The URL can be used to link to this page

RED LULU SALEM - ESTABLISHMENTS L�fnv sTrT S x r ' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax (978) 745-0343 Name Qate T f O eration s TvDe ainspection Food Serviceoutine Address isk El Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone El Mobile Date: Owner HACCP YIN El Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) L ) Time ❑ Bed&Breakfast ❑General Complaint Inspector Ina�LzqqElHACCP Out: ❑ Other Each violation hecked requires an exp ation on the narrative page(s)and a citation of specific provisfon(s)violated. Non-compliance with: Violations Related to Foodborne Illness nterventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590. (F) ❑ action as determined by the Board of Health. �._ PROTECTION MANAGEMENT _ _ ❑ 12. Prevention of Contamination from Hands 1 PIC Assigned/Knowledgeable/Duties A 13. Handwash Facilities EMPLOYEE HEALTH ::., in $ ,r - F ' ) ROTECTION FROM.CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE I El 15.Toxic Chemicals -- TIMEITEMPERATURE CONTROLS ❑ 4. Food and Water from Approved Source (Potentleny Hazardous Fooda),` ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16.Cooling 9RO7ECTION FROM CONTAMINATION _ ,, ❑ 19. Hot and Cold Holding ❑ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control Q9. Food Contact Surfaces Cleaning and Sanitizing (_REQUIREMENTS FOR HIGHLY SUSCEPTIBLE.POPULATIONS_(HSP) [121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing _ ❑ 11.Good Hygienic Practices QONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C --F47- by a Board of Health member or its agent constitutes an �` 23. Management and Personnel (FC-2)(590.003)90. 4) order of the Board of Health. Failure to correct violations DI 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 '!11/DbA,TE OF RE-INSPECTION: S.sem„ . L Inspector's Signature: Print: PIC's Signature: Print: PageA 0fages v �. .-... � "i�-i..-.il..� ^.....rt^ •`_`�: __... ,.. ,.-.� �/"-rv.c �. �w-++..�.-.Y yre'�.�r ! ^.✓-ter^.r.-, ��..,.-r:....�M. . . . i �,.'. Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination _ FOOD PROTECTION MANAGEMENT 3-302.11(A)(]) Raw Animal Foods Separated from 1 590 003(A) Asci tment of Responsibility* C Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* -� Contamination from Raw Ingredients 2-1031.11 Person in charge-duties 3302A I(A)(2) Raw Animal Foods Separated from Each Other" EMPLOYEE HEALTH Contamination from the Environment 2 590;003(0) 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 590DW(F) Responsibility Of A Fail Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer , Chat * 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(GReEortinE ty Person in Charge* 3 .590.003(0) Exclusions and Restrictions* Disposition of Adulterated or Contaminated Food 590.003(F.) Removal of Exclusions and Restr ctions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F 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 Container* - Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Not Water . 3-202.13 Shelf Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.11.4 Chemical Sanitization-temp.,pH; concentration and hardness.* 5-lUt.11 Dr 3-202.16 DriMade From Potable Drinking System* 4-1i0 L I I(A) Equipment Food Contact Surfaces and Drinking Water from an Approved System* Utensils Clean" 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency'of Equipment Food:. 590.O06(B) Water Meets s Standards in 310 CMR 22.0* ShelNish and Fish From an Approved Source Contact Surfaces and Utensils*. ..., 4-702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foal Contact Surfaces of E uimerit* Shellfish* 4-703.11 Methcxlsof.Sanitization-Hot-Water and - 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulatoAuthor 2-301.1.1 Clean Condition-Hands and:Arms* 3-202.18 Shellstock Identification Present* 2-301..12 Cleaning Prgcedure* 590.004(C) Wild Mushrooms* 2-301,14 When to Wash* 3-201.17 Game.Animals* 11 Good Hygienic Practices g Receiving/Condition 2401.11 Eatin ,Dr skin or Using Tobacco* 3-202.1 f PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Ince it * Mouth* 3-101.11 Food Safe and.Unadulterated * 3-30L 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* Employees* Tags/Records:Fish Products - 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3=402.12Recrords.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 /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. S ecialized ProcessingMethods* Devices 3-502.1.2 Reduced ox gen packaging,criteria* 6-301.11 Handwashing Cleansey.Availabilit 8-103.12 Conformance with Approved procedures* 6-301.12 Hand Drying Provision 'Denotes,critical iteot in the federal 1999 Food Code or 105 CMR 590.000. ®®Fm� �� }j11C , i . • • • • . . ' • 1,"NAMMAMMATAW—WIM4,�Mi —4 .. NOW �� r/1. ► . :.,�. �.� ' ' l�% i . ' > iAon lce ' �Zp � �t/.__! r� �►" IIWiON. !l►!_' ':�%...� del�,�:_�� r'� 1 Lr_.._•�._ � �►1�i. 01 WORM� �i7�� 1 . � !�`i \�� . —_�/�'TI_-� .i��/L��ir ..!! � � � � • //,�� °1 .e�i10 I - 3-501.14(C) PHFs Received at Temperatures Vfolstions Rotated to Foodborne illness Interventions and Risk A=m ding to Law Cooled to Factors(Items 1-22) (Cant.) 4 Vr/457 Within 4 Haus.* PROTECTION FROM CHEMICALS 3-501.15 Cocha Methods for PHFs i Food or Color AddKives 19 PHF Hot and Coid Holding 14 3-501..16(B) Cold PHFs Maintained at or below i 3,202.12 Additives*' 590.004(17) 410/45°F* 3-302.14 Protection from Una roved Additives'r 3-501.16(A) Hot PHFs Maintained at or above if 15 Poisonous or Toxic Substances - 1400P• r 7-101,11 identifying Information-Original 3-501.16(A) Roasts Heid at or above 130°F." t Containers* - Time as a Public Health Control 1 7-102.11. Cannon 2vTame.-Workin Coniadners* 2O i Control 7-201.11 Separation-Stn ' 3-501:19 Time as a Public Health { 7-202.11 .Restriction-Presence and Use* 590.004(H) VarianceRe Requirement 7202.12 Conditions of Usc* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Tonic Canam,rs-Prohibitions* POPULATIONS LISP 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for WashingProduce,Criteria* 21. 3-801.11(.} BeverUnpasteurized ues w t Pre-packaged Juices and $eremees with Warning Labels* 7-204.14 Drying Agents.Criteria* - 3-801:11(B Use of Pasteurized Eggs* { 7-205-i i Incidental Food Contact,Lubricants* 3-801.11(-D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. * 7-206.12 Rodent:Bait Stations* 3.801.11(C) Unopened Food EFIaE Na Re-served. 7-206.13 Tracking Powders,Pest Control and 'Monitorin * CONSUMER ADVISORY - TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumes Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Fa xis That are Raw,Undercooked or - Na Otherwise to Eliminate PHFs '3-40P.11A(1)(2) Eggs- 155F 15 Sec. Pathogens*Es°°.s'n xr 3 - Ems-Immediate Service 145°Fi5sce- 3-302.13, Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Animals-155°F 15 sec. * SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) Pork and Beef Roast-130°F'121 min* 590-009(A)-(D) Violations of Section 590.0}9(A)-(D)in 3-401.11(.)(2) Ratites,Injected Meats-155°F 15 see.* catering,,mobile ford,temporary-and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential:kitchen operations should he Stuffing Containing Fish,Meat, debited under the appropriate sections Poul or Ratites-165°F 15 sec, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and Tisk factors. Other 145OF* 590.009 violations relating to good retail j 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- i Microwave 165F* 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 ,t 3-403.1(.}&(D) PHFs 165F 15 sec.* ([terms 23-30) 3403.11(B) Microwave 165`F 2 Minute Standing Critical land non-critical violations,which do not relate to the Time* foodborne illness interventions and risk,{actors listed above, can be 3-403,11(C) _Commercially Processed RTE Food- found in the following sections of the Food Code and FOS CMR 140*F* 590.600. �a - Item Goad Retail Practices { .FC 590.000t, 3-403.1I(E) Remaining Unsiiced Pordtms of Beef ;! Roasts* 24. ! Management and Personnel FC-2 .00.3 - .I Proper Cooling of PHFs ' L4. i Food and Food Protection - FG--3 004 +f 1 25. Equipment and Utensils f FC-4 .q05 j 3-501.14(A) Cooling Cooked PHFs from 140°F to 26 Water.Plumbing and Waste i FC-5 'Ms 70`F Within 2 Hours and From 70°F L.Z7 Physical Facility FC-8 .0( E to 41°F/45°F Within 4 Hours.* 1.28. ' Poisonous or Toxic Materials FC-7 .1108 i J 3-501.14(B) Cooling PHFs Made From Ambient 29 S dal Requirements } .009 l Temperature ingredients to 41°FAPF 30. j Other Within 4 Hours* s.sann., ..s.za Denote critical darn in the federal 1999 FwA Carie 0'105 C-MR 390.000. s{t k 1, j r ®�!! � .ISR d...� . , - • • • i • • ' • �� R/J 'I��.i{�•��,�� RIr�� f , vI .M. �t�'�. 1.�,' .' li _ 1� ��aa . � , _�Ir/I►I� i FAT a /ti. _._i_f'd��.++ ♦l: ..� IL ?i, ~��_�•.- .� A!J �i.93+'J</_.-1ML.�i. r //JI• r e . - • i r f t 3-501.14(C) PHFs Received at Temireratures Viotafions Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F145°F Within 4 Hoo s. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHP Not and Cold Holding 3,202.12 Additives*' 3-501..16(B) Cold PHFs Maintained at or below t 590.004(F) 41 145 F* j 3-302.14 Protection from Una roved.Additives" , - 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1400F. * 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Heid at or above 130'F. " }Y -Containers* 20 Time as a Public Health Control 7-102.11. Common Name-WorkingContainers* ! 3-501:19 Time as a Public Health Ctwtrai* 7-201.11 Separation-Storage. - 590.004(R) Variance Requirement 7-202.11 .Restriction-Presence and Use* - - - 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Tonic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanitizen.Criteria-Chemicals* 7-204.12 Chemicals for 1Vashin Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beveraees with Warning Labels* 7-204.14 DDIM Agents.Criteria" 7-205.11 Incidental Food Contact,Lubricants* 3-801 .11($) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria° 3-801..11(D) Raw at,Partially Cooked Animal Food and Raw,Seed Sprouts Not Served.* 7-206.12 - Rodeat Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitoring* - CONSUMER ADVISORY T(MEl1-EMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of t 16 Animal Foods That are Raw,Undercooked or Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate Pathogens* '.vnmxr 340i.11A(1)(2) Eggs- 155°17 15 Sec. E gss-Immediate Service 145°F15sces 3-302.13, 1 Pasteurized Eggs Substitute for Raw Shell - 31401.11(A)(2) Comminuted Fish.Meats&Game E * Animals-155°F 15 sec. " 4 3.401.11(BMl)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS of Section 4 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.069(,0}-(D) Violations of Section 590.()09{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 t Poultry or Ratites-165'F t5 sec, * above if related to foodhorne illness 3401.11(C)(3) Whole-muscle,law 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#29- Microwave 165°F* Special Requirements. 3-d01:11(A)(1)(b) A(1 Other PHFs= 145°F 15 sec.* I7 Reheating for Hot Holding V/DLAT/DNS RELATED TO GOOD RETAIL PRACTICES 3403.11(,0)&(D) PHFs 165"1715 sec. * (Items 23-30) 3403.11($) Microwave 165"F 2 Minute Standing Criticahmrd non-critical violations, which do not relate to the - 1 Tune* foodborne illness interventions and risk factors listed above, can be 3-403.f 1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 705 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef i Item 1 Good Retail Practices i FC 590.00 i _ Roasts* f 23. 1 Management and Personnel 1-FC-2 .003 _ l- ?_ is Proper Cooling of PHFs 1 24. Food and Foci Protection FCS .004 125. i Equipment and Utensils I FC-4 0051 3-501.14(A) Cooling Caused PHFs from 140`F to X26. '-Water.Plumbin and Waste � '. FC-5 I .006 ! 70°F Within 2 Hours and From 70T 27. j Physical Faci' FC-6 007 to 41'F/45'F Within 4 Hours. * 128. ' Poisonous or Toxic Materials i FC-7 .008 3-501.14(6) Cooling PHFs Made From Ambient ~29. I S acial Requirements Temperature Ingredients to 41°F/45°F 30 I Other -- ? Within 4 Hours* Deno e enticat item in the federal 1499 Fa+d Cale w'105 CMR X90.000. Y i i 0 ..• • • I I 3-501.14(C) PHFs Received at Temperatures - Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors{Hems 1-22) (Cont.) 41°-145°F within 4 Hours.* PROTECTION FROM CHEMICALS3-501..15 CoolingMethods for PHFs {( 1q - Food or Color Additives 19 PHF Hot and Cold Holding 3-501.i6(B) Cold PRFs Maintained at or below 3-202.12 Additives*' 590.004(F) 41'145°F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1400- 7-101,11 Identifying Information-Original 3.501.16(A) Roasts Held at or above 130'F. Containers* 20 Time as a Public Health Control t 7-102.11. Common Name-Working Containers* 3-501.19 Time asa:Public Health Control* 7?01.11 Se oration-Stora e* - 590.004(H) Variance Requirement 7-202.11 .Restriction-Presence and Use* 7-202.12 Conditions of Llse* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Contuiners-Prohibitions* POPULATIONS HSP 7-204AI Sanitizers.Criteria-Chemicals° 3-801.11(A) Un 7-204.12 Chemicals for WashingProduce,Criteria* 21 Beverages witzedh Warnin.-Lackaged Juices and .Bevarn•es with R'arning labels* 7-204.14 Drying Agents.Criteria* - 3-801AI(B) Use of Pastetnuetl Eggs* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(®) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Raw Seed Sprouts Not Served.* I 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not&--served. i 7-206.13 Tracking Powders,Pest Control and `t Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEIfEMPERATURE CONTROLS Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate i PHFs Pathogens.*txecnw gn2a:r t 3401.IIA(1)(2) Eggs- 155`F 15 Sec. -Begs-Immediate Service 145°F15sec* 3-342.13 1 Pasteuri=d Eggs Substitute for Raw Shell E S 3-40I.11(A)(2) Comminuted Fish.Meats&Game . Animals-155°F 15 sec. 3401.11(B)(1)( ) Port:and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS l 3-401.11(Ax2) Ratites,Injected Meats-115`F 15 590.009(A)-(D) Violations of Section .590.069(A)-(D)in sec * catering,mobile food,temporary,and 3-401.1.1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections i Poultry or Ratites-I65'F 15 sec, * above if related to foodborne illness 1 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other t 1450F* 590,009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- z Microwave 165gF* Special Requirements. ! 3-40LII(A)(1)(b) All Other PHFs- 145°F 15 sec.* I 17 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRACTICES t 3-103.4l(A)&(D) PHFs 16ST 15 sec.* (Items 23-30) F 3403.11(B) Microwave--165`F 2 Minute StandingCritical and non-critical violations,which do not relate to the ETime* foodborne illness interventions and risk factors listed above, carr be 3-403A I(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. ? 3-403.11(E) Remainine Unsliced Portions of Beef t m Goad Retail Practices .FC 590_Q00 Roasts': { 22.3. 1 Management and Personnel - :C-2 .003 1g Proper Cooling of PHFs l 24. 1 Food and Food Protection ! FC-3 .004 1 25. 1 Equipment and Utensils I FC-4 .005 ! ! 3-5011.4(A) Cooling Cooked PBFs front 140`F to 6.Water.Plumbing and waste FC-5 .006 74°F Within 2 Hours and From 70°F 27. i Physical Facility i FC-6 J .007 ! S to 41`F1450F Within 4 Hours. ° X28 Pasonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requiremems _ '0009 Temperature Ingredients to 41°F1456F 30 1 Other A Within 4 Hours* °Denote&critical ism in the federal 1999 Fo d Code a'105 CMR 590.000. CITY OF SALEM, MASSACHUSETTS r 0 BOARD OF HE-AI.TI-I 120 WASHINGTON STREET,41°FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAZ (978) 745-0343 MAYOR Iramdin Qa salem.com LARRY RAMI)IN,RS(RI?I IS,CI 10,CP-PS H fi;\I:1'I I AG HNT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &A, LV,LU 50.IC M TEL#�� ADDRESS OF ESTABLISHMENT LISrIIfM.MA FAX# MAILING ADDRESS(if different) 11 I I II EMAIL- Business': `` Website: OWNER'S NAMEyoblk� -Son I Cles .Jomiybv, MU`C5[aTEL# q'1 9-5 44?33 ADDRESS Jt-{ Ilzr tiiYrnS u -sns; lP )A MAI n1935 STREET I CITY STATE ZIP c � (� ar' Mack CERTIFIED FOOD MANAGER'S NAME(S) y� f.,(,v5 leo MatcA<5lr,4,, CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) r/'_ EMERGENCY RESPONSE PERSON ZY1b.Y1 (�AkN Ca4) HOME TEL#_ DAYS OF OPERATION. <. Monda Tuesd Wednesd .Z�Wtrsda. HOURS OF OPERATION Please write in time of day. Forexample ltam-llpm i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 ---------- -- RNI---- --------- ----- = ----- ----------------------------------------------------------------------------------------14----- RESTAURANT YE NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOM -------------------------------------------------------------------------------' -------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES 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 t besubmitted to and approved by the Salem Board of Health. Purs n to MGL Chapter 62C action 49A, 1 certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax recur a paid all state taxe r uired under the law. lU Signal a Date Social Security or Federal Identification Number Upd:ted 523/11 FOODAP201 Ladm Check#&Date U /, yl✓✓ r � $ +� Commonwealth of Massachusetts e City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 10/26/2011 ESTABLISHMENT NAME: Red Lulu Salem File Number:BHF-2011-000012 94 Lafayette Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0654 Oct 26,2011 Dec 31,2012 $420.00 ESTABLISHMENT Total.Fees: $420.00 k ' PERMIT EXPIRES ecember 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans focsuch must be submitted to and approved by the Salem Board of Health. Page 1 a "Commonwealth of Massachusetts " x s' r City of Salem � r� � r � �; � ,,,�,, . '� !r � Board of Health { Kimberley Driscoll ,, Mayor ' 4 X120 Washington Street,4th Floor a ; vs -._� ` SALEM MA `01970 X? "z Food/Retail Establishment Permit'.i r DATE PRINTED: 'h 12/13/2012 . _ 'x" 'pt T:.: ..Y i" � ?.. � '%' ,_y. 5 c' �T y A �' � � -✓" .i.Y 3•� < c d c � 'm {� S {+._ s yr• y. # ]. `sem ESTABLISHMENT NAME: Red Lti1u Salem' € b � ` �,$ ss. File Number sHF-201t,000012 ` `. � � 94 Lafayette Street x _ � tom. _�-. p +�. ,�, .�'-•et n � ,,3` � % ,i � j .� c 4 `mss_._ 01970 ` a _ .:�. SALEM ' `� r � s a:p. �'' ' - � >�� .. ar 'x; ,&5` `� `� as S1' # d� ,. � ri=•-, s� A LOCATED AT x , ril Zj �. SALEM; MA 01970 a 3 Permit Type Permit No. a Permit Issued: Permit Expires �' ..e Fee-Restrictions/Notes 1L FOOD SERVICE BHP-2013-0166 _.Jan 1,2013 . 4 Dec 31,2013 $280 00 * _ a ESTABLISHMENT y M ' t e TotalFees ,$280.00 s `> Y 4 it `, sp r Ora o w.' yt m:. x ... s a, - 4 - ' - ; �. _ µ PERMIT EXPIRES December 31; 201 " ti ' •�, f _ ` Board of Health f - �,' This Permit is not transferable and must bere�ssued:upon change of ownership W.16cabon The permit mustbe posted in a prominent location in the Establishment ': In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are all plans for-'such most be submitted to and approved`by the Salem Board`ol Health p, s Page 1 x a a CITY OF SALEM, MASSACHUSETTS PublicHealth BOARD of HP:w:rl-r ".` ",".. 120 WA J HNGPON S IR8131',411'FLOOR - KIMBERLEY DRISCOLL Tr:L.(978)741-1800 FAX(978)745-0343 LARRY ItAMD1N,RS/R1;1 TS,C1-IO,CP-FS MAYOR Iramdin(g�.salem.com HI?Ajxi i AGENT Food Establishment Permit Application (Application must be//sublmitted at least 30 days before the planned opening date) le 1) Establishment Name: \e� u L Tee w 2) Establishment Address: 54 wt (I 0670 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: 17q Z 5) Applicant Name&Title: S 6) Applicant Address: In 1 W e( j V v\1 V t AlziA f4d'i&4 A4ONCY 7) Applicant Telephone No:g7f 31 5 6 24 Hour Emergency No:!� 4S U Email: Q'je widlo e46 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address c rpora no I, n indA ividual ga O LeIr D n A partnership Other legal entity r SAS 44 'Tr A UIr uw• Por 4.. I vn 01 019$3 54 4imliqid. Gr w I 6IM93 0 hvuc• erOLeC 12 Person Directly Responsible For Daily Operations Owner, Person in Charge, Supervisor,Manager,etc. A Name&Title: ylQ Address: ! 2 VV k P D� V / P � 1 Telephone No: 6 7 755 Fax: Email: LF1 11VI1 ,(® Emergency Telephone No: S 4 VA 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: .� Fax: Email: Check#:� Date: •(/ / Amount: Food Establishment Information n 14) Water Source: 15) Sewage Disposal: It/4�II DEP Public Water Supply No: (if applicable) p v 16) Days and Hours of Operation: f�7da S J a1 Zoam 17) No. of Food Employees: 18) Name of Person in Charge Certified In Food Protection Management: �X4 Required as of 10/1/2001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) / ❑ Retail( Sq. Ft) ❑ Caterer Permanent Structure V IK Food Service-( 7b' Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments ETeck one) RAIL STORE RESTAURANT Annuals(c/ ❑ Less than 1000sq.ft. $70 ❑ Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than I0,OOOsq.ft. $420 .ffi 25-99 seats $280 ❑ More than 99 seats $420 Temporary/Dates/Time: ❑ Bed&Brea kfasVChildcare Seryices/Nursing Home $100 - - ------------------------ - -------------------------------------.. ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Dentitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no time/temperature controls required) check all that apply): RTE-ready-to-eat foods(Ex.sandwiches, salads,muffins which need no further processing Sale of Commercially PHF Cooked to Orde Hot PHF Cooked and Cooled or Hot Held/ Pre-packaged Non-PHFs for More Than a Single Meal Service (' uy SUHCK Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only I Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares FoodlSingle Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities � ' To be completed by the Board of Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A,1 certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: q 26) Signature of Individual or Corporate Name: Healthcare American Provider Heart Associations Brian Roche Training NNW Narita This card certifies that the above Individual has successfully - E142T_T$AI TC ID p completed the cognitive and skills evaluations in accordance with TC N>YIN.AS8Ci`_j/,A.T the curriculum of the American Heart Association SLS for Healthcare Infoi� Providers(CPR and AED)Program, --'""-_ :--_:-.cwWW.ftllttA_6 /7g�_233_�OSQ 10!1612011 10!2013 Course _. Lacalion Issue Data Remmnrentled Renewal Dale - ' �C3COn H7lI Athlete h1Sfr(1ctOY' ,..._.�.._.._..�.__._..,D.CtUIJ_._ .. Name __..._.__.___,._. - Inst.70 It Holder's .(-iD!!1'1'�P-/-02-1002- Signature ago renWeny with hm uerC x¢Y�s.✓s eppea�ce. g0 ISO, d f • I Yl��sed.,.- EXAM FORM NO. 4616 97rvsia CERTIFICATE N 0. 7753015 t� ServSafeo Cerrunficatimboakn to BRIAN ROCHE for successfully completing the standards Set forth fa the ServSaleig Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute(ANSO-Conference for Food Protection (CFP). 4/20/2011 DATE OF EXAMINATION 4/20/2016 DATE OF ERPIRAHON Local laws apply,Check with your local rea aatury agency ter iecertil cahtm requirements. la /\7 g NATIONAL RESTAURANT ASSOCIATION o POUT Executive Djrr e(Fl ' deeGS ector National RestaurarN Assurration Solutrone oto"Namoal Resuorent A¢¢0uaf0o Educadonal Pongda0un.Ap rents YBStrved.SorvSafa and Gia Sunrsaia lapel om rvpi¢1bW badevwrY¢M the Wow ilumetrani Associsrian Educational Foundatl6n, nmF used under fcvma M Natiaaal Rnstaumnt Aasp¢iatien Solutions,tit,a vahaLp awrrea¢Utvid,q of me National RasmurantAssnelaaion. This dOcrenaM cannot 6e ropmdur.¢d 0-altered. a0p10t0f v.t 103 s CERTIFICATE OF ALLERGEN AWARENESS TRAINING 43 ley e ido $. rv._. Name ofReG1 tent;, -_ P� {B[�AN,Rt�CHE d- 4 3 Certifi,.:: esu1zcr. ' Wit_ "0122,512 ; Date of C, *6696)Qj9112Q`i 1j� s-< Date o Tact . 'ti1 Df .- -,.�r ira I e;^ {�§ Y.•.&MJ15 IOUCA By: Thr abvv w,ned Aman is hereby ivaed this wtWate forcanrplenngan atleqen aetmrenesr ra ningp agrrnn rtsagaiu,d by ahe l4fmwrhusertsDgartnieat gj'Athir klenitb N. in naordalue 10ith105 CMR 59009(G)(3)(a),. Afawrchu5zn5 RcuriurAneAsaoc,uson. 890.163.3#23 1537",unp4w Road,5o'a 102 is'ww rc�nuxuctu -. $wiiilx rn,giyh9A 6I?72 7bts rer6ficate,will bc,v lalPr ,jzve(5)years fmm dwe of xcm f111�oii, -50&-713-4v05 wKtvFn4rtAYJ¢nlatvsxuv"v� CITY OF SALEM BOARD OF HEALTH Establishment Name: RED Date: 10 - 210 11 Page: 1 of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- NO. Reference R-Red nem VerHled PLEASE PRINT CLEARLY RaJ O O' U" ' 6 07 V 4- CS Discussion With Person in Charge: Corrective Action Required: ❑ .No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion 13Re-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. r--.. 'r'Iti-.� � .� � r.."r7e r,rr-.,,.�.. -r z•y.ni. � •, 3-501'.14(C)' - PHFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk- According to law Cooled to Factors(Rams 1-22) (Cont) 41°F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS _ 3-501;15 Cw1mg Methods for PRFs 14 - Food or Color Additives _ _ 19 PHF Hot and.Cold Holding 3-501.16(B) Cold PHR Maintained at or below 3-202.12 Additives* 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives* 3=501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140°F. 7-101,11 Identifying lnfrmnation-Original 301-16(A) Roasts;Held at of above 130°F. -Containers* 7-102.11. Common Name-Working Containers* t 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Siorage* 7-202.11 .Restriction-Presence and Use* 590.004(H) Variance Re uiretnent. 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanit zers.Criteria-Chemicals* 21 3-801.11(A) Unpasteurised Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 7-204.14 in Agents.Criteria* - .Use of es with Warning Labels* 7-204.14 Incidental Food Contact,Latbricants* 3-801.11(8) Use of Pasteurized C E ed 7-206.11 -Restricted Use Pesticides,Criteria* 3-801.11(0) Raw or ed Sprouts Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed S s Not Served 7-206.13 Tracking Powders,Pest Control and -0-801.11 C) Unopened Food Pack Not Re-served. Monitoring* CONSUMER ADVISORY _ TIME/I EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Patho ns'* Eggs-Immediate Service 145°F15sec* 3-302..13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 3401.11(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 3401AI(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness 3401.11{C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave l65°F* Special Requirements. 3-401:l l(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) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical mid non-critical violations,which do not relate to the Time* - foodborne illness interventions and risk factors listed above,can be 3.403.11(0 Commercially,Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000, 3-403.11(E) Remaining Utisliced Portions of Beef Rem I Good Retail Practices .FC 590.000 Roasts': 23. Management and Person .003 .i 18 Proper Cooling of PRFs i 24. Food and Food Protection 1 FC-3 .00_ 4 I 25. Equipment and Utensils FC-4 .0 6 -i 3-501.14(A) Cooling Conked PRFs from 140°F to ! 28. Water.Plumbing and WasteFC-5 006 it70°F Within 2 Hours and From 70'F 27. - Physical 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. Special Requirements .009 Temperature Ingredients to 41°F/4.5°F 30. i Other Within 4 Hours* - *Denotes critical item in the federal 1999 Foal Cale a 105 CMR 590.(M. 1 Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 03/23/2012 ESTABLISHMENT NAME: Red Lulu Salem File Number:BHF-2011-000012 94 Lafayette Street SALEM MA 01,970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2012-0403 Mar 24,2012 Mar 25,2012 Permit for Spring Fling Food to be served: Total Fees: PERMIT EXPIRES March 25, 2012 Board of Health Page 1 y Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 03/23/2012 ESTABLISHMENT NAME: Red Lulu Salem File Number:BHF-2011-000012 94 Lafayette Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions l Notes TEMPORARY FOOD BHP-2012-0403 Mar 24,2012 Mar 25,2012 Permit for Spring Fling- Food to be se_ved: Total Fees: PERMIT EXPIRES IMarch 25, 2012 Board of Health Page 1 11 J ��,`� �1 D X14 i ► c6C) ®v _ � C T0 — gr_� a��@ Lo C-.iTA boA7o� a � t ' .t:A��', `.f. rCi.i -..�. lw..� i' '...�..ti. s P f• .Y L ('... �I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHING TUN 1'rREE'f,4II3 FLOOR KIMBERLEY DRISCOLL TEL.(978)741-1800 MAYOR FA\ (978) 745-0343 lraynairl rQsalcm.c<>na LARRY RAMDIN,RS/REPdS,CHO,CP-FS HEALTH AciENC Fees:New Establishment$18000 Remodel:$90.00 Make Checks payable to;'I'he Ciri of'Salem No cash is accented FOOD ESTABLISHMENT PLAN REVIEW APPLICATION NEW _REMODEL _CONVERSION Date: _g t QQ i Name of Establishment: Re I s�+x, Category: Restaurant_'Y,, Institution_, Daycare,_,Retail Market Other y Address: D� aJ[ 34�l Phone if available: Name of Owner: c�n � annib�M s�p��cniS�y� v1�1"w� �Ca Mailing Address: { pc.o �� OT• v m;. © i(vi O Telephone: Applicant's Name: y� Title(owner,manager, architect etc.}; PP et.t7t wsz Mailing Address: �_ o� R C • alhC .�_'_„°"�.._ Telephone: i(g 1"7 I have submitted plans/applications to the following authorities on the following dates: _V__Licensing Board _ Plumbing Zoning __Electric Planning Police VX_Building _ Fire Conservation Other( } I CONTENTS AND FORMAT OF PLANS AND SPECIFICATIONS 1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan accurately drawn to a minimum scale of 1/4 inch= 1 foot. This is to allow for ease in reading plans. 2. Include: proposed menu, seating capacity, and projected daily meal volume for food service operations. 3. Show the location and when requested, elevated drawings of all food equipment. Each piece of equipment must be clearly labeled on the plan with its common name. Submit drawings of self- service hot and cold holding units with sneeze guards. 4. Designate clearly on the plan equipment for adequate rapid cooling, including ice baths and refrigeration, and for hot-holding potentially hazardous foods. 5. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross-contamination of raw and ready-to-eat foods. 6. Clearly designate adequate hand washing lavatories for each toilet fixture and in the immediate area of food preparation. 7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment on the floor plan. 8. On the plan represent auxiliary areas such as storage rooms, garbage rooms, toilets, basements and/or cellars used for storage or food preparation. Show all features of these rooms as required by this guidance manual. 9. Include and provide specifications for: a. Entrances, exits, loading/unloading areas and docks; b. Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases; c. Plumbing schedule including location of floor drains, floor sinks, water supply lines, overhead waste-water lines, hot water generating equipment with capacity and recovery rate, backflow prevention, and wastewater line connections; d. Lighting schedule with protectors; (1) At least 110 lux (10 foot candles) at a distance of 75 cm(30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning; (2) At least 220 lux (20 foot candles): (a) At a surface where food is provided for consumer self-service such as buffets and salad bars or where fresh produce or packaged foods are sold or offered for consumption; (b) Inside equipment such as reach-in and under-counter refrigerators; {c}At a distance of 75 em (30 inches) above the floor in areas used for hand washing,ware washing, and equipment and utensil storage, and in toilet rooms; and (3)At least 540 lux(50 foot candles)at a surface where a food employee is working with food or working with utensils or equipment such as knives, slicers, grinders,or saws where employee safety is a factor, i e. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified for sanitation by an.ANSI accredited certification program (when applicable). f. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with; g. A color coded flow chart demonstrating flow patterns for: -food(receiving, storage,preparation, service); -food and dishes(portioning,transport, service); -dishes (clean, soiled, cleaning, storage); -utensil (storage,use, cleaning); -trash and garbage(service area,holding, storage); h. Ventilation schedule for each room; i. A mop sink or curbed cleaning facility with facilities for hanging wet mops; j. Garbage can washing area/facility; k. Cabinets for storing toxic chemicals; 1. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; in. Completed Section 1; n. Site plan (plot plan) I FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Foods (PHF's)to be handled, prepared and served. CATEGORY* (YES) {NQ} I. Thin meats,poultry, fish, eggs(hamburger; sliced meats; fillets) 2. Thick meats,whole poultry (roast beef; whole turkey,chickens,hams) 3. Cold processed foods(salads, sandwiches,vegetables) 4. Hot processed foods (soups, stews,rice/noodles, gravy,chowders,casseroles) 5. Bakery goods (pies, custards, cream fillings &toppings) 6 Other * A generic HACCP plan for each category of food may be available from the regulatory authority for reference. PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS FOOD SUPPLIES: L Are all food supplies from inspected and approved sour s? l NO 2. What are the projected frequencies of deliveries for frozen foodscu�.L_, Refrigerated foods 12 % -, and Dry goods ti.11. 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage _ Refrigerated Storage 4�3 and Frozen storage /� 4. How will dry goods be stored off the floor? tAgt'fb cKS COLD STORAGE: 1. Is adequate and approved freezer and refngeratio7ailpble to store frozen foods frozen and refrigerated foods at 41'F (5°C) and below?&FS^O Provide the method used to calculate cold storage requirements. 2. Will raw meats,poultry and ad be stored in the same refrigerators and freezers with cooked/ready-to-eat food . YE5 ( O If yes,how will cross-contamination be prevented? • Or�G�,.re��['onWC � .,�\1_��Fc.�.��.'�to�'� +rr_us +z> 3. Does each refrigerator/freezer have a thermomete0YES NOeE' Number of refrigeration units: Number of freezer units: 4. Is there a bulk ice machine available? ES NO Hours of Operation: Sun j_y_ _ Thurs ' 1_ Mon 5- 1 Fri — 1 Tues 5- 1 Sat _ I Wed I, Number of Seats: _ 010 Number of Staff: 670 (Maximum per shift) Total Square Feet of Facility: Number of Floors on which operations are conducted_ Maximum Meals to be Served: Breakfast (approximate number) Lunch 100 c C. Dinner �40 aux, Projected Date for Start of Project: Projected Date for Completion of Project: r Type of Service: Sit Down Meals (cheek all that apply) Take Out Caterer Mobile Vendor Other Please enclose the following documents: Proposed Menu(including seasonal, off-site and banquet menus) Manufacturer Specification sheets for each piece of equipment shown on the plan Site plan showing location of business in building;)oeation of building on site including alleys, streets; and location of any outside equipment(dumpsters,well, septic system - if applicable) Plan drawn to scale of food establishment showing location of equipment,plumbing, electrical services and mechanical ventilation Equipment schedule THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: �I Please indicate by checking the appropriate boxes how frozen potentially hazardous foods (PHF's) in each category will be thawed. More than one method may apply. Also, indicate where thawing will take place. Thawing Method *THICK FROZEN *THIN FROZEN FOODS FOODS i [Refrigeration Running Water Less than 70°F'(21°C) J� Microwave (as part of cooking process) Cooked from Frozen state Other(describe) *Frozen foods: approximately one inch or less=thin,and more than an inch=thick. COOKING: 1. Will 9AA product thermometers be used to measure final cooking/reheating temperatures of Pf YE /NO ,, 11 What type of temperature measuring device: t XkA t Minimum cooking time and temperatures of product utilizing convection and conduction heating eguipment: beef roasts 130°F(121 min) solid seafood pieces 145°F (15sec) other PHF's 145°F (1.5 sec) eggs: Immediate service 145°F (15 sec) pooled* 155°F (15 see) (*pasteurized eggs must be served to a highly susceptible population) park 145°F (15 sec) comminuted meats/fish 155°F (15 see) poultry 165°F (15 sec) reheated PHF's 165°F (15 sec) 2. List types of cooking equipment. Mary 014L" , (OANW F_. HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 140°F (60°C)or above during holding for service? Indicate type and number of hot holding units. �T r� 2. How wilt cold PHF's be maintained at 41°F (5°C) or below during holding for service? Indicate type and number of cold holding units. COOLING: Please indicate by checking the appropriate boxes how PHF's will be cooled to 41°F (5°C) within 6 hours(140°F to 70°F in 2 hours and 70°F to 41°F in 4 hours). Also,indicate where the cooling wilt take place. COOLING THICK THIN THINTHICK RICE/ METHOD MEATS MEATS SOUPS/ SOUPS/ NOODLES GRAVY GRAVY Shallow Pans X \f Ice Baths Reduce Volume or Size Rapid Chill Other (describe) REHEATING: 1. How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and,number of units used for reheating foods. Sass, . ,a ' 2. How will reheating food to 165°F for hot holding be done rapidly and within 2 hours? e�n� calm rAn 9- PREPARATION: 1. Please list categories of foods prepared more than 12 hours in advance of service. s0.i50.. / Sa 2. Will food employees be trained in good food sanitation practice . YES / 0 Method of training: F r Number(s) of employees: Dates of completion: \ p cno%ntit 3. Will disposable nd/or utensils and/or food grade paper be used to prevent handling of ready-to-eat food U!-/110 4. Is there a e olicy to exclude or restrict food workers who are sick or have infected cuts and lesio CES 0 Please describe briefly: u � Cat�,1��ai�l�' C►�U�, t�� Will employees have paid sick leave? YES J O 5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type: 0 Concentration: Test Ki S / 0 6. Will ingredients for cold ready-to-eat foods such as tuna, mayo and eggs for salads and sandwiches be pre-chilled before being mixed and/or assemble c.YY�N0 If not, how will ready-to-eat foods be cooled to 41'F? 7. Will all produce be washed on-site prior to us . YE /NO Is there a planned location used for washing produc YES /NO Describe Y n4TGtQa :� i:;,j (t %L IL ste j b or 1J1e 1n_ If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone (41'F - 140°F) during preparation. arnF- nv �n_ c�lc 1�ans 9. Provide a HACCP plan for specialized processing methods such as cuum packaged food items prepared on-site or otherwise required by the regulatory authority. 10. Will the facility be serving food to a highly susceptible population? YES /NO If yes, how will the temperature of foods is maintained while being transferred between the kitchen and service area? A A. FINISH SCHEDULE Applicant must indicate which materials (quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. Kitchen FLOOR COVING WALLS CEILING Bar Food StorageStOr"_'- 7{IQS� 5 -h 1` �rit15 .YYo� � �l Other Storage Toilet Rooms it CQ. Dressing Rooms Garbage & QrtkS Refuse Storage Mop Service Basin Area vroplrnn Ware washing Area CAI Walk-in ��h1d�5 Refrigerators - U\ C4'�l and Freezers 4 S1" B. INSECT AND RODENT CONTROL APPLICANT: Please check appropriate boxes. YE N N S O A 1. Will all outside doors be self-closing and rodent proof? 2. Are screen doors provided on all entrances left open to the outside? O ( ) 3. Do all openable windows have a minimum#16 mesh screening? O O 4. Is the placement of electrocution devices identified on the plan? O O N 5. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? O ( ) 7. Will air curtains be used?If yes, where? C. GARBAGE AND REFUSE O O O Inside 8. Do all containers have lids? O ( ) 9. Will refuse be stored inside? O (v ( ) If so, where? O O O 10. Is there an area designated for garbagecan or floor mat cleaning? ) O ( ) Outside 11. Willa dumpster be used? Number Size Sive."Umw Frequency of pickup Contractor 12. Will a compactor be used? Number Size Frequency of pick up Contractor 13. Will garbage cans be stored outside? 14. Describe surface and location where dumpster/compactor/garbage cans are to be stored JrA( Year "A Will hC S��,re V &r, r 6k AYarA 15. Describe location of grease storage receptacle I4LI An 110 NnI2 +d MkL (,Ji �,aaor (nw�,d1 16. Is there an area to store recycled containers? O O ( ) Indicate what materials are required to be recycled; Glass (�) Metal Paper (yl Cardboard Plastic 17. Is there any area to store returnable damaged goods? ( ) D. PLUMBING CONNECTIONS AIR AIR *INTEGRAL *"P" VACUUMCONDENSATE GAP BREAK TRAP TRAP BREAKER PUMP 18. Toilet 19. Urinals / v 20. Dishwasher 21. Garbage Grinder 22. Ice / machines 23. Ice storage / bin 24. Sinks a. Mop ZZ b. Janitor c. Hand wash / d. 3 Compartment e. 2 Compartment E1 Compartment g. Water Station �125. Steam tables NIA' 26. Dipper wells 27. Refrigeration ` condensate/ f drain lines 28. Hose connection 29. Potato / peeler 30. Beverage Dispenser w/carbonator 31. Other * TRAP: A fitting or device which provides a liquid seal to prevent the emission of sewer gases without materially affecting the flow of sewage or waste water through it. An integral trap is one that is built directly into the fixture, e.g., a toilet fixture. A ?P?trap is a fixture trap that provides a liquid seal in the shape of the letter?P.?Full ?S?traps are prohibited. 32. Are floor drains provided& easily cleanable, if so, indicate location: E. WATER SUPPLY 33. Is water supply public Kor private( )? 34. If private, has source been approved? YES O NO ( ) PENDING ( ) Please attach copy of written approval and/or permit. 35. Is ice made on premises or purchased commercially ( )? If made on premise, are specifications for the ice machine provided? YES ( )NO Describe provision for ice scoo storage: A wAi Mnktrfea �Aor�l 'tPG ;4 +2) lu, M" ) Ise c�uk�ed_ Provide location of ice maker or bagging operation 36. What is the capacity of the hot water generator? 37. Is the hot water generator sufficient for the needs of the establishment?Provide calculations for necessary hot water (see Part 5 & Part 9 Under Section III in this manual) / ELwc> C�;h� 38. Is there a water treatment device? YES (S,)NO (%� If yes, how will the device be inspected& serviced? Cb lNgyy t i t (r I' o � DOSP a V) vv\o P'y� 39. How are backflow prevention devices inspected& serviced? F. SEWAGE DISPOSAL 40. Is building connected to a municipal sewer? YESX NO ( ) 41. If no, is private disposal system approved? YES ( )NO ( ) PENDING ( ) Please attach copy of written approval and/or permit. 42. Are grease traps provided? YES1(NO ( ) If so, where? i�t Provide schedule for cleaning & maintenance lToow3 4, 64\Yaovts{+7m8h (111 II h/ eY�L�K� G. DRESSING ROOMS 4' 43. Are dressing rooms provided? YES ( )NO 44. Describe storage facilities for employees' personal belongings (i.e.,purse, coats, boots, umbrellas, etc.) y 2zz 1 k IbG�'9�C� Th , Sew4 ,94or Ea ---L i 4A3 }Wr l oe- H. GENERAL 45. Are insecticides/rodenticides stored separately from cleaning& sanitizing agents? YES (VO ( ) Indicate location: �Q baw ,, a ataPA KA b l e 12eg Fc'ntynl ' JOU— PPs} Ps le CAW 6- wytC 46. Are all toxics for use on the premise or for retail sale (this includes personal medications), stored away from food preparation and storage areas? YES KNO-( ) 47. Are atl containers of toxics including sanitizing spray bottles clearly labeled? YES k1 NO ( ) 48. Will linens be laundered on site? YES O NOXI If yes, what will be laundered and where? If no, how will linens be cleaned? 11 ' (� jj'�e n at'r t e, 49. Is a laundry dryer available? YES ( )NO ( l 50. Location of clean linen storage:'-b� YCaAg AV, � c )rA&; 51. Location of dirty linen storage: 01'yaA xe, �A . {,gip. /' h 52. Are containers constructed of safe materials to store bulk food products? YES' i NO ( ) Indicate type: yr' rcaCKS 53. Indicate all areas where exhaust hoods are installed: LOCATION FILTERS SQUARE FIRE AIR AIR &/OR FEET PROTECTION CAPACITY MAKEUP EXTRACTION CFM CFM DEVICES 54. How is each listed ventilation hood system cleaned? 11r1V4+r, f�AnuWjbt +,kz lac s I. SINKS 55. Is a mop sink present? YES XNO ( ) If no, please describe facility for cleaning of mops and other equipment: 56. If the menu dictates, is a food preparation sink present? YES NO ( J. DISHWASHING FACILITIES 57. Will sinks or a dishwasher be used for ware washing? Dishwasher Two compartment sink( ) Three compartment sink ( ) 58. Dishwasher Type of sanitization used: Hot water (temp. provided) Booster heater XS Chemical type Is ventilation provided? YES O NO ( ) 59. Do all dish machines have templates with operating instructions? YESA)NO ( ) 60. Do all dish machines have temperature/pressure gauges as required that are accurately working? YES )NO ( ) 61. Does the largest pot and pan fit into each compartment of the pot sink? YESANO If no, what is the procedure for manual cleaning and sanitizing? r 62. Are there drain boards on both ends of the pot sink? YESKNO ( ) 63. What type of sanitizer is used? ( Chlorin Iodine ) Quaternary ammonium ) Hot Water Other ) ( 64. Are test papers and/or kits available for checking sanitizer concentration?YES )NO ( ) K. HANDWASHING/TOILET FACILITIES 65. Is there a hand washing sink in each food preparation and ware washing area? YESY�QNO 66. Do all hand washing sinks, including those in the restrooms, have a mixing valve or combination faucet? YES NO ( ) 67. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YESXNO ( ) 68. Is hand cleanser available at all hand washing sinks?YES <NO ( ) 69. Are hand ing facilities (paper towels, air blowers, etc.) available at all hand washing sinks?YESV)NO ( 70. Are covered waste receptacles available in each restroom?YESXNO ( ) 71. Is hot and cold running water under pressure available at each hand washing sink? YES)) NO ( ) 72. Are all toilet room doors self-closing?YES�6_NO ( ) 73. Are all toilet rooms equipped with adequate ventilation? YES�'00 ( ) 74. Is a hand washing sign posted in each employee restroom? YES (N NO ( ) L. SMALL EQUIPMENT REQUIREMENTS 75. Please specify the number, location, and types of each of the following: Slicers 2LCaUtica� nv bucker �l J Cutting boards , 31s�v Can openers A= pty ml_E( 10 C b 11.2 ( D 6QPZ Mixers 1-j&n ba (LDCzY Floor mats Other STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from the Salem . Board of Health may nullify final approval. Signatures) owner(s) or responsible representative(s) Date: Z Approval of these plans and specifications by the Salem Board of Health does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with the local and state laws governing food service establishments. rRead Mail Com ose Search Email Calendar Ad ress s Folders Settings Help L000ff ' M A t L Jx From: "L Edwards" <service@just-drains.com> Sent: Fri 30/09/115:34 PM To: <BRIAN@LOLrTABOSTON.COM> Priority: Normal Subject: No Subject Type: Attachments r---�" Just Drains 55-1 Wilcock St Dorchester MA 02124 Reply Delete LOLITA BOSTON LLC Address Book 271 Dartmouth Street Boston MA, 02116 September 30, 2011 Print Dear Mark or Stephanie View Headers Next To whom it may concern Just Drains has inspected the 94 Lafayette j Previous St., establishment. The water is at proper temperature for hand sink and kichen purposes. thank you again for Choosing Just Drains, Please feel free to call on n ime. We are here to serve and help usa anytime. pYou. 4e it yai4 L. L. Edwards Folders User Profile Loaoff I . BSES Bay State Exhaust Services 18 Madison Road Halifax,MA 02338 T:(781)753-0822 C:(857)294-3399 baystateexhaust@yahoo.com 9/27/11 To whom it may concern, This letter is to inform you that Bay State Exhaust Services has inspected the full exhaust system for Red Lulu(restaurant) located in Salem, MA. There are not an adequate number of access panels and we will be installing them during the initial cleaning of this location. We do not see any problems in cleaning the system during future services. The exhaust system seems to be in full working order. If anymore information is needed please feel free to contact me or anyone in my office. Thank you, Toby Grossman Owner —®Fleeto 11 EFRIGERATION AIR CONDITIONING CO.,Inc.- SALES — SERVICE — INSTALLATION 27 Canal Street • P.O. Box 560098 • West Medford,MA 02156-0098 Telephone:(617)666-1843 • FAX:(781) 395-2306 September 30, 2011 To Whom It May Concern: On September 30, 2011, I went through all the refrigeration equipment at Red Lulu Restaurant on 95 Lafayette St. in Salem, Ma. The equipment is in good condition, though there are two units that are not running presently due to refrigerant leaks in the systems. Leaks will be found and repaired before the opening of the restaurant. The rest of the equipment is operational, and down to temperature at this time. Regards, John Lino, Jr. e3k � .G•J F/ryg � r #�,�� 1k gam' "@��°�`� � � ON '1 ti� �[ �� u6� �r egg f'c[• F �`Y��t ��'irk '•1yi� �� , y-r.P%�"'` 4�zs � Y 4 h liitl ANgI' Rod iil xyr , � . �(ti i\ z . PRIMERO quesofundido It lobster enchilada 16 tortillasouly 8 hobbling htasadmc chouse&chorbs,asrrwgq mo-ho-amanc,glazell stamen,lobster,fice POKAW cars, rich chicken broth panel clackre,crisp tortillas wasted peblaren,chiles mushmomis&m1summ,posto capothe chil imand contractor jark clarran evocator,Pico de galls,green chWers&lines,Maine sticky siture ribs 14 spicy Matti Matti Monte;le spicy butternut&chorim soup 8 bl4d pork ribs with a spicy mexlean carfee Wan, mal;1ed core.padlans,&Alpena ehille% velvet squad,son,spicy c.borim semamn, chassawn,sesame and orange girsw jack elesesa and acceade-hemandill-selles, corrienn M. aln tuna tostada 13 garlic roasted oysters 11 short rib sopas 14 Priam crucred chi tooa on ererip turn tortilla, re,11.1 east eoset oysters,valentim,met scons, bacen beamed short ratty hot aarcrrs, avocad%watmeness and chi Poor etch Imnn butler conflemad crumbs time creens,on a crisp mean pence ke spivy corsair sabirl 9 hearts,[romaine.for.fire ranged or rn.j. 11"artal of rom.1 ne.com mush-Malone, k elleese, amord manclaegachrese PRINCIPAL crest hkhrftm&.hUc roodoll mushown. TRES CEVICHES sahmoncract 23 TACOS -14- grilled wrib areseunablim.frooth 0000 &laws bear plantain mosed, achiote bb(fd chicken 11 Idd has,to comoMmilk,foralk liter, spicy areal,runs, 26 achlom-acaugeld-r, cilantro&jaloperw chijas scant chi tuxel, or nwjo queen freash mexhare umma tralliticanti &o4am aserstpetarce each ritteyetacrai 15 truchijeshiinfeeblimejuves, slyartrupajillo N slow nowdeed rib-eye, sernanorlate&mdection soure1jaralso shrimp,garlic&chiprale, camera names,garlic crems, sallgrita froah lime,avocade,park am..&freak watenow" bb(I brisket 14 Intone,&scallops,orreadc'fresh(waraw. anappervejueruz 26 sloolveloakedrulledbroks4 chilp oil,rowasto warlsi smapper,fresh anowdogarbe-caper saws. ren W"&jalapeno hush Puppies coarporrattamale VERTICAL NACHOS shrimp playa 14 carne'vaula 20 janlieshrimp with eWhnabuaaherso ehoriw 12 marrinawdskift loans with Mar urtlllas, in a vrarnetnpddww sofirde demarcate,mexican croma.Issues&classes, guacamole,miss mia,red onions&inlapencs V media chile,ruiblocal short rib 15 polloasnala, IS spicy chorriza sausage,pattern,chile deal marinated,garlic reemad chicken, red chile patomossai I tied,oggr halomenarmegar&soom P'PWM ural)&roashell lioblano, 16 pulled pork 12 grilles eorn,jeck choose&block 6ences pork chop borraclat 213 Is.twined porkeImp,gresse onion gords& rhiply located pork,sermon,latish salsa chile.coward forusel.Seattle and chile bat ease QUESADILLAS garlic little chicken 17 blackened rush i malt 15 steak larilla 12 grilled clooken lemosk onward earn, jicaroas1w,.1discl", vans, pylic lime,marimetc4l skirt steak,clay orrame, red onion art.&maklenick potatoes recall mcerad.sam,&Points, oarg.l.roasted wased. carnitts; 18 pifia loneliest duck 16 spinach&choose 9 wrimairrscared caritas.red chile potatoes, petted sack,sweat chile mote estate, fman apmmd4 crossed ladhers,thifirs&jarek rhooss grilled truschi'd&Cloth,ret.some [apple,u1sr,chicharron anclat chile chicken 10 chile rellenatenchiladas 10 vordura U black bram,fire minted eremikanookedlevan maamd pabtanocbtlies,gneam fnsrs, (men mrsdamerese,variant,ruby ordoems Saba,mj.&guscoursolho sweet Perot%ties&chy pot block beams SANCHO -6- street potato fries 7W)Cah)care chile roadated brawls sprouts slow cooked greens with barissine spies grilled corn brushed ,ltb has.soli, crispy bases&chile do arbal smoky&spicy stratood goons char lowdr,rotim cheese&block pepper vorlic lien clay pot black beans chipsoffe potato gratin icon pan earn bread with eamarro closer kjack thews winne&scosat,Pommel,in rich chromic-roam with rented garicam. GUACAMOLE fie'sco 9 picante, 10 especial 15 tuarino 11 fresh avocado,tomwa,sernme,chile, inched lower,ad.borbile, dicedoiden&riluntro, ghost chilm chile.po.mdn&char art.[ garlh,Mae better dliznle &fresh tomato nae 14 UP 2 7 1 +a i. 1 16 Al ae. 6 15 4 'I Y r =- P }� 4-2 35 A 29 X3437 315 31 3D �-: F+ Ll-- �i�16i01� UP ■ -- - �� 71 , ® � o i1 . 17 .1 moi' "�P'�I��I ' ® �� 16 ff> 25 © 0 Q19 © -� o _-- 37 .11 � !a *✓ 't ' A4 �i -� is lkilf It �4AAAga iffliitt i, }� IX ,�t�u"j•I•a�•„{¢;�`{LT"eJ 3„T h 1 ry 0. f Y h'S i ,U , ext W p t I ct a EXAM FORM NO. 4616 Ser�►Safe CERTIFICATE NO. 7753015 ServSafe" Certification TO BRIAN ROCHE for successfully completing the standards set forth for the SarvSafee Food Protection Mangger Certification Examination, which is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection(CFP{. 4/20/2011 DATE OF EXAMINATION - 4/20/2016 DATE OF EXPIRAriON Local laws apply.Chock wah your local re{Rdatury agency for rucertitrcate n ruquiroments. ox NAT 0N-AL t - - RESTAURANT ® Paulninemen ASSOCIATION® ' feasts Executive Director,National Rasteuraivt Association Sdu000n FQdid Nmbnm Remvvmv Avavaetiat EdncetarwtrumtlatiartAuri9nta nswved.Sara3oty aaeou Smafiefe leo,maagissmW aadNvrta mMa Na00MReaIXNrea[Aasvcimbn tancdionvl#aundvdou, - aid used under lxmnv by Nvacnm RIVIverentAavm1116011 Sdmkaa,LLC.acalmly owned 106ddivy of Me National RameansAvvcietlon. Tho docNOma 0s,111d W r0areduead of altered. 100pol 5 a.tlHd °. ❑ � fi t r R i r 11 t w � r n a r .r 'w e r n a t i w e r 11 � t� w t r ' i y V r l CERTIFICATE OF a Name of Re I cipient:-BRIAN ROCHE a� • • • • 1 ` D. • • . • 1 1 Issued By: G above-namedpersonI �.�".�• dNATIONAL for r r an r r Q� recognized by the Massachusetts De A C ONO parlinent of Public,11caltb V p I /' 1 VC"i is n CSouthborough.MA 01772 V " f - dli080905C U3, c �R�.Yr t t w�nni i a . �qcl 1>ey t ♦ V r t alt n.rr t t <R "rr r t at'a'1i .a Order receipt from Northeast CPR($63.00) InboxX Reply I Google Checkout noreply@checkout.google.com tome show details Oct 11 (1 day ago) Images are not displayed. Display images below-Always display images from noreply@checkout.google.com Hello Lolita Boston LLC, Thanks for buying from Northeast CPR using Google Checkout! Northeast CPR will charge and ship your order soon. How do I check on this order? Get up-to-date information about order#515653591961368 Problems with this order? Contact Northeast CPR Shop confidently Continue shopping at Northeast CPR. Search for products using Google Product Search. Visit our Deals Page for coupons, promotions,and more. Order date:Oct 11, 20112:02 PM PDT Google order number: 515653591961368 Shipping Status Qty Item Price Not yet shipped 1CPR/AED Class 10/16 Boston$60.00 Tax(MA) :$3.00 Total:$63.00 l Paid with:VISA xxx-3541 Ship to: Lolita Boston LLC 271 Dartmouth st Boston MA 02116 UNITED STATES PEST SERVICES AGREEMENT Page 1 of 2 Date 10/12/11 Contract No. REDL-0001 Billing Address Service Address Name Red Lulu Cocina&Tequila Bar Name Same Street 94 Lafayette Street Street City Salem State MA Zip 01970 City State Zip Billing Phone Number 978-594-5195 Service Phone Number Contact Name Mark Malatesta Type of Facility Restaurant PEST SERVICES AGREEMENT All-Star Pest Services, LLC. agrees to provide the periodic services below in a safe manner in accordance with current pest elimination procedures to eliminate rats, mice and cockroaches. All-Star Pest Services, LLC. will also treat for ants, crickets, silverfish and other crawling insects during regular monthly service but any necessary baiting programs or power spraying will be at an additional charge. This agreement does not cover bedbugs, pharaoh ants, birds, wildlife control/removal, termites or other wood destroying insects. Service for these will be at an additional charge. Materials and methods of application used in the performance of such services shall conform to applicable federal and state laws and regulations, and shall be reasonably acceptable to customer. To begin the services, All-Star Pest Services, LLC. will treat the premises identified below to thoroughly clean out any current infestations of pests. Should any rats, mice or cockroaches remain, All-Star Pest Services, LLC. will retreat the premises until such pests are eliminated to the customer's reasonable satisfaction. . All-Star Pest Services, LLC. does not guarantee the customer will never see another cockroach or other pest on customers premises again. These pests may gain entry with deliveries or otherwise. • All-Star Pest Services, LLC. does guarantee that during the period of As continuing services, rats, mice or cockroaches entering customer's premises will not become established on those premises. All-Star Pest Services, LLC. will provide regular periodic service to maintain the premises free of rats, mice or cockroaches. If reinfestation does occur between regularly scheduled service calls, All-Star Pest Services, LLC. will provide additional service treatment to eliminate that reinfestation at no additional charge. All-Star Pest Services, LLC will provide reasonable consulting service to identify sanitation and structural deficiencies which may contribute to pest infestation. Customer must correct those deficiencies in order to assure a pest-free environment. Initial/Monthly Maintenance Services Weekly Check One Initial Service Date: Monthly X (Must Complete) Initial Month's Service Amount: $WAIVED Other Total Monthly Amount: $ 150.00 Areas Serviced: (Describe, or include separate scope of service) All-Star will install a complete interior&exterior rodent program. Service will be performed monthly. Termite, Bird Control and Bed Bug work is not included and will be proposed separately if needed. Minor rodent exclusion work will also be provided during regular service visits. By: James Saulnier By: All-Star Pest Services, LLC. Representative mer Representative All-Star Pest Services, LLC. P.O.Box 1696 AA Salem,NH 03079 /y I OPTIONAL PROGRAMS: Page 2 of 2 ODOR ELIMINATION (12 Month Program Only) Odor Units Number of Units Price/Unit Total Amount $ N/A Recommended FLYING INSECT DEFENSE PROGRAM Item Price/Month Quantity Total (minimum 6 momhs) Vector Unit $ Mantis Unit $ Air Sentry(Space Spray) $ Treatment(Determined by survey and quote) $ Months of Service Total $ Complete) o st Jan Feb Mar Apr May Jun _/o Adjustment $ initial Service Month(Mu Jul Aug Sep Oct Nov Dec Final Total $ NA Treatment Detail System equipment remains the property of All-Star Pest Services, I.I.C. Customer agrees to use reasonable care in the use of equipment and assumes responsibility for any loss or damage to equipment. A charge will be assessed for damage to equipment. All-Star Pest Services, LLC. agrees to maintain equipment and supply necessary materials for their operation. GUARANTEE, TERMS & CONDITIONS • Guarantee—All-Star Pest Services, LLC. agrees to apply products to control named pests in accordance with terms and conditions of this service agreement. All labor and materials will be furnished to provide the most efficient pest control and maximum safety required by federal, state and city regulations. If you are not completely satisfied with the results of service, All-Star will have 30 days to resolve the problem to your satisfaction. If you are not satisfied with the results, after the 30 days, you may cancel this agreement without written notice, and All- Star will return your last payment. • Service Cancellation - Either party can cancel this agreement by giving thirty days (30) written notice. If a thirty day notice is not given, the customer will be charged the regular monthly service fee. COMMERCIAL ACCOUNTS: All-Star owns and will pick up all rodent, odor and fly equipment. If customer does not allow All-Star to pick up equipment, a charge of$200 per fly trap, $50 per odor unit, $20 per bait station and$20 per mechanical trap will be charged to customer. • Equipment— Equipment remains the property of All-Star Pest Services, LLC. Customer agrees to use reasonable care in the use of equipment and assumes responsibility for any loss or damage to equipment. A charge will be assessed for damage to equipment. All-Star will maintain equipment and supply necessary materials for operation. Customer pays for replacement equipment. • Customer Obligation—Customer understands that results of service are relative to and dependent upon the cooperation of the customer as to housekeeping, sanitation, maintenance, and accessibility of areas to be serviced. Customer agrees to cooperate with All-Star as reasonably necessary to facilitate treatment and control. Customer agrees to provide All-Star access to all areas of house or facility, including locked areas. Customer agrees to promptly correct any sanitation/structural deficiencies noted by All-Star's service technicians. In a commercial kitchen, the customer agrees to prepare the facility per the instructions issued by the All-Star technician and wash all surfaces which have direct food contact before resuming operation. • Payment— Payment is due when services are rendered unless there is a speck arrangement made on this agreement. (COD)All-Star will not service an account that is 60 days overdue. Should legal action be required in order for All-Star to enforce payment under this agreement, customer agrees to pay and reimburse All-Star for all reasonable court costs, expenses, attorneys' fees, and other reasonable costs that may be incurred in such proceedings. All-Star reserves the right, after the first year, to increase the service charge. • Arbitration—The purchaser and All-Star agree that any controversy or claim between them arising out of or relating to this agreement shall be settled exclusively by arbitration. Such arbitration shall be conducted in accordance with the Commercial Arbitration Rules then in force of the American Arbitration Association. The decision of the arbitrator shall be final and binding resolution of the disagreement which may be entered as a judgment by any court of competent jurisdiction. Neither party shall sue the other where the basis of the suit is this agreement other than for enforcement of the arbitrator's decision. In no event shall either party be liable to the other for indirect, special or consequential damages or loss of anticipated profits. New Service Agreemente • Change ❑ Save That Stuff, Inc. www.savethaww.com WWII • Date 100 Terminal Street,Charlestown,MA 02129 T617.241.9998 F617.241.02941 Corporate Name: Red Lu Lu Acct# Address: 94 Lafayette St City: Salem State: Mass Zip: 01970 Phone#: (978) 317-5796 Email: Mark@cojemanagement.com contact Person: MarkTitle.• Owner ServioeAddress: 94 Lafayette st city: Salem state: Mass Zip: 01970 Phone#: 978-317-5796 Fax#: Material Equipment Frequency Schedule&Route No. Charge NEW SERVICE M T W Th F I S Solid Waste (2}2 cubic yard 4x per week $600.00 containers X X X X Corrugated Vertec'In-house'Baler On-Call Basis $150.00 Mo. Rent Market Pricing Material Equipment Frequency Schedule&Route No. Charge OLD SERVICE M I T I W Th F S Remarks and Special Instructions The undersigned individual signing this agreement on behalf of customer acknowledges that he/she has read and understands the terms and conditions of this agreement on the reverse side,and that he/she has the authority to sign on behalf of customer. Bysigningonthe 2dayofO( 2011 ,the customer and company agree tothe tennis ofthsservice agreement. Customer M G A(4 W LU v Title 1446 kh(, Service Provider Title Terms & Conditions SERVICES PROVIDED: Service Provider shall have exclusive rights to collection LIQUIDATED DAMAGES: In the event that Customer terminates this of all the trash and recyclable materials generated by the Customer as described in Agreement prior to its expiration,and without the notification required under this Service Agreement('Agreement'). Section 7,other than as a result of a breach by Service Provider or Service Provider terminates this Agreement for Customers breach(including non- WASTE MATERIAL: The Waste Material to be collected and disposed of by payment),Customer agrees m pay Service Provider as liquidated damages Service Provider pursuant to this Agreement is all solid waste(including recyclable a sum calculated as follows: (t)ff the remaining term under this Agreement is materials)generated by Customer(the'Waste Material'). Customer warrants that sic or more months,Customer shall pay the most recent monthly charges the Waste Material will not contain any hazardous,toxic or radioactive wastes or multiplied by six;or(it)If the remaining term under this Agreement is less substances as defined by applicable federal,state,provincial,or local laws or than six months,Customer shall pay its most recent monthly charge regulations. multiplied by the number of months remaining in the tern. Customer expressly scknowledges that in the event of an unauthorized termination of EQUIPMENT: The term'equipment"as used herein shall mean all central storage this Agreement the anticipated loss to Service Provider in such event is equipment furnished by Service Provider to Customer. Customer shall have no estimated to be the amount set forth in the foregoing liquidated damages right,title or interest in the equipment Customer shall be responsible for all loss or provision and such estimated value is reasonable and is not imposed as a damage to the equipment other than normal wear and tear. Customer shall not penalty. In the event Cuslomer fails to pay Service Provider all amounts after the equipment nor use it for incineration purposes. Customer agrees to which become due under this Agreemerd,or faits to perform Its obligations indemnify,defend and hold harmless Service Provider against all claims,damages, hereunder,and Service Provider refers such matter to an attorney,Customer suits,penalties,fines and liabilities for injury or death to persons or loss or damage agrees to pay,in addition to the amount due,any and all costs incurred by to property arising out of Customers use,operation or possession of the Service Provider as a result of such action,including,to the extent permitted equipment On collection day,Customer shall provide unobstructed access to the by law,reasonable attorney fees. equipment. MISCELLANEOUS: This Agreement shall be executed by agents of the DAMAGE TO PAVEMENT: Service Provider will not be responsible for damages to Service Provider and Customer who represent and warrant that they are Customers pavement or driving surface resulting from the weight of Service authorized to execute this Agreement This Agreement contains the sole Providers equipment or vehicles in providing service to Customer at the Customers and enfire understanding of the parties with respect to the subject matter location, hereof and supersedes any and all prior discessiors,negotiations, commitments,and understandings,whether oral or written,that may exist PAYMENT: Service Provider agrees to pay Customer on a monthly basis and in between the parties regarding same. This Agreement shall not be amended, accordance with the payment tents on Service Providers invoice. modified,or changed except by a wr ting duty executed by the parties. This Agreornent shall be binding upon and shall Inure to the benefit of the CHARGES: Customer agrees to pay Service Provider within thirty(30)days upon successors,assigns and personal representatives of the parties hereto. receipt of invoice. Service Provider may impose and Customer agrees to pay a IaOe Customer hereby expressly consents to the assignment of this Agreement by fee for all past due payments,such late fee as determined by Service Provider in Service Provider to any-successors or purchasers of the whole or any part of an amount not to exceed the maximum rate for same allowed by applicable law. the Service Providers'business and expressly consents to be bound by all terns herein th any such successors or purchasers. Customer shall not CHANGES: Changes in frequency of collection service or day,number,capacity assign this Agreement without the prior written consent of Service Provider, and type of equipment may be agreed to in writing. Customer agrees to pay which consent shall not be unreasonably withheld. If any conflict or increases in disposal fees,when Service Providers'final disposal fee is raised. differences exist in this Agreement between terms that are printed and those Upon termination of this Agreement for any reason,Customer grants to Service that are typed or written,the typed or written language shall govern. The Provider the right to compete with any offer which Customer rete ves(or intends to invalidity or unenforceability of any provision of this Agreement shall not make)relating to the provision of non_-hazardous trash and recycling collection affect the validity or enforceability of any other provision of this Agreement services and agrees to give Service Provider written notice of any such offer and a and the parties intend reduction of scope of any such provision to valid reasonable opportunity to respond to it scope,where possible,rather than entire invalidation. No waiver by Customer or Service Provider of the breach of any provision of this TERM:The initial term of this agreement is thirty-six(36)monis from the effective Agreement shall be deemed to be a waiver of any preceding or succeeding date on frord. This Agreement will automatically renew for additional twelve(12) breach of the same or similar nature. The headings in this Agreement are months terms without any further action by either party unless either party give for convenience only,do riot censfibts a part of this Agreement and shall written notice of termination at least ninety(90)days,but not more that one not be deemed to limit or affect any of is provisions. Both parties shall be hundred eighty(160)days,prior to the termination of the then existing date. relieved from performance under the tams of this Agreement when performance is impossible due to acts of God,was,riots,fires,explosions, NON-PERFORMANCE: If Service Provider fails to perform the services as accidents,arrests,strikes or lookouts or any other cause not within the described in this Agreement within ten(10)days receipt of a written demand from control of the partes. Customer,Customer may terminate this Agreement upon payment in full of all monies due. CONFIDENTIALITY: Customer and Service Provider agree to keep the tents of this Agreement confidential. Both Customer and Service Provider NONSOLICITATION: During the term of this Agreement and for a period of one may,however,disclose the tents of this Agreement to their employees on a (1)year after the terminagon of this Agreement Customer,including its officers, need-to-knew basis,and to their respective accounting,tax and legal directors,employees,agents and affiliates shall not either directly or indirectly advisors. remit solicit divert or otherwise induce or influence any proprietor,lender, director,officer,employee,sales agent investor,lessor,supplier,distributor, GOVERNING LAW: This Agreement shall be governed by,and construed in customer or any other person which has a business relationship with Service accordance with,the laws of the Commonweath of Massachusetts, Provider to disconfinue,reduce or modify such employment agency or business applicable to contracts executed in and to be performed entirety within that relationship with Service Provider. state, COUNTERPARTS: This Agreement may be executed in counterparts,each of which shall be deemed an original and which together shall constitute one and the same Agreement Quote .F.5 TAI'0. United East Foodservice Design,Fquipo nt and Supplies. 10/13/2011 Project: From: FRYER TriMark United East Mark Ogilvie 505 Collins St So.Attleboro,MA 02703 Phone:(508)399-6000 Item Qty Description Sell Each Sell Total 1 1 ea FRYER,FLOOR MODEL,GAS,FULL POT Pitco Frialator Model No. 35C+S Class: 85 Economy Fryer, gas, medium-duty restaurant design, 35 Ib.fat cap., millivolt control,s/s tank,door&front,90,000 BTU o 1 ea Gas to be determined 1 ea P6072145 Basket, (2)oblong/twin size, 13-1/2"x 6-1/2"x 5-1/2"deep, long handle, regular mesh (shipped std with models 'T"SG14, SG14R, SSH55, E14, E14X, E1413, SG14T,35+,45+,batteries shipped with(1) per fryer Acceptance:p Date: Printed Name: FRYER TdMark United East Pane 1 of 1 Pitco Fri—'aiatoT li Model:35C+S Ixem#: S ;n Model 35C+ & 45C+ Economy Tube Fired Gas Fryers 4311/16 CAD diagram for tl INCHES (1110) Model 35C+, Some U) - for Model 45C+with M CENTIMETERS the exception of four CD tubes instead of 14 three. 30 913 (35.8) ` (78.9) LL 51/4 (13.3} �,y f 14 (35.8} 151f8yyyyyy......,,,,,, FLUE �(38.4)� DEFLECTOR G 6 g G FULL PORT V V314 11W NPT W DRAIN VALVE + 46 47 9'32 (�me GASSUPPL3M'NPT 34 10 1132 � LO (27.8) (45.1} M 8 11 5/ 11/16 (29.5) (4.3) O 2114 1713116 ADJUSTABLE LEGS C (5.7) (45.3) G ELECTRICAL ! CAPACITY Volta a/Phase/HZ 35 to 40 pounds(15.9 to 18.1 KG)—Model 35C+ Description 120/1/60 24/1/50 42 to 50 poundSQ9A to 22.7 KG —Model 45C+ AMPS/EAAMPS/EA ! ! NO electrical 1st pounds(73 KG)r 17.a cubic feet(1)48 cubic meters)(Modal 35C+) options available. 1$1 pounds(82.1 KG)/17.0 cubic feet(0.481 wblo meters)(Mode145C+) i • ! � 90,000 BTU -Hour{22,680 Model 35C+ Cooks fi3 1111 1-121111i*-� lbs{28.6 KG)of fries per hour—Model 35C+ 122,000 BTU's/Hour(30,744 Kcal)—Model 45C+ Cooks 85 Ibs(38.6 KG)of fries per hour—Modal 43C+ Available in Natural or Propane Gas. For other Frying area is 14"x 14'(35.6 fan x 35.6 cm) Fuel s contact ur j8pler/DistribUtOr. ! 'T FORM SPECIFICATION Provide Pitco Model 35C+,or 45C+tube-fired gas fryer. Fryer shall have an atmosphere burner system combined with three stainless steel heat tubes(Model 45C+has four tubes)utilizing high temperature alloy stainless steel baffles. Fryer shall have a deep tool zone;minimum 20%of total oil capacity. Fryer cooking area shall be 14"x 14"(35.6 cin x 35.6 em)with a cooking depth of 2%'(7.00 cm). Model 45C+has cooking depth of 4'(10.16 cm). Heat transfer area shall be a minknum of 588 square inches(3,794 sq cm)for 35C+. Heat transfer for Model 45C+shall be a minimum of 785 square inches(5,058 sq tall. Provide accessories as follows: TYPICAL • i MOM Frying a wide variety of foods in a limited amount of space. Frying that requires a medium volume production rate. Mica Frialator,Inc., P.O.Box 501,Concord,NH 03302-0501. 509 Route 3A,Bow NH 03304,USA + Phone(800)258-3708•(603)226.66M.Fax(603)225$372.www.pilazcom L70-144 Rev 08(1141118) Primed in Om USA we reserve the nght to Menge speaticaeons withoto nobbw and without incuning any obligation for equipment previwsly or wbsequemty sold. Pitco Frialator Model:35C+S Item#: i ® I Project C. CD Item No. W Model 35C+ & 45C+ Economy Quantity n Tube Fired Gas Fryers Qo I ® STANDARD SPECIFICATIONS P. CONSTRUCTION 0 m ■ Welded tank with an extra smooth peened finish 0 _ ensures easy cleaning. 0 ■ Long-lasting, high-temperature alloy stainless steel 3 _ -- heat baffles are mounted in the heat exchanger 0 tubes to provide maximum heating and ` combustion efficiency. ■ Standing pilot light design provides a ready flame = ® when heat is required. IIICabinet front and door are constructed of stainless M steel with galvanized sides and back. .n CONTROLS a ■ Thermostat maintains selected temperature 0 automatically between 200°F(93°C)and 400vF so W + (190°C-CE). r ■ Integrated gas control valve acts as a manual and 'n {` pilot valve,automatic pilot valve,gas filter, Q _--- - pressure regulator, and automatic main valve. CD ■ Gas control valve prevents gas flow to the main N STANDARD ACCESSORIES burner until pilot is established and shuts off all gas flow automatically H the pilot flame goes out. ■ Temperature limit switch safely shuts off all gas ■ Cabinet-stainless steel front,door flow if the fryer temperature exceeds the upper ■ Galvanized sides and back limit. ■ Tank-mild steel with stainless front ■ Built-in integrated flue deflector OPERATIONS ■ Two nickel plated oblong,wire mesh baskets ■ One nickel-plated tube rack ■ Front 1-1/4°(3.2 cm) NPT drain for quick draining. ■ One drain extension ■ Standing pilot and thermostat maintain temperature ■ One drain line dean-out rod automatically at the selected temperature ■ Removable basket hanger for easy cleaning (between 200°F (93°C)and 400°F (190eC-CE)). ■ 6"(15.2 cm)adjustable legs AVAILABLE OPTIONSBACCESSORIES ® NSF ❑ Triple baskets ❑ Covers CE ❑ Fryer cleaner ❑ Casters (Model 35C+only) Piteo FdafeW Inc., P.O.Box 501,Concord,NH 03302-0501 • 509 Route 3A,Bow NH 03304,USA * (603)225-6684•Fax(603)225.8472•wwwpitco.com L10.144 Rev a(04=) Rxit l 12' I Ref 2 Ref 1 Back Entrance With 12, Refrigeration 12, Frez 12" . �,� „-a•4x,..�:.as Y- 9 .-.- � { 1 s„n Enter Boh plans Key a. Ice machine b. Ice machine c. Hand sink d. Prep expo table e. Two door reach-in f. Two door reach-in g. Two door reach-in with open top h. Produce sink i. Prep table j. Two door reach-in with open top k Hand sink 1. 2 foot square prep table m. Two stack convection oven one-gas one electric theses are out side of hoods bottom will be gas in which a chimney will be made to the hood for ventilation. n. Fryer o. Fryer p. Six burner with still oven q. 10 burner with two still ovens r. Grill 15' ° 12' 12' x Door 12' Dry Storage Floorplan 9' Door ' Door Fl RNMRE SCHEDULE ® RED LUW n uwrem nen euaK r o.no 11 j. © P 0 6 ................... ...._, mr 6 en` c c c c o� ............... W _ _ EMwD runxnwneun �,FURNITIPE F4N 6M I8 A-7.2