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OMEGA PIZZA - ESTABLISHMENTS ---------------- A4 - A4 Mlassachusetts Department of Public Health Salem Board of Health 120 Washington Street,4r'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town of��Oi✓Y\ Address-s::�/ `' FOOD ESTABLISHMENT INSPECTION REPORT Tel. "( /)$ q Ct[ 19// Name ( e Type of Operation(s) Type of Inspection �17�ij1 .�� P )�J�� Fo Service ❑ ne Address O �� ^ Risk etall _-inspection I Telephone �1, Level Residential Kitchen Previous Inspection ❑ Mobile Date: Owner {� / HACCP YM ❑ Temporary ❑Pre-operation a p�Q , I ❑ Caterer ❑Suspect Illness Person-in CharTi e'y�y "y, ❑ Bed&Breakfast ❑General Complaint Inspector 1 2trgi 0�. -7y ' Permit No. QaeLl CP Each violation lchecked requires an et nation on the narrative page(s)and a citation of specific provision(s)violated. yNoo-compliance with: VioIt la ons Related to Foodborne lllneInterventions and Risk Factors-(Red AntiChoking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ (� , corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) [3 FOOD-PROTECTION MANAGEMENT_ 7 ❑ 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties __ 13. Handwash Facilities EMPLOYEE HEALTH - ❑ 2. Reporting of Diseases by Food Employee and PIC tPROTECTION FROM'CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded [114.Approved Food or Color Additives (,FOOD FROM APPROVED SOURCE- _ l El 15.Toxic Chemicals._ _ _- _ __ . ._.._ _- - ,__,_,_ ,,,__., _ ❑ 4. Food and Water from Approved Source �NiEtrEMPERATUR_ECON_TROLS(PoteM_la_IlyHazard_o_usF.00ds)� ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION [119. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing I_REQUllt MENTS FOR H[GHLYSUSCEPTIBLE-POPULAT(ONS_(HBP) J 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices I CONSUMER ADVISORY [122, 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. Noncritical (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 23. Management and Personnel (Fc-2X690.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) 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 C. (FC-4X590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5X59o.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.000) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this orde . 0. Other ATE OF RE-INSPECTION: l �/ 1 Inspector's Signature: -� V IPrint: / JOC� P[Cs Signature Print: t�t7�� Pagof(-4a �q / lee` fges /✓ �l v0 - - Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S I Cross•coniaminatron j 3-302.11(A)(1) I Raw Animal Foods Separated from li I i 590.003(A) Assignment of Responsibility* I I Cooked and RTE Foods* 590.003(E) I Demonstration of Knowledge"' I I I Contamination from Raw fngradents J 12-103.11 Person in charge-duties I 13-302.11(A)(2) I Raw Aminal Foods Separated from Each Other EMPLOYEE HEALTH I I Contamination from the Environment J 2 590.003(C) Responsibility of the person in charge to 13-302,1 I(A) j Food Protection* require reporting by food employees and 3-302 15 I Washing Fruits and Vegetables applicants* OfA Fo d Employee Or An 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility y I Utensils* Applicant To Report'Co The Person in Charge* � Contamination from the Consumer J 590.003(G) Reporting by person n Cfiaree* 13-306.14(A)(B) I Returned Food and Reservice of flood* J Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* I Food 590.003(E) Removal of Exclusions and Restrictions I 3-70;.1 1 Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE I I I Fold* J 4 Food and Water From Regulated Sources 19 Food Contact Surfaces j 590.004iA-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201.13 I Fluid Milk and Milk Products* 4-501.1 t2 Mechanical Warewashin -Hot Water 3-202.1.3 I Shell Eggs* I I I Sanitization Temperatures* 3-202.14 Eggs and t4!ilk Prsxtucts.Pasteurized* I 14-501.114I Chemical Sanitization-temp.,pH, 13-202.16 I Ice Made From Potable Drinkin;Water* j concentration and hardness. * 1 15-101.11 I Drinking Water from an Approved System" I 14-601.11(A) I Equipment Food Contact Surfaces and I 590.006(A) I Bottled Drinking Water* I Utensils Clean* J 590.006(E) j 'Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shelgish and Fish From an Approved Source I I I Contact Surfaces and Utensils* 3-201.14 Fish and Rec eationsliyCaug t Molluscan 4-702.11 I Frequency of Sanitization of Utensils and _I Shellfish` Food Contact Surfaces of Equipment* i 3-201.15 Molluscan Shellfish from NSSP Issted I ( 4-703.11 I Methods of Sanitization-Hot Water and Chemical* Sources* 110 1 Proper,Adequate Handwashing I Game and Wild Mushrooms Approved by J f RequiatoryAuthorlty I 12-301.11 1 Clean Condition-Hands and Arms* 3-202.13 -1 Sheflstuck Identification Prescm* I 12-301.12 Cleaning Procedure* J 590.004(C) I Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 I Game Animals* I I It I Good Hygienic Practices 15 I Receiving!Condition I 2-401.11 j Eating,Drinking or Using Tobacco* J 3-202.1 f PHFs Received at Proper Temperances* I ( 2401,12 I Discharges From the Eyes,Nose and 13-202.15 I Package tutegrity' Mouth* 3-10i.11 i Food Safe and Unadulterated* I 13-301.12 I Preventing Contamination When Tasting* 161 I TagsMerords:Shelistock I 112 I J Prevention of Contamination from Hands j 13-202.1$ Shellstock Identification* ( 1590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained" Employees* j Tags/Records:Fish Products 1 113 I Handwash Facilities J J 3-402.11 Parasite Destruction* I Conveniently located andAccessibfe 5-203.11 Numbers and Capacities*J 1 3-402.12 Recti7ds,Creation and Retention"` I 1 590.004(.) Labeling of Ingredientst I 15-204.11 Location and Placement* 15-205.11 Accessibility, Operation and Maintenance � Conformance with Approved Procedures Y� J /HACCP Plans I I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cleansey.Availab lily 8-103.!2 Conformance with Approved Procedures* I J 6-301.12 I Hand Drying Provision *Denotes,critical item in the Wera 1999 Pond Code or 105 C.MR 590.M). CITY OF SALEM rr� BOARD OF HEALTH m pnVl stablish ntP4 tame�lm _ dv . Date:f 2A Page: � of �V V t m Code C-Critical Item DESCRIPTION OF VIOLATION/PLAWOF CORRECTION Date. No. Reference R-Red Item �� nl Veri led PLEASE PRINT CLEARLY —rrv?��Jt.14 C' 6 I RZ I «J�l >,ann slzxc�a� } 1_us�// — �_ Do,,�, � � - ► ., ! �fiP An I / V OA it 7 Discussion With Person in Charge: _ Corrective Action Required: I o No I'tI les 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 conditio as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Cod . I ul derstand that noncompliance may result in daily fines of twen five Ilars suspension/revocation of ❑ Embargo ❑ Emergency Closure fyour food permit. l ^ � 0 Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures 11! viofafions Related to Peodbarne/tiness intervent/ons and Risk According to Law Cooled w I Factors(ftems 1-22) (Cont.) 41T/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50L15 Cooling Methods for PHFs 14 1 Food or Gator Additives ( 19 PHF Hot and Cold Holding 1 3-501,16(B) Cold PHFs Maintained at or below I f 3-202.12 i Additives* 590.(OKR 410745°F* 3-302.14 Protection from Unapproved Additives* - 1 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140T , I 7-101.11 Identifying Information-Original 1 Container* 3-501.16(A) Roasts Held at or above 130'F. 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* ( 3_501.19 Time as a Public Health Control* 7-201.11 Separation-storage* i 590.004(H) Variance Requitement 7-202.11 Restriction-Presence and Use* A 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Satdtizers.Criteria-Chemicals* 7-204,12 Chemicals for Washing Produce,Criteria' 121 3-$41.11{A} Unpasteurizedragewith Pre-packaged Juices and { Beverages with R':rnting labels* 7-204.14 hying Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801A I(D) Raw or Partially Cooked Animal Food and 17-206.11 Restricted Use Pesticides;Criteria* Raw Seed Sprouts Not Served. * 7-206.I2 [talent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. " " 17-206.13 I Tracking Powders,Pest Control and Monitoring" CONSUMER ADVISORY TiMEl i EMPERATURE CONTROLS 22 3-603.21 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-402.IIA(1)(2) Eggs- 155F 15 Sec. pathogens.* Eggs-Immediate Service 1450Fi5sec* I 3-30113 Pasteurized Eggs Substitute for Raw Shell 4 3401.11(A)(2) Comminuted Fish.Meats&Game I Egg* Ammnls-155°F 15 sec. " rSPECIAL REQUIREMENTS � 3-441.11($)(1x2) Pont and Beef Roast- 130°F 121 thin* � ` 3-401.I1(A)(2) Ratites,Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section--590.009(A)-(D)in see * I catering, mobile food,temporary and 3-40 1.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. � debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3-40I.11(C)(3) Whole-muscle,Intact Beef SteaksI interventions and risk factors. Other 145OF* 590.009 violations relating to good retail } 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165`F* _ Special Requirements. 3-101.11(A)(1)(b) All Other PHFs- 145'F 15 sec.* I f 17 ) Reheating for Hot Holding 0 VIOLA77ONS R:LATER TO GOOD RETAIL PRACTICES 3403:11(A)&(D) PHFs 1650E 15 sec.* 3 (Items 23-30) 3-403.11(B) Microwave-165`F 2 Minute Standing I Critical and non-critical violations,which do not relate to the Tithe* foodborne illness interventions and risk factors listed above, can be 3-103,11(C) Commercially Processed RTE Food- Ijaund'It the foilowing sections of the Food Code and 105 CUP I 1400P 590.000. 13403.11(E) Remaining Unsliced Portions of Beef ( 1, tram ' Good Retail Practices I FC 640.400 j fit,,= } 123, i Management and Personnel FC-2 .003 I gS Prayer Cooling at PHFs 1 24. i Feed and Food Protection ! FC-3 .004 I 1 25, 1 Equipment and Utensils FG-4 '005 i 3-501.14(0) Cooling Cooked PHFs from 340'Fto ; 26, Water.Plumhindand Waste FC-5 .006 70'F Within 2 Hours and From 70°F 27. ( Ptwsical Facifity FC-6 .007 j to 410F/45'17 Within 4 Hours.* i 28. 1 Poisonous or Toxic Materials ' FC-7 .008 i ' 3-501,14(6) Cooling PHFs Made From Ambient 1 29. Special Requirernerns '009 1 Temperature Ingredients to 41°F/45°F 30' 1 O0'er 1 ` Within 4 Hours* f Dentes critical ism in the federal 1999 Food Cale or 105 C-MR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 4\ Date: 1 a�_� —�lU Page: J of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ( A � - � I 1A3 moi/ 17� — I votw ?- I U I I - Discussion With Person in Charge: i Corrective Action Required: I ❑ No I have read this report, have had the opportunity to ask questions and agree to correct all I V°lu tary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to O// Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/FederalPod C . I understand that noncompliance may result in daily fines f twe -f' edl r� s or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. // ❑ Voluntary Disposal ❑ Other: 3-501.14(0 P14Fs Received at Temperatures Viotarlons Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors{items 4-22) (Cont.) 41'Ff45°F Within 4 Homs. { 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS I 14 � Food CH or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 i Additives* 590.004(F) 41°145°F* 3-302.14 I Protection from Un roved Addaives'r { 3-SU 1.16(A) Ho[PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101,11 identifyingInformation-Original Containers` } 3-501.16(A) Roosts Heid at or above 130'F,* } } } 2t) Time as a Public Health Control { 7-102.11 Common Name-Worlds$Containers* 7-201.11 Separation-Storage* ( 3-501,i9 Time as a Public Health Control* 3 } 7-202.11 .Restriction-Presence and Use* } t 590.004(H) Variance Requitement { 7-202.12 Conditions of Use* } REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.11 Toxic Containers-Prohibitions* ( POPULATIONS(HSP) } 7-204,11 Sanitizers,Criteria-Chemicals* i 17(A) Unpasteurized Pre-packaged Intoes and 2) 3-$41. re-pa { 7-204.12 Chemicals for Washing Produce.Criteria$ Beverages with re-pa Warning labels* ( 7-204.14 Drying Agents.Criteria° } 7-205.11 incidental Food Cmtact Lubricants* ( 3-801,11(B) Use of Pasteurized Eggs* i 3-801.11(D) Raw or Partially Cooked Animal Food and t ( 7-206.11 Restricted Use Pesticides;Criteria* I Raw Seed Stmuns Not Served { 7-206.12 Rodent Bait Stations* ( 0 3-801.11(C) Unopened Food Package Not Re-served. f 7-206.13 I Tracking Powders,Pest Control and ' l 1 Monitoring* CONSUMER ADVISORY TIMEt!EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.I1A(1)(2) Eggs- 155 F 15 See. i Pastcun=* g ` ubs c Eggs-immediate Service 145'F15&ec^ 3-302.13 Pasteurized Eggs Substitute for Raw Shea 3-401.11(A)(2) Comminuted Fish.Meats R Game Ems* Anitnals-155°F 15 see. " � SPECIAL REQUIREMENTS } 3-001.11(11)(1)(2) Pork and Beef Roast- 130'F 121 min* i 590.009(A)-(D) Violations of Section.590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 isec.* catering, mobile fail,temporary and 3-401.11(A)(3) Poulty,Wild Game,Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat, ( debited under the appropriate sections i Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other r 145'F* 590.009 violations relating to goad retail 3-401.12 Raw Animal Foals Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 340131(A)(1)(b) All Other PHFs- 145'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS R SLATED TO GOOD RETAIL PRAC77CES 3443.11(A)&(D) PHFs I65"F 15 sec.* {Items 23-M,3-403.11(B) Microwave-165`F 2 Minute Standing Critical mid non-critical violations,which do not relate to the Titer* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400P 590.000. 3403.11(E) Remaining Unstic:ed Portions of Beef Item ; Good Retail Practices FC 59tt.0U0 i Roasts* 123. i Management and Personnel FC-2 6003 i } 18 Proper Cooling of PHFS i 24, j Foal and Food Protection i FC-3 .004 1 25, 1 Equipment and Utensils ! FC-4 } .005 I 3-541.14{A} Cooling Cooked PHFs from 740`F to ; 28, 1 Water.Plumbinq and waste FC-5 1 .006 70'F Within 2 Hours and From 70`F 27' ( Physical Facifitv i FC-6 .047 to 41'F/45017 Within 4 Hours.* 1 1 28. Poisonous a Toric Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements 00930 ! Temperature Ingredients to 41°F/45°F 1 Omer 1 r" Within 4 Haus` s.w,rmro..r-z m' 'Anotrs aiheat tz<m in the L-demi 1"9 Dual Cale or 1(15 CMR 90.000. , CITY OF SALEM � BOARD OF HEALTH r Establishment Name( YW10_14A Q�22c_ Date: l c4.—( Page: of lL Item Code c-Critical Rem t DESCRIPTION OF VIOLATION/PLAN OF CORRECTION i Date No. Reference R-Red Item Verified I� 1 1,, PLEASE PRINT CLEARLY + A—a i� o Ae y1,o 1V )i0 Vim—Ain �_el' llV K'- t/ r'1 /V r �l,D� (3Ugggq I I IY �/Yrn 0,e.4J OMS Q/Iw.X - (1 X n m nn n—X _V 141 I _ _ V ! "� nS1zL)�s, ' `•'� .Lr.1 . 1 JU�1J�� I Discussion With Person in Charge: Corrective Action Required: I ❑ No IV/les 1 have read this report, have had the opportunity to ask questions and agree to correct all b-�voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described and to Exclusion P ae�inspe ti n Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that [�— noncompliance may result in daily fines of N� enty- ' e dollars or suspension/revocation of ❑ Embargo r ❑ Emergency Closure -your food permit. / ❑ Voluntary Disposal ❑ Other: r 3-501.14(C) PHFs Received at Temperatures '. Viotations Related to Foodborne 111nesstnterventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F145`F Within 4 Homs. r PROTECTION FROM CHEMICALS j 3-501.15 Cochne Methods for PHFs r ( 14 j Food or Color Additives j j 19 PHF Hot and Cold Holding I 3-501,16(B) Cold PHP%Maintained at or below ( 3-202.12 Additives* ( 590.004(n 41'!45°F* 1 { 3-302.14 Protection from Unapproved Additives" � r-501.16(A) Hot PHFs Maintained at or above I ` ( j 15 Poisonous or Toxic Suf>stences 140'F * 7-101,11 Identifying Information-Original ( 3.501.16(A) Roasts Held at or above 130'F. I Containers* ( j 7-102.11 Common Nam20 Time as a Public Health Control e-Working Containers* I ( 7-201.11 Separation-Storage* ( 3-501.19 Time as a Public Health Control' j ? ( 7-202.11 Restriction-Presence and lase* f j 590.004(H) Variance Requirement r ( 7.202.12 Conditions of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.11 Toxic Conminers-Prohibitions* POPULATIONS(HSP) ( 7-204.11 Sanitizers,Criteria-Chemicals* ( i 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ( 7-204.12 Chemicals for Washing Produce.Criteria* j 3 j 7-204.14 Drying Agents.Criteria* j .Beverages with Warning Labels* j Use of Pasteurized Eggs* 7.205.11 incidental Food C intact Lubricants* 3-801.11(6) I 13-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed 7-206.12 Rodent Bait Stations* ( Food P Not Served { j 7-206.13 Tracking Powders, Pest Control and d 3-$Q1.11(C) Unopened Food Package Not Re-served. * j Monitoring* CONSUMER ADVISORY TIMEtFEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155`F 15 Sec. Pathogens.*tri'"°""�' Eggs-Immediate Service 145T15&ec* 3-3t72.13 Pasteurized Eggs Substitute for Raw Shell i 3401.11(A)(2) Comminuted Fish.Meats&Game Bim* Animals-155'F 15 sec- ( 3401,11(B)(1)(2) Pork and Beef Roast-130'F 121 min* j SPECIAL REQUIREMENTS 3-40IA I(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 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-I65'F 15 sec.* I above if related to foodborne illness 3-101.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other _f 145*F* 590.009 violations relating to good retail 3-401.12 Raw Animal Fords Cooked in a practices should be debited under#29- ' Microwave 165'F* Special Requirements. ` 3401A l(A)(1)(b) All Other PHFs-145'F 15 sec.* j 1 j 17 + Retreating for Hot Holding j WOLATIONS R ZATED TO GOOD RETAIL PRACTICES f 3-403AI(A)&(D) PHFs 165-F 15 sec. * j (Items 23-36) 3-403.11(B) Microwave- 165"F 2 Minute Standing Critical and non-critical violations,which do not relate to the S Time* foodborne illness intemenrinns and risk factors listed above, can he 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR i 1400F* ( 590,000. 3-403.11(E) Remaining Unsliced Portions of Beef i Item ; Good Retail Practices i FC 590.000 Roasts* 1 23. I Mananament and Personnel FC-2 .003 j j lg Proper Cooling of PHFs j 124. 1 Food and Ford Protection I FC-3 .004 _ 1 25. 1 Equinment and Utensils i FC-4 .005 i r 3-501.14(A) Cooling Cooked PHFs from 140'F to 126. ( Water.plumbing and Waste i FC-5 .006 ? 70*F Within 2 Hours and From 70T 27. Phv iicai Facility FC-5 .007 to 41`F/45'F Within 4 Hours. * 128. { Poisonous or Taxc Materials j FC-7 ,008 3-541.14(6) Cooling PHFs Made From Ambient 129. Special Reouiremants .009 I Temperature Ingredients to 41`F145'F 30, 1 Other 4 Within 4 Hours* '•°"n""�"""°i 'Aeso,critical 1�ru in the federal 1999 Foal Cale w 105 C:MIt 590.000. e Commonwealth of Massachusetts s; a g 4�-14 xp a soars f Health NM jy.AM.Ugton Str6et;f4th Floor SALEMMA 01970'-, d -4- i x,, U -�:F66d/RU0;EStabNshfii9ntW . . ........ GAiF PRINTED: -12/30/2013 0' , II V X, x 4 , ".' .' g 4t, q- - ��- 7 -W qrw' 5 w- ;,n I, , ESTABLISHMENT NAMEw.�,--" Qniega PUWA-Roatif Beefo;;� j '.I File Nmbff:BHF-2064W -j.101bDring Avenue gyz 4te1' Salem h V MA- 01970 Sz, LOC d' 7Z ,TPer 66itType- PerndtNo,v JOODSERVICE� BHP-2014-0225 ESTABLISHMENT --- .................. N� -3 -Total Vee . . ... . fl, Aq 41 R" T 3y 4' -41 4 6"; 'Z VV "Y4 P E j FA-1 t 4- Ci A -PERMrr EXPIRES Ceitibeill;2014 V- IIZ,'Board W Health fN hop V e-, gV %1 This Permit is not transferable and must be-reissued'upon-'-chii'nge'-o'f;o"w'--ne-r'sfiip or location;The pifthit must be-posted:,z" inx promment Ic"timi in7the litabl- & �- Establishment I i'In'accordancewith the State Sknitary-Code,.beofre any fevoniations,'uppy- ovements;or-equipment t `all plans for such must be,su miffed to and approved by Salem Board of Health ' , - _ page 1 x£ i . • CITY OF SALEM, Q MASSACHUSETTS Ixeat BOARD OFHFN:FII •...."` •"'""" " .` 120 WASHINGTON S'IRFF:r,4111 FLOOR FOMBERLEY DRISCOLL Tttl_(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,I S/RF:1 iS,C1 10,CP-FS MAYOR Imnadin(a)salem.com HEAINIJ AGENT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned oppeni g date) 1) Establishment Name: i31l.l t OA 1 l T 2) Establishment Address: < <-0�t N J 0J�fyyl 3) Establishment Mailing Address(if different): eL 4) Establishment Telephone No: % W 7 yo 000 5) Applicant Name&Title: jo-r" hR.k 1.1 8) Applicant Address: `a( LLJ-,(-( 7) Applicant Telephone No: 24 Hour Emergency No: Email: 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address A corporation t� kLtI An individual �� .�,, " " �(` c�✓� I - " A partnership Other legal etity I SUS e�✓ i i4+cca(t) - 02101 (� �p C QL )e[l/ 12) Person Directly Responsible For Daily Operations(Owner,Person in Charge,Supervisor,Manager,etc.) Name&Title: �/l�r� (_c. h cc i Address: to Lo�'I-(.l-N e Telephone No: �t'�$'J i�0 DLO Fax:v Email: Emergency Telephone No: 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: Wl N Date: 42ha�/5 Amount: / / 0 P Food Establishment Information 14) Water Source: J _ 15) Sewage Disposal: DEP Public Water Supply No: (if applicable) C�T`Z \ 16) Days and Hours of Operation: \ ( ," 10 17) No.of Food Employees: 3 18) Name of Person in Charge Certifled in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) ��50 A 11ti vhf O J i Z i1 19) Person Trained in Anti-Choking Procedures(If 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) ❑ ,Rgeettail( Sq. Ft) 13 Caterer Permanent Structure% E!'Food Service-( \0 Seats) ❑ Frozen Dessert Manufacturer Mobile E food Service-Takeout ❑Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home 1a Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: ...... ............................................................Breakfast Establishments.............-------- (check one) RETAIL STORE RESTAURANT Annual ✓ ❑ Less than 1000sq.ft. $70 &Mess than 25 seats $140 Seasonal/Dates: ❑1000-10,OOOsq.ft. $280 ❑Residential Kitchens $140 ` ❑More than 10,OOOsq.ft. $420 ❑2599 seats $280 ❑More than 99 seats $420 Temporary/DatesTme: . ........ . ...... ... .. ... - 0 Bed&Breakfast/Childcare Services(Nursing Home $100 ADDITIONAL PERMITS ------------------------------------------------- *------------------------------------------------------ • ._---------------------------------------------------❑MAKE ICE CREAM,YOGURTISOFT SERVE $25 ❑ PASTURIZATION $25 ❑ALL NON-PROFIT' $25 *Including, church kitchens, state funded childcare&private club 23) Food Operations: Definitions: PHF-potentially hazardous food(fimdtemparsturecontrols requirooQ Non-PHFs-non-potentially hazardous food(no timetemperature controls required) (check all that apply): RTE-ready-to-ea(fiaods(Ex.sandwich=s salads,muffins which need no further Processing Sale of Commercially PHF Cooked to Order Hot PH F Cooked and Cooled or Hot Held Pre-packaged Non-PHFs forMore Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And V/ PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods IMe ed to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for andlor HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Aninal Origin Perishable Foods Only Preparation of Non-PHFs✓ Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and 1 affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. 1 have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food CoQdc\ 24) Signature of Applicant: (4I (/ Pursuant to MGL Ch.62C,s . 49X I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town of - Y��f+V(� Address: FOOD ESTABLISHME't1 INSPECTION EPORT Tel. Name I D Type 9f Operation(s) Type of Inspection ood Service ❑Routine Address Risk ❑ Retail ® -inspection TelephoneMrequilrffeis Level ❑ Residential Kitchen Previous Iction ❑ Mobile Date: )FiOwner HACCP YIN ❑ Temporary ❑Pr eration ❑ Caterer ❑Suspect Illness Person-in-ChTi ❑ Bed&Breakfast ❑General Complaint In�` �� ❑ HACCP InspectorQ Out:)OPermit No. ❑ Other Each violati l5lanIs ion on the narrative pages)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) El r FOOUPROTECTION MANAGEMENT ❑ 12 prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ EMPLOYEE HEALTH - " - -- - - ❑ 13. Handwash Facilities E] 2. Reporting of Diseases by Food Employee and PIC .PROTECTION FROM"CHEMICALS ❑ 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded _ ❑ 15. Toxic Chemicals „F.000�F.R 4. Food and Water from Approved Source APPROVED SOURCE _ _ - , TIMEITEMPERATURE CONTROLS(Potentially Hazardous Food's) - ❑ ❑ 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 HIGHLYSUSCEPTIBL'E-POPULATWNii N ❑ 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_(Blue Number of Violated Provisions Related LLLJ 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. Noncritical (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-2x590.0 order of the Board of Health. Failure to correct violations 24. Food and and Utensils d Protection (FC-3X590.0044)) cited in this report may result in suspension or revocation of 25. Equipmentt an (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FCsx590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.o08) and submitted to the Board of Health at the above address 29. Special Re Ws (590.009) within 10 days of receipt of this order30. Othe DATE OFRE-INSPECTION: IIInspector's Signatu - I Print:_ PICSSignature: I Print: ��lJL ��ffv � ' Page�ofes Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION I8 FOOD PROTECTION MANAGEMENT Cross-contamination 1 3-302.11(A)(1) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I P Conked and RTE 590.003(B) Demonstration of Knowledge* I Contamination from Raw Aaw Ingredients 2-103.11 Person in charge-duties I 3-302.11(A)(2) Raw Animal Foods Separated from Each Other EMPLOYEE HEALTH I I Contamination from the Environment J 2 590.003(C) Responsibility of the person in charge to 13-302.1](A) 1 Food Protection* require reporting by food employees and 3-302.15 1 Washing Fruits and Vegetables applicants* 13-304.11 I Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In I J Contamination from the Consumer Charge* 590.003(G) Reporting by Person in Charge J 13 306.14(A){B} I Returned Food and Resenice of Food* 13 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions I 3-70Li 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food* 4 Food and Water From Regulated Source,, ( ( 9 Food Contact Surfaces j 590.004(A-B) Compliance with Food Law* I 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* J Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 14-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Etas* I Sanitization Temperatures* 3-202.14 Egts and Milk Products.Pasteurizzd* I 14-501.114 ( Chemical Sanitization-temp.,pH, I 1 3-202.16 I Ice Made From Potable Drinking Rater* I concentration and hardness. * 1 J 5-101.11 I Drinking Water from an Approved System' I 4-601 11(A) I Equipment Food Contact Surfaces and 590.006(A) I Bottled Drinking Water* I Utensils Clean` 590.i)06B) Deis Standard.=.in 310 f.MR.22- 4-602.11 I Cleaning Frequency of Equipment Food- Water M- Contact Surfaces and Utensils* Shelt/ish and Fish From ar,Approved Source J 14-702.11 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Ivlolimcan Shellfish* Food Contact Surfaces of Equipment* 3-201.15Molluscan Shellfish from:ISSF, l.i;tzd I 14-703.11 Methods of Sanitization-Hot Water and Chemical* SourcGame n 110 Proper,Adequate Handwashing J ( Game and Wi.d iLtushroans Approved by I I Regulatory Authority 2-301.11 1 Clean Condition-Hands and Arms* 3-202.18 J ShellshxkidentificationPresem` 12-301.12 Cleaning Procedure* 1590A04(C) I Wild Mushrooms* 12-301.14 When to Wash* J 3-201.17 I Game Animals* 111 I Good Hygienic Practices J 3 I 1 Receiving/Condition 12401.11 Eating,Drinking or Using Tobacco* 1 i 3-202.11 I PHFs Received at Proper Temperaaues* 12-401.12 Discharges From the Eyes,Nose and 3-202.15 I Package integrity- Mouth* J 3-i0iA 1 I Food Safe and Unadulterated* 13-301.12 Preventing Contamination When Tasting* 16 I TagstRecords:ahelistock I J 12 I Prevention of Contamination from Hands 3-202.1$ Shellstock Identification* i 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained" ( Employees* Tags/Records;Fish Products J 13 I 1 Handwash Facilities J 3-402.11 Parasite Destruction' I J Conveniently Located and Accessible J 3-402.12 Records.Creation and Retention* I 15-203.11 J Numbers and Capacities* 590.004(!) Labeling of ingredients' 15-204.11 1 Location and Placement* f- i 5-205. 1 Accessibilperation and Maintenance J 17 I Confor11 imance with Approved Procedures SY.O IHACCP Plans I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Deuces I 13-502.12 Reduced oxygen packaging;criteria* I 16-301.11 Handwashing Cleanser,Availability f J 8-103.12 I Conformance with Approved Procedures` I 16301.12 I Hand Drying Provision 4 Denotac critical item in the f>teral 1999 Foud Code of 1115 CMR 59000. CITY OF SALEM OARD OF HEALTH Establishment Name: Date: �1 �� Page: of Nem Code C-CriticalItem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item IA15PRINT CLEARLY verified Vr T�G QUAOM2101 �- l rAenin , I I I I I I I I � Discussion With Person in Charge: Corrective Action Required: I ❑ No I6YYes 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 a--<e-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 ,e,�dollars /o�rrsuspense /revoca 'on of Li Embargo Ll Emergency Closure your food permit. �J'W��J v � ❑ Voluntary Disposal ❑ Other: R w 3.501.14(C) PHFS Received at Temperatures t Violations Related to Foodborne Illnessintersentions and Risk According to Law Cooled m Factors{hems 1-22) (Cont.) I I 41F145F Within 4 Hairs. PROTECTION FROM CHEMICALS ( 1_501,15 ( Cooling Methods for PRFs 1 14 ( I 119 PHF tint and Cold Holding or Color Additives I 3-_501.16(B) Cold PIIFs Maintained at or below 3-202.12 Additives* 590.004{Fl 41'145'F* 3-302.14 Protection from t7napnraved Additives° 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I 140`P * , 7-101.11 identifying Information=Original 3-501.16(A) Roasts Held at or above 130'17. * I Containers" I u) Time as a Public Health Contort I 102.11 Common Name-Working Containers* i 1 t �Ol.1l Separation-Storage* I 3-501.19 Time as a Public Health Control 7 ° I t i 590.004(H) I Variance Requirement I 17-202.11 .Restriction-Presence and Use* 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toxic Containers-Prohibitions* I POPULA71ONS(HSP) ( 7-204,11 Sanitizers.Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged luiees and 7-204.12 Chemicals for Washing Produce.Criteria* 1 t j 17-204.14 Drying Agents.Criteria* I .Beverages with Warning labels* 17-205.1 I Incidental Food Contact.Lubricants' I 3-801.11(6) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and ts 7-206.12 Rodent Bait Stations* Raw Seed food P Not Served. 7-206.13 Tracking Powders,Pest Control and ( 13-801.11(C) Unopened food Package Not Re-served. " I 1 Monitoring* CONSUMER ADVISORY TtMEt6EMPERATURE CONTROLS 22 3-603.21 Consumer Advisory Posted for Consumption of 26 Proper Cooking Temperatures for Animal Funds That are Raw.Undercooked or PHFS Not Otherwise Processed to Eliminate Pathogens.* 3-40i.11A(1)(2) Eggs- 155`F 15 Sec. Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Ern S Animals-155F 15 sec. 1. ( 3.401.21(6)(1)(2) Pork and Beef Roast-130'F 121 min* I SPECIAL REQUIREMENTS ` ( 3-401.i1(A)(2) Ratites,lnjeaed Meats- 155`F 15 590.009(A)-(D) Violations of Section 590.409(A)-(D)in r I ^ sec.* catering, mobile Food,temporary'and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFS, residential kitchen operations should bre E I Stuffing Coniaining Fish,Meat, debited under the appropriate sections Poultry or Ratites-I65'F 15 sec. * above if related to foodborne illness 34401.11(C)(3) Whole-muscle,Intact Beef Steaks ( interventions and risk factors. Other 145*F* ( 590.009 violations relating to good retail 3401.12 Raw Animal Farts Cooked in aI practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) Ail Other PHFS- I45-F 15 sec.* ( 117 1 Reheating for Hot Holding I VIOLATIONS R3LATED TO GOOD RETAIL PRACTICES 3-403:144. A(D) PRFs 16S F 15 sec. * I (Items 23-30) 3.403.11(B) Microwave- 165=F 2 Minute Standing Critical and non-critical violations, which do not relate to the 'Time* foodborne illness interventions and risk factors listed above, can be S 3403.11(0) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 0WR 1400F* 590.000. ' 34011-II(E) Remaining Unsliced Portions of Beef {_item ! Good Retail Practices FC 54D.t10© I 1 23. : Manacement and Personnel •. FC-2 Roasts* FC-3 .004 .003 ! t 24. Food and Food Protection Ii 18 I Proper Cooling of PHFS 3-50LI4(A) CoolingCooked PHFS from 140°F to 25. I EquipmentandUtensils IFC-4 .005 i ; 26. Water.Plumbing and Waste FC-5 om 70'F Within 2 Hours and Front 70'F 27. 1 Physical Facit'av I FC-6 .007 i to 4I'F(45'F Within 4 Hours. * 1 28. ' Poisonous or Toxic Materials ! FC=7 .008 3-501.74(6) Cowling PHFS Made From Ambient 1 29. 1 special Requirements .009 Temperature Ingredients to 41'F145'F 30. i Other Within 4 Hours* 5�vrr�,n;.G 'Denotes aiticat twatin the£^dersl 1999 Fwd Cale ur 105 C-Mlk 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of_-� Address: FOOD E TABLISHMENT INS E TI N REPORT Tel. Name Daj�j I Ty_p�fOperation(s) �Typey flnspection I LU�ood Service Q].Rouutine Address I / Ris ❑ Retail ❑ Re-inspection Telephonet Level El Residential Kitchen Previous Inspection ❑ Mobile Date: Owner , q , j ' f�,N HACCP YM ❑ Temporary ❑ Pre-operation i ( ((� C VY( I ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) //) Time ❑ Bed 8�j ea, a ❑General Complaint I /�{I I e� In: i '�� r7H ❑ HACCP Inspector ��., 7 Out: (rmit No.0-00- n �.. (w ❑Other Each violation ch requires an a la ation on the narrative page s) nd la citatioh d spf ecific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors-(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ Allergen Awareness 580.009(G) ❑ corre tive action as determined by the Board of Health. ' F/PROTECTION MANAGEMENT4 _ . _ 1 ❑ 12. Prevention of Contamination from Hands 1. PIC Assigned/Knowedgeable/Duties _ EMPLOYEE HEALTH - - - LIQ a. Handwash Facilities T • F F PROTECTION FROWCHEMICALS El 2. Reporting of Diseases by Food Employee and PIC . ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE - ❑ 15. Toxic Chemicals F1 4. Food and Water from Approved Source TIMEREMPERATURE CONTROLS(Potentlally 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 • PRO ION FROM CONTAMINATION _ - , _ _ ❑ 19.Hot and Cold Holding 8�6eparation/Segregation/Protection El 20. Time as a Public Health Control L,`(yy[Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSUSCEPTIBLE-POPULATIONS'(HSP): ) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices ,CONSUMER`A6VtSORY - ❑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. Noncritical(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-2x880.000) order of the Board of Health. Failure to correct violations 4. Food and Food Protection (Fc-sxsso.00a) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4x590.005) 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-6x590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.008) and submitted to the Board of Health at the above address 29. Special Req ' ements (590.009) within 10 days of receipt of this order. 111 30. Other DATE OF RE-INSPECTION. Inspector'sSignature Print: l( 110" C ,L (�� I�'1 P[Cs Signature: Print: r� n /MMMYY�'}}"��V/, Pae ( 4P.... Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I I * 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility I I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge" I I Contamination from Raw ingredients 2-103.11 Person in charge-duties I 13-302.11(A)(2) Raw Animtl Foods Separated from Each EMPLO"EE HEALTH Other' I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) 1 Food Protection* require reporting by food employees and 3-302.15 1 Washing Fruits and Vegetables f applicants* ( 3-304,11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Applicant To Report To The Person In Utensils* I Contamination from the Consumer Charge* 1590.003(0) Reporting by Person in Char>e* I 13-306.14(A)(B) I Returned Food and Reservice of Food* 131 590.003(D) EzciusionsandRest coons* I Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions I 3 701.31 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I E`er* 141 Food and Water From Regulated Sources 19 I Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I 4-5(11.1 11 I Manual Warewashing-Hot Water 3-201.12 I Food in it Hermetically Scaled Container* I Sanitization Temperatures* 13-201.13 I Fluid Milk and Milk Products k i 14-501.1 12 I Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* Sanitization Temperatures* I 3-202.14 I Eggs and Milk Products.Pasteurized' I 14-501.114 I Chemical Sanitization-temp.,pH, I 3-202.16 ice Made From Potable Drinking Water'" I concentration and hardness.* J 15-101.11 Drinkin¢Water from an Approved System* 1 14-601.1 I(A) I Equipment Food Contact Surfaces and 1590.006(A1 Bottled Drinking Water* Utensils Clean" 590.006(B) i Water Meets Standards in 310 CMR.22.0* ( 4-602.11 I Cleaning Frequency of Equipment Shellfish and and Fish Fron an Approved Source I I Contact Surfaces and Utensils'« 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationaliv Caught Molluscan I Food Concoct Surfaces of Equipment" 3-201.25 Molluscan J S1i can Shellfish from NSSP 14-703.11 Methods of Sanitization-Hot Water and (�dttd Chemical* Sources* 110 1 Game and Wild Mushrooms Approved by Proper,Adequate Handwashing j Reculatory Authority I 12-301.11 1 Clean Condition-Hands and Arms* 1 3-20313 Sbellstcwk identification Present" I 12-301.12 Cleaning Procedure* 1590.004(C) Wild Mushrooms* I 12-301.14 I When to Wash* 13-201.17 Gamc Animals* I 111 ( I Good Hygienic Practices g I ( Receiving/Condition I 12401.11 I Eating,Drinking or Using Tobacco* 13-202.1 f I PHFs Received at Proper Tetnperamres* I 401.12 Discharges From the Eyes,Nose and 13-202.15 I Package Integrity" I I Month* 13-f t1i.l i I Food Safe and Unadulterated ilterated * 3-301.12 I Preventing Contamination When Tasting* 161 1 T.agstRecosds:Shellstock 112 Prevention of Contamination from Hands 13-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from I 13-203.12 Shellstc>ek Idantifiwtian A9aintained'* Employees* I i Tags/Records:Fish Products I �13 Handwash Facilities � 13-402.11Parasite Destmaiou` i I I Conveniently Located and Accessible 1 1I 3-402.12 Records,Creation and Ketentiun* Numbers and Capacities* I 5-203.11 1 590.004(1) Labeling of Ingredients' I 15-204.11 1 Location and Placement* 7 ( Conformance with Approved Procedures I 15-205.11 I Accessibility,Operation and Maintenance 1 1HACCP Plans I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Medtods* Devices 1 16-301.1 t I Haodwashing Cleanser,Availability 3-502.12 ++ Reduced oxygen packaging,criteria* I 18-103.12 Conformance with Approved Procedures" I 16-301.12 I Hand Drying Provision 'Denotes cridud item in the fwlend 1999 I'md Code or 105 CMR 590.000. CITY OF SALEM BOARD OF EALTH Establishment Name: (' d\ dl .i`Y - Date: Page: (i of Item Code C-Critical Item / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- No. Reference R-Red Item lJ Vermed PL_FCRE PRkNT CLEARLY (k vt )W 1qV1 oV ii V w ill ot>J, Ut 4e JL�rvc�,,�g., I I rbc U60P lU /V_ a�4.� �2 Ij I I c,�G Lt-.mJi >J'X - �• rAPOAyl v qAv. I t� Usa IDI 41 1 — Ile, Cie�a . A.l:4In Lv',��yI' .iAfklI GtI,^� cwel vii ('-4 l,' v. IK VQ'N Al (�AnCQ (0�aA QfftA tkY4^ ' i �,J.Ir,Jj N. , cttNn�,�lr ►zan `(ht W, rr1�,�, Discussion With Person in Charge:y Corrective Action Required: I ❑ No I giYtis I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance o Employee R{estriction inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Codq. I understand that noncompliance may result in daily fines of twenty- ' 1ars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: D ) 3.501.144C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(items 1-22) (cont.) 4t'FJ45'F Within 4 Hunts.* S }� PROTECTION FROM CHEMICALS 9 3-501,15 Coolinp Methods fat'PHFs I 114 ( Food or War Additives 129 PHF Not and Cold Hotdinq 3-501.16(B) Cold PHFs Maintained at or below I 13-202.12 Additives*- 590.004(F) 41*145°F* y a U f 3-302.14 Protection from nproved Additives'E t E 3-501,Ifi(A) Hot PHFs Maintained af'or above 115 Poisonous or Toxic Substances 140 * t 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above. 130'F. f Containers* 120 Time as a Public Health Conical i 7-102.11 Common Name -Working Containers* I 7-201.11 Separation 3-501.19 Time as a Public Health Control* t I `7-202.11 (.Restriction-Presence and Ilse' 590,0p4(H) Variance Requirement 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'roxic Containers-Prohibitions* f POPULATIONS{HSP} 7-204.11 Samtizers.Criteria-Chemicals* I ( 7-204.12 Chemicals for Washing Produce,Criteria* I 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ( 4 .Beverages with Wmaarti Labels*7-204.14 Irving Agents,Criteria* 3-801.11(11) Use of Pasteurized Egs* > ,-205.11 Incidental Food Contact,Lubricants* a I ( 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and I Raw Seed Sprouts Not Served. 17-206.12 ((oder(Bait Stations* 7-206.13 Tracking Powders, Pest Control and ( 3-801.11(C) Unopened Food Package Not Re-served, I Monitoring* CONSUMER ADVISORY TiMEIfEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of e Animal Foods That are Raw.Undercooked or ` ( 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3401.I1A(1)(2) Eggs- I55`F 15 Sec. PatbO nc * Eggs-Immediate Service 145'Fi5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell tEggs* 3-441.11(A)(2) Comminuted Fish.Meats 1L Game .Animals-155'F 15 see. " 3-401.11(11)(1)!2) Pork and Beef Roast- 130'F 121 min' SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section .590.009(A)-(D)in sec.* I catering, mobile food,temporary and 3401.1 t(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks � interventions and risk factors. Other 145 OF* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Calked in a (. practices should be debited under#29- ( Micrawave 165F Special Requirements. i 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. j 17 Reheating for Not Holding I VIOLATIONS R LATER TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs I65'17 15 sec.* ($tents 23-30) f 34W.11(13) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Foal- i found in the following sections of the Food Code and 105 CMR 140°F* ! 90.000. 3-303.11(E) Remaining Unsticed Portions of Beef i item ! Good Retail Practices FC 540.000 I 1 Roasts23. i Management and Personnel FC-2 .003 18 Proper Cooling of PHFs 1 24. 1 Food and Food Protection I FC-3 .004 i 1 25. 1 Equipment and Utensils i FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to i 26. I Water.Piumbinq and Waste FC-5 .006 70'F Within 2 Hours and From 70' 127. 1 Phvsicai Facifity i FC-6 .007 to 41'F/45'F Within 4 Hours.* 1 28. 1 Poisonous or Toxic Materials ° FC 7 .008 i 3-501.14(A) Coiling PHFs Made From Ambient 129. Special Requirements ,009 Temperature Ingredients to 41'F/45'F : 30. 1 Other ! 1 Within 4 Hours* s'°�:'.`•a'` 'Denotes entical ism in the Leden:l 1999 Ford CWe w'105 C IR 590.000. , S .. CITY OF SALEM BOARDQF HEALTH L_ Establishment Name Y� r� �T A? Date: )I � ' �_ Page: of Rem Code C-Critical Item f DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Vern PLEASE PRINT CLEARLY V2' ML,��r�C 61' I Wlwp rvi-kp. rae: -T�tx� �aL�ir Pel, lASP l - 1,1I 41 —( 9 Ia1� �, X11 rAf)� 1 y rI ( LIGl n 1% 1'j vn t�1-(��tit fin^ fl,�ole v ✓ ►1l c �aI,)�i A DD csiussion With Person in Charge: I Corrective Action Required: F No I Plyes 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 e-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Foo . I understand that noncompliance may result in daily fines oft enty- ' ollars suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: f t 9 3.501.14(C) PHFs Received at Temperatures Violations Related to Foodborne iciness Interventions and Risk Acc6rding to law Cooled to ,t Factors(items 1-22) (Cont.) 41'F/45°F Within 4 Haus. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 ( 14 I ( 19 PHF Hot and Cold Holding Food or Color Additives 3-501.16(B) Cold Pt1Fs Maintained at or below 11-202.12 Additives*- ( 590.004(F) 410145"F* 3-302.14 Protection from Unapproved Additives* I 3-501.16(A) Hot PHFs Maintained at or above w ( 15 Poisonous or Toxic Substances ( I lam. , 7-101.11 identifying Information-Original 13-501.16(& Roasts Held at or above 1300F. Containers* 2® Time as a Public Health Control Common Lazne-Wtakins Containers* I ( 7-201.11 Separation-Storage* I 3-501.19 Time as a Public Health Control* I 7-202.11 .Restriction-Presence and Use* ( 590.004{H) Variance Requirement f ( 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE +) ( 7-203.11 Toxic Containers-Prohibitions ` ( POPULATIONS(HSP) s ( 7-204.11 Sanitiun.Criteria-Chemicals* ( 7-204.12 Chemicals for Washing Prodmx,Criteria* I 21 3-80LH(A) Unpasteurized Pre-packaged Imees and 7-204.14 Drying Agents.Criteria*( ( Beverages with Warning labels" ( 3-801.11(B) Use of Pasteuriml Eggs° ( ;-205.11 Incidental Food Contact.Lubricants* ( 3-301.11(D) Raw or Partially Cooked Animal Food and i ( 7-206.11 Restricted Use Pesticides,Criteria'' I Raw Seed Sprouts Not Served * { ( 7-2116.12 Rodent Bait Stations* ( 1 3-801A UC) Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders, Pest Control and Monitoring' CONSUMER ADVISORY i TIAl1EtEEMPERATURE CONTROLS 22 3603.11 Consomaer Advisory Posted for Consumption of i 16 Proper Cooking Temperatures for Animal Foals That are Raw.Undercooked or PHFs Na Otherwise Processed to Eliminate y 3401.IIA(1)(2) Eggs- I55'F 15 Sec. Pathogens,*"CDVB rnami Eggs-Immediate Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Aniuuds-155°F 15 see. " SPECIAL REQUIREMENTS `1 ( 3-401.11(B)(i}(2) Pork and Beef Roast- 136'F 121 num* I 3-401A I(A)(2) Ratites, Injected Meats-155°F 15 590.004(&)-(D) Violations of Section 590.009{A}-(I1).in sec.* catering, mobile food,temporary and t 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F t5 see. * above if related to foodhorne illness 3401.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145OF* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a - practices should be debited tinder#29- Microwave 165'F* Special Requirements. { 3401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.* I t ( 17 Reheating for Hot Holding ( VIOLAT/ONS R .L TED TO GOOD RETAIL PR4C77CES 3403.1I(A)&(D) PHFs 165F 15 sec. * I (Items 23-30) 3-403.11(B) Microwave-,165 F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne%llness inten>entions and risk factors listed above, can be 3403.t 1(C) Commercially Processed RTE Food- found In the following sections of the Food Code and 105 CMR 1400F* 590.000. 3-402-11(E) Remaining Unsliced Pordous of Beef item ! Good Retail Practices FC s3o-odo i ` Roasts* j 23. 1 Managament and Personnel i FC-2 .00.3 i ( 18 Proper Cooling of PHFs ( 1 24. 1 Food and Food Protection FC-3 .004 1 25. Equipment and Utensils FC-4 .005 1 3-501.14(A) Cooling Cooked PHFs from 140`F to I Water.Ptumbinq and Waste ! FC-5 .006 70°F Within 2 Hours and Front 70`F 1 27. Physical Facility i FG-6 .0D7 i to 41'F/45'F Within 4 Hours.* 1 28. ' Poisonous or Toxic Materials FC=7 .008 I 3-501.14 B) Cooling PHFs Made From Ambient 129. I Special Requirements i .009 ' Temperature Iagredientc to 41 017/45017 i 30. 1 Other 1 Within 4 Homs i 'Dern+ms critical iwm in the L^derai 1999 Foul Curie ur 105 0AR 590.000. CITY OF SALEM BO RD OF ALTH Establishment Name: dYlG}/ 7 � Date: l I Page: - 1 of — I Item Code C-Critical item ( / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE Pm NT CLEARLY �A/ t2P.1� rill�df 1)� (,;lrt,\ AVN)l-, Z-7 I�Invr � �I,c ✓ �t►,I,yC�-v��In � / i (sir ve" G/oS� con vy-u nauzl^' f ��• I - �� r�ca�.��et� �f�J-f n�,l.�, Jt ,-�I- �--�-U��L,T�a rorr�ti� .� aL pl(AaCII bo Discussion With Person in Charge: Corrective Action Required: I ❑ No try -ws 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 co ditions as described, and to a/ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food ode. 1 understand that noncompliance may result in daily fines of twen ' dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 1 3-501,14(C) PHFs Received at Temperatures �. Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to 4 Factors(gems 1-22) (Cont.) 41'P:45'F Within 4 Hours. CHEMICALS ( ' 3-50 L 15 Cooling Methods for PHFs PROTECTION FROM CHEMICA ' { ( { 19 PHF Hot and Cold Holding 14 { For Color Additives ' 3-501-16(B) Cold PHFs Maintained at or below { 3-202.12 Additives*' { 590.004(Fl 41°145"F* 3-302.14 Protection from Unapnioved Additives" f 3-501.16(A) Hot PHFs Maintained at or above i { 15 Poisonous or Toxic Substances { ]40`17• * 7-101.11 Identi6ring Information-Original' � 3-501-I6(A) Roasts Held at or above 130'17. Containers* C 7-102.11 Common Name-Working Containers* ( 20 Time as a Public Health { 1 r '_01.11 Separation-Storage* .'.-501.19 lune sa Public Health l Control* { f E 7-202.11 Restriction-Presence and Use's { a590,004(fl) Variance e Requirement { { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE { 7-203.11 Toxic Containers-Prohibitions* ( POPULATIONS(HSP) { 7-204.11 Sanitize",Criteria-Chemicals* i 21 3-801.1](A) Unpasteurized Pre-packaged Juices and . 17-204,12 Chemicals fire Washing Produce,Criteria° { Beverages with Warning Labels* { 7-204.14 Drying Agents.Criteiia* { { 7-205,11 incidental Food Contact,Lubricants* 3-801.11($) Use of Pasteurized C Ekes* { 3-801.11(D) Raw or Partially Cooked Animal Food and { 7-206.11 Restricted Use Pesticides,Criteria* 1Raw,Seed Sprouts Not Served { 7-206.12 Rodent Bait Stations* { { 3-801AI(C) Unoaened Food Package Not Re-served. " { ' 7-206.13 Tracking Powders,Pest Control and $ ( Monitoring- CONSUMER ADVISORY T1MEfTEMPERATURE CONTROLS 22 3.603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures far Animal Foods That are Raw,Undercooked or Not Otherwise,Processed to Eliminate PHFs i ""ter 3-40 1.11 A(l)(2) Eggs- 155'F 15 Sec. t Pathogens.* Eggs-Immediate Service 145'FiSsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell i 3-401.11(A)(2) Comminuted Fish.Meats&dame Ems, ' Animals-155'F 15 sec. IREMENTS 3.40LII(B)(1)(2) Pork and Beef Roast- 130'F121 min* { SPECIAL REQUnsofSeti 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590"009(A}•(D) catering, of Section temporary and in See.* catering, mobile foul,temporary and 3-401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'1715 sec!* above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145'F r' 590.009 violations relating to good retail 3-401.12 'Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All Other PRFs-145`F 15 sec.' f 17 Reheating for Hot Holding VIOLA77ONS R LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165"F 15 sec,* ) (Items 23-30) 3-403.11($) Microwave- 165'F 2:Minute Standing Critical and non-critical violations,which do not relote to the, Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTI;Food- f found in the following sections of the Fuod Corte and 105 CMR 140°F° ! 590.000- 3-40111(E) Retraining Ureliced Portions of Beef j Item I Good Retail Practices I FC 590.000 i Roasts` i 23. 1 Management and Personnel i FC-2 .003 { 18 Proper Canting of PHFs j 24. i Food and Food Protection I FC-3 .004 125" 1 Equipment and Utensils i FC-4 '005 3-501.14(A) Cooling Cooked PHFs from 140`F to ; 26. Water.Plumbing and Waste FC-5 A06 70'F Within 2 Hours and Front 70'F 27. i Phvsical Facility I FC-6 .007 to 41'F145'F Within 4 Hours. ° i 28" ; Poisonous or Toxic Materials FC=7 .008 3-501.14(B) Cooling PHFs Made From Ambient29- Special Requirements 1 '009 I Temperature lagrodients to 41°17/-l5'F �. l Other ! 1 I Within 4 Hours* Denomi critical jwm in the federal 1999 Fuai Cale cc 105 CSili 590.000. x Commonwealth of Massachusetts 4 City oS Salem ` .x 2 • _. «.�- . Board of Health ;�,. a`4 ,n> -A, `Kimberley Driscoll �. '120 Washington Street,4th Floor 'm :_ Mayor x r SALEM,MA 01970 r 40'0&Refail EstablishmenfPermit µ DATE PRINTED: '• 01/03/2013 ESTABLISHMENT NAME: Omega Pizza&Roast Beef ' ' n. } ' File Number:BHF-2004-000044 _ 101 Loring Avenue . Salem ' _ MA 01970 �,. ... i - a > '.3.. 4 - .ems -vi-'..a- •- _ _ LOCATED AT. 0101'LORING AVENUE y A, - SALEM; MA 01970 = Permit Type Permit No. •Permit Issued' Permit Expires F., -?Fee Restrictions!Notes FOOD SERVICE BHP-2013-0319 Jan 1,2013 Dec 31,2013 $140.00 rv. 'ESTABLISHMENT a r •` ' µ`Total Fees x$140.00 2 4 Mr wz PERMIT EXPIRES = IDecember 31,2013q b Board of Health �� ir This Permit is not transferable and must be eissued 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 g Page 1 - .., CITY OF SALEM, 1P • MASSACHUSETTS PubticIiealth Bonau or HI Ai;rx 120 WAS]IINUION SlU1,111:1,411,FLOOR KIMBERLEY DRISCOLL Ti f,j-(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REI-IS,0110,C11-FS MAYOR Iramdinnsalem.com FWAi zi-i AG F,N'r Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) I1) Establishment Name: j311e � IMrW Pt rM L SSA ©rylelg4 PIZZA /Y � a /J rJ 2) Establishment Address: AD/ Z670 kV q AM1i c/ 3) Establishment Mailing Address(if different): �/ jll 4) Establishment Telephone No: 9 7 0 yC� /000 I 5) Applicant Name&Title: Zz>, \ C., I ( P(est IILVL' ` 6) Applicant Address: (� (0(C.(Sr ST" AVj w2IS (Nir 7) Applicant Telephone No: all? -740 24 Hour Emergency No: Email: 1-l.-y't l('c,�t (Cz N Cu 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address A corporation T f 1 (1 An individual Apartnership �uN 1x3q(�S e�la � t�7�3YftA1 �{d (r '3 Other legal ent1ty I - 12) Person Directly Responsible For Daily Operations 4Owner, Person in Charge, Supervisor,Manager, etc.) at Name&Title: /(��i♦ / `a('I t Address: i b l�Cw C`T- Sl Ue'C& 1�1� Telephone No: q'W7V0 (OL Fax: Email: 7Lkr j �/}� I a) /COLIC w+ Emergency Telephone No: 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: //L1 Date: / �� /�� Amount: �/ I� pow L 4 Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Pui j Water Supply No: (if applicable) A7-5Ar` /i—/c S4,t4)47 /a-� 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): ❑ Yes 20) Location: 22) Establishment Type(check all that apply) _ (check one) ❑ Retail( Sq. Ft) ❑ Caterer Permanent Structure ❑ Food Service-( Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments------------------------ (check one: RETAIL STORE RESTAURANT s Annual ❑ Less than 1000sq.ft. $70 ❑ Less than 25 seats $140 SeasonallDates: ❑ 1000-10,000sq.ft. $280 ❑Residential Kitchens $140 17 More than 10,000sq.ft. $420 ❑25-99 seats $280 Ei More than 99 seats -$420 Temporary/Dates/Time: -- - --- --- --- -- -- - - ❑ Bed&Breakfast/Childcare Seryices/Nursing Home $100 ------------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS ❑ MAKE ICE CREAM,YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 13 TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare 8 private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no timeltemperature controls required) (check all that apply): RTE-ready-to-eat foods(Ex.sandwiches, salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill 1 Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance 1 Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of -Non-PHF and Non.- Ret?ll c?le Animal Origin. .__ .... Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered I Retail Sale Events or Institutional Food Service I Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 aqdall q(her applicable law. 1 have been instructed by the Board of Health on howto obtain copies of 105 CMR 590.000 and the Federal Food C d /jl 24) Signature of Applicant: �IVJAVtM�Y/ 1 Pursuant to MGL Ch. 62C, s c 49A,I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax retur and paid state taxesagqrequired under law. 25) Social Security Number or Federal ID: ' � AS [0(0 ( a D G I j 26) Signature of Individual or Corporate Name: '?A'c0 LM'p-46"'rt .JN` t/ L 0 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINOSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: Q�� - Received By: Complaint Number: 0I5I23 Complainant (LI Y1 Z V Address: /J I Phone: (o/2 Z3 'Jy'�U V'-VJro 15 k rA ll / VAGISr ?. Investigated By:-)_ .�1 � ^� Date: Property Owner/Occupant Name Telephone#: c�a V1a4rq�\� - • EXAM FORM NO. 4834 CERTIFICATE NO. 10164965 ILE So INAW me LERK-STIFICATI JASON M AMBROZAVITCH d4i,a� tt) SUCCe;;kuuyco_t:t.:.'ujftt.c-*.<t:o.+riSSet fotf4tfttrthe Servsafe food ProtectiovPotanagezCertiticattar,Examwratfor.. '■ " gam n cf; <accreoitec n� fna A,netica; Nahatal.Standttrds instraAe(ANSh-Conference ter Food Protection(CFP) °°mal &2 Lt A, � _ _ _ I I t£L?fb:FC3.P`• l'<41Yfrti?8t: n t Associatio, - _ ..i Gc[td din �.N�+= u1R�..�Je".et[s+O..NdI.C�Vi.ia[<Au.nnr Atan�.fe.�i in�.• �. coko r Salem Board of Health Massachusetts Department of Public Health Division of Food and Drugs 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of (:�A j e v-n Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. q q(� Nt( ( �/ 2 Name Date Type Operetion(s) Type Inspection b 0A, (7i2.11i )� I-1i'�. ood Service outine Address ''ff ��j Risk Retail Re inspection 1�l/'� , '=` Level ❑ Residential Kitchen Previous Inspection Telephone !�£ l 2� ❑ Mobile Date: Owner V 4 �-l�-I��J ❑ Temporary ❑Pre-operation �r _AA O HACCP YM ❑ Caterer ❑Suspect Illness Person-in (PIC) Time E] Bed&Breakfast E]General Complaint In: [IHACCP Inspector '?/;�-)V)I `F- J Out Permit No. ❑Other Each violation cfiecked requires ane plan ion on the narrative page(s and a citation of specific provision(s)violated. Non-compliance wlfh: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red ^' Items) Anti-Choldng 590.009(E) ❑ Vipose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ Violations marked may p q Allergen Awareness 590.008(G) ❑ corrective action as determined by the Board of Health. FOOO PROTECTION MANAGEMENT __ _ _; ❑ 12 Prevention of Contamination from Hands O_�1. PIC Assigned/Knowledgeable/Duties _-- _ _ �,.,. _ _ 413. Handwash Facilities L EMPLOYEE HEALTH - - ,` ROTECTION FROM'CHEMICALS _ ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded _ ❑ 15. Toxic Chemicals _FOO D:FROMAPPROVED SOURCE _ ,. ,-_ . . ❑ 4. Food and Water from Approved Source iTIMEITEMPER_MkCONTROI_S(P_otenNalry Hazardous Foods) 'w] ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans c❑118.Cooling PR_O_ TECTION FROM CONTAMINATION i ��nj;/ g Hot and Cold Holding ❑ 8.Separation/Segregation/Protection 20.Time as a Public Health Control (�/ �9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS_F0R HIGHLY-$USGEPTIBLE=POPU_LATIONS'(HSP) l�lY"�V"`��-J00010. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices / ( VO,SUMER.ADVISORY 2. 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. Noncritical (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-2x590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3xs90.o04)) cited in this report may result in suspension or revocation of © 25. Equipment and Utensils (FC-4x590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FCsx590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have a right to a hearing.Your request must be in writing VGA' 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: 't-q-7 1 q-7 a lUl r�as SAX Ol f Inspector's Signature: Print:_ bhl t� PLCs Signature: � 19P� (A_ � ' Pnntr-_ I\( �� > , Page-�of�ges r Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination 3-302.11(A)(I) I Raw Animal Foals Separated from 11 1590.003(A) 1 Assignment of Responsibility* I P I Cooked and RTE Foods* 1590.003(B) Demonstration of Knowledge* I Contamination from Raw ingredients 12-103.11 Person in charge-duties I 3-302 11(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* I I Contamination from the Environment ) 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) I Food Protection* require reporting by foot employees and 3-302.15 Washing Fruits and Vegetables , applicants ? 1 590.003(F) Responsibility Of A Fool Employee Or An I 304.11 I Food Contact w th Equipment and Utensils* Applicant To Report To The Person In Charge* I I Contamination from the Consumer 590 003(0) I Reporting by Person in Charge* 3-306.14(A)(B) I Returned Food and Reservice of Foal* 131 590.003(D) I EiclusionsandRestrictions* I I I Disposition of Adulterated or Contaminated Food 1590.003(E) I Removal of Exclusions and Restrictions I f3.701,11 Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE I ' I Fwd* J q 1 Food and Water From Regulated Sources 19 I Food Contact Surfaces 590.004(A-B) Compliance with Fwd Law* I I4-501.111 ManualWarewashing-Ha Water 3-201.12 1 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewasbin -Hot Water i 3-202.13 Shell Errs* I I I Sanitization Temperatures* i 3-202.14 I Eggs and Milk Products. Pasteuri.v0 I 4-501.114 Chemical Sanitization-temp.,pH, 13-202.16 Ice Made From Potable Drinking Water* I I I concentration and hazdness. 15-101.11 Drinking Water from an Approved System* I 14-601.11(A) I Equipment Foci Contact Surfaces and 1590.006(A) 1 Bottled Drinking Water' I Utensils Clean* i 590.006(B) I Water Meets Standards in 310 CMR 22.0* I ( 4-602.11 I Cleaning Frequency of Equipment Food- I Shelf/ish and Fish From an Approved Soun.a I Contact Surfaces and Utensils* ) 4-702.11 Frequency of Sanitization of Utensils and .I 3-201.14 I Fish and Recreational 1v Caught Molluscan l I Food Contact Surfaces of Equipment" Shellfish* 1 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I I Chemical* Sources* Game and Wild Mushrooms Approved by 110 I I Proper,Adequate Handwashing Regulatory Authority 2-301.11 1 Clean Condition-Hands and Arms* 13-202.18 Shellstock identification Present" I 2-301.12 I Cleaning Procedure* 1 1590.004(C) Wild Mushrooms* I 12-301.14 I When to Wash* I 13-201.17 I Game Animals* I 111 I Good Hygienic Practices 3 1 I ReceivinglCondition 12401.11 Eating,Drinking or Using Tobacco* I 3-202.11 J PHFs Received at Proper Temperature:* i 12-401.12 Discharges From the Eyes,Nose and 3-202.15 I Package uitegrity* Mouth 13 i0LI1 I Food Safe and Unadulterated* I 13-30t.12 + Preventing Contamination When Tasting* 16 I Tags/Records;Shellstock I 112 I Prevention of Contamination from Hands 3-202.18 I Shellstock Identification* 1590.004(F,) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Employees* l i C 113 1 Handwash Facilities Tags/Records;Ftsh ProductsI I Conveniently Located and Accessible I 13-402.11 Parrasiteasite Destruction, � f 13-402.12 Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients* I 15-204.11 I Location and Placement* 7 I Conformance with Approved Procedures ( 5-205.11 I Accessibility,Operation and Maintenance /HACCP Pians I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria* 16-301.11 Handwashing Cleanser,Availability 15-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision `Denotes critical item in the federal 1999 Ford Code or 105 CMR 590.000 CITY OF SALEM BOARD OF HEALTH Establishment Name:�.a '�� Date:\ k—� �'I A, Page: a of A Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red Item Verified PLEASE PRINT CLEARLY .Dwr I �1 0 Jdc OA I 1 / AA nn/n ' G C W�JIA pl \ -tr✓t,�� - sem_ -Y)C7(- on �7 - 1 CJI 07 7 .t`�.I I./�� e_ P�rr6 -I.7_i FJ I, _ , -Y\� I Q JCS'W .y 1,�l\-fit/ �f$� (2y�SL_ rna C / (1 �OiUVV14AA"7/•Y c L� X41tPu3;l,l: _ � � ,�irlO�� l �_--J Gln °G 71have cussion With Person in Charge: rre Ive Action Required: L3No Ql.- fps read this report, have had the opportunity to ask questions and agree to correct all '�Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to e� e-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that !�' _ noncompliance may result in daily fines of twe �fi ollars or suspension/revocation of b mbargo L 0 ❑ Emergency Closure .your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures s Violations Related to Foodborne illness.Intersentions and Risk According to law Cooled to Factors(items 4-22) (Cant.) 41"F/45`F Within 4 Hours. 3-501.15 Cooline Methods for PHFs PROTECTION FROM CHEMICALS i P � Food or(olorCAL Additives � i 19 PHF Hot and Cold Holding 3-501,16(B) Cold PHFs Maintained at or below 1 3-202.12 Additives* 590,004(Ft 4101450 F* 3-302.14 Protection from Unapproved Additives" 3-501.16(A) Hot PHFs Maintained at or above lit ( 15 Poisonous or Toxic Substances i 140`17. * 7-101.11 Identifying Information-Original I Containers* � 3-502.16(0) Roasts Held at or above 130017. 24 Time as a Public Health Control i 7-102.11 Common Name-Working Containers* 3-501.19 Time as a Public Health Control* ( 7-201.11 Separation-Storage" i 590,004(H) Variance Requitement 1 ; ! 7-202.11 .Restddion-Presences and Use'" 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* + 17-204.11 Satdtizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and i Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria* 3-801.11($) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 1 7-206.11 Restricted Use Pesticides;Cnteriat Raw Seed Sprotns Not Served* 1 7-206.12 Rodent Bait Stations* i 3-841.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring' CONSUMER ADVISORY T{MEIFEMPERATURE CONTROLS 22 3-643.11 Consumer Advisory Posted for Consumption of 16 Proper Cooldng Temperatures for 4 Animal Foods That are Raw.Undercooked or PHFis { Not Otherwise Processed to Eliminate 3-401.]IA(1)(2) Eggs- 155`F 15 Sec. Pathogens'*FRactY 14AMa Eggs-immediate Service 145`Fi5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-441.11(A)(2) Comminuted Fish.Meats&Game Eft Artimals-155°F 15 sec.* t 3.401.I1(B)(1k2) Pork and Beef Roast-134'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155`F 15 590.009fA)-(D) Violations of Section 590.009(A)-(D)in sec.* cathing, mobile food,temporary'and 31101.71(0)(3) Poultry,Wild Cisme.Sniffed PHP's, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections i Poultry or Ratites-165'F 15 see.* above if related to foodborne illness y 13-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail ( 3-401.12 Raw Animal Foods Cooked in a practices should be debited tinder#29- ',1 Microwave 165F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. try Reheating for Hot Holding I V101 A77ONS R=LATE®TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 165°F 15 sec. * ( (Items 23-30) 3403.11(B) Microwave- 165`F 2 Minute Standing Critical,card non-critical violations, which do not relate to the Tmge* foodborne illness interventions and risk factors listed above, can be 4 3-403.11(C) Commercially Processed R'F'E Fnod- found in the following sections of the Food Code and 105 CMR 140°F* 590000. 3-443.11(E) Retraining Unsliced Portions of Beef i, Item ! Good Retail Practices I FC 590.000 Roasts" 1 1 23. 1 Manaaarnent and Personnel ( FC-2 ..003 i i 18 Proper Cooling of PHFs i 1 24. I Food and Food Protection I FC-3 .004 I 1 25. 1 Equipment and Utensils 1 FC-4 .005 I 3-501.14(0) Cooling Cooked PHFs from 140`17 to 1 20, i Water.Plumbino and Waste FC-5 .006 70'F Within 2 Hours and From 70`F 1 27. 1 Physical Faei6ty FG-6 .007 to 41`F/45'F Within 4 Hours.* 1 28. Poisonous or Toxic Materials FC-7 .008 i 3-501.74(6) Cooling PHFs Made From Arnbient ! 1 29. Special Requirements ,009 1 Temperature Ingredients to 41°17145°F Ili 130. 1 Other 1 I Within 4 Hours* 'Drnotes critical tum in the federal 1999 FuM Code ur 105 CSiR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Dade Tyroe of Ooeration(s) Tvpe of Insoection n�i� 7;7-Z-416t Ma)t 0 FK1 Food Service El Routine 5 Address � (( f Risk [I Retail 0 Re-inspection 7 1- Lo C) jn d P Telephone ` Level El Residential Kitchen PreviousInspection �,-yam- 41 /00 Level ❑ Mobile Dater 7. Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person In Charge(PiC) 'f 1 i " Time ti ❑ Bed&Breakfast ❑General Complaint HACCP Inspector ' ��^ Out: do PermitNo.\ ❑Other ^ � put;�yS 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 ` I ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPL 7113. Handwash Facilities r OYEE HEALTH�- __, I - PROTECTION FROM CHEMICALS ^ ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [FOOD FROM_APPROVED SOURCE .`, � El 15.Toxic Chemicals (] 4. Food and Water from Approved Source �� ,71ME/TEMPERA7URE 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 [118.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) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices f CONSUMER ADVISO.Rv j E]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. I 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)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(5so.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) 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 sMnapeclFo 14.x i Inspector's Signature: n / Print: PIC's Signature: ��J�� v}j �_ Print: v I Page or2_Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION � Cross-contamination FOOD PROTECTION MANAGEMENT ( j I 590.003(.0) Assignment of Responsibility* ( 3-302.11(.0)(1) Raw Animal Foals Separated from 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 Anneal Foods Separated from Each ( 1 EMPLOYEE HEALTH 011ier* Contamination from the Environment 2 590A03(C) Responsibility of the person in charge to 3-302,11(A) I Food Protection* require reporting by food employees and 3-302 15 Washing Fruits and Vegetables applicants* 3301,11 ( Food Contact with Equipment and 590,003(F) Responsibility Of A Food Employee Or At * Applicant To Report To The Person in Utensils Contamination from the Consumer Charge* 3-306.14(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(F) Removal of Exclusions and Restrictions j 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Fund* _ 4 Food and Water From Regulated Sources ' 9 Food Contact Surfaces 590A04(A-B) Compliance with Food Law* j 4-501.111 Manual Warewashmg-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures` 3-201.13 Fluid Milk and Milk Products* 1 4-501.112 Mechanical Warewashing-Hut Water j 3-202.)3 Shell Eggs* Sanitization Temperatures* 1 3-202.14 Eggs and Milk Products.Pasteurized* 1 4-501.114 Chemical Sanitisation-temp.,pH, 3-202,16 Ice Made From Potable Drinking Water- concentration and hardness. 5-101.11 Drinking Water from an Approved System- 1 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water" Utensils Clear- 4-60-1.11 CMR 22.040 ( 4-602.11 Cleaning Frequency of Equipment Food- 1 1 590.006(B) Water Meets Standards in Sheilish and Fish From an Approved Source ( Contact Surfaces and Utensils* 1 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Fmx1 Contact Surfaces of Equipment* Shellfish' 14.703.11 ( mi Methods of Sanitization-Hot Water and 1 3-201-15 Molluscan Shellfish from NSSP Listed Chemical** Snurces Game and Wild,b)ushrooms Approved by 10 1 Proper,Adequate Handwashing Regulatory Authority j 2-301.11 Clean Condition-Hands and Arms* 3-202-18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms" 2-301.14 When to Wash* 3-201.11 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 1 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures" 1 2401.12 1 Discharges From the Eyes,Nose and 1 3-202.15 Package littegrity* mouth* J 3-101.11 Fond Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasfing* j 6 Tags/Records;Shellstock 12 Prevention of Contamination from Hands 1 3-202.18 Shellstock Identification* 590.004(F,) Preventing Contamination from 3-203,12 Shellstock Identification Maintained* Employees* j Tags/Records: Fish Products I ( 1.1 Handwash Facilities 3-402.11 Parasite Desrraction* Conveniently Located and Accessible 3-402.12 Recordi.Creation and Retenhun* 5-203.11 Numbers and Capacities* 590.00401 Labeling of Ingredients` 5-204.11 Location and Placement* 1 Conformance with Approved Procedures 5-205 11 Accessibility,Operation and Maintenance /HACCP Pians I ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 j 6-301.11 HandwashingCleanser,.Availability Reduced oxy„en packagmn criteria 8-103,12 Conformance with Approved Procedures* 6-301.12 Hand Drving Provision *Denotes critical nem in the feder-,d 1999 rmI CMe of 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: C)ai -a_� �.� , Date: 1I . �ra Page: CD ofd Item Code C-Critieai Item No. DESCRIPTION OF VIOLATION/PLAN OF 6ORRECTION Date Reference R-Red Rem verified J � n PLEASE PRINT CLEARLY 1/� �Gi �ID.c C N / I CrSOnI P0. 1 irn�ry "'^/�! r�/n L J,J�` �f l%r.��. / (, 111�� `.1 ( i l'I!, LNC �Lr., 4 - 1 - - f �+ - 777 �• 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 violations before the next inspection, to observe all conditions as described, and to Emersion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twe -five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _ 1 0 Voluntary Disposal ❑ Other: Y 3-501,14,(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(!tants 1-22) (Cont.) 4PF/45"F Within4 Hours. PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PHFs ( 14 Food or Color Additives 1 119 PHF Hot and Cold Holding ( 3-50L16(B) Cold PHFs Maintained at or below 3-202.12 Additives o 3-302.14 Protection from Unapproved Addirives* 1 3-501.16( Hot P °F* 15 Poisonous or Toxic Substances I 3-50 L 16(A} Hot PHFs Maintained of or above 7-101.11 Identifying Information-Original 3_501.16(A) Roasts Held at or above 1300F. Containers* ( � Time as a Public Health Control 1 17-102.11 Common Name-Working Containers* 17-201.11 Separation-Storage* I ( 3-501.19 Time as a Public Health Control* ( 7-202.11 .Restriction-Presence and Use* ( ( 590.004(H) Variance Requirement 17-202.12 Conditions of Use* ( 7-203.11 Toxic Containers-Prohibitions* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* ( ! 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria* I E 1 7-205.11 Incidental Food Contact,Lubricants* I ( 3-801.118) Use of Pasteurized C Ekes* 17-206.11 Restricted Use Pesticides,Criteria* 13-801.11(D) Raw Seed Sprouts Cooked Animal Food and Raw Seed Spratus Not Served. ( 7-206.12 Rodent Bait Stations* 13-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and " Monitoring* CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-602.31 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for I Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliutinate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*Effsnve rrt�r Eggs-Immediate Service 145'Ft5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs Animals- 155'F 15 sec. * 3401.11(B)(1)(2) Pork and Beef Roast- 130'17 121 stun* I SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section.590.009(A)-(D)in sec.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PM, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-1650F 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle.Intact Beef Steaks ( interventions and risk factors. Other 145'F* I 590.009 violations relating to good retail 31101.12 Raw Animal Foods Cooked in a ( practices should be debited under#29- Mierowave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 117 Reheating for Hot Holding I VIOI-AT70NS R.SLATED TO GOOD RETAIL PRACTICES i 3-103.11(A)&(D) PHFs 165-F 15 sec.* I (Iteats 23.30) 3.403.11(B) Microwave- 165'F 2 Minute Standing ( Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(0 Commercially Processed RTE Food- I found in the follaning sections of the Food Cade and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsticed Portions of Beef I i Rem 1 Good Retail Practices I FC 1 590wo Roasts+: 123. ! Management and Personnel FC-2 1 .003 I 18 I Proper Cooling of PHFs I i 24. I Food and Food Protection .004 i ° 125. 1 Equipment and Utensils r FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140 F to 126. I Water.Plumbing and Waste FC-5 006 70OF Within 2 Hours and From 70'F 127, I Physical Facility i FC-6 .007 to 41°F/45'F Within 4 Hours. * 1 28. 1 Poisonous or ion is Materials I FC-7008. I 3-501.14(B) Cooling PHFs Made From Ambient 1 29. 1 Special Requirements i I .009 I Temperature Ingredients to 41'F/45'F 1 30. 1 Other i 1 1 Within 4 Hours* *Denotes criticai aero in the federal 1999 Fool Code or 105 CMR 590.000. Massachusetts Departmentlof Public Health Salem Board of Health 120 Washington Street,4"Floor Division of Food and Drugs k Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name � Dae Tyoe of Ooerationfsl Tyge of Insoection O M e 11 i- ' ''��/Z2 � -4 �IT ,_A I ® Food Service O Routine Address j Risk ❑ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection 4`' -�u �_ I(l J , 1 El Mobile Date: 9 r`7(" OwnerHACCP YM ElTemporary ElPre-operation s.\I y 5 P1j n .� )�n� I ❑ Caterer ❑Suspect Illness Person In Charge(PIC) _ I Time ❑ Bed&Breakfast ❑ General Complaint Inspector In. q'1.y) ❑ HACCP Out:14 I t 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. LFOOD PROTECTION MANAGEMENT I ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ _ ❑ 13. Handwash Facilities OYE EMPLE HEALTH- _ - - 1 PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals LFOOD FROM APPROVEDrom ACE ( TIMENEMPERATURE CONTROLS Potemlell Hazardous Foods �4. Food and Water from Approved Source � _ ( _.__y"�_..___._. ).r, ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [:118. Cooling PROTECTION FROM CONTAMINATION "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(1P)I El21. Food and Food Preparation for HSP El 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/federai 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-3)( 90.00 s) 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-6)(661.116) establishment operations. If aggrieved by this order, you 7. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing iER28. Poisonous or Toxic Materials (FC-7)(510.108) and submitted to the Board of Health at the above address 29. Special Requirements (591.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 34, Inspector's Signature if rjfl� Put `D Pages PIC's Signature Page-/ Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(]) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* ( Contamination from Raw Ingredients 2-103.11 Person in charge-duties 1Other* 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH ( I Contamination from the Environment I 2 590.003(C) Responsibility of the person to charge to 13-302.1 t(A) Food Protection" require reporting by food employees and 13-3(2.15 Washing Fruits and Vegetables applicants* 104.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Fotxl Employee Or An I Utensils* Applicant To Report To The Person In I 1 Contamination from the Consumer I Charge* 590 003(G) Reporting by Person in Charge" I I =-306.14(A)(B) I Returned Food and Rted or C of Food* 3 590.003(D) Exclusions and Rcstrictions* O) sRonofAdulteratedorContaminated Food 590.003(E) Removal of Exclusions and Restrictions 13-701.11 I Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE Fo ui - ' 4 1 Food and Water From Regulated Sources ( ( 9 i Food Contact Surfaces 590.004(A-B) l Compliance with Food law* ( ( 4-501 111 Manual Warewashing-Hot Water I 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* I3-201.13 Fluid Milk and Milk Products* ( 4-501.112 MechanicalWarewashmg-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Produce.Pasteurized* I 4-501.114 I Chemical Sanitization-temp.,pH, 3-21)2.16 Ice Made From Potable Drinking Water" I concentration and hardness.* J 5-101.11 Dunking Water from an Approved S^stent' I 14-601.11(A) Equipment Food Contact Surfaces and ` 590.006(A) Bottled Drinking Water" Utensils Clean* i 590.006(B) Water Meets Standards in 310 CMR 22.0* I ( 4-602'11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils" 3-201.14 Fish and Recreationally Caught Molluscan 14-702.11 Frequency of Sanitization of Utensils and Shellfish* Food Contact Surfaces of Equipment* 4-703.11 I Methods of Sanitization-Hot Water and '-201.15 Molluscan Shellfish from NSSP Fisted Chemical* ! ( Sources* 110 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I Regulatory Authority `x.301.11 Clean Condition-Hands and Arms* f 3-202.18 I Shellstock Identification Present* I 12-301.12 Cleaning Procedure* I 590.004(C) Wild Mushrooms- I 2-301.14 When to Wash* 3-201.17 Game Animals* I ( t1 Good Hygienic Practices I 51 Receiving/Condition I 2401.11 Eating,Drinking or Using Tobacco* 3-202.1 L PHFs Received at Proper Temperatures* I 12-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* "four,* 3-101.11 Foal Safe and Unadulterated 3-301,12 Preventing Contamination When Tasting* I 12 Prevention of Contamination from Hands 3-203.18 Shellstuck Identification 6 Tags/Records:Shea I 590.004(F) Preventing Contamination from ( on* ( i 3-203.12 I Shellslock Identification Maintained* I Employees* I Tags(Records: Fish Products I 113 1 Handwash Facilities I 3-402.11 Parasite Destruction• I I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* I 15-203.11 I Numbers and Capacities* 5 04.11 1 location and Placement* 590.004(J) Labeling of Ingredients' I 1 7 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance I IHACCP PlansI Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 13-502.12 Reduced oxygen packaging,criteria,* ( 6-301.11. Handwashing Cleanser, Availability I 18-103.12 Conformance with Approved Procedures* 16-301 12 I Hand Drying Provision *Denolas critiad nem in the federal 1999 Food Cale cs Has CSIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: n me'(;li �)2zA Date: c) I /t r Page--) of Item Code C-Critical ItemDate No. Reference R-Red Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Verified PLEASE PRINT CLEARLY '� � � to t Pl--i,y; sIo y .- S JP�tr�� °— ✓a l ai n,�le c� tX� ✓o 219 poi)3 l I I k zW, nivJ0 rl ti s noll�Id I�f_IG�t- �� _�-)5 -v12s, rLD->Lji- I.✓ e- \A lY '� Ict, r5- v, )ODr`/l rbcVc tiA , wed L 44- n-A--r-r� -4\;'1 �A7 t t �-L--A, . I�JJ_e� I t6 c e� r�/1 2� /o cv�� J7\ —U(., _ �3 ' C c kxno�-� (-4� -ArDm 93/" ren, rf- c f bjAw ca f_ � v�ik{ -+ I J. r� vet if--. 6-I, ONJ FM-7�,� I;vi f c � . { (L I I I' Discussion With Person in Charge: Corrective Action R quired: I ❑ No �� Yes j 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 Code. I understand that noncompliance may result in daily fines of-tv�enty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r ��- __�, ❑ Voluntary Disposal ❑ Other: 1 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Coaled to Factors[hems 1-22) (Cont.) 4171457 Within 4 Hours. PROTECTION FROM CHEMICALS -501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding I ( 14 ( I Food or Gator Additives ( I 3-501.16(B) Cold PllFs �iaznraenedatnrbelow 3-202.12 Additives* 590.004(F) 41°145'F* 3-302-14 Protection from Unapproved Additives` I 3591.16(A) Hot PRFs Maintained at or above ( 15 Poisonous or Toxic Substances j Imo. 7-101.11 idemifying Information-Original j 3.501.16(A) RoasEs Held at or above 130°F. Containers* I 120 Time as a Public Health Control I7-102.11 Common Name-Working Containers* I j 7-201.11 Separation-Storage* j � 3-501.19 Time as a Public Health Control* j 7-202.11 Restriction-Presence and Use 5590.004(H) Variance Requirement 7-202,12 Conditions of Use* E REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 17-204.11 Sanitizers.Criteria-Chemicals" 7-204.12 Chemicals for Washing,Produm,Criteria* 21 3_801,i](A) Unpasteurized Pre-packaged Juices and j 7-204.14 Drying Agents,Criteria' ( Beverages with Warning labels* Use of Pastem-tzed Egos* 7-205.11 Incidental Food C<xitact Lubricants* 3-801.11{B) ' 13.801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria Raw Seed pmrrts Not Served 17-206.12 Rodent Bait Stations* j F * 7-206.13 Tracking Powders,Pest Control and 13-&01.11(0) Unopened txxi Package Not Re-served. ` I Moaittning" CONSUMER ADVISORY 71MEffEMPERATURE CONTROLS 22 3-603.17 1 Consumer Advisory Posted for Consumption of i6 ( Proper CooMng Temperatures far Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate Pathogens.'�`'n` 3 40i.11A(l)(2} Eggs- 155F 15 Sec. Eegs-immediate Service 145'Fl5secc+ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155`F 15 sea:. SPECIAL Pori:and Beef Roast- 130°F 121 min' I SPECIAL REQUIREMENTS 3-401.1 I(.A)(2) Ratites, Injected Meats-155°F 15 590.009(A)(D) Violations of Section .590,009(A)-(D)in sea * i catering, mobile food,temporary and 3-401.1 t(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be I+I Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 see. ° above if related to foodborne illness 3=i01,11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Otter 145T* 590,009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under x`29- Microwave 165F* Special Requirements. 3-401AI(A)(1)(b) All Other PHFs- 145'F 15 sec. j 17 j Reheating for Hot Holding I VIOLATIONS R SLATE®TO GOOD RETAIL PRACTICES 3-403.1 I(A)&(D) I PHFs 165°F 15 sec. * ( (Items 23-30) 3-303.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be { 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the flood Code and 105 CMR ! 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef ( Ilam 1 Good Retail Practices i FC 590.000 Roasts" j 21 i Managsment and Personnel ` FC-2 .003 18 j Proper Looting of PHFs I 1 24 Food and Food Protection ` FC-3 .004 ! 1 25. !, Equipment and Utensils I FG-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 1 26, Water.Plumbinq and Waste 1 FC-5 .006 70`F Within 2 Homs and From 7TF , 27. 1 Physical Facility FC--6 .007 to 41`F/45'F Within 4 Hours,* 1 28._ j Poisonous or Toxic Materials FC-7 .008 3-501.14(13) Cooling PHFs Made From Ambient i 29. Special Requirements .009 Temperature ingredients to 41'F/45°F j ' 30 1 Other Within 4 Hours* Denote,cnliea:4wal in the L-daal 1999 Fucrl Cale a'105 CSiR X90.000. ,r CITY OF SALEM BOARD OF HEALTH Establishment Name: O,u e G4- Date:_ a- Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF'CORRECTION /Jn, No. Reference R-Red Item `` n , PLEASE PRINT CLEAREY I r led 14- 14- t2 el- bl0V"f / �+�f�.�0i�� •_,n rlv ?l 1_An .4—Gcors"s Al I r 1 V U r/ >E1Q� ,�� cc��.rc �'�0,0�.A I >J �''('4P 1 J-ze i S��( rJ, �Iloc`o,✓ r�nvss ron {� �x VA2lzan , r c,{fcr . �re\ �lLlk�'1 ),Al 57 /. 4— 1-%A•-(l� r✓1 <�17��. L �r S`:J t'-"/�-..� / t ` V n � I), - ,l ISO V,JII� In L )CI IV - ..0t "s') k, 1,tiooJA ce',.,_,.V c`,rtfp'. i of cl" , -/i,v t ( � ,�� 1 Musile Hem�al�rl� ��JiC`�2 crc�u_��'v Y� -�►� rt� k�e7�� ✓ r�.v'1 /aJ��rv�,✓> ri! � I I fC it Ire ✓n . F'^e it' v ✓ t /i -- �J I V/ ,S� ✓L — 7 ZA C-0 Q �'-yl�2°r' G,Wt 0-1. e7 "Ir AA 19,4 Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance o Employee R>sstriction p PP Y q 9 Exclusion violations before the next inspection, to observe all conditions as described, and toe-inspection Scheduled Li Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ? noncompliance may result in daily fines of _nty_tive_dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permits V ❑ Voluntary Disposal ❑ Other: � 3-501.t4(C) PHFs Received at Temperatures Violations Related to Foodborne fiiness interventions and Risk According to law Caofed to Factors(Items 1-22) (Cont) 1 417/457 Withia 41 PROTECTION FROM CHEMICALS 3-501.15 I Cooling Methods for PHFs I 14 Food or Color Additives I S 19 PHF Hot and Cold Holding { ! 3-501.16(B) Cold PRFs Maintained at or below 3-202.42 Additives 590.0(W(F) 41'145"F* 3-302.14 Protection from Unapproved Additives" 15 Poisonous or Toxic Substances 3-50IA6(A) Hot PHFs Maintained at or above 1400P. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* ' I { 7-102.11 Common Name-Working Containers* { 120 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 SUSCEPTBSLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) { 7-204.11 Satemicals Crifor Washing i Chemicals* odu=, { 21 3-801.11(A) Unpasteurizzd Pre-packaged Juices and 17-204.12 Chemicals far Li ashing Produce,Criteria* I i 7-204.14 Drying Agents.Criteria* I .Beverages with Vr'anting labels* 7-205.11 Incidental Food Contact,Lubricants* { 13-801.11(6) Use of Pasteurized Eg;s" 1 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. * 7-206.I2 Rodent Bait Stauans* 13-801.11(C) Unopened Faad Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 16 Proper Cooldng Temperatures for 1 Anhnal Foods That are Raw.Undercooked or PHFs I Not Otherwise Processed to Eliminate i 40i-IIA(1)(2) Eggs- i55`F 15 Sec. Pathogens." Eg°s-immediate Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Conmtinuted Fish.Meats&Game j Eggs' Animals-155'F 15 sea. * { { 3-401.11(13)(1)(2) Pori:and Beef Rost- 130'F 121 nein* I SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-iD)in sec. * catering, mobile ford,temporary and 3-40).11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3.401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail i 3-401.12 Raw Animal Fords Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. { 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec.* I 17 Reheating for Hot Holding I VIOLA77ONS R kATED TO GOOD RETAIL PRAC77CES 3-403A i(A)&(D) P11Fs 165'F 15 sec. * i (Items 23-30) 3.403.11(B) Microwave- 165 F 2 Minute Standing Critical and non-critical violations, which do not relate to the Titre* foodborne illness inter entians and ris&,factors listed above, can be 3-403.11(C) CommerciallyPiocessed RTI:Foal- found in the foilowing sections of the Food Code and 105 CI1R 140°F* 590.000. 3-403.11(E) Remaining Uns!iced Portions of Beef i item Gond Retail Practices i FC 590.000 Rcasts* j <3. Manma9aent and Personnel FG-2 .u0,3 i 18 Proper Cooling of PHFs f i 24. : Food and Food Protection I FC-3 .044 : 1 25. I Equipment and Utensils i FC-4 .6D5 3-501.14(A) Cooling Cooked PIFs from 140`F to 26. I Water.Plumbinq and Waste 1 FC-5 M6 70`F Within 2 Hours and From 70'F ! 27. Physical Faciffv FC-6 .307 to 41`F145'F Within 4 Hours.* i 28. Poisonous or Tavc Materials FC=7 .008 3-501.14(B) Cooling PHFs Made From Arnbicin 7y 1 29. 1 Special Requireents .003 Temperature Ina etlients to 41°Ff45'F 1 30. 1 mOmer ! ' Within 4 Hours` S'AW'1 rc_-. m: "Den- ,(es criocat rvrn in the f_dna7 1999 FwJ Cale w 105 C\tR:90.000. a a�j I CERTIFICATE OF ALLERGEN AWARENESS TRAINING i i,. Name of Recipient:,:. Chxistina:Alefantis - Date of Completi,an:; ; Z/9,4/2012 Date of Expiratibn: 2/24/20,17 i i i The above-named person is hereby issued this reri(rate IssueJRy: for completing an allergen awareness training program recognized by the ilWassachusetts Departmeni of Public HealthBerkshire L� in accordance with 105 CMR 590,009(G)(3)(rz). imiAHEC i Area Health Education Center ti This rert�caie will be valid forfave(s)years froth date ofconapletian. Piltslield,Massachusetts �, � .cM1vrc:mafoodallcrgytraining.otg N -------- ---- ------------ is c. 03 '06/2012 12:51 #0835 P.001 /002 f i i 1 f S � y � 1 r r 03/06,'2012 12:&8 #0835 P.001 /002 I I C y \ � 1 { f ` r • 0 N ---- - -- - - -- NI. N CERTIFICATE OF Y ALLERGEN AWARENESS TRAINING a . Name of Recipient:, • Christina:Atefantis Date of Complai.6n:i_w,•, '�/9!4/2012 Date of Expiration: 2y24J204 >,.• J c The above-named person is hereby issued this certificate Issued By: fm•completing an allergen awareness trai ui ng program rerognized by the Mass acbusetts Department of Public Flealth Berkshire in aceardmrrewith. 105 CMR 590.009(G)r3)(a). �MAHEC I Area health Education Ccnte x This eertficate zaillbe valirlforfFve rSJ yea>-sfrani date ofeornpleti.ri• Pittsfictd,Massachuselts w `tem mafoodnlicrgyh wining.org IN ai ro ( IMPORTANT MESSAGE ) FOR DATE _////�_��.IL�TIME M 1 )I OF /1 1 PHONE �� I �_ AREA CODE UM R EXTENSION U FAX U MOBII F AREA CODE NUMBER TIME TO CALL 7 TELEPHONED PLEASE CALLAV CAME TO SEE YOU WILL CALL ASAIN WANTS TO SEE YOU ' L RUSH 1 RETURNED YOUR CALL �j WILL FAX TO YOU 4 ME//S��SAG/E� � f1� M 15 F✓ ��"T� 4. Ub1M ` SIGNED FORM 4009 MADE IN U S.A. NOTES � � � � ; , �, � �� 7� � Dennis the Mennis "The King of Pest Control" Termite and Pest Control Specialists MAIN OFFICE AND LABS 29 Locust Street Lynn. Ma. 01904 Boston Lynn Lowell Woburn Newton Peabody Lawrence Dedham 567-1038 592-0023 459-2950 935-DEAD 332-5853 532-3443 689-0697 251-0006 Bill Harris Omega Pizza 101 Loring Ave. Salem, Ma. We will continue you provide this address with an ongoing monthly service to include mice and roaches. Thank you r li Dennis Mast SWAMPSCOTT REFR[GERATION Family Owned and Operated Since 19.51 I AIR CONDITIONING AND HEATING a COMMERCIAL & RESIDENTIAL 153 Essex Street,Lynn,Massachusetts 01902 Tel: 781-592-1519 Email: swamnhvae!overizon.net www.swam nscott refrieeration.com Friday, April 1-7, 2012 Dear Mr. Ilarris. I am writing in regard to the refrigeration equipment located at 101 Loring Ave Salem, Ma 01970. Swampscott Rcli•igeration performed service to all refrigeration units an April 5 2012. Each unit has been cleaned and charged accordingly. All equipment has been set-vice regularly by Swampscott Refrigeration Inc. The equipment is running properly and will maintain a temperature of4l°. Yours truly, G ]on hon --- Invoice oa r' Date Invoice# 7�e, i'lgerA �t � I 4/5/2012 09259 j �?HY1tCON;D,,,. 7.` OTl 'IT ;Gr i i Gasr�urerc/a/«Rea/deryt/A/ 781-592-1519 Bill To Omeea Pizza -- 101 Living Avc salem.kJa 01(197(1 P.O. No, Terms N015 Description Qty Rate Amount Cooling 'Tech Jon 180.0(1 18000-- Servicc to all coolers and A/C systems:cleaned all condensers;changed filter,: cleaned all drains.added refrigerant as needed: mspccted all equipment;all unus are working in gond operating condifion. Refriecrant 134-A 25 00 25 001 I"d igcront R-22 25110 25.001 Thank you for-}our bUSMCSS Subtotal $230 00 Please remit to: Swampscott Retngeration, Inc. Sales Tax (6.25%) $3 13 163 Essex Street - Lynn, MA 01903 Total Telephone: 781-592-1519 Kind us on .$'-i311 h'acsmile: 781-581-7605 -_Facebook I-'mail*swamphvac(q)verizonmet Payments/Credits $000 swam pscottrefrigeratio n.com Balance Due $23313 - r. DISC<wR' 9 V, YE Past due balance,in ceeeis ol'90 days �'� ' may be submitted to wheounn INVOICE TO SITE LOCATION THE TOTAL GROUP, INC. ONUAMTOMER AME: VI•lEG I'r 1' I"Z�L.f �nm�,'�++ r P.O. BOX 185 ATTN. ADDRESS' I�/I LO NrY I TVl� ADDRESS I bl, L-o TL4>3& A11,6 ' SA'I I SWAMPSCOTT, MA 01907 w yy�� CITU r7atc-n, STATE / I - STATE A-4 ' M 781-593-9400 • 877-YES-DEMO CITYZI CODEQ�(�� a�nZIP CODE o j q-7o Customer Service Agreement TEL NO. 1 /P_ /g / ['/�If I ✓ /2t FAX NrY ? ��/, I ACCOUNT NUMBER TEL NO. /q�r/ ��7V y A7 f70 FAX NO EMAILADDRESS a rll LL WN9rIMns r£ePKKAN.. )( A wec*_ I Sry — 7�,r�ps}E,, —i'u-est A MOA_, �t �+ ��`,�;y�� ; i, 5 -.i(T,[�� The undersgned MMftal signing this Agreement an behalf of Customer acgwxledges mat he or she had read and understands the terms and condioore of this WL ■ HEREIN REFERRED TO AS'THE COMPANY" Agrsmatnt ant mat he or she had the aNhodry to sign the AgreameM on behalf of Custraner. BY. CTRLE:V✓J�I //JJ /f_ �." (AII/Jry.OT�RI/ZED SIGNATURE) /T (A ORIZEDsa�UTUR l / 1 WO / CUSOMTER NAME(PLEASE PRINT) DATE OF AGREEMENT COMMENTS- TERMS AND CONDITIONS ,r SERVICES: Customer grants to company the exclusive right to collect and dispose of all of Customer's non- hazardous solid Utc/N('1LS 111 s /�jy hazardous solid waste materials (including recyclables) (collectively, "Waste Materials"), and Company agrees to furnish such services. TERMS:THE FINAL TERM OF THIS AGREEMENT SHALL START ON THE DATE OF THIS AGREEMENT AND CONTINUE FOR 36 MONTHS THEREAFTER. THIS AGREEMENT SHALL AUTOMATICALLY RENEW FOR SUCCESSIVE 36 MONTH TERMS UNLESS EITHER PARTY GIVES WRITTEN NOTICE OF TERMINATION TO CREDIT CARD INFORMATION: -_ THE OTHER AT LEAST 60 DAYS BEFORE THE END OF THE THEN CURRENT TERM, ANY NOTICE OF TERMINATION UNDER THIS AGREEMENT BY CUSTOMER SHALL BE VOID UNLESS SENT VIA CERTIFIED ❑ MASTERCARD ❑ AMERICAN EXPRESS MAIL,RETURN RECEIPT REQUESTED,AND ACTUALLY RECEIVED BY COMPANY. ❑ VISA = ❑ DISCOVER WASTE MATERIALS: The Waste Materials shall not contain any hazardous materials,wastes or,substances;toxic CARD#: - substances,wastes or pollutants; contaminants, pollutants; infectious wastes;medical wastes;or radioactive wastes (collectively, 'Excluded Waste'),each as defined by applicable federal,stale or local laws or regulations(collectively, "Applicable Laws"). Customer shall indemnity, defend and hold harmless Company from and against any and all EXP.DATE: 3 DIGIT CODE(BACK OF CARD) claims, damages, suits, penalties, fines, remediation costs, and liabilities (including Court costs and reasonable FTI m r attomeys'fees)("collectively,"Losses' resulting from the inclusion of Excluded Waste in the Waste Materials. TITLE: Company shall acquire title to Waste Materials when they are loaded into Company's truck. Title to and Month Year liability for any Excluded Waste shall remain with Customer and shall at no time pass to Company. U.S. Postal ServiceTM CERTIFIED MAIL,. RECEIPT i10 r �Wmestic Mail Only;No Insurance Coverage Provided) r .......... 0FFICIAL ig-9-71 O Certified Fee Rl Poetmedc p Return Receipt Fee Here C3 (Endowment Required) M Resmcted Deilvery Fee C] (Endoreememt Required) (t Total Postage&Fees !LI Sent To ''R SGeef,"AW:IOo.;....................................................................... C] orPOBw No. City,Sfafe,ZIP+4 Certified Mail Provides: ■ A mailing receipt • A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mafia or Priority Mail& ■ 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 antl 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 agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". at 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 3600,August 2006(Reverse)PSN 7530-02-000-9047 ' CITY OF SALEM, MASSACHUSETTS �y BOARD OF HE,1un-i 120 WASHINGTON STRF.FT,4°.FLOOR TFL. (978) 741-1800 HIb1BERLEY DRISCOLL FAx (978) 745-0343 MAYOR ]cam lin(a�salcin.coin LARRY RANIDIN, RS/RFI IS,CI-R1,CP-FS I-II?,\l;I'I I AG I SN'I' February 15, 2012 Omega Pizza Owner 101 Loring Avenue Salem, MA 01970 To whom it may Concern: Your check#1478 dated December 26, 2011 for your$140.00 Food Permit Establishment has been returned to the Board of Health because of insufficient funds. There is a $25.00 charge for this returned check along with the original amount of $140.00. Please send a $165.00 money order or bank check to the Board of Health. Thank you. For the Board of Health L Larry Ramdin Health Agent LR/hlp CERTIFIED MAIL: 7010 2780 0002 0158 9778 Eastern Bank RECEIVED J 2012 TREASURER'S OFFICE CITY OF SALEM GENERALACCOUNT-ZBA CIO TREASURER'S OFFICE Date: 02/0712012 PO BOX 528 SALEM MA 01970-0528 Account: 9123881 We are charging your account for items returned unpaid as listed below. Returned Item Notice ]Account Amount Description 9123881 140.00 Chargeback Item 39 140.00 Returned Deposited Item Summary of Account Charnes Number Amount] Debit Total 1 140.001 lAccount Debit Tata' 1 140. *011301798* 02/06/2012 17134549 N This IS a LEGAL COPY of your C3 check. You can use R the same way you would use the ,.1 . original check. .D awM:C�lg1tNP11bl INC 1478 RETURN REASON-A G lmudaees� NOT SUFFICIENT FUNDS Ln Mp twer waa° 1, int �♦ gMy4�12 A V VA 40 40 990&t I :t4ii ID •04 F FdErlldltenr _ . M 1001448~ 1¢01130/49810 06 OOs38[39r ka d'•00147811, 111:011 130 47981: 0600536 239n, 1''0000014000111 EBF-1175 195 Market Street• Lynn, MA 01901-1508. 1.80Ci-EASTERN(327-8378) •www.easternbank,com SENDER: COMPLETE THIS SECTION �e..umua.ar:ultatlu.n r..lraaiu�aa� ■ Complete items 1,2,and 3.Also complete A. Signet item 4 if Restricted Delivery is desired. 0 Agent ■ Print your name and address on the reverse X [152(-)70a�j3 Addressee ' so that we can return the card to you. B. becelved by(Printed Name) C t ,6i ery ■ Attach this card to the back of the mailpiece, or on the front If space permits. D. Is delivery address different from Item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No AJJ _ � �� ) ✓ `V-,C 3. Service Type GAG 26 ❑Certified Mail 0 Express Mail I ❑Registered ❑Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. _ 4. Restricted Delivery?(Extra Fee) 0 Yes z. ArticleNumberl ii 7010 `2780 10002i''0158 9778 (1}ans/er from service label, _ PS Form 3811,February 2004 Domestic Return Receipt 102595024-1540 UNITED STATES POSTALW�AOE�°' � first os "8- �aidl I USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box •3 G) �. 0� n BOARD Of HEALTtto SALEM, MA 01M iz o n S I I I Commonwealth of Massachusetts s i City of Salem Board of Health 120 Washington Street,4th Floor Kimberley Driscoll SALEM,MA 01970 Mayor Food/Retail Establishment Permit DATE PRINTED: 01/03/2012 ESTABLISHMENT NAME: Omega Pizza & Roast Beef File Number:BHF-2004-000044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE' SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2012-01274 Jan 1,2012 Dec 31,2012 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 i 0014W CITY OF SALEM, MASSACI IUSE-! I:S{ BOARD OF HEALTH 120 WASHINGTON STREFT,4'..Fi,t O11, TiiL. (978) 741-1800 KINIBl?RT-I:,Y DRISCOLL F.AL(978) 745-0343 RL\YOR tramim ,nlem.com LARRY RAMI)IN,RS/RP]IS,(I IO,CP-PS Hli.v.11I dG[?N'I' 201�APPLICATION FOR P�RMIT TO OPERATE A FOOD ESTABLII IME7N(T t / NAME OF ESTABLISHMENT OR a{{ ��' 1�/�� + TEL# ��/}6� �)T�/�} ��}vjd vi ADDRESS OF ESTABLIS HMENT 16 L dl(l I I /lV��u FAX# f.� tl I U 0051 MAILING ADDRESS(if different) y) � � m � � /} EMAIL- Business': (}�a!1 L i 1A 1 )Q�Ui�1 i e/Y I Website: ((((��/}r� 7 7 p tt OWNER'S NAME I ��)--��(`(�� (� y1�`` A`//�M c TEL#l "1'I0 [ r\`}( ADDRESS V'' I 711llltn��V� 1��'l� �Q�V�CiJ 1I�7 1 V`_1Z3 STREET �.J CITY(' STATE �ZI C} CERTIFIED FOOD MANAGERS NAME(S) 1i 1 , {yam .{}} CERTIFlCATE#(S) (Required in an establishment where potentially haza{'r�dou is epar`n�n EMERGENCY RESPONSE.PERSON kJt� 11J(✓��"�� HOME TEL It (Cl04� PAY,SOFOPERATION:', I..,, °Monday Tuesday: I ';-Wednesdayf,-'1..,c•Thursday-;='1�..`'."°Friday-=-" Saturday Sunday 1 HOURS OF OPERATION I , (ease write in[-rne of I lam' ' IIQm'�� ''', slam -iD ilami�m ; �lQm IDPm _Ilum-l�p� , 12�}n �ml For exampleIlam•tt TYPE OF ESTABLISHMENT FEE tcheckonivl RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT Y_S NO less than 25 seats - (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICEaNt135Ih1G HOME---••----•••---,••_----•••,•---••----•_ ADDITIONAL PERMITS. - ----••------•-- MAKE(not just serve)ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as,church kitchens) YES O $25 `Please pay total with one.check payable to the City of Salem:` This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment , a 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 L C 62C.Section,19A,I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax r d pal state taxes required under the law. 60 Signature Date Social Security or Federal Identification Number Updated 523/11 FOODAP201 I,adm Check#&Date !�'f} ! !G $ ! — f ) Commonwealth of Massachusetts � Cityofof Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/07/2011 ESTABLISHMENT NAME: Omega Pizza & Roast Beef File Number:BHF-2004-000044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0358 Jan 1,2011 Dec 31,2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 01/26/2011 03:07 9787450343 PAGE 02 CITY OF SALEM, MASSACHUSETTS BOATED OF Hn_A1TH 120 WASHTNGTON STREET,4n,FLOOR, '.['EL.(978)741-1800 1UNSERLEY DRTSCOT.i: FMX(978)745-034.3 MAYOR nrtz zeNttntrntia7., (N.COvf DAVID GREFNWLUM,RS ACTING HL,Ajx-i AGENT 2011 APPLICATION/FOR ERMIT TO OPERATE A FOOD ESTABLISHMENT NAME Of" ESTABLISHMENT 1_/ll li t l �� Z7� TEL# l(l(1 - 9/y0 Ml t t/(�.J�' ADDRESS OF ESTABLISHMENT ) Lpri n AyenldPi FAX# 01W /0 ` bW MAILING ADDRESS(if different) I� �} r t (1 EMAIL-Business': `� } tc Website: D �,h°�` IZfvnr�JQ1��} . W� OWNER'S NAME V CSS II I E �p4 ytpbu-I(lJy TEEL# �-1'Ib� �� qN ADDRESS � 1 1 I �i �JjJ1JJ) � I�( I1)CLRVt(5 STREET 11 (� 11 t� CITY //llCc' STATE Z__IP CERTIFIED FOOD MANAGER'S NAME(S) O si Iii CS I1Y��tlV}L��j)OL DS CERTIFICATE#(S) (Required In an establishment where potentially hazardous food Is e „- EMERGENCY RESPONSE PERSON, LS�Ok �YtipbLt1 OS HOME TEL# .1-'OPERA 41N": 8,: r:m �;;^ =u`"+J,.TuB� F,„ ,},,. Qm- T�ttli8tt6Yp ' X.`-a:'<": ::4:"°+. ';Cr,� iE a� - a. PPllaaaieewrittOURS e OPERATION f) 0 )�Gtfn apm Ii 10i11-I(} kin 1C tia -` (For examplellam-11tim1 y f TYPE OF ESTABLISHMENT FEE (checkonlvl RETAIL STORE YES NO less than 1000sq.ft. --$70 1000-10,0002q.ft. =$280 more than 10,000sq.ft. =$420 ..............------............ .... ... .------..................... RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$21 25-99 seats - 80 more than 99 seats =$420 Nd........ ----------------------.......'--- ..........------------..........$,.100.----- BEQ/BREAKFAST/ ....... - CHII;DCAREAS RVj ESlNUR lNG HOME-_..................... ......................_..._--_.........._ -- _ AMITIONAL PERMITS ..... -- ......... MAKE(not just serve)ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NOWROPIT(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 Estabilsfmaent. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all pians for such must be sutmdttcd to and approved by the Salem hard of Health. Pursuant to MG*Pter S� DA,I certify underthe painsand peMltles of penury that I,tomy best knowledge and boiler,havefiled alistatetax r ms a paidulred er the law. Sitnature _ Date ' .c�rr _u N Social Security orFodcrai Identification Number Revised INWI T roon, V2oI i.adm Check#&pate ✓a ! / $ i 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 Na Date Type of OoerationU Tyge of Insoaction `Cr\Gft/ r1v"'V Y)ra v1t I�j- i�-1 I Food Service Routine Address to� OO n 1 II Risk Retail ❑ Re-inspection (.Vl1.rolA w i ) Level ❑ Residential Kitchen Previous Inspection Telephone nn ' `� ❑ Mobile Date: �� Ownern A /i HACCP Y� ❑ Temporary ❑ Pre-operation X L I, -� I ¢��-- r cloo t4 Y n5 lllJ// ❑ Caterer ❑Suspect Illness Persorain Char e((pIC /��\ / \ V Tim ❑ Bed&Breakfast El General Complaint _9 �) )l In: [IHACCP p Inspector /l�fes)� � (0 I Out: Permit No. ❑Other Each violation checked requires an expI nation on the narrative page(s)and a citation of specific provision(s)violated. lUJ 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)b 590.009 IF action as determined by the Board of Health. [FOOD PROTECTION MANAGEMENT [112. Prevention of Contamination from Hands ❑ 11. PIC Assigned/Knowledgeable/Duties ElEMPLOYEE HEALTh, � � � 13. Handwash Facilities -- -- -- )PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals [FOOD FROM APPROVED SOURCE I TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) .J El 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling I PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding [1 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing LREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(NSP)' E]21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices LCONSUMER ADVISORY i E122. 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) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.0so.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: __AV n ., i QVC� �i• S SHOlnspectFanKrl4.tlx ' 1 / G /� A5 �� t�,ll;.� V� /v-a (FYI/l � Inspector's Signature: Print: PIC's Signature: f100 t,� Q t 00en/ v, J IPrint: / �_vf�wtfI Page ,oe�Pages 10 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION Cross-contamination FOOD PROTECTION MANAGEMENT I 3-302.11(,A)(]) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge" I I Contamination from Raw Ingredients 2-103.11 Person in charge -duties 3-302 11(A)(2) Raw Animal Foods Separated from Each I Other* EMPLOYEE HEALTH ( I I Contamination from the Environment I 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection* require reporting by fad employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-3041 1 Foul C 590.003(F) Responsibility Of A Fad Employee Or An 1 . Utensils* ntact with Equipment and Applicant To Report To The Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 13 590.003(D) Exclusions and RestTictions* Food 590.003(F.) Removal of Exclusions and Restrictions ( 3-701.11 Discarding or Reconditioning Unsafe FOOD F 30M APPROVED SOURCE Fant* 4 Food and Water From Regulated Sources ( 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" I 4-501.11 I Manual Warewashmg-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* _ 3-202.14 Eggs and Milk Products. Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 lee Made From Potable Drinking Watei- ' concentration and hardness.* 5401.11 Drinking Water from an Approved System* I 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean' 1 ry90.006(A) Bottled Drinking Water' ( Water Meets Standards in 310 CMR 22.(11° 14-60211 Conanine Frequency of Equipment Food- 590.006(B)i Shellfish and Fish From an Approved Source Contact Surfaces and Utensils' I 4-702.1 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationalov Caught Molluscan I ( Food Contact Surfaces of Equipment* _ Shellfish' I 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP bated I ( Chemical* Sources* Game and Wild Mushrooms Approved by 2-301.11 Clean Condition Hand( 10 I Proper,Adequate Han sand Arms* ashing Regulatory Authority re* 3-202.18 Shellstock Identification Present* I 12-301.12 Cleaning Procedure* I I590.004(C) Wild Mushrooms* I 2-301.14 When to Wash* 51 3-201.17 Game Animals* I it Good Hygienic Practices Receiving/Condition I 2401.11 Eating,Drinking or Using Tobacco* I 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* I I Mouth* 3-101.11 Fad Safe and Unadulterated* ( 13-301.12 ( Preventing Contamination When Tasting* I d H f ti i ta 1 Contamination from Hands 16 Tags/Records;Shellstock 12 Prevention� I 3-202.18 Shellstock Identification* 1590.0(4(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained'* Employeea* , TagstRecords:Fish Products I 113 Handwash Facilities I 3402.11 Parasite Dcsrruction" Conveniently Located and Accessible I 13-402.12 Records,Creation and Retention* I 15-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients* I 5-204.11 Location and Placement* q Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance I /HACCP Plans ( Supplied with Soap and Mand Drying 3-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packa}3ng,criteria* 16-301.11 I Handwashing Cleanser,Availability 18-103.12 Conformance with Approved Procedures* ( 16-301.12 Hand Drying Provision *Denotes critical acin in the federal 1999 Food Cain or 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH (� Establishment Namel/71nnA0A-4— (wiz (i C� _l�(�v z�Q Date: 0 Page: of c� Nem Code C-CrRlcal ItemV S T f No. Reference R-Red Item U DESCRIPTION (4,f VIOLATION/PLAN OF CORRECTION v Date 1 /� Y �/� J� }. '{/) / Verified l X lL_A!"�.t-Xl n A.� A 4/ Y�JC�P `J ,S PLEASE PRINT1�_CLEARLY ��Mn7A{��.. t/k \(r,ni Y/.� 1 �A� ( \ `�nI'Wt OO�n/I Pn.in�na 7 \Li 1� /1/ gym, c�.�l' �, 1`��/ IIL�1 ��) Uu �..(2A An A tM t: A la A 1 l�J /() "r X/�7/_/ ✓ - ro �Yc`+ Il /�� - �/J C) w l 44 LA-0I I OeAA�/� n�,,:� IV n lQ AA �U �_ . � �t 00 I I � 41A_q) ��D I � I I I C,,r7r-_oI lip 0 n_0 AMS /� �\( �O(X L�T A , - AAr rL A11,� OA r^ Il K/lA�llqA/!/_V nA-[-PYI 4.1 .it o, A 0'1AA ",ca, 0V " /� 1 P ''"�,'A K-1 n �� J\(� lJ - Il/l G�r�_ Al ('� .r�/J) l AM.�/ \_�(7_ /i_�. O,P� 4' 4 A ._, _ _A Al) 00AX l&i'1A Discussion With Person in Charge: Corrective Action Required: I No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ 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 tw my-five dollars or suspension/revocation of ❑ Embargo LlEmergency Closure I..IyOUr food permit. A- (�<' ❑ Voluntary Disposal ❑ Other: T' L��1 / �/ 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(ftems 1-22) (Cont.) 41'F/45°F Within 4 Hours. * " PROTECTION FROM CHEMICALS 3-501.15 Cooling,Methods for PHFs ( 14 Food or Color Additives ! 19 PHF Hot and Cold Holding 3-202.12 Additives* I 3-501.16(B) Cold PHFs 4ilaintained at or below 540.004(F)3-302.14 Protection from Unapproved Additives* ( Hot P °F* H ( 15 Poisonous or Toxic Substances ( ( 3-501.16(A) Hot PFs Maintained at or above 140°F. 7-101.11 Identifying Information-Original 3-501.16(A) I Roasts Held at or above 130°F. Containers* 17-102.11 Common Name-Working Containers* ( ( 20 I Time as a Public Health Control 17-201.11 Separation-Storage* ( 3-50L 19 � Time as a Public Health Control* 17-202.11 Restriction-Presence and Use* 1590.004(H) Variance Requirement i 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* 17-204.11 Sanitizers.Criteria-Chemicals* ! POPULATIONS(HSP) 17-204.12 Chemicals for Washing Produce,Criteria* 121 3-801.11(A) Unpasteurvzd Pre-packaged Juices and ( 7-204.14 Drying Agents.Criteria" I Beverages with Warning Labels* 17-205.11 Incidental Food Contact,lubricants* I 3-801.11 B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* ( 13-801.11(D) Raw or Parially Cooked Animal Food and Raw Seed Sprouts Not Served. * 17-206.12 Rodent Bait Stations* ! ( 3-801.11(C) Unopened Food Package Not Re-served. " I 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*Mo.11r� t Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game i Ems* Animals- 155°F 15 sec.* I SPECIAL REQUIREMENTS 3-d01.1i(A)(2) Ratites,Injected Meats-155°FIS 3.401A I(B)(1)(2) Pock and.Beef Roast- i30°F 121 min* I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering,mobile food,temporary and 3-401A I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks ( interventions and risk factors. Other 145°F* 590,009 violations relating to good retail 3-401.12 I Raw Anima)Foods Cooked in a I practices should be debited under#29- Microwave 165°F* Special Requirements. 3401.11(A)(1)(b) ( All Other PHFs- 145°F 15 see. * I 17 Reheating for tot Holding ( 11I01 A77ONS R_IATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) ( PHFs 165°F 15 sec. * (Items 23-30) 3.403.11(B) Microwave- 165`F 2 Minute Standing Critical mrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sectinns of the Food Code and 105 CMR 140°F* I 590.000. 3-403-ii(E) ' Remaining UnslicedPortionsofBeef I i ttem I Good Retail Pre0 .FC 590.000 I Roasts* 1 23. 1 Management and Personnel FC-2 .003 I 118 I ( Proper Cooling of PRFs ( 124. Food and Food Protection FC-3 .004 3-501.14(A) Cooling Cooked PHFs from 140°F to 25. Equipment and Utensils FC-4 .005 26. Water.Plumbing and Waste i FC-5 .006 __! 70'F Within 2 Hours and From 70'F 27. Physical Facifltq . FC-6 .007 I to 41°F/45'F Within 4 Hours. * 126. Poisonous or Toxic Materials 1 FC-7 008 I 3-501.14(B) Cooling PHFs Made From Ambient I 129. 1 Special Requirements i .009 i Temperature Ingredients to 41'F/45°F ! 30. 1 Other ! I. Within 4 Hours" *Denotes crifical itzm in the federal 1999 Food Code a 105 CIvtR 590.000. ' i +r.a '+-n,�ti ' -,1�,. -..r 1+`R•ti:S g�?y� ..itYF«h 1.� 1.e„s'S ?dro-^ y„r' .:..t w:wvsra.:,,v,:a•xy,«�,.1. tv4s+.M.�.'Jt4Nre'.'p'.�TM a. .. aa�`h,.'4'", �.: Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,41" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 I,Name (� Date T e of Operation(§1 Tyge of Insoection c�II/Y1P/,AL �1 Z2 rs� UC2�i� Food Service Routine Address \ Risk Retail Re-inspection oM v Level ❑ Residential Kitchen Previous Inspection TelephoneEl Mobile Date: u-�� no�> Ownerf. HACCP�} YIN El Temporary ElPre-operation 0 (Q(-I t X s ❑ Caterer ❑ Suspect Illness Person in Charge•(PIC) Time ❑ Bed&Breakfast ❑ General Complaint 1 �JSJW1 Pit In. :I U�y L ElHACCP Inspector � � n �� I Out: /75 „v)Permit No. ❑Other Each violation checked requires an explanation 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(12) ❑�59o.009(F).E]- action as determined by the Board of Health. ' FOOD PROTECTION MANAGEMENT , „. `,,` *`.'.1'__,_"', ... - ,_ .,- s ❑ 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 W , Y ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source, - -- TrMErrEMPERATURE CONTROLS(Poterdtally Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures , ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling 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) ❑ 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)590.0 4)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590..00 ) 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 u 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: / Inspector's Signature: .-. Print:�b,( k n L{1CD-1-p�f I- PIC's Signature: Page of RagesT"71 Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 1159b.003(A) Assignment of Responsibility* 3-302.11(A}(I) Raw Animal Funds Separated from 590.003(B) ( Demonstration of Knowledge` 1 Cooked and RTE Foods* 2-103.11 Person in charge- duties I I ( Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH ( ( Other'r 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) Food Protection', J applicants" ( 3-302.15 Washine Fruits and Vegetables J 590.003(F) Responsibility OtA Food Employee Or An I 13-3(k1.1 1 Food Contact with Equipment and Applicant To Report To The Person In Utensils'* Charge' ( Contamination from the Consumer J 590.003(G) Reporting by Fetson in Charge* I 3-306.14(A)(B) Returned Food and Rescn•tce of Food* J 3 590.(l03(D) Exclusions and Restrictions* _ I Disposition ofAdulterated orContaminated 590.003(F) Removal of Exclusions and Restrictions I I Food 3-701.1i Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Fuo& 1 I Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) �Compliance with Food law" 4-501.;':; ManualWarewaehmg-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* J 3-201 13 I Fluid Milk and Milk Products* ( 4-501.111, Mechanical Warewashing-Hot Water 3-202.13 ( Shell Eggs* I Sanitization Temperatares* 3-202.14 I Eggs and Milk Products.Pasteurized* A-501 114 I Chemical Sanitization-temp.,pH, 3-202.16 I lee blade From Potable Drinking Water^ concentration and hafdness. 5-101.1 l Drinking Water from an Approved System* I i 4-601.1 t(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water' I I Utensils Clean, - ...... 590.006(B) ( Water Meets Standards in 310 ChiF.22.0' I 4-502.11 ('leaning Frequency of Equipment Food- Contact( Shellfish and Fish From an Approved Source Surfaces and Utensils* 1-702.1 i Frequency u1.Sanr;.rzation of Utensils and 3-201.14 Fish and Reereationa0y Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* I 4 3-201.15 Molluscan Shellfish from NSSP Listed -703,11 Methods of Sanitization-Hot Water and I I ( Chemical* Sources* I I0 I Proper,Adequate Handwashing Game and Wild Mushrooms;Approved by 2-301.11 Clean Condition-Hands and Arms' Regulatory Authority J 3-202.18 Shell tock Identification Present' ( ( 2-301.12 Cleaning Procedure* J 590.004(C) Wild Mushrooms` I 12-301.14 When to Wash" J 3-201.17 Game Animals* 111 ( Good Hygienic Practices J 5 Receiving,'Condition I 12-401.11 Faring,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 2401.12 I Discharges From the Eyes, Nose and 13-202.15 Package Integrity- I Mouth^ 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting"_ 6 I Togs/Records;Sheilstock I 12 Prevention of Contamination from Hands 3-202.18 Shel(stock Identification * ( 590.004(E) Preventing Contamination from 13-203.12 I Shellstock Identification Marntained* I Employees* • I I 113 ndwash Facilities Fish Products Conveniently Located and Accessible3402 1l Parasite m Dcstructiot* J --- - - 3-402.12 ( Records,Creation and Retention* I J 5-203.11 I Numbers and Capacities* 590.0040) I Labeling of Ingredients' I 15-204.11 I Location and Placement* 7 Conformance with Approved Procedures I 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans 1 Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 I Reduced oxygen packagrimg.criteria` 16-301.11 Han lwashing Cleanser,Availability J 8-103.12 I Conformance with Approved ProceduresM 16-301.12 Hand Drying Provision 'Denotes critical nein in the Federal 1990 Riod Code of 105 CMR 590.000. CITY OF SALEM f BOARD OF HEALTH Ia Establishment Name:C)n. V.o., a k0 0j� Date:(L, t Page: of t Item Code C-Critical Item lJ "Li DESCRIPTION OF VIOLATION/PLAN OFICORRECTION Date, No. Reference R-Red Item . . . Verified j PLEASE PRINT CLEARLY I .- I eA' ',r,a !A A11.1 .,4 Pe, ./YC:: .! 1�"/�ri , S/1-- � \/Dni�n 1)^'A .0/I,, �t-7) O.o./ d I�^^.Qnnn t .�R D�,_Tir•v�.r r.s'� " '��i l�.i"a�n,il p.�r,Pn'-fin !i„� 1�'S_��'7 C�d��rt A NY/n1_,iJ d_XACrn,- S°� I i 4- (11-d ?4j A A j 411)n a,4_1'r ' P,W kai(� kr) (I- J 1— MoD fit NA �/(`!.� n\.0.r,.n�o,�n/�ZA X I j/1,I n A-,Q 1 - �--/l;r A f ” on 1 P/U/L, �(lr� ,9l _,Min n �rt7 �I ..A,_ I �,✓ rn 1 m 1 x, � 0.n .N i,.., �1 1 Vil, 1 �A r�o�f �"C/n A , ..ftt — �_ �-�. 1hI, l t n�— �le.Pn �lJ✓WW�i I ' ,�� ` I i o 4h {v cif Y l i.O ._� hA11i n •4 W/� n,/1///�,n(��A nI, nan 11\`l\?r/l_n1 ron wMw-,n / �.( .� IAJ',' /�;1G �� 0 ��.nt�. / � ' \PA_00A„ai,' "� i A 00 i3O.11AA/Y (_,gf-o D �n\ M` AFI\&11 — 01 7A re n � CoA —a-PA 1, 1n .��_ . • I + M__ f.� 0170_0 ni"'t?& ,-,�1A r, f9 0/-\,/-,)�) va �o0'n VV•n rQ_4-�J7 Y/1ry�7t�'(y�A 'l--t"it� ��1r,V� " -, �rt�eAntonU_✓ - - _ _ 11” . . _ C� 0 _ Discussion With Person in Charge: I Corrective Action Required: I ❑ No I U-'Yes I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code/I understand that l !noncompliance may result in daily fines of ,twenty-ffive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. I ( / I�( ❑ Voluntary Disposal ❑ Other: � y SU1.14((') P11Fs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Ckloled to Factors(Itetns 1-22) (Cont.) 41`F/45`F Within Huuts. # PROTECTION FROM CHEMICALS3-501.15 Cwling Methods for PHFs � i '19 PHF Hot and Cold Holding 14 Food or Color Additives �-502 lb(B) I Cold PHF.1Vlaintained at or below 3-202.12 .Additives'" s90 00-(1) 41`/45°F' 3-302.14 Piotectionfront UnapprwedAddilives" 3.j1)L#bi:`<) HntPHFsMaintained:ttorat+nvr 15 I Poisonous or Toxic Substances t tnftn m+iion 101.11 Identifying g -- Clu;,inal 140'F, `i-5t:i Irl t, a t ontai t Rt,.,sts Held at or above 1,3 t0-I-r, : 20 � � Time as a Public Health Control f r 102,(1 _ Comm„n tisme - 44'„rk,a.�(•c,nt,t:n,�r,” f '----'--------' 1 7�20L11 _ "+ t,i 19 j rim,as a Public i lealrh Cunir I' . Seprt.tuon- Slrna};c^ l- ---iy t-”-----'-- ? ,- 02.11 i Hrsincuon-Pu'uncc,wt. („r• _. .. _ - 1 7-202.12 , Condition:.of Usc” I 7-203 11 i Toxic C'omamef, -Proh;bi;wit,' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE Inpr;iieun.cdPre-pacl.aeedJuicrcand ' "'04.11 Sannizrn,i'tneri.-Chcntic:=ie' I POPULATIONS(HSP) ( ( -SJl ��) t 7-?04.12 ('hcmicals fnt 4N'ar hutg Pro,;n:;u Criu"n a' , 21 1#t 7"204.14 Urtmp Allem.('naria" ( Rerer:mes with N'aruiag tatnas,. 1 305.1 t _ tacitirnt2l t.axl(`nniact,l.t,b,leant.'.--- :-A t! 11(b), L.e o; Pa>temized F.,;a: I 'M Commonwealth of Massachusetts City of Salem Board of Health Klmbefiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Omega Pizza & Roast Beef File Number:BHF-2004.000044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0035 Jan 4,2010 Dec 31,2010 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES iDecember3l, 2010 Board of health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBFI2LEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM&ALEM.COM DAVID GREENBALlm, ACTING HEALTH AGENT 2010 NAME OF ESTABL SHMEAPPLICATIIONnFOR PAR MI TO OPERATE A FOOD EST 13 HMENT -06 NT 91 70 ADDRESS OF ESTABLISHMENT I I)t I� 1 C� FAX it_ �7(J -5076 I MAILING ADDRESS(if different) EMAIL- Business': Website: / //��yy y�y� 1 (�/ OWNER'S NAME X11 `I ,� nY- �U��I��- TEL ((��V OT I '"I '10Y ADDRESS STIrEET crryZIP CERTIFIED FOOD MANAGER'S NAME(S) IIS uOS CERTIFICATE#(S) (Required in an establishment where potentially hazardous foods preps ddl EMERGENCY RESPONSE PERSON 1 Al111VI ��A l U� HOME TEL# I`aUAAS.©F'OPEFW10Nf 14.eWoiidayf� `&T0RdQirTU,,!!Vie'tli�sd"Q AT'` <TJurs IM,I Friday s.W. atuba`yING1,11'-W-5006 1 HOURS OF OPERATION 1 Please write in time of day. (For example Ilam-11pm) i 11Gm � � llarn I llarn II�m Ilam ISM; �1am-ID�m ;I�Qm-li�m IZn 9f TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------- — --------------- _ RESTAURANT YES NO less than 25 seats 14 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 ------------------------------ BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOM---•--------------------------------------------------------•------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL ChaptaK 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax r and pai all state t e r uir un r the law. Dill �0 9 Al Signature /) (J Date r ' I Social Security or Federal Identification Number Revised 424/07 FO%xD'AP2008.adm Check#&Date�� $ � R Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4`" Floor Division of Food and Drugs fi! Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name - Date Type of Ooeration(s), Type of Inspection t �) wwV" /LAO\ I IFood Service Routine Address no Risk Retail ❑"Re-inspection 0�t Level' ❑ Residential Kitchen Previous Inspection Telephone" El Mobile Date: l 1 L- 106 Owner 1 ❑ ❑ "ACCP YM Temporary Pre-operation L I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /�� , Time ❑ Bed&Breakfast ❑ General Complaint Inspector U 1 � In ��M Permit No. ❑Other V. �1 ( { 2�U ^/ I Out:- 1 I�� Each violation checked requires an explanation on the narrative pages) and a citation of specific provision(s) violated. `J 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. eQOD PROTECTION MANAGEMENT a _�- ❑ 12. Prevention of Contamination from Hands ®,1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities IMPLOYEE HEALTH '' "" �• - ................ ....._. . .._, -, ..._ ... PROTECTION FROM CHEMICALS .. ,. El2. Reporting of Diseasesnby Food Employee and PIC 01V ' --" [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE " ' -:"" El 15.Toxic Chemicals r , t- E] 4. Food and Water from Approved Source (Potemta TIME/rEMPERATUREdONTROLS ii" ) , y Hazxdous Foods E] 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 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 ❑ 9. Food Contact Surfaces Cleaning and Sanitizing .L REQUIREMENTS FOR HIGHLY SUSdEPTIBLE POPULATIONS"(HSP) , A` El 21. Food and Food Preparation for HSP E] 10. Proper Adequate Handwashing ,__ , - "• El 11. ADVISORY 11. Good Hygienic Practices El22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 2 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 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 x , 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. ,1 _ 30. Other DATE OF RE-INSPECTION:'�,\„, 1 r1 i e- Inspector's Signature: ( �V 1r � Print: PIC's Signature: x`L� // _ Print:-;�• s4�'\C� l�as I Page_\-oL�Pages .J.t�-•..........Y// .� •v 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* 3-30L11(.A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Rods" 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Fotxls Separated from Each EMPLOYEE HEALTH I Otherr 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reportnig by food employees and 3-302.11(A) Food Protection° -- --� applicants':` 3-302.15 Washing Fruits and Vegetables ---� 596.003(F) Responsibility Of A Food Employer Or A7 13-30,1.1 i Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* ( Contamination from the Consumer 590.003(G) Reporting by Person in Charge* ' 3-306.14(A)(B) Retm tied f=ood and Reservice of Food* _ 31 591).003(D) Exclusions and Restrictions,* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions food 3-70!.1 '• Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fcxxl* 4 Food and Water From Regulated Sources `9 Food Contact Surfaces 590.00 4(A-B) C]nmpliance with Food Law* 4-SGL.1 i i Manual1VarzwasMng-Hut Water 32.01.12 FuFoodin a Hermetically Scaled Container* Sanitization r atures- Teu�e ?201 13 Fluid Milk and Milk Products* ( 4-501.112 Mechanical Warewaghinr Hot Water 3-202.13 ( Shell EggS* Sanitization Tentperattaes* 3-202.14 Eggs and Milk Products,Pasteurized' i 4-501.114 Chemical Sanitization-temp., pH, 3-202.16 ( lee Made From Potable Drinking Water` i 4-807.11(A) EquipI Equipment Food Contact Surfaces and trahon and hardness, 1 5-101.11 Drinking Water from an Approved System" Utensils Clean' ( 590.006(A) Bottled Drinking Water* Coontactntact 590 006(B) Water Meets Standards in 310 CMR 22.0'" ( 4-502.11 CFrequency of Equipment Food- 590 and Fish From an Approved Source Surfaces and Uteri 702.1 i Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equmment* Shellfish" ( 4-703 11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Iii I Proper.Adequate Handwashing Came and Wild Mushrooms Approved by Regulatory Authority ( =307.1 1 Clean Condition--Hands and Arens* 3-1.02.18 Shellstock Identification Present, ( 2-301.12 Cleaning Procedure 590.004(C) Wild Mushrooms- ( 2-101.14 When to Wash* 3-2011.17 Game Animals* 11 Good Hygienic Practices � S ( Receiving/Condition 2401.1( Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401 12 Discharges From the Eyes.Nose and 3-202.15 Package Integrity, I I Mouth* 3-101.11 Fond Safe and Unadulterated* 3-30:.12 Preventing Contamination When Tasting* 6 Tags/Records:Shetstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* ( 590 004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products ( 13 Handwash Facilities 3-402.11 Parasite De:druction' I ( Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients* 15-204.11 Location and Placement* 17 Conformance with Approved Procedures a 205.11 Accessibility.Operation and Maintenance i /HACCP Plans ( Supplied with Soap and Hand Crying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging.criteria` ( 6-301.11 Handwashing Cleanser,Availability 9-103.12 Conformance with Approved Procedures*' 6-301.12 Hand Drying Provision Denotes critical iteni in the federal 1999 Food Gxle of 10�C;biR 590.000. ( Uwe„ . CITY OF SALEM �) BOARD OF HEALTH /) r Establishment Name:01/l0 ^___ v�12 . <� ��\,J<< .L �c-Q Date: 1— %19 v Page: -\ of Item Code C-Critical Item J DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY + I)� 1'��`�i�rX nn (1! d1-!A,'V� `. �?)Y.( 14n - I �,4MlA�IA4_rnO�i/��X — lv'1�P/�.�('�ISC__ p -. 1 /+ '�'1 /i 2Ci I ) �. ,i \ 7)irk Inv e n �n AOni "4JL ,f'�A 9 o \(\Q ) —�eA M/)CA/\A q Q n_A_ lk�� l✓in-ti� I Ui'?41V' P:,Ah o`�,4,� m Q9 l/L lrLt t `` /Ilrr r)) QA CyJ4�� , , Ah ()r�� P��vtiCu P_ } / L'T bl)) rt 0i!1.rY A %p�-Qi l/1 Pl T 1�-1'�Oyit/l :x /, (A/1 lr1 1 I�/1'1.� A 7 i '� I✓�\l l An,�.v l//-PJG'LC2h_ 1A1-n da7(1r1 i K)17� 00\OA �V\a _A.1 In,N ._�/_ v V CAYnnr,\ ,`n S .0/1. rA.�QiC - °aA )) �A;H I "I N4rp•n nn 1nn1'j4 A y 1�J > ' C-(� P ,� � U U t — ap. V1rlx,"A A nnr--lyi�n.�, �PnA l-Pn „ n.tD nti ct �a .qQ�t �i1�, Pit -4n 1p\ ,ar"o" 1,P A � 0 j 1 ' I � j Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑,. Yes ❑ 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. 1,0derstand that noncompliance may result in daily fines of twenty-five dollars or suspe(�G nsion//revocation of ❑ Embargo ❑ Emergency Closure your food permit. p ❑ VoluntaryDisposal ❑ Other: i L ! '-$1;1,1a(C) pfll-r ReLalvrd Violations Related to hysabmitie Mtn"Intensvilorts and RIA i According to tam f7ooled it) Factors(Itefts 1-22) (Const) H'J-45'F Withia,l Hove,," yvh 15 t,i 01411! t',b`th0r1l for Viffis PROTECTION ERMA CHEMICALS 19 PHF Hal and Goal Holding 14 Food or Col�.r Atssitofes at'll bc-lf,v, .§311214 150(1161:l 161A) W li%Mawyni'd at u.hb,yIv Poisocousna f oilc 1401' WWWAI Famsts HOW at or afmve 1360 1 20 Time as a Public Heafth Control 710Z 11 1 7.2fi i I; 1 501 l'imff as a Pitblrc I lealdf Ctarqrol`' 710111 Re lt1;C;!(yj -lWaNz wd Lo" 7-202.;2 Condalont f is,' 7 2W 11 1 Toxi,,Co;uuip,It --Pqaabi:_oo'li i REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULAVONS(HSP) 7-204. 'Sarali"rN Cswnv - OW&W 700417 1-il I "A) kinputatuntril 101mchaled Irains and 7-204.14 1)rAng Agway, (.'rg"ria Warnuip,lailiol:11 209,11 lri�idewvj I and I vao. 1 uhrylop", , I U�,,ftf pageutind Eyes 3411 1 1q), Rz,,w:x Rauall�,, Ciall-d Aviiijal Foifj ,n,#7,20e) Coreall i Rim SttnSpoa6 No! litr,,vd, 7076.12 i> it S:al;ill' sit" 1 HO 1 Lbitiond rfXxi Pacl�a;�w Nal il� '.�rxd a I n!"king lloa Jac- Pt,,il t.Dorno! iral CONSUMER ADVISORY C i`jjjjjrj tar aj,,!cIa y BP,fa,'d j,it*I,)n1zirqjk;to10 k,f TIMEfTEMPERATURE CONTROLS Ammyl r• is 17hat ma k4,vl Propw CwkInv Nor Otliam iq,Pp aesfa°d to Elim4ave PHIR, 101 11 A0 lf`zi Fgg- i''+5"' I I Ff,:?l lionfxh�aa laf,4a: t !3"T'5-zi:--] Wall K swaTiftzo 17gi::;Satisalusa kttv.Shat! Eye' 1 UAnO 0ritnonnOo H,h, Mad"a:t!mk 71 4t Pop& 155 0 0 Sao , 04WJ 400 42, Bak W Wd WE - I AW 121 oiln" SPECIAL REOUIREMENTS wMA 10, WMAKOW Son, Of 0 15 uatuin . motaltr ityrd. itanpr rely arid 3*01hAilt Way,Yvdd Gun,:, Rod&AW i ;csidcutiil kitchen orisar;rtions Irmuld N, st�d4lla!: 1:1:11 Mnlk dlibaed toldcr dia ippilatinate ,ai,noa� P-ih;rvo town :Ilxvc !f rafaled mifxs1lborlic 111rcss lrva(f llco vl.ak, fraul"Ilutloll,;aria ri";k faciore OlAn'l 1451; 5140. I) vtohationl relating to -!(Yod retai! 14OA2 ):.,u Foif=.t:,w ko! at if shaauld tv dei,itcd ut,dcr 429 1-40i IPAvjf(biJ1 ilabc; PHF�- 1�5'F 1.S tfe.: 17 Reheatinq tor Met riniding VOLATICAS RELATED TO GOOD RETAIL PRACTICES 3-10KI 1i Q&j Pi 0-114 165-1, 15,Cv. ^ 4 hem,2130) 197-1 HUI Nimmmc AW F 2 hhowe Sundup flood.net tato ,rim."I vioteto,al'. q1q,1,10,10I reline.10 Ili" I am' Avowme illivess ant, entiopov iizaI-0 jis4 tors It w3 la,tiv, ,,,I be 3-403.11(C) ConaimclaN 11noved PTF 1-i"! Anod in na,j.,Ifonlag a,izon,ta the Frain Cock and If 0 ("Aftyp WO S' 59(�"Iov, P=AiMi Rommul Lwamd 1 Wall' r c 2 ooanooronictiort Frope,Cawing"t pHra 24 Fdd Fd P rc, �-3A�- --j 901 1-4Al Cis-4itie PKFF I-om I `I-I v, ;1, 1 FC-5 W6 7h't Withal 2'H,cf�:,ovfl From 7(;,1, 77 paiIrcar Fraiifiry F0- 6 01I7 it,4: T:15 f� Wallin,; ti,yli.,, 8 $Ffain,ilus or Tont. ktfenals FG W3 31MA40 C.Ahig PHIS whid"Fra:1 lan�;dvt 77eTnq�wuve hj�(a;,ah,,fit 41�F;4�,,F hobo A HMO' D-w s.t, ,ram.11 a"It 'I a,,I ta- 1.,'11)iln,€C f Je of iW',i Nlf5'fi)1x at, S I , CITY OF SALEM < BOARD OF HEALTH Establishment Name /Andvi>1VVz_ Ln�� Q�rr .� e� Il a Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION!PLAN OF CORRECTION VDate erified 1 No, Reference R—Red Item - PLEASE PRINT CLEARLY /r LX \ ':.1 nn. , , � „ G .I ✓� ��(fi• n: J �T'VI/P. ' U iP I —NZ, 1nr4, f-A, UA I)/inA 1,1O I � , cl 11 4-6, n 4- -� I , I , r 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 violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �li� x�� ❑ Voluntary Disposal ❑ Other: Reo>iv-:d vldaperafuw- Violations Related to Foodkomv la!*ss tntervrniions jnJ Rlith 1.:•Lma ;o Factors(flares 1-22) ircoU Il`FM,5,FW4l,in:4 Rom- R)r VHK PROTECTION FROM CHEMICALS 19 PHF Hot and Gold Holding 14 Fa or Color Adoit4veri 3 ;fls ](,(vi CoW PBI,s Nialmlin(A�t Air"Jqow -2b-i,1"2 1'd&,n�st, lioll,Hh� Ntainfajo�d,toraboir,, 14 Prot,,;I;qII iroill kd;fiIv., 1 11Ut.I WA) Ic aus orToxic 140'F 7 NIAl 11finmall"T 0"'2iniLl Rimttl,Hoil 4il ot jj() K �ontdinm� I inne as a Public 4flillti Control 102,11 C,nuvwn Naflv - Ao,k�l lia 9 C S�Ijei�awu- So ll zige v)i)rriii(q) V=iarvc ReQolr�lllcw 7-202 It J 7-202J2 Coodjo,-D,41-7>,;, 7.2w it RFOUIREMENTS FOR HIGHLY SUSCFPTIBLE POPULATIONS{HSPJ F1 I 7 `04,14 D,vakg Avcw: I 19 l U,,c of P:A,wwlz�'d Evj -1-205 11 -01 11 lit, Raw or Rati,111% couk�d Annivil F"KJ Ln'l ?-''06.11 P.,o,t 1�d I isc CrII,7l!j R;I,,, st't'd Sproul, N(,t Sri-w"I. 7206,12 RiKl�w 1',Ili, S[uior,, 3-81;1 11 i C1 Un,1pcnel,l fl.xxi Pa6-ag, Nul fr�,tcoiq,, I drill CONSUMER ADVISORY 4")3.11 C',ri,towl Aii,,loonPowd fIr( -insumptito of TIMErrEMPIFRATURE CONTROLS Awilli] lxo, Mal 3q. tea,-,. .vd u. 16 Proper Cooking Tpuipt(olwns for I-Jilmnaw 3 �101 It-k(I)e.', 1;gt , I 55 F I; S,C, 6,;v I 15TIi, ,, t,30z I S,,bJwuw ki k,.m sllrIlt Meal, ciolw Arolu its 3-401,U B�l! 2 1 Po4 x,d 8,�u kimel !"It Milli. SPECIAL REOUIREMEW IS Viohn,n),of Salton 5`10 009(Al-([)) in iltico;o Mt.ltz, F I cawriog. alobilk: fixilt, tett-lo JILh4Iknhty aiid 3 40 1.11(A�tf P,�0r". k"ild i7ilollk, �,tuYcd PHF� residtri k n op,,r,vTillni iwald lie Cl mfalom.-, t=o h. klew J,!boed uloh r tile approfiriotc wl"Itoll" 3-401 11 (toll: f,v Irvzl;t per4 ir-:sks 3-4r}1.12 Ila w Nnilulll f-,"N( -kd ml prat licL•'. hoiild lie debiiod uf;dCi ?9 - Sipua[ ,!-461,1 I(Al(J 3,10 •%Ii kklier PlIFS- J,x'F 17 Reheating for Hot Fold;og v Vf0tATfONS RELATF0 TO GOOD RETAX PRACTICES 3 403.I I(Al&'(1") Phi- '16A,F IS 23-30) 3-4 0 13 10i) Nlic:,in,in, ib5"F Al ov it Ni a lid;n,,- al vwt,ul,w , wpah,.Io imt rc;aw:,) l,,? I. , 3-403.1 prok^.c�C4 RTI:kvii foll"d ill oll,j;iil, oem+,,t,he Food("n,},•„rill IlfiJ 011;! 3403,i 1(E i Lo< Ire -590,000 FC i Q04 � t8Proper Cooling of FHFs 25 4 frm 1.41,i:h• at�,l pli"birisLyiaL:A48,te FC-5 CKlb I - lxifty FC -1&1�Within 2 1401)r�d!!d Fron;711"t ----- ---- ------ F, 1,•41"`r!)5 F W;tina 4 Knw,, '13 Floimou,,or Toxic klaterltIlr, FG-7 M 3 [�f,aj ' �alrniiilt Lal R,miromqIV3 Tonl,,-Falure hk,'iLli: air o, Other Within Commonwealth of Massachusetts r City of Salem Board of Health 120 Washington Street,4th Floor Kimberley DriscollMayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Omega Pizza& Roast Beef File Number:BHF-2004-000044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0194 Dec 23,2008 Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES (December 31,2009 l 7//A Board of Health `� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4"r FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAY(978) 745-0343 ��4/a� MAYOR IDIONNEQf ALEM.COM DECy C® D JANET DIONNE, E 15 2 ACTING HEALTH AGENT „� t'— LTH 2009 APPLICATION FOR7RMIT TO OPERATE A FOOD ESTABLISHMENT J� NAME OF ESTABLISHMENT 1 / I I 1 �\ 1�. 1 IZ I�I TEL It ADDRESS OF ESTABLISHMENT l� 1��,I I�j i I V� t FAX# MAILING ADDRESS(if different) `J EMAIL- Business': Website: pny OWNER'S NAME CA1� t71��IA611hcpMTEL# I%- /lqADDRESS l �'IC ) Vm & O CII 1 � 0 I /d STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous foods prepared) EMERGENCY RESPONSE PERSON 1 HOME TEL# I-DAYSOROP,ERATION: -Ci 1. --.Monday .'.:I-::Tuesday Wednesday -i --:Thursday : 'I,:'" -Friday.` . !'. ' :Saturday. I - .Sunday` 1 HOURS OF OPERATION Please write in time of day. (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------------------------------------- ........ -------------------------------------------------------------------------------------- ----------- RESTAURANT YES NO less than 25 seats =$14 (Outdoor Stationary Food Cart$2 25-99 seats 280 more than 99 seats =$420 ------------------------------ -- ------ ------ ------------------------------------------------------------------ ---------------------YE-S - BED/BREAKFAST/ NO $100 ,CHI LDCARE SERVICES ------------------- - ------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serye) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MG apt 62C,Section 49A, certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax /returtts qnd aid tate es vired der the law. /2'� a Signature r I Date / � Social Security or Federal Identification Number hl Revised 424/07 FOODAP2008.adm Check#&Date�t1y.54� /2-5-0 � $ /LAD,– yl� a��p� �(r�3 0101 Loring Avenue Omega Pizza & Roast Beef City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone; PROTECTION FROM CONTAMINATION 978-740-1000 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical REDD,f��p Owner: Comment:Cutting boards at both Continental deli units are stained and scored. Resurface or replace cutting boards.U' VaSIIIOS SpyfOpOUIOS Violations Related to Good Retail Practices (Blue Items) PIC: Food and F d Protection / FAIL Critical BLUE Billy Spyropoulos omment: Pepsi fridge in kitchen,deli unit x.t to grill,and continental freezer had some uncovered food in them.Cover all food in Inspector: storage to prevent cross contamination. Elizabeth Salandrea VOensonal drink on counter next to microwaves.Store employee food/drinks separately to prevent cross contamination. Date Inspected:Correct By: Equipment a Utensils FAIL Non-Critical BLUE 7/10/2008 omment:Mop stored in bucket.Store mop hanging to air dry to prevent cross contamination. Risk Level: liter next to 3bay sink needs general cleaning. Permit Number: abel sugar barrel. BHP-2007-0690 an in walk-in fridge has some dust/grime accumulation; clean the fan. Status: // jCSSIta VIOLATION 401 Aper and lower shelves under air conditioner need general cleaning. DSI e-o n #of Critical Violations: /ontinental deli unit next to register needs general cleaning. Time IN: Time OUT: ✓,,TThere is some food debris between above unit and the counter next to it on the left; clean this area. Urgency Description(s): 6helves under register need general cleaning. BLUE: /half under the grill has some grease accumulation.Thoroughly clean and de-grease this area. Violations Related to Good Retail Practices(Critical (/Grill needs thorough cleaning and de-greasing. violations must be corrected immediately or within 10 oast beef slicer needs general cleaning. days)(Non-critical violations (%R/ight-hand soda cooler needs visible,accurate internal thermometer. must be corrected immediately Physical Facility FAIL Non-Critical BLUE or within 90 days) omment: Light cover over 3bay sink is broken.Repair or replace light cover. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 15,2008 ) Page I oft "r Item Status Violation Critical Urgency RED: Violations Related to Reinspection in one week, all violations to be corrected. Foodborne Illness Interventions and Risk Factors (Require ; Please have last 3 months' extermination receipts available at reinspection. immediate corrective action) tQ City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 15,2008 ) Page 2 oft 0101 Loring Avenue Omega Pizza & Roast Beef City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency _Telephone: PROTECTION FROM CONTAMINATION 978-740-1000 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:Cutting boards at both Continental deli units are stained and scored.Resurface or replace cutting boards.Owner states Vasillos Spyropoulos new cutting boards have been ordered. PIC: Jessica Deleon Inspector: Elizabeth Salandrea Date Inspected:Correct By: 7/1712008 Risk Level: ,Permit Number: BHP-2007-0690 Status: SIGNED OFF #of Critical Violations: e1 Time IN: Time OUT: { Urgency Description(s): BLUE: All other violations noted in the 7110/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 18,2008 ) Page I oft J V Item Status Violation Critical Urgency Violations Related to Foodborne Illness Interventions; and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 18,2008 ) Page 2 oft OES7 L.i.�'•f v!?�yi am jCP OUT REG iNAE — RES. COMM. iRGOCR 0@74^_•G5 zt�,; �t \` SERVICES PERFORMEDTAhar2PES7(S) i APAUCATION WIN00 Z MlSPEC2ibN ¢ TREA?MEN' CMEWCALS USED . i AMOUK2 ! Y 1 EPA W ER L LY INJ f� \ DESCRMON t REMARKS AMOUn m m m e r m m TOTAL +. m m m SERVICE REPORT m N r m m m W a a _ 24: 15"i '24 . OUT 2�lL�c� ':a- OUT i2zAV, �.'IN_ OUT _AEG bTNdE AES. r COMM _INDOOR. OUTDOOR _ROG. _1-TIME C RES E: COIN CO =INDOOR OUTDOOR AEG( i_; I-TIME _RES =CON64. INDOOR OUTDOOR Z N SERVICES VERPOPMED: TARGET PESTS)) APPLICATION METMOO SEAVtCES PEREORMEDTARGETPEST(S) I AMICATIOMMETHW SUMCES PE%OR-QED! TAI ETPESf(SI �APPLiCARAN METHOD r�i INSPECTION _ - — INSPECTION ,= INSPECTION N - TREATMENT TREATMENT e _ TREATMENT ..LIYAECALS USED AYDUM `. EPA NIMMEA CHEMICALS USED j AMOUNT °: EPANUMBER —CNEMiCAtSUSE0 '1 AYOIINT % EPA Nuum OESCRIPTIDNIREYARm I AMOUNT DESCRTPTWNIREMAAIUi i AMOUNT _ 09S !I`TION!REMARKS j AMDUMI Ul — - - U) m m m � I r m BR,:^=+ iix M cpMSEc. ID" :' '.TV'.[Eng. icc N: _ -, TOTAL . -_ )�TOTAL - ' TOTAL m - t m SERVICE REPORT SERVICE REPORT-- SERVICE REPORT N r m m Commonwealth of Massachusetts City of Salem s i Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 11/19/2007 ESTABLISHMENT NAME: Omega Pizza & Roast Beef File Number:BHF-2004-000044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0690 Nov 19,2007 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember 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 1 of 1 QTY OF SALEM, MASSACHUSETTS \ice��Irc' BOARD OF HEALTH 120 WASHINGTON STREET,4"r FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR ISCOTT@a SALE>L OOM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I? ROAR tZri TEL# 9 I8 110' iOw ADDRESS OF ESTABLISHMENT \O\ I Avg •. i�SYalFAX# mr� MAILING ADDRESS(if different) EMAIL-Business': Website: ( 00 0. OMt1,P, ?172iq S AL£hrl . C 0rr� OWNER'SNAME VAS1Y-1OC� S?`/(ZQ,PouLQS TEL# fm8q ADDRESS SOL RD -04NVM5 YY\A, CD192-3 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) \f ASIL(C3� SPy tZOPUu LOS. CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) , EMERGENCY RESPONSE PERSON QIY.YA S9yP01?()`,A -05 HOMETEL# DAYS OF OPERATION I Monday 1Tuesday Wednesday Thursday Friday Saturday i Sunday HOURS OF OPERATION 1 Please write in time of day. I I1 01_ IOPm, Illibw IOP,"; 1(kal-IOPh Ilr - 0m I(4m- IlPrrn lJon- IIPm 12?m-c`1?WI (For example l l am-1 l pm) If, TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ......... . .. — ......... - . ..........-. ................ — RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 -- SSSS SSSS- -- O ------------------------------------------------------- - BED/BREAKFASTI YES N $100 CHILDCARE SERVICES--------------- --------- ----------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM,YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A 1 certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax red plate taxes requ under the I'-- \\ \3 O� C11� (moo jloa2 Signature Date 1 Social Security or Federal Identification Number Sign--- - -----------'-----SSSS'- SSSS-----7 --- SSSS-----------SSSS—' Revised 4/24/07 FOODAP2008 adm CheckH Date 7 (/ .i 1 CITY OF SALEM BOARD OF HEALTH Establishment Name: C�Y'n;C q\ P t 2 2A Date: Page f of No. Reference R-Reed it1 I Item Roue ' o-Criticalitem Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION ' . Date I verified.*,, PLEASE PRINT CLEARLY � GxAN U% of OwNi� `25u+G' r3csm, GY,�Y„G�,CJ to la�S°.tet-C�oa� tyc�rti,,+s rt}�— i ! ti 1N AGtGLogNti� w � ! 1 F RCl \=� � Yaa�� Ya Sia— Srao ,T.ati4 i I i � I I i- ! I I I I ! i I � i I I I 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 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 ❑ Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of-twenty Jive dollarsu�sion�ation of U Embargo ❑ Emergency Closure your food permit. �-tUc U Voluntary Disposal ❑ Other: 4 Pl[F, Reco"j Ii T--mipetalwrcq I Violations Related to Forldbomp fliness Interventions and Risk 't'xtwdiiig to Ulm C rxkij I, Factors(items 1-=) (Conk) Wifil;n 1 I-Ittin-F PROTECTION FROM CHEMICALS3 C'Xllilt n W-fl*& for PHFs PHF Hot and Cold Holding Food or Color Additives ,t-501A(5tR� C04 PHFt, MRint,im(xi at tr b-4h v 3-30-1.14 Prito,,tion itlan Addinv&,, f)(14 JI) 4i`?-45' 1" Pc;sonous or T i)(A) I tot PHT,, Maucaintid at or ab,rve IF oxic Substances 101.11 I-if!l �61A! PmiQ,,t�Held aiw ,)bove 130iT Contaimrs, Time a$a Public Hoehn Control 7 iO7,11 lie:allh Convol Vwi'n:ce K::qhir•.JIWW 7-202,11 Ro:tricliorl -Presence and L,,e` 7-2()2.12 C.'adillom of tjsc' REOU11PEMEN73 FOR HIGHLY SUSCEPTIBLE 7-'(}3 '03 !J Cmtktiljm:t'-prollitil:mnil POPULATIONS(HSP) ,-204.1". sarrll/.cr;'OrIterlit-- 7-2�)4.!2 finvicnit.for'A Pr,,Otc,�,Ciiul:l� 121 i I I(A) k,np,1;reVi,M1 Swc�s and 204 Di Inv,ALvuv. i :1.R s ['N.oe 14 'e-,10 1.i I(D) R,n,tx Pal I itll Ci,,),:d Ruin l,d hmd anti 7-2i)t', I! Use Criteiiw svk'd Sim -06.12 R,x!.w Ball Sirmom' 1 -06 1! Pt,Wder; Pest Munit"i-j", CONSUMER ADVISORY 3 oti,ww�v Ajvi,,v,v tm,'d (,,r of TIMErrEMPSRATURE CONTROLS Proper Coolilng Tempe.atures for Anwol am: gate Undtmx�,ked ot 16 PHF& -i 101 IIA(11(:) log"- 15+'F i I it kthw.:en, l4s'+15,re • to'! Raw shell 3-401A C(nmoulfw'd Fish Mcaz,w&' tiallic A'nimal,- l; F 15 340l%l1(R)(k;2I - 110"! 1 1 SPECIAL REQUIREMENTS P"i� Lmd lie'J RkvM mi-) z9:, Vivk�lj,,il,6 Sci�ltco in R"Inw% kje;:A %If.,t"- 'Oc. fk �1(� y'XI, "k-o-p'ravvan ewring. 3.401 li,'A)l'i) I'wim,Wild qwxions�hould he Crofllli Cow:fl:lln�x Fish.ileac. undet [tic qpruprIUW. `ek:11011S 11'�d2lry or Kama-lo.i'l` c0al"(j to ItitAbor1w illnose Intact bo,;t5I-aks ()TJwT 134'1' 1 590,000 relal;n'o [')"mxi rcWil Ra: Animal(-k,"* .Ctklkd In a n.xlnx-,'114ild tic d&izm! oider#29 - WT 1401A JIA)(i)ib, Ali00,wi Pfh,� - 15 e� 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1-403.11(A)&tD) I'l&, 15 sr,:. - I (Iiera,,23,-30) 3"403.11(b) 'NliCVMIM'c- 10'F 2 NIMDIIStanding whi'j'do um, a61tm:to thc r r, ,,r filoethvrne-din-,n, ,iw; ttrd iiA fii,iorr b,te,l It ove ,,n 1w 3.'03.11(0;) r")qlla':vially llro'n.'Cd Trt '4%i F& ----r-s90Xo0- 2 1 Ci6,3 Proper CoOng of PHFS 1 14 1 cwllmij Ct:hId F1r0lt'*A!o'- I PC C�J)4 18 I *,,.' - i F C- x5 a -016t,wpm�md;i Eonoit8 111fA) Coi,law-C(x*xd Phl-s, front 140"F t I-- -- 20 t""atei'plulvcsle FG 5 ruA, ?;)q;Within 2 27. Pltvt,--,?A Fac.04v FC 007 iF/4f, F W;fi,in t Houi!�. 28 pc':oO"Out,x rtim ftatt,'013 FC- 7 '008 I 10'l Cnciing PHIci Nl:�de hom Amlwi.t spon'!F1 %vil lit n'Holt CITY OF SALEM BOARD OF HEALTH Name of Establishment: Omega Pizza Address: 101 Loring Avenue Owner(s): Vasilios Spyropoulos Phone: 978-777-8284 Date: November 13, 2007 The proposed new owner of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. FLOOR PLAN A Hand Sink must be located in the rear prep area. Hand sinks must be used for handwashing only. There must be wall hung soap and paper towel dispensers at each hand sink. The hand sink must be accessible at all times for handwashing. Employees must be encouraged to wash their hands frequently. There is a hand sink located in the middle room, approximately at an equal distance to the pizza prep area and the cooking area. A mop sink is located in the rear prep area. A food prep sink is available for washing vegetables, etc. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. All food must be held at 41°F or lower, or 140°F or higher, at all times. Therefore, meatballs should be at 140 before being held hot. Salad display items, such as vegetables, must be cold prior to being held cold in the salad unit. Food may not be added to containers in salad unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. Preparation of hamburgers, meatball subs, steak tips, and salads was reviewed with an emphasis on proper temperatures. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. CERTIFICATIONThere must be a Certified Food Manager working at this establishment full time. Mr. Spyropoulos will take a recertification class in January. Until then Steve Kontakos will remain as the full time Certified Food Manager. I When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. UNDERCOOKED FOODS The owner will not serve raw or undercooked meats. The Food Advisory requirements were given to him. DISH WASHING A 3-bay sink will be used to wash, rinse and sanitize all utensils and equipment. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles and/or wiping pails may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Spray bottles and wiping pails must be clearly marked 1.sanitizer". Outside area of premises, including the dumpster area, must be kept clean and sanitary. A Food Establishment Permit was received. U.i4 ? A An opening inspection will be conducted on Ptr+q% • �'• S�yro�o /�, w�tl lu-e-� -�0 5c&Pdvle �. ��rxc anne Scott, Date Health Agent 1/a 5i I io,5�y�vo�o-vldvs `� .Ixt� r,��YY1dr��Orl ' art, III 'I it I111111II� a 1 � I - �M G� I l f� t r ow $7.00 Minimum Delivery y -97/8 x_40- 1000 FAX, 978p-T4:0-0051 B € / J�� . 'Qrmje;T fi izzakSLale`, Q op 0 f 00 ° �GJ�pCDLs� STORE HOURS: C��PPER Monday-Saturday CARD we Naw accept - 11:00 am-10:00 pan Salem State Sunday Clipper Card y 12 Noon-9:00 pan 1A I r I II II II II Bd"iy�r! .Y 4' ` Pizzas Small Larne �. CHEESE . 5.75 8.95 1-WAY. 6.25 9.95 2-WAY. 6.75 10.75 9 e 3-WAY. 7.50 11.25 ^� 4-WAY. 8.00 12.50 OMEGA SUPREME. . . . . . . . . . . 8.25 13.75 ADD EXTRA CHEESE . . . . . . . . . . 1.50 2.25 AVAILABLE PIZZA TOPPINGS Onion •Pepper•Mushroom •Broccoli•Fresh -_ Tomato • Garlic•Spinach •Pineapple •Eggplant Olives •Pepperoni •Sausage•Meatball Bacon•Salami•Ham•Pastrami Gourmet Pizzas Small Laroe BUFFALO STYLE CHICKEN . . . . . . . 7.95 11.95 MEDITERRANEAN . . . . . . . . . . . 7.25 12.95 spinach,red onion, dr feta cheese ' HAWAIIAN - ham&pineapple . . . . . . 7.50 11.95 CHICKEN DELIGHT . . . . . . . . . . 8.25 12.95 chicken breast da broccoli with mozzarella VEGGIE DELIGHT . . . . . . . . . . . 8.95 13.95 mushrooms,tomato,peppers, broccoli, onion, &spinach with mozzarella&cheddar TROPICAL . . . . . . . . . . . . . . . 8.25 12.95 chicken breast,imported ham, dr pineapple GRECIAN DELIGHT . . . . . . . . . . 8.25 12.95 tomato,black olives, oregano, &feta cheese GRAND CANADIAN. . . . . . . . . . 8.95 13.75 v bacon, olives, onions, &tomato F NEW YORK . . . . . . . . . . . . . . 8.50 13.50 buffalo chicken, roasted red peppers, &red onion AFGHAN . . . . . . . . . . . . . . . 8.75 13.95 chicken, red onion,spinach, &cheese c BBQ CHICKEN PIZZA . . . . . . . . . 8.25 12.95 BBQ chicken&red onion ° NAPOLITANO (White sauce) . . . . . . . 8.25 12.95 grilled chicken:breast with broccoli florets '&mozzarella cheese THE ATHENIAN (white Sauce) . . . . . 8.95 14.25 a shrimp,diced tomato, &mozzarella cheese s' CARBONARA(white Sauce) . . . . . . . 8.95 14.25 imported ham,mushroom,onion,peppers, &mozzarella cheese ems. �I u Calzones j� Small Larne y� ASSORTED COLD CUTS . 10.50 16.50 i STEAK & CHEESE . . . . . . . . . . . 10.50 16.50 CHICKEN CUTLET . . . . . . . . . . . 10.50 16.50 BUFFALO STYLE CHICKEN . . . . . . . 10.50 16.50 VEGETABLES. . . . . . . . . . . . . . 10.50 16.50 'y sauteed mushrooms, onions,peppers,broccoli, &spinach '<x STEAK BOMB . . . . . . . . . . . . . 11.00 16.95 I� GRECIAN DELIGHT . . . . . . . . . . 11.00 16.95 "} grilled chicken, tomato,onions, '&feta MEDITERRANEAN . . . . . . . . . . . 11.00 16.50 'i spinach,onions, &feta i� CHICKEN DELIGHT . . . . . . . . . . 11.00 16.95 grilled chicken &broccoli Our calzones are whole-round Y Hot Sandwiches JUNIOR (on Plain Roll). . . . .3.25 i BIG BEEF* (On Sesame Roll) . 4.25 SUPER BEEF* (On Onion Roll)., .5.25 DOUBLE DECKER* . . . " '.^ .5.25 HAMBURGER* (soz.) . .2.99 CHEESEBURGER* (soz.) . . .3.25 SUPER CHICKEN* . . . . . . . .. . . . . . . . .5.95 char-broiled chicken breast with lettuce, f tomato,mayo, &provolone on onion roll I! FRESH HADDOCK SANDWICH . . . . . . . . .5.95 Wraps W GREAT CAESAR WRAP. . . . . . . . . . . . . .4.95 ! GREEK SALAD WRAP . . . . . 4.95 STEAK TIP CAESAR WRAP . , . %, . . .5.95 2 ' CHICKEN CAESAR WRAP . . '°k" .5.95 k BUFFALO CHICKEN WRAP. . .5.95 TUNA WRAP. . . . . . . . . . ¢' . .5.95 g i' B.L.T. WRAP . . . . . . . . . . . ' Y�. . . . .5.95 HAM & CHEESE WRAP . . . . . . . . . . . . .5.95 a �I We Now Accept _ Salem State Clipper Card CLIPPER CARD . . f x � 4 lk \ Salads ,. GARDEN . . . . . . . . . . . - <: .4.75 GREEK. . . . . . . . . . . . . .5.50 TUNA . . . . . .5.50 CHICKEN . �' s 1. .5.50 o F CHEF'S . . .a 5.75 ANTIPASTO . . % 5.75 �a N CAESAR SALAD . . . . . ps .4.75 CHICKEN CAESAR. . . . . . . .6.30 I CHICKEN KABOB SALAD (Add Feta for5oc) . . . . .5.95 SOUVLAKI SALAD (Add Feta for5oc) . . . . . . . .6.50 I chunks of beef or lamb BUFFALO FINGER . . . . . . . . . . . . . . . .6.50 BBQ CHICKEN SALAD . . . . . . . . . . . . . .6.50 ROAST BEEF SALAD . . . . . . . . . . . . . . .5.95 GARDEN W/ SHRIMP . . . . . . . . . . . . . . 7.25 SERVED WITH SYRIAN BREAD&DRESSING LITE ITALIAN•RANCH•RUSSIAN•HONEY MUSTARD •CAESAR •BLUE CHEESE(0.50 EXTRA) EXTRA DRESSING:0.50•EXTRA SYRIAN:0.50 �I Side Orders Small Lame FRENCH FRIES. . . . . . . . . . . . . 2.05 3.15 ONION RINGS . . . . . . . . . . . . 2.50 3.95 MOZZARELLA STICKS . . . . . . . . . 4.25 7.95 FRESH CHICKEN FINGERS. . . . . . . 4.75 8.95 FRESH CHICKEN WINGS 4.75 8.95 BUFFALO FINGERS 5.25 9.25 BUFFALO WINGS 5.25 9.25 GARLIC BREAD . . . . . . 2.75 d RICE . . . . . . . . . . . . . . . 2.50 I BAKLAVA . . . . . . . . . . . 1.95 !, a� Boxed Lunches Minimum Order-8 Lunches.24 Hour Notice ' u . . . . . . . . BOXED LUNCH 9.95 � Sandwich of vour choice served with a drink. } bag:of chips,piece of fresh fruit.and a cookie. 1 s Club Sandwiches HAM & CHEESE . . . . . . . . 7.50 TURKEY . . . 7.50 ROAST BEEF . 7.50 f HAMBURGER*. . . . . 7.50 CHEESEBURGER* . . . . . . . 7.50 SUPER CHICKEN* . 7.50 ABOVE SERVED WITH FRENCH FRIES Pasta Dinners spaghetti or Ziti WITH SAUCE . . . . . . 5.50 WITH MEATBALLS . . . . . ! x.6.50 WITH SAUSAGES . . . . (1° .� ;_-- . .6.50 WITH FRESH CHICKEN CUTLET "' . .6.95 WITH FRESH VEAL CUTLET . . . . . . . . . . . .6.95 WITH EGGPLANT . . . . . . . . . . . . . . . .6.50 II WITH CHICKEN, BROCCOLI, & ALFREDO SAUCE 8.50 WITH SHRIMP, BROCCOLI, & ALFREDO SAUCE .8.95 STUFFED SHELLS (s) . . . . . . . . . . . . . . .6.75 ABOVE SERVED WITH GARLIC BREAD Dinners STEAK TIP* . . . . . . . . . . . . . . . . . . .8.95 SOUVLAKI* (Beef or Lamb) . . . . . . . . . . . . .9.25 CHICKEN KABOB* . . . . . . . . . . . . . . .8.95 HAMBURGER PLATE* (5 oz.) . . . . . . .6.25 CHEESEBURGER PLATE* (5 oz.) . .6.50 CHICKEN FINGERS . . . . .8.25 CHICKEN WINGS . .8.25 BUFFALO FINGERS , r .8.95 BUFFALO WINGS . . . . ` " .8.95 BBQ CHICKEN* . . . . . . .8.95 FRESH FISH & CHIPS. . . . . . . .8.25 FRESH FRIED HADDOCK PLATE — . . . .9.50 GYRO . . . . . . . . . . . . . . . . . . . . . . 7.95 �{ ROAST BEEF SANDWICH PLATE* . . . . . . . . 7.50 1 DOUBLE DECKER SANDWICH PLATE* . . . . . . 7.95 SUPER CHICKEN SANDWICH PLATE* . . . . . . 7.95 ABOVE SERVED WITH SALAD& FRENCH FRIES OR ONION RINGS �c 00 s. Y 6 t , ra3 Ar Hot & Cold Subs Small Lorne li VEGETARIAN .n . . 3.95 4.75 AMERICANS 4.50 5.50 ITALIAN . . . . . r u: 4.50 5.50 GENOA SALAMI . . . . 4.50 5.50 HAM & CHEESE . . . . . . . . . 4.50 5.50 ` SMOKED TURKEY BREAST . . . . . . . 4.50 5.50 I;. ROAST BEEF . . . . . . . . . . . . . . 4.50 5.50 TUNA SALAD . . . . . . . . . . . . . 4.50 5.50 II CHICKEN SALAD . . . . . . . . . . . 4.50 5.50 CRABMEAT . . . . . . . . . . . . . . 4.50 5.50 B.L.T. . . . . . . . . . . . . . . . . . 4.50 5.50 EGGPLANT . . . . . . . . . . . . . . 4.50 5.50 HAMBURGER*. . . . . . . . . . . . . . . . 5.50 CHEESEBURGER* . . . . . . . . . . . . . . 5.75 CHICKEN KABOB* . . . . . . . . . . . . . 5.95 lettuce, tomato,feta, &dressing SOUVLAKI* (beeforlamb) . . . . . . . . . . . . .6.25 lettuce, tomato,feta,onions, &dressing GYRO . . . . . . . . . . . . .5.25 pita bread, tomato, onions, &txatxiki dressing HOMEMADE CHICKEN CUTLET . . . . 4.75 5.95 HOMEMADE VEAL CUTLET . . . . . . 4.75 5.95 MEATBALL . 4.50 5.50 SAUSAGE . 4.50 5.50 HOT PASTRAMI . 4.50 5.50 HAM & EGG. . . . . 4.50 5.50 PEPPER & EGG or BACON . 4.50 5.50 CHICKEN FINGER . . . . . . . . . . . . . . 5.95 BUFFALO FINGER . . . . . 5.95 BBQ CHICKEN -peppers&onions . . . . . . . . 5.95 ADD EXTRA CHEESE . . . . . . . . . . 0.35 0.45 All Large Subs Available Wrapped in Syrian Bread Steak Subs Small Large CHEESE STEAK* . . . . . . . . . . . . 4.65 5.75 ONION STEAK* . . . . . . . . . . . . 4.65 5.75 _ . PEPPER STEAK* . . . . 4.65 5.75 MUSHROOM STEAK* . 4.65 5.75 BOMB* . . . . 4.95 5.95 STEAK & EGG* =s'' 4.95 5.95 CHICKEN STEAK* . . . . . . . 4.95 5.95 mushrooms,onions,peppers, da cheese *CONSUMER ADVISORY WARNING FOR RAW FOODS: IN COMPLIANCE WITH THE DEPARTMENT OF PUBLIC HEALTH,WE ADVISE THAT EATING RAW OR UNDERCOOKED MEAT,POULTRY,OR .e SEAFOOD POSES A RISK TO YOUR HEALTH I Large Cheese Pizza w 1 Large 1-Top. Pizza & 2 Liter Soda ' $16.99 T. •ww MCMbnWhenONerLp- •Offers Can NN Pe Combined-umlroe nme War 1 Large 2-Topping Pizza $9.75 +Tax Gaurmel Tnppnse E*eWeeo IMu9MentonWhenONenng- I Ofla9 Cen Nor Be Cdnel -LIm11e0Tyne ORei- r 2 Small e Cheese Pizzas $8,99 ,T. $1+0F E.0, tl4mnef 7rwn9 MuslMental Men ONennp- •Offers Can Nrn Be Comdn.-Llmrted TMe Offer•� aff / 10% OFF Order of $25 or More Polve Teies or 01her Chnpee AddW Mus,Men.Wren 0nlennp• •Offers Can Nal Be CwnWmO-If.ed Terre ORer• I 2 large Cheese Pizzas $13.99 +Tax Elba Tg ps$175 each •Mcal Mammo men one'" ..Kers Cen nol Be CandrreO thew nma offer• I 1 Large Cho Pizza, 1 Large Chicken or Buffalo Wings+2 Liter Soda $17.99 +Tax ENe TWY'9a$,15mM • Mw Menlbn Wren ONerm9• l•0naa can Nm Be C nnbMee•unfree Time Omr•/ a n' M MW / p 1 Large Cheese Pizza 1 Large 1-Top. Pizza & 2 Lifer Soda y $16.99 ,Tax •Mutl Mmtlen NTen ON.T •Offers Cen Not Be Cnmbmee-umeen nme 011e,- IIS � H 1 large 2-Topping Pizza $9,75 ,T. Go.T.,,,o Exnlefhd Mu lMenlwn VMenOnto,- 0.,U,,No(Be Cambinetl•Llmlbtl TMe Offer 2 Small Cheese Pizzas $8,99 ,T. S1 tO Fa Eaoh namlwral Tcppmg 'we,Menlmn When ONetlnP Olkn Can Not BB CombNeO-Llmlled rme 011e,- 7�d OFFr of Moreer CllenpaarltltleC•hen Onto VeJ-LImJed r—11, I / 2 Large Cheese Pizzas $13,99 ,Te Film To...$1 T5 each •Mux Menbon When ONelmg •oRrs can NOl Be ComWmO•umnaC nme 0 1 Large Choose Pizza, 1 large Chicken or Buffalo Wings+2 Liter Soda $17.99 ,T. Ertl TWP.gl$175 eacb `• Me Com When ONaNp Offen Can W NINPe omomSmetl•LImHeET Offer dqYi 8Goo PSI LL els fo - VNIM--L. &� � � (�I�oPMvc� - i�,`hA�3C:, i �1t1"i'(Z�TPg�,�:.r?t'i:t:A 't� � � L - -•�i � � � --- f" I11t i C3CA t1Nl f ! { - tt 2iot f.i„ S + UFA. D p�,NpS1tJK- f'FMKC'�G'-zJ.� o i � F r { i ! 'F1 i�c1ctR-7PS4r. X14' P\tvt�CSSSr _ t c o c pP - }I GME Ei iG( .-- ,li+ , `' n faL, `\\ { vv I f — StjFSt � E�\GC'fZF�« RSR\CC�G9 t I 1 v ��J {) `-..FR1fltl,l�kt'coC� k ; ! v4% sttf, SC�r {31 - k j - - nit v _+7 i- �.`f�&CL7F1'S PKCb �',t- t 15C oCN\ v SS, rlAlfrr6- �RSCo14�_ Mao —5�tro ss,P.S't � r -1-_ ;;zCIO t. ca-3pi-q �` �NRr�c�ta �\t IP�WAI i AGA *a.VC_ - - . - ��/ tNC \ 62 t 0101 Loring Avenue Omega Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-740-1000 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment: Both front cutting boards a re stained and scored. Resurface or replace the cutting boards. Sharagda Kontakos Violations Related to Good Retail Practices (Blue Items) PIC: Food and Food Protection FAIL Critical BLUE Inspector: Comment:The Kenmore 13 freezer in the basement stored under a waste line. Move freezer out from under waste lined. David Greenbaum Equipment and Utensils FAIL Non-Critical BLUE Date Inspected:Correct By: Comment:The back knife container needs a thorough cleaning. 611912007 The mixer bowl needs a general cleaning. Risk Level: The first Arctic air freezer in the basement needs a visible accurate thermometer. Permit Number: Both continental deli units in front need a thoroughly cleaning. BHP-2007-0158 Status: GENERAL COMMENTS: SIGNED OFF Owner to notify the Board of Health within one week that the above violations have been corrected. #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. Jun 19,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 19,2007 ) Page 2 oft ( 4MPO��R]TANT MESSAG ) FOR ''�'7.J,J��J.' .cai hn— A.M. OATF C9 !"2. "'"CJ '� TIME P.M. M �Zr� y/A,tu�On2J PHONF,? �xt3 a09" t ;-y90 AREA CODE NUMBER EXTENSION O FAX O MOBIl F AREA CODE NUMBER TIME TO CALL TELEPHONED V,rpLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE I , q.._ SIGNEO . B�OO MOIN A I NOTES �I I I I ` I f , r` CITY OF SALEM E 4 a BOARD OF HEALTH / Establishment Name: Date: //z3/Q 7 Page: of k Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLANOFCORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY i 1 x/7-147)' 17 P! lPvvC( Q Parr /�Inf ✓7!/,�/, „ G. I/5 ham) ,17 I,c( i l G�Zo nen . �/✓dim l 17� z� n �i e In ? I/)�lr11J/ v�c lll/S < I J } 1 O�OvIPP /1(/.0 all I"(, O✓ Cf l'.r W?Gtr/n<' C11 rC (Ge S In LJn /IC �S I,L.P(lien �� J pp 1tV1,�.wi IL Ilgr4rvr !'1!(i ✓, �/I\CnvCKl 1 ) 17_eC( I /Vd �Inl, ha) 7c In lace r\ bila or }nC JO(f fio, � I1 �e I ` I Y Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes r 1 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 El Re-inspection Scheduled Li Emergency suspension c comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of jt'wenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I _ 1 PHFs !iecen,ed e.t';-emperatures - -- - Violations Related tc Foodbrine Illness interventions and RfsA According to I.o% Cooled to Factors(items 1-22) (Cont.] 4I+i45"F14diunaHours PROTECTION FROM CHEMICALS 3-5U1.I3 Cowling Methods for PHF< 14 Food or Color Additives I ! 19 PHF Hot and Crid Holding 3-501.16(b Cold PHF.,Maintained at on helow 3702.12 Additives^ tP 1 990.)04(17)) 4;`/45°F' 3-302 Id Protection iron Una> roc�ed 4ddihvec* I ?_SOI IA(A) Hoa PHF':Maintained rtr or above 15 Poisonous or Toxic Substances 7-101.11 IdentifpLtP Information-Original ! 3-SOI 1,6(.\,'11,6(.\,' Roast:. Held at or above l_U"F Coutnners" 7-103.1 1 Common Name -Work;ng Con!aineW � 120 Time as a Public Health Contrcl 7-201.11 Separation-56o;age` 3-5Ui,19 Time ac a Public Health Conhol* 7-202 11 Restriction-Presence mid Use* ( 59!).004i H) V•ni.mce Rcgunemcot 7-202.12 Conditions of L'sc"' 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS POPULATIONS(HSP) HIGHLY SUSCEPTIBLE (t15P) 7-20,1.11 Saniiizers.Criteria -('hemjcals 21 1 3-801.!i ' (A) l:nras:cuo t Prepaclaved unees,n;d1 7-204.12 Cheuu :ds f0r1ashhng Prati.We;Crir.ria" 7-204.14 Drying Agents.Cnrer!;,v Bove;ages with Warning 1 abelsT ' 3-801.i 1(13) Us.-1•f Pasteurized Eggs' 7-205.1 I Incidental Feud Contact.Lubricants% 13-801 17 D) Raw or P;iiialy Cooked Am:n-d Faxl grief 7-206.11 Restricted lase Pesticides.Criteria* 7-706.12 Rcxienl Bstt StaKar, Seed Sprouts Not Stavedtions' i 7=206 13 'I'mcking Powders.Pest Control and 3-8Ol.l L Cj j 'lnopened KnA PLkagr Not Re-served n]onimrin^' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1! Consumer Adtisory Posted for Consumption of Anined Foods'fhat ore Raw,Undercooked on' 16 j Proper Cooking Temperatures for Nr�t Otheiwlse Processed to L'Gm,nwe PHFs 3-40 i.11 A(1)(2) FW- 155`F 15 Sec. Par'nogeut.i err n: ;uv�r Eggs-Immediate Service 145°F15sec* 1 i02.13 Psteu izcd s LenSubsutute h»'Raw Shell 3-401.1 I(A)(2) Comminuted Fish, Mat es 1&Game Eggs" - Aninnals- 1$3 F 15 sec. ,e 3-401.11(B)(1)(2 Pork mid Beet'Roast- i3WF121min* SPECIAL REQUIREMENTS -401.11(Ai(2) Rzhtes,Injected Meats- 155715 590.009(A)-(I},) Violations of Section 590.009(A)4D) in sec. catering, mobile ford,temporatir and ?-4u].1 l(A)(3) Poultry,W!ld dame Srutted PHFs, n;stdential kitchen operations should be Stuffing C'rmtaining Fish.Meat, debited under the appropriate srcUonS Poultryor Rucites-165017 15 sec. •rbtmr if related to foodborne iilness 3-401.11(C)Q) Whole-muscle,Iuact BeefSteaks interventions and risk factors. Other 1450F* 590.009 c:nlations relating to good retail 3-401.12 Rau Animal Foods Cooked in a nracttces A10"Ild be debited under #29 - Microwave 165`F " Snec;.d Recuircl,icats. 3?01 11(Adl)(b) All Other PHFs- 1.15'''1-- 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4tl3.1I(A)&(1)) PHFs 165"F ii sec. ' litezttc 23-30) h13.11(B) IA,:Lto vave- 1650 F 2 Mmute Standing I Criucai rind eon-rutrcrtt vitrlotrun Mich do nut snore t„the Tinic" 1 (n>:ILurne ithrets urterrenrums urrd ria•F ld,tors Bated ribose, inn be 4113.I I(C) Commercial}Processed RTI: Food- found i1 the jo,rrnone sections of rhe Food Code 10111105 0=11t 140"F'" 590.0(11). 3-403.1 i(En Remaining Unsliced Portions of Beef ! Item Good Retail Practices FC580.000 Kuacts': I 23. Ivlaragement and Ferserne! FC-2 003 j 18 Proper Cooling of PRFs I 24. F000 and Foots Protection FC - 3 004 3-,301.14(A) Cooling Cooked PHFs from 140°P to 25. Egtrpmenr.and Utensils FC-4 005 29. Water. ?lunttrir,a enc'dY'asL: Ifi-- 5 OOG j 70-F Within n 2 Hours and From 7W ! 27. PhN;iral Facd!ty FC-6 ! 007 u+41'17/45'FWithm=Hours. ! 26, Pusonouso:To=Mtae,,als FC-7 li .008 3-501 114 B) Coohnt, PHF:, Made From Ambient 1 29 vo=ciai Reuwr<^ments i 008 Tempetattue Ingredients io 11017/45-F 30. Other l Within 4 Hrrurs'> �=�•m:rc..r ea.o-•. ;l:n aei,rmcal iiew in ds teller l No"'F,a,d r',.&,rr!05 CMR 59`1 Oini. �l CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC - 4 2006 TEL, 978-741-1800 FAx 978-745-0343 CITY OF SALEM Kimberley Driscoll www.SALEM.COM BOARD OF HEALTH Mayor .JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT f0 96-GA 1 f' t Z.ZA • . - TEL# LI` 3- 740 1000 ADDRESS OF ESTABLISHMENT I 0 J 1-04110 - OAq, FAX# c?7 8, 740 o o r l MAILING ADDRESS(if different) EMAIL--Business': Owner's: OWNER'S NAME .SYP9-ti (rbA KoIJT-AK-OS. TEL# 9`79� .5--?V /30Z ADDRESS i' .TASO,tJ Lfv re-AqA" etl?d 0 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'SNAMES) 4; T'EVE 4ox)TA t_vS CERTIFICATE#(S) KC 2.00S02Z7 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON STEtIF K-OA-JTA0,S HOME TEL# 9-71< 535' 13zZ BAYS OF OPERATION Monday Tuesday Wednesday Thursday I Friday Saturday Sunday HOURS OF OPERATION Please Write in time Of day. JJA�y I0 (for examplellam31am) F41 TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE YES NO less than 1006sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft =$250 NO ---.-- --- - --- ----- ---- lesstha..n-2-5... . ... ats..... l. RESTAURANT YES se $10 25-99 seats =$150 more than 99 seats =$200 - --- .._..... ............ .... -....._ ...10...0..... ..-- - ...- ------ ----BED/BREAKFAST YES NO 5 --- ------- - - - . .. . ... -...... .....-...... .. . .... _...... -- -- .. ... .....__......... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and Defier, haa"v�e filed all st'atte tax nreturns and paid all state taxe requ'red under the!aw. We-ml Signature Date Social Security or Foderal Identification Number --- -- -- ---- - ------------ - — --- ------ — — - --- - - ------ -- -- - ----- - - - -- - - ------------ -- Revised 11113106 FOO DAP200I adru Check#&Date �1�0 6!5 �- //' X0'0 s /0 0 1 60 Xjrg-A, t .0q;5'elr� IGniberley -Ma SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAW: Omega Pizza File Number:BHF-2004-000044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP-2007-0158 Dec 20,2006 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 12 of 16 0101 Loring Avenue Omega Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 978-740-1000 Hot and Cold Holding FAIL Critical RED Owner: Comment: Roastbeef on slicer had a temperature of 98.5'F. Roastbeef was out for approximately one hour. Explained to the owner Sharagda Kontakos that hot foods must be held at a temperature of 140oF or higher. Roastbeef was placed in oven to reheat rapidly. PIC: Violations Related to Good Retail Practices (Blue Items) Steve Kontakos Food and Food Protection FAIL Critical BLUE Inspector: Comment: Paper products stored under a waste line in the basement. Relocate paper products away from the waste line. David Greenbaum Equipment and Utensils FAIL Non-Critical BLUE Date Inspected:Correct By: 12/6/2006 Comment:The front Continental deli unit needs a general cleaning. Risk Level: Physical Facility FAIL Non-Critical BLUE Comment:The walkin floor needs to be repainted or sealed to be non porous and easily cleanable. Permit Number: GENERAL COMMENTS: BHP-2006-0171 Status: 1047: 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 06,2006 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) 1-71� 1x I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 06,2006 ) Page 2 oft ( IMPORT NT MESSAGE ) FOR A.M. DATE olp TIME P.M. M ( �—Ln OF ( PHONE "J m_ AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBN F AREA CDDEI NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU ' RUSH RETURNED YOUR GALL (' WILL FAX TO YOU I� MESSA _ alr� i5 I SIGNED I c� SOPS. FORM 4009 MADE IN U.S.A NOTES I 0101 Loring Avenue Omega Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-740-1000 Food and Food Protection FAIL Critical BLUE Owner: Comment:Onions and sauce found stored directly on the floor. Store all food at least 6.8 inches off the floor. Sharagda Kontakos PIC: Store soda in the basement at least 6-8 inches off the floor. Steve Kontakos Equipment and Utensils FAIL Non-Critical BLUE Inspector: Comment:The canopener needs a thorough cleaning. David Greenbaum The meat slicer needs a general cleaning. - Date Inspected: Correct By: 8/15/2006 Label the food prep sink"Food Prep Only" Risk Level: the front Continental deli unit needs a thorough cleaning. Permit Number: The grease barrel must be raised at least 6-8 inches of the floor. BHP-2006-0171 Knife stored between equipment. Clean and sanitize knives and store in an appropriate rack. Status: SIGNED OFF Provide a barrier between the flour and the front hand wash sink. #of Critical Violations: GENERAL COMMENTS: 1 735:13Iease notify the Board of Health within one week that all violations have been corrected. Time IN (Time OUT: Urgency Descdption(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors(Require, immediate corrective action) lv� ✓A to i City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006 ) Page 2 oft Commonwealth of Massachusetts e 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: Omega Pizza File Number BHF-2004-0044 101 Loring Avenue Salem MA 01970 LOCATED AT: 0101 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0171 Jan 3,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health 1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. page 3 of 6 � O CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR �o �°M1N6 TELL 978-741EM, MA 011800 C'17- f� O j2005 Fax 978-745-0343 e�q �F STANLEY MAYOSOVICZ, .JR. JOANNE SCOTT,AMPH RS, CHO AOOFy q(y HEALTH AGENT 2006 APPLICATION FOR PERMIT(TSO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ©H66A C 17-M TEL# q/7k- -7q o 1 o 6 6 ADDRESS OF ESTABLISHMENT 10 1 Lo Af ti G OV SALEME Mf► D 19717 MAILING ADDRESS (if different) OWNER'S NAME �MA(LA [�f�A i�aN rKl I�� TEL# 979-- JlS r 96kl ADDRESS ,�' ,lflSalJ LAIC CITYC o by STATE Mil ZIP 0 {y u< O CERTIFIED FOOD MANAGER'S NAME(S)5 TE✓E Ko1JTAIe05 CERTIFICATE#(s)_ C 0 00 0 41092-6 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON S7-e\16 V-oNTA KSS HOME TEL# q7 S3S 96 R-1 HOURS OF OPERATION: Mon. ✓ Tue. ✓Wed. v Thu. v Fri. Sat. Li Sun.��_ p 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 --------------------------------------------------------- ----------------------------------I----------............. RESTAURANT ES NO n Q less than 25 seats =$100— 25-99 seats =$150 more than 99 seats =$200 ..... ............................................................................. ...........................- O BED/BREAKFAST YES $100 --------------------------------------------------------------------------.-------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowle ge and belief, have filed all state tax returns and paid all state taxes required under the law. OL/ 87$ 707 Signature Date Social Security o&Eederal Identification Numb ------------------------------------------------------------------------------------------------------------------ --- Revised 11/03/05 FOODAP2.adm Check#&Date-21L�l �'/oma CITY OF SALEM BOARD OF HEALTH Name of Establishment: Omega Pizza Address: 101 Loring Avenue Owner(s): Nihat Aktas, Mubin Sonmez Phone: 617-529-1469 Date: November 14, 2005 The proposed new owners of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. FLOOR PLAN A Hand Sink must be located in the rear prep area. There appears to be a designated sink in this area next to the food prep sink. If not, the food prep sink may be designated as the hand sink. Hand sinks must be used for handwashing only. There must be wall hung soap and paper towel dispensers at each hand sink. The hand sink must be accessible at all times for handwashing. Employees must be encouraged to wash their hands frequently. There is a hand sink located in the middle room, approximately at an equal distance to the pizza prep area and the cooking area. A mop sink is located in the rear prep area. A food prep sink is available for washing vegetables, etc. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. All food must be held at 41'F or lower, or 140°F or higher, at all times. Therefore, meatballs should be at 140 before being held hot. Salad display items, such as vegetables, must be cold prior to being held cold in the salad unit. Food may not be added to containers in salad unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. Reviewed preparation of chicken pizza topping, with an emphasis on proper refrigeration. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. CERTIFICATION or 14f. tl There mu�be a Certified Food Manager working at this establishment full time. Mr. Aktas III take the Certification class in January. Until he becomes certified Steve Kontakos will remain as the full time Certified Food Manager. When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. UNDERCOOKEDFOODS Roast beef, hamburgers, and cheeseburgers will be cooked to order. Therefore, an advisory of this will be placed on the menu. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3rd bay of the 3-bay sink and spray bottles and/or wiping pails may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Spray bottles and wiping pails must be clearly marked "sanitizes". Outside area of premises, including the dumpster area, must be kept clean and sanitary. The Licensing Board must be contacted by the proposed owners. A Food Establishment Permit application was given to Mr. Aktas. Please call one week prior to opening to schedule an opening inspection. Joanne Scott Date Health Agent 1-7 r� 0 Nihat Aktas Date Mubin Sonmez ate .. .Mn'�•'.+h ../,�..,w...^.wr#�iF nyp�•.rvrnr rF rYNIM1M1.+N . �,..5 -. u , y ' Massachusetts Department of Public Health Salem Board S Health I" 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 1/ Datee of Ooerationis) Type of InsDection (�IU 0r, reht�� Type I Food Service n Routine ( � I Risk 11Retail ] Re-inspection Address I l� ✓� c A rP Level ❑ Residential Kitchen Previo/u�s�I;sp ction Telephone "�41 _ 1 E] Mobile Date: 7/rGOS HACCP Y/N El Temporary ❑ Pre-operation Owner I (� __T1_up�.f �l y�r C ❑ Caterer El Suspect Illness Person in Charge(PIf. Time ❑ Bed& Breakfast [I General Complaint In:-,,,,) ❑ HACCP 1-- ' .;La Permit No. F1 Other Inspector I r.Lcor�I_ �,� � Ouf�'?..'�`r-1 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 FactorsAnti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E} ❑ 590'11 F} ❑ action as determined b the Board of Health. (( ( 1 Y ( o{C��4>I�3 CGT^T0�-t 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 DiseaVs by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15,Toxic Chemicals FOOD FROM APPROVED SOURCE - TIMEtTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source E] 5. Receiving/Condition El16.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) ❑ 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, ttie 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)(590.003) 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)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5:N11nI.FPO�14 Jac n l,,-)nn ! ( Inspector's Signature: 1 J Print: �a ) y/(/fit PIC's Signature: /'J ��;/"�----ti Print: �� Arit.r-^f {f'( !'I'f O,.r I Page-1- of__Pages r Violations Related to Foodborne Hiness interventions and Risk Factors(items 3-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 I Crass-contarrina'on j i 590.003(A) I Assignment of ResponsibitiW1 3-+02 1 UA)i l) R::m aunnd Roo,is;.ds- pain;te,l C .ed lroln i 59(LtlO't1B1 Dernonsvation of Know?edge" j ueiand RTF.F�'a j 2-103.11 Porsun in charg,-dutie, Contanroatlon from Raw ingred,ents 3-302.11(An 2) Raw Amtrial FoodsSeparatedfront Each EIIPLO"EE HEALTH Others. 2 590.003(CI Rcsponsibili:y of Lhe person in charge to j Contamination from the Fnvironment j require reporting by Foix;employers and j 3-302 1 l(A) Food Protection` appli�ants :-302.15 xvasirmc Fruits mid Ve@stables 590.0W,Fi Reslarimbility Of Food Employee Or An 1 3-30.1.11 Fuad Contact with Equipinent and :lpphcanl To Report To The Person In Uten,ilc Char-c* j Con'ani navor,from ctio Consumer .`.9u.003(G) Reporting b4 Pers::n in Cliarge" j 3-806.1-I(Ali 13) Returned Food a-,d Rcwrvicc of Fund- ! 3 590.003(0) Esclun,iun::and Resh ictiorrq* I Disposition o;Adulter-ted or Contaminated 5+)0.003(F.) Removal of Exclusions and Rearictiunn Food 3 70;.11 Discard'i`g er Rc.nndiiionutg Cnsafte i FOOD F ?OM APPROVED SOURCE Feed, 4 Food and Water From Regulated Sources ( 9 I Food Contact Surfaces 590 004;.•1-B) Cotaphance w,Lh Food Law* 4-501 111 :vlanual W'.n"-,vasinnc-FIot Water 3-201 12 !-,,,oil in a Ifemeti,•ul!q Seal:-Cuataurcr'- Sanitizau:,r."I'crn-�ratares^ 3-'_01 13 Fluid Milk and Milk Products' 4-501.1 I2 kle+dtantcai Wan:wie ping Hot Waver 3-2021? Shell 1 Samination Teuperatures" `Legs* i 4-501.1 i 1, Chrmical Sanitization-temp.,pl I, 3-202.14 Figs acid Milk Product,.Pasieurized" j 11,16 Ice Made From Potable Drinking Water" � concentration F and ContacthaiUueS 5-101.11 Drinkins Water from an Approved Sv,,teui" I ( 4-6{>7 t 7(A) fiquipnxnt Faxl Contact Snrfaxs.md j ccsd:, j 590MONA) Bottled Drinking }-50'_.11 CCWater* ( , rcqu eaning,Freyurnry of Eumm p :nt Fuad- 590.006(B) Wracr Mects Standards to 310 CNIR 22.0* j Contact Surfaces and (hensils' Shaflfisi;and Fah From an Approvrd Source .1-702.1 ! Frap,,eu:y m Sanitiz.mon rf Utensils ana 1,Ll Fish and Recreationally Caught 4•Iolluscan 3-20 I !-Loud Con tact Surfaces of Equipment" ShelllishT 14-703.11 Methods or sarntizarion--Hot Water and 3 201.15 Alollwcan Shellfish Froin NSSP listed I Chetnicai'- Sour�cs r lt) Proper,Adequate Handwashing i Game and Wud Mushrooms Approved by ! 1 301.11 Clean Condition--Hand;and?sins" Re_quWory Authority -201 I8 Shellstock Identification Present" j 2-301.12 Clmnin, Pnkedure" 59(i.004(C) Wild Mushrooms." 2-301.1- 'v4h.n to lhsh' --201 1.17 dame Anunalc^ ' Ii Gond H,rgienic Practices u g Receiving/Condition ( 2 r101 11 Entutg,llnnking of lJein,Tab.xsn' 3-202.1 i PIIFv Received at Proper Temperatures` 2:}O1.12 lli:;char@es From the hpes.Nos: and 13-202.15 Package Intcruity;" j Mouth' 3-Ill i.11 F'<xrd Saf.and Uaadulwiaud " .3-301.12 Preventing Coin�:rtnahun When Tastiri t TagarRecords:Shelistock ( 12 Prevention of Contamination from Hands 3-202.18 Shelkiock Identification590. )04fE) Preventing Cunrinniniion from },nipieyee2" 3.203,12 SheTags/Records: c ids: Fish.Pro ducts aimed•' ( t3 Handwash Facilities 1-agsfRecords: Fish Products ( Conven,erWy Lorated and.4ccesslbfe j 3-102.1! Parasite Des!axtion* .3"103.1'2 Records.Creation and Retention'' 5?0i I t Nu,nbers and CnpaJL;.cs'" 590-004"11 Labeling of Ingredients' j 5='{'4 11 Location and PlacetnenY' 7 Conformance with Approved Procedures ( 5-20 .1! Accessihility, Openmon and Main(cnance j IHACCP Pians I Suop#,,d wan Soap and Hard Drying ! 3-502II Specrahzcd Pio.e.sing!Ylethodsr Devices 0-301-11 Handwashwr Cleanse'. A-,ailability 3-502 12 Reduced oxyecn pack,%,nap,criteria" I 16-301.C Hand Drying Provision j 104.11 Contornmnce with Approved PIUCCdnr"" r, "Ctem,tes cone,-item ir.Ili,Ldual 1 n,u)ppud Cole or W5 Cb1I2 140.1)(10 �l 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 Nameter) I?t I Type of Ooeration(s). Type of Insoection e. t'/2� 77jdoi n Food Service Routine Address1( A�{ Risk t Retail Re-inspection ' `�� W A Level El Residential Kitchen Previous Ins ection r- Telephone t f� j ❑ Mobile Date: Irk y��j Owner / �) HACCP Y/N ❑ Temporary 1:1 Pre-operation (7AdQGc, d a� 'F-.A / r_ ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time El Bed&Breakfast E] General Complaint r C� �� ❑ HACCP r In: Inspector �)� ( PG Out:�)9 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 determined1py the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH ❑ 13. Handwash Facilities E] 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS t ❑ 14.Approved Food or Color Additives '^ ❑ 3. Personnel with Infections Restricted/Excluded >/ �,N ,IAV 5.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(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 N`19(gand Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing [-] 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 C ealNth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 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: c S 50fosp cfForm 14 eoo Inspectors Signatur^ Print: PIC's Signature: Print: / Pages of�Pages '7)-C, J I �rl r� � h .K(7� �voti r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1.22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamina tion j t ( 590003[,\) I Asvgnment of Responsibility" I 3-3(1_.11 Ga),1) Rt.a Ai,iami Foods Sepnnaed hom 59(;.003(8) ( Demon.chahon of Knowledge* Cool:eL and S2T'H F+xx1s" 2-10.3 11 I Pecam in charge--rut:cs j j Contamination from Aa.v f igredznts 1 3-30111(A)(2 R:a3 Animal Footle Separated front Each EMPLOYEE HEALTH Othcr:: 2 59U.003(C) Responsibility of the person in charge to ( Ccattaminaten from the Ervironnent j require reporting by food employees and '; 3-302.11(A) Food Protoctiunt j 1 applkaihv� j 3-302.15 R4shutg FI'otm and V.getables 590.003(F) Rer,pumahiitty OCA Fuort Employee Or An 3-301,11 Foul Contact with Equipment and Applicant To Report To The Pcrsoa Lt I Utensils* Char ue* j Contamination from the Consorter 51;0.003(G) Reponin:,by Person in Charge' 3-306.14(A)t 0) Returned Food:md Resemice of Food" 1 5';0 003(1)) Exclusions and Restrictions= j ( Disposdion rr Aa'utt:.rated or Contamnated 5'}0.003;6) Removal of Exclusion,and Resirtctinns ( Food 3-701.11 Discarding or Reconditioning t'nsafe FOOD F IOM APPROVED SOURCE Foods 14 Food and Water Frurn Regulated Sources ' j 9 Food Contact Surfaces 5:0.004(:1-8) Compliance with Food Law" ( 4-501,111 \:Wnwl bV,;akvwh,ng-I(ot Water j '- 201.12 Rxid in a Hermetically Sealed ContainerT j Sanihzation'pentp,manes[ 3-20;.1:) Fluid Milk and Milk Products" j 14-501.1 l2 Mecliancal Ware`.vashin,-tint Water 3:t0..i;h .Shc(I Samnzation Temperaluics� F.ags� 3-202.14 Eegs and Milk Products.Pastewtzed" i 4.501.! 14 Chemical laniurtTion-temp..pH, j 3-'_02.16 foe Made PYcnn Potable Drinkinc Water* j concenhaoon and Inadneas. -101.1 I Drinking Water from an Approved Stxt.•m+ ( 4-0;01 :L A.1 tiiaipment F.rxi Cornet Surf?+cel.+rid Utersds C'ican" j 590.000(A) Bottled Drinking Water'' .;-602,11 Cleaning Fregncncy of Equipment Food- 590.000(h) Water beers Standards to 310 CMR 22 0-- Contact Surfaces and Utensls' j Shellfish and Fish Fort an Approved Source .1-702.11 Frequency of S.uiai tamon of Utensils and J-201.14 Fish sod Recreational l Y C_areln Molluacau - .r - 'F - .* Food Contac.Surfaces ui .quipmen: Shelltiehx 4.7;)3.11 Methods of S•o,, iv.aln,n-- Hot W-ter and i 3-201.15 Molluscan Shellfish from NSSP Listed i Chernic,d Source.' Game and Wild A?ushrooms App r ved by I I t0 I Proper,Adequate Handwasnvng j Regulatory Authority 2-301 11 0okin Conoivan --Hands and Ar:us* j 3-202.1 tS She1C:Uxk Identification Present, ` 2-301.12 Cleaning Proe,dure* i 590.0041 Ci Wild Mushrooms` j 12-301.14 W1ten to 1A`ash" j 3--201.17 Carne Animals" ( j 11 Good Hygienic Practices j 5 ReceivinglConditian ' 401.11 Eating,Drinking of Usun, Tobacco'- 4-202 11 PHFs Rzeeo'.d at Proper Temper_tures: j 2-`701.12 Disch;riv=s From the Eyes.Kase and j 3-20'.15 Package Inteprity" i i Mouth`. 1 3-10 L l i Fund Safe and Unadulterated 3-301.12 Preventing Cuniaminatior.When TasiiroT 6 j Tags/Records:Shellstock 12 Preven?ion of Contamination from Hands 3-202..13 Shellsttx,k Identification" j 590.004(E) Preventing Contamination From j bmplotees 3-..,,J3.72 Shellstuek klentitication Piaintained"' I3 Handwa Facilities Converrre Tags/Records:Fish Products j n nt%y Located and Accessible j j 3-40? i 1 Parasite Destruction j 3 dQ?.12 Ret.ords,Creation and Retention` I j 5--'ti3.i l Numbcis and Chpacittes` j 590.004(1) Labeling of Ingredients' ' S-204,11 Location and Plau;ntent j 7 Conformance with Approved Procedures ( j 5-205,11 .c.essibility,Operation and Maintenanc, . MACCP Plans I Suppled with Snap and hand GrVing 3-502.11 Specialized Processing Methods'- Ocvrcc' 3-502.12 Reduced oxv,,en packaging,criteria'" ( 6--sUi.l l liand'a:.+hing Cleanser.Avaiiabil,tY ` fi 301.12 Hand Drying Poc ic!o;t j s.l(11.12 Conforrinince with Approved Procedures" "Deroicr critical item io the iedcmi ^4o food Cnue or lu5 CMR 590 Uau a CITY OF SALEM BOARD OF HEALTH Establishment Name: n mpq Ct ?IGS Date:( /n Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY rr t A rK IF i U LP r.F vn ir — _ cs, h-)Z /? 4AL AD �7�.� R`t l-4 o"4, - � e F II r1A v� �i� r��r cJ r rin Y»! E)+ Pcfacl wog 5- Y\ V d!r I j op n4- ( ro /`fi(\ k--)1 �.1lnt t L ff r 1. i 1r,fx.rj� � W riot- ;"1 J A.PeIiM.iH G1 rd , we �Pv17. 0 J OCA Irl 0''-A J Irk ro' c N jc�M,�r 11 �.. t�A/% rhe a trn., i INGWej�rvil f ,I II� \ ��Y1 Discussion With Person in Charge: "~ Corrective Action Required: I ❑ 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 � pe-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of_twe 1ty- 've dollars or suspension/revocation of El ❑ Emergency Closure your food permit. J ✓ \ / ❑ Voluntary Disposal ❑ Other: 14 all ! d Violations Retat•^�i to Foodborne5-50 (C) PFIF;,Reserved cif 7emprraturea ltfness Interventions and Risk According to IA Coo tied to f Factors(Iferns 1-22) (Cont.) al"Hi J .F 6ti;thin 4 Hours. PROTECTION FROM CHEMICALS `A,IS Cooling Methods for PHR � 14 rood or Color Additives ( 14 - F't1F Hot and Coid Holding j 3-501. t6( i-:) Cold PI-iFe :Mmmaincd at or bciow 3-202.17 Additives` :79(1.0'0?`F) -11`I45� F' 3-302.14 Piotecuon from Unappuwed 4ddihve ` j di a PFF, N4 j ti01 161 A) Hot 4iLancat or above 15 Poisonous or Toxic Suostances 3- I I I 7-JU1.11 kleautymc la forianwt-Original j 16i At ! Contain;ry ( - Roasts Held a:or nbore l30'F. j 7-102.11 Common Natne Working Containers' ( 20 Time as a Public Health Control 7-201.11 Separation-Sto+aec'4 3-51'7-19 Pimc at a Public Healdi Control* j 7-20111 Restriction --Piewric, and Use: 59'.)004:,H) Vz::iance Reguiretaent j 7-202.12 Condnb.ms tit Usr'" j 7-203.1 I Toxic Contuner�-Prolnbrfi,:ns"' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 Sanitized;,Criteria-Chemicals^ j POPULATIONS(HSP) I 121 13-K01,11(A,, U';pasteunzcd P-.-p.,eka-td Juices and 7 '04.i;. Chewi:els for F'ashmg Produce,Qif cria' a 7-204.14 Drying Agents.Criteria" Ber:ra;�e+with\l'arnrne S,+bels 7-205.11 hu:idLobricains� ( 3-80'.11(1 ) Use.,P Pasteuized Eg"* Contact.conal Food I ;-gpi 11!171 R::.x er Paltiall Civ)ked Amnial Four,' and 7-206.11 Restricted Use Peitiotdes.Criteria* j } Rtr;:Seed Sprouts\u+ S,:',ed. f ( 7 06.12 Rcx(ent Bait S'tatums` ? 3-801.1 ilia Ullooened Food Package No Re-served. " 1 206.1 r, Tracking Ptmders,Tt It C ntrul and I - -- i4lomtnrin¢* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.'I C,m;umar A:vrsory Posted for Consumption tit Anonal Fails That tire Raw. Undm,naked or l4 Proper Cooking Temperatures for I Nktt Ofher,,,ise Processed to Eliminate IelrlPHFs _ F"I't,rm;mr 3-40 i.11 A(l)(2) Egg,,- Ls:Y F 15 Rea. I -'do 2.13 9asteun7ed Ef,"s Subsorutc tot Raw Smelt Eggs-h:mtediate Service 145°F15:a�c' It - 13-401.1I(At(2) CornminutedFish Meat,,@Gana r_;,s Animals- 155'F 15 sec. ''" i j 3-401.11(B)(I)(2) Pork and Beet Roast - 130`F 121 min*. SPECIAL REQUIREMENTS 3-401.11(A)(}) Routes. Injected Meats- l55`FIii I 590001KAt-(D) VioiauonsofSuction `90.009(A)-(D) in sea r cat:rine,mobile food, temporary and 3-40 i.11(A)(3) Poultry, Wild Crone,Stuffed PT-IFs, residential kitchen operations should be Stuffing Containing Fish,Meat, Idebited under the ap,nopriatc sections ':Poultry :rRatite;-165°T't5 sec above if icLa:d to ioodbornc ilinc;s 3-1,101.1 tiC!(3> Whole-nniscle,Intact BeatSicaks I in[ervention;and risk factorsQtl.-.rr 145`1" 590.009 violations relating to-clod retail 3-aU7.L? Raw Awmal Poo&Cooked in a practices should be debited under #29- Microwa,e 165'-F' ( Speeial Requirement-,. 3 -mi'll(At(l)(b) All OficrPHF,, 14S°F Iswc " j p I Reheating for Hot Holding VIOLATIONS R,.-LATER TO GOOD RETAIL PRACTICES 3-4 03.11(A)R(D) PHF., 165`F 15 sec. ^ (l terns 23-30) 9-1103.1 i(B) Microwave- i 65'' F 2 Minute Standing Critical and rca-rriin;at t•&�Lt;tnrs, Which du nol +elate m the Tune* f•)nrihnnse dots nner+,eatron: and risF jw fore listed above, can he 3-403.11(C) Commercially Processed RTE Food- fuund in the fo!lnn-ing section q1f the toed Code a,,,{105('tSIR 140"F'' 580.000. 3-403.11(E) Rnnannng Unsliced Portions of Beef I Ben Goo,7 Refait rias:ices FC 590A00 Poo„t,r 23. Man^gmn2nt anu Personnel _ FC- P .DOS f}; Proper Cooling of PHFs 24. Food and Fond Protection FC- ? OC4 25. GauiGrrn:ni and Jtensils FC-4 ,0,5 -501.14(A) Caaluu Cooked PHt's from 140'F tit j I .'_6. Waler,Plumbinq.)nd'v1+aste FC- 5 70"F Within 2 Hour.:anti From 70"F 127. Physical FariitY FG-6 OC7 to 4I'Fi45"P Within 4 Hours. 1 20. Foiscnous or Toxic MaterAs FC -' 1 .008 ?-501.14r Bt Cooling Pt-iF,A^.ode From.Ambient I '119. Spe41 ReguifencrAs 009 Temperature Ingrediems to 4l'Fl45'F 30. Gtner - --- --_ Within 4Ilours's *Denote,critical iltzu m tar f.`drr.d 990 Food Code or 105 CMI590000. Fv? �*.:»,.. .,�y.pH„'t - n uYe:s4:�4 `« .r.✓.is• +�-`' ,�.i-,r'�,�• w.: . '.z.},"i '1 s! ":?4r '-r' �'•..§3s,.'b . 'f; Jl°'�! st _+'+at=..,..wt .:.^r^., µ°. .'v--•....;.ci r ::r.-`.`u'..&.1 .-r, 'a pp '�'`'..`.X•,v.i�' WA +... .ar w,.-;y'w. •_ .ay..q u.i`_., yS•.Jd. }fi ni' 'I. ---faM+$'^'MP+a �- r i. ' y,,., CITY OF SALEM9 MASSACHUSETTS BOARD OF.HEALTH 6 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 TEL. 978.741-1800 FAX 978.745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Omega Pizza Address of Establishment: 101 Loring Avenue Owner's Name: Sharagda Kontakos Restrictions: Application Date: 12/6/2004 Permit for Food Establishment 194-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH e w, � 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT/ATO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT n " EGA 2 Z TEL# 97$? -I L�O /ODO ADDRESS OF ESTABLISHMENT IDI LOAi d) (r UjLc Q SA LE A-f MA 019-70 MAILING ADDRESS (if different) OWNER'S NAME 01.1'6r,-A PIZZALt1 lf !Im&,IIA 1�wjm4L#9 �k �70- 10D 3 ADDRESS - .J'9SOA) LN, CITY PC-Agob J STATE M A ZIP '017S6 CERTIFIED FOOD MANAGER'S NAME(S) STfyk- o"M " CERTIFICATE#(s) L� O00 4096 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON STEVE KDADTA)✓9S HOME TEL# c? 7p- 535- HOURS 35- HOURS OF OPERATIONMon. Tue. Wed. Thu.—Fri.—Sat.- I Sun. rtpt00 -- Io;Oo �Zf°° - �• °� 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 YES NO bh less than 25 seats =$100 `C1 25-99 seats =$150 1 ` more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church .kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best lowledge and b lief, have filed all st to to returns and paid all state taxes required under the law. `�.� e. �� II /30/DL/ r7 ' 9ol Signature Date Social Security or Federal Identification Number Revised 11/03/03 FOODAP2 adm Check#&Date �/d D 11 Ilk" 'i Massachusetts Department of Public Health Salem Board S Health 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 DateJJ T_vo€�of Operation(s) Tyoe of Inspection 15ivit'ef of IJjZ�r I y I�/ L- Food Service l7-Routine Address Rik ❑ Retail ❑ Re-inspection /tl/ r1 t4la* Level ❑ Residential Kitchen Previous Inspection Telephone I f'Lf ❑ Mobile Date: ❑ Temporary ElPre-operation Owner HACCP YIN 1 El Caterer [I Suspect Illness ak�� /.x 2-4- //./C I'.YiA,er /le.✓tA/4.'r Person in Charge(PIC) Time ❑ Bed& Breakfast ❑General Complaint In: ❑ HACCP Inspector n��y � . d w.tka 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 ❑ 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 TiMENEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 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 ❑ 88. 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 f r 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)i59o.o03) 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: S 5.9lilnspectFpmrS-14.d. Inspector's Signature,, df Print: PIC's Signature: _ Perot: 5(�� K��f7�K� S Page_of_ZPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 S')tk0031:?) Aesigntnent of Responribnlity" 3-3u?.I I(.A)(l) Raw Animal Foods Se!raated furan 500.00,,B) Dcmonarahon of Knowledge" ( Coo ed and R"!P,Foods': 2-103.I I Person in charge-duties ( Contamination from Ran,ingrad,ents 3-302.11(A)(2) Raw,'Am mal Frxtds Separated from Each EMPLOYEE HEALTH Cthcr 2 500.00?lC') Reapunsibility of the person in charge to j Contaminaton f om the Environment ., require reportingby Fond employers ane! 3-302,11 IA) Food Protection" apphcards' i- o2.15 W'ushuw Praik and tie,;e/ables 590 003W) kcsponstbility Of A Food Employec Or.4n ( 3, ?.-14.11 Food Contact with Egmpmcnt and App;ie.ant To IleproY To Thr.Person In Utensils: Charter j Contammetion£nom the Consumer 590.00'(6) Reporting by Person in C'hai Fe'' ( 3-306.14fA)(13) Returned Food and Rescrvexi of Fix)& 3 590.003(1), j t'Ndutdonsand Restrictions` ; I Usposition otAdutteratedor Co:rtamo,ated i 1?c3noval of Exclusions and Restriction, Pool 3 701.11 Dcscerding of Reconditioning Unsafe FOOD F 301A APPROVED SOURCE F(xxl" I ! 4Food and Water From Hayutated Sources � 9 Food Contact Surfaces 5ir!.J0d(A-B) Comolumec with Food Law, 4-501.111 11oiWater 3-201.12 Food in a Hermetically Sealed Cont.nner^ Sanitization Tcmperattsres" 3'01.13 Fluid Milk and Milk Products'' 4-50 1.112 Mechanical Wdrewatlunt Hut Water 3-202.1 3 Shell Eggs'° SAnhoation Tnuptratures' 4-St1.114 Clhcal Sanitization-unp.,pH,3-_0_.. } fgggutMilk Pruacts Pasteurized" concentration ndhatchenss 3-202.16 Ice Made From Potable Drinkme.Water" 5-101 11 Thinking Acuter from an Approved System's 4-601 11t A) Equipment eCt Food Contact Surfaces and 590.0U6(A) B&dticd Drinking,Water* C,tewnm Cleat:` -1-ti0?.P Clzamng Ereu::zncy of Equipment Food- 590.006(fl) Water Meets Standards in 310 C'Ml<22.03* Contact Surfaces and Utensil+" ! Shellfish and Fisn From an Approved Source I I Prryurucy of%aw i7ation of Uwnai Is,and 13-201 Id Fish and Recreationally Cau,hi Molluscan Fe;-ontacl 5u!iaces of P,aniprnerr* Shzlltiah I +xr:7-1-703.1 i Me±hod;of Sahni?ation-- 1-lot Water a nd 3-201.15 Molluscan Shellfish 0nun NSSP Lisled _ Chentical .Sources" 2I) I Proper,Adequate Handwashing j Game and Wild Mushrooms Approved by I Reycdatory Authority a-qOI.11 Clem Con+ Handslilinn-- Hands and Ana"`n 15 Shrllstork Identification Presenp` 2-301.12 Cleaning Procedure* 5911004(C) Wild Mu.chnwnis' I 2-301.14 When m Nl'asb* I 120`1.17 ame Murals„ I Good Hygienic Practices 24W.11 Eating,Drinking on U,di i Tobacco° y : Receiving/Condition 3-202,11 PI IFs Received at Vrav?er Tctnprtatures* 401.12 Disc harges Fuwm the Pyec,Nusr and -202.15 Package tnicruts`:: I DSn;ut,T 3-101.11 Fund Sate and Unadultinated:< j ?-3-(t1.l2 P7.wenivtg Contamination 4t-lien 7-a,dnF* j ( - ( 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstoctt j { 3-202.15 Shelktock Identification ^ I ?90.D02(E) Preve!aing Contamination firm 3-203.12 Shelisux:k IdentificationNSentLainzd" Employees" Tags/Records:Fish Products d3 Handwash Facihilps 3-402.11 Parasite Destruction' Convene nits Legated and Acressib;e 3,11 Numbac ci�andCaphics° 3 SAP.12 Records,C;eatton:and Reteniion"' 1' m ` + Labeling of ingredients* I ! 5-204.1] Location and Placement" 5)0.00=i(1) 9 g 9 Conformance with Approved Procedures I j 5-205.11 Adccse,hility, Operation and :N%hLterance /HACCP Plans Siwiic.4 v,,tn Soap and Hand Drying b-301.1 t Iian 3-50? 11 Speemhwd ProcessignMethods"' -las nd 3-502 12 Rednccd oxygen puckagine.criteria'. wat,h:nF i�(e�nser.Avallab,lity S-10'; 12 Conformance with Approved rw c .trci" ( h_7f,1.12 lftmd Drying Pr,�isiuu "Denote;.rrnunl ileus,in the Iecrr.;lN9 Four Cndc of 105 ChIR 590d)OD i CITY OF SALEM BOARD OF HEALTH Establishment Name: QP446-4 A eq�#- Date: f 11*645� Page: 2 of 2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY i I C C....•fr.r,� �/�3r .er.� sa,,w,:® .rl,vo s-cxa•..l.�n _ /4Fsu�.,R,rar �..�- i4s/�••k6 �I I � fern vU- Av.a,�F NA AF7hC/L JOPK47.8-tr c.adrct r/IUG**notPs n eau frC ? PW 617" _15 I I ..�a.rn,•irr frh.ee.. : .� asY,c .�, ,rr,.».et✓ b'Sio�t,(,lsa, r.fa- u.C.Gsirsu Gtr LAf"e � 1 t,�.� 1 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 ,ifloncompliance may result in daily fines of twe ty-five do a�s^or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: r • 411) Ptlr's Receiveri at 7'avperatures Violations Related to Foodborne Illness interventions and Risk Accordin{t:,L,m Cooled to Factors(items i-22) (Cont.) !1'F/45`F 145d,in Huuts. ' PROTECTION FROM CHEMICALS Cooliu<t;rIethudti i:,r f''rits j dd"Aiices" 1s Pill:Ilialmil Cold Holding 3-2U2.1"2 dSi 14 I ¢r Color Additives 3-50 L 1NP) Cold Pi IP:. `a dntained at cr h,elow, ! ( 590.0(1»(P? 4l'v45: 4•'^ 3-302.!4 Protetinm hom UnapproNcd \ddihvei` j 115 Poisonous at Toxic Substances 3-501.J(0) Hut PiIFs Maintained at or above ;40-F. 1-101.11 Idenut-yinu lnform.niun-Origina! i i z_ji)1.16t A) Roasts Held at or above 130"F. * Cunlainers" , ., j ! Time as a Public Health Control 7-1!2 lI Common Nanu-WrkmpContainers" 13-501. ¢ Tim::as a Public Ifealth Control'" j 7-201.11 Stimiani n-Storage" ( 590.004:1 '7-202.11 Restriction-Prescueeand Use j ( . ;-t Variant Reauvemeu: j 7-202.12 Conditions of-Usc" I 7-203 !1 'toxic Containet.c --Prohibitions, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanidzers,Cri,e,Iii -Chemi:ds POPULATIONS(HSP) 7-204.12 Chemicals G,r W'ash:n!_Produce;0 oerta"' I 121 3-6U I I If A) Unpasteurized Pie-rackaged Rotes and i 204.14 Diving Agents.Criteria" Eear.ages with Warnint_Labels'` 3-SO1,i ;(3) UseufPao.teitri7edLurzs' 7.205.11 ResIncitricted Food Cuntadi t-ubrteria* I }301,i!(D) Raw or Patualiv Cooked animal Food and ! 1-2(76.11 Restricted lige Festicic(es.Criteria* Rat,Scrd Sprouts Not Se ,,ed. 7-206.12 Roden; Bait Stations" I 13-801 I liCr unopened Ansi Package Not Re-sened " 7-206,13 Tiack+ng Powdecs, Pest Control and Monituring.< I CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3 603.11 Consumer Advisory Posted for Consumption of Animal Foods lbat are Raw. Undercooked or 16 Proper Cooking Temperatures for PEPS Not Outer mse Processed to Eliminate i 101.1]A(]n'2) Eggs- 1557 Li Sec. f l.,'tc '-3V1.13 Pasteurired Iig,,;Substitute For Raw Shell _ `-k!es-Llmieuiate Servia 145`Fl5sec* - 3-40 L 11(:1)12) Comminuted Fish, Meats&Game Eggs: Anor+als- 155-F 15 sec. _" 3-401.11(B)(1)(2) Puck ar.d BeJ Roast- 13WF 121 min* j SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites. Injected Meats- 155'F IS I 590.009(A)-(D) Violalicn;of Section 590.009(A)-(D) in sec. W catering, mobile fo id,ter.iporary and -401.11(A)(3) Poultry, WildG-iee,Stifled i'HF,, r:sideniial kitchen operations shouid be Stuffing Cont:Juiug F',sh,Mcat, debited u+:der the appropriate sections Poultry or Ratites-I6>F t5 sec. " a-iovr if*elated u,feodbcrne i!htess 3-401.1!(C)(3) Fhtle-moscle,Intact BoJsteaks ( intenv3rQiorsand risklaUors. Other 145-174- 590.009 violations relating In wood retail :3-101.12 Rate Animal Foods Cooked in i practices should be debited undcr J/l9-- Microwave 165`F" Special ReQliiroinents. 3401.11(A)(1)Ibl I All (fiberPHFs- 145"F 15 sac. .s j 117 Reheating for Hot holding VIOLATIONS RZLATED VO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PH ers 165'F 15 sec. * i (Itein523-30) 3-403.11 i til Micrm,ave- I65°F 2 Nfinnlr Snmdin_ C,itir'd and ro^;riricnt viulatiunc �,Wch do nor route to the Timce hredhorne i;l,ms,c intro+,miner mnd r7vk laths li,sird sonic, <an he 3-401.11(C) Coom,etcially Processed RTE Fund- found in the ioUewing cerlions Of the,Fond Cede and 10i CWR 140'Fr 590j)(so -403.1 t(E) Remaining Unsliced Portions of Beef I ! Item Good Retail Practices FC s90.000 Roasts' 123. ;Janapemem and Par?onnel PC 2 .003 IS 24 Focd and Four!Proter,t:rn FC-3 004 j Proper Cooling of Ff _ i ( 2�. Equipment and Wrns!s =C--4 .005 3-501.i 4i^.)-- - Coolintt Cixikcd PHF&from W 0"1 to 2e. Watei.Plumhinq and Waste FC-5 .006 70'F Within 2 clouts and Fr,m 70`'F 27. P^ys:cal Fac::itv 9C--R 007 ! to?l'F/45'F Within 4 flouts. " 26. P•visoncus or Tox:c Flaterials PC-7 .008 13-501.14iB) Cooling Pt33,s Made From Ambient ( 29 Special Rauuiremer:ts 009 Tempetamre Ingredients to 41"F/45`F 130. Other _ ---------- W)tlun 4I-[ours" i l Denotes enucaI item,n,he federal 1999 Foal Codo or 105 Chin 590 000 s CITY OF SALEM, MASSACHUSETTS , • BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR . c SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Omega Pizza Address of Establishment: 101 Loring Avenue Owner's Name: Sharagda Kontakos Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 150-04 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 1, u CITY OF SALEM, MASSACHUSETTS 3. BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT�j NAME OF ESTABLISHMENT Iro Nr 6A I' 1 Z CA TEL# WO /00 d ADDRESS OF ESTABLISHMENT 101 dL-0 I k-)6r 0)g70 MAILING ADDRESS (if different) OWNER'S NAME -`iF-IARACr bA KeN' TA L- aS TEL#47f- X3.5 96 ') ADDRESS 4' T ASO/J L/1L)k CITY DSR C3 n STATE_ ZIP 61 -1A, CERTIFIED FOOD MANAGER'S NAME(S)Sr/-v, V-oA)rALo S CERTIFICATE#(s) AC nt7nD q 0q7, b (required in an establishment where potentially hazardous food is prepared.) .S3S 9,6 �1 EMERGENCY RESPONSE PERSON 5T6V& )<o OTA Ko.S HOME TEL# C??k -2NI-V -T HOURS OF OPERATION: Mon.)I-10 Tue.W/e Wed.Ir- 10Thu. N- to Fri.fl it Sat. I(- l l Sun. 12- TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO �� less than 1000sq.ft. =$ 50 n 1000-10,000sq.ft. =$100 19 more than I0,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have fled all state tax returns and paid all state taxes required under the law. O '-1 2-,$1?''7 o r7 Signature Date Social Security or Federal Identification Number )J --------------------- ------------------------------------- Revised 11/03/03 FOODAP2.adm Check#8 DateV15-S Massachusetts�Denartment of Public Health Salem Board SHealth M 720 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 I Date//// { Tvpg of Operation(s), i� n��ee of Inspection GM&VA I t7_7rQ 6/2/0 / 12"Food Service []'Routine Address �� l d�rMF A t/t� Risk [I Retail [I Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: ❑ Temporary ❑ Pre-operation Owner � ^ rleo Mr�1�AT HACCP YIN ❑ Caterer [I Suspect Illness Person in Charge(PIC) TimeI ❑ Bed& Breakfast E]General Complaint ❑ In: HACCP Inspector� AC-S-�Q�,Aj � Out: Permit No. Ll 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) ❑ 550.009(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 TIMEtTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18, Cooling PROTECTION FROM CONTAMINATION - ❑ 19• Hot and Cold Holding ❑ B 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 [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 f 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)(590.003) order of the Board of Health, Failure to correct violations Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590,005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27, Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29, Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5 56Dlnspecrfn/ms 14 as Inspector's Signature �� Print: PIC'sSignature: Print:J��114 x0n 1L�1--0 Pageof_ZPages 1 ►I. -3 Violations Related to Foadborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination j 1 590.003(A) As,gntnent et Responsibility" 1� 3-302.11:Au 1) Rail. Animal rooms Sepa,ated from j 590.003tB) Demrntsuation of Kno eiedge* Q•d1:c1 and 12-CE:i- 2- ! 2-I h3 I l Person m charge-duties Contamination from Raw Ingredients 3-302.1 I(r3rt2) Rata Animal Foods Separated i}on,Each EMPLOYEE HEALTH Oi her" 2 500.003(C) Responsibility of the person in change to ( Cornam@iatron from the E,v;io im-o! require reporting by rood employees and 13-302,(:(A) Food Piotrdton' applicants* 3-302.17 Washing Fruits and Vegetables 590.00-YF) Responsibility Of A food Employee Or An 1 1 3-3041 i 1 Food Corvact v,:th Fyuip:nent and Applicant To Report To The Person In I 1.!rensils. Chze te* j Contaemation from tie Consumrr 590.003(6) Reportina by R7rson in Charge" 3-306.14(AI(B) Returned Food and Reservice of Food- 3 59(1 Exclusion:,and Reshictions^' Disposinon cfAduite-aced or Ccntamdtatr;d 590.003(h) Removal of Exclusions anti Restriction, Food II DisaardingorReLondibrnutgUnsafe FOOD FROM APPROVED SOURCE Fund* 4Food and Water From Regulated Sources y Food Contact Surfaces 59000!(A-B) Compliance with Food La,v'" 4-301.111 Manual Waresaashrog- +krt 4Valer 3.201.12 Fond in a flennetica0,Sealed Container, 1 Sanihzation'1':.mr-cronies- 3-201.13 Fluid Milk and Mill:Products" 1 1 4-501 112 Mechanical Wares=.•ashing- Hot Water 3-202.13 Shell Eggs': Saninzation Temperatures': 3-202.14 Eggs and Milk Products.pasteurized" i 4-501 114 Chemical ganilzation-temp.,pH, s-.',02 1(, ice Made From P:;cable Dr mkinc\1'z:er" j conecritri lon and h.udness. ' I EquipmentF,(dConn;ctSurfacesand i- 1,11.11 Urinkin^Water Iron an Aninoved S}:siem* ' lten'lls Clenn^ j 590.006(A) Bottled Drinkutg Watef* I 1 (W2.11 Cleaning Frequency of E.quipmcnt Food- 51)0.006(B) dards 0.006(B) Water Meets Stanin 310 CMR 22 0- Can;act Surf,ces and Utensils"" She;lb'sh and Fsh From an Approved Source 4.702 1 Frequency of Sar itization of Utensils and 3-201.14 FAi and keeteat,onall7 Caught Mollu,can I Pood Contact Surfaces of F n ipmemt Shellfish* ( 1 703.11 Methods of Samncation --Hot Wa!er and 3-201.15 M.cdluscan Shellfish from NSSP Liged ChemicaiT Sources" I 110 Proper.Adcquate Handwashing Game and Wikr Mushrocros Approved by '?-301.11 C tear:Condition--Hands and Arm=.* i ReyuGatory Authority ' -202.tfi Sirrilstm:,k ldeutihcation Present"" � -_•JI.C2 Clean:ne P<o.:edwe'� 590.004((') Wild M1tushrtrirnts` 2-301.14 R;he❑to Wash" � 11 Goad Hygienic Practices 3-201.17 fume Amuj jg Receivinnumisals''.ition _-?01,11 Laing, nrinkmgoi Using fobacc, -1-2 02.11 PHFs Received at Ironer Temperatures* ( '- ?01.12 Discharges br(nn.he Eyes,Nose and 7_ l� Mouth lackage lntcssit-. 3- 01.11 Food Safe and Unadulterated ^ 3-101.12 PreFenlingContamination Cr'hcr::Tv,ting•" � 2 prevention of Contamination from Hands j ( Toys/Records:Sheilstock 590004(6) Preventim,Contamnation from 3-20-1.18 Shell.ct,x.k Identification 3-203.L She:isuich triemtiticauon A9aintamed" Fnmlo,ees' TagslRecords:Fish Products Handwash Facilities l +Jorrvenrerity Locaied and Hrcessibic j 3-402.11 Pa:as,ite Destruction+ 3-4ttl.!l Rrumis.Cae;uiun and Retention' i 1 Numbea and C'apa,aieS" j 5 2.04.1 i J'sicanon curd Placement' 790.0(1411) Labeling of Ingredients' 7 -.,r ( 7 Conformance with Approved Procedures ( . 5-205.(1 .lcceseihility,C,,.,.zr_. ,n and Ltalntenance I /HACCP Pians ( Supplied zettr Soap and;land Drying 02, Dr'✓rres l l Spe-_iahz.;d Prucest.riz Methods 3-502 12 Reduced oxygen pact:agina,criteria" 1 ( 6-301.11 ti(mdwaAmig0cansei Availability F 103 12_ Conformance kilt Appro%ed Procedures" j ( 6Jt11.1_ St,uid Drying Provicin; j .v Denote:cnncai item in the f:dao I'r99}d,ud Cnde or 105 CMR 5a,;ltgp CITY OF SALEM BOARD OF HEALTH Establishment Name:&AIA;CA 10/7-A4 Date: lll� A/6,11' Page: of 2 z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I G C�flie�G Da,�ns s�.,.sn 4-t-0 PT-'d'ns(I. R&rutcGACS "W&Ae�g- rI R r-i"e AAA/toT . �,Je- L , CvNW-,tJ&NCAr. A&Aur ,rJ A417r,r4k �Aotn01�- th5r/St-S Ar'c�,SGa-rtE G�d6.tMdMcss r�A-_fi re-1 fj®rst' Ur//�'. =�1 9 C CAO a& owf- Mot; A►4 traap ATs fil A r-D G-G, Atri V-'fa&006 U&M t y r e-l--,a#J A"O r Ar• (fl zj� CA J I WA4-ir- /a Ac FAmo ,rrJ crd6 rt. _ A 4A40&X-f- ,MvX" 11i - I I ✓ld�A�t) t,ra�ee 1 t�(r � t VA t-i o 1f Discussion With Person in Charge: Corrective Action Required: I ❑ 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 Code. I understand that noncompliance may result in daily fines of twenty-five#11ars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �' ❑ Voluntary Disposal ❑ Other: L L: 3-50:.� :'( PHFs Recerved at'I'emneratures Violations Related to Foodborne fitness Interventions and Risk .According to Law C:.ued to Factors(items 1.22) (Cont.) !I'F/45`F Wallin 4 Howl. PROTECTION FROM CHEMICALS + =t 1.15 Cooling Methods lw PHF" 14 Food or Color Additives 19 PHF Hot and Coin Holding 3-203.12 Additives' 3-501.i6+B) Coin PIIFs Maintained at or below � 3 302 14 Protco,ou from Unapproved Atlditives'° 41 V45c F" Poisonous or Toxic Substnnces ? 501 1nI(A) of PHFs Maintained at or allow IS , i40'F x 7"101.11 IdemiryviL Informilion-0:16tu i 3-501 1601) ;coasts held at or above 130'; Containers- 7-102,11 Common Narn:-Work'vIe Containers" 20 Time as a Puhlic Health Control 7"_OLI1 Separation3-501.19 'G me as a Pubhc Heairh Contra:" -`;tonice' ( 500004(H) Variaruu:Requirement 7-202 11 Restriction-Presenc�.::utd t:se:' ( . - - 7-202.12 Comb Iions,ofUse` 7-303 11 Toxic Contain.,,-Prohibitions#" ! REQUIP.EMEN IS FOR HIGHLY SUSCEPTIBLE 7-204.11Sanirizcls,Criternt-Chcwicap;a` POPULATIONS(HSP) 7-204.12 ( Chemicals for R'ashme Prouace,(rete*ia a ( 121 ?-(sOi.!:(A) Unpasteurized Pre-paclmged Juices and Levert,e with`h'arnuuc Labels' 7-204.1.1 Dryfng Age is.Cnrerm' j 3-801.1 (b) 1,,e of Pasteurized bees^ � 7-205.1 Incidental Food Contact,Lubrrcanh' 3-30i.11(ll) Rau orPartial)vCtwked.4nintdl Feed and 7-206.11 Restricted the Pesticides.Crileii;0 flaw Secd S'r ,u;s Not Served. 7-206.12 Rotten Rau Stations" � - 3-90!.i 1(C) 1 Unopened Food Package Not Re-served. 7--206,13 'Pricking Powders.Pest Control r+nil j i�I0P.5t:?:Illrir CONSUMER ADVISORY TIME/TEMPER4TURE CONTROLS 22 3-60-.I I Consumer Advisory Posted for Consumption of Animal Fogle That it Raw. Undercooked or dfi Proper Cooking Temperatures for \',;t OthPrr,cessed to Eliminate PHFserwise ";<:r:,.;,a„:ol -401.I1A(i)('2) Eggs- ISI"};15Sec. Padng;era<- Eggs-humor[late Service 145-F Ciseo* 3-�1;2.73 1 Pastel:nand Egg:;Subsd'a!te fat Raw Shell 3-41JLl7LA)(2) C:�mtmnatedFict��, 54eats,@Game Ezgs" Animals- !55'F 15 sec. " SPECIAL REQUIREMENTS Pork and RecfRoast- 13L1'•'r121min* 3-401.11(A)(2) Ratites, Tn;c-ctc,iM;ata-15S'F15 I :i9O009'A)-(D) Viuldtiansef'Seetion590.009(A)-(D) in ec. catering, rnobile fo,xi, temporary and 3-401.11(.4x3) Poultry.Wild Game,Stuffed PHFS, residential kitchen operations should be Snaffine Conhiiau:g Fish; Mcar, debited under the appropriate sections Putdny or R:.dtcs-165-!' 15 sec. " a?laic ;L related t<i;oodborne il!nec j 3-401.11(C)(3) Whole-muscle,IntactRrefSloak" interventionsandFisk factors. Other 1451;* ( ;90.009 violations relatin,to good retail 3.401.12 Rau•Animal Foods Cooked tri a practices shovid be debited under i/29- Mictowavr 155'F Sptcial RcquirinDems. 3-401.11(A)(1 Rb) All Other PHFs- 1.15'F 15 sec. j 17 Reheating for fiat Holding VIOLATIOIVS R.FLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PlTs 165'F l5 sec. * (Itenris 2.3-30) ,3-403.11(E) Mjocouave- 165"F 2 NTinu v Snwding I Crtlrrul and Wert-r rhtrut rit,lr,tiar+s, wh,eh do t:ret+elate to tlx• Tirnc"' huull;urnc illrzsx nnr+rry;inrs ur+d risk tiu tine flit red r,6n�-c, can he 3-4(7;.11(C) Conm:etciidly Processen R'IF Food- (oawu in fru•fotln>7-nig cerrions of tile F'nrz"1{roil,'a+trt IPS CUR 140T* 590-000 i-to?.I t(fi) R.:mainitr'11w itced Pordans f Raul' ! Item Coed Retail Practices FC 590.000 Roasts`: v 23. Manticement and Personn=l FC-2 .003 j 18 Prop it Cooling of PHFa 1 24 `rod and Foul Protection FC--3 .OJ4 I 2, -goiprrent aryl Utensils FC - 4 .1105 _) 3-501 14(,1) Cooling Cooked PHFs from 140'F to ( 2B, Wales,Plumbing and Nlasis FC-5 006 701-Witton 2 ]lours and Flom 7WF 127 Physicai Fac itV FC - fi 007 __ I to ' 'r !t»n-t Hours. " i 28 ` e..llurs' 1 Poisonous or Toxic I/aterlais FC -7 .008 1 3-501.14(B) Cooling P11Fn nt Made FroAmbien2°. I Spec at Recwiwments .009 TerriWithin 1ratm6tcredients to 41 C/45`» 30. Other ---",------.-.t Denotes cnmal i!em ni the federal 1999 Fond Coda or 105 CMR 500 000, a t Salem Board of Health Mas,taghuaetts�Department of Public Health, 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT TeL (978) 741-1800 Fax(978) 745-0343 Name Date I Type of Operationts) TWe of Inspection 7Foo1Service Spouting Address / Risk [:] Retail �J Re-inspection //7./ 1,1k✓A,7 lyvLevel ❑ Residential Kitchen Previous Inspection Telephonel 9�� } �� ❑ Mobile Date: /- Sr-G t/ �f< - ❑ Temporary ❑ Pre-operation ` Owner T HACCP Y/N , ❑ Caterer ❑Suspect Illness I K fi 2 2OCli k'�i�/� �0 f ❑ Bed&Breakfast ❑General Complaint Person in Charge(PIC)` �� Time ❑HACCP -�S le �m7/e ICS:S In: inspector C'f Tt}Ll/ 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: Vlolations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 59o.00g(E) ❑ 596.009 IF) ❑ 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 TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source E] 5. Receiving/Condition El16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating t ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding y ❑ 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 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)(590.003) 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)(590.006) 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 i DATE OF RE-INSPECTION: S 5401nspeclFomi544tlSc, ��rl,,�__ / (f+!r _VS "t .i/ - 1 J t r�./r1�✓,{t./,Slrtrria � Print: PIC's Signature: �7�yf I Print: 5 W6� 4 �J S Page of-L-Pages Z e/�.t/ l� rf Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROI*FCTION FROM CONTAMINATION FOOD PROTECTION MANAGEM ENT S, I 590.003(A) ASsigUlrrcra Of PCs-,Clnmtli I itvy j 3-362.1](Al(i) Raw Annual Foocls Sep-raied froill S9().Ofli(B) Dernon<inoit.ji of Knmlcdgc* j Ccjokedana RTE Foods 2-103.!I Person in cliqrgC--duties Contamination f,am Raw Irlarealents 3-302.11(A)t2) Raw Aninitti Foods Separated fotat Each I EMPLO"EE HEALTH Other' 211 59w.(03(C) Responsibility of the person fit chatoy Lt, �'u ,"Protection" ination from tho Eowronment require reporting by foal employee"'and 3-302.1 i o,,) --u�"" otectioil applicants* 1-3('2.15 Wa,hing Fruits and vcg,a-.aHs .590 003(F) Responsibility Of A F.nd Employee Or An 3 904.! i Fore;(D),j(aa wiih Equiprricrt,and Appiicant'ro Report ToThe pelsolt to C hal"e, I 0ont-minntron hon tae Consumer 590.003(G, Repotting by Person in Charge' 11 3-306.14(A)(B) Rc:w twal KrOiancl P.cacrvice of Foorr i 131 590.003(D) Exclusions tind Resttictions* Dispos.1w,ofliduftrwed,3r Contamoated 590.WiIH) Removal of Exclusion and ffeclrimow; Food 11 3701.1 i -Discarll:ryCi Pecraliti,y-tolgi,;roate FOOD FROM APPROVED SOURCE 4 I Food and Water From ulatcdSoi,rnes R�,gq I Food Contact Suffaces 590.00,1A-B) wi , Fluxi I aw'r lot k:tcr 3-201.:' rood in a Hermetically Scaled Contz;%er' 3-201.13 Fluid Milk and Milk Piuducts* !2 Mechanic.a NVafevu,11ing I lot YN7,q,r 3-202.i3 Slat; Eggs' Jamuzation Temperature 3 202.14 Eggs and Imilk Product..Pasteurized' Chemical Sanitization-temp.,pH, 3 202.16 Ice Mnde Flom Potable Drinking Water- concentration and hardness. : Equipment Fond Contact SaJacut,and IOI I I Drinkiny,WI aft:-fiom all Approved System" f Utells;1,Clean" 590 5�XYIONA) Itntyled Drinkirn!Water* i 1 1 4-6112.1 i Cleah;qFrequency ofEquipmentFood- 590 006(B) Water Meets Standards�n 310 CMF 21W Shellfish and Fop From an Approved Source Contact Surfaces and Utensiis* 1 4-701.1 I PrCqupnce :f Sztjiflzation of Ulensil�and 3-20 1.14 Fish and Recreationally Catghi M011L1SV:M uvd Contact Surf-ces Of BILliurnent* 4-703.:1 rwth(&of SfinaizAwn-Hot Water and 1-201.15 lyfollusuan Shellfish from NSSP I tqec! I tChcmicaJ7 Sources* 10 : I Proper,Adequate Handwashinc Game and Wild Mushrooms Approved 9y Repufatory Ahthontv 2-301.11 Clean Com;".ion-Hands and Anes" 3-2()2.18 Shellslock Identification Pre.,.cnal ! 12-30!.12 Clcahiu.-,Frccvdltrv` 59i-:.0'04(Q Wild Mm-luvonis 2-301.1 A 'When to WAsli GpmCAn inals-1 Good Hygienic Practices c" Receiving/Condition 12 W 1.! Ea mg 3-202.11 FHFs Pecerved.jt Prupet Tvnipcfd:nc-zs* 1 2 901.12 Dit;,hsrgcti Front the Eye;,Nose will 3202 iS Pack,; c lrae;rity' Mouth: 3-i01 I' Preverqtr�Com--m ination.When'lactic;;* 3-101.11 Food Safe and Unadultcratcc*� Prevention of Coni�.-rn:raflrr.from Hands 6 Tags/Pccords:Shellstock 500.004ifl; Preventing Containindicnihom shclistocl�L ld�ntiticatlon * Shell,,,tock identification Maintaomp' 1 Tags/Records: Fish Products 13 Handvrdsh Facilities 3-402.11 Parasne Destiuction* Com enionfly i oc2rrrt and Ac.nessivlq 5-'_03.:1 Number. and Czqta(ttics i -10,.12 R.,cords,Creation and Retenuop.4 1 590.004(J) Labeling of Ingredients' 204.:1 L",cation and.Pi�ceur,11* 7 j Conformance with Approved Procedures _5 Accessibitnt.Operation and Maintentawc 1HACCP Plans Sqoofted w4h Soa;o and Hand Drylng 3-5u2.11 Specialized Prccwing Methods" C-ev"'us Reduced oxygen packaging. rnter;a! 6-30:1.it Handwa.,,hing Clctarlccr, Aoailability 5-103.12 Confounance N%idt Approved Procedures' 6 3t)l 12 Hand Drying ProVillon Dolo:es'wkal axr!in tlx Rdcral 1999 Fooll Code oi M,5 51,10.0W. f� F CITY OF SALEM BOARD OF HEALTH Establishment Name: 19?nEC" 4 )0/7-ZA Date: /- ' d d Page: C4 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION VDate erified 1 No. Reference R-Red Item .i PLEASE PRINT CLEARLY ' s I 1f!�i:f�lve Pi nig fifin d I I i�io , Se/.F-//�rciiU4 rYIP� ni &�, � 11i: s 1,*-H OA17111 6 , s i I j I 1 ` I � • I 1 — 1 I � Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es - 1-have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next ins ection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension corrnply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / — \ (�' ❑-- Voluntary Disposal ❑ Other: i .i-50114;[1 YHrs?t::.eir'ed a:'!-„nthertfture Violations Related Related to Foodborne Illness Interventions and Risk Nzo,urdin_,to Law Cooled to Factors(Items 1-22) (Cont.) 4:,P/-!S=F'Within4lioo;s: ' PROTECTION FROM CHEMICALS .15 !-Ocl:iog Keiho(b,, Int oIIFc 19 PHF Hot and Cold Holding 14 Food or Color Additives . ddt a ! H) Cold YHFs 'dcintain:d at lir beta,c 3-..0_.12 "> 'tiwoF' ! %).0,:4(F) 41`145' -F" 3-302.14 Frteetion hour Uuappw%vd Addhi%e," i-St)1.16(A) f-t:e YHFs ivfsinA::::ra lit or -!,or 15 Poisonous or Toxic Substances )�,•), y 7-101.11 IdentiPine Information-Original j ;.g;)I IniA) Rnasa Hei-i at a.agave I30 F. Containers' „{t Time as a Public Heap`Control 7- oJ.i I Gnunxm Mune-4Uurkinn Containers! j %201.11 Separation-Sh,rage^ i imr ac a Public Health Cbm roP` -2O7. I I Restriction --Presence arc! the" -`%'t,.(iG4(i1) Varanec Reyuirenraut 7,-202.12 Conditions n1[se" 7-203 I I Toxic Containcra--Pnahibitions^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20-1.11 Sanitizerk.Criteria-C'heo»cals* POPULATIONS(HSP) 20a 1' Ch:mieals for \\'aehinp Pnxluce;Criteria` j 121 34101 11(4) [inn isteuriz.d F:c-puckaoea Iuices.md ! Bcveta+_as,with Wandnc,!:+bels* 7-20+.I9 Dryine A;;ent. Criteria" ! 3-8,!1.I I(B; Use of Pastennired E;--Sq 2u5 it hterde:nal Food Cuntau Leu 11.4111[0 i-R +1 11(B) Raw tit Pattiali Cooked Auun:d F(xx1 and 7-200.11 R.,tricted se Pesticides, Croeriu" j } _ ?-'106 2 Rodent Bai:.Star:lir:v' Raw.feed Sprouts Not Sert'ed. 3-8,01 ) C� j Uruncncd Food Par.-kagz Not Rc-s:lir,,d { 7-206. 3 Tracking Powders, Peat C'ontro; and k1un+;orir,e" CONSUMER ADVISORY T1PdEtTEMPER'ATURE CONTROLS 22 3-603 I I Consumer Advisory Posted for Consumption of Animal Funds"That are Raw, Undercooked or 16 j Proper Cooking Temperatures for ! e Pruce:sed +Ehmanate I II o;t Other,,;s, is PHPs ! i 3-401.iIAt1)(2) Eggs- 155'F15See Pa;teurtz:dZLLsSubstitute for R.:wStreit L@gs- Mmodtate Scr\:Le Ids"Fi jnec* T;sx i 3-401.1 i(A)1,2) Comminuted Fish.Meats R Game .L�inrals- 155'F 15 sec. " SPECIAL REQUIREMENTS 3-401.1!(B)(1)(2) Pot kand Beet Roast- 130`F121juin, I 7o:0.0+-: (a)-iU) Violations of Sc.hnn 590.009iA)-(D) in � 3-401.1!(A)(2) � R.ntitc:., h:lcctcdR4eats- 1`.-'F Ii , ec catering, mobile food. temporal}'and ! 3-401.11(.4)(,3+ Poultry,l4'dd Gime.Stuffed PHFr:. residential kitchen openaierr:shouid be i Stut3'm_Containing Fist.Mcat. debited under the appropriate sections Poultry or Ratites-]WE 15 sec, t j above if related to foodbot no phtest i1-401.11((.,)(3) Whole-muscle, Intact Bcef Steaks ! inicnentions and ti.,k factor's. Other 145`F "` 540.009 violations relating to good retail 13-40112 Raw Animal Foock Cocked in a ' pruetiec;should be debited under#29 - Micrrrvane 105"F ,z Special Requirements 3-40,1.1 i(All l)(b) All Other PRFs- 1451,' 15 sec. ' 17 Reheating for Hot Holding VIOLATIONS R_LATED TO GOOD RETAIL PRACTiCES J-403.11(Aikl)) PIFs 165''F 15 sec. #" 17tems 23.3u) 3-403.11(B) Micrm%ave- 16.5'F-2 Minute Standen:, I Critical a,rd nun-r ri+ioil cirlritior,s, irhich u'�not relate to the Tine"" foodborne iih:r:.., infolw rrnnv and r;sk(actors listed ubn,r, can be 3-403.11(C) Contme.rcially Processed RTI:Fund ftwnd it,the follunrirg.cenuam lit the Fo,d Cade on d 105 C'31R 140'F+ 5)o.00u. 3-403.1 1(E) Remno;ne lhxbced Portions of Beef Item Good Retail Practices FC 590.000 Roasts^, ! 22. Management and Personnel FC - 2 003 I's Proper Cooling of PHFs 1-24-,-- -_i Food and Food P:otertion FG-d .0000�f 25 Equipment and Utensils FC " 4 III .005 3-501.14(A) Cuoling Cooked PHPs from 140'17 to Water,Plurr:bind and Wasle ' FC.-5 .006 70`17 Within 2 Hums and Fr-.ren 71f f j 27 Frys,ca!Faa!!iiy FC-c 007 ! to 41'1-'!45"F Within 4 Ho;tr�. * 2P. 1 Poisonous or Tox!c Matenals FC - 7 .008 S)1.t4tB) CoolmgPHFeMadeFront Aml-cent 29. Suec:e.IRtsaarenien:s .009 Temperature Irgrzdients to 41'17-+, F ..---------111w - Within a Hours" D.•nm."rnti.al nem in ibc!ede:at 1999 Food Cde u: 10j C.R 59!1000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 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 Ooerationts), TYoe of Insoection (12 Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection fl�7 /��yN� � Level ❑ Residential Kitchen Previous Inspection Telephone 79') sy N0 .. ��.� I El Mobile Date: Owner _// /,/ / HACCP Y/N ❑ Temporary ❑ Pre-operation Shd Pct d17 i7 f Yf7d�6S ❑ Caterer ❑ Suspect Illness Person in Charge(PIC - - E `S�t�� Time EI Bed&Breakfast El General Complaint In: [I HACCP Inspector V /Y/7A/�iS h4 l.S Out: Permit No. E]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 ❑ 1a. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties VisHandwash 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 ' FOOD FROM APPROVED SOURCE E] 15.Toxic Chemicals ❑ 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 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 4 ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E] 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 rd C _W _ 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-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 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 5salre IFO m 14 tl Inspector's Signature: Print: PIC's Signature: t%jam ,. print: lJ"r�G v^�+ I� S Page of 3 Pages v J (/ta I G f"" r- Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PFi:TECT.ION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 3 ': gross-contarnlnation � { i 590.O031A) Asmgnment of Respon;ibilily` ( 3-302.1 i(A)(1) Raw Annual Foods Separated it om f 590.003{g) DemonstraiionofKno,,ledge' { C:n)I:ad and RTE Foods* { j 2-J O3.i: Person in.:barge- dunce j ! :orramrha:am'rom ant,ingrodie,,'s j 3-302,1 1(A"1') Raw Animal Foods Separated frog;Each EMPLOYEE HEALTH ^••her' 2 j 590.003W) Responsibility of the person to chntge to Contamination from the Ernarer ncrt requite repurline by foci employees and : 3-302.11 A) ! Food Prcrectinn' ! appli:ant!" 3-3('2.:5 ! 01asII:ne Fra:is aid Vne.table;. { 590.003(F) Responsibilily Of A Food` mployee Or An ( :i-;0 L! ! Foi)6 Ccrd! :ct with Egoinmem and ,4pplic:uu'f,Rep,)rt To The Prrsun In (Jtensds: C haxrlc" j Contamination from the Consumer j 590.003,'G) Reporting by Per•;un to Chars,` 3U5.1-I0'0I,HI { Retained Food and JZeservrce of b'orlef" { i j 590.003SiD) Exclusions and P.cssictiorr;" Crspo,rtro,t of Aduteratedvi Co^ianmgated j 590.003(F) Removal of£yclusions and Resanctions ( Food 3-?01.1 l Diszardir.,z nt Reconditioning Unsafe FOOD F-40M APPROVED SOURCE o d" 4 food arc I'Vater From Rcguto¢ed Sou:ees ( ; 9 Fact,Contact Surfaces 5a:10::4(A Hi Comp':isncc v tth Food Law* { 4-501.111 j et,lar.ual ',Var:tta0unt, -Hot tk'ner 3-201.17 Food in a Hermetically.Sealed COahw;-O ( ! Sanitization Temperatures, 1 3-201.13 Fluid Milk and Milk Productc+ { 4-561.i;2 Mechanical Warewashing-Hnt A'<t,r 3.206 j ! ":vni�.izatu-•nTemperaturW i _.13 Shell Egvs" { ?-'(12.14 Ergs and Milk Products.Pasteurized)' j 4-SO 1.1 :4 ;'hemicai Caniti:,aurin-ternp.,pit, j omcrrtrauon and ltardness. 'z 1 3 202.16 lc:A4nde Front Potabla Drrking Victim, 4--601.1 1(A; Etptipment Food Contact Surfaecs and { 5-!dl I I Drif t?Water tir:m an Approved System" ! { Cfeau' 590 Ot006(A) Bottled Drinking Wate1* tnensils Cleaning Frequ,ncy of Fquin m>nt F-.nd- 590 WNW Ruler:Meets Standards in 311;CMR 22 0 4 6helrish and Fish Flan Approved Source = ICninact Srfaces and utensils 3-201,14 Fish and kecreatiow !y Cvoldit Rolljse;uu -702,11 Frequenty of Sanirization of Utensils and Food Contaw, Surfaces of Equipment" j shelliisir I -70 11 I Mrtho&of S;an:tIzation-IIot Water anct 3-201.15 Mollweaa Shellii1i from NSSP Listed j Sources* lel I Proper,Adequate Handwashing { Game a:td Wed Isuahrooms Approved cy I -3!i 1.11 ClemC'vmd:i,•.ut-Hands and.4r:ns" { RegulatoryAuthority 3-202.13 Shcl!stock Identification Present'" ( j 2-301 1"e Greening Pr.�cdt;re` { { 59C.004(0 `Niki Mushroom;` { { 2-301 14 'Wh.-,:.c•W; ;h { { 3-201.1 i Gsmc An:tnals* { j it Good Hygienic Practices { { s IReceiving/Condition 2-401.11 `r.arinF. Drinking or Using Tobacco* { 3-202.11 PIIFs Received at Proper Temperatures" j ` 2-#01.12 Di st barges Front the Eyes,Nose and 3-202 15 Package Integrity" Mouth* 1 3-Wt.i i Food S;de and Unadulterated 'r j 12_s:;.i.i2 { Pievtrilow Ccnuantin:^oo, When Tasting: { { E Tags,Records:Shellstock ( { 12 1 Prevention of Canta:iiimatier.from Hands { . 13 ShelL:atc!.tnentificatioa 590,004(11) Ptevenimg Contamination from { 3-203.12 Shelhtock identification iilaintained" Lmplovices" --- Tags/Records: Fish Products j { i3 { Handwazh Facilities { Carzveornliwi ocsrcdand 4ccess+'ele { 3-402.11 P.uas;tr Destruction" � ' - ' a,a ticc- j 3-402.12 Records.Creation and Retemion' { j '5-203.11 !Numbers and CI' ! 590.011411) Laboling of Ingredients" { 5-204.11 1,:n:ation and Placement* { 5-205.!1 ! Aexnsibiht Operation and Maintenmtce ry j Conformance with Approved Procedures - I i /HACCP Plans I ! .�qnt-„iaa w(th;oar�apd H.intl±irvtng j t 502.1: Snecia!ved Purcesaing Metlr.dS1 ( ! Devices 6-301.: 1. Randivashine Clearoot.Avaliahility ?-X02.12 Reduced oxVJ;rn packagin_;.criteria" ( i � { R-103.12 Conformance with Approved Procedure>' { 1 6-301.122 [land Drying?rov;sion { -i tencles griller nein;t V:v red,mil 1999 FaoJ Cyte of toe C?9R YR).09U. CITY OF SALEM BOARD OF HEALTH Establishment Name: A_Wq o r P,Is 2a- Date: Page: of 3 ;t Item Code C-Critical item J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date f. No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY 4'�"'lCitiCJ 7� 7-tSr;le/Qc -fid -/7 iYr1 . Q 7 �d//C'h i./i D F"/� �� 'Alf Ae-,9 /TItPJ CI 2'--,x'4/1-e k • i�ifiir/i.C/ieiiL,P ./'a. Civr�i �i7r�.n ,I��Gi•PO� 7.1fPS �h�/J�v.,��S`1 S'up:dGo/ ;O df C�i � Gximp / s� �/nn //nLmoi/ �/ /t� ni.l>q riil Tf9S VD 1g2CC/1 �� /A/ �(/6 S2p ey e!1 /P �/SYI 7�{//G/(Gill°. i y 1,4,17,/n//. 11-747 A-rl AO '14f.0 Pe4-(. 2( S ,5. I /17 A, //v.0 6w Z" / - I&A/C'7 ae&A/J �/� /moo"'of I /�//iv/iai2 c n,l/r �aaa� 7F �lic�i�t�N /t/ylJ /c GTf�OrhrG •, I I I I - - - � - � J I kk I i3 I-, � e��h .s wK /ee/'h /- L 't I7�JiLv-74- .Coo�Yr NP�i/s .SeZ c /nc/i✓9 ,1eC`iCtiY'/S7i7 • I I I ' s V/ I �vil/o c a0al"V.57'- az41Z'6 t ¢ rt 14 r11-1 72410L,� neo _�/odc�S / sC/�aG>'S fsC/1��GUiG�IfS � 7YI�tSI eve I 1 I 9 /A�Pcr. /(J%/// G/L�t✓E 1U0d'e'v / �f/l%7 IW X � O!t' tri<fS O I I 'np/_, �77s ClJe J Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes r I,have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension 'comply with all mandates of the Mass/Federal Food Code. I understand that i, noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. C // i/2/ �" /� ❑ Voluntary Disposal ❑ Other: — i - j 3-50L I4tC) PHF Reeeivzd at Tzngrei atw'es Violations Related to Foodborne Illness Interventions and Risk ( Accordin«to L;nt Cooled to Factors(Items 1.22) (Cont.) y i 41'F115'F V.'it}ua 1 Hours ' i-501.15 Carling P'iethods rot PHFi PROTECTION FROM CHEMICALS ! 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(Hi G)Id PHFs Mai maincd a or below 3-20'_'.l 2 Additi ret` 590.0041 F) 41"/45"F 3-302.!4 j Piotcctionfrom lhtappinvedAdditiu:.r 3-:SOL1r,iR'i Her P!-iiia Niauntainrd at or above � 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original Containers' 3-50 i.16,A) Roasts Heid at or abode 130'F " 7-102.11 Cannon Narne-- Work m^Containers'. ! 1 20 Time as a Public Health Control ! - 7-201.11 Separation-Storage" 3-501.19 Time as a Public I-Iealth Control* ! 7-20111 Restriction-Presence and Pcz'" ! � 590.004(H) Vari;n:c'e Raluirctuent 202.12 Conditions of Use' j j 7-2033 11 'toxic Contaimrs-Prohibitions` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 Sanitizers.Colrain-C'heuucals^ j POPULATIONS(HSP) 7-204.12 Chemicals for SVashrng PfOdLICe.CiAtria" ( 21 3 KO 1,11(\1 Unhjmairized i're-packaecd Juice;.:cod 7204.1-1 Dryin;: Ageut:.(-:,itrria* j Beveraees with W arn;n-Label.` it Incidental Food Contact,Lubricants' j 3 tin 1.11(B) Use of Pasteurized Legs- 7-10) j 4-1,01 1 I(D) R,tw or Pat¢ial! Cooked Annual Food and 7-206.11 Re;aricted Use Pesticides,Criteria'" i ) Rea.Seed 5orouts Not Seivetl. �' j 7-206,12 Rodent Bait Stations* j 3-ROI-11(C) Unopened Food Package Not R.:-ser,.ed * 1 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 ?-6(x.1.11 Cmsurner Adkisory Posted ror Consumption of TIMEREMPERATURE CONTROLS Ammar Fonds That are Raw. Undercooked or 16 I I Proper Cooking Temperatures for ( Not Oti:errs ise Processed to Eliminate PHFs 3-401.1IA(t)(2) Ecus- 155'F 15 See, Pathi eena.* Eels-immediate Service 145 F l5see` 3-302.13 Paslem'ized Egg. SnbStitUle for Raw Shelf 34O1.11tA)(2) Comminuted Fie.h. Meats&Game � Eggs 4' Anninds- 155E 15 sec. 4` SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pa'k and Beet Roast - 130"F 121 min` 3-=401.1 I(A)(2) Rollos,Injected Meals- IS$°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in sec. * catering, Mobile food, temporary and 3-401.11(A)(3) PonitrY,Wild Game.Scoffed PHFs, ( residency kitchen operations should be otuttmg t-ontaminr Fisn, Meat. ..:.a;r,.,; lander;}ie: Poultry or Ratites-165'( 15 eec. " i above if related to toodborne illness 3--401.11(C)(3) Whole-muscly Intact Beef Steaks interventions and risk factors. Other 145P" 590 009 violations relating to good retail 3-401.12 Raw Ani nal Fonds Cooked in a practices should be debited ander #29-- Micrrnrave 165`F" Special Requirements. 3-401.11(A)(1)(b) AI I Other PHFs - 145"F 15 see. " j j 17 Reheating for Hot Holding j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PFIFs 165'F 15 sec. * j (Items 23-30) 3-403.11(131 Microwave- 165'F 2 R4inuie Standing j Ciin(al and non-r ruieal violations, which do not relate to the Time* 1 1ondhorne illrtesa Gnerrentions and tis$(actor s lis7ecl above, can he 3-403.11(C) Commercially Processed RTE Ford- found in the followin,'sec tions of the Food Cod<aad 105 CAiR 1400E 590.000. 3-403.1!(E) I2emainine Unshcetl Portion%of Beef I Item Good Retail Practices FC 590.000 1 Roasts* ! 23, ! Management and Personnel I FC-2__ .003 18 ( Proper Cooling of PHFs j 24, li Food and Fond Prote- Iion FC-3 .004 3-501.14(A) Cooling Cooked PHFs from 140"F to 25 Equipment and Utensils FC- 4 ,005 26. Water,Plumbing and Waste ' FC-5 .006 70T Within 2 Houns anti From 70`F 27, '', Physical Facility FC - 6 .007 m 41"Fl45'F Within 4 Hours. * ='8. I Poisonous or Toxic Matenal5 FC-7 008 3-501.13(B) Cooling PHFs Matte From Ambient 29, 1 Special Requirements 009 1 Temperature Ingredients to I PF/45 F 30 1, Other j Within 4 Hours` 'Danis,critical nam in the federal 1999 Food Cole ur JOCMR i90.000. CITY OF SALEM BOARD OF HEALTH ' Establishment Name: 619LM eGC( / l�"zfl Date: /— il- 4 Page: of 3 Rem Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ' f PLEASE PRINT CLEARLY pz Y' I I G�i/1Ny�.v /�V7:;eOna-171--'L ��: L&/ iv9 GcY�is ,/ vlet4 %CV('4-/ .� I '. __ C/�/vicn,�ci�,�.��/1 /�a. zti�r�ee c00%'�� c/s 9/ ✓�� r/,67�� !/k/a � I A I t I I � I I /l -l-a v' '�Vl 41 /6,- (Z�e he-"I., 0,Ve e cvome' 91,)d� gee � 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/ violations before the next inspection, to observe all conditions as described, and to Exclusion p 11 Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal ood Code. I understand that noncompliance may result in daily fines of tw my-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure • your food permit. /� ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at'rempenam.s - Violations Related to foodborne Illness Interventions and Risk A.,coidin.,to Lavv Cooled to Factors(Items 1-22) (Cont.) 41'F/45'"FW'i0nn4Hoots PROTECTION FROM CHEMICALS ( 3- 01.15 Coolie M thuds for PHF; 14 Food or Color Additives 19 PHF Hot and Cold Holding 3c01.16(B) Codd PfFs, Maintained at or below 3-202.17 Additives' 590.004(F) 41°/45°FT 3-302.14 Protection from Unapproved Additrves�' ' ' 3-501,16(A) Maintained Hot PHFs aintaincd at of above f; Poisonous or Toxic Substances 7-101.1 1 ldennfttng Information-Original I 140`'F -501.16(Ai Rua;,ts Held at of abuse 13O'F Containers* i 7-102.11 Common Name- Working Containers" 20 Time as a Public Health Control 7-201.11 Separation-Storage" =-)01 19 Time ac a Pubb: HeAlli Control;' 7-202.11 I Restriction-Presence and Use" 59U.004(H) Variance Reuuilement 7-202.12 Conditions of Use 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanifizers.Criteria-Chemicals POPULATIONS(HSP) 7-20't 13 Chemicals fur Washing Prcxtnce,Criteria` 121 3-801.11(A) Unpasteurized Pre-pack:aped inices:md 13eveiaae�with`A•arning LaF..cls* l '7-211-}.14 i Diving Asents.Criteria" ' 7-205.11 Incidental Fwd Contact, Lubricants* i 801.11(B) Lke ut Pasteurized Fgs* 7-206.11 Restricted Use Pesticides, Criteria"' i 13-301 I I(D) Raw of Partially Coked Animal Food and Raw Seed Sprouts Not Served. T 7-"206.13 TraRodci Batt dens, e i � ?.:MIl 11(C) (Innpened Foo!Packat;t Not R�ser:ed. " 7-206.13 '('racking Powders,Pest Control and � Munimrine" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer 2kdvisury Posted fur Consumption of Anim.d Fuuds'ihat are Raw, Undercooked of Ih Proper Cooking Temperatures for Not Otherwise Processed to Elhmnate PHFs ""v�:x: 3-401.1 I A(1)(2) Eggs- 155'F 15 Sec. Pathos�ens.4 Eggs-hnmediare Service 145°Fl 5sec- 3-302.13 Pasteurized Egg> Substitute for Raw Shell L fa. 3-401.I I(A)(2) Comminuted Fish. Meats&Game Animals- 155'F 15 sec. ' SPECIAL REQUIREMENTS _"3 3-401.17(6)(!)('_) Pork and Beef lvle - 130-F 121 min'" 592009(A)-(UI Violations of Section 590.009(A)-(U)in -4(11.171A){2) Ratites Injected Meats- 155"F' Is sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game. Staffed PHF:, residential kitchen operations shuuld he Sruftmg Contnuung Fish, bleat, I .::.J,::.� .:adoi the'srpP3pt'ici.. Poultry or Ratites-i65'F 15 sec. * above if related to foodbuute illness 3-301 ll(C)f3) (Whole-muscle,Intact Reef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Annual F cods.Cooked in a I prac'tice's should be debited tinder - Miunvvave 1-65`F* Special Requirements. 3-401.1 l(A)(1)(b) All Other PHF:-- 145"F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 340111(A)&(D) P1IFs 165'F 15 sec. A: (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-rntical viodalion.s, which do roi,zdaie to the rifire foodborne illness bnerventiaas and risk Jachms listed above, can he 3-103.11(C) ( Commercially Ra;essed RTE Food- lunnd in the following su tiom of the Foil Code and 10.5 CUR I-10"F" 590.000. 3-403.11(E) Remaiuine,Unslicecf Portions of Beef 1 Item Good Retail Practices FC 590.000 Roasts' I 23. Vlanagenent and Personnel FC-2 .003 is Proper Cooling of PHFs I 24. Food and Foal Prolccticn 1 FC- 3 .004 25. Eq ,pinent and Utensils FC-4 005 3-501.14(A) Cooling g Cooked PHFs from 1,10"F to -- - ------- -- 26. Water,Plumunq and Waste FC-S .606 j 70'5 Within 2 Houts mid From 70'F 27. Physical Faulty FC-6 007 to 41"F/45'F'\Vithin 4 Hours, 28. f Poisonous or Toxic Materials ! FC-7 .008 3.S01.14(B) Cooling PHFs Made From Ambient o9. �pecial Reomrements --009 'Temperature htgiedierds to 4l"F;dS°F ob - Other - --- - - Within 4Hours^ `Denote imps[nem m the redend 11)49 rood Code of 10�CIR 590 000. mon, Best Food Best Service Best Px4ees OPEN r , elivery Cater/ng Ava)/ab& Open: Mon.-Thur. 11-10, Fri.-Sat. 11-11 & Sunday 12-10 '101 Lorino Ave. i " - Id 1 1 1 Salem, MA 4( • 7,719 )o 774& 1 1 1 �&2L?L�tS 931IllbO (Hut or Cola) 11YHD}L17fi@lie0 Rqy t�. steak TI • .........»».............................»»...»»»...»..7.25 7.75 Vegetarian..»................................»....»».3 5 4.15 Souvlakl(Beef or Iamb)'.».................»»...........»»750 1-Way...»......».»»».»»»...»..».»......»»»....550 9.25 AmerlCWRI ....................»...................».3.85 4.65 Chicken rabob...............».............................»..»...6.95 2•Way.»».........»».....»»».........»..»...»»..».6.25 10.00 Itellark»...»..»...»...........................».»»»....3.85 . 4.65 Hamburger(Soz)'.».........»........».........................550 3-Way...»»...»..»»...»....»».»..»....»...»».._7.00 1050 Genoa Salami...........................................3.85 465 Cheeseburger(Soz.)* ».........».....».....».....»..».»..5.75 4•Way»...»».......»..».»»»»..»..».».....»»_7 1150 Ham&Cheese...................................»....3.85 465. Chicken Fingers or Wings».......................».........5.95 Omega Supreme.»»»».....».........»».....»».7.5 12.95 Smoked Turkey Breast.......................»»355 4.65 Buffalo Fingers or Wings......................................75o 1.00 1.85 Roast NO.................................................355 465 Gyro.......................................................».................6.95 On on Pqw Mushroom,Bmccok hash Tamames, Tuna Salad..............................».....»..»...3.85 4.65 Roast Beef.......»............»...............................»........6.5 E��OBve; 4 Saawge, Chicken Salad.................................».....,355 4.65 Double Decker Beef .........................».............»..6.95 � �r6a�,5alanJ,Ham,Pu mG Crabmeat..»......................................».».3.85 4.65 Fried Haddock ......»...............................».............6.95 ewoulplam@$ NpizzaE1 B.LT...»...»-.....................................».......3.85 4.65 Super Chicken .................................................»....6.95 Rte. lg, FF��pplant..»............................................».3.85 4.65 Above served with rice r French hies&sakd,roll. Buffalo Slyle Chicken...»..........»..»..».»»6.95 1035 Hamburger*......................................._.3.85 4.65 @ off• "�$� Madkerrenean.......».»»» ..».»..»»»....».750 1150 Cheeseburger'....................................»...3.85 4.65 ss��rr�e.cchh red onwn,fees Breese. Chicken Kebob(fon,Mi fora,dr•sstro....»..............4.95 vv/Sauce»...............»................................».............450 HewafIan....».....»»..»»...»..».:.................6.5 10.75 Souvlald(Beef or lamb)'......................»...............5.20 w/Meathalb ...........................».....».....»...............550 Hem 6 pineapple. lettuce,tomatoes,lets cheese,onkxe,dress* w/Sausages............. .5.50 .............................................. Chicken Delight..............................»»..».7.25 1135 Gym..................................................................A50 w/Chicken Cutlet ......:...........................».............5.75 Slwedchicken breast,broccoll,topped w/mauudh. Pas bread,ansent,tomatoes,uaulkl sauce. wNeal Cutlet........................................................5.75 Vepetarlan Dell�ht..........................»....».8.75 12.95 Chicken Cutlet.........................................A.15 4.95 us/Eggplant 3.75 ' AM',12'...r offireshmudaoan;tom+me;onlow pwm Veal Cutlet................................._.....»......A.1S 4.95 Ghl ••••••ccol••••••••ffre••••••••••••••e.........••••••• brocmU sp,xk crowed wale mouaeas&chedGrd eae Meatball............................................».:...3.85 465 St cken,Broccoli&Alfredo Sauce..................650 raj Stuffed Shells(5).............................ce...................5.25 Tro i .....................rted..am ll........»».....750 1135 Sausage».............................................»....3.85 4.65 w/Shdm ,broccoli &alfredo sauce.............».....7.95 f chicken breast Imporrerl hem&pineapple. Hot Pastrami......................................»»..3.85 4.65 p Served with garlic bread. Grecian Del t.».-1h-. ......»...o.............»....750 1135 3.85 4.65 B Fresh homatoe; ck dhe;ongam&6ro these. Harp& ............................................... Grand Canadian..........»..»............»........8.25 12.25 Pepper& or Bacon...........................3.85 4.65 earns,Whorls,homeless,olives. Chicken Finger........................................................4.95 Garden.....................................................................3.95 New York................................»....».........750 11.00 Buffalo finger..........................................................4.95 Greek........................................................................475 Buffow chicken,redrawn. Extra Cheese........................................add.25 35 Tuna.........................................................»...............4.95 Af��an........................».............................7.95 1295 All of above hoy�me In sydan�sb'read(large size only) Chicken....................................................................495 Ch1cken,red onwn,spinach,cheese. 95tealk i• Chefs........................................................................4.95 "Izoiwea Ref t� Antipasto..................................................................4.95 fae8g. Cheese Steak............................................3.95 4.85 Caesar Salad...........................................................3.95 Assorted Cold Cuts(whole).......................9.50 13.95 Onion Steak .................. 4.85 Chicken Kabob Salad(tee sot aws)........................5.25 Steak&Cheese(whole).....»......................950 13.95 Pepper Steak............................................3.95 4.85 Souviald Buffalo bealadO items r rr lamb. ................................................extra) 5.75 Chicken Cutlet(whow)..............................950 13.95 Mushroom Steak.....................................3.95 4.85 BChunksales ll eg r lamb. Buffalo Style Chicken(whole)...................950 13.95 Bomb.........................................................A.50 4.95 Garden n4er Salad lad650 Ve stables(whole).....................................950 13.95 Steak& ASO 4.95 .................................................... B All salads come unless oo a�ho sseed ng and sydan .............................................. sauteed mushrooms,onlre,pepper;broccoli,spinach. Chicken teak..........................................A50 4.95 Steak Bomb(whole).................................10.00 14.75 Mushrooms,orlon;peppers&cheese. Choice ofdressinggs:Lite Ita'lan,Ranch,Russian, Imot 01a lman�sO ich4 a CIlubo Honey Mustard,Dsing:. 0 B eu Cheese..3 extra Errra Dressing:.S0 Extra Syrlan:.3S Jr.Beef......................................................................250 Ham&Cheese........................................................6.95 '1mft1@ ®Il•QIl@II•S3 BigBeef...................................................................3.25 Turks y......................................................................6,95 SuperBeef.............................................................».4.25 Roast Beef................................................................6.95 SM. Lg. Double Decker........................................................4.25 Hamburger' .........................................,..................6.95 French Fries...............................................1.75 275 Hamburger(5 oL)*..................................................250 Cheeseburger•........................................................6.95 Onion Rings..............................................1.95 3.25 Cheeseburger(5 oz.)' ............................................2.75 Super Chicken ......................6.95 Mozzarella Sticks......................................3.25 650 Fish Fillet( h)......................................................4.25 Above served with French Ws. Chicken Fingers........................................3.95 7.95 SuperChicken ........................................................4.75 Chicken Wings..........................................3.95 7.95 Chanbrorledchwken breast w/leen.",homahoe;mayo, Prices subject to change without notice. Buffalo Fingers..........................................4.50 8.25 provolone on onwn roll Buffalo Win ............................................4.50 8.25 �l Garlic Bread ............................................................2.25 Meal Tax.Prices to change �. -The consumption of raw orsubject tdercookedm atss&outher food may be hazardous to your health. Baklava ................................»................................1.5� �.- s rs rar s a goes s , s sas s . a sae . S I •I .LE Any i t i TI s n-I(2 or more t • t a . CITY OF SALEM9 MASSACHUSETTS ' 3 �. BOARD OF HEALTH J3 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: Omega Pizza Address of Establishment: 101 Loring Avenue Owner's Name: Omega Pizza, Inc. Restrictions: Application Date: 8/12/2003 Permit for Food Establishment 314-03 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 T —a BOARD OF HEALTH � 3 120 WASHINGTON STREET, 4TH FLOOR AUG 112003 SALEM, MA 01970 TEL. 978-741-1800 FAx 0343 CITY OF SALEM 97T, MP R STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, S, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT(TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTOISE6A f SIp2-Z/f TEL# t <� �'Y'0- 005< ADDRESS OF ESTABLISHMENT /0/ f-�W MAILING ADDRESS (if different) n F OWNER'S NAME ©P CC-A I'( ZZA 1A5 C TEL# % 71 ADDRESS 55- 9450A) Li✓ CITY PC-?q-Ro D x1 STATE 1-I df ZIP o!46 U CERTIFIED FOOD MANAGER'S NAME(S) ST(WE CERTIFICATE#(s) 4CQOQQ0 J2( IL°a-#AKoS (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON S7eVC KOOTM ICO S HOME TEL# QV 9G� HOURS OF OPERATION: to . (Tu 10:30 to.:nri X0.3° I TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. ($-5-9) 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 Wk $5 TOBACCO VENDOR. YES NO $50 ALL NON-PROFIT(such as church kitchens) YES $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursua t to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my b owled n have filed allsta)fe tyy x returns and paid all state taxes re cared under the law. g/c/10 3 ©(Z-- IG�f-73FK E- Signature Date ' Social Security or Federal Identification Number Revised 11/15102 FOODAP2.adm Check#&Date iT Q o2V^le— r -•--- �...�....-.. �/ .�.�- -_- � �. _.«<>.--•.....,.-...----�-^-w.+ , w+rAa+�frvai+wis.tiism<...,,l�.iw...>-n e...o-.-...,'-.,._.-....--• --•-". P'( THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPONo-f Tel: (978) 741-1800 Fax: (978) 745-0343 Name ;`� 2Z� `X'DateType of Operations) Type of Inspection 6/n 2 q � T / ❑ Food Service ❑ Routine Address / ' Lam- Risk' ° El Retail [IRe-inspection �4 ` Level ❑ Residential Kitchen Previous Inspection Telephone / /92P c/O�//�A El Mobile Date: Owner /"� V HACgP- Y/N 11 Temporary EDPre-operation n (;,q,q O/�l2zq ��C. I I ❑ Caterer ❑ Suspect Illness Person in Charge('PICC)) c��-:�- ' _y ,/ C I Time El Bed& Breakfast~ " El General Complaint El y /K(Yff HACCP Inspector O/ C.! 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 (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source ❑ El 5. Receiving/Condition 16. Cooking Temperatures C1 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling EJ 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 e ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Q 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 o 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: Inspector's Signature: I Print:'-�� PIC's Signature: I Prinb�/ Page/ of Pages FORM 734A HOBBS&WARREN -BOSTON e 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)(I) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants*, - -- 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition o/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 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501 114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* p €g � Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.1 l(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Drinking or Using Tobacco* 5 Receiving/Condition 2-401 12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products 3-402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I 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* 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM _ BOARD OF HEALTH Page: Z of 2 Establishment Name: 12 �� Date: Item Code C-Critical Item - ' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item verified PLEASE PRINT CLEARLY I � P I � I I 1 I I n 1 Y j � I y rtY ' Discussion With Person in Charge: Corrective Action Required: I El No I ❑ fes C 5 1 have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance C3 Employee Restriction/ # Exclusion -4 violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension 1 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: ` t • a 3-501.14;0) PHFs Rccei sed at'rempeintures ' Violations Related to Foodborne Illness Interventions and R(sk Accnrdine to Law Ccwled io Factors(ltpms 1-?2) (Cont) 4 i°FI45'F Within 4 Homs, 3-50!.15 Cvo]:I,g Llethods for PHFs PROTECTION FROM CHEMICALS Food or Color Additives I 19 PHF Hot and Cold Holding 14 3-50 i.16',B) Coll PHFs Maim uned at ut below i-20212 Additites* >9 5-302.14 Protection from Unapprotrd Addtbres* I 01.!r ) dl'r45"F" , 11; Poisonous or Toxic Substances 3-51.!b(A: Hut PHFsMaintamodatoiahovc: 7-101.11 ldenul}vng Inforioation --Original Contamerc„ 3-501.16(A) Roasts Held at of aboaa 1 VV17 1-102.11 C)tnnton Name Working Rmta�ncr '" ,' 20 Time as a Public Health Centro! I 'i?i11.I t Separation-Shnseu' I� . 501.1) Time as a Public l Ie::hh CuntroP< i 17 202.11 Re:(rich+at-Presence and Urso" t 590(11)4(H1 Vallance Rcgairetnent j 7-'02.12 Conditions of)':sex REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i 7-203.11 Toxic Con(ainers-Prohibrtionq^ POPULATIONS(HSP) i 7-204,11 Samitizers.Coterie-Chemicals* 17-DJ4,12 Chemicals for R•.tshm-,Produce.Critetia" 121 13-i;V 1.1 lf,A) IJnnasteuri,zd Pre-pa�kag•.;d Juice,;and Beverages with W arnine Libels 7 21,-A.14 Drninl-Agents,Craer:u* _ 7-2f)5 11 IncidentalFood Cont,:et,Labrica,:ts* -nul.i I(R) Llee of Pastcmizeci 206.11 Restricted Ilse Fesuenfen,C'raeiiw I x-401 11(D) Raw of Partially Caike;,Animal Food and Rao'Seed Sprouts No, Served 7 206 13 Rodent Rail )tabuns" 13-801 11(C;- 11nopcned Food Package Not Re-s:rred 7-206.13 '11 aekaw,Powden.. Nest Control and CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS '-2 3-603.11 Cormoner Ad�•isory Posted for C av,umpdon of Animal Foods That.:ru Raw. Undercooked of (( Proper Cooking Temperatures for Not Otherwise Processed to El.mint PHFs 3-40 L 1 1 Ai 1)(2! F.}!gs- 155'F 15.Sec Path.;goon.' 1 Eegr 3-30213 I1. uEg!runethrie Scivicc 1.15"F15aec u "Substitute f<nRar+ Shell j 3--301.1 !(A)(2) Comminuted Fish. Meats K Game E*g " Animals- 155''F SPECIAL REQUIREMENTS j 3-40LI (B)(I)!'.I Peitz and Beel'Rjocted est- 130'F121min'^ 59(009','A)-(D) Violations ofSectirnt590,009(A)-(1)) in 1 3-40LIRatites, (nicaed Mcat:- 155°F 15 ca(ering, nioNic bond, temporary and 3-40 1.11 1.4)(;) Poultry,W)!d Game,Stuffed PHFs residential kitchen operations should he Stutlin;Containing-Fish,,M14eat, debited under the appropriate sections Poultry or.Rallies- 6'°F 15 sec " above :fIelated to foodborne illness 3-401 1 l(C)(3) Whole-misele. Intact Reef Steaks I ttdei vention•s and risk factors, Other 145'F* 590.009 violations relating to good retail 3-4!)]A? Raw Animal Foods Cooked in a ; practices Should be debited tinder 1/29- vticrnwate !65'F* Special Requirements. 3-401.11(A)(1)(b) All Other PPF:s 115^F 15 sec. 17 I Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.11(.1)&tD) PHFs 165'F 15 sec * I (Item'`23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing I Cr;ti::ai and non-raical violations, glach do not tvla;e to the Tinter' I tLodbnrne dlnes.t interventions and risk riclurt listed above, can be 3-403.11(C) Cotnnrercially Processed RTE Food- jbund in the(rilowin);s&tion+r,f:t:e Feud Code ami 105 C.WR 11001::: 500.00(). 3-403.11(E) Remaininz Unsliced Portions of Reef Item 1 Cood R.^tart Practices '; FC 590.000 Roasls* I 123 Management and Pctsonnel I FC--2 003 18 Proper Cooling of PHFs I 24. =oaf and Fox P:gtecuon FC--3 .004 25 Equipment ani Utersiis FC-4 005 3-501.14(A) Ccoling Cooked PHFs f-torn 140'F to ', 26. Water, Plumonq and Waste FC-5 006 70'F 1Vtthiu 2 flouts and Flom 70'F 127 I Physical Facthty FC-6 .007 to 41 Flo:i'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7, .003 3-501.14(B) Cooling PHFs Made From4tnbrmt 29 Special Reguirer�.ents ( .009 Temperature Ingredients to at W45`,. 30 -,that Within 4 Hour!." s 2�t: "Denote,cutmai nem in the(a&n,1 1999 Food Code or 10.1 C31R=90 u00. Inspection of l Y � �''G.C� \' � �� Date ��ime C3 lJb�4-1 y1 Nam- �"�✓� " �'-� Address Owner Tel. No. c Type of Inspection Inspector <— nL-3L ( ' ) Remarks and Violations are listed below: IZCY-VA o"X\— C-�k �_c�t 1 �w,i J u �.OT C i,,�� --a-c5 !—c i 6) 4 L _U _k), \�. OC XN r dzz,�J� n-) k�{71w, r1GA 7r-)r - 6r-Y- c Y::N VV-\C--�,Ntv-) �1n .2/Cr-, UVB C4'TNL7>'� �F 7 kl`- e 7.59e-C: m Report Received by: Inspection of r'1 Date / / Time Names "'ten Address C)"1 17<--r /�✓ U _ Owner Tel. No. Type of Inspection Inspector Y1�l�cJ\ �� L�L--3C ( ' ) Remarks and Violations are listed below: U u C cY,X - .l� . f-) - fin, n, U — (e- 2) cs ) , -x _ -j �Cj _Q21 /. (L e' 7 7c Ca c7- or Report Received by: " . l.::'�>'.a.. 3b.+.^.•� Y.1-,s.` +" �: r��,(t,tiy ^•'y�it dd ! rp, - 7- ',i.f` r:!'.��.�-. ''S�.��.`!•2�4..r•'...iY..•.�P-. . j lL• `��A. r•.7�+».....Wn..�v.aC'ts'"rfF�t Fit~�»rs,.a+,+x3. Massachusetts Department of Public Health Salem Board of Health (?' 120 Washington Street,';4 th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT 1 Tel. (978) 741-1 Boo lFax (978) 745-0343 NameDate Tyke of Ooerationfsl, Tyge of Insoection 1 Q7� M G r�-- Ef7_ 11 f )I /ci/0 S I ❑ Food Service ['Routine Address Risk Retail ❑ Re-inspection -T(Ce i Q DA,S ��__ Level ❑ Residential Kitchen Previous Inspection Telephone -/ ❑ Mobile Date: /tar, c ��- + �'? LI ElPre-operation /' OwnerAVSh�-T A L HACCP Y/N Y 1 El Caterer El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint " • In:3 fv E] HACCP ; Inspector � ��ta (�`A ��a I Out:4 �J Permit No. El Other Each violation checked Fequires 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'S ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El_ , _•„ m 13. Handwash Facilities EMPLOYEE HEALTH " : . . PROTECTION FROMCHEMICALS'"'` ❑ 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 Approvedd Source IM- TErrEMPERATURE 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 ❑ 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(HSP) ' El21. 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 by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(sso.004) cited in this report may result in suspension or revocation of ::�Z5. 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: 1 ," ^/�I S 5 Ins IFOm 14 dw Iv �It� Inspector's Signature* 441 _ Print: )/[OS�h/ , r'_, PIC's Signature: � C� Prink J � � IPage of ages r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I & Cross-contamination - ( 1 590.003(A) Assignment of'Responsibility* 3-302.11(A)(]) Raw AmmulFoods Separated front 590.003(B) Demonstration of Knowledge' j Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods- Separated from Each EMPLOYEE HEALTH Other' l 2 590.003iC) Responsibility of the person in charge to Contamination from the Environment - require reporting by food emplo)%,cs trio 3-302.11(A) Food Protection' applicants" ( 3-30115 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fwd Employee Or An ! 13-304.(1 Foexi Contact with Equipment and Applicant To Report To The Person In utensils* 1 Charge+' ' I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 13-306.14(A(B) Returned Food and Reservice of Food* 131 590.003(D) E.iclusions and Restriction;" ( Disposition of Adulterated or Contaminated 1590.003(E) Removal of Exclusions and Restrictions ( Food 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* j 4 Food and Water From Rertulated Sources ( ( 9 Food Contact Surfaces 590.004(A-B) Compliance with F,K)d Law' 4-501.i l l Manual Warewashing-Hot Water 3-201.12 Footl in a Hermetically Scaled Container* I Sanitization Temperatures' 13-201.13 Fluid Milk and Milk Products' 4-501.112 Mechanical Warewashing-Hut Water j 3-202.13 Shell Eggs* I Sanitization Temperatures* 3'202.14 Eggs and Milk Products.Pasteurized* I 14-501.114 I Chemical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinking Water" I concentration and hardness. * J 5-101.1 t I Drinking Water from an Approved System- I 4-601.1 I(A) Equipment Froud Contact Surfaces and Utensils Clean° 590.006(.0) I Boated Drinking Water* I - a �o r- 4-602.11 Cleaning Frequency ol'Equipment Fund- 590.0061 90.0061B) W'atet Meets Standards in 310 CMR,e 0 Contac Surfaces and Utensils" J 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 Equipmen 3-201.15 Molluscan J Shetlscan Shellfish lYum NSSP Listed 4-703.11 I Methods of Sanitization-Hot Water and 1 ChemicaF* Game and Mid Mushrooms Approved by ( 10 I Proper Adequate Handwashing Regulatory Authority i 2-301.11 Clean Condition -Hands and Arms* f 3-202.15 Shellstock Identification Present' j 12-301.12 Cleaning Procedure* `( 2301.11 When to Wash"590.004(C} Wild � i --. - - --- . ... . ..........) 3-201.17 Game Animals' 111 ,, Good Hygienic Practices j 5 Receiving/Condition 2-40L 11 Eating,Drinking or Using,Tobacco* 3-202.11 PHFs Received at Proper Temperatures* i Z401,12 I Discharges From the Eyes, Nose and 3-202 15 Package Integrity* '� Mouth* 13-101.11 I Food Safe and Unadulterated 3-30 L I2 Preventing Contamination When Tasting* 6 I TagsfRecords:Sheiistock ( 12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification * ( 590 004(E) I Preventing Comantination from 3-203.12 Shelistcxk Identification Maintained' I Emplo}ees* TagslRecords:Fish Products I i 13 Handwash Facilities 3-402.11 Parasite Destruction,' I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention" 15-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' ( 5-204 11 Location and Placement* 9 ( Conformance with Approved Procedures I i 5-205 11 Accesstbiiity, Operation and Maintenance _ fHACCP Pians ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I 6-301.11 Devices ing Cleanser,Availability j 3-502.12 Reduced oxygen packaging,criteria` 8-103.12 Conformance with Approved Procedures* I ( 6-301.12 Hand Drying Provision *Denotes critical item in the tedeml 1999 Rind Code or 105 CNIR 590,000. R c S Y CITY OF SALEM ' BOARD OF HEALTH ` �1 Establishment Name: Al2-t- Aq--P Date: r� Page;__D of �1 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item -!_ Verified PLEASE PRINT CLEARLY\l< ( 1r= r )P n). ll1 \n. (7 O :X/ SV\�(� I L� —m.o iS Irl Vn 1.t ll�`i.I�' /nl� SSr✓rr npr - A L-1 Discussion With Person in Charge: Corrective Action Required: I ❑ No _ ( Yes I I have read this report, have had the opportunity to ask questions and agree to correct all X Voluntary Compliance El Employee Restriction/ inspection, to observe all conditions as described, and to Emersion violations before the next ins P Ll Re-Inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or/Gspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 7 /,( � ,/ ,/ ❑ Voluntary Disposal ❑ Other: t 3-5ill 14(1:) PHFn Received at Temperatures Violations Related to Foodborne Illness interventions and Risk lrcording to Law Cooled to Factors(/tents 1.22) (Cont) ,4I=F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS 1 3-501.15 Coaling Methods for PHFs 19 ' PHF Hot and Cold Holding 14 Food or Color Additives 4 50!.1643) Cold PHFs Maintained at or below 3-202,12 A7, tit'cs' sylrtHkil) 41`7.45`F' 3-302.14 PfoteoIhomfront Iluappro�edAdddtves' i I i"5i)1.16!At Hot1'HJ: iMaillnedatorabove lg I Poisonous or Toxic Substances WO F. 7 101.11 klemd in r intiamarirn - Ort;:inal 1 Y t• I Z5 INA) � Roests Held at or,2bot'c 13(°F, l)III Herz" j 7 IU:..I i Cornttnrn Xame N'ark�^t�',lar:arn;ttn' 2p lime as a Public Health Control i -----r ----_-; ?_�0: I•, int:'a�a Pnbtio lieaith Conn'olr f 7-20 L 1 1 Se raeruon- Sirn a•c` --- -'-I-=---- -_1. Itt}li - -- : }' riancr,1.cctnr.nfent —J r-202 1? { RcCq iction - Ilf-locc and i,'c' - - 02.1_ ' Condition,of st' 7 r i � 1'..x 7 '03 11 fc;.ic{'onrriner: -Proh,hl: :n:," HEQt11RE1dENTS FOR HIGHLY SUSCEPTIBLE -- —}— POPE7LAFIONS(HSP) '(;•4.17 7 ,r E2 ;.r::i 1 HA) VopP,-Imi,cd Prey}acl,agcd Ancrs and —� -_,N � C'hc i ti.tL} t}u'h3�;c t_.ru:n:'c_L inaat' i 1 7-204,14 Dnuw A}tcna..CrI ria 11,',',r�.en xall Wanton,Labels` _. r.Sul 71(iit I wi; Pa teemed roc_^., ! ' 2{)5 11 1,2.id:rttai t"•+,,)r'unaic't Lubr.C111I --_ —__..__.__� i '.1tl i : I tI t! I::f:`. :•f P it td (.a?1 Ct:Am .,4! 1-0,-J";)d 7 'U6.i1 R,.dn„eti tai Pecttude. Curet: .�_.____. _— _____. _..____ t sz,t', 4, drtt;m fit•, `, rlo;.: .”:is S::lour,` t Pjk"I rr 1 i i 2: (U� 1, •,u;:it ;� i'na':f !,,rk •3a;:aHY71...i,of --1 TIMCITENIPERA URF CONTROLS ilG ! � Pr<rper Cooking l•>inpnrafu'es Orr ... .-.. .,.",, Uaiirs,,,l:.r , . , I i PHFs : �+•s'•:d;. ; ivam•ar i tit I'1 a•- _ til -_�- r '.`:.. :_ .":_:.`. <• t : ` 1 iA iii:i -'t72: I ; s,.z• , I �aiet a3;t :not,ti.hood, lei IIpolaj, lira 4a7 All:.it.t---^Rw..irrl.li l %iia.. _.°j '.,I 1:i 11– ...I ,'+.�i(il Cf }.,(Cii4tt cjof:l ,I to; ..4:4tld 1•: 1 ' 1 .;'!`! . ' i!',<l.'t rlt,- di' 7t a:r to rq� �•i;,;l. � t tic :}! H31 itf.3ti.,i<'tE't^I:f'ht ! � C'' • .•r,v t iii. F.:e:>,%.C;._ f.' i i'7 it (itenh 2;-;tit : .tU.'.ILbr � ',ir.rni.t±.c_ Ir:h, P :. l'1•ne:'Salinhnr ( C�'u. .t :>.,h..fit., •;} r:: :'.. :'f: .>... »,.•t.Y.drt...n •,�¢q'; : I "Cunt tn<;I;,.rn. ,. , ', n .nu ti::. AUG .:i , ,'d ti"rn t •,!(.• --,n l.i l+r': C�on„rtt:•lsiir i'r c-, .,ai l ii'h•,,�±- (•a:r,-:..<.. , :' � .. , .. ... :ht ?,,.d('..._, tt, r p;r ,.S•i; i 4t)TF o,�i,is tte.•n Good ,_3r,3 i1f1'! ltrnxunu'„ ' :�'r• ' ,„� � �; 1� R^ead Fracfrees __. .. _- - _FC ,Pfi.DGU t -- - - --- - - - -- -- ' root; 18 Proper Cooling of PHFs 1 _r. t=- -' �-= p,---"-• --------- 4�. _-.°�-_ ._ 3r!ri ,gr9 i f '*•• t 501 E t:'}7 :'tx•haw Cn,k:,J PHFp h-:w 11U"irr`_.- - tL- - --- '- - - -ra, - -- . ._. _ .. __ __.. __ .n _. _____ -_ _ Pr1' Wurnn 2 Ntxir.,,•sri; nrr:3 ”'"i i �7 F,.' rrrFr -- -- 1=C-:, W '- -- F - •- 1 2tl 5tr1.i'it Ri !l'olire (iiF: A4atie Fngt:.ur;l+lent t !'--_._.,_�tr _•"._. _ _ 'h' ,r,rnIC,o:mre :n 41'1 t+'F i 3G Oto W'ithiti*llntn` � 'r t - •Ilrnvh�.rv:,c.ri Yen,nt,h .. oi':t,ni ,... . )G"t'%Ih •P r,i•. F CTTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET 4"FLOOR PabfiCgIeaIth STREET, Prevent Promote.Protect TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL Itamdin(-),salem.com - -- - Lt\Rill RA MIDIN,12S/RIiFI5,Ci 10,CP-I+S MAYOR HI{AL1'I I AGI3N'1' This Form will be collected during your next Board of Health inspection. QUESTIONAIRE - GREASE TRAPS 2012 P�z� 1. NAME OF ESTABLISHMENT: r n n 2. ADDRESS OF ESTABLISHMENT: �G LU`(- 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? I 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? A &csm f'yrw4t,(s' 1Nr, 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM?