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SEAPORT CAFE - ESTABLISHMENTSs -r, 0 0 i 4 U FORM 4009 YYY��� MAGE IN U.S.A. IMPORTANT MESSAGE FOR A. DATE U TIME M �i�C� `1 � 1 6A OF /� p PHONE "1 7 3 7 _7 3J /V K AR CODE NUMBER EXTENSION ❑ FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TD SEE YOU WILL CALL AGAIN WANTS TO SEE YOU MESSAGE SIGNED ,P/\, FORM 4009 YYY��� MAGE IN U.S.A. RUSH RETURNED YOUR CALL WILL FAX 70 YOU z i O i m I cn CITY OF SALEM BOARD OF HEALTH Date: April 21, 2010 Name of Establishment: Seaport Cafe Address: 215 Derby Street Owner: Greg Shea Phone: 978-335-1518 The proposed owner of this establishment Greg Shea presented a Floor Plan and Menu for review in accordance with the State Food Code. The floor plan is approved with the addition of hand was sinks in the prep area and bar as discussed. The preliminary menu is approved pending final menu and review with chef. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. A "Person in Charge" or "PIC' must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. Owner to forward copy of the Serve Safe Certificates to the Board of Health. FLOOR PLAN A Hand Sink must be located in each food prep and service area. A hand wash sink will be added in the food prep area and bar as discussed. The hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. The hand sink 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. A three bay sink and a dishwasher for washing, rinsing and sanitizing all utensils equipment, dishes will be available. The dishwasher must have a final rinse temperature of 180°F in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State Fruits and vegetables must be washed prior to preparation. All food must be held at 41 °F or lower, or 140°F or higher, at all times Food may not be added to containers in holding 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. The consumer advisory must be posted on the menu. o - 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. The owner must have an initial service and provide documentation of a monthly extermination contract prior to opening. 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 3rd bay of the 3 -bay sink and spray bottles 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. These must be clearly marked "sanitizer". Outside area of premises, including the dumpster area must be kept clean and sanitary. TRASH Trash must be kept in appropriate trash receptacles and a grease barrel must be used to hold discarded food grease. The trash area must be kept in a clean and sanitary manner. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. Please submit final menu for review and approval prior to the opening inspection. Please call one week prior to opening to schedule an opening inspection. David Greenb um Date Acting Health Agent Date SEAPORT CAFE 215 DERBY STREET MENU CONCEPTS Fast casual dining for breakfast lunch & dinner. Hot & cold beverages including coffee, soda, water & beer & wines; Hot & cold breakfast including muffins, bagels, eggs, French toast, pancakes, fresh fruit, etc; Hot & cold lunch sandwiches and plates, wraps, soups, chowders, salads, etc; Fried clams and fish, pasta sautes, grilled steak, chicken & seafood; Ice cream, frozen ice & drinks and related desert items. VAR Massachusetts Department of P Division of,Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT I;. Health Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name D to T a of Operation(s) T e Inspection outine e -inspection Previous Inspection Date: E] Pre-operation ❑ Suspect Illness ❑ General Complaint Food Service ❑RetailR El Residential Kitchen El ❑Temporary ❑ Caterer ❑ Bed & Breakfast Address O , Q x� Risk Level Telephone /� 1 I I Owner HACCP YM Person In Charge (PI Time AA 19A Inspector Out: O Permit No. [-] HACCP ❑Other ea�cph vlolatio necl(e requires-ananation on the narrative page(s) and a citation of specific provision(s) violated. l Non-compliance with: VP ations Related to Feed orne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require. immediate corrective 590.009( E) 90.009 (F) action as determined by the Board of Health. 1, y,, P V J c. O�., OOp PROTECTION MANAGEMENT r,. inq El12. Prevention of Contamination from Hands 1. PIC Assigned /Knowledgeable /Duties 13. Handwash Facilities `EMPLOYEE HEALTH„ �, _ r �..,a' ...._.4_". -..ION R ®.EMICAL.®.m.�,..�, -. .._. PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded r ---D -- - --- - mss -- - POOFROA M.PPROVED_SOURCE�,���-®�� � ❑ 4. Food and Water from Approved Source ❑ 15. Toxic Chemicals TIMEIIEMPERATURE CONTROLS (Potentlally Hazardous Foods E] 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling tPROTECTION CO FROM NTAMINATION --7:: i 0 /9 19. Hot and Cold Holding 8. Separation/ Segregation/ Protection _a R6� (/ ❑ 20. Time As a Public Health Control �{{ cX 9. Food Contact Surfaces Cleaning and Sanitizing [REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONg-(-. SP) U [:3 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices �C-ONSUMER ADVOR ISY:. r G� 22. Posting of Consumer Advisories 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) Q 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 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 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE -INSPECTION: Ut`5-:501Wn eOFm 14d. Inspector's Signature: 6 �,j w Print: - PIC's Signature: Print: ENd2 Pagel orc3l;,pages M Violations Related to Foodborne Illness Interventions and Risk Factors (items 122) FOOD PROTECTION MANAGEMENT 1 590.003(A)Assiv tment of Res tonsibility* 590.003(B) Demonstration ofKnowledge* 2-1.03.11 Person to 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 lee Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved S. tent* 590.006(A) Charge* 590.006(B) 590,003(i3) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions Im B in FOOD FROM APPROVED SOURCE * Denotes critical item in the federed 1999 Food Cade or 105 CMR 590.0(10. C PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(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 Products, Pasteurized* 3-202.16 lee Made From Potable Drinking Water* 5-101_'1,1 Drinking Water from an Approved S. tent* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 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* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Re ulato Authord 3-202.18 Shellstock Identification Presem*' 590.004(C) Wild Mushrooms* 3-201.17 Came Animals* 2-301.14 Receiving/Condition 3-202.11 -PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Foci Safe and Unadulterated TagslRecords: Shellstock 3-202.18 Shellstock Identification 3-203.12 Shellstock Identification Maintained* 12 Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients* Handwash Facilities Conformance with Approved Procedures (HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.1.2 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federed 1999 Food Cade or 105 CMR 590.0(10. C PROTECTION FROM CONTAMINATION 9 Crass -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* 4-501.111 Contamination from Raw Ingredients 3-302.1I(A)(2) Raw Aminal Foods Separated from Each . Other' Mechanical Warewashing- Hot Water Sanitization Temperatures*. 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* 4-602.11 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reserviee of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food"` 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures*, - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures*. 4-501-114. Chemical Sanitization- temp., pH, concentration and hardness. * _ 4-601.11(X) _ 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 2301.11. Clean Condition - HandsandArms* 2-301..1.2 Cleaning Procedure* 2-301.14 When to Wash* Ll Good Hygienic Practices 2-401..11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* , 3-301.12 Preventing Contarnination When Tasting* 12 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 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision G vv -(aL-� CITY OF SALE BOARD OF HEALTH Establishment Name 'M X,26k l Date Page: of_ Item U Cone C — Crltteal Item I��aN +J DESCRIPTION OF VIOLATIO / PLAN OF CORRECTION _ Dat No. Reference R — Red Item - PLEASE PRINT CLEARLY Verified 1 " n n n 1r�[ __ coo AAA f .r IN l.anA � 9 L2v r I 'l� iJJ Aa._, u%ZcQ' oa�?/1rr U�(tQ 00Q,I o i rt R r o . ) _.m 11 U.A" /-i" roOA .G/V 'PVAtYLi N , � r 1 a r� r r,. — Discussion With Person in Charge: Corrective Action Required: ❑ No ta- Yes . I have read this report, have had the opportunity to ask questions and agree to correct all tr Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to �Re-inspectionScheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand thatt,� �� noncompliance may result in daily fines of twe —e rs or suspension/revocation of your food permit. //`/fio -Embargo / � � I v❑ Emergency Closure C3 ik ❑ Voluntary Disposal ❑ Other: i M Violarians Related to Foodborne illness hiremendons and Risk Factors (ftems1-22) (Cant.) Im 16 TIMEFTEMPERATURE Additives 3-202.12 1 Additives* 3-302.14 Protection from Unapproved Additives" 501.16(11) 590.004(17) Poisonous or Toxic Substsnces 7-101,11 Identifying Information - Original Containers* " 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Stora i` 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.1.2 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* 7-206A2 - Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and onitorin *- Monitoring* . . C Food or Color TIMEtTEMPERATURE CONTROLS Denoeg critical imm in the federal 1999 Fecd CWv a' IV Cabn2390.000. C 3-501.14(0 Proper Cooking Temperatures for 501..15 PHFs 3401.11A(l)(2) Eggs- 155'F 15 Sec. 501.16(11) 590.004(17) E immediate Service 145'F15sec* 3401.11(A)(2) Comminuted Fish. Meats & Game 3-501. k6tA) Animals - 155'F 15 sec. * 3.40111(11)(1)(2) Port: and Beef Roast -130'F 121 min* 3-401-11(A)(2) Ratires, Injected Meats -'155*F 15 590.004 H) sec. * 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, i FC --6 Poultry or Ratites -165017 15 sec,* 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks FG- 7 145°F i` 3-40132 Raw Animal Foods Cooked in a Microwave 165F * 3-40Ll I(A)(1)(b) All Other PHFs -145'F 15 sec. Reheating for Hot Holding 3-403-11(A)&(D) PHFs 165-F 15 sec. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Time* 3-403.11(C) Conttnercfally Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Ccxiked PHFs from 141YF to 700F Within 2 Hours and From 70'F to 4VF/45°F Within 4 Hours. * 3-501.14([3) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F/45°F Within 4 Hours* Denoeg critical imm in the federal 1999 Fecd CWv a' IV Cabn2390.000. C 3-501.14(0 PHFs Received at Temperatures According to taw Cooled to 41TF/4_5°F Within 4 Hoam 501..15 CuolinR Methods for PRFs 3-801.118) PHF Hot and Cold Holding 501.16(11) 590.004(17) Cold PHFs Maintained at or below 410/45' F* 3-501.16(A) Hot PHFs Maintained of or above 140°F. 3-501. k6tA) Roasts Held at or above 130'F. 1 25, Time as a Public Health Control 3-501,19 Time as a Public Health Control* 590.004 H) Variance Requirement REQUIREMENTS FOR HIGHLY' SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnin labels* 1590.000 3-801.118) Use of Pasteurized E * FC -2 3-80L I I (D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Food and Food Protection 3-801AI C Unopeped.Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 ConsumerAdvisory Posted for Consumption of 1590.000 (.23, Animal Foods That are Raw. Undercooked or FC -2 .003 Not Otherwise' Processed to Eliminate Food and Food Protection I FC -3 Pathogens.* t `irv`( 1 25, 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 i ! 26. Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile Forel, 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-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sectionsof the Food Code and 105 CMIR 590.000. �rhsm 1 Goad Retail Practices i"FC 1590.000 (.23, 1 Manaoament and Personnel FC -2 .003 f 24. Food and Food Protection I FC -3 .044 1 25, 1 Equipment and Utensils i FC -4 .005 i ! 26. Water. Plumbingand Waste i FC -5 .006 1 27. i Ph stcal Facil i FC --6 .007 L2 _ Poisonous or Toxic Materiais' FG- 7 .008 29 LSpectaj R uirements i Other V Commonwealth of Massachusetts e City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2012 ESTABLISHMENT NAME: Seaport Cafe File Number: BHF -2003-000005 215 Derby Street Salem MA 01970 LOCATED AT: 0215 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2012-0257. Jan 1, 2012. Dec 31,2012 $420.00 ESTABLISHMENT• Total Fees: $420.00 PERMIT EXPIRES et:ember 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 IClNfBERLEY DRISCOLL j\L\YOR CITY OF SALEM, MASSACHUSE'n'S BOARD OF HE.iLTH 120 WASHINGTON STREET, 4"' FI.()t>R TEt- (978) 741-1800 F_\x (978) 745-0343 lrarndinrni -leen conn LARRY RA MDIN, RS/RFI IS, CI 10, CP -I,\ FII:.\I:1'I I A(;IiN•1• 2011 -APPLICATION FOR PERI NAME OF ESTABLISHMENT_ ADDRESS OF ESTABLISHMENT oC( MAILING ADDRESS (if different) EMAIL -Business': )'k;Irefd'r, Q r��� OWNER'S NAME 'ry �tr f ADDRESS 2�c ai STREET CERTIFIED FOOD MANAGER'S NAME(S) (Required in an establishment where potentially hazardous food is pret EMERGENCY RESPONSE PERSON GrC V.( S�{( DAY,S:OFOPERATION I =Monday Tuesday Wed HOURS OF OPERATION 7-- Please write in time of day. ! RETAIL (Outdoor Stationary Food Cart YES NO ES NO ------------ BED/BREAKFAST/------------------- -- IT RATE A FOOD ESTABLISHMENT �7 _ TEL #T(�) J 1 � FAX # Website: . C a--, TEL # 0"j a TEL At less than less 1000-10,000sq.ft. more than I0,000sq.ft. =$ 70 =$280 =$420 - less than 25 seats =$140 - 25-99 seats =$280 more than 99 seats =$420 ----.._...ter, . 1J------------------------------------------------... - - -------------------------------- MAKE not just serve) ICE CREAM, YOGURT/SOFT SERVE YESNO TOBACCO VENDOR $25 ALL NON-PROFIT (such as church kitchens) YES NO i$135 YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL C pier 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and ai all s e taxes required under the law. Z1r I'r%l r Date/ Updated 52 1 FOODAP2ll1 l.adm Check# & Date Social Securitvor 11 •- EyYTic Providers of Healthcare To:�� _- y Fax:' Phone: / Re:-WuI ❑ urgent `60r Review C 7f Zia LJDh��i Aqke =rt�d� P ?l/ Confidentiality Notice: The documents accomp The information is intended only for the use of d recipient, you are notified that any disclosure, col contents of this telecopied information is not pen us by telephone at the number above to arrange IS I•d I A�^+ 1P41fr' (3 A=EE E-rERr: LLC. g Vii, G'6'VGJ 1t'%1y!)'"'gr1 �E'.CCYt c11 C'iUst Street, Peabody MA. 01960 - (978) 977-0717 - and Bilingual Food Safety Programs 2a s ��y Sl e, Situ iYl�i�1 v(9� From: Grace Mardns RN Pages: Date: U /6 % 20l b CC: Please Comment ❑ Please Reply S4 (a ' c( UPJ 6 4 lqv�(��ti2�(r9/f�� )v1 `l�H Lt$� L �Ga • �i�C� a h� q r im 6l�m %J tying this telecopy transmission contain confidential information. individuals or entity names above. If you are not the intended ing, distribution or taking of any action in reliance on the ssible. If you have received this telecopy in error, please notify return of the original document. Thank You. XU --J 13Ca3SH-I dH WUajr:Tl oloa 9T unC r Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 06/17/2010 ESTABLISHMENT NAME: File Number: BHF -2003-000005 LOCATED AT: IGmberley Driscoll Mayor Seaport Cafe 215 Derby Street Salem I MA 01970 0215 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0451 Jun 17, 2010 Dec 31, 2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES D ecember 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 .w 0 t� CITY OF SALEM, MASSACHUSETTS BOARD OF HE.AI.fH mr� 120 WASHINGTON STREE r, 4" FLOOR. TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR DGREENBAUI,ICsALEbI. COM DAVID GREENBAUM, ACTING HLEAI:;fH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Seaport Cafe TEL # 508-527-3031 (temp) ADDRESS OF ESTABLISHMENT 215 Derby Street FAX # MAILING ADDRESS (if different) EMAIL - Business': cgshea@comcast.net Website: OWNER'S NAME Derby Partners, LLC - Cynthia J. Shea, Manager TEL # 508-527-3031 ADDRESS 31 Prince Street Beverly MA 01915 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON Gregory Shea HOME TEL # 978-969-1470 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION i lam -lam Please write in time of day. 7am-lam f lam -lam { 7am-lam { 7am-1am 7am-lam 7am-lam (For example I lam-1lpm) TYPE OF ESTABLISHMENT RETAIL STORE NO RESTAURANT YES (Outdoor Stationary Food Cart $210) BED/BREAKFAST/ CREAM, YOGURT/SOFT SERVE ALL NON-PROFIT (such as church kitchens) FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 $100 X NO $25 W336X NO $135 )M 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 fled all state tax retulnsr nd paid pII state taxes required under the law/ Signature Revised 4/24/07 FOODAP2008.adm Check# & Date 0 .Gd -f—(.L — Social Security or Federal Identification Number J, CITY OF SALEM BOARD OF HEALTH Establishment Name: CY no � ('f_14 Date: 1(1'-7 r) Page: of Item No. Code ReferenceR C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION 14� 4 Ali 4, Y�' PLEASE PRINT CLEARLY Date Verified A--- Y -N c-oiduriqj a"d -M-0 l­`Pr)11'-)1'kq_1'A-7 _F &im' h -e c)M V6KT_s �,'v__ r j —HA_Va,i nrlclr *D V i r+IC Y1_7D0 P V 4,-,)( fwC(-4 ,-rt (-I (P ti POA ,,,/ Vim, V'c4s4�Z,"W" z'- 72/"N 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-FoQd Code. I understand that noncompliance may result in daily fines of twen!t ive dollarsfor suspension/revocation of your food permit. Corrective Action Required* No, 0 Yes 0 Voluntary Compliance 0 Employee Restriction Exclusion L] Re -inspection Scheduled zi Emergency Suspension 13 Embargo 0 Emergency Closure 0 Voluntary Disposal L:l Other: f Violations Related to Foodborne Illness Interventions and Risk Factors (Ilems, 1-2�) (Cont.) PROTECTION FROM CHEMICALS orCalorAdditives 3-302.14 —4—Froteenon from tPoisonous or Toxic Substances '7161.11 i identifyinc Intoi mation - -Original-- -1 102,111 1 Corainon Namc, Worioin, Coataowns* 7-201. 11s -Su) - 7 -TO I �Rut aLion I 7-20311 1 Toxic IT 7-20-4,14DrvingA,estr. T—i6:�71 Iniad ntal 7-206.12 j Rixiew Bmt sunions� 1 206,13 l Pricking flot%der;, Pesi Control an TIMEITEMPERATURE CONTROLS 16 T Proper Cooking Temperatures for PHFS JIA(l)(--,) ('yys. 15,5'F 15 Swc. -�Z, servicv 145�'F]5sec, 71 Conitunutcd Fish, Meats & Game Amatals 3 4G �11 1(13)j 1 )(2) I Porkan- BtefRuam 130"F 12l atin* 3-4-`51-1'1(X){2} jR�ntitei, Injected fkltatS -- 155°F I 3401-11(A)()) llonitr), Wilds tme,Siolfed 111-(Fg, Stuffing ContaiinnlFishMeat, �Pllltllly or Rotnes--1-65"1, 15 see, 3-401,11(C)(3) BaJ Sleak's 3-0112 Raw Animal Po(xh Calked in a Microwave 165OF * 3-401 11 (A )(1)(b) All OthtT 111fl--i -- I .45'F 15 sec 17 Fieffeating for Hot Holding zi—, 165'T 15 sec. 403,17(5) cmave l65'f-'2'MinuwSlandin,, Tnve4' Cornuierciatb/ Processed RTE Food 140'F� 3-403A 1(F) IRemaining, Um4kvc] Pordom!, of ficef I Roast.,* 14(A) Cocifirig Cooked PHF's from 140'F to 70°F' Within 2 Hours and From 79"T 14(b) Cooling PHFN Nbide Fosu Ambient Temlicratore lngrxdictas too] 17745'F 1949 Fond Coit (�r 165 ( IMR590400 3-501 )4(C) PRFs Received ,,nTemperatures I ,According In Lain Cooled to I 41'Fol.5FWiflon"Hitters_ 3-501,16(B) I Cold PHFs Maintained at of below, 3 fl)1,16(A) Hot PHFc maintained at It- above 40 at �oxx Health CI -10 I Tim, ;apub,,c is t Time as a Public Health Control i064' Variance 3-80 1 � I I(R) .!�e of pa,tell Raw S 3-901A JC) I Un qienad Pkxd Packaiw Not ]Reserved. 22 1 3 11 CorWnlai fitoiso ry Posted for ('01cizaription d An [ iilwl I �xxls That are Raw, Undercooked or Not (;dajw ,nviw Pness�,d to Eliminate K�qte�inzd EwSobstkfne fa Raw Shell Vjolafions of Section '590,(X)9(A).(D) in catering. mobi1c. IcW, temporaf v and rcsideroial kitchen operations should he debit under the appropriate aections above if rchi[M to Ib<Aix)rnc illness nteivetitions and risk factors Other 590.0{)9 violations relating to 2ood retail pict5cea ah on Id be debited under #29 - Special Requirentents- (Henis 23-30) Criacal and non-(dlwai viotediont, which do net r4are jo 1116 ,foodborne elhwss bnn voilionswuh okfiulors Lvied above, (on br, finvia in ihefi,,Xou ing ser twi,s o'l,hG Food Code and 105 CMR CITY OF SALE BOARD OF HEALTH Establishment Name: P C; fn -3 - ' (\� Date: 6 (I'S /to Page: of Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION ... '..Date PLEASE PRINT CLEARLY : Verified Y1�C/, /t nh��\At l I C-1�CI -his IP(D I n ")I IA/PPP Vl, iii i f.11J1�D \1ADVi 1�V1f��P./C� P fn rI �1\ -lLic 76'\�01n cii'tk- n'irl rlri7 '6 i1ni1J 1 K�O V t f� o --kt o vo'-wy () re yr f r o C JM (-n -7 P �nl)Incn 1i, G r ri i f o ea U J — — I ,11 COV 2Y fel 1 -"tr.li�r�n r,1 P/c (M, �� ?P t14 i _ _ I - tor"D k'i P`&-9 r vL1i cx t oh r- ,1-IVrA r t Dr,0� t!, k i.3 r r �r ewr� A 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 t'_wenty-five dollars or suspension/revocation of your food permit. // C� �^ � � q � � Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: TT U - Violations Related to Foodborne illness interventions and Risk Factors (/Joins 1-221 (Cont) PROTECTION FROM CHEMICALS 14 or 15 16 f7 for t t Food Color Additives_ ?-2{)2,12 _� v Arldrhves' 401 tA)k2 3-302.14 41'P/45"F Within 4 Hours. > Protection from Unapproved Additives` it N4 ard l3 ei Roiiei- l ! l 1�1 Joint 3-dULe'CA}`c"; Poisonous or Toxic Substances PHF Hot and Cold Holding 7-101.11nttt}mg 3-401.1kAriIll ide Intntolmatta 'On ,nal j -401.11(B) t fit f�Rn Coni It 3n� F'o; , E 1 Contac r. ._ _... i--------- -(}i.f til' t-102 1 I — — t +� ! Common \ tm� 4t,xkt t+� C mt inn r._ 140"F. 20 t. i I 4o F 55om tion Sit aR _ - - 1-103 1101 ' 202.11 Time as a Public Heatth Control Rt tnu on - Pr ne- futd L ,� 7-202.i2 7203.11 C'rndniomofi_tse; .� Tom Conttmet Prohshi,.iory ! 7-204.11-�—} 7mnuzuti Cxitcn+ Chu tic iti 7-20412 Chunk tit for #i tih'Ifee, 204,14 }_ m!n_Aentc. Crnwtlf` _. 705,11 hind nt tl t xxi t vera t. I ubi to tnl5 ` Ltb�l Rea, i a 1 ,�. Ye tete. Cit a t._-—_-� ` 7-206.12 RiKiCrt BJO SLA10n. Izmtra aid for I Proper Cooling of PHFs - lt(;1_ IA{A} j-Cal"m. C'twi,.d PHl f=net 1 ! = ttt `;`F Within 2 !four' grid From 70'F P lA ttl :n y Hem . " -_11 3 iJl it6ij� t �rhn PPCF M1l tdc Front lmhteix F nl rause to ad.eaat� tt, 4 t ld5`F 1v,tt n 4 Hctttr �1) ,_s °r-i7"yet i, If, L:,6n 1 I"ns=. A t t PHF's Received at Temperatures `ntmc cit« Sc rt�icc 1 5 tl5sec� _� � 401 tA)k2 C orriw lttil(t FiA #teat d Ozimc 41'P/45"F Within 4 Hours. > w.. it N4 ard l3 ei Roiiei- l ! l 1�1 Joint 3-dULe'CA}`c"; t k� is . htzcc.r+}1t%tta- 1 `j'I'� i` PHF Hot and Cold Holding OCic 3-401.1kAriIll -�J' a r, Wild Canc.Stai`uIPI frs, j -401.11(B) t fit f�Rn Coni It 3n� F'o; , E - ._ _... i--------- -(}i.f til' � L`n .qi. .1. Im-G' I Proper Cooling of PHFs - lt(;1_ IA{A} j-Cal"m. C'twi,.d PHl f=net 1 ! = ttt `;`F Within 2 !four' grid From 70'F P lA ttl :n y Hem . " -_11 3 iJl it6ij� t �rhn PPCF M1l tdc Front lmhteix F nl rause to ad.eaat� tt, 4 t ld5`F 1v,tt n 4 Hctttr �1) ,_s °r-i7"yet i, If, L:,6n 1 I"ns=. A t t PHF's Received at Temperatures 'n}o�ty, {iXYCI, temporarV and ' t;'tili; i According to Law Cooled to ' .el3ti 6C _ 41'P/45"F Within 4 Hours. > w.. it _ Coolimc Methods for PHFs t RLheaGny for nrft tiaid�ny PHF Hot and Cold Holding OCic F3) Cold BHFs Maintained ined at K below j -401.11(B) Nli,:n v,vt: lis' i_-, NI'mit ;t'..:triding. E 3-501.16(A) ----11 I lot Ph3 HFs aintained at or above I�rhi- 140"F. _ 4o F Ro;o;ts Held at or above 1301 , 'r 1-103 1101 Rut mri,,, Lntiled Poitit.s of B(,0 Time as a Public Heatth Control Public H.ia1 h Contralx —� I Proper Cooling of PHFs - lt(;1_ IA{A} j-Cal"m. C'twi,.d PHl f=net 1 ! = ttt `;`F Within 2 !four' grid From 70'F P lA ttl :n y Hem . " -_11 3 iJl it6ij� t �rhn PPCF M1l tdc Front lmhteix F nl rause to ad.eaat� tt, 4 t ld5`F 1v,tt n 4 Hctttr �1) ,_s °r-i7"yet i, If, L:,6n 1 I"ns=. A REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 1 Unpa;tcut ized Pre-packaged Juices did 3-80! 1413) } i :c o Pa iti to <d I t t k 11 1 I{t)) 13cui+ ttr Patti til f tKth d In ileal [txal and Ra Si d �riuts \c Sc.tvca 1 Iltf t� i ... iT„<. rt..L t.t, k',1) ..,.,.t e 2' j 3 {tb> 1 s 1 C'untm t [ 1it�;sott ilnvt'd for (ot suatpmon tai f v iw,)] t 'rd that c fi t - Utt 9erux�}:ed tsr �Not tc tolllim6nate -it) j l l sreert ' I g �1 S fhs tettty ler Riw Shell , i -noir 5S 1 �x 9G4j-, t}j _ il I um "10 V1H 9 PHF's Received at Temperatures 'n}o�ty, {iXYCI, temporarV and ' t;'tili; i According to Law Cooled to ' .el3ti 6C _ 41'P/45"F Within 4 Hours. > lat:rd 3.xrSiiorn ��: 's 3-5(11.15 _ Coolimc Methods for PHFs 19 't:!,ii ._ Ll'. tkili.: PHF Hot and Cold Holding OCic F3) Cold BHFs Maintained ined at K below 590,(N Sy0.IN)4(4(F) 41 °/45`> [ � 3-501.16(A) ----11 I lot Ph3 HFs aintained at or above 140"F. _ ' Ro;o;ts Held at or above 1301 , 'r 20 Time as a Public Heatth Control Public H.ia1 h Contralx —� bar once 2ceonirunctt+ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 1 Unpa;tcut ized Pre-packaged Juices did 3-80! 1413) } i :c o Pa iti to <d I t t k 11 1 I{t)) 13cui+ ttr Patti til f tKth d In ileal [txal and Ra Si d �riuts \c Sc.tvca 1 Iltf t� i ... iT„<. rt..L t.t, k',1) ..,.,.t e 2' j 3 {tb> 1 s 1 C'untm t [ 1it�;sott ilnvt'd for (ot suatpmon tai f v iw,)] t 'rd that c fi t - Utt 9erux�}:ed tsr �Not tc tolllim6nate -it) j l l sreert ' I g �1 S fhs tettty ler Riw Shell , i -noir 5S 1 �x 9G4j-, t}j VIOLA7'1t3+l.S RELATED 'TO GOOV ;T'ET411. PRixrFCLS (14ent,,23 tilt C t t r.d r< r m al c tt .t. tit t) r nw z c a itr it rnet' i e roan rja-.t F ter -s iii u{ above, can br ; :nae Food Code at n . i.. ("3fR ttaar Goad Reta,i Practices FC 590.bOL 1 l! _ il I um "10 V1H 9 t,iaering. 'n}o�ty, {iXYCI, temporarV and ' t;'tili; i EI KitfEilt OUCt Ytt3f3t Y IF(�4tid i)C .el3ti 6C dei IaL t( prupriatt x.3tOIlS J �tix;��L lat:rd 3.xrSiiorn ��: 's =C r .GCI 1t,i 't:!,ii ._ Ll'. tkili.: i i; 7 OCic VIOLA7'1t3+l.S RELATED 'TO GOOV ;T'ET411. PRixrFCLS (14ent,,23 tilt C t t r.d r< r m al c tt .t. tit t) r nw z c a itr it rnet' i e roan rja-.t F ter -s iii u{ above, can br ; :nae Food Code at n . i.. ("3fR ttaar Goad Reta,i Practices FC 590.bOL 1 l! _ il I um "10 V1H 9 r Lc lt^ t ter PI tiny u,c rl va Ft; GUa =C r .GCI 2ct e.5 t i swr h r t N., i i; 7 OCic X,,[lf[ CITY OF SALEM BOARD OF HEALTH Establishment Name:Date: II o Page: a of c� Item No. Code Reference C - Critical Item R - Red Item-!.. DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified L�I. +<D I &?b- f` r -P \ 1- 01G c p. pwauidc) Ck D ¢—F16 r P(f r CL WI ---------------- 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 tlollars or suspension/revocation of your food permit. �r /y /�% ��// I "� /I`01 VP. Ih A. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance El Employee Restriction / Exclusion O Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (Itehis 1-22) (Cont) PROTECTION FROM CHEMICALS 14 ?-501.14(0:) - Food or Colar Additives TIME/TEMPERATURE CONTROLS1 ' 0-202,12 Adchuvet;* --- y_ __ 41",F/45`F Within 4 How s. * 3-30114 from Unappro=:ed Additives',�_� 15 19 _Protection J Poisonous or Toxic Substances PHF Hot and Cold Holding ir,r 5361 I0I.I1 t Identifying inbinnittion - 06g;nill 590, (N)4 (F) 41145” F" Comair er _ 'r <i.i6iAj lixiHF ltsinrainedato -1(02.11 i 20 t.1i _ ' Corattlrn \rn-e Wm6m ( ntul rs*`� S�ncttit ri 5trn ap _ - . � t 1401F. 7-202. i Rr t cu n flwsi nco rued L c' { Rt sta Held at or above 1 40,'F, i 20 7202,12 Couilnomof?,s- i to l, o t 1s >r , I 1 t 1 > 11 it ( i 1 7-"0111 �(.Tc, a fort unei ProhtM„<ns' { l� lrce`,<�utr-meat t atereilu n t Etii: t xn t iiPe,rat, ,.td I r 1 7.204, 12 Samuzeis C,ritem, Chemicals j ('11v 11 115 i.)r u i hit �i f UG tcc i_rit _ I , ri�57A.ti ne I -3lCli t ry-SsC1 4 reit r (7 17C 1 7204.14 4-D 1t --{ _._..-i 105.ii _ hni nt11t Aid(kala t latbtcinL f 7-206— I � Ro' rt d t ,r Pr ntdm�C lieu 1----,� to L112,06.1 Rk kini F3 ti-tue. t 21 d mxi I t 1 r:.c. ut+e;le r} :.:t Coll r 1 e.,.; I hFier ire 1tr. i REOUiREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPS^ i-177 -$iFTI II(A4 Unp icu iicdPrc pad.agcdJwce,;and Sr ver i ev vifi li auni�l.lh Is" __- �^8WIlt13.`It i, e,tPa,ttm ed i 5t;i I I(f.J} I t'; eyes o—r Parii;dl C (K)k,d Aaimil F-o(iJ zind _ �f a Sc d pr,tut No serve r 3.5(; _ l t 2. Cl1 10 tee! Aax{ I N 1 a,c Not ?-501.14(0:) t HFs Received at Temperatures TIME/TEMPERATURE CONTROLS1 ' Amwelinb to Lam Cooked to - —.—� __ 41",F/45`F Within 4 How s. * rroPer Cooking TeinpPt atures for I I :3-5(11.15 _ Ccxdim> Methods for PRFs 19 i r t t d J � r i❑ S' PHF Hot and Cold Holding ir,r 5361 3-501.16(5) Cold PHF(; Maintained at or behtur 590, (N)4 (F) 41145” F" Ilio dt R ee ��- 1i t, 5et 3-SO 'r <i.i6iAj lixiHF ltsinrainedato 1401F. ...�.. _ t 5(iL16(,A) { Rt sta Held at or above 1 40,'F, i 20 -(� Time as a Public Hoatth Con,, of 1 i to l, o t 1s >r , I 1 t 1 > 11 it ( i 1 --IR .t5 1'Ubht f{Pal I1 C Un4301' t r„ t.e i�ncc� . tie8t3 i � F'is 90,�(}l�H} l� lrce`,<�utr-meat REOUiREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPS^ i-177 -$iFTI II(A4 Unp icu iicdPrc pad.agcdJwce,;and Sr ver i ev vifi li auni�l.lh Is" __- �^8WIlt13.`It i, e,tPa,ttm ed i 5t;i I I(f.J} I t'; eyes o—r Parii;dl C (K)k,d Aaimil F-o(iJ zind _ �f a Sc d pr,tut No serve r 3.5(; _ l t 2. Cl1 10 tee! Aax{ I N 1 a,c Not 22 310:' I, I 'unmi m r Ae -sorb P,t ted _ r f ort cru. ucc ra TIME/TEMPERATURE CONTROLS1 ' —.—� s. rsil lT e'v Ila clot Crat vkerf cr rroPer Cooking TeinpPt atures for I I VOt r}[71 nTi+c 1 PHFs l i r t t d J � r i❑ S' -- 0401.11 Zi, -: ir,r 5361 p Ilio dt R ee ��- 1i t, 5et , Ao 1,11t A.r. ...�.. r _ SPLCIA L REQUIRE PNTS 401.1 i Cb)i i J; i to l, o t 1s >r , I 1 t 1 > 11 it ( .- -- -T -- _ ..._ ("}} , 1aL1—i,ti r„ t.e i�ncc� . tie8t3 i � F'is i}) L'7bi t atereilu n t Etii: t xn t iiPe,rat, ,.td I r 1 � � �ItI.11 Ik n. i } — --- � ` ii rl. Wild ( t7 is �i'(UIIed PI{F�F � ri�57A.ti ne I -3lCli t ry-SsC1 4 reit r (7 17C C P1 t;: C'a't tr , t ti.h kr�,.t- � t v�tldv„ rt?i tel `Iia ? rt);=1'lilt,' i, iliPi> � ti ul' k..t,+`i tier, '' ;flTn t i' .v.• 111 . s(K�it('<Pa ... to 21 d 7 t gfih stag for i l iuldmq 'IOLATJOWS RFLA,-ED TO rE TAIL tt RA .TIC'i S __. 1 -. -------- o3.tIt 1 PIU, 17°1 l5wt fltearts23-JCI) 103,11(6) F w 1iLlt,.o 5r,:ndin° l 1 1 1 ot trd, r , veer , b, l)!i)f IRC 1(` S R 1 "tt t "r 1 tiL rrJ S . i _;03.i1;(.j { nrt,�r;a,cRv l4cx sst`d `Z I( b'sx Ni- i Fua 1r :her ,1. •S s,.r 1, .. ,i¢�? <,d C,>J�rar,?, �C�a;ft r1 `,,-403. i , ,1 i i� m ntilcg L,, df Poi i ns n; 8tcril j , t _-. a -- .. ,_tear Gaal RetailFracfrses ..-- FC 6@p-Bi3e} - 1 ''Rn rgem< f1 t;F r FC: 2 0_ f Proper Cooling of PHFs 24 FL,)o tind oxt F c c t PC i W4 ' - (- --- jK -S01.14(A)i ra lim, Cook d Pills ban I F:, -- n - S - _c5 t Vatr y d4 FCS W Within koucoiui From W;'- - -- —1 l , ��s _a Fac Lt: FC -6 .iYC3 .. - a E41FVnm4ttnur ! -- - - --- 022 P7,>>,n 7xrhaE r�k_ -FO r 00= r : 501,ia(it 1 `rrlu. PHF Matic From lenient h- t i spoc:a ti tt rcrr e�, UCi j f ml rattire In rejicAts lt111L45'1 ,n3�IW t:•� Or,, -+n 4,,`1 - qn� 335 - 15 1(e 4YA - Masgachusetts Department of kiblic 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 Namate/ ^ ' J e of O orations Food Service Retail Type of Inspection Routine Re -inspection Address Risk Level ❑ Residential Kitchen Previous Inspection Telephone 5 El Mobile ❑Temporary Date: ❑ Pre-operation Owner HACCP Y/N ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Cha(g (PIC) Time In: IEl P Inspector t, Out Permit No. ElOther eacn violation cnecked requires an e*ianation on the narrative page(b) and a citation of specific provislon(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-ChokingTobacco Violations marked may pose an imminent health hazard and require immediate corrective 0.009 (F) •action as determined by the Board of Health. L F_ OD PROTECTION MANAGEMENT_ ❑ 12. Prevention of Contamination from Ha 1 PIC Assigned /Knowledgeable / Duties II//��,..,, � © F__. _ _ �Y�L73. Handwash Facilities ❑ 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 CONTAMINATION 0 Y-9 8. Separation/ Segregation/ Protection 9. Food Contact Surfaces Cleaning and Sanitizing /__ j 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 p 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) Q 25. Equipment and Utensils - (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) Q 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals I TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) J ❑ 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 W22 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: `ypt Print: Pagel oPages V y �, ..-.. w.=''• ...r} 4r "' � ~'nrt'�. y., `n...w wrw ...,. is `,r e�. - Violations Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* _ 590.003(6) 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* 3-201.1.2 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 Report To The Person In tem* Drinking Water from an Approved System* 590.006(A) Charge* 590.O(6(B) 590,003(G) Re tin by Person in Charge* 3 1590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 C C Is - FOOD FROM APPROVED SOURCE s Denotes critical item in the federal 1999 Food Cate or 105 CMR 590.00. 8 t' PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food law* 3-201.1.2 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.)3 Shell Eggs* 3-202.1.4 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 tem* Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.O(6(B) Water Meets Standards in 310 CMR 220* Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui -mint*' Shelifuh and Fish From an Approved Soume 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 2-301.14 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 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* 12 Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.0040) Labeling of Ingredients* Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* s Denotes critical item in the federal 1999 Food Cate or 105 CMR 590.00. 8 t' PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* 4-501.111 Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water . Sanitization Temperatures* - - Contamination from the Environment 3-302.11(A) I 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(0)(6 ,Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui -mint*' Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces ' 4-501.111 Manual Warewashing - Hot Water Sanitization Ten 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 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 E ui -mint*' 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* 11 Good Hygienic Practices' - 2401.11 Eating, Drinking or Using Tobacco* 2-401,1.2 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 Capacities* 5-204.1.1 Location and Placement* - 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices - 6-301.11 Handwashing Cleanser, Availability 1.6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: Sew,22rr� (23A—, Date: Page:_ of _ I ./l r_. �/ wI/�I FU r NEW ��/�j���yj�/•�//���11;�_•.. 'VITA WAWWJM�PAAZFO�Iff� I� .!�•• Vii' \.,.:. _� 9 _�►. ! Isi.� '. /' — - � � -.� 1' • • • • . • • • • • • • • • . • - • • sell •. • • ••• •• .noncompliance may re ull 10 •food • _ I 1 rtl' Voluntary Compliance ■- • • -Restriction 1 Exclusion 61"'Re-insp, n- echeduled LI Emergency Suspension Embargo u Emergency Closure Violations Related to Foodborne illness Interventions and Risk Factors (item 1-22) (Cont.) - ..,r .rt•1 �• M Food or Color 17 18 fit _tl ,. ` •.. "• Additives _ 3-202.12 ^^ --- i Additives* 3-302.14 Protection from Unapproved AdditivesiQ 3-50L16(B) 590.004(1-) Poisonous or Toxic Substances 7-101.11 identifying Information - Original Containers* 7-102.11. C rdamen Name - Working Containers* 7-201.11 Se aradon - Sto * - 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use" 7-203.11 'Tonic 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* ,,-306.12 1 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Momtori.n * fit _tl ,. ` •.. "• 4 Drnoras critical ivm in the federal 1999 Focd Code a' 105 CiNA 590.000. C 20 3-501.14(C) Proper Cooking Temperatures for 3-501-15 PHFs_ _ 3-401.IIA(1)(2) Eggs- t55`F 15 Sec. 3-50L16(B) 590.004(1-) Eggs- Immediate Service 145°F15sec* 3-401.II(A)(2) - Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155°F 15 ser:. * 3401.11(8)(1)(2) Pork and Bee(Roest-130°F'121mm* 3-401.11(A)(2) Ratites, Injected Meats - 155°F 15 .004 H) sec. * 3-401.11(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 Animal Fcx>ds Cooked in a Microwave 165°F * 3401.11(A)(1)(b) All Other PHFs -145°F 15 sec. Reheating for Hot Holding 3-a03AI(A)&(D) PHFs 165'F 15 see. * 3.403.11($) Microwave- 165` F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 344)3.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Coaling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 70°F 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 41017t45°17 Within 4 Hours* 4 Drnoras critical ivm in the federal 1999 Focd Code a' 105 CiNA 590.000. C 20 3-501.14(C) PHFs Received at Temperatures According to I aw Cooled to 41T -AFF Within Hoars_* 3-501-15 CoclinE Methods for PHFs a801.11(E) PHF Not and Cold Holding 3-50L16(B) 590.004(1-) Cold PIdFs Maintained at or below 41°145°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. 3-501.16(A) Roasts Held at or above 130'R " Time as a Public Health Control 3-501:19 Time ac a Public Health Control* .004 H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged iuices and :fleverarres with Warning Labels* a801.11(E) Use of Pasteurized teurized EEggs*._._� 3-801. A I (D) .,. Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served, * 3-801.11 C) Unopened Food Packa r Not Re -served, CONSUMER ADVISORY 22 3-603.11 Consumer .Advisory Pasted for Consumption of Animal Foods That are Raw, Undercooked or Not Otherwise Processed to Eliminate' Patho gens.* E*"""n'f f 3-302.13. Pasteuriwd Eggs Substitute for Raw Shell 1 E Plilq 1F_l, 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, mrd non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sectionsofthe Food Code and 105 CMR sin Min s svor�m�:.z e:c SAA IT'�OqF SALEM BOARD OF HEALTH Establishment Name:. 0-'-14C�RV Qft U , Date:S l� Page: of 3 INS• v(�l�.� �U1!�� WANNINEA *071 MW Lot .. w 1. a2 �1..- rISV�'IR i/. / �I� i .��✓ ' 1.1� a�� l�.Rgi7//�WW�1 R Vr%'i��/►����-��� I: 1 .t,�l7Ty � �.:-o G: 'G �.!- .... "S Lem 'fflawrom L M low, OKI 0. .■r �� =IBM .. .... ..... ... .. • • • •. • 1. i• • •- • • • • • ••• • I �� y Compliance Ll Employee Exclusion U/"Re-ins0;"fionYreduled El Emergency Suspension ■Embargo ■ Emergency Violations Related to Foodborne Illness Interventions and Risk Factors jllerra; 1-22) (Cont.) 111111=10 -� 15 16 17 -- Food or Color Additives 2.12 Additiv _ 3-302.14 Protection from Unapproved .Additives° 3-50L 16(13) 590.004(F) Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers* 7-102.11, Common Name - Working Containers* 7-201.11 Separation - Storage* - 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-2033.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204,14 DryingAgems. 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*. - Proper Cooking Temperatures for _. 3-50 L 15 PHFs 3401A IA(l)(2) Eggs- 155F 15 Sec. 3-50L 16(13) 590.004(F) E gs-Immediate Service 145'Fl5sec* 344] A l(A)(2) Comminuted Fish. Meats & Game 3-SOI.I6(A) .Animals - 155°F 15 sec. * 3.40111(B)(1)(2) Pork and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155`F 15 590.004(Hj sea. * 3-40'1.1l(,A)(3) Poultry, Wild Game, Stuffed PHFs, Staffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. 3401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F " 3-401.12 Raw Animal Fools Cooked in a Microwave 165'F * 3-40 1; 11 (A)(1)(b) A1] Other PHFs -145°F 15 sec. Reheating for Hot Holding 3- 03.11(A)&(D) PHFs 165'F 15 sec. * 3-403.11(B) Microwave- 165° F 2 Minute Standing Tirac" 34031I(C) CommerciallyProcessed RTE Food - 140°F* 3-403.11(E) - Remaining Unsliced Portions of Beef Roasts* pe g PHFs Proper Conlin of 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and From 70'F to 41 `F/45017 Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* ' Dzn0 a% aitical item in the federal 1199 Fwd Cmie 0 105 C.11& 590.000. 20 3-501.14(C) PHFe Received at Temperatures According to Law Cowled to 41'FJ45'F Within 4 Homs. 3-50 L 15 Cooling Methods for PHFs 3-801.11(13) PHF Hot and Cold Holding 3-50L 16(13) 590.004(F) Cold PRFs 'Maintained at or belmv 410145' F* 3-501.16(A) Hot PRFs Maintained at or above 140`F. * 3-SOI.I6(A) Roasts Held at or above 130'F. " Time as a Public Health Control 3-501:14 Time as a Public Health Control* 590.004(Hj Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-80 1.1](A) Unpasteurized Pre-packaged Juices and Beverages with Warning labels* 3-801.11(13) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3401AI(C) UnopenedFoodParka NotRe-served. CONSUMER ADVISORY 22 3-603.11 Consumer .Advisory Posted for Consumption of Animal Fords That are Raw. Undercooked or 1 Na Otherwise Processed to Eliminate Pathogens.*t%bervernmmt 3-302.13 Pasteurized Eggs Substitute for Raw Shell 1 E 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 - Speeial Requirements. (Items 23-30) Critical, and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the follov ing sections. of the Food Code and 105 CMR CITY OF SALEM -�!/Y\ BOARD OF HEALTH Establishlhent Name:S(2d X=,6• repo Date: Page:_L of y �i.`%J{���ii�� �fi� �•. [�w u� � ...♦.1 .� .. �..� ! / u • ...r.� y7��. i AMIKOWIMEM'M LI FROM NO t y _ i MI-AINOMIUM MA= TPUMV . . .- . .- . . .. . . . .- .-. . . .... i/�13 !MF WEmployee Exclusion aeRe-inspection Scheduled . EmergencySuspension U �mvb-argo LI Emergency Closure Voluntary Disposal LI Other: -- y Violations Related to Foodborne Illness Inter✓enHOns and Risk Factors (Hems 1-22) (Cant.) .0Roti.: r# C 17 rm Additives Food or Color -..._ _....�_...._ 3-202.12 Additives*, 3-302.14 Protection from Una roved Addiiivesk 3-501.16(13) 590.004(F) Poisonous or Toxic Substances 7-10111 identifyingInformation - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Storage* 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 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*____ rm 4 0.notcs cdncal hrmi in the federal 1999 Food Case 01 105 C.MR 590.000. 3-501,14(C) Proper Cooking Temperatures for 3-501.15 PHP$ _-- 3-40i.IIA(I)(2) Eggs- 155'14 15 Sea 3-501.16(13) 590.004(F) Eines-.Immediate Service 145'Fl5sec' 31141.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155'F 15 sec. * 3-40LII(B)Qx2) Port: and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 590.004(H) sec. 31101.1.1(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. 3-401.11(()(3) Whole -muscle, Intact Beef Steaks . 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3491:11(A)(1)(b) All Other PHFs - 145'F 15 sec. Reboiling for Hot Holding 3-403AI(A)&(D) PHFs 165-F 15 sec. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Time* 3-403.11(C) Conmterciaily Processed RTE Food - 140°F* 340121l(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 70'F to 41`14145'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made Froin Ambient Temperature ingredients to 4f'F145'F Within 4 Hours* 4 0.notcs cdncal hrmi in the federal 1999 Food Case 01 105 C.MR 590.000. 3-501,14(C) PRFs Received at Temperatures - According to Law Cooled to 41'Fi45'F Within 4 Hairs. 3-501.15 Coohnp Methods for PHFs _ PHF Hot and Gold Holding 3-501.16(13) 590.004(F) Cold PRFs Maintained at or below 41'145° F* 3-501.16(A) Hot PRFs Maintained at or above 140'14. * 3-501.16(A) Roasts Held at or above 130'F. " Time as a Public Health Control 3-50IA9 Time as a Public Health Control* 590.004(H) Variance Roc uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.1,1(A) Unpasteurized Pre-packaged Juices and Beverages with Wanring Labels* 3-80IAI(B) Use ofPasteunmi�Eggs* 3-801.11(D) Raw or Partially Cocked Animal Food and Ras, Seed Sprouts Not Served * 3-801.11(C) Unopened Food Package Not Re=served, 22 3-603.11 Cousumer Advisary Pasted fur Consumption of Animal Foods That. are Raw. Undercooked or Not Otherwise Procesw to F,litninate Pathogens,* `''b`` 3-302.13. Pasteurized Eggs Substitute for Raw Shell E 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 gotxl retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Critical, and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed abo•,.e, can be found in the following sections of the .Food Code and 105 CMR uln non Sf90Y�, &. Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: File Number: BHF -2003-000005 Seaport Caf6 215 Derby Street Salem MA 01970 LOCATED AT: 0215 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2011-0265 Jan 1, 2011 Dec 31, 2011 $420.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $420.00 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 KINIBERLEY DRISCOLL 1%1AYOR DAVID GREENBAUM, RS ACTING HEALTH AGENT CITY Or SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4". FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGREENBAUM&ALENI. CONI 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTTABLISH/M±�E/NT p� `p NAME OF ESTABLISHMENTTr�/ T C4�G TEL #979 p�9q —19 `C7 ADDRESS OF ESTABLIS HMEhii_ FAX# O S_ MAILING ADDRESS (if different) EMAIL - Bus OWNER'S UN TEL# e?76 CERTIFIED FOOD MANAGER'S NAME(S) IVA l rJ -tC�nr �re. < CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) F C'J�•C EMERGENCY RESPONSE PERSON_ l (/ v HOME TEL # nUUrca Ur Ul tKA i iUr1 Please write in tune of day, iT For example 1lam-11 m tts�l, ! 2u+ , 1 .� ri � �y _ q,. , G� } GM — i 4 +a - TYPE OFESTABLISHME- NT MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO �LI FEE Y(check only) $135 RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT -------•----- - - ------ ES -- --N6 -------------------------------------•------less than 25 seats ------------=$140 (Outdoor Stationary Food Cart $2 25-99 seats mere than 99 seats ----- ------------------------------------------t--------•-----•-------•--------------------------------------------------------------- BED/BREAKFAST/ YES NO $-1'0-0- ------ CHILDCARESERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT (such as church kitchens) YES NO $25 "Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted d approved by the Salem Board of Health. Pursuan o MGL ChapterQsCruirednu4n9dAer' ioI certify underthe pains and penalties of perjury that I, to my best knowledge a d belief, have filed all state tax retupaid tate to the law.yp, i ,!_ r•1'��/ s :ii1— !� L />_% Oaf/: tdl JCJ � � I Date Revised 10/7111 FOODAP201 Ladm Check#&Date1af,L�% S Security or Federal