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REGATTA PUB-SALEM WATER FRONT HOTEL - ESTABLISHMENTS (te��tt, Putljar«, wttitc� front V,otti 225 Ocrbv ti��l �NERSAI.® UNV-12110 V"Num Y l Commonwealth of Massachusetts `c" ` City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Regatta Pub/Salem Water Front Hotel File Number:BHF-2004-000336 . 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0259 Jan 1,2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health ✓ This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS N BOARD OF HEALTH 120 WASHINGTON STREET,4n'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAU,N1 SALEM.COLI DAVID GREENBAUM,RS ACTING HEALTH AGENT i 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TV\� K Lir, lz. D TEL# I J�YO 6 �j ADDRESS OF ESTABLISHMENT ZZ� � I<G _-_ FAX# MAILING ADDRESS(if different) EMAIL- Business': Carry\N (25Cn.\clmW(AY, aC O\.r1 Website: Sc`imv a�c�t udl� r�. Cor� OWNER'S NAME- Q'Pc c� 11`�nHcXrl r ✓� 1' far TEL# :J:(S \ ADDRESS \00 �ta7u.�� Tr<{� M�I�\t1,(�dt t1�— Aci 14 S STREET /� CITY SPATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)�j \` COtfru\ CERTIFICATE#(S) r 0KA06 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON I��`� l fwI r)\, HOME TEL zto - 4104 DMAFOPERATIOfJ; ;Monday ', tkTuesd Wednesday„� yThurstl Fndayt aSat6rday Sunda HOURS OF OPERATION Please write in tune of day. Ay��rv,” m- 7/n 1v� (For(Forexampellam41�j�P� i M� 1rD (�011am-11�j�"fa P� i M' 1rD ?^ ((n TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 ............. -s-,t-h- --------------------_......---- RESTAURANT YE NO lesan 25 seats $140 (Outdoor Stationary Food Cart$21 25-99 seats V =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR _ _— YES—NO 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 f�r such must be submitted to and approved by the Salem Board of Health. y Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes egreturns and paid all state taxes eq�the law.. .-.law.. Signature Date Social Security or Federal identification Number Revised l0n1I I FOODAP201 Ladm Check#&Date�� A Massachusetts Department€of''PubliG:Health Salem Board Hearn , Division of Food and Drugs Salem,Sal Washington S Street,4 Floor em, MA 01970-3523 t FOOD ESTABLISHMENT INSPECTION REPORT (Tel. (9 8) 741-1800. Fax (978) 145-0343 Name J1 Da)e Type of Operation(s) Tvne of Inspection / '1 3 0 ®-Food Service El Routine Address Risk ❑ Retail Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date:^ r `7 � 3311-� Owner ( ` HACCP Yii El Temporary ElPre-operation A ,- ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In: ❑ HACCP Inspector Out: .=�- Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT."';`, _,, ,'�`,�"", �,„ »,„,„; „� '"; ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH yy .�... 'PROTECTION FROM CHEMICALS a! + °` ." _,�'- e�`" -- "x ❑ 2. Reporting of Diseases by Food Employee and PIC t= 1=� _-� _ r -�� 1 _ ? ` w F4,'_'�,€ El 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded ,. ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE w';' ,,,urce��y, a^TIfJIE/TEMPERATURE CONTROLS P_otentlall Hazardous Foods �,a ' El 4. Food and Water from Approved So ( y ) ❑ 5. Receiving/Condition ❑ 16yCooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16. Cooling t� .OTECTION FROM CO �"� �' ❑ 19. Hot and Cold Holding N1'AMINAT]ON�s r 1 ` `i'.F I'A_I - I a • _ �; 9 Pq ------------- ❑ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control -❑ 9. Food Contact Surfaces Cleaning and Sanitizing •REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY,= = ;=: F ,F,�M-4 ❑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' 23. Management and Personnel (FC-2)(996.663) by a Board of Health member or its agent constitutes.an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.067) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 85801nVWFo 14.dw .� j Inspector's Signature: ( Print: PIC'sSignature: '/ Print: n G( f{57- - Pageof___(Pages Violations Related to Foodborme Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B�Demonstration of Knowledge* - Cooked and RTE Foods* 2-103.11 Person in charge_dot es Contamination from Raw ingredients 3-302.1.1(A)(2) 'Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection" applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge' Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Resetvice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 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 Scaled Container* Sanitization Tent eratures* 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-2021.3 Shelf E"s* Sanitization Tem eratures* 3-202.14 F.>>s and Milk Products.Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH,- 3-202.16 Ice Made From Potable Drinking Water'' concentration and hardness. * 5-101.1.1 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.00,6(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* SheiNish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Iisted Chemical* Sources* 14 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ufatoAuthorlt 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellsto:k Identification Present* 2-301.12 Cleaning Procedure* 590.W4(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* LLL Good Hygienic Practices - Receiving/Condition 2-401.1.1 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures*,- 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package hne it y* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30'1.12 Preventin Contamination When Tasting* 6 Tags/Records:Sheiistock L12 Prevention of Contamination from Hands 3-202.18 Sheilstock Identification * 590.004(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Ern tlo-ces* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11. Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca achies* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-20511 Accessibilitl.Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduredox e packaging,criteria* 6-301.]1 Handwashin Cleanser,Availability 8-103.12 Conformance wiUt A. rovet9 Procedures* 6-301.1.2 Hand Drying Provision '*Denotes critical item in the federal 1999 food Cade or 105 Cbl R 590.000. T Salem Board of ,�ealth Massachusetts Department of Public Health fl ,11 ,..120 Washington Street,4+^Floor Division of Food and Drugs + Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT 0 E „4 Tel. (978) 741-1800 Fax(978) 745-0343 r � Name I_ Dat T e of O eratlon s Type of Insoection r .-1 K r Food Service - Routine Address p� isk 171Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: OwnerZ HACCP YM ElTemporary - ❑ Pre-operation ElCaterer ❑Suspect Illness .Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In:a. VO El HACCP Inspector�` Out: l/(-V Permit No. ❑Other Each violati -checked i6equires an expia`nation on the narrative page(s)and a citation of specific provision(s)violated. s: .°� Non-compliance with: Violations Related to Foodborne Illness1riterventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT- Z El12. Prevention of Contamination from Hands El i. PIC Assigned/Knowledgeable/Duties E] 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS :.;-.J,--. ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded E]__ _ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE- ❑ 4 Food and Water from Approved Source - TIMETEMPERATURE CONTROLS(Potentially Hazardous Foo__ds),.'- ❑ 5. Receiving/Condition El 16. Cooking Temperatures _ ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ='+ p ,' 1 19. Hot and Cold Holding - ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing [REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS-(HSP), L 0 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices [CONSUMER ADVISORY 022 Posting of Consumer Advisories Violations Related to Good Retail Practices "� . Nllrtiber of Violated Provisions Related Critical (C)violations marked must be corrected-�._T(y,joodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C x 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.oc4) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) 1 ti the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-9)(590.009) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE'OFRE-INSPECTION. �, p S'SemnspacrFormB-ta.Ea z in Inspector's Signature: Print: PIC's Signature: '37 Print: 5'f C'�J (�� ' _ J Page-L of-SPages .., I a 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) Assig tt mentaf Responsibility* _ Cooked and RTE Foals* 590.003(B) Demonstration of Knowledge' Contamination from Raw ingredients 2-103.11. Person in charge -duties _ 3-302A 1(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection` require reporting by food employees and 3-30215 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of Food Employee Or An Utensils* Applicant To Report To The Person In - Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Foal and Reservice of Food* 590.003 G- Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated Food 590,003(E) Removal of Exclusions and ResMctions 3-701.11 Discarding or Reconditioning unsafe Fo d* FOOD FROM APPROVED SOURCE 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermeticall•Sealed Container* Sanitization Te erature,$* 3-201.13 Fluid Milk and Milk Products" 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products.Pasteurized* p.'P 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. " 5-'101.7.1 Drinking Water from an Approved System* 4-601,1'[(A) - Equipment Food Contact Surfaces and- 590.006(A) Bottled Drinkin Water" Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and - 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by l0 Proper,Adequate Handwashing Re ulafo Authority 2-30_1.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1.7 Game Animals* Ll Good Hygienic Practices 5 Receiving/Condition t 2401.11. Eatin ,Drinkin or Using Tobacco* 3 -401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* c Mouth* 3-101.11 Food Safe and Unadulterated * 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 1 Numbers and Capacities* 590.0040) Labeling of Ingredients' 5-204.1.1 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.1Specialized Methods*' Devices 3-502.12 Reued ox Lenpacka nL,criteria* 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with A. roved Procedures* 6-301.12 Hand Drying Provision 'Denotes ctiriad Arm in the federal 1999 Food Cage or 105 CMR 590.0W t - CITY OF SALEM /� I BOARD OF HEALTH - Establishment Name: 1 g6 �. 1,� ( /1 Date: _oil '. Paged. of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OP CORRECTION Date No. Reference R—Red ItemVerified '. .. , {{ JJ PLEASE PRINT CLEARLY U , l �I rd I V/1 i 1 I�. /L / �J�PJ SC 7 c/ C-.640 n' j S I-i yrcl c-S,:r r\% ' rte , P ' /_ / r I ' -cluy l C G � S 0G . /� j: SI ` A Li .Ca/ on n� _ - pq— 0 A fn DJCl.Lf, r 71^ ',r / l r IV 14)'5fCe� d o M i ttiI/ r Discussion With Person in Charge: t Corrective Action Required: ❑ No.,-" 'A Yes rLhave read this)repor, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance o 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. 1 understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. oluntary Disposal ❑ Other: -w 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According u)law Cooled to Factors(items 1-22) (Cont.) 41°F/45-F Within 4 Homs. PROTECTION FROM CHEMICALS 3-202.12 Addieivc„r` 3-501-15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hat and Cold Holding 3-501.16(B) Cold P1-IFs Maintained at or below 590-004u(F) 41`/45°F* 3-302.14 Protection from U na t roved Additives* Poisonous or Toxic Substances 3-501.16('A) Hot PHFs Maintained at or above 15 7-101,11 Identifying Information-Original 1401-, s Containers" 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Workinn Containers" 20 Time as a Public Health Control 7-201.11 Separation aration-St, nnge„ 3-501.19 Time as a Public Health Control"f00iii�1i) �Variauoe7-202.1 I Restriction-Presence and Use* .5§0Requirement 7-202.12 Conditions of Use, ' 7-203.11 Toxic Containers-Prohibitions{ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Santnzers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,0 iteria"; 21 3-807..1 H(A) .hnpastem:izsd Pra-packaged Juices and Beversees with Warnin Libels* 7-204.74 Incid rants,Criteria, 3-801.11(B) Use of PasteurizedLggs* 7-205-1.1 Incidental Food Contact.Lubricants* 3-801,11(D) Raw or Partially Cooked Animal Food and 7-206-'I 1 Restricted Use Pesticides,Criteria* Raw Seed S%ants Not Secved. 1� 7-206.12 Rodent Bait Stations* 3-801.11(0) Uno erred Food Packa>e NotRe-served. 7-206.13 Trucking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEiTEMPERATURE CONTROLS 22 3-60_.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods"that are Kaw.Undercooked or PHFs Not Otberwise Processed to Eliminate 3-401.L lA(1)(2) FPatho°ens „gs- 155`"F 15 Sec. .* Er`ncnboY"°roar E cgs-Tnunedtate Service 145"Fl Ssec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 1401.1](A)(2) Comminuted Fish,Meats&Game Eecs* Anirnals- 155°F 15 sec:. ;, 3-401.1 l(B)(1)(2) Pork and Beef Roast - 130"F 121 min* SPECIAL REQUIREMENTS 590-009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Raines, Injected Meats-155°F 15 sec. * catering• mobile food,temporary and 3-401.t1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-1fi5°.F 15 sec. a` above if related to foodborne illness 3-40 1A I(C)(3) Whole-muscle, Intact Beef Steaks interventions and tisk'factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Aninutl Foods Cooked in a practices should be debited under X129- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs--145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1)(A)&(D) PHFs 1650F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minate Standing Critical and non-critical violations, which do not relate to the Time* ,foodborne itlne..rs interventions and riskyactors listed above, can be :3 403.1 I(C) Commercially Processed RTE Focal- ,found in the fotioning sections of the Food('ode an 1105 CMR 1401F, 590.000. ° > Item Good Retail Practices FC 590.000 3-403.11(E) Remaining Unsliced Portions of _ Roasts' 23. Mona ement and Personnel FC 2 .003 1S' Proper Cooling of PHFs 24. Food and Food Protection FC 3 .004 25 Equipment and Ut©nsils FC 4 .005 3-501-1.4(.0) Cooling Cooked PHFs from t40°Fro _--'- - - ---- q 006 __.__ �_.___--_Water, um m- an ante FC 5 1 70°F Within 2 Flours and From 70°F 27. Physical Facilit FC-6 i .007 to=V1°F/45°F Within 4 Hours. * 28. Poisonou, Zro is Materials FC-7 ' .008 3-501,14(13) Cooling PHFs Made From Ambient 26. S eclat Re uiremanis _ _ .009 Temperature Ingredients to 41 017/45°F 30 __ 1,Other Within 4llours* - *Denotes critical item in the federal 1999 Food Code or 105(.`MR 590000. t l �* CITY OF SALEM t f BOARD OF HEALTH j Establishment Name. Date: Paye: Of 5 Item .Code C-Crfticul Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION No. Reference R-Red @emPLEASE PRINT CL RLV 'j'Vedfled h� 5 Z4 A2Q a { _ "ce_ NJt v _ i p s ITT D /I )till y"'l f } �E ( Discu r ionjyVith Person in Charge: Corrective Action Required: ❑ No ❑ ;Yes m 1 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 asidescribed, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that . noncompliance may result in daily fines of twenty-five dollars or-suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 's j - ❑ Voluntary Disposal ❑ Other: PHits Received at Ternperaturcs Violations R&II to Foodborne Mness Interventions and Risk Acci)rding to Lztv, Cooled 1,) Fadors(Iterft 1-22) (Contj4 1 ifF/45'F Within 4 Hours, T-5 TTl T Cciolin�Mahods for PHFl; PROTECTION FROM CHEMICALS _— ly — RHF Hot and Cold Holding F-i—A 1—-_— 1- Food or Color Additives 3.501.16(B) Cold PHFs Maintained at or behiw 202, 12 Addiliftes,k 590 W4F1 41 145'f F" 3-30114 Protection I ovoil Addillvcs* 15 P isonous or Toxic Substances Hol p[IFiNfairujuled at or above '(01.71 kle u t m Infoi makion Sol flc,,_�) 1 Rsus Hdd;Al of zibo%e 130,F. to inc— Time asa Public Heatth CanttaI 7 101,11 1Cutnnitm V snie W,trkki,Conlamer," teat a aPabheli atirionvi)V 7_201 11 Rec, 7-202f 12 Cmaijdoof Uset REQUIREMENTS FOR HIGHLY SUSCEPTIBLE K),3 H To if Ciauaincl� --viollibi! on" z POPULATIONS(PSEL 7 °04.11 Sarnti7el,,.cnlerizi- Chemic:0 — - —---------- i,,d PI�-padkfigcd knees turd I T'1(4. Waslac Reitii,fes wab Waymn, 1,al,ls- 1 7-204,14 Di�I nif Aifcu Is.Cri w i ia r= TF___ ____------- 'f-801 1413) Uf,i,f Pj�te ai,td IncidmIal Foifil Cfimt,t, Ltill]lcaws, __• —, ___4 -I I ID'i Piw, or Pailtfill', Ante r1 Fcssl a_,, j 1 led"s, CnrcuTi 7 200.12 L -7 20BI_" I i;i ki iig T oi%,;t., 1 1 '01)IT ft'i(I -------- CONSUMER ADVISORY TIMEtTENIPFAAlURE CONTROLS Posi'd !'e i, Ililid,al(141 %A, lm! 1 16 1 Proper Cooking-Tempe,atwe%:fca 1 . If PHFn N (T 3 10 i,I t,1 y.t i 1 ;,g, 155 F 40 L 11 t,1�f'f 1 ,..mVfmllocd F;.�hf Nle.tls It kitm SPECIAL REQUVREM EN 71 1plIff_o Witt, i:,�31- 1 It, kpf,r.tit!Lld — ---—----------------- 3 401.1�;A;,�'" Wild 6";;!", i'tif""'f, I � .-S S- ; Fi,11, Me,itl f f o"to"'a w1fftf;T ilw i if f fi Lei I Items 23-30t , 40111(h) 11frtli'Vo C- 165' r2Mmwe smadir"-, C"slt ,1;Z z 1!f,I3 i "u,iff, Wk, fa,Bref, me, "1 .403.1. 1t'k�F1 t,im a!IV P.i K o ss"d R i I .4f:ia 590,0JU C 2 IN Is 2,t _,v find"'otxI Pronectitir (104 1 14 F'ropo Cooling of PRFs I r- 4 L-IL 2�, i E11011mem and iyjlersz�3 F"1 4 5 0 1-14(,V, x0;n Cookc,o PPIF, I i�ml I aj�f w ----- - '26' 'W t s, vuhl"I z [Iourft it!xd From ;;)'j 27, Fac'.,. FC '-K)-/—6 C 7 00p �fios,iif-,ijs or "i,1- t_ ---------- _22 -L-,: ------- If _50 1.14,B, Nlt,dc Hom Ambiem 29 SeOCIN llw-Ld�ela'ii 41�I",I if 3tl�in 4 HkAus %Itt 111iohtf _ ! CITY OF SALEM J-BOARD OF HEALTH Establishment Name: � ' '''� �l ��f/�. Date: Jl/4O _ Page: of Item Code c-Cndcal Item DESCRIPTION OF VIOLATION/ PLAN OF CORREC'7ION ! Date No. Reference. R-Red Rem ` �t''x 'VerMied x - T PLEASE PRINT CLEARLY t�0f- ).v1 lQ�194q >' =C �4,JIIIAe rJn K I 0D I/ J--- r/ C- 4_) c.�a v rzv r c c / L/0- /5 / 3 .w ILVA , L ar, i2ZJ L - r C - _ . Le r , l /li 6 C4/ l C O-i o ,' IJI ,"1-� l I' " / ( Lf C. ♦^. _ I r r ll /J/N' /^kirl/I /A ��'/l/I l 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/ l violations-before the next inspection, to observe all conditions as describedExclusion P , and to 10 . RLae-inspection Scheduled Emergency Suspension. t comply with all mandates of the Mass/Federal Food Code. I understand that ,f noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure t your food permit. ElVoluntary Disposal LIOther: r. 501 A4(C) PIWg Received at Temperatures - Violations Related to Foodborne fitness Interventions and Risk I According to Lav, Cooled to Factors(Itelm 1-22) (Cont) _ 4I'P145`F Witbin 4 Halm. �3-501.15 Conlin-,,Wffiods for PHFs PROTECTION FROM CHEMICALS _ lq J PHF Hot and cold Holding 14 Food or Color Additives it 501.16(B) Cold PHFs Maintained at or below .1-202,12 1 Additive." 3-302.14 Protection from Unapproved Additives* I 590' 1+) 41 /4>`T'� _— 1S Poisonous or Toxic Substances -- :?-501 16fA) lit PHh 1laintained at nr above -101.11 } Idenhtyinginfoimation-Original ._ idt 'F. 501 5(A)_..- Ru ,t,Held at of above I3(T'F_'" t.onimnus t' "- 2d) 77 1 Time as a Public Health Control -I 102 It ' C.;mmon\ a� ae Rni t<ro til Cur, r,-_ �-- i-- --# � - -_ - ° ( j fis n- — { . - . iPubh<-k t,eaiht hf-t�a} ._a" oi-f i sq)a awn G !r-e Rtyt aVt'-20111 k.mlet on Ir , n utl i < - - i _ l i22 . ndui>m _. of j,,- REQUIREMENTS REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ?t}3.t1 hoxicfuttamea Proll�hihx {�- ---� POPULATIONS{HSPS_ 1 '(M.i I 'imn vus C nten, Chu uc h -r Fna3gS-- Ii(1� {-t2 , lul ces a-ul wen 04A2 f ii t,for N ,hiq 2z}i.W 7rSQA! uta Criteria' N , ' b c pf 11(h) e?05.11 Imid tl I.xvl( ntut Co? cu ' �- � -- - - -i f t-;T) 1 ' ice,tn� tlRtR ufe. t": rtt - 8ti1 ! IU?! H: n 1'ait_i,'1,L��t�:!:Au final fc:n} aid �I. S 0 t, ?itt No! 4,rvr 3 P � Aaor � t}- f i -�✓6 'iz , 'i�ra n rh F wdr� .} ,si t'unL,'�,., 1 _�.__ .. _ x._ _ _..,�� _ eil CONSUMER ADVISORY TIME(TC:MPERATURE CON PROLS 2' 3 *U: I!i i c + t w;4 r o ,J r t v un tte<m or ._7., �_.._____._.� __ ( 3 !a'. KNi {d. t }i,t j 15 Proper Cooking Tomperatwes fat , � PHFs 1 j ` + `k c , 'rtx< < d7nrrc rt , i)c.1 3(i t i t r _. .� -1, int +, hsT I K _e - s i . -t SPE=L'FEE UIEMEN Ts r,r ui ii ei nsi : I o ii .— .__- _ 1,ii 'ham i 4x t Uc } }ir h t, 1 , Au 2�� ilf , hz E t3i5 ril-!I C,z x'.e . .. .,.K., .� t tE ,vN .._ ...; ji , Plebes n3 7 for Noe Flutc.t g .- i t0f.R7r5`l.f-S 9LLk r--0 TO ._`!d„I RETAIL iii }r iftl 6 > ,c _ _ r iltrnls 23-30 - 403.1:rhi %Iwkmav( lr i' i- 2 "Minus bi4z hn', awal atawl ro no �+ct I �t l.,tt,_..�. �._ .. ? Ir��t Lr�rttr:?! s •n_r:nrr �.,tr <f r;_d,t i+t,>n li;+d,�t r,�- [set f,r� yt mr7er is lv P.i,.�::ct' �t ti i�,ai- -art rntn.l r r� s, <eE ..u, ( ,nr- r lta+;::,..rt ("ftp UrGl ,-3!l3-its 1 conal:tn;L �hcd risen I:res i_ttalt� Good YeralPratN cos Fd +0000 lmnaGf, rt d ilei o t .. _ _ �" __ (g Proper Cooiing of PHFs - c� � { rK ----- -- - --. 2,r z �u> n r,ane Ut As ' f z AIX S::t. '`•(A? (rw+tint Ca,k.d lHt< tmoillt+'1=to ,- 'fir ._ :.. . hx Fat, }C_r k7 ! t,,41'1115F u hrn li on �{ a... '' s� 1; h ' -7Q) 1.1 E; cooiw,Pwt W& Fr in (oaten t _ "i b ai h < �fl, •,r T mt ratuml r,.tiicm lo t d3'1 c )tr •I m - iLia< -.i ihr t,rHs.�i 19'}v Poixil '. . .. -� , ,,�. CITY OF SALEM / BOARD OF HEALTH ;Establis iment Name: <7+-6, Date: cJ Iii 1I�f� Page: �— of r 7' Item Codi c-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date l $No. Re lerence R-Red Item - Vertfied fr 'PLEASE RINT CLEARLY ` 1v W nJ-f O i rS (re ✓,10 d C,), 16 c) �} r _ f� � - t tcL CCS<�1/L= 4,q :✓tcC �'c-p. b ` JYp Ing Ir lf/ �l S G.'/ �Al/�t r � - r i v 1 i aDiscussion With Person in Charge: Corrective Action Required: ❑ No es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure { your food permit. ❑ Voluntary Disposal ❑ Other: r3-SUlJ4(C} PHFs Received at'remperatures " Violations Related to Foodborne Illness Interventions and Risk According to Lam Cooled to Factors(lteMs 1-22) lCont) 41'F/45'F Within 4 How's_m _ - PROTECTION FROM CHEMICALS -7501.15_ Coolin,,Methods for PHFs 19 PHF Hot and Gold Holding 14 Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 3-202,12 A("tilcs* 590-0(1-.(F) _ 41`/45`F- 3-302,14 Protut,on from Unap moved 4dditivesv 3_jili.l h',qj ILx PHFs tifaintaioed at or above 1 c j Poisonous or Toxic Substances 14G'F 101.11 Identifying tntonnation -Otjmai t'onta,u n j 1-501.1!(Al Rwmr, Held at to above 130'1" Lc }-t ,02.1 1 Common\ami 11:n E, .e i on n r *�-1 L20 _ _ea a Public HeaHb Control 7 t0 t.i I �¢i tuon 5nna _ _ f ttr a:a Public,He,t!h Conti t'7 1 11PRt ict'on-P, stnca'n d I c - - 'f(7.f'0 iM_.__._. 1 _ares Rtxirut�eu_ _. 7-20112 j Cot dt ion:,of t_s� T -- - REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-10,11 Yoau rf vlrnu "mh bi.onY I- — -- — I POPULATIONS(HSPZ_ i )4.11 Sanmic cti Ctitt in Ch. .nc Iv _ -_- I '04.1 I C'hcnur :I tttr ah not t od,u,t, (r,ecas` ( 21 ; €0' I i t 1) :;rip, tem ic;.d f t �>ai rgcd lances mtQ i 04.14 t Dr in It entc.C rt c is _ . 1 f- -� --- kit c hoes w th w umnilal Is` - f '�—' - - --1 RO' !t:}3, t 3ti n' Pu'tetm :d 1 �� t h(wd ntr) k sal t c rur bill) u r 1 -{-=-- ,w-- �-- -{ .__..�,..._; _ 1 .-1"— , lftli r R_.4v:ar 1 artiall. Cr.a}.zd Assun.d Fcx,d a;,,3 f 1{c' ,,i d I u pc. +uCiE c. , ._ a Roclo Dnfnt, A:. Servc<i. 7 'rK,.l E ?':xl t h t A.�,1, n `-' - - c : Not R .enc! �1c�uc,in° CONSUMER ADVISORY FtMEtTEMPERATURE CONTROLS I {�- 1 j > snm r at iszx4 Yuvt ! ar t oa kli nm of hoc csu? Proper_.oak�mg h t.nc rel car PHF ! t 1 t (itI t t ll tpr( c,s .�I i c { . s i' i 3 (c:r, ' t r Soh n ,o; if a sta fl 1 ,Nlnncd,uc `4u ica , F15,w ' _.. 13 f r -rt , n z , f n - -, _ SPECIAL REt3U[F1E69#'�! 4u , s , 'f i , r , . 1; Zu < , i Wait, � _ ... `' F 1` j 1 ,6_a,_ ro- „ cnn �.t,.ir - i .. 1 :'at:'tt t� ,nuit! r i<x3t' •:t•:tp: !t�; f :1t!.1u 47 i; ! 1° a +S wily (;"mc, "SwIrco PHP,, ( c"tit:.l,111 A 0chen c,l :;iEr z to Fe. i nihil c aaacriitti P,t , £, � t3 EC Y,Eg3, Hot i ,,,:Etlq LILt!.AiFONS/iF i,4 FEV r,. .,'(:00h`!;.�..-a. c", iltelos23-300 it i w '04m.. AtandinY { C, or c'aw.r ,n ,r;lh III , ,-ti.n>. ; ,ich d0 ito; c , . - _. I t nr. I;uttC` i , dUi-rrrc iF r F =rn:;�ue,an_�,.rti r+,!ia.Z:•c tc.i., t.-. tis Le :.}3. :r:, r> ,- -c se,..or tc� i I u - em Go.of Beta, PrrCl,caS 0X(I E P ol, tf:,t,t ka ti30:1 _ ._ t Manaqemer 1 ald Peroni ,: l t c S P 9 24 xf ft"l o-xtPoe itr r`G fX'=y I )i..I,LA 7,hf 1\;duo 2li l4 it .:idl.,irm Ii'n acft'aoGht .s .L ;_ Proper Cooling of PHFs = - 1 i 2 � t`r d' PtnrtimCy GU 1 r; c� JC; a o fi, J 5.rl !(E3i — f,t lu . E1P r ri FtN i A,,,Ficut i- I rn , a0 i 1 tin¢ st rr Lcrns., .i"k 745`1 ,.-1` 3tl_f _ _ _. _ - � S4itii7 _Irart" i Commonwealth of Massachusetts � F City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED.:. . 01/04/2010 ESTABLISHMENT NAME: Regatta Pub/Salem Water Front Hotel File Number:BHF-2004-000336 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0079 Jan 4,2010 Dec 31,2010 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2010 Board of Health I rfThis Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL. 97 8) 741-1800 KUVfBERLEY DRISCOLL FAY(978) 745-0343 MAYOR DGREENAAUM&ALEM.COM DAVID GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE ACFOOkD EiSTABLISHMENT(� n NAME OF ESTABLISHMENT�QL r 9L JUTEL# q1Y'7L(O ADDRESS OF ESTABLISHMENT ____ FAX# � -=�J_� MAILING ADDRESS(if different) II ( 1 I EMAIL-Business %Lk6A-,T IL u�t r F end c (Am Website:Ullulul.Slj lD m(l, )�4Lr r �n� �e l . cuv OWNER'S NAM VY11�``d0ae,( tZocAcett' + TEL# JI ADDRESS U I eeSts�k yyl� y[yL� W( dlQu � STREETI,, CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)�f U�J� r�V DD G� r IU'-e/ CERTIFICATE#(S) (Required in an establishment where potentiall hazardous food is prepared) EMERGENCY RESPONSE PERSON � HOME TEL# oD'AY$®FOPERgTIQN, ", , onday )WTuesdaW,'140 ngsday,01 Thursday;,, g' , Foch j, 'Saturday`s Sunday* HOURS OF OPERATION Kw- - Please write in time of day. � � For example l l am-11 m 1 ,v-,— U.p r- TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - - -------------------------------------------------------------------- -------------------- RESTAURANT ES NO less than 25 seats -$14 (Outdoor Stationary Food Cart$2 25-99 seats =$280 more than 99 seats 0 ---- ----- ------ - ------ .... BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME --------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO' $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted topnd'Ap ed by the Salem Board of Health. Pursuant to MGL Chapter 62C S i 49 lc( y under the pains and penalties of perjury that I,to my best knowledge and belief,have filed)all state tax ums and paid all t rHn taa�� t -41 �oMbb e Date Social Security or Federal Idenlification Number. -------------------------- --------- - -------------------- Revised 424/07 FOODAP2008.adm Check#&Date __.�_a $ � i Commonwealth of Massachusetts City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Hotel - Motel Permit DATE PRINTED: 01/12/2010 ESTABLISHMENT NAME: Best Western Salem Waterfront Hotel & Suitesl File Number:BHF-2004-000276 225 Derby Street Salem MA 01970 - LOCATED AT: 225 DERBY STREET INSIDE IST LEVEL SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes Hotel/Motel BHP-2010-0281 Jan 11,2010 Dec 31,2010 $200.00 Operations Permit Total Fees: $200.00 PERMIT EXPIRES December 31, 2010 Board of Health Page 1 A CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 I{IMBERLEY DRISCOLL FAx (978) 745-0343 MAYOR IDIONNE@SMEM.COM JANET DIONNE, ACTING HEALTH AGENT 2008 Application to Operate a Hotel / Motel $200.00 Name of Establishment: e. -C e Address of Establishment: Of 776 Mailing Address (if different): - Tel#: <7 2R- - _ P-7 per _/.n - FaX#: S'7,P- -;�ln ?7-2--Z- Business 7tiz / Business Email:l„��T �/o ,ta lr 1� � Website: �,,u w• s��a.. �, . �� // .:r Owner's Name: ZIU-., Gc- Tel# �,pi— 103/- 34-7bAddress: p -AV 619 ,� City State Zip Emergency ResponsePerson(s): Jew 7e«. Tel#: 97;11 z/o- &,6&8 How many rooms are reserved for guests? Zzo Is food served in the Establishment? ✓s Are animals allowed on the premises (other than service animals)? Alo *Please make check payable to the City of Salem.(Pay by check or money order only) 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. Pursuant to MGL Chapter 62C Section 49A,I certify under the pains and penalties of perjury that t,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Sign bf& Date Social Security or Federal Identification Number -------------------------------------- - ..--.. -.._- -. . - -- -------------- -----'----- 1 I/30/07 hotel-motet appl.doc � Check#&Date ! ��l / /7�� $ Massachusetts Department of Public Health <f Salem Board of Health s Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvoa of 0 eration(s) Type of Inspection Q2C11_ajta,1 Valf - ) Food Service Routine Address r a / Risk Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone /1 �Y ❑ Mobile Date: ,a�� Owner- 1 HACCP Y/N ❑ Temporary ❑ Pre-operation fM 10AA/D ❑ Caterer ❑ Suspect si Person in Charge(PIC)) Timer ❑ Bed&Breakfast ❑General Complaint [I HACCP Inspector i3 Permit No. ❑Other Each violation checked requires an a planation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) Q 590.009(F) action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT;" r El12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH '-. 3 ' ,, . ' • , . { �, 7 cPROTECT16N FROM CHEMICALS, k� ' ^•i ' ' ': '' E] 2 Reporting of Diseases by Food Employee an%.d PIC ' ' - - " • .< - . .� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 15.Toxic Chemicals ` FOOD FROM APPROVED SOURCE '. . . _ '„... f Tj .._ ❑ 4. Food and Water from Approved Source i�TIMFJTEMPERATURE CONTROLS(Potendally Hazardous Foods) ' r ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATtON,', I "_ ❑ 19. Hot and Cold Holding ' to St • { a.'s ' e i ,fit ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control --�,;-9. Food Contact Surfaces Cleaning and Sanitizing IREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIQNS ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing "C�OJIISUMERADVISORY': {°I " _ El 11. Good Hygienic Practices (%, 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below to ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food x 26. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION:VktNo &A Y 5:590Nspec(Porm614 da �4 X, [i111, UkWA Inspector's Signature: U Print: 1`•)�� t ( �..� - PIC's Signature: Print: Gu Page ofPages a f Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 596.003(A) Assignment of Responsibility* 3-302.1.1(X)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge- duties Contamination from Raw Ingredients 3-302.11(4,)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11.(A) Food Protection* a tlicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foal Employee Or An 3-304.11 Foci Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,003(03) Reporting by Person in Charee* 3-306.14(A)(B) Retained Food and Resemce of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(,F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Samdv.ation fem eratures* - 3.201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 1,gs and Milk Products,Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable D nk ng Water* concentration and hardness. 5-101.11 Drinkin Water from an Approved System* 4-(i01..11(Aj FquipUtensils Clean* Contact Surfaces and 590.006(A) Bottled Ihinkin Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.01' 4-602.11 Cleaning Frequency of Equipment Faxt- ShelHlsh and Fish From an Approved Source Contact Surfaces and Utensils* 4702.1 t Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from,NSSP Listed Chemical" Sources* Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing Re Mato Authodt 2-301.11 Clean Condition-Hands and Arens* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* -590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.I7 Came Animals* 11 Good Hygienic Practices Receiving/Condition 2401.11 Eatiniz,Drinking or Using Tobacco* 3-202.11. PIFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and - 3-202.15 Package Lite it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When'fast'rn * 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-20118 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" E11to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible- 3-402.12 ccessible3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-20411 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 Processus Methods* Devices 3-502.1.2 Reduced oxygen acku •ng.criteria* 6-301.11 HarrdivashinE Cleanser,Availability 5-103.12 Conformance with X roved I rocedures'° 6-301.1.2 Hand Drying Provision '*Denotes critical iter in the tedend 1999 Pond Cale or 105 CMR 590.000. - CITY OF SALEM z BOARD OF HEALTH Establishment Name-Z'7 t t �J r f`tR��iyY� lQ/Itr � - Date: Page: of _ Item Code C-Crltical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item" '. .Vdrlfled ,t n p 7 PLEASE PRINT CLEARLY r l f �ik�cC,DXINV1 _ � �_� U ( �AQAw -(bC" -'IV 4c - c., i %r ° (y/ � -5) , �] v � Q �U J It � p v J 1, A 0�x _6 ` `Jk .�, lid 1 �rl s }• +/t 2c•us•a 3P 1 t Pt iQJJ AN Sk. ' 9 4-7, Oe UAa vn ►ht Vl+✓;,� U�/'^�\ 1f1� _\� , } Discussion With erson in Charge: ° ,bbrrective 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 Exclusionviolations before the next ins P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food C-o`de understand that noncompliance may result in daily fines of twent.- five,dolfa`.s or suspension/revocation of ❑ Embargo ❑ Emergency Closure II your food permit. ! l� ��/' .a ❑ Voluntary Disposal 0 Other. r 3-501.14(7) PHFs Re: ived at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to LauCooled to Factors(Ito"1-22) (Cont) - 4I'F/45`F Within d Hours. PROTECTION FROM CHEMICALS 3-501.15 Cotding Methods for PRFs 49 CHF Hot and find Holding 14 Food or Color Additives 3-501.16(R) Cold PHFs Maintained at or below 3-202.12 Additncsr 59t).0(k(F) 41`745`i" -- 3-302.14 Protection from t"nappru,ed .Additives* 590,00 6f H 0145nt FF Maintained at o�above 15 Poisonous or Toxic Substances 101.11 tdr;uiifymgtnftatnanon-Un final _ t4U'P.a Ji(i1 16(.) 1 R:xtcts Hdd at or atwve 1 Corea rt Time as a Public Health Control : 1011I as ;Puhhc H,alth Cootlol'_ 36(.11 Yepa ;wn-Sntagc. . 2172.1; Rest icUon-Py,s:nu and F,ac —_ - --7-202.12 Conduum of qs REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic f o xaroea Pn>h bi..i<mti POPULATIONEHSP�� 11,04.11 Samtvers Criteria Cheinc I+ 5-R0 Il�il/�t� _ 7 204.12 C hums tit for A :�hu >t <,�;fisc f t tY t C yip: leu teed 1're pa�1-yged lutcac:utd�� --k cte,et r es with Ranting Lah !t 7704.14 U.,tet Arent< Cntuit _ t_ of gs` : U5 I ti lm io nt tl t text Contact.Ltifi icajili ,-S'01 !I lD)�kr u or Yn tti'ul t :+i)k( 1 Animal Ftxd and ?06.1 I 2e;'ui a tsv Pe nua.�. kw, .,d a)-r; IS tit t 3ers<o. 1 7-W6.12 Rkxl;a d: t c yto t.= __ _ __. __"_i bei 1 n{ (_ et csy. Farr '. Not R ` ; Oti.t: � l -r u,,�?L.1er f �untr:l and ... _ icnitonn� .. CONSUMFR ADVISORY TIMETEMPE6'ATURE CONTROLS 2 ? r o; u , : Ica •sort ,r :_; r ri n tanirri;n t>, 7 . Temperatures d the t c t rte i 1 :�u tc +a �P aper F'onLing far � ! F,xw `�1 11t ,3t I � t 1 East I I Z �u at 0 !?.tl Rt ,t C ! E 1."i onn _--------- SPECIAL REQUIREMENTS NT^s t - # - - i k 5SJ ),4{;,}_ 17 : , dcs : ti t 1 se + <3.(Ar12=P ))}3r �I k: :rc., 11 Llt. .�t cta . S �. i t _ 1 xt14 ° tl `1 tt U^ hst la f+", i t FrLi_:61� :.5 ;I, v: ._.. � � �`:r J ,yr j~•h .�ter vt�. d: ,t ::_,tS ns„t , s. r? 1 Reheating tat trot Molding WOL ATI)€tS FRE1.A TEV TO GOOD RETAX PRA ` -._ t lit ib 1 c ,) {Etcnzst§ 3t}t 3C 3.tlEt3 Minus t,� # 1 M!nwi, St mrf rtt rtr r 'r rjm,'I”: ill t -,ts wi rP do,w; t u+ 7:r. ( 3--403.1f(Cj C'44h at Jf r 4f3.i}(t t Rc to u.tinr;L=+�i..ea Pc�rttt s.=f littf I lien; Good Retail!practices i IFC- { J9t7,DttFa , i ir6 sProper Gaoling of PHFs lef'oa +ULld1} P�11c (=nts !�7ttzVtt C;, r i CC-5 OC!- iE:in sd Fu o 79,F 1 2 Fat ty FC- 6 007 tc : k-4,"i'k tlun ° How- 6� t ,ta-s_ FC- 7yC-7 i � :, .,01 ( : lo... P7-TF At do Ff om htthent T r F aurre h r d cots :t 7 iS itn n Al I-I'lilfs, ! .. _. t } CITY OF SALEM , BOARD OF HEALITH Establishment Name: 1 A 1 l V, 0.fI1 IL4- L✓/koub (Adate: Or\)--(_) Pager of Item Code C—Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Re?erence R—Red Item Veritled PLEASE�PRIIN�T CLEARLY //�� // N.� n �),/ 7 AA o i /n '1Xn 0 /n, A . .na i �a AAIB VY -Mlo �, _ _ )PJA'�� 4 _ / t [ L t y` pk ' r 4^ ff] t 5 t S t 1 _ Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask question as nd agree,to-correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all cond las-described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I un.dsrstand that noncompliance may result in daily fir(�,es of twenty ti've dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure _ your food permit \ ❑ Voluntary Disposal ❑ Other: � � a Y 3-501.)4((') PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lain Cooled to Factors(Items 1-22) (Cont.) - _ 41"F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-5(}1.15 CoolingMetfiods for PFiPs -- g PHF Hot and Cold Holding iq Food or Color Additives 3-20212 AddrbvG.* 350LIb(B) Cold PHFs Maintained at or below 3-3f12.14 Protection from Unappttnad Adduives° _ 54U.0iWI-) 41`/45°1 1S Poisonous or Toxic Substances - 4-591 161 A) Hot PHF c Mainraiued at or above 7-101.11 klentlfinlnformation-Original I4(i"F. * 9 6. } 5[ii 16tA) I Rwsts Held at or above 130`F_" Conta.tners — ------ ---- -- --- i 20Time as a Public Hearth Control r-102 11 C,mmon Name. World � - - 7-20t.i I Sr al,tuun Si 1� _� 'im as i Public Hmilth('anti xl' �. 7-202.F2 Condition..of fft o 7-303 t I Toxic(ijllfamelprollibinw1W, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i rQ04.11 4antoiets Criie i i Chc i ne is _ POPULATION${HSP) 7- 04.1 CeiiCh nn.a,tqr vv nh . Z 2E3,€(T 11tA} TE Unp leu [cd Pre pac).gcd juces and _ tfowrl e.witl v^. tai - 1.a1 I,' 7-204,14 Ur it,,Ai crts.C r,t l i 3 j - fi0! I I(iii I o` Yu te.arin d l 7 205.11 Lrcid atal F xd C vilracj I.or'l icams - _ i-2 -}-----. l� . U (I _ t;u ,r Plllial7 Clokd Animal FlAd andf- ai - o -7.. ()(.I1 1 langr�i>u-lctiZ.�l'~s Control awd ADJ#SC}RrYai" rn t yvci R ow I IMEtYEMAEHATt{RE CONTROLS ! 22 3x9311 FC ,n ict vii ilory flosiotl x r t in7p.iaa k' Ai z +:it 3 ss3 ,haii.-C RA-, C'txacnt>uked t 1 It Proper Cooking Temperatures for 10i_1!All (. l E, 5 e i55 t i vitx I lf4 j 11.a, � a �:aLt't.i,c; t �, Ina'•..,t iyY..1t�,� t, ( „tip t c. . _, �.__ _,__ .�� _. _._ _. rtes ` I sc. _.._ SPECIAL REQUiRFMENTZ SIAjiii , ' . � sk .33vRotr lift (> uiin' — - - -- _ _,_ at psi S of -..... �S '�, st,L.lt s. 3, ' , r.t)rra, t4 .,f is .. Suite : is - 1 c.;.2 z. ,,i , 7.!, .ir„ , .,i_' i r`{t S ',. I„ i., i.a e= t di „ ... Eors j;t1:Pr i i Y. 4eheniing t„ f t Ho,.ting ' VIOLA7-IONS REL.A TED 10, GOOD$ETAR. PRAC R7ES _ --i �._ -- --1 t ,e i {1letti�23-341) 103.111Kr �� Mio sv ivc P15, ) 2 Nlinwe bl inding ( C%of w�.ttO r ,<;tii:11 . , ..t,iu. "'h,ch r4, ,w! r <t< -r r:.” -I-i tt " - .� ni. jir rnr €h s, fiWrt ,r .i(" ce4,n.Lr { a403.1 It C) 1 { nncseix'h Z'it's -cdRIFbxxl- 1 .< m i.i,ri,lri n., nsc, + ,ncrrrttcnde iii fir', t'd!F{ IO F- _ 'U ow, i R—C—Inalma, —I Itder Good Retail, etail,Praatices i� . fCCo 5003 votlo Van C6PSCe',-6 _ --- Primer Cooling of pHFs— ' FuGwl oec FC 3 75 los F A ?SiEqncr, 1f ! G t.26 'da-- 27, iv i Pi ibi;c�uiC ,V c { 7., I vvidivn 2} aur_ n>id Frim iit`T,r ; i o phvl a eau ai'v FC-6 00/ i }I F_i 15`F'V.iti ti Htn i l 2a 0or Mc kiater,:ils- rC Clic n .3�C6 Cc oka PI-IFt hl do E"i<.m lmniaun _;� Ctq , k�,.s r 4 t tt inlet 4lhlur�ut r i ni;to -t tJS'F - -- -- - - .)--i ii. t •i::;. .. '(cr�i C. is .�. : 31< S3.fh76 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name (� 5 / W D to . Tvoe of Ooerationfs) Tvoe-of-Inspection POJt f t Y .1 Qr"/ rrn�- Ar:A-PJL. T"a� iFood Service L Routine Address / Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone O ry _ (� i 1 f�_ ( Cy ri ❑ Mobile Date: Owner 1 Tr [5 ?t (,'' HACCP YM ❑ Temporary ❑ Pre-operation �Q AAA A OA_T- S_ P P�-��P/VIOX ❑ Caterer ❑ Suspect Illness Person in Charge(P C) \ )C A Tim ❑ Bed& Breakfast ❑ General Complaint Inspector �` x e(1,p A Ou Permit No. ❑Other Each violation checked requires an expla ft tion on the narrativepag s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E)_0' 590.009(F).Q action as determined by the Board of Health. f FOOP PROTEC710N,MANAQEMENT g »» r & .�;;„1.G� ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties �EMPLOYEENEALTH«_"VP7" Irg �13 Handwash Facilities a. ^ ..r s`aitL;a: are lz �t �"PROTECTION FROM CHEMICALS ua f I , " rem; - .�t��a.,,sk ❑ 2. Reporting of Diseases by Food Employee and PIC ,� �r d �� Lmg °° Iaa°s u.��. °,o ��.3 ❑ 14.Approved Food or Color Adddives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ;FOOD FROM APPROVEOSOUROE,'""',,, ,,r ,„'„RV"„ ...° j.-nt<9EREMPERATUREOONTROLS Potentlesry Hazardous Foods m ❑ 4. Food and Water from Approved Source ° ( Y ) ..,a7gn.zci�'t siuti 9 wr„i.,.-.:.-&.��a`e'•,�.;.aikiw;ewl.ia a ,i.: ,kca«;fi a:ua.k� 5. Receiving/Condition - f 1 E1_16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling ° PROTECTION FfiOMCONTAMINATION f' z p E] 19. Hot and Cold Holding .- .' .,.,,u u«-+ uwmw�:a, El 8. S,eparation/Segregation/Protection [120.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing t.REQI3IREMNTS FOR HIGHLYSIiSCEPTI,BL'E pOPULAT'tONS(HSP) ',".= ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices ,CONS ,R,ADvISORY'f ❑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 to ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fa2)(s9 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(550..004)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 �f DATE /OFF�)RE-INSPECTION: s ssoi� �Fon �a.eo� `r i nlr'�%V /I'I-vttJJVI,ciJn^ Inspector's Signature:_A_,_ Q Cl) Print:VDC)JO lnl lz�_ c.at t PIC's Signature: 114- Print: I�.. (�`* Page of Pages V Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Respor sihility* 3- 002.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE F<xlds* 2-103.11 Person in charge-duties Contamination from Raw tngredtents 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3302.11(A) Food Protection* a ilicants* 3-302.15 Washin Fruits and Ve stables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and - Applicant To Report To The Person In Iltensi1s* Charge* Contamination from the Consumer 590-003(6) Reporting by Person in Char e* 3-30614(A)(B) Returned Food and Resewice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE 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 Tem eratures* - 3-20113 Fluid Milk and Milk Products:" 4-501.112 Mechanical Warewashing-IIot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 - Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.1 I DrinkingWater from an Approved System* 4-60 L 1'1(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean- 590.006(A) Water Meets Standards in 310 CMR 22 0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.1,4 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Add Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Alms'` 3-202.18 Slieilstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1nim .7 Game Animals* - J.1 Good Hygienic Practices 5 Receiving/Condition 2-40111 Latin ,Drinking or Usin Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-20115 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting" 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 ShellstoekIdentification Maintained- Employees* Handwash Facilities Tags/Records:Fish Products 13 Conveniently Located and Accessible 3402.11 Parasite Destruction* - 3402.12 Records.Creation and Retention* 5-203.11. Numbers and Ca ovules* 590.004(J) Labeling of Ingredients' 5-204.11 IAcation 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. Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen pack y 'ng,criteria* 6-3011 t Handwashin Cleanser, Availability 8-103.12 Conformance with Approved Procedures" 6-301..12 Hand Drving Provision *Denotes critical item in the federal 1999 Food Code or 105 C.NIR 590.0[10. CITY OF SALEM i 130ARD OF HEALTH n ! Establishment Name:QPzdt aQr-Fa.ir. �1P 11an CvrA(� A4PQ Date: 7 —:�0— G0 Page: of O� Item j ° DESCRIPTION OF VIOLATION!PLAN OF CORRECTION �I 'r f Code C Critical Item f i�r�" `"rte' �- - . ' . Date "'i =No Reference R Red ` e Fg Q Venfied a CLEANLY Al A- IM .� � �tA i1� � `'JCC) 1f �_ o.d.r/r ,n n n n_ /fin 0 0 i.L r n o it jy :t Onn L1n n Yti'1 n t� C�'it o�i — i� C n o 'k" l_n 4T70TPv ZV (_�P nn C r,ot rY n J A c_,i A fr $ nJ ire .� 0 V, t 1 nut0 Q (00.0 a o,,.._,, rT� ciJzlb11 1-14- u 1-��A r a_�, - — 4 i ? &�c? i Ann.e A.Irf To `�0.7 1 — Gk� J Pc — �_ 41-o p) I -'�:J() -0 I Discussion With Person in Charge: Corre ibe Action Required: ; ❑ No ia/Yes / have read this report, have had the opportunity to ask'qu��ions and agree to correct all Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fede ral-Food,Code' I understand that noncompliance may result in daily fines of twenty-five dollars or sus ension/revocation of ❑ Embargo ❑ Emergency Closure f four food permit. ❑ Voluntary Disposal ❑ Other: , , Pl!F%Received at Tern 50 1141101 Violations Related to Foodborne Iffn ess,Intllentions,and Risk 3_ , raffles A(Tordiz%to Law Cooled to I Factors(Items 1-22) {Cott) '1€"F/45"F Within 4 Haus. PROTECTION FROM CHEMICALS 3_501.15 coolie=%lho&for Irm-'s PHF Hot and Cold Holding 1=4 ___FR�d or Color Additives LL9 __— ne 0 A 5( 1 16(23) oLd PHFs Nlam of d t or If to 590 ow*-) 1114511� ,1 , 3-202 12 Addroes' 3-102,14 protecitoll Addilivcs' Hot PHFs%taintimed.q or above 15 Toxic Substances 501 W T " 140F, Roasts Field at of abkrce I+()`R Collourlen; -Tome as a Publit Health Control 7-102,11 ComnlonName- noll 920€. 'I__+_ i 3-S01,11) Tinic,as a Public flealdi Cona,frV S� , Lon St 7.202,11 I Rerniction -Prestrwe and U (r�* 7-202.12 Condkirqfs of Uil' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1263-11 Toxic,Comamer",--Pr:fjllhi;ionS* POPULATIONS(HS 1 7-204.11 salru7ers.crilerri -chclllicilsl� _t��j t__ 1-801 1](A) Ujilnoieurized Pre-pachged Jurces and 7-204.12 cfik�allcilhs for waah!!T IkEc�clitctW _. Beverage,,!yLth Warroq, 204 14 Divure, &6I 11�Rr 11 of Pa,tem_ j ized Ee-s 7-205,11 lal.idernal Ntxl Conrafct,1,fibitermts" FZ7 iot e,�I, f, f u Ides.i Dc r 3-fall,11(D) Rawor Parljdl�Cooked Atumal Food and r 7.�06 1 Rlm Suxl'spro.troi Not Served 7-206.12 Hoilcal 6v slations' li """!i a' N 575)6 13 'I'llickintg P,Aqlem P COnvoi and —F_ ac}�ae , 2t Re sun']--' CONSUMER ADVISORY 2 ;�:F i Willer Aeoaev Posted for ripti,70(47 TIMEITEMPERATURE CONTROLS Animal Flodt Thai are Raw, Undereooked ill f 16 ProperCookingTemperatures for PHFs Not Othtnh ist:rror,,ltsed to Flinarilate 3-401.1€Aft;(2) F�gs- 1 55'F 15 Scc. Immwdtae Service 1,159-1 30113 Egs Subsraule tot Raw Shell _ T" - CoF mminuted ib &' G Meaf� �mw Animals 15VI15 sec. SPECIAL REOUIREMENTS 3-453.11(fi)(1)(2) Polk and Beef .10F 1 ' 21 win* - Rmist - 1I 590JX)9(A)-(D) ill .— T-401.11(A)f2) RalffO..InjW'&i Wilb,-- 155,F 1.5 catering. mobil.,food,temporary and See. floulm, 'n , , ;�j Fd(7 Puffer Ire d oj FI – lemdeal'al kitchen op-rtttions should be Fitoi, Meat, debited under The appropriate sections 1 11oultiv ur Ratnos-irei"'T' 15 iee, above if rel aied to foodrome illncs t , 3-401.I1(C)(3) W`holyniuscle,Inum freel"St"aks a, d isk factorsOthr-r 14,50F l' 590 violatioto;relating to good retail F-,—Af)1,1 Raw AinrulF`fods_C(Wjk':d in pnakrwe� I ' * � ,herald be debited order#29 - I — Afitfowave 165,F Special R��,cjuirernemts, 467 11(A)(1)(b) Mt Othei PHF� - 145'F 15��_c 117 Reheating for Hot Holding �:E- VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-1(33A l(A)&(L)) Plik 105"T 1e sec. Hlems 23-30) -il(li) Microwave- 165,F NfinwStanding; 0 ii' ahwld pon-crawal vwku'ima' which do ao; relate to the I true" foodhome flln,evs blW?VMhOW and ria.kfactors listed above, f aff be, :x403.11{C_} Commercially Prorecsed RTE Fflod filund ill the=felloo vq.wt tionvof the Food Code and 10.5(WIR -7--17(3 11(E) Remaillin""un'F'Cod I'orno'l,of Beef Ito Wall ractices I FC 59000 ------------- —----- _J 003 ----i 124 Fano and Food Prolecrion FO k F-18F Proper Cooling of PHFs 3 064 __I i 25, _TFC-74 t",66C 501 WA) Cwling Coomx[PH17s 6a 14()`Fto ------- Wife,, '006 F,-5 7011-Within 2 hours and From 70i' 2-7, Physscal Facljff --__- --------L FC::Lb Lo)41 T'145'F Wiflim 4 Homr, 281 Poqsclnous of 7,mc Matreaf�s 7 1 ofis _7301 4(B) Cooline PHR Made Front Ambient 29 S '009 R'frillitament's Tmperanfue lnyllefbeus to 41"F/45 F Ott ------- Within 4 Ilixqrsl 3)mutes critical hem ill lht'lo�feo'! 1999 Cotx1 Curie of b Cent 599 000, �Pr BOARD OF HEALTH Establishment Name: Date: —SCJ ()6k Page:�_of nem Code -C-9Crk�eal k '- DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION M Date, - No. ReMrence R Red Item• , �,;�„v ;�. . ... .. � ».. ,'". � . - .,,., ;' ? # pl:EASE�1'i1N'1'txEgpiY ,. -, ., - Verified S 1 &S4 Discussion With Person in Charge: Corrective Action Required . ❑No ❑Yes � _ * s`,$ %It?` ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other t FARM 7iAR IRFV 7199(1 H1RRC 14 WGRR FN - R(lST(lN ... . .. ... . .. .. ... 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:The cutting board on the Continental R-2 unit is stained and scored. Resurface or replace the cutting board. A new J Hilary Rockett Jr. cutting board has been ordered. PIC: Dan Dailey Handwash Facilities FAIL Criticald❑ RED Inspector: David Greenbaum Comment:The hot water temperature was below 110°F at the following hand wash sinks: ected:'CorrectB Wait station-94°F Date lns P Y� Bar-107°F 3/27/2008 Restore hot water to a minimum temperature of 110°F at all hand wash sinks. Risk Level: Violations Related to Good Retail Practices (Blue Items) Permit Number: Equipment and Utensils FAIL Non-Critical BLUE B_HP-20.0.8-_0321 Comment:The Continental R-1 reach has a broken door gasket. Repair or replace the door gasket. A new door gasket has been Status: ordered. SIGNED OFF #of Critical Violations: Physical Facility FAIL Non-Critical BLUE 2 Time IN: Time OUT: Comment:There are unfinished shelve in the store room. Finish all shelves to be impervious and easily cleanable. GENERAL COMMENTS: Urgency Description(s): All other violations cited in the 3/20/08 inspection report have been corrected. BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 1 oft A,* Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 2 oft i Commonwealth"of Massachusetts ` r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/18/2008 ESTABLISHMENT NAME: Regatta Pub/Salem Water Front Hotel File Number:BHF-2004-000336 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0065 Dec 18,2008 Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2009 Board of Health i This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS / BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNE e SALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTcr ((, TEL# a11� ,'d ` Xa ADDRESS OF ESTABLISHMENT D S U 5f'� FAX# q3D9--b1r`1D46-7ZZ MAILING ADDRESS(if different) EMAIL-Business':S( M� tQm �{t c t�/�` Website: , �IG1Y1f JQ� �d^r� OWNER'S NAME TEL#� ADDRESS A. b\e-h 4 \q STREET CITY STATE p ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S)Say52LI (Required in an establishment where potentiall hazbrdousfbod is prepared) yt G EMERGENCY RESPONSE PERSON ( I I R g-/ � l HOME TEL# DAYSOF,OP,ERATION <<-'Monde :�i Tuestla -WeBnesda '';Thusd '-�Frid Saturday. Sunda HOURS OF OPERATION ,e y - Please write in time of day. ! n r `� ' ,'r,` Forexamplellam-llpm ! i ! r3elv yyr TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 RESTAURANT ES NG less than 25 seats e1" (Outdoor Stationary Food Cart$ 0 25-99 seats =$ 80 more than 99 seats BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES --------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES N $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. in accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax ms and paid all st taxes required under the law. I pg7fiture Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date Commonwealth of Massachusetts i City of Salem Board of Health 1Gmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Hotel - Motel Permit DATE PRINTED: 12/18/2008 ESTABLISHMENT NAME: Best Western Salem Waterfront Hotel & Suitesl File Number:BHF-2004-000276 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET INSIDE IST LEVEL SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes Hotel/Motel BHP-2009-0063 Dec 18,2008 Dec 31,2009 $200.00 Operations Permit Total Fees: $200.00 PERMIT EXPIRES IDecember 31,2009 Board of Health - Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HFALTII =1 120 WASHINGTON STREET,4rn FLOOR TEL. (978)741-1800 KINIBERLEY DRISCOI.L FAX(978)745-034.3 l MAYOR j17I0NN1 SALBM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 Application to Operate a Hotel / Motel $200.00 Name of Establishment;–L -V�✓—'�} j Address of Establishment: 7 2� 9A Mailing Address(if different): Tel#: '�Mn �•b�I�� Fax#: Business Email:�'J �� t Y1 � �' ebsite:ll�Wty3.� �n r,�t� 4v�y.( •f.OVYi Owner's Name:,T �A tr cse \ P 1(7 ATel#_�-(��.,. 0 \ adc Z(> Address: V�C \F CaS( °> 1 ��\Carb\c, he o—A, City State Zip Emergency Response Person(s): !�< � �1 Tel#:�•1 j1 Nit$ How many rooms are reserved for guests? Is food served in the Establishment? ,r� Are animals allowed on the premises (other than service animals)? I YD *Please make check payable to the City of Salem.(Pay by check or money order only) 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. Puritan,to MGL Chapter 62C Section 49A,I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required �under the law. tt r? Signature Date Social Security or Federal I ennfication Number 11130147 hotei•mm l appiAm SALEM FIRE DEPARTMENT INSPECTION AND VIOLATION REPORT DATE: STATION: ADDRESS: % 1 NAME: e T9i� YUP �wp/Fr lG �jG PHONE: BLDG. CLASS: ALARM CO: c� OFFICER: IF/F: F/F: MULTIPLE BUSINESSES,RETAIL SPACES,OFFICES,ETC. OCCUPANCY PHONE# OCCUPANCY PHONE # EXTERIOR ( !ASS /FAIL N/A HEATING SYSTEMS PASS FAIL N/A EXITS ('PASS FAIL N/A ELECTRICAL PASS FA[L N/A FIRE ALARM SYSTEM (I PASS) FAIL N/A FIRE EXTINGUISHERS & PASSE FAIL N/A v SPRINKLERS ( PASS /FAIL N/A STANDPIPES ( 'PASS-1 FAIL N/A EMERGENCY LIGHTS I PASS FAIL N/A KITCHENS 1ASS-7 FAIL N/A STORAGE /,'PASS FAIL N/A PERMITS 1,YES NO N/A OTHER VIOLATIONS AND COMMENTS Q ! 7 � /A e/9 --- VP ES ccs -Y t/ REGULAR INSP. QUARTERLY INSP. SCHOOL INSP. Form#16(Rev.6/2003) WHITE COPY: FIRE PREVENTION PINK COPY: OWNER 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION Separation/Segre tion/Protection FAIL Critical ❑� RED Owner: Co ent:The F-4 freezer in the store room has potentially hazardous foods stored with and above ready to eat food. Organize J Hilary Rockett Jr. L u it to store PHF below and separate from RTE food. PIC: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Dan Dailey Cc ant:The dishwasher in the wait station had a final rinse temperature of 170°F: Repair diswaher to reach a minimum final Inspector: se tem erature of 180°F. Do not use dishwasher until it is repaired. 4 David Greenbaum +The nit] 'rig solution in the cook line and wait station found too weak. Sanitizing solution of proper concentration must be Date Inspected:Correct By: `readily ailable at all work stations at all times. 3/20/2008 Risk Level: \ rt knives found in the cook line knife rack. Properly clean and sanitize all knives prior to storage. Jp. The cutting board on the Continental R-2 unit is stained and scored. Resurface or replace the cutting board. Permit Number: 'Ghe inside panel on the ice machine has an accumulation of grime. Thoroughly clean and sanitize the inside panel. BHP-2008-0321 Handwash Facilities FAIL Critical W RED Status: VIOLATION ComTent:The hot water temperature was below 110°F at the following hand wash sinks: c_Wa' station-80-F Cr W #of Critical Violations: en-105-F 1 4 - ployee restroom-77°F ;Time IN: Time OUT: iBar-100-F /�--? Restore hot water to a minimum temperature of 110°F at all hand wash sinks. Urgency Description(s): i employee restroom was missing soap. Provide soap in the employee restroom at all times. BLU Violations Related to Good TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 'Retail Practices (Critical Hot and Cold H ]ding FAIL critical ❑d RED violations must be corrected Co ment:The True F-3 freezer has a temperature of 48°F. Repair freezer to maintain a temperature of 0°F or below. All food that immediately or within 10 1 h s thawed must be discarded. days)(Non-critical violations I must be corrected immediately i or within 90 days) e City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2008 ) Page ! of Item Status Violation Critical Urgency ;RED: 1 Violations Related to Good Retail Practices (Blue Items) Violations Related to - Equipment and Utensils FAIL Non-Critical BLUE ;Foodborne Illness Interventions? and Risk Factors (Require �me t:The Continental R-4 reach in needs a general cleaning. ,immediate corrective action) a Con etal R-3 reach in has an accumulation of food spills and splatter. Thoroughly clean this unit. :Th7nt,ne',talR-5 reach in needs a general cleaning inside and out. VThe Co nental F-2 freezer needs a thorough cleaning. T same unit needs a visible,accurate thermometer. To er needs a thorough cleaning. e Continental R-2 reach in needs a general cleaning. The Continental R-1 reach has a broken door gasket. Repair or replace the door gasket. eame unit needs a general cleaning. TCon inental F-1 freezer needs a thorough cleaning. T flooring around the fryolator needs thorough cleaning. -T40thbend grill amd oven in the cook line need thorough cleaning. h ire shelving in the cook line needs thorough cleaning. cook line dishwasher not working. Repair to good working order or remove. T o . ',T uthbend ovens in the kitchen need thorough cleaning. T Continental F-4freezer in the store room needs thorough cleaning. T True reach in in the outside store room needs a thorough cleaning. Physical Facility FAIL Non-Critical BLUE .— Comment:There are unfinished shelve in the store room. Finish all shelves to be impervious and easily cleanable. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2008 ) Page 2 of Item Status Violation Critical Urgency vV ` City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2008 ) Page 3 of 1 Commonwealth of Massachusetts City of Salem s • Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Regatta Pub/Salem Water Front Hotel File Number.BHF-2004-000336 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0321 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES (December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 4 of 14 3 QTY OF SALEM, MASSACHUSETTS �1t BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR ohms d� TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR 1SCOTTOSAI.E COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION R N FO 1-Q PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1,2:!j a D L) TEL#"--7q6 G 9' ADDRESS OF ESTABLISHMENT?-'2S !E�rj FAX# MAILING ADDRESS(if different) EMAIL-Business' Ali. Website:WWI 4YYV` Gf IYl1F1�� -CQ Y1 OWNER'S NAME o TEL# ADDRESS 77 I �I bnyn rrvr'J 014W STREET CITY STATE /�/� ZIP CERTIFIED FOOD MANAGER'S NAME(S) SII CLQ 4 CERTIFICATE#(S)e�7ggg I7_ (Required in an establishment where potentially hazatTousfAod "is Orerlpared) �1 '7L` EMERGENCY RESPONSE PERSON OY� �wl f , HOME TEL#q lq- U (Y blSr 1S DAYS OF OPERATION Monda Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION 1 Please write in time of day i )Z a Ayy% (2 -A"Y✓t I2> 'Y (For example I lam-11pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart S2 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES -------------- ---- ----..---------------- --. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax etur sand pal 11 Ste a tax re=red der the law. /2 Sa'7 0210 26 b'./97_ tgnature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date V� x rn r yy,,.. ffa rt ' �,�. "�l'P° 3,y�r� yfts�X�c('irfi�u�t t^ ff' R n � - F�'.a'�'. Fj*F'gaY'�'P'K r �;� .� �,n •^b and x , .Y ._. Cammodwealtti of Massachusetts a e City of Salem Board of Health lGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Hotel - Motel Permit DATE PRINTED: 01/28/2008 ESTABLISHMENT NAME: Best Western Salem Waterfront Hotel& Suitesl File Number:BHF-2004-000276 225 Derby Street - Salem MA 01970 LOCATED AT: 225 DERBY STREET INSIDE IST LEVEL SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes Hotel/Motel BHP-2008-0399 Jan 2,2008 Dec 31,2008 $200.00 Operations Permit Total Fees: $200.00 PERMIT EXPIRES IDecember3l, 2008 Board of Health Page 2 of CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 -..." TEL. 978-741-1800 Mn� FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR RECD VMD .JOANNE SCOTT HEALTH AGENT DEC 17 2007 72007 BOARD OF HEALTH 2008 Application to Operate a Hotel / Motel $200.00 Name of Establishment: . Address of Establishment: r -Z, St /1A 61'? Mailing Address (if different): Tel#: `�317e - Fax#: 7 75 - r�77 Z Business Email: ^nm o- . // .. Website: Owner's Name: �'� � v�i� 'Teell# 27Y'-- 7510- B 79?- Address: li Zi� —fir/�,, � ��+�H / e-�/y 7<9 City 1 State Zip J Emergency Response Person(s): � o� Tel#: 7.7?` 'Z/0 How many rooms are reserved for guests? Fw Is food served in the Establishment? �e s Are animals allowed on the premises (other than service animals)? *Please make check payable to the City of Salem. (Pay by check or money order only) 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. Pursuant to MGL Chapter 62C Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax and paid all state taxes required under the law. Sign a Date Social Security or FedVal al Identification Number I(/30/07 hotel-motel appl.doc Check#&Date a Commonwealth of Massachusetts » City of Salem. Board of Health 1Gmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 DATE PRINTED: 01/09/2008 ESTABLISHMENT NAME: Best Western Salem Waterfront Hotel & Suites File Number:BHF-2004-000276 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET INSIDE IST LEVEL SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2008-0334 Jan 7,2008 Dec 31,2008 $210.00 ANNUAL Total Fees: $210.00 PERMIT EXPIRES December 31,2008 Board of Health r Page 1 of 3 � ` 0 _ RI CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'"'FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR ISOOTT(0)SALEM.COM., D DEC 0 7 2001 D` JOANNE SCOTT, CITY OF SAI fM HEALTH AGENT COILS- r_Tn�� 2008 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCAtiON OF POOL NAME OF APPLICANT:ge,,�„ /` •fps TEL# MAILING ADDRESS 2 Z S �� / 31 CERTIFIED POOL OP RATO)2 / Name: uw Cw/! Cert#:/z-ii7Szo TEL# 978 - -74o -�P79Q DATES OF OPERATION (if not annual): // DAYS &HOURS OF OPERATION: 7 ow3 A TYPE OF POOL Public Semi-Public Special Purpose FEE: $210.00 for year round pools $140.00 for seasonal$40.00 Non-Profit (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. 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 63C, Section 49a,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Sig ature Date SS#or Federal Identification Number Revised 8/14/07 poolapp.wpd Check# Date - 1.7 - - - �.� v DEC 10 2001 CITY OF SALEM BOARD OF HEALTH r� 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION Handwash Facilities FAIL Critical RED Owner: Comment:The hand wash sink in the wait station has a hot water temperature of 94°F. Restore hot water at a minimum J Hilary Rockett Jr. temperature of 110°F to this sink immediately. PIC: The bar hand wash sink missing soap. Provide soap at this hand wash sink at all times. John Slattery Inspector: The same hand wash sink had a hot water temperature of 104°F. Restore hot water to a minimum temperature of 110°F to this sink David Greenbaum immediately. Date Inspected:Correct By: Violations Related to Good Retail Practices (Blue Items) 7/10/2007 Equipment and Utensils FAIL Non-Critical BLUE Risk Level: Comment:The hand wash sink in the wait station is missing a knob. Repair or replace the knob. The Southbend ovens in the banquet kitchen has an accumulation of grease and grime. Thoroughly clean the ovens. Permit Number: BHP-2007-0221 Status: PARTIAL COMPLY GENERAL COMMENTS: #of Critical Violations: All other violations cited in the 7/10/07 inspection report have been corrected. 1 Time IN: Time OUT: Please notify the Board of Health by Friday, July 20, 2007 that the outstanding violations have been corrected. i Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 17,2007 ) Page I oft e> Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 17,2007 ) Page 2 oft 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION Separation/Segregation/Protection FAIL Critical ❑d RED Owner: C ment:The Continental F-2 freezer has potentially hazardous food stored above ready to eat food. Store PHF below RTE food J Hilary Rockett Jr. o prevent cross contamination. PIC: Thrue F-3 freezer has PHF stored with RTE food. Organize the freezer to separate PHF from RTE to prevent cross contamination. John Slattery Food ontact Surf Inspector: aces Cleaning and Sanitizing FAIL Critical ❑d RED I David Greenbaum Comment:There was only one bucket of sanitizing solution in the pub kitchen and it was found too weak. Sanitizing solution of I"pp,6per concentration must be readily available at all work stations at all times. Date Inspected:Correct By: j 7/10/2007 a dishwasher in the pub kitchen not in operation at the time of inspection. dishwasher must in good working order during Risk Level: business hours. llhe—C-U�itlng board on the Continental R-2 unit is badly stained and scored. Resurface or replace the cutting board. Permit Number: Th a scoop found stored on top of the ice machine in the banquet kitchen. Clean and sanitize the ice scoop an store handle side BHP-2007-0221 m e ice machine or in a sanitized container labeled"Ice Scoop Only' Status: VIOLATION D' y knives found in the knife rack in the banquet kitchen. Properly clean and sanitize all knives prior to storage in the rack. #of Critical Violations: Handwash Facilities FAIL Critical V RED 5 Comment:The hand wash sink in the pub kitchen had a hot water temperature of 81°F. Restore hot water to a minimum Time IN: Time OUT: ✓temper re of 110°F to this sink immediately. T hand wash sink in the wait station has a hot water temperature of 94°F. Restore hot water at a minimum temperature of 110°F Urgency Description(s): this sink immediately. BLUE: Violations Related to GoodT h nd wash sink in the banquet kitchen found obstructed. Hand wash sinks must be kept clear and accessible at all times. Retail Practices (Critical violations must be corrected a same hand wash sink had a hot water temperature of 107°F. Restore hot water to a minimum temperature of 110°F immediately. immediately or within 10 The bar hand wash sink missing soap. Provide soap at this hand wash sink at all times. days)(Non-critical violations must be corrected immediately The same hand wash sink had a hot water temperature of 104°F. Restore hot water to a minimum temperature of 110°F to this sink or within 90 days) immediately. 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. Jul 10,2007 ) Page I of Item Status Violation Critical Urgency RED: TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Hot Ytbe olding FAIL Critical ❑� RED Foodborne Illness Interventions and Risk Factors (Require ent:The Continental R-3 unit had a temperature of 70°F. Repair unit to maintain a temperature of 41°F or below. Unit isnot immediate corrective action) sed until it is repaired. 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. Jul 10,2007 ) Page 2 of ro Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE C ment:There is pancake batter dripping on pans and utensils in the pub kitchen. place pancake batter to prevent dripping on pans and utensils. l Tfwalk in had food stored directly on the floor. Store all food at least 6-8 inches off the floor. T re are onions stored directly on the banquet kitchen floor. Store all food at least 6-8 inches off the floor. Tre are uncovered/unlabeled dry ingredients in the banquet kitchen. Cover and label all dry ingredients. Equipment and nsils FAIL Non-Critical BLUE Comment, The Continental R-2 unit needs a thorough cleaning. e southbend grill/oven in the pub kitchen needs a thorough cleaning. he ntinental F-1 needs a thorough cleaning. -T ontinental R-1 unit needs a thorough cleaning. T ame unit needs a visible,accurate thermometer. T ooring throughout the pub kitchen has an accumulation of food debris. Thoroughly clean the entire floor including under and rou all equipment. e Continental R-5 unit needs a thorough cleaning including all racks and trays. .The hand wash sink in the wait station is missing a knob. Repair or replace the knob. e canopener has an accumulation of grime. Thoroughly clean the canopener. e Co ental R-6 unit needs a general cleaning. T meat slicer in the banquet kitchen needs a general cleaning. ,...,The Southbend ovens in the banquet kitchen has an accumulation of grease and grime. Thoroughly clean the ovens. The B-1 unit at the bar needs a visible,accurate thermometer. unit at the bar needs a thorough cleaning. "T a sa a unit needs a visible,accurate thermometer. e -4 f freezer unit needs a thorough cleaning. T shelves in dry storage have an accumulation of food spills and splatter. Thoroughly clean all shelves. 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. Jul 10,2007 ) Page 3 of Item Status Violation Critical Urgency GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. " 't) �� P�✓lll 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. Jul 10,2007 ) Page 4 of 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL BLUE Owner: Comment:Continntal refrigerator on food prep line requires thorough cleaning. J Hilary Rockett Jr. PIC: No sanitizing log available at time of inspection. Log to be maintained daily. Stacey denelle Cutting board on R2 unit is stained and scored. Resurface or replace board. Inspector: i GENERAL COMMENTS: John Date nsehan Correct BY: All violations unless noted have been corrected. pected: 1/16/2007 Risk Level: Permit Number: BHP-2007-0221 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 16,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 16,2007 ) Page 2 oft 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION Food ContactSurfaces Cleaning and Sanitizing FAIL ❑o RED Owner: m6 menta Sanitizer to be readily available at all work and food prep stations. Provide sanitizer with proper concentration. J Hilary Rockett Jr. Handwash Facilities FAIL Critical RED PIC: � Stan martin 1Comment: Hand wash sinks have temperatures above 130'F. Adjust temperatures so that it is maintained between 110°-130°F as mandated.--- Inspector: andated. Inspector: John Gehanar hand wash sink has no paper towels. Provide paper towels. Date Inspected:lCorrect By: 1/8/2007 Risk Level: Permit Number: BHP-2007-0221 Status: Open #of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 09,2007 ) Page I of I Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require omment:Walk in unit has uncovered foods. All foods must be covered. immediate corrective action) /Soup uncovered. All foods must be covered. 445proper storage of utensils in pub kitchen. Utensils to be stored in proper designated areas to prevent cross cotamination. Equipment and Utensils FAIL BLUE —4: y°mment: Continntal refrigerator on food prep line requires thorough cleaning. / Same unit has no visible thermometer. Provide visible and accurate thermometer. ouulhbbeend unit requires general cleaning. L—Sfly"erstar unit requires general cleaning. er-Hoffman unit requires general cleaning. No sanitizing log available at time of inspection. Log to be maintained daily. mental unit at coffee station requires general cleaning. slicer blade requires general cleaning. Walk ,refrigerator walls and floors require general cleaning. "V arewash machine guages no responding. Have serviced to work properly. PUB KITCHEN unit requires general cleaning. 3 unit requires general cleaning. unit requires general cleaning. unit requires general cleaning. unit requires general cleaning. e unit has no visible thermometer. Provide visible and accurate thermometer. nd oven requires thorough cleaning. R2/unit requires general cleaning. ,/Same unit missing visible thermometer. Provide thermometer. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 09,2007 ) Page 2 of a • Item Status Violation Critical Urgency Cutting board on R2 unit is stained and scored. Resurface or replace board. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 09,2007 ) Page 3 of CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978.745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor .JOANNE SCOTT, MPH, RS, CHO A kega- t4 POJD HEALTH AGENT 2007 APPLICATION pFOR PERMIT TOOPERATEA FOOD ESTABLISHMENT p�} NAME OF ESTABLISHMENT S4(Q�t Kl 7ih D1�}I1 TEL# I /Il J�jO O ?fO/0 ADDRESS OF ESTABLISHMENT N5_ t—�V .c_�gj55� FAX# MAILING ADDRESS(if different) G1lV _. dhml EMAIL--Business'- — (( �R OWNER'S NAME1 N TEL# —tX 1 —36?�t0J ADDRESS kEK✓wk " p- tg7!1�1 STREET CITY STATE ��/1/II y tt ZIP CERTIFIED FOOD MANAGER'S NAME(S), � �CERTIFICATE#(S) rJ�`'t1 (Required in an establishment where potentially hha .arrdgous foodis preparevi EMERGENCY RESPONSE PERSON `-1,tJ t 1 I I ItY r i r 6 HOME TEL# ttJ -C.L O& T OAYSOFOPERATION Monday Tuesday Wednesday_ Thursday Friday Saturday Snntlay HOURSOFOPERATION Please write in time of day. fForexampleflam-11Rm1 - I TYPE OF ESTABLISHMENT FEE (check onlY1 RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 _... ... - .. _.._..... - --._...... ... - ---.... ----- ----. *---....... *---- .... - .. .. RESTAURANT YES NO les. s than 25 seats =$100 25-99 seats more than 99 seats =$200 ....EAK. -FA--ST,--- -- -E------ --- -0 ---- -- - - ..._..- - - -----......._...$'' _. ... - ... -. ------- -- _ ...._ .---- BEDIBRST YS NO $100 --------------- --------- ------- ------ ..----- .--- .... ---- .._.... ...._...... __ _ _..._......-......-_..... ............ ADDITIONAL PERMITS MAKE (not just serge) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to try best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ----------------------------- --- - --------- ---- Revised --Revised 11/13/06 FOODAP2007.arm Check#8 Date dtA° al le Commonwealth of Massachusetts . m 1 1`' "w to- s"a�`"i°&i+.,.�.C,•a �1' �,1«'�8�'V`C+v[ .y iyas�(+,�'�k�` gym. '�a Pr ^»`+ tr �:' xr •a ��.� x � + �64�'� e"'qL` F� if�v w r a 3�. R.n M'i s • o "Board of Health 120 Washington Street,4th Floor IGmbetiey Dnsooll,' v �`:-� Mayors . SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Regatta Pub/Salem Water Front Hotel File Number:BHF-2004-000336 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET SALEM, MA 01970. Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes FOOD SERVICE BHP-2007-0221 Dec 20,2006 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES I.December3l, 2007 Board of Health Page 1 of 1 W �.... ,� I-srJA Commonwealth oan f Massachusetts + a , rt ,� t t +3�.`i't"` '" " r � �'City of saleui to to ,t �� a • O f�� '-.`� t" '�e `� }'' i.; `'yam' i.,.. .4`a3 �i� � 'M*4'`.� k.-'w�'E K ' t ^t .s•' ad -r.� "14 a. tat ,a ,aBoard of 13ealth IGmbeiley Dnsooll t - t tai120 Washmgton Street, ., SALEM,MA 01970 DATE PRINTED: 01/04/2007 ESTABLISHMENT NAME: Best Western Salem Waterfront Hotel & Suites File Number:BHF-2004-000276 .225 Derby Street - Salem MA 01970 LOCATED AT: 225 DERBY STREET INSIDE 1ST LEVEL SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2007-0296 Jan 4,2007 Dec 31,2007 $200.00 ANNUAL Total Fees: $200.00 PERMIT EXPIRES iDecember 31, 2007 Board of Health Page 1 of 4 t CITY OF SALEM, MASSACHUSETTS o ;gg BOARD OF HEALTH if 120 WASHINGTON STREET, 4TH FLOOR RECEIVED� SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 DEC 2 8 2006 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM Mayor HEALTH AGENT BOARD OF HEALTH 2007 APPLICATION FOR PERMIT TO OPERATE A SWIMMINGPOOL5'V" t LOCATION OF POOL 2a5 t)-e& 5 1 Sr' 1'e�n / AJI hit ry yt.' #0/if � I Ps NAME OF APPLICANT 5eff keX S M;o IK TEL# 7?-1 77S - q4?A MAILING ADDRESS ,9a5 5� S5 I �^^ d 15 7 0 CERTIFIEDXPOL OPERATOR Sal 1 ? b�� Name: �Q f p y S , M,/(J U- Cert#: Ol ' 1g y TEL# DATES OF OPERATION (if not annual): DAYS & HOURS OF OPERATION: 9 dot ' I U n rn ly TYPE OF POOL Public Semi-Public _ X Special Purpose FEE: $200.00 for year round pools $100.00 for seasonal $40.00 Non-Profit (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. 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 63C, Section 49a, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Q, oN�n o `f '3y7b �1lo(y Signal re D to SS#or Federal Identification Numbcr Rcvscd7/1/2004 poolapp.wpd Chcckp Daic,�'��p ��/®�D/o , 1'.oOrt70 Pickering Wharf Hotel Management Co.,Inc. 3420 t Y• City of Salem - Board of Health 12/18/2006 Date Type Reference Original Amt. Balance Due Discount Payment 11/24/200 Bill 01-184321 200.00 200.00 200.00 Check Amount 200.00 Cash Operating Des 01-184321 200.00 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: ``. FOOD PROTECTION MANAGEMENT PIC Assigned/Knowledgeable/Duties PASSd❑ RED Owner: Non-compliance with: `J Hilary Rockett Jr ."' Anti-Choking PASS PIC: Kenny Moberg Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date Correct By: '- Reporting of Diseases by Food Employee and PIC PASS ❑d RED Iam&%" Personnel with Infections Restricted/Excluded PASS RED Risk Level FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS ❑J RED BHP-2006-0305 Receiving/Condition PASS Q RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS ❑J RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS 0 RED 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 23,2006 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related tol I {,>,` Separation/Segregation/Protection PASS ❑J RED Foodborne Illness Interventions', and Risk Factors (Require'A", Food Contact Surfaces Cleaning and Sanitizing PASS d❑ RED immediate corrective action)10"k, Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS ❑d RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS [ RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS &/1 RED Reheating PASS DV RED Cooling PASS M RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 23,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils FAIL Critical BLUE Comments:Continental Warmer has broken panel on bottom righ corner. If warmer not to be used or fixed,discard wanner. No sanitizing log available at time of inspection. Log to be maintained daily. No test strips available at time of inspection. Provide test strips for sanitizer. Strips on order. Flour container not labeled. All foods not in original container must be in labeled. Cutting boards stained and scored. Resurface or replace cutting boards. Cutting boards are on order. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 727:All violations have been corrected unless noted. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 23,2006) Page 3 of 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone FOOD PROTECTION MANAGEMENT „ PIC Assigned/Knowledgeable I Duties PASS [] RED Owner: Non-compliance with: J Hilary Rockett Jr. Anti-Choking PASS PIC: u' Kenny Moberg::"- Tobacco PASS Inspector: John Ghan` EMPLOYEE HEALTH Date a Correct By: Reporting of Diseases by Food Employee and PIC PASS RED l Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Levet: , -- FOOD FROM APPROVED SOURCE Permit Number: - - Food and Water from Approved Source PASS [V01 RED BHP-2006-0305 Receiving/Condition PASS 0 RED Status: , Open:,-,,.. - ,: Tags/Records/Accuracy of Ingredient Statements PASS C RED #Of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS [d,, RED 2 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(976)741-1600 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006 ) Page 1 of Item Status Violation Critical Urgency RED , PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSJ❑ RED Foodborne Illness Interventions' and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS 0 RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities PASSJ❑ RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS ❑d RED Cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS ❑J RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS (] RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑d RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE L,e-o'mments: Uncovered leftover foods left in bottom Silver Star oven. Discarded at time of inspection. ersonal i ems observed in food prep area of pub kitchen.All items to be stored in designated employee areas. I scoop in pub kitchen and in pub area found directly on ice. Scoop to be in ice with handle out of ice or in separate container labeled ie scoop only. Equipment and Utensils FAIL Critical _ BLUE Commen .,Banquet Room Kitchen: e shelves require thorough cleaning. .arae Freezer requires thorough cleaning and organization. — Continental Wanner has broken panel on bottom righ corner. Repair warmer. sanitizer available at time of inspection. Provide sanitizer at each work station with proper ppm as mandated. No sanitizing log available at time of inspection. Log to be maintained daily. No test strips available at time of inspection. Provide test strips for sanitizer. all continental unit at coffee station requires general cleaning. ..2'offee station requires general cleaning. ,Shelf beneath meat slicer requires general cleaning. e machine has accumulation of grime on inside panel. Thoroughly clean and sanitize ice machine. Flour container not labeled. All foods not in original container must be in labeled. alk in refrigerator Floor requires general cleaning. Opener has accumulation of grime and requires general cleaning. od splatter on wall next to wash area. Thoroughly clean wall. ..IN6p sto d incorrectly. Mop to be stored by hanging to allow to air dry. rea that contains cleaning supplies requires organization. PUB KITCHEN: ----.Cutting boards stained and scored. Resurface or replace cutting boards. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006 ) Page 3 of Item / Status Violation Critical Urgency opener has accumulation of grime. Thoroughly clean and sanitize opener. C king Utensil container has accumulation of food and grime. Thoroughly clean and sanitize container. all co mental freezer requires general cleaning. 'c me I refrigerator holding breads and miffins(R-5)requires general cleaning. ntinental unit for desserts(R-4)requires thorough cleaning. Utensil holder that holds forks requires general cleaning. BAR: (B-3)missing thermometer. Provide visible and accurate thermometer. requires general cleaning. Water,Plumbing and Waste PASS BLUE Physical Fa � FAIL BLUE Comments:Walls around handwash sink in Banquet room kichen require general cleaning. ck door open at time of inspection. Doors to be closed to prevent entrance of insects and/or rodents. Flies observed at time of 17 inspection. ,J�nquet Kitchen floor requires general cleaning. ..fJeor beneath food prep line and cookline in pub kitchen require general cleaning. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GEN RAL COMMENTS: 6:Owner to fax over past three months extermination reports to Board of Health. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006 ) Page 4 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 15,2006 ) Page 5 of Aug 15 2006 12: 43PM HP LRSERJET FAX p. 1 0 August 14, 2006 Dear Mr. Gehan: There are four pages to-this-fax, including this cover letter. Two of the pages are simply the top and bottom of a long sheet of paper; if I shrink it to fit the page it's really too small to see. (Pages 3 and 4 are one document in two pieces!). Let me know if this is confusing. Thank you. Janet Brown Executive Chef Salem Waterfront Hotel Salem, Ma. Aug 15 2006 12: 43PM HP LASERJET FAX p. 2 Petediog ID Ems° Pest Elimination Seruices Agreement Orand'Fodn,M Sil��;, PEST ELIMINATIDN Dale—1—/—% Ecolab Acct.# Service Address Nmm� dTj�xGrarw.r /"�iiTE'i. 4'.Z r�rrFl Nanlo . Pimm:NwlgFer Phos funder _ Cealecl Nobe_. r//£ h'Pp of Facility IN ��C. =�/-F:O. _ CaNncl K. ' 'Lille Smk[f Program - Frequenty al Seryile j' _ _r - 9ervicc Fee „Iu Elimination or ❑Ertermioaliaa Only - (C'omlllJms as m[ryila[I L.Specird Insuautionaj /"ECOUVID Cockroach Program - �douthly U 011rr ��CheekPaiat Rodent Program U-Uf . PSlal Pest Raoorfinm lincluded a/a.chuen tw) - %SlMaunlily" lx:c .9ard n.&�Slnu:tard lmp"lion Scrviw Repos J E,,ii FS CieatrCAd(lticl.fine munNs serviu) S'/-� t-' $ji�IRr MonIll Ag'stest Flv-Pmgsam. N loNmr. ❑..c', n.isl.tm1turyu+m. S- �fO Cu..Mulllh �'1 fYmer YJLus \ u.'.al UYen UN.I ):.. Teulilca faa.f�� T'i1TRrm�._._ Clrth aMntYV)Vftsrvlr[ .hn Fah-MPA to t ;A ❑CmandForve Ant Program' - 0Moddv 0OtherS1—"_Per Momh C raaadPprtu Service - Cimk Man[Nalnfeervlm \\ l arpucdlt.u., lura I'[h Mar Apr Map Aa, 114 Aug Still, CN Nm' Ike PnmrWFnme Suri�mx(mmdme of aamrw,__I jilt Prh Mar AM Mn' At. Jul Aug Sep IxI Nm (Tv Gram:Uar Applivai:rn bra Fd.-tta.'Apr M14rp-JYn hl Aug v'ep..tTa..l4l,,- .. Pond Spree 1., 17e11, Wr Apr Mup- Jun III] Aug gVp W N.w Il¢ U AlrDef[nr Odor Piaginm - UMonlmv S__ _ Ptt Month NumMr NlJuls_ _ — S.W.A.T.Finti lr Servkc U cwr.A:f.10rcSimI,8,u la) _ Lm F0l, Mer Apr M, hw Jul Ang fcp (Ill Na.• It. $ \ Pcr Momh m/dQeIIWWfRYJ _ / FWI&nim: Ixu Fm Mnp lui hit nu Se Ni NI I)u J.Ll wcbllp - �I�f PcL MailCp. Mnf Jun Aug fillSerk�f�t•�e�Nu.- pw pT• �L�,�y4 uIQh1. ' Scv.S.lurWir.ul'anrmraldp;IfH:uac an aipdhun walnriRG ivavarudlilulW frrr(ce 9.W.A'i.lkaantnv�ll$•M rcGah:U. n-lau\.;n M r,.;nrw..hh numgmnr:N. U WiagClaiannd)RN Swim LiNhatlldy U Utter S� per With -Jail Fcb Maw Apr Mvp lua Jul Aug Ncp Mt Nur Pee UPM lnall P"lerfbeAn AglPcason, S_halam.ea.-PcrMradh.- 1(IalyYppliavnithFwPmF$] CJMVn A'ssl eraervlw Jan ValeValeNiw 'Nor Ma,nY tun A's Aue Nep (kl Mry Pec —_. ❑Other S Par Mumh ., .Simif'd`P?ICN�Tr275pFY�id1^Rfiiri+•IYBek•.' FS tj - Finl Sun Dllle: _ Total Monthly Fce S 7�) ` Pani. 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Jdrt'i n+:rJvrn. vluwliacoxin•raunt'I'kT rp and C•:Milkn .o rM mrcmwlk of lhisagrten:<aurtu:Ne.Ivunrlhi.aa.eemrN F.Oia rtAmvra. a'nm.xrarugma.wlm nu:•mmux, FrnM1FaNMreniivll. 11"al g.111 l'Fh.mnCrr 'N Tal'.x17110 k.eaeRtalln fJt'rJM mJjbl CIII I4aYwAheIIaVruj,"I'd"Niftil. rin.dllallal"nl01'.I.Nunm:*mil u+wr mllMLilAJa a uV )urea+f•w hrn rlm:nal Joel r nb mummer +Ilue'm•AvcYL vwh rap N w .,Joint gncJ Nae cfm ivUrc oitbin,.O dxS'ol ren'iec.SlnrW:eF•4ele•vte:•4uiwd iuuNa(rBa'AaM1 lnenimav rrrp wxknfun xgxvv raK'vau pn xN niu:Fm..1.rnlaGrimrnr rannrrrhk++n:nc:utv,aryrm'::mrrmry:(ee.<:NdmJWrrt mDk YUNe aunmyM imrnn'.fiIt''Ill'Illlimr..Ir "t 1Ftiiilx lnriwluullw uN:wz xilh am knrm+lFa'xrr¢ vim rnhnr wive non mlan lw'm.NM1 ru remNYV rkrekngl+csrya(iltlR zN•na nl'0a.x mef•um11 ..e Oaiaunl.if aw Jafaicrvplme Ynluwn annarN n'iaan ovary liO•bFvol'auL Wue.c nal lmnie nphnu a:r¢I lls agmamnl."Ih6xervuwinlunm iniriahmm:•i x ;uW•vilf+mnnnricJll rang rase iwrtlhmnnnlh b¢:s 11a:nNleC eWil lunnJm4l hr vLlm VaM1)'un?O Uulz Yrbr mgncanulil'. w1u.1r Nualnml su"ulCcnrcr Can Cu...axr pull,—SA;' FOIJ-Ams Mnm•gry C;'-.- l(laI :mI 0111 1.11all+.IIII Eydyb F. Aug 15 2006 12: 43PM HP LASERJET FAX ` p.3 ECOPEST FLIM. DIV. ,�. ,L . ' iNV0ICE NUMBER 6i2,It49`'. P.O. BOX 6007 E(I51(111E71SERVICE iFAN 1`04116, NO 5B206-bW7 ilft:7lt i $00 325-Sb71 In Flm ida Call-.--1 600 326.1674 0I1.11% ADDRESS; yR'OIINT.INIFOftION,: SALEM TfAltill 1fi iMTEt 6 SUITES A01"T P0. SALWaA4-0001 - 226 OW S1 SVSp_A, lam - SALEM MA SVSP AMIE SIHPSON.v-, onto O mOJO",uws us. LICENSE A 316M BILL PM: 97B¢YO 114814; CORP REF 4- PO N SERVICE SWLI' - SERVICE ADDRESS: PERIOD SALEM(ATIEWRCNT F "=4711312MB HOTEL 8 SUITES 9 226 DEW ST SALEM MA p.. 019705145 US - re SERV Tiff 978-519-1740- EXT; WIT k: SERVICE PER CWTTtAGT �- .,, 00 -..dPninFB€og?in Ti Sfea IIH Fly{PnA'Ogdm �.- SPECC�idMfilAiE1'It]f15 ttr IWOET PESP PRODUCT USED _ .OUANTIIy Lot NUMBER � METHOW SITES PROD#IDP OWL AAO Rets 8 Nice KEITH ALL TRAP 2.00 EA - n 009 Cal 0" p'- Flies (FIOP) STEALBN MINA 2.00 EA Cot 0 s Flies (Small) PY 1% (47338 OR PYRICIOF too) 12.00 02 003 Cot. COB, COs 45 F do-(Scat I- TA1STWONE INSELitC10E. 0.25 VA 002 - Coll' COB. C06 340 1 PROD CWF" CitA.NI*ffl - PRfOBL1 RtPTION -- q 45 1021-1424- ripp " Pyfucide fowl%Concentrate 7338 yR- _ 349 279-3206 "_ Tils6r-D5e IGITF-InseN lde(D tat-7,' - IETH005` � SITES" 002 Spot 101 Kildnn Area OB7"Sliam COS. Stmra9e..Au n 004 Checking Traps COB lcolvelear T1 oan1*& nal r �';gp is presided to idrnti}y aatt'rlaiiexr-del-ici¢tKies, s(rudm`dl Jeteml el :°@R.Wer aJwew prwcllrxs aa4riLutiig to pest Inter laiaPAr�',: CUM) IN 149W c SERV ICF RELATED COMMENTS: a irwpx ted all areas. IrsZrtcte<B dnd (enit'd led"ung. Pes(i<i Jr a}grl iraltous "le. W%6 to (Ir tu116"X4 nwr{%)fm m(.#W, -.�nl brlh t.i kixan a. Pmrfmnrs) Rider OF •Ment sero ite';.l ccMeded diel resrl all ('.XPi W '�rJn P � ac tivi(y vox <a+tui din ny Ile iotlrc j.1' - (6 >r r e No e°uL w ft ae(ivily is ;11L matmd..%luriry4(he.final*= tjin mid/m se ice In l - 1 w✓gee Ia.�Iunint. Sfrallh Fly Pro9rua Infer in, iockn t equrlmert insiwllerl. - PEST.ACTIVITY.lound..durin9..seryiea:. LYES) is K;IchenArea%allfiift n"W6irg mrske iruii IN... T{us arca was p 'nalrccted Aal servi,ad. Irnnt dLi :'mall !`pies %ited Jill Rig w'i !.. fruit C. f tYes. This arm xns,insinitled-and safmiced. SWIDIRAL CQXW`kAal:ilwld cause pest problems: (NO) n SAN ITATIli fS S Thal c.ld cause pest P .blew%..: (YES) dilcfre`+j.#c�w"'i tour tbairK in+dmf HaSaw"Pl_raie- cear Io ad arue dnwRus-krVIvegtlY TV tall,pneem a le . W, ielear �flwi ' m drains to reel of "leen n9 File~ IJ nl ai�.`N-nnrl diuim I:eyu"dly lu help pre.enl post L�rrdirg sites I r'rl fly l`.ntalrrg ,ueas rxstr:T T{anVyIFIY cion Ake Brea. a- To. 4 Rug 15 2006 12: 43PM HP LASERJET FRX ECD2DO01ChetkPaIr,LP'4rim {�� f Steal ibFiy_Pr�ren - � SPECIAL IMlullOw A a TARGET PEST PRat.CI Lau _ . pJAtf7.1.IY Lot"10 IEDA05' 5101 PROD OU, 011** his I Rice KETCH ALL.TRAP. - 2.00 PA O09 Cut 0 Fl its (FlOy) STEALTHW14A 2.00 Ek` � fAi- 1 flies {Suf}) PY 1% tif733d OR PYflUCVDE 1001 12.9002 003 Cot. C08. CIS 45 x Flix-(Suit) TALSIAR:OW iNSECIICNOE 0.26 DA O02 CDT:",-.M, COS 30 h PROD Pyroclde Fmina Concentrate 7330 (t.DY.}' ,4 349 279.3210 - - q. Talslor-One Multi•Insectido (0.12X1. m u FEIt1Or�• SITES" a^' Opt Spot C01 Kitchen Area D 003.Spatt C05 Storage Are% �yT 000 Chocking Traps COS loungellbr 4 This wnfidanlial r"srJ is w., 10 IQ idvoFly saoitotimr :kNcienOes- GGG sttuciural defect$.a!fl`iypl aye+ elm syr plm:tiv':rs twli+ibotiry to post infeslationi. J: CxITlO4sfWTpXI1[NS TAKEN: y SERViCF IEfiET£QCIMMI'S <e Irels,led all areas. lnspet led 41J tw fed sole,ied a+'ear. Pesticide "} asyrl Ira l iors were isedr to itw Iaf iuw'arYd. uaI(�Jtwlrais} IuI wxl L„Ih tittlw.ns: 'rT* Prrfultrd Inleriur rudanl eIv uI ch.;ckti:(uwI irsui -ril h,ps. W IpCienl "n activity vas lrolyd rkn i,g if, i lupsi'liuo wallet rel r icr. No olds wdcalaiu i iy was ouledtkn.icgllw..lnshuclita""XIful se.vire* Suitia FseL ice p:ifer�xd: w Stealth Ply Prngra¢ Interior rodent equipaeol installed. - R• PEST-ACTIVITY fowl-during-service; (YESI n Xilcb n Area Sall Fors Imted&I alai wlvicrc flail iliev. This arra was - hropecl¢d wd X "lust. Itnova:96, Sx II Flies Luted due ng,xe,view II01 C f lies. This area vms,jtssfleafed cad sere hard. p _ 0. STURM COFyFJIl�o1`T�'I-could cause pest'Vndrleos: (IAL a 3ANI1 k is lot could cause pest prubleat: IVES) 0 Ki ldxh al.e3 Iluel drains hr e�al of tltanuaj.Pteav- 1:hs-e in.avaLacuuntt - drains=(rtiGuenlly to he'p ylevenl twst 11 J.Liri( s twndrelOal ifuurm dlains in rwawl of cirmirr0. Please "W", in gRl:ulnnwl diaiae Lasenily Iu Ie IP C 4evrni Pert 6eedinp !Its. -fluid.it.y b.w.liyr.a+ ,o+-Ix.I.J Tlwrwyhlq..0.11 P. era. -" FACILITY REPARATION ISSUES: (NO) C a Rankyou for.Year b"ins"! rAr t M Clisi R SHNATK 0 End-iLtetlime: 0771372W6Q2;f7 AN- Your Neat Service Oats: WSTDNER COPY SMILE IIPKRT k ro o _ G_ - ;r 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION Separation/Segregation/Protection PASS RED Owner: ,. Handwash Facilities PASS RED J Hilary Rockett Jr. { PIC: Violations Related to Good Retail Practices (Blue Items) Steve Chalmers Food and Food Protection PASS BLUE Inspector: John Gehan - Equipment and Utensils PASS BLUE Date Inspected: CorrectmBy: Comments: General cleaning of refrigeration units must be done on regular basis. 2/13/2006 GENERAL COMMENTS: Risk Level: 489:All violations cited on 2/13/2006 have been corrected. Permit Number BHP-2006-0305 Status: Open #of Critical Violations: ` 0 Time IN -Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected n ;. immediately.or within 10 days)(Non-critical violations must be corrected immediately or within 90 days)` City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 21,2006 ) Page 1 of t -"r Item Status Violation Critical Urgency RED r%- Violations Related to Foodborne Illness Interventions and Risk Factors (Require k " immediate corrective action)* 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. Feb 21,2006 ) Page 2 oft a 225 Derby Street Regatta Pub/Salem Water Front Hotel City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT PIC Assigned/Knowledgeable/Duties PASS RED Owner. Non-compliance with: J Hilary Rockett Jr. Anti-Choking PASS PIC: Stacey denelle Tobacco PASS Inspector: > GehaEMPLOYEE HEALTH John n spec Date t Gehaed: Correct$y Reporting of Diseases by Food Employee and PIC PASS ❑J RED 2/13/2006 Personnel with Infections Restricted/Excluded PASS Q RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number Food and Water from Approved Source PASS RED BHP-2006-0305 Receiving/Condition PASS ❑d RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS ❑o RED 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 14,2006 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection FAIL RED Foodborne Illness Interventions and Risk Factors (Require 11-�Comments: Personal items stored on shelves. Personal items must be stored in appropriate designated areas. immediate corrective action)" , Food Contact Surfaces Cleaning and Sanitizing PASS ❑Q RED Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities FAIL Critical ❑d RED mments: Hand Wahing only signs on hand washing sinks missing throughout establishment. Provide visible signs for employees. "looms missing Employee must wash hands signs. Provide signs in bathrooms. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑d RED Reheating PASS ❑Q RED Cooling PASS RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS ❑J RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑J RED 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. Feb 14,2006 ) Page 2 of • Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE mments: Onions stored on floor. All food must be stored 6-8 inches above ground. ood thawing at room temperatures. food Review correct procedurs for proper thawing temperatures. ntinental refrigerator had uncovered foods. All foods in storage must be covered. I Ra<v meat/poultry stored above ready to eat foods in end continental refrigerator. Raw meats must be stored beneath ready to eat foods. ntinental refrigerator had uncovered dressings. All foods in storage must be covered. t'XaWm refrigerator had raw meats stored above ready to eat foods. Raw meats must be stored below ready to eat foods. Equipment and Utensils FAIL Critical BLUE mments: Cutting boards throughout establishment stained and scored. Resurface or replace cuffing boards. neral cleaning of continental refrigerator in banquet kitchen required. fives m kitchen found with accumulation of food debris. Properly clean and sanitize knives. ,W3fl�,—n had uncovered foods. All foods in storage must be covered. L, S-a-nitizer must be readily available at each work station with correct ppm's. Sanitizer running above mandated levels. True freezer in Banquet kitchen requires thorough cleaning. n opener had accumulation of food debris. Properly clean and sanitize opener. ontinental wanner requires general cleaning. deneral of ice machine required. e scoop stored incorrectly. Scoop must be cleaned and sanitized properly. Store ice scoop in appropriate labeled container. eneral cleaning of 3-bay sink and surrounding area. op stored incorrectly. Mop should be stored hanging up and air drying. ce scoop stored improperly in pub kitchen area. Clean and sanitize scoop. Scoop must be in properly labeled container. Continental refrigerator in pub kitchen area requires general cleaning. �- thorough cleaning required in continental refrigerator beneath coffee dispensers. �ermometer missing in continental refrigerator. Provide visible and accurate thermometer. ✓Continental Freezer has no visible thermometer. Provide visible and accurate thermometer. 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. Feb 14,2006 ) Page 3 of Item Status Violation Critical Urgency es had accumulation of food debris. Properly clean and sanitize knives. Can had accumulation of food debris. Properly clean and sanitize. ✓Continental refrigerator requires general cleaning. L>Pnlrinental freezer next to fryolator requires thorough cleaning. ntmental refrigerator general cleaning. ✓ tongs stored incorrectly on stove. Tongs require cleaning and sanitizing. Utensils must be stored in appropriate designated areas. vve/e requires general cleaning. S"helves beneath food prep area requires general cleaning. sils in gre tub stored on top shelf had accumulation of food debris and grime. Properly clean and sanitize utensils and tub. I coop stored incorrectly in bar area. Scoop must be cleaned and sanitized. Scoop must be held in appropriate labeled container. Drink mix stored in ice in bar area for customer use. Nothing should be stored in ice for customer use. relocate anything in ice. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 475: 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. Feb 14,2006 ) Page 4 of ,:: l�i+�, 2006.,. .. , NT - E s Hm V.NRi►'019fis-A�7 INV� .� T.At 03310 \ • 781 3 6 2-2781 {-SOb529-"tB'itE FAX781- 2-i8b1 CURRENT - 30 DAYS 60 DAYS 80 DAYS .r. Pe8t 8MI TAmVtatotiftl Professionals �e•'31788 - .. iI m.-.aIN - A.IAl - 0 Gain PT DATE _ DAY TYPE ^ PATE COD - - AGDT No -.L 1.s 1. �.4 Iir1 14 . 71020 i N1:_4 f,ue I.01. - 01/24/IP SALEMWATERFRONT H017EL a. SU REGULAR PEST -CONTROL 1ti5. 0Q 225 DERBY ST. '"'\v�.... .. - - 'r NUMBER UNIT PRICE AMOUNT ` SALEM MA 01970 MOUSE OL BD. 778-740-8788 12/ 1a/05 1100=1130 uLncTiRAP DATE PROTECTA ., CHECK NO. - -PROTECTALP - . RTU BAIT STA COMMENTS .❑MC -0VISA :❑DISCOVER RAT GLUE ED COMMON ARI AS/L-OLADY/OFFICE ACCT.# -MMEA/ALL 'RN/MAIN V,-IT IN ,PUB•/PRE - - - KITCHEN--FUNdTION RM/F'DOL EXP DATE _ SALES TAX AREia/TRASHcox-0 nail wcp. . .TOTALDUIE L.AUN1)RY-•MECHANICAL-EXERCISE ELE -RMS/-RETAiI_ SHOP -(4)qC-ANT) COMMON TOTAL AMOUNT PO f�JREA STH d 6TH Fl_ OL-,4 COMMERCIAL SANITATION REPORt . . -. . - FWo7s-lean - YES NO Counter Surfaces Cleaa-.L........ p �❑' - Drain.Areas—Clean .... .........:.......r.. :.-_ ❑ . -.._. . Rest Rooms—Cfean.......... .. ........... ❑ �._ -. . -` Dining Areas—Clean .... - EmployeeAreas Clean, '- - . Q 0 . .. Locker Arsas--Clean ....T. .... ❑ ❑ .. b .41ALii0'AI'fRAtJ'I'Y INFORMATION Storage Areas—Organized . ....:. .......� -� - -. - DWELLIZZTYPE 'Ih7APAMTY YES L1 NOD Comments f Fert6fy Q' - - �Femity O 30 Days ❑ 60 Days ❑ 2 FanVly .❑ S Family ❑ 90.Days ❑ 6 Mos. ❑ REASON TOR No WARRANTY - *Partial 8eivice requested ........................................................... ....._..Q POST APPI)CATION REGUI EMEN`fS- •PoOrsanitetlon....... . . ............ ._.._.................................. p OCCUPIED AREAS MUST BE VACATED FOR HOURS, -Cif Atalfur ROoin-Cabiflete not'preparad ......•.......•..•.....••............Q THOROUGHLY VENTILATE TREATED AREAS BMW ARE. �ClOaate/RNnNOfe'not prepared......... .................-.............................. ❑ REOCCUPIED. 00 NOT ALLOW ADULTS,CHILDREN,OR PETS ON- 'Rodent proofing,needed ....;... �. ..................... ............ ..............❑ TREATED SURFACES YINTIL-DRY. . . -1-- - `•' - �Othef -• - - --� - -- \CONTRACTING ENTITIES HAVEAECEIyEO ALL tto$SFCHUS#TTS'OEPARTMENTLIFFZDD B AGAIC'Mr RE S PESTICIDE TIMEIN aIIREAU-CONSUMER-SNEETS,NGRA4E1i "WLSrTIN FS1aV : YDrT'O'HOilFY T'.ENAI�ITS�2.7 DAYS PRIORTd APPLICATION TIME.TfIL.'ICBOVESENSA'�17$I' �7iILY:CAIY�PLETEP. +Ns sr - 70MER�5�RE NO. MA 9 -d XUd 131783SUI dH WdTS :S 9002 ,61 9a3 CITY OF SALEM + � EALTM�'It=Arr'TO: N,MAoreoz,atrr , Box91CiLytm,iHA-Mse3�:D3ro ier-mx,�is�:,�g',Qe Pale ias�Y=rear i ;v.'''cfsfi573 "CURRENT' "I 30 DAYS 80 DAYS 910AV8 "Past andTermltA�vNttot_professienals (I SAE_EM Wh'1l E:Fai'►{.UPd'1 is1tJ 1 hL.. rz_-+d 1 illa�e.u.�„� Ll.Ihf1 I'm SALEM NUMSER UNITPRICE AMOUNT EN MA lHl"i7p,.. _. D�WSEal8D., 978-740 t37NS tl/1.4r_0S It 0 •d'23, "bnrAu"t(iCTTRAP .< . tamGHET;;t NO. - `-Art/6QLTSTA -£I'�M(44ENTH LIMCi. .L3'ViSA (lV$C(WEA FIAT GCAIESO, COMMPN AREAS/LOMY/OFFICE -PREP/Citi. RR/MH3h1 FiS'T 3.N RUS/TJRE ' *CDTT.... KITCHEN-•FUNCTIQlN RN/POOL EXP DATE. Cu�s7Ax 4F2Ef3l fRfltii C 6. proq wDp LAUNDRY-MECHANICAL-E%E RC I!�E=SLE roiAi our -RPI6/.1RE3 A I L SHOP, (VpCAN", GDMhf73S+1; roTru AtiouNT PD AREA 5TH &t�6.TH 17L 0_ 9 x,m� Gam ' WL bommENft COMMERWAL$ANITATION REPORT Fbote=Clearr - YES NO - Counter SuMaces Clean tD=nATees—Clean. ... .. ' -_O 0 - Rest Room Clean .,.....a...... Din�E eeAreae--deao Cl " Locker I ClO 0 'AaGlean ......... StorageAwere—Organized Q ,'-.. .ifE$t0 RLITf `JNFDRMA_tJC/N ....:... . . ..... d p : OWELLINO TYPE - _ YiAHRAtfTY YES❑ No 0 Comments 1,FM»3yr. ❑ - 3 Fet[tiFy 0 "JO Dsyo O SO pays ❑ . - :,. O'FsoTiRy ID 90 Days 0 a mas. :1 ' 'REAWNIMR NO WARWFN :Partial service requested ....... .............................. ..................Q . ..pagT - _ pTr;. -�Pooq�sarNtatbn : .........._............»........._.....OCCUPIEDAREASMUST-BEVACAT€D'FOR - - HOURS. +XltCnerUbathroom�eabineta Dut.preparad """"„""....... ""......Q THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE 'Obaete/iumittlra not preper8d - ,................-ffEOC ............_..........tom OUPI£D.'40NOT'ACILOW AWLTS.Cabef( 0.CWFETS ON .-Rpdant pmkif%naaded ..:....... ....... ................................................Q TREATED SURFACES UNTIL DRY - ..other. - CONTRACTINGEN£RiE5.HAYE NECBVEDtt�_ - GSFt^tjDD ,A�yR TURE`54ESTiCiDE- TIME IN BUREAU CONSUMER'SHEETS,WRITTEN$TAT'MENTS,PO$TIND'I11C-rl4ErER AM HAVEAGRE�D7O NOTIFY TENANTS 2.7- DAYS PRIOR'TO-ARPLICATIONTIME THEABOWOMFIVICE RAW-B"llf"TTSFRCTOgIWOWPIL :. sa ar LIC.e' - ' 5K3NATURE T1:C�iND 1�9" E S-d XUd 13rb3SU7 dH' WdOS:S 9002 ET tad 3e{ "f [ snwiN m r4yF,xf'rlo [Y r -s .V l } '� a ¢ Mil6r Y f Oman"SZfSx Gl tV i tF ✓•'"E v 1 1 e+il j y..J I .FY .1 l ,+ •y. ?.1 x r ^� Msk r.sr'lr � [ 1�7 x�o [ [-W. s'n�'�t��Y a�3�yS�y� Vit.+' P efi s x z F- .'Y� f J. yi`�I`Y`+ ii"-• I� e r'F `?,a �'{ �— r [ y �i. }'�'EFET 'fyg,[tt} "r,T"j?EIx�'-S „r �'Y': d�y #I�>`Yt^'n ' `�'ti _ k I5' d{yx V 'r JG [ Y ' �3 d1ln [ Trnl v.! 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INVOiCE. v-6 6o�tatotv+t F HEAL m 7111-692-3731 1-W-59541M FA%Tat�6s'A27 ,. s CURRENT 30 DAYS 11 60 DAYS YS Pest and TO nTi*te CDr tr Professidn®I§ I t, W DATX DAY T•OE GTE .v ACEI.N6 _ _ G9W!'ROL P$iri AWMdE CHARGE NUMBER UNIT PRICE AMOUNT I •• yd MOUSE GL BD'.: . , MULTI-CT TRAP �y.�', - 0;4TE . .. . YitOTECTA$tP RTU BAIT BTA - QVISA 01ASCOVER -mTzLOEEn /.Y1dT B �J-L^w4R"" AX EXP DATE. -.. . Y . , - ✓ O:Ao Q +�.. TOTADUE . J�(J-y'.'"✓I- i �AMOIINIPD r ARDMONALCOMMOMt : _ PWA pEM Yds'.349 Floors--Clean 1Counter Surfaces Clean Lorain Areas—Clear Rest Rooms—Clean-................ . P'— - Dining Amu-Clean ..-..:. -..Q Q- - ❑ ❑ - +PbvaeArees-Glean ........ ..`D ❑ _ _ _ Storage Areas Clean - . O_ .. AESIRERTUu<WAryRAN'E1i,1f�F.tjRMATidN Storage Areas.—Dig11nlzetl 'To] - Cocl,lnehts - DH'EF lLiy6 PE 3 Pamir Q ttr ❑ S 60 Da Ci Ds Q0 v ys v -lily- O B Family _ Q gSOays Q 6 Mos. ❑ - REA§GN FAR ND WARRANTY :Partial service requested-..... ........ - ................................ ....... .� ifO.BTAPP7Ad70N :. ENL •Poor Ba`nitatMn ... ......................... ❑ . •KRCheNbathroom CaVnals not prepared . .. ..................._.........❑ OCCUPIED AREAS MUBT BE VACATED FOR HOURS .ClosetsFfurniture n6t.prepared - - ............... _ _Q THOROUGHLY VENTILATE 7REATED AREAS BEFOR THEY E """' "' "' CClN4EL Do' A}LOW ADULTS.CHILDREN.G F", '�R$fleht pre&flAg nBaded .....:... .:..........:. .... ......0 TREATED 9LRFACE$UNTIC DRV -' '- •;-_-` � '- r - - CD^lTF3ACTI ENTITI,E3 FIAVEREOFJ%, )A�L h,WS1(({r1U pEPAR'fpAEyl flAggIGULTUqES PESTICIDE TORE IN '�l1REAu o u`MF,n Si!EET3, RITi6N gip Er4fB P FWO Wa 3 A'i1b '0 TD-NOTIFY MAWS 2-7 DgYB TO APPLICA710N .THE A8 6ERV1 Mi18 SAT7 RILV OOMPLETED. was, ,A} Y SE H;SIGNATUAE - TECHNO. E 'd XHd 131783SU-1 dH WdlbtS 9002 el gad Feb 13 2006 5: 30PM HP LASERJET FR% P 2 t K A, -c� i7� F 7 3 , Y'34' iG�.-4 r4 ' w yy 4 4l F � t , Slf Ne 141 54 xERR AS r ONT, :Ail k �.9'.y:t"' .fi,��`„`� '3.wC'Jx• �313r.,� am'$- x a. §'u.-�'s ` L yvr r Tkl�r-�.�..-ro_ "a.; '—`; ou .... to �� .±� _ '�'��° `""-•� P�'"`r � `� - �-,F�C'Jr C -T©iAL WE t� j , eTA L wu s A - A A- n�, r. ~` s ? ro Z 'k At ` yy�1'�p//yy�� s`v�'�.*� c eeE r,� a-� ��q�,. fi`»��.7 �-r a,.a•r.��vx... ra": ,;. . OFBIR AF898 'w�- ""x'"y5- t1r•"'tG � 'S• `�`�' *?t.,ra+ r ", fr� .�," _ A. Mr46%A4M Clgan - €rFipkxy@efyts.„ rE lac;ar Aeg9 1n b q v Sroca�6Ateas1611? f i f 4 '• ,reek' 'b 3`I icy Tee Fj IY✓LI i 71 a >3cza �a?gnats nstzs fl Rmjzr 'TREATED$u B-EINT4L- - rr r- _ i Why, FP Q ice- ._ „_,. ,i. ,£ 5.,€• ' � t }1y4 :vel h H .,, ii. i.�i! .:A fV CITY OF SALEM BOARD OF HEALTH . Establishment Name: r10 K P 1/1 C4 WA al Date: &- b Page: of a Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date -No. Reference R—Red item - Verified -% PLEASE PRINT CLEARLY l h-r u t ec. -4-o t-, . Co,� '1 i ate,c 6ul- -4 Y-42 'S4-4-e- -Th") S4-4—e ht 1101 0)1 1/l �l : F ipOeci/c9-v C� �✓ty�� f1� ' �a `' s' v-r�-r ..51�•cw enflle . FX evalees o� 6/ca,5rd -�'W _!� � u do v/��• /�/-f�S� ,�.rie ✓Pae / s �-6-/dho1A e c . �. P ND 11 cc /s,r Sv�iAAWs a4�7� . J" 14 S /5 SNPs Discussion With Person in Charge: Corrective Action Required: ❑ No o Yes k 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 a 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 dollafs v suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: � 0 4 3-50L14(C) PHFs Received at'Peroperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont) 41°F/45'17 Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives i9 PHF Hot and Cold Holding 3-202.12 Additives* 590.004(17) Cold PliFs Maintained at Or below 590.004(17) 41'/45°F. 3-302.14 Prot c con from Unapproved Additives" IS Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at ar above 140°K" 7-101.11 IdentityingInformation-Original 3-501.16(A) Roasts Held at or above '130'17. M Containers* 2{) Time as a Public Health Control 7-102.11 Common Name-Workin- Containers" 3_501:19 Time as a Public Health Control" 7-201.11 Separation-Storage' 7-202.11 Restriction-Presence and Use" 590.OWp-I) VatianceRe uirement 7-202 12 Conditions of use, 7-203 1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satutizers.Criteia-Chemicals* POPULATIONS(HSP) _ 7-204.L' Chemicals for Washi❑ A'cxlnue, Criteria" 21 3-80L I I(A) Unpasteurized Pre packaged Juices and 7-204.14 Drying Agents.Criteria` Brverages with Warning labels* 3-801.11(B) Use of Pasteurized Ea'a's 7-205.11 Incidental Food Contact,Lubr(cants' 7-206.11 Restricted Use Pesticides,Criteria' 3-80L 11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations" 3-801.11(C) Ono ae red Food Packa ge Not'Re-Served. E7 Tracking Tracking Powders, Pest Control and Monitoring' CONSUMER ADVISORY TIMEFFEMPERATURE 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 Eliminate 3-401.11A(l)(21 Eggs 155'F 15 Sec. PathOicus e Ys v'zoot ULss-Immedi rte Service 14S'F15sec" 3-30113 Pasteurized Eggs Substitute for Raw Site]] 3 401.11(A)(2) Comminuted Fish,Meats K Game H'-S' Animals-155"F 15 sec. * SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Put k and Beef Roast-130'F 121 trim* 3-401.11(A)(2) Ratites Injccfed Meats- L55°F 15 590.009(A)-(13) Violations of Section 590.009(A)-('D)in „ catering,mobile food, temporary and sec. ' € p 3-401.11(A)(-,) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poulrry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscae, Intact Beef Steaks interventions and risk factors. Other 145'F 590.009 violations relating to good retail 3-401.12 Raw Anunal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec.* 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. " (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time' fondbarne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the folloning,sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC -5-90-000 Rousts'i 23 Management and Personnel FC-2 .003 ig Proper Cooling of PHFs 1 24. Food and Food Protection FC-3 .004 2526 i Equipment and Utensils ___ _FC 4 .0_05 1 . 3-501.14(A) Cooling Cooked PHFs from 140'F to Water Plumbing and Waste _ , FC-5 .006 7WF Within 2 Hours and From 70"P 27. 1 Physical FacilityiFC-6 .007 to 41'F145'1- Within 4 Hours, * 28 Poisonous or Toxic Materials ' FC-7 .003 3-501.14(B) CoolnagP'FLF's Made Frnn Ambient 29Special Requirements _ _ _ _009 TenaperaturaIngredients to 41'F745oF 30. 1 Other_ Within 4 Hours" *Denotes critical item in the federal 19991'md Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH 1 establishment Name: t e k" Date: /9- (0 0 7 Page: of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item _ Verified PLEASE PRINT CLEARLY tic9 /l V✓ /�/� 47co-1_ 4-fl- 6 l . a , Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes 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 El Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty ivedolla�spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit./ ❑ Voluntary Disposal ❑ Other: A t� - 3-501.1 d(C) PRFs Reeeived nt Temperatures Violations Related to Foodborne illness Interventions and Risk According to Utw Cooled to Factors(items 1-22) (Cont.) 41 T/45'F Within 4 Homs_ PROTECTION FROM CHEMICALS 3-501.(5 Coolda Methods for PHFs 14 Food or Color Additives 14 PHF Hot and Cold Holding ro3-5O L M(B) Cold PHI's Maintained at or below 3-302.14 Protection 3-202.12 Additives* tecti c"n froml?nar roved Additives* 590.004(F) 41`145° F- 1-5 Poisonous or Toxic Substances 3-501,16(A) Hut PHFs Maintained at or above 7-101.11 Identifying ontainent linersrs*Information-Orig140°F. * Coinal -3501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Workin*Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Conn'ol^ n90.004(H) Variance Re 7-202.11 Res`rriction-Presence and Use* uirement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Contatiners-Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Samtizet's,Criteria.-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Washin Prtxiucc,Criteria"' 21 3-801.11(A) Unpastein i/ed Pre packaged Juices and 7-204.14 Dryino A cuts,Criteria' Beverages with Waimim;Labols* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteullzed 7-206.11 Restricted Use Pesticides.Criteria* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed S routs Not Served. 7-20612 Rodent Bait Stations' 3-801.11(0) Unopened Ferri Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Ferris TTiat are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Elinunate PHFs 3-40 ( )U s- t55'PIS Sec.'LI.IA 1 2 Egg Patho�ens.* Eae�cvevrrroo Eg>s-hmnediate Service Ir45°F155ec_* 3-302.13 Pasteurized Eggs Substitute for Raw Shell] 3-401.11(A)(2) Contaminated Fish,Meats&.Game E `* Animals- 155°F 15 sec. 3-401.1l(B)(1)(2) Pork and Beet Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.71{A)(2) Ratites,l,njected 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(.4)(3) Poultry,Wild Game,Stuffed PUN. residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections 2�rms-165°F IS sec. * above if related to foodborrne illness 3-401.11(C)(3) Whole muscle,Intact Beef Steaks interventions and risk tactors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Aminal Foods Cooked in a practices should be debited under#29- Microwave 165°F' Special Requirements. 3-401,11(A)(1)(b) All Other PHFs-145°F15see, I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.9)&(D) PHFs 165°,F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do nor relate to she Tune* foodborne illness interventions and iiskfrictars lived above, can be 3403.11(C) Commercially Processed RTE Food- foarid in rhe,following sections of the Food Cade and 105 CMR 140°F` 590.000. 1403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts'* 23. Mang ement and Personnel FG-2 .003 lg Proper Cooling of PHFs 24. Food and Food Protection _FC-3 .004 25. _ E uipment and Utensils _FC-4_ .005 3-501.14(A) Cooling Cooked PHN from 140`5 to - 26. Water, Plumbinq and Waste FC-5 I 006 70°F Within 2 Hours and From 70°F 27. Ph osical Facilit FC-6 .007 to 41`F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 i .008 3-50L14(B) Cooling PFIFs Made From Ambient 29 S genal R- ulrements _ _ _ 009 Temperature Ingredients to 41°F/45cF __Other Within 4 Hours* ssr>na,m),.,a.e z'd" "Denotes critical item in the toderal 1999 Food Code or 105 CMR 590,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: fW P�6 Date: 1 ;k - 10 U 7 Page: '- of i Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONnate No. Reference R-Red Item - _ - Verified PLEASE PRINT CLEARLY- ✓) r) 03219,111 '1 D p al, , s-�l Lill_S W ivi OI C d nL(�vrcG w J � All " S 1 -69 - 0q relaola ( ✓Pdx O Ln Sio-rra I A Ilea ! c� Y a mr� 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 b Voluntary Compliance ❑ Employee Restriction/ Exclusion R violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. s. 0 Voluntary Disposal ❑ Other: 1� 3-501,14(c) PHFs Received at Temperatures Violations Related to Foodborne Illness Intervent/ons and Risk .According to Law Cooled to Factors(Items 1.22) (Cont) _ 41"F/44F Within 4 Haus. PROTECTION FROM CHEMICALS 3-501.15 Cooling,Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additivesr 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41°!45°F* 1$ Poisonous or Toxic 3-302.14 Protection fromUnapproved Substances - Additives* 3.501 16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Origin40T,al 3-501,16(A) Roasts Held at or above 130°F. Containers" 7-102-11 Common Natne-Working*Containers" 20 Time as a Public Health Control 7-201.11 Separation-Storaee* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Pcesenee and URe* 590.004(B Variance Requirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions' REQUIREMENTS ION (HSP) HIGHLY SUSCEPTIBLE 7-2l1d.,1'I. Sanitizets,Criteria-Chemicals°' POPULATIONS(HSP) 7-204.12 Chemicals for Washum Produce,Citeria, 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Wamng ltbols* 7-204.14 Dc'in r, tots,Criteria, �-� - 7-205.11 Incidental Food Contact,Lubricants* 3-8( 1.11 Use of Pasteurized Eggs* 3-801-11.(Dj Raw or Partially Cooked Animal Food and 7-206.1 I Restricted itSe Pesticides.Criteria* Raw Seed Sprouts Not Served. '' 7-206.12 TruckiRodenng Bait ders,nP" 3-S01.11(C) Uno,enedFoodPacka>cNotRe-served. 7-206.13 Traekmg Powders,Pest Control and Monitoring-" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consmner Adaisory Pasted for Consumption of Animal Foods 11at are Raw,Undercooked or 16 Proper Conking Temperatures for PHFs Not Otherwise Processed to Eliminate {_ Path), 11, * n rive 1/111W, _ 401.1]A(1)(2) Fggs- 1.55 F 1.5 Sec. Eggs-Lnmedtate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute.for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats<&Game Eggs* Amounts- 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130`F 121 nun* 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 die appropriate sections Poultry or Ratites-165)F 15,sec. * above if related to foodborne illness 3-401.1 1(C)(3) Whole-muscle,intact Beef Steaks interventions and tisk factors. Other 145°F* 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)(b) Ad Other PHFs -145`F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-30111(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing C-hical and non-critical violations, which do riot relate to the Time* foodborne illness haerventians and risk fnctars listed above can be 3-403.11(C) Commercially Processed RTE Food- fmmd in the fallonang sections of the Fund Cade and 105 CVR 140°Ft 590.000. - -- 3-103,11(E) Remaining Unsliced Portions of Beef item Good Retail Practices FC 580.000 Roasts* 23. Marra ement and Personnel-- FC-2 .003 1g Proper Cooling of PHFs 24 Food and Food Protection _-- FC-3 _ .004 _25. __ Equipment and Utensils __FC_ 3-501..14(A) Cooling Cooked PHFs from 1,40`-F to 26. Water,Plmnbin and Waste FC 5 .006_ 70°F Within 2 Hours and From 70°F 27. Physical Facility _ FC-6 .007 to 41.°F/45°1`Within 4 Hours. "` 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PIIFs Made From Ambient 29. Special Requirements _ .009 Temperature Ingredients to4l`F/45`F 30Other_ ----- j,--.,_,--__-_--_ Within 41lours* sslommv., -xno� 4 Denotes critical item in the foicad 1999 Food Code or 105 CMR 590-000. CITY OF SALEM V1 BOARD OF HEALTH Establishment Name-Ak), Ila a 0 J�X- Date: Page:_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY yl 44,- Pub d I.va o ® i u Pvw f ~54 b u t yr a� u ll ( 5� P P t Sc CX-4-C -�D 2. 4.011 a W o 44 /.7 Lam/ e_a //44 t e w ' Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of tweMy-five dollars r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I ❑ Voluntary Disposal ❑ Other: v 3-5031µ(C) PHFs Received of Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont) 41'Fl45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 1g PHF Hot and Cold Holding 3-202.12 Additives* 7501 116(B) Catd PPIFs Maintained at or below 590.004(F) 41'/45°F" or Toxic 3-302,14 Protection Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 1g Poisonous or Toxic Substances 140°F. " 7-101.12 IdeContainers Information-Original 3-501.16(.A) Roasts Held at or above 130OF. Containers* 7-102.11 Common Name-Working Containers` 20 Time as a Public Health Control 7-201.11 Separation-Stora e* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.00µ(H) Valiance Re nirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Satudzers,Criteria-Chemicals* POPULATIONS(HSP) -, 7-204.12 Chemicals for Washine Produce,Criteria"' 21 3-801-11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dt. in A ent's,Criteria'" Beverages with Wanting 1-nbels* 3-801.11(B) Use of PasteurizedP:ans� 7-205.11 Incidental Food Contact,Lubricants* 3-30L I 1{D) Raw or Partially Calked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* Raw Sced s routs Not Served. * 7-206,12 Rodent Bait Stations' 3.801,11(0) Uno genet Fnod Package Not Re-served. 7-206.13 'Cracking Powders,Pest Control tint Monitoring* CONSUMER a®vlsoRY TIMEITEMPERATURE CONTROLS 22 3-603-11 Consumer Advisory Posted for Consumption of Animal Fo>ods'Chat are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate Patho ens 3-401.1]A(1)(2) Eggs- 155`F15Sec. 'ta<r�b ,moi E>rs-hmnedtate Service 1450.F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Anim I3- 155'F 15 sec. ' 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.17(A)(2) 'Ratites, Tniea'ed Meats-155°F 7.5 590.009(A)-(D) Violations of Section 590.009(A)-(D) in see. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Sniffed PITFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under Cite appropriate sections Poultry or Ratites-169'F 15 sec. * above if related to foodborne illness 3-401.11(,C)(3) Whole-muscle, Intact Beef Steaks interventions and tisk factors. Other 145-F 4' 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145'F'15 sec. 19 Reheating for Hot Holding V/OLAT/ONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 16517, 15 sec. _ (Items 23-30) 3-µ03.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, ribich do not relate to the Time* foodborne illness arreiventions and risk factors Listed above, can be ,403.11(C) Commercially Processed RTE Food- found or zhe fallau>irag sections of the Food Code coal 105 OUR 140'F* 590.00(. 3-403.1.l(F) Remaining Unslieed Portions of Beef Item Good Retail Practices FC 550.000 Roasts* 23. Manarqsruent and Personnel_------- 24. Food and Food Protection FC-3 004 1g Proper Coaling of PHFs --_- 25 Egwpmant and Utensils FC 4 _ .005 3-501.14(A) Cooling Cooked PHFs from l4WF to 26 Water,Plumbing and Waste FC 5 d 008 __ '0 F WitIna 2 flours and From 70'F 27- Ph sical FacilityFC 6 .007 - _ _ _ FC 7 .008 to41'F/45'FWithin 4Hours. 28. Poisonous or Toxic Materials-.. ...... _ 3-501.14(B) Cooling PHFt,Made From Ambient 29. S solei Re uirements __ .009 Temperature Ingredients ro 41'17145'17 30. _ Other Within 4 Hours* ssmr»maa-s.m� ^'Denotes critical item in the Weral 1999 Food Code or 105 CKIR 590.000. CITY OF SALEM BOARD OF HEALTHC Establishment Name /tXi lei it d 14-A — Date:—/.)- '7 - 0 '-/ Page: 1 0� Item Code C-Critical nem. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION " Date - No. Reference R-Red Item - Verified PLEASE PRINT CLEARLY <. !� cru✓ In� DPr�/ rte-/ We Di .Grr, ac I Kt e + A mn-c soa u 4 e d!5l��v5v o Ali L a Gtr ve 1Ceb;17iv nl d ^ �1/ f a i `Nn 1 ✓PR .v0 yi.i� / ✓ ✓ � ..cru 1r S-r -r a/-) cll ✓0vr,0VP-L. JC .S,,7L ✓tvv- ,h .Pft/ e 1 Al u �- jZ a t I f'I/Il1`/ ✓P.Fil90rG�✓5 -!' �L�' S .^� Pr//I /S '. h f ✓C a1111h L ll/SI 1 i Discussion With Person in Charger Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension 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. r ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs 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-:,01.15 Coolimn Methods for PHFs I9 14 Food or Color Additives PHF Hot and Cold Holding 3-501.16(B) Cold PFIF's Maintained at or below 3-202.12 Protectionves 590.004(F) 41'145°F* 3-302.14 Protection from lino r roved Additives* 3-501.16(A) Hot PHFs Maintained at or above IS Poisonous or Toxic Substances 140°F, s 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Conunon Name-Working*Containers* 20 TSme as a Public Health Control 7-201.11 1 Separation e" 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re nirement 7-202.12 Conditions of Use- 7-203.1 1 se*7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria" 21 3-80L I I(A) I Gnpastew9zed Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warni..a labels^ 7-205.11 Incidental Food Contact.Lubricants* 3-901.11(B) Use of Pasteurized Egos, 7-206.11 1 Restricted Use Pesticides.Criteria* 3-801,11(D) Raw or Partially Cooked Animal Faxl and 7-206.12 Rodent Bait Stahons* Raw Sid S rrouzs Not Served. '" Uno cued Food Packa"e Not Re-served. 7-206.'13 Trucking Powder,,Pest Control and 3-801.1](C) Monitodn"* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 3-60311 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Forxls'1'hat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-40'1.IIA(1)(2)� Fags- 155'17 15 Sec. Pathogens. L s-Immediate Service 145"F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E Qs* Animals- 155".F 15 sec. '" 3-401.11(B)(1)(2) Pork and Reef Roast- 130'F 121 min" SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(19)in sec.* catering, mobile ford,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Stuffine 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 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. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1l(A)&(D) Pulls 165'F 15 sec. * (Items 23-30) 3-403.11(73) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne ti(ness internennons and riskfhcrors lishW above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 14WF` 590.000. 3-403.1.1(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590,000 Roasts* natrament and Personnel _ FC -2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _.... _ FC-3 ,004 L. 25 _ Equipment and Utensils _FC 4 005_ 3-501,[4(A) Cooling Cooked PHFs from 1.40°F to 2g Water,Plumbing and Waste FC o +006 70'F Wither 2 Hours and From 70F 27. Ph sical FacilityFC-6 007 to 41"Ft45°F Within 4 Hours. ri 23. Poisonous or Toxic Materials FC-7 .008 3-50114(B) C,00lin;PHFs Made From Ambient 29. , Sectal Re uiremenis � .009 Temperature Ingredients to 41'F145'F 30. Other Within 4 Hours;' ---- ''Denotes critical item in 7hc lideral 1999 Po(A Code or 105 CMR 590.000. , _W. hh i y i p1. .4tu'a"��Pe aF'f� �Y a '�" < +-+ri'- �.�'�t�'m{3'T�^-`*t^' A.$�,1Frv5t�lh°`��''w✓�+.++5�`ro�. e\ y . i. a .'. .+ ii �MLS� . ... Y }i ��.} a L�_.i r� A: ♦ ncw,+ ..! YaJ$.: CITYOF SAL« ..- :. r w-...I � h^^;r.]Y' f�W:•'" 1 !. w.v ivW ��.aYy� � Y T:'1^a. ' EM9 MASSACHUSETTS -BOARD OF HEALTH . � 120 WASHINGTON STREET, 4TH FLOOR Asa 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 SERIVCE Name of Establishment: PW Pub Salem/Salem Water Front Hotel Address of Establishment: 225 Derby Streer Owner's Name: J Hilary Rockett Jr. Restrictions: Application Date: 12/10/2004 Permit for Food Establishment 226-05 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 N% CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-74 1-1 800 G FAX 978-745-0343 STANLEY USOVIGZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT, 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT Raywzr^ P'o6 NAME OF ESTABLISHMENTFW VVe?S PiLem 5ALS9n uvk-c rf v rTEL# R7$- ADDRESS OF ESTABLISHMENT 2Z5 '3>0k%) S\ SALE wv% w'l A © eq-7 n MAILING ADDRESS (if different) OWNER'SNAME J•N��.R� IZaKEI� ^• TEL# ADDRESS CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)5-V644W Gtuts-i eks CERTIFICATE#(s)2'1ctt o9ee6r yft +%J 2538841 (required in an establishment where potentially hazardous fodd is prepared.) EMERGENCY RESPONSE PERSON R`�gE^� 7��"4 HOME TEL#475-144-3530 ND aO pwt HOURS OF OPERATION: Mon N��-glue*t'lZWedAtVeThu?e-It"Fri)%tle'§aO!� r Sunk TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10'000sq.ft.- =$100 more than 10,000sq.ft. =$250 V RESTAURANT E NO less than 25 seats =$100 25-99 seats - =$150 more than 99 seats = 200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code before any renovations, improvements, orequipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pu4kiM a r 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my be elief, have filed all state tax returns and paid all state taxes required under the law. 0'�-3� Sign t re Date Social Security or Federal Identification Number [ - Revise 11/03/03 FOODAP2.adm Check#& Date Aj��> ��q .� a®a CITY OF SALEM BOARD OF HEALTH Establishment Name: Re k-.,v W /w P Date: g- 3/- O y Page: / " of .? Rem Code C-Critical Item DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date t No. Reference R-Red Item -" Verified -' PLEASE PRINT CLEARLY `- r� o O- S V Q'29- -7'1V- 53,5Yxal ti Sleue L, vee n-r,/e Aee4f 4Pe�,E 4 Erle a Q d A,//2 "r OD P � } i , oyrtc4 P U -� C6 s ,. f � u-v ES li 117 ae CWd rr cc t w/417 Ae >br-k- / ,! I-S / / lutcc�7 tp o , Dov amt U Pa /P V( 5 h/G U_1/_&C 10d,41-441,4 117 O ed -/-at! ILp Q/P ' OC6t4/ hzp S " �( 9/P /it Discussion With Person in Charge: Co rective Action Required: ❑ No ❑ Yes i I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Ll Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension 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: I I 3-SOi.14{C) PHFs Received aY Temperatures Violations Related to Foodborne Illness Interventions and Risk According,to law Cooled to Factors(Items 1-22) (Cont.) 4VFAYF Within 4 Anus. PROTECTION FROM CHEMICALS 3-501.15 Cooliro,Methods for PHFs Food or Color Additives 19 PHF Hat and Cold Holding 14 3-501.16(13) Cold PIIPs Maintained at or below 3-202.12 Addection 590.004(17) 41'!45° FA 3-302.14 Protection or Tont xic Substances Additives* 3-501.16(A) Idot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101..11 Identifying Information-Original 140°F. s 3-501.16(A) Roasts Held at or above 130°F. Containers" 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Contra) 7-201.17 Se oration-rage'` 3-501.19 Time as a Public Health Control* 7-202,1.1 Restriction-Presence and Use'" 59(').004(H) Variance Re uirentent 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toni iters.Containersterin ohibi ons* POPULATIONS(HSP) _ 7-204.11 Sanitizers,Criteria-Chemicals°` 7-204.12 Chemicals for Washing Produce,Criteria" 2I -1-g01.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvin eats,Criteria* Bever t:.es with Banton Labels" 7-205.11 incidental Food Contact, Lubricants* 3-801 1 t(B) Use of Pasteurized F t_as* 7-206.11 -K estricted lise Pesticides, Criteria* 3-301.1 i(ll) Raw or Partially Cooked Animal Frwd and Raw Seed S xrouri's Not Serti ed. 7-206.12 Rodent Bait Stations* -3-8. 01,I](C) Uno erred Fnrxi Pack*�e Not Re-served. �' 7-206.13 Trackiro Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS22 3-6fl3.i 1 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foals Fhat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1IA(1)(2) Eggs- 155'F 15 Sec. Path ,er lt, 11;,120a, E es-Conteh rte Seraice 145°FlSsec* 3-302.13 Pasteurmd Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Animals- 155'F 1.5 sec. 3-401.11(B)(1)(2) Pork and Beef Roast-130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, residential kitchen operations should be Slatting Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165017 15 see. a above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145-F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked lit a practices should be debited ander#29- Microwave 165'"F* Special Requirements. 340LlI(A)(1)(b) All Othin PHFs- 145'F '15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)8r(D) PHFs 165°.F 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 factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- ./aund in the foliowing secrions of the Food Code and 105 CMR 140°F" 590.000. -- 3-403,1 I(17) Remaiaing Unsliced Portions ofBeefItem Tdood Retail Practices_ _ FC 590.000 Roasts* 23. Mona ement and-15ersonnel ___ FC-2 .003 24. Food and Food Protection FC-3 004 IS Proper Cooling of PHFs .=- 25. Equipment and Utensils FC 4 005 3-501..14(A) Cooling Crooked PHFs from 140'F to - i-- 26 Water,Plumbing and Waste FC 5 : .000606 7WF Within 2 Hours and From 70".17 27. -Physical Facility FC-6 .007 to4l'F/450FWithin4'Honrs.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(13) Coolie;PHFs Made From Ambient 29. S neral R uirements __ .009 Temperature Ingredients to 41'17/45'F 30. Other Within 4 flours" ss�an;n:nae�z m„ Denotes critical item in tit*&deral 1999 Food Code or 105 CMR 590000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Ia&"1 w o Date: S- 31-d V Page: a of Item code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified R PLEASE PRINT CLEANLY l Pie h 170 �f{2. 0," 4rot o o� ✓P V d P ,4 l2l P bpi oxer /P ✓zal-ee i for e ✓ Gam' / h�i _� J r Ak,d A s 'a Discussion With Person in Charge: Corrective Action Required: Ll No C3 Yes 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P C] Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that L noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Ll Embargo 4 .b LI Emergency Closure your food permit. 7 4._ ❑ Voluntary Disposal ❑ Other: c 1-501.1A(C) .PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1.22) (Cont.) 41"F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-SU1.15 Coahn,Methods for PHFs Food or Color Additives 14 PHF Hot and Cold Haitliug 14 3-501.16(14) Cold PHFs Maintained at or beloar 3-202.12 Additnes" 590.004(F) 41"(45°F* 3-302.14 Protccnon from Unapproved Additives* 1.5 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintainedat or above 7-101.11 7dentitying Information-Original 140°F. Containers" 3-50116(A) Roasts Held at or above 130°17. 7-10211 Common Name-Working Containers" 24 Time as a Public Health Control 7-201.11 Separation-Storage 3-501.19 Time as a Public Health Control* 7-20111 Restriction-Presence and Use'6 590.004lH) Varitmce Requirement 7-202.12 Conditions of Use` 7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP)_ 7-204.12 Chemicals fox Washing Produce,Criteria* 21 3-80111(A) Umpasteurized Pre-packaged Juices and 7-204.14 Drvin A guts.Criteria* Beverages with Warning,Labels* 7-205.11 Incidental Foal Contact. Lubricants* 3-S01..11(B) Use of Pasteurized E>>s' 7-206.1 tRestricted Use Pesticides. Criteria* 3-801.1 L(D) Raw or Partially Cooked Animal Food and Raw Seed S xont's Not Secved. 7-206.12 Rodent Bait Stations* 3$01.1]{C) Unopened Fax1 Pucka=e Noe Re-served " 7-206.13 Tracking Powders,Pest Control and Monitoring-* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption ai Animal Foods That are Raw,Undercooked or I6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-101.11A(1)(2) EPathogens.* Erres�e,n.7um ggs- 155`F15Sec. Ergs humediate Service 1450F15sect 3-302.13 Pasteurized Eggs Substitute fur Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game _ Ee>s* Animals- 155°F 1.5 sec. ,¢ 3-401.11.(13)(1)(2) pork'.and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meat's-155°F 15 590..009(A){D) Violations of Section 590.009(A)-(D)in sea * catering, mobile food,temporary and 3-401_1.1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Starting Contahung Fish,Meat, debited under the appropriate sections Poultry or Ratites-165`17 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions anis risk factors. Other 1450E* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under f129-- 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/BRACT/CES 3-403.11(A)&(D) PHFs 165°F 15.sec. * (Items 23-30) 3-403.11(B) Microwave 1650 F 2 Minute Standing Crilwrtl and non-critical violanom,, which do not relate to file Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- Mound in the following sections of the Food Code and 105 CMR 14WF- 590.000. ____ > Item Good Retail Practices FC 590.000 3-403.11(6) Remaining Unslieed Portions of Beef Roasts* 23. Mona oment and Personnel FC-2 .003 __-.- ---- ...---__------- 18 Proper Cooling of PHFs 24. Food and Food Protection FC-- 3 .004 25. E9uipment and Utensils FC 4 _ .005 3-501.14(A) Cooling Cooked PHFs From 140°F to 26 _ Water,Piumbinp and Waste !FC 5 .006__ 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 1 .007 to 41"F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(13) Cooling PHFs Made From Ambient 29. Special Re uirements 009 Temperature Ingredients to 41'F/45'17 30. ,Other Within 4 Ilours Denotes critical item in the fieral 1999 Food Code or 105 CNIR 590,000. Commonwealth of Massachusetts City of Salem i C Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2006 WHO'S PLACE OF BUSINESS IS: Regatta Pub/Salem Water Front Hotel File Number:BHF-2004-0336 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes FOOD SERVICE BHP-2006-0305 Jan 4,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 10 of 20 CITY OF SALEM, MASSACHUSETTS c ,> BOARD OF HEALTH O 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 T1s r STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO ao - 110®og' HEALTH AGENT '7O 5qz'' 2006 APPLICATIONN FOR PFERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT1\-y-� TEL 4 q ADDRESS OF ESTABLISHMENT IZS �X.YYJN MAILING ADDRESS (if different) OWNER'S NAME TEL# ADDRESS CITY STATE ZIP CERTIFIED FOOD MANAGER'S N E(S) G CERTIFICAT3E#(s) 290gz\ W I (required in an establishment where poten ially hazjrdous food is prepared.) EMERGENCY RESPONSE PERSON 1�C�L� HOME TEL#4n%I 4 tf HOURS OF OPERATION: Mon.J� uet\ ed hu.%\-Akh. riJt1fiVSat.t\:kkn Sun.\\.%h-t2Yt TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 --------------------------------------------------.....----------...........----------------------------------- RESTAURANT YESNO less than seats =$100 25-99 seats =$150 more than 99 seats =$200 -- ---------------------......-------------------...........----------------------------$...10...---------------- BED/BREAKFAST YES NO 0 - - ------------------------------------------ -- ---- ------- ..---------------------------------------- ADDITIONAL PERMITS MIAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I,_to my best know) and belief, ve led all state tax returns anis paid all state taxes required under the law. 'Oe Signature Date Social Security or Federal Identification Number ----------------------------------------------------------------j ------------------------------------------------------------- Revised 11103/05 FOOD AP2.adm Check#&Date / 41—)a i,. Commonwealth of Massachusetts City of Salem Kimberley Driscoll . Board of Health Mayor s 120 Washington Street,4th Floor -. SALEM,MA 01970 DATE PRINTED: 01/23/2006 WHO'S PLACE OF BUSINESS IS: Best Western Salem Waterfront Hotel & Suites File Number:BHF-2004-0276 225 Derby Street Salem MA 01970 LOCATED AT: 225 DERBY STREET INSIDE IST LEVEL SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SWIMMING POOL- BHP-2006-0356 Jan 23,2006 Dec 31,2006 $200.00 ANNUAL Total Fees: $200.00 PERMIT EXPIRES (December 31, 2006 Board of Health (1160!U.r ks a-d-+�-- i Page 1 of 4 J < CITY OF SALEM, MASSACHUSETTS �o (rte lc�+ Rfl o BOARD OF HEALTH f s 120 WASHINGTON STREET, 4TH FLOOR J� SALEM, MA 01970 JAN 10 2006 �Ne TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 CITY OF SALEM MAYOR WWW.SALEM.COM BOARD OF HEALTH. JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Ool -0C9 2006 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL_ �� ,[)5r&a � NAME OF APPLICANT��`PCr1 LQ� qaQ (��: �P(�TELL' 9)S—�YO'R7 z(1 MAILING ADDRESS _�p_ � CERTIFIED OL OPERA�TQY, Nami . Cha / / %��r Cert#�f-/O # DATES OF OPERATION (if not annual): �� . DAYS &HOURS OF OPERATION: Q on "( JlQS9- to Drl CDQ t l� TYPE OF POOL �J Public Semi-Public Special Purpose FE $200.00 fo year round pools $100.00 for seasonal$40.00 Non-Profit (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. 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 63C, Section 49a,I certify under the pains and penalties of perjury that I, to my best knowledge and belief,have filled all state tax returns and paid all state taxes required under the law. n�6 �P_�VV� c.� li�i0� 3 � ff76 � [Signature Date SS#or Federal Identification Number Revised 7/1/2004 poolapp.wpd Check# Date i (V C��R Cne JAN 10 zoos 40 IR VR- CITY OF SALEM ` BOARD OF HEALTH .r ' T; a1Yn 0�f P169 aP .Etas I jr" Mc Reg)stratbn No nJ NIOMy is he mby GeRined antl Reginated 'ry 4 nr me NATIONAL SWIMMING POOL FOVNDA790N. t �y45`�rf0 e 4� i I REGATTA PUB Sour ITALIAN FISH STEW We complement this flavorful tomato-based stew with fresh,cilantro.CUP-4.95 BOWL-5.95 NEW ENGLAND CLAM CHOWDER This creamy clam chowder features a special ingredient:fresh basil. CUP-4.95 BOWL-5.95 FISH STEW AND CLAM CHOWDER COMBO(Half&Half) New England meets Italy when our stew and chowder get together. CUP-4.95 BOWL-5.95 CLASSIC FRENCH ONION SOUP With dry white wine and brandy,under a blanket of Gruyere cheese.4.95 Consuming raw or undercooked meats.pouery,seahod,shellfish or eggs may increase your risk of foodbome illness. STARTERS/SIDES/SALADS BURGERS/SANDWICHES SAUTEED CHICKEN TENDERLOINS "REGATTA'BURGER Tender and tasty,and topped with a savory ham and cheese sauce.7.25 A blend of Angus beef and sweet Italian sausage topped with a bacon,mushroom and cheese sauce. 7.95 PITA CHIP BEEF NACHO SUPREME A pleasing platter of beefy nachos on a bed of pita chips instead of the standard tortilla chips.8.95 1/3 POUND ANGUS BEEF BURGER These burgers are plump,juicy and served hot off the grill. 7.25 CRAB CAKES WITH A RED CHILI MAYONNAISE Offered with assorted cheeses,bacon,peppers&onions,and mushrooms. .25 EA Tasty cakes prepared with capers and fresh chive. 9.25 FRIED HADDOCK SANDWICH PUB FRIES Seasoned homemade fries or traditional. 3.25 Fresh off the boat and onto your plate. 8.25 ONION RINGS These heavenly hoops are made right here for you. 3.75 GRILLED CHEESE STEAK SANDWICH Served with caramelized anions and a zesty horseradish mayonnaise. 8.25 CAESAR SALAD A Caesar to die for with cherry tomatoes,mozzarella and fresh basil. 6.95 with Grilled Chicken 8.95 GRILLED CHICKEN SANDWICH Prepared with a fresh and delicious Tarragon sauce. 7.25 CHEF SALAD Our chef salad is served with our own chipode dressing. 7.25 SOUTHEAST ASIAN SALAD Specially prepared with strips of chicken fried steak. 7.95 ENTREES WINE BY THE.................................................GLASS...................BOTTLE White ECCO DOMANI PINOT GRIGIO $6.25 $26 "REGATTA"SHRIMP Five succulent jumbo shrimp stuffed with crabmeat,wrapped in FOUR SISTERS SAUVIGNON BLANC $7.95 $33 bacon and sauteed in garlic butter. It soon may become the entree of choice. 18.95 KENDALL JACKSON CHARDONNAY $7.50 $32 BAKED HADDOCK REDWOOD CREEK CHARDONNAY $6.25 $26 . Fresh haddocktopped with light,buttery crumbs. 17.95 NAPA VALLEY CHARDONNAY 58.75 $40 BURLWOOD WHITE ZINFANDEL $6.25 $26 PROSCIUTTO AND CHEESE STUFFED CHICKEN Red MACMURRAY PINOT NOIR $7.95 $33 Topped with a wild mushroom demi-glaze. 16.95 STERLING VINTNERS MERLOT $9.25 $42 CHICKEN AND LOBSTER IN A BRANDY CREAM SAUCE STERLING VINTNERS CABERNET $9.25 $42 This pasta entree features chicken and lobster in a brandy cream sauce.19.95 REDWOOD CREEK MERLOT $6.25 $26 MADFISH SHIRAZ 57.95 $33 SIRLOIN STEAK AU POIVRE REDWOOD CREEK CABERNET 56.25 $26 A sizzling steak capped with a burgundy dijon sauce. 18.95 RANCHO ZABACO RED ZINFANDEL 58.75 $40 CASTELLO CLASSICO CHIANTI $9.25 $42 BEEF ROULADE STUFFED WITH BASIL,SPINACH AND FETA CHEESE Mediterranean flair with a sauteed shallot and port wine demi-glaze. 19.25 Bubbly CODORNIU CAVA BRUT SPARKLING $7.25187ml. WESTPORT RIVER BRUT CUVEE SPARKLING $25 750 ml. VEGETARIAN TEX-MEX MACARONI AND CHEESE VEUVE CLICQUOT N.V YELLOW LABEL $54(1/2 bottle) $99 (full bottle) Made with a kick of fresh bleu cheese. 12.95 DOM PERIGNON $185 750 ml. POINT'S OF SAIL -OUR SPECIALTY COCKTAILS $7.95 THE FRIENDSHIP THIS THREE-MASTED,SOUARE-RIGGED COCKTAIL FEATURES BOBO VODKA,A SPLASH OF BOTH CHAMBORD AND PINEAPPLE JUICE.THIS VESSEL IS GARNISHED WITH A LIME WHEEL AND BERTHED IN OUR GRANDE GLASS. KEY LIME MARTINI MEL FISHER FAVORITE TREASURE!THIS BOUNTY FEATURES BOBO VODKA,NODDED MELON LIQUOR AND A SQUEEZE OF LIME.WE TOP THIS WITH A DOLLOP OF WHIPPED CREAM AND A LIME WHEELI INDIA WHARF COCKTAIL STOLI VANILLA IS SHACKLED WITH MALIBU RUM AND WHITE CREAM OF CACAO TO CREATE A MARITIME FAVORITE KNOWN THROUGHOUT THE FAR EASTERN PORTS OF BOMBAY AND OTA,SALEM'S SISTER CITY IN CHINA.WE RIG THIS WITH AN ORANGE WHEEL AND SERVE STRAIGHT OR TWELVE-METER COSMO THIS TACKWL APPROACH TO SAILING BASICS BATTENS DOWN THE VODKA AND SHROUDS IN THE CELTIC CROSSING AND OCEAN SPRAY.ADD A CLEW OF LIME AND TILLER AWAY.A RACE COMMITTEE FAVORITE. ALL HANDS ON DECK OUR VERSION OF THE GRAPE CRUSH INCLUDES 888 NANTUCKET ORANGE VODKA, A LUFF OF CHAMBORD WITH A SPLASH OF SPRITE AND LEMON MIX.YOU WILL NEED A COMPASS TO STEER YOU AWAY. ALL THESE SPECIALTY DRINKS SERVED GRANDE STYLE Examination Form No. 647 Certificate No. 2790921 ServSafeCerfification TO STEVEN CHALMERS for successfully completing the requirements.set by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, which is recognized by the International Food Safety Council. Presented by the National Restaurant Association Educational Foundation 9/29/01 DATE OF EXAMINATION This ServSafe certification is valid for 5 years. Check with your local health department for their specific requirements. ELLEN MOORE, FMP SENIOR VICE PRESIDENT LEARNING AND CERTIFICATION DIVISION National Restaurant Association , ®Natural ReslaurnaAaociatlonEducationalFoundation EDUCATIONAL FOUNDATION? ®2000 National Restzuant Association Educational Foundation GN31601 v.0107 www.n raef.org ` - s.aw"+tiaam�.v+�w�arad.vve' lv.:e�'iau.3vN.+M`1+.-•ti-�LGd-sSu.�a'..+i'V.cYS�Y�F3:K:=Y«.'ewe nv�" a r"Yri�`im..•• �•'. `. �•'�•4`gun..+Avg.:unw.awwr.ate-onvv.r�awv�.m_w......... ` Examination Form No. 647 Certificate No. 2538841 f *f"' cation ServSafe Cerb i T ROBERT YOUNG for successfully completing the requirements set by the National Restaurant Association Educational Foundation for the-ServSafe® Food Protection Manager Gertification Examination, which is recognized by'theanternational Food Safety Council. Presented by the National Restaurant Association Educational Foundation 2/7/0'1 D'AT'E OF EXAMMATIO-N This$ervSafe.certification is valid for 5 years. Check with your local health department for their specific requirements. PR-ESIDE.NT All CHIEF OPERATING OFFICER } National Restaurant Association, A EDUCATIONAL FOUNDATION? - ®:Nalirr%1 ReslanintA95 blimEductoWl'Uullaa@on wwwedfound:.org ®2000 Natgml aestauraiii'ASmatirn EdumbMI Nridatan I � 4 I EXAMINATION FORM NO : 2017 CERTIFICATION NO : 3399712 efo �. �.: . ServSafeol � Ce ti ic ti • TG STACEY DENELLE for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, which is recognized by the Conference for Food Protection (CFP). Presented by the National Restaurant Association Educational Foundation 4/1/2003 DATE OF EXAMINATION 4/1/2008 DATE OF EXPIRATION - Check with your local health department for their specific requirements. MARY M. ADOLF PRESIDENT AND CHIEF OPERATING OFFICER NATIONAL RESTAURANT ASSOCIATION National Restaurant Association EDUCATIONAL FOUNDATION EDUCATIONAL FOUNDATION? OO NaOonal Restaurant Association Educational Foundation ©2002 National Restaurant Association Educational Foundation www.nraef.org 02072905 v.0211 CITY OF SALEM / BOARD OF HEALTH Establishment Name: r e r 1,10 wklav � Date: Page: of Item Code C-Critical Item „ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION- Date ;. No. Reference R-Red Item Verified PLEASE PRINT CLEARLY i� /la An has i?3 -rcc�U o•JIC� Q✓PGC LU/�/�i f"Lii7 fY�/�'/ �b A ow r ii' _ a v✓a ✓ aS� P.4 MdrP C�v taI I 6v Oic ✓P /✓P� a 5 Lvl Q5 /�.R by F/oay /.�+ 5�•d� ! r��' t s SIr7K � 1 kW 2kfti 0 &--itI r cll�C�d/ -7 n p ..cam x r Gtrra 04 l uhd_� f>lJe bviii O�>� I, Co �c�4i� -fvUslri I-ewp.4 /P v l✓ e,zaef re//rjI e'�t rov- SP a l LP 5 D-( OF d fid✓ Id" A �-/on Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes 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 Cl 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 • r�n/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 1 ❑ Voluntary Disposal ❑ Other: J r 3-501.'14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41°1-145'F Within 4 Hours. " PROTECTION FROM CHEMICALS 3-501.15 Cooling vfethod,for PHFs ---- - 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-11202.12 Addttivesx 3-%L16(b) Cold PHFs Maintained at or below 590.004(F) _ 41°145°F* 3-302.1.4 Protection from lfia roved ldditives* 3-501.16(A) Hot PFFs Maintained at or above j Poisonous or Toxic Substances 7-101.11 1'dentif}ing Intonnation-Orie nal 140`17. Containers* 3-501.16(A) Roasts Held at or above '130'F. 7-102,11 Common Narne-Working Containers" 20 Time as a Public Health Control 7-301.1.1 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-20211 Restriction-Presence and Use 590,004(H) VarianceRe uirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE _ 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.13 Chemicals for Washin=Pro<htce,Criteria'' 21 3-80t11(A) Unpasteurized Pre-packaged Juices and 8everaues with W' am lab WLabels* 7-204.14 Drvin�talents.Criteria* 3-801.11(B) Use,of Pasteurtled Eoos" 7-205.11 Incidental Food Contact,Lubricants* 7-206.11 Restricted Use Pesticides,Criteria'' 3-801.11(D) Raw or Pmtiolly Cooked Animal Food and 7-206.12 Roden'Bait Stations" Raw Seed Sprouts Not Served 7-206.13 Tracking Powders, Pest Control and 3-801.11(C) Uno.��ed Food Paeka e Not Re-Served_' Monitoring* CONSUMER ADVISORY _ TIME[TEMPERATURE 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 . Fne�c,z vr;zool 3-401.1]A(1)(2) Eggs- 155'F 15 Sec. Pathos, n+.': L s Immediate Service 145'F1.Ssec' 3-30213 Pasteurized Eggs Substitute for Raw Shell 3-401-1I(A)(2) Comminuted Fish.,Meats&Game E sv Animals- 155`F 15 sec.* 3-401.11(B)(1)(2) Pork and Beef Roast- 1.30'F 121.min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(19) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporaary and 3401.11(A)(3) Poultry,Wild Game,Stiffed 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 anti risk factors. Other 145'F* 590.009 violations relating to good retul 3401,12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs -- WT715 sec. l4 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. " (items 23-30) _ 3-403.11(13) Min owave-165°F 2 Minute Standing Critical acrd non-critical violations, which do not relate to the Thi e* ,foodborne illness inter,enrions and rials fachn s lister)abate, call be 3-403.'1.1(C) Commercially Processed R'TE Focal- .16urat in the following sections of the Food Codr and 105 CMR 14WF* 5,90.000. 3-403.'1.1(E) Remaining Unsliced Portions of Beef LNem j Good Retail Practices FC 590.000 Roasts"' _23. -_ Management and Personnel 1 FG-2 .003 IS Proper Cooling of PHFs 24 Food and Foal Protection FC 3 .004 ._-. --- 25, 1 nt and Utensls FC' 4- 005 3-501.14(A) Carling Cooked PHFs from 140°F to 26. Water,Plumb nq and'Waste FC 5 .006 70-FWidnit2Noursand From 70'F 27, Physical Facility FC-6 (07 to 41017145"F Within 4 Hours. * i 28 _.1 Poisonous or Toxic Materials FC -7 .008 3-501.148 Cooling PHFs Made'From Ambient i 29 I S ectal Reguirernents .009 i 2r Temperature lnedients to 41'FI45'F 30 Otter' ther _ Within 4 Hours* *Demes cntienl icon in the leder")1999 Pood Code or 105 C9R 590.000. ° o ITEM 0 DESCRIPTION ELECTRICAL WATER WAS I GAS MANUFACTURER MODEL REMARKS N0. �yy Buw-oj F ITEM E '3: CL ,,,-� aW � e�71 NO. P-1 3-COMPARTMENT POT AN SINK 312" ADVANCE TABOO 93-23-60-24RL W 3 20' X 20' SINK BOWLS, 2 24" DRAINBOARDS & 3 FRANKLIN 100-1035 LEVER WASTES t� P-2 1 PRE-RINSE FAUC 11/2* 1 '2° T & S BRASS B-6133-B W -6107 SPRAY VALVE, B-0044-IH FLEX HOSE & 8-0109-01 WALL BRACKET G.C. TO PROVIDE WALL BLOCKING P-1 ppp » P-2 2 WALL SHELF ADVANCE ABCO WS-15-48 ALL S 5, 48" X 15" G.C. TO PROVIDE WALL BLOCKING . P-1A p P-3 1 DISH CART SERV-O-UFT D-130-35 r1 SINGLE COMPARTMENT OPEN TUBULAR FRAME W S SHELF 35" LONG. P-2 i P-4 1 RACK SHELF ADVANCE TABCO DT-6R-12 ALL S S, 42" LONG. G.C. TO PROVIDE WALL BLOCKING). P_3 P- 1 CLEAN ISHT LE ADVANCE TABOO DTC-S6D-72L RIGHT TO LEFT OPERATION 14" BACKSPLASH 3" ROLLED FRONT & SIDE RIMS GALVANIZED LEGS W .NO CROSSRAILS 71" LONG. P-4 P-6 W 6.6 : 3/at/�1 . .208 1 X t l.{" t-+. 2" I 2" 55 A 0 TEMPSTAR GPX GAS FIRED DOOR TYPE : p_5 P-6 1 DISHWASHER BOOSTER CONNECTION 1.5 0,21 120 x JACKSON RO TEMPSTAR GPX -6 P-7 1 CONDENSATE HOOD CAPTIVE AIREL PERIMETER " " P-6 • P-7A # CONDENSATE FAN & DUCTWORK NOT IN CONTRACT - PROVIDED BY H.V.A.C. CONTRACTOR - VERIFY MECHANICAL REQUIREMENTS P-7 1 FOOD DISPOSER 3.3 2 248 X 1 2" 2 IN-SINK-ERATOR SS-200-5-MS W ADAPTOR FOR 3.5 TO 4 SINK �ENiNG, S S CONSTRUCTION. p_7q P-9 ADVANCE TA13CO DTS-S60-84L RIGHT TO LEFT OPERATION 84" X 3S0" W GALVANIZED LEGS & GROSSRALS BAGKSP ASH 1 20" X 20" X 5" PR -RINSE SINK SCR _ AP BA ET & RACK GUIDE P-9 P-9A PRE-RI N E F U 1 2" t 2" 7 & S BRASS B-0133-B W/B-0107 SPRAY VALVE, 8-4044-H Ft£X HOSE & B-0109-01 WALL BRACKET {G.C. TO PROVIDE WALL BLQq(ING P-10 I RACK SHELF ADVANCE TABCO DT-6R-12 ALL S 5, 42 LONG. G.C. TO PROVIDE WALL BLOCKING . P_9q .............. - .-.- Y P-10 C' ) P 1 2.= 9-FMS-20 " " " f P-12 D K i 2 i E`2"' y-t/z ADVANCE TABOO 7-PS-18 WALL MOUNT€D W AUCEL BASKET' DRAIN & WALL BRACKET G.C. TO PROVIDE WALL BLOCKING . P-11 P-13 1 MOP SINK 1/2' 1/2' ADVANCE TABOO 4-OP-18 W -240 SERVICE FAUCET & K-2412 MOP HANGER G.C. TO PROVDE WALL BLOCKING P-12 P-14 1 WALL SHELF ADVANCE TA13CO K-245 8" 1MDE X n2 LONG. G.C. TO PROVIDE WALL BLOCKING . P-13 CI1 P-#5 i ICE MAKER W IN 13.6 1-1/�2 208/230 1 X 3 8` z'sy MANI OWOC, INC SY-1004A -570 S/S FlNISH, 1060 LB. STORAGE CAIPACITY, SELF-CONTAINED CONDENSER, W/ICE BIN W/ TOP HINGED DOOR.. P-#5 1 WATER FILTER ASSEMBLY 318" MAN W , IN AR-4000 C.W. 0 3 W. ON N MINA 1 Y .C. IN .E G. . ND WALL BLOCKING) P-15 P-i6 1 BEVERAGE TABLE 1/2 1/'2' 1-1/2" 131 ADVANCE TABCO P-15 BEV-30-84R ALL S S, 84" X 30" W EAR & MIGHT SIDE SPLASHES, NO DRIP EDGE, 1 12" X 20" X 12" DEEP SINK ON RIGHT, FAUCET, BASKET ER 14 5" X 36 URN TROUGH ON LEFT & INTERMEDIATE & BOTTOM SHELVES P-16 P-17 I WAIT ELF ADVANCE TABCO WS-15-84 15" WIDE X $4` LONG. G.C, TO PRtOMDE WALL BLOCKING). P-18 1 UNDERCOUN IER REFRIGERATOR 6. ( D t X CONTINENTAL REFRIG. UC27 SELF CONTAINED UNIT W CASTERS & DOOR HINGED RIGHT P-17 ♦ P-19 1 COFFEE BREWER NOT IN CONTRACT - VERIFY ALL UTILITY REQUiREWMEN Wf OWNER. P-18 • P-20 1 SODA AND ICE DISPENSER NOT IN CONTRACT - VERIFY ALL UTILITY REQUIREWMENTSi W OWNER. P-19 P-21 FOOD 6.0 2 120 1 X OBE EQUIP, GC D W STANDARD ACCESSORIES P-20 P-22 1 20 QL MIXER 8.2 1/2? 120 1 X HOBART CORP. A-200-50028 W STANDARD ACCESSORIES P-21 -22 {UDj P-228 1 MOBILE EQUIPMENT STAND ADVANCE TABOO ES-242 A-25 ALL S S, 24 X 24" W NDERSHELIF, NO SPLASH & CASTERS W BRAKES P-23 1 MOBILE WORK TABLE ADVANCE TABOO MS-246/-TA-25 ALL S S, 72" X 24" W N RSHEUF, CASTERS W RAKES & NO SPLASH -228 P-24 1 HEATED CABINET 7.8 1,5 120/208 1 X CONTINENTAL REFRIG. DL1W f SELF-CONTAINED UNIT ON LEGS, DOOR HINGED RIGHT NOTE: CORD & PLUG PROVIDED BY E.C. P-23 d ❑� P-25 1 DISH HOLDING CABINET ADVANCE TABCO DC-158/MOD ALL SLS, 92" X 15" WiDE W OPEN BASE MID ELF & LEGS P--24 P-26 1 WORKTOP REFRIGERATOR 11.3 1 f.`2 I20 # x CONTINENTAL REFRIG, CR892 SELF CONTAINED UNIT W GS P. 8 P- 7 1 DOUBLE OVERSHELF FABRICATE CUSTOM ALL S 107" X 18" WIDE W ROViSIONS FOR ITEM 31 HEAT LAMP P-26 P-28 # SINK UNIT 1f2 1 2 1-1/7` FABRICATE CUSTOM ALL S S, 15` X 34 "EAR & }EFT SIDE SPLASHES, _ LASH S i X 12 24 SINK P-27 1 T&5 B 4321 FAUCET AL/CET & BASKET ET OR N P- 1 R 6.9 7 AI 9 EACH INR REFRIGERATOR 0 0 EFR GER TOR 4 12 1 X f CONTINENTAL REFRIG. 1R SELF-CONTAINED UNIT W CASTERS & POOR HINGED LEFT P-25 - # RACK DOLLY ADVANCE TABCO PD87 26-1/2- 120 6-1 2" 33-3/4-HIGH, ON CASTERS. P- g m P-31 1 60 HEAT LAMP 7.7 1.6 205 1 X APW WYOTT FD-60H-1 W EMOTE INFINITE SWITCH & CONTROL BOX ENCLOSURE - - 1 EXHAUST H000 t0.0 4.5 #20 I X CAPTIVE AIRE 5424NFR 2 SECTIONS, O.A. 14'-0" X 57' X 24` HIGH W GHS FILTERS TOP ENCLOSURE PANELS & 3" REAR & RIGHT SIDE AIR GAP P-31 111 I • 30 P-32A EXHAUST FAN & DUCTWORK NOTIN CONTRACT - PROVIDED BY H.V.A.C. CONTRACTOR - VERIFY MECHANICAL REQUIREMENTS - • P-328 1 SUPPLY FAN & DUCTWORK NOTIN CONTRACT - PROVIDED BY H.V.A.C. CONTRACTOR - VERIFY MECHANICAL REQUIREMENTS -32A P-32C OT S 5 WALL PANELS -328 • , © CAPTIVE AIRF CUSTOM U SHAPED, 57 X 14'-6 X 57 X 78 HIGH W TRIM STRIPS & 2 INSIDE CORNERS P-33 FRE SUPPRESSION SYSiEM CAPTIVE AIRE ANSUL J.B. TO BE TiED INTO BUILDING ALARM SYSTEM BY E.C. G,C. TO PROVIDE WALL BLOCKING A e' Q1 1 DOUBLE RTMECT}ST OVEN 7. 2 120 1 X 3/4" 108 SO( 11iBEND SLGS-22SC W CASTER S S FRONT TOP & SIDES & GAS QUICK DISCONNECT Hua. P-33ca P-35 1 2-COMPARTMENT STEAMER 4.0 2 720 1 X 3 8" 2� 314" 14.0 SOUTHBEND GCX-25-36 W GAS QUICK DISCONNECT HOSE _ a P-36 # FLOOR FRYER 1 2" 90 SOUTHBEND 4FR-45 W CASTERS & GAS QUICK DISCONNECT HOSE P-35 P-37 1 GRIDDLE TOP RANGE i 125 SOUTHBEND P32D-TT- W TANDARD OVEN, CASTERS, DOUBLE DECK HIGH SHELF, 1" REAR GAS CONNECTION W RESSURE REGULATOR & GAS QUICK DISCONNECT HOSE P-36 Q P-38 1 6-BURNER RANGE 1" 243 SOUTHBEND P32D-BBB W TANDARD OVEN, CASTERS.. DOUBLE DECK HIGH SHELF, I- REAR CAS CONNE TION W RES RE REGULATOR & GAS ICK DISCONNECT HOSE P-37 GATE DESCRIPTION m P-39 1 P T Fl FAUCET I 2' T & S BRASS B-0605 W ALL BRACKET G.C. TO PROVIDE WALL BLOCKING P-38 m - 2 ADVANCE TABOO- 7R20-3W FRONT LOADING UNIT W CASTERS INOTE: 1 NO SHOWN ON PLAN P-39 P-41 LOT WALX-IN SHELVING ADVANCE-TA13CO ECC-1860 2 1 X 60 -# 4 2 HI , € XY NI _ P-42 40 1 WALK-IN COOLER 1,0 ry ARCTIC OUST 5'-10` x 7-9" x 7-8-3 8" HIGH MECHANICAL DRAIWNGS TO FOLLOW. P-41 - P-42A V 0 D SIN UN 3.8 3/4 208 230 # X 3J4" ARCTIC CUSTOM MECHANICAL DRAWINGS TO FOLLOW. P-42 d7 P-43 1 REACH IN FREEZER 6 i 0 1 CONTINENTAL REFRIG, SELF-CONTAINED UNIT ON W CASTERS & DOOR HINGED LEFT -42A Z • DEMOTES EOIIPIIOl1 NOT N NITCIEN CONiRAGT P-43 C? 8/23/04 ° DORM EkS M EOIEWW NOT M KP!T31EIt CONTRACT. /21/04 ADDED NEW SHELL 6 10 04 REVISION ♦ • • DENOTES E71T5T9iO EOUP" TO DE AEIOCATEO / / 5/MSH I W 5/21/04 REVISIONS/JRD 5/20/04 REVISIONS JRD 1 DATE, 05-19-2004 t ITEM DESGRIP710N ELECTRICAL » : . N0. WATER ' WASTE GAS MANUFACTURER MODEL, REMARKS NO. FsCALEf¢"sj''-0" rawer B w w I 26 1 WORK TABLE ADVANCE TABCO TXSS-304 {2 TA-3# ALL S S, 48 X 30" W EAR & SIDE SPLASHE!., & OPEN BASE r 26 2 1 UNDERCOUNTER REFRIGERATOR Ct.2 1 /5 924 i X CONTINENTAL REFRIG. SW27 SELF CONTAINED UNIT W CASTERS & DOOR HIN_ ED RIGHT s 26 1 JUICE DISPENSER NOT IN CONTRACT - VERIFY ALL UTILITY REQUIREMENTS W OWNEP 27 ♦ 29 1 HOT CHOCOLATE DISPENSER - 1 . NOT IN CONTRACT VERIFY ALL UTILITY REQUIREMENTS W OWNER $ • 29 • : t 3 COFFEE MAKER N07 IN CONTRACT - VERIFY ALL UTILITY REQUIREMENTS W-/-OWNER 31 1 DROP-IN SINK 1/2" 1/2"' 1-1/2' POLAR WARE COMP. K1734C DROP-IN UNIT TO ITEM 57 WiTH FAUCET DRAIN KIT 31 j 32 1 UNDERCOUNTER DISHWASHER +.1 0.3 1,t J2 208 1 x 2," t-1/2. JACKSON JPX-200 W UILT IN HOT WATER BOOSTER 32 ® 33 1 WALL SHELF HOODCO SYSTEMS CUSTOM ALL S S 48" X 12" G.C. TO PROVIDE WALL BLOCKING). 33 m 34 COMPARTMENT iNK "f2" 1/L" t_1/2" AERO MFG. 3FI-1818 S-01 S-17 ALL S S 18" X 18" SINK BOWL W ACKSPLASH FAUCET & BAST DRAIN 34 a ® 35 i MOBILE WORK TABLE ADVANCE TABOO KSS-304 A-25 ALL S S, 4$" X 30" W ACKSPLASH, UNDERSHELF & CASTERS VBRAKES 3S W 36 D SINK 1/2'1 1/2" 1-1/2" ADVANCE TABOO 7-PS-20 W FAUCET, BASKET DRAIN & WALLBRACKET, MOUNT RIM 0 34" R.F. G.C. TO PROVIDE WALL BLOCKING 35 Q E'-t W W 37 T WIRE SHELVING ADVANCE TABCO EC-IM/EC-1860 CHROME COATED 3-11ER MOUNTED. ON 74" HIGH POSTS 37 tE-1�-� t 1 38 _ 6 ' 1/4 120 1 X CONTINENTAL REFRIG. DLRt-SS SELF-CONTAINED UNIT W EGS & DOOR HINGED RiGHT 38 W Q + 39 x = 1/4 120 1 x CONTINENTAL REFRIG SWF278S SELF CONTAINED UNIT W GS & DOOR HINGED RIGHT M ® 40 1 MICROWAVE SHELF HOODCO SYSTEMS CUSTOM ALL S 5 24"X 18" G.0 TO PROVIDE WALL BLOCKING 39 41 1 MICROWAVE OVEN 1.2 120 1 x PANASONIC NE-1258 1200 WATTS NEMA 5-20R PLUG 40 m �, Q W 42 1 BOOR FRYERll" 90 - W CASTERS & GAS QUICK DISCONNECT HOSE �� 41 r� i( 42 43 UN G G i D 3 4" 80 STAR MFG, 82475 S-UM245 W OBiLE EQUIPMENT STAND & GAS QUiCK DISCO `<ECT HOSE W W U 44 1 EXHAUST HOOD 10.0 0.3 120 1 x p ALL S/S, 96 X 73 X 24 HIGH W/LIGHTS, FILTERS, TOP ENCVWRE PANELS & 3 REAR AIR GAP 43 Q Hco • 44A 1 EXHAUST FAN & DUCTWORK NOT IN CONTRACT - PROVIDED BY H.V.A.C. CONTRACTOR - VERIFY MECHANICAL REQUIP,EAMI'S 44 - W ♦ 448 # SUPPLY FAN & DUCTWORK 44A • 7�+ [�] UZ-r NOT IN CONTRACT - PROVIDED BY H-V.A.C. CONTRACTOR - VERIFY MECHANICAL REQUIREMITS - 448 • Y W L',: L 43C 0 S S WALL PANELS CAPTIVE AIRE CUSTOM ALL S/S, 96 X 78" HIGH W/TRIM STRIPS 448 m et5� 45 1 FIRE SUPPRESSION SYSTEM 120 I x CAPTIVE AIRE ANSUL J.B. TO BE TIED INTO BUILDING ALARM SYSTEM BY E.C. GG I-t�R0140£ WALL BLOCKING 46 6-BURNER RANGE W C.O. 4.8 1/3 120 1 X 3 4" 2 2 SOUTHBEND 436A ONVECTION 47 SALAMANDER BROILER , LEGS & GAS QUICK DISCONNECT HOSE 46 N 47 NOTE: W W 3 EI" a0 - INTERPIPED TO ITEM 46 BY P.C. IN FIELD _ 4$ 6.2 1/5 120 1 X CONTINENTAL REFRIG. SW27-8 SELF CONTAINED UNIT W CASTERS 49A WALL SHELF 48 ALL PLUMBING AND ELECTRICAL CONNECTIONS FOR a - O O HOODOO SYSTEMS CUSTOM ALL S 5 60" X t2" W CHECKMINDER G.C. TO PROVIDE WALLLOCKING . 49A ® O a 498 WALL SHELF Hooaco SYSTEMS CUSTOM ALL s s 72" x 1z" G.C. To PROVIDE WALL BLOCKING). 496 EXISTING EQUIPMENT AND EQUIPMENT NOT IN KITCHEN ® 50 1 WORK TABLE 7 O aH 120 1 X ADVANCE TABCO KMS-309 ALL S S 108" X 30" W EAR & LEFT SIDE SPLASHES & UNCRSHELF 51 1 HEATCONY LAMP CRESCOR IFW-66-10 BULB TYP INFA-RED SPOT LAMP HANGING COURT MOUNT 'iDiUDUALALMP ASSEMBLY W ONE LAMP. � ® EQUIPMENT CONTRACT TO BE VERIFIED BY THE 114 rZ4 52 1 CONVEYOR TOASTER 3.8 1.8 120 1 X STAR MFG. OCS-1-350 NEMA 5-15P PLUG 52 OWNER AND OR GENERAL CONTRACTOR, 53 - SPARE NUMBER - SPARE NUMBER - _ - 53 NOTE: • 54 1 POS SYSTEM NOT IN CONTRACT - VERIFY ALL UTILITY REQUIREMENTS W OWNER 54 • UNDERCOUNTER REFRIGERATOR 71t 1/5 120 1 X CONTINENTAL REFRIG. SW48 SELF-CONTAINED UNIT W CAS7ERS UNITED EAST IS NOT RESPONSIBLE FOR. ANY ♦ 56 1 SODA AND ICE DISPENSER NOT IN CONTRACT _ VERIFY ALL UTILITY REQUIREMENTS W OWNER CRD F� YVAPviE+ • 57 1 MILLWORK BEVERAGE COUNTER NOT IN CONTRACT MILLWORK PROVIDED BY MILLWORK CONTfRACTOR 56 • MECHANICAL REQUIREMENTS FOR EXISTING EQUIPMENT 58 - SPARE NUMBER - SPARE UMBER- - 57 . TO BE REUSED. IT IS THE RESPONSIBILITY OF THE /PLAN/36474 PICKERING DRAFT BEER COOLER 8,6 1/3 120 t X CONTINENTAL REFRIG. KC-59 SELF-CONTAINED UNIT W EGSi 5$ L11 GENERAL CONTRACTOR, PLUMBING CONTRACTOR AND 60 1 BOTTLE COOLER 8.0 1 120 1 X CONTINENTAL REFRIG. CBC64 SELF-CONTAINED UNIT ON CASSTERS NEMA 5-15 CONNECT70N. ,. 659 0 ELECTRICAL CONTRACTOR TO VERIFY ALL REQUIREMENTS • 1 TRASH RECEPTACLE NOT IN CONTRACT _ VERIFY ALL UTILITY REQUIREMENTS WN WITH OWNIER TO ENSURE PROPER CONNECTIONS ARE MADE, I ® 62 1 3-COMPARTMENT BAR SINK #J2" tt2,. 3) 1" KROWNE METAL 18-53C FREE STANDING UNIT • 64 62 ALL PLUT1AI91NG AND (� PASS-THRU ICE CHEST 1/:2 KROWNE METAL PT-2436-8 W/8-CIRCUIT COLD PLATE & S3-24 SINGLE TIER BOTTLE RAIL - NOTE: BAR HAND SINK i fZ" ? 2" 1-1 I2 KROWNE METAL 18-iC FREE STANDING UNIT W AUCEET ELECTRICAL U71UTY REQUIREMENTS KROWNE METAL 18-34-7 W/7-CIRCUIT 00U7 PLATE dt Ss-30 SINGLE TIER BOTTLE RAIL 64 SHOWN OIN THIS SCHEDULE ARE SUBJECT TO CHANGE of # j>1 6 36' COCKTAIL STATION i 3. $ LO WIRE SHELVING ADVANCE TABOO ECC-1436 1442 CHROME FINISH, 4-TIER MOUNIIED ON 74` HIGH POSTS 65 b of ffi� j� 1 UNDECOUNTER DISHWASHER 44.1 10.3 1,1l20 208 1 X -,fa JACKSON JPX-200 W BUILT IN HOT WATER BOOSTTER 66 BASEp O�4 NAL EQUIPMENT PROPOSAL $El.�CTE[} t ® 3-COMPARTMENT BAR SINK 1 f2 1f= ». t KROWNE METAL 18-43R FREE STANDING UNIT W AUCET m BY THE OWNER AND/OR CONTRACTOR, • 69 1 MILLWORK BAR TOP NOT IN CONTRACT MILLWORK PROVIDED BY MILLWORK CONTRRACTOR kf 69 • 7Q 1 BACK BAR COOLER 7.0 1 3 120 t k TRUE MFG IBB-24-48 SELF-CONTAINED UNIT W/BLAC;K POWDER FiNISH (NEMA 5-15R PLUG} 7q H.W. HOT WATER V. VOLTS &Amdm ad ® 71 1 LIQUOR STORAGE KROWNE METAL 18-LD2 71 CENTER LINE mdb 72 # S S BAR DRAINER 1" FABRICATE CUSTOM ALL S/S, 38" X 24" W/REMOWABLE DRAIN PAN m C.W. COLD WATER N.P. HORSEPOWER D.F.A. DROP FROM ABOVE of If ♦ 73 1 SODA .SYSTEM W/(3) GUNS 72 W. DIRECT WASTE K.VJ. KILOWATT S. STEAM INLET vasda a NOT IN CONTRACT - • DENDIM Em IPI S T►DT'IM Ir%M CONIRACT decal 73 ' I.W. INDIRECT WASTE AMP. AMPERE R. STEAM RETURN CHECKED BY, • • DENOTES E78SlING EGUP11Ea11 NDT M KITCFEiI CONTRACT. F.D, FLOOR DRAIN S.R. SINGLE RECEPTACLE C.F.M. CUBIC FEET/MINUTE G.F. ♦ ♦ • DMIM Oft- Bi EMWMDO TO BE IISMTED G.F. FUNNEL FLOOR DRAIN D.R. DUPLEX RECEPTACLE COL. COLUMN SHEET NO, PH. PHASE J,B, JUNCTION BOX B.G. BOTTLE GAS A.F.F, ABOVE FINISHED FLOOR C.P. CORD AND PLUG -' o t A B.T.U. BRITISH THERMAL UNIT B.T.C. BRANCH TO CONNECTION 5 I I y1n1G n � I I I I I I -- rp I / i I _j k � � I � 1 I I V-4 np LOCATION TOF DISH CART GQeP t k, �K I I I O j-A � TO BE VERIFIED I I I S l� "# WITH OWNER. a A 04 i u DATE DESCRIPTION 1 2 - � I z i I 1 I f \ I Q p 8/23/04 RLMSED LAYOUTA, 9zzr'WPnl 11 r 6/21/04 ADDED NEW SHELL 6/10/04 REVISIONS/MSH N W REVISIO JR 52104 S D 5/20/04 REVISIONS/JRD I V (i I I I DATE- 05-19-2004 I ,./ ' DRAWN BY, J.R.D./R.D.C. I / I 45 37 36 37 �!`' I ELECTRICAL I SCALE- 1 f4"=1,-0• �tiJl/d� Id F) \ . I T I 31 26 3d / ayyn' t ry�g 1 56 29 28 55 Zl 30 J1 y� I PANEL ------------------ — — - - I , LLZJ I 3g 3� 1 40 44 42 43 -� 47 18 ------- 52 51 iL? itl 3'-0" CASEMENT 67 I WINDOW" �� bYj � t lfsf./� ILN 66 IL L6-4 W _ _ --- _ p Vr, ` E i LA da p ..m a IM .r a o cr ca71t r x a � I --- ---- ---- ---- ---- - -- I ' W p � W U) J I I I I I O O 0 ►4 {� / I F W w I I 1 i 1 I ( CAD FILE NAME f 1 PICKERING/PLAN/36474 I I I _ 1 — 1 9 60 *mmto"*,ft&XhftdBmxL I �-� ThneDa��e9ie�depaupat� I err�v�assea.�>e�sm 1 — �_ Owtrcr ad WA GSanr�aeon b d�et4 �drQ1��YW� god aaodltimr 1n�o>�3eld6esre� a I I I I oanMndlm and 1owdfl i --�- - _ _ _ _ _ 9- ,> � rim - - - - - - - - - - - - CHECKED BY- G.F. SHEET NO, K . 1 TSr('ff'A'26@: CITY OF SALEM; MASSACHUSETTS LICENSING BOARD 45 MARGIN STREET P.O.BOX 1042 TEL 744-0171 EXT.30 Chairman,Harold F,Blake,Jr. CLERK James M.Fleming JUDY DAVENPORT John H.Casey HEALTH DEPARTMENT P NOTIFICATION FORM r IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS r FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form MUST be signed by the Heath Deptartment and returned with your application) . NAME OF CONCERN: P.W. Pub of Salem, Co: , Inc. LOCATION: 223 Derby Street, Salem, MA 01970 TELE. # (781) 631-3070 TYPE OF LICENSE: Liquor License/Common Victulers License APPLICANTS NAME: J. Hilary Rockett, Jr. RESIDENCE: 5 Corn Point Road CITY: Marblehead STATE: MA ZIP; 01945 TELE# : (781) 631-3070 HEALTH AGENT/INSPECTORS COMMENTS: wi qQ Plg� �j t CP�7 q,�Jn..�-6i"��r-� � ✓.2vi�+ � eel /,�J/,r..., s qsytc� ✓ �,- HPWM (i AGENT I Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4"'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of �,7J /yn Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel-Li 4 p n( (J Name q ate Type,.6fOperation(s) Type fInspection W [L}'food Service outine Address Risk ❑ Retail Re-inspection Telephone /� Level ❑ Residential Kitchen Previous Inspection ll ❑ Mobile Date: Owner ^ HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC STime ❑ Bed 8 Breakfast ❑❑ HACCP Complaint In: Inspector O Permit No. ❑.Other Each violatidn checked requiresexplanation on the narrative pages)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 59o.009(E) El Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOD.PROTECTION MANAGEMENT. _ ❑ 12. Prevention of Contamination from Hands __ ❑ 1. PIC AssignedlKnowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM'CHEMICALS PR_ - ❑ 2. Reporting of Diseases by Food Employee and PIC [:114.Approved Food or Color Additives El3. Personnel with infections Restricted/Excluded ❑ 15.Toxic Chemicals -,FOOD-FROM APPROVED SOURCE _ - '❑ TIMEREMPERATURE�.CONTROLS(LotentianyHazatdousFoods)4. Food and Water from Approved Source ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy.of Ingredient Statements [117 Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling .PROTECTION FROM CONTAMINATION ❑ 19.Hot and Cold Holding ❑ 8.Separation/Segregation/Protection [120.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR,NIGHLY:IiU$CEPTIBL'E=POPULATIONS':(HAP)_ El 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices C.ONSUNIERADVtSORYL 649 Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. C 590.000/federal Food Code.This report,when signed below N 23. Management and Personnel (FC-2x590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (Fc-3x590.004) order of the Board of Health. Failure to correct violations �Q25. Equipment and Utensils cited in this report may result in suspension or revocation of lL (FC-4x590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (Fcsx59o.o06) establishment operations. If aggrieved by this order,you 27. Physical Facility (Fc-5)(590.007) have a right to a hearing.Your request must be in writing lX 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 DATEOFRE-INSPECTION: i n wm .e« Inspector's Signature:, t L TICS Signator • Print: Page 1. ofages a ^1k. _r.. _...� -...�� rn. --. .t..w.r.w,� _ r'..�\'--...� lea-^�f��.--`r"',. �YY ,•` -4•.. •r- r• ' Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Crass-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw An mal Foods Separated from Cooked and RTE Foods* 2-0 3.11 ) Demonstration of Knowledge* - Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302.1 I(A)(2) Raw Anitn il Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-30211(A) Food Protection* - require reporting by food employees and applicants* 3-302.15 Washin Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-30611 Food Contact with Equipment and Applicant To Report To The Person In _ Utensils* Charge* Contamination from the Consumer 590.003(0) Reporting by Person in Charse* 3-306.14 A) B ,Returned Food and Reservice of Food* ( -1 ) Dix /tion of Adulterated or Contaminated 3 590.003(D) E;:elusions and Restrictions* Food 990,003(E) Removal of Exclusions and Restrictions 3-701,f'! Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Form law'" 4-5(11..111 Manual Warewashing-Hot Water 3-201.1.2 Ftxxi in a Hermetically Scaled Container* Sanitization Temperatures* 3-701.13 Fluid Milk and Milk Products* 4-501.1 12 Mechanical Warewashing-Hot Water 3-202.13 Shell E� s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.11} Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Potable Drinkiog Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System 4-60 1.-11(0) Equipment Food Contact Surfaces and 590.006(A) Hotbed Drinking Water- Utensils Clean* 590.006tE) Water bSeets Standards in 310 CMR 220* 4-60'_-1.1 Cleaning Frequencv of Equipment Food Shetrsh and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.1 I. Frequency of Sanitization of Utensils and 3-201.14 Fish and RecreaCionafly Caaght Molluscan Food Contact Surfaces of Equipment* Molluscan 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSF Lasted Sources* Chemical* Game and Wild P4ushrooms Approved by 10 Proper,Adequate Handwashing .4e ulato Aull!Eit 2-301.11. - - Clean Condition-Hands and Anes* 3-202.18 Shellstock Identification Present's 2-301..12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals°' IS Good Hygienic Practices 5 Receiving/Condition 2-401.11. Eating,Drinking or Usin Tobacco* 3-202.11 PHFs Received at Proper Tem erahlres* 2'401.12 Discharges.From the Eyes,Nose and 3-202.15 Package hoe-it * Mouth* 3-101.31 Food Safe and Unadulterated* 3-301.12 Preventn�Contamination When Tasting* 6 Tags/9ecords:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstoek Identification* 590.004(E) Preventing Contamination.from 3-203..2 Shellstock Identification Maintained* Employees* Tags/Records:-Fish Products 13 Handwash Facilities 3402.11 - Parasite Destruction* Conveniently Located and Accessible 3-402.1^_ Records,Creation and Retention* 5-203.11 Numbers and Capacifies* 590004(!) - Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.1.1 Accessibility,0 ration and Maintenance /HACCP Plans Suppled with Soap and Hand Drying 3-502.17. Specialized ProcessingMethods* Devices 3-502.1.2 1 Reduced oxygen 2ackaging,criteria* 6-301.11 Handwashin Cleanser,.AvailabiHt 8-103.!2 Conformance with Approved Procedures* 6-301.12 Hand D Provision {Denotes critical iwni in,the f�dcral 1999 Paxl Code or 105 CMR 590.000. AN, lk ,two WIVAM)�'W, ", - irto -_�:.�:n��'., I'.. � ��:• / `.✓.rte .I �� , u . .� �.I1. ' �. mm��low if RIVER! �4+icel.A � i.� Mal l f�� Min MRA 05_ // _ iVRA �I .� • of f - g• __ t , y 3-501.14(0) PHFs Received at Temperatures P Violations Re atateit to Foodborne Illness Interventions and Risk According to Law Cooled to Factors#term 1-22) (Cont.) 41'Ff45'F Within 4 Hour&, PROTECTION FROM CHEMICALS 3-501.15 Coolunt Methods for PHPs PHF Hot and Cold Holding 14 Food or Color Additives 19 I 3-50LW(B) Cold PI1Fs Maintained at or below 3,202.12 Additives* 590'0040 41145'F* 3-302.14 Protection from Unapproved Additives'4 1g Poisonous or Toxic Substances 3-50L16(A) Hot PHFs Maintained at or above 1400P. 7-101.11 Identifying Information-Original - 3-501.16(A) Roasts Held at or above 130'F. Containers* 2® Time as a Public Health Control 7-102.11. Common Name-WorkingContainers* - 7-201.11 Separation-Stora * 3-501.14 Time as a Public Health Control° 7-202.11 .Restriction-Presenceand Use* - 590.004(11? Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanitizers.Criteria-Chemicals° 7-204.12 Chemicals for Washing Produce,Criteria' 21 3-841.11(A) Uagasteruilrtf Pre-packaged Zuices and :Bevern*es with Warning Labels* 7-204.14 ents.Criteria* 3-501.1118 Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 l(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served- ,-206.12 erved,-206.12 Rodent Bait Stations* 3-1301.11 C Unopened Food Package Not Re-served. 7-206.13 Tmt:king Powders,Pest Control and 'Monitorin " CONSUMER ADVISORY TIMEf1 EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or F6 Proper Cooking Temperatures for PHFs - Not OtherwiseProcessedto Eliminate 3-401.11A(l)(2) Eggs- 155'F 15 Sec. Patho ens.* �'nrzxr E as-immediate.Service 145'F15see* 3-302.13. Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game E r Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Port:and Beef Roast-130°F'121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec.* catering,mobile food,temporary and Z 3-401.1.1(A)(3) Poultry,Wild Game,Staffed 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 i 31301.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other ` 145'F* 590.009 violations relating to good retail. 3-441.12 Raw Animal Faxls Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-441:1I(A)(1)(b) All Other PHFs- 145T 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-003.1l(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3.403.11(B) Microwave 165 F 2 Minute Standing 0itical,mrd non-crif cal violations,which do not relate to the i Tine* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercial ly Processed RTE Food- jaund in the following sections of the Food Code mid 105 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Retail Practices FC 69_3 C-2 .003 __ i RoastRoasts* j 23_ i ManagsmentandPersonnsl i-F Ig Proper Cooling of PHFs 1 24. 1 Foal and Foci Protection FC-3 .004 25. Equipment and Utensils FC-1 -4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to g5, Water.Plumbing and Waste i FC-5 .006 i 70°F Within 2 Hours and From 70°F21 7. Physical FacilityFC-fi 007 to 41`F/45'F Within 4 Hours. * 1 28. 4 Poisonous or Toxic Materials ! FC-7 008 i 3-501.14(B) Cooling PHFs Made From Ambient 129. Special R uiremants I � r Temperature Ingredients to 41'F145'F 1 Omer --;v- i Within 4 Hours* 'Drmtes aiticat iatm in the federal 099 Foci Code"105 C:MR 390.000. CITY OF SALEM BOARD OF HEALTH Establishment Nam Date: of-3Page: of Rem Code C-Critical a DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified PLEASE PRINT CLEARLY /0 0AQA e MWI/U-41 A C42 4S E A,4 bgdAAF_ Discussion With Person in Charge: Corrective Action Required: ❑ No es 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 4e-inspection S duled ❑ 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 spension/revocation of ❑ argo ❑ Emergency Closure your food permit Ll Voluntary Disposal LI Other: 3.501.14(C) PHFs Received at Temperatures Violations Related to Foodborne illness Inter✓entions and Risk According to Law Cooled to Factors(hems!-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS S 3-501..15 Conlin Methods for PHFs 14 , H or Color Additives 3-501,16(B) PHF Not and Coid Holding 590.004{F) 4l14S F* 3-501.16(8) Cold PHFMaintaind at or below 3-202.12 Additives* 3-342.14 Protection from Unapproved additives* -YL' ----- 3-501.16{A} Hot PHFs Maintained at or above 4 15 Poisonous or Toxic Substances ) T 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* * 7-102.I1. Common Name-Working Containers* 20 Time as a Public Health Control tora * 3-501:14 Time as a Public Health Control* 7-201.i S Separation-S 7-202.11 .Restriction-Presence and Use* .590.004(H) Variance Re nirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS( FOR HIGHLY SUSCEPTIBLE POPUHSP 7-204.11 Satntizen%Criteria-Chemicals" 21 7-204.12 Chemicals for WashingProduce,Criteria* 21 3-801.il(A) BeveragesUnpasteurwt) Wanting a Juices and 7-204.14 Agents.Criteria' - :Beveraees with Wanting Labels" 7-205.11 Incidental Food Contact,Lubricants* 3-80IAI(B) Use of Pasteurued Eaas* . 7-246.11 Restricted Use Pesticides;Criteria'* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served, 7-206.12 - Rodent Bait Stations* 3-$41.11 C Unripened Food Package Not Rc-served. 7-206.13 Tracking Powders,Pest Control and Monitor in * - CONSUMER ADVISORY TIMER EMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Rave Undercooked or PHFs - - - Not Otherwise-Processed toEliminate Patbo _ns.* 3-401.]IA(1)(2) Eggs- 155'F 15 Sec. E. -immediate Service 145'Fl5sw 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell t I 3-401.11(A)(2) Comminuted Fish.Meats&Game E ( Animals-155'F 15 sec. " SPECIAL REQUIREMENTS 3.401.11(11)(1)(2) Pork and Beef Roast- 130-F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.(Ki4(A)-(D}in { sec.* catering,mobile food,temporary and 3-4,11.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-I65'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other +� 145T* 590.009 violations relating to good retail i 3401.12 Raw Animal Foods;Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401:11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 4 3-413.11(.A)&(D) PHFs 163-F 15 sec. * (Items 23-30) 4 3-403A I(B) Microwave 165`F 2 Minute Standing -Critical,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors lister]above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sectionsofthe Food Code and 70S CMR 140'F* 590.000. t 3-403.11(E) Remaining Unsliced Portions of Beef - I Item Good Retail Precdces .FC 590.oad i 123. ! Mana amen(and Personnel FC-2 .003 Roasts„ ' Proper Cooling of PHFs FR-]g Food and Food Protection FC-3 .004 g 25. 1 Equipment and Utensils FC 4 .(705 1 -- t 3-01.14(A) Contin Cooked PHFs from 140`F to �. 2g, 1 Water,Piumhine7 and waste 1 FC-5 .008 ' 70'F Within 2 Hours and From 70*F 27. Physical Facility ± FC-8 .007 to 41`F/4501`Within 4 Hours. * 1 28. Poisonous or Toxic Materials ? FO-7008 3-501.14(@) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41'F/45`F 30Other 1 Within 4 Hours* V "Denores critical item in the federal 1999 Food Cale a 105 CMR 590.000. Y ° m R. CITY OF SALEM, MASSACHUSETTS . - BOARD OF HEALTH - - - 120 WASHINGTON STREET,47 FLOOR Plllfl}1CHC8t111 rm.co.r.omm<.r.oiecc TEL. (978) 741-1800 Fax(978) 745-0343 KIM ERLEY DRISCOLL lramdin e salem.com LrARRY R,AMDIN,RS/RL.I IS,CHO,CP-FS MAYOR - HEALTH AGENT ' ' This Form will be collected during your next Board of Health inspection. QUESTIONAIRE - GREASE TRAPS 2012 - 1. NAME OF ESTABLISHMENT:- 2. STABLISHMENT:2. ADDRESS OF ESTABLISHMENT: 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? f 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS . 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? .ray ..z.✓;y� �6Rf0� 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? S. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? Al XAE it1a7- 'nIdaic£n T/, g llra,1464 67,0FA60r-7_ /gin t a-�