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RUTHYS KITCHEN - ESTABLISHMENTS Ruthy's Kitchen 142 Webb Street n i ,I 1 u V f m n� ti v o � I " Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4r"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ,,__// �/n� Date Ty of Operationpe s) Tyof Inspection "� d Service Q Routine Address Risk Retail ElRe-inspection Lac f pl Qr VL 2R� Level ❑ Residential Kitchen Previous Inspection Telephone /] ri r I /_ C� / / ❑ Mobile Date: Owner HACCP Y/N ElTemporary ElPre-operation 7M o-$- � �Nt ❑ Caterer El Suspect Illness Person in Ch (PIC) Time ❑ Bed&Breakfast ❑ General Complaint I 1� `` In: ElHACCP Inspector hhl c �! h I Out: Permit No. ❑Other Each violation checked requires a c ex anation 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 _'„ _. .n ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 13. Handwash Facilities .� '�' _ _ - PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC - 1 ­1_.. 1­ L ,"­ El •- ❑ 14.Approved Food or Color Additives [j 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE;.. „. •'7IMFJTEMPERATURECOn/TROLS(Potentially Hazardous Foods E] 4. Food and Water from Approved Source ( Y ) ❑ 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 ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)'„ 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 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: S 501,upxlFo�10 Cac��/V✓ Y/1/l//I� � niS /� Inspector's Signature: r� l�U'-D�l Print: V) ())ph (�. l .-_A PIC's Signature: C 1 Print: �A 3✓u �^ TI7I Page_of Pages i ( 1. . •�w. 'e..,s,.,c: . ... 4 r' ;, Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 ( Cross-contamination j 1 590.003(A) Assignment of Responsibility* ( 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge* j Cooked and RTE F(x ds* 2-103.11 Person in charge-duties Contamination from Raw Ingredients j 3-302 1 I(A)(2) Raw Aminal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person to charge to j Contamination from the Environment require reporting by food employee:;and j 3-302,1 I(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables j 590.003(F) Responsibility Of A Food Employee Or An 1 13-304.11 Food Contact with Equipment and Applicant To Report To The Person In I Utensils* Charge* j j Contamination it"the Consumer j 590 003(6) Reporting by Person in Charge" j j 3-306.14(A)(B) ( Returned Food and Reservice of Food' j 3 590.003(D) Exclusions and Restrictions* i I i Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Ptxxl Law" j 4-501.111 Manual Warewasbing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures" j 3-20t.13 Fluid Milk and Milk Products* j 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* j Sanitization Temperatures* - 3-202.14 Eggs and Milk Products.Pasteurized* 14-501.114 Chemical Sanitization-temp..pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. " j4601 t 1(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System" j 1 - . j 590.006(A) Bottled Drinking Watcr* Utensils Clean* j 4-6021 1 Cleaning Frequency of Equipment Frxxl- 590.006(B) Water Meets Standards in 310 CMR 220^ . Contact Surfaces in id Utensils' She)tlish 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* 14-703,11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed i Chemical* _ Sources* ( 10 I Proper,Adequate Handwashing j Game and Wild Mushrooms Approved by 1 t Cl 301 2- , ean Condition-Hands and Arms" Regulatory Authority j j j 3-202.18 Shellsaxk Identification Present" � 2-301 12 Cleaning Procedure* j 590.004(C) Wild Mushrooms* ( 2-301.14 j When to Wash" 3-201.17 Game Animals* j j it ( Good Hygienic Practices j j g Receiving/Condition j 2-401.11 I Eating,Drinking or Using Tobacco" 3-202.11 PI1Fs Received at Proper Temperatures* j 12-401.12 I Discharges From the Eyes, Nose and 3-202.I S Package Integrity" I Mouth" 3-101.11 Food Safe and Unadulietated* 13-301.12 j Preventing Contamination When Tasting* j j 6 Tags/Records:Shellstock j 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* ( 590.004(E) preventing Contamination from j 3-203.12 Shellstock Identification Maintained* ( Employees* j 13 Handwash Facilities Tags/Records:Fish Products 1 j Conveniently Located and Accessible j 3402.11 Parasite Destruction* j 3-402.12 Records.Creation and Retention" j 5-203.11 ( Numbers and Capacities* 590,p04(J) Labeling of ingredients' j 5-204.11 ( Location and Placement* j 7 Conformance with Approved Procedures j 5-205.11 j Accessibility.Operation and Maintenance I 1HACCP Plans I Supplied with Soap and Hand Drying --- Devices 3-502.11 Specialized Processing Methods* * j o-301,11 Handwashing Cleanser,Availability 3-502.12 Reduced oxygen packaging,criteria 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision f Denotes critical item in the federal 1999 Faxi Code or 105 UM 590.000. - 'h'�,• r., f .? b.r1�^?�P.Ah•.-p�y.v^-ti5.s:.,Sr,�: � ti..y^..,;.. _): 19 A yy 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 () Date \ TYY"of Operationisl. Tyne of Insoection P,(J, ), n i �( { (�1l On I I -- � U M ood Service ❑l Routine Addressl Risk ❑ Retail E] Re-inspection2P Level ❑ Residential Kitchen Previous Inspection Telephone I �Ci (1� �Jl /�/ ❑ Mobile Date: Owner 6t 4 - HACCP Y/NI [-ITemporary ❑ Pre-operation a , P4 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector , f ��h I Out: Permit No. ❑ Other Each violation checked requires ar"x�lanation 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),2'"590.009(F) .0 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 E] 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS Potentially Hazardous Foods) • ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating 1� ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION" ._ ••" -' ❑ 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) ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices - CONSUMER ADVISORY [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 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 j 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. 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)(550.006) 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: j S 5901nspeclFormE14 tloc Inspector's Signature: Print: Tl l r �qqq v, PIC's Signature: C I Print: +�m ✓u -"� I Page_Of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination I 590.003(A) Assignment of Responsibility* ( 1-302 1 I(A)i1) Raw Animal Foals Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE FciAs* 2-103.11 Person in charge - duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C-) Responsibility of the person in charge to Contamination from the Environment require reporting by fool employees and 3-302.11(A1 Fad Protection' applicants* ( 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fuld Employee Or An 3-304.11 Fool Contact with Equipment and Applicant To Report To The Person In U;ensts* Charee' ( Contamination from the Consumer 590.()03(G) Reporting by Person in Charge* ( 3 3('5.1-4A (B i Returned Foul and Reservice of Food' 3 590.003(D) Exclusions and Restrictions* i I I Disposition ofAdulterated orContaminated 590.001(F,) Removal of Exclusions and Restrictions Food 3-101.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food' 41 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) C'omplianc•e with Food Law* 4-501.11 I Manual W;uewashine-Hot Water 3-201.12 Food in a Hermetically Sealed Container* ( Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Ptoduas* ( 4-501.112 Mechanical W'arewashing-Hot Water 3-202.13 ( Shell Eggs* ( Sanitization Temperatures* 1-501.11.1 Chemical Sanitization-tem H, 3-2(12.14 Eggs and:41i1k Products.Pasteurized* P" P 3-202.16 ( Ice Made From Potable Drinking Water" &-601.11(A) EquipEcuipmeennt Food Contact Surfaces and ton and hardness. " 5-101.11 Drinking Water from an Approved System` I Utensils Clean'- 590.006(A) Bottled Drinking Water* ( Frequency 4-61)2.11 Cleaning Fre9 yof Equipment Food- 590 006(6) Water Meets Standards in 310 CMR 22.0* ShetNish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.1! Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Fad Contact Surfaces of Equipment" Shellfish* 4-703.11 ( MethodaofSaninzation-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Lsted C'nemicai* Sources* 1 Game and Aut Ip Proper,Adequate Handwashing Ragutatory Authority Mushrooms Approved by 12.301.1 i Clean Condmon-Hands and Aran. 0- Shellstock Identification Present* 1-301.12 Cleaning Procedure* 590.004{C) Wild Mushrooms* 2-301.14 'When to Wash* 3-201.17 Game.Animals* 1I 1 Good Hygienic Practices 5 Receiving/Condition 2-'.01.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures i 2401,12 Discharges From the Eyes,Nose and 3-202 15 Package Integrity* ( Mouth* 3-lot.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 TagsiRecords:Shellatook 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination front 3-203.12 Shellstock Identification Maintained* Emplovees" Tags/Records:Fish Products ( 13 Handwash Facilities 3-102.11 Parasite Destruction- Conveniently located and Accessible 1 3 ,102.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* j lobelin of Ingredients* 5-204.1 1 Location and Placement* 90.00.1(7) 9 g ( 5-205.11 Accessibility.Operation and Maintenance 7 I Conformance with Approved Procedures /HACCP Plans Suppired with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* ( 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures," ! 6-301.12 Hand Doing Provision *Denotes critical acts in the fedetai 1999 Paid Cate ia 105 CMR 590.(1(10. BOARD OF HEALTH ((�� .. pp Establishment Name2,Altj r o I'D ( Grit_ f� Date: — Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTIO—NF Date No. Reference R—Red Item Pease PRINT CLEARLY Verified nt —�Z %0,�rl � I 1,,P,_ — //> J2 J� �L u o C/VL �.� �� 0��0_1'j. A I I I i o n I I o-Ac� Cie , I I I I Discussion With Person in Charge: Corrective Action Required: ( ❑ No ❑Yes (� (i 1 I, �� Lk Compliance LlEmployee Restriction/ ` j5 `1 I_`� I( /i /Yl nom / Eon LI Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B (REV. 7/2000) HOBBS & WARREN, - BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) Received at Temperatures Acco Factors(Red Items 1-22) (Cont.)Cont. According to Law Cooled to 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 119 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(6) Cold PHFs Maintained at or below 3-20214 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 I Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°E* Containers* 3-501.16(A) I Roasts Held at or above 130°E* 7-102.11 Common Name-Working Containers* 120 I Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590 004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 I Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 I Sanitizers,Criteria-Chemicals* I 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* I Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(6) Use of Pasteurized Eggs* I 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Critena* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EHeaw 0,2001 3-401.IIA(l)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.*I catering, mobile food,temporary and 3-401.1 I(A)(2) Ratites,Injected Meats- 155°F 15 Sec.*I residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors.Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 I Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(6) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 6[ 3-403.11(C) Commercially Processed RTE Food- 590.00. R 140°F* Item Good Retail Practices FC 1590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 I Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. I Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28. I Poisonous or Toxic Materials FC-7 .008 3-501 14(B) Cooling PHFs Made From Ambient 29. I Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. BOARD OF HEALTH Establishment Name: , VN Ji Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION_ Date No. Reference R—Red Item / , /j PLEASE PRINT CLEARLY Verified 11 A, r� " I'.7� \�Or �_neq�p .P{ — I'. �/. lionA/V1 Vo vkf.''.f. Ilii,( .>4>i_0-( 01 I17�,a/�/f/'u � � n > >�w--h/vim-. n� � ,�i /� \ __, i J n v Y ��r•, c'���"'-� I 1AJ n w P.4p oAP t I 1 01 j Ail ,.O/1 4"�.. „ ,.,�_ I .( .t_I 0_ V Discussion With Person in Charge: Corrective Action Required: ( ❑ No ( ❑Yes '�Iy //�� L11 Voluntary Compliance L) Employee Restriction/ 11 I �_� q I l / C / `(fir r_ .� Exclusion i ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure f � I u ❑ Voluntary Disposal ❑ Other 4 FORM 7348 (REV 7/2000) HOBBS & WARREN, - BOSTON This Form Approved by the Department of Public Health . r Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41'F/45"F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202 12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Ellecnve 11112001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.1413)(1)(2) Pork and Beef Roast- 130°F 121 Min.*1 catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.*1 residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 1 3-401 11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(8) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41*F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. -�FyeY�"••: . .a'1 a ^n t�xa�{ Y , 11Y -1+ 7 ' Y 7%t�l Yt 'a-�91 Y'i.n' F9��"`3•'Y' �•LI !e-1.. ra �" Massachusetts Department of Public Hrh _Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Nam `t�/ l Date Type of ODeration(s) Tye of Inspection PA� &_H_ (� ,IY 1i� ❑ Food Service ]/Routine Address ( I Risk / 01Retail ❑ Re-inspection 1o_� k Level ff Residential Kitchen / Previous Inspection Telephone ❑ Mobile Date: Owner ) HACCP YM Temporary ElPre-operation Caterer ❑ Suspect Illness Person in Charge_(PIC) //' Time AT Bed&Breakfast El General Complaint ut A M IiM In:� '0(/rol ❑ HACCP Inspector 'b�/Vi\-�P C -, & I Out:I , WMA Permit No. ❑ Other Each violation checked requires an eiplimation on the narrative page() 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),2' 590.009(�)Z action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS '[1'2' 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 ' "TIMENEMPERATURE CONTROLS Potential) Haiardous Foods ' ❑�'Y'F.00d and Water from Approved Source (Potentially ) O '❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 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/Pro ection ❑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 ❑ 11.Good Hygienic Practices P22. NSUMER ADVISORY. 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/federat Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an j 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 5901nspectFomSi<mc ( Inspector's Signature:' I Print: U- PIC's Signature: vav ��4 Q1_1 � int: 1 „ P p �t/ Page , of Pages Q 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 Resnonsibility'i 3-302.t I(A)(1) Raw Animal Foods Separated from 590003(B) Demonstration of Knowledge* I Cooked and RTE FoWs* 2-103.11 Person in charge-duties j Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in ehatge to j Contamination from the Environment require reporting by food employees and 3-302.1 l(A) Food Protection' applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An l ( 3-301.11 Food Contact with Equipment and Applicant To Report To The Person In I Utensils* Charge* I I Contamination from the Consumer 1590.003(G) Reporting by Person in Charge' 3-306.14(A)(B) I Returned Food and Reservice of Food'' j 131 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 1590.003(E) Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Urnate FOOD FROM APPROVED SOURCE Fixed* 4 Food and Water From Regulated Sources j 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law4-50t.11 ; Manual Warewaahing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* 3-20(.13 Fluid Milk and Milk Products* I 14-501.112 Mechanical Warewashing Hot Water 3202.13 Shell Eggs* Sanilization Temperatures' _ 3-202.14 Eggs and Milk Pioducts.Pasteurized* I 14-501.114 Chemical Sanitization-temp..pH, ,..I 13-202.16 Ice Made From Potable Drinking Water` j concentration and hardness. * 5-101.11 Drinking Water from art Approved System` j I 4-601 A i(A) Equipment Food Contact Surfaces and Utensils Clean- 590.006(A) Bottled Drinking Water* j 4-602.11 590.006(B) Water Meets Standards in 310 CMR 22.0" Contact Cleaning Frequency of i Contact Surfaces and Utensils* Food- 590.006(B) j Shellfish and Fish From an Approved Source ( ( 4-702. 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment" Shellfish* 1-713-11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* j 10 Proper,Adequate Handwashing Game and Wtd Mushrooms Approved by ( -- Regulatory Authority 2-301.11 Clean Condition-Hands and Arms' 3-202.13 I Shellstock Identification Present* 12-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* (, 2-301.14 When to Wash" 3-201.17 Game Animals* I if I Good Hygienic Practices j g Receiving/Condition i 2401.11 Eating. Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I ( 2-401.12 Discharges From the Eyes, Nose and 13-202.15 Package Integrity- I ' Mouth* 3-101.11 Food Safe and Unadulterated" 330 L 12 j Preventing Contamination When Tasting* 1 1 I Contamination from Hands I ( Tags/Records:Shellstock 12 Prevention of CotitifHd i j 3-202.18 Shellstock Identification* 1590.0(14(E) Preventing Contamination from 3-203.12 Shellstock Idc if fiedtion Maintained'' I Employees* 13 Handwash Facilities Tags/Records:Fish Products j 1 I Conveniently Located and Accessible 13-402.11 Parasite Destruction* I 5-203.11 Numbers and Capacities* j 3-402.12 Records.Creation and Retention* I � 590.004(J} Labeling of Ingredients* 5-204.11 Location and Placement* 7 I Conformance with Approved Procedures 15-205A I Accessibility,Operation and Maintenance I /HACCP Plans ( Supplied with Soap and Hand Drying 3-502.11 Specialized Proees:.ing Methods* Devices --- j 3-502.12 Reduced oxygen packaging,criteria* j 6-301.11 HandwashinR Cleanser,Availability 8-103 12 Conformance with Approved Procedures° j ( 6-301 12 ( Hand Drying Provision Denotes critical ucm in the federal 1999 Food Cade of 105 GbiR 590.000. r i CITY OF SALEM . BOARD OF HEALTH cy ;0.440.0.0. Establishment Name:2 Date: L�` �g� Page: of r Item Cooeteified J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Da No. Reference �C-Critical Item R-Red Item Ver - PLEASE PRINT CLEARLY r� �.OMn 4nJ `7. 1(3_1�fi P)., n,-1A;.,; ,t - �(_. ��° 1 U y r lVio Fr).A SAF"�t. hA,,,,/ - lf3-? ° 1 I ~� 1 )() W M.. A 161 A,1 /v ` i,.✓�� �q r �/�J I ,�l` �1'�`�\��•G,/'1(\ i,,.. [t��d ;_AIA/_1A� � �/k/�.f�, T6nM0 .G� s(1�nnAC(_� _U,/11/erJVO/Y L\0 oQ !1 Ik A�/�'�`nlF �k-; n, �.1..ern��-,-nc�PQA—) � � 0 (�(>�/\�I.]G�� '-l�.{�yDiVl l�ln Ow1 I ,j�.(B7.�J1,1 �rr�On A V N( A / IlDs> X deo��°nQ c �( - nn,, n 1n'V, jIr;l/I,F'AoAAx o1 AA Y/ — �( (r\�0n �in� nX � (a,t'0r)- /n_onn� �WAn. v 1 M �F C� P(_� �_is.�( /Y.�_N)_. JT�Dr `/` �L l�� (#� /l� w 4 OJ \ `/t�(n'- Li r)r r� .l�/n a_ (7nhl �(1 )04Z"/ P ��l 0_ /� X/� l�fi�i/�/!�'_d �l«I �/1 Lei �) nDA _/Y( (NI1o. � 4 Nom' - I YW fX 4Y{ C Il VL xN e, I_0\4,A. , _, W Vtl_ 1 ),�V A/IX3A:31%(A.Jk.L�' P�'U 1 . V Q2_AA9L) cite -A A-k �r U 4CAA, . ", 0_4,,n) ��U�, o. 1 n } Discussion With Person in Charge: U Corrective Action Required: ❑ No / 6 Yes } i 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 r ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that _ -noncompliance may result in daily fines o(twenty-five dollars or suspension/revocation of Ll Embargo ❑ Emergency Closure j C1your food permit. xL ' M ' llI / _Voluntary Disposal ❑ Other: It i t: - - 3-54"1 Wfc'l PFIFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lau Cooled to Factors(items 1-22) (Cont) 1 41'Fl45`F Within 4 Homs. x _ PROTECTION FROM CHEMICALS ( 3-501.15 { Cooling Methods for PRFs { { 14 PHF Hot and Cold Holding { 13) Cold 14 Food or Color Additives 3-501.10( PHFs Maintained at or below 3-202.12 Addrtives 590 ol,40-) 3-302.14 Protection from IJraporo\-edAdditives, ( 3_501.16(:A) Hot l'HF=c;\taintainedfit urabove i 15 { Poisonous or Toxic Substances 101.11 Identifying Infi7unahon -Uuginal ! { ( C7mtair:et'.' { It,"v R,,ist,Hr!d at or above 1300F. 7 102 11 1 Common;`iarnr - \((skin.,(unt.ua.!r+" `'0 Time as a Public Health Control � ----- - NW 1:% Fim•as a Public•Health Control- i-70 t.I1 Srpai stron- Storage'. - _ �v3(J'tt).tFii 5'.'riarccRe Requirement { 7-:02.1 I Rc,ti-iclion-Prost ncr.mJ t.,e' � --.-__ ___.__.___ S_. ( j 7-202.12 C'wtdttion,of ljse• ( REOUIREMENTS FOR HiGHLY SUSCEPTIBLE j 7.203 11 { Toxic C'onialncu -Prohtb):ion," { 7 {^04.1 I Sannitet�,.i'tiu•ria�-Chnniests" POPULATIONS{HSP} 7.26-1.12 - - C'h.nticals for Washing,,Produce <titrtia" ( 'l ? ''S')1.1! A) Cnp:;:icunr::d Pre-paci.agcd loses and '- ---'- ----� I Revetagea with it'armng I-ab':Is` i 7-204,14 Ur\in�Arent'.Criteria' ! < gu? I i!I3) U,t„! }'sten:i�ed Eee•' { 7 705.11 hr,id;:ntal F.wx1 Contact tab;:cants' or panrdi:(1.71,•d Animal F,x:J a!ui I 7.200.1! I Rrdt icn:d i'sr 1'r.riade> C1lterta=__,_..� i i 7-206.12 1 R(NLW &:1 SiAl')n,` +C: i ! auto:t CONSUMER AD'J;SORY _ li 1 C:or••ur.tt+ 'Fu\ix,r i'o:ra! ior r-'m>timntiuo uf� TIME/TEMPERATURE CONTROLS I 12n1axt.'isrst'•Rd z'r Proper Cooking Tempetatures too Ctit!m!uca:a'.ePHFs I i_ Y..tho.:.rt ... . ..o j (- ."y innrrdvne 4e.=•t,r t 5"F15>ee ' �u' 1 t h..:re:m..:.t - 4:,6,- ut, ,>4'! tt.rs Silt;! ' ;"�!.lti:l;i,-: � �.'n:;r^tc',d 11,L, titca:• ri :is1n _. _ , - _... ._-- ____..___._.._. - .-_____._ .__.................__-_._� SPECIALREQUIREMENTS and l;:el Rol,; ! tn'1' I>' o:r_,_' _.__. -._..._.� -- � __._.__._ ____-_. <-all F..-i{AirJi : R,q;,,�,, D.,:uui 19c.tts L� (' iS .• { m i ii.' li>,1_1. ieail`'Xaiv and _1_�__._� _._. - 1ri-tiiAr li i „'.nti•r•,, gild(;;"w' Stcl(ri! l`lir, ! t:a:J'.'n:;:,l l,ii.:i:in J':`!;':o:'� hUalcl hc' I ; Ci,rl'ntc i'.'t:oantr._'1:ia(:. ;l:•n ! , ca^I;r:d c^c;;, lire et;`nrt.pnat:: �._ ^t,nc, j ' i'^;dt•; t: ;::^,i:.,-il,,. i',:_ .. .., i( - , '�.,..'\`. ,art,: .. :��: ' }" i - r•,r-he:rnn'ttot ti,s.; ci•:s•ly _ r'it>i.fsi;':"a; fir_-'i-,d;,_t• 7f<:i-':1L" ,tiE:'k.t. P7;kC77:,r.q i ; .1(tj ti,:\t•:,ln 111I 165 i' 1`, vcc', ' tllems 23-30; F In'i.1 If b) Siir.nu!,'; Ir.>' P _ALatr�St.rncf:n(_ C,:r..•n .:r;7 n.: '-,ri:.G: Vi" a,..,.,. trr:,.l.,,o .1": i IllUC� i t.'In,r.,r .il, •c. ,n.(t,,'q!(.nf^ ,.'E,.hG:/o i.H(,Iu'y:'' ,Jitir,` ''t,._ .,avt %`1JG:.''.. .. c,G. 1. .:+it '...!.;••. . Sta fr+,•;i s'nd:.<".:'! ?;{ i, ti I :-to !t.inamin;i 1)';! :^d floruon! (•flit ct i_t#enr- ,Gntct firetaJ Praclices _ _.- �T. _. '-q0,000 i t 5 1 ,-2 s cdrifi UtP'V ' _— _,.�,_ -.5 -_•_rb�t,: _' --' , to':ei ,3 ti�Fro( _ PC OP';_ ( t E'drU Proper Coating of PNFs { —. _ --, { l8 i , ' { (',n,1me ' Pl{pr t, em �- `- - -- - = 26 7`,}li Wil nt nc2 I,tf rs ,'tit un^m T'I' L27 t'-f,i F.t:Jl' hiu ca ,v -' FC-o _ ! ' 501.14IB) l Coo!iw,Pi t'th,dcl Fran Ambientn`'tl'.:ne1>`P.tL--- -Cemt;rrunne tnp rdiar.t.t ,11'"45 F 1 k CITY-OF SALEM (� BOARD OF HEALTH Establishment Name: �{ �D �\D/VlJ Date: 2-r_)11k-0q Page: of Item Code C-Critical Item (J DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date III No. Reference R-Red Item . . Verified t I PLEASE PRINT CLEARLY Q /� 'CSL.AA eTt.a_ 1 R06_r, n�il0 ��A� Y� o � — �F P,_ _n. 0,X" I, �0" _ R/\"(01 ) ' Ivv\�" Q- I !''!III �n O / AA,'_/v:./-111..9V� �PC_D'A:2 -d 00 V,__ I ^Pz) — fid � - � 'J0A110 �) v A_t-f/%4_AeA -`-rt Nin Onn .� AA 0D4.1S 4-7) �.O ��7f.G-�ioSrL. f AA t`l rl F,2 0x d ). QOM t Jy ��op Q t! .--\-7)`-WA"` A OOA o _. iA-CA l�_1J � � All G1 1 iYAi.fL _11.I1 �LDJI� — (_X �_� /�)V/�n�/101\ �,Y� Vw_ .Al "n tKl A,IOpQ nn nn '' ,,JJ I AA p�l�n-01G n � A 01n A�'u. Jj-4+0r7pn A A A a, 1 �t Ot d.11 �q' // /1l �`i'f/\✓J ,��_7w }'A nn --A^ I Un x i1U1nS 'aAiJ61A , lIt ,L_Q� VtcnwGl v � ` � tl Discussion With Person in Charge: Correc ive Action Required: ❑ No OKYes I 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 I -noncompliance may result in daily fines of twenty-five dollars orrssuspension/revocation of ❑ Embargo `, ❑ Emergency Closure your food permit: I,• /.�v I� ��o[tin i\ r / ❑ Voluntary Disposal ❑ Other: Sa . J 3 501,14(C) PI-Ills Received atTemperatures Violations Related to Foodborne Illness Interventions and Risk According to Lam Cooieid to Factors(heft 1-22) (Cont.) - 4I=Ft45''F Within 4 Hots. PROTECTION FROM CHEMICALS ( 13-501 15 Coolim;Methods for PHFs P19 PHF Hot and Cold Holding Food or Color Additives ( 3-202.12 Foo or " x-50LH(B) Cold PHFs Maintained at or below 590,0;wl`) 43/-45"F` 3.302.14 Protection front Unappru,red Additives" 13.50,1,1NA) I lot PHFs Sfaintained at or above fs ! Poisonous or Toxic Substances i !46F 1-141.11 ( Identifying info±motion Otoinai ( ' t 2-StJ,I6(,t) K(,?sty Held at or sbuve 130'1• k ! Containers, Time as a Public Health Control 7 102.11 C.amrunu N.mrc-- t4'nrknig Cowa:nrr,"-- -' ---E --- ---- i -- , ! 501 it i Iintc ss s Public wealth Control' ( i-201.11Si,ii �-�—j-.- -.— ._ ?, ill t.ian•r 2e tno:,ocw 7-2f)2,11 31,,..tricuon -Ylru�ncc,mil l,•a' ( ._----- .ii}?_ � �� 7-_'03 H C ondni ollta fisc" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 T OSIS--el 1,iim:b -Probihm„n,` i POPULATIONS(HSP) 7-204.11 Saniti;:e3a.Crncria-CLrmiu3lc' 2t I I I(A) ( tAtP:,aeunn:d Pte-pad aped Jotrei laid i 7-204.12 ( ('hems.ein for v+''a,hm t 3'rod wc,taite,,.t'' I e n : —1-----'-------� , � 3 t,, .will, P'aruing labais -7-_'0-l.Id Ur t'vc;Avert,.Cnirria" ! r Su! i 7(337 ?':: I ? 2(35 '! h:rtd�rtal F,w,(1 Contact Lub:ttnnls° ..22.22._ ur t?;rila!!. Cn,k'il:knio"I F,xd",it 1 L-206.!{ ke.!.t,ae,i l'ic Pe,tie.xdr, Cnteun__ - ____..�.�-_—.- k' .- S:rd 4 prow, Nei Sr,ved. " i ?20(3.1^_ R,.i,.:.: 8::1Simolte. ----'—?-- - =L---- Not • ' "OL !' i I:�.t.mir,*,:miter. t�,:t':etvt•'aua - + - . CONSUMER ADVISORY TWEITEMPERAWRE CONTROLS i :untcx .lsl.;uu', t'u.t.d i'+r i'rnt utnpti,•n ,, __-_ .t,;:d 3..r r?. lli�t:•r ai, '._tnderux*ked,:: ` 16 I P: ot oper Cooking TepeaY t wes— R far 1 i PHFs ! ,`.t xhit:.* •i'n;em•.i ;n 1-'iaan<ta' , itnoodrite Ser•'t,. i 5"F15>ec ! - rl 5.t:a ,r,„ }(.. Kan Si,e(( • L. Sv? R.,;s I ' 1,;, 7L cat - -------- 1 _ _ 22.2.2. .._. _ . -_ . _ __ , ' '+ti:):>;-i;•Sl-(:`t ',�n9.C;n,, + i °xt C;H�d :')i}ik)2t:�'.t t)) L' tiiAli.'.'� ,i^1'i,, 1,141:;.i ;vtc.IG ..i:'`� i'1` ? ' i ! ;etr:r7;lg nip klil ox,:. kill 1p.,rarr::nd f, 5 ;, L.i'p,rn^td` !'itt, 'r:V r,:'„t!:'&:"at liILh,:rl 0 L:fl gt7S :h„41d 41" ,i 4 I.3 tSr : _--� tld . .t, Sri.:`c 13 1. f'': �b,;in,c{'s:3:aII.irf.i is t h,..:s oli !:'I 01: �(;i';t 7?:''d`C +c;t!ibtt iO ., ,,.``.t .,... . !,C' ry:.., . . . . ,. .?( . ... . i i 1(3'.3116) thran'::nz Ir:S• r. �Srintr 5t,ldtnz ';,r(:" :,.a r:..•r-, r;.:. ',r.. �t..,:,,, a%rr h.«'v par .,•:aP.:.r i ,In'0 %,lp[rL: tt 1,,.,:5, „It<",: ,., .bdt'1t4'j,7l S::rP P<ft',i tlt.P+', (rr•t t,l' Cln pn1,ii taut ;.r` :ii: hurl c'r<.. .i+•r' !"i f li 3�i�3 iLt:) ; iZrnlaru;t„' Lr:.keo po!uor15 of P(•e, ,_tier:---,_Good Rera_I Pracf,ces QFC_ _ ' 23 Nlanaeem..:a a::d(_rr.:.,nr r,!_____ _ 7 �,�,-_�-- r_'•'.5___ 2,1 F,y',w androaf SIR I Prui-er Coot!ng of PHFs _�.—»- -- i 25._-- =`3'�'i:mr'rA�nrl tJie`its _ P_^-,t n01 + '301 Id,A) Cot'I L,C•x,h'd PHFS P'a3114i,f'to ;_. -_-- _ _ _ .. -- _ _ _ __ _. _- __ _ - ?0. `!+rio=t,Pe^,,''rlI FC-5 0()j: 7111 tt`tlhm: i!,mr•"'Id Fn:m 7r)”" FC-6 -'-Dor 1r 1:"t�;-t5 F 1k:t nt 4 ti,ou,'- 21 i5 -Pas;ro't;ul'ax:�":;te'.,(�:; f FC; _7 00'' SOI.t-316/ (!mono,(HF: Nl:zJv Fi m =iinmel,t p,itt � '3�,:oyeidnrce tn)'re,.heut, i,.-i;.!.,tS.F '0 : •^.(ne: � —..- ,',;,. . ,_c.rv:'.l:v:;. +... , .-.. : t', ,u Fr,vl ib'< r i, •. .,. • , du ­N `f-"ur1.• .-a7'. f,..�n.�l.� f.. .r + e'�'d�+41', + No` - i' r.,+ -..re.: M...++-'"K+'hdA,\N\+'�'K•,'�V'°C YX:>t'.,_,lpfjatN'+if"• .. r.er...- fI I f , Massachusetts Department of. Public Health Salem Board of Health 120 Washington Street, 4t Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Namn ate TVoe of Ooerationfsl TyQe of Insoection Vi /1 i1 ,,f41L.4 r10 -0� 'S Food Service � Routine Address //� ��,• Risk �F Retail ❑ Re-inspection 10 O , o P),-t�r- �VLP P� Level Residential Kitchen Previous Inspection Telephone a (< _ �� _ `, ( C ElMobile Date: Owner (-\, � t HACCP YIN El C; [IPre-operation l ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) D(AAA P11 Time ElBed&Breakfast El General Complaint Inspector ��n P>� �wi a Ot`6�)r Permit No. ❑Other Each violation checked requires aj bxp-anation on the narrative page(s) and a citation of specifictprovision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors v �Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective_ s90.009(E) 590.009(F,)-[:]action as determined by the Board of Health. r- , " \ '` FOOD PROTECTION MANAGEMENT.�, , ❑ 12. Prevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/.Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH " ' a v I .. PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded E] 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ,; • " •- . ❑ 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 ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices 'CONSUMER ADVISORY ; , , , „ , . _ I • 11IF 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): 1 of Health. Non-critical (N) violations must be corrected t immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspectiontoday,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below �" N P 9 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 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-5)(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: Q a G( S 500V (For 614 mo t Inspector's Signature:` a-0• itn.� (11� ( ^ Print.'-����I„'� PIC'sSignature- ` Print: �� 1 ^)rJ Page of5?Pages } Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S I Cross-contamination I 1 590.003(A) I Assignment of Responsibilitv" ( 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw ingredients 3-30111(A)(2) I Raw,Annual Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(0 Responsibility of the person in charge to I Contamination from the Environment require reporting by fool employees and 13-302.1 1(A) Food Protection" applicants* ( 3-302 15 Washine Fruits and Vegctsbles 590.003(F) Responsibility Of A Food Employee Or An j 3-iO4.11 Food Contact with F,quipment and Applicant To Report To The Person In Utensils* Chargc* Contanvnauon from the Consumer 590(X)3(G) Reporting b}'Pen Nh in Charge I 3-306.14(A)(B} Returned Food and Reservice of Food* 13 590.003(D) Exclusions and Restrictions* I I Disposition or Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I i Food 3 701.1 I Discarding of Reconditioning Unsate FOOD FROM APPROVED SOURCE Norxl" 41 Food and Water From Regulated Sources j 19 Food Contact Surfaces 590.004(A-B) Compliance with Kwd Law* ( 4-501 A 11 ( Manual Warewashing- Hot Water 13-201.12 Fexxf in a Hermetically Sealed Container* Sanitization Temperatures* 3-20t.l3 Fluid Milk and Milk Products* I 14-501.1 i 2 Mechanical Warewashing-Hot Water - __ -- Sanitization Tem fratares' 3-202.13 Shell Eggs* I 14-5;y.114 I Chemical Sanitization-temp.,pH, 13-_02 14 Eggs and Milk Products.Pasteurized* I 3-'_'02.16 Ice Made From Potable,Drinking Water- I Equiraconcencrit F and hardness. * _ 15-101.11 I Drinking Water from an Aperoved System' ( 14-e01.1 I(", Equipment Food Contact Surfaces and 590.006(A) j Bottled Drinking Water* ( Cleaning Clean" _ Water Meets Standards in 310 CMR 22 0* A-60_'11 Cleaning Frequency of tensle*Equipment Food- 590.006(B) x ShettF,'sh and Fish From an Approved Source Contact Surfaces and Utensils* _ 4-702.11 Frequency of Sanitization of Utensils and 3--201.14 Fish and Recreational ly Caught Molluscan i Fond Contact Surfaces of Equipment* _) Sheillish* 1 .4-703.11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Sheliftsh from NSSP Listed Chemical* Sources* I to I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority I 2-301.11 Clean Condition-Hands and Arms" ' I 3-202.18 Shellsnxk Tdentitication Prescnt* I 12-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms" I 12-301.14 When to Wash* 3-201.17 Came Animals* I ! it ( Good Hygienic Practices 5 Receiving/Condition I ( 2-401 11 Eating.Drinking or Using Tobacco* 3-202.11 YHFs Received at Proper Temperatures e I 2401.12 I Discharges From the Eyes, hose and 13-202.15 Package ltuegrity* I Mouth 3-101.11 Frx:d Safe and Unadulterated* I 3-301.12 I Preventing Comanunation When Tasting* 6 TagstRecords:Shellstock I 112 Prevention of Contamination from Hands 3.202.18 Shelhtock Identification* 590.0(4(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained;' ( Employees* Tags/Records: Fish Products 113 ( Handwash Facilities 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 15-203.11 Numbers and Capacities* I 590.004(1) Labeling of Ingredients' I 5-204.11 Location and Placement* 7 I Conformance with Approved Procedures ( 5205.11 Acceosibility.Operation and Maintenance tHACCP Plans ( Supplied with Soap and Hand Drying ---' Devices 3-502.11 I Specialized akMethods* � ( 6-301.11 HandwachingCleanser,Availability 13-502.12 Reduced oxygen genparkaa ng;criteria* 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision Denies critic:d nem in the federal 1999 Food Code or (1R CMR 590.000. s CITY OF SALEM QQ� � BOARD OF HEALTH Establishment Name: YX wYU tC � M10/�J Date: t Y I Q��� Page: of Item code, C'_critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date .. Verified No. Reference R-Red Item , PLEASE PRINT CLEARLY j l,oV � r-%O _ r�t/ 1 � LQ ie>�'�Xn lnA �tilO�� �Pnr, _ nR c� + 0/lrt �� as V� (ir)r - G1'1S tn� yti RI�;� n,, iin, .�a i � f . l 0 -nn ,0 I /tit X 0 f I 4 \\ i)(2 to `17a°.r .��9Ctil Y //V� / 1 QAO AJ 90,h �o,,Q fn n�7) i.t.t� r Al On 40A.) fir( p A; t 2_iM A (11M�fQ v \� /1y/ ( R - � P"E',�K/Y �-1�Y'L.lL�1 ,1rL4--J '� 1'h/✓ll:.n.✓v I,4/�•'� rin it � M an n v� �nnn cr O. iv Int 2 K„��� A — (�l� ct�P>� rti, ( )AI ,, A .:,1 ) 01)1,1+1)1A,(011 Discussion With Person in Charge: / Corrective Action Required: Ol No I ElYes (l I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction 1 Exclusion i 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. /�`/ `�/J ❑ Voluntary Disposal ❑ Other: Vlolations Related to Foodborne Illness Interventions and Risk rarfors(Ifems,7-vi (Cont} Witltfnti Rotiu� PROTECTION FROM CHEMICALS Food or Color Additives 1 19 PqF Hot and Claid Holding ' ainij,act,at Va b'€["w P..tectioll firow linappl-med AJ,jinve<' �If)I I 6k A) !lot VHFs %Iauliaimd at or bl�*ve 15 poisonous or TGNIC substarims 101.11 Id"Twlying la�umt.on--Olq�itjai 'RImQr HVIJ"i or above i qf'!" %Vorl;ng Time as a Pubic Health Control 19 Timn•as a �J6�1 leadth Control S.:pa;aLivI Slcwc" 7-7-2€S' I! it.non Pj^xtwc and L V-�: 7 202.12 Omdmonaoi REQUIREMENTS FOR HIGHLY SUSCEPTIBLE Containcr, -- POPULATIONS(HSPY' 1 7 204' .11 Sanit;7ec;.Criteria -Clarl—Ilic.'k— '(W tat wwhing llfodacc.Clitoria, I I Wifil W.traim: Crirrria` 1 --st" tB paqcu!iz�d F ag s Isci&wa! f-x,Wom n1. Lubneauri' P'Lni'111'('1KAvd Anini'll Fmj and 206.12 i RWtv Ran Stml<a�' 3 tfil 11! Pam I'aix N4" Ro ;'cn'cd "06 I PoWdeE:. PeAi Contru!and mom(orim-, CONSUMER ADViSORY f)9_ P'.'tM !�;r('tw:iw'ption(It 11MErrEMPERATURE CONTROLS 16P roper Cooking'lempeiatures for llm xc,KaV-, P HFS I Not Ofliv,• isc 1,titntuate 4()l I IA(I if-) r"t"l, 15 5 F 15 S III 1: Inuixtliate Ser-bx 145"11 5:tt- Pjsi%VwI/o'I F4 S'tl*'s t;n,It,:r(a,R'.' am,S bell 40,L2lIA),2) ! omw svc. " SPECIAL REQUIREMENTS '-401.1 1(h)(I ttb I Put 1, avd Btel Roast I 7V)`t i>i ntin 1 59a) 6 Sa-Tion (D) in 4,0!.11 0)t 2) klcm� 155 F IS ;-40I-I1(A)(4) Poulin,Wild slulte.o 1111.e' ui:::Ialiwns siwdd 1),-, S110mg C-i'lla)Iliog Fisti, Maul, I k:chtk:d utldff pollitrlv ur Xamc;-166 F 'S ilxwe if r.Iaitd to fLxAhom,,tllnc::s I&Y3, While-naixrIo hract BeVfNicI,,;;s into vv!i t:i'lv e atid dsL (aclkwv Oita violazion:,relatin- vt p,taj; Raw :AmmA I't,d�,,C(w)k,-,,l Iva :hollld bt! under #29 Micio%vaw 16-�:I- S"),-viA ;+'qldrontllt. 11 0"lle.1 PI IF,, - 1,15,17 15 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4(13A IIA)&il)) 'Pt ti'� 165"1 I (Hent';23-30) I (B ]('5'r' 2 MIIIUI::swflding cn.i zl, u'0 h0.11-'t7f:'.al �io".ev'wt' wh;'�'h do no; rekite rite nzk 14<rury 1. icdabove, (an be Time' id comm'r,ial1v WIF. IMOR!ol:kt' rh,� Iood 10 CNIR It 1: Rollamin"UlAl"ad Pozuonsof Beel FC 2 l� 003 Proper Cooling of PHFS 124— F-A�-ind Fcmcl PrtiVntior 00.4 1 2h Et4uiprneraandjute"Fais L: -5,)l 14A) ir"n' 140tFul I I- L-:I--- Watel,P��4rn�.q2�'rd'jv'l"'te IT-1" %6 70'F W'i:hm 2 Ifour,,and FT,nnPC...6 007 2T Fivs.�Iaj t-r WF,4S F Within-1 How:,, I 217t i POISOr'00"or Tma-NI'tef'ais I Fc, 00b :01 14(9) f7colitit;PHFt Ma& From Ambient Te'%'Vrawre 1(''W1"451F 1Yithin 4 llkcrs .1;',ln 1,aj J'^.11t a I it,IV,It'rVI I I'q'I CITY OF SALEM BOARD OF HEALTH Establishment Name: . 'Az ' -� Date: LA'- ko -(-)01 Page: D�_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference : R-Red Item - " ._.?`" Verified PLEASE PRINT CLEARLY I t ✓ (� it v 1 i i Ii ,-- o-P M A,fl /v� /\A no�6i ik _ri YJP A oX-��i f A-0. -e V I `. )A )!1/,0 0A / vAA ea---t ( 1 It 1 n,v. — -17/ )0 _ A n/\nn /`n L o . o � I 1 Discussion With Person in Charge: Corrective Action Required: ❑ No O Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ Excursion ' 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 �L I �,� ❑ Voluntary Disposal ❑ Other: r� Walati ons,Related to Foodborne Illness soofvvntiorls and Risk I Acv,phy to W. Qeded n, f=actors(items 1-221 (Cont} 1 VF VAGn Homy Nl­,:u�,tix VHF: PROTEC'nON FROM CHEMICALS "PW Hol,3nd Gold Holding 19 14 Forld or Co;or AedriNpe i 1 ` so! me, Cvht PFIFS MrlptOmtd;'l or t-kdvl4 lrom 3:;t1 WAI Uo" i HE, NILAP:�hak!at-.r hboet P6sKmous or f exic Substances 140 or sltove 130"e, 20 Tine ltsa publicHawth Control 1 i-561 pum"laws Contrull: ! ad W 7201i2 s (AnAdort"0 Uv,' 7-'.()3 11 REWREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HS,-) neud'ed 00 lWaxed jymeq a1w --:!04 !2 Cinjill,%fl. l'or vizofiall, • 7104 14 D"MM Awnm fbwdW my A VB; tt Ioci&rval It'DI j Rxy,v Pa!i,ah,,, C,.*:-d Animal Fuxoj all,! Use ly2i6us fAte, a 700112 Ralcm Ext Tat"n Ra', st,0,Svronf, �ot So Wd hAq !PQ UpTaltal A.6 Paaa" W Rv humuL 7006 13 Ftwkivv,P.. P,-,�Cwor,d arct 1100hun ng, 3 CONSUMER ADWSORY 22 3413 i I 0vaurn Amemy&Nod to TIMFftEMPERATURF,CONTROLS Ibal �ZV k;w, UvLkq".lktd cl 1 1 16 Propel Cooking Temp04 atinfes for PHK 3 Ili t )iA(l;(_; EAg, I F 15.tics. 16W.SnOf ITHiNUD Coomamwi Yoh.Nfumv r!Glum L3401.1 1(8)t[,(21 P,-rk ad I',,,f Ro.,st 110 F Q n"In SPECML REQUIREMENTS 5'1i I(WA Nod 0 OR Lwow of Sek�iiVit (FA in 19"A A 0 0 Rown 11"'Od Numb- 155'r 1` 1 ttvil bx)j, t, fnpc:raxy and 3 WIUAYA PouYrt V,ild Gann",Slufad PHFs rc,!0,w;:tl I ace.wa ,hotild be V OMW COMMON HSI Nwa, uml,�r 11cour"VS,hull„-In5'F 15 Vim. move ifsel,o,d tv f,:,Ahorio­i ihte\s ;'i:t,!c lou`:r€t:, Intco uevfSw,;wS ARIVNIMP; and ns, Cay WS {mor 143T 11 vio!;"23oo4 Tcial rrlg to::okNj i'_ Rw.v -.Analrtl Fo UIS CV)kcql in a Frlk� 4ntdl Yk'11,44tcil wl&r #29 - WA IRAN KI, All 00Ai NILS 115't: (5 Roheating too Not Howing i VIOLATIONS RELATEV TO 000D RETA& PRACTWES 2W11 it A)&j01 Nun 05"1 15 wo , 1 23-3Q x4m put Nuz,owave- 10"r0. snmn;r� Fan' fpTibf"le mf:t""e,,R,14pldr, 3-4'13 11{C) Corrlrrl,,l;ullN llnxo,mj RTF f"xi 14W rmol 4jo I fktiwvd r.rhons or B,,:f 1 FC SWOO_ nn� Proper C00ng of PHFs Provxii,n - ------- �(Aj hAt ttx4ing cotived We We IAfF U, 23 EWtMtn1 And Wel�3�tS VC - 4 N)" 702 Wan 2 Ifow,amd Froot`Al`l '17 *0; W 4FT95,p "Wn 4 lQuy po. p"Swows Two Apwv! VIA l4h) Cmfjt2;N ulh MWV Yrom AmbiPnf Tempnlekoe laiedicia;it, AANn 4 iWO D.."WWA MM m 0,IrWhd NO WNW,ko,105(14K SWA. Commonwealth of Massachusetts s City of Salem Board of Health IGmberiey Driscoll s 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Ruthy's Kitchen File Number:BHF-2007-000010 102 Webb Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2009-0143 Dec 23,2008 Dec 31,2009 $70.00 Total Fees: $70.00 PERMIT EXPIRES December 31, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS + t BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIN BERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNE(a�,sALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT q lJ S t�1p C✓� TEL# ADDRESS OF ESTABLISHMENT # MAILING ADDRESS(if different) EMAIL-Business': Website: V t� a OWNER'S NAME 61-t/ l-A� TEL# -n 1 '3rV l 3 J ADDRESS Ti 0-u� e" A^ V • k LAL ✓ �� rNJA �_- STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) -` t l3 LAVN CERTIFICATE#(S) y Q /-� — (Required in an establishment where potentially hazardous food is prepared) 1 �vO 733«c+ -� EMERGENCY RESPONSE PERSON f , "� �'�- HOMETEL#l"r / I DAYS OFOPERATION... Monday -Tuesday - Wednesday• :-.'.Thursday . j Fddav ' ! 'Saturday- i Sunday HOURS OF OPERATION ' Please write in time of day. I �- I f — �— I I ^ l I (— !(•� 3 (For example l lam-11 pm) TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE YES NO less than 1000sq.ft. =$70 TTT 1000-10,000sq.ft. more than 10,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO I $100 CHILDCARE SERVICES - ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and aid all state taxes required under the law. t., J-� IIIi-)- I (DZ © s� �b � � Signature Date ` Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&DateT, A0 1V �r� 102 Webb Street Ruthy's Kitchen City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) (978) 745-5545 Equipment and Utensils FAIL Non-Critical BLUE I Owner: Comment:The small prep table needs a thorough cleaning,including the shelf. Janet W Brown & Luis Rom NI The Vulcan oven needs a thorough cleaning. PIC: Janet Brown The Vulcan stove needs a general cleaning. Inspector: The back refrigerator is missing the bottom grate. Provide a grate on this unit. David Greenbaum Date Inspected:Correct By: The Imperial freezer needs a thorough cleaning and defrosting. 8/22/2008 The All metal unit needs a visible,accurate thermometer. Risk Level: Special Requirements FAIL Critical BLUE Comment: Rodenrt droppings observed in the utility closet. Owner to notify the licensed pest control operator and ezterminate as Permit Number: often as needed to abate any problem. BHP-2008-0097 Status: PARTIAL COMPLY #of Critical Violations: 1 Time IN: Time OUT: j Urgency Description(s): BLUE: Owner to notify the Board of Health within one week that all violations have been corrected. 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. Aug 25,2008 ) Page I oft Item Status Violation Critical Urgency - Violations Related to Foodborne Illness Interventions and Risk Factors(Require immediate corrective action) 1\ Jp Y v IV ✓V 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. Aug 25,2008 ) Page 2 oft Commonwealth of Massachusetts City of Salem Kimberley Driscoll Board of Health Mayor lip 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/11/2010 ESTABLISHMENT NAME: Ruthy's Kitchen File Number:BHF-2007-000010 102 Webb Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2010-0217 Jan 4,2010 Dec 31,2010 $70.00 Catering event for Barbara Timmons on Federal St — Total Fees: $70.00 PERMIT EXPIRES December 31,2010 n Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Paye 1 kOJilez) CITY OF SALEM, MASSACHUSETTS M ` BOARD OF HEALTH 120 WASHINGTON STREET,4rrr FLOOR TEL. (978) 741-1800 ICIMBF_,RLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRFENRAUMaSAI.FM.CONI DAV1D GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR (P�ERMMIT TO OPERATE A FOOD ESTABBLISHMENT�^ t� NAME OF ESTABLISHMENT t f` S k.I '!�p^_��4 I TEL# �1 T g �(f S- J f I S/ ADDRESS OF ESTABLISHMENT I0 � We jo 49-V - FAX# MAILING ADDRESS(if different) EMAIL-Business': k -U S �� 1 'r a\ to .L W(ebs e: I)Ai"'X • 6&VX r IC r OWNER'S NAME J O.-t�-CY 6v't/d LA-A/ TEL# / ADDRESS ),y W 0040 �4. IAJ Ao✓" Sen 6-vL-A STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# 0AY$IQFQPERA3I0N; Mp6dayTuesd'ay4ItNednesda_yThur$day ? y ",;, -I SaC(dayal £Suitlay; 6 HOURS OF OPERATION Please write in time of day. (For example l lam-11 pmt TYPE OF ESTABLISHMENTFEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------------------•------------------------------- --------------------------------------------•--- ----------------------------------•••--- ----- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME------------ ----------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 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 knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. oa, yvN ; % 4 Signature Date ,J Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date "I 9' $ t' 0 , r Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 One Event Catering Permit DATE PRINTED: 11/05/2009 ESTABLISHMENT NAME: Ruthy's Kitchen File Number:BHF-2007-000010 102 Webb Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes CATERING BHP-2009-0599 Oct 29,2009 Oct 31,2009 $25.00 Permit for Barbar Timmons On Federal Street Total Fees: $25.00 PERMIT EXPIRES October 31,2009 Board of Health Page 1 CITY OF SALEM, MASSACHUSETTS _ BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUMna SALEM.COM DAVID GREENBAUM, ACTING HEALTH AGENT CATERING NOTIFICATION FORM 2008 FEE: $25/Event $200/Year Date of Application: � i'2_1 Date of Event: Check#: Check Date: Name of Catering Business: LJAAAddress of Catering Business: 1 �_ v v� 1/� s �f� Owner of Catering Business: rQA� 9-YI)V A/\ Address of Owner: V"k 1-4A �IA Name of Customer: ty'i7�1_Ndfl /HCl i M KA f)011 S Address of Event: �C�✓ 0� ?S ' Menu: " �k �I p IL q�5 . b r CITY OF SALEM BOARD OF HEALTH Date: May 13, 2008 Name of Establishment: Ruthy's Kitchen Address: 102 Webb Street Owner(s): Janet Brown Phone:Q7S4,� 9 The owner of this establishment, Janet Brown, requests an addition to the menu. This request was reviewed in accordance with the State Food Code. The addition is for raw meats to be marinated and packaged for sale. MENU/FOOD PREP Reviewed preparation of the marinated meats.. All food must be held at 41°F or lower, or 140°F or higher, at all times. The items for sale must be labeled with the name, the ingredients in descending order, the weight, the use by date, and the name and_address of the establishment. Given the size of the establishment, separate areas of the establishment will be used for handling raw foods and cooked, or ready-to-eat foods. This addition to the menu is allowed on a trial basis. The safety of this new addition will be evaluated during routine inspections. If there is difficulty maintaining equipment, or the establishment in general, in a clean and sanitary manner, this addition may be eliminated by the Board of Health. The owner also requests the ability to sell cookies (made, wrapped and labeled, at the establishment) on the beach boardwalk. The Board allows this with the understanding that the owner needs to check with the Licensing Board and the State to determine if additional permits are required. The owner was told to check with the Licensing Board to determine what is needed to place a picnic table for customers on the property. ()1_1�_e� /3 -ok J anne Scott Date Health Agent E-/)31 Ja et Brown, Owner ' Date r MOI f suss DltAkulRAei4. 1 _ w I �b 'M N, �I - 4 ' � o ;• 3 ;t7Fs�i.ezY g-r,c�• �r L ou ti1'E 6 C Z �3 -L l071 i i i l J�. y4tlrA.,' -.Nt,i'u.�• •�,,.' Awe_ „-�-,.,.2.d; & .'�±9�" mmoirWWti of MasiachiseitsIlk City of Salem Board of Health IGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/RetaH Establishment Permit DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: Ruthy's Kitchen File Number.BHF-2007-000010 102 Webb Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2008-0097 Jan 3,2008 Dec 31,2008 $70.00 Total Fees: $70.00 PERMIT EXPIRES December 31, 2008 - Board of Health A v 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 revonatiions,improvements,or equipment changes are made,all . plans for such must be submitted to and approved by the Salem Board of Health. page 25 of 46 Soul GGt.Zt [ C cif I �l/a�J gIGS� I r a� CITY OF SALEM, MASSACHUSEM BOARD OF HEALTH r 120 WASHINGTON STREET,4"r FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR iSCOTTOSALEM.GOM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT u NAME OF ESTABLISHMENT �v � S �1 �� '1 TEL# � ADDRESS OF ESTABLISHMENT , L 2 UJ t lo FAX# MAILING ADDRESS(if different) 1`v� , EMAIL-Business': Website: OWNER'S NAME G I�Q g '� �^^ TEL# C11 )L ( $3 3 G ADDRESS �✓ Mit V� .f fi \�3 .v.t� �.t Vy/1 iA t 1 STREET CITY j STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) c V�t�� u �'� CERTIFICATE#(S) 7 0 j I / ) (Required in an establishment where potentially,hazardous-f000d is prepared) EMERGENCY RESPONSE PERSON JnLr V 1/bl'Ut HOME TEL# � DAYS OF OPERATION i Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION ? v Please write infimeofday. I �" I' I (�� I � ' � ' 10 -3 (Forexample I1am-11pm) TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE ES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------- RESTAURANT YES NO ess than 25's-e'ats =$140 (Outdoor Stationary Food Cart$210; 25-99 seats =$280 more than 99 seats =$420 -------------------- -------NO d -- ---------... ------------------------------------------------. $100..... BEDIBREAKFAST/ YES CHILDCARE SERVICES .... -------------------- -------------------------- ------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all stale taxes required under the law Signature Date Social Security or Federal Identification Number --------' -------------------—--- ---'—' --- Revised 4/24/07 FOODAP2008 adm Check#&DateI L A4 � 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 SCOTr, MPH, IRS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT RUT-Elk.J "S kITcHiEr1 TEL It a ADDRESS OF ESTABLISHMENT I L' tn1tE i?5 STA"-i J -�A�'"J`FAX it MAILING ADDRESS (if different) EMAIL--Business': Owner's: ) Sa f `t OWNER'S NAME •tArsfLS bia 16Y4,0wt-f �' Lro'JiS 12_04,A ` TEL �4-9 9z_1 533 co ADDRESS t 8 B.;T yix AN ,5T- M A- '' yy AVDr -ri F s T . 1P`4F A 3c by STREET CITY STATE ZIP S) .,8311 U�• 1 t2 t>us`t S� CERTIFIEb FOOD MANAGER'S NAME (S) CERTIFIGATE#(S) �`�0 I q/4- S'AFF— (Required in an establishment where potentially hazardous food is prepared) q se q 2 1—s-3 3 c7 EMERGENCY RESPONSE PERSON yo L4 5 R cirv36 HOME TEL# K J ^ }}3 2 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION A M Y Please writeintime ofnew. /1 JJ it /I /I _ GZ-rJS lD (for exampletlam-iimai ? P. M . TYPE OF ESTABLISHMENT FEE (check onl RETAIL STORE YE NO less than 1 000s ft. kLLOD 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 _-"...-.-"... ......... - .--... - ----- ---- -- - ---- -- - _ ..._I s -t,. n_2- --- ---- ----- ---- - - --- RESTAURAN r YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 _.. "-- _ _ ------- ---- .... - ... .... -.. -...-..----- - --- ----- ----------------- BED/BREAKFAST YES NO $100 -- ------- ---- -- --- -- - ...".-...."-...._... -- -"" ._ .._."-.... . — ---- ----- ADDITIONAL --ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOf T StRVF 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 rt 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 rnust 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 Bled all state tax returns and paid all state taxes required under the law oz2- s L4 (6g�f n Social S cunty or Feder I Identification Number — -- ------- `—a ------- --- �7-- — -- ------------ ----------------- - - - - Re used 11/13/06,FOOp�PJ007 adm C eck &O.ite f'(0 � �- -_ 5 ;j-a q'F/'70ti9ag� a� , s `� �o r• t k � / v 102 Webb Street Ruthy's Kitchen City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION (978) 745-5545 1 Good Hygienic Practices FAIL Critical RED Owner: Comment: Employees drinks observed in food prep areas. Employees to eat and drink in a designated area to prevent cross Janet W Brown & Luis Rom contamination. PIC: ! Violations Related to Good Retail Practices (Blue Items) Janet Brown Food and Food Protection FAIL Critical BLUE Inspector: Comment:The flour container must be labeled"Flour" David Greenbaum Equipment and utensils FAIL Non-Critical BLUE Date Inspected:Correct By: 6/25/2007 Comment:The Vulcan oven needs a general cleaning. Risk Level: The Vulcan stove needs a general cleaning. Permit Number The big reach in need a general cleaning. BHP-2007-0424 I The same unit needs a grate at the bottom. Status: I PARTIAL COMPLY The front display case needs a grate at the bottom. # of Critical Violations: GENERAL COMMENTS: 2 Owner to notify the Board of Health within one that the above violations have been corrected. 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. Jun 25,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) M U 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. Jun 25,2007 ) Page 2 oft Memo to file: Ruthy's Kitchen From: Janet Dionne Date: June 14, 2007 Re: Meeting With Owner Janet Brown On this day of June 14, 2007 Owner and Certified Food Manager of Ruthy's Kitchen, Janet Brown came to the Salem Board of Health to meet with Senior Sanitarian Janet Dionne with questions and concerns at this Establishment. Ms. Brown has an internal issue with an employee not sanitizing utensils and equipment correctly. I discussed with Ms. Brown that as the Certified food manager and the owner of this establishment it was her responsibility to ensure that all equipment and utensils are cleaned and sanitized in proper manner. Ms. Brown agreed and I said that I would note it in the file that this issue be addressed at next inspection. We also discussed sanitizing buckets and the proper manner in which to sanitize food contact surfaces. I gave Ms. Brown a sanitizing packet explaining proper procedures. Janet Dionne Senior Sanitarian '\ / Pest Control Service A9 reement B & B (PEST CONTROL 8223 29 School Street SAUGUS, MASSACHUSETTS 01906 (761) 599.4317 luaTOMEr :r.MMptOGniwn E , $TPfiT crcC PTn*E rM rir - - "— F(gsCnlo eF cuMACiEu FtAryff;rrwNG— rlwn N F.M p KFTTy 10 PC VMCEO O/TE rEP�ACr K?MC F..FlnAT M�-7� — gr:NGWnI .awCr;'Wv4PEPEOPNEO ��•O '-O � � I n f l MONTHLY U QUARTERLY (1 OTHER - ------ ---------- ... �_ _7P�t"-�-'�rT.CeU .�.e iia`E... 7 0 +�• �a...w e..� s+yo _ . . "r,CIAI M—M-MT-MR --- - ------- iEPMP ANP ITp!'u r l /fteQ SERVICE GUARANTEE:We agree to apply on amieals to control above-named pests in accordance with terms and conditions of this Service Agreement. All labor and materials wl I be furnished to provide the most efficient pest control and maximum safety required by federal.state and city regulations. SERVICE RENEWAL:This agreement shall be for an initial period of one year,and will renew Itself annually unless either pony cancels this agreement by glving thirty days written not ce before any expiration date. ANNUAL AGREEMENT CHARGE $ my __ INITIAL SERVICE CHARGE $ �-/�' OA/ TE -- 4 N .PPR ri MONTHLYIOUARTERLY PAYMENTS $ FOR E..1 /CUSTOM.F g` DATEre, ` , • c®ppprintcenter Complimen,'�:ary Self-Serve Fax Cover Sheet To: -TctFkx,3 From: 3A-,Jlm�f se_CL--�-j — K- Tcti&- Fax#: q 11t % 4 LIS o3 4 3' _ Phone #: Dater 0 R o ReplyTax #: - Number of Pages (Including Cover): Z... Urgent ❑ Confidential ❑ Confirm Receipt H-� 01.E ! 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't .,Y�!ZB08rd Of llealth rpf:�.•.:9-may .gr ._.1.-' .i.,, . •*. � �IGmbelley Driscoll= `; WasliingtoitStree` 4th Fl00rr;, ,7 w" a w 1 a �Yr • ' tM1'% a lY1 SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/06/2007 ESTABLISHMENT NAME: Ruthy's Kitchen File Number:BHF-2007-000010 102 Webb Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2007-0424 Mar 6,2007 Dec 31,2007 $50.00 Total Fees: $50.00 PERMIT EXPIRES December 31, 2007 Board of Health e T This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 CITY OF SALEM BOARD OF HEALTH Date: January 8, 2007 Name of Establishment: Ruthy's Kitchen Address: 102 Webb Street Owner(s): Janet Brown; Louis Rome Phone: 978-473-9006 An owner of this establishment, Janet Brown, presented a Floor Plan and Menu for review in accordance with the State Food Code. This is a retail establishment where food will be prepared and offered for sale in containers for re-heating off premises. CERTIFICATION Ms. Brown is a Certified Food Manager who will work full time at this location. A "Person in Charge" or "PIC' must be available at this location when Mb Brown is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. FLOOR PLAN A Hand Sink must be located in each food prep and service area. This includes the front service area, and the rear food prep area. Therefore, a hand sink must be located in the rear food prep area. The owner must notify the Health Agent of the final location. Hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the-beset. cakxv A dishwasher for washing, rinsing and sanitizing all utensils, equipment, dishes is used currently, as is a three-bay sink. The dishwasher may be removed. MENU/FOOD PREP Reviewed preparation of several items including a soup and beef dish. All food must be held at 41'F or lower, or 140"F or higher, at all times. Food will be rapidly cooled and placed in the refrigerator or freezer. The items for sale must be labeled with the name of the dish, the ingredients in descending order, the weight, the use by date, and the name and address of the establishment. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKED FOODS The owner was given a copy of the food advisory. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Outside area of premises must be kept clean and sanitary. Trash disposal methods have not been finalized, This establishment is scheduled to open in February. Please call one week prior to opening to schedule an opening inspection. An application was given to Ms. Brown. No check was received. panne Scott Date Health Agent �- J, et Brown, Owner Date Our menu will be changing on an almost-daily basis; we would like to keep our selections fairly straightforward; however, we would like to change the offerings every two days or so, while not deviating from the given format. As a general rule, we want to include the following on any given day: 2 appetizers (this will probably come later on, depending on business) 2 "dips" or spreads, such as; tapenade, caponata, roasted red pepper relish, chutneys, etc. (I to start with, then,) 2 Green Salad choices; Chef's, Garden, Greek, Spinach, Caesar, and so forth. 2 Sauces: Roasted Garlic Cream, White Clam, Bolognese, Pomodoro, FraDiavolo, Marinara, Spiced Cream, etc. 2 Soups 2 - 3 Chicken dishes I Beef(Lamb, Veal, etc) (not necessarily every day, and we may do away with this altogether) I Seafood 2 Pasta selections, i.e. Penne w/ vodka sauce, Spinach & wild mushroom lasagna, Rigatoni alle Fava, Pasta Provencale, etc. 2 or 3 side dishes: orzo, rice, potatoes, pasta, garlic bread, roasted zucchini, peppers, tomatoes, vegetables, etc. Choice of cookies or baked goods (brownies, bars, pies) We would also like to have probably two, and perhaps three, bread choices; Foccacia, baguettes, maybe a sourdough or country loaf. We would like to offer larger cheese/fruit/meat platters; however, this will take us some time with building the business. Examples would be: Antipasto, Cold Cut, Vegetable Crudite, Cheese & Fruit, Smoked Salmon, Roast Beef or Roast Turkey Breast. An example of any given day is given below. Ruthy's Kitchen Appetizers Crab Salad with Endive Wild Mushroom & Brie Puffs Dips Garlic-Roasted Red & Yellow Pepper, Red Onion, Lemon, Kalamata Olives Mango-Papaya with Honey-Sesame Salads Spinach Salad with Pecans & Cranberries Fresh Garden Salad with Tomatoes, Red Onions, Baby Carrots and Celery Sauces Pomodoro Roasted Garlic Cream Soups Tomato-Basil Asparagus & White Bean Chicken Entrees Chicken Saltimboca — breast fillets with sage, prosciutto, spinach & red peppers with a Marsala wine sauce Chicken Piccata — fillets with lemon, caper, ground black pepper & white wine sauce Beef Entrees (Beef may not be included in our menu at all) Beef Bourguignonne — beef, pearl onions, garlic, red wine, cloves & mushrooms Seafood Entrees Stuffed Sole — Maine Crabmeat stuffing over toasted coriander and lemon rice with a roasted red-pepper aioli Pasta Pasta Provencal — fresh tomatoes, capers, artichokes, olives, & Romano cheese Penne with vodka sauce — chopped basil, sun-dried tomato, sweet onions and fennel sausage in a pink vodka sauce Vezetables —Risotto —Potatoes— Roasted Asparagus with Garlic Green Beans with toasted Sesame & Almonds Yukon Gold Potatoes Breads Rosemary & Asiago Cheese Foccacia French Baguette; whole or half Desserts New England GingerSnaps Lemon Squares January 7`h, 2007 Ruthy's Kitchen As it stands now,we are buying all of the equipment which was used in the former owner's business (Deborah's Pie's). We have not added anything, but may do so in the near future. The inside measurements of the building are as follows: The length (inside wall) is 28 feet; the width is 15 feet. Our equipment is as follows: Double-door(sliding) refrigerator: 54" wide by 32" deep Commercial Freezer 32" wide by 31" deep Un-refrigerated display counter(getting rid of this) 6'5" long, 35"wide Short Display Refrigerator 4'wide, 35" deep Separating wall in middle of kitchen is 9' long, 7" wide Small refrigerated unit (glass door) 40"wide, 26" deep Three-sink unit 71"wide, 30" deep Convection Oven about 30" wide Hobart Mixer(atop small stainless steel fixture) Double Electric Burner(also atop stainless steel fixture) Stainless Steel work-table 5' 6" long, 31" deep Three-door, bottom counter refrigerated unit, 5'6" long, 34" deep There is a pantry space of approximately 158" A bathroom of approximately 67" long A work-area comprised of a water heater, and various water pipes, about 5' long 102 Webb Street Rut 's K City Of Salem REGEIV 0 RETAIL FOOD - Food Establishment IJUL 16.2007 CITY OF SALEM Item Status Violation Type U BOARD OF HEALI 1 PROTECT[ON FROM CONTAMINATION Address: 102 Webb Street Good Hygienic Practices FAIL Critical RI COMMENTS: Employees drinks observed In food prep areas. Employees to eat and Telephone: (978) 745-5545 in a designated area to prevent cross contamination.f Owner: Janet W Brown &Luis Rome Violations Related to Good Retail Practices (Blue Items) PIC: Janet Brown Food a � �7. - 7 7 Inspector: David Greenbaum COMMENTS: The flour container must be labeled "Flour" - Date: 6/25/07 Equi i s� rirnrci*nc —Y7i Rl*k'Level: COMMENTS: The Vulcan oven needs a general cleaning. HACCP No The Vulcan stove needs a general cleaning. Correct By: 7/2/07 Permit Number: ' BHP-2007-0424 The big reach in need a general cleaning. i Status: PARTIAL COMPLY 1j The same unit needs a grate at the bottom. ar /t-- #of Critical Violations: 2 The front display case needs a grate at the bottom. Time IN: OUT- GENERAL COMMENTS: Owner to notify the Board of Health within one that the above violatic been corrected. Urgency Description(s): BLUE: Violations Related to Good Retail Cey of Sakm Board of Health 120 Waahhr0ton S6eet�4th Floor SALEM MA 01970 :5978)741-1800 Fu:(978)7450343 GwTMSe 2005 Dw Laurkm Munklpal Solueon;Int. COMMONWEALTH OF MASSACHUSETTS 102 Webb Shat Rat 's k City of Salem RETAIL FOOD - Food Establishment Item Status Violation Type U Practices (Critical violations must be corrected immediately or within 10 KN daysxNon-critical violations must be corrected immediately or within 90 C vim? 1 t� — 1 ` ( A-c days) tt l� gi RED: Violations Related to Foodbome Illness t)/—' CA Irk— Interventions and Risk Factors (Require immediate corrective action) � v�-CL RECEIVED IJUL 16 2007 CITY OF SALEM n BOARD OF HEALTH li lasp&tDr 54namre �Yn+ CB7 0}Alerrr Boats of FMahh 120 Was4lopeon Sfinef&4th Fluor SaIEM !IA 01970 Phone:(978)741-1800 fax:(9 0343 =i�� Oe07MS®2008 Den taurlers Municipal SoMlons,Inc COMMONWEALTH OF MASSACHUSETTS I' CITY OF SALEM BOARD OF HEALTH 'r Establishment Name: 12Vlll i S K ITC \cAJ Date: Page: of I I` Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified S PLEASE PRINT CLEARLY I I - t i»2 1ti c;.Rh� �arie� Cenli f� nVr �._ �.oq1� o Nit llr.r..\a tl I �i ` I _ 02 (hiTi rcR 'C-t\V \-I,Sa4 C .NSL I Sr-N Tr>1 1 C_Oaw T7ad> � l? r��;,, 1 1 I ! I I ! I I _ a Discussion With Person in Charge: � , � ( Corrective Action Required: I ❑ No I ❑ Yes ' '❑ 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 fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. '' to e1»� .� " ❑� Voluntary Disposal ❑ Other: \j ! �-`ti i.iI+,f'} � f`-LPs Li:reiv�a at-feral-craturns Violations Related to Foodborne Piness triterventions and Risk Acrnrtsing to Iaaw Co,•led to Factors(hems i.22) (Cont.) 114:^F',5-F,;tdtin•1;Lours. ' 6111 I5 Cuolm;;mefllo& for P-{'rs PROTECTION FROM CHEMICALS I 19 PHP Hot and Cold Holding id Food or Coln Additives ; Cold Pl1Fs Nisinlamcd at ut below l 3-202.12 Additives'" ( ! ) , 590 004'F; 11`r45o F 3-302.i4 Poison si us or Toxic: Substances 1-50 ( 4-50LI"'(A) HotFTIF, Maintainedatorabove 15 Poisonous or Toxic Substent:es � - 7-101.11 Identitvmc infonn-bun--Original l 3.501,l6Ui; Contain ',;, I Roasts Held it or above 130-F. 7-102,11 Cutmnrn"7;rnc -Wurkin:.Cont:;^ern 20 Time as a Pub?:c Health Control j -501 15, ' ?•int as a Pubii..Heairi Oiteol" ?='01 I1 $epa rr earn-Siuraee>: j 59f,.00dt H? I lhtriantc Reyuin° + j 7-20211 Restriclion-Prescuce ad Use* j n.eut 7-202.12 Conditions of Use" 7.203.11 'Toxic Container.-Prohibitionsa' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chenticats' i POPULATIONS(HSP) 'r?0? 12 ( Cheinicais for Washi ne Prodo:e,Criteria'' ( 121 ( 3-SCI 11.;A) thrpesteurtz;+d Pre-packaged Juices and Bovent:'es with bV.irnine I.6eL;'. 0.04.14 Drying:agents.Cite:ia j 3-SOI.;!(R) Use u`Pasteunzed 8^_gb" 7-05.11 ( Ltcrdeutal Food Contact.Lubricants" j ! '?-206.i l Resincted L''se Pe,tictdes.Criteria" j 13-301.i Rim ar Paititdly Caked Anunal Fuad and Katy Seed Sllroras 1,;,)! Se:%e 1 '?-206.!2 R«;ent Pati Staiiona" 3-80I I liCl Llnonened Taxi Package h'rn Re-served ',-206.13 Tracking Powders.Pest Cuntroi and I lonitorina^ I CONSUMER ADVISORY TIME/TEMPERATURE CONT ROILS 22 3-603.! 1 C,nw omer Advisory Parted for Consumption of Ammal 1-cocts 11lat re Raw.Lrnderennked or PHF16 Proper Cooking Temperatures for j Eggs: Net Otherwise Processed to bl:minare Eggs- ns.`re,=circ v::eoo, 3-401.IlAt11(2) E1Si`;,� I;iSet.. Pathoge Et;es-brim;r.:iatc Service 145`Flis::�` 3-302.13 Pnste,in..ed Fog.Suhsr,;;ae fl)r Roc. Shell i3-2)I.I I(Ai(2) Cueammtled Fish;Meats R:Gant: I Ly11LL Animal.- i 55^F 15 see. 340i.11(H)(1)(2) Pork and Rezi'Ru:st- 130"Fi?l min=' I SPECIALREOUIRE44ENTS 3.401.1 L(A)(2) Rattles, Injected Meat:, -.155°F 15 i590609(A)-1 G) Violations of Section 590.009(A)-ill) in sec catering. mobile food, trroporayand --ilii.11(Ali 3) Poultry,Wild Game, Stuffed PHP,, r std:niial kitchen operations should be Stulfmg Containing Fish, Meat, debtod ::rider the appropriate sections Poultryor Ratite,-165"F 15 se,. 1: above if related to fcer;i,nrnc iihicss 3-40!.1 Whole-ma,sc1c, intact Beef Steals inttery nbons and It3k iactors. Other F 115" .:. 590.009 violabons relating 63 good retail :i 401.12 Raw Anim.i Pools Cooked in a ( pntetices should be deb;'.ed under #29- Microwave lo5'F t Spccial Requirements, 3 401.1 I(.A)(1)(b) All Other PH Fs- 1.15°F 15 we * � j 17 ( Reheating for toot Holding VIOLATIONS R.3LATE0 TO GOOD RETAIL PRACTICES 3-403.1 I(A)&(U) PHFs 165o1- 15 sec. ' litems 23-30) 3-403.111(13) Microwave- 165'F2Minnie Standin„ Cribra.+and;lon-:riltrat violahun,, .,lochdr,nntrelaeit,the Time' .f;odbo re illeee;rat,)vrnn.,na unci risk lar toro iistad:,t•ure, ran be 3-403.11(C) Commercially Pt'oc_ssed RTE Ftwd- ,jnrnd in tkc}ollnw,';,g sertions It the IooJ Ceu.-and 105 CIIR 14u'F` 590.000. ,-403,11(Fi I Remaining Cnsliced Portions of Reef I item Goadfletall Practices FC 59dwoo j Roasts::, 1 23. Manacteniert and Personnel FC-2 .003 IR Proper Cooling of PRFs f 1 24 Fax!nmd Fox Protection F(:--3 .004 J 25. Equipment and Utensils F C-4 Ms 3-501.14(;1} Ca)Ung Conked PHPs from 14{)°P to 2F,. +Nater Flumbinq and Ntaste FC --5 .006 70'1;Within 2 Hours and From 7p°F ! 7.7. I Physical FacaiPJ FG -L 007 , to 41"F/4.5`F Within 4 Hones. ' 12t3. 1 poisonous or Toxic'01aler.alc FC-7 008 t! _ ?-5I.14(B) Coling PHFs Made From Ambien 29. j Special Reuuile .ents n009 TempeiatureingredicrostodI F/45`"' 30. 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