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AREA CODE NUMBER TIME TO CALL
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RETURNED YOUR CALL WILL FAX TO YOU
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SIGNED
FORM 4009
MADE IN u.S.A.
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IMPORTANT MESSAGE
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SIGNED
Orr M. FORM 4009
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NOTES
IMPORTANT MESSAGE
FOR
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PHONE NO - &17"
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AREA CODE NUMBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE floor
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SIGNED
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IVERML. 413005 MADE IN U.S.A.
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Commonwealth of Massachusetts
it
City of Salem
Kimlxpdov n.;e...,u
y` 120 Washington Street,4th Floor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED:. _01/29/2010
.ice y
ESTABLISHMENT NAME: Anna's Pizzeria
File Number:BHF-2005-000006 400 Highland Avenue
Salem MA 01970
LOCATED AT: 0400 HIGHLAND AVENUE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2010-0005 Jan 4,2010 Dec 31,2010 $140.00
ESTABLISHMENT
Total Fees: $140.00
PERMIT EXPIRES December 31, 2010
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4."FLOOR
TEL. (978) 741-1800
KIIvIBERLEY DRISCOLL FAX(978) 745-0343
MAYOR DGRC ENBAUNl(l!)3ALEM.COM
DAVID GREENBAum,
ACTING HEALTH AGENT
2010 APPLICATION FOR P MIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT—A Ok V Q//�� ( rl,, // TEL#
ADDRESS OF ESTABLISHMENT ��AX#
MAILING ADDRESS(if different) SO I
EMAIL- Business': Website: �—�/ (<J/l A7}
OWNER'S NAME t e C0 ftej ( J — �j/ ,T7J
ADDRESS Q ,1 - t'�C
STREET / �� t PITY r STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) JPr CERTIFICATE#(S)
(Required in an establishment where potential az'
ours foo'od is prep �d))
EMERGENCY RESPONSE PERSON o / 2 l 'I�Q A/ HOME TEL#
DAYS OF OPERATION Monday Tuesday Wednesday:.: Thursday Friday SatuN Sunday
HOURS OF OPERATION
Please write in time of day.
For example Ilam-11 pm
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$70
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
-------------------------------------------------- --- -----------------------------------------------------ie------------------------------------------ -----
RESTAURANT ES NO less than 25 seats =$140
(Outdoor Stationary Food Cart$210) 25-99 seats =$280
more than 99 seats =$420
------------------------------------------------------------ -- ------------------------------------------------
BED/BREAKFAST/ YES N $100
CHILDCARE SERVICES/NURSING HOM----------------------------------------------------------------
---------- - --- ------------------------ ------------
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT(such as church kitchens) YES NO $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with t State Sa itary Code, before any renovations, improvements,or equipment changes are made,all plans for
Vptls
ubmi to and proved by the Salem Board of Health.
Chap 62C,S n 49A,I cert'rfyunder t pain and penalties of perjury that I,to my best knowledge and belief,have filed all state tax
t e re ed under the law. a Date Social Security or Federal Identification Number
---------------------------------- ---- ------- ------------rr- ------------------------
Revised 42 &4/07 FOODAP2008.adm Check# Date $ V
CITY OF SALEM
BOARD OF HEALTH
Date: January 5, 2010
Name of Establishment: Anna's Pizzeria.
Address: 400 Highland Avenue
Owner(s): Paul Linder and Roger Williams
Phone: 978-740-2771
The proposed owners of this new establishment presented a menu and floor plan in
accordance with the State Sanitary Code.
CERTIFICATION
There must be at least one full time CFM at this location. A "Person in Charge"
or"PIC" must be available at this location when the CFM is not present. The PIC must
have knowledge of sanitation techniques, holding temperatures, operations, etc. Mr.
Williams is Serve Safe certified and two additional employees will also become certified.
Owner must provide copies of all Serve Safe certifications to the Board of Health.
CHOKE-SAVING
Establishments that have 25 seats or more must have someone that is Choke
Save Certified on hand any time it is open for business.
FLOOR PLAN
The floor plan is approved pending the replacement of the hand wash sink
near the pizza oven in front. All hand sinks must have a wall hung soap and paper
towel dispenser. These must be stocked at all times. The hand sink must be used for
hand washing only.
All floors, walls, and ceilings where food, utensils, paper products, etc, are
stored, prepared or served must be intact, impervious, and easily cleanable. This
includes any such areas in the basement if these products are to be stored in the
basement.
A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes
will be used. This three bay sink must be NSF certified and large enough to provide an
adequate number of service ware and to hold all equipment.
MENU/FOOD PREP
All food must be held at 41'F or lower, or 140°F or higher, at all times.
Therefore, soup and other hot items should be brought to boiling before being held hot.
Food may not be added to containers in holding unit. Instead, a sanitized
container with new product may replace the existing container and the old product may
be placed on top of the new product. Food must be cooled and heated quickly.
There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or
tissues must be used when handling such food.
All refrigerator/freezer units must have internal thermometers maintained at
proper temperatures as stated above.
UNDERCOOKED FOODS
The consumer advisory is on the preliminary menu and must be place on the
final menu.
EXTERMINATION
Monthly services of a Licensed Pest Control Operator are required. Please keep
receipts for inspections. Before the new owner can open this establishment for business
they must provide a signed contract with a Licensed Pest Control Operator and an initial
inspection must be conducted prior to opening.
SANITIZING SOLUTION
Sanitizing Solution must be accessible at each prep station and for the patrons'
tables.
Test strips corresponding to the kind of sanitizer, must be on hand to check
concentration of solution. Solution must be made daily, tested, and the results recorded
on a log sheet for examination by Board of Health inspectors.
Spray bottles with clean paper towels may be used, as well as wiping pails with
wiping clothes always held in the solution in the pail.
Outside area of premises, including the dumpster area, must be kept clean and sanitary.
Please call to schedule a change of ownership and opening inspections.
An appli ftio d check was not submitted.
—lo
id Greenbaum Date
Acting e h Ag t
1)J-11161
Paul Under Date
Roger Wiarns Dat
7
Sal Vs Dinners
Fresh Garden 5,95 Ziti with MeatbaCfs 9.95
(made with homemade marinas sauce)
Caesar 5 95 9.95
� BakedZiti
r' CGriffedChicken Caesar 7.9$ (ricotta, mozzarella romano cheeses)
m
Steak 7!p Caesar 7.95 Three Cheese RavioCi 9.95
t-
tariffed Shrimp Caesar 7,95 (homemade&stuffed with 3 cheeses)
4Y 4 Chicken Parmesan 9.95
%�ntaStO 8.9$ (tender Chicken breast,topped with marinara sauce)
Dressi s
Chicken BroccoCt & Ziti 9.95
PIZZA
(sauteed in lemon, butter&light garlic sauce)
Marian daframrc Ziti Aado
9.95
Cheese Siwe 2.00 creamy Mahan caesar (sauteed cream, batter,cheese, garlic&lemon sauce)
Shrimp Scampi 9.95
mopping SCtce 2.50 stiffs (sauteed in garlic, butter, lemon&cheese sauce)
Smad-Ofeese (so 9 6.95
�
,i". . .' c Large Cheese /i67 9.95 a (-.q,5r Specials
Tuna 4.95 6-9-f Catcof ftfe Day marketprice
?'pings $L5o each Chacken Salad 4.95 6:95
yepyeroni sausage AaAan 4.969Meat
mushrom meatdal ofthe-Day marketYrue
roastedredye4.95 69S� ro � l
Chicken Parmesan 5.9.5 795 _aur Cheese lasagna 9.95
Spec<y Pizza eggplant Parmesan 5.95 79S (ricotta, mozzarella, parmesan&romano cheeses)
2ggplant Parmesan 9.95
)Yheat Daugh Yeggle 11.95 Steak Yp 6.95 895 (homemade&pan fried in olive oil w/marinara sauce)
----------- ----------- --- ---- - --- - Chicken Brasciolatini 9.95
Margarlta 11.gs CONSUMER ADVISORY WARNING FOR RAW FOODS (stuffed w/proscutto, spinach, mushroom&cheese)
Meatfovers 11.9.5 IN COMPLIANCE MTN 7HEDEPAR7MENT OF
ShrimChicken r'4tarsala 9.95
PUBLIC NEALTH, WE ADV/SE TNAT EATING
p Scampi 12.9 f RAW OR UNDERCOOKED MEAT,POULTRYON (chicken tenders sauteed with mushrooms, garlic,
Buffalo Chicken 1zg-s SEAPOODS POSES A R/3K TO YOUR HEALTH cheese, butter&mvine)
NOT RECOMMENDED FOR CHILDREN
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CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Date: `7(R ho Page: of
Item Code C-Crmcal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date-
140. Reference R-Red Item verified
PLEASE PRINT CLEARLY
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Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
violations before the next inspection, to observe all conditions as described, and to Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure
your food permit.
❑ Voluntary Disposal ❑ Other:
3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to
Factors(Items 1-22) (Cant.) 41'F/45°F Within 4 Hours.
PROTECTION FROM CHEMICALS3-501.15 CoolingMethods for PHFs
14 Food or Color Additives 19 PHF Hot and Cold Holding
3-501A6(B) Cold PHFs Maintained at or below
3-202.12 Additives* 590.004(F) 410/450 F*
3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above
15 Poisonous or Toxic Substances
7-101111 Identifying lnfonnation-Original 140°F.
3-501.16(A) Roasts Held at or above 130'F,
Containers*
7-102.11. Common Name-Working Conminers* 20 Time as a Public Health Control
7-201.11 1 Separation-Storage* 3-501A9 Time as a Public Health Control'
7-202.11 ,Restriction-Presenceand Use* 590.004H) Variance Requirement
7-202.12 Conditions of Ilse* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP
7-204.11 Sanirizers.Criteria-Chemicals*
7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and
7-204.14 n encs.Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(8) Use of Pasteurized E "s*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* -Raw Seed Sprouts Not Served
7-206.13 Tracking Powders,Pest Control and 3-801.t 1(C) Unopened Faxl Package Not Re-served.
Monitoring* CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw.UndercoDked or
PHFs Not Otherwise Processed to Eliminate
3-40i.11A(1)(2) Eggs- 155°F 15 Sec. Patho ns.*""t
Eggs-Immediate Service 1450F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
3401.11(A)(2) Comminuted Fish.Meats&Game Eggs*
Animals-155°F 15 sec. *
3401.11(8)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS _
3401.11(A)(2) Ratites,Injected Meats-1550F 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 PRFs, residential kitchen operations should be
Stuffing Containing Fish,Meat, debited under the appropriate sections
Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness
3.401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other
145°F 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.
17 Reheating for Hot Holding VIOLA77ONS 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* - foodborne illness interventions and risk factors listed above,can be
3-403.11(C) Commercially processed RTE Food- found in the following sections of the Food Code and 105 CMR
1400F* 590.000.
3-403.11(E) Remaining Unsliced Portions of Beef item Good Retail Practices I .FC 59tIow
Roasts" - 23. Manarternent and Personnel FC-2 .003
18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004
25. Equipment and Utensils i FC-4 .00.5
3-501.14(A) Cooling Cooked PHFs from 140°F to �, Water.Plumbing and Waste FC-5 OD6
70°F Within 2 Hours and From 70°F 27. Physical Facility FC-6 .007
to 41'F/45'F Within 4 Hours.* 28. Pdsonous or Toxic Materials FC 7 .008
3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009
Temperature Ingredients to 41°F/45°F Other __
Within 4 Hours* s:sm�a„m„urx az
'Denotes critical item in the federal 1999 Foci Code or 105 CMR 590.000.
CITY OF SALEM
BOARD OF HEALTH
} Establishment Name: Ai ltJ§NS Date: 2- - ) - id Page: of /
k nem Code C-critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONpew
No. Reference R-Red Rem rt,; y Verified
F PLEASE PRINT CLEARLY
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Discussion With Person in Charge: Corrective Action Required: ❑ No t ❑ .Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
inspection, to observe all conditions as described, and to Exclusion
violations before the next ins
P ❑ Re-inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure
your food permit.
� ❑ Voluntary Disposal ❑ Other:
3-501.14((,) PHFs Reuived at Temperatures
Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to
Factors(Items 1.22) (Cont) _ 41'F145`F Within 4 Howe x _
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
iq Food or Color Additives I9 PHF Hot and Cold Holding
3-501.16(B) Cold PHI,Maintained at or below
1-202,12 Additives' 590-004(F) 41 /45°f _
3-302.14 Protection from Unapproved Addthves''
15 Poisonous or Toxic Substances
-- 1-501,16(A) Hot PHFs At tmtained at or above
IWAI Identiyinglnforntation-Ori,loal 140'F.` -
__ Contmnen 50I I b(4) IRc m,t Held at or above 130°F.x
+ AZO 1 Time as a Public Health Control
t 102.11 Commontiame NotkmCuuttin•rax -- —
9 X01 t Filwi as a['ubhs Health C onu•a
01. 1 Sr moron Scut tg
0 .11 v -old , e e
722
meat
202.12 Condition of Ose
7 ?03.1 I Toxic Coalaincn. -ProhtbititaW' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
-- — -� POPULATIONS(HS�_�
1 ^W.1( Sannvnis Lntertn Chunie ds —
7.204-12 Ch�nu{tis for th nh> t oduee C tituia" ��> Slit I 1 tA) i rap t icurtxed Prc. pae lgcd Juleec+uul
- — N nnili fab iv
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204.14 Dn A entsu - - �--�- .. —
- -"- .C nu l- i ' 801 11CB) Us ti Pu tekin td
/ ?OS I1 lncad nlel t axl C ural tt t_IArbi c ❑ns t t-SOI l l{U) d..0 or i'attisp { tKsk:d Anonai Ftxd and
--
1206.(1 RUxno n liu. !'e, ttud,..Carty tal t
�-- .-- Ra St r cunnus�t t Sernd
1 7 206.1 R1-1I1 1 R it Slaonm, r-- -
i {{ r-;, td t�-,xi Pt ' t t Not R ervul- '
t � .06.1 lrtchmgPorcder .l .tConn,.l .uui , ._-.-_ ..�..1 ._L_ne_
CONSUMER ADVISORY _
TfMElfEMPERATURE CONTROLS
2 3+s0: 1 1 ' onetu tee 10 ixirt nus i t >rC:on�nm�ticn nf�
� nnirusl l rad llrt i Ra-,i, Undcrux?t.ed ca o� Proper Cooking Temperatures for I
� 1 _ I PHFs _ I I �ttt Ch! n isc Pu+t ss d az 11n mut
+ 4flt.1.cAlL(±±) 1f6 157.r 5..e
1 t� lnlm dt ltL Sur Rl lf
L 5315:ef.�. 3I ��-Sub f tLft I(e Raw$Liril r
c _
1 , 491.1 ti AW, Comminuted 1 i h Mews K. (i«mC
tntttl> 1» 11 sc:. _
SPECIAL REQUIREME —T'0'_1hH (f Ot P"'), tnd iel ,i I0 1 121 milli,
-
- 5(":) vi(dll t s' (lols)r
t atcr to1ut6Ilr.fix"LL i°mp al, a.ld
1 4Ct_1t.A')::j lnp. UildCam �� kitchcn c enoi(n ,it(tad he
1 5n Ome Containing Pish, tvl L � � ! debit t.(: tjnd1,T 1110 a{))7rOprlsifc.v't i.iWlfi 1
r------rliar --i---- -4.ax. ^ l abt>vt tt�t;,rrd .�lr:~rbtuartzs - 1.1esr
, iCii.t ti i �I t, a;w. 1e utt et (3a.f S ,v,• I � � s tt .... �_ fi
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1 17 1
,--W3.1 11-0 ti`ft! 165"T. L) ct _ — _ __..._� -{I.0LA)'0AISRELATED- -_. OO _.-. .....__�_ __...... .._._
Reheating for Hot Hoidin "' 7D z;.CtJJ RE'PAJi PRACtt(7 S
tenis 23-30,
i_ 4W.11B) Sheuu.-{vc- it.,' F2klm aS!andnl� { C r :rul on r'i« r1 .us. wire do no: cf rr - w
inl ' I f t Ibt rn, il 1 » -r! no and ii t I icrn c 11e(< j tVr, can be
13,t ltl t ILunla ettti3lh t4r>,-s 1st} Iia - 1 4 t in 11t.J >a t, sit I ao
'ne ° dCode and 105 C'iJK ...
0000 _
Proper+Cooling lot PHFS uons of 1+ i..74m 1 3)d:)ndFood`n dPrand ow.tion �-FC -3--i-A)04 D110
t)fensia OL),
Cwhnt Cxk d!HL ( m I , f to 1-,26 rater Pl m r7q_utC rJ !e QFC-a OU6 _
70'F Within s 1 f(,urQ and from 71 1 x 3i Fa Otv FC f> 60/
to 411145 F fit'thin 4 Ho --3oi-;ono,js or Toxic tAk"feti8is i FC 7 00
1 501.1.#(B) C'cx lut r PHF ALtdc Front Ambient � ` Spm i i R<ywc seen
Temperawrt Ineredients It a 1 FidS'f _; ?thrr
Within 4 Htnu