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MEETING PACKET OCTOBER 2015 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR Prevent.PubyPcHean otc.Protect. TEL. (978) 141-1800 Fax(978)145-0343 KiMBERLEY DRISCOLL lramdin@salem.com LAItItY RAMDrN,RS/REHS,CI-IO,CI'-PS MAYOR HEALTH AGENT NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting Tuesday October 13, 2015 at 7.00 PM City Hall Annex 120 Washington Street 3.d Floor Room 314 o MEETING AGENDA 1. Call to order rn � 2. Approval of Minutes E, ,'`n 3. Chairperson Communications D C 4. Public Health Announcements/Reports/Updates to En a. PHN Report G b. Health Agent c. Administrative d. Council Liaison Updates 5. Subdivision approvals: (1) Clark Street lots 6, 7, 8 &9 (2) Alameda Street lots 116 & 117 6. Joyce Redford Director of North Shore/Cape Ann Alcohol and Tobacco Policy Program- Discussion on program policy and procedures. 7. Salem Grill Z Chicken—Request to reinstate tobacco permit 8. New Business/Scheduling of future agenda items Larry Ramdin Health Agent cc: Mayor Kimberley Driscoll, Board of Health, City Councilors Next regularly scheduled meeting is November 10, 2015 at 7pm at City Hall Annex, 120 Washington Street 3'"Floor Room 314. Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City Ordinance section 2-2028 through 2-2033 This notice posted on "Official Bulletin, Board" City Hall, Salem, Mass. on l,✓ at c� 3.t'HA1 in accordance with MGL Chap. 30A, Sections 18-25. CITY OF SALEM BOARD OF HEALTH MEETING MINUTES September 8, 2015 DRAFT MEMBERS PRESENT: Dr. Shama Alam, Chair, Mark Danderson, Janet Greene, Paul Kirby, & Dr. Danielle Ledoux OTHERS PRESENT: Suzanne Doty, Public Health Nurse, Council Liaison Councilor Beth Gerard, Heather Lyons-Paul Clerk of the Board, Larry Ramdin, Heath Agent, Mr. Robert Carp &Mr. Samir Patel TOPIC DISCUSSION/ACTION 1. Call to Order 7:20pm 2. Minutes of Last Meeting P. Kirby motioned to accept the minutes with corrections. (July 14, 2015) M. Danderson 2"d All in Favor. Motion Passed 3. Chairperson Announcements Paul Kirby and Dr. Alam met with the Mayor to discuss keeping cnrnxriupication open for topics that may be relevant to the Board. P Kirby motioned to take the agenda item 5 out of order. D Ledon 2"d all in-' Monthly Reports-Updates A. Public Health Nurse's ...Copy available at the BOH office Report B. Health Agent's Report *Transfer Station at this time has is no impact on this department besides setting up a rodent control plan. *Proposed Hotel on Essex Street Mall is currently in preliminary discussions. Copy available at the BOH office C. Administrative Report Copy available at the BOH office J. Greene motioned to accept the reports. D. Ledoux 2"d All D. City Council Liaison in favor Updates *Dr. Jeremy Schiller has been nominated to the Board. His appointment will be considered at the next City Council meeting. *No further activity by the legislature on the bill that will reduce the Board from 7 to 5. The bill was positively reported out by the Joint Public Health Committee and is in the Joint Health Care Finance Committee. No hearing date has been scheduled *Councilor Gerard attended an inspection by the DEP. K& C i Auto Body was inspected because of numerous odor complaints from a neighbor on Franklin St Ct. DEP inspector asked the business to use their equipment during the inspection. No odors were noticed during the inspection. Minor violations not relate.* to odors were observed. 5. Tobacco Hearings A. Bunghole Liquors Bunghole Liquors 204 Derby Street Appeal of the 7 day Mr. Robert Carp owner of Bunghole Liquors has requested the suspension Board reconsider the 7 day suspension. He has paid the$200 violation at the meeting and is not disputing that the sale was made. He informed the Board that he is an attorney and a former law professor. Mr. Carp has questions about all the facts that lead to the violation and is asking for more transparency of the process. He has requested more information about the minor who purchased the cigarettes from his store. That request should be sent to Joyce Redford, Director of The North Shore/Cape Ann Alcohol and Tobacco Policy Program. D. Ledoux motioned that we rule on this today and we uphold the 7 day suspension and $200 violation for Bunghole Liquors tobacco permit on September 20, 2015 to September 26, 2015. 2°d M. Danderson All in Favor Mr. Carp asked for transcription of the recording, a copy of recording, list of attendees, and a copy of the minutes. He will be filing an appeal in superior court and will provide a notice of deposition. Copies will be supplied within a 10 day period in accordance with the Freedom of Information Act and Open Meeting Law. Deposition and scheduling will be handled with the City Solicitors office. Mr. Carp then asked for more time between now and the suspension so he can have time to prepare for the appeal. P. Kirby suggested we amend the motion to a later date. J. Greene motioned to amend to move the suspension dates another week out from September 27, 2015 to October 3, 2015. P. Kirby 2"d Discussion All in favor B. Nicole s Mini Market Nicole s Mini Market Essex Street Appeal of 1st violation Mr. Samir Patel owner ofNicole's Mini Market asked the Board to reconsider this 1st violation. His business has had no previous violations. Owner has purchased a system that will not allow the cashier to enter a tobacco product without s p o canning an ID for proof of age. All employees were trained on this. M. Danderson motioned to deny the request based on the regulations governing the violations of the sale of tobacco to minors. P. Kirby 2nd All in favor 1p Dr. Alam expressed questions and concern on the FDA pilot Auto Body was inspected because of numerous odor complaints from a neighbor on Franklin St Ct. DEP inspector asked the business to use their equipment during the inspection. No odors ! were noticed during the inspection. Minor violations not relate to odors were observed. 5. Tobacco Hearings A. Bunghole Liquors Bunghole Liquors 204 Derby Street Appeal of the 7 day Mr. Robert Carp owner of Bunghole Liquors has requested the suspension Board reconsider the 7 day suspension. He has paid the$200 violation at the meeting and is not disputing that the sale was made. He informed the Board that he is an attorney and a former law professor. Mr. Carp has questions about all the facts that lead to the violation and is asking for more transparency of the process. He has requested more information about the minor who purchased the cigarettes from his store. That request should be sent to Joyce Redford, Director of The North Shore/Cape Ann Alcohol and Tobacco Policy Program. D. Ledoux motioned that we rule on this today and we uphold the 7 day suspension and $200 violation for Bunghole Liquors tobacco permit on September 20, 2015 to September 26, 2015. 211d M. Danderson All in Favor Mr. Carp asked for transcription of the recording, a copy of recording, list of attendees, and a copy of the minutes. He will be filing an appeal in superior court and will provide a notice of deposition. Copies will be supplied within a 10 day period in accordance with the Freedom of Information Act and Open Meeting Law, Deposition and scheduling will be handled with the City Solicitors office. Mr. Carp then asked for more time between now and the suspension so he can have time to prepare for the appeal. P. Kirby suggested we amend the motion to a later date. I Greene motioned to amend to move the suspension dates another week out from September 27, 2015 to October 3, 2015. P. Kirby 2nd Discussion All in favor B. Nicole's Mini Market Nicole's Mini Market Essex Street Appeal of 1"violation Mr. Samir Patel owner of Nicole's Mini Market asked the Board to reconsider this 1"violation. His business has had no previous violations. Owner has purchased a system that will not allow the cashier to enter a tobacco product without scanning an ID for proof of age. All employees were trained on this. M. Danderson motioned to deny the request based on the regulations governing the violations of the sale of tobacco to minors. P. Kirby 2"d All in favor Dr. Alam expressed questions and concern on the FDA pilot program for tobacco inspections and impact on local violations. The Board would like to discuss this program with Joyce Redford to further understand the impact to local violations at the October meeting and to also understand the compliance program further. The Board discussed whether to empower the Health Agent to set the suspension dates for the 2❑d and 3rd tobacco violations that have not filed an appeal. J. Greene indicated that she would like to continue hearing from the business owners about the impact the suspensions will have on their business. The Board was in agreement that this discussion will be delayed to a future meeting when they are more prepared to make an informed decision. Training for businesses by the North Shore/Cape Ann Alcohol and Tobacco program has been scheduled for September 23, 2015 and businesses have been notified by mail. The Board requested to be notified of the training date. 6. Opiate Discussion Overdoses have increased over the past few months. The issue is predominant among the white non-Hispanic community. L. Ramdin will be ordering 2 copies of the "Anonymous People"DVD. Screenings will be set up for the schools and for the community. J. Green suggested we contact the YMCA Ames Hall to check on availability for the community viewings. Dr. Alam requested that the Board be notified of the screening dates once available. 7.Healthcare Round Table M. Danderson attended the meeting and summarized for the Update Board. The urgent care department will be closing at Union Hospital and expanded at Spaulding building as part of the NSMC. A mental health care and addiction center will be added. M. Danderson asked at the roundtable meeting about their emergency preparedness planning. There are impacts to their current plan and changes are being made. 8. Shared Kitchen M. Danderson motioned to table this topic until the November meeting. P. Kirby 2nd All in favor 9. Protocol for Evaluating Health P. Kirby motioned to table this topic until the November Agent meeting J. Greene 2°d All in favor 40 New Business/Scheduling of future *Invite Joyce Redford to talk about NSCAATPP agenda items *The request for Salem Grill Z Chicken's revocation of their tobacco permit will be scheduled for the October meeting. * The shared kitchen topic will be scheduled for the November meeting *The process for evaluating Health Agent will be 1 scheduled for the November meeting 11. MEETING ADJOURNED: P. Kirby motioned to adjourn the meeting. M. Danderson � g 2 nd All in favor 10:00pm Respectfully submitted, Heather Lyons-Paul Clerk of the Board Next regularly scheduled meeting is October 13, 2015 at 7pm At City Hall Annex, 120 Washington Street,Room 313 Salem. � I i October meeting. * The shared kitchen topic will be scheduled for the • November meeting *The process for evaluating Health Agent will be scheduled for the November meeting 11. MEETING ADJOURNED: P. Kirby motioned to adjourn the meeting. M. Danderson 2nd All in favor 10:00pm Respectfully submitted, Heather Lyons-Paul Clerk of the Board Next regularly scheduled meeting is October 13, 2015 at 7pm At City Hall Annex, 120 Washington Street,Room $13 Salem. N � • Health Agent report October 2015 Announcements- • Erica Rimpila, BSN, RN, has been selected as Salem's new Public Health Nurse her start date is December P. • Jeffrey Barosy, MPH, Sanitarian has completed his 6 month probationary period and is now a permanent employee Community Outreach • Letters of Support were provided to Salem Police Department who are applying for a naloxone support grant and to Northshore Community Health to support their opiate treatment program. • Letter of Support was provided to Northshore Community Health to support their HRSA grant application Public Health Highlights • We were contacted about licensing of food trucks. We will license Food trucks as long as they meet the requirements of the Food Establishment Regulations 105 CMR590.00, currently we do not have a fee structure for food trucks and current city zoning regulations do not allow for food trucks. • 85 food inspections were conducted at temporary food establishments for Haunted Happenings. Meetings and Trainings • Larry Ramdin, Andrea al-Turkmani, Representative of Girls Inc of Lynn met with Margarita Ruiz, School Superintendent and Paula Dobrow, School Nurse Leader to discuss general public health collaboration , Opiate overdose awareness and Underage drinking prevention grants. • Larry Ramdin and David Greenbaum met with Notch brewing, the new Hotel that is going in at the Joshua Ward House to discuss the food permitting processes and requirements for licensure. Inspections Item Monthly Total YTD 2014 Total • Certificate of Fitness 35 467 559 Inspection Certificate of Fitness 0 4 17 reinspection Food Inspection 104 261 384 Food Re-inspections 3 52 124 Retail Food 5 14 23 Inspections Retail Food 0 1 7 reinspection General Nuisance 1 21 14 Inspections Food— 0 0 1 Administrative Hearings Housing Inspections 11 156 183 Housing re- 3 28 39 inspections Rodent Complaints 3 19 23 Court 0 6 10 Hearings/filings Trash Inspections 18 104 218 q Orders served by 0 0 2 Constable r J S Item Monthly Total YTD 2014 Total Certificate of Fitness 35 467 559 Inspection Certificate of Fitness 0 4 17 reinspection Food Inspection 104 261 384 Food Re-inspections. 3 52 124 Retail Food 5 14 23 Inspections Retail Food 0 1 7 reinspection General Nuisance 1 21 14 Inspections Food— 0 0 1 Administrative Hearings Housing Inspections 11 156 183 Housing re- 3 28 39 inspections Rodent Complaints 3 19 23 Court 0 6 10 Hearings/filings Trash Inspections 18 104 218 4 Orders served by 0 0 2 i � Constable Tanning Inspections 2 3 1 Body Art 0 0 1 Swimming pools 0 17 23 Bathing Beach 7 106 100 Inspection/testing Recreational Camps 0 12 14 Lead Determination 0 0 1 Septic Abandonment 0 0 1 Septic System Plan 0 0 1 Review Soil Evaluation 0 0 1 Percolation tests 0 0 2 Total 182 1500 1739 Suzanne Doty RN, BSN Salem Board of Health Public Health Nurse Public Health Nurse Report Reporting on September 41h to October 8th, 2015 Disease Prevention • Investigated reportable diseases and reported case information to MDPH. • In contact with North Shore Pulmonary Clinic and MGH pulmonary clinic on current active tuberculosis cases. • In contact with NSMC Infection Control department for prevention of disease within the hospital. • Received Tuberculin/PPD from the Department of Public Health at Tewksbury State Hospital for a contact investigation, and was able to provide the Lydia Pinkham Memorial Clinic with 20 doses in order to provide free testing for children prior to beginning school (which meets the requirements of DPH provided testing). Health Promotion • Updated the Salem Board of Health Facebook and Twitter pages with information on M • Household Hazardous Waste day. • Began holding Wellness Clinics weekly at the Council on Aging to provide blood pressure checks, glucose checks and teaching with personal glucometers, diet and exercise education and helpful pamphlets on the flu and hypertension. • Attended the Salem High School open house with Claire Wilson, coordinator for the MAOPC Salem working group, where we provided materials and spoke with parents regarding opiate abuse and prevention, overdose training and local resources. We gave out several Strengthening Families DVDs as well as pamphlets and a poster presentation. • Hosted two Influenza vaccine clinics, one at the Salem Council on Aging on September 291h and another at Salem City Hall Annex for the city employees, family members and retirees on October 8th. Upcoming clinics include an after school clinic at the High School on October 14`h and the Lifebridge Shelter clinic on October 151h. Clinics specifically for the Police and Fire departments are TBD. • Providing support at several other local clinics including clinics in Marblehead on October 8th, Beverly on October I"and 13th and Swampscott on October 14`h. • Assisted a neighboring town with their directly observed therapy in the absence of a nurse for 3 visits in the beginning of September. Meetings/Trainings • On September 8th, attended the MAOPC Salem Working Group meeting where we discussed numerous ideas for outreach on opiate addiction and overdose prevention. • • On September 10`h, attended the North Shore REACT meeting in Danvers where we collaborate with neighboring towns to discuss upcoming challenges and resources for seniors and discussed planningfor where a new ant called Confrontin Abuse in Later In g Life North Shore(CALL-NS). This grant will help provide services for people over 50 years old who are experiencing or are at risk for abuse. • Began precepting a student nurse who will be completing part of her clinical hours for public health with our department. We have been able to go over some of the key functions of the Public Health Nurses role and she has been assisting me at the Council on Aging Wellness Clinics. Monthlyeport of Communicable Diseases September 2015 Disease New Carry Over Discharged Total#Of Running Total for Reported Cases this Total for 2014 Month 2015 Tuberculosis 0 2 0 2 3 5 (Active) Latent 0 0 0 0 5 31 Tuberculosis* Babesiosis 0 0 0 0 1 0 Calicivirus/No 0 0 0 0 1 1 rovirus Campylobacte 2 0 2 2 9 10 riosis Chikungunya 0 0 0 0 0 1 Ehrlichiosis 0 0 0 0 0 1 Enterovirus 0 0 0 0 1 0 Giardiasis 0 0 0 0 1 0 Group A 0 0 0 0 3 2 Streptococcus Group B 1 0 1 1 7 6 Streptococcus Human 0 0 0 0 1 0 Granulocytic Anaplasmosis Haemo hilus p 0 0 0 0 1 0 Influenzae Hansen's 0 0 0 0 0 0 Disease Hepatitis B* 0 0 0 0 0 2 * Hepatitis C 4 0 4 4 22 37 /R • On September 10'h, attended the North Shore REACT meeting in Danvers where we collaborate with neighboring towns to discuss upcoming challenges and resources for seniors and discussed planning for where a new grant called Confronting Abuse in Later Life North Shore(CALL-NS). This grant will help provide services for people over 50 years old who are experiencing or are at risk for abuse. • Began precepting a student nurse who will be completing part of her clinical hours for public health with our department. We have been able to go over some of the key functions of the Public Health Nurses role and she has been assisting me at the Council on Aging Wellness Clinics. Monthlyeport of Communicable Diseases September 2015 Disease New Carry Over Discharged Total#Of Running Total for Reported Cases this Total for 2014 Month 2015 Tuberculosis 0 2 0 2 3 5 (Active) Latent 0 0 0 0 5 31 Tuberculosis* Babesiosis 0 0 0 0 1 0 Calicivirus/No 0 0 0 0 1 1 rovirus Campylobacte 2 0 2 2 9 10 riosis Chikungunya 0 0 0 0 0 1 Ehrlichiosis 0 0 0 0 0 1 Enterovirus 0 0 0 0 1 0 Giardiasis 0 0 0 0 1 0 Group A 0 0 0 0 3 2 Streptococcus Group B 1 0 1 1 7 6 Streptococcus Human 0 0 0 0 1 0 Granulocytic Anaplasmosis Haemophilus 0 0 0 0 1 0 Influenzae Hansen's 0 0 0 0 0 0 Disease Hepatitis B* 0 0 0 0 0 2 Hepatitis C* 4 0 4 4 22 37 , Influenza* 0 0 0 0 29 27 • Legionellosis 0 0 0 0 0 0 Lyme 0 0 0 0 2 7 Disease* Malaria 0 0 0 0 0 1 Meningitis 0 0 0 0 0 2 Pertussis 1 0 1 1 1 2 Salmonellosis 1 0 1 1 6 3 Shigatoxin 0 0 0 0 0 1 Producing Organism Shigellosis 0 0 0 0 0 4 Streptococcus 0 0 0 0 2 2 Pneumoniae Varicella* 0 0 0 0 0 3 Vibrio 0 0 0 0 0 0 West Nile 0 0 0 0 0 0 Yersoniosis 0 0 0 0 1 0 Total 9 2 9 11 98 148 *Notifications only, LBOH not required to follow up or investigate per DPH. Summary of Current Communicable Diseases Active Tuberculosis: Case#1: In June, a Salem resident was diagnosed with an active Tuberculosis infection. I accompanied them and their significant other to their first appointment with the pulmonary clinic to complete an assessment, do medication teaching and to explain the process of Directly Observed Therapy and a contact investigation. I began DOT daily following that appointment. They have been very compliant with DOT and are taking their medications without any side effects at this time. They are feelings well and no longer have symptoms of Tuberculosis. I completed a contact investigation and planted PPDs on all household contacts per the TSA nurse and protocol; contacts with positive results were referred to the pulmonary clinic. Case#2: In August, another Salem resident was diagnosed with active Tuberculosis. They were hospitalized on proper precautions and started on medications. I began DOT with them after they were discharged from the hospital. Their symptoms have improved and they continue to tolerate treatment well. They have been very compliant with DOT and I accompanied them on their first visit to the pulmonary . clinic. I will follow up with a contact investigation 8 weeks post exposure per protocol. This case has continued to be compliant with DOT and their treatment regimen. However, at this time, they have required hospitalization due to an unforeseen issue. I have been consulting with the Tuberculosis nurse • assigned to this case from DPH as well as the pulmonary clinic and further follow up will be necessary. Household contact testing is scheduled for this week. Campylobacteriosis: Case#1: This case had recently traveled out of state. They have no knowledge of any contacts of theirs being ill as well and they were treated by their primary care. They do not work in a care setting or as a food worker. No further follow up is required at this time and this case is closed. Case#2: This case was lost to follow up after several attempts to reach them by phone and a certified letter that went unreturned. Group B Streptococcus: I was able to speak with the hospital regarding this case and was able to obtain the appropriate clinical information. This case was seen for a procedure and treated with antibiotics. There is no further follow up and this case is closed. Pertussis: This case was seen by their primary care physician and started on proper treatment, household contacts began prophylaxis medication. Symptom surveillance was put in place due to the fact that the duration of the incubation period has passed since this case had been in contact with some groups of people. We did not receive any reports of other cases of pertussis in Salem. This case does not require any further follow up and after consulting with an epidemiologist at DPH this is now closed. Salmonella: This case was treated at the hospital and symptoms have resolved. They have no history of • recent travel and do not work in a care setting or as a food worker. All appropriate information has been reported to the Department of Public Health. w continued to be compliant with DOT and their treatment regimen. However,at this time, they have required hospitalization due to an unforeseen issue. I have been consulting with the Tuberculosis nurse assigned to this case from DPH as well as the pulmonary clinic and further follow up will be necessary. Household contact testing is scheduled for this week. Campylobacteriosis: Case#1: This case had recently traveled out of state. They have no knowledge of any contacts of theirs being ill as well and they were treated by their primary care. They do not work in a care setting or as a food worker. No further follow up is required at this time and this case is closed. Case#2: This case was lost to follow up after several attempts to reach them by phone and a certified letter that went unreturned. Group B Streptococcus: I was able to speak with the hospital regarding this case and was able to obtain the appropriate clinical information. This case was seen for a procedure and treated with antibiotics. There is no further follow up and this case is closed. Pertussis: This case was seen by their primary care physician and started on proper treatment, household contacts began prophylaxis medication. Symptom surveillance was put in place due to the fact that the duration of the incubation period has passed since this case had been in contact with some groups of people. We did not receive any reports of other cases of pertussis in Salem. This case does not require any further follow up and after consulting with an epidemiologist at DPH this is now closed. Salmonella: This case was treated at the hospital and symptoms have resolved. They have no history of recent travel and do not work in a care setting or as a food worker. All appropriate information has been reported to the Department of Public Health. Health Dept. Clerical Report FY 6 Burial Permits Certificate of $ Permits Plan Reviews Fitness $50 Copies / Fines Revenue Permit Fees July-14 $475.00 $2,210.00 $1,950.00 $4,635.00 Food Service Est. <25seats s14o August $700.00 $985.00 $1,500.00 $3,185.00 25-99 seats S280 >99 seats $420 September $1,475.00 $2,165.00 $4,300.00 $300 00 $8,240.00 Retail Food <l000sq' $70 !x October $0.00 1000-10,000 $280 >10,000 $420 November - $o.00 Temp:=Food z-3 days $300 ' December $ $0.00 4-7 days shoo >j days $; January-15 Example of>j, tempfood permit. $0.00 2 4(days)divided b 7=ix i600:=$1200 February K Frozen Desserts $25 $0.00 March '' $0.00 Mobile Food $210 -� April ` $0.00 Plan Reviews, ; New sa8o May Remodel` ;s o _. $0.00 9 June Catering $25 pereventl$2oo $0.00 catering kitchen Body Art Est. $315 t Total $2,650,0 $$5,360.00 $0.00 $7,750.00 $300 00 +: $16,060.00 Body Art Practitioner 135 Review Plans $180 Fiscal Year Budget 2014 Suntan Est. $140 Rec.Day Camp $10 Salary Starting Ending Expenses Ext.Paint Removal s35 Full Time $357,223.00 $279,009.41 Starting Ending Transport Off.Subst. $105 Part Time $16,545.00 $14,228.75 $18,300.00, $16,175.67 Tobacco Vendors $135 Overtime $2,000.00 $1,358.24 Swimming Pools Seasonal $140 Balance $375,768.00 $294,596.40 Health Clinic Revolving Account Annual$210 Nonprofit$40 $S,087.99 Title V Review s18o Well Application s18o Disposal works $225/18o David Greenbaum From: Larry Ramdin Sent: Friday, October 09, 2015 4:39 PM To: David Greenbaum Dave, The note for the subdivision is below: The BOH is required to review sub-division plans and issue conditions that impact public health in the subdivision.The process is that the plans are filed an a member of the Technical staff reviews the plans and makes recommendations to the Board based on the review of the application and its impact on Public Health,the plans must be reviewed and commented on within 45 days. In past a standard list of conditions was devised that addresses all major public health concerns. The Board may amend these conditions at any application hearing as it pertains to that specific application. The applicant has an opportunity to present their proposal to the Board and discuss their proposal. ***** Do this after presentation***** We have reviewed the application of the Clark street sub-division and based on the Salem being in a Radon zone( highest risk area) we are recommending that item 14 on the standard Isit of conditions be changed to read installation of a Radon mitigation system is required and add a new item 15.The final construction must comply with all requirements of the State Sanitary code We have reviewed the Alameda subdivision sub-division and based on the Salem being in a Radon zone( highest risk area) we are recommending that item 14 on the standard list of conditions be changed to read installation of a Radon mitigation system is required and add a new item 15.The final construction must comply with all requirements of the State Sanitary code.Additionally,a potable water supply must be provided to the residence prior to occupancy and shall meet the potability standards for drinking water established by the Department of Environmental Protection Sincerely Bawtt Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS Health Agent Salem Board of Health 120 Washington Street Salem MA 01970 978-741-1800 (office) 978-745-0343(Fax) Office Hours Monday- Wednesday 8:00 am—4:00pm Thursday 8:00—7:00 pm Friday 8:00 am- 12:00 noon . Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal officials are public records. FM:.f.please refer to: http://www.see.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 V David Greenbaum From: Larry Ramdin Sent: Friday, October 09, 2015 4:16 PM To: Danderson.Mark@gmail.com;Janet Greene (greenegma@yahoo.com);Jeremy Schiller Odschiller@gmail.com); Paul.B.Kirby@gmail.com; Shama Alam Cc: David Greenbaum Subject: Sub-divisio hearing Dear Board Members, There are 2 subdivisions that will be before you on Tuesday, I have a background below to apprise you on the necessity of this presentation. • The BOH is required to review sub-division plans and issue conditions that impact public health in the subdivision. If you review section 8 of the Legal handbook that was provided to you it may provide some additional information. • The process is that the plans are filed an a member of the Technical staff reviews the plans and makes recommendations to the Board based on the review of the application and its impact on Public Health,the plans must be reviewed and commented on within 45 days. • In past a standard list of conditions was devised that addresses all major public health concerns. • The Board may amend these conditions at any application hearing as it pertains to that specific application. I have reviewed the plans and have some recommendations,they are listed below. David will provide you with the recommendations at the meeting. Clark Street We have reviewed the application of the Clark street sub-division and based on the Salem being in a Radon zone( highest risk area) we are recommending that item 14 on the standard list of conditions be changed to read installation of a Radon mitigation system is required and add a new item 15. The final construction must comply with all requirements of the State Sanitary code Alameda Street We have reviewed the Alameda subdivision sub-division and based on the Salem being in a Radon zone( highest risk area) we are recommending that item 14 on the standard list of conditions be changed to read installation of a Radon mitigation system is required and add a new item 15. The final construction must comply with all requirements of the State Sanitary code. Additionally,a potable water supply must be provided to the residence prior to occupancy and shall meet the potability standards for drinking water established by the Department of Environmental Protection . There is no water available at this site and they may be requesting a well permit hence the requirement that water meet potability standards Sincerely Bp1' * Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS Health Agent Salem Board of Health 120 Washington Street 1 ' CITY OF SALEM, MASSACHUSETTS IV BOARD OF HEALTH P1ltblicHeallth 120 WASHINGTON STREET,4`}'FLOOR Prevent.Promote.Protect. KIMBERLEY DRISCOLL TEL. (978) 741-1800 FAx(978) 745-0343 lramdin@salem.com L,\RRY R,\MDIN,RS/REHS,CHO,U-FS MAYOR HEALTH AGENT October 20,2015 Family Convenience 247 Jefferson Avenue Salem, MA 01970 Dear Owner: On Monday September 28, 2015 at 10:43am personnel from the Tobacco Control Program conducted a compliance check. During that compliance check blunt wraps were found for sale. Documentation is now on file at the Board of Health regarding that sale. Family Convenience is in violation of the Salem Board of Health Regulation Affecting Section G - Prohibition of sales of blunt wraps. According to this section, no person or entity shall sell or distribute blunt wraps within the City of Salem. In accordance with section P-a,violations will be punishable by a fine of$100.00 Hundred Dollars for the first offense. FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore/Cape Ann Tobacco Alcohol Policy 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$100.00 for the violations 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 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. Sincerely yours, Larry Ramdin Health Agent LR/hlp CERTIFIED MAIL: 7013 3020 0002 1522 7525 cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program Dr. Shama Alam, Board of Health Chair and Members I Violation1oti City "w Board of He 1 Y •1 yen{ Promote: Prptect f .a a r notice is to inform you chat your establishitient vioTato�the Beard of Health'Sale of T'Qbaceo Proiricts &Nicotine Delivery Products andltrr.Envrran�en# 1 Tolaaeco Srnpe(EMI 3)Rgulatioti'; ` Nain8'of esta `is Address Date o vioiati Time:of vioiat;on minor's age/gender minor's 11)# ` T 5 •. finance,.Sect I. a atio g ( �hstitutijg Violation) , Narrative information- , ' 1 I affirm,under the'pains and pena�ties of perjury,that the above report is-true to the best of my knowledge - -� a be Inspe`t (Signature) (Prtrtt name) VENDOR STATEMENT I acknowledge I ieceived this Violation Notice on ,;20 • at /PM and I am being given a carbon copy of this ponce I also acknowledge:.that l hate Feen.info d'that the 'eabody.0pard:of Health will provide additional,follt�w,iip info i iation'tti :this viol ion: once Of ner/1Vlanag r/CJ r1c,.(S jhh i2 r � (Prtr�t littme Yf vendor refuses this Notice+or if the;,inspedo feels.unsaf in.deltventig it,an explanation must.be wfitten on a note attached hereto Mailing of this Nattce is thus required =Contact tfie North Shoire/Cape Ann tobacco Alcohol l'ohey Progra[n at 781-S8G b821 wiC i`c uestions Estatalishment white NSTCP-ye11oW $oard of.Health=pink .' " CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH PublicHedth .tl�l 120 WASHINGTON STREET,4 FLOOR Prevent.Promote.Protect. KIMBERLEY DRISCOLL TEL. (978) 141-1800 FAX(918) 141-0343 Iramdin@salem.com LARRY RAMD1N,RS/U."VIS,CHO,CP-I IS MAYOR HEAI::I l r AGINT October 20, 2015 Salem Market&Tobacco Niaz Ahmad 73 Harbor Street Salem, MA 01970 Dear Owner: On Wednesday September 23, 2015 at 2:15 pm personnel from the Tobacco Control Program conducted a compliance check. During that compliance check tobacco wraps(leaf)were found for sale. Documentation is now on file at the Board of Health regarding that sale. Salem Market and Tobacco is in violation of the Salem Board of Health Regulation Affecting Section G- Prohibition of sales of blunt wraps. According to this section, no person or entity shall sell or distribute blunt wraps within the City of Salem. In accordance with Section P-a, violations will be punishable by a fine of$100.00 Hundred Dollars for the first offense. FOLLOWING THE THIRD(3RD)OFFENSE, THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore/Cape Ann Tobacco Alcohol Policy 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$100.00 for the violations stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4!h 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 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. Sincerely yours, Larry Ramdin Health Agent LR/hlp • CERTIFIED MAIL: 7013 3020 0002 1522 7832 cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program Dr. Shama Alam, Board of Health Chair and Members f Violation Notice Cit wn -� Board of Health H�Wi !�+ e ent. Promotew Protect. • i This notice is to inform you that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. Cl��.�� Lk Name of establishment -- `�- Ad ress Date%of violati n Time of violation Minor's age/gender Minor's ID# t (Ordinance,Sectio 'Re ulation (Act Constituting Violation) '� Narrative information rU: : -- r ' V c Y-40 J affirm,under the pains and penalties of perjury,that the above report is true to the best of my knowledge and belie ;� Ins7ior .•ignature) (Print name) VE OR SATEM _ • I acknowledge I received.this Violation Notice on r� , 20 at :_ ``1 M�`' I am being given a carbon copy of this notice.I also acknowYedge that I —have been informed that the Peabody Board of Health will provide additional,follow-up information to this violation notice. N—Ac - _Cilsz�, b)VnO/Manager/Clerk(Signature)` (Print name) If vdndor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be written on a note attached hereto.Mailing of this Notice is thus required. Contact the North Shore/Cape Ann Tobacco Alcohol Policy Program at 781-586-6821 with questions Establishment-white NSTCP-yellow Board of Health-pink The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health -- 250 Washington Street, Boston, MA 02108-4619 CHARLES D.BAKER MARYLOU SUDDERS Governor Secretary KARYN E.POLITO MONICA BHAREL,MD,MPH Lieutenant Governor Commissioner P, C E IVE® Tel;617-624-6000 SEP C 2015 www.mass.00v/doh September 21,2015 :1; , r 6A[ EM UAHD OF HEALTH Dear Water Quality Awardee, For 2014,a total of 2,282 public water systems in 33 states received these awards,including 63 in Massachusetts. I am pleased to present you with a 2014 Water Fluoridation Quality Award from the U.S.Centers for Disease Control and Prevention(CDC).Fluoridation of public water supplies in our country began more than 65 years ago. Today in Massachusetts 70%of our residents,more than 4 million people in 140 communities,are receiving the health and economic benefits of community water fluoridation. Each community's water system reports their fluoride level to the Office of Oral Health. We then monitor and document the results in the Water Fluoridation Reporting System(WFRS)managed by the CDC. The CDC presents this Water Fluoridation Quality Award annually to public water systems that 1.Adjust the fluoride concentration of their drinking water; 2.Achieve a monthly average fluoride level that is in the optimal range for 12 consecutive months in a year; and 3.Document their fluoride levels in CDC's Water Fluoridation Reporting System. This award recognizes your investment in ensuring that every resident of your community receives the benefit of good dental health. Thank you for your hard work and dedication and congratulations on this special recognition!. Sincerely, 4S. dATC,RN,DrPH Brent D.Martin,D.D.S.,M.B.A. Director, Division of Health Access Health Oral Health Consultant, rice of Oral Cc Board of Health Cc Mayor WFRS Water Fluoridation Reporting System 2014 r., Water Fluoridation Quality Award BEVERLYAND SALEM STATE OF MASSACHUSETTS Ae Centers for Disease Control and Prevention commends this water system for its consistent and professional adjustment of the water fluoride content to the optimum level for oral health for 12 consistent months. Consistent, high-quality water fluoridation practice, as demonstrated by this water system, is a safe and effective method to prevent tooth decay, improving the oral health of community residents of all ages. Presented by the Centers for Disease Control and Prevention United. States Department of 'Health & Human Services L� Centers for Disease I►�••-'J Control and Prevention II��/�)�• National Center for Chronic National Fluoridation Engineer, Division of Oral Health Disease Prevention and Health Promotion National Center for Chronic Disease Prevention and Health Promotion D � I Shared Kitchens Shared kitchens have been used successfully to enable start-up companies to utilize common space to manufacture their products without the costs/investment in a kitchen.This proposition can prove to be costly for some start-up operations. There are 2 types of situations: 1. Retail :the manufacturer sells their product directly to the end-consumer 2. Wholesale :the manufacturer sells their product to a third party who distributes their product or resells the product or uses it as an ingredient or menu item All wholesale products are regulated by the Department of Public Health's Food Protection Program and possibly the FDA or USDA. Retail Foods must comply with the requirements of 105CMR590.00 The main concerns we have are: • that the operations should be separated by time and space i.e. 2 operations cannot occupy the same space • Protocols for cleaning should be developed and approved • Protocols for equipment use should be developed • Storage should be provided for specialized utensils that are not used in common or owned by an individual manufacturer e.g. candy cooking pots • Separate storage should be provided for raw materials and finished products We have participated in workshops at the Enterprise Center at Salem State University and support shared kitchens.The City has had a committee looking into the concept but there is no one willing or able to sponsor manage such a kitchen at this time Health Dept. Clerical Report FY 2016 Burial Permits Permits Plan Reviews Certificate of Copies / Fines Revenue Permit Fees $25 Fitness $50 July-14 $475.00 $2,210.00 $1,950.00 $4,635.00 Food Service Est. <25seats $140 August $700.00 $985.00 $1,500.00 $3,185.00 25-99 seats s28o >99 seats $420 September $1,475.00 $2,165.00 $4,300.00 $300.00 $8,240.00 Retail Food <i000sq' s7o October $725.00 $3,295.00 $1,400.00 $5,420.00 l000-io,000 s28o >io,000 $420 November $0.00 Temp.Food 1-3 days s3oo December $0.00 4-7days s600 >7days s January-15 Example of>7 day temp food permit: $0.00 14(days)divided by7=2 x shoo=s1200 February $0.00 Frozen Desserts $25 March $0.00 Mobile Food $210 April $0.00 Plan Reviews New s18o May $0.00 Remodel s90 June Catering $25 per event/$200 $0.00 catering kitchen Body Art Est. $315 Total $3,375.00 $8,655.00 $0.00 $9,150.00 $300.00 1 $21,480.00 Body Art Practitioner 135 Review Plans s18o Fiscal Year Budget 2014 Suntan Est. $140 Rec.Day Camp $10 Salary Starting Ending Expenses Ext.Paint Removal $35 Full Time $357,223.00 $245,426.75 Starting Ending Transport Off.Subst. sio5 Part Time $16,545.00 $13,210.00 $18,300.00 $13,249.89 Tobacco Vendors $135 Overtime $2,000.00 $593.25 Swimming Pools Seasonal $140 Balance $375,768.00 $259,230.00 Health Clinic Revolving Account Annual$210 Nonprofit$40 $6,022.99 Title V Review s18o Well Application s180 Disposal works s225/110 I Municipal Tobacco Control Technical Assistance Program Donald J.Wilson,Director c/o Massachusetts Municipal Association (617)426-7272 One Winthrop Square FAX(617)695-1314 Boston,Massachusetts 02110 djwilson@mma.org MEMORANDUM TO: Joyce Redford, Director of the North Shore/Cape Ann TAPP FROM: D. J. Wilson RE: Municipal Pilot Program Regarding FDA Compliance Checks DATE: November 3, 15 Under the Home Rule Amendment for city ordinances and town by-laws, or under M.G.L. Ch. 111, Section 31 for health regulations, municipalities in Massachusetts may assess fines and/or permit suspensions to retailers that violate their local tobacco sales policies. In most cases, these municipalities also utilize the Non-Criminal Disposition method of ticketing which allows for a civil ticket after the municipal enforcement entity receives authority to do so through either town meeting or city/town council. Violators are most commonly caught during an adult-supervised compliance check when an under-aged youth, trained according to a statewide protocol, attempts to purchase a tobacco product. Concurrent to these locally-conducted compliance checks, the U.S. Food and Drug Administration(FDA) also conducts their own compliance checks, using a protocol that mostly mimics that used by Massachusetts cities and towns. The FDA does not divulge when they are doing compliance checks or which local retailers they will visit. Within three business days of a potential violation, the FDA will notify that retailer by mail. While the FDA does not notify the municipality of the potential violation, the compliance check results will be posted on the FDA website, generally within eight to ten weeks of the sale (currently the Mass. Health Officers Association does notify municipalities of violations). However, due to lack of local authority and the longer period of time it takes for that FDA website posting to occur, municipalities cannot also penalize on those FDA compliance checks. In place of a penalty, some cities and towns, upon receiving FDA notification, will ask the violating retailer to attend a board of health meeting to explain how the tobacco sale to a minor happened and what they intend to do to rectify the problem to avoid future illegal sales. A number of cities and towns have inquired as to how to utilize their local penalty scheme against a retailer caught in an FDA compliance check. �I A pilot project was established for this purpose. The participating cities and towns deputize the FDA compliance officer, often times someone they currently use, or have used in the past, for their own compliance checks. With proper deputization, that FDA compliance officer can immediately notify the board of health of FDA violations by completing an MTCP compliance check form and record a failed compliance check as both an FDA offense and a local offense. Prior to actively using this format, municipalities should inform their tobacco sales permittees that they will be subject to two sets of penalties if they sell tobacco products to minors. As to procedure,the FDA will continue to use their protocol and the participating municipality shall use their protocol. If a retailer wishes to appeal the penalty, appeal procedures for each are separate and can be found on the FDA website and within the local measure. Outside of Massachusetts, both Georgia and Connecticut have instituted a protocol to issue a state-level ticket on an FDA-conducted compliance check in addition to the penalties issued by the FDA. In both instances, rather than utilize one compliance officer as we do in Massachusetts, an FDA compliance officer and a state-level person attend to the compliance check resulting in the state-level person witnessing the sale and then issuing a state ticket to that retailer. In this scenario, the FDA compliance officer then follows the same penalty protocol used in Massachusetts FDA compliance checks. The FDA law does not preempt or otherwise block boards of health from enforcing their tobacco regulations. In authorizing the FDA to regulate tobacco under the Family Smoking Prevention and Tobacco Control Act of 2009, Congress stated '[n]othing in this chapter, shall ... limit the authority ... any state or political subdivision of a state to enact, adopt,promulgate, and enforce any law, rule, regulation...for the sale, distribution,possession ... of tobacco. (21 USC sec. 917(a)l). Therefore, if a board of health has evidence of a violation of its regulation, it is well within its scope of legal authority to act. In this pilot program, a deputized agent of the board of health provides such evidence. The fact that this person is also collecting evidence of FDA violations makes no difference. He or she has full authority to act in both capacities. Someone might argue that double jeopardy blocks this dual enforcement. That claim is wrong. Double jeopardy blocks multiple prosecutions against someone by one sovereign government. Since our constitutional system interprets our federal, state and local governments as different sovereign governments, each has a chance to pursue prosecutions. There are several examples of such multiple prosecutions when it comes to criminal matters. In the civil context, the tobacco industry itself was sued under the civil laws of both the state and federal governments for the exact same behavior, deceiving the public about the harm caused by tobacco use. A Technical Assistance Project for cities and towns funded through a Massachusetts Department of Public Health grant to the Massachusetts Municipal Association. I 2015 Mosquito Season: MDAR/SRMCB Weekly Report Epi Week 41 (October 11-October 17) — Report#20(10/22/2015) Introduction: This is the twentieth mosquito surveillance report of 2015.The goal of these weekly reports report is to keep stakeholders updated with the most current information about arbovirus activity in Massachusetts,by documenting and evaluating conditions pertaining to arbovirus threats in the state.The contents of.this report complement the Department of Public Health (DPH)Arbovirus Surveillance Report for Epi Week 41 (see also westnile.ashtonweb.com for DPH's Arbovirus Daily Update). This Week: There were 0 mosquito pools reported positive for West Nile Virus (WNV)or Eastern Equine Encephalitis (EEEv) in MA during Epi Week 41,out of a total of 19 mosquito pools submitted and tested (129 mosquitoes). This includes pools that were collected from traps between 10/6/2015 and 10/9/2015.All samples submitted were from the Central Mass. Mosquito Control Project. DPH also confirmed 1 additional human case of WNV in Suffolk County,for a total of 9 human cases this season.See.http://westnile.ashtonWeb.com for the latest risk maps. Positive Mosquito Pools to Date (2012-2015*): 2015 Epi Epi Week 2015 2014 2013 2012 Week Dates 164/4524 WNV(4%) 56/5016 WNV(1%) 332/6082 WNV(6%) 307/6746 WNV(5%) 41 10/11/2015- 1/4524 EEE (0.02%) 33/5016 EEE (.7%) 60/6082 EEE (1%) 262/6746 EEE (4%) 10/17/2015 *Historical data may be approximate.2015 numbers have been adjusted to match State Lab totals(a.06%difference). General Statement: With a hard frost coming in at the start of Epi Week 42,surveillance has been completed by all districts.As DPH noted in their own report, risk of arbovirus transmission is minimal following a hard frost,since nearly all mosquito activity will cease.Surveillance was also minimal this week,with only Central Mass. Mosquito Control Project submitting pools for testing; most Districts/Projects have now turned their attention to water management projects. There was no arbovirus found this week.Arbovirus levels as a whole for the season were low,with only 1 EEEv+mosquito pool found.According to DPH,the last time Massachusetts had only a single mosquito positive was in 2002 (in Tewksbury),and the last time we had a season with 0 EEEv+mosquitoes was 1996. This is expected to be the final report of the 2015 season. Weather: Epi Week 41 was another dry week for most of the state,except for the Cape and Islands and the southernmost tipof Bristol County,following thunderstorms that passed through on Oct. 16`h delivering an Y g P g J; inch or more of rain in some locations.As noted above,a hard frost is expected to start off Epi Week 42,the earliest hard frost the state has seen in several years. Expect a return to above normal temperatures by the middle/late part of Epi Week 42,followed by a gradual cool down. Questions/Comments?Contact: Jennifer Forman Orth,Environmental Biologist,Mass. Dept.of Agricultural Resources,Jennifer.forman-orth@state.ma.us or 617-626-1735 L MDAR/SRMCB Weekly Mosquito Report,Epi Week 41(October 11-October 17)-Report Date Oct 22,2015 'V, Precipitation in Massachusetts for EPI Week 41,2015 l L, (October 11 -October 17) t3enlvngton vT ` Jamey NH 0 Nashua NH Nam O • O00 �. ,. L _.� �, t \.• �,,t1 ,�` F' L I o.03 r.,,�i J,.I �L r ��t �;AJi i.. 07 r' . f I'. Flldtllunp i / �i ID Q� 1 tr o 1 o pea ,.l�f.y;*^ '.. lay Norwoa t tr-' , Provkmtown O YYknor LOW , O �.�3.�, ° O O O tI111MLowRO. .'\\ s a ' ° VJitlrrlalDc CT L j i._'d•-.ae o.s `` � _- s egend O Proride O O u ( is „'OD,nu 7: 'math m a EI Obcwvabry ,)1: � cRY,ia ati>raY.ay "f,.rdY, L 4 �y''s �(� F� Inthesol,pnlcipitation NewPorlRl 1" •�� ,; om•a.Ts JO y - �` �• a+rf'Lxd ° Hawn t.St,2.28 ►dotes: Because of the relatively large die tent �36 `, ® aae•3oo between observatories. significant .localized ti `NamU&Ad 1 ' Cation events my not be represented. k • .a Pile _ 3:76•a:70 Data courtesy of, MA Office of Geographic and Environmental (� DA R 4.51-a.26 information(Maas Ol8),and the Applied Climate Information Systam,operated by • $�" the NOAA Regional Climate Centers 0 15 30 Mlles I 1 I I I x " Long-term weather outlook maps for 10/23/2015—10/27/2015 are below: Precipitation Temperature 09/7, Sao/ { { 0 Ob g OO I / ;S f •t A. 6-10 DRY OUTLOOK 1-11 DRY OUTLOOK PRECIPITATION PITRDTICDN PR6OBRBIL YID R�K lr rCa. TENPC RRTURE PRO 20 3BRBILIT D��[P B�Migc �.meil VNLIO IOCT �Sa0147. 2015 ;r7�jL -eC� R" VALID IOCT 23 - 27. 2015 N �wioco cs IKY. 90% 60% 70% 60% 50% 10% 33%_..33%:..;40% SD% 60% 70% 60% !b% 90% 00% 70% 60% SO% ants 33% 33% a0% SO% 60% 70% 60% 904 WobablDtyeleMow I—I hobaNDtVa1Abm Prob"Itv.lft— 1-1 Prob"Itvofmow Questions/Comments?Contact: Jennifer Forman Orth, Environmental Biologist,Mass. Dept.of Agricultural Resources, *ennifer.forman-orth@state.ma.us or 617-626-1735 Salem Grill Z Chicken 105 Lafayette Street Salem MA 01970 Owner: Assim Mustaq Violation Hearing Violation Type Date Date Fine Motion i Suspension Sale to minor 1st 71212012 None $100.00 None(Owner Niaz Ahmad from 1/1/12-9/23/12) Sale to minor 1st 2/25/2013 None $100.00 None Mr. Assim Mustaq, owner of Salem Grill Z Chicken,was found to be selling prohibited blunt wraps, at the last compliance check. They sold Six(6)boxes of blunt wraps 2nd 10/2/2013 11/12/2013 $20000 tobacco products to a minor at the previous compliance check after were found under the counter . selling to a minor previously. Mr. Mustaq admitted that it was his second violation and agreed to the seven day suspension and a fine of$200.00. The suspension will take place from November 18-24(inclusive) — r. motioned to revoke the tobacco permit for Sale to a minor and cigar MotionD Ledoux g pricing and packaging are 3rd&4th 1/25/2014 2/11/2014 $300.00 Salem Grill Z Chicken effective February 24, 2014 and pay the$300 incorrect fine. 2nd by Dr. Alam All in favor(Chair abstains per custom). Motion passes. Elio Motion by Dr. Alam to deny request to reconsider revocation of 1st Request for Revocation 3/11/2014 tobacco permit of Grill Z Chicken; 2nd Dr. Ledoux.Motion approved unanimously Commonwealth of Massachusetts City of Salem Board of Health 120 Washington htreet,4th Floor Kimberley Otisooli Mayor SALEM,NIA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2012 ESTABLISHMENT NAME: ( Salem Gril Z Chicken,, File Number:BHF-2009-000017 105 Lafayette Street SALEM MA 01970 LOCATED AT: SALVA, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions 1 Notes FOOD SERVICE; BHP-2012-0297 Jan 1,2012 Dec_31;20121 $140.00 ESTABL ISHM-ENT TOBACCO VENDOR BHP-2012-0298 Jan 4,2012 "Dee 34;2012y $135.00 Total Fees: $275.00 PERMIT EXPIRES ec mber 31,2012 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 revonailons,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 e T. 1 MAN 1 � CITY Or SALEM, MASSAC-HUSIHTTI.S BOARD OF HF-1LTH 120 WASHINGTO N STREET,4. I I.00R Til']_ (978) 741-1800 KINfliERl.1 1'I)RISC01.1, F.\t (978) 745-0343 Nl, YOR IramdinQsalgm.cvm 1,\ItRI'R:\1f171N,RS/Itl•:1 iti,(:1 It),t:Y-hS 2012.APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTA� i l, (•'�!/G/ TEL# ADDRESS OF ESTABLISHMENT 10 S Zen��e 7� FAX# MAILING ADDRESS(if different) © , _fit ��T�� rig-" EMAIL-Business':_//Z�fl Ab ,4,tkcVNebsite: , ,, / OWNER'S NAME / / f TEL# Y/ 0/, 6 86?— 1 ADDRESS �b 'W STREET �J CITY STATE `ZIP CERTIFIED FOOD MANAGER'S NAME(S) /�I�//T2 ��1 CERTIFICATE#(S) d 3 - I1 fl Required in an establishment where potentially hazardous food is prepared) ERGENCY RESPONSE PERSON /%'¢� /LfjyJi4D HOME TEL# DAYS OF OPERATION Mond a TuesdayWednesdayThursd Frida Saturda Sunday HOURS OF OPERATION f Please write in time a day. I ` A. °olJM //;oo I//: oo�Q�r1 1 ooA i ll %30 i /1►3 o Artit For exam a 11am-t ipm G• P r �yf j oU o _TYPE OF ESTABLISHMENT. FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft =$420 . -----..------------ ... -----•-----------------•----------------- -........--•--- ---- -------- RESTAURAI'+IT 1'ES NO lass ti;ai�25 sects . .._-$;401�•' "—' (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES -- ------------ ------------------------------------ ----------- $100 CHILDCARE SERViCESLWURSING HQME__________ ADDITIONALPERMITS ------------------------------•--••-------------.........------...........-•-•- ............................ I AKE(not just sere)ICE CREAM,YOGURT/SOFT SERVE XE�j NO $25 TOBACCO VENDORt/' (Y—ED NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted In a prominent location In the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes requireg under the law. 42317 Al f r3 IZo�l 03 �- L/- 21den2h , 431 �•ry•w� Date Social Security or Federalcation Number----- Updated 5fI311 I FOODAP20 I l.adm �Checkt!&Date 0r�3 f , FG� j . C-11Y OF SALEM MASSACf-HUSE- "TS' V u BOARD OF HEAl;rl-I Jud u aseald:�aP 120 Wr1SHINGTON STREET,4"'FLOOR A blicHean Prnxn�.Irmmtc,f'rnlrr,. TEL. (978) 741-1800 FAX (978) 745-0343 r KTMBERLI�Y DIUSCOIJ., Iramdinnsalem.com T.,.1RR1'R,1IN11)IN,RS/RI?!IS,(:I I August 16,2012 Salem Grill Z Chicken, 105 Lafayette Street Salem, MA 01970 Dear Owner: On Tuesday,July 12,2012 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 15 year-old male purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. r .Salem Grill Z Chicken 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($100.00 Hundred Dollar fine)for the first 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$100.00 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, 0 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 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. Sincerely yours, ai i Larry a din� Health Agent LR/hlp CERTIFIED MAIL: 7010 2780 0002 0159 0033 cc. North Shore Tobacco Control Program Barbara Poremba, Board of Health Chairperson and Members City of Salem -Board of Health Tobacco Control Regulation -Violation Notice •sue•a•• 4 This notice is to inform you that your establishment violated the Salem Board of Health Youth Access(YA) Regulation and/or Environmental Tobacco Smoke(ETS)Regulation. Name o " sstablishment Address r Datb of violation Time of violation Minor's age/gender Minor's ID# fpspector �1\" J iJ � (Ordinance,Sec664n'ate-'latipn) __.� l.t "(Act Constituting Violation) Narrative information: �,x --j L �• ��^, C +� �,t ....._. i I affirm,under the pains and penalties operjury,that the above report is true to the best of my knowledge e and Belief. ot Inspector(Signature) (Print name) r VENDOR STATEMENT: I acknowledge I received this Violation Notice on .. , 20 ---»— at AM/PM and I am being given a carbon copy of this notice.I also acknowledge that I have been informed that the Salem Board of Health will provide additional,follow-up information to this violation notice. 1 Owner/Ma ager/Clerk(Signature) (Print name) 'If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be written on a note attached hereto.Mailing of this Notice is thus required. For further information,contact the North Shore Tobacco Control Program at 78I-477-0432 Establishment-white NSTCP-yellow Board of Health-pink tj T� Gommonwehlfflt of Mass&CjJ]usettsnz hoard of:xualth Klmbeie Orsfolt� n _ �� _Jr_ 4 i •_ rw• ••1, dyi4+:�t T,s.r••- �, f.vt r 'IYI Q ''�x.`,x•. c r 1Z0 Washlagton Street,4th Floor` "` r f c ,?, /r t r SALEM,MA'#r 0191y0 ; I�; Rd4 l i ..� i.., , L r � t �•�h..rr• .I sr ti � ;, h 'Foo�I/RetailxES#abLshnent Fermat • '`t *,� !. /'♦..- -y } f ',. lk` t trx y .i.� Y r.. }. ,. } y i '�1 q t c> + , k :'DATE PRINTED -4- 12/18/2012 Vi h_Vt' "� Y rt• r ♦ x«... T,ydaf= F it ; •S t t 't: d "L.� zr ryc !'r,.l•�r}")S t�° 3 r?''�ys+.�� yl 'N. y * ;.`�P + ,�1'ej" .S,*'•5* itr, ; 1r .+�Yr t Y='.D WjFw•.}}., 4 {;4Y�• ii,i a . ', dr Of q .t .i t_ ,tr l .f y.•r�.- .+ite. i'y'pP�7L 4'.1•vY yr ,.JF a" !" r,. '.r e,1 .Y ..f..- f - r�Y.f. 'r rs fr � '•x ta.i r•�-Jr•- ,�v Y�.ir.w .',.:, fly .�..J'C,i �,� �t�l,#4`� s �� .s .I' '•,�V tit�''3•*.q J' -• y,.�. ( ,x ESTABEISHMENT'NA " ME. ' �= Salexrt Gr>li Chicken t+��'-# �-. t. "J r7 .-." 'F �...�.d t,+ t z3•;y i"3'"i h t+,{ jr•'nf` k s�vt}-;� sit, ',.;f° .L _ °. •„ F�=p s -,d"'S"M -� FileNumber:BHF 2009-000017, '4 t +r 105 Lafayette Sheet �N�; tt •i t *1�,tt a 4 � - . * .. r •Y �1 �: - 1 y 3t,��,rr 2 Y"{f " 3 Y:F}1 d ;.j i Y., 1. j'�j t'f.. r +.., r S i �d`• tr J;, -st �},- # 'k "*:ttd � • w[�A cL�sir�r�'.,��Y ��y ,R.r ,c. (� (� „r "2 :.�. 3,,,'�, t?Li iia r J a•, r n r��a'r f#,�� ,v�� f:"yf .r �'T�,ti,�'� .r"r: � r7l�leL�l,'1 S?rc '�,r's ,. 1'l�z �5 4 1�A r / � °•v�. i'� *`K N'��: w .•+ ,sa`i 4F,^ �1• a"h'�� : Y 2 ' `'. � � � •r t-.,>. � .ei' ;' � '•. ' .�.•�� LOCATED AT �; � � .�,± '� �'�� =w,,,x'>.`� � �', � ; 1 ' -� , '1"{ *s st.�Y t"- '� � � +.Y r 3} r L. �t r ny .,. * y AtII-�.,LL Yt •#+bf£•*:, -a F .v n r^'s SALEM;1 M �41 77 .rr ��k?" -. •.,. ::.iS tit. t r ."�•...+� 3"�. ":....s�„F a , 9,;�a �4 +' Atr F,,,c",.r r:a r '�.-.Y r it •; 4 S, ,;." 7 -3" # �'. 4- �1 •z ,, Permit Type n �Permif No. `'Permt,,Issuedt`+Permit-EzpireSI.-�. F e Restrict ons/Notes " F001?_SERVIC E �'BWP 2013-0243 � 3a �1 2013 Dec 31 3A13 $140 00 ° �f. «t� " �k�+ A�jT`-e 7'y�j7+ f ;J ¢ 1 ''}Y ? y S 1 11 wee " `•�.' �,A�7'1•ABLIJ'['11,r1 C"r tom,--,„ rot .FPS-t ry ` ,ItIsTAII FOOD j 'BHP•201M24T '�-Jan1,2013 j ;Dec31,2013 rj'+i:$70�00 i0flA m VENDOR"BHP 2013-624 Jan 1 2013 sec 31 2013 " $135 00 � �"{ `` '� �tr.T'. �,,,, L +'` y ! #•'•. 5 ,wit" ToW Pees:,r ` rf-�• . e `{ .,,r+.'t �'ati � ii 1" ,,,.+, r" r v .1� a r :s *• z -. •J •a h iti", r-,T ro r= .t t 6y`:S} , rJ r t• .� is t y r T 3..> t ; ;' ! ,�. o •r ,,.a .'' r { r ,T �+ '*r ,• i + � ,t " 'fd." ry;i ca• l ' � •Y fRY" c.y! ..:' �, r t� 1p.L'in r��..y. ..�, �' y.t a'41... •+' Y-4,%.:wf-al a� t '`r 4 .; yF r >y. ", ��• ; a'' ^J' * 'l ,+ ..-1 .�i� Y Jy1r it ,t't.I ',• t.... "r,• rt . i Itr.t �, ;q.? r ta- F�� *y... I. t a r+j- t d 4�'rI •t* .�•T 3 '`t.ra, ,j fi y i� i' �,9 t-r:•+ * -;s j 1 ..t '$,...: �E';, t,t i,., , "'. a Ng,f ^ .. i#.., �. ! tea.= ley ra• x.• rT` .d{ ..--•tl '.: `.� A F4 r Y :;#s rTr * L t* z,> 9 tin _* t Z• .11 4 J3df t n rd.. c' + ' •r''.�4* to.y *:..;r...; < e' .r •{ram ,t.',} p,�'ay �r°L.h{eY��1f5 f.�,.*:. •i a i 1,,*'�k r :.e: � v. .r y.v�sr,�„r..• ��p ';",trt.%� rr,,�;t .y; r. 7 * r�t *"+•� ti 3:. �' a ws r r:, .. yn' ! a y�..�� ,y, r,. .t .. .. 7,t ' • � � 1 YS't•.1+.\i -.y ' 1'' 1 �� S4 YJv'• ='d-. i+ e ti• ,X -.. a ': r• -.;'. p ti," zZ sy t µ*4 l ri d t ,'+, ,c 'Y Y • 4 -n .a.' ._•a.I ... a 4. ."•4i....,�'ca -.r.--'a �. ., - ,.. -5 z'..,.;�+.;y., * ,PERMIT EXPIRES ece�nber 31,T,2013 *hiP. -3c r'.... r •�'� , `Board of.Health t !. r3i 'A 3 F R � �T Kr A "."+rL',Y. 'Lsy, i'-iy..-. Tt"yft f C .. •�.#�.'.:,�.'i`,�Ih�.`4id t Y!i+YN a•*',. .+'�' r a''. j^�4 d.- '",'z~ This Permit is nontransferable and must be reissued upon cbange'of ownership or location:The permit mint be posted tin a prominent location nite Esfahllshment In accordance with the State Sanitary;Code,beofre any revonations,improvements,or,equipinent changes are made, ' all plans for such must be submitted to'and approved by,the Salem Board of Health p � ,. s * /! )} t f't.. d.t, •_ t;. iTLf .j,T. O,••• - y J'.y,�- . _ t -I ... I • r R CITY OF SALE.M, MASSACHUSETTS LJ Bwm)OP 1-I1?A1;174 PUb1FCIIe82th 120%VAST IINGION SIRR.l.T,4'n,Fl.00lt KINIBERLEY DRI.CCOI.L 'rl;l„(978)741-1800 FAX(973)745-0343 MAYORltamdiu(n�� leicoj�� I-AltR1'RAAiI)IN,,ILS/Ri,I-IS,CIIO,Cl)-I S ' HtA1:1"f I A�71:N'I' Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date 1) Establishment Name: �/7f ��j C C�C`Cy , 2) Establishment Address: 3) Establishment Mailing Address(if different): / 4) Establishment Telephone No: '77o - 7y,r, �d 5) Applicant Name&Title: 6) Applicant Address: d rQ� fr Avery^ 7) Applicant Telephone No: � 97J/ 99f 24 Hour Emergency No 97�7�f q°f d Email: 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of An association Name A corporation Title Home�ss An individual L--"-- A partnership Other legal entity 12 Person Directly Res onsible For Dail O erations Owner, Person in Char e,Su ervis r o ,Mana er,etc, Name&Title: � MUf 17r,4 Address: Zr/ 4.11,r- Telephone No: y7© 77/, g9f 9 �Emergency Telephone No: / 97P- Fax: Email: 7,*r 13) District or Regional Supervisor(if applicable) Name&Title: Address: Tele hone Na: Fax: s Email: '%eck#: Date: I� Amount: J i i Food Establishment Information 14) Water Source: /G 15) Sewage Disposal: la �C DEP Public Water Supply No: (if applicable) t/" 16) Days and Hours of Operation: 7!�'�>J' • i 17) No.of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 1011/2001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): d Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) j Retail( 3e'0 'Sq. Ft)a ❑Caterer Permanent Structure �^ �IFood Service-(. 9 Seats) ❑ Frozen Dessert Manufacturer Mobile p Food Service-Takeout ❑Residential Kitchen for Retail Sale ❑Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑Food Delivery ❑Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments re ---••----•• ---•---- --•-•................••----•--• (check one) RETAIL STORE RESTAURANT, Annual Less than I0009q.ft. $70 Ef Less than 25 seats $140• Seasonal/Dates: D 1000-10,000sq.ft. $280 ❑Residential Kitchens $140 0 More than 10,000sq.ft. $420 ❑25-99 seats $280 ❑More.than 99 seats $420 Temporary/Dates/Time: --- -----•-- -- ------------------------------------•---$_1 O Bed&Breakfast/Childcare Services/Nursing Ho- me-- 100 ADDITIONAL PERMITS ---------------•-----------------.--..------------------------..---------------------------------------- ❑MAKE ICE CREAM,YOGURT/SOFT SERVE $25 LC3 PASTURIZATION _ - $25 t1j TOBACCO VENDOR $135 O ALL NON-PROFIT $25 (including, church kitchens state funded childcare&private clubs 23) Food Operations: Definitions: PHF-potentially hazardous food(timeltemperature controls required) Non-PHFs-non-potentially hazardous food(no timeltemperature controls required) check all that apply): RTE-ready-to-eat foods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: _ Pursuant to MGL Ch.62C,sec.49A,I certify under the penalties of perjury that I,to my best knowledge and belief, ' Have filed all state tax returns and paid state taxes require�dy under law. 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: 7a -•'y4 x+ '' ' �fiY ,•�.rr= . �� J • .c t:`t4i omm.,conwe'i W" M"�Rusetts' _ ', m C Ns. 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Page 1 . t , CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR PubHcHedtth TEL.(978)741-1800 FAx(978)745-0343 prevent.Promote.Noteot. KIMBERLEY DRISCOLL IramdinAsalem.com MAYOR LARRY IUMI)IN,RS/RI:I1,S,CFIO,Cl)-I,5 Hi,"AL-11I A(;HIM' 201_APPLICATION FOR PERMIT FOR SALES OF TOBACCO &NICOTINE DELIVERY PRODUCT PERMIT FEE $135 NAME OF ESTABLISHMENT_f��lO-a/ `C/�� TEL# 7 ADDRESS OF ESTABLISHMENT 1l,S_ � ,4 e.%�o ..�_��` L._.�'�._ FAX# DEPARTMENT OF REVENUE APPLICATION NUMBER: MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME fSi, /yILIJ7`,4 TEL#_� /n• 9_ �J o�G� ADDRESS 2- Ef�— vGr /� 4 STREETCITY STATE ZIP EMERGENCY RESPONSE PERSON L, (isJ, f,t� HOME TEL# CI 79 - 2,zR it/f �►p / e of Products Sold: Cigarettes v Cigars_ Chewing Tobacco✓ Pi e/Ci arette Tobacco v P 9 acco Nicotine Delivery Devices ✓ Other Tobacco Product(list on additional Sheet) DAYS OF OPERATION Monday Tuesday Wednesday Thursday j Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. (Forexamptellam-itpm) 1/AP7 �� // D/y/ t /AP7 *Please pay total with one check payable to the City of Salem. 1 This Permit is not transferable and must be reissued u l in the Establishment upon change of ownership.The Permit must be posted in a prominent location In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health, Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. OP 1c)-Af 3 -3�r Signature Date Social Security or Federal Identification Number Updated 723/12 TOBACCO.doc Check#&Date • 1 tts ``.��.�,r� ss'rSf� +;d'� - �.ty�i•.�x: Cornmof�wealth of na�aact, ^t`1 �U�`+�)- : r } ti�* [ . .. �t~�'"..:;i{`'a✓ � �'.; i,, �.f� r t'� ria -� p � r; .1 .J "y.s 9-4 .ytt,+', t •L � � ..ri u'F�.r .,$.:j y f r i t f h >*:'6rhf:. " � �7.a,' yi, 4 r • ` ? v c r�.a n:Y� •1 s^. Ct, :�[, '�` r � '•H'� 1�2s a w' f vi � �' � • ,'S •�` K� A `cft DATE PRibl la�D7 `f 12/ Q/2Q X e ��. f fit # +/i X.: � �jF l ,Tw• � Y f✓ t ^J N' fi. w?N .. - .a�.�y� o-,.pri T s � e �t. -' F'r�.y1. ��•.y.^�Ifa+' `�'.<' �� ' fi �:: s} i fY �� r t � P4�b sxk.y'`*'�A+ '��ca �. a`� a s �Y -t .r.e •w f t tom. � .r�.0 �, �.J Sws" .y �� ,tL �ds ;.•1� ..rt k � -a ='. �»a s'r .c .. .� ,F.- x a a e •. 5 1� �•�' [ r�+:R�v {t��7k 77►��-t��i'-�a •t "t dr f'��s,tr• _ -sR3 t ESTA��,S I Qd 1�T N1� ar off. �° p..�' •u'w1g.r� f`r a.-_ t(rfti.x� k r<.. r .• { ��fi.3 s a J. F11�Numb�" CF 2009-000017' �r Q5 Y • "b` '.t�c4 / r �'. �a, �"j `T'R,; ; •� 7G,� , I9- c ,� •y' #+ :: �� "•.�? +st arA 't.r^ w �'� rr r lfi- .i s z,k T `�-., S '' ��'t�" V 17 J�d' LOCATED='AT''Y .4" 1 ..,�'•`� ,/ y c � v r r=ij .� c,y��.. T.e'r,rh� g +ac y��y-krc� wCj4�Fi f* '•y J •�c t,; a . c.. f ,�:. 2 ��ir�+�r:' •k�G �s._a ed .. . 'v�� -'S '�c�`,��' r"�(t?��,�a"•,� `" a s s - 4 v �'. M ten. i x d r .� 4�.tc >sr�iut `ype erauttoer�ntt ed3FeeRtricho J r •- s x '{ w�Yvs Site i•s - L,t. FOO SERR�C`E BHP ZQ14-02t5�} �JSn�L 291$, •,I 2 1 �711L7!✓Iti�4 F ��:r y N �,,euJslz<r t,.eT}+-'r+.i 1..�.� � 'iv� t� � �-? J r � r v.c � !,i i ''iL: ,.ra f }"w .'. 'F 'c-+ t- t+.-i' t.5•--f,t s ;�' :'- ip".f .. - G7.,` r.'i�$- ri .ra'ku:`�'ht J ` ✓r,✓`fi'� J.'t. '°�: i J 4 v 1.«-ram Y•��'sksa t'Ms t�s� ,Es'* .. .. :i3k �` .r t ;r� f_t 4) r .... •. 3 `u i' �'. L- 'w..� 1'a'a+,":�+4, ... .... .. �. v - J:k y`'. . - • f .t... . • , +1v -:�` JY ./ ;��o,'F�1{� Zb<, - . - • , c 'yy.�F-.(� y. "f r - . .,; t t } 'R.., b �/ Ev�rtt ;...-k•{.�df.Yf .a.; .. - .r'. .�t f .� fop 'n• s / r# w,'t y h [. t G'N} a r ck r <�, • � i.tj'.1><y,..Y'. n f.3_ .Jti:ti it _ �, - .. - - .' . PERMIT EXPIRES e�ember 31"�iftk. t 4.•. aC h, .' r?' S."�? `'+l s' P "+xSr r i f Y w - - - ' •� ;'�OAI'�'Of;H�sitll o t G {t.`.� ��-�� a 7.. '�r s �� _ y- 6 .'r:t , , ;., 4 -s ri'{py,_y t .i, t >" ''"'". r . • This PerinGt is not transferable and must be reissued gpon change of owaership or location.The permit must tie posted i a, omiben tocatlon in;the Estkbl sI*,ent. f *j. R L'. . �.r accordance witti'the State SanYtary Cone,beofre anyJrevOpations��n�srovedents,or equipment changes are made, ' a�l:plans fur such mast be submitted to and appX ived by the Salve"®Boazd 6 ke'alth: I CITY OF SALEM, 1VIASSACHUSET TS BOARD OrHrw.•ri-i H 120 WASt IINGT'ON S RLHT,4""FLOOR KIMBERLEY DRISCOLL Tl-l..(978)741-1800 FAX(978)745-0343 MAYOR LARRY ItrIMDIN,RS/RrSHS,CI70,(,P-I'S a 7 HI?AI:rH AGi':N•I- Food Establishment Permit Application (Application.must be submitted at least 30 days before the planned opening date) 1) Establishment Name: /� �� / LL Q ------------- 2) Establishment Address: D. Z/'1`14 yZ� / / ,s 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: 5) Applicant Name S Title: 1�f l�o 8) Applicant Address: 7) Applicant Telephone No:y�O g79- 9919 24 Hour EmerLcy :1 7zf74�9os�a Email: 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) N a corporation or partnership,give name,title and home address officers or partner. of An association Name Title A corporation Home Address An individual A partnership Other legal entity. i 12 Person Directly Res risible For Daily Operations Owner,Person in Charge?Supervisor,manager,etc. Name&Title: /U//�l /11ya'(/ JAIAl Address: ti 171,57 6T '76 Telephone No: yip q 9_ g lf Fax: Email: Emergency Telephone No: 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: Date: . / Ti - 3 J/, {)mount:_ / �1 Food Establishment Information Water Source: ,:P Public Water Supply No: if a 15) Sewage Disposal: { applicable) 16) Days and Hours of Operation: 17) N .of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management Required as of 10H/20011n accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more); 0 Yes N ) o �) Location- 22Establishment Type{check ali that check o aPpiY)( one) ❑Retail{ Sq.Ft)Permanent Structure i 0 Caterer / Food Service—( , Seats Mobile Food Service—Takeout ) 0 Frozen Dessert Manufacturer ❑Residential Kitchen for Retail Sale O Food Service—Institution ❑Residential Kitchen for Bed and { Meals/Day) Breakfast Home 0 Food Delivery 21) Length Of Permit: ❑Residential Kitchen for Bed and (check one) RETAIL STORE...... .. .... .... ...... . . tiESTa Estabiishrrlgnis.. AURAIVT . Annual l.r 0 Less than 1000sq.ft. $70 RLess than 25 seats 140 Seasonal/Dates: ❑1000-10,000sq.ft. $280 D Residential Kitchens $140 0 More than 10,000sq.ft. $420 ❑25-99 seats $280 Tern o 0 More than 99 seats $420 p rarylDatetllime: _ 0 Bed; BreakfasUChildcare---------- Services/Nursing Home - --•-••-- $100 ADDITIONAL PERMITS------------------ " " ❑MAKE ICE CREAM,YOGURT/SOFT SERVE S25 ❑PASTURIZATION $25 0 ALL NON-PROFIT' $25 *Irrclud. , church kitchens,state funded childcare 8 /v a club 23) Food Operations: Defrnldons. PNF-potentially hazardous food(Wroeftemperature-controls required) (check all that apply): Non-PNFs-non-potendaNy hazardous food(no Unm4emperatum contrws required) Sale of CommerclallY RTE-rea -to-eat foods Ex.sandwiches,salads;muffins which need no further ocessln � VHF Cooked to Order Pre-packaged Non-PHFs Hot PNF Cooked and Cooled or Hot Held �Sale f mercially Preparation of P for More Than a Single Meal Service o ComHFs For Hot And Pre-packaged PHFs PHF and RTE Foods Prepared For Highly Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be vacuum Packaging/Cook Chllt Prepared by Consumer Reheating of Commercially Customer Self-Service Processed Foods for Use of Process Requiring A variance Service Within 4 hours and/or HACCP Plan(including bare hand contact alternative,time as public health Customer rvice of ice Manufactured and Packaged for Control. Non-PHF and Non- Retail Sale g Offers Raw or Undercooked Food of Perishable Foods Only Animal Origin Preparation of Non-PHFs Juice Manufactured and Packaged for Pr Retail Sale spares Food/Single Meals for Catered Events or Institutional Food Service Offers RTE PHF in Bulk Quantities Retail Sale of Salvage,Out of Date To be completed by the Board o health or Reconditioned Food Total Permit Fee: Payment is due with application 1,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food a abiishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of t CMR 590,000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch.62C,sec.49A,I certify under the penalties of ury Have filed all state tax returns and paid state taxes required under law that f,to my best knowledge and brief, Social Security Number or Federal ID: tf U l 3 i Signature of Individual or Corporate Name: CITY OF SALEM, MASSACHUSETTS IV BOARD OF HE.kLTH 120 WASHINGTON STREET,4"'FLUOR %b�iKealtma�c.Protect. TEL.(978)741-1800 FAx(978)745-0343 Prevcnt KIMBERLEY DRISCOLL tramdin@salem.com LrUtItY 1t,1MDIN,RS/lWt 1S,Cl 10,[;N-I'5 MAYOR February 3,2014 Salerrrn Grill Z;Chicken 105 Lafayette Street ' Salem,MA.01970. Dear Owner. On Saturday,January 25,2014'at 2c03pm 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 17 year-old female purchased tobacco from a clerk in your store and cigar pricing and packaging are incorrect. Documentation is now on file at the Board of Health regarding that sale. Salem Grill Z Chicken is in violation of Section G of the Salem Board of Health Regulation,Affecting the Sales of tobacco to a minor and incorrect pricing and packaging of cigars. According to this section,A person or entity who sells or distributes to a minor within the City of Salem shall be punished by a fine of($300.00 Hundred Dollar fine)for the fourth offense and a ' r .revocation of their Tobacco Permit. Further,you are required to attend a meeting of the Salem Board of Health on February 11,2014 at 7:00pm 3rd Floor of the City Hall annex, 120 Washington Street to discuss these violations and actions you are going to take to prevent their ' re-occurrence. FOLLOWING THE Fourth(e)OFFENSE,THE BOARD MAY CONSIDER 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 and revocation of your permit will be determined by the Board of Health. A check or money order payable to the City of Salem must be at the Board of Health office,120 Washington Street,4"'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 investigation reports,orders,and other documentary information in the i 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 yours, Larry Ramdin Health Agent LRmlp CERTIFIED MAIL: 70121640 0002 3312 9700 cc:North Shore Tobacco Control Program Barbara Poremba, Board of Health Chairperson and Members • Violation Notice City own �Y"`r�"1 Board of Health mgwublic Heatth Prevent. Promote. Protect. w f , This notice is to.itiform yod that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. - - d Ic Nalme of establishment 4, - _ -----Tr Address p ' of vio atio Tim of violations-"" inor's age/gend (Ordinance;- ect*m egu tton� r w (A ,Constituting Violation) - - i ..;. . Narrative ormationOA • V 4 � C V�40 Y(z A ' .> 4 " I rm,under the pains and penalties,of perjury,that the above report is true to the best of my knowledge an belief Inspector gtiatu' i Print name) t t VE R S A ME :I acknowledge I r g eceived this Violation Notice on 20� �d I am being given a carbon copy of this notice.I also knowledge that I have een i f d that the Peabody Board of Health will provide additional,follow-up information to this violation no i e. anager/ erk(Signature) (Print name) If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be Written on a note attached hereto.Mailing of this Notice is thus required. • Contact the North Shore/Cape Ann Tobacco Alcohol Policy Program at 781-586-6821 with questions Establishment-white NSTCP-yellow Board of Health-pink CITY OF SALEM BOARD OF HEALTH MEETING MINUTES February 11, 2014 MEMBERS PRESENT: Dr. Barbara Poremba, Chair, Martin Fair, Dr. Shama Alam & Dr. Danielle Ledoux OTHERS PRESENT: Larry Ramdin Health Agent, Council Liaison Beth Gerard, Suzanne Doty, Public Health Nurse, Joyce Redford, North Shore Cape Ann Alcohol and Tobacco Policy Program Director&Peter King, Tobacco Control Inspector MEMBERS EXCUSED: Gayle Sullivan TOPIC DISCUSSION/ACTION 1. Call to Order 7:40pm 2. Minutes of.Last Meeting Motion by M Fair to accept the minutes with corrections, (January 8, 2014) 2nd Dr. Alam. Approved unanimously 3. Chairperson Announcements No update 4. Monthly Reports-Updates A. B. Health Agent Approved; Copy available at BOH. Report The Board would like to discuss public health concerns during haunted happens at next month's meeting. ' B. Public Health Approved; copy available at the BOH Nurse's Report C. Administrative Approved; copy available at the BOH Report Will add revolving account balance D. City Council *There is a trash concern on Balcomb Street, possible abandoned Liaison Updates property. Sanitarian Elizabeth Gagakis was there and is in the process of resolving the matter. *Board reduction has not been brought up at a council meeting yet. *The potential marijuana dispensary site located in Ward 6 is being reviewed by the City Council 5. New Business A. Tobacco Violation Hearings • Salem Grill Z Chicken 105 Lafayette St Owner Asim Mushtaq Hearing Violation- on 1/25/14. Two violations were cited per BOH tobacco regulations; sales to a minor and a cigarillo was sold under the$2.50 price point. 3 previous violations were: 1 1. 7/2/12 sale to a minor—$100 Fine paid 2. 2/25/13 1 —sa a to minor $100 Fine paid 3. 10/2/13 blunt wraps behind counter—$200 fine paid & 7 ' day suspension. J. Redford also recommended mandatory ; education at his last suspension hearing. Joyce Redford will look at the attendance sheet and get back to the Board to make sure Mr. Mushtaq attended. Mr. Mushtaq did not dispute the violation only the date of the violation. He claimed that the visit was on Friday night before closing; Joyce Redford indicated it was on Saturday January 251h when Mr. Mushtaq signed the violation. This was supported by Peter, King Tobacco Control Agent and the signed document. The Board discussed concerns with the timing of the hearings being prior to 21 days appeal period. Motion—Di:.'Ledoux motioned to`revoke`the tobacco permit for, - Salem Grill Z Chicken effective.F.ebruary 24, 2014 and.pay the 1 $300 fine. 2nd by Dr. Alam All in favor(Chair abstains per custom). Motion.passes. • Walyo's Variety 22 Essex St Owner Predeep Madan Hearing violation - on 1/21/14 @ 2:15pm; violation cited per BOH tobacco regulations: sale to a minor. Previous violation: 2/25/13 sale to a minor—$100 fine paid Joyce Redford informed the Board that this establishment is also a liquor license establishment so they should be accustomed to asking for identification all the time. Motion—Dr. Alam motioned to suspend the tobacco permit of Walyo's Variety for 7 days effective February 24, 2014 and the fine of$200 be paid. Dr. Ledoux 2nd All in favor (Chair abstains per custom). Motion passes. • Marc's Market - 51 Harbor St. Owner, Elias Rana Hearing violation - on 1/25/14 @ 1:27pm Two violations were cited per BOH tobacco regulations; sale to a minor and sold cigarillo under$2.50 price point. I st and 2nd offense— Owner said new employee sold to minor on his Ist day. Motion- Dr. Ledoux motioned to suspend the tobacco permit of Marc's Market for 7 days effective Feb 24, 2014 and the fine $200 be paid. Dr. Alam 2nd 2 for, 1 against(Chair abstains as per custom). Motion passes. • NYFC Food Market -21 Salem St. Owner, Niaz Ahmad &Isabella, store clerk Hearing violation on 1/25/14 @1:41pm violation cited per BOH regulations: sale to a minor(2nd violation) Previous violation: 6/11/13 sale to a minor- $100 paid fine Joyce Redford explained that this establishment tailed 2 out of 3 f compliance checks. The owner does not dispute violation but is asking for us not to suspend his tobacco permit due to the amount of people in the store at the time of the violation and that the store clerk, 18 years of age, was alone and overwhelmed at the time. Motion Dr. Ledoux motioned to suspend the tobacco permit of NYFC Food Market for 7 days effective Feb 24, 2014 and the fine$200 be paid. Dr. Alam 2nd ; All in favor(Chair abstains as per custom). Motion passes. Global Gas Station 200 Canal St Owner Dildar Hassim. Hearing violation -on 1/21/14 @ 4:08pm; violation was per BOH regulation: sale to minor Previous violation was: 6/13/13 sale to minor—paid fine Joyce Redford noted that this establishment has a history of I st offenses. (Tolling period was 12 months; as of 2/4/13 it is 36 months). He's had I st offenses for many years. Motion. Dr. Alam motioned to suspend the tobacco permit of Global Gas Station for 7 days in effect on Feb 24, 2014 and the line$200 be paid. Dr. Ledoux 2nd All in favor- Chair abstains from vote Mr. Hassim asked Joyce Redford that during these tobacco trainings, they allow the owners to explain that when these violations happen they are usually from an employee.not the owner. He believes there should be a more fair way of giving out offenses that do not harm the business owner's license if an employee of the business is the one that committed the offense. Joyce replied that during the trainings that her office conducts, there is an exchange allowed and business owners are encouraged to share their methods of how they keep their employees from committing these violations; in the end, it is the responsibility of the business owner to set their own policies for dealing with their employees. s 7. MEETING ADJOURNED: 10:00pm Respectfully submitted, Heather Lyons-Paul Clerk of the Board Next regularly scheduled meeting is March 11, 2014 at 7pm At City Hall Annex, 120 Washington Street,Room 311 Salem. f Ii Jf 1 i ! i Commonwealth of:'Massachusetts ? i City of Salem J Board of Health fln1beriey Driscoll }) 1 120 Washington Street,4th floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 09i24f2012 ESTABLISHMENT NAME: Salem Grill Z Chicken File Number.SHF-ZD09.00M17 105 Lafayette Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 1 Permit Type Permit No. Permit Issued Pew Expires Fee Restrictions d Notes FOOD SERVICE BHp 2072-0599 Sep 24,2012 Dec 31,2012 $140.00 ESTABLISHMENT J RETAIL FOOD BHP-2012-0600 Sep 24,2012 Dec 31,2012 $70.00 TOBACCO VENDOR SHP-2032-OWI Sep Z4,2012 Dec 31,2012 gS135.00 Total Fees; $345,00 1 i t 1 i j ) i PE 11+1IT EXPMES e¢eltnber 31,2012 Board of Health 41 s This Permit is.not transferable and must be reissue upon change of ownership or location.The permit must be poste in a prominent location In the Establishment, In accordance with the State Sanitary Code,beofre any revonat ions,improvements,or equipment changes are made, all plans for such must be sulenritted to and approved by the Salem Board of Health. Page! - CITY Or SALEM, MASSACHUSEI J.'S RECLj �GD rn..r. nem„. n„•.. BOnitu cm FIl?.u:ll I 120 WASI IINCI'ON-SIRFE r,4111 r'l.00lt 2012 I�II\IBERLEY DRISCO U, TrA-(978)74I-I 800 F\x(978)745-034AUG 2 IramdinCa�salem.com UmtN'K,\,N(DIN,RS/RI{I IS,CI 10, � Cl'-1 S M 'OR BOARD OF HEALTH Food Establishment Permit Application (Application must be submitted at least 30pdays before the planned opening date) 1) Establishment Name: 2) Establishment Address: �0� / �`C s�,M VXe M /'V!4 01970 3) Establishment Mailing Address(if different): /� 4) Establishment Telephone No: 1 7 k' 77S' S p 7 5) Applicant Name&Title: //n M(/J//7 4 6) Applicant Address: �� rO�ffs;r U�� jC/yJ fl, 4 © /C9�7a 7) Applicant Telephone No: 9/0 9 p 79 9?s 24 Hour Emergency No: �qj 979 994E�mail; 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of • officers or partner. An association Name Title Home Address A corporation CAn individual) A partnership Other legal entity 12 Person Directly Res onsible For Daily Operations Owner,Person in Charge, Supervisor,Manager,etc. Name&Title: S//!f lmUsllTAQ Address: o� 6 /CD,��si Telephone No: W49 979 995y Fax: Email: Emergency Telephone No: �0 -/ 7/ 991 g' 13) District or Regional Supervisor(if applicable) Name&'Title• Address: Telephone No: Fax: Email: Check#: I i o I Date: ) Amount: l(-� l_ Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: if applicable) ' 16) Days and Hours of Operation: ' 18) Name of Person In Charge Certified in oad Protection Management:o. of Food Employees: Ato rV� c Required as of 10/1/2001 in accordance with 105 CMR 590.00 (A) i 19) Person Trained in Anti-Choking Procedures(if 25 seats or more):20) Location: 0 Yes No (check one) la�) Establishment Type(check all that apply) (Permanent Structure Retail( Leo Sq. Ft) Food Servi ce-( �Caterer Mobile Food Service-Take Seats) 0 Frozen Dessert Manufacturer 0 Residential Kitchen for Retail Sale 0 Food Service-Institution ( Meals/Day) Residential Kitchen for Bed and O Food Delivery Breakfast Home 21) Length Of Permit: D Residential Kitchen for Bed and ---------_." Breakfast Establishments (check one) RETAIL STORE RESTREST�NT Annual Less than 1000sq:ft. $70 Seasonal/Dates: O 1000=10,OOOsq.ft. $280 Less than 25 seats $ qp-a O More than 10,000sq.ft. $420 O Residential Kitchens $140 " O 25-99 seats $280 Temporary/Dates/Time: 13 More than 99 seats $420 C]Bed&Breakfast/Childcare Services%Nursing Home - ---•-----------------•-- - --- •----•-----------•--- -•----•-- $100 ADDITIONAL PERMITS " '-'_"'•----_.___. _ O MAKE ICE CREAM,YOGURTISOFT SERVE 25 , .'TOBACCO VENDOR ` $13 0 ALL NON=PROFIT $13'~' Includ/n , church kitchens,state funded ch/Idcare 23) Food Operations: De & rivate clubs finitions: PHF-potentially hazardous food(timelteiiiperature controls required) check all that a l ; (/ Non-PHFs-non-potentially hazardous food(no timeftempera RTE-ready-t ture controls r ready-to-eat foods(Ex sandwiches,salads,mums which need no further el processing Pre-packaged Non-PHFs Sate of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Sale of Commercially Preparation of PHFs For Hot And for More Than a Single Meal Service Pre-packaged PHFs Cold Holding for Single Meal Service for and RTE Foods Prepared For Highly Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Susceptible Population Facility Prepared by Consumer Vacuum Packaging/Cook Chill Reheating of Commercially Customer Self-Service Processed Foods for Use of Process Requiring A Variance Service Within 4 hours and/or HACCP Plan(including bare hand contact alternative,time as public health Customer Self-Service of Ice Manufactured and Packag e d for control. Non-PHF and Non- Retail Sale Offers Raw or Undercooked Food of Perishable Foods Only Animal Origin Preparation of Non-PHFs Juice Manufactured and Packaged for Pre Retail Sale flares Food/Single Meals for Catered Events or Institutional Food Service Offers RTE PHF In Bulk Quantities Retail Sale of Out of Date Salvage, To be completed by the Board of Health or Reconditioned Food Total Permit Fee: � Payment is due with application 1,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 690.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CM 590.000 and the Federal Food Code. R 24) Signature of Applicant: Awli i Pursuant to MGL Ch.62C, sec.49A,I certify under the penalties of perjury that 1,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. ocial Security Number or Federal ID: i 26 Signature of Individual or Corporate Name: i D v6o 4 e ' +. ` • tea CITY OF SALEM, MASSACHUSETTS BOARD OF HENLTH PulblicHedth 120 WASHINGTON STREET,4'"FLOOR Prevent.Pretnote.Protect. TEL.(978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL ka ndin salem.com 1-[S, `" LAltttY[Lr11�iD1N,RS�RJ3 CI-IO,Cl)-l"S MAYOR HEALTH AGL:NT March 18,2013 Salem Grill Z'Chickew 105 Lafayette Street Salem, MA 01970 Dear Owner: On Monday February 25,2013 at 7:59 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 male purchased tobacco from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Salem Grill Z.Chicken is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Salem of tobacco to'a minor. 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 Y _($100.00 Hundred'Dollar fine)for the first offense:y? 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$100.00 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,4!"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 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. Sincerely yours, Larry Ra�in Health Agent LRlhlp CERTIFIED MAIL:70121640 0002 3312 8369 cc: North Shore Tobacco Control Program Barbara Poremba, Board of Health Chairperson and Members Tr— i -t vi *i �4t' I o anon Notice �' City/Town 1 Board of Health i Public Health Prevent. Promote, Protect. 4 s This notice is to inform you that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. Name of establish ment^ - Address Dale of iolati Time of violation Minor s age/gefider "Minors ID# Lnance,Section, u ati ..' (Act Constituting Violation) Narrative information: , U, 6�- t C\ L<:�! J'affirm,under the pains and:pen'na1 s of perjury,that the above report is true to the best of my knowledge and belief. Inspector ignature) _ M` (Print name) s r VEi IFSfi TE T: acknowledge I received this Violation Notice on ,•20 at A d I am being given a carbon copy of this notice.I also a knowledge that I have en in rmed at the Peabody Board of Health will provide additional,follow-up information to this violation notice. t' /;;' ,ner/Manager/Clerk(Signature) (Print name) If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be written on a note attached hereto.Mailing of this Notice is thus required. Contact the North Shore/Cape Ann Tobacco Alcohol Policy Program at781-586.6821 with questions s LJ CITY OF SALEM, MASSACHUSET"I"S BOARD OF HEALTH Ptib�iCHeBltth 120 WASHINGTON STREET,4"'FLOOR Prevent.Promote.Protect. TEL. (978)741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL Iramdinlramdin�salem.com LARRY RAMlllN,RS/RFIVIS,C:HO,Cl IN MAYOR October 21,2013 Salem Grill Z Chicken 105 Lafayette Street Salem;MA 01970 ' Dear Owner: On Wednesday,October 2 2013 at 1:06pm personnel from the Tobacco Control Program conducted a compliance check to determine If your permitted establishment would sell a tobacco product to a minor. No sales were made to a minor but six boxes of blunt wraps were found under the count. Documentation is now on file at the Board of Health regarding that sale. Salem Grill Z Chicken is in violation of Section G of the Salem Board of Health Regulation,distribution of blunt wraps. According to this section,A person or entity who sells or distributes blunt wraps within the City of Salem shall be punished by a ., fine of($200.00'Hundred Dollar fine)for the second offense and a 7 day suspension of the establishments tobacco [ permit. . Further,you are required to attend a meeting of the Salem Board of Health on November 12,2013 at 7:00pm 3rd Floor of the City Hall annex,120 Washington Street to discuss these violations and actions you are going to take to prevent their re-occurrence. 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$200.00 for the violation stated above and will not be allowed to sell tobacco for 7 days at a time to be determined by the Board of Health. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4c"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 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. i If you have any questions regarding this notification please call me at 978-741-1800. I Sincerely yours, La �din Health Agent LR1hlp CERTIFIED MAIL: 7012 3050 0012959 3452 cc: North Shore Tobacco Control Program Barbara Poremba,Board of Health Chairperson and Members Violation Notice CityMwn_ Board of Health PubhcHealth Prevent. Promote. Protect. This notice is to inform you that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine.Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. Name of estabbshmetir _ Lc Address J.cr 5 -Z i OCO IDate: viol Pion. Time of violation Minor's age/gender Minor's ID# 4 ` t - ,'(Orrdinance,Section egulatign) t - (Act Constitutling Violation) z - Narrative information: I affirm,under the pains and petilties o perjury,that the above report is true to the best of my knowledge nd belief. t, Inspect Signature) .: (Printname) 1 - VENDOR STAT I acknowledge I received this Violation Notice on - , 20 at M d I am being given a carbon copy of this notice.I also acknowledge that I have been informed that the Peabody Board of Health will provide additional,follow-up information to this violation notice. ner/Manager/Clerk(Signature) (Print name) If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be written on a note attached hereto.Mailing of this Notice is thus required. Contact the North Shore/Cape Ann Tobacco"Alcohol Policy Program at 781-586-6821 with questions Establishment-white NSTCP-yellow Board of Health-pink CITY OF SALEM BOARD OF HEALTH MEETING MINUTES `Novemher 12, 21J13� MEMBERS PRESENT: Dr. Barbara Poremba, Chairperson, Martin Fair, Gayle Sullivan, Dr. Danielle Ledoux & Dr. Shama Alam OTHERS PRESENT: Larry Ramdin Health Agent, Joyce Redford , Director North Shore/Cape Ann Tobacco Alcohol Policy Program EXCUSED: Heather Lyons-Paul, Clerk of the Board TOPIC DISCUSSION/ACTION 1.Call to Order 7:05pm 2. Minutes of Last Meeting G. Sullivan motioned to accept the minutes with corrections. (April 10,2012) Seconded by M. Fair Unanimously approved 3. Chairperson Announcements The Chair expressed concerns about the filling of the Public Health Nurse vacancy. The vacancy is having a negative effect on the provision of services especially in communicable disease investigations and hosting of annual influenza immunization clinics. 4. Monthly Reports-Updates A. Administrative The administrative report was unanimously accepted. The Board Report commented that they liked the new format,as it provides more details on the budget. B. Health Agent The report was reviewed and amendments were requested and it Report will be resubmitted at the next meeting for acceptance. C. Communicable The report was presented, corrections and formatting changes Disease Report requested. Report is to be resubmitted at the next meeting. D. City Council Liaison Councilor Furey sent his apologies he had a conflict and is unable Updates to be at the meeting. 5. Violation of Tobacco 7-1 1 of 28 Norman Street and Salem Grill Z Chicken of 105 Regulation Lafayette Street were invited to be heard by the Board prior to any • 7-11- 28 Norman St suspension of permit action for second and third violations of the Sale of Tobacco and nicotine delivery devices regulation. Joyce Redford of the Tobacco Control Project advised the Board of the violations and noted that both establishments committed third /second violations, in June and October. 7- 11 had previously sold tobacco products to a minor and cigars below the minimum pricing set out in the regulations. During the last round of compliance checks they were still selling cigars below the minimum pricing. If, the regulation is strictly read then the 7-1 1 has committed a third violation. Larry Ramdin advised that despite 2 violations being committed at the first visit to 7-11,he felt that this was a second visit, and then the violations should be treated as such. Joyce Redford Director North Shorc/Cape Ann Tobacco Alcohol Policy Program pointed out that the regulations are specific in that it is violation based not visit based. Mr. Romany Yousscf,owner of the 7-11 store told the board that the cigars come already coded with the prices from 7-11, he contacted 7-11 at the last violation and that did not change the pricing. After this violation, he contacted them again and they • adjusted the pricing. Mr. Yousscf, was advised another option if the pricing did not meet Salem Board of Health requirements, was to not sell the products. After discussion, Dr. Lcdoux motioned to suspend the permit for 7 days in keeping,with a second violation, and that the suspension takes effect from November 18-24 inclusive. 2nd Dr. Alam. Vote 5- 0 motion carried unanimously. • r. Assirn Mustaq�owner of Salem Grill Z Chicken,was'found to Salem Grill Z Chicken NM 105 Lafayette St The selling prohibited blunt wraps;at the•last compliance check. They sold tobacco products to a minor at the previous compliance check after selling to a minor,previously. Mr. Mustaq admitted that ' r it was his second violation and agreed to the severs day suspension,' � p 1 and a fine of$200.00. The suspension will take place from_ _~ November 18-24(inclusive) j 6. Medical Marijuana Dispensary Chris Edwards of the Alternative Therapies Group presented to the Board on the company's desire to open a Medical Marijuana Dispensary in Salem, if granted a license by the Department of Public Health. The application process, requires either a letter of 6. Medical Marijuana Dispensary support or non-objection. (Cont) Mr. Edwards requested a letter from the board. He submitted a draft letter to the Board Chair and the Health Agent. Larry Ramdin advised that the draft letter appears to endorse the application and the Alternative Therapies Group and suggested that it may be better to issue a simple letter of non-objection. Further, there may be other applicants, who arc seeking similar letters. Thus, it may be prudent for the Board to authorize the Health Agent to issue simple letters of non-objection upon request, by applicants. After discussion. Dr. Shama Alam motioned that the Health Agent be authorized to issue letters of non-objection, to the siting of medical marijuana dispensary in Salem, to license applicants upon request, 2"d Dr. Ledoux. Vote 5-0 motion carried unanimously. 7. Memo form Human Resources The Board discussed the contents of the memo and gave advice and guidance on resolving issues contained in the letter. MEETING ADJOURNED: 10:05 P.M. Respectfully submitted, Larry Ramdin Health Agent Next regularly scheduled meeting is December 10, 2013 at 7pm At City Hall Annex, .120 Washington Street, Room 311 Salem. t v vi iv ic. vc.rri LL1 �.vLLcuo aiiu t,atl./, LL1. -� J.7Va.lU VI rIVaIL111 L. nCUIIU111 1.7/O!`lVV3`43 Y g 1/2 Cottens and Carp, LLC Phone:61 -7 861-4529 Fax:866-723-8737 P" To: Board of Health, L. Ramdin From: Robert Carp Fax: 1-978-745-0343 Pages:2 Re:Appeal Date:August 18, 2013 Please provide this to Larry Ramdin, it is a request for a hearing before the Board of Health to appeal a suspension. Thank you, Robert Carp, Esq. 0 0 1215 Chestnut Street, Needham, MA 02494 Millions are now using the internet to send and receive faxes. Are you?No more phone line, no more fax machine. Try it free at www.rapidfax.com/free. -- •• �..++ vv ...vaa.... awaau vua lr LLv / Lv ui U vl lll�ui l.111 L 140.11IU 111 1�11V!2JV JIJ Y- gr2/2 CQTTENS AND CARP LL.0 1215 CHESTNUT STREwr NEWTON MA, 02464 AUGUST 17, 2015 City of Salem Board of Health Attn: Larry Ramdin 120 Washington Street,4th Floor Salem, MA 01971 Dear Larry, Please accept this letter as our request to a hearing before the Board of Health. In order to prepare for the hearing, please provide all documentary evidence obtained in the alleged purchases by minors at Bunghole Liquors. Respectfully, r ,1 Robert H. Carp PHONE:617.861-4LAW(4529) FAX:866.723-8737 WWW.CGrrENSANDCARP.com TRANSMISSION VERIFICATION REPORT TIME 09/'01/2015 22:55 NAME FAX 9787450343 TEL 9787411800 SER.# 000BON341991 DATE DIME 09/01 22:53 FAX NO./NAME 918667238737 DURATION 00:02:42 PAGE(S) 06 RESULT OK MODE STANDARD ECM CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH FtlbilcEle� 120 WASHINGTON STREET,4"j FLOOR Prevent.Promote.Protect. KIMBERLEY DRISCOLL TEL. (978) 741-1800 FAX(978) 745-0343 lramdin&salem.com L,\ItRY R,\MDIN,RS/REI IS,CIIO,CP-I S MAYOR Hli,;u,'nI AGI?N'I' August 10, 2015 Bunghole Liquors 204 Derby Street Salem, MA 01970 Dear Owner: On Tuesday June 2, 2015 4:37pm 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 17 year-old female purchased tobacco from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Bunghole Liquors is in violation of Section III (A)of the Salem Board of Health Regulation Affecting the Sales of tobacco to a minor. 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$200.00 Hundred Dollars for • the second offense and a 7 day suspension.The suspension dates will be discussed at the next Board of Health meeting on September 8, 2015 at 7pm 120 Washington Street 4eh floor. The owner/representative is required to attend this meeting. FOLLOWING THE THIRD(3R)OFFENSE, THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore/Cape Ann Tobacco Alcohol Policy 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$200.00 for the violations stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4eh 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 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. Sincerely yours, Larry Ram in Health Agent ' LR/hlp CERTIFIED MAIL: 7012 1640 0002 3313 4186 cc: North Shore Tobacco Control Program Dr. Shama Alam, Board of Health Chairperson and Members Violation Notice CC!V/ITOwn ",I Board of Health blic Health vent. Promote. Protect. i This notice is to inform you that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. Ole 61y 4loye ,.5; Name of establishment i 0" Address K Y Dat of vi lation Time of violation Minor's age/gender Minor's ID# :2 (Ordinance,Section,Regulation) (Act Constituting Violation) i . Narrative information: 6h/ , fy�n,under th Mains and penalties of perjury,that the above report is true to thebest of my knowledge andEbeliff. �.......- _. Inspecto Signature (Print name) VENDOR STATEMENT: I acknowledge I received this Violation Notice on , 20 at AM/PM and I am being given a carbon copy of this notice.I also a knowledge that I have been informed that the Peabody Board of Health will provide additional,follow-up information to this violation notice. Owner/M nager/Clerk(Signature) (Print name) If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be written on a note attached hereto.Mailing of this Notice.is thus required. Contact the North Shore/Cape Ann Tobacco Alcohol Policy Program at 781-586-6821 with questions I Establishment-white NSTCP-yellow Board of Health-pink CITY OF SALEM, MASSACHUSETTS 10 • BOARD OF HE, LTH 120 W ASHINGTON STREET 4"'FLOOR PublicHealth f Prevent.Promote.Protect. TEL. (978) 741-1800 FAY(978) 745-0343 KIMBERLEY DRISCOLL lramdin@salem.com L,\RRY R1MD1N,RS/RI?FiS,Cl IO,(.-])-IS MAYOR Hi"Aun i AGFINT August 31, 2015 Re: Hearing Request for Tobacco Violations Bunghole Liquors 204 Derby Street Salem, MA 01970 Dear owner: The Salem Board of Health requests your presence at the next Board of Health meeting for a • discussion of the tobacco violations at Bunghole Liquors on 204 Derby Street. The meeting will be held Tuesday, September 8, 2015 at 7:00pm, City Hall Annex 120 Washington Street 4th Floor, Salem MA 01970 If you have any questions, contact me at 978-741-1800. Sincerely, For the Board of Health Larry Ramdin, Health Agent LR/HLP cc: Dr. Shama Alam, Chairperson of the Board of Health, Board Members, &Joyce Redford, Director, North Shore/Cape Ann Tobacco Alcohol Policy Program CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH PablieHealth .�� Prevent.Promote.Protect. 12O WL\SHINGTON STREET,4 FLOOR KIMBERLEY DRISCOLL TEL. (978) 741-1800 FAx(978) 745-0343 lramdiri@salem.com DIMY 1L\MDIN,RS/RI I IS,(11O,CP-FS MAYOR HF?;\I;TI-I AGI."NT August 10, 2015 Nicole's Mini Food Market 406 Essex Street Salem, MA 01970 Dear Owner: On Wednesday June 3, 2015 5:11pm 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 17 year-old female purchased tobacco from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Nicole's Mini Food Market is in violation of Section III (A)of the Salem Board of Health Regulation Affecting the Sales of tobacco to a minor. 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$100.00 Hundred Dollars for the first offense. FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore/Cape Ann Tobacco Alcohol Policy 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$100.00 for the violations 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 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. Sincerely yours, Larry Ramdin Health Agent LR/hlp CERTIFIED MAIL: 7012 1640 0002 3313 4179 cc: North Shore Tobacco Control Program Dr. Shama Alam, Board of Health Chairperson and Members 1 r Violation Notice City/Town 4, Board of Health .ibhc Health vent. Promote. Protect. This notice is to inform you that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. I ' A . � Name of establishment. Address Date of violation Time of violation Minor s age/gender Minors ID# (Ordinance,Section,Regulation) { (Act Constituting Violation) Narrative information: f`f "r 'D IM ) r a firmunder,t'he ins and penalties-of perjury,that the above report is true to the.best of my knowledge ttrre) (Print name) VENDOR'STATEMENT:I acknowledge.I received this Violation Notice on 20 ` at AM/PM and I am being given a carbon copy of this notice.I also acknowledge that I "`r •' have been informed that the Peabody Board of Health will provide additional,follow-up information to ;:4 ' this violation.notice. IJ Ow Manager/Clerk(Signature) (Print name) " 4 r t If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must be , } • written on a note attached hereto.Mailing of this Notice is thus required. k Contact the North Shore/Cape Ann Tobacco Alcohol Policy Program at 781-586-6821 with questions „ Establishment-white . NSTCP-yellow Board of Health-pink' ' '`` Nicole's Food Store 406 Essex St. Salem, MA 01970 Phone: 781-696-7377 August 14t' 2015 CITY OF AL e S EM �'lz�� BOARD OF HEALTH AU0 19 120 WASHINGTON STREET, 4TH FLOOR t3oq i Y of R 2015 �OF jj�� M Re: North Shore Tobacco Control Program Notice C`'oTy Dear Larry Ramdin, I am writing to appeal the first offense notice of my employee to check for valid identification of minor purchasing cigarettes on June 3rd 2015. We have been in business for over 15 years and have complied with all city, state and federal regulations. I have personally looked into this matter and have taken the following necessary steps to prevent such incident in the future: 1. New POS installation which reminds the cashier to asks for ID upon purchase of any tobacco products. 2. Training seminar for all current and new employees. This will include information to the employees on checking Valid ID which includes a DOB for any person under the age of 27 who attempts to purchase any tobacco products. 3. Placing more signs and postage to remind employees and customers that Cigarettes and tobacco products are not to be sold to minors. I am confident that these new changes will prevent any future sale of cigarettes to minors at our place of business. We will continue to have a good track record of complying with all city, state and federal regulations. I humbly request you to reconsider this as an offense as it is our first violation in 15 years in business, and grant us a warning instead of a recorded offense. If you have any questions or concerns please feel free to contact me. Regards, Samir Patel, Manager CITY OF SALEM, MASSACHUSETTS IV . BOARD OF HEALTH 120 WASHINGTON STREET 4'"FLOOR %NcHean Prevent.Promote.Protect. TEL. (978) 741-1800 F.-�X(978) 745-0343 KIMBERLEY DRISCOLL lramdin@salem.com L,\RRY RAMD]N,RS/RL:I-IS,CI-K),(.:P-FS MAYOR AC;13NT August 31, 2015 Re: Hearing Request for Tobacco Violations Nicole's Mini Food Store 406 Essex Street Salem, MA 01970 Dear owner: The Salem Board of Health in response to your request will hold a hearing at the next Board of Health meeting for a discussion of the tobacco violations at Nicole's Mini Food Store 406 Essex Street. The meeting will be held Tuesday, September 8, 2015 at 7:00pm, City Hall Annex 120 Washington Street 41h Floor, Salem MA 01970 If you have any questions, contact me at 978-741-1800. Sincerely, C, �� For the Board of Health Larry Ramdin, Health Agent LR/HLP cc: Dr. Shama Alam, Chairperson of the Board of Health, Board Members, &Joyce Redford, Director, North Shore/Cape Ann Tobacco Alcohol Policy Program rr' President Comptroller Massachusetts Health Frank P.Giacalone,RS Steven Baccari,RS,CHO Saugus Westborough Officers Association /MHOAI Public Health Leaders,Advocates,Educators Vice President Secretary } N Derek P.Fullerton,RS,CHO Samuel S.Wong,PhD,REHS Middleton Hudson August 31, 2015 Salem Board of Health 120 Washington Street Salem, MA 01970 Dear Salem Board of Health, The Massachusetts Tobacco Cessation and Prevention Program (MTCP) recently conducted a tobacco retail inspection/compliance check in Salem as part of the Food &Drug Administration (FDA) contract with Massachusetts. After the retail inspection/compliance check was completed in your community, MTCP submitted the results to the FDA. The FDA has determined that the following vendors have had violations of the Family Smoking Prevention and Tobacco Control Act: BUNGHOLE LIQUORS 204 DERBY STREET NICOLE'S FOOD STORE 406 ESSEX ST — These vendors have received warning letters from the FDA for these violations. The inspection results are posted on the FDA website: http://www.fda.gov/ICECl/EnforcementActionsNVarningLetters/Tobacco/default.htm This letter is simply to inform you of the violation. No action on your part is necessary. If you have questions,please contact me at 413-636-6418 or at sarahmccolgan23@gmail.com Yours Truly, Sarah McColgan . Tobacco Control Director Cc: Joyce Redford, Lynn Tobacco Collaborative www.mhoa.com August 24, 2015 Dr.Shama Alam,Chair Salem Board of Health RECEIVED 120 Washington St.4`n Floor AUG 2 7 2015 Salem, MA 01970 CD OF HEALTH Dear Dr.Alam, My name is Asim Mushtaq,and I am owner of Salem Grill&Chicken on 105 Lafayette St. I am sincerely wishing the Board of Health to once again allow me the privilege of tobacco sales.Over a year's time has passed since that major part of my business has been taken away. It really has affected the livelihood of my business. Due to the fact about 65-70%of sales stemmed from the purchase of tobacco products.At the current moment, I am barely surviving to keep my business afloat and may possibly face having to lose it.This by all means is something I truly would not want to happen. I as owner of this establishment,ask wholeheartedly to be granted once again the privilege of tobacco sales. I do not in any shape or form want to lose my business that I have worked so hard to obtain. I am asking for leniency in allowing me to once again have the privilege of tobacco sales. It means a world to the livelihood of my business.I will do whatever is absolutely necessary to be in full compliance with the Board of Health if allowed this opportunity.Thanks for your time. Sincerely, /4c Asim Mushtaq, Owner Salem Grill and Chicken 105 Lafayette St Salem Ma 01970 The Commonwealth of Massachusetts - - Executive Office of Health and Human Servicts _ Department of Public Health • -- 250 Washington Street, Boston, MA 02108-4619 CHARLES D.BAKER Governor MARYLOU SUDDERS Secretary . KARYN E.POLITO MONICA BHAREL,MD,MPH Lieutenant Governor Commissioner IVE® Tel;617-624-6000 www.mass.aov/doh 2015 September 21,2015 1, `,�;�ALEfW LOAi-iD OF HEALTH Dear Water Quality Awardee, For 2014,a total of 2,282 public water systems in 33 states received these awards,including 63 in Massachusetts. I am pleased to present you with a 2014 Water Fluoridation Quality Award from the U.S.Centers for Disease Control and Prevention(CDC).Fluoridation of public water supplies in our country began more than 65 years ago. Today in Massachusetts 70%of our residents,more than 4 million people in 140 communities,are receiving the health and economic benefits of community water fluoridation. Each • community's water system reports their fluoride level to the Office of Oral Health. We then monitor and document the results in the Water Fluoridation Reporting System(WFRS)managed by the CDC. The CDC presents this Water Fluoridation Quality Award annually to public water systems that 1.Adjust the fluoride concentration of their drinking water; 2.Achieve a monthly average fluoride level that is in the optimal range for 12 consecutive months in a year;and 3.Document their fluoride levels in CDC's Water Fluoridation Reporting System. This award recognizes your investment in ensuring that every resident of your community receives the benefit of good dental health. Thank you for your hard work and dedication and congratulations on this special recognition!. Sincerely, 4S. dATC,RN,DrPH Brent D.Martin,D.D.S.,M.B.A. Director, Division of Health Access Health Oral Health Consultant, Office of Oral Cc Board of Health . Cc Mayor � I L All WFRS Water Fluoridation Reporting System 2014 Water Fluoridation Quality Award BEVERLYAND SALEM STATE OF MASSACHUSETTS Ae Centers for Disease Control and Prevention commends this water system for its consistent and professional adjustment of the water fluoride content to the optimum level for oral health for 12 consistent months. Consistent, high-quality water fluoridation practice, as demonstrated by this water system, is a safe and effective method to prevent tootle decay, improving the oral health of community residents of all ages. Presented by the Centers for Disease Control and Prevention United States Department of Health & Human Services Centers for Disease �. EM Control and Prevention National Center for Chronic National Fluoridation Engineer, Division of Oral Health Disease Prevention and Health Promotion National Center for Chronic Disease Prevention and Health Promotion D �