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'�.4:: .. ..x 'k6 >�?`d!�.'�' r'.•. GSA 'i�:. � sfa. 4-J .'{H-ram � •r @.Y a. �-:. .. _ " g - py°S ice' '".s_ ..:t+s.: .z" _ ,Y`' w f r t �r .�� � �'..�,�. .+R, � "z m.s - k `fir '�' �3yti.� ,�tC'..4_, � Y 'rL $•_.. - ; 'G;� < i�-S i ?b 5"+'� .. 'rS+SE�Ik, - 5 [ A x Y Y"f .�?^ in-. •is ... `a- k: ��i'•+ P t -'%x, f�.. :: - y - r �7WE W ` i!p '.,..'wy&sRw. t•`'' .r. _ a: • ypt�� CITY OF SALEM, MASSACHUSETTS M AF p BOARD OF HEALTH • 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRI rNBAUM aSAL.rM.COM 20110 SEP -8 A t t• 51 DnvrD GRr,►:Niinum,RS CITY {. ` .i I 'SS. ACTIN(, HEAL:n-I AGIiNT NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting on Tuesday, September 14, 2010 at 7.00 PM at City Hall Annex, 120 Washington St. Room 311, MEETING AGENDA Q /Call to order .� (Approval of Minutes from July 13, 2010 3. Chairperson Announcements 4. Pub ' Health Announcements/Reports/Updates i alth Agent L� b. Public Health Nurse o • t�Administrative ' c�Councilor Liaisoni Sunny Market-Hearing regarding sales of tobacco to minors bE 6. L e ct r w- '60s4 ,44" d Av�nue..( t� 7. St. Joseph's Redevelopment project review- 135 Lafayette Street (mixed use with pharmacy and drive-through) �.8. Miscellaneous � tg 9. Adjournment Next regularly scheduled meeting is October 12, 2010 at 7pm at City Hall Annex, 120 Washington Street Room 311 f/ � I David ree bau • Acting Health Agent Cc: Mayor Kimberley Driscoll, Board of Health, City Councilors CITY OF SALEM BOARD OF HEALTH MEETING MINUTES July 13, 2010 • DRAFT MEMBERS PRESENT: Dr. Barbara Poremba, Chairperson, Kemith LeBlanc, Martin Fair, Dr. Larissa Lucas & Gaylc Sullivan OTHERS PRESENT: David Greenbaum, Acting Health Agent &Thomas Furey, City Council Liaison MEMBERS EXCUSED: Marc Salinas TOPIC DISCUSSION/ACTION 1. Call to Order Meeting called to order by Dr. Poremba, Chair, at 7:00pm. 2. Minutes of Last Meeting Unanimously approved with corrections (June 8, 2010) 3. Chairperson Announcements None presented 4. Monthly Reports-Updates A. Administrative Report Presented and approved (Copy at the Board of Health Office) B. Public Health Nurse Presented and approved. (Copy at the Board of Health Office.) Report Lyme Disease: Dr. Lucas notified the Public Health nurse of a possible Lyme Disease case. Tracy sent a letter to all parties • involved informing them of the possible Lyme disease infection and where the infection was possibly contracted. Included in the letter was a public health fact sheet on Lyme Disease. Rabies:Recent case of woodchuck positive for rabies. This is the 3`d possible exposure in about 1 year. G. Sullivan suggested that information on transmission and danger of rabies be provided to the public. The board requested that an article be sent from the Health Department to the Salem Evening News. Presented and approved (Copy at the Board of Health Office) C. Acting Health Agent Budget:FY 2011 budget has been approved. Report Tobacco regulation: Legislation regarding the authority of Boards of Health to regulate Smoking and Hookah Bars was vetoed by the Governor. The legislature could override the veto. The BOH members discussed the poten, act of such a veto and moved that letters be sent to Sena r B�-ry nd Representative John Keenan urging that they not support such a veto. D. Greenbaum will draft the letters to State Rep. J. Keenan and send to Dr. Poremba for approval and signature as Chairperson of the BOH. Health Agent Position: The Health Agent's position has been posted in the Salem Evening News, Salem.com and other public health websites. The Board suggested that the position also be advertized in other venues such as the Boston Globe, Craig's List • and Monster.com. D. Greenbaum will contact HR with those suggestions. Transfer station update: appeal in process. D. City Council Liaison None presented. Updates r 5. New Business Frank Vetere, LSP presented an overview of the letter from A. High Rock Bridge Street LLC MA DEP regarding existing risk characterization and Atty. Joseph Correnti, and Frank Vetere, potential possible health risks at the proposed site. New data Licensed Site Professional (LSP) From GZA collected on 6/30/10 and 7/01/10 was presented that show presenting for High Rock Bridge Street LLC. significantly reduced contamination levels at approximately • 5% of the original data. DEP requested that the new AUL have increased conservatism. Indoor air quality sampling will be conducted after the construction of the building is finished. Air exchange modeling will be done at a more conservative rate of 2 exchanges per hour. A sub-slab vapor barrier and a passive venting system will be installed. Soil contamination will be isolated and contained to specific areas of the site. Questions allowed from the audience: Dr. Zabcar. 6 Phelps St. asked if there were still wells on site. F. Vetere stated yes. Dr. Zabcar asked if the Head Start Program proposed for this site is excluded because of the new risk assessment results. She presented a letter from Mayor Driscoll to the City Council regarding the new Senior Center/Community Life Center which identified possible programs that might be offered. This included a Head Start preschool program (Copy on file at Board of Health office). K. LeBlanc reviewed the,document and informed the board that it is dated back to 03/19/07. Dr. Zabcar asked if there will be maintenance of the vapor barrier. F. Vetere stated that the vapor barrier is underneath the concrete slab. It is a plastic membrane with no movable parts that requires no maintenance. Jim Treadwell 36 Felt Street asked is there an up-to- date list of proposed uses for the building. The BOH does not have such a list, however all uses would be dictated by the AUL. By definition, the AUL determines building usage. This presentation addressed all concerns regarding existing risk characterization and potential possible health risks at the proposed site raised in the MA DEP letter. It supports that all uses described in the AUL present no potential health risks to children or adults. The Board is satisfied with the presentation. No further action taken. B. Electric Sanding Variance For Erin Erin Higgins requests variance to use electric sander for her Higgins of 270 Lafayette Street front porch, mostly new construction, no lead paint. Motion by M. Fair: to grant a variance to allow power sanding on any wood surfaces that are not older than 5 years old and that proper shrouding of the area will be in place to allow no fugitive dust. 2"a. 4 in favor, 0 opposed (Chair abstains per usual custom) Motion carries. • D. Greenbaum will be informed before electric sanding commences so he can inspect the area prior to the sanding. C. Needy Meds Program Needy Meds Program is a national non-profit discount drug Presented by Dr. Richard J Sagall, President program. According to the information presented, the program offers up to a 50% savings on over-the-counter and prescription drugs by providing discount cards to anyone in need. Dr. Sagall states that it has been in place in Gloucester for 6 months and has saved an average of$26 per prescription totaling about $36,000. In addition, each time the card is used, there is 25 cents that is donated to the health programs in the city. For Gloucester, this netted approximately$330. To start a program in Salem, contact information would need to be provided and support would be needed from the mayor, city council, and board of health. Recently, the Salem Community Health Center has been given a number of cards and is offering them to patients in need. Since this is a new program in Gloucester,the Board would like further information before recommending if any action be taken. Dr. Lucas will do further investigation and report back to the board. (An informational packet is available at the board of health office). 7. "MEETING ADJOURNED: 9:00 P.M. 0spectfully submitted, Heather Lyons Clerk of the Board Next regularly scheduled meeting is September 14, 2010 at 7pm At City Hall Anne., 120 Washington Street,Room 311 Salem. f • BOARD OF HEALTH HEARING September 14, 2010 The owners of Sunny Corner requested a hearing in front of the Board of Health to discuss a fourth violation to the City of Salem Board of Health Regulation #24 Affecting the Purchasing of Tobacco Products and Posting of Laws Concerning Their Sale, Section III (A). According to this section, the sale of cigarettes, chewing tobacco, snuff, or any tobacco in any of its forms to a person under the age of eighteen (18) will be punishable by a fine of $300.00 for the fourth offense. The Salem Board of Health is a seven- member board. The members are volunteers appointed by the Mayor for a three-year term. The purpose of the Board is to promote and protect the Public Health of the citizens of Salem. The Board derives its authority from the Massachusetts Legislature. The members are 1 . Dr. Barbara Poremba, Chair • 2 Martin Fair 3 Dr. Larissa Lucas 4 Gayle Sullivan 5 Marc Salinas 6 Kemith LeBlanc David Greenbaum is the Acting Health Agent for the Salem Board of Health. The Acting Health Agent carries out the policies of the Board, assists in the enforcement of local and State regulations, and directs the daily operation of the Board of Health. On June 1 , 2010 at approximately 3:43 PM, personnel from the Tobacco Control Program conducted a compliance check at Sunny Corner to determine if it was in compliance with Salem Board of Health Regulation #24 Affecting the Purchasing of Tobacco Products and Posting of Laws Concerning Their Sale. The Board of Health authorizes such a compliance check by the Tobacco Control Program. As a result of that compliance check, on June 18, 2010, the Salem Board of Health ordered the owners of the Sunny Corner, Lorner & Thomas Truong, to pay a $300.00 fine for violating Regulation #24. On June 25, 2010 The Board of Health received a request for a hearing for the purpose of appealing the $300.00 fine. Regulation #24 was promulgated in accordance with Massachusetts General Law, Chapter 111, section 31 . This chapter authorizes fines up to $1000. Regulation #24 stipulates fines up to $300 for a fourth offense and each subsequent offense. The petitioner, Thomas Truong, will have the opportunity to show why this order should be modified or withdrawn. Counsel may represent parties involved. The names and addresses of all parties, counsel, and witnesses, must be included in the record of this hearing. Evidence may be admitted only if it is the kind of evidence on which reasonable persons are accustomed to rely in the conduct of serious affairs. • The petitioner has the burden of proof and shall proceed first. All parties will be allowed sufficient time to state their cases. Any witness may be cross-examined by either party. The Board may make a decision and enter it into today's record. If the order is sustained or modified, State law states that it must be carried out within the time period designated in the original order. However since the original order was received on June 24, 2010, an extension shall be granted allowing payment of the fine in the office of the Board of Health by Monday, September 20, 2010. Each day's failure to comply constitutes a separate offense. Failure to comply with a decision rendered by the Board will result in court action according to Massachusetts General Law Chapter 111 , sections 187 and 189. Mr. Truong, you or your counsel may begin. M L CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR DGRFFNBAUM@SAI..EM.COM DAVID GREENBAum,RS ACTING HI!AI.:I'II AGENT August 31, 2010 Re: 460, 462, 440, &488 Highland Avenue, Salem, MA Atty. Joseph Correnti 63 Federal Street Salem, MA 01970 Dear Atty. Correnti: The Salem Board of Health requests your presence at the next Board of Health meeting for a discussion of the plans for 460, 462, 440, &488 Highland Avenue. The meeting will be held • Tuesday, September 14, 2010 at City Hall Annex, 120 Washington Street 3ro floor conference room at 7:00pm. If you have any questions, contact me at 978-741-1800. Sincerely, FAthe43oa f Health .16 e baum, Acting Health Agent DG/HL cc: Dr. Barbara Poremba, Chairperson of the Board of Health and Members • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRFENBAUM@SAI,F.,M.COM DAVID GREENBAum,RS AcrING HI AL.:TII A(:.f,,NT August 31, 2010 Re: St Joseph's Redevelopment 135 Lafayette Street, Salem, MA Atty. Joseph Correnti 63 Federal Street Salem, MA 01970 Dear Atty. Correnti: The Salem Board of Health requests your presence at the next Board of Health meeting for a discussion of the plans for St Joseph's Redevelopment 135 Lafayette Street. The meeting will be held Tuesday, September 14, 2010 at City Hall Annex, 120 Washington Street 3`d floor conference room at 7:00pm. If you have any questions, contact me at 978-741-1800. Sincerely, For the Boar Health 4DavG4rnbau cting Health Agent DG/HL cc: Dr. Barbara Poremba, Chairperson of the Board of Health and Members CITY OF SALEM, MASSACHUSETTS !n BOARD OF.HEALTH 120 WASHINGTON STREET,4"`FLOOR TEL. (978) 741-1800 KIU BERLEY DRISCOL.L. FAx(978) 745-0343 MAYOR I)GRI-,rNBAUM S.ALl`AI.COM DAVID GRL I,NB_AUM August 10, 2010 A(,nm—, HI:,.AI;l[-I AGf:Nl' Sunny Market 331 Lafayette Street Salem, MA 01970 Dear Owner: On Thursday,July 29,2010 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 16 year-old Female purchased blueberry blunt wraps from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale.. Sunny Market is in violation of Section III (A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes,chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of ($300.00 Hundred Dollar fine)for the fifth offense. FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. • The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$300.60 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7)days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney.;Please also be informed that you have the right to inspect and obtain copies of all relevant inspection.or"investrgati'on reports,-orders,grad other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 978-741-1800. Sincerely you D d reenb um Acting Health Agent DG/htl CERTIFIED MAIL: 7007 1490 0002 3077 4861 cc: North Shore Tobacco Control Program Barbara Poremba, Board of Health Chairperson and Members Lo MA OL°-Jo r-gues i-- o W aW� ko I� u s� cf na aM�- ctva Aug C� bA&M sS . TI wakl akso u kct al Sty Vy\Cc • KIP 26Zo o OF SALEM .rt[7 OF.HEALTH j 1 - • CITY OF SALEM, MASSACHUSETTS • � BOARD OF HEALTH 1> 120 WASHINGTON STREET,4T"FLOOR TEL. (978)741-1800 KIMBERL EEY DRISCOLL, FAx(978)745-0343 MAYOR DGIt1 13NI3AUM&A1.1;M.COM D.AVID GRF.,.F..',NBAUM June 18, 2008 ACTING HEAUrf:I AG:FN1' Sunny Market 331 Lafayette Street Salem, MA 01970 Dear Owner: On Tuesday,June 1,2010 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a.tobacco.product_to a minor. .A 1.6.year-old..Female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Sunny Market is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes,chewing tobacco;snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of ($300.00 Hundred Dollar fine)for the fourth offense. FOLLOWING THE THIRD(3RD) OFFENSE, THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$300.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4e floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing'before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven(7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that-yotithave the right to inspect and obtain-copies-of— all relevant inspection or.investigation.reports, orders,and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 978-741-1800. Si erly yo David Greenbaum Acting Health Agent DG/htl CERTIFIED MAIL: 7007 1490 0002 3077 4380 cc: North Shore Tobacco Control Program Barbara Poremba, Board of Health Chairperson and Members • June 27, 2010 ECEI JUL 0 6 2010 CITY Or David Greenbaum City of Salem, Massachusetts �AAO�� LiH Board of Heatth 120 Washington Street, 4th Floor Dear Mr. Greenbaum: I would like to request a hearing before the Board of Health in regards of the tobacco violation. If you have any questions, please contact me at (978) 741-0079. Sincerely, Thomas Truong Owner Sunny Corner • 335 Lafayette Street Salem, MA 01970 • � o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET,4'r"FLOOR TEL. (978) 741-1800 KINMERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRr:I:NI3AUM p,SAI,FM.COM DAVID GR1:?.I::;NBAum,RS Ac,IING HE?AI.;ri I A<Jr?N'r August 31, 2010 Re: Hearing Request for Tobacco Violations Sunny Corner 335 Lafayette Street Salem, MA 01970 Dear Thomas Truong: The Salem Board of Health requests your presence at the next Board of Health meeting for a discussion of the tobacco violations at Sunny Corner 335 Lafayette Street. The meeting will be • held Tuesday, September 14, 2010 at City Hall Annex, 120 Washington Street 3`d floor conference room at 7:00pm. If you have any questions, contact me at 978-741-1800. Sincerely, For the Boar Health a avid Gr enb um, ing Health Agent DG/HL cc: Dr. Barbara Poremba, Chairperson of the Board of Health and Members, &Joyce Redford, Director, North Shore Tobacco Control • Administration Monthly Report August-10 Burial Permits @$25.00 $1,000.00 Permits $1,025.00 Certificate of Fitness@$50.00 $3,850.00 Copies $0.00 Fines= $100.00 Total Monies Collected= $5,975.00 Animal Bites Reported= 0 := Annual Budget Expended Available Balance Salary/Longevity $337,609.00 $41,896.59 $295,712.41 Annual Budget Non-Personnel $21,200.00 $155.00 $15,594.00 • • • Administration Monthly Report July-10 Burial Permits @$25.00 $975.00 Permits $2,750.00 Certificate of Fitness@$50.00 $1,700.00 Copies $0.00 Fines= $400.00 Total Monies Collected = $5,825.00 Animal Bites Reported= 0 Annual Budget Expended Available Balance Salary/Longevity $337,609.00 $16,388.11 $321,220.89 Annual Budget Non-Personnel $21,200.00 $0.00 $16,849.00 Public Health Nurse Report July/August 2010 Activities Disease Prevention • In contact with North Shore Pulmonary Clinic regarding active cases and case contacts. • Investigated communicable disease cases and reported to the MDPH. • Ppd test provided for 2 Class 61 resident referred to NSPC Meetings/Clinics • DOT provided Monday through Friday for an active TB case. Attended North Shore Pulmonary Clinic NE Regional TB meeting. Recent surge of class B1 immigrants in the area was discussed. New clinic time for pediatric patients. • Inspected YMCA Theatre Camp at the Lynch van Otter Loo YMCA. Permitted for the 2010 season. • Inspected Schooner Fame sailing camp. Camp permitted for 2010 season. • A yearly inspection was conducted at the Witch City Ink Tattoo Parlor. The establishment passed inspection. • Attended the NSCAEP meeting in Peabody. Emergency Preparedness :information was discussed. • Salem State College Sports Camps were inspected and permitted for the 2010 season. • Participated in Salem Fire Department Public Safety Day with Jade Langlely, MRC Coordinator for the NSCAEP Coalition. Materials on Public Health and Public Safety were distributed to Salem Residents. • Monthly Report of Communicable Diseases July/August 2010 isease —_ New Carry over Discharged Reported Campylobacter o 0 0 0 Hep C 1 0 1 1 Shigella 2 0 2 2 Lyme o 0 0 0 Salmonella 1 0 0 0 Pertussis 1 0 1 1 Tuberculosis 1 0 0 1 Varicella 0 0 0 0 Hepatitis C: 32 male. Refused to be interviewed. Pertinent data obtained from Physician. Shigella: 1.5 y/o male. No history of travel. Attends daycare. Excluded from daycare until no longer having diarrhea. Daycare director notified. An inspection was conducted by David Greenbaum. Director will monitor for increased absences, and will notify parents via letter and Public Health Fact Sheet. 13 y/o male. Symptom onset 8/9/10. Returned from two week trip in the Dominican Republic on 8/9/10 through Miami. Salmonella: 3.5 y/o male. Does not attend daycare. No one else in the household is ill. Patient recovered. Pertussis: 9 y/o male. Coughing for 3 weeks. 9 contacts identified and prophylaxed with Z-Pak. Tuberculosis: 75 y/o male. Daily DOT. Massachusetts O�a■ ■ ®� Tobacco Control Director: ■ Sarah McColgan ® ®®0 ■� Phone/Fax:413-596-8967 Health Officers Association an*®®� ; smccolgan@mhoa.com �aa! Public Health '14) !Q� rye'[• Ymr+voa.' e 17 C,t July 21, 2010 JUL 2 72010 Gayle Sullivan c!TY Or SALEM Salem Board of Health BOARD OF:HEALTH 120 Washington Street, 4 h floor Salem, MA 01970 Dear Gayle, You recently signed on to a letter that was delivered to legislators as they were considering the FY 'I I budget. Your support to defeat an amendment that would have undermined local boards of health's ability to regulate products that are harmful to public health did not go unrecognized. As a result of the overwhelming support the efforts of public health advocates received on this issue,the Governor vetoed this amendment. In the future, as the state continues to navigate through difficult times, local public health officials will be called on increasingly to advocate to the Governor,legislators and the gY � g public on various areas of concern to public health. We encourage you to remain active • and involved as advocates and educators. Sincerely, L Thomas G. Carbone, President Massachusetts Health Officers Association Sarah McColgan, rco Director Massachusetts Health Officers Association 23 Mountainbrook Road • Wilbraham, MA 01095 www.mhoa.com V /1 1J iV it : loa L-eianu nussey '781 -593-4944 p. 3 r ,t ,� CITY OF SALEM, MASSACHUSETTS Bo.,uw ov I-Ii:Ai:1'1-1 120 WAsi IING rc»S IZIai'P,4:;;Fj.ocnt • TI:1_(978)741-1800 I<1MBERLHY DRISCOLL 1'Ax(978)745-0343 D"n)G V :NBAUM Ac"1'NG HFAIXII Aca:N'r July 14,2010 VIA FACSIIVIILE Senator Frederick E.Berry State House Room 333 Boston,MA 02133 Dear Senator Berry, The Salem Board of Health discussed the impact of a possible override of Section 102 of the FYI state • budget at its meeting on July 14,2010. The Salem Board of Health believes that if an override of section 102 of the budget is successful it will dramatically limit the ability of local boards of health to promulgate reasonable public health regulations. Therefore the Salem Board of Health asks that you do not support an override of section 102 of the FYI 1 state budget. Sincerely, Dr. Barbara Poremba, Chair Salem Board of Health • Jul 15 10 11 : 17a Leland Hussey 781 -593-4944 p, 2 ,.s V CITY OF SALEM) MASSACHUSETTS 120 W 1SI IING I ON$'11i1':I:'r.4 ftooiz (978)741-1800 KINTBER.LEY DRISCOLL FAx(978)745-0343 MAYOR rx:Rlil;nit:�t:,�l�s,u.l:al.c:cl�t D.xvI a GRI a:NnAUN-1 Ac'nNc,HVAl:rl l AC;I{N'I' July 1-4, 2010 VIA FACSIMILE State Representative John D.Keenan State House Room 195 Boston,MA 02133 Dear Representative Keenan, The Salem Board of Health discussed the impact of a possible override of Section 102 of the FYl1 state budget at its meeting on July 14,2010. The Salem Board of Health believes that if an override of section 102 of the budget is successful it will dramatically limit the ability of local boards of health to promulgate reasonable public health regulations. Therefore the Salem Board of Health asks that you do not support an override of section 102 of the FY11 state budget. Sincerely, "-A-4-- Dr.Barbara Poremba,Chair Salem Board of Health Acting Health Agent Report • July/August 2010 Meetings/Trainings 1. Attended the monthly meetings of the NS/CA Emergency Preparedness Coalition for July and August. Key items discussed include: • Updates on upcoming deliverables and how to meet the deliverables A presentation was given on the best practices for the H1N1 pandemic was handled • Local State Advisory Committee updates The use of Social Networking sites to advertise the MRC and recruit volunteers 2. Attended the Ota Japan luncheon held at Winter Island 3. Met with representatives of the Beverly Health Department, representatives of the City of Salem and representatives of Clean Harbors to discuss the upcoming Household Hazardous Waste Collection Day. Discussion involved: • What items would be collected an who is responsible for collection 4. Attended a workshop about Grants from the Department Health and • Human Services sponsored by Congressman John Tierney. Key items discussed include: • An overview of HHS by Christie Hager, Regional Director of HHS A presentation about the Office of Public Health and Science of HHS by RADM Michael Milner and what grants his office oversees. A presentation on how to use the Grants.gov website 5. Attended the Mayors monthly department head meeting where the Mayor updated department heads on major projects in the City, i.e. Lowes/Wal-Mart and the St. Josephs project. 6. Attended the Haunted Happenings Kick off meeting. Items discussed include: • Preparations for the Carnival • Transient vendors, temporary business • Traffic/road closures • October 31st— Expectations and Coordination 7. Attended a one stop meeting of all departments to discuss the possible development of the site located at 207 Highland Ave, formerly Hillcrest Chevrolet. • Upcoming Public Health Activities/Plans 1. The following flu clinics are scheduled: • • October 13, 2010 from 9am to 12 pm at the Salem Council on Aging • October 14, 2010 from 5 pm to 7 pm at the Salem Shelter 2. Household Hazardous Waste Day is scheduled for October 2, 2010 from 8AM to 12PM at Salem High School. Significant Communication or Complaints from Residents 1. A request for a variance to the food code was received from the proposed new owner of a new food establishment, East Sakura. This establishment has requested a variance for the acidification of rice for sushi. The rice for sushi would be held at room temperature and the acidity of the rice would be lowered to a ph of 4.0 or below. Lowering the acidity of the rice makes the rice non-potentially hazardous. A Hazard Analysis Critical Control Point (HACCP) plan has been submitted. The proper acidification of the rice is imperative because at the lower ph it inhibits the growth of bacteria. If the rice is not held properly and the ph is not properly monitored the risk to food borne illness is increased. This establishment will be before the Board on October 12, 2010 to discuss this variance and all information will be provided to the Board for the October Meeting. 2. A request for a hearing regarding a trash order to the owner of 19 Linden • Street was received in the Board of Health office. The hearing will be scheduled for the meeting on October 12, 2010. All information regarding this matter will be distributed to the Board prior to the October meeting. Inquiries or Reports from the Media 1. On July 12, 2010 Tom Dalton of the Salem Evening News inquired about the letter form Pat Donahue of the MA DEP regarding the Gateway Project. Mr. Dalton reviewed the letter in the Board of Health office. • • Flu Clinics Sponsored by Marblehead, Swampscott & Salem Boards of Health Come see us at the Lynch/van Otterloo YMCA, 40 Leggs Hill Road, Marblehead. Friday, October 1, 2010, 10am-2pm OPEN HOUSE FOR 55 AND OLDER And Sunday October 24, 201010-am 3pm HEALTI-i AND WELLNESS FAIR FLU SHOTS WILL BE ADMINISTERED TO AGES 18 AND OLDER ..................................................................................., PLEASE BRING YOUR INSURANCE CARD WITH YOU TO THE CLINICy \�® ...................................................................................... a Er F s^' any ; � Sa:p-m Q^ard ^{ HPaith 120 Washington Street Phone: 978-741-1800 4tn Floor Fax: 978-745-0343 � Salem, MA 01970 Email: dareenbaum(ap-salem.com 4 is 7*�. r www.salem.com for more information y�3 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • w� 120 WASHINGTON STREET, 4TH FLOOR u SALEM, MA 01970 TEL. 978-741-1800 DEC „I FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM MAYOR HEALTH AGENT HEA171-1 DEPT. 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD EST BLISHMENT NAME OF ESTABLISHMENT ��/'� � � TEL# 7 7 ��>o ADDRESS OF ESTABLISHMENToff - IAM MAILING ADDRESS (if different) OWNER'S NAMEAI i-�I /✓ TEL S�Z_cfCK3 ADDRESS 7 % '� ZIP ft?o CITY ,Nhi _T, STATE CERTIFIED FOOD MAN ER'S NAMES) _ CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) • EMERGENCY RESPONSE PERSON %f COW-re- HOME TE /)Haiti G1/U DAYS/HOURS OF OPERATION: Mon. Tue. ed. hu.,j/Fri. �a (/Sun. C/ Po' FE heck only TYPE OF ESTABLISHMENT 40 RETAIL STORE E NO 1� rQoZ $40 RESTAURANT YES N $40 BED & BREAKFAST YES NO ADDITIONAL PERMITS MAKE ICE CREAM,YOGURT $5 SOFT SERVE YES NO TOBACCO VENDOR NO �T �D�- �_' NO CHARGE FOR NON-PROFI (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPT FORM Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must • be posted in a prominent location in the Establishm ent. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my • best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. 10 Sig ature D to Social Security«or Federal Identification number Revised 11/1/01 foodap2.adm W~ Check#&Date- — So ' 9 f 1` jj� a CITY OF SALEM, MASSACHUSETTS a BOARD OF HEALTH 120 WASHINGTON STREET. 4TH FLOOR 2-3^ JAN 07 c.��:3 a. SALEM. MA 01970 -74 1- 1 800 TEL. 978 , FAX 978-745-0343 - o--�- ,LTH BOAR SOVIC7_. JR. JOANNE `. COTT, MPH, R5. CHO AYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT TEL NAMEOF ESTABLISHMENT .. ADDRESS OF ESTABLISHMENT � L�J ' � MAILING ADDRESS (if different) r_ OWNE R'S NAME TEL#�� 9 Q'I! 3 ADDRESS 0 STATE CITY �✓ I ATE# t/� CERTIFIED FOOD M AGER'S NAME(S) ��� CERTIF C (s) (required in an establishment where potentially hazardous food is prepared.) e `7 Qui p�lllr HOME TEL# EMERGENCY RESPONSE PERSON�/L�l:�l �I - �1+L► A� h&-FM A� M¢t !''rlf �1 F�'1 HOURS OF OPE RATION: Mon. Tue. &ed.�Z 10 Thu.'7 10 Fn.�•% atr7 l0 Sun. !v TYPE OF ESTABLISHM FEE check only RETAIL STORE YES NO less than 1000sq.ft. _$ • -0 3 1000-10,000sq.ft. 4101 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS $5 MAKE ICE CREAM, YOGURT, SOFT SERVE Y NO oZ"Q 50 TOBACCO VENDOR $ 5 ALL NON-PROFIT(such as church kitchens) §S NO Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The.Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best k . wledge and• belief, have filed all statE tax eturns and paid all state taxes required under the law.� P ZPJ rJ"L .- ,45'14 ignature Date Social Security or Federal Identification Number ------------------------------------- ----------------------------------------------------------------------------------- Revised 11/25/02 FOODAP2.adm Check#&Date f� �d?-ad .G �O � x x�< `-:.1 w �����-*. '�'•{•`'fin- �- CITY OF SALF- MASSACHUS.Pl S BOARD OFy HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-74 1-1 800 FAX 978-745-0343 ANLEY USOVIC.Z, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT ;i 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME'OF ESTABLISHMENT S'U'NN /1�ARk�T 1 N<< TEL# 7$ ^ 7<//` 770 C ADDRESS OF ESTABLISHMENT 33 �A F�Y TT f-= 57 , MAILING ADDRESS (if different) OWNER'S NAME -T NOMAD TR�aN� A-NQ�)1V&A /v Yrj�-- TEL# 781- 7a/ 7649 I ADDRESS 3 6-t RAVES CITY i l�N STATE )L4 iF _ ZIP O/q0d- CERTIFIED FOOD MANAGER'S NAMES) 1w1CjMEi- CERTIFICATE#(s) (required in an establishment where potentially hazardous food 1s,prepared) s k i S4 � 'r 4 3 EMERGENCY RESPONSE PERSON N11C*15 - HOME TEL# s _ SDAYS/HOURS OF OPERATION: Mon. ✓ Tue. ✓ Wed. vThuk Fri. 1r Sat. Sun. TYPE OF ESTABLISHMENT /�6 FFcheck only RETAIL STORE E NP, /j`-1' 4 RESTAURANT YES c $40 BED& BREAKFAST YES $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE (NO S TOBACCO VENDOR YE NO �3'6 10 NO CHARGE FOR NON-PRO (such as church kitchens) PLEASE INCLUDE COP F TAX EXEMPT FORM Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements, or equipment changes are made,all plans for such must.be submitted to and approved by the Salem Board of Health. Pursuant to M Chap 2C, Section 49A, I certify.under the pains and penalties of:perjury that 1,to my best know and li , have filed all state tax returns and paid all state taxes required under the law. • 65- 17 dam- O 35 -7 67 Sigga Date Social Security or Federal Identification number i ------------- ---- ---------- Rev' ed 11/1101 oodap2.adm Check#&Date ���6c CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH u / 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 O TEL. 978-741-1800 NOV 1 9 2GGR FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, IRS, CHO MAYOR HEALTH AGENT CI T Y OF SALEM 2005 APPLICATION FOR PERMIT TO,OPERATE A FOOD ESTA& Rf HEALTH NAME OF ESTABLISHMENT Q AIN _ TEL ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME LP Lc.Qit/ - ADDRESS CITY _ it/ STAT E AIA ZIP L7 11 bZ CERTIFIED FOOD MA AGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON I6}1s_- HOME TE(G2$ HOURS OF OPERATION: Mon.7___/_QTue. '—/( Wed.7— Jhu.-7—/0Fri.`7--/0Sat.7_/USun. 7 —/v i TYPE OF ESTABLISHM FEE check only RETAIL STORE ES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. 100 j V more than 10,000sq.ft. =$250 Y$ i RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats -$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR E NO ALL NON-PROFIT(such as church kitchens) ,q_�}r ES iJ0 $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best_ �^ knowledge an belief, have filed all st to to returns and paid state taxes re uired u er the law. • 0 �^ � Signature ate Social Security r Federal Identification Number ----------------------------------------------------------------i---------------- --7�--- j ---------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date(, �( � � /6 CITY OF SALEM, MASSACHUSE11zt BOARD OF HEALTH ' 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 NOV 12 2003 TEL. 978-74 1-1 800 � FAX 978-745-0343 EY USOVICZ, JR. CITY OF SALEM JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT BOARD OF HEALTH f' 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) pa OWNER'S NAME , /f/J�- %/2 (�I)A ICf- TEL #C7 D q� �47 S=7"/ ADDRESS VZ;S .042rr WE CITY f /I//t/ STATE ' ZIP O CERTIFIED FOOD.MANAGER'S NAME(S)_,= ... _ CERTIFI ATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON � L.- HOME TELL Wf HOURS OF OPERATION: Mon.7-IO Tue.7-/O Wed.7_iOThu.'7-/O Fri. _iv Sat.7 !o Sun.7-10 #4Af-'PA? TYPE OF ESTABLISHM FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 j-�� 1000-10,000sq.ft. - 100 • more than 10,000sq.ft. = 50 RESTAURANT YES NO less than 25 seats =$100 25-99 seats = 150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE Y� NO $5 TOBACCO VENDOR NO 50 ALL "�u^",!- OFdT ,such as church.kitchens) S NO Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best k owledge and belief, have filed all statq tax returns and paid all state taxes required under the law. S // 2oa3 ?:7S- 90_ >s,T-el-2 'Signature Yate I Social Security or Federal Identification Number • ------- ---------------------------------------------------------------=------------ ---- ------------------------- ---------- Revised 11/03/03-------- FOODAP2.adm Check#&Date9 //— / CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 .fat TEL. 978-741-1800 FAX 978-745-0343 — STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR "HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL# ADDRESS OF ESTABLISHMENT � G��Sl, VI{��, MAILING ADDRESS (if different) OWNER'S NAME flcle-u c3�.�- TEL# _M J S'cjT tgn3 ADDRESS 3 55 gU�c►1✓SZ- CITY ^ t,E-Yy1 STATE yy-)P, ZIP p�Q::J® CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# 3, j 3(og HOURS OF OPERATION: Mon._ Tue. Wed. y. Thu. Fri. _Sat. _Sun. _ Qo'30 Ann— 101 cxo PM • TYPE OF ESTABLISHME T FEE check only RETAIL STORE YE NO less than 1000sq.ft. _ 1000-10,000sq.ft. =$100 /V ( '9 more than 10,000sq.ft. =$250 RESTAURANT YES less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS I MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 i TOBACCO VENDOR 1W NO ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. I • Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my E best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. { KD ck I I �52!t7 96 csi-{Z Signature Date Social Security or Federal Identification Number --------------------------- ------- - Revised 11/03/03 FOODAP2.adm Check#&Date h0 I i i CITY OF SALEM, MASSACHUSETTS o J V i c BOARD OF HEALTH D 120 WASHINGTON STREET, 4TH FLOOR 40 SALEM, MA 01970 DEC 0 g 2005 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 CITY OF SALEM MAYOR www.SALEM.COM BOARD OF HEALTH JOANNE SCOTt, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABL ISHMENT NAME OF ESTABLISHMENT9U/,)A/ 60R /FR # 7 77!/ 6-0 ADDRESS OF ESTABLISHMENT Qj S G- <;T' C-toi '=� a /l& D im0 MAILING ADDRESS (if different) OWNER'S NAME TEL I 5—fr Z ADDRESS �/ CJ L. -77f7 CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) A-fte� CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 1, CA4-o-CG 7 Z e-0t,4r HOME TEL �F HOURS OF OPERATION: Mon _ ue. _. yVed ,..... F,ie2yDO�,y 6 s 30 Ann — 10100 PN4 • TYPE OF ESTABLISH FEE (check only) U-2-t TZ)R°El .YE NO / less than 1000sq.ft. _''� 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ------ •. . . •--- -------------- ----- --- RESTAURANT YES less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ..N.AL...--•-PE••--•- -IT---S---------------------------------- ----------------------------- ............................................................. ADD ITIO RM-- MAKE (not u� t serve! ICE CREAM, YOGURT„SOFj�ERVE YES � $5 W. /.END' 1l0�� O� M NO ALL NON-PROFIT(such as church ki�ens) YES (!!�) 5 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a.prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief?have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ----------------------------------------------------------------------�--------- - )------------------------------------------------ Revised 11/03/05 FOODAP2.adm Check#&Date `�'�7 ��✓ `dS CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH RECEIVED • * 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 I� �— 3 2007 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM www.SAI:EM.COM BOARD OF HEALTH Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1^03 RAI,6 F A2 TEL 0 -7ZJ II 7 IIT� ADDRESS OF ESTABLISHMENT Ste' �>D MAILING ADDRESS(if different) EMAIL--Business': , Owner's: OWNER'S NAME ���� �tIA.f� TEL# ADDRESS�C ���4 V " /%" 9;7 a L �� O STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) / 1.= CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) i EMERGENCY RESPONSE PERSON 7RJ1W&4&_ HOME TEL 7F WFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday NO-ORS OF OPERATION A44� �11'1 /r�ti►•f p/sJ Pam / �/YJ �q���jyl �iK/RN [Fore amplePlease write ln time of llam ttumlY (D ^�lC�—/ d b (�— /(� t� (� ei(1 1C� tip 1 f!� TYPE OF ESTABLIS NT FEE check onl RETAIL STORE YES NO less than 1000sq.ft. =V501000-10,000sq.ft. = more than 10,000sq.ft. =$250 i ------------- -------------------------------------------- ------------------------------------------ i RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 - ---- ----- -- --- BED/BREAKFAST YES NO $100 -------------------------------------------------------------------------------------------------------------------------------------------- -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 { TOBACCO VENDOR M NO �5 ALL NON-PROFIT(such as church kitchens) 7T S 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. i �uant 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 retur s and paid all state taxes required under the law. A AA-A 5JS--yj-J_tj7T.(0 - I Signature ate Social Security or Federal Identification Number ----------------------------------- ----------------- ----------------------- Revised - ------ - - -- - - - -- - - -- -- - - - ---- i 11/13/06 FOODAP2007.adm Check#&Date /5_2(`j / /o $ /L20 O0 c f/vj- !l• J .co a.� ., CITY OF SALEM, MASSACHUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 RECEIVED MAYOR 1scoTrasALEM•COM JoANNE SCoTr, DEC 12 2007 HEALTH AGENT . CITY" OF SALEIVI BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT SU WN 09-NEP- TEL# (ct") q4.1 DU" ADDRESS OF ESTABLISHMENT 335 LAFAyEj-�E T op C7AkfMIAA Uiaqo MAILING ADDRESS(if different) EMAIL-Business': i_ Website: OWN 1_ ER'S NAME ,66 -NA -T. ��U�(JN v, TEL# (11%) q�l _6641� ADDRESS �?7� X-AF yV+Z 5�- �. iM 1A A- U A40 STREET CITY STATE ZIP C TIFIED FOOD MANAGER'S NAME te`''S) e7 A CERTIFICATE#(S) (FWed in an establishment where potentially hazardous food is prepared)EMERGENCY RESPONSE PERSON �L N A�i� `I Y�UI�N�1 HOME TEL# (�KI q4) � DAYS OF OPERATION Monday Tuesday ! Wednesday Thursday Friday ? Saturday Sunda HOURS OF OPERATION `(vAN--W?M �IkM iD PM (CAM -.10 PM IOAM• i��Pi� 0P1`� Please write in time of day. � � For example 11 am-11 pin) i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE ES NO less than 1000sq.ft. 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 Nb ----- - - ---- ---- --- RESTAURANT YES less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 --------- ----------------- -- BED/BREAKFAST/ YES 10 $100 CHILDCARE SERVICES_______ � --------------------------- ---------------------------------•------------------------•-------...... ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE a NOTOBACCO VENDOR O P25 ALL NON-PROFIT(such as church kitchens) YES NO *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be,posted in a prominent location in the Establishment. ' In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes-are made,all plans for sust be submitted to and approved by the Salem Board of Health. Want to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax retu ns and paid I state taxes required under the law. [) h 6 ignature Date Social Security or Federal Identification Number ------------- -----------------------------` -----16 ------$-----------— Revised 4/24/07 FOODAP2008.adm Check##&Date CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET,4"FLOOR ` TEL. (978)741-1800 RECEIVED % KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR "—�)DIONNE�SALrM.COM JAN 2009 JANET DIONNE, C', , —, ACTING HEALTH AGENT BOARD OF HEALTH 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABL.ISHMEN Z TELd 2 --CU�Pq ADDRESS OF ESTABLISHMENT MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME E.L ,7 i 1 ADDRES `— STREET CITY SATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) KGENCY ed in an establishment where potentially hazardous food is prepared) RESPONSE PERSON HOME TEL# —5p9-r2— DAYS©F OPERATION MondaY. <. Tuesda Wedrisda _: '.T..hursda f,:iida ', Saturda HOURS OF OPERATION pIq Am P� 0�m Am A94 �M �� �� � PM Please write in time of day. � ,�„ (For example11am-11pm ��`f d _ �-- .— Z �° LtJ�- C7 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE E NO less than 1000sq.ft. _ 1 �-- 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 + ------------------------------------------------------------------------------------------------------------------------------------------------------------------ RESTAr'RANT YES NO � c._.. � � v � ... �+ �@SS a�ar�2J 58catS _$i 4v i (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 -------------------- ----------------------------------------------------------------------------------------------_100----- BED/BREAKFAST/ YES NO $ 00 CHILDCARE SERVICES ---- ---------------LDy--- -----------------------------------------------------------------------------------..------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE Y NO $ TOBACCO VENDOR t� NO 13 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. i In accordance with the Statb Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. JIWant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax r1W an paid all state taxe "required under the w. as t/D Signature bate gocial Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm N Check#&Date�? >r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120.WASHINGTON STREET,4h`FLOOR TEL. (978) 741-1800 �/KIMBERLEY DRISCOLL FAX 978 745-0343 ( ) , MAYOR DGREENBAUM(a7SALEM.COM DEC DAVID GREENBAUM, Cl;. , ACTING HEALTH AGENT 13 A fir,H i 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT /U TEL ADDRESS OF ESTABLISHMENTS � 1�� MAILING ADDRESS(if different) EMAIL-Business': Website: Q /� OWNER'S NAME �—o�Iv �c � I�IC T 6-0r, / ADDRESS O T- STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) CERTIFICATE#(S) (Required in an establishment where potentially hazard'ouns food is prepared) GENCY RESPONSE PERSON ty� 2� A-O 1LQ l� HOME TEL q"?l �WG r- S;2 -- HOURS OF OPERATION Ak-m ,. P(Ili .1�-yl t l Pn /�W� pl AM ` i �?t K A-m � P IV&$-1V1 ��YJ Please write in time of day. For example 11am-11 4 _ Lv i&-its I t7 6Q9 (L QO — 1(� T�— 0 4, :0 1.f) �..t O TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE NO less than 1000sq.ft. _ 70 1000-10,000sq.ft. more than I0,000sq.ft. =$420 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - ------------- ---------•--- --------------------------------------------- BED/BREAKFAST/ - -- YES NO - $100 CHILDCARE SERVICES/NURSING HOME------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE yam, NO $? TOBACCO VENDOR YE ] NO 1 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. P uant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of pedury that I,to my best knowledge and belief,have filed all state tax reand paid I state taxes required under!,hpl o-5 o il s 5: --�? 1 7 9"-?,g Signa Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check# VIV $