�Y ��) .� n, r ) .l' ,,�-, _:�t-�ry D '-47) ( V�P�or eAaC�� iu_t1anA � <: '-Y-\,-i 0 �.0 ITl$Oil i %',,t kA D nn +V^1 'e1(\\1 r) \'V) �/�n1 t X_. �. �70 4 .(.2^) _'l nn.i/ —47) In, J )A lir on, 1/ AIA �1_ �n t - %! 1�A -, r,nn ` t �r�Sh 7 in'n V. /fin n a� - "� �nn 1 A"< > N V, kY s �A_t.tom//Nr flyA— 4,Pn,�2, A A,,1 Discussion With Person In Charge: l Corrective Action Required: I ❑ Nov I ❑ Yes J 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 P � Lt Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal F/dod/Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 7-7-1 / �' //// �� Y` 1/ ❑ Voluntary Disposal ❑ Other. u Violations Related to Finodiwrve 111retis Intereendorts,eadiVak AI�_,IT&ug to In t% Cwltd to Factors(Hrms 1,22) (Cont) .t?-1445�'F Wiih;tt a ho %5ol.] for Pt F. PROTECTION FROM CHEMICALS 14 PHF Hot and Owd Holoing 1 14 Food or Color ArWitive-, �_2w 12 Colt!PHFS Mapil'JuLI.1 at,)) nolow ;.)I,bf�!Yv) II-M�` F II i Pinn'tu"n Ivan 1 41iqrf,I�,l v(I 15 poisonon.ts or Toxic I'�ubsttoleos 16;Ali 1;3 11 il�,t NL-un_)n4e.J at cir ab.IIv,� lol.11 nhialifying lqi")tridlion .Otn%�na; i 3 501 if-.! ',I It,at of IhQvr I lu"IF, Comolnert. If I ince as a Pubiii:.H"fin Central 1112 t# ftnernItnNi'I't- ,�ubbc h.,atth Cittilrol- slowtic" ! �IXO R,Iqnmcnn,nn 1 Fitiviclion -PreiLnc�and I�I,:, 7-'02.12 contippin,of 11w, [I `toxic(:onuqnci>-- I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-"�14.i savn�zel .Crvenr --chenlicAs, I POPUL AT IONS(HSP) WI(i 7-'(4.12 clicial'Alt,for'A I"linn!ho,,iw, with 1-ab'*4 -,'04,14 Di lingAanuts,Craria" t in i,_M tcg, I ."W )rn-i&ival Ro)(1 Cttrimt. Luiwiapts' '[i " )I 'r Pinball, Anninill Fftitj and 1-106.11 kosmui,�J i:w Crimi I- 1 Rw. Sprouli Not 7, R'ilent I"III 206.12 ritt 1.11;C,._I k'ls,mcned Vi XHi tia:U I',, Not R(:-Sc r::1 7 206 Fi I'tacking Po ,ler,, Cotanti anti Mortit"Ini;' j t1OWUMEP ADWSORY Piy;t,.J ItIr 0; TIMErrEMPERATURE CONTROLS 16 1 Proper Cooking too Ai,hvil �,Ild fhat I,ru R,w, ci 1 .,(,1 I PHFs I .i 4 1) 1 At 11(2 E" I, ls�+ bk��C. I I I a 30 !J &)v shell COMIIIUIRII^n f7i'li,Mezv;& Gant Ntiiwa�t; F I II Set- SPECIAL REOUIREMIENTS =40#.t1(13)11;t2: Po(l, ii.d I xfxnzi i if;'F IV m:ni 5q nl1911; I Di VEti�.Illon, ol in 1 ii�.11 k"Vn 2) Rjinc, ln4cocd %I-q! 1 15 F2I. , Uraf v and .;.401.l[(Aj� il, flouirr%,VI ild `.Infti!ti lnllfr,i J),Nuid be Slulbl;jj k'nta,nnffli;l7iO. undoit 111c I'oullrv'in kfqiq,,s-165'T I cnilize'd It,tikxlbrtrn. 3-41 A lic'n3f 111"Id,:1 lict,I.',tcal,,, t inict vendm� and dsk fail 1r3, Other 1451. 5140.609 Itiolatzow, re4nirto to-o,xi p-lad K.,w Artnial ht,o.Gtk,(l it, a hvidd N�Jcbiicil un&- #29 - 165-F" 4aCUl al AI10ihei Pllk-- 145`i- 155cc 17 Reheating for Hot Holding VIO 11 A WINS IiELA TEL) to r,ooD RETA& PRA cucEs 1 3 D) Pflk t65'1I titerrig 23-?ol3 i 13.40' 1!1h) Nficonta,I, 10'r: 2 NIInkn,. Snuidini; -tit I:VI•voio, 101iiit do n)z I"i'W"b; 11 Ir 'I Ilric, "it ;1.1:yS,, :W It,'Wwpm and n"A-J:?t n?rT Itv,j abol: ,in be 1-401.1;ici, Connwviailv RTE iinm.:it:nit 4,,l rhe °fwd I odt-am?Pki C.AIR 14(i'P ;4fi3 1 i(F) Rcmalpin't up,!,eecl Pof,61,f"tic Owe! Lfg- I -ow Ill I F,�vi 0 I-I,od Prn;crtia, K J, rPOA I Proper Cooling of PHF6 ------ 00� t iOl J 4(A) Uvj4qIG,okI,d PHF,I Into; l4itfiw 22 ptumoxi'Incl W11. Wil"In I Hour�'Incl From '!01 E '17 1 pl.... A-Z rr 6 n.4 11/45'1,W-iflnn 4 How %It lox, ---------- 3-.7111 111(b) kla&.ww AmNetn R.Y,t lIrcrttink, -- 4- TeIaljortaure to Wk'7415.]I Willint 4 rtn",);Itin III!jj,I j,4,jit,: I'%)q J•,i.'i .";OS( %in 5V+;100 CITY OF SALEM BOARD OF HEALTH �j f Establishment Name- - hit"i' _S 7 2a Date: to0 1 Page: 3 of `i' Item. Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION 1 Date No:; Reference R Red ItemI Verified' PLEASE PRINT CLEARLY 1. 1 V2 S( - XUAA tom pn-E!�\ D r 1R bli 9-1 i I � t�� / [ Y�� 7/Y"1• f�� MPU � , ✓`^ Yr tnnn(), z rTlu� 0iI/✓ &/V\_tO, -M OAA t r a cN111' Ui t DSD -fi) ,^I/n Pi �� a.�7 (' � �;Irllnq/\--f rn - .P, ,.in 4; , n n 0.4 - '\,� , �o, `' 1AAA a�41 '-C/\ p n I I Ar-G� i5!-�= ` \(J:i� (�'��i/X-�'L �7) Y_Y�_ �1 A.LJ,/Cl/C1 n nA /Y i j r/17_4j A�Q�L. 1 n /�. pnr,YA (_lit 0 _?0- V�1 r„ ;n s--��>� x7,�v r�? „n �/ \ 'JA'-_1 n "1- .�n 1n„n e ,I -n I 1 r}S�C7 �V ,� �� o r�i,1 r..1.7 "c C /'ie�( /ndapp!71/I /!� 5L F1'62) -e,� 2 -,aA I I vv I { I � l Discussion With Person in Charge: Corrective Action Required: I Li No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food�Eode/ I understandthat noncompliance may result in daily fines of twenty-fivffd,�ollars or Sup of ❑ Embargo ❑ Emergency Closure your food permit. �!(/l.11 ❑ Voluntary Disposal ❑ Other: r 1301 'Jog PbF-i;•`u:,ar,,d a! f�avr¢xa'awnw I Virlotions F7otatad to?~oodbarne lUr est,lnfrrventions and Risk E :i.:c't+)di::g ti,lav C'X)4,Q to Factors(inetna 1-22) (Cont) PROTECTION FROM CHEMICALS St,? )z - v :<x> s•;i. efhn ' r I lrrt _._._. 1 44 i ! Food or Color Ats7is;ves 19 i PKF Hot wal Cold Holding 3 !! ; SU: jaq C',>1,I Flit", Maiut:nnud d'a k-ehna' A:1ahtii'00 ! I _ . i ?302.14Pra>;ccut::trow(4.ac: nr :d Aafrit[:s,;z" I I +•3-jt)1.t£A! IW FWFs hfunlained•tt u, at-we j IF Poisonous or Toxic Suostances i i 1 IWAI hklmfymrtnk,na�,Uon--{)ng,mti I .: r, ;4(4'1-. ` E I W i :6S,,%p ',loran:,H till at at Sate i-:0%. I ('urtainers° ! ! Nome- Nt,rkin,. tre a Punk Health CanitoP : f ,-rnu:,n::n.' `>{}--1- inas lout 19 run,n as a F'onfi� health Cvn,tal ! %'_OS.ii � 5<psc.a•:n -5uns,ga," _�:.�....�.___..._.____._____._ I7.2002-t• 1- "Nall , f R�.,i)ict,on -Prrc�nc;.:ul,i t,.r^ i 7-Na i 2 7 ?01 11 j IMK r.'al Anz - Prc,hibno n' i R Glt3?RE:MENTS FOR HIGHLY 5i35CEP7i13LE ; 204.1! 4;ani+i:•et,,Criteria --C'hetnic;A, j POPULATIONS(HSP) 17 ,t1.'2 21 n0tt )itAi FArIaS:paJuicen hnd { ! , t tL'e;.::,tfantoe&s+tw:Rtitr;, >a,ttu.p.;:;`?: c' 17 ) J4 Unin? Aw nt. Crq_no' ! _ _ !i huxdent.tl f:xxt:triact.lx+hricaut., r___-___ -__ 4 ) ir i k.:u,aWWC,:"I,r,3;lattnnf k=ix,d .tnd 17-?{)r� Rc,::rtc:ed L.'.cr Ce�nci,tr., Cntvi ---1-- j 7- pia.-',2 i KWn' Hail `u,ulon," I 'a" PC! j t.;n,}t;nr,i I:><xi padzaec No!Ro-,ervc1, ' 7 '£)n :_ Ir.shitf;l',,•,ide.r: AMC',MU0,1ni ':funuun'„ CONSUMER ADYSORY T!IRRETEMPEfiATtIFiE CONTROLS 341 11 I i',.rau:uct Au,i+of; Nowd ::,r bount12„n„1 16 Proper Cooking Temperatures for ( i Anutall t',un}c 2'i:ii.a,t, FHFs 1 . `.. ? Lt"'>dt<+c t": ;'r�,,.•5sc.d tot ,;:ixru:,:e .Wi11Altat::: t'gg, .S F ,�St.c. :, ' F„ hmu:Ji.ao 1;cl vwv 10f1Nec i I ' �`•i'• ! 1 ;nre.l K;iw SnOl t-a0f.tii.l},2; C'rn:tutntncdF,sh,. :t9cst�aRt::unv AninAs 145 T 15 <et., ' 1 t KJ 3 �fUi.I(0fl}t:;�2r !"uti, and Bud Kutst ti!r'i' 12i ruin` SPECIAL REWRFMEWS 1 -._-_ I .. 592:,"4ih}r)r V,c)a`,:nfi,is tic�rit,t[ T)t:CE}'if,yS-{t}i ut ! 'S-,St:i.;t(A)t:i j a;1tc•, h�tt'oicd lc:ats - I55'F' "ai2flur. rtt,'.)vl:. 1,ptaL te?opt,rare and. ! ±-30LtItAir3t � 3'oati[Tl S1ild(iv21 w $titi?:'J YHI"a, � � fc:'t1{'[ti;':I �IKhrli : t,,cchftP.,9�hvtt hj he i', to .'.,`i tt:'i) UNRIC'01C .t:li`gte ze,- !v)15 S+af,u:z' C':+r�t:uanx;1>is)t. L•:ut, -(." i set.. nbi`lam R S,:}:tf,:tl to ik).X!;',trnc Iilre:,, ) :i--iUl.I i+C}i;,! � tt'ix}e.:±:u:,c•fe. trcac: licef Steal,, lnic:rianl)nu: nrf risk. ?zcit'T:: {114'40 141 P 59100109 rj:d:cit;c;' rclatin,' ,ti zood : :11)1.12 I?:,u1airtai F"O,CC,,.•,kod in tt I,rs;.itt'.situ„lci ;,<del,itcci !ander t1'Tt> - it:crv:r Y: 165'};` 4t,>tll1uCi1l,ats 01,0(A)t13tb) Ali(;ther}'i#t:= - 1-15'1 17 Reheating tot Hot Holding j VIOLA WMS W ATEC 7'O GOOD RIETA1 PRACTICES 13-403.11i,Aic dl) 111 ti., Ibi'i= l7tcc ” f(tL'3Tzr:23,01 i-10111($) It xrawavo. :b,`s F 2 h;,nu,e&,£ndla•_ ( Clio •r'my O;r:-l-id,.,;/ 1i-"W:,,,ni. u:.itit,lc colt rrldrf:,,rk( i_.. ._ .,., Time r`t»n.'ncre. flt,nr, sari,�ti„„n',n,J n:d,thrt;,rc Ii,toad dhorc ,rut Lr 3o),i Iin Conancrrtalh Prcxess,J P TF}athl� � round is !iro Lrt;rt.vr�;srrt::m n;rkr Feaal f'ac(r rt�:rt Jfti i'dik - i €£e<n ' Gond Fikta7t ora__^Uc:°s QFC .5'J0.0[tQ +--1i!"i.!?[i:) ( Pcnia)tiicg (:n;-{ltt:d I'ortti.^,ci tsre: ?.: FP'+,.).t7`=.1+X1 Frn1��i,rr� Lin 1 Propor Cooling of PHF& j �-- --_.T_- _....-.. �_. >5V ! F-C._.t ,,,p '- I MRj un) C"Mlle C«:ked?HFt% Irow 11O'F o, 1 }-:ry —-`- - -”- - ' _I LL i 'v"i.'.f.^.r.)�:,�R:bi'1Q N:C":`11150,? ! Ft. -� - � �i)(:� - _ 7C"I' W'tthu:2 1ltmr�"Id Fn+n;,104.7 � i o; � Ph•s,.a)Fa•: u,: X 7 _ •---`--� • t , ti t1A?'F}tttitir,.HmnV. r ! Cs. : c`,u;,,no,;:a'rrsXbias,;r,:,ls 008 TO t4b) Cfx HUH.14It•c„kiuJc Flka)l Anthi,ut Femperawre inen, iirin,it,41`ki,45'F . Win.t 1I„0' 1” "w,d M;a,DU)1!tiMow,A1^74 Wo i,•.19o4 105 1.`All Cy,)0") CITY OF SALEM ? BOARD OF HEALTH I Establishment Name:4ri y V O Date: �7 -� -(1 61) Page: of t+- Item-- Code . C-Critical Item DESCRIPTION OF VIOLATION] PLAN OF CORRECTION Date No. Reference R-Red ItemVerified PLEASE POINT CLEARLY I� �` AA Yl ` (� AA AL_ 1 JJ J X (nit a CA M _AA Oe is I rr CG 1__ ' V \n rl �1 t\ 1 /) � fi°Uo ., .,_. _ — �/�1 iQ'01 rJ ( \in 7� lOJ.)p.A �—Ynn I L��vv k Xl n n nt i CU � a; b�, iI ( 1 �;t,/ll.�')�,- ,C+�,o,� r�,y, 77�" _ /' { /Ji/ �— 1' `J�rr .t_�nn (i 1, t lnn n� Vx.� 17) fJ� 0V 0 0, nen 11/1 A) �gl �t.(�nl - �x �.:,_n ,C 'XIL - 00 .rv- - A if .. X.(7 U�-(1�/ /�/. A - / r 1 /.1/I "C/.L 3L/✓LiC-// 9�i Discussion With Person in Charge: Corrective Action Required: I LlNo I ElYes h have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction J violations before the next inspection, to observe all conditions as described, and to Exclusion P � ❑ Re-inspection Scheduled ❑ Emergency Suspension $ comply with all mandates of the Mass/Federal Food,Code. I understand that noncompliance may result in daily fines of twentty-f�ive/dollaarrss or suspension/revocation of ❑ Embargo L3 Emergency Closure your food permit. �� %W+ L/l1 JGl/✓/l/✓�" ❑ Voluntary Disposal 0 Other: So! ij,,t 1 PHFl Vm)jsacboe� Violations Related to Foodborne flfnoteu and Bline: smorly In Un Cm&d irl FAmys f2rom 1.22) (Cont) 41-Ft-i::'€ Wattv 4 Wol PROTECTION FROM CHEMICALS t 3 50 i I iin PHFs t4 Road or Color Additives i t9 i Rids Net,and Cold Holding in', ma, CNN!FWFS NimlaWed at•W behm F- 3-302 14 i pux,cl"N,firki'll p,itwo;3 or Toxic Substances 0 ' 100 7 WA i klell"utyint., InfollKN.Cin - iurii,6riat 110LANQ 04st, Held za or We BVF eellmillLu- Time as a Public Haahh Control 1.1 i}2,I I I (k,milem Ni:,nie - ill-rF ing Onimm!n-* 7-20F 11 "11H 19 vient.as a PUK,�Betide("Tarul 7.20111 P,;,tfktioell 1"mm md Cal ".90.1194,til 'v�rlapo,-,e krofn rt."It'11 7--1(y2A2 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7imnicAs �204.1 t PnPULAIIONS(HSP) 21 VOLl UQ Unp:,Nklourmd feitc,3 and NN uo"ce- I I 7 M4 14 Dan:, Awnitv('ntr:m'- :SQ! Hill) j,',zo(,F 2(.)5A 1 linificorgal Foist Coll. #,,r Prot Ott,(AtmW 3 W11 A 1 jel Vi,t% or RituAl, Food�md 7 -06.12 R(Nkn: Be"i 3ml I(c, FXvi llitcl;aoo; Not Poo Coanti :Wd CONSUMER ADASORY 22 1440 11 i Qqo,w, Ailymny haNd i a(Imm,le6m v TIMUTEMPERATURE CONTROLS 16 Proper Cooking Templixaifurlt5 for P1411% vt t P, I -v�v�s-�d'.1 Hinou',Gfo Patinowol , 3401 liqlal Egp- 151+ 118m 7:1 Aulk low mW • lol'kerv. Shelf 145LFhAeo:) (Ammmetwd FEN Movo (Anee: Weim"; 0W 15= " QuILlAymyl 11-1 k and MY RAW - 1100 121 onto SPECIAL REQUIREMENTS IMMA RAND R,Qev,, Qov Wah- W r 15 591 DIN Apo) ViKlail 1p,%"i sclAiijoi lXY)(A)-(D) in I,,r- to.ringrinAnic to,J,temp-rai y need J-40:1,1)(A)0pctntr,. Wild C;-me, stufte'i PFFS, i rvMdinf.ill 'Kitchen operall(ins should t.'c qmRnq Oorvve!MN Wh, WIN: tjndi the eccuons Keediry nt Rjtq,:!iA(,5,tF 14 stic. if r,djlad o'):ca lbomc i IlKess betiuj 1,11 at vote i itpand i-iA ,"'iet"(ors 011ecr 1.71=11'' "90.009 relating to"I'm.11 ridali Ro*Arnetat Un,iek 1•-:(xilecit 11;a pjatfikuK litniki fic,kictiftcd tvide; #N - Nlicivwyc WIF 17 Rellepatine;for Hot Holdinq VIOLAVONS REG 6TED TO GOOD RETAIL PRACTICES 05 10 I .cc. " i(E) microeati, - 1650 p 2 h4mme Wamug Won vhWami, uhmh do 4moup pi ey, TioNo.,` Iiin, lio(J"flor",b"I'dait')l" can be, I (ANWMLW1aljV Nuawal RIF WmJ- Am0n Ifer tmltto"'ne ,e,'r4ons iht Jev.id Cve aie,ee 105 4=',14R 144 W 1 '. 3 401!1 jj Rallompine Perdevl ol'lied !ir-eam- Gneod Retail Practices 590.900 'preNr I atj PFTaOnl d PC 00? qg Proper Coding of PRFs1 1. FoA and Few FrI:'Noe'tKN, FC I E,,N�*qnrei ao)d thensiM f.—'i—t A0 300L 1 4A) C"Jmy CmApit PUB R"m I Ur F U, 1 —5, 1 1 2,T w9mpbrolmn irldVoW q ! 701, Within 2 tkfflr:wW Wen /OF 1 27, Pl^ s,:al F3CIN, i EC—G-4. ;W1105 F WAbot I himm. 1 iRey famsy"m WTm MtJtr:j!3 ! 008 WMATH! CDAleg Phil's Wde Fun!Ankleat 21 j 3per'*g p 31 i 0 F"Infe"alurt, 5, -2 Whin I air, Ili 4,i"lend 1034 W% i,,,h v 1171( M W-0) Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor ,.9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name �/ r Da eO Type of Operation(s), Tvpe of Insoection 01 A(�}i t Z?A IptiM `®-Food Service © Routine Address 11 1 1 Risk t ❑ Retail © Re-inspection 1 r_ ��'1Mf A! Level El Residential Kitchen Previous inspection Telephone Y ❑ Mobile Date: Owner , JJ HACCP Y/N ElTemporary ElPre-operation PC1 c�rCI c,IO'✓j( r14-n/ ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) " Time ❑ Bed&Breakfast ❑ General Complaint 1In: (/.3o ❑ HACCP Inspector � ^ I.&, up I Out:,, , ) Permit No. ❑Other Each violation checked regdires an explanation on the narrative'page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT'' " ` " ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties �2'13. Handwash Facilities EMPLOYEE HEALTH ' ., PROTECTION FROM CHEMICALS , ❑ 2. Reporting of Diseases by Food Employee and PIC [:114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded �15.Toxic Chemicals FOOD FROM APPROVED SOURCE ,. . =. E] 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(PoteMlelly Haiardous Footle) ❑ 5. Receiving/Condition [116. Cooking Temperatures _- ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION'S - "- - ❑ 19. Hot and Cold Holding ❑ 8-Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) , ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories 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 I 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)(990.003) 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.o07) 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: f] �A S 590Mn WtFo/ -14 as - / ' �,`i't I-l g �J //n/y /a 1,1 1 1--, - 1 IInspector�siSignature: p� / Print:- JErenA PIC's Sig toes: I ' " Print: �wrty ` Pages of L.- Pages tk n 141,VAl�.lL,r,=ice itc(M.d V-N64 �;,A-Al I Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 1 Crass-contamination 1 590.003(A) Assignment of Responsobility* 3-302.11(A)(I) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge0' Cooked and RTE Frv.ids* 2-103.11 Person in charge--duties j Contamination from Raw Ingredients 3-362.1 U A)(2) I Raw Animal Foods Separated from Each EMPLOvEE HEALTH Other 2 590k03(C) Responsibility of the person in charge to Contamination from the Environment require reporting by fo3-302.11(A Food Protection* applicants* 3-302 15 Washing Fruits and Vegetables f 590,003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In +�+ Utensils* Charge* I ( Contamination from the Consumer 590,003(G) Reporting by Person in Charge* ( 3-306.14(A)(B) Returned Food and Reservice of Foci& f 31 590.003(1)) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 590.003(5) Removal of Exclusmns and Restrictions ( Food 3-701.11 Discarding or Reconditioning l;nsafe FOOD FROM APPROVED SOURCE Fes"' J 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) _Compliance with Food Law* 4-501.111 Manual Warewashom-Hot Water .3-201.12 Food in a Hermetically Sealed Contamer* ( Sanitization Temperatures* 3-201 13 Fluid Milk and Milk Products* ( 4 501.112 Mechanical W-arewashino Hot Water I 3-202.13 ShelI Eggs* Sanitization Temperatures* J 3-202 14 Eggs and Milk Products,Pasteurized'" i 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 ( Ice Made From Potable Drinking Water* j concentration and hardness. * l 5-101.11 Drinking Water from an Approved System- 4-601.11(Ai Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean- - 590,006(B} Water Meets Standards in 3 16,C CMR 22.0" ( 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* l Shellfish and Fish From an Approved Source ( ( 4-702.11 Frequency of Sanitization of Utensils and 3201.14 Fish and Recreationally Caught Molluscan ( Food Contact Surfaces of Egnipment* Shellfish* 4-703.11 I Methrds of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical'" Sources* Game and Wild Mushrooms Approved by 10 I Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Anus" 3-202.18 Shellstcck Identification Present* ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 11 Good Hygienic Practices i-20L17 Game Animals � 5 ReceivinglCondition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 12-401.12 I Discharges From the Eyes. Nese mid 1 a i Mouth*3-202.I S _ I Packa_Sind -301 12 Preventing Contamination When TastinO 3-1()1.11 � Food Safee old linearity,Unadulterated* � ___ � 6 � Tags/Records:Sheiistock I 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 1590.004(E) Preventing Contamination from 3-203.12 ( ShellstockIdentification Maintained Emplovecs* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 I Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) ( Labeling of Ingredients* 5-204.11 Location and Placement* I 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance IHACCP Plans j Supplied with Soap and Hand Dry�hg 3-502.11 Specialized Processing Methods* Devices 6-301.11 Handl;•aching Cleanser,Availability 3-502.12 Reduced oxygen packaging,criteria* ---- 9-1(13.12 Conformance with Approved Procedures* 6-301.12 Hand Drring Provision "Denotes critical item in the Wersd 1099 rood Code or lit CNiR 540.000. S a� x CITY OF SALEM I BOARD OF HEALTH k Establishment Name: ��,,� 7_?�1 Date: Id, Juai Page: of _Q, i item Code - C-Critical Item„ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date } No. Reference R-Red Item '- "Verified PLEASE PRINT CLEARLY ' 12 ,11 +b ( n l/l.:'. � I 10, _ /`1._" 4 -W� . ,1ri( p ✓1 � 1-4 I 13 �• I 12 /2 vi In rn.,� 1 - a — • - ' 1 3 � �,` . 1-770 1 f^� 11 X11.7 /1�� si)r ((/ �/1O/�Jpi r. j1i,/1� C,✓�{t- , an ! - h - / / ) I Ir7i1 ��. rr 111 �pra !%1-(r( 0 1DprzY _ YI.'i' rJ •_ �, i CJ /eC,4 l7 t- v Irj71- 1. ( br, r% --I,- A/n.J/11�J (_Orin. n�. -fr1/VJC�.I_l'� �I '1,`i// .7r n0 n �/r•r_. S I...,r.. !ll�--- I,VJ.-i& ,7./�.✓i-Ii IJ.II I G/70 i�r 6 A D`! r� J h �� L � �4, )v,,-e,447 1- 1 � .-�-f- G.•s7)I- (/ �K/u J✓, ice, ✓,: -,n n., ,., � �...1 !"..,A.fnrsr .-H L3oJ .4,. un r i .✓,pct �f,.vt rae s --aa f\,>"a�tr�v�wt ./ •;� V jet i�_ � � I Mn / n X Ga 11' ✓i �, nAno ln�/ 5rlcyrr k /0 Discussion With Person in Charge: I Corrective Action Required: I ❑ No I �i�Yes t r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion t p �/Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/FederallFood Code. I understand that noncompliance may result in daily fines of twenty-five dollars of suspension/revocation of ❑ Embargo ❑ Emergency Closure Elyour food permit. ( ' , -r�/h `-� /ti Voluntary Disposal ❑ Other: r v -3"! 1'4w; PRPReteived ITenIWvdureq Violations RWated to Foodborne 114viss Intorvonflons and Risk in Ccx)W aI Fartors(items 1-22) (Cont) 3' PROTECTION FROM CHEMICALS PHF 1AA and Cold Holding 14 Food or Color Additives I Cold plllmt iro'Jiled at or k-olow 3-Y1114 Pr.,wijjon froal F(,i PHLI at o, ab.,ve Poisonous or Toxic Substent'vi; W1.11 Idirlid"ving ittl oimaijon Orl;nnal Ro,�zaa tic Id:ti or abl>t,e I Ajol% Time aa a Public ldit3Mi Control 7w2'I I ComnionNarnk ;-20t 11 -si+r,age' 7-202,11 -Pr-"svf'w"aid -�t' R�'ohir'!w';W 7-_t};,!.1 Conditiovi,of Uso" REWRENIFNTS FOR HIGHLY SUSCEPTIBLE -'w it POPULATIONS(HSP) 21 1 t'! 1(,i7 Ju"s and f.i? Clumduds fol A u'lling Projoec,I.Wtl 1.14 7 '04.1. Drving /o-lit".Crllm�' 3et ,I Inkid"..mal f-:'yl C"Iqact.lmbocajll' ijr P", ��r I)a, all" P'tv' S.�J tin�\o, 'SCf ve-11. I I i(o'il I,ot'd 11w Pc�dcides'cil ' li '40k�'.d Aroma) Fuld jn( i---7b.{2 1 R(XI('11: Boo StItuolk" ,�(J I pc: i;flor.'ricd [�"Xi plicl'agc No, pc-scncd 7 2e13 j T%lCUIg Pssl Control and I'lumoldn":' CONSUMER ADViSORY TWEITEMPERATURE CONTROLSV 34,11.: 1; Ad,isov', P.Nt;IJ l:,r I'onusnpdon of ilia: we Kaiw, Unjoia,xk:d ci 16 Proper Cooking Tempei atures for cts'd lo! Fr"Ilkale PHFs F fit; 140k JiAlli(,'; i1q,,- 155'F 15,k;,,,. InImediate i is'!- i-401,t N comnIondej #',:hA 4yG.,mlit I rain 10l.il"W 1��2, pvr� ant, rio�lkov,a- I-Yfl 1) SPECIAL REOU11VIEMENTS 3-!t)1,11 Wt Rkllil�' Injoct"'d M,.at' 1�5 F I' N rich} I),of S;mt'Al lit caiefwt". tnobil" (ootl' tempka'al'I- :11111 3 40 11(Ali.') roanrl,Wild(;.ane, Siul,"ed WF,, ';,uftwit colit mon", MMLI uiAtood Iindft-r Vie dppronrlat-' P"-Jitry or 15 :f'r'Aw"fi, ;')food!>Iwli.: I (C)i-1 Whole-;Illl".Ic lntIj T 9c0'f sicaKs UII^Ave11t'O]Ii al,d dak fdclore Other vildaiiom lei'virrr to;'o;A rctd;l 3- 0 ft!i% 'Iolmlal cfx)IkA III a ihoolu'iv:do hiled under 429 !05 F 17 Reheating for Hot Holdtiq VIOLATIONS RELATED TO GOOD RETAIL PRACTfC.ES 1 403.1!iA)' f0l T1111 . ll'.*VP IJ 'Ct. (hems 23-30) Nficrowaw- ICS'V 2 Mioui,-tkawfiq;;1C';t: "I'IfIM wlich do n',li relaw Io ow 11m, I fw'�R'w'-rw tiln�, �wdr;,l im,r� ';iIida;',n.- I;In Lr Consiiwciallv flrlces.leJ PIEF,,od i fi,widin e�'ouao'of;lo Fsed Cod, a,al!'�5 C'111? 1liFi Relliamin,Unz bred Pvtsoric4 to!" Ca000 Retail Practices 1 Fr 590,0W 4 Zq FC 001 Proper Cooling of PHFs --------- --- 2ti Fr,,-_3, 501 1,-'iA) from 1.40 !'1,, IFC-5 (XX 7-j'F%Vid,m 1 llour�ujid From 7:i'! I I al Fac.I!!t,, C' l 00 7 1 L.: 111 5,F Within- flotin'. 12F__ j ilo lonou or-r,)>Ic 7 i 00a 3-501-1,W Colin}!PRFs Made Honk Ambwnt ir, colp-11 jueni q th,• 1 9'19 t3oNj � . CITY OF SALEM BOARD OF HEALTH Establishment Name: �� :� _r �7?/L Date: it )1 j (\`4 Page: 3 of S Item Code - C-Critical Item DESCRIPTION OF VIOLATION/PLIAN OF CORRECTION Date No. Reference R-Red Item - .. _ .Verified PLEASE PRINT CLEARLY Ir� C_L�,vir (�1'� I"(. )✓1 r. ' for //j twll'(/7L.. , JJn. f74e a-. To b , 1A- n r1-.� .A 'X � .n n_ �. � �LIS•n , r r te. j _r �! r' J I�/{ -7.�Z1J^ / 1LJl nvyppp �1n 1 A� n� 1-4o / T 2. f I ti ov- f�- / r- roo Q( 'f r(at' / _0 i I �-�7n �1 !/_/O_ �c.10_ (l� l •• fI1',c�_�- .1'\r / Iw� 'p r_�lA......JJJI n rN � (7 ten-, 0, _. ( lG. 7 / /rh (i ( i._.. l—ice_r • '1_ 000a _,, 9A � srFt rl�'i'u 4`17/ (1 J�_ y�,�vr' �i/n.�Cn_-'1- --I n I„ !tea I {— (_n_ �_n (- .�'1 !l 11 PO lG_ n "ir L4 11)"', i 't- C_V» Ir x .0 '!117 IIr 1,.✓ yrJ E�. (i 0J.�; n, ec,-c �: ! o� / T) i y 1 I• - h � I//1 '/) �1 �.�� /V n,. LA� , _— _ I I f./ T7/1 C rte( U fr� �. ( J,c.l- Discussion With Person in Charge: Corrective Action Required: ❑ No T❑InYe4 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee RI/mss/iriction� violations before the next inspection, to observe all conditions as described, and to ��f Exclusion i P / yr / Re-inspection Scheduled LI Emergency Suspension comply with all mandates of the Mass/Federal Food Code. III undejstand that noncompliance may result in daily fines of twenty/-five dollars or suspension/revocation of ❑ Embargo ❑ -Emergency Closure your food permit. ` t I/�„ ` ' ❑ Voluntary Disposal ❑ Other: I Violations Related to Foodbarne illness Intervendpris and Risk !Aw Ckx�lej to Factors(Iffeffis I-2P) (Cont) A 1'+4S'F 45 izbol 1 houts "hIliljzi -0ilho& iin IIHFn PROTECTION FROM CHEMICALS d or Color Additives 19 FHF Hot and Gold Hoiding A-IQ I foN PFF,Militmiewd at or 56 w 3-102 i4 Peou ci.,Irr front Unal))oo,-ed II'll Kli-,I.Milmilolled'it or above Poisunou.,at Toxic Substbilm's 101.11 ilnnal I t" 1, 1 { i(Ill") Rutlu HOd 4r or illuve J 30-'F. 20 I Time,Asit Pubfit Health Claral of ,-;,ti 19 Tiaw 1�a Vuhl;C I lealill ContrA, 2;12 if R=mrim,,r, - ricc aod lj•e` Re,,alfuwuv -y -101 12 Corlrllil,.Dr�of Uw, 7.243.11 Toxi;Qmlarl,ur, -Plollih6of.", REG'-fiREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7 2-rA.I I Sano;m I,Crou', CllCotIL,kk' 1 1,�} 1 7-�()4,!2 Cii,mwrlf�f,)r Wa:hm,-� w:m:i4 I 1 7-204.14 Drying Al,cait'.Craeria l Pvffa^C,, wit", Vidrllmg U&As� npg 7-205.11 hiciderl(ril F4�xl CQntoo Lub6cilpiv 20fi i I Critelli'! l Aattn'a! Fod aod d 3foai, Nol Served. 7 Mb.i2 R,l,lcol BAIT st;oilm, '-1-061 1± 2T.Icl�,hlg p mdttr.-Pt�SL Col'trul a;'d CONSUMER ADVISORY -i2 -:ou>;unw ilr of TIMEn EMPERATURE CONTROLS i I L11-der" I Proper Cooking TompeiefurP5 for 1 "kl.d'I 16 J-14om PHFG A. fol I�v. sh,:11 [Inniccliarc srrvict, I i,;�F)5s 4 A - I � -- I -4fI 1, (A)('I C tmjI!;1lwtrd f iQl, Meat, Glolc L 1 - ",--— SPECIAL REQU!REMENTS J-ff)1.11(131(l L2) I floi-N and t,,"t R,tiq I"IlT 121 11,11"' V--- \)�:D i 2.461.11 iA)(2! Ram" Injecit-ki NlLmi,-- 1;5 F I', 3 R)LINA)f1i Wild(000,, Slurred Flir" I rt,Ni,1l!oi:J kilcriil opcntijrlv, :hotltd Ile dt-hov! ond'r 111c or k,mcq.1 141,,,,:. rollxlfcvqc JlncK into,vantioot luid 64, faculm Wier 5"40.00'., vwlivion,rellaIll", v)gmkki roij, 1.12 R;oh .Aminal Ft,o,C o,,ked in a hvtlld Nu(IchitLd ll-ititr #29 - Mi"Inwri,e lo'-f SP vial It)1,1!(A I(b) All Ot;iei fliE, 115"F 15 ,,cc Reffeating for Hot Holding VIOLA TIOA'S RE,-A TED TO GOOD RETAIL PRACTICES (ftetos 23-,1A) I 4Qj lift) Miclkwajrc_ 165°, F 21 M,Pwlc Sturdir%. d GIlonvi,,jaliv Prox-,.,,cd'R'li:P,"l- 1<qrd,,*3l it,, fls4,,,ws�v,-iie,m ell--4w t=rod t ode,ol,d Pi.'+i"MR 3, ,03 11 I:7 Pc irounia, t.to wred of&ef ifew Good Retail Fractious 5' 2,1 I-Crlat,d am Coaling Of pHFc 1 no'l 25, �lrd FC- 4 501 14(Al PHI',. f-om 1-4N,ill FC- xili 7,J'F Wilhut 2 lloor�a:ld F,,c�m l'I'l 6 007 towrmi, 1 PC--7 tx18 'T 1,141f I 0- tine,PHF' NRICIC ('10111 aVlblcol 1h,1',41.0 Ib V4 I:lw,l ttalc,�I ON(AI I,V), r CITY OF SALEM BOARD OF HEALTH Establishment Name: N ,k-r)-5 Date: I I f, 1) J Page: 4- of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONa to l No. ' Reference R-Red Item .,c; '-, . ;.,', PLEASE PRINT CLEARLY/ " VBrlied 4 rCY> t�• (_m ✓. I�7 ,�� 3mIQr �iM o�tOn on�X i )/1� i — �)�1P/1 f A��t.C� f�PG/l,J i n � (Y 77-;.'ffl 0V., rur) U 9 C,s.,47,, JL3 �a ,I c{c�c��rs/�Noo� -I /' ) �- G �O�lr�r G!/L'f.( . �.(,�.,t .!/1 - -X CY PI*10- �Q S, c�cr Joc G " G In it 1t ` < If�� C�vtt(IJI _h2[ C AAP. .S, , r I nro, r_�v limn ''IC�.VX�-l5 c�1.'lK-Cv ( /1 S'✓11�. �JAO<i r . I 1� CEJ2On LC) n ,�/'i r Pun � nJ6o4 Vyr_ei,- c,,14 01,„nek?z L�AsL. � / G<1nl/I S, ✓ � dP9N� r C-17 GJ � I / ND 5AT?. 1-vn /�S h_o,Jr ko_p�— 5-An,- 7g, t,)<, <Ltae�- to Cd r t-\ / 1 r,MY, V1 Cj S / 0.0 l�C L.r) hQ(0-d DiDi ucsssion With Person in Charge: Corrective Action Required: I ❑ No I ,Yes i I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Res' friction violations before the next inspection, to observe all conditions as describedd, anto Exclusion � P � Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal"Fiood Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. , �� / /n( r/ /� n �^ ❑ Voluntary Disposal ❑ Other: 1 t Violations Related to Foodborne lifir-ess Im1mrIntions.and Risk :lcvu 1"1-sv. to Factors(item 1-221 (Cont.} Within How,, —55:,1,15 C,yllril �cir NW� PROTECTION FROM CHEMICALS Pr4F Pot and Gold Holding 14 Food or Color Additives 501.Hlll Cl.,M atof b4o,,, go4i F, A 1'i45"F, I ;-302A4 prowdion Imm tinappr"r,id Ad,law"I;' j I- M A", Hot 1'14!2q at or ab ,tic Poisonous of Toxic Substancfil t40T' 17 10L I On6val 501 1("A) Rmm: Hvid,it v 13?PT, j 20 Time as a Pubtm Healtin Control 1 7-11)2.(1 common Nanw- work;nF,rI 7 201A! Naw Ill,a I'liblic Heakh C,mrrul -20111 Pt,tlidiop -prl"Wpc,awd U,e' 7-202.32 Condition:of j 7 I!ijl 11 Toxic Cow.wv,,!> -I'rolllhinou," ACQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7'_'04.l i SJn1li7.erS,ColrM--Cheokldk' j ----POPUI ATfONS{HSP - - I --L------ 7-204.�2 ChIrylicak for Wwhing Ili 0 1w,";44 21 !lt,%) Laijokl- 1 7-:204.13 Drving ',Vvnt,,Crol-via., -80E.11 in It Pu,tmo44,Ij Fap::' lld)i k,,v or Cioki d Arrioal Food 4tid 7-206,!1 R�Arrcled tilit Ye>rit ides cntw3� flilk':Jt.4 Soomi'a N,: siCj wil. 7-206.12 RWew B,iit St;twu , jUl;orcmi Fol-i prittmiw Not llkcsmed, 0h 1"acLmg R:Nv&r: Control aml CONSUMER ADVISORY 22 11 ALhisor,I hwd i�,v i ousum-prion lif TIMEITEMPERATURE CONTROLS 16 Proper Cooking Ternpefiltiaes for I PHFs '--* -- -7Pazoo��,,,. ,101 I]A(11(--,� i��, 15,�F 15 Sl:�. �;cr.,o v 1 V, q F � silhs�;Iuiv frx R;tw V�1101 1401.111:1}(2; Comomiwd Fi,h,%:at,e,, (iaiw Ankiiiis - 1 i7'I 15 sc�. SPECIAL REQUIREMENTS 401 11 Wji I)i 2l 1 NO and f`; ,[ Roisl . I 101- i2`. uiir� 1 "9:j Sclrctl :'!961)(NIA)-(D) in 401,11(A)(Yl Rmirc,, I,I)L•ci•d Nleit, 15 t ziwbj!t:ik>,od, lImporata'and Pooltr),Wid Gamc, Stuffed PHP�i, I e I 40i.11iAy fl�l;llllwal I ti,tivil opur".lioril,."i ould I - Sulffule Coaz.mmls!Fish. Meat, 6011ed WWel 0W appropriae seoiolic Pmhrvork,,wocil 'I o5"T if i it)E��Irikviw i iloes, 3-401.IjlCY3i Wllok m1u,"Ac, Inuct imui kc:niori aod tysk faciom Oibff (439" 1 vlolaiio;l,relatinlo to,ooj rk:tail 3.401,I' Racy. nimal Frnicl:Csa:k.d to a sh,rIld He debiic-d under 429 - 114-quirmictrV, x.40),l I(A)(1)fbl; All Oflict PHI:s 15 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 165',' U iCi' I illerp's 23,1(f} 3.-103111(F5? "filrowavc 16'I'V2 Morme 0;wo� zip.! iIw-tlola: itiach'I(l,w; r,2ruW!,l ffi,' 3-4t;3.1 I lc.) Cocom mmiry Pioxciej RTF h,-ld - 140"P 3-4031 (F i Rcmainim,Unficw lloaionc,)f I'm I 0oodHvter1Prjc6&vs i FC 54vow i 23 FC - 2 OM 24, 4 1-11011'and 1-006 K-- 3 004 Propm Cooling at PHF& r-,5— , --- iE 501AI(A) Cooling pl-IF, lroml 1 4) ['to i� l�v ale,Pii mbilic:ano 1,14 u�,,te FC- , .0 Widon 2 tiouts ciill Fvnn 70'1' Phys ce!P,-Oftv F(. c 6 ON [o.I 1-J-145'F\ii/jtjjjn 41 jj,lUj' Pc—,on,.js 7,I,�cMatef,dls C :7 ,Yo Coolim,PiiiF,MwdtI From L,,nibmilt 609 Tkmp,,ratury 111gr.1111MIN t(141'1143 F 130, 1 Ottm - Willi4i.;li,,or,l 1 lelh,111.;nlWa)'o m m 01,le,k•ll! il,ll) 105( k4lt W6(k CITY OF SALEM BOARD OF HEALTH _ Establishment Name: 1IN)I rOS 2'71 i1- Date: 1t Page: 7,of f� t Item,.. Code C-,Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ate No. Reference R-Red Item 'Verified . PLEASE PR INT CLEARLY \Vt11r In J"+s-70 12��F >ol. �/ ✓ � Y1eo�nTtJn ,rl 10 b04.4(1,4 Ah. clP i 13rAE - �1�.1 t 'Jo h11¢IAiJ lti2l - /l_ C� InY c /J flOr✓t lit!✓+ c� /✓1 F- ) �{ I I � r �a 3 -'��. tE ✓ Pv41\ /1c,1C1✓? 1W -5 0Ad� r r s >��i .tom- ✓ 1J� }„ L d hGroIrv<i i ,(� ,r _ ►� .zi, 0�4 l,�>zr. �,rd,�,p -IU lc�l�.a.-1 0-�-'c.��»/^ .v 1 Discussion With Person in Charge: I Corrective Action Required: ❑ No pryes t 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 5 violations before the next inspection, to observe all conditions as described, and to Exclusion P i Re-inspection Scheduled ❑ Emergency Suspension r comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twentty-five dollars o/rl/:suspension/revocation of ❑ Embargo ❑ Emergency Closure } your food permit. ��t A !t Ij�;I/X/ �l^/ "�/�LJ" CfiX-V ❑ Voluntary Disposal ❑ Other: Violations Related to Foridborns 111treas Interventions end Risk A,-owdilzg 1,1 Ir v, Corled to Facioriildarffi;1-22} (Cont.} withm 1 qtuu:, PH[, PROTECTION FROM CHEMICALS 14 Food or Color Additives PHF and cold Holding 12 Adrbtmw' 3-202.14 prolecl)(a) from 11111ppm".od I-o't VH!�,%taintaiiwd tl(,,r abor� Poisonous or Toxic Substhrices 101.11 loentirvins ntf2nnviilon Orjrin:;! or :tine 13"I'T Cont liner, T irne as a Nb!ic Health Control 7 102 if CowawnN�inj, I I,'im", l'uhtic Stealth Contiol, 7-202.11 Rtmri,.Oon-Po,t�-w,� aid INuicenicnt 7-202.12 Counim:onzoif Ls: 1 ohj REOUIREMENTS FOR HIGHLY SUSCEPTIBLE -1 � -03"11 To�i,. ('o;,njjT)Cr� prltn:l�.K;"; POPUZ.ATiONS iHSP 7-204 11 lulon a() Avems, Crit ria'' 1,uhm,anW ;-206.t1 Re,;i.6,tej 1',%v Ilt:licides Clitekll' iakv PmUd;! Co%,1,,(kI Armin! I-,,xd md P-ak ',,,i Jrrvcd. 7-206.12 R'dow 13 pit Cr")rt,ne'!rlixd pad ag, Not Itc,en-eft 7:206 13 Flocking P�E Control awi ""lonory,in", fNONSUMER ADVISORY 72 ',, � oqnn,r Ad�JFo) 'I"wil f'r Cm,-quiption of TIMEITEMPERATURE CONTPOLS Altku,! tlia Ra" Under",oktd!t I 16 i Proper Cooking Temperatures for lu,"i,it,' irox:"sed to Flonni"(v PHFs 171Lg', I i't,F I"Sec: Connylinaled'Fi'll, Omil,t Aniiriaii- 1'+5`Y 15 sec:. SPECIAL REQUIREMENTS g51;j(K�0 I I LiO !' cail'mw, mtobl!�: ;-401A I(Ay 3) Priiiltry Wild Canine. NlFt,, I ':an.:rll,ad KociiUn ,;tmns Awtild I"! Sitill'on, t,ohlierj Luldd<'r filQ Ilk'all ry tw Rau m, I o5 P Rx(: )f Nhtl,'d U-f;,x)(J)'WrIC i i II)CV 340i,l:i(7)r3) Mhdn -nwoiv, Inoi,t BrJ S1,nk; Othor 5`40.00,1 vwlanvjw^Telanno to pool retail 1.t2 I R,i%,Arional Fo d,Coikd m a Otwiice. i,,c debited under #9 - Mmo,",avo 4(ijA!(A)(I)(b) ;Wt(rilvei ltlll5-- 1.19'1: If Reheating tot Hot Holding VIOLATION'S RELATED TO GOOD RFT41 PRACTICES 212 At, PHI,: 155-F 15 Sec 1 ljfw:�23,30) 4w.11(B) i I(s t"1'''M i TiTel' be 3-4ri3.1 I t(7i Congmi"wjly dl I:I"',d Of ifi,:Food Coit-wd 10 ('4111? :-403,1 l(F, Rcmaming Ujwhcedlloftion<of Bc6 1 1 irio Nr:mn.,r! FC OW Proper Cooling of PHFs 2-4 ^,ind Foxi Froj,rti,) FC 2F, iFQ,Rnie - P ?*4 a;.6 UtelsL FC -4 005 ^-501141A) 0h,lifig C PHF; from 14C, tit �Ise,�t,) FG -5 066 -a-5tv - !ii'F W4hok 2 Hour,; nd Frooi ,' ) i L FC—$3 7 41-r!45'F W,tlon A Hotip, I rn ------- i 50 1.I,toi) Coilifig 111-114,Ni:,Jv to-m Ambictit ...... 'I'mPerature no"roditim to 41'F/45 F t Within 4 Hmt,, I los i,.%It:591!N'(} yl.,,.�=tVw•- ....,.r!...y+ .,'n.W�..,.. �". .r, ,Cfi'.�i~i!. �`j � «-- rs.�:.;^..ai w w:,'.'rti,.,•v! •� y. , � , x•t ,:,w•-.,r r� Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 NameDatel Tyt a of Ooerationfsl, Tyge of Insoection Q, 1\O S (ZZ4 /// �5�_ '21�,Eood Service ,❑ Routine Address Risk ' El Retail Re-inspection Level ❑ Residential Kitchen Previous I s ction Telephone �/i/A, C S"� ❑ Mobile Date: /INI Y Owner HACCP YIN E] Temporary ElPre-operation �Glr [a 1<,I/� rI i<./� ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑❑ General HACCP Complaint In: �-fa Inspector �� 1.. Outq .z�0 Permit No. ❑Other Each violation checked rec unres an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH' - -- � ' PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC - .• ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals u FOOD FROM APPROVED SOURCE"' `" `•` ` ^` E] 4. Food and Water from Approved Source TIME/TEMPERATUREcONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18•Cooling PROTECTION FROM CONTAMINATION • •' • ' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Prote11 ction ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(NSP)• ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. Good Hygienic Practices ' CONSUMER ADVISORY • '" , ' ' , ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation'of �25. Equipment and Utensils (FC-a)(5so.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 OPRE-INSPECTION: S 501nspe FlPo ld me N1��r �� Inspector's Signature: // Print: �/�-``�7 � yyy111/p/�'� PIC's Signature: Print: Ir Ghtr(X� K�i'r�f 'L,11�`T1V�/ Page+of Pages IV \ Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S Cross-contamination I 590.003(A) Assignment of Responsibility* j 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I { Cooked and RTE F�;uds* � 2-103.11 Person in charge-duties Contamination from Raw Ingredients -I 3-302,t l(A)(2) Raw Aninutl Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to ( ContaFnination from the Environment- { require reporting by food employees and 1 3-302.1 I(A) I Food Protection" applicants* 3-302.1:1 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Frxid Employee Or An 3-3(14.11 Food Contact with Equipment and Applicant To Report To The Person In ( I utensils* Charge' Contamination from the Consumer 590,003(G) Reporting by Person in Charge` { 3-306.14(A)(B) Returned Food and Reserv:ce of Food* 11 590.003(D) Exclusions and Res rictionsx Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I I Food 3-701.1 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food+ 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* { 4-501 111 Manual Warewashine-Hot Water { 3-201.12 Food in a Hermetically Sealed Contatner* Sanitization Temperatures* j 3-201.13 Fluid Milk and Milk Product,* 4-501.11-1 MechanicalW'arewashing-Hot Wafer 1 3-202.13 1 SheL Eggs* { Sanitization Tempennnres* 3-202.14 F,ggs and Milk Products,Pasteurized* 501.114 Chemical Sanitization-temp.,PH................ . 3-202.16 Ice Made From Potable Drinking Water" concent ation and hardness. " 5-101.if Drinking Water from an Approved System' ( 14-601'1 I(A) Equipment Food Contact Surfaces and j 590.006(A) Bottled Drinking Water* Utensils Clean- 590.006(A) 590 006(B) Water Meets Standards in 310 ChtR 22.0" ( 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscrn Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish from NSSP Listed 1.703.1 1 ( Methods of Sanitization-Hot Water and _ _ Chemical* Sources* { 10 { Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authordy 2-301.11 Clean Condition -Hands and Arms* 3-202.18 Shellstock identification Present* ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushroom;' 2-301.14 When to Wash* { 3-201.17 Game Animals* it ( Good Hygienic Practices 5 Receiving/Condition { 2-4131.1! Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* ( 2401 12 Discharges From the Eyes, Nose and 3=202 15 Package Intogritys f Mouth' 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting*_ { 6 Tags/Records:Shellstock 1 12 Prevention of Contamination from Hands 3-202.16 Shellstock Identification * ( 590.004(E) Preventing Contamination from 3 203.12 Shellstock Identification Maintained* { Employees* 13 Tags/Records:Fish Products Handwash Facilities I ConvenientlyLocated and Accessible 3-402.11 Parasite Destruction" 3-402.12Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5 201.11 Location and Placement* 7 I Conformance with Approved Procedures ( i 5-205 11 Accessibilitv. Operation and Maintenance /HACCP Plane I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods"' Devices 13-502.12 Reduced oxygen packagingg criteria* ( 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures" ( ( 6-301.12 Hand Drdrng Provision *Denotes critical item in the federal 1999 Poral Cvde or 105 C_%1R 590,000, I I CITY OF SALEM I BOARD OF HEALTH Establishment Name: i 1� �c �,z_z� Date:I II YL -a, Page:,-2 of a, Item ' Code;; C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item I PLEASE PRINT CLEARLY' �/' - Verified cirtr.n,v19 NC. A .rl 1 i � I th \/nrL � � �. n CbA / f).,IsJ : 4 ✓/--rt-l.,iA /;�. groan�,�+. �L r.�..�/'�cG v-' .✓ .� n� ..c 1rA,�„ � .:." � (,OC)Ikl, EA �'r �.` I )r_,i�r— vnr_ If)in/oo .. !'�n..,:.,,� hPnr7_ ��., 1, ..r�r A) , .6/ n -./2 J/°1 /I . J, ._�74 J/ 1 v l 6,,,.tAr/ '.('AAv77 I— 74v r Ova r__/9k..lJ J-,-fo�Z' I ac I I Discussion With Person in Charge: Corrective Action Required: ❑ No I-t1 Yes I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ ' violations before the next inspection, to observe all conditions as described, and to Exclusion P � Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Codg. I understand that noncompliance may result in daily fines of tvWnty-f've dollars/or suspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. // ❑ Voluntary Disposal ❑ Other: , Violations Related to Foodbame,Illness intmerolonv end Risk lo fix,.CNA�td to Factors(IkIes 1-22) (Cant.) PROTEC'nON FROM CHEMICALS3 5('1.}; CoAinLVlc-,!hd: 14 Ptly", 14 Food or Color Additives PfJF Hm m3d Cold Holding 50, !(,:B) Cold pffl,:i vidillomed al tr b"l,%V 3-24.Q 12 4 Prx'Ic0ton Hol FW', Or 81110W Poisonous of Toxic Substances 101.1.1 ld4mt;fylm, intitalz,iwr - Owlgm! 1 140 f "w 1 1 k) koam,Held;m or sh,,%e I 300F, Iiiale,As a puttlic Heath Conti of 7 1 tl-' �I Claamm MineCowaincr,, !13 )imv. IN a ruhlic Health Clgllvoll 7 !a I ot(fsQx 7-103 t; To�ic Gjlllairiol; -prohlbl:,oll, REGUIPEMENTS,FOR HIGHLY SUSCEPTIBLE 1 -204.1 NaJjui7,C�, -Chell&.il POPULATIONS(HSP) 7,YW)2 Cfiejllicaj� fof h,wlhw�,.Cme6�1 wid ",-7!)4A4 with Di Aliv.nu. )O` liamb-mll) F,Xxl lith:lcallw 7-200,11 R:,iri,,cd Us: Flc,nk ides,Crvzr,;,' '-SOL!Ill)) llai-:i:alk Cio1<,idAnq;jaf Fmd ind k;,I, S";.-,u Sprool, nk,,T 3c;lt'l. 7-�'W!2 k(klem 13�1;t sl%ilutl", i i ec, I I l"glid Pa:;rda, Neil kv-w,�Cd 'It wking P-'aE Contm!and CONSUMER ADVISORY coimmlor Coo,"lotption of TIMErrEMPERATURE CONTROLS P . ', h't, na 16 Proper Cooking Tempel atu,Ps for PmFs I Mi 1 55,F i 5 P)1r, ol,- fol Ralw Shelf cuallw-wed FE'l, Mei,v;& Animal,; 155`1' Y7 SPECiAL REOUIREMENT S 3-40 l I I t B)(1 42 P,l(l, ,�wl ko;l�l 13')'� 1�I [,,)in' -T,�-,,T— ,-4!;1 J I iA)C ll:tliv, h1jec!,d I 40t I hAVil Mild Gamc, "olt'red 1,1!f Utchut, oiien;tims sh(zuld lie the avpronmAtc Ci-,ffmc Coat;omn.g MMI, S`F !'-' i 3.401 11 iC.0, %Vlwle nlmJe, 11m,o risk fak;wrs 0;b(-r vlolaill)J's frolalill" ii, tart rcu!fl 12 Raw Anail;il 1,,d',C wk,;d in a pra,wQa Jiliold Yd6izcd bli-jer #29 - 165 1- 40 i ti(A)i i 1i h) All Otfiei Plif,c- 145'F 15 17 Rehea!ing for Hot Holding i VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-M3.1 VA),ktM Pfff: 16,VT I '.t,% {lien-2 k-10} l65"F2%i!nweSmndmi,, rime" enti n,w z'iil:i,k fmu,rc 1,vcd ai-on, (an 6e -403 11W) Pro c,:. d R'€k '!i C.lip i 4w� ita;n- T pro,&;coa 3-403 1 i{Fi RrnlallllN,,l,llQ:keJ pom(ml,l lice) FC 590,600 23, i an-di ine. 18 --- Proper Cooling of PHFs 21 K4,uard F x)d Prowcu, 25 i Eaul�malll rind U!ewji;A F C,-4 cl, i- 11 Cwlll) CN4,,d rfj!-,c Itow 1:10,17 to 3— Njl�!�P!L�rlb�luz I FG 5 ON' "WIF;Withm 2 114xjr<and Frkwa'19'�, I Prl- rp!racij;ly -7 J Po:,-,;lsozjs 3 50 i 14(B� ccolj�t,,PjfF, Made Fr,lii latmfiem1(�41-F/4-3 F Witbin-1 1 lmr� A,,r 10, rAMW[�•••-•ti...,,�!'Y+,II :JJ elf•f�f.'rna;� lsnraJ'.f�'Y,nLF.�V�r'T�'t('r+('reTr�itA" i� N.��I:tiyfW$}My'^l ra� . � A�.r. 'Rri[ / - Y .W IYI brn•• �.t��i4 r. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 0 Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name \ ' '/ D f Tvpe of Ooeration(s) Tyge of Insoection �2 �/ r�/11� Good Service El Routine Address •� ` 1 Risk r El Retail fi-iinspection a5 A i '/�` Level E] Residential Kitchen Previous Inspection Telephone /�S y ❑ Mobile Date: /,WZ;!/ Owner HACCP YM ❑ Temporary ❑ Pre-operation CfH� t'��L f, ❑ Caterer ❑Suspect Illness Person in Charge(PIC) y� V Time ❑ Bed&Breakfast ❑ HGeneral ACCP Complaint In: inspector [IInspector ` nh �/,_ ��n I Out: Permit No. ❑ Other Each violation checked requiiies an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. ,FOOD PROTECTION MANAGEMENT,' . ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC -- ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE" E] 4. Food and Water from Approved Source • TIMElTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures;r ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1 B. Cooling ) PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control El9. Food Contact Surfaces Cleaning and Sanitizing ',REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),,,,_ ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing E] 11.Good Hygienic Practices `CONSUMER ADVISORY El 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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fo2)(ss0.eo order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(50.00 ))) cited in this report may result in suspension or revocation of _ 25. Equipment and Utensils (Fc-a)(s9o.00s) the food establishment permit and cessation of food :::Z26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5WIne fFor -14D Inspector's Signature: ' /�- Print: PIC's Signature: i r�/� - Print: 1 "Ivu I Page f-?Pages `J E - Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 1 Gross-contamination j I 590.003(A) Assignment of Responsibility" 3-302.1](A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* j Cooked and RTE Foods* - _1 � 2-103.11 Prison in charge -duties j Contamination from Rawingredionts 3-302.11(.A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(0) Responsibility of the person in charge of I Contamination from the Environment require reporting by frxxi employees and ( 3-302.11(A) _ Food Protection^ - -- ----- aPitlicantsa` 3-302.15 Washing Finita and Vegetables j 590.003(F) Responsibility Of A Food Employee Or An j 3-31A.17 Foat Contact with Equipment and Applicant To Report To The Person In j utensils- Charge* ( j Contamination from the Consumer j 590.003(1;) Reporting by Person in Chat;ee* I j 3-306.14(A)(B) .j Returned Food and Reservice of Food* j j 3 590.003(1)) Exclusions and Restrictions* j Disposition of Adulterated or Contaminated 590.0031 E) Removal of Exclusions and Restrictions ( ( I Food 3-701,11 Discarding of Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 141 Food and Water From Regulated Sources I j 9 Food Contact Surfaces 590.004(A-B) Compliance with Food taw* ! 4-501.1 l 1 Manual Warewashing-Hot Water j 3-201.12 Food in a Hermetically Sealed Container+ j Sanitization Temperatures* - l 4-501.7 12 Mechanical Warewashim*-Hut Water j 3 701.13 Fluid Egs*Milk and Milk Products* 3-21).,.1-q Sltj t Sanitization Temperatures* � j j 4-501.1 L,t Chemical Sanitirttion-temp., pH,3 202.14 Eggs and Fo Products.Pasteurized` ( concentration and hardness, '" 3-202.1 ti j Ice Made From Potable Drinking Water- j j 5-101.11 j Drinking Water from an Approved System- 14-601.11(A) Equipment Foal Contact Surfaces and 590.006(A) j Bottled Drinking Water* Utensils Clean` 1 j 4-602.11 Clearing Frequency of Equipment Food- 590.006(13) Water Meets Standards in 310 CMR 2211* j _ Contact Surfaces and Utensils* ! Shellfish and Fish From an Approved Source I i 4-702,11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* I i 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP I3sted I Chemical* Sources* to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 12..301.11 Clean Condition-Handsand Aims* Regulatory Aurhorrty j 3-202.18 Shellstuck Identification Present* j 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms" j j 2301.14 When to Wash` I j 3201.17 Gane Animals* j 11 Good Hygienic Practices g ReceivingfCondition j 2401.11 Eating.Drinking or Using Tobacco* 3.202.1 t j PFIFs Received at Proper Temperatures* l 2-101.12 I Discharges From the Eyes, Nose and 3-202.15 Package Integrity- j I Mouth* 3-101.11 Pcwd Safe and Unadulterated 3-307.12 j Preventing Contamination When Taxiing* j j 6 j Tags/Records:Shellstock j 12 j Prevention of Contamination from Hands j 3-20218 Shellstock Identification * j 590.004(L) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* j Employees" j Tags/Records:Fish Products ' j 13 Handwash Facilities j 3-402.11 Parasite Destruction* Conveniently Located and Accessiole� j 3-402.12 Records. Creation and Retention* j j -' 2g3.il j Numbers and Capacities* 590.004(J) I Labeling of Ingredients' j j 5-204.11 j Location and Placement* 205.d l j 7 � Conformance with Approved Procedures 5 � Accessibility, Operation and Maintenance- IHACCP PlansI I I Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* j Devices 3-502.12 I Reduced oxygen packaging,criteria* j o-301.11 Handwashing Cleanser,Availability j 8-103.12 Conformance with Approved Procedures' j 6-301 12 Hand Drying Provision 'Denotes critical item in the federal 1999 Fond Codec), 109 Cali 590,000. CITY OF SALEM t BOARD OF HEALTH Establishment Name: �) �� _.� i /.� 7 .I Date: (//1 Page: of }{ Item- , Code C—Critical Item ' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-1 Red Item Verified - - � • • . . PLEASE PRINT CLEARLY (� t �,C\.� 1 `. T' r•I�Y- 1n n�{ Le{ �F,•.•-(� �n-. _.F- i if'_ �.�! '11/� •_^ N.� C��'A� I' ./'a/7" � ^ . r r [n� �__l.._ 1 ✓✓✓ r n �^ 1_ rh 'C rJ LFsn J t�Y ^ VY S1.0 dj ' 1� V12 /2—n N / r � I I I 1 •" 1 E I j . r I � I - 1 1 Discussion With Person in Charge: Corrective Action Required: 1 ❑ NoI�[�' Yes I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance L) Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to "K Re-inspection Scheduled ❑ Emergency Suspension f comply with all mandates of the Mass/Fedep fyd/Code. I understand that noncompliance may result in daily fines of twenty ve dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. Ilw ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne filpess ln,*c-rvcnNoefs and Fff,�Jc Ac-ujh,,:10;A, Carted to Factors(items 1-21 fContj :1,1-45,I- wifh:n PROTECTION FROM CHEMICALS Wihc-d: for PHF, to PHF Hot and Cod Holding 14 1 Food or Color Additives jt,y,bolow 3-302,11 j protec!!,m fma urap-nn-ved I i'a I'mi \Iaiwqir(dq('s abow poiscnou.of Toxic Substances if)i I I l0entihmfe Infulfidlion ovil,inal i A,H I Hc!tj at r conwin3n , 'rime as a public H03tth control i 7 i I! f (f,,nvwonNurw pamu"a afec 1202-11 RQ!trictiouReqmrQnwas 7-202.12 Comfitumir,of I f,," j I.n-, I I REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 204 c6tcri.4 -C'noom;'N' it POPULATIONS(14SP) I(A) Cap,u-miVi Pr,,pa,Faped Joices Mrd 7.104.f I Chemic,k for wa,hing ll!odlloe, with "icamimp ufl),k- 7-204 14 Dr,mg Acerm.Crim ia' lncid,-mal F,�xl Comf:% ol P,:lewlzoo Anidi'll F�xd and ?-706-11 Rc:irik,:Nl Vsc ('11teria, --,w.12 QW,-w li.11t,dAioTv,, r,pcned FV,xVN,,t k-scned, ^06 13 1r,wking Po%,\dvrz. Pem Controjand \lorhorin 1- CONSUMER ADVISORY 11ME/TEMPERATURE CONTROLS22 3 10 ufio .,rt, Ptcte.d 1,tr Cmisomption of ' -i km�J 4 :m R4w, Undenwktd U1 PHFs :o hlhnilka� 3-101 HAM(-,i Jbinlwv f-c Iww Shell Commimit"d SPECIAL REQUfREMENTS ,,,e) pol, and Beet R. Fl-I rnin° t 2-401.1 0)(1) kdtae\ ;fqCcfQ,!Mv.1te 13; F 15 Vi Vi s I N!,S,F sec t i op S41 t.WX (D) in tnohil.txfc'a tcnp,rary and Z 40 1-I (A if,3) P W�hcii op,-taticrns should be OL;�wY,Wild cifmw, Stuffed Plif,� �IdThllc L'Ont:141M� Fii,11. Wat, debih-d undei the ai�rroprja(v ,e,,0oaN Rmft,t or Puows '165'P 't rf.I�Ifod :o fKxjhorlllime:.s 3-40E1 1,0,,'.;? qnm,�, [mact B", tmu ventions and risk t�lctut� 00-ff vi-lawTn�relm,Iih( ,,i reudt 3 4') Z R,,H AninW C,4ike0 in A plutim .hk�dd Ix.wNted under #29 - iOT lt�qok!qicnt:,, '-401,11(Ar(!)(b) 111 0111�-T Nif ;-- I J it I 17Raheafinq for Hot Holding V10i ATIONS RELATED TO GOOD RETAIL PRACTICES 3-M3.1 1(AAi D) T'lil, W,.F 11 ire'. " 23.3(1i 3-403.11(bi \Ticik;Vav: , t0mcte Sim<tin, df.11w ciar", W 111" nskjq41vrS be 1(C') Comfnmiailv RTF Hx*l finend in dfc ;efj,;tpx of:ft.'f"od Codew,d 105 C'Mr? 3-403 i 9([:i Remamiw, Cii,lt,,,.d I'VfoomY of lice! -yaql� Go0nRVtqf!Praa,.e; FC 590.000 i R,)a,t, 2V, mma urzVni and Pet:formfflFC 2 ckt,� 1% -77 prettier Cooling of PrIFS F-,,,,,d nnd Funs)d 004 2� 1 FCuipmera and U:en�i!3 FC.-J.. -0. cooling C-x)f,:d PHI^ lrom !,W,t-ifs 20, Wato,P,tm,rnqmrjvvffate Vc ,7 �11 70"F Wmp 2 Hour,�,,nd FrsAp'1WI-' P :v1,caFa6:iy r-,c-6 w? 41'Fll�) P Wiflzin- Hoonz, k, Pcoa Di ij, or Tom Mfilofals 1 FC-7 1 NC, --501 1403) Cool4ig PHFz,',V1,ide 174om Ankbm,t Temp,,i,miffe io 41-1745 If Other Within 4 t.leq,! P>1110i.,,,,H , 105 t rs tri : ► , iA•. rt" 4G4 . .. 4 v• - .. r '•-r r er -�, r > r rtr.+ "Massachusetts Department of Public Health Salem Board of Health Division Of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name A I // Dat vpe of Ooeration(� Type of Inspection z_Zi // 1� ood Service ❑ Routine Address Rik LJ etail A-Re-inspection Level ❑ Residential Kitchen ( Orevious Inspection Telephone 3 ❑ Mobile Date: Owner "'CCP Y/N ❑ Temporary ❑ Pre-operation ��N_� ❑ Caterer El Suspect Illness Person in Charge(PIC) V Time / ❑ Bed&Breakfast ❑ General Complaint ' In: �} ❑ HACCP InspectorJ�'^ Flo Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT,` _ ❑ 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties " ""'�` "-. '• .,, ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food 11 Employee and PIC = .-.-µ " "' • -•� El 14.Approved Food or Color Additives F-13. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals " `-FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Haiardous 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 REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 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) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(9590.090.0 044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5801ns (Fo, 14. ^3 Inspector's Signature: Print: n1;v "'CCC it PIC's Signature: (' Print: v( ' i/�A �^ ^ I Page t ofd Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S Cross-contamination 1 590.003(A) Assignment of Responsibility'* I 3-302.1}(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* ( Cooked and RTE Fads* J 2-103.11 ( Person in charge-duties ( Contamination from Raw Ingredients 3-30211(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 59(1003(0) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and ( 3-302.11(A) Food Protection' applicants* ( 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fad Empluyee Or An I 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensiis* Charge* I Contamination from the Consumer 590.003(G) Reporting by Person in Ch:uge* ( 3-306.14(A)(B) Returned Food and Resenice of Focal` ( 3 590.0030 Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated ( 590.003(12) Removal of Exclusions and Restrictions Food '61.11 Discarding-or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4I Food and Water From Regulated Sources ( 19 Food Contact Surfaces 590.004(A B) Compliance with Food Law* ' 4-501.1 (I Manual Warewashing-Hot Water 1-201.12 Food in a Hertnetically Sealed Contamer4 ( Sanitization Temperatures* ( 3-201.13 Fluid Milk and Milk Produce;* I 1 4-501.112- Mechanical Wareivashing-Hut Water ( 3-202.13 Shell Eggs* p Sanitization Temperatures* I ( 3-202 14 Eggs and Milk Products.Pasteurized* ( 4-501.114 Chenucai Sanitivation-temp.,pH, 3-202.16 Iee Made From Potable Drinking Water" ( concentration and hardness. " 5-101.11 Drinking Water from an Approved System" I 14-1't�1.11(A) Equipment Food Contact Surfaces and ( 590.006(A) Bottled Drinking Water* ( Utensils Clean* ( 590 006(B) Watet Meets Standards in 310 CMR 22.0* 4-6(>-•11 Cleaning Frequency y of E nails* t Food- Shellfish and Fish From an Approved Source I Contact Surfaces.std Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Eompment* Shellfish' I A-703.11 I Mettud,of Sanitization-Hot Water and i 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 1 2-301.11 Clean Condition-Hands and Mins* ( 3-20118 Shellshck Identification Present* ( ( 2-301.12 Cleaning Procedure* ( 590.004(C) Wild Mushrooms* I 12-301.14 When to Wash* ?01.17 Game Animals* I I If I Good Hygienic Practices ( g Receiving/Condition I ( 2-401 11 Eat title.Drinking or Using Tobacco* _ 3-202.11 PHFs Received at Proper Temperatures" 2401 12 Discharges From the Eyes, Nose and 3-202.i5 ( Package Integrity- Mouth' .12 ( Preventing Contamination When Tasting* 3-10 t.l t Food Safe and Unadulterated 3-301 * ; ( 6 Tags/Records;Sheilstock ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification; I 590.004(12) Preventing Contamination from 3-203 12 ( Shellstock Identification Maintained- I Emplo}ees* ( I Tags/Records:Fish Products I 113 Handwash Facilities ( 3-402.11Pmssitc Destruction* ( Conveniently Located and Accessible ( 3-403.12 I Records,Creation and Retention* I 15-203.11 Numbers and Capacities" 590,0040) ( Labeling of Ingredients* ( ( 5-204.11 I.oeatiun and Placement* T Conformance with Approved Procedures i 5-205.11 Acce<sibility, Operation and Maintenance /HACCP Plans ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ( Devices ( 3-502.1 2 Reduced oxygen packaging,criteria" I 16-301.11 Handwashine Cleanser, Availability ( 8-103.12 Conformance with Approved Procedures* ; 16"301.12 Hand Diving Provision Denoter crvical;tem in the fedeial 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: � � t{��, Y/2-2-14- Date: 11/z? / d Page: of -Z— Item Item Code '; C-Critical item :-: r, DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ,; :; Date No. Reference R-Red item.. - " --- Verified [ PLEASE PRINT CLEARLY- ' r� f\, r Gf Y7, ll J �fl 11 �i �o� fnnv �— I I I I I i j - 1 -Aik Q j . I � 1 { I r. 1 Discussion With Person in Charge: Corrective Action Required: ❑ No '13.'z Yes { I have read this report, have had the opportunity to ask' questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / I � Ll violations before the next inspection, to observe� a tall conditions s 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 if twenty-flve��lars or suspension/revocation of ❑ Embargo LI Emergency Closure your food permit. J � ' � ❑ Voluntary Disposal ❑ Other: Violations Ridefed to Foodborne Illness frinanentionis end Risi, v--,crdir�10 Lark ckirfl,:J to Factors 0rem 1-22) Wont) Within 1 Rouls. MvAiwt, i't" PHFs PROTECTION FROM CHEMICALS 19 PHF Hat and Cold holding 14 Food or Color Additives Cf,iff Pill-r Men-itain"I at or 1,dow ?-202 12 Additwc`i 3-302,14 Pilc,,ctiot,Crum ljllai>pnw.edHi'l Ph! abyte Poisonous or Toxic Substances Rff.,ms licid.:ter Affiviv 1301% Tince as a Public Health Control -,-Inll Common NN;lm�, - W,,:iikilw, -0 1 '-20- i.i Tit-let as a f"llblil,Iwadth ControV I.11 - st"ta9c' 202,11 Rmuicl,lin -Pif'st;tce and U"-,- fkku I Ii vitriarve 7-202.12 of IJwl REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 >01 I I Tori,;Cximaineii Pltohibi:iori,' POPULATIONS(HSP) 7-204.11 SAnil'ZtN.Ctilcli:1-01,11iCAS' 7-2(J.1.12 JQ, ',Nlar .hiiir I'rfKht0,'i . 7-10414 DiingAectlu,U r1bil,11,11 i8ill !;ilii k. ;,,fit tlikstocizcd Ecg J'akk,i,r jijtt%ll I"r Bill and 7,206.i? ;.2Rodent Bait Stati,R, halt=: stld Sprottv,Not Served. . -:iti i,I i T'n"'mrted Nx'd Not Rt-sv,cfl to 206 12 T1'lCk$n1.1 Pll%v&r: F:tSl%('011tr0l Ucd oritfirin" iCONSUMER ADVISORY 3 6 " ftfli(Twt Ait�Is"l, Pimc TIMEITEMPERATURE CONTROLS 22 4 1 ( o - 0 i'r Colmalilloittli of Proper Cooking Temperatures lot ihat.!ry ka'," Ullderolflkcd to PHFS 3 40 1.1 IA(I q1rggl 135'F Ii S-t:. j-k�c`- llmli:^dmtc 1vlvicv 145,1-Itistc, ("Ortim:nlp=,d Araliiali;' I i5 F IS se,.. ' 3 401.1 Uiltlf I:!2r Poil, :end titei koest I:(a F 121 nim, SPECIAL REQUIREMENTS ViLtittimni,fdSk,*tivn �0(l(9)91 ikl-(D) in i-401.1!(Ag sil i)0il(,V; fit 155 F tll0l0c I(X"d, 'clilporai'v iind 40 IA I(A)'If Aidn,me, S1,j!ttdPJiF rc.md-,lifiA 4itchcn operation ,filndd he S -mP li"athmitig Fist). Nfo,,l d"hil(cJ1 to nd"'I 111f: alit in pufte qQ0i0lis Poidit,,,q kamwi;-it)5"F iS ser. Akiye 't wt::t,%A if!i°,kx!hor!w 3-4t)1,1 i('-I t'3 i mtel t,enlielilWill isk i�,.wrs "heir I 'Ittn, t6 Ole i"uI009 , 01, sJI ri-tdil i ?--?0;.l: Rim >rliiyvl f-iyj,: M a holild be Je1iiiLd lirldcr#29 I I(A)(10).l MI(Rhea Pffi,- 1,15-1i 15 sei: 17 Peheating for Not Holding -I VIOLA TtONS RELATED TO GOOD RETAIL PRACTICES - 3-W3.1)fAIli(D i TIHI•: 1ri5`F t?:r: then is--!-) 403.1 11(h Nlwrtlw:iv(, 16`f- t 10tiluie swrjdin�, -'ihichdonn; 1' Iftrcpi me 3-IQ I I I W) RIF hod 1-41H ;40 FN -401,1 I(Ei Rommilrig Uw,wi�d lice! -I-tem I r FF 6- r,, ,:3 i1cnjqr-r.c:1l and pem�mql -2 nN [-Fq, ----,�YO Pioper Cooling of PNfo -24, i F,�cil tfd Fout Protv"iop Fc :i 0(.,4 f !S1 005 j 501,14(A) Cthtliily cfx%,�u Pill's fv�,klf I W'Fll� pl,r"ific TT, FG-S 00b 7WI,I.Vition 2 1 cur,iiid From 7X1 L27, lltjy�j�Fwltlty FC-6' 007 Lz-j! '1115 F fik4!thin 4 I-Jojifz t "^a.vc, ftaia,"is 4—" C.'Oflile fiff"il klli&F1 Art "110l'ttift' Tm1wrawre lllffcki;ollt.lit 4 19 F 31)... `t%tqhm,t Poitt]ill i %11,51t0fifif, Massachusetts Department of Public,Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4 Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name /) I DatQ_ Tyne of Onerationisl, Tyge of Insoection - ,S`�' /5 '� �) Food Service ❑ Routine Address ��1 )f I t IQ `� v R sk I I❑ Retail Re-inspection Telephone ,: Level ❑ Residential Kitchen Previous Inspection p � l � Z?� ' El Mobile Date: 3krG ElS Owner HACCP YM Temporary ElPre-o eration A « ^ I ❑ Caterer ❑ Suspect Illness Person in CHafge(PIC) / `i Time ❑ Bed&Breakfast ❑❑ HACCP General t- Complaint In Inspector ( �Sv4lw �nk rOut:), � Permit No. ❑Other Each violation checked FequiresJan explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations R ated to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT, ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El„ ._ 13. Handwash Facilities EMPLOYEE HEALTH _ _ PROTECTION FROM CHEMICALS Eli Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded r r [115.Toxic Chemicals FOOD FROM APPROVED SOURCE TIMElTEMPERATURE CONTROLS Potemlall Hazardous Foods ❑ 4. Food and Water from Approved Source ( y ) ❑ 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 [119. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control `❑ 9. Food Contact Surfaces Cleaning and Sanitizing .REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing E] 11. Good Hygienic Practices ' CONSUMER ADVISORYEl ., 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590A03) 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: \ ' 1 s seainso�'rFomisia eoc . I V IInspector's Signature: Print: / I r �I/ 11 " ._)-1) y(�1 J(�d.I1�r I PIC's Signature: `�� i A q � Print: 'u tId A�(1 �`' I Paget of�Pages J� J r" Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I 1 590.003(A) Assignment of Responsibiiity` 3-302.11(A)(1) Raw Animal Foods Separated from 540.003(B) Demonstration of Knowledges- I Cooked and RTE F(x)ds* j 2-103.11 Pcrson in charge--duties ( I ( Contamination from Raw Ingredients 3-302,11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require roportmp by food employee.and ( 3-302.11(A) Food'Protection- applicants* ( 3-302.15 Washing Fruits and Vegetables I 590.003(F) Responsibility Of A F xxi Employee Or An ( 3-304.11 Food Contact with Equipment and I Applicant To Report To The Person In Utensils' Charge" ( Contamination from the Consumer I ( 590 003(6) Reporting by Person in Charge* I ( 3--306.14(A)(B) Returned Food and Reservice of Food* _ 131 590.003(D) I Exclusions and Restrictions* I I Disposition or Adulterated or Contaminated 1590.003(F) I Removal of Exclusions and Restrictions I Food 701.1 l Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE I Food° Food and Water From Regulated Sources I 19 Food Contact Surfaces I 590.0.04(A-B) Compliance with Food Law* j 1 4-501.111 Manual Warewashing-Hot Water I ( 3-201.12 Form in a Hennettcally Sealed Container* I j Sanitisation Temperatures` 13-201.13 Fluid Milk and Milk Products* I ; 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs`" I j Sanitization Temperatures* 13-202.14 Eggs and Milk A4-501.114 Chemical Sanitim ion- dducts.Pasteurized" I temp.,, P H, J ( ness. 'k 3-202.16 Ice Made From Potableconcentration and hard Potable Drinking Water" I 14-601.]1(A) Equipment Food Contact Surfaces and I 5-101.11 Drinking dater from an Approved System" ( 590,006(A) Bottled Drinking Water'` I Cl-miUtendis Clean* ( 590.006(B) Water Meets Standards in 310 CMR 22.04 14-617'11 Cleaning Surfaces of Equipment Food- I Shertfrsh and Fish From an Approved Source j Contact Surfaces and tion of tit 4-7U2.t I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish- 14-703,11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources" ----- . ............� I to Proper,Adequate Handwashing. Game and Mid Mushrooms Approved by ! 2 Regulatory Authority -301.11 Clean Condition-Hands and Atms"` 3-202.15 Shcllstnck Identification Present* I 1 2-301.12 Cleaning Procedure* 2-301.14 When to Wash` 590.004kC) Wild Mushrooms` I 13-20 L 17 Came Animals" I 111 I Good Hygienic Practices I ( g I I Receiving/Condition 12-401.11 Eating.Drinking or Using Tobacco* I 3-202.11 ( PHFs Received at Proper Temperatures* I 12-401.12 ( Discharges From the Eyes, Nose and 13-202 15 I Package Integrity- ( Mouth* 3-101.11 I Food Safe and Unadulterated* I 3'01.12 Preventing Contamination When Tasting* 6 I Tags/Records:Sheiistock I ( 12 Prevention of Contamination from Hands 3-202.18 Shelistrick Identification * j 590.004(E) I Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Empiovees* Tags/Records:Fish Products ( 113 Handwash Facilities 3402.11 ParasiteDcstmction* I I CcnvenienttyLocated andAccessible 3402.12 I Records.Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.0040) ( Labeling of Ingredients* I I -.--- Location and Placement* ( 5.265 11 Accessibility,Operation and Maintenance ry ( Conformance with Approved Procedures biliOi - I /HACCP Pians ! I Supplied with Soap and Hand Drying 3-502.11 I Specialized Finessing Methods' Devices 3-502.12 Reduced oxygen packagingcriteria* 16-301.11 Handwashing Cleanser,Availability 1 ; j I 8-103.12 ( Conformance with Approved Procedures* I ( 6 3{)1.1' Hand Drying Provision *Demotes critical item in the feJeial 1999 Fond Code or 105 CMR 5901X)0. i CITY OF SALEM I BOARD OF HEALTH i r Establishment Name: Ni 1)C' � _ [ Date: �1I /J_� Page: J of Rem Code - C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. y Reference , R—Red Item : •I - - Verified PLEASE PRINT CLEARLY r7-� �k•�1�1 .11 -,I +i.,.ln hn�rc��_ i,J .J PsJ 4 fec•�,tl.r, �i _ 0p ,may- � ` I I{` dS A-, /nM � . 2 F"'Ii )O VPnt-J,, -1-1i.� 1-17 O(L., (I GA/J �y�LjO lll ' // I C - •• ✓• � to 1 0 o cJ� �// l. (` 0(l� i ' I r 1 :.[ -7 C,-a.7� (� l O . I.A,c c-(4 r- -- QAiK - ,A.) r..��IG� Ajo-A , �c� -h,,rr. ( (`ftc ., , ,.� (;(.,yt( C��., _i„ -7L 11 C 40 /-a r,- rfzlo�, i��L45 oi,;r�� C, r, �r ,{ ��n<K� � M�n�n✓ �h� Irl /l i�r,_ 7Lc :. ( � L 0 I (IX it-, / ' I \\ I ( �:1_r? r�� 1 d1 f� t.�/`e �.. .• T/1 r'�i ir'i1. /! ^{— Y2,-_n ✓t z^'44- _ I � j 1 f I 1 1 C — Discussion With Person in Charge: Corrective Action Required: I ❑ No I 0/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 P I Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Fo6d Code. I undeFstand that { noncompliance may result in daily fines of twenty-five dollars or s Vuspension/revocation of C3 Embargo Ll Emergency Closure !your food permit. f ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Mortar,Intortronflons and Risk Factors(Itinars 1-22) (Cant.) Ti45,F Mi4ilat'! Hous s, 1 15 �'V,,Llton tor FHF,c PROTECTION FROM CHEMICALS f y PHF Hot and Cold Housing 14 Food or Color Additive-s (�vtd PHF-, aim btlew 1-302 W IS Poisonous or Toxic Substances 101.11 ld-nt;h,Dw inituon - Oti�,irlal Hdd i is ibutc 130,1F Colltdicn- 0 1 fine as-3 Puhiic Health Control 7 102 11 It) Tim, a N!bl,t!lqc;Irh Colill A SIorafc" f Reotlircillelit 7-202 12 C,willifim of 'USe- REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 203 11 T,,tic(,Amtais.11. PrtfiN!atk;" POFLJLAT�GNS!HSP) 7 a04.1 Saniu7ers,Crii(•ri, - Clicii,ic,W 21 SO! ;HAl jul(es W141 1-1 04. chknaicaktol-Wa 7-2041-4 D-riyaAgtnti,,Cravria' •of 't.205.11 Inctilmal f I tiNicar,<s- n f-kxd and 7-206 H I'Clirldrd 1 1,11'PC>Ticvlos' itt, 1,1 i r Pat�,Aly Ct,,,k,dA it %I I kwl,sl�k V,)l S,Iwl, I 7-206.12 Rkillvill r5,i,t slafltiv.- iWl I Uq-poicd!-'cxxi P;,,,kj)yC Not pe-vr,,Cd z -1,206 11cm( ontrol and Morillifin", CONSUMFP AWSORY TIME/TEMPERATURE CONTROLS Conlittription of 16 Proper Cooking Tempet stores for I PHFs 145 F 5 '.;i, 1" Ill-fix, sh,11 4()L I I(A)(?) congl,irrjled & G""m SPECIAL REOWREWNTS 3,-40 1.11(B)l I 1"0.,;in j ll:c!Kill c -I 3,ti F 121 min 1-401 11 ftV al: - I ij (- i " cawring, rtti,htl lklittL tinop,raily and 3 401 II(A)0) flottitrl,Wild Cixirt Siulfed Pffs, fc:,ldow:.d 1:i%ilen op(:iatiors ,Itoald be S 1, 6ef"llir(] t;,ji(jCj.11 uffll-q,Confaillm�, plsfi� Nlea� IQ 81,Pf-,MJXC 14MI(iti, aIx-e ifro.;;ijed iolrxidt-orric 3-MIA li(',;t3) bzao Swaics irim',k iwm;art(! rj�k facto-,q, Ocher 145'1: vloialioll,luhmtn', i';^111x1 rl�qai! 1.1411,i.12 R;,w Analul ixlk-cil ill u d i�dj)401 imd;: 29 r # 1,11(A)tlil b) Afl Othin PlIFs-- I 1$1- I 17 ler nating for Hot Holdhig VIOLATIONS RELATCD TO GOOD RETAIL PRACTICES '0111(A)&i 01 1 i �Cc. , i -,-t- - (Iteurs 23-MI) 3.403,11(b) i Mic;tyxa%i.- lw'i'F 2 Minae Swothik-, 0;ii,l';zo'd ri,r- lliwal with h ,o mi rclwc pllhe 'tune" 1 runr lilt�d b" 3403 1 1(F Renmjiumr Ur,Q;:ed llotri-isof riot r FC 530.000 R'n"W "Aanmie, nir�l a,,d Per,m,,d Fr- 2 0".13 i. 24, F"X)d aft'l Pow Pwo,!;c1 Fc "i f)(14 -.- Ig ! Proper Cooling of P4F&, i I. -A --- --- ' ,l5, Laoixs zin,�trll i j rl�n 3,ls Fi.- 005 3 501,i4(A) Cr cure htmi 140 Flo 1 -41, ?nater.ivtPi�mbmcjartc;Wu,lw 70q�Within 2 floss ani' From iti t i Fac�!Ibj Fir—1� W7 I m1.1-7im C'mlim, liK Tvwl� From Aqlhj�iit C, -�6� 0tta 111pr TemlrawrePlit 41'Fi4Y F - Within 4 litAii, 1 1"'99 105 i Vkl<Yrt 1111w Commonwealth of Massachusetts City of Salem Board of Health IGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Niko's Pizza and Roast Beef File Number:BHF-2004-000082 333 Lafayette Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0245 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 23 of 25 ,�• CITY OF SALEM, MASSACHUSETTS t� 1,1t'�e BOARD OF HEALTH eq,, mc1^ 120 WASHINGTON STREET,4'r`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR 1SCOTTaSALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT N rW s e'QnP- TEL# I�U �1 C1 T�Z ADDRESS OF ESTABLISHMENT 333 MAILING ADDRESS (if different) EMAIL- Business': Website: OWNER'S NAME VAQA W(7 Vd�NCty\ TEL# ADDRESS 2J NCtSU kkO1 SA- wc)\O112.V1 M\(-)- STREET ' (-)-STREET ' CCI/TY STATE /�ZIP p ��1 CERTIFIED FOOD MANAGER'S NAME(S)�p �PY1LfPf LIC�VI CERTIFICATE#(S) F,560D �060� (Required in an establishment where potentially hazardous foJod is prepared) EMERGENCY RESPONSE PERSON 1L1�V�C1�Illl N/v�l,AA/,3�\aXUV) HOME TEL# DAYS OF OPERATION I Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. ,rn �,, ))- IJ Ila - )O(' IIA- 10� 116- \O( lIOA — t -`F (For example 11 am-1lom) yk Q TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 - - ---------------------------------------- ----------- RESTAURANT YES NO less than 25 seats = 40 (Outdoor Stationary Food Cart$21 ^^15-99 nests =$280 more than 99 seats =$420 - --------------------YES N6 ------------------------------------------------------*-----------------------$1-00----- BED/BREAKFAST/ CHILDCARE SERVICES ---------------------------------------------------------------- -------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES 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 tate Uyes required under the law S gna[ure ` Date Social ecunty or Federal Identification Number --------------------------------- --------------------- ------10- - -��-/q - ------------- Revised 4/24/07 FOODAP2008.adm Check#&Date , �" / S t Massachusetts Department ofj Public Health Salem Board of Health Floor Division of Food and Drugs 120 Washington Street,4'" 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name !! Date ! Type of Ooeration(s) T.yoe of Insoection t�/ t K u l 1 7 7 Lz_ 1 t % . . q n� ��9 I v s -Food Service E] Routine Address � T Risk ' ❑' Retail ❑ Re-inspection Z ( Level ❑ Residential Kitchen Previous Inspection Telephone > S v ❑ Mobile Date: Owner /I HACCP Y/N ❑ Temporary ❑ Pre-operation r, ) T i u r, ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) e In: Time ElBed&Breakfast ❑❑General HACCP Complaint Inspector `� ,[d k ,11� Out:;j,n� Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT '"' - ' ' , " " ' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El. 13. Handwash Facilities EMPLOYEE HEALTH " " - . .., .� _m .� _.. ... .. _ .......... : „. ...,��... ... ..... , PROTECTION FROM CHEMICALS , ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE", E] 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potemially 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 [1'8.-Separation/Segregation/Protection ❑ 20.Time As a Public Health Control .2'9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP), ❑ 21. Food and Food Preparation for HSP 17110. Proper Adequate Handwashing El11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-4)(590.0004))) cited in this report may result in suspension or revocation of X 25. Equipment and Utensils (Fc-0)(660.005) the food establishment permit and cessation of food x 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: J�/n d s590tr,.(For tome i '1 n Inspector's Signature: Print: % i n -AJ it J_p YA� �f,i�o� ��(�cA PIC's Signature: �, Q I t,JO y n Print: V,[(,t/1/ f V 9� I T" I Page of!(-Rages .� I _j, Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 ( ( Cross-contamination 1 590.003(A} Assignment of Responsibility' 3-303.11 tA)(1) Raw Ammal Foods Separated from 590.003(B) I Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge - duties Contamination from Raw ingredients . 3-30111(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Othcr, 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.111 A I Food Protection- applic:mts* 3-302.15 Washinz Fruits and Vegetables J 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 j Utensils* Charge' Contamination from the Consumer 590.003(G) ( Reporting by Person in Charge* ,-306.14(A)(B) Returned Food and Res.e"ice of Food* 3 15904103(13) ( Exclusions and Rcsrric1mrv;* i - I Disposition of Adulterated or Contaminated 590.003(1-:) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food"' 141 Food and Water From Regulated Sources ( 19 Food Contact Surfaces 540.004(A-B) Compliance with Food Law* A-501.I 1 i Manual W'arewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container; Sanitization Temperatures* -3-201.13 Fluid Milk and Milk Products* ( ( °4-501.112 Mechanical Warewashing-Hot Water 3-202.13 I Shell Eggs* ( Sanitization Temperatures* _ 3-202.14 Eggs and Milk Products,Pasteurized* ( I 4-:301.114 I Cheutical Sanitization-temp.,pH, 3-202.16 ( lee Made From Potabie Drinking Water" ( concentration and hardness. " 5-101.11 Drinking Water from an Approved System' 14-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean° ( 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in.310 CMR 22.()a` Contact Surfaces and Utensils* Shed7ish and Fish From an Approved Source I 4.702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan 1 I ( Fiv.id Contact Surface:;of Equipment" Shellfish*ca Mo ( 03 1 1 Methods of Sanitization-Hut Water and 3-201.15 Molluscan Shellfish from YSSP Listed ( - I Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Anus"' 3-202.18 Shellstock Identification Present* 2-301.i2 Cleaning Procedure* 590.00,40 Wild Mushrooms" 2-301.1.1 When to Wash* � 3-201.17 Game Animals* I1 Good Hygienic Practices g Receiving/Condition c 2401.11 Eating,Drinking or Using Tobacco" 3-202.11 PHFs Received at Proper Temperatures e j 2-101 12 Discharges From the Eyes, Nose and Mouth* 3-101.11 3-202 l l Food Safee and Package and Unadulterated ty* I 3301.12 Preventing Contamination When Tmting4-` � � 6 TagstRecords:Shellstock ' 12 ( Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.00.4(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" ( Emplovees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction" Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 590.U04(t) Labeling of Ingredients' � 7 Conformance with Approved Procedures 5 205.11 Acces<':ailit . anI 7 Operation and Maintence - -- _-I /HACCP Plans I ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-SU2.12 I 6-301.11 Handwaching Cleanser,Availability Reduced oxygen packaging,criteria* 8-103.12 ( Conformance with Approved Procedures` 6-301 12 Hand Drying Provision •Denoles critical aem in the fede,al 1999 Fond Cc&oi 105 CMR 59(6000. CITY OF SALEM J BOARD OF HEALTH Establishment Name: .�. « . c 1 ? it �. Date: 0� Page: i of LI ( Item Code C-Critical Item :,, DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. • Reference R—Red Item co ,. Verified �, l..YZ)� PLEASE PRINTCLEARLY. ✓ I �J�Pr, ..r �T /Or 11.),/� OAJ AIOO,.IA (\Io(:n/{Y_' /\r IAI V5= Nvn JA J- ) 1�A 1c 4 d vim/- / 1 n_/ �/ I A/(: h_10112i� _,Jv., .Yi r¢S,.r &an ^ .iI 1 /� �`l -�.Co t� - • � 1�' I..IQ �it7r C ✓,\%for -AAA& (7�i0_ � AJool d2on,174 r�rr,�P �J: �� '�c..(/✓I N ` lirvr- n)on4/1 � � r7 � ,J•� ( ( �� l ��/eCL V1o�l . nci ( 1r.a `2 , l( f- .C_I (10 r-Jeo � �!- -7 r> 1 ! n�n n 4 ( �On,n INIt l j,�,fi, „ ✓� ��,-�� 1 f � ✓/� 1` r �-'„t,r n( ..,;.� I/ �_ .Acs.-4-. ,/ir,_L. Discussion With Person in Charge: Corrective Action Required: ( ❑ No Iifes I have read this report, have had the opportunity to ask questions and agree to'correct all ° Voluntary Compliance 13 Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P O g�Re-inspection Scheduled ❑ Emergency Suspension i I comply with all mandates of the Mass/Federal Food Code. I understand that 1 noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure {f your food permit. V I/ =— — -5 V X I ❑ Voluntary Disposal ❑ Other: v h v.t rr� I v Virrhations Related to Foodborne fitness interventions And Risk Fartars(Itporits 1-22) (Cont) -I! F14S_T Wilzltin,l Huta , PROTECTION FROM CHEMICALS t___ 14 Food or Color Adduiver. 19 P HF Nat and Cold Holdin (I'010 PFd:,%bimaimxI atiy f,,A,,%v 3 302,14 j pn,wcll,m from Ajdulwc' Poisonous or Toxic Substanms Main 'Hued at of A.aw lol.11 3�1�1t!.I6tAI or qb(>,,e IAVI`, 7-;(J21 i Cumpton ,:mw i 26 Time as 3 Pubk 4eillh Control "rkm" 7. 11 In alamr Requimmil' 't-202.1 1-102.1 coutilf;m"kit Uie I 7 !W i I REQUIREMENTS FOR HIGHLY SU$CEPTIBLE POPULAT;ONS(HSP) 21 -;,:it I!,I I i,%I kn,;t,icutiz,cd Pr,: pa(J ngiIl joike.,I wnfj 7-_04 QChemical.,fi,,IAashvig i1f,0v_v,0nn�a' 7-2(4,14 Diongkttrm,Croond' I I i I i 13) €;.i0 f Feu,- - /.201 AT ------- j z.Snt.I It D) i !,ikv or Pjin,tU_,, AnimA F,KJ and 7-20(A) flti�, Stt,d �proali N,i Sti�,vd 06. 7 -' Rxlew licit swt,,Iw.* 1.706 i3 1rat:kn1LhIidvi> P� I(_OltrtAcnd Zi oaitorin•� CONSUMER ADVISORY )2 3-I)0_ 11 (')V,waf k�t,!bo,v 'ot-Con'ItImption I't TIME/TEMPERATURE CONTROLS I i't'n"A I ,A, that m,iia:. Lnderomkvdol 16 Prow Gaoling Temptnatutes-for NO WF15St.4 17. coammin!'d MCIII� (Ina, I — .<401.1€(B)(Hi2l NO, .,nd Bvl RA*<t 101- 1,' rom", SPECIAL REQUIREMIEWS 3-41)L! I Lnec;t;ti Mc,ta - !'.5 F 1-5 I ,'WCII'Ifl, InOhi][I' tixiltf, jcoipl,rary end 40 1.11 i Ai!,i) rowim,Wiij Game, 14ufred I-I frrs rcidf.wlat mt:ht:r. ujvfafionJit-Itild fie Coat:lmunFish. Nfo7lt, 'e(Duils or kjfnt:t-165 1' is w,,. 40 To fcWN-rn,, i!lnes� (Alt("( 14 i'l a Viii009 vikiluu,yiv*rdaLimto tt,kAretail kaw Ani nhtl Ft,�Ul,ckv"Kcd III aj utnivr #29 - 17 RehRalinct tot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1-163.11 tA)e,,(I Nll': 165'F 15 wI_ Oteola 23,40 j, tfk",I 14"; It'J"F 2 "Imus:!stmAing, cf"i •(41:at,.'pivit %.;oiatr,ma. Ivbiflh do sw "Odw. �,,I'/I,- I I alr, 1"'odhj,me lx, : vi , 1,7cd oiitv, (an be '-'2!'}3.11(('} comm"j,mlIv RTI 1 FXxi 1fuwl��,"'t lh. I%,�J:,+"=,ra,sfy^:om, td,h,!',vd("�:ic,w 1 tr,s ('411? f4f)T, Rt'inalpint"un�llk�W portinqi 411 7 3401 1 I(E i FC 590,OW 23 FC �) K - 3 U04 18 Prapet Cooling of PHFo ac,pnlenzvld FC -A lrolu I .... ... -lumbItIQ i01 Within 2 tj()Ur41 1,31,1 Fr 1 �,7 F,%tOivy FC- 6 007 t,�4i'T/44. FWitWT,,! how�, p6so,`,U ,r M;iteq,A ( FC- 7 5()IAd(W cooliftlt PUR.Madc Fr,in Amblent PvxiOreltew.. Tmpomwit 111Lwdieut;1., 145 <,thel Witbin 4 11,CT: 5 � v CITY OF SALEM / 1�.�� i7� ., .i-. �cn�i� BOARDOF HEALTHDate: �k%I'Dv, 1 n �? Page: . of Establishment Name: k.)t h Item Code - ., C-Critical Item . — DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I No. " Reference R-Red Item /- Verified - PLEASE EEjPRINT CLEARLY r7 -7 .a. /_1 t(PnJ 1, n J_.1 (`;!/_ /IO.t� 1/ /'-`(O ror/i•s� J ?ia :�, •`7,�-. (1 e� �(;�i.rl., � /bs Ij ..\1 i c mnc.a�' ��r` oma.. /11 :�, s.. m/>-�--�,r.( /�(2 �ti-, � 04 O 1 Cl -0 <, V,� I„/�,c J» ( - ,� / U( < n1„rfwcc-,- tVl, rf--i4- 1AJ.A -r �nr �D ri { ,/n 1/ A /- !/// /l 1 I 1 �. ��-'.p._ I� .v ill+ — _ .. - w •- .� 4 : -�.-v� `- E �' -A y� lie rCr /nI�- l ).� ( kms' J . __ 1Gil A ivl C�n`�n.� A�nwn _ r �qi/y - � -- ,n _ c �..v'.� . ..� 6--y_J O f f✓f AlO� �/ _1� �_rJ�X FI< fJ 4-- c r Al r Discussion With Person in Charge: Corrective Action Required: ( ❑ No ftRestriction Yes t I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee / violations before the next inspection, to observe all conditions as described, and to Exclusion P i �, t�Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fede dal/Food Code I and rstand that noncompliance may result in daily fines of twe,Inty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. //r /! �Jr/ ,I i`�` Y XXX iiii((f iCilnX ❑ Voluntary Disposal ❑ Other: PHFs R'tl"'iwd a Violations Rotated to Frodbotrat fitness Interventions hod Rlsir it,1. %' CXard ill Factors(item 1-22) {Cont) F Within I Houvz" )f !At lv if ii-viol, for Pch-,, PROTECTION FROM CHEMICALS l 19 1 PHF Pat and Gc:d Holding 14 Food or Color Additiver, t at ls I 1 202,12 Addaiv, 1-30114 pr"tect)110 frkarl I i'tA; Uo�l PHF� ��t ol.A�;)ve it IF Poisonous or Toxic Substances 1111 22 , kLxtttinttt irflUIn'ti'M Oflgmai ln!Al Convucers 20 Ti,re as n Public Health Card;of 77 i0211 ("Innon Nvink"-- N8"'vk;T'C 3 uiA) i'ml: Puoli""!lcaldf Comml; 1 S•tpa'aijkm -Slot ag., R'Quirclocic flud U 7.202A1 clmdwonc of i 7. PEOU'REMENTS FOR HIGHLY SUSCEPTIBLE 103 11 loxi"("onwim.r"- POPULATIOtiS(HSP) 204.11 S3nui"'l&r%;'crilerio- Chemic:lW 0 if 21 so I 11(A jvucs'diel 7-21,4,12 7 2f;4 1.4 Di Fiug Agenr,.Craeri;jl' -'Si'; hicidemill f'lltll(.'volact, I 1 11(Dq ,r Pav%zi!', Auivial fix,d aiid 7-206.11 Raw S."-d:;Jnoat i N"! Srrsi,'I. 17-206A2 Rvii,:ifl Bail sla(wo-' �vlfqlirkfring CONSUMER ADVISORY .etion of TIMEITEMPFRATURE CONTROLS I I "'baf, I 1 16 Proper Cooking I errpt-4 atu,as for §urerux,Scd,x PHFs "Ot 3 i0i I I A0 I.v '- 155"F i"'Sce for KawShtl( ii'Fl 9ar,- Yi"o, & 140 1.,01 i SPFCIAL REOUIREMENTS 59,Tf`l-iWTI (D) in 3-4c,L1 I(AIQ� Rmlies, lolem-li MvAr- I 5S F I Mhlk. at.d 40LIltA1( Pokfliy%,Wild Gaim, ;tuffed IIIF,, C"Pl'li�6043s A)OUld be 'C Cllfenn.mflf: t' lender 11w fy:1rij1v!'ttc '-':�[-fils ilitcy or it I'viotca io fokolorm inlao lt"" Otter I 00i" 'q'1Iajjtic�Teiaiinl(- it)5;0i relUJI 34',l 1,12 ll'�rvawi Folds,Ctw+'d ill a 41ollki be d6ited Lt dcl #29 - In -F ?-401,1 I(Alilyb) M \11 Oiii�� " -�- 1;T V I 17 Reheating for Hot Holding j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES .3-403,1 NA)1'1*d,i 1111% 16;,; 1 '- I i Items 2" X I I If B) "jjCrkj%VR`,r _ F 2 Mmwe a4amhnf cri;i•';alai f:ow l t ,'iath d"oo; f larc I't M( Oil,, m",r;tPfi?'f• t S low'f'&o", (an lo. 3..-103.11(C) Cllnanel,'ially k'yl=btkX-i li,4oul ill 4wcoud('.,de...?I 10i i'AIR I el itoa'i F G- 0-0-d--R-e-hitif P-rachit'lar T-Fe- 590.000 'fanariiir*nt and plamool'al i FC- 0M F zird F,=Pall,rNp Proper Cooling of PHFS I-C 3 .004 25 ipiltv and LlrenS113 f f-C.-4 00c 3-901,kl(At Cixlling('(-)UJ PHF's how 140 F to 71UFl,%pfL1l . 1 —.15 - -F -I Uncmil and 104��s to FC- 7iYf:Within 2 lhairs end from 27 (=f,vy'-a!Pal FC A 00- at.4 I-R!45 F Within,11 lioiuj i 2a Poi,3,tti, is nt T-,,,; Rtfaj&p:lls 7 1 008 3 50 1.Wt B) Ci,f,liui,PHF, Mtde From Ambio,..," Tcmpef aifr: lnf;re,iim to 41"P/145,F Wvfiiin4 11,mnO I CITY OF SALEM 1 ' VO-17.4— � �7 BOIARD OF HEALTH / Establishment Name: ry L NI/, c O� -1 .a— I- Zcc��" l Y Date: .`_Z �e 1 J-i Page: of �L Item Code C-Critical ItemDESCRIPTION OF.VIOLATION/PLAN OF CORRECTION nate No. Reference R-Red Item; - Verified PLEASE PRINT CLEARLY f-_W,) ?n. iLe. t f• �.. :Y'n i-�7r/ (.(7'.�C 'V� -- I S:90 ,7 p 1- -p�, r � 1 S:90 ,7 2-re- I- �y�]�/ .-keP Ar- L f7li L- L T1w,� /,��_ �c_ �hO C _'� SG I•l�i'37� /l jilt�cJ s'.1 76. ' 'A rV1,r^ (✓/1 J/'f5.�. /r / •ft(!/_ll9 rr r /l.�-k.rf A� h.�-. .�; - V ' (/ - - C J-'t l�- `/ to �r': _✓. {-�ll IU�CG va fit ri (LOG/J„n . ("bcn/ 4`/V) .<Gn 170 .liss� 1�2r�IA D(t% nlozjArj Gt�- r(n)If �fP I 1 ' I 1 I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No �I�GS Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations violations before the next inspection, to observe all conditions as described, and to ;,�Re-inspection Scheduled ❑ Emergency Suspension jt comply with all mandates of the Mass/Federal/Food'Code. I understand that noncompliance may result in daily fines of Twenty-Ge dollars �r/suspension/revocation of ❑ Embargo ❑ Emergency Closure r your food permit. '//� l/ f` • ��---CCC/moi C ❑ Voluntary Disposal ❑ Other: � e � J i Violations Related to Foodborne IfinesIf Intmentions and Risk ,t.CmjivF to Uw Cfv)I•Al to Factors(Item 142) I'Cont.) ckx'lin.• "i'r Plf : I PROTECTION FROM CHEMICALS IV PHF HA and Gold Ho'ding 14 Food or Color Additives 3-202 1� _k SW !I�(W Cold PHF�� at(r bal'a 3;302.11 J Prwqi:m from f fwyprowd Addilivz:I" PHF� Ig Poisonous orToxic 5ubst4nws 101.11 Orn"iDa3' ',td.;6�IA� Wid I Ai,1% l) Conua "ns, I 11mens a Public mealth control Wj6 in, 7-2 1.11 S��rlzlrnak.a--Stol iugr` 3 IQ a tlijbji�licald, 202,11 fke"trioion-PI 'u-nee.wd U e, 7_20_1J2 C,)udji;onI,,,f REQUIREMENTS FDA HIGHLY SUSCEFTISLE N) 11 T POPULATIONS(HSP) 234.f I Si=nfl!Ms,CrIer1:1--ChCIItn,,1W 2t 3;,U: llrry7 Pr�-p LcLagcd Jonet,Itid 7--'_04.1"-1 ('11CIIII,als for XVI;,hmy Clinml;o "vt!h I al',Ib 1-%04.14 Dr }iup Aveuts.CritriW' i-SJ! 1111k, t.:t or onum.I Attrncwo'�� (D) et I! Pa,fiAiv Anoml FkxyJ,md Y-206,11 R�';irioed Csv pe>ncitfi'I, ("11term" std "'Inow, Not S.-mvc.i. 7-20(02 R(Xiow BIIn Sunflon'- 1.1 (C; 7^06 1 '1 I"ckifrg po'%dcr'. cmaro! lnni , i CONSUMER ADVISORY I',•nw:n"l Ad,i>"ry 1'oqej I's("IniumpLiva Gi TIMEITEMPERATURE CONTROLS 16 Proper Cooking Tempei atunes for Anf'.:'A ilha' n't, R;'v" 0i ifrr,i�e Pr Mry ko 1"Umolate PHFs -jit"I V" I'.1 'Qum sllcil vfjw-ImIne(liate 5cfvnx I"V'l-)51W 1-40 1 11.A)k 2) 1 (Aimminmed Fi>h_I% x�lci:om ...... SPECIAL REQUIREMENTS 111TIO 2) 1`t14 .}fid li.�Ql Itoe't I' !i—innIn 1 59 ; Vii nj Se,' co n9(I,;Xk9W-i DI m :.401.,I(A)f2) R_mn." ln;cer,'o Mcal:. I I`-F I f(yxi,tempora,1v and 3-40LIVAji i) PoinTry, Wil'I(�a_rtW" �'�Wf�d�'Hcs' om,'Imntial �ifcf;I:n ;tt,wld be F,ultry Or k%lws I63"1' it alxwc if rciollkA4 to 15';'x Ilnrllu iWxs'; Wet .101) Viol in'(Ikd Wail RI1% AIIIIIII;t!Fc Id'u,Co'l,.:d In a pro,Aio.,> Loldl Nd0i!cd indvr #29 %fielowalv All Otho NIF1 14`i'C t``se,: [_g7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ;-303.1 If AI,'W)l tyf It,, 105`4- '.;w::' , I 1-403.1 If It) Micrklwa%c- l65, F 2 %Imntr II.hich dc.1"i efdr".';Ihe nIkIII,z,rs U :"d c"11 lw 403 1)t(".} CI;aqn:1640k'Rvx.:t. 'j R'D_ Kk>i i;! III,fiW. JI,lo•jd CodewI'7 jO CXI.l? I 1Q'F 3-403 i I(E) Rcnwiniw,,, Ln,wtd Porion of liect PrIictio-e's, 23 pw'.nii i'ld Pe*')fm"q I FC 9 �,nd�(xxi Proitx-v' Proper Coaling of PdFs 1 0"' 1 F-I,-:+ 004 FC ------------- ce FC-5 0013 501.14(A) FroAnY3`. 2 7 fIhv_.Cj 00" Al Po:�y")t�s"r rnrw I FO-7 008 501 14(B) Ciclirie III(-F.• Madt [ ow Afabieja Withip 4 lhkir' 333 Lafayette Street Niko's Pizza and Roast Beef City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I Violations Related to Good Retail Practices (Blue Items) 744-9752 Physical Facility FAIL Non-Critical BLUE Owner: Comment:The flooring throughout the establishment, including the basement floor is in disrepair. Repair or replace the flooring. Richard Kalaydjian PIC: GENERAL COMMENTS: Richard Kalaydjian All other violations cited in the 9/17/07 inspection report have been corrected. Inspector: David Greenbaum Date Inspected:Correct By: 9/25/2007 Risk Level: Permit Number: BHP-2007-0324 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 26,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) L� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 26,2007 ) Page 2 of? 333 Lafayette Street Niko's Pizza and Roast Beef City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 744-9752 PIC Assign /Knowledgeable/Duties FAIL Critical ❑ RED Owner: mment:There was no knowledgeable person in charge at the time of inspection. In the absence of the CFM a knowledgeable Richard Kalaydjian r Ic must be designated. PIC: PROTEV ION FROM CONTAMINATION Food Contact urfaces Cleaning and Sanitizing FAIL Critical ❑0 RED Inspector: mment:The cutting boards on both deli units are badly stained and scored. Resurface or replace both cutting boards. David Greenbaum Date Inspected:Correct By: lI Di knives found stored between equipment. Knives must be properly cleaned and sanitized and stored in an appropriate knife 9/17/2007 r k. NO etween equipment. Risk Level: Th ea liter has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Zbereadily beef slicer has an accumulation of grime and food debris. Thoroughly clean the slicer after each use. Permit Number: BHP-2007-0324 nly one spray bottle of sanitizing solution in this entire establishment. Sanitizing solution of proper concentration must available at all work station at all times. Status: VIOLATION There is no sanitizing solution in the basement. Sanitizing solution of proper concentration must be readily available at all work #of Critical Violations: stations a II times. 5 It s not appear that the three bay sink is being used properly. The 3 bay sink must be used in a three part system to wash,rinse Time IN Time OUT: d sanitize all dishes and utensils. All dishes and utensils must be placed to air dry. Handwash Facilities FAIL Critical RED Urgency Description(s): BLUE: mment:The bathroom is missing paper towels. Provide disposable paper towels in the bathroom at all times. Violations Related to Good a kitchen hand wash sink is missing paper towels. Provide disposable paper towels at this hand wash sink at all times. Retail Practices (Critical violations must be corrected Th a is food debris in the kitchen hand wash sink. Hand wash sinks must be kept clear and accessible and used for hand immediately or within 10 ashing only. days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 18,2007 ) Page I of Item Status Violation Critical Urgency RED: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Hot and Cold H ing FAIL Critical ] RED Foodborne Illness Interventions and Risk Factors (Require mment:The True deli unit had a temperature of 60°F. Repair unit to maintain a temperature of 41°F or below. 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. Sep 18,2007 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE C6nidient:The Beverage air reach in has uncovered food. All food in storage must be covered. e Arctic air freezer has uncovered food. All food in storage must be covered. Equipme/9ndensils FAIL Non-Critical BLUE t:The top of the pizza oven has an accumulation of food debris. Thoroughly clean the top of the pizza oven. The a deli unit has an accumulation of food debris and grime. Thoroughly clean this unit inside and out including the top c p ment. ee Beverage air reach in has an accumulation of food debris and grime. Thoroughly clean this unit. yiSe BI dgett oven has an accumulation of grease and grime. Thoroughly clean this oven. �th microwave ovens have an accumulation of food spills and splatter. Thoroughly clean both microwaves. T micr ave area has an accumulation of food spills and splatter. Thoroughly clean this area. Th ri idaire freezer is missing a thermometer. Provide a visible,accurate thermometer in this freezer. T can pener needs a thorough scouring. Th ble and walls at the meat slicer have an accumulation of food spills,splatter,debris and grime. Thoroughly clean the table d walls including all shelves. Th helves and walls at the 3 bay sink have an accumulation of food spills,splatter and grime. Thoroughly clean the shelves and IIs. Twalk in flooring needs a thorough cleaning. elves and racks in the walk in need a thorough cleaning, e dou h mixer has an accumulation of food debris. Thoroughly clean and sanitize the dough mixer. T ba ent stairs are greasy and slippery. Thoroughly clean the basement stairs. e tall eezer in the basement has an accumulation of food debris and frost. Thoroughly clean and defrost this freezer. ;h/ bo reezer in the basement has an accumulation of food debris. Thoroughly clean this freezer. prep tables in the basement need a thorough cleaning. li T�entirelcook line has an accumulation of Breese,grime and food debris. Thoroughly clean entire cook line including under and equipment. Thectic air freezer has an accumulation of food spills,splatter and mold. Thoroughly clean this unit including all shelves. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 18,2007 ) Page 3 of Item Status Violation Critical Urgency Physical Facility FAIL Non-Critical BLUE omment: Both the front and back doors found open. All openings to the exterior must be sealed. &, The flooring throughout the establishment, including the basement floor is in disrepair. Repair or replace the flooring. Ther re water damaged ceiling tiles above the cook line. Investigate the source of the leak and repair. Replace all damaged c ng tiles. Other-See Notes FAIL BLUE Co ent:There wer no extermination invoices for the inspector to review. Owner to provide six consecutive months of termination invoices for inspector to review. This fire establishment is in need of a complete cleaning, including all walls,floors and surfaces and under and around all e �pment. Professional cleaning is in order. GENERAL COMMENTS: There appears to be a complete lack of sanitation in this establishment. The results of this inspection will be discussed and the owner may be required to appear at a hearing before the Health Agent. Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 18,2007 ) Page 4 of '.�.'>,,CITATICINNO.' SALEM - 16-0 14' 1 VIOLATION NanCE PD "ArM �j4�INgIAL)f ON SIREETADDRESSI\ CITYfrOWN STATE LICENS I EXP.DATE DATEOFBIRTH M R- -A 0 Ell;NAME(LAST, EI-3 W > FLO m m x s Fn I STREET AlDoinrSi CITY/TOWN STATE ZIP K'.(n - > > -444 5� -y i A) -11y QN4k >mc REGISTRATION NO STATEI EXP.DATE � IIAKET'PE I YEAR JCOLORJ m > 6P DATE OF VIOLATION TIME ATE CITATION WRITTEN IEH�Al- Ln ! INJUR Icn CIAM bYES z [I QM EINO �oz F 0 LOCATION OF VIOLATIONA-'/�-3 If 4:ORCIN PT W3(4��.% 0 Lin OF ENSEHAP c un FLI ri B > -1 0 r OFFICERD NO TOTAL DUE $ FINE 111 /, FFFICER CERTIFIES COPY GIVEN TO VIOLATOR IN HAND X/ BY MAIL L 0 DO NOT MA(LCASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK Fs CITY HALL 93 WASHINGTON STREET (A) SALEM,MA 01970 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THF FIRST OPTION AS STATED ON i REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF S CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER 114FORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO. CITATION NO, CITY OF SALEM P7 L+�] /� VIOLATION NOTICE u 60J `# NAM�6^(LAST FIRST,INITIAL) r STREET ADDRESS J CITY/TOWN STATE ZIP LICENSE NO ' LIC EXP DATE DATE OF BIRTH IOWNNER-S NAME(LAST,FIRST,INITIAL) �� I/` "/,�i xcv,' TI -4Ai 7 f -)ti��r1�� STREETADDRESS7 CITY[FOWN /STATE ZIP L iab //o; Lt_lrn57�5? l�7'1 ( /7hGn tl,4 1 l REGISTRATION NO STATE EXP DATE ` MAKE/FYPE YEAR COLOR DATE OF VIOLATION TIME DATE(CITATION WRITTEN PS US M ONAL L- iruuav C]A ❑PM 1 El YES []NO LOCATION OF VIOLATION IV�fos r�ZZG/ ENFORCING DEPT y � 6r, W#W OFFENSE f CHAP. SECT FINES B t vl .-.4e U, C ./ ��- C ./ S y OFFICER _C D Na TODUE ELI ICEh(,En11rTco GIVEN TO VIOLATOR El IN HAND X .. �jw....- bR-SY MAIL DO NOTSH-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 H SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL Ilk 333 Lafayette Street Niko's Pizza and Roast Beef City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-9752 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:The cutting boards on both deli units are stained and scored. Owner has ordered new cutting boards for these units. Richard Kalaydjian PIC: The meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the slicer after each use. Richard Kalaydjian Inspector: David Greenbaum Violations Related to Good Retail Practices (Blue Items) Date Inspected:Correct By: Food and Food Protection FAIL Critical BLUE 1/24/2007 1 i i Comment:The walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. Risk Level IGENERAL COMMENTS: Permit Number: All other voiolations cited in the 1/17/07 inspection report have been corrected. BHP-2007-0324 Status: SIGNED OFF #of Critical Violations: 2 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 25,2007 ) Page 1 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. Jan 25,2007 ) Page 2 oft 333 Lafayette Street Niko's Pizza and Roast Beef City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-9752 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Cmenta The plastic table ware to be placed in on direction handle side facing out Richard Kalaydjian PIC: �"es boards are stained and scored. Resufface or replace all cutting boards. Richard Kalaydjian nd stored between equipment. Properly clean and sanitize all knives and store in an appropriate knife rack. Inspector: l� The meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the slicer after each use. David Greenbaum Date Inspected:Correct By: Ther no sanitizing solution available at the time of inspection. Sanitizing solution of proper concentration must be readily 1/17/2007 a able at all work stations at all times.Including the basement. Risk Level: Handwash Facilities FAIL Critical RED i Permit Number: C ment: Employee observed washing dishes in the hand wash sink. Hand wash sinks must be used for hand washing only. BHP-2007-0324 Status: VIOLATION #of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2007 ) Page I oft r n Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require '� Comment:The walk in has food stored directly on the floor. Store all food at least 6.8 inches off the floor. immediate corrective action) Equipm=ment: s FAIL Non-Critical BLUE e ctic air refrigerator has an accumulation of food debris,spills and splatter. Thoroughly clean this unit. Th all Continental unit is not working. Repair to good workin order or remove. If repaired unit needs a thorough cleaning. The Tr a reach in needs a thorough cleaning inside and out. everage air reach in needs a thorough cleaning inside and out. The wa behind the flat top grill and roast beef slicer have an accumulation of food debris and grime. Thoroughly clean all walls int c ine. �T Blodgett oven needs a thorough cleaning. Bot waves and the shelf need a thorough cleaning. T B47 in shelf units need a thorough cleaning. Th let white freezer in the basement missing a thermometer. Provide a visible,accurate thermometer in this unit. e mixer i e basement has an accumulation of food spills and splatter. Thoroughly clean the mixer. Th asement Floor and shelves need a thorough cleaning. Physical Facility FAIL Non-Critical BLUE C.dmm nt.,The fl000r in the back of the kitchen in disrepair. Repair or replace the floor. Tr h found loose on the ground. Keep all trash in an appropriate trash receptacle. GENE L COMMENTS: Reinspection in one week. All violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2007 ) Page 2 oft Kik I el .ix`` srr&Fs '.e 3=+'1� N� nj° '""y.l-� All ab*� < �r 4 :°� � ,.,' ��, „ ,�'Commonwealth of Massachusetts Miw City of Salem ,. � ,� �,�: - _ 4 • • ^n"'ks �ytt``"4 � .x'y3t:" «A ar x e 5 -, , y,= % 'Yi, "Y"Pt�<. f.�''',�." k .5R'b.'y9 ., - - 4 AY^a, i•,,, c F' -r.� `m,5. r S'a BoaCd Of Health _ -IGmbelley Dnsooll .. �. 120-Washington Street,4th Floor .c Mayon,;.. SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2007 ESTABLISHMENT NAME: Niko's Pizza and Roast Beef File Number:BHF-2004-000082 333 Lafayette Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0324 Jan 5,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 i Board of Health _ This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 11 i CITY OF SALEM, MASSACHUSETTS . , BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 Ti 978.741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, HIS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT IVt2K-U5 �/Z� f`�I13 r �/r`� TEL# ADDRESS OF ESTABLISHMENT .)5i3 &e0'2 -ell e- ��Cr/ FAX# t MAILING ADDRESS (if different) EMAIL--Gusiness': Owner's: OWNER'S NAME WIRfTSEL# ADDRESS `13A/KS/�w Sr} 7 C/ iwt� C3�c7� STREET yy CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) l 7f'i"� (n'" CERTIFICATE#(S) (Required in an establishment where potentially tpazaarcfous _food s prepared) +. EMERGENCY RESPONSE PERSON J� O �Y tt-Oft )Afi HOME TEL# DAYS OF OPERATION Monday Tuesday Wednesday r yThursday Friday Saturday Sunday _ HOURS Of OPERATION Please write lei time ofday. tforexample llam-11pm1 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE {( NO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,001 =$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 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 riot 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 penury that 1, to my best knowledge and belief, hav d a state ax tur and paid al!stat to es required under the law fy' Signature / atc: Social Security or Federal Identification Number ---------- - - - - - - - Revised 11/13/06 FOODAR2007 adm Check#8 Date_ `-'�, _ ) Massachusetts Department,ofPublici Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ) Date Type of Ooeration(jg Type of Inspection -F 1r. a � &-Food Service ❑ Routine, Address 1�AvnI <Uo /: Mail / ❑ Retail Re-inspection i �r Level ❑ Residential Kitchen Previous Inspeption Telephone ❑ Mobile Date:'Q G "4 El Temporary ElPre`-boeeration Owner (( 11 (( HACCP YM dvaA El Caterer Suspect Illness Person in Charge(PICS t v Time ❑ Bed&Breakfast ❑ HGeneral ACCP Complaint Inspector �� n� Qu�f I Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑\ action as determined by the Board of Health. \ 1 FOOD PROTECTION MANAGEMENT_, ,'. . • '❑ 12. Prevention of Contamination from Hands _ ❑ 1. PIC Assigned/Knowledgeable/Duties - ❑ 13. Handwash Facilities - EMPLOYEE HEALTH - ., PROTECTION FROM CHEMICALS " '- ❑ 2. Reporting of Diseases by Food Employee and PIC -- • -- ---., - • _.• ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded • ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE,,""' ❑ 4. Food and Water from Approved Source ' TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [:117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1 B. 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(MSP),'-- El HSP),-❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices : CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ri Health. 590.000/federal Food Code. This report, when signed below. C -N-1 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: S 59olnspecfForm6-14 eoc �^��/ Inspector's Signa e: , J / yI�/(I Print: / ,{,, l P' g AJC )VA rpt Sit Jl /` �,LOMII /1 �'4JU PIC's Signature: � 4L / Print: Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 1 590.003(A) Assignment of Responsibility* ( 3-302.1 I(.A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* I Cooked and RTE F(xAs* 2-103.11 Person in charge--duties I I I Contamination from Raw ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH I Other- 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require repotting by food employees and 3-302.111 A) Food Protection" applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report Tonic Person In Utensils* Charge* i Contamination fronrthe Consumer 590.003(G) Reporting by Person in Charge* I 3-306.14(A)(B) ( Returned Food and Reserviae of Food* j 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions ( Food 3-7,01.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 I Food and Water From,Regulated Sources ( i 9 Food Contact Surfaces - 590.0(4tA-B) I Compliance with Food Caw* I 4-501.1 I 1 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* I San ization Temperatures` 3-201.13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs:mit Milk Products,Pasteurized* I 14-501.114 ( Cheinical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinking Water" I concentration and hardness. * _ 5-101.11 Drinking Water from an Approved System'° I 14{'01.1 I{A) UtenEqusils C 6'axl Contact Surfaces and Utensils Clear- 590.006(A) Bottled Drinking Water* I 14.602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards to 310 CMR 22.0 Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils'" 1 ( 4_-702.1 I Frequency Sanitization Utensils* Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( Fain Contact Surfaces of Equipment* Shellfish' 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I I Chemical* Sources Came and Wild Mushrooms Approved by 1f1 I Proper,Adequate Handwashing C 11 Clean - - . ean onditon-Hands and Arms ' Regulatory Authority 2i ' I 3-202.18 Shellstock Identification Present" ( 2-301.12 Cleaning Procedure* - I 1590.004(0) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 Came Animals* I 111 I Good Hygienic Practices g I Receiving/Condition ( 2-401.11 Eating,Drinking of Using Tobacco* 13-202.11 PHFs Received at Proper Temperatures* 12-401.12 Discharges From the Eyes,Nose and 13202.15 Package Integrity- Mouth` 3-101.11 Frwd Safe and Unadulterated': I 3-301.12 Preventing Contamination When Tasting*_ 1 6 I Tags/Records:Shellstock I ( 112 Prevention of Contamination from Hands 13-202.18 Shellstock Identification1590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* Employees' Tags/Records:Fish Products I 113 I Handwash Facilities 3-402.11 Parasite Destruction* I ( Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* ( 15-203.11 Numers and Capacifies* 590A04(I) I Labeling of Ingredients' I I 5204.11 Location and Placement* I 7 Conformance with Approved Procedures 15-205.11 Accessibility. Operation and Maintenance I /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging.criteria" 6-301.11 Handwashing Cleanser,Availability I 8-103.12 Conformance with Approved Procedures* 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Poral Cale nr 105 Cb1R 590.004 M . -.e..K.....�„vv.'..r..y, � _ . ♦ . . _ w ».,;:- -rim , �• ._... ' Massachusetts Department of Public Health Salem Board of Health + p 120 Washington Street,4 h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name '`� Date Type of Ooeration(s) Tyge of Insoection (&Food Service © Routine AddressRis 1 E] Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone _ I ElMobile Date: v ❑ Temporary ❑ Pre-opr tion Owner I J I` I) HACCP Y/N I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Y Time ❑ Bed&Breakfast ❑❑ General HACCP Complaint _ - In: Inspector 'Z' I Permit No. El Other (�c 7g(� )� r��r. Q, Out„ a Each violation checked Pequifes an explanation on the narrative`*106) and a citation of specific provision(s)violated. Non-compliance with; Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F)`❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ` EMPLOYEE HEALTH El 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _, .,_ ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE E] 4. Food and Water from Approved Source TIMER'EMPERATURECQNTROLS(PotentiallyHazardous 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'S ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C 'N' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations ��24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of C _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 _Z27. 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: ss�,ns�� ,ae. a Jam . Inspector's Signature: � '/� � --� Print: A �� PIC's Signature... �/' Print!/) M a/(/6 r •/ '1AXT,� 19AII Page4 of3 Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S Cross-contamination 1 590.0031 A) Assignment of Responsibilitv` 3-302.1 I(.Aal) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" I Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Aniitml Foods Separated from Each EMPLOYEE HEALTH Other, 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.11(A) Fond Protection` applicants* 3-302.15 Washing Fruits and Vegetables J 590.003(1`) Responsibility OTA Food Employee Or An ( 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In I Utensils* Charge* I Contamination from the Consumer 590.003(G) I Reporting by Person in Charge* I 13-306.14(A)(B) Returned Food and Reservice of Food* f 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food law" ( 4-501.11 t Manual Warewashmg-Hot Water 3-1.01.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201A3 Fluid Milk and Milk Products* ( 14-501.1 12 Mechanical Warewashing-Hut Water 3-202.13 Shell Eggs° I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* I 14-501.114 I Chemical Samtiiatinn-temp.,pH, 3-202.16 ( Ice Made From Potable Drinking Water* ( concentration and hardness. " 5-101.11 Drinking Water from an Approved System" I 4-601.1 1(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 14-602.11 Cleaning Frequency ot'Equipment Food- 1590.006(B) Water Meets Standards in 310 CMR 22.0 Contact Surfaces and Utensils* ShefNish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan i Food Contact Surfaces of Equipment* Shellfish* 14-703.11 ( Methods of Sanitization-Hot Water and 3-201_15 Molluscan Shellfish from NSSPListcd Chemical* Sources* 110 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2.301.11 Clean Condition-Hands and Arens* 3-202.18 I Shellstock Identification Present" 2-301 12 Cleaning Procedure* 590.004(C) Wild Mushrooms- I 2-301.1.1 When to Wash` 3-201.17 Game Animals* I 111 Good Hygienic Practices 15 Receiving/Condition 2401.11 Eating.Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures' I 2-401.12 ( Discharges From the Eyes, Nose and 3-202 15 Package Integrity, I Mouth* 3-I01.1t Frxt Safe and unadulterated 3-301.12 Preventing Contamination When Tasting* I 1 12 Prevention of Contamination from Hands 6 Tags/Recortls:Shellstock � __ __ I 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products ( 113 I, Handwash Facilities 3402.11 Parasite Dcstnuctionw I ( Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* ( 15-203.11 I Numbers and Capacities* 590.004(1) Labeling of Ingredients ( 15-204.11 ( I-ocation and Placement* 7 ( Conformance with Approved Procedures I 15-205 11 ( Accessibility.Operaiidn and Maintenance 7HACCP Pians I ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-50..?.1,, Reduced oxygen packaging;criteria __- * 16-301.11 I Handwa6hing Cleanser,Availability _ 8403 12 Conformance with Approved Procedures* ( 16-301.t2 Hand Drying Provision ^Denotes critical rem in the federal 1999 Fond Code or W5 CMR 590.000 r CITY OF SALEM �� IB,aA OF HEALTH / Y Establishment Name: N)i �[� �27G 1 O� T� Date: �!/�G t� Page: of r ItemCode C-critical Item . DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified �j PLEASE PRINT CLEARLY 11PIar--CLJ,' L,�-� af-Pba,J 7a�r ooR), 4.0 r_Dse.P 7 I n r. .an v� n x- � ncn< v✓ . r r� i6 �oJJ_I? .�e VAn�- -�� 1 , F -}�_ rP, « A/0ac�_ r4,f n, i-- 0 � �f7 � f L, , }I o r Gn n_1 r rnr.G r r.► )� G,�.( � 1� 1 In��/� G r�0 �v,I (n�9�v tr J',,)Lhue nJQnt �_Iku�or✓ CY�i. l�/ (� l � `,� t I r_ Lair ftit,. � r.�_ n , , tt�0 b1t/rsJ � 1l)n� � /tic . r u�l Discussion With Person in Charge: Corrective Action Required: I ❑ No I �: res t 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 LI Emergency Suspension tt comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-fi /dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. ❑ Voluntary Disposal ❑ Other: �OD r 3-501.i; C, PRFs Received ji 1 emperatureF I/Wations Related to FoodBnrne;lumss lntercentinns and Risk. According to Las Conled to Factors(Items 7-22; (Cont) 41'F/45'F'Nithin 4 Flours. ' j-501 15 Caolinp Method%for e'FIl PROTE4 TION FRC}6?oof or `:CALS P}fF Hot and Cold r ns .9 i. die. f li Foad of CcloJ Additives 3-501 10(B) Colli FEIFs ilainl�rned at(ir below 3-24)2.12 :Addiu.ea" 150 F' 3-Wq ,14 PrntiClioi l n; , 1:nappimcd Addimes' 3-StJl.16(A) Hca PH F;Rlaintaincd at or above }5 Foisunois or Toxic Substances 7-i0i.; ! }dentityn, lnfcr:stntn-Original 3-501.16(A) Roasts held at or above !WE r C,:Jilaioei;:, i-102.i i Coneu,m*Jarctc-ti',r:king C.eitainer.-,' ( 20 Time a.a Public Health Comrol i 201.i t' Se1„) r -S? , u 3-501.i 9 Time us a Public Heald,Cunu of j m)on" tie .,_, ;(10.0Oa(H) Variance Reaurzaient � 7-20,^ it Re:^rirhon-Pres(rite mid u£e" 7-?03.12 Condit:oro;of Use,: i-303.1 I Toxic Containers-?soh bui,)tt.,i. REQU€FiEMENTS FOR HIGHLY SUSCEPTIBLE 7-20-1.11 Scorei: rs.Crit-no-Cti.n::call* POPULATIONS(HSP) 7=u'.12 v-hetnic::b for\4a.hmg Produce.Cracria* It 3-801.11(A) linpnstcunzed Pre pac'sagcd Juitet.mid 7-20!.14 Dr i >, 1 et s Caret:a" I be:•e;af:ts with Warning,E.abels� Si z g' r. . 3-801.11(B) I!se of Pactentized Bc^s* '7,2(fi I I itn,ideund Food Contact.Lubucaws`- - - - j "7.')6.11 rie>tficleti ?;:.: Rstid:lea.Ciiteua' 3-80111(D) Raw or Partialh,Cooked Animrl Food and i-206.12 Rodcci Hail Saniions`' I Raw Seed Sprouts tint Served. 3 SO1.11(C) Unopened Food Package Not Re-ser4e(1. "7-106.13 'Rac6 me R-:a-dcrs,Pest C•,r:;ro1 and i b(oni:'o.iligl: CONSUMER AUViSORY 11 3-603.1 1 ConsmnefAdvisot'v Posted for Consunn tion of Proper Caak!ng TiMFJTEtttPERATURE C Wog T:.Sen:r•�r�tures'.or Animal Foods that are Raw, Undcrcn,ked of PHFs Mil(lthcrvl,e Processed to Etinunaie Pcthogem5,•. Er•N.o•=rm Jai 1A.(l)(b Eggs- 155eF 1; :ec. }tt�,:edialc v�.e: i45` '1Sticc' tib'13-302.13 PasteurrzEgg. ed Substitute to,�Raw Shell 2te•_a- S:r 3-101 I l,A)(2) Comminuted Fish,bleats&Came F"lisY Anituai,,- I_,Y F l5 =ec. r 3-401.111 B);i,(?) Polk and Beef pe,asl- 134)`F I?I min- ! SPECIAL REQUIREMENTS 3-461.I 1tAli2) Rattles' Injected A•;cat:, -155"F 15 590,1090%)-(f)! Violations of Section 590•009(A)-(D) in sec. , catering, moble ftxid,temporary and 3-401.1 !(A)(',) Pquioy,utld Game Stuffed PHFs. residential kitchen opera!ons should be S!niting G�ntaining Fish, bleat, debited under the appropriate seasons P•.ruE!ry or Ratite,-t6°'P 15 sec. above if related to foodborne illness j :•-u0!J:(i)(3! ot9 ole-nnsC,'I: Into:ctlieef Sleaks interven tions and risk la(torS. Otter 1 45"P„ 590.009 violations relating to-o(xi retail ?- u1.12 RLw,knimai,F.,,ds Caked:n a pracdec_:should uc debited under//29-- Nti_ruwace 1033 F Special Requirements. 3-401.1 t(A)(Ialr) Al' fRLzr PII s- 745„F• 15 sce. 17 Reheating for Hot Holding VIOLATIONS RCLATED TO GOOD RETAIL PRACTICES 3-403.11(A)Kit)) Pt!Fs !6S'P15sec. ' ( (Uetrts23-30) 3-44)3. 1,B) Ylicrovave- 165 1- 2 Minute Standing Critual and nmi-critical viol mmis, which do nor ielgte io the 'rime, ! foodborne illness inter vennarr and riskJartors Ewe,'above, izm be ' 3-403.1}(", Cooiruoioally Procasscd R?E Fvxl- i found in the,Callon-ing seciiuns of th.'Food Code and 105 Cffl? 140`1' ; 59!1.000. 3-403.11(F:) R:atainingLu,bccdportioneofBctl' item---GoodRetail Practices FC snout ;v ris,a 23. Manaoement and Pei sonnei FC--= 003 }g ( Pro per YCooling of PHFs ( ''1. Fond and Food Protection FC-3 004 25. EWvmsnf and Utensils FC--d .005 3_5111.1-1(rl! l•uul.ue Ox•.ked III Fs from 140`'F io - --- & -_---- 7 i � ^ r • 26. Wats: Plumoinq and FC - 5 ', A06 ( 0`. Within } gun;and Fniru 70'F 27. Physiral Facility FC-6 1 007 to?i` 145"F Within 4 laoua. 28. Poisonous or ToKw Materials FC-7I_.001, Cooling PFtF,Made From Amhieot 29 Special Reouircments :)09 ! Temp„rotors Lu(redients to•-'.i"Fid;`F I 1311 Other 'vt`rthin 4 I?ou:,x 1)011,1!-,cnacnL:te n n tiV!t.leral 9'19 1 o 1 C'•,d.or 10°.Cttk 51!1110. t CITY OF SALEM ` BOFIDOF HEALTH ) Establishment Name: ��\�t ,Z� +��S� _r Date: G Iccky� Page: �[ of f Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item \&rifled PLEASE POINT CLEARLY , ' F �2J1_ L 7AW-N ,� � �ns. � I�i�� ,.,r�r.��er,� S, v, � nl ooc!�t �c(/k�e.� u `I4jc r-rp On, o.' nr7ed ar, IJA-k 1A ) U,,,DU —/n r n-)(01 /UDQriALP �'Oa/!I/1G _ � �� .U�� Cha(fir ✓7� v / � ��()� r�nren,� )�o� I- ✓fir. c /.= /�,:r —ten �� '/ p2f�p7;pro ki91 � f I �/11�c�- �c\l1�Mo� /J+I,rtJ.l.n 1 r,n �Ucr.2 (:� YI/IM,Jr�7m/2c-1 IIff I)(//Ujn�iln!^ Ci t1C- 1�:.,.on� # Discussion With Person in Charge: Corrective Action Required: I ❑ No too"es I t ❑ Voluntary Compliance ❑ Employee Restriction/ t I have read this report, have had the opportunity to ask questions and agree to correct all � /� Exclusion i violations before the next inspection, to observe all conFil, S as described, and to A( -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Counderstand that �� noncompliance may result in daily fines of twenty-fi . or suspension/revocation of ❑ Embargo ❑ Emergency Closure l your food permit. �J// �— ❑ Voluntary Disposal ❑ Other: L ' i +1 1-!iC') PRFs Received at Temperatures Violations Rotate~to Fr..,•+.=borne tft::ess Interventions and Ris7+ Acsrding to I taw Coolcd to F-aGtors(itemsl-22) (Coo'') "1'F/45`F Within 4 flc,ur;, ' 1 i I 3-501 15 Cooling Yteth,,d:, (or 1114Fs ! PROTECTION FROM CHEMICALS 14 ( Foodn.-Color Additives 19 PHF Hot and Cold Holding 3-20 7 ( 3-50 t.IN B) Cold lit Maintained at or htlo�� 1._ Additir ve, 590.04-#(F) 41145' F- 3-302 Id P:ocJaon i otn (7napow"rd Additives" ( ;-501 IGtAi lint PiIF:.N1:urutined at nr a6uve 15 Pa'soruus or Toxic Suostancm. 7-10LIti Idenafymg hlfort„ai ion-Or.-i:;,d 140'F.Cotir, ^ i et, 3-501.16(,A) Roasts field al,ri,above I'VE ' ! 20 -rime as a Public Health Control 7-102.! i ceaa,i ,Name-`,Yorkin"Cortuiners' 3-ilJl.19 Ti r.1e as a Pubic Health Centro]s � ',-'_01.11 Sop„ration-Stili oke` j 7-202 ll Ra-sttichrm-Fit:::ere and IJs'.' 590.004(1-t) Variation Require neta � 7-202.C? C,ndrihans of i ke` 7-203 : ! Tois Contaiu,•r:: -I'rohibitiole" REQUIREMENTS FOR HIGHLY SUSCEPTiBLE Sanitizeo-Cuter.:.--Chet:ituh.'; POPULATIONS(HSP) 7-30-?J2 Chontiala !"or Prisnit:o i',l ri::aq('chola" ! 21 3-Y01.11(A) Unpasleunn;d Pre-packaged Roce,and : , ! Beveratees.with Warning Labels 7-x.04.1-x Di Ing Agents Curer;^" 7-205.11 incideinal Food Contact. Lubncan*:^ f ! 3-SO!.?1tB) 'Js>ofFStsterti zedL^'e;zs" 3-80t,11 Raw orPadiallvCoukedAnonalFood and 7-_'06 1 l Rc>tiictcd Csr !sstiatles.Cntertn" ! R::c✓Secd Sl,rouis Not Served. 'P 17-206.12 Rcxlcrt Bait Stati,'ns' 3.g{)1.111G Linopened Fcx,d Packa;;e i\nt Re-aereii. ' 7-206.1 r Track,a••Rnvde*c-?at Control ,utd -- -- 1i0iatuatl;;:. , CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption ill TIMEffEh1PERATURE CONTROLS Anon:d FoodsThat are Raw.L'ndelcooi ed or lb Proper Cooking Temperatures for Net Otherwise Procrsed to Elintutatr Pflfa 3--t0LlIA(1)(2) rcL%, I55`FISSec. i'athutens.T"9`':" , F-::f-es-in:acedia,: " 3-302.1 Pt,steunzed Echis Substitute lot Raw Shell i , ccrcLx ;45"riisrc : :. i 3-401.11,,\)(2) Cutneiintlt rd Fish,Meal, &Ga1n, i ` ` f A:uma,s- 155'F 1 3-401.11(B)(i)(%) Pot#, and BeefC<:,asi - '.30"F 121 min:r' SPECIAL REQUIREMENTS 3-401.1 I(A,C) Rahres.Injected Rfeats- 15'i'F 15 590 00')(A)-(D) Violations of Section 59().009(A)-(D)in rte• < catering, mobile ford, temporary and 3-401.11(A)(3) Poulin,Wi'dGame <atffed Pl-lk, residential kitchen operations should he Stn,`ting Containing Fish, Meit. debited under the appropriate section: , ! Rndtrt'or Ratite, 165°F 15 ser. above if related to foodborne illness 3-=401.1 I+(")(;) p't+n+��_r,,,,.,ie; :utast Beef S)eaFs interventions and risk factors. Other I 145=;T I 590.009 violations rcia.ting to good retai; S.40I.12 Ka+=. A:,.oal Foods Corked it a i pracace� should be debited under#29- Alicrowa,e 165`F A, Special Rcquirerne)us. 5401.11(Aalhb) Aii 01h, rPIIFs-- 145'F 15 s=_c. :` 17 Reheating!or Hot Holding VIOLATIONS R.MATED TO GOOD RETAIL PRACTICES 3-103.11(A),t:(t:) PHF3 '65`F 15;:.c (i terrL523-311) 3-!(13.11(B) Nlicrotiave- i65'F 2 i1Fnm!e Standing ( Critic at and nun-crifieot viototioni, which do not reline to the Time" ,foodhorne illnrs.s inter venrions and KA-lortors lisld above, can be i 3-403.i I(C) Commercially Processed RTF Food - i found)hi the fullnming.,eoions of tire Food Cod,and 105 CitfR I401-T I 590.000. 'i-401 I It E) P.entalnml;larAiccd Pori tons of Becf I Item Good Retail Practices FC 6,9006 R,rise;- 23. tdanaawnent and Personnel FC--2 903 24. Food and Food Protection FC- 3 .004 13 Proper Cooling of PHFa 1 25. Eauigrnent and Utensils FC-4 .005 _5,0114fai i CaolinCool:cd I'HFs from {40`Fio ----P i 26. Water.Plumbing and Waste fC-S ( (1106 R)"F 1Vithin 2 Hours and From 70'F 27 Ph'vsical Fastin~ FC-e 007 t•.v #I )F/45'7 Within 4 Hom,-' 28 Poisonous or Toxic Materials FC - 7 ! .DOH 3-30i.14(H) Cuuhr r PIIFs Made From Ambient 29, Special Requirements 1 009 j Temperature htervdicnt;to 41�F/4.5`17 30. Other - - ----_--- Within.1Haus` Denolr,c.rwezl i!em In III,i'de'al 1999 Poo.)(ode,r lac ChiK 51t:00:+. 1 Massachusetts Qe artment"Of !Public Health Salem Board Street,4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name 2 Da I Type of Operation(s) Type of Inspection ly� fj 1� S T �2C. + ood Service Routine Rik IJ Retail Re-inspection Address , Level ❑ Residential Kitchen Vrevious I spection 1 Telephone S , ❑ Mobile Date: ?/1 pyvr / if HAGGP YIN 1 O Temporary ❑ Pre-poper on JI /� ( � f Caterer ❑ Suspect Illness rj ❑ Bed& Breakfast El General Complaint Person in Charge(PIC) I Time ❑ HACCP p , �� Permit No. ❑Other inspector Each violation tAecked tf'equires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-comptiance 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 590.00%E) ❑ 599.909(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ` ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIMElTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117, Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices, Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.093) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you =27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. _ 30. Other DATE OF RE-INSPECTION: Jjfj� S 590mspectform6.14 We Inspector's Signate:"7/� l '/ t 1 l Print: n / Pa v.-:�----- f� es PIC's SignPa haf6ree. // /U Print•/P ^ 1i /��/l�� i 1�11/ ire o f g i /71A 11 7 ' Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM -CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ! Cross-contamination j 1 590.003(A) Asadinanent of Responsibility" 3-302.11(A)(1) Raw Animal Foods Separated hom 590.003(R) Detuonciration of Knowledge; I Cooled and RTH Foods'" Person in charge--duties Con[amration tram Frauu Ltg,oritents 3-302.11(A!!2) Raw An:malFoods Scparatedfrom Each EMIPLOVEE HEALTH Oihcr' 2 W0.003(c) ResennsibiliQ:of the person in charge to j Contamination from the Environment i require reporting by food employees and 3-302.1 ItA) Food Prosection" applicants' _ 3-3C12.t5 Wmi-enc Fruits and Vegetables 590.003(F; Responsibility Of A Food Employee Or An l 3-304.11 ^or>v Contact :•+ith Equipoamt and Applicant To Ripon To The Person In Utensas' C'harge'r j Co:aammation mom the Consum w 540.003((;. Renortinv,by Person in Charge* 3-306.14(A)(13) Returned Food and Reset t ice of Foi,d' 3 590,003(D) Exclusions and Rcstt'ic.nunsr' j Disposition of Admterated or Conrametated j 590.003(E) Removal of Excl«cions and Restriction, Food 3-70 1.11 Dircarding Of Rcu;nditiomng unsafe FOOD F IOM APPROVED SOURCE Food: Food and Water From Regulated Sources i 9 Food Contact Surfaces 590.00d(A-B) C'oniplemo-with Food Law"' I Li01.': t! \Q:mu;,i \V:u'evt•ashing-tIotN\'a�:r { banitizationTem erutures* 3-20 12 Food m.t Hermetical ly oducts Container" � 14-501.1 12 M.-chanrcal Ware%uashin,r riot Water 3-201.13 Fluid Milk;rad Milk Products* Sanitization Tentper.nures"' .3-202 t3 Smell Eet)sT 14-561.1 Id Chemical SaitizaunepH i 202.14 :g*s and Milk Products.Pasteurized" i 3-202.16 Ice Macre From Potable Drint rng Water' i Equ:PI Iconcenn nt F :nal hafaCt S d-601 1I�A) Equ:p:nrnt r'rrxl Contact:surfaces and � 5-!01.11 Urinkire Water itont an Approved System` � Utensils(;lean' 590.006(A) BailedDrinkin !Vater" ' }' i 4-602 11 Cleaning Frequency of Egr!ip:nent c'vhd- 5'A1.00ti(R; 1b'nterMeets Standards in 310 CMR 22 0" j Shetifisn ane!Fish From an Approved Source 4-702 Surfaces,nil Utens.ls X02 1 l Frequetny of Sanirizatton of Utensils and 3-201,14 Fish and Recreationally Caught Mollurcan Food Contact Surface;of Ligaiprnent� Shellfish" 14-%03.11 Nlethcxls of Sanmzuuon--I-lot Wat?r.tntl 3 201.15 Molluscan Shellfish from:NSSP Lit,ted I Cherni;aiT j Sources' 1 to ( Proper,Adequate Handwashmg Came and Wild Mushrooms Appiovodhy ( 2-301.11 Clean Conueion Hands and.Ar ars" j Regulatory Authority .r?03 1 F, Shellsuxk Identification Present" j ( 2-'[}L 12 ('leaning Pnx•educe" 004(cl Wild (V(uslu'ooms* 2-301.14 %Mien to Wash" 3.201.17 Came Annu;ds" !t Good Hygienic Practices S Receiving/Condition 2401.11 Caung,Dru:tmgor i)sinr;Tobaxo' 3--202.1 1 PEINs Received at Proper Temperatures k i 2 401.12 Disrh:rrm:;Frorn tlX Eves.\o;e and 3-202 15 Package lateen ty-0 Mouth 3-101.11 Food Safe and Unaduitetated ' ' 3-301.1= k'rco-nting Cont-mma0on 5\-`hen Tastuije� 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 2-21)2.13 She•.I.ux:k Identification"` 1 590.004(E) Preventing Contamination fry:m Emploeecs* 3-203..2 She]:stoc.r c Identification Maitna ned i II3 Handuvash Facilities � TagafRecoids: Fish Products ry Gated arm.Accessible Convene^.:•t n �' ,: 3-402.11 Parasite Destruction° j 3-402.12 Records.Creation and Retention 5-20".11 'Numbers and C ar acities'> Labeling of Ingredients* 5-20x.1 I Location and Piave meaty i4tihQ4(.l) g 9 ( ;205.11 Accessibility,Operation.and M.:a:mance j 7 ; Conformance with Approved Procedures � r RiACCP Plans � Supo6ed vriLa Soap and Nand Dry;ny DC vices I ! 3-501-.1 l Specialized Processing Methods" i j itandt)n 3-502.!? Reduced oxgecm packaging,en'.erp63(11.1'_r` ( b-301,11 land Orvune rfe:unra.Aesilah�lity S-1(43.12 Grafixruance .vithAph:ovedProcedntes" ( im;-Provision cnncal itran in the terie:'al 1499 ib,nt{;rude or tn5 CNIR 590.0up CITY OF SALEM BOARD OF HEALTH Establishment Name: �/7 ) r) Imo'Z r / i C . >Gsd-- v Date: ��-4/c7/, Page: 07 o-N 1 Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified II n PLEASE PRINT CLEARLY / I J t / r Q I I r I � I � I I I I � I I I � I � 1 I 1 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No rave 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 Knderstand that noncompliance may result in daily fines of twenty-fiv ollars or-suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. ❑ Voluntary Disposal ❑ Other: �-;4ri �tfl�F��✓JJ� 81Y -`liar i:f' PHPs Rre,e(�ed„t iemperaturrs Violations Related to Foodborne 111aess tnterveations and RrsH � Accord ing to Izw Co!ded ro Factors(Items 1-22) {Cont.) %t"Fl45`f t3ntIli n 4 How's. i 3-5C!.'S PROTECTION FROM CHEMICALSCoahmlblcib,deforPHI7,. 19 PHF Hot and Cold Hcfdirg I hi Foud or Color Additives I ! 3-202.12 Addiu vcs3-501.16(B) Cold PPF' *Mminntined at of below, '" - 3 302.14 Protection frons i?nappro�ed Addim:^s` ?%u.004F) 41 V-1;I Fx 15 Poisonous or Toxic Substances SO 1,INA) Hol PIFFs Niamiamed a: oraboie '" 7-101.11 fdentifyme lntou140"F.nation-Original I 3-SOIJ6 , Cnwamers, (. ) Roasts Held at or above 1-W1F. 7 102,11 Common None-Wotkon,Container[," ! 2.1) lime as a Public Health Control i 7-201.1 t Separation-ShnaKc Time a.,a l§tblic Health Cvtihoi' 7-202.11 Restriction-F'rrscvice and Use" I � 590.00461) Vanwlce Requireuteta 7-202.12 Conditions tit User REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Container,,-Prohibition,- POPULttft ":S(HSP;a 1-204.11 Sanitizerc,Criteria-Chemicals^ j 1 121 3-801 I l i Al Unpasteurized Pte-packaged juices and 7 04.1.1 Chemicals for Washme F lochia.,C itcria" j Warning I.ibel.s� 7-2204.14 Drying.4Feats.CnteriaT bt�eutges with ^;; 7-205.11 incidental Food Contact.Lubricants ( I ] 1 t(:,) t ke of Pastenti zed beo;` 3-3Ci.11(D;• P.iov of Pad,al'y Co)krri Animal Fucxl and 7-206.11 Restricted Use Pc<ticides,C'ruen;r` 1 Rine Sc cd S pens:s;sot Set ved. 'n 7-206.12 Rcxlantliam dsae" 7 3K0L1](C) Unopened Food Package Not Re-served. � '_'O6 l3 'I'rad;ing Powders,Yrsi Conrol and Monitar;n,,: CONSUMER ADVISOR`/ TIME/TEMPERATURE CONTROLS 27 3 CO3.11 Consumer Ad�!sory Posted for Consumption(it fluioc l Fords Mar are Raw.Under cooled or ! 16 Proper Cooking Temperatures for PHFs Not Otherwise Proce.:aed to hlanmate , w,5•- �m 3-101.i 14(1)(2; Eggs- 155'P 15 Sec. I ati:off:ens.^ . "` ,', Eggs-immediate Service 145'F15src-^ -307 13 Pasteurirtd E-gs Substitutr for R-q . S!eli 3-401.11(A)(2) Comminuted Fish, Meats,k G.urie Eg:-s' Animal;- 155`F 15 sec. ' 3-401.1101)111(2) P,;rk and Bect Roast - I3U`F 121 non* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155-F 15 -590 009fA)-(G) Violation,of Section 590.009(A)-(D) in sea I catering. mobile food,temporary and 3-401.1 I(%)(3) Poultry,Wild Game, Stuffed PI ffs, ! nsulenrtal kitchen operations should be Stuffing Containing Fish,Nleat, I debited under:he appropriate sections Ponit:q or Ratites-165'P I5 sec. ( above if related to Fodborne iflnes5 3 40t.I](C)(3) Whole nmscic,Intact Beel Storks interventions and risk "Uctors. Other 145'P* 590.009 violations relating in good retail ! 3401.12 Raw Animal Foody CotAed in a ;n actices shuiJd be debited under h29- j ALciowave iWF"' S ,1 Ric uutunemts. 3-401.1 I(A)(Ili b) All Other PHF:; - 145'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RZLATED TO GOOD RETAIL PRACTICES 3-403.11(AWD) PFFs 165°F 15 sec. (Itetrt,23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standinst C,inral and non-critical viotailunv. ahith do nor rely e to tbv Time"' roodborr,=ilht•as.c mtia venriom and risk jar hors listed above, ran be 3-403.1 I(C) Comtuenutlly Plot cssed I2TF Food rolled at lite iblh,wilig vo-;ions ti)the Fond Cod(,and 107 G3/1? 140'Fy 5:10.000 3-413.1 hE) Rcmam*m,,L'nsliced Portions of Becf ! tram Good Retaff Practices FC !, 580.000 I KonsW, 23. Nanaoement and Personne: FG -2 .003 ! 24 Food end Food Protection FC-3 004 18' Proper Cooling of PHFs ,,. � ,-501 1,1(•1; C'oulow Conked 11-117s front 140'F to 25, .auipmenl and Utensils FC-_4_; Atl5 26. Water.Piumbiril and Waste FC-5 .006--1 70'F Within 2 Hour,and From 76"T ! 27 phvsical=aclNv FC--n" ! 007 ! to4i'E!45'FW0hir.4Hours. * ! 28 Poisonous or Toxic klatena!: FC-7 .003 __ ! 4-5n1,14(f3) Cooling PHR\Rade Front Ambient ! 2° Sluc=cia:Requirements 009 Temperature Ingredients to 4 `F(45'F ! 30. Other ! Within 4flouts." Denote:cnncd!Item m iha Rdeial !44H Fund Cod,or ;65 CMR 590 N)0. Maaaaaaassashusetts Department of Public Health Salem Board of Health 120 Washington Street,4t"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ` DajeSl� TYoe of Operation(s), Type of Inspection I `I+ '�n S I/ 77C k �Y14/ G1P2 l a od Service `EJ Routine Address 22 'I Risk 1_I Retail ❑ Re-inspection �w v Level C1 Residential Kitchen Previous I spection Telephone ❑ Mobile Date:,J�� t + ❑ Temporary ❑ PFe- peration Owner ''II // / r HACCP YM ,<h?fi er y �< G �� ri < I l/I ❑ Caterer El Suspect Illness Person in Charge(PIC) -/j 1 Time ❑ Bed&Breakfast ❑ General Complaint ❑ HACCP InspectorOu;:x'dEl No. Other � �.1Gn�.. I�n..Vir o. Each violation 'cit eckkecVregriires 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) El. 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities , EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentially,Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16. 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) E] 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR cfC_-Nh . 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations ^25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(550.005) 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 714 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: �/f S ssoinsa aFcros is MC �'^ Inspector's Signa ke: Il 4 Print: I PIC's Signature:��"- t/r l 1I��`�j`�"-� Print: i/ If��•b Y � � �(� I Page 1 of2-Pages ', Violations Related to Foodbome Illness Interventions and Risk Factors(items 1-22) PROTECT!ON FROM, CONTAMINATION FOOD PROTECTION MANAGEMENT I 590.003(A) A,;m-IMoOlit if Responsibility 3-30-7.11'A Kl : Kaw Anunal Kaxls Separated from 59).001(B1 Demonstration of Knowled,-Vx Con k�,d and PTT-Foo•ls* 2-1 N-t-soninchw-g-duties Raw Ingredients Rxv Annual FoocL:,Separaled lr,,m C-:.h I EMPLOYEE HEALTH Other- 1 2 590.003(0 Rosp,�nsibility of the person in charge"0 thz Er.v;xnrce,,-,t t tequite teporting by fo.-d employovs ari-i 3-302.11;;`,) Food Pf".tectiow, 'P:-iicants* 3 302.15 Wimiting fr,!it� and Vel,ctablvs I 590.0031F) Responsibilil v Of A Feud Employee Or An 3-304.11 5aod C::ntact-ith Equipm-,-a and .%ppl:cant're Report To The Person Cha tram thu Consumer 596.003(6) Repoatrot by Pers-ii in Ch,:r,-,,,- 3-306.1 Rottimej Food and RcservtLe of Ravi* 3 N0.(103{1]o Exodus eins and Rcitrio,oie;4 Di5pri!;Non rAduftemed or CorrtamtnaiOd 590.00307,, Remnval of Fxclusioie,and Restrictions Foor' 70 i,I --r Recom :tioruug Unsafe FOOD FROM APPROVED SOORGE Food.. 4 i Food and Nater From Regulated Sources 9 Food Contact Surfaces 590.004:A B i � Coin 1111111 c , 'e[ Fow Lox I 501.11•! Manual IAA!atew�sfiing-Hot VVaicr 'Jja� %N it 3-201.12 Food inn Heruietacalk Scaled Container" i San,tization'reir-peratures, 3-201.13 Fluid 61411,and Milk Produce,* I 5LIJ �- h2 mvanic,i Wirc,,,ashing-HW !tut 1-2(12.13 Shell Egj�s:' 1 St�Iiili/atwu Terolciaturcs' I E,, sandNli1kP)cKlo,;tt ilast-uri,ed' =-501.114 Chemical S.,re',imlion-tcrnp.,liff, - 19 6 concentration end hardness. 3 2D2 1 Ice Made From F*6tabte Drinking W,,,ter- S-J'01 11 Drinking Vater fronsan Approved System" :,-0,:31.1 I(A) Equipment Food Contact Suitaces av�d 999.006(A) Bottled Diniking Vvatcr° Utensils:'lean" 1.60" 11 Cleaning Frequency of Fru mment Food- s,-')o 006(B) Water Meets Standards in 3110 CNIR 2?014 corew Surfac.zs andutcleqls Shel,',-ish and Rah From an Appioved Soutce 4.-11l 01 1 Frequccv('t Sanitizanon of Utensils and 3-201 ll, Fish and Recreation:'''y C,'.io,la Mollus.-an Food Contact Safaczs of Equit,aaeiv Method,, Ho;Watcrand 3-201.I S YwHuscan Shellfish from NSSP Listed Chemic.:; Sources" Proper,Adequate Handwashing Game and ilhi'd Nushooms Arirrovcd ry Reotna.Ioo,Authoriti, Clean Cordiiiri-;lands and Ai ni.0 3-202.13 i Sh llst)ck Identific jon P"sent* 2-3:)1.12 {Uranin, proo-.'jur�' C k ai 5()0.0(t;.(Cl Wild NlUshrooiw; 2-310 1.14 When to 1 3-201.17 Gain- Animals* i f l Good Hvgfem-Practices Receivinq/Condition 2-401.11 F:3tiiq,Drinking or Us'n;-Toba,cia* 3-2c,2.11 PH[7,keeeived at Proper Temperatures* 2-401 1-' Discharge From the Eyes, Nvse ar;cj '3-202 15 Package lnaegritp' -Nioufh� 3-1fil.]I Foo." Saf�anti Uiazlitlt,�Itd 3-3(17.12 Preventing 0��tajoinatwn'Xh-it]�,.sting, Tagt;!Records.ShOlstock 12 Prevention o?contamination 3202.13 Sliellstock Iderurication 590.001d') Presenting Gxamoiatiiiri from 3-203.12 S-nellstock identification Nfaintaincti..' Enrplov�cs' TagS/ReCordS:Fish Products IA Handwaoli Facii; el I.oratedend Accessible 3401 i i Parasite De:.ouctiori- i I-402.!2 Rec,-,rd%,Creation and Retention* 11 Nuri hers aed -Capacities* Labeling of ingredients* 4-204,11 Lcat:uo and Placement" 7 Conformance with Approved Procedures 5-205.11 Accessibility.Uperni:on and \1:::niznancc /1iACCP Plans I opplw aN,3oap and hand Diyk,g 3-502.11i Specialized Pawesqw!Methods 0evices i 6 ;01.11 4an'wa shia?CJcan,ei Av�;J' 3-50.-.1.2 Reduced oxyg-1packaging,arteria* ',)'-103.:2 Conform:::co h,ith Approwd Procedure.' F-30:1.12 Hand Drys,; P,-ov:a;on De1hle1CfiuLd':rev i,flh,i4,d,nal 1999 Fqx!Co!e ot :05-'' R S00 of)(" r I } CITY OF SALEM BOA D OF HEALTH Establishment Name: / S. < ZZc 1 tLoc Date: I X/oC Page:? of _ Item Code C-Critical Item DESCRIPTION OF VIOLATION/"PLAN'OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY i. �. C "' D lnl j- .-L,, t /��.7' CIO, 11 AL �. � kA, n > 1y1_( (A 1, f �, 41-4:41 CIJ� V7 - , r �_GnavY� l)c1f1-riS.dL4 --S;/y(r< �2 I,JaIVI_ �, -L( > >_ �� ,.,� n — I,b�� h., ' rnl��. :)�r rp G JVYI�1l��1��o/ — Y A?Po r ✓�r1�l lv� lei»l d,•, �. � I I /;- /i 1 N'O '�J'zla"I/- 11—i(PrY ,/1 'bn7ai CLCT- l IlkJ'' �l.Liv� (f V.7G✓� {71, ate ,. , , y l I IL ICA Discussion With Person in Charge: Corrective Action Required: ( ❑ No Yes - ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the oppor ayity to ask questions and agree to correct all Exclusion violations before the next inspection, to obse a all conditions as,, escribed, and to Re-inspection Scheduled Elg Emergency Suspension cdmply with all mandates of the Mass/Federal F od Codeund6rstand that P `• noncompliance may result in daily fines o t int, Ifiv doll rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: v PI[Fs Reitr.oil it-temperatures Violations Related to Foodborne iliness Interventions and Risk A-cording to I-ai,Cooled to Factors(items 1-22) (Cont.] =41'1715 F WKidd I. S Hours. PROTECTION FROM CHEMICALS j = - .15 Coating hleflod�;or I11-1F, j j 14 Food nr Color Additives ( ;q Pfit Hot and Cold Holding ' 3-501.16(8 Cold PIIF: Maintained it of below J-20212 Additives" 540.Ot1 (P;� 11''f};" F^ -302.11 Protection from tJn;:PDrm,ed Ac(din�.ect ( 3-50 t.16(A) Hot PiIFs Ntaintamed tt+)r above 15 Poisonous or Toxic Substances 7-I0I 11 kleniifymc htfonn.:uon-(Aigraai ( 3-501.;(rCn) Roasts Held at or abote !30`P. * Containers 1 , 1 j 'n Time as a Public Health Control 7-10»_.11 Common Name- Working Containers* I ! IJ nine ac a Pubi;-Heiddt Conttai"t - -- 7-_'01.11 Sapmation-Slora>?c` ! � i41).004t H1 b'.rn;nee Rcgm rr.;can 7-202.11 Retri.unn-Pr,seace and Use* j 7-202.12 Condition:of Use" j 7-^_03.11 'f:+xic Containcre - Prol :hi tions" j REOIAREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criieno-C'nen is" POPULATIONS(HSP) j 7-204.12 Cilemiad, fit tVaahmc Produce,Criteria` f 21 3-80IA NA) I Unrastean nal Prz-peckaged Juices and I Beveia;_es wilb Warning lab 7?0+.14 Dtviuy, Agems.Criteria' 1 - i-801.1 iib) I Use of Pd;aeuriz�d Ex^_s" 7 205.11 Incidental Food Contact. Ltirricant's* ' Rai or Partially CeOked:lri:ua1 Fofxt and 7-'06 I1 Nest ric�ed Lace Fe�qudes Grace's' Raw Seed Sorouts Not Sc;v:d. 7-206.12 R,xleni Bait Station," L P 7-20o.13 Tracking Pott-dcrn,Fry Control aria -Soi.I I(C) ..arient;d Fax; ackag; Not Reserved. Motdtorn) CONSUMER ADVISORY 22 3-60:3.1 1 Com+um?r Ad`.tsar Posted for Consumption of TIMEffEMPERATURE CONTROLS AniwA Foote- fha! m;:rc Ras%. undercooked of Lo Proper Cocking Temperatures for \or Othcrn,ise Processed to Eliminate I PHFs s 3-401.1 l At 1 t(2) ELgs- 15,,)'F 15 Sec. I athog rs. E}acs-hnmcdiate Servl;e I15"F1Jt,ec+ I 3-302.t.i Pi,t.ur:zed Eggs Subsrimw for Raw Shell 3-401.11(A)(2) Conmmntued Fish,Mears k Ganic i I"ge`W Animals- l:._.'F 15 cec. _ SPECIAL REQUIREMENTS ( 3-401.11(B)t U(2) Park and Becl kmi st- 13WF 12) min. 590 OQ9tA' �D) t ' t 3 401.11(A)(2! Ratrtcs. Insctcd Meat::,,- 155"F 15 j )- , holatioas.nt Section 510.009(A)-(D) in sea" oaten:;,,, mobae fond,temporary tmd 3-401.i 1,',1)(3) POuIUt',Wild Giinse,Stuffed P1ih, residentrti kitchen aperadons should be Stutting Coutrining Fish, [cleat, dehited under the appiolniaic sections Poultry or Ratite;-165`F 15 sec. ,. above it rely ed to fntxibon:.iLness 3-401.11,t.)(3) 'Alwle-rmsde,IntactBeefSteaks ( interventions and risk factors. tither 145"1"* 590.009`„t,latieiis relating to nood retail j 3-901.12 Ravi Animal Foods laxrked in a practice,should be deh+ted under /t29- TO.iciowave 165`F x Special Rialuiretnctits 14,fit ll(Aal)(b) All Otherl'IIFs - 1.15"F 15 sec. " 17 1 Reheating for Hot Holding VIOLATIONS RLLATED rO GOOD RETAIL PRACTICES I 3,403.1!(A)S�(D) PHFs 165`F 15 sec. "' 'I tents 23..10'V 3-103.11(Bi Microwave- i 65,F 2 R4tnuie Standing Ci in,r:!unA nrrt-crier ext vintarrotm, airirh do nor relare to the Time* ,(;odbnr^.e,d!aees ani rrer.;mns ut+d ris:(u un-r lilted above, can be 3-403.11(C) Camtttrcnndly Processed RIEFood- j band in Lire),:,lbrtring sections of the Fend Code and 105 C'<L9k 3-403.11'E) Reu:aining 1-7nshezd Puitiumx ol'Becf Hear Good Pe ze;Frarbres FC ! 590.1100 Roasts* I 23. Managcme:t and Personnel FC -2 ! .003 tg, Proper Cooling of PHFs ! 24 Feed aril Food Protection FG-3 25 F-qu¢xmni anq Utersii3 FC-4 ! .005 I3-501.1d(A) Conhnr,Conked PFlFs from iJ.O°P to I26, Water,F'lurnbino and Waste _FC-5 .008 _I i 7(G"F Within 2 Hour.,and From 70`F 1 ( 21 Phvs:cal Facillh, GC--6 to 41`F!45"F Within 4 Hours. . i 128. Poisonous or Toxic Materials FC-7 ! .008 3-501.141P) Cooling PIJFs Made Frunt:Ambient29. Special Regwiements T:P,retature Ingredients 1,)41�17/45'F 130. GiPrr Within 4lluurrx Denotes orical item m ih.:federal 1904 KIM Gale or 105 CiAlt 59(1:,00. r .�� Via, :,.,r . *r^ • ... �. .,� < . - '. f � t .: � ...�. ';Ma sachusetts Department of Public Health °Salem Board of Health ° Divlslon of Food and•Drugs 120 Washington Street,4th Floor:-"..e• - S:•, .,,,,, ,s.•,_ ,. .• , -. '"' • ', Salem,'MA,01970.9523.},yrrr ,frrttna:M FOOD ESTABUSHMENTANSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-034 Name , 1\1X0 ., j / Date Type of Ooeration(sl Tyge ofPstiection I - �( �Food Service El Routine Address RisV ❑ RetailI�Re-inspection Telephone � r Level ❑ Residential Kitchen /devious I spection ❑ Mobile Date: 9 /0T_Owner ) HACCP YM [I Caterer :1 Pre-operation )d, c�rw..I Y t� Ott 4 c n_ I El Time ❑Suspect Illness Person in Charge(PIC) r' I Time ❑ Bed&Breakfast ❑General Complain �� 1 In: ��.�}' I ElHACCP Inspector �X� Outx) Permit No. ❑Other Each violation checkld Xquires an explanation on the narrative pages)and a citation of specific provision(s)violas Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Vblations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) E action as determined py the Board of Health. y'FOOD PROTECTION MANAGEMENT F-1 1. PIC Assigned/Knowledgeable Duties El 12. Prevention of Contamination from Hands / EMPLOYEEHEALTH _,. _.a.. w [113. Handwash Facilities -. - _ PROTECTION FROM CHEMICALS - ❑ 2. Reporting of Diseases by Food Employee and PIC I El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded Z FOOD FROM APPROVED SOURCE" El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 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 10. Proper Adequate Handwashing [-] 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofCeaNh . 590.000/federal Food Code. This report, when signed bel 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s)(sso oos) 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 addres 29. Special Requirements (590 009) within 10 days of receipt of this order. _ 30. Other DATE OF RE-INSPECTION: Inspector's Signature: \ I {r Print: ! PIC's Signature: v ✓ ,`,� ( l ,` Print ICAl Page 01762 Page! .j ' Y` tVl l Y Vr or1L_1_Ivi - - c` BOAR �OF HEALTH .it l7p Establishment Name: ��. J.(,�� 2GC (< cS} - Date: 1 cs,ail Page: of C_ 1 Rem t ;Code y 's' C-Critical Rem DESCRIPTION OF VIOLATION/PLAN�F CORRECTION Date Nix - ReferenceR-Red Item I Verified .� -^`-' ' _ - `• PLEASE PRINT CLEARLY C I - r - � .�t I - - - - - - - - - - - - - - - - - - - - - - - - �" I ... : w,1 4 1 ,i$Cuss!on With Person in Charge: I Corrective Action Required: ❑ No Yes read this-,report, have had the oppo u ity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction! $efore the next inspection, to ob e e conditions as describ d, and So Exclusion ,.. .> p � ❑ Re-inspection Scheduled ❑ Emergency Suspension alt fnandates of the MasslFed r Fo d;Code. 1 n e stand feat {may,resutt in daily fines of y- 've�lollars o s spens or�Qvocation of ❑ Embargo u Emergency Closure lam` ❑ Voluntary Disposal U Other: V BCARDfi F HEALTH n time t Name: �J, u-, Date:---(� . . Page: r-- Of tc6de Ill C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION bate Terence R ' Red Item Verified PLEA 9E PRINT CLEARLY Lv 'J- ') Aj IC 4 1)c /Cell dc�CJ C 6C, A i,A�A]2 IA1 711 RVl—)Iil .,rIn rw f" 'I (49 140 if. V- I�J c-),/I-10 AX-)t C A j A fie le\j �(gl)pqez45slne- a-r "i 0fjfK—,oj A)UdA4-o �e r wP4 rel\ e(�s,Ll rl �GIIO a 0 of N Lln -7 C, tilt istiussion With Person in Charge: Corrective Action Required: O No Yes read this report, have had the opportunity to ask question's and agree to correct all 0 Voluntary Compliance 0 Employee Restriction Exclusion Ab216re the ext inspection, to observe all conditions as described, and to Re-inspection Scheduled Z) Emergency Suspension mandates of the Mass/Federal Food Code. I understand that �(9 may suit in daily fines of twenty- Is or suspension/revocatign of o Embargo ZI Emergency Closure 0 Voluntary Disposal Z) Other: "if--- TMM . ; ,. CITY OF SALEM BOAR .OF HEALTH Establishment Name: 1 , Z2�- f-j< Date: �11cc /0 Page: of 7 ' !ttemf �C6de4._;,, C-Critical Item :. DESCRIPTION OF VIOLATION J PLAN OF CORRECTION Date ;No.;4� Referonce " R=-Red Item � � � Verified w PLEASE PRINT CLEARLY l t } t J A)QP _ - � ! 11)fJLd4c] ro ' /1of '_ Cer4-47(a.4-",\ I-) "n-With Person In Charge:— Corrective Action Required: u No I-\J2,Q Yes^I i sport, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ y the inspection, to observe all conditions as described, and to Emersion next ins p Re-inspection Scheduled ❑ Emergency Suspension �a dates of the Mass/Federal Food Co . I understand that y�result in daily fines of twe -f' cars. suspensianlre ealiion of ❑ Embargo ❑ Emergency Closure s; ❑ Voluntary Disposal ❑ Other: s- ,�� \ �� r� � � � � Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name �/ Date, Tyne of Ooeration(sl Type of Inspection 1� I I \(� P12,7C ��0 �� d t7/4,N I Ei Food Service ElRoutine Address , r ! o (� n 7 Risv I ❑ Retail fi� Re-inspection Level ❑ Pr Residential Kitchen Previous Inspection Telephoned ��/ " I El Mobile Date: Cl k,41/0S"-. Owner ) I HACCP YM El ❑ Pre-operation fid, cw..I Kc (k1/-�/ f f c n I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)" Time ❑ Bed&Breakfast ❑ General Complaint //_� J In: (a.� El HACCP Inspector -��X-.� Out;o A7 Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined,by the Board of Health. / FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS k ❑ 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 TIMENEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection Q 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 El 21,1 Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board of Health. today, the items checked indicate violations of 105 CMR C 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 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-s)(sso.00s) 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 (Sso.00s) within 10 days of receipt of this order. 30. Other t ` R DATE OF RE-INSPECTION: /v Nkd- S 590/n5 tFa m 10 d. ^1 /� Inspector's Signature:( Print: r )nom I ,r7r.L� I PIC'sSignature: �j�= j...� Print: _ __l'// Pae ofc2ja es' Violations Related to Foodborne Illness interventions and Risk Factors(Items i-22) PROTECTION FROM CONTAMINATION Foo©PROTECTION MANAGEMENT ( 8 Crcas-coil,taminaron ( ? 590.003!x) Assignmfnt of Resuoucihililt" I 3-?Oi.I L'Ali 1) Rat+ Animal Foxis Separated Loin :i>O.UU3(B7 CJenwnsu align of P.nnwled:.e* Coined and RTP.Fo:,&: ' 2-103.11 Person in charge - dad�'s Coniamnatior,r from Raw ingrco;sli s 1 3-302 11(x)(2) Raw An:mel Focds Separ.Ged Truro Each EMPLOYEE HEALTH C'tdt'r" 2 5'r+O.OU3(C) Respnnsibdity of the person in charge to j Contamination 4um the Emarontrant require reporting h} food emplu}'ers and 3-?02.I i(A% Food Protection" j aoplicant;^ 3-302.11 Waslnne Fruits and Vc_vetoh!._s 590 UO3(F) Responsibility Of A Ford Employee Or An 3-304 11 Food(1%nfact;v:i'o .:gnipmera and Applicimr To Repori To Thr Person I I-Timsils Charge* Conta,mhaton from the Consumer 590.003(6) Reporting by Person in Charge* j ?-"06.14(A)(B) Returned Food and Ren nr -ice of Food` 3 540 0030t) tisclusiOns and Rcshictions ( OrspxNon of Aduiferated dr Crntartanafed I Food 590.003(F) Removal Of Exclusion,andP.ostrictiuns j 3 1(l1.11 Dts:,ardrag or Recondinomnig:;nsale FOOD F IOM APPROVED SOURCE Foo& 9 Food Contact Surfaces 1 4I Food and 41later From Regua?ed Sources i 1 , ' 4-501.111 Manual V,are•.vashing- Ilot tidafir 590.01)+(A-B) Cuesphanc�with Fuad Law'" � i-20!.12 Fond t❑a Fknuctica}Ic Seated Container' Sanitirar.on'I'emprraturesr , I %.501 112 Niee,hdrdcal Warewilshiu� I-lot Water 3-10i.13 Fluid Milk and Milk Products* I j 3?02.1 i Shcil E S:r:iaietion Temperatures"gr,'." 4 501.114 Clirm:._al Sanitization-tem tl-!, 3"0''_.1=1 Ems and o ilk Products.Pasteurized" ! P4 I ;-202. cuucentration and L-si dress a, j16 fcc}.lade From Potable Drinking Watcr, I i 4-601 11(:a,) Equipment FtW Cnntact Surface,and i 5-101.1 ! Drinking Watcr from an Approved Svsivin j j Lltensds.Clean* 500.006+A) Bottled Drinking Wuter" 4-6i'211 Cleaning F•equency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22 0' j Contac Serfa.es and lltea,rs<' Shefifish and Fish From an Approved Source j 1762.11 P:�quencycfSmm:zahonofittcnsiiaand 20L14 Fish and Recreationally Caught Ntullu:can ( ( Frxtd Contact Surfaces of Equipment" Shfi0ish'4 i 4-"7U3.!1 A?nilods u:Sam'+i..a:un Hot Water and3-201.15 Molluscan Shelli}:h from NSSP Listed -- Chemictd' j Sources" j 1f) Proper,Adequate Handwashing I Gaino and Wdd Mushrooms Approved by 1 j Re"yulatory Authority 2-301.11 Clean Condition -Ham.'s and Armc,' j 3-2011 e: Shells'ock Identif,catior,Presents, 2-301.12 Cicauin:'Proccdwe� j 51AU)04(C) `:gild Mushrooms"' I 7 3{;1.14 "Ashen n:Wit,W 3-201.17 Gainr Animals` j ( i t ( Good Hygienic Practices j g Receiving/Condition +' i ntag, Dr+akmgot Using Tobacco' j 202.1 1 P}1Fs Received at Proper Temperatures'" j 1 2-401.12 Discharge,i rxii the }es, Now:incl 3-202.15 Packa"ic Inreenay:: ! R!ouflh* 3-Jul.II !�odSafe and Unadulterated;" 3-301.12 Prevent:neContaminaUuuWhenTasting,- 6 Tags/Records:Shelistock ( 12 Prevention of Contamination inam hands j 3-:102.1 S' Shellslrek Identification" 1 590"0O4(E) Preventiiw Conta�i ilnalion from 3-2{)3 j 1 -2 3 12 ShellMuck Identification Maintained' j Fmphttees' 13 tlandwush Faci!it+es Tags/Records: Fish Products 1 Ccnvenierm'y Located and Accessib/c j 3-102.11 Parasite Dest!ucnon' j j 5-2w,I I N+.m:beis and Cap.;cinesih 3 401 12 Records.Creation and Retentions: ;9().004(,}) Labeling of Ingredients` J j 5-204.t I Lo„ttion and Pla:.entent"" j 9 ( Conformance with Approved Procedures 205 11 Accessibility, Operation and %laintena)ae j IHACCP Pians j Suo did wth Soap and hand Drymy Devmds 3.102.11 Socialized Processing Meihndc^ j 3-`02.12 Reduced oxygen packaging,triter i:' i b-301 t Handuaalune C(e inset..'.v:.rilatd'uh• 8-103.!2 Conformance with Ainnov Prucedures" ti-3(1;.12 Hand Urvmg Fres-isiun d Dtno:e,anunl nem i::the ledeml 1009 Fou:!Cndc or 105(Alk 501:,00" CITY OF SALEM BOAR OF HEALTH t Establishment Name: 1��, V,-)x i ZZG F�c�S} - Date: I�� _. �O� Page: � of �C _ Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION VDate erified No. Reference R—Red Item j� � \-P PLEASE PRINT CLEARLY / r ( s-w_ IJ<,r )rl W(1tLK-,n /, Dod,A +., LO l � , ",;i L/. � r7/! OG s-.4C(?onCvU.0 CG '� .o .Ylyi„ii-�� -F-(_Jl f I/1 I�✓ci/�"-i.n "/'1-�SrJ 6��1r� c�t_ F I (srj")_en Fl� _iI I,, iii_ 10�_ rl co s'? ["lly .PILSP u 'J b I •S % L V I 1 1 r, I ' I Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes t I have read this report, have had the oppofh1ea sk questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to obonditions as describ d, andto Exclusion I ❑ Re-inspection Scheduled ❑ Emergency Suspension 4comply with all mandates of the Mass/Fedode. I n, a stand hatnoncompliance may result in daily fines offlollars o s spens on7gvocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: s v / a, ? sit 1.'44C} PHFe Rerived at Violations Related to Foodborne Illness Interventions and Risk Aso..-dimz lo Las, Cocled to Factors(items 1.22) (Cent) 4I'F/45'FWithin 4 Hours. I PROTECTION FROM CHENIPCALS Method,brr PH'Fs, 14 Food or Color Additives 19 PHF Pat and Cold Holding 3-202.12 AdrfitiNcsI` Cold P1IF- MiiIDtajrwd it or bc1ov., 3-302.14 Pro.cdion front Unapproved Additives* 590 004117) 4i�/4S�F- Poisonous or Toxic Substances ii.ai(A) Hot PIIFs rvl:lizitmuedatorabov� I ing Ini 14,0T, 7-101.11 Identify ' Orelatfoli - Onginal Containers, 3-501 16;:0 Roosts Hc1dat or above 1_10'F. 7-102,11 0,munan Name - Workial- Conijincr.0 20 Time as a Patine Health Control 7 "It.I I Scrniraion-Sloane, 3-501 19 Time ssIa PuNicHcalthConnoPt i 7-202.11 Restriction - Presence and Use* -9 RVIluiremem i 7-202.12 Conditions of Use- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ?-203.11 Toxic Cuntainec.-Prohibitions POPULATIONS(HSP) 7-204.11 SanitiM-s.Criteria-Chemith- 7-204J2 Chemicals for Washing Produce,Ci itt-rial- 21, -3-901.11(,A) LintnIsteuitz"I Pre-packaged Juiccsood 7-204.14 Divifo� Agents.Criteria' Beverages with WarnI at [obeys' 104; Use of Pasloillized hg,* 7 205.11 Incidental Food Contom Lubncants^ I !(D) Raw or Patialiv Cooked Annual Fond and 7-mri'I I Reqricwd Use Pesi�cides, Criteria' Rare Sc,�d Sprout; Not Set vd. 7 2 Rodra Fait Statiou:, 7-!06.13 Trackire,Powder�,Pest Control and 3-lio J.!I(C) Unopened!_-'ood Package Not Re svrvedl. CONSUMER ADVISORY TiMEITEMPERATURE CONTROLS 22 :i-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking To Annual FtI ft Temperatures For hat are k,o�s,Unde:cc,oked it- PHII Not 00icrttu,e Pr-;ceFsc-d to Efirainate 3-401 Ilfvtll(2) s- 15�'F 15 Sec. Pathogens-I' ""'7" 9 3-3iQ.13 Pasteuri,ed Eggs Suh.4titute for Raw Shell E2.,,s-hiijncdiarcSeriue 1-15,F115scc, 3-161.11(A)12) Connnianuned Fisii, tsfe-jas&,Cants I Fggsl 1(F.)(I,,(2) Pork and Beef Roast- 130`F 121 min" SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, injected Meats --155'F 15 I 590 009iA)-(D) Vi0i.IWAIS Of SCILtIon 590.009(A)-iD) in se;. catzrin,,. mobile food,i.critporaty and 3-401.1 I(A)13) Potdtry. Wild G;nre, Shifted PHFs, residential kilefter, operations should be Stuffing contilinin'-, Gish, Meat, caleNI.M under the appropriate sections Poultrytor Rin4cs-165`17 13 sec. I above is related to fowborne Jhicsc 3401.11W)(3) Wholo-muscle,111taLl Bed'Sicaks ifi,-iNent;onsa-(Irisl�lfactors. Other 1457 4: 590.009 violations ie!,nhil, to eOcA retail 3-101.12 Raw Animal Foods Cooked In a prltcti,_!,should be d'ehited under #29- Nfictowave 165`17 Special Retail I ement,,. 3-10i,l](A)(10) All Other Pfft, 145'F 15 sec. 17 Reheating for Hot Holding VIOLA 17IONS R.LATED TO GOOD RETAIL PRACTICES 3-403.1I(A)&(D) PHFs 165'F 1.5 sec. '" tems 23-30) 3-403.111(lo) Microwave- 105'F 2 Minute Standin2 crivc!d and ta"H_-ritic"d which Jr,not t'ehire to ,/I, Tine'' /uodborn� ono vemions and risk1la(t,)r.-,-lisfeslabove -an be hiiind�H I iheftlionluir se,(lens, orthe Food Code evtd 105 0OR 3-403.11(C) Colurnor6all.v Pjoccssed RTE Food- 1.70°F' 590.000. 3-403.11(E) Reniquyin" Urisliced Portions of Beef fttt) Good Retail Practices FC 590.000 23, Monaaamern and Personnel F,-) .003 24 Fetid end Food Protection FC-3 004 18 Proper Cooling of PHFs 25, Equipmert anol-Iterriiis K, - 4 '005 3-501 14(A) Coahng Cooked PHFs from 140-Fitt a vilatei Piumbina and Waste FC-s 006 70"F Within 2 Hours and From 70'F ?7. Phye,ieal Facoity FC; -6 1: .007 23. Foisotious,or Toxic Materials FC,- .002 3-501.14(W Coolin.,PHFs Made From Arri 29 Special ROQUIremel Its 009 Temperature frivredients to 41'17/45 F I 30 Other Within 4 1 lvum" Dt,nute"critical nem III the folti III 19IN Fund Cide or 105 UmlB 590 thio. _. .r.mr.FT+•.el-'""+..•,'+ .-CMi..+ ,„':4r e..a*..i 'M .,n�.,�...h nr�M1,.. . Massachusetts Department of Public Health Salem Board of Health M 120 Washington Street,4�h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name Da T e of Operation(s) Tvpe of Inspection !Ki,-) -) 71e, 47 c, C1 11, 7 I 'Food Service Routine Address - j jl I Risk ❑ Retail Re-inspection '�` i Level E] Residential Kitchen Previous Inspection Telephone ..J/� ,r l 11`L ❑ Mobile Dated jjr ��3- 171 ❑ Temporary ❑ Pre-6peration f Owner 1 r r( r��i HACCP YIN , ❑ Caterer ❑ Suspect illness 'VI ❑ Bed&Breakfast ❑General Complaint I Person in Charge{PIC) Time In: (. �p ❑ HACCP Inspector �� 1�'ora OutS?r ( Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. - Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590-009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12, Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15,Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water 4m Approved Source [1 5. Receiving/Condition El16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans 0116. Coaling / PROTECTION FROM CONTAMINATION `P6_9.Hot and Cold Holding ❑ 6. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices [122, Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction- Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below c ( 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 __tee!'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)(590.009) and submitted to the Board of Health at the above address 7��A 29. Special Requirements (590.009) within 10 days of receipt of this order. Q( 30. Other DATE OF RE-INSPECTION: S ,a aoc � lv��k✓'' Inspector's Signa e: } .! Print: a-�V� ,i�\-�'PC�t /,/I Iff'� YIC's Si re:� Yrint%Y`K/f0/a11rf�1O /'1 r5/�/�,�"�r C/¢/V I Page If or_""1'ages , Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT j 8 I l'%ross-coofarrifon I 1590003;A) Assignment of Responsibility* j 3-302.1 IA)(1) Raft Alumni Fcxxls Sepam,n ed from 590.003(11) Demonstration of Knovdedge'"'` I ('ook:d and RTL' Food 2-103.1! ( Person in charge -dudes j Contamination front Ravi)ng,edier? j 3-302.1 I(A)(2) Rats Armond F,),xla Saparatrd trout Each EMPLOYEE HEALTH Other' j 2 5 0.003(C+ Re„pons+bibty of the person in charge to ( Crnt,,mination from the;F„mirenment + reyu!re reporring by food employees and 13-:,02.1!(Ai Fend Pratrchnn'. applicants" 3-30315 Washing Fruita and Vr_'etables j 590 003(F, Responsibility Of A Food Employee Or An ( 3-304 11 Ford Contact with Equipment:mu Apphe:mi To Repott To The Person in Uten,ils'* Charger j Ccntarrinaton nom the Consumer j 540.00 3(G) Reporiiag by Person m Choree" j 3-300.i4(A(R) Rrrurned Food and Resc;vier j 3 590 Will)) Exclusions and Resttictions# � I D,spo>hion of Adulterated or Contaminated 590.003(E) Removal of Lxclusions and Restrictions food 3-Iii LII Fisc;:, ding,r Recn;,ditiunine IIt:vie FOOD F AOM APPROVED SOURCE r-)od 141 Food and Water From Regufated Sources I g Food Contact Surfaces j 1 -1-501 111 M.umal Warevnmc�hing- Hot Watur 590.OU4tA-S) Coniplis,nce wroth Food Law" j i j _-201.12 Food inaliernmeticallyS,_aledContainer^ ! `;anidzation,rcmprratures* j j .,'OI.1-3 Fluid Milk and Milk Prrxlucts" ( i 4-501.! !2 Mechanic:.t Warewashing- Hot Water j 3=02.13 She118,rgsT I Sanifiz:diun Temperature," ' 3-202.14 Egg,:and Milk Produce.Past,urized" I a-501 114 Chemical Sanitization-temp., pH, i 222.16 Ice blade From Potable Drinking NNatrr' `r+neenn'aton;:nd haring.;. 4-60! 1!(A) equipment Fore Contact Surf'ac.-s and 15-101 11 Drinking Water from an Approved System' I Utensils Clean' I . Clean- 51)0.006(A) W tiled Dt to Standar et` I +{102.11 t 1,aning Frequent) of Equipmcnt Food- Contact 590.U0b(13) Water Meets Standards m 310 CMR 22.0" I Contact Surfaces and UtcnsiV j Shellfish ane Fish From an Approved Sourre j i ! d-?(}1..! 1 Frtn cg .ncy of Sratitizdti o!?u1 Urensits and 3-20!.14 Fish aro Recrcationaily Caught Molluscan s',:od Contact Surf ac es of Equipmeet°' Shellfish* 7it3.11 Hct wooer:rod 3-201.1:1 Molluscan Shellfish Froinn NSSP Lided Chemical^ S,rarces' l j It) I Proper,Adequate Hanowashinq Game and Wild.Mushrooms Approved by ( I Regulatory Authority i 2-301 11 Clean Cordition--Hands and Ari*t," I3-202.18 Sh,11stoek identification Present, ! I '-301.12 Cleaning Prowluter 590.004(C) Wild Nlushrou it;'. 2-301.!,t '09ien to Wash". j 3-201.17 Game Amwsis" j i 3 i Good Hygienic Practices j j 2-401 I1 1',10r. Drnikin "^S ReceivinglCondition of Using Tobacco ( g 1-202,11 PHFs Received at Proper Temper skucs* 12-401.12 Discharges From the -Eye!.. Now and -2(:2. I Mouth'" l l5 Package Inusd'ir:'� 3-10:.! : Food Sate a-:d Unadulterated " ( 3-301.12 Preveminl Coritatmnatiun When Tasting` ( 0 Tags/Records:Shehstock ! 12 Prevention of Contamination from Hands j 3-20215 Shcllsmorkldentiticatinn" I 5'•90J),14(E) nc:entinpContamination From '-20' 12 She ll.0+ck.ldenoi;cationMai tit amcd' Fmru vee." Tags(Reeords:Fish Products ( 13 Handwash Facilities j j ?-1tLt.il ParssitcDeshuc!ion` CenvententlyLocatedar.dAccess,bhn j 3-dU_'..i 2 Krcords.Crratiun and Rrtrnhon'' 5-2tb.1 1 Nmnhers and Cupacities 1 m5-20111 'vocation and P?acertleat'! i 590.0(!4(1) Labeling of ingredients` 7 Conformance with Approved Procedures 5 20N.11 A'cessibilit,.,t tper:,ttuft anti 3lauuenanee I IHACCP Plans Supplied mfh Scan arrd Nano'4'rying i Devices 3-Sill 11 Specialized Processing i\3-thods' 3-502.12 Reduced uxigen packaging. criteria� ( 6-301 11 ,Iauuoashi;:g Cleanser.A,-;:ilnlnbtY .� g ` j S-!0'3.12 Conformance with.AppiotedPioceduies* j b:;(17,P_ Hand DryingPry:isiun j ti't's"cra,ent ilun in ihr rode,el Y)99 Fmxl Cob or 10 CNlh 599,000. CITY OF SALEM BOARD OF HEALTH ° I' 1 ` Establishment Name: �/ ��5 �22c tic Date: <�/�! / �� Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified e PLEASE PRINT CLEARLY /I 1 �^ I. rK .-'-,lr' -�.', _f1aAr 'n,.,-A ' �.oj�` ;>�n/- �>."�C Llo,914 4, kw Lep - \..a<OJ4rj � �.,�,�a�, 1�! l �C�Gn ,.��,ri4 r7f �4(SO� r"l✓/�n� vv/jl 4 ? ,'f rII7--e��1J�1 ! p A P�P4 fl) 7)V1fAJ Aa end II '(�PJA(.�HELlPJ (-Xr/lj�x�j c>A K.�YS� G�o /�JSf 1 7� oUoA/ f k.'A YVntj ofi- rr-,C �' .n C�/TIge tA) �CAeN0A _)A0S'rnt v J / .� �? IA)afe,-1 .1 /<JQQ Ve /Ab CA ec slw (N6 .A&Ui +?L7r,u),� 90"N' - /71 rn A/n(Co^ caf ftA1 s S )/7 c T K t� u X ,-1/N.T1 2— NS / t I Discussion With Person in Charge: (' j Corrective Action Required: I ❑ No I/pYes 1 ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to �❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code.Dupderstand that noncompliance may result in daily fines of twenty-f. Y' or suspension/re of ❑ Embargo Llemergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: :'-5;11.11t � PExB;I2ev:vui at-fcmper.,tutr* Violations Related to Foodborne fitness Interventions and Pick Ac,ording to Iaw Cooled to JI Factors fltenis•1-22) (Cont) -}i'F/,5`E Itrithin d Fb,>me .!5 Cvo`io}, ''clethodsforPYl'e PROTECTION FROM CHEMICALS j g4 I Food or Color Additives I 19, ol Nat and Cold ling 3-5111 '16!B 1 Cold PI-11's 5hiin[ainvned xt or below J-202,12 .".dditiv,^,e" 59:.).ou-I(F) ( 41'/45' F' 3 `ifl2 14 Protec+ion front Cnalummer'Additive;" < 501dbt.4i � Hnt PHFs b$anucined at or ohms 15 Poisonous or Toxic Substances j oi40-F, T 7-101.11 Identif)mc;information-Oiiginal I - 1 Containers- 3-503,i 0(A) ' Roasts Held:tt or abm'e 130%17 l t Health C H Public 20 I Time a7 a Puc eaControl. j 7-102.1 I Common Name- l4-arcing nta Coiner.'' j j ! 7 2 JOl.l li Time-,a Public Hmdth Contrult i -_)LI1 Sep:,rstioa-St:aage" j 7 202.11 _ Resrricuon-Presence and Lice j ")U.004(H) Variance Requirement j 7-202.12 Conditiomof(Jse 7-2.03 11 Toxic Containers-Prohibitions'' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATit;NS t'HSP) 7-204.41 Cfiuou als for ten-'-g'l Produce, i 22 3-80L.1'(A) Unp'rstem izcd Pre-packaged luires end 7-204 12 C:Iieuu call for Wa<[nit�f'rudace,Criteria"" ( j 7-204.1-1 Drying Heents.Criteria'. L?tYetapte,+vtth tVarnine,label; ; '405 I I hteidental Food Contact, Lubricant;"' St)1.I I(B) Llw of Pasteurized 7-206.11 Restricted U:.e Pesticides,Cnteriot I 3.301.1 itD) Raw or Pa:nalhr Cooked Annual Bloc!and j Rau'Sled Slirmii Not Set�cd. * 't 7-206.12 Rodent Bait Stations" 3_80 L 1I(C) Unopsied Food Package Not Re-served. t-'_06.13 7tack;ne Powders,Pest Control and Monitoring" CONSUMER ADVISORY TIMEITEMPERATURE CONT ROL$ 22 3-60311 Consmner Adtisoty Posted for C.'on>tunprion of Animal Fonds Chat arc Raw. tindercooled or 1( Proper Cocking Temperatures for PHFs Nos Otherwise Proces;rd to Eliminate 3-401.1 lA(1)(2) Eggs- 15S=F 15 Sec. Piathgeens. a%rxcv.,,.r:M. 3-30..1 9 Psteu:i;:•d e o.,Sub,,L:uite !or Rax'SI;eR L-gga-hunr..diatc Service i'15'F15sec' e' ' 3-401.1 i(.1)(2) Comminuted Fsh,Meats.4 Gants I Psi, AmrnaL I55'F 15 sec. SPECIAL REQUIREMENTS 3-401.1 Park and Beef Roast-L71)'F 121 min* ` 401.1 IfA)(2) Rntites, Injected Meats-- 155"F 15 590.009CA)-(D) Violations of Section 590.0:09(A)-(D)in sec. ` catering. mobiie food,temporary and ?-=01.11(A}13) Ponitp,Wild:Jame. Stuffed PHPs, resrdenha3 kitchen oneratiuns should be Stufline Containing Fish, Meat, ( debited under the appropriate s,cl.iors Poultry or Ratite;.-165'F 15 sec. " above i(relate to loodborne illness 3-401.11(C)(3} Whole-muscle, Intact Hoof Steaks I interventions and rte, factors. Other 145°F` + 590.009 violations relating :o good retail 1 3--401.12 Rax Animal Foods Cooked in a pr,utu es should oe debited under 1f29 - Microwave 165"F" Special Regn:reirtents. 3414 I ICA)(i)(h) All Citlict PHE;-- i453F 15 sec. j 17 Reheating for Hot Holding I VIOLATIONS RcLATEO TO GOOD RETAIL PRACTICES 3-o,03.11(.A)E(D) PHFs 1659'15 sec. ;, (Ito ems 23-30) I 1-403,11.(B) Microwave 165°F 2 R4inute Standing Cri!lca!au.!non-rrincr:l violaboos, trrr,.h do not voids fu il:e Time° foodborne tones; i,iterrenhun.::olid risk/nr tors lisu'd above., can he j 3-403.i 1(C) Comruercially PAocessed RTE Food- Jound in theJa/rrnring.tecttnnc of tfe Food Code oral 705 QL1R 140'7' 590.000 3-403.'.i(F) Rentaulin UnAicedRlitiorsofBeef lfam Good.4et.NPractices FC ! 390.000 j RoastO' 23. Management and Personae: FC-2 .003 24 Food and Food Protection FC--3 004 IS Proper Coaling of PHFs l 3-501,14(,k) Cooling Cooked P[ffta from 140°P to 25, aociomeM aad ens;is FC-u OC6 26 \Eater,Plumbino and N1est2 F^-S 006 _ 70"F Within 2 Flours and 'Front 70"F 1 21, ??r,pica Facility FC;--6 007 to 41'F/45"F W itlu-c4 Hours. 1 23. Pcasonous or Toxic Matorisls FC --7 .Oo& J 3501 141 B) C'uoling Pl IFe'•lade From Ambient 29, Special Requirements 009 "remperatme Lieredients io 41`0/,15"F (_30 Other Within 4 I Inure^ ' Denot",cmncal,:em m ill, fe,teral 1999 Fund Code o;10`•Cntl 590 000. CITY OF SALEM E �7BOARD (�OF HEALTH Establishment Name: 1� � . 1( �S Y.ZZG 1 (1 rF � T Date: Y1I4/DY Page: Of 1 Item Code C-Critical Item . DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item 1 L Verified PLEASE PRINT CLEARLY (4,11, Y to I � l dr - � . - I CQ(�hiC� ",t- C'2,4 ri -1) .f-14/7G4-Q- /'20� I f 1 kl � 1 ' I ' I 6� , ` I - t EI , y■yi T F Discussion With Person in Charge: Corrective Action Required: I ❑ No 111�7 Yes tI have read this report, have had the opportunity to ask questions and agree to correct all Li Voluntary Compliance Ll Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion : P Re-inspection Scheduled ❑ Emergency Suspension e comply with all mandates of the Mass/Federal Food Co . I understand that _ noncompliance may result in daily fines of twe f' lars_- suspension/r�cea�ion of ❑ Embargo ❑ Emergency Closure your food permit. ` • —'` "� ❑ Voluntary Disposal ❑ Other: PI-!Fr.Fsacened at':empernures I R Violations Related to Foodborne Illness interventions and Risr• According;o lAw Cooled le J Factors(Items 1.22) (Cont.) 4IT/45'F Within 4 t ours. PROTECTION FROM CHEMICALS „jl 15 Cooling Methoc.,for PHFs 1 19 PHF Hot and Cold Holding9a Food or Color Additives i Addi ;-501,16(BI Cold P€IFt, Maim:J -2 tive;. iii.i(or below Sorl 3-302,14 Protection from Unapproved Addinaes' I �, 501,16(A: Hot PHFs htaul.uned at or above 15 Poisonous or Toxic Substances 4011FF 7-l0 L t I ldenttl'vine Infcr-r.mon—Onginal I i 3-5(a i.i 6(,\) Roasts field at or above t 30"P. " Containers" -, 7-102.;1 CommonName Workim;,Contaoiei,* 20 vine as a Public Health Control 7-201.11 Separation--Sioraie" 3-501 19 Time a,a Public health Control* 7-202.1 1 Rzsniction--Presence diol Use 59U i)04{H) Var�..nce Kc'Uuirenirar 7-202.12 Conditions,of I.:se" i-^_,13.11 'Ioxic Containers- Pnihih:iions', REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ;'-20.1.II Sanitizers,Criteria—ChemPOPULATIONS(HSP)icals' 121 1 sSVI Ih:1' 1-��^; r- ° . 1 g�- 7-'_04.12 Chemical,for W'ashine Prodace,Criteria" 1 ts,.urved ,rc-tacka d juices and Beve:aees w:(h W'anune 1-ntcls- 7-204.14 Dryin., Ueats.Criteria' ( 3-801.;1(B) L's_ , Pa;; teurized Eeey 1 7-205.11 Incidental Food Conlam t ubricant:s^ i-801,11 i D) Raw or Pmrially Cooler'Animal Fcxxl and 7-206.11 Restricted l;,e Pesticides,Criteria' k;.✓Seed Sonans N;t Served. 7_206.12 R«lent B::it St.:Gons* z &:Il.l l i Cr I Unopened Food Package Not Rc-served 7-206.13 Tracking Powders, Pest G:rntrol and Moniterin;^ CONSUMER ADVISORY TIMEREMPER9TURE CONTROLS 22 3-603;. I Consumer Aivrsoiv Posted for Consumption of Animal Fouls'n,,t are Raw, Undercooked or 15 Proper Cooking Temperatures for 'vol Otherwise Processed to Eliminate PHFs 3-401.1!A(1)(2) Eggs- 155'F 15 Sec. Pa6n,gens.:-a;ecac - I Eras-hnmediato Service 145'Fl5,es j 3-3t)?.i3 Pasteurized F.gge Suhstitut-for Raw Shell 3-401.11-(A)(2) Comminuted Fish, Meai><&Gan:e Eg "•' gs Animals-'15Y14 15 sec. " 3-401.11(B)(1)(2) Pork and Beef Roast 130'F 121 min." SPECIAL REQUIREMENTS 3-401.111Aa2) Ramos, lnjecv:d h4eats- 155'F 15 I 5a0 0;r4(A)-(D) Violations of Section 594.1)49(A)4D) in Sec,- cateiing, mobile*eYxl,tcmuotary and 3_.101.1 I(A)(3) Poaltn',Wild Game, Stuffed PE1t-s residential l schen operations should he Stuf iq Conlauung Fish, Doc debited wider the appropnute sections Poultry or Ratites-155'17 15 see. ; above if',clated to foodhorne illness 3-41)1.1 (c)(3) Whole-muwle, Intact Beet Steaks ( interventions and risk factor::. Other 14S'F I 590.449 tiulatio*is relaun,to food retail 3-401,12 Raw Animal Fcu,ds Cooked in a practice. should be debited under#29- Mic,owave 165"F* Special Rcgttheo nts. 3-401 ll(AI(lyb) All OtherPI'Fs-- 145'F 15 sec. ' 17 Reheating for Hot Holding VIOLA IIONS LA TED TO GOOD RETAIL PRACTICES 3-401111A)&(D) PHFs 165°F 15 sec. a (Ifetne 23-30) i-103.11(B) Mica'owave- 165° F 2 Minute Standine Gif:rai andnuro-rrui;:n[r;rrtatrons, rrHrch do not,cit,re;,,7,e Time` ,(Lncthurne r![ness olf,rventiuns and rta,I'Ociu,,s lilted above ,tin he Commercially Processed RTE F>od- /irwrd i..the Juthr,:nig see!inns it`ll,¢Farr.rg{-ode nrni 165 LhfX 140`'r" 590.016. 3-4113 1 1(E) Remaining Casliced Portions„I'Becf i Item Good Retail Practices FC 590.000 Roasts"" 23. ManaoemertondFersonnel =C -2 .003 18 Proper Cooling of PHFs 24 Food and Ford Protection FC—3 004 25. Equipment and t'cns4s FC - 4 .005 3-5111 14(A) Cooiidg Cooked PHFs from 140`17 to 26 Water,Plumbinq and Waste FC -.S nog 7WF Within 2 How s and From 70'17 -27. Priv-tical Facality FC—6 007 o,,41°171 45"F Within 4 Hours, w 128. Poisonous or Tonc Mztenals FC-7 I .COII � 14i B) Cooling PHFs Made From Ambient29. Special Re-7uirernerts 009 Temperature liviredients to 41'17/45 F ( 30. Other Within 4 A,nrrs` Denot.s critical item in Ihi federal 19119 F it Code or 105 CKIP 5td):6)0. Commonwealth of Massachusetts F �yze�m PEumpin�g JAN 0 9 2006 Massachusetts System Pumdrm Record CITY OF SALEM BOARD OF HEALTH system Ownrr System Location Ninety Nine Restxur,mt Pub Corp. Ninety Nine Restdurent And Pub k15 150 Olympic Awnue 1.5 Bridge St A'obuin, MA, Salem, MA, 01970 1791) --932-5103 xCtorp (978) -740-8999 x Type: Emegenay Routine ��fY g- Cesspool: No Yes Septic tarn: No Yes Date of Pumping: 'Z/�`� Quantity Pumped: 6albns System Pumped By: Wind RAer Eavinwmenta/, LLC Permit#: Contents transferred to: Contents Disposed at: I / lF/ Date: Pamper Sigm Condition of system/Other Comments Dep Approved Form - 12/07/95 Commonwealth of Massachusetts City of Salem sr Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2006 WHO'S PLACE OF BUSINESS IS: Ninety-Nine Restaurant File Number BHF-2004-0050 15 Bridge Street Salem MA 01970 LOCATED AT: 0015 BRIDGE STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0298 Jan 4,2006 Dec 31,2006 $200.00 ESTABLISHMENT FROZEN DESSERTS BHP-2006-0299 Jan 4,2006 Dec 31,2006 $5.00 Total Fees: $205.00 PERMIT EXPIRES (December 31, 2006 Board of Health L� This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 9 of 20 �r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH I�s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. IISOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 29 f ro`dr/rvv rt Ab TEL# 97V 2W -9999 ADDRESS OF ESTABLISHMENT IS 130dOP MAILING ADDRESS (if different) J OWNER'S NAME 99 WX-St /-7— TEL# 7�1-933 �99� ADDRESS /60 CI n,0'4 CZ-V2 CITY G6b61Vn STATE M4 ZIP 01&h CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) J-43 t (required in an establishment where potentially hazardous food is prepared.) Q f fuck.¢�l EMERGENCY RESPONSE PERSONYl(hae( C xL13 HOME TEL# 7o l-.281.66I'f HOURS OF OPERATION: Mon.//.'LO Tue.rNoO Wed.lr'oD Thu. 0100 Fri. ra!00 Sat. lama Sun. /0�30 (Joen cla 'l)r TYPE OF ESTABLISHMENT FEE (check only) //r30am RETAIL STORE YES VSO/ less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - - - - ------- - - --- RES-TAURANT� YES NO ��yyy less than 25 seats $100 7 yt; ,O( ^ more seats =$150 U `(J more than 99 seats - 200 - ... ..................................... .............................................................. BED/BREAKFAST YES N $100 ............. .............. ............... ............. ------- . tJ/ .4DDITION.AL PERMITS--------- __� IC'MAKE (not just serve) ICE_CREAM,YOGU_RT, SOFT SERVEy (�iD NO 5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES N $25 do-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, h ve filed all state tax returns and paid all state taxes required under the law. '7 kale fl/30% 0/3-(OV-y:?l Signature Date Social Security or Federal Identification Number -- -- - ------------------------''�7- - --+ ---------------------------------------- --------- ------- ------ --------- Revised 11/03/05 FOODAP2.adm Check#8 Date_ / lU 7 " aa- i CERTIFIED FOOD MANAGER'S MANAGER CERTIFICATION TYPE Michael Wells, General Manager Serve Safe #: 2901940 1 Glenn Doty, Assistant Manager Serve Safe #: 4235358 Chris Plistch, Kitchen Manager Serve Safe #: 4384556 Commonwealth of Massachusetts s r City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Niko's Pizza and Roast Beef He Number:BHF-2004-0082 333 Lafayette Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0165 Jan 3,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES IDecember 31, 2006 l� Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre ani revonations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 10 CITY OF SALEM, MASSACHUSETTS m BOARD OF HEALTH j s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPE�R/A�T,E A FOOD ESTABLISHMENT �j ` NAME OF ESTABLISHMENT N 105 �d4 Ifs" �"I TEL# / 9�7 / " Q7J)- ADDRESS OF ESTABLISHMENT �33 z - �S l %Ml ' dl( 70 MAILING ADDRESS (if different) p�� n, OWNER'S NAME I1` (G��F(Q( l` ""Al;`Y"t I TEL# 9T ADDRESS CITY \A)/-VCAf I/VI , V STATE /✓IA ZIP oi2g3�2- CERTIFIED FOOD MANAGER'S NAME(S) 6,PM f CERTIFICATE#(s)h5'(:'4"C� )�`" (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon.II 10 Tue.&IO Wed.(I-la Thu.f l-W FriJIAO Sat./(-[O Sun.fl-/O TYPE OF ESTABLISHMENT FEE (check onlv) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 .......... --------- RESTAURANT YES NO less than 25 seats n 1v66 more seats =$150 more than 99 seats =$200 ------------------------------------------------------------------------------------$-10----------------- BED/BREAKFAST YES NO 0 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. Purs nt to MGL Chap er 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best state kn d e and b I' f ave ed all tax r urn and paid all state taxes required under the law. Signature D�(te Social Security or Federal Identification Number --- ------------------------------------ Revised 11/03/05 FOODAP2.adm Check#&Date h �� .� 4j-e,� ,. e"...°^•x+ r �.•wy,n..r,ti•Iw�w J+'�.'�,...+ryY..,.wi^.• � . . .. .w.-^ � , - -• N Massachusetts Department of Public Health Salem Board SHealth M 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 Name Date roe of Ooeration(s) Tvpe.of Inspection Nf f<hf el ;'?A f•- t4144r6-/UV&f I 2 '7/s� I ®Food Service IEIRoutine Addressr� I Risk ❑ Retail (] Re-inspection `3 g�j L�tfNrhF(I1� �T Leve E]( Residential Kitchen Previous Inspection Telephone , 7 WL/ �7S 171 Mobile Date: , HACGP Y1N O Temporary [IPre-operation Owner Int f/isfK� /frt 1-4 u.DJIAw Caterer ElSuspect Illness Person in Charge(PIC) ! TimeE]I Red& Breakfast C3 General Complaint In: ElHACCP Inspector�•� 4j jjjA j r,I f y +e{ r(�CJS Out: Permit No. ❑Other Each violation checked regdires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compffance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑�, 12. Prevention of Contamination from Hanos ❑ 1. PIC Assigned/Knowledgeable/Duties X13�- . Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15,Toxic Chemicals FOOD FROM APPROVED SOURCE TIMtITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding i '8. eparation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices, Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 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/federai Food Code. This report,when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003} order of the Board of Health. Failure to correct violations L,--Z4. 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: S 59UI,,,Wow 14 do,'F ect e: / / Print: It !! 1(' r �i,fo•�St/rPkt'/Sy/ \.) PIC's Sign re " /W�n( 1�f,Y� Printi/ VlA 04 (A _ 1 Page A of Pages A , Violations Related to Foodbome Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT { ii Cross-acnta:rin,,00n I 1 1590.003(A) Aesienmant of Responsihtiity" 3-302.11(A)(I) Raw Animal Fo ds Sepnra .:d bntn 590003(B) Demonstration of Knowledge" ( Cooked and b'.'F'F F,,,,d,` i 2 103 11 i Person iu charge--duties { I Contamination from Nar!Ingredreots 3.302.1 I(Alt 2) Raw Animal Food,Separated Iron?Each EMPLO"EE HEALTH Other' 2 590.00310) Recponeibility of the person to charge to ( Contamlratinn from tr,.e Environment I reyuuc reportinn by fact employees and I ? -,()2,11(A) Fries! I'rotecr:onr applicants^ 3302.15 Wash;n,_Fruits,aid Vcgeiables 590.003,F) Responsibility Of A Fuotl Fmployee Or An i3-304-11: Cuod C'ontaet•with Lyuipment and Applicant To Report son To The PerLi Uten,tis" Chu_!eContamination from the Consumer 5,90.0031G) Repotting by Person to Charge' I 3-306.14(A)(B) Retained Food and Reseo ice of Food- 31 +.nd- 3 1 590 003Q)) ExCiusions and Restrictions* i Disposition of Adulterated or Contaminated { 59U.0031,E) Removal of Exclusions and Rectrtetiuns Few 3-701.11 Di:cnrding or Reci nditiomne 1Jtsare FOOD FROM APPROVED SOURCE Focal" 41 Food and Water From Regulated Sources ( 14 Food Contact Surfaces I 590.004(A-B) Courphame with Food Law'" I i 4-50 1.!1; 24ar.asl R-an:washing-Hot°.b'atcr -201 12 Food in a I*rlaCtically Sealed Container. { Sanil:zation-remperattues' { 3='Ui.l3 Fluid A9ilk and Milk ProductsN ( q_501 112 Mechamwl Warewashing-Hot Water 3-202.13Sheri EggsT SanitiZutiun Teutperstutes` { 3-202.14 F,ces and Milk Products. F'asteurtzed" 14-501 114 Chemical Samuzanun-tcntp. faH, { 3-202.16 Ice Made.From Potabb- Drinking Water" { crnx:ement n and ontactss. " { 5-I0i.11 i Dr:nktne R',ttvr from an Appror•ed System" 4-60 1.i (1.A) Utensils cl Ptxoi Contact Surfaces anu { i40.006t A) Bolded Drinlanv Water" I Cleanin Crequ { 590.006(15) !bate( Meets Standards to 310 CFeik 22 0* I j 4602.11 Cleaning Surfaces of Equipment Faxl- Qmtact>,arfaces and U:Cnsils* Shellfish and Fish Froin an Approved Source pp 4-702.i 1 1'rzr Dene wf Sattitiamon ofUtensils and 7 3-201.14 Fish and Recreationally Cau�yn Mollucan Food Contact Surfaces of Gyuipntenr' Shelllish� l i-7113.11 MethodsofSanikativii HotWatcrand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources" i t11 { Proper,Adequate Handwashing Game;nd Wiri Mushrooms Approved by { 2-:101 11 Clean Condition --H.mds sad Arm," j { Requlatorylutho�,2v { 3-20Z.IS Shellstuck hientificaticn Present" I '--301.12 Cleaning Pnxzriurz` I { 5,)0.00 t((') Wild Mushrocans' { 2-301.14 When ro Wmh'; j 3-201.17 Game Annuals°, 111 I Good ffygienic Practices { ,5 Receiving/Condition I 2-401.11 Gating,Drinking or Using TobaccoT I 3-'_02.11 111117s Received at 1-Toper Temperatures* 2-401.12 Discharges Ft an tl+e Eyes. Nose and 13-202.15 Packaye Integity'` k4ou;fr' 13-I(}L11 Food Safe andOnadultuaszd 3-301.12 Preventive,Crint:unmatiohWhcr)Tisnn,^ I j 6 Tags/Records:Sheilstock 112 Prevention of Contamination from Hands 190.00-I(r_•) Preverdiv,Contamination ham { 3-202.15 Shellstock identification F { F,mployzec*" { 3-203.12 Shellstock Identification Maintained' Tags/Records: Fish Products I 113 Handwash Faciiines 1 5--102.1( Parasite Destutction* I Convey ily Lccatedend.Accessrcle { { 3-40'_'.12 Records.Creation and Retention" I 15-203.11 Numbers and t'apaciuer° 590 004(7) Labeling of Ingredients' ( 2U4.11 I-ocahon and Plac?ment' 7 Conformance with Approved Procedures { 5-205,11 Accessibility. Operation and Maintenance IHACCP Plans ( Supplied with Soap ano Hand Orying { '3-502.:1 Specialized Prccesaing Methods'` I Devices ( I 6-301.11 andwe„hing C!eanar. A•rtilabilitol2 Reduced oxygen tact<t„«nv.cn)et6-30t.:2 Hand )rviny�:co° cicn 3-103.12 Conformance with Approved Procedues* { 0,110 en antical.i!;:in the rederil 1999 Fuad Code or 105 Ck-ik 590 00h CITY OF SALEM BOARD OF HEALTH Establishment Name: N/Ko i' PIMA It- <oarrG,raF Date: 'dt- /7- 0,5- Page: r9- of 1/Z Item Code 'C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE POINT CLEARLY �/ , a /c cr Y/nt it/i /,a 7711 P/l7' cy-r7ikPr 0/7",/ �nQ l�/� 1S/Y • `' .^' C./OS�PnYI Lri y" "-)'/7//d��.tD�if_rn 2 iP.S _ _ _ - ------------------------ I dS — `7?�l/PlP�Wcrz vP — C!LP.tyr /�slr/2/D2 2 4Z - /rPn°d C�i�_ �P�ml e hid ,cmn u rave /G tnam 44//1.PC/S GQP,C,,/ Caw -1iA.1 C, r ,A- -YM0de 64 fb /Der Fd/f7///eek r 7"-11671 I g r/Atir)wrrs ti,A,/ 91 1 .�xYt�/ni•z,q t� � � Gdod /'- 7Yt(OS I ✓ RPad�17��f ��!' - qGd vis ✓ P Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes i 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 o serve all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fed ral�Food C d . I u I erstand that noncompliance may result in daily fines 6 tw ry�fiv do tars r Suspension/revocation of ❑ Embargo ❑ Emergency closure } ` your food permit. ❑ Voluntary Disposal ❑ Other: - � e r PRFs Recerred at Tcr,:2craturac Violations Related to Foodborne iliness Interventions and Risk =ccn-ding lo Ia r✓Cooled o0 Factors(items 1.22) (Cont.) 4I'Fi45`F Within 4 Hou';. ' PROTECTION FROM CHEMICALS " 15 Coolin,Methods for PHFs i 14 i Food or Calor Additives 19 PHF Hot and Cold Holding i _ 1 3-207..12 Additives* ( `-501 Ih(H) Cold PfE1".Slaintained at or below 590.002(F) 3-302.14 Yro%cction{Fpm lhmppr,ned Artditives* ( ' 1 3-SOl.16(A) I-tol PHF: M,imained at or above 15 Poisonous or Toxic Substances 1111_` .A 7-101.11 Identifying hdormeition-Onsioal ( 3-501.16:.1) Roans Hri;i at or above 130`41. Containers' 7-102.11 Common Nome -Working Comainet.'* 211 Time as a Public Health Control 17-201.!1 Sermiaticn-Storage' ? 151,19 Time a,a Public Hes'ah Coauol^ 7-20111 Rearici u,n--Presence:aid Use 590.004(H; Va dance Requirement � 7-20212 Cond,tions of Use" 17:03.11 Toxic C'ontainen-Prohibi;ions'' REQUIREMENTS( FOR HEGHLY SUSCEPTIBLE 7-204.11 Sanitizers,C'riteria-Chenlic:+is., POPULATIONS II(A) {HSP) 7-'_04.12 1 ,. 21 ?- Ul Iltgl Unp::,RrunzeiPrc-packagedlu!cesaad C temicals for tiVushu[g E uxlu.:c,Critzria" i . /-204.1•f ! Bcvetaees with R'arniru t.abc Ls. Doling Agent,.Conte t" ! 3-801 11(8) Ute of Pasteur:zed E_,gs^ ! 7-205.11 Incidental Food Con[tct.Lubr:c:mts' ,t t.I i(D) Raw or Patbally Co ked Animal Food and "7-206.11 � Resiricled Use Pesticides. C'mer:a' ' 7-206.12 Rodmi Bait Statioae" Raw Sc-d Sprouts Not Served. 3801.1i(C) Unopened l�ccd Packzze Non Re-served 7_-200.i3 Tracking Powdrrc,Pest Control auC - Moui!orin,, CONSUMER ADVISORY TIMEiTEMPERATURE CONTROLS 22 .-6i!? 11 Camumer Advisor} Posted for Con;uniption of le Proper Cooking Temperatures for ! Annual Foods"I'bat are kay. Undeicooked or PHFs Not Otherwise Processed to Eliminate Patho-',=a+.* `nr,.:..loci.. 401.1 LAI l IQ) 1;ggs- 155-F 15 Sec. - y y i-30''.;3 Pasteurized fiygs Sul+Stitme for Raw Shell Et_s-hnntediaie Service 145`Flis^cam Eggs* 3=401.1l(A)(2) Comminuted Fish, NEcats of flame i Animals- 155`'F 15 sea j 3-401.11(B)(1 i(2) Pork and Hecf Roast- IXT 121 min" SPECIAL REQUIREMENTS 3-401.;1;0.)12) Ratites; {njcetai N(rats- IS>"F i5 590.1!09(A) (D) Violations of Section `40.009(A) (ll)in sec.. " carering. mobil; food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, ret id.atiai kitchen operations vhould he Stuffing Containing Fiat, Meat, debited under the appropriate sections Poulo-voi Ra,it,s-!65`F 15 sec. ' above i('related to foodhnr,,illness 3-401.1 I(C)(3) W21olr-mus-le,Intact Beef Sienks ( nnrerventions and risk factors. Other 145`F 590.009 violafions rclatine to good retail j 3401.12 Raw Animal Foods Cooked in a practices should be debited under 1129- Rlicro'r=ave 1(,5'1, " Special ftequiiements. 3-401,11 i(A)(1)tit) All Other PHFs- 145`F 15 we, * i 17 ! Reheating for Hot Holding VIOLA rlONS R,:LATF_tl TO GOOD RETAIL PRACTICES 3-403.1!(A)&,(D) PFIFS [05 F13:<ec. ° 1 (hears 23-30) 3-403.11(B) Nliceowave- 165°F 2 NIn:ute Standitr, Clitoral att.l rear-:ritual vi,4atroni, .:inch du no!relate to lite Tune* - kiodbortw ilirress inter ventinis and risk(actors listed,,b'we, can be 3-403.11(CI Conuucrcrr0y Pt'cxesed R'I'F.Food- [cturd in rhe,fidlowaiq sectrrrs,'C1/fe 1'oaa Code and/05 L'tL1X 140'1,' 590.floor 3-403.11(E) RemamingUnslicedPortions ofBeef l Item Good RetailPractices FC 540.000--] Kia;t,* 23. ,Uanaoen t and Personnel FC--2 .003 I g Proper Cooling of PHFs 24 Food slid F,>t'x!Protection FC._1 ,1104 j -q an '5 Equinrnsnt and Utensils F:. ;105 3-501 We A) CooLne Cooked PH FS from 140"6'io ( 20. Waier Piumt�inq and Waste FC .006 � 70'F i> 41itr•2 Hour.,and From 70'F ; 21 Prysltal Facility FC_ 6 .007 to 41'F/45'-F Within 4 Hours. " 128 Poisonous or Toxic Mairria!s FC-7 .008 3-501.14(B) Cooling PHF,Made Picini Ambient ! 24. Speci< Rcpwrs:men's --- 004 Terapewlaao Ingredients to I I°F/45=1, 1 30. Othe, l W:titin 41lourr% :.1na ' Deuoty,goodl,i iluu 1a i!ie falual 1999 Food Cude or Iii i CMI }901100. I ^rY: .«-.n •:i„ .q,.E...�..:...N`., ap...-,w.+�-.xi:....�trt.��xe_s.-. .*..>r=.mnK.err,,...u....w......._. .-_.. .. _ . n .., .r",Mi, - , CITY OF SALEM9 MASSACHUSETTS r 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: Food SERVICE Name of Establishment: Niko's Pizza & Roast Beef Address of Establishment: 333 Lafayette Street Owner's Name: Richard Kalaydjian Restrictions: Application Date: 11/1/2004 Permit for Food Establishment 004-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS — l BOARD OF HEALTH 01& 120 WASHTNGrON STREET, 4TH FLOOR SALEM, MA 01 970 TEL, 978-741-1840 FAX 978-745-0343 STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2044 APPLICATION FOR _IP/ERMI TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT l t( KO'S i 2�f) iO�rSf ��} TEL# At ADDRESS OF ESTABLISHMENT t/A R f/eVe MAILING ADDRESS (if different) �/ '1'` f f OWNER'S NAME PPI GPf/1lcL� A ql tl b—je4 TEL#U�b -P3h_ - $71�5' ADDRESS Ilan 16-t q7-eAJ OZIT' CITY WJA-LT14-A-s'trtV STATE 41A ZIP cvy� CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where poteenttiially hazardous food food is prepared.) Al-EMERGENCY RESPONSE PERSON !�f MM )U (G•#!& �f HOME TEL# Ak-1-1424 L HOURS OF OPERATION: Mon.A Tue-IL Wed.�I'i?�Thu. �_ _Fri. Sat. )(-t Sun. (!nt TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 more than 10,000sq,ft- =$250 RESTAURANT [1f ESZ NO 6,ess than 25 scats =5100-> 25-99 seats =$150 more than 99 seats =$200 BEDIBREAKFAST YES NO $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 $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to M Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I,to my e t knot'lad 1 a eI f, ha a filed allstate tax returns and paid all state taxes required under the law. 't '", '_ a-04 7Y - 413 f( Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------ --------------------- Revised 11/03/03 FOODAP2.adm Check#&Date 30 C f j 5/'. _-pt' i COURT DOCKET NO. A I CITATION NO. CITY SALdA 2915 VIOLATION NOTI E E a NAME(LAST,FIRST,INITIAL) STREET ADDRESS CIT�\Y,/yT/0 S(TA E ZIP 7 LICENSE NO 1 LIC EXP BATE DATE OF BiCSf OWNER'S NAME(LAST,FIRST,INITIAL) kf)_S�„n I I STREETADDRESS CITY/TOWN STtTE ZIP L/IP. J REGISTRATION NO ST. E EXPIATE MAK PE YEAR �fh DATE OF VIOLATION TIME DATE CITATION WRITTEN i'NJR.o`SL g oq 3 7.19914 [-]NO oNO LOCATION OF VIOLA ON �OORfINGDE OFFENSE � CHAP SECT FINES A & p-jD2 1 20 eve 5 B C OFFIC ES I D NO TFI ELI$ CER CERTIFIES COPY-GIVEN Ta VIOLATOR IN X I i�.[/L{�/'17 (/\ILA `�vwX ❑ind�unAILD DO NOT rv1AIL CASH-PAY ONLY BV POSTA_NOTE,MONEY ORDER BY CHECK MADE PAYABLE TO . CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THEAMOUNT OF 1 $ CASE# I 1 SIGNATURE ) SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL I CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH o 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: FOOD SERVICE Name of Establishment: Niko's Pizza and Roast Beef Inc. Address of Establishment: 333 Lafayette Street Owner's Name: Nikos Duni Restrictions: Application Date: 1/15/2004 Permit for Food Establishment 259-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT ' CITY OF SALEM, MASSACHUSETTSgS jyf {may BOARD OF HEALTH • w 120 WASHINGTON STREET, 4TH FLOOR I��)VVV SALEM, MA 01970 1 03 Q 20 gB�M1l� TEL. 978-741-1800 NOVY I V lJ J FAX 978-745-0343 STANLEY USOVICZ, JR. LI� Y OF SALEM JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT A/hnn 1,f P/2;zA TEL# c9( -7S X44 9152- ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME 1 1V14O -b U."1/ TEL# ADDRESS /-3 A' S; CITY /-�Ea1aS—.0 7 STATE Mir ZIP O o CERTIFIED FOOD MANAGER'S NAME(S) / X02 CF CERTIFICATE#(s) ,-n--)//tf— (required in an establishment where potentially,hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon ¢_/�l'ue.// /wed. //-rcThu. //-/OFri. /Y-feSat. //re Sun. TYPE OF ESTABLISHMENTFEE check only RETAIL STORE YES NO �� U less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT E$ NO Qss1hang segs =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES 41z�' $5 TOBACCO VENDOR YES cid $50 ALL NON-PROFIT(such as church kitchens) YES V�Q, $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 ChapterSection 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and beli , have filed all state tax returns and paid all state taxes required under the law. t Signature `� Date Social Security or Federal Identification Number Revised 11/0 /0 dm Check#&Date L96(/0? C`0 5'O- /-/ 'G}� _ 3 `5 8'�- 1 7 9- I� r t CITY OF SALEM r BOARD OF HEALTH / Establishment Name: ttjlK6 S �/Z?✓F Date: // Od Page: / of j Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY • I A .«w LO ALA'IH W'n11A/ sH6KF�� 1 I � /fi r c�rtl�w�rcT mow now #ez*-A*kw_" fvea .!wawr *t+2 rtdir. � + srtsr� so.r�i'wrc� e_.w7A G7v-Ari�S r�1'i,/�u cn/I' ldd-S ^6Cv— A%U �,+:�Ji,1 l .£N615 t;n Oft0i,Fi7� A fdco 1C rF_ &-JUdAu,I r. j _ I — 1 - I a I el�x 411 I - Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines oft ent -five o11 rs or suspension/revocation of El Embargo ❑ Emergency Closure your food permit. K i"l/v� ❑ Voluntary Disposal ❑ Other: -r r ---- 1 NIF.�Received at"temperatures Violations Related to Foodborne t/lnoss lntemenifons and Risk h;i;nv Cooled to Factors(items 1-2P) (Cont.) 41 W45-F Within 4 Hours. " PROTECTION FROM CHEMICALS 5 Coo"-'1-2i :ti:ethn lc for Ylll s 14 Food or Color Additives i4 FHF Hot end C,,Id Holding , 3-50:.16,13) Cold Pf1Fs Maiuta:n.ri at or below 3-202. 12 Additives" ! 59(?.004(F) i!`it:'F" 3-302.14 Protection from Cnapprovtd Additivei" 15 Poisonous or To*is Substances It-,i q) Hot f'HP�h�iairtirnne,l at cr abcne I i lr,F 7-i OI.I i Identttpmg Information-O:lginal 3.501.16(A), Roasts Fiz ld at or above l0`F. " Container," 1-10111 Cotmnun Name - Workint C:onn:inersl � � 20 ra e as a Public Health Control I %20L11 Sep4ration--.5turn ee` 35OEie) Tim as.:Pub!ic Health Conoid 7-207 11 Restriction--Presene,and L',sek ( ( 5)0.004(Hi j Varian:e Requirement 7-203.1Ian:,of(;;c '7-)03.11 REQUIREMFNTS FOR HIGHLY SUSCEPTIBLE 1 -tU .l1 Toxic t�zicContainzr<-Prolhibirons^ i POPULATIONS;HSP) 1 7-^04.11 San:U�era,Criteria-Chemical,,;* 213-3UL11(A\) Unp,istetnszedlke-li,claigedJuices and 7-204.12 Chemicals for Washine Produce.Csitrria°' � L�„er;te•-s with`av':.nune 7-204.14 Dr)ingAgems.Criteria" ( z_•,t) ,,' n (R) t: e of Fas:etmized hates" 7-205-11 hoicha tal Fund Contact.Lubneants' i-;M!A (D) Raw or Pa&ah% Cooked Annual Foodand 7-206.11 Restricted Use Pesticides,Criteria" 7?0Ci.12 Rod-ml Batt Station," ! Rate Seen SttrOUts ivot Sett�ed. 3-ROi.i l(C) Unopened Food Packa_-e Net Re-se reed. 7 204.13 Tracking Powders,Peat Control and Monitaingx CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 ,03 11 Cons:nner,\ iso l- Pnsted for Cm moption of 16 Proper Cooking Tempzra#ores for .=tniiml FoaL'1'hat re Raw, Undeicook:d or PHFS `tot Otherwxr Fr,,cer.seS to Eliminate � 3-401.I1A{!)tt) Egg:- ISSF ISSr;. 3-302.13 Fasteunzed Egln Substitatc for Raw Shell F.cess-hmnediateService145"Fl5sece r' EY s � 3-401.1 J(At12i Comtrunnted Fish;R9cats&Game Animals- 155 F 15,cc. :, 3-401.i 1(13)(1)(2) _ York and 13c,31 Roost- i30-F 121 min" SPECIAL REQUIREMENTS 3-401.1I(A)(2) Ratites, Injected Meats-155'F 15 590.0091 A)-(D) Violations of Seetion 590.UU9)Aj-(D) in sec. .: I catering, mo:ule food. temrorary and 3-401 1 I(A)l3) Poultry, Wild Gaine,Stuffed PHFc, resident:::l kitchen opet u ions should be Stuffing Containing Fish,Meat, debited under tic appu+priate sections I Poultrh rr Ratite;-;65'F 15 sco. above it rcldled to ioodborne illness 3-401A ItC)(.3i Whe)le mnsele,Intact Bea?Si-oak,. otterventions and risk fxctnrs. Other : 145E 590.(()9 violations relating to good retail 3-401.12 Raw Animal Fav1s Cooked ma ptuciicec should be debited under i{29 -- Micuhwave i45'F' SpecialRegoiiemerts. 3-401,11(A)(1)(h) AdOtheiPEIFs- 145'FIssee. ''` 17 Reheating for Clot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 3-403.11(.4)3(D) PHFS 165"F 15 see. T ! Otenxs 23-30', 3-403.1!(B) Microwave- 16-', F 2 1-Mnmle Standing Cute<d and non-crit;::al rwtotrrnr: which do wit relate to the i Time* itodborne ilhte.s'i in.:vrventions and vis.{janors lLted above, can be, 3-403.!1(C) G}mnterci:,lly Prccc3sed RTF Food - found;r, ibfoih;s%rng serdnns q%the P,tod i'•rJ[wia 105 C'L(k 140T 590000. 3-403.i 1(L-i Remaining Unsheed Portions of Bcef ( I Item Good Retail Practices FC 590A00__ Roasts'. 1 23. M•;naoerr:ent and Frrsnonel FC -2 ! .003 ! 18 Proper Cooling of PHFS 24 Food anal=ood Protection. FC-3 004 25. Equlpnwm and'Utensils FC -4 !, .005 ! 3-501.14(A) Cooling Cooked PHFS from I40"F to 26. Wates, Pl'.Imhlnq and Wmte FC-5 006 ! 70T Wn1un 2 Hours and From 70`F : 2' p• - Physical Fa-il;t4 :,--6 007 j to 41"F145=1`Within 4 Hours. " 28. Poison as or 1"oxlc Materials -7 11 .(10- 3-50 1. 0033-501.14(B) Cooling PFIF,Made Froin.Ambient 29. Special Reauitemcnts .005 Temperature htgredionts to v 1'Ft45 I; 30. Omer wntan 4 llou s p °n:,r:•<r�,:Jo- Denmescnoc;l wm m t to:;,Jttml :'J90 r,),4 Code or 105 Cb1R 590000 CITY OF SALEM BOARD OF HEALTH Establishment Name: /vl leos• o/?l"u Date: 1611,91ey Page: of item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY OUB G"d ri C A'1W f �rr5/sus,erg �.✓iaa- �ar�J��c�Ifi�I �- Y �(j/tt�.+�•drl� L/Grlr' r.rtf SOS /�R-a r:e r• � ref �otdiCT: " GrJri f1 w/6- hoRsOs s uxan ia++0 Sf7{v t�b[R /�'�Sv/r--Felc.F of /1�� /%Lhj if- 14-ox4ry rn 0xb(oaAr- .r-.4�, nz+ rrd- s7eLJf'7n4 & , A4L WK�c.. P�-e vrn� T.t}rr r�7z�M t t'o Luff or✓ .4.� .•£✓c.I (i•�a t r S(Y�ile.✓ .e-f' �-K l A UG' JNt(� r" FAr-*r 7.6scc lNhr� vrS't>,1� . i9cZ,/ 2avlGM i1ia� p/� 1Jr 0&irilw- krf(.L- MACE G0M.1.rr'"jNr of 00L#r1A19' Ctmg rt/ f/fte1,'Y — Gt f`b4-L_ er.>�PcSGnud MerJOrMI r/li�sN � � "aP/M - Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p LI Re-inspection Scheduled El Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of'wenty-fived liars or suspension/revocation of ❑ Embargo Ll Emergency Closure your food permit. Q ly, , ❑ Voluntary Disposal ❑ Other: - r 'ir U .',-SUi.id;C) i>i-6=s P.ecei:ed aTempera(etes Violations Relater!to Foodborne Illness Interventions and Risk According to IAw Cooled To Factors(Items 1-22) (Cont.) 4 F;45 F Within 4 Hours. " PROTECTION FROM CHEMICALS j 3-5t!I I5 Cooling Me:i,oda ter PHF' Food 19 PHF Hot and Cold Holding ) .4 ood or Color Add! ( i 3-501.1o(B) Cold PFIFs llamtained at(Ti below 3-202.12 Additives* j 591110:)4fF) 3-302.14 Protection from UnappioN d Additives ;-5!)1.I6i A) ti�2 YHF; h1aiutained at or at;o�:e j 15 Poisonous or Toxic Substances 140'F ., 7-I0I.i l Identsfylig Infinmanm-Ortginai Container-,- 3:i01.16(A) kosfield eld at ur above I;U'E. Dl _ __ 7-102.11 Corntnon Maine--tN„rkine Containers` ( 20 Time as a Public Health Control 17 201.I 1 Separanun -Sua'age„ 3-5)1.19 Time as a Public Heal!b Control" -90.004(H) 5rat;ance Rrqutrement j 7-20111 Restriction-Presence and Us,,* j j 7-202.12 Conditions of Use" j . j 7'_'03 I t FoXIC Contdiaets - rohtbitions' REO:iEREMEN FS FOR HIGHLY SUSCEPTIBLE j 7-204.11 Sanitieery Criter::,-C'henticids: POPULATIONS(HSP) 7-204 12 CLemiuds for Washing Produce,Criteria' j 12S ( '-Stll.11 t A) Unp:nteunzed Ptc-packaged Juices and cls' Lt�seiages with Warning Is: j b'7-204.14 Drying agents.C'riter'ia` l 3.501,I i(H) Use of Pasteuu7ed Eves` - -7-205.111 Incidental Food Contact.Lubncauts* ( 3-301.1 i(D) Raw or Partially Cwn ed Annnei Four!and j j 7-206.11 Rearicted Use Pe<ticule:,Criteria' j j Station 7-206.12 Rodent Baas' Rats Seed Sprouts foot Set,reu. * f M1 7-206.13 'Pricking Powders,Pest Control and j 3.YOl.I 1!C't thuiper:cti Fra1 Pa:,kao-;r ;t Re-served. +` i A?,minoring^ CONSUME91 ADVISORY TIME)TEMPERATURE CONTROLS 22 3-6,,03,t 1 Consumer Adwory Posted for Consumption of Anuital F,-,ids flus: nrr Raw Undercooked or lb iProper Cooking Temperatures for I Not Otherwise Processed to Eliminate PHFs 3-401.11A(1)(2) Eggs- 155'1- 15,Sec. Pathog ns.'-`- Eggs- immediate Service 1=45"F1.5sec„ 3-311..?3 Past sari zr:d Eggs Substiu.n_its Raw Shell 3-401.t1(A)(2) ( Cormninuted Fish. Meats&Game Eg„`.r Animals- 155';1-' l5 sec. 3-4U1.1 I(B)(1)(2) Pork and Beef Roast- 130'F 121 min" 1 SPECIAL REQUIREMENTS 3-101.i I(�0(2) Ratites- tujected Meats- 15 "F 15 S9:).,'s19(A) !D) Viclarions of Section 59U.00%A)-(U) In sec. ' ( catering, mobile Food,temporary and 101 I I(A)(3) Poultry, Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appro,trlate sections Poultry or Ratites-16�."F :5 sec above if related to foodborne illness 3-401(1((')(31 Whole-nntscle, (mast Beet Steaks interventions and risk factors. Other 145°F^ 590.009 violations relating to good retail 3=401.12 Raw Anhwd Foods Cooked in a pracirt: should be debited under !/29- Microw'ave 165'F* Sper;ai Raluirements. -401.11(.A)(1)(b) All Other PHFs- 145"F i 5 sec. j 17 i Reheating for Hot Holding j VIOLAT/DNS RELA TED TO GOOD RETAIL PRACTICES _ 3-403.1:(A)&(D) I PHFs, 165'P 15 sec. l 1 (l terns 23-30) 3-403.11(B) I Microw.ive- 165"F 2 Timing Standing Grctreri ott,i non-critical violof:,ar,,, whir.h du got,Y(uie to Clic Time4 I foodburne illness intervcntiuns,rn,t n:;b j,,;lurs listed above, ran be 3-403.11(C) Commercially Processed R'fE Fond- loand;ii the nig srwtions oftIm Fuud C'nJe,aid 105 C WR 140'F" 59(t0t)0. 3-403.1 I(E) Remaining Lnsliced Pottionv of Beef ! ( Item Gcod 4etail Practices FC 500.000 j Roasts' 23. ldanartement and Perso:nind FC-2 .603 J j f8 j Proper Cooling of PHFs j 24 Food and I a ci Prot-ctior. FC - 3 .0()'t 25. Equipment and Utensils _ FC -4 .005 -5(11 14(,1) Cooking Crx,ked PHI:. from 140'F itr 26. Watt:. PbnnbinG ano Waste ----- -C`-r--- -.065 70`F Within 2 Jlonts and Frem 70"F 27 Physical Facitty ( �C-6 007 f to 417i457 Within 4 Hours. ' 28 poises nous of Tex:r fdatedals FC-7_ 668 3 50L 141 R) Cuolin;;PRFs islets Fnxu Ambien t29 F1Deuai H2pmrement; TentpeiatnreIngredients to,,1"F/45�F 36 tither Within 4 flours'. Uenole:cnnCal nem m,he hfiCral 1990 Fund('ode or 10�UNIIR i90 000. r CITY OF SALEM BOARD OF HEALTH Establishment Name: "IK v 'T >A/ 7744 Date: /O/�d,d'`/ Page: of + nem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I r No. Reference R—Red Item Verified y' PLEASE PRINT CLEARLY rrllhtu,� ✓h4J' �N/JJ�i7¢b .'? c /,orf- �� G7/� c�3tr of l� ly,._Milft.7'v�P e.�rr�d, fn.,L� Letr�u/iN6— G✓Af' NdfZ£�' ! "" ��JM� /rJ ft.aa� Nttzrc i![S .�tAlt£ /Mt�tC✓�vtJt f, ( �✓ /�A>:.r� i.r �'►ai�-s��a=�r� M�1s �a ,�crs. !'s�',n1�- �rr�ts1-o• I I I I I I 1 i I � - 1 Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /�J� — I ❑ Voluntary Disposal ❑ Other: -501.:4t C) PRFs Recened at Temperatures Violations Related to Foodborne Illness Interventions and Risk ! Ac,outin„D'•lay. C::cled to Factors(items 1-22) (Cont.) -41'F/ 4S 144thin d Hours. " PROTECTION FROM CHEMICALS I 3-SOI I5 Cooing=Me!hexls for laffs 14 Food o.Color Additives 119 PHF Hot and Cold Holding 11 =n l.16t B': Cold PMI's Maintained it or brlow 3-202.12 Additive>' ( ' 3-302.14 Protection Irom tln.:ppunecl Additives* ( 590.0(;O( 4 ofFII45� F- _ ;-50!.!6(.4} HotPFIPst4la;t::aineda[oraboi'e 115 Poisonous or Toxic&ubsfances I 1400F. * 7-101.t 1 Identitymc lniu,-m,wou-Original 13:SOl.lii(,1) Rt pasts Held at ur:;bo+-e L 00F. ' 1 Containers' _ 7-10.2.11 Common Narue-41'or Frog Containers* I ( L0 i Time as a Public.Health Control 17-201.11 Separation-Sfora c„ ( i 3-301-10 Time as it Public Health Conn'o:t 7=20211 Restriction-Prcecnce and (.Ise* 59000Je,1-1) Variance Requircuiun 7-202.12 Conditions of User 7-203.11 Toxic Coataincr.;-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � 7-204.11 Suzuci zers,Criteria- Chemicals" i POPULATIONS(HSP) Chemicals Produce, t I 12.1 ; 3`:01 tl(A; Unp:!steuuzect Pre-packaved Juices and 7-30.9.1.1 _ bemtcals for Wash:n;: r, ;dure,Cr.turia 7-N)4.1 - Havmia.a�s with Walmme I ithelc* -1 Drvin„Aeents.C:t::er:a" ;-, ! , d0 (d) Usc of Pa;.tenr;zed li_c:,` I 7-205.11 Regrint:ti Fuca)Contact. .CritcteuS eria* � I 3-801.1 I(D) Raw or Patlnrllp Cooked Annual Food and I '1--306.1 I Rcaricted L'se Peeticxles.Criteria* Ran,Sced Sle-ou,s Not Served. 7-206.12 Rodent Bait Stollens' -- --- 7-206,13 Trae4.ntg Powders.Pest Centro! orad i 13-801.111 Ci Unopened 5x,d Packa-w Not Re-served. i Monitoring" CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3-003J ! Consumer Ade,sory Posted for Consumption of Antm.il P..>as ihat are Raga Uudorowked of i 16 Proper Cooking Temperatures for I Tv t 0therwisc Processed to L-limurate I PHFS ! i'a:'rtw' -t01.I1.4(1d2) t:r5 755'PI5Sec.. `u`''' - Eegs-humed'utu:Ser:ice I.15`PL'seC 3-=02.13 ;'asteunzed Eg_ti Subs:imte fat Raw Shell 3-401.1 I(A)(2) Comm n ned Fish;Meats t:Game An:uwis- 155'F 15 see. '� 3-401.1! 3 (I t7 1 , I SPECIAL REQUIREMENTS t t) ),J Pork and Bcei Roast- 13(}"FIs 1 min 3-401.11(A)(2) Ratites, trr.rtcdlYlnns-- 155'F IS 590.009(A!dC)) Vooaanona of Section 590.009(,q)-(D) in jsec• x catering, mobile food,temporary and 3-X101.1 I(A)(+) Poultry. Wild Gnme,Stuffed PHFs, i residen!ial kitchen operations should he Sinftiuit Cont!iuin;Fish,Meat, debited under the appropriate sections Pordn s or Ratites-!65°F t5 s c. _ above if related to foodborne illness 3-901.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and tisk factnrs. Other 35'P 5910•()09 violations relation to good retail 3-401.12 Raw Animal Foods Croked in it practices should be debited under//>9- Microviave 185"F'p Special Regniremer.tc 3401.11(A)(i)1b) All Othet PHFs-- 145°P IS sec. J7 Reheating for Hot Holding VIOLATIONS R.e1.ATED TO GOOD RETAIL PRACTICES 3 400 .I I(A)4(D) PHFs 165"17 15 sec. * (Items 23- 30) 3-403.11(!3) Microwave- 1650 F 2 Mintde Standin^ Critic al::nt!nun-rritu'al rialaiwits. ..hich do not relate to the Time` trndhorne dhows rarer✓entinn.c and 1 sk Jin tors ksied abore, can be 3 d0?.I 1(C) Commercially P:'ocessrd RTF'Food- I f:wid in tkellollrnoi„y sectio;,)!'the Food Cade and 105 CAR, 140'F`. 51)0.001), 3-403.11 fro Reutaining U'nsliced Portions:»Beef (ram (good Retail nractices FC 5?0-000 J Ruast.,. 23.- Manwonienr and Per.cnnel I FC-2 .003 Proper Conking of PHFs 24. 1 Foci and Foss:Protect:cn --- FC -3 .00j, 25, Eauiarnent and Utensrs FC-4 .005 3-501. Coolins,Cooked PIIFs from 140`F to I _? ----- Water,Plu-:iGinq and Waste hC-5 .006 70'F Within 2 Hours skid F'rc,m 70"P i 277 PhYsicar Fac!lity FC-6 007 to 41°F/457 Within 4 Hours. "" ( 28. Poisonous or Tons:Materia)s i I-C-7 .008 3-501.14ib) Cooling PHFs Mad: Froin Ambient 2°_ Special Regmremeots .009 Temperatate Ingredients to 41'F/45°P 30. Glher ----_- Within 4 llottrs` e •nen:e.ro e.:,- Donates:Trtn al rtem m the(rderai 7991)Pond C}dc or 1liS Ct<f!{59::U(!0. CITY OF SALEM BOARD OF HEALTH Establishment Name: Ali Ko'S /wiz z a i �o»/ ��rr�, rhr Date: ib — / `/-OSS Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY , Pfo,,p. A,1,J Vim &wYk_a-ry Q�• Wl5 I 901or • I 1�0.� r'J-IGm �fd-n '• KiP�ia-I� tea /a�ac/ryQn �� t^arH/�lP-ltrl /'wr7-c.. kP h i i s lszi i Cites/ • A t 1 n f,�•cks 0.rv5 ( G� 17o�rkaJ u� r}GI f��[ �Rrv� i 1� u' �lhmMe.r E /oca,4--/6,, Sf7a ✓/ d 7�I1 Qw —f1}Z�I'/ ��s�-ter sF�S �,.: r K�� r`r r.-r a ��x �J s-� Li�Gv-G dGte�•f/i.L�� XPi✓i G S • _��c..i..v I f-ivs-/ S-Ea-lc �;S oma-, Jaz.,.. • ,t��vr-ewv� dr �4zf-se, dell 0'11751 Lin -( .r'�rri� vu-��•( rye i-, a�-� /`�o°F- m- GI��.->' a-e a �iii� cvf L//"x" &Y- 6,1J.<4 y 6ed•-� fv t=d ( ids vu c�sf l� yo��1 / od r� x-17 4"c�s -/7550-e_I yr f/overs f , l�/zp_� R�sf �� Cor �va�7azr cla� ly �oo�/JH) Discussion With Person in Charge: J?e ,7,pCorrective Action Required: I ❑ No I ElYes � W'�K ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 1 PHF,Recerced,aTciuperatures Violations Related to Foodborne Otness[r!tervenfions and Risk Acccrdi 18 to t.av, Coaled to Factors(Items 1.22) (Cont.) 41'F/45'F W4thin 4 Flour:. x PROTECTION FROM CHEMICALS 3-50:.15 Coniige ,vtelhrds for I'H 9 PHF Piot and Cold Holding 14 Food or Color Additives 3-Sit1 161Br Guo PHFs Vlainiaiocd at or bclrxt 3-202.12 1dditiNes-` 3-302.14 Protection from Uncppnnad Ar,dldves^ 590 004(F) I lot F °jr 1 13-501.16(.'1) Hot F'kIP;. Mai,a::iaed at or above �, �. 15 Poisonous or Toxic Substances 40'F. 1 7-101.11 klennf}vtg lntonua:ion-th'iginxt � Containers :,-St)).16(A) Roasts Held :a ur above I:0'1. ^ 7-102 11 Con nu a Name-Working Containers* 2f1 Time as a Public Health Control 1-501 19 Time as a Public Health Control* 7-_01..i 1 Sep:vation-Sturacz' 7:?t12.1 t Rrtitrictlnn-Pn-seuce and Use* J 590.004{1-j} \4uiauce Requitement 7-202.12 Condition:;of Use- 7-203 se" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203)I 'Cogic Container.. - Proh;Mtions" � 7-204.11 Sanitizes.Criteria--C'hemicas' POPP.ILATiONS(HSP) 7-209 12 ( Chetnicals for Washui_e l rochl.c,Criteria" 21 2-Stq.IUA) Unpaaem'zcect Pre-pa:.kaged Juices and 7-204.14 Drying:'teens.Crtteria'' Beceraees with Warning larb,_ls' - 3-x01.1 1(B) Usc of Pasteurized hogs* 7-205.1 1 Incidental Food Cuntact. Lubricants^ 3-8(.1.1!Wt Raw or Pmtiaily Cooked Animal Food and '7-206.!1 Restricted Use Pei icides, Criterm* 7-206.I2 ( Rodent Ban Stations" Raw Secd Sprouts Not Served. 7-206.13 'Tracking Powders,Pvst Control and I 3-80LI}(C') tinopen,d C'ood Pac6sge Not Kms-sewed. r� ivtonitorinr* CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 '6`8.11 Comumer Advisory Posted for Coneurnpnon of :lnintai Foos That are Raw. Undercooked or I<i Prooer Conking Temperatures for Not O:hc=wise Prrr;ss_d w Eliminate HF Ps F,a,ry:,I vrcow I3-101.11AO)(2) iggc. lis"FiSScc I Pathoacnt..+. { -30''.13 Pasteurized Eggs Substitute for Rain Shell Eggs-hrunediate Service 145`PIS,,ec+ 3-401.i I(A)(2) Comminuted "Fish,McanEggs. Animals 115'17 15 sec. SPECIAL REOU€REMENTS � 3-401.I1(Hi:,1){21 PurFand Beef Roast- t30'F12imin* � 3 401.11(A)(2) Raines,Inje,.tedMeatt- 155`F 15 I 590.00o(A)-t D) Violations of Section 590.009(A)-(ll) in sec.* catering, mobile food, tcraporan=and 3-401.11(A)(3) Poultr:,":iid Game Staffed PHI•s, rc>.dential kitchen operations should be Stuffing,Containing Fish,Meat, debited under :Alto appropriate sections poultry'or Ratites-165`17 15.sc... 1' noire ifrelated to(i;rnibnrne ilhnesS 3-401.11(0(3) Whole-muscle,Intact Beef Steaks interventions and rick tactors. Other 145`17 x 590.U09 violations relating to good retail ! 3-x=01.12 Raw Animal Foods(:oohed in a practices s;wuhl to debited under tr29- R".!crn-,aave 165°F'' Special Requircnneuts. I 3-40L11(Aulyb) All Othw PHF, I-Ii-F 15 sec. '* 17 Reheating for Hot Holding ( VIOLATIONS RiLATED SO GOOD RETAIL PRACTICES 3-403.1I(A)SaD1 PHFs 165'F15sec. ' ( (Ijetnt23-30) 3-403.11(B) Microwave- 165` 1;2 Minute Standing CriliLrd and non-crid,al vrukmons, n+4u.h do not relate to der Time* I jixodhnncr tllness iur;•;irntrans inn riskjaci,:n listed above, ran be 3-403.1 1(C) Commerciahy Processed RTE Food- iJound is the fine �-ing rertiona of the Fuoa Code and 10 CMI? 140''F- 590.000. 3-103-11(E) Rentammo Unsttccd Portions of Becf Item Gantt Retaii Practices i FC 590.000 Roosts* ( 23. Management and Personnel FC-2 .003 j8 Proper Cooling of PHFs 24 Fo x'and Food Ptotxtion FC - 3 0C4 25 Equlpnnrr..and Utensils FG-4 005 • 3-501.14(A) Coohng Cooked PHF,, Goin 140"F it, 26 ''hater P,umbinq and Wl' to FC-S 006 _---_-_ 70°F 14 ohn: 2 hours and From 70'F 27. Phv.^,:.,al FaciLly FC--6 .007 to-9 t'F'45"F W9tlnn 4 Hours. " 28 Poisonous vt Toxic Materials >=C-; .003 _ 3-501.14(B) C'oulin,;PHFs Made From.Ambient 1 29 Soecial Requirement, I OG9 l Ten:pctatareIngredients t„41"Fl-,iF 30. Other - --------__J Within 4 Huurs* •.,`�„"�°"'.., D11101+F t,ncLJI 11011,H)1110 leder.d 199')Food C gle ur 105 CP;k 591 t o (). I � CITY OF SALEM BOARD OF HEALTH i Establishment Name: Date: Page: P- of -'7 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY USA Irl 14.11 � 1117 1101..,' Aeea, r ti„4 .�eo /fGiL✓l 4 I I I I , ' I 1 • i I I I i I Discussion With Person in Charge: Corrective Action Required: ( ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food Code. 1 understand that noncompliance may result in daily fines of tw ty-fif e dTola7rs f s7pe of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: t(C' PHFs Receiv,dat Temperatures Violations Related to Foodborne Illness Interventions and Risk ,a e'otding to T.aw C,ii-.led to Factors(items 1.22) (Cont) -0I`F!45`F Z1htInn4Kom s. ' PROTECTION FROM CHEMICALS ' 3-50:.:5 Ci* tut_ ;bledzods for PHF4 14 Food or Color Additive= 19 FHF Hot and Cold Holding 3-501.16,'B) Cold Pf1Fx Slaintained at or below 3-202.12 Addiu%cxs 590004(F) 41'145'F, 3-302.14 Protection trom Unapprowd Additives" ! I ;_501.I6.(A) F.r+t PH. .: v� Rtauttamed ah:rabove I 1.5 Poisonous or Toxic Substances 1 7-10i.il IientilVmg Information-Original Cuutainer," 3-501.1601 Roast;Held at or abuse 130°F. * _ 7-102.11 Common Name-�6+�rkiar:,Coriainets" Time as a Pubic Health Control 3-501J0 Titr+c as a Pubiid He_,'th Control* 7-2ULI1 Separation-Stortec" 59.).0u4(H) r,' ,, � 0 I n.mcekega+rcntent i-_t12.11 Restriction-Presence and (.'�se` 17-20'-.12 Conditions of Llsc' 263 1 i Toxic Cnniantors-Prohibitiron,,. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20,11.11 Sa»tizets.CrircrlaPOPULATIONS(HSP)-Chr+nmals'^ i 7-263 !2 Cherncals for W'asbme Produce, Crites" i 21 1 3-301.1:(At Cttp nsrrunzed Pre-packaged Juices and Be,•eraget:W+ih Warn;nx L bels^ 7-204.14 Dr•;ingAgents.Crdetia" � � 3-80t.1I(B Use s ) Pasteurized Egg * 7-2105.11 RcsInctrintel Fax)Contact.Lubrter n`'* 13.501 A 11 D) Raw or Pm-tialh,Ctntked Anima Food and 7-206.1 t Restricted Li::r Pestir,des.Critcnn* Raw Seed Sprouts Nut Servrd 'r j 7-206.12 Rodent Bait S(aGnns* ' 7-'_06.13 Tracking Powder,,pest Control and I i 3-SO1.11(C; Unar:ened Food Package its, ' Monitoring* COhJStJ45ER ADVISORY TIMFJTEMPER WURE CONTROLS 22 3-603.1 i Consumer Advisory Posted fOr Cansuulption of + ( Animal Fr,ads that are Raw.Undercooked or ib Proper Cooking Temperatures for PHFs N-4 Ciheraise Processed to hlitrunate 3-101.1IA(1)(2) Gggr ISi'FISSec. Pninc';2o ns Fees-Lumediate Srnicc 145'Fl5sec* =_ .1 I P::steuri,%�d Eggs Substitute for Raw Shell 3-401.11(x;(2) Commintued Fish, Moat,&Game Ejncs' Annuals- 155'F 15 se,. .' SPECIAL REQUIREMENTS 3-4!!1.11(A)(21 Ratites.Tnjcflc;lMcais- 155'515 Pork and Beef Roast- 130"5 i'_1 mine 3_.{01.U(AH2t -390 00 r 9(A)-(D Vialatioes of Section 591)0091A)-(])) in � sec. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuf;ed PHFs, tesidentia) kitchen operations should be Snuffing Containme Fish,Meet, debited under the appropriate sections Poultry or Radtcs-165`17 15 sec. * I above if related to foodhorne illness 3 401,11(()(3) Wrho!e muscle,Intact Beer Steaks interventions and tisk lactors. Other 145'F* 590.0()9 violations relating,to good retaii 3-401.12 Raw Animal F+,od:.Cooked in a practices should be debited under#29-- bliwowacel65`Y" I SpccialRequiretttents. 3401.1 i(AI(l){b) All Other PHPs- 14-,')F i5 we, ' 17 Reheating for Clot Holding j VIOLATIONS WLATEV TO GOOD RETAIL PRACTICES 3-403.I t(A)&(D) PHFs 165'F 15 sec. ., (Ifernk 23-111) 1 3-403.11(B) Microwaw- 165'F 2 Minnie Statdina C�ilncal acrd non-nidral violations, nh0i do not rotate m thr Time* rtvdbarnr i'4ms.c o:rerrentivns and tiskja,rors liwtd above, can he 3-403.11(() Cammcrually Processed RTE Food ,menu'is rhe fullwk inti• ser?ions of the Food Code and Ilii Clvlk 140"FT .59f).000- 3-403.11(E 90.!100.3-463.11(17) Remaining,Umliced Portions of Beef I Nz^m 1 Good Retail Practices FC 2 ,590.000 " 2 m Roasts3. 1 Managoent a:d Fersonrel FC- 003 t3 Proper Cooling of PHFs 24. Few and Fond Protection 004 25. Gqu+omnnt and Utensils FG-4 , 005 J 3-56 L 14(A) Cooling Cooked PHFs from 140`17 to 1 26 Water Plumbinq and Waste FC-5 1 006 70'F Within 2 Hours and From 70'F 127 PhVsical Facildv FC--6 1 .007 1 to 41'F(45`F Within 4 Hours. 't ( 25. Poisonous o: Toxic Materials FC--7 1 008 ! 3-501.14(B) Cooling PHP,Made Front Ambient 29, Specie:Requirements 005 Temperature Ingredients In 41"F(45'P 30 Othe: 1 Within 4 Iloure* "10r'.`". Denobes critical item 111:hr oden] 1494 Pond Codc or 105 CNIR 590 000. I i �bL .1 �g b If i Z 3 " J� 4 - _ f Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvoe of Operations) Type of Inspection Nl leo s 122/ b�Wloy 10"Food Service ❑ Routine Address3?3 �� y(��L Risk El Retail e-inspection Level ElResidential Kitchen Previous Inspection Telephone 7 V y- 9 7S-Z f'"l ❑ Mobile Date:G-IS-_C7 Owner HACCP YM ❑ Temporary ❑ Pre-operation N"to 6(/f4f ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) S Time ❑ Bed&Breakfast ❑ General Complaint In: [I HACCP ector Out: E] O herr P /1A�r A d'Kccdtdl3AVM f��aitdv�! e Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding VSeparation/Segregation/Protection El20. Time As a Public Health Control Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR r• C Health. 590.000/federal Food Code. This report, when signed below �� 23. Management and Personnel (Fc-2)(990.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901nspecYFomS-14 doc Inspector's Signature: Print: PIC's Signature: ^I Print: � Page_of CZ Pages v Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Ci oss-contsminanor. j j 1 590003t A) ( Assi;znnientot Responsibility 3-302.11(A)i 1) Ra•.4 Animal Foods Separated &nm 590.l03(13) I Demonstration of Knowledge* j Cooked and FTE Fotals" j 2-103.11 Poistiuinchante --Julie, j Contenvnerfoptron)Rawingredrent 3-302.11/A)(2) Rack'Amindi Foods Separated from Each EMPLOs'EE HEALTH 0th.cr' 2 590.003(0) Responsibility of the person :n charge to ( Contamination from the Eaviraxuent ! i require reporting by to employees and j 3-302.1 I(A) Food Prntection" j applicants3-30'2.15 Washine Frwts and Vrretables 590.003(F) Responsibility 01 A Food Employee Or An j 13-304.11 Food Contact whit Equipment and Applicant To Repoli To The Person In i Utznsi(s Ch.v'ce* contammahon`om the Consumer S90.?03(Cil Reporting by Person in Charge* j ( 3-306.W(A)(P,) Reiurn.d Foed and Rcs;rl ice of Fund— i 3 590 003(D) Exclusions and Reshictions' Dispos:iicn of Adulterated orContaminated 590.003tE) Rennn:d of Exclusions and Rcslricunns Food 3-701.11 Disc.:rdmg lir Reconditiornng 1"nsafe FOOD FROM APPROVED SOURCE For✓'µ j 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces S9G 004(A-B) I Compliance with Fu-od Late` ( 4-501.111 Manual War.aka Jrng-riot Watet jjSanitization YamperauircO j 3-201.12 F(wd m a Hermetically Seed C Sealed 3 -07.73 Fluid Nlilk:m3 Milk Products* 4-501 112 Mecltaniad Warew•ashinp-Hot Water 3-212-13 Shc116gns Saruazntiutt"(emperahu es"` 3-202.14 Eges and Milk Products. Pasteurized" j }-5(?7.174 Chrtnieal Sanl((u'1TIei1-temp,pH, ctmcentiatinn and hardness " 3-101.I(i Ice Made k aro Potable Drinking Sara 4-6W.1;(A) Equipinent Fcxd Contact Surface.,and j 5-701.11 Drinking Ratcr fnmt an Approved System* ! 5y0.0b6(A) Bottled Drinkine Water" t)tcnsilz Clean* 59(1.006(13) Water Was,Standards in 310 CMR 22.0' j 14-602.11 Cleaning Frequem•ynf Equipment Food- Shellfish and Fish From an Approved Source j Cuutact Surfaces acrd f1te nils" _ I 4-701,11 1=reyuencs-of Sanitization of Uten ils grid 3-_'01.14 I Fish:nod Kzeteaiionally Cauglll bfolluacan Foil Contact Swfaecs of Iiyuiprc:ent` j Shellt7shT 14-7(F.11 Methods of Samtizadon --Eioi Water and 3-201.15 molluscan Shellfish front NSSP Listed l Chemic;l= .Sources* I 1 Game and Mid Arlushxoms Approved L,y i0 Proper,Adequate Handwashing 1 Hams and Army" 1 Re_qulatory Authcrif✓ ?-30:.i 1 Clean t-'undiuor.- i � 2-301 12 C9eanin:;Procedure" :i-20? 1 S Shellstock Identification Present"' 1 5`)01104(0) Wild Macltnxdm'' 2-301.14 Pollen to Wasn,. : 201.77 Game;lnuntds" '= Genii hygienic Practices 5 ; Receiving/Condition ( 2-401.11 Erta:c, Drinkire,or i lsme l'obacco, j 3-201A :nt1 PtIN, Rk-Lcv,ed at Plover Temperatmer." j I -,}i;i.'.2 ilisdhurgc;From the Eye:.. \nse a:d iYiouth-' 3203.15 Packagecp'rity" 3-301.12 PrevrtnimeContaminaloonWhen Tasting, 3-i01.1 I Flood Safe and Unadulterated Prevention of Contamination from Hands f. Tags/Records:Snelistock ,.1 Y Shellsux.k Idenilrc. 3-,r„� 7 -_7tion 590.004(1.) Piecent:na Cwrar:mcatinn from � ` i i 3-103._12_ _ _ ; Suell+tc,L}:Identification Maintained, F, I Tags/Records:Fish Products j j 13 Handwandvoash Far_ilities j j I Con�reniently Loc,atad.r^d Accessihie j j 3-402.11 Parasite D:structiva4' 3-402 12 Records,Creation and Retention" I 5-20-3i.I I Numbr-rs and Capacitors" j ?�O.GGM1LIf Labeling of Ingredients' j 5-204.i I Locar,rar and Placement' j 7 Conformance with Approved Procedures j '`-205.11 Acccssibildq Operation and Maintenance j 1HACCP Plans I Sup;:.Yed with Soap and hand Drying 3-502.LI SpecwEvi�d Processing Methods" j ! Devices 3-502.1' Reduced oxy¢en Packa_my,,ttttn'in' ' 6-301.1 I lland',:ashin}Clean+ : AI'ailalu ly j if-10,1.i 2 C'nnformance with Approved Fnxeduras'' ( � 6-301.12 [and Drying Pn>.ii loin j `Ucno:aw trilled nanr in ilte.tcdual 1999 Fn,n Code of 105 Cldli°':uJIlID - CITY OF SALEM BOARD OF HEALTH Establishment Name: h//KSS /0/77& Date: G/w bw Page: Z- of o2 Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY n/P �ir�. rpGr�vu +ivPi�c AC� P,i,4rQ., n iPa ,/PrL�LL/ A!,✓ AWWI l/fin/,7144r s r ..Li/ i,✓ /-/. c< I-AAvc. <Aovy, 1 I � I 1 I � I � F � F Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 7: PHFc Reserve_{it'1'emperatur:•s --- Violations Related to Foodborne Illness Interventlovs and RisA Accord)n•,:to Lav:Cooled to Factors(items 1-22) (Cont) 41''Ft45'F Withi:t 4 Hours. PROTECTION FROM CHEMICALS 19 PHF 3-501.;i Cooling Med..,ds for Pf4Fs 1 14 Food or Calor Additives 1Hof and Cold Holding 3-3c)1.1(if B) Cold PHFs Maintained at or below 3-202.12 Addiu,es; 590.00-f(F) 41%-ti°F' 15 1 3-302.14 Protection foun Unappox,cd Additives" 1 INA) fi•,t PI-IFs Maintained at or abode Poisonous or Toxic Substances I 1710111 Identitym1(rhclnformation-Gctginal I 3-501.16(A) 140-F;Heldatorabuae130`L- Container:,' j 7-102,11 Common Nnnte,--Working Containers" 70 Time as a Public Health Control 7-201.11 Separation-Stontvr' I 3-501,1) Tune a:.it P;+biic Health Control' 7-202.1 I ReAriction--Presence and Use- I � 590 0041 I-1i `;:.riance Requirement 7-202.12 Conditions of the` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j i 04 11 Soni iters. neem- Prohibitions{ POPULATIONS(HSP) 7-201.11 Sanitizers.Critena-Che+ricals^' j - 11 Pte- ' :, t 7-'_03.12 Chemicals ter W'ashm�Produce,Criteria' I _1 Sof. (A) Lnoaeteurized . p•u}.age..else and Bevrr,ices wadi Warn;n�Libels* 7-204.1,1 Drying Agents.Criteria' 3-80L i 1(B) Use of Pa.teurized leis' 7 205.11 Incidental Food Contact. Lubucant.c` j 7-206.11 Restricted tire Pesticides.Criteria* 3-80;.31 iD) Rau-of Pi aially Cocked Animal Food and Raw Socd Sprouts Not Set ved. " j 7 206.12 Rodent Brut Stations` j 3-801.11(C') Unopened Food Package Not Re-served. " 7.206.13 Track+ng Pomden'. Pest Cnntr,,l and - Monitorm"t* ' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 2�2 3-603.11 t onsumer Advisory Posted ;or Consumption of Ann nal Foods flat it, Ravi, Undercooked or 16 Proper Cooking Temperatures for Not 01herwisc Processed to Eliminate PHFs 0,-e e. xr 3-401.I1A(1)(,2) Fggs- 155'F 15 Sec. Pr:rint;;ens. E;yes-hnntedisteService 145°F15sec� i ,1712-1.13 Rateurized Egos Substitute for R:tw Shell 1Ers's 3-40 LI l(A)(2) Comminuted Fish, �1cros&Game Animals- 155='F 15 sec. ' gpECIAL REQUIREMENTS3-401.11(11)(1)(2) Pork and Beef Roast - 130T 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 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Butting Containing Fish,Meat, debited under the appropriate section, Poultry or Ratites-165'F 15 scc. * j above if related to foodborne illness 3-I01.1!K)0) Wlro!e-mus�(e,httact Beef Steaks imerventions and risk factors. Other 145-P m 590.009 violations relating to gout retail 3-401.12 Raw Animal Foods Cooked in a I practices ;hould he debited und.r#'9- Miciowave 165'F p - ;i R;yuirctents. 3-401.11(A)(1)+b) All Other PHFs- 145°F t5 sec. '' 17 Reheating for Hot Holding VIOLATIONS R iLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 seu. " ( (items 23-301 3-403,i I(B) Microwave- 165` F 2 Minute Standing Gircai ung!narrrrili,a,l iula6nns, nlrh.li do not rclur to B;e Time'' ,foodborne illness unci venuuns aril rind);rrmrs[Wed abmv, Can he 3-403.11 C) Commen+aliv Puxecsed RTP Food- bund in the folle,inq scrtions,!f the lord Code,,,,,1 105 CMR 140'P' 590.00o. 3-403.11(E) Rrutaming Unsliced Portions of Beel' Item Good Retaii Practices FC 580.00 j Rohslt v ' ( 23. Managenent amu Personnel FC-2 .003 _ l 18 Proper Cooling of PHFs ' 24. Food and^ood Protection FC-3 004 95. Equilin-:eat and Utensils FC -4 :OCS _ -SOL 14(A) Coulimc Cooked Pt-i(is from 140"F u+ 2g, Water, Pl:,nhinp and Waste F( -- 5 -- -.006 70'F Within n 2 Hours and From 7W!' 27 Physical Fae lav FC-ti ; .007 l Lo.t l"F7451-Within-(Hours. '" 28. Poisonous or Text,Materials PC-7 .0'+8 7"501 Wt B) Coulms PHF:,Made From Ambient1 29, Streeta,Reauitements 009 l Temperature Ingredients to "I'F(45"F 30. Other 1 Within 4 Hnurc:x ."cN ' !)enures cnacal nem to ilte f••doral 1900 Food Cude or Ulf.CPIB 590 000. 'v Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4`h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ' SDate Type of Operation(s), Tvpe.of Insoection 0/� AeO 11 Ait•J U& N O #r 67sl1eN I B-Trood Service routine Address 33 3 �iirltyl r-as; Sr Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone -7 r�y_ 9752 M ElMobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation N IXO Pat-" I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP Inspector 0Apl0 (LR-4&eStl8q-VM Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [__1 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT _ ❑ 12. revention Of Contamination from Hands El1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS E] 2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ' ❑l88�Separation/Segregation/Protection El20.Time As a Public Health Control ®f9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP f" El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [:122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 4. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of thisord . q 30. Other DATE OF RE-INSPECTION: `��/O S 5XInsp CtFom 14 dm i Inspector'sSignatuPrint: // PIC'sSignature: Print: {�7�7Q \ ��G�YIi, PageLoJ? Pages C i W01410017S Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PRUIECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 1 (,-/ass-cordantinatio'l I I(A ifl) Rcw Antinal '3-eparated L-om ;Q0,003(A) 1 A:mgnmere of Respi,jmbilitv' 590.(103(H) Denionstf alion of Knowledge i Cooked and R715 Foodsx 2-103.i1 I Percoji in chalee-kltics Oonte,il.tnauo^trot,Pa-,frigredients 3-302.:I(A)(2) Raar Animal Fo.xI, Separiniedi`rortt Fach EMPLOYEE HEALTH 1-1 2 590.003�0 Respoustbilik� of the person tit-,hqi�co) ConfarrinaWn fro,the Envirrmievrit le'luire rerlurnnt by fociii eniployev,;and3--02.11(A' Kxxi Prote��iio:t' app[icantO Frtjiu;,-n,l V--,etables 590 003(F i Responsibility Of A F.wxl huiplo)ee 0j An 4(kI.1 1 FcW C-itact xvizh Equipment and Applicant To Repoli To The Pel""n't al Charu,e' I Contamina!'on from the 0onquiner 590.003(6) Reporting b, Perst-ji in Charge"" ( .;-;J6 111 A,;V) I Renamed Food and #2-service of KKNJ 3 590003(D) FKcivisions and Rc,t]-ictiom, I O.'sposition W AdjIter3ded or Contaminated .n%,003(177) Reteovaini Exchmons and kestvictions I Food i 70 i.ii Discarding or Rveondownin,, FOOD FROM APPROVED SOURCE i Food 4Food and Water From Regulated Scaitrej 19 Food Contact Surfaces 1 4-10 i.I I I Manual 1Xajcwa4nrw- Hot NNatet �90.()(kK"B" Compliance with Food La,k�r saniti".1ahal ,�-2W.12 Food in a Hermetically S�tied C.otit.iincr` 1 ,:, Nfechamc,l Warce ��rshiij-Hui WaLtr Fluid MdK and Milk Productsts 3-20!.13 3 4-5()1.114 ('�.ernjcal S�.n;dzatmn-tc-nip.,pH, -202.1:; Shelf S 0--2ii2 11 Eggc and Milk Products. Pastemizd- COPCentiation and haid-wsF, 3-202.16 Icc',Yllede Ftem Potable DrmkifigWa*er' I 1 60:.:1(A) Food and 1 5-101 1 flunking water front an Ar.pj,)Vcd Systiall, i I ;96.006(A) Bottled 4-602.11 (71eaniiq, Fre(juvricy of Equipment Fo,rJ- %der Meets Standards in 3 i CNIR 122 Surfaces and (Acntals, 9hcf'(ish and Fish From ariAppimed SOW00 I %02.i I F-.,q;jmfcv,-.f�ani!ivafitijj of.Uteit�Hs,and 3-2V 1.L4 ht Molluic'.11 Fo.wl Ctakioia Surfaces of Equmnien!x 'helifish' 4-�O;.11 Nhithod,of Sanitization-Bn Water ural 3 Molluscae;Shellfish irona NSSF Listed-2r I�15 Sources* it' Proper,Adequate Handwashing Car,(?and Wild Mvahrosna;.Approv�i by ( 2.lw.: i Clef,,Condition --Hands !ad Aians4 qupalprory Authority Shiillstckk filtriti-icntion Present` 1 I =20I 1:, Cleari;na rroo-dum" 2-301.14 'NT-011 to W3,Slit 5oij.004(Q Wi!d Mushrooms* - Good Hygienic Fractions i-201.1 7 Garne Animals* F Feceiving,'Condition I 210!.!: Ex'np 1 12 Disch:o,�,,n, From the Eves, and ,.I I P111s Received Piope.,Tviopefatures' Month:: a i-30;.12 PreNenting Cuntamination When'atrial" 3-101.11 Food Sitfe and Unadidicratee TaristRecords!Shellstock i- Ri 12 Preven of 10rdamination front Hands Shellstock identifiention- u; n(I Il 5rri%cnihic Contamination from _)-A -3-203 11 sh,-!ktock ldmatific,qion Nlamtio�,,d" I n 4a�ldwash Facilities: Tags/Records:Fish Products Conveiiertiy i Xlteddhd Acc&SSble 3-402 D(iiAJUCti011* 5-203.i I Nuint)IN and 3.402.12 Pe��oi 6.Creation and Rcft-5i! on 59000#(.1} Liabding of Ingredients* 5-204 1 !:.,cationandplie'viarlit* Conformance with Approved Procedures s -o�.I I 5Aucp�evsjebi,itry,operation and Maint cnan:e HACCP Plans H 1 ,Soap a'o Hary prying 3-502.11 Specialized Piocessmy Nlethodn* 6.301.11 Handwashofc Chiairsta,Av-h,Ih:htv 3-502.12 Reducedmvultm i3O(11kagmlg.rriteiia' Devises 6-30L!2 H-and Drqng Provis;i,�n F� I o 3,12 Ct if I ro:ma nve with Approved Prot:e Rues* flenig e"citric d der tit itis 1,it.1 it] !991)Food Cooe"I 10::C I A R 590.000. A CITY OF SALEM BOARD OF HEALTH s Establishment Name: //�kGh�t` t017W-A-AW LoArrrA_CF, Date: 41f�/W Page: Z of Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified PLEASE PRINT CLEARLY a/61Vi- /11wo Flza&zal;ge ""I"Tf1JF' I 699,0"OX: afv! St ac ,4r1 je,,w r r-lsof mx A4. Afif r^cr.e,_ , II T-d rr eaMaoAe- ^'&—.6n9 A" 1+,E( !'' !'�.ns,1Jr N11CC.I,/A n/I1^M e_ewrlascwrAt_ 49:! '- /050W c�Nec�6,�60 rso,,o -- Ae t - Ir—eAaaO 1 W murr Ax- At~ /hwl,r- M IS.QI „ - n*ictMnh.�t�E'!� /� Y4f r/4 4,>< ✓/SillClt A-cr t A-A-rt£ S'rj-ja_'MMw d f6 ri�iC _ ei-9C Pt AA I SC i FC/- Wlds iL_MnAcrQ__ .(fir a Lf)Q.0 rl/St/Szx- fA[i'�I.chfl: c ,rllir IL..u.•1,t,1:i7C.c. SII 1 Z� �� -� A-AGr-,rMIrFrrIC P>cit.V 1n,: V 1 S I- BL& iJ c.r ..5. arlE 111-4i &4-'A~WICrA'x- /3 G -• M41-ttOL rt 3Pt S/N/t rAS y rwr) G78AMY. /0 aNX/#%r4 PH S'J 9k ^4 tis r A,*- r /.,c 4A- .s„rO A ce-4£ss I fa -k AP I 9 G c<�'Ilr� /3ar,cDs a,.E sv,o-. p ANO SrwR.��. /t�55"ures I f Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P 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 su�nsion/revocation of ❑ Embargo LI Emergency Closure I your food permit. ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Riax Acxrd,n-,to Lrw Gu)led tij Factors(items 1-22) (Com.) I'T-/-15-F Within 4 Hours. PROTECTION FROM CHEMICALS i 3-5111.15 Cootin M 2iodsforl'HFs PHF Hot and Cold Ho?d;ng 14 Food or Color Additives I I 3-2W.12 Adilit,;l3 soi.!uB) CA-1 PI`;Fs.%laintajnx1 at or beim 3-302,14 Protelo ion iron(Joapia oN ed Additives" =130 U,14CF) 41Vdfl'Ft 3-501,16(;1; I ii).PHF, Mmintamcd at in abtl`ll, 15 Poisonous or Toxic Substances 7-101.11 Identifying Inloi orition-Original I 31-5o I.WAI) Heid at or above 1'0'F. 7-1()2 11 Common1sove WorkinuConwiraqs 1 20 Time as a Public Health Control 7-101.11 Servradon-SlojaFel, 3-501.1': T irne a.,a I"lublic Health Control* 7-201 i i Restric!ion - Presence and 590.004(H) Varlamc k"OLdreti:eni 7-202.12 Conditions of Use:' REQUIRHAENTS FOR fllr�HLY SUSCEPTIBLE 7-203 11 contaieit. - Probihirions' 7-204.11 Sanitizes.Croerm--Ch?iaiczt��s POPULATIONS(HSP) 7-."144.12 Chemicals for ftsfanL,Produce:Criteria" 21 3-801.11 t A" Unp.isteuriarf Pie-paekirged huces and 7-204.14 Dryine Alrentsl Criteria' Fe�,trage,,wirh WirnmL,,llalicis, 7-205.11 Incidental Food Conlam 1.ubricants� 4 �(B) Use of Failwin ized Ege,� 7-206.11 Restricted 1,75.2 Pestm&.s C"racn.)l' ;-go'A 1(D) Rx.v or Pwt.:i0v C-:tl�ed Animnl Biod and Raw Seed 4�vrouj s Not Served. 7-206.12 Rodent Bait Stiuioni,' 3 ullopencd F(YM liaAas e Not Re-served. I- I Monitoring* 7-206.13 Ttack:r�,,Pr,,s1vn,,Fest Control and ...... CONSUMER ADVISORY TIMEtTEIMPERWURE CONTROLS 221 2-601 if Consumer ktkilory Posted for Consumption of Fot�s! Animathat arc Raw.Undilicooked or 16 Proper Cooking Temperatures for I _1� . r Not oalr�:,e, rLwesq PHFs I �ed to Eliminate 3 4 01 11 A(;)(2) Egg.- 15� F i 5 Sec. fiathog.ii!. * "' ;,:zoo, 3-302.'j Pasteurized Fgg�SL[tsloote 101 Raw Shelf ru Eg',n-hnediateScrvice 145"P15scc^ I 3-401.1 i(A)(2) CV111moulted Fish,meals&Game Eeg, Animals- I 5i'17 15 sec. 1 1 3-401.11(If)(1)(2) Porkand Beefflo.ist - 130'F 1?1 min" SPECIAL REOUIREMENTS 3-401.1 t(A)(2) Rattles,Injected file:as -155'F 15 59.4�009(A� f D) ViolatiOIIS Of SCLtion 590.009(A)-(l))in Svc. CatCi*ing. ynol);kl food. Lernpo;ary and 3-401.1 [(A)(-,) Poultry,Wild Came, Stuffed[if lFs, elidcotiall kitchen operations should he Stuffing Curtaining Foll, Meal, dcbj1Cj under the appropriate selttoril; Poultry or Ratites-165T 15 sec. I ah(ele if related to focjborn, illness 3-401.1 i W)(3) Whole-musele, Intact Beef Steaks intcr,,ei&ons ,not risk factors. Other 145)F : 590.01)9 violations rolvting to good retail 340;J2 Raw Animal Foods Cooked in a ,iractiots should be debited imider#29 - Nlici owave 165"F Special R-qui villents. 3-401 1 l(A)(1)(Irt All Other PHF,l - 145'f' 15 sec. l': 17 Reheating for Hot Holding VIOLATIONS R.ZLATED TO GOOD RETAIL PRACTICES 3-4011 l(A)&(D) PHFs 165l'17 15 we. * (Items 23-30) 1-403.11(13) Microwave- 165°F 2 Minute Standim-, I Cl aL(d emit non-crfo(""I violations, which do not t elore In rhe Time- foodborne illness hiller vcnuons and risk fac tors "bove, con be 3-403.1 t(C) Commercially Procesed RTE F.x)d- r-lind in the fol!tAl oCq %ertioms of 11h Food Code and 105 C.AfR 140_F` 500.000 _ 403.1 I(E) Remaining Unslieed Portiuns of Beef ltem Good Retail Practices j FC 590.600 Rons�s�4 2q. toanaqcrn�st and riersaopl FG - 003 18 Proper Cooling of PHFs 24, Food and Food Protection FC 3 .004 25. Ellubn1cirt and UlonsiI3 FC 4 005 K 3-501 14(A) Cooliiw Cook.-al PqNq from 14-)'F it) FC-5 ooi� I I Water,PkJffJJ'i.qq and Wa�,ic 70T-Within 2 flour.;and From 7WF 27, Prvscal Faeifiv/ Fc -6 to 41°F7457 Within 4 Row Fol'sonous or Toxic Matantaiii PG-? L.028_ I 3-501 A-413) Cooliro,PI-IFt.Blade From Ambient 1 29. Special Re.-oirements 0019 Teraperatule IngrojiciAs to 41"F/45�F 30, cai-er within 4 Hours* 16.:1, Denotes cr...c ji item!n ih,h,leral JTKI rod Code or 105 CNIR 390 000. CITY OF SALEM BOARD OF HEALTH /� Establishment Name: I✓ KC7 P1 Zzrt- 4Wt Xfi,45 PJ"L�G, Date: 6114 'I'll Page: 3 of Item Code c-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY , 4-- 9 ('_ C i-I oPtSl` &&- /VAT /fir✓ i6CL_uf6&lC_Aa rAW 93f /0'00!1 lJtt` A4.T- A-KG' CZdncoelFzdCY C X_AJ✓ AKO &#6&Af k- a ZS C.. - Flo -74WiCr7,&j A SSA" wie%W n(y PAeI,&A- GeNeI�NQ'�r4�vl� �v14!lyd�CJS. SAnrf rr�,.ic svt ttl�r el✓ MVSf -A B& A&" 10 .f✓N1c.trgt� A� .4 tL Wmlx- s�,anuncS' .4►- �-c-C. r,�I c£'S'. \ I� M 2r7 Ar/0 4AC.0- 6e Ae, "Xt o^7s nld� N AS r r7AN. Ac L OBfr6r-S Vl> FT49 AE do r-bs -1CZ M u S r I ,Dfc S'ff��LaO, ftvkti,�,L rne�r41'mP/J nR- ctd f4 NrA-fvr�3 W!<.t.- /LfsS'U(,{'. I t i•! M r,,.r�c-rrf.t� fzrrz�r ..F �2 Sr,ot)' /FIs.�� /S'1`!l�' I I .o�d°A-rr Fa�esnr !��A.r4rr' 1 I - GneO e'cG.uff t4M- i -"OW '� 101crLsdN v tf r7 - Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance, ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit, �_ r� ❑ Voluntary Disposal 0 Other: ?H`rs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk Actoi uin9 to L.vs Cooled to Factors(items 1-222) (Ccot jl Ft-l5`'t V4nHr d Hous;. PROTECTION FROM CHEMICALS 2 ^.(:11.:5 Cooling 1lelhods flx PHFS l+; ! PHF Hot and Cold Holding j 14 1 Food or Color Additives 12 Adduiccs` ; _ ,, 1 (n i 6 1 ) Cold PF1Fs:dainbtired at or blow 202. j � 590,004,'F) 4''111j- .: 3-S02.Id Protection from Uuappnrved Additives" 13-501 160) Po,PHF:. Maintmned at or above 15 Poisonous or Toxic Substances 7-101.ti Identifying Information-Original 3.5;i1 16(.'\) Roasts Held at or above 130'F. ' Containers- 7-102.1 ontainers- 7-102.1 I Common ?lame -11'n=king Cat[ainers+ ( 2i` i'i "time as a Public Health Control 7-20(11 Separation-Stureero ( 13-50:.:9 Ti*ge as,r Public Health Conrro':'� 7-202 11 Restriction --Ptecence mid Use ( ( 5`-�J U'Jdf H) V;vian�e kccu,rement 7-2!•2.12 Conditions ul U.:.* 7-203 i I Toxic Contain.-,r,,-Prohibitions" PEOUREMENTSx FOR HIGHLY SUSCEPTIBLE 7-204.11 ssnitizers,Criteria --(Ecmicals" POP;{:-ATIONS(HSP) 7-20-4 !2 Chemicals for Washwe Produce,C.ritoria' 21 ?.SCI.::(A) Unpasteunze6Pre-pa�kagedJuice;and Beve!ales with W'arnme Libel i,- 7-204.14 Drying Agents.Criteria" ( j 3-SCT.: !(13) Use .,t Pasteurized h?gs' j ! 7-205.11 Incidental Food Contact.Lnbnrtnh^ ( ' 3-801.11(D) RawcrPatiali Ctioked.AnuualFood:ind 7-206.1 i Restricted l Ne Pe<tieides.C:ileua" ( j R,im Sced Sorauts Not Served." 7-206J2 Rcxicnl Bait Stations- 1( 3-90l.I 10 Unopened Pond Packa_�e Not Re-served. * j 206.13 '('racking Pon-tiers,Prat Control and Nton::orino�* CONSUMER ADVISORY T0111E7EMPER4TURE CONTROLS 22 3-b03 11 Cornu:ner Ad:-,sot}Posted for Ccnsumption of Animal Foods;fiat ate Rae-, Undercooked of 1b Proper Cooking Temperatures for No:Otheiv,ine Processed to Elinunaoe PHFs13-46 LI I A(I)(2 i Eggs- l.`5"L- ;.5 Sec. Pathu:ens.^ 3-301.13 Pnsteunzed Eggs Substitute for Raw Shell hints fronediate Service Ia5`F,5sect 3-401.!1(A)(2) Comimnated Fish, Meats Fc Game Egg,` gg`w Animals- 155"F 15 sec. ,: I 401.11(13),11(2) Por6tnd13MRoast- 30'F1_ min=' I SPECIAL REQUIREMENTS 3-401.1L(A)f2) Rallies-Inje(ledMeats-155"F 15 590.009(A).tD) Violations of Section 590 009(A)-(D) in Sec, - I caterine, mobiic Food, tanpontry and -101.11(.A0) Poultry,Wild Game, Stuffed PH.Fs, readcrdial kitchen cpzratio,:a should he i Stullow Comaining Fish,Meal dcbi:ed under the appropriate sections Poultty or Ratites-165=F l:i sec. " above if retitled to foe iborne illness 3-401.11((')(3! %%ole-nmsele,Intact Beef Sieakg interventions and task factors. Other 145017,. 590.009 violations relating to good rete! 3-401.12 Raw Animal Fo;xls Cooked in a i practices siiould be de!vited under 6'29- Microwave 165^F* Special Roauirerncuts. 3-=101.1 I(A)(I)(h) All Other PHFS-- 145'F 15 sec. " 17 Reheating for Hot Holding WOLArolvs R2LATED TO GOOD RETAIL PRACTICES 3-403.11l,A)&0)) PHFS 165'F 15 sec. i diems 23-399 3-403.11;B? Niicroa'avc- 165'F2 Minute Stand:nc Cri?e<d::ud non-rrilic(d cudatu,rs, w1tich do nor oalert io the Timex' ,foodborne dine;ss inter erntons and risk fii(lor:�(i tied oborc, an he. 2-403.11(Cj Commercially Pt messed RTE Foud- ,found in the Joilnu,ing�eridrn.t of th'e Find Cod,-and NLS CMR 140'F* 90.00. > j !tern Good Reran Practices FC 59o.o00 -..iO3.1 J(E) Rerxiuung Unsliced 1 orticns;,f HecC ------1 --- 23. hAanapement and Personnel FC-2 ,003 Roast." j 24 I=ood and Food Protection FC-3 004 1$ Proper Cooling of PHFS I ! 25. EquWater, Pt al:d Utensils FC 4_ ,_.005_ 3-5(Il I4(tl) CuaLn;,Cooked, PHPs from !till'1=to ! 2&. taster,PI!.mhinq and vVas!r. FC-5 006 7W I- Within 2 Hours as-•; Fro:o 70"F � 127 Firwea(Fac,lity PC--6 007 j to 417/457 Within 4 Hour;. al- Foiscnous or Togs n9ater:als F,3 -7 .008 3-501.14(3) Cooling PI-IF Made From Ambient 1429._ Soecial Requirements j OOS Temperatare Ingredient;to 41=Fi45'F I Within 4 Hoarse Qervuat enuca{itun m the fedetz! 1999 Food Code or 105 CtvIR 590 00R-:. P, Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 41" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name" / i D�Late� Jo y I Type of Operation/sl, T✓pe of Inspection /L////.•.s �72a 51 i�O q-Y- ,CSP F / �C / ® Food Service ❑ Routine AddressRisk ❑ Retail ElRe-inspection33 3 7Z2 S> Leve El Residential Kitchen Previous Inspection Telephone JyU�47 7,,; I ✓� El Mobile Date'�01 -03 Owner HACCP Y/N [-ITemporary ❑ Pre-operation /7// 5-;"; /)/"/;)/ I E] Caterer El Suspect Illness Person in Charge(PIC) Time ElBed& Breakfast E] General Complaint S'4w<f In: ❑ HACCP Inspector/ ��venfaru� Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. 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) El 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail.Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, signed below, when C N P 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (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: fins ector' SiQQ�ure: - Print: FIC's Signature: �''; Print: / I PageL of A Pages l Violations Related to Foodborne fitness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-conlomk7aton I I 59(1"003i A) Assignment otRcip(irisibility" 3-302.11'A)t P Rry Auinad Foody Sep:u.atcd fioun 590.003(B) Demonstration ol'Know ied- Cookcd and R1 Efooik* 2-103,11 j Fergon inChargeduticc j Contamination frcm Raw Ingiodiotas 3-30111(A)(21 I R:tw Animal Foods S.par,tedGran Each EMPLO"EE HEALTH Oih,'rl 2 500.0031C) Responsibility of the person in cliarne to Contaroinatien from the Eoveonment onflure reporting by ford crllployces and 302.11(;'0, Food Proleclion applicallis* j 3-302,15 j )N%3shuuz Frua.and Vegetables 590j)0Z(F) Responsibility OfA Fund Finployee Or An 3-304.11 Food Contacr will:Equitamentand Applicant To Report Tr The Person In Ltznrals I I Charge ij Contamination from.rhe Consumer 590.003(6) Reporting, by Person in Charge" 3-306.14(A)(B) Returned Food.aid R-scivi-c of Food 3l 590.003(l)) Exclusions and!-',cstJctuays* Dispos'ion of Aou!teralod or Coufdonfrnsed 500.0031 E) Removal of Exclusions and Restrictions Froo 3-701 11 Discarding of Rt-conditionin.,,Unsafe FOOD F IOM APPROVED SOURCE Food'' 41 Food and Water rrorri Ruguinter;Sources Food Contact Surfaces 4-50]A 11 Manual Warewishurnz-Kor Water 590.004(lA-B) Complranc,�with Food Law" 1 3-2W.i 1. Food at a flerineticalb,Seined Container" I I SanitizationfempciatLRCS* 3-201,13 Fluid Milli, and Milk Pi oducts4 "501.112 Alechani,al Witrcwarfimg Hot Water J-20113 Shell E,2.-,Sl Sialifization,Ttyneeralures" 4-50 i.I i JI Chemical Sanitization-temp.,pFI, '1-20114 Pugs and Mill, Products.Pasteunzcd' cow,entral ion and hardness. " I 102.16 lev Made From Putable Dr'akin,.�, Water* d-601 11:At Ecjijorriem Point Contact Surfaces and 5-101.?I chinking Water from an Approved Stislcni' 51)(10061 A) Bottled Drinking Ware,' 4 6(:2,11 C)eanirr�Frequency of l7quipment Food- WaLci klects Standcok in 310 CMR 22 0' Contact Surfaces and UtensilF* Siiellfisn and Fesh From an Approved Source I '1-'7()2,!1Frequency of Sanitization of Utensils and 3-201.14 Fish:mid RccrcalioaallyC.mOrt Molluscan 9heUfish* Food Contact Surfaces of Equipment'" 3-201J5 Molluscan Shellfish from NSSII Li,aed 4-703.11 Methocisrd'Sanu;zat'in Hot Waterand Chemical, Source"* tl} Proper,Adequate Handwashing Garre and Wid Alushrocrils Approved by Reflufatotv Authrritv ( ?-201.11 Clean Condition--bands Idmis und ,xi-nis'4 3-202.18 Shellstock Identification Present' 2 3e4.12 0eaning 590f004W) Wild Mus!uorans';- 2-301.14 When to Wash' 31101.17 Gmae Annuals* Good Hygienic Practices Receiving/Condition 2-401.11 r"no),,'Druikiag or Using Tobact,t) 3-11-12.1 i P111s Rdecoed at Proper Tempera(urts' 2-101.12 Discharges 1-rxii she Eyes, Nose and Mouth' 3-202.15 P'ICL.e tiltezrity* 3-101.11 Food Sate and UnadulteratedPreNcinurg Contamination 1klien Tastily Tags/Records:Shellstock 12 Prevention of Contamination from Hands 590 ir)*E) ?r,�xeriting Cuinxii,nation f,um1-202.1� Sheltstock ItIcntification 203,12 Shelktock Identification Maintained' Tags/Records: Fish Products j 13 Handwash Facilities Corverrently Localed 2nd A-e55ble 3-402.11 Paiasite Dertruerion* 5-203.i i NantAicas and Capacities" 3402.12 Record::,Creation and Relontion' 5-204.1 Location ami Placement, 590,0040 1 Labeling of ingredients* 7 Conformance With Approved Procedures 5-205,11 Ac;cssibila ,Operation and Nlainternin,e /HACCP Plans j I oupp6ed wifti Soap ano!idnd Crying 3-5`12.1( Specialized Processing Methods* De&oo 3-fu)2A2 Reduced oxygen Packaging,criteria' 6-301.11 lianclivnshing Cianj-.tt�ailalulity ,-W3.12 Conformance with Appro,'ed Pruc-durcs' ( tom 301.i2 i Hand Drying PrciviLion 19901"lo'Icojeol 11riCli1R?90,01i) CITY OF SALEM BOARD OF HEALTH Establishment Name: /1/r/fo< /9-2, Inst ems , /<t'0_' Date: U Page: -I— of '9'_ Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified � ) 7— PLEASE PRINT CLEARLY I (✓)OSfir✓/inn .7 ) ` i veS q41,)/�11,t/o W,91c [ �/p�c�rUASliirv4 �C/fu/77?�rU9 ? 7?1rn/ct /,Parr ,, v TorlP 74- '-) / a+5 - 'W// .��-2 s/r"C' vc. Z.1rr,< 7` ,t�F`Pl�s n_/_02,.��.vo 1 7/A,r 7' �/�SSi/L� ri/Sr�`P ��ci�PivT_ r�Pl�sa9cr fa /2s�v wtFrrrr <- c�rHar u n,€ Hn,Arht! ?�_. !/ n//01 S tv 9, t1uc.r,£P.n t .uA"e.FA It E"XP/G�I�FI��P — t�il%/nI7UdL a T I v fadc?f72�ApS vU.lrtnca,� ' 4t v, rlTsk". 'wtewt S/f'N/1'2 Zr A15� (10".er,P y Ct-0Ir � lr Rvc %E �ceayr1UD CV v ,pcu .-X/-r�e�ve vSUc r F/�s t /t l p f ! w lc�sf I✓ ,i,=uruu�I y✓ s, vcr✓ Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ les 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. / y �Y/Koi/✓/ �j�r , ❑ Voluntary Disposal 0 Other: 3-501.l4i0 PHic Ruccived at-temperatures Violarions Re;ated to Fnodbanre Illness Interventions and Risk Accord:n;b,Lair Cooled u• Factors(Items 7.22) (Cont.) 41'F/4-VF Within.1 Hours. PROTECTION FROM CHEMICALS '^ +-501.15 .'tvtlinMethods for PIiC= j { IJ Food or Color Additives I 19 PHF Hot and Ce:d Holding i-501.16(F3? Cold PHFs ;riaim•,tr,-d at or bchaw -3-202.12 Additive"' 1 59i1.C4)4(F) 41''(45" F"•' 3-'02 14 Protection trnm lhtappimcd Ailditites` SOL16iA` HotYtlF:. h+latntdi?: H 5 Poisonous or Toxic Substances ! ed at of above. 140°F 7-101.11 Wenttfomginformation-On_.;nal Cnntumer:" i 3-SOLI+;(.q: RuPac H,Id at o: ;;nn•.c i3{)"t: - I { 0_.11 Coruuton Name-Workinq Containers" 1 0 Time as a Puo!ic Health Control { 7-201.11 Separation-Stota);e` ( 3-Jot'.(1 19 Time a:it Pul',1ic Health Control;` I 202.1 1 R"tricl+on-Presence and l'ce'A 590! 4(IIl \ranano:Rcyairenwnt { 7-202.12 Cond;tions of Use ! 7-!!03 11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizeis,Cntela-Chenlic:tls POPULATIONS(FISP) =204 I_ Chenucals for\Va.hing Produce,Criteria" I21 3- UL1I(A) U-pas%uti2.edPte-pa.kagedluicc:,end Bevera%ea tiith Pv':trnm,F<+bt!;". 7-204.14 ChyingAzrnts Cuwti:t'' 1 ; Xli .1 (B) U,eofPasteurized F. S^ 7-205.11 Incidental Fnral O'•ntect. Lubricants* j ?-2.06.1 l Rc arictzd Use Pe,ticides,Cuter i:r' 3-S01 I I(D) Raw o:'Partial]),Cooked Ahura! Food and I '06.1' Rodent Rail Stat;ems" F:at Szed Sprouts Not Served. '# 7-206. 6. 13 Tracking!Powders,Pest Cont-,o! .md I -'-501.1 UC) t?nopened F,wJ Pat:ks+_>e Not Re-s<•ned ktun+tarmg" CONSUMER ADVISORY 22 3-603.11 Consuntor A.d+isoty Posted for Consamption of !'IMEtTEIdPERA7URE CONTROLS animal Foo in'Fhat are Raw.Undero ked of 16 Proper Cooking'[emperatures for PHFs { Not Othenv9se Pooerss'd in Eliminate 3-401.I1A(i)(2) E@s- I55°F 15 Sec. Paltaalens. E& rrr.v.N Eflis-immediate Service 145'FI Ssec" 3-302.13 Pristourized Eggs Substiuire for Raw Shell 3=+01 tl(A)(2) Comminuted Finn. Mem;& Garvie ""''% s\runtals- 155'F 15 3.401.11(8)(1)(:?) For and Beef Roast- 130°P 121 minSPECIAL REQUIREMENTS" I 9(A)_(D) Violas ns of Section. :t { 3-�40111(1i(2) Ratitcs,Injectedhdeat:- i55''Fi5 5)+ '""� i' T)G.00)(A)-( d see. calerine, utcbi;e foci, re: gxn'an'and { 3-401.11(A)(3r Poultry,W`tld Game, Stuffed I'H[s, residential kitchen operation, should be Stuffln„Containing Fislt, \4zat, debited tinder the appropriate sections { Poultry of RatheS-165'F 15 5cc 3bMl if i s"ait,d to foodborol- tlhtoJs 3.401.11(C)(;) Whole-muvcie, Intoe(Bzrf Steak: interventions and risk factors. Oilier 145`F"' 590.009 violat;un�relating to and retail 1 3-41)1.12 Raw Animal Footle Conked in a practi:,es should bc debited tinder J129- Vticrowme 165'1- * Special Requirements. 3-401.1I(A)(1)(b) ,Ml Other PHFs-- 145+ 15 set'. { 17 I Reheating for Hot Holding I VIOLATIONS R-LATEO TO 0000 RETAIL PRACTICES { 3-40111(A!K(D) PHFs 165''F 15 sec. t { (Items 23-30) 3-40:4.)1(B) Microwave- 165'F 2 Minute Standing I Cr'ihcal arrd non-tri;Ica(i ioiatio,is, udnch do not rchne to are Time* roe"ibol"l, ilinrs;:interrernions anti nsk(adorn i:steel ahnmq can be i3-403 1 i(C) C'immiarcialk Processed RTE Fadi- finu.d in du,fnitonvt);sc<'tiorrs of rLr fuu.i Cade end 105 CAfR 5vJ.o0o. 1-403 1 I(F.) Remaiu;ne, Unshced Portions of Beef Item Gond Retail Practices FC590.000 Roast," 9- Nianactement and Peisciard FC-2 .003 { 1g Proper Coming of PHFs 24 Food,and Food Protection FG-3 .004 25 i Fquipment and Utensils j FG-4 .005 3-501.14(A) Conlon,Cracked PHPs from 14Y'F to 21i Water.Plurnhino artd'JV rite IFC--5 .006 7WF Within 2 Hours and From 70'F 27 Phvs.ce;Fa:ilii•p FG-6 ( .007 in 41'F745'F Within 4 Hours. " ! ( 23. - - �Pnisonous or Toxic Materials IFC-? .00II 3-501.14(B 1 Coolow PHFs Made From Ambient { 1 29. Special Requirement.^, .009 Temperature Inin-cdientstozlff,'a5'F ( 30 Othei j Within 4Hours- " i ` 0.note•:riIca I Item in the Icderel 199s,1',+nd Code's 105 CM R:i90.( lo. C Michael K.Murphy,Esq. Partner MURPHY &RAYMOND LLP Attorneys at Law t � 60 Washington St.-Suite 202-Salem MA-01970 Phone 978.542.1900 Fax 978.542.1910 t Michael.Murphy@MurphyRaymond.com Im/�y I i �uM1�+.�, �ict� eco CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET. 4TH FLOOR SALEM MA 01970 TEL 978-741-1800 9P� Fix 978-745-0343 STANLEY USOVICZ. JR JOANNE SCOTT MPH RS. CHO MAYOR HEALTH AGF;JT 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 : Nikos Duni Name of Establishment : Niko ' s Pizza and Roast Beef , Inc . Address of Establishment : 333 Lafayette Street Type of Establishment : FOOD SERVICE Application Date : 01/02/2003 Restrictions : Permit for Food Establishment 215-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. ✓HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH m 120 WASHINGTON STREET 4TH FLOOR a" _ lits SALEM, MA 01970 TrEL 978-741-1fl00 9F�/M1NE�t�' FAX 978-745-0343 S-r.NLLr USOVICZ, JR JOAr•'11F_ SCOT1, MPH. RS CHO MAYOR HEALTH n.C.Gfll 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT A e-c7 JJ /1/72A � ° TEL# of -16 74" 9752- ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME TEL# 51' 7 72/ ADDRESS �d G/�✓��A-1 CITY �'�/A73®� 9 STATE /`Y/� ZIP 0 ll Ea CERTIFIED FOOD MANAGER'S NAME(S) .2At![i,'CERTIFICATE#(s) (�✓D of P-10 A�-1 1117r- (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON e,�J/.e--P!/LCHOMETEL# �7 HOURS OF OPERATION Mon. Tue. Wed.—Thu.—Fri.—Sat.—Sun Q� (fvE�DA-7 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE NO less than 1000sq ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq ft. =$250 RESTAURANTYES NO 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 YES NO $5 TOBACCO VENDOR YES NO $50 ALL ;'CM,PROF!T;-ruch as church ki'chens) 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 52C, 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 Signa tur Date Social Security or Federal Identification Number J_2_.3J__.02----------F -1 _ � � ?-� Revised 11/25/02 ODAP2 adn, Check#8 Date /a90 - /a-3�-oma ^"w^•'e+rli.'4-+u.�'°�'-.-.:F`.irr,.n,n+H^F�.t.r.w;.d^fn.:+�+:..ri�++..,rh.. n:...iin;: .' .+hn.m•+'H*+r�`^°t"� ,. �"'�^�....se •/" THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name �/ Date Tvng of Onerationlsl TT a of InsnectQ IfIl �� ®i�� i � - Food Service }�J Routine Address `� / /1 / Risk ❑ Retail (� Re-inspection Level ElResidential Kitchen Previous Inspection Telephone /a / �'7 C�'1 ❑ Mobile Date: Owner L7� / '- / HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) y7 f Time ❑ Bed 8 Breakfast ❑ General Complaint In: ❑ HACCP Inspector p �'�� Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items). Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE - TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ' ❑ 20. Time as a Public Health Control ❑ S. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing El❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical(C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C_N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 1 Inspector's Signator • Print: PIC's Signature: U 7 f/ I Print: Pagel of_ZPages FORM 734A HOBBS d WARREN - BOSTON Violations Related to Foodborne Illness k` Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 13-306.14(A)(B)I 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-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22 0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing 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* 3-201.17 Game Animals* 11 Good Hygienic Practices 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 I Package Integrity* I 13-301.12 I Preventing Contamination When Tasting* I 3-101.11 Food Safe and Unadulterated* - 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* Tags/Records:Fish Products 13 Handwash Facilities 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(1) Labeling of Ingredients* 5-205.11 7 I Accessibility,Operation and Maintenance Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 I 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* •Dentes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 2 Date: 2/43 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ' PLEASE PRINT CLEARLY I I I I I I I I I 1 I � Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion comply with all mandates of the Mass/Federal Food Code. I understand that P El Re-inspection Scheduled ❑ Emergency Suspension • noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _ 0 Voluntary Disposal ❑ Other: 3-501.14;0 PHFs Received at Temperatures Violations Related to Food•borne limens Interventions and Risk According,to I,i,v Cooled to Factors(Items 1-22) (Cont.) 41'F45 FWi J1m 41-Ioo.s PROTECTION FROM CHEMICALS '-50(,17 Cuai umr Ltrilitxls for FHFS 1.y Food a3-Color Additives ( 19 PHP Hot and Cold Holding 3-501.14(B) Cr,id PIIFn Maintained at or betoe, 3-202.12 Additnea" 500.0041 P) 41 ?5'F=` 302.14 Protection tram Irnappro•,ed Adduicesr ( 13-501.16,A) Hol PIFs:M sat:h1e + ued at:n above 1.5 Poisonous or Toxic Substances ( _4W F r i 7-101.11 ldeotif;Ing Information-Original I ;_501.16(A) Roasts 43eid at at above l3t"F Container:," ! 21) rime as a Public Health Control '7-102.11 Conunrnt Vance- VA++rk_ing Containers ( '-501.1 J Tune as a Fablir me.nt Cvn " in+i 7-201.11 Separation-Ston age•: 7-202.1 1 Restriction-Presence and Use' ! � 59UA04(H) A',u-lanec ReyuiRequirement 7-202.12 Condrt;one of Iae" ?03.11 'toxic Containers - Prohibitions*' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizels.Criteria-Chemicals' POPULATIONS(HSP) "(14 1'_ Chenurtls fur Wushiug Produce,Criteria" j 12t 13-6('1.1 I(A) j Unpasteurized Pre-packaged Juice,and 7-204.14 Drying Agents.Criteria* ! ! Bevera,grs withAM1'arning Labels* 7-205.11 hnridental Food Contact, Lubiic.inv,' ! j 3-Si>LI I B) Use of Pasteurized Eggs` 3-801 11(D) Raw or Patialiv Cooked Antrnal Find and 7-206.11 Restricted Use Pesticides,Cruet ia' I Ra'aSeed Sprouts Not Served. '7-206.12 Rodent Bait Stanons"' 7-206.13 'Tracking Powders,Pest Control and '-8(11.11(0) Unopened Food Package Prot Re-served Monnorini:" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 C onmmnei Adsisor} F4,sted for Consumption of Animal Food,That are Raw,Undercooked or {6 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs Patiu,gets. .i-401.!iAi I)(2) Eggs- Ii5`F 15 Sec ! - E?;t;.c (rnrnediate Service 145°FI Szce' 3-3')2.13 Pasteunzed Eggs Sn1,Sti ULl fier Raw Shell 3-401 11(A)(21 Comminuted Fish.Meats&Game Erys.. Animals- 155F 15 sec. " i SPECIAL REQUIREMENTS 3-401.118)(1)('_) ( RatPoiites, and BeefRoast Me - 130`F 1'F ruin" 5vU.0U4(A)-(D) Violations of Section 590.009(A)-(t)) in 3-401.11(A7(2) Ratites. InJecied Me.,ts- I55'F IS we. M catering, mobil: food, temporary and 3-401.11(A)(3i ( Poulny,Wild Gane.Stuffed PHF:,, residential kitchen operations should be Stutnng t_ontatnutg Flslt,Meat, ....L,.;u �.iidcr the r ;,( i,.t, -....,.a.:,, Poultry or Ratites-165'F 15 sec. " above if related to toodbornc illnes 3-401.11(C)(3) Whole-muscle,Intact Beet Steaks interventions ant risk(actors. oilier 145=17 j 590,009 violations relating to good retail 3-401.12 Raw Amoral Food,Cooked in a practices should he debited under#29 - hlicrowace 165`17* Special Requirements, 3-401.11(AI(1)(b) All Other PHFs - 145"F IS sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 11(A)&(D) PIIF, 165'17 15 Sec.. * (Items 23-30) 3-40? 11(B) Microwave- 165'F 2 Minute StandingI Ctitu.al and non-rn4,al viohatiuns. nhich do not relate to the '1'irne* jbodborne illness imnm.mtians aurid iiab,fri000 bsred above, can be 3-+03 11(C) Commercially Piocessed RTE Food- lbund in the following sc(none of dee hood Code and I05 CHR 140'P' 590.090. 3-403.11(X) I Remaining L'nsliced Portions of Beet I Item Good Retail Practices FC 590.000 RoaLiW 23. Mlanauement and Pe, FC-2 ( .003 24. Food and Food Protection ! Fc-3 .004 18 Proper Cooling of PRFs - l 25. [pwpment and 111ens,13 FC-4 ! ,005 __ __ 2-501 14i Al Cooling Cooked PI-TFs front 140`F W 26. Water.Pb:mbin0 and Waste F%-5 ( .Opo 70'F Within 2 flours and From 7O+ j 27. Physical Facility Fc-6 007 to 41 FJ45'F Within 4 Hums. * 1 28. Poisonous or T"oxic Materals FC--7 ; .008 i 3-i01.14(B) Cooling PHFs Made Froin..Ambient j 29. Special Reouirements .009 Temperature Ingredients to 41"F(45'F ( L_30 Other j Within J Hour;. '-":•�." ; ' Denolen critieal item in the federal 11)91)Foist Code u, 105 C\-i Ii 5011.00,0. �w o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR ` SALEM, MA 01970 � _ a J TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH. RS, CHO MAYOR HEALTH AGENT January 31, 2003 Niko's Pizza C/o Niko Dunn 333 Lafayette Street Salem, MA. 01970 Dear Mr. Dunn: Recently, your business has been in violation of the State Sanitary Code. On numerous occasions this month the dumpster at the rear of your store has been uncovered. Please correct this problem upon receipt of this mailing. Failure to comply with the regulations set forth in the Sanitary Code regarding the storage of trash will result in twenty-five dollar ($25) fines for each time the violation is noted. I anticipate your cooperation in this matter. If you have any questions please call me at (978) 741-1800. Thank you. Sincerely, 7 �i Jeff Vaughan Sr. Sanitarian Salem Board of Health 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 h ' f/ ' n rl Date T n -f nerafinn(W Tyoe of Inspection Food Service © Routine Address j Risk ❑ Retail �❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone W//_ q2574 ❑ Mobile Date Ownerh / - HACCP Y/N El Temporary ElPre-operation kro ; ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /Z- ( /�-e�z- � �I/ Time Time ❑ Bed 8 Breakfast ❑ General Complaint In: El HACCP Inspector C /_ /�1..�C��.�.I(/�G� (L 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 ❑ 2. Reporting of Diseases 6y Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 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 El 17. Reheating El7. Conformance with Approved Procedures/HACCP Plans ED 18. Cooling ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing y' ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP s y 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 Y, 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: InsP g Inspector's Signature: Print: PIC's Signature: til Print: f L ,/Y \ \ Page lofe Pages FORM 734A HOBBS&WARREN - BOSTON / j 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 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in •---A_t - - .. Charge* I Contamination from the Consumer 13-306.14(A)(B)I Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 1I 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products, Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-60211 Cleaning Frequency of Equipment Food- . 590.006(8) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* I 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 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 3-402.1 I Parasite Destruction* 5-203.11 Located and Accessible 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 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 CNIR 590.000. CITY OF SALEM }h� 11 BOARD OF HEALTH s Establishment Name: OV / k, 03 Pi Date: " 3 Page: of } Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION I Date zNo. Reference R–Red Item PLEASE PRINT CLEARLY Verified � I I Pr� n ;` O - -;w* '-1-yc' �7tty GJ�nc _ Sn-r),'-ik ?5-Y? yv—) mai _4� 1'7c-"�\: 5% CAZ T _ I '�✓_ C4bth <; _ v 0_1 l�. i S '�v�✓�i �5 ZS%z .S�i-�,�YG�-f�--, �-✓� -�(-� i��-I b,�X� w�c�_ - I 1�v�951'I i ✓� 006-c�f X17 I RD Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑Yes t / I have read this report, have had the opportunity to ask questions and agree to correct all C) Voluntary Compliance 1:1 Employee Restriction Exclusion € violations before the next inspection, to observe all conditions as described, and to comply ❑ Re-inspection Scheduled ❑ Emergency Suspension 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 your food permit. ❑ Embargo ❑ Emergency Closure ! ❑ Voluntary Disposal ❑ Other i FORM 7348 HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures to Factors(Red Items 1.22) (ContAccording to Law Cooled) 41'F/45'F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/450F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140'E* Containers* 3-501.16(A) Roasts Held at or above 130'F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590 004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.1l(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* _ 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Etlecti-11112001 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145'F 15 Sec.* 3-401.11(A)(2) Comm nuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155'F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(6)(1)(2) Pork and Beef Roast- 130'F 121 Min.*1 catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 Sec.*1 residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165'F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to 000d retail 145'F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165'F* 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 Sec* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165'F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165'F 2 Minute Standing foodbome illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. I40'F* Item Good Retail Practices FC 590.00 f 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water, Plumbing and Waste FC-5 .006 70'F Within 2 Hours and from 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 f 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 f Temperature Ingredients to 41'F/45'F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590 000. � Q 3 BUY 1 LARGE „'• - �-�'_ - - - "-'y- E - --- �6E T PIZZA, c MEATBALL . . . . 4.25 4.75 GET A 2 LITER PEPSI CHEESE. . . . . . . . . . . . . . . . . 4.65 7.50 ITALIAN . . . . . . . . . . . . . . 6.50 11.00 1 SAUSAGE. . . . . . . . . . . . . . . . 4.25 4.75 ARM 1-WAY. . . . . . . . . . . . . . . . . . 5.30 9.00 W BUFFALO CHICKEN . . . . . . 7.00 11.50 o STEAK & CHEESE. . . . . . . . . . 4.25 4.75 Imo" 2-WAY. . . . . . . . . . . . . . . . . . 6.00 9.50 ° ' . . . . . . 4.25 4.75 3-WAY. . . . . . . . 6.80 10.50 a SPINACH & FETA. . . . . . . . 7.00 11.50 ' STEAK & ONION. . ' 4-WAY. . . . . . . . . . . . . . . . . . 7.30 11.00 Q MEATBALL . . . . . . . . . . . . 6.50 11.00 STEAK & PEPPER. . . . . . . . . . 4.25 4.75 iiIiii , Ad SPECIAL. . . . . . . . . . . . . . . . . 8.50 13.00 o PEPPERONI. . . . . . . . . . . . 6.50 11.00 STEAK & MUSHROOM. . . . . . . 4.25 4.75 �jJ1/8$: ONION, PEPPER, MLISNROOM, Z STEAK & CHEESE . . . . . . . 6.50 11.00 STEAK BOMB. . . . . . . . . . . . . 4.75 5.50 IEM. ORDER BUFFALO 1 BROCCOGT, FRESH 7t�M47t�E5, GARLIC, W STEAK & EGG. . . . . . . . . . . . . 4.50 5.00 WINGS OR FINGERS, STEAK BOMB . . . . . . . . . . 7.00 11.50 s EGG, HAM, & PEPPER. . . . . . . 4.55 5.00 SM.S 2CHEESE PIZZA LITER SODA SPINACH, EGGPLAM; PINEAPPLE, OLIVES, CHICKEN BROCCOLI. . . . . . 7.00 11.50 o I ANCHOVIES, PEPPERONI, S46/S4GE, _ CHICKEN FARM . . . . . . . . . . . 4.25 5.00 (SUN-MON h -rues ONLY) N, t4[AMI NAM, CHSGt'EN S VEGETARIAN. . . . . . . . . . . 6.50 11.00 I CHICKEN FINGER . . . . . . . . . . 4.25 5.00 $100 w CHICKEN FARM . . . . . . . . 6.50 11.00 W VEAL PARM. . . . . . . . . . . . . . 4.25 5.00 o. o. 'J GYRO. . . . . . . . . . . . . . . . . . . . 5.25 , ROAST BEEF . . . . . . . . . . . . . 4.50 5.00 STEAK TIP . . . . . . . . . . . . . . . . 5.75 rBEEF, UY ANY 2 x°v i RS OF ROAST CHICKEN KABOB. . . . . . . . . . . . 5.50 . . . . . . . . . . . GET SMALL o . , y r.. • - C FRIES... ` OT VEGGIE 4 25 4 75 CHEESEBURGER 4.75 { ` o EGGPLANT. . . . . . . . . . . . . 4.25 4.75 ipE 2 SLICAN ES OF CHEESE PIZZA " /guaw 4 & 20 oz. SODA - COMBO W/ FRIES `" $ 75 1 . 3 CHICKEN FINGERS S l LARGE - - - -- - ° _ ry �. 3 CHICKEN WINGS GREEK PIZZA . . . . . . . . . . 7.00 10.50 o - -_ �Zi _ •�'1..--. . - :• 3 MOZZARELLA� �LATIX 7LlNA/OES, OLIVES, OREGANO, � - r 8 FETA CHEESEmiff VEGETARIAN PIZZA. . . . . . . . . 7.50 11.50 u I / W H��roEs..s 6.00 9.50 JUNIOR BEEF.-.� . . . . . . . . 2.60 3 IL _ � z LARGE cHEEPEFPERA AWIl tl &SPINACHIAIAN . . . .� i . 4.25 4.75 PIZZAS,CHEESE BUFFALO CHICKEN . . . . . . . . . 6.50 10.50 REGULAR BEEF. . . . . . . . . . . . . . . 3.50 i +�` + m SUPER BEEF. 4.50 AMERICAN _ 4.25 4.75 7 ncs. CHICKEN NEW YORKER. . . . . . . . . . . . . ZOO 11.00 � • • • • • • • • • • • • • . • o WINGS, GARDEN CHEESEBURGER . . . . . . TURKEY . . . ` 4.25 4.75 a . . . . . . . . 3.00 g = BDITER CN/-4 N. RED ONION �� MEDITERRANEAN. . 6.80 10.50 N : - B.L.T. ��_�' 4.25 4.75 SALAD, & 2L. PEPSI CHICKEN SANDWICH . . . . . . . . . . 3.50 SPINACH, FJFrA GENOA. . . . 4.25 4.75 •99 8 RED ONIONS REGULAR PASTRAMI. . . . . . . . . . . 3.50 HAM & CHEESE . . . . . . . . . . . 4.25 4.75 SUPER PASTRAMI. . . . . . . . . . . . . 4.50 _! TUNA. . . . . . . . . . . . . . . . . . . 4.25 4.75 EXTRA CHEESE, LETTUCE, TOMATO 0.25 � CHICKEN SALAD. . . . . . . . 4.25 4.75 O v O .. Ka Kill ANY ORDER s 0F 525.00 OR MORE �y BUY 1 LARGE 2-TOPPING PIZZA, GET A 2 LITER PEPSI TUNA CLUB . . . . . . . . . . . . . . . . . 6.75 CHEF'S SALAD . . . . . . . . . . . . . . . . . . 5.00 ARM CHICKEN FINGER 6.75 GARDEN . . . . . . . . . . . . . . . . . . . . . . 4.00 � = CHICKEN WING 6.75 GREEK. . . . . . . . . . . . . . . . . . . . . . . . 4.50 �a ROAST BEEF. . . 6.75 TUNA SALAD . . . . . . . . . . . . . . . . . . . 4.85 / CHEESEBURGER . 6.75 ANTIPASTO . . . . . . . . . . . . . . . . . . . . 5.00 00 STEAK TIP . . . . . . . . . . . . . . . . . . . . . .00 M. ORDER BUFFALO CHICKEN KABOB. . . . 7. CHICKEN KABOB . . . . . . . . . . . . . . . . 5 5.50 WINGS OR FINGERS, STEAK TIP . . . . . . . . . . . . .�. . . . 7.50 SM. CHEESE PIZZA CAESAR SALAD . . . . . . . . . . . . . . . . . 5.00 & 2 LITER SODA PINNERS SAeVEP W/Tfr+FRENCf/GR/ES, suN-MON-rues oN�n SA1,40 B ONIONRINGS GRILLED CHICKEN C, CAD . . . . . 6.00 (VL7 QQ . j Rat BUY ANY 2 ZITI%SPAGHETTI & SAUCE. . . . . . . . . 4.50 ORDERS OF ROAST ZITI & MEATBALL . . . . . . . . . . . . . . . . 5.25 - BEEF, GET SMALL ZITI & CHICKEN . . . . . . . . . . . . . . . . . 5.25 FRIES... IARM ARM - mmT S^4"ZITI & VEAL . . . . . . . . . . . . . . . . . . . . 5.25 5M4 ZITI & SAUSAGE. . . . . . . . . . . . . . . . . 5.25 PIZZA ROLL . . . . . . . . . . . . . . . . . 1.85 ZITI, CHICKEN„ BROCCOLI. . . . . . 6.50 FRENCH FRIES. . . . . . . . . . 2.00 2.75 e / F MOZZARELLA STICKS. . . . . 4.00 6.25 , ( .� COMBO W/ FRIES :,_�; _ ' •.-;. % CHICKEN FINGERS. . . . . 4.50 7.25 � �' � � I I ' y • 3 CHICKEN FINGERSI'"% 6 OR 10 PIECES `�`�'f - I. 3 CHICKEN WINGS : 3 MOZZARELLA STIX CHICKEN WINGS. . . . . . . . 4.50 7.25 TO SALEM& MARBLEHEAD AREAS • Min $6 Or er • r` T '- - BU6FOR 10 pCrHICS EN FINGERS5.00 7.50ece BUFFALO CHICKEN WINGS. 5.00 7.50 f 2 LARGE / 7 OR 12 PIECES SYE7QYDMr E CHEESE ONION RINGS . . . . . . . . . . 2.65 3.50 -�` PIZZAS, 20 oz. BOTTLE. . . . . . . . . . . . . . " 1.25 - I'' 11:00 am to 10:00 pm - 7 acs. CHICKEN 2 LITER BOTTLE . . . . . . . . . . 2.00 CHICKEN BASKET W/FRIES. 5.25 _ - WINGS, GARDEN *0 OFFAeAN5F WTNG$ -s 9 now caf R�Nc_! SALAD, S 2L. PEPSI �_ c OFPEPST D,a?TNKS! a - I N O� OFF FET CHEESE. . . . . . . . . . . . . . . . . . . 0.50 2 LG. CHEESE PIZZAS WPM 9w PITA . . . . . . . . . . . . . . . . . . . . . --= ANY ORDER 'MOUS BAKLAVA E PUDDING 205 333L�A .35 DRESSING . . . . . . . . . . . . . . . . . . . . . 0.25 OF $25.00 AMERICAN CHEESE . . . . . . . . . . . . . . 0.25.� OR MORE r / / ACROSS FROM SAL'fM S'TATf COIL'FGE r