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SALEM HOUSE OF PIZZA - ESTABLISHMENTS Lniversal one. www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA I i CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR • MAYOR TEL.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS/RENS,CHO,CP-FS LRAMDIN(a�SALEM COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Il Time: Received By: �y Complaint Number: 0134 Complainant f�aVS Address: Phone: • Investigated By. Date: Property Owner/Occupant Name Telephone #: � �a.ci�3t�e� �.ea� '�-a�►a�u,"�. �i �v�r��r��r3 � Ibis �`l�� ISS✓� d�,1�0�n1� $ = Commonwealth of Massachusetts ` m City of Salem v .. "Board of Health � Kimberley Driscoll 120 Washington Street,4th Floor ' Mayor SALEM,MA 01970 Food/Retail Establishment Permit _ DATE PRINTED: 12/05/2012 Y ESTABLISHMENT NAME: ` .< Salem House of Pizza File Number BHF-2004-000028 - 23 Endicott Street g 3p Salem _ MA 01970 LOCATED AV,° 0023 ENDICOTT STREET b' SALEM, MA .01970:: A Permit Type Permit No. Permit Issued Permit Expires , . Fee Restrictions/Notes ! FOOD SERVICE _ BHF-2013-0063 Jan 1,2013 Dec 31,2013 x $140.00 !# ESTABLISHMENT. f Total Fees: $140.00 4 i _ 5 I PERMIT EXPIRES- December 31, 2013- Board of Health This Permit is not transferable and most be reissued upon change of.ownership_or location_.The permit must be posted; - - i s in a prominent location in the Establishment. F; ', `<-_ =' <e- - -'3c " -''T " - - - ;_ - = 1 In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, t f all plans for-such must be submitted to and approved by the Salem Board of Health. '.; ,F Page 1 a CITY OF SALEM, RECEIVEDv ASSACHUSETTS IP Ith +q BOARD ca?HEw.r1F [ r�1 1 i" 120 WAST-11NGTON S'IREE'r,41°FLR OO KIMBER1.EY DRISCOLL Q`C' C1 S� ,,MT1 a1-(978)741-1800 Fnx(978)745-0343 LU w,'IWMDIN,WS/RHFIS,0110,C11-FS MAYOR �II'j 0' Nom.\-,N Icamdlnnsalem.com � HI_,Al.;l'fIACL:N'C BQAFD Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: SAL /fo U//S 2 CL 2) Establishment Address: 2 7 HL ST SmA- 0 1 7 'L.4 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: `�'7 Q —7q y— Q p ( -7 ee Z 5) Applicant Name&Title: 1jj0 f1j1M t gp 4-(-e4,j p✓e-fl-All 6) Applicant Address: ' �r, F .1 A _C' N IVl1� O / 7 2 7) Applicant Telephone No: t j 7.7 3 f 5$/) 24 Hour Emergency No: &-7--731'f_4(_)Email: K N ABS 9� P X'aHeh,esti 8) Owner Name&Title(if different from applicant): <41,c12 AI' C14,41.1 V2a C cA✓4?-- 9) 9) Owner Address(if different from applicant): 3 P IAt"01'— Gw✓cLt'` -43-c- G�rr,.b Y1' (V\^A oat 3 9 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address corporation An individual McHAma^l/D AFLAM fqt�, A partnership Other legal entitv I A-c-- 12 A M A- D I7Lq Cxlg9 AC-r SfH9lf -7,14-45'k✓`— 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge, Supervisor,Manager,etc.) Name&Title: ALt' Y*4-14 W n R--✓ Address: ; (A+()U V Gr r c�v` 44-3 0 ('Pr'Y\B Iz1 'pce rA ff 6)— (3 9 Telephone No: W4-jo L- Fax: Email: Emergency Telephone No: Ciyr..lV 13) District or Regional Supervisor(if applicable) Name&Title: Address: 1� Telephone No: Fax: Email: I Check#: f ) VI Date: I I -3 1 �— Amount: (`t 0 • J� Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) 16) Days and Hours of Operation: A-r-N 17) No. of Food Employees: S 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 5R,- 19) Person Trained in Anti-Choking Procedures( if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) \ heck one 0 Retail( Sq. Ft) 0 Caterer %ermanent StruNi UFood Service-( 2 h Seats) 0 Frozen Dessert Manufacturer is ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale 0 Food Service-Institution 0 Residential Kitchen for Bed and ( Meals/Day) Breakfast Home 0 Food Delivery 0 Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments-„--,----„-,,,_, (check one) RETAIL STORE RESTAURANT nnua 0 Less than 1000sq.ft. $ 70 Ei'Less than 25 seats $140 easonal/Dates: 0 1000-10,OOOsq.ft. $280 0 Residential Kitchens $140 0 More than 10,000sq.ft. $420 0 25-99 seats $280 0 More than 99 seats $420 Temporary/Dates/Time: - - - i - - - r'-H-------------------------------- - 0 Bed &BreakfasUChildcare Services/Nursig ome $100 --------------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS 0 MAKE ICE CREAM, YOGURT/SOFT SERVE $25 0 PASTURIZATION $25 0 TOBACCO VENDOR $135 0 ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no time/temperature controls required) (check all that apply): RTE-ready-to-eat foods(Ex.sandwiches,salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal'Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Fcods Only i Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be comaleted by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on howto obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A,I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxers required under law. 25) Social Security Number or Federal ID: S,S - 68 3`L019e 26) Signature of Individual or Corporate Name: ///�/�CW✓ Y �' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town ofAddress: FOOD ESTABLISHMENT IN PE ON REPORT Tel. Name Dat DTAof Operation(s) Type of Inspection tj Food Service ❑Routine Address r Risk ❑ Retail 91Rctspection Telephone . Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: OwnerHACCP YIN ❑ Temporary ElPre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(P i Tim /w� ❑ Bed 8 B�reaUgfast ❑General Complaint [I HACCP Inspector 0 'l Out ' ermit No Cite/ ❑.Ot err Each violet ch c ed requlres lavation on the narrative ge(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 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD.PROTECTION MANAGEMENT _ _ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ ❑ 13. Handwash Facilities EMPLOYEE HEALTH 'PROTECTIONFROWCHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOODFROMAPPROVEDSOURCE _ ❑ 15. Toxic Chemicals ❑ 4. Food and Water from Approved Source i TIMFIT_EMP.ERATURE CONTROLS(Potentlall HazardousF.00ds)R_ ❑ 5. Receiving/Condition ❑ 16 Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling PR,AECT10N FROM CONTAMINATION _ _ El 19. Hot and Cold Holding L�JJ88 eparation/Segregation/Protection ❑20. Time as a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSUSCEPTIBCE POPULATIONS(HSP):,_, El 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP _ ❑ 11. Good Hygienic Practices ,CONSUMERADVISORY _ - ❑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. Noncritical(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 24. Food and Food Protection (Fc-0x590.00 4)) 23. Management and Personnel (FC-2x590.0 order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4x590 005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5X590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special R ements (5so.00s) within 10 days of receipt of this order. , 30. Oth DATE OF INSPECTION:(nJ�,r °�,lfp(f/� IL'{Y ' It' s o-,eao Ui Inspector's Signa I Print:, PICS Signature: Ah� - PnaLMn��m�� ,��y� Pagel oftages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* J 590.003(B) I Demonstration of Knowledge" 1 Contamination from Raw ingredients 12-103.11 Person in charge-duties I 3-302.11(A)(2) Raw Animal Foods Separated from Each I Other* EMPLOYEE HEALTH l I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to I 13302.11(A) Food Protection* 1 require reporting by food employees and 13-.a 02 IS I Washing Fruits and Vegetables applicants* J 590.003(F) I Responsibility Of A Food Employee Or An 13 304. Food Contact with Equipment and Utensils* Applicant To Report'Po The Person In I Contamination from the Consumer Charge* 590 003(6) I Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Reservice of Food* 1 3 590.003(D) I Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated Food 590.003(E) I Removal of Exclusions and Restrictions I 3-70Li I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I I Food* J 4 Food and Water From Regulated Sources ( 1 9 Food Contact Surfaces 590.0041A-B) Compliance with Food Law* ( 4-501.111 Manual Warewashing-HotWater 3-201.12 Food in a Hermetically Scaled Container* 1 Sanitization Temperatures* i 3-201.13 Fluid Milk and Milk Products* I 14-501.112I Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-20'_.14 Eggs and Milk Pratuc[s. Pasteurized" 1 14-501.114 I Chemical Sanitization-temp.,pH, ' 1 3-202.16 Ice Made From Potable Drinking Water* ( concentration and hardness. 5-101.11 I Drinking Water from an Approved System* ( 4-601.11(A) I Equipment Food Contact Surfaces and Utensils Clean* 1590.006(,41 ( Settled Drinking VVa1er' I 4-60^_.11 CleaningFre of Equipment Food- 590.006(,B) i Water Meets Standards in 310 CMR.^_2.0+ I quencv 1 P Sheiifish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught tvfotlusc.°I I Food Contact Surfaces of Equipment*ShelLish* _ I 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shelltibb from Li NSSF ,ted Chemical* Sources* Game and Wild Mt6hrooms Approved by 1 to I Proper,Adequate Handwashing Regulatory Authority I 12301.11 1 Clean Condition-Hands and Arms* J 13-202.18 Sheilshx k Identification Present* I 2-301.12 Cleaning Procedure* 590.004(0 Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 I Game Animals* I 1 11 1 1 Good Hygienic Practices 13 I I Receiving/Condition 12401.11 1 Eating,Drinking or Using Tobacco* ) 1 3-202.1 f I PHFs Received at Proper Temperatures* ( 2-401.12I Discharges From the Eyes,Nose and I 3-202.15 I Package humity Mouth* 11 3-1(-1.11 Food Safe and Unadulterated* I 13-301.12 I Preventing Contamination When Tasting* 6 'o agsl9ecords:Shelistock I 1 12 Prevention of Contamination from Hands 3-202.18 I Shellstock identification * I 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" 1 Employees* Tags/Records:Fish Products I 1 13 I 1 Handwash Facilities 1 3-402.11 I ParasiteDcarucdori* ! ( I Conveniently Located and Accessible 3-40^_.1^_ I Records.Creation and Retention" I 15-203.11 Numbers and Capacities* 590.004(1) I Labeling of ingredients* 15-204.11 Location and Placement* 15-205.11 I Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures y� l+ /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Pvtethods* 1 Devices , 3-502.12 Reduced oxygen packaging,criteria* I 16-301.11 1 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 I Hand Drying Provision •Denotes critical item;n the federal 1999 Paid Code o+ 105 CMR 590.000. r CITY OF SALEM BOARD OF HEALTH Establishment Name: Z7allelm paf� Date:_A#,d1r Page: of Item Code C-Critical ItemDate NO. Reference R-Red Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Verified PRINT C EARLY /J / I I I I _ I Pte• ikfl E � ` rr `199 ' ' z (ln fY1 ;�� E iV a,61 4V� -M rrnrtIZAI') G2 f ' °—� We yr , I IIJL 10 'y G111 ��V'F/f�,�'D�_t,�%1fC�Hn �J?-��f�l� lo.l°� CL:I/V?til-p� • �I✓Irl�_ ��_5 , Dussion With Person in Charge: _ Corrective Action RequiredT� I ❑ Yes isc I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance �� ❑ Employee Restriction inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or�suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. -=r ❑ Voluntary Disposal ❑ Other: i 3-501.14(C) PRFs Received at Temperatures Violations Related to Foodborne Illness tntementlons and Risk According to law Cooled to Factors(Hems 1-22) (Cont.) 41'F/45°F Within 4 H( r 501.15 Cooling Methods for PHFs } PROTECTION FROM CHEMICALS � 19 PHF Hot and Cold Holding } 1 14 1 Food or Color Additives { 3-501.16(B) Cold PHFa'Maintamed at or below } 3-202.12 Additives* i 590.004(F) 41°145"F* r 3-302.14 Protectiou from Unanproved Adiiitives* 3-501.16(A) Hot PHFs Maintained at or above } 15 Poisonous or Toxic iubstances } 110°F. * 7-101.11 identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* } 20 } 7-102.11 Common Name-Working,Containers* 1 Time as a Public Health Control 7-201.11 Separation-Szora=e } 3-501.19 Time as a Public Health Control* 1 7-202.11 Restriction-Presence and Use* } 590.004(Hl t Variance Requirement j 7-202.12 Conditions of Use* } REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203"11 Toxic Containers-Prohibitions* } POPULATIONS(NSP) 7-204.11 Satudzers.Criteria-Chemicals* } 7-204.12 Chemicals for Washing Produce,Criteria* 21 Labels*21 801 l l(A) UnpasteurizedPrr-Iuzca kged tutees and 1 } }7-204.14 Drying Beverages with WarniingAgents.Criteria' 1 3-801.11(6) 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 7-306'12 Rodent Bait Stations* ( 3-801.11(C) Unopened Food Package Not Re-served. * 1 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY r TIMEf6EMPERATURE CONTROLS Animal F 22 3-603,11 Advisory Posted hs Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.11,0{I)(Z) Eggs- 155 F IS Sec. Pathogens., Eggs-immediate Service.145'F15sec+ 3-302.13 1 Pasteuriwd Eggs Substitute for Raw Sheil 31401.11(A)(2) Comminuted Fish.Meats&Game Eger" 1 Animals-155'F 15 sec. * I i, SPECIAL REQUIREMENTS } 3401.11(B)(1)(2) 1 Port:and Beef Roast- 130'F 121 min- 3Ratites,Injected Meats- 155`F 15 ( 590.004(,0)-(D) Violations 3f Section 590.590.009(A)-([))in -401.11(A)(2) i ( sec * catering, mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish.Meat. debited under the appropriate sections f Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other I 145°F t` 590,009 violations relating to good retail 'I 3-401.12 Raw Animal Foods Cooked in a � practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. } 17 } Reheating for Hot Holding VIOLA77ONS R SLATED TO GOOD RETAIL PRAC77CES 3-403.41(.A)&(D) PHFs 165°F 15 sec.* 1 (Ztettis 23-30) 1 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relax.to the Time* foodborne illness inteiventions and risk factors listed above, can be 3403.t 1(C) Commercially Processed RTE Food- jound in the following sections of the Food Code and 105 CAM 140'F* 590.000. 3403.11(E) Remaining Uns?iced Portions of Beef 1, item I Goad Retail Practices J. FC 59o.Wo Roasts" 123. _ i Manaqament and Personnel ! FC-2 .003 E_ 1g } Proper Cooling of PHFs 24. i Food and Food Protection ( FC-3 .004 i 25. ! Equipment and Utensils i FC-4 .005 • 3501.14(A) Cooling Cooked PHFs from 140`F to 1 2& Water.Plumbing and W aste t FC-5 .006 70'F Within 2 Hours and From 70'F 127. Phvsical Fatuity FC-6 .007 I to 41 OF/45'F Within 4 Hours. * i 28. ; Poisonous or Toxic Materials '; FC=7 .008 3-501.14(6) Cooling PHFs Made FromAmbient 29. Special Requirements .003 I Temperature ingredients to 41'F/45°F Other Witton 4 Hours* '0.rrotaq en ieat tum in the L-dewl i 999 Foci Ctxie a'ins C-MR 590.000, F Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax(978) 745-0343 City/Town ofAddress: TI FOOD ESTABLISHME N ECTION REPORT Tel. Name 1 DatjZk Typ Operation(s) Type o spection /� Food Service outine Address410j r Risk ❑ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YIN [I Temporary El Pre-operation ❑ Caterer ❑Suspect Illness Bed&Bre fast Person-in-ChTim �� L]General Complaint In: ❑ HACCP InspectorOut " Permit No7 ,DjI]Other Each violatiod'chec id req t es a e enation on the narrative page )and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ q corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) El 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 __ - -. _ _ _. - . , E] 15. Toxic Chemicals _ F] 4Food FROM APPROVED SOURCE and Water from Approved Source i TIMEITEMPERATURE CONTROLS(Potentially Hazardous F.god9) � 4. F _ ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved ProceduresIHACCP Plans Cooling 7CTION FROM CONTAMINATION _ � and Cold Holding / separation/Segregation/Protection ❑20. Time as a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HldHLYSUSCEPTIBLE=POPULAYIONS(NSP) , El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP _ ElCONSUMERADMSORY 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories` s 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. Noncritical (N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR cf Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-5X550.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4X590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC5Xs90006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590 007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7X590.008) and submitted to the Board of Health at the above address 29. Special R ents (590.009) within 10 days of receipt of this order. 30.Othe DATE OF RE-INSPECTION', Inspector's Signa I Print: PICS Signature: N ,�/ /b _ Print-.-M6�/�{`rvtµAn -L/y- 1 Page I of,�Pages . n.rY �- ._ .nJ� .. A.y,*.r*$r� ..,..w � �IMP�,.�-1 _ �r l.r,+rr • _4-"• .•v.v.y�+ �..�� "\. [ Y Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 18 ( FOOD PROTECTION MANAGEMENT Cross-contammation 13-302.t I(A)f1) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I I Caked and RTE Foods* 590.003(B) Demonstration of Knowledge* I I Contamination from Raw Ingredients 2-103.11 Person in charge-duties I 3-302.11(AN 2) I Raw Animal Fails Separated from Each EMPLOYEE HEALTH Other* I I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) ( Food Protection* require reporting by food employees and 3-102,15 I Washing Fruits and Vegetables f applicants* 13-304.t 1 ( Food Contact with Eqmpment and An 590.003(F) Responsibility Of A Food Employee Or Applicant To Report Tc.The Person In Utensils I I Contamination from the Consumer Charge* 590.003(G) Reporting by Person in Charge* 13-306.14(A)(B) I Returned Food and Reservice of Food* f Disposition of Adulterated or Contaminated 13 1590.003(D) Exclusions and Restrictions* Food 1590.003(E) I Removal of Exclusions and Restrictions I 3-70'.1 ! Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE I Food* J 4 Food and Water From Regulated So;.rces 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I 1-5111.111 Manual Wazewashing-Hot Water 13-201.12 &rat in a Hermetically Sealed Container* _ I Sanitization Temperatures* i 3-201.I3 Fluid Milk and Milk Products* I 4-501.112 Mechanical W'arewashing-Hot Water 3-202.13 I Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* I 4-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 ice Made From Potable Drinking Water* I concentration and hardness. * 15-101.11 Drinking Water from an Approved System" I 14-601.11(A) I Equipment Food Contact Surfaces and Utensils Clean* 1590.006(A) Bottled Drinking Water 4-602.11 Cleaning Frequency of Equipment Food- 590.00fi(B) Water Meets FisStah From in App3 10roved CMR 22re ( I ( Contact Surfaces and Utensils* J Shellfish and Fist From an Approved Seurce � I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Moliuec'° I Faxf Contact Surfaces of Equipment* i ShclLgsh* I 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* Game and Wild Mushrooms Approved by I to I I Proper,Adequate Mandwashing Requtatory Authority 2-301.1 I I Clean Condition-Hands and Atms* 3-202.18 Shetistock identification Present•` i 2-301.12 Cleaning Procedure* I 1590.004(C) Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 Gamc Animals* I (1 I Good Hygienic Practices ) 5 Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperannes* I 2401.12 Discharges From the Eyes,Nose and 3-202.15 I Package integrity* I I I Mouth* 3 l 0i.11 I food Safe and Unadulterated* I 13-301.12 I Preventing Contamination When Tasting* 16 Tays/Records:Shelistock I 112 I Prevention of Contamination from Hands 13-202.18 Shellstock Identification* ( 590.004(E) I Preventing Contamination from 13-203.12 ( Shellstock ldenti6cation Ivlaintaiaedll Employees* Tags/Records:Fish Products 113 I Handwash Facilities 13-402.11 Parasite Dest'ruction' I Conveniently Located and Accessible I 13-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* I _ I 1 - - 590.004(.f) Labeling oT Ingredients' 0'204.11 Location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility.Operation and Maintenance /HACCP Plans I ( I Suppled with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria* 16-301.11 I Handwashing Cleanser,Availability J 8-103.12 Conformance with Approved Procedures^ 16-301.12 I Hand Drying Provision *Denotes critical item in the fwleral 1999 Paxl Code m 105 CMR 590 0,10, l CITY OF SALEM I _ - BOARD OF HEALTH ) �7 Establishment Name: P !� Yi�7./I� Date: Page: r7i of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PL S'PRINT f.IEARIV 7'Sir r�)41' � r SIA �SUhllo (� �D '• o� , _ o InP, �,I I II I m �P t Discussion With Person in Charge: Corrective Action Required: I ❑ No es - I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3--501.14(0) PHFs Received at Temperatures Violations Relater!to Foodborne kinesia lrimmentions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41*F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS { 3-501.15 Cooling Methods for PHFs ' Food or Color Additives ( { 19 PHF Hot and Cold Holding { I { 14 { 3-501.16(B) Cold PHFs Maintained at or below { 3-202.12 Additives* 590.004(M 410145"F* 3-302.14 Protection from Unapproved Additives" { { 3-501.16(.0) Hot PHFs Maintained at or above Poisonous or Toxic Substances { 15 t40 7-101.11 IdemityrigInformation-Original I Roasts 3-501.16(A) RoastsHetd at or above 130'F. Containers" {{ 7-102.11 Common Name-Working Containers* ) { Time as a Public Health Control ( 3-501.4( Time as a Public Health Control** 7-201.11 Separation-Storage* 590.004( ) { 7-202.11 - {.Restriction-Presence and Use* { H) Variance Requirement l { 7-202.12 1 Conditions of Use* { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* { POPULATIONS(HSP) { 7-204.11 Satdtizers.Criteria-Chemicals'* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and .Beverages with Wartime tine Labels* { { { { 7.204.14 Dtving Agents.Criteria* { 3-801.11(B) Use of Pasteurized Eg„as* { { 7.205.11 Incidental Food Contact.Lubricants* { 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* { Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Faxl Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and " Monitoring* CONSUMER ADVISORY TIMEII EMPERATUAE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 26 Proper Cooking Temperatures far + Animal Foods That are Raw,Undercooked or PHFs ` Not Otherwise Processed to Eliminate 3-401.1IA(I)(2) Eggs- 155`F 15 Sec. Pathogens.* f Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 31401.11(A)(2) Commiaaied Fish.Meats&Game { Egos* Animals-155°F 15 sec. * { SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) { Pork and Beef Roast-130'F 121 min* { 1 590.009(.0)-(D) Violations of Section 590.009(A)-(13) in 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 see.* catering, mobile fool,temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish.Meat, debited under the appropriate sections Poultry-or Ratites-i 65'F 15 sec. i above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other I' I 145'F* - 590.009 violations relating to good retail �! 3-401.12 Raw Animal Foals Cooked in aI practices should be debited under#29- 1 Microwave 165i `F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec.* j 17 Reheating for Not Holding 1 VIOLATIONS R LATE®TO GOOD RETAIL PRACTICES 3-403.41(A)&(D) PHFs 165-F 15 sec. * { (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-103.11(C) Commercially Processed RTE Food- found in the folloning sections of the Food Code ural 105 CMR 1400F* 590.000. 3-403.11(E) VRemaining Unsiiced Portions of Beef I, Item ': Good Retail Practices FC 590.000 Roasts* 123. i Management and Personnel ; FC-2 .003 lS { Proper Cooling of PHFs { 1 24, Food and Food Protection l FC-3 I •004 j 125. 1 Equipment and Utensils i FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140°F to ( 26, Water.Piumbinq and Waste ! FC-5 .006 . 70'17 Within 2 Hours and From 70'F 127. f Physical Facility FC-6 .007 to 41'F/45`F Within 4 Hours. 1 28. ' Pasanous or Tooc Materials t FC-7 .008 3-501.14(8) Cooling PHFs Made From Ambient 129. , Special Requirements .009 1 Temperature Ingredients to 4VF145°F 30' 1 Other ' Within 4 Hauls` 'D.notes criticat iu a in the federal 1999 Fwd Cate ur 10 CMR 590.000. CITY OF SALEM 1 I .( BOARD OF HEALTH Establishment Name: �_ �1Q/1M �� rf �� Date: �_�/ �'(� Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY VPrI Or Fff.4' mil tarn fl W1 U-) �v�� _ Gfy� �w) r/ 1 .ry�rA IGS U'7) L-q UX4iC _A � 4� "Afl Discussion With Person in Charge. CJ Corrective Action Required: ❑ No Itis I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: t l i - y 3-501.14(C) PHFs Received at Temperatures 7 Violations Related to Foodborne illness Interventions and Risk According to law Cooled to { Factors(Items 1-22) (Cant.) 41=`F/45°F Within 4 Hans. ° 3 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS 119 I PHF Hot and Cold Holding ( 14 ( Food or Color Additives I 3-501.16(B) Cold PHFs Maintained at or below ' ( 3-202.12 Additives ( 590,004(F) 41°145"F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above ( 15 Poisonous or Toxic Substances 140 * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1300F. * 1 Containers* ( 20 rime as a Public Health Corttroi f ( 7-102.11 Common Name-Working Containers* } 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Storage* Valance Renuirement 7-202.11 Restriction-Presence and Use* I 590.004(H) ( 7-02.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.1.1 I Toxic Containers-Prohibitions* ( POPULATIONS(HSR) ( 7-204.11 ( Sanitizers.Criteria-Chemicals* ( 21 3-841.17(A) Unpasteurized Pre-packaged Iuices and ( 7-244.12 ( Chemicals feu Washing Produce,Criteria° ( Beverages with Warning Labels* ( 7-204.14 Drying Agents.Criteria* ( 3-541,11(B) Use of Pasteurized£xgs* ( 7-205.11 Incidental Food Contact,Lubricants* ( { 3-S01.11(D) Raw or Partially Cooked Anneal Food and i ( 7-246.71 Restricted Use Pesticides;Criteria* Raw Seed Sprouts Not Served,* ( 7-306.12 Rodent Bait Stations* ! ( 3-801AI(C) Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and ii Monitoring* CONSUMER ADVISORY 1 22+t 3-603.11 Consumer Advisory Posted for Consumption of TIMEMEMPERNTURE CONTROLS Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Pmin rocessed to Eliminate PHFs Pathogens,*`�pCO�'n7uet 3 d01.IlA(1)(2) Eggs- mmed 15 Sec. Eggs-Immediate Service 145°FLSse:--* 3-302.13 Pasteurized Eggs Substitute f�Raw Shell IS Eggs 3301-I I(A)(2) Comminuted Fisb.Meats&Game Animals-155'F 15 sec. 4 3.401,11(13)(1)(2) Poria and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violationsons of Section 540.(104{A}-(D)in sec.* catering, mobile food,temporary and 3-401,11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be ' Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-1650F 15 sec, * above if related to foodborne illness 9-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3301.12 Raw Animal Foods Cooked in a i practices should be debited under#29- Microwave 165°F* I Special Requirements. ( 3-40LI I(A)(1)(b) All Other PHFs- 145'F 15 sec. j 17 Reheating for Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 163-F 15 sea* ( (Items 23-30) 3403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relate to the Tire* foodborne illness interventions and r."sk firetors listen above, can be 3403,11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3303.11(£) Remaining Unsticed Portions of Beef +, ttem 1 Good Retail Practices ; FC 590.000 Roasts* � 1 23. i Management and Personnel I FC-2 ,003 ( 18 Proper Cooling of PHFs 1 24. I Food and Food Protection I FC-3 .004 125. 1 Equipment and Utensils f FC-4 A05 t, 3-501.14(A) Cooling Cooked PRFs from 140'F to f 26, 1 Water,Piumbim and Waste FC-5 '06 I 70°F Within 2 Hours and From 70°F ( 12T 1 Physical Fact& FC-6 .007 i ti to 41`F(45'F Within 4 Hours.* i 211 ' Pasoneus or Toxic Materials FC=7 .008 j 3-501.14(B) Cooling PHFs Made From Ambient 129. I Spacial Requirements 009 i Temperature Ingredients to 41'F145°F i i Omer Within 4 Haus* 'Denotes crilicai rem in the federal 1!)99 Food Cate w 105 CNIR 590.000. k r n w CITY OF SALEM �! �1I ,^^,, I ' BOARD OF HEALTH / Establishment Name:- �v„ VI �_._�_ Date: Page: L of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date i No. Reference R—Red Item Verified_ PLEASE PRINT CLEARLY /{��}�1 1 f"� � i A� gltNo�l I P I L/ o1 a _ J I � t� inn,l� t� _ I u � (.DA-1 I , ,. rA I _ M At Discussion With Person in Charge: Corrective Action Required: TO 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 dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness interventions and Risk According to Law Cooled to i Factors Ilfams 1-22) (Cont.) 41'F)45°F Within Hairs. PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFs 1 ( 119 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(B) Cold PIIFs Maintained at a below f 3-202.12 Additives* 590.004(F) 41°145°F* ' 3-302.14 Protection from Unapproved Additives* I 3-501.16(A) Hot PHFs Maintained at or above j 15 Poisonous or Toxic Substances 140` 7-101.11 Idemit)ing Information-Original � 3-501.16(A) Roaststs Heid at or above 1300F. Containers* 20 Time as a Public Health Control 17-10211 Common Name-Working Containers* I 3-501.19 Time as a Public Health Control* 7-201-11 separation-Storage* ( } 590.004(H! Variance Requirement( 7-202.11 .Restriction-Presence and Use* 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 7-20412 Chemicals for Washing Produce,Criteria* 1- 21 3-801.t l(A) BeverUnpasteurized ges w with eniees and � . Beverages wish Warning Labels* 17-204.14 Drying Agents.Criteria• 3-801.11($) Use of Pasteurized Eggs* I 17-205.11 Incidental Food Contact,Lubricants* I 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* i Raw Seed Sprains Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY ( TIMER EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 116 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.11A(i)(2) Eggs- 155'F 15 Sec. I Pathogens.' Eggs-Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw shell 3-401.I1(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'F 15 see. SPECIAL REQUIREMENTS y 3401.1I(B)(1)(2) Pork and Beef Roast-130'F 121 min* ' 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section .590.009(A)-(D)in t see.* catering, mobile food,temporary and 3401.1 t(A)(3) Poultry,Wild Game,Stuffed PHR, residential kitchen operations should be Y Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a � practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.1l(A)(1)(b) All Other PHFs- 145'F 15 sec. = I %7 Rabbeting for Hot Holding I VIOLA77ONS R LATED TO GOOD RETAIL PRAC77CES 3403A I(A)&(D) PHFs 165'F 15 sea* I (Items 23-30) 3-403.11(B) Microwave- 165-F 2 Minute Standing ! Critical and non-critical violations, which do not reline to the Time* i foodborne illness interventions and riskfacrors listed above,can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CUR . 140°F* 590.000,' 3403.11(E) Remaining Unsliced Portions of Beef 1 Item 1 Good Retail Practices i FC 590.000 i Roasts" j 23. i Managament and Personnel ! FC-2 .043 I E 18 Proper Cooling of PHFs 124. i Food and Food Protection FC-3 .004 i 1 25. Equipment and Utensits FC-4 .005 1 3-501.14(A) Cooling Cooked PHFs from 140'F to 12g, Mater.Plumbinq and Waste FC-5 .006 70'F Within 2 Hours and From 70`F 1 27. 1 Ptivsicai Facility FC-6 .007 I to 41`Fl45°F Within 4 Hours.° i 28. ' 0isanous or To)6c Materials i FC-7 .008 i 3-561.14(B) Cooling PRFs Made From Ambient 129. Special Requirements i .003 ( Temperature Ingredients to 41'F145'F 130, 1 Giber ! Within 4 Hours* "Drnotes critical twat in the federal 1999 Food Coale or 105 0,11Z 590.000. tt CITY OF SALEM —Ale ((' (�,BO-,AARD OF HEALTH /� I 2 Establishment Name: �(/VI>°An �� OP h /�L4i\ Date: 62J(C Page: ._> of Item code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red Item Verified PLEASE PINT CLEARLY It r n indl `I1 �Im,k,?A- I� l LUCA r tne, all , n r�, �') f- - I Icy, � �� " �a— !..l01 t� jarkV'5' P f 1P�vt{ r. In �e �- • 111� � 11 `lrfY1� 1 D siD cussion With Person in Charge: Corrective Action Required: I ❑ No U-1 les I have read this report, have had the opportunity to ask questions and agree to correct all o 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. �b p ❑ Voluntary Disposal ❑ Other: i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled w Factors(items 1-22) (Cont.) 41°F145°F Within 4 Hours.* I PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFs I 14 1 1 Food or Calor Additives ( 119 PHF Hot and Cold Holding 1 3-202.12 Additives*' 3-501.16(B) Cold PIFs Maintained at or below 3-302.14 Protection from Unapproved Additives* I 590.004(F) 41'145°F* 3-501.16(A) Hot PRFs Maintained at or above f 115 Poisonous or Toxic Substances I 1400F. * 3 7-101.11 Identifying Information-Original Containers* 3-501.16(A) Roasts Held at of above 1300F. rs i -102.11 Common Name-Working Containers* I 120 Time as a Public Health Control 7 J 3-501.19 Time as a Public Health Control* 7 101.11 Separation-Storage 1 • Variance 7-202.11 .Restriction-Presence and Use* j �90.004(H) I I { 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE r 17-203.11 1 Toxic Containers-Prohibitions* I POPULATIONS(NSP) 7-204.11 1 Sanitizers.Criteria-Chemicals* ( ( 21 3-80L11{A} Uapasteurizest Pre-packaged Juices and 'r + 7-204.12 { Chemicals fru Washing Produce,Criteria' I 3 .Beverages with Warning Labels" 17-204.14 Drying Agents.Criteria* ' 8a1.11(E> Use of Pasteurized Eggs* I I 17-205.11 Incidental Food Contact,Lubricants* 1 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.i 1 Restricted Use Pesticides,Criteria* ( Raw Seed Sprouts Not Served 7-206.12 Rodent Bait Stations* I 7-206.13 I Tracking Powders,Pest Control and 13-801.i1(C) Unopened Food Package Not Re-served. " I Monitaring* ` CONSUMER ADVISORY l tion of 3-603.11 Consumer Advisory Posted for Consumption i TIME/TEMPERATURE EMPERATURE CONTROLS 22 p i Animal Foods Thai are Raw.Undercooked or f 16 Proper Cooidng Temperatures for _t PHFs Not Otherwise Processed W Eliminate tt Pathogens.'re"1/` "t i 401.11A(1)(2) Eggs- 155°F 15 Sec. 1 , 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs-Immediate Service 145 F15sec, 3-401.11(A)(2) Comminuted Fish.Mears&Game ( Eggs* 3 Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3.401.31(6)(1)(2) 1 Pork and Beef Roast-130°F 121 min* 590.009(A)-(D) Violations of Section 590.f�9(F,)-{T))in { 3-401.11(A)(2) Ratites,Injected Meats-155°F IS catering, food, Sec. , mobile f dtempovary and a 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be ' Stuffing Containing Fish,Meat, debited under the appropriate sections r Poultry or Ratites-165OF 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a { practices should be debited under#29- Mictowave 165°F* i Special Requirements. • 3-401.11(A)(1)(b) All Other PRFs- 145'F 15 sec. 17 Reheating for Hot Holding WOLA77ONS R:LATED TO GOOD RETAIL PRACTICES 3403A I(A)&(D) PHFs 165"F 15 see.* I (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relam to the Ti ce foodborne illness interventioar and risk factors listed above,can he 3-103.11(C) Commercially Processed RTE Food- found in the following sections or the Food Code and 105 CMR i 140°F* 590.000. 3-4U3.11(E) Remaining Unsliced Portions of Beef % Item ! Goad Retail Practices IFC 590.0w Roasts" 1 23. 1 Manaqement and Personnel FC-2 I .003 118 Proper Cooling of PHFs 1 124. i Food and Food Protection ! FC-3 l .004 125. 1 Equipment and Utensils FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 26. 1 Water.Plumbino and WasteFC-5 .006 y F 70°F Within 2 Hours and From 70`F ( 27. 1 Physical Facility FC-6 .007 to 41`Fl45°F Within 4 Hours. * t 128. 1 Poisonous or Toxic Materials FC-7 .008 } f 3-501.14(B) Cooling PHFs.Made From Ambient 129. Special Requirements 009 Temperature Ingredients to 41°F145°F 30. I Other ! i Within 4 Haws Denotes critical iwni in the ledaai 1999 Food CWe o'105 C4iR 390.000. 6 d { " 'li CITY OF SALEM ARD OF HEALTH —/ Establishment Name: 1 .�/�a ,2g Date: Page: of J Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No, Reference R-Red Hem Verified PLEASE PRINT CLEARLY I •► l a I eel alrbF h - Z/ 1 'd a. nrrs Al vv ZS U JI L � ,Ikln _ 'Avl cn tAL4D ct��J L "OtiY�lS. rry s A) N, fA_ V1--►/YnZrYM . I _ ,,,_ I vn.N � , n0 1`I _ i �Discussion With Person in Charge: I Corrective Action Required: I ❑ No I la/Yes II have a fetid this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance El Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. – ❑ Voluntary Disposal ❑ Other: ti k t 3-SUI,t4(C) PHFs Received at Temperatures L Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45°F Within 4 Hours.* ! ( 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS t 14 O Food or Color Additives ! 49 PHF Hot and Cold Holding 1 I I 3-501.16(13) Cold PHFs Maintained at or below 3-202.12 Additives* r 3-302.14 Protection from Un proved Addirives" 3-50 L 16( Hot P 'F* 15 Poisonous or Toxic Substances } 3-501.16(A) Hot PHFs Maintained at or above 7-101,1i IdentityingInformation-Original 140 . * 3-501.16(A) Roasts Held at or above, 130°F. Containers' j i 20 Time as a Public Health Control i 1-102.11 Common Nam-Working Containers* 1 7-101.11 Separation-Storage" E 3-501.19 Time as a Public Health Control' 7-202.11 .Restriction-Presence and Use" } 590.004(H) Variance Requiremeat � 7-:02.12 I Conditions of Use* ! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE t j 7-203.11 Toxic Containers-Prohibitions* j POPULATIONS(HSP) { 7-204.11 I Santtizers,Criteria-Chemicals* 21 3-801AI(A) Unpasteurized Pre-packaged Juices and 11 7-204.12 Chemicals fornt Washing Product,Criteria* I Beverages with Warning Labels* t� 7-204.14 Incide Agents,Criteria" 3-BOl.11(B? Use of Pasteurized Eggs* 7-205.11 Incidental Food PesticidtaLtes, ,Criteria* � � 3-801.11('D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* j Raw Seed Sprouts Not Served 7-206.12 [rodent Bait Stations* j 7-206.13 Tracking Powders, Pest Control and j 3-$Ol.tl(C) Unopened Food Package Not Re-served. MonitorinpT CONSUMER ADVISORY 4 71MEIFEMPERITURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of ( Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs { Not Otherwise Processed to Eliminate Pathogens.*e"° 3401.11A(1)(2) Eggs- 155`F 15 Sec. Eggs-Immediate Service 14501715sec" 3-302.13 I Pasteurized Eggs Substitute for Raw Shea) 3-I01.11(A)(2) Comminuted Fish.Meats&Game Eggs' Animals-155°F IS sec. * SPECIAL REQUIREMENTS r 3.401.11(11)(1)(2) Part:and Beef Roast-130°F 121 min* j 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590.409(A)-(D) Violations of Section 590.0(}9(A)-(D)in sec.* i catering,mobile food,temporart,and 3-401.1 t(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be '• Stuffing Containing Fish,Most, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne it mess 3.401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. } 17 'Reheating for Not Holding , VIOLA77ONS R_iLATED TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) PHFs 16S F 15 sec.* (Items 23-30) 3-303.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness inten�entians and risk factors listed above, can be i E 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR ` 1400"k 590.000. j 3-403.11(E) Remaining UnsiicedPortions ofBeef i Item 1 Good RetailPracttces I FC 590.00 j Roasts* 1 23. I Management and Personnel I FC-2 .003 18 Proper Cooling of PHFs j ! 24. : Food and Food Protection FC-3 .004 125. 1 Equipment and Utensils I FC-4 .005 3-501.14(A) Coaling Cooked PHFs from 140`F to 1 26. Water.Piumbinq and Waste i FC-5 .906 70°F Within 2 Hours and From 70"F ( 27. 1 Physical FaciuN FC-6 .007 to 41`Fl45'F Within 4 Hours. * 1 28. 1 Poisonous or To*Materials FC-7 .008 3-501.14(6) Cooling PHFs Made From Ambient 29. , Special Requirements ; .009 7 Temperature Ingredients to 410F/45'F 30' I Omer ! t Within 4 Hours* r . `Drnorra criiiCat ism in the Lderal 1999 Fual C<dc w 103 C'NR 590.000. , CITY OF SALEM BOARD OF HEALTH ✓J Establishment Name: r^N� Vt/,/� Date: it Page: of / lipl nem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified _ PLEASE PRINT CLEARLY I ezvv) t- f In �►mn,w ,l- r W[e t I I I I I I I I _ I Discussion With Person in Charge: Corrective Action Required: ❑ No es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I . ,t r I F 3-501,14(C) PHFs Received at Temperatures violations Related to Foodborne lines interventions ano Risk According to Caw Cooled to .� Factors(items 1-22) (Cont.) 41'Ft45`F Within Hours. PROTECTION FROM CHEMICALS 3-501,15 Cooling Methods for PHFs 114 I 1 Food or Color Additives 1 19 PHF Hot and Coid Holding I 3-501.16(13) Cold PIIFs lvlaintamed at or below 13-202.12 I Additives* 1 590.004(17) 41'!45"F* 1 3-302-14 Protection from Unapproved Additives' I 3-501.t6(A) Hot PHFs Maintained at or above 1 15 Poisonous or Toxic Substances 140 * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. .1 Containers* 120 Time as a Public Health Control 17-102.11 Common Name-Working Containers* 3-501.19 Time,as a Public Health Control* j 7-201.11 Separation-Storage* 590,004(H) Variance Requirement 7-202.11 -.Restriction-Presence and Use* 7-202.12 Conditions of Use'+ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE et 7-203.11 1 Toxic Containers-Prohibitions* J POPULATIONS(HSP) 7-204.11 I Sanitizers.Criteria-Chemicals* I 27 3-801.1]{A} UnpasfanrirzdPre-Packaged]uicesand a 7-2(14.12 ( Chemicals for Washing Produce,Criteria' 1 .Beverages with Warturu,Labels* * ( 7-204.14 Irving Agents.Criteria* j 3-801.11(13) Use of Pasteurized Eggs` I r 17-205-11 I Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and �& 7-206.11 ( RestriMed Use Pesticides,Criteria* 1 Raw Seed Sprouts Not Served.# 4 7-306.12 Rodent Bait Stat ons* 13-801.11(C) Unopened Food Package Not Re-served. " 1 i 7-206.13 ( Tracking Powders,Pest Control and Monitoring' CONSUMER ADVISORY :! TIME/TEMPERATURE EMPERATURE CONTROLS 22 3-601.11 Consumer Advisory Posted for Consumption of 16 ( Animal Foods That are Raw.Undercooked or Proper Cooking Temperatures for `y Not Otherwise Processed to Eliminate PHFs Pathogens.'ERera+e rn2w!r (} 3-401.11A(1)(2) Eggs- 155`F 15 Sec. r Eggs-immediate Service 145°Ft5sec* 3-342.13 EggsAPasteurized Eggs Substitute for Raw Shell s {S) 3-401.11(A)(2) Comminuted Fish.Meats&.Game 13g� Animals-155'F 15 sec. i. SPECIAL REQUIREMENTS j 13401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min" I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155cF 15 sec.* catering, mobile fbod,temporary and residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Staffed PRFs, `}} Stuffing containing Fish,bleat, debited under the appropriate sections ,L Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450* 590.009 violations relating to good retail 3-401.12 Raw Aminal Foods Cooked in a practices should be,debited under#29- Microwave 165F* Special Requirements. 3401AI(A)(1)(b) All Other PHFs- 145F 15 sec." j 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3433A I(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical aood non-critical violations, which do not relate to the 's Tom* fioitaorne illness interventions and risk factors listed above, can be 3-401.11(C) Commercially Processed RTE Food- found in the following sections of the Food Cade and 105 CMR 140°F* 590.000. 'f 3-403.11(E) Remaining Unsliced Pardons of Beef them '; Good Retail Practices i FC 590.000 i Roasts* i 23. 1 Managerrent and Personnel ' FC-2 .003 I a I 173Proper Cooling of PHFs i 24. 1 Food and Foci Protection 1 FC-3 .004 I SS 1 25. 1 Equipment and Utensils 1 FC-d .005 I 3-50LM(A) Cooling Cooked PHFs from 110`17 to 29. 1 Water.Piumbinq and Waste i FC-5 .006 70`17 Within 2 Hours and From 70`F 1 27._ Phvsica Facilin, FC-6 .007 1 to 41`F/45'F Within 4 Hours. * 1, 28 ; Poisonous or iosic Matenals FC-7 .008 _ 3-501.14(B) Cooling PHFs Made From Ambient 1 29. ( Special Requirements 30. i Other ! ,d Temperature Ingredients to 41017/45017 a Within 4 Hours* - Dmote critical umm in the£edc:.:t 1499 Focd Cade tw 1W C.MR 590.000, it s r- JL- Martins Training Center,LLC 22 Peabody Square Peabody,Ma 01%0(978)977-0717 This document serves as a Contractual agreement between Mohammad Alam from Salem House of Pizza and Grace Martins of Martins Training Center, (MTC)for the purpose of creating and implementing a plan of correction to address all of the cited violations from Salem Board of Health. The client Mohammad Alam from Salem House of Pizza agrees to work with Grace Martins/Martins Training Center who will provide training and assist in the implementation of best practices. To best provide assistance and meet staff needs, Grace will visit at different times during the 10 hours to observe all staff at different time frames. Martins Training Center expects co-operation with scheduling staff to attend the classes as needed.At the completion of services, a report will be sent to Mr. Ramdin with details of progress. Services will begin 9-26-12 through December 1, 2012 Signature: ✓%i/�2 /i �/ - Date: Signature: uOrmIlAlalb-'17 Date: i I` C04J Martins Training Center,LLC 22 Peabody Square Peabody,Ma 01960 (978)977-0717 September 25, 2012 Larry Ramdin 120 Washington Street Salem, Ma 01960 Dear Mr. Ramdin, As requested,I have visited the Salem House of Pizza and met with Mohammad Alam to discuss the results of the last inspection and violations. I have created a plan of correction and am submitting it for your review. I have assisted other restaurants with improvement plans and feel that I can help him correct the issues at hand. The BOH had requested a series of visits to the establishment. Based on their individual needs 1 am including the schedule and plan of action. in order to implement the above corrections, it is required full cooperation by owner/manager and his staff. Once completed, I will submit to you a complete report. The following is the proposed plan of topics to be addressed and dates of visits: Wednesday September 26,2012 3-4PM 1-Hour Week I Review violations and implement schedule to correct violations with owner. Create plan of correction and submit contract and plan of correction for approval Monday October 1,2012 4-5PM 1 -Hour Week 2 Complete food safety evaluation check list to determine staff's educational needs. Monday October 8,2012- 9-11 AM 2-Hours Week 3 Provide 2-hour basic food safety class to all staff Class includes: • Providing safe food • Food home illnesses and prevention • Specific foodbome pathogens and biological toxins • Contamination and food allergens • How food handlers can contaminate food • Personal hygiene program • Allergy training for staff • Observe staff during rush hour Monday October 15, 2012 5-6PM 1-Hour Week 4 Observing staff and create a master cleaning schedule Monday October 22, 11:30-12:30 1-Hour Week 5 Observe staff and create an Active managerial control approach Saturday November 3,2012 9:3010:30 1 Hour-Week 6 Observe staff, create policies and&review hiring practice, implement health and safety guidelines Tuesday November 13, 2012 7-8PM 1-Hour Week 7 Visit facility,have a taff meeting to educate on safety,policies and best practices. Saturday December 1, 2012 2-Hour Week 8 Final site visit review with manager the need for continued follow through with continuous improvement. Submit report and submit to BOH Please contact me should you feel that I need to add any further information to the plan of correction. Respectfully Submitted, "I' (If Grace Martins, RN Martins Training Center, LLC 22 Peabody Square Peabody,Ma 01960 978-977-0717 Martins Training Center,LLC 22 Peabody Square Peabody,Ma 01960 (978) 977-0717 September 26, 2012 Mohammad Alam Salem House of Pizza 3 Endicott Street Salem, MA 01970 Dear Mr Alam I have spoken with Lary Ramdin at the board of health and submitted a plan of correction to address the latest inspection results. Please plan your schedule to maximize the 10-Hour of consulting services. I will provide the following schedule to assist with implementation of the plan of correction. I look forward to assisting you in resolving this food safety and health issue. Wednesday September 26,2012 34PM 1-Hour Week 1 Review violations and implement schedule to correct violations with owner. Create plan of correction and submit contract and plan of correction for approval Monday October 1,2012 4-5PM 1 -Hour Week 2 Complete food safety evaluation check list to determine staffs educational needs. Monday October 8, 2012- 9-11 AM 2-Hours Week 3 Provide 2-hour basic food safety class to all staff Class includes: • Providing safe food • Food borne illnesses and prevention • Specific foodbome pathogens and biological toxins • Contamination and food allergens • How food handlers can contaminate food • Personal hygiene program • Allergy training for staff Monday October 15,2012 5-6PM 1-Hour Week 4 Observing staff and create a master cleaning schedule Monday October 22, 11:30-12:30 1-Hour Week 5 Observe staff and create an Active managerial control approach Saturday November 3, 2012 9:3010:30 1 Hour- Week 6 Observe staff,create policies and&review hiring practice implement health and safety guidelines Tuesday November 13, 2012 7-8PM 1-Hour Week 7 Visit facility, observe staff and have a Staff meeting to educate on safety,policies, Saturday December 1, 2012 2-Hour Week 8 Final site visit review with manager the need for continued follow through with continuous improvement. Submit report and submit to BOH Respectfully Submitted, OPGAG 14011 Grace Martins Martins Training Center, LLC 22 Peabody Square Peabody, Ma 01960 978-977-0717 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY , I I III I 1 I I I I I I � I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: k3-101.t4(C) PHFs Re(-ived at TemperaturesI Violations Related to Foodborne Ntnessinterrentions and Risk According to law Cooled to Factors(Nems 1-22) (Cont.) 41'F/45°F Within 4 Hours. 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS P{ 14 Food or Calor Additives19 PHF Not and Card Holding 3-501.16(B) Cold PHFs Maintained at or below 13-202.12 Additives*' { d 590.004(F) 4101450 Ft- 3-302.14 Protection from Unapproved Additives* ( 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1400F. �. 7-101.11 ldentif}ing Information-Original 3-501.16(A) Roasts Held at or above 130'F. " } Containers* { 20 Time as a Public Health Control I 7-102.11 Common Name-Working Containers* { { 3-501.14 Time as a Public Health Control* 7-201.11 Separation-Storage* { l { 7-202.11 .Restriction-Presence and Use* SM.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 Sterilizers.Criteria-Chemicals* { 21 3-801.l I(A) Unpasteurized Pre-packaged luices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria' 3-801,11(B) Use of Pasteurized Begs* { 7-205.i i Incidental Food Gmtact,Lubricants* j 3-801.11(D) Raw or Partially Cooked Animal Food and { 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprotns Not Served.* { 7-206.12 [rodent Bait Stations* j 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Cent"and Monitoring* - CONSUMER ADVISORY T►MEiTEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisor Pasted fur Consumption of I6 Proper Cooking Temperatures far Animal Foods That are Raw,Undercooked or Not Otherwise Processed to Eliminate PHFe Execawr+n2Vn1 3-401.1IA(1)(2) Eggs- 155F 15 Sec. PaO'� Eggs-immediate Service 145'FlSsec* I 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3.40L I HA)(2) Comminuted Fish.Meats&Game Eggs* Animals-155'F 15 sec.* SPECIAL REQUIREMENTS { 3.401AI(B)(1)(2) Pork and Beef Roast- 130OF 121 min* { 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 0�" (A)'(D) Violations of Section temporM,and in sec. * catering. mobile fotrd,tcrrtptxary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited ander the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.Ii(A)(1)(b) All Other PHFs-- 145'F 15 sec. i7 Reheating for Hot Holding VIOLA77ONS A=LATER TO GOOD RETAIL PRACTICES 3-103.11(A)&(D) PHFs 165°F IS sce.* (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations,which do nor relate to the Time* foodborne illness inrenentions and risk factors listed above, can be 3-403.11(C) Conmtercially Processed RTE Food- found in the following sections of the Food Code and 105 OUR 140°F* 590.000. 13403.11(E) Remaining Unsliced Pordons of Beef item ! Good Retail Practices FC 590.000 i R oats* 23. Management and Personnel I FC-2 .003 { 18 { Proper Cooling of PHFs 124. i Food and Food Protection ! FC-3 .004 i 125. d Eauipment and Utensils l FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 26, 1 Water.Plumbing and waste FC-5 .006 70°F Within 2 Hours and From 70'F ( 27. Physical Factl1v FC-6 .007 to 41`F/45'F Within 4 Hours.* 128. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Annbient 129- Special Requirements 009 I Temperature Ingredients to 41'F/45°F i 30' I Other i Within 4 Hours* 'Denotes c.-ideal twni in the Lden.ti 1999 Foal Cade ut 105 QMR 590.000. 3 3 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified PLEASE.PRINT CLEARLY I I 1 I I I I I I 1 I I Discussion With Person in Charge: Corrective Action Required: I ❑ No o Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne illness lnterrendons and Risk According to Law Cooled to Factors(learns 1-22) (Cant.) 41'045`17 Within 4 Hours.* 1 PROTECTION FROM CHEMICALS 3-501,15 Cooling Methods for PHFs 14 PHF Hot and Cold Holding 14 ( ( Foo!or Color Additives 3-50 L 16(B) Cold PLIFs Maintained at or below 3-202.12 i Additives*, 1 590.004(17) 41'/45'F* 3-302.14 Protection from UnaQproved Addiuves' ,-50l A6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances - 140 * 7-101.11 identifying Information-Original 501.16(A) Roasts Held at or above 130'F. Containers* 120 Time as a Public Health Control } 7-102.11 Common Name-Working Containers* } 7-201.11 Separation-Stor ae* 3-50IA9 Time&e a Public Health Control* 7-202.11 ,Restriction-Presence and Use* ( 5"W.004(H) Variance Requirement 7-02.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-203.11 Toxic Containers-Prohibitions* } POPULATIONS(HSP) 7-204.11 Sanuizers.Criteria-Chemicals* i 21 3-801.1)(A) Unpattcuri7ed Pte-packaged Iuices and 7-204,12 Chemicals for Washing Produce,Criteria* Beverages with Wartime Labels* 7-204.14 Drying Agents.Criteria* j 3-801A I(B) Use of Pasteurized Eggs* 7-205.11 incidental Food Contact.Lubricants* ( 3-801.11(D) Raw or Partially Cooked Aminal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Radom Bait Stations* i ( 3-801.11(C) Unopened Fuel Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring' CONSUMER ADVISORY T[MEt3 EMPERAi URE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or Not Otherwise Prot�essed to Eliminate PHFs Pathogens"cY'b""""•r�''I 3-401.11A(l)(2) Eggs- I55`'F 15 See. 3-30213 Pasteurized Eggs Substitute for Raw Shell Eggs-immediate Service 145'F15sec^ Eggs" 3.401.11(A)(2) Comminuted Fish.Meats&Game Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* 590.009(A)-(D) Violations of Section .590.009(A)-(D)in 3401.11(A)(2) Ratites,Injected Meats- 155`1715 sec.* catering, mobile food,temporary and 3401.1 t(A)(3) Poultry-,Wild Game,Stuffed Pfff%, residential kitchen operations should be Stuffing Containing Fish,bleat. debited under the appropriate sections Poultry or Ratites-165'1715 sec, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and Tisk factors. Other 145'F* 590.009 violations relating to goodretail 340LI2 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(i)(b) All Other PHFs-145'F 15 sec. Y7 Reheating for Hot Holding } VIOLA77ON3 R;LA TED TO GOOD RETAIL PRACTICES 3403.11(,".)&(D) PHFs 1657 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations, which do not,elate to the Time* foodborne illness intenentions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the foilowing sections of the Food G)de and 105 CMR 140017* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef I item Good Retali Practices 1 FC 590.000 Roasts* f '3 Management and Personnel '; FC-2 .003 - 18 Proper Cooling of PHFs i 24. Food and Food Protection I FC-3 .004 125. ! Equipment and Utensils 1 FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. ! :Nater.PlummRa and Waste FC-5 .006 70'F Within 2 Hours and From 70`F ! 27. 1 Physical Facility FC-6 .007 to 41`F/45'F Within 4 Hours. * i 28. ' Poisonous orTmc Materials FC-7 .008 3-501.14(B) Cooling PRFs Made From Ambient 1 29. I Special Reituirements .609 Temperature Ingredients to 41'17/45'1 30, 1 Other I Within 4 Hours* D,noteq caticat tvm in the f der.rl 1999 FocJ Cale ca 105 CMR 590A00. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Nem Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified - - - - PLEASE PRINT CLEARLY 1 I I � I I I I I I 1 I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I E3Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance LI 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 o Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Factors Related 1-2 to Foodborne Illness interventions 3-501.1440 PHFs Received at Temperatures ons and Risk Factors(Nems 1-;2) (Cont) According to Law Cooled to 41'Ff45 F F1"labia 4 Hours. ( 3-501.15 Cool re Methods for PHFs PROTECTION FROM CHEMICALSI ( 14 ( Food or Color Additives ( 19 PHF Hot and Cold ttclding ,r ., 3-5OLie,(B) Cold PRFs Maintained at or below 1 3-202.12 1 Addititees, ( 590.()WF) 41°1450 F* 3 3-302.14 ( Protection from Unavproved.Nddi rives* ( 3-50IA6(A) Hot PHFs Maintained at or above ( 15 + Poisonous or Toxic Substances 7-101.11 Identifying Information-Original 340°F. Containers* E 3-501,16(A) Roasts Held at or shove 1300F. 7-102.11, Common Name-Working Containers* 7-201.11 Separation 1 20 i({ Tithe as a Public Health Control F 3-301,19 Time as s Public Health Control' 1 f # ! 7-202,11 .Restriction-Presence and Case° 590.004(11) Variance Requirement ( 7-202.12 Conditions of Use* 7-203.1.1 'Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitize".Criteria-Chemicals* ( POPULATIONS(HSP) ' 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-861.11(A) Unpasteurized Pre-packaged Juices and Sevenaces with Warning labels* 1 7-205.1 Incidental ood Contam 1 3-901-II(B) Use of Pasteurized E � 7-205,11 Incidental Food Cuntatx,Lubricants* ( * 7-206,11 Restricted Use Pesticides;Criteria* ! 3-801-II(D) Raw or Partially Cooked Animal Food and 7-206.12 RGdent Bait Stations* 11 Raw Seed Stvuuts Not Served° ( 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unorened Food Package Not fie-served. ` Monitnring* CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'Mai are Raw.Undercooked or 16 Proper Cooking Temperatures far PHP$ Not otherwise Processed to Eliminate, 3.401,11.(1}t2} Eggs- iS5"F 15 Sec. SS pathogens*ePkI .,n.�af Eggs-immediate Service 145'Fl5sec^ { 3-302-13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Animals- 155*F 15 sec." 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* ( SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering, mobile food,temporary and 3-401 A t(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meal. debited tinder the appropriate sections Potltry or Rathes-165°F 15 see.* above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.€09 violations relating to good retail 3-401.12 Raw Animal Faxks Cooked in a practices should be debited under#29- Microwave 165T 4 Special Requirements, 3-401.11(A)(1)(b) All Other PUN-- 145'F 15 sec.* f ( 17 Reheating for Not Holding i VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(4;1&(D) PHFs 165°F 15 see. '* (Items 23-30) 3-401it(B) Microwave- 165`P 2 Minute Standing Critiral mid non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed abnrr,can be 3-01,11(C) Commercially Processed RTE Food- fnund in the following sections of the Food Code and 105 041? 140°F* 590.000. ( 3-403.11(L) Remaining Unsliced Portions of Beef ; Item i Good Retail Practices FC 540.000 23. Management and Personnel ! FC,-2 ,003 ( 18 Proper Cooling of PHFs j 24. ; Food and Food Protection I FC-3 .004 i # 25. i Eouiument and Utensils i FC-4 ,oa5 t 3-501,14(A) Cooling Cooked PHFs from 140`F to ' 28. 1 1Nater.Plumbum and waste FC-5 008 70'F ti6'ithitt 2 Hours and From 70°F 1 27. j Physical Facility FC-6 .607 to 41"F145'F Within d Hours. * i 28. I Poisonous or Toxic Materials ( FC-7 .008 { 3-50LI4(B) Cooling PHFs Made From Ambient i 29. Special Requirementsi ppy } Temperature ingtedients to 41'FAVIF 30• 1 Other 1 Within 4 Hours* - -Urraltcs znticai twat in the Edna; I Jv9 Fwxi Code ux 103 Cott.31+0.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1 1 P I Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ res I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P EI Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Saw Cooled to Factors(items 1-22) (Cont.) I 41'F145°F Within 4 Hours, PROTECTION FROM CHEMICALS 1 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holdinn 14 Food or Color Additives 3-50L16(B) Cold PRFs Maintamed at or below 13-202.12 Additives* 590.004(F) 41'145'F* 3-302.14 Protection from Unapproved Additives* } 13-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances i 1400F * 7-101.11 Identifying Information-Original ( ( 3-501.16(A) Roasts Heid at or above 130'F. Containers* , 2® Time as a Public Health Control 1 f 7-102,11 Common Name-Working Containers" 3-504.19 Time as a Public Health Control' 701.11 Separation Storage" 590.004(Hl Variance Requirement 7-202.11 Restriction-Presence and Use* 7-202.12 Conditions of Use* } REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203-11 'roue Containers-Prohibitions* � REQIREMPOPULATIONS(HSP) 7-204.11 Chemicals Criteria-Chemicals, 21 3-801.11(A) Unpasteurized Pre-packaged tuices and 7-204.12 Chemicals firr Washing Produce,Criteria* j Beverages with Wanting Labels* 0 7-204.14 Drying Agents.Criteria* 3-801.1 J(B) Use of Pasteurized Eggs* 7-205.11 incidental Food Contact.Lubricants* 3-801.11{D} Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Cnteria* Raw Seed Simms Not Served-Annual J 7-206.12 Rodent Bait tiers,, Pe , 3-801.11(C) Unopened Food Package Not Re-served. " 1 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMF1rEMPERATURE CONTROLS Animal 3-603.11 Consumer Advisory Posted fur Consumption of ! 16 Animal Foods That are Raw,Undercooked or Proper Cooking Temperatures for I Not Otherwise Processed to P.litninate 1 PHFs Pathogens.* 3-401.11A(1)(2) Eggs- 155`F 15 Sec. Eggs-Immediate Service 145'F15.we* 3-302.13 Pasteurized Egg Substitute for Raw SttcIl 3-401.11(A)(2) Comminuted Fish.Meats&Game Emyr Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) Pork and Beef Roast-130°F 121 min* ] 590 009(A)-(D) Violations of Section 590.009(A)-(D)in 3401.11(A)(2) Ratites,Injected Meats- 155cF 15 sec.* i catering, mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Staffed PRFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F" 590.009 violations relating to good retail 3-401.12 Raw Animal Foods;Cooked in a } practices should be debated under#29- Microwave 165'F* , Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145'F 15 sec.' 17 Reheating for Not Holding WOLAT70NS R-LATED TO GOOD RETAIL PRACTICES 34113.1 i(A)&(D) PHFs 165"F 15 sec.* (Items 23-30) 3-4W-11(B) Microwave- 16.5"F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed abuse, can be j 340111(C) Commercially Processed RTE Food- � found in the following sections of the Food Code and 105 CMR 140'F* 590.000. flim Good Retail Practices FC 59o.Wo 34ll3.i 1(£) Remaining Uns!iced Portions of Beef ' 23. i Nanagament and Personnel FC-2 .003 ' Roasts* 1 24. Food and Food Protection I FC-3 .004 + 18 Proper Cooling of PRFs 1 25 ( Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from I40°F to 26, 1 Water.Plumbino and Waste ! FC-5 .006 70'F Within 2 Hours and From 70`F 27. 1 Physical FadfltV FC-6 .007 to 4I`F1450F Within 4 Hours. * 1 28. ' Poisonous or Toxic hlatenals FC-7 .008 r 3-501.14(13) Cooling PHFs Made From Ambient I ?g. Special Requirements .009 Temperature Rngredients to 41'F145°F 30. i Other Within 4 Haars° 'D.nota,cdheal t:�m in eh::ferler�) 1999 rwA Cnde w i05 C;MR 390.000. 1 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 L` Date Tyoe of Operation(s) Type otlnsoectlon �- IG-1I Foodservice LJ-R-outine Address /: �p c� C y� ( Risk ❑ Retail ❑ Re-inspection M ( 7 Level ❑ Residential Kitchen Previous Inspection Telephone rr� � r 0 ❑ Mobile Date: vl �u � 4"4- (^�Q (� ❑ Tem ora Owner j/� � HACCP WIN Temporary ❑ Pre-operation ..1 nn nn/t¢� l V /)�Vt ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) n f r MDQ I Time 1❑ Bed& Breakfast El General Complaint In:10 � ElHACCP Inspector A � D � Out: Permit No. ❑Other Each violation checked requires an expfanatlon on the narrative page(s)and a citation of specific provisfon(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Chokings Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 59 M 0.009(E) M,-,590.009(F) action as determined by the Board of Health. FOOD PROTECTION_MANAGEMENT :1 °12. Prevention of Contamination from He nds ❑ Assigned/Knowled Knowledgeable/Duties i 13. Handwash Facilities I c�^ �[EMP_OYE HEALTH ce/_p }-$r � _ n 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 L FOOD FROM APPROVED SOURCE ' ' S ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures F ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑�,�' ` 18.Cooling PROTECTION . 111 ' FROM CONTAMINATION . ' t' Yll 19. Hot and Cold Holding J'�Df 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing [JREOUIREMENTS_FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)! v' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices ICONSUMER ADVISORY rnl ,�°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 i 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-9)(590.009) 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)(510.111) 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.50 �,..� ��pp /�''// �--ISS-) (rAr1A1 nA1), l ,Gt/M"a�� 04<i tj Inspector's Signature: i, �j /1 _ _ r<)O � Print:\A.1 PIC's Signature: lit: Pa e� of-_ Pa es /J..iJ. �i/�r/�7�-�'.� /i� /L9Il f-/f�/>7M y'{ L) �i'�M gg k „1 ,1ie +t lCOc� C)Y Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION Cross-contamination FOOD PROTECTION MANAGEMENT 8 3-302.11(A)(I) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(3) Demonstration of Knowledge* J Contamination from Raw Ingredients f 2-103.1 I 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 to charge to 3-302.11(A) I Food Protection* reyuirc reporting by food employee,and � 3-302. Washing Fruits and Vegetables applicants* j 304 590.003(F) Responsibility Of A Food Employee Or An l I ' tact with Equipment and (1 Fond Co* Utensils* Applicant To Report To The Person In ' I Contamination from the Consumer Charge* l 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 3-701.1 I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Focus* 4 Food and Water From Regulated Sources I ( 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* ( ( 4-501 111 Manual Warewashmg-Hot Water 3-201.12 I Food in a Hermetically Scaled Container' Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* ! 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 She11 Eggs* f Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized' 14-501.114 I Chemical Saratization-temp.,pH, 3-203.16 tee Made From Potable Drinking Water" concentration and hardness.'k I 5-101.11 Drinking Water frum an Approved System'" 14-601.1 I(A) Equipment Fond Contact Surfaces and 1 590.(A)6(A) Bottled Drinking Watery Utensils Clean' 4-602.11 590.006(B) Water Meets Standards in 310 CMR 22.0* ( Cleaning Frequency of Equipment Food- 590,006(B) Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Reereativnaily Ctmght Molluscan Foal Contact Surfaces of Equipment* Shellfish" 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Nfbshmoms Aoproved by I ( t0 Proper.Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 ShelWock Identification Pre,enl* 2-301 12 Cleaning Procedure* 590.004(C) Wild Mushrooms` ( 2-301.14 When to W'asb* 3-201.17 Game Animals* if Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.1 t I PHFs Received at Proper Temperatures* 12-'301.12 ( Discharges From the Eyes,Nose and 3-202.15 Package Integrity* I Mouth* 3-101.11 Food Safe and Unadulterated * ( ( 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records;Shellstock 12Prevention of Contamination from Hands 3-202.18 Shellstock Identification" 590.004(F) Preventing Contamination from 3-203r 12 Shellstock identification Maintained* Employees* Tags/Records:Fish Products 113 Handwash Facilities 3-402.11 Parasite Destruct iou' Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-1-04.11 Location and Placement* g I Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance 1HACCP PlansI Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Metbais* ' Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,,Availability 8-103.12 Conformance with Approved Procedures* ( 6-301.12 Hand Drying Provision Denies critical ucm in the federal 1999 Pond Code of 10 CMR 590.000. a n _ 9 n r� BOARD OF HEALTH Establishment Name:C, � Qo.n/v� �n.t.�-e, rJ-''E ,ltva&, Date: �—l�t it !/ Page: .� of Item Code C-Critical nem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference / R-Red Item GF PLEASE PRINT CLEARLY 'T(Yl't .X7 I Verified L n/ V� P.. . ;t �P VOSf� I M tda"V\ �,hl�) �� (UO I1>DnPit< `PIJf ` �___->I �/.c\• �_��+-4/�� N/� \V (r;,,A_ 1 .4r �' lA441 l ��`��J L JV ` \\�,��, NpY �C'>Yl (7 i rX`QVI JV0- IdYtAnC� W 1 A14A l.n �. � Y�P ` Q�Fe� -�X v!� � JS� � i %i/�5,� o>1� /I (� /it 0 Pn "FG(� , . 1,v'n`OF c I 1� l✓�] L / /'L'O 0,nAAO.f>(X..tn P � IC 4V a lz,�llrl� %lO/. u AV(4"' 6 1 ,('iIAAo- o. Q' N "c er,,,„ o ,,P�� )'\1, Q,46;�I6 �.! 1 61 1q, I &70>'Ik6-)�1��.h�L,_ . , ��.,.� 1109, A-,f'A' N 1400 G� _ 110° a-tIi I I 1)n14- e-0.'1 wiN W A li n7 cA \ L fmA lid."}',^._ N\i!/. •Y � �Q Pd - (8MM ("!EI �9�---�7I CSI �4-/ r Discussion With Person in Charge Corrective Action Required: ❑ No' ( Ces g _ , I 3V Voluntary Compliance ❑ Employee Restriction/ e ._s_n_ Exclusion t J � /,D(j ^ O �1 Re-/'ReScheduled ❑ Emergency Suspension Q ❑ Embargo ❑ Emergency Closure s F ❑ Voluntary Disposal ❑ Other FORM 7348 (REV. 7/2000) HOBBS &WARREN, - BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) Received at Temperatures Acco Factors(Red Items 1-22) (Cont.)Cont. According to Law Cooled to 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs I 14 I Food or Color Additives 19 PHF Hot and Cold Holding 1 3-202.12 Additives* 3-50L16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* I 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 120 Time as a Public Health Control 17-201.11 Separation-Storage* I 3-501.19 Time as a Public Health Control* 17-202.11 Restriction-Presence and Use* 590004(H) Variance Requirement 7-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* I 1 Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206 13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or { 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Execnre'1"200' 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 13-401.11(A)(2) Rattles,Injected Meats- 155°F 15 Sec.*I residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under J129- 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 I Reheating for Hot Holding I (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, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* I Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 124. Food and Food Protection FC-3 .004 IS I I Proper Cooling of PHFs ( 125. Equipment and Utensils FC-4 I .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 126. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(8) Cooling PHFs Made From Ambient 29. Special Requirements .009 I 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. CITY OF SALEM , (� BOARD OF HEALTH Establishment NameQ€ VAV\ ,&s2 , U4 z cL Date: l- t61 - 11 Page: 2) of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item I I Verified PLEASE PRINT CLEARLY „ AO (' AAO 04 P (7rr v] _a,"n rO I, 0_Voma,; L_ V )P�Y 0 0,A � ® ,�rl��,r o`r�—��r_o Q.�v�j-n ,f 1/ I r I.'/T�✓��,,(q�/��0 /S�, i/ J�Ir\l X' (/��/I) h /�6(n�11 /.7 4 I I v , /p i,t_O j 4,9 Ci\(`A (,1) we,� Irl r? I YY U I l ��-n..ln�4-1� f X*n, �' ,O/e�iv �FI Uo rr SS� O��n�/J L�'AA4i tWA �(\ ,14��o two_ I I - N � l / )4 1 -n !2P _,RAS yin,+ ��n_TI n,,A-fr,_tT�PrJI A�tn. ��.� ,�f �x�o� r,� y� �'. 61/A Y._ n_� sA/1 1V1iAL-1 t✓A !�_ t I AP (,Vol" �-�—fn_<� - I r/re/' lJ�,� 'r lnP \()/i ��v�n n�A/ I —_I Glof-I ' 01,12,2, - i,7) Q ��f1 a , (n� inn eil) C l ) roi, Q,.v -.D 1 Ann C�D/1 �OD -I`' d�� lJAn S1 U �^^j- v�o�in(�aJ ` l(� _ I , 0\ r)PAV'O ( JC r��n ,nn,�3 1 Y/A nn,\ \`rn ,I �JP �JQ� I1 ,lti/lcn;,ln0 (n, 6A JPA Discussion With Person in Charge: T Corrective Action Required: I ❑ No &r 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 toExclusion 0/'Re-inspection Scheduled ❑ Emergency Suspension J comply with all mandates of the Mass/Federal Food Code. I understand that r�IrrA�,,�,,��,,��,,,�� noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo"o "�— ❑ Emergency Closure your food permit. `n /j Ll Voluntary Disposal ❑ Other: C` 3-501.14(C) PRFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs PHF Hot and Cold Holding 14 O Food or Color Additives ! 29 �, 3-202.72 I Additives* 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 410/450 F* 3-302.14 I Protection from Unapproved Additives* � 1 15 Poisonous or Toxic Substances ( 3-501.16(A) Hot F. * Maintained at or above 7-101.11 Identifying Information-Original ]40'F. 3-501,16(A) Roosts;Held at or above 130°F. Containers* 7-102.11 ! Common Name-Working Containers* 20 Time as a Public HeaM Control ` 4 7 201.11 Separation-Storage* ( 3-501.19 Time as a Public Health Control" 11 ! 7-202.11 Restriction-Presence and Use* 590.004(11) Variance Requirement 7-202.12 ( Conditions of Use* ! 7-203.11 ( Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 ( Chemicals for Washing Produce,Criteria* 121 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria" ( 7-205.11 incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 13-801.11{D} Raw or Partially Cooked Animal Foodand 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served- 7-206.12 erved7-206.12 Rodent Bait Stations* !( I + 3-801.11(C) Unopened Food Package Not Re-served. Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for I Animal Foods That are Raw,Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. I Pathogens.*E"°'°'" ' Eggs-Immediate Service 1450F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs' Animals-155'F 15 sec. " SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(0(1)) Violations of Section 590.009(A)-(D)in sec.* catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHR, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165017 15 sec. * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to goal retail 3401.12I Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403AI(A)&(D) PHFs 165°F 15 sec.* I (Items 23-30) 3403.11(B) I Microwave- 165`F 2 Minute StandingCritical and non-critical violations,which do not relate to the I Time* foodborne illness inter entions and risk factors listed above,can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Cade and 105 CMR 140°F* 1 590.000. 3403.11(E) Remaining Unsliced Portions of Beef I I Item I Good Retail PractisFC_. $ 90.WD i Roasts4` 23. Management and Personnel FC-2 I .0703 i ! 18 Proper Cooling of PHFs 1 1 24. Fond and Foal Protection FC-3 .004 i 125. Equipment and Utensils FC-4 1 .005 ! 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 25. 1 Water.Piumbinq and Waste ( FC-5 .006 I 70'F Within 2 Homs and From 70°F 1 27. Physical Facility FC-8 .007 1 to 41°F/45'F Within 4 Hours. * 1 28. Poisonous or Toxic Materials FC-7 .008 1 3-501.14(B) Cooling PHFs Made From Ambient I 129. I Special Requirements 1 009 I. Temperature Ingredients to 41'F/45'F 130, 1 Other Within 4 Hours* s..nplenw.cM2dx 'Ihnotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 1 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'Floor Salem, MA 01970-3523 Tel. (978)741-1800 Fax(978) 745-0343 City/Town Of Ste,-*, Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Date Type ofOperation(s) Type of inspection 2,Z S �L��, )a�\� 1 (- n I -1 • 114 • 1'1-- I ElFood Service ❑Routine Address Risk ❑ Retail ❑ Re-inspection 2-AF L" SC Level ❑ Residential Kitchen Previous Inspection Telephone y� �1 \ ❑ Mobile Date: Owner HACCP YIN 11 Temporary ❑Pre-operation ►\ �N'Y qr,M to n LQr+ ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) z> Time ❑ Bed 8 Breakfast ElGeneral Complaint [I HACCP Inspector In. I err LinLW..t, p '1�- ta4�-*c.p-; n)rh I out: Permit No. ROt 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 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) E] Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health, FOOD PROTECTION MANAGEMENT r _ d - _ r ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH -- -- ❑ 13. Handwash Facilities E] 2. FRO 2. Reporting of Diseases by Food Employee and PIC M'CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded [114.Approved Food or Color Additives _ - - - ❑ 15. Toxic Chemicals FOOD�F-ROM APPROVED SOURCE _ ❑ 4. Food and Water from Approved Source TIMEITEMPERATURECONTROLS(Poie_ntt_aiyHaz_aidou_sFoods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance vnth Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION _ _ , _ - ❑19.Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ,REQUIREMENTS FOR HIGHLY3USCEPT dLi-POPULATION$(HSP).' El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP El11. Good Hygienic Practices CONSUMER ADVISORY _ ❑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. Noncritical (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-2X590.003) 24. Food and Food Protection (Fc-3X590.004) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4X590.005) 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-6X590 007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) 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 (1 DATE OF RE-INSPECTION: Inspector's SignatePrint: P[Cs Signature:A��GG`� /�� I Print: �OL1XIrillriXJ� Arn/1 Pagej_of-L Pages .�. v.R.J�•1„ti�.-r+.r J+'��\ ��\ � -'r..,P r •�-- .,)� N,Y � r "` i +. n - r. .. - _r�.r ��.. �• ., . t Violations Related to Foodborne Illness e Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S Cross-contamination 3-302.11(A)(1) I Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge" I I , Contamination from Raw ingredients 12-103.11 Person in charge-duties I 13-302.1 I(A)(2) I Raw Anima Foods Separated from Each Other" EMPLOYEE HEALTH I I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection* require reporting by foot3-302.15 I Washing Fruirs and Vegetables J applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Foal Employee Or An I I Utensils* Applicant To Report To The Person In I I Contamination from the Consumer Charge* 3-306.14(A)(B) I Returned Food and Reservice 0f Food* 590.003(0) Reporting by Person in Charge* Disposdion of Adulterated or Contaminated 13 590.0030 Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions I i;01.7 l Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fad* 4 I Food and Water From Regulated Sources ( 19 I Food Contact Surfaces 590.004tA-B) I Compliance with Food Law" 4-501.111 Manual Warewashing-Hot Water 3-201.12 I Food in a Hermetically Scaled Container* ( I Sanitization Temperatures*` 3-201.13 I Fluid Milk and Milk Products* I ( 4-50 1.1 12 I Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 E_gs mid Milk Products.Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* I concentration and hardness. 1 4-601,11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System' Utensils Clean* 590.006tA) Bottled Drinking Water' I ( 4-602.11 Cleaning Frequency of Equipment Food 590.006(B) Water Meets Standards in 310 CMR 22.0* I e 4 Y to l Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* J 4-702.11 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Rec eatiomdiy C'aup t Moliu;r<tn Shellfish* Food Concoct Surfaces of Equipment* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish fromSSF Listed I Chemical* Jounces* 10 I Game and Wild Adushrooms Approved by Proper,Adequate Handwashing I RequlatoryAuthority I 2-301.11 I Clean Condition-Hands and Arms* f 3-202.13 Shellshxk identification Presem" I 2-301.12 Cleaning Procedure* 1590.004(C) I Wild Mushrooms* I 2-301•14 When to Wash`" 13-201.17 I Game Animals'' I 111 ( Good Hygienic Practices 15 I I ReceivingfCondition I + 2-401.11 Eating,Drinking or Using Tobacco* f 13-202.1 t I PHFs Received at Proper Temtu perares* I ( 2-401.12 I Discharges From the Eyes,Nose and 13-202.15 I Package huegrity* I 0°th 3i0i.1 I Foci Safe and Unadulterated* I 13-301.12 Preventing Contamination When Tasting* 6 I 1 TogstRecords:ahel!stock I 112 Prevention of Contamination from Hands 13-202.18 Shellstock Identification* I 590.0(9(E) ( Preventing Contamination from 3-203.12 I Shellstock Identification Maintained* I Employees* TagslRecords,*Flsh Products I 113 I I Handwash Facilities Conveniently Located and Accessible 3-402.11 Parasite Destruction' I 3-402.12 Records. Creation and Retentiun* 5-203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients' 15-204.11 I Location and Placement* 1 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance 1HACCP PlansI I Supplied with Soap and Hand Drying 3-502.11 Sveciali7ed Processing Methods* Devices J 13-502.12Reduced oxygen 0 packaging,criteria* I 6-301.11 I Handwashing Cleanser,Availability I 18-103.!2 I Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision °Denotes critical nem in the federal 1999 Fmi Code or 105 CMR 590.0001 CITY OF SALEM BOARD OF HEALTH Establishment Name: SALL t+, P 1-7,'LAe Date: g- )4 - 12 Page: 7 of Z item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION D8te No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 7v� tz> ��r,ReT�iv6Ll'> 7\ S� z,Pm, �L\ � )C--,A I Zz^r2�u�t\ caR�a.� da S6�> uvl-� wlejl C,�e e�vuT�o ��o T\ate cV 100 Pd VVbt'k I'K' � _(_,1� t4, i7� ae• c7'i7 R�1 el�1y 4�16� tS \TAV.4,-C I ) � b,�� ,'L2,�.�Zi, os��Q-.►,_ �r �r �r:'ca� t,.-, . �� I.� , ., —toa��a�cF�� I ( iL\'b Moa�c> d� 1JrasA�T�_ I � I Sh.�ca ,'Q 6AE��cJ ,��\\.f1\] Gias-� tw a .-� S`t✓G'iV-,cr(c�n�h, l 3 . 'ls�\t '�1�<� \ Dis on With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r ❑ Voluntary Disposal ❑ Other: r 3.501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to law Cooled to Factors(items 1-22) (Cont.) 41°F'45°F Within 4 Horrs. PROTECTION FROM CHEMICALS -501.15 Cooling Methods for PHFs i 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(B) Cold PRFs Maintained at ar below 3-202.12Additives* i 594.004{F) 41°/45°F* 3-302.14 I Protection from Unapproved Additives* 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 1 l40`F 7-10111 Identifying Information-Original ( 3-501.16(A) Roasts Held at or above 130°F. Containers* 120 Time as a Public Health Control 7-102.11 Common Name-Working Containers* 3-501.19 Time as a Public Health Control* 7'_41.11 Separation-Storage" 7-202.11 .Restriction-Presence and Use* } 590.004(H) Variance Requirement 17-202.12 1 Conditions of Use* ! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-203-11 1 Toxic Containers-Prohibitions* 1 POPULATIONS(HSP) 17-204,11 Sanitizers.Criteria-Chemicals* ! i 1 � 21 13-801.11(A) Unpasteurized Pre-packaged latices and 17-2(g.12 Chemicals for Washing Produce,Criteria* Beverages with Wanting Labels* 1 7-204.14 Drying Agents.Criteria* 3-801.1I(B) Use of Pas 7-205.11 Incidental Food Contact,Lubricants* 1 1 tuld Eggs* le 1 3-801AI(D)1(D} Raw or Partially Cooked Animal Food and 1 7-206.11 Restricted Use Pesticides,Cntetia* Raw Seed Sprouts Not Served. * 1 7-206.12 Rodent Bait Stations* t} 1 3-801.11(C) Unopened Food Package Not Re-served. * 1 j 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TINiEt1 EMPER4TURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of t 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or Not Otherwise.Processed to Eliminate / PHFs Pathogens."� `'n, pr i 3-40LIIA(1)(2) Eggs- 155`F 15 Sec. i 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs-immediate Service 145°F15sec* 3-441.11(A)(2) Comminuted Fish.Meats&Game Egg Animals-155°F 15 sea* SPECIAL REQUIREMENTS 13401.11(B)(1)(2) Pork and Beef Roast-130°F121 min* 3-40I.11(A)(2) Ratites,Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in we * catering, mobile rood,temporary and t 3-401.11(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 3-401.11(C)(3) Whole-muscle,Intact Beef Steals interventions and risk factors. Other 145°F 9' 590.009 violations relating to good retail 3-401.12 Raw Animal Fords Cooked in a practices should be debited under#219- Microwave 165°F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.¢ 1 11 Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRAC77CES 3-443A I(A)&(D) PHFs 165°F 15 sec.* 1 (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations,which do not relate to the ( Tile* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CUR 1400P 590.400. 3-40311(E) Remaining Unsticed Portions of Beef _Item Goad Recall Practices ( FC 590.000 i t Roasts` l i 23. ! Ivlaneirement and Personnel ! FC-2 .003 i 1 i 24. 1 Food and Food Protection 1 FC-3 .004 1 18 Proper Cooling of PHFs 1 25. 1 Equipment and Utensils i FC-4 A05 1 3-541.14(A) Cooling Cooked PHFs from i40`F to ! 2, 1 Water.Plumbing and Waste ! FC-5 006 ! 70°F Within 2 Hours and From 70'F 1 27. I Physical Facility FC-6 .007 to 41`F/45°F Within 4 Hours. * 1 28. ' Poisonous or Towc Materials FC-7 .008 I 3-501.14(6) Cooling PHFs Made From Ambient 129. I Special Requirements .009 r Temperature ingredients to 41°F/45°F ! 30. 1 Other Within 4 Hours" "Antes critical twin in rhe federal 1999 Food Code or 105 CMR 90.000. r 6 � Commonwealth of Massachusetts i City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/28/2011 ESTABLISHMENT NAME: Salem House of Pizza File Number BHF-2004-000028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2012-0142 Jan 1,2012 Dec 31,2012 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember 31, 2012 Board of Health KK ! 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 BOF TH 1ZU 11�HINGT )ti SrREr-,T, 4:... FLOOR tt)Ft TEL. (978) 741-1800 KINIBF.RLEY DRISCOLL FAX(978) 745-0343 1�L11'Olt lramdin a.salem.cnm LARRY RAMDIN,IIS/Rlil IS,(.110,(P-hS H I A A xi I Ac kNT 204_ APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT S&ETM �h7uSe•-or= 22A +1_L# 979-771/y U ADDRESS OF ESTABLISHMENT 3 6ISG{t'Co ff ,;: I- FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME140 &t,4zm,4 D LAM n C a tt ''rget M TEL#--- Z LJ ADDRESS er- ._�, Pth- f ILt m C o,4do�+3' Cc,"-ft7gtA e. M A e 2 t. 1 . STREET �t CITY 1) STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) 41,4M CERTIFICATE#(S) 0 33 3 9 (Required in an establishment where potentially hazardous food is prepared) ? EMERGENCY RESPONSE PERSON GNBR AL1 -SL1 -f4fa fi HOME TEL#—III 7 ) ['DAYS OF OPERATION Morday,' ,1� Tuesday (.Wednesday., i-_-,Thursday'.--';i - . '.Friday'. Saturday Sunday I HOURS OF OPERATION !{ { ! Please wrde in time of day. ftr (Forexample llam•llpm) j TYPE OF ESTABLISHMENTFEE (check onlvl ('�� ) RETAIL STORE YES � less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 - ----------- - -------- RESTAURANT ES NO !e s L~ 25;vats =$140 (Outdoor Stationary Food Cart$210 25-99 seats = more than 99 seats =$420 - - BED/BREAKFAST!------------------YS------146 --------$1-0.0. ------ CHILDCARE SERVICES(NURS-NG HOME---------------•-------------------------------------------------- .--------------------------- ------------------------- 11 .-----------•----------- PERMITS MAKE(not just serve)ICE CREAM, YOGURTISOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFfT(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 and paid all state taxes required under the law. /- A/a� Atin nr00// )W9--" (L-11- 11 > Sr— {3 $13 ('� ` { 5 Signature Date Social Security or Federal Identification Number Updated 523/11 FOODAP201 Ladm Check#&Date CITY OF SALEM, MASSACHUSETTS 0 BOARD OF HEALTH KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR • MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDIN,RS/RENS,CHO,CP-FS LRAMDIN(0)SALEM COM HEALTH AGENT COMPLAINT INTAKE FORM Date: Time: n M Received By: Complaint Number: 0070 Complainant YVNA\iaSIS OF h( Ch. Address: Phone: Lv%,n\jtiS � P�1,o•► • l I��f�-� IS i oc� raffia �Lacl\ h�i... o��=,R - �''u� S\'�� ►�d�1,1L Investigated By: Date: C Property Owner/Occupant Name S)W--fL S`}6�1� Telephone#: -Ss?oXe' -it) IDultA-. - S)-1 7L 5V)tn\� ti2e.wV--h\ .\D\V,�A d-A i vzy' \ Sl1F, ?ntL )OkA �a�,�-�\,3• �-��'o c�C.�Qh��.6J o C��o-� 5��. T''r<x�t� a's�� Sk C br111 Pvr k,,,,- 1C-�G ERR Wr S\ x"x Cz1) 4--3 -Z-Nv-p \\\ cry 1 c l 1 (2� U@e-t--'� )7� • 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: 01/06/2011 ESTABLISHMENT NAME: Salem House of Pizza File Number:BHF-2004-000028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0205 Jan 1,2011 Dec 31,2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health t This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 :t I • CITY OF SALEM, MASSACHUSETTS / BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIN[BERLEY DRISCOLL FAX(978) 745-0343 MAYOR UG1213HNRAUPoI(n_SNLAi.COM DAVID GREENBAUAI,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTS fAl- 4 M LIoL4V— l- PI''vvc, TEL# 173-71111 - 3, 7 ADDRESS OF ESTABLISHMENT 7- 3 Fn d l'"ff- C-R" FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAMES 6NAA1114-gQ FILAM, -r s 2 s#tel TEL# 7, ' 9)�- 7- 7 7 ADDRESS 9 GU (Z✓!� S� 1-3 (� M P 6 Z 0(() STREET CITY STATE GZIP q CERTIFIED FOOD MANAGER'S NAME(S)_Zdp"Ine-1 i;�.P CERTIFICATE#(S) 0 3 33 l (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON Si/t A HOME TEL# (7 C-76-1 -7 7 1'.DAYSOF-OPERATION.1.,- ( ; ..Monday' I ,' Tuesday.i;:'Ai aWednesday,., 1;::cThursday:;` „- :="F.riday ;:-:is i 'Saturday Sunday' HOURS OF OPERATIONw- - i7.(Ari#Joti—IicA y,— _lsu�4N �" �r ; Please write in time of day. y�-Z III °, ,,,' tl 1v (Ay" 1L 1y� (For example l lam-11pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ONO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - --------------------------------- RESTAUFtANT ES NO less than 25 seats =$140 (Outdoor Stat oI Ary rVJd Cal 412101 25-90 sc..' =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSINGHOME------- ............................................ ................ ......................................................... ADDITIONPERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number Revised 10/7/11 FOODAP201 l.adm Check#&Date $ ry_,. r A Y '11 Sal Massachusetts Department of Public Health 120 W soarsashington of SSHealth 120 Wtreet,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name c n / Dat Tyge of Ooeration(s) Tyoe of Insoection 1 \\_r ' Food Service El Routine Address �� h ( 1 ( n OJ Risk LI Retail ip Re-inspection Level ElResidential Kitchen previous Inspection Telephone zL ❑ Mobile Dat¢: 1 Owner HACCP YIN ❑ Temporary ❑ Pre-operalion))r AtIrl j 1, -� f,, 1 ❑ Caterer ElSuspect Illness Person in Charge(PIC) � ° Time ❑ Bed&Breakfast ❑General Complaint InZ 7,� ❑ HACCP Inspector T nth Vo rill/ I Out Permit No. ❑Other Each violation checked-0,equlres 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 El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ' _ - El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source - 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 '"'- " - " ❑ 19• Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations �4. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: `� Print: PIC's Signature: \---y/ Print: S�,/�-�� rl�i��(� 1 Page o&Pages 17 r '1 Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1 590.003(A) Assignment of Responsibility* ( 3-302.11(A)(1) Raw Ammal Foods Separated from 590.003(B) Demonstration of Knowledge* _ Cooked and RTE Fads* 2-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302.1 i(A)(2) Raw Annual Fads Separated from Each EMPLOvEE HEALTH Other* 2 590.003(0) Responsibility cif the person in charge to I Contamination from the Environment require roporting by fad employees and 13-302.11(A) Food Protection" I applicants"` ( 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fad Employee Or An 1 ( 3 304.11 Fad Contact with Equipment and Applicant To Reprn:To The Person In I Utensils* Charge' ( Contamination from the Consumer 590 003(G) Reporting by Person in Charge 13-306.13(A)(8) Returned Food and Reservice of Food" I3 590.003(D) Exclusions and Restrictions* j I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces I 590.004(A-B) Compliance with Foal Laws 14-J(Il I I I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* 3-201,13 Fluid Milk and Milk Pr duct%* ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.11 I Eggs and Mill.Products.Pasteurized'" I ( 4-501.114I Chemical S.mitizattion-temp.,pH, i ! concentration and hardness. " i 3-202.16 Ice Nude From Potable Drinking Water* ! 5-101.11 i Drinking Water from an Approved System' 14-601 11(A) Equipment Food Contact Surfaces.md Utensils Clean" 1590.006(A) Bottled Drinking Water' i 590006(l B) Water Meets Standards in 310 CMR 22.0* ( 4-602.1 i Cleaning Frequency of Equipment Food- Contact and Fish From an Approved Soiree ) Contact Surfaces and Utensils'" 702.11 Frequency of Sanitization of Utensils and -20 i.14 Fish and Recreationally Caught Molluscan ! T Frvd Contact Surfaces of Equipment* Shellfish" I s-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed SChemical* Sources* Game and Wild Mushrooms Approved by ( 10 I 230111 ClProper,Adequate Handwashing - - . ean Condition-Hands and Arens* _ Regulatory Authority ( 3-203.15 Shellstoxk Identification Present* ( 2-301.i 2 Cleaning Procedure* I 590.0aVC) Wild Mushrooms* 1301.14 ( When to Wash' 3-201.17' Game Animals' ( 111 I Good Hygienic Practices i g I Receiving/Condition 12-401.1I Eatin_ Diinkin„(it UsingTobacco" 3-202.11 ( PHFs Received at Proper Temperatures* f 2401.12 I Discharges From the Eyes, Nose and I Mouth' 3-202.1Package Integrity* I 3-301,12 ( Preventin 11 Contamination When Tastin ' 3-101.111 Food Safe and Unadulterated* ( ' 6 l Tags/Records:Sheilstock I 12 l Prevention of Contamination from Hands 3-202.18 Shellstok tdenuficaoon* I 590.004(F,) Preventing Contamination from 3-203.12 Shellstoc):Identification Maintained" Employees* 13 Handwash Facilities TagslRecords:Fish Products I 1 13-402.11 Parasite Destruction* I Conveniently Located and Accessible 3402.12 Records.Creation and Retention* 15-203.11 ( Numbers and Capacities* 5)0'00- J) Labeling of Ingredients* 15-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and-Maintenance ( /HACCP Plans I Supplied with Soap and Hand Dry;bg 3-502.11 Specialized Processing Methods, I Devices 3-502.12 Reduced oxygen packaging,criteria* 16-301.11 Handwashing Cleanser,Availability 5-103.12 Conformance with Approved Procedures'' ( I 6-301.12 Hand Drying Provision Denotes critical nem in the feilerat 1999 Fad Code ui 105 CSiR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: �_�-IPLA In. �� o� //2�� Date: il� lJc)/c�,U Page: C51 or,4- i Item Code C-Critical ItemVete I r DESCRIPTION OF VIOLATION/PLAN OF CORRECTION No. Reference R-Red ttem , Verified ' PLEASE PRINT CLEARLY s 1 " Cu�a ,nc -I) Al inn is JI S Sall A1 .0 J9 C) ( (0Cl/I ✓�J l�(P�i�rz h✓, i �- (I I n,,ffl�pd L O I YK f2�,e4 rn�I✓ kr r1/1 i7( / n "I -� J� rL' -�yP2v��.-C .P c f�-17�r s�.vrr��1 - V Imo` .VA r-1�_<,_AC � w• 4-P, f�C In P _ n K1. r T A e 7C� S") CS/n�ti c / l/ACS r n/✓ G k Q l C , t <' I xk L, A,& is " 1 .t- rccPt v-e J c, I k, "r�v_ 4 U ` I I i c _ I I I I . I 1 I 1 j r 1 C I � .- Discussion With Person in Charge: Corrective Action Required: I ❑ No I q� 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. ❑ Voluntary Disposal ❑ other: Vlatittions,Related to Foodborriv illness tnrarvenrrpns and Risk to I,ii,, ClItited i.i Factors latents 1-22.i IlCoot) F 1A':IIaT1 J mittu". \IrLhctl,TcT PROTECTION FROM CHEMICALS PHF Hot and Cato Hoidinq 14 Food or Color Additives 3501.16'BCo)d PIIFt zMiyaomedet ar beltnv 3-202,12 AddifiI,,l,' 5')o ot�U(F :Qs:.41I:- pf"wmon front thialInvy"rd A'Wffi'xSv Pill 1,111 q "Iaiva�iw'd al 0i AIm 15 Poisonous or Toxic Substances Rl�i,ltE Held ai vrifIcIc 130't�' Cf atainers' i 20 Time as i Public HoaRn Control '7 ;02.I I Common Nance - Workii,-('owaimo," af,a rablic I lealrb(:viaikjl 7 201.1' S'-I);.i.!tion-sme-'Fc" 7-'o2 it kv"6'wvI - pm�-"�X'uld Uatw 1eqaoeweat colonam"(It Use, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) sw I ltm Vnp�"Ieia;zzil 12 CII,.lmi'Ak for kNa�holv Vrodncv�C61e61 i - I W.irl'inL 7204.1$ DryinIf Criw!6 Nit I I I(Ti) I -I P,,temiz,-d EcI,0 110 1 }111'}a F vj,,r TI,Ititaih Anoint Fx,,d tild 7-200.11 k,ni1nI,t,%J1 Use Vr�fi6,IeF Criteftl' R.Iv' St ,,I Sprota,I Noy.s-nved' 7-X06.12 R(Xicnl Blit sutuoka' I 21)6 13 'Irac'xinf;Pwderi.P`„(intro iii,d CONSUMER ADVISORY 22 3 4,03 11 \tt,i,ory flo;i-d!,it Com7timpti,m ti TIMEITEMPERATURE CONTROLS I� 16 tImper Cooking Temperatures far t-,xxl� Mai:jrt! !6w, Ondeic,,okvil Flimotwe PHFs 3 401 11 A!, Fm,- '5i'F 15'5,:t', I,; Fe fo! kAw Shell E.m"- cora-minw., -d hzzlit, & Aiiiamls- i 9;'F 15 s-to. - -SPECIAL REOUIREMENTS 3-201.11($'11_1)12) Poil, and Beef Po�im - '110 1-' 12 i min- Vidw;on,ci Section it, "-4flE I I(A)0) fiat,e,,, joiwn--Iii 1'45 F IS I -iib!ring. mobil,,�. lo,,d. maporw aid 3 401 HiA,0) I Poit4f),WiN Gaivic, StuCfe-'VJ-IF,1 t!ei'Ilvd alldet tile 1 11:1111try' f#fw kam��-165 F 1��,�c. �' I ANnle if rolowd to 3-40I.I1tCi(3: 'Ahole viwdv, Itrio Uei 1%St,,ns ititc!semtm,z eid isl, fuctor.N Oil,m 540.009 rqol:'iiullq rofakina to -axyj ref'01 I"m An"Im!Foigls C"oAcil In it taeticf,N ic rictiied uodzt #29 - i-4 "" 10-5'F , I Spicial R"quireni'lllu s-401 lItAitiO,) Ali Otbm NWi , 145'F 15,vc 17 Reheating for Hot Holding VIOLATJONS RELATED TO GOOD RErAlL PRACTICES 3-403.!IfA)IW1 16i"F 15�:c( {Items 2"-30) 3.403.1 If B�i 165 V2 Wiwi-Staub I ag Ctitf:'Iii111i'l ll"nqri:;fol viOlislw?Cl' '0,1Ihdo lim 71le ['into, finojborrx;!In. n6wv'aza f',k)ifCfw:I hIl"d iIbl•llll' "M b" 1-403.11{C•) I Cnram,rmlly Ne�es;,ed PIF t`,kiil- 14,10;d-,'If:12: Cod',"1:0 joi 0IR 342 3 I I"E) Rcmamiwll Uaslwed Povio"of 11�'dme.'" FC 5goofao 1 23 Mcmacement and Pemr1r,np1_ ]-FC- 1 OM M FC--3 004 18 Propat Cooling Of PHFS �4, Fooif-,,�,)Fad -4 4 )it' i-501A ICA) COCIIHIZ f:fK&'d MR I'M 140'F to f G, ',NfIti P',:n,biro And VVa:lie PC-5 (Kit 70'3• Within 2 1 loury and From'17•1, i 27 Ph'^1eaJ Paol:tl' FC-'t) OW How- I—e. 0f3CI,)1j' PC--7W 0M., Ciohxw PHR,Mede Fmiq Aal:biew 174 0014 fivredinte It.410F.Mi'F ITN h"'d 105 0'1!; I Massachusetts Department_ of Public Health Salem Board of Health Division of Food and Drugs °° 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date' Type of Ooerationfsl Type of Insoection do uA I /ojJ o c_ . Z2.g- Iv�i�JJ/ ❑ Food Service ❑ Routine AddressA 2 ( ]r� 0� Risk E] Retail ElRe-inspection n Level El Residential Kitchen Previous Inspection Telephone _ � ❑ Mobile Date I`�Q Owner HACCP YM ❑ ElPre-dp�eTemporary r'ation VA.,]KcrAur, J J ''-- ( ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint � ) In:d [-] HACCP Inspector ` 0.� K4r t� Out:4 Permit No. E)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 v [113. 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 � - _ _ 5.Toxic Chemicals FOOD FROM APPROVED SOURCE - ❑ 4. Food and Water from Approved Source TIMENEMPERATURE 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 0 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)',' El21. Food and Food Preparation for HSP E1,1 0. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices ;'CONSUMER ADVISORY ' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions I immediately or 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. today, 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:�C� C U a 0j s svoinspemPo.ms�a a« ,I Inspector's Signature: °�• � Print: /), I /� I'PIC's Signature: gwjU Print: �`{� i} vCr�/./'� J` I Page ot�TF'�Pages .yY ' Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S Cross-contamination I - I 1 590.003(A) Assignment of Responsibility* 3-302A l(A)(1) Raw Ammal Foods Separated from no 590 003(B) Demonstration of Kwledget` I Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw ingredients 3-302.11(A)(2) Raw An'anal Foods Separated from Each EMPLOYEE HEALTH I Other- 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require reporting by food employees and ( 3-302.1 t(A) Food Protection* anplieant:;* 1 3 302.15 Washing,Fruits and Vegetables 590,003(F) Responsibility Of A Foxl Employee Or An 3-304.1 i Food Contact with Equipment and Applicant To Report To The Prrsun In Utensils* Charge* ( Contamination from the Consumer 590.003(0) Reporting by Person in Chute* I ( 3-306.14(A)CB) Returned Food and Reservice of Food` 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated orContam.hated 590.003(E) Removal of Exclusions and Restrictions i ( Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 ! I Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501 1 i f Manual Warcwashing-Hot Water 201.12 Fuc,d in a Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewastnnr Ant Water Sanitization Temperatures" 3-202 14 Eggs and Milk Products.Pasteurized*1 3-202.13 Shell and I ( 4-Sq l.t l d I Chemical Sanitization-temp.,pH,i concentration and hat di 'k 3-202.t6 Ice Made From Potable Drinking Water* 14-601.11(.4) Equipment Food Contact Surfaces and 5-101 11 Drinking Water from an Approved System' Utensils Clean* 590.006(A) Bottled Drinking Water* 1 1-002.11 Cleaning Frequency of Equipment Food- 590 006(B) Water Meets Standards in 310 CMR 22.0"' i Contact Surfaces and Utensils* Shefifish and Fish From an Approved Source I f 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Moiluscan - Foal Contact Surfaces of Egmpment* SheiliishT 4-703.1 I I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ( 10 I Proper,Adequate Handwashing I Game and Wilt Mushrooms Approved by Regulatory Authority '2.301.11 Cteau Condition-Hands and Arms* 3-202.18 Shellsttmk Identification Present k ( 2-301 12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301 14 When to Wash* 3-20.i.17 Gamc Animals* ( 111 Good Hygienic Practices 5 ReceivingfCondition i 2-401.11 hating,Drinkin€or Using Tobacco* 3-202.11 ( PHFs Received at Proper Temperatures* 12-401.12I Discharges From the Eyes, Nose and 3-202.15 I Package integrity ( Month* 3-101.11 I Fund Safe and Unadulterated* i 13-301.12 I Preventing Contamination When fasting* 6 Tags/Records:Sheilstock I ( 12 Prevention of Contamination from Hands 3-202.18 1 Shellstock Identification * I )9o.uu4(E) Preventing Contamination from 3-203.12Shellstoek Identification Maintained'" Employees"' I 13 Handwash Facilities Tags/Records:Fish Products I i I 3-402.11 Parasite Destruction` I I Conveniently Located and Accessible 1 i 3-402.12 Records.Creation and Retention` � 5-7.03.11 Numbers and Capacities* 590,00.1.(1) Labeling of Ingredients' 5-204.11 f peation and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and:Maintenance I /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ( Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 16-307.12 Hand Drying Provision 'Denotes critical item in the Weia] 1999 Foal Coie of 103 CMR 540.000. IL S x' CITY OF SALEM BOARD OF HEALTH / Establishment Name: `J� �x M 1�.� �.� ,�� , Date: jo a Page: of Item Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dere No. Reference R-Red Item . . Verified " i .-.� � �' ` , � � � PLEASE PRINT CI ena,v � � .. �Kofh, .SG • IAS , — NJlA il/— nn. d C J' i 1 14 IrS�J ('Q„✓ -L�^(��/n/1 /lM man- [il-.r.__�(_ �1-�rp� r-.� c�1 r((.1- r1 f/n /'(n.,.__/ i.�n��/g- c^ / it-V_J P1 _r_v1 :.fi (� In Cl_ I�'C'��,/p / li+_ `C, - •' ✓ % n � ,j I a rqC rf`C� �Ia.��l�/. ,f'1 /i r\,� Cly j N / l 1 G. �i..-((nn�� .Mt•.1 .) .. ,� ra,•xyr I r �i.a'. /4 c Discussion With Person in Charge: Corrective Action Required: I ❑ 'Nom ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restrict on/ ' violations before the next inspection, to observe all conditions as described, and to � � Exclusion ( p d�(Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I understand that �� \ E noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Violations Related to Fordborm-fihne.,5s Interventions and Risk A,,,ozdj z,,,tc•:au (2(xavd .q Fncrors(iffains I-ZZ lCoat,) WF/4,s�[- kV.1biI1-1H,tLWS I I M,qht�j� t,Ir PROTECTION FPOtA CHEMICALS it—67 FHF Hot and Goid Holding 14 Food or Color Additives 50'Aft(fi; rold PHFNbirit,iood at r bJ:n, �140 1'14 F' 3 302,14 htwo:mt fmiv) i fnapprwal Addiuv,,s lf,�A i I I I llli!�� poisonous or Toxic Subs'Unces 140 1% WL Omijn;d Ro,,sLs H'Ad aior ahoe i 30"F, 10-1 It 1 20 Time as a public Health coattol — Tt>z T:B;,�d�,a "unit,}1::;1h contro:,S�pw:tuon- Rc-,trioitln -protimce,u3d Coldilloll.of i" REQUIREMENTS FOR WGHLY SUSCEPTIBLE o'l 11 Twi,,Cowajn�k, - P,0W)z::otk0 POPULATI LISPL 1 1-204.11 N,n]67,1 ",meri" - cbevl:cnfq" ONS --F`,`,—,$)P'-:Imeur,y,,tt Fre-1,ao ji�, jul,",I so, 7 104 14 Dr,vi2 Atatits Cnwmi' pit,teu6zed .0,11113, 7-,orl,i t hxidtni,d F,%xl 1.0n.ftw,' U�v lle,iicideF,critet in P,itilik Amoral efId Rim Sr,6 �proal-, v,: 7-;:7-,-,06.12 R(K�ew 13��q St�kuoyl, cjl,p�;wd [%�ql No 2W 6 i3 'I rllzi,�is iI po�%dvz�, P�-m( owrO at�d CONSUMFFI ADVISORY TWEfTEMPIERATURE CONTROLS Aitm, cx! 1 F, - ;'� Izc jt� ftjw, 16 proper Cooking Tempm states fm PHFS 3,101 W,(11: i S5,F 15 3 ;0". 1'tIe�Sum",kov fo) Raw Shel,1111wdiatc Ser-:ice 1- 5 1-1 !-40LII(A)(2j A.IIwoq- 1�5 1; 1`sm, Polk and ku'-st - 1110SPECIAL REOUIREMENTS -l' I'l fl)l0 fi:ieoctii 1.�4 1, 1 it; Ing, mAiNd" is ielvOrav ,111d Vou)tr, Wild Caine', SwiTed ;ijvr4ti(7219 110tfld IX Cout wl�ng Fwl, ar"j."; flh *.21)!)It-rMiite w,,:uow V 0 ,C. , r;,!wt,4i kol',KAhom, idiTsIt InvIcz W.If iirah. iuti.7)entiolf,i and isr4ctor.,,- Oder 14501: it)7,Ck)d rk:jitjl 4 10 1,12 R;Ix,?nlfruti m a 6c dcbtc)O wid-f Sp--tml lk,W Ali Chho Pill 14 i'F I'II ec 1 17 Aeonating to? lint Holding VIOLATIONS REI,ATEV TO GOOD RETAIL PRACTICES 3 4,03A IIAI&u)i PRIF; I.,Iri) 0". Microwayt. I -403JJW) CommIvlail-v pfw,:Sc,-J FTE F,wxt 01? Food Cild"wid P0 ,403,1 I(Fr RZ-mamin", un�iwed poftiom�of lik^111 :tem G od Retail practict;sS i F:C 90,000 Proper Cooling of PHFG I rC 1 Gr14 501 14(A) CcA)Iwil PKFr ;oml 14),T)o F;-4 0,1' FG -5 0(6 rf;wilbi n 2 1 latjf;i,nd From 7;I'1 27 1 501.:4{U, CtxilinL,FHF,Mita: Ffoui AlDb!'kil ION 11 utxv,-, i"Ifs, k-: jo� CITY OF SALEM ` BOARD OF HEALTH / J Establishment Name: �A(a +A 44.")JV fl— ✓12Z/-L Date: 6D I�/ v Page: of Item Code -.; C-Critical Item;, DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R=Red Item - - Verified - ` f( �{Ir PLEASE PRINT CLEARLY [ ,7 4•� '�J,) . 2 / �, r-(v A 11'1` f .Y l(s r-✓] V. ).P� rnJ N n v c1 �� C�o�n,n/ _ !`�o-P�i� -4- -�v ,c� �,R,e�,. ��o - AA �G1,,., -1� 7odca.-)vrs , a2d r )QG 1,iC_ N�,�� . [� LAnn�A 1 §L1 <� In in-1 I d• �ro (JI-n, r� As I01 ct ��ril� �� s,.. "A/oue 1 n1\ se-evi rk" ev h . _ - 1 �1 i'o,S3I.W;i n')kod in SnA�I �,ru�o dl Vocl � r) ciV�. ✓.orrl �.tfl _,'A, 1 r� `��.�CQ fl��l v/i✓ �ll_�O 0 d S� �O _t !/0!U` Jvh�j t�riit PN -4- r/J./7 ��7.oN_ •� 7i�� / ( AO. Z ( Fr�rQii Jn14I -)v7 n VA .,r ->_ e) r klkn .41 a ,ark-4,Z)A IM 11/ae M f 11 Discussion With Person in Charge: Corrective Action Required: I ❑ No Ib541 Yes Z 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 ❑ e-inspection Scheduled ❑ Emergency Suspension '4 -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. ; ,IA ❑ Voluntary Disposal LJ Other: r r v ! 1 Violations Refined to Foodborne 111nos5 lMerventlnns and Risk to Um Cw;,�J Z,2 Fitclorit(Itchts 1-22) (Cont.} i-14,15-17 tVidii,t I Hv s M,fho& r M-11", PROTECTION FROM CHEMICALS ty, PIAF Hot and Gold Holding Food or Color Arldifivet Coh'plll-.a'clam!'jif-d tif or tIrli,w 011 12 ., ! -1,)k,ixt.i lI- al',(.} nFA i 102 14 PfulcUMIJ from I IN At Not Pli!�,Ntalln�lw�d at or aL',-Ivv is i Poisonous or Toxic Substances FAI,L�14,C:tj it ty 1 ;NA� Cont uner,<° i I Ttme as a Public Health Cowintin 7-�t77 77 sio?agi:` and U,e' 7 202.!2 17:0111711iNn'Of lj.ilt' REGOREMENIS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) _ 04 ! dai sO(.tart:? L1;,I.11cfm ,ed Prc-pnd::qzcd 3on.rs Iao - % Ivq h Lal�-A.;' 7-204,14 Di 4np AtIcw�.Croeviu' dt-mai I-,YIj CtInf act,1,01,'can"' ino 3-1;0! litit'i Animal I-(xA antl 7--,06.11 PI�t;iric(cd L:,,4e lle�ri,�Ots,Ctit�,ia' Not S,�rwdI 7--1)(3.72 B,iit N[AIOB� �.801 I fit-" R,- �kncl, -2,)6.12 ')P,icId Tk d i,a,:'agv N 1-20,1 liifcknl3;Pm%Jc,,,,Pest olarka anti CONSUMER ADVISORY TIMErTEMPERATURE CONTROLS 22 t,fK' I I I:,O:t.J lin CItimumpLi'ta 0 snni, 1w; :itc Unjero Atkc I i,,., 16 t Proper Cooking Temperatures,tot I PHFS kjtlhtf.tw to;-livalwc 3-4W Pat, 3i 3 .1 Sflhalillnr 1"; ka`1 SPECIAL REQUIREMENTS 190 Sv,litai in Mtav, i51 I 15 caii:,rmg, ini'hi[:(itoil, wilipt rat,'and F 3 40 1.t I Aii:i) I'tunfrN,Wild(;ame. Stu I I'ed III I F.., Fclnkiiiinl I:ifthcn opor::iirm:; Jitit I:ld tot tIoNcil ultdcr the Ipproprimc jbiya irlel.ital I"I Lxxjhornic 3-401A J(ct,3ty}€l,lt-n,us.lr ivaat I liect SwaI�s F WWI Vcnfnlll.'11A riai, lazlorq, 145"1I lc E 5!30.o0'i vio;alioaq lekittris to good 3-5:11.12 I-V&Litcli vn&r 09 14',Ni,)� Ina 1-40; II(Aft,I)ih) Ali 00nt !'Hk 1-19,1, 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RE-TAIL PRACTICES 11111-. 165`t- 13,e::. ' (ILem.;23-.10) )Ij„na c Sjantjinl; 1311,`� li,IWI do,joi :,?tul, 10 b,' 3 Corniwv,i.11lv Pjf&ew.j RTF !,�Xki jj:tj?•:1:tj 1,It, ji 0i It, ils I",;tj I'ad."I n:(I'J'ij I? 140 IF 3-401,11(F) fittnttoiu« urrslwed porti(m,of Ho 1' 1 trent I Condit Rvfh;l prjaciioai, -5moao FG - 1 003 IAm?,Qf.Irwnl aria Proper Cooling of PHFS Fond tint Pm.nxfi,)n 004 FC 1 21; Equjpnmi�i and I,n�-Pvs Fc- 4 .,',Oh_ i 5p( ;4(Aj --—--- Cc�, .Iun�CfKtkin�t Pill,, {rima 1,1W F n, kNitt"i,pi, Fc,-5 w", 7oJ:Within-, IlourIi�nj Front ?7 Pitvs,^,i,FIr,:kl-RyI FC C, 007 2!b ,v 8 3 501 14(B ispet'lal 00, Cooling PHs Madv From \nilnem jqreduas I"al,f/45,1F Vithin4 lbow,' ',Tk 596 u00 i I CITY OF SALEM / ( _ ( BOARD OF HEALTH / c� Establishment Name: �la-,,lP 0��v 'cam (moi 2Z/} Date: /b f.?1 D Page: of Item Code ( C-Critical Item -- - DESCR_IPTION OF VIOLATION/PLAN OF CORRECTION '. - - -� ,ye;Pied . , No. Reference R-Red Item f /'� PLEASE PRINT C@EARLY 1 17� (.�5��. �� i �c_ t,r,I Af _I i - ��/ N�Al�l ✓�jYtn��vaz'f �7 � (/ / -)la ` G 00AOct 4 rn /Oi- n)1)t2nJA T iv"- v 0 Ir r5„�- J ✓ SPI�(.p mac — 1p,D lb S ,nrQ�t/��1 �' ,Inczx_ .yt y I I �YIrY I�nN J. r7_Wi G � l f �n�7f� hn � I I j .�,�G�r„�I/1 • 1 / )' n� /.. 7�� 1 b/ dew �J�G ✓Ya�n Ci t�'�'iVfI�J% l( J.7Uo �/ ( 1/ I �I Discussion With Person in Charge: Corrective Action Required: ( ❑ No Yes 4 I have read this report, have had the opportunity to ask questions and agree to correct all O Voluntary Compliance ❑ Employ /RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ' noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne 1.11nesw Interventions and RiskLAIll Factors(Items 1-22) front) �III`FI(41`1 Within -, H'aw, --h-50i 15 co6n,,'O'dx0s I'll IIHF's PROTECTION FROM CHEMICALS PHF got end Cold Hol&nq 14 Food or Color Additives If 19 i z 3W.WBi j (',)i.1 PlIF,"Agna"lukA zit of kh,'+rkv 3 2t)2,12 i Aikiitiw ," I", 3-302,14 PrOWL6011 Ifulu,Unak)jnu;od ti Hol fllli-� 'Mahiained ator I:+ i Poisonous or Toxic Substances 401.31 i I&IIIIfying inil,'Iluali011- 011'lMil 3 'iq If, 'q I Rc',SfIs HOd;IL or IN)V;, I-0"1:, Cont iilwfs 20 rinit,;IS a Piubfic ficafth Control 3 X01 1,� f;nl-As 4 Public lizallh -210 LI I SQ1%i sit); Vari;mcc 1-20111 Rc'ViOl"ll-Pit•u'n(x and U,e, 7-201i2 (-()rldit§,al,of REWAREMENTS FOR HIGHLY SUSCEPTIBLE U POPULATIONS(HSP) 7-204.1 Sanri,,e,i.('werjo- 21 '3,0 1 111 A) Pre gcci All,ti wid 12 clrknql�als for wl"'Inug V:ojlt,:c,Oncri:I't 7-204 14 Di,,ing Agunt<.Criteria' wllb Warning 3-SW I 1:S) l-ke of Pa>tt-itti,�Id -205.11 Incidental Contam Lohncwil,,"' D) Rz,�� IlaiiuoiW, Cl�,kQd Ainwil Fixd �n I 7-2n6 11 f(o,lrljad I sv 0 lteru?, vcd. - 7-206.12 RWw 13::il Mown-itins, I CONSUMER ADVISORY 22 3 4,0,: ',; :cn�tnIwf ut,vwrt Po�l.:J fork"011s"Wiltilln Of TIMEITEMPERATORE CONTROLS Ani-w,§ Ptak are R,1>t, Proper Cooking Temperatures for PHFS i:;c a 11)F'ivunate !iyF F.gN,slll,61niv K)l R;iv, S1101 Inluwdl,ku: 115 .00,111IIJUlt"d i :,h, `,Irate& I An1wris J31 F k5 cec. fSPECIAL REOUIREMENTS -40L 11(Sit I Pon, snld bk-:.i R,Ksl lifl' 121 trlux I Vidaw,;l, Il; Sccli,,it �I)0(0(A)-(D) ift 4-40 1.11(M 1) Ilownt , Wild Stuffed PHI,", miA 1 it,h;n ,Iwuta W con;-.onntl!Fish, apjl(qurlaw.i�,ciouls Poulity or lkatim'-]t"It 1, ;f;ci,1l,,d it. ttlnc,� D'u,"de-lfua::t Re.lf�wakf nwkleWRull,land -i;k loctor,I 0"N.., 145"1; reqaiill,� w"o,iIj retail it) "V debito! uz�dcr #29 ".-40j.K! flaw -'lnuuAl Flj"h,Co,)kCd ill 11 M ,:!wv,Ivc 10.5 F 3401,1!(Alk T)lb) Allthhet P1 W.a- 15 17 Reheating for Hot Holding VIOLATIONS RELATED TO 0OOD RETAIL PRACTICES 1-103J J(A'j,�i[D) I'lli 4= 165'F 1 SC�' . I (Items.23-,W) 403.11(B) ;'Aicicwaw 16s�7 2 Minute, S"Indin;: m,d ::lll Dal," If.... ja1lens 'it; t,(,lLow vul n,kjwtors hw,d alwre I,j-be (IJ JiC) C'norn,'malIN iliw-,s j R'I't I-txel- JI'lird i$?r"j" <,I,(j,rt :!eInt Food('01i,LF,I d PA C"WR etail practices 3403 1 IL) Rcinamirt,, Unsliced N,rdrine at FC 59tT.Ci.M7 L 2:3 monagelp,-f a�ld P��ornpi I FC "03 - -- -.—I - ----- ----- ------ - I Fovt;:,d Food Pr,,i�,bor FC -,1 004 Ik Proper Cooling at PHFs 1-080 -- 4 3 501,i 4'A) C",',aw Cotlk�%i PHF,, (rom 1 Kiz Fit, -EM--Z 1�rld,yit,�Li� --.- : FC 60,1 _Ks3-------- .tnd i Fc-5 66,0 , 701F Witimi 2 1 Itnfrr:,nlj Fronk 79,V 27 f"M"I--,V Faclit, FC-r, 00,1 1,4 1'Fi45' 1' Witina.1 Hows. )r OIu, FC-7 x;)01---P 3 jol.14(Bi Cf�,Iijjy PIJF,,,tNjprI,- Ftkun Anibiew 'v)q Trrnp.rawrc in,rvdi,;nN W 4 -her itbin 1 Ikut, r / t� • .r- "' x ') *p V^;; 'x;_'Gs 817 MOODY STREET,WALTHAM,MA 02453 Phone:(781)893-1810 • Servicing Office: WA LTHAM S LOWELL STREET,MU-IINGTON,MA 01887 Phone:(978)657-0931 Client: SALEM HOUSE OF PIZZA Service Location: SALEM HOUSE OF PIZZA Client Address: -ENDICOTTSTREET 107053 23 ENDICOTT STREET SALEM,MA 01970 SALEM,MA 01970 Work Started: 10/15/0810:10:34 AM Work Finished: 10/15/0811:26:29 AM Customer Signature: Technician Signature: K Customer Name: Technician Name: Elrif Homan `~Lk:.#:37136 Service Order Details for Visit Service Order At Service Type 1511717 Commercial Service A Device Summary For Visit Device Type Activity No Activity Total Inspected Device Exceptions For Visit Device Type Repaired Replaced Removed Inaccessible Site Deficiencies Site Status Date _ Deficiency INTERIOR->SERVING Not Resolved 1/31/08 9:5925 AM Very large accumulation of bash/bread under beverage cooler. INTERIOR-> STORAGE Not Resolved 5/22108 10:14:18 AM Repair bottom of walk-in,mice nesting underneath,Metal framework needs to be flush to floor. EXTERIOR-> PERIMETER Not Resolved 6/23/089:4415 AM Please seal cracks and crevices at sde,valk of side door near restrooms.Entry point for rodents. INTERIOR->DINING Not Resolved 5/29/07 10:23:28 AM Door Needs Rodent Roofing front door has gap f ,rodent entry INTE'tIOR >COOKING Not Resolved 6/23/08 9',4992 AM Please repair the kick plate Ir white ,all freezer,mire accessing underneath ai:d possibly main nesting area,8/22 _- •COOKING 4 Not Resolved 8/22/0810',03:17 All ni spillage and,0r food residue under cookime,sanitation is poor. Device Deficiencies Site\Device Status Date Deficiency INTERIOR->COOKING\AREA 1.00 Not Resolved 10j22/07 10',24:57 Ali Please remove trash or debris accumulation under cooking line. 1NrERIOR-> STORAGE\AREA 1,00 Not Resolved 10/22/07 1043:00 AM Please remove trash a debris accumulation under counters,attractive to rodents. Recommendations No Reconxwndabons Exist Device Pesticide Applications No Device Pesticide Applications Exist ' Site Pesticide Applications EPA Number Lot Number Pesticide 241-392 Phantom Termiticide-Insecticide Site Qty Conc. Area Weather Wind Temp. INTERIOR->COOKING 8 Ounces .5% 0 N/A 0 NA 0 Method: Crack and Crevice Target Pesti German Cockroach EPA Number Lot Number Pesticide 4321259 Maxforce FC Select Roach Gel(Reservoir) Site Qty Conc. Area Weather Wind Temp. INTERIOR-> SERVING 8 Grams 0.01% 0 N/A 0 NA 0 Method: Crack and Crevice Target Pest: German Cockroach An • rc'�I�rsammr rnma.® I tv �. .H` 817 MOODY STREET,WALTHAM,MA 02453 Phone:(781)893-1810 INTERIOR->COOKING 6 Grams 0.01% 0 N/A 0 NA 0 Method: Crack and Crevice Target Pest; German Cockroach EPA Number Lot Number Pesticide 432763 Suspend SC Site Qty Conc. Area Weather Wind Temp. INTERIOR->COOIING 8 Ounces N/A 0 N/A 0 NA 0 Method: Crack and Crevice Target Pest. German Cockroach Site Inspections Site Time INTERIOR->COOKING 10:4648 AM INTERIOR->SERVING 11:14:33 AM Notes Recommend second visit next week, Device Inspection Detail Site\Device Time Service Activity Pest Qty No Device Inspections Exist 4 ` u A 1R��'I�osxvruns Pam.. H f 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED _Owner: Comment:Cutting board at pizza topping fridge is stained and scored. Resurface or replace cutting board. Mohamma Alam -Sher Shah Violations Related to Good Retail Practices (Blue Items) PIC: Food and Food Protection FAIL Critical BLUE Mohammad Alam Comment:Sandwich unit had uncovered food.Cover all food in storage to prevent cross contamination. Inspector: Other-See Notes FAIL BLUE Elizabeth Salandrea Comment: Recent extermination report cited several deficiencies in establishment that could contribute to pest entrance or Date Inspected:Correct By: harborage.All recommendations from exterminator must be followed to aid in pest prevention. 4/6/2009 Risk Level: Permit Number: I BHP-2009-0247 Status: SIGNED OFF #of Critical Violations: a2 Time IN: I Time OUT: Urgency Description(s): I BLUE: All other violations noted in the 3/26/09 inspection report have been corrected. Violations Related to Good Retail Practices (Critical t violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately I or within 90 days) ' - A City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 07,2009 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions" and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 07,2009 ) Page 2 oft r 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 Separation/Segregation/Protection FAIL Critical L11 RED Owner: vi�omment: Kelvinator freezer had bread stored on meat.Organize freezer to properly separate PHF from RTE food. Mohamma Alam -Sher Shah 1 rst Kenmore freezer in basement had bags of bread,vegetables and meat all stored on and next to each other.Organize freezer to PIC: properly separate PHF from RTE food. Ali Shah Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Inspector: V-&mment:Sanitizer at sandwich station in front did not register on strip when tested. Provide sanitizer of proper concentration(50- 'Elizabeth Salandrea 100ppm)at all work stations at all times. Date Inspected:Correct By: ysanitize bay of 3bay sink not being used correctly;bay was not filled with sanitizer,but rinsed dishes were observed put into it. 3/26/2009 3bay sink must be used in a three-step system to wash,rinse and sanitize all dishes&utensils. Risk Level: Cutting board at pizza topping fridge stained and scored. Resurface or replace cutting board. Permit Number: wean opener needs cleaning&scouring. BHP-2009-0247 Handwash Facilities FAIL Critical RED Status: viclomment: Back handwash sink missing soap and paper towels.All handwash sinks must be stocked with soap and paper towels VIOLATION at all times. #of Critical Violations: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 6 Hot and Cold Holding FAIL Critical S6RED -Time IN: Time OUT: I �ommen�izza topping fridge was measured at 54°F at time of inspection.Repair fridge to maintain temperature of 41°F or I below-PHF may not be stored in fridge until proper temperature can be maintained. Urgency Description(s): First kenmore freezer in basement at 10°F at time of inspection. Repair or turn down to maintain temperature of 0°F or lower. 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®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2009 ) Page! of 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 j and Risk Factors (Require /comment:Steam table had uncovered food in it.Cover all food in steam table to prevent cross contamination. immediate COfreCtlVe action)_ rigedaire freezer,sandwich unit,pizza topping fridge,and walk-in fridge had uncovered food.Cover all food in storage to prevent cross contamination. zsv andwi h unit had bag of vegetables stored directly on uncovered tray of onion rings.Cover all food in storage to prevent con mination and do not store anything directly on food. V-Kizza dough fork being stored in cheese container.Store dough fork in a clean,sanitized container designated for the fork only. illalk-in fridge had container stored directly on uncovered chicken.Cover all food in storage and do not store anything directly on food to prevent contamination. Equipment and Utensils FAIL Non-Critical BLUE L/omment: Frigedaire freezer needs general cleaning. b loor in corner near steam table has food debris and trash-thoroughly clean floor. Ip/andwich unit needs general cleaning. ✓Microwave needs general cleaning. rill/fryolator area has some grease build-up.Thoroughly clean and de-grease this entire area. psi fridge behind counter needs general cleaning. VSame unit has gap at top left when door is closed.Repair gasket to prevent gaps when door is closed. f/Pizza counter needs general cleaning. 1, z' topping fridge needs general cleaning. //Shelving under blodgett oven needs general dusting/cleaning. Salad fridge needs general cleaning. All food containers including pizza sauce bucket in walk-in fridge need cleaning. V-1fraulsen fridge needs general cleaning. Vugh machine has accumulation of flour.Thoroughly clean dough machine and general area. " AII freezers in basement need general cleaning. ( /AIstairs to basement need general cleaning. y Back kenmore freezer has broken thermometer.Provide new visible,accurate internal thermometer for this freezer. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2009 ) Page 2 of Item Status Violation Critical Urgency Area under 3bay sink has dome grrase and grime build up;thoroughly clean this area. PhysicalFacilityFAIL Non-Critical BLUE yc:omment: Bottom left corner of door to walk-in fridge is in disrepair.Repair door to be in good condition and to prevent any gaps. k1frovide covers for light fixtures in both bathrooms. 4-11(splace all stained ceiling tiles in dining area. ✓rile around vent in ceiling above walk-in is in disrepair. Repair or replace tile. Other-See Notes FAIL BLUE �/—Comment: Recent extermination report cited several deficiencies in establishment that could contribute to pest harborage.All recommendations from exterminator must be followed to aid in pest prevention. Reinspection in one week, all violations to be corrected. ✓/Please have January and February extermination receipts available at reinspection. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2009 ) Page 3 of 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: 01/04/2010 ESTABLISHMENT NAME: Salem House of Pizza File Number:BHF-2004-000028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0038 Jan 4,2010 Dec 319 2010 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES jDecember 31,2010 Board of Health j�.f-GwYY M i 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 x CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGRFFNRAUMnq SA1RM.COLI DAVID GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT e gQ ASV/ 0224 TEL# J j ;X ADDRESS OF ESTABLISHMENT ? FAX# MAILING ADDRESS(if different) EMAIL- Business': n Website: OWNER'S NAME ML?bilnad- ,A (�//j.�I - / TEL# 117- .S�/O M S 0l ADDRESS ie? l'l(2)/P C4 /✓CSG 1 MA- §� S r� /STREET /CITY ^ STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) F ShQl> )LLCERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON /w/ , .1- 40 n,7 HOMETEL# 6!7- , S/b' �� S J%XYYS!QPQPERA71QN r{ Mgiday r ; Tueatlay i ,:' VJed'n_esday ," T#iuisday !; Fnday i Saturday z Synday�` HOURS OF OPERATION I AFM !1�vl f}M AM �{g�9 A N}� F/M /J,s.1 /�v 141, t Please write in time of day. r 1A1v1119_A 4i 1-1 / 1 7�/ //� !/�l a (For example t tam4 l pm) / j ! TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280' more than I0,000sq.ft. =$420 ---•--------------------------- = ----------------------------------------- --------------------------------------- RESTAURANT YES NO less than 25 seats _=$j i4 (Outdoor Stationary Food Cart$210) 25-99 seats =T28O more than 99 seats =$420 ---- ----- ------ - ------ .... - BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS ----------------------------------------------------------------------------------------------------------------------------------------------------- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. n Signature Date ' Soda']Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date $ w , J Massachusetts Department of Public Health Foodborne Illness Complaint Worksh,eet Please Complete and.Send or Fax to: Questlons? Call., Date: 1 E j 9 MDPH Food Protection Program Food Protection Program: (617) 983-6712 305 South Street, Jamaica Plain, MA 02130 Division of Epidemiology: (617) 983.6800 #: Fax: (617) 983.6770 Enterics Laboratory: (617) 983-6609 — �- jPerson Completing Informatio �� j 190--- Affiliation: �y� Name: i (c�1Ct �ic� !C� 1. f� * �— @: ( ) ! t t l�tL Affiliation: Local OH (town): S2l V -� O State DPH (division): y Q Other: i_Reporter/Complainant Name: � 5n': - Affiliation: Consurrieri specify: —} Laboratory division, O Local BOH facility, n-i A ❑ Medical Provider adddressess,, O State DPN town, etc. O Other Illness Information # Persons ill:� Symptoms: (mark rf reported for anyone/: Diarrhea O Vomiting Nausea Abdominal cramps Fever O Bloody stool O Headache O Muscle aches O Chills `.Loss of appetite O Fatigue O Dizziness O Burning in mouth O Other symptoms: Sh r)h I r) ...... ..... , Onset: > Earliest Date: _/11+ /�)q1 Time: �? OAM OPM Latest of > 211) Date: / !v Time: CLAM OPM :...............:..........................—..,.............,,................... ........- -...................,: Duration: O Less than 24 Hours O 24-48 Hours More than 48 Hours O Ongoing O Unknown Ill Persons: Age Name Address/Town (yrs) Occupation Med. Provider/ W 1 Ksame as reporter(above) 1 } 2 � SaNyR. 3 4 I li Medical attention received (by anyone/? O Yes XNo O Unknown —> ff Yes, specify above:T Stool specimens submitted (byanyoneR O Yes XNo O Unknown —;•To SU '7 O Yes O No O Unknown Medical diagnosis reported? t 01 pi 'State Laboratory Institute,305 South St.,Jamaica Plain,MA,02130: 617-522-3700 Sept 2005 'Always record Time if possible;otherwise,choose B=breakfast,L--lunch,D=dinner 'Total N persons(both ill and well)who consumed indicated foods) J% Food History I —r Obtain history back 72 hours prior to symptoms,or, if organism identified, b1n min and max incubation periods (see p.2) —>If > 2 01,follow above time frame for common meals(foods)only Restaurant f store where Date&Time s Frxxffc) cansurnad mtrchated{name,town' Plltsr ex slaumad. 0 B 0 Same(as left) 0 Home !i 0 Other Apeotfyl: 0L E3 MDPH FoodbornerWorksheet Page 2 of 2 Food History (continued) # Restaurant (store where Date&"rimer Exp' Food(s)consumed purchased {name,town)- Place consumed tct B n Same(as left) W Home L wIfM pao7zr, n ache (Specifyf: n D T..)G i ere c1 n g 0 Same(as lettl n Home 0 Other(specifyl: 13 L C3 D recce. �rcvtOUS -4, � d n B n Same(as le/t) n Home C3 0 Other(specifyl: 0 08 n Same(as left) 0 Home n Other ispecifyl: E3 0 n B n Same(as left) 0 Home 0 Other fspecify): 0 E3 :5hajecQ ,j�, . Iuc wu� no 0y f`0 {;�PO4A 4a San ) ck,r)G- 'State Laboratory Institute,305 South St.,Jamaica Plain,MA,02130: 617.522-3700 Sept 2005 'Always record Time if possible;otherwise,choose B--breakfast,Jrlunch,D-diancr 3Total N persons(both ill and well)who consumed indicatcd food(s) CITY OF SALEM, MASSACHUSETTS • ' BOARD OF HEALTH 120 WASHINGTON STRF.ET,4°f FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR INC INIGS,AI.EXCOM JANE;r MANCINI' A(:MING Hi,Aiaii AG[:N'I' Facsimile Transmittal To: n Fax# 0 RE, Cornpi Date : 11-4 101 ----�-� i Page(s): including this # this cover Message: ( Corn ) ! c6y_Y1 G�� co1 `?n� rec a_u, o nil Board of Health News Your Information OFFICE HOURS: Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON {MPORTANT MESSAGE ) FOR lY 1� L�J �CS DATE TIME MUYIyVInCN >.S �J OF PHONE AREA CODE NUMBER EXTENSION U FAX U MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED x PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH l RETURNED YOUR CALL WILL FAX TO YOU ((� (n� MESSAGE - �� jl1S@:�-t- �d`�heto, �lucv uo-.4 I rt , ��rw s h,4 SIGNED U- FORM 4009 MARE IN U.0 MOTES C l s. CITY OF SALEM C BOARD OF HEALTH I Establishment Name:_7Ct�� YY1 SI I✓12�f� Date: al - cl Page: of Item ., Code , C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION; Date" f ,No. Reference R-Red Item -- - - - ' ; Verified PLEASE PRINT CLEARLY 1 i Y�Y7t«� tvnn Ce nvt n�c¢ t> VeTcrCIfnCoto. C (oaviLVS55 o+ Tltg- ti -�_y onf UJ`(�si_ �&taVCH Ck YI I R'S nZC,Ti 7Y1 c c c(1 1� 4' C.O ndu&--eA nvi� -tUz rnt1�_ Prr; t IV 1 C�rv�l�;navl� svai�� —All42AQ-, { I CUnO( olt'� PC < cMypd k -fyutz S 4 fn 6 (-u)-fo VL E I cxVk� _V\c � v>1ob fit v Ih much Ir1Sfctyico� x�r kcvd rat Cc�r�^t �' ��MAI-,nI of �1��( ��Cl I c�i�f on l'tao i+ S � clo-Y C6\M lJ 177L.I"`ZAVVt , nla ( I�infi cC�rQie^Pc� C1[�f v 'cl_)or Ui(h r 1 ec Yc,lirx �,ycPs ih-y I ��'c�xbli�hy�tQ+�rt� art �i 3 InSnAC�bY1 . �� , �c �,enoceTW c�N-�� ih st s Imue� ukc- Or ��A an uccr Ing A 6tnn o-P r- ('(MO and A, bir, T on it- 1 l;5hfli nt v�-t�� clQ�� -( Icer tilettQ�-(fit (�� vcllr�C, h�x � c��d v1% �Y1� I�e �Cl�t SAQ45 ClQckn tl -Ck -From �_-o tf/dtri� Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ les t 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 inspection, to observe all conditions as described, and to Exclusion j 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 i, your food permit. Other: ❑ Voluntary Disposal 0 :-;lir .•Iii# PMA Ra awd at i'em(a:t,.Uarrs t Violations RMAN to froodborno illness fntcrvenflons and Risk u,Tai= T:�XAt d to } Factors Awros ITQ {Cant} t W-1 145"F t4 ftlfin I Hour ' " f 1-4trt.l'+ Qxrl u 4tct6cW hw PHF, PROTECTION FROM CHEMICALS 19 PHI-fret and Cold Hotdinq } 14 Food or Color Additives i� "14tt v ft1 ;lan; nt tl Nt, F¢'l,nv 1-21'3.12 ; dtv,,;. 5(:() )ii,:(h }i°:15. ., Pa.'krils,nfronti'nuppn,.edAddi?t':e;;' 1 13 In t 1t, t h((.j ,? 1t3.1-'..'`$3irYl zl:t`:at.'<f Ur L+tj•tV,' I { C Poi,,%onoba or`Toxic Subrtancer . }4F} f' 7 MIAT i Hmiuntuln{ormun,tn--On"'inat j f h' # � ;.Si:t.}F.;:?' Eta.sat:€l.:ict,u Lr al;wr 1 iit't: + i Cunazalins ,,,{t s } Time as a Public Hoatth Control ('otnnwIlNm,r :001 to "tin= 1%;i1'36E:€te.u.hC nnnl' ! V;;rr,nce R^unircrs?•a;r � � •'^4;3.31 � Kestriction -NrcFCrv:c an,i L..,:^ `..=—..... . 1'r.;,ic f.'<;nta?nci: - Prc!ti€n i:'n," REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 4POPULATtCNS IHSP) 100111 Sao is et<,Crile:ir -C'iiri,ticnts` } y 17-=t,}.I..!' � C'?t'.:t:,iri}>{,;t Wahu:*,I':n,,4 t,: ,Gitt'i:ti t I ! i l•nn:r tcm t�::t i'r"'-{.acl a,:cct J{'i'ts a;;cl i'fln it'a?ntng 1,81-v.ls" ! 7 -0. 1.i t I3t'ritvK 4rteau,(`rtreria"_ r ( UIV of plaWs"i WN, -15 }1 uujax.ntal t-axl(,U;S:?:? lAwaic:inrl»' 1 i 3ti >, ? r` + t-Stll ! t## f 3'.:vY,)'i'ntrt'i`t t-,,,#};nd Amm;h Ftad:. it i 1 C�,i i R"t twad 6, Pt'>rit'ufen C rile,::t { j 7.,:06.12 Rc'cicts? B 6 Sctuonc" ! 1 AM A"':! I u ipmai Faxut Pacl<::v.c W RC aen..tl 7 2M is Tf� eking P,ntdc•r< P:^'„C iintr.,i and i CONSUMFP ADVISORY TIME(fEMPERATURECONTROLS : 2.. is..st' ,fret,'<} Ei>r("nn>,e..nt,ti,rit:tt ! I'+kj. star air! low UPIO rru'I'rd c i 16 Proper Cooking Temperatuies for € PIKE I { +'}t{t,�r::sac rrxc.:.sr�d t:; 2-101 I i At t x[` (','s;;.. 15 WO 15 Fr., i f l,advae?ti.;..' ` • .'.m.. +.-iii,'. 13 i is�Ix',tt':,art�..'t:..�t::h?.ti tile' to Now Shot trs;!',-niuuxha2 S.:'�i+:r 115";=1`•:e,:� I f ' }4M A NANO ;omtni„clad Ft.h, %lioi,& Gang, ' , ;:.,y SPECIAL REQUIREMENTS ( .;."tvY.i};fljt'i(t_; 'ur.Lxcdl3,rtdtev.,:'t - !:1(1'1' 1":la#in' � _.._ 5yWill t DVnIia <<sn. or i 41AP G,:o-A kkd155i,;c::le'n 't,t7.tN13E:1',.(Iiitn ! � sr,. y 4 j rets:rtitx?. ^I'tt;itt:i•tn;ci. trtltpa,marV t#tic: 401,11(,1i`.I) ]',t,ti?r,Gl"ild Game,Stu:1'ed I'1{r!.. i r:.its:: Fal!:ti>,hett a,Jetxtrior,5>Jiostid hc: � tit, lmg{ t :t:rruttt.Finn.ba; fe al r, rn=ste .� r , 11�:nluv o tutu,-165 I• 1 a`u+.n'c' i l rAxed to f nnitux'it,: Any ny -401.11tC)'3t f;dc-alvsVrImal13e:;T4tcaks 4udri:i1. lmtnr; rnhnr i'k{}00)vivb'uon'.rCimin�- I(, ?,qKl t02t1{ .34`i!.i» m.,..___._-...k t; Annual i<",d,5 Co,&,.'d in d }t;'debitrY: rari.i.r n29 - 111crowmv 551 " titte,iai ?2.rt3ur'ctndtsts '101Iti•tKI;tt,) 1N001m €'ll€ 145'1' 15 see 17 Reheating tar Hot Holding T �) ytpt-A 1IONS RELATED TO GOOD RI TA:L PRAC710ES ;."t!?J.tliRl.ki'l.ti Piit 165'F IS wo - Ihunis 23-30) 011 HH) ::",'ItC*PL\`d4. )I'"F 2 ZAMM Sousa; \ ."`i'r'•H'v; ral'.al c•,a.P1Rb;.`, tt't:;t'h rIU,Ip: riiRb°U''h, 13.:@?.i NO � Canmter'ia;ly Ptu:'.;scd 4"!:.}•axst- � /Gt.adst:ito j,�ihr.:nr� .fir•:.r,,:ui fi.,:Fnuai'ott:•aarll't's '.';'3k ii; Item--r Goad Retail Prac.ices--- -----t'KC- ---590.C� ,.<t{}, lii Reariunim;i.n<Fi.0:1 P„ruin,(if ti.:cl _t. krva:.t,,x t 23 i_"".?:tage tt,nt a:d Paisoroai- ri. _ i ,103 ; Ig Proper Cooling of PHFs ! 2r;. Fr.nd wd i=cr.7 Winton tion FC - ? ,-C•r: - v. i , r5 __--; E 't„r.:';rtt arn_!1?ar's,is Ta.-4 .PGa� 3A01 I.}tr1 Ca ilCouL:dPht�': 4'rrr t t _ tL r'_=. ._. } n 1(rE=tt' r ;?� : 'i,dawt.,'iun!„i:rs<t;�d`Nu:.to _ _--t '";;-g--i-�,l; '0"F mown 2 Bonn and Froin 711-1' _..{�_- i 2;."'_.Phys.Xx Fat;•;4 ct -.. (Y3/ -� io 41'F/15 } N'itl:in a tiouir. ' I -1 Wt«,h _ s_'r T^U i�"n% m' <iF�ri.:3i F,•:tit<tte±*fetttfr .!ii,9 ;.SJi.l7tiiy t"'r•olin;;PHF: 1la;le Finn rlr#bt�nt . ....i : ! T,mp+:rature l:u�rcu:cat,to ori F,�.t� t' _.'t -._--- -_ 'Oman,nnaAAmv 0y0101 v14 My t-',;'.;., 161 t oil%,nt Kr Commonwealth of Massachusetts b City of Salem Board of Health iGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISIIMENT NAME: Salem House of Pizza File Number:BHF-2004-000028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions 1 Notes FOOD SERVICE BHP-2009-0247 Dec 29,2008 Dec 31,2009 $140.00 ESTABLISHMENT' Total Fees: $140.00 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 v �Y •t CITY OF SALEM, MASSACHUSETTS ' BOARD OF HEALTH 120%VASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ]DIONNEnSAlrnr COM 6, y � �� J :C� c JANET DIONNE, ACTING HEALTH AGENT DEC 7 5 2008 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT SALEM MW7 c gl izY1 TEL# c 7 Cl Lt —o 01 7 ADDRESS OF ESTABLISHMENT-7-3 T FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAMEf1ao� awln , - Wn/vt / I�iPi✓/9�i' c il�&A TEL# �- ADDRESS C1 e, U.✓ve_ /,Iew 4-oPNnom- STREET I CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) MpI (,MpoAfV AYAnit CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared)/ EMERGENCY RESPONSE PERSON S;A t%✓ SA A-4\ HOME TEL# 917-5_16— _73 /�/-7 1DAYS OF-OPERATION ' -j Monday 1, :- Tuesday' '.j Wednesday i,: Thursday: . Friday- Saturday I' Sunday HOURS OF OPERATION 1 Please write in time of day. \l+j.rh, (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check onlvJ RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------------------------------- -- ------------------------------- ---- RESTAURANT E NO less than 25 seats $1 (Ouideor Stationary Food Gari;210) 25-99 seats - z8G more than 99 seats =$420 -------------------------------------------------------------- --- ---------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES N $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES <0 $25 TOBACCO VENDOR YES <0 $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 and paid all state taxes required under the law. / /WoGt wt,c� zIL� #-ZLi - of SS — U 93 q I I) Signature Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date *y RrY i P (✓ 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: � Violations Related to Good Retail Practices (Blue Items) 744-0017 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment:The basement stairs need a thorough cleaning. Mohamma Alam -Sher Shah PIC: GENERAL COMMENTS: Mohammad Alam All other violations cited in the 3/31/08 inspection report have been corrected. Inspector: " David Greenbaum' 'Date Inspected:Correct By: 14/8/2008 Risk Level: Permit Number: BHP-2008-0248 Status: SIGNED OFF #of Critical Violations: 0 Time IN: I Time OUT: Urgency Description(s): ;BLUE: Violations Related to Good :Retail Practices (Critical violations must be corrected :immediately or within 10 'days)(Non-critical violations '[must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 08,2008 ) Page 1 oft I� 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. Apr 08,2008 ) Page 2 oft Page 1 of 1 David Greenbaum 1^;s 5xin- 51YJ: From: Joanne Scott Sent: Monday, December 24, 2007 10:34 AM To: 'Joan Lovely' Cc: David Greenbaum Subject: RE: Salem House of Pizza Dear Joan: Thank you for filtering that call for us! Would you like a copy of the report? Merry Christmas! Joanne From: Joan Lovely [mailto:joan.lovely@verizon.net] Sent: Friday, December 21, 2007 4:12 PM To: Joanne Scott Cc: Thomas Stpierre; Jason Silva; Salem Police Department Subject: Salem House of Pizza Hi Joanne, I just received a cell phone call (978-821-0856) from a man who was calling to complain about a leak in the roof at Salem House of Pizza. He said that he called the Board of Health and that city hall was closed. I explained to him that city hall closes at noon on Fridays and will re-open on Monday. He asked me if I thought that a leaking roof and the serving of food was a problem. I told him I was not a public health official, but that I would refer his call on to you. He said that since I was a councillor, I should know about these things. I explained that I didn't, but that I would contact the BOH. He said that if I didn't help him, that he would be my worst nightmare. I asked him to please identify himself . and he refused. I told him I couldn't help him if he didn't give me his name. He repeated the worst nightmare thing again and I told him I couldn't help him and hung up. So...someone may want to check in with Salem House of Pizza on Monday or sometime after the holiday regarding their leaky roof. I'll let you know if I hear from this person again. One more thing, he sounded very inebriated. Merry Christmas! Regards, Joan 5 �� I) V3+V)N\a IN wak'/&m ?� Joan Lovely Councillor at Large 14 Story Street Salem, MA 01970 978-745-4796 joan.loyely_@_v_erizon.net 6 12/26/2007 Commonwealth of Massachusetts s � City of Salem Board of Health IGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Salem House of Pizza File Number:BHF-2004-000028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0248 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES (December 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. 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 24 of 25 • ems \ CITY OF SALEM, MASSACHUSEM BOARD OF HEALTH �'➢ec�;.�� _ 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL, FAx(978) 745-0343 RECEIVED MAYOR iSCOTF(OUISALEA COM JOANNE SCOTT, NOV 3 0 2001 HEALTH AGENT CITY OF SA:_---:1 BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT -5411---✓VI NO 051 PI'2.2-)l TEL# 17B f 7'-1 ('I - v c, / -7 ADDRESS OF ESTABLISHMENT 2-3 t 0d,[o I7 S-r (-fl ce m FAX# MAILING ADDRESS (if different) EMAIL-Business" Website: OWNER'S NAME M O H A Y✓I W1.R b 4L Iq-w\ TEL# P 7- , 1 a — ( q) L— ADDRESS I CU9V,- ST Alt (A/1 MR (32t'/6� STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)L120N///YI�IJ3 &,J' 'h CERTIFICATE#(S) 3C� , SIO (Required in an establishment where potentially hazardous food is prepared) / / EMERGENCY RESPONSE PERSON S� l� AL( S l� �; HOME TEL# b ( 7 7 b' 7� 3 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday I HOURS OF OPERATION9 Please write in time of day. it / I�Pm ' �)Ip illpm .ilyQrh iti�.r� � 1\ (Forexample Ilam-11pm) .,\Qw \�\�`r^ IIUy' �)Gr~ \\Q� \Vi`� \\Qw TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ................................................% ..._J ._.._.._....._..........._.._...__...__.._........_.......a'n-2-__.. ...... __...-vim., . RESTAURANT ES NO less than 25 seats =$140 (Outdnnr Stationa;Y Food Car!$910) 25-99 seats - more than 99 seats =$420 - - - - - YE ---- ................................................................................ ........ BEDIBREAKFASTI S O $100 CHILDCARESERVICES ---------------_....__. ...---------------------................----------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES (o $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES N $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 52C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax returns and paid all state taxes required under the law /t,/o1,A //- Lv -o1 SS- o331-/y9S Signature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008 adm Check4 R Date/,37� +' 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: El Item Status Violation Critical Urgency Telephone: PROTECEomment: M CONTAMINATION 744-0017 Separaegation/Protection FAIL Critical RED Owner: L There is chicken stored above deli meat in the walk in. Store all PHF below RTE food to prevent cross contamination. Mohamma Alam -Sher Shah Food Contact aces Cleaning and Sanitizing FAIL Critical [ RED PIC: Sher Shah mment:The cutting board on the front deli unit is badly stained and scored. Resurface or replace the cutting board. Inspector: Theat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. David Greenbaum Good Hygienic Practices FAIL Critical W RED Date Inspected:Correct By: Co ent: Employee drink stored in the front Pepsi Beverage air unit. Store employee drinks in a dedicated employee refrigerator 3/31/2008 prevent cross contamination. Risk Level: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold H ing FAIL Critical RED Permit Number: B_HP-200_8_-_0.24_8 mment:The front Frigidaire freezer has a temperature of 32°F. Repair unit to maintain a temperature of 0°F or below. Status: T small pizza prep unit has a temperature of 48°F. Repair unit to maintain a temperature of 41°F or below. VIOLATION -- #of Critical Violations: _5 Time IN: TTime 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. Apr 02,2008 ) Pagc I oft A{ } Item Status Violation Critical Urgency i 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 Comment: The large pizza/salad prep unit in back has uncovered food. All food in storage must be covered. immediate corrective action) The small pizza prep unit in back has uncovered food. All food in storage must be covered. Equipment an/dJlltensds FAIL Non-Critical BLUE �rh ent:The front deli unit has an accumulation of food debris. Thoroughly clean this unit. e wal at the meatballs has an accumulation of food spills and splatter. Thoroughly clean this area. T fro rigidaire freezer needs a thorough cleaning. ;waj1at the meat slicer have an accumulation of food debris,spills and splatter. Thoroughly clean this area. 0s canpener needs a thorough scouring. Tt wa in has a broken thermometer. Provide a new visible,accurate thermometer. T wa in floor and walls need a thorough cleaning. T la a pizza/salad prep unit has an accumulation of food debris. Thoroughly clean this unit. e small pizza pre unit has an accumulation of food debris. Thoroughly clean this unit. � The basement stairs need a thorough cleaning. e�two Kenmore freezers in the basement have an accumulation of food debris. Thoroughly clean and defrost both freezers. lrhe dumpster found in the open position.Keep dumpster closed when not in use. 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. Apr 02,2008 ) Page 2 oft 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 744-0017 Physical Facility FAIL Non-Critical BLUE Owner: Comment:There are some water stained ceiling tiles in the dining room. Investigate the source of the leak and repair. Replace all Mohamma Alam -Sher Shah stained tiles. PIC: GENERAL COMMENTS: Mohammad Alam All other violations cited in the 7/12/06 inspection report have been corrected. Inspector: David Greenbaum Date Inspected:Correct By: 7/24/2007 Risk Level: Permit Number: BHP-2007-0343 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: I i 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. Jul 24,2007 ) 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 24,2007 ) Page 2 oft r% 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I PROTECTION FROM C TAMINATION 744-0017 Food Contact Su cleaning and Sanitizing FAIL Critical ❑d RED Owner: Co mm ent:The meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Mohamma Alam -Sher Shah Good gienic Practices FAIL Critical RED PIC: Mohammad Alam ment: Employee drinks observed throughout the food prep areas. Employees must eat and drink in the dining room to prevent r cross contamination. Inspector: TIME/TEMPERATUR�NTROLS(Potentially Hazardous Foods) David Greenbaum Hat and Cold ding FAIL Critical ❑� RED Date Inspected:Correct By: 7/12/2007 omment:The Traulsen unit had a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. Risk Level: The Kenmore freezer in the basement had a temperature of 40°F. Repair unit to maintain a temperature of 0°F or below. Permit Number: 1 BHP-2007-0343 , Status: VIOLATION #of Critical Violations: 3 Time IN: I Time OUT: I 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. Jul 12,2007 ) Page I oft r Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Equipment and ils FAIL Non-Critical BLUE Foodborne Illness Interventions and Risk Factors (Require nt:The kitchen flooring needs a thorough cleaning including under and around all equipment. immediate corrective action) 7Tere spills and spaltter in the walk in. Thoroughly clean the walk in. �k�arejneod rs in the walk in need a thorough cleaning. T e Trauls unit needs a thorough cleaning. oo�Surior ket of the small pizza unit has an accumulation of food debris. Thoroughly clean the door gasket. deli unit in front needs a thorough cleaning. e fro Frigidaire freezer needs a general cleaning. T be ment stairs have an accumulation of food debris. Thorough clean the stairs. Th GE freezer in the basement is not working. Repair unit to good working order or remove or Label freezer with a sign stating o Not Use" e dining room floor needs a thorough cleaning. Physical Facility FAIL Non-Critical BLUE Comment:There are some water stained ceiling tiles in the dining room. Investigate the source of the leak and repair. Replace all t stained tiles. 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 12,2007 ) Page 2 oft COURT DOCKET NO. CITATION NO. CITY SALEM PD 6018 VIOLATION N NOTICE NAME.( ._,(LAST,FIRST,INITIAL) n / �O'+! STRSEL DDBESS CITYJTOWN STATE ZIP 1�C z�„n�+ t, 614 1() LICENSE NO LIC EXP DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) LL STREETADDRESS CITYROWN STATE ZIP of 3 Jnc�� T3-i SuLoA PA 6R REGISTRATION NO STATE EXP.DATE f MAKET'PE YEAR COLOR DATE OF VIOLATION TIME Ll I DATE III CITATION WRITTEN PERSONAL NJURY ❑PM ❑YV/E)S/} 1l•A Gn7J / f NO a _LVI ENyF" ❑ LTI '1 IUTfI OFFENSE CHAP SECT FINES A {lure t6 A y Qd i--e7K"7 C c H R, 516 OFFICER ID NO TOTAL FINE DUE I$�6� OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND x KBY MAIL I DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF///��I $ -�ld l jj CASE#If IIS SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL ' 'C.":3s..;p'vt.`..:�.�t.f A}`.-n'..S0.wki:..^Kc,.A":sv.�-..nrR.{•ry�r'2";r c't^.��.s`,.E-'✓.�3>."r.t4✓✓t'i =.eri+vti.'(r"k±.i`�"iy'Af-':'4:7�4'rr✓�`nf,,r�am1:-s•..��:..'T,"}.��-v,..}t ma-, aJ .i/•,.V..,/.=:I'ld'J..,.a�:.?'.-Y.'''-s_",-.V-...oSJck''Y�..JSsfS{svu,w1�.+%�S.�:;:%i>A..i 9;.':�'_�:✓yf...3L..^�.'.,_f_T'_.rs-',`..t„�,��rF/"`?-,:aSGz.]Y+"�Mz,'`+.+:.:-�3r5i'i.-+.X.4C-v•.i�,.',.:�4`Js:'�.1T."3z1"`R.(`_v3+t';-$'.:Y:fD2v,;H:D' i.Cm-K}�.�vE'<.''T:;,;t��.Mst;vu.aqr'+--`':,V:."+`�'.r4.:..µs3+:'l<£CrS>caV?�::S:•;-�.:i�YSk..`rv_cx.a�.r:r>:;"•'z,':.i:.:�E.o..::.,t;,e.�":;>�:*.#°•o-.',hN. `77 .a..C:i. 7AiiD;Nn+�7N ✓rt� CI7Y,iOFSAGEM *x: r %✓ ` ; '+ .''�'`5 :�\. S%�` �ti�� ''�'�1��'�11�ti1'�*;l' ., to FIRST.AIITIAL} R N t✓ JJ NJ l ✓ ✓JJ J I/!✓/✓Yd✓/ A # a to 'Yft�li 'J°';fJ ' �lIJ�''lJ//'/J.r s ss. , �✓ J� JrJiJb�f rJJ,. rr�Jrrfr-✓�f�' 2X\\ N ~'\ f✓✓%f.%f,%jff lflf UCENS a XP.DATE .DATE OF BIRTH Y f✓ ✓ "/ JlJlJ r' ✓ .o�/.✓J.✓Jf'��rf�ffl„rJ.✓✓✓.�Jr✓,.f/�*:FI✓J I E 'S ME(LAST FIRST INITIAL) /i 1/ 1tf/ .pjrl.jQ rr' jls 1. f. Ly4MMu Uy — t�Gf �ftR�( i tP, h 1 Q% STR RESSCITVlTO N STATE ZIP 16 REGISTRATONN0. STATE EXP.DATE 4 MAKE7TYPE YEAR COLOR til c— � DATE OF VIOLATION TIME DATE CITATION WRITTEN PLS aSO - I QPnMn )) Ilwu uvES _ J { NO r 0 c� LOCATION OF VIOLATION—5r-/” J�='O, i E RCIyGIF o OD - OFFENSE } j,,,, CHAP. E FlffH �0 IA �u'j/GN'P� a177/.�?Y4 C1 Ep 1-0 X C 1 CH(Z_ �5b OFFICERI D,NO.I TOTINE AL]`$/ t I Foo s I " Ty � DUE L � ' I OFFICER CERTIFIES COPY GIVEN TO VIOLATOR 7 ' ❑ 1N HAND Ln I X 165 By MAIL .13 DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ". Ln ?j ORDER OR BY CHECK MADE PAYABLE TO € X 0 I= I CITY CLERK CITY HALL —D{ I 93 WASHINGTON STREET {'TI i SALEM,MA 81978 I TEL.(508)745-9595 X 251 1 HEREBYELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE ) PAYMENT IN THE AMOUNT OF CASE# i � D y SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION Q _ w ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAT. ED O a� €ar 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 744-0017 Hot and Cold Holding FAIL Critical RED Owner: Comment:The Frigidaire freezer in front has a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. Mohamma Alam -Sher Shah I Violations Related to Good Retail Practices (Blue Items) PIC: Equipment and Utensils FAIL Non-Critical BLUE Sher Shah Inspector: Comment:The GE freezer in the basement not working. Repair this unit to good working order or remove. David Greenbaum GENERAL COMMENTS: Date Inspected:Correct By: ' 2/1/2007 All other violations cited in the 1/24/07 inspection report have been corrected. Risk Level: Permit Number: BHP-2007-0343 Status: SIGNED OFF #of Critical Violations: i 1 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 01,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) -7� 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. Feb 01,2007 ) Page 2 of 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 Separation/Segre ion/Protection FAIL Critical ❑d RED Owner: C ment:The Kelvinator freezer in front has potentially hazardous foods stored with ready to eat foods. Separate PHF from RTE Mohamma Alam -Sher Shah ods to prevent cross contamination. PIC: FooZContactaces Cleaning andSanitizing FAIL Critical ❑r' RED Sher Shah t:The meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Insp Davi Gr Gooctices FAIL Critical ❑d RED David Greenbaum Date Inspected:Correct By: co ent:The Continental deli unit has employee drinks stored in it. Store all employee drinks in a dedicated employee t rigsrator to prevent cross contamination. 1/24/2007 Risk Level: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold Holding FAIL Critical RED Permit Number: Comment:The Frigidaire freezer in front has a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. BHP-2007-0343 Status: VIOLATION #of Critical Violations: 5 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. Jan 25,2007 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Goo,046tail Practices (Blue Items) Violations Related to Food and Food P ection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require me . The walk in has uncovered food. All food in storage must be covered. immediate corrective action) T Continental deli unit has uncovered.All food in storage must be covered. Equi nt and tensils FAIL Non-Critical BLUE omment:The dough machine and floor around needs a thorough cleaning. canop ner needs a thorough scouring. �re walk in oor and walls have an accumulation of food debris,spills and splatter. Thoroughly clean the walk in floor and walls. The p' at ings reach in needs a thorough cleaning inside and out. Th i oven needs a general cleaning. e Continental deli unit needs a thorough cleaning inside and out. �tWe fron ngidaire freezer has an accumulation of food debris. Thoroughly clean this freezer. table here the steam table is needs a thorough cleaning. T lat to grill has an accumulation of grease. Thoroughly clean the flat top grill. T ood filters need a thorough cleaning. The GE freezer in the basement not working. Repair this unit to good working order or remove. T front Pepsi Beverage air unit needs a thorough cleaning. T flooring throughout this establishment needs a thorough cleaning. Physical Facility FAIL Non-Critical BLUE C menta The shelf behind the pizza prepare needs to be repainted. 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 25,2007 ) Page 2 of .- Item Status Violation Critical Urgency 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. Jan 25,2007 ) Page 3 of IMPORTANT MESSAGE , FOR 'E�k 11 -DxuI.o/ DATE ��-`�/�� TIME M OF PHONE AREA CODE NUMBER EXTENSION O FAX U MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED �I PLEASE CALL CAME TO SEE YOU ( WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL II WILL FAX TO YOU MESSAGE�l O 17- 6=� Wr n SIGNED y FORM OR W4rA9 i •Hlm\,s i ns CLL 8-7m)45 �-k p 9yt�! so oeb 1\.b @c% �awnsa�n� � -��•t> Stse� 1�3,1So�{\� S310N Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2007 ESTABLISHMENT NAME: Salem House of Pizza File Number:BHF-2004-000028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0343 Jan 5,2007 Dee 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES (December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 ` CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 4D TEL 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTx� HIA!(S/C {Piz'?, t TEL#��•�L� C?L?f 7� ADDRESS OF ESTABLISHMENT A ) r--,V r o '5' I FAX# MAILING ADDRESS(if different) EMAIL--Business': t Owner's. OWNER'S NAME D er? � all Im pp TEL# /_ 17- ADDRESS 3 ,f�<�/714,M �CVi�/ea6-qt/�0 �a � h"�.2 t/I11-.- STREET A�J CITY STATE zip t CERTIFIED FOOD MANAGER'S NAME(S) /W. 4-&1 CERTIFICATE#(S) (Required in an establishment where potentially hazardous food its prepared) /f ` J EMERGENCY RESPONSE PERSON r k5z zllr ' hA ; d- /Y Ad"I HOME TEL# G j� S 7- } 3 73 DAYS OfOPERATION Monday Tuesday Wednesday The all Friday Saturday Sunday HOURS riteinOPERATION /tt /t fll f�ll �r !` Pieasewnteintimeoleay. J (for example 11am-11pm1 i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES'p NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO loss than 25 seats 100 25-99 seats =$T5 more than 99 seats =$200 .... ... ...... - ----- ----- --- --- ------......... ..._ . - ---- ---- ------..------ ---------- ---.... BED/BREAKFAST YES NO $100 - ------ ------- -------- --- _ .... .... ..... ..._ .......-....... .......... -- ----------- -- ...... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO/ $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NOV $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 MGI-Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have filed a state tax returns and paid all state taxes reaisred under the law. dfV //�/ Signature Date Social Security or Federal Identification Number -------------------- - - ----- --------------------- ------ ---- Revised 11/13/06 FOODAP2007 adm Check#&DIte l.— 1 % PORTANT (MESSAGEE FOR cl. M OF 1//7 PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU {� RUSH RETURNED YOUR CALL �) WILL FAX TO YOU MESSAGE✓,( r 4 - 4 SIG NED � /FORM 4005 MARE IN U 5 5 V NOTES -- -- - ---r - 176vs-e el m, `1zr�ca r - I _ I _ . II t IP� + ' I AI # I � r I r f i I I{ 4 I f � i CITY OF SALEM BOARD OF HEALTH Name of Establishment: Salem House of Pizza Address: 23 Endicott Street Owner(s): Mohammad Alam, Sher Shah Phone: 978-744-0017 Date: October 30, 2006 Following the investigation of a complaint at this establishment, Senior Sanitarian Janet Dionne attempted to speak with the Person in Charge, PIC. However, at that time the owners were not present and no employee was acting as the PIC. Therefore, the owners were asked to speak to the Health Agent about the necessity of training an employee in sanitation techniques and operation of the establishment so that, in their absence, that person will be responsible for the operation of the establishment. The owner agrees to designate a long-time employee as the PIC in their absence, and to give him the necessary training. 16 - 30 .0(i Joanne Scott Date Health Agent �® Z4. h .- - J Mohammad Alam, Owner Date S Shah, Owner Date M Commonwealth of Massachusetts lopCity of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Salem House of Pizza File Number:BHF-2004-0028 23 Endicott Street Salem MA 01970 LOCATED AT: 0023 ENDICOTT STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0197 Jan 3,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health (}�K. � ; — V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 10 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH I s 120 WASHINGTON STREET, 4TH FLOOR lk,(Dk4�8� SALEM, MA 01970 TEL. 978-741-1800STANLEY J. LISOVICZ, JR. FAX 978-745-0343 �MAYOR WWW.SALEM.COM Q /1 JOANNE SCOTT, MPH, RS, CHO O j /(/�///J/ HEALTH AGENT eog9oOFSq�FOf 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT yF9<y NAME OF ESTABLISHMENT <AlLG vI A/0 if.t /= Y%Z7-6 TEL# 1178-71-( 11 - --�- I -) ADDRESS OF ESTABLISHMENT 23 �✓ /c� d-T S/��Ei/I /y/f� o) �-� p MAILING ADDRESS (if different) OWNER'S NAME/YJONi7I11/17,� D ALl9/+7 l" d7fF411 TEL# G/ 7- 5-1- ADDRESS 9 -C-2 CITY a. Ala W4-.,-7 STATE lz--� 4 ZIP of Lr / '1 i CERTIFIED FOOD MANAGER'S NAME(S)MOHf)MmAD A[F/n'10ERTIFICATE#(s) 3So 90'7-) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Sf/ 2 _rl-1914 HOME TEL# (9/7 176�73�3 HOURS OF OPERATION: Mon.//-// Tue.&-//Wed.//-// Thu.//-// Fri.// (1-Sat.//- 12- Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 seats =$150 more more than 99 seats =$200 - ------------------------------------------------------- BED/BREAKFAST YES NO $100 ----------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES N $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., 171�'64 � //)o i/-3a -m-)' ss - 083 � 1/l ')) Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date 1 —2�.. /l—,3 - — b, i 414W OWN >�_` INS X15' •C; nb 'j4'-u+ ':SYrC .h'�'53f f;:� 7� Nst!A:C' +�.• 7' L✓ 4='� fZ: r ',Lhti:.+:�+'.',-':.c1..i�ir-,� e, ::' ..�,..�_ '..rv.,rry ,yy.,;,.,ul�,{q i•.-. . . ,,�;+ ',°'l.a-�'.;'I�`J"`''�-.;:��l^. .sai, *�'t� �,f.'.G??�„�.�ti tl-„1::;+'s}�G' 'i i i / rr 11 11 If "�:,'',`rA. �✓yf ./I�l 1rrr.�r✓J'fly/•//%/1%� J+�'�1i�q✓✓"J, ::. r: :.COURTDOCID:TNO:' - - ::., ::.: T'+CITAX ' l/Y/lfl/J/✓,JX!/ ✓✓✓/f f✓1'/!/ / r .i;:.. ,., CITY OF.SALEM 4 b N _ VIOLATION /✓. ✓I✓�r/ /✓!/✓ %.'f✓l1J//1l/l, ✓ NAME - .\. �\\��•\\�'\�\�'\'\\,ITi.� [LAST,SF.FIRST,INITIAL) sf�✓rf ✓ i f . ..✓ 1 rr✓rr��; I Sll�-k a, 1)ov5I of a%uA �. f//, ff✓✓s!/A'l.�`t/.,r'/fff>I✓✓ff/✓✓ ✓. STREETADDRESS CITYrtOWN STATE LP LICENSE NO. _ X TE DATE OF BIRTH r/, i0�'ffffffi�,li�`✓I///✓,.'Ifl,:',/f/f// -0O ',!, / ,/�f ✓ f✓, ✓'/ . : , OWNER'S NAME(LAST,FIRST,INITIAL) I .� orf rf/.//✓ ` /% :' . : i.�'%,i�%.C"%'.;:. e- R�.d�d'1'1 � h'10��'(�M�{� ' s,w '' �\.\,� ,��^\' •^ W �` STREETADDRESS CITYROWN STATE ZIP `. C.._ rn�'•- ` Z3TEt� is !'/ ✓,%//✓®f„ /, !% ..:'/%Dp ' . , ,..:,, ,� \-� \ �•, N N F' REGISTRATION NO STATE EXP DATE MAKE/TYPE YEAR 1COLORJ ITIME 0 , r V -�.:i - _-,/ ✓ J, � _- A=p,� :. -ZDAeTE OF VIOLATION TIME DATECITATION WRITTEN IwL Oyy C9'.`I QRbYES u PMONO Vlp.' S LOCATION OF VIOLATION N mm LOCATION DEPT. W - ^ " ' s' �% �p%_'I'„ OFFENSE 9•lW sT�lR,i- X71 AP. SECT. FINEST �.'„ ,:\ . . \ zSPA J 1 41 B49 fL 1 c> OFFICER I D.NO. TOTAL O 7.�FINE I�CYe DUE 1 un G O FICER CERTIFIES COPY GIVEN TO VIOLA�r �LS.VJ• IN HAND i Url 1 X '�� ❑ BY MAIL I \ DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY I ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK TTI CITY HALL 93 WASHINGTON STREET I� SALEM,MA 01970 O TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE SIGNATURE 9 7Dj G - SEE OTHER SIDE FOR FURTHER INFORMATION I m c ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL N 3 Ln i Bx� 1 9E r 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 744-0017 Equipment and Utensils FAIL Non-Critical BLUE Owner: .. . Comment:The door on the tall white freezer in the basement is in disrepair. Repair or replace the door. Mohamma Alam -Sher Shah PIC: The door on the long white freezer in the basement is in disrepair.Repair or replace the door. Sher Shah Owner is has ordered one new freezer and is working to replace the door on the other freezer. Inspector: David Greenbaum Date Inspected:ICorrect By: 9/18/2006 Risk Level: Permit Number: BHP-2006-0197 Physical Facility FAIL Non-Critical BLUE Status: Comment:There is a gap at the bottom of the back door. Provide a sweep on this door. SIGNED OFF The front door and screen door do not close properly. Seal this opening. #of Critical Violations: GENERAL COMMENTS: 0 Time IN: Time OUT: 831:AII other violations cited in the 9/6/06 inspection report have been corrected. 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. Sep 18,2006 ) 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 18,2006 ) Page 2 oft M 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: L PROTECTION FROM CONTAMINATION 744-0017 Food Contact Su ria leaning and Sanitizing FAIL Critical ❑d RED Owner: 7/gencePrtactices t:The cutting boards are stained and scored. Resurface or replace all cutting boards. Mohamma Alam -Sher Shah PIC: slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Sher Shah coo FAIL Critical ❑J RED Inspector: _ Com : Employee drinks found stored in the Pepsi reach in. Employee drinks must be stored in a dedicated employee David Greenbaum ref' erator and consumed in the dining room to prevent cross contamination. If the Pepsi is now the employee refrigerator all ood or drinks that will be consumed by customers must be removed. Label the unit"Employee Refrigerator Only" Date 2006'cted: Correct By: 9/13/2006 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) . Hot and Cold Hol g FAIL Critical J❑ RED Risk Level: menta The Pepsi reach in has a temperature of 70'F. Repair unit to maintain a temperature of 41°F or below. Permit Number: BHP-2006-0197 Status: PARTIAL COMPLY #of Critical Violations: 3 . Time IN: Time OUT- Urgency Deschption(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. Sep 13,2006 ) Page 1 oft ` Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to ` Equipment and U ds FAIL Non-Critical BLUE Foodborne Illness Interventions and Risk Factors(Require mment:The walk in shelving has an accumulation of grime. Thoroughly clean all walk in shelving. immediate corrective action) T pi reach in needs a new visible,accurate thermometer. T shelf above the meat slicer has an accumulation of grime. Thoroughly clean the shelf and all dishes and utensils that at on the shelf. T nsul system hood filters need a thorough cleaning. , rhe door on the tall white freezer in the basement is in disrepair. Repair or replace the door. The door on the long white freezer in the basement is in disrepair.Repair or replace the door. Physical Facility FAIL Non-Critical BLUE Comment:There is a gap at the bottom of the back door. Provide a sweep on this door. The front door and screen door do not close properly. Seal this opening. GENERAL COMMENTS: 810:A final reinspection will be conducted on Monday, September 18, 2006, all outstanding violations to be corrected. 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. Sep 13,2006 ) Page 2 of 0023 ENDiCOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 SeparatiZSegreioN Protection FAIL Critical 0 RED Owner: he Kelvinator freezer has meat stored directly on top of bread products. All PHF must stored separately from RTE to Mohamma Alam -Sher Shah s contamination. PIC: Food Contact Su s Cleaning and Sanitizing FAIL Critical d❑ RED Mohammad Alam C menta The sanitizer throughout the establishment found to be too weak. Sanitizing solution of proper concentration MUST be Inspector: adily available at all work stations at all times. David Greenbaum All cutting boards are stained and scored. Resurface or replace all cutting boards. Date Inspected: Correct By: 11�- 915/2006 L_Phty'knives found stored in the deli unit.All knives must be cleaned and sanitized and stored in an appropriate knife rack. Risk Level: T eat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Permit Number: The kWand tongs in the cookline have an accumulation of grease and grime. Knives and tongs must be properly cleaned and BHP-2006-0197 0ized at least once every four hours. Status: The ay sink is not being used properly. The 3 bay sink MUST be used in a three part system to wash,rinse and sanitize all VIOLATION as and utensils. Relable the 3 bay wash-rinse-sanitize. #of Critical Violations: Di nives found stored between equipment. All knives must be properly cleaned and sanitized and stored in an appropriate knife 7 ck. Time IN: Time OUT: Good Hygienic Practices F:� Critical ❑� RED Co ent: Employee drinks found stored in the Traulsen reach in and th Pe i reach iYn�i-Employee drinks must be stored in a Urgency Description(s): icated ployee refrigerator and consumed in the dining room to prevent cross contamination. BLUE: Violations Related to Good Em Yee prescription found in the walk in. Personal items such as prescriptions must be kept in a designated employee area to Retail Practices (Critical vent cross contamination. violations must be corrected immediately or within 10 Employees Aloe Vera Gel found stored in the Pepsi reach in. Store all personal items in a designated employee area to prevent days)(Non-critical violations 5ja<s contamination. must be corrected immediately Handwash Facili es FAIL Critical J❑ RED or within 90 days) mment:There is no soap In the ladies restroom. Provide soap in the ladies restroom at ALL times. i 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. Sep 06,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CHEMICALS Violations Related to Toxic Chemicals - FAIL Critical 91 RED Foodborne Illness Interventions and Risk Factors (Require co ent:Chemicals found stored in the cookline with RTE food. Chemical must be stored in a separate designated area for immediate corrective action) emical storage. NO food is allowed to be stored with any chemicals. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold Holding Iq�J FAIL Critical QQ RED Comment:The Pepsi reach in has a temperature of SO°F. Repair unit to maintain a temperature of 41'F or below. T tall w ' as freezer in the basement has a temperature of 10°F. Repair unit to maintain a temperature of 0°F or below. The Ik in had a temperature of 55°F. Repair the unit to maintain a temperature of 41°F or below. 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. Sep 06,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Foo Protection FAIL Critical BLUE mment:The walk in has food stored directly on the Floor. All food must be stored at least 6-8 inches off the floor. Th ontinental dell unit has uncovered food. All food in storage MUST be covered. Equipment and U ns Is FAIL Non-Critical BLUE C ment:The pizza roller has an accumulation of food debris. Thoroughly clean and sanitize the pizza roller. a cheese containers have an accumulation of grime. Thoroughly clean and sanitize the cheese containers. & .The walk in shelving has an accumulation of grime. Thoroughly clean all walk in shelving. _ T alk in needs a thorough cleaning including under all racks. T ca ener has an accumulation of grime and food debris. Thoroughly clean the entire canopener including the holder. T pizza reach in needs a thorough cleaning. The same it needs a new visible accurate thermometer. T re en reach in needs a thorough cleaning. Th dou machine has an accumulation of food debris. Thoroughly clean and sanitize the dough machine. Th ails near the meat slicer have an accumulation of food spills and splatter. Thoroughly clean the walls. The shelf above the meat slicer has an accumulation of grime. Thoroughly clean the shelf and all dishes and utensils that at on the shelf. -Th all pizza toppings unit has an accumulation of food debris. Thoroughly clean this unit. T pizza oven has an accumulation of food debris. Thoroughly clean the oven. T elvinator freezer needs a thorough cleaning. T same unit needs a visible accurate thermometer. -The Ansul system hood filters need a thorough cleaning. T microwave needs a thorough cleaning. T fryolator has an accumulation of food debris. Thoroughly clean the fryolator. T Cont' ental deli unit needs a thorough cleaning including the top,bottom and the door gaskets. 7h to Table has an accumulation of food spills and splatter. Thoroughly clean the steam table. - T Frigidaire freezer has an accumulation of food debris. Thoroughly clean this freezer. 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. Sep 06,2006 ) Page 3 of 4 Item Status Violation Critical Urgency The cookline has an accumulation of grease. Thoroughly clean the entire cookline. Professional cleaning is in order. Th ixtuis in the men's room need thorough Cleaning. Th enmore freezer in the basement needs a thorough cleaning. T freezer in the basement that is not working must be repaired to good working order or removed. The door on the tall white freezer in the basement is in disrepair. Repair or replace the door. (1� a long white freezer in the basement needs a thorough cleaning. The door on the same unit is in disrepair.Repair or replace the door. Physical Facility FAIL Non-Critical BLUE \ C ment:The back door found open. All openings to the exterior must be sealed. ,LThere is ap at the bottom of the back door. Provide a sweep on this door. "'TTTTT T is a missing light sheild above the pizza oven. Provide a protective cover on this light fixture. The re water stained ceiling tiles above the cookline. Investigate the source of the leak and repair. Replace all stained ceiling ti Th sem nt stairs have an accumulation of food debris and grime. Thoroughly clean the basement stairs. .The sement is in need of a complete cleaning and reorganizing. Remove all items that are not pertinent to the business. T entire establishment is in need of a thorough cleaning,including under and around all equipment. The front door and screen door do not close properly. Seal this opening. GENERAL COMMENTS: 776:Reinspection will be in one week, all violations too be corrected. 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. Sep 06,2006 ) Page 4 of COURT DOCKET NO. CITATION NO CITY OF SALEM P C o I VIOLATION NOTICE U q NAME(LAST,FIRST,INITIAL) SCALY lr, ?Q-2A STREETADDRESS CITY/TOWN STATE ZIP L3 1 a7,cc s Srv'�o' LICENSE NO LIC EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) Auv%--, . tticm(ah-vn6\ STREETADDRESS CITY/TOWN STATE ZIP Z3 T`ztu p-' ,,, -Tz( 4=' 1N REGISTRATION NO STATE I EXP DATEIMAKE/TYPE YEAR(COLOR DATE OF VIOLATION TIME DATTEE CIT`ATION WRITTEN IwuFv AL <Ao OYES LOCATION OF VIOLATION ENFORCING DEPT OFFENSE CHAP. SECT. FINES B D IT.. OFFICER I D.NO. TOTAL FINE $ ^ DUE OF ICER CER. IFIES COPY GIVEN TO VIOLATOR r I IN HAND X ElBY MAIL INT DO NOT MAIL CASH-PAY OF LY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL City of Salem, Massachusetts -A. Fire Department r� 48LaayecreStreer � ` 'n � � Salem, MassaehufetU 01.970-3635 , �� l 'Davuf 1 U ('ddy Tel 978-744.1235 fire m� CFie �9ureau uteau FaX 978-745-4646 978-745-7777 9%6.744 6990 d'afyQ�'so(rm[nm Salem House of Pizza 23 Endicott Street Salem, MA 01970 ATTN: Owner/Manager MAINTENANCE,CLEANING,AND TESTING OF FIXED FIRE EXTINGUISHING SYSTEMS. MAINTENANCE,CLEANING OF HOOD AND DUCT SYSTEMS WHERE COOKING GREASE IS GENERATED................. The Salem Fire Prevention Bureau requires that all hood and duct Systems are to be cleaned from the cooking area(hood)in the kitchen, all the way to the extreme end of the duct THIS CLEANING MILL OCCUR ON A QUARTERLY SASH A certificate showing the name of the company,the person, and the date of the cleaning shall be posted near the hood area. The certificate will indicate what work was performed,and will also Indicate areas not leaned. ALL FIXED FIRE EXTINGUISHING SYSTEMS ARE TO 8E TESTED AND CHECKED SEMI- ANNUALLY. THIS TEST WILL ALSO INCLUDE A TEST OF THE INTERIOR FIRE ALARM SYSTEM. The cleaning company and the fixed extinguishing service company shall file within(5)five days -after the work is performed, a report with the Salem Fire Prevention Bureau of all their activities relative to the above listed systems The report shall also list any and all deficiences of the systems and the remedial action to be taken. Failure to adhere to this public safety requirement will result in the shut down of the systems. Prior to resuming operations an inspection will be -conducted by this office. Per Order, augnnr 7o 7nnx Lt. Erin Griffin Date of Conveyance Fire Marshal FORM SIR(4/05) CC: file Health Licensing Building ZO 39Gd HH31Vc1SIQ 38LI W31VS Z0069OL8L6 Zb:80 900Z/6Z/80 I. CITY OF SALEM t BOARD OF HEALTH —7 Establishment Name: ' lam_ YVl _�l }� o \1 'l _� Date: —1 - � D�o Page: I of sr Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I , �s�c� u>, �n � /'��mrl�ih-F -��✓i� � C�s/z��nor� ham a�'1ocL /G -i'Vq r4ll /'Ar77i7/AOC✓ Q7 4,//e rl� Ai) V�ld AD I �� Nis�oss� tir/h -z;y/ �Q 'y�P� !e �ojol On 'k"o I This Y I I irn�ays�� ! -�h�/ i�i�noir`i�h�r /�' �P9i�s�� /Y/Us•' � /7 774 1 �— = Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and,to ❑ Re-inspection Scheduled ❑ Emergency Suspension 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 6 your food permit. �� •� �r 0 Voluntary Disposal 0 Other: PHFs Krcervecl!t"Fenwer.nurec Violations Relarea to Frodborne illness lnterveniions and Risk .^.uxnding to l:tw Cooled to Factors(Items 1.22) (Cont.) 4i`r',145'F'oeiddn 4 hours. " PROTECTION FROM CHEMICALS 3-:,0 .15 C:t,almz Methods for PHFs j 13 Food or Calor Additives j 19 PHF For:rd Cold Holding 3-501.16M, Calci P1 IF., MainGdncd at or below 3-202.12 Addiowe,' 3-3()2j4 Protecnt»t fmrn Unapnroeed Acidan-es" I I z Siil Ifi(a) !int Pi-IFs Maintaiued at or aboNe 15 Poisonous or"toxic Substances -1 Ol.l 1 Identit_nne infrxmoitum-Ori;-mut ( 3-501.16(A) Roasts Held a;or above I;0-T, i'ontainer,* ' 21) Time as a Public Health Control 7 102 11 Common N'+rue-Working Containers" Time as a Public health Conholx 17-7fi I.II Separation-Stat age' 590.004(1d) Variance Requirement ! 7.202 1 ! Re,tricrion-Prescncc and Use" 12 Conditions of Use" REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7--?03.1 I Toxic Cu.Criier -i-Chip kali' POPULATIONS QHS?) ?-204.11 `'anitizers.Crnena--Chemiads- Produce, ! 21 3-50!.I I(A) Unpi:;teunzcci Pic-packaged Juice,and :'- 01.12 Chemicals sur Washing Criteria' j j 7-204.1-1, Drying Agents.Criteria': I ( BevelluIca with W armne I,;:hels'. ' 3-SOL I UBI Use of Pasteurized 1-ges 7�(1S a 11 htcidental Food Contact.Lobrican[s' ( 3_gUt.l 10L ) Rau-orPlutiaAr C'ani.ed Anim:d Food and j %''06 1 l Restricted Use Pesticides.Critercl� Raw Secd Sroouts Non SenelL 7 20o 12 Rodent Bait Stations' 7 206.13 Tracking Puwdera. Pest Control and I 3-fiUl.!!(C) (innpcnc<i Fans Package Not Re-served. Monitoring M CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS ' 22 3-60;A 1 Q LIMMICr Adt,Sary Nested r,-Ir Cansunrr,ian of l lfi Proper Cooking Temperatures for 1 Anhn:i! Fnods'friat we Raw. Un&I'LO ked 01- PHFs hkn Chi:erc.Ise Processed to F.!:minaie 401.IIA(1)(2) Eggs- 155`FISSec. Eyes-Immediate Service 145"F15sec* 3-302.!: Pasteurized Eggs Suhstitute for Raw Shell Eggs 3-401.11,A.)(2) Comminuted Fish. M1Reu!,,C� Egg'Game I Animal.;- 155-' 15 sec. 71 3-10t.IIiB I) o * SPECIAL REQUIREMENTS )( t-I Park and Beef Roast- t3O'F I_I :nun` 590.009iA)-(D) `diolnl:ons of Section 59Q00%AWD) in i 401.11(A)(2) R rtes.Injected Moate - 155'F 15 sec. : j catzrin^ nioNiefood,tempoiayand 3-401.!1(A)(3? P--sultry,Wild Game,Stuffed KfFs', n-sricatial Hitchen operations should bz en:ftinu Containina Fish,Meal, cicbitc:I under the appropturte sections Poultry of Rarites-1657 15 sec. above ii related to fo;dhorne illness 3=401.1 It r)(;) Whole muscle,Intact Beef Steaks intervention; 0,nd r:sk ;actors. Other 145"F* 590.009 violations relating to good retail 3--101.12 Raw Animal Foods Cooked in a ntactices should be debited under 1729 -- Microwave 1650F" i Special Requirements. 3-401.111%A)(l)(h) Ali Other PFWI - 145"F I sec. 17 Reheating for Hot Holding VIOLATIONS RZLATt"D TO GOOD RETAIL PRACTICFS 3-403.11i.A)-J)) PHFs It`5"F 15 sec. 1 ( (Items 23-30) -4403.11(D A9rcu+nvaee- lfi5` F Z Rhnute Standing! 1 Critirai and non-ori ieal I iolallons, which to,rut w1we m r$c Tome* ! /orzahnr'nc d?rvcs.s anei venri,ns and rick fa<+m'.t I15Ic111 obor+r, tar be 3-403.1 1(C) Commercially Pitwessed RTE Food- finwd in du,fnllru-icrg seciiole,srthc Food Cade or+d 1015 CIrIR 140.'F:' j 590.6tt0. ----------- 3-403.11(L) Reimaning nt Coed RUnchced Portions of Beef I Heetail Practicer FC 599.000 Roast"* 1 23. Pm Panaee ��nt and P rsonielFC-e .003 j 18 Proper Cooling of PHFs 24 Fcod and Faad Prete--tion FC - 3 004 25. Fruicmen'srld Utensils FG-4 1 005 ! 14(:1) Cooling Ctx>ked i'HF,from 110'F to ,; ------ 2„ Mata:, Pimnh;rq aan,Warta FC-5 OOb _ 70'F Within 2 flours and From 70'F 127. Phys!oal FaciRv rr,-6 .067 I to 41"Ff45`F Within?Houck. '" I 28, poiso:-ous cr Tox,t klalerials FC- 7 .008 3-:101 I+tBI Cooiina*P1IFs Made iron Ambient 29. oDectal Requlremuiss 009_ Temperature htgredients to dt"F/45-F ( 30. Other Within 4 Hours* I,.,:n,.,r+ `toenorr:.critical icni m int iI,jeril I99a Pond Code or 105 CNIR 590 n00. COURT DOCKET NO. Q CITATION NO. CITY OF SALEM nCI O^ $ VIOLATION NOTICE r NAME(LAST,FIRST,INITIAL) STREETADDRESS CITY/TOWN STATE ZIP LICENSE NO LIC EXP DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) ALY)YY1 Tnognn,rnA STREETADDRESS CITY/TOWN STATE ZIP 13TEtvm5wl �.A,\_ RW2LFAJ6 Inc) 01152 REGISTRATION NO STATE I EXP.DATE MAKE/IYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN RR"ONA NIEIAM UREl YESV 3 .®PM �1 ' 14 G5 ❑NO LOCATION OF VIOLATION ENFORCING DEPT. Z3 Lot3 IcA?i- 's- i3.o- 14 OFFENSE ICHAP SECT FINES ASh: 471. 1 7 FY 6it. �l B V 1aL11 i�ocaC T4 �l-i . S i RTS OFFICER(' �(( I.D.NO.�- TOTALI$I-1�^V'�1:>C.• iv�� i'r, DUE lJ. '��7 OFFICER CERTIFIES COPY GIVEN TO VIOLATOR �❑l IN HAND X # LTJ BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF S CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL �\\ -COURT DOCKET NO. �- .cfTAnoN No CITY OF SALEM PD 0j381 : - - :\¢� ` j `:�': •, j�" VIOUITIONNonCE NAME(LAST,FIRST,INITIAL) - � . ; SJALgY)r, HovsI& <3 Q1ZzA 2' c (fl STREETADDRESS CITY/TOWN STATE ZIP O Z3 rNp)(,oTT s-, mcg 01°110 (4( I LICENSE NO. I LIC.EXP.FyA / , IRTH I 1 I I _ OWNER'S NAME(LAST,FIRST,INITIAL) LU ALY')Yn Yr"ogA1'1,fzI'-a u F- I STREETADDRES$ CITY/TOWN STATE ZIP `^) D' j 23 TEWr.-,Siat 'RAIL MARLI>assl Inq oLls-L sQa i D' REGISTRATION NO. STATE EXP.DATE MAKERIII YPE YEAR ICOLORI I Ln TION TIM ATE WRrFrE [a DI�ATEOF7-1�0 j 3 E 19 AM PM IDII CD1Y N�5 N 1,1 wU El NO ❑YES / p LOCATION OF VIOLATION ENFORCING DEPT i 1 IZ3 ENDIwi- S.014 Er OFFENSE CHAP. SECT FINES 1 ❑ ZN 03: G T B V ioLCi�\c�W Tc> TC , S 1(STI,. PLL "' cto c 5 lea ^meq C �� m W N o CV ❑ ! iOFFICER I D.NO. TOTAL �Q (` FINE d I$'�S• � I n O ¢ ❑ I 'J' V'��. r( J � DUE fw00m a _ Q=z .a OFFICER CERTIFIES COPY GIVEN TO VIOLATOR P, C� W J ❑ ❑ V'�'�/\ IN HAND P; m W N y JI� �� ) L/J BY MAIL B J \ O DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY a 4Q v ' ORDER OR BY CHECK MADE PAYABLE TO: N Q /'` S CITY CLERK IV Tu CITY HALL m �` 93 WASHINGTON STREET rn 0 V SALEM,MA 01970 TEL.(508)745-9595 X 251 •i ❑ I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON s, O) ' ❑ ' REVERSE,CONFESS 70 THE OFFENSE CHARGED,AND ENCLOSE 3n3 a PAYMENT IN THE AMOUNT OF @ o LL $ CASE# WO .Y 2� = Q I.-1E co a SIGNATURE ' Y t >-o O SEE OTHER SIDE FOR FURTHER INFORMATION Y >- LL ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 4 r 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 Handwash Facilities FAIL Critical RED Owner: Comment: The back handwash sink found obstructed. Keep handwash sinks clear and accessible at all times. DO NOT store Mohamma Alam -Sher Sha anything on or near the handwash sink. PIC: Violations Related to Good Retail Practices (Blue Items) Mohammad Alam Equipment and Utensils FAIL Non-Critical BLUE Inspector: Comment: The cookline has an accumulation of grease and grime. Thoroughly clean the entire cookline including under and David Greenbaum around all equipment. Professional steam cleaning is in order. Professional cleaning must be completed before the next routine Date Inspected: Correct By: inspection. Keep invoice for cleaning for inspector to see. 2/16/2006 Risk Level: GENERAL COMMENTS: 489:Keep up a daily cleaning schedule to insure proper sanitation. Permit Number' BHP-2006-0197 All other violations cited in 2/9/06 inspection report have been corrected. Status: SIGNED OFF #of Critical Violations. 1 Time IN: ?- Time OUT. Urgency Description(s)' BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected' immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Laurlers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Feb 21,2006 ) Page / of 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. Feb 21,2006 ) Page 2 oft 0023 ENDICOTT STREET Salem House of Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner. Comment: The metal disks and squares used separate pizza trays have an accumulation of grime. Thoroughly clean and sanitize Mohamma Alam - Sher Sha all metal disks and squares after each use. PIC: No sanitizing solution available near the meat slicer. Provide sanitizing solution of proper concentration at each work station at all Mohammad Alam -/times. Inspector: The front cutting board is stained and scored. Resurface or replace the cutting board. David Greenbaum Date Inspected: Correct ByThe meat slicer needs a thorough cleaning and sanitizing. 2/9/2006 All pizza topping containers must be cleaned and sanitized after each use. Product must be rotated out with the old product on top Risk Level: of the new product. Permit Number: The tongs for the steak tips must be cleaned and sanitized at least once every four hours. BHP-2006-0197 Prevention of Contamination from Hands FAIL Critical ❑d RED Status: ---� Comment: Employee drinks observed in food prep areas. Employees must eat and drink in designated employee area to prevent VIOLATION cross contamination. #of Critical Violations: Handwash Facilities FAIL Critical ❑d RED 4 —� Comment:The back handwash sink found obstructed. Keep handwash sinks clear and accessible at all times. Time IN Time OUT. ___� The back handwash has no hot water. Restore hot water to this sink immediately and maintain at all times. Urgency Description(s): TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) BLUE: Hot and Cold Holding FAIL Critical RED Violations Related to Good \ Retail Practices (Critical v Comment: The small pizza topping cooling unit had a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. 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 Launers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 13,2006 ) Page 7 oft Item Status Violation Critical Urgency I RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Equipment and Utensils FAIL Non-Critical BLUE Foodborne Illness Interventions and Risk Factors (Require JComment: The Traulsen cooling unit has an accumulation of food debris and grime. Thoroughly clean this unit. immediate corrective action) he Continental deli unit in front has an accumulation of food debris and grime. Thoroughly clean this entire unit inside and out. \\ The front Frigidaire freezer has an accumulation of food debris. Thoroughly clean this freezer. �J Provide wall hung paper towel dispensers in the restrooms. � The wall behind the pizza cooling unit has an accumulation of food spills and splatter. Thoroughly clean this area. r. The cookline has an accumulation of grease and grime. Thoroughly clean the entire cookline including under and around all \ equipment. Professional steam cleaning is in order. vThe basement floor and stairs have an accumulation of food debris and trash. Thoroughly clean the fllor and stairs. GENERAL COMMENTS: 472: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 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 13,2006 ) Page 2 oft 0023 ENDICOTT STREET Salem House of Pizza City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-0017 _ Food Contact Su ces Cleaning and Sanitizing FAIL Critical ❑� RED Owner: C ment:There was no sanitizing solution or the sanitizing solution was too weak throughout the establishment. Sanitizing Mohamma Alam -Sher Sha olution of proper concentration must be readily available at all work stations at all times. PIC' Mohammad Alam - Prevention of Contamination from Hands FAIL Critical RED Inspector: Comment: mployee making tuna without wearing gloves. Gloves MUST be worn when handling or preparing ready to eat foods. David Greenbaum Hand Fa ' ies FAIL Critical ❑d RED Date Inspected. Correct By: It mment: The back handwash sink is missing soap. Provide soap in a wall hung dispenser at this sink at all times. 10/27/2005 Risk Level: counter handwash sink has oil stored around it. Keep the handwash sink clear and accessible at all times. The men's room is missing employees must wash hands sign. Provide a sign in the men's room stating"Employees Must Wash Permit Number: Hands Before Returning To Work" BHP-2005-0118 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Status: Time Asa Puc Health Control FAIL Critical d❑ RED VIOLATION C mment:Steak out thawing at room temperature. Potentially hazardous foods must be thawed under cold running water, in a #of Critical Violations: efrmerator or in a microwave,NOT at room temperature. 5 . 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®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 28,2005 ) Page I of 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 cment:The counter Continental reachin has uncovered food. All food in storage must be covered. immediate corrective action) Won, a milk crate. Store loose onions in a cleaned,sanitized container. Equipment and U sils FAIL Non-Critical BLUE t^x`C ment:The dough machine has an accumulation of food debris and grime. Thoroughly clean and sanitize dough machine. —T ra en cooling unit has an accumulation of grime. Thoroughly clean unit inside and out. Th a ener has an accumulation of grime. Thoroughly clean canopener. T walkm floor has an accumulation of food debris. Thoroughly clean walkin floor. T pi refrigerator has a broken thermometer. Provide a new visible,accurate thermometer. abel 3 bay sink"Wash-Rinse-Sanitize" e to eiththe roller has an accumulation of food debris. Thoroughly clean table and roller. T 'e ator freezer in front needs a visible,accurate thermometer. T Co nental cooling unit at the counter needs a visible,accurate thermometer. e same unit needs a thorough cleaning inside and out. Th rigidaire freezer has an accumulation of food debris. Thoroughly clean freezer.The same unit has a broken thermometer. plac the thermometer with a new visible,accurate thermometer. e micr wave needs a thorough cleaning inside and out. ` T ood filter have an accumulation of grease. Professionally clean the entire Ansul system. The entire cookline has an accumulation of grease and grime. Thoroughly clean the entire cookline.Professional cleaning is in order. t T e re freezer in the basement needs a visible accurate thermometer. T sanitizing log was last filled out on813105. Sanitizing log must be completed on a daily basis. Physiral Facility FAIL Non-Critical BLUE C ment:There are open spaces and water damage on the kitchen ceiling. Investigate the source of the leak and repair. Replace mis ' Facility ceiling tiles. - T flooring throughout the establishment has an accumulation of grime, grease and food debris. Thoroughly clean all flooring, cluding under and around all equipment. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 28,2005 ) Page 2 of Item Status Violation Critical Urgency Th sement stairs have an accumulation of food debris and grime. Thoroughly clean basement stairs. .., he nt prep area has an accumulation of grease and food debris. Thoroughly clean under front prep area including all e ipment. Spe Requirements FAIL Non-Critical BLUE Co ant:There is an infestation of fruit flies in the kitchen. Owner will contact their exterminator to treat the establishment for t flies. GENERAL COMMENTS: 364:Reinspection will be conducted on 11/7/05, all violations to be corrected. Repeat violations will be subject to monetary fines of$25.00 per violation. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 28,2005 ) Page 3 of COURTDOCKETNO CITATION NO " CITY SALEM PD 4 4 1C VIOLATION NOTICE 13. V NAME(LAST,FIRST,INITIAL) 14kC,44 14ousX STREET ADDRESS CITY/TOWN STATE ZIP 23 &t4icarr S r� ..Mto:AA ,* o+p74o LICENSE NO LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) 14«Y14 - 144*14`,@AAAAQ SSTTR�}EETADDRESS`�aO y �9��.�CIT�Y//TOOW�N� .(STATE ZIP 2G J me",o &N . x*m- I'•i�•"'�[FI`C>_• m* Oft �- REGISTRATION NO. STATE EXP DATE MAKEITYPE YEAR COLOR DATE OF VIOLATION TIME I DATE CITATION WRITTEN PERSONAL /r' ( /? / ry AM / )) INJURY _ p(27/ft`T j� ' Lj14K ONO LOCATION OF VIOLATION ENFORCING DEPT - 23 6 /hfQico-PTs'G /So 14 OFFENSE CHAP. SE`s, FINES A / f"< "P6Af - t/tetAnt r C OFFICER TO /y�` D NO NE DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ffrl-14 HAND X ❑ BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 0023 ENDICOTT STREET Salem House of Pizza City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency TelephoneNon-compliance with: _ 744-0017 Anti-Choking PASS Owner: - Tobacco PASS Mohamma Alam -Sher Sha PIC: FOOD PROTECTION MANAGEMENT Mohammad Alam PIC Assigned/Knowledgeable/Duties PASS RED Inspector EMPLOYEE HEALTH David Greenbaum Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 11/9/2005 Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0118 Receiving/Condition PASS ❑/7 RED Status: SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations: - Conformance with Approved Procedures/HACCP Plans PASS ❑d RED 0 Time IN: I Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 10,2005 ) Page 7 of 3 ,.. Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION _ Violations Related to Separation/Segregation/Protection PASS ❑/ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS ❑/ RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑Q RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS ❑Q RED Cooling PASS Q RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑d RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 10,2005 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils FAIL Non-Critical BLUE Comments:There is an accumulation of grease and grime along the back of the cookline. Thoroughly clean entire cookline and backsplash. 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 GENERAL COMMENTS: 367:AII other violations cited in the 10/27/05 inspection report have been corrected. Due to the excessive amount of repeat violations cited monetary fines of$25.00 per violation will be issued. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 10,2005 ) Page 3 of 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 Type of Ooeration(s), Tvpe of Insoection Sft t�rti /fd I)Sr! nG _ 2��/6j J21 Food Service p-Routine Address Risk ❑ Retail ❑ Re-inspection 23 6mileirr sr Level EJ Residential Kitchen Previous Inspection Telephone 7Y4 A6j7 I int ❑ Mobile Date: Owner ❑ Temporary ❑ Pre-operation ;f4,#N r"*,1 A GAS A S 461 A <dyr,G I HACCP Y/N ❑ Caterer 1 El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector Jn In: [__1HACCP t MrI A 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. P evention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties 3. 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 FOOD FROM APPROVED SOURCE ❑ 15. Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection El20.Time As a Public Health Control I1J,9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 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 9 immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): !G 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 CHeaNh. 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 '26. Equipment and Utensils (Fc-a)(sso.005) cited in this report may result in suspension or revocation of 25. 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 (590.009) within 10 days of receipt of this or .er. 30. Other DATE OF RE-INSPECTION: �!, a S ssmn.: dFO�14 da Inspector's Signaturef c-�--_jS PIC's Signature: � Print: rr'ioIIFI/�7rnf?� ,qG f/r✓l JI PageofPrint: Pages/1/ G/r L � Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-rc"^raminanon j j 1 1 500.003(A) Assignment of Responsibility* j 3-30:.1 1(A (I) Rats- Amoral Foods Separated 6om 590.003(B) I Ucmanstr<nton of Knowledge* Cool cd zinc[RTF Fotxts'9 j 2-103.1 1 Person !n charge--dutic, Cooeim%nattorr,irom Raw lugredients j 3-30111'A)(2) k:v:rAnim.?: Fouls Sep.;ri led from Each EMPL.O"EE HEALTH I Ott:se: 2 590,00.,(;! Re,ponsiN I;ty of the person in charge to ( (3nnta;-r7aSint fnrn the Environment require repoitin by food employeesand 1 ( 3-102.11(A) Focd Pinlection, applicants' 3-302.1) tl:,shnng Fiuit:.[:nd Vegeiables j 590.003(F) Responsibility Of A Food Employee Or An 13-304.11 Food Contact r+ith Equipment and Appheant To Report To The Person In Utensils* Charge* + Con,a-,mirtairun from the Consumer 590.003(0) Repucting bg Person in Charge^ j 3-306.14(A)(ti) Retarn_d Food and Resen ice of F(xxl" j 3 59(IA03()l Ew!s;ions and Restrictions* � � D'sposrbcn of AdmYerated or Contaminated I 59p.OD3(Fj R:nu,v:d of Exclusiouc and Rcctricttons Food j 3-701.11 D�sc,cdiug o: Rccundttinnutg Uivafe FOOD FROM APPROVED SOURCE Fon`'i 4 1 iFord and Water Fre,r:Regulated Srurce.s ( 9 Food Contact Surfaces j 59U.004(A"B) Courpiiancc with Food Law 4-501.111 ,NIancel \V�u'cw.ish�n�_-Hut Water 3e"UI J;' uooilmat( r citleticaliy Sealed Contaiaer^ 11 ,xnitvation Tempa autres` I . I 4-531 11 R echm?��-al Wrirrwathin,^_-Ilul',V'irr -1W.1 3 Fiord �Milk:md Milk Products'" j 3-202.1: S;ell Eggs* Sanitization Tenmerannrs' 3-2,0114 Eggs and Mill, Product:.Pastemizcd" 4-501.?IY (`heroical Sanitization-temp..pH, j dt:ncrnlmann cord hardness >' 3-_'02.16 fa :vlade Prom Potable Drinkm>_(Oaten ( 14-601.11(.x) Equiputcni Foud Contact Surface,.and � j 5"101 It Driuk in,^_water from an Approved Svs!em* 590.006(2) Bottled Drinking Woter* j j T_Ileanio-)Fo:gl" j 4-6(t_ 11 Clear.:ng Frequency of Equipment FccKl- 1 590.006(B) \4atci Meets Standard; in 310 CMIi 22.0" Contact Surfaces and Utensils` I Shzllfish and Fish From an Approved Source j 4-702.11 1§cclnency of Sanitization of Utensils and 3'-:x)1.14 1- Aiand Recreationally Caught Molluvcan Fond Contact Suriaces of Equipment` Shellfish* 4-703.?I Methods ct'v;uutz;uion -Flo Water d 3-201.15 Matlusc.in Shellfish tram NSSP I�sted Chemica!-' I ` an ' Sources'' 10 Proper.Adequate Handwashing (Same;nd Wr%d Mushrooms Approved by ! 2.301 11 Clear Condition--Hands and.army" 1 j Reouiatory Authority 2-'_02.1T' ! Shellstcwk ldcmihcation Present" j 2-301 1) Ch-nml-Piucedurc" j 590.0t.*Q ',Vdd fvluchrnon r;s 2-301.14 Whca to V✓n40, 3-201.17 (Yime A,1111alS4, j it Good Hygisnic Practices g Receiving/Condition 2-401.11 Fati ng,Dr mknuc or Using Tobacco"" j 3-2)2.11 Pt1F.,,Received it Proper Temperaur"" 2-401.12 Disehargas From the Hycs,\ose and Mouth" � 3-202.:5 c _eehnegnty* 3-301.12 Prc:entingContamination WhenTasting 3-10':.l 1 ]-(F(mdSafe and Unadulterated" 112 Prevention of Contamination from Hands j j 6 Tags/Records;Shellstock 590 3-202.IS ShelWmk Identification ' .00x1 El Frevening Gttrtammatiun I;om 1 Empinoees^' 3-203.12 .She?istock Identification Maintained' j TagsiRecords:Fish Products 1 j t3 Handsvash Facilities j 3-402.11 Paasite Destcuc[ion" orlvenrenily Lrc=ted and Accessible 3 dty2.1'2 Rccords.CieaOun and Retenti:-n" j 5 203 11 NumbeCc.and Cacciisl t 59().(104(1) labeling of Ingredients' 5"ZO4.t Le+�t�tto:� and Fiace:aenY'" 7 Confrr,?ance with Approved Procedures `-=G5. 1 r.--cene:hility,Gper.n:o!t and alauucna;ce j !NAG CP Plans i I Dsvrces S'ppired.nlh Soap a:-d Hand Drymd 3-102 11 Speciulized Prnces,ing Methods" 6-30I.II Handtrashiue Cleanser.A,ailabiht9 j 3-50'.12 Rcdaced oxvgen packaging,criteua' j 8-103.12 C'or,tlrmanec with APprurcd Procedures' j 6-301.2- Hand iA'wmg Pruv:num j Denot<,en::c:!it:nue the federal 1499 rood(axle w 105 C'6-lk 500.000 l CITY OF SALEM y BOARD OF HEALTH / Establishment Name: S44No� 10f )UfAr of tit.TZ4 Date: a17/, f Page: Of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1 2+� �✓� + K Cr.WFr 44 WIr .J dar25 4 sTlVLweW# C� i.�s71�vmf .to eJr I (I' f aff tr 44.r tin/edwxdw ICow D_ Me "d O? in/ rfbA01-'a._ /Yuri' deb b&&,,k e! C �i tt IJ!'ett� t�ert l�iPl� r0ou6r lhi�J,� Nw �t'«tut.hCi�sa! .We XWO asSotr. ,. � �,� .r ca �� nl,l�,�.a� .rim su�rrrr+� a►/Rt'�L seer- (ria . � 9 (+ .S'�i0�r1L�. I 37PrLt�IJ /3es«G� eAt ur .s./O a�r3 Cis /Jtti i✓S'/Lx ro .4 4L GLa vvj;4 - � � S trlZt�n wsin .s�dtt�l7 trf tFPi'.��°.r..tlle" rGt�' ?J! �✓� `��F /B AhaY� Ar v� PAS ~n&r &_V_W S Geed"�_ [rt c^W4G- ANO Acusi—rte � �f14�1f .s-bJr/�rr✓d itr/I C'�+'JCt�M� U►Jri�' rtfr/1� �e� L' e.etA�df7 ./�tVO-J'.t+rilY�� '�� • �GE?Tf IeseC�S A•tro -%Ail ✓ttt6 ♦,J MOL& frI N/f*k MH OK F'dw aril — �+1t�1 k34 ct�. Y7M41�A6[d�� C46Mt Mt "CWe r 610 JTAZtt/oez d lty ws wfto .W fen M".4rl d of too'0 setas ,hra 40AW C/*£S� Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Ye� 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 I noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /Zi C� ItIu-N / `-7Jr 11 Voluntary Disposal ❑ Other: PHFi,Received of Semperatures Violations Related to Foodborne Inness Interventions and Risk Ac cording to Iaw Cooled in Factors(items 1.211 (Cont.) 4i`'Fi95 FWithin 4Howl. " PROTECTION FROM CHEMICALS ( 501 15 Cuolint;1%1ethrds for PHFs Food or Color Additives i 14 I (y PHF fiat and Cold Holding 3202,12 AdcfitF:en> 6i3) i 1 S01.1Cold PI IFN Maintained at or below 590.004(F! .i t''/45- F. f i-102.14 Frotzction from Unappruved Addit:ces+ ( 3-50'.16(A) hit PI-?FN Mai ntamerJ at or nboce 1.5 Poisonous or Toxic Substances ?-Ili l.li lrleaiifvmg lrformei;:o- Otiw!nal 3-501J(,FA) Rvat,i,Hrld :u.r}r abuse !30°F. ' Containers` 7-10111 Common Name-Working,Container," ' ( 21) Time as a Public Health Control 7=2'01 11 Separation-Storage"' ? r?t 19 'lime;x a Public Health Conavl* 7-?.02.11 deq.-ictn)n-Picseace and Use I `%0.004{i{) Variance Req_tremuri 7-202.1? Conditions of Use- 7?03.11 Toxic Containea: --Prohibitions,' I REOUiREMEN'iS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets,Cr;tena-Chemicals" I POPULATIONS(HSP) '04,12 Chemicals for Washing Produce,Crucria' I 21 3-801,H(A) Unpastcui ved Pre-packaged Juices and 7-204.14 Drying Agents.Criteria'' I Beect';;zes. vmh Warning Labels* i-2015 11 Incidental Food Contact.Lubrn•an!s` I 3-9():,f I(B) Use of P;3etenrizcd trees' 3-801.11;D) Raw or Po tially Corked Animal Fuad and 7-206,11 Rc:;tricted Use Pccticides.Criteria'" - 7 206.1)_ Rodent Batt Stations'" Raw�,Seed Slit, tint Served. 'h 3-801 1IfC) UnuPened Food Package Not Re-Ferried. ' 7.'_06,13 Tracking Powders P,st Control and Nlonituring° CONSUMER AVVISORY 22 3 4i'3.1- C'onsam:-Adtiso!v Posied for C'onsamlrtion of TIMEITEMPERATURE CONTROLS Aa mat 71"0& litat arc Raw.Undercooked or 15 Proper Cooking Temperatures for I PHFs Not thherais. Processed to Eliminate 3-401.i 1 A(U(2) Egg.- 1.55°F 15 Sec. P-tt:uPus.,` j Eggs-h'amediate Service 145"F15sec, 3-302.1 3 P„steuozcd F,ggs SubNtitutc for Raw Shell 3-1101.11(A)(2) Comminuted Fish,Nh9 ats k Game F'hg''` Animals- I55'•F 15 sec. " I SPECIAL REQUIREMENTS 3-40!.11(S)(i)01 Pork and BeclRoast - 130"F 121 min* 59n i)09(A)4D) Violations of Section 590.009(A)-(D) in 3-40i.1 l!A)f') Ratites, (njett•.;dA9eats - 155°F IS sec. " Laterint-, mobile food,temporary and -401.1 I(Ait3) Poultrg,Wild Game, Stuffed PHFs, rts3ricvtial kitchen operations should be Siufl m_,Cortainin Fish. Ment, debiieu under the appropriate sections Poultry in Ratites-!65'17 t5 sec. ^' abuse ii'TClatod to foodborne illness 3-401.!!(C)(3j %VNile-nimcle,Intact Beef S!eakN inrcrvent9on,.imd tisk factors. Other 145T' 590.0og s•ioiations relating to good retail 3-401,1_ Raw Animal Fads Cooled in a ptachces should Oe dehited under#29 -- Mwq)wave 165"F* I Spe.l,l R4quircinents. 3-401 1 I(Adl)(b) All Otho PHFs-- 145`F 15 see. 17 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4M.11(A)F(D) PHFN 165"F 15 sec. * I (petit,,23-30) 3-403,11(3) Microwave- 165`F 2 Minute Standing; ( Criiiial and non rrhical violotions, tiInch do not reiate to rhe Tinnc* .foodborne illne^e noelwentians and riskfn(tors listed abo;e, can he 3-403.!5(C) Commercially Pnxcssed RTF.Food - .found+•x the jolhnvirq;se¢t<ene.;ql the Food Cude and 105 Cb9R !-40'F' 590.400. 3-403.11(E Renw:nmg Unshced Portions of Rccf Item Good Retail Practices FC ! 594000 Roast," I 23. Md n igameni and Pe- trnne, FC--2 ! 003 18 ( Proper Coaling of PHFs I ( 24. Focd and Farr,'Prctect:on FC--3 ,004 j 25, Equiprncrit wc.Uiensds FC-, 04`5 -----� .'-501.141:1; C'nohng Conked PHFs front 140"F w 26. Wa:cr,FIu:TUrawnd caasre 1'C-5 ! 006 70"F Within 2 Hours and From 70'F 2l. Physca Fac:lii't FC -6 007 _-_- to 41`F745"F Within 4 Hoorn, '" 28. Poisonous or Toxic riateriels FG- 7 .008 i 3-501.14t B) Cooling PHFs Made From Atubtent 29, Special Requirements .flog -_) Temperature Ingredients 1,)41'F..... 1 ( 30. Other W;ffiin 4 Rotas L).nore<amcal Ocm ni ihr Ce,lual 1999 Fuud Code or 105 C'NIR 590000. CITY OF SALEM BOARD OF HEALTH // Establishment Name: r11-1_ C AA AlmsyA7 o6 PtO74 Date: 2�/otr Page: of Y Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified f PLEASE PRINT CLEARLY � -F 44rK ..-N .4 e-c f.AA4 u4011r7wn/ 6fP- /s r/J O.�.Z.S14 a P010 ,ells s/ CXR S'lior Il'siA3rd� w T Ctrl rrtz.� NAPr# -r'^/It .r ,t� rJiJ.e,rl..y.�_ /tes�.s lr et.o- ✓mss,'i ias ACAW$ I•f RlaC6 JQl� C.GS af✓.r.A� 7n Fl/ r SMI Prt wc�uAteX.NYer1 sPf Faeo 1/Owr**, ,D 94lumA. e7fn.v�drsfU� is' S'r�n ,rr9 rf>a+ffi✓Av . AA3d"vrur .au- ksl'[.eeW c�ilvT1e�R ✓/�in.4so, 1 '�'_/ r'_ • a�.,tJ' � sYs�'N aa,><an s+L67�as' d� .ar,r dacc..�rrtirvnAr ,..� rrr.��„r. OGM..nt�C 1 V Drrrllr. /Wg &A A /�NSGeC1r1NC�Ji1b G�.� rr.PVJ"/ ry Gttf/fN nw�,f nWiihd" d� s4sI3•'dG s'e/eVIE M. fi,LXIe�dr rh fX_ C�is,�wn�� .�r i._s.�ar a%teAf fhpl� 2 .✓/Cl' K.� /9tectS'�ti �d►ts A4 i 1c0o'4 tl c7frfXw�e verr DxaWD!£ A '49V 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/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo/ ❑ Emergency Closure your food permit. 1 ❑ Voluntary Disposal 0 Oth_e�r. �, I MIC; Ptir's Received it I'emperitures Violations Related to Foodborne Olrass Interventions and Pisx r\r,oa{i na to law Cooled m Factors(items 1-22) fCont.) 41°F744F Within 4 Hows. PROTECTION FROM CHEMICALS ' S0' S Ccolinp I\",eohnds for PHFc j ( 19 PHF Hot and Cold Holding (q Food or Color Additives i-Sr)1.1w B; Cold PRFs Nhtudatred at or bekla 3-202.12 Addiuves'r 591)004(F) 41 '745°F` 3-302 14 Protection from rfnapcm,vcd Adu:uves" 3-50L!G(A) Ifoi PHFc Ma;o1ai::ed at or abode j 15 Poisonous or Toxic Substances 1.t1)_F s: 7-101 11 blentityine Intbrmaroa - Onral ( ;-SUl.lh(:\: Ruasra FIcF.I 2,t or zbree l30'F. " Containers 7-102.1 1 Common Name-Working Containers' 21) Tne as a Public Health Control 3-501 to 'rimo"s a Public Health Control' 7-2101.11 Srpm anon-Storage'' S14004(1-1) Variance Rir'mem 7-2011,11 Restriction-Presence and lice" j ance: eQr ` 1-202.12 Conddionc of Use" 7--1.03.1 I roxic Containers-Prohibition." REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 204.1 I Sattitizers.Criteria-Cttemicds* j POPULATIONS(HSP) 720412 C.'.hcmfralsP,rWashmLProduce,Criteria" 21 3-801,11(,?) UnpvteurizedPre-packaged ltoecsanti F,,-eerages with Warnmt;t«hots' 7,,94.14 Drvm:,Agent.'.C'Onta t, 3-901A I(B) Uce of Pasteurized Epps" 7-..D5.1 ( Incidental Food Contatt. Luhne:uns� -801.1 t(tit Raw ur Fatf!allr Conl;rd Animal Fond anti 7-206.11 RodontiH t S.e Pestions,!ies.:.;nterc,* j Ra1v Seed Sprnu:,c Not Ser;•ed. # 7-206 12 Frackit Bait Stations' 3.8Q!, Unopened grad Pack;gv Not Re-se ved. " 7-706 13 t}acki�,;Poc'derc,Pest Control anti I ' Monitoring* CONSUMER AL,v;saHY TIMEITEMPER 1TURE CONTROLS 22 3-603 11 Consumer Ad\isoty Posted for Consumption of 16 ( Proper Cooking Temperatures for Animjl Fi-,J71tat arc R.t+nr, Undercr.oked of PHFs Not^illeivose Processed to Eliminate 1 3-401.11.4111(2) Eggs- Iii"713,Sea Pathaan:.." ""`x" ' Eggs-htmtediaec Service 135`F15sec, 3-'02.13 Pacteunzed Eggs Subsiiltue for flaw Shell 3-401.11(A)(2) Comminuted F';;h, Meat,kil»me Lugs` Animals- 1531 li see. 3-401.'I(B)i_I)(2 r P,ak and Beef Roast - 130'F 121 min; j SPECIAL REQUIREMENTS 3-401.11(A)(2) Routes, Injected blcat>- 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(DI in s,-c. ,: catering, moCnle food, temporary and 3--101.11(AH3) Poultry,\'wild Game, Stuffed PHFs, j residential kitchen operations ahould be Stuffing Containin Fish,Meal, dthitrd under the appropriate sections j Poultry,,r Ratit"-1650F 15 sec. "° j above i€rciated to foodborne illness i 3-401.11(00) R'hol nwsc:e, Intact Beef SteaLx rr,terveution:;[md risk [actors. Other 145`F T 590.009 violation:;relating to good retail 5-=01.12 Rnm,Ananal Foods Conked in a I pramces should Cie debited under 1/29 - Microwave 165`F* Specutl Requirements. 3-401,11(A)(I (b) A':i Other PRF;. - 145'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS R,2LATEV TO GOOD RETAIL PRACTICES 3-403.11(A)S(l)) PHFS Ih5`F 15 sec. * j (Items 23-26,)) 3-403,11(B) ;4iicronave- 165°F 2 Minute Standing I Crown and nun.-rrhiral violations, U)nch do not relate m the Time` ,%oodburne ilhnsy orlon=ntions and civ„lite tors listed above an be 3-405.11 tQ Commercially Processed RTE Food- loud in the folluwirg se,rin>ta q)ihe•Food Code and 105 CA4R 14WF* Son,pyo. 3-104 11(Ei) Remaining Unsliced Portious of Beef Item Good Retail Practices FC 590.000 li,,,f StO 23. Manatterrent and Personnel I FC--2 .003 I$ Proper Cooling of PHFs ( 1 24 Focno and:'ood Proirepon FC -3 004 3-5(?1 !4 a Cooling Cooked PRFs fr 25. Equipme,,!and UtensLs FC 4 005 ( } om 140°F to 26, water r',umbino and V4aste FC -5 .006 70-F Withm 2 tlours and From 70'F 27. Phlsical FaciMV FC-6 007 to 41`Fl45'F Within 4 Hours. * j 28, P.,sonou&cr Tors slatecais FC-7 .008 f 3-501.14(131 Cooling PHFs Made From Ambient ( 29, Special Roquirements 009 1 'rempetatute Ineredientc to dl`F/45"F 30 othci Within 4 Hours' Pc,rob:a a ureal ituu m tin trd.-al 1999 Food Code or lQS UNIR i90000. CITY OF SALEM BOARD OF HEALTH Establishment Name: CA4_.1AAt 1M0_7,S_ a fi24-r Date: 2 A /cb� Page: 4/ of y Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified 11 - PLEASE PRINT CLEARLY I 2; ��t_ t'�,u�r dr rr ..resod' .>�� I�..ano��.a.a� c�ks�lrfav �l�.s.�•.� .4e-,e ,p4,ft..n.x_/ a< e.� A,~ of6fr. /l��nc� � 1 I �� 2 We, &J1170 47" /b.+.A/C MAI M.4- A,-Czr .c4A%wJ a ir.t ®d?N! 6i+�tr ew✓/) :rte ruld2�61t»4mNif:f C� d.,n rf.nfvzas e/Nrf ..,.r� C„r n,L ,.*M _ n.,m .rrcras.rWrr I = � or 1100041 I r 2--7 IJtle ��'Fd G� r r t /iNJ�£.wrNlr , ,Il_4Y2 P.t f&,,7ow -.b..,cAr. I I Iii.. r.lt- nt,J.(Ote lr ISMrlrA" KC - - X/Pfo-Y � e..(!fA�ufi�.lit�7li_: L1V!1(/r 9ArtG/ I I,.¢xna�u.n-rnrraf �% I_Di .-$.hfrnrrJA scussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ` O lam` 0 Voluntary Disposal 0 Other: 3-50:.i't!o P LPs Re:er,,•d is Temoer.nmes Violations Ratsred to Foodborne Illness interventions and Risk ,S:cording to Late Grole I to j Factors(Rents 1-22) (Cont.) I4!`G195=F:i'tflrin4Hvurc. - j 3":411 15 j Ciolina Method,, !or PHFs j PROTECTION FROM CHEMICALS j 79 PHF Hrt and Cold Holding j 14 ( Food or Color Additions j ?_SO I.I6(S) I Cold PHR Mairazancd at of below .3-202.12 Additives" j 590.00'!P) i 41'115'F` 3-302.14 PnIlechon roan Unappu,l,ed Addiliveck jToxic Substances 3-50 i.i 1,(A) It(,. PH'r. 1iahuained at or abpve ;5 Poisonous or Tox 7-1(11.!1 klcnnfymglnf,rimai,i)-Original ,; : 3-5191 16('4) Roasts I"teld at or above 131. C. Coutalners� j 7-192.11 Common Name-Workin„r,Containm j j 21) I rune as a Public Health Control j 3-5Time as Timas a Public Health CcntraN 7-201.11 Separation-Sior"agc^' J 7 202 11 Restriction`-Presence and Use" j 590.004!1) ; 5'arisne:; Kegm.e trin 7-20112 Conditions of Use 1REQUIREMENTSFOR HIGHLY SUSCEPTIBLE7-2011l T,sc Gmtainers -Prol,ih,tionO POPULATIONS(HSP)7-2U4.tl Sauitizers.Critena- CnemicAj 7-204.12 ( Chemicals for Washing Produce,Criteria" j 21 3-501. l.'?,1 lhtpncteunzed Pre-packzged Juices and 7-204.i4 ^ ; Be,eiages,vith 14:u uin�**latb;l;;' j j Drq:r:�,-. znts.Criteria" ;-901 ll(B) Use ofPastenrizedL2gs* 17.205.11 jb%idmialFood Contacl. Lobrtcantsr ( i-S01II(D) Raw otPmv:i!yCookeGAnimal Food and 7-206. Rectrieu d Usz 'r'esd;.t:iee. Cntercit .,nt Bait Si:ninns"` Ran;Seed 6mouts Not Sef.ed. 7-206.12 Rod " 1 i 13-SQ I.I I(C) Unopened Focxi Package Not Re served. 7-206.i 3 '1 urc4mg Powderc.Pesr Control and I Mon,to;ing'" CONSUMER ADVISORY TIMEiTEMPERATURE CONTROLS 22 3-603.i i Consumer.A0h isory Posted for Consumpboa of 16 Proper Cooking Temperatures for Annual Foode tfhat::re Raw,Undeteook.ed or PHFs Not Otherwis: Processed to Eliminate 3-301.11 A(l)(2) Fgg,- 155°F 1.5 S'ec. -- - - Pathogens.% Egos-Immediate;Ser n-iu, 145"Fl S,,ec" ( 3-KC.13 Pasteurized F,ggs Substitute for Raw Shell 3-401.11(Al(2) Comtmnuted Flsh,Meats Fc Gana I Eg`s' Animals- 155'F !5,ec. j 3-401.11(Bi(1)(21 P,tk and Beet Roast- 1',0'17 121 min" SPECIAL REOWREMENTS I3=4,11.11(.A)!..) Ratitec,Injecc:ctMeats- 15>"FIS 590 t;t?9tA`-iD) Violations of Section 590.009(A)-(D) in sec. .atcrin„ mobile fcxxl,temporary"and i3401.11Poultry,Wild Game,Stuffed PI lPs, reslt@ential kitchen operations shoWd be Stul ma,Cowainmg Fish,Meat, debiied tinder the appropriate sections Poultry of Ratite,"165'F 15 sec. * ahw•v iF related io Wdhnme illjwss 3-401A 1(CO) Whole-uunde Ira,ct Beef Steaks im reentionc and risk facPors. 0,,her 145'F 590.009 violations relatinv to good retail 3-401 12 Raw Animal Foods Cook d is a pt'act;ces 51'ould be dehited under N^9-- Mic,owave 165"F x .Special Requirements. -illi l l(Afl)(b4 All Other PHFs- 145'17 15 sec. 1'7 Reheating for Hot Holding j VIOLATIONS R.LATED TO GOOD RETAIL PRACTICES 3-403.11(.A*(D) PHFs 165'F 15 sic. ': I (Items 23-30) 3-403.11(B) Microwave- 165` F 2 Minato Standing ( Criri„ti wall non-r•rWCoi rhAmotu'. n•kich du nor relate to the Time* i will7prne illtte.c.c nct-ivemnons and riskJ'at torn listed ab(we, can he 3-403.1 I(C) Commeru.dl r PnIcessed RTE Food- ( kno,d it th,J'u)n wain,t,• sections til the F'nn,l Gvde and 105(LIR 590.6W_ i 3-403,11(E) ReutammgI-Imll.:ed Portions of Beef I 8e:-r. Good Retail Practices FC 590.0w Rto,}t�r- 23. Manap2ment and Personnei FC- 2003 1 24. Food and Foci Protecrlon FC-3 ----Op4 j 18 Proper Cooling of PHFs , 1 25 '-a'-aIment and U,ensns Fc-4 j 0175 1) I -S 1 Id'A , Ct�)lln;Cocked PW s from !40'F'to , -------- I 1 26 '�A a:er,Fium;inq and Ntacic FC-5 I 006 70'F Within 2 Homs and From 70"F 27. Fhi a a!Fac!lihl PC-6 007 to A I-F/45F Within 4 Hours. '" 128, Poisonous or Toxic Mats.ak FC-7 j .008 3-501.14(B) Cooling PHFs Made From Ambient 1 129 Special Requirements .009 1 Temperature Ingredients to 4'1`Fi45`F Wilhin 4 Flours:z .'•+n„-.n,:u,:i.„: pellotes cuucal Dern m,Irr t:doral 11191)F...,d i',ode or 10,`,CNIk 590 000, (C ....n.vMr. .... ., v �.:At. rr a-e • . .ti.' I Wlasn=husetts Department of Public Health Salem Board SHealth Department 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 at��o% I Type of_Ooeration(s) Tyoe of Inspection 12.ri�J4xm /�it4lri� rt' �/7n.s P 5ood Service ❑ Routine Address Risk ❑ Retail 4;]-Re-inspection 7 'A f'r�� /�&' J' Leve E] Residential Kitchen Previous Inspection Telephone I� ❑ Mobile Date: 7"ti, r-.'7 El Temporary ElPre-operation Owner I n,we �� HACCP YJN , ❑ Caterer El Suspect Illness Person in Charge PIC) I Time 1 ❑ Bed&Breakfast ❑ General Complaint .5-lIgr A- X&w A( In: � ❑ HACCP Inspectorr9,,,L.. ..4 ' r �y aR 1 Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 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 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 at 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)(59a.0o3) order of the Board of Health. Failure to correct violations �4. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 5. 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 5WInVwx v s-i4,dm Inspector's Signature Print: / 0 f w lo Print: Page it{ItL !4/J�V I _< i,4 CLF � n L PIC's Signature: f.'Pages i Violations Related to Foodborne illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ' Cross contsranut:cn I 500.003(A) Assigntnent of Respongihilitya, I 3-302.11(x)(1) Raw Animal Fcxxis Separated horn 941.1103($) Demonstration of Knowledge' j CoJed and RTF.Fuad,:" 2-103.11 Pcratm in charge duties ( Cortamstavon from Rauringredrents j 3-302.11(A)(2) Raw Auirn it F,u)&J-parated from Each EMPLOYEE HEALTH Omer' ., + 300.003(C) Responsibility of the person in charge to ( 'onfarrina4io-i bore the Ire,vonmrni require reporting by food empuyees and ( 3-302.11(A) Food Protection,, j applicants" ( 3-302.15 Washing Fruits and Vegetables Pi0.UO3(hJ Rc,pons&ihty OCA Food Employee Or An ' 3 304.11 R.,,rl Cont.!Ct with Equif:nein and Applicant To Repon To The Person In Utenei! j Chage' j Contaminan-en from the Consumer j 590.003(G) Reporting by Pot won in Charge* .306.14(AHB) Retained Food z:nd Resendec of Frio& 3 59U.l.103((}) L:xcla:.ion,and Restrictions" j I t.45posfrcm of Ar wterated or Contamirwred 590.0O3t6) Removal of Exclusions,and Rcstnctiovg Food 3-701.11 Discarding of Reconditioning Unsafe FOOD ;^`40M APPROVED SOURCE Food 4 Food and Water From Regulated Sources ( i 9 Food Contact Surfaces 590.00,,(A B) Compliance w',th Food Law:' ( 4-501 111 Manual Waicivashing- FIot Rater 3-201,i2 Food in a Hcrmcticallt•Sealed ContuiMr- Sanitization Temper:uures* i "- ' 501.112 k-ieLhanicai 'Waretta:;hint lb,n Water 3-201,13 Fluid Milk and Milk Products" ( j �nnitinttiou Tempt raurrs 3-202. 13 Shelf Ecgs'� - ^,_ � d-501.1 i a Chemical Sauitizati.m-temp., pH, 3-202.14 Bgg,and Milk Prociocts,Pasteurized' ( j conceauation and hardness, j 3-202.16 Ice JNCAe From Potable Drnkine Nater' }-fi(Il.tli A) L^yuipmen?Fcxxl Contact Surt:•tc_s and � 5-tUl.11 IhinkmgFN'atcrtn)tnanApproved Syslem* " Llrcnsda Glenn^ j 590,00N All Bottled Drinkine`Water" I * 602.II Clear,ingFrequencyofFyuipmer;tFood- j i90.U06(Ft) Haler Meets Standards in 3lO C N4R 22 0" Contact lurfacec and Utenals- Snellfis`r and Fish From an Approved Soutce ( 4-7(12 i 1 Preyuency of S:a»tizanon of Uten,i(s and 3-u?L 14 F'tgi�and Reaea:innalh`Caught M,rllus�an Food Contact Surfaces of Gqu4unent C%:lftiriP'° =1-703.11 Methcxic of Sanni attion -Hoc)A atei and 3-201.15 Mollu:cdn Shellfish from NSSP Listed Chemical', Sources' j 10 Proper,Adequate Handwashing Cama and Wild Mushrooms Approved by I r . 1 Regulatory Authority ( 2-301 17 Circa CamL t:v:; Hand;and A tie." j 3-?02.18 Shellctock Identification Present' j '--3U1.11_ taeaning Pnxedwe"' I j j 2.301.W When to\Nath"590.O04tC; Wildh1a:,hnw'n;" ( j 11 Good Hvgienic Practices I 3-201.11 G n,e,4nuuals- 5 Receiving/Condition ( 2-401 It Gating,Unnkmg of U,ina Tobacco` j � 202.i I PIIF,Received at Proper Temperature* j 12-SOL 12 Discharges From the Eye..Nosz and 3-2(12.15 i'.u'ko2elntc:_>4ityr'' 1 Mouth' 3-101.11 Fawd Safe and Unadulterated ' j 3-301.1'_' Preteotiu'2 C.ntanunation Wl wn Tasting" j ( 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 13 Sirelistock Identification j 590.O04(r) Prevent;u�Cnntamiomion tom andw.203.72 Shells[ocMaintained,Identification atntained" j 13 Hliandmashsh Facilities j TagslRecords:Fish Products j " ConvenientlyLocatednd`Acrerible 3-40211 Para=ite Deshuction* 5-2:u3 11 Nnibets ,14 Capaciues 3- .f12,12 Reeuras.C7eationand Ietentira " ;90,00aO) Labeling of Ingredients' i ! 5-204.11 i_oLation turd Placement"' j 7 Conformance With Approved Procedures j i-205.11 Accessibility,Operation and�lam[cnancc /HAG'CP Finns SuUoirad:+i"^Soap and ti3^d IJry.ng I, 1 502.11 Spectalizod Processing Ivle:hodl * j 1'ev,ces I 3-502.12 Reduced oxygen eknine,enteria' 6-3UI.ii .iandwa.hmsCleauccr.Availability pa , r" ( 6-301 12. I-Ia:d Drving Pro}i.aon 8-:03.12 C•.mtirrnance with Approved Procedure.0 `Venoxa rrmcil i:am i❑the telem: i 990 Food Cole of hi CNil'5901110. CITY OF SALEM BOARD OF HEALTH Establishment Name: -;4t,&A4 /dvwira er-f z4 Date: rZ/� �I"T Page: 2 of 2 Item Code C-critical Item DESCRIPTION OFVIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified � PLEASE PRINT CLEARLY /1-0-9r a� w r fft rl.�. Gt�r?fi 160- .aw ACe aW uL.T -Al OOe 4b " ag, I ` I I � I � I � I � I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es 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-fivedollars llarslor suspension/revocation of ❑ Embargo Ll Emergency Closure ,your food permit. �(� / ❑ Voluntary Disposal ❑ Other: A f 3-+04 44•IC't PHF,Recetveu at Temperatm'es Violations Related to Foodborne Inners.Interventions and Risk According to L. w Coaled to Factors(items 1.22) (Cont) i I'Fi 1-Y F v';idSn 4 Hours. ' m PROTECTION FROM CHEMICALS ( 3 i01 15 C'ooline Methods lir PHFs i 1 14 PHF Hot and Coln Holding I 14 Food or Color Additives 3-5'i 1.10(B) Cold PI-IF,M timained at or below 3-202.12 :additives'' 590.00 (F; 3-302.14 Protection from Unapproved Actditivee= ! ! i 3-at;l.'6(A) flor FsRa3muined at or:above 15 Poisonous or Toxic Substances 7-l01 11 idenU(yume 9rfbrmation -Original 1 ! r j 3-50i L, i` i40'F. ) Roasts Held at or above 130°F. Container" 7-102 It Common Name-\Vorkint Containers' 20 Time as a Public Health Control 7-201.11 Separation-Strnsge' 3-501.l? Time.e;a Pubic Health Centrol� 7-202.11 Restriction-Pr.stoce and Use`, 500.0U401) varianceR.cqumrement 7-202.12 C.mdrtcn:,of Use' 7 REQUIREMENTS FOR RICHLY SUSCEPTIBLE 7-203 it Task Container, Prohibitions,iPOPULATIONS(HSP) 7-21}4.;f S.mitizers.Criteria --Chcwicxls*'^ I j 7-20.4.1: Chemicals for Washute Prrolocc, Criteria" 21 ! 3-RO1,11(A) t:npaatea.r :rd Pre-pacAcged fitice�and m fic.ertges with Warning 1 abcls" i-20-4.14 Drying Agents.Criteria` 13-gp1,11(H) i Ise of Pastemized Eeasx 7-205.11 In.;iden(ai Fnod Contact.Lubneartsx 3 YOi !1 m D) Raw or Padialha Cmxikeu Animal Ftr;ei+rad 7-205,11 Restricted Use Pesticides. Catena" Raw Secd Sprouts\oi Sawed. '# 7-206.12 Rodent Bei+ Stenions' 3-801 11(C) Unopened Food Package Not Re-served. ^` 7--2016.L3 'Fiac king Powders,Pest Control and 1 Monitoringv CONSUMER ADVISORY TIMEPI EM aERATURE CONTROLS 22 3-003 I I ! C'onsumc: 4dvisor}Posted 'or Consumption of 16 Proper Cookiry Temperafuras far ! Aniuml Pa}ds That arc Ravi,Undercooked w I I PHFs Not Otherwise Proxssed to Eliminate 3-401.11 At I m(2) Fags- 155°F 15 Sec. ;-3(m' 13 i 1'asteur./ed F,,,Snbstihde for Raw Shell E,,«s-hmuediateServiceI-.Set ( I g- 3-401.'1(A)(2) Comminuted Fish,Meats k Gamy fiees' Animals- 155'F 15 sec ,x SPECIAL REQUIREMEN e S 3-401.11(1)(1 a2) Po A and Becf Roast- 130'-F 121 )tin` 3-401.1 I(A)(2) Rattles,injected Meats-155'F IS 59(),009(A);D) V tolatinn;of Sec! on590.009(.4)-ill) in Set w catering. mobile food. temporary and 3-401.!1(A)(3) Rmltra,Wild Game,Stuffed PHFs, res &--litial Aitchen operations should be Sniffing Containin,Fish,Meat, .1cb.nr-d under the appropriate sections Poultr, ut Ratites 165'F 15 nec. " ; sieve is related to foodborne•ihness 3-401.!illCl(3) 1 1Vhn!.e-muscle Intact Kecf",leaks ! interventions and risk factors. OlLer d 1=45'P': I 590.009 Violations rclatintg to-cod retail 3-41)1.12 Raw Animal Fcxxis Cooked in a I pracdccs should be debited under #29- Microwave 105°F* S ecial Pequit'cntents. 3=40111(3)(1)(6) All Other PHFs- 145''FI5sec. pry Reheating for Hot Holding ( VIOLATIONS Rr=LATED T<7 GOOD RETAIL PRACTICES 3--403.11 m A)&(D) PHFs 165'F 15 sec. :' I (Items 23-30) 3 403.11(H) Microwave- 165' F 2 Minute Standing ( Critic od Ia d nun-rriheol vfohyrune, which do ,at relate to the Time'' 'vaborne i(hae:a hit(rncniim*s and iiA],;(tors listed abr, ,v coq br 1 3-403.11(C) Commercially Pcocexsed RTE Food- I ;Found in the juttowintg sections c(rthe Food Calle and 105('AIR 140'F" `90.00_), 3-403.1 i(L) Renuining Unsliced Portions of Beef I Item Good Retail Practices FC i 5.40.000 Roasts": 23. Managemew and Personnel FC -2 1 CO3 IR Proper Cooling of PRFs 24 rood and Food Protection FC- 3 1 .004 25. ,-pulpa:eni and Umnsi13 FC-4 005 3 501 14(A) Cooling Cooked PHFs from 140`'F to ( 26. Water,Plumhinn anr'•Waste ! FC-5 ! 006 70"F Within 2 Hours and From 70°F 27. Pnysical Facility FC--6 i .007 to 4! F/45"17 within 4 Hours. " ( 28, Poisonous or To<ic FAaleria_!s FC--7 ! .005 1 3-501 W(B) Coiling PFIFs Made From Ambient 129, Suecia!Requirements 009 Tempera attire Ingredients to 4l"F(45"F 3o Other j Within 4 I lour.` inn„n:, -a a•. .Denol,s ericai item in flit ioderal 1999 Fond Cadc or 105 C61R 5-fir 000. w -.,7, ....... ..w.,.-x, . .: wF+. .:x,+'•n>-. .s,:.h,..,... ,»�••.+-a«ti.`:d'e a-... ,a- t-jz,::•w�v§u,..s..e ,... -•..w�,;m..:.,,... CITY OF SALEM* MASSACHUSETTS �. BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Salem House of Pizza Address of Establishment: 23 Endicott Street Owner's Name: Mohamma Alam & Sher Shah Restrictions: Application Date: 11/22/2004 Permit for Food Establishment 47-05 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. EALTH AGENT y ; +I�, CITY OF SAILEMI, MASSACHUS TS Adrr ` s3! BOARD OF HEALTH iVU✓ r� 10 1 20 WASHINGTON STREET, 4TH FLOOR `��(jC¢ SALEM, MA 01970 eTEL. 978-741-1800 0 C/)Y CF Y ' FAX 978-745-0343 AAS AFH SEM STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO Fq�Ty MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT SiJL&-M //[;Wecry y/ TEL# 0"( 7 ADDRESS OF ESTABLISHMENT �.3 MAILING ADDRESS (if different) - 57C-77_73 OWNER'S NAME M6i/A/n/7Z1q ALAN/„ S'Ae-r S A x A TEL# 508-491)_"J'7-3 ADDRESS 23 li-ci. 1♦q-� CITY AvIPCff6 X— STATE 44 .4 ZIP o/ 7)t CERTIFIED FOOD MANAGER'S NAME(S),A O,, WM&7AD f9C M CERTIFICATE#(s)3So 9 0 7 J (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON �Ae_- HOME TEL# l/7-)76-73-73 HOURS OF OPERATION: Mon y/// Tue.Zi// Wed./, / Thu.(/-// Fri//-(2-Sat.//-1z• Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 n LL more than 10,000sq.ft. =$250 RESTAURANT YES NO ll /`OJ less than 25 seats =$100 25-99 seats 150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church. kitchens) YES NO P25 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 a d b ef, havee filed all state tax returns and paid all state taxes re ired under the law. ��G //� /r-/-7 l 5 S- 09' 3` figs- Signature Date Social Security or Federal Identification Number -------- --------------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date +_I z-7 9 . I I — /7—�`N . ... .. KlI RT DOCKET NO.' ,dv.=.;-:;?,;^•:�l a`.3;::i<;`;,drkmoN NO:".''. } - T:ITYOF,SALEM'' - VIOLATION NOTICE"PD." � . O33 )='NAME(LAST,FIRST,INITIAL) •,- . . _ (.. - N o CID i. 15 X411 /du 0-X OOPr""74- I STREETADDRESS CITY/TOWN STATE ZAP .q.� ¢ :CENSE 'l E'1 tom' of I/o Q I LICENSE N 11.EXP.DATE DATE OF BIRTH O I OWNER'ST=711-1NST'RSITm[) STREET ADDRESS CITY/TOWN STATE ZIP a� mcoAuc* rA*L M .,I� of74 REGISTRATION NO. STATE I EXP.DATE I MAKE?YPE YEAR COLOR �. DATE OF VIOLATION TIME DATE CITATIO WRITTEN n/2quua�r ( v� b� �eN 3.� Lila oN °0 ONO LOCATION OF VIOLATION ENFORCING DEPT. o "' 23 EIc_�frfYj /g6Kg E OFFENSE CHAP Ste? FINES Ln A�I L� rPB Pte~ V Pec,fll ./r l N Do O it f OFFCER I.D No /1� TOTAL FINE (\ EJ. " -,s.�P`/IJ • l DUE Q \ CO , OFFICER CERTIFIES COPY GIVEN TO VIOLATOR r71 Q .a IN HAND O X ❑ BY MAIL O DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY 0 O_ O ORDER OR BY CHECK MADE PAYABLE TO. Q LL w CITY CLERK CITY HALL bw LJJ w O 93 WASHINGTON STREET I-- SALEM,MA 01970 d �'^a - TEL.(508)745-9595 X 251 O • AS STATED ON REVERSE, CONFESOS TO EXERCISE HE OF ENSIRST E CHAARGEOD,AND ENCLOSE 0 =u w L LL ,S PAYMENT IN THE AMOUNT OF V2za 7\ O OJ N N (r2 '1 ^� $ CASE# QQ v O SIGNATURE h N m = SEE OTHER SIDE FOR FURTHER INFORMATION o ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL o 1 w¢ �1 mw aom O [-'o w CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Salem House of Pizza Address of Establishment: 23 Endicott Street Owner's Name: Mohamma Alam & Sher Shah Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 127-04 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 L CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH VV 3 • 120 WASHINGTON STREET, 4TH FLOOR NOV 17 2063 SALEM, MA 01970 TEL. 978-741-1800 t;i-IY OF br,LLNI FAX 978-745-0343 BOARD OF HEALTH STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT S41-,F / SOF P%zZR TEL# 978-��1'o� � Z ADDRESS OF ESTABLISHMENT 2-734nd(\LO(Y sS- -v&,gl9 1449 0 ( `170 MAILING ADDRESS (if different) -5,4nl_�: OWNER'S NAME/-1611, M/11,4D 41,,4177 5hW R /y4H TEL# 509-Ll 93 4S � 3 ADDRESS 2 Z Tec crmse A rr'c,,4 /fs o CITY Nla,✓JbA ✓o STATE M4 ZIP 0 /7,5'"x--- CERTIFIED FOOD MANAGER'S NAME(S)MOf1AM/YIAU AL4n9 CERTIFICATE#(s) S3 �,s (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# K17- HOURS i17-HOURS OF OPERATION: Mon.N// Tue.//-// Wed1 Thu.//-// Fri. /1-12.Sat.//-I2_ Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 1 7 16 more than 10,000sq.ft. =$250 RESTAURANT YES NO /O` less than 25 seats = 1U 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NOS $5 TOBACCO VENDOR YES NOLO $50 //tLL NOM-PIR OF.'T(°J-1i(i.I as VIl{17411.t itch e/'I Jt YES N\/ $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 anp belief, have filed all state tax returns and paid all state taxes required under the law. �� / ,09rr,' n- 7-o'3 s= SR31, Lig,5 St is g ature Date Social Security or Federal Identification Number -------------------------------------------------------------------------- ------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date =k 10s '7 . if- -7- 37 l-- ✓il- . l Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Type oLOoeration(s), Tyge of Insoection s/�1r£iNl /1vVpeS of /p/ZLA ^7)1,3/ey CV] FoodService El Routine Address 23 6rin/Ght� ft Risk El Retail P14-inspection Telephone Level El Residential Kitchen Previous Inspection Od 17 M ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation PNS- J'Mw Al I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint InspectorQ, G/+&knlQwM U rlloS71N 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 El13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE E] 15.Toxic Chemicals " ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures t ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing E] 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 cfCealNth. 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 r 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 (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5Mnsp CtFor 14 ea 5101 Sig ure: U' N/If4�T � Print: PIC's Signature: ///`l fJ v� Print: �Of�A/�1/nI�D AL f�/'✓l I Page of-a Pages f! A :.A Violation;s Related to Foodborne tflness o trterientions and Risk Factors((terns 1-22) PROT.EC7'iON FROM CONTAMINATION FOOD DROTECIION MANAGEMENT ; t ! ss-ccrtam:rat: n 1 :yU.tiQ1(4) I Aesi;;nmont Ct Rc;ponsihility' ! s-su'_.I1 tA!(!; Raw(rota FowlsRet;atated(ruin 590.003(B) Ocinomtrtmmn of Knoededge" Co:,:ed:u;ti RTF 2-i 07.1 I Yct son in charge- unties I Contamineu:r,from Raw ingredients I 3.302.I i(A)(?) Raw Aaiimal Pu;u7;Separatcd front tech j EMPLOYEE HEALTH i C,:her' 7 1599.003(C, Rc,;ponsibilily of tho Terson ur charge n, C:onlam,nation frocr the Enwrcnment rr.:{circ is^<;t'!ur�by fxxt employees: 1 13 302.1!;A) rer`d Pr^o-rnu,t" mts a }' ' ! I fol i i >-Vashing Frnit.;"::d Vegzab',er i I fi�':' 1 Respoosibilil}of A Rxxl Employe?1)r All 3-'D I I I Fu.w G-mTact w,tl, Egmprneat alW ! rlpplic.::nt'I'u_<.Gott'Fo The Person h; Charge' j ( confam nafon tc,,ro the Consvnler j 5>t).OU3(iS) Rel:orcing be Pzrsun in 3-300.14(ANL^) R-untiedFood a:,1 eeeraice u'i F;xsi' j j 3 _40.00";tl)) Exc.lusio:isand Restrictions" Dispo-,WcoofAdulenitedorCo^rami:sated 5()u.0n?(E) Rrinotal of P.aclusions anct Reetuctions j mood ! i 701.11 Di;c;o-c+ngca Re;enditionim-,linesafe FOOD F`sOM APPROVED SOURCE Fouci f 41 Food and Water From Regulotod Sources I ( 9 Food Contact Surfaccs j 590AO,tA-B) Compliance,will) Food I.av " 1 4-501.111 ! -Manual Wa:cuashmv Hct Nater -i-201.1' Food-a it lterutcticaiiy Scaled Container"_ j ( Satuti::an nn'temperatures* ;'1(1.13 Fiord Milk find Ali;k i'rodnct s" ( 45UL1!2 A?Cehr„r:_a114'areuat,hing,_;-tut Cv:net i C:niitzaticit Tcrnpe rauiic?:. 3 202 13 Sheill Ergs''= : - -1-110 1 a.d\lilk Produc,.Paeturied^ I 4-50 71; Sin6'auon-temp.,pH. - cr ntcentratinu acrd hardness. j 3-202.i6 lo—Made Fi om tbtable Drinkin;;��:nen` - + i 4-001.11,Ai �q:::pusnt t'cod Contact Surfaces and ;-to-, 1 i Drinking Water from an Aeprrnei!S�sten,' i ( L;.=r.ads Clean' i S+:�C.00b(.'J Hottled Droikine water- —1 11 Cieamw Frequenr;of Equipment Food- I5dV 005(B) Water Meets Stan(tuds)n 310 CMR 22.0” 1 -` I Con;zct Surf.:ces and[i:ensils% ! efifish and Fish From an Appro,-ed Source 1 14-702.11 Ft eguuttp f S%tri;ictiiou of Liteaails and ? 201 Id Pah ani:Recreationally Ca,:ght MLmllusrin Food CI ^ oMad Ser;aces of Egollmiz=.a ! Shcliiis], j 4-703 11 Vic:.^.iids'I' Sxiiozation-1Pot Water and l 3-201.1, Aiotlus:an She1!f::h fr,an tiSSY Le,tcd 1 ChenucaF to Proper,Aderoate Handwa3hing j Game and Olid Mus,`rcorrrs Apprrved by 12 JU L L Clean C.',ndit:un-I-Int.'s and Ar:ns" i Nr'.,qu!rtiory',4uiho+'rty + 16 Shclist.ek]dentifieauon present' I `L-301.12 Cleanim>Po.><e3orx 510.00;;C't Wild Mushrooms* � . 2-301.1-" When to Wash I �lll.''7 Gane Animals''` j ,' Good Hygic^lc Practices 4 flacelving/Candition I 2-401.11 E'ing. h ink(ng or i ts!,n 'ruhacco- 3.202.1 1 PHFs Ra•_etvcil at Yuoer Tempo;_tin et.r 240i.12 Di,rbvree;. From the Eyes, No:--.nal ivl, nth" 3-2`)2 15 P.ickPr'e Inregrn>' I z,,UI 12 t':cventiug::nuta:nit:atinn\14ten'1'a,ting', 3-!Ol I I Food Sate and L r;iduttc-ated ' 6 Tags,'Recards:Sheilstcek j 112 Prevention.of Contemin0on trom Hands I ;_20?_}3 Shrllasl.Identification j 590.(10-1,H) Pte�ent a:g Contav+inatiun fi;m ) h1.ntiGtationMlamtained" I r9bsiRecoids;Fish Products ! 1 13 Handwasn-acilides ,0 2.11 Pa-isite Dcwta:lion` Gonvrnierlly eccarer,'and,4:;cess,'bte - ` I i 5-203.`.1 I Numbers and Capacitie,.' : '1-402 12 Records.C7eation i:d Retention S90.u0.1(I) Labeling of Ingredien!s' ++ )`L; ! Lnczt:oa enol Phx•emeat" ! Conformance with Approved Procedures I 15-_0`. Fu:,rssibility(lperai:un and".laimeua:r,c Confor antePians e ! I Suoaied with Soap and nand Dryog j Uemces Sns•ializcd Yroczs>mg hlethots"' i ! 3-502.3 Reduced oxygen packaging.critetia" j 6-30i•tI N%m:hvashing C"enn.er. .4+,ailah:hcv i 5403.12 Conformance with Anproved Pnxxduresr' I `01 12 Nand Gry;its Pmvitaon Dram.:,critical acn,in:',r Weal 1799 P.„xl Cuaz :, iT15 CMP,590,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: f4t'K- t /4twoJE OF Pi-VA Date: -71Ir3lotil Page: 2 of 'Z- ° Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified / ) PLEASE PRINT CLEARLY 2S A( rw'i PU/ WA.rfvF ANn_ .f�/d F��i r7C RA.'7.4 cS �_ A�1 SIWX_ I I - C-n„6 r– 64",e- CY3df-rf 9A_r, t-y C 1-&A9 0L'C alfJ f�tht.f s 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 F 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 I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ i Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � /b A/10 ��+ d ❑ Voluntary Disposal ❑ Other: :� I r 4 -501 PHFs Received at T•emmeratw'es j Vintat%.ons i'tera'ted to Fccdborne Mness Interventions end Risk Acini ur.np tt:I au'Cowled in j Factor::(items 1-22) (Cor L) 41••Fk45'F Within 4 Homs " -•-SOI.IS Co:6119 Ma dwcis tint PHFs I PRO T ECTION FROM CHEMICALS ' 19 PHF Hot and Cold Bolding 14 I Food or Color Additives j ?-501 Ic(Bi Cold PH';,;Maintained at ur be w'A' 1, ';_202.12 ,\ddttives* i90.004ffr 41'!45'I' j ! 3-30,214 Protection from Unapproved Additives-, 15 Poisonous or Toxic 5uastanres j 3-?O1.16(A) htot PH Fs Maintained at of aho♦-o 7-1();. Iderrlfrymv lnfonndtion-Ou�>inal oi,f ` • 3-50!.16(A) Rua�is Held at or.rbuee 130-F Containers' 126 Time as a Public Health Control ' 7-10211 Common N:i m;-Working Cnnrcinee`° ! ' 1-^t)1.I I Sr r unt-Storing" i 1 3-50119 Time a':a Pahiic flealth Control" j 1 Pr at i 590.00'4(H) Var':ann; RULai;'Cornet 7 2u2.11 Fce:tliction-Presence and t'isc' i-202.12 Condttwns II';e" 7 203.11 'toxic Containers-Pmhilntions* I POPULATIONS OPULATION (HSP) HiGHt.d SUSCEPTIBLE 7-'-'W.11 Samtizeis.Criteria-ChemicalsT � POPULATIpNS{HSP) 2i)d17 Chemical;for WashingProKhee,Criteria* 21 ( 3-801.1l(A) tinpistcnriz:edFrc-,,^atckaged.iuims.md Hevera'ee!; tenh Warning l abets* ! 6x7ina.Aoa•urs.Gitexia' 1 3-801.11(B) Use of Paswur;zed El--,," j l 7-205.;1 htcidtioud F'notac d Cont, Lubricants` d I ! 3-30! 11(Dt Rai,,or Pat'ually Oxked AnimalFood and 17-2061.1'• Restricted lise Pesticides, G'!rria° _ � Raw Send Spt'�ri::s Not Ser,na. T 7-206.12 Rodent Bail,Cewvats" 1 3-SOL i 1(C) Unripened f7c xi Pack_a"c Not Re-son-ed. " dn0j" Tracking Ponders,Pest Control and Momtorine' CONSUMES ADVISORY TIh9EJTE?APERATURE CONTRQLS 22 3-603.'1 i:onsruuer Advisory Potted for Consmnption of ! 1fi Proper Cooking Temperatures for Animal kr�.is-Drat are Rau-, Undercooked or PHFs Not Othere-ise Processed to F!iminate 3-401.11 A(1)(2) Eggs- l 55"F I S Sec. ! PaOwgers.*' rrrev,-vvrs: 1 Fess-ImmedrutC Service 145"Fl Sled` 3-202.13 P,stcunzed 6_ge Substitute flu-Raw Shell 3401.1 NA)t2 i Comminuted Fish.Meats&Game 1 Anneals - 155-F 15 sec. * SPECIAL REQUIREMENTS 3-401.118)(1)(2) PorleadBeef Roust- 130•F12! min' � 1=!ul.1 kA)(2) Ratitcs, Injected Mews- 155 F 15 5'Ai 009iA)-ffo Vio;ations of Section 5901109(A)-(P) in sec catering,mobile tood, ietnpofarpand 3-46L11(A)t3,1 Poultry,Wild Gamc-Smffcd PHFs, residential kitetxn operation, should be Stuf!in,,C'oninining Fish. Meat, debited tinder die appropriate sections Poultry or Ratites-165'F 15 sec. ` above it related to foodborne ilhiess 3 401.11(Cl(3! Whole-muscle. Intact fleet Steaks interventions and rill:factors. Other 145 F i 590.009 violation, relating to good retail 3-7o 1.12 I Raw Ani nal Foods Cooked in a I piactices should he debited under 1129 - bhcrowave 165'F^ .51)ecial Requircinents. 3-401.11iA)(l,0) ( All Other PHFs - 145'F 15 sec. " 17 I Reheating for Hot Holding ( VIOLA TIONS R,:LATE'D TO GOOD RETAIL PRACTICES 3-403.11(A)&D) PHFs 165"F 15 sec. (Items 23-30) i1-403.11(13) I kliciowave- 165"P 2 Minute Standing G'Urcal,,,td non-'I.Wcal rudutiona, ithreh oto not r4aw to tha , 'Piute" fnodhoree dines., and risL fzCtura hstenlabove, can he 3-103.11(C) Cntometciuilg P.a;essed RTE Food- Jn,md in the'4•,t(o;i,ing se<Iioru r, the Food Cude and JO',U IR 140"�` Neti.O(10. 3-403.11(E) RemainingUnshcedPortions ofBtcf Item j GocdRetail Practices FC 590.000 j Roasts" 23. Management and Personnel FC - 2 .003 I 18 I Proper Cooling of PHFs 24. Food and F-od Protection FC--3 .004 25 ! Eomom_ent and Utensils FC-4 .005 ? 501.14(.4) Gating Cranked FHl's from 1.70"F to ?°. ----?-VV 2ter.Plumbing and Waste ! FC-5 .008 70 F Within 2 Hours:ind From 7W l- j ?7 Physical Facility ( FC--6 .007 to 41'F/4YF Within 4 Hours. * 2& PeISOn)t15 or Toxic aaateals FC--7 .OUR 3.51",1.14(11) Cooling PHFs Made From Ambient 1 29 Special Regoirements ; 009 Teniveratona Ingredmits to4l 30 Other ! \Nithm 4 t-tour:' ' D:nrlu,eniical.rem in lh:ted:rat 1949 Food Cede of (P Clil:5'i17.bOn. CITY OF SALEM BOARD OF HEALTH Establishment Name: XQ r1 /JM)Z�&_n-C Pr 7412 Date: '/0- Page: I of / Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified �} PLEASE PRINT CLEARLY I ( fvbP� /7 />vYry� tang �f>O✓)ur�� -�-i) �_ ISn_ / ice � hnU /J�✓J /.p //n>,1/ war// �� J yw�.e LPA—Lf ✓n �lt�.(iP. /�._�eJ_/s�_ o_I ,Qe>��t/..�,f.� �iai� �ltt ✓ql/�10 � _ I /� 1 r 01AJA,9w /D�/).OSL/,.,i ✓.O..n0/1.u� 1 I - 1 Discus§ion 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 ❑ E cEmployee Restriction/ violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. j ", /- ❑ Voluntary Disposal ❑ Other: 3501.14((:) PH h: Re,eivedrt'h,n,peratur;s Violatle,is Ralatca to o-ooct:ornc nlness Interventions and Risk A,cording to Lim Cooled!n F.-ctors(Nems 7-22) (Cont.) I 41'T'!115"F Within 4 Hcurs. PROTECTION FROM CHEMICALS � I ?-SUi.15 Coi!;ngAfetitcds!brPI!Fs 1y FHF Hot and Cold Holding j 1.y I Food or Color Additives 1 ? X01 I ti(;i) Cu!3 PHFs 3Sainhijned at ur balow r-2U?.L Add:t;\-es# I - )t (dk}(I=) 41 ',4 fi 335x2.11 Protection Gum I inapprot ed Addidr e.f 13-St!1,16(A1 riot PHFs Maima atrted ,or ohnoe 15 Poisonous or Toxic Substances t -i 101.11 IdcntitcineInformarnn-Ortginxl 40 ,. . V;L l b( l) 12na!',r<Hr!d at nr nba'e 1'A0 P. ' Comniners' 7-I O'.I 1 Common Name--1\'orkne,Containers* 241 Time as a Public Hea it Control ?-501.19 Tont as a Public Health C,nnroP` 7?OI 11 Separer.on�-Storage'' 7-202.11 Restriction --Presence and Us. i 590.004(H) Var. ance Requirement ''07.12 Coadninm oft::;c ' 7-203 11 fuxic Conutinss-Prohibitions^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE "'io .I1 Sanitizets.Criteria --Cheuncals^" POPULATIONS(HSP) ( 21 : 3-:K'!.Ii(.A) CinpaueuntedF'rc-p .k: aeal7uices:md n4.1s Chenticeng Pr iri for Washioduce.Criteria' i i ! 7-?04.1'i Drvmp Ascents.Criteria' ! Beserages z,ith`irarmn:•,t.abels'4 1 ?(i i.l i htci denial Food Contact. L�.tbri:ants" i 34$O1.1 1(B) Use of^ast:w i;.ed Ems" ' 3-801 i 1(D) Raw of Pu?jail} Cooker(Animal Food and 7-206.1 i R,stricted Use Pesticides,Cr' epi•.t'' i Raw Seed Sprouts Not Servet.' 7-206.12 Rodent Bail Stations" i 3-801-1 i(C) Unopened Food Package Nor Ro--sewed. i 7-206.!_i Trackim;fend t:., Pest Crotrnl and ASumn;ruig' CONSUMER ADVISORY 22 3-613.i i C_nnsumer A&ison PoC;:ted for ons imptiun of TIMEITEMPERATURE CONTROLS A 1C, ! Proper Cooking Temperatures for a octal raids Me:are Raw. Undercookedor PHFs N':it Othenvj:.r Processed to Eliminate: ?-4P1.lL�(1)(21 Eggs- 155`FISSee Pa(h w m.. E,,9; Immedtaty Jcriice 14S' Il sec" 3-302.13 Pasteuumd Eggs Submitute for Raw Shell E,t s 3 10L1 i(A)(21 Comminuted Fish.Meats&Game \nimats - 155'F 15 pec. " ! SPECIAL REOUIREMENTS 3-30!.1 I(B)Wnl) Pork and Reef Roast- 130`P 121 min' I i9C.t109(A)-(I)i Violations of Section 59(1,009(A)-(ll) in 3--101.11(A)(27 Ratite.. Injected Mcaes- 155`F 15 ( .,ec, * catering, mobile Jxid, temporar} and 3-40!.11,'A)(3) Pnuitry Wild Game. Stuffed PHf§• residential kitchen operations should be Stuffing Cnntaintne,Fish,Meat, debited under the appropriate sections Pauliy or Ratite,-165'F 15 sec. above if related to foodborne illness 3-401,11 C)(3) Whole-mu.5c!e.Intact Beef Steak, I intcrvenuons and rLsk [actors. Other 145`174, 590,009 violattatm relat:ag to good retail 3-401.12 Rmt Anitnnl Fouls C(K)ked in a Inaoices should be debited under N29- Microwave I65"F v Special Requirements. 3-40!.11(A)(I)lb) All Otlwt PHFs-- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS R.=LATEL7 TO GOOD RETAIL PRACTICES '1-103.11 ( Pt IFs 165'-F 15 sec (Items 23-30) 3-303.! l(B) !Microwave- 1650 F 2 Minute Standin,. Critredi and nrvi-crihcul violations, „loch de twi relote to the Time* foodhomc dlncss inien enrions end risk:fncrnrs listed ubore, cw,kr 3-403 11 W) Commercially Provessed RTE Food- ,found i;+ thejoflowbi se iiores of i e•Port Code aml 105 QVR 140'F" .540.000. 9-403.11 tEr Remsming U isliced Portions of Bee` I ,, Item ! Good Retail Practices FC 390.000 Roast,.' 23 1 Mansgemimt and Personnel ; FC-2 .003 18 Propar Cooling of PHFs i 2c. Food and Food P,o`.ection FC-3 .004 25. Equipment and'Utensils FC-4 .005 3-50I.14:1A! C;nohmg C'nokiid PHFs from 1-'WF to i 26 Watt',,.Paimb!nq and Waste FC-B 906 70`F Within'-) Hours and From 70"F 27 Physical Facility =C-6- .u07 to 41'I',4517 Within 4 Hours. I ! 28.4444- -Posonous or Toxo;fdaleua!s FC-7 j ',-501.14(B) Cooling PHFs Made Fran Ambient I gra Special Regwements 009 ------I 1 -lemperature lr:gredients to 41-F/45'F 30. other i Within 4 Hours` . .. Deno,o nie n item in the iederui 1099 Raid(oic ui 105 CNI!C'90.000. - CITY OF SALEM BOARD OF HEALTH Establishment Name: f"M /do v7rF P - ra1727 /1 Date: 141eSo10111 Page: of l Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I IA-3 caw(). ,cr6"i 64, ,rA /Jt<.II -4 A.-tI14 {je 8�Ais ,c.�nftc�) tlnMct,n- /�1eF� CoAWzr 23 s>fu�A� P.G sfeA/ I In„1�.afrb.iR G_IJ-._� G_ .K.-�.✓, nIG tvt@J' ,�v-�'�n . I I � I - S5 Ar(I r, z . 1,46 1I_A-,4!5 t.X' 1 A t 6/6-kJ,,r .n Puss x_ l� t+S-7G_ AA1 AT Af:A.E.r its /3 rr1edtP1✓`.0 rJ 0CX_L A03 t nt- vg' &edrsAftft. 1tfCet^a/I Irl in.£ A&4li � I r t. _ I rAii.4r e'I /1,1-111 P r I -Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion 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 Ic your food permit. 14V D '�— ❑ Voluntary Disposal ❑ Other: <-),(11 1;::`? ( PRFs Recened at?'entper.rtures Violations Related to Foodborne Illness Interventions and Risk ! ALarzding to Lam-Cooled.a Factors(items 1.2211 (Cont.) '; 4!'F/^_i"F Within 4 Hums. PROTECTION FROM CHEMICALS ( ,o(inR i4lcthc'ds'iu:PHFs 19 PHF Hot and Cold Holding 11-0 Food or Color Additives i SOLI ldB) Cold PIIF, Mandaincii at or below i 3-2112.12 Addiuvea, i 590.1104(17) +I'14:i" ',^'': 3-302.14 Protecion from(!nappmved ;lxddiuves* _-5:)LIh1 Ai FIntPHMaintained atotabo�e 15 Poisonous or Toxic Substances MOT m ',-101.11 1:':entifgtag htfonnauon-t)ntcival I 9;+ z.ai - l .. fi(:U Roa:as Held at or above i 30`F. Containers- 7-102.1 1 Conte Nantc-vr4 urkina,Container.` 20 Time as a Public Health Control i ( 3-501.(-? Time as a Public Health C'unuo!" 7-'_01.11 Sep,uation-Storage" j 7-202 11 Restriction --Ptetence mid C.ce* j 5"0 004(H) Variance Requaeutc of 7-202.12 Cunditionc of Ilse" I Toxic Containers-Prohibitions* REQUIREMENTS( FOR HIGHLY SUSCEPTIBLE 7-1141.11 Sanitizers,Cr:terta-Ch,.iai..al.s' PI.HiA)iO"d8( iniz 7204.12 ChmicalFf._,rWafhtnt Product,Criteria- 7-1104.14 3-301.tl;Ar JnprsreunnedPyr-pxkagtdtrucessod 7-201.14 Dtvinr;,Aeents.Ctttet:a' 1 Bc'"era_c;es with b'+:n-tnn_labels;. 3-801 11(B' U>e of Fxstewitcd F!;gs^` 7-20`.11 hicideutal Fuad Contact. Lubricmns^ j j 3-:801 11 tai Ra'�r of Pmuslh Cooked Armin,!Yornj and 7=26.11 Restricted Cse F'estic:;!es,Criteria' Raw Seed Snron!s Not Berson. 7-206.12 Rodent Bait Slahon6' ? S01.11(C) C-rx,pencl Food Rx•ka^c Not P.e-san•�d. " 1='06 13 Trackine,Powders. Pest Control and ' Monitorin;,., CONSUMER ADVISORY TIMEF6 EMPERATURE CONTROLS 22 3-603.?i Conswn%r Advisor} Posted for C'onsumptivn of 16 I Proper Cooking Temperatures for ' Ar:irnal F,xxts'1'trar are Rawl Undetcuuked or PHFs Not Othetwise Processed to Eliminate u ,�r,zcs.c ns.or 3-401.1 LAl 1)(2) Eggs- 155`17 15 Sec. - 3-30'.13 P Eggs- Inativcliare Service 145"Fi5secw I „steudzed 1,c a.Subem ae fol Raw Shell i 3-40L I I(A)(2) Comminuted Fish,Pars&Game .Animals- 155'F 15 .ec. 3-401.11(14)(1)(2) Pork and Beef Roast - 130"F 121 t)in 3 3SPECIAL REQUIREMENTS 59ti00t)(.1}-i DJ Violationq O Section 590.t)1i9 A (L) it, -101.11(A)(2) Ratner. Injected Meats- 155`17 15 ( ) catering. mobile fo,_tti, temporary and 3-40;.!I(A)!3) Poultry,Wild Game,Stuffed PHFs, residential kitch_n operations should be Stuffing Containing Fish. Meat, debited u=nder the appropriate sections Prrultrp nr Ra[ites-165'17 15 sec. * ahovc if related to !oodborne illness i 3-401.1 i(Q(3! Boole-muscle,Intact Beet Stealer interce;:'ions and risb: factors. Other q5`F : 591).009 violations relating to good retail 3=10;.!2 Raw Animal Foods Cooker)in a I pr ac.to:,:,shonid be debited under #24-- Microwave 16S'F" Special Requirements. 3-40i.ii(A)(lub) All Other PHR9- 1.15'F15sec. * j j 17 Reheating for Hot Holding VIOLA TIONS Ri.:LATED TO GOOD RETAIL PRACTICES 3-03.11(al&(U) PHFs 165'F 15 sec. ^ I (ltett?523-30) 3-403.111Bi NBcrowave- 165'F 2 Minute Staudiu^_ Gitiral rar,,t non-crib(:ul w;rrtnnnx, ivIl"it do rtor iclare to the 1 Tune*` ,foodborne illness inrn ventions mid r u,6;'w tori lived above, 'zni he 3-403.i i(C) Cunnnerusilp Prtxeesed RTE Food- ( ,foiard in the(ot.4m mi; rertion.s qr the Food Cade and 105 CLIR i ritP'F- 59a0r,0. 3- , ,; i Item Good Retail Practices FC j 590.000 -103.]t(F Rentauting tinshee.;i f trtions oCRcel' ! � Roast," 1 ( 23. Management and Personne4 FC-2 .003 I 24 Foca and Fon!Prolec con FC--3 00= 18 Proper Cooling of PHFs 25, EgJipraent and IJuI nsis 173-4 t'i 3 501.14(A) Cooling Cwked PH Fs from 140'F to 20. 'J9aie1,Plumbing and waste FC-5 006 70'17 Within 2 dour.:and From 70'17 ' 27 Physical Facility FC--6 i 007 i to 41"F/45'F Within 4 Hour, 28 PelW)110L1s or Toxic Materials FC-7 .008 '3-501.14(14) Cooling Pt?Fs Made From Ambient 29. Splenial Requirements 009- Temperature Ingredients to 411/45°F 30. Otter Within 4 Hours* ' Omote:critical ilrrn u:dic 1,deral 10911 F-od Code or 105 ChIR 500 000, is Daily Cleaning Work & Responsibilitie JUL 7 - 2004 CITY OF SALEM CERTIFIED MANAGER BOARD OF HEALTH 1. Will make the sanitizing solution and test it making sure it is available at every station. 2. Will make sure that the Men's and Ladies rooms are clean and in working condition and towel and toilet paper and soap are available. 3. Will oversee the cleaning process everyday. 4. Will take care of the table area and area by the register behind the counter. 5. Will make sure all the freezers and refrigerators have visible thermometers. GRILL MAN 1. Will store and keep all cold food at 41 degrees or below. 2. Will clean the front cutting board every night. 3. Thoroughly clean the grill prep unit every night. 4. Will make sure that all food is covered under the front prep unit and in the front freezer. 5. Will clean the fiyerlator and will clean under and around the unit. L 4 PIZZA MAKER 1. Will clean the pizza prep unit inside and out every evening. 2. Will make sure that all food is covered under the prep unit. 3. Will make sure the refrigeration unit that holds the pizza dough is clean inside and out. 4. Clean the pizza roller every time it is used. PREP WORKER 1. Will clean the slicer and dough machine thoroughly every evening. 2. Will make sure the 3-bay sink is used properly to wash, rinse and sanitize. 3. Will make sure that the prep area walls, floor, and shelves are clean. 4. Will make sure the walk-in refrigeration unit is clean and everything is stored above the floor and properly covered. r. � I Massachusetts Department of Public Health Salem Board Health S 120 Washington Health 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(sl lyge of Insoection �n /,OM , 11,ZP 4� ,� � 16/e.t/+�/ I ✓❑" Food Service ly'Routine Addressi� r / 1 1 I Risk [I Retail [IRe-inspection- ', .'� i 114)t_'1Aj7 ,e1YwT Levert F1Residential Kitchen Previous Inspection Telephone j-r ❑ Mobile Date: 'Z/s 104 � 1771 Temporary ❑ Pre-operation Owner S h HAGGP YIN , ❑ Caterer ❑ Suspect Illness Person in Charge(PIG Time ❑ Bed& Breakfast ❑General Complaint Affl14 Mar AD *LA*4 In: I ❑HACCP Inspector/� 'j>fnnnv f ( 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 Ll 1. PIC Assigned/Knowledgeable/Duties [ 3.Handwash Facilities t$? EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives C33. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMENEMPERATURE 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 [118. Cooling 7PROT TION FROM CONTAMINATION El 19.Hot and Cold Holding 8. Separation/Segregation/Protection E]20,Time As a Public Health Control Food Contact Surfaces Gleaning and Sanitizing t{s� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. 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): J of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within90 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 2 . Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 5.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 7, Physical Facility (FC-6)(590 007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 59tllnspeGMmi6-14.W+c Inspector's Si nal re: Print: au r� tJ tt e_ �._!r � Pl(C'S$ignatnre: `p �,.,..�-- ( Print 10n144��A, D (��'Y/v'7, Page of . Pages v Violations Belated tc Foodoorne liiness intervenrions and Risk Factors(items 1-22) PROTECTION Fi2OAh C0:'VTA&9iNA7(OAS FOOD PROTECTION MANAGEMENT g i;rrss-wntamrnetron 596.603(A) ! Aesrg+uoent of R;:cponsibiNty=" I 3=3(_;2.!'(Ant 1 F:ax- <;nuual F.u:i:;Separ«;ed tom 5961)03(:;) 1=)e naneu allon of Knowled:'e Cook, anti RTE Foods <-U!; I I ! person in ch:uge—da!,cs ! t enta.mine,arn fr m Paw tny(edierrs .3 11(A),,7) Rn,a Annual Foods Separated from Each EMPLOYEE HEALTH Othzr � 2 :i90.003(17) ResponmWityoi n the erso :n chabL x: Gortamnrat!en lrsm fho Env,lcnmeat ! tryuirc rep,„tmg by food eugdopee::and 13-3W 11!A) Foul Protection- appli—mts* 3-162.15 Vo,;fi ug Ftnits ad\,ef_riables 59'",Ott t(P) R.sporsibilit-,Of A Frnw F,n;plavice Or An 1 3-304.11 1-omf C. ntact::i:h zyaipme::: and apphrant Tn Kep„rt To i he P.rcnu In I ! Uteri�ds` t vonami,:alix.nom the Consur,,;; � i 596.({)3(G) Reporting In Person in Charge" 3 't;6.14(A1!Bi Returnrd Fm: t and Rescmo,of Food' 3 S;U.t103(J; Bscittwm and Rcstric0onc' j I Otsposibon vAdultacaied or Contamir+ated cr?C p0?t G. Removal of Exa;:r;ions and Restriet,ms Food 3-761 11 Discarding or nsn e I FOOD FROM APPROVED SOURCE Foci* ! 4 Food and Water From Roguiated Son,r,2s I .' Ford Contact Su faces `9t�.60Y{.', H`. Congyl::tmce with food ia,v::' 4-501.1 i Manual LV�tn:acn:r��- Hot Rater 3-201.12 17,'od in a flermrtica!l;,Scaicd Coammn-, " Sarueization'CeIII,era:urea" ! + 13 Mer! 201.1' Fluid Milk and Milk Products" - - - tanicnl Warewac!ung-tint Water i Sani;rzatwu Temperatures` 1 3-202.13 Sboll "+-2( ti {_501.11= Chenic:. Sinidzt?on-temp., ,H, i? , ., i - nwcetumtion L-ad hardness. " 6 fee Made t,�rom Potable Drinldn- Poater- 1 a! i ,•.:r- �, ry i }-b!i1 ; i(A) C-:,u+p,;ent Food Cuntazt Surfaces and 5-.` I ,t.s },Vr,ter frn:x:an Auer: rd Jyst�tr Uteusac t:'iean' So:)C06(),) Bottled Driokin7 Wr,!er'r 4fiU' II Clean.nr ;:rra;nency of:;_ja,pm[ar'r';,r„' 790 C:66(ti) Water Meets Swnda+'dc in 310 CMR 2.201 I - 1 ' I (_,ARIL! Sa:ta e:,and Utensi!c Sf-,e!ltish ar!d Fish From anApproved Scarce 14;702.11 Fteyu:rrcp of S<m!tizaflcn of;Itens;!s and j 3-201 11 Kish and Reciea!b.mally Cmight:biol lu;cnn ( r .:� of eui Hunt" Food.on, t.c,. res r3_ I 4 a Sbclliisl)' 1 42703.11 10.;tbods of SaniCzation—Lroi Water auci 1 ±-261.15 !vioiluccan Shellti:h !7om\SSP Luted I r;i217tira' Ci llTCe��` i j Game and Wild Mushrooms.4pprrved by ( l0 Proper,;adequate Hanuv,ashing Reputat,ry Author ty 2_:!)i.i i c'fes•r Cercr,;or.--H:mds and Anna" I ',-iU3.i8 Shai;tuc'xldentificrLonE'rescit* 2:.;)1.12 Clern:n_Pr..cedo,eA j «ltd Mushroom, -$ll 14 When to C<4 3-201.17 : .ecd Fygienic Practices name Animalsj neceiv EmglC;nditicn12-»!J1 I I hating. Dnnk:ny rr Using-tobacco'' 3-207.1 1 PIIFs Ricen'a.d at Proper T empUnutes r 2-401 12 D:sci,+rges From the Eyes, ftvse mid 13?62 j5 Package Inte;rriry" Mouth. , l i-i6Ll! f'txul Safe and L',:adulter:de,i* i 3-301.12 Prev,nuc-('Oa:nu,el7atl n'Wh;n Tags/Records:Shei!stock 1? Pr<±vention of Contamination from Hands 590.6tr1!3; Pte`:e: ;nit Conran=n:<t:,,r l:nm 18 She)ictwk Identification"S 2(. t aplueccs". x_ ;.1;? ( i:ellstock Idcntificatton Maintained" i I Tac=_1Rerotds:Fish Products I 13 Manr'wash Faci0?tea I eglentiv Lwared apd ArcvsSablo I i--=.DLII PsacitcDasCruchon' 'ti3 i i Vnmbecs and Case..� �.t s I 3-<}0::.12 Recorctc.Creation and Retcnuon°` I I - - I„,. .• ( c r; Labeling of Ingredients* I `-21)1.1; ,:u:aton In,! ?Isom:,,"" ( Approved Procedures � ),.I fve:.essibi, t-. icration nn;Cottiormnnce with pv I /HACC'P Pilaus ! Sueoue>? ^,;ih Scat,ono tiar7d Bry „ ing 3-507.: S'.�ecia!lzedProcessingMetho,is* De+,ices 1 1.561..i 2 Kea,!ec;i nr, .n r3u a a;;.trate:'," 6-101 11 li,mdwa:hing C:eauset,A; a,iabdl!ity j 0 3.12 Confortnarce L',iCh Appmvcd Proc;dui es" I I ti-3i+l.l? hwid Drying Pn;vis;<,a 8-1 1 *Dnroics trid,.:i«:u�n t!,r!eda a! 1';99('N)J Co'e,n lU:;rp.i is 5n(1 OOii. •i CITY OF SALEM nn I / /� BOARD OF HEALTH Establishmenf Name:"l/1 /I MHouse 'j0'/-z.-35—r Date: 61291oy Page: of 6 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Z Nle, rrKA tl w g a uK,v-- IFAS rF N A-e, L-,m v 4*.r'-i elf o-f OWAiC 4"O FasA i9j.R19111 . vrla�un.w�/ c,,EAN urs, r- /nre 04- A-MO iiul' � I G + 01*109s ^st-vt�o ot,��rw eN Isc«.a _ racr_ ceao ,Host R,c A «art- ; I I I�_�t ,rrc•rf�r � ��' ��,�. I I I - II I \I� V�� i i tile- Ierf Gaeo A0tER4/S_ fR,f-o VON u4 cA.AsMl ir9ir tN7(04- AftO vur- g I c �- c�rtTi►�r. Ad*-AD nt� Pt zz,4 P"p t," t-P' g Ari w s to X647 .a rrO 5$?tt N0.1 I lir rwn 04- f30A*T) Mtr-.r /3E c sfrA& vNtV J0*8 uNe6u6.tt6P Fov9 A-eO d&60.7 A- nitnLuc/G4 ccb�rrr�K�1 IAZt_ f urs 4 qtr 3Ya,c,Fc.Tic .�cvSa' Q� G.t�t,�HO GG��,tlf uN+G% r NFt 0�' t naf'. C ' In ctr-N &X kr(- 17&AALt I I I I o►x r �a+0 Gl�i rtt . s-kf0% .erur"JL j e- c A r A4, 0 5'Ar4 ,r726 &ffP XArG4A;&YVrl A- t ;r I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes r� { I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that -noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: j .1 1((S> I'Hbs Received at Trmrerotur;; Violations Related to roodborne Illness Intrrvrw ons and Risk ,Accovlm'h;Lav:Conflict to 11 Factors(items 1-22) (Cor.,L) JI P/47 F WitHn 4-Hoa:s PROTECTION FROM CHEMICAt,,S j 3-501.15 Cooling,Methods f,•a PHF-, E4 Food or Color Additives 119 PHF Hot and Cold Holding 3501 ](,(if! of(] bi PHFs n:n; fined at or below' i-10..12 Add;lit�s,F 5'�CLOOv(Fl 41 3-302 L; Prutection front Unappro,ed Addane:', is Poisonous or Toxic Substances 1.16(A i Hut PHFs hl:nntvned at or above 1401: " 7-101.11 Identilt ine lnforruatwn--Original j 33-501.16(A) 1Zoa,tc. Held at o; above !301-. C JntlinC.rSiP i-102.11 Cotmr-on Name-Working Contxinrrs"' ) j til flats as a Public Health Control '_°01.19 Tien.as::Pnf:7ic ile.:at.ControP` 7 201J Sup::ranun-Biro age' ' 7-:02,11 Resl rictiou-Prcwircc and UiicI i 590.(}04,lll Vanatue Requiren;wt j 7 203.12 Conditions of Use" { 7-2iL.11 o ic.:untainers-i'ruhibitions^ 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Samtizers.Criteria -CheuHr ah' . 21 i-So!.!1(A) Unpik teunred Pre-packaged Juice-s and j 7-_04 12 Cbrmicn!s for Washing Priuince, Crit.ri r,^ j Beverages with Wacning Labels" i -7-204.14 Drying Agents.C aeric'' j ?''0> 11 Utcd ata(Food Q>n[act,Lnbncautti"` ( 3-Z,'O1.!1(BI Use of 1'tr1,wizol 3-SOI !1()) Rant or P,utiallq Cooke,' Animal Focij and j 7-206.11 Restricted Ilse Posncides C:rueti0 , ,-: . ! Raeed Sprout:, No Screed. 7 i ''0b.i2 Rodent Bait Slawais' ' 3-g01 '7(C) UnopLned Food Package Nor Kc-served i 7-2(16.13 Tr.'cking Powders, Pest Control and M oro mrwe'' CONSUMER ADVISORY T4MEffEMPERATURE CONTROLS 22 3-603.11 Consuln-i Advisory Posted for Con:utnptien of t( I Am:nal 1-oodc ]'hal :Ire Raw, Undercooked or Proper Cooking Temperatures for PHFs N,,t Otherwise Processed to I-I n owe )( Eggs- 155'F 15 Sec. 3-102 131 Pasteurized Eggs Sabstitute fa Raw .Shell Eg,,c- !tnmedra:e Scrvu:e 145'F15se,- 3-401.11(A)(2) C'nnaninutcd F+,eh,Meats& Game Animals- 155'F 15 sec. * PE 3-401.111R)(Iit 1) Pork and BeeZRSPECIAL REQUIREMENT'S oast- 130`F 121 miw' 59,1 ti09(A` REQUIREMENTS 3-401.11(A)(2) I Ratites, InJccted Meats- 155`•F 1' 009(A)141)) Violations of 59590.009(A)-(())590.009(A)-(())fir,; seC * :alerirg. mobiic food: temporary and 3-4O1.11(A)(3) Poultry, wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing_Fish,Meat, dcurtcd under the appropriate sections Poultry cd Ratites-165'F 15 se.. ' abuve if ic3aLed to foodborne illness 3-401 111 CIf3) Whole-moscie, intact Beer Steaks ;!tier renttous and risk factor,.. Other 1 las°F'° 590,009 violations relatinz to good retail 3-401.12 Raw Amina., Fo:xls Cooked in a Practices should be debited under ff29 -- \4icruw ave 165`F'T I Spee;aiRegmrcioews. 3-40111iA1/I)(h) All Other I'HF, - 145=F 15 sec. ' 17 I Reheating for Hot Holding VIOLATIONS RcLA TEU TO GOOD RETAIL PRACTICES j 3-401 1I(A)&,D) F'tIFs 165-F 15 sec. {, (Tterut 23.301 13-403.11(8) Vliccowave- 165'F 2 Morale Standing ( Critical and nor-rraical oioiafiuna.. .ahirh do not rcla'to eke I Time` fuodhorar ilhass byer,-entions anal ri.,b Jacrorr tested abo,tt car,be 34031IIC) ConimerciallyProcessedRTEFour(- ( timndit :heluiiutrio,tisectimesr, riceTionCadeand 105CIfIR 140°F` Soln,nnv. 0311(E) I?cmainine Unsliced Portions of Hee( I Item ! Good Retail Practices FC 53a.R00 a-4 Roaus:: 23, Mara_gemen'and Personnel FG-- 2 .003 18 P > ,gj t v 9 Fund ann Food Protection FC--3 .004 -- ! Prower Cooling of PRFs I_21----;— ', Equipment and Utensils FC-4 _.OUB _ 3-501.14(A) Cooling Cook. d i,IFs from I-.0 F to ( ;6. \Mater.Ptumparq and Vda>te FC-5 .006 70'F Within 2 Hours and From 70`F ? Phy,iaal F.,ci!dy FC--6 .007 to 4t'F/45'F-Within 4 Hours. * 1.28.______Pononcus�,r Toxic Materials i FC-7 .00.3 I 50 •!• i5. Special Requreme tis ! 005 C l 4(B) Cooling PHFs blade From.ambient ! j Temperature Ingredients to41'F/45`17 30 Other - _ _- jWithin 4 Hour,* .•,. '.Uanore.�n;iant nem,n the lederil 1499 Fu,d Cod,m 105 12VIR 500.00p. CITY OF SALEM BOARD OF HEALTH / p I Establishment Name: 3*AM/4 /dfUJSS' Cr toinvi- Date: 6A_9l� Page: 3 of G Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 2s NIL' Ttg1Jt� LIr-��I� CA'nf of�sN�,� /daS ,fihr_AC_¢.t.lrttiv+r-ie/� eI�" Gus9 O�I�GS I I.A....�v �,rr �ra�,e.�,,c-�,+ c�.� r+ �s,n-► ,rte �ar�� I le— I wy -rG f w c..,ro/_ "icy cy lxry r".._ e_i9 /Sb,Ar� I I I I I I C, A AoaQ *1`40 F-ven ycumc 0 6 n*Ce rel ,y I I f-*r nd,C Zv,_V_ At-4-- V-6 Uo ,rr Wav4a4.& o4Ua- 4&" CaA- c ,,O A_- R-I..a,V 0 I 13 I C'_ I- AN"WAT it r/W9 10 P4c-(Z- M ts'ry 96-_ -rte lg MJO PiQ lit(- n wrc z. I S� rtnc "&&4z+ A v-1%I6& ,Uk& CktS4-fere,_ P44-409- SO&P Mffn ('r' gid- I I k ewsL�7 i,s &_r4U_ 1d'-UNC- A-f- A-M— rz nAa% C A49 L_ I I7,1-fg- ,d,6 ►ten t'ra-sMl4rf- n11 r^ T �dubldl4.i1.C1C0.�'�— �r c£Nb4.fto"rc� wt(7Q' Ft.�/Z- .�/✓(� SOU . iZdeI�4U�rdP`M I I I. .F�r n ..✓� �,a Kt tmcr I . I LICu sY.t GE Nee so M%16 4&us-.f D,o- sj,�K ��,N t s� v '43. 4 swr nwAt. cl AN AN11 34M A VAX I I I I rePV--_ u Jali;; v"W Aj 9.99- � PAPrrt n" & , I I .r 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 ❑ 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 ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs ke-.eived't Tcluperature: Violations Related to Foodborne Illness Inrerventions and Risk I According to I aw Cooled to l Fa:tors(Items 1.22) (cont.) a1 F;»5'F'Within 4 Hours 5-5OL15 Cooling ivlrthnds our PHF'; PROTECTION FROM CHEMICALS ( 'y PHF Hot and Cold Holding 14 Food or Ccior Additives ; 1-501 IF.B? t edri t'HFs A^air;tamed at or bC10'a' 202.1 2 A4df1Irs* I -302.14 Ptotr%lionfrom Unuppri,,edAddmscr. 3-501,U-4A 14,s- i'F -SJI.h=.(A: 14 t'. t b(arnr<+u:ed at of ,Ibuvc tg Poisonous or Toxic Substances 7-101.1; Ideatif,;iagIntormahon—Onginzl _; 501.16(4) ( Boas.:;Held at--",; bone !30"!-'. ' Containers` Titne as a FuLfric Health Control 02.11 tuoruum Name—Wurk!og Contmners `7• _ time as a Public I Icslth Control* 1 7-20[,11 Separa!ion—Shu arc"` i 7--,O1_ 11 Restriction—Present and lire" 59t wf)4(H: banana"Requilen:eot j 7-302.12 Condivons of 11.e• 7-20; 11 71 oxic Container. - Prohibitions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS iHSP) 7-204.11 Sanuizers.Cnteva—Chemirda'" 2li '4-:111) t 1(,-'t) Unpasi::urired Prc-pxcksged Juices and 7-20-7 12 Chrnrca!s for lda<hine Produce, Criteria"' ; Pectases with Warning t,bele ! 7-204.14 Drying A,rnts.Criierin' I j 3-?!Ul.l lilt! Use of Irastcuriud Edgs.. j 7-205 1 i Incidental Ford Cuntoct,Lubt ono,'" j - -2�I1.11 Re,u'icted Use Pesucides,Craeiia:e 1 13-8[)t I I(D} Rdw at Para iady Cra}:eti Animal Fond and ke w-Seed Sprouts N:•t Served. 7-106.12 ixodcmBait Stations' lhuopcncil Food Package Not Rc-scrr'cd. " 7-206.1: 'll acking Powders, Pest Control and Monitoring' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-601.!! Cunsuruer A&isoiv Postcd fur Consumption at' 1B I Proper Cooking Temperatures for NotOl Funds That are Raw,UndeEliminate n+,8:ed ca' PHFs I hen O:henac Processed to Stiminate -401.1 lA,I)(2) Ec-F- 155'F 15 Sec �s-immod;fleScrvicc 145`F15iec 3[)2,14 Pa:lcunr.ed k ags Subsritutc for RaI, Shcli > 3401.1 1(4,(21 Comnumned Fu;h. Ivteats K Gamei L'ggs animals- 15.5'F 15 sec. ' SPECIAL REQUIREMENTS 3-401.1 i(B)(D(2i Pork and Peet Roast I3WF 121 min` 1 590.009(A)-(D? b'/OlallOnS of Section 590.009!A)-(ll) in 3-4W,11(A?(2) Batite,. hrjected blcato-- 155'F IS I e, catering, mobile food, temporary and 3-401.111 A}(3) Pua!tc9, Wild Mame.Sniffed PHFs, j resirlru,ia] kue6cn operations should he Stuffing Curtaining Fish,:Meat, debited under the appropriate sections Poultiv oc Ratites-165'F 15 sec above if related to foodhorre illness 3-401.1I{C3) Whole-muscle,Intact Beef Steals` interventions and risk factors. Othrt 1 44'F:_ ( 590.009 vio!atiuns relating to good rata fl 3-401.12 Raw Annual Food,C,oked in a Practices should tu+debited tinder ft?9-- Miciowave 165°1' * Speci--i RequirclnCDN 3-40LIUA)(!)(b) All Other PHFs - 145'F15aec t7 ( Reheating for Hot Holding VIOLATIONS R=iATED TQ GOOD RETAIL PRACTICES j 3-403 11(.A)&:(D) PIIFs 165'F li sec. #` (Itents 23-31)) 3-441.11(6) Microwave- 165'F2 Mull tt StandingI Crim uti mrd iron-c•rmcal solations, which do not r',hae!r,the I 'Flair." loodhorna ilhtes.t i;uerrrntions did rick faclot:, fisted irbol", Can be 1(C) Commercial!)Processed RTE Fcx)d- tinn+d in the follmvinly eeCtiona tJ the hood(-;ride and IOS LAIR 40`F` I 590.O0o. ! 3-4031!(15) Remaining Unsliced Pottions„i Becr ( '� Item Good Retail Practices FC 590.000 Roasts= j 23. Management and Persoorel FC--2 .003 ' 1g Proper Cooling of PHFs i 24. Foo+and Food Protection FC--.3 004 25 _Equipment and Utensils FC—a ,005 3-501-1.t(A) Cooling Cookvd PHFs from 14[)'F to 1 - -----_----------- - -- f--2P.--- T Water,Plumbing and Waste ---- --� FC-5 .00P 70'PWithin'LHumsandProm70`'F 1 27 I Phvs'C•auFa,ility FC—6 007 to d 'F145'F Within 4 Hours * 1 28, Pasonous or Toxic Materials FC--7 008 3.501.14(6) Cuuhng PHI$Made Porn Ambient 29 - ''�F-Speual Roquiiernents_ .009 'Pc:nperaturc Ingredients to 41 Ti-15'F 30-- i Oilier Within 4 Hour:` Dem*,,iitieal nim in the t ilmil 1999 Food C,*u, 105 i \iR WO 000, CITY OF SALEM BOARD OF HEALTH / Establishment Name: �l �t M /d0u3 d"' 141774 G129/eq Page: Y of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY '; C.rKtrrP /5e00 13Y CAN o/'�NsJ� IS /34411y P rFrO S Grit? A I I 'rl N 1 f✓ G f�u- N��+N" St !CS f- l h�7 .�N SCG r r M Ul rtt�_In t f �G f'ue f� SfrT1N� I I I I A"V L I I I f I I + MX&L . S L/1Tfd M IrrrilIZi A M064C 04*i t_ At a A-" o -Cr IW t/+. ,W a/x- I ' I I + ILr+t"SCS -TMo a;a rs acv n K ,s a f,f vwfcr Ni'. ,«+f ver; a.�6 ccs 6 c r..►f rsa l I I I I4wn SW14(own ,eft I I I 1600 c7 NA r l I I I I 9 I G �- ��a c.,�n Na san�o ,s s�.�►<�+a a,r0 s fit, Kso. ezAFVkv,ec.& 0II-- aMPl e f l I I I I /9 C 4- 6ACvrt MAS Q A— A)oM PoiseNnAW I07-A,w0to Ii IMUS /9s lames- k rziMlo &te q Ir af<-6dz6or, I I I I I ?-Tt I Nle- (3AY9, AQ r - rc 1pn /M,V raaJ AeX,,Mu`4*4n #W Tf 01xr A?.(-D CAeA&7 I I I C0_,9 ►a r! 4Hn sw"f, I. : 12s� I ale, + GC nrCISOX 4 VI? fIll f74,c-v,4e Jt t 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/ s violations before the next inspection, to observe all conditions as described, and to Exclusion I p ❑ Re-inspection Scheduled Emergency Suspensi ❑ on comply with all mandates of the Mass/Federal Food Code. I understand that 'IV noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: , 3-501.1;oE) PHFf Peceiverlat Vict3dons Related to Fo->olborne Illness Interventions and Risk Acooling,to fov Cooled to Factors(Items 1-22) (Cent.) 4PF1,15T Within.1 Hours 3-501.15 C ooi: 'victinAls lot PHFi PROTECTION FROM CHEMICALS 14 Food or Color Additives 19 Pill;Hot and Cold Holding 3-501 16,01) Co,!; ')HF.;Mairluuned at or below 3-202.12 Ad.itiw�" 590.000; �F) 41-/45"F 3-302.14 Pr'.lLCCti0h from I filial,;-noved Addime:;* f 3-501.16"A) IIA PI-IF- at or atime 15 Poisonous at Toxic Substances 7-101-11 Identifying information—Orwin.,l Coniajilers�' 3-501 Fi-'tV) It oast:Held a, or ahol.e 1302E zo Time an;a Public Health Control i -10211 Coronion Native -Working Cori 3-501 111) `(tyre its a Public ri:411h Control"7-261 11 Separation—Stoiave" 1 7-2411111 R--str;,-non—Presence and Use" 590 Of'4(H: RUIlth"Mont 7-2))2.12 Conditions of I T C I Js REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I 2i 13.11 '1 oxic(A,ntainers—Prohibition, POPULATIONS(HSP) 7-704' 11 sanit�zcrs Criteria—Cherp.;cals* 21 2-801) llfA) I lnpasreutiied Pre-pa�.kagcd.)arise,,and 7-204,12 Cherineak for Vl-dshing Pvodri,�c,Criteria* btcerage> with 'Warning Labels 7-204.14 Diving A-,etrts.Urn,,ia 3 80 1 11(B) UFe of Vast---aize'i Egv�s' t; 7-205 11 incidental Fund Contact, Lubricants" 3-3111 110D) kaxl, it Pcalii Ily Cooked Annual Fo;id dnd 0+5.11 Restricteo Use Pesticide,,,Criteria* Ral% Seed Sprout:; Not Served. 7-206.12 Rodent Bait Stations* 3-901.i I W) unopened Food Pac4jge Not Re-st-rv-d, 7-206.13 Tracking;Powders, Pest Control and CONSUMER ADVISORY 22 3-601.1 Corsuryrr i\6illotA,Pcxted for Comomption tit TIME/TEMPERATURE CONTROLS Animal FoodiThat are Rirl%Undercooked or 16 Proper Cooking Temperatures forPHFs Not Otheivisv Processed to Eliminate 3-401.11A(l)(21 Eggs- 155'F 15 Sec. Pathogens., Eggs-Immediate 5ieri,ice 14Y'F l5sco 3-302 13 Past=urged Egg,Substitute fir Rav, Shell Fggsw 3401,11(02) Comminuted Fish.'Monts&Game Animals- 155°F 15 sec. * 3-401or 01 I I(B)(1)(2) Pk and Beef Roast- 130T mon"n* SPECIAL REQUIREMENTS 3-101,11(A,;(2) Kvoous,injected Meati— 155F IS 590,009(A'-(D) Violations kit Sec6on 500 in iticbile food, temporar';and residentiol kitchen operations sliould be 3-401 II(A)(3) Poultry,Wild Came.Stuffed PFF< app debited under ttheropriate sections Slultint-Containing,Fish, Meat, Poultry or Ratites-!WF 15 sve, abovc if related to foodlica ne it Bless, 3-4f)l.I l(C)('3) Whole-muscle. Intact Beef Steaks I inlet ventions and Fisk hl:crors. Other 1-15`F 1 590.009 violations relating to'good retail 3-401.12 Rroy Annual Foods C(K)ked in a practices should be debited under 0'29— *NliLfflWa`VC 165'Fr Special Ro.quirenrents. 3-4 4ol.l I(A)(I rb) All Other PH!F,; 14>+ 15 sec. 17 Reheating for Hot Holding j VIOLATIONS R-LA TED TO GOOD RETAIL PRACTICES 3-103 1 I(Ai&(D) PHFs 165'F 15 see. (Items 23-30) 3-401 11(B) Microwave- 165"F 2 Minute Standing I Critic Of riui non-cl"'iLal I lulatioro, which do nm relate to the Time" 1m.dhonir iliness and risk,toefots listed whore. can b., 3-403 11 Wi Commercially Processed RTE Food- found in trllujollonvin�'sertiom t the Food Code and Iff(,'.IIR WOOF' 5yo.0f)(1. 3-403.11(E) Remaining,,Unsliced Portions of Beef Item Good Retail Practices PC 590,000 1 Roasts'. 23. IManagement and'ersonnel PC-2 '003 18 I Proper Cooling of PHFS I 24. Food and Food Prntertion j FO—3 00e4 3-[101.1 4(A) Coolinnl,,Cwked PHF,from 140'6,to l 25. E�pmern and Utensils FC—4 .005 1 26. vViller.Plurnrinq and Waste 1 FC—5 '006 7(!'F Within 2 Hours and Front'(ff 27, Physioa!Facility FC- 6 .097 to 41 'F/4'+ Vv;thm 4 Hours. 1, i 28. Pnison()US or 7owic Ninterials FC—7 008 3-sO 1.1 If B) Cooling PHFs Mace From Anibeent 29� Special Requireme-4s; -1019 i'30 ---Oth�sr Within 4 Hours'^ i Deno:,!,critical iton in the federal 1"99 Food Colleln 1f15 CNIR`90.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: S 41,,cm ieA. jT& r3f; j4/77A- Date: G 1G4 Page: of 6 Mem I Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY G o .170064C urtI-q- ,ten AA9&-n Nn4i:X s XreA4C6) r^rtOW A*,-,�r AA&A-r-- I I B40DA&AA � P,.M."'9ll,w �� 2i.r ��ur 0-hBg 0k4UTc �j6 se-r�$f_ero I r6:Pd,L.e�dW r_ h /'�ac�.f �' iCnsr C.r.Tr4wtrt/.�-/-ia/✓ _I I I I I I I I 2� I N�C `I- /4CfJMo.ur /t.2�ra �S/c „r iS41,c .r.FKr NScnS vr9r d4a sc�,,ruiar vs��i5w,� 1 . I .ate- .A&4— } I I w ,Jn rL�+� s�N'K-- i S Gt.esr..2.s 0. />>41✓t 0� ru r uc a— Pitts� �Isi'r@ t f�- .S?Sn( ' I n 1C0,6-.r sr,L Al,J.rn 3'/NL4 f AA na f n I a- tcw. I \II I I 4j6m M&C-61f AMrtAL +A-u— r.r3ri.t- t7� r.rn LstA.a,r_ r.✓alfQJ 1f6utGl)6)C_ I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ 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. yyl�y�y�y ❑ Voluntary Disposal 13 Other: 3-50114rC} PHFs Rcecivedat'f.niperatmes Violations Related to Foodborne Illness Interventions and Risk According to Lain Cool Factors(liems 1-22) (Cont.) 4VF,'45'F Within 4 Hovi s PROTECTION FROM CHEMICALS ( ? 57)1 15 Cooling Methods for PHFs 1-0 Food or Color Additives ( 19 PHF Hot and Cold Holding 3-Sul,1601) Cold It 11's;4Mintained at u;below 3-202.12 Addidtes` { 5`RO(W(F1 til"/4:i" F- 30'2,14 '3('2.14 Protection front Unapproved Additit-es a IS Poisonous or Toxic Substances =-`'31.1ir(:A) H,t. .3E;N_aimainel at or shore I Iai)%1. T 101,11 Identifying Information-Original ;.501.16(A) Roasts I-Ie)d st or above :30'F. Cuniainers` 7-102.1 I Common Naa+e-Working Containers' � � 20 Time as a Public Health Control ' i 3-5'!1.19 Time as a Public I-?ealtL Control- 1 7-?('illi Separarion-Stoi age" 7=211: 11 Restriction-Prescncc and Ur ( i 590.00,1(14) \'.uianec Re priremeut 17-'07.12 Gmthtums of Use- 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Containers - Prolnbrtioni: POPULATIONS(HSP) 7-204.11 Sanitizers.Crier's-Chemicals- 7 204.1"s Chenueals for Washing Produce. Criteria* ( 21 j 3-bila)1(.A) Unaastcurized f're-p.iekaeeit juices and 1 Beverages vvith Warning Labels" { 1 7-204.14 Drying Agents.Criteria* ( , , ; 3-ti01.1;(B) Use or.I a:tornized 17205.1! hwidcutal Food Contact,Lubricants` j 7=206.11 Revricted Use Pe,ticides,Criteima 3-s01.1it i Raw or Pa tial'} Qx,ked Annual bout and Raw Seed Sprouts Not Screed. '" ! Il Rodent.Ran Stations* 3-8r!1.l l(C} ( Pnnpened Ptx,d Fac}:,,pe Not Re-served. " 7 1106.13 Tiack;ng Powders,Pest Control and N4onitorin•* CONSUMER ADVISORY TIMETfEFdPERATURE CONTROLS 22 3-603.11 Consumer Adrisory Posted for Consumption of I6 Proper Cooking Temperatures for .Animal Foods That are Raw. Undercooked m Not Otherwise Precessed to Eliminate PHFs FftPccv r;:no, l 3-401.11 A(i)2) Eggs- 155^F 15 Sec ! Padu>.gens/ l3-302.13 Pasteurized E.<.s Substimte for Raw Sholi I Eggs-lmmedidre Service 145"N 5sec` 3-401 1 PA)(2) Comminuted Fish,bleats K Game i I Animals- 155'F 15 sec. "' SPECIAL REQUIREMENTS 3-401.111B)i 1)2) Pott:and Beef Roast- 130`F 1'21 min" j So0.On9i A'- Di ;9( un].I1rA)(2) Ratites. hnlected Moats- 15i'F ti j - ) (- Violations of Section. )00)�A)-(D) in sec. t j catering, nx,bilc feed, temporary and 3-101 11+A)(3) Poultry,Wild Uamz,Stuffed PHFs,, I residential kitchen operations should be Stuffing Containing Fish \feat debited tinder lite appropriate sections Poultry or Ratites-165°F 15 wc. " ( above if related to foodborne illness ( 3 401 A l l(20) Whole-muscle. hatter Beef Steak, interventions :md risk factors. Other 13:'F` 590.009 violations relating to good retail: 3-401.12 Rath Animal Foods Locked in a j pi actices should be debited under .H29- i bticrotcave 165-F^ j Special Requirements. i 3-401.1 i(A)0)(b) A;l f ther PHFs 145'F 15 sec. * j 17 ! ( Reheating for Hot Holding VIOLATIONS R-LATER TO GOOD RETAIL PRACTICES 3-403.11(A)R(D) Pf1Fs 165°F l5 sec. * (Items 23-30) 1 3-403.11(B) Microwave- 16 'F 2 Minute Standing j Critical and nor,-(-nical violariong wlnc4 do rot relate to the rile* j luorltterne i16;esa anter reation.c aril ri sL(aetma irsled abevr, cern be 3-403.111 C) Commercial iv Processed RTE Food- Juund ir,tv<e fi)lloa,;ng serlin:o o!the F(.nd Code and I95 GIIR 140"F' 590.(1(16'. 3-403.:1(E) Remaining Unsliced Portions of Reel Iters Good Retail Practices FC 590.000 Roast:," 23 ! Mlanagement and Porconne, ( FG-2 .003 iN ( Proper Cooling of PHFs '-? Food and Food Prolect:on j FC-3 004 j 2-9 I Egmpm<^nt and I ltensiis FC-4 _.005 :,-501.14(A) Cooling Cooked PHPs from 140°F to 26. j eYater. Flumhinq and W zste IFC-5 .006 -- - --I 70'F Within 2 Hauer and From 70"F 27. Physical Facility Fc-6 007 to d 1'F/451-Within 4 Hours. * 2II. Pn!sonous or Tows.Materials 1 FC-7 .GOb 3-501.14(B) Cooling PHFs blade Ftom Annbient 1 29. 1 Saecial Regmramenis .009 Temperature ingredientsto $I'F/45`F 30 Othe: Within 4 Hoar:" iknolc� rmcal'tarn inthc federal 1499 Ford Code of 11F t blk S90.00,i. CITY OF SALEM BOARD OF HEALTH / Establishment Name: SA-lsM fiftlujt3 e- jftz.0-- Date: 109t 441 Page: (es of G Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY NO r-A,rtWLf tJG- Se" LW tntP PNisP€ A- C4WetL d04 -1 dVW AlrWL4611c ;"AT4 to 2j ^re' rege'Lm dK /-)r P"04s A- Corrc6Mr�A+�-ate !Mc/sf" !S � I I �,aolw .�e-t.►t�,..r-es,r.� � ,o-u.. wo-,4.c ,rnene.,�rs � �� s-rrKsr• I I f 14Y AN r-060 fff.A R,T AVID QV4 i< _ 0Jae4,x rd-t.1 C-l,.!C411 Fcow`- w c.'uo1 N(r tINo&/- C, W'0 AA&&A4 A1.4- ,�©tJLfOfU� n� tl 1 2-7 1 w(c 4 ,8,.t— &n4u-t A+ 4 v rwo"trn-.r ef11l*W-qW6- i I I ,l f2fCi6fYF (&/,I, f6- I I I tJ� Krt�,k,,Nfir'rar✓ I I I s,a.f„tozf/4 >w r,fto r I . W_my cc d.0- ud�nt I �9 Quf9uf+� I I I I I I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance El Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� l ❑ Voluntary Disposal ❑ Other: -5tH 14W) PFI Fs Rees;yed at Temperatures Violations Related to Foodbcrne illness Interventions and Risk A0--ore ing to F aw Cooled to I Factors(Items 1-22) Want.i 4 i'74 S-F '.i'rthin Y D'O'S - PROTECTION FROM CHEMICALSI 3-5t)1,15 C, 1i t' M9 6,,ds for FIIFs 19 PHF Hot and Cold Holding I 14 j Food or Color Additives 1 t6(HH C.r!d PIWS.% vniainr: ^I nr heiow -20�.li ,\dd:rives S90.004(F', 4i`/»5' p.: 3-3f,2.1a Frrnection hour lluarpnaed Additivc,* ! 1 3_Sn1,16('t; 1-lot PHF, Niao;tained at o; abs ve P c I Poisonous or Toxic Substances i 140 7-1:i L 11 ldentibing Information–Original i 1 Couainrr;," 3S01.1o(A) Roa'.,.Held at,nn thcve 130F. ' 120 ! Time as a Public Hneno Control i7-70' 11 Gatrmmn Nxme--tNorkiug Containers* ?-strl.l+) ; -;ono ac a Public Health C,nooP' 1 i7'Ol 11 Separ:tion–S;ocage.>: r-0711 Rcsuiction–Presence and L sa" 540.00„11t I Verrvnee Rxiuireutem 12 Conditions(.acs i L';e' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 20> 11 `i n;:ic!:ontainue–Prnh:brtiuns* POPULAT€ONS(HSP) 7-.,0,.11 Sanitizes c,Cntrria--Chemicals' 1 21 7-2(14.!' Chemicals for Washing Produce.Criteria* j 1 ?-.A01 i I(A) i Unpasiem vel Pre-paekaged lance:and rcvcrrgc> with Warnin;Ltib- 1 ?-204.!3 DlvingA2ents.Ctneria' I 1-205.1! 1bici&,aal Pard C'�ntac;. Lubrieants” j � FliiL!iIB) Gse of Pasteurized Egos` ; 3-ACI !!(D) Ra« nrPe:rtiadly Cooked Ammal Food and 7 206A i Re aricted Use Pesticides,Criteria` P.aN'ie,°d Spr"nis Not Served. ' ! 7-2013 L> Rodent Bou Sta!iuns" ;_apt 11(C) Unopencel Food Package Not Re-served. ` I 7-2Jb.1 I I Tracking Po idem,Pest Control and 1 Momtoring" ! CONSUMER ADVISORY 22 3-003.1 I Consume:Auvisory Posted for Consumption of TFMEttEFAPERA'TURE CONTROLS AmmarFucds ihat arc Raga.Undetcuoknl or 16 i Proper Cooking Temperatures for ( Not Otht --wise Proces>.ed to No-omile l ' PHFs rs. 3-401.11A(1)(2) Eggs- 155`F 15 See Pat,x\t� . jEe+4s- Immediate 5avicc 145`b 15suc' 1 3-302.1= P nsicurited 134,11, Substitute for Rart Slid! j 3401 1 l(A)�2) Comminuted Fish. Meats K Game rt"' j Animals- 155"F 15 sec i j 3-401.11(Eui)(2) I PoikendbestRow- 130°F 121 tnin'" I SPECEALREQLIiREMENTS I 590.(X�(At z-10!.ii(Ai2) Rattea.ir)ectedReats- 1?5°F1 -t D! Vinhoons of Section 590.0109(Al-(U) o-, ' catering, tsee. nobi!c food, tomporarvand 1 3-d0!.11(A)(3) Pootov Wild Marne. Stuffed PHFs. 1'eetdential kitcheIi Operations should be j Stuffing Containing Fists.Meat, debited ender the appropriate se:tions j Poalit s or Ratites-10'F 15 act. " above if related to Arodbornc illti tis 3-401.11C) ) Whole-omse!e. Intact Beef Straks interventions and risk factors. Other 14F'F t_ I 590.009 violations relating to grind retail 3=101.12 ( Raw Animal Foods Cooked in a I ptadiees shautd he debited tender#29– 1 Nliciowave 165'1''` Special lteguirenicnts. -4o1.11(Aa I)(h) ( Ab Othet PHFs 145`F l sec. '' I - 17 I I Reheating for Hot Holding I VIOLATIONS R-LATER TO(300D..RETAIL PRACTICES 3-403,11(A)&.tLf ( PHFs 165-F 15 sec. a, I (iFerus 23-30) 3-403.11;'B} Nlicrowave- 165`F 2 Minute Standing Critical and r+,,;7 l7incal vi,ferions, 'hich A0 not re!nte to the Time' loodhorne ihtn n.c into meurions anal risk f rc!ors lister[above, can he 3-403.11(0) Comwerei ally Processed RTE Fool- found in rh:,foNnu i+;g se;rang :!(the!'nod{;oAe and ltkCMR 140'F'' 590.0,9(1. 3-103 i I{E) Rem.ndning Unsbc:d Portions of Beef I Item 1 Good Retail Practices FC 590.000 I Roast: 23. khe)a9ement and Personnel j F;;- ^ 003 aFood and Food io'cotion C 004F 18 Proper Cooling of PRFs 25. Equipment and Utensils I FC-4 .005 4-SUI.I-t;A) Coo'int Cooked PH Fs from 140T u• 1 26 Wale,.Pi;:mbino and'Naste FC--S .006 70'F Wiihio 2 Hours and Front 7017 1 27, Physical Facc;Wy FC-6 007 to 41"F/45+'A iihat 4 flours. * 23 Puror ous or Toxic Materials FC–7 .008 3-50i.14tBi Cooling PHF:; Macre Front Anakient I 29 Specia'Requirements Oris ; Temperature Ingredients t„41'FJ45,1; 30. Other j Within 4 Hours" ' Denote,critical te,,,in the lederal 199;+Fo,.d c'10e 0, lir.CNIR 540.001. rP "'t •,:,'•QUALITY ASSURED^ . ..,,:SERVICE REPOkf3�'�- Pea,a„d Termite Control aince 1893 613518 SERVICE ADDRESS Waltham Services Inc.. ..," _ i . , TI_ies�a' --sr: : "x800-423-6933. w »,• : ..Y 04%1.3/04 »._. '." SALEM--HOUSE OF PIZZA t 03C ^LAFAVE ,3 .LAMES.-iT?_ �. `" , •Theo QirjaviSSS:£ 23- ENDICOTT STREET Ph :978-744-0017 SALEM MA 01970 COMMERCIAL PEST CONTROL BILLING ADDRESS ACCOUNT# 107053 NET 30 SALEM HOUSE OF PIZZA M2TUE Alt -, Theo L•lr favi .'ei : aoS_23 ENDICOTT STREET SALEM, MA 01970 C-PE. TCT RL-M KITCHEN, PREP AREA, COUNTER, BASEMENT ❑ CASH ❑ CHECK AMOUNT MACODE TERIAL AUSEDT I TECHNIQUE OF CONCENTRATION SITES TREATED APPLICATION AREA OR VOLUME TREATED TARGET PESTS ,O MATERIAIIEPA# _ I (PEST SPECIES FOUND: I n 7LI-, , y % ; F f /, a! r Y. � f =c�-f mac'" ( ,�_t= � �Ll-!—`i�.�� •—� n-1—l-I-G pp ICONDiYi6NS CONDUCIVE (STRUCTURAL DEFICIENCIES: '� /, %i ., ,. , r; ._. �' 1 i•�1-�1—i -U.�r' ' '. J. .� ,o I i/n�, 7.^I (_i%�� SUMMARY & RECOMMENDATIONS: uZ \J H H M M ❑ AM ' . •^- k,^4. H I H I M'I Y F-1 AM ,q,#,,,a^. M M D D V Y IME IN: J '/� ( J ❑ PM TIME OUT: ( /I,n I(/lGl ❑ PM '- �O C� s �.7 G. ' ui^} l-/Y1�^)C' V--- �--- Ir �- �f-� ,fes�� - DATE .,.,LICENSE# ❑ NOTICES ISSUED 0 PESTICIDE USE INFORMATION ❑ POST APPLICATION PRECAUTIONS CLIENTS SIGNATURE TECHNICIAN SIGNATURE I Waltham `:= .;: . QUALITY ASSURED ;- SERVICEREPORT Pea and Ter ,te C..,,.l ai.1893 629651 SERVICE ADDRESS Waltham Services, Inc. , Tuesday 800-423-6933 '05/ii/04 SALEM HOUSE OF PIZZA 0-36 - LAFAI$E, JAMES. Theo Girjavi 00:25 23 ENDICOTT STREET Ph :978-744-0017 SALEM, MA 01970 COMMERCIAL FEST CONTROL_ BILLING ADDRESS ACCOUNT# 107053 NET 30 SALEM HOUSE OF PIZZA Mc TUE Alt ; Theo Oirjavi Cel : 23 ENDICO-T STREET SALEM, MA 01970 C-PESTCTRL-M KITCHEN, -'REP AREA, COUNTER, BASEMENT 1 ❑ CASH ❑ CHECK AMOUNT MATERIAL AMOUNT CONCENTRATION SITES TREATED APPLICATION OF AREA OR VOLUME TREATED TARGET PESTS CODE USED APPLICATION IMATERIAI/EPM - - —- (PEST SPECIES FOUND: {0.'l O ( re- r L H ('o-i 01,1 1v / 00del- i" /'" t'_ ,v th 17 o ll _z_ i c, C.- `,74 1�,�d'ol.v( U 1 t r{ 61/' � vG6 r I� co U)(1 � 7o a h � S - i,d e a �' Lo,ut, � � 7L: , Ur-1d ^ � z ?? 14a .a/ ONDITIONS CONDUCIVE: o j,j �. f V a r ._o e i, 1 I i /e_ca I t �� , l �/1 1.. -r�,� �, C �9s o 6� cl r, 1 � 1 ISTRUCTUR LDEFICIENCIES: �.., n /P n L,� (.,//� u ;' ��(i 2 L��(Y" h SUMMARY& RECOMMENDATIONS: C, a1- (3,- it, //Cj CL 19 e Jl Cc v O l' ec? 'Ct / r� ..F'-.a. ,ME IN: N / V ❑ PM J TIME OUT:I+I'e: �•� M PM ` M M D o v v. DATE LICENSE# ❑ NOTICES ISSUED ❑ PESTICIDE USE INJ�OATION ❑ POST APPLICATA94 RE CAUTIONSI: FIAT � � n CLIENTS SIGNATURE i';.' TECHNICIAN SIGNATURE L Waltham QUALITY ASSURED SERVICE REPORT • Pu..d Termite Cantrul ai.e 1893 647904 SERVICE ADDRESS Waltham Services, Inc. Tuesday `- 800-423-6933 06/08/04 SALEM HOUSE OF PIZZA 0-3C — LAFAVE, JAMES. Theo Pirjavi 00;25 23 ENDICOTT STREET Phs978-744-0017 SALEM, MA 01970 COMMERCIAL PEST CONTROL BILLING ADDRESS ACCOUNT# 107053 NET 30 SALEM HOUSE OF PIZZA M2TUE Alts Theo Cirjavi Cel : 23 ENDICOTT STREET SALEM, MA 01970 C--PESTCTRL—M KITCHEN, PREP AREA, COUNTER, BASEMENT ❑ CASH ❑ CHECK AMOUNT I MATERIAL AMOUNT CONCENTRATION SITES TREATED TECHNIQUE OF AREA OR VOLUME TREATED._ __..- --TARGET FESTS-- CODE USED APPLICATION -.,- -- I MATERIAUEPA# IPEST SPEC ES FOUND: j� f P1 �7 0 i Y l iC f? G1 �`/ C✓' .4 c, U� U}; IVt : 0 /,-1 04LLL a-y� � � �2 Ccs. 1 /, I( _ hep. / I /*.J` j,t,w— I "Zi 0~0 lel /. I N C -C� ... ! / C}1'l.�l l.._6 ui-L'tn �'� Q ./ %C,,.�/ ✓��J`y / 1�-� I I CONDITIONS CONDUCIVE: ( 0/-, {( O Cl \,7 t�f1 1 -{' 11; C�.}_e.�i `,) ��CJ U c� el-- / /" G1 s!'1j`/Of t STRUCTURAL DEFICIENC ES: / SUMMARY 4k RECOMMENDATIONS: f4 ,1 L� G r �l S' I AM _ _ _ _ _ H MM cr AM y}M��/M� D;g�� D Y .Y IME IN:I /io I 101 El PM TIME OUT:� 00 � PM 11:19 p `I-�i �.`-moi I 1 I (Itn„ 1 DATE LICENSE# ❑ NOTICES ISSUED ❑ PESTICIDE USE INFORMATION U PAST APPLICATAON PRECAUTT085, ,i CLIENTS SIGNATURE TECHNICIAN SIGNATURE - n S8W Rev 121W L— Massachusetts Department of Public Health Salem Board S Health 1" 120 Washington Street,4ih Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978)745-0343 Name �/J ��77 Date I TYpe of Operation(sl, Type of Insisection Sn/O m /4/jG,_ r/6' O%2 z�. �`/r/'O f LTJ Food Service 10 outine ` Address Risk ❑ Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: opO/{ �rlx Gael /r0/7 ❑ Temporary ❑ Pre-operation OwnerSki e /7/ HACCP YIN I ❑ Caterer ❑ Suspect Illness ya�7Nv�z ra,.r , . ❑ Bad&Breakfast ❑General Complaint Person in Charge(PIC) s rJ Time In: ❑ HACCP Inspector--p Pos�re fqn f� //Z/ yyjlfvOut: Permit No. ❑Other Each violation checked requires hn 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 revention 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 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 CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22. Pasting 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 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 (Fca)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 59tlMn Ctrorm 14 na I pector's• ign re: II Print: 1Q,�. on�r.�...-_.. �1'1.,cCtdTrbJa,) Print:PIC's Signature: ,.gyp II t I Page of_ ges �'l.z�!.�,a�-• ��f�"-' Md f/A/Itn�L! !) ,9 LL1M Violations Related to Foodborne Illness Intcirmitfons and Risk Factors(Items 1-22) P4O72:CTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT j 8 ( ( i'ross-cnmam:na';bn I 590.003(:1) Asstgninent of Resputr;ibilitt' 3-302.1](A!(;) I Rrw Ana::.d F,wds Sepatated from 5y,jnr.'1B? ')anowaj:ttumofKnoxledge" ( r!,,n!:rd andR'.'F.Foods* ! 2-103.11 j parson in charve-- duiics SoMwrupation from Rate fr,i,rea'ients .1-302 : :G%)(2-, i flaw::nirnal Foals Szparated fr,m Each j EMPLOYEE hEALT':-I Other' 2 I SyO.fr g!C! Responsibility of the person in:•haws o, Gon'2mi•rsue.n r;:m the Fnvironmmvit :r:pn re rcpota mg by f Kk!employee.and ( ?-.U2.1 l(A) Food Protection" :;pplicunt` ( z_.ir!7 15 Wa<nmg Frim.,and bcLrtab!eti 5c;0J003(F! Rrs.nonsibAity Off\Food Employee Or Ar. � 3-3:J4.11 Form Corueet with Equipment a::d ,.1p,,!;c:mt To Report"(>The Person In Utcns,k* , chn ),e* ( Ccnta.?unaron f-Drn the C.o�santer 59O.0OS40 Reporting i>y Person in C. tu.r• . 306.1":`i.t;R) j Renured Foua and I:sc^:Ice of 1 cod` I ( 3 4-b.G03(D; Exdasionsand Restricnons* 0,soostr+ono!Adulter=,tedorContaminated :i40.i)03(H! Renweai of Faclus;ons and Restrstn,ns Food 3-701.3 ' Discarding or Retwnd!6onmg FOLD FROM APPROVED SOURCE , 0 Fnod enfant Surfaces ! � I Food and A;_ler Frotr:Fleyul-,tad Source> 590.001;A B) ! Co,::plumre with Foul Law* t lams:`!Warew'+shmr,-Hca W,,,,r .°ianitt'Let:Or.'('P:npernfU[e:,'" j 3 201.1': F,,od in a Hermetically Senb:d Cont,mer` 14 5{.1 I I2 i\4-chati cal Warcwachint !-fur Viater ' j 3-201.14 I Fluid Mill:and Milk PtoductsT _,.ban 1's Shell L•g;;c:- I `•',nitikation Temperflures! I Y-o2 !4 F,«>s.mdMilt Prcduct�.Pasceurize,P' I i01.f bl Cheuncal Sanitirannn-temp pH, 3-2(1_.16 ice Made f.um Potaidc' Drinking Wit-cr, j •.ono.ntr ;;�n and ht:rdn:,s 5 [of I 1 Drmkin \Purer fent*;an?,,,prove,;System" 60 i.l i(A) I Equipment Fov:d Cor' Sw-iace,and 590.011.16(4) BnnledDr ( Ua•asilsC.lean' 0 )'( mkmy `h',<ter^` 4-601.11 ! C'lennury Frcqur rcy of Equipment Food- _540 OOc,B I W,iter'D4cets Srmtdardc in il0 CMR.?20 I! ,Sb0h,-h and rash Fiorn an Approved Source Cunt.,ct Sur.`::cc_ani Utensils, i •' 4-70.'..11 i Frequency sof Sanitization o:U;ensils and _1_201.14 F':.h at:; Re creation,illy Caught Mo!ie!xan I � Food C oulrct Sot ije;s of Fqw 1,;ent" Sheiifi`ll, ( 1.7{,3.11 Methods ni Snnitiza,ion- Hot Waterand 201.15 11folhrscan Shell!lsh from NSSP LiAed C'nentica{" Sources'. ' ! 10 I People,Adequa?=_hdar.dvaas^'ng Gamand Wild Mushrnorris Approved by 2-30111 C:lean Condn;j:.- H:u,ds anti Aim.0' Rewf?,Wy Authonry 1 3-: '.18 Shellstock Identification Pw,eniK '--"(1:.112 Clea!rna Prx:edt!tc 0 5,)000 t(C) Wild Mushruoms^ j 2-301.1' When to \Yaa6' j 3-..0i 1 7 CLunc rsnimuls`" ! 44 Gpoo Hygienic Practices ! ! . ° Rece%vino/Condition 2-4,JI,l 1 Elting,Drinking or(!sim*Tobacco'" 3-202.1 ! PHFs Kecen•ed at Proper Temperatures^ j ( 2--01.12 ")ischarge+From fhe Eyes, Sone and -202 L. Package luiegrity 1 3-141.:`. food Safe and hnaduit,rr!cd`' ( i-301.12 ! Preventing Contamination When I acnrg' 6 ; 'fags/Records:She!lstock � j .2 : prevention of Contamino2ior,from Hands 3-20n_ R'. She!istod;Ideutttic.al.:n" :91:.00;-:F? Prevc:t:ng Conumination fro Employ esk 03.1 ,ha!stock it,ntificaoun A3aintaia,&' Tags/Records:Fish Products Nandwesh Facint,as :nnvaNent!vt_ocaredaneAcc?ssi9;e i_402.11 Parasite Astrurtiou' : , , �^ 12 R.coah.C.eahnn anal Rc:, !Jnio, i ! 5-.n.(13 I 1 °dumbats and Capac::ics- j n,. SO.0040) Labeling of Ingredients' j 5-204.11 m-a on and 6 t ccrrcnt Conformance with Approved Procedures `''(}5.i t Acte;.�ihi:::) Gpaarion a::d :a[nt-zn:utcz /HACCP?!era ( j Supo..tted I-4P Scap and Hind Drying L%6'vlCes 3-5;1^.1! Specialized Prot-esung Methot!r,' j-5"+2.12 Rehired my,-; pan!:agin;i.crrreria j -'!11 !: I;,,ad�`•a�hing Clcan�cr. AvtIilirn,lny ! 8-!(13.12 Confommuce\vitn:Approved Procedures'' j � 6-301.12 Hand Diving Procisaun , " Cr-Dice c�i,;cal itclu in ane!rite.:,.! !•Pi°!-t,,d C:ed<o, 0F,CMR ggpi a:O 4 , CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: .2-17-011 Page: r:2— of Item Code C-Critical item �D�SCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY _ i 9i/J7.7rveIv, /a �e1/ /� !r�� — r7�s� Gp�Q p /pL I / zo/,/,o f d154�_n nnr=L/.Y/.P //rP,( l/O.pU 6/iP r 1V !'o �1J.C�.to/!�-i'J�P/./ //)') ✓h �v_��/,n r I I I /yiL4 /'/ A/.!»Lziv /"/ il`/J/�P�P /////moi O o7 �_�"fifFi//c 17.�n4a1.1 IV - ,, f r I I - A I ' I - Discussion With Person in Charge: Corrective Action Required: I El I ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion (�I P C3 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 ❑ Voluntary Disposal ❑ Other: I' _ 3-501 14(C) PHFs Receivrd at Tengservtv"es - Violations Related to Foodborne Illness Interventions and Risk gccordim_to 1 xuv Cooled to Factors(items 1-22) (Cont.) 11•Fr45'F Within 4 Hours PROTECTION FROM CHEMICALS I 3-501.15 CoolineMethods for PHF:. I 119 PHF Hot and Cold Holding 14 Food or Color Additives 3.5nl.lf,(6) Cold PHF; Maintained atort>ak+v, 3-202.12 ;Ndditivesw j 590.004(F, 41"k45"1-1 1-302.14 Protection from thiapproved Additives' I I ,3-501.1u(A) Hot PHF,N14intaine'at of above 15 Poisonous or Toxic Substances I 140'F 7-101.11 Identifying lntoruiation-Original I35w. so RoastaHeld utaraFio,e13(YF. Containers" ' 7-102.11 Common Name-'Working Container, i 170 I Time as a Public Health Control j 7-_Ol.l 1 Separation-Sinrazel ( i 3-501.1+? Time a,it Public Health Control" 7-202.1 ? Restriction-Pres:nceLaidlloel' ( 1590.00d(1-1) Vananc.Requirement 7-202.12 Conditions of I.Ise., 17-203 11 '1-ori•_Containers-Prohibitions I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ! 7-104.11 S.ntitizeis.Criteria-Chemicals, I POPULATIONS(HSP) 7-20.4 12 Chemicals for Washing Pronate, Criteria` ( 21 3-801.11(A) Unpasteurized Prc-packaged Iuicrae and 7-201.14 Orymp Agents.Critetiaa I Seveia+,es with\'winning I,Fele* 3-801.11(B) U,e of Pastcut Iled Eggs* j 7205.11 Incidental Fond Contact,Lubricants ( ( 3.8(11 1 I(D) Raw ui Partially Cooked Ananal Ford and j 7-206.11 Restricted Use Pesticides.Cnteri`i' j Raw.Seed Sprouts Not Served. f j 7-206.12 Rodent Bait Stations` ( ( 3-801.1 I(C) Unopened Food Package Not Ro-served. " 7-206.13 Trackim,Powders,Pest Control anti A4onitoong' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 2.2 3-60; I I Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Fond`That are Raw.Undennokrd or PHFs Not Otherwise Processed to El i rti nave Pathog1111.0; 3-401.1 IA(i)tb Eggs- 155`,15 Sec ;_;02.1 Pasicut'ized Eggs Substitute for Raw Shell Eggs-Immediate Service 145'F15sec' 3-401.11(A)(2) Comminuted Fish. Meats X Game Animals- 155`F 15 REQUIREMENTS 13-401 A I(B)(1)(2) Pork and Beef Roast- 130°F 121 min" REMENTS ( 5)Q009( SPECIAL CIAL Violations(if Section 590.004(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meat;- 155'F 15 sec. * catering, mobile food, temporary and 3-41)1.11(A)(3) Poultry,Wild Game. Stuffed PHFs, ( residential kitchen operations should be s del:,ted under the a� ropriatc sc:tna:i, Stufl7ngGmtainmgFi.h..vleat. rl' r Poultry or Ratites-1650F 15 sec ` above if related to foodborne illness 3-101 A I tC)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145"F" 590 009 violations relating to good retail 3-401.12 Raw Annual Foals Cooked in a practices should be debited under#20- Miaowave 1650F* Special Requirements. 3-40t.1I(A)(1)(b) AtIOther PHFs; - 145F15sec. " 17 Reheating for Hot Holding VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3-40111(.4)&(D) PHFs 165"F 15 sec. * i (Items 23-30) 3-103.11(13) Miciowave- 165°F 2 Minute Standing Critical and nos-crdirul violations, which do not clate to the Time* foodhnnte ilhtcss baenreuriou.r and risk(urrots listed above, rout be 3403.1 1(C) Commercially Processed RTE Fail- I found in the fntlowing sct tions of the Food Code and 105 CbIR 140'," 590 000. 3-403 1 l(E) Remaining Unsliced Portions of Beef I Item I Good Retail Practices I FC 590.000 Rodsh,' 23 klaracement and Personnel FC-2 .003 113 Proper Cooling of PHFs ! 24 Food and Food Protection FC-3 .004 3-501.14(A) Cooling Cooked PHFs from 1101,to ! 25. Equipment and Utensils FC--4 ,005 ,, 26 Water,Plumbinq and Waste FC-5 006 70'F Within 2 Hours and From 70"F ! 27, Physical Facility ! FC-6 007 to 41 OF/45'F Within 4 Hours. ' 23 Poisonous of Toxic Materials ! FC- 7 .008 i 3-5o1.14(B) Cooling PHFs Made Froin Ambient 29Other,, ^^ _Special Requirements '( __009_-� f Temperature Tngretlientc tit 41`,i1S°, 30 I Within 4 Hoon' ' Ucnote- o nicA«cru in the ledaal 1949 Ftwd Code ui 105 CbiR 590 000, 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 Tyree of Ooeration(s), Type of Insoection -4L-L1_M 'Jl= 1012.Z* I Z. i 91'! �oocl Service ❑ Routine Address -Z 3 Risk ❑ Retail Q-Ree inspection Level ElResidential Kitchen Previous Inspection Telephone ❑ Mobile Date: t� JI 7 ❑ Temporary Owns p ry El Pre-operation r J(4-n)�1,.4-V1(i9m .A'C. 1A JHt.Fi2 rW,4lif HACCP Y/N ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Sy Lr r I� )W- Time El Bed& Breakfast El General Complaint In: El HACCP Inspector r Permit No. Other � Gn�rrNl3�hw1l,� ,Mn�r�allcr4' � Out: El Each violation checked requires an explanation on the narrative page(s)and a citation of specific provisions) violated. INon-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 El2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals - ❑ 4. Food and Water from Approved Source - TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E] 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Q 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 cited in this report may result in suspension or revocation of (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: 5 5901 Vs 'Fom 14 tl c _spt �S at . Print: � 0J � r PIC's Signature: ��,J _ � 1 � Print: --5 v _/f (,7L PageL of?-pages Violations Related to Foodborne filness lrth.:ttventrons and Risk Factors(items 1-221' PROTECTION FROM CON4AWNATiON FOOD PROTECTION MANAGEMENT 18 I i 590.003(A) 3-301: 1 fAui Raw ,"nunji Fx,&Serarals '-om Co�,kedan,� RTE FoKV 590.00(b) 2-103.1 1 lcr� hony Pan,"11j"vdiont's I son in chai,rc -dat=e.; 3-301 !I'A)(21', Raw AminA Foods Sepanft,!d from Each EMPLOYEE HEALTH Othvc: I w3w) Re.�pori,iH_itvof ibe peo�on in chio ge to Con,'amiratior,hon)t.,,e&vkonment require v-1YOrtin"by Ihnd ernpkryee:.and j 3-302.11;A) h"'A PjOectiva, 3-302 5 Wa4iing Emus an I ivecetiiiis .)90.0(;5 nwt with hquilarientanc'. 3(1F) PesponsiNfity 01 A Fk�,d Employee 0,iVi 3-304. Clr i\pplicavir !(I Report T,,Th,Pec:ot: fa i7unrsl k" Charge, ConLmmq_,9ori fcm the Oon&uner 590.003(Cif Repotlir!2 by Pe:soji in Chante' 3-3U6.14(A)1 5) Returned Foo:andR-svrviv, ofFood* 3 590.003(Tyl, E.Wwi,ris.tnd Rcsixictions* Oi6pori4on o.AdOtgrated or Gontar,-Vreteo 59,,ii,00YE) R.,iyw�val of Fxclusions and Restrictions F,,,od Recoiid;donw unsafe rcoo FROM APPROVED SOURCE 41 Fxdaiid ViVater From Regulated Sources 19 Food Contact Surfacps i 5(11 111 Nlanuai Watewashing-Hoi Water 590.0(WIA-13) C(unpliance IN ah Fond Law" 31-2f)1.12 Foo(4 ir;I H,rrixti.-aliv Seated Coutaiiw' Tew;)eratur,s` -2�11 I Fluid MokandINFIk products'' =t-1;01.11' Nlech.)iucil WarcAuslurg, 1f(AW,.i._1r � 3-2102.13 Shell F"Is Samtiz,,ion T,mncr;ai;rc,;:: 4-501.111 Cheinica! saaItiration- OH! 3-1-021.14 Ergs�tnd Milk Prodwjs. Pilsfewizd* 3-2U2.16 ice Made From Potable Drinkmc�Waur, j i 4-401.1 1(A) Eqmf=�,�,W FG0d COTIMCL SIIIJ'13Ccs:flld ICL Oainiivlg Fater from,in Appi"Wed Svsoeajjl I - I utenc;::;0-an, 5cQ.006(A Bottled Drinkui�Waie,* i.) ; 4 602.1 ClenriiFrquernvol--.qu;pmenl Ford- 5913 006(8) Walet Nlect�.&andard%in 3 10 CMR fpc i Cozk1k;("t silrlaf,"and Ui� "osils* 6relffi,-h aridhbu from an Approvad So-ice i 4-7012.1 1 of"".11ilizalion of Utensils and I1-20!.14 Fish uid Recreationally Caught:Vfolluscan I Food Guntact Sur-"aces of Da:_!pulcnt! ' of Saliiti�!tiorl-Hot W,Vcr and 1 3-201.15 IvTa!u ;c an SII from NSSP 1,ifted Ch: I 1uIc:& Game and INWAlushroorrys Aorromr,by Proper,Adequate handiijashing -Clm�n-l"(frulition--Pfinds vnd firms"Qjfa-, ri,Authority 3-20118 S'leflslock ldv.nutic,titc PrescnVl 1.!2 Clear,;IIE Proedure" -,,�,1.14 When to Wash, Wild JNIUN;Ioji�qf's, Good Hygienic Practices lame Animate" Reveiving/Candition -1-4,01 11 Entine, D-inking o:-FiriR'rohak•cw' 2-401 12 Di�wtwtr,-es Ftoin dw Eyes, NoNoand 3 ?,(),.If Pkif�, RuCeivcd at Ptoptr'Ycaiperaturei" -2 15 Package integritv- Mouth- 3-101 11 Foo"! saleatul Unaduit 3-301 17 I Prevtn!tw- Wlita Faumg! Talls/Rectirds:Shellstock 12 Prevention of Co-Ta-aunation from Hands 6 1 1, 1 C 3-m2.1" Shells!�,x,k ld-�,aification 5�)0.5(141 r) re.N.^ntoi -ontainmrtiop from 3-201.12 Shelislock Identification Maintained' I Furfilow", Tags/Records:F'sh.Products I 13 Haadwasl�Facilities 3402.1 1 ;XsIfuction- 4 402.121 Cieintion,and ReEcmion4 15-203.11 I Nwylbzrs and Capa-il:csA i .590.004(.•.) Labeling 0 In.oredlents' 5-204,11 LA�ca6oa and Placcinent, 7 Conformance with Approved Procedures I Ace�.,.ibilitv.(Mentlion and I'virimernucc !HftCCP Piers; j Suppled wit',Soap and!-lard Ciyog Methocs, j Drakes 3-502.12 Retraced oxvgen pad,agaig.arteria" 1�inil-xaslniu,C!c:irr%-r. Availability 6-301.12 hand thyrng Piovision 103 12 Confoinatoce v,i:*i Affirmed Pivic,dures DeOWlel L1 16CA)VD!in hc tVdV,:,Il 19""Food 11 1(F CMR 500.000, CITY OF SALEM BOARD OF HEALTH Establishment Name: SA 1-6 -t Not-CS 0J—_ dOrz-7..A Date: 2- /`/% Page: 2 of 2— f Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY (3,kf 4; C .r n.tr6- /3 c),4d'LO Ta a zE- e&F OL-4 C'r-is z r3 it-1r=rL e'5a I rr-"s rw 4*-r 6lrrcr G t!f U L 9 rll. AL:-S LIfr I r riscussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes ave read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ ' inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� / ❑ Voluntary Disposal ❑ Other: 3S01.i4t0 PI IF, ReeriyedatT?mperatmes ✓iNafioas Related to Foodborne Hiness interventions and Risk Atcur414.�to 1 au•C,1od it, Factors(!ieins 7.22) (Cont.) 41'F74S'F Within-1 Hours I i-501.15 ( Ccmlht)t Me;luxls tot PH :: PROTECTION FROM CHEMICALS1 19PHF Hoi and Cold Poha w.g j 14 ! Food or Color Additives j 3-5U!.16(B! Ctitd Plll•t Muinlained to or below j 3-202.!' ;lddititiesk 59W)0-h F) 41'i45" F' 3-302.14 Prot.ciron irorn ',,:A) I [S i Poisonoue or Toxic 9ubstancca FFnt^HCs Tl-faicdaiu:d:d or above 7-1! i.li Idnf^.'_{ ]rtnrmatinn- )*gn:+j 3-5016.'At Rocs tc Hct,'. at or above I?0`:-' Containers" i 2p Time as a Public I-Isalth Control j 7-102.1 : Cunuutun Name-WorkingCantainzr<'" j ( j 501.1':+ Time a;a Public Health Control" 7-201,1 Separation-Storage' j 590.U!J1tH; Van:mc:Recuncn;ent � ?-202"i ; RcaricU on-Presenco mrd Use:' j ( -7-202.12 Condaions of Usel j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-203.i 1 'C:,x:c C'nntainer.. -!'rob!bt;ion;' POPULATIONS(HSP) 1 Sanitizcl c.Crueria-Chemicals- r 121 3-tii!l,1 l(A) UP' nna,rcuri,ed Pre- ackaged Juieas and ! '7-20.1.i 2 Cher;o& for Wa,huy!Produce.Criteria" ! j 7-2:i4 14 Drtiing d.eentc.Criteria Beveiaetn. v,ith Warman l abe;c" :-KU 1.11(B) C'sv o[Pasteurized E, s" j ?-2o, I t Fncidentai Ford Contact, 1_ubricants i 13-&:)1 II([): Raw or Partiall}•C+xzked Am:nal l'aod and 20t),I I Restricted Use Pe"•ticide;,Criteria 2--206 12 Rodcut Bait Sta[ions" j Raw Seed FoodSproP;Package Served. 7-2i!E 13 Trackim-,Pu%vdcrs,Pest Control and i 3-1+01.1 (C; Unupevc<i Ford Package Not Re-s�ned. Monitoring` CONSUMER ADVISORY 22 3-60t.I I C n.sunt.:Advisory Posted for Consumption al. TIME/TEMPERATURE CONTROLS Anomi; Ponds'l bar are Raw. Undercooked or 16 i Proper Cooking Temperatures for PHFs Not{)fhenzisr Processed to Eii:n:nata 13-401.1lAt1)f2) r'.e;,s- 15SF IS Sec. . I Figs-lmm dtate Scry ce :451 15sec, 3--iu .l3 Pasteur.,:ed Ergs Substitute for Rim Shci! 3-401.11(4)i2) Comminuted Pn;l=..R1e>rts R Game Vu nak- 155'F 15 sec. " 1 SPECIAL REQUIREMENTS j 3-40111(6)(1)!.2.1 Pork and Beef Roast- 1.30'F 121nwt' 5900040;-( )) Violation.,otSectiim590.Ot'i(A)-(D) in 3-401.11(A;(2t Ratucs, hyc�ted Meats- i55°F ;5 catering. :nobile broil, tenzporary and ! -401.11(AU 3) Poultry,'Wild Game, Stuffed PHI-s, residcntial'Kitchen operations should he j Stuff ti L Cntauting Fisn,Meat, dehited under the appropriate sections j Poultiv or Ratites-165'F 15 sec. "` ahove i;'iclated to foodborne illness 3-401.1 i(C)(3) Whole-muscle. Intact Beef Steaks interventions and risk fa-ztoc,. Esher 135'F - 590.009 aioii.tiotl5 rt:lvng to gorA retail 3-4)1.12 ( Rau'Animal Foods Cooked or a I practiecs should be dcbtled tinder t120- Microwave I65`F I Special Requirements. ! 3-401.11(A)(()t b) All Gthei Plllts-- !45'F 15 sec. j 17 j Reheating for Hot Holding VIOLATIONS R.FLATED TO GOOD RETAIL. PRACTICES .3-403.1'(A)&-(D) PF-IFs 165`F 15 sec. *' j ('tents 23-3171 i 3-4(}3-1 !(b) Microwave- 165'F 2 Mmnte Standing Craicai and non-cancel violutionc, which also not relate to the: Time* I foodborne i16ress torten ention.s and rise(Incinrc lrs7d aLoi•a, no,be 3-403.i I(C) Commercially Processed RTE Food- found in the forlowing se,tt,r;d (l0he hood Code wn1105 CNK 40"Fl 590.000. 3-403A 1(E) Remaining Un,liced Portions of Beef I 1 :tem Good Rntaif Practices ; FC 590.000 Roasts' 23. Management and Personnel FC - 2 .003 18 Proper Cooling of PRFs 24 Food and F=1 Piol&;ticr. FC--3 .004 25 Equipment and Utensils ( FC--4 "005 :t-.)01.1=!A! C(wlmt Cooked P�Fs-liom 140`F'to 1 26. Vater.Plumbino,and Waste ( FC-5 .006 ' 74'F Within 2 Hours and From 70`F li 2.7 1 Physical Fanlry FC-6 .007 to 41"F/45'F V6thm 4 Hours 1 28 1 Poisonous or Jbxic Platerials IFC-7 .Oon 3-501AX13) Cooling VHFs Made From Ambient - vocial Requirements 009 'Termer wte htgredicnts to 4l'F/45'F 30 ' Other Within 4 Hours" - `Din 4c,critical uau:in the ted,ral I'MI)Fngd Cal,or It!5 C\9R 540.000. THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 fax: (978)745-0343 Name // Date T.vpa of Ooerafioni(M Tybe of InsnecUM J`7 rite 0'r �2y� 2/, xm/ Food Service IBJ Routine Address 1., Risk ❑ Retail ElRe-inspection �J Level ❑ Residential Kitchen Previous Inspection t Telephone ,/.y� 7 /f ❑ Mobile Date:G-/V03 Owner ! /] HACCP YIN ❑ Temporary ❑ Pre-operation (7l//iln S�P2 /1��lilrl I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint I -�rl��i0 rYtn In: El HACCP Inspector /!/. Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. - Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (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 ❑ 2. Prevention of Contamination from Hands El 1. PIC Assigned/ Knowledgeable/ Duties 13. 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 ❑ 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 ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ ❑ 8. Separation/Segregation/ Protection 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) -, 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP CONSUMER ADVISORY P"I 1. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related C/ 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 oHealth. 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 i/ ✓ 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food I/ 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: nsp�ctor's'SigdaCure: Print: PIC's Signature:',,,,x/W�, '' '•1 Print: yby��y/7r7/� D �/GlfM Page 1 of 3 Pages . /f FORM 734A HOBBS 9 WARREN - B05TON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(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 3-306.14(A)(B)l Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products, Pasteurized* P'p gg � Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* - 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 11 _ Good Hygienic Practices 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 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products .0 Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 5-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* I -- •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM /� BOARD OF HEALTH Establishment Name: �� cse O� 1%20,2 Date: o�- �'Q7 Page: a of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY r I /!/O /v � I S'o1vCott �- vivas .ct°ii v,rGL442e /7"n.JaPS 7K .oGe ti.9f'C+i >[,�_Z-_,1 I fel o/e /,v 7i-7_e, 2d79Xt,,k-12 a2 I • �A' 7'7 ed J ri `." �.P�i �9 G C.F�/inn �/J.er --- ��-v I f Z7 I G .n/,4 Y'�7 /Al Z fi /P�/ (�mra�e�cm Vy I z7 I C I L1a/i-1-c aAl?Yle- P/ep -t-a AA41 eyc 7_S7 t7' fa61.17O/ o� X11/ 9 I G I— S>vr7, Gac s /r)Wpal r7ot711zsT llb&GG —S/. km e ✓ SC , iZ��j {�dc� I I I 4P" X/ cam/"yrzP�l C" IaZ4' ,2 2 I r-t l c- I - e� >rre z eA4V(-'c/L llw ua&sG ,s/ N PP�s 2 cDC' /.6LeJ�PiP///n�'/P!�',� I Nle, �s/ "7/rYr, f uriiia a yOE� ue7�� s✓eA�s 1//Si�4�e a9ccu'etr/e 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 L3 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: v ! 3-50114(0 PHFs Received a:"i e:npc r;toms Vie,at%or,=. iielated to-:oodbo.no 111oriiss tnfcrvouLti ns and Risk Accordine to LaeCoolw lu Factors(Ifems 1-2P) (Gnat j 41'F/45'F Within 4 Hours. " PROTECTION FROM CHEMICALS i H.I j Coul;n Niriltods for PIiFti PHF Not and Cold Holding 14 Food or Color Additives ( 19 1 ' 3-501 16(61 Cold Pllfs Maintnined at or bvlow 1203.12 ,`,dd:tiees* 590.004(F) dl` "F. 3-302.14 Pr;r,ectionfr..nnihiapp:ovcdA,iditi'vc:` I ;.50L16(:1) Hot PH"rsNlaintaintdatorabote is Poisonous or Toxic Substances ! (40"L 7-101.i' Identtfing Information-Oridrn! j Containers" i 3-501.161Ai Roasts Heid at or above !30-F -P -p Time as a Public Health Control 7-70"_'.: I C,ptnionName-`A'o^kin,Cnua:igen: -501 19 Time its a Public Health ControP` '01.11 Sen^r4- -Si Jr:!{,t` 7'02.11 Resection-Pres:nce and I i'c;+ Sc}t).604(H) Vartatice Requirement 7-202.!2 Conditions of(ise. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 203 ! i 'soxic Cnttainrc-Prohibitions° POPULATIONS(HSP) "204.11 n.^i z.:rs.Criteria--C"'emirnis:. i-2o4.i Chemic,is for lVa,hmg Pn-,rlucn.C,:.i[erilc:. 121 I ;-h01.! 1(A) Unpasfeuriz:rl Pre-Pacl-razed Juices and beverages with Waning in€;1 abet. 7-204.! DiNina Agenrs.Crrmtia ' � ',-205.ii Incidental Food Contac: i,ubricants; 3-i;l)LiitB) Dee of Pastrutize(1 NYns 3 801 : '(D) Raw or Pat'i&fly Co;,keel Animal Foorl and 7-206,i i Restricted Use Pe,ticide:,Crreriu` "06..2 Rodent Baii �talions"' � � Raw Seed Sprouts Not Served. 3-801.11(C) Unopened Focal Package Not Re-ser.ed. 7-206.13 Tracking Powders,Pest Co:•:-oi and Momlonnc` CONSUMER ADVISORY 22 3-60'3.11 Consurner Advise" Posted for Consumption of TIME/TEMPERATURE CONTROLS Anunal I exalt"t'hat are Raw, Undeicooked or 16 Proper Cooking Temperatures for No,oi E)therwicz Pr.+cess?d to Eliminate Padbog 3-401.1 iAil;2l Efgc is .s- 155'8 IS See 3',62-i3 Pasteurized E,a,F>s Substitute for Rata Shrit hes-Immediate Scr:kee 14 5"FI Sse,.' 3-401 11(4:(2) Conunimncd F,di.1\�edts &Game . . Auiutal: - 155'F 15 s,1c. SPECIAL REQUIREMENTS 1 3-=401.I Ii8I(i)(21 Po:k area Root`Rona 1311`F 121 min" ; 59)0019(,x)-(D) Violations of Section 540009i k)-(D) in ' 3-1n1.1It,At(2) Ratites, lnjcctedMcais- 155'Ft5 entering, mobile food, ternporary and ,401.11(A)(3} Poultr.y, ''Wild Came. Stuffed PHFs, I residential kitchen operations should he StuBine Contannlne Figh. Aaeci debited under the appropriate sections Poultry or R.�c:,z:165'8 15 ace. ' ( above if related to fotxit,orne illness 3-I01A li3O(3) 1A'h.de-muscle, Intac: Beer'Ssesks interventions and risk factors. C)thrr 145'F 4 590.009 vir ions relating to 1-0od rcta;l 3-401.12 Ra,= Anita al 1--.cads C(x+ied in a practices should be debited under 929-- N?ic.ros,avc 165F* Special Requirements. 3-401.i i(1)(l)(b) All Other Pfi 1v-- .45-F 15 sec. ' 17 Reheating tot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 'i-403 11(.1)&(Di F'HFs 165''F i5 sec. ". Uterus 23-31}) i3-403.1 i(R) Nlicruwavo- 165`F 2 Minute Standing Guinea)andiron Critical violations, wh;[lt do net 1<101v to the Tine' ,focdborae illness btlen,entions and can be 3-403 i(C) Corxnertiidly Puxecsed RTE Food- I found in the JeU(MInq s'e(ti(no o'the F'nod Code acrd 105('.UR 1.10'8'' 590.1)1)0. 3 403 11(E) Renaming 1.n,liceu Portions of Beef I ! Item Good Retail Practices j FC 590.000 Ko sts� 23_... Management and Personnel FC-2 003 18 Proper Coming of PHFs j 24 Fond and Food Protection FC -3 .004 1 25 Equipment and Utensils FC-4 005 .5-101.1-":(A) Coolin,,Conked PHFs lrom Ido"F to i 26. j Water. Plumbing zed N/este IFC-5 .006 ( ;f'F\iei dun 2 Hours and From 70'1 27 Physical Facility Ft:--6 007 to41^E145�F`Althin " Hours * 28. Poisonous or Tex:c Materials IFC-7 .008 3-501.13(6) Cocal,io PHPs Madc i'rom Ambien 29. Special Requirements ( .009 Tanperature ingreri:ono.to 4I"FhfS:I 30 Other Within-t Four,- «<: Urnotn mob lit item in vie iedersl I:)y9 Fuca CWt o: HF(:NIR]()0,00(1. b CITY OF SALEM BOARD OF HEALTH Establishment Name: S�4F 144 f{d U1� n Jr' ,p/Zf2�F Date: 2l r�m Y Page: of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 2, 7 K /C— 2 7 C4' 19P- 16,11 A19 Z,L'.f�S MY 1; /'L4 (//,C, Gt^//v �,l o�J1 a Z7 //<-2 /.n /1 I/JR.HR"v4 V/ 2 IZ� ^ /l/r/1-G. l/ 7�' F_✓VnY.?lL"i2 r.>_ �T! /'ir�/hTlP l7 .f/P-f�i®� �/I R�%iit e.Li /'.�P/fl�ff/i(.�J' Nd.�/d L /!in>k/t✓/Ar 6/lnP.d /d„ /Art a i� Ole i/.e'f /on _A/YJ ' I CCuRrYT,o/✓ /rvFr•Fmx7rrt -//rliiSnar«_ �,vir�l✓fd Yif>L Xa-r/S l.Gi/✓rnro nia Ski C'1 Y7.�.r1..� �ti/,o.� r nrtD�irvr fey/rdlr.� C 11F lzrfs fc Ari .— 0af-Amyr 7�tiwt, r " I �%1'Ft£��t.NAIr�A— /�../.S1J.r✓ Grf (` 1rlrM ,Discussion With Person in Chargesl7'v` Cdr iJ�h Corrective Action Required: El No ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ r Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension i 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: �� rIIS`(�� f I o 1✓ o fJ v�r�!�/�- - /�y�— IcF M 9 i c� (3E !f �f , 3-iU1.14(C) PHI r Recen'ed tn'Cerperatuies Violations Related to Foudharr+ 1Uness inter.,entions sec'Risk According in Ccoled to Factors(lterris 1-2 (Cont") 41 11-/45:1'V,ith;n 4 Hont F. ' PROTECTION FROM CHEMICALS I 3-50;1.15 Gx'lhte Methods tin PHFs I T4 Food or Co!oe Additives j I I9 PHF Hot and Co!d Holding 3-501.16(H) Cold PHFs Maintained at or bei,nv 3--10:.12 .lddiu.e<- 590.00a(F) 41'145'F'. Prote-tloo !tont U:,ap{na,rcd Additite,,' 3-i01,16(A) Ikn PHF:.N-Iatrnain,d at of above ]C Pols.o::s rt Toxic S21os to ces Ielf) " i t:?LII baenn }'nc :r'),rm:!ttor.-Original 13-501.I6(A) Roa,tclteldatorabove :3WF : Cont4i!ter;' 1 I tc.I I Comm:,; Name - ttr'oildn?Contain;'. I 120 ( Time as a Public Health Centro! i '7"'01 I1 Separation--Storni." 3-501.19 'Pune a:a PUNIC Fle:aith ConrzoP` 590.OU'li,Ht Van'tanez 7-=02.11 Pcgrr:ticn-Presence a?,! 1lsd'` ( 1Regmr.ment 7-'_02.12 Con';non,of Use" t-__13.11 1':rc!r Gstainers-Prohibitions` ( REQUIREMENTSLATIO (HSP) !G iLY SUSCEPTIBLE 7-1,,-,4 11 Snnirizets.Cr;t,!"it -Chrra;;atsa I POPULATIONS{HSP) j 7?,id 12 Cher.?iosls`pr)Vash;n;i Pr:>;.1nce, Critzr;a^ ( 21 i 3-80i.11(A) Unpasteurized Prc-Paciage;t.luicas and Rec}'erage.with Warning Labcs"' i 7-Wet 14 Drying A:,ents.Criteria:. ;-801.11113) Use of Pasteurized Egs' r 201.1 I hicidental Foud Contin,Lubticant�' ( t ! I 3-801 I{D) Raw or Partially Ctvked Animal Food and i 1 7-2U6.11 Restr;tied Uee Pesticide,.. Criteria' Raw Seed Sprouts Nrit Scrod. 12 Roden Beit Station," ( ( 3-801.111,0) t)nupenect Fo:xi Pact apse Not R::crve•� i 72pr. t? T;a�kin,_� t'undc:',,Fest Control and Monitorial!" CONSUMER ADVISORY T€ME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Adet,ory Posted for ConsuntoUon of 1 16 Proper Cooking Temperaiures for Animal Foods that rue Raw, Undercoekcd f,r I PHFs I Not Otherwise Proc• stied to Eli inmate 3-40).i1AtI)(2) E-1- 155'F15Set Ptf hl ms.,;,anent rn^mr Fa fnuoadmie Service IIS"F1Seec. 3-302.13 Pasteurized Eggs Sabstiude tot Raw Shell -401.71(A)(2) Cut;:mim:Ecd I•iah, Vierr.e K('Tattle('TattleEggs., :+rima!,- 1?5'F 15 sec. A 3-401.11(B) 10^ SPECIAL REQUIREMENTS ( )._) Pnt'S and Beef Roast- 1 k F 121 man, I 5')0.009(A)-( }) Violations of Section 590.004)(A).(D)in 3-401.11(A)(2) Rant:.s,Injected II'icat.- 15SF 15 catering, motu;le food, temporary and 3-40i.it(A)a?) Poultry. A%ddG:n:e. SnffuiPHFr. residential kitchen operationssh•oaldbe Stat int,coutainutg Fish,A?eat, debited unlet the appropriate SeC[io?s Poultry,,r Ratites-165'1` 15 sec. ' above if related to Ioodborne illness 3--401.11(C)(3) Who;e-muscb:, Intact Beef Ste':;ks interventions and.risk factors. Other 1-45'F* 590.009 violations relating to good retail 3-401.12 Raw At irnai F;xxls Cnokcd to a practices should be dehiled ttodet /and; - :'vFiu'uwave 166'F!- Speen; Requirenn•uts. 3-401.1I(A)(10) All Othet Pf-ll§ - 1.45'17 15 sec. 17 ( Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES i 3-403.1 t(A)lioD) PH:., 165-F 15 sac. '. (Items 23-30) 3-103.1 UB) :blicrmwave- 165'F 2 Mi;iute Standing Critu al and non-;,rnicul violations, which do not%eta!e ro the Tim:'' foodhorne times:;interncntions and)rsk faciots instal above, can he 3-403 11(C) Con?mpreiaihy Processed RTE Food- fnnnd in the inllowing r.cctiom of lite Food Code mad 705 CddR 140-F* SIU.UUO. 3-403.11(E) RemaoningUn.hcedportion;oi-Beef Item Goad Retail Practices FC 590.000 j Roust,s' 22. Manaqement and Personnel FC-2 .003 IR Proper Cooling of PHFs j 24. Food and Food Protection FC- 3 004 j 25 Egmpment and Utensils j FC--4 005 i 9-50114(A) Cool inr'Cooked PHFsf-om140°F to 26. Water.Piurobingand Waste FC-5 Ct06 70'F`N nit 2 Hours and From 7WF 27. Phvsical Facility FC-6 .007 j to 41^F/d5 T Within 4 HvtlrS. > 1 1_28. Poisonous or Toxic Materials FC--7 :008 ' 3-5W.:4iB) Cuoiiu]•,('lies Made Faurt Ambient 29.----1 SUncial Requirements 00^, 'iemper.nure ln2iedicus to 41'F/15'F j 30 Other Within 4 Flours* w Denote,ethical rtzm m the tedend !')Yat Mad Code of 10>CNIR 5901 X00. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH r,. r 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Mohamma Alam & Sher Shah Name of Establishment : Salem House of Pizza Address of Establishment : 23 Endicott Street Type of Establishment : RETAIL FOOD Application Date : 06/23/2003 Restrictions: Permit for Food Establishment 303-03 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 CITY OF SALEM, MASSACHUSETTS �� •-�, BOARD OF HEALTH «. r 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 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENToG TEL# %78 - 7GIW- 00/-7 ADDRESS OF ESTABLISHMENT 7_ 2> EA10tC U T 5'7- SAGE_M /ylA MAILING ADDRESS (if different) OWNER'S NAME MOHAMMA AL 9/" , Stlg /Z 51y qyTEL# 5-,38- ADDRESS 2-S TECUMJE 7�,?0 '- CITYMAe(86/2p STATE 0144 ZIP m/7 L CERTIFIED FOOD MANAGER'S NAME(S)jj1 T7 d CERTIFICATE#(s) 2 (,gS?73 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON SA 9 SHAH HOME TEL# 9/ 7— �76`7777 HOURS OF OPERATION: Mon./L Tue.//// Wed./i=// Thu.//-// Fri./i tZSat.//-/i Sun. //- to 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 O NO �6� less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belie, have filed all state tax returns and paid all state taxes required under the law. 63S 03- 3o2ur Signature Date Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm Check#&Date a97 1 CITY OF SALEM A BOA D OF HEALTH Establishment Name: ��/�e[i/lr _ i2r /J� zzcr Date: to �( GL3 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified / PLEASE PRINT/CLEARLY ,� _ _ � /�s(/�/1P✓ i�i��i.S �"/ /ixt��/� hG,�euJli�� rr� ' t CL.CSf'7PhSP/' I /h .lSii/� /-�rP4 iii o�if�Jti.f'/i� .5i.�- I I I � I I, Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to Correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion 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. )�2 ❑ Voluntary Disposal ❑ Other: .y ^t 3-50i.1-KI PHfs Rccc;ved at Tinperatufres Violations Related to Foodborne Illness Interventions and Risk .Acco?dling to Lao Cooled to Factors(items f-.°?) (Cant.) 41'FA5 1' ,Vithin s Hoots" PROTECTION FROM CHEMICALS 3-50I.1 Ctx lino le-hods tot PHFs 14 I ( Food or Color Additives 19 PHF Hot and Cold Holding 3-507 lr,;,B) C(t1d PHFs,`d:aintamcu al ur heir:u i :-202.12 Additiics* 590.004(F) .11'/45'F,. f i-302 14 Protection from Unarinoved Addili�es" ( 3-501.I6(A) Her PHFs Maintained at or above 15 I Poisonous or Toxic Substances 140'F. 7-iol.11 identifying Information -Original Reis, Hrldntnuabove l3fPF ` C'ontonere:` no,t Name -W'urkin;;Containers" ! 1 20 Time as a Public Health Control Co?utj 3-501,t9 Time its a Public Heahh Control" 7-201.11 Separation-Stof agc" 7-202.11 Restriction-Fresence andUsc'' 590.004(H) Mari:mceRequirement 7-202.12 Condition':of tlse* _ i 7-20;.1 l Toxic Containers- Piol ibnionO ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saaitizers.Criteria-C'henr.ede* POPULATIONS(HSP} 1-204.!3 Ctternicals for Washing Produce, Ctiteti,r.: 21 ;-ripl 11(A) Unpasteurized Pre-packagedimides and i 7-204.14 Dr,in,Ay,=encs.Criteria: Beverages with`,1' nin Labels" 7-205,! t incidental Food Contact,Lubricants" 3-80L!I(B) I1!;e of Pascal ized E--s* j 7-2o6.i l Rearicied Use Pesticides,Cr)tefia'" 3-801I H(D) Raw of Paatiall�•Cooked(Amoral Fcx,d and ! --- - Raw Seed Spoons Not Served. :. 7-206,12 Rodent Bait Stations ! 3- t 1 `s 1 i., 1 CI Uno-coed Food Parka=e Not R:-Served. " 7-206.13 Trackin.!Poi+�ders,Pest Control and ' R4oniro*'erg CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Ad,i>ory Posted for Consumption of Proper Cooking Temperatures for Animal Ftxids,'hat are Raw. Undm"uviked o'- Nnt Others!se Processed to)slum line PHFs Paliur ca' ... 3-401.IIA(1)(2) Eggs- 155'FISSec. ;-302.f3 PasteunzcdF.Fl; Suh�tittfteforRa�tShell Eggs- lmmed?ate Service 1:7 a'F75sec` 3 40 11(A)(2) Comminuted Fish.Bleats R: Game Bgs s' Animals- 155"F 15 sec. iSPECIAL REQUIREMENTS 3-401 J l(B)t l)(^_) I Pork and Beef Roast- 130"F 121 ntin* I 5 SN0.009(A)-(D) � Violations of Section 590.004(4)-(U) in 3-401.11(A)(2) ( Ratites, IR7ectedNleav,-- 1 ,i'FIS sec. * atter,ne, nulbile foal; to;nporar- and 3-401.1[(A)(,) Poulhv, Wild Game.Stuffed PHF:,. residential kitchen operations should be muting r.ontmning Fish. Meat, I ..-Dodo ,.odor the ;•; nr r-11 Poultry or Ratites-165'F 15 sec. ' above if related to foodbtn ne illness 3-401.1'(0)(3) Whole-muscle. iniad Beet Steaks I interventions and risk factor's (Mier las"F ' 590(109 violations relating to Ig(iod retail 3-401.12 Raw Anneal Foods Cooked in a practices,horrid he debited under' tvlicrowrave 165`F* Special Reguircinents. 3-401.1 1(A)(t)tb) All Othet PHFs - 145"F 15 sec. 17 ( Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.1 I(A)&(D) PHFs 165'F 15 sec. '" (Items 23-30) 3-103.11(B) Nticimwave- 165°F 2 Minute Standing Ci ideal and::on alio,:(oiohiii mn , irhich do not rrlaie to rhe Ti 10* fondhorne dhw<s infetreuriou.e and risk factors listed above, can he 3-403.11(C) Commercially Processed RTL- Focal- found in the tolimring.ce(uuas rJl(he Poon Code and 105 011? 1400F 590.000. 3-403 11(E) Remaining Unsticed Portions of Beef I Item Good Retail Practices FC 590,000 Roasts". 23 Alanagement and Personnel 1 FC-2 _003 _ 18 Proper Cooling of PHFs I ( 24 Food and Food Proteclon FC-3 004 25. Egwpment and Utensils FC-4 005 3-501.14(A) Cooling Cooked PHFs from 140'F in q6. Water.Flurnbingand Waste FC"-5 006 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41°F/45'F Within 4 Hours. " 1 28. _ _Poisonous of Toxic Materials FC -7 .008 -501.14(11) 1 Cooling PHF,Alade Ftotn Ambient 29. _ Special Requirements .009 -Pemperature fngredicots to 41'F/15"F ; 30. Other Within 4 Hours: "fimotc�,nucal amain the federal 19=+9 I,x,d Codcu, 105011 590.000. L Z,,` CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 120 Washington Street Salem,MA 01970 978-745-9595 ext. 421 Chairman,Herold F.Blake,Jr. Stanley J.Usovicz,Jr. James M.Fleming Mayor ROUTING SLIP John H.Casey Clerk,Judy Davenport The Salem Licensing Board requires each applicant to have the appropriate Departments sign this Routing Slip and return it to the Licensing Board Office prior to the issuance of a license. BUSINESSNAME lloh(Anne,!Z) ��A Anh SIo4M1 AC, Corporate name: d/b/a: S atc h i•-ia LOCATION: C%1) 1Co11 Tele. # �') TYPE OF LICENSE: APPLICANTS NAME: 1� �nM �`11n Residence y Street: H TnaI Home tele. # 50S L1'rs5 -`Is a3 City: 1�h�c�"^� State: Zip: TO ALL CITY DEPARTMENTS: your signature on this form is notifying the Licensing Board that all requirements of your department have been met, at which time the Licensing Board will issue a license. Salem 's c Commiss• n 120 W ington Stree Sign Review/Planning Dept. 120 Washington Street iNsP«nM esrnrtl. - a,N v��o Salem Health Department ' 120 Washington Street Fire Prevention 29 Fort Ave. v Building Inspector = , 120 Washington Street Department of Public Services (Water Dept.) / 120 Washington Street routing slip