ONEILS PUB & RESTAURANT - ESTABLISHMENTS fAll 120 '0) f)ft(t
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UNV-12110
MADE IN USA
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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 Tel.'(978) 741-1800 Fax(978) 745-0343
Name
"L� ��t Date jyt)eof 0oaration Us TYpopf Insnection
OZ��� 0-;M-)- Ij M,�Pood Service k.LKoutine
=ess C) On"a kZ/VA 'ZtA 4_Pj Risk El Retail El Re-inspection
Level [3 Residential Kitchen Previous inspection
Telephone LO 1:X1 R I [I Mobile Date:
El Temporary El Pre-operation
Owner HACCP Y4
\ft�
)0) Q Caterer Suspect Illness
Person in Charg Ti D Bed& Breakfast El General Complaint
in m7,'A(kjM HACCP,
inspector Permit No.
Out 0 Other
Each violation chocked requires an lanation 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) tl' 590.009(F)
action as determined by the Board of Health. Ntevi
E R
DOD PROTECTION MANAGEMENT 0 12. Prevention of Contamination from Hand
[_1 1.� PIC Ass-Igned/Knowledgeable/Duties 93 13. Handwash Facilities
EON EALTH ��PROTECTION FROM CHEMICALS -
El 2. Reporting of Diseases by Food Employee and PIC
0 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives
LFOOD FROM APPROVED SOURCE
_Wate_f___ ApprovedSource
JR 15.Toxic Chemicals
E] 4. Food and r rom TimErrEMPERAiURE CONTROLS(Potentially Hazard6ua Foodsi
[:] 5. Receiving/Condition El 16.Cooking Temperatures
El 6. Tags/Records/Accuracy-of Ingredient Statements El 17. Reheating
7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling
PROTECTION FROM CONTAMINATION
, I El 19. Hot and Cold Holding
0 8. Separation/Segregation/Protection El 20.Time As a Public Health Control
9. Food Contact Surfaces Cleaning and Sanitizing I REQUIREMENTS FOR HIGHLY SVSCERTISLE-POPULATIONS(HSP)�.
El 10. Proper Adequate Handwashing D 21. Food and Food Preparation for HSP
[:3 11. Good Hygienic Practices LCONSUMER ADVISORY.
El 22. Posting�_ofConsumer 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
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
7-N 590.000/fecleral 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
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)(111,108) 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.5WI�F�14 L-ki
inspector's Signature: fd,, Print:
- _r
PIC's Signature: )-A4 Print: Page-\ ofCl� kages
�_byv\/ T)-,(- I
Wl - q 93 - eu_�,
Violations Related to Foodborne Illness
interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION
8 Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from
I 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 3-302.1 I(A)(2) Raw Aminal Foods Separated from Each
I I Odic, I
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 lRensils*
Applicant To Report To The Person In Contamination from the Consumer
Charge* 3-306.14(A)(B) Returned Food and Reservice of FoW*
590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated
3 590.003(D) Exclusions and Restrictions* '=ood
scur
590,003(E) Removal of Exclusions and Restrictions 3-7,01.11 Di , ding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
141 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatin
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Saniti zation Temperatures*
3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water* I concentration and hardi
5-101.11 Drinking Water from an Approved Systern� 4-601,11(A) Equipment Food Contact Surfaces and
590.(X)6(A) Bottled Drinking Water* Utensils Clean*
590.006kB) Water Meets Standards in 310 CMR 22.0- 4-602.11 Cleaning Frequency of Equipment Food-
Shellfish and Fish From an Approved Source Contact Surfaces and Utensils*
4-702.11 Frequency of Sanitization of Utensils
-201.14 Fish and Recreadonally Caught Molluscan �and
3 Food Contact Surfaces of Equipment
Shellfish' 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSS Chemical*
Sources* to I Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands,and Arms*
RegulatoryAuthorfty
3-202.18 Shellstock Identification Present'r 2-301.12 Cleaning Procedure*
590.004(C) Wild Mushroonns� 2-301.14 When to Wash*
3-201.17 Game Animals* if Good Hygienic Practices
5 Receiving/Condition 2401.11 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 Integritvw Mouth*
3-101.11 Food Safe and Unadulterated 3-301.12 Preventing Contamination When Tasting*
6 TagstRecords:Shelistock 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 Destruction* Conveniently Located and Accessible
3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities*
590.0040) Labeling of Ingredients* 5-204.11 Location and Placernent*
7 Conformance with Approved Procedures 5-205,11 Accessibility.Operation and Maintenance
/HACCP Plans pplied with Soap and Hand Drying
3-502.11 Specialized Processiog Methods* Su vAces
De
6301 It Handwastaing Cleanser,A
3-502.12 Reduced oxygen packaging,criteria* -
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical itein in the federid 1999 Food Cale or IM CMR 590.000.
k
441A�Sevu\ce
V/ C-A, k) CITY OF SALEM
__)DOVK__� BOARD OF HEALTH
Establishment Nam.C.J4"J, P�' P'J'kZRS-zia'�""J— Date: 10 -at- A/ Page: -or
Item Code C-Critical Item 11,0 01bff DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ate
No. Reference R-Red Item IV_ --t 'P Verifled
PLEASE PRINT CLEARLY
ic �__" ) I
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v'CRij%AQ�jn '_�7019V L5)'4A 1Fd (k).1Vd(S<A
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4b
-,�V 4) (A,/,A 4TtX&) I 01,t_ '�e C e ^A
r. Y,' "'C"
A(-Dee
lrr�— NZ
rmiscussion With Person in Charge'�kV,,,�
64� _ C& +<L Corrective Action Required: u No 0,-�,(es
v_'Voluntary Compliance 0 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 WI"Re-inspecti?n Scheduled Li Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that 9_U_L�
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of u Embargo u Emergency Closure
your food permit. tl-� 0 Voluntary Disposal Ll Other:
Z
3-501.t4(C) PHFs Rewived at Temperatures
iticistiona;Related to Foodborne Illness Interventions and Risk According to In w Cooled to
Factors Meats 1-22) (Cant.) 4 17145*17 Within 4 Boom
3-50L15 Cooling Methods for PHFs
PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding
14 Food or Color Additives 3--501.16(B) Cold PI-Irs Maintained at or below
3-202,12 Additives* 590.004(F) 4101450 Ft-
3-302.14 Protection from UnavvrovedAddiLives* 3-50LWA) Hot PliFs Maintained at or above
15 Poisonous or Toxic�ubstsnces 140cF.
1-101.11 ldenfiiying Information-Original 3-501.16(A) Roasts Held at or above 130'F.
Containers* 20 Time as a Public Health Control
7-102.11 Common Name-Working Containers* 3-501,19 Time as a Public Health Comrol*
7-201.11 Separation-Strragte� 590.004(H� Variance Requirement
7-202.11 Restriction-Presence and Use*
7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203-11 1 Toxic C;antamers-Prohibitions* POPULATIONS(HSP)
7-204,11 Sanitizers.Criteria-Chemicals*
7-204.12 Chemicals for Washing Produce,Criteria* 21 1-801.11(A) Unpasteurized Pre-packaged Juices and
Beverages with Warning Labels*
7-204.14 Drying Agents.Criteria* 3
7-205.11 Incidental Food Contact,Imbricants* Use of Pasteurized Eggs*
3-801.11(D) Raw or Partlafly Cooked Animal Food and
7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Syrouts Not Served-
7-206.12 Rodent Bait Statione 3-801.11(C) Unopened Food Pa&age Not Re-served,
t 7-206.13 Tracking Powders, Pest Control and
Mrrnipning� CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 ConsumerAdvisory Posted fur Consumption of
Animal Foods That are Rau,Undercooked or
16 Proper Cooking Temperatures for Not Otherwise Processed to Elftsimate
PHFS path
ogens.,
3-40 1.11 A(l)(2) Eggs- i55F 15 Sec. 3-30'2.13 Pasteurized Eggs Substitute for Raw Shell
145�Flfi&ecl
Eggs-immediate Service
3-401-II(A)(2) Comminuted Fish.Meats&Game E9W
Ammals-155F 15 sec.* I
.340111(11)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS
3-401,11(A)(2) Retires,Injwed Meats-1550F 15 590-009(A)-(D) Violations of Section 590.009(A)-(D)in
see. catering, mobile food,temporary and
3401.11(A)(3) Poultry,Wild Game,Stuffed PFIl's, residential kitchen operations should be
Staffing Containing Fish,Meat. debited under the appropriate sections
Poultry or Ratites-I 65OF 15sce, above if related to foodborne illness
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other
145T 590.009 violations relating to good retail
3-401.12 Raw Animal FookLs Cooked in a practices should be debited under#29-
Microwave 165F*
3401.11(A)(1)(b) All Other PHFs-145OF 15 sec. Special Requirements.
17 Reheating for Hot Holding WOLA77ONS i`LATED TO GOOD RETAIL PRAC77CES
3403.1 I(A)&(D) RHFs 165T 15 see. 1' 2'-30'
3403.11(B) Microwave- 165'F 2 Minute Standing Ctica and non-critical violations,which do nor relate to the
Time* foodborrie illness interventions and riskfactors listed above, can be
3-403.11(Q Commercially Processed RTE Food- found in thcfollowing sections of the Food Cade und JOS CMR
1400P 590.000.
3-4011,11(E) Remaining Unsticed Pordmis of Beef 1 Itern Good Retail Precdcas FC 690.000
FC-2 .003
Roasts* 24. Food and Food Protection FG-3 004
; 23. 1 Manataxiient and Personnel
Proper Cooling of PHFs I
18 1 25. Equioment and Uteranis i FC-4 005
3-501.14(A) Cooling Cooked P.Hrs from 140'F to '; -16. Water.Plumbing and Waste ! FC-5 006
t 70'F Within 2 Hours and Roin 70'F 1 27. 1 Physical Facility 1 FC-6 1 .007
to 41cF/410F Within 4 Hours, * 1 28 Poisonous or ToxicK,enats FC-7 008
Cooling PHFs Made ForinAmbient Special RIalilernents; 009
3-501.14(B) 29
Temperature Ingredients to 41'F/45'F 30. i Other
Within 4 Horus�
Dmoms aiticat nerain tb-fiederal 1999 Fwd Cmieur 105 CNIZ 590-000.
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,4 th Floor
Division of Food and Drugs Salem, MA 01970-3523
F06D ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Nam!, P, j J r"I'R�0,� i A"A A .!re jyKof Ooerationial. Tyqe of Insoection
& Food Service Q Boutifie
Address Risk LJ Retail -inspection
Me
_J.AIA Level El Residential Kitchen Previous inspection
-T-�j)
Telephone L Mobile Date:
El Temporary 0 Pre-operation
Owner HACCP Y/N Caterer El Suspect Illness
Person In Charge(PIC) Time Bed&Breakfast El General Complaint
A%, [I HACCP
inspector Sill- Permit No. 0 Other
ou
Each violation checked requires an ex f- on o-n�iihe narrative-:pag and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodl: as r terventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) �Ks 009�!F)
action as determined by the Board of Health. I
LMOOPROTECTION MANAGEMENT U0 GS
0 1. PIC AssigneCknoWedgeable/Duties El 12. Prevention of Contamination from Hands
E] 13. Handwash Facilities
EEMPLOYEE HEALTH PROTECT16N FROM CHEMICALS
E] 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives
El 3. Personnel with Infections Restricted/Excluded (9�,V,-15.Toxic Chemicals
LFOOD FROM APP-ROVED SOURCE
El 4. Food and Water from Approved Source �TmElTEMPERATURE CONTROLS(Potentially Hazardous Foods) j
E] 5. Receiving/Condition El 16.Cooking Temperatures
C3 6. Tags/Records/Accuracy of ingredient Statements El 17. Reheating
E] 7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling
[119. Hot and Cold Holding
PROTECTION FROM CONTAMINATION
E] 8. Separation/Segregation/Protection El 20.Time As a Public Health Control
Gt�9. Food Contact Surfaces Cleaning and Sanitizing LREQUIREMENTS FOR HIGHLYSU$CEPTIBLE POPULATiONSi(HSP)1
1110. Proper Adequate Handwashing Ej 21. Food and Food Preparation for HSP
-ji---- ___ ,
El 11. Good Hygienic Practices P COXSUMER ADVISORY 1.2
92__2_. 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
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
C _N_ 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
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
0q- 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)(51 0,011) 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 Mnl��14 d. (CA a�l 4as, &Mjte�
Inspector's Sigi Vi^Aj"-_k (14, PrinqA,_,,6,(,,
PIC's Signature: "W1 o Print: PageL od-ra-ges
iature:
- I v7l.,
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION
Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(]) Raw Animal Foods Separated frout
I 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)12) Raw Animal Foods Separated from Each
I Other*
EMPLOYEE HEALTH I Contamination from the Environment
2 590.003(C) Responsibility of the person in charge to 3-3U2.1[(A) Food Protection-
require reporting by food employees and 3-302.1.5 Washing Fruits and Vegetables
applicants* 3-3(A.1 I Food Contact with Equipment and
590.003(f) Responsibility OI'A Food Employee Or An Utcnsds�
Applicant To Report To The Person In 'ination from the Consumer
Charge* C=
I 3-3('16.14lA)(B) R ed 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
590.0030 Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE I I Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501,111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Scaled Contamer* Sanitization Temveratui
3-201�13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.)3 Shell EVs* Sanitization Tempeiatures*
3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinkine Water- concentration and hardness.* I I
4-60 1.11(A) Equipment Food Contact Surfaces and
5�fill.I I 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 3 10 CMR 22.0* Contact Surfaces and Utensils*-
Shellfish and Fish From an Approved Source 4-70111 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreational ly Caught Molluscan
I Food Contact Surfaces of Equipmej
Shellfish� 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources*
Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing
Regulatory Authority 2-301�I I Clean Condition-Hands and Arms*
3-202.18 Shellstock Identification Present* 1-301.12 Cleaning Procedure*
590.004(C) Wild Mushroorns� 2-301.14 When to Wash*
3-201.17 Game Animals* it Good Hygienic Practices
5 1 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-202.11 PHFs Received at Proper Temperatures* 2401,12 Discharges From the Eyes,Nose.and
3-20115 Packa�e Integrity* Mouth*
3-101.11 Food Safe and Unadulterated 3-301.12 Preventin�Contamination When Tasting*
6 Tags/Records;Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Employees*
Tags/Records:Fish Products 13 Hantiviash Facilities
3402.11 Parasite Destruction* Conveniently Located and Accessible
3402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities*
590.0040) Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance
IHACCP Plans upplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* SevAces
3-502.12 Reduced oxygen packagim, criteria* 6-301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
-Denotescriamil itern in the federal 1999 Food Code oi 105 CNIR 590.000.
CITY OF SALEM
BOARD OF HEALTH
Establishment NamerAlud/-�' PJ,- Date: <3 —R-( I Page: of L1,
I -
Item Code C-Critical Item DESCRIPTION OF VIOLA ON/PLAN OF CORRECTION Date
140. Reference R-R .--r4 Verified
- .1 . ASE;N JCLEAILY
())VCO A-HA I -VI 0
—ao
n AA A 4 AA
�IT'
r- Ph,
f-A r
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at 'p- :0/vou &Vd-4 J
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L ��t'6
V�
Al"
A
Discussion With Person in Charge:- Corrective Action Required: a No fes
I have read this report, have had the opportunity to ask questions and agree to correct all C3 vo ary Compliance Q Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to �Reinspection Scheduled L) Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
.noncompliance may result in daily fines of>eL3y-five dollars or suspension/revocation of 0 Embargo u Emergency Closure
your food permit. U Voluntary Disposal L3 Other:
r f,
3-501,14(C) PHF&Received at Temperatures
Violations Related,to poodbarre Illness Interventions and Risk According to Uw Cooled to
Factors fftems 1-22) (Cant.) 4 l'F/45F Within 4 Hours.
3-50t.15 Cooling Methods for PHFs
PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding
14 1 Food or Color Additives
3-20112 Additives- 3-50L16(B) Cold PIJFs Maintained at or below
3-302.14 Protmfica from Unaporoved Additives" 590.004(F) 410145�Fs
Poisonous or Toxic Substances 3-50lA6(A) Hot PHFs Maintained at or above
15 1 1400P. *
7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1300F.
Containers* 20 Time as a Public Health Control
7-102.11 Common Nam-Working Containers* 3-501,19 Time as a Public Health Controll
7-201.11 Separation-Storage4t .590.004(H) Variance Requirement
7-202.11 Restriction-Presence and Use*
7-202.12 Conditions of Use� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Containers-Prohibitions* POPULA71ONS(HS1P)
7-204.11 Sanitizers,Criteria-Chemjcafs� 21 3-801.1](A) Unpasteurized Pre-packaged Juices and
7-20412 Chemicals for Washing Produce,Criteria* Seven ties with Warnim,Labels*
7-204.14 Drying Agents.Criteria*
7-205.11 Incidental Food Contact Lubricams* MOLII(B) Use of Pasteurized Eges*
7-206.11 Restricted Use Pesticides,Criteria'r 3-801.11(D) Raw or Partially Cooked Animal Food and
Raw Seed Sprouts Not Served-*
7-206.12 Rodent Bait Stations* 3MI.11(C) Unovened Food Package Not Re-sened.
7-206.13 Tracking powders, Pest Control and
I Monitoring* CONSUMER ADVISORY
TIMErrEMPER14TURE CONTROLS 22 3-603.11 CassumerAdvisory Posted for Consumption of
Animal Foods That are Raw.Undercooked or
16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate
PHFs
path
ogems"
3401.)IA(l)(2) Eggs- 155F 15 Sec.
Eggs-immediate Service 1450FISsec, 3-302-13 Pasteurized Eggs Substitute for Raw Sheil
3-401.11(A)(2) Comminuted Fish.Meats&Game Eglis�
Animals-155OF 15 sec.* SPECIAL REQUIREMENTS
3401.11(B)(1)(2) Pui,and Beef Rated- 130'F 121 mur* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in
3-401,11(A)(2) Rallies,Injected Meats- 155-F 15
sec.* catering,mobile food,temporary and
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHR, residential kitchen operations should be
Staffing Containing Fish,Meat, debited under the appropriate sections
Paul"or Ratites-165F IS sec. above if related to foodborne illness
3401.11(C)(3) Whole-muscle,Inflict Beef Steaks, interventions and TU-factors. Other
145OF T 590.009 violations relating to good retail
3401.12 Raw Animal Foods Cooked in a practices should be�debited antler#29-
Microwave 165'F Special Requirements.
3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec,
17 Reheating for Not Holding VIOI A77ONS R�FLATED TO GOOD RETAIL PRAC77CES
3-403AI(A)St(D) PBFs 165'F 15 see.* I (Items;23-30)
3403.11(13) Microwave- 1650 F 2 Minute Standing Critical and non-critical violations,which do not relate to the
Time* fivelbome illness interventions and riskfacrors listed abot,e, can be
3-403,1 I(C) Conarnercially Processed RTE Food- jbund in thefollowing sections of the Food Code and 105 CMR
1400P 590.000.
3-4031l(E) Remaining Unsliced Partions of Beef Item i Good Retail Practices 1 FC 590.000
23. Manamment and Personnel
Roasts* FC-2 .003
1 1 24� Food and Food Protectior FC-3 004
Proper Cooling of PHFs 1 25, Equipment and Utensils FC-4 .005
3-501.14(A) Cooling Cooked PHFs from 140'F to 26. �fater,Plumbina and Waste FC-5 '006
70*F Within 2 Hours and Front 70' 27. Physical Facility FC-6 .007
to 41'F/45'F Within 4 Hours. i 28, Poisorims ot Toxic Materials FC-7 �008
3-501.J4(B) Cooling PHFs Made FrontAnibient 1 29. Specuid Reauirements .009 1
Temperature Ingredients to 41*F/45'F i 30. 1 Other
Within 4 Hotus�
Dcnotes critical wm in the fidew] I L)99 Food Cc&ta 105 C.MR 590.000,
Magtachusetts Department of Public Health Salem Board of Health
DMIsion of Food and Drugs 120 Washington Street,0 Floor
Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Name Date Tvve of Overation(s) TLype of Insoection
-;-12
UNfood Service LYRoutine
Address Risk [:1 Retail ENe-inspection
\ac) Level Residential Kitchen Previous Inspection
Telephone 6h,,� IL�o- R'kW Mobile Date:
Owner HACCP Y/N [3 Temporary El Pre-operation
I El Caterer El Suspect illness
Person in Charge(PIC) Time El Bed&Breakfast C1 General Complaint
VPA In:i+() El HACCP
inspector Out: Permit No. 0 Other
Each violation checked requires an lanation 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)JO
action as determined by the Board of Health. P,
L�000 PROTECTION MANAGEMENT_ __:_j El 12. Prevention of Contamination from Hands
�N 1. PIC Assigned/Knowledgeable/Duties N 13. Handwash Facilities
[EMPLONT(E HEALTH 0. PROTECTION FROM CHEMICALS !.1
El 2. Reporting of Diseases by Food Employee and PIC [:114.Approved Food or Color Additives
El 3. Personnel with Infections Restricted/Excluded
I El 15.Toxic Chemicals
LFOOD FROM APPROVED SOURCE---------,"--_7_ -1
E] 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardo6s Foods)_-j
5. Receiving/Condition 16. Cooking Temperatures
6. Tags/Records/Accuracy of Ingredient Statements E] 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling
I PROTECTION FROM CONTAMINATION E) 19. Hot and Cold Holding
El 8. Separation/Segregation/Protection [120.Time As a Public Health Control
9. Food Contact Surfaces Cleaning and Sanitizing LREQUIREMENTS;FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)�
E]21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
LCONSUMER ADVISORY
E] 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.
c_-N- 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
,X 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
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
X 27. Physical Facility (FG-6)(590.007) have a right to a hearing. Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(*110,001) 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: 'R -C�
S�inv�o�14,� �,V -
-z
Inspector's Signature: Print:
PIC's Signature: Print: Aj n 14 q 11�)a I I/k_"_) 1,e-L oapages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION
8 Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from
I 590.003(A) Assignment of Responsibility* Cooked and RTE Foc
590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients
2-103.11 Person in charge -duties 3-302.11(A)(2) Raw Annual Foods Separated from Each
I Othcr�
EMPLOYEE HEALTH Contamination from the Environment
2 590.003(C) Responsibility or the person in charge to 3-302.11(A) Food Protection*
require reporting by food-ruplityces and
3-30115 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 Rt�poil To The Perhon In
Charge* I Contamination from the Consumer
5%003(G) Reporting by Person in Charge* 3-306.14(A)(B) I Returned Food and Reservice of Food*
Disposition of Adulterated or Contaminated
3 590.003(D) Exclusions and Restrictions* Food
590.003(F) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water
3-201.1Z Fmf in a Hermetically Scaled Container* Sanitization Temperatures*
3-201.13 Fluid Mi[k and Milk Products* 4-501.1 t2 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Termeratures*
3-202.14 Eggs and Milk Pioducts,Pasteuri7ed* 4-501.114 Chemical Sanitization-temp.,pH,
3-20116 lee Made From Potable Drinkim,Water' concentration and hardi
4-60 1.11(A) Equipment Food Contact Surfaces and
5-101.11 Drinking Water from an Approved System' Utensils Clean*
590.006(A) Bottled Drinking Watcr4
590.006tB) Water Meets Standards in 3 10 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-
Shellfish and Fish From an Approved Source Contact-Surfaces and Utensils*
3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils and
ShellfishT Food Contact Surfaces of Equipment*
3-201.15 Molluscan Shellfish from NSSP listed 4-703.11 Methods of Sanitization- -Hot Water and
Chemical*
Sources* to Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
RequIatoty Authority 2-301.11 Clean Condition-Hands and Arms*
3-202.18 Shelistock Identification Present" 2-111,12 Cleaning Procedure*
590.004(C) 'Arid Mushrooms- 2-301.14 When to Wash*
3-201.17 Game Animals* it Good Hygienic Practices
5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-202,11 PHFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes,Nose and
3-202.15 Package hitegrity* MOU6,
3-101.11 Food Safe and Unadulterated 3-30L.12 Preventing Contamination When Tasting4
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstmk Identification Maintained Employees*
Tags/Records:Fish Products 13 Handwash Facilities
3-402.11 parasite Destruction* Conveniently Located and Accessibie
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities*
590.0040) Labeling of Ingredients* 5-204.11 Iocation and Placement*
7 Conformance with Approved Procedures 5-205.11 Accessibility, Operation and Maintenance
/HACCP Plans SuppW with Soap and Hand Drying
3-502.11 Specialized Processing Metbods* Devices
6-301.11 Handwashing Cleanser,Availability
3-502.12 Reduced oxygen packaging-criteria* 6-301.12 Hand Drying Provision
9-10112 Conformance with Approved Procedures*
Denotes critical acta it,the Weral 1999 F(x)d Code oi 105 CMR 590d00,
CITY OF SALEM 4
BOARD OF HEALTH + U r
Establishment Name:O)-V\ eA' �n pkldr A (b,)Cf , Date: q—� Page: ok of
Item Code C–critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dee
NO. Reference R–Red Item PLEASE PRINT CLEARLY Verified
�—A
4A
Ir
\r #AAA
() A 0, /
A1j1)14.AAr,) - y rl,
-
(AJAA SA --j q 0-
/1Z L�(o ((J(-)6
1AJ 1� 1
0 '5PrAA I _'t A A1 ,A.
ry
ok"I Av�
A r) A
t ��r�V 0 1 Le 001A AlAft
4 4_z
L
1,A1 18 U
_N/7 �z' �11 NP, �P A
0 ij� /VU�A L V��p A 111A
V
7-(k ITAnAl . d 47*k�/_ (/u
0 A
a
�_P F r A 4-15
7U 1:1 0-11, 1�
19A KA44
Discussion With Person in Charge: Corrective AdtUld Re uired: Li No 011 Yes
,q
I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary.Compliance 0 Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions-as described, and to 0 Re-inspection Scheduled L) 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 0 Embargo Ll Emergency Closure
"Lour food permit. 0 Voluntary Disposal Ll Other:
3-501.t4(C) PHF&Received at Temperatures
Violations Related to Foodbonto Illness Interventions and Risk According to Law Cooled to
Factors(Iterria 1-22) (Cont.) 41'F/45F Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PffFs
19 PHF Hot and Cold Holding
14 Food or Color Additives 3-501.16(B) Cold PHFs;Maintained at or below
3-20112 Additives*
3-302.14 Protection from Unapproved Additives* 590.004(F) 410/450 F*
15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Inforanation-Original 1400F. *
3-501,16(A) Roasts,Held at or above 1300F,
Containers* 20 Time as a Public Health Control
7-102.11 Common Name-Wrorking Containers* 3-50119 Time as a Public Health Control'R
7-201.11 Separation-Storage* 590.004(H) Variance Requirement
7-20111 Restriction-Presence and Use*
7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Containers-Probibitions*
7-204.11 Sanitizerq.Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 121 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents.CriteriO Beverages with Warning Lab
I J-80I.II(B) Use of Pasteurized Eg4s*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.11 Restricted Use Pesticides,Criteria*
I Raw Seed Sprouts Not Served.
1 7-206.12 Rodent Bait StaEiGnSt 3-801.11(C) Unopened Food Package Not Re-served.
7-20&13 Tracking Powders,Pest Control and
Monitoring* CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooldnii Temperatures for Animal Foods That are Raw.Undercooked or
PHFs Not Otherwise Processed to Eliminate
3401.]IA(l)(2) Eggs- I 55F 15 Sec� Pathogens.*E�Pl.1��(
I Eggs-Immediate Service 145'FI5,we. 3-302.13 Pasteurized Eggs Substitute for Raw Shell
3-401.11(A)(2) Conaminuted Fish.Meats&Game
I Animals-155'F 15 sec. *
3-401.11(B)(1)(2) Fork and Beef Roast-130'F 121 min- SPECIAL REQUIREMENTS
3-401.11(A)(2) Ratites,Injected Meats-155OF 15 590-009(A)-(D) Violations of Section 590.009(A)-(D)in
see.* catering, mobile food, temporary and
3-401.1 I(A)(3) Poultry,Wild Game,Stuffix!PflFs, residential kitchen operations should be
Stuffing Containing Fish,Meat, debited under the appropriate sections
Poultry or Ratites-165017 15 sec.* above if related to foodborne illness
3-401,11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other
14.5 OF* 590.009 violations relating to good retail
3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-
Microwave 165'F* Special Requirements.
3-401.11(A)(1)(b) All Other PBFs-145F 15 sec.
17 Reheating for Hot Holding VIOLA77ONS R LATED TO GOOD RETAIL PRAC77CES
3403,11(A)&(D) PHFs;165F 15 sec. * S 23-30)
3403.11(B) Microwave- 165'F 2 Minute Standing tai!cal wid non-critical violations,which do not relate to the
Time* foodborne illness interventions and riskfactors listed above, can be
3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR
1400F* 590.000.
3-403.11(E) Remaining Unsliced Portions of Beef i Hem I Good Retail Practices J .FC 1 590.wo 1
Roasts* 1 23. 1 Manixierrent and Personnel rc-2 003
18 Proper Cooling of PHFs 24. i Food and Food Protection I FC-3 .004
25. Eoulornent and Utensils 1 FC-4 oQ5
3-50114(A) Cooling Cooked PBFs from 140'F to
26. Water,Plumbinq and Waste FC-5 006
70'F Within 2 Hours and From 7GF 27. Physical Faclfltv
FC-6 .007
to 41'F/45'F Within 4 Hours. 28. Poisonous or Toxic Materials FC�7 1 .008
3-501,14(B) Cooling PHFs Made FromAnibient 29. Special Rectuirements 009
Temperature Ingredients to 41OF145OF 1 30. 1 Other
Within 4 Hours*
1)�wtcs critical iteni in the federal 1999 F�d Cc&4 105 CMR 590-000.
,wa-�k_
Salem Eloan H I
�ublic Health 120 Washingt( th
, Massachusetts Depprtment of, P lo,re as
)n St e8t.4th Floor
Division of Food and Drugs I Salem, MA 01 970-352�
I I
FOOD ESTABLISHMENT.INSPECTION REPORT f, Tel. (978) 741-1800 Fax (9�4) 745-0343
Name D is Type of Insiaection
U j CIDO 9,Food Service El Routine
I TxPe of Ooeration(si
in, 0, 5 64)rc, L
Address Risk El Retail Re-inspection
Level El Residential Kitchen Previous I
Telephone spa tion
El Mobile Date rc
0 P �j n
Owner HACCP Yft1 El Temporary re-up6ratio-9
All El Caterer El Suspect Illness
7 D Bed&Breakfast El General Complaint
Person in Charge(PIC) Time
In: E3HACCP
inspector Permit No. 0 Other
Each violation checked requires an explanation on the narrative 0age(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009(F)
action as determined by the Board of Health. I
FOOD PROTECTION MANAGEMENT 0 12. Prevention of Contamination from Hands
[] 1. PIC Assigned Knowledgeable Duties EI 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food Employee and PIC
El 14.Approved Food or Color Additives'
3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE, TIME/TEMPERATURE CONTROLS(Potentially Hazirdo6i Foods)'
E] 4. Food and Water from Approved Source
E] 5. Receiving/Condition El 16. Cooking Temperatures
Ej 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
[:1 7. Conformance with Approved Procedures/HACCP Plans 0 18. Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
El 8.'Separation/Segregation I/Protection [120.Time As I a Public Health Control
9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
El 21. Food and Food Preparation for HSP
Ej 10. Proper Adequate Handwashing
[111. Good Hygienic Practices �'CONSUMEIR ADVISORY
Violations Related to Good Retail Practices Number of Violated Provisions Related
X,O�El 22. Posting ol Consumer Advisories
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
23. Management and Personnel (FC-2)(590�003) by a Board of Health member orit-s agent constitutes an
I
_,3e,24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Fail ure to correct violations
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 5XM�tF��K� n , /) r----,)
Inspector's Signature: Print:
I I �
PIC's Signature: Print: Page of�ages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 590.003(A) Assignment of Responsibilitv- 3-302.11(A)(1) Raw Annual Foods Separated from
590.003(B) Demonstration of Knowledge" Cooked and RTE Foi
2-103.11 Person in charge-dutics Contamination from Raw Ingredients
3-302.1 I(A)(2) Raw Anitnal Foods Separated from Each
EMPLO"EE HEALTH Olher�
2 590.003(C) Responsibility of the per�on in charge to Contsminatroni'rom the Environment
require reporting bv food employers and 3-302.11(A) Food Protection-
applicantO 3-302 15 Washing Fruits and Vegetables
590.003(F) Responsibility Of'A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utvnsils*
Charge, Cntamination from the Cnsumer
590 003(G) Reporting by Person in ChargO 3-306.14iV)(B) Returned Food and Reservice of Foods
3 590.003(D) Exclusions and Rcsrric6ons'� Disposition of Adulterated or Contaminated
590,003(F) Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE FOO&
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.00,bA-B) Compt iance, with Food Law" 4-501,111 Manual Warewashing-Hot Water
3-201.12 Food ina Hermutically Scaled Coluainer* SanitizationTeroperatures 1
3-201�13 Fluid Milk and Milk Pjoducts* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shelf E,-9s* SanitizaLion Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* .1-501.114 Chemical Saintizinion-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water� concentration and haidness. �' 1
5-101.11 Drinking Water from an Approved System' 4-60 1.11(-k) Equipment Food Contact Surfaces and
Utensils Clean-
590.006(A) Bottled Drinking Water* 4-6112.11 Cleaning Frequency-of Equipment Food-
590.006(B) Water Meets Standards in 3 10 CMR 22.0* Contact Surfaces and Utensils�
Shellfish and Fish Ftom an Approved Source
3-201.14 Fish and Recreational ly Caught Molluscan 4-701.11 Frequency of Sanitization of Uteimils*and
Food Contact Surfaces of Equipment
Shellfish' 4-703.11 Methods of Sannization-Hot Witter and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources',' I to Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.1i Clean Condition--Hands and Arms'�
3-20118 ShellstockIdentification Present* 21-30 1.1-1 Cleaning Procedurc*
590.004(C) Wild Mushrooms* 2-301.14 When to Wish*
3-201.17 Came,Animals* if Good Hygienic Practices
5 Receiving/Condition 2401.11 Eating,Dnnkin2 or Using Tobacco*
3-202.11 PHFs Received at Proper Tcnrperatures�' 2-401.12 Discharges From the Eyes,Nose tu�
3-202,15 Package ftaegrnty� Mouth*
3-101.11 Food Safe and Unadulterated 3-301.12 Preventinn.,Contamination VAien Tasting"
6 Tags/Records:Shellstock 12 Prevention of Contamination from -Hands
3-202.18 Shellstock Identification * 590.004(F) Preventing Contamination from
3-203.12 Shellstock IdentificationIvIaintained' Employees*
13 Handwash Facilities
Tags/Records:Fish Products
�402.11 Parasite Destruction I Conveniently Located and Accessible
3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities*
590.004(f) Labeling of Ingredients* 5-204.11 Location and P1 acernent�
7 Conformance with Approved Procedures 5-205 11 Accessibility, Operation and Maintenance
IHACCP Plans
uppled with Soap and Hand Drying
3-502.11 Specialized Processing tvlcthc)ds* Devices
3-502.12 Reduce(]oxygen packagiro, criteria* 6-301-11 HandwasNng Cleanser,Availability
8-103.12 Conformance with Approved procedures* 6-301.12 Hand Drying Provision
Denotes critical neni in the foJend 199()Food Code oi 105 CNIR 590.011t).
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Mn' (I Date: Page: 0 of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLANDF CORRECTION Date
No. Reference R-Red Item PLEASE P0'1NT CLEARLY Verified
L L J41, _,e
1 1, \4-
Discussion With Person in Charge: Corrective Action Required: Ei No llli�Yes
0'Voluntary Compliance Ll 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 0 Re-inspection Scheduled 0 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 cj Embargo Lj Emergency Closure
your food permit.
L] Voluntary Disposal zi Other:
Pfllti�Re,;clived at Tmperabyres
Violations RelaW to Fwdborne Illness Inter%,entions and Ris), Ackwding to LaN, Cooled to
Factors(item 1-22) (Cont) 4 1 1 4 1�F/45"F Witliin,l H(mrs.
PROTEC"nON FROM CHEMICALS 3-501 15 Coolili4ll4elhodtt for PHFs
F 19 PHF Hot and 4old Holding
14 :DdtorColor Additives 3-501,16(B) Cold PUi,Mamt4med at or below
Z
'.t-202,12 590.0)1(f-)
3-302.14 Protection front tjoapprwed Addiliwsl S01,16(l%� licit IIHFs liltain(amed atorrrb,v�
15 1 j Poisonous or Toxic Substances Wit I-'
[01.11 lih,111ifying infolmil -On"mai
I'llA) Ro,,I,H�ld a;I)i abote I I(Fl�
4--
C,mrition N,inn 20 1 i Time as a Public Health Cont_r_oT_*___'
�_l slit l')
it 11-11 al,a flubbcAtealih Oinuol
r;ap�e ReQuiTi,qieti,
Pre"I.C�,ind I
7-202,12 of Us,tl
7-201 11 1�,Xic Comalr�crf REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7 204l 11 )a1lizil -;-NM lltAi Lcrpl�sieuii,ed Pio,-jmc;:vu
, -cis.Criteria-clallnicl,k� POPULATIONS(HSP)
7-_'04.12 Ownucalt,fol Wa,hill, P]�,fl.tcc I�1 ite-rial ged Juices�id
7-?04,14 Divitil., Al,eta,.Crlteiia'
Sit! I,t 1j) L,<%�,(1! Ila-T,ll1nz-j Ett',
7 205,13 jnlid�,rllal comact l'itialf:1111ts,
J�- - U I(D) P;:�t or C"ok,11 'Arlirrial Fol'J 'llid
_i)6�i i Cwe!!,�)f
7-_06.12 RIXICal 15,lll S,Awll�,- .'d linota,Nw Sc'I lol�
1�'IX,4 P,Lj:,j, No! R,
1, �CKilw Coatrl 4 v!d
CONSUMER ADVIS09Y
A 4'0, 1; 'V; it�ot,l Cowomption o;,
TIME/TEMPERATURE CONTROLS
Proper Cookaig Temptitatotes tot At itf " 1 that �tw R�tv L:rjJer�,XlkVd 0
16
PHFs (Ww", ;s� "Ps-c-s"J i l
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SPEC!A' REOLPREMENTS
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Massachusetts Department of Public Health Salem Board of Health
Division of Food and Drugs 120 Washington Street,4 th Fl;or
Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel, (978) 741-1800 Fa�c(978) 745-0343
Name
Djj
ql_� Ty of -peration(s) Type of InsDection
I Service Z:Routine
Rltlk I Retail El Re-inspection
Address roodo
Telephone Level E] Residential Kitchen Previous nspection
El Mobile Date
Owner HACCP Y/N El Temporary El P,e;?4a3ra/tiojnr
0 Caterer El Suspect Illness
Person in Charge(Pid) Time El Bed&Breakfast [] General Complaint
In: :�,, I ) I El HACCP
inspector out6?A . Permit No. El Other
,41 fir'
Each violation checked requires an exp 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 El 12. Prevention of Contamination from Hands
C] 1. PIC Assigned Knowledgeable Duties [113. Handwash Facilities
i EMPLOYEE HEALTH
PROTECT16N FROM CHEMICALS
E] 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
FOOD FROM APPROVED SOURCE' - I "' 1-
E] 4. Food and Water from Approved Source TIMElTEMPERATURE CONTROLS(Potentially Hazardous Foods)
[1 5. Receiving/Condition 16.Cooking Temperatures
E] 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
[:1 7. Conformance with Approved Procedures/HACCP Plan's El 18. Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding
El 8. Sep-aration/.Segregation/Protection 0 20.Time As a Public Health Control
J��-'9. Food Contact Surfaces Cleaning and Sanitizing �'REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
1-j E] 21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
El 11. Good Hygienic Practices CONSUMER ADVISORY
El 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of'Health. Non-critical (N) violations must be corrected
Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CIAR
of Health.
-N-] 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
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 addressi
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION: V
S 501nVectFc�14
Inspector's Signature: Print:
PIC's Signature: Print: y Page�_JUDIPages -4
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 590.00(A) AssignmentotResponiabifily*
3-302.1 l'A)(1) Rav, Annual Foods Separated from
590.003(B) I Demonstration of Knowledge�' Cooked and RTE FkAAs*
2-103.11 Person in charge--duties Contamination from Raw ingredients
3-3'02.1 I(A)(�Z) Raw Annual Fourl�Separated from Each
EMPLOYEE HEALTH Other'
2 590,003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food eniployces and 3-302.1](A Food Protection-
applicants* 3-302.15 Washing Fr uiLs and Vegetables
590,003(F) Responsibility Of A Food Employee Or Art 3�304.11 Food Contact with Ekluipment and
Applicant'ro Report To The Person In Utcflsils�
Charge- Contamination from the Consumer
590,003(Ci) Reporting by Person in Charge� 3-306.1 4(A)(B) Returned Food and Reservice of Poo&
3 590.003(D) Exclusions and Re�rrict ions* Disposition of Adulterated or Contaminated
590.003(E) Removal ol'Exclusicins and Re�trictioas Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE I Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
( -5,'1�I I I Manual Warewashing-Hot Water
590.0W(A-B) 1phance with Food Law 4 0
3-201.12 1"in a llcrmelu�ally Scaled Container* SannizationTerimeratures*
4-501.1 t2 Mechanics] Warewashing-Hot Water
3-201.13 Fluid Milk and Milk Products*
-1-20".13 Shell Eggs* Sanitization Tejnrperatures�
3-202 Eggs and Milk,Products.Pasteurized* 4-501.114 Chemical Sainiti/ation-temp.,PH,
3-202.16 lee Made From Potable Drinking Water- concentration and hardi
5401.11 Drinking Water from ap Approved System- 4-601.11(A) Equipment Food Contact Surfaces and
590.006(A Bottled Drinking Water* Utensils Clean-
4-602.11 Cleaning Frequency of'Equipment Fooif-
590 006(B) Water Meets Standards in 310 CMR 22.01: 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
Shellfish* A-703-11 FoodContact Surfaces of Ecufipment�
3-201.15 Molluscan Shellfish from NSSP Listed Methods of Sanitization-Hot Water and
Sources* I Chemical*
Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing
Regulatory Autnorky 1 2-301.11 Clean Condition-Hands and Anns4
3-202,19 Shellstock Identification Present, 2_30 1,12 Clearing,Procedures
590.004(C) Wild Musfirooms� 2-301.14 When to Wash*
3-201.17 Game Animads* it i Good Hygienic Practices
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco*
3.202.11 PFFs Received at Proper Teniperatures:� 2-401.12 Discharges From the Eyes, Nose and
3-202.15 Package Integrity- Mouth*
3-101.11 Food Safe and Unadulterated 3-30 t.12 Preventing Contamination When Tasting*
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
590.004(E)
3-202.18 Shellstock Identification* Preventing Contamination from
3-203.12 Shellstock Identification Mamtained� Erinilovecs-t
TagstRecords;Fish Products 13 Handwash Facilities
1-402.1 Parasite Dcstruc6on� Conveniently Located and Accessible
3-402.12 Records.Creation and ReLenticari' 5-20.11 Numbers and Capacities*
590.0040) Labeling of Ingredients* 5-204.11 Location and Pilacernent*
7 Conformance with Approved Procedures 5.205,11 Accessibility, Operation and Maintenance
/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing lylethods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 1 Hindwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedurres'i 6 301.12 Hand Drying Provision
Denores critical itein a,the federal 190Q Fcx)d Code oi 105 CMR 590.000.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Date: Page:
.2 of A
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item I PLIA11 PRINT CLEARLY Verified
eq /I eo__
dJ-) 0 + x�, ro is,c a, —1 -1 A_JC�C4
0r A�'0 r�
(17 iri L j_�a io .k. Lr" oprii rLsLr
,C) A)00(4� 4-
- Ir 1-- ,
T"'Z AZ; 45i;A- 1"V '17*L 41—
�J\o OrIA
4
(1) r2dd T::[,,, L't?&9" 4y"n 1. kk� A)0"1' rvd/"I't.2,2-
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A V, (1, �4
'5�r� k70, 1 I�N
L pf�t�
WA /1�1 Ix
IJ L/j
AA -
Discussion With Person in Charge: Correct!ve Action Required: o No Yes
I have read this report, have had the opportunity to ask questions and agree to correct all o Voluntary Compliance 0 Employee Restiiction
Exclusion
violations before the next inspection, to observe all conditions as described, and to *'�Re-insipection Scheduled 0 Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that X
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of L) Embargo Lj Emergency Closure
your food permit. C3 Voluntary Disposal Lj Other:
3,-501,W(c) PHFs Re�ivcd ITT Temperatures
Violations Ratatod to Foodborne illness IrttmentionTi and Risk ACCOrding to II Cooled to
Factors(IteM 1-22) (Coot) 4 1�F/45'F Within 4 Houa��
PROTECTION FROM CHEMICALS 3-501 15 C00HO"Methods for PHFs
14 Food or Color Additives t9 PHIF Hot and&old Holding
�-202 12 Adliti%cs- 'A-501.16(B) Cold PHFs Maintained at or beliny
3-30114 Protection front Unapproved Addjtiyc�l 590 00-'(F) F-
Poisonous or Toxic Substances 3-50 OiA)
1 140 F
101AI Orl"inat
I Pwttt:,Held at orabove 13001%
Containefz�,
I Time as a Public Health Control
7 102,11 omoval N�Inw - L2 L)
In,,a.,a Volific Health Comiiil�
7-20111 R,�,tr;ction -Pwia,nec an I L
—--- — ---------
7-202,12 Condoikii:-of Use'
7-703 11 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
I . h,xit:Containciz POPULATIONS(HSP)
qo.l.I I CloCT'la -Chl Init,;'[S'
7-104 12 Fii-1 --1,0111(A) Pie-oaclagedluikesand
Chejtllcal�for IAa,hwp hoducc, 6int:a,
7 �04 14 Dr,naT Avnit,.Crooiia' I Rutelzwe%with vNioninE Ullj�k�
Ill'id.,wal i—xi Funlac: E_,till—I C-11--------- -80 T 11(B, o! pa�wI11_i,-Cd Lce
It 0) R;vwor patitail"CTK*'.d Animal Food 'It'd
Pe'ri"vie" ('11rcl�,I' i I I
kw,� It t'd �prokv,Not S��I wit
1 7 206.12 i3ti,1"n, 131�1,1
1 1 Kc I I C 1."Xqi pLJ:.J
ec N'11 In.-IcIt,
CONSUM ER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3 4,01, 1 Cor"I"n't
F1 6 1 Prom Cooking Temp�iatwps tot li6tiw)l Mal ig. UnJcf,�Xtt,�h
3 F !5 5
jnj�,,V.j I T'2_ jl_;tem 1z T:t� - �o;w�:Int f"I Raw sh�!l
+ ---------- 1:1,!,*
SPE-CtAL REOUIREMENTS
I j Tin n' I
F
401 IiIA;Cii u!,1' TV,
i;z!!IC 1111:Imin'!Fi.,,!, klt�oz, j�4'j'11Q,: t:jjT'j tilt' J"t� i�-,;it�'IS
J,
C I
16
V A Vi C,G,10C ;'F 4 �RjI I�'
h NS E 4
i A ;110 ttn� z- mew.s 23,'Zill
f,.! 11� q-.
Con) t Tit w-; ."h,
aU F,
_7
Gv06
aqp.rr��,t A� T P�r,r,,'
ptoper Cooling ot PHF5 t "C U)I
2; F:Lo""trit'in('k let n'43
t0l 1,11�At 11FIFF onn I arl
FC -n X��
71) 1, Within 2 jjT)Uf4:;1!1,1 f Itj!tj-11I"i F(, 007
4;+?-1; F WitI.In� linu�
-30) l4di) Co,!uw H iR Nhulv Fz,�n,
1XIII
TcTni�iawfe 1,
CITY OF SALEM
11AID OF HEALTH
Establishment Name: Date: P a g e: of dhl-
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Peference R-Red Item PLEASE PRINT CLEARLY Ve I rifled
zltlz'� / z UA) C-71- bn
<
"kc:)�- C� c').-)C12-1 Hb617.1,); 1�2eA o r,
'-*qa) n /"A a in) 1A1,. —f A f-,.,)o 6�-I, J(2o r� 06'_/7, j
t, lef U-N, Ct.i-viC A( � �-An (v, "I
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12�, 54
('ov e? 4,1 14, )� 1��j T 1� k't_)0 AJ&V4— W00j,_',
A )
14
A-46 . X' (,)C4
J�_ 11/7 '
iscussion With Person in Charge: _Fco��tlon Aequired: NV
LD Voluntary Compliance 0 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 e=inspection Scheduled Ll 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 0 Embargo Lj Emergency Closure
your food permit. yk, Ll Voluntary Disposal 0 Other:
'IfIrtess Interventions and Risk 3-5w,ww) PlIFI;Rexived at'Femperatures
Violations Related to Foodborne According to Lom Cooled to
Facitors(Ifernts,1.22) (Cont) 4 1�F/45'F Within 4 Hours�
1-501 15 ckiolmI,Imet.has for PHF&
PROTECTION FROM CHEMICALS
14 Food or Color Additives 19 PHIP Hot and Cold Holding
'�1-201_ 12 Adiiuite,�* 501.16(B) Cold PHF�Maintlimed at or below
3-302.14 Protection froill I jnappro�ed Additives' 590 W-Iff) 410/450 F'
15 Poisonous or ToAc�ubstanms 1-3f)[AWA) Hot fflf-,i.Mainiained at or above
- 16.11- 1 Idt'lair"Ing Ini,(,!Inlamp -Orl"'inal I 140'F t I
z-51�J.tt)IA) Roa�t,Hdd at or,ibukc 13WI;
Time as a Public Health Control
ownion Nanw-. W,irkint"f"Jwaln�j,,
I Public Health Control-
Sto:ag,",
-1 n2,1 Pi:qriolial ilod I 'e, Re�tfirvwcllf
Cofafili"s), it Uwl
Conlajnel� --
-n3 I I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7_204�I I -Ownlic.ii, POPULATIONS(HSP)
21 ;-1,11 1 NAI Unpaaeui iy,�d Anucs wid
"-2CI4.12 Ownii(afs fin kN a,hing, C titez i�i'
I i with Varuim,
I U4 14 DI Nlng .kvext�.Criteria, I - I
I -_ I Sk A fBI U�i:I,!
P !kv or Ilailtall.;Ciok�fj Aninial [--kx.-d�itid
',-2(;6.!1 ke,irl,f�d V,� ilft!M'
L
d Scrsvd,
----------- iif('; I U;j"p%:[ted Rxii!Pat \,)I
Monti,:iq,�
CONSUMER ADVISORY
TIMEtTEMPERATURE CONTROLS 22 k oll,Ili III'(Ad I r I,-OWI(011,11111 ot
It
Pieper Cooking Tompe�aturvs lot t J(11
PHFs
�5 !� i5 st"'.
inail"dow st�l 1 5 ii-1:�e, S.Ihs,:.Ii;,, fo� liav:.S�IQII
1-1-4_01 I.!!-I i%��,
SPECIAL REQUIRFI0,FNTS
I VI, S,��`T(Z�
Itwff!� nlii'111, I�ll Ip at i'ld
�;,:Iwlxj 11w
o!
T
f'4 tl r L A L C
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S
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I" !Z'j F""a I r P
Ue I
,-4(:', 1 HIE) R�rlawlno 0,14 etail p- tactIces 59-00DO
Gper Coo PC, I Ck 4
lin—go—IPH-F...s- 2-
';(!I 14iAl I C�q)k4"j jifj 1-" 11 Inj ------
PJL r4lt'i` PC"-I �x
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17071[i',ra;IlTe
lkllh,n� li'All"
"Ilwal 11eill"I I,r",1,tim C1, I: ZI,
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Ali,,I�t _117,4- /�O_" Date: P�/ A /1)(; Page:-/— of S?)
Item Ccde C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data
No. Reference R-Red Item PLEASE PRINT CLEARLY Verified
P4, L5 11 r�
aq A'041
1"a AZ,4L4 ,P.
PAI) aJ
Y12)yi 7�
I I/ lo� r)A'k f S�)7 V
AAN4)�� rp,,)) rv,1 ,4-
0 4t\,
_2eD [�)JJA4"rl' Cj(/11Z417W_ 1/1 V
DA
k
Discussion With Person in Charge: Corrective Action Required: o No RPre.'es
o voluntary Compliance 0 Employee Re!
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 KRe-inspection Scheduled 0 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 o Embargo Ll Emergency Closure
your food permit. lk -) 0 V� 0 Voluntary Disposal U Other:
J
Violatiorts Related to Foodborne,fitness Interventions ard Risk 3-501 )4((;) PHF�Remwd at Ternper,,itures
Acwrdintf to Lu� Cooled to
Factors(Iteiris 1-22) (Cont) 4FT-/45'F Within 4 Hitins t
PROTEC71ON FROM CHEMICALS 3-50LIS Cooliri.��Nlctho&for PHF&
19 PHF Hot and Cold Holding
14 Food or Color Additives
,-50!.16(B) Cold PHFs Maintained at or bolow
3-202 12 "'IditfNeO 59C, 41�141�F'
1-302.14 Pi otect ion from I jnoppro%ed Additi vc� 1,1 of A) I Int IIHF�Mattitained at(ir abive
Polsorvous or Toxic Substan�s
101.111 1�1"rtifyiffg infiL1111�11;j�n k)tj"in�t;
Hdd ai orabove 1309�,
Coinaiii-r,,,
20 1 Tim as a Public Health Control
102,11 1 Common Narm mvam�!r,'
svm,,ulon- swia"',
N"'ranco 1,�,Julmlmlt
2, of REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
,-�ol [I Toxic confaincl, POPULATIONS(H§_?j_
Critvmi
21 11 !,,di —,"I'ud JwL�� did
7-204,12 Chouical,f�q 111,xktct, lj��nal
2 0 14 1
4 Di-ong Avcvt�. u-i ia i
!!iBl L k,! Pa,min,Cd
0 1,X) Cimino.
"k-knimal
Vw,� S, Nol �wj�VJ.
7
med
�()(i I-Z
P"'. ,Jitr J�wl
-- ---- COM�U%IER ADVISORY
22
TIME,TFMPERATURE CONTROLS
i Proper Cookirig Temperatures for 'A''11al j1C t:n,7ruA,ikVd
PHF- �ol tljw!, �c
!:!1 1 ;Af, I m, 1, 51, -------
't'd !�N"N 1
w
ltAi, i� Vj,0'r,, Ik if! hC
16,
z:
it r'I"! TO f4i;A�ti '�RXX
I f V 2 %;,u�-
I 1h P� R'l 1,1, to t !:W!"
zor�t y Rvr� P'ar 11cp
23
1 Proper Corning of PHFi;
S01 1 iiA� ('whrw(:,x)k�d 111-114 1 �f�
Wkihir, i im,i.,id Fr,�m 1,11
3
iti,Pi IR M:,d,- Fion �Q, 'J
EXAM FORM NO. 10167
CERTIFICATE NO. 7262307
IF 0
F
R
11 C
M N
A T
0' 10:'67
E NO" 7262307
ServqSaffiee Clefe-tificatihn'%fl,
..... 'CHARY PARKER
To ZA
for successfully completing the standards set forth for the SerySafe"Food Protection Manager Certification Examination,
which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection l
8/18/2010
DATE OF EXAMINATION
8/18/2015
DATE OF EXPIRATION
Local laws apply Check with your local regulatory agency for recertificavon requirements.
NATIONALA7
RESTAURANT
ASSOCIATION,
Paul Hinernan
#0655 Execut.ve Director,National Restaurant Association Solutions
02010 National Restaurant Association Educational Foundation.All rghts reaniried.SorvSas and the Si logo are registered trademarks of the National Reassure at Assoc lanion Educational Foundation,
and used under license by National Restaurant Association Solutions,LLC,a wholly owned subsidiary of the National Restaurant Associabon.
This document cannot be reproduced or all
IW70201 v.1007
J.
Commonwealth of Massachusetts
City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/04/2010
ESTABLISHMENT NAME: O'NeWs Bar and Restaurant
File Number:BHF-2004-000042 120 Washington Street
Salem MA 01970
LOCATEDAT: 0120 WASHINGTON STREET UNIT C
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes
FOOD SERVICE BHP-2010-0075 Jan 4,2010 Dec 31,2010 $280.00
ESTABLISHMENT
Total Fees: $280.00
PERMITEXPIRES Decernber3l, 2010
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4r`FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DC.Ri-r�,NI3AUMa;ALE?,1.COM
DAVID GREENBAum,
ACTING HEALTH AGENT
2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT 0 Pa 13 /- 1Z/;-5-f- TEL# 61-7 t- 7 tr-o -FrI
ADDRESS OF ESTABLISHMENT /I (W -IZ4 t.-1q5H1A1v-7)91 5� FAX# 5-o F- 66 e) - g Irs,
MAILING ADDRESS(if different)
EMAIL- Business': Website:
OWNER'S NAME RO AIIVIC- TEL#
ADDRESS � 9 1,A10i,5qA- 9/Z— 4F- ozo
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(s)Affv�ll,' 51tvl; CERTIFICATE#(S)6A- n374-s7
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON AOAIAIIC— 1-51W7AA1 HOME TEL# 53 K- t6o -K41k'4
Ny oym
HOURS OF OPERATION 30 30 11, 30 30 4f, 1 /2-0,
Please write in time of day. I
(For example 11 am-1 1 pri) I-o. Ari /.Zn /-.00 17rl /-00 '411 1 /-00
TYPE OF ESTABLISHMENT FEE (check oniv).
RETAIL STORE YES NO less than 1000sq.ft. =$ 70
1000-10,000sq.ft. =$280
more than 1 0,000sq.ft. =$420
------------------------ ----�d--------------------------------------------ie-s-s,-]��n...2S---saais---------------4-1,4-0,....
(Outdoor Stationary Food Cart$21 25-99 seats =$280
more than 99 seats =$420
--------------------YE�§------i4d------------------------- -------- - -------------- - ------------------------$-1-0-0,------
CHILDCARE SERVICESMURSING HOME
-----------------------------------------------------------------------------------------------------------------------------------------------------
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify underthe pains and penalties of pedury that 1,to my best knowledge and belief,have filed all state tax
returns and,, id all state taxes required under the law.
/Z -/9- 0 D 3(,--7 5// Av
igna e Date Social Security or Federal Identification Number
Revised 4/24/07 FOODAP2008.adin Check#&Date %I q $ Z&
4.
Salem Board of Health
Massachusetts Department of Public' Health 120 Washington Street,4 th Floor
Division of Food and Drugs Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel;(978) 741-1800 Fax (978) 745-0343
Name Date Tyqe of Ooeration(s) Tyqe of InaDection
.C.29 -5-Food Service Routine
Address Risk El Retail Re-inspection
Jc,16,A J_�, Level El Residential Kitchen Previous Inspection
TelephorqJ944, - (J [I Mobile Date:-4/,, to2
Owner - HACCP YIN El Temporary 0 Pre-operation
J�ai�l cd 0 Caterer El Suspect Illness
Person in Charge(016) Time El Bed&Breakfast El General Complaint
In: 3,1 HACCP
inspector Out: TuL) Permit No. El Other
Each violation checked �equires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009(F)
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT' 12. Prevention of Contamination from Hands
[-] 1. PIC Assigned/Knowledgeable Duties
EMPLOYEE HEALTH E] 1�1. Handwash Facilities
PROTECTION FROM CHEMICALS'
M 2. Reporting of Diseases by Food Employee and PIC
El 14.Approved Food or Color Additives
E] 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE,
E] 4. Food and Water from Approved rce TIMEITEMPERATURE CONTROLS j06teiritially Hazardous Foods) t
E] 5. Receiving/Condition El 16.Cooking Temperatures
E] 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
E] 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling
PROTECTION FROM CONTAMINATION �9. Hot and Cold Holding
9 9 'of' -120.Time As a Public Health Control
El 8. Sap'aratiorAe' re aion�l Pr action E
9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY suscEpTiaLe POPULATIONS(H&)
El 21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
E] 11. Good Hygienic Practices CONSUMER ADVISORY,
[:122. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report,when signed below
C 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
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
the food establishment permit and cessation 6f food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you
i127. 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 501�,�F��14d. (0,,)0,7�
0 ,
Inspector's Signature: Prinl*\L)
PIC's Signature: Print: kje7y�ev I%,^, Pge�--f-1 Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 590.003(A) Assignment of Responsibility* 3-302.111 A)m Raw Art mal Foods Separated from
590.003(B) Demonstration of Knowledge" Cooked and RTE Foods*
2-103.11 Person in charge--duties Contamination from Raw ingredients
3-302.1 I(A)(2) Raw Amim�il Foods Separated from Each
EMPLOYEE HEALTH Othery
2 590.003(C) Responsibility of the person in chaj ge to Contamination from the Environment
require reporting by food employees and 3-302.11(A) Foori Protection-
applicants* 3-3011�L5 Washing Fruits and Vegetables
590.003(F) Rsponsibility DfA Food Employee Or An 3-304.11 Food Contact with Equipment and
ApplicantTo Report To The Person In Utensils*
Charge* Contamination from the Consumer
590.003(G) Reporting by Person in Ciii 3,--,06.J4(A)1B) Returned Food and ReserNice of Fon&
.3 51)0.003(D) Exclusions and Res'erictions- Disposition of Adulterated or Contaminated
Removal of Exelasions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B i Compliance with Food Law* 4-501.111 Maraud Warewashing-Hot Water
3-201.12 Food in a Hermetically Scaled Container' Slniti7atio-.i'feiiil,,eiattffes�
3-201.13 Fluid Tvililk and Milk Piaducts* 4-501.112 Mechanical Warewashing-flot Water
3-202.13 Shelf Eggs* &uutization Temperatures*
3-202,14 Eggs and Milk Products. Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-2(12.16 Ice Made From Potable Drinkin-Water' I concentration and hardr
4-60 1.11(A) Equipment Final Contact Surfaces and
Utensils Clean�
5-101.11 Drinking Water from an Approved System- I I
590 006(A) Bantled Drinking Water* 4-601.11 Oeani-q Frequency of Equipment Food-
590,006(B) Water Meets Standards in 3 10 CMR 210*
Sheifflah and Fish From an Approved Source I Contact Surfaces and Utenqils*
3-201.14 Fish and Recreativaratly Caught Molluscan 4702.11 Frequency of Sarritization of Utensils and
Shellfish" I Food Contact Surf�aces of Ectunnuent*
4-703.11 Methods of Smitization--Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed I Chemical*
S.surces* 10 Proper,Adequate Handwashing
Game and Wid Vu-17rooms Approved by
Regulatory Authority 2-301.11 Clem Condition-Hands and Arrns�
3-202,18 Shellstock Identification Present' 2-301,12 Cleaning Procedurc*
590.004(C) Wild Mushrooms' 2-301.14 When to Wash�
3-201.17 Game Animals* ]I Good Hygienic Practices
2-401�I I Eating,Drinking or Using Tobacco"
5 Receiving/Condition
3-202.11 PHFs Received at Proper Temperatures" 2-401.12 Discharges Front the Eyes. Nose and
3-1-02.15 Package Integrity' I mouth*
3-101.11 Food Safe and Unadulterated 3-301.12 Pfeventing Contamination When Tastimi*
6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintame& Employees*
Tags/Records:Fish Products 13 Handwash Facilities
3-4()'.r I I Parasite Destruction� Conveniently Located and Accessible
3-402.12 Records,Creation and Retention* 5-1-03.11 Numbers and Capacifies*
590.0040) Labeling of Ingredients' 5-204.11 Location and Placement*
7 Conformance with Approved Procedures 5-205.11 Accessibilitv,Operation and Maintenance
/HACCP Plans Supplied with Soap and Hand Drying
3-502�I I Specialized ProcessingMethods,* Devices
3-502.12 Reduced oxygen packa�aing,criteria's o-liti.I I Handwastring Cleanser, Availability
8-103.12 Conformance with Approve I Procedures* 6-304�12 Hand Drvin-1 Provision
'Elvin,l"eririwl acna in the federal 1999 Foist Code oi 105 CNIR 500000
CITY OF SALEM
BOARD OF HEALTH
Establishmeni Name: n' f\jr . 11- I)L 'ZAI, Date: (I Page: of 4nt
Item Code C-Critical Item Date
" ';1 DESCRIPTION OF VIOLAT ION/PLAN OF CORRECTION
No. Reference R-Red Item verified
PLEASE PRINT CLEARLY
Hop nokJ �)a� t-Iviuci A�-A
-S I ao� Cr\,0 -0- 0 .4 e �� av OT4;:-:r &ka�dA r)
I A C "PA4- <J01 P-1 01 1
Da— 0,-�� cwc , L IQ nAA )D� t c, � -k�p 4
I "- , I - — I '-'_ _n _kn' L�A I
<jnnA 4 A4 0— r
n Or 0/) It 6 4-4,40�N
ry wi re
C_k YVL,(-t (-�C C�J\Jel_'-W rl IV) S�pe(;'A 13.,— LAn,-4-
?,q -7
arVA
Discussion With Person in Chirge: Corrective Action Required: Li No
�j Voluntary Compliance 0 Employee Rdstriction
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 X/Re-inspection Scheduled 0 Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily f ines of twenty-five dollars or suspension/revocation of 0 Embargo U Emergency Closure
your food permit.
L3 Voluntary Disposal U Other:
1 3-50, i'lit"l FI ff,, �d li�
Violations ffol�tiof to Foodborne Wooss triterlentlow;and Risk Ai:ovdinf,iz,1�,,, Ck�wed Ill
Factanq(item 1-22) (Coot %V;lhiq : itqi,s
PROTECTION FROM CHEMICALS s f:_1 Cur VIIF�
it) l rHF,Hot and Gold Holdino
14 Food oi Color Aefdilives
i "AW,I hfp.� t':W6 PliFN ma;nzj'�rred at ,z �dtlw
-20 ,12
i-30?-14 P((V,�o i'm frol I I I jill,ppro"�0 Add i I i�e
I j 3 �>Q i,I&A.� I int 111-11 MamT.mi,ld't or ilbove
Poisonous or Toxic it;ubsumces
bit if Id"trill[Vill'! "Tillior'llop - 011"'illal 141� t2 -
I or bo%it
Clillialners,
1 20 Time as a Puthfir Hrl-�fth Control
7 10-2,11
j9 �lvt as �:PuNiQ i�otklth Convi-4
7-10 1.i I SQ�Ia�lulm- Sit))il�c'
7-2011! R,,,ui�tlon- Bf,.�wc aud L,e'
if 7-20",12 Coqdlllqm�ol Lts�:'
7-�0, I I jo�il,17 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS(HRP)
20,4.11 0,ewic"ll,-
21 julcts lied
�'o; �4'v fling i""tdhl�o e.;iwli�t
wifn V�fe-imilt Lsblk-'
7 ')0414 Dl Viol,Atrua�.Criwl id
Incidl-ilt"d Fk�xl Coillflo� blhtp:Ar'w of
J) klx-it, Pato"W% (2,4,:d Animal I:kxd jud
Cti.Pc�o'adrzi'C;it�lln
Rwv S,��d Spnwis Not Svot3.
Rodent B,,a Si�t ('
i0fl,131 'frich'i � i 1'r:'lDel'ed flx-,d NO! V(' iCletl
g ollir'l"Ild
CONSUMER ADVISORY
2-1 ii)'�.I vlMl,oil,Pv�i�il f,,r ol
nMEfTEMPERATURE CONTROLS
Proper Cooking Temperaturef,for
16 i Rav,. Cndcr�)kcd o;
')dwt
Pmrs
W! I All l("'i Fqi2.,- i 55'F !5 S,��
;-46 IJ Fi'h' .1'1=� G'vilv LJ
Allift,ui� 1�51' 15 �C-
401 t SPECIAL REQUIREMEWS
il�,Lk and lifo.arl lifi F 1 11 min'
�li sealull
WO)
'atoriou" z"whih,If fln,'p,iLa v and
1 IiA)�,31 Foii;tr). Wild ri�vic, Sto!"01 1114F%, rc%Illonl tii 1:iti.hert opclrwion�AloOd be
k�ow;llmltt Foil. kviltat, oollovej llndl�t !N'-
w 65"it 1'i S�c tlb"�c ;f;'A'll�"d ill ftK0X",rnv dillosl;
14i'11 5')f).!v-4 violation,;reintn", to�'L�Kj rowl
i': Raw Animal ill pr�ttdkc,-� haAj ioe�J6i;cd uiidtl�r 1'29 -
�Ie
I ai'thcol-mr.
3-701 ItAq1vtj All 111W, I�st F l' r�
17 RLIllatim;to-Hot H.Olding VIOLA TIONS RELATED TO GOOD RETAIL PRACTICES
3-103�1 I(Ai& D) 11W, i�ll F 11-5, �' - f I teikitt 23-Miji
i I I 1 13) 10' f, Mviuw C�6'i� 1i rl;T',W I'll, do'lo; rCizlf':;o 1;1.�
;iw i4ja,zor�ii,wdall'.vc an bl,
it(:) 1 Conlrq�lcidl� Prw'i�icj PIE f�lw"dl [oftld ilt cri;fli: Fthq'('ldeal�d ltl)� ("AIR
f4l�'Fr
UlVhced porti�""4 Bof:i em , Cood Reta;,Practices FC 590.00
i: tZrtnqom�-Iwid Peo orinci FT, 2 W3
Food Ptoj��tj,,
r wo��nd R,- 4 W4
18 Pr r Cooling of PHFs ------ 11---.�
Te f !-FC
501,1 A(A)
i-Anif(*(ok,it PHI-'s frow 140'F to
Pit.ritbino vac,
70'i� withly, 2 Hour,�!rd From't'Wl i 2-� 0,tysiord.Fr'��lftv Fc, o�'7
to 4 1 T14i F Within 4 How,
2P, ofl,l')nrJ3('t rn'�' F-C-7 00a
5f)1,14(ld i I Cooliiw PHI,',kladc Vrom Ambleol
Ti:mp,,-r,a kirt: I w�Tedi wtt'1"4 1�Fi-;5 T --Othf,r
Wittlie.11 ikurs
V�,'Io� lile-0 Item ill t'. wdo;,1 I I Old k "r I t"."04':'9ll 00")
CITY OF SALEM
BOARD OF HEALTH'
0, Date: Page:
Establishment Name: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. fe :e— R-Red Item Verified
PLEASE PRINT CLEARLY
4, og(4,> d:qj—�n,
A 0 r, qOQ-1-:
Ceaylpl rr-A�(4 I 1114110t- if 1) d. CA
'.A J 4, r, j-ye/
D1i,q1)(* -)- ,o1? 02
it WL )c.,, vr� A7, J4- e )It-4
4-1,
If
C,1, 51L /,S -'C3C eAP d L J,4t 4 bW r) (14061-1:7 1
ID -4.5lo (A &sirwl!�*4 J- —1-JAA) 11�bQp- <�4-r-�kt a. eli r,�'
C� ,j `r6rrd) r, vp 4u--) DA�
L M
14(1 k to (1/)r* r S /Ij� ��cQ -4?,j �?p Z4 o(
Ici 4 .6-01, a (2 N<, ot--V- !Qo-�-J TOY ./rAA o ye rj 45�)rti 'v 6(A r 0 ,,1 1 )"JeA
Ll
+A 0- <4yll kt,�) o"
Discussion With Person in Charge: Corrective Act ion Required: Ll No ��S
Ll Voluntary Compliance U 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 Ll 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 U Embargo U Emergency Closure
o voluntary Disposal 0, Other:
your food permit..
vb
j-30; 14, PHFs Reened at Tenifteraturos
Violations Related to Foodbutne ffines.,Intorvontionsand Ri3x Acvordir-',�lo I�N% Cooled to
Factors(items 1-22) (Cont.) 1-1+/4'�T-WMiin 4 Hours.
3 '�)O 1 1 5 Coolina Nlednxk for PHFs
PROTECTION FROM CHEMICALS 11
I'l Food or Color Additives PHF Hot and C-n!.:l fielding
3-501.16tb) Cold PlIrs Maintained taor bcjoA
3-202.12 Addju�es�' I
�590)0-10F) 41'1!�5�
3-302.14 Protection fronj UflapproNed Additivci:, Hot PIIFs Mjiyaawed at orabow
15 Poisonous or loxic SubstancesI
7-101.11 IricnWynn,Inforwation-OnIg 40-1".
linal
Container;- 3-4GI 10(A) Roasts Held at or.,.ncoa 130'F.
7-102.j I Conan,e, Nante-Working-Coiitaatzrs� 20 Time as a Public Health Control
7-201.11 Separation-Stojat�elt 3-50f.19 1`im(�q�tt flt�b�ic li�jnli Contro."�
7-202.11 Re,ariction-Prcscnce and Ue- 5�)0.004(14) Vatianct-Rcquir�rnent
7-1102.12 Conclii�ons of Use-
7-20111 Toiic Gaitaintcr,,-Profi'bitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATUCNS(HSP)
7-204.11 Saniti-wi,.Criteria-Chernic--is- )1 3-801.1!!A,i L'tiptMeurized Pw-packagcu huce-,,,nd
7-?04�12 Chejiaica!�fiv Washing Producc.Criletial i3cvei:c,cs�mth Wamme I.abets-
7-204.14 Drving Agents,Criteritly
7-22'05.11 Incid..,mal Food Contact. Uihrwnms� 3-801JUB) USC Of P�StcdliZed E.-I"S'
3-801,11(P) lta',t or Pat tia!Iv,1"(vkec!Animal Food and
7-1206,11 Remrictod Use Pe�iicvdce;�Craerw*
Raw Scej Spiouts Not Scned.
7 206.1) Rodent Bait Statiow.' Unocened Food P,,I,-,Iagt Not Re-seneti.
7 706,13 Tracking Powdeis. Pest C,-ntro' mid
',yfiariitorinl,,�
CONSUMER ADVISORY
TIME)TEMPERATURE CONTROLS 22 1-603 It Constimer Adv�sor,Posted for Consumption of
16 Proper Cooking Temoeratures for Aninial Fmkis'lliat are Ra,,-,. tfnalerc-�oked(it
PHFs Not Otftcr�;�e Proce�s�d to-Plitirinate
I`athog,,-ns.--
3-40 1.11 X 1)(2) E�-,,�- 15 y-F 15 Sec.
Eggs-hirmediate Service 145�1`15svc- 3-302.i3 l"IStIEUroed FggS Sklb��UU;t- For Raw Shell
3-101.1 I(A�(2) Commouned Fis�, Mears&Cjanx� Fl�gs*
At,;rajils- 15,5'17 1
SPECIAL REQUIREMENTS
1 3-401.11 i,I3nI;-I'2) Pork and Beef Roast 130"F 121 niin* 590,009,A)-(D) Viti'Xions of Section �90-0169(A)-(D)in
3-40 1.i I(A)(2) Ratites. loJecti-d Meals- 155'F 15
sec. * catering, wobile food,teinInctra'ry and
3-401 11(A)(3) Poal�ry. Wild Gante,Stufled loffs. I uNiciential kitchen operations s!iould be
'�ulting 0, 1 -
nitarraing Fidi, Meat, debited wnder file appropriate sections
Po0try or Ratitcq-165"F 15,wc. al-tovc ifielated to foodl,orne iiiness
3-401 111 C)(3) Whole Inuscle, Intact Beef Stea" interventions and ri:;k facrors. Other
1-1511F* 500.009 violations relalin'.�in go�-)d ret;i)l
3-401.12 Rim Animal Foods CoakM in a pricliics�hould bc cehited undler 1/21)--
Mioowavc 165'F t Spec tat Requireatcalts.
3-101,11(A)(l)(b) All Other PIIF�-- 145"F 15 see.
17 Reheating for Hal,Holding WOLAVONS R,!LATE0 TO GOOD RETAIL PRACTICES
3 4W.I I(A),k(D) PHI- 165'F 15 sec. (Iterw 23-30)
3-403.11(B: Microwave- 165"F 2 Minute Stand'Ing -c; Ical v; kgyon�, iihh�h do not reluIc io ihr
TiDIC'
foodbo-ae dinevs intei veniion und riskfiw�on� Ii ved above. (an be
--403.1 li'C" C0ngAICrCIaIIV Piocessed RTL Food- iind in the Wg sn'titais orthe Food ode and 105 CbIR
fiolloo i
140'17� 590.006�
'i-40;�I I(r�,) Roiconint,Uri.iliccd Portions of Beef item i Good Retail Practices 590,000
Rotsts* F�-
P3. lvlara.j�nicIni?nd Pe,sor-II6 1, -2 .003
Proper Cooling of PHFs 24 Fool and Food Protection R---j 004
'1-501 W 'Colinu Cooked PYIFs from 140OF it, 25 Equipmenll and Ulem;fls 4 005
A)
:16 Wale-, Paanbncl ano Wa�to PC;- 5 0o"
7()r,F Withm,2 1 lour� and From 70' 2-i Phv-,ical Facil,tv PC-6 ()07
u,4 1'17/45�17 Withiti 4 flows. t 1 28, Po'sonrius a I oxi�Malprials FC--1 A08-1
3-501.14�13) Cooling PHFs N PP St)ecrai He wrements
Mado Fron, Ambient q
Temperature higred';enis to 4 I'F/45 F
Wition 4 11our;;',
I lknlo�es cr:11(al Item In Ific folectl 19()Q 1�,wd,"mk-or 105(Wik 500 OotI.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name:00(" k Date: 31;)-�7 /x' Page: of
Item de C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION ,:, Date
Verifil
Co R-Red Item I
N110. Reference PLEASE PRINT CLEARLY ad
A I A o,,,o(_ —�—v
_4 I- 1A V,A
<:�)4 'c4
r
0
i t 0 J7 jr sa�/7 4- :Z Z:
�V, f.JO,/_t� AA;,',A 4�11_1- 41 t-
ter-e/I y'?0 A 1"'l,/
rr? r /,,j ;Ir,-'761 t�+ C./ 4%-_-rN_9 r-,AA U�-o 5t---- C_
(a-0 cJ (_J, _�jr, A, A)A, J f -
J
6ro,— IJA)— U k—"r 0/-,/ r� RA12 4,� d 12e A-10-47 4,,
uqE -,n sef-v( 1, r-wole-e `0
r(r_/? AJ(IL�A rd f4eAJna,,�
V
Discussion With Person in Charge: Corrective Action Requiredl o No
1 have read this report, have had the opportunity to ask questions and agree to correct all El Voluntary Compliance Lj Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to e-inspection Scheduled LI Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand -that le
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Lj Embargo Ll Emergency Closure
your food permit. u Voluntary Disposal 0 Other:
Vio4ahoos Related to Foodborne fflnes�Interventions and Mair Tdirig IQ I-iII Cot'led III
Factors(item 1-22) lConQ 'Xiihin 1 Htaus.
PROTECTION FROM CHEMICALS 19 f PHF Hot and Co!d Holding
14 Food or Color Additives
.4 201-,Q i roM PHI"'I'imilt,imt(I at kc,h,low
31-302,14 Pwto�,uon from UiiappTI,,ed -%dditiyc�'
Poigonotts or Toxic Substances I(tt A", 111,1 i'l-Wit Mitiplamed at or abow
101.11 lklontifying Imi,i mtt�on -Od.-inal, 1*07 '
11,ij it,or,ibvv I'O'F,
Contain,(
1 imc as a Public Health Control
7 10211 OMMOTI Nitro, -- \h(.rking(owam�ri-
I ti'j.J�� I'm-irt't;a ojK,ti I 1,:ialth C(ailrol,
sopaiawin- slu"ag"., ,1(11) 'eqw..'alent
-iffl� Vur;an(-.�R
-7-20111 lz�qricok,n- rr.�:a nor "au I 1, 0
7-2(cl, C�iadii:�at, 411 T iN",I
RFOUMEMENTS FOR HIGHLY SUSCEPTIBLE
loxtc 03ntamett� .-prohIlunonl'�
7—`04.11 Saniiiicrs,Cru,riii cbrinic;,W POPULATIONS rHSP)
-1,")1,1 11 A) 1:it,:iq ou r,fod PI"pocl,,I�cd jui t�3 wid
2 04�12 Ch�nu;:Zd,i"s Aashitq� f1ri6acc, tueiia' I I
lil,""laiidi,willi Waintn'.
7 204 14 Dning Aiicmi,.Cni�ria'
ms It fma&atal Fcod Ctwnct,I,ih!ivam,,.
11;D1 P,IV ka-Ii.1111-11h, ct'lit"t'lAnitnal Ftrixi alid
7�206,11 R�Anct,:�,i Lisc Pel�twidft, C;iti tit
7-�0(3,12
R(A�mi B�Iil St tu"'IN, No lk,� si�rviol,
'hir&mg PoN%,ler�,P,sl(Aititrof and
CONSUMER ADVISORY
TIM MEMPERATURE CONTROLS of
Aitintl I I�qxj I'llia ii.L R.Aw Undef"Xiicd ,I
16 Proper Cooking Temperature,for
PHFs v,isi:PrI,,xtssed to ltl:nmi.�
I],%f 11(-') 1: 1,53 F 15 5
13 P.Mcurii,:i,i Fg��-�ul)�Littuc fo ite;nIt Shell
C,)imnuiult'd Fi:h Meai:; K (i-unt
SPECIAL REQUIREMENTS
3 1101.1 Pin I, and fitivi Roast - I 1!) 1, 121 Imp
401.1 hM 2, Ralst,:�, lnjcc,�"d kfv,lt�,- l"t5 F I If SQ�:�iott in
z,aler�i)L, mot, ",
III, t�md,le7np;a-ai v Ind
401.1liAy,ii Iloaltr.�,Wild !�wlrcd NiFs, kild,---n aper�tioiis shoi.,ld hiii
'�iaffi�w Comasnini,- lilk�ail undi;r Ihe appronri,itc, ;K11AMS
R�uiti,,krRiiotoq-165"It tf;scc. ahi,vc if it)fit.KAlborric illocsit
Wht,fe InpCI Intel ITIMUons and rii;k factorii, Other
t'45,+' vir,�Illton,;relakino to"lokii-I road
R;i,%- NnIuLd a Ix. dchilm1witicr #29 -
-40 1,1
%4ljk.t,,Wii�,i Requirizillicylts,
40 1,t i(A)(.1 Y b) Nil othel Hfi',%; - 1,15`1 1� ie,
17 Reheating for flat Holding V;OtAlIONS RELATED TO GOOD RETAIL PRACTICES
0) )"1 it 4 Ic5'1- 1 hetn,,23-�M
3-4W,l l(8) I Nliorwtaw- 10,F,2 Mmili�,sum'Im" Ciw.a!��Io m-n-,"'I".al i'1:1ch do trol 1/,,'
1 Tiim,' ("ni"t
�-403 11(C) Orri'met(I'dly pro,�,,�d RTL FIXIt- fi,twt,'�,pi th, of ilw I...)d C11,11?
14(1'F' 00U,
340 1 Mii pwniairuu�',U10tiTd IIt,rt1,,qS of Reel
22 1_11 —2 1 OW
Proper Cooling of PHFs 24 F,�Jd,nd Itw t,iou:,�tlor, 004
---- ; F-C - 'i
qu: �Am arid utc-�,;�N 005
501,1-I(A) Cixilin�Cfok,'it MiFs fort, 140'F'1, 22 . —--—
2c, i FC-F, rX16
7�,,F Within 2 1 lour,wid From 73";ii
to 41'�145 F Within 4 11,uu,
or T,,�yt,klit?efz�!s FC - w?
3 501.14(Bi PHF,Made Noll Ambm-of W9
q, 30
T�inpofirtutui In,�rc,':unt,,I,41"P/4S
Within.1 lkiwl�
i:rvical t;�iiim th, li�'!e'it Fiut,! 0.,(,Mk IIP)tA JO,
,_I- - V -,*to-% q,�'� '"P I !,, c I f,
49
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,4 1h Floor
Division of Food and Drugs Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343
Name D tel Tyqe of Ooeration(s) Type of InsDection
nwpm� Pj64- k)ns4vurcll)-� 0-Food Service El Routine
Address [] Retail
Risk'- ER,Re-inspection
Level Residential Kitchen Previous Inspection
Telephone 9*y El Mobile Date:,-,) Plib? .
Owner HAC El Temporary El Pre operation
1Z,�^ C' YN 0 Caterer El Suspect Illness
Person in Chal rg� Time El Bed&Breakfast El General Complaint
In: El HACCIP
Permit No. El Other
Inspector
Each violatio
n chocked requires an explanation on the narrative pa6e(s) and a citation of specific provision(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [:1 590.009(F) E]
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT. 0 12. Prevention of Contamination from Hands
1. PIC Assigned Knowledgeable TDuties El 13. Handwash Facilities
EMPLOYEE HEALTH
_ 1�1 � , " PROTECTION FROM CHEMICALS
El 2. Reporting of Diseases by Food Employee and PIC 1 11 _ _1 , I I - � .-
El 14.Approved Food or Color Additives
E] 3. Personnel with Infections Restricted/Excluded 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE", '7
E] 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Haiiirdoui Funds)
El 5. Receiving/Condition El 16.Cooking Temperatures
Ej 6. Tags/Records/Accuracy of Ingredient Statements Ej 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling
PROTECTION FROM CON I TAMINATION A19 Hot and Cold Holding
El 6-�e��r�iio"n-'/'S-'e'gre-g-atio'n'/Protection'' El 20.Time As a Public Health Control
E] 9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMIENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),,','
E)21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
El 11. Good Hygienic Practices CONSUMER ADVISORY
[122. Posting of Consumer Advisories
,Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report, when signed below
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
�5. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food
6. Water, Plumbing and Waste (FC-5)(590.006) 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
28. Poisonous or Toxic Materials (FO-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 501ns�CfFo�14� F A"-+,�zy?1�
IInspector's Signature: Print:
\1 '7�o ril-
PIC's Signature: Print: v 7 1 V I Page_�of&Pages
( e�A
Violations Related to Fopoiborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 590.003(A) Assignment of Responsibility' 3-302.1 l(A)0) RaW Affinal Foods Separated from
59 Demonstration of Knowledge* Cooked and RTE Foodst
2-103,11 Person in charge-ditties Contamination from Raw ingredients
3-302.11(A)(2) Raw Annual Foods Separated from Each
EMPLOYEE HEALTH I OtheO
2 590�003(0 Responsibility of the person in charge to Contamination from the Environment
tequire reporting by fm 3-302.1 wk) Food Protection,
applicants* 3-302.15 Washing Fruits and Vegetables
590.003(F) Responsibility 01'A Food Employee OrAn 3-3(A. Food Contact with Equipment and
Applicant To Report To The Persi Utensils*
Chargt* Contamination from the Consumer
590.003(G) Reporting by Person in ChargO I 3-306.14(A)(B) Returned Food and Reservice of Food*
3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
I Food
590.003(r,, Removal Of Exclusions and Restrictions 3-101�I I Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food andl/Vater From Rogulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law" 4-501A i I Manual Warewashing-Hot WaLer
3-201.12 Food in a Heriueticall� Scaled Contqiner* Sanitization Temperatures*
3-20 t.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-I-Iot Water
3-202.13 Shell Eggs* Saintization Temporatures,r
4-50LI14 Chemical Sanitization-temp..pH.
3-202,14 Eggs and Milk Products.Pasteurized*
3-202.16 foe Made From Potable Drinkin-Water* concentration and haidi
4-60 1.11(A) Equipment Food Contact Surfaces and
5-fOl.I I Drinking Water from an Approved System-
590.006(A) Bottled Drinking Water* Utensils Clean,
590.000(B) Walej Meets Standards,ut 310 CIMR 22.04, 4-602.11 Clearain,g Frequency ofEcaupment Food-
Shellfish and Fish From an Approved Source Contact Surfaces and Utensils*
3201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipmel
4-703-11 Metho&of Sanitization-Hot Waterand
3201.15 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 Aarns;4-
3-202.18 Shellstock Identification Present' 2-301.12 Cleaning Procedure*
590.004(C) Wild Mushrooms- 2-301.14 When to Wash*
3-201.17 Game Animals* it Good Hygienic Practices
51 Receiving/Condition 2-401,11 Eating.Drinking or Using Tobacco*
1 3-202.11 PHF.-,Received at Proper Temperatures* 2401,12 Discharges From the Eyes, Nose and
3-20115 Package lntegritv� Month*
3-lul.]I Food Safe and Unadulterated 3-301.12 Preventing Contamination When Tasting*
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
590�004(13) Preventing Contamination from
3-202.18 Shellstock Identification
3-203.12 Shellstock Identification Mwnuuned* Eiiipl(,,Nees*
Tags/Records:Fish Products 13 Handwash Facilities
3-40111 Parasite Destruction* Conveniently Located and Accessible
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacilies*
5-104.11 Location and Placeinent*
590.004(.1) Labeling of Ingredients'
7 Conformance ivith Approved Procedures 1 5-205 11 Accessabilitv, C)ueration and maintenance
/HACCP Plans I Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability
8-103A2 Conformance with Approved Procedures- 6-301.12 Hand Drying Provision
Dewae.xr crittud iteni in the Waal 1999 Food Coile oi 10i(NR 590 000
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: C� OQJk \2 4�4A-�f Date: Page: of
item Code C-Criticalitem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date le
No. Reference R-Reditem Verif d
I A� PLEASE PRINT CLEARLY
:?JYJC,�i
I A r 3 �0 4��, rQ 4-1 — o c�a
a
t
+C
V(rjC�, 4-d0Y_C� 124 ILI.m� A40 - z
)J'
_5�)_x- c(u, 2 -5
4r.3-f=.
�r J/) rrir( 4-�J 4:.p 6ZIL
'kt_6J_ C`f- 47 A�-L D�-f
o
)A, rr- I r C
1h a,.� -�u AAct +vch�,) P.A_z� 411 U
IN CrA n
or
C�`?6A_J bo K)M Ci I A 0o A'Aei )e— ho
_It
T bX Yes
Corrective Action Required: La No
Discussion With Person in Charge: I I A
I have read this report, have had the opportunity to ask questions and agree to correct all 0 Voluntary Compliance 0 Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to )(/Re-inspection Scheduled L:j Emergency Suspension
comply �ith all mandates of the Mass/Federal Food Code. I undilirstand that
noncompljance may result in daily fines of twenty-five dollars or suspension/revocation of U Embargo 0 Emergency Closure
your food permit. Ll Voluntary Disposal Ll Other:
Violations Related to Foodbarre illness Interventions and Risk kIvOrdir'l it,I'laNi ctvlm III
Factors(Ifismas 1-22) lCon&�
I F14:';iF�V iklan 4
Method, l"or VHFF
PROTECTION FROM CHEMICALS PHF HolgInd Gold HoWing
14 Food or Color Addifivin,
I Col';pffl�, MiiIIkv,aCd at(tr
3-2(0,12) 4J"!45" F'
'-302�14 Prutection firau t�majipri,%,Ill Addinvei' �111 16,A) I hil P141- Nf%intame'd-It el above
Is Poisonous or Toxic Substancerl
licld at wbul,,t, I A) 1%
I inge as a Public Hitafth Control
ColarlioriNane
galth Control'
V�elame
7-202.11 Ri,,tiki�on-Pwseau and
7-102J2 l"Ol REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
1,-�03 t I Tmic Colllalnll(� - prohibitionse POPULATIONS(HSP)
7-2�A.11 salirlile,�'Crilt-i;1 ('111mic,W
7-2W 12 Chow,gl�1�m �Nzt,fiwr P!ojocc,clitw:a, 'avd Jwce�wid
Pc�,ev:t—s wilh Wlmim,.I
L204 14 Dj vnilI Aicmt.Cm,.,I
3-�l I I z")i K"N,, 0.4,(ld Amimal Fmd mid
7 1.15 "A01 ll(b� o'paqtan;-'d r."
'-206.11 R,:,moed Vw Pe,ocIdey,Critei ta I I
7-206.12 P(Xlew Be4 Spuiiiiil,' St
I z Kf�l I hct Uw?pt,"Ied FXxi pakk�kg� Not Re-�Crved
CONSUMER ADVISORY
22 11 Congtml�t At�,isory Nlil 1�)r(-Itusktnjpu,,n of
TIMErrEMPERATURE CONTROLS
16 Proper Cooking Temperal tot A�lhtml f I Itai it,: kaw, Undz;roxlkv,J I;
"I",�Stl to Flil"Iflafe
PHFs
,-401 F g-5 F I� S,�C.
7q) h,lo�inf�d Fvw�;Stlbsttw%�J�n l6vl Shl!lt
Eve,i- Inapt,diatc i ST 15,,c,
-K)1.!I(A)(,) Comminoted Fcl), 0 mt,
Aniilmk. I�,S`F 0
SPECIAL REQUIREMENTS
3-401A Iffl)(I)i 2; Po(k tiial IiM RIlmi 130'� 121 rn�n�
ol Secuen "I)o(W))(A)��Di in
i-4f)1.111 AV 2) Palm�, lllgi,tw tl mN ;."s F 15
I'arklring, mohile, klliti, kemportuy wid
I AY 3) op�natirtns tic.
V"1111tr'It,Wid Gawe� �wlfetl PHF-s, rcmde
Clmtaii,in�Fmlt. Mein, J1cbikd Undt!r III,: gel LI011l,
1',mi4rl, or R-witel; 165�1,' 11"Ove if'wLill it)tkilxlhtirm�
3-401 PiCf(3) Will,Ile n lwic-le Int"'o Beit stcakr iroe)v(l)uunt;,oi d Ii�zk fa�torg. OthcT
1 4
iw Anlitul 5,K��,Citl m a praclikeN iho,Ul fIe detitcil und-r #29
K)3 F
I(A)H,lih) All Othei Plfi--�-- 14g'k, 15 ,ec
17 Reheatinq lot Hnt Holdmq VIOLAWNS RELATED TO GOOD RFTAk PRACTICES
5-101.1 I(Afki P) ]'Il I ]IS"F I (Ileireg 23-30)
3-4W.J I e b) Nbcrowavl-,- I05'F2.Nimwe Stgnting cliifl'd, g?"!wla-,riigl.al �l I,,&igj; i-jur, ll�III,
Pjg,,,-,sd RTF hxid- ["wIl"ill �vt Til-m" I,,!the Food ude'Ind P)5 CIAIR
140T� -,�j
;iL---71
3-403 1 l(F,t R�rriamm- Un,titled Pvt um(if i�vel t, Good ROO Practielel* FC'
2� Mayem,rt and Pellmnirtl oo 3
c:L
Pruper Coollng of PHFr, Fc;;�j Prc�,��i�o'r PC- I ml;
501A,4(A) CtNIliap C,xxi,dPl4Fs filmi 144)'[-4 to �`Tjlanl�P2.!Aqf-1!L�fj-!a FO- 4 LIC§-
2i5l rc-5 006
70'17 Wltillm 1 1 I-wl�114j J�Igln)7f1I`j-'
Phy�-a F80,10lt PC -6 OU
cktion'jij,-�r Torw KlIeT,w Fr - 008
3 gol 14�pl C(g,lut',,HIR Madc Fvmi Ambient p lyJ9
Temperatite hyredients iwWI,i45 F 10 Cqhe;
wittim 4 1 4AII I
il,01)vnod('Al:'r 105 I'Mil 5900il(j
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; Tel. (978) 741-1800 Fax (978) 745-0343
Name Da T a of 0 eration(s) Type of Insoection
C_-,�00- Irir-awr,11 '377/0� 9 Food Service Ej Routine
Address$ Risk El Retail R Re-inspection
I d C9 Ln <,4ypad [] Residential Kitchen Previous Inspection
Telephone Level D Mobile Date: �7 to A.�
q 1-8 1 r [:] Temporary [I Pre-operation
Owner 1'�.c I k_� HACCP Y/N I [I Caterer El Suspect Illness
Person in Ctiarge(PIC) Time El Bed&Break-fast El General Complaint
I !i�
n:l 0 El HACCP
inspector Out. Permit No. El Other
Each violation c-fiecked 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) E] 590.009(F) E]
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMIEkT ' , El 12. Prevention of Contamination from Hands
1. PIC Assigned/Knowledgeable Duties
El 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 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
FOOD FROM APPROVED SOURCE. '
TIMEITEMPERATURE CONTROLS(PotentlellY Hazardous Foodsj
4. Food and Water from Approved Source
E] 5. Receiving/Condition 19. 600kin,g'Tarperatures
El 6. Tags/Records/Accuracy of Ingredient Statements 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans E] 18.Cooling
JZ�9. Hot an Holding
PROTECTION FROM CONTAMINATION "' 0
- I— .-I'll I I 1-1 - I- - ..........
E] 8. Separation/Segregation/Protection El 20.Time As a Public Health Control
El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(kSP)'
El 21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
El 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 CIVIR
of Health. 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 r
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
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 50i�fFo�-14� /0 H 0 4 k,7,C�_O"
Inspector's Signature Printoow�)�ty
PIC's Signature: Pagej oQ/
Print.,q,, 0 ir I I _Xages
Violations Related to Foodborne Illness
Interventions and Risk Fact ors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 596.003(A) Assignment of Responsibility* 3-302.11(A)(!) Raw Animal Foods Separated from
590.003(B) Demonstration of KnowdedpO Cooked and RTE Foods
2-103.11 Person in charge-duties Contamination from Raw Ingredients
3-302.11(A)(2) Raw Aminal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590.003(C) Responsibility of the person in charge to Ccniamination from the Environment
require mportin,by food enifiloyeas and 1302.1](A)
Food Proleciion-'�
applieams* 1-102,IS Washing Fruits and Vegevall�,
590.003(F) Resporsibilit) Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
A Uicnsils*
, pplicant To Report To Tire Person In
Charge� Contamination from the Consumer
590.003(6) Reporting by Person in Chartie' I 3-106_14(A)(B) Returned Food and Reservice of Food*
3 590.003(D) Exclusions and Resulctiorj%* Disposition of Adulterated or Contaminated
5()0.003(E) Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditionin2 Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A B) Compliance with Food Law* 4-501]11 Manual Warewashine-Hot Water
3-1.01.12 Food in a Hermetically Scaled Container* Sardtization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechiinical Warewashin-flot Water
3-202.13 Shel I Eggs Sanitization Tenmcrrrture�s
3-202.W Eggsand Milk Products,Pasteurized* 4-501.114 Chemical SanitiLation-temp.,PH,
3-202.16 lee Made From Potable Drinking Water- concentrar non and harth
5-1 Ot.I I Dnnktn�Water from an Approved System* 4-601.1](A) Equipment Food Contact Surfaces and
590.000(A) Bottled Drinking Water* Utensils Cleaa*
590.006(B) Water Meets Standards in 3 10 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-
Shellfish and Fish From an Approved Source Contact Surfaces and Utensils*
3-201.14 Fish and Recreationally Caught Molluscan 4-702.1 i Frequency of Sanitization of Utensils and
Shellfish� 4 Food Con'tact Surfaces of Equipmer
3-201.15 Molluscan Shellfish from NSSP Listed �-703.11 Methods of Sanilizatioin-Hot Water and
Sources* I Chemical*
Game and Wild Mushrooms Approved by Proper,Adequate Handwashing
Regulatory Authority 10 2-301.11 Clean Condition-Handsand Arms*
3-202.18 Shellstock Identification Present* 2-301.12 Cleanim,Procedurc*
590.004(C) Wild Mushroums� 2-301.14 'When In'Wash*
3-201.17 Game Animals* Good Hygienic Practices
S Receiving/Condition 2-401.11 Eating.Drinking or Using Tobatco*
3-202.11 PHTs Received at Prover Temperatures* 2-101,12 Discharges Front the Eyes, Nose and
3-202,15 Package lnteLjitv* Mouth*
3-101.11 Food Safe and Unadulterated 3-301.12 Preventing Contamination'Mien Tasting*
12 Prevention at Contamination from Hands
6 1 Tags/Records:Shellstock
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identil'itation Maintaine&' Employees*
Tags/Records:Fish Products 13 Handwash Facilities
3402.11 Parasite Destruction- Conveniently Located and Accessible
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacifics�
590.0040) Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved Procedures 5-205.11 Accesi;ibilitv,Oi)ei ation and Maintenance
/HACCP Plans Supplied with Soap and Hand Otying
3-502.11 Specialized processing Methods* Devices
3-.�02.12 Reduced oxygen packaging,criteria' 6-301.11 Hindwashinp Cleanser, Availability
8-103.12 6-301�12 Hand Drying Provision
Conformance with ApproNed Procedures*
'Denoles'critical acra in the federal 1999 Ford Code ta 10�OAR 590,000,
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: nl �jaafj Date: 3J-T�";. Page: of =' _=N-
Item Code C-Critical Item Date
DESCRIPTION OF VIOLATION/PLAN OF CORRECTION
No. Reference R Red Item PLEASE PRINT CLEARLY Verified
IN V 6. Av-tJ.4 91rA 10'5 4�
C,n L it Al) c,4 (6
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at I 10r,4,f 5 A, 0/ ;:Ir,. /I A .::;,.4
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3 120�_Po�r 11r,"-flo —'L k_J) J�- J'vel'�' I KI fl '�
ILI
-P AA lc� a f,"
Corrective Action Required: La No Yes
Discussion With Person in Charge:
o Voluntary Compliance o 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 R�) inspecton Scheduled E) 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 0 Embargo 0 Emergency Closure
your food permit. 0-0 1_'kA Li Voluntary Disposal C3 Other:
Violations,Related to Foodborne illness interventions and 1113h ns IA,k Cwks]It
Factors(item 1�221 (Coot)
4 PFI-i�,-F V�idial l Kim
-,5 0 1.1 J fiv PHT-t,
PROTEC'nON FROM CHEMICALS
14 1 Food or Color AtIdiCV86 14 PHF Hot and Gold Holling
i �n 1.l oqt) l'i,l;l iit�b,jo*w
s9c"ok,
3 302�14 Pmlecli,in from linapprw.tid Ndditvcs ;-501 INA) Inq PHF�Mairnmned at Iw ab,,x
Poisonous or Toxic Substances
HM0 at or atvve I 301-�
cmltaill�ls'
Time As a PuhfiC Hojtth Control
rim� a a P0114,�1 itIalrb
7�'02.11 Pn,,x_,,CC allil U�e'
7.1!)2.;2 Cl,adnion,-ot Us,,
mau.,RwENTS FOR HIGHLY SUSCEPTIBLE
I I POPULATIONS(HSP)
1-2',)4,i I Salliti-,"r�.crilerl'a-ChellikiW
t '-SW IhAt Unpv,zcnri��d Pit: pai-I aged jwts zind
7-"(4.12 chollicni:,ful Wa�hil,g,hoditce, clit'nia,
7-204 W Diyina�Avent�,Critna" Vamins'lal�Olsl
;_Sol 11flil U4Z,. f Pas�
--ms'll intidernal (:vnlac'� kaw"i lialuall" C-�Ak-d Annual Fkxtj'ind
7,206,11 io��Incleli Via: Pe:lit nif., C,inn;,)I k -
. S�"'d -pri ull,
7-206.12 RtAk"ni Bs4 Siutlon�. 3 1 II(,j IZ,�O No
206,11 Ti,�kjrii
g Po%%der�, P-,�it Coutrul and
CONSUMER ADVISORY
12 1
emumu( P(y.;t,,d 1�,r t%on�kimption of
TIMEITEMPERATURE CONTROLS
I Alml-I F sd, arc UWerCAXkrd Oil
1 16 Proper Cooking Temperatures for i
PHFs \,m Ofll,�rwiw flms�esse�i to 11zininaw
)-ff)j 11 A i 155'F I'S%.o Patho,�n�.
A� tiEA Fy,Siih01j1v fo! Ra%�,5101
F,�!gs- $cc I
Comminint,t] Fkh—%Ieat�&6,11111:
Aninials t i5 ! I-,; ,Ck
4.401.1 103)(ItD Pori, and B-I�l R4 SPECIAL REQUIRWENTS
I, I tart 1101-, Q] nil", 5T 00);At I)) Vidj!ions 6 Scbcn in
It-,))A I(;vy �I kwile%, lf�wc!;,fl klcah - 1 j4, I- i
ca,�riov, tnobik (�Iopolal v and
3 4I]il.IliAy I) Poultr%,Wild Gallle�sruleed PHF�, �itchl�v �botild b--,
solffilia l�,qalnlrlg Nloilk% lichted tuidcn flic appropriate�-,iions
Follnry'�,r Kttniw�-165'r lfiwc, ' a)j,,'TC: I f r�ilai ed t I,f,-,<xlhon I: 10
3AQl,lJiC)r3) I;c��l Sis�;IK� ;k1tel ventlml�and Ki"'k lackorq, ftij)cr
W51� i
511O.W9 vlolation�relakino, to�old rt�lujl
3-401.12 RakN Ccw&�A)it a Pl,acflce� ho,lid be d0itcd und-j�r #29 --
Mlo'yvavc W5 11"1
2-40lA i(A)il0l Ali Oirnin Pf fF,- 145,lz 15 stQ
17 Reheating for Hot Vc!tnng VIOLA PONS REI A TED TO 0OOD RETAIL PRACTICES
3-103.11�Ajsk�,(D I Pill, 1� �C� f1teini 21,,10)
;-103.1!'B) Nficrowavt:- 16�%'T'�, klinui,�S%,,andin�, Cn1w,I1 aw,POP, �,6,h tic,not 'e'nre l'i flu.,
Tirre" 1�bwv�IIIT�t vein;,,av-md rctkja,tort 1,�Ied zlh,w�, (on br
3-403.11(Cl Comwrviallv Proe,ised RTl% �iod- zp:ht- fil,"I Coth,wid P�i(31P
140 1P
Itent I Good Pltsd Practices T-F'-
34)3 11 i F I Rcilialtini"unihi-ed Pwt7k1n,I0f ll(�Cf
P,,js1,4 lvla�rtgqql�,Il and pof�",)Talej F1, 1� oil 3
18 Proper Cooling of PhFa 2;i--- ---- Foxi�md FoW Piotscnorc FC 604,__�
:i 501,14(A) Coojinizc(x&��(IPHF, ironl 1441'Fto
no
I:iGr q'T'd V1 I,$Its FG-5 006
26% 1 we,, ,I�I,I,
71"F Within 1 liotn�wid Prolti'10-1 27 Phys;ca!Fix�tli!y_ FC, -6 ON
to I!'F/4 i F Witljn 4 Hotw,, Poi,,jllou� -,Tix, Matonji3 i FC-7 d0z�
............ ------ I
ji 1101 14�'B) PHF:,Makit i-wni Artil,lent 009
Tcinpztavn�Invedi(jity to 4 1"P45 F 1 30
%I,qhln4l-tkAtW
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,e Floor
Division of Food and Drugs Salem, MA 01970-3523
FOOD ES�A'B'LISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (976) 745-0343
Name Dato' Tyne of Ooeration(sl. Tyqe of Insoection
1, t/%T 4�Aorrely� 7/Q/Q cl 2!-:Food Service C3 Routine
Address Risk Retail Re-inspection
Level El Residential Kitchen Previous Inspection
Telephone El Mobile Date:
owner HACCP Y/N El Temporary El Pre-operation
icy RA,4 El Caterer El Suspect Illness
Person in Charge(0 Time 0 Bed&Breakfast [I General Complaint
HACCP
inspector Out:1) Permit No. 0 Other
Each vIoIat167WcfiicVed requiresRan-explanation on the narrative i5age(s) and a citation of specific provision(s) violated.
Non,compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009(F)
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT,'
1. 1 1 "1 L1 12. Prevention of Contamination from Hands
1. PIC Assigned Knowledgeable Duties El 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
Reporting of Diseases by Food Employee and PIC El 14.1 Ap proved F I ood o"rCo.lo I r I I Additive's
El 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIMEJTEMPERATURECOtiTROLS(PatiiiWyHazi�do6sFGodsj
El 5. Receiving/Condition El 16. Cooking Temperatures
El 6. Tags/Records/Accuracybf ingredient Statements El 17. Reheating
0 7. Conformance with Approved Procedures/HACCP Plans F_] 18. Cooling
PROTECTION FROM CONTAMINATION ..... . El 19. Hot and Cold Holding
El 8. Separaiionj,Segregation'/-Protection El 20.Time As a Public Health Control
0 9. Food Contact Surfaces Cleaning and Sanitizing f REOUIREMENTS FOR HIGHLY SUSCEP-naLE POPULATIONS(ASP)
10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP
11. Good Hygienic Practices CONSUMER ADVISORY
C3 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
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
C N 590.000/federal Food Code.This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of
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)(510,011) 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 5M��'F��Kd.
Inspector's Sign op Print:
ature:
Print: Page
PIC's Signature: oL_3 Kages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 596.003(A) Assignment of Responsibility* 3-302.1](,A)(],) Raw Annual Foods Separated from
590.003(B) Demonstration of Knowledge* Cooked and RTE Foods*
2-103.11 Person in charge-duti�ts Contamination from Raw Ingredients
3-302.11(A)(2) Raw Ammal Foods Separated from Each
EMPLOYEE HEALTH I Other,
2 590,003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by too( 3-302.111 A) Food Protection,
applicants* 3-202.15 Washing FruiLS and Vegetables
590.003(F) Responsibility Of A Food Emptuyee Or/w 3-304.11 Food Contact with Equipment and
Applicant To Report I o The Person In Utcnsils*
Charge* Coniansiration from the Consumer
590.003(G) Reporting by Person in Charger 3-306.14(A)(B) Returned Food and Reservice of Food*
131 590.003(D) Exclusions and Rcstriction,�* Disposition of Adulterated or Contaminated
590.003(H) Removal of Exclusions an([Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Foo&c
4 Food and Water From Regulated Sources 1 9 Food Contact Surfaces
590.0(14(A-B) Compliance with Food Law* 4-50 1.111 Manual Warewashme-Hot Water
3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures*
a-501.1 12 Mechanical Warewashing-Hot Water
1-20 L13 1 Fluid Milk and Milk Products* I
3-202.13 She][ Em� Saritization Tenmeraturc�
3-20114 Eggs and Milk Products.Pasteurize& 4-501.114 Chenucal Sanitimnon-temp.,pit,
3-202.16 lee Made From Potable Drinkin-Water- concentration and harchiess. * I
v� 4-00 1.11(A Equipment Food Contact Surfaces and
5-101.11 Drinking Water from an Appro ed Syqtem� Densils Clean-
590.006(.A.) Bottled Drinking Water*
4-602.11 Cleaning Frequency ofEquipment Food-
590.006(B) Water Meets Standards in 3 10 CMR 220 Contact Surfaces and Utensils*
Shellfish and Fish From an Approved Source 4-702.11 Frequency of vanitization of Utensils and
3-201.14 Fish and Remationally Caught Molluscan Food Contact Surfaces of Equipmer
Shellfish* A-703.11 Methods of Sanitization-Hot Water and
3-201.1i Molluscan Shellfish from NSSP Listed Chernical*
sources* 1; to Proper.Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.11 Clem Condition-Hands and Arms4
3-20118 Shellslock Identification Presenv� 2-30 1.12 Cleaning Procedure*
590.004kC Wild MusLwms* 2 301.114 When to WasW
3-201.17 Came Animals* Good Hygienic Practices
S, Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco*
3-202.11 PFTs Received at Proper Temperatures 2-401,12 Discharges From the Eyes, Nose and
3-202.15 Package Integrity* Mouth*
3-101.11 Food Safe and Unadulterated 3-301.12 Preventing Comairrination When Taqtin_-�,
6 TagslRecords;Shellslock i 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification:, 590.004(F) Prevemitut Contamination from
3-203,12 Shelhaock Identification Maintained" Ernplovec�'
13 Handwash Facilities
Tags/Records:Fish Products
Conveniently Located and Accessible
3-402,11 Parasite Destruction� 5-2013.11 Numbers and Capacities*
3-402.12 Records.Creation and Retention"
71 590.0040) Labeling of Ingredients* 5-204.11 Location and Placerncnt�
Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance
JHACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methorls* Devices
3-502.12 Reduced oxygen packag 6-30IJ I Handwashing Cleanser,Availability
ring craciiO
8403.12 Conformance with Approvcd Procedures- 6-101.12 Hand Drying Provision
-Denotes craiud isem in tire Federal 1999 Fx)d Codcoj 105 CNIR 590.01)0.
CITY OF SALEM
BOARD OF HEALTH
Page: of
�)a, Date:
Establishment Name:
Item ' Code C-Critical Item - DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date
ified
No. Reference R-Red Item Ver
PLEASE PRINT CLEARLY
IS
Discussion With Person in Charge: Corrective Action Recui�e� 'W-1 S
ect all 9—Voluntary Compliance 0 Employee Restriction
I have read this report, have had the opportunity to ask questions and agree to Corr Exclusion
violations before the next inspection, to observe all conditions as described, and to El Re-inspection Scheduled u 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 0 Embargo U Emergency Closure
your food permit. u Voluntary Disposal U Other:
Vialafform Riltated to Foodborre,llftwels ffitervertions cnd Risk AccklrdiP,-io Uw. C(,IA,,d I,)
Factors(Ifem. 1-;W) jCont) i"I'Vidmi I Htltw.�
3A01 i�
PROTECTION FROM CHEMICALS
14 Food or Color Additives VHF HIM and end Holdinc)
Cc1l P11F, at(v L-lvw
4i"4�)�I;,
-2W1'1 uflle�'
3--,0114 Pi,aer�),vi ircim UmqTro,ell Addiliw,
1 :; "3 1 1 1 tw ab-iw
poisonous or Toxic Substances
Hc�'d illor'Nwc J30,'F
7 1021: 1 Time Its I Public Hisaflof Control
Lmtt�'ienjlh
'7-2o2'l; Rc'lrifj!':n - Plc�mlcowl'l L�c� 2MIMe
7-N)2A2 cwldvi�w'.4 U';�"
REGUIREMENTS FOR HIGHLY SUSCEPTIBLE
Toxt� Prollibi'mil" POPULATiONS(HSP)
7.204.11 sinit ivcr'�Cri"wrill -cllemik':'K� 11
I :-X" !�(A) t!;Ij 4 111 U I I PrL�.I dt�',:'gCd an"i
7-24.11 Ch,.nlic�ll! fm NA63'hll'� il!'Kltwe� Cdlodo- i I
lvit�, 'Waiimitl labdt,-
7 204,�'4' Oi�nw AvcInt.Cr4ort'Xe I
: �"St i,i I"b' L K�0 h�tk,�il4v,f
HWA -,-4 Anqmll Fcl J t�id
7
-206 �I nel it'
7-206.12 Rcllctil L"It skalioll� Mau St.'d�'protit�Nt'l Scl%�d'
if('� ct� 'polw-t T ,,A Paw;:as-�v "Not
Fiacking drtd
CONSUMER ADWSORY
2Z I 34ii�' I! Jkluqmv i po4"'j "r Coo,alarlption of
TIMEITEMPERATURE CONTROLS A
Proper Cooking Temperauives Itor
N�,;
PHFs i
4W I I Ali I it 2) F"tgt,. 1';� F 1'�5, Pwhr'K'-rc.-
3,3k:'.I 1',�ctcori7t,i Shell
1
1-4f`IIJI(Ai0i�1 C�lmlivil"I"d h't", Mad'� G"'Inv
sec,
F 121 niiiil SPECiAL REQUIREMENTS
�q� t "qt'A" (1), vi',!�11!%)I,� (,I se,twil Q0(X)9i t In
-40 1 11(A)� -�ti �&"I�' I�1�1 15
Sec.
w.,biled allavi.the aJ)j'rt'nriW1C cc,P)AN
Fih'
.".VF t5 3�:C. wimed 1") illvo�
3--irHA IICVJI� '�10"'!� blum Ile-'f Sloaks teiW'Int, 01�d r;s� fitictor-.. Oit�cr
i45T, I rctall
pi actucc, ihoilld 1v dk-bitM :oidt-r 1/1-9 -
l0i't
2
�-401,1
jj7 Rcheating tor Hot Holding
VIOLA TION.13 RELA TED 7-0 600V RETAIL PRACTICES
(Z!ws 23-310)
403.11,At,,(111 161,17 15 qc'
�1%:al libi Nficiowl �e ll,�'F 2 Miltui-Sizindirr, li';1OP ic'l' 'which di'l'107 "eh;re!o lj'�-
laic milt It I,,m��w,! i,,k rs It,!cd In be
t C) Connoevia:]v F*fE t"Iold ill lh�';c'bollmg W th, Food Cod�'twel CMN
3
140'P,
3 403 1 l(Ft Rcria,larn, 1�11'bcetj pordl:n,;oj'B'�I �2!ism 1 Good Reni0practlCes FC 90,000
mlarl"elerne'ra ard Pelf'onnal
FC I r03
Proper Coolinq ot PHF,1 Fr,,A na Re-la Ftol(�t;ov FC - ^3
F-
- 4 AC15
it, ,uin
*'N' i0l q ��C'IN im vt- I Will
70'Y%k"ittim 2 1 calc�ilnq Fr�,jn ------
�Y phv�lf al�6�41il FC-6 '007
1,, 1 J'FA5-1;Witilin 4 f lovl,� r(; - 7 001
kla*w'at�
Cot5l4w PHF� Viidt� Fr�m Amheia
ifie,
NVIll'iri-1 Imils
n6-;jI�clll ill If,,lo'!er'� 1�9't lo'�l i"A�'f W"i
COURT DOCKET NO.QCITY OF SALEM P, CITATION NO
VIOLATION NOTICE 6451
lNAME(LAST,FIRST,INITIAL)
ciwc-)L\,'5 ?wt- -,-
STREETADDRESS CITY/TOWN STATE
so-' sn"k��'
LICENSE NO LIC EXP DATE DATE OF BIRTH
OWNER'S NAME(LAST,FIRST,INITIAL)
STREETADDRESS CITY(TOWN STATE ZIP
I'v e"-)zx"r4 vjm5�*k-;' r,�% Cla�olll-1
REGISTRATION NO STATE I EXP DATE � MAKID7YPE I YEAR JCOLOR�
DATE OF VIOI-ATION TIME DATE CITATION WRITTEN I��EJ�SONAL
ri AM - U�,
c., Y.;El Pm 1jr
I ClYESj
CI No
LOCATION OF VIOI-ATIO InLxAlcl ENFORCINGDEPT.
OFFENSE CHAR SECT�FINES
A
B
OFFICER I D NO TOTAL
FINE $)ct- lL
I DUE I
_QFFICER CERTIFIES COPY GIVEN TO VIOLATOR
IN HAND
x BY MAIL
DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY
ORDER OR BY CHECK MADE PAYABLE TO
CITY CLERK
CITY HALL
93 WASHINGTON STREET
SALEM,MA 01970
TEL.(508)745-9595 X 251
1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON
REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE
PAYMENT IN THE AMOUNT OF
$ CASE#
SIGNATURE
SEE OTHER SIDE FOR FURTHER INFORMATION
ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL
COURT DOCKET NO, CITATION NO.
CITY OF SALEM
VIOLATION NOTICE
PD6221
NAME(ILAST,FIRST,INITIAL)
6 "t:�.) L-�'ls 7�
STREETADDRESS CrrY/TOWN STATE ZIP
)-IQ N--Ala*�V 6-5-0, z,�-lk
LICENSE NO LIC EXP DATE DATEOFBIRTH
OWNERS NAME(I-AST FIRST,INITIAL)
*��o\,llj�lllj
STREETAIDDRESS TE ZIP
JTO T
CITY
REGISTRATION NO STATE I EXP OVE, N MAKE,7YPE YEAR ICOLORI
1 0 L7 I
DATE OF VIOLATION N TIMBt�, — DATE CITATION WRITTEN IPERWNAL
m INJUAY
AM 0 YES
oVlk 11 VIFTIRM ONO
LOCATION OFA�IOLA\Ohl ENFORCING DEPT
OFFENS�E CHAP BE 11 FINES I
0 UA
B
C
OFFICER 10 NO I TOTAL�,
OFFICER CERTIFIES COPY CjIVEN TO VIOLATOR
j \ HAND
x L-] BY MAIL
DO NOT MAIL CASH-PAY ONLY13Y POSTAL NOTE,MONEY
ORDER OR BY CHECK MADE PAYABLE TO
CITY CLERK
CITY HALL
93 WASHINGTON STREET
SALEM,MA 01970
TEL.(508)745-9595 X 251
1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON
REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE
PAYMENT IN THE AMOUNT OF
$ CASE#
SIGNATURE
SEE OTHER SIDE FOR FURTHER INFORMATION
ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL
Commonwealth of Massachusetts
City of Salem
Board of Health lQrnberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Estabtishment Permit
DATE PRINTED: 12/30/2008
ESTABLISHMENT NAME: O'Neills Bar and Restaurant
File Number:BHF-2004-000042 120 Washington Street
Salem MA 01970
LOCATED AT: 0120 WASHINGTON STREET UNIT C
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes
FOOD SERVICE BHP-2009-0328 Dec 30,2008 Dec 31,2009 $280.00
ESTABLISHMENT
TOBACCO VENDOR BHP-2009-0329 Dec 30,2008 Dec 31,2009 $135.00
Total Fees: $415.00
PERMITEXPIRES Deeember3l, 2009
Board of Health 11'f'All All AM,41 14
114
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,an
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
CITY OF SALEM, MASSACHUSETrs
BOARD OF HEALTH
120 WASHINGTON STREET,4`FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978)745-0343
NfAYOR IDIONNERNALF.M.CONI
JANET DIONNE,
ACTING HEALTH AGENT
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT 0-1AT1tz,'5 P413 �- )Ze57� TEL# '77 f- -74-o - 9'X//
ADDRESS OF ESTABLISHMENT 1Z Cf-17-6 1,r145H1,vC-7,)iV 5T, FAX# 50r- 660 - r7WX
MAI LING ADDRESS(if different)
EMAIL- Business': Website:
OWNER'S NAME A0WRIJ 1,51?06*AA1 TEL# 617- r 3
ADDRESS 9 t7111,01__-AA1 vlupb��f 174 DFo 3 Z
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGERS NAME(S) A"11-7- 511,ilA CERTIFICATE#(S).L/,�o 3-7 �eS7
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON 9041191,12 611,OeRil/ HOMETEL# /9/7- 9'3 7- 0o
1�DAYS OF,OPERATION� -� 'I:r. -'Monday Tuesday , I" WedfteidaV,, " Thursday- ' 'I Friday Saturday.- 1 Sunclay:
Please write in time of day.
HOURS OF OPERATION 144-3D 09tl 3,D A ti 111-3a /9r1 3a qrl 3a 1?r-1 1/- 30 A?rl Z,00a
(For example 11am-11pm) I-oj Rrl u..5.41-7 4ri 0a 1;
TYPE OF ESTABLISHMENT FEE (check onIA
RETAIL STORE YES NO less than 1000sq.ft. =$ 70
1000-10,000sq.ft. =$280
more than 1 0,000sq.ft. =$420
----------------- ........e.2`,-'3.... ------------------------------------------ ---------------------------------------------
(YE 146... le"s's than 25 seats =$140
(Outdoor Stationary Food Cart$21 25-99 seats =$280
more than 99 seats =$420
-----------------------------------------------------------------------------------$160,------
CHILDCARE SERVICES
----------------------------------------------------------------------------------------------------------------------------
MAKE (not just serve) ICE CREAM, YOGURTISOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of pedury that 1,to my best knowledge and belief,have filed all state tax
returns and paid all state taxes required under the law.
e_X� 125_� //_/,�_o X 0 3 Lt-7,5-//c�
Signature Date Social Security or Federal identification Number
------------—--
Revised 4/24/07 FOODAP2008.adm Chmk#&Date Z X 7L 11-1X-0K $ 4�/5'a�
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,4 1h 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 Type of Operation(s). Tyqe of Insuection
0 a I c,,--,+ cv� Food Service 0 Routine
IAddress Risk K Retail 4:Re-inspection
;)� . � Level El Residential Kitchen Previous Ir)spection
Telephone El Mobile Date: �7 ka tj
Owner HACCP Y/N El Temporary El Pre-operation
Caterer El Suspect Illness
Person in Charge(1216) Time El Bed&Breakfast E3 General Complaint
In:1,)� 1-0 [] HACCP
inspector Out: Permit No. El Other
Each violation checked r6quiris an explanation on the narrative page(s) and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009 IF) E]
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT_ , " I'll ; I I I. . : El 12. Prevention of Contamination from Hands
171 1. PIC Assigned/Knowledgeable Duties El 13. Handwash Facilities
EMPLOYEEHEALTH TION FROM CHEMICALS
PROTEC
"i Reporting of Diseases by Food Employee and PIC
El 14.Approved Food or Color Additives
F] 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE'
E] 4. Food and Water from Approved Sourca� TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
0 5. Receiving/Condition El 16.Cooking Temperatures
El 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
e pa El 20.Time As a Public Health Control
El 8. S ration/Segregation/Protection
E] 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEP-nBLE POPULATIONS(HSP)
EI 21. Food and Food Preparation for HSP
10. Proper Adequate Handwashing
11. Good Hygienic Practices 'CONSUMER ADVISORY
[122. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/fecleral 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
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
126. 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 50M�aF�14 d. X�_ ,
2
Inspector's Signature: L
Zrinntt:: -1 IIA Page
PIC's Signature: ofa Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT Cross-contarrination
I 590.003(A) Assignment of Responsibility* 1-302.1 UIAKI) Raw Animal Foods Separated from
590.003(B) Demonstration of Knowledge:' Cooked and RTE FoWs*
2-103.11 Person in charge-duties Contamination from Ran,ingredients
3-302.1 I(A)(2) Raw,Animal Foods Separated from Each
EMPLOYEE HEALTH Other r
21 590.003)(C) Responsibility of the person in chatpe to COolan)IMN(in from the Environment __j
require rQporlln�by food enif 3-302.11(A) Food Protection-
applicants* 3-302.15 Washing Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An i 304�11 Fund Contact with Equipment and
Applicant To Report To The Person In Utensils,
Charge' I Contamination from the Consumer
590.003(G) Reporting by Person in Charge! 3-306.l4(A)-,'Bi RetumcdFood aradReservice of Fund*
13 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003(E) RenioN a] of Exclusions and Restrictions Food
3-701,11 Dis=din-,or Reconditioning Unsafe
FOOD F90M APPROVED SOURCE Food�
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
59U.004(A-B) Complianct;with Food lawr 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Scaled Container* Smitization Temperatures*
3-1-01A3 Fluid Milk and Milk Products* 4-5011.1 L2 Mechanical Warewashing-Hot Water
1-202.13 Shell Eggs* Smitization Temperatures*
3-202,W Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sannizanion-temp.,PH,
3-202.'6 Ice Made From Potable Drinking Water- concentration and hardness. * I
1 4-601.11(A) Equipment Food Contact Surfaces and
5_101 11 Drinking Water from an Approved System- Utensils Clean-
590.006(A) Bottled Drinking Water*
590 00t)(B) Watei Meets Standards in 3 10 CMR 22.0� 4-602.11 Cleaning Frequency of Equipment Food-
Shellfish and Fish From an Approved Source Contact Surfaces and Utensils*
3-201.14 Fish and Recreariumilly Caught Molluscan 4-702.1 i Frequency of Sanirization of Utensils and
SlrellfisM 4-703.11 Methods of Smitizatinn-I-lot Water and
I Food Contact Surfaces of Eduinment*
3-201.15 Molluscan Shellfish from NSSP Listed i Chemical*
Sources* 10 Proper.Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authorltv 2-301.1 i Clem Condition-Handsand Arms"
3-20118 Shellstock IdennhCation Preecut* 2-301,t2 Cleaning Prinedru-0
590.004(C) Wild Mushrooms" 2-301.14 When to Wash*
51 3-201.17 Game Animals* it Good Hygienic Practices
Receiving/Condition '2401.11 Eating.Drinkin--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- Mouth*
3-101.11 Food Safe and Unadulterated 3-30t.12 Preventing Contamination When Tasting*
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained" Emiplovees*
Tags/Records:Fish Products 13 Handwash Facilities
3-402,11 Parasite Dcstructmri� Conveniently Located and Accessible
3-402.12 Records,Creation and Retention 5-203.11 Numbers and Capacities*
5-204.11 1-ocation and Placement*
590�0040) Labeling of lngredlents� 5-2105.11 Accessibility,Operation and Maintenance
7 Conformance with Approved Procedures
/HACCP Plans Supplied with�oap and Hand Drying
-502.11 Specialized Processing Methods' Devices
6 301.11 Handwashing Cleanser,Availabilitv
3-502.12 Reduced oxygen packinging.criteria'
8-103.12 Confrnmance with Approved Procedures* 6-301.12 Hand Drying Provision
Denolaq critical aeni in the Weral 1999 Food Code oi 105 CNIR 590u00.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: C) 1�j 0 Date: Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
—PLEASE PAINT CLEARLY
71(_+�(A Her'41, A Jov C4,1 I, I, ",ja f
-7�
(k) c4
(U. 1 17.....
-T
Discussion With Person in Charge: Corrective Action Required: u No es
I r,
)D,*�Voluntary Compliance U 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 0 Re-inspection Scheduled :3 Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily f ines of twenty-five dollars or suspension/revocation of Lj Embargo 0 Emergency Closure
your food permit. U Voluntary Disposal 0 Other:
PHI� Rtrc�iv,�,!�,l Tmia<r,aumiz
Waistions Related to Foadborm Illness ftdterlvMI;'ons and Risk ia-urdmg it,I Cwir d ill
Factiorc(Whis 1-221 (Cont) widan , R,iu?s � I
-�01 15 M,Lhkij� fin PHF�
PROTECTION FROM CHEMICALS I i
14 Food or Color Additives 19 PHF I-lot and Cold Holding
Sill Il"'iBI Cold PUF�Nialwaii-mi at or LJow
1*40 01,141 1 V45,-,I,-
3-302J4 P,-,tectlon irom I -; �,-I I; I Ili A
Poisonous or Toxic Substances 'I', 14WF .)v
kl�ak;fvilq lotonmi'm krrl�;nal 501 IfJA�
Collohlan,, WkI .Ator bilve 1 11)'T
1 20 Time"i Paull,thiniln Controi
10211 1 commoll N:Irrw -
Corarol
I toon -
-102 R,,,uicnon- Prt,.�nce and L �fil
7-102.12 01ablion, ,f I t"",
prolurnnoic,l REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
chelllic!�W
1-204�I i Sani, POPULATIONS(PSP)
I .,I w"! lt,v, Pre-JI:I,[:"Acd jui�will
7- (4.�2 for Nvil,fimg Clilcl
vvith L&&s
7-1104,14 Dl,ing Artalu.Criler4l"
A0;'!I f 131
Cowalt, I uhm,,�,N- U"! t I kill �:fl, .,r Palvailv Cf�Ac,l Aniall"I rKyj.11d
Pr,�ic.jdes,
Rliv, Sproui,f Nol
7-2-06.111 Bmt S:;,Ii,)a,,
� -11 Re-S
106
CONSUMEP ADVISORY
......lst,�yw�r plwJ for((milkaription rl�
TIMErrEMPERATURE CONTROLS
!Ira� -tr� Raf,, L1a&iaX)k,d cl
16 Proper Cooking Temperatures for
PHFr Pr, �eswd:��1--Iiwlnai�
Wi !;A�1)(2, Fllg, 155�F 15 Stx
O'F]SI(ic' 1 P,:�tc,wv-,d ,ae,Stil."mul- kil Raw Slidl
&
1-4n 1.11 Commilimcd Fi,h. �,vfcw�
SPECIAL REWREMENTS
IWA)(13)(13`2; Poll, iind b-cl klm�l L,04- )�! luirl�
590(if')(A)-,;)) Violau,xi,oi-Stc!ion 5'00,WWA�-(D) in
R;)iiws liiiet!A Wati, - 155 V 15
061,:v Avrild f,�
40i.l iiAi�-ii 11"alir, V�i10 Galite Sniffed PFFI,
-ichillid ureler the av;vvnriafk, lvr:!io!iii
�ioffin Olrv�uvini- ViIh. Nivat,
v,l'.kafltc�� 165'F� 1.� abovc if In ici,�!borni: ilhte��
-1�,Irriac! Pe'l Sivak, entoici ai'd mk rjc:tor� OkNT
145"F 4
5,P0.009 vtolatirm,;r0stuilo n, :fciod relail
-AQ 1.1'2, R:I� �Ielrhtt Fffruj,�(Lftpiwd Ill a hei dvhit-d #29 -
Mt�n,lww- 1WF' lz!�;tlirclwints
-1401,IlfAl(l itb? �`il Othel PHI�-- 145'F 15 eQ
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD qETAiL PRACTICES
3-103.1 IWI&tl)) Pf 11,� 165,+ 1"sec. " I Itelill,23,30)
I Ift :0,F 1,Nbnul��suln'lin', Caprrf;:z?1f1 n:,? e Rwa! cit':dfow- Ili 01 dc,na; �eievl !,l ljl(
Time, t0"bP
1-403.1 ("Ornmell'JaIN KIT �cmli- fwaiu'i,i thtfi-i�mm,� r,!I t, th,f F,,�d Code and JOS C411?
1410T' 5Q0.661i
'I A 6cel
R�mamja, Uodwed Poin -j-9910-4 F 590.0lio
oast, 2� r pme"t aie:Per,
--t-na-M, 00
�ivyjmzd'-' )dProlc-011,1 �c 00
18 Proper Cooling of PHF6 r-,m1-- ---f2---=�----
3 50 141 A) Coll i Ill-Cwkcd PH Fs, i I om 1 4W F n P(I'Arlmera ancl uk-li�$K f F0-4 00�
'Nasle I PC-5 0,)e,
70�1;WiLinn 11 Hour,�wl Rom 7f)"F 27 FC-6
Li. JVJ`145'�Within I Howl, 2e Poisoous r Tom FC --1 wo
� 50 1.I'll h) (7,li�lilw 11HR Made From Arnbient 2.4
SpKiii!
Forip"I"ItOre Ingreoicia�it,-41'F143 F
ill 1.,,,j� i9TI 1-olylOxic',M�
I
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 Tel. (978) 741-1800 Fax (978) 745-0343
Name Dat Tyqe of Ooeration(s). Tyqe of Insoection
Food Service F] Routine
AddresV Risk Retail (E]'Re-inspection
1�� 9AIii Level El Residential Kitchen Previous Inspection
Telephone Mobile Date:
(L.7( J
Owner HACCP Y/N Temporary El Pre-operation
0 caterer El Suspect Illness
Person in Chargi_(PIC) -L/ Time 0 Bed&Breakfast 0 General Complaint
In: [I HACCP
inspector Oup?;� Permit No. El Other
J,:" 04n
Each violation checked requires an explanation on the narrative pdge-(s) and a citation of specific provision(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [1 590.009(F) E]
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT, El 12. Prevention of Contamination from Hands
n 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities
EMPLOYEE HEALTH" '
PROTECTION FROM CHEMICALS
[1 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
FOOD FROM APPROVED SOURCE' ,
Ej 4. Food and Water from Approved Source TIMENEMPERATURE CONTROLS(Potentlatij Hazardous Foods)
5.f Receiving/Condition El 16.Cooking Temperatures
6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding
B. I S I eparation/Se I gre I g I ation/Pro.tecti I on 20.Time As a Public Health Control
R"; Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE PdPULATIONS(HSP) , ,
. El 21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
11. Good Hygienic Practices CONSUMER ADVISORY
El 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report, when signed below
JC_-N
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of
25. Equipment and Utensils (FC-4)(590.005)
the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address
29. Special Requirements (590,009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
S 5WInVnWo�-14 dw &/
Inspector's Signature: 47 Print: /'LL.
PIC's Signature: W�, Print: Page_�f? Pages
V
Violations Related to Foodborne Illness
Interventions and Risk Factors(Itenis 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 590.003(A) Assignment of Respoiisabilitv� 3-30111(A)(I Raw Animal Fruits Separated trout
590.003(B) Demonstration of Knowledge* Cooked and RTE Foods*
-2-103 Person in charge-duties Contamination from Raw ingredients
3-302A l(A)(2) Ram,Annual Foods Separated from Each
EMPLOvEE HEALTH Other,
2 590�003(C) Responsibility of the person in charge to Contarnination from the Environment
require reporting by to 3-302.11(A) Food Protectiw
applicants" s-102,15 Washing Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Repon,ro,rhe Person In Utensils*
Charge, Contamination from the Consumer
590,u03(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food.
3 590.003(t)) Exclusions and Vestrictions* Disposition of Adultersted or Contaminatod
590.003(F) Remo,alof Exclusions and Restrictions Food
3-701.11 Discarding ca Reconditioning Unsafe
FOOD F IOM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Sealed Confame& Saritization Tenioeratures`
4-501.112 Mechanical Warewashimi-Hot water
3-201.13 Fluid Milk and Milk Products*
'4-202.13 Shell Eggs� Sanitization.Temperatures .......
3-202.14 Eggs and Milk Products,Pasteurized- 4-501.114 Chemical Sanitization-temp.,PH,
3-202.16 lee Made From Potable Drinking Waler� concentration and hairiness. * 1
4-60 i�I I(A) Equipment Hod Contact Surfaces and
5-t0l.J I Drinking Water from an Approved System- I Utensils Clean-
590-006(A) Bottled Drinking Water* 4-602.i I Cleaning Frequency of Equipment Food-
590.(K)6(B) Water Meets Standards in 310 CMR 22.0*
Shellfish and Fish From an Approved Source I Contact Surfaces aod Utensils
3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanifization of Utensils and
I I Food Con'tact Surfaces of Eurripmer
Shellfish� 4-703,11 Methods of Sanatization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources*
Game and Wild Mushrooms Approved by to Proper,Adequate Handwashing
Regulatory Authority 2-30IJ I Clean Condition-Handsand Arms*
3-202.18 Shellstock Identifieation Prescuf� 2-301.12 Clcamn-�Pnccdure�
590.004(C) Wild Mushrooms- 2-11)1.14 When to Wasb*
3-201�17 Game Animals* 11 Good Hygienic Practices
Receiving/Condition 2,101.11 Eating,Drinking or Using Tobacco*
3-202.11 PHFs;Received at Proper Terriperatmes* 2-401,12 Discharges From the Eyes,Nose and
3-20115 Package fntegriry� I Mouth*
3-101.11 Food Safe and Unadulterated 3-30 i-12 Preventing Contamination When Tasting*
6 Togs/Records:Shellstock 12 Prevention of Contamination from Hands-
3-202.18 Sbellstock Identification * 590.(Y)4(F) Preventing Contamination from
3-203A 2 Shelistock Identification Maintained" Employees*
Tags/Rerords:Fish Products 13 Handwash Facilities
3-402.11 Parasite De�txuvtimi* Conveniently Located and Accessible
3-402.12 Records,Creation and Retention" 5-203.11 Numbers and Capacities*
590.0040) Labeling of Ingredients* 5-204.1 t Location and Placement*
7 Conformance with Approved Procedures 5-205�11 Accessibility,Operation and Maintenance
IHACCP Plans Supplied with Soap anct Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 6-301.1 t Handwashing Cleanser,Availability
Reduced oxygen pacLagin.g,criteria" 6-301�12 Hand Drying Provision
8-103 12 Conformance with Approved Procedmes�
I fienot��critical item in 1he Weral 1999 R"I Code o I V CMIZ 590 000
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: (-)' I, Io j- 20 �1-14U r�^yc� Date: Rage: of
Item Code C-Critical Item DESCRIPTION OF.VIOLATION/,PLAN OF CORRECTION Date led
No. Reference R-Red Item Verit
PLEASE PRINT CLEARLY ' I : I I
_7" -D �D IJ
3:)(- 1,-YY1\ ?1 ,01 170 C(L
L v hce r\L, /,1-,4- �v,- I,,P ,n 4i�v
V I It )r - I � -
I"I QJP j17
I if I
-61 a-)�A 7,4- -4, A-1,,J.%r— J'-0 C�n 0 /, , )
n'A- -,J,
P czj� r n4 -4o tm i�e le a,/ l�'4 jor P ik)29t,4l
r,;& 07 )�'p y I All J.Q'I,
r vC 5-.
-3-3:b', 1 LJA , nL—
C,�I-4-)A-i co,
'11111flllf�-
\/V/ 1(k,"v; 61�(A L� L-1 72E
6 A,
Discussion With Person in Ct�arge: Corrective Action Required: Li N ta,,"ires
1 0 14
L.3 Voluntary Compliance 0 Employee(Re'striction
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 inspection Scheduled 0 Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that ).-A-
noncompliance may result in daily f ines of twenty-five dollars or sus pens ion/revocation of 0 Embargo 0 Emergency Closure
your food permit. U Voluntary Disposal Lj Other:
wwations Retaimi to Foodborne Ifiness,Intinnentionsand RifsA to
Fartars(items 1-2�i fConQ 11�Fi4l�'P Wi I)i fit 4 fLtw
15 1
PROTECTION FROM CHEMICALS V�th(xi,for["HPc
14 Food or Color Additives 19 PHF Hot unit Coin Holding
12 Addlm(s,�
X2 4 14 Pwiccwai ii-om Uisipifro,ed kdditiye�' Y)i ifiiA", !lot P'HF. Niflinlainne at(a at-)w
Poisonous ot Toxic Substanceu
101.11
tic It! it or Ibi)"t t 1001,�
Time,as Public Control
7 102 it C,�mlls,ll Nmtnie Ctiwiiim�r,` mm
70t.1) V,i:1-ivce !�eqmr�welli
Roettiction -Pre,�f�c�� lod
"-202.12 Comillioll,(if'Use-
?-�o I I ptohibl";on�l Ri-OUIRFMENTS FOR HIGHLY SUSCEPTIBLE
7 �04.11 sanilizei-N,crilcri'l- POPULATIONS(HSP)
—1 F�;I j-�:-,NT I TI,,%) iwpt��d Jti;t cs�ud
7-N)4�i 2 Cheiaica!�for W&hing,ll�odiwe.Ciit�iia
7 204,14 Dmwl Atsinu,','rvcria)'
131 si� 1A puilefill,
7��ul,I I lnia&nt�) I:,,id(Atwa,t, 1-l-bricant" "r alld
7,21)16,[1 kosirioeti U1%e
R'Xittil li ;I Sumon"
206.13 1'r.tckine Pm,dw, 0��f Convol awt
Morlitoring
CONSUMER ADVISORY
TIME/TEMPERATURE CONTROLS i-,iv,umoi
1 16 Propet Cooking Tomperatui-$lot fow,A I t�rc R�iw, Llnucr�XA.td ct
X(s
PHFs
3-101 1 IA�1;1, Fao, 15�'F 0, 5cc.
R:3k F�f- ft)t RAw S1,11
401,U i A)(", C(iOlinlrult�j *Aw';& G in"
SPECIAL REQUIREMENTS
-;-4f?0!(B)4J,f2) Rift and 13,�zf Rtxkst - 1301 !21 1111*M1
Rmile, 111i'm
401.1 - ------I hi"d fJtchc�l 1,ici wichl';Ilik'Old tic
i(A),3 f 1`0�t;tT�
kXitlilco 'Indff the appri,priatk"
11oull(vul kliniv"A651, lss�c. F�Iatod i,
killaLt BC,f SJC,)k�4 !11-0!vtnticn,alld !i3k iliclors; Other
14YT f1140.tX)i) vlohililili r0arlll,to 2f��ifi !culii
Iff i.12 R,� Animal Fu,xk Co&,id in 11 he debitt:d t'!9 -
Xlioowavc 11651'
1'401,11 V'i)k!�Zbj A!� Ot:itj Mif-i-- 1451 1
17 Rehfaiting lot Hot Holding VIOL A TIONS RELA 7ED TO GOOD PETAIL PRA CTICES
3-�WAPAOiit) )TIk 165'F 15 sec.
140"'1 11h) Miclowa,,�, Ini,V 2 i4muze st-ladirn, 1�,i,a! vi,uhdo isal �elaf��')ior
Tillic, Plw�';af�,V�-wc'u.md'i,�A 1,1,tors lim:d lb"ive zvrt I"
3,401;1 K) Cornffi��i�iallv Pnft�,�sfcd RTFK�,ii - �h,�Vovd(u4cucd ii�i "VIR
140 1,
PC 590�00
?-103,11(1:) Wnifullia, Ujit'llred Poroon�Or Hf�H i ;
P�firl!c! PC
PC- �1 i 0(14
is 1 Proper Cooling of PHFS -------
LE C cn1-,�ndyYL1Lij3 FC --4- 56 1)
i SWA141A) Cioli!ta Coukt,'t PHFs frow 1401 to --
70 1 Wiftn 2 1 lnur�will rrom T1 I' F 2-7- -1.111 S al i!i tv rTC-6 M7
-kt! Pctifoi,o,ia or T'i FG--7 00h
4 1 T.'45�F W�Win 4 f itim, ' i -* f ld'U,A:S
�-50 1401 Cooling PHR.%,Wc Fiout Anihi�nf 21),
'Witilin', lik-ir,
CITY OF SALEM
1301��p OF HEALTH
Establishment Name: A Date: 7 /2 0 Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R-Red Item I � . I � I ' Verified
PLEASE P9lNT CLEARLY
0
1rnnG'C-0 lvr"'] 4— lc�n X 0
+
I - I -A j
J-
C a_-'r 0 r t,
4- ev- C
�rl(_
_J *1 V
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j _-�14 A)_n I�L JAJ f�"
Z_
R(odit'4A OCd"O'Y A'--\ VW
:2
Discussion With Person in Charge: Corrective Action Required: L) No ell ILI Yes
0 Voluntary Compliance u Employee Restriction
I have read this report, have had the opportunity to ask questions and agree to correct all
Exclusion
violati6ns before the next inspection, to observe all conditions as described, and to
/6 Re-inspection Scheduled Ll 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 0 Embargo 0 Emergency Closure
your food permit. Ll Voluntary Disposal 0 Other:
Violations Related to Foodborne illness friterientlens end R13k
Factors(Urtlas 1-22,i fCorl 11,V11Y 1� Within-f It,fut-',
It
PROTECTION FROM CHEMICALS
Food or Color Additives 1 19 PHF He-,and Cold Holding
5,11.1till) 00M P81,Nbtnk"i,ed atot be!ow
in e,;4
3-3412 14 litiowl,tval froln ll!lapprolml
OVabove
3 . lit" P111 :u
Poisonous or Toxic Substancm
14WF
l6W Ro.l�tE Hod wo,i&o,c I'V4%
102 it woe�;Ill,CltwaincW 2c; 1 T inke as a publl�Health Contra!
-alfil Coal I
7-20 1.1 S�Pai ation- slill'ilge" ;1fli",ii�a vubti,. lk 1
?-202.
condilion,�ot REOUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-10,1 11 71�,Xic 0)lltainiti, -
7 POPULATIONS(HSP)
-204.1 i sairiliver%t.c6wria--Clwl,)ic,t�l
7-21)4,1? Ch�nlir::Of%fol Wzi,hirz VilX!l1ce,Clilk-lia" If 21 1 ;�sil,,[z"vi Unr"Ictif i�kd Vrc p;iChizcd klikc�wil.1
7 'Oft,0 Di-lins �Vmiil.Criv!i ia' wnn ikt,�rail)
-1 os,11 Ificidental FkVAJ(A-MW "Ib)!CWJVl'
I IkDl Rai,, ,ir llif;lit,li� C�Y�k ld Aphmi F(xd�l�id
7,206.i I id"d t��V fle-rir ikle�, CI itel la
7-206.;2 R(KIlml B lit SLAIC,7)k, ji-fiz;ied Fi,vt 1130�11g� "Nol lf�-,Crvcel
7 206 Tr.ickirigl`o�%Jrr�
CONSUMER ADVISORY
22 "1 i C<iri Alf,i.wr- or Collitullp6on of
TIMMEMPERATURE CONTROLS
16 Proper Cooking Temperfilvies for F-k,tvi Clot �Iri:fl�l,,% Uiljezx�kt�d ill
PHFs
In,
�i 401 1 I'll()q�, El�w ;�5'F I
flit
E4gs
''-40 1.11(A)�2) conl1writicd Fllikl 'Q�uk�& Gilf7k.,
3 40 1.11(B)(I It ef Poll, iinij SIci qoart - !1)�F UI litilt, SPECtAL.REQUIREMENTS
I
i-401.1 I(A)f RaWL l%311 i 35 F J S Vii%'I,z1I,)rl, W Sk�,�iiorf flft[)9�Ai-iDl) In
oateriog. fkNid, teki,p�irai i wid
, , J N
3-40 1-11�A)( citdilt.J ;IHF�, i�ck,�n opoll:liolns ,likikild hL
lkl'iffmg Hilh, fileiii, ujidei thi: apj,rupn�kry �ct,tion�
11 above if relw'-d to fi,1W!),trrtc 111110:;i,
'll I,] kii6ics.I O'l r 1'1 lzIf- , I
3-401�I I iC)0, Inlao 6,:JS,eikk� and i,lk f,Ictkr�, "Allm
145'T YWYQ�) va,Wfavl r0atiml to"0(KI rctal*i
4 40 1.1 1 1 un
R�,i� Arnol Cokcd lit a �Iio�;Iij he kiebitLl dcr #29
Ilk')(I kilif Ali Onei Pill-
i-- 14
17 Reheatinq lot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-40 3.11�Ajk,�101 PRI., 165'1 vvc. f items-,3-30)
3 4W.1 (8) Nlicnil"aw- 14)5,F 2. sirndifw,
Tinle,
3-401.1�f C) C:i&,awl P6 CWR
),40 3 11(I� tr"ill'Ced Item i Voral Retail Pffecticeq 41100-
23 M appm arz,�ro
M ft:lt nd It I G02
Proper Cooling of PHFS 24 F�md ard f,'ow FC 1 (9,4
quiprifla aig"I l'.-A 001)
Cvdiiii, PH V, it ow I-9)'F Ill --666
7�;,F w4kim 2 lllrlur��isd Fronk 70`�
Fa6i't,,
klafen-!s FC -7 X8
5w,wll� C(hluIv PHF�'VIvfje
Terripe'rat,ill, 1111ne,licat� ------
Within 41 1 lolff"-
oltical Awmm 1he rol I F(l,,J C',t!l:,r i it)i
'R
0120 WASHINGTON STREET O'Neills Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP:
Item Status Violation Critical Urgency
Telephone: FOOD PROTECTION MANAGEMENT
740-8811 PIC Assigned/Knowledgeable/Dubes FAIL RED
Owner: V/Comments:Cook that is on staff needs to be left as person in charge and shall be educated in proper proceedures of running
Ronald Brogan kitchen is.sanitizing solution etc....
PIC: PROTECTION FROM CONTAMINATION
Angie Silva Food Contact Surfaces Cleaning and Sanitizing PASS RED
Inspector: Handwash Facilities FAIL RED
Janet Dionne
Date Inspected:Correct By: ,/Omments:Mens restroom hand dryer not secure to wall.secure hand dryer.
1/23/2008 osition handwash only sign at handsink in kitchen to be easily seen.secure sign to wall.
Risk Level: 4p
Permit Number:
BHP-2008-0276
Status:
Open
#of Critical Violations:
4
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@ 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 29,2008 Page I of 2
Item Status Violation Critical Urgency
-RED: Violations Related to Good Retail Practices (Blue Items)
Violations Related to Food and Food Protection FAIL Critics BLUE
Foodborne Illness Interventions,
and Risk Factors (Require V(mments:At the island cooler there is raw meats stored next to ready to eat foods.Provide splash guard to prevent cross
immediate corrective action) conamination and splash of raw meats into ready to eat foods.
Equipment and Utensils FAIL Critical BLUE
�A/Imments:White Holiday unit needs general cleaning and organization of contents.
,'�an and sanitize knife racks and do so on regular basis to prevent accumulation.
white freezer chest temperature of 10 degrees F.freezer must be maintained at 0 degrees F or below as mandated.
e machine in basement had accumulation of mold growh on inner panel.thoroughly clean and sanitize machine and inner panel.
clean and sanitize on regular basis to prevent buildup.
P'I,scoop and ice scoop holder to be cleaned and sanitized daily.provide ice scoop container that can be cleaned and sanitized
d ly.ice scoop container had water and debris a bottom of bucket.
U-4broken handle on walkin fridge door.replace and provide handle in good repair.
%-tfabb,I wiping sanitizing buckets. I raw meats only.the other to be used for all other cleanups.
Other-See Notes PASS BLUE
GENERAL COMMENTS:
All repeat violations upon reinspection or noted at next routine inspection will be subject to monetary fines
starting at$25 per violation.
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. Jan 29,2008 Page 2 of 2
0120 WASHINGTON STREET 0 Weilis Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: El
Item Status Violation Critical Urgency
Telephone: FOOD PROTECTION MANAGEMENT
740-8811 PIC Assigned/Knowledgeable/Duties FAIL RED
Owner: Comments:Cook that is on staff needs to be left as person in charge and shall be educated in proper proceedures of running
Ronald Brogan kitchen ie.sanitizing solution etc....
PIC: Non-compliance with:
Angie Silva Anti-Choking PASS
Inspector: Tobacco PASS
Janet Dionne I
Date Inspected:iCorrect By: EMPLOYEE HEALTH
1/1612008 Reporting of Diseases by Food Employee and PIC PASS RED
Risk Level:
Personnel with Infections Restricted/Excluded PASS RED
Permit Number: FOOD FROM APPROVED SOURCE
BHP-2008-0276 Food and Water from Approved Source PASS RED
Status:
Open Receiving/Condition PASS RED
of Critical Violations: Tags/Records/Accuracy of Ingredient Statements PASS RED
Time IN: Time OUT: Conformance with Approved Procedures/HACCP Plans PASS RED
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@ 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2008 Page I of 4
Item Status Violation Critical Urgency
RED: PROTECTION FROM CONTAMINATION
Violations Related to Separation/Segregation/Protection PASS RED
Foodbo�ne Illness Interventions
and Risk Factors(Require Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED
immediate corrective action)
I Comments: cutting board stained and scored.resurface or replace.
Proper Adequate Handwashing PASS RED
Good Hygienic Practices PASS RED
Prevention of Contamination from Hands PASS RED
Handwash Facilities FAIL RED
Comments: Mans restroom hand dryer not secure to wall.secure hand dryer.
reposition handwash only sign at handsink in kitchen to be easily seen.
PROTECTION FROM CHEMICALS
Approved Food or Color Additives PASS RED
Toxic Chemicals PASS RED
TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
Cooking Temperatures PASS RED
Reheating PASS RED
Cooling PASS RED
Hot and Cold Holding PASS RED
RED
Time As a Public Health Control PASS
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
Food and Food Preparation for HSP PASS RED
CONSUMER ADVISORY
Posting of Consumer Advisories PASS RED
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. Jan 17,2008 Page 2 of 4
Item Status Violation Critical Urgency
Violations Related to Good Retail Practices (Blue Items)
Management and Personnel PASS BLUE
Food and Food Protection FAIL Critical BLUE
1mr ts: label all dry ingredients not in original containers.
itemstandup refrigerator in prep area had some uncovered food items.all food in storage must be covered.
At the island cooler there is raw meats stored next to ready to eat foods. Provide splash guard to prevent cross conamination and
splash of raw meats into ready to eat foods.
�/Ketchup dispensers had dried debris and splatter.clean and sanitize.
there was soup/beefstew stored in the white Articair unit in a deep pot.all soups to be cooled in proper manner and held in
containers no deeper than 4 inches for proper cooling.
�-Also noted was utensil stored stored in sheppards pie.do not leave utensils in food.
Equipment and Utensils FAIL Critical BLUE
Ymments: refrigerator in basement holding at 48-59 degrees F.all food items have been removed.service unit to ensure that a
tem,perature of 41 degrees F or below id maintained.
White Holiday unit needs general cleaning and organization of contents.
knives and knife rack had dried food debris and food debris accumulation.clean and sanitize knives and racks and do so on
regular basis to prevent accumulation.
tAde scoop at bar stored incorrectly.store ice scoop handleside up in ice.
WeI white chest freezer in basement. provide visible accurate thermometer maintained at 0 degrees fahrenheit or below as
m.a.ldate.
�rganize contents of same freezer.
Provide visible accurate thermometer in long white freezer chest. If
ice nachine in basement had accumulation of mold growh on inner panel.thoroughly clean and sanitize machine and inner panel.
clean and sanitize on regular basis to prevent buildup.
ice scoop and ice scoop holder to be cleaned and sanitized daily.provide ice scoop container that can be cleaned and sanitized
daily.ice scoop container had water and debris a bottom of bucket.
broken handle on walkin fridge door.replace and provide handle in good repair. 0
Physical Facility PASS BLUE
Water, Plumbing and Waste PASS BLUE
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. Jan 17,2008 Page 3 of 4
Item Status Violation Critical Urgency
Poisonous or Toxic Materials PASS BLUE
Special Requirements PASS BLUE
Other-See Notes FAIL BLUE
1/nornments: Mop stored incorrectly, brooms stored next to serving area for soups.designante area away from service area for
ops and other cleaning equipment to prevent contamination.store mop mop head up not touching any surface to air dry.
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. Jan 17,2008 Page 4 of 4
Commonwealth of Massachusetts
City of Salem
Board of Health lUmberley Drisooll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/08/2008
ESTABLISHMENT NAME: O'Neffls Bar and Restaurant
File Number:BHF-2004-000042 120 Washington Street
Salem MA 01970
LOCATEDAT: 0120 WASHINGTON STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes
FOOD SERVICE BHP-2008-0276 Jan 7,2008 Dec 31,2008 $280.00
ESTABLISHMENT
TOBACCO VENDOR BHP-2008-0279 Jan 7,2008 Dec 31,2008 $135.00
Total Fees: $415.00
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 2 of 3
QTY OF SALEM, MASSACHUSEM
BOARD OF HEALTH
120 WASHINGTON STREET,4'm FLOOR
TEL. (978) 741-1800
KINMERLEY DRISCOLL FAX(978) 745-0343
MAYOR TSCD'rrf@SALEM.COM RECEIVED
JOANNE SCOTT, NOV 3 0 2007
HEALTHAGENT CITY OF S,- -
]BOARD of=HEALTH
2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT O�VEICL,'5 TEL# 17 1 - -7vo - gr//
ADDRESS OF ESTABLISHMENT 1Z 0 tfA381"7W 5r- FAX# 5-OF- 660 - Cyg'
MAILING ADDRESS(if different)
EMAIL-Business': Website:
OWNER'S NAME A0011F, AZN�Al TEL# 41-7- V3F- 670/
-AA1
ADDRESS 6 K -AfOl: 17A oz,) 32
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S)A)11,111-� 5/L VA CERTIFICATE#(S) /,/A- 0.)oo 3-7 4�57
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON AP14�le 51i-tlA HOME TEL# 9-IP- 7Va -o641-o
DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday I
HOURS OF OPERATION Jk-30 erl )a A-t 3a A r? //-3o A ri 3o A/1 3a A rl 72 Ala4AI
Please vvite in tinne of day lqm lArl I
(For example 11 am-1 1 pm) q ri Ail 1411 2AII
TYPE OF ESTABLISHMENT FEE (check oniv)'
RETAIL STORE YES NO less than 1000sq.ft. =$70
1000-10,000sq.ft. =$280
more than 1 0,000sq.ft. =$420
........................... -----No
less than 25 seats =$J40
(Outdoor Stationary Food Cart,$211 25-99 seats
more than 99 seats =$420
------------I--------------- -------------------------------------------------------------------------------------------------------------------------------
BED/BREAKFAST/ YES NO $100
CHILDCARESERVICES -------------------------------------------------------- -------------
------------------------------------------------
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE S NO $25
TOBACCO VENDOR 6 NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
Please pay total with one check payable to the City of Salem.
7 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
�uch must be submitted to and approved,by the Salem Board of Health. .,
I Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state taix
ret state taxes required under the law.
//-I-
//- Z7- a7 Ott- 3 4-7 5711av
Signature Date Social Security or Federal Identification Number
----------- ------------------------------------------------;------------------------------------------------- --------
Revised 4/24/07 FOODAP200g.adm Check4&Date Ad / JJ- 7-7-al $ 9�15-00
')_4
0-420 WASHINGTON STREET OWeiffs Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: El
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
740-8811 Handwash Facilities FAIL Critical RED
Owner: Comment:All handwash sinks are reading over 140*F. Sinks to be reading between 1 10'F-1 30*F as mandated.
Ronald Brogan
PIC: Restroom sinks reading over 140*F. Sinks to be reading between 110*F-130*F as mandated.
Angie Silva
Inspector:
John Gehan
Date Inspected:Correct By:
5115/2007
Risk Level:
Permit Number:
BHP-2007-0194
Status:
SIGNED OFF
#of Critical Violations:
1
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. May 16,2007 Page I of 2
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. May 16,2007 Page 2 of 2
0120 WASHINGTON STREET O'Neills Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: El
Item Status Violation Critical Urgency
Telephone: 1 PROTECTION FROM CONTAMINATION
740-8811 Food Contact Surfaces Cleaning and Sanitizing FAIL RED
Owner: ."'e
omment: Cutting boards stained and scored. Resurface or replace boards.
Ronald Brogan
PIC: Handwash Facilities FAIL Critical RED
Angie Silva __�Comment:All handwash sinks are reading over 140'F. Sinks to be reading between 110'F-130'F as mandated.
Inspector:
John Gehan -R�troom sinks reading over 140oF. Sinks to be reading between 110oF-130*F as mandated.
Date Inspected:Correct By: Violations Related to Good Retail Practices (Blue Items)
518/2007 Food and Food Protection FAIL BLUE
Risk Level: ro�mment White refrigerator has a temp of 50*F. Refrigerator must be at 41'F or below as mandated.
Permit Number:
BHP-2007-0194 Equipment and Utensils FAIL BLUE
Status: J---c�.m--ment:White freezer in disrepair. New freezer on order.
Open I
,Same freezer requires general cleaning.
#of Critical Violations: I
2 --rm—p—enal oven requires thorough cleaning.
Time IN, Time OUT: Tirg"aAad bar requires cleaning around handle.
Urgency Description(s): �Bread avir6-rs require general cleaning.
BLUE:
Violations Related to Good �eqwres thorough cleaning.
Retail Practices (Critical __j�,efb—eneath the grill require general cleaning.
violations must be corrected
immediately or within 10
days)(Non-critical violations Other-See Notes FAIL BLUE
must be corrected immediately ��mmnt.There are visible fruit files in the bar area. Exterminator has been notified.
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. May 08,2007 Page I of 2
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. May 08,2007 Page 2 of 2
11L
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH RECEIVED
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA01970 DEC - 4 2006
TEL. 978-741-1800 CITY OF SALEM
FAX 978-745-0343 BOARD OF HEALTH
Kimberley Driscoll WWW.SALEM,COM
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT 0'4(C16C5 P'q13 �-11,�75 r. TEL#
ADDRESS OF ESTABLISHMENT /20 VA�5klill/47aiLl 57-- FAX # ->o Y- 46o 47W
MAILING ADDRESS (if different)
EMAIL-Business': Owner's:
OWNERSNAME A`01Vq1,,0 13IZ06:091V TEL# 61 7- F3 Yol
ADDRESS 69 CIVOC-491V /9/Z- r1A 0,?03?—
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S)4146,16 614-L-4 CERTIFICATE#($)46:A oo oi)3 74,!5-7
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON/Z0 V4CO /5/109�04/ HOME TEL# Y-3 9 170
I DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday
HOURS Of OPERATION //-30 Art 1/-3a Arl 411 3, Art 'QrI �Vo-'v
Please write In time of day
fforexamolellam-llpml A rl J A ri fQ ri A rl An 11?rI A rl
TYPE OF ESTABLISHMENT FEE (check oniv)
RETAIL STORE YES NO less than 1000sq.ft. =$ do
1000-10,000sq.ft. =$100
more that) 1 o,000sq.ft. =$250
'RE§�NORAW.............fts�)'N6- -- -- --- less---I h--a--n---2--5---s-(-,-a-Is--- --- =j---1-o(-)---
25-99 seats 615D)
more than 99 seats =$200
6�baFiLmF�:§Y ;�Es -- - -- ----- --- - ------- --S"lo-0.... ..-. ..... .......... .. ... .
---------- ------ I------- -.... ...... .... .... ..... . ...... ........ ....... ...... .... . ...... . .... ..
ADDITIONAL PERMITS
MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE NO $
TOBACCO VENDOR E NO &
ALL NON-PROFIT(such as church kitchens) ES 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 nnust 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 arid penalties of perjury that 1, to rTly thest knowledge and belief,
have filed all state tax returns and paid all state taxes redo red under the law
A'� 13, //-,?1-0 0 Lt- 3 47 5//F
Signature Date Social Security or Federal Identification Number
------------------- ------ ---- - -----------�/------ ------------ -- --- -
k ------------ ------I------------------11------11----- ------ ------ ----- ---
Revised 11/13106 FOODAP2007.adm Che(:k#&Date 0 s 200-00
Za
--alftollmassachusetts ft-v
4A 4;W
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Ath Floor.,
�,�Ji()'W�shington Street,
�7'
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 12/20/2006
ESTABLISHMENT NAME: O'Neills Bar and Restaurant
File Number.BHF-2004-000042 120 Washington Street
Salem MA 01970
LOCATEDAT: 0120WASHINGTON STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes
FOOD SERVICE SHP-2007-0194 Dec 20,2006 Dec 31,2007 $150.00
ESTABLISHMENT
TOBACCO VENDOR BHP-2007-0204 Dec 20,2006 Dec 31,2007 $50.00
Total Fees: $200.00
PERMITEXPIRES Decernber31, 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 15 of 18
0120 WASHINGTON STREET O'Neills Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP:
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
740-8811 Handwash Facilities PASS Critical RED
Owner: Comments: Hand wash sink in kitchen missing sign. Provide"hand wash only"sign.
Ronald Brogan
PIC: Mens restroom handle in disrepair. Repair to working order.
Angie Silva I
Inspector:
John Gehan
Date Inspected:Correct By:
1111412006
Risk Level:
Permit Number:
BHP-2006-0172
Status:
Open
#of Critical Violations:
0
Time IN. Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-criticai 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. Nov 21,2006 Page I of 3
Item Status Violation Critical Urgency
RED: Violations Related to Good Retail Practices (Blue Items)
Violations Related to Food and Food Protection PASS Critical BLUE
Foodborne Illness Interventions
and Risk Factors (Require Comments: Knives found in knife rack with accumulation of food debris. Thoroughly clean and sanitize knives after each use.
immediate corrective action) Superior refrigerator has uncovered foods. All foods in storage must be covered.
Equipment and Utensils PASS BLUE
Comments:Woods refrigerator requires general cleaning.
Kitchen cutting board badly stained and scored. Resurface or replace board.
White freezer in kitchen requires thorough cleaning.
Shelf and all that's on it beneath grill, requires thorough cleaning.
Superior refrigerator requires thorough cleaning.
Sanitizer reading low. Have machine serviced so that proper ppm is obtained.
Sanitizer to be readily available at all work stations.
Utensils being stored incorrectly. Utensils to be stored in proper designated areas.
Sanitizing log not up to date. Log to be maintained daily.
BASEMENT
left white freezer requires thorough cleaning.
second from left white freezer requires general cleaning.
Traulsen refrigerator requires general cleaning.
White artic air refrigerators require general cleaning.
Walk in refrigerator has broken handle. Repair handle to working order.
Physical Facility PASS BLUE
Comments: Floors and mats in kitchen require thorough cleaning.
Walls in kitchen require general cleaning.
GENERAL COMMENTS:
All violations have been corrected.
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. Nov 21,2006 Page 2 of 3
Item Status Violation Critical Urgency
I PIrl J/0-j—
Cityof Salem Board of Health 120Washington Street,4th Floor SALEM MA01970(978)741-1800
GeoTMS&2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 21,2006 Page 3 of 3
Commonwealth of Massachusetts
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: O'Neills Bar and Restaurant
File Number.BHF-2004-0042 120 Washington Street
Salem MA 01970
LOCATEDAT: 0120 WASHINGTON STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes
FOOD SERVICE BHP-2006-0172 Jan 3,2006 Dec 31,2006 $150.00
ESTABLISHMENT
TOBACCO VENDOR BHP-2006-0173 Jan 3,2006 Dec 31,2006 $50.00
Total Fees: $200.00
PERMITEXPIRES Decernber3l, 2006
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit most be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 6
CITY OF SALEM9 MASSACHUSETTS \V/
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970 DEC 0 8 1005
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAx 978-745-0343 C'Ty OF SALEM
MAYOR WWW.SALEM.COM E30ARD OF HEALTH
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT 121- 24
MAILING ADDRESS (if different)
OWNER'S NAME lZOOR 1,19 15a06AW TEL#61-7- K 3 F- 67o
ADDRESS lol A&135191241-7- /Zd
CITY Alt)l7wooO STATE___&, -ZIP 02�,A ?-
CERTIFIED FOOD MANAGER'SNAME(s)AA/eie: Iiji-m CERTIFICATE#(s)CA00e>a07W,�"7
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON 1a0zvQ1,d 15126,-.0" HOME TEL# 7KI-762 -oo37
HOURS OF OPERATION: Mon J/-3a-/Tue./t-k-i Wed.//�36 4 Thu.//-�6-/Fri.iloc-/sat. —Sun.12 - 119n
TYPE OF ESTABLISHMENT FEE (check onIv)
RETAIL STORE YES NO less than 1 000sq.ft. =$ 50
1000-10,000sq.ft. =$1 00
more than 1 0,000sq.ft. =$250
-- ---------------------------------------------------------------------------------------------------------------------
------------- NO ess than 25 seats =$JOO
25-99 seats 4�ED
'more than 99 seats =$200
bbwbkE4�Asf--------- ...... -------------------------------------------------------------------------------------$-4-0-0,----------------
;----------------------------------------------------------------------------------------------------------------------------------------------------------
ZNTIONAL PERMITS
MAKE (=rve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5
(-TOBAC OR) (2D NO $50
ALL N&M-PROFIT(such as church kitchens) YES NO $25
*Please pay total with one check payable to the City of Salem .
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes
are made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best
knowledge and belief, have filed all state tax returns and paid all state taxes required under the law.
124-o5 0 4,- -3 4,7 587
��n at6re Date Social Security or Federal Identification Number
---------- ------ ------ --------- -------- - - - - --- ------ - --- - -------
Revised I-1-/03/05--FOOD-AP2.adm--------Check#-&-D-at-e-A,-'Re 1--712- --------------------------------------------
I
Massachusetts Department of Public,Health Salem Board of Health
Li 1 1 � .120 Washington Street,4 1h Floor
Division of Food and Drugs Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343
Name �2 D Tyqe of Ooeration(s) Type of Insoection
0 1 M lla(le (FjP Food Service ALRoutine
Address Riik Retail 'O'Re-inspection
Level E] Residential Kitchen Previous Inspection
Telephone -:;,40 <F-,,2 El Mobile Date: J-Z
01 _J, 'D/0 5-
HACCP YIN El Temporary El Pre-operation
Owner El Caterer El Suspect Illness
fc-0 I
Person in Charge(PIC) Time F-1 Bed&Breakfast El General Complaint
In: El HACCP
inspector Permit No. El Other
out: 1,2
Each violation checked-requires an expliination on the narrative paji(s) and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009(F)
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT, El 12. Prevention of Contamination from Hands
F71 1. PIC Assigned Knowledgeable Duties El 13. Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
F� �. ke"po��in'g�fbis-ea'se's'by'Food' Emplo.yee and I I PIC
El 14.Approved Food or Color Additives
3. Personnel with Infections Restricted/Excluded
-11 El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE " I I " "' � I ':'
4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods)
El 5. Receiving/Condition El 16.Cooking Temperatures
El 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
El 8. Se I p,arat-ion/Segregation'/Protection El 20.Time As a Public Health Control
El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEP11BLE POPULATIONS(HSP),
El 21. Food and Food Preparation for HSP
El 1.0. Proper Adequate Handwashing
11. Good Hygienic Practices CONSUMER ADVISORY '
El 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report, when signed below
_N
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
cited in this report may result in suspension or revocation of
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
-�7. 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: � J I WIV Z Print:
PIC's Signature: Print: Page I oarves
_T
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
I 590.003(A) Assignment of Responsibilitv' 3-302.i I(A)(A Raw Animal Foods Separated from
590.003(B) Demonstration of Knowlerig0' Couked and RTE Foods
2-103.11 Person in charge-duties Contamination from Raw logractients
3-3011.11(A)(2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH I OtheO
2 590,003(C) Responsibility of the person in charge Lo Contamination from the Environment
require reporting bv foorl 3-302.11(A) Food Protectionk
applicants� 3-302.1-5 Washijw Fruits and Vegetables J
590.003(F) Responsibility Of A Food Employee Or An 3-304�11 Food Cent ct with Equipment and
Applicant To Report To The Person In uwdsils*
Charge* Contanninatior from the Consurr er
590.003(G) Reporting by Person in Charge* 3-306.t4(AhB) Returned Food and Reservice of Fee&
3 590.003(D) Exclusions and Resarictioris* Disposition of Adulterwed or Contaminated
590.003(E) Removal of Exclusions and Restrwhons Food
3-70�.I i Di�carrfing oi-Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004(A-B) Compliance vvith Food Law* 4-501,111 Manual Warewashine-Hot Water
3-201.12 Food in a Hermetically Scaled Container* Sanifization Teraperat
3-20 L 13 Fluid Mill-and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Terrimeratures
3-202 14 Eggs and Milk Products,Pasteurized* 4-501.114 Chernical Sandization-temp.,PH,
3-202.16 ice Made Front Potable Drinking Wawr� concentration and hardness. *
4-60i�I UA) faluipment FocKI Contact Surfaces and
5-tOl.I I Drinking Water from an Approved System* Uten.03 Clean-
590.006(A) bottled Drinking Watcr4
4-602.11 Clearing Frequency of'Equipment Food-
590.006(B) Water Meets Starid,�rds in 3 10 CMR 0*
Contact Surfaces and Utemils*
Sheffish and Fish From an Approved Source 4-702.11 Frequency of Sarritization of Utensils and
3-201J4 fish and Recreationally Caught Molluscan Food Contact Surfaces of Eum
Shellfisli* 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 2-30 1.t 1 Clean Condition-Hands,and Arms*
3-202.18 Shellstock Identification Present' 2-30 t.12 Cleinin.2 Prcccdurc*
590.004(C) Wild Mushrooms* 2-301.14 When to Wash�
3-201.17 Game Animals* G000 Hygienic Practices
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco*
3-202.11 PHEs Received at Pitoper Temperatures* 2401�12 Discharges From the Eyes, Nose and
3-202,15 Package ftntegrity� Mouth*
3-301.12 Preventing Contamination When Tasting4'
3-101.11 Food Safe and Unadulterated
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained" Employees*
Tags/Records:Fish Products 13 Handwash Facllities
3-40111 Parasite Destruction' Conveniently Located and Accessible
3-402.11. Records.Creation and Retention* 5-203.11 Numbers and Capacities*
590.0040) Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance vAth Approved Procedures 5-205.11 Accessibilitv,Operation and Maintenance
/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
6-301.11 Hindwashing Cleanser,Availability
3-502.12 Reduced oxygen packaging,criteria* 6-301.12 Hand Drying.Provision
8-103.12 Conformance with Approved Procedures*
4 Denotes,crioud acia in the fedff�d 1999 Find Codcor 105 CIVIR 590.000.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: r �2' 61",4 Date: Page:,;�"— of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
rO. /e
C�-rA
_4414-1"
nc_si
0C_#
-M I I C�)3 lall AD" Q _C1 C-7'
4.o
4-1)19 D�- r_kA_�Y__
-�\n('� a4- CL_Ifr� 44�-'
GtAri �)_nr cd- 6Z;4-A)Oad r�llnn'4'
90-1 11 J1A_ j dolt-,�j 4,7;1
k
Discussion With Person in Charge: Corrective Action Required: EI No
Li Voluntary Compliance Ll 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 U Emergency Suspension
T X
comply with all mandates of the Mass/Federal Food Code. I understand that
dollars or suspension/revocation of U Embargo El Emergency Closure
noncompliance may result in daily fines of twen M,
your food permit. 0 Voluntary Disposal D Other:
1'1,F�Reccivo�: u Tempeiatures
111,ilat;ons R�laied to I ondborne Maass Imorventions and Risk to 1�)w Cok,!cd it)
Factoist,(Items 7-22) (Copf)
11
5 Mcitiods for PfiFs
PROTECTION FROM CHEMiCALS
PHF Hot and Cold Holding
Food or Color Additives
Cold PHFs Maintained a�or below
20-2.12 Addh:-,es
3-302,14 Potei.11011 iroro Unatir-roved Addifiws$ 390.004(F) .11 111�5�F,
3-50 1,i N(A) Hot Pl`�F�Mlaintained at olabo�e
15 Poisonc-us at Toxic Subs-ances
7-101.11 identifying Infai ination- Oril,n lial 140�F
cola'a, 3-501 Roaqs 1-feld at or;,bove l 30cF.
7-10,111 Connuoii Ngm. c--Wivoc-Coivairwrs� 20 Timc a*a Public Health Control
I i 5C , �,s a Public Health Corarol
7-201.1 1 Sepal auon- -1,19 Ti itil:
7-20? 11 R2�,lfi,Jiorr-P�Nwnicl arid 0!l-* 3o(J.004(H) Varianc, PcuL1iiCjoClj�
7-202.12 Conclificirs of
-1-1o" if 7oxil:Coluainl�rs-Pothibitions RE01AREMENTS FOR WGHLY SUSCEPTIBLE
7-2o4.1l sanitizers. ciilerol - chcrllicaN�. POP"'ILATiONG(HSP)
7-104 12 Chemicals "of Washing Producc,Critei ja;4 2 i J-801,I];A) Unpateui lied Pre-pack,iged Juices and
B'velages withWa-mirw I 1'bei
i 7-204.t4 Dr�in-A�eiits (riLeria"
7-205�I I I -"S")l 110l U-10,of PaStelkl i7ed L._'jes
Incideotal Foccl Cofftam Luoricarrts�:
;-s1:1.I Raw or Part,afly CookeflAturnal Foolt!and
7-200.11 1 P�stricfcd Usc Pe-uitid-s.Cr'lcril�
Rndent Bait Stations*
7-206,11 Raw Se�,d S-,rou;s Not Seived
Urlopen--d w;d Packa,v Noi:Re-s,rvcd.
206.13 Tracking Voivilers.Pest Contiol and
Moraftorin, CONSUMER ADVISORY
TIME/TEMPERATURE CONIROLS 22 3-603,11 Consumer Ail,i�cry P,�stel: tue(_!ousuruption of
16 Proper Cooking Temperatures for Anunal Foods, Fhatare R,jw, Underzooked ot
PHFs Not Otherwi,,e PrcceF.S-d to Unfunate
1-40L 1 1A,1)(2) Fgg�- 155'F 15 Sec. Pla�.l�geus.-
L�2g� Sutstiiuw for RaiN SK-11
Eggs-linmediat, Service I 15r Fl liwc�
3-40j.11 W(2j cormillnuied Fish,�4cats&Galue
Annuals- 155'F I
'-401 11 i B)�,I Pork and Beef Rcsot- 130T 121 ruiu� SPFCIAL. REOUREMEWS
3-4,C)LI t(A��2) Ratitest Injected Mcla�- 155'F 15 4190 01')9(A)-(D) Viol,iiions of Section 5911.009(A)-(D) in
mobile food, tz!npoi w-,'a-ad
sec.
1 3-401 1-1 l(A)(3'. Poultry, tkild Ganic. StUffLd l'IfFS, resolvrit'a! kitchen operations should be
Sulffiflg C011tuiRial Fish,Meat, d-'.."iLed under th,- appropriate seci;ons
Poultry of Radics-I 650F 15 sec. above ifte;atcd to fnOdboritc illness
3-401.1](C,(3) Intact Reef Sicaks imorvent:ons and risil factor,. Other
145'F 590.,X10 vioiations reialing to good rcta'l
3-40i I? Raw Atiou,il Foods Coolled in a praLlIces should '�dc6;ted under d29-
1V1uJ'UWaVe 165cF Special Requirements.
�'1-401,1 I(Afl)(b) All Orher PHF,,,- 14�'F 15 set
17
j Reheating for Hot Holding WOLATIONS RrLIATEDTO CCOD RETAIL PRAC77CES
3-40;.11(A`l&(M ;
PHFL, 16-5'F 15 sec. 4 (Itelmr;23-30)
3-403.11(H) Mi,�towave- 165'F 2 Minute Standin- C-ifical an",owl-croicu!ilolath'I's, loh�ch do not jelurt 10 I/W
I ini0c flwdhom�?oflnes.� into v,nuotv.and i iskjac ior, Usl(dabove, Can be
(C) Convincrcially Pioces.wd RTE Food found ni the fofloa ing ecniom�?,-f th,�Tood Codra,,,i 105 Cllk
590.000.
3-403-1 1(E i Rernauniv,Urislic,d Povions of Beer Item Gore'Retail Practices
R oss,t s 23� klanarienlent and P�rsonnef "C' .00,13
_i4_ Food and Food Pmtj_ti__ FC-3 001
18 Proper Cooling of PHFs or,
25� Eauirtmori and Ulorisils FO - 4 005
3-501.14(A,i Cooluu,Cooked PHFs from 14(FF to I
16. Water,P�unibinq and W-ste rc-.5 .0010
�U'F Within 2 Flours and Froni 70"T 27, Physi(.al Facifty Fc' -6 OfJ7
I
to 41�17/45'14 Within 4 Hours. M. Poisonius o. Foxic lvlaliiflli�s FC-7 011e
(",loling P)IFs ), Special Fleaut.-Mlents
501,14(B) t , Made From Ambient 009
Terripciature In.1,redients to 41'1'/45'F 31). Other
Within 4 llours.�
Derl-a��,criti,'!ilcn)w If.,sedend !999 Fovj Code,,r 1115 CNIR
,�90 1100.
Massachusetts Department 9f. 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 Tel. (978) 741-1800 Fax (978) 745-0343
Name Date
V/
TYpe of Oneration(s). Tyqe of Insoection
�Z Z2 Food Service Routine
V
Address Risk 'Ll Retail Re-inspection
Level El Residential Kitchen P evious Inspection
Telephone EI Mobile Date
Cj Temporary 0 Pr - 6efZtZ
Owner HACCP YIN Caterer [I Suspect Illness
Person in Clhhrge-(1131W Time El Bed&Breakfast D General Complaint
E) HACCP
In: /
inspector Out: Permit No. El Other
Each violatio67chcrckird 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) E] 590.009(F) E]
action as determined by the Board of Health.
-112. Prevention of Contamination from Hands
FOOD PROTECTION MANAGEMENT_ E
[] 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities C,
EMPLOYEE HEALTH' PROTECTION FROM CHEMICALS
n 2. 4�lporting' of Diseases by F I ood Employee a I nd PIC
E3 14.Approved Food or Color Additives
E] 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE'- TIME/TEMPERATURE CONTROLS(Poijklaltj Hajardous Foods)
4. Food and Water from Approved Source
5. Receiving/Condition El 16. Cooking Temperatures
E] 6. Tags/Records/Accuracy of Ingredient Statements [:] 17. Reheating
E] 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling
PROTECTION FROM CONTAMINATION— D 19. Hot and Cold Holding
El 8. Separation"/I Se I g r re I gation/Prote I ct I ion D 20.Time As a Public Health Control
[1 9. Food Contact Surfaces Cl�aning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),
n 10. Proper Adequate Handwas6g E]21. Food and Food Preparation for HSP
11. Good Hygienic Practices CONSUMER ADVISORY
[:]22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report, 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
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 SXInVwFo�14 d� in
Inspector's Signature: Print:
PIC's Signature: Print: Pag-l' of Pages
tjil� �" I �, !1:, I (� 51
(A
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
i 590.003(A) Assignment of Responsibility* 3-302.1 It A,)(]) Raw Animal Food's Separated firorn
590.003(B) Demonstration of Knmvtedge�' Cooked and RTE Foods*
2-103.11 Person in charge-duties Contamination from Raw Ingredients
3-302 1 I(A)(2) Raw,Annual Foods Separated from Each
EMPLOYEE HEALTH Oaher*
2 590,003(C) Responsibilityof the person in charge to Contamination from the Environment
require reporting by fm 3-302.11(A) Food Protection-
appficants�' '1-102.15 Washing Fruits and Veeetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To ReporT To The Person In Utensils�
Charge Contamination from the Consumer
590.003(G) Reporting by Person in Charge' 3-306.14(A)(B) Returned Food and Resei-vice of FoW*
31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
59(t003(E) Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food'
4 Food and Water From Regi,lated Score" 9 Food Contact Surfaces
590.00'4(A-B) Compliance with Food Law" 4-501.111 Manual Warewashing,-Hot Water
3-201.12 Food in a Hermetically Scaled Container* Sanitization Tein*peratures*
3-201.13 Fluid Milk and Milk Producti* 4-501.112 Meclunucal Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Temperatures* . I
3-202.M Eggs and Milk Products.Pasteurized* 4-501,114 Chenticat Saintimnon-temp.,PH,
3-202,16 ice Made From Potable Drinking Water* 4-60 1.11(A) coricenti ation and hardness. � I
Drinking Water from an Approved System' Equipment Food Contact Surfaces and
101.11 Utensils CleZD-
590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food-
590�006(B) Water Meets Standards in 3 10 CMR 2101:
Contact Surfaces arid Utensils*
Sheffish andRsh From an ApprovedScurce 4-702.11 Frequency of Sanifization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan
Food Contact Surfaces of Equipment*
Shellfish* 4-703�I I Methods of Sanitization-Hot Water and
3-201,15 Molluscan Shellfish from NSSP Listed Chemical"
Sources' to Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by -1-301.11 Clean Condition-Hands and Arms*
Regulatory Authority
3-202.18 Shellstock Mentification Present* 2-301.12 Cleaning Procedure*
590.004(C) Wild Mushrooms* 2-301.14 When to Wash*
3-1.01.17 Game Aninnals* Good Hygienic Practices
5 Receiving/Condition 2-401.11 Eqting,Drinking or Using Tobacco*
3-202.1 t PHFs Received at Proper Temperatures* 2-40 1.12 Discharges From the Eyes, Nose and
3-202.[5 Package huegrity� M,)uth*
3-101.11 Food Safe.and Unadulterated 3-30LI2 Preventing Contamination When Tasfirm*
6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification * 590.004(F) Pruventine Contamination from
3-203.12 Shellstock hientification Maintained Erimloyee's*
Tags/Records:Fish Products 13 Handwash Facilities
3402.11 Parasite Desbuction� Conveniently Located and Accessible
3-402.12 Records,Creation and Retention* 5-103.11 Numbers and Capacifies�
590.004(f) Labeling of Ingredients* 5-204.11 Location and Placemem*
7 Conformance with Approved Procedures 5-20.5.11 Accessibility,Operation and Maintenance
/HACCP Plans Suppiad with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criterii* 6-301.11 Handwashmg Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301,12 Hand Dryinv Provision
�Denot�qcridcal iteni in ilie federal 1999 Food Codeoi 10�CMR 590 000.
Massachusetts Department of Public Health Salem Board of Health
Division of Food and Drugs 120 Washington Street,4 1h Floor
Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Name Dgtej Type of Ooeration(s) Tyqe of Instlection
crs Food Service Routine
Address
Risk El Retail Re-inspection
Level [I Residential Kitchen Previous Inspection
Telephone El Mobile Date: P 13/ 0 �--
Owner [I Temporary El Pre-operation
HACCP Y/N Caterer
El Suspect Illness
Person in Charge -PIC) Time El Bed&Breakfast El General Complaint
inspector In: -() El HACCP
,,ejljn� J</(;rAj2a_ out: Permit No. [I Other
Each violation checke4 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) El 590.009(F) El
action as determined by the Board of Health. V�o 6-�)n CP
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hand
1. PIC Assigned/Knowledgeable/Duties S
El 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 2. Reporting of D J i-seases by Food Employee and PIC [:114.Approved Food or Color Additives
El 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
E] 5. Receiving/Condition El 16. Cooking Temperatures
El 6. Tags/Records[Accuracy of Ingredient Statements 17. Reheating
Ej 7. Conformance with Approved Procedures/HACCP Plans 18. Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
[1 8. Separation/Segregation/Protection El 20.Time As a Public Health Control
E] 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
E] 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP
El 11. Good Hygienic Practices CONSUMER ADVISORY
El 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22):
of Health. Non-critical (N) violations must be corrected
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
ol Health. today, the items checked indicate violations of 105 CMR-
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
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 5901�tF��.14d�
Inspector's Signature: Print:
PIC's Signature: Print: Page Pages
4-
ON
Violations Related to Foodborne Illness
interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTANNAMN
FOOD PROTECRON MANAGEMENT
I 50(1003(A) I(A'fl) Seriar;n-j !q'in
590.0-03(f
1 3) R rE
.3 . Person in clirc- dutics Contamioatio.,nom.R �',,qr&oiai3ts
11 i Ai�2) -1
Rx,� Amaral Foc ds Separated frow Each
EMPLOYEE HEALTH Other
Re�pod,ibilit,(if the person in Jim=t�� Con.,a.min.�iot,Lo!-the Environmutt
rtnoic r-POrtir&by toW employo��am� ��-302.1 I A) �vod Pr.x�ction"
i;ppficantsl� 3-302,15 Wa�hjng Fr.;its and%T�geu,.�lies
5YU,003(F) Respon�ibilitv')fA Food Employee Or Au 3-304.1 ;
F.i,,,d Conuct with Equipment aiid
�pplv�ant To Repoit To The Pv,son In Tjlpn�ds*
Charee Crnfaninati.�n fromthe Consumer
590.003(G) 1,eportitig ti-y Person in C harge' 31a!0 140)(H) Pelnrrt�d Fotid arid kc�crv;ct ia`Faoci'
1 3 -,90 003(D) hXClUFi0nS and PC�tridii)M* Lksvo5ittor.of Art0orated o,Contaminated
500 001-11 E I Removal ni 'Exclusions,and ResActions ,-,-ad I
3-'701,11 Unsafe
FOOD FROM APPROVED SOURCE Food`
1 41 Foo�and Water From Pegulated S6=ez
Pond Contact Surfaces
590.004(A-B) Compfiame with F")d Lwi 1-�(AII i lklarrj�il Ware-tashing-flotvNfacr
1-201.12 roixt in �i -Hermetically Scaled Comciner" Tc-n�ercv—s�4 I
a.13 Flu;j Milk a-d Milk Proiucts'� 4-501.112 Nfechninkal'NarevasYh.rig-14,)t Water
Saditi7aLlon Teurpi-rattir."�
3 202.13 sndf Eg-"s*
3-2'u 14 Fo 4-50:.!'-! Chenmcal Sandizaiton-temp.,PH,
ggs and Milk Product-,.Pasteunzedl�
cojweubali�,,a and lia:
3-20 2.16 lee,-Nd�dc Fiodi Potable Drinkirip Water-
5-101 11 Drinking Widei front an App.ov'rd Sister!' -1-601 H(A) Equipumni Food Coh[JCt SW-filLcS�Lnd
Llengil� Cleaii-
500.006(A? Boufod Drinking Wauzr* Clearrinc,!�equrcyoi Equipment Food-
-602.11
390.006(11) Water Mv�t,,,Staadards;n 310 CMR 22.04 Colima Sudact;s and Uter-cals"
Shellfish and P'rh Froin an Approved Source 4-702,1; Frequencv(it Saniti7anon of I Ttcn,i!,�arid
3-201.14 Fish and Rm-reation,fly Cmight Mollusczaq
1�xyd Cordau Stufaccs of Eqwpmthl�
Shellfi�h' 4-K)3.1 M�t!yi&of Snartizat'or,-Hot Wawrand
1-201�15 Molluscan Shellfkl)firvin NSSP Lim"d Chc,nj,aP'
Soutc.s* Proper,Adequotp Handwashing
Game and Wild Mushroom,3 Approved by
2-3;)1.11 Hi-nds and Anns
Regularcry Authority
3-20118 Shellstmk Identl&3tion Prc.,etrt� clearring proi.,durc*
ii`)0.004(C) Wild Mushrouaisi` 2-3101.14 "��Ien to 14 qSlr`c
1-2,"ll 11 G,-4mv.Animals* Good Hygienic Practices
Receiving/Condition 2 101.;1 Dnnkia-,or Using Tobacco,
3-202.11 P-[F� ReLeivcd at Prcpor-2 ernperatures" 2-10 1.12 Discharge,From the E,,cs,Nosc and
3-202 15 package hir-'121-iLy- Mouth'.
3-lul.11 Ford Safe.6nd Unadulterated j-301.12 Prcvenztra�Contarninhion When'T'asting,"
TagsMecoros:ShelliAock
Pvcuention of Contamination from Fands
�90.00-'(E) Pc%enting Conianjinatitin hom
3-202.18 Stiellst-vk Identification * I
3-203�12 Shellstock Ideraikatior,Mairdinw-d" Handwash Facil;t es
Tags/Becords:Fish Products
Conven,ant,y Located ar�c Acoe�sbo
5-203.11 Numbers and Capactties�
-,1-4,1? 12 Rec,)rd;,0-,ationand Rctention�
590.0,040 j LabeNng of Ingredierns* 5-204.11 1'ryatiurl�;Id pldcc uw1it*
7 Conformance vvith Approved Procedures Aclersibilit).Opucatior,and Maiatl�!Iuncc
jF
-ACCP Plans Supp.fed with Soso ano Hand Dnvng
Devices
3 304"!1 Speciaiized Procesring Methods*
('--iol I I 1-i",ndwashing Cuanser, ,kiailability
11-502.12 Rvduce1vxygcn pachaping.craeria*
6-301.1-2. Hand Diyjn!,Pto,,isioa
Conformance with Approved Prdctdurel�"
�Venote,�vntw�kd acm intke FoJozal 1990 F,,d r,ae oj tiil�
Massachusetts Department of Public Health Salem Board of Health
Division of Food and Drugs 120 Washington Street,4 1h Floor
Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343
Name C)l oe Date/ Type of ODeration(s) Type of Insoection
Food Service Routine
Address Risk F] Retail 4Re-inspection
nspeotion
VQ 0 Level Residential Kitchen 'Previous I
Telephone E] Mobile Date':
El Temporary 1-1 Pre-operation
Owner HACCP Y/N El Caterer El Suspect Illness
Person in Charge(PIC-) Time E-1 Bed&Breakfast El General Complaint
In: El HACCP
0?,Q) Permit No. El Other
inspector out:I 2_,A
I )/-' �da quires an explanation on the narrative page(s) and a citation of specific provislorl violated.
Each violation checked fe,
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009(F) E]
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT [_1 12. Prevention of Contamination from Hands
El 1. PIC Assigned/Knowledgeable Duties El 13. Handwash Facilities
EMPLOYEE HEALTH
El 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS
[1 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives
FOOD FROM APPROVED SOURCE Ej 15.Toxic Chemicals
El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
E] 5. Receiving/Condition 16. Cooking Temperatures
[1 6. Tags/Records/Accuracy of Ingredient Statements E] 17. Reheating
F] 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
El 8. Sep ration/Segregation/Protection El 20.Time As a Public Health Control
I` 'j, Z
EN:�;�_9-_Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
4e�, _ F1 21. Food and Food Preparation for HSP
EJ 10. Proper Adequate Handwashing
0 11. Good Hygienic Practices CONSUMER ADVISORY
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
immediately or within 90 days as determined by the Board Official Ord6r for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
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
(FC-4)(590.005) the food establishment permit and cessation of food
25. Equipment and Utensils cited in this report may result in suspension or revocation of
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 5XOS�dFo�14 d� n nl---)
Inspector's Signature; Print:
PIC's Signature: Print: Page( ofZPai-es
g
Violations Related to Foodbotne Illness
interventions and Risk Factors(Items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT
590.003(A) I --Vzsi,-nnwiu ofRestanisibil:rv, 3-X12.1 1(,A�i 1) Raw Ammal Fwids Scpamted from
590.003i,B) I DemonstraiJon of KnoMerh, Cooked and RTER)-dsl
2-303.11 Pvrson in char-,e-duties C ornarninatfon ftm Raw ingra-,isras
I I(A If 2) Raw Auimal Fooj�S,parated front Eftch
EMPLOYEE HEALTH Ofi,;-�, 1
2 Resporsibility of thepei son in chaq,,-4,) Cortartra.ation frort thc�Fr7wronment
rtiluir"wportin,bv food eniploye�-;ari-� 3-302A 1(A) Food,Ptotwiei-
applicants* 3-302 13 ashing Fruits arid V�-Coblvs
Or Aji I- I
J90.003(F) Responsibility OfA 1 '1304.11 Fowl Coutat,! houimner.0 311C
Applicant To R,mport'ro TIw Ptrson In
Charge., cal7tamt1at/j.'!,,orn!he collsonrof
59(I.(:03(Q1t Reportinl-by Person in Chfirg-0 j 3-306.111(A)(B) Rctuimcd Food and Re�er%uf-of Focid�,
3 590.003(1)1 EItchodOns ard Rostrictiors�� Dispof,,Non rf Adulterated or contamioaIed
590.00YE) RemoNal of Exclusions and Pe.slro�fiffns Food
1 1
3--791 11 fNs(%ird:v,, it Re"niftionipg Unsaft
FOOD FROM APPROVED SOURCE FlyC' I
Food anti Water From Pogufatea Sourcor i 9 Food Contact Sufaccs
141 1
590.00.�A-B) Coiaphjnc��with Food Lxw' 4-301.111 Manual Warewa�hi ri,-,-Hot Watej
3-201.12 Fooct in a Permeticafly Sealed Ctartfiinef�
-1-101.13 Fluid Milk and Milk Producv;* 4 5C 1.1 2 Al"ClIfinual Wfrcvashin�-IJ(,t Water
-21'r H shell Eggg3l� Sanitization TemperaWrrS`r
1-20.1.14 13�,,gs find Milk Prwftrci�.Pa�teufizt� I 114 ch(.!mcal sallitization.-temp, PH,
-Mcmitiavon and hf&dms. � I
3-202.16 ice Made From Potable Drinkin�Water' 4-6111 1 l(,*k) Erluilaracra Fccd Cont-ict Surfia.es find
1 5-101 11 Drinking Watei born an Approv'�'!d Sv,aem- Dens+;clem,-�
I 500.006�'A) Bottled Dritikinr Wfuei' 4-002.11 Cleanim. -'reauency 01'F'Juipment Fowl-
;90,006(fi I Water Meet s Standards in 3 10 CMR 22.0'
1;hoffffsh and Rsh From an Approved Sourcp conta"',�urfa'ccs arid Utensils,
i 4-701i I Fterfuencyof Saiatization of Ulensils and
-201.1.1 Fish and Recrcational ly Cmight Molluscau
I I I Fowl Colual"! Surfqo-s of l7quipp,
slivllfisil� 1-703.i i M,,thod! f,i`Stitifuzation--Hot NA'Itlerand
3-201.15 Molluscan Shellfish fromNSSP Listed ch�ltmcal*
sourc-0 I I -. I
H) Proper,Adequate Handwashing
Garre and Wild Mu�nrooms 4pproved b� Clef;fi Copd'iion Handq find Arnistc
Rvgut-�foty 4utnonty I
3-201�18 3�iellst,sck Idera:firation Present" Cleamn.,Prf�vd-re�
I ',')1 14 Whm to Wttsb�'
590.00-lik(C) Wild Mush�ooins* --
3-201.17 Garat- Animak* Good Hygienic Practices
neceiv ing/Condition 2-401.11 Eating,D�-inhing-,.-Using Tubaccol
3-202.11 PHFs Received at Pfoper Tccrp�-tatures;' 2-10 1.1-1, DiFehai-g�s From the Eyes.Nose and
3-202.15 Pfalage hitegrity" V-.�Atth� I
-301 12 fli-tventiril-Contamination When Tastin-34
f 3-101.11 F.-.0d Saf-and Uaadultert.Af-d Ptevention of Contamination ficat 14.ands
TagsiPecords:Shelistock
59{).f;J4(E1 Previfnaim:Contamination from
3-202 IS Shellstock identification
Eninlmccs$
--i-201 I Sbelistock fdontificatior,Mainiamed' Handwish Facilities
Tags/Recofdri: Fish Products
3 $12.12 Retords,Creationand Retennot, -03.11 Numbers and Caaacuies�-
590 004(j) Labeling of Ingredients, 5-20".11 Location and Plaremen�*
Coniormance with Appioved Procedures 0'potation taid Mlaiitf�;"ict�
/HACCP Plans ooppted M.r,Soso and rlatv. Oryrg
Lis vioes
3-502-11 Specializtd Prooessin�Melbods*
Fhtrtd,�ahiup,Cteansr,Availabdit,
3-501.12 Rctluo-d oNy-en pLcka
&ziro, mr, at (-3rI 1. Hane Dr�inlg Pmiision
1011.1 CWtfvxmanc�with Appwvet'..'Prw:edv;re.v'
1),atfie,;crina:itcrn:n i�T it�dtad Pat)"1-trid 04-of 105(-,\IR'00,tifto
CITY OF SALEM
Establishment Name: Rio-,/15 �5_&"r!30 Date: G- Page: of 02,
77D OF HEALTH
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAIN! OF CORRECTION D:tre
No. Reference R-Red Item PLEASE PRINTICLEARLY V ified
Ci /w5z 4eWOA-It�u j\(jMC(' r�a"�Xj L'Ij-4 ckuellvf
'17 1
orvf d'd t'0Q1-'1Y-G11V PUAhe)(n 4h cim I k.La'
A4- I-i- 'S,,,od u r4- c7t--i p�w,; jDe,-1w, W% /Jo-0d,
:;�Q t, '-4�4i- 5�0!�j Arl In Unv 10 ,-30A— 1201�
Now )�6Y.1-0 "P-'-'0
JnA -C�v/(L/(?/
d' '.V 4 A,12
F61-scussion With Person in Charge: Corrective Action Required—p No "S
13 Voluntary Compliance U Employee Restriction
I have read this report, have had the opportunity to ask questions and agree to correc a Exclusion
violations before the next inspection, to observe all conditions as described, and to 6�e-inspection Scheduled Ll 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 Ll Embargo U Emergency Closure
your food permit.
G, J Voluntary Disposal U Other:
.7d Risk I According,to Liv, C�K)Ied it)
Violations fielatea to Fbodboenvi'.'Iners Piferventions,a
Factors(items 1-22) (Cont.)
4 I'ff4'^*1'F W;Ilii o.1 Hours.
3-501.15 Cooling Methodi lot fliffs
PROTECTION FROM CHEMICALS i I
19 PHF Hot and Cold Holding
14 Ford or Color Additives 3-JO .l6aB i Cold I'll I F,M holow
3-202.12 Additives 59fW04(F) .11 1145'F-
1-30114 Protection trom Unapprowd lNddih,,c;*
15 Poisonour or Toxic Substances -�01,161 A) I lot PHF�Mnitained at cir above
14WF
7-101.11 Iderinly'ni,Inforriation-Oii�,,ijnd
1-�u 1,16(A) Roasts Hod �it orabove 130'F. i,
Contai net,,-,�' - - 1
7-102,11 Common Nome Contion,rs 20 1 Time as a Public Health Control
7-20 1.11 S�nln&"-' - 1 3-501 i9 Turie as,a Public Hevnh Control
7-,202.11 Rcitridion-Polsenve and Use" j 590.004(H) Variance Rcquo-ement
7-202.12 (--�onchticqyl of Vw`
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
1-203 11 TDx:,Ciain,,�ner�- POPULATIONS(HSP)
7-204.11 Sanit;?ets,Criteria-C!eniii,�:Is
7-20412 21 3-80 1.11(A) themsteun/ed Pre-packapcd Juicesand
ch'-m�cids for"Vashilti,Prodlw�'C riteda"
7-204,14 Dr�ing,%�ejns,Cntv,ia�: fievefaues with Warnini, ii�bc
i-801,11 I(B) Use of Pasteurized �-iigS4
7-205,11 Incidrisl Food Cotakict
11-01,1 I(f)) Paw or PiatialIv Cooked Atian.0 F,wd and
-1-206 11 R�-stijctec][U�ef`est;i,ldes Cricrin" Raw Seed Spro'
tits Net Sci,,ed.
7-206,12 Redent Biw Statiorc,' Sit 1.11(C) thmpened Food Pvckin-7e Not Re served.
T�06,1 rocki ng Powderi,Fe�t Control and
CONSUMER ADVISORY
TIMErrEMPERATURE CONTROLS 22 3-603�11 Consumer Advisoiv Posted for Consumption of
16 Props, Cookmg-.emperatures for Aninial Food!; I hat�nrc kaw, Undercoolocd ni
PHFS Not 011icr"ise Pro-essed to Eliminate
3-401.11 A(la"') I�3'lF IS Se�-. Fathogiene.i' """'" ;("
3-30113 Pasteurized Eggs Suh,tituie floi Raw Shell
f, - hninediate Ser i,:c 145'Fl S,�ec I
3-40 1.11(A)(2) Comminuted Fish,Mc-ati;&Garric Eggs*
iorimah,- 15�'F 15 s,c. 1, 1
3-401.1 I(Bh Il(2) Fork t,nd Livel kwist- 130'17 12 1 n1in� I SPECIAL REQUIREMENTS
3-401.1 I(A)(2) Rnmes' Wocted ?vf,%:L�-- 15S F 15 590.0(N(A)-(D) Violations of Section 990.009(Aj-(D)in
sl�c.- I --ring. mobile food, tempor.ov and
cat,
3-40].JkA)0� Poulh�,Wild Garnic,Stufted PHT'li.
residential kitchen operat;ons hould be
Stuffinng Cor,�awm�,Fish, ideal, elctited under die-.ippropriate sections
Povi'trv,of Ratit,:;-1 657 15 sec. l above if related it, foodborne Plnes�
3-401,11(c)(;) Whole-naiwie, lrrta�t Beet S�caks Interventions and risk factors. Other
1450F 590.009 violations relatin, to-ood reiai I
3-40 1.1 R,.,.v, Aniniall F(vvis C-:�oked in a piactices Aiould be debited under #29 -
Microwave 165'14;,-
Special Rcquiterrionts.
3-401�I )(h) All 011m PHF�- 145�F I
17 Reheating for Hot Holding VIOLATIONS RELATED To GOOD RETAIL PRACTICES
3-403.11(A)&(D) III IN 165"F 1 s sec, * (Items 23-10)
3 40111(B) Nlictowave- 165'17" %linalt-Standin,-, Critical foadnon-critical violationv. nhichdo not I clate to the
Time' foodborne iflneo into vcnnons and risk fc(tors 1iytedobcl:;e, �-an be,
3-403.1 IfC)
Coujnarm-,Jl� RTE Fo,�,d- finind in thefolfoii ing set-!ioti,�of the Food Codc and 105(MR
140'F� 5oo�ifnt).
3-103,11(-) Uwli,ej Portioas offlec." 'Ite -dooti j��practices FC .590.000
Ronistial 2S. MarjaqpT.cnt and Personnel FC-2 .003
18 Proper Cooling of PHFs 24 Food and Food Protection FC-3 10 0 4
25 Equipment and Utenials FC-4 .005
501 W(A) Cooling Cuokod fIHFs hron. 140"F to HDC---- Wate,, Flaimbinn nd Waste F---5 0106
�()�F Wititin 2 Hours and Noun TPF 27. Ptivsical'PaCiliti, FC-6 007
Eo 4 I'F/45'F'A nhin 4 liouri,. 1 28, Poisonous or Toxic Matenals FC- 7 .008
3-501 W(P) Cooling Pf[F.s Made From Ambient 29 SPecial Reauirements 019
Tornpiliatuic In l I---------- -A
gredicn's to4!'F,145-F 30, Othpr
Within 4 fll)Lff�"
Dcnoi,�critic it it�rn n tiv Ectiroo 101)9 Rxd( We,, 105 Ckik 51)f)ON),
Massachusetts Depaetment of Public Health Salem Board of Health
Division of Food and Drugs 120 Washington Street,4 1h Floor
Salem, MA 0 1970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343
Name D
jja�,,/O� TvpeofOoerationisl Type of Insoection
k 4wo 4L�Food Service X.
�Routine
Address Risk I Lj Retail El Re-inspection
Telephone Level El Residential Kitchen Previous Inspection
E] Mobile Date: got-30 t zr-�'
HACCP Y/N El Temporary E] Pre-operation
Owner 001)G 0 Caterer El Suspect Illness
Person in Charge(PIC) Time El Bed& Breakfast E] General Complaint
inspector In: F,:fo [I HACCP
Permit No. F
ir)-R n� Out: Zj -1 Other
Each violation`cli�eikelcl reiIiu-ires; an explanation on the narrative page(s) and a citation of specific provision(s)violated.
V Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [_1 590.009(F)
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT El 12. Prevention of Contamination from Hands
E] 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities
EMPLOYEE HEALTH
2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS
3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives
FOOD FROM APPROVED SOURCE E] 15.Toxic Chemicals
E] 4. Food and Water from Approved Source TIMElTEMPERATURE CONTROLS(Potentially Hazarclom Foods)
El 5. Receiving/Condition El 16. Cooking Temperatures
El 6. Tags/Records/Accuracy of Ingredient Statements [j 17. Reheating
[] 7. Conformance with Approved Procedures/HACCP Plans E:1 18.Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding
E] 8. Separation/Segregation/Protection 20.Time As a Public Health Control
9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP
E] 11. Good Hygienic Practices CONSUMER ADVISORY
El 22. Posting of Consumer Advisones'
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C) violations marked must be corrected To Foodborne III nesses,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
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CIVIR
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
the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5)(594006) establishment operations. If aggrieved by this order, you
5?'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: -3,
S 5WIns�ctFo�14 dx �7 A-
Inspector's Signature: Print:
I � �� � I (-Keo�
PIC's Signature: Print: I Page I of_�?Pages
I I- V -\-,�, I�, "r. rt
V
Violations Related to Foodborne Illness
Intet,ventions and Risk Factors(items 1-241)
PROrEcnON FROM CONTAMINATION
FOOD PROTECTiON MANAGEMENT
t 190.003(A Ass;�riment of Responsibilitv 3-302.1 41--"�f 11) Rv,'Z"o111d FwK�S' Senlr"tcd"Wre
590.003iB: Demorr,tration of Kno"Itdge" Cooke'4 and WFE Fo�xls*
t; 2-103.1 : Pcisen in chaige--dutie,� Contannim,;,lion f'xm Rar�1,�,ytd;ents
�i-302.;�(A)(2) Raw.Aninial Foods Separan-J from Fach
EMPLOYEE HEALTH Other,
2 .59ftowor) Pespratmbility of th, -rson in chaige n, Contarinalion from t,�&Environmen,
require ieporting byi") 3-302.1 i(A) Fv,,i 1,�-oiection'
appiicants* 3-302j5 \kami-,in,, Friut�wid V,,-gztnble-�
59i i 003(F) Responsibiln�()I A Food Employee OrAn t:
Food Contact with Equipmeot and
ApplicantTo R�por�To The Per"O]
Ch�wv C�ntar?,,nahion trorn Yho Oonsumer
590 00','(;) Reporting b� Peisoo :n Ch,rizc*
Foiud'
3 590.W11))
5 Q 0.0 0-;,kF Removal of Exclusions aad R--str;ctiow Food
i-701 it Discarding cn Reconditioning Umafe
FOOD FROM APPROVED SOURCE
4 Food and Walta,From Rego'eted S0111003 9 Food r omart Rurtaces
'19D.0(A(A-B) Compliance with Food Law" Manual not *Watcr
1,12 Food in ii Heriurlic;dly Sealud Gxitaincr� Sanitiz.,fion Teiuij-�,at
3-20!.13 Fi6d Milk-and Milk Products* 4-501.112 Meeinniial W',,rek�;Wiing-Hot Water
3-102.1 slioll Fggs* �atwi7ation Tempe
Chenil�al Sanitimtron-temp.,plk
3-202.!4 Eggs arid Mill:ProducLs.Pasteurizej* 4 onc�ntnn!or,and hxdne,,s. ;1
202.16 Ice Ninde Froin Potabie Di inkire,WW,' 4-60 1 A) Equ;pracint 1�1('OnUrl Surfaces and
�-Jtfi It Df inking Water froin ini Approved S"i erW
Putt!ed Drinking Water* Utensil,Clean'
590,006(R) Water Mere,So=idards in 3 10 CMR 22.0' 4-611".11 clerwing Frvquerwyof Equipment Food-
ehellfish and Firh From an Appiovod Sbume
Contac! Surfac--s and Diensils'?
1 �02.11 Frecloc,,eyof Sairrization oF Utensils and
3-201 14 Pi0i,and Pecreation-4fly 0night Molluscpri Foo�Coraw S:!r
fac�s oi'Equ
Sliellfish"
3-201 A 5 Molluscan Shellfish front MiS�!�.slud 4-703,11 Method�of-inilization-Ho,Waterand
""herincil,
source."'�
10 Proper.Adequate Handwashing
Gamo and Wid Mushrocnis Approved by
1-3o, CleauCondit;on- H.m�-,3nndA:-ms4
Fkgu&on,Autnordy
3-202AS
Shelb,tock Identification Prescrit 2-10!-- Clearnne Procedure*
590.004(0 Wild Musrrooms* 2- 01.14 When to Wa�h'
Good Hygienic PriettIces
3-201.17 Ganr�Anirn-alq*
2-4ol if Eating,Drinkirip or tj',,mPToh0.Cco4
5 Receiving/Condition
PHF,;Rcceivedat Piop,-i-Tesupeiatrues Discbargc,Froiii t!,e N�)svand
3-202.15 PaLkage hitegritv- lvlorrth-�
3-101.11 Food Sdfe and Onadun.2i,ted 3-301.1-1, Pr--�entinrr Contamination When Tasting'
6 Tag%/Records:Shellstock 12 Prevention ol Contamination from Hands
�i9f).00�t F� �rt ienting(7,nounination fyom
J-202.1 Shellacck IrkotifiQation
3-203.12 Shellstock Iderni fication Maintinot(PI Elllnlowe�
TagslRecords:Fifh Products 13 Handwash FicHiVes
Gorivsnionfiy I ocatod and Acce�sble
1 3402.1 i Panusaw Deqcucflon�
5-203.11 Nv!FLers and Cavacwes*
3-402.12 Rr,�oids,Creation,.,nd Retention* I I
590.004(J) Le;beflng oftngrodionts* 5-2(4.1 Location and Placenjourc
7 Conformance with Approved Procedures Ac�es�ib�fltv,Gpej,nmn and %biritcnaircc
/HAC;-.P Plans 1,edwn,�Soap and Hand Diyiog
Specialized Prmessarig Metfiods� ��s I
3-502-12 Reduced oxy'-t-n pickwTing.cnteiia* 6-'�t I I I 'y
Heoidwaqhing Cioans.-r,Availabili,
I'l H[Dnd Eirving Provision
8-103.12 Cviifororincc with Aprrow-d Procedures'
I
o Den,,!L�uriwl tem in Inc CN1=11 1999 Fowl(We oI i(15 UNIR.'00'000.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: S �'j 20-4t,Ira^ Date: U/71 I- Page: Of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN Or CORRECTION Date
No. Reference R-Red Item PLEASE PRINT CLEARLY Verified
r
t
P(ba il -,b(- r-Q 4Y)je4,j-.An J/-i IP1 L)k�V M PA IC C,
Cf (T'
-A AM
r
Abpd I
004
f)kj �ndvf-s- 12 d Ir W
5A
b�l Ino C4_6 od i J kl 00V, S—,/I
4f �a4l ALLq- (A lqjeAt
No les
Discussion With Person in Charge: Corrective-Aafion Required-76
I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance L3 Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to 11
X Re-inspection Scheduled U Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that N
noncompliance may result in daily fines of twenty4ive dollars or suspension/revocation of Embargo Lj Emergency Closure
your food permit. L) Voluntary Disposal LI Other:
-i-.�o;,: P1 114�Received at"lemperaosro,;
Violations Related to Foidbotnie IllneIss iriarveritions and Risk Accorduo,to Law Cooh
Filetiarstlitems 1-=) (Cont)
4
PROTECTION FROM CHEMICALS i 5 Coolinl,,Isfedimk for PHFs
14 Folso or Color Additives 19 PHIF Hot and Coid Holding
3-50!,1 o(P) Cold PHFs Maietained tit or beiow
3-202.12 Additives* 590 0,1417) F-
3-302,14 Protection I'mm kinappiovc-l! �ddiuvcO
15 Poisonous or Toxic Substances 3-50].VeIA) Hot PHFs Maintanted[it ot abcrie
140'F.
7-10!.11 lidentitving Information-Oiilginal
-5l)1:16(A) Rmsts Held at tic ithove I;Q"F.
containers' 20 Time as a Public Health Control
7-102.11 Common Nome Containers!
I I 5o 1.19 Time ai,a Public Health Cvntiol
7-29 1,11 &�,-'ard6ol �;la:r4e- 590.004(1-t) Variance Requirement
-7-202 11 Retricrion -Prcsmcc�rd Use
7-202.12 Conditions ,)f I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-10111 Tosic Contamer� - il:ohiletions*
7-204.11 S�Inl7isis,Criter,:i-Ctki-caCals* POPULATIONS(HSP)
21 3-�()1.1 1(A) Lirpasteurized Pro-packaved Juicei and
7-20 1.12 Clictint-ils for Washing Fn;duce,Chtcria� -
7-204.14 Di yin,,Agents.Critetia� Beveraget,with Varning I
7-205.11 fncidc'mal Food k"Vinao. Lubricaniri' 3-80�.11(P) Use off"astaurized
3-30[A I(D) Raw or Pil Cool�ed Anonal Food and
7�206�11 Ro-,ty-icicti Us� P-stit;cIcs,Criteria, Raw.Sevd Sprotas Not Set v,,d.
7-206.12 Rod�in Bait Stations*
3-801 II'C) Unopened[",led Fackage Not Re-served
7-206.13 Tni.Airc,Isom der,. Post Gjatrol and
CONSUMER ADVISORY
TIME/T EMPERA'URE CONTROLS 22 3-693,11 Consuincr Advkory Pc,iaed fr'Consumption tit
Proper Cooking rernparat"Ines for Aninnil Foods firat.ne Kew, Underoliked(it
No,01ficrAisc Processed to Eliminate
PHFs
�401.1 I A(l)(2) Egg., 153"F i5 Sec. Pathogens.1'
Eg,,,s-ininaciliate SeI-vire 145'"1 9sec: 3-302.13 Pasteurized Egisis Substitute for Raw Shelf
3-40 1.11(Ali 2) Comminuted Fish, &,Cattle Eggs'
Amorials- I i�'F 15 sIzic. :�
I(Pni,:(2) roi k and Bcfkloist- 130'F I�I mir SPECIAL REQUiREMENTS
3-401.1 I(A)(2), Injec�cd aiitjts --151i'F 15 590()(),)(A)-(D) Violations of Section 590.009(A)-(D) in
,,,-c.� caterin'it. mobile focid, tempta ary and
3-40 1.11(A it 3) Pouln Y,Wild Came,Solved FqFs, retiticutial kitchm operations should be
Stuffirv, Fish,Mcat, d6i'Led under the appropriate sections
Po�lovoi Kinoes-i651- ltiswc. ;'; above if related to foodborric 'flness
3-401.1 1,oc)0) 'if,hole-uni.wle, intact Bc�,f Siet4i's intervention�and risk factor� Other
145 IF 59fUt0c) violations relating to good retail
3-401.12 Raw Anonal Foock Cooked in a praCLICCS S110111d he debited,under#,ii)--
miciovN ave I 65)F So.-Icial Requir-nic-ifts,
1 3-40j.11(A)(I)ib) All 01hei Plif's- 145'1; 5-sec
17 Reheating for But Holding VIOLA TIONS Rr.-LA TED TO GOOD RETAIL PRACTICES
3 403.11(A)&-fi)l PHFs li`I5�17 5 sec. 4 (items 23-30)
1"
,403.1 B) Micruwave 1,2 Minute SlandirlL, CUioll el"d non,ritical violalron,;, which do nof lu file
t ime' 'foodhorne Illness intervenii0m,and l is!,foctors lis�ivdabove, rar, be
3 403.11(C) Cornmercialb,Pi otessed RTE Food- foluld ill che.folit)"ing Sections of the hood Code aea 105 C,11R
140 Ft .5.90.600,
3 403 �I(Fjt Reunainirv� Undiced I'voeons of Beef Item Good Retai,Prartices FC
.000
i 23. Manalicinent and Perisonnol FC .003
Roirsts, 2 1 590
24, Food arid Food Protection FC-3 1 .004
18 Proper CooNnq of PHFs 25 Equipment and Utensils FG-4 005
3-501 14(A) Cou'livu Cooked FHI-s from '40'F lo 26 yi Plumbinq arid Waste FC--5 006
701FV;,,,qio ' ilour;iIjId Frxa 7(','F 27 Physical Facility FC-6 M07
41'F!45'!�Within 4 Hour,;.
a I
2 8, Pcisonous or Toxic Materials FC-7 00"
29 Special Recluirerilerits;
3-50 1.1,4B) PHFs Made Frout Ambient 069
Tempvtature Ingredients it)4l'FI4,5,r Other
30, 1
Within 4 lionr�--
1XI10te, il�nl lic f.dcral 109111......I Cod,,-or 105 Ckll�11)0 N)o.
0120 WASHINGTON STREET 0 Weills Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: El
Telephone: Item Status Violation Critical Urgency Nature of problem or correction
740-8811 Non-compliance with: Not Done
Owner: - Anti-Choking PASS El
Ronald Brogan, Tobacco PASS
PIC: ,, I
FOOD PROTECTION MANAGEMENT Not Done
Angie Silva PIC Assigned/Knowledgeable/Duties PASS RED
Inspector:
Not Done
Janet Dionne EMPLOYEE HEALTH
Date Inspected: Correct By Reporting of Diseases by Food Employee and PIC PASS RED
813012005 Personnel with Infections Restricted/Excluded PASS RED
Risk Level:
FOOD FROM APPROVED SOURCE Not Done
Permit Number: Food and Water from Approved Source PASS RED
BHP-2005-0190 Receiving/Condition PASS RED
Status: Tags/Records/Accuracy of Ingredient Statements PASS RED
Open . Conformance with Approved Procedures/HACCP PASS RED
#of Critical Violations: Plans
3
Time IN Time OUT
Notes.
260'
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
GeoTMS@)2005 Des Lauriers Municipal Solutions, Inc. Rev. Sep 06,2005 Pajze I of 3
0120 WASHINGTON STREET O'Neffis Bar and Restaurant
must be corrected immediately PROTECTION FROM CONTAMINATION Not Done
or within 90 days) Separation/Segregation/Protection PASS k RED
RED:
Violations Related to Food Contact Surfaces Cleaning and Sanitizing PASS W RED /uiting board stained and scored.
Foodborne Illness Interventions Proper Adequate Handwashing PASS RED resurface or replace
and Risk Factors (Require
immediate corrective action) Good Hygienic Practices FAIL RED Ve rsonal items being stored near plates.
personal items not to be stored in food
prep areas.
Prevention of Contamination from Hands FAIL Critical RED _gloves not being worn when handling ready
Vto eat foods at time of inspection.gloves to
be at all times to prevent bare-hand
co tact w th ady to eat foods.
co
Handwash Facilities FAIL Critical RED ��' -ti me of'insrpeection fish was being
t'
defrosted in handwash sink. hand sink
shall be used for handwashing only.
handsink to be free from all objects to allow
handwashing at all times,
a d sink at bar missing sing. provide sign
n
.t��that states handwashing only.
PROTECTION FROM CHEMICALS Not Done
Approved Food or Color Additives PASS RED
Toxic Chemicals PASS RED
TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done
Cooking Temperatures PASS RED
Reheating PASS F/-1 RED
Cooling PASS k RED
Hot and Cold Holding PASS &01 RED
Time As a Public Health Control PASS F%11 RED
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO NotDone
Food and Food Preparation for HSP PASS Fv] RED
CONSUMER ADVISORY NotDone
Posting of Consumer Advisories PASS RED
GeoTMS@ 2005 Des Lauriers Municipal Solutions, Inc. Rev. Sep 06,2005 ) Pac�e 2 of3
0120 WASHINGTON STREET OWeilis Bar and Restaurant
Violations Related to Good Retail Practices (Blue NotDone
Management and Personnel PASS BLUE
Food and Food Protection PASS El BLUE
Equipment and Utensils FAIL BLUE /S anitizing buckets not being used properly.
If using wiping cloths and bucket system.
two buckets clearly labeled shall be used
one labeled raw meat clean up and the
other labeled for all other cleanups.
t hup dispener had accumulation and
b6,',Icd up thoroughly clean and sanitize to
remove all buildup.
fryolator splash guard cracked replace
�splasn Jard.
e ac
e machine in basement had
accumulation of mold on inner panel.
thoroughly clean and sanitize to remove all
mold growth. perform regularly to prevent
contamination of ice.
VIJIC�E scoop container at ice machine needs
to be thoroughly cleaned and sanitized.
'W d sink at bar needs proper sign provide
Vs,gln�that for handsink that states hand
washing only
Water, Plumbing and Waste PASS El BLUE
Physical Facility PASS BLUE
Poisonous or Toxic Materials PASS BLUE
Special Requirements PASS BLUE
Other-See Notes FAIL BLUE stored incorrectly in mop closet mop
V?o bE stored mop head up not touching any
surface to air dry.
GeoTMS@ 2005 Des Launers Municipal Solutions, Inc. Rev. Sep 06,2005 Pajze 3 of 3
0120 WASHINGTON STREET 0 Weilis Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection
HACCP: [I
Telephone: Item Status Violation Critical Urgency Nature of problem or correction
740-8811 Non-compliance with: Done
Owner: i Anti-Choking PASS El
Ronald Brogan Tobacco PASS El
PIC:
Angie Silva'� FOOD PROTECTION MANAGEMENT Done RED
Inspector: PIC Assigned/Knowledgeable/Duties PASS
Janet Dionne EMPLOYEE HEALTH Done
Date Inspected: Correct By. Reporting of Diseases by Food Employee and PIC PASS RED
9/8/2005 Personnel with Infections Restricted/Excluded PASS RED
Risk Level:
FOOD FROM APPROVED SOURCE Done RED
Permit Number: Food and Water from Approved Source PASS
BHP-2005-0190 Receiving/Condition PASS RED
Status: Tags/Records/Accuracy of Ingredient Statements PASS RED
PARTIAL COMPLY Conformance with Approved Procedures/HACCP PASS RED
#of Critical Violations: Plans
PROTECTION FROM CONTAMINATION Done
Time IN: Separation/Segregation/Protection PASS RED
Time OUT.
Notes: Food Contact Surfaces Cleaning and Sanitizing PASS RED
280 Proper Adequate Handwashing PASS RED
Urgency Description(s): Good Hygienic Practices PASS RED
BLUE: Prevention of Contamination from Hands PASS RED
Violations Related to Good
Retail Practices (Critical Handwash Facilities PASS W RED
violations must be corrected
immediately or within 10
days)(Non-critical violations
GeoTMS@ 2005 Des Lauriers Municipal Solutions, Inc. Rev. Sep 13,2005 ) Pajze I of 3
0120 WASHINGTON STREET O'Neills Bar and Restaurant
must be corrected immediately PROTECTION FROM CHEMICALS Done
or within 90 days) Approved Food or Color Additives PASS RED
RED: � RED
Violations Related to Toxic Chemicals PASS
Foodborne Illness Interventions TIMEfTEMPERATURE CONTROLS(Potentially Haz Done
and Risk Factors (Require , Cooking Temperatures PASS RED
immediate corrective action)
Reheating PASS RED
Cooling PASS RED
Hot and Cold Holding PASS RED
Time As a Public Health Control PASS RED
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done
Food and Food Preparation for HSP PASS RED
CONSUMER ADVISORY Done
Posting of Consumer Advisories PASS RED
Violations Related to Good Retail Practices (Blue Done
Management and Personnel PASS BLUE
Food and Food Protection PASS BLUE
Equipment and Utensils FAIL Ej BLUE fryalator splash guard craked. replace
splash guard
Water, Plumbing and Waste PASS BLUE
0
Physical Facility FAIL BLUE VbacklOha ap at bottom of door
provide door sweep to help prevent
entrance of rodents and insects.
Poisonous or Toxic Materials PASS BLUE
Special Requirements PASS BLUE
Other-See Notes PASS El BLUE all other violations cited in 8-30-05 report
have been corrected.thank you
GeoTMS@ 2005 Des Lauriers Municipal Solutions, Inc. Rev. Sep 13,2005 ) Poke 2 of 3
0120 WASHINGTON STREET OWeills Bar and Restaurant
GeoTMS@ 2005 Des Lauriers Municipal Solutions, Inc. Rev. Sep 13,2005 Page 3 of 3
CITY OF SALEMI, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 0 1970
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 111, 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: O'Neills Bar and Restaurant
Address of Establishment: 120 Washington Street
Owner's Name: Ronald Brogan
Restrictions:
Application Date: 12/01/2004
Permit for Food Establishment 94-05
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 SALEM9 MASSACHU
BOARD OF HEALTH
0
120 WASHINGTON STREET, 4TH FLO
SALEM, MA 0 1970 NOV 3 0 2004
TEL. 978-741-1800
FAX 978-745-0343 CITY OF SALEM
STANLEY J. Ui JR. JOANNE SCOTT, MPH, IRS, CHO BOARD OF HEALTH
MAYOR HEALTH AGENT
2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT f2c413 TEL# Ao — eKk
ADDRESS OF ESTABLISHMENT /2,o 1-,A5111iV61raA1 57-
MAILING ADDRESS (if different)
OWNER'S NAME 14?0JVA1,1-? 131?01r4A1 TEL# �/7- 9'3F-61?o1'
ADDRESS lob 1012-
CITY--go�Vo STATE HA ZIP o,?a 6 2
CERTIFIED FOOD MANAGER'S NAME(S)Atz,�//-- �JLIVII- CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON 90011q1,19 1317J,�-,AAI HOME TEL# -7YI- 762-oo.?-7
HOURS OF OPERATION: Mon.//-/ Tue.ff-_L Wed.Ll-_L Thu. FrL1L::�_�SatJL-_4,,-_Sun.
TYPE OF ESTABLISHMENT —FEE check only
RETAIL STORE YES NO less than 1 000sq.ft. =$ 50
1000-10,000sq.ft. OD
61 more than 1 0,000sq.ft. =$250
RESTAURANT NO less than 25 seats -$100
25-99 seats <EED
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YES $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.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my
best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law.
Signa re Date Social Securityor Federal Identification Number
.. ........ -0 L� b r-----------------------------
-- ----------------------IL2-2------ X )Ogle q
Revised 11/03/03 FOODAP2 acm Check#&Cat
7%01
PLEASE REMIT,ROME-
.1 Exterminators
IN EFAR
V
D STREET,LYNN,MA trli)�=-:4697' AIM
A gill--w78l-592-2731'14WD-5254825 FAX 781-592-7641
-A ;lCURRENT,t_3 '4��30 f6l). S�L
N
Pest�rd Terrnite Control P' ro'fesslonals
UUI)-Y1�1"-,"*`ACCT NO 4ll. WW J�
In DATE DAY TYPE DATE 1:-.L;h
_wii
07E�P,' Wed 101
OINEI,LS RESTAURANT 'REGILJI,7AR,?1
,'CONTROL FOR'*,'�
Al
120 WASHINGTON ST9 , ER TUNITPRICE�
OU
SALEM-'MA W �11
978-745-1633 04/26/05 0- 5 ;L
--DATF-- PR T
i . ", 1 1,1 - . . '. ;
671 PR
Clliid� T
COMMENTS
-U MCGVISA��-C]DISCOVER- -RATGLUE,BW��,
KIT/PREP/DR/BSMT/RR/LOU LI0.UOR - #;
RM/s-roliRABE
TAX,,
EXP DATE M119
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A DrriONA COMWIN
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COMMERCIAL SANITATION REPORT
-NO-
t 'ji:7
Floors
w" 0-1"'El
CounlarSurfaoss,-.Clean,
�'C] It!13
E] [3
..........
Rest Rooms-.Clean ....
.............. .. ....
Dining Areas-�Clean . j............ ........
El El
Erriployeeiki;ai�_-'Claain ..... ..... 0
Lo6ker Areas-`Clean'.. I...........;.......... E) 0 �'J',,'RES1159INTIAL WAR) .... ..
Storage Areas-Organized ..................%N
I
_v- �I I I DWELLIN6*TYPE ,t% :WAARANTY-
comments
'i FirmlV;`13 t��-� Family `0 lf"
Xba�js
.2,Eamily-.'.13 1-1��E 6 Family' POO Dao
4
REASON FOR NO WARMAN I If
t. - -PdrtihI service requested.:........ ... ..... ...
.. . .... ......
REQUIREMENTS �lsftof sanitation..;.�...:E�............. .................................i
Kilichentbat
OCCUPIED AREAS MUST BE VACATED FOR HOURS. -Cloieis/furniture not prepared..... ....... n
THOROUGHLY VENTILATE TREATEDAREAS BEFORE THEY ARE opqden�prooflng needed
................
REOCCUPIED. DO NOT ALLOW ADULTS,CHILDREN,'OR PETS ON .... ..................... ...... ......
TREATED SURFACES UNTIL DRY. --Other
CONTRACTING ENTITIES HAVE RECEIVEDALL MASSACHUSETTS DEPARTMEN.t'OFFo6D8:AGRICULTURE'�-PEST]CibE,�
IN
BUREAU CONSUMER S TEMENTS,POSTING NOTICES AND HAVE AGREED TO NOT
WRm
ABOVE SERVICE HAS BEEN SATISFACTORILY COMF i,
DAYS PRIOR TO APPU=N'TIME TW T
- THIF
CUSTOMER SIGNATURE r
Whfte_2Of6c'eC0py' Can C
SEE REVERSE S-CE FOR PEIRTIN�l INFORMATION ary- Ost6iiiiiPopy.i)UFP�
IMPORTANT MESSAINE
FOR '�net
DATE TIME
pLjchl )r- Elje-xz�a
5 ' -0
0 �I- �7-�o(I n f) D
PHfON 1 -VS094 —
U �4 PAREA DE �JUMBEh EXTENSION
,X
FAX
0 MOBP P
AREA COD,E NIMIER TIME TO IALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YO WILL FAX TO YOU
MESSAGE �j V��rC�
N-5 �nm& cn t nound
ll� I
4 1 b
-�nnrj nhnLL+ '
SIGNED -T(7
FORM 4009
MADE IN U.S A.
CITY OF SALEM
0 /�j BOARD OF HEALTH
'Itstablishment Name: r27AY-Date: Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
1 .,Ao6ri q- c6molall rn� elijed �D&/
c7l�dn 1z1a_q eelqducka' '4/-
mmll z0as
��Iri(pizja�le lhi"nl evlo �Iemoq -�)s7�7khshln,�-1774-
h e
'.�640LY Code, 6,00
anew -es-1.w611_vht77e1-z'1- I
If) J 19AId
�IAo re7llv�no imo mos-1 check area- 171aA�
r
01
J
LI No Q Yes
Discussion With Person in Charge: Corrective Action Required:
I I I I
1 0 Voluntary Compliance 0 Employee Restriction
ir 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 Q Re-inspection Scheduled U 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 ZI Embargo L3 Emergency Closure
your food permit. u Voluntary Disposal 11 Other:
'I-5o -kQ llt-fFt Re�enr,, t T-niocraturcs
Violations Rotated to Fooniborne Illness Imerventions ass Risk Alceordin",to 1'k'� Coo!efi l)
Factors(items 1-22) (Cort.) 41"r,45 F'Wid;:n"How,
PROTECTION FROM CHEMICALS '-50; 15 CooLa- ',lcthcdz�for PPi�,
14 Fond or Color Additives 9 PFIF Hot and Colo Holding
7)02.12 AddiL!",S), ',-5W,J B) Cold PHFl, aL,)r hCIOW
3-3ij2,14 Proteciron fcota Unapproved Addnrvci� 519f).('-0-1(�) 4li45' F,
1-4�)1 16(4) 1 1,,t �H F,' Nlainljj�ied at caribow
Poisonous or Toxic�ubstances
1 1 Identil'yoIg inforrillition 0: 3-501.i 6(A) Roasts Held at or�ihove I 30,F,
20 Time as a Pubiic Health Control
3-50 1.P-) 'li me as a F*Lbir� Health CLAItICIP
7-201.11 Separation -Slot rtt"c`
7-202-11 RUStfiLtion--Pwscnc�and Use;' V�,riance Recrinenlent
7-202.11 Co'ndjtiuns of I Fw-1
-;-203�11 Toxic Contriin,r,-Pr�-Jlibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Saniiiz�is,Criteria-Chernitn1s," POPULATIONS(HSP)
7--'04.12 Chemicals for Washim,Prochwe,Critecial 21 SO'l I!l A) Unpastourizeri Pre-pachaged Juicei and
-1 '404.14 Dryiftg Agents,Craterial Poveral,zes%voli Warro�i.P I
I t(m lJL;eoFPasIe.utizedEi,g
7 205.11 ln�-Iideutrd Food Cotaqct,Lubr;,anti
3-K, (0) Ra" v�,Partiadsro:�,kcd,loriinafd Food and
?-�06.11 Rcs!rrued Ute Pesi'mlcs, Criteiial i I
Raw S,.cd Sincuts Not S��Ved.
7 206.12 Rodcrut Bart Station,14 (C) Unovelled Frale!Packtge Not.Re-served
'i_2G6.!3 1'ra,king Po,�rdcrs.Pest Control and
CONSUMER ADVISORY
TIME/TEMPERATURE CONT ROLS 22 3-603.11 Consuniot Adtiscliy Powd for Coll,aimption of,
16 Proper Cooking Temperatures for i Aninard Fooasfliat are R�lw, Undracookc(
1','ka odr�'
PHFs lN,SeP,ees,_ ,Elim,ja[e
W
3-401.114,(1)(2) F�gRs- 155F' Pathogzis,- E1�11
3-302.13 Pa�tcuiimd Fggs boostitote fit Raw Shell
E�!tvs-finracdiotc Service 145'Fl5sc'
Conan,ruted Fish. Mears&Came
3 401.11(A);,.)
Aniurals- 155�F 1�sec.
3.401.1 I(B)(ll(2) Fork.and Beef Roast- 130c F 121 join* SPECIAL REQUIREMENTS
1 3-40 1.1 1(A)(2) Fairies, Injceted fsleal,-,-15-'F j5 590 009(A)4D) VicljtIons of Section 590.0(a)(A)'-(D I in
see. j titerin.,, rimbile food, temporary and
3-401.11 IA)(3) Poultry,Wild Game,Sturfled FHFS, cmidentia' kitchen operatjun� 0iould lie
Striding Containing Fish,Meat, dchowd under thc appropriate sections
Poollryor Ratites-165'F 15 sec, -illove$f ipluicd to fqndborric illness
�1-401.1 1 K-)(") Wholc-n'aisde,haa(( Bed Steaks, Interventions and risk factors. Otl:e-
1450T� 1 1590.009 violations ielatin.,to 1-ood retail
3-401.12 Rfnx Arlonal Foods Cooked in e.
I prau tr"should In-debited onder#29 -
Nficiowave 105'F Special Rerp-li;ernents.
3-40L I i(A)(I)tb) All Otim PHFs-- 14�'F 15 we,
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.11(A)&(D) P1 IN 1 65'F 15 sec. (Iterns,23-30'
3-403.1 1(B) Microwave- 165'F 2 IM)ulte Standing C;itical('10 wrl-c ritical Nolaironv, which do vw,elate lo the
Tinnel rovot,;t)rr,.-ilhi,sx inlei venfi,m und iisk hutors Irweci obere, (an br
3-403.1 i(C) Commer(ialiv Piocc�sed RTE Food- finf.-w."in ir-,.Wons qf the Fo ad Cox/p and 105 011?
14o"FT
3-403.11(E) Rernamitc,UnFliced Portionsof Beef Item Good Retail Practices r-C 590.0w
23. Marlaq-tri and Per�onr FC-2 .013
Roaoa�* IV: I
18 Proper Coaling of PHFs 24 �Ocd at)d F000 Rotect'on FC -3 .004
25 Ewipmeni an�utensils rC-4 005
501 14(,l,) Cool;v.,Cooked PI iFs from 140'F to I vialer Rurn�alq and Waste 1 .006
Willa It 2 1 fou r,and From 7 PhvsicaiFaci�itc F-C-C 007
to 4['F/45'F Within 4 Hours. — 'Toxic I-A-lallials FC.-? .008
26
70''F wt;
Pcis000us or
Coo"InS P1 IFs Made fil"111 Ambient 29 �Lecial Rrqu:remerlis 009
,-501,141 B)
Temperature LIgredients to 41`F/45'F Other
%N ilhin I Hours
itoli'll tile t"leta!
CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 0 1970
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 111, 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: O'Neills Bar and Restaurant
Address of Establishment: 120 Washington Street
Owner's Name: Ronald Brogan
Restrictions:
Application Date: 11/26/2003
Permit for Food Establishment 40-04
Frozen Desserts/Ice Cream
Permit for the Sale of Tobacco Products
These Permits Expire December 31, 2004
This permit is not transferable and must be reissued upon change of
ownership or location. The permit must be posted in a prominent location
in the Establishment,
In accordance with the State Sanitary Code, before any renovations,
improvements, or equipment changes are made, all plans for such must be
submitted to and approved by the Salem Board of Health.
HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
E30ARD OF HEALTH
120 WAS H I NGTON STR EET, 41
SALEM, MA 0 1970 NOV 2 4 2003
TEL. 978-741-1800
FAX 978-745-0343 al Y uF ��ALEM
STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO 130ARD OF HEALTH
MAYOR HEALTH AGENT
2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT L9'1VC1&&'5 PaIJ �- IZC9 t�_ TEL# W'?- _144o - 17711
ADDRESS OF ESTABLISHMENT IZO 41A�liljtle-7dW 511
MAILING ADDRESS (if different)
OWNER'SNAME 1�6041,12 159dt-AW TEL# -7 9/- 16 ?,-00�3
ADDRESS /19'7
CITY ffolivooD STATE MA ZIP 0106 Z'
CERTIFIED FOOD MANAGER'S NAME(S)AWm,- 54VA CERTIFICATE#(s)C-A 00oo 3'74,p�l
1,7,)$11+�,d b1Z04A,,1 A 13 00 a 0-5-7 ir it7
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON_12,)VAt�d 1317,0,-AIV HOME TEL#IfZ�_�-00 -3
HOURS OF OPERATION: Mon.//- I Tue._W/-_1Wed. //- 1 Thu. //- / Fri.//-/ Sat.jl-/-Sun./Z -
TYPE OF ESTABLISHMENT _FEE check only
RETAIL STORE YES NO less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 1 0,000sq.ft., =$250
RESTAURANT OYES NO less than 25 seats =$100
<_�� 6ziD
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YES $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.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my
best knowl ge and belief, have filed all state tax returns and paid all state taxes required under the law.
Signature Date Social Security or Federal Identification Number
-------------------------------------------------------------------------------------------------------------------------------------
Revised 11/03/03'FOODAP2.adm Check#&Date ?,f,2/- //-/7-
A
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,4* Floor
Division of Food and Drugs Salem, MA 0 1970-3523
FOOQ FSTAI:3LISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343
Name Date,_,)q Typp of Ooeration(sl Tvpe of Insoection
g3 Food Service El Routine
Address w o n !�-'T Risk El Retail 9 Re-inspection
Level NA El Residential Kitchen Previous Inspection
Telephone El Mobile Date: 11_217_1�le(
Owner HACCIP Y/N El Temporary El Pre-operation
f)ln'el El Caterer El Suspect Illness
Person in Chirbe�PIC) Time El Bed&Breakfast El General Complaint
inspector /J.-N In: El HACCP
r-n r, I Out: Permit No. Ej Other
Each violation-ch-e6ked 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) Ej 590.009(F)
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
El 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities
EMPLOYEE HEALTH
El 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS
Ej 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives
El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
F-1 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
E] 5. Receiving/Condition E] 16.Cooking Temperatures
[1 6. Tags/Records/Accu racy of Ingredient Statements E] 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans [-] 18. Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
E3 8. Separation/Segregation/Protection []20.Time As a Public Health Control
[2r9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
El 10. Proper Adequate Handwashing EI 21. Food and Food Preparation for HSP
El 11. Good Hygienic Practices CONSUMER ADVISORY
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
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
C N 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent cdnstitutes an
24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
cited in this report may result in suspension or revocation of
15. 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 a,the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
S 5W��P.FF��14 d.
intct,"Sisign.A re: Print: e
v PA, 11 5.1 V j
ijjpat�re': Print:
I Page of�ages
�j 0 YVi-A
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTANIINATICN-
FOOD PROTECTION MANAGEMENT Cross-vantapvcation
5900030) 1 3-30.�ARA)H) Raw Animal Foods Sepa.la',id fioni
590.0s)3(B) Demoastraiion of Knowledge" Cool,W and FTL'Forods-
2-103,11 1 Person in charge- dutics Cot tambration from Raw ingred&ritt
3
-301!1(A)(21i R,-.v.-Ani real FoWs Sepa.ated fi out Each
EMPLO"EE HEALTH Other'
2 590 00 if C f Rcq)on:iibili1-Y of tho pet�on In cliar�go to Cornami,7atroor frorrilhe Enviontnent
require reporting-by food cruployces and 3-302 1 ItA� F�xi Protecuket
applicants' 3-J02 15 Waslim,F-ruits and Ve,,tibles
I g
59-1003(fi) Responsibility OfA F000t Employee Or Art 3-3�),[.Jl Food Corot,!ct with Eop6pnivatand
Apoficant To R,-ffort To The Person in uteu�fls'
Chao-"e` Comamindtion front the--onsumer
590.003(G) Rfpofrtin-p toy Poison in Ch�iree` 3--o06.l4A)(B) Returned Fooel:nid Re�ei vice of 14,��&
3 590 003(D) E�ccll)siongaud Restil.,tions* Disposition o'Adatiorated or Contaminated
590.0030-1) Removal of Exclusions and Restrictiore, Food
I I DiSLarthrig or Reconditioning Unsac
FOOD FqOM APPROVED SOURCE Foo-d-
141 Food and Water From Pagulated Sourcos 9 Food Contact Surfaces
1 590 OO,4(�% B) Cornphonve with Food Law' 4-50 1,111 Manual Wu-.,nvaQnoog-flotWotcr
Sar)iuzwionTcmpejatur
1-201.12 Food fee Hermetically Sealed Corotmner' I
3-201,13 Had Milk and Miik Products- 4-50! 112 Mechanical Warewashiug-,Hot Waier
Sanui2,atton T.-inperatur"
3-2011.3, Shell E--s�
4-501.11.1 ChemicalSdifiLiZati0ft-tcnip.,pH,
3-202.14 1; gs and Milk Product,,.Pasteuriz�ed-
'9�
-1-202,16 le-, Mode Front Potable Drinkim, �V;uer*
5-101 11 Drinking'YX toter from an Afojnoi,�d S�s�em;' 1 4-601�I I(Arl Equipment Fu,d Conwct Surfaces and
Uttinsi Is Clean
'�90.006(A) Bottled Drinking,Watet� 4 (101,t I Cleaning Frequeney oI Equipment Food-
1 590.006(B) Water Mect�Standards in 310 CMR 22 Oi- Contact Surfacc�and Utensil!,i
Sheiffish and Fish From on Approved Source 4-702.11 Fiequency(if Sainitization Uic-nsils wqd
3-20!.14 Fish and Recreationally Caught lorlollui;can
Food Contact Surfia�es oi Equipi
Slielffishil 4-703.11 Methods of Sanniz,ation --Hot Water and
3-201.15 Mrilluscan Slicllfi�h frorn NSSP Lisled Cherfoi�'11'
Source.0 to Proper,Adequate Handwashing
Game�rirr Wild Mushrooms Appioveir by 2 301A 1 i-leanCoididon Han&andArrnt,4
RepalAtuotvAuthocty,
20'2.18 Shellstock Identification Present" )-30 1.1 c1c"onin,Procedul
5901)04(Cj� Wild Mushjuorm' 2-30 1.14 '��I wil to W.1011
3-201.17 G�,ut:e Aroincils,ft it Good Hygienic Prsctices
Receiving/Condition 2-401 It Enting,Drinking oi Using Tobac,o'
1 ?02 11 PI!Fs RccviNedat ProperTemperatur-i'r 2-401 12 Dis'cF ir,-eL,. Form the Ev�;.Nose arij
';-202,15 Pa�kave ln1cgxitv* Month*
"to .1 -f01.12 Preverifim,Gwarinnatine WIten Taq
hiliclate-, 3 1 0 11,
jul.11 Food Safe-d unaid 12 Prevention of Contamination from Hoonds
1 6 Togs/Records:Shellstock 590m04(E.) Prexenting Ct-fitarnination ftom.
3-202.18 Slwllsto�k identification � I
Ernployee��
3-203.12 Sficlhtock Identification Maijuamed:� Handwash Facilities
Tags/Recordo:Fish Products Conveniently Loceteo and Accps5be
1 3-402.1 Parasite DeFteoiction:�
5---'(113,t I Nunibe�s and Canacnfci�
3402.12 Record,,. Ciealionand Retcntj(m'� I
590.0,)4,'J) Labeling ut Ingredients' 5 204.11 Location and Plac,,ment,
7 Conformance with Approved Procedures �-"m.11 Acc-essibility,Ofoc��zti�m ond V�dnavnanue
/HACCP Plans Suppitod MPP?Soap ancy Hand Drying
Devives
3-501,11 Spe6iflized Processing Methods,
6-301.11 Hanjwa,bing Clcaie,�r A-,ailaluht�
3-.�nl� Reduotd oxygen packaping.crilerki"
6-301.12 Hand Dr�ing Provimkm
'f-1 O's; 12 Cmloroiance with Approved Proccdurc�.' i
I-)9(,';7(,,d(',,de ur 105 CNIR
CITY OF SALEM
BOARDOFHEALTH
Establishment Name: 01 no it Date: 1 ;;i_ -t'9 -oU Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
_C30 InY r-IA69 Vllnl-;�l 4-1)r1CH - �v of') r/'<)1 9'-4 - Un,
rt4n'n �MLA cv� wy��V_ ?-Z-A"10_0 rC,
141
00 04 /1 0 nP �-H OF vpl()7j
"A� -7\f100 AM-710I.-
A) :�nn/r)-x -�7) vv \Inro- i v\ n_i,mn 4 rtyt/lln C ev �m-sl of)(
k( cc'; _(�rkmo ftuil' 1)12 V-vi nA� o a(kQ- -,r) -M') (,o
4-0 athiprz) Vi r&rrhlm '� 0 fvr( 60
7hI, R r P) .
Dis cussion With Person in Charge: Corrective Action Required: U No Ll Yes
I have read this report, have had the opportunity to ask questions and agree to correct all 13 Voluntary Compliance U Employee Restriction
Exclusion
violatrons before the next inspection, to observe all conditions as described, and to LI Re-inspection Scheduled U Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncowpliance may result in daily fines of twenty-five ollars or suspension/revocation of Ej Embargo 0 Emergency Closure
your food permit. I �A 2 El Voluntary Disposal U Other:
3W !(C) PI tFs Recoived at Teny'a.'auroq
Violations Related to Foodborne file,5s Intervention--and Risk Acco�din�,,to Laa,Cuoledm 'L
Factors(items 1-22) jCont) 4:'��1�5'F Within 4 Hours.
PROTECTION FROM CHEMICALS
C-,'14jn:,Me�h,ds for Pfif's,
14 Food or Color Addifives 19 PHF Hot and Cold Holding
3 Additiv-�',' 3-5:)[ 16(13j� Cold PHFVV.-.�intajned at o,� below
20112 596 004(P) 41 a/4 5`F:'
301.14 Protection floor Unapproved AddittNe��
3-�C,1,INA) Bol PHF-, Maij!toined at or aboNc
15 Poironous or Toxic Sub.,tances
[4o'F
7 101.1 fderltilyln�! Inforinailol I-03 1--,1 nal
Containers- 1 1 3-50 1,i 6(A) Poists Heldat ornbeve 13WR
7-1011 Comanoit Nanic-Workin-Coarainors* 1 20 1 Time is a Public H�alth Control
7-201.1 J-�ol 1.) Ti-nic ic,a PuNic I-leahli Contrc-14
I Separation-Storaiz,� 59(,�.04(H) V�Iri2nce Requircirrient
7-202�11 Re,,tri,tion--Pres,11ce md Use
7 202.12 Condi6ons of U;c-
7-203.11 Foldc Containers-Piohibitioas,� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7- Sanitiz.-rs,Criteria--Cherniculs" POPULATIONS(HSP)
21 3-MI:.!!(A) U!)Pa!,rea,lzCd P!V-packigcd Juices and
7-204�12 Giennicals for Washing Product,Crituria�'
1 7-204.14 Dr�ing Agents.Critcow I Bevcf--.�e,� with Warninp !,I,bols-
7-205.11 In6dental Food Contact,Lobrh-all[S' -401.11(B) I Use�)! Pasteurized Pgg�*
I I(D) Raw or Puilially Cooked Animal Food and
7-206.11 Rewided U�e Pesticides, Critcrn�* R,�w Seed Sprouts Not Set
7-200,12 Rodent Bait Stations- Unopened Food Packaue Not Re-serv,�d.
7-206,13 Tracki it,,Powder;,Pest Control and 0 1�I I 1�
Vfonitorin-,� CONSUMER ADVISORY
TIME(TEMPERATURE CONTROLS 12 3-603�1 1 Ctsasumc,r Advisory Posteu I-or Constuription of
Anuo,ii �,vads that ine Raw.Undercooked(it
16 Proper Cooking Temperatures for N�q othetwisc Processed to Llimillate
PHF9
Pat
401.1 IAfln2) F,_,,a s- 155'F 15 Set'. no'lerlF.-
3 30113 P�,:aeurizcd-, I�g:;SubsLitute for Raw Shell
lngl't,s-Innuediate SerN ice 145'Fl 5.�ecl
3-401.11(A)(2) Comarinoted Fish, Nlests&Garne Eg"s-
Animals- 155-F Ii sQ,:. I
340 1.11(B)k 1)(21 Fork and Bvef Rimst- 13WF 121 rnitl� SPECIAL REQUIREMENTS
3-401.11(Ah 2) R;ilit,,s, Injected Nlcai�-155-F 15 0001A)-(D) Violalions of Section 590.009(A)-J)) in
see. catcring. tnobile food, tempoiar-jand
3-401-11,1,41)(3) Poultr�, Nk'i!d Rairso, Nintled PHF-s, rn�dcatiall kitchen opeiations should he
Stuffin�,Containing Fish,Meat, del-ited under the appropriate sections
Poultry or flatitcF-1650F 15 above ifrelated It)food"orric illness
"-4()I,l 1(C)to') 1,k1ille-nalselt, Intact Beef Steaks iinorventiorj�im.d risR factors. Other
1450F 590.009 violations relatin o lo good retail I
o
3 401.12 R-ov Anurtal Fnods Cooked in a ritnetices si ould be d-lebited under#29-
i0ficrowav-- 165'F* Special Requircatents.
3-401 1 I(AO)(b) All Other PHF;- 1-1 5T 15 sec.
17 Reneating for Hot Helping VIOLATIONS PiLATED TO GOOD RETAIL PRACTICES
3-403,11 P!IF-, 165'F 15 sez� * (Items 23-30)
40 3.11(B) IvI:-,iqNvave- 1650 7 2 Nitrate Standin.- ctoicall and non-crithal, oolaonvs, whiGh do not re!ure e0 tbe
Ti;iW� 11110TC111i"hs und risk fi"to,-�, tiv,"i above, can be
3 403.11(C) Connitutcial IN Piocetsed RTE Foxl- found in dle Ing S""coons tf�
I �tze Food Conle and/05 CAIR
i40+t 590.000.
3-403 11(1-,) R ernai ning Uns I i�-,ed Per ii on s o I*Bee r train Cood Pnetaii Practices FC 590 000
Ronsis' 2 3. Manpounn-t-it and Pernonrel FC-12 003
Proper Cooling of PHFs 24 Ford and FoW Protection FG 3-3 004
14(A) C o o.lins!Cooked PHFs from 140'F to 25. Ecuiproent and UlenMs 1-0-4
26. Water,Plumbinq and WaEl�e -5 006
7W!�Within 2 flours and Fn irn-7 21, PInytical Faclit� FG-6 007
I
to 4117/457 Within 4 Hoor�. 28. Poisonous or Toxic Nqater:�ls FC-7 1 .008
3-50 1.14(P) Cooling P1 iFs Ni,ide Front Ambient 2-9. Special Roi,;irements 009
Tempeiature Ingredients ic,41cF/45,F 30, Oiier
Within 4 flours
liffiefcd-nal 999 Fc,,jC'ode-r 1:15 CNIM 590000
Massachusetts Department of Public Health Salem Board of Health
1 120 Washington Street,4 1h Floor
Division ol Food and Drug's Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Nam�,, n 1,11 e _:FXI V Type of Ooeration(s). Tyi2e of Insoection
Date Food Service ETRoutine
Address Risk El Retail El Re-inspection
�AkOn 1 1 4A'�
Level r4 El Residential Kitchen Previous Inspection
Telephone El Mobile Date:
Owner HACCIP WIN El Temporary El Pre-operation
El Caterer El Suspect Illness
Person intKairge-(0116y Time E-1 Bad&Breakfast El General Complaint
In: [JHACCP
I inspector 4�IhAIAP, out: Permit No. El Other
Each violatkit decked -requires an explanation on the narrative page(s) and a citation of specific provislon(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) El 590.009(F) El
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT D 12. Prevention of Contamination from Hands
El 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
El 2. Reporting of Diseases by Food Employee and P16 El 14.Approved Food or Color Additives
E] 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
Ej 5. Receiving/Condition 0 16.Cooking Temperatures
E] 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
0 7, Conformance with Approved Procedures/HACCP Plans El 18. Cooling
PROTECTION FROM CONTAMINATION �Kl 9. Hot and Cold Holding
[;/Cseparation/Segregation/Protection El 20.Time As a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
EV9. Food Contact Surfaces Cleaning and Sanitizing�p 21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing
El 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
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
C N 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590 003) by a Board of Health member or its agent constitutes an
,,'24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of
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 oider.
30. Other DATE OF RE-INSPECTION:
S 501ns�lFo�14 doc
InsPedforls Signature: Print:
Plcl§-S*gn'tare: Print:
Page /Of3pages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMEN't Cross-comaniration
1 -590.0031,'l) -Amignment of Responsibility� 3-3,02".11(At 1 lKa"k All�mal --oods SepaiatVC,florn
590.003(B) Demonstration of Krc)Medgm�
Cooked and RTE Foods�
2-1031.11 Person in charge dotics
Goot�niinatoi)f,-rm Haw alla-dionts
3-302 1 I.'A)(2) R�cv Animal Fooc':;Sepniated floor Each
EMPLOvEE HEALTH Orhcr4
2 500.003(C) Re:;p-ifisibilkyofthe pe,son inchargc to Contamination from,ft7v Frioroqment
TeqLl:rC,lef)01611�11 fly food eclfl(-�WCS an" 3-302J 10) Fund Protection
appficants� � 3M.15 Waghintz FrujLq vnd Veveiable,
.590 003(F) lk�sfroir;ibifir�Of A Food Ernployce Or An 3 304.i 1 Food.confaa wrill f";uipinentalic
Applicant To Reporr To Tht Pei Sol] in Ulen�itl' I
Chugv� coricam"inatorl honi the Consumer
590.003(G Rcportirn�by Pei Non in Charge, 3-306.14IAi�B) Returned Food andf!eia�nfcc of Fooj�
3 590 003(D) Fxclusions and Restril,Lions* Dispc�-,iiiorr of Adulterated or Contaminated
sw.ow(F) Removal of ExciLlSiOlIS and Restriction, Food
3-70 i.I I Di,-,;irding or Reconditioning UM'Safe.
FOOD F'1OM APPROVED SOURCE Food,
41 Fod aridWaterl',on?Regulated Sources 9 Food Contact Surfaces
i 590.004(A P) Compliance vith Food 1_1,1� 4-501.11 j kdanuad WarewaAnng-I lot W,ler
1 3-20 1.12 Food in a Hermetically Scaled Corlanncr� S�initization'renil)erattire,��*
4-501 112 Mechaill-al Warewashin, Hot Water
3-201.13 Fluid Mill, :ind Milk PrOducts4
3-20113 Slicil &-l" Sapiriz-atcr.Tenioeraiures�
4-501,114 Chemical SankiLation-ternp., pli,
3-202.14 F.gqs and Milk Products.PastcarrizedT concenti ati,in and hal dncs,�, Ic I
3-202,16 Ice Made Frorn Potable Drinkine �Naterl t-601 11iA) Equipment F�4ld ContactSurface�,end
�5-101.1 i Drinkinv�\atei from an Approved S,�slcm" Uten'�ak Clean,
500,006,A) Bottled DrinLinc Water' 4-602.11 Clearing Frequ�ncy
5;J0,006(B) Water Meeis Slim&rds in 310 CIVIR 22 01 . of Equipment Ftmad-
Cont,.ct SurfaiLes and Uterrzdst
Sneffish and F,0 From an ApprovedSourvo
i 3-20 1.14 Fish and Recreationally CauOlt Mollusi--an 1-702.11 Fr.,�quency of Sjlnt�zatiorl of Ulensils and
I Food Contact�4via
Sh�llfifr: 4-703.il Methods of Sann'zatiou -I-lo',Water and
3-201.15 Molluscan Shellfish from NSSP Lsted chelcie'd-
Sourc��:� Prcpar,Adequate Handwashing
Gatire and Wild Mushrooms Approved by
Rogulatiory Authority -MIA I Claim Condhion- Handq and Arryis"
3-202,18 Shellstock Identification PrewnO 2 3W.12 Clearing nrocedure*r
590,004C) Wild Pvfu�hroorns� 2-30 i.1 11 Wile n tu Wash-
3-201.17 G.une Annnnah.4 Good Hygienic Practices
Receiving/Condition 2-40 1.1 i Fatina Drinkingai U�ini,'Tobacco*
3-20-1.1 i PHR,Receivedat Proper I'cioperatures 2-4o 1.12 D:sch:irgo Flom the�yu,.No%, and
102 15 Package bitccrity," Mouth*
3-30L 12 Preenting Curnamination'A`hc�)'Fast:n�
I()I�I I Friod Si4c and Unadultet aterl
Tags/Records;Shellstock Prevention of Contamination from Hands
3-2f)'.18 ShOl'tock rdentification �90.0(4(E) Prevenrin.,I-Outainarucioa From
3-203.12 Shelistock Identification Maintained* Employers*
L; Handw'ash Facilities
Tags/Records:Fish Products Conveniently Located and Accrssitle
3-402-11 Patasitc Destiticii,in' 5-2o"�l I Numbei, and Capacane,"
0-401.12 Records,Cteacoo and Retention4
590.0WO) Labeling of Ingredients* 5-204.11 Locanon and Placcuti
7 Conformance with Approved Procedures 5-205.11 Acce�s:bflity, Oticritom and Nimmenare,
IHACCP Plans Supplied with Soqo end Hand Drv,ng
3-502.;1 Specialied Procos�ing Nletliodsl* Dt�y%'COS I
6-301�I I Ilaadwasinow Clc--�Osvi,Availability
3-502.i 2 Reduced oxygen packaging,critei ial 0-301.12 I-ki-nd Drving Pro�ision
8-iO3.112 Conforupince with Approved Procedur&
'Dopol,,critical rem io 1he fe�deral 11'�on F,,,1 Codle or 165 CNIR 590 oftj
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: J�)o V Date: Page: of 13
Item Code C-Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R-Red Item PLEASE PRINT CLEARLY Verified
C_z)10;@d Co-#7'Aa hmakl7i 1� SO
-b)r'41- tZ 4.7
—'-a t /?J/-14z)-d
J
no W
��j
?10 Ce- dL1 17
4
A-11 Gzt) In st"z
t,& Czverk-ed
'Kniops, /)-) &)�4e, )�ark- Al,-d ckb,�7s-
_TA6Yb-Vah LCI NPCh 4 <�/l n I QA -;;Z 1 L#:7�; IW>IZ)
'Wfl j'q Lmi4; Oe_-i4
C-)'O11 'Pf Or( q _<Z�-/? lu
Dis.cussion With Person in�Charge: _Eorrective Action Required: Lj No ZI YeS
LI Voluntary Compliance J 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 L3 Re-inspection Scheduled 0 Emergency Suspension
comrly with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five doll s or suspension/revocation of u Embargo 0 Emergency Closure
f your fo�,d permiL
o Voluntary Disposal Q Other:
IIHF�Re�eived at Tenifict'Llures
Violdtions Related to Foodborrip fitness infer vontions and RI-A, According to l,aw
Factors(items 1-22) (Cont) 0
;I Fi45,F Vv;thin 4 Hotn.;.
PROTECTION FROM CHEMICALS 1,15 "'ooting I'vietho&f-�r PRI-t;
14 Food or Color Additives 19 PHF Fiat and Cold Holding
3-202.12 AdditiNes 3-50�,l"'(1311 Cold PlIFN M,�,,.intamed at or below
59�1�)04(T) 41'/45`F-
3-302.14 Protection fro:i: tjnaprro�ed Addiiivl�i-
Poisonous or 7 oxic Substances -5,01 16(A�
I-; i 140-l-, 1
Mentihnna Infonnalion-Or�gnnal
3-5(jl.!6(,k) Rm,sts I it'd at orabove 130"F,
7-102�I I Common Minto-Workt;i:,Con!;jinersl 1 20 Time as a Public Health Control
7-201.11 Separafi,m-Storage' -31-5(J]�P) Time ie, : Public fl�aiih Cnntfol'!
7-20211 Reqriviion-Presen,�e and Use* RL-QuirCojellt
7-?02.12 Condltion�of US0,
7-203.11 r Fox ic Cont.iiners --Poohibitiorn REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 stalitizers.Cliterin-Chcnncals-� POPULATIONS iHSP)
7-204�12 Cliernical�for Wa�hing ProduCL, Ci j er;ti` 21 3-180 t.i :(A) L',-).1steuriz,-d Prv-packaged litices and
7-204.14 Dning Agents,Criteria, with V.arron',
3-901 1 I(B,l Use ui P-,teudzej Ege,�
7-205.11 Inctdcrital Food Conta.r. Luhrit�mts�
R,,w or PaAially Cooked Af.dool Food and
7-206.11 fte�nicted Use Peslii,ide�, Crncrin*
R,,�Seed Sprouts Not Srzv�d.
7-206.12 Podcro Bait Statiom' 3-'-,'0 1.1!(C) I Uno�,,ened Food Packag, N,tt Re-scrved,
7-'!06.13 Trackirv,Powdvr�.Pem Control and
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-003,A 1 Consumer Ad�i��,ny Po�ted for Consumption kit
16 Proper Cooking T ennaeraturer,for Artsual Fowk Fhza:�re Raw.Undc-rcooked o,
PHFs Not 011mrwise Processed,to Eliminate
1-40 1.11 A(1)(2) F��gs- J55`F 15 Sec. pintio,"rs�`
3-302.;3 past,--uri led E,, s Sub.S'Litliti: for Raw Shelf
E�,,gs-Ininitdiate (;enice 145'1415i,ec- gg
3-401.1 l(A)(2i Comminuted Fish, Mrat�&Game
Animal�- 15�'F 15 see. �:
0 3 SPECtAL REQUIREMENTS
-40 1.11(B)(I it 2 1 Po�k and Bvcfkoast- 130'F 121 min-t
3-40 1.11(A)(2) Raines. injecled Mcats- 155�F 15 590 069(A�-(D) Violations of�ection 590-0091,A)-(D)in
sec. CatCril1g, Mobile fiClUd, teon)Ortury and
residential htch�n opei:;(ions should be
0 1.11(A)(,i) Poultry, Wild Game,Sorted PlfF,,
Sluffini:�Coraainin:, Fi�h,Meat danted undej-fli, appic),m)are sections
Poultry ot Ratit�s-1657 15 sce. .bove if re!atcd to fo,rdborne iflness
3411.1 1(C)(3,i Whole-muscle,Intact ficef Sleakg interventions air(]risk factors, Otber
145-F 590 009 Niol,dions relating to good retail
3-40 1.12 Raw Animal F ouds Cooke,] in a line-uccs should be.debiten under#29 -
Microvave 165'F Special Requirements.
3401,11(Ai(l)(b) A]! Other PHFs- 145'F I S sec�
17 Reheating ter Hot Holding VIOLATIONS R-zLATED TO GOOD RETAIL PRACTICES
3-403.11�'A)&(D) fflf's 165'F 15 sec. * (11 ferns 23-39)
3-403.11(Bl Microwavc- 165"F I Minute Standing which do nat,elure to the
Toue�'
fiwdborne d/nevs and risk 1�uto,�v liped ah�ove, �an he
3 40i.I I(C) ('011nercialh Proce,,�ed RTE F"- finold ii,1h,-jc�!Ioii ing saclions,f t&,,,Fo Code cmd 105 CAIR
!40'J-T
500.000.
3-403.11(E) Remainitu, Uwinced Portiom ofFte.2f Item Good Retail P,,actices i FC oo—000
Roasis, 23. tlarattem-ent and Personnel : FC-2 o,)a
18 Proper Cooling of PlAFs 24 Food and�(rA Prote�tio, i FG-Iq r-011
25, Equipment and Utensils FC-4 '005
3-501 14(A) Coolinv Cooked Pl-[Fb from 140'F
26, Water, P!,nibinq arid Wnste FC--5 .0,1,,
i0-F Wi t`-�n 2 1 four,,and From T)-F 27 Ph9sical F,�cif;tv (7,-6 007
0,
u)-1!'F/45�'F Within 4 Hours. 28 Pti�orous rr lox:r fcla,.80u�:3 7 �a
3 501 14(R) Coohn�,PFfFs Made Front Amb,eru �3let,;sf Requ:r�.rnents
Other
Within 4 flours
Denotes t rjt:cjl ncrri,n the te,�Iirrd i 991)Food Codeor 105 5u:�0o;)
CITY OF SALEM
BOARD OF HEALTH Page: of
Establishment Name: 0' \_Q'SAnUV�l & � Date: W0 ,1- 0
Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
Item -Red Item Verified
No. Reference R PLEASE PRINT CLEARLY
--a0Q-_-M O-A k
1011 rl,k-h r- -F;-�(A(I'e- bo C
10P
-P/J7-f � I V) <:,4� 4C)
4lv)nn 4 jvviA J., +r) St,)-rp <Ql)ll Or,
It"o -7)1/7/1 h 1 '/7 a o la'-�
hfi C� /)jj C_M_h0A,0d It-0 4-1'��rJ W) 6� M
ZF z�_e/tyGT`� 4;667E47bt,4_
fZ10
7G
-_S�on" on,l� hoa n(1rj )mt)1af7 aii i-t o,�
Oa_n apigneo I)c�c( opv;e)in ola-�Ilo
AuA_P 10�o Wd )Wd h4le- Uy) 44 (!a-
+
bil4u Y_7 Q
Discussion With Person in Charge: Corrective Action Required: El No El Yes
Ll Voluntary Compliance Li 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 C3 Re-inspection Scheduled U Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-f ive dollars,'or suspension/revocation of Lj Embargo 0 Emergency Closure
your food permit. LI Voluntary Disposal Ll Other:
It
5,11 140", PHFs Received at'iernpm2i�circ�
Violations Related to Foodborne Illress Interventions and Rh;A Acording to Law Cmvicd too 'ik
Factors(Items 1-22) (Coi �i 11--i45'F'tVithin 4 R
PROTECTION FROM CHEMICALS 1 3_50�.;5 coolin-Mlethod� to',I I HFs
14 Food 0, Color Additives 119 PHFH0t and Coid Holding
do I WIT PliPs Maintam.-d atilt below
'It,
3-201.12 Add ...b
5'�C W417) 41-145"F-
3-3b2.14 Proctect;ort fi-orl [j"avhrovcdAdJitivcsA
--50 1,1(-,(oo) lfm PHF� Vki ma I tied ai-orabove
15 Poisonous or roxic Substance-z - [4o"F,
7-101.11 kicratrIm.Information-0jiglillai
cont�araor�� -1 �01.16(A) RMAS fieldAT frabove 130"17.
7-102,11 i Contiotai N�mlc-Worlkoil, Cmt,irans' 2o Public Health Control
7-201.11 SmuotJol-Sl"rage' '3 Time a-a Pub!��1-fealll)Control"
7-202 11 Rei,irictiou-RWICIILO and Use 990.0(*H) V;0arxe Rquircirent
7-202.1 22 Conditions of Use,
7-203 J I roxoContainers - Prohibitions! REWREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizei Ctiterm-Chenacais* POPULATIONS(HSP)
7-204�12 Chemicals for Washing Produce,Criteria, 21 3-80:.!1�AT Unplasteun,tall Prc-packtiged Jui,,cs and
7-204.14
DeyintoAFents.criteliaT itverage,, with '�Varning I
7 -105.11 Incicirmial Food Claitim Lubricants �-XOJ I ltfl� Use ol'Pasteurized
3-',101,INDi Raw or Platialiv Coo)ked.Anioial Food and
'7-206.i 1 Remitmd Use Pe,lii Critenal I Tot
7-206.12 P,(x!cnl 13�4 Statiorts 1 R:rwSc,dSl1oILIt� .1 Served. ;",
't-A"W-11(C) I Unorened Pood Pai Not Re-served.
7-206,1 Traeking Plevdoer;,Pest Control and
CONSUMER ADVISORY
TIMErrEMPERATURE CONTROLS 2 2 T-�Ti);,I I Consumer Ado isoi) Posted for Con-umption kit
16 Proper Cooking Temperatures for Aninitl Foods]"hat are Raw. Undercookcd(it
PHFS Not 0:m-,rooi�e Processed To Eliminate
3-40 Ll i A(l)(2) Eggs- 1.53"F 15 Scc. Patho�,cnt I
Eggs-lournediarc Smice 145'Flfisect 3-302.1�, Pn,,treunzed Egg- Suhstitute!or Raw Shell
3-401.11(A)(2 I Comminuted Fisb,Meats&Game Eggs"
Anituals- 155T I i sec. `
3-110 1.11(B)oT 1)(2) Pork and Beef Roast I IWI- 121 min* SPECIAL REQUiREMENTS.
3 401.1 l(A)(2) Ramos, Injected Meats-- 155'F 15 �90 009(A)-(11) Violations of Smicart 590.009(A)-(D) in
sec. catering le I
mobil Tood, tt-arporary and
3-40 1.11(A)(3) FicultrN,Wild Gain--, Stuff(,(! PfffTs, ret'Jcirtial kitchen operationst,1101.11d be
Sluffing Comaining FiFh., N—A, diobiwd ander'he appropriate sections
Poultry or Ratites-165"17 15 scc. :`
above,if related to lbodborme illness
,401.111 C'IT3) Whoile-mosx-le,Intact Beef Steaks imerventionsaii(l risk factors. Other
145IV* 590.009 violations, relating Lo good retail
-1-4t'1.12 Raw Anintal Food,,,Cooked ina pract�ces�eouldix debited under #29
W--i 165'F Special Rquii,ruents.
3-401�I I(Ali 1)(1)) A1101licrP111's IISTFi5sec
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
1-403.11(.A)&(D) 1,HFs, 165T 15 sec. (Items 23-30)
Nlicrow-a-,c- 165)F 2 follrRite Standing -ifico
und rvinch do not iclart io The
Time' for)(lborne 111tseso i1i ve?III0nTI,;;h'1 isAjatio,;-� I:an be
3-403-11(C) Conmorcially Proceswil RTE Food- fiolital ill thefiofilovrll� IeCtieao III The F,,A)d CoJ4 aiid 105(Will
141)"F 51,10.000
3-403.i I(E) Pernainiat,Unsliced Portions of Beef Item Good Retail Practices
Rolras, 23 f0priacterneird and Persontital FC .003
18 Peoper Cooling of PHFs 24, FOW and Food ProteCtion F C; 3 004
3-SOL14(A) Coolini,Cooked PFiFs from 140,rf 21, Eq iometl�and Utensils FC -4 005
to 26, VVater,Plorribinq a,d Wnste FC-5
70':F Within 2 Ilour�and Front 70'F 1! 27 Phys�cal F_ci'jtv FC-6 007
Lo4l,F/j�r'FW4Nn4Hour,s t 1 28, Pnsonoul or Toxic kl�dej atis r0-7 008
1 29 Scecial Rcou'remon!3 009
3 501 14(B) CoolTri PHR Mede I�rcini Ambient I
Terriperware fngredietlt�to 41'E/45'T 1 31), Other
Within-1 Hours* TI IT
Derocs tritic at Item IT)I as I'dulal 199ti Food Codo at ft CMR 5CY,0110.
COURT DOCKET NO CITATION NO
CITY OF SALEM
VIOLATION NOTICE A 2916
NAME(LAST,FIRST,INITIAL)
o'Ne I I I's ep,.,7 k Y' iee-e'�'u r'l/L'�
STREETADDRESS CtTY/TQWN STATE ZIP
LICENSE NO. LIC.EXP DATE DATE OF BIRTH
OWNERS NAME(LAST FIRST INITIAL)
K f '
(jl�q-1
STREETADDRE S I [TOWN STATE ZIP
AM 1'(sjacjvr�07
REGISTRATION NO. STA�y DR.DXFE MAKE,7YPE �YEAR JCOLOR�
DATE OF VIOLATION TIME DATE CITATION WRITTEN I PEM.NAL
INJURY
aAl LJYES�
El Pm ONO
LOCAT ON OF VIOLATION ENFORCING DEPT
Wash in sr 714ea'%W�
OFFENSE CHAP SECT FINES
ApV-te,V4Dr,2
�B
C
OFFICER D�NO TOTAL $
FINE
DUE I (:Z�Wj
OFF
)6eR CERTIFIES COPY GIVEN TO VIOLATOR
�1111 I El IN HAND
x
DO NOT MAIL CASH PAY ONLY BY POSTAL NOTE,MONEY
ORDER OR BY CHECK MADE PAYABLE TO
CITYCLERK
CITY HALL
93 WASHINGTON STREET
SALEM,MA 01970
TEL.(508)745-9595 X 251
1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON
REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE
PAYMENT IN THE AMOUNT OF
R CASE#
SIGNATURE
SEE OTHER SIDE FOR FURTHER INFORMATION
ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL
COU CITATIONNO.
CITY OF SALEM A
VIOLATIONNUrICE M2916
NAME(LAST FIRST,INITIAL)
STRFETADDRESS CITYfTOWN STATE ZIP
/C�40 wd<�h wi-f6l ��04
71�\ LICENSE NO JILIC EXP DATE DATE OF BIRTH
Ln
un V.Pit.,NAME(LAST,FIRST,INITIAL)
m'o c STREETADDRFSS CITY/TOWN STATE ZIP
> o
B-3 M>
LIJ -K w JO
'1 0 M REGISTRATION NO STAI�/ EXP DATE MAKEr-YPE YEAR�COLORJ
0 z m
>G)m 0 1
0 2�F 0 DATE OF VIOLATION TIME DATE CITATION WRITTEN
Z OrM
ow 'a Ely
Elol� 111110!4AL ES�
El Pm ONO
OF VIOLATION FORCING DEPT I
OFFENSE CHAP SECT. FINES
A
B-3 B
>
0
C
U-1
OFFICER TOTAL
FINE
$
DUE C�s
OFFICgR CERTIFIES COPYQIVEN TO VIOLATOR
IN HAND
x
Q� tk-k� 11-gy MAIL
DO'NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY
ORDER OR BY CHECK MADE PAYABLE TO.
C, CITY CLERK
CF) CITY HALL
1 93 WASHINGTON STREET
0
SALEM,MA 01970
TEL.(508)745-9595 X 251
I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON
REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE
PAYMENT IN THE AMOUNT OF
$ CASE#
SIGNATURE
SEE OTHER SIDE FOR FURTHER INFORMATION
ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL
Massachusetts Department of Public Health Salem Board of Health
120 Washington Street,4 1h Floor
Division of Food and Druis Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Nam Date T e of 0 erat:ion(s) Type of Insoection
t�FS7-)qb/�fW7- -60 nood Serv! a El Routine
EJ Retail
Risk [�-Re-inspection
Telephone.., Level El Residential Kitchen Previous Inspection
_Q- 7740 0 Mobile Date:5-,�o - oy
Owner HACCP Y/N El Temporary El Pre-operation
El Caterer El Suspect Illness
Persor�in Charge(Pic Time El Bed&Breakfast El General Complaint
1 In: El HACCP
I Inspectorl -1 Y) j/. -7fi/n <Zj�jt/ Out: Permit No. D Other
Each violatio6 checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated.
Mon-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) E] 590.009(F)
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
171 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives
El 3. Personnel with Infections Restricted/Excluded EI 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods)
E] 5. Receiving/Condition Ej 16. Cooking Temperatures
[-] 6. Tags/Records/Accuracy of Ingredient Statements E] 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans L] 18. Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
El 8 Separation/Segregation/Protection El 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 D 21. Food and Food Preparation for HSP
E] 11. Good Hygienic Practices CONSUMER ADVISORY
El 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(items 1-22):
of Health. Non-critical (N) violations must be corrected
immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection
of Health. today, the items checked indicate violations of 105 CMR
c FN7 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
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 5900V�fFc�14 d�
S, Print:
� i Purs Signature:r A_,� 1A A Print: 111-770'1)�' r I/ NA3 Page-L of 6RPages
Violations Related to Foodborne Illness
Interventions and Risk Factors(Iteins 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8
I 5(10,00;tA) As�ignunent kit Responqdiihtv'� Ravt Anima� Foods Sepanocil fioni
Demonstration of KnoMedge' Cooked and RTL i�nods-
2-103�11 f'CT,,on in charge-Juti�s Gcntaminatlon from PaivIngredients,
3-30111(A)i 2) Raw Animal Seporated h tan Each
EMPLO�'EE HEALTH
2 59().003(C) Rcspniisibilityof the pens-mi in charge to Confamloation from,the Env�ronrrent
[equire repoltitig by hXKl and 3-302A I(A) Fooll vnitecoori�
applicann- 3-3,02.15 Washine Fruib,and Vegvmbl�s
3-3(M�!1 Fu��d Cont,U,-vith Equipmeotand
590 003(F'� Re.,ponsibility Of A Pood Einplo�yee 01 An
i�pplicaat To Report To The Pei son In utensik�,
Chat ge� C0,11,51nliodi!X7 ircir the Cortsurner
390.003(G) Reporting by person in Charge, 3-306,14'A)(B) Reitnn�d Foodimr-'Re%ei,lice of Food,
3 590003(l)) BLILhiousand kvshicfiijn�* Disposit'an o!Ad.,iiteratc-dc,rCo,,7tainin,.tecf
590�003,,I, Food
Removal of Exclasiom and Re-,trictions
3-70 1.11 Discarding or Rec,nditionowl"usate
FOOD FROM APPROVED SOURCE F,,od-
141 1 Foodand Watet-Fron?Reguialcd sofjrce� 9 Face Contact Surfaces
('0raphARLI�with Food Law� 4-50 1.i I I N1,11111,11 VNalewaFfling-Hot W,Itcr
590,o04(A-B) I I tn I
�-201,12 Food in a HQrnieticaily Sealed Containcr4- Saniuzadua IWrperatarcs*
201 1 i Fluid Milk and Milk Pioducts'r 4-501.112 Nlo.clianical Warcwa4iin.-Hoi Water
3-202 13 Shell Eg,,t,,;' Samozation Tenaperatines'
I 2o2.14 Eus and.'vlilk Products. Pasteurized' 4-501 114 chrmloal sanitization-terrip. I)H,
LoncentraUcat and hardness.
'i �02,16 Ice Made Front Poiablc Dr'nking�k atcC 4-6f)l I 1(,A) Equipment Food Contact Snrface�anrl
5-101.11 Drinking V�ater from an Approved Sy�tcmv llwn�ds("can'
5()0.006�A) Bottled Dfinkin't"Water* 4-602.11 Clearing F"mquencyofEypipmont Ftvol-
5o0.00(,(B) Watei Mects Standards in.1 10 C IR 22 0*
N C,julact Surfaces and Ulensils'
9.17effisn and Fish From an Approved Source 4-702 11 Frequ-ney of Sanniz.ii:'oi ,f litensib and
Fish and Recrcationally Caught Mollu,,can ;�es of Ftluipmen
3-201.14 Food Contact Sun f, t�
3 201,15 Tvlollwc,oi Sliclifish fron)NSSP I j,aed -4-703.11 Metho6sofSanitizatio.-a HotWa�-,rand
Chornical'
S,,urces�, to Proper,Adequate Hindwashing
Gatrie and vV0 Mustiroorrs Approved Dy 2-301,11 Clean Condition and Aruisl�
Requfatoty.4 uthority
3 201 18 Shellstock,Identification Present� 2-301,12 Cie-unn,, Pr(y,-Pdure*
5 iO.004(C) Wild Musluoorns'� 1-301.14 when ,j Wa�h,
3-201�t7 Gjaine Animsis' Good Hygienic Practices
5 1 Receivinq/Condition 1-401.11 Ealc)-%Drinkmg or Using Toba�co�-
2-40 1.12- 0i.wharges Front 1he Eyes.Noc and
3-202.11 Pi-IFs Rccenvitl at Propei Temperatures"
3-1.02.15 PaLtam, lraeqity�: I
3-!01.11 Food qaf�and I inadulienned 3-301.12 Prewrain-a Contamination When Taqtine
6 Tags/Records:Shellstock 12 Prevention of Contamination Irom Hands
3-20-2.18 Shc I baoek Identification 590.00-l(E) PrM'Cot:11.2('Ootah�!=aion-�Offl
3-203.12 Shellstock Idewification Maintained* Employees� I
13 Handwash Facilities
TagsiRecords:Fish Products Conveniently LocatedandAccessibio
3-402.1 1 Parasite 11-stioction*
3-402.11, R,-cords,Creationand Re-nnon' fi-203 11 Nurnbci s and 0paci dc,*
5 204,11 Loca'jon and NacuwnV
590.004(l) Labeling of Ingredients*
5-205.11 Operodon and Noiirir,oance
7 Conformance with Approved Procedures
/HACCP Plans Supplbd ivith Scap aricliand Drvag
Speciali2ed Prccessing Methods* oeviecs
6-301.11 li;lndwashinv Clearizer. Availability
1 3 502,12 Rcdttc�d oxygen packa�,mg,criteria'
i 8-103.12 Conlorinanc,with Approved Piocedurvs' (,-Iol.11- Hard D.,v;ri,-P.OV1,11011
D�n,-te-raical wai in ih�jc(kral 1W)')Fod co,te of Ill.',UtAIR i0f,00f:
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: 6�/P)/ /--c, _Pfi-R i ICES 7_)q6h'�RAI 7- Date: "5 .0 Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date
No. Reference R-Red Item y PLEASE PRINT CLEARLY Verified
Al 9 A, -V I�W) P
A& 1e7'_ A 4V-C_
rz�lelo'c:r' V f /J /0
DFiscussion With Person in Charge: Corrective Action Required: P—No 0 Yes
I have read this report, have had the opportunity to ask questions and agree to correct all LI Voluntary Compliance LI Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to 0 Re-inspection Scheduled C1 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 �uspension/revocation of U Embargo 11 Emergency Closure
your food permit. Li Other:
0 Voluntary Disposal
;"HF� Receive,' ji Temperatul'-s
Violations Related to Foodborne Illness IntervPriticrts and Risk A�cordiu,,:i Tl�,y Cooled to
Factors(items 1-22) (Cont.) 4!�Fj',"5 T�'Xit!as 4 f foues.
PROTECTION FROM CHEMICALS I d-'101 15 Col'�ia PHFs
PHF Hot and Cold Holding
14 Food or Color Additives
Ck�l� PH71'M,dirtained atoi bek-�,v
-4 202.12 Additi�es*
5(,'f�.00407 1-'/4''F!,
3-302.:4 Pioteujon from UnapprovedAcidtive3-
1,16(A) Hot PI!Fi Nlj;nr-�:ned at or
is Potsonous or Toxic Substances
7-101.11 identifying Inforwation--Ortgiv,0 140T.
3-56 1. 6(A) Poits Held at,-r +ov- I;01F.
C0aL-1:ner,�-
20 Time as a Public Health Control
7-10211 Common Nimv�,-W,fkirig Conodrcrs�:
7-201 11 Separarion-slo!a'e- 3-iol [9 Time as a Pubiic Health Contiollt,
7-202,11 Restriction-Presence and LT�;c�i 59��A,)-hfi) Vat iance Requji-rient
7-202.12 Condoiqn�u'f ljs�-y
7-203 11 Toxic Contai�ier�--laoinbitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.i Saintizets,Criterir-Chcorcals� POPULATIONS(HSP)
21 1-80 J I(A) I T Ir f,�_
'ro izcd Fit-rackiteed.lifice,and
7-201 12 Cherai�al% for Ww'hno,ilroduct� Ciileria i F -
7-204.14 Dmiu,A2cnts. Beverages�itn Nkarning 1,�.bols*
7-205.11 incidental Food Contac,,. Lubricanti- 3-80 LI I(B) Use )f PjyteurizeJ
7-206,11 Restricted Utv fia�airidc�.Criteria' I IfD) RaA or Pu)tialIv C�vked Aronel Fjotl and
Rwx Seed Sliflarts Nui Sel ved.
7-206,12 Rodent Bart Stalions' -t;01�I I i C,� Unorevied Food Package N-,)t R� served.
1 206 13 Tn�cknu,Powders,R-st Control and
Mrnitorinl-* CONSUMER ADVISORY
TIMEtTEMPERATURE CONTROLS 22 3-604�11 CMM[mcr Aivitairy Foqttd ior Consumption of
16 Proper Cooking Temperatures for Amind coods Mar are Raw. Uudceo�ulodl or
PF.Fs Nol Oracr-,-J.se Proc-,�&ed to Eiminwe
3-46L 11 A(l)(2) Egg�- 15i'F 15 Sec. I'ath:,,,zcnx.* �'�11
3- 2.1-, RasieurizLt"Eggs Sub�riooe lot Raw Shelf
Eggs-Munediate Service 145'1715.�ecl
3-40 1.11(A)(2 i Communuted Fish, Nli�ats&Garne Egi:sl�
Animals- I�5�'F 15 �ec.
SPECIP&REQUiREMENTS
3-491.1 1(13)(i)(2i Pork and Beel Roast- 1 3 0-1- 121 unn,
3-401.1 I(Ar(2) Ratites, Injected Nic ats- 155'F 15 59CiJ)09(A)-(D) Violations of'Section 596.0091 A)-(f.))in
sec. 111011)il�food, temporary and
3-401.1 I(Ayi) Poultk y, Wild Game, Stuffed IIHFs, le�olcntial kitchen operationsshould be
Stuffine,Cont�;in'n,Fish,Mcat, i
Ocbjit�d under the appropriate sections
ove:'rc�ji-d to foodborne fflnc,�s
Poultry or Ratit 165�F 15 sec. al, o . ,
3-40 1.11(C)(3) hna�-t Beel'Sleaks hateivein ions and risklactors. Olhcr
145T
590.009viniations ielatin,g to.-c-�d retail
i 3-401.12 Raw Aniond Foods Cooked iti,3
piricticcs should be debiled under #29 -
Mictowaiv i65'F Special Requiremenis.
3-401.11(A)(1)(b) A�! Other PHF,- 145'F 15 qcc�
17 Reheating to, Hot Holding
VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3403.11(.%)&,(D) PHF:, 165'Fl-i sec. (Henis 23-30)
3-403.i I 1B) Nliciowave- 165,F 2 N'lovite StandinL, I G;Ilical and non-critical violatiotm iliichdo notrelale to the
Time* tooaiborne dh4esv into vewiam ano'riskfintors listed iblov,?, can be
3-403.1 1(C) Comincrcidliv Pwce-�scd RTE Food - fiemd in rhvjol1fnt4n,, se(.i�ons ot the Tood Code and 105('Afl?
140'F� �90.000.
3-403.i I(F) Remaining Losliced Portions of Peef Item Good Retail Practices FC 59acoo
Roasts' �& ManagnmPni and Personne.;--------- FC-2 .003
24 Foq�and-ood Prol�cfian FG- 3 004
Proper Cooling of PHFs 25. Equa:rneriland Utensils FC-
3-50IA4i,Ai Cooling Co�ked)'HFs from 140'rF
to
n Water, Pianb,pci and Waste Fir-5 006
if,'F Wimin 2 1 Icair,and From 70-1- 2'
I Phyt3tcal Faciii1v FC-6 6Y7- I
uj 4 1'F145'F Within 4 Hours. i 28. Pononeus oi Toxic Malanalz FC -7 i .008
3-501.14(B) Cooling PHFt. Made Front Ambieni ;39- Soeciai Fl-tirtrements
Terripriature ln�rcdients to 4['F/45'F 30. Other
Within 4 Hours* I
Dcnolv%criteil item ip tire rede'al 1999 R-o,!Code c, 105 CNIR 5�40 0(:0.
Mbissachusetts Department of Public Health Salem Board of Health
120 Washington Street,4�' Floor
Division of Food and Drugs Salem,MA 0 1970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)74.5-0343
Name Date TVftR of ooeration(si Tyne of Insitection
e
'At P I 'PY7 i- _VLI 5-06_014 t'�Food Service [ff Routine
Address / I I Risk [] Retail C] Re-inspection
�e) Ljj=<�wq*w Level 17 Residential Kitchen Previous In ect,?F
Telephone El Mobile Date:/ZM
F-1 Temporary El Pre-operation
Owner HACCP Y/N 171 Caterer [I Suspect Illness
E] Bed&Breakfast E] General Complaint
Person in Cfiaige(016i Time C]HACCP
In: Permit No. El Other
Inspector Out: I L
Each violation c6ecied 'requirbs 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) rl 590-009(F) 0
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
El 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
[:1 2. Reporting of Diseases by Food Employee and PIC El 14, Approved Food or Color Additives
[3 3. Personnel with Infections Restricted/Excluded [] 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE TIMErTEMPERATURE CONTROLS(Potentially Hazardous Foods)
[] 4. Food and Water from Approved Source
E] 5. Receiving/Condition El 16,Cooking Temperatures
1771 6. Tags/Records/Accuracy of Ingredient Statements El 17, Reheating
E] 7. Conformance with Approved Procedures/HACCP Plans [118, Cooling
PROTECTION FROM CONTAMINATION Z 19�Hot and Cold Holdingg
El 8. Separation/Segregationf Protection El 20,Time As a Public Health Control
V9. Food Contact Surfaces Cleaning and Sanitizing AQ\ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
0 21. Food and Food Preparation for HSP
[110. Proper Ad6quate Handwashing
CONSUMER ADVISORY
E3 11. Good Hygienic Practices El 22, Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22):
of Health, Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days.as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code.This report, when signed below
C W- 23. Management and Personnel (FO-2)(590.003) by a Board of Health member or its agent constitutes an
____./24, Food and Food Protection (FC-3)(590oOZI) order of the Board of Health. Failure to correct violations
cited in this report may result in suspension or revocation of
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)(590o07) have a right to a hearing. Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590o08) 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:
I tor 9' Tatu Print:
,7
Irp
iiiiatu. Print: Pagel of\3 Pages
L v/i
Violations Related to Foodborne illness
interventions and Risk Factors(Iteins 1-22)
PROTECT ION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 CiLss-contaminalion i
1 500,003CA0 Assignment of RcsronFibflit)'� 13-302.11(A)(11) Ra\� Anirnal Food,Sepal ated fivin
5Qf).00VB) Den-lonoration of Knowledg,-!* Cook-ed and RTF R od�� I
2-103 if Person in charge - duties Raw Ing,odi'n'ts
3-302.11(A)(2 K�w Ari;uriil P�ods Separated froin E;t(+,
EMPLOYEE HEALTH Other-
2 590.003(C) F.-,,;ponsi1uIiLy of the person in charg�to Contatornation pow tno Elvironmem
requite jeflortip...,by food employces and 3-302.11(A) Food Protection
applicants* 3-302.15 Wa,,furez F]IIA;aid VC_�retables
590.003(F) Resrouqibilit1v 01 A Farxt Employee 01 An 3 104 It Food, Comlwt�� Ih Equipment ill"
Applicant To'Report To'[he Person in Utcrlsils*
chat-'e* Contamination from a7e Consumu,
590.003(0) Roportin.,by Person in Charge 3-306.14(A)W) R-iumed FuMand Reser,�icc ot Food�
3 590 00(1)1 Exclusions and Restrictions* Dispasiffor of AduIrcrated or Contarriviated
�90.003(E) Remio ill of Exclusions atid Re-,trictions Food
3-701.11 Discording og Fecolubtioning Uns'do
FOOD F IOM APPROVED SOURCE R)�;iiz' I
4 Food and Water From Regulated Sour,es 9 �ood Contact Surfaces
590.004(A-B) Compliance vith Fol)d Law* 4-501.111 M��nual�%��i-cwashin, -Ilk); Water
Sanitizatior, 1cmpvoiturc�l-
'.-201,12 Tood in a Hermetically Sealed Contalne-1 4-5,01.112 Mecicirucal W,rowalhi�,,--Hot Watei
3-201 1-, Fluid Milk andMilk Pioducts+
Shelf Fggs*
I 1 4-50 1.114 Clicow-al Sanitization- iirnip..pH,
3-21j2.1 4 FlIgsand Milk Products.Pasteurized'
I
3-202�U5 Ice Made Fiom Potable DrinkitiL Watert corcentrat:Urt and haidruss�
A-6i)1 11 A) EquipinemFo(c]Contact Surfl�cesnnd
5-!01,11 Driqking IVatej from an Atillioved System'
I wrist k Clean,
590.006(A) Bottled Drinking Wltc, 4-602.11 Cle.aning Frequc.9cv of Equipment F,-,,d
5w,,006(13) Winer Nfeets Standaids in 3 10 CIVIR 1.2 0*
Contact Surfaces arld Utcnsil,�
Soeffish and Flsh Froin art Approved Soutro 4-702,11 Fnzqoency c.f Sint Lization ofUteum 1,and
3-2ol.14 Fisl i and Recreal tonally Caught Mollus�an
Food Contact Suifilco.,of Ellin
�;hei(fish* 4_�133.11 Methods rF S:oijtzation--Hot Wa��cl and
3-201,15 Molluscan Shellfish front NSSP Listed (hemicd;*
sourceO Proper,Adequate Handwashing
O.q,,e and Wild Alush!ooms Appievedby
Regulatory Authority 7_�IW,I I Ovan Condition--Hands-,..a"'Arms,
3-Nj2.1 l; Sliclistock Identification present- 2-�01,12 0canill",plocejnn;�,
590.004C) Wild Musluoorrr,� �-101,14 'Milen to W�ls]Vc
3-201,17, Gyam�Annruds* Good Hyme,.uc P,iwticer
S Receiving/Condition 2-401�I I Fiilimr. Oririkml�oi lising
3 202,11 PlIrrs Re-eived at Pn.pci Temperature,* 2-401.12 Dis�harges Froin the Uy._s.Nose and
3 2011 Package Inte,inny* lvluulh�
3 301.19_ firevenanir Contamination %Nlici)
3-101.1 i Food Safe and L.nadult-rated Tlstinv�
6 1 rags/Records:Shellstock 12 Prevention of Conteminaflon from Hands
590,00-1(F) Preveniiii.,Contlanniaiion from
1-202.7 S, Shcllslol�klderrtification
-5-20- 12 Shell.ql,ck Identification Maintained,,
13 Handwash Facilities
Tags/Records:Fish Products Corvenrendy L=tric andAc,,rssible
3-40-7.1 1 Paiasile.Destruction*
3 5-203.11 Numbers and Capanici�
-1-402.12 ReLords.Creation and Retention 14 5-204.1 Lovation and Phiccolent
i 590.0040) Labeling of Ingredients'
7 Conformance with Approved Procedures J-205,11 Accessibility, Orleiatmn and Maiatell.111ce
/HACCP Plans Sppffcd osth Soav end Hand D�vtng
Deocos
3-50",11 Sjiecoflu,mi Proces sing Methods*
6-10,J] lilindwisturig Cle,111,,el.ANriialoloy
3-5N),12 Rechced oxygen frackamilra,critel in, I
1 1 6-30!.12 Hand Drying Prm�i�iun
8-lul.12 �Ojdormqncc Nvidt Approved VilicedUrcs,
Denole,crifical iwol it!the jcd�ral 1,)")9 F,,d Code or ills CNIR 590,(�-oo
CITY OF SALEM
ant Name: &A/9)IS '81/- iP ztiz BOARD OF HEALTH 5130 . 41)4
Establishm ji �L Date Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION If PLAN OF CORRECTION Date
No. Reference R-Red Item PLEASE PRINT CLEARLY Verified
P,�l ln�'V)PK470-A 110kl� �HU 4�1161JMO-.
0 4_e,%TI L) Ilie, op kIpAllizo a(�' I-)?anda bcj
rn/�'v ! C*_
gQ) 0 )n-rf 5 -i�y'I rl(?" Ji J-4.
S i ')/'
CY4-w-h Zi n;� , N(4( 4rm,- A)d S /"a/( a�� k�anl) a
rat)1y;7--h(_M -
cc:�L-letu
9 -0,,Anq h-wa, ' 15 S(�Oi-Pd 11- 14ri 9-�gJnWf - 0), �Y_J)777/70
4- )r� reef
11)t01-P CY4-hi
kwo hos, nl) l- beul� main-fain"Orl n�14(1/.
7�-S� — Kiij'4�? ;�X- d-001h 0/a/ul ( n'-I . - I
-)4 -)r -�-
r
PQ,0 n-427 I k7 aa
�j �J(�Ojj (167 2 Irlx
fY)dL( n4n toigbli CLY-Ag kn�n /)'�U) lwr;;�z Jim I
_bt',_71a14 ?d_ll�/7/7 i�:a k
Mauonat-w kio(� I)r 11,10i Saune tor 'Vor &A&
-hr
i nq wo i yt
Corrective Actiori Required: Lj No Lj fes
Discussion With Person in Charge: I I
Cl Voluntary Compliance 0 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 L3 Re-inspection Scheduled u 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 Ll Embargo J Emergency Closure
your food permit. ZI Voluntary Disposal 0 Other:
-2, /L
lo(�) PHFs Received ,t'I'viopetatures
Violations Related to Foodborre:illness Intervention,;arid Pi3k According to I�m Cc);)Icd to
Factots(Items I'Ui (Cold.) 41'F!45�F IN,thin 4 Houv�.
PROTECTION FR()-V, CHEMr-ALS 3 15 (2001in'2 Wthod� Inr Pf L,�,
19 PHF Hot and Cold Holding
14 Food or Color Additives 1(1(13) Co,W MlFs;Maintained at oi below
1 7 0112
590 004(F) 4 1'/45"17-
3-3oZ 1 1 Potccri,s� fcorn Ui:appnned Addjt:�cs* 3-,501.16(A) Ilot PHF,�Iandiuned at erabov�2
15 Poi,�oncnjs or Toxic�vbst�,,ces
I I On,inai 140'F.
I 3-501.16(A) Roasts If,Id at or above 130'F
Containers, 20 Time as a Public Health Control
7-1li2,11 Corairnon Nqrne- Cone:incn�"
Senarali,,n-St,-Tage- 3-501�19 Tuno as a Public Health Corrnol*
7-202.11 Roqn*�-;on-Pre"'elice and Us&� 590,004(H) Vaiialwo:Requiremont
7-202.12 C'unditions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-M3.1 I T(,N;c Ovatain-�r,-Prohd-;t�or,�, POPULATIONS(HSP)
7-204.11 ��nnizels,Cntel l-C
7-204�1 Chenscals for Weshing Produc�.i-iiiene 21 3-80i.I I(,A) Unpasteurized Prc-packuped]nice;alld
Peveraees with Warnin
7-204.14 Dr-sn-p Aoa,,�,is.Criteria g,I�abok
I I(B) Use or Pasteurized El-vs�-
7-205.11 1 Incidental FooJ Conta.'t.Lu�ricaaus�
T , PeSji,jje�
7-206.11 801,11(D) Raw or PartialIv Cooked Annual Food arid
i Rzs'litcled L rio
Ro�!ellt Bair sulfions�
;-80 1.111 C) finoriened Poixt Package Not Fe-serveci.
7-206.12 r RaW Sto-d Sprouts Not Seived.
7-206,13 Trzick;ng Pcwd,:,S,Pest Contoi and
CONSUMER ADVISORY
TIME)TEMPERIATURE CONTROLS 22 3-603�11 Consio-mca Advjsor� Posted for Consumption of
16 Proper Cooking Temperatures for Aninial Foxxls'rhat are Raw, Undercooked ca
Not OtlivrwiSe Processed to Elinnnate
PHFs
3-40 1.11 A(I)(2 i 155�F I S� Palhogeris.*
C
-302 igg�SL-NS(iftltC tor Rav,Shell
E�"s- I is T`!'iwc1 3 -.13 Pwqeurized T
C I -je�Lq*
3-461.1 IW(21; o-mininuled Fish, Game E ?
1557 15 SCL� t
3-40 1.11(Bli 1)(2) Pork and Beef Roast- 130+ 121 min* SPECIAL REQUIREMENTS
3-401.� i(A'a"t Ratites. injected Meats- 155'F 15 590.00C)(A)-(D) Viclitiolis of'Section 590.009(A)-(D) in
sec. catering, mobile food,temporary and
3-40i.11(A)(3) Poo;hr,,oiviW Game,S'affed PHFi, residential kitchen opoci ations should he
Sle"firg Containiny Fisi�,'Nleatj debited under the appropriate sections
Poultry nr Ratite� 165,�F 15scc.
above if ielutcol to foodberne iflness
3-40 1.111 C)�3) 'Xhol,-auscle, h-itact Beet Sleal s
interventions and ri�k lactors. Other
i 590.009 violations relatina to pod retail
3-4W I? Raw knuna! R)ods Comk�d m a practices should be dcbited under#29 -
Tvfioanvav�-- 16YIz* Special RCqUIrMICIAS.
3-401 ll�Ai(�','(bt All Ofli-I PHF� - 145F' I-
,�
17 Reheating for Hot Holding VIOLA nays naAmv TO GOOD RFTAIL PRACTWES
3-40.1.11 W&(0) PHFs 165017 15 sec. * (Iteuts 23-30)
-4,)3.11 m) Mictowivoe- 165' 7 2 Minute Standing C14tindaild non-crith ai viodoirronv, which do not rclate it)ihe
Tillit, loondborne illnes,� intervepilions and riskjoi(turi listclabove, can be
1 3-403.! I l Cornuaerc;alj.�Processed R'lE F�,d- inind in q the Food('(,do,and 105 CAIR
14(;'F- 590,000.
3-403.11(F R-inainin,, Unoli,�ed Portiuns,.X Beef I Item Good Retail Practices I FC 590.000
Roiists� 1 23. Manatjorn ont and Personnel FC 2 .003
18 Proper Cwlinq of PHFs 24 Food and FeW Pidect;orl FC 3 004
25. Equipment and Utenso0s' FC--4 .0,15
�i-50 i.I l(A,: Coolliv Co,,Ked PHFs, from 1401'F to "6. Water ftrnbinq and Waste FC—5 006
?0-P Within 2 Flovr�and F rern 7() F 27. Physical Facsity FC--6 00-7-
n)4PF/45'F1Ni,hi,-,4 ilours. t 1 28. Poisonous or Toxic Materials FC - 7 .008,
3-501.144B) 0�eling PIIF�Wde Frniri Ambient 29 Special Rtiouirements .009
Tellipermuic im,redients to)41"F/4 "lo Othei
W;tha!.1 �Ion,
Dewa,,,viaic�i oeiri lhoederal To,l�:Ae or 105 CtIR 590 1�00
ftish pu,
changes
its address
By TOM DALTON
News staff
SALEM — The Irish .pub
coming to Salem has a new ad-
dress even though it' staying in
the-same building. 11
On Monday night, the Li-
censing Board approved a
change of address for O'Neill's,
an Irish restaurant and pub that
will open in the Peabody Block
on Washington Street,
The pub is moving one door
down, from 120 Washington St.,
the location of the former Cafe
Bagel, to 124-126 Washington St.,
which is right next to Castle
Pizza.
The owners of the pub had
signed a lease more than a year
ago, but then terminated it and
signed a new one, according to
an attorney representing
O'Neill's before the Licensingg
Board. i
The new location ill b I I erl
and better suited to the comb a-
tion restaurant/pub, e atto ey
said.
The business will be owned
and operated by Kevin Trainor
and Ron Brogan, who are from
County Monaghan in Ireland.
Trainor has an interest in two
Irish pubs in Cambridge and
Boston.
O'Neill's will feature tradi-
tional Irish music, poetry read-
ings and Irish food.
Renovations are Ider way
)c to op
and the pub is exj ec�ted ed
by late May or early Junei in the
O'Neill's will be a tenan
Peabody Block, the sprawling
and largely vacant building
bought more than a year ago by
Swampscott developer Haim
WeizmaTin. The city recently
signed a 10-year, $3.6 million
lease for office space in the same
building.
The Phoenix School plans to
move to the other end of the
Washington Street block, but in
the same inter-connected serie)
of buildings.
CITY OF SALEM
BOARD OF HEALTH
C Page: of
Establishment Name: LO Wt s ',&r 4-- Peshau Pop P7 Date: 6 - 0 y
Item Code C-critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
?-Ylsp nu-
F n-0 I V? r)A OY- -k Np 6r 'Lli k?e14UJ
'_lk 0 q . cri
—"?�)44-7)ry� <21 _W n 0 O&S" -f on tq '( V) t )J74-
j
n joeiC �jn S,�eto A7gr( 1�hlvldivr (LOW (,--17)Wd' h
(tinta( KoIrs . rh(j-ql hp. yyacn-ta in rd i r) n4nItist7JAal aho
V10 hi/A10,A 4MI) ),L it)r.h^ /�P- P)P-JOW-
4/-,nn P,Nn-fmll V`ioli -61 �w �q k�o I or( -T(-,-o Qi-�Imlo ?)h
0 viv 1) (A-e-vj V)<Z1(4 o
C J be c ( aapud 52q)eUAp
FA4e0A11 (hlr��d rvy)n-�klq
Nn t o�A i vi 9 vi 1)047i�
-V-) Ph4 4�V7)"--f -
V,
Discussion With Person in Charge: Corrective Action Required: Q No a Yes
I have read this report, have had the opportunity to ask questions and agree to correct all U Voluntary Compliance LI Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to
ZI Re-inspection Scheduled C1 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 LI Embargo Lj Emergency Closure
your food permit.
Ll Voluntary Disposal Ll Other:
k
Violations Relatact to Fooe-,,oeire 1,Mest;!nt,rventions and.qrsk. 3-50-: PHF�Received at-temperatures
Accui di ng to Law Cool,d to
FRcfars(items 1-2P) "I F/45T in 4 Hilkirs.
N1,7ith
PROTECTION FROIA CHEMICAL,8 Coolill" Method's for PJ4Fs
14 Food or Color A6clithirs )q PHF Hot and Cold Holding
I I �-s-01.16(11) Cold PlIF,'N'taintainea atoi helwk
3 201 � I I
1 30? 14 PrOtcdlz';� !tow Unapp,,',ed Aji 59CW04(F) 11�1/251 F,
3-50 1,INA) Hot PHF�Maintained�t or above
1.5 Poisonous a, Toxic Substanccs
7-101.11 fd�nfilyatv information-Ori"ifl,I i4fl-t-
3-%1!.!6(A) Roasts Will at or above 130'R
20 Time 39a Public Health Control
7-102�11 Comill"n Milne, --Wnm�r.'�C'Izt�i'.els' 3-501 19 Time as a Public 1-feaIth Contiol-t
7-201.11 Separation-Stolage- 50W)W,H) Vaiioncc Requirenient
7-202.11 Rc�trict�on-r-Cscuce aud Usel
7-202.!7l Condition',t.f ti CT
js
7-103 11 'lok;c f'0qt:!�P'Crs-Pluhllljb"'rn"� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS(HSP)
7-204.i I Sanitizers, CrItena-chvillic sis
7-204.12 Chpinicajs f.w V"at;hllw�Prodlt'c'Cl�itelial' 21 3-801.11(A) Unp�;steunzed Pie-packaj,'ed luices ind
7-204.14 Dtvinl�Apents.CritcriaT Beveiages"ith Warnme Labels*
7-205.11 Inciticni,-.1 Food Cont,,�rt,Lurn�antF� 3-801.11(B) Use of Pasteurized EL-,Ls-
7-206. R,stricted Use Peq�rides,C'riitr:,�t --S01 I I(D) Raw or P�tttiallv Cooked Ani mod Fooli and
tions-
7-206.12 Rodent rkw lita, I Raw Seed Sprouts Not Served.
7-206.i 3 '1 vicking Powieri,Pest Control and 3-',10 1 1'(C) Uiarlftled 17OW Packave Not Re-served
CONSUMER ADVISORY
TIM.EITEM PERATURE CONTROLS -22 3-603.11 Cort Ad�isory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Flxxis That ore Raw, UnderWIlked 31
PHFS Not Citherwita- Processed to Eli minate
3401.1]A(i)(2) Ft-'�- 155'F ;5 See. Pathu-cns.�
3-3U2.13 Pn,'teurized F gs
Eg"- Irlmediatc S--rv�,�e 145�Fl 0 11, , Subsfillne for Paw Shell
3-40 1.11(A)(3) Comaninut,-d Ph, NA.-us&,Cattle Egiss'
Animals lin' SPECIAL REQUIREMENTS
2) Pui,� ;in(]l3c.-fik"'ist- [30 F 121 -mini,
3-4o 1.11(A)(2) e,;,l"jecil-c.Mv�jls-I�F 15 590 0091 A)-(D) Violabons ofSec-Lion 590.009(A)-(D) in
Set:. catering. inobile food, temporary and
S-40 1�I I(A 0� Poultr�,Wild 6,tino,Stufj',if P1 Ms' res,.duntial kirch---n operations should be,
Stuffin,,Cor*uinm-fi-,h Meat debited under the appropriate scctioris
Poultrvin R�ijiics-!WF 15 sec. 4 above ifrelated to foodborne illness
3-401.MC;(;) Whole-mtvcle, Intact 3CC�*Steaks irtierventions and risk factors. Other
145eF 590.009 violations relatin-) it)-0od rctait
3-401.12 Rav, Nnimal Fools C,-oked in a Practices should be-debited under #29 -
Mi,10WdsT 165-F 1
Special Requitemeniq.
3-401.� All Othe: PHJF�� 143'1; 1� se
Reheating for Hot Holding
VIOLATIONS 14 XATEV TO GOOD RETAIL PRAcTicEs
3-403.11(A)&(D) PHIFs H5'F 15 sec. ;�`
(Itenis 23-30)
Woctowavc- 165�'F 2 Milano Standim� Ctitical andnon-criw.al violations, whit It do not ielate to the
foodborne illness onervrnlion,�and viskfic Iors listedabove, 4 tin be
3-403.11 Coulmorclaik Pr'�C�s�i R-1 E Food- found in thefolhm ingsertions of the Food Codeand 105 C&IR
l4e"Fy 590A(10.
[--tt-em-1--Good Retail Practices FC sqamo
�--103J I Rcipainialp 1,uqbed Po�tions(�f Beef
R',lsts' 23. Manactement and Personoel FG--2 003
24. Foodand Food Proancflon FC-0 O(A
is Proper Cooling of PHFn 25. EQuirment and Utens'lls FC-4 M5
3-501 14(.,) Civilill',Coked PHF, Crorm 140"IF 1�" 26. Water, '14aubirajnd Was�le FG-5 006
70'T'Within 2 Ilout,and From 10- P7� Phesical Facilitv
. ---o 001
to Hotirs. 1 28, Po!sonous crfoxic Materials FC- 7 .008
1 29, sperial Reaullemerta 1� octo
3-501.14(15) C,olim,Pill'i.Mado Fn�rn.lunbaejtt
Terriperature b:'ej edicnt�r6 4 1'17145'T L30, Other
4 lloiws�
lj"),J"op twl;,eln 11 ine te�:'.al I00, 10,�CNIR�90 1100.
0120 WASHINGTON STREET O'Neills Bar and Restaurant
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCIP: 17
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
740-8811 Handwash Facilities FAIL Critical RED
Owner:
Ronald Brogan 7�Comment: Hand wash sink in kitchen missing sign. Provide"hand wash only"sign.
PIC: �Mens restroom handle in disrepair. Repair to working order.
Angle Silva
Inspector:
John Gehan
Date Inspected]Correct BY:
11114/2006
Risk Level:
Permit Number:
BHP-2006-0172
Status:
Open
#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)
Cityof Salem Board of Health 120Washington Street,4th Floor SALEM MA01970(978)741-1800
GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 14,2006 Page I of 3
Item Status Violation Critical Urgency
RED: Violations Related to Good Retail Practices (Blue Items)
Violations Related to Food and Food Protection FAIL Critical BLUE
Foodborne Illness Interventions "I
and Risk Factors (Require �C6;;ment: Knives found in knife rack with accumulation of food debris. Thoroughly clean and sanitize knives after each use.
immediate corrective action) Superior refrigerator has uncovered foods. All foods in storage must be covered.
Equipment and Utensils FAIL BLUE
6-C—omn�ent:Woods refrigerator requires general cleaning.
�;-K�I:che�nc ttinb board badly stained and scored. Resurface or replace board.
_a c
t t f
e freezer in kitchen requires thorough cleaning.
fl�elf and all that's on it beneath grill,requires thorough cleaning.
--.815'parlor refrigerator requires thorough cleaning.
L-Sardtiz—e—rr—eading low. Have machine serviced so that proper ppm is obtained.
�ffi'tizerto be readily available at all work stations.
diensh being stored incorrectly. Utensils to be stored in proper designated areas.
-�Ia�nffizmg log not up to date. Log to be maintained daily.
=BASEM T
y1eftw its freezer requires thorough cleaning.
w
econd from left white freezer requires general cleaning.
Z-Traulsen refrigerator requires general cleaning.
,,White artic air refrigerators require general cleaning.
—.WM<kn refrigerator has broken handle. Repair handle to working order.
Physical Facility FAIL BLUE
--e6-m�ment: Floors and mats in kitchen require thorough cleaning.
1--w"sin'Mitchen require general cleaning.
GENERAL COMMENTS:
Extermination reports to be on hand at reinspection or faxed up to BOH.
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. Nov 14,2006 Page 2 of 3
Item Status Violation Critical Urgency
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. Nov 14,2006 Page 3 of 3
Commonwealth of Massachusetts
City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/06/2011
ESTABLISHMENT NAME: O'Neills Bar and Restaurant
File Number:BHF-2004-000042 120 Washington Street
Salem MA 01970
LOCATED AT: 0120 WASHINGTON STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes
FOOD SERVICE BHP-2011-0257 Jan 1,2011 Dee 31,2011 $280.00
ESTABLISHMENT
Total Fees: $280.00
PERMITEXPIRES IDecember3l, 2011
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,
all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 -
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4 T1'FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAx(978) 745-0343
MAYOR DGREENBAUMna�ALEM.COM
DAVID GREFNBAum,RS
AcTING HEALTH AGENT
2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT P2u(> 1— TEL# 'I—IF— -/4r'O- FF11
ADDRESS OF ESTABLISHMENT LrA514tP1675W 57, FAX# '5�K— 666 - 5�,7per
MAI LING ADDRESS(if different)
EMAIL-Business':J-0A-A,-e(.ry C� C�� Vcko,) - Coil Website:
OWNER'S NAME Rewivie Alz o C-A A/ TEL#
ADDRESS 1—A49r:,AW 12,a, F� VA&I90&,1,�: o Ze 3 Z
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) /� W1 6 511,VA CERTIFICATE#(S) 64 - 0374-57
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON R(5JVIVII� b1?-6a"AA1 HOMETEL# 61-1- VF—olo
1,DAYS'OF,OPERATION.�,,',,�.,,!.-'-;�,�Monda 11�, 1, ,,_--Satpji ay��
Y Juesday-�`4, I'-�*Wednei;dar�qP"hdrsday rd
HOURS OF OPERATION
Please write in time of day 3,0A(I 3a A rl //- 3,o Arl� /1-a� Ab�,
(For example 11 am-1 1 pm) 1-60P(f 1- 0,9 1 -,)o r7
TYPE OF ESTABLISHMENT FEE (check on[A
RETAIL STORE YES NO less than 1000sq.ft. =$70
1000-1 0,000sq.ft. =$280
more than 1 0,000sq.ft. =$420
-i�-----li�------ ------ ------ --------------
J4 6 ess n 25 seats =$140
(Outdoor Stationary Food Ca' "211 0�� 25-99 osats �$280
more than 99 seats =$420
--------------------Yi�§......�id-----------------------------------------------------------------------------------$1-0-0-------
CHILDCARE SERVICES/NURSING HOME
K66:664ADymmif§-----------------------------------------------------------------------------------------------------------------------------------------------------
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of periury that 1,to my best knowledge and belief,have filed all state tax
returns and paid�l state taxes required under the law.
Date Social Security or Federal Identification Number
Revised I onn I FOODAP201 Ladm Check#&Date /-43Y S ZLO-,,o