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SALEM HOUSE OF PIZZA - ESTABLISHMENTS (2)oto hevi() ©f Qi22# 2� ej(o ft IrPtt RNIVERSAL® UNV-12110 MADE IN USA SUSTAINABEE MIN RECYgID FORESTRY rORESINITIATRY CDNfQIT10% C.Old Fber Saurdnp ��T"�U� mvw ifiproprem mp '1101 'A, Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name( \/lr 11n,.a, �� _ Date '_'DK Tvpa of 0 eration(s) Type of Inspection Routine Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness El General Complaint El CP ElOthe Food Service 0 Retail El Residential Kitchen ❑ Mobile El Temporary ❑ Caterer El Bed & Breakfast Permit No. Address" 6o'l D k , , ° ^ ' 0 AA ° Risk Level Telephone �, 4 \ `� I OwnerJ 71.0 4 r, .1� i i 32 HACCP YM Person in Charge (PIC) n ) Time In:1 Out I5i Inspector � p r� !� Each violation checked requires an ex��ation 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) pi action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT r ' .„,,. �,5 � � a,. _„. m£ ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned / Knowledgeable / Duties „m,m2 vHm _ air �9qM ❑ 13 Handwash Facilities `EMPLOYEE HEALTH e i r ai, ', ❑ 2 4Reporting of Diseases by Food Employee and PIC of 'PROTECTION FROM CHEMICALSu'4 11 ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded -r FOOD FROM APPROVED SOURCE;,ea�..:,g„„eau' +> ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potemia0y Haiardoua Foods}'�t ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION°��`a '� " ` "! ® P r-1 El 19. Hot and Cold Holding ❑ 8. Separation/ Segregation/ Protection ❑ 20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. PIC's Signature: '7 _ ✓ - ,''� Print !] 23. Management and Personnel (FC -2)(590.003) (� k 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (Fc-a)(sso.00s) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) _ / 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other s: s9J, Vs tFo, ta.do !t, REQUIREMENTS FOR HIGHLY SU$GEPTIBLE POPULATIONS (HSP)" El it. Food and Food Preparation for HSP ECONSUMER AbVISORY,�' ,.«,.:tet," ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. J-, U Inspector's Signature: )) oi_ `IAA.. �nw D- D Print: - PIC's Signature: '7 _ ✓ - ,''� Print !] y I -}I Page 1 0f� Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 594.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-20113 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Char e" 590.006(B) 590.003(G) Reporting by Person in Charge* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions im 5 FEN FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Foal Cate or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Henneticall ° Seated Container* 3-20113 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.1.4 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-10111 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0" WashingFruits and Veetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.1.1 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated TagstRecords: Shel]stock 3-202.18 Shellstock Identification * 3-20312 Shellstock Identification Maintained* Tags/Records; Fish Products 3402,11. Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(J) Labeling of Ingredients* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures 1HACCP Pians 3-502.11 Specialized Processin M_ ethods* 3-502.12 Reduced oxMii packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Foal Cate or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 8 Cross -contamination , 3-302.11(A)(].) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302A I(A)(2) Raw Animal Fads Separated from Each Other` Contamination from the Environment 3-302.11(A) Food Protection* 3-302.1.5 WashingFruits and Veetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* _ Disposition of Adulterated or Contaminated Food 3-701.1.1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501..111 Manual Warewashing - Hot Water Sanitizafion'rent eratures* - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * " 4-601-11(A) Equipment Foal Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Fred - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Saintization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms" 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401..1 t Eating, Drinking or Using Tobacco* ' 2401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and C a acities's 5-204.11 Location and Placement* ' 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices (x301.11 Handwashing Cleanser, Availability 6-301.].2 HandDrvingProvision ITY OF SALEM BOARD OF HEALTH Establishment Name: �a D 0� :\-),4 n10a _ ) Date:_ fi 1 - I O -1 0 vV Page: of Item No. Code Reference C - Critical Item R - Red nem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - Date, PLEASE PRINT CLEARLY (:� Verified 1 ))_N. %;u SII �?\ r I.,,_ I.. y�l)ir� ., b I . i P� r. nnn . A,t, U l U %-1(V-)/0 iii 110f, Ski1�P h - P__tt 1 v a / Ow �7 p�' Oo Yt PT L P L C s n a i i PA I nnnnJA.(Nn -n_ _—\-),o Al _r' AA,1A r � � \ S 6 x - �), .Lien n n n A o /u n rr ,c P;A APO d LP)S ' u PGA LLtA )VR _rA LA / ) Q� 5 AA i. ` 0 'i� d n (i '�'i /i /r 1!7 - n,t /N.� A /l.t ,i d ,n A 0 n _ A i . Or, f' ,1 r r�v1 .VAA -�'LP�CP� )(/1'\ �) )rX -' ��„� 2.r�. .� 11 Discussion With Person in Charge: Corr tive Action Required: ❑ No Yes have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ 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: a. Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIMFJ i EMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives*_ _ 3-302.14 Protection from Unapproved Additives* 3-50LM(B) 590.004(17) Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.1. I 1 Separation - Storage* 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Usc* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMFJ i EMPERATURE CONTROLS * Denotes critical item in the federal 1999 Foal Cafe a 105 CNR 590.000. 20 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3401.3lA(1)(2) _ Eggs- 155'F 15 Sec. 3-50LM(B) 590.004(17) Eggs- Immediate Service 145'Fl5sec* 3.401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155'F 15 sec. * 3401.11(8)(1)(2) Pork and Beef Roast - 130'F 121 min* 3401.11(A)(2) Ratites, Injected h4eats -155°F 15 590,004(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Staffed PHFs, 27. Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165'F 15 sec. 3-401.11(0)(3) Whole -muscle, intact Beef Steaks i FC - 7 145°F * 3-401.12 Raw Animal Foods Cooked in a i Microwave 165°F * 3.401:11(A)(1)(b) All Other PHPs - 145'F 15 sec. _ I Reheating for Hot Holding 3403AI(A)&(D) PHFs 165-F 15 sec. * 3403.11(B) Microwave- 165' F 2 Minute Standing Tom* 3.403.11(C) Commercially Processed RTE Food - 140T17 3403.11(E) Remaining Unsticed Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and From 70'F to 410F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45'F Within 4 Hours* * Denotes critical item in the federal 1999 Foal Cafe a 105 CNR 590.000. 20 3-501.14(C) PHFs Received at Temperatures According to law Cooled to 41'Ff45'F Within 4 Hours. 3-501.15 Cooling Methods for PHFs Unpasteur mil Pre-packaged Juices and Beverages with Warning Labels* PHF Hot and Cold Holding 3-50LM(B) 590.004(17) Cold PHFs Maintained at or below 410/05' F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 3-501.16(A) Roasts Held at or above 1300F. -;-801.11(C) Time as a Public Health Control 3-501.19 Time as a Public Health Control" 590,004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE CONSUMER ADVISORY 22 (HSP) 21 _ _PO_PULATIDNS 3-801.11(A) Unpasteur mil Pre-packaged Juices and Beverages with Warning Labels* Animal Foods That are Raw, Undercooked or 3-801.I I B Use of Pasteurized Eggs* Not Otherwise Processed to Eliminate 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Pathogens.* " "' -;-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.0w 1 23. Animal Foods That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* " "' 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. EggO 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical, and non-errrical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code mid 105 CUR 590.000. - Hem Good Retail Practices .FC 590.0w 1 23. Man gement and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25. E u7 ern and Utensils FG - 4 .005 26. Water. Plumbing and Waste FC -5 .006 27. -Physical Faciiit FC -6 .007 . 28. Poisonous or Toxic Materials i FC - 7 .008 29. - Special Requirements i .009 30. I Other _ I S:I�fonMslYn2 Cos y'..�^rt, y. Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4i" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name �1 , Date C�/ T e of 0 eration s T e of Inspection Food ServiceRoutine Retail e❑ -in /, Y -1 c} Address / n Risk /0 A Level ❑ Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone C, _ I� r I `H _ ZS ❑ Temporary ❑ Pre-operation Owner HACCP Y/N J) r ` ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness El General Complaint Person in Charge (PIC) ITim ( In,� I Permit No. ❑ HACCP ❑ Other Inspector, nlOut: Each violatidin checked requires an exp`ldnation on the narrative page(s) and a citation of specific provision(s) violated. v Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-ChokingL Tobacco / Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E). �jJ 590.009 (Fy❑ action as determined by the Board of Health. V FQOUPROTECTION MANAGEMENT ,,,❑ 1. PIC Assigned / Knowledgeable / Duties v�,,' EMPLOYEE tFALTH _''�" El 2. Reporting of Diseases by Food Employee and PIC El3. Personnel With. Infectionsi Restricjted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source " ❑ 5. Receiving/Condition ❑ 6., Tags/Records/Accuracy of Ingredient Statements --.[] 7. Conformance with Approved Procedures/HACCP Plans PROTECTION PROM CONTAMINATION`"- - 'ED.8. Separation/ Segregation/ Protection G9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing J\ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and. Personnel (FC -2)(590.003) G�vL 24. Food and Food Protection (FC -3)(590.004) �\ 25. Equipment and Utensils (FC -4)(590.005) 1P 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other �s�s9)01nspectPormGta.tloc J 1 _�� _ CtA CLV1% (1 J ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities )'PROTECTION FROM CHEMICALS'," " "' �❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals _._ ;�TIMETrEMPERATURE CONTROLS (Pdterd�ally Hazardous Food' T�6 ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control tYREQUIREMENTS FOR HIGHLY SUSCEPTIBLE, POPULATIONS (HSP) . El 21. Food and Food Preparation for HSP ;;CONSUMERADVISORY.4 „,c,„,,.,,r" ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related `-�--' To Foodborne;lllnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an Inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: kc",_t 4.11 lq-d' 42p, S ;C3 c� Gtr Inspector's Signature,:% .�� U Print: PIC's Signature: ti /-` Print: -Z U Page ofv Pages � - v Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assim gnentofResponsibility* �590.003(B) Demonstration ofKrrowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590:003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To ReportTo The Person In Drinking Water from an Approved System* 590.006(A) Charge,* 590.006(B) 590,003(6) Re oxting b Person in Char>e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions in a C * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources -� 590A04(A-B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Product's. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Watcr* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.1.1 PHFs Received at Proper Temperatures* 3-202.15 Package lnte it * 3-101.11 Food Safe and Unadulterated Togs/Records: Shellstock 3-202.18 Shellstork Identification * 3-203.1.2 Shellstock Identification Maintained* Tags/Records: Fish Products 3-40111 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 S ecializxd ProcessingMethods* 3-502.12 Reduced oxygen acka 'ng; criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.11 t Manual Warewashing - Hot Water Sanitization'Pent eratures' 4-501.112 Mechanical Warewashinb I3ot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization -temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4702.1 t Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301._12 Cleaning Procedure* 2-301.14 When to Wash* Il Good Hygienic Practices 2401..1 t Eating, Drinking or Using Tobacco* 2-401.1.2 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventintz Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacities* 5-244.1.1 Location and Placement* 5-2(15.11 Accessibility. Operation and _Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 HandwashmR Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM ") BOARD OF HEALTH Establishment Name: Date: Q — 1 k - I oPage: of T Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date' No. Reference ' R - Red Item -.. PLEASE PRINT CLEARLY Verified nv ar4, ,,�, IDA PAI F pn ,. , ., 4;_ {j// C6, ( E It!) ZZ JJ J �o ��SevV 3b I 6_.. C 'r 1 .1114,' /n k -PA 11 PA i , .lam K1✓�� v/. -1, 2 rJ, iv i � .,. - 11-r! 2 `LX ice(/(� �`' P -J ' C- aL all, U� o n � 'AlaR t,2/ � 0 Q[n.c� /nr. 2P+�%.0��. ) , P_ . /1 D.+--ira . �I l in /,�., n �!t i V't'tA t� ----IQ1 A"P 1, 4 1_v - n /V'aw_ (/d/?", -VY anC�� n 11�hn t- AiQ 41 A,J� l \),I- 'VVI''- Will Person in Charge: \/ t °4 n.er� tioXac� fes` Corrective Action Required: ❑ No ❑ Yes ❑ `Voluntary Compliance ❑ Employee Restriction Exclusion [Discuss'o' have read this report, have had the opportunity to ask questions and agree to correct all iolations before the next ins ection, to observe all conditions as described, and to P -,j W ❑ Re -inspection Scheduled ❑ Emergency Suspension omply 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� / j ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness fnterventions and Risk Factors (Items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 j—Fi�_ �. J _ Food or Color Additives 3-202.12 Additives" 3-302.14 Protection front Unapproved Addniccs',_� 1.5 7-501.15_ Poisonous or Toxic Substances (y -101.11 klentd}ging lnfotnation--Ongioal :i 1 Comahier,' r-10__1'1 Coimann'Yante Working(t,uaat r," i -511776;A) _ 1401' « ! Rttsts Hc(d at or above 130'i�. --I i 201.11 srpi m<n i t yin .esapubh�H�atth Cx>ntrol`__ , 7-102.12 Condoion of Usc _ 1 ?-2173. t 1 ra„tl C r tt linea Prof bitivf '2 1 Pcb .atmq for Hot Holding ... _._-_ i 2104.1[ Suvuiets lriuti+ Chcnno is ';-40"A 1 (ts) 71174.12 C'hvnucdc tit X'Vanhwg hodace, Cidoiote 3-403.11X) [7>yfn Ai entc, Critcl it ir7'04.i4 hi -403 � H(I:,, ��t iz ,, ; t;,g Lt,tl-red Pt�rtet e o1 13.v"r 1 10511 lniid nt1!i Nk1 ckinlam L116! a)S' i / 206.11 1 Rc Im t"d Co: PL alder=.0 1 tend .�...�� 1 7-206.1 ! Ro,wnz23 $tat t t-206.1' , 1 is l i1„ P adz i "„t Q,nirJ atid ( 1Roa! '�`a.._._ _ - -1 TIME(TENWERATURE CONTROLS j—Fi�_ �. J _ Ptop;.r CnoNit;g Tempet a+ures for � 1'ttF According to Law Cooled to - ___ w 7-501.15_ _ Cooling Methods for PHFs (y PHF Hot and hold Holding :i ! 590.0t}4(f) i 59 L 16(A) t i -511776;A) _ 1401' « ! Rttsts Hc(d at or above 130'i�. --I i Time as a Public Health Conti of i t yin .esapubh�H�atth Cx>ntrol`__ , ___� 9U,itt>. 'H- _. � u 1 I;t 1 Pcb .atmq for Hot Holding ... _._-_ PA)`u)7 liii 1(,51 i 5 ';-40"A 1 (ts) Slutelwttr Ns F 2 N"howt sii!mw!_ns 1 3-403.11X) (um.ncxt9aily P.ta.sad 411}TMai. I hi -403 � H(I:,, ��t iz ,, ; t;,g Lt,tl-red Pt�rtet e o1 13.v"r 1 I 5..501. 14(A) i CiNiling O'X& ti p1iFs Berm 1411" P to "Ni`F N'itilrn Z F!eur r,±sd From .i`l"E. __ Wit,}t Mi:''Within 4 H(gu _ t_sC)L i4ih 2222 t+I t PRI Nhvk,Fiom Ambient �. } i n1 tawTe In ilredicall, n 71"Fi.45`F vitt n-4F:&ttt critical ex .ttrl:,k! i `wou (:,dc', 1 i¢(. 'w-r,c4_ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 t tR) I1np t tea iz,ci Pt pati twcd Luices and � 8ul eto es wttlr Nalnni� l.abals - _ h('i; 1 L(t37_ of pa ti. wind E"-" ?WIL1111), tRao, ofliati::a;) Fvdand I.1 i Wt I t ; ti, icd Fsui Pec aflr No pc—serve.'. ' CONSUMER ADVISORY i 2 1-bt7: 11 1 coni ai cr tf ;sols P< c' sur (' '- nr ptirn ,I :. usiltw' i +ck1 Prof ao, R w E'Tal ( i a,. UL, 1 SPECIAL i?EQUCR£',1iENTS _ cst,r tg 3t;t3tlt•.itk'i.tetND a., a,.c3 � 1 sx'• a.:., .; � to s s 4 . r -wits s .,._.i±a !''c { t , ;,iae d tt ids t zit linrutirta' , z^; i x. WOLA TIONS RFLA TE?) TO GOOD RF-TAIi.. FRAC, tCL-.S +I1ems 23-30i 0, y. ,,- `Ihd wdl , W!,'fii It _ N,r i ;3 N e {h do UD£ (iao ! -..n. tor'x r.u';:`J_'rli,nre'+t �t an,o`i; flaevorr?iucl rr�_c?tt fSc rhel 3-50 i ,.IA(C1 PHFs. Received at Temperatures According to Law Cooled to - ___ 41`:F/45`F Within 4 Haws. s 7-501.15_ _ Cooling Methods for PHFs (y PHF Hot and hold Holding +-501 .1 b(L3) Cold PHI s Maintained at or below 590.0t}4(f) i 59 L 16(A) 41`/45°f" I lot pl-IFq A3aintalued at of above i -511776;A) _ 1401' « ! Rttsts Hc(d at or above 130'i�. --I Time as a Public Health Conti of t�Ui t yin .esapubh�H�atth Cx>ntrol`__ , ___� 9U,itt>. 'H- _. � G_ ,tnceit�vi tx tnestr _ _-- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 t tR) I1np t tea iz,ci Pt pati twcd Luices and � 8ul eto es wttlr Nalnni� l.abals - _ h('i; 1 L(t37_ of pa ti. wind E"-" ?WIL1111), tRao, ofliati::a;) Fvdand I.1 i Wt I t ; ti, icd Fsui Pec aflr No pc—serve.'. ' CONSUMER ADVISORY i 2 1-bt7: 11 1 coni ai cr tf ;sols P< c' sur (' '- nr ptirn ,I :. usiltw' i +ck1 Prof ao, R w E'Tal ( i a,. UL, 1 SPECIAL i?EQUCR£',1iENTS _ cst,r tg 3t;t3tlt•.itk'i.tetND a., a,.c3 � 1 sx'• a.:., .; � to s s 4 . r -wits s .,._.i±a !''c { t , ;,iae d tt ids t zit linrutirta' , z^; i x. WOLA TIONS RFLA TE?) TO GOOD RF-TAIi.. FRAC, tCL-.S +I1ems 23-30i 0, y. ,,- `Ihd wdl , W!,'fii It _ N,r i ;3 N e {h do UD£ (iao ! -..n. tor'x r.u';:`J_'rli,nre'+t �t an,o`i; flaevorr?iucl rr�_c?tt fSc rhel I CITY OF SALEM BOARD OF HEALTH Establishment Name:Qyr onv._Ll/n,nn , Date: R—t K- I e Page:_ of Item No. Code Reference .0 - Critical Item 'R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION-` - 't-< w PLEASE PRINT CLEARLY - Date ' Vedtled ,'t ti, � J I 1 OGln An-00 -A, L1 11nn \ � i � P � • � ,C V �� D O / P /'1 .r 0 � � `49t0 � A 4 A /'n n •_ aLl �*�V�. n_ nn .- �VLP J /1 .. �'1�S a i i d -t=. ✓ _ _ _i _/'i 1 rAJA, 0 0� + a S t rcussion With Person in Charge:Corrective read this report, have had the opportunity to ask questions and agree to correct all lations before the next inspection, to observe all conditions as described, and to 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 your food permit./ I Action Required: ❑ Noave ❑ Voluntary Compliance C3Employee RestrictionExclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related, to Foodborne Illness interventions and Risk Factors (Iteft 1-22) {Cont) PROTECTION FROM CHEMICALS 14 food or Color Additives 3-202.12 AddJti%ce;4 3-302.14 Protection from Unapproved Additive" 15 Poisonous or Toxic Substances Nine, lafonnalion - 06;inall Ciilaffwcr^^ 7 107 11 (,omfej)jj Rot, inf, ( at,kmten* Cooling Methods for PRFs 19 7- 292? 1 I pe"triction 11f,"'a nee al)d [,,C* Coeldiwa), of '-ISO' 7 W H Toxic Con(am-ef 7--`0,L ii -Ilrollilbl,:OnO� Saniu/ers, Chcmic�0k r-12ai:IA Z Chniicals fix c Ciito[ii,l i 7-704,14 1 3 �1-iJh;A3 > N!1-alli caw�, 7-206A] t 7 R.a n i r, 1 " Pr n iiltns. clifem), I Rexicni 13,!ISiallon", Tyackm?,mdvP,,S[ (',iMTTJ X�11 I 1i 3.4Qi I IVel l5i F 15 S'e Eft>!S- mune Aa scl "I'C 1 I9 15'ec, !Jft- 4i) 1 1 i (F ta, ..r,0 Bkvi Rmm 1 l- 12t Elfin ---- --- — --- --- ------- PlIFs Received at Temperatures Ae:rording to Lam Cooled to 3 4(, 1 i i (A)0 Game, 57utrcd ill i»�� Ivloffilw Cleelimerisil. Nf.,Iaf. 41"F/45`F Witbin 4 How s. 1"4' S Cooling Methods for PRFs 19 ee, 'Ht Ratinq for fiat l-WOv"4 Cold PHF., Maintained at or below �S90 olpff) 410/45� F, J-403.1145) Nfiklovial— lei !lot IIHFs Maintained at or abow 1401- 1 3 �1-iJh;A3 lk 1[ E F ,u LS I I (L) i R"malmn, u,"il"'vej Por ons 01, lie'e, I 501 . 1,11A) 1 Cieed;tee C<ffke e 1111F, rtonl 141 F lie K,'F Withen four' wid From !:)'T - F WitblT) .1 s-SOi.i4iB! Cir ut Pili 10 -4 5 Wdc Fwm,-ijnbiew Vonicraeure la,-rcdicns io 4;ii-i l5�F 11itllire4 lbqa�' mu'.I; j'C"I 1,U n" ho"', 1 !I)i (XhC - 'Y : Utlq', REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS with vVen-11ine 801A IW 0t pawmicd f)) K;m or PeuliAj', C;e%Ik,,d ,Lnitnal FeeeO and —H(C; rple-;Ied 1-4XKi pafka,'C Not CONSUMER ADVISORY 22 3 11 (ootiullwi AIt,;wiN Pcntcdi,er C(Twomption III fteIin,,,,J Fz,, S'Jesimmic inti Ras She!! ---------- --J Sl)=CIAL REQUIREMENTS . loidj tk-te(i und"I tit c eipqr"Tp ilte i Ion e i �! Zi Ci 101 1 is z o� J ji OCILA —;,IONS RELATE'D 70 I',00D, RE7A't. P-RACTWES items 23-.10} ab,il r con i foodCojean"! V"5 i"Jel{ �ind t(1111 GC :'e 004 ,,eeni and Ute�,IVS 2'"Nati Pintmq,ued + Wt i FC - 5 FI (c) PlIFs Received at Temperatures Ae:rording to Lam Cooled to 41"F/45`F Witbin 4 How s. M] 9 Cooling Methods for PRFs 19 PHF Hot and Cold Holding 50!.16(B) Cold PHF., Maintained at or below �S90 olpff) 410/45� F, 3-501.166 A) !lot IIHFs Maintained at or abow 1401- 1 3 �1-iJh;A3 RoastsHeld ator above 130-P, 1 Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS with vVen-11ine 801A IW 0t pawmicd f)) K;m or PeuliAj', C;e%Ik,,d ,Lnitnal FeeeO and —H(C; rple-;Ied 1-4XKi pafka,'C Not CONSUMER ADVISORY 22 3 11 (ootiullwi AIt,;wiN Pcntcdi,er C(Twomption III fteIin,,,,J Fz,, S'Jesimmic inti Ras She!! ---------- --J Sl)=CIAL REQUIREMENTS . loidj tk-te(i und"I tit c eipqr"Tp ilte i Ion e i �! Zi Ci 101 1 is z o� J ji OCILA —;,IONS RELATE'D 70 I',00D, RE7A't. P-RACTWES items 23-.10} ab,il r con i foodCojean"! V"5 i"Jel{ �ind t(1111 GC :'e 004 ,,eeni and Ute�,IVS 2'"Nati Pintmq,ued + Wt i FC - 5 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT k Salem Board of Health 120 Washington Street, 4�' Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date a of 0 eration s . ! arae of Inspection S �%1 ( �) -� - Food Service V ElRetail Routine LlRe-inspectionl) AddressRisk Yz U 0-A rA Level` - _ ElResidential Kitchen ❑ Mobile Previous Inspection Date: a_3 11-0 q Telephone (l J Il E)Temporary L]- Caterer ❑ Bed & Breakfast [IPre-operation/ ❑ Suspect Illness ❑ General Complaint OwnerHACCP Y/N Person in Charge (PIC) Time In:�. l(I ❑ HACCP Inspector i �i �� Outer: Permit No. ❑ Other Each violation checked requires an eAplanation 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)J2_1� 590.009 (F� action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT�'_q ❑ 1. PIC Assigned / Knowledgeable / Duties a EMPLOYEE HEALTH...... `F'7,n 7-7--"- I ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans fPROTECTION FROM CONTAMINATION ❑ 8 Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. _&"i 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S, MlnVedFw-ia.eoe ❑ 12. Prevention of Contamination from Hands ❑ 13: Handwash Facilities ".PROTECTION FROM CHEMICALS �❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals p TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods)`'"'.'" x,=...�, ...once +,a ❑ 1 6. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSP)„a ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY- El DVISORY.`;"' ' _ . `".wa,�µa.,�:t ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order.. DATE OF RE -INSPECTION'' � al �_k Inspector's Signature: (%� „ p, Q, ; 0 Print: r l . �PIC's Signature: her cr �- Print: (/�L Page 0f CiPa es C LCt"1 'CY'�GL(, g g Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT I 596.003(A) AssignmentofResponsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge -- duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs" 590.003(F) Responsibility Ol' A Food Employee Or An 3-202.16 - Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Char re* 590.OM(B) 590.003(6) Reporting by Person in Charge* 3 1 590.(X)3(D) Exclusions and Restdc[ions* 3-201-15 590.003(E) Removal of Exclusions and Restrictions C C C * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs" 3-20214 E gs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinkin- Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.OM(B) Water Meets Standards in 310 CMR 22.04' Washing Fruits and Ve *etables - Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201-15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-20118 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package tette it * 3-101.11 Food Safe and Unadulterated Tags/Records; Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained' - Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with A. oved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 8 Gross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Fcxtds* Contamination from Raw Ingredients 3-302.1,1(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Ve *etables - 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Resetvice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem eratures" - 4-501.112 Mechanical Warewashino Hot Water Sanitization Temperatures* 4-501.11.4 Chemical Sanitization- temp., pH, concentration and hardness. 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms"` 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth` 3-30112 Preventing Contamination When Tastin * 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashime Cleanser, Availability 6-301.12 Fiend Drvin Provision CITY OF SALEM BOARD OF HEALTH Establishment Name:.y P/` YN 30 1 V) PJl Dater— I lo—O Page:_ Of Item No. Code C - Critical Item Reference R - Red Itemverified DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date; .. . 1 (. i 7 J D. V/�o r"'p l A J_}Y._'ll t-!rU n�OM.a I �UM1vi+al c 40 Al) "'mJ.,.. 0V— C—O=�ti �ry-�T��A P�� I�r��n )Ievo kyj a o I - i �i.0 �lA)I -C"A/`b'Y �(� J(rX (AA nyiw'� �)111`�Li771.�'1'_F}��\ n y. N(S vie IJ,T,tA /l. .Ml� uj �D�kut�r_ I AV, \I A4U('P 100 �a. ,,1R /XI1�1o1 A rcy, t J �4'�fl)��(//f} A)t�C7. }'l �(�^^ .WA {�(.�,{.(yn �.yQ��^.'✓Wf'I,P��/1Y ,�(�� I `y] n l )-�Y�C�/`,i.Y1�\; A,fV`eC,L��-'pY\(C21,��l`iCL'Y'v�i�l I,'(Y�);n„ :9C..P/t�'I'g\�(.M1tfy',-N7OG�=ti Mf,+i�,IrtAA,aR-/A L4 l ofi- 6,) A ""Ll i em 'o6 �_J A' a6 Ill,( Inn i;llY Lr/U \x Lnn !AAn-A �\ n n %)�n ,fi;<<C, (-jp,),, ,G '4\ '0�OQ,. 0»„\ion,? C �, /Yes Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. Corrective Action Required: ❑ No lef �Voluntary Compliance ❑ Employee Restriction / Exclusion Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Ralatad to Foodborne Illness interventions and Risk Factors(Itewts 1.22) (Cont) PROTECTION FROM CHEMICALS 14 & ti:an;i: Food or Color Additives I 3-202.12 AdohtiveO _ 3-302.14 Protection from Unapproved Additives*... 1S 3-501.14(A) Poisonous or Toxic Substances 590.004(F) 1 101.11 ktenutymglnfointmnin-Oti�gina! I Containers` _ tc 41 1-11.5"F Vvitinn 4 riot _-- -_ + 102.11 I Common Name- t4trki.,g 1101.11 Via; W(in -S44;1 1 C" Within 4 11,wss 1-202,11 I Restnt t o n- 1'ry sur r and Use, li , 3 17 202.12 Coudnica of lase" Reheating for tiof it iauig �7 ?03.1i Toxic. Coni tinea "cohribion .,)3,t1ta1Cilii _ �� 204.11 Sannvers CYiieri+ Chunk 1♦ lira out vc- It T 2 Nlmw: Standing_ H04.1I- c4cmicak'br CI t(nia Dnin A rte Crit is �-7204.14 rT1 1 2('5.17 _ tncad at tl t >'YI rrrtut 1¢thti�unti'-�� _ 1 7 206.7 7 Re- l l u f a, ,et I'e a .fr. ("wen :' 1 7-206.i% I R<xla n h. t 5,rit o c K Ir.ilki g Poi%de !YS' C mirr 1 tit(i i 1Cin I ol i t TIME/TEMPERATURE CONTROLS 16 1 ._..._-.j_ Proper Cooking Temperatures for 31.101.;.1Atl,t:; Ir«: 155F155ae. -403.11(0) & ti:an;i: I 40 1.11(13)( 1 121 � Pot tf, and li 1 Rulisf 1 "0 1 121 nvu' I _ _ lic ' 3-501.14(A) 'i ! s, � 590.004(F) i 4t �t it C/}d.,it.1n t„+.?, ia,, i 3-501.INA) tc 41 1-11.5"F Vvitinn 4 riot _-- -SU1.14{11y i'lu, ., 41,1n:! Be i v Within 4 11,wss 19 j t .ari iu�.`}. , li , 3 ii 01 n HF, 171 Reheating for tiof it iauig .. t �... _ .... __ � it'1 i6 'i t ,r .,)3,t1ta1Cilii _ �� _� ! -dU3.l 1f1i1 lira out vc- It T 2 Nlmw: Standing_ -403.11(0) C.:xn r:el"la.ly flex, sod R'I3 F"ki - I 3-403.1 I"El R�nlaininr i.i slwed Portio(+s of 6cei _ R nasi>x Proper Cooling of PHFS _ 3-501.14(A) f txdina Call, dP}IPe front I4U Bio 590.004(F) '0'F within 21Towr> and From J?)'1' 3-501.INA) tc 41 1-11.5"F Vvitinn 4 riot _-- -SU1.14{11y Cooling ( ling l;'Fil, filidc F:oni Arnb,C!,t Tunprrauirc )ngred':e*;t; r,; q ;,`11212`;' v Within 4 11,wss •I cn iacnucalu t'a ihr ��riri o;:?t �:: H; R_ i r"„500. 19 3-501.14(C) PHFs Received at Temperatures According to Law Cowled to 41`F/45"F Within 4 Hours. ' 3-501.15 Cowling Methods for PRFs PHF HM and Gold Holding 3-501.1'6(B) Cold PHFx Maintained at or below 590.004(F) 410!450 f 3-501.INA) Hot PHl s Maintained at or above 1467.x Roasts Held at or aboNe 13O'F, v Time as a Public Health Control 19 Fim,as a Public PiealthCrearJ_V "917 004(1) W t i trip.( 2(n�at CllleliC REQUIREMENTS FOR HiGHLY SUSCEPTIBLE _ -POPULATIONS HSP) _ j 2t -T *- 01 i l Ira) { l;np i teu ixcd Pro i acl;aged Juices arul I i 141 • i,.•.es with R-arnin2 lawS`• i-$07 I I {i1) ' Rau. c r }'aniail f iRixerl AnimaF Foor,3 and -5W 1!rG ! UjniirCiiedFrxxil-acraircN,, R serve+3.- `-C'NSUi*AEP, ADVISORY -i--T 3>>.;3 t (t arsann r 1r• •nor Pou•.:,' s ,r t .,t.. ant: �.cn of t 1 mitt.(l i:4xd<'Iliain RLr.. Urid F.::>iil:eti s;t ,iso Pro etc.,._ "Ii t i 1 1 i ZrEC1A€. REQUIREMENTS _ aur ti1�s r i�-:141"i-i':, aP[h C'�'iii{ 7C+�tOixc ,..•,3 rIOLA7:,7WS REL ATEL1 r Ct ,rPc.'ir D RETAIL PRACT(CL•S _... (items 23.31)) a tit, a.'.J1L1 tkr l ,tatrcrl t .+;.+i:. v. h iFG1t GO "ol tollwillm, Irurn� i' n �„•r. veut: � ra erra risk factorr tAn <t •bout_ carr be u.t io' iii ifta i rl re "H rra n ""i ;he Fooil Code iv rd 1r)5 C'I"R '--"--Por*.�0.,a•.«.,+'r..+w+M.,d,;.,;,,e{�.�ty...,.-.�!., ;,;,.r.�.s,.n ..:,4i"e�^.*�,;,-rF4v-'x7...,��r+C4!>,..y,�,:ew+e.'-:'1.�.•.^'."k. .=�..,�.A:-,;•"r,e-+'+a..) Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4i" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT.INSPECTION REPORT 1 Tel. (978) 741-1800 Fax (978) 745-0343 Namedate t "Q%� Tyne of Operation(s) Tvpe of Inspection f®yFoodService t❑ Retail ❑ Residential Kitchen ❑ Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Routine NRe-inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness ❑ General Complaint El HACCP ❑Other Address? C nn n T( Risk Level Telephone _ , 0 Owner0 9Q r -P9A I (n p HACCP YM Person in Charge (PIC) L A Q)) Time In.( (U(Y� Out: 1/i�, Inspector t a D ^. 1 Each violation checked requires an px0lenation on the narrative page(s) and a citation of specific provision(s) violated. �J 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 PROTECTIONMANAGEMENT a b e` -r El 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/ Knowledgeable / Duties ❑ 13 Handwash Facilities (EMPLOYEE HEALTH "`-' ,i'' ' `, ''"°I �mxxzw.o�. PROTECTION FROM CHEMICALS ra F��A� EF a = n _, ; g ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals T FOOD FROM APPROVED SOURCE TIME/tEMFERATURE CONTROLS oteMlal Hazardous Foods"' .1 ❑ 4. Food and Water from Approved Source p' ty ) e ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ,. , T . `�%y , ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N ;_ 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S. 5901 Vs tFom6-14.0 ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR MIGtILY $tjSCEPTI$L£'POPt76ATt¢NS [121. Food and Food Preparation for HSP ,!.Wri$UMEi ADVISORY'„ ,7-2 :( ,iz "re'-"'ata`tele7 ria m I ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION:;_�I,,,t 1 1 vi7O�.t5b r v� �l Inspector's Signature:O Print: b ,, ,f / PIC's Signature: / Print: Z 'r Page__ of Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(.0) Assignment of Responsibility* 590.003(B) Demonstration ofKnow_led e* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by foal employees and 3-20LI3 Fluid Milk and Milk Products* a licams* Shell Eggs* 590.003(F) Responsibility Ol' A Food Employee Or An 3-202.16 - Applicant To Report 'To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003((3) Reporting by Person in Cbar e* 3 1 590.(H)3(D) I Exclusions and Restrictions* 3-201.15 590.003(8)Removalof Exclusions and Restrictions 4 C C C *STIt1. "•. ♦. - Denoics critical item in the federal 1999 Prom Cafe or 105 CMR 590.000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food ma Hermetically Sealed Container* 3-20LI3 Fluid Milk and Milk Products* 3-202.1.3 Shell Eggs* 3-202.14 E,= and Milk Products. Pasteurized* 3-202.16 Iee Made From Potable Drinking Wafer* 5-101.1.1 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 7202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Inte it =* 3-101.11 Food Safe and Unadulterated Tags/Recordie Shelistock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of ui ntent* Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.1.2 Reduced ox en packagirmt criteria* 8-103.12 Conformance with Approved Procedures* - Denoics critical item in the federal 1999 Prom Cafe or 105 CMR 590.000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foals Separated from Each Other* Contamination from the Environment 3-302.1 I(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-3(A,l 1, Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition ofAdulterated or Contaminated Food ' 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tent eratures* - 4-501.112 Mechanical Warewashino Hot Water Sanitization Temperatures* 4-501..11.4 Chemical Sanitization- temp., PH, concentration and hardness. * 4-601..11(A) Equipment Foal Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of ui ntent* 4-703.11 Methods of Sanitization - Hot Water and Chemical* IQ Proper, Adequate Handwashing 2-301.11 1 Clean Condition - Hands and Anns" 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2,101.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination WhenTasting* 12 Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Em hlees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 Thindwashing Cleanser, Availability 6-301.1.2 Hand D 'n *Provision .EM 'H te:,? - j Page:— of nemF No. AA, Code tV 0, - Reference 4,R •C -Critical ftern, -Red Item -- . a 1�DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION 7t, 4, 1-4 _C� Im LF 'r tP, - � t,, &A� PLEASE PRINT CLEARLY' Dates s 4Verified A, y. 9 A to x- P �Q? Nt 0 1,10 W 9.,twc-ro /d A "A_ I-PAO PIP U A'A f L't V-)�� ',/)I L�d, A A Q QQ V R tkt A Zt-P1V_)'9 4, �V, 6�11 /-, !I,,, (-)AA J 04 XA J,.- i 4A AAIY/YYa:hl L) J yj C oeo Sri I n (-c� c� '�IA-2klj A;i4 67 Discussion With Person in Charge: - )A t -0 C I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. Corrective 'Action Required: �3 I o No 1 w-- Yes 1 ,- 0Voluntary Compliance Ll Employee RestrictionExclusion ED Re -inspection Scheduled L3 Emergency Suspension C) Embargo U Emergency Closure 0 Voluntary Disposal LI Other: Violations Related to Foodborne fflness ftnernernions and Risk Factors (items 1-22) (Contj 14 4 Food or Color AdOffives 3-202.12 1 A51 '17 3-30114 -'CoteiAnlu is Toxic Substances 101.1 ", it,Orwinad _04.1? Colaaillers" 7-204, W (.0ouneeiNxno 7_20tJ i St eaL 1-20111 Restriction - Vffricetnd Use* 7-202.12 7_iO3 11 Toxic ConlamxiPro!iilykion,'" Crit 204.1 I Stulil«tl,,. _04.1? Chemicals for Wilshinv Ilrodilce. Oltenia 7-204, W DiNu�,Ao_,qv1"rut r:a' Inc identa; t <x>d t u i xt LakinctmW 7-206.11 w, Pe wiles crinei is 7'06.1i-_ I _'k Zee[ b_elt Sll`i_op,_' 206 J3 1 Taickina Powdeic Fes[ Control and TIMFJTEMPERATURE cotfrROLS 16 Proper Cooking Temperatures for PHFS 34-1,11A(lkl-,t 1 "4e, 155 c1 S S,"c' Zogs-3nsrncdv "vics, I 15'Fl 5,sec, tcc. 4(H.l1(13)(Ji(2) loi), and f3 et Retest- UWT 121 min, 4-40 1. 11 { Ak") R an 1 es, Iniec 1'_d %a Air 15. 5 F I _3_4(Ull 1 (—A)l Fith, Pleat. Pxi<ryciR to 'F5`( 15 sec. Alwle-oru: is !iwcl W Steaks mm�1450P F -11k, _(AlZed in 11 Nficiowave 16Y'F 1-(A)(1)(b) All Other ?HF,; -- 145417 i5 Vec. T7 Reheating for Hot Holding ;403.11 (B) Nficnwave - _2 —Muita, Semitho, 3-403 . I I (C) Corurticrciaily Proce"erl RTF. Kati- -734 F�3 of _B(TI Proper Cooling of —PHrs—- 3-501,14(A) coolmg C'Kikcd PHF's firm) 140,F to 76"F Within 2 1 lours and From 70'1' ro 4 1"F/45 FAVithjnA Boar=,'l 3-50Lt4 B} ('0oling, PHFkitlade Front Ambient Temporanut, IngediVias, to 4VF/45'F Within 4 flotv's* ges) in the i'clenll 19957 FlAXI c'xlslAo5 ("m 5tio oft. 19 I PlIF's Re, nwilaiTemperatures Acre; dial, do Lilv, Cooied to i 'WF145'F WilLin 4 Hours. Coni PRFs Maintained at of lltlow 41 V45- F - _356F1 fFt PHI —s _Mainlaiundat or -above 3-5011,1 O(A) I Rwels Held at or above 130,F, I Time as a Public Health Control '1_b;W jo Tow as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE _POPULATIONS- HSP 21 3-S61 :11 lEA)— 7 A) Uis tall npa�lcinizcd Pce-j'ack1ged juict5 Bevcrtn"" with "Vilmin " Lab"N' %-SO!, I I (B) pa"TV11rizM 1"Qas^ SO' 1. 1( ! Raw )r Paitollh, Cc�oked Aninall Food and ", 'S - 21 1 3.603 11 1 ConsullierAdviisaa Posted for Gmuountitionof 'kahnA 1,KW firia are RawUndercooked ol Not Odwm itt Pres tssed to Flinon rte 3 FegtSilbsnione fat Rew Shelf SPECIAL REQUIREMENTS . —*----------- 59O.0a9fA)1-'D) I TViolstvwls of Section 5W069lA).(U) in I conering_rnrd)ililixid, tenipgan, and r"'saleal'al kitchien operations should be dobdco under the appropirrate qecriona absve if ictived to foodborne flin 'css intervenlionq rand risk factors, Other 1 590.009 violatotnrelating to good retail piactices should he debited under #29 - Special _Vi0_L:X_T1dWS_RELATED TO GOOD RETAIL PRACTICES (Iterns 23-30) crniqt` qRd non -c riih:ai vhiiadiens, which do nre riOlate Joe f(wdhornc dines in,ei'venfionq,ald riA fiwtors 1wed above, ran be fauna:` tie the ohon-ing otrriont, rif the Food (side and 105 CMR 5V0.000 CITY OF SALEM BOARD OF HEALTH Establishment Name: �n Date:--� Page: of Item No .'� Code .Reference C - critical Item R L Red Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION • PLEASE P 'FtINT'CILE�RLY' Date Nerified -'-A AAJ- _.AAza .4 -01 -4- It it 0 /-An 42 K—)I-, �-1A J�_[Q 2 J4A 0_4 0 Ph".. Ph ) IMA(IflO 0/)� P A, (�)kc",k )N A A Q A K) rltl xx A A'A 0 TO—A Ae 1 A P f (A Mt A Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. I Corrective Action Required: ci No b --Yes oluntary Compliance ❑ Employee Restriction Exclusion a Re -inspection Scheduled LI Emergency Suspension Li Embargo u Emergency Closure U Voluntary Disposal Lj Other: Violations Related to Foodborne Illness interventions and Risk Factors (llems, 122) (Cont) PROTECTION FROM CHEMICALS i -.t --T— I Food orColorAdditives 3-,W2,14 1 Pionaction how Un roved Addifives" --f--PO;f�msuq or Toxic Substances 161.11 1 Identifying hifonnation - Original 'kamlion name ame E(72.11 C - T -2F)?' Pr('Sitnco and u5it'l' 7203.11 Toxic Coiaamts,, -- Proirlhi:'("W 7 ,-204.17 SaZllll"Trncroi _—C'falow1ll1e 7-204.12 clWillicid's for washille Vrodlwe� C litinia, 7-205.11 hicidental -206.1 1 Regricted L"sc Pe, 'tiides. Cracktal 7-206.12 Rolima Bell 206.'13 Tracking larwder;, P,,,la Control and Proper Cooking Temperatures for PHFs IIA(l)(21 F, " gtp� - 15 5 F 15 Si,c. F)5sec' Coonninule 1"t, 3-401.f 1(B}(1)(2) Ptak and Beet Priael - lff'F 121 min' 3410111(A)t'} — -- _7 —Ini—ecwd 1-5— i 4(;1 11 (A)l Wid Ca aoe S`ttiflec3 PHFs,� Sniffing Firli, Nlem, Poultri, ill- Kamer- 165'F 3-401 11 iC)!3j Wbole -nais'.0c. Intact B Sicaks 14"- - V 17 aw AnimalVoilck Cawiled w a Nficlowioe 165'F ir ! ' 11 15 403.1 Kb) (".onan(acialiv PanesledRTF Kiod - --403.3 I(YI R, nk sa nog cn'T"d 1; .. zio- 'if71,�T 3-501A4(A) Calling C(x)ked Pffl,s foTro 140'F to 7(1'1 Within " Hours sod from 101' to 4 1"I"145,F Within A fiolli�. 'l �T)OT 14(H) Cirolinig, PWC Made From Ambient I Temperature lit ,rediccts 1(: 4J'F/45`F Withit14l-fsn-i` critical mil) in lhx Wen,! 49i)000 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 3-801 li(A) I I , �Isl R zu or fh,utiaulv C(okcd Artinial Food and Rv Sced Spro'clei Na Served. 22 3-601 11 iCon,lumcr Aeeisoic Pcowd lorCiNmumption of 4knilnli Y"Ar'lhai mc Riew, Undercoilkedei Ib! Proceiwed in Eliminate 111 1 pate.criicd Fgli: Subsolnc r0i Raw Shelf 009(13- k D) VifAafinlc oi Section 590 009(A) -(D) in catering. nobil . frau l. teragna-ary and rcmdcalial 00,en operihimis,qi(alld be didlinod uadcr flie appropriate wouclas above it related to foodhorne illness intelveldionsand risk factor's Other 590.009 Violations ladatirlIg togoixl ritual piactices +hould be debited ander #29 - sp"'clal Requirements. (I erns 23-30) Ciieiral and rion-crilecal vwtalwiei, alwh tic) nee,ehire t') the foodborne obots infei livled above caia be heirld iii the fioit'llon" 4cmonv offill; Food Cerd,,? teed 105 (,',VR Massachusetts Department of Public Health Division of Food and Drugs FOOD.ESTA$LISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 ame e: Print: A� A,�"\ Q Date Tvoe of Operation(s) Tvoe of Inspection Food Service ❑ Retail ❑Routine El Re -inspection 1p r Print. Z J (_ V - l FGA � 1/1Page d Address; a ^ , Rik rr` - Level ❑ Residential Kitchen Previous Inspection Telephone -}&i , -::N _ 7-q j Z %`>`) [I Mobile Date: U [ITemporary ❑ Caterer ❑ Bed & Breakfast 7� Pre-operation ❑ Suspect Illness E] General Complaint OwnerHACCP (-( ( ( YM Person in Charge (PIC) I LE Time e' Q ` AC] In: Out: Permit No. ElHACCP ❑Other Inspector t 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. Foot) PROTECTION MANAGEMENT 4 `';� °' 1 1R'�'"" ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH $" s� e yh,',{ ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 7, FOOD FROM APPROVED SOURCE_.�:�,�a ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans 1* PROTECTION FROM CONTAMINATION 1� 77 8 Separation/ Segregation/ Protection 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) .j ,//25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other 5: 5901rrspacfForm6-14.tloc f/^` ❑/�12. Prevention of Contamination from Hands 213. Handwash Facilities PROTECTION FROM CHEMICALS ,». -A»?.,� �..'a El14. Approved Food or Color Additives ❑ 15. Toxic Chemicals UTIMEREMPERATURE CONTROLS (Potentially Hazardous Foods) -,"`' tea❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling [119. Hot and Cold Holding ❑ 20. Time As a Public Health Control T' REQUIREMENTS FOR HIGHLY SUS6E0TI113U POPULATIONS (NSP)" ' ❑ 21. Food and Food Preparation for HSP "..CONSUMER AOVISORT,,' [122. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspecto `'s Signatu e: Print: A� A,�"\ Q null K V fi' PIC's Signator, : cr / /� r Print. Z J (_ V - l FGA � 1/1Page d of -4 Pages1 Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 590.003(A) I Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11. Person in char e - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* a licamts* Shell Eggs" 590.003(F) Responsibility Of A Foal Employee Or An 3-202.16 Ice Made From Ping Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(73) 590.003(G) Re oiling b Person in Charge* 3 I 590.003(D) Exclusions and Restrictions* 3-201.15 5)0.003(E) Removal of Exclusions and Restrictions 10 6 in * Denotes critical item in the federal 1999 Foal Calc or 105 CM It 590.000. $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetical) -Sealed Container" 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs" 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Ping Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(73) Water Meets Standards in 310 CMR 22J)* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock IdentiTication Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Pfo er Temperatures* 3-202.15 Package tette it * 3-101.11 Food Safe and Unadulterated Tags/Records: Shelistock 3-202.18 Shellstoek Identification * 3-203.12 Shellstock Identification Maintained' Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces ofE ui mente Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.12 Reduced ox gen packaging, criteria* 8-103.12 Conformance with A. roved Procedures* * Denotes critical item in the federal 1999 Foal Calc or 105 CM It 590.000. $ CrpSS-contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Annual Foods Separated from Each Other - Contamination from the Environment 3-302.11(A) Food Protection* 3-302.1.5 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Ten eratures* 4-501.112 Mechanical Warewashin;- HotWater Sanitization Tem eratures* 4-501.114 Chemical Sam fization- temp., pH, concentration and hardness. * 4-601.I I(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food -- Contact Surfaces and Utensils" 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces ofE ui mente 4-703.11 Methods of Sanitization - Her Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11. Clean Condition - Hands and Arts* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.1.2 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventin Contamination When Tastm 32 Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices rr301.11 Handwashi ng Cleanser, Availability 6-301.1.2 Hand D 'Ig Provision CITY OF SALEM BOARD OF HEALTH CC Establishment Name: Q� L'!� �) i? Date: `I 0 I Page: of item Code ` C -Critical Ite�m � �„r ;`f'•^'DESCRIPTION OF VIOLATION/ PLAN OF COR RECTION Date - N_ o. _Re.fe.�, rence" R -x RedIt„eFP Verified' PL -ASE PRINT CLEARLYe M e -o Pen) no i nsPec 6 n ISS (6riqu(_a ju, 7R�_ to 1 1 ow niq 0315" IYuc uvr�i a� -_rorUA CounAee �\O Marna NAC,c YfDP?2 -\CA )- �;CMCQ. 0&! Q V\ SU t -Q. A-eA_iXA ` 'K- OP H I of 6y 196bW l S tY\6l 0_(A 1 [U& Ctkd 3M )qVf S NTLI I Y I nq (1101 re . "O((4 C5_ - Thova� h� UcL.n and SnOL414K Knives and ICMe )Zf(Y d� I L s 0&�J QI -Urtiq -po mt D W wW on V1i a hoL'40- nor f 1 n nrn ' qW IJQ 4 t`f-iriI0f- U (`,�J D,040(t II 0V, Discussion With Person in Charge: J I have read this report, have had the opportunity to ask questions and agree to correct all Corrective Action Regdired: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violatigns 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: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cori 14 15 16 Food or Color Additives +'7' _' Color "' 2 Additives" 101.11 1 Identifying Inflarnalical - Otiglflu 7-206.11_ 1 Resiricied Use Pesticides, Criteria* i -----T w -'06.12 R(Xlcnl Blit Stamens'" 1-20613 Klwde.m Yest Control and 3-401 . I I A(l)(:z) b4 "-'l IF i s 5 x. 40 1 . I I (,T)( 6mlanote i FiehMeats & colo Atijina]s - 155"F i 5 see_ 34F) I. I I (B)(l;(2) 011(4 and fiect Roast - 110"F 121 rid' n 3-4,01.11(A)(2) RatiteN, Injeoccl kk,& - 1`5'1~15 _3-401 _11fA)(i, Poultry, 'Xild Game, Stuffed PHRs', sluffilig C(atiaming, Fish Wail Poultry or 10tites- 165°T` 15 se" T14-6-1 I 77C) 13 _1 wlele-nallx1e, Intaia 13=1�11 11 3401.12 Raw Ananal FuNKk Cilokcd in a Mictowave 145°F All Other PHFs -- 145'T 15 sec. 1 17 Reheating for Hot Holding 3-S53_1 F(A)& FD) PHFN 1654",F 15 se;I. 3-401. I'l (B) Microv avc- 165 F 2 Tsfinine, Standing, 3-403.11(C) Commercially Processed RTE Feud - l-403,1 l(F_1 Rcmaimm,11 UaFlwed Portions of falef Roast.'*' Proper Cooling of PHFs Coldh �,Cwkr,�,i PHFr torm 140T to 3 --- -tit, i RA) 7001, Within 2 Hours and From 701' to 41 7A,�'� F Withol a Hours. 501 14(11F) f o hn PF1Fs M ad From Ambient Tamps rattiveltigredi(,,ittsto41'F/45'F jall)"te, lrbcal item, in me E'Ax' "I 1999 FOM CWe of 105 Cklk 590 000, 3-561.14(0 14(0 PliFs Received at Temperatures 7 102,11 Common Name - Working('oa(a 7-201.11 S Sl2r_Kf__ 7-202.11 %,wicoon - Pre stnce and Um * 7-202.12 ("ondilions of Use, 7-203, t I Toxic Containers - Prolabi!ionsl' 7-204. IT— _SanikcrsCriteria _77he'laicals- 7-2(4. 1 Chelliicms for Wash 7-204.14 D"ina aaaaitTCriterilr 7-206.11_ 1 Resiricied Use Pesticides, Criteria* i -----T w -'06.12 R(Xlcnl Blit Stamens'" 1-20613 Klwde.m Yest Control and 3-401 . I I A(l)(:z) b4 "-'l IF i s 5 x. 40 1 . I I (,T)( 6mlanote i FiehMeats & colo Atijina]s - 155"F i 5 see_ 34F) I. I I (B)(l;(2) 011(4 and fiect Roast - 110"F 121 rid' n 3-4,01.11(A)(2) RatiteN, Injeoccl kk,& - 1`5'1~15 _3-401 _11fA)(i, Poultry, 'Xild Game, Stuffed PHRs', sluffilig C(atiaming, Fish Wail Poultry or 10tites- 165°T` 15 se" T14-6-1 I 77C) 13 _1 wlele-nallx1e, Intaia 13=1�11 11 3401.12 Raw Ananal FuNKk Cilokcd in a Mictowave 145°F All Other PHFs -- 145'T 15 sec. 1 17 Reheating for Hot Holding 3-S53_1 F(A)& FD) PHFN 1654",F 15 se;I. 3-401. I'l (B) Microv avc- 165 F 2 Tsfinine, Standing, 3-403.11(C) Commercially Processed RTE Feud - l-403,1 l(F_1 Rcmaimm,11 UaFlwed Portions of falef Roast.'*' Proper Cooling of PHFs Coldh �,Cwkr,�,i PHFr torm 140T to 3 --- -tit, i RA) 7001, Within 2 Hours and From 701' to 41 7A,�'� F Withol a Hours. 501 14(11F) f o hn PF1Fs M ad From Ambient Tamps rattiveltigredi(,,ittsto41'F/45'F jall)"te, lrbcal item, in me E'Ax' "I 1999 FOM CWe of 105 Cklk 590 000, 3-561.14(0 14(0 PliFs Received at Temperatures According 10 lIawCclolodlw 41',F/4Y F Willem 4 Hours, _;ot_W� ingthods (crFF, PKF Hot and Cofd Welting 5(iT 7t6(8) PHFs Maintained at or bTlolv 590JXWF) 4 1 °ASII 1', T�)T) F, IF" ] i ol _Ph1Fs SIainl 'amed at —orbove a— 3-501.16(A)Roasts _140"R Held at w above 130'F. - 7-firmas a Public Health Control —teatth 3-5(;TTqT'--t Time as a rubtiv f controv REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP 2t x51 I I AI f3apa,aeurized Pca-jj6agcd Ancts and 7 fieverw" with Warlall 3.801,11(B) of Pasteltrizcd 13-8o1 11 (D) Rawor Pailjall,, Goked Avirrail r(xrJ and Raw sc dSw� 'vol 11(C'1 C) Unonered Flax! Packaec Nei Re -served 22 1-603 11 J (IODSUaner Advisory Posted for Consumption 01 "alial,li 'f'4 I(XiI That arc, Raw, Undmooktd le 'Not Othem isk, pnxessed to Elimalaut plmtnred 9324*W 5,00,A) -if)) i Violations ofSection 590AWiA)-(D) in entering. mobil. tool, 'terlafaxtuy and residetWal loitchen opeumior"i should be deboed -under the appropriate wetiojis atluve if related to foodhorric itincss interventions and risk factors Other 590.009 violations relating to cood retail practices should fle debited under #29 - cival Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Iterris 23.30) C,jailwl and non-(rilwal vioamwry, which do mn relate r,l rhe ftssriborne dine'sl later renfiow and mlkjaaors limed above. can be fuund in the follow �ecfiW m of Ike Food Code raid 105 CMR CITY OF 0 Discussion With Person in Charge: L) 0 C�' I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to,, 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 your food permit. 7 Corrective Action Required: I ❑ No 1 ❑ Yes ❑ Voluntary Compliance ❑ Employee hestricuon i Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Voluntary Disposal ❑ Emergency Closure ❑ Other: BOARD OF HEALTH 3 I Establishment Name:_TN �I�N��f jLQ/) Date: �) b Page: of 'nem wCotle ti,. -C -Critical Item - `�' �' "' `DESCRIPTION OF VIOLATION /PLAN OF CORRECTION W g, �. , Date " INo_ -R -Red Item' r ,�,,, :[- �. ,.z ` _ z a x Verffled ;Retece� .r. _ ., PLEASE PRINT CLEARLY ^T' 0 Discussion With Person in Charge: L) 0 C�' I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to,, 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 your food permit. 7 Corrective Action Required: I ❑ No 1 ❑ Yes ❑ Voluntary Compliance ❑ Employee hestricuon i Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Voluntary Disposal ❑ Emergency Closure ❑ Other: Violations Related to Foodborne fitness Interventions and Risk Factors (Ifents, 1-22) (Corti) PROTECTION FROM CHEMICALS 1=4 -jFC'0d or Color Additives 8 3-2h2 tT---rA,"M . c,, 3-302,14 Protect i on 1.5 Poisonous or Toxic Substances - -1 7---4-ru',�- 7 (1, 11 jenyinglivitanialion -Orj�,timal containers., �T5-6114(1;) 7 102,11 1 ComationNamo- W,wkin,,Cianaurers' ,20Ti 17 --Storage --- ReArii,,ortvi - Pf,�st:ace auk] Usc� Dmaes critical item in lhr I odoral 7-202,12 Conditions Of U501 7-103.11 Toxic ("Ontainor" - Probibi'anW, 7 1-204.11 sant i7efs' crltcrid - chenrictits* 7-204.12 Chemicals forL!S'�wlug Produce, Criteria}: 7204,14 acria' 720511 Incidental FocA Coraw, Labj icants" --- 7-206-3 ) To ,nddTa, j 7-200.12 Rodlic B"t RTI-011TI- 9.206.14 1 r tcking 11csa Control and m IIA(l)(2) I Egtp,- 155'F 15 Sort 3-4©L21{.1)(23 Comminuted fish, ?steals & Game Animals- 155FJ 5 sec. 3 fork:anJ Ect kwal - 1-30"1" 121 rainT 1-40 1.11 ('V)( Ratite" lilleocail %I, ais 155 F 15 wc. Cwffimg Containhl;g Fish, Ideal, Foultry orWiles- 165°F 15 sec. Whole -muscle, Intact Beef Steaks t45 h 3-40 Raw Wrnal I'vxxis CrxikQd in a Mictowave 16S'F M Othei PIIFs .- 145'F 15 sec 17 Reheating for Hot Holding 3403.1 If A),'k (D) PHF. 1651-T 15 sec, 3-403.H(S) Acrowavc- 16-T' F 2 'Mitace Standing 3-403. H (C) (E') Commercially Piccessed RTF Kwid - 14WF" -- on� of Beef Retraining 61sITreed I;01U Roast,* 8 Proper Cooling Of PAFf 7, 501.14(A) Catling Ga)k<d PFIF's from 140'F to 7(i FIWithin 2 it<wrs and From'WI'' to 4 1 'F/45'It Withi n 4 Hours, I �T5-6114(1;) Cooling PHFa Made Front Ambient Temperature Ingredients lo,111,145'It Within 4 How Dmaes critical item in lhr I odoral I TO FotJ CtxM cr 105 C MR, 5913 (a)(0, )4((,) PHFs Received at'Vempetatures a I' ' to Lau Cooled ar"n"a a' �=11crr 41 Hmil", 5� -Nl�thtids for PHFs 'I" k"Jin_ "I' thea C,yilia J" ic 3 5w.rm'-B) I Coki P1114g Maintained at est belowigo ()()4(F) ..... r ILI.4 �H'I� Maintained at or above Roosts Held at or above 1-30'F. 20 C Time as a Public Health Control I 3-501 19 Time as 21 1 3-801,11(A) I D} Raw or Pamall,, Cooked Alums) fixid and Raw stn�' nagas N(A served, -TR(I I —1l (f T—U'."� ..... i P".4 la '+"." N!"I R' -",""T I 22 3 -003 11 Consurocr Aiwwiv fli.o'wd tor CowninDtion of i'm)miai F -ods That arc Raw, Undeiaxied or Not Oth ry ise Processed to 1,16vanatt, 13-3ol. 13 1 Pcsieurmd Fat:: Substiclle for Raw SPECIAL REQUIREMENTS i} -(DTT in catering, mobilc focal, temportuy and rcsideat,ai kitchen operations Aitruld be I Jebiled under the appropriate sections abuvc if related R) fbodhorre: 11111css nteivetnfrons and risk factors Otircr 590.009 violations relating to "'ootj retail practices should be debited under 1129 - Special Requirements. (Item; 23-30) Critical atid non, riloatviolahwr�, which do mc, r0are go the foodborne illness imun ventiony and riskjrvoars tilted above, con be /oUnd iii the rbllnstltrrg ssrrom of the Foad Code orad 105 LAIR 59a:ttft. FY OF SALEM 6 BOARD OF HEALTH Date: Page: of Item No. Code,7 Z Reference, C C"t Critical Item R-Rld DESCRIPTION OF VIOLATION PLAN OF CORRECTIO NP' v I PLEASE Date Verified'" ad LLW� Ck LQ-Ct- (Y) WA6 M area.. A'YA-A -4 MW, ( '20CK OHa) Wa NUO 0 UaSf- O/Dw&i V!45c 5Y\J0MS on � A- i0ye P uqx� - tSqwltl 0 ��bto b - . at WoofA UA, _nw 0� 10 (�Wct_7 611�' URI W61 (Ud 1) Q, 0 lb kW - Y1 '�LYAI 6l\ Wo -e -K S-f&f!6YL_ 6(11,L, haue twD 4CO-5- ikl& KEW YU(M ON an -�r- r1fm'o L20f)L0&- Poe tb-y ft2,)c1 0 064 rK AAA Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violatiQns before the next inspection, to observe ,all pond - itions as described, and to comply, with all mandates of the Mass/Federal Food 6o'd'e.,, l,udderstand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: o Voluntary Compliance 0 Employee Restriction Exclusion LI Re -inspection Scheduled 0 Emergency Suspension 13 Embargo 0 Emergency Closure 0 Voluntary Disposal 0 Other: Violations Related to Foodborne Illness Interventions and Risk Factors (/Penis 1-22) (Cont) PROTECTION FROM CHEMICALS iA f ----T FoodorColor Additives 3-302,14 1 protection 7-2(7311 Poisonous or Toxic Substances 101,11 identifying Intonnallon -- Original 7204.12 (71winicak for Washl —4.14- —, Containers' I ,hC oranion Naroe liners* incidental Food Contact, l.mbi imits" On - Ist -1 7-201 IT Rcqfictton - Prcsenco aDd Use* 7-2(7311 TOXIC 2 — I 7 04.1 Sanni7tLs. Criteria-- CF111nictlk- 7204.12 (71winicak for Washl —4.14- —, I ,hC I incidental Food Contact, l.mbi imits" 1-'-'r.06. L-i:� Resirioed Use Pc ri ides. Critnt,)* 7-206.12 1 Rodent ffilil svntons" 7 206,13 1 Tracking Powders. Pesi Control and TIMEITEMPERATURE CONTROLS 16 Proper Cooking Temperatures for PHFs I 11 A(I )(2 ) 15 145'Flfisoc, I -4() I I I —(A) Q,, Cornjunuwtd Fish, Mems & Gaine Afinvals 1551".15 Set'- " s40LII(H)(1;f27 ItNk and fleet Roast - 130'F'121 ndrt* Routes, lit itocd McAts 1.55'F 15 we. * ---- - 3 40f.WA)i3t Poultn. Wild (Javie, $tuffed PffFs, Containing Fish Meat, 3-401ANC)Q) Whole -muscle, Intao fleet Steaks 14,51, 3401.12 Raw Airoinal Fo,qh Cooked in a Nficrowave 1651-, * (i)(b) A. 1 11-1 —If 4 —T F -1 —5sec-1-- 17 Reheating for fict Holding ,3-403.11 4)K(L7) PfIF" 16517 15 Wt' I -3 4-(-)3.I I (B) Nficrowave- 165" h'2 'Minfile Standing Tirm" corninelei 3-403-1I(E) Reintunin',, Unsliced Portions, of Beef Roast,* — —Proper Cooling —ofPHFs -- 3-501.14(A) Cocling Coolo,,d PfiFF from 1401P t—o 70'F Within 2 Hous and From 70'1' to 4 1 'F145'F Within 4 Hours. ' 501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'1`/45`17 -Within 4 Hours* ie,111 III the Gelerni fly),) FoMCode,T 145 (JAR5WWO IIB 3-501.14(Q ltliFs Received atTemperatures I According to 1aw Cooled to' I I i' F/45 -F Within,! Homs. - Cold PHFs Maintained at or beA)w 59{), "" "1""" 41 /45° F* r35 �l`l 716',, I lot PliFs Maintained at or abov, 14WE 'i I lot") Roasts Held at or above 130°F. 20 Time as a Public Health Control 3, -77knaas a Public llealth Control' I 590.004tll) Vnrian REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONSHSP 21 3-801,14A) UnpaqteunzA Pw-paclaged juices and foevortiaes with /Lain' 1-0)ds* —+Ii -86T 1-1 (,— -- — IL- -8w, I I (B� r� -�L-- of Pa --1 =m 3-801 1I(D) Raw or Pai-uallv Cooked Aturrial Food and Raw S(,,,d Sdtsinnts Vot Set ted __ W, I P—vi P,-4 —, v 22 1 3.60' - I I Covuroer Adyisorc Posted for Coniomption of vun)l FX4K That are Raw. Under")kM c� Not &herwisc Prtx�eq;e-d to 'Elinunate lladnwens _3()! TPastem u.d F;io-,.; substialle fo RAw, Shell 590,009(A) -(D, I Violations osSection590.fX)9(A)-(f)) in 1 catering, mobile fo(td, temporary and residetd;al kitchen operations should be debited under sections above if I elafed to fi-,odhorne illness interventions and tisk factors. Otbff 590 009 violationq relaung to mood retail ln'ncnct. should be debited under #29 - spceial Re ulnen cores. (items 23-30) Cruval :ail noon , ripul vh4afi,sts, whichdo no; elate to the foodhorne ille4ess of10VcabvW4nd n,%,tjo4torr lited above_ (on be found in the)&mag sernotis qf the Food Code and 105 CUR 90. 000, CITY OF SALEM BOARD OF HEALTH Violations Related to Foodharne Illness Interventions and Risk Factors (items 1-22) (Cont;) PROTECTION FROM CHEMICALS _. 14 1 1 Food or Coiar Add€fives Pl-fFs Re eivcd at Temperatmcs According to Lata- Cooled In 4 FF/45F Wifbin l Homs. * Cold PHT's Maintained at or below ` 3-31}2.44 protection Procse t o t}1Pr t.•ed A.duttiacs'` 3-501 16(A'I I int PRF * 4 ttntnined at or above 5Ic 15 j Poisonous or Toxic Substances 1401'. 7_I Identi,ympiniorma€van on."inal 3-501.16(A) Roasts Held atarabove 130°1!a.'a� -7.� i Commonrs^` _ �2fl Time as a Public Health Control {�7.1-02.11 j Cornntott'same 4torkin C tnttiners 3.51 1 S9 TsmtasaPublie#fealthGann oi� T20 i-_- - �S'et�adon-Stt�iagc' x -- "" x202.11Rc. �iction Pr scnuevud I *c _� „��1) {Hl Vertantr Ree irensent .� 7-202. 12 _ Condinon.. of Use. 7 33311 Tait runt tingProhtbi ion REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 204.11 S mt�ze- Crite tt CE)arricsls POPULATIONS (HSP) r --u-^ (2! ?-8i)t 11 (i)� Cnp �,teurruxi Pec 1+ac` agcd Intoes astd 2C4.1� Clxun als fat GYasht� k milia f utetia4" 1 , (Severt es with 1Sarmtn. 1 abels. 7-204,14 Dryina, 1z m#e, 7 204_I F mci&notl Foal (Aotact.i.uhricants 1 (: r-- - -'SO i. I i (DI 1 Raw or PnAiail r Cooked Animal Food and 1 7-206. €1 Resutu d # e Pe ,nudes. Cntena* ! ` - _� ft to 4-'d S13rtnlls tio. Seetc.a 7�3 _Roden Bat Sutjjo s Pi ontoand rrckn Pnwdc v 3 -${ll I I iC} Un eneci Taxi Pat x a r iVoe Rc s..rvcrl. " _. E bfonstnrin�� CONSUME_ R ADVISORY 22 j 3-6() 11 Consmn r ldrisrn s PoWd for Cowlarulation of 'ii616ElfEMPEflATURE CONTROLS Ib Proper Conking Temperatures for 11 nim tl i reds 3lu# trc Raw_ C nderawi ed cc PHFs tint f}tharw isv. Pro*.esscd to strt;onate _�..� — --- Pathra ons * ' r" ii 1.1I A(1 )(2) F s 155 c 15 4 < ° — ' 2 P steunr d t ge�: Sahst tui fzar Rain Sbte11 _ YP� - Itm�edt ur. 4 r iec,c ! k5't'S Ssec� � - 3-401.11(A)(2)._ Comminute' FM'vfeat� k Game --"— --- — -- ___ snttn d: t F 1 see SPECIAL REQUIREMENTS 3-401.I1(B}(€)127 Psrks,dCcetRaiet-i 11fllnu0 —. -- -- - - -- 190009(A) -(D) Violations ofSection 540.0O9(A,-(D)in 2-401.11(AV2) j hinres,injtc dWais 155°F15� (cats:rtng, mohilo tixaci. temporary and ( 3-4{11.11W(3) Poultry, Ivtld Game, Strife€ PfrFs +ecoid{ ntial kitchen operations sttottld 6e ( Surifsng Containing Fish, hlem, debited under the approprr rte uections i __cocltry or Rattus -165'F 15 sec.* above it related to Rtodborne illness ��3 01,11tC}(3j h.h.-ma Ic bract Be fSteaks bntelvent3onsand iskfaclora Other 145 F _ 590.009 violaiion5 relatin,o to mead rettrib } 3-111.12 €itu 3tlirrWl 1 axis C.atk.c.d in a � L.S at ttcc"s �.;Ptauld be debited under 1129 - �__ Mictowave 165 F _ a tab RexbuireInctrte. '-4iil.1F(Attljtb} Alt CRherP[dl s 145`F 15 sec. �` � __ _ _ _ 117 1- Reheating for Hot Hoklmq VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103,1 HA)&(ll3 PFIPs Ifi5"P 15 sea '^ __ Micsvveavc- 1(15' F 1 h1inuta Standing _ Time'" _ 3-4`)3.11 W) C nozoereiatl4 Prc>eesse d R'C€: F<xid - 013.7 1{I l � Rernaa,ustg Unslued Portions of beef 13-501.14(A) Cwling Cook "d PHFs fron 140'0' to ''v°F Within 2 odours and From 719°' ' �...__ to 4 i -145 P Within 4 Rourr. ' 3-501. I -Z - olieg PF2Fs Made from Ambient } 1' mperature lnt,redieats lo41°F14S°F ( R Within 4 Parc,- "1)enwes criucat hese, m ise Ctdeza9 19"49 Fuxi Cutin ar 105 C41t 590 000. (Items 23-30) Critical rural nun-criliaal t ielydrons, clench do not relate Io the foodborne iilraess %nrervmttirrr:}' and r6'4 fh fors Itdent above_ con be f nendin the folloninn .sertionv oh the Food Code a+ed 10-5 C;92ll J 9tJ.QtXJ. v CITY OF SALEM BOARD OF HEALTH Establishment Name: ` t I Pil`��i n(2r2 Date: 1 %z24Qe Page: of Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION PLEASE PRINT CLEARLY I Date Verified 4I�P f n nPT , A o l /ice ol) 0 1,3� /�_ JP /ln4P_.' ' )1)) V/ Q S NUAE I ' I r .(Ili I all Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P 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 your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodbarno illness interventions and Risk Factors (hems[ -22) (Cont) PROTECTION FROM CHEMICALS F4 -- -Food or Color Additives ...._...—_.--. �-202.32 dditiva x 'a73t)2.14 ( Protecfion finiLl ap 9 etl '#dditt4es"_ X5 I _�io_is_o_n_ous or Toxic Substances 7-IOI.II k4 ?entri4mrz—In fo)Inal i—on -flit na- 7-102.11 t Common Nartxa - 7-201.11----'5-raration - Star. 7-202.1, ! EdesG"lction 7-202.12 Conditions of Fisc - 1'rolcbi:;om4: 7-"x.12 1 Cheinicals for 7_-206.1 C_-1 Resold"d Use pe ttcides. Criteria" 7-206.12 _'i_R�txiE nt F3+af Slia ion,: �_ 7-206.I3 1'ra�ktttt, potystcr . P�st Control and F,• Proper Cooking TemperaturesPH 01.tC.ktll(1.} ii,6�� 555115Sec� *-40tH(1)f27 Comminuted t ch. Nlea« & (raise At11YF'ACg- F�� F FS sec _ -40L11(RXtj(2# Polk and fico( Rhust- P9t} t�€21 r i-40F.FC(A)t2} Ratite<,TniccuC4Featts €55 P tS ham( T-4GC.Ii{A}(3) Poultry, bi'tCd („tine, Stutfui P1iFs Stirfltng i`oatmaiit frisb iv4at, P<niltry err kenos Ib5`F 15 see. 3-401ANC)(3) lvh lE mn lc Inwo Fie f Stenos 3 —40E rO 1.12 Rix tnimtC F t arts Conked in a 41.etowavc €b5 F'r _ 3-io3.Cl(q ( Contmer6ailyProcessedRT'EFood 3-403,1.1(E) Re naming Unshved Portions of Beef Rciast*. Proper cooling of PHf s :3-56114lAd Cowling. Ca>koct PHI -'s from 140'F to 7000; Within 2 Flours and From -10'1' _ th 41"F145 F W'hIvn 4 Hone. ?-St)LI4 t3)� Cernlin PI{Fs viedeFront Ambient 1 mperatnre htgred;ents in 41"FI45`F * Denotes untwal stem fii the le c .1 1984 Fend C,dt ar I a5 t: R1i2 590 t3a0. 3-501LIdfC. PFIFsReccivedat'rumparatuies <lscordin io Lew Copied to k 1lvl&q r. IV ffi i., A w -vac * 3-501.15 CoolanMMetho& far PHFs PHF Not and Coid Holding 3-501.16(B) fold PHFs Niaira,lined at or bans 590JW(F) 11°145` F" _ 3 SOl.l6iA'J Ilnt PFiB IMaintained at oa• above 140'F * 3-501.16(A) � Roasts Held at or above 1300F, *` Time as a Public Health Control 3-501.'19 Tirrre as a Public Health Control' t- 21 1 3-801 11(A) I Unpasteurirsd Pre-packaged Juices 3-80' i C(B) (1�« oC Pa�xenti7ad F�� 3-805110)) 1Raw orl,utiativCooked Animal FoiAdrift R iw Seen 5ltrtantg hot Ses•vcd -801. I Cf(a Ln+anened Front padaac. ;trot Rt served. 22 3-60111 Corl,ann:r rlsivisorc frosted fix Cowuniption of Animtl loods That arc Raw, Under000ked or 1 Not CJsrNisu Pa,esved to Eliminate I Puth(-tnh < rm nuA zoo j 3302.1. Paste trirul Lggs Substitute t;aa Raiv Shall SPECIAL REQUIREMENTS 590.0074(A} -{(S) Oletatis5ns ofSection :5''10.(k)9lA)-(D) in catering. mobitc. Rl od, temporary and residculilal kitchen operations should he debited under the appropriates coons atwte if D_ rated to fxxlitail I[Iness inletcenttoru and tisk factors. Other 590.009 violations relating to goexi retail gra( aces .should be debited under 1129 -- Special Regniremt:ftts. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23.30) CrWoal and narocrnwal wofatioto, which do mn relare io rine foodhorne illness 6iaer ventionx and risk joctars killed above_ eon be found in the jeiflotning sections of the F`t>nd Cade and 105 CNIR S> xx mdacit Z.0 a � 401 I1. (A)(1)(61 A ! Offier PF7Fs - 145`P 15 sec. 's 17 ~_ Reheating for Hot Holding 3403.1 HA)S:(17) rill z 155'1 t 5 see. 3403,F1(33j Ficaowav 165 F2 Morino Standing; 3-io3.Cl(q ( Contmer6ailyProcessedRT'EFood 3-403,1.1(E) Re naming Unshved Portions of Beef Rciast*. Proper cooling of PHf s :3-56114lAd Cowling. Ca>koct PHI -'s from 140'F to 7000; Within 2 Flours and From -10'1' _ th 41"F145 F W'hIvn 4 Hone. ?-St)LI4 t3)� Cernlin PI{Fs viedeFront Ambient 1 mperatnre htgred;ents in 41"FI45`F * Denotes untwal stem fii the le c .1 1984 Fend C,dt ar I a5 t: R1i2 590 t3a0. 3-501LIdfC. PFIFsReccivedat'rumparatuies <lscordin io Lew Copied to k 1lvl&q r. IV ffi i., A w -vac * 3-501.15 CoolanMMetho& far PHFs PHF Not and Coid Holding 3-501.16(B) fold PHFs Niaira,lined at or bans 590JW(F) 11°145` F" _ 3 SOl.l6iA'J Ilnt PFiB IMaintained at oa• above 140'F * 3-501.16(A) � Roasts Held at or above 1300F, *` Time as a Public Health Control 3-501.'19 Tirrre as a Public Health Control' t- 21 1 3-801 11(A) I Unpasteurirsd Pre-packaged Juices 3-80' i C(B) (1�« oC Pa�xenti7ad F�� 3-805110)) 1Raw orl,utiativCooked Animal FoiAdrift R iw Seen 5ltrtantg hot Ses•vcd -801. I Cf(a Ln+anened Front padaac. ;trot Rt served. 22 3-60111 Corl,ann:r rlsivisorc frosted fix Cowuniption of Animtl loods That arc Raw, Under000ked or 1 Not CJsrNisu Pa,esved to Eliminate I Puth(-tnh < rm nuA zoo j 3302.1. Paste trirul Lggs Substitute t;aa Raiv Shall SPECIAL REQUIREMENTS 590.0074(A} -{(S) Oletatis5ns ofSection :5''10.(k)9lA)-(D) in catering. mobitc. Rl od, temporary and residculilal kitchen operations should he debited under the appropriates coons atwte if D_ rated to fxxlitail I[Iness inletcenttoru and tisk factors. Other 590.009 violations relating to goexi retail gra( aces .should be debited under 1129 -- Special Regniremt:ftts. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23.30) CrWoal and narocrnwal wofatioto, which do mn relare io rine foodhorne illness 6iaer ventionx and risk joctars killed above_ eon be found in the jeiflotning sections of the F`t>nd Cade and 105 CNIR S> xx mdacit Z.0 � 401 I1. (A)(1)(61 A ! Offier PF7Fs - 145`P 15 sec. 's 17 ~_ Reheating for Hot Holding 3403.1 HA)S:(17) rill z 155'1 t 5 see. 3403,F1(33j Ficaowav 165 F2 Morino Standing; 3-io3.Cl(q ( Contmer6ailyProcessedRT'EFood 3-403,1.1(E) Re naming Unshved Portions of Beef Rciast*. Proper cooling of PHf s :3-56114lAd Cowling. Ca>koct PHI -'s from 140'F to 7000; Within 2 Flours and From -10'1' _ th 41"F145 F W'hIvn 4 Hone. ?-St)LI4 t3)� Cernlin PI{Fs viedeFront Ambient 1 mperatnre htgred;ents in 41"FI45`F * Denotes untwal stem fii the le c .1 1984 Fend C,dt ar I a5 t: R1i2 590 t3a0. 3-501LIdfC. PFIFsReccivedat'rumparatuies <lscordin io Lew Copied to k 1lvl&q r. IV ffi i., A w -vac * 3-501.15 CoolanMMetho& far PHFs PHF Not and Coid Holding 3-501.16(B) fold PHFs Niaira,lined at or bans 590JW(F) 11°145` F" _ 3 SOl.l6iA'J Ilnt PFiB IMaintained at oa• above 140'F * 3-501.16(A) � Roasts Held at or above 1300F, *` Time as a Public Health Control 3-501.'19 Tirrre as a Public Health Control' t- 21 1 3-801 11(A) I Unpasteurirsd Pre-packaged Juices 3-80' i C(B) (1�« oC Pa�xenti7ad F�� 3-805110)) 1Raw orl,utiativCooked Animal FoiAdrift R iw Seen 5ltrtantg hot Ses•vcd -801. I Cf(a Ln+anened Front padaac. ;trot Rt served. 22 3-60111 Corl,ann:r rlsivisorc frosted fix Cowuniption of Animtl loods That arc Raw, Under000ked or 1 Not CJsrNisu Pa,esved to Eliminate I Puth(-tnh < rm nuA zoo j 3302.1. Paste trirul Lggs Substitute t;aa Raiv Shall SPECIAL REQUIREMENTS 590.0074(A} -{(S) Oletatis5ns ofSection :5''10.(k)9lA)-(D) in catering. mobitc. Rl od, temporary and residculilal kitchen operations should he debited under the appropriates coons atwte if D_ rated to fxxlitail I[Iness inletcenttoru and tisk factors. Other 590.009 violations relating to goexi retail gra( aces .should be debited under 1129 -- Special Regniremt:ftts. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23.30) CrWoal and narocrnwal wofatioto, which do mn relare io rine foodhorne illness 6iaer ventionx and risk joctars killed above_ eon be found in the jeiflotning sections of the F`t>nd Cade and 105 CNIR S> xx mdacit Z.0 Establishment Name: SYi� - m 71 Gy L CITY OF SALEM BOARD OF HEALTH Date: Page: I of Item No. Code Refer ce C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - PLEASE PRINT CLEARLY Date Verified 21 TI}32u 6-N1Yy Cc C-02 cart-6,�IL_ >?l \=\ooh 1iL S cl THc, ir< L1+36J. ?WW �Yti '�c�K-C�lY �c7 FWel �L�:s �aaCt SC.Rv�� T-oit- Z� Ti\.tt �, Y�(\.v "J r�J-c'd�. Cjiv� tr��SS �G�b � �GSg-T\�.:. S iv.i T\y.�c, •JAN 1aJV `LcA� %% '-C�-�':. Y�-eAR.� b \w T�-17, r(�c1� r�i`%�'l. 1S �a�'��1 tt�,P c>�-. �•c2VrQri. \x•10 T -�-�-� � i t t� r� `j ��s\ami � . >a Lti � v.o �p,c.o �+ � n-v� �, 4 � Loi• ti• �,vr �,'� ,�'� � o`t Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. / � C. (j [� '(W v - Corrective Action Required: ❑ No FE, Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Con, L) 14 Food or Q( ^-202,12 3-302.10. Pfot&ti2onjfrond, '11ti°ed Additives* Poisonous or Toxic Substances Original containers* ,Ah, I I '1 205.11 locinkxntal RYA ContamLal-nican's 7-206.1citte,77 L .7, 06.12 Rodcru frait Staiuons" 7-206 13 1 nicking Powder lrtsL Control and TIME/TEMPERATURE CONTROLS 16 1 1 Proper Cooking Temperatures for ;.-401.11 ACIt(2) ["'ggs- ;'55'F 1.5 Sec. lil. 1I(A)(2, cornminwed Fish, Meats & Clint I Miuntls 155"F i5 set.. f 3 KI 1(13)(1)(2) 2 nuo _LfluhnLb�ofRoast 13OT-1 177 4 RAutc,, hticcftaf M.–ft, 155 F 15 sec. 4i"I 11 t AY 'orut, r M ��erne, Stu I f P�TF' sluffine Coir:oning Fish, Most, Ratoes-iWF 15 scc, —3401 INQ37 'Irde-0111 Inum Beef Steaks -145 �F 3 401 12 Raw Anona! Foods Cfx)kvd m a Miclftwave 10,14 �3c—lll 1 (A)0 )(b) Ali (infer PH - 145"F 15 sec, 1.? Reheating for Hot HoldIng 3 i 0 �(A) & (11 PHI-, 165t�F 15 wG, (B) I Micorwaf,,- 165- F 2 kllnwe Standing 3-403.12(C) 1 CoruynemailN Precasted RTE FfNxl I I(E) I Rerrajrang Unshked Portions of Boni 1€3 i 7.202.11 Reqrictnat - Prest-i 3-561.14(.6) 1)1.WA) Ccxlhu- Cooked PoTs fi-la, I It, 7-202-12 Condiuqns of Use" 7-203.11 – --S 7-204.I1 7,ni�r/nr', Z'—vteeia 7-N4A2 Chenuralr for %i, '1 205.11 locinkxntal RYA ContamLal-nican's 7-206.1citte,77 L .7, 06.12 Rodcru frait Staiuons" 7-206 13 1 nicking Powder lrtsL Control and TIME/TEMPERATURE CONTROLS 16 1 1 Proper Cooking Temperatures for ;.-401.11 ACIt(2) ["'ggs- ;'55'F 1.5 Sec. lil. 1I(A)(2, cornminwed Fish, Meats & Clint I Miuntls 155"F i5 set.. f 3 KI 1(13)(1)(2) 2 nuo _LfluhnLb�ofRoast 13OT-1 177 4 RAutc,, hticcftaf M.–ft, 155 F 15 sec. 4i"I 11 t AY 'orut, r M ��erne, Stu I f P�TF' sluffine Coir:oning Fish, Most, Ratoes-iWF 15 scc, —3401 INQ37 'Irde-0111 Inum Beef Steaks -145 �F 3 401 12 Raw Anona! Foods Cfx)kvd m a Miclftwave 10,14 �3c—lll 1 (A)0 )(b) Ali (infer PH - 145"F 15 sec, 1.? Reheating for Hot HoldIng 3 i 0 �(A) & (11 PHI-, 165t�F 15 wG, (B) I Micorwaf,,- 165- F 2 kllnwe Standing 3-403.12(C) 1 CoruynemailN Precasted RTE FfNxl I I(E) I Rerrajrang Unshked Portions of Boni 1€3 i Prager Cootr�q of PHFS According lo Law Cooled to 3-561.14(.6) 1)1.WA) Ccxlhu- Cooked PoTs fi-la, I It, 3-5i}1.15 coolin"'Melbo& for PF(Fr 70"F Nk"ithin 2 Hours and From 701' PHF Not and Cold Holding "P"ffsMaint 5-01 . 1-4(R—)— ithin 4 H�•, � to4 J'FAY F Wow Cooling PHF!, Mack Froul AmNele 540,00tvF) 41`,45° F' TntniporatuTe Ingrnflients lo 41'F145'F Hot PI -11's Maintained at or above lWithin 4 flout Den"tes 'nucal itellf in W 1, dcral 1999 Fomlf:"re "r 105 ("1' 3-501.14(C) PHIFs Received aft Temperatures According lo Law Cooled to 41Ti4S'1 W itldn ,l Hotels. 3-5i}1.15 coolin"'Melbo& for PF(Fr 19 aF PHF Not and Cold Holding "P"ffsMaint ;..50 7f[–O(B�)— 7,7ZI at or bdo' 540,00tvF) 41`,45° F' I 16(A) Hot PI -11's Maintained at or above 1407 * 3-51;1.'16(0.) Roads field al or above 130'F. 20 rTilme as a Public Health Control 3-5 Tinan as a Public licalth Control` Time I �SIFF9942fi 21 3-801 $I(A) 3-801.11(B) 3-801A I(D) KavSwed 43I iAtt4 V'c.f Served 901, 1 I(Ci tintanc nail f'oort, Packaev hot Re-served. Coustorjor Advirtsy Posted Fur Comurnittion of Anima nikoA f xxls Dint are Raw, Uyalercxx>ked of Not Oflierwi%e Pro eased or Nivanate Padho-"ens* flost�urir d Fgiz.: Suhsottnr for Raw Shell SPECIAL REQUIREMENTS T.- FDTJVIoTlat171—ns' �90—_(W(A--)(—D)i n eawring. mobile R-Kal, temporary arta rct,f&,mial kitchen operation ,should be Jetaled under the appropriate sections above if elated to RxAbornc illness 590.00t) violations relating togood retail practices should tie debited under d29._ -Special Reqoircrrtent� (items 23-30) C)if;('fof and non, riih:al violarwry, which do noi rdure to file foodborne diffess rr.Nkjacrorf lwedfzbove, con lfc, found in drefio'lowing sections of 11n, Food Code toad 10-5 (1411 5 590.0W s' 19111 ,,,IV '.V' CITY OF SALEM BOARD OF HEALTH Establishment Name: S A S t,�_ 7)1 P C% r1 Date: Page: / of / Iltem Code ; ,� ,Cy -Critical Item �,. �?r ;;DESCRIPTION OF VIOLATION /PLAN OF CORRECTION ° a- z r� Date No.'s ' Reference = R - Red Item p1.EpseyR�NT CLEARLY ^ Verified v, <7N \__.. 51 — U: S Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. ___? Corrective Action Required ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ No I ❑ Yes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: Violations Related to Foodborne fitness Interventions and Risik Factors (items 1-2{) (Cont) PROTECTION FROM CHEMICALS 14-�;Fsad or Color Additives 3-302,14 Protection from tillw"l '"ditives'. 140'Fl Poisonous of Toxic Substances I 0twinal Roast", clsaainersk 7 102,11 1 C oismon Name - Workim, Conianuirs' 7 9-202.I,._,_._ -2012). Reif, ict *n - Prl,,eaco and L, sc's 7-103, t I I Toxic Containcts, - P 7-204.1117S,,116 1 � 7ers. Criteria Cfilwlia" 7-204.14crc aria, --2-Di-oe J�L-t9viv, ------ - --- F-7265 1 —I hicid--naal F�xxl Conitict, ljibrilanits,� [7 -L(�6 11 1 7-206.12 1 Rmlere 13aa Statwivs* 2(06 1 Fr,wkme Powders. Pest C'sintrol and 11 o n it of i n TIMErrEMPERATURE CONTROLS 16 Proper Cooking Tompei stores for PHFs I "w )(2; Eggs- 155 F 15 Sc Ecifs- Imintaiatc, Servicc 145"Fl5sec, "'m .. ilvileal F, h, Meets & Game Animals - 155'F 15 sec. 401.I I (B)( I "', (2 I'M k afal bQef Rossi 130"F 121 null' 14,01.11(, Q) Ratiteslaie�iud Meats� 155 F 15 Sec. 3 40 1-11 (AV5 i lloohr%, Wild Gave, Sluffed 111417", %iffingCorn amnig, Fish � hi at, Poffltry or Ratites -1615°F 1,5 sac. 7- 1 —0, 11 (C), 3) whitle-naisde, 'Intact 13ccf 51eaks 145"T 3-401J2 Ra% Animal FANxis Cooked in a miclowave 165,F -74011(A)Wb) Ali Other f3liPs -- 145t'l-' 15 sec, Reheating for Not Holding 3-40T1l(A)&A)) PHF, wc. ;-4033 I(B) Acicrwavc- 165° F 2 Minute Standing rinit, I3-403. 11 tC) Commercially Pavessed R1 F Kxxt - 140'Fl 3-403A I (Fi Ujilice'd Portions Iff Bcaf Roast", Proper Cooling at —PhFs —501.14(A) 7 ( Cook �,Aiag Ck�,d PFIF's from 14)'Fto- 701- Within 2 Hours and From 70'F to 4 PF/45 F 'Within 4 Hono. � 5-50, 1 (B) Cotdilig PRFs Made Filan Anibiem[, Temperawrli Ingredictits to 4"'/45cF Within 4 11kitils I 3-501,16(ft) Cold PHFS, Marra4med at or below 5-90.-(i14ff) -4 1 "AY F* 3-50 I L16fA'� Sint PHF� %taintained at of above 1400Y. * T =,(74 1 t; I —Af ; —AA11, PRFs Received lit'refuNraht Recording to Lau Cooled ti) 4 1, °:P/45'F Within 4 Hunts, . * 11% 20 1 1 Time as a REQUIREMENTS FOR HIGHLY SUSCEPTIBLE Pw-jiackiged luiocs and Bewraael. with Wlehis labz1s* I [(D) R w Or Paitilifl,' Ox*ed Animal Riod and %'A st, —wd r"".q %, 22 3-03 11 Consumer Adisory Posted for Collsoulption of Pusinwl F -ods 1 -hat are Raw. Undercxloked c) N,,q (itiierk kc flrkxes'seal to Liu timate. Pliqekirved Fgge stlhs,wwe let Raw Shell 590 Viol uti, lns of Section 590.009W) -(D) in eviering. rnobiL, flxxi, temporary and ic%fth rh,al kitchen operations 4iould be dobited andev the appropriate soclions shove if relwed to fbodborne ithicsg will risk factors Other 590,009 violations relatino to 'good retail practitos should he debited under #29 - Spceial kcquh-erliolitinter teotions a, (ftews 23-30) naital rued Ter riiwal vwfaiwris, whichdo aa� ekafefo 1hr foodbome ithicss iiJja4,fors tatted above. Can be tcanu in ihtvl i: 1 g, serhoto of cte, rood Code and 105 C.UR '90,0(k). I Is, � ; , I,,z If, S Establishment Name: 11 CITY OF SALEM BOARD OF HEALTH Date: )ij -V9i 0k Page: I of Item No. Code " ' Refer ence C — Critical Item "' R — Red Item Al�,,j, , "' � Z, , , - , - DESCRIPTION OF.,VIOLATION / PLAN OF CORRECTION', e PLEASE PRINT CLEARLY Date Verified 7 0 I ,--S7 0,2'LA 7121 T,, '2 "P 111S LL Po k-- 9 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your . ur food permit. (24- (//-/ (_7� I/ i Corrective Action Required: El. No a Yes El Voluntary Compliance Ll Employee Restriction Exclusion L:l Re -inspection Scheduled 0 Emergency Suspension 0 Embargo 0 Emergency Closure u Voluntary Disposal Ll Other: Violanens; Rojagid to Foodborne Illness interventions and Risk Factors (Itedis 1-22) (Cont) PROTECTION FROMCHEMICALS iT ____LFod or Coto, Additives .1-2()2,12 1 Addiaivc,* _Poucuon 3-30114--7 Irma 1-501,16(B) Poisonous or Toxic Substances 151.11 1,!" x 3 501,16(A) I lot PIIFq INfairicanedat or aboI,c C onanon Name WSrki?, 3 _51 ( Rtacsts Hdd at i];Tiz, I �_,n` Rcstriction - Prescnrai and Use* 7-20112 1 Conditions of Uso. 7-203 11 4A 1 sanittzem, "'titerhI . cheinicak 7-20.12 Ch�iuicak for Wush!Eli�s 7-N)4A Dminv ents.Criterhl" 1I-106-11 1 Rasuicied UW peqienies, Criterrall . — —4-�-- ' 7-206.12 Roilew B,iit stcbonss w. 7-20613 , Tracknig Pow,leri. Fest Control and 16 1 1 Proper Cooking Temperatures for 340L L I Aft i('} I 1ggs- 155'T 15 See Cutwinwed Fish, I'Awts & Gana: Aloroak 15-1T 15 sec.:' i 40 1.1 f 7(BT)i 7-(2) flo;k ard B�,eef RoaW I 3(S"F 121 aria 3-401. 11 1A)Q) tratine,' bike cd Mc<its -- 155°F 15 :,-401 1 11 (,kin) I Poultry. Wild Gawo, 5tuffcd PHFs, stuffole Fish, meat, Pooftry orRafinis-J65°T 15 sec. 740-1 1-1 i—Q-11-177=01ole _01a"ll 1451� * In a shcfowave 165'F TW(T] .I I (A)( t)(b) All Other PHEs -- 145'F 15 sec. -Reheating for Hot Holding T,63.1 I (A)&f5) NiF, 165"T Ii sec. 3-403.11(B) Miciowavc- 165° F 2 Minnie Standing T !S' - T- 7 1 _(c) trc' c I, I a I lp.,.,, 63 "In C R I al I V Pil )Q c S A It k 111W7 QL f, 3-403.111 E) Reniamm, Unshced Portions of Fled Proper Cooling i3liFi 7,� oolik -s fion, 1, a ,,it IZA) �C�Ivqp CookePRF it F 70'F Within 2 flours and From 7WF io 4 1 `�F'1'45rr. Within 4 Houls, Wdllu� 1 11 C,00ling x RHF� Made From 1 '11" , 1, 3-501.'7 L, 4F, Nil In Affbient Made 11,11, noti, T rat rre Ingredients liiait� n; 4 !`F/43'F Tenitierawre lngew'w, I llenotcs critexl item is th,, folcral 1999 Foot) Gglc (,,I 05 (INIR i90 000 1 1-501 14((') PHFe Received It Tempratures According to Lw Cooled to i ff145-F Within 4 Hours, iw, _Cc"1 Methods for IIH—Fs PHF Hot and Gold Holding 1-501,16(B) Cold Pfffis Maintained at or below 590.004f 1"145`F- 41`145"F ___ x 3 501,16(A) I lot PIIFq INfairicanedat or aboI,c 3 _51 ( Rtacsts Hdd at i];Tiz, I �_,n` I Time as a Public Health Control 3_50 1 1 19 1 171 rwas a Pubfic Health Control I variance Reouirervent REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 3-801,11(A) I Not Sensed. , 38W,H(C) I CONSUMER ADVISORY l- 3.i)o76F pontej f"Ir consunipwal of Auuo,o F this That are Raw. Urdlerc(iokcd or Not Ofluaise Prowessed ro h1hronatt 2Lf 3-302.13 1 N%qteunyed Fig,: Sobs trait for Rase Shell SPECIAL REQUIREMENTS Violawins of Section 540.W9tA)-(D) in f cafe ug_ maid food. temporai " v and rcmdonfial kitchen opefationa, should be dicinted under the appropriate sections alyoye if related to ftxAborrie ithiesfi interventions and risk faclom Other 590,009 violations relating to pod retail pracfices should he debited under #29 - Spacial Requiremards, 'W0_CA_-r_1dN_S REL—AT—ED—TO _GOOV RETAIL —PRACT—fCE3 (Items 23-3(I) Ciiw,al arid non-,, rat, (21 vwfmbarI, winch do not refute to the foodburne illness ilw'l ecauions and rokfinios hstqk ahiu,e, (an be found in thi: Vi j�,41�)mng o�rsi pii ofr& Food Code and 105 CXIR Commonwealth `of Massachusetts ` F City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Foo"etail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: File Number: BHF -2005-000011 Salem Diner 70 1/2 Loring Avenue Salem MA 01970 L11CA1 ED Ar: 70 1/2 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0314 Dec 30, 2008 . 'Dec 31, 2009 $280.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $280.00 This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHT;SETTS • _ � e BOARD OF HEALTH N -.11 120 WASHINGTON STREET, 4�" FLOOR TEL. (978) 741-1800 I{IMBERLEY DRISCOLL FAA (978) 745-0343 s MAYOR IDIONNE(Cr)sALEW COM +O 109 JANET DIONNE, y uFy ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT -T-`t e Sq1eVK D i k ey ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) EMAIL - Business': Website: TEL# q1r-1'4W)g/8' FAX # OWNER'S NAME Z-0 TEL # (W) ) L/ ADDRESS -5(p Mer r STREET CITY STATE ZIP n -�?—c^ f/ CERTIFIED FOOD MANAGER'S NAME(S) Zt7 e F—Lc-fvi e4 kJ N CERTIFICATE#(S) J AOO 3 41Cb L d (Required in an establishment where potentially hazardous food is prepared) __'____"_"_____"_______.. _ — C/ o %tl _ 1 -e .._--__ I i � t/D. LJ n�Ie�- EMERGENC RESYVNSEPERSON_ l/(/G ILL;; [61 / /J r—/)/] zDAY,S OF OPERATION z Monday Tuesda ;; : Wednesda , j,.,, -.,Thursday: lFnda Saturda ,. Sunday. HOURS OF OPERATION Please write in time of day. jbaM-3P14 bas 3ps-' 6vkK 3,a w. (oav-t-3p-k^ 7a N.-ap"k (For example 11 am -11 Pin) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 --------- RESTAURANTYES NO less than 25 seats (Outdoor Static, Food Cart $21v 25-99 seats =$280 more than 99 seats BED/BREAKFAST/ YES (NO MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) $100 YES NO $25 YES NO $135 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. f: u�F i+faJol%off 33 —IIS 9N%/ Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check# & Date a Commonwealth of Massachusetts a 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: File Number: BHF -2005-000011 Salem Diner 70 1/2 Loring Avenue Salem MA 01970 LOCATED AT: 70 1/2 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0082 Jan 4, 2010 Dec 31, 2010 $280.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $280.00 31.2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR DAVID GREENBAUM CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 "N FAx (978) 745-0343 DGRUNBAUM&ALEM. COM Pry p4r ACTING HEALTH AGENT f V� ' + 0009 0,t. �� 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT' 1- NAME OF ESTABLISHMENT l k '�L �W ems- TEL # ADDRESS OF ESTABLISHMENT_gb L O Y I VL,3- !lo FAX # MAILING ADDRESS (if different) EMAIL- Business': Website: OWNER'S NAME 4- Z= LDtLC-'Fkyl-gger; ADDRESS 'J l/0 /t�C'_irrf I) 4-vc if STREET CITY # (a/7 y8 -L/ 7S/S� STATE )b c r' ZIP CERTIFIED FOOD MANAGER'S NAME(S) Za e i—/ c -F4 -Q r1 c4J/T CERTIFICATE#(S) J3JOo a �Ag' (Required in an establishment where potentially hazardous food is prepared) 1 EMERGENCY RESPONSE PERSON �U e E(47& -e Yl q d/ T HOME TEL # ®gY$?OFsOPERATIQNa 4 � Monday ; Tuesday �J WeGnesday�;,. „.Thursday ", Fnd"ay, a, Satu day :; Sunda_"yi w2 HOURS OF OPERATION 1 Please write in time of day. %4 wt (oa wt (vg yt1-3 �(pa.v»..�3 11..; (OgAt �3 V:.� y r (�tWr�3 hci et pa -2,�k� For example 1lam-11j - TYPE OF ESTABLISHMENT RETAIL STORE YES NO A% (Outdoor Stationary Food Cart FEE (checkonly) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 less than 25 seats --$IQ 25-99 seats egg more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES O $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT (such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. faIoIloct �3 -2�,—Jl$^gLi`il Date Social Security or Federal —-----------------------�- ----------------------- Revised 424/07 FOODAP2008.adm Check# & Datei1,gidhhh�^ $ �d Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Print: .--- Date o O � T of Operations) Type of Inspection mood Service Lj Retail ❑ Residential Kitchen E] Mobile El Temporary ❑ Caterer [IBed &Breakfast Permit No. ❑ Routine ❑>Re -inspection Previous Insp ction Date: / J d VDI [I Pre- Aeration ❑ Suspect Illness El General Complaint ❑ HACCP ❑ Other Address, \ Ris Level Telephone �[� T Owner - HACCP YM Person in Charge (PIC) Time In: Joy Out: Inspector 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. ":FOUDPROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties ` EMPLOYEE HEALTH 1' 7 s °� F it r # �r r V y ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3.. Personnel with Infections Restricted/Excluded F, FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION'"'" ❑ 8 Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28- Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities `:PROTECTION FROM CHEMICALS �F,"'� c" I� r"=" , ',"'"""g r t cq , t L 4 t,4, ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMFJTEMPERATURE CONTROLS (Potentla8y HaYardous Fatids) - "II v ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling Cjr19. Hot and Cold Holding I ❑ 20. Time As a Public Health Control [:121. Food and Food Preparation for HSP ( ) '"REOu1REMENTS FOR HIGHLY SU$OEPTIBLE POPULATIONS HSP CONSUMEFIADVISORY„-, ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Z-ur- 41f Inspector's Signature: ` \ Print: .--- PIC's Signature: �" rl Print: Paged of --,Pages I✓ Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowled e* 2-103.11. Person in charge - autres EMPLOYEE HEALTH 2 390.003(C) Responsibility of the person in charge to Compliance with Food I aw* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* a ilicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant'ro Report To The Person In Drinking Water from an Approved System' 590.006(A) Charge* 590.006(B) 590.(H)3(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(F) Removal of Exclusions and Restrictions 4 N C C ... -• . . • ]3enotes critical item in the federal 1999 Foal Code or 105 CMR 590.006. r� PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food I aw* 3-201.12 Food in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System' 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* WashinE Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-20218 Shollstock Identification Present* 590.004(C) Wild Mushrooms* 3-20117 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PIFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records; Fish Products 3-40211. Parasite Destruction* 3-402.12 Records, Creation and Retention* 590,004(1) Labeling of Ingredients' Frequency of Sanifization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures IHACCP Plans 3-50211 S ecialimdProcessin Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with A. roved Procedures* ]3enotes critical item in the federal 1999 Foal Code or 105 CMR 590.006. r� PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 WashinE Fruits and Vegetables 33(4.11 Food Contact with Equipment and URensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.111. Mannal Warewashing - Hot Water Sanifization 'ren eratures* 4-501.112 Mechanical Warewasbina Hot Water Sanitization Tem eratures* 4-501.114 Chemical. Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanifization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods ofSanifization-Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anns"` 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* ?401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 1 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessibie 5-203.11 Numbers and Capacities* 5-204.1.1 1 -ovation and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.1.2 Hand Drying Provision Establishment Name: —1 r CITY OF SALEM BOARD OF HEALTH Page: -) of 3 Date: 1J, Item Code C Critical Ilam"' 0"" -DESCRIPTION OF VIOLATION/ PLAN OF,CORRECTION ,,,,,, Date Verdied "„ 0. ReferenceR- 'd Item:" Re v" 2, 9 PLEASE RIN;c`LiiAFIiL'�' '2 'SE A' P F, '-�' 1, 0 t^ 'Y, 12 A-19� +V-1 40 f "I c n. �1,,_gz, n. - !/'� (rl , S ,- I n_� I )n )✓4 r �n �t(?111r / n�n �owiWo _0_0i4e I _<��c I 1A I -i �A 119A Ag r'-) 4R� A-DO rl -JA)j- IAI kl,-AQ�JA (�nJA I)A 6,LA 67_/"� IG !_YVI _1,;-&An0z;r1"# 4- A ir 4 A L�(14111_1 JAI r_rJ Ii 7L Wrkll AP lf'4'41-A r V - ' 4 1 J7 5 )e-, JI)( ()j A), 4A r L W I J' 5 wennAL A Discussion With Person in Charge: Corrective Action Yes I have read this report, have had the opportunity to ask questions and agree to correct all C] Voluntary Compliance 0 Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to Re -inspection Scheduled 0 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 Li Embargo 0 Emergency Closure your food permit. N U Voluntary Disposal Li Other: 132 Violations Roudind to Foodborne illness interventions and Risk Fartars (ltet»s 1-22) (Cont) I-) 4(r,) PHF9 Reonved at Temperatures Acc�adiag to I.aw Caned to 41"F145`F Within 4 How s- :-,�'ill }.. �^ PHF Hot and Fold Haiditeg Ad q r� Food ar Ca]ar ditives 501 16fgi Cold PHFs Maintained at or below 3 2tt2.?2 Rtadifna,* 590,004(F) 41°,45'� F- 3 302 14 F u tarn frotn LnaPPros=ed Addtfives"`� 797 ICi'A) iI<it PHI v ii tintatued at tar above 1S Poisonous or Toxte Substances rl(37.11 i lc� tenlr# nt�lnfornt,tion tirtornal � � 1 44'F * "--- S "SSPt3r7tA) KaastsHcIll ator"above l3tPF.* isaiatauiers` 2d Time as a Public Health Control I 142.11 'Common iti imr 4York� i Contuners*---- 7-201.11 Sejaai anon Strnagc 40f 1 S �_ Ftmt as a Fuitfas, Heat h f usiruI� 7 <02.1� RFtrict on Prsrcnce and Lsu s ananec R turenrett` ..�_. i _ ___.�....__._.__e.._. 7-202.12 Conditions of UsQ' _ 7 245.11 Toxic font ainot Proinbi-ion, REQUIREMENTS FOR HIGHLY 5i)SG`@Pi'ISb,E - 04.1'E Samurevs Ctiteea ChemieaN POPULATIONS HSP} --- 72104.12 C-hcrunatsfor Washm>Produce, Ciiierial' I 21=-80IAi(A) LinpatcuxiredPr packaeadJoicesand 7204.14 Drain tnts. Crtte a'r �- flrseta>es vitb 15atinn_ ---- ��. 3�54.1_ l i(.. ie; of Pal,teur-irui f ?_s' _ i 7 OS.i 1 bxademal F xxl t ori ict laobi cant's= 3_g01.1 t(D) Ra�ti.all r Cca* d aminal Focxt and 206.21 Re�ene.led l se Pe hulas. Crit n a __ i't n Sell 7-206.12 Rali nt boat Stations 1 ,_g41 t 7 fCr Un+.i enect Fcxxi YacFage ;voi Re .erved- 7 206.'13 Trac.k;ng Poa-dere,. Pest C.ontrat and ..__..._. "`�'- Un raled -�- v0' 4lonitorinR* CONSUMER ADVISORY _ TIMEO'EMPERATURE CONTROLS 22 360:1 ( )imal)tr rR �rhal Posted frs C ert xiption oC T6 proper Cooking Temperatures for ' vitas is F uidc that ire Raw, t.indzrawked or PHFg Net Ctiies e is Pttx treed to }atm)natc __ Pathotrens x i -401.1.I A(l)(2) l gg. S 55"F i Set -- _ _ tis linntedr uu 5 r.icc 1,5'31 5sec' i '`-{f1 t 13 Yaste ret r,..tt F gg-: Strbslitutz Eoa It,av Shelf 3-iioLlt(��it�) Comnart ed1l,h—%,Icats&Cia)ne Animals - 15t17 15 sem:,SPECIAL REQUIREMENTS (f3)r I j(2Po�k and Fie Rihist -130 } 121 nein 3 441.1gik)C't K rotes xnjurc,ci Meats 1 5 F i.S 594.{3(39tAj-i17� Vsc.�fatnu. of Setlton 91),OO9fA}-(I7} in s, c calering mobile fcxxl temporary and 3-40L1 i to}t3) Poultry, tkild Came. Stuffed YHFs: ra;.�;icir ut.al kitchen op..eaai,ans sbcatild be stufti.ig Containing Fish, steal- i debited under the appropriate sections ! P ialtrf or Rallies- 165'T 15 sec abase f related to ftxaaborne ilhress 3.401.1140[3) 'Allrole-nulsoc, intact floor Intel tent ons and risk factors Other 145 f 5%).009 violationv relating to good retail 3-401.12 Raw Animal Foods Cooked ill a � � p; actaccs stiltdd tie debited under, #29 — _ _ sticaoteave 16.S*F * Special Requiremeim. 3-401.11(Aifl)(b) iM! Omi PliF- - 145`1' 15 sec� 17 Reheating for Hot Holding _ VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4f13.1I(Al&fI)) PHI>165°I 15 sctn.* (Itents23-30) 3-403.11(B) Microwave, 165 F2 Minute, Standing Crus al and nem r rufla < sloe P errs, which do afn relate to fila Tinier" __ __ foarlbr mcon be e illness rnt<�rve »8e1na e:rtcf n.,t J'crttars 2 src�d Whore, 3 443.I J W) C smmerci.Z Ravessed RTF Tc - found r`n zJte ?r +t.iii Deg .ver ions of the I e nal Cotte curd )t)5 CMR 3-403,11(F) I Reinamint; Unetilnxt 3-501.14(A) ( Ccx?ling Cooked PHFs from 1.4WF to 70'F Within 2 Hours and From 7,fF Lo 41714Y F Within 4 Hours. * _ Coding PHFs Made Front lmbinnt Temperature Ingredients to 411 /45`F Within 4flkltlf� 1)8nuies mtv;al atm Ili iht laterui 101) F(A Cua4 or 105 CNIR 994 9bQ. 5 . krt4`-2.N. Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name J�Pi/rt Datg d T e of O eration s Tvpe of Inspection ❑Routine 14 Re -inspection Previous Inspection Date: IJ//l��u [I Pre-op'efatiorf ❑ Suspect Illness ❑ General Complaint ElHACCP ❑ Other Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Address r r AVC Risk Level Telephone Owner /� f HACCP Y/N Person in Charge (PIC) n Time In:D ) Ou Inspector 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. offrfi Ii , �� Vlon-- C'Jrr c 14/' 1i7h 1,Q [FOOD PROTECTION MANAGEMENT,m,,. _„,„,b , "_,,,, •t+.� q, �'. ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2 Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS 41- rt I '�" Fci �' "°� ` i« t,,.„ ❑ 14 Approved Food or Color Additives ❑ 15. Toxic Chemicals §FOOD FROM APPROVED SOURCE, „ tm...4:; El 4. Food and Water from Approved Sourcee �� TIMEITEMPERATURE CONTROLS (Potentially Hazardous Fonda) "' -1 , , v y ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION r, "I -- I ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.o07)' 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S:501mpe fFor 14,dm ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (kSP),-,9 ❑ 21. Food and Food Preparation for HSP „�OONSUMER:ADVISORY,- «.«. ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: Print: PIC's Signature: Print:yCX_ �_ lr(_T j C r 4 7 Pagel of-APages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 7 590,003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C} Responsibility of the person in charge to Compliance with Food Law* 3-201.I2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Fags* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinkinn Water* Applicant To ReportTo The Person In Drinking Water from an Approved System* 590.006(A) Char e* 590.006(B) 590.003(G) Re orcin b Person in Charge* 3 1 590.003(0) Exclusions and Restrictions" 3-201.15 590.003(E) 'Removal of fixcins7ons and Restrictions EM 6 * Denotes critical item in the federal 1999 FoNl Code or 105 CMR 590060. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.I2 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Fags* 3-202.1.4 Ea gs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinkinn Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0" Washing Fruits and Vegetables Sheltlish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by ReaulatorY Authorit 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.1.5 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shelistock Identification * 3-203.12 Shelistock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(J) Labeling of Ingredients* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures IHACCP Pians 3-502.17 S eciaGzed Proeessin Methods* 3-502.1.2 Reduced oxygen packansr. criteria' 8-103.12 Conformance with A. roved Procedures* * Denotes critical item in the federal 1999 FoNl Code or 105 CMR 590060. PROTECTION FROM CONTAMINATION $ Cross -contamination , 3-302.11 (A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.1 t(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-3(A.I I Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111. Manual Warewashing- HotWater Sanitization Tem eratures* - 4-501.112 Mechanical Warewashina Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. 11 4-601_11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - HotWaterand Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anus* 2-301.12 Cleanin* Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.1.2 Discharges From the Eyes, Nose and - Mouth* 3-301.12 Contamination When Tasting* 1,2 _Preventing Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca aci ies* 5-204.11 Location and Placement* 5-205.11 Accessibility, 0 reration and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision M CITY OF SALEM BOARD OF HEALTH Establishment Name: t o �ia�P LA Date: icy L ln_ q - Page:—? .3� Item Code , C —Critical itemDESCRIPTION OF VIOLATION / PLAN OF CORRECTION "' - Date No. Reference , R —Red Item '� '" �« 9 %� „,., Verified P� a z " lkt' a _ _ r' - �-:. PLEASE. PRINT CLEARLY `� Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all Corrective Action Required: ❑ No ❑I Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next ins ection, to observe all conditions as described, and to P /� © Re -inspection Scheduled LlEmergency 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. n A� �, �� 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (item 1-221 (Cant) PR nTPOITICIN MOM rMEMICALA L 14 1 road or Color Additives Addnivs, -3:302,14 Protection (rota thn 15 Poisonous or Toxic Substances Ideno fyinir InfoN ination - Ch igi tal Containers* "7-!02.11 Common 'Name - working Conourrer%* 7-201.1 1 S2-atlol:I -Storage" — —Ule 7-2011! ReqficlIon - presence Zid 7-202.12 CondjlionS of Usa* 7203 . l I Tootic Conlaimn- Probibi,jors" 204.t 1 SanC,�eu, Criterhi - Chernicals* 7'(1412 h �01;odilcccfhai Chum kads for Wa� ini 7-204J4 CrireriaX t 205-71 hicidwal Faxi t e at cr. Ebnesu�,� 206.11 Renuriocd Vw Pericrdes' ("riterni'r 1 7-206J2 ?,206 13 i Rodent Pail Stations, Fnicking itori Powderi, Pest Control and I orrn., - --- M I 3-50114i0 P14Fs Received ar TeurNratures According to Lau Cooled to 41 F/45'1,- WhIanA Homs, 4 1-5 Methods for Pfflct 3-501A6(ft) I Cold PITI; Maintained at (s btlow 590.1 Mf _4_Ir plil, 'aboveamrained at or above '!IV4 'e A lkozsts Held at or Ab(>%e 130'F, I Time as a Public Health Control N, I Thu, as a Public I ieaddi Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 3.801,14A) 1 3-801,11 (D) +p'ali or Pattialp'-CrxkeA Animal 1'(XYJ and � -,,,4, nencd FtII6 Packarc Nor Rescnroed. TIME/TEMPERATURE CONTROLS 1 22 3 -fib: 11 Cor',anner Mvisory PI-med for Consumption of --1 i�kinoiai f-,xAs That are Raw, Undercooked or 16 Proper Cooking Temperatures torPMFS ___� Not Cithem ise Pr<xuntied to Eliminate 3 401A 1A(1)(2) F'glr- 155,F 15 'S'x' larinctfiate Service 145')Fl 5sec, - -TI 2) Connaintoed Fish, Meats & Cmaic 7iZI (AV Mirnals 155`171'Sec -401.i I (1i)( I )i 2) Pin{, and ( cf Rwst J30"F 121 rrd0 3-40'1.11(x'1)(7) Ratite,, Injeoai klcats -155'F 15 3-4(i[ I I (Ar 3, Ponjory, Wild ("orinc. Staffed 111 -IFS" SwiforiletUrataining Fish, Marti, Pouftry or Rtahes-155°F 15 sec. 101J)oC)(3) 'Nhole-risisvIc, lined flM S,CaKs 145.454'1.+ `- rn�l —Ksxk' cwkc�(,— os ,1 401 Ii _R Imi, a Microwave owaw 16ST �:41)1I I iA)( 1) (b) All (thei Pills - 145'F 15 Reheating for Hot Holding 1401, 11 fA)& (D) TIHN 165-F 15 sec. -1 3-403.11(x) N'ficrowaw 165' F" Mmuic Standing 3-4-03.11(0) 14 'Fs 3-403A 1(1-,') Remaining Unshced Portions o f ficel Roast,* 18 1 Proper Cooling of PHFs 3-501.14,A) CovlurgCookers PHFs froir, 14WFto 70°F Within2JfourtaraJFrom70`l' to 4 1 'F/45' F Willa n 4 Hmrs, I 7501, 14(li)k Cooling 111IFs Made Front Ambient TMveratore Ingredients, to 410b/45°F Within 4 I Donofes crioal rem In Iry 1eaeatl 1999 Cvxie or 105 t:: MR 590 ()a(,', ,I I Paste lwo,ed FII -'R2• -Substitute for Raw 9� Vic` itions of Section 590A9(Ar-(D) in calaring-mobdo. tosid, temporary and rcauticutial kitchen operations should be dclaied underthe appropriate sections iibrc,ve if related to feodborne ihncss interventions and risk 6rclors. Other 590.009 violations relrain.,, to good retail piactices, should be debited under #29 - spcsat (Items 23.30) Critical and nort cIlwaa vivaowns, which do not swat to o) fite foodborne diners imet vennomy,oul rcskfimors IIIsled (bone can be faunal in rhe fottatotag sections of the Food Code erred 105 CNIM 5 oo, 000, Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Nam Date 1 �� T of 0 eration(s) ❑ Food Service LJ Retail Kitchen E] El ElMobile El Temporary ❑ Caterer El Bed & Breakfast Permit No. Type of Inspection ❑ Routine El Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness E] General El HACCP Complaint ❑ Other AddressRisk �� Telephone --Z _ 1 7X ' Level %l {i Owner HACCP Y/N Person in Charge (PIC) 1 n ,� " - Time In: Out: Inspector-J.1'w A 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,„„°_ „�,�„f"'�i"'N ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH3 `"F'6'1"'�f I 4,tal�e..�ti ❑ 2. Reporting of Diseases by FoodEmployeeand PIC ❑ 3. Personnel with Infections Restricted/Excluded F FOOD FROM APPROVED SOURCE'N. u µ„E°'� vg,-�„r„� 9��, ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CON`rAMiNAT10N �' �' ' a I ,i 1 __ _, H,r,9 , ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S, 5901ny tFa m -14.W I ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities F PROTECTION FROM £HRMI£ALS 2", )>*i,N...,k.L.,,, ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEfrEMPERATURE OONTROLS (Poterttla(ly Hazardous Foods) 1- I :) _- El iii._ Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control it REQUIREMENTS FOR HIGHLY SUSGEPTIBLE'POPULATtONS (NSP) 1 ❑ 21. Food and Food Preparation for HSP '-'-CON UMERAbViSO Ypr4i"F Q710 a a rma ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Ins ector' i�si`a Print: ,f� PIC's sikm to Print t r Page / of Pages v Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590Dem .003(4)Assignment of Responsibility*-� 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge -- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-20112 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eus* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3590.003(D) 3-201.14 Exclusions and Restrictions* 3-201.15 590.003(B) Removal of Exclusions and Restrictions 4 5 FOOD FROM APPROVED SOURCE "Denote critical item in the federal 1999 Rx)d Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-20112 Food in a Henneticall Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eus* 3-202.14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Iisted Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatoty Authority 3-202.18 Shellstock Identification Present* 590,004(0) Wild Mushrooms* 3-201..17. Game Animals* 3-701.11 - Receiving/Condition 3-202.11. PHFs Received at Proper Temperatures* 3-202.15 Package integrity* 3-101.11 Ford Safe and Unadulterated Tags/Records; Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained- Tags/Records; Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(1) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures IHACCP Plans 3-502.11 Specialized Processing Metho1S* 3-502.12 Reduced oxMn packaging. criteria'* 8-103.12 Conformance with Approved Procedures* "Denote critical item in the federal 1999 Rx)d Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302-11(A)(]) Raw Animal Foods Separated from Cooked and RTE.Ftxlds* Contamination from Raw Ingredients 3-302] 1(A)(2) Raw Animal Foods Separated from Each Other, Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adufterated or Contaminated Food 3-701.11 - Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem eratures' - 4501.112 Mechanical Warewashing liot Water Sanitization Temperatures* 4-501..11.4 Chernical. Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arens* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, hose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employers* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-20411 Location and Placement* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 Handwashin Cleanser, Availability 6-301.1.2 Hand Drying Provision Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: File Number: BHF -2005-000011 LOCATED AT: 1 �r i yea. P.^+.♦ IGmberiey Driscoll Mayor Salem Diner 70 1/2 Loring Avenue Salem MA 01970 70 1/2 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2008-0207 Jan 4, 2008 Dec 31, 2008 $280.00 ESTABLISHMENT Total Fees: $280.00 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 21 of 24 KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 ISGOTrna SALEM. OOM 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTA P Cd 1 (f )) _ 1 / i ('1 � V ADDRESS OF ESTABLISHMENT 9 0 l -0'Y t t "J— "% MAILING ADDRESS (if different) EMAIL - Business': Website: TEL # `? / o r) W - 9 q/ FAX # OWNER'S NAME z -Tt,' C . TEL # (n I 9 ADDRESS Yvi /) A�e-- CITY ZIP IV? tf- CERTIFIED FOOD MANAGER'S NAME(S) 7,t) C Yt<Re_4l CERTIFICATE#(S) 73 (Required in an establishment where potentially hazardous food is prepared) J �✓C /li�rlC✓,cclrl EMERGENCY RESPONSE PERSON v HOME TEL # DAOPERATION ' Monday 1 Tuesday Wednesday 1 Thursday Friday Saturday i Sunday HOURS OF OPERATION ?�I / Please write in time of day. �N&3 nM & k At 2 /o -4 M —PPA (; Anr -JI'!M. V AM -3j'>,M C^ 4A- 31)/N(p Am, 7/�vr (Forexample 17am-11pm) TYPE OF ESTABLISHMENT RETAIL STORE YES NO- ----------- ............. ---- - ---- RESTAURANT E NO (Outdoor Stationary Food Cart $210 --- ----- ----------------------- ---- BED/BREAKFAST/ YES NO CHILDCARESERYICES-----------------------------*-----------------....._ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only) $25 less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------- ------------------------------------------ less than 25 seats 0 25-99 seats 142N0more than 99 seats 420 $100 YES NO $25 YES $135 YES 0 $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 j returns and paid all state taxes required under the law. _---------- Revised 4/24/07 FOODAP2008.adm Date Social Security or Federal Identification Number CheckN& Date NOV-21-2007 09:16 AM WHEN SECONDS COUNT i` i Choke Saving Course Registration #o; Each attendee must complete a Registration Form To reserve a span: in the Choke Saving Course Registration Form, piease complete and retut Registration form to the Salem Board of Health. Course provided by When Seconds Count, l 'Class size is limited and will be on a first come first serve basis. { i *Registration Fee is Non -Refundable • Registration Deadline is Friday, December 28, 2007 at 4:00 p.m. r Form Completed by. Date of Registration: p Name: _ Restaurant: Business Address: _ _ _ City/Town Business Phone: _ State &Zip Email: I understand that the information provided to the City of Salem &When Seconds Count, confidential and I hereby attest that the information supplied on this Course Application is accurate. Cost: Choke Saving Class $5.00 per person ] Course Date: Time: Location: Wednesday, January 16, 2008 0 2 p.m. to 4 p.m. City Hall, 120 Washington Street, Floor 3, Salem, MA I have read and understand the above registration form, its requirements. Student Signature: Date: Return the completed application and payment to: Salem Boa] 120 Washir Salem, MA P. 02 i r, 0 CITY OF SALEM 3 BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MASSACHUSETTS 01970-3523 Salem Diner 70 1/2 Loring Avenue Salem, MA 01970 REDI-SEAL NO MOISTURE NECESSARY RAISE FLAP AND SEAL KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT NAME OF EST CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 ISCOTFOSALEM. COM 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) EMAIL - Business': O ivtdn= / Website: TEL # q / e FAX # � %1. - 917/ 81i - OWNER'S NAME z _TI t G TEL # ADDRESS rvj 0 Aue- Cm STATE ZIP 7if�_ CERTIFIED FOOD MANAGER'S NAME(S) ZU C EK7 �crIG(Ai � CERTIFICATE#(S) 73_ X00 D"aP (Required in an establishment where potentially hazardous food is prepared) 7vC F_ Fev�ccttf _ EMERGENCY RESPONSE PERSON /Z__10 I HOME TEL # DAYS OF OPERATION I MondayTuesdayWednesdayThursdayFrda Saturda Sunda HOURS OF OPERATION Please write in time of day. �iyn3 n�1 64A APM� b' AM-3prh'; fFnr examnle l l am -11 nml TYPE OF ESTABLISHMENT 60' RETAIL STORE YES ----------------- -- -- NO - RESTAURANT E (Outdoor Stationary Food Cart $210 ---------------------- ------- - ------------------------- BED/BREAKFAST/ YES NO CHILDCARE SERVICES....... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 less than 25 seats140 ------------- 25-99 seats =$280 more than 99 seats = 420 $100 - --------------------- ---- ------------------ YES$25 YES $135 YES 0 $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. Date Revised 4/24/07 FOODAP2005.adm Check#,& Date Social Security or Federal Identification Number CITY OF SALEM BOARD OF HEALTH Date: November 9, 2007 Name of Establishment: Salem Diner Address: 70 Loring Avenue Owner(s): G&Z, Inc. George & Zoe Elefteriadis Phone: 978-741-7918 The proposed owners of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. CERTIFICATION Ms. Elefteriadis is a Certified Food Manager who will work full time at this location. A "Person in Charge" or "PkP" must be available at this location when Ms. Elefteriadis is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. FLOOR PLAN A Hand Sink must be located in each food prep and service area, this includes the serving area, prep area and the back area. Proposed locations of those three sinks are approved. Hand sinks must have wall hung soap and paper towel dispensers. These, must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the basement. A dishwasher for washing, rinsing and sanitizing all utensils, equipment, dishes is proposed. It must have a final rinse temperature of 180 degrees in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENU/FOOD PREP Reviewed preparation of several items including chicken parmesan, shepard's pie, and salads. All food must be held at 41°F or lower, or 140°F or higher, at all times. Therefore, hot items should be brought to above 140°F before being held hot. Food may not be added to containers in steam unit or salad unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready -to -eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKEDFOODS The owners are choosing not to serve any undercooked foods. There must be a statement on the menu stating that. CHOKE SAVING A person trained in choke saving techniques must be available whenever this establishment is open for business. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the sink and spray bottles or wiping pails may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Outside area of premises, including the dumpster area and grease holding area, must be kept clean and sanitary. Trash will be held in a dumpster in the rear of the establishment, as will a grease barrel. This establishment is scheduled to open in late Novemebr. Please call one week prior to opening to schedule an opening inspection. An application was received. No check was received. Jo&nne Scott Health Agent / — 07—el It - <j -t,�) Date s 0 0 0 0 J lu JOHN J. LALIKOS ATTORNEY AT LAW 12 PEABODY SQUARE TELEPHONE (978) 532-8400 PEABODY. MA 01960 FAX(978)532-8410 EMAIL attyjohnlalikos@aol.com ril(ev GI.CeSC- w�-Octcel. CJ'C e. S e �/44 el f ;LT S ("(0 5 et -n-- +eaf' ;(1Cesc Sac* eppe0- 14 u S t^ ►� uoYti. S/�- eta �i IfJOVn6 a I., w1 134cok 6v P't C,v,y 62 L i o 0 5 �s erks se c u. Ice -3 4CJvC �V1z7G,v� ��e C a (CG Uy(rvf Cu(Ce p �A P CO (,Jrz�io�5 ,Uurl F;I1e} Uf sjc iZLrc,tFlh 13 cd- Nop�(e( 5kr; w.Jp SC -C V pf Pic -p so/ALL` L¢ec`13 �fIi $}v-fI SE.eI/r s-�L,, ff,eS RaLij v'1S 540, - OL� Cork,l �eL� �Ee� .7rYU�ont, LAO kolE e 13 eef Nco 41(f i-cor� GkoW��• . �r vrui-o RiLe ue,,oA-abtc ++ e-�e- GCLn ce-f lj ec r i e I �.-ini Liiea UV 2E7 GZdLv\. 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AA''-- Aoc' v e S��Lvi`C14c f "3 eectJ G -reek SaiaA i" S r�2�• 5�� Su lad G ra to wt e a4- S a Iat aid "e.eSc GvnrSvMr-Ro2S wA2 AL RA .v,,v W F—O obs Zti Ccad.Vjli`cKr e- wi 4kc Dcjoarfw�e*v+ of joublis Tical} lti/e ac►vise 4h -a+ Raw ay Metf haul iA- TtJ✓r Fried haddock w/lettuce and $5.25 tomato SaLaOS Garden salad Chicken salad Tuna salad Greek salad Roast turkey Chef salad Chicken kabob on salad with feta Steak kabob on salad with feta Caesar salad $3.50 $5.50 $5.35 $4.50 $6.25 $5.75 $6.75 $6.95 $4.95 w/grilled chicken $6.25 ®n THe sloe aev2paa2s Corned beef hash $2.75 Coffee: decaf or regular $1.25 Bacon, sausage or ham $2.50 Tea $1,25 Homefries $1.75 Hot chocolate $1.50 English muffin S.85 Chocolate milk $1,75 Raisin toast $.60 Bilk small $1.25 $1.65 large Homemade muffins $1.25 Juice small $1.25 $1.65 large orange, apple, tomato, grapefruit or Bagel w/cream cheese $1.75 cranberry Soda $1.25 Oatmeal $1.95 Iced coffee $1.75 w/blueberries or raisins $2.55 Cold cereal $1.95 Iced tea $1.75 Challah toast $1.50 Egg Beaters (per egg) add $.75 Whole egg add $.85 Cheese add $.50 *Served Monday through Friday only* SaiiC�Vl/ICFi2s CLUB SaM1G ole S Triple decker sandwiches served with bacon, tomato, lettuce & french-fries Cheeseburger hoz. $2.75 Roast turkey $5.75 Hamburger 6 oz. $2.50 Tuna $5.50 Ham & Cheese $3.95 Ham & cheese $5.75 Roast turkey $4.75 Cheeseburger $5.25 BLT $3.25 Hamburger $4.95 Grilled cheese $2.50 Chicken salad $5.75 Grilled cheese & tomato $2.75 Grilled cheese & bacon $3.50 Grilled cheese & ham $3.50 Tuna melt $4.25 Frankfurter $1.75 Grilled chicken $4.95 Egg salad $3.50 Fried haddock w/lettuce and $5.25 tomato SaLaOS Garden salad Chicken salad Tuna salad Greek salad Roast turkey Chef salad Chicken kabob on salad with feta Steak kabob on salad with feta Caesar salad $3.50 $5.50 $5.35 $4.50 $6.25 $5.75 $6.75 $6.95 $4.95 w/grilled chicken $6.25 on THe 9102 Corned beef hash $2.75 Bacon, sausage or ham $2.50 Homefries $1.75 English muffin S.85 Raisin toast $.60 Homemade muffins Bagel w/cream cheese Oatmeal w/blueberries or raisins Cold cereal Chailah toast $1.25 $1.75 $1.95 $2.55 $1.95 $1.50 Iced tea$1.75 AA Ln XT E Egg Beaters (per egg) add $.75 Whole egg add $.85 Cheese add $.50 "Served Monday through Friday only* Sanowlewes CLUB Sanowi S Triple decker sandwiches served with bacon, tomato, lettuce & french -fries Cheeseburger6oz. Hamburger 6 oz. Ham & Cheese Roast turkey BLT Grilled cheese Grilled cheese & tomato Grilled cheese & bacon Grilled cheese & ham Tuna melt Frankfurter Grilled chicken Egg salad Fried haddock w/lettuce and tomato Garden salad Chicken salad Tuna salad Greek salad Roast turkey Chef salad Chicken kabob on salad with feta Steak kabob on salad with feta Caesar salad $2.75 Roast turkey Coffee: decaf or regular $1.25 Tea $1.25 Hot chocolate $1.50 Chocolate milk 51.75 Milk small $1.25 $1.65 large Hamburger Juice small $1.25 $1.65 large $5.75 orange, apple, tomato, grapefruit or cranberry $3.50 Soda $1.25 Iced coffee $1.75 Iced tea$1.75 AA Ln XT E Egg Beaters (per egg) add $.75 Whole egg add $.85 Cheese add $.50 "Served Monday through Friday only* Sanowlewes CLUB Sanowi S Triple decker sandwiches served with bacon, tomato, lettuce & french -fries Cheeseburger6oz. Hamburger 6 oz. Ham & Cheese Roast turkey BLT Grilled cheese Grilled cheese & tomato Grilled cheese & bacon Grilled cheese & ham Tuna melt Frankfurter Grilled chicken Egg salad Fried haddock w/lettuce and tomato Garden salad Chicken salad Tuna salad Greek salad Roast turkey Chef salad Chicken kabob on salad with feta Steak kabob on salad with feta Caesar salad $2.75 Roast turkey $5.75 $2.50 Tuna $5.50 $3.95 Ham & cheese $5.75 $4.75 Cheeseburger $5.25 $3.25 Hamburger $4.95 $2.50 Chicken salad $5.75 $2.75 $3.50 $3.50 $4.25 $1.75 $4.95 $3.50 $5.25 SaLaOS $3.50 $5.50 $5.35 $4.50 $6.25 $5.75 $6.75 $6.95 $4.95 w/grilled chicken $6.25 70 Loring Avenue Salem, MA 01970 At the corner of Loring Ave. & Canal St. Phone: (978)741-7918 THe SMIRM DIneR CR@W WEILCOML99 YOU menu Hours Monday thru Saturday 5:30am — 2pm Sunday lam — 2 pm Consuming raw or undercooked food may be hazardous to your health and could cause food born illnesses @GGS L900 SanoWfCHRS Served with toast, homefries and coffee ham, sausage and cheese Corned beef hash and cheese $6.95 Two eggs $3.75 Egg $1.75 with bacon, sausage or ham with canadian bacon $4.75 with bacon, sausage or ham $2 with corned beef hash $5.50 $5.75 Egg and cheese $2..225 5 One egg $3.05 with bacon, sausage or ham $3.25 Cheese omelette $3.50 Western w/onions, ham & green $3.25 with bacon, sausage or ham $4.15 pepper Eastern w/ham and onions $3.25 with canadian bacon $4.95 Egg $6.50 $6.25 with corned beef hash $4.95 Eggs Florentine: English muffin topped w/two poached eggs, spinach, mushrooms and hollandaise sauce (no toast) $1.75 0MLILeTT2S Served with homefries and toast Super Omelette w/bacon, ham, sausage, tomato, pepper, onion, mushrooms & cheese House Omelette w/bacon, $7.25 ham, sausage and cheese Corned beef hash and cheese $6.95 Western w/ham and onion $6.25 Spanish w/salsa $5.25 Feta cheese $4.95 Cream cheese $4.99 Meat choice omelette w/cheese: choose ham, $4.75$4.95 sausage, or bacon Veggie choice omelette w/cheese: choose spinach, broccoli or mushrooms $4.95 $4.95 Tomato and cheese $3.25 Egg only omelette $4.50 Cheese omelette $3.50 Veggie w/mushroom, onion,a p peer and tomato $4.15 $55.99 Steak and cheese omelette .25 aReMPaST SPLC141LS $ Served with homefries and toast unless otherwise specified Big Man's: two eggs, bacon, sausage or ham, and two pancakes Eggs Benedict: English muffin topped w/two poached eggs, Canadian bacon and hollandaise sauce (no toast) $6.50 $6.25 Everyday Special: Two eggs w/corned beef hash and beans $6.25 Eggs Florentine: English muffin topped w/two poached eggs, spinach, mushrooms and hollandaise sauce (no toast) $6.25 Sirloin steak and eggs $7.50 orl TWO SVUaaT Slob Three golden pancakes w/bacon, sausage or ham $3.75 Blueberry pancakes $4.95 Strawberry pancakes $4.95 Chocolate Chip pancakes $4.95 French toast $4.95 w/bacon, sausage or ham $3.75 Short stack French toast or golden pancakes $4.95 w/blueberries, strawberries, or chocolate chips $3.25 $3.95 Massachusetts state tax is 5% VOOD THE NATIONAL REGISTRY OF 0� SBFT r kt {� FOOD SAFETY PROFESSIONALSO a� O ?. •.. CERTIFIES d L '� t>n" a }Aw '�tP�', zI 1 uH P 5A2 k Q. J t,a'ia10,04 ZOE ELEFTERIADIS " CERTIFIEI,�"' 'I ay t.a- " iY k HAS SUCCESSFULLY SATISFIED THE REQUIREMENTS FOR r (M 000 SAP/IY MANA6 a, 44- y THE FOOD SAFETY MANAGER CERTIFICATION EXAMINATION i t t �'Trarrn>zg h}� the°rllner'i ��, ' FoodSca�eiylnstatiate6" s 0100)'723 3873 ' F' 4� a'A k.�' v « 4�1 t4 ,' : a .! President Y]' N aatlonal Rcalstty of Food Safetµ; P fws[tintils " t lnrrnuu / f wrch rg , ISSUE DATE: JUNE 15, 2006 * 73a1,n I` CERTIFICATE No: BJ20026628 Ile.5r1. k�}'q.t'ti3 TEST FORM: BJA 00656 Notification of Test Result ID#: xxx-xx-5376 Scaled Test Score: 97 Candidate Status: Pass Test Date: June 15, 2006 Congratulations! Attached is your certificate and wallet card. Please notify the National Registry of name or address changes at the address below. Ensure Food Protection Purchase and Receive Food Food and Supplies Storage Foods Preparation, Service & Display Equipment & Facilities Maintenance and Cleanliness Personnel Hygiene, Training and Behaviors Related to Food Safety Legal Compliance This cerlifieale is not valid for more Nan five. years front date pr issue. National Rcgistiy of Food Shfety Prol'cssiunal. CERTIFIED FOOD SAFETY MANACEI ZOE ELEFTERIADIS ZOE ELEFTERIADIS 36 MERRILL AVE BELMONT, MA 02478 You scored 820/,correct. Competent You scored 100% correct. Mastered You scored 82% correct. Competent You scored 100% correct. Mastered You scored 100% correct. Mastered You scored 100% correct. Mastered You scored 100% correct. Mastered &,tificae No. BJ20026628 Issue Dale. ars 15, 2006 National Registry of Food Safety Pio essionals(D 1 5728 Major Blvd Ste 750 1 Orlando, FL 32819-0000 I Phone: 407.352 3830 1 Fax: 407352.3603 70 112 Loring Avenue City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Telephone: i PROTECTION FROM CONTAMINATION 741-7918 Separation/ Segr anon/ Protection owner. Costas Bougardes PIC: Costas Bougardes Inspector: David Greenbaum Date Inspected: Correct By: 10/23/2007 Risk Level: Permit Number: BHP -2007-0205 Status: VIOLATION # of Critical Violations: 4 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) Food FAIL Critical Salem Diner Critical Urgency NEU a Tappan freezer has potentially hazardous food stored with ready to eat food. Separate a RTE food from PHF to contamination. hite Westinghouse freezer in the basement has PHF stored with RTE food. Store PHF separate from RTE food to prevent contamination. and Sanitizing FAIL Critical d❑ RED The dishwasher does not appear to be sanitizing properly. Service dishwasher immediately to insure proper sanitizing. meat slicer has an accumulation of fiid debris. Properly clean and sanitize the meat slicer after each use. Hot and Cold olding FAIL Critical VRED omment: Eggs found stored at room temperature. Store all cold PHF at a temperature of 41°F or below. e G nco reach in in the kitchen has a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. j; 5 e front Coke reach in has a temperature of 48°F. Repair 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® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 23,2007 ) Page I oft .......... Item - Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Violations Related to Good Retail Practices (Blue Items) Food and Food FAIL Critical BLUE Cafnment: The Sterling Diner in the reach in at the counter has uncovered food. All food in storage must be covered. Equipment and U ris Is FAIL Non -Critical BLUE vvin t: The microwave ovens need a thorough cleaning. e st ing Diner reach in at the counter has an accumulation of food spills and splatter. Thoroughly clean this unit. T vent fan at the counter has an accumulation of dust and grease. Thoroughly clean the vent fan. Specia Requirements FAIL BLUE Comment: Rodent droppings observed in the basement. Owner to have the licensed pest control operator inspect this ,>o establishment for mice. Monthly extermination is being conducted. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. Owner has informed the inspector that this establishment will be changing ownership. Prior to any change in ownership the potential new owner must present plans for approval to the Health Agent. 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. Oct 23,2007 ) Page 2 oft 70 1/2 Loring Avenue Telephone: 741-7918 Owner: Costas Bic M Salem Diner City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency , Violations Related to Good Retail Practices (Blue Items) I Special Requirements FAIL BLUE Comment: Rodent droppings observed in the basement. Owner to have the licensed pest control operator inspect this establishment for mice. Inspector: David Greenbaum 1 Date Inspected: Correct By: 1 10/31/2007 Risk Level: Permit Number - BHP -2007-0205 Status: SIGNED OFF # of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Monthly extermination is being conducted. GENERAL COMMENTS: All other violations cited in the 10/23/07 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 31,2007) Page 1 oft RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) 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. Oct 31,2007 ) Page 2 of CIN OF SALEM, MASSACHUSETTS BOARD OF HEALTH j 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT To: ADVISORY tau •_ �. v You have an outstanding Bill of �,i�,nnow►is ;�Crce�S� da11� This bill must be paid in full before a 2007 Food Permit will be issued You may not operate your establishment on or after January 1, 2008 without a valid permit IMPORTANT MESSAGE-) FOR p DATE (/��I�i �O ,TIME e! M OF PHONE AREA CODE NUMBER EXTENSION D FAX ❑ MOBILE 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 s Lye lei r" 1 L4 SIGNED NOTES 7�V-o 700 :, 70 1/2 Loring Avenue Telephone: 741-7918 Owner: Costas Bougardes PIC: Costas Bougardes Inspector: navlrf (roaninmirn Date Inspected: Correct By: 3/29/2007 Risk Level: Permit Number: 131-113-2007-0205 Status: SIGNED OFF # of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) , City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Prevention of Contamination from Hands Status Violation PASS Critical Salem Diner Critical Urgency RED Comments: Employees drinks observed in the front cookline. Employees must eat and drink in a designated employee area or in the dining room to prevent cross contamination. Handwash Facilities PASS Non -Critical ❑d RED Comments: The wall hung paper towel dispensers in the restrooms found empty. Stock disposable paper towels in the wall hung dispensers at all times. Paper towels available at the time of inspection. TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooling PASS Critical [] RED Comments: Gravy found cooling in large containers. Cool gravy in small containers no more than 4" deep to allow the gravy to cool evenly. 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. Mar 29,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: The Glenco reach in in the kitchen has uncovered food. All food in storage must be covered. immediate corrective action) The sterling diner reach in at the counter has some uncovered food. All food in storage must be covered Equipment and Utensils PASS Non -Critical Comments: The long silver cooling unit in back needs a thorough cleaning. The same unit needs a visible, accurate thermometer. The deli unit in the kitchen needs a thorough cleaning. Both microwaves need a thorough cleaning. The Blanco reach in in the kitchen needs a thorough cleaning inside and out. The screen over the exhaust fan is in disrepair. Replace the screen. The White Westinghouse freezer in the basement needs a general cleaning. The basement stairs need a thorough cleaning. The Sterling Diner reach in at the counter needs a thorough cleaning inside and out. GENERAL COMMENTS: All violations cited in the 3/20/07 inspection report have been corrected. BLUE 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. Mar 29,2007 ) Page 2 oft 70 112 Loring Avenue Telephone: 741-7918 Owner: Costas Bougardes PIC: Costas Bougardes com nt: The wall hung -� g paper towel dispensers in the restrooms found empty. Stock disposable paper towels in the wall hung Inspector: David Greenbaum Date Inspected: Correct By: 3/20/2007 Risk Level: Permit Number: BHP -2007-0205 Status: PARTIAL COMPLY # of Critical Violations: 4 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. Mar 20,2007) Page I oft City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Salem Diner Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Prevention of Contamination from Hands FAIL Critical ❑ RED Co ant: Employees drinks observed in the front cookline. Employees must eat and drink in a designated employee area or in HanlLt dining room to prevent cross contamination. ash Facilities FAIL Non -Critical RED d' ensers at all times. Paper towels available at the time of inspection. TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooling FAIL Critical ❑� RED Com nt: Gravy found cooling in large containers. Cool gravy in small containers no more than 4" deep to allow the gravy to cool nly. RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Violations Related to Good Retail Practices (Blue Items) Status Violation Critical Urgency Food and Food Pldtection FAIL Critical BLUE The Glenco reach in in the kitchen has uncovered food. All food in storage must be covered. JThe sterling diner reach in at the counter has some uncovered food. All food in storage must be covered. Equipment and nsils FAIL Non -Critical BLUE C ment: The long silver cooling unit in back needs a thorough cleaning. Te sa unit needs a visible, accurate thermometer. T deli unit in the kitchen needs a thorough cleaning. Bmi waves need a thorough cleaning. T Glencc reach in in the kitchen needs a thorough cleaning inside and out. The an over the exhaust fan is in disrepair. Replace the screen. �e Westinghouse freezer in the basement needs a general cleaning. e ement stairs need a thorough cleaning. he Sterling Diner reach in at the counter needs a thorough cleaning inside and out. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. oy� o� ?W) City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 20,2007) Page 2 oft 4' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT '� NAME OF ESTABLISHMENT .5tTli #V;11 TEL#4��' ADDRESS OF ESTABLISHMENT LOI7111/. FAX # MAILING ADDRESS (if different) EMAIL -- Business': OWNER'S ADDRESS Owners: CITY TEL CERTIFIED FOOD MANAGER'S NAME(S) /' ad4jCERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSONiffeGlVii< 4&7Af4G6g.4J—HOME TEL # 9rJ��- *7264(� Please write in time of ear. 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 S NO - ..._..--less than 25 seats .� 25-99 seats = more than 99 seats =$200 -- - - BEDIBREAKFAST YES ---NO --- ---- ----------- --- -- -- - --------- -- - - ----- ----- - --- - - -------- -- ----------------- ------------- ADDITIONAL PERMITS- $5 MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO TOBACCO VENDOR YES NO $50 $25 ALL NON-PROFIT (such as church kitchens) YES NO `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. --92 - Signalure Date Social Security or Federal Identification Number --------- ------------------ - ----- -------- Re�ised 11/13/06 FOO DAP2007.adm Check# & Date 55 5_(2/42$ Zip 5 /56,Qa y,&" a1 e4. AllcClo6 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: File Number: BHF -2005-000011 LOCATED AT: Salem Diner 70 1/2 Loring Avenue Salem MA 01970 70 1/2 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0205 Dec 20, 2006 Dec 31, 2007 $150.00 ESTABLISHMENT Total Fees: $150.00 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 2 of 11 70 1/2 Loring Avenue Telephone: 741-7918 Owner: Costas Bougardes PIC: Costas Bougardes Inspector: David Greenbaum Date Inspected: Correct By: 10/13/2006 Risk Level: Permit Number: BHP -2006-0313 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) Salem Diner City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 1:01w, Comment: The sanitizing solution in the kitchen found too weak. Sanitizing solution of proper concentration must be readily available at all work stations at all times. The dishwasher does not appear to have sanitizing solution and is not reaching a rinse temperature of 1807. Service dishwasher to insure sanitizing solution is being dispensed or the required minimum temperature of 1807 is reached. Owner to forward all service invoices to the Board of Health within one week. GENERAL COMMENTS: 897:All other violations cited in the 10/5/06 inspection report have been 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. Oct 16,2006 ) Page 1 oft �s RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 16,2006 ) Page 2 oft 70 1/2 Loring Avenue Telephone: 741-7918 Owner: Costas Bougardes PIC: Mark Celani Inspector: David Greenbaum Date Inspected: Correct By: 10/5/2006 Ric!,, I o ni- 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 FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Status Violation Salem Diner Critical Urgency Separation/ Segrega ion/ Protection FAIL Critical L RED Co ant: The Tappan freezer in back has potentially hazardous food stored above other food. Store PHF below other foods to event cross contamination. The g silver cooling unit in back has PHF stored above other food. Store PHF food below other foods to prevent cross ntamination. Foo Contact rfaces Cleaning and Sanitizing FAIL Critical ❑� RED C mment: The sanitizing solution in the kitchen found too weak. Sanitizing solution of proper concentration must be readily vailable at all work stations at all times. The dishwasher does not appear to have sanitizing solution and is not reaching a rinse temperature of 180°F. Service dishwasher �.� to insure ;;san' ' g solution is being dispensed or the required minimum temperature of 180°F is reached. The ' scoop found stored on top of the ice machine. Clean and sanitize the ice scoop and store in the ice handle side up or in a an, container labeled "Ice Scoop Only". Handwas;Faciliti FAIL Critical❑ RED CThe back hand wash sink found obstructed. Keep hand wash sinks clear and accessible at all times. 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. Oct 06,2006 ) Page 1 oft Permit Number: BHP -2006-0313 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 FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Status Violation Salem Diner Critical Urgency Separation/ Segrega ion/ Protection FAIL Critical L RED Co ant: The Tappan freezer in back has potentially hazardous food stored above other food. Store PHF below other foods to event cross contamination. The g silver cooling unit in back has PHF stored above other food. Store PHF food below other foods to prevent cross ntamination. Foo Contact rfaces Cleaning and Sanitizing FAIL Critical ❑� RED C mment: The sanitizing solution in the kitchen found too weak. Sanitizing solution of proper concentration must be readily vailable at all work stations at all times. The dishwasher does not appear to have sanitizing solution and is not reaching a rinse temperature of 180°F. Service dishwasher �.� to insure ;;san' ' g solution is being dispensed or the required minimum temperature of 180°F is reached. The ' scoop found stored on top of the ice machine. Clean and sanitize the ice scoop and store in the ice handle side up or in a an, container labeled "Ice Scoop Only". Handwas;Faciliti FAIL Critical❑ RED CThe back hand wash sink found obstructed. Keep hand wash sinks clear and accessible at all times. 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. Oct 06,2006 ) Page 1 oft RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Violations Related loPood Retail Practices (Blue Items) Status Violation Critical Urgency Food and Foo rotection FAIL Critical BLUE omment: Th ,Glenco cooling unit has uncovered food. All food in storage must be covered. T erling Diner reach in in front has uncovered food. All food in storage must be covered. Equipment and sils FAIL Non -Critical BLUE menta, The long silver cooling unit needs a thorough cleaning. Tdeli unit in the kitchen needs a thorough cleaning. T e fryolators has an accumulation of food debris. Thoroughly clean the fryolators. ne fryolator does not appear to be working. Repair to good working order or remove. p/stored on the floor. Clean mop and store upside down not touching any surface to air dry. „ Elie 'ver King cooling unit needs a visible, accurate thermometer. a Whit Westinghouse freezer in the basement needs a thorough cleaning. - T Sterling I Diner reach in out front needs a thorough cleaning. Phy ' Facility FAIL Non -Critical BLUE C ment: There are water damaged walls in the ladies restroom. Investigate the source of the leak and repair. Repair and repaint e walls. t TThh�Xase/ment stairs have an accumulation of food debris and grime. Thoroughly clean the basement stairs. Specie Requl irements FAIL Critical BLUE Co ment: There are mouse droppings on the shelves in dry storage. Owner to contact licensed pest control operator and have the stablishment exterminated as often as necessary to abate the problem. GENERAL COMMENTS: 878: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® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 06,2006 ) Page 2 oft 70 112 Loring Avenue Telephone: 741-7918 Owner: Costas Bougardes " PIC: A, ' Costas Bougardes Inspector: David Greenbaum Date Inspected: Correct By: 317/2006 Risk Level: _ g Permit Number: BHP -2006-0313 Status: -PARTIAL COMPLY # 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 FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Handwash Facilities Status Violation FAIL Critical Comment: The sink in the men's room is falling off the wall. Repair and resecure the sink to the wall. The sink in the ladies room is loose. Resecure the sink. Salem Diner Critical Urgency RED Owner has ordered new sinks for the restrooms and has hired Bob McEachern Plumbing and heating to repair all plumbing violations. Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: The deli unit in the kitchen has a broken door. This door must be repaired. The Glenco cooling unit in the kitchen has a damaged door. Repair the door. The Sterling Diner cooling unit at the counter has a broken door. Repair the door. Owner has ordered parts for these units through Diamond Brothers Refrigeration Co. Water, Plumbing and Waste FAIL Non -Critical BLUE Comment: There is a leak at the sink in the men's room. Repair leak. Bob McEachern Plumbing and heating to fix. Physical Facility FAIL Non -Critical BLUE Comment: There are many broken/damaged floor tiles throughout the establishment. Replace all broken/damaged floor tiles. Owner will continue to replace floor tiles as needed. GENERAL COMMENTS: 517:AII outstanding violations must be corrected by the next routine inspection. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 08,2006 ) Page / of 1 1", RED, Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action);-;` Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 08,2006 ) Page 2 of P(MV4 FL6 0 6 2006 CITY OF SALEM d' BOARD OF HEALTH f Vt'�lYl ►"122 � "ZCU �--U(�,I Yl rl�v2 Ury��✓7'1 V)')i9 C�/`p �� Rf-r-- nab b -o( done,, r� r� neLres2 c -)p6be ,-3P4&n.-xn Wicks up �ilee— �' G -r). c�,-L one 4-i(y)-& —'L' he ovfu �, Irl i"�le. � ti-kC�G1�t� ��s'�i � rL� �(�►'�-�L G (l � �S then he s -f -rfe5�( (�,Lol� ( Er)<t? -rll C�n11 qnU 70 112 Loring Avenue Telephone: 741-7918 Owner. r _' Costas Bougardes PIC' t Costas Bougardes Inspector David. Greenbaum Date Inspected: Correct By: 12/812005' available at all work stations at all times. Risk Level: Permit Number: 134-72005-0388 Status: VIOLATION # of Critical Violations. 4 - - Time IN: - Time OUT: Urgency Description (s).' BLUE: Violations Related to Good ., Retail Practices (Critical violations must be corrected immediately or within Gl O r days)(Non-critical violations must be corrected immediately or within 90 days) V ' `- Salem Diner City of Salem FOOD. SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Separation/ Segregation/ Protection FAIL Critical Q RED Comment: Meat loaf stored with lasagna in the steam table. Do not store meat loaf with lasagna to prevent cross contamination. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical W RED Comment: There was no sanitizing solution in the back prep area. Sanitizing solution of proper concentration must be readily available at all work stations at all times. e� The meat slicer has an accumulation of food debris and grime. Thoroughly clean and sanitize the entire meat slicer. The ice machine has an accumulation of grime. Thoroughly clean the entire ice machine. Handwash Facilities FAIL Critical ❑� RED Comment: The back handwash sink was found completley obstructed. Handwash sinks MUST be kept clear and accessible at all times. 'vThe sink in the women's restroom is falling off the wall. Repair and resecure the sink to the wall. 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. Dec 12,2005) Page 1 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 Comment: The Sterling Diner cooling unit has uncovered food. All food in storage must be kept covered. immediate corrective action) Equipment and Utensils FAIL Non -Critical BLUE Comment: The Tappan freezer in back has an accumulation of food debris and frost. Thoroughly clean and defrost this unit. The GE freezer in back needs a thorough cleaning inside and out. r V The silver in back has an accumulation of food debris and spills. Thoroughly clean the entire unit inside and out. �.r There are some unfinished shelves in the back prep area. Paint all unfinished shelving and clean. \The microwave has an accumulation of food spills and splatter. Thoroughly clean and sanitize the microwave. The shelf holding the microwave needs a thorough cleaning. The Alto Sham unit needs a thorough cleaning. �J The Glenco cooling unit has an accumulation of food debris and spills and splatter. Thoroughly clean the entire unit inside and out. The deli unit needs a thorough cleaning. The fryolators has an accumulation of old food debris. Thoroughly clean the fryolators. The oven needs a thorough cleaning. The White Westinghouse freezer in the basement has an accumulation of food debris. Thoroughly clean the freezer. The entire dry storage area has an accumulation of food spills. Thoroughly clean the entire dry storage area. The basement stairs need a thorough cleaning. The Silver King cooling unit at the counter needs a visible accurate thermometer. Check all light fixtures to insure they have protective covers. The Beverage air cooling unit fan neeeds a thorough cleaning. The Sterling Diner cooling unit has a broken door. Repair door. The same unit has an accumulation of food spills and debris. Thoroughly clean the entire unit. ater, Plumbing and Waste FAIL Non -Critical BLUE Comment: The sink in the ladies room does not drain properly. Repair the sink to drain properly. Physical Facility FAIL Non -Critical BLUE V Comment: There is water damage on the walls and ceiling in the ladies room. Investigate the source of the leak and repair. Repair 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. Dec 12,2005) Page 2 of If Item and repaint the ceiling and walls. Status Violation Critical Urgency 7/ The floor in the ladies room needs to be repaired. The walls in the men's room have water damage. Investigate the source of the leak and repair. Repair and repaint the walls. _. The light fixture above the dishwasher is missing. Replace the the light fixture. The flooring throught the establishment need a thorough cleaning including under and around all equipment and out at the counter area. GENERAL COMMENTS: 400:Reinspection will be 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® 2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 12,2005) Page 3 of 70 112 Loring Avenue Telephone: 741-7918 Owner: Costas Bougardes PIC: Costas Bougardes Inspector. David Greenbaum Date Inspected: Correct By: 2/28/2006 Risk Level: Permit Number. BHP -2006-0313 -. 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) Salem Diner City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM Separation/ Segregatf-on/ Protection FAIL Critical 1:743] Co ment: The produce sink has paint, windshield washer fluid and other miscellaneous items stored inside. The produce sink ust be cleaned and sanitized and used for produce prep ONLY. Fooontact Su es Cleaning and Sanitizing FAIL Critical 0 RED mment: T eat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. There s no sanitizing solution at the counter or in the back prep area. Sanitizing solution of proper concentration must be `\re y available at all work stations at all times. There ar irty knives stored in dirty bucket above the prep line in the kitchen. Knives must be cleaned and sanitized after each use ands red in an appropriate storage area. Prevent f Contamination from Hands FAIL Critical ❑Q RED Com t: The cook was observed handling ready to eat foods with bare hands. Bare hand contact with ready to foods is 1 pro ded. Employees must wear disposable glove or use tongs or deli tissue. in the kitchen using yellow gloves for cooking and washing dishes. gloves for washing dishes cannot be used for food only disposable gloves for food prep. FAIL Critical W RED LComm handwash sink found completley obstructed. Handwash sinks MUST be kept clear and accessible at ALL ti . he back Fhe sink in the men's room is falling off the wall. Repair and resecure the sink to the wall. The sink in the ladies room is loose. Resecure the sink. 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. Mar 01,2006) Page 1 of RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediatecorrective action) Item Violations Related to Good Retail Practices 1 Status Violation Critical Urgency Food and Foodfj/otection FAIL Critical BLUE vnment: There is uncovered food in all cooling units throughout the establishment. ALL food MUST be covered. - Rela all dry ingredient containers in the basement. Equip and Utensils FAIL Non -Critical BLUE rs Comment: The deli unit in the kitchen has a broken door. This door must be repaired. e deli unit in the kitchen is missing a thermometer. Provide a visible, accurate thermometer in this unit. The Glenco cooling unit in the kitchen has a damaged door. Repair the door. aovers in the Glenco cooling unit have an accumulation of dust and grime. Thoroughly clean the fan covers. lento cooling unit needs a thorough cleaning inside and out. The icrowave has an accumulation of food spills and splatter. Thoroughly clean and maintain the microwave. e small GE freezer in back is missing a thermometer. Provide a visible, accurate thermometer in this freezer. T appfreezer in back is missing a thermometer. Provide a visible, accurate thermometer in this freezer. Th liver cooling unit in back has an accumulation of food debris, spills and splatter. Thoroughly clean this unit. Theove in the kitchen has an accumulation of food spills and splatter. Thoroughly clean the stove. e SSilverking cooling unit outside the restrooms is missing a thermometer. Provide a visible, accurate thermometer in this unit. ...The Sterling Diner cooling unit at the counter has a broken door. Repair the door. Tsame unit needs a thorough cleaning inside and out. Th n at the counter has an accumulation of dust and grease. Thoroughly clean this fan. The up bottles on the tables need a thorough cleaning. ,Ther a food spills and splatter in the dry goods area. Thoroughly clean all food spills and spaltter in this area. ,.Di0y1owels and aprons stored on basement stairs. Store dirty towels and aprons inappropriate storage area. T flooring throughout the establishment needs a thorough cleaning including under and around all equipment All tab , shelves and surfaces need a thorough cleaning. Water, bing and Waste FAIL Non -Critical I -19Z Comment: There is a leak at the sink in the men's room. Repair leak. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 BLUE GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 01,2006 ) Page 2 of Item Status Violation Critical Urgency rhe toilet in the men's room doeas not flush properly. Repair toilet to flush properly. i Facility FAIL Non -Critical BLUE V� Comment: There are many broken/damaged floor tiles throughout the establishment. Replace all broken/damaged floor tiles. There' chipping/peeling paint above the shelves in the back prep area and above the kitchen cookline. Scrape and repaint all chi mg/peeling paint. Thoor sin the ladies room are in disrepair. Repair or replace all floor tiles in the ladies room. The 's an open electrical fixture above the dishwasher. Replace the light fixture. GENERAL COMMENTS: 504:Reinspection will be on 3/7/06, all 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. Mar 01,2006 ) Page 3 of i 70 1/2 Loring Avenue Telephone: 741-7918 - Owner: Costas,Bougardes PIC: Costas Bougardes Inspector: David Greenbaum= --' f Date Inspected: Correct By: 12/19/2005 Risk Level: Permit Number iBHP-2005-0388 Status " PARTIAL COMPLY u .. # of Critical Violations: Time IN:.,. ,_ _ Time OUT Urgency Description(s): BLUE: Violations Related to Gond Retail Practices (Critical & 1^ violations must be corrected immediately or within 10-= days)(Non-critical violations must be corrected immediately or within 90 days) Salem Diner City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ RED Comment: The meat slicer has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer. Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: Check all light fixtures and provide protective covers for all lights. The Sterling Diner cooling unit has a broken door. Repair door. Physical Facility FAIL Non -Critical BLUE Comment: The floor in the ladies room needs to be repaired. The walls in the men's room are in the process of being repaired. An electrician will be replacing the missing light fixture above the dishwasher. GENERAL COMMENTS: 405:AII other violations cited in the 12/8/05 inspection report have been corrected. 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. Dec 21,2005 ) Page I oft RED .firs Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) -` Item Status Violation Critical Urgency 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. Dec 21,2005 ) Page 2 oft Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2006 WHO'S PLACE OF BUSINESS IS: File Number: BHF -2005-0011 LOCATED AT Salem Diner 70 1/2 Loring Avenue Salem MA 01970 70 1/2 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0313 Jan 4, 2006 Dec 31, 2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES (December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 11 of 20 eAR�ri r " STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 3,Je w1 -Di k1 e ✓' TEL # 973 '/ - 9 8 ADDRESS OF ESTABLISHMENT 70'L LOr'Inj Ave . SA-Je ,41,4 MAiLING ADDRESS (if different) r1 r( OWNER'S NAME <Sa5 /-,f/ I�yt/�tzolC'S TEL# 119~ annaFcc 9k 4M� Of i:Y OL CITY iW STATE )U ZIP DL` CERTIFIED FOOD MANAGER'S NAME(S) / 1 aA-10E/C&f4 , CERTIFICA (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON maria 4Jlt HOME TEL# /Tri—W—IVDI HOURS OF OPERATION: Mon.j:2 Tue. L?, Wed. b -L Thu. b -Z- Fri. b -ZSat. b-2 Sun. Il - TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO �� less than 1000sq.ft. =$ 50 �� 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -- RESTAURANT YES NO ................ less than 25 seats ......100. $ 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 $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. Revised 11/03/05 FOODAP2.adm Check# & r)/nC 0/ -033 -a095 - 156 7 or Federal Identification Number CITY OF SALEM BOARD OF HEALTH Name of Establishment: Salem Diner Address: 326 Canal Street Street Owner(s): Costas Bourgardes Phone: 978-741-7918 Date: February 28, 2006 During an inspection and in consideration of a complaint received by the Board of Health, Sanitarian David Greenbaum observed many violations of the Food Code. Some of these violations are critical and increase the risk of foodborne illness. The owner agrees to: Maintain a handwashing sink in the middle food prep area and the rear area. 4 Maintain a produce sink in the rear area. This sink must not be used to store any items. Hand sinks must be used for handwashing only and must be continuously stocked with soap and paper towels. There may be no bare -hand -contact of ready to eat foods. Sanitzer must be made prior to opening each day, and placed at each food prep area. A sanitizer must be available for the patrons' tables as well. A daily cleaning schedule must be followed. Costas Bourgardes Date Joanne Scott Date Owner Health Agent 70 112 Loring Avenue Telephone: 741-7918 ` Owner Costas Bougarde: PIC: Costas Bougardea Inspector: David Greenbaum Date Inspected: Cori 4/20/2005 Risk Level: HACCP: ❑ Salem Diner City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Done Anti -Choking PASS ❑ Tobacco PASS Permit Number: BHP -2005-0388 Status: SIGNED OFF # of Critical Violations: 1 Time IN: Time OUT: FOOD FROM APPROVED SOURCE Done Food and Water from Approved Source PASS ❑D RED ❑d RED ❑/ RED ❑d RED Receiving/Condition FOOD PROTECTION MANAGEMENT Done RED Tags/Records/Accuracy of Ingredient Statements PIC Assigned / Knowledgeable / Duties PASS EMPLOYEE HEALTH Done By:j Reporting of Diseases by Food Employee and PIC PASS Personnel with Infections Restricted/Excluded PASS Permit Number: BHP -2005-0388 Status: SIGNED OFF # of Critical Violations: 1 Time IN: Time OUT: FOOD FROM APPROVED SOURCE Done Food and Water from Approved Source PASS ❑D RED ❑d RED ❑/ RED ❑d RED Receiving/Condition PASS�/❑ RED Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED Conformance with Approved Procedures/HACCP PASSd❑ RED Plans PROTFf.TION FROM CONTAMINATInN nnnr. Separation/ Segregation/ Protection PASS RED Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑Q RED White cutting board in back needs to be 105 r Prnper Adequate Handwashing Urgency Description(s): Good Hygienic Practices BLUE' Violations Related to Good Prevention of Contamination from Hands Retail Practices (Critical Handwash Facilities violations must be corrected immediately or within 10 days)(Non-critical violations { GeOTMS® 2005 Des Launers Municipal Solutions, Inc PASS PASS PASS PASS RFD RED RED RED resurfaced or replaced. ( Rev. Apr 20,2005 ) Page / of 70 112 Loring Avenue Salem Diner must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASS ❑d RED RED: Violations Related to toxic chemicals PASS ❑O RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS (Potentially Haz Done and Risk Factors (Require Cooking PASS ❑Q RED Temperatures immediate corrective action) Reheating PASS ❑Q RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASSd❑ RED i REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS Q RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE 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 All other violations cited in 4/13/05 inspection report have been corrected. 66 4 Y� &-� GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 20,2005) Page 2 of 70 112 Loring Avenue HACCP: ❑ Telephone: 741-7918 Owner: Costas Bougardesl n PIC: Mark Celani Inspector David Greenbaum ,ry Date Inspected: Correct By: 4/13/2005 Risk Level: 1 Permit Number BHP -2005-0388 Status: a VIOLATION„ # of Critical Violations: 5 Time IN: Time OUT: 9t' Urgency Description(s):' ' BLUE: Violations Related to Good Retail Practices (Critical=: violations -must be corrected immediately or within 10 days)(Non-critical violations Salem Diner City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Not Done Anti -Choking PASS ❑ ` Tobacco PASS ❑ FOOD PROTECTION MANAGEMENT Not Done r'IC Assigned / Y.nowledgcoble / Duties r'AGG RCD EMPLOYEE HEALTH Not Done Reporting of Diseases by Food Employee and PIC PASS./❑ RED Personnel with Infections Restricted/Excluded PASS ❑d RED FOOD FROM APPROVED SOURCE Not Done Food and Water from Approved Source PASS ❑Q RED Receiving/Condition PASS ❑d RED Tags/Records/Accuracy of Ingredient Statements PASS 0 RED Conformance with Approved Procedures/HACCP PASS ❑d RED Plans GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc ( Rev. Apr 13,2005 ) Page 1 of 70 112 Loring Avenue must be corrected immediately x within 90 days) RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require mmediat(icorrective action) Salem Diner Separation/ Segregation/ Protection FAIL Critical RED ling he otentially hazardous wi eady to eat food. to prevent cross ion. =boards. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑� REDboards are stained and surface or replace the cutting Proper Adequate Handwashing PASS ❑J RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASSd❑ RED Handwash Facilities FAIL Critical RED Han sh sinks in back and in mens room alling off the wall. Resecure sinks to the wall. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑Q RED Toxic Chemicals PASS ❑d RED TIME/TEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures PASS RED Reheating PASS ❑d RED Cooling FAIL Critical ❑d RED Fo out cooling in containers that are too ig. Food must be cooled in containers that are no deeper than 4". Hot and Cold Holding FAIL Critical ❑d RED Eggs stored out at room temperature. All poten " azardous foods must be held temperature of 41 °F or below. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS./❑ RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 13,2005) Page 2 of 70 112 Loring Avenue Salem Diner Violations Related to Good Retail Practices (Blue Not Done PASS ❑ Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE Fo stored directly on floor in back. All PASS - ❑ ood must be stored at least 6-8 inches off the floor. M ooling units have uncovered food. I food in storage must be covered. Equipment and Utensils FAIL Critical ❑ BLUE The fo wing cooling units need visible, ac ate thermometers, the freezer in the asement, the silver cooling unit in back and the Glenco unit. The counter cooling unit needs a thorough cleaning. Silver cooling unit has an ac ulation of mold and grime. -Thoroughly clean unit. . J osiiver cooling, unit in back has an accumulation of grime and food debris. Thorou,ghly clean unit. needs a thorough cleaning and LYParslicer sanrti g. o-shaam heater has accumulation of food debris. Thoroughly clean unit. Mi ave needs a thorough cleaning. amtimn "lution in kitchen too weak. Sanit g solution of proper concentration t be readily available at all work stations at all times. Water, Plumbing and Waste Physical Facility PASS FAIL Non -Critical BLUE BLUE Ther an accumulation of food debris spills in dry storage area. Thoroughly clean ea. Ba ent stairs need a thorough cleaning d sweeping. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other- See Notes PASS - ❑ BLUE GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 13,2005 ) Page 3 of 70 112 Loring Avenue Salem Diner GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 13,2005) Page 4 of STANLEY J. USOVICZ, JR. MAYOR NT; {.�WBOARDSOF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Salem Diner Address of Establishment: 70 1/2 Loring Avenue Owner's Name: Costas Bougardes Restrictions: Application Date: 1/10/2005 Permit for Food Establishment 260-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT STANLEY J. USOVICZ, JR. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 56dLo- 1Jfl TEL#�_,%� ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S CITY CERTIFIED FOOD STATE ZIP (required in an establishment where potentially hazardous food is prepared.) if- TEL #-97g - 7qG- %Z6/ EMERGENCY RESPONSE PERSON %r%Ci'IVl ii 1I/ ( HOME TEL # 9?g- 5 (ZO - -) a 49 l 5+30417 V4�7 HOURS OF OPERATION: Mon. Tue._ Wed. Thu. Fri.—Sat-.-Q Ph Sun. - /^ TYPE OF ESTABLISHMENT 5! �,O A-1" 3Ph 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 a �� -0 less than 25 seats $1 25-99 seats=$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (notjust serve) 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 belief, have filed all state tax returns and paid all state taxes required under the law. Signature z ,%� Date// .2t/_p4Social Security or Federal Identification Number �-v"�� u -311—U7 -A 9JZ Revised 11/03/03 FOODAP2.adm Check# & Date,-*,) 36^0 -/-/D-S STANLEY J. USOVICZ, JR. MAYOR U CIT„YjOF, SALEMv,� MASSACHUSETTS y., »iH ;�y, BOARO,OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALE,M, MAO 1970 TEL. 978-741.1800 FAX 978-745.0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: Food Service Name of Establishment: Salem Diner Address of Establishment: 70 1/2 Loring Avenue Owner's Name: James Georgakakis Restrictions: Application Date: 1/5/2005 Permit for Food Establishment 85-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTjSY& C 'I� ,-- ]L BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR �/��✓ 'aT // )) SALEM, MA 01970 2� •,U TEL. 978-741-1800 C/ Z01 FAX 978-745-0343 aQgR QHS STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO �OFNgGFM MAYOR HEALTH AGENT Fq�Ty 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT p /� NAME OF ESTABLISHMENT �a ).Q Wi DI yu?, `- TEL # 0 `T,q ` / i7 ADDRESS OF ESTABLISHMENT70//?- L oY; sl a S@ le)m QY1A. bi 9?o MAILING ADDRESS (if different) OWNER'S NAME 'Tq W & k C7CC yXRP � a t m TEL #(Le:•Q° 6 y 9 93 ADDRESS 1 f5 Wi 1 CITY �ey� r� eTATE 'IP OtIS / CERTIFIED FOOD MANAGER'S NAME(S) <'EERTIFICATE#(s) 344$S b (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON JCkMeN GWVQ-o�%1HOME TEL # (7 1 - 6 -09g3 3pw -3pM 3�,, 3pn 3pr� 3�M HOURS OF OPERATION: Mon9foXfl de. -.30 �Ku.Ss ��MFFi.S 3oa 2t.$.'3b..�Sun. f a t_ 1 �wr TYPE OF ESTABLISHMENT FEE check only . RETAIL STORE YES NO less than 1000sq.ft. • =$ 50 1000-10 000sg ft =$1011 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than. 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES 11P $5 TOBACCO VENDOR YES $50 ALL NCW ;PROFIT such. as church kitchens; YES 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. 033 -Sb— Social Security or F Revised 11/03/03 FOODAP2.adm Check# & Number ITY OF SALEM BOARD OF HEALTH Establishment Name: S'14cze*.f /%/i✓IFG Date: iZ'd/oar Page: / of � Item No. Code Reference C - Critical item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified fzc Cl7a/1r CJ ♦I�. G�a4I'f �'�fSK rJ�si w+`Sa� !—•tG,hr� /�r� a v,.:g r- /LttPrtr rte,✓o- Aarfmcwr v C GU 0 ttj�,••rti ad c�i rryi~sg uJ/P ,e.ru-Nf— tf tf 1% ,�`i• GY1C3/J L�C/f'. Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. ^/ l Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 E 17 1s TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 ,.- Additives* 3-302.14 Protection from Una t rowed Addifives,* 3-501.16(A) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers" 7-10111 Common Name-Workin=* Containers* 7-201.11 1 Separation - Stora e- 7-202,11 Restriction - Presence and Uses 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers - Prohibitions" 7-204.11 Sanitizers, Criteria - Chemicals - hemicals*7-204.12 7 -204. E Chemicals for Washine Produce, Criteria* 7-204.14 Dt 'in tints. Cri feria` 7-205.1,1 Incidental Food Contact, Lubricants' 7-206.11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Trac n. Powders, Pest Control and Monitarim** TIMEITEMPERATURE CONTROLS * Denotas critical item in the fooeral 1999 Food Code or 105 CMB 590000. 3-50L14(C) 3-501,25 Proper Cooking Temperatures for 19 PHFs 3-401.1 1A(1)(2) _ Eggs- 1.55'F 15 Sec. 3-501.16(A) E=es-Immediltte Servioe 145°F15seek 3-401,11.(A)(2) Comminuted Fish, Meats & Game 2{1 Animals - 155'F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast -130'F 121 min' 3-401.11(A)(2) Ratites, Injected Meats - 155'F 1.5 v eels) Re uiremenis sec. 3-401..11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, of Ratites -1650.1" 15 sec. -Poultry 3-40111(_C)(3) Whole-mascte, Intact Beef Steaks 145°F ^' 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * -1401-11(A)(1)(b) All Other PHFs -1.45'F15see, Reheating for Hot Holding 3-403.11 tA)&(D) PHFs 165'F 15 sea * 3-403.11(B) Microwave- 165° F2 Minute Standing Time* ,403.11 (C) Commereially Processed RTE Food - 140'F* 3-40311(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501,14(A) Cooling Cooled PHEs from140`17 to 10"F Within 2'1fours and From 70'F to 41'F/45'F Within 4 Hours. 3-501.14(B) Cooling, PHFs Made From Ambient Temperature Ingredients to 41 °F/45'F Within 4 Hours* - * Denotas critical item in the fooeral 1999 Food Code or 105 CMB 590000. 3-50L14(C) 3-501,25 PHFs Received at Temperatures. According to I.aw Cooled to 41'F/45'F Within 4 Homs. Coolin° Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(13) 590.004(F) Cold PHFs Maintained at or below 41°/45°F* 3-501.16(A) Hot Il Maintained at or above 14WF. * 3-501.16(A) Roasts Held at or above I M'F. 2{1 Time as a Public Health Control 3-501.19 'rime as a Public Health Control- 590.004(Ii) Variance 12e uirentenC 21 3-801,11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnin * L.tbels' 3-801.11(F3) Use of Pasteurized Bees' 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 's 3-80 L I I (C) Unopened Food Packs,, NoC Re -served. r 22 3-603.11 Consumer Advisory Posted for Consumption of 23. Manaciement and Personnel Animal Foods That are Raw. Undercooked or 24. Food and Food Protection Not Otherwise Processed to Eliminate 25 26 27. _Equipment and Utensils ___FG Water. Plumbing and Waste Physical Facile_ Pathogens�m _ 28. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 29, v eels) Re uiremenis Eggs* 590.009(A) -(D) Violations of Section 590.009(A) -(ll) in catering, mobile food, temporary trod residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and tisk factors. Other 590.009 violations relating to good retail practices should be debited under 729 - Special Requirements. (,Iteuts 23-30) Critical and non-critical violations, which no not relate to the foodborne illness interventions and) iskfactors listed above, can be , fnarnd in the folfon>ing sections of the Food Code and 105 CMR 590.0(10. item Good Retail Practices FC _59U.060- 23. Manaciement and Personnel FC - 2 .003 24. Food and Food Protection FC- 3 .004 25 26 27. _Equipment and Utensils ___FG Water. Plumbing and Waste Physical Facile_ -4 '_ .005 FC -5 .006 FC -6 I .007 _ 28. Poisonous or Toxic Materials FC - 7 .008 29, v eels) Re uiremenis .009 30. Other s-s°o[--b,k6.x.m, a r STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1.800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: Food Service Name of Establishment: Salem Diner Address of Establishment: 70 1/2 Loring Avenue Owner's Name: James Georgakakis Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 143-04 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 V r v Q s STANLEY USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �i'1 Illiii�� 120 WASHINGTON STREET, 4TH FLOOR DECrygg SALEM. MA 01970 UJ — 9063 2004 APPLICATION NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME CITY CERTIFIED F TEL. 978-74 1 -1800 FAX 978-745-0343 011Y OF SALEM JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH HEALTH AGENT Z PERMIT TO OPERATE A FOOD ESTABLISHMENT .WF'm TEL#q-46-741--` ,_/ qL9 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE HOURS OF OPERATION: TYPE OF ESTABLISHMENT RETAIL STORE YES O RESTAURANT ES NO BED/BREAKFAST YES NO ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) TEL 7C3 -Sat.—Sun.— FEE t.Sn. FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 $100 YES $5 YESO $50 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 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. -P' fd.G1 %._�/T]C3 In, V 67)1V 1'1 r7734<ir ,1r Social Security or Number ------------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check# & Date ��a 7 �— 30 •G CITY OF SALEM BOARD OF HEALTH Establishment Name:�tgLM D/fife- Date: /2� 3�d?. Page: of / Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R - Red Item - PLEASE PRINT CLEARLY Date Verified A5* L9 r "05 VW deE ot/ #L- h/ rifC X.4e-& &fit- - of,G# ,0- /iGG st fJ ✓� JCf/'IQr� �1 Z15/iL1l G �M' S ! S' rAl� Alv ~N, L tAI t d it.Lit-K � d � M' /% I �o A� ust C[E40 N tiff of AAJV VA4J. Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. CSu-� 7;12 � << Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color Additives PHFs Reccoved at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. Cooling, Methods for PHFs 3-202.12 Additives'* - 3-401. t IA(1)(2) 3-302.14 Protection from Una roved A<idltives* 15 Poisonous or Toxic Substances 3-401.11(A)(2) 7-101.11 identifying Information - Original Containers* 3-50'1,16(A) 7-102.11 C'ommonName- Working-Containera* 3-401.11(13)(1)(2) 7-261.11 Se.arntion-Stora e" 3-401.11(A)(2) 7-202.1. t Restriction - Presence and Ilse'w 28. 219_ 7-202.12 Conditions of Use` 3-401.11 (A)(3) 7-203.11 Toxic Containers - Prohibitions* Time as a Public Health Control* 7-204.11 Sanidzers, Criteria -Chemicals* 590.004(fl) 7-204.12 Chemicals for Washine Produce, Criteria" 3-401A I(C)'(3) 7-204.14 DryingA*ents, Criteria* 7-205.11 Incidental Food Contact. Lubricants* 3-401.12 7-206.11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations" 3-401.11(A)(1)(b) 7-206.13 Tracking Powders, Pest Control and Monitoring* ' 16 17 18 * Denotes critical item in the federal 1999 moil Code or 105 CNIR 590.000- Proper Cooking Temperatures for PHFs Reccoved at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. Cooling, Methods for PHFs PHFs 3-401. t IA(1)(2) Eggs- 155'F 15 Sec. FC - 2 E nzs- Immediate Service 145'F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Came 3-50'1,16(A) Animals - 155'F 15 sec. '* 3-401.11(13)(1)(2) Pork and Beef Roast - I30'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 28. 219_ sec. * 3-401.11 (A)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control* Stuffing Containing Fish, Meat, 590.004(fl) Poultry or Ratites -165'F 15 sec. 3-401A I(C)'(3) Whole-nmsele, Intact Beef Steaks 145'F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3-401.11(A)(1)(b) All Other PHFs-1.45`F'15 see,* Reheating for Hot Holding 3-403.11 (,A)&(D) PHFs 165'F 15 sec. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Time* 3-403.11(C) Commercially Pnxessed RTE Food - 140"F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts' Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70"F Within 2 Hours and From 76'F to 4t'F145°F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F145'F Within 4 Hours* * Denotes critical item in the federal 1999 moil Code or 105 CNIR 590.000- REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 3-801..11(,A) Unpasteurized Pre-packaged Juices and Beveraeea with Wamine I bels* 3-801.11(0.) Ilse of Pasteurized Eras* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed Snrouts Not Served- * 13-801.11(C) 1 Unopened Food Package Not Re -served. * I 22 3-501-14(C) 3-S01, 15 PHFs Reccoved at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. Cooling, Methods for PHFs 19 23. PHF Hot and Cold Holding FC - 2 3-50t.16(B) 590.004(F) Cold PFIFs Maintained at or below 41'145' F* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-50'1,16(A) Hot PHFs Maintained at or above 140"F, * 2I. 3-501.16(.0.) Roasts Held at or above 130°F. 20 28. 219_ Time as a Public Health Control FC - 7 3-501.19 Time as a Public Health Control* Other 590.004(fl) Variaace Requirement REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 3-801..11(,A) Unpasteurized Pre-packaged Juices and Beveraeea with Wamine I bels* 3-801.11(0.) Ilse of Pasteurized Eras* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed Snrouts Not Served- * 13-801.11(C) 1 Unopened Food Package Not Re -served. * I 22 3-Id'i t Consumer Advisory Posted for Consumption of FC Animal Foods "That are Raw. Undercooked or 23. Not Odtermw Processed to Eliminate FC - 2 Pathogens. * crteoays riV20,11 _ 24. 25. 213._ 3-302.13 Pasteurized Eggs Substitute for Raw Shell FC -- 3_ FC -4 FG -5 Eggs* . rCti IAL MCUIU MIR CN i a 590.009(A) -(D) violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited wider the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 7129 - Speciai Requirements. ;I�� K�+�rIeTRZ�l7 (Items 2.9-30) Crituxtl and non-critical violalions, which do nae relate to the foodborne illness interventions and? isk factors listed above, can be found in the fo(loaving sections of the Food Code and 105 CMI{ 590.000. Item Good Retail Practices FC - --..- 590.000 23. Mang ement and Personnel FC - 2 .003 _ 24. 25. 213._ Food and Food Protection_ Equi mens and Utensils Water, Plumbingand Waste y FC -- 3_ FC -4 FG -5 .004 .005 .006 2I. Ph sical Facilit FC - 6 .007 28. 219_ _ Poisonous or Toxic Materials S ecial R uirements FC - 7 , .006 .009 30, Other 5:$YOrmcOock( 2,1- ;�- co � �NINB STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Facsimile Transmittal To: Ar rY Jerfrr J. LALIXO Fax # 417P, ar32 -.Qyre RE: rAt-6M /(r!LLL - Date : / 2-,6 ) /e 4 Page(s): including this cover # 2 Message: /Nd'OtCo-naw XwaA— Aff)tcAAw. Board of Health News Office Hours: Effective September 12, 2003 Your Information 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 Do Salem Residents Know ? — The Board of Health meetings are held the second Tuesday of the Month. Series 900 Last rax Date Time Twe Identificati� i Fax History Report for Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of food borne illness. D THE SALEM DINER 70 Loring Avenue //•�'�� /^1 Corner of Loring Ave. & Canal Street Salem, MA 01970 Phone 978-741-7918 M -F 5:30AM - 3PM, Sat 5:30AM - 2 PM, Sun 7AM Eggs Breakfast Specials Two Eggs, Home fries, Toast $ 3.50 Big Man's $ 6.25 With Bacon, Sausage or Ham $ 4.50 Two Eggs, Bacon Sausage or Ham, With Canadian Bacon $ 5.25 Home Fries, Toast, Coffee & Two Pancakes With Corned Beef Hash $ 5.50 Eggs Benedict $ 5.75 One Egg, Home Fries, Toast $ 2.90 English Muffin w/ Two Poached Eggs, With Bacon, Sausage or Ham $ 3.90 Canadian Bacon, Hollandaise & Home fries With Canadian Bacon $ 4.75 Everyday Special $ 5.99 With Corned Beef Hash $ 4.75 Two Eggs w/Corned Beef Hash, Beans, Home Fries, Toast & Coffee Egg Sandwiches Eggs Florentine $ 5.75 Egg $ 1.75 English Muffin w/Two Poached Eggs, With Bacon, Sausage or Ham $ 2.75 Spinach, Mushrooms, Hollandaise & Home Fries Egg and Cheese $ 1.99 With Bacon, Sausage or Ham $ 2.99 On the Sweet Side Western $ 2.99 Three Golden Pancakes $ 3.50 Eastern $ 2.99 With Bacon, Sausage or Ham $ 4.75 Blueberry Pancakes $ 4.50 Omelets All served with Home Fries & Toast Strawberry Pancakes $ 4.50 Super Omelet $ 6.99 Chocolate Chip Pancakes $ 4.50 w/Bacon, Ham, Sausage, Tomato, Pepper, French Toast $ 3.50 Onion, Mushroom & Cheese With Bacon, Sausage or Ham $ 4.75 House Omelet $ 6.75 with Bacon, Ham, Sausage & Cheese On the Side Corned Beef Hash and Cheese $ 5.99 Corned Beef Hash $ 2.75 Greek with Tomato, Onion & Feta $ 5.99 Bacon Sausage or Ham $ 2.25 Western with Ham & Onion $ 4.75 Home Fries $ 1.50 Spanish Omelet $ 4.75 English Muffin $ 0.85 Feta Cheese Omelet $ 4.99 Bagel with Cream Cheese $ 1.50 Cream Cheese Omelet $ 4.25 Homemade Muffins $ 0.95 Ham & Cheese $ 4.75 Hot Cereal $ 1.80 Bacon & Cheese $ 4.75 Cold Cereal $ 1.80 Sausage & Cheese $ 4.75 Chale Toast $ 1.50 Mushroom & Cheese $ 4.50 Spinach & Cheese $ 4.75 Beverages Brocccli & Cheese $ 4.50 Coffee $ 1.00 Tomato & Cheese $ 3.99 Deaf $ 1.00 Plain Omelet $ 2.99 Tea $ 1.00 Cheese Omelet $ 3.75 Hot Chocolate $ 1.50 Vegetable Omelet $ 4.50- Chocolate Milk $ 1.50 with Mushroom, Onion, Pepper & Tomato Milk $ 1.50 Juice $ 1.50 Extras Orange, Apple, Tomato, Grapefruit, Cranberry Egg Beaters Add $ 0.50 Soda $ 1.00 Per Egg Add $ 0.85 Iced Coffee $ 1.50 Cheese Add $ 0.50 Iced Tea $ 1.50 English Muffin Add $ 0.50 Raisin Toast Add $ 0.50 Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of food borne illness. D Sandwiches Deluxe Sandwiches Cheeseburger $ 2.50 Served w/Lettuce, Tomato and French Fries Hamburger $ 2.25 Roast Turkey $ 5.35 Ham & Cheese $ 3.75 Tuna $ 5.35 Roast Turkey $ 4.25 Ham & Cheese $ 5.25 BLT $ 2.99 Cheeseburger $ 4.95 Grilled Cheese $ 2.25 Hamburger $ 4.65 Grilled Cheese & Tomato $ 2.50 Chicken Salad $ 5.35 Grilled Cheese & Bacon $ 3.25 Grilled Cheese & Ham $ 3.25 Wrap Sandwiches Tuna Melt $ 3.99 Served w/Lettuce, Tomato, Fries & Onion Rings Frankfurter $ 1.75 Grilled Chicken $ 5.50 Grilled Chicken $ 4.95 Sliced Turkey $ 5.50 Egg Salad $ 3.25 Hot Pastrami $ 5.50 Crabmeat Salad $ 3.95 Corned Beef $ 5.99 Fried Haddock $ 4.99 Tuna Salad $ 5.35 Egg Salad $ 4.99 Hot Sandwich Plates Chicken Salad $ 5.35 Served with your choice of French Fries Crabmeat Salad $ 5.35 & Cole Slaw or Potato Salad & Cole Slaw Ham & Cheese $ 5.25 Grilled Rueben $ 5.99 Hot Pastrami $ 4.99 Weekday Dinners Served w/Potato and Vegetable Cold Salad Sandwich Plates Salisbury Steak $ 6.25 Served w/Lettuce, Tomato, Cole Slaw Roasted Stuffed Turkey Dinner $ 6.25 & Potato Salad Veal Cutlet & Spaghetti $ 5.99 Tuna fish Salad $ 5.35 Spaghetti with Meatballs $ 5.99 Chicken Salad $ 5.35 Liver & Onions $ 5.50 Egg Salad $ 4.99 Baked Meatloaf $ 5.50 Crabmeat Salad $ 5.35 Baked Sausage $ 5.50 Chopped Sirloin $ 5.99 Cold Salad Plates Ham Steak with Pineapple $ 5.99 Served w/Cole Slaw & Potato Salad or Chicken Fingers, Fries & Cole Slaw $ 5.75 on Garden Salad Roast Beef Dinner $ 6.85 Garden Salad $ 3.25 Franks & Potato Salad $ 5.50 Chicken Salad $ 5.35 Chicken Wings & French Fries $ 5.75 Tuna Salad $ 5.35 Franks & Beans $ 5.75 Crabmeat Salad $ 5.35 Fish Cakes & Beans $ 5.75 Greek Salad $ 4.50 Fried Haddock, Fries & Cole Slaw $ 6.45 Roast Turkey $ 5.95 Hot Turkey Sandwich $ 6.25 Chef Salad $ 5.50 Hot Roast Beef Sandwich $ 6.50 Steak Tips, Fries and Salad $ 6.75 Club Sandwiches Chicken. Teriyaki, Fries & Salad S 5.75 Triple Decker Sandwiches Served wl Chicken Kabob on Salad with Feta $ 5.99 Bacon, Tomato, Lettuce & French Fries Steak Kabob on Salad with Feta $ 7.00 Roast Turkey $ 5.35 Tuna $ 5.35 On The Side Ham & Cheese $ 5.25 French Fries $ 1.50 Cheeseburger $ 4.95 Cole Slaw $ 1.50 Hamburger $ 4.65 Potato Salad $ 1.50 Chicken Salad $ 5.35 Massachusetts Meals Tax 5 CITY OF SALEM BOARD OF HEALTH Establishment Name: a7_a/Prv7 Date: / L „? 9-o ✓ Page: / of Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified � d e_&54 a s Q 5 P:'qd G d . a vN4// as Ail r5aiD.11/LJotia .e c d I P era — it S c' cu // ija s e K�P✓Mrrrd — Or/ ti /C/S /cam/ 13 WX A -lams -1 de"✓Psr,/ w el 7�o (llOGr>SSCc� X� AjV/x✓ Discussion With Person in Charge: have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ElVoluntary Disposal LI Other: IJ Violations Related to Foodborne Illness Interventions and Risk Factors (Items 9-22) (Cont.) 14 Food or Color Additives 3-202.12 ladtiitives'k 3-30214 Protection from Una) roved Additives* 15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Oria nal Containers"' 7-102.11 Common Name-- WorkingContainers* 7-201.11 Separation - Storage" 7-20111 Restriction - Presence and Use 7-202.12 Conditions of Use* 7-203.11 'toxic Containers - Prohibitions" 7-204.11_ &Ijutizers,Criteria-Chenauds* 7-204.12 Chenocals for WashingPnxluce, Criteria'` 7-204-14 DrinR<'<ents.C:riter(a" 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides- Criteria* 7-206.12 Rodent Bait Stations* I? 7-206.13 'Tracking Powders, Pest Control and 3-403.11(A)&(I)) Monitorin, lb Proper Cooking Temperatures for PHFs 3-401A IA(1)(2) _ Eggs- 155'F 1.5 Sec. F =gs- hxuteediate Service 145'FSSsec* 3-401.11(A)(2) Comminuted Fish, Meats 8t Game Animals - I55'F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast -13WF 121 min* 3-401.11(A)(2) Ratites, injected Meats -155'F 15 sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Loehr , or Rati[es-165'P 15 sec. * 3-401.11.(C)(3) Whole -muscle, Intact Beef Steaks 145`F * __ 3-401.12 Raw Animal F__ocxls Cooked dl a Microwave 165'F * 340111(A)(1)(b) All Other PHFI,-1.45'F'15see, * I? Reheating for Hot Holding 3-403.11(A)&(I)) PHFs 165°F 15 sec. a' 3-403.11(B) Microwave- 165° F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 1.40'F* _ 3-40111(E) � Remaining Unsliced Portions of Beef Rossts" 1g Proper Cooling of PHFs 3-501..14(A) Coohne Cooked PfiFs from 140'F to 704:17 Within 2 Hours and From 70'F to 4t'F145°F Within 4 Hours. 3-501.14(B) Cooling PHFs Made Front Ambient Temperature Ingredients to 41'F145'F Within 4l"lours`" *Denotes critical item 111 tile: federal 1999 Food Code or 105 CMR 590.00(. 3-561.1d(C) PFIFs Received at Temperatures According to I,aw Cooled to 41" FI45°F Within 4 Hours. 3-501.15 Cooling Methods for PHFs PHF Hot and Cold Holding 3-501,16(B) Cold PIfFs Slaintained at or below Hot PHFs Maintained at or above 140'F. * 3-501.16(A) Roasts Heid at or above 1301F. Time as a Public Health Control 3-50L19 Time as a Public Ftealth Control* 21 3-M1,11(A) Unpasteurized Pre-packaged Juices and Beverazes with byaraing Labels* 3-801..11(f) Use of Pasteurized F;egs* 3-80,1,11{17} Raw or Partially Cooked Animal Food and F�m Raw Seed Snrouts Not Served. '% ?ackage Not Re -served. 22 3-603.11 Consumer Advisory Posted For Consumption of Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Elitninate Pathogens.* enern....... oz 3-302.13 Pasteurized Fggs Substitute for Raw Shell _ SPECIAL REQUIREMENTS 590F09(A)'(D) Violations of Section 590.009(A) -(D) in catering- mobile food, temporary and residential kitchen operations should be debited under the appropriate sections alcove if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 1(29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Critical and non-cridaxt violations, which do not relate to glee foodborne iflness interventions and risk factors listed above, can be found in the following se(. tions of the Food Code and 105 CMR SSk9Grn.Mdfi2s CITY OF SALEM BOARD OF HEALTH Establishment Name: bw✓ Date: //- ;?y-nV Page: -�2 of -" Rem No. Code Reference. C - Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY —/ Date Verified /j mor -' D I !'� k 600 l d S PS /Lt�JS� IJS� .�I _Li�J IA -11 I ( �J�� / /Se / Saw4 'Okis Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P 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 your food permit. 11 Corrective Action Required: ❑ No Q Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 3-202.12 Food or Color Additives Additives* 3-302.14 Protection fromUnaproved Additives* I5 Poisonous or Toxic Substances 7-10 L I 1 Identifying Information - Original Containers` 7-102.11 Common Name - Working Containers" 7-20'1.1I Separation - Storage* 7-202.11 Restriction -Presence and Use* 7-202.12 Conditions ofUse* 7-203.11 Toxic Containers - Prohibitions" 7-204.11. Samuzers,Criteia- Chemicals* 7-204.12 Chemicals for W ashine Produce, Criteria*� 7-204.14 Dr 9❑ ants, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11. Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations` 7-206.13 Tracking Powders, Pest Control and Monitoring* IS 'Doa otes critical item in the tMerai 199'i Food Code or 105 CMR 590. 000. 3-501.14(0) Proper Cooking Temperatures for 3-801 1.1(B) PHFs 3-401.11A(1)(2) Eggs- 155`F 1.5 Sec. 3-501.15 Egos-Lmttec6ate Service 145`F15sec* 3-401.1I(A)(2) Comminuted Fish, Meats & Game 3-501.16(B) Animals - 155°F 15 sec. ,x 3-401.11(B)(1)(2) Pork'. and Beet Roast - 130°F 121 min* 3-401.1 l(A)(2) Ratites, Injected Meats- 155'F 1.5 FC - 7 sec. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 20 Stuffing Containing Fish, Meat, 3-501.'19 Poultry or Ratites -165'F 15 sec. x' 3-401.11(C)(3) 'Whole muscle, intact Beet Steaks 145`1' * 3-401.1.2 Raw Animal Foods Cooked in a Microwave 165'F 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 sec. *` 3-403.118) M+uowave 165` F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTF Food - 140'F' 3-403.1.1(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F Within 21fears and From 70'F to41.` /457 Within 4 Hours. 3-50L14(B) Cooling PFIFs Made From Ambient Temperature higredients to 4l'F/45'F Within 4 Hours'r I 'Doa otes critical item in the tMerai 199'i Food Code or 105 CMR 590. 000. 3-501.14(0) PHFs Received at TtInperatures 3-801 1.1(B) According to Law Cooled to 3-801 11(D) 41`.F/45'F Within 4'Hours. 3-501.15 Coolin. Methods for PHFs l9 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41V45°F* 3-501.16(A) Hot Flips Maintained at or above. FC - 7 14WE 'l 3-501 16(A) Roasts Held at or above 130'F. 20 Time as a Public Health Control 3-501.'19 Time as a Public Health Control* 590.004(H) Variance Rcoluircruent REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beveraees with Warniue I :tbela* 3-801 1.1(B) Use of Pasteurized Fe,as* 3-801 11(D) Raw or Partialty Cooked Animal Ford and Raw Seed Sprouts Not Served. 3-901.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY JYG41fiL 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Either 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. l3isf�ai�si'fr7 (Items 23-30) Critical and non-critical violations, which do nor relase to the foodborne illness iarervenrions and risk fa fors listed above. can be found in the foilolt ing srcriolm of ahe Food Code and 105 CMR 590.000. Item Good Retail Practices Consumer Advisory Posted for Consumption of 73-603,11 Anhnal Foocls That are Raw. Undercooked or FC -2 Not Offiemise Processed to Eliminate 24. Food and Food Protection Pathogens.* `rr"n"` 3-302.13 Pasteurized Eggs Substitute for Raw Shell _ Eggs* JYG41fiL 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Either 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. l3isf�ai�si'fr7 (Items 23-30) Critical and non-critical violations, which do nor relase to the foodborne illness iarervenrions and risk fa fors listed above. can be found in the foilolt ing srcriolm of ahe Food Code and 105 CMR 590.000. Item Good Retail Practices FC 590.000 23. Management and Personnel FC -2 .003 24. Food and Food Protection FC -- 3 .004 25. Equipment and Utensils 26. W afer, Plumbing and W asie FC - 4 FC - 5 ! .005 .006 27. Ph slcai Faclliy FC - 6 1 .007 28. Poisonous or Toxic Materials__ FC - 7 .00II 29. _ S eciai Re uirements -. 30. Other ..009 55�92nn6acM1&rz Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health. 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741.1800 Fax (978) 745-0343 Name /��Q Da� ' T of Operation(s) Type of Inspection Food Service LJ Retail ❑ Residential Kitchen ❑ Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast I Permit No. ❑ FFjjAAutine Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address V �1 Lem Risk Level M Telephone Tyr 7 it Owner .1A�I GdreWAeAK/S HACCP YIN Person in Charge (PIC) .4714t1 Time In: Inspector I0 4,R&_,QTd4L)A4Out: 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 ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ' ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION' ❑ 88. Separation/ Segregation/ Protection [< Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C.. ,N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 5001nsp fFcr 14.dw F57 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR. HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signatur Print: PIC's Signature: Print: T"� �� Page/ of Pages V Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) Ll FOOD PROTECTION MANAGEMENT 590.003(A) Assignment of Responsibi,liry" 59{).003(6) �Bernon<txation of Knowledae* 2103.11 Porsonincharge-duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to 1p rmcc. with Food Law* 3-201.12 require reporting by foal employees and 3-201.1.3 Fluid Milk and Milk Products* applicants* Shell E,,,,s* 590.003(F) Responsibility Of A Foal Employee Or An 3 202-16 Ice Made from Potable Drinking Watar* Applicant To Report To The Person In Drinking Water from mt A unved System* 590.006(A) Charge* 590.006(B) 590.003((1) Re Cortin b Person in CharKe* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 5 1 Denote, critical Stem in the federal 1999 Frnxt Code or 105 ('MR 590.000. -♦ a g Food and Water From Regulated Sources � 590.004(A-B)C.t>_m 1p rmcc. with Food Law* 3-201.12 Food in a hermetically Smiled Container* 3-201.1.3 Fluid Milk and Milk Products* 3-202.,13 Shell E,,,,s* 3-202.14 E¢es and Milk Products, Pasteurimdr 3 202-16 Ice Made from Potable Drinking Watar* 5-101.11 Drinking Water from mt A unved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washine Fruits and Vegetables Shettflsh and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP L[sted Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Came Animals" 3-701.11 Receiving/Condition 3 ?02.11 PRFs Received at Proucr Tem rerxmres'r 3-202,15 Package lnteerity* 3-101.11 Food Safe and unadulterated Tags/Records: Shellstock 3-202.13 Shellstock Identification * 3-203.12 Shel'kiockIdentification Maintained* TagslRecords: Fish Products 3-402.11 Parasite Deshvction* 3-402.12 Records. Creation and Retention* 590.001(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and rf ices nt* Food Contact Seof & ui �rne Conformance with Approved Procedures',, lHACCP Plans 3-502.11. S eciahze 1 Processing Methods* 3-502.12 Reduced oxv9en tackagine, criteria" 3-103.12 Conformance with A coved Procedures* 1 Denote, critical Stem in the federal 1999 Frnxt Code or 105 ('MR 590.000. -♦ a g Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated flora Cooked and RTE Foods' Contamination from Raw Ingredients 3-30211(A)(2) Raw Animal Foods Separated from Each Other' Contamination from the Environment 3-30211(A) Food Protection* 3-302.15 Washine Fruits and Vegetables 3-304.11 Food Contact with Equipment and l.ltervat;k Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Waiewashing - Hot Water Sanitisation Iom.eratures* 4-501.112 Mechanical W arewashing- Hot Water Sanitization Tem eratm-es* 4-501-114 Chenticai Sanitization- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Food Contact Snrfaces and Utensils Clean" 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils" 4-702.1 i Frequency of Sanitization of Utensils and rf ices nt* Food Contact Seof & ui �rne 4-703.11 Methods of Sanitization -- Hot Water and Chemicals` 10 Proper, Adequate Handwashing 2-301.1 t Clean Condition- Hands and Arms* 2-30112 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Sating, Drinking of Using Tobacco* 2-401.12 Discharges From the Eyes. Nose and Mouth" 3-301.12 Preventing Contamination When Tasting, 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em rlo gees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca amities* 5-204.11. Location and Placement* 5-205.11 Accessibility, O' elation and Maintenmtce Supplied with Soap and Hand Drying Devices 6-301.1.1 llandwashing Cleanser. Availability 6-3()1,12 Hand Divin=Provision K CITY OF SALEM BOARD OF HEALTH Establishment Name: ,5 l.4c- l<my1t4xe Date:—/—O- 10 Page: Z of 2 Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R — Red Item Verified PLEASE PRINT CLEARLY 91 F%Pkv s S" Ns/1 • /16T�ycfrsc� Oi l�i�Lrt[b CtNTZ/=� +=Gt IdLI. 1dq 1^rAlW7zYV rCX17JAr . >4� 4 Sa N C.a~r, rikv. di@1�7�-- cs cf Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. (�• ❑ Voluntary Disposal ❑ Other: n Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 15 to " Denote& c ural ileisr in fire f�doal 1999 Food Code or 105 CMR 590.000- Food or Color Additives 3-202.12 Additives" 3-302.14 Protection from Unapproved Additives* 25. __ Equipment and Utensils 26. Water, Plumbin and Waste 27. Physical Facility Poisonous or Toxic Substances 7-101.11 klentifying Information -Original Containers* 7-102-11 CommonNarrte- WorkingContainers' 7-201.11 Separation - Still ae* 7-202,11 Restriction- Presence and Use`" 7-202.12 Conditions of Use* 7-20311 'roxicContainers- Prohibitions* 7-204.11 Sanitizets. Criteria -Chemicals" 7-204.12 Chemicals for Washine Produce, Criteriav" 7-204.14 Dein*. enrs.Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.'11. Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* " Denote& c ural ileisr in fire f�doal 1999 Food Code or 105 CMR 590.000- Proper Cooking Temperatures for E3-501.15 PHFs 3-401.1.1A(1)(2) Eggs- 1.55°F 15 Sec. 25. __ Equipment and Utensils 26. Water, Plumbin and Waste 27. Physical Facility Eggs- fnmrediate, Service 145'F15sec*' 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-801.11(C) Animals - 155'F 15 sea ' 3-401.1 l(B)(1)(2) Pork and Beef Roast - 130'P 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 sec. * 3-401-II(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. ^' 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F * 3-401.12 Raw Animas Foods Cooked in a Microwave 165°F * 3-401,11(A)(1)(b) _ All Other PHFs-145`F15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 sec, x 3-403.11.(B) Microwave- 165' F 2 Minute Standing Timex` 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-403-1.1(E) Remaining Unshoed Portions of Beef Roasts" Proper Cooling of PHFs 3-501. W(A) Cooling Cooked PHFs From 140'E to 70°F Within 2 Hours and From 7Wb to 41"Fi45"F Within 4 Hours. 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients, to 41'Fl45'F Within 4 Hours* " Denote& c ural ileisr in fire f�doal 1999 Food Code or 105 CMR 590.000- 21 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45`F Within 4 Hours. " E3-501.15 Cowling Methods for PHFs 19 PHP Hot and Cold Holding 25. __ Equipment and Utensils 26. Water, Plumbin and Waste 27. Physical Facility 3-50t.16(B) Cold PE1Fs Maintained at or below 590.004(F) 41'145°F* Raw or Partially Cooked Animal Food and Raw Sc'ed S rrouts Not Served. 'w 3-501.16(A) Hot PHFs' Maintained at or above 14WE * 3-801.11(C) 3-501.16(A) Roasts Held at or above 130°F. * 20 Time as a Public Health Control Pasteurized Eggs Substitute for Raw Shell 3-501.19 Time as a Public Health Control* 590.004(H) Variance Ke uirement 21 3-801.11(A) Unpastemized Pre-packaged Juices and Beverages with Warning Labels` 24. Food and Food Protection 3-801-II(B) Use of Pasteurized'Eg.,s* 25. __ Equipment and Utensils 26. Water, Plumbin and Waste 27. Physical Facility 3-80 1 A I (D) Raw or Partially Cooked Animal Food and Raw Sc'ed S rrouts Not Served. 'w 28. Poisonous or Toxic Mater 3-801.11(C) Una ened Food Pscka .e Not Re -served. CONSUMER ADVISORY 22 3-60;,11 Consumer Advisory Posted for Consumption of 24. Food and Food Protection FC -3 Animal Foods Mat are Raw. Undercooked or 25. __ Equipment and Utensils 26. Water, Plumbin and Waste 27. Physical Facility _ FC -- 4 _ FC 5 FC-6'007__-- FC Not Otherwise Processed to Eliminate 28. Poisonous or Toxic Mater FC - 7 Pathogens.* E1ei°`"A `;rnaor 29. S ecial Re uiremants ;9-302.13 Pasteurized Eggs Substitute for Raw Shell 30 Other Eggs* Violations of Section 590.009(A) -(D) in catering, mobile food, tetnporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under J129 - Special Requirements, (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors lived above, can he found in the following sections of the Food Code and 105 CMR 590.000. Item I Good Retail Practices _ 23. Mans, ement and Personnel FC FC --2 500.000 .003 24. Food and Food Protection FC -3 Ao4 25. __ Equipment and Utensils 26. Water, Plumbin and Waste 27. Physical Facility _ FC -- 4 _ FC 5 FC-6'007__-- FC 005 _ .006 28. Poisonous or Toxic Mater FC - 7 .008 29. S ecial Re uiremants .009 30 Other 45v0(<n',pM1Rk62.tlac >. l 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 SA-tcm 01tiag DateTypeof Igy O eration s Type of Inspection LZFood Service Retail El Residential Kitchen ❑ Mobile El Temporary ❑ Caterer El Bed & Breakfast Permit No. U -Routine [IRe-inspection�2 Previous Inspection Date: ElPre-operation ❑ Suspect Illness El General Complaint El HACCP ❑ Other Addressid L..uRIN(� t/� Risk M TelephoneLevel "jc�/ 79�� Ownerr J AMArr r4rr,9f*4,K,4fe r' HACCP YM Person in Charge(PIC) �� Time In: Out: Inspector 19/1•:119 Each violation cnecxea 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 ❑ 1. PIC Assigned/ Knowledgeable/ Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 88.. Separation/ Segregation/ Protection 91 Food Contact Surfaces Cleaning and Sanitizin() ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. CNi 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 6. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S5901nspectFomi610.tloc El 12. Prevention of Contamination from Hands P'-13. Handwash Facilities "PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) ' ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑18. ooling 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ;REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)I ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: 1D�dy Inspector's Signatur Print: PIC's Signature-.,�,L� Print: �"� f �� p t/ Page of Pages U � , Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 9 590,003(A) t Assignment of Resptnsibiliwy 590.003(13) I Demonstration of Knowled e* r2103.11 Personincharge- duties i ra M a a C EMPLOYEE HEALTH 590.003(0) Responsibility of the person in ahaige to - require reporting by foal employees and 3-201.12 a 7Fa'tnts* _ 590.003(F) Responsibility Of A Food Employee Or An 3-202.13 Applicant To Report To The Person In 3-202.1.4 Char -0 590.003(G) Reporting be Person in Charge- har ge-590.003(D) 590,003(t)) Exclusions and Restrictions* 590.003tE) Removal of Exclusions and Restrictions * lhnole, critical dein iii the federal 1999 Paul Code or 105 CMR 590.000. -� Food and Water From Regulated Sources 590.004(A -B) _Com 1p lance with Food Law*" 3-201.12 Food in a Hermetically Sealed Container" 7-201,13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.1.4 E>gs and Milk Products. Pastew'i zed'" 3-202-'16 fee Made From Potable prinking Water* 5-101.11 Drinkin,,\rater from mt A }roved System* 590.006(A) Bottled Drinkin, Water" 590.006(13) WaterMeets Standards in 310 CMR 22.0* Food Contact with Equipment and Utensils* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally CdughtMolluscan Shellfish* 3-20,1.15 Molluscan Shellfish From NSSP Irsted Sources* Reauned Foodand Reserviee of Food* Game and Wild Mushrooms Approved by Re utato Authortt 3-202.18 Shellstock Identification Present!' 590.004(07 Wild Mushnooms* 3-201.17 Game Animals* Receiving/Condition 3-202.11. PFIFs Received at Proper Temperatures" 3-202.15 Package hiregrity* 3-101.1.1 Food Safe and Unadulterated Tags/Records: Shellstock 3-20218 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* TagslRecords: Fish Products 3-1402.11 Parasite Destruction, 3-402.12 Records. Creation and Retention* 590.004(7) Labeling of Ingredients` Methods of Sanitization - Hot Waler and Chemical* Conformance with Approved Procedures lHACCP Plans 3-502.11. Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria - 8 -103.12 Conformance with Approved Procedures* * lhnole, critical dein iii the federal 1999 Paul Code or 105 CMR 590.000. -� Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from t ook til and RTE Foods* Contamination from Haw ingtocrents 3-302.11(A)(2) Raw Animal Foods Separated from Each Other" L3-E3O2.11(A) Contamination from the Environment 3-302.15 Food Ptoteetion- 1 Washing Frmts and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination f,�om the Consumer 3-306.1F4(A)(B) Reauned Foodand Reserviee of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food - Food Contact Surfaces . Manual Warewashin, - [Iot Water Sanitization "tem.eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tent reratures* 4-501.114 Chemical Sanitization- temp., pH, concentrationand hardness. 4-601-1](A) Equipment Food Contact Surfaces and Utensils Clean* 4-602 11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.17 Frequency of Sanitization of Utenaiis and Food Contact Snrt3ces of E uiEmenk* 4-703.11. Methods of Sanitization - Hot Waler and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condiuon- Hands and Aimi,* 2-30112 CleaninLProcedme* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, DrinkinE or Using Tobacco - obacco*2-401.12 240 t. 12 Discharges From the Eyes, Nose and Month* 3-301.12 Preventing Contamination When Tastin ^` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employee,* 13 Handwash Facilities Conveniently Located and Accessible 5.203.11 Numbers and. Capacities - a acities-5-204.11 5 -204.11 Location and Placement* 5-205.11 Accessibilij, O eration and Maintenance Suppiiod with Soap and Hand Drying Devices 6-301.1.1 Handwashing Cleanser. Availahilit 6-301.12 Hand Drvin Provision CITY OF SALEM BOARD OF HEALTH Violations Related to Foodborne fitness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 17 * [)enutec critical item ur file lateral 1999 Food Code or 105 CMR 590.004 Food or Color Additives 3-202.12 Addiflves* 3-302.14 _ Protection from Unapproved Additives* 19 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11. CommonName- WorkinnContainers* 7-201.11 Separation - Stora e* 7-20111 Restriction - Presence and Use't 7-282.12 Conditions of Use* 7-203.1.1 Toxic Containers - Prohibitions* 7-204.11 Sannizers, Criteria - Chemicals"' 7-204.12 Chemicals for Washing Produce, Criteria'" 7-204.14 Drying Agents, Criteria* 7-205.11 Incidental Food Contact. Lubricants's 7-206.11 Restricted Use Pesticides, Criteria* 7-286-12 Rodent Bait Stations' 7-206, 1 Tracking Powders, Pest Control and Monitoring* * [)enutec critical item ur file lateral 1999 Food Code or 105 CMR 590.004 Proper Cooking Temperatures for PRFs Received at Temperatures According to Law Cooled to `' 41'F/45'F Within 4 Hour s. PHFs 3-401.11A(1)(2) Eggs- 155'F 1.5 Sec. 19 E cgs -immediate Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(B) 590.004(F) Animals - 155'F IS sec. s 3-401.71(11)(1)(2) Pork and Beef Roast - 134°F 121 mm* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 3-501.16(A) see. * 3-401..1.i(A)(3) Poultry, Wild Game, StaffedPffl7s, Time as a Public Health Control Stuffing ContainingFish, Meat, 3-501.19 Poultry or Ratites -165°F 15 sec. 31 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks Variance Requirement 145`F * 3.401.12 Raw Aninad Foods Cooked in a Miorowave 165F * 3-401-11(A)(1)(b) All Other PHFs- 1.45'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 sea *' 3-403.11(B) Microwave- 165° F 2 Minute Standing Time" 1-403.11 (C) Commercially Processed RTE Food - 140"F 3-403.11(E) Remaining- Unslieed Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 148°F to 70"F Within 2 Hours and From 70°F to 41°F145'F Within 4 Hours. " 3-501.14(13) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F/45'F Within 4 Hourst * [)enutec critical item ur file lateral 1999 Food Code or 105 CMR 590.004 3-80 1 11(A) 3-501.14(C') PRFs Received at Temperatures According to Law Cooled to `' 41'F/45'F Within 4 Hour s. E3-501.'15 3-801.11(D) Coo lines Methods for PHFs 19 Uno cued Food Parka >e Not Re -served. PHF Hot and Cold Holding _ 25__ _ _ 3-501.16(B) 590.004(F) Cold P1IFs Maintained at or below 4l V45° F^ 26. 3-501 16(.A) Not' PHFs Maintained at or above 140'F. *` 27. 3-501.16(A) Roasts Held at or above 130°F. 20 Poisonous or Toxic Materials Time as a Public Health Control 20. - - 3-501.19 Time as a Public Health Control* 30. 590.004(H) Variance Requirement 3-80 1 11(A) Unpasteurized Pro -packaged Ruces mid Beverages with Aarning Labels" 3-801.11(B) Use of Pasteurized Eees* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. " 3-90t.11(C) Uno cued Food Parka >e Not Re -served. 22 3-603.11 Consumer Advisory Posted for Consumption of 23. - -- Management and Personnel_ Animal Foods `fiat are Raw. Undercooked or 24. Food and Food Protection Not Otherwise Processed to Eliminate _ 25__ _ _ and Utensils -Water, Pathogens.* srravo;:vzoa1 26. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 27. Ph sisal. Facility _ _ E gs, SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail Practices should be debited under 9f29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (.Items 23-30) Critical and non-critical violations, which donor relate to the foodborne illness interventions and risk factors Hazed above, can he hound in rhe following sections (I/ the Food Code and 165 CMI? 590.(X)6. Item Good Retail Practices FC 590.000' 23. - -- Management and Personnel_ FC -2 .003 24. Food and Food Protection FC - 3 .004 _ 25__ _ _ and Utensils -Water, FC - 4 'x..005 26. _ _ WaterPlumbin and Waste FC S 006__ 27. Ph sisal. Facility _ _ FC - 6 26. Poisonous or Toxic Materials FC - 7 .008 20. - - S eclat R uirements .009 30. Other sssnro„-saaza�, CITY OF SALEM BOARD OF HEALTH Establishment Name: .r1.iL&M &NAX- Date: /a Page:�of 3 Item No. Code Reference C - Critical item DESCRIPTIONOF VIOLATION / PLAN OF CORRECTION R=Red Item PLEASE PRINT CLEARLY Date Verified g- L/yA �F ( C Li S f Q i a f N /Jd *1 #W AtC----= .A rnn Ov- Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to 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 your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS I4 Proper Cooking Temperatures for Food or Color Additives PHFs 3-202.12 Additives" 3-501.16(A) 3-302.14 Protection from Unapproved roved Additives* 15 FC - 3 Poisonous or Toxic Substances 3-401.11(11)(1)(2) 7-101.1,1 Identifying Information - Original Containers* Ratites, Inject.'ed Meats -155'F 1.5 7-102.11 Common Name - Workin, Containers' 3-40111(A)(3) 7-201.11 Se.A7at10n-Stoi'itge" Stuffing Containing Fish, Meat, 7-202,11 Restriction - Presence and Use'' 3-401.11(C)(3) 7-202.12 Conditions of Use" 145`F * 7-20311 Toxic Containers - Prohibitions" 7-204.11 Sanitizers, Criteria - Chemicals,' All Other PRFs -- 145'F 15 sec 7-204.12 Chemicals for Washing Produce, Criteria* 3-40311(.0&(D) 7-204.14 Drvin A*ents. Criteria* Microwave- 165'F2,MioUt'eStanding 7-205.11 hicidental Food Contact. Lubricants* 3-403.1](C) 7-206.'11 Restricted Use Pesticides. Criteria* 1407 7-206.12 Rodent Bait Stations" 7-246.13 Tracking Powders, Pest Control and Monitarme, 18 ' Denotes critical item in the foderal 1999 Food Code or 105 CyW 590.000. 19 3-50, 1.14(C) 3-501.15 Proper Cooking Temperatures for 3-80J.II(B) PHFs 3-40'1.I1A(1)(2) Eggs- 155'F 15 See. 3-501.16(A) as- hmncdiste Service 14YFlSsec* 3-401..11(A)(2) -I Comnanuted Fish, Meats & Game FC - 3 Animals - 155°F 15 sec. * 3-401.11(11)(1)(2) Pork and Beef Roast - 130'F 121 min* 3-401.11(A)(2) Ratites, Inject.'ed Meats -155'F 1.5 28- 29. sec. * 3-40111(A)(3) Poultry, Wild Game, Stuffed PHFs, 30. Stuffing Containing Fish, Meat, Poultr or Ratites-l(i5'F 15 sau. * 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145`F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401.1 f (A)(1)(b) All Other PRFs -- 145'F 15 sec Reheating for Hot Holding 3-40311(.0&(D) PHFs 165'F 15 sec. * 3-403.11(B) Microwave- 165'F2,MioUt'eStanding Timex, 3-403.1](C) Commercially Processed I2TE Food - 1407 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501. t4(A) Cooling Cooked PHFs from.140`F to 70=1- Within 2 Hours and From 70'F to 41`F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F/45'F Within 4 Hours* ' Denotes critical item in the foderal 1999 Food Code or 105 CyW 590.000. 19 3-50, 1.14(C) 3-501.15 PHFs Received at Temperatures According to Law Cooled to 4]'F/45'F Within 4 Homs-" Cooling Methods for PHFs 3-80J.II(B) PHF Hot and Cold Holding 3-541.16(B) 590,00-1(F) Cold PRFs Maintained at or below 41`/45'F" 3-501.16(A) Hot PHFs Maintained at or above 140'R * 3-501.16(A) Rousts Held at or above 1.30'F. FC - 3 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.404(H) VarianceRe rnremelit 3-801.1 ](A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 3-80J.II(B) Use of PasteurizedEegs* 3-801,11(D) Raw or Partially Cooked Animal For- d and Raw Seed Sprouts Not Served. 3-801.11(C) Unopened Food Package Not Re -served. 22 3-603-11 Consumer Advisory Posted for Consumption of Animal Foods'That are Raw. Undercooked or Not Otherwise Processed to Eliminate 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 590 -009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary mid residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relaCino to good retail practices should be debited under #29 - Special Requirements. WZY'rokdw-.1ol (items 23-30) Critical and non-critical violalions, which do not relate to the foodborne diners irnerventions and risk factors fisted above., can be found in the following sec. tions of'the Food Cade and 105 CVR 590.000. Item Good Retail Practices FC -59d.000 23. _ ManaeLemeni and el Personnnel___.- FC-2 .003 24. Food and Food Protection FC - 3 .004 - 25. 26. 27. _ Equipment and Utensils Water. Plumbin and Waste Ph sical Facility FC -- 4 FC 5 FC -6 .005 .006 .007 28- 29. _ Poisonous or Toxic Materials S ecial R uiremants FC- 7 .008 .009 30. Other s5eo¢„rebs#a-z.anc ~,4 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat c! of Operation(s) T e of Inspection t[i Food Service ❑ Retail El Residential Kitchen ❑ Mobile Routine lRe-inspection Previous Inspection' N2 'r Address , a N 2 Risk Level i1 Telephone ElTemporary Date: 7/ ao-O.g k6A-si ElPre-operation OwnerHACCP Y/N � T nP5 ieaeoAlI ❑ Caterer El Bed & Breakfast ❑ Suspect Illness El General Complaint Person in Charge (PIC)Time In. [I HACCP Inspector GI!&61v13 V I• Out: Permit No. ElO herr Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties a EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION-�,�...:_ ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices _Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C'S N'. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S, MlnspUFOr 14,do ❑ 12 Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS a "` ❑ 14. Approved Food or Color Additives y._. ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)' t ❑ 21. Food and Food Preparation for HSP i.CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: InSWAr' at Print: 9 PIC's Signature: Print:.-� Page of v Pages J- J Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) so 590.003(4) Asm-rimentafRespoiAbiltt., 590.003(B) Demonstration of Know led e* 2-103.11. Pet son incharge -- duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by Plod employees and 3-201.13 Fluid Milk and Milk Products* a tlicants* Shelf Svgs* 590.003(F) Responsibility Of AFood Employee Or An 3-202.16 ice Made From Potable Drinking Water - ater*5-101.11 Applicant To Report To The Person In Drinkin Water from an A roved S stem* 006(A) Charge* _190 590.006(B) 590.003(6) Reporting b Person in Chaise* 3• 590.003(D) Exclusions and Restrictions* 590.003(E) Removal of Exclusions and Restrictions C C C ''Denoies critica I item in ilie rederrd 1999 rood Code or 103 Cvtit 590,000. 1 ♦_ PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590,004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shelf Svgs* 3-202.14 E<>�s and Milk Products. Pasteurized* 3-202.16 ice Made From Potable Drinking Water - ater*5-101.11 5 -10L 11 Drinkin Water from an A roved S stem* 006(A) Bottled Drinking Water* _190 590.006(B) Water Meets Standards in 310 CMR 22.0* _T201 14 Sholifsh and Fish From an Approved Source Fish and Recreationally Caught Molluscan Shellfish - 3 201.15 Molluscan Shellfish from NSSP Iisted Sources* Game and Wild Mushrooms Approved by Re Mato Authorit 3-202.18 Shellstock Identification Present* 590.004(0) Wild Mushrooms* 3-201.17 Game Animals* Receiving/Condition _T202 1 1 PHFs Received at Proper Tem eratnres* 3-202.15 Packatzc Inu it 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202,18 ShellstockIdentification * 3-203.12 ShelistockIdentification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention` 404(1) Labeling of Ingredients' Conformance with Approved Procedures /HACCP Plans 2.11S L ecialized Processin Methods 12 Redneed ox en tacks na. eriteria* 3.12 Confatmanee with A. roved Procedures* ''Denoies critica I item in ilie rederrd 1999 rood Code or 103 Cvtit 590,000. 1 ♦_ PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(]) Raw Animal foods Separated from Cooked and RTF Foods* Contamination from Raw Ingredients 3-302.11(.4)(2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-302.11.(A) Food Protection - rotection*3-302.15 3 -302.1 5Washing Fruits and Vegetabics 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) ; Returned Food and Reservice of Fo d* Disposition of Adulterated or Contaminated Food 3-701,11 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.,11 1, Manual Warewashing - Hot Water Sanitization Tem eratnres* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratnres* 4-501.114 CheniicalSanitization-temp.,fill. concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Faluipment Food - Contact Surfaces and Utensils'* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment' 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11. Clean Condition -Hands and Arms" _i-501 i2 Cleating Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eatin , Drinkmv or Usin- Tobacco* 2-101.12 Discharges From the Eyes. Nose and Mouth* _3-101 12 firerentin i,ontamination tiVhen'Pasfrn " 121 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Ent louses" 13 Handwash Facilities Conveniently Located and Accessible 5-203. i l Numbers and Ca aeities*° 5-204.11 S.ocation and Placement* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin Cleanser, Availability rf3(11i .1.2 Hand D g 'n Provision ,eJ ITY OF SALEM BOARD OF HEALTH Establishment Name: Date: i co'Page: of 1 -- Item Item No. code Reference C - Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified U! ..., . - _Aw i r: r ! a A /s" ne e - e Y Ae7,e /3 d T s✓ v i, ,1 /3 (/ / all✓2 t e-7 v,*f a �` 4e-- o� /mss ion With Person in Charge: ead this report, have had the opportunity to ask questions and agree to correct all Fhave s before the next inspection, to observe all conditions as described, and to 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 your food permit. a Q G3! i Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee RestrictionExclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 E 17 18 Drnote,, Critical item in the federal 1999 Foal Code or 165 CMR 5W.000. IN 20 !,♦- 3-501.M(C) Food or Color Additives 3-202.12 Additives* 3-302.14 Protection From Unapproved Additives* 3-501-16(B) 590.004(F} Poisonous or Toxic Substances 7-101.1 1 ldentiiyi ng Information - Original Containers* 7-102.11 Common Name- Working Containers" 7-201.1.1 Separation - Stora e* 7-202.11 Restriction - Presenceand Use•" 7-202.12 Conditions of Use* 7-203.11 7-204.11 'CoxicContainers- Prohibitions* Sanitizers. Criteria - Chemicals* 7-20'1.13 Chemicals for Washing Produce, Criteria` 7-204.14 Dryim, Agents. Criteria* 7-205.1.1 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.1.2 Rodent Bait Stations" 7-206.13 Tracking Powders, Pest Control and Monitoring, Drnote,, Critical item in the federal 1999 Foal Code or 165 CMR 5W.000. IN 20 !,♦- 3-501.M(C) Proper Cooking Temperatures for _ 3-501..15 PHFs 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-501-16(B) 590.004(F} E -s -immediate Service 145'1-- 15seer 3-401.11(A)(2) Comminuted Fish. Meats & Game ,animals - 155"F 15 sec. I` 3-401.1 l (B)(1)(2) Pork and Beef Roast - 1.30'F 121 min* 3-40 L I I (A)(2) Ratites, Injected Mears - 155°F 15 sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165'17 15 sec.. 3-401.1.1(C)(3) Whole -muscle, Intact Beef Steaks 145-F,: 3-401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3-401.11(A)(1)(b) All Other PHFs -'145°F 15 sec. Reheating for Hot Holding L403.1.1(A)&(D) PHFs 165'F 15 see. t 3-403.1l(B) Microwave- 165' F 2 Minute Standing Time* 3-403.1l(C1) Commercially Processed RTE Food - 140°F 3403,11(E) Remaining Unsliced Portions of Beef Roasts,' Proper Cooling of PHFs 3-i01.14(A) Cooling Cooked PHFs from 140'F to 7UT Within 2 Hours and From 70'F to41.°F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'FI45'F Within 4 Hours* Drnote,, Critical item in the federal 1999 Foal Code or 165 CMR 5W.000. IN 20 !,♦- 3-501.M(C) PHFs Received at Temperatures According to Law Cooled to 41'17/45°F Within Within 4 Harris. _ 3-501..15 CcnslingMethods for PHFs 3-801.11(D) PHF Hot and Cold Holding 3-501-16(B) 590.004(F} Cold PHFs Maintained at or below 41°/45° F* 3-501.16(A) 3-501.16(.x) Hot PHFs Maintained at or above 140'F. Roasts Held at or above 130'1. Time as a Public Health Control 3-501.19 Time as a Public Hcalth Control" 590.004(14) Variance ,Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-80111(x) Unpasteurized Pre-packaged auices and Beverages with Warning CONSUMER ADVISORY 22 Labels* 3-801.1](B) 'Use of Pasteurized E,ns* - 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Snouts Not Served. * 3-801.11(C) Unopened Food Package NotRe-served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of' Animal Focxls'rhat are Raw. Undercooked or Not Otherwise Processed to Eliminate pathogens.* r11,'u, ",vXn 3-302.13 Pasteurized Eggs Substitute for Raw Shell Etr Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness Interventions and risk factors. Other 590.009 violations relating to good retail practices should he debited under #29 -- Special Requirements. (Items 23-30) Critical and nota critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 C'MR 590.000. Is 11U c..nm [do -.:c -Nop KE HMD s Nk 7 s,Nk'j RErYeT'S/ I I� 8 Fjl/�PiJEZ 5?oJE 0000 0000 � fpµ IL P�SJ Ch%MI�F� A#4 64sT�ro+ /1, �K�SLLATUC I 4 lsM 1-1 TAFj,Lg SE�J%G �. Ta 131-E ZCE Tf:f�- 1 , u,ot, 200 _ F yr �v 1 wAZ/- E.C, -- Z j/ ® Q V aiT- Nand 0 0 0 0 xce.- '7.i 11 • ,Sar&,vlm-en ,- ZOr/may 14e 9 r � •� � rNFjT / I r � SiFlk 'D2Aw6 O O ['oFr-ex a?FrkB.c � G'PE<nJE�C j/ ® Q V aiT- Nand 0 0 0 0 xce.- '7.i 11 • ,Sar&,vlm-en ,- ZOr/may 14e 9 AUTO -CHLOR SYSTEM 140 WASHINGTONFOXBORO, MA Jbhnson Diversey, lnc. _ FOXBORO, MA 02035 � � Recap No./Ma k Center Customer Name: —. Add res City State: Zip: Customer No. Customer Service: lilMalMPRIIINJi` INVOICE I Invoice No. I 1 319401 1 Dishwasher Serial # _ Today's Meter Last Meter Reading Cycles Washed Racks/Cycle Racks Washed Dishwasher Reading Minimum Charge #1 $ #2 $ #3 $ Total Racks Racks Extra Racks Rack Extra Rack Charge Washed – ,Allowed.. — Washed x Charge — $ Dish Machine Products: — Product Name Pack Billing Product # Size Unit Ordered On -Rand Today Last Svc. Unused Amt. Amt. Used mis Units ExcessUnit Allowed Charge Unit(s) Net Price Amount Det. Rinse San. Det. J. Rinse San. Product Name Product# Pack Size _ .. Billing UnitUnused .... Amount Delivered Today Unit Price Net Amount 1.r Invoice Signature INVOICE TOTAL Sub -Total: $ Tax: $ ._ ... Fuel Surcharge: $ ;INVOICE TOTAL: $ TERMS & CONDITIONS t: Terms. THIS INVOICE IS EXPRESSLY CONDITIONAL ON ACCEPTANCE OF ALL TERMS SET FORTH HEREIN. THE TERMS OF THE, CONTRACT SHALL RE AS HEREIN SET FORTH. THE SUBSEQUENT EXECUTION OR SIGNATURE BY SELLER OF A PURCHASE ORDER OR.OTHER SIMILAkR i6 HASE AUTHORIZATION DOCUMENT FROM PURCHASER SHALL BE CONSTRUED AND INTREPRETED AS EVIDENCE OF ACKNOWLEDGEMENT OF RECEIPT OF SUCH PURCHASE ORDER OR SIMILAR DOCUMENT BY SELLER ONLY, AND; NOTWITHSTANDING ANY OTHER LANGUAGE, TERMS, OR CONDITIONS CONTAINED IN SUCH PURCHASE ORDER OR SIMILAR DOCUMENT, SHALL IN NO WAY BE CONSTRUED, INTERPRETED OR BECOME EFFECTIVE AS AN AMENDMENT OR MODICATION OF ANY OF THE TERMS AND CONDITIONS OF THIS CONTRACT. 'ANY ADDITIONAL OR DIFFERENT TERMS PROPOSED BY PURCHASER ARE REJECTED UNLESS EXPRESSLY AGREED TO IN WRITING SIGNEDBY AN AUTHORIZED REPRESENTATIVE OF SELLER - 2. Order' Cancellation, Product Returns. Order cancellatio roproduct returns are not accepted once Seller issues the bill of lading unless first approved by Seller in writing. Purchaser's failure to notify Seller of a damage or defect in writing within ten (10) days of receipt thereof shall constitute a waiver of all claims with respect to such goods or services and, in any event, the use of the goods or services shall be deemed to mean that the Seller has satisfactorily performed. �Plaanxxx�sD;ss. 3. r Claims for Sbortages and Allowances. Claims for shortages mast be supported with signed documentation and must be noted at the time of delivery on all carrier documents. Claims for allowances must be submitted within thirty (30) days of shipment. Purchaser agrees to reimburse Seller promptly for any allowance received without required performance. 4. P[IC¢s; Cba[g¢baekS. All prices/discounts/rebates are subject to change without notice. All general or special taxes, imposts, duties or penalties or other governmental charges fixed or imposed by any lawful authority upon the production, sale, shipment or delivery of the services or goods or upon the material from which they are produced and thereafter becoming effective within the life of this contract, shall be added to the price and paid by Purchaser. Seller reserves the right to charge back to Purchaser any detention charges incurred at the destination. There will be no penalties for late deliveries without Seller's prior written approval. 5. - Transportation. Seller shall select the mode of transportation, routing arid carrier for delivered orders. All less than truckload orders may be subject to pooling shipment scheduled at Seller's sole discretion. Seller reserves the right to pass on to Purchaser incremental costs incurred on order placements as a result of such orders not meeting Seller's order continuum order or other specifications for the applicable products. 6. Shipping; RISK Of LOSS. Unless otherwise stated on the reverse side hereof, the products shall be shipped F.O.B. Seller's facility. Risk of loss for, and title to, the product, shall pass to Purchaser when product is delivered to carrier for shipment, notwithstanding price is quoted "delivered". Seller shall retain a security interest in the product until Seller has received payment in fill for the product. - - - - 7. Disclaimers. EXCEPT IF, AND TO THE MINIMUM EXTENT, OTHERWISE REQUIRED BY APPLICABLE LAW, ALL WARRANTIES„CONDITIONS, REPRESENTATIONS, INDEMNITIES AND GUARANTEES WITH RESPECT TO THE PRODUCTS OR SERVICES FURNISHED BY SELLER HEREUNDER, WHETHER EXPRESS OR IMPLIED, ARISING BY LAW, CUSTOM, PRIOR, SIMULTANEOUS OR SUBSEQUENT ORAL OR WRITTEN STATEMENTS BY SELLER OR ITS REPRESENTATIVES OR OTHERWISE (INCLUDING, BUT NOT LIMITED TO ANY WARRANTY OR MERCHANTABILITY-, SATISFACTION OR FITNESS FOR A PARTICULAR PURPOSE) ARE HEREBY OVERRIDDEN. EXLUDED AND DISCLAIMED. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, SELLER SPECIFICALLY DISCLAIMS ALL WARRANTIES REGARDING THE PROFITABILITY, SUCCESS OR VALUE OF ANY PRODUCT OR SERVICE PROVIDED HEREUNDER I 8. Limitation Of Liability. NOTWITHSTANDING THE FORM (CONTRACT, TORT OR OTHERWISE) IN WHICH ANY LEGAL OR EQUITABLE ACTION OR CLAIM MAY BE BROUGHT AGAINST SELLER, SELLER SHALL IN NO EVENT HAVE ANY LIABILITY TO PURCHASER OR ANY OTHER PERSON FOR LOST PROFITS OR GOODWILL, OR FOR SPECIAL, CONSEQUENTIAL, INDIRECT, INCIDENTAL OR PUNITIVE DAMAGES. WHETHER FORESEEABLE OR UNFORESEEABLE, EVEN IF SELLER HAS BEEN ADVISED OF THE POSSIBILITY OF ANY SUCH DAMAGES. PURCHASER'S EXCLUSIVE REMEDY SHALL BE THE REPLACEMENT OF SUCH GOODS OR SERVICES OR ,AT SELLER'S OPTION,DAMAGES, PROVIDED, HOWEVER, IN NO EVENT SHALL SELLER BE LIABLE HEREUNDER FOR DAMAGES WHICH EXCEED, IX. THE AGGREGATE, THE PRICE ACTUALLY"PAID BY. PURCHASER TO SELLER FOR THE PRODUCT OR SERVICE WHICH GAVE RISE TO SUCH DAMAGES EXCEPT IF, AND TO THE\AUNLMUM EXTENT THAT, APPLICABLE LAW SPECIFICALLY REQUIRES OTHERWISE. SELLER NEITHER ASSUMES NOR AUTHORIZES ANY PERSON TO ASSUME FOR 1T'ANY O'T'HER LIABILITY IN CONNECTION WITH THE SALE OR USE OF THE GOODS SOLD OR SERVICES PERFORMED HEREUNDER 9. Force Maiere. In the event of war, fire, flood, strike, labor trouble, breakage of equipment, accident, riot, acts of governmental authority, acts of God, or other contingencies beyond the reasonable control of the Seller, interfering with the production, supply, transportation or consumption practice of the Seller at the time respecting the goods or services provided hereunder, or in the event of inability to obtain on terms deemed by Seller to be practicable any raw material (including energy source) used in connection therewith, quantities so affected shall be eliminated from Seller's obligations without liability, but the contract shall otherwise remain . unaffected. Seller may, during any period of shortage due to any of said causes, allocate its supply of such raw materials among its various uses therefore (e.g. manufacturing and sales) in such manner as Seller deems practicable and allocate its supply of such goods or services among such various users thereof m any nanner which Seller deems fair and reasonable. 10. Governing Law; Choice Of Formas. This contract and any disputes arising under or related thereto (whether for breach of contract, tortious conduct or otherwise) shall be governed by laws of the State of New York. without reference to its conflicts of law, principles. Any legal actions, suits or proceedings arising out of this Agreement (whether for breach of contract, tortious conduct or otherwise) shall be brought exclusively in the state courts of New York or the United States District Court for the Southern District of New York, and the parties to this Agreement hereby accept and submit to the.personal jurisdiction of these New York courts with respect to anv legal actions, suits or proceedings arising out of this Agreement. Any action brought by Purchaser must be commenced within one (1) year after delivery of goods or, completion of services, notwithstanding any 'statutory period of limitation to the contrary. This contract is not assignable by Purchaser.