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PIZZA HUT - ESTABLISHMENTS PIZZA HUT 8 TRADERS WAY 4 'I r. r. 7 Richard Englin Restaurant General Manager A ---,( Salem Pizza Hut $Traders Way Salem,MA 0 978-744-13500 Fax 97&542-1977 WingStreet �/nJ � �-�`�' ��� � �� �-�"°� COURTDOCKET NO. CITATION NO. CITY OF SALEM 4 n ' VIOLATION NOTICE pp Li NAME p(LAST,FIRST,INrrITI++A��L)II !! },� 4'JC CA STREETAESS CITY/TOWN STAT ZIP DDR $ i e'er 5 GUatI X 100 LICENSE NO. LIC.EXP.DATEDATE OF BIRTH OWNERA �ST,FIRST,INITIALy iljrJLf� �f'+/I(t//•/y}!'f BESS CITY/TOWN STATE ZIP 7Z REGISTRATION NO. STATE EXP.DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL ❑AM ❑VES ❑>�PM ❑NO LOCATION OF VIOLATIONK Q y ENF RCI NG D PTA OFFENSE CHAP. SECT. FINES A 4�& 0aY B ! _ i,- 8c n fpr-r, C � CJ G OFFICER I.D.NO. TOTAL FINE WC '. ti- 1 DUE FICER`C RTIFIES COPY GIVEN TO VIOLATOR ❑ HAND X � ( Y 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 AMOUNMPASE# $ SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL APPLICATION FOR APPLICATION NO.(COURT USE ONLY) PAGE Trial Court of Massachusetts CRIMINAL COMPLAINT of District Court Department I,the undersigned complainant, request that a criminal complaint issue against the accused charging the offense(s)listed below. If the accused HAS NOT BEEN ARRESTED and the charges involve: F Salem District Court 65 Washington Street D ONLY MISDEMEANOR(S), I request a hearing D WITHOUT NOTICE because of an imminent threat of Salem.MA.01970 D BODILY INJURY D COMMISSION OF A CRIME O FLIGHT ❑ WITH NOTICE to accused. D ONE OR MORE FELONIES, I request a hearing D WITHOUT NOTICE D WITH NOTICE to accused. ARREST STATUS OF ACCUSED D WARRANT is requested because prosecutor represents that accused may not appear unless arrested. D HAS D HAS NOT been arrested INFORMATION ABOUT , NAME(FIRST MI.LAST)AND ADDRESS BIRTH DATE SOCIAL SECURITY NUMBER Pizza But Of America PCF NO. MARITAL STATUS 8 Traders Way Salem, MA 01970 DRIVERS LICENSE NO. STATE GENDER HEIGHT WEIGHT EYES HAIR RACE COMPLEXION SCARS/MARKS/TATTOOS BIRTH STATE OR COUNTRY DAY PHONE EMPLOYER/SCHOOL MOTHER'S MAIDEN NAME(FIRST MI LAST) FATHER'S NAME(FIRST MI LAST) INFORMATIONCASE COMPLAINANT NAME(FIRST MI LAST) COMPLAINANT TYPE PD Salem Board of HEalth D POLICE D CITIZEN D OTHER ADDRESS PLACE OF OFFENSE 120 Washington Street, 4th, Floor 8 Traders Way, Salem, MA Salem, MA 01970 INCIDENT REPORT NO. OBTN CITATION NO(S). OFFENSE CODE DESCRIPTION OFFENSE DATE 1 111/127 A/B ailed to pay citation 6PD6016 1/1/07 VARIABLES(e.g.victim name,controlled substance,type and value of property other variable information;we Complaint Language Manual) Failed to pay fine for not reCieVeing 2007 Food PErmit from The Board of bealtb OFFENSE CODE DESCRIPTION OFFENSE DATE 2 VARIABLES OFFENSE CODE DESCRIPTION OFFENSE DATE 3 VARIABLES REMARKS COMPLAIN T'S SIG A TUR DATE FILED X COURT USE ONLY A HEARING UPON THIS COMPLAINT APPLICATION DTE OF HEARING TIME OF HEARING COURT USE ONLY 10 WILL BE HELD AT THE ABOVE COURT ADDRESS ON} - C\`•] AT E DCCR-2(08004) COMPLAINANT'S COPY( '4 4 1 PIZZA HUS OF AMERICA,INC P ZQ P.O.1�OX 32430 e2 2a LOUISVILLE;KY"-00232 zo9e-o9 N s11 CHECK DATE CHECK NUMBER AMOUNT 5 06/27/2007 05449891 """""""..... 0.00 VOID AFTER 180 DAYS PAY One Hundred dollars and 00/100 cents CHASE BANK USA 21 of 33 STREET1201 MARKET WILMNG ONBE 19801 TO THE SALEM, CITY OF ORDER OF BOARD OFHEALTH 120 WASHINGTON ST 4TH FLOOR 'v dnc, I AUTHORIZED SIGNATURE SALEM MA 01970 11/0544989 in' 1:03L1002671: 6301420984 509u' 1 i• fi... e c URT DOCKET NO.^,~ CITATION NO a f o � ;LLs ° CITY OF SALEM o VIOLATION NOTICE PD Q'I o LAST,FlRST i ( a CtA �.,` �Z Gam Z " \ Q STREETADDRESS �n CITY/1OWN STATE, ZIP - 'o O m $•_ �`+"�' (�•71it " _ �m3 1 LICENSE NO, LIC.EXP.DATE DATE Of BIRTH cP. " Ah '. toil;`. N N w i ,Q ¢O ER'S NyAM�E(LAST FIRST,INITIAf�^ o ZG rC ZN ," Q Ir _ I STR�DRE S CITY/T WN STATE �nZIP -76 Ln Ad<x m �_II REGISTRATION NO, STAT EXP.OATE MAKFJTYPL YEAR COLOR � 1 i Yv DATE OF VIOLATION TIME DATE CITATION WRITTEN PEAq NAI WT O ❑PM Cl AM �IY�ES S O fL LOCATION OF VIOLATIONq y E RCIN09FP , O 1 OFFENSE CHAP T. FINES _ m / // // Lo i N Y h 41B LD OFFICER ID.NO TOTAL } O FU LL Q p /OFFICER CERTIFIES COPY GIVEN TO VIOLATOR C1 F )N HAND p Z 1 F• I'm I X. YMAIL �- I U cv u> (Cf Z� O DO NOT MAIL CASH-P-PAY ONLY BYPOSTAL NOTE,MONEY j •_• ORDER OR BY CHECK MADE PAYABLE TO: W:: o '� -jjo r CITY CLERK CITY HALL G O Q~ m 93 WASHINGTON STREET O lll(� O = -SALEM,MA 01970 O N LL z TEL.(508)7459595 X 251 SOS~ � Q CI I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON I I N U�� ED REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE <03u) 1 m :�dQ PAYMENT IN TH " NT ". aa� Z w QO� Q 2 �_ �'7 ASE#- N N Wm� DOLn G SRA,TURF.. O SEE OTHER SIDE FOR FJRTHER INFORMATION N w ¢ ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 0= I � 0O i 8 Traders Way Pizza Hut of America, Inc. City of.Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: Item Status Violation Critical Urgency Telephone; PROTECTION FROM CONTAMINATION 978-744-1350 i Handwash Facilities PASS C] RED Owner: Comments:Handwash signs missing from sinks. Provide signs. Highlander Plaza Realty Tru iViolations Related to Good Retail Practices (Blue Items) PIC. Equipment and Utensils PASS BLUE Chris Campane o Inspector: Comments;Traulsen freezer requires general cleaning. John Gehan McCall unit requires general cleaning. Date Inspected:Correct By: 315/2007 Traulsen pizza unit requires general cleaning. Risk Level: Pepsi refrigerator requires general cleaning. There is no sanitizing log available. Log to be maintained with ppm as mandated. Permit Number: BHP-2007-0365 Test strips on hand but missing level chart. Provide new chart. Status: Sanitizer reading to strong. Sanitizer to be reading at proper ppm as mandated. SIGNED OFF #of Critical Violations: j Physical Facility PASS BLUE 0 --- Comments:Walls and ceiling have accumulation of dust. Thoroughly dean walls and ceilings. Time IN; Time OUT; _ I i Vents aboverestrooms require thorough cleaning. Urgency Description(s): BLUE: Many shelves have accumulaion of grime. Thoroughly clean shelves. Violations Related to Good Retail Practices (Critical GENERAL COMMENTS: violations must be corrected All violations from 2(26107 have been corrected. immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2007 ) Page I o}'2 Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) i U City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2007 ) Page 2 oft W8 Maders Way Pizza Hut of America, Inc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 1I PROTECTION FROM CONTAMINATION 978-744-1350 Handwash Fa ..ies FAIL d❑ RED Owner: Comment: Handwash signs missing from sinks. Provide signs. Highlander Plaza Realty Tru Violations Related to Good Retail Practices (Blue Items) PIC: Equipment and Utensils FAIL BLUE Chris Campane o Inspector: Lzom�Traulsen freezer requires general cleaning. John Gehanc✓M Call unit requires general cleaning. Date Inspected:Correct By: —"—Traulsen pizza unit requires general cleaning. 2/26/2007 Risk Level: V,-15'epsi refrigerator requires general cleaning. u There is no sanitizing log available. Log to be maintained with ppm as mandated. NuN Permit mber: BHP it Nu 03 r: T� est steps on hand but missing level chart. Provide new chart. Status: - San er reading to strong. Sanitizer to be reading at proper ppm as mandated. Open j #of Critical Violations: Physical Facility FAIL BLUE 1 �Eomment:Walls and ceiling have accumulation of dust. Thoroughly clean walls and ceilings. Time IN: Time OUT: � /'' �/ents ab verestrooms require thorough cleaning. Urgency Description(s): BLUE: Many shelves have accumulaion of grime. Thoroughly clean shelves. 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. Feb 26,2007 ) Page 1 oft Item Status Violation Critical Urgency s RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) V V 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. Feb 26,2007 ) Page 2 oft a re w w yrs 4 m t a tFi 3+ k+ m yr » ,R{* .�°*tn .�t t i °e pi. ma aka- S.-4,���r3 dd+rz`P'�6'hrl'� � Arwe»�d fTY"rn"t .�FY�a1^isa- i r: Y� * t} F 3`vri. c. .x.n yy,�r.:�s�.h .,' .�-s t s✓'.i.C M MYe f� �'.� Y .. , Commonwealth of Massachusetts City of Salem Board of Health IGmbefte -brIS0011! 120 Washington Street,4th Floor - Mayor,.. SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2007 ESTABLISHMENT NAME: Pizza Hut of America, Inc. File Number:BHF-2004-000340 8 Traders Way Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0365 Jan 8,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES ;December 31, 2007 Board of Health V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 2 Jan 04 07 07: 34p Joanne Scott Salem 80H 978 745 0343 p, 2 OGCITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1Boo FAX 978-745.0343 Kimberley Driscoll WWW..ALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTy 'Q—&,' 1'{ZTEL tf Jq.Z__a� 135 ADDRESS OF ESTABLISHMENT_ ,p/._( S W&* yfAX 8 } +TAILING ADDr:CSS(if dirfCrenl),��._„�t �l�.t3 U. �..ti .�._�rt_F�(�,• '?,JZ .... EMAIL OWNER'S NAMEvl-C4� J-AC_ TEL tt_50Z-_�� t t f ADDRESS 116 AM( I.SLt S 14 2?, 'Z STREETr �i . lit r^rt2LyaI A S1'A CERTIFIED FOOD MANAGERS NAME(S)l.VY t 5�0� l rtfYPle A#U (4? CERTIFICATE#(S) (s)iIIiar1 'S !"urra &u { 443952 (Required in an csLm6snmern where potent)i�,{/�1f i S fly��haza.dous food's prepmeedl 910 + q EMERGENCY RESPONSE PERSON -6 C.6 M�—HOME TEL a L I-1' t I 0 -q U 7 (1-- 6 pAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Sataruav Suadav,� NONRSOFOFF RATION & A A h Please write Incline o(nay. 3t�Pr IZ� 10'-3U�11 (For eramo(e 111am•110m) — TYPE OF ESTABLISHMENT FEE (check only{ RETAIL STORE YES No less than 1000sq.t1. =$ 50 1000-10.000sgft. =$100 more than 10,000sG.tt. =$250 RCSTAURANT YES NO less 01311 25 Seats 25-99'eats =$150 more than 99 scats =$200 QED/t3RF.AKFAST YES NO $100 ADDITIONAL PERMITS MAKE (nut just Serve)ICE CREAM, YOGUR 1, SOFT SERVE YES $5 1 UBACCO VENDOR YES $50 ALL NON-PROFIT(such as ch(uch kitchens) YF-.'S NO $25 -Please Pay total with ono check Payable to the City of Salem. L Permit is not if insterable and must be reiSSued upon change of owners(1ip 1liv Permit muCt be post?d in a nent location in the Establishment. cordance with the State Sanitary Code,before any renovations, improvements, or equipment changes are all pians for such must be submitted to arid,approved by the 5alern Bum d of I tealth, t I I1 MG1..Chopto 62C, .`o,000 49A, I cv,lily undei the tram{.nrd JUN onagio i ul perµ11y Trial I, to my br.;,I knuwlogr and helix.(, cd,ill f-0teLa%re ut5 J00(Qid 111ntg pC So(", Se urily or FCl9eral I�evlilicalion NU111h1( _...... �`�...�.J.... ({..�.{.t III V 1,100DN 10111.�Am lho<ka$Ualr "r-t,)q Et-(} ( i5�67 -a a. 8 Traders Way Pizza Hut of America, Inc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: - PROTECTION FROM CONTAMINATION 978-744-1350 Handwash Facilities FAIL Critical RED Owner: Comment: The handwash sinks only had hot water at temperature of 95°-99'F. Restore hot water to all handwash sinks to a Highlander Plaza Realty Tru minimum temperature of 110'F. PIC: `' - Violations Related to Good Retail Practices (Blue Items) Kenneth Neenan Equipment and Utensils - FAIL Non-Critical BLUE Inspector Comment: The Pepsi Beverage air cooling unit needs a visible,accurate thermometer. David Greenbaum - Date Inspected: Correct WBy: The canopener needs a thorough scouring. 3/30/2006 The Tmulsen pizza station has an accumulation of food debris. Thoroughly clean this unit. Risk Level: The same unit needs a visible,accurate thermometer. Permit Number: The pizza cutters must be cleaned and sanitized at least once every 4 hours. BHP-2006-0316 GENERAL COMMENTS: Status. 550:Manager will notify the Board of health within one week that all violations have been corrected. SIGNED OFF #of Critical Violations: 1 X Time IN: Time OUT: Urgency Description(s): BLUE Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 ' 4 days)(Non-critical violations must be corrected immediately or within 90 days) ,.� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2006 ) Page / of ,r • 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 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2006 ) Page 2 oft Commonwealth of Massachusetts City of Salem Board of Health ��. 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2006 WHO'S PLACE OF BUSINESS IS: Pizza Hut of America, Inc. File NumberBHF-2004-0340 8 Traders Way Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0316 Jan 5,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES IDecember 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location."Che permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements,or equipment changes are made,all plans for such most be submitted to and approved by the Salem Board of Health. Page 3 of 3 Dec 21 2005 12: 16 PIZZRHUT# 508-765-0221 5087650221 p, CITY OF SALEM, MASSACHUSETTS « « BOARD OF HEALTH 120 WASHINGTON STREEr,4TH FLOOF SALEM, MA01970 TEL 978.741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR WWW.SALFM,COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2406 APPUCA71ON FO PERMIT T1 O OPERATE A�7G0 FOOD ESTABLISHMENT ( S' NAME OF ESTABLISHMENT -LZ& � LSEL# q It Ui(]gq-1,3s( ADDRESS OF ESTABLISHMENT (A MAILING ADDRESS6f different) ( Y� Z} f tri f cy Y1r�1� �t2/ r OWNER'S NAME t 22h td_� t7T l�t L6. �l t[j�TKL ADDRESS fQ,•,A "1 L d' 0 CITY 6y1 i Syi i STAT 21P Q? _ CERTIFfEDFOQ MANAGER'S E( kW S)_ VLt17 A✓1 CERTIFICATE#(s) K CifS � �si � Foy r'tsu l �S (required in an establishment where tentially hazardous food �isrprepared.) h f EMERGENCY RESPONSE PERS N i�� I V " l ✓I HOME TEL#q I-7 0'q_t�766-- /M HOURS OF OPERATION Mon. € us. Wed.�Thu. ti/ Fri. k,/,Sat /St,, ,. ✓ TYPE OF ESTABLISHMENT FEE (check only,) RETAIL STORE YES Nb less than 1000sq.ft. =$ 50 1000-10,000541. =$t GJ more than 10,000sq.ft. =$250 RESTRURRNT YES ....N f j/j jl ' less than 25 seats 10 �j/ /-'L/ 25-99 seats =$150 more than 99 seats =$200 _.... ------------------------- 8EDIBREAKFAST YES - • N $160 _..... - - -------------- ------------------------•---------._--.---...-......._.•..._......_............_... . ADDITIONAL PERMITS MAKE(not just serve)ICE CREAM,YOGURT,SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as chu ch kUahem) YES N $25 *Please pay total with one cher payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership.The Permit must ne posted in a prominent location In the E tabiishment. In accordance with the State nitary Code,before any renovations, improvements,or equipme� . :. ranges are made, all plans for such mu t be submitted to and approved by the Salem Board of Healtt, i 5M?f, pte'r'82G; S ction 49A, I certify under the pains and penalties of perjury that I have filed it state lax returns and paid all state taxes required under the iaw �2 Z20 7 - MS� 931r S tore Datd Social Security or Federal Identificahon - — -- - - - -- - - — - - - - - - ------- _. Revised 11/03/05 FWDAP2.adm heck#&DalD6''u? e (8 p q ��1���00 — 0 0J 8 Traders Way Pizza Hut of America, Inc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 978-744-1350 Non-compliance with: Not Done OWneC' Anti-Choking PASS ❑ _ Highlander Plaza Realty Tru Tobacco PASS ❑ PIC. Richard Englin FOOD PROTECTION MANAGEMENT Not Done Inspector' 4 PIC Assigned/Knowledgeable/Duties PASS ❑J RED _ § David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By:. Reporting of Diseases by Food Employee and PIC PASS d❑ RED 4/5/2005 =' Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: ., FOOD FROM APPROVED SOURCE Not Done Permit Number. Food and Water from Approved Source PASS ❑d RED BHP-2005-0417s Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED SIGNED OFF Conformance with Approved Procedures/HACCP PASS Q RED #of Critical Violations: 3 Plans PROTECTION FROM CONTAMINATION Not Done Time IN: Time OUT: Separation/Segregation/Protection PASS ❑d RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 67 Proper Adequate Handwashing PASS RED Urgency_Description(s): ,. Good Hygienic Practices PASSd❑ RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASS d❑ RED Retail Practices (Critical Handwash Facilities PASS ❑Q RED violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page I of 8 Traders Way Pizza Hut of America, Inc. must be corrected Immediately PROTECTION FROM CHEMICALS Not Done or Wlthln g0 days_) Approved Food or Color Additives PASS ❑J RED RED: Violations Related to Toxic chemicals PASS ❑D RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require Cooking Temperatures PASS ❑Q RED immediate corrective action) Reheating PASSd❑ RED Cooling PASS RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Non-Critical ❑ BLUE Canopener needs a thorough cleaning. Traulsen cooling unit needs a thorough cleaning. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page 2 of 8 Traders Way Pizza Hut of America, Inc. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page 3 of / ,.. �, ��- � r�1�� p ',t ����� (�" ��� � 1 t� �jri",',",�C.I�^' 3 �� � , � �} ,� ,� _ �� �� i. �` ,t {� `4 t ,. +, 4- Jan 13 05 03149p Joanne Scott Salem BOH 978 745 0343 p' 4 i/OS39 7�.�r� NAMEDJr.4Y,TARBTR4ttALi y STRPETAOIWSS •.CITYftOMM "S/TATE bP 'T>' �.Ifdc4�r Gi iY 1� g ox? ` R'; UCBN9ENO. UC. .DAM, WOEOFSWH C� # osr 3y56! o.A* HxmcJuv.nN '"TMa, STHEETAOORE$S CITYrro" STATEE ZIP ter x jr AEGISTRATIONNO STATE EXP.DATE. 4(eM E YEAR C' OR Q TC Of YIDIAlION Emc DATE CITATION WRITTEN 'iFS - •nr 0PM �-- /•C75- Yo LOCATION OF NOU1110N PM A°r�IEL r.✓ ^ OFFENSE(l / CHAP SECT FINES.�t. A. fLTrrGl:.r�Y �; /Il 0 OFFIOER i O NO. T()TA ( FINE $ /(/Q DUE v OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN i. NU DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK CITY HALL ' 43WASHINGTONSIHtti SALEM,MA 01970 TEL.(500)745-9595 X 751 i I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STAI'E0 ON REVERSE,CONFESS TO THE OFFENSE CHARGED.AND ENS tCNSf PAYMCNT IN THE AMUUN 1 OF CASCn„_,. i 1 SIGNAIURE SEE OTHER 5tD@ FON FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL PIZZA HUT OF AMERICA,INC P.O BOX 32430 LOUISVILLE,KY 40232 SHARE-0000110539 PHI —VENDOR CORP 05134561 VOUCHER INVOICE DOCUMENT INVOICE GROSS DISCOUNT NET NUMBER NUMBER -ID DATE AMOUNT AMOUNT AMOUNT 00703141 PD0522 01/11/2005 100.00 0.00 100.00 I I I I TOTALS 1 100.00 0.001 100.00 ADDRESS CHANGE INFORMATION PIZZA HUT OF AMERICA,INC VENDOR NUMBER SHARE-0000110539 P�ZZa P.O.BOX 32430 f/4 LOUISVILLE,KY 40232 NAME: IF YOUR ADDRESS HAS CHANGED, PLEASE DETACH AND RETURN TO THE ADDRESS ABOVE. ADDRESS: PIZZA HUT OF AMERICA,INC 62-26 P�Z4 P.O.BOX 32430 X11 zona-os LOUISVILLE,KY 40232 CHECK DATE ' CHECK NUMBER .••AMOUNT «. 5 01/14/2005 05134561 "'100.00 VOID AFTER 180 DAYS PAY One Hundred dollars and 00/100 cents CHASE BANK USA 1201 MARKET STREET WILMINGTON.DE 19801 TO THE CITY CLERK/ /7;f/ or -safp"2 ORDER OF CITY HALL 93 WASHINGTON ST AUTHORIZED SIGNATURE SALEM MA 01970 CITY OF SALENIt MASSACHUSETTS BOARD OF HEALTH # 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0849_ , 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: Pizza Hut of America, Inc. Address of Establishment: 8 Traders Way Owner's Name: Highlander Plaza Realty Trust Restrictions: Application Date: 1/24/2005 Permit for Food Establishment 277-05 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 Jan 13 05 03: 49P Joanne Scott Salem BOH 978 745 0343 P• 5 X' CITY OF SALEM, MASSACHUSETTS BOARD S HEALTH Q�' wo 12U WASHINGTON STREET, bTH FLOOR SALEM, MA 01970 TEL. 978.74 I.1800 F^x 978.745,0343 STANLEY J. t.1SOViCZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR - HEALTH AGENT 2005 APPLICATIONNrrOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_. 1-zr— '7Raa/ —TEL 9 ADDRESS 01" ESTABLISHMENT Z-Ir ( tl n� — 7—� MAILING ADf)RHgS (it I((anent L L 311t OWNER'S NAME'g_�"�``L_V2=_`�°1.L�.._�e�^G_-- TEL N��y'VVV �!'•, rjj CITY�('�_. STATE ZIP7 CFRTIFIED FOOD MANACEA'S NAME(S') _CERTIFICATEH(s)AC��j-,i3YZ. (required in an establishment where polcnlially hazardous food Is prepared ) (} — EMERGENCY RESPONSE PERSONA / /11 _ HOME TEL N-q-SY/, I•IpURS OF OPERATION- Sur, .. TYPE OF CSTA-BUSHMENT FEE check only RETAIL. STORE YFS CN-O ) NO less (hall, 1000sq fl. _$ 50 /1000-10,000sgft =$100 �J L y or ; than t0,000Sq fl =S"1.50 RESTAURANT YEA NO // 25-99 se.+ls 0 moil than 99 sc5t< =S200 UFO/bKFAKI-A'1-1T YLS rNO SICU AUDIT IONAL HFRMI15 MAKE (not rust serve.) ICE CREAM, 1'UL+UR7, SO[I SFRVL Y[S NU 5.5 I OBACC0 VLNOOR Yi t> Syn ALL NON•PROFirisuch as Church kdchens) YES N SZt: Plcase pay total with one check payable to the City of SaIC171 This Pcnlia is not tianshrrable and III USI be ICiSSued LyJun Chailyr of owner5nip. Thr I'Ctnul mast he Po5tcd m a protilifiew location ill the F'stabtiSivttent In occuldanG(.` wall tro State satwi,y Cock, holorru any ,,Ullovo lions, Inlpruvcments. III C'g,rpilwot Ch:rnars o.v niaoo. ae pians for SUCK nxuSt bo stih,nitted to.iod appioved by Ow Salem Board of Health hi r,11 '•I i'.ICli lli;i iiY(:_ '�i'tluiii J']A. Iiia ldy i!nii.i Ilu li.ri r, ,ui,' in'i i,it Lt" til lu.�lu,Y IIS 'I Tlwli.istir ,nut ht:IWI ii.wi. Idrd .111lil,11r' 1nairlunr.; ,1110IL140 .111 "i;dc 1'lxr4 rCiiuilod m'o ,�w w ..upraw . lCili irI I :ii'..linry �u del.fl is dihr H .,.... I I �P�7 U.i ISP➢i,'•I" iJnlh,..y ;;. il.u' 6M(.l-G`r P-611s PIZZA FWT OF AMERICA,INC P:O.BOX 32430 LOUISVILLE,KY 40232 SHARE-0000052237 PHI -VENDOR CORP 05134560 VOUCHER INVOICE DOCUMENT INVOICE GROSS DISCOUNT NET NUMBER NUMBER ID DATE AMOUNT AMOUNT AMOUNT 00703142 722015HP05 01/13/2005 100.00 0.00 100.00 TOTALS 1 100.00 1 0.00 100.00 ADDRESS CHANGE INFORMATION PuIZZa PPIZ BOX 320430 AMERICA,INC VENDOR NUMBER SHARE-0000052237 T LOUISVILLE,KY 40232 NAME: IF YOUR ADDRESS HAS CHANGED,PLEASE DETACH AND RETURN TO THE ADDRESS ABOVE. ADDRESS: COURT DOCKET NO. O CITATION NO. CITY OF SALEM PD x522 VIOLATION NOTICE r it G NAME(LAST,FIRSTINITIAL) 1-91 />Ti 7` 0f rr1-ri. fin/ Ct STREETADDRESS CITY/TOWN STATE ZIP I7 r�.�f�rs trrx. i ,7 /,t, LICENSE NO. LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) .r A ht,•tf,� z.-,7�'t=,�itz.�z. /CPftr.L �Ca:T STREETADDRESS CITY/TOWN STATE ZIP REGISTRATION NO. STATE EXP.DATE MAKERYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL ❑AM INJURY ,p PM I NOS LOCATION OF VIOLATION q ENFORCING DEPT. O/ /� ♦ ,'71'elr t.. OFFENSE - CHAP. SECT. FINES x Q B C OFFICER I.D.NO. TOTAL @ • v>"��tc.SX/` FINE DUE p - OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑l/IN HAND X fJ /J J. C-�£'-4`<f::.a�Gfl CR6Y 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)795-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR �l�Sa SALEM, MA 01970 TEL. 978-741-1 800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT Facsimile Transmittal To: �ew — u�. G Fax # 9--/- 50a- -2S4- RE: olca6 A�_�lra�u� Date : /-/0�5 Page(s): including this cover# 7 Message: as d f Board of Health News ----------------------------------------------------------------For Your Information Office Hours: Effective September 12, 2003 Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON Do Salem Residents Know ? — The Board of Health meetings are held the second Tuesday of the Month. HP Fax Series 960 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem.BOH 978 745 6343 .tan 1320053!51pm IA9 Fax Date Time T�= Identification- Duration Pages Result Jan 13 3:48pm Sent 915028746173 2:13 7 OK Result: OK - black and white fax I ?COURTDOGfETND CITATIONN0 t' tom . ,TY n M'' D ' CE NAME OAST,FIRST INITIAL) A: ,'m -w .. UCENSENO'1..,k,cy-)•qW ""Y�:s LIC DATE-E. DATE OF IIIRTHrt i -.OWNER'S NAME(AST,FIRST,INITIAL) ' Lp hl+LFr 24. kP.dLY�/ STREET ADDRESS .:3'. CRVROWN STATE . ZIP - ' alic,0 7YLl/OLG'GLCRar/1)R- %77<t�LE SHIT .. REGISTRATION NO.: STATE EXP.DATE NIAKEITYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTENAM rmsaNu - wURy mo PIA �.�"�_�S— LJ VES ..:� LOCATION OF VIOLATION .." _ EN RCIN. D G!0 �F�r, IF . .. OFFENSE. .., CHAP. SECT. FINES . 0 A Fcl/&wP . - - - BDOI� C OFFICER - I.D.NO. TOT G 4 FINE $ DUE - - OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND X , — , /r AL�{�1< '.�v, Rk/BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,t$ONEY - ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK - CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 - TEL.(508)745-9595 X 251 - HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# _ iSIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION i ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o' SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Pizza Hut of America, Inc. Address of Establishment: 8 Traders Way Owner's Name: Highlander Plaza Realty Trust Restrictions: Application Date: 9/28/2004 Permit for Food Establishment 321-04 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 i ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a a 120 WASHINGTON STREET, 4TH FLOOR c s SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT PIZZQ Hui 4 ArAtricA j TEL# ADDRESS OF ESTABLISHMENT 8 Traders Waa SAiEnlc., " 01910 MAILING ADDRESS (if different) 1 Marshal Cowan OWNER'S NAME 14►ah1QMf-r-?IQaTru%+ TEL# $S6-(#69. 6810 ADDRESS ZOOO ►m ICW0001. �Dr- CITYk dt STATE ZIP0$051, CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) RCpbon 393y (required in an establishment where potentially hazardous food is prepared.) h EMERGENCY RESPONSE PERSON tG FY1 d HOME TEL#_1q8-59(o-94A: — ` HOURS OF OPERATION: Mon.Jl=11 Tue. III I Wed.11 I I Thu.l I I 1 Fri. 112Sat.1I-12 Sun. I TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$2`5''0 RESTAURANT YES NO less than 25 seats 25-99 seats =$150 more than 99 seats =$200 BEDIBREAKFAST 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 I, to my e w knowledge and elie , have filed all slate tax returns and paid all state taxes re ired under the law. Signature ciefte Social Security or Federal Identification Number ----------------IV--------------------------------------------------- --------------- - Revised 11/03/03 FOODAP2.adm Check#&Date, CITY OF SALEM _ II BOARD OF HEALTH Establishment Named Z7 T17 r Date: Page:Page: of_ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red ItemVerified PLEASE PRINT CLEARLY trh(VLC U Vl-Loc anti P '_ffol� I I J / 1'1 I- 6( / 9124010 Y V 14 haD6 �P V f i t Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I ; I have read this report, have had the opportunity to ask questions and agree to correct all LI Voluntary Compliance LI Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five doll s' r suspension/revocation of ❑ Embargo L] Emergency Closure your food permit. �s ✓ '"'�"� ( ❑ Voluntary Disposal ❑ Other: Imo, GI`/,r/S DUYa(@Yl 3-SQI_14((-,) PHFs�Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(items 1-22) (Cont.) _41'E1451F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 CoalMethods for PHFs 19 to Food or Color Additives PHF Hot and Cold Holding 3=202.12 Additivcs'r 3-501.16(B) 7111 PHFs mainta"I d at or below 590.004(F) 4('145'P* 3-30214 Protection from'Una roved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 40°F. * 7-101.11 Identifying Information-(h'ightal 3-501.16(A) Roasts Held at or above 130'F. Containers" 7-10211 Common Name -Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora c* 3-501-19 Time as a Public Health Control. 7-202.1 590.004(H) Variance Re u--Im .1 Ractriction-Presence and Use* --a- nt 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicalsa` POPULATIONS(HSP) 7-204.12 Cheruicals for Washine Produce,Criteria* 21 3-80'1.11(A) Unpasteurfzed Pre-packaged Juices and 7-204.14 Drying C, eats, nteria* Beverages with Waini2 Labels'' - 7-205.11 Incidental Food Contact. Lubricants* 3-801.11(B) Use of Pasteurized E ras* 7-206.11 Restricted Use Pesticides. Criteria* 3-801.11(D) Raw or Partially Cooked Annual F'cxd and Raw Seed Sprouts Not Served. 7-206.12 Kaient Bait Stations`" 3-MI J I(C) Une cued Food Packave Not Re-served. 7-206.13 'frack'ing Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS F603.1Consumer Advisory Posted for Consmnption of Animal Foods`('hat are Raw, Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs 3-401.1 IA(1)(2) Eggs- 155°F 15 Sec. 11 thogens.s E es-Iamrediate Service 145°P15sec* Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comnunuted Fish,Meats F Game E s's* Aninuds- 155'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast-130'F 121 ruin" _SPECIAL REQUIREMENTS 3 401.1't(A)(2) Ratites,Injected Meats- 155 E 'l5 590.009(A}(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Y2u�atites-165°17 15 sec. above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 1129- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(h) All Other P6IF's-145'F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40111(A)&(D) PHFe 165°.F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Crin,al and non-critical violations, which do not relare in the Timex' foodborne illness uaerven£ions and risk femurs listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in shefollowing sections vfthe Food Code and 105 CMR 1400F* 590.O00. 3-403-ii(E) Remaining Unsticed Portions of Beef Item Good Retail Practices FC b80.000 Roasts' 23. Mona ement and Personnel FC-2 1 .003 lA Proper Cooling of PHFs 24. Footl and Foo Protection_____ -FC-3 .004 25 E ui ment and Utensils -FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to -�� - - 26. Water.Plta and Waste F�-7 .006 70"1 Within 2 Hours and From 70'P 27. Physical Facile F .007 - xc - to 41'F/45'F Within 4 Hours. '" 28. Poisonous or Toxic Materials _ F .008 -T-5011 4(B) Cooling PHFs Made From Ambient 29, S ©sial R uirements _ ( .009 Temperature Ingredients to 41'['/45'F _-ther Within 4 Hours* Denotes critical nein ur Ole:federal 1999 Frond Code or 105 CMIl 590.000. CITY OF SALEM OARD OF HEALTH Establishment Name: 7 / _ 1 12��' C�l 1 i _ _ o Date: 9 a Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OrF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY --- 1 - �2 OC oG /YP - T2ccj is mn ip-I' - ➢ - O/ If 6 -I ,/ ' _{f T r I - I P7 0 Pie- 4D dzXL_e_ _ r �1 h g4 'e CA Discussion With Person in Charge: �pyf/j� CL`7,C Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P LI Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of wenty-five dollars or suspension/revocation of ❑ Embargo El Emergency Closure your food permit. \/ n //n�,�,1 n �YJ�P/`✓ ❑ Voluntary Disposal ❑ Other: t 3-S)l Ti(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41°F745`F Within 4 Homs. PROTECTION_FROM CHEMICALS 3-50'L15 Cooling,Methods for PHFs 14 u Food or Color Additives 19 PHF Hot and Cold Holding 3-50t.16(B) Cold PEtFs Maintained at or below 3-302. 3-20112 Addr14 Protectioil Io590.004(F) 41`145°F* n frorn Lfia r roved Additives* 3-50L16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140"F. ' 7-i{)1.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers" 7-102.11 Common Name -Workitr,Containers* 20 Time as a Public Health Contra) 7-201.11 Separation-St'oraee" 3-501.N Time as a Public Health Control" 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions 1-111 se* 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanitizers,Criteria-Chemicals"- POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteria* I 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Beverages with Warning r..thels* D •in ants.Criteria' Us 7-205.11 Incidental Food Contact, Lubricants' 3-801.11(B) Use of Pasteari-ted E�{s* 7-206.11 Restricted Use Pesticides, Criteria* 3-80111(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served,'r 7-206.12 Rodent Bait Stations" 3-801.11(C) Unopened Food Packa>e Noe Re-served, 7-206.13 Trucking Powders,Pest Connor and Monirorino'^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercooked or 15 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401-11A(1)(2) Eggs- 7.55`F15Sec. Pathogens Flre ev, 1/1/2011 F tis-hmnediate Service 145°F15sec* 3-302.13 Pasteurized Fggs Substitute for Raw Shell 3-401A 1(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 titin* SPECIAL REQUIREMENTS 3-401.11(A){2) Ratites,Injected Meats-155°F 15 590.009(A) (D) Violations of Section 590.009(A)-(D)in� sec. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. i above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°17* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#'29-- Microwave 165°17* Special Requirements. 3-401_I1(A)(1)(b) All Other PHFs- 145°P'15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(I)) FEIN 1650F 15 sec.* (Items 23-30) 3-403.11(B) Microwave-165°F 2,Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk J'actors listed above, can be 3-403.11(C) Commercially Processed RTI~Food- ,found in the following sections of the Food Cade and 105 CMR 140'5'* 590.000. 3-403.11(1) Remainin Unsiiced Portions of Beef (tem Good Retail Practices FC 690.000 Roasts* 23. Maria ement and Personnel FC-2 .003 IS Proper Cooling of PHFs 24. Food and Food Protection FC 3 004 ----C-3 41 25 Equipment and Utensils FC 4 . .005 3-501A,I(A) Cooling Cooked PFIFi, from 140`17 to 26 Water,Plumhin and Waste FC 5 I .0o6 70017 Within 2 Hours and From 70°F 27. Physical Facilites FC-6.007 to 41°F/457 Within 4 Hours. * 28. Poisonous or ToxicMaterials FC-7 .008 3-501.'14(13) Coohng PHFs Made From Ambient 29_ S ecial Re ulrements _ .009 'temperature hugredients to 41"17/45°F 30 Other Within 4 Hours" ss+armre;eazm� Denotes critical item in the federal 1999 Food Co&or 105 CMR 592000, IMPORTANT MESSAGE FOR Dp�ATE II �5 TIME iL M 4m t)" (VL OF PI2 0. PHONE -AREA CODE CODE U BEt✓ :TENS ❑ FAX ❑ MOBILE AREA COD BER LL TELEPHONED �� LEASE CALL CAME TO SEE YOU WILL CALL A WANTS TO SEE YOU RUSH r.. RETURNED YOUR CALL WILL FAX TO YOU MESSAGES C3-- appl ;c�� F>Kafzroa petrn �� bersw sbe oma- Vi-L7 ra ►� tree v�tic �1(� e, aF w�nrrlrl �� 9 L 28 SIGNED iYr�7. FORM 4009 MARE W U.S.A. CITY OF SALEM BOARD OF HEALTH Establishment Name: 2 a S�✓ec Date: Sir/'� Page: of a Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference. ,R—Red Item. Verified PLEASE PRINT CLEARLY a C cw�r�1 wr 1 ee- rStw q �/ ro ) d'c. �f(! o .�'- 10S �� , v ! / 7.cr�4 O 3 q 7&- /aryr `� � ✓cve� 45 ✓vim �P 5U�L �e € �LvS/ . { tiu Jr/J a--7c' P�/i / an Y L Q Z 'V r .t1 7 - K e_ ,S pp e -Z a �/Q R PC ,LaC� YP�/s Q 4 be a 01= rss ze—, Pyr d1 A fe a la✓ S S nus `iw �Q u Soni qr � � �a "t 4 U5( !'0 ! /¢✓ -/7) //( �! 4 Gt r -, S c f Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ' I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHR.Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.]2 Additives* 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 4'1'(45°F* 3-302.14 Protection frtlrn Una raved Additives* Poisonous or Toxic Substances 3-501.16(A) Hot PIFs Maintained at or above IS 140'E'. 7-101.11 Identifying Information-Original 3-501.16(A) Roast.,Held at or above 130°F. Containers"Name-Working Containers"' 20 Time as a Public Health Control 7-103.11 Common 3-501.19 Time as a Public Health Control', 7-201.1.1 Se.aration-Stora e* 7-202.11 ,Restriction-Presence and Use* 590.004(H) Variance Ret❑iteretent 7-202.12 Conditions of Use* 7-203.11 'Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteria* 3-801.1I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvim*Agents.Criteria* Beverages with Warnino labels* 7-205.11 htcidentui Food Contact,Lubricants* 5-801.11(6) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria', 3-801.11(D) Raw or Partially Corkin Animal Food and Raw Seed Sprouts Not Served. * 7-206.12 Rodent bait Stations* 3-801.11(C) Unopened Food Package.Not Re-served.^' 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMP_ERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of I6 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to'Elitvinate 3e4e155'FISSoo, Pdlogens.* War -eoor El-os-Immediate Servico 145'Fl5sec* 3-302.1.3 1 Pasteurized Eggs Substitute for Raw Shell 3-401.1.1(A)(2) Comminuted Fish.Meats&Come E s* Animals- 155'F 15 sec. " SPECIAL REQUIREMENTS 1-401.11(B)(1)(2) Pork and Beef Roast-130'Fl2lturn* 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590-009(A)4I) Violations of Section 590,009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, esidential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec * above if related to foodborne illness 3401.11((')(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw.Annual Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-4101.11(A)(1)(b) AtIOtherPHFs- 145'F'15see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.'11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.1.1(13) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can he 3-403.11(C) CommerciallyProcessed RTE Food- Jound in rhe following sections o(the Food Code and 105 CMR 140°F* 590.000. 3-403,11(E) Remaining Unsliced Portions of Beef Item I Good Retail PracticesFC 590.000 Roasts*' 1_23 _ Management and Personnel_ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection_ FC-3 .004 25 E uipment and Utensils FC-4 005 _ 6_ Water, umbinq ste 3-501.14(A) Coto oling Within Noun 4 Hours 70'F ( 27 }_Poisonous Facility nMa enols FC 7 OOg 3-501.14(B) Cooling PHR Made From Ambient �_Requirements _ .O09 29 Sacral Re w, ___ _ Temperature,Ingredients to 41'Ff45'F 30. Other - 1 Within 4 Hours* *Demes crifical item in the t'ederal 1999 Pond Cale or 10CM11 590.000. CITY OF SALEM f/n BOARD OF HEALTH Establishment Name: Oow4> Date: Page: vZ of �2 Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - -. Verified PLEASE PRINT CLEARLY �r 6 y r Discussion With Person in Charge:e: Corrective Action Required: '❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. yn erstand that noncompliance may result in daily fines of twenty fj edollars o suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / Sze �_/_U ❑ Voluntary Disposal ❑ Other: 3-501.14(0) PHFs,Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to I.aw Cooled to Factors(Items 1-22) (Cont.) 4'1'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(13) Cold PHFs Maintained at or below 3-20112 Additives* 590.004(F) 41'/45'F* 3-302.14 Protection from Unapproved Additives" 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'F. 7-101.11 identifying Information-Onginal 3-501.16(A) Roasts Held at orabove,l30"F * Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.(1 Separation-Stora e* 3-501.19 Time as a Public Health Control" 7-20111 Restriction-Presence and Ilse* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(NSP) 7-204.12 Chemicals for Washing Produce.Criteria* 21. 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying� Agents.Criteria* Beverages with Warning Labels* 3-801.11.(B) Use of Pasteurized Eras* 7-205,11 Incidental Food Contact,Lubricants* 3-801.1.1(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. * Tracking Powders, 7-206.t2 Rodent Bait ors * 3-80'1.11(C) Unopened Food Package Nat Re-served. 7-20fi.i 3 Pest Control and Monitoring` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods-that are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs arm"""29013-4(11.11A(1)(2) Eggs- 155'F 15 Sec Pathogens ' Eggs-Immediate Service 14501715sec` 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Earns* 3401_11(A)(2) Comminuted Fish.Meats&Game Animals- 155'F 15 sec. ' SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Perkand;BeefRoast-130'F 121 turn* 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 5%009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile Pool, temporary and 3-401.11(A)(3) Poultry,Will Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate,sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°lr* 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. 3401-11(A)(1)(b) All Other PHFs--145'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES. 3403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do nor relate to the Time* ,foodborne illness interventions and risk factors listed above, can be 34011 I(C) Commercially Processed I2TE Food- ,found in the following sections of the Food Code and 105 CMR 14001,"* 590.000. 3-403-11(E) Remaining Unsliced Portions of Beef Item Good Retail PracticesFC 590.000 - Roasts': 23. Management and Personnel FC-2 .003 1e, Proper Cooling of PHFs 24. Food and Food Protection_ FC-3 .004 L25. ipment and Utensils FC 4 __.005 3-501.14(A) Cowling Conked PRFs Prom 140'F to 26. Water,falumbinci and Waste '.. FC 5 .006 7WF Within 2 Homs and From 70'F 27. Ph sical FacilityFC-6 .007 to 41°F/45`"F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S coral Requirements 1 _ .009 Temperature Ingredients to 41'F/45'F 30. Other I ------- ' --.........---- Within 4 Hours ':`10r°"""`6-2"'= *Denote,critiad item in the federal 1999 Food Code or lr>CM R 590.OM s'id _ Jy 7 -. - orl INITIAL SERVICE REGULAR SERVICE � IF ��� D EXTRA SERVICEa C;BRAN4Ii,t„ ACCOUNTpr:;; IRT A "o TELEPHONE'Pf HID, SSAY; F 1T! to+P,fi000CTIpN i;tj:;!; }+'."(IME;(N }`,sn� ";jyITINJE OU'C. 4 ". j - - '� i,� Il �OI IV 1- ";stein t1F?SERVICEPRORERTYA7,' E,. .; - w. ,y „et: ,I! t ,.ek u' RANCH'' . ” - L .,f.�3aB Nom r. w„ �r i%.�� hfi{3 {may<"..— r••"e-i L=->`1�'- b g� {,Ci?) i..,apUY„ s f Sc) hZvli( 1V, F't OPERATOR NAME&CERTIFICATIO NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER Pes[s ❑ Onenral^ xrwcnes 1 FeAma C3 saesF�an `R ❑ nlhe l.. I t a i ncan Cockroache 7 q ertin AU � A Mcg ❑ SW Targsf _�Qet a OwkpappgrJ❑-cave a tamg-},£' � Rats:L}.sj ❑ emaatoral mvadam (g7a}grjgfS Hosea cosec rg 2Cs j ') aProtlua pests a50 lnsitlers .620 WINO-UP TRAPS F'! .-t8m nsect Monitors❑ 610 TIN CATS OtM1er Guckrpacbes! U Other Ants O Flies3 O.Othdr "410VI1Bromone Tra F Y` 645 Rat Bait Stations 1 t 600 Qlue Tra 640 Mouse Bait Snoions PBSt(',rOO{I'O( MaterlalS Used ;EPA Reg A,, T/C E/C Amouni 630 Sna ha a 655 Liquid Bait Stations z93 Advanta Granular A,4�Baic(AbemecHn Bi)0.011% k•;:. (� 49sa7a'- Areas Inspected and/or Treated 295 Advenoe Dual Choice Ant Balt(Sulfluramidf 0.6% + {� 49g-459 Peso Con•trot matenale—used —fno;ostad,or comes from Pst a,sees 315 Ascend Fire Apt. ail{Abamectin Bi)0.017% 499370ts Eoad Areas h"/\ 14(r7L 309 Avert Rpach Bait Stations Nbamec:tin)0-05% _ 499467 Owed,Areas 385 Advance 33�B Ant Gel Bait(Borax)5 4% 499-492 Brnd OL�.onices 15 Send (Odho etc Aenr 99% 9444_-129 Ty public Areas iuyf S(Lambda-cyhalothrin) ❑0.015% ❑0.03% ❑0.06% 100-1066 210 Darrel G(0e4emetthil 0,05% 432-836 "`�J. ResVl.xker Rooms 158 Tri Bulk Dust(Silica Gell 40%(Pyrethrins)1.0% 499-429 0Dianay Amos 41 Gentrol BC.(Hydroprene)0.08% '?X. 2724-351 U Laundryleollar Room 540 'Generatlpn Ml Blocks Balt(Dllethialone)0.0025% 7173-2189lorageNtdfq p. -h_._(,� 43' Kicker EC{Pyrethrins) G0.05% ❑0.1% ❑9.P% 432-1145 UWarehouse Area z,,SSO.brguiToxll,Bait(Drsodium Itof phacinune), '_6:106% 124556' -- - .,. ppro..es3'np Arens _ 1352 M;N.Mk FCROacb Bell 8stions(Ppronil)0.05% 6424811/4321257 _ ❑Pattern Boone 351 upsilons FC Ant Bait StaP:ons(F(pmrdij 0.01% 642-0a-i0t432:256 7Guesi Rooms a" 357 MaxlorcD FC Ant Gel Bait IFlproni1)0.001% 64248 1/432-1264 ❑Baspmenr 354 Mu£mce FC Roach Bait Gel(Rphera)Url% 64248 14/432 1259 355 Maxforco FG Insect Bait(Hydrametirin 10% '^ 64246-19/4321262 7600r - 360 Nlban 8a,Wbaa FG Balt{nIIhobml acrd)5% 64405-2' O Erman,Perimeter 46 Nylar EC(Pyriprox)fen) Ji 00.02% 11715307$7079 0 Landscapaa Amos 1 49 Orthene Ted,Tree.&Shrub WP(Acephato)75% 59639-26-ZA 0 Loaam9 oockr[Wa ter _.... We pre-Empt Roach Gel Bait(Imidadoprid)2.15% 3125-5251432-1365 151 PT Cy-Kick Moose)(Cyfluthrin)0,1% 499-470 70 PT Cy-Kck CS(CyOunat 0.025% 0,05%0.1% 41 Precautions Keep out of reach of children and pats. 312 PT Avert Gel Bait(Abamectin Bt)0.05% - 499-410 May cause eye.nose,throat or skin irritation. 69 PT 565 Plus Xl-O Aerosol(Pyrethnnsj 0.5% 499-290 Arodbdealsrng sopors mists,or dusts,n.ml,n it swalmwed. 159 PTTr0o Aerosol(Silica Aftei 4,8%(Pyrethrins)0.5% 499-385 Dampen granuiesto adnate. 121 Suspend SC(Deltamethrin} 00.01% 00,03% Douai 432463 So not temper with maontlaae placements Dp net ret brown uMdaew-vantuattmt 81 Tempo Ultra WP(CNluthrin) 00.025% 00.05% 00.1% 3125-482/4321357 Do nor touch treated areas until dry 63 Tempo S_CUltra(Cyfluthfin)00025% 00,05% 70.1% 3125-498/432-1363 For flea treatments'remain at treated area fora annimumof four hours dr!hmil dry, 91 ULD BP 100 ULV(Pyrethins)1.0% 499452/71910.9 Leatmem Cotle fllq: C' , rack&Cresfca v.Void G=t3eneral 92 ULD BP 300 ULV(Pyrethdrs)30%, i- 4994501115401 9=Spm aT:.-Bat DC FDirected Contra B=3'Board SIP,Space 591 Wea'-,herbFok XT Haft(Bmdtaca,mj If all 100-1055 tN=fmcast. ' —... I --- Equipment Code luck CS-comp Air Sprayer T=Trop 85=Bait station HD-Y". VDcow A.Arai BD=Net Gun FIT=Power Tarnishes Fa DLv Posting Service Slicker? 0 Yes 0 N Supervisor's Comments: r 1 u I i Nt OMER'S l r E'„9 /J ^,r' / �",1/ � AMOUNT PAID 1 E UNRESOLVED PROBLEMS? cnEcfc CALL 1.800-TERMINIX(1-800-837.6484) CUSTOMER INFORMATION TERMIN/Jit' Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent any conditions present that may be contributing to a current,or possibly a future,pest infestation. interior Areas Pests conditions Food Areas Pests Conditions ❑ Offices — '-Q Dining Area U'Lobby/Public Areas -,Q Stove/Oven Line Q Entryways _..� _ - -'Q Food Storeroom _ r O Rest/Looker Rooms 'Q Dishwashing Area ❑ Janitor Closets ❑ Deli/Bakery U Laundry ❑ Processing Area _._.._ D Boller/Furnace Room Q Packaging Area _ ❑'Storage Utility U Produce Area ❑ Warehouse — ❑ Meat/Seafood Shop ❑ Basement —._ _—._ Exterior Areas ❑ Patient Rooms - ❑ Exterior Walis-North ,— U ICU U Exterior Walls-South — U Linen Storage Rooms ❑ Exterior Walls-East ❑ Kitchenettes -- ❑ Exterior Wails-West _ ❑ Nurses Stations ❑ Loading Dock — ❑ Guest Rooms -- - U Dumpster _ U Sanquet/MeatingRooms - -- Q.ExtoriorStorage=Rcgms —, w U Display Aisles it U Roof — ❑ Other -- U Other _— -- U Other - U Other _ t. German Cockroaches 8_Pharaoh Ants 11. Occasional Invaders 16. Rats 2. American Cockroaches 7.Pavement Ants 12. Hunting Spiders 17. Mice 3. Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests 4. Outdoor Cockroaches 9,Argentine Ants 14, Brown Recluse Spiders 19. Other. 5. Silverfish ?0.-_ Ants. 15. Black Widow Spiders 20. Other I A. Drain Clogged/Dirty I. Paper/Litter O. Poor Storage Practices Y. Move Dumpster Away From Bldg. j B. Food Debris Under Table J. Water leak R. Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned 1 C. Food Debris On Shelf K. Mops Improperly Stored S. Seal Exterior Cracks/Holes AA. Mercury Vapor Lights Outside D. Food Debris Under Appliance L. Trash Containers Need Cleaning T, Trim Bark Tree/Shrub Branches BB, Keep Doors Closed E. Wet Organic Matter in Cracks M.Heavy DusVDirt Deposits U. Remove Piles of Debris CC.Repair Door/Screen E Grease Deposits on Floor N. Numerous Cobwebs Present V. Cut Tali Grass/Weeds DD.Replace DoorWeatherstripping ! G.Grease Deposits or EquipmentO. Repair Fioor/Tilestwall/Ceiling W.Improve Outside Drainage EE. Poor Outdoor Storage Practices 1 H.Soiled Dishes Left Over Night P. Seal Holes/Cracks in Walls X. Install Gravel Foundation Barrier FE Other i j Comments i I 41 leis eats A 4 Ys « a sz c fi ZA America's favorite thick crust pizza—crispy on 'p the outside,soft and cheery on the inside. thin'7 crris�y Just enough crispy crust to get a mouthful of toppings in every bite. .* With a ring of delicious y cheese baked into the crust,it's the pins you just have to eat backwards. (Available in large only.) Y A pizzeria-style crust,this is crust { 11.�nd; and toppings coming together In �(� balanced perfection. j : f r e. ("'dere omllaale) it Y We start with a huge 16" bubbly,traditional crust and make it extra saucy Then we cut it Into 8 slices so big vt you've got to fold 'em to eat'em.*K '*Boxed on mmAarison o{ure to a Rx.No rev pma. (where p,skrise) i Cheese or one Topping $9.99 Additional Toppings $1.50ea I OnNnWmcro94riP lmxWnq oqa caiwn po,udq,. .; o�rymPggtwanew�nmq aatwuan ce•orud. � 899 si $Q99 o 1 08 Medium Pizza I Large Pizza AnyWayYouWantlt al [-Topping pp W a T,AW to..,,une•o�sw ). e e k4^SUP�„<41 mxe Z I id EYPIreS Y2(dt/pIExpires IWIM `y CA INNIJU1111111811IN1111111111 J3T gl ce esT fq udph«6boM)M6Wg4NgpTgz 0.Ymrybm W WWgv AaY wY. I No vglM WIM1 ONqMars.ptVNery e@Nse�dcliH,gBsseywryi PERSONAL PAN PIZZAe s ( All the tempting flavor of our Pan Pizza packed into an individual serving.Perfect for lunch.Now available all day every day. Up to 3 toppings: $2.99 Lover's Linee: $3.49 Supreme: $3.49 IJ I li 4 4 4 Great for any occasion. Get one today! KwiTME JOIN THE VIP PROGRAM II join the VIP program for lust$14.99 and get a free large pizza with {, your first order,Earn more free pica each month for every 2 orders placed.Eat pizza,Earn pizza.lea that easyl Product availability,prices and delivery minimum mry vary.Deliveryv ere available:delivery chargee may apply.The M.H.risme,bgos and relaud marks are nademarks r,4 P.Hut pec ®2003 F.Hut I..PEPSI,PEPSI.COIA DIET PEP WRE)CHERRY PEPSI,MOUNTAIN DEN, MOUNTAIN DEN CODE RED.SUCE,AQUAPINA,SIERRA MIST and die Pepsi Globe design are m,mrsd trademarl¢a Pep7Ini,UPTON a dl BIRSK am re�sremd trademarks of- Upcon.MUGre�srared trademark of New Canary Ramage Comparry. J : pick your favorite ,I SPECIALTY PIZZAS ' Medium $12.29 Large $14.29 ISUPREME Our signature blend of pepperoni,beef and pork toppings, green peppers,red onions and mushrooms. I CHICKEN SUPREME Tender chunks of grilled chicken breast with green peppers, {{ red onions and mushrooms. j SUPER SUPREME I A nine-toppings feast of pepperoni,ham,Italian sausage, t I� beef and pork toppings,green peppers,red onions,fresh i mushrooms and black olives. ($1.00 more) �II PEPPERONI LOVER-So Loaded with more cheese and more pepperoni. 1i MEAT LOVER'S® i� A combination of pepperoni,Italian sausage,ham,bacon,beef j and pork toppings. p' VEGGIE LOVER'Se 'I Fresh mushrooms,red onions,green peppers,tomatoes and black olives. CHEESE LOVER's PLUS® A massive,melted layer of 100%real cheese topped with any 2 of your favorite toppings. P'ZONE* PIZZA Savory toppings and cheese sealed inside a 12"folded pica crust.Choose from P'ZONE°Meat Lover's,VZONE'e Pepperoni Lover's,or P'ZONEe Classic. $5,99 II Cmst typ xp fty pivas,n0 toppings may wry by kco0on. LARGE Any way You want n! .'2 MEDIUMS nay w.y Po %d nwei 099 I Only qi paglclpaihipltteb¢.Ga mupm�wtle,. .�-�Onlygl pallgpolltlg laa0.nw UremupT poertle,. S. $1499 p,3 1 Large Pizza 1 2 Medium Pizzas1 I Any Way You Want It 1 a,1111,Any Way You Want Them l I vq,a)IDvpl'Nry ame;erc'w 9epmnu "p,qi foy96..PYry amv4 110 Expire.1231/0! Expires lWIM4 1 1 Cc EWI�IIItHHfilA1�1�111111lIHI J3T I CQ IIIBiiiiiilifiNlii11111111Wi11 AT P 11M VM{'MhgMtlIM.WOzde4MRpz 03.sYivaSmd AVQr.mryvry 1Np WJrvFnolMtllm9.WJmtletlgaAi WNpyaeaaMvltlgvireyvry 1 maikre �it� almeal "` BREADSTICKS Crispy on the outside,soft and chewy on the inside. Regular or with cheese. Served with tangy Italian •�' tomato sauce. y Single order of 5 sticks/with cheese $2.49/$3.49 1` " Family order of 10 sticks/with cheese ' $4.79/$6.79 s BUFFALO WINGS Start with a kick,hot or mild! Served with blue cheese or ranch dipping sauce. li Order of 12 wings $5.99 Family order of 24 wings $10.99 CINNAMON STICKS A freshly-baked treat Ioade6 with cinnamon and sugar. Served with creamy icing for dipping. j Single order $2.99 Family order $5.99 C ® Sim Ev IS Im Selemi s may vary by Won,Subsdwbom mop ocm Minimum o,*,of$8 required fm delivery. orseatte you rr N PICK THE SIZE Medium Large Cheese or one Topping $9.29 $11.29 Additional Toppings $1.25ea $ I.50ea f, GET A SECOND PIZZA FOR LESS* Medium Large Cheese or one Topping $6 $8 Create your own or Specialty $6 $8 ' TOPPINGS l Pepperoni Pork Topping Fresh Mushrooms Beef Topping Ham Green Peppers Chicken Black Olives Pineapple Bacon Red Onions Jalapenos 1� Italian Sausage Tomatoes Extra Cheese *Second prsza at be onequal or lesser tel Available far carryout or delivery(where awibbkf onh.Sxo,M Dissa pdang not avaibbk on The&g New hinder Prrzo._. � With fewer fat grams per slice than our regular recipes, Fitz\ ask about our Fit'N Delicious"pizzas.Choose from 6 j Eldici s great recipes or create your own from select toppings. My variauons to the standaA toppings and/or toDDing combustors for Fit W Delirious`"pica recipes will change the nutrient content e amrlyfe�eyding;f Benz y 6 i�5. , . y i s ,,tin 1��. �r>en,wu�, `yv GET 2 MEDIUM PIZZAS ' ANY WAY YOU WANT THEM 10 BREADSTICKS A PEPSI® 2-LITER ppII FOR ONLY 6„ i $ 19. 99 Up to 3-Toppings, any Lover's Line® or Supreme. Super Supreme $1 more. Only at Participating locations. Not valid with any other offer. No double toppings. Pe Psi°substitutions may occur. ' Pepsi•is a trademark of PepsiCo,ill©2003 Pizza Hut, Inc. 21 AMI LYp ZZA DEAL - 2 RGE3 am wey rm wtm mo. urN at aanclpn,lno locailmeone coal aa•a'a¢ Y only at ciat oai glxxr.a»arn e,o _ 0' 991" $1899 s pP 10 0 Large Pizza I-Topping ®1 fi532 + h1 1 Large Pizzas Medium Pizza o1 Any WayYou Want Them E Any Way You Want It Upa,3,lppi,S n LL r,ra•n,wm„,e, s 3ra°�wrve�si� ^ " ' Purer 12/3VW m Expires 1=110i CE IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII J3T gl CF IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII J3T R NOIraII4mthgholoxoM. l iye,eesend,ha,goa,myv,,t InaIrYi"..,yet,t rlentpla,0 .tranvdaagein', 58'-5" 70 8 T77A EXISTING SPLIT FACE NEW SPLff FACE BLOCK 70 U91 !� BLOCK TO REMAIN TO MATCH EXISTING ` R! -: T78A � 0 6 O 18 � I I � 722C 7258 112C 112C 112Htil I 162E U90 / T48A ~ 876 I VISI U97 'd 30 F N N 4 QI 7 � 1 / 1 -j 0 4 �— - - }� � U23 I � - - - - I - - - - r 112G (x4) 523 I CHECKED. 30 2 I CDISHN T61A T29D I 109A 116A BELOW 30Y L \ _ 0 ! 10 -- _ / J 878 L — BELOW BELOW 878 L —) 421 r 7 40A 61A 3 312 —1 — r — X001 I•, 30Z 871 SPLASH ®2 3 3 (x2) 97 II I I II — I BEVERAGE IL�_ _ _ VENDOR (x2 GUARD — — — J (x2) r i l 141 16 = u 37"x34" TOOL SPLASHI HOLDER GUARD4 I I ®3 3 x3 (3) 878 5 2 B �' (x2) 7 17 8 - - _ J 281A ( ) 7 298 / I 3 26A 541A 19 108A 7 541A --_� c --� 3 I I (xi) 3 3 36 36 — 2fi —_— x2) \ ooI 1 >n MopCOMPUTER FREEZER BUCKET x2) T85C JU 2 T27A 114G I FLOOR AREA FOR PATCH PANEL rT 5 ClL — -J BEVERAGE CASESI 5 x8 x SPEED RACK 1 G 8'-6"HGT. 1 75 r 183 370 I 311 I I 481 466 12'-0" I . 118E _ 485 MIN. NEW SPLIT FACE BLOCK 118G I „ D B D C 3 J 70 55 TO MATCH EXISTING Q EXISTING OVERHEAD T85D I I', MM 570 V DOOR N 183 _ T07A 0 2) x2) ATELLITE vt a COOLER "' I I; I Ilii I'I T07C (x2 545 26 9'x15'x I " I 545 545C r 7 6 LOCATION EQUIP 117G <= 8'-6"HGT. 1118 112C I I T29E 112D L ---------- I 522A 9 5 N 371A -I 3 N 78 N 1176 2 6 2§ 2 6 2 8 545 2628 545 8 /2428 I I ( 371 315 \ N 117 0 I 108A 83 L 7 co I 117H 117G m o Tom- o ��� I I 170A T29E ;- 1 12G [:; 112E X002 I 7 N 6 S L�I [ Z 0 0 814C 370C O Z LJ EXISTING BLOCK Ql DEMISING WALL EXISTING SPLIT FACE BLOCK TO REMAIN Z w N � ZQ Z w � � w U � o � C= c � Q Do KITCHEN EQUIPMENT PLAN 1/4"=1'-O" REVISIONS OF OATE DESCRIPTION KEY NOTES LEGEND pI2/18/041 ININGSTREET �j REFER 108/109/A6.2 FOR TOILET ACCESSORIES ELEVATIONS. O NEW EQUIPMENT REFER SHEET A6.2 FOR TOILET ACCESSORIES. O RELOCATED EQUIPMENT S INDICATES "S HOOK" CONNECTIONS AT CORNER EXISTING EQUIPMENT SHELVING UNITS O Q DELCO DATA 12-4856 CONTRACT DATE GROSS AREA 1781 SQ.FT. 1 2. 1 8 .0 3 NET AREA 1670 SQ.FT. BUILDING TYPE DELCO SEATS NONE P-OODA-JUL03-C OVEN MM 570 DOUBLE DECK PROTOTYPE ISSUE DATE STORAGE MATRIX 07 . 31 . 03 STORE NUMBER TOTAL SALES $14,691 + $1,350 (WINGSTREET) _ $16,041 303092 x 1.16% (GROWTH) = $18,608 DRY COOLER FREEZER SHEET NUMBER REQUIRED 39 34 9,89 PROVIDED 1 48.67 37.13 9 A l e 2 OF MATRIX 109% 91% EQUIPMENT SCHEDULE EQUIPMENT SCHEDULE (CON 'T) FURN INST UTILITY REQUIREMENTS FURN INST UTILITY REQUIREMENTS Of of (if Of U I- I- O F 0O Fes- W O H O H D_ ii z W ZO W Zo W W Q Z Z Z Z Of Z W OU W L) Of W 3 J Z H Q J N J 1n J H Q U J a aof W a ¢ a 3 w li W W W W o _z o z a W W W W o W z o z E'f � Z Z Z Z N J F- Al! W N O Z Z Z Z 1- J H Q U A.E. # QTY• o o ITEM DESCRIPTION o ; a o REMARKS A.E. # Qn 0 W o W o o J `' `� o o REMARKS it o cD o cD ITEM DESCRIPTION x v " o w u) ox a o t! l 10 2 D X COAT HOOK MOUNT INSIDE RESTROOM DOOR © 5'-0" AFF 814C 2 X X I STAINLESS STEEL HAND SINK W FOOT PEDAL X X X AD 16 1 D X BULLETIN BOARD 822 1 X WATER HEATER X X X sl 17 1 D X DISPLAY CABINET MOUNT WITH HINGES AT TOP 823 1 X GREASE TRAP RE: MECH 18 1 F X LOCAL AREA MAP 833 23 D X 72" SS CORNER GUARDS C 19 1 D X CAR TOPPER BRACKET 8718 2 D X ELEC. SWITCH GEAR X i 55 1 P X FAX MACHINE X X 873 1 T T* X* TELEPHONE TERMINAL BOARD X X *SEE NOTE 6 70 1 D X PIZZA HUT LOGO DOOR PULL DARK BRONZE SEE NOTE 2 875 1 T T* X* DASH PHONE SYSTEM PANEL X X *SEE NOTE 6 Ij 73 1 D S X SAFE X SEE NOTE 3 876 5 T T* X* WALL TELEPHONE X *SEE NOTE 6 75 1 X X FIRE EXTINGUISHER MINIMUM RATING 4A 6OBC 877 3 T T* X* DESK TELEPHONE X *SEE NOTE 6 78 1 D X FIRST AID KIT 878 4 T T* X* CREDIT CARD READER & RECEIPT PRINTER X X *SEE NOTE 6 83 1 D X TRAINING TV VCR UNIT X T05 2 D X QUALITY RING RACK 108A 2 D X 24x14x33 2-SHELF WALL MOUNTED UNIT MOUNT BOTTOM SHELF ® 66" A.F.F. T07 1 D X CUT TABLE 109A 1 D X 18x24x33 UNDER COUNTER SHELF T07A 1 D X 24X30 PAN CART 111 60 D X S' HOOKS T07C 1 D IX I 3OX48 PAN CART I'. T 1118 1 D X 30x18x74 6-SHELF UNIT SEE NOTE 9 T12G 1 D X HOT HOLDING CABINET FLH BRH WITH AUTO FILL 'j 112C 3 D X 24x36x74 5-SHELF UNIT SEE NOTE 8 T14 1 D X CAN OPENER ORDERED BY FIELD OPS W SMALLWARES 112D 1 D X 24x42x74 5-SHELF UNIT SEE NOTE 8 T27A D X QUALITY STATION 112F 1 D X 24x54x74 5-SHELF UNIT SEE NOTE 8 T29D 1 D X 3' BREADSTICK STATION 112G 2 D X 24x6Ox74 5-SHELF UNIT SEE NOTE 8 T29E 1 D X WINGSTREET 60" SAUCING STATION 112H 1 D X 24x72x74 5-SHELF UNIT SEE NOTE 8 T29F 1 D X WINGSTREET 24"x30" PREP STATION 114G 1 D X 30x6Ox74 5-SHELF UNIT SPEED RACK SEE NOTE 8 T30 p X 3X3 WALL GRID SYSTEM 116A 1 D X 18x48x33 UNDER COUNTER SHELF T48A 1 p X 4'X6' LOGO FLOOR MAT 117B 2 D X 30x3Ox74 6-SHELF UNIT SEE NOTE 9 T50 1 D X SHORTENING SHUTTLE �. 117G 2 D X 3Ox6Ox74 6-SHELF UNIT SEE NOTE 9 T61A 2 D X ORDER ENTRY MODULE 5' ge 117H 2 D X 3Ox72x74 6-SHELF UNIT SEE NOTE 9 T62 1 D X DRIVERS STATION 18"x60" 118E 1 D X 24x48x74 5-SHELF UNIT SEE NOTE 8 T65 118G 1 D X 24x6Ox74 5-SHELF UNIT SEE NOTE 8 T66 1 D MANAGER'S DESK 141 1 D X DELIVERY POUCH CART D 2 DRAWER FILE CABINET T73 1 D X MEN'S SIGN r5 162E 1 B X 40" UPRIGHT BEVERAGE COOLER X T74 r1l D X WOMEN'S SIGN x� 170A 1 D X SINGLE DOOR FREEZER - RT HINGE X T75 D X HAND WASH SIGN Q 183E 1 D X 9' x 14' x 8'-6" WALK-IN COOLER X X T77A D X SIGN - HOURS a� a 183F 1 D X 5' x 8' x 8'-6" WALK-IN FREEZER X X T78A D X WELCOME TO PIZZA HUT WINGSTREET SIGN X 233 1 D X 2-C PROOFER T79 D X DELIVERY DRIVERS ONLY SIGN 236A 4 D X DOUGH CART T80 D X NO DELIVERIES AFTER 11:00 AM SIGN _€ 242B 1 D X LEFT-HINGED 1-C RETARDER w SHELVING X T85CI p X PREP STATION - 30" X 48" WITH CASTORS 2628 1 D X "E" PIZZA MAKETABLE X X T85D 1 p X PREP STATION - 30" X 60" WITH CASTORS 281A 1 D N X ALL SIZE OIL DISPENSER WITH COMPRESSOR X SEE NOTE 10 T86 2 DX LID CART 311V 1 D M* X* 2 DECK 570 PIZZA OVEN W START-UP X X X SEE NOTE 7 T90 1 S S SECURITY ALARM SYSTEM PANEL 312A 1 D X BREADSTICK TOASTER 315 1 D X DUAL FRYER X X X 00 U23 1 D X PIZZA HUT VISION PANEL DOOR BY G.C. Lo U26A ao X MENU BOARD PACKAGE � 370 1 D X STAINLESS STEEL PANELS 10 U256 1 D X WINGSTREET MENUBOARD 45"Wx23"HCONTRACTOR SHALL VERIFY QUANTITY I 370C 1 D X 7'W x 8'H STAINLESS STEEL PANEL U29B 1 D X WALLCOVERING MENUBOARD WALL W 371A 1 D X OVEN HOOD-BLACK IRON 10'-0" x 6'-3" X U30W 1 D X COUNTER LOGO PANELS 1 PAIR-PH ON LEFT CONTRACTOR SHALL VERIFY QUANTITY J 371H 1 D X 4' FRYER HOOD X X IU30Y 4 D X IRON MAN ORBIT MOLDING 1 1/2"x8') z 421A 1 D X SAUCE WARMER & PUMP X U30Z 1 D X WINGSTREET MURAL 7 x14 X W 466 3 D IX CHARGER FOR DELIVERY POUCH HEATING ELEMENT X U70 1 D X 5' WOOD PROVENCE BENCH = N 481 35 D DELIVERY POUCH U90 1 D X WINGSTREET INTERIOR BLADE SIGN U 485 35 D DELIVERY POUCH HEATING ELEMENT U9' 4 D X UGHTBOX- DOUBLE SIDED ILLUMINATED VEGGIE GRAPHICS X N 522 2 D X 30" TICKET STRIP U97E 1 D X CUTTER ART CANVAS 28 Wx42 H 522A 1 D X 36" TICKET STRIP U97F 1 D X PIN ART CANVAS 28 Wx42 H Z 523 1 D X BAG HOLDER U99 1 DW X MANAGER'S CHAIR 541A 3 P P* X CASHOUT STATION W1 DRAWER BRACKET X x y *SEE NOTE 5 LEXAN 1 X X 24 X 72 LEXAN ® MAKETABLE :_5: 542 4 P P* X* ORDER STATION X X *SEE NOTE 5 In 545 2 P P* X* KITCHEN MONITOR X X X *SEE NOTE 5 545A 2 P P* X* KITCHEN MONITOR E 545C 1 P P* X* KITCHEN PRINTER W WALL BRACKET X X *SEE NOTE 5 UNKNOWN EQUIPMENT NUMBERS L Z Q 570 1 P P* X* CPU CABINET W MONITOR & REPORT PRINTER X *SEE NOTE 5 X001 1 D X BEVERAGE VENDOR X BASED UPON DIXIE-NARCO MODEL DN 501E 72"Hx37"Wx34"D Z 00 722C 1 D X DISHWASHER; CORNER; TALL; W BOOSTER HEATER X X X N Q X X002 1 D X 24x42x33 3-SHELF UNIT d; W W ckf g 1 7258 1 D X 2.5' CLEAN RIGHT HAND DISH TABLE D.W. ON LEFT) °� WITH VEN FAN NTROL 0 726A 1 D X DISHWASHTHOODCOuj o CORNER X X Li o 740A 1 D X 3—C L.H. SINK DIRTY TABLE W SPRAY & FAUCET X X X v= Y a op N 06 751 1 D X GARBAGE DISPOSAL X X 0 782 1 X X MOP BASIN X X X o RENSIONS NO. DATE DESCRIPTION o Q1 2/18 WINGSTREET SCOPE OF WORK - OWNER PROVIDED EQUIP. REFERENCE INSTALLATION o NOTES: Q 1 EQUIPMENT AS SCHEDULE ON THIS SHEEP A1.2 & A1.3 RE: SCHEDULE THIS SHEET 1. VENDORS SUPPLYING AND/OR INSTALLING EQUIPMENT ON BEHALF OF THE OWNER INCLUDE: a 2 BUILDING LIGHTING FIXTURES E4.1 BY G.C. B: OPERATIONS' SELECTED LOCAL SOFT DRINK BOTTLER 0 3 EXTERIOR BUILDING SIGNAGE A4.1 BY SIGNAGE VENDOR, ELECTRICAL BY G.C. C: OPERATIONS' SELECTED LOCAL BULK CO(2) DISTRIBUTORD: YUM! BRANDS AUTHORIZED DISTRIBUTOR (UFPC, PRIMESOURCE OR WASSERSTROM) Q w 4 TOILET ACCESSORIES A6.2 F: LOCAL FIELD OPERATIONS E G OPERATIONS' SELECTEC LOCAL GAME MACHINE VENDOR Q M: OVEN MANUFACTURER'S AUTHORIZED REGIONAL SERVICE REPRESENTATIVE N: OIL DISPENSER MANUFACTURER 3 P: INFORMATION TECHNOLDGY DEPARTMENT'S POS VENDORS CONTRACT DATE d NOTE: ITEMS 722D,(INCLUDING BOOSTER HEATER), S: LOSS PREVENTION DEPARTMENT'S SELECTED LOCAL SECURITY COMPANY 0 183E, AND 183F, ARE 277 VOLT. SEE ELECTRICAL E1.1. T: VOICE SERVICES DEPARTMENT'S TELEPHONE EQUIPMENT VENDORS 1 2. 1 8.0 Z a G.C. SHALL COORDINATE WITH OWNER TO FACILITATE TIMELY DELIVERY AND INSTALLATION BY EACH VENDOR. J BUILDING TYPE N 2. CHOOSE APPROPRIATE DOOR PULL BASED ON EXISTING STOREFRONT. DELETE IF NOT USED. D E L C O i 3. G.C. SHALL PROVIDE POWER FOR AND SET IN PLACE THE SAFE (#73). VENDOR WILL SECURE SAFE TO FLOOR AND MAKE ALL FINAL SETTINGS. P-OODA-JUL03-C 4. NOT USED PROTOTYPE ISSUE DATE i 5. G.C. SHALL PROVIDE ELECTRICAL POWER AND CONDUITS AND J-BOXES FOR CABLES FOR POS DEVICES. G.C. SHALL RECEIVE AND SET IN PLACE THE CPU FLOOR CABINET (PART OF ITEM #570). VENDOR WILL PULLALL CABLES, CPU CABINET (#�70). OPERMANENTPLATES ELECOTRICAe LE POWERCTISOREQUIREDBOXES AOD PERDORMINSTATHELSTART-L AND UPART-UP AALL POS DEVICES INCLUDING CASHOUT STATIONS (541 A), KITCHEN PRINTERS (#545C) AND THE 07 , 3 10 3 STORE NUMBER rn 6. G.C. SHALL PROVIDE ELECTRICAL POWER FOR TELEPHONE DEVICES AND CONDUITS AND J-BOXES FOR PHONE LINES. G.C. SHALL PROVIDE PAINTED PLYWOOD BACKBOARD FOR LOCAL TELEPHONE PANEL. � VENDOR WILL PULL ALL TELEPHONE LINES AND ORDER, INSTALL AND START-UP ALL TELEPHONE DEVICES INCLUDING DASH PHONE SYSTEM PANEL (#875), WALL AND DESK TELEPHONES (#876 AND 877) 303092 AND CREDIT CARD READER AND RECEIPT PRINTERS (#878). v 7. G.C. SHALL PROVIDE ELECTRICAL POWER AND GAS DISTRIBUTION FOR AND SET IN PLACE THE PIZZA OVEN (#311V). VENDOR WILL ADJUST INTERIOR ELEMENTS, MAKE FINAL SETTINGS AND START UP THE PIZZA OVEN. SHEET NUMBER w 8. FOR 5-SHELF UNITS PLACE TOP SHELF AT TOP OF POSTS, PLACE BOTTOM SHELF WITH 6 INCHES CLEARANCE BELOW SHELF, AND PLACE INTERMEDIATE SHELVES TO PROVIDE EQUAL SPACES. 9. FOR 30 INCH WIDE SHELVING IN COOLER, PROVIDE 6 SHELF UNITS. 10. G.0 SHALL PROVIDE POWER FOR OIL DISPENSER (#281A) VENDOR WILL CONNECT ELECTRICAL AND TEST THE OIL DISPENSER. Al e3