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ROCKAFELLAS - ESTABLISHMENTS (backAPILuS 2.21- Stl�«t yotttM /� tA p tRfi ftNIVERSAL® UNV-12110 MADE IN USA F'&SET r' MBI.RECYQID 11 INITIATIVE �1a C.rtipeEFfier Sourcing rosTP(MUMER ' N'Ww sfipmgr.m ON mmHg I Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4"Eloor--- Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800`Fax (978) 745-0343 NameG Date I Tvo_e of Ooerationfs)• Type of InsDection Q()C CL�c 2QXC1/��C Y c.�n� C/�Xa1 tQa 3�1-1 I J mal Food Service Routine Address �n��l D�� Risk L.I Retail � Re-inspection aam Level ❑ Residential Kitchen Previous Inspection Telephone � 1SC awl. El Mobile Date: 4-� Owner �- A HACCP YM El Temporary [IPre-operation I PAn ii An N_1e ni^ Gt e.t•t r I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)n Time El Bed& Breakfast El General Complaint I ! ann on In M ❑ HACCP Inspector �Uw I Out: Permit No. ❑Other Each violation checked requires a explanation on the narrative page(s) and a citation of specific provisfon(s)violated. CNon-compliance with: Violations Related to Foodborne II ness Interventions and Risk Factors Anti-ChokinrTobacco / Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 9L✓ 590.009(F) Q action as determined by the Board of Health. QD PROTECTION MANAGEMENT 3. Handwash Facilities EMPLOYEE HEALTH knowledgeable/Duties r/1 PIC Assi ned/Kn - � � �I 12. Prevention of Contamination from HandsI O - = � ❑ 2. Reporting of Diseases by Food Employee and PIC I PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives r�-'.�.� El 15.Toxic Chemicals L FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source I TIME/rEMPERATURE CONTROLS(Potentially Hazardous Foals) ❑.5_ Receiving/Condition [116. Cooking Temperatures E]--6: Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling I PROTECTION FROM CONTAMINATION "' ""• ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control 9:Food Contact Surfaces Cleaning apq Sanitizing^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE,POPULATIONS_(HSP) El 21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic PracticesV I�CONSUMER ADVISORY _ y O�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)(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-a)(sso.o0s) 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-71(596.008) 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 s.9JrnapecrFomiure.aoc p Inspector's Signature: f- ry Print: ,14J A PIC's Signature: �'�!1 -,/� Print: II ( r- li K ev'LM 0:,, (n i i I Page`ofazages Sok ( o-�R Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION Cross-contamination FOOD PROTECTION MANAGEMENT I S I 3-302.11(A)(]) Raw Animal Foals Separated from I 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other` EMPLOYEE HEALTH I Contamination from the Environment I 2 590.003(C) Responsibilitv of the person in charge to ( 3-302.11(A) Food Protection- require reporting by food employees and 13-302.15 Washing Fruits and Vegetables applicants* 3-304.11 590.003(F) Responsibility Of A Food Employee Or An Food Contact with Equipment and Applicant To Report To The Person In Utensils APP '" P ( Contamination from the Consumer Charge* 590 003(G) Reporting by Person in Chat ( 3-306.14(A)(B) Returned Food and ed orC iof Food* � Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food* ' 4 , Food and Water Fran Regulated Sources 19 Food Contact Surfaces 1 Law* 4-501 1!1 Manual Warewashin Hot Water 540.004(A-B) Compliance with Ford law' I 8- 13-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperahves"l 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Warewashing-Hot Water 13-202.73 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products,Pasteurized* 14-501.114 Chermcal Sanitization-temp.,pH, concentration and hardness. * 3-203.16 dee Made From Potable Drinking Water- I 5-101.11 Drinking Water from an Approved System* I 14-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* I 4-602.11 Cleaning Frequency of Equipment Fuad- 590.006(B) Water Meets Standards in 310 CNIR 22,04c Shellfish and Fisn From an Approved Source I Contact Surfaces and Utensils" 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* Fail Contact Surfaces of Eyttipment* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish frons NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by ( 110 I Proper,Adequate Handwashing Regulatory Authority ( 2=301.1 1 Clean Condition-Hands and Arms* 3-20218 I Shellstock identification PresenO I ( 2-301.12 Cleaning Procedure* � 590.004(0) Wild Mushrarms` I ( 2-301.14 When to Wash* 3-201.17 Game Animals* ( 111 I Good Hygienic Practices 5 Receiving/Condition 12-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity' Mouth* 3-101.11 Fond Safe and Unadulterated * ( ( 3-301.12 Preventing Contamination When Tasting* 6 I Tags/Records:Sheiistoc4 I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification" I 590.004(E) I Preventing Contamination from 3-203.12 Shellstock Identification Maintained* i ( Employees* Tags/Records:Fish Products i 13 I ' Handwash Facilities 13-402.11 Parasite Destruction' I I Conveniently Located and Accessible 13-402.12 I Records.Creation and Retenuon" I 15-203.11 Numbers and Capacities* 590.004(J) I Labeling of Ingredients' 15-204.11 ( Location and Placernent* 7 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Procossing Methods* Devices 3-502.12 Reduced oxygen packaging, criteria` ( 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 I Hand Diving Provision *Denotes critical;tem in the federal 1999 Potnd Cade of 10 CMR 590.000. A CITY OF SALEM BOARD OF HEALTH (Yvt1 n Establishment NameA�zr/c&0k'Q D.QQ. (CA/Ct_ai ,�_,n Date:, -a G( Page: of Rem Code C-CHU vftem � } 1t� DESCRIPTION OF VIOLATION/PLAN OF CORRECTION "Tate No. Reference R-Redp,[ge•A�,� J r YU d'0 1 JJ 14PLCFASE PRINT CLEARLY t J\r`�t,�7�_ verified �l/V /i�L.i4/ 1l .�,fACXCAi CTr��L. rl,U fit/ / A 0, /1120, A U at-A C�/ ��0 I l/fa''/ / Y() al-0, l I I I V K �� n A/ Q/1 tz _� R PIA PIAo./,P I C ,rn7� ,J��: g� Irl\ BMn a I,! l I e�R4l'k 14 Vr0 - - ' �7�I/+ nri — A)n� 1 t trr9t)1 rz A111yAb J-1e1.(npAA ,1� ,* Q / C ov, - ti � /i i 0 AU .(°t, (r. il)1 nA .,�ti �i) tko tQn&'I, . . � - (Akt .Aej r 'vu _ ,Q a l.o . 0 eozl 1l'_O_ ,G _V C;7� , I � � r _(((1 A f� JI,I)J/V� I t L+2/" ID � Q), nPAIIn � _: _ - �'�1 t D i? �/J¢ - PIY1�n, , UvU t-� 0 t7) � l �,'n.i.P,�a-i� ( ,0 A)1 alp (VIO/7'n 0 _' - — - - OLI I I/i•,4NAA(1/1/ �/%`1r1�1(�/4'/U'� �r�iO i I.P�n'l,Pll% i;f�rt 1 LJ��/� t p /n S'n- /\ �o �ta�F7P'1�!11 n n!/�+ (Ja, (--\�RA;� ( .tit 0"'al> s,eA� Discussion\With Person in Char e: 1 ' Corrective Action Required: ❑ No of Yes I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to / Exclusion 0 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code-:1-understand that noncompliance may result in daily fines of twenty=fie dollars or suspe ion/revocation of ❑ Embargo ❑ Emergency Closure yourJood permit. k; , t 1 •4 ❑ Voluntary Disposal ❑ Other: i AW F ' 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness,Interventions and Risk According to Lav Cooled to Factors(Mans 1-22) (Cont.) I 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs J 14 Food or Color Additives I { 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41°/45°F* 3-302.14 Protection from UnaQoroved Additives" I J ( 3-501.16(0) Hot PHFs Maintained at or show15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original I 140sts Containers* { 3-501.16(0) { Roasts Held at or above 130°F. J 7-102.11 Common Name-Working Containers* { J 20 J J Time as a Public Health Control { 7-201.11 Separation-Storage* ) 13-501.19 I Time as a Public Health Control* I 7-20231 { Restriction-Presence and Use* J 1590.(104(11) J Variance Requirement I 7-202.12 I Conditions of Use* J REQUIREMENTS FOR HIGHLY SUSCEPTIBLE J 7-203.11 +I Toxic Containers-Prohibitions* POPULATIONS(HSP) 17-204.11 Sanitizers.Criteria-Chemicals* J 7-204.12 Chemicals for Washing Produce,Criteria* J 121 3-801.11(.A) Unpasteurized Pre-packaged Iakes and J 7-204.14 Drving Agents.Criteria* I Beverages with Warning labels* 7-205.11 Incidental Food Contact,Lubricants* J 3-R01.11(B) Use of Pasteurized Eg,-°s* I 7-206.11 Restricted Use Pesticides,Criteria* ( 3-801.11(D) Raw or d Sp Cooked Animal Food and { 7-206.12 Rodent Bait Stations* ) Raw Seed Sprouts Not Served.* i I 13-801.11(C) Unopened Faxl Package Not Re-served. 7-706.13 Tracking Powders,Pest Control and " I Monitoring* CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of ( 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or ` PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*`"°`°"°"" Eggs-Immediate Service 145°F 15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shelf 3401.11(A)(2) Comminuted Fish.Meats&dame + Eggs" Animals-155°F 15 sec.* I SPECIAL REQUIREMENTS J 3-401.118)(1)(2) Pork and Beef Roast- 130°F 121 min* 3401.11(A)(2) Ratites,Injected Meats-155°FIS 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* + catering, mobile food, temporary and 3-401.1 l(A)(3) Poultry,Wild Game,Staffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, I debited under the appropriate sections Poaltry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be,debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. J 17 ( Reheating for Hot Holding I VIOLA77ONS R-LATED TO GOOD RETAIL PRACTICES 3403A I(A)&(D) PHFs 165QF 15 sec.* I (Items 23-30) 3-403.11(B) Microwave- 1650 F 2 Minute Standing ' Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk_factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- ( found in the following sections of the Food Code and 105 CMR 140°F* 590.600. 3-403.11(E) Remaining Unsliced Portions of Beef Mem I Good Retail Practices FC 1540.WO I Roasts* I i 23. 1 Manaaement and Personnel FC-2 I .003 I J Ig Proper Cooling of PHFs 124. Food and Food Protection FC-3 I .004 I 3-501.14(A) Cooling Cooked PHFs from 140°F to 125. i Equipment and Utensils i FC-4 .005 ( } g ( 26. Water.Piumbina and Waste FC-5 f .006 70°F Within 2 Hours and From 70°F 127. Physical Facility i FC-6 I .007 to 41°F/45'F Within 4 Hours. * 128. Pdsonous or Toxic Materials FC-7 I .008 i 3-501.14(B) Cooling PHFs Made From Ambient 29. I Special Requirements 009 Temperature Ingredients to 4PF/4.5°F I 30. 1 Other I I Within 4 Hours* 'Dmotes critical herrn,in the federal 1999 Fcad Code et 105 CMR 590.000. . s �. .,..+„J". 1 '�' ..^VFNF'A41.SFTT'RST"�i/i"A-Tvvn"nl..w�'✓1i+ow"sf�'vi<;'C� -��`-""ii^Y*.-w�,r 1�,YR.�.T-y..-. HiW1X�.�y,.�A.w.`ay w-"�'�Fwgt SPF i�v4. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor g Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ) � I .� ('n Date Tyt a of Ooeration(s). Tyge of Insoection rStr, DO 9a nw�unn ori I -� -)n IQ Food Service ] Routine Address , rf\ . �) I Risk ElRetail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone /] �u �5 I ❑ Mobile Date: Owner i HACCP Y/N ❑ Temporary ❑ Pre-operation fiPnAA ..,z � b1- l I1 i wnn n I ❑ Caterer ❑ Suspect Illness Person in Charge•(PIC) Time ❑ Bed&Breakfast ❑ General Complaint �rnn o In yew. ElHACCP Inspector �� (nl �� ^ Out:/ {-;yrJ,yVl 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)\E] action as determined by the Board of Health. YN FOOD PROTECTION MANAGEMENT`"""'""""' "" ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH' `PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals El 4. Food and Water from Approved Source TtMErrEMPERATURE CONTROLS(Potentially 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 FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control 0�-p 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E]21. Food and Food Preparation for HSP C1 _R 10. Proper Adequate Handwashing U _ 11. Good Hygienic Practices CONSUMER ADVISORY ., . I ' z ©'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)(590.003) order of the Board of Health. Failure to correct violations .;�e 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: S 14 dac0U_Q_ 1 �(,` /} ,r� �j�� /1 K _ V\11n��"�"`lA 1/`.QVC///• Inspector's Signature: ` 9 (() Print:,�� PIC's Signature: �l'�"/-�"%,�%�°'�� Print: +��iVv .�/ //c��J I Page of r Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 ( Cross-contamination 1 590.003(A) Assignment of Responsibility" I 1-302 1 t(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* j 2-103.11 Person in charge-duties I I Contamination from Raw Ingredients 1-302.1 I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Other* 2 590.003(C) Responsibility of the person in charge to i Contamination from the Environment require reporting by food employees and ( 3-302.11(A) Fowl Protection' pi ; 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or.M 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Uten>ils* Charge"' Contamination from the Consumer 5y0.003(G) Reporting by Person in Charge" I 1 3-306.14(A)(B) Retained Food and Resetiice of Focal 3 s91).003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F,) Reinooal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD F IOM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" 4-501.1 I I Manual Warewashing-Hot Water 3-201.12 Food in a flerineticalh Sealed Container* ( Sanitization Temperature,,' - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashinr Hot Water 3-202.;3 Shell i Sanitization Temperatures' � i 13-202 14 Eggs and Milk Products.Pasteurized* ( 4-501.11' Chemical Sanitisation-temp., pH, 3-202.16 Ice Made From Potable Drinking Water" j concentranon and hardness 4-601.11(A) Equipment.Food Contact Surfaces and ki 5-101.11 Drinking'Water from an Approved System" I Utensils Clean- 590.006(A) Bottled Drinking Water* ( 4-60v 11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22^.0 Contact Surfaces and Utensils`" Sheilfish and Fish Fiom an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-207.14 Fish and Recreationally Caught Mollnveau Food Contact Surfaces of Equipment Shellfish" i 4-703.11 ,Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 110 ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority ! 2-301.11 f Clean Condition-Hands and Ants* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms" 2-301.14 When to Wash* 3-201.17 Game Animals* I I LI Good Hygienic Practices g Receiving/Condition I 1 2-401.11 I Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2407.12 I Discharges From the Eyes, Nose and 13-202 15 Package Integrity' Mouth' 3-101.11 Food Safe and Unadulterated'* 3-301.12 Preventing Contamination When Tasting° 16 Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification ' 590.004(E) Preventing Contamination from * 13-203.12 Shellstock Identification Maintained` I Employees* Tags/Records:Fish Products I 13 Conveniently located and Accessible 3-402.1 t Parasite Destruction- 3-402.12 Records.Creation and Retention* i I 5-203.11 Numbers and Capacities* 7 I 590.0040) Labeling of Ingredients' ( I 5-204.11 I [-cation and Placement* Conformance with Approved Procedures ( 15-205.11 I Accessibility.Operation and Maintenmicn_ /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-502.12 Reduced oxygen packaging.criteria* I 16-301.11 Handwashing Cleanser, Availability 18-103.12 Conformance with Approved Procedures' 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Pond Code of 105 Cb112 590 000. CITY OF SALEM y BOARD OF HEALTH D�1 Establishment Name-PO(A n &k'Fit.[s/ ! �/, �m Za v/�n n_J Date:Js -36_—l(,/ Page: of _ — Item Code C-Critical Item 1 tJ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date i No. Reference R-Red Item �OM Verified , r PLEASE PRINT CI_FARLY =p�((. Pis t��Q kbcll(-M An 3 �t, I� FA , l �i , I1�1�( 0 . sr14/)XA On.e Aa N/fl.,Vr rk0 "-�\. ^ U II I,Vh`.tA"✓,l 4- 1—,4c) ` II&A �ItW1) Ul�l�x F� y �i�U 9-q-10 - '` O�l-�'Y\�I�(T(�1� `t.2X..e�( ; 1 PM„n2 t-1'1 0 _ 1 `c n�i�/�r�R/,{2�f�� I�'n,ns �,�-`,�rn,:�,✓I I� � I.LYI._Ikn<c17 P —y � _ 7l I I 1 �f—.s 0"P,, , l 7 1 : IsA.�-iiva ll I"/(,(it/Y- \�Ii.I X-P -�> A ;ll-f'rt )'/Al i; al� "�/.J,1 A)IF e' A q At l0/.a pi7 w. :..r7�n.n..��1 Inn� 1Te (V�D/� n \V�C7A.,• n. i I I � �� - ��l e �n. � �/�l •.t,� nnlP �-- r'X'L;n/li - /1�t;/ ,!�.(/lneef"� �t,ln��sn./„ o �_1/ I ` VVY .. _ J - V //'',,�, •�`y t� ` L�-C Cn 1n/7n/e/.t //l_. y � �n�.GI1 n/� n� I �� V Al// �p� �N:,i 7f A N V ` AAC_'A'A' �O e y o " �lOle, l.�/ k Y'Y` (n't /,i l-/p� �/. � � [� `.f'J J J L �71 A) Q'l:.l,^ 1C,."f/tAni/ D./Y /1.1 A I-c"I /l.(.//7C-14,1�-.�,./-� n1/1(Al, ;i7_ I , , /h��, �(n,�. . `yV(-(i� `� I .,. � � �,�,., �,.,., ..�- - h�, I•r�_� -�1 b�n U�.�.�C�p�l�- %'S u,,..cd o,,,.� �,:<� 0 �1_.1Vrt� I Discussion With Person in Charge: Corrective Action Required: I ❑ No I O Yes Voluntary Compliance ❑ �o' 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 t 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 0 Other: ?-501 )4(C) Pllrs Recerwil at Temperatures Violations Related to Foodborne Illness Interventions and Risk Ac:arding to Lau Cooled to Factors(Items 1-22) (Cont) 1 4 FF/45"F Within a Hours. { j 3-501 15 Coaling N}ethods for PHFs j PROTECTION FROM CHEMICALS 14 Food or Color Additives ( j 19 j j PNP Ncd and Cold Holding 3-262.12 1 Additiwc k ( 150!.16(9) ( Cold PHFs Maintained at m below 590 4SO 3-302.14 I Protection Dont Unapproved Addih,:e;` 3-5OI4(}1 Ihit PH P" k }-591.16i.1j Hnt PHFs Afnintained at or ab:nr 1-S I Poisonous or Toxic Substances WO F. , 7 (bi.lt IdentiNityintoiindllnn - Onr!na! -_� 16:At i Rt,.tst Hc(datorabove I30% I- ------- `26 --- 1 Time as a Public He3fth Control 7 102 It # — '- ----- - -- I % ! Yia,<•as a Public:}icalth Control" ! ;-NOL I1 S );u auan-Sturat;:` , �.#.__. i_s._..__ ._-._. 1 ` tU.'tt'-vHi --- U_Va_iac;r leyuireatat! J ( 1-201 11 kco-tnuxm-Fr.'scn,'c nod t,..' -.- -- -- 7-703.12 Condit tvt'of ttw" REQUIREMENTS FOR HiGHLY SUSCEPTIBLE 7.2031} Io�ic(;ontaincu_Prolrhrnm.` POPULATIONS(HSP} w 2'0-!.11 Saniti7ec r.Cateri., -Cltemicnl. 7-'_'(}.913 C'htvti�als fol tt'a�hicnyt':odi:ce.C.4 ncua' ' 2d ! ;.yUt tit,\t t'npasttunr.d Pre-each:gcd Jut,.ts a(:LI 7-204,14 Divin> .Acme.Criteria' --- _ I j Rewta^es wish N'an?inr lit.irivnlai 1.nhttt:atC<•--�I 11,k,of Pa�t+�n:i;rd i.alt.." '-Si?t i 1 j), IZ.;a or Pa 11,111•:C(K)k:d Aminal Foid and j Re'urritdt`5r !'r..ry tder.Cntcrn'T ------ - ---- - _ —.._.l 7--!16.12 i 1,X6.111 Rant Sa(jon>" e, t.,' , ..,d PAL; tit: "C•. : d. -. tt, No' p<•-a.n...! t _On #I ! 9ta:kmr,. );dre:.ycet( ,xxn t vC t�_._._...__-.._._.,-:. --.-- -, -..---• _ CONSUMER ADVISORY i22 j 34,(i: 11 C on,urn,:r A.. ion i'Xr:ted i ,, ti nn<,tutptit,n TIME/TEMPERATURE CONTROLS _ i { 4.1# t' i, :tl,:!.:rc }F:, to#cr...t)):c'i< : j 16 I - Proper Cooking Temperatotp� 'or I C•n 'hitcr„i r Prt"ess,'d # ¢C:. ;5, }: lz,'s bnu•:date Scn trt i ;`.'•!- f f .. t 4., a „mak ,t.. h.r i1.3t j '.-P't#..l,aC,vrn;n„yet':{-ch,11i:.. e� � :tit SPECIAL REWREMENTS „{;1'r; ,..r, ,.t , it S.._i tots .`9t#.i,4f)1A -( I�}UI I(Ai(:'I Nola.:., ir•t,a:"i M' lf> !"-+ # .. lY; lir` _!___�..____..—.2..2..22_._.-._ __ .....-__..—, . . j j 3=40i lieAif'i; Poolr;.1\dd Gamc 4uRid 1'i}}' , j rt,;.:a u51 :icnra oF,,'t,,:•on 'ttizaiG 1, t''±ntaltiIDs•Fl+!' 61.:: 1 u'Y•n Cd tt;,dcl the .tY lti f r, .. ..,L{ tt. 4),1,4),1, , . ,-, ..1.... . { '"cl,•':- .4 it r at P'i. a? I r Stct,nztir„?or }tor FSrS;±i:; 1'!C; R HEL9 ;oIt ; r t;0,01 RE'T nc; P A !:.1 40i_`.1)t ESi 1#ti rtr•.+:;r.'- (':.. 1" 'rL ntar Gto ani. "+h. 111,ch r/r,,W: rdn;.':r', f i luta %ccD'c',rz '.'1 v:'z• 'it :r•, r..•.... ttn.l,rL hrrh:r< 1"rtd.,Fn,r 'tir -i(N.i l.r"•� � f,-un,oea:tally Yrtx;..,ti ;:;'-.i"= „ .,::n.- fit ''._ . r..::r,:..::,;: .,t 't: F':<.d Co:r a,r.' 1 , „R 2 2------ � -- iZr•rt:u inni,,i,a?ti:ce:ce:d f.e'x`its:,f bcrl _ttcn• _µC:cnc.4e.ad Practices 2...222 _F^_ - _ 59t:.;ith,.-- , I h•'aa::c 23 ' '�.7a9s4e're:"ar.c Farrar,n.-! _ _^_ -_ri. �G '�C- __ _ ! 1H Proper Cooling of PHFSc_1x;_ rd xxt PrpturCc _. '_FC. _:, - r(';_ t 't Sit tG\t - !:x,6t,d PNPc f .n142 2Sti._-- ^-C r{t-_J: Cr'rn-6-Ule,151 9 , f, -A- - -.?. 'd3'et. t:rp"g -. - -' s �.., F N'uhln _ Ifour,.:aa Frr:n : -7 ---fare.-a Fa r, _ ^rG_. :__.✓�; _. . to 411"/-t" F11'itl:iti' 1'.,flE:' 501 ;.t(lt) i k•1 Out _,PHE, Nit,di: c j Trrn3 i nunrc #n rases== [''±:''::5'i+ +, _ ! ntr,.; .,»r .,.rth•._r item.,)il. .,,,. ., '._ a +1..- dh . ,. CITY OF SALEM BOARD OF HEALTH Establishment Name:t YxG ,,//r O ro -/ J�� „ . Date: Page: a of d �— Item Coe C—Critical Item ` i ' V I 1 ✓ DESCRIPTION OF VIOLATION!PLAN OF CORRECTION -';;,;;u: ,Verifi�d - i No. Reference R—Red Item�' •—� _ - - —-- _, - �\1� � o7F.45E PRINT CLEARLY '^ .trerRled i�i� LIZ HAin,-� \_ ,Uig S Y I ()AA i l I j' .T)iv I I - I I I I r I Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all X Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Emersion violations before the next ins p �° \ Re-inspection Scheduled ❑ Emergency Suspension 1 comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. �— �� _ �-�_ �� ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Rfs6" 3-5ol 14(C) PHFs Received at TemperaouresAccording to Law Cowled to Factors(lists 1-22) (Cont) I 41'Fl45`F Within 4 Hours. PROTECTION FROM CHEMICALS i 3-501 15 Cowling lMethods for PHFs 14 Food or Color Additives I 14 PHF Hot and Gold Holding 3-501.16(B) I Cold PHFs Wlanunined at or below 3-202.12 Adthtives* 5()Q.(X)4{F) 412l4511 I- 3-30Z 14 Protection from Unapproved Additives` II �i-501.16tAt I lot Plll-� Maintained at or abode i c I Poisonous or Toxic Subsiances j I 34(t F.' 7 RHAI Idcutifying lntonwitinn -Otn:inal I ( z. i �t t 16,Ai Rt„1st:Field•xt cr.t{rove 130`I + i.nmatuen I Time as a Public Health Control i ? 102 11 i C tgww,i N;inw - 4t nrkin!:i:'untan,er,,- ( L2 —_. _. `^b! !':_.. Tim:z::a Poblic)1ea)th Control' I 201, 11 l Japa,auort-5[waga` --~ ---� j-:--... — �-2r, y .., ,.tr}rrt)di ltl V::rlinme Reuuiremeat ,r2.1 i Rcnt�kuon--1 t,x ncc,u;d L,•” � � 7-::02.)2 Toxic Con;,r11F c" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-'t}3 tl toxic C'untamti: -Pn,kr,hr.iun,°' --} POPULATIONS(HSP) j 7-21}4.11 S:mrize£`,.Cruemn-C'hcnticds, I 7-204.12 C'h.micdn for vk�a hit,t t'rouuec C ii*eria' 2.1 I{A) { Uapawconr,d ter::pat):uged lot cc;:md I �J-2114 Id { Drv)rll;Aceno.Cr1wria' I i Sr.rra'zes t�itt� R',,rt;in:.)abc1;^ t 80:.1It13) I l a of pa,temwd bus: i 11 ht�tdrmai F-•wxl Cunta[t.l.ah :ea tnts' i '-SOI I I ll l P;tw or Rutialit Ftx,d-ind `7_2296.!I it,e_` tod I,w 11e>tro:u)re Crite7 ta' j R,,;t 5t tJ Spr,ut, %,1 Sc rs:a. :.06.12 Rskin !3•rt 5;::aoao'' t i .A:r \:.: }L•� c.'ved I i x'41) � •i Lq'^.,hk1 r -!• }i•t � __.—_—.._--I—`__"�_.'.. __....222..2._. _..__—._�._.___ `'t'+ni:n;iau CONSUMER ADVISORY _ ` 11- r-_un,tnu.t .lu ,,,,', i',„tvJ i.ir''rusomotion of TIMEtTEM?ERATURE CONTROLS 2,v-)-oo, t::ut :,[ Proper Cooking teropm awrvs for s I PHFs ti,x '}ti:. I•la 1'1res::,';i•.,: ':U:a[ta,e _ 1 _ t0! I i 'I)i- i i-?;g' 1e5.1, IS 4.:,.. Cah':c4°" — —._.. —.. _! :: , t'�,^'- i:mu"•I:aic:e,:'tcclii'1'75...; i - _!2I }�;,.tt'+tmri Fx'`: Suto:''t„F:• r:.r ,,..,, '?oe,l t .i(t' ' F •1't:: � tt,nm:aa,'n' f",:,h. )Ea.., !: C.n:n. ..__ 0 - SPECIAL'13 QU!RE3SEttTv 'ot_ - — - I - ._R}!4 �r -t,t „} :) :t,a,"t _ i. r,t.n' \ttbi,l{7Y,L, t•r -VIM,Ai.-�r �iJd)ir }\:11:1 (e:ln.,, i SIv(t,t.g't'+it:ntt,,n, Nisi: hk•.. ,2^he'-2;22to, }tot L,16 .„•z___ _ __. _, iV0ia_4,1. J {c it7r.fr _ _ te,r,- i'i ti -i 1ci, ?'s-h>) ,-M „Ior.l lib, i \Sl.;;,,r.a.t.- i+.” I'_' t'E •S:;n.lisg C;ti.; ". a,.' ::,;-r a: :zt rr,•�,>r ..i s is err•:n,' •.'f„r-':,: Fnri, ' j:q.cr;.r -tie :'7.,.. :r:, ;•,nt::m .,+,r:r;�l r,n for< .,n;i or:,ntrt'tallt !'![nPsc i?'ti' Ili"\i ;f.,,n: a:. '.n.:r.t ., . .. ?:•,r,1 s >.1; •. .•1 .''n <<an ',te:,tarung,l n,i•r.eJ pr'bori”ol`I:.ri ftE+n C,00C Retart Pracuces 2222 , FC _ __. 580.0(X1 ` j 1in:r,.I,, 113 4d_ay;?:rit.r,S an(S Peo )r .-i- . t'_ __ t(N __.. 1,4 PC( Proper Cooling of PHFs - 24 Fr�y}.:�d°o[xi F?rota t,u.^ _. - ___. �_C,("'* 1 _ _ `. 5tr) LLA} f'in4ttttl C•wd,:d PHii: i�ou, i'U,`Pb• 1 .' t'1�dct Pt..robL=�st'C'Yl:.-__.__.__. _ 22.22 .. `.__ __ - , 1 r PF'Wtillin 2I{Ottf� :. - _ . . .- - rd Froin'.,):)' � .;, .. ;rr.::^a'F3c.li -- _ •,.4;"F/ ' it;@nn i H„m' air:,of ',x.�* n ss PC - 7_ p(iS f 191.14 111 ` u,t,:t^;+ P'rF.l''tio-dr i - .. i - - -- -- -- - - -..- - - - _ -.__ -' °:.,+5`}: CITY OF SALEM BOARD OF HEALTH Establishment Name:�_C�6�i L\-� A S _- Date: 10- 2'7 _ I o Page: / of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified PLEASE PRINT CLEARLY 1�SG� (,_1L J of 7—1 hvCJL�ko10 Ya 11 \:� . JC 5 Ccs.- \N N T -t - cx4- 101 2:51 ate. c S J?L�n �= \L ' 'ate I At \_n-�Z'e' I I 1�\,tL��SS �oc' � v\Z , S� ,i , x+c� � l-�tAa Ton. Gl��• �f -� 1 I - I � Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension corhply 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. �J �/ / ❑ Voluntary Disposal ❑ Other: 3-501.14(C) I PHFs Received at Temperatures Violations Related to Foodborne Illness Interventlons and Risk According to Law Cooled to Factors(?lams 1-22) (Cant.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS i 3-501.15 J Coaling Methods for PHFs J 14 ' Food or Color Additives ( 119 J PHF Not and Cold Holding J 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 3-501-16(B) 590.004(F) 41°145°F* 3-302.14 Protection from Unapproved Additives* J 15 Poisonous or Toxic Substances ! 3-501.16(A) Hot PHFs Maintained at or above 140'F. 7-)01.11 Identifying Information-Original ' 3-501.16(A) Roasts Heid at or above 1300F. * J Containers* J 7-102.11 Common Name-Working Containers* J J 20 J Time as a Public Health Control J 7-201.11 Separation-Storage* J 13-501.19 Time as a Public Health Cartrol" 1 1 7-202.11 Restriction-Presence and Use* � J 590.004(H) J Variance Requirement J J 7-202.12 Conditions of Use* J 7-203.11 Toxic Containers-Prohibitions* J REQUIREMENTS FOR HIGHLY SUSCEPTIBLE J 7-204.11 Sanitizers.Criteria-Chemicals* J POPULATIONS(HSP) J 7-204.12 I Chemicals for Washing Produce,Criteria* J 121 3-801.11(A) Unpasteurized Pte-packaged Juices and J 7-204.14 J Drying Agents.Criteria* Beverages with Warning Labels*B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Coarser,Lubricants* 7-206.11 Restricted Use Pesticides,Criteria* ' 3-801.11(D) Raw or Partially Cooked Animal Foal and f Raw Seed Sprouts Not Served. J 7-206.12 Rodent Bait Stat ons* J 7-206.13 Tracking Powders,Pest Control and 1 3-R01.11(C) Unopened Food Package Not Re-served. "` J Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for i Animal Foods That are Raw.Undercooked or PHFs I Na Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens'*e v "" Eggs-immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155°F 15 sec. * J 3401.11(B)(1)(2) Pork and Beef Roast-130°F 121 rnin* SPECIAL REQUIREMENTS f 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 I 590.009(A)-(D) Violations of Section 590.009(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 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,lhtact Beef Steaks I 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)(6) All Other PHFs- 145'F 15 see. * J J 17 J Reheating for Hot Holding J VIOLATIONS R ELATED TO GOOD RETAIL PRAC77CES i 3403.11(A)&(D) PHFs 165F 15 sec.* J (Items 23-30) 3403.11(B) I Microwave- 165°F 2 Minute Standing Critical and noncritical violations, which do not relale to the Time* foodborne illness interventions and risk factors listed above,can be 3403.11(C) Commercially Processed RTE Food- found in rhe following sections of the Food Code and 105 CMR 140'F* 590.000. 3-403.11(E) ' Remaining Unsliced Portions of Beef I Hem I Good Retail Practices FC 590.000 1 Roasts* i 23. Management and Personnel FC-2 .003 I J 18 J J Proper Cooling of PHFs 1 24. Food and Food Protection FC-3 .004 j 3-501.14?A) Cooling Cooked PHFs from 140'F to 125. Equipment and Utensils FC-4 .005 I 26. Water.Plumbinq and Waste FC-5 .006 70'F Within 2 Hours and From 70°F 1 27• I, Physical Facility FG-6D07 to 41°F/45'F Within 4 Hours. * I 12B. I Poisonous or Toxic Materials j FG-7 I .008 3-501.14(B) Cooling PRFs Made From Ambient 129. I Special Requirements 1 .009 I Temperature Ingredients to 4PF/45°F ( 130. I Other ( C Within 4 Hours* s"'"•"""'°""�"" 'Denotes critical item in the federal 1999 Food Cale or 105 CMR 590.OW. Commonwealth of Massachusetts a City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 05/26/2011 ESTABLISHMENT NAME: ROCKAFELLAS/Jay El Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0338 Jan 1, 2011 Dec 31,2011 $420.00 This permit includes the first floor ESTABLISHMENT and second floor kitchen Total Fees: $420.00 PERMIT EXPIRES December 31, 2011 Board of Health 0— 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 _ f .:'I)) IBOARD OF HEALTH Establishment Name:_V__X_'UU c f i CA -� 1 oc3�f I[[ A�7 0 Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified t� PLEASE PRINT CLEARLY Ti; I i.l-I ( ) 1 { 11/' {M )t4 1 A 1.x'1 v) I' ( '11 1; C ,C .irn I/�i(o r c ��t 4 {f n /f I°)I.i 'i f 5I1� 7 X)("1-� IS ! UDCe'IV}- {CT r!' nI� II n)c'T-�iT--Arr UA9 gid")' � ' c✓. I I I �_cYrniira.lizn I � , I 1 I I Discussion With Person in Charge: I Corrective Action Required: ❑ No I ❑ res I I have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance 13 Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twentyfive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �'�, ❑ Voluntary Disposal 0 Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk Accord-ting to Law Cooled to Factors(items 1-22) (Cant.) 41'F'45'F Within 4 Hairs. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 19 P 14 Food or Color Additives HF Hot and Cold Holding 13-202.12 ! Additives° 3-50L16(B) Cold PRFs Maintained at or below 590.004(Fl 410145'F* 3-302.14 Protection from Unapproved Additives' 15 Poisonous or Toxic Substances } 13-501.16(A) Hot PRFs Maintained at or above 7-101.11 Identifying Information-Original 14pts ` Containers* 3-501.£6tA7 Roasts Held at or above 1300F. ° } 20 Tama as a Public Health Contort 7-102.11 Common Name-Working Containers* 1 3-501.19 Time as a Public Health Control"' C 7-201.11 Separation-Storages` 7-202.11 .Restriction-Presence and Use* } } 590.004(H} Variance Requirement } 7-202.12 Conditions of Use* , 7-203.11 Toxic Containers-Prohibitions* } REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � POPULATIONS(HSP) 7-204.11 Sanitinrs.Criteria-Chemicals* 21 3-301.1)(A) Unpasteurized Pre-packaged Juices and 7-204.12 } Chemicals for Washing Produce,Criteria* I Beverages with Wanting Labels* 7-2.01.14 � Drying Agents.Criteria' 3-801.11(B) Use of Pasteurized Eggs* j ^,_x05.11 Incidental Food Contact.Lubricants* 3-801.11(0) Raw or Partially Cooked Animal Food and 7-206.21 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served * 7-206.12 Rodent Bait Stations* } f3 801.11(C) Unopened Food Package Not Re served. 7-206.13 Tracking Powders, Pest Can"and x } Monitor ng* CONSUMER ADVISORY TIMEITEMPERNTURE CONTROLS 22 3-603,11 Consumer Advisory Pasted for Consumption of i 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHles Not Otherwise Processed to Eliminate 340£.11A(1)(2) Eggs- 155'F 15 Sec. 1 Pathogens.*`"""1p,�` Eggs-Immediate Service 145'F15sec:" ` 3-302.13 Pasteurized Eggs Substitute for Raw Shell 31101.11(A)(2) Conuninuted Fish.Meats&Game Ems* Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3461.11(B)(1)(2) Pork and Beef Roast-130'F 121 mink 590.009(A}-{D) Violations of Section.590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats- 155'F IS see. * catering, mobile food,temporary and 3-401.1 l(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145T* 590.009 violations relating to goof retail 3-401.12 Raw Animal Fools Cooked in a I practices should be debited trader#29- Microwave 1657* Special Requirements. 340LI1(A)(1)(b) All Other PHFs-145'F 15 sec.* } } 17 Reheating for Hot Holding WOLA77ONS R.LATER TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 16ST 15 sec. * } (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing I Critical and non-critical violations,which do not relate to the Tile'' ` fiwdborne illness interventioac and risk factors tested above, can be 3403.11(C) Commercially Processed RTE Food - found in the following sections of the Food Code and 105 CAM 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item ; Good Retail Practices i FC 530.000 Roasts* j 23. 1 Mainattement and Personnel _ I FC-2 .003 ; 18 Proper Cooling of PHFs 1 24. i Food and Food Protection I FC-3 .004 I 1 25, 1 Equipment and utensils i FC-4 i .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 1 26, Water.Piumbino and Waste FC-S 1 .006 70`F Within 2 Hours and From 70'F 27, Physical FacilitV FC-6 .007 to 41'F(45'F Within 4 Hours. * i 28. Poisonous ar Toxic Materials FC-7 ROA I 3-501.14(8) Cooling PHR Made From Ambient 129. I Special Requirements I 009 TemperatureInrr-redientsto41'F145'F 30. i Other ! Within a Hours* "Denotes critical,trim in the federal 1 tM Fwd Cale 0'105 CMR 590.000. CITY OF SALEM 1BOARD OF HEALTH Establishment Name: iP0 Cs c f CFS U L7�Ctt r"5 Date: S��f �t? Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I �1 ;�dllk� `,•isJ�rt �"1A �f� ��C'� �{�C�tnir�r�c ,ch i'�l•tir ��r'-��ihi�nz'iYt �x � . rrt (n.1 \ tif, -f-Ilk �Ioii'AR Cil I <--, y < 4! r x i I N,-A' c X f is r Vv1 t`P�t c,�rYlj, a"rirl C Ui t L S SFc�x>nd , ooh rlo —Tr ( )O -'i-, c-c_rl 14nt c3L �`F cy1 r )�4 r:E-' I C �fYE c`tf�r � rir � �r +6 c��er ctfii�Yt . I , I Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ s Exclusion violations before the next inspection, to observe all conditions as described, and to 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 twenty-five dollars or suspension/revocation of Ll Embargo Ll Emergency Closure your food permit. —!/ y�� ❑ Voluntary Disposal ❑ Other: i ' — 3-50I,I4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness fnterrenflons and Risk According to Law Cooled to Factors{Pleura 1-22} (canL) 4I'F/45°F Within 4 Hours.* � PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods far PHFs ( 19 PHF Hot and Cold Holding 14 Poop or Calor Additives ! 3-501,161B) Cold PHFs,Maintained at nr below 3-202.12 Afor Add 590.00d(F) 41'145°F* 3-302.14 Protection from Unapproved Additives" g9 13-501.l6(A) Hot PHFs Maintained at or above Poisonous or Toxic Substances I40°F. * 7-101.11 Identifying Information-Original y 3-50I.16(A) Roasts Heid at or above 130'F. Containers" ( 20 Time as a Public Health Control ( 7-302.11 � Gammon Name-Working Containers* � § 7-101.11 Separation-Storage" ( 3-501.19 Time as a Public Health Control* 7-202.12 .Restriction-Presence and Use* 590.004(11) Variance Requitement j 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'toxic Containers-Prohibitions* POPULATIONS(HSP) ( 7-204.11 ( Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals frrc Washing Produce,Criteria° 21 3-801.17(A} BUnpasteurized verages w t Pre-packaged Juices and I ( .$evzrnges with W"siting labels* ( 7-204.14 Drying Agents.Criteria* Use of Pasteurized Eggs* { ( 7-205,11 Incidental Food Contact,Lubricants* ( 7-206.1 L Restricted Use Pesticides,Critetisa 3-801.11(D) Raw or Partially Gaoled Animal Food and ( Raw Seed Sprouts Not Served* 7-206.12 Rodent Bair Stations* 7-206.13 Tracking Powders,Pest Control and ( 3-$t}l.i 1(C) Unocened Food Package Not Rn-served. Monitoring* CONSUMER ADVISORY TIMEIfEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 16 ' Proper Coaling Temperatures for € Animal Foods That are Raw.Undercooked or PHFs 1 Not Otherwise Processed to Eliminate Pathottens.*r=r,«nve'n:aoar 3401.IIA(1)(2) Eggs- 155°F 15 Sec. Eggs-immediate Service 145'Fl5sec^ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'F 15 sec. * SPECIAL REQUIREMENTS ( 3.401.11(B)(I)(2) Pard:and Beef Roast- 130'F 121 nun* ( 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec * catering, mobile food,temporary and 3-401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish.Meat, debited under the appropriate sections Poultry or Ratites-I65'F 15 sec * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 4-401.12 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- 1, 15 sec. 1 17 Reheating for Hot Holding ( VIOLATIONS R:LATED TO GOOD RETAIL PRAC77CES 3403A I(A)&(D) PHFs 165"F 15 sec. * ( (Item 23-30) 3-403.11(B) Microwave- 165-F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventfnns and risk-factors fisted above, can be 13-403.11(C) Commercially Processed RTE Food- found in the following scrtions of the Food Code and 105 CMR 140°F* 590.000. ( 34011 I(E) Remaining Unsliced Portions of Beef j item Goad Retail Practices FC ( 5?A.000 1, ( Roasts* j 23. Manaoament and Personnel 1 FC-2 .603 i ( 18 Proper Cooling of PHFs 1 24 Food and Food Protection 1 FC-3 .004 ! 1 25. ! Equipment and Utensils FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140'F to ,, ! Water.Plumbing and Waste __ ; FC-5006 _ ~ 70'F Within 2 Hours and From 70`F 27. Physical Facility FC--6 ! .W7 l to 41'F/45'F Within 4 Hours.* 1 28. ' Poisonous or Tocc Materials FC-7 ( .008 ! 3-501.14(B) Cooling PHFs Made From Ambient i 29. I Special Requirements � � .009 1 Temperature Ingredients to 41*F/45'F 30' I Gib 1 Within 4 Hours* """''""'s'�` "Di Qts critical i4m in the f-deral 1999 Food Cale or,105 CMR 390.000. IMP—ORRTANT MESSAGE FOR DATF �/ a7 �� TIME M (L-e L ))A(� OF C)c K/Z, I EC , PHONE '� -7,2--7 AH A CODE NUMBER EXTENSION U FAX U MOBII F AREA CODE NUMBER TIME TO CALL ITELEPHONED ix PLEASE CALL ' CAME TO SEE YOU ' I WILL CALL AGAIN v `( WANTS TO SEE YOU ' RUSH RETURNED YOURS�CALL' WILL FAX TO YOU MESSAGE // � Pi+.�d Z) /LP D Ot�CN, SIGNED ( IJ� �" v VERSAL. 413005 MADE IN U.S.A. NOTES _ _ _ C impaRTAIU4 mr:ssAGE ) FOR . A.M. DATE TIME/P.M. M Vvati PHONF AREA CODE NUMBER EXTENSION ❑ FAX CI MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED V /PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU ' "AES�APF n �12 C ' SIGNED OPUVERSAL,. 48005 MADE IN U.S A NOTES Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/24/2011 ESTABLISHMENT NAME: ROCKAFELLAS/Jay EI Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0338 Jan 1, 2011 Dec 31,2011 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 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 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 i CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEALTH 120 WASHINGTON STREET,4"`FLOOR TEL. (978) 741-1800 KIAIBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DGRI?ENBAUMOSALEM.CONI DAeID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ROC It6 �-1—C //';-5 TEL# g 7�- -7 Z Y f I ADDRESS OF ESTABLISHMENT 03 I d SJ C X R, FAX# TY 7Y� 2-Y7 MAILING ADDRESS(if different) n G [ / EMAIL-Business': P o C k o no C k q-6 I I Gsd7 J 41 MWebslte: /<n dzk q1 - l 1910--P-r e �e OWNER'S NAME�r rt n rt If M( v--//c l(" k o TEL# ADDRESS �_� YZe 100 I Gl J � � I J� kx �r/j /t('4- C)I G STREET `/— �i nCITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) l C%rr4 �� 0` lV In ce-C(tl l e O CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 12613 �l U 1 k HOME TEL# s XSQFQRE TION ; MondayM'� T_uesCay a 1. l@driesday I� Tfiyrsda'y= _., iiday i3Saluid Sw-RK-�Sil dia , I HOURS OF OPERATION Please write in time of day. f—/� _ (ForexamWellam-llpm) i /WN r i 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 YE NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$4 ------------------------------------------------------------------•----------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME.... -------------------------------------*---------------------------------------------------------- MAKE - MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted 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 retnd paid all state tyres requir under the laYat! / Oy r ature / 1 Social Securityor Federal Identification Number Revised iona 1 FOODAP201 Ladm Check#&Dare CITY OF SALEM BOARD OF HEALTH Establishment Name: Qo C_1C n h L\ ra.S Date:- 1 -2-'A - 11 Page: 1 of / 1 Item Code C-Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I I IN ,ad_ ZleJY . I I ! I I I ! I I I • I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-.five/dollars)or suspension/revocation of C3 Embargo ❑ Emergency Closure your food permit. r ❑ Voluntary Disposal ❑ Other: 3-501.t4(C) PRFs Received at Temperatures Violations Related to Foodborne Illness.Interventions and Risk According to Law Cooled to Factors(!tams 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 114 Food or Color Additives I 119 PHF Hot and Cold Holding ' 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives*' 590.004(F) 410/45'F* 3-302.14 Protection from Unapproved Addiuves* 115 Poisonous or Toxic Substances I 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original ( 140 T. F.3-501.)6(A) RoostsHeld at or above 130°F. Containers* 17-102.11 Common Name-Working Containers* I 11A Time as a Public Health Control 7-201.11 - Separation-Storage'• ( 3-501.19 Time as a Public Health Control* 17-202.11 Restriction-Presence and Use* I590.004(H) Variance Requirement 17-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 17-204.11 Sanitizers.Criteria-Chemicals* 17-204.12 Chemicals for Washing Produce,Criteria* I ! 21 3-801.11(A) ` Unpasteurized Pre-packaged Juices and 4 7-204.14 Drying Agents.Criteria* 1 f 1 Beverages with Warning Labels* 17-205.11 Incidental Food Contact,Lubricants* I 3-801.11(B) Use of Pasteurized Eger* 17-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) I Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 1 7-206.12 Rodent Bait Stations* I 3-801.11(C) Unopened Food Package Not Re-served. * I 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME(TEMPER'kTURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*e�PV6 lf,X00' Egos-Immediate Service 1450F15.ce:.+ I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 1 3-401.11(B)(I) Pork and Beef Roast- 130'F 121 min* I 590.009(A)-(D) Violations of Section 590.009(A)-(T))in 3 401.11(A)(2) Ratites,Injected Meats-155°F 15 sec * + catering, mobile foci,temporary and 3-401A 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 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* ( 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Not Holding I VIOLA77ONS R ELATED TO GOOD RETAIL PRACTICES i 3403.11(A)&(D) PHFs 165°F 15 sec. * +I (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing 1 Critical and non-critical violations,which do not relate to the Time* f foodborne illness ituerventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR J 1400F* 590.(00. 3-403.110 Remaining Unsliccd Portions of Beef I nem I Good Retail Practices I .FC 590.000 Roasts* 123. 1 Managentent and Personnel I FC-2 .003 .I 1 18 Proper Cooling of PHFs j 24. 1 Food and Food Protection FC-3 .004 j 125. Equipment and Utensils I FC-4 .005 i 3-501.14{A) Cooling Cooked PHFs from 140°F to 126. Wates Plumbing and Waste FC-5 .006 70*F Within 2 Hours and From 70°F 1 27, PhvsicN Facility FC-6D07 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 ( .008 3-501.14(B) Cooling PHFs Made From Ambient 1 29. Special Rea&ement5 l ,009 I Temperature Ingredients to 41'F/45'F 1 30 1 Other 1 j Within 4 Hours* s"'0tin"haLi""" ' Denotes critical item in the federal 1999 Foal Code or 105 CMR 590.000. Luncheons at Rockafellas Brunch Buffet Rockafellas �_ �A Exclusively for Tours and Minimum of 20 people ROCK"EIAS • Corporate Functions $18/per person or Functions A Change ofAtmosphhere in Ciisua-Dining All Lunch Entrees are served with Salad, §,-. 1 Fresh Chilled Juices :, T e Starch, Vegetable &Dessert, Unlimited Coffee 1 +; ff Assorted Muffins & Bagels Reserve today for any occasion. 14,. 1- Scrambled and Soft Drinks. - . � . t. Scrambled Eggs We have an area of our restaurant x : 4i. , 6.25% Meal Tax applies, and an we use for that special event front %18 Gratuity will be added to vour check. Sausage Links Maple-Cured Bacon y Parties Bai/Bat Mitzvahs, Communions, �" $19.00 Per Person Birthday Retirement Parties " ` f Red Bliss Potatoes > > .i + � °- - ✓ „`' Choices Fresh Fruit Rehearsal Dinners, , Marinated Sirloin Tips Yo urt Bachelor/Bachelorette Parties, U.S. Choice Sirloin Tips' marinated g We Anniversaries, Small Weddings, Granola in our own special sauce Quiche or any Special Day. ! Baked Haddock Let us do the cookin or you. •- ' l Garden Salad gf y Function /Menu Six ounce Haddock Baked with butter and Enjoy our delicious arrangements i :e& vu crumbs Assorted Fin Finger Sandwiches: ' `°�'`° g of fresh meats and fish So much srtiore than dust a restaurant Grilled Chicken Teriyaki (Choice of Two) k, .m °. at the restaurant or take them home i. " Marinated boneless breast, Teriyaki Glaze, Fresh All-White Tuna ^Y ' ¢ M' Chopped Scallions for that special day. a�iaa w Chicken Salad As always, Rockafellas will make , Starch Crab Salad y' Rice Pilaf or Garlic Mashed Potatoes it an event you will never forget. Salad Turkey & Cheese11,flv_s. House Salad Coffee, Tea, Soda r *Omelette Station IRA,, Dessert - Seasonal $3 additional per person h 't i "! Bereavement Buffet Luncheon ROCKAFELLAS Please accept sincere condolences from the members of the Rockafellas Family. During this difficult A Change of Atmosphere in Casual Dining , J 4" ' time we would like to offer our facility for you,your family and your special friends at a specially 1 }� reduced price, $15/per person. 231 Essex Street ? } �sex SreAt' (The Daniel• w uil Tossed Salad (The Daniel Low Building) �� lk g' Choice of entrees: Salem, Massachusetts 01970 !Sal'eiii; Massachusetts Chicken Marsala • Baked Haddock • Steak Tis • Chicken with Broccoli & Ziti E-mail:0 @roc afellasofsalem. om P e-mail: rock@rockafellasofsalem.com ,, ""j, IH N 11 Seasonal Fresh Vegetable Mashed Potato or Rice Tel. 978-745-2411 8 Coffee, Tea, Decaffeinated Coffee and Soda Fax 978-745-2471 Assorted miniature pastries available for dessert $3/per person www.rockafellasofsalem.com &° a e a o s A etizers 114' Entrees Rockafellas / PP ah �\ All Entrees are served with our House or Caesar Salad and choice of starch Choice of 4 Items f (Garlic Mashed Potato or Rice Pilaf) and Vegetable Medley. Function Menu $16.00 Per Person �� D Choice of 2 Entrees Brus231 Essex Street Chicken etta Qrn 0� O i` Ott $28.00 Per Person (Daniel Low Building) Chicken Teriyaki \`� k U C Rustic Rosemary Garlic Chicken Salem MA �197� Mini Pizza \� gb `q Grilled and marinated rosemary chicken served with a mushroom demi glace. Artichoke Spinach Puff U l � Pasta Primavera 978-745-2411 Stuffed Mushrooms D C' Penne Pasta and fresh veggies, tossed with Olive Oil and Garlic. wwwrockafellas.com Chicken Fingers � � }(a� Baked Haddock 6 5.` �✓ Fresh Haddock with Ritz Crackers, lemon,garlic, red peppers, scallions and drizzled with butter. Beef Teriyaki G All prices include entertainment when y �`� ;r✓ 1C ,�'\ % Marinated Sirloin Tips Mini Crab Cakes n available, linens (table cloths and �Y� �k x¢ p U.S. Choice Sirloin Tips, marinated in our own special sauce. napkins), china,glassware, Scallops & Bacon w� `1) �'� J/ Roasted Kabobs G ed Shrim Skewers +_ �0 Your choice o Chicken Bee ; Sea Seafood or Vegetarian. silverware, candles, host, service p ,d ti f t f g and barstaff, soda and coffee. Cheese Board ` Chicken Broccoli co Ziti Alfredo � © �� Sauteed Chicken and Fresh Broccoli with Fettuccine Alfredo. � $3.00 Per Person U d Ch t ISeasonal Ravioli Menu rices do not include An Array of mporeeese, prices 6.25% meals tax or 18%gratuity Crackers and Fruit \f\ An eclectic selection ofgourmet ravioli accompanied with a chef made sauce to compliment the dish. �� Honey Glazed Salmon Tri-Color Nachos Fresh wild salmon marinated with boney,ginger, soy, cilantro accompanied by sprouts. Bar Options: Per Person $2.00 Per Person Bourbon Turkey Tips Champagne or Wine Toast $3.00 Per Person Side Salsa Grilled and marinated in a bourbon sauce. No knife required with this dish. (See Coordinator for more options) Bread & Pesto Baked Stuffed Shrimp Lunch • Dinner $3.00 Per Person Jumbo Shrimp Stuffed with Seafood Staffing. An Array of Bread with Fresh Pesto Black Angus Prime Rib Live Entertainment Aged, slow cooked,juicy Black Angus served with au jus. (Wednesday through Sunday) for Dipping Chicken Marsala Crab & Artichoke Dip Served with Penne Pasta. Reservations Recommended $4.00 Per Person Chicken Penne Parties of 4 or more Displayed with various Bread Chips, Crackers Seasoned sauteed chicken breast with sun dried tomatoes, scallions, Parties of 40 or more may be Veggies & Crudite Display and Kalamata olives in a creamed chicken demi glace. subject to room charge. $3.00 Per Person Chicken Parmigiana Broccoli, Carrots, Celery, Peppers, Asparagus Baked Macaroni & Cheese Hours of Operation Monday, Tuesday: 11:30 am to 11:30 pm Shrimp Cocktail Desserts $2.00 Per Shrimp $3.50 Per Person Wednesday-Friday: 11:30 am - 1:00 am Cocktail Shrimp and Housemade We have a variety of desserts both made in house and imported from local bakeries. Saturday: 11:00 am - 1:00 am Cocktail Sauce If Sunday: 11:00 am - 11:00 pm you choose to bring your own cake please add a $2.00 per person plating charge. 0) A Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4`" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name,( 0 A �j � 4 Date I Tyoe of Ooeration(s) Type of Inspection i 1 r n U �0tJ A. O✓1V i � ) i SC/YP Food Service ETRoutine Address 7 /}�` � Risk - Retail ❑\Re-inspection PP_ Level ❑ Residential Kitchen Previous Inspection Telephone' , ❑ Mobile Date: tSc-�l�}_�-� 4 I I Owner-r-�'� l n HACCP Y/N ❑ Temporary ❑ Pre-operation inn A /,�. , � 1A'l 111 AI_ PA _ .M 71 ( ❑ Caterer ❑ Suspect Illness Person in-Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector )/ I An lD In: El�o I Permit No./� �y ❑Other CP I i,��n, v� �_ I Out I ), rC Each violation checked requires anlexplanation 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 J 590.009 Violations marked may pose an imminent health hazard and require immediate corrective (E) ❑ 590.009(F)E] action as determined by the Board of Health. 'FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ( 1. PIC Assigned/Knowledgeable/Duties . ._.. ....... . ..... .. ,. ., ,_..,... . , ❑ 13. Handwash Facilities EMPLOYEE HEALTH _ PROTECTION FROM CHEMICALS' _ ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ' ❑ 4. Food and Water from Approved Source TWErrEMPERATURE CONTROLS(Potentially 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 FROM CONTAMINATION "-"' `r "'` ' ' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control �I 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATiONS_(HSP)'- giLJ` El21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below _EJ N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 4) 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)(19o,00a) 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: $5Winsp dFoT1 14Eoc U I Inspector's Signature: Print: � e l✓ (_ � nature: g 7 g PIC's Si // //"' Print:yam- // l Pa a of�ges -�<i �..,�. 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination I 590.003(A) Assignment of Responsibility" 3-302.11(.4.(1) Raw Animal Foals Separated from 590.003(B) Demonstration of Knowledge* Calked and RTE Foals* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-30111(A)(21) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(CG Responsibility of the person in charge to Contamination from,the Environment require reporting by food employees and 3-302.1 1(A) Food Protection,. applicants* 3-302 15 1Vashing FrnitS IL^,d Vegetables I l 59ir.003iF) Responsibility Of.1 Food E:upleyee Cir Orr 3-304.11 Food Contact with F:gntpment 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 I ( Returned Fail and Resen:ice of Foal* 3 590.003(D) Exclusions andRcr,irictions* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions I ( Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE )-3)o!* J 4 Focd and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12Food in a Hentehr:al} Scaled Coniamer" Sanifization"Temperatures" 3-201.13 ( Fluid Milk and Milk Products* ! 4-501.1 l? Mechanical Warewashing-Hot Water 3-203.13 Shell Eggs' Sanitization Temperatures* � � 3-202.l4 Eggs and Milk Products.Pasteurized" ( 14-501.114 I Chemical.Sanitiz pion-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water' j concentration and hardness. 5-101.11 ( Drinking Water front an Approved System* 4-60L11(A) I Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 4-603.11 Cleaning Frequency of Equipment Food- .590.006(B) Water Meets Standards in 310 CMR 22.0" Shellfish and Fish From an Approved Sourre Contact Surfaces and Utensils i 4 702.'.1 Frequenev of Sanitization of Utensils and 3-201.14 Fish and Recrea[ional]y Caught Molluscan i Foal Contact So,faces of Equipment* Shellfish` ( 4-703.11 ( Methods of Sanitization --Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed Sources* Chemical* t0 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authordy 2.301.11 Clean Condition-Randa and Arms* 3-202.15 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004;C) Wild Mushrooms" ( 2-301.14 When to Wash* 3-207.17, Game Animals* I1 ( Good Hygienic Practices g Receiving/Condition 2-401.11 Eating.Drinking or Using Tobacco* 3-202.31 ( PHFs Received at Proper Temperatures* 12-401.12 Discharges From the Eyes, Nose and 3-202 15 Package Integrity* IDlouth^ 3-101.11 Food Safe and Unadulterated* ' 3-30L 12 Preventing Contamination When Tasting"_ 6 Tags/Records:Shellstock ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification" 590M(M(E) Preveutmg Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products ( 13 Handwash Facilities 3-402.11Yarasi[cDestn;ction" Conveniently Located andAccessible 5-203.11 Numbers 3-402.12 Records,Creation and Retention* ( and Capacities* _ 590.0040) labeling of Ingredients` ( 5-204.11 Loccationationand Placement* 7 Conformance with Approved Procedures � 5-205.11 Accessibility,Operation and Maintenance � IHACCP PlansI Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methn&* Devices - -_ - 3-502.12 Reduced oxygen packaging.criteria" o-101.1 f Handwashing Cleanser,Availability 5-103.12 Conformance with Approved Procedures* 6-301.12 ( Hand Diving Provision Denoies erinud nein in the federal 1094 Foix!Code rn 105 C;\4R 500.000, r CITY OF SALEM ' I nn BOARD OF HEALTH ; Establishment NameQ ( _. _ b� JPV Jl,//�� ' — Date: Page: of Item Code. C-Criticarltem „ U DESCRIPTIONOF,VIOLATION/PLAN OF CORRECTION t� -;i' ,.,r Date No. Reference R-Red item - Veri i "PLEASE PRINT CLEARLY 0n41 I / � � ... 1 . "p J _ a-Pn�f ten 0I[._ r'4 ?iln )_kCrA)OAA A ) yYy..�} — 11�C PAA R1 _ — ( JXID_'PY7 P ,`LJ� AAS 00 -PPAI I I rF)o� qP��r /)it, ,)n_ - � D_n_ o� �7_, �/�o_ /yam U��a .� r n -,Q - /-�nn ,nn0� 1 �V !1-r5oAR � C (n i,e �+� 0t7 na�m .� ilv—( fit {� aneu� Qtn�l'�.lnn � If - - - I S no �0,1) v0n 11 . Pp nrnn ,L�� -- I L� _70a 1 DO (_l �,, /r �o2rl1 ��('� 1ni� ��- C�-AAA070aoF (An 00_Phe) I ^7 C 4-7) Y'� � r .A ` � /1_,� of n r ki 7) �0/✓�c1�1 Q 0 It ni\ctt/n,,�" l A_ilDn P �_�Ia 11 i1 vi_�dAX li(1L� X� ��U L�C.nen_�-t�fA a o i S �O / /�'o,ii n niX oiX `t-CnU _/tn a -A _ Discussion With Person in Charge: C rr ctive Action Required: I L) No les . F I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion r P Ll Re-inspection Scfieduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �r-w n n r.P n�� -��t 0 Voluntary Disposal ElOther: ar Plll-,! Rel:'ived%q VloilaboneRvialawl to Foodborne 111nose Interventions and Rlsk i !"cording ic,Law Clllkzd Ili ;Cont) wifh. n I Hows, PROTECTION FROM CHEMICALS R'fr 19 PHF Hot and Cold Holding 14 Food or Colo, AdditifiliS 12 Adov�k�:� 3 '�0! MOB) ("xil'i PFTF,Nuilit.waxi at,r h�,{cw 3-31)114 plt�tectmlj fitors I mapprw��.d Ajdl%w., i9ll!X�, 41-14,"�' F' Poisonous or loilic^'utir4ences yninry 11"I I 19, 11 7401.1 i Myno 3.nq I A h(Al I Ed t or it,,%e 611,F, cwwwwri, lime 4s a Vubiic Health Control 7 lVal C olins,+n 'Niaw - W sting Wwanism, 40 1 3 :01 4 lrtlbjk l feakl!Control, -20i.11 at L"n-'Aoiaj�& TM 11 justknon -pn'stpw Uil:� `faitfleasmu�nr 7-2f)2.12 Coudjvcal,of kjsC` RPOZAREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(t4SP) 7_204.I I SannizeL"",rI1cH;, -0icinic'ie' Chonicals fol kil*whire P!odll,c cwwlkl� 21 1001 1 YOM I Unpa wrcunml Fla InNazed Junw.wo I 1.czffa2" xn!, IlfarningiAwls 7 '_0-}.13 Of criteria, 7 205A i im-nifwai Fwki cvntic7 i ohri,:apis 3510 1 110 1 or Mix 11, Oolad AmmW KNO and '-2116.11 R,,Irictod Uw fKa"Ies CHOW M, II 12 Sj'nilln"* _i�*; k�niic N,�t v,penc,I F'ixld Pa. 57M 11 MAN C"ntP'l 411it to CONSUMER AVISORY 22 of TIMErrEMPERATURE CONTROLS 16 Proper hi.- fila ;�n: R"w, Un leccul,ked cl Elilllimtt.N K Ulu!IQ Q. Eggy 1550 15 YK F"simri S;,hsnlbi�. tol Psw!Ohell MAUAQ ComwOulud Fbh, Mmw Ev", t,inn, Ardlxtk- t SyF 19<eC. 340L I U01 112) M4in16 FiM R141st i^i)`F 121 nun, SPECIAL REQUIREMENTS 340i l(AW! TwA, Moon! Ms 1�,�TIJ, Vokown;J Sc0cm 590.019IMM in t;,i• j Catcrir,e. inollik n%xi, tempt,raq and a a"IUAP I PmNr) VwHd Mae.SMY PHfk, j icsidenOiM lJiviien oj,matiou�-h(Add he Mul WmAhm;Kh,Nimi, dahllcl urAc( file d{3513' Tlati' Ili 1o.57F 15 wi- abow UP I. vi Whmnr Mw, 3-.SMA WCKA 'Mwj,ntns�,Iv,, l'u'tes 13ocf S!r:lksiro,.trvention; mmi rts% fj�-fors Oiber 1451, 9W)09 vikilflln)w; relatinS ill mall 34AAL RIar AnI.Inti 11,a pwvcc:x he debited under #29 - Mictowme Ws MI MAKIVIn AH (Aho PIK wr ;5 se. Reheating for Hot Holding MAE=RELATE;M GOOD RIETAX PRACTICES 3-0 it I I(A)(D) 14M ISVP 15 cl. ` i Otems 2300) Simi It M) Monmaye, Ivy? 2 Wane Standing mo:al ltlech qlown I ei-jrc I,,f;w IWO, ...id rjt.l'bl,n),', ( itt ,In W) COMMM611V 91F.bW- f"Isnii in ph'. .lop;of ate iv,)"d Codcand 10CAIP 1401 _91M I,- 1 if I: Ronojlis�, (,$Owid Parton,or lwcf ft-rin-1 J-C-wd_R�c'na IF Pf Go&cc S ! FO 50,00 td pemtr -TF6 7� -=_ - RM" L a.-. rx1_ Proper Cooling of PRFs i 24 1 Fc,)d ard5,x-w i=C -3 004 25 LE cii% 4 (105 MINA) (AxilhIg CoWd PHIlk Doin I 'G --.1- -__i wMal,olt,Innlq.IrIqWastl- FC-5 OW 70F MThrn 2 11mirs and From 771' 1 10 Powni F.Tiv F 0-G i 007 to 4 17115,F W:trin i -P060,P"r Ir Ma�c�nal� F(: 7 w8 4 __ U�renn ! 31M.14(0) Coo!ing Ill IF4 Made AuMut ----- -lni�, Opn 11a2fermlirt Ingred4w N,4 M QF j Oil. 05M... ie, cn ta,l IleHi 115 LN w A i 4't9 A uY 0 6 ,r 185 1 AIR 29p rif ,L•.�..yv 77'"x-v�'fr+.r,.+-s,.+..ra�4S*,'{.-...o.,}.+'divgoNr:�'�'',i1 .P7.�' ]rr*:;,skt'..isii iJ�',. `�..: "�A lAal�wMR'i,�t �vnif$'° '(w' • � . _ . M1•� Fk EM}}'.`:: .NR. 1.+fbkw .6#.^�' 3d^"1 '^"�d'AFS 'Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name nn /1 n (� Date Tyroe of Ooerationfal. Type of Insoection ri(. . YV jo LAX �M� Y vz e V C - S�1� 2k Food Service Routine Address _"'A ql�� ( { y� J v Risk 1 ❑ Retail Re-inspection C - J 1A o CX Level ❑ Residential Kitchen Previous Inspection TelephoneElMobile Date: Owner-�-- l/�1 �1 n HACCP YM [I Temporary El Pre-operation 1 : /AAS )M()_U ° V 11(.t/I CjJ V) n I ❑ Caterer ❑Suspect Illness Person in Charge(PIC)/ Time ❑ Bed&Breakfast ❑General Complaint � 1 l UAA V/) In: F-1❑ HACCP Inspector V_).l jai P� � ��01, Out�3;��V, ' Permit No. ❑ Other Each violation checked requires an e.zplanation on the narrative page(s)and a citation of specific provision(s)violated. Noncompliance 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(FeD action as determined by the Board of Health. .,.w.,, FOOD PROTECTION MANAGEMENT""""': --� , .,, ,.,.._. ,_.__. .. . .' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties X13. Handwash Facilities �EMPLOYEE HEALTH -,-•`-�•"-�"` " ` PROTECTION FROM CHEMICALS• •" "' ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE:'"; .1"" -1;.; '„•„'„. 1._1 . �.:_.. E] 4. Food and Water from Approved Source ;TIMEJTEMPERATURE CONTROLS(Potentially Hazardous Funds)" ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures vj"' t❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION " ,"'""` �"' ' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control X[7 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP);,; li, ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing 11. Good Hygienic Practices CONSUMER ADVISORY ,.22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions I immediately or withi6,110 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 O� 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: S ssainspecrFamre iadoc Inspector's Signature: ( i ature: Print: PIC's Signature:i5XZ&_,9 F \&IA4.a:P �1 Prmt.'&Q U(P :l)Gr 44 nom/ 1 I Page-L of Pa es t. Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I's Cross-contamination 1 590.003(A) Assignment ot'Responsibility* 3-302.1 t(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTE Fools* 12-103.11 ( Person in charge-duties I I Contamination from Raw ingredients 3-302 11(A)(2) Raw Animal Fools Separated from Each EMPLOYEE HEALTH I Other' 2 590.003(C) Responsibility of the person in charge to j I Contamination from the Environment require reporting by fool employees and j 3-302.1 ItA) Food Protection" applicants* j 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 Applicam(To Report To The Person In IJtcnsds* Charge' j I Contamination from the Consumer 590 003(6) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Resenieu of Fold' I3 590.003(D) Exclusions and Restrictions* i I I Disposition of Adulterated or Contaminated 590.003iF) 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 19 ( Food Contact Surfaces 590.004(A-B) Compliance with Food Law" j 14 50t.1 1 1 Manual Warewashing- Hot Water 3-201.12 Fool in a Hermetically Scaled Container* I Sanitization Temperaiures* I 4.501.112 Mechanical WarewashinR Hot Water?-:01.13 Fluid Milk and Milk Products* r+ I j 3-202.13 ( Shell Eggs* I Sanitization Temperatures' 13-202.14 I Eggs and Milk Products.Pasteurized* 4-501.114 ( Chemical Sanidi loon-temp-,pH. 3-202.16 ( Ice Made From Potable Drinking Water" Equiconcpment and hardness 5-101 11 Drinking Water from an Approved System" 4-ti01.1 I(A) Equipment Fool Contact Surfaces and Utensils Clean" 1590.006(A) Bottled Drinking Water* 4-602.1! Cleaning Frequency of Equipment Foul- 1590.006(B) Water Meets Standards in.310 CMR 22.0"` Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I i 4-702.11 Frequency of Sanitization of Utensils and '3-201.14 Fish and Recreationally Caught Molhnscan Food Contact Surfaces of Equipment* Shellfish- 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I I Chemical" Sources* Game and Wild Mushrooms Approvad by 110 I Proper,Adequate Handwashing Regulatory Authority 12-301.11 Clean Condition-Hands and Arms- 3-202.18 Shellstock Identification Prescat" I 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 Game Animals* ( 111 I Good Hygienic Practices 5 Receiving/Condition I 12-401.1 1 Eating,Drinking or Using Tobacco* 3-202.1 l PHFs Received at Proper Temperatures* j 2401.12 Discharges From the Eyes, Nose and Mouth 3-1(11.11 Frail Safee andand Unadulterated 3-202.15 Package Integrity, I 3-301.12 Preventing,Contamination When Tasting* * I 6 TagstRecords:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(L^) Preventing Contamination from 13-203.12 Shellstock Identification Maintained" Employers* 13 Tags/Records:Fish Products I ( Handwash Facilities Conveniently Located and Accessible j 3-40211 Parasite Destruction' 3-402.12 Records,Creation and Retention* i 5-203.11 ( Numbers and Capacities* 590.004(1) I Labeling of Ingredients* I 15-204.11 I Location and Placement* 7 I Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3=502.17 Specialized Processing Methods* Devices 3-102.12 Reduced oxygen packaging,criteria' I 16-30111 Hand 6-301.12 Hand Dry ng Drying Provision Cleanser,AvailabilityI 18-103.12 ( Conformance with Approved Procedures* I Denies critical nem in the federal 1949 Foal Cade or 105 CMR 590,000, 'I CITY-OF SALEM ! y� BOARD OF HEALTH Establishment Name:Jkor 'A(-.-4-0_D_0' �ta 'Q 'nnTn }Ps�Date: Jr- �k-�T� Page: of a Item Code C-Crltical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. ` Reference R-Red ., Verified ` PLEASE PRINT CLEARLY{-- � IL�,1tA . k t Mi117 / .mo � 1 —1 o/�nn ,-,v„, �:y. (_�1L�x-F-a,�nnn P��lAP_i�dYl � �- M f1 q �vUe bno�D�l o, i Ii=Y��2 �J/�'IJ (Ivy' I 1 ��// �t� 4F)� 1 OK--5; QUt•,��A u ) 3` I j C)k-/_ 1�M oil I I 1 ov-_0 r , } I lq9, — �,��t, 1a--- '`-I_/�7 �appR�e�v. (�5�te1((�� n ~ '917(�"�'�;(y+�� t 1 l9 jo - A.1 �l,G'11 ,1�;i fA,. iV AA AX v 0 r&")� �A on,v_ V i11_ J}y- Il 7W �y( + I p S I �IL _ -L�l -> �WIY,�`�1M,� � - Y��tt�P,/' �,1 �::(1.,.4.t:.,_P ��l_{� r �/n J-_ti .�n 0. i -/ ��re,u l,.� .,��I iir, 1 / v A�- X10— l v\” 'IIi mt.?A /160-k'v 1•(,7o �/�rY1. )Q '�11 _ YiAn� I !.��\s-civ✓' fh 1 .1 �� (�,_,A, A( A),ja c'��-\ ice/wp,., ( XA P('I) 1A, If if 0A'O l l\f< I1 1 lVV17�n'�6' J@ NP.•Lt. (AA'h" ) //11�� 1 /V`J}fes 4 7l./'Q�1`F�.1 V•� ( Y.VA nn:#t yJ v�l�ir'k A1��/ _ _\� _ _ _F, ' 1 nFa 1 /-A Id IJP K(4/& rQz �t :7 ;,--. 1 1 !� �' �Y� - �/i.M.tA, "-e 1 �/r,� �no� Am \CL- __ (.f.ln A,�o.,� � Y\O.P� I�.YR_1A-17 7 r!C ssion With Person in Charge: Corrective Action Required:�o I)S]/Yes ave read this report, have had the opportunity to ask questions and agree to correct all L❑� Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars o suspension/revocation of L3 Embargo ❑ Emergency Closure your food permit. y/��— // C\ �!L��/,1.� <• A .�%�� ❑ Voluntary Disposal ❑ Other: 5r.?,1-ltil PIP t Re.:,ejv�d et Femoe"ifureq Warations Related to Foaditcane Illness Intervention.;and Risk Aocitrditig to I zl+ Cx,lud to Factors(hems 1,22f I'CoPQ itom J fbac"". '. I PROTECTION FROM CHEMICALS for FRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding '-Of(!PHIls Maintained at or k,eietk 4.903.;2 1 3-3{t_'.14 Paiwwuorr fmin Unapproved Ndditives" Poisonous or Toxic Substancesi.16f 10 if�' lif-IF,M"�iI'lorld at or abow WIA7 Hmid at vi :.bote i 3WI-, Cortaiow" 20 Tarts as a luNto Health Control 7"1{72.1! (�,wnvtn NAme-- Workim,4,olltamlrsl i i 3 '5(k f-, is't Pobfil'il'�affh Contrul 7 20 1.j I S11 N�Ige* 1 -'-2o2-I t It qrctmll-Prtis'c ncc Wkl U Reqnir.:111cra 7-2()2.12 ("OndiiRle,(if Tiso%it REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 103� [I Tltxi, Conlamen -Probibi:wn,l: POPULATIONS( POR 7-20,L 11 Ou,mk:,W I i 21 1,:�(A'f L J9wCq and -1-304.!" for\VuAn'�'t 1*10,11wc,Clits-6a! 7 ?()4,14 Dr)vng Nvevtt.(:riteria- ixcd j-.�gn" fairdi-mA F.it)d ontuct,ilibi ieanW f 1(w, l�a'A i'r Rlwatk clol"dAtrwal Fkt,id'oul T"06.12 Rfitlow B.,o Statiwrv' i tolj PCI t )-206 i3 hocking Polld,r•;,I"!'NE Cotard.tad Moiirtofingl CONSUMER ADVISORY --T------ i (:owwwr AO,isory Nkl,!d :.,r TIKIEFfEMPERATURE CONTROLS I t,A' DIX t'L Ri", CrfdrLlAtk' I t,: )6 Proper Cooking Temperatures for i Okhet'�PHFs m -int' lit Flirilwail 3 401 1 lAi 1)(., Eilf"t, 155 F 13 Scc. i i iti, 145 - sob,itiwle fts Raw SlIC!, Wut,;&.- L Altilwtri t,5'Y 19 i;t- SPFCIAL REQUIREMENTS I(ri)fl�Q) I"kgk iind BeO Rfvst 130"l' ] l etijC 1-f()f Violau tn,;I Set tion temp,rat w still tzl [en vpci,;tions Awtild be 3-401,11(A)% l') Pmtftr,, Vr lid Gant- ;,wfied SwIfin,ff Hsh' NIOUL, e4 baed under f1w approprjaic ;ectluaN I�otdlr% or kaiit�g-i05'F 15��cc. �ib' vo il',�Ixcd to 1tx)dhurli;-' !!�nes, j-401.11 41lao liv--'t swak, a-ld jsl: fa"-Iorc ()tb(.,r l4i'j- 5� to 1�j retailf-3 -i.12 u.R,its 'jcttwl Cotkcd fit a lliitk'tkes..,hoidd re debited wider #�9 - %fielow�lvc N15 F'l OtA)(lyb) At!Othtl piij-s-i-17"i-,T 15 17 Reheating for Hot Holding j VIOLAWNS RELATED TO GOOD RETAIL PRACTICES 13.403.':If A)&W) 1111., t65"v liuc. ^ Otews 21-30) 3-loij lfkil 165"F Mmula&arljirl! 0Jah ruval whteh do'::r: rdllt�;il 'he qel :rna rokfozrors cint be commzlcfulty flave'scd RTF vtif+i foonli in ofrhe Irood Coda...110ie IR -T- 340'3"!I(L1 R-nnallim-,Un<lwed item Good Retail practices rc ortionsof ricel I 1 eo and Personnel PC 2 i 063 1 "4 1 Ferny-ind FaW Foi,,cflci,lr PC (A4 7 €8Proper Cooling at Pi '---I--- --- I 1-1,1--f—I----- —1 I 2'i Equ' niW,-atfiUtentala C-4 005 l-501 WA) cool wlz C'�'ki:d PHF"' l"ow 1 4W f l(l ------- 700F Witb!n 2 1 four<and From 7?}'(' w3tot'Prot�loszrfo etne,Waste FC-5 1 OW 2", PC-6 (X17 t,,41'FliiS F Wtljrt A Houls, 211. Po:s,,nlus of TRwc kikfirtriala PC-7 008 Sol.14(ifl Cit'hfqg PHF�"%Cidv Float Ambient Rl,,"wremsses 9 Tonperawr- tngeklicras t( 41 Olhu Wifien 4 illAir'l Oti'.O car al frol the rodewl 19,311 1,;,,1(".'e"r 105 Til)(1, -t J 0 Jt 9 ❑ INITIAL SERVICE O REGULAR SERVICE LJ EXTRA SERVICE OTEA 9MINIff. AID �8.OFT F PRODUCTION. _BR.NNCH ACCOUNT FIT TELEPHONE T if A 7 z 1 111 SERVICE PROPERTY AT -BRANCH. OPERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER j Target Q G.Cockmachas U Piseeavi Q Rats .3 materials llftiad #Us" Pests 0 Amencan Qxvkevc�� D ftert'reArts st=p.ftaiPests I I I WIND-UP TRAPS 450 Insiders 6M U oriental Cockroaches U RvAre U Silverfish :1 Cster- 1400 Insect Monitors 1 1610 TIN CATS 0 oth.ants 11 Flfi.,, 1:1 Chhe,_ I,41oPha.mm.TiamsI 1645 Rat Bait Stations 1.600 Glue Trans I I 4_1 1640 Mouse Bait Stations Pest Control Materials Used EPA Reg.9 Tic EfCj Armurt 1680 Snap Traps 1 1655 Louid Saft Stations 293 M�mGmnulwAntSO(AbamecUnBl)0.011% 499-370 Areas Inspected and/or Treated 295 Advance Dual Choice Ant Saft(Abamectin BI)0.011% 499-496 315 AscendH`meAmBmt(Abamecfn8I)0.H11% I 499-370 I Ip.ooe Ae. j 309 Avert Reach Bart Stations(Abamei 0.05% 40,167 365 Advance 388B Apt Gel Sort(Bow)5.4% 499-492 100 Bond Dust(Orthoboric acid)99% 9444-129 10 Publi.Avas IS DemstrurIGS(Larrisca-cylial Q0.015% 00.0% 00.06% 100-1066 210 DeltaGarl G(Dolonrethirm)0.05% I 432-836 158 TrDje Bulk Dust(Slica Ge!)40%(PyTethirms)10% I 499429 I ra Areas 41 Gantlet EC(Hydroplane)0.06% 2724-351 Q LpmdrylBo R. W Generation Mini Blocks Bast(Difelffialonel 0.0025% 7173-218 I Bsasaulatuirty 541 Generation Blue Max Blacks Mt(Dulethatons)0.0025% 7173-236 6VWah.W. 39 Intace Granular Bat(Orthabork,Acid)50%- 73079-2-- J Racessi,Aeac 43 Kicker EC(Pyrethums) UO.05% 70.1% 00.2% I 432-1145 nPalev4 R..; 550 UquiTex It Bait(or$",.Salt of Diphacinone)0.106% 12455-61 Gu t Room 352 Mallorca PC Rosi Bait Station Figrorill)0 05% 432-1257 O ea em nl 351 Mafs,caFCAmMStpuxms(Rp,onr0,0I% 1 432-1256 0 R.f I 357 Maxiorce PC Ant Gel Bait(Fipronill 0.001% 432-1264 351 Maxforps FC Meet Rab Bag Gel(Rprom!)0.01% I 432.1259 355 Maxfonce FG Insect Suit(Hydramethy1non)1.0% 432-1262 I U tardscaped Ar. 46 Nyi.EC(Pydpmxyfen) UO.015% 00.02% 1 I 11715-307-57076 Q Lu .*W Eacl,sJuer,,., 151 PT Cy-Kick Aerosol jCyffuthfln)0.1% 499470 Cl CAh, 70 PT Cy-Kick GS(Cylluthimi 70.0075%00.025% 00.05%70.1% 4119304 I Precautions 312 PT Avert Got Brut Obarnectin BI)005% 499-410 69 PT 565 Plus XLO Aerosol(Pyrethrins)0.5% OMO 159 PT TriDe Aerosol(Silics,Aspogel)4.8%(Pyrethnns)3"' 49�385 A��atla,g vc�m mists,or duals.Harmful ss�llxwac. a Tempo UpaWP(CyftAmm) 00.025% 0 0. 1 Damp eaul�to activate I 05A JOAM 432A304 83 Tempo SC Ultra(Cylluilumt)70.025% 00.05% 00.1% 432-1363 E.eet'am.w.ww A.vartiat., 91 ULD SP IM UUF(PMthrms)1.0% 499252111540-9 I I loarmtl..d..vsavastualfd, 92 ULD BP3000IJV(Pyretfimmi 499-450/11540-1 591 WeatherturoliKi'Brit(Blodfaccum)(1005% 100-1 ttee Ment cane fq: C=Cracl,&Crevice V-vim G S-most W=B,pc D0=NapeJC.nt. 8=3-13pivI SP=8,. IN=Impaction j_,ja(Vc) cs=ove,.MSvsM T-Trap 05=twitsbacen His o.0 OusW A=Ae BG=ftl G.ri R=P.,TiamM , F=ULV Pasting Service Sfcker7 0 Y. U No Supervisor's Comments: SPECIAL SERVICEINSTRUCTIONS' r Qi Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent any conditions present that may be contributing to a current,or possibly a future,pest infestation. Interior Areas Pests Conditions Food Areas Pests Conditions ❑ Offices - - "© Dining Area .✓"`�"""r - ❑ Lobby/Public Areas "El Stove/Oven Line ❑ Entryways - —0 Food Storeroom -❑Rest/Locker Rooms ` ,.,®"``-"1 p❑ Dishwashing Area ❑ Janitor Closets ❑ Dell/Bakery — J - ❑ Laundry Cl Processing Area — ❑ Boiler/Furnace Room ❑ Packaging Area — y ❑ , 'Storage Utility - G .� �,.. ❑ Produce Area — ❑'Warehouse .r- ❑ Meat/Seafood Shop ❑''Basement ' c -.rte Exterior Areas X❑ Patient Rooms ❑ Exterior Walls-North ❑ ICU ❑ Exterior Walls-South — ❑ Linen Storage Rooms ❑ Exterior Walls-East ❑ Kitchenettes - ❑ Exterior Walls-West ❑ Nurses Stations ❑ Loading Dock — ❑ Guest Rooms ❑ Dumpster ❑ Banquet/Meeting Rooms - ❑ Exterior Storage Rooms ❑ Display Aisles ❑'Roof - - ❑ Other 0 Other - — ❑ Other ❑ Other 1. German Cockroaches 6.Pharaoh Ants 11. Occasional Invaders - 16. Rats 2. American Cockroaches 7.Pavement Ants 12. Hunting Spiders 17. Mice 3. Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests 4. Outdoor Cockroaches 9.Argentine Ants 14. Brown Recluse Spiders 19. Other 5. Silverfish 10. Ants. 15. Black Widow Spiders 20. Other A. Drain Clogged/Dirty I. Paper/Utter O.Poor Storage Practices Y. Move Dumpster Away From Bldg. B. Food Debris Under Table J. Water leak R. Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned C. Food Debris On Shelf K. Mops Improperly Stored S. Seal Exterior Cracks/Holes AA, Mercury Vapor Lights Outside D" Food Debris Under Appliance_ L Trash Containers Need Cleaning T. Trim Back Tree/Shrub Branches BB.Keep Doors Closed E. Wet Organic Matter in Cracks M.Heavy Dust/Dirt Deposits U. Remove Piles of Debris CC.Repair Door/Screen F. Grease Deposits on Floor N. Numerous Cobwebs Present V. Cut Tall Grass/Weeds DD.Replace DoorWeatherstripping G.Grease Deposits on Equipment O.Repair Floor/ iles/Wall/Ceiling W.Improve Outside Drainage EE. Poor Outdoor Storage Practices H. Soiled Dishes Left Over Night P. Seal Holes/Cracks in Walls X. Install Gravel Foundation Barrier FF. Oth-, Comments `Customer's Signature - - .Service Professional's Signaturew; Date CUSTOMER'S COPY EXTRA SERVICE vj 1,711 q st"al W-1 OvA I"%j 0 1 BRANCH ACCOUNT RT TELEPHONE GRID S D F T PRODUCTION' TIMEIN TIMEOUT SERVICE PROPERTY AT BRANCH Mz OPERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER 1> Target Pavement rima 0 itao, ❑ O..nal Materials guarad rdear, Pests Q American CocMroaches U ftemira,,ota �qmlrs F1 stored Product sinn, 450 Insiders 620 WIND-UP TRAPS Cl Oriental 0drinmarbas a Fre Ants U slaaer 0 Other 400 Insect Mondcas 610 TIN CATS 0 other Corlkcacl Cl Carer Ants 0 Rue 0 ouna, 1,410,Pheromone Traps 645 Rat Bait Staborts j.,1wo Traps W mcmde Bait Stations Pest Control Materials Used EPA Reg.9 T/C BIC 630 Simp.Trans05 Undid Bait Stations I 293 Advance Granular Ant Bait(Abamectin BI)0.011% 499J70 lI 11 I Areas Inspected and/or Treated 295 Advance Dual CholceAmBalt Atiamictin 3110.011% 499-496 30 Ascend Fire Ant Bait iabannean BI)0.011% 499-370 309 Avert Roach Saft Stations Obamecun)0.05% 499467 anm.4r�y-- 365 Advance 3880 Ant Gel Bait(BOM)54% 499492 ltotrc. 100 Bond Dust(Or3t.boric scroll)99% 9444-129 15 DeparmICS(Lantloda-ciyliakithin) Q0.015si- 90.03% U0.06% 1001066 210 DeltaGand G(Deltmeftn)0.05% 432-836 158 TdD!e Bulk Dust(Elvd,Gel)40%(Pyrethrins)1.0% 499,129 '7D9P1kyA,oaa 41 Gentrol EC(Hydnomerie)0.06% 2724-351 W Generation Man Blacks Bart(Difethialone)0.0025% 7173218 541 Generation Blue Mair Blacks Bait(Difieffnalone)0.0025%, .7173,23q 39 Intice Granular Bat(Orthimcdc Acid)5.0%� I Q prucraorigAr. 43 Kicker ECIPyrethnns) 00.05% 00.1% 00.2% 11 P"an t tior). 660 Liqui-rox H Bait(Disiodium Salt of Dipitimmon")0106% 1 06% 12465-61—, 1`1Guest Ff.. 352 Madonce FC Roach Bart Stations(Rpronvit 0.05% 411-1157 361 Madorce FC Ant Bait Stations(Filprond)0.01% 432-1256 I71 Roof 357 Muforre,FC Ant Get Bag(Apromil)0.001% 432-1269 351 MfmceFCSeL-dRoach Bat Gel(Fp=U)0-01% 432-1259 I J E,,terlp—na. 355 MaxforceF6Insect S&(Hydramethylnon)10% 432-1262 I I i J Landorsiod Areas 46 WarEC(Polmoxy1fan) 00.015% 00.02% 11715-307-57076 U Lr,,i;nV pociornimusis 151 FFCY=lt1diAenosaI"uftrm)0.1% - 499470 U an., 70 PT OY-Krcik GS(CyfftdhHn)1:10.3075%9 OM25% 0 0.05%Q 0.1% 40-304 312 PT Avert Gel Bait Aloarrectat 31)0.05% 499410 Precautions 69 PT 565 Plus XUO Aerosol(Pyratturne)0,5% 499-290 K�- W of rwr1i of cliflifimn and ane T TnDlo Aerosol Seita Amage)4.8%(Pyreflants)O6% ma,,cmpe air,.,inner,or�.�mic� 159 P 499 3115 Poo nJbraarfir,va,,nrrku,,ordusts Harmful ffsmasuno. 81 Tempo Ultra WP(Gyfluthnn) 00025% 00.05% :10.1% 432-1301 I I I N.'r,ronuirowararra's 83 Tempo SC Ultra(Cylbuthrin)00.025% 0005% 00.1% 43 -o not acnwut mcfarlourk,planarrofte 0.not M.0.m srO aftervenblat., 91 ULD SP 100 UI.V(Pyrethrins)1.0% 499-452/11540-9 Do ma to nufted areas wt,l d, 92 ULD BP 300 UI-V(Pyreffirms)3.0% 499-450/115401 Port strstm,nu,..n."treated.W a rhrnan of mor Hours or urnd dry 591 WeaUdearblok XT Bait(Brockfacounn)0.005% 100-1055 TreafteritCopeff(C): C=Cask&G,evjrs V=Vrnd G=G.aal T 6-Spot U-Sent VC=Dr.tiidCo.i,t B=3-6and SP=spars IN=ftd. Equipment Code(VC) CS=Comp.Ar iionryor T:TW :s-sentstaf. He-Hand Duster A Aierrod G=E3a1G. PT=Paver Treatimern, F Ul-v Posting Service Sticker? ❑nas 0 No Supervisor's Comments: 'SPECIAL SERVICE INSTRUCTIONS, CUSTDqERs SIGNATURE AMOUNT PAID SERVICE TECHNICIAN'S SIGNATURE _DA ' CASH UNRESOLVED PROBLEMS? T!4 CALL i-M-TERMINIX(1.800-837-6464) CUSTOMER'S COPY l v _ ' CUSTOMER INFORMATION Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent -any conditions present that may be contributing to a current,or possibly a future,pest infestation. Interior Areas Pests Conditions Food Areas Pests Conditions a `a ❑ Offices U Dining Area ❑ Lobby/Public Areas -,A Stove/Oven Line ❑ Entryways ..,,0 Food Storeroom .ErRest/Locker Rooms •-U Dishwashing Area —` ��'"''`••°'� ❑ Janitor Closets ❑ Deli/Bakery ❑ Laundry U Processing Area _ ❑ Boiler/Furnace Room ❑ Packaging Area ,GI-Storage Utility "' f`'"-'"'"` ❑ Produce Area _ ❑ Warehouse I ❑ Meat/Seafood Shop +, O'Basement �'"'"''� ,. Exterior Areas ❑ Patient Rooms ❑ Exterior Walls-North - ❑ ICU ❑ Exterior Walls-South El Linen Storage Rooms O Exterior Walls-East ❑ Kitchenettes ❑ Exterior Walls-West _ ❑ Nurses Stations ❑ Loading Dock _ ' ❑ Guest Rooms ❑ Dumpster ❑ Banquet/Meeting Rooms - ❑-Exterior Storage Rooms _ U Display Aisles# ❑ Roof U Other- ❑ Other ❑ Other - ❑ Other 1. German Cockroaches 6.Pharaoh Ants F 11. Occasional Invaders 16. Rats - 2. Amencan Cockroaches 7.Pavement Ants 12. Hunting Spiders 17. MLre 3. Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests 4. Outdoor Cockroaches 9.Argentine Ants 14. Brown Recluse Spiders 19. Other S. Silverfish :10. Ants. 15. Black Widow Spiders 20. Other A. Drain Clogged/Dirty 1. Paper/Litter Q. Poor Storage Practices V. Move Dumpster Away From Bldg. B. Food Debris Under Table J. Water leak R. Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned C. Food Debris On Shelf K. Mops improperly Stored S. Seal Exterior Cracks/Holes AA. Mercury Vapor Lights Outside D. Food Debris Under Appliance L. Trash Containers Need Cleaning T Thin Back Tree/Shrub Branches Be.Keep Doors Closed E. Wet Organic Matter in Cracks M.Heavy Dust/Dirt Deposits U. Remove Piles of Debris CC.Repair Door/Scmen F. Grease Deposits on Floor N. Numerous Cobwebs Present V. Cut Tall Grass/Weeds DD.Replace DoorWeatherstripping G.Grease Deposits on Equipment O. Repair FloorTles/WaIVGeiling W.Improve Outside Drainage EE. Poor Outdoor Storage Practices H. Soiled Dishes Left Over Night P. Seal Holes/Cracks in Walls X. Install Gravel Foundation Barier FF. Other - Comments ❑ INITIAL SERVICE Q REGULAR SERVICE ❑ EXTRA SERVICE r,EA 9MINIX. ,BRANCH - ACCOUNT. - RIF '-TELEPHONE " '-_ ` GRID S.DAY F -Ta 9-PRODUCTIONS -;TIME IN " TIME OUT " - • - _ - .SERVICE PROPERTY AT _ - -- __ - , - - .BRANCH - 1 ! -� 3 - OPERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER Target "U Gemsancwmad,m' a PavemsmA ❑ Ads 7 occasional Invader MaterialsI #Used I #Used 0 gy Pests 0 Amerce#Gpcwpachaa entre An6 "Hd r4rce 0 scored Product Pena I:451),Ineders 620 WIND-UPTRAPS 1 O odenw Gocwoames U F Ams U sNedrsh 0 oMu '1'400"insect Monitors 1 41- 1 610 TIN CATS I 0 Other Cocwoacnes 0 otlrer Ams 0 Flres 0 other I-410.Pheromone Trans l — 1645 Rat Bait Stations I I Glue Trans I '"1 1 640 Mouse Bot Stahons 1 Pest Control Materials Used ( EPA Reg.If vc BIG 00 I Amount I s3D SnwTmps 1 1 655 UomtlBait Stations zea Advariae Drawler Ant exit Nbonectin 61)0.011% I 49970 (Areas inspected and/or Treated ( 295 Advance Dual Choice Ant Bait(Abamectin 61)0.011% 1 499496 I I rest contra#mntenais peee'mxated by cedes loom Mf ar left 315 Ascend FreAnt Bet(Abamectinst)0.011% _ I 499-370 I I - I}Food Areas I 309 Avert Roach Bait Stations(Abamectin)0.05% - 499467 365 Advance 38813 Ant Gel BailB I l0inmg aces ( orax)5.4% 499492 I'1 o1r es I 100 Bond Dust(Odhabonc add)99% 9444-129 1 d s is 7aubkc aea4 15 Demand CS(ambdacyhalothnn) D0.015% 00.03% 00.06% 100-1065 1 I 210 DeltaGard G(Deltanwimin)0.05% 432-836 I I U Red2ocker Roans 158 TnDte Bulk Dust(slice Ge640%(PYrelwins)1.0% I 499429 I'-' kwey A`o. 41 Gentrol EC lHydroprene)0.06% 1 '2724-351 .1 tnory/60ilar Room 1 540 Generation Mini Blocks Bail(Difethialme)0.0025% 1 7173-218 '-J Sma9PoUhlity i I 541 Generation Blue Max Blocks Bot(Ddelhlalone)0.0025% _ - __7173-236 _ I I ._I_ - - LO waenouse Area - - 39 InBce Granular Bait(Onhobonc Am'd)50% 73079-2 1 I 10 Pmcom,Arm 43 Iscker EC(Pyrethnns) 00.05% 00.1% 00.296 1 432-1145 1 I 1rlPadantRooms- 550 UquTox II Bmt(Disodium Sall of Diphecindne)0.106% I 12455-61 _ I 1 11 Guest Rooms 352 Maxfoma FC Roach Bail S� m(FiproniQ 0.05% 432-1257 1 I I 0 I 351 Maxfome FC Ant Ba Station(FPronin 0.01% _ 432-1256 357 Maxfome FC AM Gel Bail F rani 0.00196 O Roof { P Q 1 432-1264 354 Maxfome FC Select Rossini Bait Gel(Rinl iQ 0.01% 432-1259 1 F o P mat 355 Ma force FG Insect Bait(Fydramethy1non)10% 432-1262 a a d ep e A ear I -OB Ny1ar EC LPyriPmxyfeN 00.015% ']002% 11715-30]-57076 0LoaGn9 oocW0umps!er. 151 PT Cy-Kick Aerosol(CyfMImr)01% I 499470 1 I lUother I 70 PTCy-Kick CS(Cyfluthnn)-00.00]5%00.025% 00.05%00.146 1 499 04 1 Prec� autions - 1 312 PT Avert Ge Bait w mmol(in EliO05%. 499410 esp out of reach or childon and psis. I 69 PT 565 Plus XI-0 Aerosol Pyrehn )0.596 499-290 I I I May ceere eye.nose,throat,or soon lrotation I 159 PT TnDie Aerosol(Sill Aetogeh 48%(Pyrethrins)0.6% 499-385 Igv¢tl hrea:kng vapor mam,oa sHoolii zwamvea I . 81 Tempo UlVa WP(CyfiMrin) U0.025% 00.05% 00.1% 432-1304 I IOmP 9mw mamrvate. I 83 Tenryo SCUVa(Cyflmhnn)r�0.025% 00.05% 00.1% 432-1363 I wnot rap wim mdemindep ran . Do not oW,o to mom until re, ws.r. 91 ULD B100 ULV(Pyrethrins)1.0% I 499452/11540-9 I 1 I _ �o nm much treated areas urNl dr, 92 ULD BeP 300 ULV(Pyre[hnns)3.0% 499450/11540-1 I � IFarilea o-eaenesus remain ott treated area mramwmwn of lour hour or arra dry 591 Weathemlok M Bad(Brod"dacourn)0.005% 100-1055 I I Treomentenae(TA.T_ o=Cann&crelw v=Vdd G=General I s=spot eT=Bait Da=Deectsd Gonial 8=9'eaM sP=space m=me,st. I 1 - C-gnlp(rient code lFUGI: Cs=Comp Av sparer r=Tap -. 65=Bait sM. Ha=Hand Duster A=Aerosol BG-Bat Gun Pr=Pourer Tmaiment F=ULV Posting service Sticker? ❑yes ONO Supervisor's Comments: I x- SPECIAL SERVICE INSTRUCTIONS - CUSTOMER'S SIGNATURE AMOUNT PAID SERVICE TECrrHNICIAN'S-SIGNATURE,, DATE f _ CASH UNRESOLVED PROBLEMS? �L \ I -, -- '. �--^^_• - I �i i's` �: CHECK CALL 1-800-TERMINIX(1-804-83;-6+64} e_ CUSTOMER'S COPY Seryice Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent any conditions present that may be contributing to a current,or possibly a future,pest infestation, Interior Areas -Pests Conditions Food Areas Pests Conditions U Offices _ `Q Dining Area _0 r Q Lobby/Public Areas a�Stove/Oven tine =" _ Q Entryways_ t _ 'U Food Storeroom ^? .Q Rest/Locker Rooms - - Q�Dishwashing Area U Janitor Closets ._ U befi(Bakery U Laundry _._ Cl Processing Area _ U Boiler/Furnace Room - U Packaging Area" U Storage Utility - - Q Produce Area -- Q Warehouse --.,.— Cl Meat/Seafood Shop _..— —..._. Q Basement Exterior Areas " Q Patient Rooms Q Exterior Walls-North Q ICU, Q Exterior Walls-South _ Q Linen Storage Rooms _ " " Q"Exterior Walls-East U Kitchenettes --- :Q Exterior Walls-West _ Q Nurses Stations-- U Loading Dock" —....—.-_ - U Guest Rooms Q Dumpster G Banquet/Meeting Rooms —i— Q Exterior Storage Rooms U Display Aisles#-.:� —,. _ U Roof Q Other -- U Other U Other Q Other _ t. German Cockroaches 6.Pharaoh Ants 11. Occasional invaders 16. Rats- 2, American Cockroaches .7 Pavement Ants „ 12. Hunting Spiders .. 17. Mice 3. Oriental Cockroaches 8.Fire Ants - 13. Web-Building Spiders 18. Stored Product Pests' _ 4. Outdoor Cockroaches 9.Argentine Ants 14, Brown Recluse Spiders 19. Other 5. Silverfish 10. Ants. - 15. Black,Widow Spiders - " 20. Other A. Drain Clogge&Dirty 1, Paper/Ufler O.Poor Storage Practices . Y. Move Dumpster Away From Bldg. B. Food Debris,Under Table J. Water leak R. Repair Water Damaged Wood Z, Dumpster Area Needs Cleaned C. Food Debris On Shelf K. Mops Improperly Stored _ S. Seal Exterior Cracks/Holes AA.Mercury Vapor Lights Outside D. Food Debris Under Appliance L. Trash Containers Need Cleaning T. Trim Back Tree/Shrub Branches BB.Keep Doors Closed E. Wet Organic Matter in Cracks M.Heavy DusVDlrt Deposits U. Remove Piles of Debris CC.Repair Door/Screen F. Grease Deposits on Floor N. Numerous Cobwebs Presets" - V. Cut Tall Gias97Weeds DD.Replace DoorWeatherstripping G.Grease Deposits on Equipment O.Repair FloorMi es/wall/C,eiling W.Improve Outside Drainage EE. Poor Outdoor Storage Practices H.Soiled Dishes left Over Night P.' Seat HoiesfCracks in Walls X. Install Gravel Foundation Barrier FF Othw- Comments }}- C3,SS _tn� `'} � R Customer's Signature Service Professional's Signature wfJ - •- Dat o . cusroMEr s caPv t= _ ; I.-Ij r1I=k7UL-1L%r1 0[::nVIk1r- Ll EXTRA SERVICE ACH A'C-CO 91Vl I,kTj1T=E1LE*]P1H?NyAE -*-�4j GRID1 TIME IN N ACCOUNT RT PRODUCTION TIME OUT J'S.DAY I.,FLj T• PR 7J SERVICE PROPERTY AT BRANCH T� "iik OPERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER F Target b, tr"P.�.t kZ'ft J AR.rs 0 o onsl Mvamio (Materials I -ukoof I OUsid Pests -D Q ftidsan.M. a,1-mu2d- .0 stoso Pm.n Pests liters 1 1 620 WIND-UP TRAPS Cl ossintaicam ooma, :1 0 & sh, 0 on,ar- QM -r 1610 11N CATS "mad M. -�. 0 ftercimmei 0 oft'Am CI ff.. 0 SIO Ph..M."T 645 Rat Bait Stations Glue Trans 640 mouse Ban Stations Pest Control Materials Used EPA Reg, TC Etc Amount 1630 Snap Trade 1 656 Liouni Bait Stations 293 Advance GranuhsAm Bait(Abernemn BI)0.011% 4 370 Areas Inspected and/or Treated 296 Advance Dual Chaim Am Bist(Abarneciai61)0.011% 99_496 315 Amend Fits Ant Bad(Abariectin 81)0.011% ... 49967 370 Cycoa Arma 309 Avert Roach Bait Station(Athamectin)0.05% lo., 365 Advance 3888 Ant Get Bait(Baas)5.4% I 499492 ors 100 Bond Dust(Onhobodc acid)99% 9444-129 Cl Pobfii,Ama 15 DentansICS(Lambda-cythalothnn) 00.015% :10G3% 00.016% 100A066 -T4—, 210 D.IloGam G(Deltameftn)005%-- 432-936 Ise TdDde Bulk Dust pirica Get)40%(Pymthnns)1.0 Li ovioy 41 Gentrol EC(Hydropiene)0.06% 2724-351 D a naMBoO R.. 540 Gemination Mini Blacks Bait(Difethiabone)0.0025 " 7 541 Gemination Blue Max Blocks Bait(Offethialone)0.0025% 7 39 (mice Granular Bait(Goldol Acid)&0% 7 93 Kicker EC(Py'affirm) 00.05% 00.1% U11.2% 5 4 550 Uqu-iTox 11 Bait(Disocium Salt of Diphannode)0.106% %21 516 352 Maidowce FC Roach Bait Stations(10.05% 2-1257 wxf. 351 Madame FC Ant aaA Stations,(FiPmod)0 01% 132-12M0 Pool osemat 357 Maxie=PC Ant Gal Bait fflpmnil)0.wI% 432-1264 0�Pe Rtes 354 Maidoom FG Select Roach Bait Gel(i out h, 432-1259 365 Maidoice FG Ideas Bait(1-hydiamethylam)1.0% 432-1262 0 I.,villald Area - 46 Ny1aEC(Pymwcxydn) 00.015% :10.02% 11715-307-57076 U Wadmg Doc mpster 151 PT Cy-lack Aemeal(Cyflutmid)0.1% 499-470 Omar- 70 PT Cy-Kck CS(Cyll.thn.)LI 0 0075%0 0.025% U 0.05% D U.1 X 499-304 Precautions 312 PT Avon Gel Bait(Apamecon B11 0.05% 499-110 69 PT 565 Plus XLO Aerosol(Pyiethiins)0 5V. 499-290 Irgayceuse v,,ii.,thimt,or vl,ln imubon 159 PT TdDie Aidosal(Si[im Aemijel)4.8%(Pyrethrins)0.6% 1 499-385 Motb.,ahi,.,c,cvs.,d.M H.Udsmbved, at Tempo Ultra WP(GyRutlain) 00025% 7005% 1:10.1% 432-13(14 Dampen granufesmacava:e. 83 Tempo SC Ultra(Cylluthinn)70025% 00.05% JGJS 432-130 91 ULD8P1000LV(Pyrethnns)I.0% 499452/11540-9 IDo ot,au icated.aidl ft 92 ULD BP 300 ULV(Pynal 3.0-A 499,150/1 1540-1 591 Weatherblok XT Bait(Biddifamum)0.005% I 100-1055 Tnumnerocii,de(r/q. c=Civd,&c. V=Vdki G-G..I ;S=SNt BT=B.t 0C=DmctoJCmtaat 13=3'02M SP=SVem IN a(I.,mcio, Edpnwvt Code(EtC), CS=Comp Ar Sprayer T=Tinip I I B$-Barts atm "D=Hand Dimer A-Feo.l BG=seG K=Pourer Treaursol, F=UIN Posting Service Sticker? U yo. U No Supervisor's Comments: SPECIAL SERVICE INSTRUCTIONS /-CUSTOMERSSIGNATURE j ANIOUNTRAID CASH UNRESOLVED PROBLEMS? ERVICE,TECH'NICIAN'S SIGNATURE-- I DATE J -837-W4), I, , CHECKCALLCALL 1-aDO-TERMINIX(1-800 CUSTOMER'S COPY ---- -- ------- - -CUSTOMER INFORMATION i l .d Service Areas-Activity and Conditions Observed of esti found in the area,and letters represent This pest iort nvasions.For each of he areas dliin and st d below,numbers crepre represent the type o lists hose steps you can take to help limit or any conditions present that may be contributing to a current,or possibly a future,pest infestation. Areas Pests Conditions - Pests Conditions Food - Interior Areas y ?= �OeDining Area - ❑ Offices '+❑, Stove/Oven Line - ❑ Lobby/Public Areas -0,Food Storeroom r, Ta"Dishw• Entryways ashing Area ❑-Rest/LockerRooms ❑ Del/Bakery — ❑ Janitor Closets "tet :I-'Processing Area - ❑ Laundry a � ❑ Packaging Area - .9'Boiler/Furnace Room ' 1 - ❑ Produce Area QStorage Utility ❑ Meat/Seafood Shop - - ❑ Warehouse Exterior Areas c ❑`Basement - ❑ Exterior Walls-North ❑ Patient Rooms — ❑ Exterior Walls-South ❑ ICU - - ❑ Exterior Walls-East ❑ Linen Storage Rooms - ❑ Exterior Walls-West ❑ Kitchenettes — Loading Dock Nurses Stations ❑ Dumpster ❑ Guest Rooms - - ❑ Exterior Storage Rooms ❑ Banquet/Meeting Rooms - - ❑ Roof - ❑ Display Aisles If ❑ Other ❑ Other ❑ Other Cl Other - -- - invaders 16. Rats ' nal 11. occasional 6.Pharaoh Ants 17. Mice 1. German Cockroaches 7 Pavement Ants 12. Hunting Web-Building Spiders 2. American Cockroaches - g Fire Ants - 13.- Web-Building Spiders 18. Stored Product Pests 3. Oriental Cockroaches 19. Oth _ 9.Argentine Ants 14. Brown Widow S Spiders 20. Other - 4. Outdoor Cockroaches 10 Ants. 15. Black Widow Spiders 5. Silverfish - y. Move Dumpster Away From Bldg. I. Paper/Utter 0.Poor Storage Practices A. Drain Clogged/Dirty - R. Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned J. Water leak S. Seal it Wale Cracks/Hoies AA. Mercury Vapor Lights Outside B. Food Debris Under Table K Mops Improperly Stored BB.Keep Doors Closed C. Food Debris On Shelf T. Trim Back Tree/Shrub Branches CC.Repair Door/Screen D. Food Debris Under Appliance L. Trash Containers Need Cleaning U Remove Piles of Debris M.Heavy DusVDlrt Deposits V. Cut Tall Grass/Weeds DD.Replace DoorWeatherstripping N Numerous E. Wet Organic Matter m Cracks Cobwebs Present F. Grease Deposits on FloorW.Improve Outside Drainage EE. Poor Outdoor Storage Practices G.Grease Deposits on Equipment P Seal itHoles/Cracksr/ TileaIVC;eil'ng X. Install Gravel Foundation Barrier FF. Other H. Soiled Dishes Left Over Nigh Comments I , Commonwealth of Massachusetts ' e City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: ROCKAFELLAS/Jay El Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0101 Jan 4,2010 Dec 31,2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES (December 31, 2010 n Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 IQIvfBERLEY DRISCOLL FAX(978)745-0343 MAYOR DGREENBAUM&ALEM.COM DAviD GREENBALim, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT \ IG-I-O Cr, "uOriSCSDBA RO(k4lc j (&S TEL# VY ?Y S 2-V t l v _ ADDRESS OF ESTABLISHMENT 23 1 E: SRX S� FAX# 97k SKS 2 q, 7 / MAILING ADDRESS(if different) X ®R l � °"` w1,JLd: ROGKG-Et 64.5 6f�SS4,tem, Coin EMAIL-Business': OL OCi�C7e ( G / ��a^• Websde: OWNER'S NAME 7�rl-Rn/�Ce K2Vrk /4,q,-c LIII/hl�-v _ r°!TEL#�41 72 7 1VIOZ ADDRESS 6 {?2�1 n /res A0 04kt-fe d 4 0)1A0 STREET U CITY STATE v ZIP CERTIFIED FOOD MANAGER'S NAME(S) SG/wt 7h/' l CERTIFICATE#(S) X F-?-O S26.3 S (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# ISD"A.1'S"OF3QFERQTIONyr';��i=t �Mpiiday �r�,)�Tu"esday„"�„�„� YVed'_riesday; '�, raTli9rsday '��IFiitlay�l; �i" Saturclay��` ASuntlay+ '� HOURS OF OPERATION Please write in time of day. (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 RESTAURANT YES less than25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats $42 A --S ------------`-------- --------------------------------------------------------------------------------•-------- BED/BREAKFAST/ YES N $100 CHILDCARE SERVICES/NURSING HOME------------------------------------------------------------------------------------------- -------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES N $25 TOBACCO VENDOR YES O $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 slate taxes roquired u der the law. C Olk59- 1275 Signature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date 800lDy /U 21/6 9 $ —5L20 ^ 4�`" City ®�f Salem assachusetts Fire Department 48 Gaffayette Street �DavuC�4V. Cody Fire 2revention Bureau Chief Sarem, 5WassacFiusetts 01970-3695 29 Tort Avenue 978-744-6990 Ter978-744-1235 Te[978-745-7777 dcody@sam.com Ea C978-745-4646 Tax978-745-9402 VIOLATION NOTICE RECM009 E IED Rockafellas Restaurant oy' � L LMonday October 19, 2009 231 Essex Street Salem, MA 01970 uJARD STH An inspection of your facility on Friday October 16, 2009 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on TO BE DETERMINED at / / If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code Article Division Page Count 10.17.1 occupancy load posting 10.17 1 0 0 P Y P g Maximum Occupancy per Certificate 214 persons. Actual count 243 persons . General. (a) Scope. The decoration, operation or use of places of assembly and education shall comply with the applicable requirements of 527 CMR 10. 00 and 21 . 00 and 780 CMR. (b) Permit required. A place of assembly or one for educational use shall tot be maintained, operated or used as such without a Certificate of Inspection from the building code official. (c) Posting of occupant load. Each place of assembly or education shall be posted with an approved legible sign in contrasting colors conspicuously located near the main exit from the room or space stating the number of occupants permitted within such space. The number of occupants permitted shall be determined by 780 CMR. Assembly rooms or spaces which have multiple use capability shall be posted for all such uses. The owner shall be responsible for installing and maintaining such signs . (d) Overcrowding. No person shall permit overcrowding or admittance of any 10/19/2009 17:03 Page 1 � �M�ar G �Zty ®f Safem, 9dassachusetts (Fire Department �Al1YR 48 Gaffayette Street �Davi�`W. Cody Fire Prevention Bureau Chief Sarem, Wassachusetts 01970-3695 29Tort,4venue 978-744-6990 Te[978-744-1235 7ef978-745-7777 dcody@safem.com Eax978-745-9402 Fad 978-745-4646 VIOLATION NOTICE Rockafellas Restaurant Monday October 19, 2009 231 Essex Street Salem, MA 01970 person beyond the established posted occupant load of any place of assembly or education. The head of the fire department, upon finding overcrowded conditions or obstruction in aisles, passageways or other means of egress, or finding any condition which constitutes a hazard to life and safety shall cause the performance, presentation, spectacle or entertainment to be stopped until the area posted occupant load is re established or the obstruction or hazardous condition is removed. 10.03.1 means of egress 10.03 1 0 0 There is to be NO STORAGE in the exit ways from the occupancy Any obstacle which may interfere with the means of egress or escape from any building or other premises, or with the access to any part of said building or premises by the fire department in case of fire, shall be removed from aisles, floors, halls, stairways and fire escapes . Doors and windows designated as exits shall be kept clear at all times . - X r Holloran, Jr. , Charles R Chris Christoudias Inspector Occupant/Owner CC: Chief David Cody Salem Building Inspector Licensing Board Salem Board of Health File 10/19/2009 17:03 Page 2 Commonwealth of Massachusetts I* i City of Salem Board of Health Nrnbetley Driscoll I* 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 05/05/2009 ESTABLISHMENT NAME: ROCKAFELLAS/Jay EI Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes SEASONAL FOOD BHP-2009-0453 May 5,2009 Dec 30,2009 This permit is for the spring and ESTABLISHMENT summer outdoor promotional BBQs. Total Fees: PERMIT EXPIRES (December 30, 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 IMANC.INIOSAII_M COM JANET NlANCINI, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Pbe kc, �e-h lx, TEL# (q90 7qr, ag11 ADDRESS OF ESTABLISHMENT ((1o�3( FAX# Axr) �N� o1`191MAILING ADDRESS(if different) 2CdaA,,. Ntn,IPSS (1k 37? (p EMAIL-Business': 'Y'6ck >Q' YOL��tllusO�C�i�1x •Coyl Website: UJC09J,(y'OG/CG\C611-0B Sr,tp24- %C,)iM OWNER'S NAME TEL# - U ADDRESS Kt A,(( P)lqw) STREET CITY STATE �� ,Z_I.P�,/ CERTIFIED FOOD MANAGER'S NAME(S)� r CERTIFICATE#(S)XL azo ars3 S 1S (Required in an establishment where potentially hazardous11 food is prepared) \ 1' EMERGENCY RESPONSE PERSON �L.A vA IML kl � HOME TEL# �� I �Y(' (%m I DAYS OF OPERATION Monday': 1 ' Tuesday Wednesday.. Thursday. Tdday' , Saturday I Sunday HOURS OF OPERATION 1 Please write in time of day. (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ----------------------------------------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME---- -------------------------- ----------------------------- ADDITIONPERMITS 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 701 s and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns an a state taxes requir under the law.C /J Si ure Date 1, __Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date $ ai ��rr`/�� ,s i� �r� �ou of- oa,,- S,�f-tJn S GN�L� JLtl'wvYnnPj(/� <21.� i .i dljd' �F��101ti�� / Z1— 0,-A, U1 yam, Ln �/1��C playbAe- ! �o O lz E Q5 lzJ t`b Gi KSS P&41 f cls, 5 l 1� �} a 4.. doss 0 t • Commonwealth of Massachusetts e City of Salem Board of health IGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: ROCKAFELLAS/Jay El Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 a LOCATED AT: 0227 ESSEX STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP=2009-0219 Dec 23,2008 Dec 31,2009 $420.00 ESTABLISHMENT 'total Fees: $420.00 PERMIT EXPIRES December 31,2009 i Board of HealthYIA This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS - BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAA(978) 745-0343 MAYOR1DtONNE(a SAt"nnc CONI JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT KO C (- A F-2( (AS TEL# ??R 7YS 2.Y 1 I ADDRESS OF ESTABLISHMENT 231 E5 d (26 5f FAX# ql fit' 7 Ys -XK -71 MAILING ADDRESS(if different) 1 (( EMAIL- Business': kvc-K @ ROC(tiaP�1,14SS4tea.Waoebsite: IyyZOC kAGZ(/{I--1of ,S9 rvl (004 � OWNER'S NAME 7'r1 �rL,cC KtJl�, '"1GrG�l�v TEL# ¢, 7 ) 7'Y1 J ADDRESS G korolds KD. Do,lutcld MA- o1S9,U STREET U CITY STATE ZIP CERTIFIED FOOD MANAGERS NAME(S) r-r-g44 Y`2vl\tvtarlW4- CERTIFICATE#(S) `3130777 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON DIRV I d MC k, t 1 D10 HOME TEL# -191391 -6&52- 1 1DAYSOF.OPERATION I" - Monday ,.Tuesday d Wednesday,,]'::r.Thursday A Friday,' 1 . Saturday I ' Sunday,. " HOURS OF OPERATION Please write in time of day. II30�1hn,t IIi30-1hj I1,)0-1Ar~ � I1;30 1AAn ; ( I%;d�lA, (For example llam-11 pm) 1 , TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ® less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------- YE NO less than 25 seats $140 (Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats 4eg> BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES --------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $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 r!ru d paid all state taxes requr nder the law. /-(/!i✓A�c� Z� i be C)(8' 58' )27 S Signature Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date��_7 /�7'� r $ µ 1 Commonwealth'of Massachusetts ` E City of Salem Board of Health IGmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 03/26/2009 ESTABLISHMENT NAME: ROCKAFELLAS/Jay EI Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2009-0433 Mar 26,2009 Mar 26,2009 Winter BBQ food to be served; Hamburgers hotdogs and ribs Total Fees: PERMIT EXPIRES (March 26, 2009 Board of Health 0 Page 1 t � CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KINIBERLEY DRISCOLL FAX(978)745-0343 MAYOR IDIONNEONALFM.COM JANET DIONNE, ACTING HEALTH AGENT APPLICATION FOR A TEMPORARY FOOD SERVICE PERMIT FEE: 1-3 DAYS= $300 NON-PROFIT=$25 4-7 DAYS= .. _ $600 - OVER 7 DAYS -->7 DIVIDED BY 7 X 600=THE AMOUNT DUE (EXAMP.LE:I4 DAYS DIVIDED BY7 d2 X600, .S1Z00)`•`' _ CHECK PAYABLE TO THE CIN-OF SALEM.N9 SASH NAMEOF-EVENTy)OL`km-G�BLIS U.G - LOCATION GLYP.L -�3I E;uF�i. �b.UGA.I• _ \` p�e1,�r-- _ DATE(S)OF EVENT 3'ci(o'Oga,K — q NAME OF APPLICANT=1 ,,AARA� TELEPHONE# V& �lO�'3Z63. ADDRESS IPO. ROK 141 SC�t,IaW_ IIVIw., OIa70 NAME OFBUSINESS 1`�,k0_&tL,s •,�/ TELEPHONE# r17$'74'•1%l ADDRESS l3 E4l e,v ',�4 i\mIdA01,1170 CERTIFIED FOOD MANAGER'S NAME M.&" Hor _ CERTIFICATION# XE)03.\63 I I A PLAN OF THE ESTABLISHMENT IS: ENCLOSED DRAWN ON THE BACK TYPE OF REFRIGERATION: GAS ICE DRY ICE OTHER METHOD FOR COOKING/HOTHOLDING: GAS OTHER METHOD FOR SAN ITIZING: _CHEMICAL _OTHER 77 SOURCE OF FOOD: NAME: Ro,!.6nI16-IS ADDRESS aZ I ESSZX SIT. l_LI MA �I R 70 FOODS TO BE SERVED INCLUDING INGREDIENTS AND METHOD OF PREPARATION: r dS�OS 4ijOVL naay G�1 N� s CCbk� Cn� �irGo( rI �� ) J I HAVE READ THE BOARD OF HEALTH, "REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS."I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS. I UNDERSTAND THEM,AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT. PERSUANT TO MGL C62C,S49A,I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I,TO MY BEST KNOWLEDGE AND BELIEF,HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE T REQ 7 /' UNDER LAW./!%/�/ _ SIGNAT DATE SOCIAL SECURITY OR FEDERAL ID# TEMPAPPL WAN 11125(02 PERMIT# C1 CK# DAIS x CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745.0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS These requirements are in accordance with the State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.030. This code state%, The Board of Health may impose-additional.requirements_to protect,_. againstA0alth hazards.related:ta the conduct of the�Wpoca�y od Y" f establishment, may.prohlblt the sale of some or all p entlallyy;ha ardour floods, and wfieri !dhibealth hazard`will-result;may waive or modifythe requirements of 1lid0 regulations-, � > Therefore the Salem Board of Health reserves the right to evaluate individual establishments and make necessary requirements to protect the public health. FOOD MANAGER CERTIFICATION IS REQUIRED OF ANY TEMPORARY FOOD ESTABLISHMENT THAT PREPARES POTENTIALLY HAZARDOUS FOODS, ALL TEMPORARY FOOD ESTABLISHMENTS MUST COMPLY WITH THE FOLLOWING: The Board of Health must receive the aoDlication for a temporary food establishment at least one week Prior to the Planned event. Halloween vendors must submit their anotications at least three weeks prior to the event. Unoermitted establishments shall be excluded from the event. Foods served are limited to the following: Baked goods, fresh fruit and vegetables, and pre-cooked potentially hazardous foods. Raw chicken,, raw beef, raw pork. or other raw votentially hazardous food is NOT allowed. The application must be filled out completely. Incomplete applications may result in a refusal to permit the establishment. • The application shall include a plan of the set-up of the establishment including the location of equipment, cooking facilities and cooling units. Necessary permits for the operation of the establishment, including the Food Permit, must be conspicuously displayed. • Running water with liquid soap and disposable towels for hand washing must be available. Bottle water with a pull out spout is acceptable. All food handlers must wash their hands after utilizing toilet facilities, eating, or smoking. Smoking is not allowed within 10 feet of the establishment. • All utensils and food contact surfaces must be sanitized with an approved sanitizing solution. Test strips for that sanitizing solution must be used to verify its strength. • Premises must be kept clean. Refuse and garbage must be disposed of in a satisfactory manner. • All utensils, equipment, and containers must be maintained in a clean and sanitary condition. • Food handlers must wear clean outer gannents and utilize good hygienic practices. • A permit from the Fire Department is required for the use of propane. Contact Fire Prevention at 978-745-7777. A permit from the Electrical Department is required for the use of a generator. Contact the City Electrician at 978J45-6300. Permitmay be,required.-from the,_Licensing�Deparrrient Contact . Q Licensing at 978-745-9595 ,x -TEMPORARY ESTABLISHMENTS MOST ENSURE=FOOD=RROTECTION BY- ADHERING TO THE FOLLOWING REQUIREMENTS: • Only foods listed on the permit may be served. • Cold foods must be maintained at a temperature of 40F or less. • Hot foods must be maintained at a temperature of 140F or higher. • Food must be obtained form a permitted source. Proof of the source must be on site. • Stem thermometers must be on site to check that proper temperatures are being maintained. • All food must be covered and protected during transportation, storage, preparation, and display. Food shall not be stored on the ground. Trash bags shall not be used as storage containers. • Bare hand contact of food is not allowed. Tongs,.tissues, clean gloves must be used when handling ready-to-eat-foods. ON SITE INSPECTION OF YOUR ESTABLISHMENT WILL BE CONDUCTED BY BOARD OF HEALTH SANITARIANS TO ENSURE COMPLIANCE WITH THE CODE AND THESE REQUIREMENTS. IF VIOLATIONS ARE OBSERVED YOU MAY BE REQUIRED TO CEASE OPERATION AND TO LEAVE THE EVENT. Joannes folder:tempfood ROCKAFELLAS A Change of Atmosphere in Casual Dining T. Kevin Marehino OWNER/OPERATOR W W WJW CKAFELLASOFSALEM.COM Cell: 781.727.7542-Office: 978.745.2411 -Fax: 978.745.2471 231 Essex Street-Daniel Low Building-Salem,MA 01970 R APPETIZERS R For the hungry at heart,you can add sweet potato fries to any order for just 2 1J GRILLED TERIYAKI CHICKEN Marinated, skewered and served with homemade sweet n' sour sauce and garnished with scallions 8 JACKED WAFFLE FRIES A mix of Jack and Mozzarella cheese served on stacked waffle fries with bacon bits, scallions,and sour cream 8 CRAB CAKES Maryland style crab cakes pan fried and served with arugala salad and a mango mustard vinaigrette 10 SPINACH & ARTICHOKE PUFFS Spinach,artichokes,sour cream,parmesan cheese, and garlic in a puff pastry baked with a red roasted pepper sauce 9 `OYSTERS ON THE HALF %dozen of one,six of the other,does it really matter?They're all fresh and they're all good 1 1 '/z DOZEN 2 EACH CHEESE FONDUE Homemade fondue with smoked gouda,crabmeat and horseradish. Served with fresh veggies and assorted breads 14 R NACHO NUEVO GRANDE Tricolored nachos topped with chili,scallions,olives,jalapenos,angus beef,guacamole,Pico de Galo,and sour cream 9 OYSTER ROCKAFELLAS Four oysters topped with spinach,bread crumbs,bacon, garlic,and parmesan cheese baked to a golden brown 1 1 FIRED UP CHICKEN Boneless style chicken deep fried and tossed in Frank's hot sauce served with bleu cheese,carrots,and celery 8 CHOWDER & SOUP NEW ENGLAND CLAM CHOWDER CHILI & SOUP OF THE DAY Traditional home style chowdah,rich/thick and We don't know till the chef wakes up. We delicious(Winner"04"&"05"chowder fest) do know it's always fresh CUP 4 BREAD BOWL 6 CUP 3 BREAD BOWL 5 BRICK OVEN PIZZA TRADITIONAL CHEESE SOLO 7 REG 12 VEGGIE PIZZA SOLO 8. REG 13 Imported mozzarella,vine ripe tomatoes,fresh basil Red& green peppers, olives, spinach,mushrooms, red sauce and romano cheese on our homemade dough onions, red sauce,mozzarella and romano cheese WHITE PIZZA SOLO 8 REG 13 CHICKEN & PEPPER SOLO 9 REG 14 Roasted garlic,ricotta cheese,mozzarella cheese, Grilled chicken sliced and accompanied by mozzarella caramelized onions,olive oil and fresh basil cheese fresh red and green peppers, basil, and red sauce PROSCIUTTO SOLOS REG 13 MAKE YOUR OWN PIZZA Fresh prosciutto di Parma thinly sliced with fresh tomatoes Add pepperoni, sundried tomatoes, onions,bacon, mozzarella, fresh basil,red sauce and romano cheese mushrooms, peppers or artichoke hearts for 1 chicken(grilled,buffalo or bbq for 3),hamburger 4 SALADS 11 CAESAR SALAD ROCKAFELLAS ANTIPASTO Garden fresh romaine lettuce tossed with dressing and Fresh imported meats and cheeses' mixed greens,olives, home made baked croutons. Anchovies optional 8 tomatoes,roasted red peppers and artichoke hearts 9 ASIAN SESAME CHICKEN SALAD NACHO SALAD Fresh mixed greens covered with crunchy noodles, sesame Fresh mixed greens with our own chili along with seeds and ginger vinaigrette. Topped with grilled chicken tortilla chips shredded jack cheese in a tortilla bowl 8 and fresh mandarin oranges 9 FRIED BRIE SALAD POACHED PEAR & PORT WINE SALAD Mixed greens with lightly fried brie cheese and sliced gala Mixed greens with crumbled Maytag blue cheese, hell apples topped with walnuts and apple cider vinaigrette 1 1 nuts with sliced pears and port wine drizzle 9 GREEK SALAD MAKE YOUR SALAD A MEAL Fresh cut greens, Kalamata olives, onions,feta Add to any salad:turkey or grilled chicken 2, cheese, cucumbers,and vine ripe tomatoes 8 steak tips 6 shrimp 2 each SIDES SWEET POTATO FRIES 4 CURLEY FRIES 3 SEASONAL VEGGIE 2 STEAK FRIES 3 BAKED POTATO 3 GRILLED ASPARAGUS 3 SIDE SALAD 2 WAFFLE FRIES 3 RICE 2 ASK YOUR SERVER FOR THE SPECIALS OF THE DAY!!! *Served raw or undercooked.Consuming raw or undercooked meats,poultry,seafood,shellfish,or eggs may increase your risk of food borne illness PANINI SANDWICHES. WRAPS &MORE Served until 5:00pm All sandwiches and wraps are served with sweet potato fries In a hurry?We've recommended some items that will be the quickest to prepare.Look for this symbol(FL). TOWNHOUSE SQUARE GRILLED CHICKEN Sliced tomato, buffalo mozzarella,Italian dressing, Served on a roll with choice of bbq,teriyaki pesto on grilled rustic white bread 7 or cajun style. lettuce,tomato, onion on the side 7 231 ESSEX ST THE MISSING STAIRCASE Roasted eggplant,provolone cheese, sun dried Grilled chicken breast marinated in Italian herbs with tomatoes and pesto on grilled rustic white bread 7 zucchini and pesto on grilled rustic white bread 7 % VEGGIE WRAP FOLLETT'S REUBEN Fresh avocado spread, sprouts, cucumbers,tomato, Fresh corned beef, served with a homemade sauer- and balsamic dressing on a spinach wrap 7 kraut dressing, Swiss cheese grilled on marble rye 7 HIGGINSON SQUARE THE DAY AFTER Thinly sliced prosciutto di Parma, provolone, roasted Oven roasted turkey, cranberry chutney stuffing mayo, red peppers, and pesto on grilled rustic white bread 8 grilled on rustic white with a side of brown gravy 8 1/2 LB. BRUSCHETTA BURGER 11 LOBSTER ROLL Served on focaccia bread with a bruschetta mix Maine lobster, chopped celery, mayo, lemon, lettuce, and topped with Buffalo mozzarella 10 and black pepper served on a buttered grilled roll 16 1/2 LB. BLACK ANGUS BURGER $, GRILLED CHICKEN WRAP 100%USDA fresh ground beef,cooked to your liking Marinated and grilled chicken breast with lettuce,tomato, with lettuce,tomato, onion and your choice of cheese 9 bacon,and honey mustard on a spinach wrap 7 BUILD A BURGER 11 TURKEY WRAP Add these; .50 per topping;roasted peppers, saut6ed Oven roasted turkey with lettuce,tomato, roasted onions,mushrooms, Maytag bleu cheese, bacon,jalapenos peppers and honey mustard on a spinach wrap 7 LUNCH COMBO Includes half sandwich and choice of soup,chowder or salad and fries. Excludes burgers 9 BRUNCH (Served Saturday& Sunday only, l lam-2pm) UoW MARYs To DIE FoR All brunch plates are accompanied with roasted red bliss home fries or corned beef hash ROCKAFELLAS HOMEMADE BELGIAN WAFFLE Start with whipped cream and your choice of fresh seasonal berries,chocolate chips, apples,pears, bananas and even gummi bears for the kids 9 TWIN PORTOBELLO BENEDICT Grilled Portobello mushrooms, poached eggs, Canadian bacon topped with hollandaise sauce and garnished with scallions 13 LOBSTER & ASPARAGUS OMLETTE Maine lobster meat saut6ed with asparagus and your choice of cheese 14 ANGUS STEAK & EGGS Grilled Angus steak with two eggs any style grilled tomato and hollandaise sauce 13 ROCKAFELLAS OMLETTE STATION Use your imagination with this dish choose up to three;mushrooms,peppers, onions,cheese, scallions,tomato, asparagus potatoes,ham served with Canadian bacon or sausage with white toast. 10 THREE EGGMIGOS Served any style with bacon or sausage,red bliss home fries, and white toast 9 HALF MELON Fresh in season melon filled with whipped cream or yogurt topped with seasonal fruit and vanilla granola 8 SIDES BACON-CANADIAN BACON-SAUSAGE 3 RED BLISS HOME FRIES 3 PASTRAMI SMOKED SALMON 8 BAGEL& CREAM CHEESE 3 TOAST 2 Plate splitting is an up charge 2 R ENTREES R entrees come with choice of starch or veeetable of the day unless otherwise snecified % BLACK ANGUS PRIME RIB (Served Friday&Saturday)aged, slow cooked,juicy,Black Angus served with au jus and a Yorkshire pudding. 1 20Z CHEF'S CUT 19 1 OOZ HOUSE CUT 17 SOZ PONY BOY 15 (ADD 1 PER ADDITIONAL OZ.) 1h LB ANGUS BURGER 100%USDA-choice,fresh ground beef,cooked the way you like,and served with lettuce,tomato and onion on a seeded roll 1 1 T� MARINATED TENDERLOIN TIPS U.S. choice tenderloin tips, marinated in our own special sauce and grilled to your liking 16 FILET MIGNON 8 oz Choice aged filet,grilled and topped with our homemade beamaise sauce 23 N.Y. SIRLOIN 12 oz Choice Angus sirloin,center cut,aged, grilled and seasoned. This is one of our finest 21 BLACK & BLUE SIRLOIN I Ooz Black Angus top sirloin,pan seared with melted Maytag blue cheese, poached pears and Port wine drizzle 22 I{ COWBOY STEAK 18 oz bone in, choice, aged rib eye in an espresso and chili rub, grilled to perfection.Bring your appetite for this one! 26 HONEY GLAZED SALMON Fresh wild salmon marinated with honey, ginger,soy, cilantro accompanied by sprouts and vegetable rice cakes 16 BAY SEA SCALLOPS Fresh baked sea scallops topped with choice of ROCKAFELLAS sauce or our own crabmeat stuffing drizzled with butter 18 BAKED ICELANDIC HADDOCK Fresh Icelandic haddock with Ritz crackers, lemon,garlic,red peppers, scallions, and crabmeat stuffing drizzled with butter 17 BOURBON TURKEY TIPS Grilled and marinated in a bourbon sauce.No knife required with this dish 15 BABY BACK RIBS Dry rubbed in our secret seasoning, slow roasted then slathered in bbq sauce and grilled FULL 19 HALF 13 FL CHICKEN PENNE Seasoned sauteed chicken with sun dried tomatoes,scallions and Kalamata olives in a creamed chicken demi-glace served over perm pasta 16 TAPAS SHRIMP SCAMPI ALA FOCACCIA RAVIOLI ROSA Large shrimp sauteed with shallots, garlic,fresh basil,tomatoes, Florentine Supreme cheese ravioli butter white wine sauce served over homemade Focaccia 13 accompanied with a homemade Rosa sauce 1 1 " TUNA SASHIMI LOUISIANA CATFISH FINGERS Pan seared rare,coated with sesame seeds served with wasabi Deep fried, seasoned and floured catfish fingers Mayo, mesclun greens and a Mandarin vinaigrette 12 served with a cajun honey mustard sauce 9 FAR EAST FLANK STEAK RUSTIC ROSEMARY GARLIC CHICKEN Grilled Black Angus marinated in soy, lime juice, garlic Grilled&marinated rosemary chicken served with a mushroom and brown sugar. Choice of starch or veggie of the day 14 demi-glace and choice of starch or veggie of the day 13 LEANING TOWER OF PORTOBELLO DRUNKEN DUCK Marinated Portobello mushroom caps layered with goat cheese Fresh Duck breast pan seared in a Bourbon cream Italian vinaigrette,pan fried eggplant, and topped with marinara 1 1 sauce served with the chefs'own mushroom risotto 16 11 CHICKEN FETTUCINI NAPOLEONS QUESADILLAS Sauteed chicken with tomatoes,walnuts, fresh Spinach tortilla loaded with your choice of chicken or beef, dill, and scallions served over fettucini Jack cheese, scallions,tomatoes, accompanied by in a light creamy pesto sauce 13 Pico de Gallo and sour cream CHICKEN 10 BEEF 12 Gratuity not included.Gratuity will be added to parties of six or more. 0227 ESSEX STREET ROCKAFELLA S/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-2411 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Owner: Comment:Cutting boards throughout establishment stained and scored.Resurface or replace cutting boards to prevent cross Terrance K. Marchino contamination. (PIC: Bar using shakers as ice scoops.Provide and use proper ice scoops at all times.Upon reinspection,it was noted that ice scoop Y6 David Mckillop was available but was not being stored in correct manner.Store ice scoop in clean dedicated container labelled ice scoop only,or Inspector: store in ice handle side out.Nothing to be stored in ice used for customer consumption. Elizabeth Salandrea Violations Related to Good Retail Practices (Blue Items) Date Inspected:Correct By: Equipment and Utensils FAIL Non-Critical BLUE 13/20120 3/20/2008 __ Comment:Mop stored in bucket.Mop must be hung to air dry and not stored in bucket. Risk Level: ( Smaller kenmore freezer in basement holding at 12°F.Repair freezer to maintain temperature of 0°F or below. Permit Number: Physical Facility FAIL Non-Critical BLUE _ BHP-2008-0213 ' _ Comment:One partial ceiling tile missing in waitstation.Replace tile and continue to seal any holes or gaps throughout Status: establishment to prevent entrance of insects or rodents. PARTIAL COMPLY Establishment has many gaps,cracks and holes throughout both the basement and upstairs area,including holes around pipes #of Critical Violations: 9 and fixtures.All holes must be sealed to deny rodents and pests access to the establishment. 1 Other-See Notes FAIL BLUE Time IN: I Time OUT: Comment: High level of rodent activity noted at establishment,confirmed by extermination reports.David states exterminator will come twice a week.Fax all extermination reports to board of health at 978 745 0343. 'Urgency Description(s): BLUE: GENERAL COMMENTS: Violations Related to Good f All other violations noted in 3/13/08 inspection report have been corrected. Retail Practices (Critical violations must be corrected # Choke safe certification must be obtained within one month - at all times one person on staff must be certified. immediately or within 10 days)(Non-critical violations must be corrected immediately 3 or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS@ 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 24,2008 ) Page 1 oft 1 Item Status Violation Critical Urgency RED: 'k ,'0 ....� ...�. Violations Related to, Foodborne'lllness Interventions and Risk Factors(Require immediate corrective action),;: . h City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 24,2008 ) Page 2 of D INITIAL SERVICE U.❑.REGULAR SERVICE ' EXTRA SERVICEWe F, .0 BRANCH ACCOUNT. 'RT- r-'TELEPHONE - GRID S.DAY_ ,R T - PRODUCTION . .TIME IN, -TIME OUT r SERVICE PROPERTYAT:'. - ,_ , - - I - - . - .BRANCH=- - - - y n"* ..IL j.r T::, e- . %;. - - - 'tTt�s`Fil;�t .-_✓1... _ . -IOPERATOR NAMEr&CERTIFICATION NUMBER - SUPERVISOR NAME&CERTIFICATION NUMBER - 111111 Target U GarsuicdAwannen 0 Parementans U Rau U mvad acaxunwrers tMaterials Bused 4uam l Pests _ Cl Amncan G«borJ,es U A9rft1 Mia "'T3j acw _ °J am=en vtcevst Peso -I{r 450 insiders 620 WiND-t1P TRAPS i 0 omartal Gd4a .s J F Ams U sllverGan U once,. 1 400 Insists Monitors 610RN CATS I 7 ane,GPCWwchea ❑ otne.Ams C! cues - --, ane+ vl-A10-Phwomena Traps 645 Rat Bait Stations ,Glue Traos 640.Mouse Bait Stations i Pest Control Materials Used EPA Reg.# vc Etc Amount I e3o Snaoiraos 655 Liquid Bait Stations 293 Advaxa GralNa att Bat(Abameuhn Bi}6.91i% 499376 FIAreas Inspected and/or Treated 295 Advance Dual Choice Ant Bah(Abameotin8l)0.011% 499-496 f Pell ConlrtAma[eriNs used mdrcatedhvccdes fmm asratlere I 315 Ascend Fke Ant bat Ntueneeen 84}0.011% . - -499370 . , ' ]F�dgreas - „' - . 1 399 ASelt Roach Bat Shmons(Abamectin)0.05% _ 499-467 I I �J�otnurg Areas r'I'' I 366.Advance 3888 AM Gel Bart Bonn)SA% 494492. I Jim. - - -- 1 I 190 Raid Dust(OdhoWnc sort)99% 9444 29 15 Demand CS(Lambda-cyhalo0uin) 00.015% X003% 00.06% 1061066 jNblw Areas �AecVtacker Rods �` 210 DeltaGardCftalnelMn 0.05% � 432-836 (De ) 158 TriDIs SO Dust(Silica Gep 40%(Pyrelhm6)10% 4N429 _ I Jo¢play Press 41 Gartrd CC(Hydmpomse)0.06% 2724.351 _-- IUtaimdN e.t?n^n� I 640 Generation Miry Blocks Bat(01femialone)0.01125% ' Ti73-218 I'+S'$tonrc3alu14M ].::541 .flonaatipn Bhce.Max BWc%s Bait(Qite0liatoiia).0.00Ya%- -- ._ - 7173-236- 39 Intim Granular Bait(OrthoboneA"S.0%'. 73079-2 I J Prot ving seas I 43 Kmius ECIP"itums) 00.05% 00.1% 002% 432-11455 ' JPauem noomv - -- 650 Uquil.11 Bait(Diane.Salt of Diahxc6wne)0.106% 12455-61 I �G swR 352 Madorce FC Roach Bait Stations(Flpron!)0.05% 432.1257. Uaosemvmt 351 -Maxtorce FC Ant Bait Saii(Rivenili0.01%' 4321256 I 1' 1 367 Maxfmce PC Ant Gel Balt(Fipicalt 0.001% 432-1264 1,3 Root t 354 Modaue RC Select Roach Ba Gel Fipmru'q 0.01% 432-1259 �- -1 Znx A0f 355 Maxftece PG Insect Bait rameth ran 1.0% 432-1262 J farascapea&cosi I Myd N ) I 46 NYIa EG(Pydproxins)-U0.015% 00.02%' - ,11715-307-57076 1 �.. --11.aa pOxkttRrmpsa I 151 PT Cy-10ck Aerosol(CYBurfum)0.1% 499470 Uumer I 70 PTGy-Ktck CS(Cy%Ahdn)000075%U0025%-150.05%:50.1% 494304 - ( I I Precautions.' I 312 PT Avert Got Bat(ALameciin 81)0.05% 499410 J 111_ 69 Pt 565 Plus XLO Aercsol(Pyrethims)OS% 499-P94 ! I , �M ,tet a .ham 159 -PT TnDie Aerosol(sties Aemge04 B%(Pyrethrins)0.69A 499385 -� I I, IAwdbrealtimg vapors mcets,wausu.HarmlwHsraluwetl 81 Tempo Ultra"(CyLM n).U0.025% 00.05% 00.1% I 4321304 Dap nr w too Mam. ( 83 Tempo SC tRt2(CylkNuin)00.025% 70.00% U01% 432.1363 - Trona return to room anal I Old d mibiron.91 UA BP 100 ULV IPyIeNnns11.0% 499-052111540-9 � � I Mnot[auto treatetl areas unw my. j 92 LRD BP 300 UUF Pymthmm3.0% 493456111540-1 tI a s e u.a anotiV na sbramm ma a nss aw as 591 Weehatclok XT Bait(Bradhecoum)OA05% 100.1055 tmalmdtl Gude(r7f.7 Ln LrackB Creviw V=Vatl G=f.neret (. I S..sPPt BT=N. rx=0eettetl Gcnraa rt sxaa,d sP-spate IN=In,ertmr. co tin muceeanfxy G6=C PA snrcy T Trap iI 65=&Lt SIah u NO=H o..te/ A=Aemw1 BC=Bart Gun K-%,-- rTtment F=tXV Posting Service Sticker? 7Y. 7No - - - - - superviscies Comments: SPECIAL.SEMCEINSTRUCTiONS - -Id s:t i. r 0 CUSTOMER'S SIGNASUREY AMOUNTPAID t { .1.: is vkJ - SERVICE TECHNICIAN'S SIGNATURE DQTE I OASR UNRESOLVED PROBLEMS?. ' _ c.' � ; ' - ` GNFGic CALL 4-&Q4-TERMiNiX(1-880.837-6484) v CUSTOMER'S COPY CUSTOMER INFORMATION Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent any conditions present that may be contributing to a current,or possibly a future,pest infestation. Interior Areas Pests Conditions Food Areas Pests Conditions n ❑ Offices O�,Dining Area C3Lobby/Public Areas —_ """f ,!` '+Stove/Oven Line ❑-Entryways �y~` Q rood Storeroom " 'Q Rest/Locker Rooms ❑tDishwashing Area ❑ Janitor Closets ❑ Deli/Bakery — ❑ Laundry ❑ Processing Area ❑ Boiler/Furnace Room ❑ Packaging Area — `C`3,Storage Utility —%- '� .r� ❑ Produce Area U;=aIrefiouse ❑ Meat/Seafood Shop — '°U Basement - - r `} a- Exterior Areas ❑ Patient Rooms /p Exterior Walls-North ❑ ICU 1 f� ('� Exterior Walls-South ❑" Linen Storage Rooms 1 /�L� ❑ Exterior Walls-East ❑ Kitchenettes A ❑ Exterior Walls-West ❑ Nurses Stations ❑ Loading Dock ❑ Guest Rooms ❑ Dumpster ❑ Banquet/Meeting Rooms xtenor Storage Rooms_" - ❑- Display Aisles#,..t•_ . k. - .-❑ Ro ` = - ❑ Other ❑ Other - ❑ Other ❑ Other 1. German Cockroaches 6.Pharaoh Ants 11. Occasional Invaders V, 16y Rats 2. American Cockroaches 7.Pavement Ants 12. Hunting Spiders ti17.Mice 3. Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests 4. Outdoor Cockroaches 9.Argentine Ants 14. Brown Recluse Spiders 19. Other S. Silverfish 10. Ants. 15. Black Widow Spiders 20. Other A. Drain Clogged/Dirty I. Paper/Litter Q. Poor Storage Practices Y. Move Dumpster Away From Bid B. Food Debris Under Table J. Water leak R. Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned C. Food Debris On Shelf - K. Mops Improperly Stored `S._Seal Exterior Cracks/Holes AA. Mercury Vapor Lights Outside D. Food Debris Under Appliance L. Trash Containers Need Cleaning T. Trim Back Tree/Shrub Branches BE.Keep Doors Closed E. Wet Organic Matter in Cracks M.Heavy Dust/Dirt Deposits U. Remove Piles of Debris CC.Repair Door/Screen F. Grease Deposits on Floor - r-N. Numerous Cobwebs Present V. Cut Tall GrassiWeeds DD.Replace DoorWeatherstnppmg G. Grease Deposits on Equipment A�l3epair Floor/tiles/WalVCeiling W.Improve Outside Drainage EE. Poor Outdoor Storage Practice H. Soiled Dishes Left Over Night. 'P.-'Seal Holes/Cracks in Walls X InstallGravelFoundation Barrier FF. Other Con ntent� tno{t C,,&a -Ka i Its does wok- 014;,,1' lei �� Ct>� �w `� �o S6 giovv� -r!Ls phi A4 ova Customers Signature''`r F Service Professional's Signa ure''LDI" '=✓` `r Datee l r't ` TIICTlIhAGR'C(:APV 5^ kI f At 790849t'i 1:11d'.;e I'r:i.r1'l.fc§rl , , , 0f #1.0C t it30 9046679021 T �kINITIAL SERVICE 0 REGULAR SERVICE L] riNMIN® EXTRA SERVICE 04-•04:3 l7 rr,)u 1-ar I.OC* rtr'e-Til elf, * to o- � , . . � . BRANCH ACCOUM AT. TELEPHONE GRID S.DAY F T PRODUCTION TIME IN TIME OUT : :3C3'7 1D(�7t11i3};r[1L=i._ ?4'1.:E 2 6k rGa , Glt) 4ff}`>.'f0E3 J!"0257 ( .171:)) 74;'J'•-24.1.1 (41::. f SERVICE PROPERTY AT I BRANCH r0CI(E F r:-i:rzi7 t#: #e #zraa:x srlr .#a#�I Txcarr,t.. 1.30 r-,U.)Ml"r RD ROAD; i1't..G 9 ,Pf! 01970 4`7 j,i'TLlt4lIM 1 02466 (OPERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER OF•IN F 7.76;.'.;6 P':Cf;L .JI , 1I H1!".'i9 Target 0 Gem,an Ctckmaches 0 Pavedent Anis 0 Ran,,,.'/ ❑ oaa-anal m=asers ' Materials ruse, ( Iuuaaa Pests J Amer.Coclaorl J Argenters Ann �MI V J Stored Protect Pasts (400 Insiders 620 WIND-UPTRAPS ❑ Q rsffd@ kmaches U Fire Ants 0 slivernsb J Other 1 400 Insect Monitors 1 610 TIN CATS quer Gtckmaches 0 other Ann J Res 0 Other 1410 Pheromone Traps 64.5 Rat Balt Stations 1 I o.... Glue Traps 640 Mouse Balt Stations i Pest Control Materials Used EPA Reg.# T/C PJC Amount 630 Snap Trans 655 Lapuld Bait Stations 293 Advance Granular Ant Bag(Ammedm 131)0011% 499-370 j Areas Inspected and/or Treated 295 Advance Dual Chmce Ant Bed(Abamectm8l)0.011% 499-496 Pec,4omrorma,eoals oaedadrrated byeades from bslallef 315 Ascend Pre Ant Bait(Abamectin Bl)0011% 499-370 l"FcW Areas # 309 Avert Roach Bad Stations(Apartment)0.05% 499-467 o Cmrtg Areas 365 Advance 3886 Ant Gel Bak(Borax)5.4% 499-492 100 Bor d Dust(Orthobonc acid)99% 9444-129 ❑C cls 15 Demand CS(Lambdacyhalothnn) J0.015% 13003% ❑006% 100-1066 I-J Public Areas, tin x Pav 210 D¢IlaGard G(Dekamelhnn)0 O5% 432-836 -t RestMcker Rooms 159 TnDle Bulk Dust(Silica Go 40%(Pyrethrins)10% 499-429 UDeplay Areas 41 Gentrol EC(Hydraprene)0.06% 2724351 I J tsund,y/Boller Room # . 540 General kill Blocks Bail(Ddethlalone)0 0025% 717&218 ],e storageMh % ity ' 541 Generation Blue Max Blocks Bag(Distillalons)00025% _. - 7173-236- - - -n 1:];V.hous,Ared p 39 Inlie Granular Bag(Odhobon,Acid)50%'` - 73079-2 IJProcesT seas 43 tacker EC(Pyrethnns) 00.05% LIM% 1302% 432-1145 J Patient Rooms i 550 UquRox II Bail(Olsodwm Sell of Diphacinone)0.106% 12455-61 I Guest Rooms 352 Maxforce FC Roach Balt Stabons(Fiction)0 05% 432-1257 1 y 351 Maxforee FC Ant Bart Stations(Flpmnll)0.01% 432-1256 aaeemess 357 Vendors.FC Ant Gel Bait Fishing)0001% 432-1264 uRtof 1354 Maxforce FC Select Reach Bob Gel(Fipmnlp 0.01% 432-1259 a Extend Penmeter 355 Maxfome FG Insect Ralf(Hydramethylnon)l 0% 432-1262 0 tandetaped Areas 46 Nylw EC(Pynpmxylen) J0.015% 00.02% 11715-307-57076 J Loatling Dackfuumpner 1 151 PT Cy-Kick Aerosol(Cyllulhnn)01% 499-470 Joiner r 70 PT Cy Kick CS(CAulhnn)000075% 00.025% 00.05% J0.1% 4991 312 PT Avert Gel Bag(Abad In8/)005% 499- Precautions410 Keep out of reach of children and pets 69 PT 565 Plus XLO Aerosol(Pyrethrins)0.5% 499-290 I 159 PT TnDle Aerosol Silica Ae a 48% P hrms 0.6% 499385 May peeeye.naso,mmat,trekmint anon ( m9 0 1 net ) I Avoid dreathlrg vaPtrs mists,or ea=ts Harmmirtswalmwea 81 Tempo URm WP(Cygulhnn) J0.025% 00.05% 001% 432-1304 Dampen granules to aobvote 83 Tempo SC Ultra(CyflNhnn)00025% 0005% 00.1% 432-1363 '"'not temper in rodenbcme p'acemenn 91 ULD BP 100 ULV F rethnns)1.G% d99-051/11540-9 m not touch torted e.ohl after venttlatbn { Do not touchtreataiareas off dry iE[ 92 ULD BP 300 UW(Pyrethnns)3.0% 499-050/11540-1 I For flea treemrents,remain on veatea area for amimmum of four n6urs or untllary 591 Weatherblok XT BeR(BiddRacmum)0005% 100-1055 Treatmermeoffil e=Cackacamce v=Vold G=General <d/ (fry ' to I, r S=Spot BT=Baa DC=Directed Contact 0-3 Blind SP=Space f hIu- IN=Inspec4on t B9ruPmem coal lPJC7 cs=comp Air sprayer r=rap t �•r`+-�.-f Y -t a".. 1'�'J las=Bent Stars, HD=Hand Duster A=Aerosol X `}""( ' I Its=and Gun al,=Povrer Treatment F-LIN ( R4 Posting Service Stickel J yes 0 No c i �) 3 �.,-t{,y ��♦ f L f' ftt:�. Q`[ l Supervisor's Comments: i :i.o T' B 11:171 ce. 51O , tit} 1 SPECIAL SERVICE INSTRUCTION QI �Q%� (y a X C 111:1 T'9 F:J. , , , + kess /CUSTOMER'S SIGNATURE r l)'t'. 1 CI IA E. r t 17 �'' _ AMOUNT PAID +, , DATE SERVICE TECHNICIAN'S SIGNATURE J. } CASH UNRESOLVED PROBLEMS? f c^,3 J CHECK CALL 1-S00-TERMINIX(1-800-837-6464) fa I.4T(-)MFRrS Rf1pV i CUSTOMER INFORMATION N l 1 x''31 L';iiSE:A`. T ")01 E11 ,HA 01970 = Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent {t, any conditions present that may be contributing to a current,or possibly a future,pest infestation. I r Interior Areas Pests Conditions Food Areas Pests Conditions C) Offices LI Dining Area ❑ Lobby/Public Areas El Stove/Oven Line i ❑ Entryways "CI Food Storeroom ❑'ResVLocker Rooms � O Dishwashing rea , ❑ Janitor Closets ❑ Deli/Bakery ❑ Laundry t LJ Processing Area f . ❑ Boiler/Furnace Room _ ❑ Packaging Area -❑'Storage Utility 777" e-1 ❑ Produce Area ❑ Warehouse ❑ Meat/Seafood Shop i A"Basement 14 Exterior Areas ❑ Patient Rooms ❑ Exterior Walls-North ❑ ICU ❑ Exterior Walls-South ❑ Linen Storage Rooms ❑ Exterior Walls-East t ❑ Kitchenettes ❑ Exterior Walls-West + ❑ Nurses Stations ❑ Loading Dock ❑ Guest Rooms ❑ Dumpster ❑ Banquet/Meeting Rooms ❑ Exterior Storage Rooms ❑ Display Aisles-# t ❑ Roof j ❑ Other ❑ Other 1 ❑ Other ❑ Other r 1 1. German Cockroaches 6.Pharaoh Ants 11. Occasional Invaders 16 Rats } 2. American Cockroaches 7.Pavement Ants 12 Hunting Spiders -�j7:'Mice i 3. Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests ` 4. Outdoor Cockroaches 9.Argentine Ants 14. Brown Recluse Spiders 19. Other 5. Silverfish 10. Ants. 15. Black Widow Spiders 20. Other 1 A. Drain Clogged/Dirty I. Paper/Litter Q.Poor Storage Practices Y. Move Dumpster Away From Bldg. B. Food Debris Under Table J. Water leak R. Repair Water Damaged Wood Z Dumpster Area Needs Cleaned C Food Debris On Shelf K. Mops Improperly Stored .S�Seal Exterior Cracks/Holes AA. Mercury Vapor Lights Outside D. Food Debris Under Appliance L. Trash Containers Need Cleaning T. Trim Back Tree/Shrub Branches BB Keep Doors Closed t E. Wet Organic Matter in Cracks M.Heavy Dust/Dirt Deposits U. Remove Piles of Debris CC.Repair Door/Screen I F. Grease Deposits on Floor N. Numerous Cobwebs Present V Cut Tall Grass/Weeds'' DD.Replace DoorWeatherstnpping 4 G. Grease Deposits on Equipment "O.'Repair Floor/Tiles/Wall/Ceiling W.Improve Outside Drainage EE. Poor Outdoor Storage Practices r H Soiled Dishes Left Over Night "P'Iseal Holes/Cracks in Walls X. Install Gravel Foundation Barrier FF Other Comments • C!�pt» LT, ; �� ct'�..1'J 5 t ' It Customer's Signature / A^.,� I Service Professional's Signature{ 1— r /Date a CIMP®RTANT MESSAGE ) FOR DATF v�`" � �U TIME��a� 1�. M OF PHONE AREA CODE NUMBER' EXTENSION ❑ FAX ❑ MOBII P AREA CODE NU ER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AOAIN Ih WANTS TO SEE YOU 1 RUSH RETURNED YOUR CALL �I WILL FAX TO YOU L MESSAGE Y SIGNED � FORM 4009 s MADE IN U 5 A. I IMPORTANT MESSAGE + hFOR . o A4, n fes'/DATE E �_yaP.M. A-tvl- 3 -�'�' -O TIM C M OF �5 PHONE /- 4/ Z'l- q G/ AREA CODE NUMBER EXTENSION O FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED V PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH Ir RETURNED YOUR CALL WILL FAX TO YOU I MESSAGE SIGNED WyopsFORM 4009 MADE IN U S A. IMy�PO . .ANT MESSAGE FOR vn I'h4 TIME GATE 8 A.M. M �r NetsG OF PHONE 1$ - 3� L+c/ AREA CODE NUMBER EXTENSION O FAX O MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU 4 RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE E W zqi t5 4t 4mac (k' +o ,/ou "azo t I SIGNED f ; � FORM 4009 YYY�� MARE IN IJ 5 A �� - --- .._ - - - ,/. — ' ,` S�1�N s, - a i IMPORTANT MESSAGE FOR r (I A M. If DATE TIME M OF D xvAppJ/.v_ PHONE ?Z — AREA CODE NUMBER EXTENSION O FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED v EASE CALL CAME TO SEE YOU WILL'CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR C I WILL FAX TO YOU I J MESSAGE ,Hzc/%piP�t/r r SIGNED �/ r W� FORM 4009 MADE IN E A NOTES I 0227 ESSEX STREET ROCKAFELLAS/Jay E/ Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-2411 Separation/Segregation/Protection FAIL Critical ❑d RED Owner: ILComment:Arctic air and kenmore freezers in basement had potentially hazardous food stored with ready to eat food.Organize Terrance K. Marchino freezers to separate PHF from RTE food. PIC: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Kevin Marchino Comment: Cutting boards throughout establishment stained and scored.Resurface or replace cutting boards to prevent cross Inspector: contamination. Elizabeth Salandrea I�p mb�c 6 "-tw wts6Viz b�H�Q� e n ie Bar sing s kers as ice scoops.Provide and use pro er is ops a al tim Date Inspected:Correct By: L. 3/13/2008 Handwash Facilities FAIL Critical RED Risk Level: 4. omment: Handwash sink at bar obstructed with bowl.Handwash sinks must be clear and accessible at all times. 4 Men's restroom missing soap in wall-hung soap dispenser;dispenser was labelled toilet cleaner.Replace dispenser and keep filled Permit Number: at all times. BHP-2008-0213 Status: VIOLATION #of Critical Violations: 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page 1 of Item Status Violation Critical Urgency RED: a r � � 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 ,�mment: Bread in kitchen uncovered.Cover at all times. immediate corrective action) �Trrue salad unit and pizza unit had some uncovered food.All food in storage must be covered at all times. d4ottles of salad dressing in small refrigerator near dishwasher have accumulation of dried dressing on them;clean and sanitize the dressing bottles. Equipment and Utensils FAIL Non-Critical BLUE — Comment: Mop stored in bucket.Mop must be hung to air dry and not stored in bucket. Vrrue salad unit needs general cleaning. rue pizza unit needs general cleaning. ¢IM//asterbilt freezer in kitchen needs general cleaning. &I.Sa/me unit missing thermometer. Provide visible,accurate internal thermometer for this unit. bPryolater needs general cleaning. 1CJ! ill area has build-up of grease;thoroughly clean the entire grill area. k6eillcer in basement needs general cleaning, including the table and shelves. —Smaller kenmore freezer in basement holding a 15°F.R pair freezer to maintain temperature of 0°F or below. 4/4aSmme unit needs new internal thermometer. t,�mi-fridge in waitstation holding at temperature of 55T.Items discarded from fridge at time of inspection. Fridge may not be used until repaired to maintain temperature of 41°F or lower. Physical Facility FAIL Non-Critical BLUE ikoFamment:Window in kitchen has ripped screen.Repair or replace screen. PAIruminum-wrapped pipe in kitchen had gaps in wrapping and insulation was coming out.Re-wrap pipe to ensure no insulation is exposed. ew cement in basement must be sealed. oam Ceiling in walk-in fridge in basement has foam chipping off it.Provide ceiling material that is impervious and easily cleanable. ¢� �Svtct(1 O)ca slff/ n7IS 7! everal ceiling tiles missing in basement and one missing in waitstation.Replace ceiling tiles. i Establishment has many gaps,cracks and holes throughout both the basement and upstairs area,including holes around pipes and fixtures.All holes must be,sealed to deny rodents and pests access to the establishment. ��{� Vim d)-, City of Salem Board of Health 120 Wa3ffington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page 2 of rE - Item Status Violation Critical Urgency Other-See Notes FAIL BLUE Comment: High level of rodent activity--note'd-atagwAlskment,confirmed by extermination reports.Owner must comply with exterminator recommendations and r 'n foundation ith cement to seal all potential rodent entrance areas within 3 days. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. Notification of repointing of cement to be given to board of health within 3 days. -R4a� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page 3 of t -S ` CITY OF SALEM - �/ BOARD OF HEALTH t I Establishment Name: hne-V r_��l 1 ; t v Date:i� (.�1 I �_" Page: I of Rem Code C-CrRleaI Item DESCRIPTION OF VIOLATION/ PL'AN OF CORRECTION Date No. Reference R-Red Item - Verified PLEASE PRINT CLEARLY It (I on f f lin , ro r Ii-a,- ( h ! F 10 'Qa/ ,mbl 0//}-(J1/'r! i r n. t � 1 o_n n n 0 I n m '__X11in_.n /JI 1 1 10n �Fn /'+/II tY/,11U �� /tfl!/lA i7� �j( t�-F r'{Z, /1 � /l/ l 1 �O// ,r'n \`naa l' 'i o Ti r:l k A n Jn ,� 1 rrd�f i��)�rrrnrn`i 1 " ri '1 rl moi 7`7 r vi !I i:I .n � �h� !, iC ir1,�/� f�, Iln.A)In4A 1i1a!10✓ �'�ninr� .' 1 v _ v_ _ . _ v . . J v - , I lnl�hn,n� /tih/I1w/� Tt� -�n�`� �L-hI/1ltc�nYvto(1 -�-- � d1n0-{ 1AIi�n �/OI-hen �Divi(��rl�� ht. �nnn nk � Cnlil\gad VYnnInd 11n , 40181 Al\;r\vn -I-9,. In/aCOf;pfd014 \1 4,,\nn o I w 1n� /r,n�( !10 nf7 71x1 QVI 16i - t�,n n t�0U ltitrtC 't� A (_1V�0 � lnnlinl In!_a ,T r I � A - r I ,nyn�� 1 \/71WQ1111_PD ( lr-,^�P Ian.. 5i�nnn IInI >1h Ylnn I /I f\ n /1 0A e QA Ina n n I rn � %+ IA ��' T t I 'C n CII Y\ rir� b(Yl to ,, fir\ n(I A ,. , �n /_S rF 7�n, J I (ti� /) \off _/? G C J1 I I 7(1 nn� � -1-n I/YO__r nr$ t1 /,) /ZV /l14 /Z 4`I �i7P� � t`� Vf Iltr/1(!," \n/_, op -P rn(pI 1") ./i 1)-a /LIC I_I1 / Corrective Action Re uired:' ❑ : No ❑ !es Discussion With Person in Charge:', d Q I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension Z 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. `/��1 l 1 ❑ Voluntary Disposal ❑ Other: f i rF Violations Related to Foodborne Illness Intervention$and Risk lo U.'. Cooled w } Factors(flepts 1-=) (Corti) th'itbin.+ Houie, lll,thod�too Vlff-'� PROTECTION FROM CHEMICALS Food or Color Additives Pi4F Hat ind Cold Holding 5(9 , I it t r,oN pfli-.�.vlairtt,hr�d at or 1400(1, 1- ;-302A4 prottcl[joll from(41alilln,"xi �'Adlljvl::O i Poisonous of Toxic Substlinces 3 1 At A) i ljoi I ll: is ab,,)v,,, 101.11 OrqJwd i "cej-VF. J'A"Lahim, 20 1 Timv ss f)Ps�bhc Heafth Control Climm"n Nang. - WorLirl�a 01W41n,-r�, i t w.I I I I Tim,-Z,a puhh,:l*a1th Comi�ui 1 i Rewitilon -pw.cwz alid L>t, 7-_02,12 cmdilionr ut US0, 7.203' 11 lox;,. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i-_04. 11 Sanitiser..critt'ri",.-chollic"Is, POPULA-mONS{HSP} It Sf 11 ill-V? ta,kayd Jwl,es wid 04 Chejltic,t4 for Wa1lii�,c I'l-orhice,C14,liiq Hc"(-'Ute: 'Vill, l'al"lhl. 7-204,14 Dyling Amit��Crm-ria` 7 20', 11 Incidmial C lnflr t.I-libi;k'anril, 1 3-S01 11MI P,iti,jj, Fd ij 7-206.1 1 Rl::;limd tli,c P�vw Strfl",orolit,4 N')t 1 R<liew Boil Ni:o!l,w,1 Nol Re�er,,Ld 1 106 11I(:,&ing P-1-m and CONSUMER AO'li;SGRY TIMEITEMPERATURE CONTROLS Y'Plw',:j [,if Ckrij.:uulpuor,ot, 16 Proper Cooking Temperatures to, Imlini,I Flqyj, lh� .qc I'iaw, 'l Not PHFS i0? tkAflt :iFi;Q 15,'•"." I. i�w:nisi F;W RlAw ShOl lllcll�lhate sol,•ik.� l'i 5 q; 3-401A I(A)(' 1 Vi%b, MQ.tt" Anil)d'-, 1 1',-)T I Pick and i3eet Rwm - 1"o SPECIAL REQUIREMENTS 155F1, 521,!0091,%) (D i Vii, lli �• Clhal `Q0J)('9(A)-(Dl in f,A,L'ieMptlraiy mid 401.11!Ai Ilowirt,Wild GuilL, Vtuiiej Nff.+, hoOd he viil, Meat, tw'ai� epnatc. 'k f�-x X1 borl I k! i{it I 3-401 llick';) WhIv mki'de, itit;m I . I vt:ilticln;40ij 6�1- faciiir� 01h�l 590-009 ',iohA6(irl;!Oalimi to gokld fkliul ",4(1:.j.- Raw Allilrial VvlxiC',mkf d in a ;h0old he lkbilcd under #29 - Ilia uv Ulk T 's� i,,1' , -40 1,11(A)(1)�b) N I I-,s - I ,51 i' I D7 Reheating for Hot Holdlng VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11;10&4 D) N&, 1651: 15 {Item-23-36i) 3-102.11(B) "V11clo"kaw- 10,f,< Minw,Blanding f Cd;l;,:t,.;teat filp a! wh;,h do,w: -elate pi 4w nm be se,rias. ode awl V?i ("WR ,d portion" ileirr I Cood Retail Practices -403,11 F i Rcmalltm�-Lash( .4 Ilid FC. 2 i N-3 Poopor Cooling of PHFS -501 IA(Ai I Cwlitli: i1fil-F from I tli`17 ji 6;,-, PC-.5 1 00b 701, Within 2 1 hluv.wid I'r,,,m 19-F 27, F Facliry Fr,_g W7 to 11'F,10 F A"ithin 4 How, TFC-7 OC,8 3-501 4(ft) Crniling flliFl,hiiidc Flom Mnbiew 50ocial 1'4,nij.-fratkne lu,imdievr,l iv 4!'F�151' € IP.1""_ .,.ClineT- .......... 2, Wahm 4 fl,Au�I isucal ill l,-l-tew: 1,1911 110."( M)" t!o t Oil CITY OF SALEM '/^ r BOARD OF HEALTH Establishment Name: l k&��'"( l (1 Q Date: r! a 111 Page: n( of (� Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item • ' Verified + PLEASE PRINT CLEARLY { Main Y)wui A Yl iC riq -c)o n" 1-1n o a . P_or-fit. W&Uy -1-n VlindSrinic' /-Y-- P , f I �,'r-�hwe �")�'Vrm 6 -4-►nno 1,�`�l Av rlyy n/"1�iv��rfi�rC oaaih 'do _ Q�/'t n I`h l t��-r� i � . ��,nR �-7, 1�i V'�,�,, r:ad ✓v01(7,t�oti' Am loo�" Iiia Ino VPmn � (,A SIM A-t� by YY1 a t ! rn v3 Vl xu' ;' w ir '�f Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance El Employee Restriction/ Exclusion 4 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 o,,rnsuspension/revocation of Ll Embargo EI Emergency Closure your food permit. u ❑ Voluntary Disposal ❑ Other: I � I PHF,1".c"eiv^r,:at 7•c:uperauTea Vio1R!=-.s Rela;eti to Foodborne illness interventions and Rich Aco) d,•�,UJ i-w;, Coded to Fartors(!tees 22) (Cont.) 41"Fl-t5`F Within-< Hours. ' 3-S6i.i5 Cov:ir:;; ble:hodsfor PHF:: PROTECTION F ROM CItE:MICALS j 1-4 1 Food or Color Additives 1 14 PMF Hot and ColdE-taid!ng 3-501 ih±Bl 1'nid P?IFa S'i.nrhunct(at .,:b:i:r:✓ ,202.12 Ajtlicivcs' i z 102 Id Protection from I:nappnned Addihvec' j YHF:. rvtnintamed;,,;r::hnve 1^ Poisonous ov Toxtr Substances j t i ldenbijlne Inibrn:ait'll-Orir!ina! 140'5 '- . t oresnety:< 1 3-50:.:6(A) 1 Roasts Meld a;or abrnr '; F 30° , r '-102.11 ! Common Name-W,trkiae Contamets` ( 20 I Time as a Public Health Control j .lti Time ac a Public Health Cmool* i �O1.I1 � Sep<:rn;ion- ;atx�oc" ; ' , t 59()OC fW ( varaneekeyurrell 7-2:)2.11 Reshicm>n- !resence and Use 7 L C,• mlllmns�a tfsm 7--'u? I ?'oxi. Conta;ner,-Prohibitions^ j REC WKv-41ENTS FOR HIGHLY SUSCEPTIBLE 7-20,1.1 S:.nirizers.C:i teriz-Che::nrds POPULATIONS(HSP) 7-2(1-1.12 Chenucals for Washing Produce,Crirena": 2i +-50:.!ii.\) iinpa�leur;red I'r.:-pac?,.:p?ed Iuiss.:Ilii 7-204.1-1 Drying A,ttente.Cn:ert? Bevcct^_en c.iih W'arnin,n,t abels` i-801 Villi Use of Psstoo�izeu^!: j '-205.11 , bicidemA Fntxl Contact,Lubrmens" 3-SMI ItT)) Raw or Pattiflq Cooked animalxl Ftxand j 7 206 4 1 R.,:n wled Use Pe,siicules,Criteria, 1 j .7 2 i, e, ! t krv;Secel FpromF'tint Ser,,ed. "_tt6.13 " 96.12 1 Fni .i Ban. .,aeons"ng Poa��der�..Pest Control and ! z-ill)I.I i(C) Ungrellcd Food Pjcka;;e Not Re-set ed. "T- IFrackii nhoil to1;ri CONSUMFR ADVISORY TIfil a)TEMPERATURE CONTROLS 22 3-6031 I I Consurncr auiviso } Pu,ted for Con.umpdon of ,:vnin:al i-liods 1`n it.tic Raw, Undetcooled of 76 j ( Pieper Cooking Temperatures for ( Not Otharn'ise Fmeemed to Elirtnnate PHFs f 3-40i.i1.41Ui2i Eggs- 155`17, 15Set;. i'a[hona Ila. El•cs-Immediote Ser:ice Id5"F15secf 3 302.13 Fa�teur.zed Eggs-Substitule fn:Raw Shell -40L111A1(2) Commir:tuedFish, Meatitk(came Fm!O ! Auitnals- 155=515 szc '" .i-•N;I.it x SPEC!ALRFQUlPFA1=NTc (i )(1 i�c) Poll, and Hccf RoaFt- 130"F 1_I runt 59ti 009(;\)-(D) Vioiaiiims of Section 590.009(A)-M) In 3-401.1 i(A)Q) Fatites. Injected Meal,-- 155`F 15 ec. " r;tcrira,, mol)Oe food. ternporary aad z 3-40L' 11()O) Poultry,Wild Gam,, muffeO PHFs remdentwd kitchctt operalions shotdd he Crofting Containing,Fish-Meat, :{coiled under tits -,ppropriole sectlor.s Poultry or Ratites-165"F 15 sr.. j abort; if rel^ted to foi dbornc illness ltC:(;) \Vhole-muscle,lilac: lf-MSteaks I tnierwntions and rist. factor:. Ovhcr 145°F '_ 590.009 vio!rttions relating to good letcil ? tlol.12 Rau Aro mal fi o&Conked in a praalte.shonLd he debited under u29- Micuaware 105'1-'* Special Requirements. ?-10 Ll iCAKI t(b) All Other PHF:-- 145'F 15 sec 17 F?eheatirtg for H¢1 HoldingI VIOLATIONS R.i.ATFO TO GOOD BETA&FRACTIC[S 3-403.1 (A)MD) PtiFe165`F15sec. '" (Items 23-30) Miciowave- i65`F 2'Nlinute Standiue Citic4l n_:..I ron-critic✓(cit :'uau;:s, wtvth du:rut relate m the Time' foodborne oiiness interventions and i isk jac tors fisted above, can he 3-4(i';.11(C't Comntcrc rtlly Pi t essed RTE Food'- fn:utd m tic fdin+:v rq sections cf rin:Fn„a Co e,10;11 fps C47P 140"F` I 590.fN10 -403.1Ii F? I:rnmo'lo"lnr heed Pcrtions of Beef 'I item Good Retard Pra•:•t;ces FC 530.000 ' hoist:.* 23. Management and Personnel FC-2 .003 1?Y Proper Coolie o}PHFs ( 26 Fred and Filed!Protection FC-:' 004 P g 2E t - 1-=--------� I Equiomeni and Utensils Ft;-4 ! OD5 -501.1d(A) Co.�lm;t Cooked PHF''s from 14WF to ( 26. Water,Pluml)inq end'Wasto FC-5 I Ct06 'M"F Within 2}-[none and From 7WF j 27. Physi(;.il Farfi"v FC-6 rn7 -- ' to 4 i`F/45'F Witlan 4 Flour,. T � 8. Poisonous or Toxic h1atena!o FC -7 I .008 ? 50 L 14(g) tooling PRFs Nlade From Ambient 29 Specia;Reeuirements 009 � 'I'rmp,,molre ingredients lo,P`FM i.F -3f', Other Within?Hours n,Vd 2a.... ' Dcnucai item m the 1;rl.rat 1094 Fno.l Code t,r I o5 CNIR 5911 r1110. I IMPORTANT MESSAGE FOR DATE M OF PHONE AREA CODE NUMBER EXTENSION ,U FAX U MOBII F AREA CODE )iUMBER 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 69,* J9 (' �aw11.A rl�L�j/ax �/sl-y>�Ox/fXS'i,Ce+� r IGNEO,'„/ � VIEW. J/710f.' FORM 4009e�l YY��77 MADE IN U S A NOTES J Lli f i i I � I I�' 1 i ltty r d t i �r " PQuy a hs' lab �vl � y � � i � � �,�. - - i Y _ - - I_ .- - -- - �� ri Commonwealth of Massachusetts City of Salem Board of Health IGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01470 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: ROCKAFELLAS/Jay EI Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE SHP-2008-0213 Jan 4,2008 Dec 31,2008 $420.00 ESTABLISHMENT _ Total Fees: $420.00 PERMIT EXPIRES IDecember3l,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 19 of 24 e 3v CITY OF SALEM, MASSACHUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOR r` ^ - TEL. (978) 741-1800 u ,[ KIMBERLEY DRISCOLL FAX(978) 745-0343 r "" MAYOR fscoTrasALEM.COM DEC 7_1007 C'. . L.r= ANNE SCOTT, H TH FIEALTH ENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT G --L TEL# 6'90- g43 - aya ADDRESS OF ESTABLISHMENT V-C(�UO 1St- FAX# MAILING ADDRESS(if different) EMAIL-Business': II&SSGlelA, 0. MIO •GON1 Website: 1j.) 2t Rev-o��l4f aSlet-v , C0!"I'1 OWNER'S NAME bwvl UAekd�p1/I 4YGw5z, k--k1a1-6ii1IAD TEL# / CX ' - ADDRESS LRO( d zp "_<4 AI 1 C_ C STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) L( 4et V "Ili CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION ,,/ ?013 116 r, it 30 w w^ o' r4 M Please vette in 6me of day. Iit 30 y}�� II �R o� 30 / ; ( � 1/1 / II � (Forexamplellam-11pm1 IO ' M IO 1..v k} WNn ( WDtn• r t4 I., SA TYPE OF ESTABLISHMENT FEE (check onlv). r 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$21 25-99 seats _ 280 more than 99 seats $42 - - -._---------------YES....... - - NO $ ---------------- -------------- --- ---------100 - ------ BED/BREAKFASTI CHILDCARESERVICES ....-. -----.. ---------------------------- - ------------------------------------- ADDITIONAL FiikkTS 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 paidd alLst taxes regw d under the law. 3��S7eln Date — Social Security or Federal Identification Number --'-- ------------------ - -- ---9 _ – $� ------ Revised 4/24/07 FOODAP2008.adm Checkft&Date > 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-2411 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑ RED Owner: Comment: Kitchen has cutting boards stained and scored. Cutting boards on order. Terrance K. Marchino PIC: John Pellecchia Violations Related to Good Retail Practices (Blue Items) Inspector: + Equipment and Utensils FAIL BLUE John Gehan Date Inspected:Correct By: Comment:Walk in fans have dust surrounding them. Clean fans and surrounding area. 4/18/2007 1 Downstairs walk in floor has accumulation of ice. Find source of leak and repair. Risk Level: Permit Number: BHP-2007-0325 Status: 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. Apr 18,2007 ) 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. Apr 18,2007 ) Page 2 of 4 � 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises CL-- City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-2411 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment: Kitchen has cutting boards stained and scored. Resurface or replace cutting boards. Terrance K. Marchino ' PIC: —,,Pn fuer to be readily available at all work stations. Kevin Marchino Handwash cilities FAIL RED Inspector: John Gehan Comment: Papertowel dispenser missing. Provide dispenser. Date :Inspected:Correct B P Y 4/11/2007 Risk Level: Permit Number: BHP-2007-0325 Status: Open # of Critical Violations: 3 Time IN, (Time OUT, Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 11,2007 ) Page 1 of 2 4 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 pd'mment: Knife found with accumulation of food debris. Thoroughly clean and sanitize knives after each use. immediate corrective action) Equipment and Utensils FAIL BLUE ,form ent: Pizza refrigeration unit requires general cleaning. e unit-has no visible thermometer. Provide visible and accurate thermometer. nives stored between knife rack and table. Knives to be stored in knife rack or designated container. Ansul system requires thorough cleaning. Tag states 3/07 due for cleaning. rill requires thorough cleaning. -�Walk in-fans have dust surrounding them. Clean fans and surrounding area. UpstairsbWalk in shelves require general cleaning. Downstairs walk in floor has accumulation of ice. Find source of leak and repair. ,-elQa beneath pallets in downstairs walk in. i Walk in downstairs missing thermometer. Provide thermometer. downstairs meat slicer requires general cleaning. ,26verage air unit in coffee station has no visible thermometer. Provide thermometer. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 11,2007 ) Page 2 of V1 k W A75" i VA Jdairt-. t- -T Commonwealth of Mas h tts -�rs- 114 1�7 qeV v City.of Salem -,," "Bodid of Health 115 : 7 120 Washington street,4th Floor _j Mayos. , SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2007 ESTABLISHMENT NAME: ROCKAFELLAS/Jay El Enterprises File Number:BHF-2004-000274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0325 Jan 5,2007 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 8 of 11 c CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FORPERMIT TO OPERATE A FOOD ESTABLISHMENT 11� NAME OF ESTABLISHMENT o(kA2 dbr,S TEL# (` %) P(/r- d Y// ADDRESS OF ESTABLISHMENT J,S I V S, �30 S4- FAX# 0?99-) 7` S - dY�,/ MAILING ADDRESS (if different) / EMAIL--Business': gc+c e4 " IAA 1 /7/ •GOIM Owner's: i +u+� ljr�f� j�vlt G"�4lhp OWNER'SNAME� td Gi, 11r0 TEL# (9kl\ N/ -07 ,9-r4- _ ADDRESS q kocv art. _{u OAfAIJ1GLt4S� L� 1 SS STREET / CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)Y.-,,I)tCERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON_ e0i n IUG»,d1,1 n �? )�7dt? -4S rg2 �^o ., t i{ j OAYSOFOPFRATION Monday Tuesday Wednesday Thursday ' Friday Saturday Sunday I I HOURSOFOPFRATION Please write in time of day. go 30 w 30 w 01 (For examplellam-load II Aw +' J TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - .-...---- --- NO les... .....- ... - - --.---- --- --- l ...-_.._. es's. h t. .an.....25.... ^ seats... .-.._0.. RESTAURANT YES $10 25-99 seats more than 99 seats =$200 .... .._................... .. .. ---- ---- ---- -- ----- --- ---- -- - - ........------.._.....--...------------- BED/BREAKFAST YES NO $100 ADDITIO ....NAL PERMIT- -- R--I - ---- --._ _ _ _... . ..-_... ._.... -..... . .. ... --- -.---- - _ ...-.... - - ... _.- S MAKE(not just serve) ICE CREAM, YOGURT, SOFT SLRVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have 6, late tax re bans la!d all state taxes re cared under the law r,� aturr. / ate Social Security or Federal Identification Number f ------ ----- ----------------- - --- ---- - ---- - - y �. - - -- ------ ------ - ----------- - - -- -- Revised 11115/06 F00DAPn07 adm Checkq& Dale'{ GZS I/ O p�, ! 777 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-745-2411 PIC Assigned/Knowledgeable/Duties PASSd❑ RED Owner: Comments: Terrance K. Marchino PROTECTION FROM CONTAMINATION PIC: Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED David Mckillop Inspector: Handwash Facilities PASS RED John Gehan Violations Related to Good Retail Practices (Blue Items) Date Inspected:Correct By: Food and Food Protection PASS BLUE 10/26/2006 1 Risk Level: Equipment and Utensils PASS BLUE i Permit Number: Physical Facility PASS BLUE BHP-2005-0220 GENERAL COMMENTS: Status: All violations from 10/06 have been corrected. SIGNED OFF #of Critical Violations: Owner or CFM to monitor temperatures of hand wash sinks. - 0 Time IN Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 06,2006 ) Page I oft Item Status Violation Critical Urgency s RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) 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. Nov 06,2006 ) Page 2 oft 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I FOOD PROTECTION MANAGEMENT 978-745-2411 PIC Assign Knowledgeable/Duties FAIL Critical ❑d RED Owner: Comment:There was no certified food manager at time of inspection. PIC/CFM to be on hand at all times. Terrance K. Marchino j PIC: PROTECTION FROM CONTAMINATION David Mckillop Food Contact S rtaces Cleaning and Sanitizing FAIL ❑� RED Inspector: omment:Cutting boards throughout kitchen are badly stained and scored. Resurface or replace boards. John Gehan Handwosh Facilities i FAIL Critical [] RED Date Inspected:Correct By: 10/26/2006 Co ent: Kitchen handwash sink paper towel dispenser missing paper towels. Towels on top of unit. Towels to be place in roperly. i Risk Level: station hand wash sink paper towel dispenser empty. Provide paper towels. Permit Number: ownstairs paper towel dispenser empty. Dispenser to have paper towels. BHP-2005-0220 Status: nstairs hand wash sink temperature reading over 135'F. HWS to be holding at 110°-130°F. Openei0room downstairs beneath stairs has no hot water. Handle in disrepair. Repair handle to working order. # of Critical Violations: ar had 5 no paper towel or soap available at time of inspection.Soap and PT provided at time of inspection. 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. Oct 26,2006 ) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food ction FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require ✓Comment:There were cloth towels being store in small freezer with french fries. Cloths to be stored in proper designated areas. immediate corrective action) any knives found with accumulation of food debris throughout kitchen. Thoroughly clean and sanitize knives after each use. L1MS ilk n refrigerator has uncovered foods. All foods must be covered. ,cken at grill station being covered by what appears to be paper towels. Chicken to be covered by more appropriate cover. Equipment and Utensils FAIL Critical BLUE .0mo ment: Sobe refrigerator has accumulation of spills and splatter. Thoroughly clean unit. et has no visible thermometer. Provide visible and accurate thermometer. e unit had utensils stored improperly in it. Utensils to be stored in proper designated areas. t wdn-,t for salads requires general cleaning. , Unit end of food prep area has broken thermometer. Provide thermometer. Mi "ves require general cleaning. True unit for pizza/nachos requires general cleaning. I�chen sanitizing log not being kept daily. Log to be maintained daily. n requires thorough cleaning of walls floor and ceilings. i I station"refrigeration init requires general cleaning. ,.Can opener has accumulation of grime. Thoroughly clean and sanitize opener. ,Bfa,k kenmore freezer downstairs requires thorough cleaning. , Sama�has no visible thermometer. Provide visible and accurate thermometer. walk-in freezerlrefrigerator downstairs has outside temperature of 80°F. Inside temperature of 43°. Unit giving off heat at time of inspection. Unit to be serviced immediately to find source of heat. PIC didn't know if it was freezer or refrigerator.Unit to be holding at proper temperatures. Icachine inside panel has accumulation of grime. Thoroughly clean and sanitize panel. Phys iCca�l F'acili FAIL BLUE omme,t,,t-,a throughout dishwash area has accumulation of grime and mold. Thoroughly clean and sanitize area. ire kitchen requires thorough cleaning of walls. 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. Oct 26,2006 ) Page 2 of Item Status Violation Critical Urgency GENERAL-COMMENTS: ermination reports to be provided to BOH. Cityof Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 26,2006 ) Page 3 of � w Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 DATE PRINTED: 02/10/2006 WHO'S PLACE OF BUSINESS IS: ROCKAFELLAS/Jay El Enterprises File Number BHF-2004-0274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2006-0411 Feb 10,2006 Feb 11,2006 $0.00 /TO BE SERVED: Chocolate Rasberry Dessert Total Fees: $0.00 PERMIT EXPIRES (February 11, 2006 Board of Health Page 7 of 9 CITY OF SALEM, MASSACHUSETTS ,.� BOARD HEALTH STREET, � n 120 WASHINGTON STREET, 4TH FLOORSALEM, MA 3 970 0TEL. 978-74111800 L �V IV FAX 978-745-0343 f-JOANNE SCOTT, MPH, RS, CHO 6 Ci91046 Kimberley Driscoll HEALTH AGENT OA^O OF� Mayor 11/� 0Fy��M/ APPLICATION FOR A TEMPORARY FOOD SERVICE PERMIT FEE' 1-3 DAYS= $200 Y) t 4-7 DAYS= $300 / MORE THAN 7 DAYS= $400 CHECK PAYABLE TO THE CITY OF SALEM,NO CASH NAME OF EVENT r V LOCATION DATE(S) OF EVENT �O/QI((O�� (r1(/1/� c p �{/ NAME OF APPLICANT V,kr, ik-S TELEPHONE# / 7f / ' -�V,/ ADDRESS )-3/ ,S-e)c S1,14 NAMEOFBUSINESSC..I�L LGLG�J TELEPHONE# 7 � "'•��/� ADDRESS a 3C 4Met' 5 CERTIFIED FOOD MANAGER'S NAME �""r 1 �// CERTIFICATION# �— � /) Gr A PLAN OF THE ESTABLISHMENT IS: ENCLOSED DRAWN ON THE BACK TYPE OF REFRIGERATION: GAS ICE DRY ICE _OTHER r lV METHOD FOR COOKING/HOT HOLDING: GAS _OTHER METHOD FOR SANITIZING: C(HEMI1�AL//�� OTHER }}fi�tt` _ G,� SOURCE OF FOOD: NAME: —��iJ141t'(��W.S ADDRESS a.3 I (S-S�/` Foo S TO BE SERVED INCLUDING INGREDIENTS AN Q METHOD F PREPARATION: 1 . �leQ�v✓I . .SrIGc✓r J�UJTIVr1 C�°G�iS1 `�Aery-1 Pure' " fit}"fry �e�(c C to W ki.'L i,,-k fv 4 w'- [�'G�i M �7� �USLU'v- I HAVE READ THE BOARD OF HEALTH, "REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS." I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS I UNDERSTAND THEM, AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT PERSUANT TO MGL C62C, S49A, I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL ST E AX RETUR ALL STAT/EfT/AES/REQUIRED UNDERLAIN. GNATURE DATE SOCIAL SECURITY OR FEDERAL ID# ---------------------------------------------------------------------------------------------------------------------------------------- TEMPAPPL REISED 11/15/02 PERMIT N CHEC"S DATE 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone. PROTECTION FROM CONTAMINATION 978-745-2411 Handwash Facilities PASS ❑J RED Owner: Comments:The handwash sink in the cookline has a spray nozzle. Handwash sinks must be dedicated for handwashing only. The Terrance K. Marchino spray nozzle is to be removed. PIC: Inspector to check in with Health Agent and get in touch with owner regarding nozzle. David Mckillop Inspector: Inspector checked with the Health Agent Joanne Scott about Nozzle. Nozzle is to be removed to prevent any other usage beside John Gehan hand washing. Date Correct By. Violations Related to Good Retail Practices (Blue Items) 166 Food and Food Protection PASS BLUE Risk Level: Equipment and Utensils PASS BLUE Comments: Cutting board in kitchen that requires special order. Contact BOH once cutting board has come in. Permit Number: BHP-2006-0190 Physical Facility PASS BLUE Status: Comments:Stairway to downstairs has chipping tread. Replace tread and make stairway impervious and easily cleanable.Stairway Open to be corrected within one month. Contact BOH upon completion. #of Critical Violations: GENERAL COMMENTS: 0 674:All violations from 6/15/2006 inspection have been corrected unless noted. Time IN: I 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 Laurlers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 26,2006 ) 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 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 26,2006 ) Page 2 oft a a IMPORTANT M SAGE FOR _ DATG 9 a8'-aI E � o .M M OF PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBII AREA CODE )NUMBER TIME TO CALL TELEPHONED /PLEASE CALF. CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU ' RUSH RETURNED YOUR CALL[ 4M LL FAX TO YOU MESSAGE _... � l'il/IM.�.Ai 0 SIGNED FORM UO9 Y ISI�R MAOE IN U.S.A NOTES I Commonwealth of Massachusetts = City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Temporary Food Permit DATE PRINTED: - 08/10/2006 WHO'S PLACE OF BUSINESS IS: ROCKAFELLAS/Jay El Enterprises File Number.BHF-2004-0274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD Aug 10,2006 Aug 11,2006 $0.00 Permit for the best of Salem pizza Total Fees: $0.00 PERMIT EXPIRES August 11, 2006 Board of Health • w CITY OF SALEM, MASSACHUSETTS :+ * BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR V/ SALEM, MA 01970 TEL. 978-741-1800 Gry� FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR A TEMPORARY FOOD SERVICE PERMIT FEE: 1-3 DAYS= $200 4-7 DAYS= $300 MORE THAN 7 DAYS = $400 P1 CHECK PAYABLE TO THE CITY OF SALEM,NO CASH NAME OF EVENT 0 1 )AGI // LOCATION DATE(S) OF EVENT 0'- ID — -hvv1 yePL NAME OF APPLICANT .�n G k 4CO-0 Gye TELEPHONE Qk _ a I/ ADDRESS a3l ss e,,. 54-' La 1,-a- I /' NAME OFBUSINESS �hG KLA�e.+�l TELEPHONE7A �1I- 1 ADDRESS CERTIFIED FOOD MANAGERS NAME \/�li 1. U 4-'d.PJ� CERTIFICATION# �U /" '-Sdw k,-it/ S A PLAN OF THE ESTABLISHMENT IS. ENCLOSED DRAWN ON THE BACK - pa D.fi/ �Wf� TYPE OF REFRIGERATION: GAS ICE DRY ICE _OTHER -I '(?V'15i METHOD FOR COOKING/HOT HOLDING: GAS _OTHER METHOD FOR SANITIZING: ,/HEMICAL OTHER SOURCE OF FOOD: NAME: ADDRESS FOODS TO BE SERVED INCLUDING INGREDIENTS AND METHOD OF PREPARATION: I HAVE READ THE BOARD OF HEALTH, "REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS. I UNDERSTAND THEM, AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT PERSUANT TO MGL C62C, S49A, I CERTIFY UNDER THE PENALTIES OF PERJURY THAT 1, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE T URNS AND PAID ALL STATE TAXES REQUIRED UNDER LAW SI TUR DATE SOCIAL SECURITY OR FEDERAL ID# ---------------------------------------------------------------------------------------------------------------------------------------- TEMPAPPL REVISED 1125/02 PERMIT p CHECK#&DATE a 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency TelephoneFOOD PROTECTION MANAGEMENT 978-745-2411 PIC Assigned/Knowledgeable/Duties PASS ❑o RED Owner: Non-compliance with: Terrance K. Marchino Anti-Choking PASS PIC: Terrance Marchino, Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date Correct f By: Reporting of Diseases by Food Employee and PIC PASS RED 1e 6 i,IZ2luV Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2006-0190 Receiving/Condition PASS 0 RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS ❑J RED #of Critical Violations. Conformance with Approved Procedures/HACCP Plans PASS RED 3 ' Time IN , Time OUT. Urgency Description(s)' ._ BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Laurlers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 15,2006 ) Page / of 4 a Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities FAIL W/ RED Comments: Handwash sink in bar obstructed. Handwash sink to be clear and accessible at all times. ,Kafn-dwash sink in kitchen had bucket of sanitizer in it. handwash sinks to be kept clear and accessible at all times. The handwash sink in the cookline has a spray nozzle. Handwash sinks must be dedicated for handwashing only. The spray / nozzle is to be removed. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS W RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 15,2006 ) Page 2 of S Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE /Comments: Uncovered tomotoes found in pizza. All foods in storage must be covered. L Unit across from grill had uncovered foods. All foods in stoarge must be covered. t—WaWn-refrigerator had uncovered foods in it. All foods in storage must be covered. L15aw poultry boxes stored on top of milk crates. All potentially hazzardous foods must be stored correctly. oultry stored on top shelf in walkin. All PHF to be stored correctly. Tixue unit had uncovered seafood on top shelf. All foods in storage must be covered. Equipment and Utensils FAIL Critical BLUE .,�Co ents: Cutting boards in kitchen stained and scored. Replace or resurface cutting boards. Strainer sifting in drainage base in kitchen. All equipment to be stored in correct and appropriate areas. rue unit requires thorough cleaning. L�e.unit missing thermometer. Provide visible and accurate thermometer. y/INi/cro"waves requires general cleaning. ✓Refrigerator unit across from grill holding at 50°F. Unit should be at 41°F or below as mandated. 1-6ryolator has accumulation of grease on it. Clean fryolator to prevent hazzard. samfl er.at downstairs produce area. Provide sanitizer in labeled container. i mchine had accumulation of grime on inside panel. thoroughly clean and sanitize panel. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE Sorh'ments: Womens restroom downstairs has peeling and chipping paint. Floor to repainted to be made impervious and easily cleanable. Door to establishment open at time of inspection. Door to remain closed to prevent entrance of rodents and/or insects. t'Establishment may be subject to a monetary fine starting at$25.00. Stairway to downstairs was to be corrected of any loose stairs or tread based on 1/4/2006. Stairway to be corrected within one month. Management and Personnel PASS BLUE 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. Jun 15,2006 ) Page 3 of T Item Status Violation Critical Urgency Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 656: 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. Jun 15,2006 ) Page 4 of Commonwealth of Massachusetts s 6 City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: ROCKAFELLAS/Jay El Enterprises File Number:BHF-2004-0274 227-231 Essex Street Salem MA 01970 LOCATED AT: 0227 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0190 Jan 3,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 10 of 10 4 CITY OF SALEM, MASSACHUSETTS ; BOARD OF HEALTH / 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 "Ne TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT t'\Mkf� el IA7 ('�R.A el Er'+t1-Pr1Se) TEL# 978 NS 2W ADDRESS OF ESTABLISHMENT ��`Z3 �SSe X •Sl MAILING ADDRESS (if different) OWNER'S NAME - rK t rciri 1k ° M A-axi+NO TEL# / ?bI'7 27 ZS`/2 ADDRESS lD Q4J(1o�dS CITY W t}KR4- eJd STATE MFT ZIP 0I ero CERTIFIED FOOD MANAGER'S NAME(S) 7krnnu k, 40rico N- CERTIFICATE#(s)_-; 7 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 'V g`Ckt 1610 HOME TEL# -?p 39I -0(0,5 HOURS OF OPERATION: Mon. IQT�ue. 1m-iWed. ba Thu.Il��Fri.l/� Sat. I -/a-/ SunA2)J TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ........... ---------------------------------------------f ------------------------------------------- ---- --i ........- - ...-----------_--.....-------------- RESTAURANT less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 - YES ---------------- -------------------------------------------- --------------------------------------- BED/BREAKFAST �v $100 .. - ......... --------- - - ------------------------------------------------------...------------......------.......----------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES O $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $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 k ge and belief, have filed all state tax returns and paid all state taxes required under the law. G� / r�/( /�. 12//10- Ole SO t271 Signature Date Social Security or Federal Identification Number ------------------------------------------------------------- -------- -- ------------------------------------ Revised 11/03/05 FOODAP2.adm Check#&Dale ^ �. ~ .0 d� O 0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-2411 Separation/Segregation/Protection PASS Non-Critical RED Owner: Handwash Facilities FAIL Critical ❑d RED Terrance K. Marchino PIC: Comments: Food debris discovered in downstairs hand washing sink. Hand washing sinks are to be used for hand washing only to ensure proper hand washing techniques. Terrance Marchino Inspector: TIME(TEMPERATURE CONTROLS(Potentially Hazardous Foods) John tor: Hot and Cold Holding PASS Non-Critical ❑d RED Date Inspected: Correct y: Violations Related to Good Retail Practices (Blue Items) 1/4/2006 10,10 Food and Food Protection PASS Non-Critical BLUE Risk Level: I Equipment and Utensils FAIL Critical BLUE Permit Number: Comments: Microwaves found with splattered food and debris. Microwaves needs general cleaning. BHP-2006-0190 Status: Open #of Critical Violations: 3 Time IN Time OUT: Physical Facility FAIL Critical BLUE Urgency Description(s): Comments: Stairway tread to downstairs bathrooms found to be loose and cracking. Repair stairway to prevent accident hazard. BLUE: Contractors contacted. Violations Related to Good Walk in Freezer found with build up of ice on floor. Find leak and repair in order to provide a safe environment. Freezer should be Retail Practices (Critical holding at 0°or lower as mandated. Freezer found at 10°at time of inspection. violations must be corrected GENERAL COMMENTS: immediately or within 10 days)(Non-critical violations 420:410: 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. Jan 12,2006 ) Page I oft 7"410* 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 12,2006 ) Page 2 oft i�0227 ESSEX STREET ROCKAFELLAS/Jay EI Enterprises City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-2411 Separation/Segregation/Protection FAIL Non-Critical ❑v RED Owner: omment: Raw meat stored above pizza dough in True refrigerator. All potentially hazardous food to be stored below Terrance K. Marchino nonhazardous foods. PIC: Handwash Facilities FAIL Critical ❑0 RED David Mckillop il�oomment:Two paper towel dispensers found not working. Make sure that all dispensers work properly. Inspector: John Gehan �gns missing above or near hand washing sinks. Provide signs in visible area for hand washing sinks. Date Inspected: Correct By: Food debris discovered in downstairs hand washing sink. Hand washing sinks are to be used for hand washing only to ensure 1/4/2006 proper hand washing techniques. Risk Level' TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold Holding FAIL Critical [] RED Permit Number: Comment: Refrigerator beneath foodline found at 46'F. All refrigerators mus be held at 41`F or below as mandated. BHP-2006-0190 Status: all white square freezer found at 22'F. All freezers must be held at 0°For below as mandated. Open alk in Freezer downstairs found at 10°F. All freezers must be held at 0°F or below as mandated. #of Critical Violations: 6 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. Jan 05,2006 ) Page I of r 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 (Requirement: ment: Panko bread crumbs package found uncovered and opened in dry storage. Make sure that all food in dry storage is V._cove immediate corrective action) ✓Uncovered food found in Sobe refrigerator. All food in storage must be covered at all times. red found on top of microwave. all stored food must be covered. _ Equipment and Utensils FAIL Critical BLUE ® � omment: Mold/Build up discovered behind warewash line. Properly clean and sanitize area. L.-cCing board scored and stained. Replace or resurface all cutting boards. Microwaves found with splattered food and debris. Microwaves needs general cleaning. '"icer has accumulation of food debris. Thouroghly clean and sanitize. r yrenmore freezer in basement found with food spills and splatter. Thouroughly clean and sanitize. Vermometer missing in Antic Air Freezer and Beverage Air Fridge. Replace or provide thermometers in refrigerator and freezer. All ingredients not kept in original containers to be labeled. Many containers in basement found to be not labeled at time of nspection. -- - Sanitizing logs not being maintained. Sanitizing logs to be maintained daily to ensure proper parts per million is obtained and recorded. Hives stored between units. all utensils to be cleaned and sanitized and held in appropriate area or containers. , sed utensil stored incorrectly in Sobe refrigerator. All utensils must be stored cleaned and sanitized bewteen uses and stored in appropriate manner. Physical Facility.,. FAIL Critical BLUE omment: Light covers missing above downstairs food prep area and above the upstairs food line. Provide sheaths or appropriate covers on fixtures. Paint chipping and peeling above warewash area. Repair any loose or chipping paint appropriately. reen absent from exhaust fan leading outside. All openings to outside must be protected inorder to prevent entrance of insects or rodents. L,Qutside dumpster found open. Dumpster should remain closed at all times to prevent rodents or insects. 1try" G��pi/Stairway tread to downstairs bathrooms found to be loose and cracking. Repair stairway to prevent accident hazard. ea.Ceiling tile missing in dry storage area.ceiling needs to be intact.replace ceiling tile. �Cp 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. Jan 05,2006 ) Page 2 of _f i Item Status Violation Critical Urgency upstairs bathroom missing employee must wash hands sign. Replace or provide appropriate sign. Walk in Freezer found with build up of ice on floor. Find leak and repair in order to provide a safe environment. GENERAL COMMENTS: 410: 1 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Launers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 05,2006 ) Page 3 of rt: / 0227 ESSEX STREET :)CKAFELLAS/ OWNER: TERRANCE K. MARCHINO City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: - Item Status Violation Critical Urgency Nature of problem or correction 978-745-2411 Non-compliance with: Done Owner: Anti-Choking PASS ❑ JAY EL ENTERPRISES Tobacco PASS ❑ PIC: Terrance Marchino FOOD PROTECTION MANAGEMENT Done Inspector: _ PIC Assigned/Knowledgeable/Duties PASS ❑d RED Janet Dionne EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 8/8/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS �/❑ RED BHP-2005-0220 Receiving/Condition PASSd❑ RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED Closed - Conformance with Approved Procedures/HACCP PASS ❑d RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done Time IN: Time OUT. Separation/Segregation/Protection PASS ❑J RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 242. - Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS ❑J RED BLUE:- Prevention of Contamination from Hands PASS ❑d RED Violations Related to Good Retail Practices (Critical Handwash Facilities PASS ❑/ RED violations must be corrected immediately or within 10 days)(Non-critical violations GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 14,2005 ) Page 1 oft 'a '^ 0227 ESSEX STREET :)CKAFELLAS/ OWNER: TERRANCE K. MARCHING must be corrected Immediately PROTECTION FROM CHEMICALS Done or Within 90 days) - Approved Food or Color Additives PASS ❑d RED RED: Violations Related to Toxic Chemicals PASSd❑ RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS ❑ RED Immediate corrective action) Reheating PASS ❑d RED Cooling PASS RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE _ V( o-��`f i on s ad �e uL den jj�'— , A GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 14,2005 ) Page 2 oft 0227 ESSEX STREET :)CKAFELLAS/ OWNER: TERRANCE K. MARCHINO City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 978-745-2411 Non-compliance with: Not Done Owner. Anti-Choking FAIL ❑ JAY EL ENTERPRISES Tobacco PASS ❑ PIC: Terrance Marchino FOOD PROTECTION MANAGEMENT Not Done Terra Terra ceor� � PIC Assigned/Knowledgeable/Duties PASS ❑d RED lnspeJanet Dionne - EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 8/1/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number. Food and Water from Approved Source PASS ❑d RED BHP-2005-0220 Receiving/Condition PASS ❑J RED Status: Tags/Records/Accuracy of Ingredient Statements PASS RED Open ': ' ' #Ot CrIYICaI VIOIatIOnS. Conformance with Approved Procedures/HACCP PASS ❑� RED Plans 3 PROTECTION FROM CONTAMINATION Not Done Time IN Time OUT. Separation/Segregation/Protection PASS ❑d RED Notes: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d REDting boards stained and scored. 237: resurface or replace Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS ❑Q RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASSd❑ RED Retail Practices (Critical Handwash Facilities FAIL Criticald❑ RED _ /upstairs mens restroom missing soap. violations must be corrected V owner to provide soap at all times. immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 02,2005 ) Page 1 of 0227 LSSEX STREET :)CKAFELLAS/ OWNER: TERRANCE K. MARCHINO must be corrected immediately PROTECTION FROM CHEMICALS Not Done Or within 90 days)_ - Approved Food or Color Additives PASSJ❑ RED RED: Violations Related to Toxic chemicals PASS ❑D RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require Cooking Temperatures PASS ❑d RED immediate corrective action) Reheating PASS ❑d RED Cooling PASSd❑ RED Hot and Cold Holding FAIL Critical RED upstairs walkin had temperature of 58°f. all t,04rentially hazardous foods were relocated at time of inspection to walkin in basement which had temp of 40"f. y�zZa prep bench had temp of 58"f. service "unit to maintain temperature of 41'f or below as mandated. Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ./❑ RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑Q RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 02,2005 ) Page 2 of 0227 ESSEX STREET :)CKAFELLAS/ OWNER: TERRANCE K. MARCHINO Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE - "alkin had food stored on floor. all food to be kept at least 6-8 inches off floor Equipment and Utensils FAIL Critical ❑ BLUE _ ylf�es stored between units. knives had 1*accumulation of food debris. knives to be cleaned and sanitized before being placed in knife rack. 2H—microwaves need general cleaning of food debris and splatter. dement-white aRtic air freezer needs general cleaning of food debris accumulation. T rack in basement to be secured to Ill wall. w in in basement had accumulation of on floor.find source of leak and repair leak. jpKe and black freezer needs general to'Eleaning of food debris accumulation vewaitestattion ice chest had accumulation of mold.thoroughly clean and sanitize. itestation fridge had temp of 60"f all - dairy products were discarded at time of inspection.service unit to be maintained at 41°f or below as mandated ar-hand sink had strainer and food debris. hand sink to be used for handwashing only. �e scoop stored incorrectly ice scoop to e stored handleside up in ice or in a cleaned and sanitized container labeled "ice scoop only" Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL ❑ BLUE II flourecent lights in food prep areas need plastic sheaths Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 02,2005 ) Page 3 of 0227 ESSEX STREET :)CKAFELLAS/ OWNER: TERRANCE K. MARCHINO Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 02,2005 ) Page 4 of r ..!-w... r - f..;<.. .�, .�.,-'� .,.y;9vewi,... da�� ¢«q+.a�4'��;.1S.u:.eSa.4•«f�''�,0i'° k"�'�a+'tt +. '�..�y�`,;+b'..•.s. ,..,... 1`'?S SY^;xaw a� .:t }may a,� J,.r .�. 3!aSy..''K•-:i. }Sl,�� ?-ay�f,+•�,.,�s+ wi� % CITY"OF'SALENh MASSACHUSETTS ,. BOARD OF HEALTH 3f 120 WASHINGTON STREET, 4TH FLOOR - .r. SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Rockafellas Address of Establishment: 227-231 Essex Street Owner's Name: Terrance Marchino Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 122-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT 4 � CITY OF SALEM, MASSACHUSE C�� o BOARD OF HEALTH r % r- ig 120 WASHINGTON4TH FLOOR SALEM, MAO 1970 Nov 2 9 2004 i�,y�ryg1 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT II TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT RhCVr&eI,I0,_ TEL# (RIM 9'IS- JIM li ADDRESS OF ESTABLISHMENT d3i �_S'S2�o (QMA htilh nL�hn MAILING ADDRESS (if different) OWNER'S NAME Tkv,&5W��kdlo} fe?'Mvz k IN�k6kV -3 TEL#('t�fr�tikS-dy11'1 ADDRESS r1 V1,?J Jssl /'t l ` CITY (VI A11,_a STATE MA zip O a t`fX CERTIFIED FOOD MANAGER'S NAMES) lZr/446 (C Mx✓eli'.00 CERTIFICATE#(s) X130 77-7 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON c 1te)rr1+-Q- �'lCl 1 I d� HOME TEL#7911 311 0&,fk HOURS OF OPERATION: Monll` 1 Tue.l(- 1 Wed.l l-1 Thu.f( - I Fri.11-) Sat.( ( - ( Sun.11- 1 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT /YE NO -� less than 25 seats =$100 25-99 seats 50 more than 99 seats =$20 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YESNO $5 TOBACCO VENDOR YES NO $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 knowledgee�a� n�,gelief, ave filed all statIe tax returns and paid all state taxes required under the law. `�.p, GC-Cl/la_ 1Il x' lvy i'DIe 5-8' 1X75 Signature Dhte r Social Security or Federal Identification Number -------- - -- ----- ----- -- - ----- 1 7 Revised 11/03/03 FOODAP2.adm Check#&Dale 5` / ��/d7 ROCKAFELLAS A Change of Atmosphere in Casual Dining ROCKAFELLAS From Route 95 follow 114 East into Salem. Follow North Street over the bridge and turn A Change of Atmosphere in Casual Dining left at the lights onto Essex Street. Follow to the end and straight ahead is Rockafellas. u4 � o <� f - u. o°e°o 0 �r. 114 - - - Gift Certificates The North Shore's Newest Destination Lunch • Dinner for Live Entertainment, Late Night Menu (Thurs. - Sat.) Fine Food & Fine Wine Live Entertainment (Wed - Sun.) So Much More Than Just A Restaurant Reservations Recommended Hours of Operation TAKE-OUT MENU Sunday - Wednesday 11:30 am - 12:00 am 231 Essex Street Thursday - Saturday 11:30 am - 1:00 am (Daniel Low Building) 231 Essex Street Salem, MA 01970 (Daniel Low Building) 975.745.2411 • Fax: 978.745.2471 Salem,MA 01970 978.745.2411 • Fax:978.745.2471 www rockafellasofsalem.com www.rockafeRasofsalem.com Entrees Desserts All entrees served with a side salad Angus Prime Rib (served Friday& Saturday) Chocolate Luzor $7.85 14 oz chefs cut$21.95 12 oz house cut$18.95 The Pharaohs would be envious!A solid chocolate Juicy slow-cooked served with a Yorkshire pudding, pyramid outside chocolate mousse and cake inside mascarpone mashed potatoes add$1.00 per additional oz. Create Chocolate Raspberry Cheesecake $6.95 Grilled French Pork Choc, $19.95 12 oz pork chop grilled, accompanied by a stuffed Creamy cake with a raspberry filling and white chocolate frosting baked apple, walnuts, mascarpone cheese and roasted cora salsa mash "lh Black Angu BIL $8.95 Muddy Berry Bowl $7.85 A chocolate dipped waffle bowl with a pool of chocolate The best ground sirloin, cooked the way you want and raspberry mousse and wild berries swimming on top served with your choice of toppings and sweet potato fries Pan- Seared Salmon $18.95 Classic Carrot Cam $6.95 9 oz salmon filet dredged in sesame seeds seared then 71vo layered carrot cake with a whipped cream cheese placed on a bed of stir-fry veggies center and a lemon meringue frosting Stuffed Sea Seallops $18.95 8 oz fresh sea scallops topped with our own seafood Stuffed Pineac,ole $7.95 stuffing, baked to agolden brown and served with rice pilaf Fresh pineapple stuffed with an assortment of fruits Fresh Crab Stuffed Haddock $18.95 mixed with watermelon lemonade 9 oz piece of Icelandic haddock with our light crabmeat stuffing on top broiled to a golden brown and served with Ginger&Cream $6.85 grilled asparagus Home baked ginger cake served warm with a scoop Filet MIL market price of vanilla been ice cream 9 oz filet grilled and served with a wild mushroom ragout and mascarpone mashed potato Chocolate.Chocolate.Chocolate Cake $7.95 Baby Back Ril2g Full$24.95 Half$12.95 What can we say except that there is a whole lot of chocolate in every bite Dry rubbed in our secret seasoning, slow roasted and grilled, served with steak fries and many napkins --, We also have a selection of Chicken Penne $16.8 Seasoned grilled chicken sliced and sauteed with Espresso, Cappuccino and I.atte'8 sun-dried tomatoes, scallions, calamata olives, in a Full Children's Menu Available creamed chicken demi-glaze and served over penne pasta N.Y.Sirloin market price Live Entertainment Weekly 14 oz sirloin marinated in a sweet soy sauce then grilled Book Your Small Events With Us and served with mascarpone mashed potato Tomato Basil Chicken $17.95 Come View All Your Favorite 71vo chicken breasts, basted in basil and oil then grilled and layered with buffalo mozzarella and ugly tomatoes on Sporting Events On Our mixed greens with raspberry vinaigrette _ 46" Wide Screen Plasma Pelevision Cornish Game Hen $15.85 ' Fresh game hen slow roasted then topped with fresh orange marmalade and corn salsa mash BovvTie Rock Shrimn $17.95 Fresh Rock Shrimp sauteed with asparagus,chopped tomato,peas,in a light garlic cream sauce over bowtie pasta 'Pan Seared'ltina $23.95 9 oz yellow fin tuna steak pan seared medium rare and served over seaweed salad with pickled ginger, wasabi, and tobiko sweet soy sauce Vegan Customers please ask about our chef's special of the night Appetizers Soups and Salads For the hungry at heart,you can add • New England Clam Chowdah cup$3.95 sweet potato fries to any appetizer for just$1.00 Tradjlional Home•Style Chowdayh Crab Cakes $9.95 rich, thick and delicious bread bowl$5.95 Homemade crab cakes,pan-fried and served with wasabi Soup of the Dav cup$2.95 mayo on a bed of mixed greens We don't know till the chef wakes up Country Patk $8.95 We do know it's always fresh bread bowl$4.95 Pork, beef,and chicken pat46 served with toast points, guava paste,grain mustard and diced red onions Caesar Salad $7.95 Assorted Cheese Platter $8.95 Garden-fresh romaine lettuce tossed with dressing and Ask server for cheese selection!All cheeses served with a served with home-baked croutons guava paste,assorted crackers and nuts Greek Salad $7.95 Green Goblins $7.95 Fresh cut greens with onions, black olives, tomatoes, Five proscuitto ham&provolone stuffed cherry peppers, cucumbers and fresh feta cheese batter dipped and deep-fried,served with red sauce Crabmeat Salad $11.95 Qyders"Rockafellas" $10.95 Fresh crabmeat tossed with herbs, mayonnaise and hue large Nova Scotia oysters topped with our secret sauce celery on a bed of mixed greens and lightly breaded and baked to a golden brown Asian Sesame Chicken Salad $8.95 Fired-up Chicken $7.95 Greens with sesame mandarin orange vinaigrette,crisp Deep-fried chicken with just enough fire to make you look noodles,grilled chicken and mandarin orange segments for the bleu cheese,celery and carrots Antipasto $8.95 Conch Fritters $7.95 Garden fresh mixed leaf lettuce with artichoke hearts, Caribbean style, homemade, deep-fried and served with olives,cucumbers, tomatoes, topped with imported creamy dill sauce provolone cheese and fresh sliced proscuitto Di Parma Grilled Shrimn Kabobs $13.88 Fried Brie Salad $8.95 Five jumbo shrimp skewered and grilled then served with Fresh mixed green with lightly fried brie cheese and sliced our own fresh cocktail sauce. gala,apples,topped with walnuts and apple cider vinaigrette Scallops and Bacon $10.95 Garden Salad $6.95 Fresh extra large sea scallops wrapped in bacon then baked Fresh mixed greens with tomatoes,carrots,cucumbers, until crisp ShrimP by the Pool $10.86 olives and onions Five jumbo gulf shrimp hanging around a martini glass, House Salad $8.95 ice chilled and served with our tangy cocktail sauce Buffalo mozzarella on a bed of mixed greens with yellow Cheese Fondue $1&95 tomatoes,roasted red peppers and artichoke hearts Homemade fondue with smoked Gouda,crabmeat and Mozzarella and Proscuitto S ls" $8.95 horseradish,serued with fresh veggies and assorted breads Sliced beefsteak tomatoes,fresh buffalo mozzarella and Baked Stuffed Artichoke Hearts $7,95 proscuitto,layered on a bed of fresh greens Artichoke hearts stuffed with our own seafood stuffing then Add chicken for$2.00 or shrimp for$2.00 each baked to a golden brown and topped with hollandaise sauce Choice of dressings. Italian,Balsamic vinaigrette, vinegar From the Raw and oil, bleu cheese,thousand island, the chefs own tomato basil uinaigrette,apple cider vinaigrette,and ranch *Chm=tones each$1.50 On the half shell,served with cocktail sauce and horseradish Sides *Oysters on the Half each$2.25 Sweet potato fries $4.95 112 dozen of one six of the other,does it really matter? Potato of the day $2.95 They're all fresh and they're all good Cole slaw $2.95 *Tuna 3eghirai $13.95 Vegetable of the day $2.95 Pan seared and coated with sesame seeds,thinly sliced,served on a bed of seaweed salad,with wasabi,pickled ginger and soy sauce Lobster Cocktail $1785 � *We are obligated to inform you that consuming raw or 71vo fresh Maine lobster tails chilled on ice and served in a under cooked meats,poultry eggs or fish may increase martini glass with cocktail sauce the risk of food-borne illness I' Lunch Rockafellas Own Panni Sandwithes Half Rack:Baby Back Riba $12.95 Baby back ribs dry rubbed, basted, then grilled to lbwnitouse Square $6.85 _ perfection and served with steak fries Sliced tomato,fresh mozzarella,Italian dressing,pesto, and lettuce on grilled rustic white bread Large Stir Fry $9.95 Lrge black tiger shrimp sauteed with roasted red II 231 Essex Street $6.95 peppers, snow peas, mushrooms, and onions in a sweet Roasted eggplant,provolone cheese,sun dried tomatoes, soy sauce over a bed of rice pilaf and pesto on grilled rustic white bread Scallops"Rockafellas $8.86 i The Gobble Stone $6.95 5 oz of fresh scallops topped with Rockafellas sauce and Mrkey breast with bacon, lettuce, tomato, and honey Japanese breadcrumbs, baked to a golden brown and mustard on grilled rustic white bread served with rice pilaf HiWinson Square $7.95 Marinated Steak Strias $10.95 Thinly sliced proscuitto Di Parma,provolone, roasted red Juicy steak strips marinated in our own special sauce, peppers,and pesto on grilled rustic white bread grilled to your liking and served with steak fries or rice The MissinLr Staircase $7.95 Grilled Salmon $8.85 Grilled chicken breast marinated in Italian herbs with Filet of salmon grilled placed on bulky roll with sun grilled zucchini and pesto on grilled rustic white bread dried tomato pesto, cucumbers, lettuce, and rice Daniel Low $9.95 Fresh crabmeat tossed with mayonnaise,fresh herbs,and Pizzettas baby lettuce on grilled rustic white bread Traditional Cheese $9.45 The Classics Imported buffalo mozzarella, vine ripe tomatoes, red sauce,pesto, and fresh basil on our homemade dough Follett's Reuben $6.95 Roasted Garlic and Penner $9.95 Fresh-cooked corned beef with our own Rockafellas sauerkraut Fire-roasted peppers, red sauce,pesto, and fresh dressing and Swiss cheese baked on marble rye roasted garlic on homemade dough Grilled Chicken Wran $7.95 Grilled Chicken and Penner $10.85 Grilled chicken breast, chopped lettuce, tomato, bacon,and Our own seasoned grilled chicken, sliced and honey Dijon dressing rolled into a spinach tortilla accompanied by roasted red peppers with pesto Stir Eky Wrap $6.95 Proscuitto $10.45 sauteed roasted red peppers, mushrooms, onions,snow peas, Fresh proscuitto Di Parma, thinly sliced with fresh and cheddar cheese rolled in a spinach tortilla tomatoes, buffalo mozzarella,pesto, and basil Grilled Chicken and Avocado Wran $6.95 Veggie $8.45 Sliced lime,avocado,grilled chicken,alfalfa sprouts,cucumbers, Red peppers, black olives, spinach, mushrooms, onions, and brown mustard rolled in a spinach tortilla pesto, red sauce, and Romano cheese In lb Black Anus Burpor $6.95 The best ground sirloin,cooked to your liking and served Make Your Own Pizza with your choice of toppings Add.50 per topping, $2.00 for chicken$4.00 for shrimp Lobster Salad Roll market price Sun dried tomatoes, asparagus,provolone,pineapple, onions, Fresh Maine lobster mixed with a hint of celery, mayo, artichoke hearts,grilled zucchini, and mushrooms and served on a fresh bed of lettuce(roll optional) Pulled Pork $7.95 Grilled, roasted, then marinated in BBQ sauce served on Here at Rockafellas we strive to make your experience a bulky roll with roasted red peppers and cheddar cheese the best.We also strive to get the finest quality All items above served with sweet potato fries Products with little or no preservatives.We use fresh local produce and import all of our fish from the cold Lunch Combo $6.85 deep waters of southern Canada.All of our meat is top includes a half sandwich and CHOICE OF shelf Black Angus beef. Never frozen always fresh. soup or salad and fries _ Executive Head Chef John Hottel Jl d CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Rockafellas Address of Establishment: 227-231 Essex Street Owner's Name: Terrance Marchino Restrictions: Application Date: 5/11/2004 Permit for Food Establishment 302-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT ROCKAFELLAS A Change ofAtmo'sphere in Casual Dining T. Kevin Marehino OWNER/OPERATOR W W W.SOCKAFEIJ ASOFSALEM.COM Cell: 781.727.7542-Office: 978.745.2411 Fax: 978.745.2471 231 Essex Street-Daniel Low Building-Salem, MA 01970 CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH • r 120 WASHINGTON STREET, 4TH FLOOR a $ SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT R0C W A F CLLA S TEL# 97S' 7Y5- Zt1 Il ADDRESS OF ESTABLISHMENT? Es�2>c MAILING ADDRESS (if different) p� OWNER'S NAME I e Mn(f �MAarr L�ln o �A� Fi I 'Cn1 j/-p TEL# C1�79 7 y� Z�l ADDRESS 438 Mor.(fo,4 Sl. i CITY Al A I dln I STATE M,1 ZIP CERTIFIED FOOD MANAGER'S NAME(S) Terrgm(� K.MArct, by CERTIFICATE#(s) ,2 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON D �J ID AAC-k; I lop HOME TEL# Tf 3910-&52- HOURS OF OPERATION: Mont".1—Tue.lWed. Thu. I I I Fri. l ( ( Sat. / Sun. p w _VXA— /+-w-. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 0 1000-10,000sq.ft. =$100 Lq6�J more than 1 0,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS �) MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE ` NO $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES QQQQOOOO $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 knowledg aM belief have filed all statq tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------- - - -------------------------- Revised 11/03/03 FOODAP2 adm Check#&Date 33 �6-Ee S�`1 0�r � aoa. . CITY OF SALEM BOARD OF HEALTH Establishment Name: OC;cLZY-P //CCks Date: �r,--�,--,—��age: of ' Item Code c—Critieai Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I �-/nslae�firm o�-�f�rbllshn�o.�l f woe h�r�>��Ih,(�� he� 1 1)0,neR Mrl- wim lei/ qP�f lrl�or� i� I wi 475 Gro oto .gtZah.s ov► J)�!!�/J'�-/iJ.0 . -end ane / 7 /JJ14A �W,0 s 1 - my same- i 5;,i�rr ?i,reoF_ /V I 47, Gae Irl Cie /s aY nar6 -6 he S-�Orind ih Sind . 1 I �'rn-Ifinuah� , /,)ir I��i�� ,ay , - �/' ( )-lPv ) k �_ I grn l , ,,II ll�>>lF IY) 1WKP_fzk 011171 ini-1 �fi1.:h 'Qf '100, oc I � - r ' I l , f, I � I I _ Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twe y-five dollars or sus p s'o ' evocation of ❑ Embargo ❑ Emergency Closure your food permit. �� — � 0 Voluntary Disposal ❑ Other: PFIFF Recer:ed a T'Iliperatttres Violations Related to Foodborne Illness intervertiors and Risk A<xordme tar Law Cooed to Factors(items 1-22) (Cent.) 41-F/45'F Within 4 klour PROTECTION FROM CHEMICALS 15 Cooling Methods for PHFs � Food or Color Additives ' ( 19 PHF Hot and Cold Holdinn 14 s-`0l.lo(B) Cold Pl[Fs Mairaained at nr below ?-202.12 Additives* ( 590.004(Fi 3-302.14 Protection from f hm�aprnced Additives A 4 /-1;°P^ 3-501.161 A) lino t PI-1Fs Matnhuncd at or above IS , Poisonous or Toxic Substances !1ti'F * i j7-101.11 klentilytne fn form rtux:-CAi�mal j Containers- 3_50l.lix a A) Roasts Held , or above 130°F'. ' 20 Time as a Public Health Control 7-102.11 Common N.nete- W'orkin11 Containers' . a ;01,19 Tim,"as a Public Health Conhol* 7-201.11 Separation-Storag,c: 7402 11 Restriction--Presence and Use" 590.004ili) VarianceRegfor,(r.)ent 7-202.12 Conditions of I;e' 7 103.11 'Coxit,Contain rs-Pro!r,h;iiuru* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ' IPOPULATIONS(HSP) 7-204.11 Sankizers.Criteria-Chemicals'• ( 21 ( 3-801.11(-i) t Uteal izcd Pre-packaged Juies aid P Pre- c . i 7-204.12 Chemicals for W'a June Produce,Cr.tcria" ( I nit"" 1 Beverages with W'armn_labels" 7-204.14 Diyin;;Agents:"rircrinr - 7-205.11 htcidental Ford Contact.Lubucanis` 3-u0t.!I(B) Lse. If PasternizedFz?es^ ( 3-80,i.!I(D) Raw or Partially Ccxvked Anuuai Ford and 7-20n.]1 Restricted Use Pesticide:.Criteria" I Raw Seed Sprouts Not Setled. .r 7-2116.12 Rodent Half Stations" ;-801.i I(C') Unapeacd Food Package Not Re-ssrved. " ',-'06.13 •Pricking Povders,Pest Ccwtrol and ! - e- -- ----- i4tnniturin2* i CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3 6113 11 Cor.stuuer Adsisoty Posred fur Curaumption of to Proper Cooking Temperatures for Aninad Foods licit ate Raw,Unclurcooked or I I PHFs Not Otherwise Processed to Eliminate 3-401.11.4(I)(2) Hggc- 155`F 15 Sec. _ Pothl_cns.* E}-s-Immediate Seivic. 145`P75sec* 30::.13 Ps stcumzeo Egg;Substitute tot Raw Slreil 3=401.I1(A)(2) Comminuted Fish, Meats&Ganic F'^`" .4uintals- 135'F L sec. ` SPECIAL REQUIREMENTS 3 401.11(B)t I)(21 Pork and Beef Roast - 130`F i?1 min* 3-401.11(A)(21 Ratttes.Injvcn:dMeats- 155`F 15I 590.009(A)-(D} Violations of Section .590.009W-(p) In sec. * catering, mobile fool,temporary and 3-401-11(A)(3) Poultry,Wild Game,Stuffed PHFs, p:.,idendal kitchen operations should he r'Wffiag Containing Fish,b9eat, debited under lie appropriate sections Poultry or Ratites-165`ri 15 sec. ° ( alcove if related to foodborne illness 3-401.11(C'(;) W'ho'e-muscle,hitact Beef Steaks interventions and risk ;actors. Other 145`2* ( 590.009 violations relating in good retail 3-401.12 Raw Animal Foods Cooked in it practices should be debited under 1129-- Microwave 165`F " Special Req!iirements. 3-401A t(A)(It(b) AIt QOrer PHFs- 145`F 15 sec � 17 Reheating for Hot Holding VIOLA TIONS RZLA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) Mips 165`F13wr. '' (Itenns2330) 3.403.11(B) Microwave- 165-F 2 Mmate Standing Crutrrd and wm-rritical vnitafionv, which do not real, !l,the Time* foodborne illi^ss haerrenIu,ns and riskjo(uirs listed above, can he 3-403.1 I(C) Commercially Processed RTF:Food- kurrud is the jotl u4m,sec tions of fire Feud Coate and 705 C49R 140117't 590.01010. 3--103.1 t(F:) F.emaining Lhtshced Portions of Reef Iter, Gond Retail Practices FC580.000 Roasts* 123. Maragement and Personnel FC-Z i 003 lg Proper Cooling of PHFs 24. Foo:and Food Protection FC -3 004 ,t 5( r C r . ,` 25. Equipment and Utensils FC-4 )1.14iAt ooldtc Cooked (iutal4(PFio 26. Water, Plwn6irganj'JVa=te PC-5 006 70"F Within 2 flour.and Froin 70"F i 27. Physical Faciinv FC--6 007 � -o 41'1`?/45']F Within . Hours. t 28. Poisonous or Toxic Materalc FC -7 ',. 003 3-501,I-!(B) Cooiine PHl-s Made From Ambicat 29 3pe-Jai!ieouiroments .009 Temperature Ingredients to 41°F/45`F i 30. Other Within 4[lonr,:` I I Den:;xs cralWt nem In ih.:1'edcrni 199.1 Fond rade or 10K C14fi 59i i 0-:0. CITY OF SALEM ��// BOARD OF HEALTH : Establishment Name: (1(.K f, I I(/ Date: Gt Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ' Date " No. Reference R—Red Item Verified PLEASE PRINT CLEARLY )w l�i11) ' I r J I i t M-f G v v lJ �I I I II Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ :es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations:before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Foo Code. I understand that noncompliance may result in daily fines of twent/yzrve ollars or suspensi6 /r ocation of El Embargo C3 Emergency Closure your food permit. jG— i__. ❑ Voluntary Disposal ❑ Other: v 3 361.:4tcl PHFs Tlec--tvetl al"Fempvatureg Violations Related to Foodborne hinossfratervemUons and Risk Acro-ding q,IA,Ar Cooled to Factors(items 1-22) (Cont.) 41=F/45"F Within 4 Hours. PROTECTION FROM CHEMICALS 13 ,k,01ing Moth--ds fo.r NiFs 14 Food or Color Additives 19 PHF Hot and Cold Holding ;-50;.!6!$) Cold PRFs M""malned at o' belo, 3-20112 Additives* 'w 5 9 0.001 F, 4!`I-^-5'F. 3-3021x: protection from I,'hiuviark)�ed Addiijves,t I3-501.!6(A) Ho: PHFs AT%iqiaincd at o, shove15 Poisonous or Toxic Substances 14WE 7-10111 ldcrai�,irig Infona,mon-Ori.ginal 1(-aA ilContaincrr` aiast,�FfJo it or ahoy' J3(,V'F I 2o Time as a Public Fisalth Control 7-102,11 Common Name-Working,,Containers'` 7-201.71 S-�Reparation-Soa ai,-'� 3-501.!9 Time as a liu--ic qic.'lth Cenftol* 7-202.11 Restriction-Pre.w.9ce and Lice' I 1590.00 ai) Variance Rvquircment 7-202.142 conditions of use� REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 Toxic Cojitain,r, -ProiNtions'r POPULATIONS(HSP) 7-204.11 Sawtizeis,Criteria-cheillicals". ()lA!iA- Unpasteuri/ed Prc-ii..J.agc]Juices and '1-2(4.12 Cliettiacals for Washme Pr(KIUM Criteria 21 1 XI I 7-204.1-1 Drying Agents.Crjloxia� Beverages with Warning '�bcls- 3-80 Use-,f Pasleurized Egga 7-205.11 incidental FX1d Contact,Lubricanti- 3-80 .;1(D) Ram ta Pzqiallv CwLvd Anirmil Food and 7-1206.11 ke,aricted Use Pesticides,Criteria, 12 Rodent 13At Stauuns' Zaw Seed Slircuts'Noi S.;"cu. 7-206.13 Tracking Pos%ders,Pest Cvntrol and i Urim-e-ned Food Pa,kage Not Re-f;ervcd. CONSUMER ADVISORY TIMEITEMPERATURE,CONTROLS 22 3-603.1 i. Constirwr Advisory Posted fa-Constiollition of 16 Proper Cooking Temperatures for Aaiawl F,xlds Thad are Raw. Uadorcooked or PHFs N(It Otherwise Provesscd to Plirainate Eggs- 155'F I�' See. "'3[� 3-401.1 IA(l)(2) i caeos..: 1-,02.13 RISIcUrlZed P,^)s Stb.�Wtlt,- for Raw Shell ELYU-miniedialeServicc 145'171�5sec� I(A)(2) Coaawrarted Fish, Moats '( 171C L;?cs* Animals- 155°F 15 sec. ' 3-401.11(3)(1)(2) Pork and Hee''Roast- 130 1 SPECIAL REOUIREMENTS 3-401.11(A)(2) Ratites, injected Meats- 155'F 15 590.004(A)-(D) Violaiions of Section 5,90.009(,A)-(D) in sec.. t -alffi:lg' mobile fixal, temporary mid 3-401.11(.1)13) Poultry, Wild Game,Stuffed PHFs reodc-atia' kitchen operations�liouild be Switiviv Corv.ai*linl,Fish,Nleat JJ-:'ted Under the appropriate sections Poultry or RafiLes-i65=F IS sec. above if Telatzd '0 foodbornu illness 3-901.1!((')(3) Whole-muscle,Intact licef Slrats in:orvenbonsand risk factors. Other 145-1, - i 590.009 violations ielmin.- to good retail 3401.12 Rase Animal Fwds Cooked in a practi>_er,should be debited wider #29- Microsvame )F Special Requirements. 3401 IFIA.)(1)(b) All Odwr PHFs- 145�'F 15,sec. .4ehestF ing for Hat Holding VIOLATIONS R,:LATEO TO GOOD RETAIL PRACTICES 3-403.11(A),v,(D) PHPs 105'F 15 sec. ;1 (items 23-30) I(B) Vficro',kave- 10.j'j F2 Minute Staadiny lvhrJl do not,rial,-1'1J)" Til))C* liNtodabove, can be 3-403.1 I(C) Coniracrciailv Prixesscri RTE Food- mond in the A,700w, o0he Fond Codca)ui 105 CMR i4W17i �9(UXA). Remaining l)nsficad Portions of B,-el' item Good RvadPractires j Fc 5 .000 Roasts' n. Manaciernait and Personnel FG 2 09003 24 Fooand Food ProIrItion Proper Cooling of PHFs d c FC-3 004 25 Equipment and Utensils FC-4 05 4 ;01.14(1) Cooling Cfx)kcG'PFIFN from 140'F to 1 '6 Water, Plumbinia and Wn5te FC-.13 !-00(5 701 Within 2 flours aid From 70'F 27 Phv-ial Fadhiy FC--6 007 to 41`F/45'F Within 4 Flours. 11 28, Prasori o!Toxic Materials FG 7 006 3-501.!4(13) Coolina,PHFs Made From Arabi en' Special Reouirerrents .009 Teittp?i attire higed;,nrts to 11'F/45�F 30, 01hor ---- Within 4 Hours* Dcriwes Qraical acin nith, Irdrnd 1';99 Food('cede or 105 590000, MaS6pacFfusetts 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 Nam-1 I n n Date Tyne of Ooeration(s) Tyge of Insoection I`UI �V`� I IQ S H -2-04 [D Food Service ❑ Routine Address�a � �SSt'X Risk El Leve �'Re-inspection Telephone Level E] Residential Kitchen Previous Inspection (IIA - �(15 -aj' f 14 ❑ Mobile Date: Ip 25 ay OwnerHACCP YM ElTemporary F] Pre-operationTeb�al (Ge K, }�Q • I I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)n _ , u� 1�v"^ ""`( "c{� Time ❑ Bed&Breakfast E] General Complaint I In: El HACCP Inspector ),,j r Out: Permit No. El0 herr� . I�/w1� I 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. 0 FOOD PROTECTION MANAGEMENT ,- ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH -` El 2. FROM CHEMICALS 2. Reporting of Diseases by Food Employee and PIC ` [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially 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 FROM CONTAMINATION Z 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E] 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR c�Health. 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 J 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-s)(sso.00s) 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 5901ns (Fom 14 do I (I InstCr �t r . _ Print: V I I'PI('s1's Signaj re:"�� Print: Va LA LNCkiI/ JJI Page Of sPages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-;?2) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 I Orrsr-coriaminatirr, I I 500.003(A) -Asm.niment of Responsibi6t} I 3 ((Ali Ra, Alloual Fr,ds Separated from 590.003((3) Dernonsb jl!on of Knowledgo Cxtked and RIE FowNlt 2-1011 : person ill charge--duties C"onramlhritvn from.Raw ingredients 3-301;1(At �) Raw Animal F',Kds Scrarated from Each EMPLO'_EE HEALTH Other, ';90.00(c) Rc�piat�ihility of tire person in clawyo to CorfirriOntion from the Envrownertt requir.-,r,.-porll n-,, by food rnjpicoc,'s 0 PC] 3-302.11(A) Food pro!'Cl;ot' applicants-, 13-303.15 Wasinng Fruits and Ve.etablcs 590.003(F) Responsibility Of Fmidll Employee 01,*Am 3-304.11 Food Colat,._t wim Fqmpment and Applicant To Repu,A To Thc Person In Charge' from the Consume, 590.00i(G) Reporting by Person in Charge' 3-306.i4(j\)(R) Peturned Fjtd and Reta;re ictot Foal" 3 500.0�0([)) Lxchmons, rid R.txrhiioi-s* i I t7is;;os,;iorot„duts;atedorCenGvnmrzred 590,003(F) Removal of Fxclusions and Restrictions Food 3-701.11 I Dis,;irdirlj,or Reconditioning Uioale FOOD FROM, APPROVED SOURCE Food': 4 Food and Naict From Pq[ju!atvJ Soilless 9 F:lss Contact Surfacer 590.004(A-B) Compliance with Food Law* I 4-501,111 Manual Warewes'llinz-Hot Water 3-201.12 Food in a Hermetic-ally Scaled Container* 3- 13 aid Milkanlk Pro 4-501.112 Mechaca; Warewqshing-Hot Water 20!� Pd Miducts* ni Sanitizati.,il Temperatures" 3-202.; , Shell Eal.s* i4-50;.11 1 Chemical Sanitization-1=tr'pHj I'l. Eggs arld Milk Prtxlucts.Pasrcurized� I 3 202.16 lee Made From Potable Dunkin Water- ctocentration and llaidne<";. 4-60 1.1 i kA) Eq,upinant Food Contact Surfaces and 11 Drinkin',Water ilo!e an Approved System' 1 Iftcusils ClfearO 590.000(A) Bottled Drinking Water* 4-602.11 Cl-airing Frequency of Equirment Food- 590,006(B) Water Meets Standuds in 310 CMR 22.0 Contact Sur-taces and Utensils'r I Sheflti3h and Fish From ao Approved Scarce 4-70?.11 Frequency of Sanitization of Uiensils and 3-201.1 Fish and Recl-cationally Caught Molluscan I F11"d Contact Surfaces of El: Shellfish' �_70�11 ❑Medildo;of Saintimrion-Hot Water anti 3-20!.:S IVI�-JIUSCan Sfiell&b firoin NSSP ListedChermcal" Sources` ! IQ I Proper,Adequate Handwashing i 4ppxvndby Regulatoty Authority 12_;0;.11 Clean Condition --Hands ard Arms- i-202.18 Silellstock hh-rififi.ation Present* 2-301.J2 Cleaning PrOcdare" 590.004(C) Wild Mushrooms' 2-101.14 When to wash" '101.17 (jarric Animak;: it Good Hyqien'c Practices Receiving/Condition i.J I Eating.Drinking or Uoig'fobacco* 3-202.11 PI iFs R.zcel%ed at Proper Tcritperalures 2-4('1.!2 Discharges Fn the Eyes; Nose and 3 202 15Package Integrity, Mouth' I 3-301 12 Presenting When Tasting" 3-101.11 FmI Safe and Unadulterated 6 TagstReco'rds:Shellstock 12 Prevention of Contamination from Hands 5 9 1) 4 k E) Pre,,ritinz Conuoninatirn from 3-'02.18 Shellstock Identification 4 - Ec 320112 Shellgtoct:Mortification Maintained' I 13 i Handwniployash' Facilities Tags[Records:Fish Products 3-402A 1 Parasite D.-'struct6w, Conveniently Located arid Accessible 3-402-1 2 Records.Creation and R6entiotirl Numbers and C,,pacturs- 590Y)I(J) Labeling of Ingredients" IUCJuhjjj ae(t Pj al�elllc0l* I 7 Conformance with Approved Procedures 5-205 11 Acr.e�;shiihty Ororati,,n and 1.1iintrilanct, IMACCP Plans Supoked wM-,Scale and Hand Drying Devices 1-502,11 Specialized Pnicessing ivIerfi;,ds* o-30 L I i Hau�lwwhing Clearlsr,Avuiflabili�y 3`02'.12 Reduced oxygen packaging;criteria' I:, Hand DrOnl,, Pro,.isiojt 8-10,�.12 Conformance ki ith Appro,.ed Piocedurcq* r CITY OF SALEM BOARD OF HEALTH Establishment Name:--k('0 K"r "( 16 S Date: H -,2_'-0q Page: of _ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 4,\ No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I I�?P-li-�st�rh�n �w-1�r-1 -fh.e Fi�llniAiiha I R°F. _Fyw��P,-2 t?-3 V-w YYY-C1 i l lVl�i r o4 a -ker}lp Gr ()"e /_it �Y1nl.cl (1'C CY1rfd Y��1� . t I r{ O/d vi + Cr2 h f IN {r'Q Jnr p k,_JA0y_ 11'0 ��,�� l�nnn� 1n I 1hr�vl,riohlu� � I Q�� rio�( ✓�?+� G _ �� Ir1fl�-ih �o�.Q lvo/{ �-/sm1 S-i-ni�r� a�� la�� I �r�'r,�_ rnr�e�- vv- (O+i)� /1{ 3 Uo X9111( O f jl SWl PS + C�at1 i-h Thr" Inn -(v !Y`tr-r� E7IhoC� i � L_o_0 r-�qnleA. - IDrlonrnJ - j Cr<vin -b, Vv Str�reA SvtQ op tp 1CQ 6Q 1 n (IAM7inorZ 4 I `f Arr l hr,1S hooin N oral nrf ell`0 )KlbOI O(j " ICe- SC0nP0n1q" Discussion With Person in Charge: Corrective Action Required: I El No I ❑ Yes w I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that : noncompliance may result in daily fines of twenty-fiv�doli rs or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. ❑ Voluntary Disposal ❑ Other: i i ti I 3-SfV.I iF. PHFt. i2e;er.cd:t remperatums Violations Related to Foodborne fitness Interventions and Ris4 Accordine to(aiw Cooled to Factors(Irems 7.22) (Cont.) at+45'F V;`!!an-1 Hotas. ' 2..11;1.,3 1 (,00ltnsMedtodsicrPHFs PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Hokang tq Food or Color Additives 3":101.1&Il Cold Plii�s:.faintahted at or below 3-202.12 Additic. ` 5960-04(F)) -4:`14.5° F- }.:102.14 Prutectioa grout Unapproved Additives* 4_�0L 16(A) Ho; PITS Maintained at or abov., 15 1 Poisonous or Toxic Substances ! t 10'F. 7-1!11.11 Idenufymg tnfn trots n-01igin:tl 1 1-1(;1.16(.`,) Possis Held at or above 130°F. Container-,-- - ' E -7 102.1 ; Comnt.,n Name - W'orkiny 20 Time as a Puhlic stealth Control Conn:inere* ( 7-201.11 Jepara[ion-Storage' 3-50;.!9 1'::pe as i Pid,hc Health Control ` C 7-202,i I ? Restriction-Presence and I.,e' ( 590.t!Wlf H) ( Varivnc ,Requirement 7-202.12 Conditions of Use 7-203"11 ( Toxic Containers-hohibitionO REOUiREME TS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitimrs,Critem)-chcmicals' POPULATIONS(HSP) 7-'_04.12 Cheuucals for Washing Produce,Cuieria": 2^ ( ';-80! I l(A) 1 Unpasteurrred Prepackaged Juice:,,act 7-204.14 Drying Agents.Criteria* Pevera,Qe,,with 1Vatnhw I abeiq^ 3-801 11(3) U,e of Pasteurized h-os,� 7"20511 incidental FotdContact Lubricants^ 3_Sr(.3;(D; RateurPatti}tl) CooHed;lnim:d FrK,;l:rid 7-_06.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts ;tiof Se pini 7-206.1Rodent Bmf icts,P,, 3-901,)1(0') Unopened Food Package Not Reserved ' 1206.13 I Tr::cking Powdc^s,Pzs[Control and j Monitorin;;" CONSUMER ADVISORY 22 3-601,11 Consumer Advisory Posted for Consumption of TiME1TEMPERATURE CONTROLS Anitn-,i Foos=-'hat ate Race,Undercooked or (6 ( Proper Cooking Temperatures for PHFs Nn`Otheivn;e Proczsszd in Eliminate i 3-101.11.4(1)(2) Eggs- 155°F IS Sec. ( ;- 02.13 F'::;teunncd F Substitute for Raw Shell Eggs- bnmedinte Service b}5°FiSsec+ i Ygs 3-401.11(A)(2) Commmuied Fkh, Meats& Game Animals- 155'F l5 sec. SPECIAL REQUIREMENTS .3-401.1 1(8)(1)(2) Pori, and Beef Roast- 130'F121 min* � 3-401.11tAt(2) R:ttiten, fnjectedN(eats- 155"F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) m sea* cateriue. mobile food,tempor uy and 3-101.11(.4)1 i 1 Poultry, Wild Gane,Stuffed Pli!�s, residential kitchen operations should be Staffing Cuatairune Fish,Meal, debited under the appropriate sections Poultryor Ratite::165`P 15 sec. * above if related to foodborne illness 3-401.1 I(C)(3) Whole-n-:uscle,Intact Beef Steaks iuterveetieos and risk factors. Other 145°F* 590,009 violations relating to good retail 3-401.12 Rn,v Animal Foods Goked in a practices <Fould be dehited under//29- Miclowave 105+ ` Specud kzquirc;nents. 3"d11li(A)(l)(b) All Other PHFs - 1.45°F 15 sec * 17 Reheating for blot Holding I 'VIOLATIONS PlizLATED TO GOOD RETktL PRACTICES 3-403.11(A)Rt(I-)) PHF,, 165-F 15 sec. * I (Iteirist 2.3-30) 3-403.11(B) Microwave 165'F 2 Minute SiandinIg Cr ivad uad nun-reinsl violations, i.:hich do nor relaw to the Time"' fn»„Lor,<e tlk:ess inrvi renrions unci rsk fac tors Us ted above, can he 3-403.11(C) Commetcialh Rv acsed RTE Food- found of the fo lnn fit g sertiuns of the Food Code mid I?>5 011? 140-`F" .590.000._ 3-403ut .11(E) Reainntz Unslived Portions of Reef Rem Good_Remit Practices Fc ,590.000 Roasts' 23. Mcnagemera and Personnel FC-2 .003 J is Proper Coming of PRFs 24 Food and Food Pretect:on FIC--3 .004 I 25 Ecuioment and Utensils FQ-4 .005 2-501 14(`12 CooGagCooked PHF, from 140"Ptt, I <<^6, Water, Pl:mbinq.,rd Waste FC-5 006----- -� 7WF Within 2 hours wid Front 70'F 1 2? Phq.ical F=acility FC-g 007 1 to 47"F/45'F Within i Hours. * 1 26. Posonoos or Toxic rsalerlais FC -7 .008 _1 1. 3 501.id(R) Cooling PHFs blade Fret:Ambient 129, Specia:Recuirements __; (1109 Temperature Ingredients it,4I"F145°F 30. Other - Within 4 I-luurs` ,•,':1 •+..,""r..,,,< ' Dennis moot!acro m,he ledecrl ]')so 1-ou11 Cad.or Ins C\,;i2 50i,Orn;. it -" CITY OF SALEM • BOARD OF HEALTH Establishment Name: /X'V(?fe (1,s Date: 11 `Z - O(-I Page: ?J of Item Code C—Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ' No. Reference R—Red Item Verified` PLEASE PRINT CLEARLY �_Q \/r M('j m�� nt -o�( G� �i�DYI hove, loop-n ro)rrer 4-r . ITrlce I'1 IC ( ,kU L - - I Ar)I -o �� 1 til erl-hems n + -hrno nF' re h�per_-bo� 1 ( � Yoc r� I Ftiv►rrn a t zr n_a Cf �Zc h 6Yts o 1 :� I /Nc1��wRstun 1 40✓u JDC tri I� 1 I � I d: oWith Person in Charge: Corrective Action Required: I L) No I EI Yes f [D-iscussin have read this report, have had the opportunity to ask questions and agree to correct all ❑ ' Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five doll or suspe.slon/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ voluntary Disposal ❑ Other: Violations Related to Foodborne 18riess lnt2rvortiors and R;sk Aiwrdmg-,it)fav;Cooled to Factors(items 1-22) (Con:.) 4 l`F!4j'f- Within 4 Hours. PROTECTION FROM CHEMICALS i 3-5t}. for PfUF< 14 Food or Color Additives 19 PHF Hot and Cold Ho!oing 3-501.16(13) Cold PHF,Maintained w or belov, 3-202.12 Addiows* 590 004(F) 41 V45"F' 3-302.id ProteMon front Unapproved Addi!,ves* II-Col,Itn't" lin Pilf-s t-Jaintained at nr:,buw IS Poisonous or Toxic Substances 40"f -101.11 Identifying Intonnnnon-On--,iral 1 I 1 :-50Lio"A) koast� Held at or.�,hove 1101- Conlamers^ 20 I Time as a Public Health Conti of 7-102,11 Common Naine WorkingContain.-rt 7-201.11 Separation-Slorartet-5nl,19 That,-as a Public Health Contrv! , j 500.004(II) Vaiiane,- Requirermirt 7-2011 ; Re,tricl;on-Frcscnce and Use* 7-202.12 Conditions of Us,; REQUIREMEN rs FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Proh[lbitiorv;14 7-204.11 Sanitizecs.Criteiia ('11en I i 1j POPULATIONS(HSP') 7-2(f-l.12 11 3-801 11tA) Unpa4eurized Pre-I' red Juices and Chernicak for Washimi Prothwe,Ciiieria" 7204.14 I DrvinR Agents.Crfter[10 Be.vrrages with 'iVamunt t,ai0s^ 3 �()1,11(B) I i,e of Pasleurized 7-205.11 Incidental Food Contact. Lubrleantq* ;-SOLI '(Di Pa-or Pattialiv Cooked Animal Ktoj and i /-206.1 i Restricted Use Pe<ticrder.Criteria' IRaw St,.d Silrou"i Not Ser. d. 7-206.12 Rodent Bait Station,. 7-20ty i 3 Tracking Pmvder�.Pest Control �id 3-80 L I I(C) Unctitteued Food Pacl,�eze Not Re served CONSUMER ADVISORY TIMEfTEMPERIATURE CONTROLS 22 3-:OI I Consumer Advisory Postsd for Comuniption of AntroM Foots That are R,!w,Undetcooked or Proper Cooking Temperatures for N PHFs oL CahM ersc Processed to Inlitrunate 3-401.1 lA(l)(2) F,,g:- 15:rT i,S Sec. Erg, Ig pq immediate Service 145'F!5secl 9L 1 3-302.1�� lt.!steuriw� E Substitute for Paw Shelf 3-401.17.'.1)(2) Comminuted Fitt, Nlnat:&Gains Animals- I�i`F 15:ec. 3-401.1 ICB)t 1)(2) Part, and Beef koast - I 30'F 121 min* SPECIAL REQUIREMENTS 3 to 1.11(A)(2) RMITIS,luiCLIed bleats- 155'F 15 590 009W40) Violations u Section. 590.00t)(A)-(D) in see. catentig. mobile NO,ternperiai2,and 1 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchon operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Plultry or Ratite,-165°F 15 sec. above if related it,fbodl-orne i Iness 3-46t.i I iC)(3) Whole-muscle, Intact Beef Steals I intervc.,ttions and risk factors, Other : 145°F m 590.009 Violations relattig to good retail 3-401 12 Rem ,',rima t%,,ds Cooked in a practices should he debitod under#29 - Microwave 165'F a SPociai Rcouiternerits. I-40 "I(AtflNb) All Other PHFs- 145''1= i 5 aec. 17 Retreating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-463.1 PHFs 165°F 15 se- !, (Items 23-30) 3-403.11(B) Nficiowave- 165')F 2 Mutate Standing Time* fiio,'ii;�O,n,-ilt!,ss oltel,Veuliorrz aad,ivkfilil turi litird above, urn be 3-403.1 i(C) Commercialk Piocecsed RTE Food jawid in the tollmwiw seeriow of the Food Code and!0_5 C3,11? 140-Ft I '.10.000, 3-403.11(L) Remaining Unshoed portions;of Beef F—!tem -Good Retail Practices Fr-, -000 5 Roasts* 23. tilanatfan-ent and Personnel FC -2 1 0'0'q()3 1 t8 Proper Cooling at PHFs 24, Feud reid Food Protection FC-3 1 004 25. Ecr,'i)rnrs-,1 and Utensil-- FC -4 :005 3-501 j4(A) Cooling Cooked PHFs from 140'F to I 1 26 Watta,Pliar6re ane Waste FC-5 606 7011-Within 11 Hours and From 70'i-7 1 27 Privsical F-ril'tV FC-6 007 to 41'F/45'F Within 4 Hour,. * 1 28, Poisonous or Toxic Malenals FC, 7 .003 3-5(17 14fP) Cooling PHN Made From Ambient 1 -9. Special Rcouirements o09 Terripeial tire Ingredients to 4 I'F/45'F :30, Other Witlan 4 Hours* Denote,vrascal em in the federal P)1)9 Fomt(:,de o1115(,'M-'590 000, * CITY OF SALEM9 MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 ' FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III , Section - 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Terrance Marchand & David McKillop Terrance L. Marchano Name of Establishment : Rockafellas Address of Establishment : 227-231 Essex Street Type of Establishment : FOOD SERVICE Application Date : 06/20/2003 Restrictions: _ ,e Permit for Food Establishment 308-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT t ` CITY OF SALEM, MASSACHUSETTS `� BOARD OF HEALTH 1,20 WASHINGTON STREET, 4TH FLOOR A ` SALEM, MA 01970 �' D TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION /FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ROCKAFEUAJ TEL# 7? "3�Y "0 �7Y ADDRESS OF ESTABLISHMENT aLGA I—B I G556>C 51 • S41-em. MA M10 MAILING ADDRESS (if different) T2rr4.CaK IOARCN/No DAJ bs.Mcica lar OWNER'S NAME Ta GI �nl�l!-�ri Se L L --Fe, 'u Z kA'zct4 TEL# 978 ADDRESS )- L3 �SSZx S�• CITY S Al pm STATE zip O 14-70 CERTIFIED FOOD MANAGER'S NAME(S)?'vrr-Anta.KWI# 1V)AfCI+1,m CERTIFICATE#(s) 3130777 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON erp 59 I V nl a(ECH i N 0 HOME TEL#tel-j4S-71(o I HOURS OF OPERATION. Mon�11 1aTue.11�"Wed! i�2ilNThu�lin IAM Frig '1AMSat! "+ MSun.�IZAm TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO 305;"Oj less than 25 seats =$100 25-99 seats150 more than 99 seats =$20 BED/BREAKFAST YES NO $1006 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR 'YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. • Pursuant to MGL Chapter 62C, Section 49A, 1 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. Si na re �7 Q DateSocial SPcI{ri or Federal Identification Number —g�T"�IYIft+tiNA/a+�✓ Revised 11/25/02 FOODAP2.adm Check#8 Date ti Holly D. Zhang -� American Account Manager 285 Columbus Avenue Red Cross Boston,Massachusetts 02116 of Massachusetts Bay (617)375-0700 phone x 374 (617)375-0727 fax ZhangH@usa.redcross.org October 17, 2002 Ms. Joanne Scott \ Town of Salem Board of Health Re: Restaurant/Food Service Training and Certification M.G.L. Chapter 94: Section 305D Dear Joanne: It was a pleasure to speak with you today about the Chokesaver with Restaurant Emergencies course. The following is a brief summary of the skills that Restaurant and Food Establishment employees will learn in just two hours: 1. Recognizing an Emergency 2. Emergency Action Steps; Check, Call, Care. 3. Protecting Yourself • Good Samaritan Laws • Obtaining consent • Preventing disease transmission • Demonstrate Glove Removal 4. Before Providing Care 5. Prioritizing Care • Demonstrate conscious choking skills (Adult, Child&Infant) • Have students practice abdominal thrusts. • Demonstrate unconscious choking skills(Adult, Child&Infant) 6. Wounds • Controlling severe bleeding • Care for Burns Course Materials: 2 Adult Choking Posters(One side English,the other in Spanish).Each participant receives a`Til Help Arrives Booklet and a wallet card"Emergency action steps to save a life". Course Cost: $240.00 flat fee for a maximum of 20 employees. It is$7.00 per person over the maximum. Certificate: A"Chokesaver"certificate(wallet size)will be sent approximately 10 days after course completion and it does not have an expiration date. For the M.G.L Chapter 94: Section 305D go to httD://www.state.ma.us/legis/laws/mel/index.htm then click on"Link to a specific Chapter or Section"then fill in the Chapter and or section number. Please call me with any questions you may have or to schedule a class for a"best time"in January or February. Thank you for your interest! Best regards, UnitedQWay Visit us at www.bostonredeross.org 1 THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Type pf Oneration(sl Type of Inspection IL�O3 ood Service ❑ Routine Address Risk El Retail QReei spection �? -23/ (-SSS/�� Level ❑ Residential Kitchen Previous Inspection TelephoneElMobile Date: �g/^ _ C�� El Temporary ElPro-operationOwnerr / / HACCP Y/N 1. Ad t�GM,dUI)/tr.M t/Lcr�,Ml Q X C/4GCr� El Caterer El Suspect Illness Person In Charge(PIC) ' Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspectorn �IA2 Out: Permit No. ❑ Other J�• Cr�C{.11�.�v'rtA a . ach 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 (Red Items) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. 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)(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 Sigi Print: PIC's-Sig an lure: c, j Print: Page of L-'Pages FORM 734A HOBBS"RREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 11 590.003(A) Assignment of Responsibility* Cooked and RTE Foods*590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and Applicants* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in -- Charge* Contamination from the Consumer 13-306.14(A)(B)I Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water I 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 11 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* 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 Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 1 3-201.17 Game Animals* 2.401.11 Eating,Drinking or Using Tobacco* 5 1 Receiving/Condition 2-401.12 Discharges From the Eyes, Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records.Creation and Retention* 5-204.11 Location and Placement* 590.004(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Roc,Establishment Name: t FvGe,4 Date: �Z/ �� Page: of 2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified I PLEASE POINT CLEARLY ae, s I I I I _ I ® P�EtL � fit( A,4 j-0,4 G f(/VG6 SCe, f_# c�S r✓ar3�rsr/ruQl f rE%�� I viLFt� TL�Y��7 Pt_'4WJ ✓_ ' zr rovc OF mc!4 K. I I I S I r I a I I � I I r Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand)hfit Fo ncompliance may result in daily fines of twenty-five llafs-o suspension/revocation of ❑ Embargo Ll Emergency Closure ro, ur food permit.., ❑ Voluntary Disposal ❑ Other: ---- .-- • 4 3_;0i ?zCC'i PliFa ttecei,ed at Zu:pelatura j , Vioiafions Related to Fcodacrne Illness intrrventiotts and Risk a ccordin to 1.,w Cooled to Factors(items 1-22) (runt.) 4 'FF{5"F R.ahin Y Homs. :' -._5tt1 t? Cooling Methods ba PHF; j PROTECTION FROM CHEMICALS 1; Food or Color Additives 19 PHF Hat and Cola t-eIif nlg 12 ,ldditi�es^ ( '.-501.16(Ff} C'uldP"r{Fs?:[ul,i.:o:rdatorb,lu;,, �-302.14 Protectlion ont Unaq;noved Add+u,e::' ;9(1.()()4(*,,-) 41'/45"I't' j Poisonous or Toxic Substances i 3-`01.16(A: Hot PI-{Fs N-I:(mtai;:ed at of Ab:,ve 7161 11 lden!d}vx ininr(mnton-Original + 140`1' x Container' j 3-5Q 1.16(:1) Roa:lc H-1.d at of above 13WF ." 7-102.1 1 Cununou Name -Working C'nlltairter< ' i 21) '1 one as a Public Health Control I I I Soparolinn-Shxag3-=(11.19 'Time as a Public Health Control 7?C! c" � 7.2U?t1 Restriction-Presence and t-lse'" � 500.604iH) 'dm'ianec Reciuuemenl j 7?02.12 Condiionc of Use � 7-'It}; 11 Toxic Containers-Prohibitions;, ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Samtizers.Criteria-Cheuu cats* ' POPULATIONS(HSP) 7-264.12 Chentieals for R'esLi,:_Produce; Ctilena: ( -'i 3-301.1 1(A) tn:pas:enri zed Pr-p::ckagaUuicts and 7-204.14 Drvine Agents.C];ierio"' Be:err::e�. oitli Warning f.ahels" j '7-265.1? hladental Fcx,d Cnnrtet, Lubucnnr.;°' 3-80 1.11(13) I !;r of P,steurized Fggv* .3-301.1 t;D) ( Raw d Partially Conked Anima!Foo,[and i 7-266.1 I Rrsiri�ed Use Pea.<:idee,Criteria`" Rd%% Seed Stimuts Not Served. 7-266 12 Roclen! Bort Stations i -3OLl I(C) iJnupcned Prod Package Not Re-srn'ed. "7-5266(.13 5151 ticking Powders,Pest Control ane! , hlunrtorinl;' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60-1.11 Consuincr Advisor} Posted flit COIJUn11t(ill Of l6 Proper Cooking Temperatures for Animal ood> Tttal ,rc Raw,Um:Cnrolced or PHFs ?,,+t Otherdis, Proc:etsed to Eliminate 3-461.1!A:1)(21 Eggs- 155'F f5 Sec. PaUu+;ren,, • aeor.:-.aonr Fggs- tum Aid:,Service 1-lS'F15,ec" ;-?; -.1 Prstcu:izcli vgg>Subs:itutr for Raw Shell 3-401 I I(A)(2) Comminuted Fish,Pleats S: Game ggo;' oi SPECIAL REQUIREMENTS 3-401.11(6!(1)!2) PPori: nend Bezfi2oast- 1305E 121 tnfn' 59U.UU9(A7 ill) Violations eel Section 590.009(,A)--(C•)in 1-401.I IIAI(2) Ratiu•s. hrjerted Meats- 155`F 15 � sec * caiering, mobile food, temporary and 3-401.11(A)(3) Poulin• Wild Game. Staffed PFII:z, tesidential kitchen operations Should be slufting Containing Fish,Meat. debited under the appropriate ,eciions t'uultrt or Ratites-l(tii-'F 15 See. ' above :1 I.fated to foodborne illties� 3461 ll(C)i3) WholL-musde.hltac{Hunt Stc::ka intetvet:tionsand;iskfictuts. O:Iicr 145"F " 590.009 violation,,, ;elating to;lout retail 3-461 1? Raw, lnimal Foork Cooked in a I practices ,hoold be debiied under Kilt - Ivtiu'owave ui5°F T ;pec'td Requirements. 3-401.11(A)(1)(b) All Other PHFs - 14SF 15 sec. " 17 Reheating for Hot Holding VIOLATIOPIS R-L.ATED TO GOOD RETAIL PRACTICES 3-103.11(A)XtP) PIIFs, 165�F 15 sec " (Reins 23-30) 3-403.11(13) Microwave- 165'F 2 Minute Standing{ Critt<¢I unl,+•+a-rnneeti V• .ri utionc, which to nu:retale to tilt Time* Joridbortie dk!ess interreurions and risk(actors tested above, ca,r be 3-403 11(C) Commercially Processed RTE Food - !o;md 8r tie J"ollon•ing sett;u+,a q1 die boort Cod, and 10;C IR ?-403 i i(E) Remainmt, U n,licecl Portiuns of 6cef lfr,- Good Retail Practices FC 590.000 Roasts': 23. lvtaoauen,ant and Personnel FC - 2 11103 ig Proper Coaling of PHFs 24. Foal and Fo+xi Piotaction FC - 3 r:(A 25 Fqulpment and Utensils FC-4 ,005 3-501.14(A) Ccaoling Cooked PIIPs from 1=0'F to > 26. ; Water,Plun-ihin4 and Waste FC;-S .006 705E Within 2 flours and From 70'1' ! ?7 Physical Pacai'y Fr,- E G07 ht 41_F/45"F Within 4 Hoon. ' ( 128. Poisonous or Toxic Matedals FC -7 ,008 3-501.14(6) Cooling PHFs glade From Ambient 29. Special Requlrem=nts i COP ! Temperature bonedicuts to•11`F14 5'F 30 othet -! Within 4 Hum;," D:m4uu<tritiud itzm in the federal 1999l ood Code o !U3 CIMR::92000. y ' . THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Type of Ooeration(A) Typb of Inspection /1 d C k_O f t_ /LO S //-03-e7.� IV Food Service 3/Routine Address Risk ❑ Retail ❑ Re-inspection a a �- a 31GS' . 0)f et4- Level ElResidential Kitchen Previous Inspection Telephone -7 9/ IV- 9171y ❑ Mobile Date: 8 is-o3 P Owner / _' HACCP Y/N ❑ Temporary ❑ Pre-operation ele&ii�Cc Ma PP��/tin/7£k/�P&ALJjhP3%rr ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) / r/o yp!lreta�0 Time El Bed&Breakfast El General Complaint Inspector A.r vim �7r �GLd,0 El HACCP I/ Out: '/ �/01/.C777 /�IS/T /7{A2 _7Jl�c}'P�irScl.!!dl) Permit No. El 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 (Red Items) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals �• FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition [1 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling F-1 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control EW8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [E'9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. 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)(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 )/ 1,, 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: Ali .�� / T- I Print:- r r a vi G r� A V r_ L',i, ee PIC's Signature: [ , YV'I r Print 1 Page-Lof 3 Pages FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contac[with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in J Charge* Contamination from the Consumer 3-306.14(A)(B)l Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem lL 3-202.14 Eggs and Milk Products,Pasteurized* p,P @g � Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* 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* 1 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2_301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 + Good Hygienic Practices 3-201 17 Game Animals* 2-401.11 Eating,Dunking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* -� 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* � 5-204.11 Location and Placement* 590.004(J) I Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* - - 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: P'7r KA reL/_GS Date: Page: a� of 3 Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified PLEASE PRINT CLEARLY �yfi.vi 7N,t rr.77/1n APY*',l 7/ie 1 - /GP .Cri/aP ,CA',""'e /.7w lap aL ze w ifv�n /A/ .teAI-rl2,-ir /fdX,i Ale'< r I 7 6l7 17 r /� �vn�- /.�. r.�� AS M/.CC//✓/4 t of / f/ T ec�s o 7c; AZ i nP ♦G OPPY7,n/o ,//7/i/O//,C/rL(/ " i1f4v.UO ��.Pi/C � FQ '_97'eR-d � ,Cfd/&CK 7a.A- �,G,jeX JCpi/ O� /pv�l�ii[ o�. / / � 7�s � ,�.ArPif /ti (.4 V1 enLafiirn r4e�i�l-eri 6G e I I /ti T7//a ,C'P�CY/�Y/� l�J>f�S/.✓/-.P.0 '/17JG �✓/.F /(/t/tel ffiL//Y/�/ /-OOL(.S Owl L(� I ��P �7Y�ln.� rt-iir_ -7Yla,t'.4e2° "��.,+,•�ze�F�,�aYtie.e Fo ods J I I I I ay I d � //a s ��i,U//i,�/n�ihrt of 9,C-�cl.sP -L' Gecrm 7�e,Pavg�i/_v I ' 1 �'vy / ve�✓dinlll f3�7�i LrJdes ' Y_7W,0W,5 70iier /POo_� I 1 oK I rat fo fi2)! � I -X � irr.^S/ ( ✓ f�LtPG,fL �P'e-/.� I�.(�P/�PfG 0.171�/�e,� lJ� , C2s9/ �7 z/,rip ._CII G U7471 Q � 1 ozz /ad//K .Sfu film c 7 Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p El Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 1 501.kliC) PRFs Re;.eived at Temperatures Violations tielafed to Foodborne Hite interventions and Risk .According to I aw Cooled to Factors diems t ??) (Cont.) 4l'Ft45'F Within 4 Hous PROTECTION FROM CHEMICALS � >-501.1 Cooling Methods for YHFc 14 � Food or Ce!or Additives � 19 PHF Hot and Cold Holding 202,12 3-501.i r!ri) Cold?HFi Maiutainrd it or nelov,, i.30' L! Protrc6na fnnn Unapnaltad Additive,' 590.004(P` 41'745"F': 1; I Poisonous:or Toxic Substances ( 3-`t)1.16(A) 1PRFs Maintained at or abuse ' ;4040`I. ! 7-IUI.11 (deni4yuu:Infonuatital-Original ! ;-501.1(,(Ar � s" ( i Roasts Held at or ah•,t- e 130'17' Container 7-I(1'_.I 1 Comtrwn i4a?nr -58urkinp C'onia,ner,- ( 2t) Time as a Public Health Control ?.-So1,19 Tulle as::Puhh;1-(tial:h Control" 7.2ol,II Separation-Storage" ;g0.'')d(H� I 7-202, 11 Re:.ttiction- Presence and U�e'F j (A Varrmez Rec,uire.uent j 7 2-01.12 Cundoionc of l",r j 7-20-3 11 `texic C'uata.n-cr..- i'ro6tbrtirns` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE '7-26.1.1 1 5auitlzers.Critet:a-CheiniudsT POPULATIONS(HSP) ! 7-20,1 12 Chvuucak l"or Kash;a^ Produce,Criteria^ I 21 ( 3-801.)1(3) Unpasteurized Pre-packaged.Juices and l 7-"64.14 P;v n- A-Clots Cr:t is* ( ! I Beteragec with Warnin;t G:bels" 13-811!.11(13) Ul&of Pasteurizcd E, 7-104 11 Incidental Fnnd ConT,)rt, i.,rbri�ants'" 1 3-3(11 !I(D) Raw or Partially Cooked Animal Foil and j 206.11 Rearicted Use Peet=:,ides,Ccrerin' ' Rau'Seed Sprruis Not Served.m j ?-?116.12 Rodent Brat ns Statio ' : ?-8UI.I I(C (i ) m:prucd F'uod Package Nor Rc::erred. ! 7-206.13 Tracking Pt-dors. Pest Cr+n:roi anti Mnnimnng CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60.3.11 Crnsutncr Acisisury Posted for Consuulpuuu of 16 I Proper Cooking Temperatures for Anunal Foods, ]'bar tiro Raw, ilnderco,•ked or PHFs Not Otherwise Processed to Eliminate Pathogens., _`"�'`"°";•Pool 3-'lO L i l A(1?121 Eger:- 155"r 15 Sec 3-;02.13 Pasteurized Lggo Substitute for Raw Shell E,1,,s-Immcdlatc Service 145`F15sea' 3-401 t l(A)(2? Commimrteu Fc.h. k'1e.tts 8:Gants Animals- 155'17 ?5 g'c. ' ! 3-40 1.11(B)(I)i2) Pur 1,and BeefRoaA -I33u`F121nwr` ( SPECIAL REQUIREMENTS _ 5r)0,@i)9(A)-Q)) Violations kit Section 590.009(A)-(D) in 3-dt,l.l I(AI(..J) Raines, injected Meats - ISrF I,:+ se, * calerin , mobile food, temporary and 3-4(;1 I l,A)(z) ?'u,ll i;y,W'ii4i Game.itutt't;li PHE`s, residential kitchen operations should be Stuffing Ctmtai:une F;sh,Meat debited under the appropriate sections K,lfl1ry or Ratites-165'17 15 sec. ' j above if related to foodborne illness 3 401,11t(')(3) Whole-muscle, lntrid Beef Stcak, ( interventions and risk factora. Other 145"F -' 590.009 violations relating to good retail 3-401.12 Raw Animal ,,,(Als Cooke:in a j practices should be debited under #29- Microwave 165'v^ Special Requirements. 17 I 3-401.1 1(Al(1)(b ( Ali Caller PHR, - 145'F 15 sec. Reheating for Hot Holding ( ViOLATIOPIB R?LATEO TO GOOD RETAIL PRACTICES 3-463 11(A)&!D) PIFs 165''F 15 sec. e (Items 23-30) 3-?t)3.1 t(!3j Pliuowavc- I 65"F2 l)f,nats Standing Crincnl rind non-critical i,'k>lations, which do not relate to in,, Tirue" foodhorne diness iater enrlan.s and risk lactnry i sted above, can hr 3403.t t(C) Cvrcnoercially Pr' -cecsed RTE Food- found in the follan ing section.t aJ du,Food Code,anti 105 C•h7R 140'4` • ?-40311(E) V.-mining Unsliced Portions of Bevf I Item Good Retail Practices FC 590.000 Roasts' 23 Management and Personnel FC-2 .003 ! 18 Proper Cco!ing of PHFsI 24. Ford and Food Piolcction FC-3 004 ---- ------ -- 25. c� _Epment and UlenMs FC--4 005 -501.111A) Ctxu i ng Conked PRFs from 1,4WF to 26. Water.Plumbinq and Waste FC-5 .006 70'F L\-n.hut 2 Hours xnd From R)'F 1 27. Physical Facility FC-"a 007 :o-il'F{d5'F`S'ithm iHous I_28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHF9 Mlijde From Ambient ! 29.i _SFlmiai Requirements aG09 Tenrperure iTrn,edieun,ru 41"F7-}5"17 30---"" Other ! W'10hm 4 Hours" sm11l;21 D,Pote, niit.,l ern'. 19T)ftun!Cade ut Mt CtR 5900(o). n CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Nov 3, o2Oa3 Page: 3 of 3 Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I 7; r/ !a%s X461C,C//eP. 7W ,B1-- n2d 64 4 O. S.a p. — NOleal a`So /,L/ ,Shame. -hal_ a A Ps i�Ioolel- �1-is o3 I I I I I Lice e— I I v ti-�roD/,co,�li.v� �Soo�o/7atveLS,i`�frc-�dwr.vi/v9 LLh,��/ S/q.vs �Kp/b�vc�S X'e'e' NYS - �- I /X /r"U. I I I ✓ I r,�� ac _ u�it-Gr/.� �or�'.o �//iFo,�l�ly� .Pvf�i�s — Q°Foe,BP� FC',�Lef'S� I /Zsrsrn„cs I I I I I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes ' I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion j Y' 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. _ ',; ` �/ '/, (� atirh '} '' ( IK I ❑ Voluntary Disposal 11 Other: 3-501 N(C) PHF,Receised atl'ernoeratures V;etations Retaeed to Foadhorne.'ttnnss'nte:verrfions and Risk According to L.akv Called to Facturs;ltems 9 .^2) ;,,^.ani.t 41'17/45�F Within 4 Homs. 1 i-507.17, Cooling Methcxls for PHFs PROTECTION FROM CHEMICALS 119 PHF Hot and Cold Holdinq 1Q AddiFear l r Color Additives 3-501 tri Ri C & r v U ( 1't{Fs':slaint.u..dalurbei�ns' 3-Z1 t12 rotecves' i90.004(F') 41"11`'17" 3-366.14 Pttricen„n from Urappio:rd Additt,-es` 3.90!.t6!A) Hot PHPs R�iaintaine(I a7, n7, dL`oee lj Poisonous or Toxir.Substances 14(i'F. "7-IIJLII ktenl,h'iuglntnunation-Onginai ( ;.j1):.i.b(A) Roasts Held at o: aiwvel3U''F ' Containers” j 7-10'_11 GItrunon Nam: -Work€mContainers 20 Time as a Public Health Control 1 3-;o t 19 Time as a Public I Ie:dth Control" 7-201.II Sep.:ration-Sturakc^' 1 i90.004(li) Variance Rcclm,eruent 202.1 1 Restriction-- Pr.srrce and tis:." 7-202.12 Gr,:drions of IIcr' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20311 'InxlcGwtnl:rrs-- 1't,41R11ious' POPULATIONS(HSP) 7-�(A.II Sanit zer,.CMeiia-C1:fenvcxa` 7 20-1 12 Chenncal:. ini A'ashing Puxluce.Criteri.1- ( 121 3-SUI 1 I(A) Cnpa,leurize(i Pre-packaged Juice.,and abels* ?04.14 IN 0n-,A;;.ars,C'riteua' Beverages with 1R'arninl -5()1.11(B) Use of FasTeui€zed Eggs'"L 7-20i I I irridental Food Contact, Libncent:,'- ( 13-801 1 I(D) Rae•oi'Partially Coo6'ed Aromal Fond;,Id 7-'0-6.11 Restricted Use Pzstiei(tes,Criteria' 7?qn 12 Roden Bait$rg,+ions" ( Raw Seed Sprouts Not Served. 3-501 1 I(Cl i ir.npened Food Packa:;•a Not Re-ser ie(1. ' 7-2(16.1. Tracking Powders,Pest Cant-cd and j kloniterm¢' CONSUMER ADVISORY 7lMEJ7EMPERATURE CONTROLS 22 3-603 11 Consumer A&isor' Posted ibr Cwisumpuon of 16 Proper Cooking Temperatures for I Anmtal Foods lhai are Raw.Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.11A(I)(2) E2,,,S- 155'FI5See Patho.g' Lg„s- inunediatc Scn'icc 14SFl:iseo- 3-302 11 ( Pasteurized E,ge Substitute far Raw Shell 3-=101.71(;'+)(2) Comminuted Fie". Veaix R.Game I ' Animals- 155'17 tri sic. * SPECIAL REQUIREMENTS 3-40i.'1(BH1)(2) Pork and Bee,Roa�t- 130'F121te:n` 3-40;.1I(AN2) Ratites; hjJe,-ted Mea[.- 15:5`17 l7, 590.009(A)-(D) Violations of Section 590.009(A)A D) in .,ec. 4, catering, mobile food, temporary and 3-401.11(A);3) Poultry,Wild Game. Stuffed PHFs. residential kitchen oper.ilions Should be Stul'tin,Curtaining Fish,Meat, debited under the appropri it. sections Ponitry or FaLC:s-1,65't 15 see. ' above if related to foodborne illness 3-401.1 I(C)(3) Whole-muscle, Intact, Beth Steaks interventions and risk factors. Other IA'`F:' 590.009 violations relating to goal retail 3-401.12 Rant'Anim.il Foods Co:iced in a practices should be debited under#29- Micio,',:.c ;65`t' Special Requirements. 3-401.11(A)(1)(1b) ( AU Other PHFs-- id7`F 15 sec. " 17 Reheating for hot Holding ViOLATiOiVS R kATED TO GOOD RETAIL PRACTICES 3-403 1 iCA)8c(D) PI-IF,. 165'F 15 xec. ; (Items 23-30) -J0:.11 t 13) A?icruwave- 165'F 2 Minnie Standing, Critical unu non-cral cal violations, which it,not relate to the 'filee” 6odhorne iihtes.r interventions anal risk!nc!ors fisted abo,e, c(u be 3-403 1 I tt:) C'ommeie.ially Poxessed R FE Food - found in the follon ing sectional q(the Fool Code and 105 CMR 1.1(1"F* x96UN10. 3-4031Ii E) Remaining Utiglwed Portionsof Rcaf 1 Item 1 Good Retail Practices ' FC 590.000 Roasts::: 1 23. Manaciement and Peisor nel FC--2 .003 18 ( Proper Cooling of PRFs _24.__- _Food and Food Protection_ - FC-3 C104 �25 1 Egwnmentand Utensils FC-4 .005 j Coolln�Cooked PITFs omI-10-F to 26. Water.PlumbinOand Wa, FC-5 .006 7G'F Wi,hin 2 Hums air([From 70`F 27 1 Physical Facility F"- C07 to 41'F/4i'F Within 4 Hnur<. � � 23. Poisonous or-1 ox!c Materials FC- 7 .008 1 3-501.14(B) Cowling PHFs Made From Ambient L29. _ I_Special Requiremenis 009 Temper;nune Ingrcd4rnr:to-+1'-F;'45` 36 Oi."car \t,(thin 4 1-Ivur�,, I 'bcnotu,cuticat aero in the lederal 1999 rood Code w M CMR 7,90 000. o I ql CITY OF SALEM, MASSACHUSETTS \ c LICENSING BOARD 120 WASHINGTON STREET 978-745-9595 ext.421 NOTIFICATION FORM IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form MUST be signed and returned with your application). NAME OF BUSINESS Corporate name: Jay El Enterprises LLC d/b/a: Rockafellas LOCATION: 227-231 Essex Street TELE. # Cell 781-727-7542 TYPE OF LICENSE Alcohol/Restaurant APPLICANTS INFORMATION Name: Kevin Marchino Home address: City: State: Zip: Home tele. # OUTSIDE:SE HEALTH AGENT/INSPECTOR'S COMMENTS: €_ A`W HINGT N IDE 1 /cvne� �45 c,4 nc� u/Se i �n l� '�GP� rX �CW4ad slcc�v5/u 1 ✓1 t>r,4 P.' 4 11 67! /r' �Ct i e s' YI J vt Y �D /Q rl y /a (' / f✓� All C,44,-1 ✓QC�vidPvuc.c l s t'I�vP l?z�, alth AgeneA notification form Memo SEP 19 2003 �UJ CITY OF SALEM BOARD OF HEALTH Date: September 16,2003 To: Joanne Scott, Health Agent From: Joyce Redford, Program Director and Patrick Mulligan,Compliance Inspector RE: Salem Tobacco Inspections On Friday evening between 8:00pm and 9:00pm,September 12,2003 Patrick Mulligan and I conducted random Environmental Tobacco Smoke(ETS)inspections at the following establishments following reported complaints and there were no violations found. In Compliance Victoria Station Pickering Wharf Rockafella's Essex Street Bay Bridge Bridge Street • Based on our inspections and discussions with the Management at each establishment it appeared that both Victoria Station and Rockafella's complaints might have been based on confusion about where the patio areas ends. Both establishments simply use rope to indicate the end of the patio area and the general public can be standing right next to the rope and smoking. Thus may have lead to the complaints. • Bay Bridge was in compliance at the time of the inspection, however indicated some confusion about patio smoking when servers are present Therefore we clarified the rules of the regulation with the identified manager before leaving the establishment CITY OF SALEM BOARD OF HEALTH � Page: of Establishment Name: ,��1 L(�� Date: Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY LA l (,x�_ CLt-vi�� - C-y._\Z2 A5. L1. �. Discussion With Person in Charge: Corrective Action Required: ( ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. —y�A ,fin . /v/ ❑ Voluntary Disposal ❑ Other: _;-:i01 i;+Cl PHF,Reeci;ecf at Temperatures Violations Related to Foodborne Nines Irterventioas and Risk According w law Cooled to Factors(hems 1 22) (Cont) dl'Fa15'F` ;thin Y Hours. 3-50111 Crsllimt Methods t:e PH'rs PROTECTION FROM CHEMICALS 14 Food or Color Additives ( 19 ( PHF Hot and Calc Holding 3-2.02..12 Additive;;* 3-50116,(6) Co1dP11Fc,Ya;mmn:•datorbclow : -i?.0od(F) --i)''/4i: 1 3-302.W. Protection from Unapprosed Additives" SUI.Itd:U Hut ?'iiFs P,4ainhu nod ai ra above is Poisonous or Toxic Substances I 1-r)„F, , 7-101.11 Identiljing lnfinniation-Orginal ( 1-501.15(A7 Roar:s Held m of abo,e 130-F. " colltainets` ' 17-102.i I Common Natne-Working Container2(i T.Container:" 1-0 as a Public Health Control 3-501.11 Time ac a Public Hoalih Contr d" � I i Separation-Stirate' I _ 7-2612,17 st Rariction-Presence.and Use;. 15y'd.u) H r Vallance Reouilemcnt 7-202.12 Condition:,of Use" 1 7-203.11 Toxic Containers-Prohibitions" ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � 7-741A.11 Sanitizers.{'utero-L'heu:irataPOPULATIONS(HSP)^ � I I + 1 (hlpa,leurited Pre-packaged icoces and '7-<'t)4 12 Chemicals for��ash+ng Produce.l'ritens' + 21 3-801.11(A) 7-2`4.14 Doting Agents.Criteria* � ' 3eteragec with'iVarninI Iwdn•Is* =-8O1.1 I B 1 Use of Plsteurized 7-105 11 Incidental Fruvl Contact, 1-nbucanl,, ; 3-801 11(D) Raw of Partially Cooked Anun,ti Food and 7-206.11 Res+ric:ed Use Pesticides,Critetia° . ' Raw Seed Sprouts Not,S�r,..tcv ; T 7 2ru4 12 Rodent Bao Stations�� ( 3-801.i K) Unopened Food Package N�6 R,t-served. ' 7-206.13 Tracking Powders, Pest Control and Monitoring" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-003.1 I Consumer sldvi:.vy Posted for Cori omption of Animal foods'I'har:;re Raw.Unuereouked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Nrocessrd to Eliminate 3-401 ll A(l x..) Eggs- 155`F 15 Sec Eggs-]mmed+ate Service 145TI5sac, -`-302.13 Pa;teurizeJ Eggs Substitute for Raw Shcli 3-401 11 A)( CouumnWed Irish. Moats&flame. Aninrds 155'F 15 ar . " I SPECIAL REQUIREMENTS 3-401 11tAi(J Ratites,Injected m( 3-401I1(B)(1)(�) Pori.andBectedMeats- I55`P 15{- 13(1•F121rnur' ) 590_0;0iA)-(D) VioialiunsolSection 590.0(Jy(A)-(D) in sec catering, mobile food, tetnporar)�and 3-401 1 UA 1(3) Poultry, Wild Game.Stuffed PHFs. residential kis':teri ;per.tiona should be Cluftim•Containing Fish, Meat, debited cutdet' Ile appropriate uclions Pouitr}`nr Rtu 1,,;-1(15'F 15 sec ` above it related to foodborne illness ?40I i I(C)(3) Whole-muscle.lnnlcl Gert St.aks. intervention:;and r;A Factors. Other N.5'F' 590.009 vinlauous(rating to gtod retail 3-401.12 Ratti Annual Foods Cooked in a practices should be dehited under N29- Microwave 165'F Special Requifemems. 3-401.11(A)(ipb) AtlOtherPHF,- ! 4- IS sec. 17 ( Reheating for Hot Holding VIOLATIONS R2LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165''F 15 sec. * l items 23-30) 3-403.11(B 1 Nticrowaw- 165'F 2 NTatulc Standing Critk ul acs non-unto„! i ioll,fio ts, trF,ck du nni ro'''le w the Tune* ("urinoma°dierss inlrr�rnt4on.r and r;sk fu::hm, listed above, call he 3-403 1 I(C) Comnleretall}Processed RTE Food - ,found in the•fo1lonirg sn tions of the Eoud{:ode,and 131 CAIR 140'F" Svoxuo. 1-^U3 1 I(F.) Remaining Gnsileed Portions of Beef Item I Good Retail Practices I FC 59(1000 Roasts'. 25 ta)ananereent and Personnel FC-2 .003 18 Proper Cooling of PHFs ( 24 Food and Fcod Protection FC-3 .001 3-501.1-ttA) Coo'im,Conked PHFs from ld0'F to ' 25. Ealapment and Utensils FC-4 .005 26. l gior.Plumbing and Waste FG-5 .006 70"F Within 2 Hours and From 70 T 27 Physics!Fac9ity Fr- 6 007 to41'F/45'17 Within dHours * 28. Fox 0110USurToxic Materials FC-7 ,008 3-501.14(B 1 Cooling PHFs Matte Hvnl Antb;eot ' 217 Spec!al Requ;remeris .009 Temperature Ingredient,.m 4 t"F/45'F 30, Qther Wilful Hours` "Denote, rnhud nam m the:Ld:rri N9 0 Fwd Cupie o, 105 C.Mk%,',000. CITY OF SALEM BOARD OF HEALTH ` Establishment Name: J45 � �i✓�_ //"7 .4 Date: to /07--1 XT Page: l of Item Code C—Criticarltem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ,4111 /00 si�liv fel -d�1JrrP — �l�oir�.,�, i.�fzOP��_ii�n .c ��: Jre �T� /1 ale i f 1I I • {I I I 5 Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I undgrstand that noncompliance may result in daily fines of twe o rs or suspen�/revocation of ❑ Embargo ❑ Emergency Closure your food permit. `� / ❑ Voluntary Disposal ❑ Other: 3-50!.14((,:) PHFs Re-et sed at'Temnrr,4ures '✓iciation;Related to Foodhorne ifimrss Infertcrtions and riisk. to Lttw Ccolcd Factors(Itemst-2P) (Goof.) 4!`rl45'F\Within4I-€mus. 3-:i0!"15 Cml;;i^ivlmhnds lot P1117, PROTECTION FROM CHEMICALS 19 PltF riot and Cold Hol6ing � 14 AddiFoodtive.;* iv Color Additives ! �t-SU.i 5(B 1 Co:J PFlFs JIaimamed al or he(ov, 9-;102.7' Addiuv:•a" 3-302. a Protection fro/ i lJngm,,)-,ed Addiuces.� ( �`1U.00-(F1 41 PH F €`' 3-jQ i. 6(A) 1140 Y(-lFs lQa:n; -..;:.ed at or above jj Poisonous or Toxic Substances 7-10!.!1 idem'ymc111formation--Orl"itm; I=10`F 3-50!.i b(A) Roasts Held ac o,above 130`F ' Cuutaiuers` - ?-102.' ! Common Name-Workin,Conun nerc 21) Time as a Fuh!Ic Health C.arttai 3-30!.19 Tom-as a Pui;!i: rll-aWl Control j 7-201.11 S varation-Storaec` ( 500.11)04r 11) Vammde Reyuvemord 7-202.! ! RGtrio,on-PCciteice and UsQe' ' 7-302.12 Crndniuns of Cine" 7-203.1 ! royi;,Container,-Prohibition" ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.! 1 Saintizem Cn!ena - Cberx;icals* POPULATIONS(NSP) i-o !a ! ! >. 1 21 3-SWAVA) Unpasteurized Pu;-naJaged?vises and '• U=1. Chvilmil a ur NVi0w:t E rothree, Qireria-' ` BeveraLes with Warnin;;L,abcle'i 7-204.i4 Dmnp A erm.Croons* ' 3 K01 71;B1 Usz vi Pnstruri:;ed :;;,:" '7-205.11 Incidental Fond Concoct,Lnbricarasx ( 3-801 11,D) Raw ac fl tially Cooked Animal F,xd and ! 7-206.11 Recrrieted Use Pe.fieide:,Criteria" RawSeed SPr suis Nn: Ceased. ! 7-200.;2 P.odcnt Bait Stations" 501.71:C'i Unope;cFood Pat ka rC N,x Re-SCM,-,d 7-206.13 Tracking Powder.;,Pest Control ami I "- "d � N4onitonng- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer A6i,ory Posted for Consumpt,ur,of AnnilA Aad:: f iii are Raw. Uaderwoked or I5 Proper Cooking Temperatures for PHFs No! ('ter. L .ise Processed to Elmrmate n, Patho^ens.° 3-401.11At1)(2) Lgs- 155 F15Se,. ( g E,,gs-lmmrdrate St,rvi,.e 145'Flisec 3-30.'..I� Paatemseri Egg:Substitute for Raw Chell IT , 3-401 II(A)(2) C'onnninutcdFish. 'LlcatsRGamc i Animals- 155-F 15 sec 3-401.11(8)(11!2) Polk and Beef Roa,t- 130`F1-1nao SPECIAL.REQUIREMENTS 3-401.1 l(A)(2) Rati tcs,hijeclyd Meats- ;55`P 15 500 009tA)-(i)) Vioiations of Section 190.0,09;A)-W)- in sec - catering, mobile food, temporary and 3-!i11.iI(A'(',) Ponlny,'Wild Game. Stuffed i'HI',, residential !ntchen operations should be Stns'in;Containing Fish, Meat, debited under the appropriate sections Poniry nr R:n;les-165'F IS ace, above if related to lood'norne illness ' 3-40LlI(C')(i) Whole-muscle, Intact SeelSraks ( in'..er•,entionsand risk factors, Othcr 145'F* ( 59.009 violations rel<rting to good retail 461.12 Raw Animal Foods Cooked in a practices should be debited under !29- Vicrowave l65`P'" ,.�� r<egnitcnicnts. 3-401.11(A!(t)(b) All Other PHFs- 145'F 13 see ' 17 Reheating tot Hot Holding VIOLATIONS R�LATED TO GOOD RETAIL PRACTICES 3-4(731I(A1&.(D) PHP, 165'F 15 sec. y (Items 2.3.30) 3-403 11 13) Mic,owave- 165'F 2 NTi;utte Standing L'.itrca!unu evn-uilira;ii�rrgt;.gms, n'haCh du nor reLa6:to;lie Tiule* I i-uodbor'ne illnes., in!erne;rir;r.r and ri.;k Inc:on hand above; Can be 3-403.11(C) Commercially Puxessed RTE Fond- fr ind in rtie fn!lotvieg ser icor;. r`the Fo,d Cede uw! 105 C-AdR 11(PF'' 590.0/10. 3-403.12(E) Remamine, UnsLccd Portions of Reef I Item Good Retail Practices ,'C 590.0CC j Roasts' ! ! 23. Ilan im;llem ord Personne; FC-2 .003 ! 18 Proper Cooling of PHFs j 24- Food and Food Prot-ction. FC-3 .004 25 Equipment and Uleuslls FC-4 .005 3-Sol 14(A) Cooling C-.oked PFIPs from 1;0:F tor j 26. Water, Pla:nbinq and Waste FC-5 .005 70'F Within 2 Hours and From 70'F � j 21 ! Physical Facility FC -6 007 to 4i�Fi'45'F NAithm 4 Hour,. ' ! 23. 1 Poisonous or?oxic pAaterials FC - 7 .WJ3 i 501 14181 Cuulmg PHFs :Made From Ambient j ?9 Spec al Renu!remerts Temperature lotradicot>iu.11 Fl-, 3C Other:°"F � Within 4 Hours' •.'."' 'Drroic,cr!hc.J rani in the tedersl P:4ti 1'm,d Cuda ni 101 CNIR S90 000. CITY OF SALEM BOARD OF HEALTH Establishment Name: _eo ea i� S Date: &�12-o3 Page: 1' of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �l ��e- o Pew rN� i�r.>,.e e.fio-., was Gtfdr>ck'o� cur•FG� ou�.cp� T%K. I IIiP.,>,e i o,F Po-(t�, kf&-A - o zt)&'/� h�nrf p�.sr 4-7-1,1.-1 —AD A-e— `Gtr -7 a A All-0.1 Sr-7&' Ca,( 9 Q l l `l.wG `ur�.n.s�.�v (�• s Du d�i�4 C 6/.lP /<p Ail AAr 11,d /JISt1waS� �- fwkt! Yi✓7SX I �5r-nrosl't I All vw/;,4 herwe .014/-)k" wd1/s� L' GT:.s Co/IH-* S. U144,o o� 1�Jd dP tol�.4 .Pty r>i�J ,rsn�� IJ�P�rs!/Sr �z�lP.i YIV i',4 A,-e 548i/eL 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all :❑ `voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-:i01.14(C)' PHFsReceiredatTentperattues Violations Related to Foodborne illness Interventions and Risk Accordin,*in Law Cooled to Factoes(Items 1:2) (Cont.) 141 Fr47'7 w'iritin"Hotn's -501 IS C(whng Methrrlc for PHF. PROTECTION FROM CHEMICALS 19 PHF Hot and Cola Holding 3-202.12 ]4 I ' Food or Color!additives 3.501 1fitB! CHF OIFs Maitu:r:ed at ur hclucv ! Additives" j 3-30'.:1 SYt).004(F) »I'i45'P Protection horn I h+appioeed :Additives' Poisonous or Toxic Substances ;_50LINAl fh,t PHF:. RIaintai!od at 1m aho e I ]5 ( � 7-101.11 ! identityine Information- or)einal 140+. ' x 3 St)1.16(A` Roa,tc field at<a above 130'F C'omainers� T 7-10"2.1 I Common Marne-Working Containers.t I ( 20 Time as a Pubic Health Control 7?01 11 Separation-Storage'" ! 3-5!}1.19 Time as a Pub6:, Health Control- 7-202.11 Reetrichnn - Presence and 1)se'' ! 5`)0.(IU4(li) Variance Rcyun-ement 17-_'0112 Conditions of Use` ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7.2113,11 Toxic Cortn#ners-Prohibitions' I POPULATIONS(HSP) ! 7-2014.1 ! S:dritizets.Criteria - C'he+mcakS ( - ! 7-20-1 12 Chrnn:als fta Washing Produce.Criteria' I 21 '-H01.11(A) Unpa,teuriped Pre-Packaged prices and + Be%eraces with Wanting Labels 7 ' 17-20 .14 Drying Agents. Cn '+` � 3_gpl.71(Hr Use of PasteurizedFpgs* -2055. 1 Incideuta! Fund Contact,Lubricants* 17-206.11 Restricted Use Pesticides,Criteria"' 3-801 It([)) Raw or PaP.ia;ly Cooked Animal Food and Raw Secd Sprouts Not Served. 4 7'206.12 Rodent Balt Stations � I ?-Vi I(C) Unopened For ni PackaLc Not Re-served I i 7-20h.13 Trackit>;,Powders,Pee st Control and I \4onitorine' ) CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-6x)3.11 Consumer Advisory Posted for Cun:utnptiwt of :\mtnai F.,ods That are kay. Undercooked or 16 ( Proper Cooking Temperatures for PHFs Not Od-:erc;ke Poo€esscd u,Elimutate F'111-!Lv 711y 0111 -402.11 Ail Eggs- 155'F l5 Sec. Fatho:;.na' Eggs-ImmedialeSeivice145"Fliwe' 3-302.'3 Pasteurized E,, sSubMiLUu !c);Raw Shell Falls, 3401 A I1 A)(2) Comminuted Fish. Meats&Came An;mals- 155'F 15 sec,. j' SPECIAL REQUIREMENTS 13-401.1l(B)(I)(2) IPorkand Beef Roast- 130'F121min' j9CU09GSPE 3-401.11iARatite, )(2) Infected Mcats- 155 . F 1� Violations of Section 5)0.0)9(A)-(D? in sec. , catering. mobile food, temporarg'and 3-401 11(A)(3) I Rud!ry.Wild Came. Stuffed PHF,, I I residential kitchen operations should he Metonq Umtai note ,Aleat, -LNuw Nadel the Pradny�or Rantes-165"F 15 sec. " I above if related to foodborne illness 3401 1 l(C)(3) W'holc-muscle.Intact Beef Steaks interventions and risk factors. Other 145''F 4 I 590.009 violations relating to good tetad 3-401.12 Raw Animal F,xxlt,Cooked in a practices should be debued under#29- Microwave 16,S`F" Special Requirements. 3-401.1 l(A'(l)(b) All Other PHF:-- 145'F 15 sec. 17 I Reheating for Hot Holding J VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PfIFs 165'F 15 sec. I (items 23-30) 3-103.11(B) ;Mici owave- 165'F 2 Minute Standing Critical and non-crakul violarb,ns, ivh;ch do not relate io the Tinto"" foodborne illness interventions and risk facings listed above" ca"he 3403.11tC) Commercially Processed RTE Fcxxl- found in the following sec tiorn of the Food Code and 105 C'141? 140'F' 500.000. 3-403 1 I(E) Remaining Unsliced Portions of Reef I Item Good Retail Practices FC 5,00.000 Roasts1 23._ Hanagement and Personnel FC-2 .443 ]g I Proper Cooling of PHFs I 24 Food and Fuorl Protection FC-3 004 3-501.14(A) Cooi!rg-Cooked PH Ps from 140'P to 25._ Egwpment and Utensils FC-4 D45 26 Water, Plumbntri and Waste ( FC-5 006 70'F Within 2 Hours and From 70`F ; 27 Physical Facility FC-8 007 to 41"F/45'F W'ithm 4 Plonc.. 's 23. Poisonous or Toxir,Materials FC-7 .008 3-501.14(B) Cooling IsHFs Male 1ram Arahient �-2-J--- Special l-H zYw-_rement ._-_------�- 009 Tuuperaure incoredient.to 41'FJ45'F 30. Other Within 4 Hrurs , F- 'Drnae<ct ilical item in the tederal 1991+Pood Cure or 105 CNIe 598000. CITY OF SALEM /� BOARD OF HEALTH Establishment Name: K I_Ka e'P f d J Date: /-z ._. r) Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY A'7"f) l I?Q (��A/► Seer L rf.� � ri O? 1/1 appal 1n cr y rI IF 1AL-1 1-o'/(--r 4-n D7,�- W22K .� O f7�.r .n y ink D�i+,L r.�. .• v =- . I ' - I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dol ars r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Receivrd of Temperature!. Violations Related to Foodborne fitness Interventions and Risk A.cot di rw to l etw Coolest to Factors(items 1-22) (Cont.) 41-F/45•F Within 4 Hours, PROTECTION FROM CHEMICALS 3-501.15 C ot- in)t Methods for PIIFs 19 CHF Hot and 14 Food or Color Additives ( 1aHolding int 3-501,16(B) CoL3 fH+ -Maintainedal in below 1201-.1? Additivcci' I Sy0.0!t.1(F) dl'",'�15"F°. 3-302.l a Prottefion tl'otn Unapproved Additii-en ( 3-501.161.\) Hot PHFs Ma ntainrd: or abnoa 15 I Poisonous or Toxic Substances I :40'F. 7-101.11 Identifying lnloruuihon-Onginal 1 „ Containers'" 501.14(,,A Roasts Haid at or above 130'F. ' Time as a Public Health Control ! 7-102.11 Common Name-!\'orkin„Containers" I 0 t-501 19 Tinn•ac a Public Heal!h Contmi 7-201 11 Seporation-Storage^' 17-202.11 Restriction-Presence and `Jse" I 159U.t)U4(Ht hatmnec Regorrenrtnt I 7-203.12 Conditions - I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20311 I'oxixic ContainersProhib ions I POPULATIONS(HSP) 7-204.11 Sanitixers.Criteria -Chemicals* I i 7-2t>4 12 Chemicals for Washme Pnxlucr,Criteria' I 121 3-Xitl.l I(A) Be%eiUnpateei,witzcdh Pre-packared Juices and 7-204.1-1 Drvin•,Agents.Criteria I Be�rrat;ea with\h'aruiu;�,Lal?elss' I 1 ''iii I I Incidental Food Contact,Lubricants" I 3-801.1 l(H) Use of Pwreunied F,,�s' 7-206.11 Restricted Use Pesticides,Criteria` ( 801 I(Dl Raw a Pa natty Cooked Amnia) }lxxl and Raw Seed Sprouts Not Served. j 7 206.12 Rodent Bait Stat.lous* I Ut.! ,(C tin" 3-x ) lmned F<x,r1 Package Not Rc-xn'ed. " 7204.13 Tracking Pest Control and Monitoring' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Adtisot y Posted Dar Consumption of 16 I Proper Cooking Temperatures for I Anttnai Fonds That are Raw. Undercooked or ! PHFs Not Otherwise Processed to Flimmate t ( Pathogens. "•"'"°`,;'; 3-401.11Ai,1)(2) Eggs 155`F 15 Sec. b� Eggs-Immediate Scrvt:e 145'Fl Ssec - 3-302.13 Pasteuri:.,ed Eg Substitute for Raw Shell � I 3-401 11(k)(2) Comminuted Fish. Nleats&Gamc Eggs- Animals- IWF 15 sec. " SFECIAL REQUIREMENTS 3-40111(B)(l)(^_) Pak and Beef Roast 1 15 121 ruin" I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-4(i1,11tA)(2) Kati tc:., Injected Meats s- 15j'F lj sec. ' catering, mobile food, lemporary and 3-401.11(Ad 31 ( Poultry,Wild Game, Started PHi3, j residential kitchen operations should be aunnng t.ordaining Fish.Meat. --o,,,,. ..atter Poult:p or Ratites 165'F 15 sec ! above if related to food'ooine illness 3-401.11(C)(3) Whole-muscle, intact Beet Steaks ! intervent;ons and risk factors. Other 145-F- 590.009 v'solations relating to good retail 3-401.12 Raw Anuual Foods Cooked in a I practices should be debited tinder#29- Microwave 1WT* Special Requirements. 3-401.11(A)(i)(b) All Other PHFs- 145'F15sec. ` 17 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PFIFs 165-F 15 sec. ;_ I (Items 23_30) 3-403.11(3) Microwave- 165' F 2 Minute Standing I Ciitirui and non-critical t-iulations, which rig not relate to the Tune" f rodhnnre illness hits,venticnc and risk fac!ot t Gated ab,,,e, can he 3-403 1 1(C) Commercially Processed R1 E Food- fotmd in the following se(tinrn <f the Food Code mol 105 Cd•I2 1400F` 590.00". 3-403.11(E) Remaining Lnsliced Portions of Beef I Item I Good Retail Practices Fc 590.000 Roasts* 23. Management and Personnel FC - 2 003 18 Proper Cooling of PHFs ( 1 24. Food and Food Protection FC -3 004 j 3-501A.1W Conlin,, o 25. EpwpnteM and Utensils FC-•9 .005 ! _ Cooked PH Ps from 140 F to 2�6. Water,Plumbino and Waste ! FC-5 006 70-F Within 2 flours and From 70-F 27 Physical FactRy FC-6 .007 ; M 41°F/45'1F NVithut 4 Hours. * ', 28 Poisonous or Toxic Materials ; FC - 1 ,008 i( 3-501.11(B) Cooling PHFs Made From Ambient I 1 29. I Specite Requirements it .009 Tempenitwe Ingrech.nls to 11'F/45'P -30 -1 Other I Within 4 Hours' ''"'""°""` `'" 'Derea"aitiail stern in the federal 19(()9 Food r_'ade ui 10i C\1R 590.0011. P CITY OF SALEM BOARD OF HEALTH Establishment Name: L)AnIe / Date: 3- 37-O3 Page: I of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified /1 / PLEASE PRINT CLEARLY / Vol / -o",// Ic<.� dit 14 /�P-NJ /LJG_S P/d' La 4-F'64 /.L[� l /B✓✓�d!'.0_I u I Voll/N kt I✓lv'v' I�l.�, a /) Of /.rs/-4-Gr �-n�/n.�i•-.� (/�,/�/ 4/e�S .' I 4• I �r /J—A I I /P Liicv 4 rP? 9w a .,54 Lr h74< if / ' I I I I ✓/�� wf -f� �Lla , �/ _ tel_/1�m c�.� /.v,�c, � �D� /, 19 .1- I (�✓on sr . /,,, I / -Zip _ iL�� I>✓�S/�c r. , /r /I� . d�o.F_ � I I /n/.�v� �,. ✓P rtra/•�, C.�Y,cer-,.r lbi.� �-n•�-��sx.� . h"t,",d SI K 7nnn4ec1 Lr op '� f�A/ /9-✓p4 l2t/ � I'IL414 /1�14M� SNf� r T •' Hce 4-.e l a is a/ ✓o ✓P l ' Ae4k ✓oq T°�/) PiPpi'a/ru.r 'o-or Discussion With Person in Charge: f Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next ec insption, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i 3-501.14(t') PHFs Received at Temperatures Violations Related to Foodborne INness Interventions and Risk According to I acv Cc oicd to Factors(items 1-22) (Cont) 4l"P/45"F R'itbin 4 Hnnrs. ' PROTECTION FROM CHEMICALS 3-501.1') Cr„lin;?Nlrthuds for PF"1Fs j 1a Food or Color Additives j 19 PHF Hot and Cold Holding 3-501.16{B) Coli PIfFs Maintained at or below 3-202.12 Addnivcs" 5911,001(F) 1"l=4:;" F'' 3-302.14 Protection front Unappruced Addi irc,, 3-501.16(A) Hot PHFs Maintained at ur above j 15 Poisonous or Toxic Substances j 7 101.11 Ide nl ovinc information-Original Containers° I 3-501.I6(A) P,oasC; a Hz)d at nr above 130F j 7-(02.11 Connnon Name -P4'orking Container, j j u Time as a Public Health Control ! j 3 501 19 Tinne n:.a Public Health Centre!' 7-201 11 Separation-S1onnic" 7-202.11 Restriction-PresencoandUsc* j j 500.00-4(11) VarianceReunuement j 7-202.12 Conditions'U of Use* T ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-20311 Toxic Cuntaincts-Pr nhibnions'� ( ( 7-204.11 Sanitizzrs.Catena-C'hemicaPOPULATIONS(HSP)ts* ( , Produce, 121 3-501.1 I s') Unpactcunzed Pre-packaged end j 7-..04.13 Chznurtic for W,1<hing 1 rndnce,Criteria" ( I j 7-204.14Becc Drying Agents,Criteria* j a._,es wilh Witriiinpt Libels* 3-901.11(&) i1wol'PosteurizedEp;oss j 7=_'05.1 I htcideutal Fold Contact, (ubricnns^` ! -SM.I I:;D) Raa or Pa:•tially Conked Animal Fgrxl.end j 7-2.(16.11 Rectric4rd Use Pesticide;,Criteria 3-SM. Rant- Seed Sprouts Not Served. j 7-206.12 Rodent Ban Stauons" ! j 3-801.1 l(C) Unupem:d Food Package Not Re-s:recd. " 7-206.13 '[Packing Powders, Pest Control and Manston°g' CONSUMER ADVISORY TIM ElTEMPERATURE CONTROLS 3-66.3.11 Consumer Ade+sory Posted for Consumption of Annual Foods That are Raw. Lindercooked,a- 1 fi Proper Cooking Temperatures for tint Othcrwise Prucecsed to Eliminate PHFs n;=�,,.e;. 3-401.11A(I)(2) Eggs- 155'F 15 Sec Pathoi;ees." + 17.,,,"s-Immediate Service 145`Fi iscr' 3-302.1: Pasteurized Egg; Substitute lar Raw Shell 3-41}l.l I(A)(2) Comminuted I•ir.h. !bleats 8c G;une Eggs Aninnals- 155"F 15 sec. 4' 3-401.11(B)(1)(2) Poch and Beef Roast- 130'F 121 rat n,+, j SPECIAL REQUIREMENTS � 3-401.11(A)(21 Ratila;, Injected Meat:- 155`''P 15 500.009(.A)-(D) Violations of Section 590.009(-5)-(D) in sec r catering, mobile food, ternporary and 3-401.11(A)(3) Poultry,Wild dame,Stuffed PHFs residential kitchen operations should be + Stuffing Containing Ftsh,Meat, :Nii;d tinder the?pprodri;nc Poultry or Ratites-165'F 15 sec '" above ii related to food[rotne illness 3401 A IlC)(3) Whole-muscle, Intact Beef Steaks � interventions anti risk Factors, Other 14.5`F s= 590.009 violations re)ating to good retail 3-401.12 Raw Animal Fools Ctxrked in a practices should he debited under ff29 -- I Microwave 165'F X Special Requirements. 3-401.11(A1(1)(b) All Other PHFs - 145'F 15 sec. * j 17 Reheating for Hot Holding VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES j 3403.11(A)&tD) PHFs 165'F 15 sec. It (stents 23-30) 3-103.11(B) Microwave- 16.5"F 2 Minute Standinv, Crihcai and non-crnicul violations, which rbc not relate to the Time"' ,foodhorne illuess intrrnerriour and rick fiivlw t listed abate, can be 3403 11(C) Commercially Processed RTE Food- found in the following rcaioim of the hued Code mrd 1115 041? 14WF" 590.000. 9-403.11(E) Remaining Unsltced Portions or Bee( I I Item I Good Retail Practices FC 590.000 j Roasts"' 1 23, I Manawment anti Personnel FC-2 .003 ! 18 Proper Cooling of PRFs j ! 24. Food and Food Protection FC-3 .004 ! 25 Equipment and Utensils FC-4 .005 3501t4(A) Cooling Cooked PHFsfront 14WFtoj 26. Wets ( FC-5 .006 7WF Within 2 Hours and From 70'F 27 Ph4sical Facility FC-6 .007 to 41'F/45'F Within 4 Hours. 28. Poisonous or Toair,Materials FC- ' .008 ! 3-501.14(BI Cooling PRFs Made FramSpecial Requirements .009 Ambient 129. -- Temperature Ingredients to4l'F145"F 30 Other Within 4 Hours" •,,':'""- D:note,critical item in the tederal 1999 Food Code m IOi C:\4R 590,000, CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 3 - -7—D Page: of ZL Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY /�U "ILS /J"`I T7l DP�'N ING/ T/1 I . ' 49 '1_�d G� do o -e4'711`7 y I I I I I I Discussion With Person in Charge l ` ' `( J ` -r rix b -C.r recjjyp Actio nRequuired hl El No I ❑ Ye's ) f , ,. a f 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 p C] 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 I' your food permit. 0 Voluntary Disposal ❑ Other: 3-5)1.1.4(C! PHFs Receieedat 1'eml-erntures Violations Related to Foodborne Illness Interventions and Risk According,If,l.,or Coolod m Factors(items 1-22) (Cont.) 41'FraS- Withut 4 Hoots. PROTECTION FROM CHEMICALS ( 3S(il IS Cooiin= McOnals fm PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding "I 3-501.16(B) Cold PHP;Maintained ai or below 1 3-202.13 Additives# 5)r t1.004tF1 4 i-V45"F' I =-3t12.1d Pr otrchon brn otE hur epi oveJ Addnnes` � - 3-501.16(A) lba PHFs Maintained at of abo,e 15 Poisonous or Toxic Substances 140`1 r i7-101.11 ldennf)anclnformation-Original ( 3-501.1ti(A) R,a,tsHeld at(it aho,v130T. ` Contamers;' y0 7-102.11 Conunon Natne-Worki hr Containers°" Time as a Public Health Control 7-'_0 L 11 Separation--Storage" 3-701 I'i file,a:a Public Health CbntroPl 5c}1,004(:`1; Varmce Requacmern 7-202.11 Restriction-Presence and O:e' l 7-202.12 Conditions of Lyle" � 7-203 It toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Cruet in--Cbemicals' POPULATIONS(HSP) 7-204 12 C:henticals for Washing PAKIUCe,Criteria" ( 21 ' 3-501.1 I(,A) Onpasteuriied Pre-packaged Juices and � 7-204.14 Drying A- Ins,Criteria' 1 ' Bevera.ler,with Warldn;t 1.atbets* ?-801.11(B) Use of Pasteurized Egos'" 7-?05 It Incidental Food Contact,Lnbticants+ ( 3-901.1 If D) Raw of PaAmfly Cooled Animal Fond and 7-206.11 Restrirted (Ise Pesneides,Criteria" - 11 7-206.12 Rodent Bait Stations' ( Raw heed Sprouts Serer J. 3-90LII(C) Unopened Food FsckatkagcNot Kc-srn'zct 7-206.13 Tracking Powders,Fest Control and n9uniamng" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption orf Animal Food,That are Raw. Undercooked or 15 Proper Cooking Temperatures for I Not Otherwise Processed to Elinnnate PHFs 3-401.11A(I)(2) Eggs- 155"F 15 Sec. Pathoeens.' Eggs-Immedtata Service 14?'FI Isis` j 3-302.13 Pasteurized Egg,Substitute for Raw Shell 3-401.1 I(A)(2) ( Comminuted Fish,6--teals&Game Lags' Animals- 155'1 15 sec. * SPECIAL REQUIREMENTS � 3-401.11(Bit 1)(Z) � Park and Beef MM .009tA)-(D) Jiolalions of Section Roast- 13(1'F 121 mini � 5e0 590,009(* -(ll in 3-401.t1(A)(2) Ratites,ht)cctaoats - 155°F li ) ) ;ec . I calen ng, mobile food; temporary and 3-401.11(A)(3) Poultry,Wild Game. Stuffed PHF,,, ' I residential kitchen operations should be muffing(ordaining Fish. Meat J bii<d cadet the approprictc ,arc;;c-1s Poultry or Ratites-165"0 15 sec. " ( above if related to foodborne ilhi:ss 3-101.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk iacturs. Other 145'F i 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited tinder/t29- I Microwave 165'1• * Special Requirements. 3-401.11(A)(Utb) .All Other PHFs - t45'F 15 secf`f 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 11(A)&(D) PHFs 165'F 15 sec. t (Items 23-30) 3-403.11(6) Microwave- 165'F 2 Minute Standing Critical and nun r;rilic+al violations, which der not relate to the Time* loodho>rne dbress intemexrions and nsk custom listed above, can be .3-403 1 1(C) Commercially Processed RTE Food- found in tnc foll(nving se(liana of the T ood Code and 105 CMR 14WF* SVU.ouO. 3403.1 I(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 530.000 Roasts'; 23. Management and Personnel FG-2 .003 18 Proper Cooling of PHFs 24. Ford and Food Protection FC-3 .004 3-501.14(*) Cooling 25 EquipmentandUtensils FC-4 .005 Cooked PHFs from 130"1 to 26. Water,Plumbinq and Waste FC-5 .006 7W F Within 2 Homs and Front 70"F 27 Physical Faalav FC-6 .007 to 41°1'(45''1 Within 4 Honrc. - 28._ Poisonous or Toxic Marenais FC-7 008 3-501.14(B) Cooling PHFs Made From Ambient �29. Special Requirements ! 009 '1•empertturr ingmdients to 4I'Ft45"F 00, Other Within 4 Hours. n.�.,,....o- tm:. `Ucnotco critical item in the tederal 1999 Fuad Gyle w 1(15 C\-IR 510.000. , a ( IMPORTANT MESSAGE ) FOR DATE 'CCCC///�9'Q 3 TIMEV �%D�(P . OF /• / art e PHONF AREA CODE NUMBER EXTENSION O FAX U MOBII F AREA CODE J)YJMBER TIME TO CALL TELEPHONED y /PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL \ WILL FAX TO YOU MESSAGE E GNED ®�� MAAOE IN 40 NOTES 4 ( IMPORTANT P49PSAGE ) FOP . )i) P I A.M. // DATE�9 � � � TIME P.M. OFCJ PHONIFA / E �U�L BER EXTENSION O FAX O MOE3P F AREA CODE 1. NUMBER TIME TO CALL TELEPHONED �Ar PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU ( RUSH RETURNED YOUR CALL I I WILL FAX TO YOU MESSAGE SIGNED ps. FORM 4009 ' MADE IN U 5 A NOTES _ __ r s ,. "' ... r• .. .. „r.,�..n s..,l'• .a. ,.,o. . .. ,,T' .. ,.r:!»1.M .,, �,,,� ...-«rr K, .. .. „ 'K ../, b FAassachusetts Department of Public Health Salem Board SHealth M 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 �J D Type of Operation(st, Tyne of Inspection ��n R ( c��a5� [good Service ❑'Routine Address "9'� t i /r.SSS V Risk ❑ Retail ❑ Re-inspection Level El[I Kitchen Previous Inspection Telephone [IMobile Date: 7� �� T ❑ Temporary ❑ Pre-operation Owner ` HACCP YtN ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time I ❑ Bed&Breakfast El General Complaint In: Q HACCP Inspector \�>{ 0 I out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590,009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [:114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded Q 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEMEMPERATUR£CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition Q 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION 2119.Hot and Cold Holding Q'8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices [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 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 cf Health. 590.000/federal Food Code.This report, when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) ) order of the Board of Health. Failure to correct violations X24. Food and Food Protection (FC-3)(5590.090.0 044)) 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)(590.006) 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 5WJi I A F -,q.ua Print: � Prin�J� , lPage_of4Pges 460 ' Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FPGM CONTAMINATION FOOD PROTECTION MANAGEMENT S Crow-contamrnat-on j I 1 S9,),owiA) Alignment of kespon,ibthly"` 3-302.i t(,1)(1) Raw Animal Foods Separated ffnm :,90.003(13) Demon<tr,noni of Knowledge* ( Cnt.kad and RTE,f�ooi ' ? 10?,1 1 P,:r;on in chane- dutie, j Contamfiatcn bom Rau,lnrrcdrents 3-303.1Rzov animal Po dk Separated from Lach EMPLOYEE HEALTH Other" 2 59., o.WNC i Responsibility of the person it;cba,gc v) G'e17IIan;na6on tion the Environment require raporimc by food etnplo7ce:,and 13 302 11(A) Food Pr bzctwn' applicants` 3-=0215 Washing Fruits andVegetab!en 590.003iF) Responsibility OFA Food Emplo),cc Or An I ( 3-3(14 11 Foul Contact w,ii: Equipment and "-rpplirmt To i2e.poii To'1'he Person L: Utensils" Chm"vc* j Gontsm natrbn from the Consumer 590,003(6) Repolim?by Person in Chrrve 3-306.14tA)(B) Returned Foodand Res-; dce of F(;rd" j j 3 59109-lil)) I lixc!usions and Restriction,* Disooeiticn of.4du,Yerated or Contaminated 390.003(F,) j Reu,oyal of Exclusions and Rcstrict on, ; Food 3-70i.II DrscardogorRecordroomm:ITosate FOOD F-30M APPROVED SOURCE Food' 4 food and Water From Regulated Sources j 9 Food Contac:Surfaces 590.004(4-13) Compliance wdh Fond Law" 4-501.1 i 1 lila n ni Waiewsshing-sot Water ! -'01.12 Rtud int,Rernieticall Staled Container* SmtitLrttion Temperatures* i , , .t s,. 4-_i01 11 Mechanical Warewashinb I lot`Nater I3 _0i.i3 Fluidt111.kandPlr.kPlcduct. Sanittsion Tem,ernrres"' i I r ( :i?U2.13 Susi &;,�s 14-_ I Sanitization- 202.14 1.1 gs and N7 ilk Products,Pasteurized' nC 1.1 l& Chemic:; oq and hand t,--nip,, pH, I 3 202.16 Ice Made Prom Potable Drmkine'Warer" j e' mputentvn and hardness" ^t ' I 1-601 ?1 uA) Equipo,mn Fix}d Cimuret Surfs<es an:; 5-101.11 Drinking Water from an Approved Sgstcrn'- ( Uter.sds Cieau" j i9().pU6(,41 Bottled Drinking Water` i 14-602.1: Cleanine Frocluencv ut Equipmont Food- 590,006(11) W pater Nicets Standards in 310 C:NIK 22.0' j ( Contact surf.,tes and UtcnmN j Shellfish and Fish From an Approved Source , ' YJ02 11 Preyuenty of Sattitirtion a{'Uten:.iie and 3'01..4 Fish and Recreational) Caught Mollu,can Food Contact Surfaces ut Equipment Shellfish" I 4-703.!1 Methods oFSamhzatiot --Ha 1Vater and j 3 201.15 Molluactn Shellfish from NSSP Listed Chen;,cal' S°urcesx ➢t? Proper.Adequate Handwashing i Game and Wrld Mushrooms Aporoved by Re"qulatory Authority 2-301.1! {;lean Condition-- .-lands and Arm:,'' j j 3-'_02.18 S}tetlitock Idemification Present" � 2-31};"?2 Cleaning Procedrne" i 1590.004(C) Wild Mushrooms" I 2-301.Iv 1\3t:n ro Wvh' 3-201.17 Game Anunals^` Good Hygienic Practices j 5 Receiving/Condition j 2=101.1 i Eating,Drinking o Using Toba,,co* I 3-302.11 P1IFs Receivedat Proper Temper:uure;' 2-10!.)2 DisA trges Front the Eyes,Nose and IVl.,utn 3-202.15 Package into?-,tity" i 3-10!.I i Fond Safe and Unadulteraied ,301.12 Preventing Contamination Vvl;cn Tast;rrr '� I 6 TagsfRecords:Sheilstock I 1? Prevention of Con,terntoaron from Hands Shellatock ldeni,ficatinn` I 590M04(E) Preveuting Conia,,Matren from 5-203,12 She!lsteck Identification Maintained' ; F mpin:ccs* 13 Handwash Facilities Tags/Records: Fish Products I j j Conveniently Located and Acces>ble 3-40111 Parasite Drstructi„a` ( 5-203.1 1 Numbers and Cap:cities j 3,-40^_.R Records,Cmation and Rctenhun'' j 59;1.004(3) Labeling of Ingredients' . ( 5-204,11 Location and Pla,,cmcnt* I 7 ( Conformance with Approved Procedures j 5-205 11 Acce,:;ibility,Operation and Mnintenanr.e 1HACCP Plans Suppled rvth Snap and Hand Drying 1 3-502.1! SpLetaltced Processing Methods' 1 P,evices 3-502.12 Reduced ox}gen packaging,criteria" i o-3Ui.i i 3andwashing C!am r, avai(ahilitp 8-103.12 Crotoraranee with Approcect Piocedures" � 0-301,12 Hand Dv'ng Proric(nn � 'De joter critical item w 6u tedcia] 1,M)ford Cod,,or 105 Ckik 59u,00n CITY OF SALEM �c // / BOARD OF HEALTH p� Establishment Name: �Ga �/a ,r, /Date: �4 Id /U Page: of !yam Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified .� PLEASE PRINT CLEARLY Kb()1fn1e1_USPPr-1im0 _1W16Uvr,G. ✓ �! C ttvn 6n0eP -17o UDTolinsi;rrribes cao-/va.l. a/1 016WI91 to he s?-2Ced fo prewltc _Pr) e 7.r•e. oP .1nsecA /20Aoft}s 'e-L. .. n 1 ii ° �r ne hod .�orn� /,nrouered T�1 . X11 f9> d m,�or2w6 rm usl 6-e-, 1U0w hr1r_k _PnYY0hce . kI )i' d MC/ Ae )SO-Pt a?t /Oasl ice- 8 �r�rh c 1'00Ic Alvl 2. 1/ qC'� - .Sa Ind ()ear f ri'mill' hl"a <zOirmd / Scored- realaCx liar hod ¢ kM off' 41�°F -T►ld/Aa _/n lie mn�a�fiii��d'of a rc �` J.P/'N.DoF dl °F '9Q below as rnardav-�cf. r1 -9W,0.UP— l^, d nn ctc�_-umLlo%/76i-I ,9� vd - lVI/rie)kV0V. hoe4s` .� I ay.l�tnrd� rtean.er� luo-)e Prcl.)area, I-m/ m7-ef'-0 Vis/bLe arr_D)zr' ' 4hpk7'?/9jW�4e/? Ma-�14fa//2lPQ 4vnC/o G-/' 06,; or G,v low /2< wandl7 - / aS� - Ovima imt[ harp -Pvad u--Pn-ae4 cL6nS `M,"v �4� ou / . 77)oivcic1{� lc/ •1 .J � PITz-,_grPp /)rLt.t " rvl)dctfie rl,thnc� �u�� r� �ta�►�d + Scored . reo)ac . r^nIn� gAffd �i, le�a� hlr�rp t - moi +o i �e s �i„rr( m�,r� I warl op f� A-ti, - M114 hurk l"n1l -11111 SlA r7lr0 - IAYt J 0-1-C Discussion With Person in Charge: e I Corrective Action Required: I ❑ No ( ❑ Yes rad this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ I have e P � PP Y 9 9 violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled El Suspension comply with all mandates of the Mass/Federal Fo9d Code. I understand that // ,noncompliance may result in daily fines of twen five ollars or suspensio w cion of ❑ Embargo ❑ Emergency Closure your food permit. ^ ❑ Voluntary Disposal ❑ Other: t . -50!..4;C) PRFs Keceived at Temperatures Violations Related to Foodborne Illness Interventions and RiSY Accord;n;l to law G,oled to Factors(Items 7.22) (Cont.) 41'F45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3SOL 15 Cooling Methods for PI-IF;; 1 Food or Color Additives I 19 PHF Hot and Cold Holding 14 j 3-.101.15(15) Cold PHFS Maintained a[or below 1 3-202.12 Addiuves't SnO.Ui!4(F) -4_145" 3-302.14 Prote,Iion t�omUnapproved.Additives, -4 ,501 Ih1Ai I[t4PIiFsMaintameda,nr:tbo,:e j IS Poisonous or Toxic Substances 14 'F C. 1 1(11.11 Identiipmg Information-Onginal I .3-361.l ti(A) K 0O'ss Held at or abm- 130°F. r.,tainers' 1 20 i Time as a Public Health Control j j 7-102.11 Common Name-W'orl mC Containers` 3-501.:9 Tl;ne as a Pnbhc Health Control* j 7-201.1! Separation-Strnage' j j 7?t12.1 I Resn iUion- presence 1114 Ilse' >>U.tlUdtH'� ( V riance RrgnlrelnClll 7-:102.12 Conditions of U,e" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'toxic Containers-Prohibitions` j 7-204.11 Sanitizet's.Criteria-Chemical,}"` POPULATIONS(HSP, j 7-204.12 Chemicals fol Washnne Produce,Criteria"` i 21 i-S0i 11 i A) Unpastrnnaed Plc-packaged Ja:ces and j 7-204.1-4 Drying Aeents.Criteria's j Be.vera)tes with W�ruintt Iabds^ --_ -- j ( 3R01.11(P) Use of PasteurisedEtgs�* j 7-..r 05,11 incidem�.! Foal l'u[neet Lnbricunte^ 3_g0i.':l(D) Raw or Paihalbi Caked Animal Foo,J and j 7-206 11 Re;a[icted Use Pesticides.Criterur` I j Raw Seed Spr'.>ais No Seer rd. " 7 206.12 Rodent Balt Stati,nua' j Unn lai u1 Po<xl Pacb:tge tit[ 7.206.13 Tracking Powders PestC,ntroland j 3-SOI.I1lC) I, ,• ) Re-served. Monitoring* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-60111 ('onsumar Acivis(q,Posted Jnr Consumption of Art,:-nal Faits Ptu,*ac Kaw. Uro9erccokrd rn 16 Proper Cooking Temperatures for PHFs Not Otherwise Frucrssed to Eliminac 11r At(t)(2) rg?y ,55cF 1.5 Sec. '� Painof`efrl `�;t•.ore .i:poor ?-•101. : , Fc+is-Iuntediate Service 145`Fl5sec 3-?(i2.t3 Pasteuri zed F",ggt Substitute foe Kmv Shell 1-401.11(Ali 2) Comminuted Fish,Meats.F Ganle I F'g1- Ammais- 155.'F 15 sec. 3-401.1 l(13)(1)(2) Pork and Beef Roast - 130'F 121 min" j SPECIAL REQUIP.£MENTS 3-41)1.11(A)!2) Ratitei, Injatcd I44cats-155'F 15 ! 59O.0O9(Aj1-(D) Violations of Section 590.009(A)-(D)in sec. * ctilering. mobile food, temporary and -140 1.1 i(A)(3) Poultry, WildUante, Stuffed PHFs, recideutin; kitchen operations should be Stuffing Containing Fish, Meat, deb;wd under the appropriate sections ' Poultry or Ratites-165°F 15 sec "` above if related to foodborne illness 3-401.1I(0Q) Whole-muscle, intact Bert Steaks i in:ervenUums and risk factors Other 1450P: i 590.0(1)violations relating, to good retail 3-401 12 Raw Animal Foods Cooked in a inactices should be debited under#29-- Microwave 165`F" I Spccial Regairemcnts. 17 ! i401.1!(A)(]!?b) All Other PHFs-- 145"F 15 sec. * I Reheating for Hot Holding VIOLATIONS R.=LATED TO GOOD RETAIL PRACTICES 3-403.11(A)6(D) PHF,, 165'F 15 sec. " (Itettt5l3-311) 3-403.11(B) Microwave- 165'F 2 Minute Staudir.s I Ctil+Cat and 11017-uinral vioktlun+.c. ¢4nrh do nor relate to the Time" ,fi,o orae illness nttrrvrnrir,va and risk fo(toc, li,vled chore, ran be 3-403.11(C) Commercially Processed R'!'E Fax:- ,mond ie lire fibllnu-lag sertirn.v r).1 the Fa,J Code and 105 Ca7R 140"17" _590 0;l0. 1 ;-403.11(F.) Remaining Cns!iced Portions of Beef 1 item Good Retail Prac:iccs FCII 530.4D� Roasts`4 i 23. Mana•„emer.i and PP:2onnei F0-2 .003 j I S Proper Cooling of PHFs I 24Feed and Food Protecnon FC--3 .W4 25. ni and Utensils FC-4 005 j 3.50Ll4(A) Couhtn,Collect PllFsfrom i"10+it) 26, IWater,Piurtkincl and LNaste PIC-5 006 - --- 70'F Within 2 Hours and From 70`1F j 27. Fhlsica!Faedity FC - 6 ' 007 I to 41`F/45"F Within 4 Hours. ' 28. Poisonous or Toxic,v aterais FC,-7 008 3S0L.14(B) Cooling,PHF;Made From Alublent29. Special Reouirements j 009 --- Temperature Ingredients to 41°1--145,t; 130 Other I_ W'irinn 4 ]"for r:� l s•'nr,„n:.i r-z a:,: '[)motes cruu.al intern nr tile fedead 1Q99 Fold Code or 105 CMR 590 000, r CITY OF SALEM /� / BOARD OF HEALTH / 2 t Establishment Name: —(I )O(_' �C.C!4 L(/Q S' Date: ��/aS�d Page: `_ of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Can onPnpQad 2 't)rnUlQ�iav� 6(' >�iod d�{�rns-77�a/�UGhlu n/aa�. � �J�Ol1 — G -l�Ind�'if2AiwaSPR Foa�'nn -�- wP . all -6z'' n1 / �l rho_ rfpf al lOOSl- _Cn M-t l mi f !N � cjnno d /l lbs ue 2nlj ALAI{ VO !,4, rVl 1710 _,0�0/47), r'. 0// WafS /a 6 Stns--eJ G _/ew and V �ivm ' �r a.iw o// / 107j,-& C/'lis'�: ren lmlh/l�-iaYl. I — 30 Ago �YiL-h?I` Vlf' jp' 5' lm�c %J av�rclati/f /. v ot/, /17SX1q ieh- lon✓ido_ es ),o hP_ k of n1i2cly d-1 I)m-ae�? rvnln. k No �i7d� �'� oP_ be) Prp4t/ &l 41 nu a � irimac'fimi . Pro��rle" s�zn;�i'�inG Svl�i iG� t S�a.0 ve A)p#-Lc -'i"D k_V '/rf A0_4 al a-tl (111 IW . o S� - _31; t" 4111I( 1n �yq_ rP10 be-it(y 'fiod 4h `, )e(k'e q!,cri., '-l7P �� I (Ser u�iZ.s S-f�fion I ✓ /9 G Pn&;I - vrs)bt, -Aeijw ) v¢ k iiia._rt-i�,Ji7pd iv 'a -exit o a/' ih °% ae hiola u a'S -maif coo 5d' t-/as - �� rr� ninclS gehotta.l l'lpcucu2a ' - lea �rrron kv,` -hired ((Azinrllp c),-/v_ U10 i141yc_ -/cQ SCa)D/Ai1119a In)i-a trari i/1s)rCbdr1.J Discussion With Person in Charge: Corrective Actio6 Reg6ired. I ❑ No ❑ Yes +" a and a ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity tb ask`questions gree 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 t" poncompliance may result in daily fines of4twent;Aive'dollars or susp ation of Embargo ❑ Emergency Closure your food permit. x �' �� - //J J� LI❑ Voluntary Disposal ❑ Other: 'F1 1".e Ten -,-50;.11,C) PHI '-eJVV(1 15t Violations Palafad to Foudbom-illness interventions and Risk Acc,,I dial,to I. w cool.d I Factrrs,(Items 1-22,1 iConf.) ",-Al: 15 Cooiialg I'vit,ullod!, tnr tTjjZ PROTECTION FROM CHEMICALS 14 rood or Color Additives 9 FFIF Hct and Cold Holding LI 6,ffl, Cr idPt.M;Mamtaincd..tott)elrv" 3-201121 Additiw<' i90 004(7) 3 301-1-1 1 COLLCIMI fio111chlal);)RI),ed t%`1d;iIVeS` 1-5�11,16IAI Ho PJF; NitinLutled-,; ornbov, Poisonous or Toxic Stjbstanc*3 7101.11 'Ientiforl"Infolmation--01-wala! 3-50 1,1(;,(A) R-1ci at orabo,, I.-,(:"F. Containers" 'I into as;�Public Health Control 7.l 5? 11 CotnrnenNome- 3-50).19 Pqb"- 7-26 1.11 sej,,:tuioq - 7-'202.11 Restriction -Prt-wiwe and List-" H) j V-tiartle Refilin',N]Ient 7-202.!2 Conditions it (j(j 7-203.11 To).',-,Con:t;oct> Piehiiiiijow I IREQUIPEM.ENT;S FOR HIGHLY SUSCEPTIBLE 7-204.11 SXlitizei!,C6e,m; Chcmicalv" POPULATIONS(HSP) -n4.1 2 ch�nlicab. fur�Nas.h;nef,,r; CI wrio't 21 3-MlL! :(A) I,nln;is!��1)n7,d T.I.—Imeke�7,,d J:ioLcLi and 7-120414 'it\ing Agents.Criteria,, Bev,a.-eN lvAi'Aarn,n-, i ;6lwl -,-80:.I I I(B) 111:;e;•i,Pmeulizej I 113cidem:ii F,,,d Contact, Lubnearlts- 3-80i,I I i D) Rim I):Palially CooledAn! F,)od and -206,11 Re-;tpurd I*se Pe;tiddes.C�,Iterrrt 1, �(aw hoedSproLits No�SfLked, 7t, I -1206,12 Ro6mt P�,it Stdt;-,,:s ?-Y,OLi1fO Unopened 1-I.q)(I Pa(tage N;A Re-swed. 7-206 1', Tnt,:King Powdeis, Prot Cow rut srd Aluniturin,* CONSUIVIER ADVISORY 22 6", I I Consumer P:)sted for Con-umptivo(if TIMMEMPERMPE CONTROLS Animal Foo-1,I;TLat:ue Ra,,I, Undctcootrd it 16 Proper Cooking Temperatures to., Not Otlirw;,e ProceFseu to Eliminate p th Pa 3-40 1.11 A(i q2) 155,F i5sec. 3-402.13 Pa,lemi/cd 1-gg, 1-,Ir Paw Shelf 3-161.[I(Ai(2) C,io�nunuted Fish, Mcat� (,ame Anhn.,[s_ 1»LF Ij IC. ' 3-401.i 1(11)(1'i(.1) Poik and BvJ Ream- 130"F 1 221 nlirl* SPECIAL REQUIREMENTS 3-401.i 1(A)(2) Rattles, htjtctrd Me:rits- 155']F 15 590.000�,\)-(D) Vwjuduns OF Section �)90JYO(A)-(D- )in Fee. caterme, nnobile fitv,)d,ternD11),rary and 3-40!,11(A)(3) Poultm Wild Gante.Slui'ted PHFS, u-sie-critial kit-1wn operations shout, be Stuffing Clmlairrintz,Fish,M-at, debited u!-idet I ht-appropriate ,e,:tions pouitry or katites-165,F 15 ;0t. tibove if related to foo6l?ui-ne !!hies 3-1,01 11(C)(!) Whole-musel-I !Iitau Beef sletiks intcrventiot-,s and risk01fler 1450F t 590.009 violations r0aunl-to good 12 Rau Anim.,! Cuo&('(Y,)Sed in It !)I aeticcs should be(1cl,ited under ft-)9- .Aficr,,vvave 165'F* Special kc-quimments. 1 I(A)(1)(b) .6111 other PFIF,;- 145'-F 15 sec. 17 (?cheating for Met 1-11o!dmg VIOLATIONS RULATEV TO GOOD RETAIL PRACTiCES I IIHI-,, 165'F 4: t%ftenq 23-36) C.,.I I(B Mier-,wave- 165° F 2 Mintao Sta-dip', -I!:fnI and non-rt-tioa1 viwhiril dima 1 f to tile Time"' luodbomw illness hnemcaizuns and risk faftoic IiNv,,d ab,we, can ht _;-40? 11(C' cown;ercialiv ptme,I;,VJ Fo,'d- finaw In S,r was 01rth" T.....I ode Iu;(,' .590.000. 1-4 03.111 C) keonninin,UnFliced Porti,ils of Beni' FC 5-00.000 I pams!st 23 tvanawriml and Pa-sonn F-,--2 003 18 Proper Cooing of PHFs �2�4j F,,l and Food r ictect:on I f0-3 004 25.__ quipm- ant aro Ufomliis i-C-4 005 3-501 14(A) Cooling Ccok-c;-', PlIB from 1409,It) PIZ, IN alu,Plua6itKI pmfl',IAJasta FC,-3 70'F Within 11 Ijoursbid Fr:nf, 70"F 007 I,)4j'Fi45"FWithin 4 HoukN, Foib�jnpxts or Fie tAatLrial!: PC-7 .0','e, -501.141 R) 29. S!,00;01 PCqa reme"Is j 009 C,olin',PIJF,,,Made Piom Aakie,111 Tempt!4:ur2 iitpedients Wohin 4 Aours, Demme; xwui itown 01-:t ted ral i,r99 F,.od('o!e(,r M5 CNI12.590 000 CITY OF SALEM BOARD OF HEALTH / Establishment Name: 4�cklaf"�" 110 S Date: ,'-0 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PL/AN OF-'CORRECTION Date No. Reference R—Red Item I Verified PLEASE PRINT CLEARLY '' 9 �_ � --�s-tzlbllsh/nPn-F /S �slnq lur�> � l'la rl� su��lem �� y'irir fi-z-inG . int„ tlrncJ DMD n< ,pGt� 'Yu�G7�S fdflwn S1aJ2S. /Uhr.�eJC- I is AP 4t; Y�nW WPals' /A,0f )Ae&l. ) f Si heY /s U<rd 400 &AWk I 01"0-n v4 . &a1 �"2 /s Jx/d-21,> --tleod. k1 -17-11P-Al-17-11P-AlAO/F Vr I I 4�r1's ls � n� l uQ iPlh �a Of dJO),vI7 ( ' l jeS mhl ,W l rboapd. u 4171LSh n,_fl 12n6 AUo Paw /Ua f Ph--p /s /lone uolzblis /QcfC .'john' I�vk+el 4coo '-_?)nn f-P_ t11va,) -6 )-lea tAAeti 1V1oo�iY�i� c�/l o�//�lo c/ AR //1xn /o ---2 _7 - Oel /�r t 3- aci i-e/ o� /lC 11,6 -I' I ll�Clrlf[��r />:/S01YrDn l /fYOL/ d/ PLe7UL'.d6 6P. Sobint4CK ✓ x If°vrn�v�r� hen - tit ren n ni I I ; 1 (fat wi.D/nq r1(iff hCl v+K ^,4 I ✓ �.van(t' in ,P�-F -(ids- '(�laves l�ol�� cuar>7 I j0ui sire y Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to . , ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twent five dollars or s�us�enron/revocation of Ll Embargo ❑ Emergency Closure ` # . J /�our food permit 1 /_lam ❑ Voluntary Disposal ❑ Other: PHFa Received e! '1'etnperaiares - Violations Related to Foodborne Aloess Interventions and R;sk .according to Iaw Cooled tG Factors(items 1.2211 (Cent.) ! 41^E ia5'F Within +Hour.;. PROTECTION FROM CHEMICALS 3-50':.I5 CoolmC;vfctltxisto-PHFs i 19 ( PI1F Hot and Cold Holding lA Food or Color Additives 3-50:,lb(B) ( Cn..!d PJIFs:Maintained al of below 3-202.12 car lid iu veer ! 5St1.11Ut(c) -}i`/t5.• Fo: 3-302.:4 Piote.Lun 1=ori: Unatrprmed AcWamec'° ! ! Snl.16(A) I Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140, _ : 710111 identifying Information ( 3-50t.;6(.4) Roasts l-ieWa[or:triove130'P. ' Ccutainers" 7-10111 Common Name-\ otkinp C 7nrainers' I � 210 Time as a Public Health Control = 1,19 Time as a Public Health Ccat:rol' 7-202.11 RestricNnn-Pas 7-201A1 Separation- r"sacnce and Ilse'j 59uwii 1) ; Variance RPgtlirCInc:ll 7-202.12 Conditions, xic ons of Use" 7- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE '_i)3.I t Toxic( TContainer. - Pndlifirtions" � POPULATIONS(HSP) 7-204.11 ( Sanitizers.C'ritena-Chcmic-s" 'i 2-801 POPULATIONS O ' 7-2al.12 ( Chemicals for Washing Produce,Crileria�" � � - J np�Aeurized Pre-pac•riaged Juices mid j 7-204.14 ( Drying Agents.Criteria I Bevetages with Warnin*Labels- ,-So 1.11:1 B) Use of Pasteur zed Egg s^ 7-205.11 Incidental Fovd Contact. lnbr,cari 1 3-501.11(D) Raw or PartialN C•t:,ked,lninta.l Food and 7'206,11 Ro�tricted Use Pe•,ucides Criteria' - ' ( Rage Sced Sprouts tint Seived. '• 7-..06.12 R(xi•,nt Brit Stations" '4-801.11!C1 1)na eucdFwd pPacka . e Not Re-served r=206.13 Tr:!ckmg Pgrxder:,Pest Control and illoniturin;;T CONSUMER ADVISORY TIMEITEMPERA7URE CONTROLS 22 ; 1-613 11 Consmner Adt,soiy Pnsted iii( Ccatsuleptiell of 16 I Proper Cooking Temperatures for ( : Aninnll Foods-Heat are Rav,,Undcrcuoked or PHFs ( Not OtherA?se Processed to ELminate 3I ,-g?ens.'er•,�v: .::voar -dOLIIA(1)(�a} Eggs- 1.Si°F 15 Sec. Path . Eg,,S-luunediate.Sercicc 145`171 ; 15se(F 3,0113 Psteen'uzd Eggs St&tilute for Row Shell Egos* 3-401.11(A)(2) Comminuted Fish, Meat,&.G:one , Animals 7155'F I s sec . SPECIAL REQUIREMENTS 3-401.11(11)(1)(2) Pork and Beet Roast - 130'F 121 min* � 3-40i11(A)(2) Ratites, InicctodMeals- 155''F15 59000'a(A)-(D) Violations of Rection 590.009(A)4D)in Fee. " I catering. mob_lC food, Lemporarn•and 3-401.1 I(A)(3) Poultry,Wild Game,Sniffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultrti or Ratites-165°F 15 sec. :. allove if to frx,dborle illness 3-401.1!(C',)(;) Whole-mw,cle,Intact Beef Steaks I :n[etventions and risk factors. Other 145`1* 590.009 viol-,-,tions relating to gond retail 3=401.!2 Raw Animal Foods Cooked in a pracaccs should be debited uadet #29- Microwave 165'F . ! Special Requirements. 3-401.11(A)(l Hb) All ()they PFlFs- 145'F I S sec ' 17 Reheating for Hot Holding VIOLATIONS R.:LATED TO GOOD RETAIL PRACTICES 3-403.11(.x4 (1)) PFI Fs 1651; 15 see, ` (Items 23-30) 3-40'.11(B) Microwave- 165°F 2 Minute Snmding Ctineal urd non,r-ilicul ooialwns, n•/rich do nor,elnr�to the Time* foodborne i!!nesy into,venn<nss utid;c4fi,actur's!wod above, rot?he 3-403.11(C; Commercially P,aesscci R'('F.Fu>d- (tund in the jv!'o"ing sections u(the F'uuu'Code and!(Li C%v1N 140''F` 0lh7. 3-iO3.11(E) Remaining I nsliced Portions of Beef , Item mid FWad Practices FC 1590.000 Roasts` 23. Management and Personnel FG -2 .003 24. Food and 1$ ` ) ProperFGooi:rig of PHFs -2n. --- Water, Cl t,,ndnUand Waste FC-5 00�-- ---- 3 501.14(A Cooling Ccwked PHFs from 140"F to 7014 Within 2 hours and Front 70"F 27. Physical Farildy FC-o" 007 11 to 41'4745"F Within 4 Hours. ` 28, Poisonous or I oxlcc Materials FC-7 .008 ! 3-501.14(15) Cooling PHPs Made From,Ambient ! 29, Spada!Rormrements o09 i Temperature Ingredients to"I°F/45`F 30 C11-er - - ------ Within'l Hours* •m:-n:,,r,-,a,: ' Denotes soar A nem m the(Meral 19+19 Food Cud&or 105 CNIR 5910000, r CITY OF SALEM BOARD OF HEALTH Establishment Name: o C' eo 4e 80_S Date: w" -7 -0 V Page: 1 Of Y item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date �* No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I ice oc�N �. o-T ,�ti �s Pslabhshsx�,� T Kew%/ /�1p cL�No Gv a s a 5 r�cl _k75 f2- ( j- (c70- P%�s a�.d v .c u �v Ike_ I � Wke �+- �e I v !4<is9.-_ r,v a sGr S"/_1 t uJOS Oh sQiv-P�J )1&1 01-1 IX l o 0'a I b'e /c C4 ��C4- LLAX-/-e t - C?�vo� ( S(�(e /.s . 7G1rs Sl-slG vu<y ,'� ' L):x d �n e 1-414/Ubl )X_ vG O/1JLy moi! �XCJsr( b e d/S12 SvS "k a- -7y 4�C) bre LUQ ALP P 1/"" /blrs lu-r� SryC. A'(_0-:'W 17.e, P�,O__ . cv/-12* 6-1 0,4f c/ a9 r r 1 Z !y/ Q l( rnyu(41✓-A aw t , U-/� I , � �// / / � 5 �� /� hu sk( ! 7 K C C�/l yci Aa)lam Cq 1� a s'0a(.Ve__ I �� -kc �l/sir•-rn�1-( - �, _.. , Discussion With Person in Charge: iuV ( 'Corrective Action Required: I ElNo I LI Yes ✓d'�`� � ' �(9`�7 ❑ 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 noncompliance may result in daily finesof twenty-five dol ars pr suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. !//��fi//v/(// r Q�>,u ❑ Voluntary Disposal ❑ Other: a � y - til ht( ": I'I-!!: R°ccrivcd at'Cemprra0err� Violation;Related to Foodborne Illness Interventions and Risk A.c:;J;ns P,!,a+t co, cri to Factors(!terns 1-22) (Genf.) 4: '9r45'F VY:th:n 4 Hum::. ` f PROTECTION FROM CHEMICALS :n,ling Methods ::,r PHF 124 ; Food Or Color Additives ( 19 PHF Hot and Cold Holding j =-501.1(tB) Cold PHFs kiairinurred at or bcIvw �-2(17. 17 I Additives* S<i6.l,l:dli:, °i•' '': c-302.111 Protection from t'nal)PInV-ed Additives'' is Poisonous or roxir Substances Hot PI Nlsiut-::uzd al :e ,,I)ovr 140"'F - 7-IUl.11 Identifetn_ Inn:+nnihnn- Original 2-5O:.lo(A) Ro,asta lldj,4i .r:a'r,,•n: 136 F. '^ Contaittrrs'" Conunon Name.- Workiie,Cantaine;;` ( `t) `i` Time as a Public Health Control 7=_'O1Jl Scpatmli,m-Stortl;c"' 1 3-502.i 9 "Ita:r as a Public H:alth C•mtru!^ 7-202.11 Restriction-Presrucu and Ua.e:> ( 590011=1'12) `:'W u:::ee Requu,nu.nt 7 202.12 Gatlin .ns� f I.iTsr^ "r 03 1 I toxic Contain-r>-Probibitiuns;; ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PAPULAWNS(HSP) 7-'L04.1 I Sanitiz:rs.Criteria --Cheauuvls^ ( .i r^ : > 21 13-SO:J I(A) Cin[)astcunm:?Prcp:,aated 7riccs and ,- 04 Cheinicak tar Washing 1 Produce.Criteria' ?-2(1.1.14 ( Drying Agent+ C'rilrtia" ( Bewrres with Warning Tzrbe!0 ! 3-80-1 (B) Use-ofPantrmizedF„„ 7-205 11 I Incid.r:tal Food Cotnxct, Luhi waat ”'! Pesticides,; 3$O[ !DD) RaV+ o: Yarttall;Crnhetl Anima!rood and n `� [ 06.11 Restricted Use -shades,Cr¢>t I:px 7-^06.12 I! Rodent Bait St.:ti<ms'" I Rae- Seed Sprouts No: r ,!ci, .- 7-206.1; ! Packing Pimdets, Pest Control and I 1-11,10i.11(C) linnpered Prrd PacCkagee NN Re:-srnrd. j R-0un:iurwe' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60"x.1! G,nsumer A,kisucv Posted for CoMtmrP6011 cit 16 i Proper Cooking Temperatures for Anun ,! T'ucds 1 hat are Raw. Und:rd-oked of ' PHFs ( Not Otherwise Proces,ed to El!mrtn,te Pathorens 3-40 1.1 I A(I)(2) Eels- 15:i'F 15 Sec ' E1~:�c-lmmed:an�Servic. lA5`F15so:° 3-30'_.!J Paatrm;iea 6g€.Substitute for R:tu- Shcii 3-401.! ItA)(2? Comminuted;rIsh. Mlyds<£,Gan,c )otimals- 155'F 15 sec. ' N SPECIAL REQUIREMENTS 3-401.17(B1(!)(2) ( PurlCend Beef"Roast- 130", 12! inin SPE : ! 3-401.1 H')('2) Ratitcs, in)ected Mcata- lis"F p0.00�:A1PE E T 1� Violations of ruction 590.009(A)-(1)) in sec , ( catering, mobile food, lewpotary and 3-401.T 1(A)(3) Poultry, Wild Game. Smfted PHF,. residcnti:d kttchen operations should be ;tuftimrr Containin=Fish,Meat, dcL:tcd under the appropriate se_iieus Poultryor Ratitos-i6fi'F 15 sec ' above ii u9ated to foodhorne illncs 3-4011I(C)(3) t4'hule-muscle, intact Bert Steals i:,trneniunte and risk factors. Other I 25'F* 590.009 violations rciatin to;zood 112111:1 3-401.12 ( Raw Animal Fo;xl:.Cooked in a I practices should be debited under#29- Nlicrnwave 16.1`F I Specni! Requirements. 3-40I.I:(A)(1)(b) ( All Other PHFs - 145'F 15 see. ` 17 Reheating for Hot Holding ViOLATIONS R,aLATED TO GOOD RETAIL PRACTICES 3-403.11(A)X(D) PI-IF� 165"'F 15 sec. ?Item;23-30) 3 -ttA.11(B) Microwave- 165"F 2 Minnie Siaudmg Critia::u::d mne critieul r:u;a'ionV, u,hivh do ao; relwc to the: j 'i'nnr' ?h,dboi ,c ri�k acr„rs lisrnl u6<,ic. ca::he 3 403.1 1(C) Commercial Pitx)ecsed RTE Food- h,ioid to tote tollumin,,se,dale+ n!the Food Code mrd 105 CLIR 140c'P -590.000. - I03 I I(I-) R<:nainine Unshced Portion+of Beef 1 Iters Good Retail Practices FC 550.000 Ruasi,"" 23. [.1a.age:::enl and Personnel FC -2 003 —) ( 1S Proper Cooling of PHFs 4 Foo_and Fccd Protectior FC 3 ! 004 25 EruiGment and Utensils FC-4 1 .005 j 3-501.14(A) Coo!:a-Cooked PlTFs from 141FF to - 6 `lv stet, Plumbin0 and vast; FC-5 � 006 7WF Withht 2 Hours an•] From 7Ci`F 27 Physical Gad Ity FC - fi 007 to4l'P/45"F Nvithm i Hoar. '. 23- -- Polsor:cus o:-f rxc Materla:s FC-? ' .i-?01.1?(Bt CmAing PHFs Made H',mi Ambient L-21- _.. V" ccia!_Rer�;,ramen, 009 ,craper,nure lnla<:h:ots tu-?l'FldSi: 30 Other N'rihm 4 Hours' - I ante:mtiaai nem m the ledsa' 199')F:wd C,,deer 105 C-MR�96.00o. ahPYMd m -a Massachusetts Department of Public Health Salem Board Health DepS 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 (} I D�Se/ I Type of Ooeration(sb TyW of Inspection /Poalu6! GtIAT' 4 1°�0q 2' PoodService ❑ RWine Address Risk ❑ Retail e-inspection Z7- 23h�ssScs 5Y Level ❑ Residential Kitchen Previous Inspection Telephone [] Mobile Date: SMot/ 976- 7vf"-' 2V// ❑ Temporary [I Pre-operation OwnerHACCP YIN E] Caterer [ISuspect Illness oGyrjfAlWe& K- M,+1tC*1lJd ❑ Bed&Breakfast ❑General Complaint Person in Charge(PIC) Time In: ❑HACCP Inspector QA lrr f) t°. 1t&h?V8 d t(fA Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives C33. Personnel with Infections Restricted/Excluded C] 15.Toxic Chemia14 FOOD FROM APPROVED SOURCE TIMElTEMPERATUR£CONTROLS(Potentially Hazardous Foods) [:] 4. Food and Water from Approved Source El 5. Receiving/Condition ❑ -Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 188./. Cooling PROTECTION FROM CONTAMINATION P1t'9.Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices, Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions J immediately or within 10 days as determined by the Board and Risk Factors (items 1-22): t 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 t: 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)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC7)(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 59DlnspeclfomK 14 d. Inspector's Signature: � ..- Print: / PIC's Signature: ,71�' lea Puge ( of Pages Violations Related to Foodborne Illness interventions and Rask Factors(items 1-22) PROTECTPGN FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cre,.ss cortamrnation j 1 � 5vti.0U3(.A) I A�sigmmnt of Rcsponsibilit}" 3-''U2J 1('F,a l) Rata•Ani,ral P<xnis Sencraad horn 500.0(13(B) Dcu:onstration of Knov Iedge f j Conked and RTE Food:." 2-103.I 1 Persun in charge-duties j Contamination from Raw Ingredients 1-302.11(AI(21 Raw Aro:nai Fords Separated trust Each EMPLO"EE HEALTH Other* 2 590.003(C) R sponsibdit} of the person in charge to Contamination from the Environment require reporting by food employees and j 3-J02A I(A) Fcxxl£'rotecn:,ar applicants* Washme Proirs and Vegetables 590,003rr) Responsibility Of A Food Eutployee 01 Ali I j 3-304.1 Fond Contact with hyuipment and .Applicant Tn Repoli To The Person In j Utensils* Choice* I j Contamination bast the Consigner j 540 Reporting by Person in Charge" � 1-306.1 I(Aa B,• Returned Foci a,td Reserviec of Frnxf'- j 3 p)o 003(D: Exclusions and Resttiction;x � ( Disposkion ofAduiterated or Contaminated 590.0030 Removal of EXCILB10115 and RC'aricuon, Fern 3-701.' 1 Discarding or Reconditioning Uimitc FOOD FROM APPROVED SOURCE Food 4 Food and Water From Hegul tted Sources i t) Food Contact Surfaces j 59QOtt4(:\-Bl Cumphanc c with Food Law" 501 I t I Manual Warewashuna-Hu.Water 3-201.12 Food m a Hernrticalty Sealed Container'- ! Sanitazatton'Pemvern:ures` 3-'01.13 Fluid A{ilk and Milk Prt aluct;" I 4-501.112 Mechanical Warrwashin�Ho Water Sanitiz:num TempeiantreO' .3-202.13l Shcii Eg11 11 3-202.14 Fens and Mi16 PUKluce:. Pasteurized' 1 14-501 114 Chenncat Sanitimtion-temp.,pH, concentixuon and hardness. ,. 3.202.tfi lie'blade Front Potable Drinkine t\"iter" 4-,0I 1!(A) Fr;nipinent Food Cenntct Surttce�and 5-iol11 DrinkingWatcrfront mt:\pproveciSvsteni* !E ,.590.006(A) Bottled Drinkme Water* ! Cien;ds Clean -}-h02.11 C zoning Frequ.ncyo[F,yuipmant Food- 5q0.006(B) Water Meets Standard:to 310 CMR 22 0' Contact Surfaces and 1-itensik SheDGsh and Rsh From an Approved.Source 4-7:17.11 Freyuzurc of Stunt yahoo of Chenr.l,,and � i 3-201.14 Fish and Recreationally Caught Mo`:lcscall j ( Final Contact Smiaces tit P,.;uipircntT Shellfish-" ' 4"703.;1 Methods ut Samnxation-Hot Waler and 201.15 Molfisam Rhelifiish front NSSP Listen I Chemical I Suunes� ( It1 ( Proper,Adequate Handwashing Game and Mid Mushrooms Approved by 2-3011.11 Cleac Condition --Hands and Aro»" Re",7ulatory Authonty 3 207 18 Shellstock Identification Present ( 2301.12 CICx1im,Prccedu;v° !-301.14 til�icrt 1 590.004(C} Wild Mushuxmts' � to Wnsh'" � 1 3'501.17 Gant, Animals ( ' 1t Geed Hygienic Practices j E g ! Receiving/Condition 2-1-101.11 Eating, drinking or Using`Pabacrco' j 3-202,11 PHFs Received at Prover Temperatures," 17..401.12 Discharges From the Eyes.Notre and 3-202 15 Patkxec lnte[rrit}':: Monh^ t 3-101.11 Fount Safe and Unadulterated ' 3-3111.12 Preventing Contamination W9ten"lasting' 12 Prevention of Contamination from Hands F Tags/Records:Sheilsiock 3-202.?S Shelisaxk identification` 590.004(E) PieVelitin9 Contatmnaunn from 3-203.12 ShOlsiock Identification MaunautoxV Emplo}ee<^ 13 Harldwash Facilities Tags/Recards: Fish Products I tom-anienthy iocared and Access,7�le 3-402.11 Parasite DcsuuCtion" 3 405 12 Records.Creation and Retenhou"' ! 15-2031 i Namhas and Capactr,cr` 5-204.11 Location and Placement" 590.001( ) Labeling of Ingredients* 5-205.11 Acceasibilih',Onerauon and MamtcnamcC j 7 Conformance with Approved Procedures 1HACCP Pians I Supo;ied with Snap acd N.3nd Onahg 3-502.11 Specialized Procersing\Methods' Devine." 3-502.72 Reduced oxygen packa;;ing,cnteria," j ! F._:OL! HsndwashnteClense.t.1o,aaabthty 8-103.1'2 Conformance with Approved Procedures' ! ti-30;.12 Hand IA,mg Prot-:stun 'Dcaot: crac�l if,,In the fed,al 1999 Pond Cndc or 105 Cb1R_19021OG CITY OF SALEM BOARD OF HEALTH Establishment Name: df0C,C ,4 fCt4o S Date: //'t �OS/ Page: 2 of 2 Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY AltEW C,.rl7A4(- d tj4AOir`d0' S41 -4 0 Lf 1W fr kl d B cFF/f rh1Z06.rL90_ M4rriiz - Atliaf /QCs.,'-L-rlrc>M1-OrnA_ e .1-- �- I I f�d La 10 F ni-- ni .,It— t .rt.Ji lI /4 C"- "T M ✓f A a V, , (_'49.1 a Am C e CrZ6 1) 0,/f ��/�A^Lj 7 A1:3"o c�Cri ,of I /4tA — .JA✓& Bc£r8N <-AAe.ts oref� � r I � 1 1 I i i i Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all co ditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food/, I un idrstand that noncompliance may result in daily fines of twee ' „e- ollars r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. - ❑ Voluntary Disposal ❑ Other: v r 3-_i(H ill(C) PHFs R.:ceived at"Icnipernures Violations Related to Foodhorne illness interventions.and Risk Acwr dins to late Cooled to Factors(items 7.22) (Cant) `-- I4J"F!,5-F- vlrthin 4Hnair:. + PROTECTION FROM CHEMICALS I 3-501.15 Cuoling Methods for PRFs 13 Food or Calor Additives 119 plip hot and Cold Holding ?-50( 16Conti PFtF,Maintained at or below 3-'_02.12 Additi toes i` ggt_ 7: (l(B) 3_302.14 Protcctton frnrr ;? s; + ( 0 h, ) a 1'., 45° F" nappr:ned: , owes 1 2.561.16(A) Hot PHFs Minaamed at or ab-one Is Poisonous or Toxic Substances 7-101.11 IdentitvingInformation-Original ( I 140'F. Containers" I -1101.16(A) Roarxs Held t or ahove 130"F � mo_- 1 I Common Name--W'orUnr C on;airi 120 I Time as a Public Health Contra! I i 13-501.1 Timc aa.,a Public Health Contra,:'7-201.;1 eu60n-StorWee'' 1 0.0('litP Variance R.•gairentelu 17-202J i Re 1 e>Ui0i on-Ptcaence tura Use" 5g � 7-202.12 Conditions of Use' 7-203 11 Toxic Contaiuers-Proh b;,;(wsa, i REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 SalliliZel'S,Criteria-C'heniic;ilsPOPULATIONS(HSP) ; 3-w!1.11(A) Uap;:steun td Pce-packaged Juices and 7-_04.1 Chemicals for Washuie f nuluce,Criteria' I 21 ! Beverages tvtth Warning Labels4. 7-204.14 'Drying Agznts.Criteria" I I 7-205.11 Incidental Food Contact.Lubnca 1,:� 3-301.i 1(F.) L'sr or Pasteurized Eges" 7-206.11 Restricted L'sr Pe:aicries.Cri tcrur* 3SOi.1IiD) Rath or Partially Cooked Amaral Food and 7-206.12 Rodent Lan Sl Loons" Unop Send FoodSprouts?kageNot add. 7-206 13 Tracking Powders, Pcst Control and ( I ?-kOLl1(C') Unopened Foci: Pacl:aea Not kr-served. Monitoring"' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 27 3-603.:I C .*snmcr Adliscay Posted Rm Consumption of Animal Foods'F-hat are Raw.Unuercooked or (6 Proper Cocking Temperatures for I PRFs Not Oditawis, Processed to E6,mnale 340I.31A(1((2) Eggs- 135TIS Sec. Pathogens. 3 ;0?.13 Pw4ermzed E,ens Sub6uiute Pix Raw Shell Even- hnn:ectirtc Seit.ic. 143'1715ner* c,rs* 3-401.11(A)(2) Comminuted Fish, Meoi;&Game Animals- 1i5`F 15 sec. 3-401.11(B)(I)(2) Pori,and Becf Roast 13th'F 121 min* I SPEC°!L REQUIREMENTS 3-401.11(A)(3) Rnnres.Injceted Meats- 1`5'F 15 ! 59(t.n1 A)-(D) Violations of Section 590.0119(A)-(D) in sec. catering, mobile firxi, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should lx Smiting Containing Fish,Meat, df-kited under the appropriate sections Poultry of R46Las i65"F 15 sec. ^ above if related to foodborne illness 3-901.1 :(0)(;i Whole-muscle,Intact Beef Steaks in;orveutions.vidrisk factors. Othcr 145'F'' 1 X90.009 violations reiating to good retail 3401.12 Rata Animal Foods Cooked in a i practices should he debited under 1129- Microwave IWF'' Special Requiternents. 3-401AVA)(1)Ib) A!! OtherPHFs- 145`F H,we, 17 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL-PRACTICES 3403.11iA)&(D) PH Fs 165'F 15 sec. ^ I (Renis 23-30) 34(RA I(B) Mit rowave- 165°F 2 Min itr Standing ng'non-rr'!i(,al cirr4r(in;:,, which do not relate u.nbc `]'lure* faodhorne incervcnium::and,t.kja(tors tilled obovr, can he 3-403.1 I(C) Commercially Processed RTL Food- ,%ound in the jn7!nt,ing aernons of tlac Fnwr,'c(ale,a::d 105 140'F" 591rWoo. 3-403.1 I(E) Rnmrining Cnshced I'ottions of Bee( I I Item Good Retail Practices PC 590-000Koasts!' 23. Manecorcierl and Personnel 0-2 00 I IS Proper Cooling of PHFs 1 1-24_1 Food and Fos1 Protection FC--3 004 ! ( 25. ; EGWprrent and U?ensas FC -4 .005 Cahn Cooked PHFs from 1401'ir. 26_ Wales,Plum .incl and Was - -- k ., e FC-5 � 006 70'F Within 2 Hours and From 70"F ' 27 ( Fhysica:Fac ty FC- 6 I .007 � l0 41=F/45"F Within 4 Hangs. * I 28. Poiscnous or Toric Materials FG-7 .008 3-501.14(8) Cooling PHFs Made From Ambient l 21), SPeaai Requirements ( : t' Tempi:em a� .n);trdiems to 41`r/450 17 d0, Oner I Within 4 Hours """ -t,: ". Den.aes ermcal gam ni the tisleod 1999 Foci Cudv or 105 CHIP 590 Ono, Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameD to DyWof Ooeration/� T [fe of Insoection it4��i/{PuaS I /� ev I Q Food Service Routine Address �,a3/ jrS�v .C� I Risk E] Retail ❑ Re-inspection ❑ Residential Kitchen Previous Inspection Telephone Level 177/- 3a'/. F'7 7s1 k*41 ❑ Mobile Date://-/e2-03 Owner / ' HACCP Y/N F-1Temporary ElPre-operation � M,4r«NiNo I I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) S14rN - Time ❑ Bed& Breakfast ❑ General Complaint Inspector DwPnr/ ��ii o9 v��F k/S Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties Irk 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE EI 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) r ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑, 18. Cooling PROTECTION FROM CONTAMINATION LTJ' Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control iI 9. Food Contact Surfaces Cleaning and Sanitizing- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) r El 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP f' ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR r f Health. 590.000/federal Food Code. This report, when signed below Management and Personnel (FC-2)(590 003) by a Board of Health member or its agent constitutes an.. 2 ood and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations`. ✓'25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation'-of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-5)(990.009) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901ns ctFo, 14 IOC / ,&s Atp �s ignft: ' e= _2 Print PIC's Signature: '-'� ��n a J g �p�tiAnnn.� Y 1I1iL�.(M Print I Page ofZPages Viviations Related to Foodborne Illness Interventions and Risk Factors(tterns 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT Y Cross-contamination t 90.003(A1 I sSmgnrnent of kespomability' j 3-302.11 A(!) R:w Armed E'uod.: Separated from 5901003(H) f! Deunmsh anon of hnowlydgz" Con'sed and RTE Ruch ' 2-103.11 ( Peron in charge-duties I Contvmmzbon tram Raty ingredleot5 1 3-302.it(A)(2i Raw Amn,.alFoodsSeparated ornEach i EMPLOYEE HEALTH 0her* 21 590.003(C) Respowrlsility of the per.on in chatge D, Cortam;nation from the F-nvrr rnnient { i require reporting by food employees and ( 3-.102.11.A) Food Prote;"onl' I appiiaa t0 3-.30'LJ i Wa-;hing Fruits and Vegetables 590 0031 F) R-:ponsihility Of A t'ivd Employee Or An j 1-304. ! !-,od Cnniaet midi Equipment and applic:mt To Raeort Tn Tue Persrn In Utens:ls* i Charge" I ConLamim.,Nori!rwn the Conswner 590.003 G Reporting b Person in C harco' 1 3 3uti.14 Atilt Rrtumed Foul and Rcservice of ( ) p g 7 t ( j3 590.003(D) Exclusions and Retrict;oms i I Drspcsif on OT'Ad:utterated or Coetam,nated { 59(UJ03(E) Removal of Exalnsiuns end Restrictiorrs I Foo-' ;,-701.11 Di=Cardin,a: Recondaiomng Unsafe I r FOOD FROM APPROVED SOURCE Food* I 4 Food and Wafrr From Regulated Sources I r; Food Contact Surfaces { 590.004(A-3) Crarpliame with Food L;re-' Mat:nal wa-ewrlshi nc-1401 watrt ! 3"201.12 1 mood in a Hermettcally Sealed Come:nei- hmnica' W ntp,, a:Ai g- I-Di r 501.113 Rfcchanica': Ware,+•aching-1-fat W;der - 1.13 Fluid Mill,ar:d:VGlk Products* I Sanitiza'on Temnerrntres* { 3.202 14 ShedEg;s* I 4-5(I;.11=; Che:-n!cai Saniti.w^�nn- tzmp; uH. ( { 3=202 14 I-gs.and Milk Products.Pasteurized' i I concentrationn and h.aaaesc 3-202.16 Ice Made Flom Potabie Drinkins.Wafer" I + 4-601 i :(4) Egmpri rit Ford Contact Smi::ccs mid 5-10;.! 1 r)pnhing Water from an Approved System' Utensil;C.leen" ".607.1I ckam 590.006(A) Bottled Drinkinp Water'" I l,"It ns Fre:p:encpu'£iquipmmtFrrri- ! { 590 006(8) Ware, Meeis Standards in I -it, CMR '22.0" { ( Cuutac:Surfaces end 'U_tensdl* Shelifish aria Fish From an Approved Source { i 4-70.. Frequen-:v of Saniticanon of r,heneils and 3-201.14 Fish and Reerear.onaliv Caught Molluscan Fnixl Contact Su:fiaces of Equipment" Shellfish" 9 705.t! M-that:,ui S:ilii;zatinn-Hot Water and 3-201.15 R!ollus(an Shellfish'rom NSSP Listed Chemtcap Sourceq* 111 Proper,Adequate Handwashing I Gam, and Wtid Mush,00ms Approved 9y Fcgu;afory Aulhonty "301.11 C!ean;:onddion-Ii:nids :rid Arms'' I { 3-202.13 Shcilstock Identification Prea:.ni' i ( 2-:,01.1% C".zariing t nxrdute* I { 51)0.004(C) W,ia Muahrtunrx" 2-301.14 A*,Ien to wash* 3-20 1.1 7 Game AnSmal!.' j 111 Good Hygienic Prac!:ces I Receiving/Condition { 2-401.ii °r.mF ilnnzl:r,?or Usirg Tobzrcn" { ' 3-21i2.i 1 PHf-s Recziveci at Proper Tempzratures k I -=r''v1,12 Disa:arge;,From.he Epos, tin;:::ord Mouthx 3-20 2.15 Peckage hitegrrty` 3-!01.1 I Frwt1 Sade and Unaduhzrtter("" ! ! 3 301,12 Prevenhne Contaatim:t:or. Vvtrer.'l asdt:-"' 6 'ragulRecords:Shellstoc'r. ' 112 Prevention of Contamination tram Hands 3-2f2 18 Shelisto;k Idemitication 590.004(E) Pre%enfing C-.mtamination from 203.12 She11stoc', lderitificaaun Maintamcd" ' Emplovices* I { 13 i Handwssh Fac44h,es Tags/Records:Fish Products i ,^or:ven'enttF�ocared arr.'Arcessi�de, { 3-402.11 Par'asre DcshoctiW I , i 3-102,i2 Records. Creation and Rctenoun: I I ='''03.t: \umhere.acid Capacities- 590.004(.I) Labeling of Ingredients' I { 5-2u+ 11 Location ana Placerncm* I 7 Conformance with Approved Procedures 5-205.11 Accessibility.;ipet:rtion and MainL^rimes- { IHACCP Plans { Supolied with Scap and i-1erc Drytoy j 3-502.!1 Srcc;ali7ed Procesmin,,MJh,xls* Uevicas '.50.2.1.^. kedueed oxv;;zn Paeka�in;t,enteric t " I 6-101.i Han.!.,a;.hi.^.�Cledrisc-,Acailabihiv { +t 103.12 Confurnarice with Aprrored Procedures' 6-till 12 Hand Drvu1,;:'rov:sion I . Uax4es:ntaa arra in ib: I.,J,Ial 1"911 Fold Code o*10j CsiR CITY OF SALEM BOARD OF HEALTH Establishment Name: le,A _r<e/ //v S Date: f U-021 Page: 2 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY -1-A/c LJ.C/7`7/th Ai+ti1a�: .,/Yi fihJri I -V - "77/1?c>1Pn/i/,t/T (p6.P, LVi� 77-m o /J�,/7J B� T��n 11 Ar PPrf-/7 ��o PI-�l7uST L!/01-r is le /4 P IrFLIj �n P��c>�i/,ve.� ,�o.,e��n P o,P ,P•r�./c p / 7-4 �/�,c� �� AO&"- i,• 2"(. �S- � 5�//ur`ivs /�� ri�__V' / 2S L �/ BPL Po r¢ SLNk 17"1 Arm-lS+r/��.G L? m/ll/e�P4, Cl/De, r�L24c( :.�rr�vr•sPc(' Y�iaf ,P,v�or>L' r/in/n-hr�.rc 7,�„G/_ ,PP C///_T ��/ �i/rr�P /'i/t� �A/a > _.._ roah�mal� �arr,/T�No inn J �pP✓r,/>`� /, 1 -W omotU/AC`,/N 9 ifi /�/,cnPv7/n/�/vprcYikg/1 PrP �.:as: -' ✓ /Litre_ S_ Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. I! X17_ / ❑ Voluntary Disposal ❑ Other: 3-50: i?{Ci PRE,R:cetved iq Tc!npetatura Violations Related to Foodborne Illness Interventions and Risk Acccra,rr to I-aw Co„led to i Factors(items 1.22) (Cont.) 41 Fr45`F Viahin -1 Homs. 3 `0I IS Cooling Methods fur PHrs PROTECTION FROM CHEMICALS I 14 Fold or Color Additives I 119 PHF Hot and Cold Holding :i-20'' 1° .ldditivc." 3 `t1 L t6(B) Cold PIIF. Maintained at or below ' I 59Q0t11;F; 41'/45` F" 3-302.14 Protection iFcrrt t?napprmrod Additives* ( 3-501.16(A) 1-hit PHFS M intoned at or above 15 Poisonous or Toxic Substances I i40-F 7-101.11 tdcntdf,ine lnfornr,mon-- 0iijital ,-5,'t NA, Containers. 1,LRoasts held at or above 130'F. 7-102.11 Common Name-Workin;Container,` 12't Yime as a Public Health Control 7-201.11 Se oration-Shus 13-501 19 Time as a Public Health Control* p+ le•- 7-202.11 Restriction-Presence and I Te,. ( iSo0.Ot1'-:(Hi Variance Rcuwrcuicnt 7-202.12 I Conditions ut Uae* REQUIREhMFNTS FOR HIGHLY SUSCEPTIBLE 7-203.1' I Toxic C:ontaincrc-Prohibit:•-,ns'' POPULATIONS(HSP) 17-204.11 I S,ntitizems,CriterIn-Chemicds" 7-204-12 Cheuucals for Washinc Produce,Criteria' I 21 3-SCaI 1;(A) Unnstcunzcci Pre-packaged hticec and Be.euiecs with W'acnin::F.,bels`. 7-204.1-t Drying Aeents.CriteriaT I 3 . 1 nUi I,(B) live of Pasteurized Eggs'^ , 7-205.11 RcicfentaiITbePeuncideg,Criteria" ( 13-90i.1:1(D) Ra" rPtatiallCcwikedAnimalFoodl nd I 71-206,11 Restricted Llae Prairidec,C'ritenar I Y Raw Sced Sprouts Not Ser'.ed. 11 � 7-206.12 Rodent Banti Stauons* I t 206 13 Tracking Powders, Pcst Control and =-891 I UC) -htupered Food Package hot Re-saved Monitorin - CONSUMER ADVISORY TIMEiTEMPER4TURE CONTROLS 52 3-603.; i Consumer Ad'osoty Posed for Consumption of Anim>_d faod::'I'hat arc Raw.t7ndcrcuokrd or 16 Proper Cooking Temperatures for ( PHFS Not Olherwisc Processed to Eliminate 3401.I lA(1 i(2) Eggs- I:iS`F IS Sec. Par o4ens. Ess-humetiiate Service 145`PlSsec� 3-3V2.133 Ristc=xi.zd E�fzs%&b itute her Raw Shell 140LI1(A)(2) Cum!mnuled Fish. Meats&G:uue gy,ns- Animals- 155`F''l sea 13-401.1)(B)(If(2) Pork and Hee(Roast- 130`P 121 a6n* � SPECIAL REQUIREMENTS 1-.{(}i.,7(.�)t..; Ratites; GtiectcdNLeats- IS.,5] I y. :i9(i.009;A)-(D) VIOlibons of Section 5v0.009(A,)-(1)) in FF IJ set. . catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Sniffed Pi-lFs, residential kildren operations should be Slatting Containing Fish,Meat, debited under the anpropriae sections Poultry or Rat c,-165`F t5 sec. above if related to G:vadborric illness 3-4MA I(C)i 3l Whole-muscle,intact Beef Steaks interventions and risk factors. Othe r 145'F:' 590.009 violations relating to gond retail 3-401.i2 Raw Animal Foods Caked in a ( pracuces should be debited under 1129-- M!ctowave 165°F k Special keruifenicilta 3-401.11(A)(I ab) AII Other PHE, - 145"F 15 sec. " 117 Reheating for Hot Holding VIOLA TIONS RELATED TO GOOD RETAIL PRACTICES 3.403.11(A)&(D) PHFS 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Monte Sanding C itrmzd and orad-critical viulatronv, +vhrch du run+c.'aic to the ']'Intel ."oodborne tlln"sr intervertiars and risk la:torr tLoed above, can be 3-4U3.11(C) CAnimereially Processed RTE Food- fO101d in the'1071M,tug;c,.to,nros:y'th,Food Code aad J(;_5 C MR 140"F` seO.Onn, 3-40111(F) Remaining Lnsliced Portions of Beef I I Item Good Retarl Practices I FC 990.056 23. Maneement and Pei so mel FC -'? ,003 Roasts* ai 1? Proper Cooling of PHFS I 1 24 Food=nd Food Protection FC-3 1 004 2n. E-uip merit and Utensils FC -4 .005 3-501.14(:1) Cooling C coked PHFS from I"'0'F to I e6. Vv'etat.Plu:r.binq and Waste FC-5 '� .006- _l 70 F Within 2 Hours and From 70°F 27, Physical Fac,lit'v FC-6 .007 to 41"F/45"F Within 4 Hours. '_a Prssenous or Toxic Matenals FC-7 .UDS 1 ] 50 L 14(tt) Cooling PILPs Made Front Ambient ( 29 Speaal Rww;n3rnents j 009 j Tempc!ature ingredients to,i I'F/45°F 130. Ott:ei Rlthin 4 Huars;x De;nte':'meal item In die redaai 1999 Fund Code or la5 CNIR 590+700. uncut c Kom,sliced tomatocs,fresh moz>arelh cheese,Italian dressing and lettuce on gulled focaia 6rcad $595 drilled Chicken Wrap-rolled up in a flour tortilla with chopped lettuce,tomato,bacon,and honey djon $695 o6ster oIL fresh Maine 106steron a fresh baked roll with a bink of celery $1 1.95 Half Pound Aneus Nrecr—cooked to perfection and served on a freshly baked roll with your choice of toppings $795 eu6en-homemade tamed beef,sour kraut,swiss cheese on a fresh roll $6.95 kir r ra -sauteed roasted red PeFPrrs,mushrooms,onions,snow peas,and cbecsc on a(•)our tortilla $595 Turkey Pamni-oven roasted turkey breast with bacon,lettuce,tomato,and honey mustard,grilled on fresh backed foga 6rcad $6.95 Roast Nccf Fannin-homemade roast beef with your choice of dressings,gulled on fresh baked focaia 6rcad $6.95 Prosautto fr erovoone f'anini -thinly sliced prosciutto,imported provolonq roasted peppers,gn�led on fresh baked focaia bread $6.95 e ilanu-roasted eewvplant,provolone cbecsc,roasted red pcppere,pesto sauce,and baby lettuce on fouatia broad $6.95 The Capaenolo-grilledchicken breast marinated in itallan herbs,roasted red peppers,pesto sauce,and baby lettuce $6.95 Soup Ckowder New F neland Clam Chowder-traditional style clam chowder,rich and thick $5 95 Soup of the day Sa�ads Chilled Chicken Caesar—garden fresh romaine,with parmesan cbecsc topped with grilled chicken and Caesar dressing $7.95 Garden Salad—fresh romaine,tomatocs,carrots,omum6crs,olives and onions $595 Antipasto fresh from the garden mixed leaf Iettnce,artichoke hearts,olives,cacum6ers,tomato,topped with provolone cheese and 656 sliced prosautto, $6g5 des Sweet Potato Fries $4.95 rle law $1.95 Three{)r:an Salad $2.95 After Lunch Served till midnight All items served with your choice of sweet potato fries or a side salad Skewcrcd Cheese Tortellinis Multi-colored cheese tortellini with a side of marinara sauce for dipping $7.95 Scallops,6acon and peapod Deep sea scallops wrapped with smoked bacon and a peapod 47.95 Half-pound(Mack Aneus Neter Cooked to perfection served on a freshly baked roll with your choice of toppings $7.95 Tomato.Prosciutto&Fresh Morella Served on bed of mixed greens with aged 6alsamicvinegarand extra virgin dive oil $8.95 l')uckct Of Steamers Steamed with hotter,6cer,garlic,and parsley $995 Ousters Rockefdla Four oysters 6aked with c6epse,bamn,spinach,and 6readcrum6s 4995 Fjoneless Buffalo Wines No bones s6out it! peep fried chicken served with blue cheese dressing with a hint of fire $8.95 Cap.56. Tender 6.6,9 shrimp lightly fried with 6omemade cocktail sauce 4995 Pulled pork&fi Finn gauce Layered pulled pork smothered in 669 sauce served with freshly baked bread $8.95 Grillecl s6dmp Ka6o6s Five grilledjum6o shrimp skewered and served with our homemade cocktail sauce $1 1.95 App om6o Choose three ofyourfavorites from up shove $16.95 Flat Bread Pica Traditional Cheese Mozzarella,vine ripe tomatoes,&6asil 48.95 Roasted Garlic&Pepper Fire roasted peppers&fresh gadic 4995 Gnlled Chicken b Feoper Tender pieces of grilled chicken with fire roasted peppers $10.95 osciutto Mozzarella,vine ripe tomatoes,6a5iil&sliced prosciutto $9.95 c 'c Roasted peppers,61ackolive5,spinach,mushrooms,&onion $8.95 From The Raw 'Cbem{stones A half down on the half shell $7.95 -Ousters On The Half A half dozen farm raised oysters $8.95 'S6rimp Cocktail Large gulf shrimp im chilled with tanpuy cocktail sauce and horseradish to hoot 4995 'Tuna Sashimi Pan scared,coated with sesame seeds,served with wass6i,pickled ginger,and soy sauce $9.95 Desert&Coffee Apple Cannel Fie 44.95 Walnut Hot F.Aee Fjrownics 44.95 New York Stule Cheese Cake $5.95 'We are required to remind you that consuming raw or undercooked meats,poultry,eggs,or fish may increase the risk of food 6omc illness ENIKL5 W11 1 5F 5F RVF D FROM 5-10FM Lunch Grilled Chicken Wrap-rolled up in a flour tortilla with chopped lettuce,tomato,bacon,and honey dijon $6.95 Lobster Roll-fresh Maine lobster on a fresh baked all with a hint of celery $9.95 Half Pound Anoes Burner-cooked to perfectio and served on a freshly baked roll with your choice of toppings $6.95 Reuben-homemade corned beef,sour k ,swiss cheese on a fresh roll $6.95 Stir Fry Wrap-sauteed roasted red pe rs,mushrooms,onions,snow peas,and cheese on a flour tortilla $5.95 Turkey Panini-oven roosted turkey reast with bacon,lettuce,tomato,and honey mustard, grilled on fresh backed foctia bread. $6.95 Roast Beef Panini-homemade r t beef with your choice of dressings,grilled on fresh baked focatia bread $6.95 Prosciutto6Provolone Panini -thinly sliced prosciutto,imported provolone,roasted Peppers,grilled onzowder-traditional ked focatia bread $6.95 Soup Chowder New England Clam) style clam chowder,rich and thick $5.95 Soup of the dav/ $4.95 1 Salads Grilled Chicken Caesar-garden fresh romaine with parmesan cheese topped with grilled chicken and Caesar dressing $7.95 Garden Salad-fresh romaine,tomatoes,carrots,cucumbers,olives and onions $5.95 Antipasto fresh from the garden mixed leaf lettuce,artichoke hearts,olives,cucumbers,tomato,topped with provolone cheese and fresh sliced prosciutto, $6.95 Desserts r n After Lunch Skewered Cheese Tortellinis $7.95 Scallops Wrapped with Bacon $7.95 Black Annus Burner $7.95 Tomato&Fresh Mozzarella $7.95 Bucket Of Steamers $7.95 Prosciutto&Cheese Platter $7.95 Oysters Rockefeller $9.95 Boneless Buffalo Winos $8.95 App combo three $13.95 Calan Shrimp $7.95 Pulled park&BBQ Sauce $7.95 Grilled Shrimp Kabobs $9.95 Flat Bread Pizza Traditional Cheese $7.95 Roosted Garlic&Peoper $8.95 Grilled Chicken $8.95 Prosciutto $8.95 Veaaie $6.95 From The Raw Cherrystones $7.95 Oysters On The Half $8.95 Jumbo Shrimp Cocktail $9.95 Tuna Sashimi $9.95 Desert&Coffee Apple Carmel Pie $4.95 Walnut Hot Fudoe Brownies $4.95 Pew York Style Cheese Cake $5.95 01/12/2006 08:01 7815927641 Al EXTERMINATORS PAGE 01 163 Shepard Sheet Lynn,MA 01902 Voice 781.6924731 y 800 52531125 rminators Fax 781.592-7641 Fax To: From: r6uce/i, Fa�c�9��/✓n ��s a/� i Pages: 3 /1 Company: h �i/.�t Q f P��Q.f Date: Re:Aldva• Lee )d/ zrj cc! ❑Urgent ❑ Far Review q Please Comment ❑Please Reply ❑Please Recycle �/2 01/12/2006 08:01 7815927641 Al EXTERMINATORS PAGE 03 A Exterminators PLEASE REMIT PtAYMENTTO: 193 SHEPARD STREET,LYNN,AA 0190.2-4W INVOICE P.O.Box 310 Lynn,NAA 01903-0310 ® AlT81-592-2731 1-990-529.4325 FAX 761-582-7641 ,.. CURRENT ( 30 C AVS 90 DAYS BO DAYS Peat and Termite Control FYcfessionais as@Ba,3 At DATE DAY TYPE PATE k'uij A9CT:NO. 1V)1bIJ0 I-t-m;tow1w wo5 1110:3 Thu ift 11/03/0 5 ROCKAFELLAS WIMROL= RIESULAR NEST" CONTROL cECNq 701 00 i231 ESSEX STREET NUMBER UNfT PRICE AMOUNT SALEM MA id;;97..0 MOUSE 41L SO 4378- 727--7542 09/01/05 0945- 10;30AM rf �/ Mucn•C"TRAP DATE L�` PROTECA — CHECK NO. PROTECA UP RTU BAII'STA COMMENTS 0M 0VISA 0DISCOVER �I�RATAj EED —7— INSPECT/TREAT ACCT If rk" c KITCHEN/PREP/DINING RM/STORAGiE/RSR/$SMT 1} 4 EXPDATE sr,LESTAX U' iS�.L•i...i - �^•'e�.. CA.C'yQ CHGO NICD TC MAL DUE T(oALAMOUNTPD DIRECTIONS /�✓'� �"~S CONT:Y,F_VIN MARCH 1190 CELL. 781-727-7542 HERE BY 8:30AM OPENS 11AM ADDITIONAL COMMENTS 0 T S r cam'; COMMERCIAL SANITATION REPORT Floors-Clean YES NO ...........I.... . .., p ❑ Counter Surfe9es-Clean ............:...... . 0 Q Drain Areas-Clem ......................... ❑ p Rest Rooms-Clean ... ........... ....:: O ❑ Dining Areas-Clean ......... .. .... ...... Employee Areas-Clean ............. .. ..... 00 Looker Areae-Clean ............... ...... . p Q RESIDENTIAL WARRA NTV INFORMATION Storage Areas-Organized ....... ❑ p I Comments •�•• DWELLING TYPE WARFiAANTV YES p NO 1 Family ❑ 3 Family ❑ 30 Days p 60 Days Q 2 Family Q a Family p g0 Days ❑ a Mos. p REASON FOR NO WARRANTY -Partial service requested..-..,........... ['] POST APPLICATION EMENTS -Poor sanitation.................................... ...................................................... In THOROUGH MUST BE VACATED FOR HOURS. +Kltchen/bathroom cbinata not prepa,'ed_............... . ..................... n THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY AME -Closets/furniture not prepared..................................................................Q REOCCUPIED,DO NOT ALLOW AbtJlT9,Ci1k.DREN,OR PETS ON -Rodent proofing needed..................._..._.............,..._................. ...............� TREATED SUAPAOES UNTIL DRV. -Other CONTRACTING ENTMES HAVE RECEIVED NJ.N HUSETTS DEPARTMENT OF FOOD&AGRICULTURE'S PESTICtOE 11ME IN TIME OUT BUREAU CONSUMERS WRITTEN �AEtJTS,P09nN0 NOTICES AND HAVE AGREED TO NOTIFY 2.7 (�j QO (�'cA DAYS PRIOR TO APP_ tONAtIME!7'f jF St/E SERVICE HAS BEEN SATISFACTORILY COMPLETED._ l STOMER31P sJ /f'fi' IL /U�C�.�k ) j� TECH SIGNATURE TECH NO � 'A ll //<—•- C �--- AZA (y )� S�ERSE SIDE FOR PERTINEWI INFORMATION Whae—OAlce copy CIV1er7� Pink-ReUnnpnce COPY 01/12/2006 08:01 7815927641 Al EXTE(RMINATORS PAGE 02 y AExterminator!; PLEASEREMIT.PJIYMENTTO: ® 781-M-2731 EPARD TREE11:�a „A 1902-990 n�. INVOICE P.U.Box 310 Lynn,RIA 01903-0310 Pest and Termite Control Professionals 5 CURRENT 30 DINS BO DAYS SO DAYS �� 991 70. 001 1?1. 0SC1 0 0. 00 Rr DATE oAV TYPE- oATE COD ACCDNG. 101688 TECHI100S// 00n 1'r-'01. Thu 1.01 Lam /ori ROCKAI-ELLAS 901MM M REGULAR PEST CON-rROL SWACECHARGE 70. 00 231 ESSEX STREET 4, NUMBER UNIT PRICE AMOUNT SALEM MA 01970 MOUSECLBD 978-727--7542 10/13/012 0945--1030AM MULTI-07 TRAP DATEa_I�� PROTECT CHECK NO. PROTECTALP RTU BAR STA COMMENTS ❑MC ❑VISA ❑DISCOVER RAT GLUE BD INSPECT/TREAT AOCT # KITCHEN/PREP/DINING r.-_.,....,. RM/S'T'ORAGE/RR/BSMT EXP DATE SAI.ESTAx 0.0.9.0 OHG0 N/C❑ TO rAL DUE -P QeLeSt �rrLe*, I BM. , r TO IAL aLnauNr PD e DIRECTIONS CONTaKEVIN MARCHING C1-LL 1 '741-=727-•754.2 FIERE. BY 11 30A OPENS 11AM ADDITIONAL COMMENTS COMMERCIAL SANITATION RIE2ORT- Floore—Clean YES NO Counter Surtaces—Clean [) C] DralnAreas—Clean ❑ C3Rest Rooms—Clean ...... ..............:... Q Dlning Areas—Clean ................... .. Employee Areas—Clean .............. .. .. 0 [3locker Areas—Clean ................. ❑ Storage Areas—Orgenhed .......... ....... ❑ ❑ RESIDENTIAL WARRAN IY INFORMATION ❑ ❑ DWELLING TYPE NARRANTY YES NOD Comments 1 Family' ❑ 3 Femlly ❑ 311 Days ❑ BO Days ❑ --- 2 Family ❑ B Family ❑ 911 Days ❑ B Mos. ❑ REASON FOR NO WARRANTY -Partial service requested...................................................................... ......❑ POST APPLICATION REQUIREMENTS •Poorsanitation............................................................................................❑ •Kitchen/bathroom cabinets not prepared...................................................[] THOROUGHPIEDLY AREAS MUST BE VACATED FOR _HOURS. •Closets/{Urniture noprepared................................ THOROUGHLY VENTILATE TREATED AREAS BI?FORE THEN ARE tre� d "•""""""""""""""""❑ REOCCUPIED.DO NOT ALLOW ADULTS,CHII.D9EN, OR PETS ON -Rodent prooflng needed.............................................................................❑ TREATED SURFACES UNTIL DRY. -Other CONTRACTING ENTRIES HAVE RECEIVED ALL MA£BACHUSEm DEPARTMENT OF FOOD a AORICULTiJAE'S PESTICIDE TIME�V TIME OUT BUREAU CONSUMER SHEETS,WRITTEN STATEMENTS,POSTING NOTIOES AND HAVE AGREED TO NOTIFY TENANTS 2-7 L�a I o T 'L DAYS PRIOR TO APPLICATION ME T ABOVE SeRVICE HAS BEEN SATISFACTORILY COMPLETED. INS s� v -J CUSJT�O RE Iawg.a' �'I (1 1T1;CH SIGNA I T©NO ESE R 11 PERTINENT'IN FORMATION 6 WWhite—OfficeCopyCaCan�neey—CusWmer Copy Pink—Remlitanoe Copy 6 A-1 Exterminators INVOICE PLBA 310 Lynn, 183 SHEPARD STREET,LYNN,MA 01902-4597 P.O.BOX 310 Lynn,MA 01903-0310 ® 781-592-2731 1-800-525-4825 FAX 781-592-7641 CURRENT 30 DAYS 60 DAYS 90 DAYS Pest and Termite Control Professionals `� ! i7 RT DATE DAY TYPE DATE L U LI ACCT NO 1 VJ i t�l d I L-L,tl:v"446/ / 01 /05/06 ROCKA EL-LAS CONTROL FOR REGULAR FEST GCONTRCI- SERVICE CHARGE '70. CA A 231 ESSEX STREET NUMBER UNIT PRICE AMOUNT SAI-EM MA 0197LA MOUSE GL BD 978-727-7542 12/15/05 091.5-1030AM {( ^' MULTI-CTTRAP DATF 1 f V6 PROTECTA PROTECTA LP CHECK NO. RTU BAIT STA COMMENTS ❑MC []VISA ❑DISCOVER RAT GLUE BD INSPECT/TREAT ACCT.> K 11'L:HE.bI/F'}�L.'r '/1.71 Id 11Ju RI4 PTORAl3E./RR/BSMTn EXPyyDATE SALES TAX C ly t/� co b'❑ CHG❑ NIG❑ TOTAL DUE s TOTAL AMOUNT PD � I � a ADDITIONAL COMMENTS COMMERCIAL SANITATION REPORT YES NO Floors—Clean . ... ... ... ... ... ... ... ... ... ❑ ❑ Counter Surfaces—Clean . .. ... ... . .. . .. . .. . ❑ ❑ Drain Areas—Clean .. .. . ... ... ... ... ... ... . ❑ ❑ ., Rest Rooms—Clean . ... ... . ... .. . .. . .. . .. . . ❑ ❑ Dining Areas—Clean . ... ... . .. ... ... ... .. ❑ ❑ Employee Areas—Clean ... ... ... .. . ... ... .. ❑ ❑ _ Locker Areas—Clean .. .... .. ... ... .... .. . .. ❑ ❑ RESIDENTIAL WARRANTY INFORMATION StorageAreas—Organized ... ... ... ... . .. . .. ❑ ❑ DWELLING TYPE WARRANTY YES❑ NO❑ Comments 1 Family ❑ 3 Family ❑ 30 Days ❑ 60 Days ❑ 2 Family ❑ 6 Family ❑ 90 Days ❑ 6 Mos. ❑ REASON FOR NO WARRANTY -Partial service requested......:...................................................................... ❑ POST APPLICATION REQUIREMENTS :Kior tchen/bathroom athon............................................................................................ .❑ •Kitchen/bathroom cabinets not prepared'...................................................❑ OCCUPIED AREAS MUST BE VACATED FOR HOURS -Closets/furniture not prepared.................................................................... ❑ THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE REOCCUPIED. DO NOT ALLOW ADULTS,CHILDREN,OR PETS ON -Rodent proofing needed..............................................................................❑ TREATED SURFACES UNTIL DRY. -Other CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD&AGRICULTURE'S PESTICIDE TIME IN BUREAU CONSUMER SHEETS,WRITTEN STATEMENTS,POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATION TIME.THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED 1 INS 5-1 CUSTOMER SIGN-ATONE /T`Lii••�rQ H SIGN'ATeU3E1` ^2 TECH y10 v SEEREVERRSEESIDEFORRPERTINENTINFORMATION White—Office Copy Canary Pink—RemiiHanceCopy CHECK THE CONCENTRATION OF EPA REG NO. I LIST CODE TOTAL AMOUNT OF MATERIALS I ] MATERIALS USED MATERIALS USED USED(oz.,gal.,lbs.) [ ) Advance Dual Choice 0.500% +99459 I ] Avdei Concentrars 25>, 1161£-0 I ) Avitro Who p Com 540 11649 7 I i BP-700 Sao Lahr ,t-'94;2 I ) C3-80 Fxira Sze Labe 9ce4-1751 [ ) C✓nquet 0271-4.of Cs`o trot-1P.1 -J?O;G I 5 :'entree Blox 035% 12=95 73 I ) D13r.Scgar 50/a I ] I%t17<U.ut Sea-abet 43E-991 IGR Concentrate 9% 272-:-2.'.i I Jur.,ud:,r HPi See -abet 8443-13J [ I Larva Lur2✓ fi56-802 [ ] ivtaxforce Ant Sad Gal 001%, I 432-1.04 [ ) Max�o:ra FC gait Stat on •05%, 432-1250 [ ] MMxfoce PC Ga! ,01W, 432-1259 E ] r4nxforce 711 Select .01'N' +132 1259 I ) Ma'mrce Gel bee Lahe: 442-1254 I ] Mvxinrce Tick Svstem 0 r. 432-1248 [ ) NylaCarGet Spray Sea L�bei 4768 '69 6707E l [ ] Pnantu^i 25.,, 5`n..12c i:, 241-382 I ) Purge li: See Label 9444-33 [ ) Preccr 1?°r.. 2721-352 i [ ] Pro C;ol"ol F.9ge* See:abs! 489-•165 [ ) Pi=th:!iVAG 6A 62715-4!514 I ] Recant iV 5?0 6b?19 453 I ) Rozol Trackinc Powoc C2°„ r17%'1 3 [ ] Sosuenc SG 01 in or.03% 932-733 I ) ien•nv i Dua. 312E-559 I ] len-1+dor SC 06%.or.t^5:C 7968-210 [ ] Tiro-bar Se 64403-8 [ ] wash Fraeze see!test 499-362 . [ ] `,Jsather 31ok 705r" 1 CG-1065 - - ( ] 4Vhitrd:e.` I See Lauel I ) 7P Tecract Po'..der fork, 121x5-1 [ ] I 3 TARGET PESTS METHOD APPLICATION BAIT STATION APPLICATION CODE PLACEIAENT CODE [ Ants [ 1 Wlipecc- [ I Sq.i'ds Ea4 Siniion -d£ Jrde,sm US [ Eels [ 1 lr^.Its- [ j Ta rntl,._. B^lacca=_: -3C 3e in9 Sto+re 85 [ eirds [ ? Pua ler Post BaetlesJ Ticks Br sh -3R Rehina Pefngeratet BR [ Centipedes [ Raccoon [ j Weirs Coach d.:.er:ce -CC Chisel [ Crickets [ 1 Has t [ Vr od Brirc'n o_ :c:.ter -D Floor F Earvi I 1 Fioaclr; Foam --iA v: S 1 gs I o,hr• [ 1 Fleas [ [ Sliverfa, j rsos.;ti an Onl` ec - Cali:rret CR 1 bltco my-ator At [ I Flies [ Skunk ] Orr F)mic In!zaor -SI [ 1,Hornets f I SowbLco ] Otre` Dara Lva Volume -U'-V 1 Mica Spiders a3 A-1 EXTERMINATORS MISSION&GOOD PRACTICE STATEMENT A-1 Exterminator adheres to all Federal and State regulations pertaining to the use of pesticides.Our misslon:s to provide our clients a th srtabcdon through reliable pest control services.Or.occasions,we shall Instruct you to vacate the area of treatment or to remain off of treated surfaces until they have hired.Your family,clienEs,employees.and pets are always out first priory.Labels and MSDS sheets are available upon request Commercial property and public buildings shal!be posted to notify you of the pest control services being provided at your location.On File in the comracting entty's office is a list of`Materials In Common Use—General Pest Control."Please eor to this notice for information required should you have questions Do not hesitate to contact our office for pest control questions or needs a r r ' YV tA 000000OU0 0000, 0 Ll 0 0 0 Bathroom 0 (D . 0 IV v 0 01 Bathroom 0 0 FIN 00 0 0: 0 c 0 as � a a % ' HIM 4, .3,q ft City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 PubhcHealth Iramdin@salem.com Prevent. Promote. Protect. Kimberley Driscoll Larry Ramdin RS/RENS, CHO, CP-FS Mayor Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2014 Permit Number: FM-14-433 Permit Type: Temporary Food Non-Profit Goods&Services: IFood Service: Temporary Name of License Holder: Rockafellas Name of Food Establishment ROCKAFELLAS/Jay EI Enterprises Address of Food Establishment 227-231 Essex Street Salem MA 01970 Restrictions: North Shore Pride Festival Salem Commons Serving, puller pork sandwiches, potato chips, cole slaw and bottled water. This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 6/21/2014 unless sooner suspended or revoked. Permit Fee: $0.00 Issued: 6/18/2014 " CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR KIMBERLEY DRISCOLL TEL.(978)741-1800 MAYOR FAX(978)745-0343 lramdinnasalem.com LARRY RAMDIN,RS/REHS,CHO,CP-FS HEALTH AGENT CHECK PAYABLE TO THE CITY OF SALEM.NO CASH FEE: NON-PROFIT=$25 1-3 DAYS=$300 4-7 DAYS=$600 OVER 7 DAYS=>7 DIVIDED BY 7 X 600=THE AMOUNT DUE (EXAMPLE: 14 DAYS DIVIDED BY 7=2 X 600=$1200) APPLICATION FOR A TEMPORARY FOOD /SERVIICE PERMIT NAMEOFEVENT GC. (\� LOCATION JG10,0, nh ,� DATE(S)OF EVENT 91;1/14 " NAMEOFAPPLICANT�Lc-2&cjc%(, //I�G,o, TELEPHONE# nhk 945 - OtWl ADDRESS (H( ;SP v''II S-4-- \C !Linn V,v SS O lq v) NAME OF BUSINESS �CK-4�",cx-�lC.s TELEPHONE# lT�l ADDRESS SS�,k S� /' lA"1&Cc oleihO� CERTIFIED FOOD MANAGERS NAME:L4i.IJ 144 G CERTIFICATION#: 1-I61/ I"4 *A PLAN OF THE ESTABLISHMENT FOR THE EVENT MUST BE ATTACHED TO COMPLETE THIS APPLICATION* FOR ESTABLISHEMNTS OUTSIDE OF SALEM.MA: *A COPY OF THE CERTIFIED FOOD MANAGER'S CERTIFICATE AND ESTABLISHMENT'S PERMIT MUST BE ATTACHED TO COMPLETE THIS APPLICATION.* TYPE OF REFRIGERATION: _GAS �CE _ 1RY ICE _t� OTHER METHOD FOR COOKING/ OT HOLDIN GAS yOTHER 11401 k v- METHOD FOR SANITIZING: CHEMI(j LL _OTHER Q J (,, ,I SOURCEOFFOOD: NAME: TCD /91v-t,G.t�Qe�] ADDRESS 1\OGY-.�:t. ll A n FOODS TO BES RVED INCLUDING INGREDIINTS AND METHOD OF PREPARATION: Pi (`OLt 'PPV U-- SG_bv0'.i.C" kcwee r,� k%t. L- I HAVE READ THE BOARD OF HEALTH,"REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS."I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS. I UNDERSTAND THEM,AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT. PURSUANT TO MGL;C6 :249A,I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I,TO MY BEST KNOWLEDGE AND BELIEF,HAVE FILED ALLSTATE TAX RETUR TAXES EQU/IR�EDq/////l /,, / �/(�� U ERLAW. sem//L/ J H 1 6y 2n h `'Pl SIGNATURE 4 b f EE SOCIAL SECURITY OR FEDERAL ID# CHECO. DATE Amouw PAID' APPROVED IM. DATE: TCUPAPPI 1D_11 n IIPnATCr1 A/19/11