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RISTORANTE GIOIA - ESTABLISHMENTS (2) e S�ocan�� G o r'u 1 uo w® r�l��fo� frrtie� RNIVERSALD UNV-12110 MADE IN USA SUSTAINABLE MIN REMM FORESTRY CONTENT10%® _ Cergfied Fiber Sourcing POST-CM%W .,fiprogremorg 1unTN 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: 01/19/2011 ESTABLISHMENT NAME: Ristorante Gioia File Number:BHF-2005-000046 Alto. Vito Santangelo 140 Washington Street SALEM MA 01970 LOCATED AT: 0140 WASHINGTON STREET I SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0333 Jan 1, 2011 Dec 31,2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember 31, 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 aprominent 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 KIMI3ERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRF,ENnAOMt7a SALEM.CONI DAVID GREENBAum,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I ��1'G✓I 7`t' In l G _TEL# 9 k7 Y et - 333 ADDRESS OF ESTABLISHMENT NO WCJ J 4 rn' Q 4,, Ja FAX# MAILING ADDRESS(if different) J A EMAIL- Business': }--1 S tU t''&n ,o° 'C/ ®M a Website:+ t S IO t ek nklG)a C-00-1� OWNER'S NAME %k S&"4 TEL# p7 -ZP9f0 ADDRESS 3-Y -Je / H4 . (74!9D STREET // / CITY L/ STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) r'i A SaW CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# -�DAY,6`OFOPERATION f _ - _Monday Tuesday: , i '�'Wednesda --.[^:;Thursday- :-� Fiday=, _ Saturday 's=t; `- Stiotlay":' HOURS OF OPERATION j G J Please wore in time of day. _/ For example l lam-11 pm /0 O 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 - - ----------------- --------- ------------------ RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$"210 25-99 seats =$280 more than 99 seats =$420 - --------------------Y-------ES---------O ---- -------------------------------------------------------------------------------$---10-------- BED/BREAKFAST/ N0 CHILDCARE SERVICES/NURSING HOME - 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 2C,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 pad all state to r nder the law. /'7 -9-/0 Si ature Date Social Security or Federal Identification Number Revised 10/7/11 FOODAP201 Ladm Check#&Date C) $ / 1 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: Ristorante Gioia File Number:BHF-2005-000046 Atte.Vito Santangelo 140 Washington Street SALEM MA 01970 LOCATED AT: 0140 WASHINGTON STREET 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0080 Jan 4,2010 Dec 31,2010 $280.00 ESTABLISHMENT Total Fees: $280.00 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 ICIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGRF.FNBAUJJQSALEM.COM DAVID GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �'`/N�� TEL# V 7- 3 - 74�i - 733 ADDRESS OF ESTABLISHMENT-- 140 l/ / 4S/v//4/C Vti _4j�Ax# MAILING ADDRESS(if different) EMAIL- Business': 1RJSW P-AVrr, 621,0%i@ ®��` JTP4t'« wAWebsite: k1w - ISYU;JJtiY£Cy(�/� .l'Gth OWNER'S NAME !/ / YDTEL# //O ADDRESS 3P ( 0(4,16 rp t �l &d'.S.S U 19'CJ STREET / CITY rJ STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) //� Sd/ nc /� CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DglS(QFOPE,RItTONMonday ' ,TuesdaypWed'ngsday, Thyrsday HOURS OF OPERATION Please write intime ofday. - I M'3UPn•11 '1 4;30-/0•'0 1��t7, 10•Gt9'; /1.3P.= /0.0, /).13d -/t)•DJ !/.7C—//U 'J� For example 1 lam-1 1 pm 1 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 25-99 seats more than 99 seats -------------------- ------------------------------ 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 $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 ap d by the Salem Board of Health. Pursuant to MGL Chapter 62C,S i 49A, I ce ' under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax returns and id ate taxe fired unde Sign6iuie Date Social Security or Federal Identification Number. ------------------------- ----------- ---- ----- — --------------- Revised 424/07 FOODAP2008.adm Check#&Date $ III 1 T� Commonwealth of Massachusetts s _ City of Salem Board of Health tGmbeDriscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: Ristorante Gioia File Number:BHF-2005-000046 Atte.Vito Santangelo 140 Washington Street SALEM MA 01970 LOCATED AT: 0140 WASHINGTON STREET 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0323 Dec 30,2008 Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. 'In accordance with the State Sanitary Code,beofre any revonations,improvements,or.equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KINIBERLEY DRISCOLL FAX(978) 745-0343 MAYOR 1DtONNE(ct�sALEW.COD1 JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT T/O� OPERATE A FOOD ESTABLISHMENT o NAME OF ESTABLISHMENT R t 3> Y? �C (h u f r STEL# ? '7J- 944- 233 ? ADDRESS OF ESTABLISHMENT_ )y � l�d�)2/ ,44✓ -r .J9 FAX# MAILING ADDRESS(if different) EMAIL / EMAIL-Business': hfSnH�a17 y10icy ®�jr��M'g'VCoA Website: I"'IJY0VC'.'7� d glOi • P0,072 OWNER'S NAME y/ �h c6n r� / // TEL# 7 7a'— 269 -3f'�`y ADDRESS 3 �rr9g ply 1p �(/' f2Pd4c2CY') /7g b)Wd STREET � ( CITY + STATE (, ZIP CERTIFIED FOOD MANAGER'S NAME(S) Ilk �r/� 6:j `o CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday Tuesday, Wedne "...Thursdai��,- .I�,,,.'Fdd6y I >Saturday Sunda HOURS OF OPERATION Please write in time of day. C&,O, For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ONO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 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 ection 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns a all state to required under the law. 1,9 g 02,03 - C9,0 -06y Si ture Date Social Security or Federal Identification Number c ------------------------------------ Revised 424/07 FOODAP2008.adm Check#&Date IMPORTANT MESSAGE FOR ln1J` DATE��f� -TIME M _aeL1YfA OF n PHONE AREA CODE NUMBER EXTENSION ❑ FAX D MOBILE 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 t1 , I SIGNED FORM 009 MADE IN .S.A. - -- 0�5 � \\ N �, �- /�- "% /� 1 J RealeOq From: Tom@CallFreedomPest.com Sent: Friday, March 14, 2008 2:45 PM To: JREALE@BEVERLYMA.GOV Subject: 140 salem st., salem March 11, 2008 <?xml:namespace prefix= o ns = "um:schemas-microsoft-com:office:office" /> Board of Health <?xml:namespace prefix= stl ns = "urn:schemas-microsoft-com:office:smarttags" />Salem, Massachusetts 120 Washington St <http://maps.google.com/maps?q=Haverhill,+MA, +United+States+of+America&sa=X&oi=map&ct=image> <http://maps.google.com/maps?q=Haverhill,+MA, +United+States+of+America&sa=X&oi=map&ct=image> Salem, MA 01970-3529 Dear Health Inspector This letter is in response to your request for a letter regarding the corrections that needed to be completed at Ristorante Gioia, 140 Washington St., Salem. Our technician was at the location Monday morning, March 10, 2008 for our regular service visit. The technician noted that the owner has been sealing up holes where rodents were gaining access. In addition to the rodent correction efforts he also degreased the walls and floor in areas that grease had build up. Further more in addition to sanitation corrections they lifted the bottom shelves on the storage racks in order to prevent any issues with sanitation in the future. If you have any other questions please feel free to call anytime. Thomas Drapeau General Manager, Freedom Pest Control Co., Inc. i x Freedom Pest Control Co.,Inc. PO Box 458 99 Central Street Topsfield, MA 01983 877-737-8755 February 19, 2008 Restaurante Gioia Vitto-Manager 140 Washington St Salem,_MA-0-1-970 3529 Dear Vitto; 1 This is a follow up letter regarding the mouse droppings that were located last month. Your IPM plan points out the need for good sanitation,which your restaurant does a good job at: MANAGING A RODENT PROBLEM Three elements are necessary for a successful rodent management program: sanitation measures, building construction and rodent proofing, and, if necessary, population control. Sanitation Sanitation is fundamental to rodent control and must be continuous. If sanitation measures are not properly maintained,the benefits of other measures will be lost,and rodents will quickly return. Good housekeeping in and around buildings will reduce available shelter and food sources for rodents.Neat,off-the-ground storage of pipes,lumber, firewood,crates, boxes, gardening equipment, and other household goods will help reduce the suitability of the area for rodents and will also make their detection easier. Garbage,trash, and garden debris should be collected frequently,and all garbage receptacles should have tight-fitting covers. Your procedures have been working well in the past and will continue to do so. Freedom Pest will return this month to follow up on the activity. If you have any questions please feel free to contact me at any time. Thanks gain for using Freedom Pest. Thomas Drapeau General Manager,Freedom Pest Control Co.,Inc. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Type of Operation(s) Type of Inspection L) I Food Service El Routine Address1 Risk ` ❑ Retail 10 -inspection In vl 7,r�i Level E] Residential Kitchen Previ � ous In pection Telephone - 1 El Mobile Date: � �� Owner ff HACCP YM ❑ Temporary ❑ Pre-operation ' SG Sf ( ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) \ Time ❑ Bed&Breakfast ❑ General Complaint Inspector E] HACp, -o`� Permit No. ❑O herCP Each violation checked refquires 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) ❑ 59o.009(F) ❑ action as determined by the Board of Health. Z FOOD PROTECTFON MANAGE ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH N m y_PROTECTION FROM CHEMICAt.S n`ate'; ra`"3 n tms c ❑ 2. Reporting of Diseases by Food Employee and PIC a�'2' +_-- r .•. �.-i t ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals .FOOD FROM APPROVED SOURCEnw � u �' ";-„•fix ,. _ El6_4. Food and Water from Approved Source s TIMEtTEMPERATURE CONTROLS(Pptentia8y HOzardous'Foods) QEF! - ` ❑ 5. Receiving/Condition [:116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling `PROTECTION FROM CONTAMINATIONZIW ❑ 19. Hot and Cold Holding �ffi....A,.�•a:�e. L-B ,,, �u urn:f: .w«u n e-�. I I tip- ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 14EQUIRE9ENTs FOR HIGHLY sUSGEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices t DN$UtJ1EA.ADVISORY; n„ tl1 rte= [122. Posting of Consumer Advisories Violations Related to Good Retail Practices \ Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official OrderItfor Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the item's checked indicate violations of 105 CMR of Health. : kN590.000/federal Food Code. This report, when signed below ,r 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 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:5801ng tFo, i<.tloc ! !�..C� 1 f ( ��"-�• � I / Inspector's Signature: \ / -Print: t PIC's Signature: / / J Print: l `•- 1 ai N u n Page of�Pages A 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 Animal Foods Separated from 590.003(B) Demonstration of Knowledge* - Ctoked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302.1.1(02) 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 foal employees and 3-302.11(A) Food Protection* a >licants* 3-302.15 Washing Fruits and Veetables 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 59UW(G) Re orcin b Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Foal* 31 590.003(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* 4-501-111 Manual Warewashing-Hot Water 3-201.1.2 Faxi in a Hermetically Sealed Container* Sanitization Temperatures* . 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell E---s* Sanitizaton Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinkinn Water* concentration and hardness.* 5-101.11 Drinking Water from an Approved roved S stem* 4-601,11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0"' 4-602.11 Cleaning Frequency otEquipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan 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* Ip Proper,Adequate Handwashing Came and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification 2301.12 Cleanin Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash*3-201.17 Game Animals* 1.1 Good Hygienic Practices g Receiving/Condition2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 -Preventing Contamination When Tasting* 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-20312 Shellstock Identification Maintained* Em to es* 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 Capacifies* 590,004(J) Labeling of Ingredients' - 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 -Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.1Specialized Methods* Devices 3-502.12 Redued ax sen packaging,criteria* 6301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Foal Code or 105 CMR 590.000, CITY OF SALEM I BOARD OF HEALTH ^� Establishment Name `� G� J!� �1 C� t Date: r� ``'3 CJ Page:_ G of Item Code , C—Critical Item "' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION, ," Date I No. Reference R—Red Item �' Verified Y C s" PLEASE PRINT CLEARLY �': f^ ( x h !�E;_-rv,rc n ,,.� ►1c I- C Lx� _ 1, j k 10q O i a I f 7-l- G. I l ` C 6(_300,64'5U210Q1n at o I I — t ciu U ir4 i i Discussion With Person in Charge: Corrective Action Required: ❑ NoQ� t, I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ P PP Y 4 9 Exclusion 1 violations before the next inspection, to observe all conditions as described,land to A—Re inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that i .4toncompliance may result in daily fines of twenty-f:ive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: t q h. 5(71-14(("l PHFx Received at Temperature, Violations Related to Peodborne fitness lnterventmns and Risk iAccording to Law Cwlud to Factors(items 1-22) (Cont.) -1 I'F/45"T-Within ' How CtK)Ilrk, McthoOK for PHF!a � Food or Color Additives- E19 P4F Hot and Gold tloldicq --� PROTECTION FROM CHEMICALS Cold PFIB x4vintamed at or bebm,7�ofE 7�11�mll 590,0040 410/45'F- #1-1,12,14 ow -7T5�f I,I 6(A) 2�s Hot[If ft'c Maintained at or abow Poisonous or Toxic Substances 140'1:. 7 101 11 7 101.11 Identifying Infia mation 060nal 3-JAH.16t.A) R(MMS Held 130F, L Containers* Tim,"�P�Lat 20 Time as a Pnblk,H�afth Con��ol 1 Ttznc as 11 Public TITilib Corti 7-102,11 Common Nam�- 7- 3 501 B 201.11 uQn --�2:iva— --- I Variance 7-20111 Rom-iction--pv,scnce,wdL�e* -R 7-202.12 Conditiow of Use, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7201`IT—-ToxiF;..fame,,-Frofiild!wn�* POPULA IONS(HSP 7-204.11 sanhi7en,Criteria -chenric.,110 —,— --1 --7--- — 1 21 3-801 TI i]A�' L'InTaMecinzad Pru-packlizcdTw1c,.116 7-2 A2 finucals for Ciftetia* wich Warnit -.at 14 3-801,It I(B) U�e of'Tfa,wurized -kLln�kEflj�.��itefial 7-261,11 Incidental focd Contact,billi iewits 3-801.1 1(D) Raw or Parunib,Ckn)kedXbiin7i—Food and 7-206-H Rcstricl�el Use Pesticides,Criteria* Ra,.: Sud S>rPn14 Not Ser%ed. 7-206.121 Rtxlew B�at Seaioa,�* =�06 I? racking Powders,Pest Control and Nionihein", CONSUMER ADVISORY TIMFJTEMPERATURE CONTROLS AnimA F�x)ds That"fre Raw, undercooked(1i at 26 Proper Cooking Temperatures for ""(A©tater s ase Prca vssed to Flirwriate PHFs 15,5'F 15 Sr C. 1-302.13 Pxsve mzx,d Fgp;5„ )Sma,for RawshelfIt Linccliate Servicc 1 450F)5,w, Comminoted f7isb, Moats& Game Anunals 155'1` 15 se — SPECIAL REQUIREMENTS 401 H(13)(1)(2) FoA and heel Roast - 130"1"121 hall, 3-40L71(A)(2) F;gvcs, Injecied kleab,- 155 F 15 vioj2tjorlti of Se tion 596 N;9(A) (1)) in catering, mobile food, temporaivaod 3-401,11(A)0) Pouhr),Wild(.3ame, Staffed KfFs, remdential kitchcri operations should be Stoffille('0rortining Fish,local, detail under the appropriate ieelionx Poultry or Kati ves-i 65",f, 15 sr c. abiwo if related to folyflMne jlfiross -� S-401 Iif(-),3j V hole-nms,Finvao BeJ Slejks inrdrvendows and risk factom Other 590.009 violations relarme to-okx!retail 3401.I2 Raw Anima{FoxlCookcdill a 1 I'l aoices 3hould lc debited wider#29- _ 29 - Microwave 165'F jf01�I(T -�C r(71) lo�_ ,V!Other 111-11-4, - 145'T 15 see 1=7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403;7 I(A)&(D) Pl*s 165 15,w (items 23-30) 1-463.11(73) Microeaw- 165”F2 kbnui,Standing Ctitirccl and ram-,rot cal violaw;m, ithich do mg iOare to the Time'' ,foodborne illness imel venliow,erd rid ja(rors bqcd ahwvc, tan be 403,11(C) Commercially Pavossed R'EK;;� found in dit-jollmong :ret of'ha Food Crele cwd 103(111? 40'F* - T -9 0,0-00, 7z(T1Iw) Remainin UmficedPortionsofBeef itenT Gno -i- —----- T 590,0 1 Rwsts� 23 Management 3�d pemonnpl FO -2 24, 1 Food end Food Protection FC- 3 004 1=8 Proper Cooling of PHPS — —--------,--- --4 _?5------ Equip FC-4 .o]rint and Utensils 3 501 14(A) Cool ing Cwhed PHF's frorn 140F to 26, watel,Pluml;m and Waste FC-5 I - ---------Lq....... 7W'F Within 2 Hours and From 710-F 2T Physic�e Fwiilb FC-6 1 W7 Toxic Matenals -F(',-7 3-501 14(B) Cooling PHRx Made Norn Ambiera ---?2----Okqo�n(Rsgi cznet1, TernWawre Ingredients it,41'1,'/45F jO, 1 Other Within 4 llkxir: "'1?enr tat cniicst item mih,joxall 1999 Foci(:,Xleor 105 C;MR 191160{1. - �cJ-+L'*'� �'�,,b"�.a)f,!'i�.'ia4+Pk-r'$4.t°ti-++!..E'(c`�LL.H �.irhe^�`'�t't'�► .��t..r S't+�!". ��.",-r'w:n;d*'.v;`YM.+�Sy�:�'✓"...�r.•,,:.�-:,..1+�.-,..,`'+�' i:;,,,XYi.+a....'.. Massachusetts Department of Public{ Health Salem Board of Health Divi3ion'of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 - -Name1 . Date (� Type of Oneration(s) Type of Insoection 1� 0/, Q, )CAS I (- U I QFood Service 1© Routine Addressnn Risk ' ❑ Retail Re-inspection qO W-)� IA,j1 Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner (()� HACCP Y/N C1Temporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) v Time ❑ Bed&Breakfast ❑ General Complaint /1. ❑Ina } aj ✓L` HACCP Inspector �� (17� A V Out: Permit No. ❑ Other Each violation checked requires an'6 planation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking '.Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 0 590.009(5)-f action as determined by the Board of Health. `FOdD PROTECTION MANAGEMENT�"„a'�' a ,`>°;� `"' �"`"' `; ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties El 13 Handwash Facilities f'EMRLOYEE HEALTH , " p�u� „ F= r o-r a� ��+- 9r]r? 'i,r kc „„ 707 .�a-,.�.maFikPROTECTIOtd FROM CfiIEMICAL$ '`3 '� r 3, 4EV� �, .s £ ''' � ; ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded Toxic Chemicals ,F00D FROM APPROVED SfSURC U. •' ❑ 4. Food and Water from Approved Source TIMElTEMPERATUR�CONTRbLS(PolemlaltyHiazardaus Foods) �� .. ..t wr.,m,W U'l-u..owiir`wi... El 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑.6. Tags/Records/Accuracy of Ingredient Statements // El17. Reheating I07. Conformance with Approved Procedures/HACCP Plans '\,Nr18.Cooling 7PROTECTtON FROM CONTAMiNAti6k' 7 , 'r-`-` ` a� � C El 19. Hot and Cold Holding .- (JI - [ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control 01I� 9. Food Contact Surfaces Cleaning and Sanitizing iREQUTAItMENTs FOR MIaaHLY$t)S EPTtBi.(TIiQ ULATIONSSH P)�1 C'-"- ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.'Good Hygienic Practices 1CONSUMEFtADVISORv ? ,� j��r P, ®GMS ❑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 Cs by a Board of Health member or its agent constitutes an G'l 23. Management and Personnel (FC-2)(sso.00a) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-a)(sso.00a) 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 (FCa)(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: S:59JInspecfFomKi< \ 1 Ytla �,} ,, /� I„ Inspector's Signature: , Print: lr 1 PIC's Signature: ),.� (\ Print: / • �• Page of3Pages , t Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination , 11 590.003(A) I Assignment of Responsibility* 3-302.11(A)(].) Raw Animal Foods Separated from 1590.003(B) I Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge duties Contamination from Raw Ingredients 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 3-302.1.1(A) Food Protection- a licants* 3-302.15 Washing Fruits and Vegetables 590.003(E) 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.(X);3(G) - Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* F-31 590.003(1)) Exclusions and Restrictions* Disposition of Adulterated or Contaminated L590-001(F) Removal of Exclusions and Restrictions Food 3-701.1.1 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_11 i Manual Warewashing-Hot Water Sanitization Tem eratures* 3-201.12 Fluid in Hermetically Seated Container* 4-50'1.1'12 Mechanical Warewashingb Hot Water 3-201.13 Fluid Milk and Milk Produces* 3-202.13 Shell Eg'g's* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness.* 3-202.16 Ice Made From Potable Drinking Water" Equ 5-101.11 DrinkingWater from an Approved S stem* 4-Ci01.11(A) Utensils C Food Contact Surfaces and 590.006 A) Bottled DrinkingWater" Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food- 59Q1x)6(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-20114 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 Wild Mushrooms Approved by Regulatory Authoi 2-301.11. Clean Condition-Hands and Arms, 3-202.18 Shellstock.Identification Present* 2-301.12 Cleaning Procedure* 590 004(0 Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11. PI-Ts Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package htte it y - Mouth* 3-101.11 Foal 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(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* - 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.1] Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.1.2 Hund Dn=Provision *Denotes critical iter in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM �n� nn BOARD OF HEALTH Establishment Name:`P4-�/JA7" C� n Y 4 YJ1g n I(t Date 4—R-Ot Page:1 65�, of Item Code C-Cndcal Item DESCRIPTION OF VIOLATION/PLAN OF ORRECTION Date 'No. Reference R=Red Item , � �.:,,� t;� g ,.r,. ;�, s ^E " INT -- �- • +� x � � e � ^* Verified ti a 9 bna�,. t"°dk•.ten �� ..,t PLEASE PRINT CLEARLr I�,(/-��4�'��" � /,♦' . i0 n.Gt Y3C. kfV A 0 !fin o� UAA 4 YO.n i.� �v c/) Pg P UA.2� p /J p n p n "� 1;,f 17 A.(/)L/ 1��7r1 n„ �Q �1--n�n`X/L \l_ .M1�.Gt/, . .y.�. `� z J!] t/ 1t.�1.(/✓1 — Y�o (2,4A n i P�r r i l(� Y T'� I iw (( l / P,m, V iA A ,.P ITI)b Y �. ,rP 1-00 c,n (A!\ rtnn� �n - l/t� �� or (JO,. cV'MA � !)�I'W. n nni l�n ni n n C.i b_`i/1�.tr. . Qtn �/!!\ n ) trA D,'AAA fn Yi, c�AYN r4IJV4,r "^ /lA oa stvJ -�7) M-11A J A 0 Dn �^Cd �i✓\ (onn�_ r Inn -� .P� A� k -0 fna 4-d A I\n n,cO ( . �0 , A QA �YID0, kA U. �i� 2 A), &A CJAA � � 1 PAY A�/1%A� .. l 41G� �il fel/ (�/in A / . . — o -) �1 Jr " _ r4Ao, �( (V(� QJ I G, \1 nn 10 U) ->f n A n 0, 0""k - Discussion " A .Discussion With Person in Charge: U /� Co rreEtive Action Required: ❑ No ❑ Wes ! v Voluntary Compliance ❑ Employee Restriction / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions asslescribed, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food�Code. I,iI n'erst `that noncompliance may result in daily fines of twe�!nit'-fi� rs or enslon/revocation of ❑ Embargo ❑ Emergency Closure your food permit. d /� ❑ Voluntary Disposal ❑ Other: v k s Violations Related to Foodborne Hinelni knerventions and Risk j Accuydin�,,to 1,uw Cooled Ill Factors idisher 1-22) (Cont) IPF-i45'F Within<iftluis '--L—Vng PROTECTION FROM CHEMICALS CLxAIcthw&for PRFs Lj-9 PHF Hot and Gold Holding Food or Color Additives Cold PlI7T'41aint,,,med at or below 12 Addiu, ," m 590,004(F) 11"(4 Y�F, .3-302,14 pitotectitHl front lj)r!2�Sdd III y e�' 1,K A) Hot PHF,Mainmil)ed'rt or above Poisonous or Toxic Substances 140'F. 7 F4111 -fill 16(A�) Rwsts Held at or kove 110'F, Containers' I Tame as a Public Heafth Control C-a 1 Common Name- W�orkirq,Contain --- in Public Health CoraroP -T--6—, I i SaDriial.ikrrl-St 02,11 R,,qricvarl -llwscnce rwd U�e* -2 7-2n1 12 Condwrvre of Ujs-c- AEOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 10, it Toxic ContairreT,-ProhibviorlslPOPULATIONS 7 204 11 chcodc�!S* {litelial Pru-mac ktt'ged juwtc wid 7 -- 2 k7.12 cklnic;lls for Bl�veraes with Waruin�'Lab'�h� r7204�14 Dr err s-801.19(B) the of,pa,tcle ized El,cs tants`i �Fil Incidental NNA ilmirct'Luh]; --T---T -- -- 3_801.11(D) "Raw or Piilrail,, Cwk�d kininal Fxld UNJ% 20G. I 77,rded7�, PeTuade,' CrCte , I kliv. St SiLroulif,,ot Seiwd. � I i 7-206.12 r Rosie w 13at Soitiore,' 7--j r 7 '06--f, —Rst Control—and E—K' Packliec Not pe-cervC& Mortil(ldn" CONSUMER ADVISORY A0, TIMEITEMPERATURE CONTROLS 0suiner Animal I'liat are Raw, Undercuillarf of -P-roper—Cooking Tempel for Not ntjjct 1, vi,�c prox eraeo�) d .hplimun PHFs a-401.11 All)(--, Etrgps 'lervict 116T]5sec, - 155'F 15 S�,c. l-307.13 PaSloorized Elig2:Sulw!kuta to,—Rlw Shelf E1l(-Kv1 commillitiod Fish' Meats&Game Arnuials I51"F 15 sec,. ` SPECIAL REOUIREMENTS polk and firel Rkxw - 1301' 121 moo 71—(b), P-91�009(A) on �90.009W-(D) ill 1.11(A)(I) RAwc , II&O"d Mvdtl, 1-55`F 15 scl'. catcring, mobilo.tixid, temporary and --- mdefriial kitchen Operations should lie. 7 461 TI(At,T) FlretltT,y,Wild Ganre. $Iuifell PITF's, i rc Solffm�Containing Fish, Shea, i jLbited under[ficappropriate sections Poaliry or Mata ctl-J65115.wc. above,if rcJwod to to(ititiorne ifncs i ours Ir,—Entac--iReef—Stvak� 40 1.1!i 'A I W)(,,r I 145"'1; 590.009 violationrelating It)sood retail 3401.12 16% Anuit�Rwis Cx�rkcdwa Ile debited under #29 - Mi(Arminc 165'F* Special kcfjuircnlem. 401 A I(AI(1) All(Xhei. 15 ccc IT Reheating for Hot Holding Y VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-t03.1],A)&-(D) pf* 165`f 15'wc. (Items 23-30) 3 403.11(8) "iclowavc- 10,F 2 Kan ,Stan Criiira!and rive-� wal von'alion,l, which do ntu l6we,to the lurre" 71,111 fil1 ftwdhorfre illndss inklt veni;0my'MdriVA-filctors VFwd at5ove. (olt be 3-403.11(C) Cominerciailv Palce&ied RTE Food found ill the fol forvmg sec-izon,.e,,l tha Food Code cud 145 CAJR 40'F' 59aotx), FwW-J-doWfitnaii Poiplticm� T ,401 11(Ul Rein cutin";tinslrced pvfzious of Beef FC 590 OW ------------1, 1 FC -2 1 0(ca r--8 r Proper Cooling of PHFs 112 aastcn -24, 1 Food and Food Protection QFC 004 1 faEasio Fr-4 005 3-501.14(A) ('(xl]ing CwklA Pfllct� from 1,9)�F 1() 26-------- ,6 70°F Within 2 ttours and From 191' FT Physica]Facility FC-(, 007 to 41F14 P Within 4 Houn, Pusonous or Toxic Materials j FC -7 008 Cilolhig PRFs Made From Arrill R Ttimperature Ingredients, lo 4PF/45 F Within 4 Hours Z4, Dclloleslrtical gell)ill she roJeo i I9'a9 Folli trate or 1035 C;tiiTt 59x7 frt30. t CITY OF SALEM t BOARD OF HEALTH i Establishment Name:' I `�f�� n+P l nt �� I r` Date: T-CI-f7Gl Page: of i nem ;Code; ; C-critical Item Vim- ax-a �"P DESCRIPTION OF VIOLATION/ PLAN OFC RRECTION Date 's No. y, Reference ,R—Red Item �, s .a w ,,. ✓ € "' s ^m api'%' � PLEASE PRINT CLEARLY'• ' .� _ Verlfled°k ��\r'Q.l / /I '1X,114 1��:�� v f Pv \A, 1In ie f�ls1\. lJr r / P O A", \ 1C� U/nA r "o r \ f 1 1 / z fihF} 1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes t ❑ Voluntary Compliance ❑ Employee Restriction / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion III 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. t ❑ Voluntary Disposal ❑ Other: S Violations Related to Foodborne fitness Interventions and Risk Accvrdncl to Lai,, Claisted ill Factors(item 1-22) (Conti WFIRS`,FWAbin4Helws CCK)lill t Iv 1 x1 PROTECTION FROM CHEMICALS for fMt1___ 19 PHF Hot and Cold Holding L14 Food or Color Addftive* old PHF.,maintairrai at 0, b„low "W"F- 12 41 3-30Z t4 Proreculal Fro 2_jL!2Mlvlaj Ilrddit -1 3-59k 16Al fint PRFs Itellarrec"nedeet or abot,e LL5Poisonous or Toxic Substances lot} I,. TIT, tai fying Infol inatiest-Original 1-501.16(A) Raeasti,Held ill ar above 130'1-. coutailvl,0 i 20 1 Tints as a Public Health Control Ceabraien'Natine - Vi orkia"Clnitain�'rl* q-%l 19 Men al;a Public Health Control 7-,701 skn�li!:LllnI ", -_ Ston 11 ",I--- 1,202.Lt__ Rem,{coon -Pr arta:and Use* Ei� abl7"__ =- 02 12 10M Of t 180* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-?03 11 loxic ClalrafttaT7�r_a)Klonll POPULATIONS i.- � 1 7-204.11 +�Saribizei:s,Criic-ia -ChoijiaiW —j —_-7 —T§� —------ 21 -S(( 1.11h ) U3Rv,,acurjod Juices"d I F7-12_014�12 CfiollrCaknor Nva�l]! I ! � i yl�—I-,C 7-204,14 Bevemee�with I iii)IAI(B) Use of Paqeeaizci�&; -1-205,i I Invidental Fiaxi Contact,Lubmants" T, orR"ll', F,,�,ndl 3-bol. aWorPa11jeAJeC(K)k,-d [7 20&IT fr�.itricn.,d llw Pesticides,Critcria� Ra,se�d H7-206.12 Rixiatil Bait StaliewiO _ --- L_" �L' E( ?(gj 13 Tiacking Powderq.ln�elL Control and CONSUMER.ADVISORY f i T)(T3 I i '"MEITEMPERATURE CONTROLS 2 'vein lilk Kxie Illat in RaUndercunked till 16 Proper Cooking Ternpuatures for7 Not rithem ise Pr(ee:esed ll)E'linunWe PHF6 i �.,r��, Path I I IAO)(2) T7,gg, I 55'r 15 sco. Ege 1,3(C.13 ied Subalitrjte feel,R:�T—sild, gs-hilanediate �ervicv 14�'Flfis I_e� -T40-170(A)(2) Coramijuacd Fish, Micals&Gallic Ail i{nak- 15,517 15 sce. ' SPECIAL REQUIREMENTS .1_110T I 1(13)l 1p2} PPorh and Best Rtiast - 13.0-F121 bull' ecrion _590JI09fAi-(D) in -1-401.1 l(Ag2) i Reetitcti, likiecaxi NeLats-- 155'F 15 caloring_ mobill: f(x)d, teiliporary and 401.1l(A)(I i _411�10�1.1�1t,� �,lFd_Gune rondent;al kitchen operations should be sluffing,c(avainim,Fish,Ideal, Jobiled under the appropriate w,:i.Rais I Louln Rantcs-165'1 15 we. alleuve if relaltA to ftKAborric illncss T40,.11110) 3) 'Alhole-cluccle.Intact Serf Siesta inter ventrons and rick factors Other 145"t-,1i 590,009 violations relating to good relai 3-40 1.12 Raw Anuml Footle,C(xjk,.,,d in a practiceie shklidd fee debited under#29 - 165`F' 3-40t,1 HAKI)(b) "Mi Other flfifi - 145,1 1s sec Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 0TIT(AFE-0)) pllF 165'} t5 le" (Items 23-30) 403.11(B) Microwal, 1{,5' 'a 2;l+Ttnate Standing Crux i wild nr n crriicar w<r r3ona. hkrch Ito rule ierare -o rive Tillie' jirlodborne ilbleest illiervehliony and riAfactors Uqedalac,v, (an be, 3-403.H(C) t amresercixFlia Paxcseied RTE Kee fincd in ren,follfewing stvions the Food Code aid 1(6 CAIR 140'F 3_403 I I(F) Renlaillin,Undicted Pofdores of llmf Item Good Retail Practices F , �91i.Oft Man�,Vemeql and Personni? FC -2 1 103 PIt roper cbbtt� -R*I'i _F _P� .1-.W,-,;-- - '-f-F&T _��j 01 -.2 24, d _j 004 ctPHFs —1 -Eglilipulant and Vlecsas F0- 4 00_5 _14( Ctlilling C(xek�t PHF's freran 140'F it) -------1 P1Wq_,ya1 lWaste 70'F Within 2 Ifour,wid Froln 701' pyi, 1 ysiqa!Facmnnility FC-6 L 007 Majenals 1 FC-7 W8 _561 li(IF Cocelinv PHFs Ma& From Arabian Tcalperature Ingredients to 4101,/45 Within 4llour,+ 11 notes moral re'll ill the Ivile'r,11 VY49Foot(Axtvor 1S CNIR59C(joi) 'I `l'1(/�� \-� .,��✓�' r �♦-��..�'� --�� , 71k-�e�7 C';[JS�. ��( R.1 Fl/ \�.d..1-A�� .A �.(". ..��'1'-V LCYl� � — , ~CITY OF SALEM BOARD OF HEALTH 1 t Establishment Name: 'f 0 t e l CP _ Date: :• I /Vi Page: of 41 I '�, , >,.t DESCRIPTION OF VIOLATION PLAN OF CORRECTION %,1,w `," x Date Item Code; C Critical It , . ,. 'No Reference 5 R-Red Item a: r ;�..,vr '/ f afy-y "c'i N-PLEASE PRN CLEARLY'Y ' �F Venfled ..u ,�vf✓'/r.;x ..+cf't y ?s ✓ �»^ 6e - NO ''eILJ `11 AJ_ V0 c 1 _x .11— `'Vt o GIV A/ — kO_ hC(Ae_"1�-�r� — _ D AV 0 V D'7�On , on (1. r A aZ/ �_nnn,P`7 rt A.0"rA w n A --,12. U'l rTP 11� ( ( )r_r Vit\�On/!r: } �7 -- �� - yP t/tn 1 r) } Jn f 1P�r,1:_. �-� {•i 0 �) C,PM �P.�W, ( `Ci'_. i k r/�.nf2 'Nk ort t_o r.FU ;n- q tiP �� r,r =--•1 ti -� L�P;�i �' �--�. , i i _ .�� st)j0� ( t/ 6VoA ,r� r� kit lip. nr, � \n ` 1 P tS 0- t-0 r'" Y) I S 4X w S LiWNtl v c� ) J Cil a4g Discussion With Person in Charge: / Corrective Action Required: ❑ ` No © Yes ' j I have read this report, have had the opportunity to ask questions and agree to correct all voluntary Compliance ❑ Employee Restriction i 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. r 01 J4(cl) PHR Reu.ived all"emperalurcs Violations Related to Foadborne Illness interventions grid Risk Actrr diag to Lrw. Cooled to Factors Items 1-22Cont) II�F/45' t. Abin ;Ht ) u c(K61n,M�,Lho& for PRFs PROTECTION FROM CHEMICALS LI-9, I PHF Hot and Cold Holdin P1 Food or Color AdiflVves - 6- _tl�( Li6(B) PHFsMaintrated at or below 41 145"F' P(oteiH 'Mon 4Additivesli - 5--_ 3 16(,V, Hot PHI-,Nlaintained at or above Poisonous or Toxic Subsjan�8__q 140'F "I'ton "ma'j :3 1,16(A) ,ts 140d at ora Containers- bove 1300F, 4 Time�T. as a Public Health Control 011 1 ContramNa= Work"' ci ..nau.", 3?6 1.19 T>_mi'"..'a nii,Hglih ciu.1, 7-201.11 1 s�ai adon--Sri)!rqtc' rr i-202.11 I Rest,icnon -Presvaoe and UNc* aance 7-101.12 Coadnnln�of Uw REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7_203 t I Toxit;Cranamets - Pmhibvioii�* POPULATIONS tHSfl_ 7-204.11 Sardt,,Js,Criteria-Chcunic"ilj 21 _7�_�_'o 171 FJ"F,,,I to ri zed 11i c-pa,�I,a ge d Jar cc s will 7-)04A-2 fiendeak for Wa�hLn,� Flcvert es witty alat bde* 77t#.14 Di L 1 -80! 11 Hi 1 of Paqtnit i7�d F 05 3i Inci&mal t-oiA comac!'I Allu icans'_ nl:T or Partml!,' lr �l Ronin od U'ce pei[icide�' CriteriaI �5) Raw SctdSlrroate Nol Sel vcd 66.12 Rafetn It it smnion�' 1 4 66 11 Tr tckoig Pontdcr ,fest Copooland Tuahurie CONSUMER ADVISORY 22netimwr advisory Fwd ��)rcowuuni)lar of TIME/TEMPERATURE CONTROLS F C Ai)nnal arc Raw, Undenxgaked er o Prop er Cooking Temperatures for Not 0Lh_rviw Pr�xe�,se.d io lilinanat, r P 1 a(1)(271 Fits T",�c Z01 13 IlbqleormA Fglrs substinfie lo! Raw Shell 1-40 1.11 iA)(21) Comminuted FivhMeia�F Gjinc Ardavds 1.55"T' l st�c. SPECIAL REQUIREMENTS -74671103)(1)(2) Poll, and Walla - 130"F 121 mm* 3 40 1�I I(A)(2) 155"FI'5 IN) <>-5c Ston 5')0.(X)9fA)-(D) in Vinlalk s oi eawring. mobilo food,tentporaiv and 3-40 1.11 f An 3) Poultry, Wild Game-Stuffed PI[F , kitchen operations Should tic, sluffulF Connnnia'. Fisht Meal, 7 1 defurod under the appropriate.sunons 15 sec. it'rehiled to ffXXIb0rTW illness Sl I intact lteJ'Staks intci ventions and risk factors Other 590.009 violations rclailn'Q to good retail I i rJ1.12 RawAirnati F'(NKk C00ked it%it practices should be debited under#29 - Miiowave 16"'1'* Special k(njuirenicats- D7 Reheating for Hot Holding y VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHI 165"F 15 sec (Itews 23-30) 401 11 ff�) Mciowavc- 165'r 2 tel Standing Ciaial(vid pion ndicpt ivl ihoto, which de)no; ?euve to the Ttat� fliodborne illness imenentiottv and mkjtnlrtrs rur bra 3-4 3.11(C) cominerriall"lllo�;'Zd Fn I-oW Anmd it, ter!sons q1rthe Food code and 105 CNIR 140'F" _)C4.000' Item 3-403 J i Remainin", Unslired Portions offna I __�Good Retail Practices FC 1 5iiawo Roauv <3 ef %?!a2g94u!1cnl and Personnel 1 FC -2 i 003 ---------- Proper Cooling of PHFs Foos and Food protection cc _i M4— �d FC-4 05 50 1 1,�tA) Cw,iing Cooked'PliFl; from 14)'F tj) -2-6atat� w �,bin ......4-- t 70'F Within 2 flralrs e.ud Froin 701' plwsi�'al Facliltv FC-6 007 28, Potsonous or Tn)uc Materials FG -7 008 5-5i71.14(fi) Cooliov Pf(Fr,Made Froin ambient Temperature higicificiaq to 41 Other alloursx --- colwA Item in the 1'�le'ral 1999 roorl,f ride wr 1 OC'Mit�9111 000 01_ssachusetts Department of Public,Health Salem Board of Health 120 Washington Street, Division of Food and Drugs Salem, MA 019 0-35234'h Floor ivi FOOD EST(�A,1BLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name )S r I olk Daatc Typa of 0 eration(s) TVDe of Inspection Food Service ❑ Routine AddressRisk ff Retail elil Re-inspection Level ❑ Residential Kitchen Previous 1 s cti n Telephone 3 ❑ Mobile Date: Owner HACCP Y/N Temporary El P1 tion r G ElCaterer ❑ Suspect Illness Person in Charge(PIC) Time ElBed&Breakfast ❑ General Complaint In: ElHACCP Inspector Q 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. a'FOOD PROTECTION MANAGEMENT `""�;°'-. El12. Prevention of Contamination from Hands F1 .1. PIC Assigned/Knowledgeable/Duties ` EMPLOYEE HEALTH - y * j a El13. Hand ash Facilities PROTECTION FRAM CHEMICALS ""'t ' ' _ °I` .r �g ❑ 2. Reporting of Diseases by Food Employee and PIC -.r ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ,FOOD FROM APPROVED SOURCE�, :_�„-„ ' � �s�ry�, ,_"". ��,j ❑ 4. Food and Water from Approved Source I TIMEITEMPERATURE CONTROLS(potentially Ha2ardous fopda) I xF 4Y -.. .fik • ld .,` I ava. n�i .-a Fl u.".ue ...v ._..ny xc..a ,,. w,'§bx E] 5. Receiving/Condition El 6.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION 17 a; ' f `3 1 WSA9. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection LJ 20.Time As a Public Health Control 2'9. Food Contact Surfaces Cleaning and Sanitizing f REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP).,= w - _ El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices O0('E ^09! %-ONSUMERAOVISORY,m r ". �4 ,• g�,a� .�" ��",, uv (]22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related y 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 1C _W7 by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) = cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days"of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Print: 0 114 PIC's Signature: r� / Print: , Page_of Pages t- - Violations.Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F8 Cross-contamination 1 I 596-003(A) AssignmentofResponsibilit * 3-302.1.](A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Forxls* 2-L03.11. Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anirnal 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* 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((3) Reporting by Person in Charge' 3-306A4(A)(B) Returned Food and Reserviee of Food* FTI 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 Foo& 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetically Sealed Container* Sanitization Ten eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-Hot Water 3-202.13Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized' 4-501.11.4 Chemical Sanitization-temp.,pH, * 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101..11 Drinking Water from an A roved S stem* 4-60L 11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan 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 Regulatory Authority Game and Wild horitMushrooms Approved by 2301.11 Clean Condition-' Hands and Arms* 3-20118 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* - 3-202.11 . PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-20115 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated r 3-301.12 Preventing Contamination When Tasting* 6 TagsfRecords: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 3-40211 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of ingredients" 5-204.11 Location and Placement* q Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Pians Supplied with Soap and Hand Drying 3-502.11 Specialized Processin :Methods* Devices 3-502.12 Reduced oxygen ucka ging.criteria* 6-301.11. Hindwashing Cleanser,Availability 8-103.12 Confo mance with Approved Procedures* 6-301.12 Hand Dry.n P ovTsion 3, .;'.�I7enotes cnncal went ietttli,4ederal 1999 Foal Cade or 105 CMR 590.000. P CITY OF SALEM I I / BOARD OF HEALTH f Establishment Name: '< slxn ( r (3 Date:, Pager of Item Code C-Critical item ( DESCRIPTION OF VIOLATION/PLAN OF CORRECTION + "Date No. Reference, R"=Red Item A> ,a •' '�+ _ - '" " "' IN '`_ �` - Verified y, /. x PLEASE PRINT CLEARLY r � / if O).-1- C. 7Td.lJ �- IOJr' �PO /T�l. „n. O (/!, `. t �, � , � . !1 L. .. rJ IGiA/ �e /_''l ..ALP �n ^fit Gov F t LF-4- 1 J r /T� 4 't Oi M/ �. G G I , ( . f / A /0 0 0/-V) �. fir — _r ra A C-49 W' 1A R2f Q GGn � rl_ ll G rn h(10, t<l _ 0 orf, . C J 1 ice\ wnln _�� - /! e n nom, n, .� ,,.Lr..lr 1 /�� 1 11..>_�/ l/1/.v/� G✓i�' 40 0 ( i o r I�V "'/ -c- ! r t -F� Discussion With Person in Charge: Corrective Action Required: ❑ No .�IvYe`s S ❑ Voluntary Compliance ❑ Employee Restriction / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion 2 violations before the next inspection, to observe all conditions as described, and to e-inspection Scheduled ❑ Emergency Suspension p 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 your food permit. ❑/ �� f / Voluntary Disposal 0 Other: r . 3-SRI i4tCFPlIFs Received Tem at ralures Violations Related to Foodborne illness Interventions and Risk ae vosdin to Lay.Cooled to Factors{7#eMs 1-22) (Cont) #l ]145`E Within d Hniusa _ PROTECTION FROM CHEMICALST S01 2 Ca nSS da x1s for PTIFs _1 l4 I j Food or Color Additives 19 PHF Had and Cold Holding II SO1 IC f3} Cold PFII s Milinuained at or belvw 262.22 — dd ivc,r 590.004(FFl J114511F 'T,1)2 14 Prot.t ti<ut frorztUrrapprzr, ed Additives lS , Poisonous or Toxic Substances 1_503.Sir(A) i 4sFFiI.M.ntt€.tined it os above lzflff m 71Q1.I1 { lslenntytnglntonnatron--On}1snal 1 35ti11b(2)��___ ._R,r,,.sisfieldoorabove 1300F. �'�� _ I Contauzer,x 24 I Ttme as a Public Health Control 7-7021( ' CuriMinnName lt'v3hm*C<siitutua-` --sx— 501 19 ES Tull asaI'ubttcI3 aithCoat,(3y -EL)1.1I Se t urorr Sroi i c 29211 RcPtricii n -Presence and Loo- rano Rr. tuau3r ut 7).i2 Cort tidos of 1, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE '7=203.tI Toxic.tbmainet --Proltibitiuns" POPULATIONS 7-204.11 Samnzets Crate a i Chemic:i s 21 T3-&0t-1T(A lit a eursU,dPol racl_a-ed Juices and 7',(}4.12 Chwrtic3ls for Was 2}it P qdi a C rs+ciia'" . ) P I 5 •.. ..� --k _.._ _-..._ q},l a is with t3atnvn ,l.ab lax. 7 2E)d.13 Llntn Az encs.C rttcrra . ;._80{ 21($} Ii_(If pall fit f e 7505_-_ 11 btcxdr ntal t xxl(collet Lubs ants' 'i-SNAJ(D) R sw or Prali-At,,Olt,*:d Aluinal Food aid ! i 206.1 t RaSoio d I,se Ye treules.Coleus* a �.---- ---- _ Rau Sed.ipnruts NCA Sea'tc.d 7-206.12� 1 Rodent Bmt Statacrtaz 3-R61.t 1r{�j_-Lino enes.l Ford Parka r Not Reserved. r-, 706.13 -Srac.karzg P)wder>,l'esa Control and �""' 'p"'"""""`"'"" -"" ---"-- ___� Manstaring'^ CONSUMER ADVISORY TIMEPCEMPERATURE CONTROLS F-22 3-60; 11 (Constimer:Advisory Posted for Cmrsumption of I Animal t Reids That a c Flaw,Underax;ked ur I Proper Cooking Tomperatures far , _,. PHFs Not Other,"t5e l rucssed to of ln)na _ , 3-t01.114(1iCG) Eggs- 153"ut SLc i � - . ---.� e 303 3 Yateurizui F 5abslrtut•1d.Raw Shell _ h�s-f�nm ar ue.5c rv2c€ 545-115set I f ��s� ?-40 Id I rA)1't Cum ninntui F tth '4lea s a Cisme ----. _ Antin ds- 155"F t sec. _ SPECIAL REQUIREMENTS 3-46t11(4)(S)(,2) oorb and73eei Roast- 110F 121 mi0 ----7 -,-401.11(Alu") R miter, I(ljeoed 14kcats I7 -F 15.-. 5`J0.{��(A; tB) Vtt'rlaFitru3<sfSetlion 9{},(g}�{a�-{p) in � s c * i cratering= tra dmic itxict, tempoiary and 3-4(31.ri(A)(3) Poattry,Vritd Garne,StukTed YHFs, rt side ulial kitchen operations -,h uuid be 'r Fish, M1loat debited, sander the appropriate,secllons I Shi�ns;C.rntainant,Ir .. i IP P Poultry oilIOtne s 1 WF 15 secs""_ I Shove if related to fcwdborde 3llress u 001 11iC)(33 Whole xautcli, Lvactlil5teaxs � inteaventions.uad risk factors, Othfm _____l45'-J"1_______ 590.009 violations relating to gotxl retail 3401.12 Raw.Annual l+xxis Parked in a � prae cci ,should tv debited under#29 - � Micicrwave 165`F* III Special Requirements. i .3-40LII(A)(I)ib) All Otho PllI s - 145'T 15 sec ry Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-d03,t1(A)&f0) Pllla 165`F I (Menses 23-30) 3-403.11(h) Ylicroware 165"F2 M1nu e,Standing C•rii.•a?aul ivh0i do+rd, latae Pyr the �.. gime" fnodhorne Ulne"mot +cot,ons alul rt.kfaerors lie d above can be 3-403.1)(C) Commerciatly Ptocesced RTE 8auf- found in;he)oa`in r+rg,sr t rrrtn l), the Foot?Code and 1105(WR . . _ _. - _ i 0.0D0 I 3-463.1 t(S) Rcinaiaiing Umbers] Pomona of Beef iterGood 1 . _._..Reran Practices FC 59 � .r ..t Roast,* t 20r~han omens and Feu ,Jolie r , -2 i 903 24 Ftxid and Food Protection - FC 9 t)QC !g Proper Cooling of PHFs - vb Er..tu,pmetrt and E,ten.,�Is tFr a _,c65 3-501.14(A) U ulhq:Cook d PFiI s frrnn Hf fF to 28 ; Water Pturnoi�rg"+nd'N sae 1 FG o rxm to 41 F145i 2 Hoors alto From 7Q`I' Y k _ + Wit �27 Ph sical Fabl FC b W7 _ to 4I Tlr#5`Y 4t-ttlrtn a 13s7ui s * 28 Paso�ous of To�c Mntet�ais I rC_ ? 006_ I _. 710—if 4{S) Cooling PHFs Made Floor Arnbient t X29 _44 cial nmol firemen+ 3E009 1 Temperature Int,mdients to 41'1,/45`F i-_40. yOther - *Denotes critiesl ate,» i.r the 101cral N99 tool(Aie arr 165(-"AR 59;)000. CITY OF SALEM t , BOARD OF HEALTH r Establishment Name:_I_Qkr1A)�r Date��l I I l�� Page: � of -3 2 "'-�' `°'x �' DESCRIPTION OFYIOLATION 1.PLAN OF CORRECTION �"� e ;� ' ,� '? -Date r--, F item Code' C=Critical item �xs, ,. Verified e !Lf No Reference R—Red Item ` gg •# ., 3s 1 W, ',z �. _ -9 ' PLEASE PRINT CLEARLY ! c� ` : �� I ti t ,J1 n ,�) IQ j rc,DDfn� c 1 Cin r- I� o 0o A rb,1511., 04i / / I O •5 r�- cep �e er 1 f� in /Z l- ��r �I f 11 ) !'a ffnU D O.ri N �✓71"V/ �! J� a rV/r� 1 �iUn , C'C'i' t nr•./ _ F' 17l�� S��wrAJo � 'f ✓I (M .i1N/ ^g r v l� 'Ler rid * — G �� n oe �n 2 l u ne �/ U / `7''1 ,ll a �K � �./c.e0 uSr e nl n� • t q . _ r ILL.�e Al C, f-F A.1/tX AA Jrd AeC C ,n, P.AA.).UQ //.. ( W ILL.0 .i f r , ( 1 or Gn n)� Q7„nio l3S �h t. �/ Wd 0/ G I -Discussion With-Person in Charge: U Sy c ay- S1^r Yrs ce FroRe-inspection Action Required: .❑ No Yes i I have read this report, have had the opportunity to ask questions and agree to correcYall ry Compliance ❑ Employee Restriction p pp Y 4 9 Exclusion violations before the next inspection, to observe all conditions as described, and to Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I�jRderstand that noncompliance may result in daily fines of twenty=five`dollaars�.or suspension/revocation of ❑ Embargo ❑ Emergency Closure I 1 your food permit. �' /� � � - ❑ Voluntary Disposal ❑ Other: L/ t i i F-119t)1-14(F)- 1 PHFs Reecived Violations Related to Foodborne illness interventions and Risk r # a Cardin to Im Coolad w Factors(Items,1-22) (Cont) Within 4 Houls, 3-501.15 Coofiw, Mahws ter PHFg PROTECTION FROM CHEMICALS Food or Color Additives 19 1 PHF Hat and Cold Holding 1-501.16FE) Cold PRFs Mmiltilmod at of bolo%k 590 O(WF) 4104Y°F, Protection 1 Protection fromLrn ices" 1 Poisonous of Toxic Substances 3-301,16(A) Hat llflf�Mairialmed at or above -4---- 140,�E 101.11 Iderad'sing Inflonnation-Original Roasts Held at or above 130,F. Containers' • C,Q L20 Time as a Public Heafth Control Nk�7)R '011tL 110i I I Common Name—L)�Jnll F9 Time as a public,I lealth('�ofarcil' 7-20 1.11 ��2al 7-202ATF Restriction-Prosenceand Use. 7-202.12 Conditimv of Uw' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7103.11 1 1 oxic CoolamciProlidri:wns* POPULATIONS{HSP 204.71 Sanni-efq,Criteria --Chemicals* —T- 756,f 12 h7eiacajs for Rcw-la�es with, �alclll 20-4,14 ts� teritr ---- ------- 2f l 7-1-- --P n_qtte! ; 3-801,11(B) Lia of paxtaL�cd�l 17 205 I I Inuidental Foxxd Cvn"tal:t,i'alatcanti" OfL Li(D) Raw or I'mijaIN Ckok-d Artitual Frxld and 11 Reiilitad,Use PcAcides.Critenn" 7-206.12 Rodent Bart Siatloiv,- Vtonitonn CONSUMER ADVISORY [--i2— 3 = oflo T I Consw �r Ao�ioory stud iorCowlimotion of TIME/TEMPERATURE CONTROLS A"li mal F xxf� 1-hat are Raw. Underc(xlked of 16 Proper Cooking Temperatures for Net Oduav�i�Prla!essed to Fliminate I — PHFs "-I�" Pad-ra,ens * Pggs- I 35,F 15 5,,C. — I ..adercService 15 Flfeoc, S -F,,rgz� zlbsamjtr for Raw Shell 102 13 FIVA�Uriyzd '40, 1 )(1l conallilluted Fish,Meals& G4111C Annuals - 15'T' 15 sec — SPECIAL REQUIREMENTS 3-46 1.11—(B)(1 Ti -atldfi-ee Rollia 130"1-' 121 rain 1-401.11(A)U) RameN, btrec;ed Meats � I`5 F 151171 6'irfilatta�t5 ieeeian in cateran g� mobilc bx7d,temporta v alad T401—IhA)(� Poultry-,Wild rc,�Idcwial L-itchen operations should be 171 stuffing Cornainliv FishM-=, debited under ille 1ppropiriateseclionS 2L)c!tnofRante.1 105'F-'15 secstalx�v c if relail ed 1i)Rxilblal ku I Houss o< 1401.t'tC)t3j Wh<1e mod lc Into Belli`Steaks irittj ventions and risk, factor-,. Other 145F l' 590.009 violations relating to good retail i�j 3 4 0 It 12 Raw Animal Flixl,Clxlked it,11 jyacmes shouldise debited under,#29 Mitaowave 10'F * llp,Tial Requirements. 3-401,1 f(A)(1,cb) All Other PHFs-- 145"F 15 sec, F-17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Itertis 23-30) nn 3-403.11(13) Islicamaw- 165'F2,Minuel Standial,, Crial-cit and non-criwal viv�alwns. o hichoto nen reiate ro the lialel illncss buo volliony.and liskjaf lors listed abow, (an be 3,03.11(C) Commercially Processed RTE Food found in thefo"'flwiny sertioro of the Food Code wal 105 CAV? I.10'F 590.0(4 � 590,000 g Unsficed Portions of Pmf .............. 740 11(E) R�,mamm he I Carl Retail Practices R�3�ez* 23, Maria ent and Pelsorald 11,10,11, ........... 1=8 ------tProper Cooling it —24--PHFS Paslectioll �004 Equip ieptaqdlU tei)Ms_ FC-4 '0 F to 26, md aste C-5 006 5(71 14(A) C"llin.cookd PHFs folm 14W i ?WF Within �Flgurq laid From 7l1'F 27, FC-6-4 .007 v)41'FAF-,Wiflfirr 4 14 ------- ours t ? _008 -3--50114(iT) Cooling PIFs Made Horli Aunbient -29" : 009 R'quiremialls Tcmjxraerrc to 41"F/45'F I Other_ Within 4 Demaes critical iien;ill in"lojlzal 1999 Fool)Cate or 105 ""IR 590 000, f 1 Commonwealth of Massachusetts City of Salem Board of Health IGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Ristorante Gioia File Number:BHF-2005-000046 Atte.Vito Santangelo 38 Goodale Street SALEM MA 01970 LOCATED AT: 0140 WASHINGTON STREET 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0313 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 5 of 14 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR `ISL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ISCOT70SALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT f CStSJ Va Yl.}Le n /a TEL# 74 4 3 ADDRESS OF ESTABLISHMENT I�t O I,yC,4,)J�(NA91t^ Jo • FAX# MAILING ADDRESS(if different) / I p/ M/ / , EMAIL-Business': h I h��N/I E{�I O lc�b{gy / Web � site: L tuv". ' 0!�V`� i CONI OWNER'S NAME TEL# 9 ?e� 7 333 ADDRESS STREET /`/! (7 CIITYY STATE / ZIP CERTIFIED FOOD MANAGER'S NAME(S) !///0 J.,] 7/ � ' lb CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) p EMERGENCY RESPONSE PERSON rCI n J C0A1 HOME TEL# / cS 31 DAYS OF OPERATION Mond a Tues0 Wednesda Thursday Friday Saturday Sunda HOURS OF OPERATION `>/ o me of day. I_ For exam le 11am-11 m d !O :.0� I O:00 20 ,pQ Please write in G /O .DJ f O. f�c7 C): 00 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 ------------------------------ --------- --- --------------I--........ RESTAURANT YES NO ess than 25 seats 40 (Outdoor Stationary Food Cart$210) 25-99 seats 280 more than 99 seats =$420 '----'— YES NO ....... ---------------------...-----------.....-----------------..$100......... BED/BREAKFAST/ CHILDCARESERVICES ---------------------------------------------------...-----------------------...__. 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 filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number _- ------ _-_-_-------------- -_-___ Revised 4/24/07 FOODAP2008.adm Check#&Date a $ Massachusetts Department of Public Health Salem Board of Health Floor Dit. lon of Food and Drugs 120 Washington Street, 4'" 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name f , / Date ' Type of Operation(s) Tvoe of Inspection ( in -f' T t? lG 7I i' l;(A ❑ Food Service ❑ Routine Address ' 1,4 U /Ilk A r � _ Risk E] Retail El Re-inspection f t Level ❑ Residential Kitchen Previous Inspection Telephone 74:r .l tet. ❑ Mobile Date: Owner V CV HACCP Y/N ❑ Temporary ❑ Pre-operation t n l nc p. ) ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)k k �� Time ❑ Bed&Breakfast ❑ HGeneral ACCP Complaint ImZL I El Inspector � 1 D r Out. < Permit No. ❑Other Each violation checked requires ari 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. FOQD PROTECTION MANA . "a �� ra mmmN n, EMENT O ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties pEI= 13. Handwash FacilitiesEMPLOYEEc,fF=n..�€ .-.m, �. .PROTECTION FROM CWEMIGALS y 9 �t E&ai ❑ 2. Reporting of Diseases by Food Employee and PIC rbr � ��a� �_� � '�• �_ r- El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FRONT,APPROVED SOURCE'"°c��a�.�,�u�"�"�a°,m�wazak� TOME ti El 4. Food and Water from Approved Source f-TIMEtTEMP RATURE CONTROLS(Putentially Hazardouo odds)k "ti ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling r`PROTECTION FROM CONTAMINATIONgy ;.e '"" ,��,» t ❑ 19. Hot and Cold Holding ❑ S Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing g_hkowhEMENtd ORiiIGHLYFood aeon fimaLt or HSP S POPULATION (Wsot El 21. Food a❑ 10. Proper Adequate Handwashing El 11. Good Hygienic Practices i.CONSUMER ADVISQRy..€ r `"r�.,,�it»: ❑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#' N '' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(550.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007)' have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: \ Print: Pa � PIC's Signature: �� ' ` Print: U/�q-.t _��.�.�� j�� Page of- Pages 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 I Assignment of Responsibilit* 3-302.1.1(A)(]) Raw Anhnal Foods Separated from 590.003(B) Demanstsation of Knowledge* Cooked and RTE F(x)ds* - 2-103.11. Person in charge--duties Contamination from Raw Ingredients 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 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility OPA Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char e* Contamination from the Consumer 590.003(G) Reporting by Person in Charge` 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590.003(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 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetically Sealed Container* Sanitization Temperatures* - - 3-201.13 Fluid Milk and Milk Products* 4-501.1'12 Mechanical Warewashing-Hot Water 3-202.13Shell Eggs* Sanitization Temperatures* 3-202.14 E =s tmd Milk Products,Pasteurized* 4-501.11,4 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* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.1 1 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* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-30111 Clean Condition-Hands and Arms* 3-202.1$ Shellstock Identification Present* 2-301..1.2 Cleaning Procedure* 590,004(0 Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eatin ,Dr nk n=or Usin Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes,Nose and 3-202.'15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting` 6 TagslRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstoek identification Maintained* Em zlo•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 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* g 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 3-502.12 Reduced ox • enacka 'ng,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-30].1.2 Hand Drying Provision *Denotes critical item in the fedmil 1999 Food Cade or 105 CMR 590.000. - rCITY OF SALEM a BOARD OF HEALTH S Establishment Nam . W f ct A +f C1 o t 6 E Date: o 1 1r C� Page: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY n r IhM Co k 7hr AA if A>— Y — t s UAk 20A k I i / f y I t ! I 4 �I C i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes > . u- ti 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 P comply with all mandates of the Mass/Federal Food Code..Iunderstand that noncompliance may result in daily fines of twenty-�e-dollars o\r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. —) ❑ Voluntary Disposal ❑ Other: F'75 f) 1(CT) PHFs Received ct'rern ralures Vlobitions;Related to Foodborne fitness tnrerwentiams and Risk According to Lay. Cooled to Factors(item 1-22) (Cont} 41QF/45sFWhho)4How%' 37 PROTECTION FROM CHEMICALS L PHF Hot and Gold Holding I— - ____Ltood or Color Additives I ,6(B) 9t7 d at or belo�k Cold PHFs Maintained�O2 12 1 AfJdj1iVcs* 590fy.wp) 410/45°F- 3-302J4 Prr)r�ccoon from T3 to io,ed Additives"' _ FT�)I716(A) Hot PHF,Maintained at or above Is Poisonous or Toxic Substances - In TT), 1-1 fl-td�c�It i"�yin 0-In fol�a� i�I i 0 --()I I"—ai 140'F, '1 501.16(A) Roasts Held at orabove IVA;, Time as a Public Health Control -7 --,as a public Ifealthconno lnunur 7 7 102,11 Counnon Naqi� Worlkilo�Cooniorcn,* --7 3-i( 7 varian�L 7 ,:{}7.1i semcauon-stolaLl 1-2,0111 RcStrichorr - and Ua�,s 7-22,02.12 Cli ad ow of Usc* L1-11j1-1— - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 t I Toxic C.ontainert--lrrofifn6ow* POPULATIONS 1-204.IT an,"ric,"TtMn',- i ImIL IV 21 �-fa)I I I(,N) Ilnp�otcurizcd Juices and 7-204.12 ChainicaLt for clitetia" Rever"lats with 720414 tsXrlut ia'r - k T�Wb.7i 1�'Se—Pc��iodcs'('rtmia'! 3-801�I I(BI Ijs�of pasteunz d I, —711-11615A C i Incidsmid Food ontact.Lisinicarns' 3-So 1.11(D) Rawor Pawafl,,OKAd Animal F(rod and i " R S.t'd�S)TfltusNA Served T106.12 Rodent ftit Station,' ,� 3-k01 i 1 tG tiro} ned t ad Pack t r tio1 Re screed. 7-206.1 Tnicleng po%%der'.A"SE Control and — CONSUMER ADVISORY — � TIMEITEMPERATURE CONTROLS 22 3 ) i Animal Foods That'cr;Raw, Undircoidsod o; 16 Proper Cooking Temperatures for PRFs Not OthcT�fce Procetised to Eliminate IIA(l)(23 F'L' gt;s- 15J'F 15 launediate Servicc 145s],15sec, 3-30' 13 P-atenriz,d Fgg Subsrtwfai Raw Snell I — Comuunw�d Fvh,Meat; Mole L— ua— AntEnals SPECIAL REQUIREMENTS 3-401.2 ItR)(1)(2) Poik and 13cef Roast - EFt, izi linn'd Viol iljow;ol'Sutton 590Aff)(A)-(D) in 3-401.1l(A)f2) Raines, fiocc'ed Mckas - 155"F 15 cafering, mobilofrtod, ternpotary and 3-401.11(A)0Paulin,Wild Garne.Stuffed PHrs, resident al kitchen operations should be Stuffing Confunaing FishMein, debited under fire appropriate aa:IhiaN _pL,tdn-L(j, Pto 165tl5�,,c above if related to foodhortie i thicss 1 whole-nan,de.Intact fic4stealks inter ventions and risk factors, Other 145sb 590.009 violations relainflo to l000J retail 3-401,12Ra% Animal F(4xIs Cooked w a I in-acrices should be debited under #29 - �'tfterowavc 165'F* ---, Special Requirements. 3-01 11(A)(1)(b) srh Othei PHI's-- 145'T 15 sec. r-77— Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1D? -it" I 15 acc, (Nems 23.30) 1-403-1 l(B) microwarc- 165,F 2 Minute Standing Criaral and non-(rilwo, r4otarons, rvirich do mn reiare m rhe 'F nae, ;foodborne illness uwt ventiony and risk factors lured above, cam be I Com in e rc itf I V Processed el I eSFWT-1x1d-- firund in the ftWou ing sts-1wris of rhe Food Code and 105 CkIR 14(1'F J()0'00o' —4�--- - - ----- .3 - --403A I(Fi Remaining Un�ficed Portions of Beef 6WT Good 4sbnt Piacticres, --C 530 OOD _i ---- f- - 4 FC 2 1 6073 Food rd Food Prolectior, FC '3 rm 1=14 Proper Cooling at PHFS — 25 -0 p nt Ulensfls FC-4 005 3-5:T)1,—14(A) Ccs:4 mg CookLs' PHF's qw �R aqd_ ------- 26, Water,PluT692,odl4yu e I FC-5 006 70°F within 2 flours,and From 70so— 4' Lhy6 aLF�lCility i FC-6 007 �2—8 Poisonous or royx matenals I FC -7 008 to 41-F/4� F A"iflan 4 Hmm�� 009 .......... 3-501,14111) Coolitor PFIFs Made Front Ambient stdal R a� qnf Temperature lagredicias to 410f/451F30, 1 Other L With-in 4 kbmrsz m the 1"Iteral 1499 FtxAC'sleroe 105 CrItr 59900f) 0140 WASHINGTON STREET 1 Ristorante Gioia City of Salem TEMPORARY FOOD - Temporary Food Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 744-7333 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑J RED Owner: Comment:The dishwasher did not reach the mandated final rinse temperature of 180°F. Repair dishwasher to reach a final rinse Vito Santangelo temperature of 180°F. Owner must use the three bay sink to wash,rinse and sanitize all dishes and utensils until the dishwasher is PIC: repaired. Vito Santangelo I Owner plans to remove the True salad reach in and purchase a new dishwasher. Owner to notify the Board of Health prior to Inspector: 11 changing the equipment. David Greenbaum Violations Related to Good Retail Practices (Blue Items) Date Inspected:Correct By: Physical Facility FAIL Non-Critical BLUE 8/2/2007 Comment:There are water stained ceiling tiles in the kitchen and men's room. Investogate the source of the leak and repair. Risk Level: Replace all stained tiles. Owner to repaint all stained ceiling tiles by the next routine inspection. Permit Number: GENERAL COMMENTS: BHP-2007-0442 Status: I All other violations cited in the 7/12/2007 inspection report have been corrected. SIGNED OFF #of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 02,2007 ) 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. Aug 02,2007 ) Page 2 oft Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2007 ESTABLISHMENT NAME: Ristorante Gioia File Number:BHF-2005-000046 Alto.Vito Santangelo 38 Goodale Street SALEM MA 01970 LOCATED AT: 0140 WASHINGTON STREET 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2005-0513 Dec 26,2006 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 7 CITY OF SALEM, MASSACHUSETTS a BOARD OF HEALTH n 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC 212006 TEL. 978-741.1800 FAx 978-745-0343 CITY OF SALEM Kimberley Driscoll www.sALEM,COM BOARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR FOR PERMIT TOOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT IrSTQrdnk C O tcA TEL# ?333 ADDRESS OF ESTABLISHMENT /40 Wd 3A1 r,U4h � FAX It MAILING ADDRESS (if different) EiviAIL--Business': -l_ 1✓ O �z Owner's: OWNER'S NAME I Sf7fdi7 �'4 TEL#T rIA �'7 �j-3"5;20 ADDRESS 3F C000lolk cS W' Pecthody N14 STREET ,CITY STATE �" ZIP CERTIFIED FOOD MANAGER'S NAME(S) t/ t 7YJ �c�Y/4�fJ�yy^ CERTIFICATE#(S) yyI3/OcP3 (Required in an establishment where potentially hazardous food is prepared) /_k / ( / EMERGENCY RESPONSE PERSON HOMETEL# p700S� OAYSOFOPERATION Monday Tuesday Wednesday_Thursday Friday— Saturday Sunday MOORS OF OPERATION 30 Ril 30 All (, W (p•1t: � fid t�(p U N_� Please write in time of day. CLOb • �' 1 ( � /_ d� �-� (for exampleiiam-num) 1(7:()()Qd1',. (O;Oc) V.M :: l0.'(W ?-M U�r,;U 0T /(7(qo PM �'.DO U-1; TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YESNO $100 - -------------- ---....--- -- --- ----- -. .. ..---- --- ---------- ...... ..... ............................... .-.. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief, ;ave file 1! e t re s ❑d paid all state taxes required under the law. nalure D e Social Security or Federal Identification Number -------------------------------------------------------- --------------: fl� Revised 11/13106 FOODAP2007.adm Check#&Date, xq, g �L k 0140 WASHINGTON STREET 1 Ristorante Gioia City of Salem 0— CD TEMPORARY FOOD - Temporary Food Inspection oCD o (n HACCP: ❑ 0 0 Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 744-7333 Food Contac rfaces Cleaning and Sanitizing FAIL Critical RED Owner: omment:The cutting boards are stained and scored. Resurface or replace the cutting boards. Vito Santangelo n PIC: >L_,4ions no sanitizing solution in the food prep areas. Sanitizing solution of proper concentration must be readily available at all at all times. Vito Santangelo 0 o O Inspector: i es in the service line. Properly clan and sanitize all plates. � � -1 Z r y David GreenbaumZ The dishwasher did not reach the mandated final rinse temperature of 180°F. Repair dishwasher to reach a fina irinse-We63tae W n Date Inspected:Correct By: of 180°F. Owner must use the three bay sink to wash,rinse and sanitize all dishes and utensils until the dishywRh j 71irod H D x- 711212007 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) so O o r , Risk Level: Hot and Cold Holding FAIL Critical = R6Dv N r sD� � Ln A D p mm t:The True reach in had a temperature of 53°F. Repair unit to maintain a temperature of 41°F or beq�w2 o m m D Permit Number: Z 0 w eu m . N BHP-2007-0442 a True freezer had a temperature of 20°F. Repair unit to maintain a temperature of O°F or below. (q w o o a = D n Status: n VIOLATION O °o N #of Critical Violations: m 3 N Time IN: Time OUT: 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 12,2007 ) Page I of 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 me , e produce sink has dirty dishes in it. Clean and sanitize the produce sink and use only for cleaning produce. immediate corrective action) bel all c stainers of dry ingredients. Tr arreach in has uncovered food. All fod in storage must be covered. T Superior unit has uncovered food. All food in storage must be covered. Equipment and Utensils FAIL Non-Critical BLUE Co ent:The True reach in has an accumulation of food debris,spills,splatter and grime. Thoroughly clean this unit including all elves. Th mnit needs a visible,accurate internal thermometer. rTh-e True freezer has an accumulation of food debris. Thoroughly clean this unit. �uperior reach in has an accumulation of food spills and splatter. Thoroughly clean this unit inside and out. sam rt needs a visible,accurate thermometer. ��XW, she here the plates are stored has an accumulation of food debris. Thoroughly clean this shelf. ��e Tru alad unit needs a visible,accurate thermometer. dish ahser has an accumulation of food spills and splatter. Thoroughly clean the dishwasher. w at the hand wash sink have an accumulation of food spills and splatter. Thoroughly clean the walls. oro hly clean the mixer. p stored in the bucket. Clean the mop and store mop head down not touching any surface to air dry. T Vulc ven/stove has an accumulation of grease. Thoroughly clean the oven/stove. Th =fire has an accumulation of food spills and splatter on the walls,floors and surfaces. Thoroughly clean the kitchen Its, Floors and surfaces including under and around all equipment. Physical Facili FAIL Non-Critical BLUE G r' mment:There are gaps around the back screen door. All openings to the exterior must be sealed. There are water stained ceiling tiles in the kitchen and men's room. Investogate the source of the leak and repair. Replace all stained tiles. 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 12,2007 ) Page 2 of Item Status Violation Critical Urgency 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 12,2007 ) Page 3 of 0140 AHINGTON STREET 1 • Ristorant*oia City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 744-7333 Separation/Segregation/Protection PASS Critical ❑d RED Owner: I Comments:All units are disorganized and require thorough cleaning. Organize units to prevent cross contamination. Vito Santangelo Food Contact Surfaces Cleaning and Sanitizing PASS Critical RED PIC: Vito Santangelo Comments:Cutting boards stained and scored. Resurface or replace boards. Inspector: There is no sanitizer readily available. Sanitizer with proper concentration must be readily available at ALL work stations. John Gehan j Date Inspected:lCorrect By: Handwash Facilities PASS Critical ❑d RED 12/21/2006 Comments:The kitchen hand wash sink hot handle is in disrepair. Repair handle to proper working order. Risk Level: Same sink has hand sanitizer instead of soap. Hand sanitizer is not a replacement for hand soap. Hand sanitizer does not break down food borne pathogens._ Provide hand soap. Permit Number: BHP-2005-0513 Same sink has no paper towel. Provide paper towels in dispenser. Status: FULL COMPLY # of Critical Violations: Time IN: Time OUT: 1 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. Dec 21,2006 ) Page 1 oft Item . Status Violation Critical Urgen* RED: Violations Related to Good Retail Practices (Blue Items) Viol&ions Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:can opener found with accumulation of grime. Thoroughly clean and sanitize opener. immediate corrective action) True refrigerator has uncovered foods. All foods must be covered. Personal items being stored directly on food items. Personal items must be stored in designated employee areas. Meat slicer has accumulation of food debris. Thoroughly clean and sanitize meat slicer. Equipment and Utensils PASS BLUE Comments:White galaxy freezer requires general cleaning. True salad unit requires general cleaning. Superior refrigerator across from grill has accumulation of spills and splatters.It requires thorough cleaning inside and outside. Utensils being stored incorrectly. Utensils to be stored in proper designated containers. True refrigerator has accumulation of spills and splatter. Thoroughly clean inside and outside of unit. True Freezer has accumulation of food spills and splatter. Thoroughly clean inside and outside of unit. Microwave requires general cleaning inside and out. Sanitizing log not available at time of inspection. Log to be on hand and maintained daily. Physical Facility PASS Critical BLUE Comments:The entire kitchen floors,walls,and units have accumulation of food splatter and grime. Thoroughly clean and sanitize all surfaces. Back shelf by the door has exposed wood. Make shelf so that it is easily cleanable and impervious. GENERAL COMMENTS: All violations have been corrected from 12/14/06. V 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. Dec 21,2006 ) Page 2 oft 0140 WASHINGTON STREET 1 Ristorante Gioia City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 744-7333 Separation/Segregation/Protection FAIL Critical ❑d RED Owner: comment:All units are disorganized and require thorough cleaning. Organize units to prevent cross contamination. Vito Santangelo Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑O RED PIC: Vito Santangelo mment:Cutting boards stained and scored. Resurface or replace boards. Inspector: There is no sanitizer readily available. Sanitizer with proper concentration must be readily available at ALL work stations. John Gehan Date Inspected:Correct By: Handwash Facilities FAIL Criticald❑ RED 12/14/2006 omment:The kitchen hand wash sink hot handle is in disrepair. Repair handle to proper working order. Risk Level: e sink has hand sanitizer instead of soap. Hand sanitizer is not a replacement for hand soap. Hand sanitizer does not break down food borne pathogens. Provide hand soap. Permit Number: BHP-2005-0513S� �Fd ek has no paper towel. Provide paper towels in dispenser. Status: j Open #of Critical Violations: 5 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. Dec 14,2006 ) Page I of ' Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) ViolaiGons Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:can opener found with accumulation of grime. Thoroughly clean and sanitize opener. immediate corrective action) r�ue refrigerator has uncovered foods. All foods must be covered. ersonal items being stored directly on food items. Personal items must be stored in designated employee areas. Meat slicer has accumulation of food debris. Thoroughly clean and sanitize meat slicer. Equipment and Utensils FAIL BLUE L- l ment:White galaxy freezer requires general cleaning. ue salad unit requires general cleaning. S wr refrigerator across from grill has accumulation of spills and splatters.It requires thorough cleaning inside and outside. sils being stored incorrectly. Utensils to be stored in proper designated containers. e refrigerator has accumulation of spills and splatter. Thoroughly clean inside and outside of unit. True has accumulation of food spills and splatter. Thoroughly clean inside and outside of unit. icrowave requires general cleaning inside and out. r a1fitmng log not available at time of inspection. Log to be on hand and maintained daily. Physical Facility FAIL Critical BLUE ment:The entire kitchen floors,walls,and units have accumulation of food splatter and grime. Thoroughly clean and sanitize all surfaces. ack shelf by the door has exposed wood. Make shelf so that it is easily cleanable and impervious. GENERAL COMMENTS: Owner to fax over past three months of extermination reports to the Board of Health. Inspector to discuss violations to Health Agent. Owner may be required to meet with Health Agent. Street,4 h FI r SALEM MA 01970 978 741.1800 City of Salem Board of Health 120 Washington t oo S ( ) GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 14,2006 ) Page 2 of Item //Status Violation Critical Urgency s Cityof 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. Dec 14,2006 ) Page 3 of i 01- of Salem, Massachusetts .fire Department ��ry It \rYt r q 48 Lafayette Street id � � $afem, Matsachl&lettr 01970-3695 1 L E fire Pavcnnon DavTV. Cady Tel978-7441235 Bureau ch.f FwC 978-745.4646 978-7457777 978 7J4 6990 di ad�Crtalem cam Ristorante Gio#a 140 Washington Street Salem, MA 01970 ATTN: Owner/ Manager MAINTENANCE,CLEANING,ANDTESTINGOF FIXED FIRE EXTINGUISHING SYSTEMS, MAINTENANCE,CLEANING OF HOOD AND DUCT SYSTEMS WHERE COOKING GREASE IS GENERATED—....... ... The Salem Fire Prevention Bureau requires that all hood and duct systems are to be cleaned from the cooking area{hood}in the kitchen, all the way to the extreme-end-of the duct. THIS CLEANING WILL OCCUR ON A QUARTERLY BASIS. -A certificate showing the name Of the-company,-the person,and the data of the cleaning shall be posted near the hood area. The certificate will indicate what work was performed, and will also indicate areas not cleaned. ALL FIXED FIRE EXYMOUISMNG-13YSTEMB ARE TO 13E TESTED AND CHECKED WJM- ANNUALLY. THIS TEST WILL ALSO INCLUDE A TEST OF THE INTERIOR FIRE ALARM SYSTEM. The cleaning company and the fixed extinguishing service company shall file within(5)five days after the work is performed, a report with the Salem Fire Prevention Bureau of all their activities relative to the above fisted systems. The report shaft also list any and all deficiences of the systems and the remedial action to betaken. Failure to adhere to this public safety requirement will result in the shut down of the systems. Prior to resuming operations an inspection will be conducted by this office. Per Order, August 29 2006 Lt. Erin Griffin Date of Conveyance Fire Marshal FORM SIR(4105) CC: file Health Licensing Building E0 39Vd HCitldSIO 3613 W3-IVS Z07666LBL6 Z6;B0 900Z/6Z/80 Massachusetts Department of Public Health Salem Board of Hearth ems:-. - .{ 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name / Date ` T e of O eration s Type of Inspection " i a ( I q / �� ood Service (i�oRoutine ress Addl Risk' LJ Retail Re-inspection ^� Level ❑ Residential Kitchen Previous Inspection Telephone EIMobile Date: Ia1-7 ) -Owner HACCP YM El Temporary ElPre-operation n El Caterer El Suspect Illness Person in Charge(PIC)\t �A-... Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspector Opt: a Permit No. ❑ Other Each violation chec ed requ res 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 ,„. t . us ;�" -112. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH - er f" t'PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC (�% rid • � � � a�� -ts��• .�»4 _n "` ? _ _� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals L FOOD FROM APPROVED SOURCE, " -= ;i�'4, �� '� '� 'i v d- .= 4 . ;�..aui� ..c.R-h �m �� TIME/rEMPERATURE CONTROLS(Potentially Foods ❑ 4. Food and Water from Approved Source a ; i 1 1 ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling " PROTECTION FROM CONTAMINATION'; '' Hot and Cold Holding .»..'.»',.a... 1E] 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing RE0U1REMIiNTS FOR ip&LY SUSOEPTIQLE POPULATIONSQiSP) j ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY r'x 'wa ❑ 11. Good Hygienic PracticeseUyd. 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 7 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): J 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 violation's of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 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)(590.067) 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: n S:590In5peUFOr 1444 Inspector's Signature: Print: ,P PIC's Signature: ` Print: Aro �� n Pagel otf;Pages U Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F8 Cross-contamination 1 596.003(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-duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Annual 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 3-304A 1, Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char e* Contamination from the Consumer 590.003(6) 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 Restrict ons 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 taw* 4-501.111. Manual Wtuewashing-Hot Water 3-201.12 Food in a Henuetieall Sealed Container* Sanifization Tem 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 E s and Milk Products,Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Wafer* concentration and hardness.* 5-'101.1.1 Drinkin Water from an Approved System* 4-60 t.11(A) Equipment Food Contact Surfaces and 590.006(A)' Bottled Drinkin Water* Utensils Clean* 590.OM(B) Water Meets Standards in 310 CMR 22.0" 4-602.11. Cleaning Frequency of Equipment Food- Shellfish and Fish Froman Approved Source 4-702.11. Frequency of Sanitization of Utensils and 3-201.1.4 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 Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re uiato Authorit 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-,301:12* "�' .-,Cleaning Proeedurc* 590.004(C) Wild Mushrooms* r►S� T2_301.14 lWhen to Wash* 3-201.1.7 Game Animals* 11 :IGood Hygienic Practices 5 Receiving/Condition C 2401.11 Eating,Drinking or Using Tobacco" 3-202.11 PHFs Received at Ptv er Temperatures* 2401,12 Discharges From the Eyes, Nose and 3-202.15 1 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(E) Preventing Comantination from 3-203.1.2 Shellstock Identification Maintained* Employees Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients" 5-204.11 vocation and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans - Supplied with Soap and Hand Drying Devices 3-502.11 Specialized ProcessingMethods* 6.301.11 Handwashin Cleanser, Availabilit 3-502.1.2 Reduced oxygen acka rue criteria* 8-10312 Confannance with A roved Procedures* 6-301.12 Hand Drvim Prov sion t *Denotes critical item in the federal 1999 Part Cade or 105 CMR 590.000. - - k CITY OF SALEM r •� / /. BOARD OF HEALTH ct ' Establishment Name:T_n I � Date: J� /c�G Page: of S 4' Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN F CORRECTION Date r No. Reference R—Red Item E R Verified PLEASE PRINT CLEARLY zj L 45 . N b 4 ix D — PJM (vV t 1 I 2rlt - c n , 'Discussion With Person in Charge: Corrective Action Required: `a 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 conditio s described, and to—as Re-inspection Scheduled ❑ Emergency Suspension com{�ly with all mandates of the Mass/Federal Food Cod . I unders d,tl at noncompliance may result in daily fines of -five dollars spensii m/revocation of ❑ Embargo ❑ Emergency Closure your food permit. \) ❑ Voluntary Disposal ❑ Other: i `a t -' 3-5011.1-4(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 Homs. * PROTECTION FROM CHEMICALS 3-501.15 Conlin-Methods for PHFs 14 Foo19 d or Color Additives PHF Hot and Cold Holding 3-501.16(B) Cold PHN Maintained at(it below �-202.12 Additives* 590.004(F) 41°145°F* 3-30114 Protection from Unapproved Additives* 3-501.I6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 40'F 7-101.11 Identify ng Information-Original 3-50116(A) Roasts Held at or above 130'F. Containers* 20 1 Time as a Public Health Control 7-102.11 Common Name-Working*Containers* 7-201.11 * 3-501.19 Time asaPublic Health Control* S orattoae 7-202.11 Restriction-Presence and Ilse'" 590.004(H) Vananu:Re uirement 7-202.12 Conditions of Use' 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanmzers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteria' 2;t 3-801.11(A) Beveiaces w;d Prz p nc.kaged Juices and Bevel tees with biarnmg Ib�ls* 7-204.14 Drying Agents.Cnterie* 3-801.11(B) Use of Pasteurized in.-s- 7-205 11 Incidental Food Contact.Lubricants* 7-206.11. Restricted LTse Pesticides.Criteria* 3-801.11(D) Raw er Partially Cooked Anunal Food and Raw Seed S}touts No[Served. 7-206.12 Rodent BaitStaiions* 3-801.11(C) UnoenedFoaiPacka*e NotRe-served * 7-206.13 't7acking Powders,,Pest Control and Monitodn°* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-60111 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Anunal Fot ds That are Raw-Undercooked or - PHFs Not Otherwise Processed to Eliminate 3-40 1J.]Ali)(2) Fgs- 155'F 15 See. Pathogens itn.e�� ^nay Eggs-Intraccliate Service 145'F15seC 02.13 Pasteurized Eggs Substitute for Raw Shell 3-401..1 I(A)(2) Comminuted Fish,Meals Sc Game 3-3Eggs* Animals- 155�T 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS _ 3-401.1 l(A)(2) Ratites,Injected Meats- 155 E 't5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * eatarutg. mobile food,temporary and 3-401.1 l(A)(3) Poultry,Wild Game, Stuffed PtIFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited tinder the appropriate sections Poult a or Ratites-165°F 15 sec. "° above if related to foodborne illness 3401.11(C)(3) Whale-muscle, Intact Beef Steaks interventions and risk 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#29- Microwave 165'F* Special Requirements. .1-40 1.11 All Other PHFs- 145'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)c&(n) PHFs 165"F 15 sec. * (Items 23-30) 3-403.14(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do setrelare te,the Time" .foodborne illness interventions and risk factors listed above, can be ,403.11(C) Commercially Processed RTE Fo d- found irr the following sections of the Food Code drat 105 CMR _ 14WF* 590.000, 3-403,11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices t FC B84R00_ Roasts* 23. Manaaement and PersonnelFC-2 1 003 1g Proper Cooling of PHFs - 24 Food and Food Protection _ FC-3 .004 _25 _ Equipment and Utensils _ FC 4 ._005 3-501..1.4(A) Canine Cooked PHFs from 140'F to 26 in and Waste _Water,PlurrmbFC-5 70°1°Within 2 1tours and From 70°F 27. Ph sical Facility FC-6 .007 - - to 41.°:F(45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC -7 I .008 . - 3-501.14(B) Cooling PHFe Made From Ambient 29. S eaial H ulrsments - _ .009 Temperature'Ingredients to 4l'F/45°F __ _ , ,her Within 4 Hour,c* ---Denotes critical hent ue rho federal 1999 Food Code or 105 Cklk 590900. S i. CITY OF SALEM } / BOARD OF HEALTH j Establishment Name: 6 s Jr r77 in, c, Date: V� /C Page: of Rem -Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date -� No. Reference 'R—Red Item - Verified*; -r PLEASE PRINT CLEARLY ' ('y/�� ((�� N74 `` i L -�. o� e r Sao- l s ,y I - cn o D t c fl ((� it. -4i551. V oc i,'mss. I )(C2110 �0 / f / LPLAN 7 �T Discussion With Person in Cha e: Corrective Action Required: ❑ No rW Yes I have read this reporta had the oppor[unity 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 e-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I uYtImtamd that noncompliance may result in daily fines of twe. ;five dollars o suspend q/revocation of ❑ Embargo ❑ Emergency closure ` your food permit. , ❑ Voluntary Disposal LI Other: s I 3-501.14.(C) PHFs Received at'11olpffanareq Violations Related to Foodborne Illness Interventions and Risk Accordiin,In"W Cooled to Factors(items 1-22) (Cont) 4 I'F/45"F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 C(x)ling Me hods for PHFs _ LA_ Food or Color Additives 19 PHF Hot and Cold Holding 3-2401,12 3-50t.16(B) (.old PHFs Maintained at or below 590,004(F) 4P/45"F` 3-30114 Protection from Una pproved Additives* - 3-501,16(A) Hot PIlFs Maintained at or above 15 Poisonous or Toxic Substances 7-101.11 ldcntifyol�information-Original 14WE � Containers- 3-501,16(A) Roasts Held at or above 130'�F. - 2=0 Time as a Public Health Control 7-102.11 Common Nnino - Workin',, Containers - - I Separation-Siolaselc 3-501.19 Time as a Public Health Control* /-20L 11 7-202.11 Restriction-Presence and Use 590.004(1-1) Variance,Requiremant 7-20112 condition's of Use` 7-201.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitoters,Criteria-Chcnac�ils* POPULA IONS(HSP) 21 3-80tI I(A) Unpasteurized Pre-packaged traces and 7-24)3.12 1 Chemicals for Washilitt Produce,Criteria'� , I Beverages with Warning 1�abclsl' 7-204,1-1 -CrItella, 3-$01.11(B) Use of Pusternized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 11 3-801.11(D) Raw or Pailially Cooked Aninial Food and -7-206.71 Tsinci�d Use Criteria* Raw Seed Sprouts Not Served. Rodent BaitStations'. - Tracking Powders,Pest Control and 3-80 L I I(C) Unopened Food Package Not Re-served, Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS Consumer Advisory Posted for Consumption of Proper Cooking Temperatures for Animal Fonds That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate 3-407.1 IA(1)(2) Eg .5YT gs- 1 15 Sec. Pathnens �"'�`00' _E s-�homed rat a�.Sor�ice 145"F 15,gcc, ;tl-3(')'- 'I I Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Mens&Game Eggs' Animals- 155'17 15 sec. * 3-401.11(6)(1)(2) Pork and Beef Roast -130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles, 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 PI-IFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited Linder the appropriate sections Poultry(11 Ra"Is-1-6VT'15 see. 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 in a practices should be debited under#29-- Microwave 165°F* - Special Requirements. 3-40 1.11"Ar(l)(b) All Other PHFs - 145°F t5 sec. r-__ - LL- Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4011 PHFs 165'F 15 sec. * (items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Ct nicai and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk,lwtors listed above, can be s-403.11(C) Commercially Processed RTE Food- found in the-tollowingsections of the Food Code and 10.5 Crfl? 140'F!, '590.000. 3-403.11(6) Rcnlaulmg Unsliced Portions of Beef Item Good Retail Practices FC 590,000 Roasts* 23. Management and Personnel rG-2 .003 - Proper Cooling of PHFs 24-Food and Food Protection FC-3 1 .004 --r- 25, E ent and Utensils FIC-4 11005 _ 3-501.14(A) Cooling Cooked PHFs from 140°F to 26 Water,Plumbincl and Waste -hC�J-mo - 70'F Within 2 flours and From 70F I' -2F--- P-h-v-sical Facilites____. PC-6 .007 to 41"F/45F Within 4 Hours. 1 28. Poisonous or Toxic Materials FC-7 008 3-501-14(B) Cooling PHFs Made From Ambient 29, special Re ulrements oog Temperature ingredients to 41'F/41'F '_Other J Within 4 92urs'e 'd-, Denote,critical Item III the i"dend 1999 Food Code or 105 CMR 590-(700. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name //' Date T e of O eration s Tvpe of Inspection k4, jeC 1 r C .(?/) lr Food Service ❑ Routine Address Risk LJRetail ® Re-inspection ^ Level ❑ Residential Kitchen Previous Inspection Telephone ' ( ❑ Mobile Date: 9( )-1 Ix OwnerHACCP ti YM El Temporary ❑ Pre-operation 4Nc _n ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint Inspector Permit No. ❑ OtherLY9_> 0 out:z, 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 PROTEc710NMANAGEMENT ��_ ";,� i,g �,�,,,,....... a �"� ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities Q EMPLOYEE HEALTH�Z ?-"- FPROTECTIbN FROM CHEMICALS [:1 2. Reporting of Diseases by Food Employee and PIC _, . aAdditives X; � .<, E] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color ❑ 15 Toxic Chemicals `FO.ODFROMAPPROVEDSOURCEm?„;M �;��„:�',�„� ,;.`�„"c,` Ey ,�y,,,; ,T E" ., ❑ 4. Food and Water from Approved Source 'F,TIMEITEMPERATURE CONTROLS(Pptsntially Hazardous Foods)' ❑ 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 FRDM CONTAMINATION _ r °i El 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing "REQUIREMENTS FDR HIGHLY SUSCEPTI9LE POPULATIONS(HSP)a�`:-'. El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices jRcONSUMER ADVISORY tiy,� ,rn„' '�;u, g22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ��^`J �� Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. C , Nli 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.005) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S'S90NspeclFo,m614.tloc ( ` /� U o, a00(o i�i J li Inspector's Signature: Print: PIC's Signature: Print: - 6,��, /� �hPag _of�Pages L� Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT tf Cross-contamination . � 1 �590.003(A) Assignment of Responsibility* 3-302.11(A)(]) 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 - 3-302.1.1(A)(2) Raw Anirnal 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 OPA Food Employee Or An 3-304.11 Food Contact with Equipment and - Applicant To Report To The Person In Utensils* Char*e* Contamination from the Consumer 590.003(43) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restr ct ons Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F9 Food Contact Surfaces 590A04(A-B) Compliance with Food Law* 4-501.1.11. Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tent eratures* - 3-20113 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-50t.114 Chemical Sanitization-temp.,pH, concentration and hardness. 3-202.16 Ice Made From Potable DrinkingWater* 4-60LI1(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System'tem* 590.006(A) Bottled Drinkin Water* Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish Surfaces and Utensils* and Fish Froman Approved Source 4.702.1 1 Frequency of Sanitization of Utensils and 3-211.14 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* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.1.1 Clean Condition-Hands and Arms* 3-202.18 Shellstock identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices Receiving/Condition 2-401.11. Eating,Drinking or Using Tobacco* 3-202.11 - PHFs Received at Proper Tem eratures* 2401.12 Discharges From the Eyes,Nose and - 3-202.15 Package hue it * 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(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained'r Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* Labeling of Ingredients* 5-204.11 Location and Placement* 590.0(4(J) 9 9 5-205.11 Accessibility.Operation and Maintenance 7 Conformance with Approved Procedures 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices _ 3-502.12 Reduced oxygen acka ham,criteria* 6-301.11 Himilwashing Cleanser, Availabilit 8-103.12 Conformance with Approved hroeedures* 6-301.12 Hand Dr 'nom Provision Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. - !I CITY OF SALEM�` } BOARD OF HEALTH' 1 \ ' ? v Date: {� 2-�� Pa e: of I, Establishment Name: � �� t� a= ,{—„ , � 9 Item Code C C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date . No. Reference R—Red Item k 1' Verified I - -PLEASE PRINT CLEARLY - 11{EE ! p t t \ � r - xAe r A t G At .c Discussion With Person in Charge: 1 Corrective Action Required: ❑ No Yes c ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and,to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that , poncompliance may result in daily fines of twen�e dollars sus slap/revocation of ❑ Embargo ❑ Emergency Closure your food permit. t \) o Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received to Temperatures Violations Related to Foodborne Illness Interventions and Risk - I According to Law Cooled to Factors(Items 1.22) (Cont.) 1 41`F/45-F Within 4'H'ours. PROTECTION FROM CHEMICALS 3-501.(5 1 Cooling Methods for PHFs I9 PHP Hot and Cold Holding 14 Food or Color Additives 3-501.16(B) Cold PIIFs Maintained at or below 3-201,12 Adrhuves* 540.0040 41%45' F' 330214 Prot ulion froml'Ina>rroaedAdditives* 15 Poisonous or Toxic Substances 3-501 16(A) lint PHFs Main[ained at or above (40'F 7-101..11 - 1'tientit7iisg Information-Ongina( 3-501.16(A) Roasts Held at or above 7 iF 0° . Containers* 7-102,11 Common Name-WorkinP Containers* 20 Time as a Public Health Control 7-201.11 Se.aration-Storacc` 3-50L19 Time as a Public Health Contra]* 7-202..11 Restriction-Presence and Uses 590.004(H) Variance Rruirement 7-202.12 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toxic Containers-Prohibitions'' POPULATIONS HSP 7-204.11. Samtrcers,Criteria Chemicals" 7-204.12 _ Chemicals for Washine Produce Criteria" Z:f - 3-801.tl{A) tinpasreusized Pre-packaged Juices and 7-204.14 Dr mg A eats,Cnterma Beverages with Warning Labels* 3-801 I I(B) Use of Pasteurized E,,,,,* 7 205.21 Incidental Food Contact.Gtbrirants* 3-801A1(D) Raw or Partially Cooked Animal Fowl and 7-206.11 Restricted Use Pesticides.Criteria Raw Seed S,xouts Not Served. '" 7-206.12 Rodent Bait Stations" 3-501.11(C) Unopened Food Packa�e Not Re-served. " 7-206,13 'i'racking Powders,Pest Control and Monitorinn* CONSUMER ADVISORY TIMErrEMPERATURE CONTROLSConsumer Advisory Posted for Consumption of 16 " Proper Cooking Temperatures for Animal Foods That arc Raw, Undercooked or PHFs Not Officrursc Processed to Eliminate 3-401.I.IA(1)(2) Eggs- 155`F 15 Sec. 22 3-603.71 PathOrt.ns leIh-v )ai E es-Immediate Service 1.45'F1511ec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(&)(2) Comminuted Fish, Mcats&Cattle Animals- 155'F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 mini` SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590.0O9(A){D) Violations of Section 590.009(A)-(D) in sec. * catering, mobile food, temporary and 3-401.11(&)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Sru,ffine Containing Fish,Meat, debited under the appropriate sections Poultry or Radtes-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventionsand risk factors. Other 1450F,: 590.009 violations relating to good retail 3-401.72 Raw Animal Foods Cooked in a practices should be debited under #29- Microwave 165'F* Special Requirements. 3-401_l I(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)&(f)) PHFs 165'F 15 sec. 4' (Items 23-30) 3-40111(B) Microwave-165°F 2 Minute Standing Grirical and non-critical violations, which do Trot relate to the Time' foodborne,illness inrerventions and risk faceors listed above, can be 3-403.11(C) Commercially Processed RTF Food- ,found is the following sections of the Food Code and 105 CMR 140°F" 590.000- 3-40111(E) 90.000_3-40311(E) Rennining Unslicod Portions of Beef Item Good Retail Practices_ _ FC 590.000 Roasts* 23. Mans anent and Personnel FC-2 .003 ------Protection_...----______ 1$ Proper Cooling of PHFs 24. Food and Food Protection FC-S 004 25 E9uipment and Utensils FC 4 _i .005 3-501.14(&) Cooling Cooked PHFs from 140"F to 26. Water,Plumbinq and WasteFC 5 1 .006 _ 70"F Within 2 Flours and From 70'F 27. Phial Facility_- FC-6 _007 to 41.'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 , .00 3-501.'14(13) Cooling PHFs Made From Ambient 2g. Sp©cial Requirements _ .009 Temperature Ineredients to 41"F/45'F 30.___ Other Within 4 lIours'k 'Deid tvx critical item in 1ho Intend 1999 Food Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ff Dat¢ l TVDe of Ooeration(s1 Tvoe of Inspection I�r . 0 i 1S'/)X11 Food Service ❑ Routine Addressr I Risk [I Retail m Re-inspection inti^ '^ Level ❑ Residential Kitchen Previous /Insp ction Telephone � f..- 3 El Mobile Dater fl d ?(X Owner HACCP YM ❑ Temporary El Pre-operation O ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint El Inspector Ou 3� Permit No. ElOtherCP 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 a FOOD PROTECTION MANAGEMENT El" "` ,�', „ ' "x G. .E 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH r 1 ..¢ n� " o- t� ❑ 13. Handwash Facilities . ar §PROTECTION FROM CH MIGALS .1 .»R.;'tw�.aw ❑ 2. Reporting of Diseases by Food Employee and PIC _�= n u ra 40 .-_� e w.�. . ti r ... i a ,- ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ,,FOOD FROM APPROVED SOURCE'.'4Pa: °: € '„�,"u2�',"`i _ r a. s ❑ 4. Food and Water from Approved Source 3^.TIM&EMPERATURE CONTROLS(PotentWlly Haizardous Fodtlaj r 4 ❑ 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 CONTAMINATION " , , _ , r> " xr ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing �KREOUIREMENTS FOR Hip HLY SUSCEPTIBLE POPULATIONS(HSPj [:121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices ;:CONSUMERADVISORY'Y: „ .� ® k ,„ .r El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N ` by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(5 23. Management and Personnel (FC-2)(590.0 4)) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(590,00 )o.00s) 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 rH28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s ssninspecrFo,m&ra eoc / 1 r Inspector's Signature: \ Prink PIC's Signature: Print: 7' Sdh l h<� Paged of Pages 71 Violations Related to Foodborne 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) Demonst anon of Knowledge* Cooked and RTE Foods* 2-]03.1'1 Person in ohar e--duties Contamination from Raw ingredients - 3-302.11(A)(2) Raw Aminal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to 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 3-30411 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) Retuned Food and Reservice 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* a Food and Water From Regulated Sources 9 Food Contact Surfaces 590A04(A-B) Compliance with Food Law* 4-501..111 Manual Warewashing-Hot Water 3-201.12 Foal in a Hermetically Scaled Container* Sanitization Tem eratures* - 3-20113 Fluid Milk and Milk Products" 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 .E<�,s and Milk Ptoducts.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water" concentration and hardness. 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 2101: 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 Saiutization-Hot Water and 3-201.75 Molluscan Shellfish from NSSP Listed 4-703.11 Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatort,Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleanin--Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices -9 Receiving/Condition 2401.11. Eating,Drinking or Using Tobacco* 3-202.11 - PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 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(0) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-002.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* Location and Placement* 590.004(1) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Accessibilit .Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S uialized Processin Methods* Devices 3-50212 Reduced oxygen acka hq criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301..1.2 Hand Drying Provision 'Denotes critical item in the Federal 1999 Foal Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: l �1 c7 w Date: VC Pager a of 6 Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY (( pp � T r eAir ril 1 - + in12 A t� c✓ 1 4 R tr} T r11 'E .f r' ,L 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/ viviolations 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 twe vd'd rs or pe 'on/revocation of LlEmbargo ❑ Emergency Closure yoN,r food permit. ❑ Voluntary Disposal ❑ Other: r r f 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness interventions and Risk According to Inv Cooled to Factors(Items 1.22) (Cont.) 4VF1451'F Within 4 Hous. PROTECTION FROM CHEMICALS 3-.501.15 Cailim11 =Methods for PHFs Food or Color Additives 19 PHF Hot and Cold Holding 14 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41 V45°F" 3-302.14 Protection from Unapproved roved Additives* 15 Poisonous or Toxic Substances 3-50(.16(A) Hot PHFsMaintained at or above 140'F. 7-101.11 Identifying Information-Original 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 Control 7-201.11 Se.wation-Storaee'^ 3-501.19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence and Use 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7303.11 'toxic Containers-Prohibitions"' POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 7-204.1.2 Chemicals for lhashin Produce,Criteria* 21 3-807..17(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dr in ents,Criteria" Beverages with R naing Labels" 7-205.17 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11. Restricted Use Pesticides.Criteria* 3-801.1 1(D) Raw or Partially Garold Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.11(C) Uno lied Food Package Not Re-served. �` 7-206.1rs,Pest Control and Monito ing* CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods Mat are Raw,Undercooked or PHFs Not Otherwise Pressed to Eliminate 3-401.11A(1)(2) FPathogens. ogs- 1.55'F15Sec. * rr�`rc�e v+aoor Eggs-'lirmrediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell B as* 3-401.11(A)(2) Comminuted Fish,Meats k Game Annuals- 155'F 15 sec. SPECIAL REQUIREMENTS 3-401.11(B)(I)(2) Pork and Beef Roast-130'E 121 turn* 3-401.1 l(A)(2) Ratites,Injected Msats- 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 wider the appropriate sections Poultry or Ratites-165'F 15 see. * 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 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 3-403.11(A)&(D) PHFs 165oF 15 sea * (Items 23-30) 3-403.11($) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to file Trate* foodborne illness interventions and iiskja(tors lisied above can be. 3-403.11(C) Commercially Processed RTE Food- ,found in the following sections cif the Food Code and 105 CMR 1.40'F* 590.00ft 3-403.11($) Remaining Unsliced Portions of Beef Item Good R__ if Practices FC 530.000 Roasts* 23. Manactement and Personnel _ FC-2 .003 lg Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 .004 _ 25. Equipment and Utensils FC- 4__ .005 3-501.t4(A) Cooling Cooked PHFs from 140'F to 26. Water, Plumbin and Waste FC-5 .006_ 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC- 7 .008 3-501.14(B) Cooling PHFs Made Fronr Ambient 29_ 5 ecial R uirements _ _ .009 Temperature Ingredients to 41'F/45'F 30.----_-Other _- Within 4 Hours* Lao, '§Denotes critical item in the t le al 1999 Food Code or 105 C lAR 590.000. Y CITY OF SALEM c BOARD OF HEALTH l ` Establishment Name: 91 S i o _q N T\, G 1 y\ r-'t Date: 12—1 ' I0 Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference 'R-Red Item 'Verified PLEASE PRINT CLEARLY - - - - '�1 '� (�C-1C Sc 12�'z Y-A Rio Ptl�R�l —'r\� IR, c ic. 5 7 ZN w I (D dro ' .- r\ k A-,A Z� v \A--ft G / �j P,v) 7 VA C'\v f i t } t ~ Discussion With Person in Charge: Corrective Action Required: ❑ Nc ❑ Yes r 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 Emersion P Ll 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 tw%e ty-five dollars or suspension/revocation of Ll Embargo LI Emergency Closure your food permit. ( ❑ VoluntaryDisposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to L.aw Cooled to Factors(Items 1-22) (Cont.) 41°F/45`"F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling,Methods for PHEr' 19 PHF Hot and Cold Holding Iq Food or Color Additives 3-501.1621) Cold PHFs Maintained at or below 3-202.74 Additive _ 590.004(F) 41°/45° F" 3-302.14 Protection from Una -roved Additives* Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above IS 140'F. * 7-101.11 Identifying information-Orin==final 3-501.1.6(A) Roasts Held ator above 130°F. " Containers" as a Public Health Control 7-102.11 Common Name-Working Containers* 20 Time 7-201.17 1 Separation-Stottt>;e" 3-507.'19 Time as a Public Health Control* 7-20211 Restriction-Presence and Use* 590.004(1E Variant:;Re-uirement 7-2012 Conditions of Use, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7--203111 Toxic Containers-Prohibiiions"` 7-204.11. Satnnvers,Criteria-Chemicats* POPULATIONS(HSP) 7-204.12 Chemicals for Slashing Prodacc,Ca;iteria* 21 3S IA I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying. encs,Criteria* Beverages with Warning fabels* 3-SOI 7-2.05.11 Incidental Food Contact.Lubricants-` 11(B) Use of Pasteurized Ee,as* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Cooked Animal Food and Raw Seeedd sprouts prou gouts Not Served. 7-26.12 RodentBait Stations*- '3-801.11(C) Unopened Foci Package Not Re-served. 7-2006.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS22 3-603.17 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'rhat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate Pathogens- e;�n�a v,.aoni 3-401.1IA(1)(2) Eggs- 155°F 1.5 Sec. Eras-Iimnediate Service 145°.F15sec* 3.302,13 PasteurizeEggs Substitute for Raw Shell ' 3- 001.11(A)(2) Commented Fish,Meats&Game E>gs* Animals- 155°'F 15 sec. 3-401.11(13)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 59O.009(A)-(D)in sec. * catering-mobile food, temporary and 3-401.1 I(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F J 5 sec. alcove 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 3-401.1.2 Raw Animal Foods Cooked fn a In should be debited under f129-- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-Id5`F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)Ra(D) PHlrs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minafe Standing Critical and non-critical violations, which no riot relate in the Time* ,foodborne illness interventions and risk.factors listed above can be 3-403.11(C) Commercially Processed RTE Food- found in the following seclions of the Food Code and 105 CMR 140'14* 590.000. 3-403.1.1(E) Remaining Unsliced Porrions of Beef item Good Retail FracYlces FC 590.000 -- Roasts* 23. Management and Personnel_----- a3 .004 (g Proper Cooling of PHFs 24. Food and Food Protection _25 __ __ Equ mnot and Utensils 3-501.14(A) Cooling Cooked PHFs from 140°F to 26 _ Water, Piumbin and Weste 70"F Within 2 Hours and Froin 70°F 27Ph sical Facilit -Facility 41°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 ' .008 3-507.14(B) Crxlling PHFs Made From Ambient 29. 5 ecial R uirements _ ! 009 Temperature'ingredientsto41`F/45"F 30. Other W iflun 4 1-lours" sa•.or::,::,r.,ia-za„--- *Denotes critical item in the t doral 1999 Food Code or 105 CMR 596,060. CITY OF SALEM BOARD OF HEALTH Date: October 13, 2005 Name of Establishment: Ristorante Gioia Address: 140 Washington Street Owner(s): Vito Santangelo Phone: c/•fig_ ? �Z g. 35 a o ("I1 PA`t) 97ir, 5',S - & (/L/7 (Ac---P ) The proposed owner of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. CERTIFICATION Mr. Santangelo will be the Certified Food Manager who will work full time 9 9 at this location. He has enrolled is a CFM class. A "Person in Charge" or "PIP" must be available at this location when Mr. Santangelo is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc/ FLOOR PLAN A Hand Sink is located in the foodre area. P P The hand sink 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 caner does not Ian includes an storage of these items in the basement. Theo p Y g to use the basement at this time. The Board of Health must be notified prior to the use of any space in the basement. A dishwasher and a three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes will be used. The dishwasher must have a final rinse temperature of 180 degrees in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENU/FOOD PREP Reviewed preparation of a soup item, and a chicken cutlet item. 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 deli 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. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKEDFOODS The advisory was given to the owner. If no undercooked food items are to be served, then the menu must state that. If undercooked items are to be served upon request then the advisory must be followed. CHOKE SAVING A person trained in choke saving techniques must be available whenever this establishment is open for business. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. 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. Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles may be filled there. 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 and grease holding area, must be kept clean and sanitary. This establishment is scheduled to open in December. Please call one week prior to opening to schedule an opening inspection. An application was given to Mr. Santangelo. No check was received. . nne Scot Date Health Agent l ,/ /0 Owner Date l,��heo«nJs <<.v41 Examinee Score Analysis - Detail Page 1 of 1 National Restaurant Association A Developing the Restaurant and Foodservice Indu EDUCATIONAL FOUNDATION ResourcesMQ JWUCATIGNS ' zip code Monday, November Examinee Score Analysis Report - Detail This report is meant for online viewing only. Printing a hard copy of this report may not be considered appropl documentation to meet regulatory requirements. If you passed this course, you will receive a Certificate of Completion from the individual your proctor designa responsible for exam results. If, for any reason, you need to obtain a duplicate of the original certificate issued to you click here. Course Name: ServSafe Food Safety Manager Certification Exam Student Name: VITO SANTANGELO Class Tracki Class Organization Instructor Exam Exam Type of Hold of Hours Certification Pe Number Name Name Location Date Training Code Training Number 505,371 Pilgrim Richard MA 10/19/2005 Classroom 8 Hospitality Doyon Test Pass Your Form Percent Percent Score Score 4243 75% 74 Foods 67% Clean/Sa n itize/M ai nit. 60% Facilities 79% Personnel 91% Temp. Measuring Devices 100% Allergens 100% High-Risk Populations 0% Legal/Regulatory Issues 75% Facility Layout/Design 100% Training Employees 100% � �y C 2001-2005 National Restaurant Association Educational Foundation 175 West aclson Boulevard, Suite 1500, Chicago, IL 60604-2814 Legal Notices and Priv www.restaurant.oro 1-800-76,5-2122,of In awagoland 31), 715-1010 https://www.nraef.org/I RC/classes/StudentDetail.asp?Curriculum I D=85&StudentI... 11/7/2005 Examinee Score Analysis - Detail Page 1 of 1 National Restaurant Association n Developing the Restaurant and Foodservice Indu EDUCATIONAL FOUNDATION Home TAboutUST - iGo FIND TRAINING CLASSES:, zip code Monday, November 2 Examinee Score Analysis Report - Detail This report is meant for online viewing only. Printing a hard copy of this report may not be considered appropl documentation to meet regulatory requirements. If you passed this course, you will receive a Certificate of Completion from the individual your proctor designa responsible for exam results. If, for any reason, you need to obtain a duplicate of the original certificate issued to you click here. Course Name: ServSafe Food Safety Manager Certification Exam Student Name: VITO SANTANGELO Class Tracki Class Organization Instructor Exam Exam Type of Hold HoursOfCertification Pa Number Name Name Location Date Training Code Training Number MRA Kathy 511125 Hospitality Murphy MA 11/9/2005 Classroom 0 Institute* Test Pass Your Form Percent Percent Score Score 4255 75% 74 % Foods 71% Clean/Sanitize/Maint. 60% Facilities 85% Personnel 80% Temp. Measuring Devices 100% Allergens 50% High-Risk Populations 50% Legal/Regulatory Issues 67% Facility Layout/Design 67% Training Employees 100% y 2001-2005 National Rt taurant.; location Edi.wat,unrd Foundation 175West 17'kscn Boulevard,Suite 1500, Clticlyo it 6 0 604-2914 Legal Notices and Priv w� 1-800-765-2122r ar in Chicig Oland 312-71 1010 vded v;.re staura nF.orq https://nraef.org/I RC/classes/StudentDetail.asp?Curriculum I D=85&Studentl D=3... 11/21/2005 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 I R k o` Food Establishment Permit ��NrHe DATE PRINTED: 12/07/2005 WHO'S PLACE OF BUSINESS IS: Ristorante Gioia File Number: BHF-2005-0046 Vito Santangelo 140 Washington Street SALEM MA LOCATED AT: 140 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2005-0513 Dec 7,2005 Dec 31,2006 $150.00 ESTABLISHMENT 008-06 Total Fees: $150.00 PERMIT EXPIRES: December 31, 2006 Board of Health Agent This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 i k CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH '� 97 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 _ STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A� FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I` ) S 2` 0 RA ,*- / ,*- 7-£ �) O/ATEL# ADDRESS OF ESTABLISHMENT )G O �VOSh 140S v: J�c_ MAILING ADDRESS (if different) Z)rP t9oodee OWNER'S NAME V-10 Sdh Y6,17 , -� � TEL# ADDRESS CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON G"3 ro/Yh 50)1 t2� HOME TEL# ?J 7 HOURS OF OPERATION: Mon.0 oz iTue.2t-1 D Wed. 4_IOThu. Id- 10 Fri. P-)OSat.tA /0 Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 ,, more than 10,000sq.ft. =$250 ry RESTAURANT YES NO QQ� © less than 25 seats 100 25-99 seats 1 more than 99 seats $2 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 1 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 knQwledg a d belief, have filed all state tax returns and paid all state taxes required under the law. a�-os D�3 -J4 r96t Signature Date Social Security or Federal Identification Number - --------------------------------- ----- ----- q ----------------------------- Revised 11/03/03 FOODA P2.adm Check#8 Date,b )I�a-}t-OS - JOU IIM MESSAGE FOR /J a DATEE � A.M. p TIM M 7 YlJ�17 d✓l/T'UJ OF PHONE AREA CODE NUMBER E ENSIDN O FAX O MOBILE 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 o A.11 -) Yl d(l SIGNE WFOA-FORM 009 MADE I U.S.A. 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