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SALEM BEER WORKS - ESTABLISHMENTS world 278 P',(by fitt j UNV-12110 WpENUSA Onow w +6 Commonwealth of Massachusetts + •�L + City of Salem Board of health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establlishment Permit DATE PRINTED: 12115/2011 ESTABLISHMENT NAME: Salem Beer Works File Number:81417-2004-000273 278 Derby Street Salem MA 01970 LOCATED AT: 0278 EIERBY STREET SALEM, MA 01970 Permit Tvpe Permit No. Permit Issued Permit Expires Fee Restrictions J Notes FOOD SERVICE 13HP-2012-6045 ,Ian 1,2012 Dee 1,L 2012 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT YEXPIRES IDecember3l, 2012 p "n, Board of Health This Permlt'.is not,,transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Cale,beofre any revonations,improvements,or equipment changes are made, all plans,forsu&nmst be submitted to and approved by the Salem Boar&of Health. Page 1 w CITY OFSALEM, MASSACHUSETTS + a� BOARD OF I IE-17.TH 120 WASHING'3'ON SI'REFT,4•"Fi..(n}R TEI.. (978) 741-1800 KIN[BERL.EY DRISCOLI., FAX (978)745-0343 j4I AYOR irwmhnUlSalcm.Cnm LARRY RANIDi N,IiS/RP:1 IS,(31(),CP-I;S H v\i;It t r1C31?NT 2012-APPLICATION FOR PERMIT TOOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT J ./i P-PS TEL# 7?$' ?yS' " ,2337 X ADDRESS OF ESTABLISHMENT 78 /-PW jb, S� FAX# 116 7'11- 7+ 39 MAILING ADDRESS(if different) //)- Com""► 6f.L 60-541:'-n , ` O>1 t y EMAIL-Business': JAMI ,& Website: AAdAW, "-f OWNER'S NAME 4 1n 1� Ste 5 A-,-- TEL# bt 7 M -9300 ADDRESS STREET / CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) SeZ Ce?uS CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON Jt� 5te HOME TEL# 6117 719 , &.Z&dJ DAYS OF OPERATION. : ( " .Monday Tuesday I—Wednesday , i >Thursday- " :r :.Friday : Saturday 1 Sunday HOURS OF OPERATION 1 j A-P I 1 Please write In the o1 day, f 1t +'12 itA�y I jl J dsw� ' I R ID �- D - Jkt^ o (For examoe Ilam-11pm) E F t 1,c TYPE OF ESTABLISHMENT FEE !check only) RETAIL STORE YES less than 1000sq.ft. =$70 1000-10,000sgA. =$280 more than 10,000sq.ft. =$420 - -... ---------- ---------------------------------------- -----..----- P.ESTAUR4N? ES "d0 less tf ian 25 seats =$140 (outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 - - - - --------------------ES----- - -O - - - - - ---- ----- ---------------------...--- --- --------------------- ----------$1---0----- - BED/BREAKFASTI Y0 CHIT DGARE SERVIGE$(NURSING HOME--------------------------------------------- •----- ------ ----- •------------- ----- - ..---------- ADDITIONAL PERMITS MAKE(not just serve)ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $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 annd,,,paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number Updated 523/11 FOODAP201 Ladm Chmk#&Date EXAM FORM NO. 1929 e CERTIFICATE NO. 5366249 OST ! 0 .0 warm Serv,Safo Certirication n for successfully completing the standards set forth by the National Restaurant Association Educational Foundatlo- " fcr the Ser•aSafee Food Protection Manager Certff:cation Exam asuon, which is accredited by the American National Standards Institute(ANSI),-Conference for Food Protection(UP). Presented by the National RestaurantAssociation Educational Foundation 5/14/2007 X DATE OF EXAMINATION h 5/14/21112 W n a W DATE OF EXPIRATION ^Z Eccal Saws apply CGxi•n41A youe Focal regWevxY aging fW reoertiriraUan:equeemanta .a a x I N v National Restaurant Association :`\— Marvrh.A409 EDUCATIONAL FOUNDATION < o Ptesitewt and Cher operating DMFwr Natwml AoStz,2M Ass ,niun£duCNionai Foundation W', W-nraef.Org Mif dewmew cenrgt be topmduced or aWed. *2WIft Na&,WReseawaw,Anavaeontdo OonatFoeada6m CStM7kR vg7a1 h IJ CERTIFICATE NO. 110583 Certified ServSafe-Instructor& Registered ServSafe Examination Proctor JOEL PINKWAS has successfully completed the following requirements for becoming a Certified ServSafe° Instructor and Registered ServSafe° Examination Proctor: • Maintaining a current ServSafe Food Protection Manager Certification* • Passing the ServSafe Online Advanced Test • Completing the Online Instructor and Proctor Tutorials •Agreeing to comply with the Performance Agreement 01/25/2010 DATE OF APPROVAL 01/25/2015 DATE OF EXPIRATION NATIONAL l - RESTAURANTDamtl Gilbert ASSOCIATION® Chief Operating Director, Officer, nalmesl Restaurant Restaurant Association Chief Ope Director,National Restaurant Association Solutions `This cetlicate is confinnmion of your dual ole she m as a Camped ServSafe mountain mm as a Rstsaimd ServSafe&m aretwPool Prmmm M w n Proctor This is NOT a SannSafe eon Manager Cameroon and should nomw mmm nted as one.You en a cannot Sardinia Food Pmtemon Manager Certification in ort rto return your Combed ServSafe Insuucair aM Sm,Saf t Embr maunn Procmr minus Oagomg rammrsmmarto mahmm train shouse as a Camfied ServSafe Instructor and Registered SewSafo Estimation Proctor mat be remained in a hMo time 082009 National Remaurent Associmian Educmional Foundation All rights maarved.ServSafe and it,.Sa.Sef t logo are national tmdemorm ofthe Nmonal Rema dart Associmon Edmatim al Foundman,and mad under license by Nmnnal trimmed:Associaton Solutions.L.C. a wholly owned subeidary of the Nmional Restaumm Associaimn.www ServSafe com This document cannot be reproduced or altered. 08018000 v0907 EXAM FORM NO. 4301 orw CERTIFICATE NO. 5152155 fSooervSafe N N ServSafe® Cerriticatioff n R�ir a �^ ..� •S c I TD ® P M "FERRARI . � for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafeO Food Protection Manager Certification Examination, which Is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). Presented by the National Restaurant Association Educational Foundation 1 /10/2007 DATE OF EXAMINATION 1/10/2012 DATE OF EXPIRATION Local laws apply Check with your local regulatory agency for recern ication requirements Iwo National Restaurant Association Mary M.Adolf EDUCATIONAL FOUNDATION President and Chief Operating Officer National Restaurant Association Educational Foundation vv w.nraef org ©2006 The National Restaurant Association Educational Foundation 05061402 y0611 Commonwealth of Massachusetts ` # City of Salem ' Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Salem-Beer.Works' Fite N=ber:BHF-2004-000275 278 Derby Street Salem MA 01970 LOCATED AT: 0278 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions(Notes FOOD SERVICE BHP-2011-0229 Jan 1,2011 Dec 31,2011 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l, 2011 f Board of Health ✓tJ 1 ,1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 i • CI'T'Y OF SALEM MASSACHUSETTS Bc)ARD OF HEALTH 120 WASHINGTON STREET,41"FLOOR TEL. (978) 741-1800 KINMU 7.EY DRISCOLL FAX (978) 745-0343 4fAYOR 0GRZENBn w n vnr�i�N CONS D AF7I)t GREENBAUN4,RS ACTING HEALTH AGFNT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ARAE OF I cSTABLISHMENT &Ur tnro Vict TEL#, q+2)*7 y S_ 277 -4 DDRESS OF ESTABLISHMENT 2-10 ll-2'�.L•1 r - FAX# 1 AILING ADDRESS(if different) R{er �✓C--1 C— CP OA4t Le- f(u c Dery j _0 �a I PA& 0-1,11q MAIL-Bus Less': Website: WNER'SAAME <'1eSct-rR/of• flrevl*Sj TEL# (,i1' 514 Z360 ADDRESS 00 Cr-t.^ ,f J .#— (i f +`vl 0ot d 2( ly STREET CITY STATE ZIP °RTIFIED IrOOD MANAGERS NAME(SI)� Q n c a CERTIFICATE#(S) ;F 'YuUry squired in ai,establishment where potentially hazardous food is prepare!) AERGENC+I RESPONSE PERSON HOME TEL# 1 I9 6 Z 6 b r .-r�C'ir1 ^�S': ":P:;" :T�<. p'+ :'JTi.:E d¢d�, �,Y,ax..x .}.y.., tURS OF OP Y� OP .ATI-RATION ^r i ,,I;I*.Mo�rdai :: 1(� �.: .,Wt `" :-.-.Yursr L .� (,(1d ;:Z,: ...` BhYitYZ Y<;'i=:r=:,atds , rPE QF ESTABLISHMENT FEE (check only}• I :TAIL STORE YES NO less thart 1000sq.ft. _$70 10OD-10,000sq.@. =$280 more than I0,000sq.Tt. =$420 T ___- --------.... ........ Y ------------ less----_....,.__....--••-•t— ..------ .._.__..,,.__. :STAURA'NES NO titan 25 seas =$140 utdoor Stationary Food Cart$21 26-99 seats =$280 more than 99 seats =$420 _ ..._ ... •---__ _ .....---YES --------------------- ---------------------------------------- *» ----•-------$--100---EDlBREAH:FAST7- NO UDQARE,3ERVICESII`# KING HOME.................... --,......................... ................__....._....._._...._-,........ )DITIONA, PERMITS WE(not jl lst serve)ICE CREAM;YOGURT/SOFT SERVE YES NO $25 )BACCO WENDOR YES NO $135 LNON-PROFIT(such aschurch kitchens) YES NO $25 ease pay fatal vrith one check payable to the City of Salem. its Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted In a prominent location :he Establishment. accardan;e with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for ;h must bt submitted to and approved by the Salem Board of Health. ursuant to MOL Chapter 62C.Section 49A.I certify under the pains and penalties of perjury that L to my beat knowledge and belief,Save filed all state tax me and pall as state taxes required under the law. 11fl_f {?c} � t22ZLTL lature Date Social Security or Federal Identification Nimber lead IW7/I1DAl'2011.adm Checkp&Date "'-1)x{7 1 )I z •d 269LTbLBLBT S)IdOM N33H W3ldS WU66 : 1 OT02 GT AOW CITY OF SALEM BOARD OF HEALTH Establishment Name: S Date: 3 —i h -V� Page: ) of I Item Code C-CrItical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date, No. Reference R-Red Item PLEASE PRINT CLEARLY I Verttled � to� taY,u sa11G� - - I I i I I � I Discussion With Person in Charge: Corrective Action Required: I Li ____P Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: v 3-501.141C) PRFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk According to Iaw Cooled to Factors(Items 1-22) (Cont.) 41'F/45"F Within 4 Houm PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 1 19 PHF Hot and Cold Holding j l 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 3-302.14 Protection from Una moved Additives* I 59 01.16(? Hot P 'F* 15 Poisonous or Toxic Substances 1 3-507.16(A) Hot PHFs Maintained at or above 1400F. 7-101.11 Identifying Information-Original Containers* 3-501.16(A) Roasts Held at or above 130'F. 1 � 7-102.11 Common Name-Working Con[ainers* 20 Time as a Public Health Control 77-201.11 Separation-Storage` j 3-501.19 Time as a Public Health ControP 7-202.11 Restriction-Presence and Use* ! 590.004(11) Variance Requirement 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Satdtizers.Criteria-Chemicals'* 7-204.12 Chemicals for WasMne Produce.Criteria* 121 3-801.11(A) Unpasteurized Pre-packaged Juices and .Beverages with Warning Labels" 7-204.14 Dryma Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 13-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 1 I 3-801.11(C) Unopened Food Package Not Re-sensed. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME(fEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for I Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- i55°F 15 Sec. I Pathogens.*Em v""`: f Eggs-Immediate Service 145°F15sec^ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game i Ems* Animals-155'F 15 sec.* I SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 thin* 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.004(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-40IAl(C)(3) Whole-muscle,Intact Beef Steaks ( interventions and risk factors. Other 145OF* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(6) All Other PHFs-145"F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS R-LATED TO GOOD RETA2 PRACTICES 3403.11(A)&(D) PHFs 165-F15 sce. * (Items 23-30) 3403.11(B) I Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the fallowing sections of the Food Cade mid 105 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsticed Portions of Beef i Item I Good Retail Practices FC590.000 mj Roasts* ! 1 23, 1 Management and Personnel FC-2 .003 I 1g Proper Cooling of PHFs 24. i Food and Food Protection FC-3 .004 25. Equipment and Utensils I FC-4 .005 1 3-50L 14(A) Cooling Cooked PHFs from 140'F to 26, Water.Plumbinq and Waste I FG-5 .006 f 70'F Within 2 Hours and From 70"F 27. Physical Facility FG-6 1 .007 I to 41°F/45=F Within 4 Hours.* 1 28. ( Poisonous or Toric Materials ! FC-7 1 .008 1 3-501.14(B) Cooling PHFs Made From Ambient 1 29. Special Requirements 009 1 Temperature Ingredients to 41°F/45"F j 30. I Other ! 1 Within 4 Hours* 'Denotes critical item in the federal 1999 Foci Cate o 103 CSAR 590.000. I F 11 in•I I III I oil I I I III u .uln...I i I I nm�In�i�mu��m�iu aims uu•a°I d... ., �rnl.!..,.d,.., ° ..... ._.. . .,,..! ..... .,.... .... ..... .. .. .—. .. . r . ... II ' El I 1 1 SODA 002 Z8 29 30El I O EE I 31 28 (0 O) I -- � - -� 33 QCT 0) (O O) Q V QCT O) I 26 � - r-- - - - - I /d� �bl ❑ 34 70 27 60 I 35 � I � n n 24 25 I e I 361 Q 0) Q 0) QCT a) - - - - — ❑ I 56 Q J) Q O) (�J ��) ' I / I 20 D 37 3 1 4 5 6 I 2 38 � . I� N ® I 8 0 't 55 - - XZ2 ❑ o QCTO) QCTO) nn �t , 7 7 I ❑ e I 39 I Qc.J 0) (0 Q0 l,= d 40 3_ I I (0 0) CL 3) (0 - 64 41 54 III rU QJ Q J) (0 J) Qn CD) Qn� (00) (C.) 0) (n 0)'F1 43 (0 O) (0 nn) (n 53 1� 44 0) Q ' C» 13 Ell 0)52 - -+ I I 0) Q0 0 QD 01 10. I a 1 I i I �p V v 0010 005 I TAP 86 90 \ V/ I r' 83 84 85 91 92..,... in O �O II 80 82 gg 93 94 I 1 81 87 _ 95 , I 11 89 u (�I —1 I I I j 1 - ► � � LI I , u ; I I, 198 0000 99 96 97 1 ae I . O DATE No REVISIONS SALEM BEER WORKS 278 DERBY ST / SALEM, MA 01970 978-745-2337 EASTERN BAKERS SUPPLY CO., INC. \ 145 NORTH WASHINGTON STREET BOSTON,MA 02114 617-742-0228 PHONE 617-723-8835 FAX SCALE DATE DRAWN BY 9 1/4" = 1 '0" I DEC 22,2010 �+Cu✓��Ni¢ DRAWING NUMBER i 2010122201R1 ..A. LR 'r fF<. '+"'�,-... ,i w•7. :Y"'"^`I;c^' ry .wt F'*"!)..*a..... rwt-s' .�.r- •a.e.-F�»v»•.r +7a1-'� :7+°r'"r.•:71�+r'+,a{'.w'*,f°.,�.,,�.,.;r.'v'`'- ..y .�.vw Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT v Tel. (978) 741-1800 Fax (978) 745-0343 Name, (� Date Type of Ooeration(s). Type of Insoaction `.n Q 0/Yv _ \ l n D 11 , l j -,Iy C V\ j7- �_ /)I N. Food Service IN Routine Address tri Qn A " C A p � Risk E] Retail Re-inspection J Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner ll1 �`' HACCP Y/N El Temporary ElPre-operation PM I P�(2� ❑ Caterer d ❑ Suspect Illness Person in Charge)(PIC)� r / �\�pn Time ❑ Bed&Breakfast ❑❑ HACCP General Complaint In:�:W�� 1( Inspector �� 'n o �(D or4 P V. Out:- -A77;rW I Permit No. ❑ Other `Each violation checked requires an expf`ari'ation on the narrative page(s) and a citation of specific provision(s)violated. Q Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco / Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [1 � 590.009(F)�I action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT,_', "- ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities - EMPLOYEE HEALTH ' ' """ "' --' ' b„ " PROTECTION FROM CHEMICALS -_.0'2,. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE._,,,.,,;.,::f; _._:... TIME/rEMPERATURE CONTROLS(Potentially Haxaidous foods) El4. Food and Water from Approved Source ❑ 5.•Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating y. ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16. Cooling l PROTECTION FROM CONTAMINATION" - , ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection _ ❑20.Time As a Public Health Control Z 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY (� 11. Good Hygienic Practices 22. posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-z) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.0so.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: �,(C�--d r ssaln s speaPoma-ta aoc �i �� 'v) _ o:JCX c,�iajva4o Inspector's Signatdre:-,(1 U Print:( f riN )Jll f�tR a , (�i-)k k I � (_/�"_XT✓Xe PIC's Signature ., %(. Print�� hCG C Page of ges �J ✓ .� .. v V v Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 j Cross-contamination ( 1 590.003(A) Assignment of Responsibilitvr 3-302.11(Al(I) Raw Animal Foods Separated from 590.003(B) Demonshation of Knowledge* Cooked and RIE Fools* 2-103.11 Person in charge--duties Contamination from Raw Ingtedients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* J 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1 NA) Food Protection" applicants* 3-302.15 Washing Fruits and Vegetables -_-_-� 590.0(13(F) Responsibility Of A Fond Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In (, Utensils* Charge* j Contamination from the Consumer 590.003(6) Reporting by Person in Charge* I ( 3-306.14(A)(B) Returned Food and Renervice of Food* j 31 590.0030 Exclusions and Restrictions* ( i Disposition of Adulterated or Contaminated 590,003(F.) Removal of Exclusions and Restrictions j Food j 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 1 4 1 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compttance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 ( Food in a Hermetically Scaled Container* Sanitiration'remperattires* 13-201.13 I Fluid Milk and Milk Products* 4-501.1 t_ Mechanical Warewashing-Hot Water - _--� Sanitization Temperatmes*3-202.13 1 Shell Eggs* I 3-202.14 I Eggs and Milk Products. Pasteu ize& ( 14-501.114 Chemical Sanitization- temp.,pH, concentration and hardness. *' 3-101.16 lee Made From Potable Drinking Water- 14-601.11(A) Equipment Food Contact Surfaces and j 5-101.1 t Drinking Nater from an Approved System- � 1 590.006(A) Bottled Drinking Water* Utensils Clean- ( 4-602.1 i Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 2_. n 0' Shellfish and Fish From an Approved Source ( Contact Surfaces and Utensils* Fish and Recreationally 4-702.11 ( Frequency of Sanitization of Utensils and .1 ally Caught Molluscan Food Contact Surfaces of Equipment' Shcll ish' 14-703.11 I Methods of Santtization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical' Sources* j 10 ( Proper,Adequate Handwashing Came and Wird Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms"` 3-202.18 Shellstcx k Identification Present, 2-301.12 Cleaning Prrxcdure* � 590.004(C) Wild Mushrooms- 2-301.14 When to Wash* 3-201.17 Game Animals* it Good Hygienic Practices g ( Receiving/Condition I 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 ( PHFs Received at Proper Temperatures* I 2-401.12 Discharges From the Eyes, Nose and 3-202,15 Package Integrity* Mouth* J 3-101.11 Food Safe and Unadulterated* ( 3-301.12 Preventing Contamination When Tasting* 6 Togs/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellsteck Identification* 590.004(E) Preventing Contamination from 3-203A 2 Shelistock identification Maintained- Eutplovees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible j 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.0040) Labeling of Ingredients' 5-204.11 Location and Placement* 7 ( Conformance with Approved Procedures ( 5-205.11 Accessibility, Operation and Maintenance IHACCP PlansI Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Method-0Devices 3-502.12 Reduced oxygen packaging,criteria * I ( 6-30111 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures'" ( � 6-301.1? Hand Drying Provision - I r Denotes critical item in the federal 1999 rood Cate or 101 CMR 590.000. z a CITY OF SALEM BOARD OF HEALTH 'i Establishment Name: Q0 iv-Y-, c:e1� C`k S Date: far C Page: I of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date F No. Reteran �UF/1Air"yR�IW�l—'Red Item tem IL PLEASE PRINT 1CLEARLY Verified V �_\ !UOIAUy��O/ 11. n''Vni,(Y 94iA,,rP,, A)'nn PnII:'th,2 f 01,�I ._0, D, 0 A_9).) 1l_�—a 1 t/�. " 1V_/�_ �� A ��Z �Q/L)i1�_._�_ 1!`(A� O'Ao/_11AYE I�AnT I AAA!( SAY `C)( r1 X !� V AA 1uP Y f.w (nn U �rA 't I �4(n. "(4-11f�rrgs,""11�!!//''�S� �XN. >0.9 �lrinV 1` I i1`' ,�(� \CJ L Vrll v f I AlL ]arc1n -�o Fa P Aft z�,o e u. -L Li tnt t le.� t e I 0x— Q,4A_r),j2 t1(; ,Cil �u17i O_ L. k/� )AA AJUt 11� Kl.. (Ab)P 0-13-01 to- 3T C1 (. -�� '2 Ci -� I ry _6 nOA -i'0, r: �10� 1 ufi� (�'.R4k -6 !°QAC.P2 1� K0 -./r:i> SFA . `1�1V✓�G'L/�.{� IY YY/Inc . I 4 �� \� /10 rllf �J Y V"n fft, i JI C�\ y., Q cA rf AYr -4?A 0.1 ,V ,1n V1.10 Discussion With Person in Charge: Corrective Action Required: ❑ No O Yes { I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I understand that .I noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure r your food permit. � ❑ Voluntary Disposal ❑ Other: i f 4-501 )4(C) PHFs Received ar Temperatures Violations Related to Foodborne Illness Interventions and Risk Acewding to LauCooled to Factors(Iteltts 1.22) (Cont) 41`F/45`F Within 4 How's *" PROTECTION F90M CHEMICALS � 13-501.15 I Cooling Methods for PHFs � 14 Food or Color Additives 19 I PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or beloix 3-203.12 I Addiuvcs" 590 00.4(}) 141/45°F" ll 3-302.14 Protection frontnapnroNed Additives, j 3-501 i6fA) I llot PHF=s Maintained at urab•rva i 15 i Poisonous or Toxic Substances i 140.1' 7101.11 identifyinginfonnalion -Ortgma' i I ;1.16(A) Rt Fera>H..id at,>r above l?tl'F l ontainers' t (.% 102 11 _! Common Name -W'„rki4tc Coafawar>` L20 Time as a Public Health Control i I i-'_OIJ 1 Sr�ar.tuun-51ura•e i '.`pl 1:---- Pim,.•an a Public l leaith Comit;l' 7-202,11 f Restriction-Pr:acncc mid L,r` db,'iC>-ltHt,—_- -1 V`ra,c.'t._Rejtdrenxut i 7-202.i2 I C'ondnion:(IfUsc'" 7-2w t I Toxic Coaramw -Probibitiom,, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � 7- 04.11 Saniuzers.Critrria-Chr)niaa' POPULATIONS(NSP) 7.204.12 C'hentiead>fbr Wa,hmg lliodIicc, �- --- Ciuter._ft' �t 21 1-Mz 1.11(A) Unpa:teun,cd P¢-naelagle,adbl,•oisic ec wid 7-?04,14 Urlirw Arent.Criterl3etzwith isaruine -- 1](13, 1Cg,` -205,11 t>>1 Cuntet. Lubncm,!, i _— .;I!ltt i,,lv or)';�t3;s€�. Ct',tk:d Animal Fo(d anti j I 7�206.1I _ Re.p r,Ird 1 >e Pe>tiuder".Cnteu?+ 7_ �__. Iia',: tit °;1 nn:d, \'oi $c'!'z 7-_tri 12 R++IctH 13,rf Nin wii,,' � ___ r=i. , t , 4 r' '1 :.: i:( t., .t.'l, 1' " ":I i(:'I ^, ir,'cV,'na;,^a�Err:.Y' _��__.._ 4++nttoi+n,;" OONSVMEf', .-^DVIS CRY 3,,1: 3 1 t or."ur1e, "n:.:,on 1 o:wd for t :mstunnli„n o� TIME'TEMPERATURE CONTE OLu i i'— i 1 .,!4'114+: i •4`i{, i[F.+t ai",' IC.P t'LICR JPnr:r 4': ' ib nto9>or Cooking Sempe:atarea;or I .. ' tt'iCt r x '7011:::(11;. }i;;,:?,:-i;nn:,d:.tt: Sri.,., i :5'Cis'e: i . , _., t .r;;,.d•F; S,i+<'=un•'t;r Etat, slwii ` ;. I0!A iia+(,^: i e_,:nrr:ini:(ed E'P.h, i:ic'a. °. *-.X:i:' 1rUif"i!r e: is G,n" i i Cd3Et'tr ^Y .t C2 F, f T.ry -491 ! I(At;'. � }.,.,+iii i:,izt!n; kh�!: ,i ' t' ! i ,''t.'.'. SS'1it,...i,.n Jd',.t.tt •'HS iHf/iar-i U, :,, I we iF„Fal',+ and 3 (Ali, 4, '.::' 11 c ' •,";i-. ! :�:'r.'ti:.;tl t.'iC ti.'t . " . ,.::Crit: i .t I J [i1 Ii V' i t t)tr^, i5„t l�;:t'!:: i4i'�Y,:i , t 1 '1;^: '. tuC 1,. lY i ' ;� "Y^•itf?irfi;ifSt Tia"e ltp}4±Irr4 _ x,,.v..,,,n'ib� ,,t:,.�o ,�.r'.)ij tCia'f_ - !44 , - ; - ,Y '3 ' 1 3-.;03.1€,A)•t'i E)' i=i il• !h`•. .. vc.: ...— _ ._! t,1f+=rzt= 21,jttl - ;-403.)lilt! %11,hn,:,l'e- F Mmul, .yarding G+:a -r .,rhrta:-,,.o.:r,: :. .i: •'... :nut:do 'ar: •,':ut^D%:1•,' j Imle, ,ri.. rrtc"/Gt,•c, pt•,+';At:� r., ,..c i,,4C idle,(, Y,le,t,;:Vw, r.al it I 4n3.i 1,Ci ! i,',.w!r,=a t•t.t!Iv lS ta:...,:d ':IF 1, " -'- k,"ur: n: :t.,v ,,,� ,. hr ,`o,;;,''f'.�,ic,u:,l Int 403 . hL, tRrmamta,!Unnhceu Po.Bons+:i EScr; ftenr `, Good r:cta;t Practices .I FC 590.00 �.v.___°"r:^,;tnRG^nturt 7t'C ._ •_C,.`r,dnrd`lx,d f:'Oit_tit,;i ! G(.' s "-;-(A4 --- -� 18 i Proper Cooling of PHFs 74 __. n:' G,��tft:,nt•7nd il__t,gi.3 F,^_ t-...t. _ ? 501 It A) t'tx=lin!>C:xtA�dPH1=c hom i-A)•i=7v _ .^_ . t ( � ', o. i•`Jat.rr P6.r,,.,nC"mac ! ! :WF \t'nir:n 2 Hour,and Frim : 1,1 1 27 Fac!;r� -- - --- ---F(, o;t3nri_t t{nw:• ' ! <<^ir >o!,o;:;tis of ',tx;c ra;te•,a:: --- mil -7 -- - 5o1,1411i, ` ''tvdine HIR Mair Prom A;n€'mot Trm}'etaunc lntre.iicait. t.'=i' 't:'< P :�' _: either - t .,.,... ----- 2:1, yr v. .i , ....:i('.... Lr.t ',il.. ,,.r, h- ,.rr. �;-a• x. .. .. bi�rJ.w..-N?J.MsYe 1. ws1 w .s�RNy+k+wrdanesl� ;*' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'"Floor Division of Food and Drugs ) Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date a of 0 erasion s Tyge of Inspection ��AQOnM �-P0A ��(i1(4 C 0-�� ( Food Service Routine Address 1 A \, Risk El Retail El Re-inspection u'n �a - Level ❑ Residential Kitchen Previous Inspection Telephoneq r ElMobile Date: Owner 1T_ HACCP YM ❑ Temporary ❑ Pre-operation a- 1 P�K?�P �' PDQ I ❑ Caterer ❑ Suspect Illness Person in Charge-(PIC) \\�� Time El Bad 8 Breakfast ❑General Complaint ,_/ �/t�T' OA Cl Ti: I i ❑ HACCP inspector ^� �� Uhl a/ I Opt: g Permit No. El Other Each violation checked requires an explanation on the narrative- pages) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking /Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 0 590.009(F)i po action as determined by the Board of Health. CZ FOOD PROTECTION MANAGEMENT, ; , ❑ 12. Prevention of Contamination from Hands�) E31. PIC Assigned/Knowledgeable/Duties (" \ • , , „ ❑ 13. Handwash Facilities EMPLOYEE HEALTH - ° PROTECTION FROM CHEMICALS " ❑ 2. Reporting of Diseases by Food Employee and`PICEl 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded l� - FOOD FROM APPROVED SOURCE''" El 15.Toxic Chemicals :, `.-, " ".. """".. " ❑ 4. Food and Water from Approved SourceTIME(TEMPERATURE CONTROLS(Potentialty Hazardous Foods) E] 5. Receiving/Condition /�� El 16.Cooking Temperatures [16. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating l\ E] 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling l PROTECTION FROM CONTAMINATION "' ❑ 19. Hot and Cold Holding / [18. Separation/Segregation/Protection El20.Time As a Public Health Control (/ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(MSP) �J[ ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing I }�\\\ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C _ N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-x)(59cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(5900.. 044))005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s)(sso.00s> establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901W.tF. rte d. Inspector's Signature: �.��(V� JJ, Print: C'I�- PIC's Signature: �X c Print: ��G,-.b �(�,X-rLv c` I Page ' of I Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT (.8 Cross-contamination 1 590.0031A) Assignment of Resnonsibility* ( 3-302.11(A)f 1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge` Cooked and RTE Foods* 2-103.11 Person in charge--duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge n) Contamination,'ram the Environment require reporting by(ml employees and 3-302.11(A) 1-ood Prrtecrion" applicants* 3,02.15 Waahing Fruits and Vegetables 590.003(F) Responsibility Of A Form Employee Or An 13-303.11 Food Contact with Equipment and Applicant To ReportTo The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* ( 3-306.14(A)(B) Returned Food and Resemce of Food* 3 590.003(0) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions ( Food 3-701.11 Discarding or Reconditiomng unsafe FOOD FROM APPROVED SOURCE Food" J 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" ! 4-501.1 1 1 Manual Warewashing-Hot Water 3-201.12 Frxxl in a Hermetically Sealed Container" j Sanitizarion Temperatures* l 3-201.13 Fluid Milk and Milk Prcxf=c * 4-501.;1_ Mechanical W'arewashino Hot Water 3-202.13 Shell Eges* '. Sanitization Temperatures* i 3-202.14 Eggs and Milk Products.Pasteurized* ( 4-501.11Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water- ; coneentianou and hardness. * 5-101.11 Drinking Water from an Approved System' 4-601.1 I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean' 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 220" Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source j 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Eauinnient* Shellfish* i 4-703 11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed f Chemical* Sources* ( to I i Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2.301.11 Clean Condition-Hands and Arens" , 3-202.18 Sheli;hxxk Identification Present* 2-307.12 Cleaning Prv.:rdure* 1 � 590.004(C) Wild Mushrooms' 2-301.14! 2-301.14 When to 3-201.17 Game Animals" 31 Good Hygienic Practices 5 Receiving/Condition 1 2-401.11 Eating,Dnukmg of Using Tobacco* 3-202.11 P 2-401.12 I Discharges From the Eyes,Nose and IIFs Received at Proper Temperatures' ( Y 3-202 i5 Package Integrity* Mouth* 3-101.1 L Food Safe and Unadulterated* 3-30112 Preventin Contamination When Tasting*_ [; Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.16 Shellstock Identification * ( 590.004(E) ( Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 PaiasiteDestruction I I Conveniently Located and Accessible 3-40'_.12 Records.Creation and Retention* 5-203.1 t Numbers and Capacities* 5-204.11 Location and Placement* 590.004(J) Labeling of ingredients' C 7 I Conformance with Approved Procedures 5-205.11 Aceessibt!ity, Operation and Maintenance /HACCP Plans ` Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices - -- 3--502.12 Reduced oxy„en packaging,criteria" 6 301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures' 6-301.12 Hand Drying Provision r Denotes critical item in the federal 1909 Foot Cale oi 105 C-MR 511(1.000. CITY OF SALEM p BOARD OF HEALTH '' ( ' Establishment Name:� A,,') ) Date: _ Z,—�Q Page: of { Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I AT1�,�t ,_� (nJP �Acv1�A� rlDAAU 0P1no'A4)V ;PAf "V A'/n /1/ � J L/�cl ( p Ir �(�� ',,;,(�ar1�f ' <.aX>�� -I 11b M,- h (a n�)rn� L� II )nA 4)A_Y AAJ (Af)C11 (M,- — �uY4onMeG �KLZ \!P/I 1fJi1AY.Lt, I L :* I�1o�A� t�TA o .1 1P �I � o 1� /��a'Qz —� I crli� It (�/�/gyp A P an 1� 1 i �� \/ % 1✓,I(�P/il'__/ ( M.M, n�_� l�C}J(X,. .ICY -c'l Z'e'(n /lC /1! i�1! A .Q �j Y ,r-tf> I . ��1 o ,L- \I- A 0.,A/1 - iivl l o n,,� �� 0�1 ��C` � �• _ - / �n.4� l7� �_/��7.(11 CC-nr.�0._ ,(��b7n,r i�/; � _ !. 1 0 a.�/1 X/ on�7 A 01 I\An (31-0 r/I�!_��A a a i tDiscussion With Person in Charge: / Corrective Action Required: ❑ No ❑ Yes —1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. L / -v 1i(P r/ '4 //6 ❑ Voluntary Disposal 0 Other: Pffl-s at Tempurarmkw A&A"s MAW 1c,Fcodfw it,hiness,[Wmvm'.,oras zzmet R13k i Acco--fitg to Ltm CcAvled to Factors(items 1-2Z) {Conti PROTECTION FROM CHEMICALS 3,500 15 CarlingNlzarcsds tor PHI's 14 1 PHF Hot and Cold Holding 14 Food or Color Additives 1 WLM{Bk Cold PHEs 39ninu6ned at ,I bizil�w �-202 121 1 Azbbti,i:zs, ;qu 3 31)2 lit poe,t%tl,ar front(,noj!proi ed A&i!-r.", 3 MY INAj I hil P!His NIUALdned it 1W abiv, E 1S P6qrmous of Tcinc SuloatAnIzes 7 1111.H iiO,:z,,1n2! I^z,v Rtyt,.field at or above I TOP. 6 ioTime as a Public Health Control Io2 it ("Isnaan"Nan't WWWWamm, I 1 3001 B RMO as z,flobli":Health 1-cntvt)P 541rm)(s;olr V triap�,tz Kc-4wremern 7ow 1s yy 'Ri,m-mior, - 'Pratwe and LMA WW2 nxu:h4m�M 1 Q- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) j 204.11 I sxtiliver"ctnuenj-chowrov 31 300C 1 U Q UnpanteurIzed PrnlWagcd;Diet's sat'7-",(4�i 2 ells 7 20?14 Dn0f. Ammn I YB) uo!of Paz fealli7ed 1cLttz 320L i i;',7} Rawrr Partially WKd AWmal 10A mnl o--,06,I lo�wh wA 1 A PVU"p& CrIm W, Raw S'ed:;pr"alit No Served. 7 -'00 1" ! %PAIN, I Win tied F,�Ol N,;s 7 206t: lonkmgNsAr. Pat Gowind +-:.-•._.._...__ — CONSUMER ADVISORY 22 3 403 11 Consumer Aokooi� i1wod lor Ccrtu"uptioa k.1 '"MEITEMPERATUnE CONTROLS Aannal F.xA, 11sa, ary Raw, L4tderx,,Ltd(it 16 Wt, WakinTemperaftwes to ,,t 0dw g v.: se Prc,.Csted n) 34W vy") I!, On V I q oa hu"Kne Q,io' I 1-1101.1. Awmlk 15; '. 15 Svc. SPECIAL REQUIREMENTS KWLI VBI I Q) rwL w d 13ml Won IW 111'_1 non' oi� eoj(,Jj �Iaj�Q)9t1?t I'Zzant, 1---5.;_ IS wo , A 4WA hAr Y S Noty Wild Wow Winq!WMrvmdential citJPen orvn�tilrna hunld be pisn szle;at, J-Antcd Lkodo,Ilic apprupraftc ,,etiions 15zOO. alx,tt;if-,elated ii,IbcAbunw i[Int-si 30OLI wc0o ho!'- nau"t-10, inna Eteof Mcaks q90.009 ro,.ttkxi !';tail 2 Rnriprivv,iicee houla he debitc0undvi !Qt; 165 T N A 9 P11) (Thz,I Q W - I ay k So' 17 ftaRa±ting tar Hat HoWing i 17 Lai rJOWS RELATED TO GOOD RETAIL PRACTEWS 3-40111(AEW 0) II PIH- I WF 15 w. - 23-30) 6013-1 HH! j Mwlox avo, 16 ` F 2 Atatue swulng t ctilrraAnel n:,,zii r4n,al vk,kilp,n,z. vvwch dow); clare co ire, Tate' frommVinne 0h SA www anknu iml 10A jacywf liqui Wwr, "in be 3 Pcovzwd Anwof I 0wp&N,oq.,,,Pmn r,;'ch,'f ot,d furl!,,:,!,? h6 Ci4l? j W!t 1 No Rommup Kuhred ENO non%of IWIS Item 1 Good Retail Practices 23 ; k - 2, j Rout ' t...-_-- L-N WC 18 Prapssr Cooling of P,4Fs 1 24 1 FD)d oa,d r0W Prolectron i FL- 3 ON r2tt-T-Eq'�-Lpj-j1 � -- ------ i 1 WITAI CNIngCook"d ptii';- imp, QPFU, _m!md Utensils : FC,-1 I 2R: JI-Y"'Oona.railwmbwq znd lnmte 1 FW 5-"OK 1 TT WhInn 2 1 kaurs and Fran 7T1 rq. posso A= PG-6 d07 I � 1-1 1 4 1-1-140 I�\knIny"I Howe �,, lj:,voy w N Trutt MMMY 1 FC 7 1,X)b 1 yy ismI Wing P1 To Win Nan Ambient A- plrenlenm Tcrnpownc hiped4w 1,:it VV/45T Win 4 1 Inurl, "tum de. Mma ties M,I"A'd ITY RN(AW&10,WTU 59upW CITY OF SALEM n �/� BOARD OF HEALTH J J r Establishment Name:��'P YQn,. Aogzb t ( ►_� 1r�� Date: l _ X9)-0 Pager—_ of Item Code C-Critical Item _ / -"DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified t PLEASE PmNT CLEARLY { i nAQ4� I /� �ay"n. �! m�r)� e`170 _nA # 0�/;.a,�r/jf l 0, 1_nX, /V —�` t�� J ✓n-1^_ /1 Pln.✓P A /P 0A, r \ � I MAPA r t ;✓ (�i� n`i . A � -T ov,�) l I f > 4t�f� ,P A a``r1t12OAMs ._� i %��/Y�11 A7J1AP VII /J /lt rm 0 j�AA ft�t ( I Jk(`cK Rn'� . v 1 �'nt9.° 1 (.f.lttl .�J _ ( 7C'l �/1nn/l_inn �PQl i I , t Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes 1 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ��> �� ( � LlVoluntary Disposal LJOther: Violations Related to Foodborne Illness IntervvrVons sad RNA j ACCvT1Jna,,I0Nm CxrIeditu Faf1ors(Iferes 1,22) (Cont) .11`FAS,F Wilhi P, 4 bl�no PROTECTION FROM. CHEMICALS U) ( ;Kwtii0 Nillt(VJS for VHFI I t9 PHF Hot and Gold Holding j 19 I Food or Color Additne" k 2-oris.E(tf}37 Cord InfIbe 3-2P?J2 Ad&!i,e,. 540ty! f zi rt F' 3-302.14 i hrewcu,)n front Criapjm . � ed `oidftlS�, I t-Nf!wwA) 101 l"IfFs abovt is poisaalouts wTcAic Su»`clsncon 7 IMAi watru,mg ho vwn- ougais <::q INA) Was Held at w above 130"k. 0 Time as a Public Health Cordtot C"gamo!, Narn., 3001 10 1-i Mn as a Role I wald) .202.13 IrZct�ti,cn,a,-!Wwwv nQ L,e �1)uN)1011 Vwiance 7-202.12 Condit i,-n�ot lhr, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 2WJ I TAR Wmmw"- PAXww', POPULATIONS(!:!§P) 7-20?11 I-nucr", Chvmicl,W Pwi,acyavc d Or,aad 7 2,04,14 pe"'envaes with tkalilnlg utt"tis wNar fivititoe'd Fore, ihB) I %e of Pastc1ni/!'d Eug,` ING L I I Uq Now w PwuAy DWA Ammal Nxi wad Ro"rill,al toe Crlt�ol,- Rae,St cd Sirrool, No, S,,,ytd, 7-20(021 ;,o!r -kW I UCC 1 Uwvcwkl 1�cxwl P:lLkavt N„t RV 'wrve:! 1 aw is %ding mudcInt Owl and NI'Mauring, ICONSUMFR ADVISORY 3 It flv.lud (,wonskol,pti000t TIMEtTEMPERATURE C014TROLS Aninwl Focxio fl,at irc Raw, UndcrcAxrkcJ i1i 16 Pm"r Cooking Tmlpefallams tot Na 1 hwan in pAwns. EU Fi,omwe buds 11A(lq-*. f4g, l5f,'t 155v., Ugg:-Stth.tilutr tei Ra.,Yioll #',,.1;, &(rinac I L SPECIAL REQUIREMENTS 0-6 ,,n:': Rol Numm Wt Q aw'... 5T)IWI)i 040) diol; hort� vi Sltivn :3et:.004fA,,-`tR ;n 141q A qAW RAw bps,id %as - lot F 15 sw. S k:alorwg, n1ohil".ft'AXL lclop&a.,-, and 4WA 1 rAWioulir',,WNCam, LnJien opeialkyn,;Iwvld he ToRing(AaUxtring FW Mea, dohlied luldel the aPpropriale. ;mlwns %duv u Wans. 166 y 15 sm j!Kwo it related w fo-xllxmY i!hos� 34011DUN TWAyawn!" lmw Nudonk j Intel veldions and risk lo:'IklrS (Aber 101, i 541t!'00 violidlow;rclakinr G),�txxl folail 54WJ2 Ra% An;irlal F0 KI, C'tw:i;ZO :1:1 pactim shon1d he dKied 729 NW.Wman 165 F Spomal Reelumenusits. 3-101,1l(A)q*1 At f1m PHR - 14Y F 11 nw.L.A! 17 Reiveatfing for Hal I joiding i , WOLATIONS RELATED TO GOOD RETAIL.PRACnf1cWS 3-4n3.l11AI&f03 111", IWF 15 wo I (Ifenw,23-30) a 0 w am, NWOW-m- 45"0 1 Ni"noc!"arify Coon:d and wwq no, Inswo4v "01 k 0,wn,daw w 0 fnoelbonw;,flneSz for"s"Iniow and rOfire tort cw, be xMI;PC) Qrniramily pwz ,', J RTF 1',oJ Wd A the PASwwke sec o/th�Food Code tw,i 10(111? 100 jubmu, - POW33up, j perlainiq', (,r0m,j Pord"nq ,f Berl 1 23 Mananincri and Pel,mri_ Fc -2 0M Proper Cooling of PHFS 24 h,,,-4 F(---4 00,' n -'rx'4-- i�Lmf�nlandlnensi:j FC- dT'Hl--F Fmn WOW 1��. 26 Watt-,Phimekna and WFI8te n7. --i',F 411 R;-5 007 1 I, 4VF YF"Wu IH,mu, I 2ND PiGanous or Tonc fAdem Il Fc- 7 Jot; 3 501 lot) = f7;whtzg PIIFn NInd,v hoin,mlinit T04,MWre AWMA"I"sw 0 rFNS F 011 CITY OF SALEM 1� BOARD OF HEALTH 1 Establishment Name: �raX vi1M �_ A P�1 l �� S Date: — "-fl Page: 1 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R-Red Item PLEASE PRINT /� CLEARLY Verified e-4/1.4 _'Q_ ) p , ^ l'J.1 /Rn/Wl i 1�t17,C.� rA .f ) V J,(,4 -t- %V�l ,r , 10_ A /J. 0 .4_ '1 IA Q, /�/, C n._A .A/ f�VV �_\-�C �e IJvn„ A-A- - L)i vl a_k"A cQ Ate'0410,11A AJ2— I AA C Qcam- i i_M v��nM I v I I I Discussion With Person in Charge: Corrective Action Required: No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Y}{F�s Rc;:.cired at'i'zcnpc:ratmrs { Viatatlon;Rotated to PoodLorne tttne4s?ratervenitoan and;;&k ' Acccudint to Lav Cooled m Factors lite"I-Z) (Coni] { ;I'FIA 5'F Within-1 How:, j PROTECTION FROM CHEMICALS 19 t.5tt1,15 cootiue Nlc1hod> for pF{F, i { 19 PHF Hot and Gold Holding 14 i Food or Colot At+dnives 3-501.I6fb i Colt PRFs hiasnt.uned at or below 3m02.82 ,4:ldt:;w:" .._.-i 590('0414t 41145`F- 1.302,11 Prt;tertiou i'soet k.±nal,pr ed Addiu'.Cl' `c i ;,t)i this^r s lint I HFe 1$ain4ained.+t c,r above j I's ` ! Poisonous or Toxic F,uastances i 110'F i 7 101.11 '. Icitmovine int;,rtrt.,uun - Ckrt:tn;u >-5:`rF w"') } K C otuaure3s" ) R,.'lq Heid at or;+bcee I it 01•. j 7 02.1; f C"40ruo'n, am,' - W:rkine+:outarnrr+" 20 I Time ac a Public Health Control j .;tsi t`r 't'itnc as a Public Htal;h('unuat 1 7201.1 t Jeparaocrn -tiaeag�" � ! sry(k.{r(bE(H: Vsriazct•Requsry m+:n4 # 7102.11 lt':q;ict+on -F`seaea,cw:uid1.�,.. 7.'02.12 t':xto+tiosr..,s[Usc' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 'U.I iS Nalli*vice"airnetn e -clicnjior,t' POPULATIONS(HSP) 7-2U•I.k I Sanh;rrr�,Crtc•ria -E.^hc:uicale 7?t)-1.12 Cltetnieats t�:r�h,t"h) 1'.,nir�:c. 2l iUi.il(rt) ! t'npa:teur,ra^d Pre-itac}.az;cdluice<arui 7.204 14 DninR At*_s:am.C:rlu.ria" t?cvrra�:es titch Warning labois' -801,11(A) ; U,eoffiwteunzed r-2�' i-tivi t It[)) Paw or Pamall^, Cvikcd AuimsF hied and 9:205.?! t RcYtrt.icd !i;r Fa ti:a.!r,.'1 Itcrn, 1 I Rai .St ed`:pr,snte Not Scrved. 7 206.12 l;cxicn: Tarin Stsucr;s^ Fll1 A I IC: tin,imied F,x d Ptu kaer Not Rr.-senc•l. ^ ? 2 Lvm...�.�� ..0ti 13 � "t r.t.F 1114 Fr+,.:ic::.YeSt C:u:rr;,l .:act L1:+iz,tar:n, CONSUMER ADVISORY TIME/TEMPERATURE IPERA7URE CONTROLS 21 r G0: t 1 � Cou, umcr Ad+;ua v 1'sntcd for<ouz;anptiou of i ( 16 I Proper Cooking Tempezatums for i I ':nulwl t-XAd lltat die Raw, Urrl-l'<Xikc S<:t PHFs E Not(Marro,ise Pr+scessed to Flinali'Vr , ,i{311VArit(2; F�•e.- 13 F (34.<.. � ( Padrnprn,." :. n.,..^ ', " I 1.zO2 ; + ,stcori--d F.c^.:SuhbGtale foi Ftat, 5he14 Egi:: uww-dlau: Set,r,.e 1115"F 15zc, - 1• ` 1 ?-40IJt(A)i:t Ct„a.r,nutr:d t c:h. .` cuts& Gain_ I t !::'''•' ` } Anlnwds. l55'i'I5 sec. ” , SPECIAL REQUIREMENTS3-101.t3(f3itk;:_2t l•ns+, and Fc.i Rcxt,t - t3i}`t' 12t min 5^>U.iF�+�}t.ts-rl7 ViOuboti:,of Section 5 (XY)t�^ tEJ in } 3-4t)l.11(A)rT, Haate,, itncr:cd M1?tate- Its F t.; t } } 4 L caterilsg, rnohd, fooel,ieurptxai and 3-401.11(Ait"+j Bahr,,11ild Gai,le,Scatted}'f'?�:_..._., resadenunl Litehcn upeiationq,Jwuld be Sn,kfini Conrrtiam 'rah Aie debitee under tilt approprmtc zemnms j 'Pooltryof Wanes-]65'F t 5 bcc. ° atx,ve..if l elated to f.vdl>rrtt tUres; 1-101.1 nct'3) ':;9a ke-musat, isno t 1,,,J:orak, intervenocu.;and risk fnctor4. 01her 1 "t 590 009 viol ttonq relatut, b,4o,xi n taa! ,i-101.12 Ram An:i,ud t',.;iln Ccvkd rrt a prae:titcs should 1'x:dehited und+:r h'29 - ;s4tr, w'a'ke tb,"F' Special ltequirernenis. ,i 40 i I(A K!!i AL Omit Pllk -. 1•;5 }7 19 17 Peheatirg for Hot Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.1t(A)&it11 Pl11•�' 1559F15.tc. i {ItenrS2,3-3(I} 3.403.11fbi miaerauvt Ifii''t ' 'hteaut:: Stsoding C+third and m:n-(rilwalrtof;ut„rrs, Which do no; i elate"'i the I 7 rn'rs'' 7 toodNrrnc ifl„ess mwi r,nt,ons•and riskjai tors tined ahnre r an ter• 3-.101 l ItC:} i:oa,tut:rria!h P:ex;..z.1 Fi1'F F•+.x ul- pnind in ih;:jn)l.nu+rg arrtiotu ui'th ,Feud Code a+.d 1 0.7 CUR 3403.1 1(E i Rcmamin^Umti and Portu,n�of lice! I item Good Retail Practices QFC 53x.000 k•,,r,t., + 1 23 ! Management and P'rsonr,a!_ j FC -2 I 003 _ IR Proper Coating of PHFs 24 vcwA and Foal Protection � FC �9 : 004 _ ---i 12S Equipment aid.Utensila F C -4 ? SUl.ld(As C'cone Gs&"cd PHF froar l�tr):E-a) 1 26 Vd'::,.r.Pi.:nib,n ,nd Name----QFC l =-- — —� ( C 4---- `F7 lyithrn _'FFours and E�rr,:n 7;•r`F' � ri7_' i Ph;,y:,;,y Fu:•ility _ _ '� Ff.-f i .007 ta.i;'F:/ac c W?tlun d How, ° 2& �s.uonvus or?nuc M:tfen•,Is FC -7 , IX7fl_ t 3-301.14(L) Cs clivg PUF:.!trl de Fust?^cni.ieut I L.'3______tSP gat R-,qu:rementt .. UUP — — Trnapxiait;rcinarediemnt,,.:.J`Ff4iF Penotr,^nttcml a^or:n I•ta!ee 0 I.n°I`oxl('A.”'r toy t Mk`90+e)0 ' o CITY OF SALEM i t (� BOARD OF HEALTH j Establishment Name c-ry Yn. ., Vim_ e o.� )�� c� 5 Date: 1 - �_1 --Y�) 6) Page: I r of Item Code C-Critical Rem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION I iDate No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I ` I I I I I 1 I � Discussion With Person in Charge: Corrective Action Required: I ❑ No , I ❑ Yes , have read this report, have had the opportunity to ask questions-'and agree to correct all C3 Voluntary Compliance ❑ Employee Restriction/ Exclusion i violations before the next inspection, to observe all conditions as described, and t0 ❑ Re-inspection Scheduled ❑ Emergency Suspension j comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure i your food permit. 3 ❑ Voluntary Disposal ❑ Other: i r Vloitttions Relaw to Foodborre fflpii3c Inpx*w-n6wsand M3k Arconiing to 1-1%, Uk'd W Factors(Ifer" fCcotl 7 t F14 S°+ Vvilhin-, Hmrr. PROTECTION FROM CHEMICALS CcOlin", for PPF,, 14 Food or Cr lw Additives PHP Hot and said Holding Cot,; at or b6in, :-202,12 1 Ad,Wivif.` 4 1 n,4 F- ..3t1? if.,xii ikddiwr:' E 16iA; No abow IF Poisonous of-Toxic SUt-,Stain;ns 140 1% I tilt.I I ld,xijivine lqhl�ilf,,�Iion Orn-naiJ, ., - I kuwie Held at or Ait,:av i IWF, 20 Time as a Public Health Control '-.pit; 19 Tkqlc ase Publit. I 1�,dlth Cortrol- U Msgfii) Varwrict Requircmal .20211 R,�qn�t�oti- lot` rei�qc�and 7-20-2,12 Conditiow of I)S,l 7 2-P [I 'L,vt,. G_wawv, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE Zo•1 4.11 Sdm;i7,tt,i,Cfm-it, POPULATIONS(HSP) 7 '-41 !2 7-to)l ti(Ai lliipasicunaaf anj Bewrj�,t�wilh Wamill� I zt,lis, 7 `04,34 LN)ma Awlv-Crew mt- 0 i 7-204 if 111'.i4ttakal I�t,o 110i) I��:-of pa,lvon,�Ci Eklii" R tw or Pniliiffl-. C,,ok�d ADimal F�k)d ji,d Cfiteo,, pav,,S��xl sliroat" N'�,l Sri�vd. i-:.{35.32 11�,J,11 i 'w SiAl"fit if(,) I'Tiopened 3aX0 ylat:1-4gcilio: 206, 13 �ntr,i and Mosot,x;v,,, CONSUMER ADVISORY TIM67EMPERATUR-C CONTROLS 3 1 �ovsmnei Ad,isofy Potad for Conumptio 4 Fitivi, 11,11w ?rc ll.w, Undmooltide: 1 Proper Cpoking Tewpetatures for EEmin'lut PHF6 ;tw Sh,11 L, ),;,re:trviitd ffork R 1-4 0,1, 1 t A',i Ft,b- cc Awiwtis 15, �v, SPECIAL REOUtREMENTS t MCA, ir) -aw(mg, nwtsil;, ftxA,tempi,raiY and 3 4(ft I[,A^31 rc,ldcw lal kiichtn jpn<itio-.iAiovld l�s: :ruder 11w apprujrrwtt. tcvllom 5 aln)s-it retied to ib,tJfx)rni 3-101. )X0,) lzvl:"Ttt nm, it, hilao Bv't slxarK inm vcndow;wqj cisf. facivrq Odher 500 001) vwlalmoq rclatin'l to�'mxi rood piaowes::houid N,,debited uncivr #29 - 401 il(A)(1;;f'? 0;11e1 1'1w; - w 3c (7 1 Reheating for Hot Holding i VIOLATIONS RELATED TO GOOD RET41L PRACT)CES 3-it v,l I(A)&il', 11111- W5,1` 1,�t:,: ^ 1 1 (Items-13-30,I ri;h,al violavont, tvixch do,w; �eawe, :,�the (Jiorne 1,'Iwm ;Wfr wnti,mv,mdr.hk 11ii tart bv 3- i0K i)XI Rlf,F,, 411. i"aind in:he lwfis ,,,f thro".4,Ciide.,md li'"f 1IR !'F Rcmjonir,, Uns3s2d flknionii if BM Item Goocf Retail Pr.iclices rr 5-Wim I an oncol and Piatonr;ri i,�yj ind Pood Prn�tlon FC 3 (A4 Proper Cooling e,PHFS ......... C�x4vd NIF: lioral 14W f� 26, W- Cwliltl, Mei,Pl.mnmci ane Wricte I FC, -5 1 �c-6 OOc ,,(if IN!0vit 2 ,ioui��!,d Ftom �T! ,)0 7 ?7 Fa�,Iily---�Kl� - p-j "4:, P W�tj,in 4 Hous, 2LI POISO,,�Wr�)r TW et I ulg- FC, 008 5f)j N!Fi, M;,Om mck kmhi�ln, U'—�') —] (� ot R--awfemerx� H�R LAI- I Commonwealth of Massachusetts F City of Salem i• Board of Health 120 Washington Street,4th Floor Kimberley Driscoll Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Salem Beer Works File Number.BHF-2004-000275 278 Derby Street Salem MA 01970 LOCATED AT: 0278 DERBY STREET ' SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0217 Dec 23,2008 Dec 31,2009 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KIMBERL.EY DRISCOLL FAx(978) 745-0343 MAYOR fDIONNEaiSALENt.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT /TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT !:�0440A bei LAS �5 TEL# 979"- 7`/s- ,;z 33 7 ADDRESS OF ESTABLISHMENT _17S� Dt-, by S�, L,{YLP"A 1 tI^2, FAX# R-1Y- 7Y/- -76 3 ;i - �� l MAILING ADDRESS(if different) 70 &e/ wwy5 C,Po-ra-t IIt0 , OAA-, O2( ki EMAIL-Business': ,be_JP& bee,0o. " •Pe-+ Website: Wtdi.)• (jeerub�J�S,aa OWNER'S NAME Z21-e5114' bC05 , 5{e,0114d1 co, J\c , TEL# 6 (7 ' $9(0 -x300 ADDRESS )/0 CP'"aI SF, JJ das-I-o'>1 IgeL, 01f1y STREETaa CITY �r, STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) !%eb/ h Jljp,I/ ti fi /aS( (UG@ERTIFICATE#(S) N o 11 a-7v15-366 -yQ (Required in an establishment where potentially hazardous food is prepa red ) \ EMERGENCY RESPONSE PERSON �2 S �esR�/_V'�PSI��) HOMETEL# 617 -7/ 9 - I DAYSOEOPERATION . .i Monday 1'5 I'<'i' -Tuesday Wednesday 'I-i- Shursday';, L `': Friday r' - 'J , , ,-Saturday Saturday - I Sunday I HOURS OF OPERATION i Please write in time of day. (For example 11am-11 pm) TYPE OF ESTABLISHMENT FEE (check onIA RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------- ....4------...-------------------------------------------- Q RESTAURANT fE� NO less than 25 seats =$14 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more an seas , =$420 ------------------------------------------------------------ -------- ----------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES --------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES 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 pa' 11 state taxes required under the law. P1Iuq 0 4 J 2.z. 13 0 Signature Date Social Security or Federal Identification Number ---------------- Revised 424/07 FOODAP2008.adm Check#&Date *1 SO 3 SD 9 //-2 5--D-0s _ ` P 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 Handwash Facilities FAIL Critical RED Owner: Comment: Handwash sink at bar must be labelled"handwash only". PIC states sign has been ordered. Joseph &Stephen Slesar Same sink had a coaster and plastic wrap in it. Handsinks may not be used for anything but handwashing,and must stay clear and PIC: accessible at all times. Robert McAleer Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE Elizabeth Salandrea Comment:There were containers of uncovered food in the small fry freezer at the cookline.Cover all food in storage to prevent Date Inspected:Correct By: cross contamination. 9/15/2008 Equipment and Utensils FAIL Non-Critical BLUE Risk Level: somment. v5olcett:,h Co Same unit was holding at temp of approximately 35°F.Repair unit to maintain temp of 0°F or below;food 1n unit at time of Permit Number: inspection must not be re-frozen. BHP-2008-0217 Physical Facility FAIL Non-Critical BLUE Status: n�u Comment: Dishwasher has small leak on seam under temperature gauges. Repair dishwasher to be free of leaks. webATIO u S\`J Pipe under rinsing sink at dishwasher has a leak. Hire services of a licensed plumber and repair pipelsink to be free of leaks. #of Critical Violations: Repair men were on site at time of reinspection for both of the above items. 2 Time IN: Time OUT: Urgency Description(s): BLUE: All other violations noted in the 9/3/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 15,2008 ) Page 1 oft • Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 15,2008 ) Page 2 of? Commonwealth of Massachusetts s City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Salem Beer Works File Number:BHF-2004-000275 278 Derby Street Salem MA 01970 LOCATED AT: 0278 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0102 Jan 4,2010 Dec 31,2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES (December 31, 2010 Board of Health /� �✓'d1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS * BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KINIBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENItAr JMn,SALEM.COLI DAVID GREENBAuAi, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT--d/e--' �� / TEL# enk-7y5 -2-337 ADDRESS OF ESTABLISHMENT c/4 f/ �T FAX# MAILING ADDRESS(if different) [� EMAIL-Business': S-'le"I 9- )30e1VOrn,�, AI L Website: 1??&-I✓a!� OWNER'S NAME lTe J®Sad` TEL# &7-0M-,23L00 ADDRESS 113 C,?" S�rf jos417 /'%1f STREET ��JJn CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) /C?A,9Lo //e S/1/.? CERTIFICATE#(S) bf Sa — (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# -DAYS OF OPERATION;= ='1-Mofida';'.;::_%� T,ue`stla ;:` jr ,W,etl iesdayI Tbu sdayT= ,,:u ; Fdday,. ; ;i; .?:; Satyrda'ye ; °=rl Sunday _ -;% HOURS OF OPERATION y y _ Please write in time of day. (Forexamplellam-11pm) i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ANO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT ✓YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$2 25-99 seats = 280 more than 99 seats $42 BED/BREAKFAST/ YES �------------ - $100 CHILDCARE SERVICES/NURSING HOM - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES 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 su mitted to and approved by the Salem Board of Health. f u t to er 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 s ani all'state taxes required under the law/te D % turC� D Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date z 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 SeparaVo'lm'slaw. egregation/Protection FAIL Critical ❑N RED Owner: ment:Walk-in fridge in dishroom had containers of meatloaf and other meats stored above ready to eat items like celery and Joseph &Stephen Slesar Organize fridge properly and ensure PHFs are separated from or beneath RTE items. PIC: Food Conta Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Ben Bythewood mme nt: Sanitizer throughout entire establishment was too weak,and no one present knew where test strips were located. Sanitizer of proper concentration(200ppm)must be available&accessible at all workstations at all times,and test strips must be Inspector: avail ble&accessible. Elizabeth Salandrea Date Inspected:Correct By: ndi er log not up to date;sanitizer log must be maintained on a daily basis. 9/3/2008 IJA�f ite cutting boards at the deli units along the cookline are stained and scored.Resurface or replace cutting boards. Risk Level: arge ice machine had small build up of grime on inner panel.Clean and sanitize entire inside of ice machine to prevent con me ion. Permit Number: BHP-2008-0217 me ice machine did not have a scoop present.Scoop must be available at all times,and stored in a clean sanitized container or in th ice handle extending out. Status: VIOLATION lice had accumulation of food debris on the underside and some on the slicing surface.Thoroughly clean and sanitize the slicer. #Of Critical Violations: otato slicer had small amount of food debris on it.Thoroughly clean and sanitize potato slicer. 5 Handwa�s/h JF�cilites / FAIL Critical ❑d RED Time IN: Time OUT: It2'omment: Handwash sinks in the dishroom and cookline both had food in them.Handwash sinks may not be used for anything but handwashing; no food prep or disposal may take place in these sinks. Urgency Description(s): �Handwash sink at bar must be labelled"handwash only". PSC �) J. l BLUE: y S` a .5" 1 ��2n Violations Related to Good ! TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) J Retail Practices (Critical I Time As�lic Health Control FAIL Critical ❑d RED violations must be corrected immediate) or within 10 mment:2 containers of bacon found at room temperature at the cookline. PIC stated they had been cooked that morning. y Potentially hazardous items must be held cold at 41 OF or lower,or hot at 140"F or higher,and may not be held at room temperature. days)(Non-critical violations All bacon was discarded at time of inspection. must be corrected immediately } or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 09,2008 ) Page 1 of ,lip Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Violations Related to Food anVdF,,d Protection FAI L Critical BLUE Foodborne Illness Interventions o ment:One barrel of dry ingredients in the dry storage area was open.Cover all food in storage to prevent contamination. and Risk Factors (Require 0 immediate corrective action) 'Were was loose celery being stored directly on a rack in the walk-in fridge.Food may not be stored directly on racks or shelves; ;stor in containers with covers. 7.rcoveredcontainer of cranberries in the walk-in freezer had a bag stored I directly on the cranberries.Cover container and do not'Yore anything directly on food. WI mere were containers of uncovered fries in the walk-in fridge and under the grill.Cover all food that is in storage or under , equipment to prevent cross contamination. i a small fr�'ir�-at_the - a'I-is �Tlhere were containers of uncovered food in the small delfield fridge to the right of the grill and a"fry'�r� earn cookline.Cover all food in storage to prevent cross contamination. Vany small containers in the deli units along the cookline did not have covers on them.Cover 11 cont�amer ,I unitsw1hen not being actively used. Equip t d Utensils FAIL Non-Critical BLUE M70 m M"ant: Mop being stored in the bucket in the back room.Store mop hanging to air dry. 0911�re is some ice build-up on the floor of the walk-in freezer and around the fan. De-ice the freezer. Rx-(�'o Nq4er�' Fener needs scouring and genereal cleaning. e racks to the right of the 3bay sink have some grime accumulation.Thoroughly clean the racks. love, love in dishroom needs general cleaning. god'91" team cooker needs general cleaning along the back inside edge of the cover. 71.,nit at far end of cookline missing a thermometer. Provide visible,accurate internal thermometer for this unit. Wtov t the cookline needs general cleaning. ni 'r ress needs general cleaning. Z'0 ji f, I fry freezer at cookline had an accumulation of food debris in it.Thoroughly clean this freezer. am, freezer was also missing thermometer.Provide visible,accurate internal thermometer for this unit. Physical F�Ycility FAIL Non-Crittcal BLUE mment: Some lights in dry storage missing covers. Provide covers for all lights. Dishwasher has small leak on seam under temperature gauges.Repair dishwasher to be free of leaks. Pipe under rinsing sink at dishwasher has a leak. Hire services of a licensed plumber and rT kt drpipe/sin obefreeofleaks. OX r,r, 4�� VKhere are many tiles in the dishroorn near the dishwasher that have what appeari 091WRh ace all tiles with mold City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS@)2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 09,2008 Page 2 of 3 w Item Status Violation Critical Urgency or staining on them. Reinspection in one week, all violations to be corrected. 6 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.18001 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 09,2008 ) Page 3 of 3 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency ,Telephone: PROTECTION FROM CONTAMINATION '745-2337 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED 'Owner: aComment:Meat slicer had accumulation of food debris;properly clean and sanitize meat slicer after each use. Joseph $Stephen Slesar Proper Adequate Handwashing FAIL Critical ❑d RED ,PIC: t Bill Glidden womment:Waitstation handwash sink missing paper towels;provide disposable paper towels at all times. 'Inspector: all-hung soap dispensers required in all restrooms and at all handwash stations. Elizabeth Salandrea Date Inspected:Correct By: 1/22/2008 Risk Level: I °Permit Number: ' BHP-2008-0217 fStatus: PARTIAL COMPLY e#of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): I BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations 9 must be corrected immediately . or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 23,2008 ) Page 1 oft Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) I Violations Related to Food and F od Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors(Require Comment: Beer ingredients stored directly on floor;store all ingredients at least six to eight inches off the floor. immediate corrective action) rash green beans in cookline need to be covered. Equipment d Utensils FAIL Non-Critical BLUE / mment:Waitstation fridge missing a thermometer; provide visible accurate thermometer in this unit. M Hofld filters have an accumulation of grease;thoroughly clean all hood filters.Ansul system due for cleaning on 1127108. Stove needs general cleaning. �T/me unit at end of cookline has a broken lid;repair lid. Z1/R4 each-in needs general cleaning. a��lk-in freezer has accumulation of ice;find source of moisture and repair,remove all ice. xitchen flooring needs general cleaning. vrhere were food spills anf splatters on kitchen walls;thoroughly clean all walls. Physical F lity FAIL Non-Cnfical BLUE omment: One light fixture in dry storage missing protective cover; provide protective covers on all light fixtures. There is no smooth impervious ceiling in back or in dry storage;a ceiling that is impervious and easily cleanable to be installed. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 23,2008 ) Page 2 oft a 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 745-2337 Physical Facility FAIL Non-Critical BLUE Owner: Comment:There is no smooth impervious ceiling in back or in dry storage;a ceiling that is impervious and easily cleanable to be Joseph &Stephen Slesar installed. PIC: Ceiling to be installed by next routine inspection. Josh Lewin GENERAL COMMENTS: Inspector: Elizabeth Salandrea All other violations cited in 1/22/08 reporrt have been corrected. Date Inspected:Correct By: 1/30/2008 Risk Level: Permit Number: BHP-2008-0217 Status: SIGNED OFF #of Critical Violations: 0 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2008 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2008 ) Page 2 oft e Commonwealth of Massachusetts City of Salem Board of Health [Qmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Salem Beer Works File Number:BHF-2004-000275 278 Derby Street Salem MA 01970 LOCATED AT: 0278 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0217 Jan 4,2008 Dec 31,2008 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRESDecember 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. 4t In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 20 of 24 r 3 e CITY OF SALEM, MASSACFIUSEM c BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 ( ) MAYOR TScoma SALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT SM-kl" Beer (Vddk-t TEL# 9 37`fS233� ADDRESS OF ESTABLISHMENT A77% ()C-fix„ ff lodeln A44 FAX# 978-7y/ 7632 MAILING ADDRESS(if different) (:/0 R22✓INO/Ic,f Cv Kpd r-Mt-C/ /10 Cana. (�• l3l/uf�^ 0 Z� i7f EMAIL-Business': Website: WWW.62e✓wa✓�cJ qe � OWNER'S NAME S/etfL-- Brdr.Bre-. &; .j, 41 c TEL# 60- 5116- 2,700 ADDRESS Il0 CG^al fA 8af4rit /14A 07- 11(l STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) d Sesw rd�Fn < l �O/ �/ ao EMERGENCY RESPONSE PERSON J 2 l /��p Cf / HOME TEL# �' y 62f DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day (For example l lam-11 pm) - TYPE OF ESTABLISHMENT FEE (check onlv), RETAIL STORE YESNO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sci t. =$420 - - ----------------------- -.N....O- -------------------------- RESTAURANT YES less than 25 seats =..$140--------- ' (Outdoor Stationary Food Cart$7-10) 25-99 seats =$280 more than 99 seats =$420 --------------------- -- ----- --------------------------------------------- .. BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES-.--_.- -----------------------*-------------.....------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of pequry that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. e-- j if, 2-7-j-3- 0``-31Z-ZV30 Signature Date Social Secunty or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date- GGkJ�,q i; ServSafe :.. ,M EXAMINATION FORM NO : 4001 br, CERTIFICATION NO : 4011270 i „•r A"i , & : m ServSafeO Certification r.N:d '�R• .yx, .x na+ '*ev: `S' +. g .ts'° r7i0. ` c& Mey�`�� „*, for successfully completing the standards set forth by the National Restaurant Association Educational Foundation , for the ServSafe® Food Protection Manager Certification Examination, which Is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP) Presented by the National Restaurant Association Educational Foundation 8/30/2004 DATE OF EXAMINATION 8/30/2009 DATE OF EXPIRATION Local laws apply Check with your local regulatory agency for recertification requirements v :R Mary M Adolf President and Chief Operating Officer National Restaurant Association Educational Foundation National Restaurant Association 4. EDUCATIONAL FOUNDATION ®20041 Restaurant Association Educational Foundation WWW nraef org 03102301 v.0405 EXAM FORM NO. 4301 W CERTIFICATE NO. 5182158 rse!rv�Safe ServSafo Certiricatiffon 70:W°FLI DEN for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafee Food Protection Manager Certification Examination,which is accredited by the American National Standards Institute(ANSI)—Conference for Food Protection(CFP). Presented by the National RestaurantAssociation Educational Foundation 1/10/2007 DATE OF EXAMINATION 1/10/2012 DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recandicavon requirements � National Restaurant Association \- , Mary M.Adolf V EDUCATIONAL FOUNDATIONNMI < President and Chief operating Officer National Restaurant Association Educational Foundation www nraef.org 02006 The National Requram Auociabol Educational Foundav 9 • 06067402 I .v.0611 ' I EXAM FORM NO. 4315 CERTIFICATE NO. 5439066 rS* ervSaf� ServSafe° Cerrciation.a ifi TO FREDERICO N DASILVA for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe®Food Protection Manager Certification Examination,which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). Presented by the National Restaurant Association Educational Foundation 6/21/2007 DATE OF EXAMINATION 6/21/2012 DATE OF EXPIRATION Local laws apply�Lheck with your local regulatory agency for recertification requirements National Restaurant Association Mary M.Adolf EDUCATIONAL FOUNDATION President and Chief Operating Officer National Restaurant Association Educational Foundation www.nraef.org This document cannot be reproduced or altered , Exam Faun No.4308 ;. Cert.No. 633o33 ssa '�... ServSafe'CeCrtification�I 7„ TO_ so ' fo-tuumNUIXc�PmkMam tla�W�mlan Wme XaomY Penaiam Auaal�m EJxamul FwNmmhtMSeKie®lwERmayxn Nmapa Gnxxawnbnmveum { Date of Examinatm 4/23/2007 Date of Explratlon: 4123/2012 S 1 L 01b apA cxeckwrN {I) br rp[erofi[etion regmremem[ EDOUIiDNAL NUNDPPON BEER WORKS CORPORATE OFFICE fiee"'7eV&W l Yom'- 110 Canal 54 Boston.MA 02114 �.. Corporate General Manages 4 cell.617.904.8138 fax:617.896.2301 Ioef@beer rks.net www.bee.rks.net BEER WORKS CORPORdT BOSTON BEER WORK 110 Canal St,Boston,MA 61 Brookline Ave,Boston,MA Near NcTrtW Station rk ph one:617.896.2300 ph one:617.536.BEER BOSTON BEE WOR EER WORKS 1 12 Canal St,Boston,MA 278 Derby St,Salem,MA Near North Station In Historic Salem . EER phone:978.745.8 EER BOLD AMERICAN OOD AW RO WINNING BEER. ` 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 Food Contact Surfaces Cleaning and Sanitizing PASS Critical RED Owner: Comments:There are stained and scored cutting boards on the kitchen cookline. Resurface or replace boards. Joseph &Stephen Slesar PIC: Neto sabastion Inspector: John Gehan Date Inspected:Correct By: 5/17/2007 Risk Level: Permit Number: BHP-2007-0353 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 17,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:Chicken next to grill holding at 56.3°F. Chicken to be held at 41°F or below as mandated. Chicken discarded at time immediate corrective action) of inspection. Steak tips holding at 55.9°F. Steak tips to be held at 41°F or below as mandated. Steak tips discarded at time of inspection. True unit found with uncovered foods. All foods must be covered to prevent cross contamination. There is uncovered foods in the unit across from the stove. All foods must be covered to prevent cross contamination. Small refrigerator next to grill found with uncovered foods. All foods must be covered to prevent cross contamination. Equipment and Utensils PASS BLUE Comments:Small refrigerator at end of food prep line requires general cleaning. Walk in freezer has accumulation of ice on floor.Remove ice. Find source of leak and repair. Shelves by the potatoes in back require general cleaning. Expo station true unit requires general cleaning. Physical Facility PASS BLUE Comments:There is mold on ceiling above dish wash machine. Remove mold. There are holes in the wall by dry storage. repair holes. Dry storage is miising three lig t covers. Provide covers. GENERAL COMMENTS: All violations from 5/10/07 have been corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 17,2007 ) Page 2 of `mow~ 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: /Comment:There are stained and scored cutting boards on the kitchen cookline. Resurface or replace boards. Joseph &Stephen Slesar I PIC: Joe Ferrari Inspector: John Gehan Date Inspected:Correct By: 5/10/2007 Risk Level: Permit Number: I BHP-2007-0353 Status: Open #of Critical Violations: 2 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 10,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require mment:Chicken next to grill holding at 56.3°F. Chicken to be held at 41"F or below as mandated. Chicken discarded at time of immediate corrective action) inspection. ,Sk- c�tips holding at 55.9°F. Steak tips to be held at 41°F or below as mandated. Steak tips discarded at time of inspection. True unit found with uncovered foods. All foods must be covered to prevent cross contamination. There is uncovered foods in the unit across from the stove. All foods must be covered to prevent cross contamination. /Small refrigerator next to grill found with uncovered foods. All foods must be covered to prevent cross contamination. Equipment and Utensils FAIL BLUE J r6omment: Small refrigerator at end of food prep line requires general cleaning. _AWrm freezer has accumulation of ice on floor.Remove ice. Find source of leak and repair. elves.by the potatoes in back require general cleaning. Expo station true unit requires general cleaning. Physical Facility FAIL BLUE �^ant:There is mold on ceiling above dish wash machine. Remove mold. here are les in the wall by dry storage. repair holes. storage is miising three lig t covers. Provide covers. `y\W� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 10,2007 ) Page 2 oft Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2007 ESTABLISHMENT NAME: Salem Beer Works File Number:BHF-2004-000275 278 Derby Street Salem MA 01970 LOCATED AT: 0278 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0353 Jan 8,2007 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2007 Board of Health V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of t j w CITY OF SALEM, MASSACHUSETTS • s BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 TEL 978-741-1800 FAx 978-745-0343 Kimberley Driscoll www-sALEM.GOM Mayor JOANNE Sco T, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �A ►✓�Q 1' W��S TEL# q -78 711 S'3 3 37 ADDRESS OF ESTABLISHMENT ,27R 5fiYze f FAX# MAILING ADDRESS(if different) `_ , - EMAIL--Business': JO" k`ef!XUJov�5 oN(_+ Owner's: J8e- & q YJt4y`_VJ0y OWNER'S NAME 1012— S K5A�(' TEL# ADDRESS VW CAYiilR t, /7f, &54vv%, 1P'tA-, o; A t S STREET .) CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) f� 7t u t, l 1 P� M CERTIFICATE#(S) -713999 ,li5oo-K y M A INVA gvit)-70 (Required in an establishment where potentially hazardous food is prepared) m EMERGENCY RESPONSE PERSON 7 t "' u HOME TEL# ID V7 11 t 3 700 OAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday If HOURS Of OPERATION Please write in time at day. - t( r tfer example Ilam-Iland TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 — ... - --- --- -- ----- ----- - --- - --- ---less--th..a..-n- -.25.-s--at.. - s. - ------ RESTAURANT Y S NO e $100 25-99 seats 150 more than 99 seats =$20 _ _ ...._.............._._..... ..__..._... ..... .--- -... ------ -..._...--... - - -- --... ---------_ -------- BEDlBRERKFAST YES NO $100 ----------- ------- ---..... .. .... ------ ----- -- --- .... ..... .........-......- .... _.. .. ---.. .... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sa itary Code, before any renovations, improvements, or equipment changes are made, all plans for such must s bmitted to and approved by the Salem Board of Health. Pursuant toMGL hapler'62C, Sec i n 4 JA, I certify under the pains and penAties of perjury that I, to my best knowledge and belief, have filed afI slate ax ret ms an d at state taxes required under the law. Signature pate P ,0 Social Security or Federal Identification Number - - - ---- - ----� - ---- -- -- - ------ ----- l2ev,sed 11113/06 F AP7(707 adm Ghec 0 8 Dale_- _ 1-14-07 s _'Rooif_00 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name L-- 1 Date Tvpe of Ooeration(sl Tyroe of Insoection :7>C1 1 Id Z 7 lob ®'Food Service ❑ Routine AddressRisk I El Retail ,Re-inspection ;277'��J �` 5+�� Level ❑ Residential Kitchen Previous Inspection Telephone(,, I ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast El General HACCP Complaint In: Inspector (h rJ �� Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. _FOOD PROTECTION MANAGEMENT,„_ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties -_„ .. , ... .. -_, „ a.. , -„ .,. ❑ 13. Handwash Facilities EMPLOYEE HEALTH r - PROTECTION FROM CHEMICALS' ❑ 2. Reporting of Diseases by Food Employee and PIC _-- •- 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals r,FOOD FROM APPROVEDSOURCE'," ,�. .. ❑ 4. Food and Water from Approved Source TIMEREMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION '" ` - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY . ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions �( immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(Sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s 590In5pBCfFo/m3-td em Inspector's Signature:, ( Print: -9- Print:Signature: � Page_oPagese��, ` Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 I Cross-contamination I 1 590.003(.4) I Assignment of Responsibility* i 3-302.1 i(A}(1) i I Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge -duties I ' Contamination from Raw ingredients 3-302.11(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other` 2 590.003(C) Responsibility of the person in charge to j Contamination trom the Environment require reporting by foal employees anti i 3-302.1)(A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An j 3-3(M.11 Food Contact with F,quipment and Applicant To Report To The Person In j Utensils* Charge* j Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I j 3-306.14(A)(H) Returned Fond and Reser vice of Food* I 13 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(F.) Removal of Exclusions and Restrictions I Food 701.1 l Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food* 4 I Food and Water From Regulated Sources ' 19 I Food Contact Surfaces 590.009(A-B) Compliance with Food Law* 14-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* -201.13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 F,ggs and Milk Products.Pasteur zed" ( 4 50 L i 14 ( Chemical Sanitisation-temp., pH, concentration and hardness. 3-202.16 Ice Made From Potable Drinking Water' 14-601 11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System' l Utensils Clean" 590.006(A) Bottled Drinking Water* ( j .t-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.04' Shellfish and Fish From an Approved Source ( Contact Surfaces and Utensils* ( 4-702.1 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contac( Surfaces of Equipment* Shellfish' 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* 110 ( I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 11 C 301 ?- . lean Condition-Hands and Arens* Regulatory Authority I j 3-202.18 Shellsttick Identification Present* ( 2-301.12 Cleaning Procedure" 590.004(C) Wild Mushrcxnns" 2-301.14 When to Wash"` 3-201.17 Game Animals" I I I1 Good Hygienic Practices S I Receiving/Condition I 12-40i.II Eating, Drinking or Using Tobacco* 3-202.11 ( PI-IFs Received at Proper Temperatures* I 12-401.12 Discharges From the Eyes,Nose and 13-202.15 I Package httegrity' I Mouth* 3-101.11 I Food Safe and Unadulterated* j 3-301.l2 Preventing Contamination When Tasting" 6 Tags/Records;Shellsfock I 112 I Prevention of Contamination from Hands 004(E) Preventing from 3-202.18 Shellstuck Identification* ( g Contamination 3-203.12 ShellstockIdentification Maintained' I Employees" Tags/Records:Fish Products I 113 Handwash Facilities I 13--902.11 Parasite Destruction* I Conveniently Located and Accessible � 3-40'.12 Records,Creation and Retention* j 15-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* j 5-204.11 Location and Placement* q Conformance with Approved Procedures l 5-205.11 Accessibility,Operation and Maintenance _I rHACCP Plans I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* ( Devices 3 j 6-301.11 Handwashing Cleanser,Availability -502.12 Reduced oxygen packaging,criteria* j 8-103.12 Conformance with Approved Procedures" I 16-301.12 j Hand Drying Provision j 'Denotes critical item in the federal 1999 Fond Cade of 105 CbiR 590.000. CITY OF SALEM c- BOARD OF HEALTH Establishment Name: Date: I/ 12Z -k? Page: f of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Gni%alp A� Oon Yui IG7vCZf norLC ul I P,C' �U� a OL4P✓ve�� ' hl ITLI.ELLL. ✓i`✓! C' VI vf. M.��L1 �!11 rGl'N!,i�. t-C� . 7r 1 ..✓� rp J �'0 'p-DI.t_ l o CI/� Lvl kUr'( I &l bj LC "IkiC' "d 1707 } ! t All C)+-�--e. V vn o l" (h r 5 vv'h 11 1 S o 6 to ✓P 0'e'a" I ! ldirPC �—e �� 1 . 1 1 1 1 1 _ I � Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P E) Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty fine d�olla/rs -'r-s lispension/revocation of Ll Embargo ❑ Emergency Closure your food permit. � �-�% ❑ Voluntary Disposal 0 Other: 3-5v!.i41(') ?M-s I2ece:ved at i•emperatures Violations Related to Foodborne rOness tntervartions and Risk According to Las:Cooled to Factors litters 1.22) (Cont.) 41'F1 f Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Dae / Type of Operation(s). Tyge of Insoection /in. /c� / IA 1®J k �_ 11 Lt WI rood Service 1:J'Routine Address ^� Ribk I El Retail El Re-inspection `O b r! Level ❑ Residential Kitchen Previous Inspection Telephone -7� �7 t El Mobile Date:9 ix S � � Owner HACCP Y/N El Temporary ElPre-operation ❑ Caterer El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint 11 In: ❑ HACCP Out: inspector Permit No. El Other P T � �7I do�- r Each violation chii ck _ e ed requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT �-,„ � ' ,.; . ... � �... " ... 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - - - _. PROTECTION FROM CHEMICALS ` ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE, TIMEREMPERATURECOn/TROLS(Potentially Hazardous Foods ❑ 4. Food and Water from Approved Source ( y ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION "• ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)""' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N 23: Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations ✓'✓ 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of x`25. Equipment and Utensils (Fc-4)(590005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you j`27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 501n�FOm 14 as Inspector's Signature.: Print: i T PIC's Signature: / Print: I Page of 7Pages 7 r� J i Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Aniawl Foals Separated from Each EMPLOYEE HEALTH Other' 2 590.003(0) Responsibility(it the person in charge to ( Contamination from the Environment require reporting by food employees and 3-302.1 t(A) Food Protection" applicants* 3-302.15 Washins Fruits and Vegetables 590.003(F) Responsibility Of Food Employee Or An 3-304.1! Food Contact with Equipment and Applicant To Report To The Person in Utensils* Charge* Contamination from the Consumer 590 003(G) Reporting by Person in Charge* 13-306.140)(B) Recumed Food and Reservice of Food^ 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 5'}0.003(El Removal of Exclusions and Restrictions ( I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* _ 4 Food and Water From Regulated Sources 9 ( Food Contact Surfaces 590.004(A-B) Compliance with Food law F 4-501 111 ,Manual bYazewaehing-Hot Rater i 3-201.12 Food in a Hermetically Sealed Container* ' Sanitization Temperatures* 3-201.13 - Fluid Milk and Milk Products'" 4-501.112 Mechanical GVarewashinb Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* --� 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 I Chemical Sanitisation-temp., PH, 3-202.16 Ice Made From Potable Drinking Water' _ concentration and hardness. 5-1111 ]I Drinking Water from an Approved System" 14-001 1 I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean- J 59(}.00(i1B) Water Meets Standards in 310 CMR 22.0* ( 4-602.11 Cleaning Frequency of Equipment Food- I ___ Contact Surfaces and Utensils* J Shellfish and Fish From an Approved Source ( 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( ( Focal Contact Surfaces of Equipment* Shellfish'" 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* - Sources Game and Wild Mushrooms Approved by 110 I Proper,Adequate Handwashing Regulatory Authorkv 2-301.11 Clean Condition-Hands and Aons* 3-202.18 Shellstock Identification Present* � ( 2-301.12 Cleaning Procedure* - 590.004(0) Wild Mushrooms* 2-301.14 When to Wash` 3-201.17 Game Animals* I1 ( Good Hygienic Practices 5 Receiving/Condition I ( 2-101.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Tmnperatures'- 12-401.12 Discharges From the Eyes, Nose and 3-202 15 Package integrity* Mouth` 3-1(}1.11 Food Safe and Unadulterated 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.0(4(E) Preventing Contamination from 3-20312 Shellstock Identification Mainuuned" j Employee;* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located andAccessibfe 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.0040) Labeling of ingredients` 5-1204.1t Location and Placement* 5-205.11 Accessibility,Operation and Maintenance i 17 Conformance vdth Approved Procedures ( Y /HACCP Plans ( Supplied with Soap and Hand Drying 3-50_'.11 Specialized Processing Methods* Devices 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced oxygen packaging,criteria`` - --- 8-103.12 Conformance with Approved Procedures' 6-301.12 Hund Drying Provision - Denotes critiLal nem in the federal 1999 Food Code m 10CYiR 590 000. i exec Vh , �' l ) Ct C�' d -� ,/1ft•.ate tJ 31� +M a..c.1�,�, :, 1 �,$- .. Inc_•J (¢Cf c) C ti CITY OF SALEM F BOARD OF HEALTH Establishment Name: S'J�t �fiiv� /Na✓�G Date: if /h3 K-1 D b Page: Z of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OWCORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �.�P iS �l Ow t rlA U o !v ��✓J LP� a lel/ t �e, ZZ- ICO� v� �/Ar AfnoLr('Aur,ufiov� dt glrrotR 00IY1SrLL[- ! n -�. / 1'160!, n 4n ds" / r 7-" 1017 Ut/1 ft CAA r .. D K (Af ' a C C V" Ic 1 e✓N ov ICP ,utn r`,v 7 Jy Ce vher i� be�n� V-)O'f .d� ori . AfC0Vd, C_ Po l- -2-70.",/,r 1`4tS11A1.0 � VYI61CCiA , nN VIaJ 0C C V W JI"C14n n✓ o u-3 -r Ct.Pa wn CPL It wU . = 1 � I 2-7 ctr_kC(%.- o✓,C V, 1Atsl�f nWUSk area I n d t S vP- 6VI 1 I a;✓- �-6 WOJ � tn� d ✓Otcv '= I J< j I P7 ? � K.kk2.4 tits „�ts� ,�ti� i, � l.� G0�1QvS . CG�/�G✓S Q✓Q Ort w s V- V V t'' I -�'�S" ,, �.•. -" L�Ins;l� bettr\� C1-nr.i� �w�ore�.cri..l �r k. �c�a_v+ . l) �CMs�lc I r t �� r =.� kD �i :51-nv PoQ t�. '�JrJ7-t✓ �5 i c h a-�e G{ Q ✓.PQ S• Po .� Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes y, { ❑ Voluntary Compliance ❑ Employee Restriction/ have read this repoit, have�had the opportunity to ask questions and agree to correct all Exclusion E violations-,before th'e.' next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension s comply,with all mandates of the Mass/Federal Food Code. I u nd that noncompliance may result in daily fines of twenty-fives lar s nsion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. A �� ❑ Voluntary Disposal 11 Other: PH"rs Reccv eJl , Teniperaoio s Violations Related to Foodborne illness Interventions and Risk I Accord:ng io Lw,% Co,!ed m Factors(Jtems 1.22) (Cont.) 41^F/45-Fll%itbin4Hot rs. ' PROTECTION FROM CHEMICALS i 3-50:.1 1, Cooling, M.-diods for PHrs j ` 19 PHF'Hot and`-old llwding j 14 Food or Color Additives 3-;01 1,,dB) Colli P7I's Nimmamed at o1 below 3 2011 kddiuves'.` i 59C�.f,O-4 ;- (') 4IV45` F- 3-302.14 Protection front (hralrpnwcd Adch6ves` z, q01 16(.A) ( Hot r i3fs Maintained at or abov: 15 Poisonous or Toxic Substances j 7-101.11 kteny tifying Information-Original 14C'F. ^ 3_5(111!6(A; i ;Dant:: Held at ar mbocr l 3WF. Coutainer," 7-102.11 Common Nance-Workuw Containers ( 20 Time as a Pub;::Health Control j 7-201.11 Separation-St+n a(•e" I 3-:i01.!9Pitpz as a Pub!is Health Centro!" j j 7-202. It Restri,tion-Ptemnae and Uce" 59G.n{;41_H) I 'V.,iance Reguiremznt j 7-702.12 Condition;of U•a", 7-203,11 '4nlicContaim:r,-I'r:d:dbinons" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20.1.t t Stutitizet's,Criteria --Chemicals' POPULATIONS(HSP) j 21 ! 3 80 L 11(A) i.n,r,;istewr¢cd Pi -packaged Jtucec and W' i 7-201.12 Chemicals for mshine Produce,Criteria"' ! Berrrattes with 1F.',u�nine ta'ozis^ 7-204.14 Drying Absents,Criteria' 1 3-801.11;13) Use of Pasteurzed E!_gs* j 7-205.1 ! Incidental Food Contact.Lubricants 3-80:,;i 1 ill) RtuF or Ps:tially Cex-+ited Aroma: Food�rnd i 7-200.11 Pwmr.cted Use Pesticides.C'riter r= co R:,v. S ,-d olx:•uts Not Served. j7-206.12 R(K1entBail Stations- :.801.11;Ci UnoneredFa)dFactar= x: 20t, I3 Tricking Powdei s,Pcst Control and j - j e Tv.rt Re-se«+rd Monitoring" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-693 11 Consumer Athlsory Posted for Corsa option of Animal Food!;That are Raw. Undercooked of 14 Proper Choking Temperatures for Nol Odtcrc:ise Proc•rsvzd to l linunate PHFS rr+ea,.v;uc j 3-401-1lXl)(2) Egg;.- Iii°F 15 Set. Pail:ovens ' I Largs-Immediate Servos 145`P(5ssc r 3-302,13 Va.itemizttl Eggs Stihstibue for Rau,'Shell ' 3-401.11(A)(2) Comminuted Fish,Mcats&Canic Egf's" Pon orals- 155'F 15 sec. ` SPECIAL REQUIREMENTS 3-401.11(It 1(1)(2) Pork and Bcef Ruest- 130'F 121 min" 3_ 590.ot19(,1)- D) Violations of Section .'90.0('()(A)-(j')) in - 401.[ [(AL2) Rattles. lajectem h4caL; -155`F 1- cateriue. nnibdefeed. temporary and j 3-40I.I I(A)(3) Poultry, Wild Came,Stuffed PHFc, re�ldcatial kitchen operations should be Stuf ire Contaimn;Fish,Meat, dehi?cd under the ap-tropriatc section,, Poultry or R•itites-165'F 15 ser. {' :dove if rcfalt;d to foodborne illness 1 3-401.11(C)(3) Whole-muscle,IiltaO beef Steake intuven6ow,and rick factors. Other j 145'F.o j 59(,'%009 violations rcloling to good retail 401.1 ' Raw Animal Foods Cooked iu a praclices should be debited under #29 -- hllcuwa r IG5`F" Special Requiternrnts. 3-401.E 1(A)(I a b) All Cther PHF - 145`F I5 sec. "' j 17 Reheating for Hot Holding j VIOLATIONS R_LATER TO GOOD RETAIL PRACTICES 3-403.!1(A)&(D) PHF, 165`F 15 scc. * j (itenrs 23-r(>) ,i-403.11(8) Microwave- 165'F 2 Mumte Standing Ciitienl and nor-r ritical violas ntr, :•.Itich de not rchae to rite Time' ro,)dborro,dlro-ass nrterventi las wui risk jru tors hated abov-, con be 3-403.'1(C) Conumrcndly Proccsi ed RTE Food- ,Jo;ind in the%oUouir.;sev;ler;;rat the Fond C'cdc and 105 CVI? 140 T- 590.000. 3--4t13.11(E) P.enwinine Unsliced Portions of Beef '. tram Good Retail Practices Ft` - 59D.000 - i Roasts* 123. lVinnap=o,nn1 and Persrnne! FC-:? ( 003 1K Proper Cooling of PHFs 24 Facd and Food Protecton FC- 3 _' 004 I 25. Equ:pmorx and Wer.;ils FC--4 !, .00,5 3-50i 14(,1) Cooling Cooked PHF,,from 140`F to 26. Water, P�umbinq and`Nate FC-5 -006 70'F Within 2 Hours and From 7P'F ! 27 Physical Facifily FC-6 007 I to a I"F/=45°F Within=Hours. ' ( 28 Poisonous or Toxic Nlatenai, FC- 7 1! .008 j 3-501.!48) Cooling PFIFs Made From Ambient ( 2l `-+aeaa!Requirements 009 - - -1 Tentperanne 1m;rrihcrus to 41°F/45' 30 Other J Within 4 Hours I-100,rt:ae zap.. 1 Denotes clawal tlem m:11 federal 199y Fond Cade or 105 CMI[ !iQl OW, CITY OF SALEM BOARD OF HEALTH Establishment Name: L. Date: /I ��S�b � Page: 127;7 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date G No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 7� ✓ �,��-@ to �G��, S� � n.[of G n /� S c o r t OQ l' cJ �z ✓tG ,trxxt ryS. ry CP �I✓�aO✓ P(J��iCIL �Oa rl�C - I -- V � �� /C/rx� 6�p✓ui� ,o( v-zi ac(cv"A %j �i rrt � uIrvv 1 . I J r n t 21 �nl"�� o. � ,Pox,1 r✓ f.lC,�.�,✓eg a�-Gvu rfcX � t.Pn r;� nc � f " I . �> 17i ,j U)(Q.+ gt-�i-1-,�,•. 1-4a ,n r! ,A_�ecl,. strt � ,1.�(�U.),✓f7C S -e v..f.r a.-1 t I C�1> f. ✓� . .nc J I I p ft 1 I e_,'r on.� ��i_firlot4 iv% r Gr ver�d " cit t/YI4 6�i11AA SL Oo- toy Go"A W. _ ,t L.r, AU CA 1 oV __n'0td C"%f 1 h IICA 6U A' 1Ps,cJ.1, ( ted ce nJ s, ra.,r t I �'7 '} •s+ �.ci.rnn,.,.. .., ,MISS�r�,G 'tFfM"� �lSr(f!5 \M.VS, .w7AS� �a �c�Gt` � ,CY1• I t__ I • - �rnu,�f r .. Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ les I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance El Employee Restriction/ violations before the next ins-pection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Co e. I un stand that noncompliance may result in daily fines of twenty f' dol�pe sion/revocation of ❑ Embargo ❑ Emergency closure your food permit. ❑ Voluntary Disposal ❑ Other: i i I 50: ,-;C, t'HFs Recer.ed tit jealperaturss, Violations Related to foodbarne fitness Interventions and Risk According to Lamy C,.ded to factors(items 7-22) (Cont) ei i ;4',F Within 4 Hours. ' PROTECTION FROM CHEMICALS 5u1 I Crnaliar Iedxidc for PHFs j 19 l PHF Hat and Cold Holding 14 Food m Color Additives ( l 1-.(i! 16(13; Cold P1IA; Maintained m or below 3-212.12 Additiv''s"e 590 Ot)4!F; 41`/-45" P'' 3-3112.14 Protection tams y.tc S ro,-ed Additives' 3-501.i6(A) I lot FRFs Maintauted a, or above 15 Poisonous or Torre 5ubstanre:: 1,10"F, 7-101.!1 ldent:f}%mg !rform,m-n-Ouginal ! 3-507.11eA r Cnntaincrs'^ 1 ,, ) Roasts field at or above 130"F " 7-102.1 1 Common Name-Workiug Cnntaincrs, ( 'LO Time as a Public Health Control -201.11 Separation-Stutiwe'' ??i!1 (4 Time a:, a Public Llealth C'unhel" 590.004(H) Var:anee Requirement I 7-201 11 Restriction-Poscncc and Use, -- 7-20°.12 C'ocdi,ivms of Use' 7-203 It fu7.iC Ccntainer" - Muh,hltions" REMMEMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizes,Criteria-C'hemic:1s,,, POPULATIONS(HSP) j 7-2(}1.12 Chemicals for Washuie Produce,Criteria' ( 2: 3-801.11'A) I Cnpasreurred Pic-packaged Ruces and 7-204.14 Cry4ns:agents,Criteria" c;evetage; wiat li'm'ning Labels -R.,-,1.1 I(R) 1 Us: of F'astrurize9 Eee.," 7-205.1 i incidental Foul C'or,rdet. Luhrltants' � ( - ' 2 e Pesticides. Criteria* � � c^tt I I i'M j Raa cr P-atially Cooked Anuria! Food and - 06.1! RM,,alted tt ' R.ry Seed Sprouts NOL Screed. 7-206.12 RM,,al 6a:it Stations" ( 1.11(C) I Ilrv,pened Foos{ Package \ol Re-served '-206.13 '('racking Pow ler.,Pest Control and Ahunitnrtn�"' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-(03.1 ! Cva;unr r Al-Msory Posted for Consumption of Ib Proper Cooking Temperatures for Animal Ft>rrls'7hat arc Raw,Undercooked of PHFs I4.:;0cherw mse PrecesseJ to Eliminate Ptrc11-ige r 3-401.I1Ail)(2) Eggs- 155'F IS Sec. 1 ,.n<..' ?-3(t'.I? Pa;teunzed F3 tg2�,Suhstitute for Raw'.Shelf htnueuiate.Servia" 145`F'15secr - 3-401.11(A)(2l Comminuted Fish. Meats&,(;tune Errs- Animals- 155-F 15 sec. ' � 3-401.11(6);1)!21 Pork and 6ecfRoast - 130"F' I;lmin* SPECIAL REOUIREMENTS 3-401.11(A)t2) Ratites. Injected Meats- 155'F 15 590.009(A)4D) Violatiouc of Sectio::J91l.009(A)-0"))in sec. * ! caterin_, nobile rnod,tcmpomrry and -401.11(A)(3) Poultry, Wild Gmrae,Stuffed PHFs, reNd-ndal kitchen operations should be Stuffing Cuntauoog Fish,Meat, debited ander the appropriate sections Poultry or Rat:tcs-105'P 13 !;Cc. ° above if related to Gaadborne illness 3401.11(C)(31 N"nole-muscle,1ntaU Reef;teaks intarventionc and risk factors. Other '•45°F* 590.009 violations ie!;;ring to gutxl tetail 3-40i.12 Raw Animal Foexls Cawked in a pract,ces should be debited under#29- Miciowave 165`F " Special Rcquhernetits. 3401.1 I(A)(1 tib) All Othat PHFs-- 145'F '5 sec. j 17 Reheating for Hot Holding VIOLATIONS RELATE(?TO GOOD RETAit_PRACTICES 3403.1 If PHFs 165'F 15 sec. (Items 23-30) 3-403.11;'B) Microwave- 165'F 2 Minute Slanding Ciat,(dead non-,ritual vi„),trans, :shish do not refute to the Time' ,lbodhorne illness rrnerrcntirna and risk foe tore lured rboV,?, sae he 3-403.11(C) Commcrei-d!y Processed 12TE Food- i Ii,und in thcfto m nen recti,:ns of the Fond Cuue and 105 C.141t 3-40z.1 I(E) Remaining Unsltced Portionsof Hc,f Item -Grad fe-ta- -Practices FC 5.,0.000 a Roasts* I 123 Vanaoernent and t'ersonne. FC- ! 003 18 Proper Cooling of PHFs I 124 =ocd and Food Ptoieaton FC- 3 ! .004 25, Fq:;ipment anj Utrnsiis FC-4 005 ! -501.14(N Coling Cook.sd PHI-,, from 140`F to ' ' 26 Water,Plumbinq arra Waste FC -5 .006 70"F Withut 7 flours and Front 70`F 127 F6fs;aai Facility FG-6 1 007 Lo 41'P/45'F Within 4 Haar;. ` ( 23. Po!sonous cr I ox,c Maiedws FC-7 'i, .008 _ 3-501 14(f31 Cooling PHF:,Made Front.Ambient 29. Special Heawremeots 009 Tempetaune Ingredients to 41'F/45`F i 30. Oiher -- -- Within 4 Hours' 'C,cn„tes enncal item it the federal 701,9 Fw<d('-.ode or 105 Ci !t 590 001'x. 1 " 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 1 Handwash Facilities PASS RED Owner: Violations Related to Good Retail Practices (Blue Items) Joseph & Stephen Slesar Food and Food Protection PASS BLUE PIC: I Stephan Slesar Equipment and Utensils PASS BLUE Inspector: John Gehan Physical Facility PASS BLUE Date Correct By: GENERAL COMMENTS: I7�g : 690:AII violations from July 5 2006 inspection have been corrected. Risk Level: Permit Number: BHP-2006-0192 Status: FULL COMPLY j #of Critical Violations: 0 Time IN. !Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 13,2006 ) Page 1 of J " Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 13,2006 ) Page 2 oft 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 745-2337 PIC Assigned/Knowledgeable/Duties PASS RED Owner: Joseph & Stephen Slesar Non-compliance with: Anti-ChokingPASS PIC: George Mullen Tobacco PASS Inspector: EMPLOYEE HEALTH John Gehan Date Correct By: Reporting of Diseases by Food Employee and PIC PASS 0 RED Imo. Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2006-0192 I Receiving/Condition PASS ./❑ RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS RED # of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS RED 3 Time IN. Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 05,2006 ) Page ! of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors Food Contact Surfaces Cleaning and Sanitizing PASS RED (Require immediate corrective action) Proper Adequate Handwashing PASS ❑d RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwas'h Facilities FAIL RED yomments: Provide employee must wash hands sign in upstairs bathroom(Mgr's). PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS RED Cooling PASS So� RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑r' RED CONSUMER ADVISORY Posting of Consumer Advisories PASS [VI RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 05,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE !/Comments• rtic air freezer has uncovered foods. All foods in storage must be covered. covered foods throughout kitchen area units. All foods to be covered when in storage. Equipment and Utensils FAIL Critical BLUE mments:Walk in Freezer has accumulation of ice on floor. Remove ice. Ice machine has accumulation of grime on inside panel. Thoroughly clean and sanitize ice machine. dizer log not up to date. Log to be maintained daily. ,,TfRe units in kitchen require general cleaning. L,Arll�c�air freezer has build up of ice. Remove ice. - Cutting boards throughout establishment kitchen are stained and scored. Resurface or replace cutting boards in.kitchen. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE L- m ments: Provide a barrier on round vent cover over soup holding unit in back. Gen€ral cleaning required throughout back and kitchen area. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 688:AI1 violations to be corrected within one week of inspection. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 05,2006 ) Page 3 of • Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 05,2006 ) Page 4 of ( IMP O R TANT MESSAGE ) FOR A.M. DATE TIME P.M. M C OF PHONE R D E ER - DW O FAX ❑ MOBII F AREA CODE NUMBER TIME ID CALL TELEPHONED 1 PLEASE CALL CAME TO SEE YOU 1 WILL CALL AGAIN 4 WANTS TO SEE YOU + RUSH RETURNED YOUR CALL' WILL FAX TO YOU MESSAGE rbc `LIN (� SIGNED bps MADE IIN U.S0A. 4 + NOTES II n 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Owner: Comment:All cutting boards in the cookline are badly stained and scored. Resurface or replace all cutting boards. Joseph & Stephen Slesar PIC: � Sanitizing solution found too weak in many areas of establishment. Sanitizing solution of proper concentration mus[be readily available at all work stations at all times. Do keep sanitizing solution for cookline on floor. Scott Blatterman \ Inspector: \ , Dirty salad bowls kept near the brick oven. Salad dressing can be a potentially hazardous food,therefore bowls must be cleaned and sanitized after each use and not stored dirty at such high temperatures. David Greenbaum Prevention of Contamination from Hands FAIL ❑d RED Inspected nspected Correct By' Date 006 J Comment:An employee observed eating in the kitchen. Employees must eat in a designated employee break room or in the dining Risk Level: room to prevent cross contamination. Violations Related to Good Retail Practices (Blue Items) Permit Number Food and Food Protection FAIL Critical BLUE BHP-2006-0192 Comment: There are many cooling units in the cookline with uncovered food. All food in storage must be covered to prevent cross Status: j contamination. VIOLATION Equ,,ment and Utensils FAIL Non-Critical BLUE #Of Critical Violations: Comment: The KR4 cooling unit in the cookline needs a general cleaning. Time IN Time OUT Y I Provide a visible,accurate internal thermometer inside the walkin freezer. The kitchen and cookline Flooring is in need of a general cleaning including under and around all equipment. Urgency Description(s). BLUEGENERAL COMMENTS: Violations Related to Good 429:Reinspection will be in one week, all violations to be corrected. Retail Practices (Critical - vlolations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2006 ) Page I oft I J Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2006 ) Page 2 oft I 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-2337 Food Contact Surfaces Cleaning and Sanitizing PASS Critical Q RED Owner: Comments:All cutting boards in the cookline are badly stained and scored. Resurface or replace all cutting boards. Joseph & Stephen Slesar PIC � Sanitizing solution found too weak in many areas of establishment. Sanitizing solution of proper concentration must be readily available at all work stations at all times. Do keep sanitizing solution for cookline on floor. Joe Ferrari Inspector: Dirty salad bowls kept near the brick oven. Salad dressing can be a potentially hazardous food,therefore bowls must be cleaned and sanitized after each use and not stored dirty at such high temperatures. David Greenbaum Prevention of Contamination from Hands PASS RED Date Inspected: Correct By: 1/19/2006 Comments:An employee observed eating in the kitchen. Employees must eat in a designated employee break room or in the Risk Level: dining room to prevent cross contamination. Violations Related to Good Retail Practices (Blue Items) Permit Number: Food and Food Protection PASS Critical BLUE BHP-2006-0192 Comments:There are many cooling units in the cookline with uncovered food. All food in storage must be covered to prevent Status: cross contamination. SIGNED OFF Equipment and Utensils PASS Non-Critical BLUE #of Critical Violations. Comments:The KR4 cooling unit in the cookline needs a general cleaning. 0 Time IN. Time OUT: Provide a visible,accurate internal thermometer inside the welkin freezer. The kitchen and cookline flooring is in need of a general cleaning including under and around all equipment. Urgency Description(s): BLUE: GENERAL COMMENTS: Violations Related to Good 439:All violations cited in the 1/12/06 inspection report have been corrected. Retail Practices (Critical violations must be corrected immediately or within.10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 20,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) J City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc Commonwealth of Massachusetts ( Rev. Jan 20,2006 ) Page 2 oft 'Q Commonwealth of Massachusetts e City of Salem b Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Salem Beer Works File Number:BHF-2004-0275 278 Derby Street Salem MA 01970 LOCATED AT: 0278 DERBY STREET SALEM, MA 01970 Permit Permit Issued Permit Permit Type e t N .o Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0192 Jan 3,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonatious,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 10 I_ 4 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH D _ s 120 WASHINGTON STREET, 4TH FLOOR �4^uxe SALEM, MA 01970 I� TEL. 978-741-1800 DEC 0 81005 Ill 11A STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR WWW.SALEM.COM CITY Oo= JOANNE SCOTT, PH, PIS, CHO BOARD OlzHEALTHEgLTIy 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Safeco (�. wd.-Lc-r TEL# q-79 -70 - Z-7-7-7t ADDRESS OF ESTABLISHMENT X6 7UA-, fi- MAILING ADDRESS (if different) c-/) 3412-1- Wc✓kI Ca rOJ<a�t d+"►T i)0 Crt1c�( /} QaJ OWNER'S NAME 0/-rt. &-I,�l TEL# 6/J-31 -4700 ADDRESS//D CITY 0JJ4rVN ST TE %iceiF ZIP 0 a-/(C/- CERTIFIED FOOD MANAGER'S NAME(S) V /�h CERTIFICATE#(s) 7® (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON-.')'otgQh S/PSa--- HOME TEL#A/t 2-111 Yf btu -IN 96zk° HOURS OF OPERATION: Mon.q�n.V +Tue. I/-72PVVed. rt ly"rhu. -L9 Fri. it ii��at.1I Ib7o Sun(A TYPE OF ESTABLISHMENT FEE (check onlvJ RETAIL STORE YES NO less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ............................................. than.....i... - ............................................ . NT RESTAURAES NO ' less seats $100 25-99 seats =$150 more than 99 seats <ZED -------..... - - ....... - .... - ..... BED/BREAKFAST YES NO $100 ADDIT!ONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES N $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. i(•Lti-n/' 04-317-7-7-0�0 Sig t e Date Social Security or Federal Identification Number ---------------------------- -------------------------------------------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#8 Date 3/0-6If /.I oZ00 r E 0278 DERBY STREET Salem Beer Works City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 745-2337 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Joseph & Stephen Slesar Tobacco PASS ❑ PIC: Todd GOOGoodwinFOOD PROTECTION MANAGEMENT Not Done TOd Todd Go PIC Assigned/Knowledgeable/Duties PASS ❑ RED InspDavid Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 9/15/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS �/❑ RED BHP-2005-0198 - Receiving/Condition PASSd❑ RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑J RED SIGNED OFF Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations: Plans Time IN: Time OUT Notes: 299: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 - days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 16,2005 ) Page I of 0278 DERBY STREET Salem Beer Works must be corrected immediately PROTECTION FROM CONTAMINATION Not Done or within 90 days) Separation/Segregation/Protection PASS RED RED: Violations Related to Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Some of the sanitizing solution throughout Foodborne Illness Interventions establishment too weak. Provide sanitizing solution of proper concentration at all work and Risk Factors (Require stations at all times. Sanitizer refreshed at immediate corrective action) time of inspection. The cutting boards in the cookline are stained and scored. Resurface or replace the cutting boards. Proper Adequate Handwashing PASS Q RED Good Hygienic Practices PASS ❑/ RED Prevention of Contamination from Hands PASS ❑/ RED Handwash Facilities PASS ❑d RED PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS 0 RED Reheating PASS ❑J RED Cooling PASS RED Hot and Cold Holding PASS ❑d RED NOTE: The two end cooling units had temperatures of 45°F. Units were being , serviced at time of inspection. Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done I, Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 16,2005 ) Page 2 of 0278 DERBY STREET Salem Beer Works Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE Cooling unit K in the cookline has uncovered food. All food in storage must be covered. Equipment and Utensils FAIL Non-Critical ❑ BLUE The racks in the walkins have an accumulation of grime. Thoroughly clean all racks. The floors and walls in the cookline and kitchen need a thorough cleaning. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE Management will notify the Board of Health within one week that all violations cited in this report have been corrected. �% GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 16,2005 ) Page 3 of fL]4�'v^. ",'.""l^- Se°.as*+.Yrl,• ..cvc� ai`'!...+s :+r."'`.KP'•.^4C�:"+"a^'!.`.',^. i.`�ee w- dam.Z. 't 7d ,kT N:a+:'i4 ='yea fit<k sem$ , a r';A:rs'3v e...n♦�tW'�a+gs:-l�.m.:t -�a-nvCy..•-4'1�'» -'-�`x-u..J-a_.,-. n.'.,..�;- _ ,.ii..',i.=5:i"'i ""' i .w,3's� �:t 't: Y Vk..3 �1 �i'N�A�/, 4i� .. L..';41.- .RbS f'll'(}.^[ - e ' .-..n _n 'wL=.ice..-.--.vaw+v - i✓.-m t.a: wK 4�H CITY OF.SALEM9 MASSACHUSETTS 3 , BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Salem Beer Works Address of Establishment: 278 Derby Street Owner's Name: Joseph Slesar Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 121-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT " CITY OF SALEM, MASSACHUSET Nevnvq BOARD OF HEALTH �j •' gj 120 WASHINGTON STREET, 4TH FLOOR 2004 J q 0 o' SALEM, MA 01970 NOVVY L VW TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT-_! g dv1 Apo ",. kS TEL# ADDRESS OF ESTABLISHMENT 1JR / Sq kni _.mA a (q-? Cg MAILING ADDRESS (if different) I r OWNER'S NAME__�&P/yl,� 51CSet/ TEL# ADDRESS #0 CITY 30S9w6_'_ STATE M 4 ZIP CERTIFIED FOOD MANAGER'S NAME(S) 30 CERTIFICATE#(s). vA'I irfvt9( r , �� ve (required in an establishment where potentiiallly hay / ardous food is prepared.) l EMERGENCY RESPONSE PERSON )TP041� S/lSe,-- HOME TEL#_&a-_�Lf HOURS OF OPERATION- Mon. ✓ Tue. Wed. Thu. - Fri. " Sat. ✓ Sun. .911 Ayr 001^ 1I'3o Ivv1 C/03C 1-00 4M TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT NO ✓t�� less than 25 seats =$100 �d 25-99 seats =$150 more than 99 seats =$20 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL MON-PROFIT(such as church ,kitchens) YES JO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signaturg�f, e' Date / Social Security or Federal Identification Number --� ��--- ----------- ---------- ----------� ?f�4�g1-------------7 T /------------d 31�.�7 -$..-- Revised 11103/03 FOODAP2 adm Check#&Date f j Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name� Date� Dm of Ooerationfsl, Type of Insoection tfifax- WdtZKP (h/�1/eV I 0 Food Service ❑ FFjo�utine AddressI Risk El Retail die-ins ection `7R n 2 tr z^t/ r`' Level ❑ Residential Kitchen Previous Inspection Telephone 7�y< /-t ❑ Mobile Date: Owner. HACCP Y/N ❑ Temporary ❑ Pre-operation T Elt /a� oLeK I Caterer El Suspect Illness Person in Charge(PIC) I Time ❑ Bed& Breakfast ❑ General Complaint In: El HACCP Inspectort^.-t4la N.1 A4,1 I Out: Permit No. ElO herr Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded ❑ 14. Approved Food or Color Additives FOOD FROM APPROVED SOURCE [:115.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION P,19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing F-121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): 1 of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR c f C each. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 59JlruspecfFoim6-14 tla Inspector's Signature;^ 1A Print: PIC's Signature: \P A I Print: Page of Pages 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAIVII RATION FOOD PROTECTION MANAGEMENT SI Cross-crnta-,inatton { 50(f003tn) Ass;gnmentafResprmsib;lity"" 3-30"2.11(A)(!) R:w Animal FondsSclvtr:acdiiom 500.003(B) Denro n,tranou of Knowledge* Coked and RTL:Foods" 2-1 fl 11 Person in charge -duties Contamination from Raw tntgredtents .3 302.11!,A)(2) Raw Animal Fooct,Separated from Each EMPLO"EE HEALTH Other" 2 W(1.003(0 Rzspnnsibility of the person in ch:age to Contaranatton Dorn the Environment aqui:reporting b} Rina employees and 3-302 11(A) Ftxal Protecoon' aprlicants'" 3-3(17.15 Washinp Fruits and VegetaoLs 590 003(F) Responsibility Of A Food Fmployee Or Air i i 3"304.11 Frod Cuniact w"if i Equipment and Applicant To Rept-rt To The Person In iu : uteailc Chart,e* Contamination from the.Consumer Sv0.003(G) Reporting by Person in Charge^ ( 3-306.141 A)(B) Returned Food;:nd ResemFce of F(xxl" 3 5900031 D) E.edusiunsand Restriction:;° Disposthon of Adulterated or Contaminated 590.003(1:) Removal of Exclusions and Restrictions ( Foor.' 3-701.! 1 Discarding of Reunnditiomng lin;ate FOOD F IOM APPROVED SOURCE Food- 4 1 Food and Water Ran Regulated Sources 9 rood Contact Surfaces 590.00d(A-H) Comphano,, with food Law' I 4-50I 111 ,b�tanuai i0areu�;ahing- F[ot Water 3-201.12 Food in a ❑ernne!i:ally Sealed Container. Sanniwation'remperatutes* 3-201 13 Fluid Milk.mdMilk Products' ( 4-501 112 Mechanical Warewashing-Ho;. Water :i-202.13 Shell Egg;' Sannizatunt Temperal ureF* i 4-501.11. Chemical Sanitizahon-tculp, pH. 3 202.14 liggs and Milk Prodtwts.Pasteunred" coneertiration and hadnen,. 14 3-20216 Ice Made Front Potable Driukmc`Muer" 14-601 1 It H) Equipnnent Food Contact Surfaces and 5-101.1 I Drinkine Wafer from an Approved System j Diens;is Clean"� 590.0061 A) Bottled Drinking Water'' j r`(P_1' Cleur,mg Frequency of Equipment Food- 59{),00((};) Water Mot:.Standards nn Approved CMR 22ce ( Contact Surface..and Pte•n;ils" Sneltfisr,and m d Fish Froan Approved Source d702.11 1^reyuen�_y of Sanitization of lJten;iis and 1.14 Fish and Recreationally Caught Molluscae '-�'0Fuix1 Contact Surfaces of FyuilnnentT Shelitish* ( 4-703.11 Methods of Samhtation --Hot Water and 3201.15 Molluscan Shellfish ish from N ;ter SSP Lil , ChcmicaP- ionnre"`' 10 Proper,Adequate Handwashing Game and Wt!d Mushrooms Approved by Regulatory Authority 2-301,11 Ciean Condition-- (-lands and Anu:.' 3.-02.18 ShellstockldentificatinnPresent' 2-301,12 CleanlnrProcedure` j 590.004(C) Wild Mushrooms"- 2-301.64 When m Wazh 3-201.17 Gaure Animals" ( ( 1k Good Hygienic Practices g Receiving/Condition 2-401.11 boon%Dirmki;¢or Using Tobacco" 3?02.11 PI IFs Re.-mvcd at Proper Temperatures* ( 12-401.12 Discharges From the byes.Vose.md 3--202 I5 Package hntemity" Mouth" 3 IOLI l Food Safe and Unadulterated 3-301.12 Preventug Contamuutbon When Tasting^ 6 1 Tags/Records:Sheiistock 12 Prevention of Contamination from Hands ! ,3-202.13 Shelknxk Identification"` 590 0(4(E) Preventing Contatmuatittn from 3-203.12 Shellsan:k ldentdication Maintained" L'ntployeec* I nn cles TagstRecords:Fish Products Conveniently Llrated j and Aecessbie 3-402.11 Parasite Desnuction* 3-40'_.12 Records.Creation and Retenmm" 5-203.1 I Numbers and C:',^acitics 590.0040) Labeiing of Ingredients' � i 5-204.11 Location and Placement` � 7 Conformance with Approved Procedures 5-205,11 :%Ucessihi lily,Operation and 1^.a:nlcnane.: /HACCP Plans I S;:pplied wdh Snap and hand Dry;nty 3-502, Devices 11 Specialized Prnecs;ing Methods* Reduced oxcgen packag;nl€ criteria" 1-502.12 ( 6.301.1 l l landwaahing C zan,-ir Availability 1.12 Hand prying Pnrviv:m 8-103.12 Conformance with Approa;d Px7cednres'; D.non;,:rnlcal hent in the federal I)09 loud C otic or{��i ChII:X9(11)(10 CITY OF SALEM BOARD OF HEALTH Establishment Name: Jf4rffti4 /j &yAees Date: �z�z21,01y Page: 2 of 2 Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY c/ C ^� /ItC t�� C�a✓G itrrt� � ,.e �etP of 6i°f . �,a,.. „N,r N .*.rx.Nrt.va .A GZiatO of ulio< ane Sr1te�. I � I � I I r/FLL_ �n&,e,t runt ..,s.�c cr oa.� t2/(�v /NSrlrenor/ i4ar'drY� I /f stn£ /�i�s•J ��x,4t orti Q. I I � 1 1 1 1 • I I 1 I . I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next ins ection,to.observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fine's of'twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure dour food permit. ❑ Voluntary Disposal ❑ Other: r I � • J c,v1 14ii.; ( PHFs,Recetv,:d at Temperatures Violations Related to Foodborne Illness interventions and Risk Accvrdm^.to Law Cooled to Factors(items 1.2 ) (Cont.) 41^Fr45"'F Within 4 Honra PROTECTION FROM CHEMICALS iCool:nv McLi'cd:.for'4-50i,15 l 1Ps �e 14 Food or Color Addhives 1 I I y ( PHF Hot and Cold Hoiding 3 5 11.16(x;) Cold 'HF:. Maintained at or below 3-202.12 Additive,* ( i 590.0 1!F; 41-/45,'F 3 702.14 Protection from Unappru'ed Addiliw<* I 3-50i.:6(A) Ilot PHFs Maintained ar or above lg Poisonous or Toxic Substances ( 1 140,F. 7-1(1111 Contitytnint?n'm.du1:-Or:?;oat ( 3-50L16(A) Rnests field at or above 130]. Ct,ntainers'" ! 2iJ Time a::a Public Health Control 7 102 1 I Common Name-Work;ng Containers* ;-iU}.l`J Time as n PublicHeahh Control* or 7-201.11 Separatinn-Stage" I agt).Q04('-I) �''-u'iatue Requirement '7-202.1i Rellricilon-Presence and Usdr 7-20'_.12 Conditions of Use- 7-203.11 r(wc G:nuaineis - Prohihitiowi REOUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-204.11 Satiitizers.Crirene�-i'hemrcalrPOPULATIONS(HSP) 1-20112 � i 1-201.12 Clmoiicals R:r Wa,hitiz 1'n:duce, Cincria" 21 j 2-801,il(A) Lnpasrcuroed Pre-packaged Juices and 7-204.14 Urving Agent,,.Criteria`' i ! Serer:.t�'es with kkarnmg L;abolO _ ' i-801 II(Bi Use of r'sste:rized Es:,s" 1 7-265.11 lucidental Food Conta-.1. i.ubrtcants^ ( 3-S01 1](D) Raw or P- utha Iy Coil:^d Animal F'.xd and 7-_06.1 i Restricted Use FeSULI&s C:nteria'" R,tw Seed ;grouts Nor Ser,ed. 7-206.12 Rodent Bait Stations` ( 3-8UL1;(CI UnopenedFcxxiPackage Not Re-served. '° 7-206,1 3 Tracking Powder-,Pest Con+.col and Monitoring* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 12 3-603.1 I Cem.amcr Adtisory Ported fur Consumption of Aui:u:d Fends'['hat src Raw.Undercooked or 16 I Proper Cooking Temperatures for Not Othenaisc Proces;rd to Eliminate PHFs 3-4101.1 IA(1)(2) Eggs- 155°F 13 Sec. 303.13 r`asteunzed Eggs Substitute lot Raw Shelf Eger-lnmrediateService 145`P15ser 3={01.111:11(2) Comminuted Fish, Meats&Gamr EEa,s Animals- 1556F 15 sec. " 13401.;7(8)(1)(2) Pork and Beef Roast- 130'F 131 .^.'.in" I SPECIAL REQUIREMENTS 3-40Llt(AJf2j Rants,. L:jecnd )bleats- l55'F 'S I 590 009,`A)-(D) Violations of Section 590.009(A)-(D) in sec. * I catering. mobile food, temporary tmd 3-101.1 I(A1i3) Poatrry, Wild Game,Stuffed IIHFs, reatdeut,al kitchen operations should be Surfing Containin;Fish,Meat, debited under file appropriate sections Poultry or Ratites-765`F L5 sec. '' above if reidl:-•d to f6odbome illness 1 3-101.11(C)(i! Whole-muscle,Intact Beef Steaks intet tent ions and risk factors. Other ,yr , I45`P t'009 Violations relating to good tefo'd 3401.12 Rays Animal Foods Conked in a practicc>sltcuid be debited under #29- Microwa,e l65'F" Special Requi:c ncins. 3-401.11(A)(10) All Other PHFs- 1.15`F I S sec. + j 17 Reheating for Hot Holding j VIOLATIONS R.LA TED TO GOOD RETAIL PRACTICES 3-403.111A7ty(D) PI"lFs 165'F 15 sec. "^ (Renis 23-30) _i-103.11(13) Microwave- 165`1,? Minnie Standing) Griticrd and non-rrifical violation, trhich do,:nr gelate to lire Timet ,foodhnrne dlnesr imervenficros and riskJnetors li,rred,7i1)re tan be. 3-403.11(C) Counwreialh'Processed RTE Food- lount in dta jb/tnn ia,C ae:'ri,.ns of the Fnn_i Cade awl 105 Gd7R 140°F'' 590.01)0. 3-403.1 1(E) Remaining Unslice,l P0000ns of Beef item Good Retai!Prortices FC 590.000 Ruzsta"' 23 t4ananemenl and Personnel FC-2 .003 - 24 Focd end Food RmirctIrn Fc-3 004 18 Proper Cooling of PHFs I _ 25 '�gWprneni and Utensils F.^,--a A05 I 3-501 14(A) Coohng Cooked PHF<from 140`F to gg Watei,Plurn",nii ar.c W,-.ste =C-5 .006 70"F Within 2 [lours and From 70'F 1 27, Physica'Faci.ity F;;--S .007 to-1["F/45'F Within 4 Hours. "' 28 Pcisonous er Tex c Ma',erias FC-7 .008 1 3-501.Ht f3; Coo;ing PHFs MatEe Fol)o Ambtfnt ! 29 5p„c:ni Requ tcmen,:, 1 009 "temperature htgredients lu 41'F/15'F 1 30. Qthet - Within 4 hours" •:.,"n:.:r.,:,;-Z-, Dena,,,critical item m n:.FMcmf 19)9 Food Cud,,r it 15 CMR 590 000 r � 4 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Type of.Operation(s) Tvpe of Inspection -?Afu-Cm /ycri� Wd(/lr' /2X r/q ©mod Service B-Routine Address �7� Day S� Risk i [IRetail ElRe-inspection I Level El Residential Kitchen Previous Inspection Telephone -7--/f . 2�f7 t*1 ❑ Mobile Date: Owner HACCP Y/N El Temporary ❑ Pre-operation .r�seirlrrr r Jw�r/ r14LrsA I I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time El Bed&Breakfast E] General Complaint inspector In: [_1 HACCP p &4,A /1wlc drsA.wa Out: Permit No. ❑ Other Each violation cfiecked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El13. HandwaSh Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS L] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMFJTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. ooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection El 20 Time As a Public Health Control -J'9/.. Food Contact Surfaces Cleaning and Sanitizing j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590 006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (990.009) within 10 days of receipt of this rderA. 30. Other DATE OF RE-INSPECTION: �2�Qt(`/ S 5MnVp 'Fo m 14 dx Inspector's Signaturevi1� ythti //- Print: I / PIC's Signature: /ll`f�J.•f•�- Print: li Page!of Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PR3'I'ECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT j 8 Cross-contaminator, 1 1590003(A) I Asst;;nmentofResponsibility"" j 31-ii .I!(A)(1) Raw Animal Foods Scpatatrdborn 590,003(13) Derronsuation of Anoa!edge* Cooked and IZTF rrurds' 2-103,11 ( Person in charge - dutizs j Co;aamtcaiion'rom Raw logiodients f 3-302-111A)(2) Rave Anima' P,nds Separ.:trd frau Itch EMPLOYEE HEALTH Other- 2 '190.W 3(C) Rr;ponsibi1 iv t•f du person to charge to Con`arnination Ecm tine Env`rorment j require repotting by focal employees and 3-302.11,A) Food Protection* j applicants' I j 3-302 15 .S'ashitta Fou;aad ve),'.•tables j 590.00.(F) Responsibility Of A Feat Employee Or An ( 3-304.1; Food Contact a•^i;Eu.uipment and Applicant To Report 9o'rhe Persue ht Utensils' Charge' I Con,amination:9om the Consumer 590.003(6) Reportim;by Person in C'han,c' j ( 3-306A VA)(Is) Returned F ucd and Pesrrcicc of Fix& j 3 5900031Ui E�Llusions and Re!Jrictiors I j Uis;nosrtvn of Aovaerated or Contaminated 59C.0'03(Fi) j Rcinoval of Esduawns and Rastrwtions j Food 3=It)f.:i Di>cardirg or Recondniomng Unsafe FOOD F IOM APPROVED SOURCE rood` 41 Food and Nater From.Regulated Sources 9 Food Contact Surfaces j 590 004(;\-B) Contph:mce with Fund Law:' j 4-501 11! Mamtal Wraowashhtg-f Iot vFar?r i j 3-201.12 Food in a Henneticaily Sealed Container* S-niu: ,tion re.mperauttesn + 3-`_0(.13 Fluid j j4-50:.:12 Niecbani;al Wir,washing-Ant Warcr + 3-202.13 Sheli Eggs* i Sanitizaiior Temperat:,:es` -+--501 114 Chemrcai Samdzation-ten. �H. j 3-202.14 Eggs and Milk Products.Pasteurized" cnccntrstion and bardnea sn'' 1 j j i=_'02.16 !cc Made P7orn Potable Drinking Win.,r', 4-601.1 i(A) i-gaipincnt Food Conr,�t Surfaces nna i-101.1 I Drinkin! Water from au Approved Svaern' I Ute:+sits Clean` S00.006,A) Bottled Drinking Water* j 4-692.11 Cleaning Frequency of Equipment F,-,)d i 5y0.006(R i 4�4der Meets Sisk Ro ds in ppi vedCNI22(P' j Contau Surfaces and Utensilsx j Shellfish and r"ish Frum an Approve,Source 4-702.!1 Frequency O Sat-itization of Utensils'Ind3-201.14 Fish and RecreahConall} night Molluscan I i Ford Conta:^,Surfaces of 54uip:nentr j Shellfish" 1.7:13,11 Methods of Samhzation-- Ho, Outer and j 3401.1 i Mollosc.:n Shelitlsh from NSSP Lusted i Chem6;.il' j Sources` 1 10 I Proper,Adequate Handwashm,; j ! Barno and✓Vdd Mush•ooms Approved by j j Regulatory Authority 301.11 C:ean Cnndniun - Hands and Arms" j 3-202.18 Shellstock Identification I'resem"` ; 2-301.12 Cieamrty*Procedure" j j 59(11J;04(C) Wild Rtnshrawts' 2-30!.11 When ro Wai;10 j 3-201.17 Gwne Anm+als'" i t1 j Good Hygienic Practices j i 5 Receiving/Condition j 2-401.I1 bating,Dnnkinp of Usine robaccus j j i-207,11 PTI 's Rece;ved at Pro)tr Tem.,t euros e j 2-4(i(.12 DLticna,-ges Fnnu the Lyes.Nos: end 3,'.03.15 Parka^e tntc>,'it}•"" j Mtoutht 3-bJl I 1 ktid Saf-and Unadulterated 'e 3-301.12 f'r ceniing C„llaminatinn Nhcn Tostiiig, j j 6 j "rags/Records;Shellstock j ( 12 Prevention of Contamination from Hands j ! 3-202.13 Sh0,,toCx Identification 590.004(E) Preveming Contamination from j 3-203.i 2 Shellstock Identification Nlain£ained"•' acdwash H j TagstRecords:Fish Products ( 13 srdvtti Facilities " 11 _ Paraeiie Drtitruction' 1 Convefverihy Lucared,lid FlccEssihlc t2 Recon(,,Creative and Reterno:i', 5-203A 1 Numbers and Capacati`".+' 140.(}(4;t) Labeling of Ingredients' 5 ;:01.11 1 ocat:,ni and PlaL-Incnti- j 5-261:1.i: Surlcczsa ,ibihty. Operation:mil Mamn:n.mce j 'J Conformance with Approved Procedures `r ad Nand Urin_ ped with.Seep an iHACCP Piens I I �` a 3E 3-502.11 Spec.iahied Processing,Methods* I 6._301.11 H•+ndv;achirg C!can,:.r.r'naiiahtbiv j l" Reduced oxygen packaging,criteria': IFmd . j 5.103.12 C,nfortrance with AaproYf:d Procedures` j 6-30;.12 Fund Drving Pror"iI,Juc I rkrmo s o me it dem n+the Crrersl 1':97 Pond CCAC or U)5 CMR SOu.0(n) CITY OF SALEM BOARD OF HEALTH J' Establishment Name: .liateLat rOL94A- GJdK,rs Date: /2�ir/`/ Page: 2- of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY *q /M S /f_ r+.c,•,/ of /ZiEYMx drvsr ,,, ns+*� t r1F •//�f OIL /✓�C �.�1� .rGY crri �.c.�./� un,l' /M"'r N Vi'Z44f- od"a s-ar y7/cC.G,uai.+riTt{it , r r I �/ Q/ d_n+71i61 J'N/eso /qtf rr.,as£tPj emu ,4,ec+tS� /�i�1 t/E3 /� /S eGefQnrc�✓� S.iNrl ilk go*,a5 //J coexc,#,4E /0rt.& .rr*,,rzL J 4r/6 I l /l�eeC C..1rT7r❑lr I.pdV+t/�C I Jrj i r N ti m olr ,? t//l'1,0LcS 4-c.e il �7Ptl+�✓�l��"t�/�3r ?-S plc fr 4-A41.f a V/.riJSr,jC itCZ-OA-,•rte e7u,4 f ,Ads /1nf /�rr 6!H J/ .rn.�r� d/ Fa.�/J OL a,4 r, c��,��/,�s-,n c� UI�/C . I 4j � 9 C 10 /Z0 Vzf r Fetwo /#4 "ele . ,ew MV wrtlrr df C4'f" ew Discussion With Person in Charge: ( Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction 11 violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. j f(/ ❑ Voluntary Disposal ❑ Other: ISI PFiFsReceivedat'i'eniperaturrs Violations Relafsri so Foadbarre Illness intceveni'cns rnd Rrak According to Lavr Cooled to Factors(Items 1.22) (Coat) 41`F/45T Within 4 Hans. PROTECTION FROM CHEMICALS }ol 15 Cooling Methods for PHFs I 14 ! Food or CoW Additives � 1 y PHF Hot and Cold Holding -5U 1.16(B) C'nid PIIFs'Maintained at Of below 3-202.12 Additi•roc. { 15909r14tF 3-302.14 Protcction (,in tJoaprin cj Additives" ! ) 41145'F' { 3-50:.16(A) tint P4IFs Alaintained at lir above 15 Poisonous or Toxic Substar;ces 140T ` 7-101 11 -501 16(A) Roasts Hold at or above !3U"F. "' ( C entuir,0r," { 7-10211 C'"m inn Name-c"ork1,;z Ca^tai nen," ( 20 { Time as,a Public Health Control { 7-201.11 Separation-Steta,ve" { 3-501.1.' Time as a Public Fle,ilth('rstaott(rol=` { 7-202.11 f;estrichun-!-'resence a- * Uses { 590.004(H) Valiance Requircnient { 7-20'.12 Conduinnsof'Jse' { '1--2ol it toxic Containers-Probihilion,.,, REQUIREMENTS FOR HiGHLY SUSCEPTIBLE 7-201.11 { suiitizere Crte-lit-Chemical" ( POPULATIONS(HSP) > { 121 ( 3-8{01.1I(A) UnpasteirwedPrc-packaged Juices awl � 7-�04 12 I Chemicak for V;ashu:c(rosin,,C:iteria'" 7-204.14 [hrting.Agems Cr:feria' { Bevera.es with Warning Labels^ 3-801.1 i(P.) Use of Pasteurized hggs" 7-205.1 ( ; incidental Fural Contact.U:hrcantc' 3-C O1.11(D) Raw or Partially Cooked Am mat Fsxxl and 7-206.11 1 Resicicted Use Pesticides,Criteria, { 7-106.12 Raw Seed Sprouts Not Sen ed. k 1 Rodent Brit Stations" : - I +-80i.i7tCr I Unopened Food Package Not Re-served.7-206.13 i 'i t ac4ln<,Poivdar:,Pcct r'onuol and 1 Monitorirgq CONSUMER ADVISORY TIMEfFEMPERATURE CONTROLS 22 s-603 11 Consumer Adrisor) Posted for Consumption of 16 i Proper Cooking Temperatures for j Animal Fc"h;That arc Raw. Undercooked or I PHFs Not Otherwise Processed to F.litninate 3-401.i 1:,(1'd2) Fegs- 155'F' 15 Ser. Patho_ene Lyes-hnniedlate Service 145'Fl5st,:, 3-302.43 Pasteurized Eggs SUbStitale for Raw Shell 3-401.i I(A)(2) Conunuuned Finn, gloats,k Gallie .Animals- i 55'F 3-401.1l B)(I)(2) Pork and Bea!'Roast - 130'F 1s1 mm SPECIAL REQUIREMENTS 1-401.1 I A)(2) Ratner, InjedOd Mears- 155E IS 590 00Y(A) (D) Violations of Section 590.009(A)-(D) In catering, mobile food, ternporary and 3 401.11(,Ali3) Poultry, Wild Game,Stunrcd PHFs, residential kitchen operations should be Sni(Cq Cuntsinine r@.h,Meat, debited under the appropriate sectioac P.)atrvoiRantet-165`F 15s.c. above if related toloodbonieillness 3-40L11(Ct(3'. Whole-muscle,Intact i;ecf Steaks intervention,and risk factors. Other 145°F, 590.009 violations relating to good retail 3-401.;t' Raw Animal Pard,Cix;ked in a practiccs should be debited under x{29 - R ivuw,ivr 165q " Special Requirements. +401.11(3)(1)16) All Other FHFs 145'F 15 sec { 1' Reheating for Hol Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES PHFa 165"F ii see. * (ltettii 23-311) 3-403.11(8) Rlcrowave- 165'F 2 'vinitue Standine Ci itial and non-critical violations, it hich do not rclate to the :6110* foodborne illness interveniuins and risk Tactors liAwd obove, can be 3-403.11(C) Commerunik Processed RT7 'r+v;d- found ire the folluuong sections q1 the Food Code and 105 CAfR 140'F" 590.00 . _ 3-403.:1(F:) Ren:amoa,Unsliced Puuionc of l3cef I ! item Goad Retail Practices FC 590.000 i Roasts'" 123. Management end Personnel FC-2 .003 $ Proper Cooling of P11Fs ( 24 -- Food and Food Protection FC-3 'j04 I 25. _ ( Equioment and Utensils FC-4 005 ,-501 14(1) Cooling Cooked PHF:. froth 140`F to ------ 26. ( Nlater, Plumbing and Waste FC-5 x'08 Withia 2 'dour;.slid Front 70'1 27. Phviical Fatuity FC-E A07 { to 41 T/45017 W;thin 4 Hours. ` 28. Poisonous or"I one Materials FC 3-501 14:11) Cooling P1 IN Made Ft oro AmMcnt29. SpeOiai Reaur.enivnia 000 tauperatcrc ingreuients :n 41°F!-:5`F 1 '30 Other - -- AVicon.11tonrc^ •..,pro.:e�:i x::,,, Denoteacnucal lie:'..m the tedcred 19941 wa10,&or tC5 C khv 51!110110. ., .i CITY OF SALEM BOARD OF HEALTH Establishment Name: [ /Ie£f_CV "40A& Date: t2t1/1'/s`1 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY i ox /r[ Rniw< ,.rwrr,.,✓ { I "A � I sod r'tS .£.ff' fadOp V 1 ' 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r 0 Voluntary Disposal ❑ Other: l 4(C) PHFs Received at T-opct,tnucl Violations Related to Fco:dborne 0;^ess Interventions and Risk According to La\\ Cooled to Factors(Items 1.22) (Cord.) 41'Ff45`F Within-1 Honrs PROTECTION FROM CHEMICALS � 3-501.15 Coolin, vteoiods for PHF, I 14 Food or Color Addaiaes 19 PHF Holland Cold Holding j 3 02.12 additive' j 3-50L16(B) Cold PHI,iNaintained at or belnw 590.004(F) 41'145'f* 3.302.14 protection tv;m Uiappa, d Addffives" ( 3->{JI IraA1 Hnt PHFs ldaimeroed at orabo\e j 15 Poisonous or Taxis Substanrns j 140'F. 7-I01.I 1 lde:::ifvmc Information -(higiIla! 1 16(4) Roasts Held at or above l3p'F r Containers' � '7 H12 11 Common Na:::e-Workm;;Cnntaincre" j 211 T line as a Public Health Control 7-301.11 Czp,tration--Sioras:,` j 3-501.19 Time a:.a Public Health Control' 17-202 11 'Restricli:m -Pnescnor and Ua.e" I 590.004(H) Variance Requirenrcnt 7-203.12 Conditions of I Ise' '7-?Iii I I Toxic Contain: - F-nridrntion * REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1--?04 11 &Initilers,Criter,a--C tt<^s*icai j POPULATIONS(HSP) 7-204.12 Chemicals for\4;uhui2 par duct.Cnter,a' j 121 3-301.11(A) Unpasteunzed Pre-packaged lwces anal 7-204.1.1 I Dr'ong AK-nus.Criteri=a„ I Beverages with Warning Lab.ls^ 1 7-205.11 incidental Food C"ntac:.Lubnetmss- 3-801.11(B) Use of Pastan ized Eggs'" 7-200-11 kestncicd Use 'es Jetties.Catena* 3-501 11:,D) Raw of partially Cocked Animal Focal and Raw Steil Snroms 11TH Sewed.:x 7-2(K, l^ Rodent Ban Stations'. 1 j +-801.I1(C) I Un Fend Package Not Re-screed ' 7-306 13 'l7acki:;q Powders.i'e,t C'or.;rol and CONSUMER ADVISORY TIMFfTEMPERATURE CONTROLS 22 3-603."I Concnntcr Advisory Posted for Cluncmnption of Animal F'ncxis'niat art-Raw.Undetcunked or 116 proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate j i 3-1;11.11.4(1)!2; Eggs- ;54;`F 15 Pathogom..�Sec. C Ejvstc-lnmifuiate Serwicc 1-15'Fa5sec- '-;(C.13 Pasteurized Eggs Sabadtutr For Raw Shell 3401.1 I(A);2) Comminuted Fish, f.Icar>:k t7z,n:c An;n:al:;- 155`F I` ;ec. ( 3-401.1l(W(Ii(2) Porl,and BeARoast- i30'F121min* SPECIAL.REQUIREMENTS 3-401.11(A)(2) Ratites, lei(cted Meats-.155'F'15 590.009(A)-(D) Violarions of Section 590.009(A)-(D) in sot. - catering, mobile tood,temporary and ;-401.11(Alf 3) Poulin', Wild Game, )1::'ted PHFs, residential kitchen operations should be � Stultntp•Containing Fish,R'?eat, i debited under the appropriate sections Poultry or Ratite;-165'F 15 sec. '° above if related to foodborne;llncss 3-401.11ic;(;) kVhole-mus^ie,Intact Be.t Sicaks I interventions and rine: factors. Other 145'1; '' 590,009 violations relating to good retail 3-401.12 Rase Animal Foods Conked in a ( practices should be debited under#29-- Microwave 165`1= ` Special Requit:me;its. 3-401.11:,A7(iF:b) .all Othet Flif's 145`F IS sec * � - 37 ;.cheating for Hai Holding VIOLATIONS RELATED TO GOOD RETAX PRACTICES ;_403.11(.a)StD) PHFs 169-17 :5 sec. 1 items 23-30) � (B) Miaovrace 165°F 2'slinute Slandirg l t;riticaj mrd nun-rritit,d vwlatiuny, xktch du not relate to lite Tin;c* ,foodborne iihzeSs nrrervcnhom and risk fa(tars listed above, can be 3-403.11:1 C) Comtnetc:.FFy Pro-e�sed RTF Fazd- ]wind in the following vectiona qJ the F w,1 Code and 705 CMP 140'17" 590.000. 3- 011 I(R) t:eainiring tinshred Portions of BceF Item Good Retail Practices FC 590.000 I i?uast,a: l 123. Management and Personnel FC -2 .003 18 Proper Cooling of PHFs I 124. : Food and Food Protection FC—3 .004 25. Gqupment and Utens!s FC—d 005 3-501 14(10 Gaoling Crohed PHF,Fsom 140`F tf' j 26. Water, Plumping and Waste PC—5 0061 7b=F Within"IG,urs and Front',0°P j 27 Physical Facility FC-6 0o7 u:41'F/45'F Within 4 Hours. " 28. Poisonous or Toxic Materials FC- 7 .008 3-501 14:,13) Cooling PHFs blade Prom Amhient 29, Special Henuirements .009 Tempeiature ingredie,us to 41�F145•F j 30 Othei Within-tCFour; „'.rc„,m *Dcno:ee canoe!item m ih•'F.,Nlai 19';9 Coal Cod:or 1W Cslp 5u:)00t;� 4 Massachusetts Department of Public Health Salem Board of Health p 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name I Dat g- ��JJ ! TYpe.,of Ooeration(sl, TYos of Inspection SALIEtvt Aes-xtL 1t/n12kr 9 0 0.9 )'Food Service �,❑--, Routine Address Risk 71 Retail Urine-inspection '7"7,9 t AAAV Sr Level{A E] Residential Kitchen Previous Inspection Telephone I_` ❑ Mobile Date: 47.7/?• '7*4(-- ? 9.4"7 ❑ Temporary ❑ Pre-operation Owner HACCP Y/N , ❑ Caterer ❑Suspect Illness t�-Sro,ts, r��eAttF Jc1CJka ❑ Bed& Breakfast General Complaint Person in Charge(PIC Time ❑ HACCP tISS�t_ 11'16 0? In: Inspector /� t n_.tR�c-AIA4v M Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties [] 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives [3 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE E] 4. Food and Water from Approved Source .-TtMEREMPERATURECONTROLs(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION Q14 .0Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices 17122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correctiom Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003} order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6)(590A07) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S S.M)Ins drum 14 U. Inspector's Signatuggq��!!!}}}, l Print: PIC's Signature: Print: i jjj �/ / !X 1 {S +A r/� l Page (_of -Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROs ECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT Iii i Gross.contamination I I 590003(A) l Assignment of Respousibili(o,-' 3-3021.1 I(A)(1) Raw Animal Fonds Separated lion 590.003(R) Demonstration of Knowledge" ( C'n,?ked:md W1 Foexls': j 2-103.11 Person in charge-duties ( I Contarntnatien from Raw ingredients j q-502 1 1(A)l2 i Raw Annual Foods Separated from Each 1 EMPLO"EE HEALTH j Other ! 2 590.003(C) Responsibility;of the person in charge to ( Ccnram)nanon from the Frrdronment requne reporting by L„xl enrplovecs and 13';02 t i(A) Fa,¢! Prot.• tiun*r applicants': 32.02.15 Washing Pruie and Vcr�vntbles j 59iW03(F) Rcsponsibiht) Of A Food rmplovee Or An 1 3-3(9.1 1 Food Contact with Equipment and Applicnnt To,R.epon7 To The Pcrsou In U*onr iLr'' Charge:' Contam.hation from the Consumor j 500.003(G) Reporting by Pcrson in Charge* ( 3-'06.14(A)(B) Returned Fund:?nd Res--!vice of Food'^ 3 590 OMiD) Exclusions and Reslrictions` I Dsposlrlon cfAdulterated or Contaminated 590.003(H) Removal of Exclusions and Restnctinna ( Food -701 11 En,.cnrdmg of Rcconditionmg Uirsale FOOD F 20M APPROVED SOURCE Fo,Ai I ,t Food and Water From.Regulate.Souroos ( I 9 Food Contact Surfaces 590.0041A R) Comphrnce with Food]also" 4-50:.i I i \4artod R arewnshine-Hot Water 201.17 Ford in a 1-ierntetica!l� Sealed Con,nincr" I Sanitization Temperatures* ;-21j],13 Fluid Milk and MAL Products^' ( 4-501112 Mechanical Warec.asinw, Hot Water 1 3 2(;2,13 Shell Eggs Saninzati(n Temperatures'" 3--202.14 Eggs and Milk Products.Pasteurircd" 4-511!.i 14 Chrmi•.ai Sanitization-temp.,p}f, 3-202.1fi Oce Made Perm Potable Drinkm�Water" concerittati in and hardness. ( I 4-601 1IA) Equipment Fcxl Contact Surfaus and 5-101.11 DrinkingWater fromn Aproo-ed SY'tern' ! tonils ('Iran" 1590.0(/61x1) Bntticd Drinking Water* i .590.006(H) Water Meets Siandatds ;n 910 CBIR lL0"' I j q ''(!}'I i Cleaning Fraces y orPquipe Fund- 1 Contact Suaitces;uud {)ten=ils" She;tfish and Fish From en Approved Source I 1 4-7702.11 �,rccueucs of Saautiration of Utensils and 3-201.!4 Fish aur!Recreationallti Ci:ught Molluscan I Food Contact Surfaces of f,',in cent* Shellfish-, ^-7n3.11 Methods of SamHot W .;zation-- ater and 9-201.1.3 Molluscan Shellfish from NSSP Listed 1 I Chemicu' Sources' Came and Wild Mushrooms Approved by I 110 Proper,Adequate Handwashing Regulatory Authority ( 2-30111 Clean Condition --Hands and.Arm," ? 20'_.18 Shellstuck Identification Present" I =-101.12 Cicaning Prcrcee'ute` 1190.004(0) Wild Mushoomy' I 12'-301.id When to Wash* I 3-201.17 Game Anneals, ( I It Good Hygienic Practices ,5 Receiving/Condition i 2-401.11 Eating,Dnnkmg of Using Tobacco ';-202.11 PIPs Recervcd at Proper Te p 2-40 1 12 Disch . ares Frgu'.;rhe E es Nose and i to craturev I 1' I Month'1` Paekat:e Inizgn'it}y` I 3-lUI.I i Food Safe and Unadulterated` 3-30!.',2 PreFentirg Cont::m;nation When Tasting^ 6 Tags(Rccords:Shellstock I 112 Prever•;ion of Contamination from Hands 3-2O.?.ig Sheiistockidentification590.004(E) Pre,.entingComtatnnationftonr Employees' 3-203.12 Si?ellstock Idcntiticatiun Maintained" 1 Tags/Records:Fish Products I '' Handwash Facilities j Conveniently Located and Accessible 3-402.1 I Pnasite Destruction" ( 7-203 i I Nuurbcrs and Ca;:reifies - ^ ( 402.12 Reu:rds,Creation and Retention" 1 590.004(1) Labeling of Ingredients` 15?Od.t 1 Le�:a±ion and Placement* 7 -- - - Conformance with Approved Procedures i 15 205.11 r+. "sibilit„Ooera:un and 1:r:nrznancr IHACCP Plans ! Suooled c,&Soap and;land Drying 3-502.11 Specialized Processing Methods* I i oewces 3-502 12 Reduccd oxygen packaging,criteria;, ; ( 6-30i.1 i Handwashiog Cleanser.A,Ti;k bility S t03.12 Gmtbrmance with Approred Prosdda," ( 6-301.12 Hand DrOm,Pnrvivon j `'nznote �raicdl dru:in Ole fcaial 1999 Rr d('ndc or 105 C115R 590!foU CITY OF SALEM BOARD OF HEALTH Establishment Name: S�[�itf F3�tC�t !n/O/ttCT_ Date: �/2v /� Page: 2 of 2 Item Code C–Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item Verified - PLEASE PRINT CLEARLY 14 C -- f-OWK &MAe.,d fti/ AT-- ►%r,*tr sf-A-f-toa IMT' 4 i'-SrN#- /--Ie S�m� 11,0f_V1r I V►Jtf" f-A MAirh"A,r/ �'LF.r`1P. a� �!°F of-- a&LOw-: I / 9 (r— a AC4 14J "C Jt- TSM? 410 Gy or, 4 of-orf- Ut-Ilr 1-0 11 I i I 1 U_ U) 61 r-i vNS' C e CAW i rf �S/i71e /Nr(/'sci x N ee��rSt-� �i4t/1's R�� cnte+�-t�C'�Ci L54J� I I I I I I 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ,• noncompliance may result in daily fines of e y-fiv dollars or suspensio/revocation of El Embargo C3 Emergency Closure your food permit. C-Zl— LI Voluntary Disposal ❑ Other: l ' -�.r:1.!-lP„ ?RFs I:ecei.�d at"I'emper:nures Violations Related to Foodborne Illness Interventions and Risk .lc,ording to 1. w(`.pled to Factors(Items 1.22) (Cont.; 41'FTd5 F Within 4 Hours. ' PROTECTION FROM CHEMICALS I s ,Ol 15 C:)olm,Wthods for PftFs f 14 Food or Color Additives I t9 PHF Not and Cold Holding j f 50l lo(lf) Cold PHFs Mdintained at or below 3-202.12 Additive* 590.004(F! 3-302.1-' Protcction prem IinaDpro ed Additiies � � i.!6(A) Hut P6IF>Maintained;.: or above $ Poisonous or Toxic Substances i :40'F 17-101.11 Identilvutc Information- Orr^mod 3_SD7 7;�,? Container;." ,) Roasts Held at or above 130"F. 7-102 11 Common Name-Workin„Containers' ( 20 Time as a Public Health Control 7-201.11 Separation-Stinage' -5�)1.f, Time It,It Public Health i_onttd.'r 7-202.11 Rv'frivdoll-PrLscree and Use'' ll%m m) varemec RPQnitenient ;'-202.12 Conditions of Use, 7-^_03.11 'toxic Containers -Prohibitions' REOU€POPULATIONS(HSP)S(HSP) FOR HIGHLY SUSCEPTIBLE 7-1104.11 Sanitizers.Cnterm-C'hcntic::!s* I Produce, 3-801.17(A) i.inpa,teurned Pre-packaged knees and 7-204.1_ Chemicals for Washing 0lReveuie�'-s with W'.,rnin:t 7-204.1.1 Diving Adeno.Criteria' ( Y Labels:: '-Sri],I 11131 Use of Pasteurized P,i,N 1-205.11 Incidental Food Contact.L::hr:cants* ' 3-;:f)1 i€(D) Rau,or Pailmlly Cooked Animal Food and 7-206.!1 - -- Restrictedria Use PesticideF. Criteria` Raw Seed 5prntns Not Set,ed. 7-20(1.i2 R<xicnt Bait Station I 3 301.i 1(Ct Unopened Food Package Not Re-:,,em ed. " 7-206.:3 'Itad;ing Powders,Pest,Control and Monitcnin'� CONSUMER ADVISORY T€MEiTEMPERATURE CONTROLS 22 3-60-,.Il Consumer Adt!sorV P„sted fur Con,autption of Rnimal Foods(fiat are Raw. Undercouked or l6 Proper Cooking Temperatures for PRFs Ism Othcrwisr Processed 1,1 Eliminate _-- - i401.11AIl2) Eggs- 15iFISSec. yaho;,ens. EtIec-hmtediatServi-e 145"^15scc3-302. i � ar,•zr,.v';:a�n for Raw Shell 3-401.11(A)(2) Comminuted Fish,(feats&Game Animals- 15S'F !5,ec " 3-401.118)(!)(2) Pork and beef Roast - 130'F 121 nun" i SPECIAL REQUIREMENTS 590.008 /UA' :D) Violatit,r:s of Section 590.009(A)4DI in 3-401.11 W(2) Rant;;, Injected M155"T'F Mens- S 15 sec.'' catering, mobile I'tood,tcorporary and 1 3-401.11(A)(3) Poultry,'Wild Game, Stuffed PNTs, ve,talential kitchen operations should he Stuffing Cont,umm_Fish, Meat, dehiicd under the appropriate'.ectioas Poultry or Ratite,-165'F t5 ser "' above if related to foodborne illness 3-10L1 1(C)(3) \Vhote-muscle, boast Bret Steaks interventions and risi, factors. Other 145°F 590.o09 violations relating to good retail 3-401.12 Raw Animal Foods Cook,d in a lnactl•.es:.!could be dchited under N29- Microwave 165"F` I tipecial R.quircments. 3-401,11(A)(1)(b) All Other PHF�- 145F 15 sec. "- 17 Reheating for Hot Holding V10LATfONS R,2LATED TO GOOD RETAIL PRACTICES -400.11(A)& D) PHFs 165'F 1.5 sec. ' (Items 23.30) 3-403.11($) Microwave- 165" F 2 Minute Standing Cniu rl and non-rral-'al viololrun,s, u•frrch do nor relate to the Timet_ (oodbanr rllnes, into;rennun�and risk)atom iisted above, can be 3-403.11(C) Commercially Proce,sed RTE Fo(d- ,toned in the 1e110,inq sections(�f the Food Cede and 105 CUR . !40`F* .911.000. I(F,) Remaining Unshed Portions of P l I Item Good Retail Practices FC159D.G00 123. MaraGement and Personnel FC-2 .003 IR Proper Coaling of PHFs ! 24 Food and'cod Protector FC-- 3 004 3-561 J,I(A) Cooling Cooked PHFs from 140"F to 25. FqdGmeni and Utensils FC-4 : 005 26. ''Nater. I't.:mbinq and,Arac?e FC-5 006 70`t Within 2 Flours and From 70"T ?7. Physmal aci!dy FC-g .007 j to 41'Fi45'F Within 4 Nouns. ' j 28. Poisonous or Tol Materials Fi:--7 LO8 3 501.14(8) Cooling PHFs Made Froin Ambient r 29 SP(rrr Raourre:nents 009 Te lrtp n ore ingredient;to 41'F/45`F ( '. 30 Other Within 4 Hours'` ""'^'"'"'`• ' DouOkS genial i@:11 m me lidera: 1,'99 F god Code or 105 CNW,590000. r CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Salem Beer Works Address of Establishment: 278 Derby Street Owner's Name: Joseph Slesar Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 110-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT� r CITY OF SALEM, MASSACHUSETTS .. BOARD OF HEALTH 9 120 WASHINGTON STREET, 4TH FLOOR ` SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT -Scjee, AAeer j✓ork i TEL# 9)9 -?'15'- A33) ADDRESS OF ESTABLISHMENT �7 0 I IPF>y -R/M 97 MAILING ADDRESS (if different) OWNER'S NAME ' �frp�g , s,lSO/ /�nt�Ob \ I�C4f TEL#6/7- ,�6-�,M O ADDRESS //01-la-1 CITY (3'oS}ten STATE /V�9_ ZIP oxII Lf L CERTIFIED FOOD MANAGER'S NAME(S) rz/n4u� CERTIFICATE#(s) I U d� Ly✓r 3r /Te,rtc /Vl v/�a n 01 &)vvrl (required in an establishment where potentia yhzYzardous ood is prepared.) I EMERGENCY RESPONSE PERSON It i HOME TEL# b17-7/9-4 ro HOURS OF OPERATION: Mon. ✓ Tue. Wed. Thu. Fri. —"Sat. -- Sun. /k11ti g7p,.. 11 . CF18c /:'" 11 '1 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YESNO 1ess 10 1 000 1 0 000sgsft.ft= $100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$20 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES N $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowled a� eli f, have filed all state tax returns and paid all state taxes required under the law. Signatur / Da Social Securityor Federal Identification Number -- - ------------------It(�f"fr? --------------------------- Revise 1 / 3/03 FOODAP2.adm Check#&Date 076 -of a60 - r ,r v E E E E E GE I O d, November 17, 2003 City of Salem NOV ) Board of Health 8 2003 120 Washington Street 4h Floor CITY OF SALEM Salem, MA 01970 BOARD OF HEALTH Re: Salem Beer Works Dear Sir or Madam: Please find enclosed the 2004 Application for Permit to Operate a Food Establishment. If you have any questions,please feel free to contact me at(617) 896-2300. Sincerely, Mark Davidner Controller BOSTON BEER WORKS BOSTON BEER WORKS SALEM BEER WORKS BEER WORKS CORPORATE OFFICE 112 Canal St,Boston,MA 02114 61 Brookline Ave,Boston,MA 02215 278 Derby St,Salem,MA 01970 110 Canal St,Boston,MA 02114 Near North Station,ph:617.896.BEER Opposite Fenway Park,ph:617.536.BEER In Historic Salem,ph 978.745.BEER Near North Station,ph:617.896.2300 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DateTvpe-of Operation(s), Type of Inspection &V&R o.IOL&Y I S�7)NI 2 FoodService El-Routine AddressI Risk [J Retail ❑ Re-inspection Z7w D&/t.6 / ry Level ❑ Residential Kitchen Previous Inspection TelephoneMobile Date: s-�H- Sys_ 2 3?7 � M ❑ / 1i.doy OwnerElE]Temporary Pre-operation SPsPM6N f- .i tIT&.4/r _174, r0- HACCP Y/N I ❑ Caterer ❑ Suspect Illness Person in Charge Time ElBed&Breakfast [IGeneral Complaint Q Inspector In Permit No. ❑Other � Q4v�� >Z�BrldAvH � Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Ami-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board bf Health. FOOD PROTECTION MANAGEMENT I ' ❑ 12. revention of Contamination from Hands El1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH „ PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ ❑ 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding V9El Segregation/Protection El 20.Time As a Public Health Control LSI 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health.I 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590 003) by a Board of Health member or its agent constitutes an 4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso oos> cited in this report may result in suspension or revocation of ,/ 25. Water, Plumbing and Waste (FC-4)(590 Dos) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this or. er. 30. Other DATE OF RE-INSPECTION: S 590/nsWtForm 14 do / Inspector's Signature` Print: PIC's Signature: Print: Page t �of Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT N Cross-contamination I 590 003(A) Assi;2;ment of Responsibility" 3-302.1 1(A)(1) Raw Ania,al Ponds Separated Crom 590.00318) Demonsiratinn of Kno%vl+dgc'" I Cooked and 1ZTF 2-103.11 g Contamr^ation`. rn Raw in red+ents Person m charge - duties 9 3-302 11(A,(2) Raw Andral Fo;KN Sepatated form Each EMPLOYEE HEALTH ( Other* 2 390,003(C) Responsibilvy oC the person in charge to ! +Contaminvion from the Eovircnment require reporting by f;n,d empiayce,and 3-302 111 At Food Protection- j aPPhcants'6 3-302 15 Washing Fruits and Vc.seinbles 500 003(F) kcsponsibihty Of A Food Fniployee Or An 3-304.11 Rud Cont-xt with Equipment and Appinant T+,IZepoil To The Person In j Uten,iisr %haigre* j Contamination from the Consumer 590.UO3(G) Reporting by Person in Charge"' j 3-306.14(A)(B) Returned Food.:nd Rcs.rvh:e of Ftxid;- j 3 590.003(D) Eeclur.iore;and Restriaions* Deposition ofAGuNerated er Con+amrrated 590L003(L) Removal of Exclesions and Restrictions ( Food ?-701.11 Docorthng or Rccooditiomnc Unsafe FOOD F'1OM APPROVED SOURCE Food* 41 Food and Water From Regulated Sources ( 9 Food Contact Sur"aces 590.004(A-B l Compliance .aith Food Lal%-` 4-501.111 kranual ti\area-aching,-IInt Water j i-201.12 Food in a Ilerntencalty Seaied Cojuaincr� i Sanitirnnon 1'ernncraure;' ; 3'01,13 Fluid Milk and Milk Products* 4-501.112 Mechanical Yraiewanhing- clot y),'ar i Z_ t ' Saunization Temperatures" .. ZO.:.l3 Shell tiggs* 3-20214 liens and Milk Product,. P:steurized' 14-Stti 114 C'h:;nisation;ndrl Sanitiza+ion-temp.,pH, L:mcea:h 'nard,:ess " 3-202.Ib Ice Made From Po[abic Drinking Water* 4-601.1 if A) Equipmenr Fcanf Contact Surfaces and 5-101.11 Drinking Water from an Aoprood Svniem" Utenads Clean^ j 540.00ti1.'i} Bottled Drinking Water* .1.602,11 Cleaning Frequency of Equipment Food- 590.006(ft) Nater Meets Standards in 310 C'MR 22 0'- Coma_+ Surfaces and lacnsils" Shellfish and Fish From an Approsea Source 4_702,i I Frequency of Stuti+.iz.thon++f Utensils and 3-201.14 Msh and Recreation.d ly Caught Molluscan i Fond Contact Surfaces of G9uiputent'^ Shellfish* 1?0= (1 klcthod::of Saaaizeron--Hot`r4'at,r and 3-201J5 Molluscan Shellfish from NSSP Limed Chemic„i' Sources* ( 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I � 2-301,11 Clean Condition--Harms and Arm;" Regulatory Authoritv j 3-202 16 Shelistock Identification Present, I 1 2-301.12 Cleaning Proce:iure" � S90J)ij4(Q Wild Mushnxr:ns` _ 111.14 Rhen to Wash" 3-201,17 Game Annuals" ( 11 Good Hygienic Practices $ ReceivingtCondition 2-+01 11 Entiag, Di nking or Using Tabaccoo' 3-?02.1 ! PIIFs Received at Proper Temperatures* 2-401.12 Di,x harges From the Etes.Nose and 3-202.15 P;n•ktee hrtc�'ity* Month" 3-301.12 F}c.enting Coniamtnation Whc i Tastin•*^ I �-(01.11 Ftxn3 SaiC and Unadulterated ' I I d Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 SheElstockLdentifieation* i 590.00-4(F) PrevenringContamination froin 3-203,i2 Shellztock Identification Ma+mainedT ( F,mplovees* Tags/Records:Fish Products I 113 Handwash Facilities I Cxwon+ently Located and 4ccessible j 3-.02.11 Paiasiie Destruction* 3 402.12 Records.Creation and Retention,. I `-103 I l Numbers and Capai,i:ie:* 590.004(1) Labeling of Ingredients* 5-204,11 laxation and Placement" 7 Conformance v✓ith Approved Procedures j 5-205.11 Accessibility, Operation and kl.ir,tenan;e j /HACCP Pians I Supplied pith Soap ann Har'rd Drying 3002.11 Specinlved Proxe brig Methods- j Domes ?-5ni 12 Reduocd oxygen pack,,-,):?,criteria` 6-301,11 H andwasbmg Cleznser.Ayaiiabildy ! j h- + 8-It13.12 {:oniitrmance with Approved Procedures" I 301,(2 1?and Diving Pro•.ision Dente.,,uncal nem ni ihr,f,dcral 1909 Pond(„,&of !051 Ci%1R 590 0:1(r CITY OF SALEM BOARD OF HEALTH Establishment Name: /3G��< #✓areE'S Date: 5 �7 Ay Page: of 2 Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item 4k Verified PLEASE PRINT CLEARLY { I 2 S' t+ It, Std vs.[A/_ R fs I�2� �e�A.a a r.uliJ UN#9',,r ,Nr ss,rr� nd&jc,radM rrrxs I rrL nC v+.S )< &QA V r nes V IS f 4 s f Ace-014 VX V-AIAR, ej A4'srr*_Xs / r� c, edovw "&- uwi IT l I _vvf- 4bF Gcti.>:, 0000- ax Parsr/St,; I 13 rr lG Ldaru ✓ w— kl,4M0r.ri4Z4- D ver h/�?_..rnt ,asAF+ntG en lt�. r v A I-L r. r`f nrlat a f Si 71 F C�! f.(� A A� d4nz.+/ srkt ow 4. 0 Cr.,.JW. /J,f SvBG'A e X ^A- M&AA C/C ,UL- Coa. ,, "v (�arTt ice' /3diFRp 2y Ci "- �caht/F L.cL,/.-sw.dr"ierr �rr+rd-s r'orvG"rf,ti`/f.() trNPat�.G�l1 /-cu�n. ✓�!L Z7 .4/c- -/ t� !%C' Fire I t "Le— 1447 Ar( 04:<< rM CWo#4-nnl l� ,L SAT AP .,t tA4-llr ,r.ox FDNi) nx,&4s 4-tto 0_Vj^mL I e-�dnIt nuBelG,{ r c.T Atf kOO SAK4r176- CA&J A0%to'624 L � 15� *.rLr4drrP%A.ntro &J4 r relfto I � It'f'G�.�t ,nft-J'i._.r✓ ��7�Si.rJ ,r/CaN A-+s-G.�f I f(ten n 1-6-M ror Discussion With Person in Charge: Corrective Action Required: ( ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollarosion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I(i', PHFs Received at l'eny)e ntntrzs Violations Relstcd re Foeduome Iliress interventions and RisA According to L.:w C,n)led to Factors(items 1-22) (Cur;:.) 4I7.145'11-Within 4 Homs. PROTECTION FROM CHE'MICALS j s-301.15 Co,Iin,Mcthodsfor PHPs j j 14 Food or Color Add!t:ves j 19 PHF Hot and Cold Holding j a_ r ,,.:, l.l6(B) Coid PtIFs Maintained at or below Adutnci ( 2_ o 590.(}0-t(Fi -4i-i-i5' F. 3(1_ :id Piotectinn Isom l:n;a;pren ed Additive:` i 1S Poisonous or Toxic Substances j 1-501.16(A) I lot PH F: Maintaured at or above 14C'F. 7-ICI.I1 Identif)ane]nhr mahCi on -- ngint" C3-50L 16(A) Roasts Held at or above 130`'17. roitawets^ ( i 7 107-1 1 Common Name.-W\ wl,ung Cntttaimcrs` j 1 20 Time as a Public Health Control j 7-301.11 S,psradon-Siam e" j 3-501 !9 Time.as a Public Hea!di C'ontroP' j j .r 4-202.11 Rec'..iU•iori --Pues,nnc-•:aid L tr.e', 590.004(H) Var.ancc Requirement j j 7-20.12 Condniun•,of l!x" j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-22,0.1 11 Toxic Containers-^iu!uhdiom I j POPULATIONS(HSP) j 7-204.11 Smt:titer%,.Criter,a--Cheo)icals' j - j 7-20.1,12 Chenrica'.s for'iVa:hmc Fn)dutc. Cnteua' j 121 3-801.11(3) 11 Uop.isleurized Pr.-packaged Juices and j ?204.1.4iav:nz Agents.Cninrt" 1 Bevefayes with Waming I abzis' 7-205.11 I3-901 11(B) Use ncidental Food Contact, i-uhrinofis^ e,of Pastemixed Eeesx j 3-801 11(D) Raw or Partially Cooked Animal Fog?and'-200.?i >?e,trcdzd tse?esticldee.('n tznn* i j Rata Seed Sprouts taut Served. ' !7-2C6.I2 i?aic:ri Bait Stations' 1206.13 'I7::ckir,;tPnader.?'estG:;irn! and j 3-801.11(C) Unopened Food Package Not Re-served. ;vion+P.uing` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 i C'ortsumer.)dGisouy Posted for(`oiisuniption of Animal Foods-17)at are Raw. Undercooked of 16 ( Proper Conk!rq Tempeiahtres far Not Otherwise Processed to Eliminate I PHFS Eeenvc utvn+r 3-401.11.4(1)(12), f.ge:; 155'r 153ec. i Pathoycna* j Eg�ze-hnmrdiate Sen-ice 145'.Fi5,ec r 3 30_1.13 Pasteunzed Eggs Substitute for Raw Shcll j 3-401.11(A"(2)11(A}(7r ( Commnnu:ni Fish,R4eat,&Came Eggs' An;awls- 155'F 15 sec. * ! 3-401.11(B)tl);2; Pork andBrel'Roast I':)`F '^_I :ai0 SPECIAL REQUIREMENTS i 401.11(?){21 Rahtec, injected Nleata- 155''F 15 590.009i,1)-(D) Violations of Section 590.009(A)-(D) in Sec, - I caterins. mobile food, temporary and 3-401.11(A)(3) Poubry, Wlid Gana Snfft'cd PHFs, residential kitchen operations should be Slufting Containing Fish, frleat, 1 debited under the appropriate sections Pontis( of t;atites I65°F 15 ;cc. above it related to foodborne.illness 3-401.1 I(CV(3) ')wscir-„ had(t Beet $tows, interventions and risk (Ucbors. Other 590.009 violations relating to good retail s5 401.12 Raw Animal Foods Conked in a practices should be debited under X29- Moaow'-'e 105 F * Special Requirements. 3=tpi.i((A)(I)tbi jAll: CRhcrP>-IFs- 11; F !5;c�. ' 17 j Rehsatit;g to Oat Holding j VIOLATIONS RcLATEO TO GOOD RETAIL PRACTICES 3-403.11(.s:)R(AW(D) j PHFs 165`17 i:i sec. (Items 23-30) 3-403.1 i rB i IvI:,rov,ave- 1650 F 2 :v}inute Standi ng i C,itic Irl am''non-,no,al ciutehuns. which de not rdatz to the Tuve" foodborne ilines>irrc•rrennont and rirkju;tors fitted abuse. crit be Comfrwrcmil}Peoce.std RTE Food- I ,fawd in the jbllof,,arig serlions of the Fo„d Code rind 105 011? 14WF'" 5(10.000. 3-403.!1(F) Remmwnng linsh-eel Portions of neel I Item I Good Retail Practices FC 590.000- 1 ;toasts' I 23 Management and Personnel FC-2 .003 _ I j 18 Propar Cooling of PHFS i 124. Food and Foal Pmtixtion F(,-3 .004 3-501 1 !(A) Coolim, 5'Z5 -- Equipment and Utenslis FC--4 .005 .,Cocked(HFs from IlU"F to --- -- --------{ 26. Water. Phnnbinq and Waste F('-5 ,066 ''0"i Within 2}-iu::re.and Fnnu'0�F 27. Physical Facil!lV FC-E CC? to 41'Fi45'F N,:tf;n 4 Hours. z 1 28. Pasonous or Tone.Materials FC-) .008 3-501.14(B) Cooling PHFs Made Frofn Ambient 29, Special Requirements .009 1 Temature peringredients to 4 i'i"/-At5 F 30. Other j lVnhin 4 Hours` s•nr „cafi za., ' Drmar:.ru¢al gee.i in tit:f du al 1904 Fa-d C'do ,,105 CbIG"590 000 'THE.,COMMONVVEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH Addre11 ss: 120 Washington Street, 4th Floor �, Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978)741-1800 Fax: (978)745-0343 Name Date Tyne-of Operation(s) Tvp6 of Insoection yy/ /�QoP fp //(/oRt5 /"d�-0'� �'] Food Service d Routine Address - ` �1`3 C/ r� Risk ❑ Retail VRe-inspection �J Level LlResidential Kitchen Previous Inspection Telephone / ! .yS_.i>J.3 7 El Mobile Date:/`/J-O `/ El Temporary ElPre-operationOwner HACCP Y%N 1TC'C,0/1 .S.�.FSQrN I ❑ Caterer El Suspect Illness Person In Charge(PIC)./-), 4e 71 r{1/ i i� L'n G' S Time El Bed 8 Breakfast ❑ General Complaint _! In: ❑ HACCP Inspector ✓ �{S /, < - Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) Violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items). Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) Cl 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties I El13. HandwaSh Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives � t ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements [1 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection r REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ED 9. Food Contact Surfaces Cleaning and Sanitizing El[1 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials .(FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements , (590.009) within 10 days of receipt of\this order. 30. Other DATE OF RE-INSPECTION: Inspe-ctto-r-'s`.$igndtul• •• �.7 d Print: '' /C.7�Trf/. _rV`FX�I.Ii/--�.( !/• �"/�7.C.T7,/.( {„!.Q PICS�s' i nalu e: Print: ,,11 /�A/j Page of C2-Pages FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATIOV. $ Cross-contamination FOOD PROTECTION MANAGEMENT _ 1 3-302.11(A)(]) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 1 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* - 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590 004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 10Proper,Adequate Handwashing ' Regulatory Authority 301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Drinking or Using Tobacco* 5 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* I 2-401.1- MouDiscth* From the Eyes,Nose and 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* � 6 I � 12 � � Prevention of Contamination from Hands Tags/Records:Shellstock 1 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 16-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: /- aPage: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY e f- i err f i �_7 �a GCr�r r t/4 I Gly Urclr€ /kris el4 d A✓ 1-/3-oV /NsA��-Cfi,"--n 61e46k7-� I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yea I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ElRe-inspection Scheduled ❑ Emergency Suspension corAply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure yopr food permit. i�S ❑ Voluntary Disposal ❑ Other: *� 3-'i0JJ4((') VIiFs Receiwd ¢Tztnpen.'wrrs' Violations Related to Foodborne Illness Interventions and Risk A,c rdi it,,Lo Lu v;G ,led to Factors(Hems 1-22) (Cont.) 4! 'FrdS'F` ;ffiln Y flotns ' PROTECT9QPI ;FROM CHEMICALS3-50i.: CK ,o;, ',1,ih,idF furPH,< 19 PHF Hot and Cold Roiling Food or Color Additives ' 3-50:. !b(H) Cold PI Ws,\iaor:.,ined a(or below 3-202.12 Additives.% 590.004(F? 41'!a5�F' 3-302.14 Protection from Unapnrowd Addtnvcs" ( 3-50!.IeVA) Hot PHFs Mainhiincd at or uhmr j 15 I Poisonous or Toxic Substances 7-101.11 Identnying Information-Orie nal I 4 0 3-501.ie,A) P,nasts Held at of above !30'F Containers" n Time as a Public health Control ( 7-U)?il Common V:unz-q'nrkin;Co!ttainzrs' j i 0 � 7-,-I01.11 S.Pxruion-Smitten- 3-501 1'� :dile as a Public Heahh Cantu.; 7-202.1 1 Re,triction-Presrnc:and Use, j 500,004(H) Van ince Requirement { 7-203.12 condition";of sc` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2 T 03.11 'I'oxisicGmtainers-1'roh;bitior.s^ i 1 7-2()4.l I Snmiizers.Criteria-Chetmei,s' I POPULATIONS(HSP) : 7 204 12 Chcuucals For Washutg Yrr:rhue,Criteria` 2t 3-301.1 PA) 1 Uupasteurizod Pre-packaged Juices and i O ' 1 i Beverages with Warnin;;Labeh"` 7-204.1-} wing A:,znts. Crueria" 7-105 l i Incident;! Food Contact, Lubi ica:its" lib) Use r$P Penalty C ked 7-20(.1! Restricted Use Pesticides,Critet'ia' S01 I I(D) j R;w ar Pat2tally Cooked Animal Mood,utd Rs c;Iced Sptouiti Not S^roz,;. 7-3!'6.12 Kodcr.! Bait Stanuns° 3-8O J I((') j i7nopuied Foal Package Not Re-served 'hacking Powders,Feet Control and Monitoring* CONSUMER nDalsQRv TIMEITEMPER6TURE CONTROLS 22 3-003.1€ Consumer Adris,,n% Posted for Consumpti:,n of i Pjouiui Foods'I•h:a arc Raw Urdorcooked ryr lfi I Proper Cooking Temperatures for Not Othin wise Processed to Elimuiate ! PHFs F,=errs r;v2oni 3-4U 1.11A(!)(2) Eggs- 155.'F 15 See, Yaingnms... Legs-lmmcdiute Service Ids"F i5sce" ( 3-302 13 Pastcun c i Etgs Sub,tiwte het Ravi,Shell ?-401.11(Ay 2) Comminuted Fish.Mcats R Garric Animals- 155'F 15 sec. 3-4OJA1(B)(I)t2) Pork and Beet Roast- 130`F 121 min' SPECIAL REQUIREivtENTS i 3-401.1 I(A)(2) Ratites, Injected Mean- ;55'F 15 >t)0.Oc9(a1-(D) Violations of Section 590.00(tA)-(t))in I sec. catering, n;obae road; temporar} .rad 13-4oL11(A)(3) PoulVy,Wild Game.Sttdfed PHI'S, residential kitchen operations should be Stuffing_(.ontallling Fish, bleui debited-widetilio appropri»ie icctions i Poultry or Radius-]0s'F 15 sec "' above if,elated to foodborne illness i3-401 1 l(CD(zl Whole-muscle, Intact Reef Steaks interventions and risk faclots. Other 145'F" 590.009 viaLiUons relating to mod retail 1 3-461.12 Raw Animal Foods Co„ked in a pra.tic'e1 should bo debited ntulet 4129- Microwan'e i65'F Special Requirements. 3-4OLI I(A1(I)(b) All Other PHI-c-- 145'F 15 sec. 17 Reheating for Hot Holding ( VIOLATIONS RELATED ]"O GOOD RETAIL PRACTiCEs 3-403.11(A)K(D) Pffs 165'F 15 arc. ` (Items 23-30) 3--103.1 7(B) Microwave- 165`P 2 Minute Standing Cri(;jai mid noir-cmical violations, Onch du not reimr to the Times` foodborne illness nsk f ictuea listed uhntr, can be 3-403 11(C) Commercially Processed RTE Food- l(inmd in rhe fu1,1Ou ting sectinm cf tike Fuud Cwh and 105 CMR 1401,` 590.0/)0, 3-403.11(E) Remiiuing Uusliced Portions of Beel' N.am Co-nod Retail Practice:; j FC 590.000 Rost," I °3. _ _PAanngement and de-scnnel ( FC-2 .003 j 18 Proper Cooling of PRFs 24 Food and Food Pro'ecticn j FC--3 .004 I 25Equ;Ptnert and Utensils FC-4 .005 3 501.14(A) Cooling Cooked FHPs from 140"F to 126 Water,PlombirQ and Waste FC-5 .006 70'F Within 2 Houu•:mil From 70'F j 27 Physic a]Fardin, ( FC--6 .007 to 41'/45"F Wilhm 4 Honr<. ' 2E. _ Yo,son=:3 or Toxic materials j FC-7 .00E 35( 1.14(Bi Cooiinv PHFs Ntnde From Ambient 1 29. Special Req, remertc 009 Temperature Ingn-dients to 41'F/11 :'F3:' i Other ! Within 4 Hour;" i Drnnre. -d;cal icon:n the tedeul 1449 Foal Code,of 105 Cv,R 590 Ota 1. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 0 Floor Division .,f Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Typdof Ooeration(s), Type of Insoection C�//yrr Pi? //(/iIPKS /- I [E"Food Service ❑ Routine Addressd7� �� C>` Risk El Retail El Re-inspection Telephone Level El Residential Kitchen Previous Inspection �94�17ys-- 2_3 3 7 I ❑ Mobile Date: Owner .TSe,0H ,S/_�SrJ Q I HACCP YM I EI CatereEl r El ElPre-operation ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint inspector 1 In: [IHACCP P /��Pr/mF�i7��rn 1iviST. Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT .., ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 3. Handwash Facilities Cy, EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El 3. 14. Approved Food or Color Additives 3. Personnel with Infections Restricted/Excluded ' ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of IngredientStatements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [110. Proper Adequate Handwashing [-]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related I Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions / immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): 111 of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an ?�4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations ✓25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-a>(5so.0os) the food establishment permit and cessation of food V. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you . Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing . Poisonous or Toxic Materials (FC-7)(590 006) and submitted to the Board of Health at the above address . Special Requirements (590.009) within 10 days of receipt of this order. . Other DATE OF RE-INSPECTION: S 501�tf ri iJ dM Print: ns cto s not // /. � /iC PIC's Signature: rrN,/y��-eee�G��?C'))ly //Gs_..j.i v� � S Print: Pagel of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM. CONTAMINATION FOOD PROTECTION MANAGEMENT I 8 500.003(A) I Assi,11MCUL of Responsibility' 3-302.1 1(1)(1) Rim Amrn;d FwKk SNpn-wcd irran ook,,d ;nul RTF R,�,ik* 590.003,113) 21(:3.11 Persnn in chai ine -duties Conta,,natfon froM R416 Ingwtho;?rs, 3 302 i(A)f 2) Ratti Annnol Bl(Nls Separatrd from Each EMPLOYEE HEAUT14. i 2 590.00,(0 Responsibility of the parson in chaige n, I (rnfambahin from;hr Ervirooment ri-ifaue i-cpai ane by fn(id employee,and 13-3x2.1 I,AI 1-uW illcitecnol.i applic'111W 13-302.1_' VN'3shiriiz Fruiis and Vesetnl:;ies J90 Of 1(F) kesponsibilit3 Of A Fkqid Employee Or 'm 3 1,04.11 Food C(ontau with Fquipmznt and Applicant To Report To The Person In Chargo* 59(m)()YG) Reporting by Person in Chzirzze 10nfa1n00V0Mrr0n7 Me Consumer Puttimed Food and of 3 590.00311)) j Exclusions and Resrriclions* Dirpasslion I Removalfnal of Fxclusionsnudi Rem'etions Food 3-701.11 Diwaidinff tit Reconditioning Lnsafe FOOD FROM APPROVED SOURCE 4 Feud and Water From RPauiateCl Source:: 9 Food Contact Surfaces 4y0.OtA(A-13) Compliance wnh food Lav,:' I 4-501.1 I I Tlvlanur.! Warew.,shing-Hot Wantr 3-201.12 Fo(A in o Herin.2iwally Scalcd Container* 3-20I.L3 Fluid Milk and M'flk?n'xtucts, 4 J01L I 12 Mech,niuil Wqr-v,aOirc-lint Witter Sniliti;,ii[ioll Tenlperdtjcesl 4-5(11 01'wl','al Sailitiziniimi-temp.,pit, Eggs and Mill:products. kjst-,udzt-d cuncenti idnin and haidnps. � 3-202.16 Ire Made Minn Pot ble DrinkingWitnr� 4-601 &JU111111-111 Fl and (-Ubt�Ct Sdl'faLC�.and 5-101.11 Drinking Water hunt art: System" ub:nsils Clean, 1 602.11 C�c imi ng Frequi-acy of Equipment Iod- it)0.001)(A) Bottled Drinking Water" 590 006(8) Water Mects,Standards in 310 CMR 22.04' Co'Timct Surfaces ar.Id t;unSjlN* ShEliffish and Fish From an Approved Source ton of Utensils and rquencv,11 smlitilat J-201 11 Hsh and Iferreationady Caulght Molluscan Shellfish* 4-703.11 Method,of Sarno ation-I!,)I Water and 3-201.15 Nlolluwan Shellfish I-Offt NSSP I JrAed C�-Cruicqj� Sources"' lo Pr"npzr,Adequate Handwashing Game and Wird V,shooms Appioved by Regulatory Authority •"IOL 1 i Cle-ui C' nor.:ion-Hands,and Aims, 3-202.1 "'hellstock Identification prescin" 12--;01.12 clezal:nia Prts edarv; 590.004c C) :'.-;01.13 When to Was!-,* I Wild Mnshioclais'* 3-201 17 Came kniunais' Good Hygienic Practices 5I Receiving/Condition 1-40i.1 h,6.ia.Drinking or Using Tnhacco'' PHFs Received at Propet-T-infieratu.-W Dischargc<From the Eyes, Nose and Mouth) 1 3202,i5 packige Imeguty" ( ! 3-301.1 Pieven::ng Contan:--,ni,n NVItm Ta,ti-,O Fi-,cd Safe and Unadulneratud I 6 Tags/Records:Shellstock 112 Prevrinfirin of Contamination from Hands 3-202.18 Sbellsrwk identification 59C,004(E) Presenting C.,..itajnination firnm 03.12 anied Employces-1 3-2 !-,'ltellsuick Id,qt�![,ation Malat 17 l4andwvsh Facilities TaqVSecords;Fish Preducts -,-Z,02 I] Parasite D"rriwioa' 'i-402.12 Records.Creation and Rnt�ntion* 5 -10,11 Numbers,old Cl.uacitie�-- =+-20'1 I i Location in,!Piacnnicntl '�txioi'�J) Labeling of Ingredients' with Approved Procedures Conformance 5-205 11 Axe,,siblit,%Opu�jtinti and IMainsenaii,e IHAC P Pians supp/"ed with Snap and Nand 01y'ng 3-502.11 Specialized Processing Methods*' 060ces 1-502. 2 Rcdnced oxy en packaging craerii> 6-3':11.11 Knidm,-�shing Cleanser, Availahlin, 9 F-10 12 Conformance with Anp-oved Procrtfurcs, 6-301.1 7 Hand During provision crni.;i:ltionl;'.file:ed- )99 Fun!co x CITY OF SALEM BOARD OF HEALTH Establishment Name: Ae/1 Date: // �5� Page: a of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I fVvfin,e -,1V5,6xr77� tih 2S - s�-tcro Gitit a/-11al7'% 'rri)/i. W 7Asc/,� qrc- r'af. ;S 1151 e �emenu�,e 4ns3r1- /4�v�lul/sb rrnGv `ys` =sa�'�c' yS�cc�oaa� fid Be ,a/ 'nPcCf c P;'naKflac's r/8r�Z,& S>ae /cp C'/".e . a_ Sa'0iIize r efeG/-Pk,—'/e�r YJ ' II _Sa/i'/,�92PcP .OP. ffliPP/NN /,U('P_S \WJ 2 '� --l2aNPfsOa a7"-"OfC/71-11&e/�e. 1//5/15L2 I - FLo��i,vq /.v ,U,�P,f �f�erireaL r'Ler�rr,.vc. �4ZI��aGLu C�?oaf�e`J ry7,Crr��c.,c'f�.e/��ri — Ger!$�Gfi�rr166aSC.s/ t-K i�Le&e 1 , 7leo 7e2ci `L7 GP�Pzr e eei/i.v� .�,!a r r/rii rev La�iv�t Fpot7=i�assi/3L¢ 7?�a L r'u r.�><71/it 2- 7 , `Y/t/,c/i3O'o,1 �eG,cri coa7m2 llyci;;xrt-1 h.f irn �devAe-6✓PVIi;I//Cg Afe /A"-.4-s off F�cc P I /.tec�G-SZR 2/,vif �l�e� v4 A/e'ods cuash.r.�c�ecr�r� I - � �/ l 3 �' -" ,E/a�rr�i./.os h i,v9 S'ivX 4/P�cIS ,Sad.b iN/,uaGL -f�i/v9 G//S.tletic SPS cT Ute,Ld dLe ®f QGL 'T/n7 P`$ i Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had:the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that nonc3mpliance may result in daily fines of twenty-five dollars or suspension/revocation o' ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal 0 Other: 3-50L kh(') PIJFq Reeei,,,d it 11,e:i;;;erohures Violatiers Feiiiied to Foodborne filnesi;Interventions and Risk j Acui din,to T,',rw C,'y,'!cd4 to, Factors(Items 1-22) (Cont.) 4:'F;45iF Vvehmi 4 Hours 3-501.1`, C'.0fine Method", ;"kir PHS:PROTECTION FROM CHEMICALS jo j PHF HSI:eed Cold Holding 14 Food or Color Additives 3-202.12 Additi, 3-50 1,1 H) C,id PHF; Nlaintaint-i it -r'-,gone 3-302.14 C'rutcction from Unappjorcd Addifi,;(-O' �i-SOI 11'�(A) Unt PlfF"'Maimi:Imed 4! C.; above15 Poisonous or Toxic Substances i46-T. 7-101.11 identi(ying littormalion-Orignnal Couljuier,," 3-501.16(Al Roas:<Held o; dhow I"(,,'F Time as a Public Health Control 7-102.!1 Common Nlarne-Wi-irkinlo Containers -0 7-201.11 Separation-Stow2c' --S()l.It) Tinic as a Public I lealth Control 7202.11 ;'M!804(1-I; VW'idnCc RC`lLIuCuI,'Tu - Re,triction-Prescnc�and [Tso 7-201.12 Conditions of Use' 203 11 T,�xicContaine..,-PnJubitions* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizes.Criteria--Cherracals4 j POPULATIONS(HSP) 21 .1 (A) Unpjshwizial Frc-p�,tckaged Juices and 7-20-4.12 Chemicah,lot Washing Pr(KILWC,Crile-tri Bc,:eya-.et, m:hWarnio Libel,* 7-204.1 1 prying Agents.Criteiia' 7-295 It IficiLmitalFood Contact 1,111111cams, Os;of PiSemized Egg, -1-801.11(Bi -11 7-2106.11 Restricted Use Peqicaces Criteiia 3-30! I(D) Rov,-,; P.,rtially Oimloesl Anilual Food and 7-20.6�12 R,-deut Ban Stationer, Ran'Seed Sprouts Not Strvvd 7-206.13 Tracking;Powders. Pest Control and 3-801 11(C) "Jisilmed Food Package Not Re-scrvei.i, Mnmtt1n 17C`' CONSUMER ADVISORY TIME(rEMPERATURE CONTROLS '12 3-603.11 Consumer Advo.oiv Posted for COn,uniption or 16 Proper Cooking Temperatures for Anored Ttodt: Fhal arc Raw, Undercooked o) PHFs Nin Ofhcrwrise Praces:;ed to Eliminate 3-401.11 A(l)(2) Eggs- 155'F' Li See Pathogens,* Ecus-Inuni:di:!Ic Service 145'Fl'is,c 3-302.1-, Pasteurized Eves Substitute for Raw Shelf 3-401.1 IIA)(2) Comminuted Fish 'Mc-:Its&Came Egie* I Animal: - 155'F l5sec. �� 3-410 1.11(By 1)(2) Pol kand Beef Roast- 130'F 121 niii", PECIAL REQUIREMENTS I 590.009(A)-(D!!fViolations of Section 5910.00c)(A)-(D) in 3-401.1 I(A)(2) Ratites,Injected Meats- 155-F ISI, I sec catering, mriNle food, temporary and 3-40 1.11(AI(3) Poultry, Wild Came.Stuffed PHU6, resolmial kitchen operations should be Stuffing Containing,Fi h,Meat, debited under the appropriate sections Potilu i,'or Ratitcs-165°1- 15 sec. ' above it related to foodhorne illnes, 3-401 [I(Ch3) Whole-muscle, lower Beef st'"Ikr. ijiLern'entions and risk Factors. Other 145`F* 590.009 violations relaiine to good retail 3-401.12 Raw Annual Fni-xJ5 Coerced III a prjWc.s should be debited under#29 - IMiLloWaVC 165'V* Special Requirements. 3 401.11(A)il 1)(b) All Other PHFs-- 145'1- 15 sec 17 Reheating for Hot Holding VIOLATIONS RZLATED TO GOOD RETAIL PRACTICES 3-4031 1 IfAt&tD) PFIFs 165'F 15 wc. ;:4 (terms 23-30) 3-303.11(6) Microwave- 165°F 2 Minute Standing Crit,cal which do not rel'air to the Tune" Joodhome ilhiees iwvrvcmi:m.)ond mv4ft,co;,,listed chore, can be 3-40".11(C) Coma:t cially Processed IZTE Food Imind in thePlImunp s,r tion s :Phe Fool Code aptei 1115 CUR 1401 3-403.1 i(E) Remaining 1-holicud Portions of Beef Item Good Retail Practices FC- 590 000 Roasts" 23. Nlanact,,rient and Peo,onnei F('--2 .003 18 Proper Cooling of PHFa ?4 Focia and Food Protpcticri F'--3 .004 3-501.14(A) Eittapment and Utencils F-'-'-4 00.5 Coelho,Cooked PHFs front 14,20F to 26 Water,P[,;rrbrIci and Waste FC-- 70 T -70T Within 2 Hours and I'min 70'F 27, FhyicGi Faulty j FC-6 .007 1,)41'F/45'F'Within 4 Hours. * i i 23. Poisonous or Toxic Materials F0-7 0018 3 50L i4(B) Cooling PHFq Made Foint Ambient 29, Special Requirements G I 'leropenitum Ingredients to 4PF/45F 30 Other Within 4 Hours^ Dymac:,criecad imn in the fialm 1 1999 Pci,)a Code ol 1'16 0 1 R j90010. CITY OF SALEM BOARD OF HEALTH Establishment Name: Ae'ek /,1E9,2hfS Date: Page: 3 of 3 Item " Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION vDate No. Reference R-Red Item Verified PLEASE PRINT CLEARLY , C r�ri n L lis 2, e�JJ'7 JJ '0<' ' _7 mil lrri') . 1 E�/.4D YpO�ACC ,,� 27 OnA.cP , �iP�eL i(/?��s //0 (/�/J 1',19Y r/nio D/� Wyaas'e e�5 //'rv/pian zp Y '-;IV /Li �C�//io 9 ew'p"� ANS ,:u/Lc, ED(/7" (IC,P�jlirn�.n 172t'✓vd W/1- ,V/h/'f' /Al ./7//I//n/O O.PeGf +yfl rlr�rla'S�//�✓� f c lY� em/ti07�o2 - Q2//,1.1L2�9F,�7 J.�STC°}?-17WL ewCL2 -,Ip S .L/ �4 2/N r3 �-/- �nn.P.C.r.+ rni C'llas�ov. 4 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspa slon/revocation of ❑ Embargo ❑ Emergency Closure yourfood permit. ❑ voluntary Disposal ❑ Other: Ii ._— Id:,C, PHF.s Reccitied at`I'empen^ores �I Violations Related to Foodborne illness lnterventIons and Risk Factor's(!(tors 1-22) (Cont.) PROTECTION F1iOhT CHEMICALS i 3-50i.!` G;+ding Metho,6 fia PF1F; fJ Food or Color Additives j I 19 PHr Hot and Cold Holding I i-501.(5(131C,dd=iiFsMaintaitnuofwK-:,,.v 1 3-2(12.12 Ad(litnes i (40.4(4(F) 4I";4 •F* i-302.!:1 Protection form Umprroeod Additive.` 3-5,J].IfilAf F:n1H� sA o I-int j 15 Poisonous or Toxic Substances 1 , _ ... .,,)ned:,;orabo'oe 7-1(11.1 1 Identifvine(nfor natmn-Original Quu,uner.:" 5111 rio(s) Roasts he1:;et rt vho"e 13U'F. " . '-102.11 Cvnmion Name -Working Containers"" ! I zfi I Time as a Public,Health Control 7-201.1( Separation-Storage' 3-Sul.19 Tim.ns a Public Health Contrn,i" ! ]-202.1 l Res,rirtioa-Prcacme and Ctse'r 590.004(H) V(utan.e Rcgn;rcn)crt 7 205.12 Conditions Use' i 9-2113 It Toxic Cont,6ners-Podtitntiom I REOUEREMENTS FOR HEGHLY SUSCEPTIBLE �OPULAT?ONS(HSP) 17-_04.11 Saenlicak Cntfor N ashm"I P rduce. ( 1 ` 3-30i.' I'= Un Is enrized Pre- ck(et d.hzices and i 7.2x4 12 Uteuucals. for Washer Produce. GSteria'^ I 1 ' I t' ) 1.':,^ p'; ' 7-2W.14 Dr7,nc Agents.Criteria" ( i Bever:mzs cath Wantim+ (-.bels" i1 3-80L!I(B) Use uFPastemired Epgs^ 1 7-207 11 htcidental Food Contact,Lubl'Icanm" I 3-301 i i(D) Rawa:Parhally Conked An Fowi and 7 '266.11 Restricted Use Peq;cide.. Criterm' f Ras Syed fiprouls Not Served. .. r06 12 Rodent Bait Stations I i-30':.;1(C' O 7-'206(.(3 Tracking Powdcn,,Pest Control and ( I ) no P a e": d Fond Packag*e No.Re srrvrd. - I Monitoring CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS ?2 3-603.11 Cortwowr ,16lsary Poated for Consumption of 16 1 Proper Cooking Temperatures for Anim:d Foatds That are Raw. Undercooked or IPHFs Not Othe.nvise Processed to Fttm)nare Fatho,c t }401.1 tAC1)(2) I Ergs lis°F IS Sec. ( Fame rizcd 7Fs Substitute for Rot,. SEmli Lens- Immediate Service 1-15°1`15sec' 3-401.11(A)(21 Comminuted Fish.Meats: Game Animals - 155"F 15 sec. a, 3-401.11(6)(!)3) ( Polk and Beef Roast- OW17 121 min. SPECIAL REQUIREMENTS 3-40LI I,A)(2) ( Ratite,, Injected Meats- 155"F ii I)) Violations of Srrtiou 590.009(A. -(D) in sec ^ earerin g, uwbile food: temporary and 3-401.11(A)(3) Pnchrv,Wild Game, Stuffed PHP•, j tesidentiai kitehca operations should be Stuffing Cnntainina FiAi,Meat, debited under the approptiate �eclions , Pouitry or Ratites-lt-,5'F 15 sec, t ebov- if related to foodl;o;ne illness 3-401 11iC)(3) Whole-nmscle intact Beef Ste:,ks 1 unerventions and tisk factors. Other 115'71' 590.009 violations relating it,,;()oxl retail 3-401.12 Raw Annual Fords C(x)ked w a practices should be debited turner r29-- ,Mit.rowave 1-65`7* Special Requirements. 3-401.11(A)(1)(F.) All Other PHFs - 145'F 15 sec. " Reheating for Hot Holding WOLA PONS DELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) I PtIFs 165'F 15 sec. (Item:23-30) 3-40 i.1 1(13) Microwave- 165`F 2 Minute Sumding Cr/tical uxd uu;,cental!rioLuimt,, >hict,d,-)not ndntr to the Tinte4` !b„r'Gvrne dlneec ituer'ewian.s anrt risk lix•iocs listed aha:,, run he 3-403 i 1(C) Commercially processed I2'I'E Food - found i,t<'ke fi,(i'rnri,+,[,•se( idea of l6r Fund C',:dr and 105 CAIti 14017” 1 590.00). i 3-403A I(E) Remaining, Uns!icrd Portions of Beef I Item Good Retail Practices FC 590.000 Roasisx_ j 23. Mananorncnt a-c Perso:r,el FC-g .003 18 ! Proper Cooling of PHFs 24. Fr od and Food Protsclion FC - 9--- - W4 ! o , Eqt ipment and tJ'ens'Is FC-4 .005 3-SU1.i41Ai Cooling Cooked PHFs from 140'F to Cooling I 26, ! oNaler. Plumoinq and Wa:,t2 FG-5 006 ! 70'F Within 2 Hours and From 70^F 27 1 Phvs!rai Facility FC - 6 007 hr 4',1-145"'F Within 4 I-tour j 23 1 Posonous u;Tmer Mmena!s FG- 7 .008 . Cooling Made From Aniblent0109 30. Other ! 1'094 11 4(6 29Sp�sial Paquhemenis Temperature lnt'cdicnts to , 57 - Within 1 Hours* 'I 1" 1,""' --- ' Denow,v ritical nein in the tedera I'M;Pu,d Code r Inc.CINIR 590.000. o T CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • s 120 WASHINGTON STREET, 4TH FLOOR � o SALEM, MA O1 970 TEL 978-741-1800 FAx 978-745-0343 STANLEY USOVICZ. JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Joseph Slesar Name of Establishment : Salem Beer Works Address of Establishment : 278 Derby Street Type of Establishment : FOOD SERVICE Application Date : 12/20/2002 Restrictions : Permit for Food Establishment 124-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT o IL ca CITY OF SALEM, MASSACHUSETTS sti BOARD OF HEALTH m s 120 WASHINGTON STREET, 4TH FLOOR tY+�� DEC 1 92002 SALEM, MA 01970 TEL. 978-741-1800 1 FAX 978-745-0343 B( ',RID ,,,,- HIEN— H STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT & � A]e. e.,r / tnJ.A'f 1 TEL# ADDRESS OF ESTABLISHMENT '1A V 1511pe / MAILING ADDRESS (if different) OWNER'S NAME SD�eOh �>le.Sai TEL#6/7_ 95G,A3o0 ADDRESS /I f) / 2 Sf�Pe t CITY n)fon SIri-iE /t/IR zip CERTIFIED FOOD MANAGER'S NAME(S) L ,e F_1-11,U koe CERTIFICATE#(s) .� I �eA Mf✓,es ' ✓1. .1• k x^ m/✓rI l (required in an establishment where potentially h zardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# 61?-24 a-9 16 HOURS OF OPERATION: Mon. I Tue—Wed. . Thu. � Fri. Sat. � Sunk /fil d"ys opt, 1130NM e/ole 11o0 4M TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ES NO 1� less than 25 seats =$100 25-99 seats 50 more than 99 seats =$200 BED/BREAKFAST YES �l� $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES RNO $5 TOBACCO VENDOR YES $50 rer .yna;ogpF/r i�„�!,as rhurch k,.etcharte� vFS $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. Pursu t to G Ch pter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my b wl a d elief, have filed all state tax returns and paid all state taxes required under the law. OU Ago re I Date // Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm Check#&Date I r•-r ,-e,...�•--,...-...tr --, .-vrrvw'^-�'.., ..-..o-,..�,R,.w.....v r-...��+r•.�r-...r ...r'*wmr�� V A -'H COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name (� Date Tyoe of Ooeration(sl Tvoe of Insoection C � � �� Food Service X Routine Address �"'�1 �Tl-rl ... Risk ❑ Retail ❑ Re-inspection //j �!1� Imo• Level ❑ Residential Kitchen Previous Inspection Telephone ( ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation d� 'S, )d�_� Ci f 1 13o L1�C4 1 � ❑ caterer ❑ Suspect Illness Person in Charge TPIC) Time ❑ Bed &Breakfast" ❑ General Complaint In: ❑ HACCP InspecWr" Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source EJ16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating Elngr 6. Tags/ Records/Accuracy of Iedient Statements El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below c ry by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of X 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food - 26. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing.Your request must be in writing i 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 1 / g Inspector's Si nature: Print: PIC's Signature: Print: Jd I E'�(•� • -f Gl-fA1C Page/of Zpages FORM 734A HOBBS&WARREN BOSTON Of Violations Related to Foodborne Illness , Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 11 590.003(A) Assignment of Responsibility* _ Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer f 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water l590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 3-202,14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, I Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensds* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms A roved b 10 Proper,Adequate Handwashing PP y 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* It Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401 12 Discharges From the Eyes.Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shelistock Identification* Employees* 3-203.12 Shellstock Identification Maintained" J 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402. Records,Creation and Retention* 5-204.11 Location and Placement* , 590.004(4(J) Labeling of Ingredients* 7 I Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CNIR 590.000. CITY OF SALEM ' BOARD OF HEALTH Establishment Name:_ I� � ' x ZQ �^—�L � Date: /�/J �� Page: / of Item Code C-Critical Item DESCRIPTION OF VIOLATION ! PLAN OF CORRECTION Date No. Reference R—Red ItemPLEASE PRINT CLEARLY Verified z As: c g _, I 6�ra� rte,•--,�S - �--` _ rx �S Vo S I I. k � 6 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / " violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may LJ Re-inspection Scheduled EJ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS &WARREN - BOSTON w Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures 3 Factors Red Items 1-22According to Law Cooled to (Cont.)/ 41'F/45*F Within 4 Hours.* PROTECTION FRO d CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original140°F.* Containers* I 3- 01.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* I 3-801.11(B) Use of Pasteurized Eggs* I 7-205.11 Incidental Food Contact,Lubricants* 3-801.l I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1](C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPER'1TURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens* Enechv 11112001 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145'F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155'F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 Min.* catering, mobile food, temporary and 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections . Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165'F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23.30) 3-403.11(A)&(D) PHFs 165'F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165'F 2 Minute Standing foodborne illness interventions and risk factors listed above, cart be Time* found in rhe following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.0.0_ 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70'F Within 2 Hours and from 70'F 27. Physical Facility FC-6 .007 to 41*F/450F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41*F/45*F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ( IMPORTANT MESSAGE ) , FOR---- Q M. DATE 'r/'-U`� 7TIME• -JoZ �f n � OF PHONE- - 97�- 7 Ste- . /-� -,7- AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED I �KfASE CALL . CAME TO SEE YOU l WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE ,�¢.�, /Sem //.✓d.+.�i� /T<!:� Li,.:T i.( i tirK S/✓c <,. V SIGNED FORM 4009 .�f1RRRR MADE IN U.S.A. NOTES .--- __ . ( IMPORTANT MESSAGE ) FOR A.M. DATF n TIME a•'�// OF C p PHOI\ AREA CODE NUMBER EXTENSION O FAX O MOBN F AREA CODE ff NUMBER TIME TO CALL TELEPHONED ti LEASE CALL 1/f CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED FORM 4 MADE IN U A NOTES . i 3 b --F 1 = i r .-��•'�h �x. CITY OF'SALE Y Nle.ySS�AC U_SE'. ^S � HELTH,' :;, • re .,� : � � � rig&. '[R 4 -FI F.�OOR r�"., � > °"�' .� �` a,, yy 120 WA$FIfNGTO•, �.<. EEPTT�y,., �"�'e:...r1r. s N crSALEM"MAO 1970 T 978{7411 800 t „e. S br r FAX wl!9 r* Tv. 0*1 STA LE�YJSOVOICZ,,.JY'R :; _ a,eNi°,`a JOANNE MO r'SxH'�'NR,S;'CiFiO'+� EALTHAG E NT' "r 'F'+� iL"'..1•,�}AR �.r r> ...,, ,y+�.ly 3. q '�,' •� ,4'� +�� Iw yto YSf h E' a E+•�. . ,NH` sa-�X•1S •�'A33. w' -ig F 1 e.1 A .'+,fir.. �.# !f'4±Tktd,+7',-`is � t ��'rxe Via!' * by'y ra t �.F9-($.� . •��y . {� �'� ..� ^�iW,*,"l ; *�'°"�� ^+� � .�xAir 421 �, t Y' iAM �4r•;-Yr d .F j� ! ?. ; yyg��M1 .yTF. n '#; '$� iq - °ya.�nSy. IN WT "� '; a .i _ � ,+ �r�`$"`z al'' c. 'fiM„•vl'., $. - " 8 ±A, J n, - �;. . ' omm(i WEALTH OF SSP;CHUSETT5 ,�,pC YY [t � Sx fi��* ' Ah' '"f 8 �na'�e•e.Y `te .'F, reu a^. 5 pEgNRTTQ' OPERATS�A FOOD .ESTABI;ISHL�NT �� a* e, F �" n acc rdarnce ,regula 1 ns : romulgate un a uthority of Cha ter ,•; "q++«r;Ahe"" `rr!'k ....+rt= nt.� -aw�w.f.-Vie, «i4? .r. ;.w3w ..rca n.r±'. ,. 3Kr V *T'.•86f:.. " rp 4, ecti+on3;OSA and' ChaptIISee-tion • o.` the Genera a atas� ;o ,operat'e Str;as-,• zfi`' :!# r'stt�t.,' > 3s+"Y .ss3'X-s - $$ Fpkod ystabl shment :` the Citi o a]em 9s h e ranted wne r s Name Jos ,l�esar ,. - �• e ,K, s ` }' ',' c , +„y5 '{. 15 ;.. 7 jj^a! ame Tof �Es,t�abshme t... al,e . 'Seer or_ks < .:, ' Y ` 'cdres` ` f st b`] shineYnf2'Te bySree . ' �'�- m. � ppl 'cati'o Date"•,.t1�1�28,/,=2',0� ' _, �; i ,�„ _r estila�l°°ons ` ,. • h c Perm_i fork ` o'` s 1 hent *n hese 4. .erm�` -s >Expse Dec er '.O.U2 ' Tha_gp" etmi�s not , iaasferable aad�must• 'beelssued upon ange o� Y'K1bw".i A.- YY mcg- rr�y{fie vz."`Ye ..jr`/ rt+�},!4' fS"` ` t c'mP' s M waershipSForlocajt�on �he e t�mu�Gb�e _poste$ ia a :^prominent ocatiun�� n the }�stabllshmeat., - A .y.,.�y `�i'Y. a � ;''�yY�.4t,."QTY �. i �� •�� , X�4� ,r• +�+�,.� �^'� �#Ic .' r�.^ 3:< E. ,'.a !x�` `.^'z �.�kD �! n ca�ordance with the ,State :Sjg1taNyyyyde before aay eno�vatsons, * AMPS hanges are made, a,11 'plan� for' sucM s•t 'be, •; #"' X a. 4 ar`'#� � �.` 'a„�.-V...a.,y4s�r• . ubmlttecHmol ndl`ap oxed�b 'the" S em poard `of Hea r.S�SM ,✓ yr{i'�g ,� e, V c„� r � - r .-y?? 4x `E•e•r. #Hi ,' , r "•'��" 'i ` s,Lr HEAsLTHGENT ifA }� y�t �s'� ' y 'y�, t } �'F• �L k' � s.�+� +�. 1 '".3} 'F'* Y` E .h� T� �4.� 4', i �'. it-Ali I RL I J {*'.y�yy • y �i $ S4J'MI'`Y`, .1Ali� � PuPl _ J` CITY OF SALEM, MASSACHUSETTS y BOARD HEALTH STREET, y� � 120 WASHINGTON STREET, 4TH FLOOR tt "�jf `J`J{{I l�li{��114It'eell SALEM, MA 01970 TEL. 978-741-1800 ivo+� ry FAX 978-745-0343 u ( iF J STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO GITY OF SALEM MAYOR HEALTH AGENTH..fi.�Tr1 r + OE PT. 2402 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTq(P gpr r nrY,S TEL# U73. 7,6'. x i I } ADDRESS OF ESTABLISHMENT Pry �f S.h1YjA 019 i7 MAILING ADDRESS (if different) OWNER'S NAME -�OkOh S ar TEL# 617- 36-xJ } ADDRESS A / &Jdlm, Ivy CITY / nth)., TATE_ ZIP _ CERTIFIED FOOD MANAGER'S NAMES)---- Ja 1 CERTIFICATE#(s) J. (rjw� L . "Q l' Mf✓hI (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Ann l pr.cP HOME TEL# 7 7 ��/' I! 7 DAYS/HOURS OF OPERATION: Mon. ..- Tue.=Wed.r Thu. .- Fri. .- Sat. - Sun. r Alibtiy5 - O(tr-, 11.30 4^ CtV I.00 4A — TYPE OF ESTABLISHMENT FEE check only RETAIL STOREY qN $40 RESTAURANT $40 BED& BREAKFAST YES ( $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES N $5 TOBACCO VENDOR YES ;�10 NO CHARGE FOR NON-PROFIT(such as church kitchens)PLEASE INCLUDE COPY OF TAX EXEMPT FORM Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to M chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best kn e d belief, have filed all state tax returns and paid all state taxes required under the law. hl> lo/ /)44 3117a3 o ' nature" Date 7 Social Security or Federal Identification number Revised 11/1/01 foodap2.adm Check#&Date vrld /s�7ry�/\—f /I �1y�J VV 0 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINOSALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM n Date: 'S I'1 9 I f Time: 2 I `� Received By: L , 2A M 1 Complaint Number:/ �-0247" Complainant ytxtirC- Address: � © � Phone: G J-L-VA • Investigated By: Date: Property Owner/Occupant Name Telephone#: • i( MPORTANT MESSAGE ) FOR ollse rL, DATE M[1.VCil'l L��13ME � OF �J `moa-len PA a f key PHONE 79 / .J�,� AREA CODE U'ABER EXTENSION 0 FAX 0 MOBP G AREA CODE NUMBER TIME TO CALL TELEPHONED ,/11i PLEASE CALL x CAME TO SEE YOU /� WILL CALL AGAIN WANTS TO SEE YOU 'I RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE C — ppn j — fl,V-1 [1 �(eh�e � I� OTGav �fvres� Q4 SIGNED �/ � "%NERSAL. 48005' MADE IN U.S A NOTES _ Lrntitled Page Page 1 of 2 Dashboard Guest Issues HR-Applicants HR-Employees Payroll R&M Admin Messages Update Issue: #13030230918 3/2/2013 6:52 PM Salem Issue Details Analysis for Determining Posted By: Donald Hunt Appropriate Discounts Table Visit By: Meghan Dahl Severity: Severe Check# Issue Fixed: No FOH MOD: Meghan Dahl Time To Fix: Immediately BOH MOD: Renato Da Silva Overall Bad Brew MOD: No Brew MOD Experience: Chef Notified At Yes Affected Yes Time: others at Brewer Notified At No table: Time: Guest Contact Info Items Deleted/Discounted Item: Type: Price: Name: el paso Comp-Guest $11.00 Email: salad Phone: Sub-Issue #01 Food Wrong Ingredients BOH Manager Actions Taken By: Renato Da Silva Employee Involved: Detailed Description el-paso salad. guest found small pease off metal in it. of Issue: Detailed Description took of the bill. of Action Taken: Required Follow-Up Chef http:%/portal.beerworks.net/guestfUpdate.aspx?nGSIssueID=26796 3/18/2013 Untitled Page Page 2 of 2 . i Completed Additional Comments / Notes / Follow-Ups Update: Updater: Follow-Up? Add FG—M Review / Close Issue Update History Saturday, March 02, 2013 10:58 PM - dhunt Issue Created Sunday, March 03, 2013 9:59 AM - Emad We checked the salad mix it was good OPrint Issue J Beer Works Portal->Guest Issues->GS/GC List->Update Guest Issue Copyright 02013 Boston Beer Works All Rights Reserved. I Version 1 3.4.22 http://portal.beerworks.net/guest/Update.aspx?nGSIssueID=26796 3/18/2013