Loading...
STEVES QUALITY MARKET - ESTABLISHMENTSikrtP Qval{tt'-"qflgt 6 3 6 Muf 9i o f tr<et universal one. www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2011 ESTABLISHMENT NAME: File Number: BHF -2004-000291 LOCATED AT: Kimberley Driscoll Mayor Steve's Quality Market 36 Margin Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2011-0078 Jan 1, 2011 Dec 31, 2011 $280.00 TOBACCO VENDOR BHP -2011-0079 Jan 1, 2011 Dec 31, 2011 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l,2011 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, RS ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 F AX (978) 745-0343 DCRFFNBAu419SAI.En1. COM 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_ TEL # q f _ ADDRESS OF ESTABLISHMENT FAX # bE Ir i-4 MAILING ADDRESS (if different) EMAIL - Business': OWNER'S ADDRESS Website: ss�7 l 1xs—MQY cI(-. cary� TEL Qe)� Iqi k�-qI STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) 4 l vtfOxR,-4JAWk fIVA CERTIFICATE#(S) (Required in an establishment where potentially hazardous food d) r I EMERGENCY RESPONSE PERSON r �Vl(O ilei t Y HOME TEL #�/� Please write in time of TYPE OF ESTABLISHMENT RETAIL STORE, ES NO RESTAURANT YES (Outdoor Stationary Food Cart'$210) YES FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 ✓ more than 10,000sq.ft. =$420 less than 25 seats =$140 25-99 seats 4280 more than 99 seats =$420 $100 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR eyD NO 13 ALL NON-PROFIT (such as church kitchens) TES 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 thi 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 toft��,G,L Chapter 62C, ection 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and pa aiLstate tgxes r44uired under the law. _ Signature , _ U Date Social Security or Federal Identification NL ---------------------- ---- ---- --- --------- - - -------------------- Revised 10/7/11 FOODAP2011.adm Check# & Date 1 $ cYJ Nfassachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name ll N`�I � a X , Y L(kr Date -( ( Tvoe of Ooeration(sl Type of Insoection URoutine ❑ Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness [:1General Complaint [I HACCP ❑Other Food Service Retail Residential Kitchen ❑ Mobile ❑ Temporary ❑ ❑ Bed & Breakfast Permit No. Address .. D d v .1 4 Risk Level Telephone U Owner n n nn.l n HACCP YM Person in Charge (PIC)Time r In:l \a/vo Out: Inspector / n a P u e. c't» :� Each violation checked requires an a planation 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) L/J 590.009 (F) [� action as determined by the Board of Health. ,I (^t,` FOOD PROTECTION MANAGEMENT_ +Lj�r12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties 6r -3.. Handwash Facilities OYEEHEALH_UEMPL -_-- - - I OTEC710NFROM CHEMICALS •_ _ ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. ADDroved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE f ❑ 4. Food and Water from Approved Source O W5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 15. Toxic Chemicals TIME/TEMPERATUREcONTROLS (Potemlelly Hazardous Foods) �•' ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling _PROTECTION FROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. Separation/ Segregation/ Protection ❑ 20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTSFOR HIGHLY SUSCEPTIBLE POPULATIONS.(HSP) El 21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing J'� .�t1- Good Hygienic Practices (CONSUMER _ ADVISORY- k22. 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) U� 25. Equipment and Utensils (FC4)(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 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: ) _ b C� J i) � ) X Inspector's Signature: J,Pr 'Print: -- -_ ... _ _ . _ .. . \ i 1 Page of Pages PIC's Signature: Print:r - Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590k03(C) Responsibility of the person in charge to Compliance with Food L.aa-* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* a ticants* Shell Eggs* 590.003(,F) Responsibility Of A Fool Employee Or An 3-202.16 Ice Made From Potable 12rinking Water* Applicant To Report To The Person In Drinking Water from an A roved System* tem* 590A06(A) Charge* 590.006(B) 590.003(G) ReportiU by Person in Chu e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 C C C FOOD FROM APPROVED SOURCE "Denotes criuW item in the faedeml 1999 Pond Code or I 0 CMR 590.000. C PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590,004(A -B) Compliance with Food L.aa-* 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 Ice Made From Potable 12rinking Water* 5-101.11 Drinking Water from an A roved System* tem* 590A06(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* _ 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 Regulatory Authority 3-20118 Sheilstock. 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* 3-202.15 Package Integrity' 3-101.11 Food Safe and Unadulterated Tags/Records: Shelistock 3-202.18 Shelistock Identification * 3-203.12 Shellstock Identification Maintained* 12 Tags/Records: Fish Produ&,s 3-402.11 Parasne Destruction* 3-402.12 Records, Creation. and Retention* 590.004(1) Labeling of Ingredients' Handwash Facilities Conformance with Approved Procedures tHACCP Plans 3-502.11 S ecrialized Processing Methods* 3-502.12 Reduced ox gen packaging, criteria* 8-103.12 Conformance with Approved Procedures* "Denotes criuW item in the faedeml 1999 Pond Code or I 0 CMR 590.000. C PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foals* 4-501..111. Contamination from Raw Ingredients 3302.11(A)(2) Raw Anitruil Foods Separated from Each Other" Mechanical Warewashing- Hot Water Sanitization Temperatures* Contamination from the Environment 3-302.11(-A) Food Protection* 3-302.t5 1 Washing Fruits and Vegetables 3-304.11. - Food Contain with Equipment and Utensils* 4-602.11 Contamination from the Consumer 3-306.14(A)(B) Returned Ford and Reservice ofFoW* _ Disposition of Adulterated or Contaminated Food 3-70111 Discarding or Reconditioning Unsafe Fool* 9 Food Contact Surfaces 4-501..111. Manual Warewashing - Hot Water Sanitization Tem eratureO 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical. Sanitization- temp., pH; concentration and hardness. 10 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* 14 Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Arms* 2-301..1.2 Cleaning Procedure* 2-301.14 When to Wash* Il Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3301.12 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 Hatidwashing Cleanser,.Availabilit y 6-301.1.2 Hand Dn g Provision iI CITY OF SALEM BOARD OF HEALTH Establishment Name 4 oe < ` „ (, $. , `-1r\i r . Go n$ Date:_ la—IQ - IQ Page: of C - Critical Item n DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date NO.Reference R - Red Item Verified PLEASE PRINT CLEARLY O t -T/ -1- 1-' �r� 1i�N�/. adi� i —1100 /I VItem,,Code !.r.• ®r ) 7"-X-i"._P -1n i ., .�,r %R/11 I II,�I � �(bl JiY�acQ. 3& 2�0.cam i J () l Yl n�—Y 1 .(�.�,/ln (lY Lid U.t yy-- -v -004d,40, 0A I a� N t A / rpv r - - ,/�- 10 ^ V (, e \/ . "1.^,., �A, t J�n1.� v. T \'(L /n 1 A \ /1,(.rn _i.� I ,1 t�.-� �X�"rc 1iI LJ�✓, I;, �iG V)1 41A'4 v Discussion With Person in Charge: Corrective Action Required: ❑ No Q Yes y I have read this report, have had the opportunity to/ask qu stions and agree to correct all g Voluntary Compliance L) Employee Restriction / violations before the next inspection, to observe all conditions as described, and to Exclusion / comply with all mandates of the Mass/Federal F,00d�Cdde. I understand that Ll Re -inspection Scheduled 13 Emergency Suspension ,noncompliance may result in daily fines of twefive .o ntyllars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /� LlVoluntary Disposal LIOther: t - Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 15 16 C 18 TIME/TEMPERATURE CONTROLS 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 7-107.11 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* 7-203.11 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* TIME/TEMPERATURE CONTROLS * Denotes critical item in rhe federal 1999 Food Code or 105 CMR 590.000. IEN 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3.401.11A(1)(2) Eggs- 155F 15 Sec. 3-501.16(B) 590,004(F) Eggs- Immediate Service 145'F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 min* 3.401.11(A)(2) Ratites, Injected Meats -155'F 15 590.W4(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. - Stuffing Containing Fish, Meat, FC -6 Poul or Ratites -765'F 15 sec. 3401.11('C)(3) Whole -muscle, Intact Beef Steaks FC -7 145OF * 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 3-403,11(A)&(D) PHFs 165T 15 sec. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F' 3403.11(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 707 to 41`F/45'F Within 4 Hours. * 3-501.14(B) Cooling PRFs Made From Ambient Temperature Ingredients to 41'F/45°F Within 4 Hours* * Denotes critical item in rhe federal 1999 Food Code or 105 CMR 590.000. IEN 3-501.14(C) PHFs Received at Temperatures According to law Cooled to 41'F/45'F Within 4 Hours. 3-501.15 Cooling Methods for PRFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(B) 590,004(F) Cold PHFs Maintained at or below 410/45' F* 3-501.16(A) Hot PHFs Maintained at or above 140'F. * 3-501.16(A) Roasts Held at or above 130'F. 25. Time as a Public Health Control 3-50].19 Time as a Public Health Control* 590.W4(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIDNS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and :Bevera es with Warning labels* 590.000 3-801.11(B) Use of Pasteurized Eggs* FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Spriarts Na Served- * Food and Food Protection 3-801.17 (C) Unopened Food Package Not Re -sensed. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw. Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection I FC - 3 Patho ens.* Error.. rnrmer 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. 1 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 good 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 above, can be found in the follondng sections of the Food Code and 105 CMR 590.000. Item I Good Retail Practices I FC 590.000 23. Management and Personnel FC -2 .003 24. Food and Food Protection I FC - 3 .004 25. Equipment and Utensils j -FC -4 .005 26. Water, Plumbing and Waste FC - 5 .006 27. - -Physical Facifi FC -6 .007 28. Poisonous or Toxic Materials FC -7 ,008 29. - Special Requirements ,009 30. I Other a?UpidnMOAY.l b+c CITY OF SALEM BOARD OF HEALTH 1 Establishment Name:S�on a I AA , D,�1n b, Date: Page:�� of Mem No. Code Reference C - Critical Rem R - Red Rem v DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date, - Verified L1)nt � Dan (a)n.1 f„�; ��.:1/:_v 1 ) , 1)f VV, _ � nom, )n - {. l �.(- �9.� p �.(n n.�• .�'r- I LN � /�Fll (` (J. A e . �- iVp'Y) Qnn � � � "SOV, n!A Yf ,A., 1,[V U � IP)1`¢I \-"✓1. (0 - .Jin ro e: -a_ �.� C (k1. rW�)/� r Al d q �i"�� /} _ �•� �n� �, � A./ ryc.�a. o nn -a �i - , � � - 0 )"TA" /1' Jam- V r Jig / �- �� Yii ��-'_ �, It, qSn N_a�0 9.)"q, y"1 r•,." I AJ I�R A ... Aob� "tNo .L�t 1.CWin/ n "�' p g _ �) l_1An 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 describedand to J I / 1 , comply with all mandates of the Mass/Federal F 05/Code 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 Foodborne Illness. Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 M 18 TIMEITEMPERATURE CONTROLS 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 7-101,11 Identifying Information - Original Containers* 7-102.11, Common Name - Working Containers* 7-201.11 - Separation - Stara * 7-202.11 ,Restriction-Presenceand Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Wishing Produce- Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 - Restricted Use Pesticides, Criteria* 1206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS * Denotes critical i�ar in the federal 1999 Food Code N' 105 CMR 590.000. WE 3-501.14(C) - Proper Cooking Temperatures for 3-50LIS PRFs 3-40i.11A(1)(2) Eggs- 155`F 15 Sec. 3-501.16(B) 590,004(F) Eggs- Immediate Service 145'F15sec* 3401-I1(A)(2) Comminuted Fish, Meats & Game 3-501,16(A) Animals - 155'F 15 sec, * 3401.11(B)(1)(2) Port: and Beef Roast - 130-F 121 min* 3401-11(A)(2) Ratites, Injected Meats -155-F 15 590,004(H) sec. 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, - 6 Poultry or Ratites -165'F 15 sec. 3-401 . I I (C)(3) Whole -muscle, intact Beef Steaks 145°F" 3-401.12 Raw Animal Foods Cooked in a Microwave 165F * 3-401:11(A)(1)(6) All Other PHPs - 145°F 15 sec. i Reheating for Hot Holding 3403AI(A)&(1)) PHFs 165'F 15 sec. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Time* 3403.11(C) Commercially Processed RTE Food - 140'F* 3403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFa 3-501.14(A) Cowling Cooked PHFs from 140'F to 70'F Within 2 Hours and From 70'F to 41'F14.5'F R9thin 4 Hours. * 3-501.14(B) Cooling P'HFs Made Froin Ambient Temperature Ingredients to 41'F/45'F Within 4 Hours* * Denotes critical i�ar in the federal 1999 Food Code N' 105 CMR 590.000. WE 3-501.14(C) - PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. 3-50LIS Cooling Methods for PHFs -801.11(8) PHF Hot and Cold Holding 3-501.16(B) 590,004(F) Cold PHFs Maintained at or below 410/450 F* 3-501.16(A) Hot PHFs Maintained at or above 140'F. * 3-501,16(A) Roasts Held at or above 1300F. 25. rime 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 3-80.1.11(A) Unpasteurized Pre-packaged iuices and :Beverages with Warning Labels* 590.00 -801.11(8) Use of Pasteurized E gs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprotits Not Served. * _ Food and Food ProtectionF� 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods That are Raw. Undercooked or FC - 2 .003 .I Not Otherwise Processed to Eliminate _ Food and Food ProtectionF� C - 3 Path ens.* Eft cr,s 1/' 0Wf 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell .005 26. E * N34e my 11 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-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, cant be found in the following sections of the Food Code and 105 CMR 590.000. Nem I Good Retail Practices .FC 590.00 23. Management and Personnel FC - 2 .003 .I 24. _ Food and Food ProtectionF� C - 3 .004 25. Equipment and Utensils , FC -4 .005 26. Water. Plumbing and Waste -' FC -5 .008 27. -Physical FacilityFC - 6 .007 28. Poisonous or Toxic Materials 29. S ecial Renuirements ,009 30. Other i S:h9@M '-26' r a Massachusetts Department of Public Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Ith Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Named t �T Q ^() . /� �i i., it Y\_ft.A Date IA_(-( Tvoe of Ooeration(s) Food Service Retail Residential Kitchen El Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Type of Inspection aRoutine © Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness El General Complaint [:]HACCP El Other _ _oA Address 2'n �� n � J 0 Risk Level Telephone 1 /� , ( 1 I i Owner a, A HACCP YM Person in Chargii(PIC)\ ..P- . A) nniv Time In:i/� � Out: /p,' inspector 1� A , o ' -2 (� Each violation checked requires ad6xplanation on the narrative page(s) and a citation of specific provision(s) violated. U 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)p 590.009 (F� ❑ action as determined by the Board of Health. l / ❑ 12. Prevention of Contamination from Hands (JF ® 1 PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ' r A,'„} � PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC— a= _� �•�•� b El 14. Approved Food or Color Additives El 3'. Personnel with Infections Restricted/Excluded h / r J15. Toxic Chemicals FOOD FROM APPROVED SOURCEu�TiME/TEMPERATURE CONTROLS (Potentially Ha ai'dous Foods`- )""'n -,-,_ L] 4. Food and Water from Approved Source � � � � w , - 0�:N'-5,; Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION "" `� �-� " Ej im- 8. Separation/ Segregation/ Protection 49_ 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. Cr 7W 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) �L. 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)(510.008) 29. Special Requirements (590.009) 30. Other S: 5 ::9110Ms tFom -1444 ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control �IREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATION$I HSP)', ❑ 21. Food and Food Preparation for HSP of Number of Violated Provisions Related r --1--r 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 - ` �_ I >,,' )/ Inspector's Signature: ^() . I(�A Print: PIC's Signature: r IPrint: W-er Pagel of__3pages 5kYe11 Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) C FOOD PROTECTION MANAGEMENT 590.003(A) Assi2imentofRes onsibility* 590.003(B) DemonstranonofKnowtedge* 2-103.1'( Person mcharge -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 Report To The Person In tem* Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(0) Reporting by Person in Charge* 3 590,003(D) Exclusions and Restrictions* 3-201.'15 590.003(E) Removal of Exclusions and Restrictions 4 C C * Denotes critical item in the federal 1999 Fail Code or 105 CMI? 590.000. ..�.. • :.•ti • eft ,a= •r 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Eotxl in a Hermeticall • 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 Potable Drinking Water'" 5-1.01..11 tem* Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 31.0 CMR 22.0* bVashin Fruits and Veetables 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 Regulatol Authorit 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 ReceivinglCondition 3-202.11 PHFs Received at Proper Tem eratures* 3-202.15 Package hue ity* 3-101.11 Food Safe and Unadulterated Tags/Records: Sheiistock 3-202.18 Shellstock Identification * 3-203.1.2 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* 3-502.1.2 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Fail Code or 105 CMI? 590.000. ..�.. • :.•ti • eft ,a= •r 8 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and [ITE Foods* Contamination from Raw Ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 bVashin Fruits 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 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem eratures* - 4-501.112 Mechanical Warewashina 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 oY 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 Chetnical* 10 Proper, Adequate Handwashing 2-301.11 - Clean Condition - Hands and An ns* 2-301.12 ..Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* %401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 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 6-301..1.2 Hand Drying Provision CITY MOM eTe: Establishment Name jfvll� Page: 2l-\ of -P� Item No. Code R Terence C - Critical Item R - Red item u DESCRIPTION OF VI ATION / PL ORRECTIONpp t PLEA RINT ARLV ,O/1 nB/Y\.�/LI. .O .I�.� \r A n - ...-. Date Verified 4/ i✓o,! /� K1�Awa/p✓ ^A i4'.�. 0. •, �'1 ' [A nr/n //i .{� r/�1_l 1.?.�.�I fn. , I )n'n. / % -.r ._ ("-I- l{e i "A`. 1%A x✓ Q').Pn ..f'xA. t_�A_ All i_n - moi✓ `.-' J �%7 /t('\.l — n` Ivi) a _ �.q ov, �� I -F7n.\n/ AI m\.\ \ Al(n —L' )Q0 A nn e��,.�_j Q�(>_..i.il �J`t7 "A 4 ' '?A 0 v J - I nZPnn CnA. %AnAll� I /t� _ l Y�r,u - �t-e U¢¢ _;Yrc k p Q , .i�.V/aQAe,A-_�) -AAV sX- 0,'A' �dov.`�\-,•)r( l� /,�,. -J n,, /J -- .1_ '1 ^ - � Cy�,(A�(n �S(➢,9/.� t-l�(A 1 r,.4.1�✓, Oe I_ti PX.t. - �d �' �� X1''11 �� '1� /1� 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 observle 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 twendollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No ^ �t7 Yes VoluntaryCompliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ other: S Violations Related to Foodborne illness interventions and Risk Factors (ileMs 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 401.'.13-.1){_, Food or Color Additives 3-202,12 Addiuot,,* 3-302.14 _ Protcclion tiom Llnupproaed Addttives" IS 7}()1.11 i Poisonous or Toxic Substances lentitSmg Info mai on Oriina] it f ;1.6Liic4);3) � Containers __ 1(12.11 F— _. CornmonName F4orhf >(ow in rs* i :. 7-201.11 S tuon Strn t _ -iii. k 20211 Re,t.cbon - Pr scnee a d U.� y F 7-202. F2 — _OttdihOn of Use 7-'03 [IToxic 7-1104.11 samtizels C ant nnci Prop bitim ," Criteria Chooictis 7 -?04. 1 Chonicak for W Rhlt f.1 OG ECL �.ritE.ri 1� 1 7 704.14 Ai nts C nu f i l f �_Di�cut. tt15, 11 I htcid w i1 f xx] i antic^ 1_Uni aritO i 7206.!7 _Mf _. ­.-m7,d suer 3-i ides ci icily i 206.12 ` Rc*1 r i Bziit s .ufon, i-2076.( ,bfi. aiu7rin"' 16 0 0).1.1 U1 fl - i t al,l 155 r i� 5 401.'.13-.1){_, l�J„?L In111<4t , iR n.f. 3-d03.iliC`j � { mrna�ia!} 15cxes.e,3?21F.F-cxn9- ! dti'F's � 4S,.i 1(L/ j 12c staining, i.n�f 'uc'Pouu ns of Hcef \nc:.0 15 F I4— �I it f ;1.6Liic4);3) P air- NVildStuffcj('1'.Is, Su ftftie Cnn,� wink kiln_ ttii ,a-, Cold PHF . Maintained at or below i :. _._ _...� .. .222...2. -iii. k t i t_ ti, axe � ,,, � •k ' i.: ., l int PHFq Maintained atorabove F 40,17 3403.1It )K'ti)i j I'm" w5­f- 15 sec : AG3.41i B) �—� tiifc uncatic Ii ' f;: (93-23-,.- Siandinp PHFs Received at Temperatures —� 3-d03.iliC`j � { mrna�ia!} 15cxes.e,3?21F.F-cxn9- ! dti'F's � 4S,.i 1(L/ j 12c staining, i.n�f 'uc'Pouu ns of Hcef (g i I Proper cooling of PHFs 3 501_ ]d(A) C.ox�line cookiA 111-11's Fmm 14Y F ic, '7u"): Within 2 !'ftwrc .;nd From "Y'l' I _ t 41'F145'F'Within ; Homs.' r i-501. i-1iF3)�� (iaif i r� PRF^ 81 do (crani mbiefft E Fcntl- num in ruSerrs ti-i-1"i%#4�F 1S'ithin 4 ll,kr>�� '-l.'i 'z ci�uc9l ic�i =��r. ,-af �: ,, 1,,,3-. ;•tt„f it �'=t_4;f;. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATiONS (HSP �L ( 3-801 1 i ('lI UnfTiqitmized Pre—packaged Iotces and 80 ! (i#) t of Pa tcmizcd F,Ltc�,� _ 3_SC73 11 i 111 if. w nt Paii mil v Clsra-d Animal Food and R Sc ,! 'v ,t Serve F '' i$!i I'iC! F Ij , i.k,,;i. ro(xki Pa r ,w, No R CONSUMER ADVISORY 2 3 {60 I + c `onsu II wr kw 1so: 4 °ir f a„r (c)lt,auipcian c i;fu; `i ~Ude I hat jw Raw, 4;t deco �,,.iSx=i c� tla(ho , .' w i'ste: i I ' 3 c S cba tat: 1073- RA`m $hell ('+4t J.ta.�i-177 1 ufi i t.'tyottt 1 ac�ltt lrzl t3j;o i t l a _ �.tcn z i� isc.Loii(1 xxc, 1. nw,rra� � a.ui I i rc�Siti+ n i.t t ifctun } tatiot iicicid "7e i t � c�bif t. Eider ilio vi, r3- nriarc ,er''tosis :-_- i i IULAr, WS Rf FATlEb Ta C b6b 0 rAI �r�.acrrcLS (Ifetns 23-30) Cii,i _! ziw,4 a: f< ,'ti.n0, )sulci'io not 4W.a!&r f roc't rre al s1 UH -1,x =it i s nc"t n { f0ti ro ti !(,d abow, can be l""ard... if,. �i iii .fg yet . tits , r 'h" ? and o ode ctr d N_ C'41IR _- __..r __ _ ... ... Item600a Retail Practices FC a 590.bY;0 2m _..,! ,- DhFldnpirea and P t sr. [ } � (=C 7 ani arat tite!7s[is '- l C - 4 - :005 *fbinn� J C 1 r.` i cC C TKJ:i 41y_ FC 6 W7 or .'nx r Ua e -ails -FC - 7 1 .308 --So 1. W(C) PHFs Received at Temperatures —� According to Lein Cowled to _ 41°F/45`F Within 4Hows. * 3-501.15 _ C("ing Methods for PHFs 14 PHF Hot and Cold Holding -501.I6(B) Cold PHF . Maintained at or below 540.004(F) 410/45° F 4-50116fA) l int PHFq Maintained atorabove 40,17 C + till.lri(A) �Rw%.ts Held at or above 130°F. Time as a Public Health Control 1 _ 1 f n as a Public. Fie aldt Control - it [ an, r.cat r=inet_tt REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATiONS (HSP �L ( 3-801 1 i ('lI UnfTiqitmized Pre—packaged Iotces and 80 ! (i#) t of Pa tcmizcd F,Ltc�,� _ 3_SC73 11 i 111 if. w nt Paii mil v Clsra-d Animal Food and R Sc ,! 'v ,t Serve F '' i$!i I'iC! F Ij , i.k,,;i. ro(xki Pa r ,w, No R CONSUMER ADVISORY 2 3 {60 I + c `onsu II wr kw 1so: 4 °ir f a„r (c)lt,auipcian c i;fu; `i ~Ude I hat jw Raw, 4;t deco �,,.iSx=i c� tla(ho , .' w i'ste: i I ' 3 c S cba tat: 1073- RA`m $hell ('+4t J.ta.�i-177 1 ufi i t.'tyottt 1 ac�ltt lrzl t3j;o i t l a _ �.tcn z i� isc.Loii(1 xxc, 1. nw,rra� � a.ui I i rc�Siti+ n i.t t ifctun } tatiot iicicid "7e i t � c�bif t. Eider ilio vi, r3- nriarc ,er''tosis :-_- i i IULAr, WS Rf FATlEb Ta C b6b 0 rAI �r�.acrrcLS (Ifetns 23-30) Cii,i _! ziw,4 a: f< ,'ti.n0, )sulci'io not 4W.a!&r f roc't rre al s1 UH -1,x =it i s nc"t n { f0ti ro ti !(,d abow, can be l""ard... if,. �i iii .fg yet . tits , r 'h" ? and o ode ctr d N_ C'41IR _- __..r __ _ ... ... Item600a Retail Practices FC a 590.bY;0 2m _..,! ,- DhFldnpirea and P t sr. [ } � (=C 7 ani arat tite!7s[is '- l C - 4 - :005 *fbinn� J C 1 r.` i cC C TKJ:i 41y_ FC 6 W7 or .'nx r Ua e -ails -FC - 7 1 .308 Establishment Name:- Pa )P n_ !r) I r IJ, r ''fNl a, A 9(a i , Date: t A--1-oQ Page: -:2� of 2 Item No. Ccde Ret'erence C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date verified /', r) A '0/y -k �P 'C4_' ./1I(^AD Ntr YV DP�f�Q— -\n/AM nnM �A11 �, 1/Y jA .A kit, .,, % 1'!/i ._/.J�. ihlC��nJ'i,(a/..�\ LI. AA —��ti1 r_l -f" 0 D ✓_ i:o -" 11 9 --1 I MA4 /7._, 11 A wl ),ff4_orr\A)_M.DP.11�n/ {11 %fit' In..n'ti%r,�/iV . �w- I'7P Jh N'4"V"..>,in✓,. C(1 P tB)I JUn Ali ,>� — C%k,.•v 0 I�Mw,r n� /1 � �1 l � a� - — vqj+ 1-0. - +t� he_ r° 919—A p4)() jjd M c_ �Pn L AA C• �th'J��i�,r ,);t An .�,"„U t. �'\C71.ro TY2r.�.,n U�!.\.c (,ii iZ) �7) rYCX/ate r �,' I1 -dA r: ' _ - x � i, h% 4TT Pry A', Od -in %1� QA POt &) �zj01A1, .Qiz ^rt�lr „ D,9 erg 61 Or ���,> �'?n„ --iii 0 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 x � comply with all mandates of the Mass/Federal' I understand that noncompliance may result in daily fines of tw n ,, I ve dollars or suspension/revocation of ypur food permit. ry_ Corrective Action Required: ❑ Nco No Yes r'./y=-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 (Itenis 1-22) (Cont) PROTECTION FROM CHEMICALS 14 55'17 15 S Food or Color Additives I lrraw�ds:ite seivicc 11,51-1 5Se 3-202.12 Additives'" 3-30114 Protection front Unapproved Additives I 1-5 100.1 !ffl,iO)Qj Pi oisonous or Toxic Substances 19 WEIT identifying Intonnallcn -- Orifinal Ralme" flliecr-.d Klcnai, I 3-501.16B) Cold PHFs Maintained at or below i 4011VA), 3j 7-10-1,11 Common Nato, orkir,,-, Cowaiier, 7-20 L I I _72021 T &paia ton - 5lo, a 7-202-12 Condition, of tjsc� 20_ 7 ?O3. 11 7-- Toxic Container — -C rnerui-Chemic ,�,W -2-204.17 rrv� a� a Public I IciI t I cont) 01, 7-204-12 Chijmcak t,tr AN'anhww, PmdiwCiit,:oal 1 7-204,14 Dniyo,, Avenv. Crjteria' -1 205,11 bwidnwl food Conlact. Lahti cap(s' -206,11 R�<,Ioed L"gv Gitcnn� i 7-206.12 1 Rotkni B'61 S%flioll!" (oltio! ,na 16 101 11 A1 1 55'17 15 S PHFs Received at Temperatures I lrraw�ds:ite seivicc 11,51-1 5Se According to Lau Cooled to 41 `F/45'F Within 4 Homs. 100.1 !ffl,iO)Qj i PoF' aEd Bee! ko�Kl 1 10 F riin, 19 3-46 L' I (A)' Ralme" flliecr-.d Klcnai, I 3-501.16B) Cold PHFs Maintained at or below i 4011VA), 3j I PoWtp, udd Swl'cj 41`/45° F* 1 591 16(A) I lot PHF� Maintained at or above 40 F. * i kuaims Held at or )bo%e 130"F, 20_ Time as a Public Health Control .ski',5 f rrv� a� a Public I IciI t I cont) 01, Varo; Requircluent 17 1 1 Rnheatiflg Tor Hot Holding _4 lmo�vo-j6)" T, 2 Nlosl�qldhl,- -4,011NQ j commercialK RIF 1 3-4()3.1 I(F" 1 Rcriamilk", U,,k,ed Po,00n+ of ficl 1 Proper Cooling of PHFs i.501A4A)� Cooling, C,,x)k-A PHI -'s oom 14WF to W;`F Within 2 1 foljrs wid From M'i 11o4l Within 4 How!,, I 501,14( b Coollog PHR: M:dv From Amb;cni 1-cinperawre Ing redialts ic,4111,4YF Within,4 lfour 4 , I . 1,1-r 1,; ', Fi,00( ;" r 105 . "M ..; ofK, REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) it -T POt I LT IU8 � I I"'ll) 11, f P winized Eegs, L - �11 .a� — I I(D) Kz.�or Paomllv Cool,�,d Arimil Foid d;id F,Xu4 pae,!,ac, No! CONSUMER ADVISORY 22 4)03 1 1 1 (on tk;mzi A(o isots' Poted tar Conmimptiun of Anini'll Undere oktd oi ganare fur p6w Shelf SPECiAL REQUIREMENTS f,pa,,rine. nwbik, f".10d, t,'Inporwv and 1:ilchcn op,; tions sIioiljd be kli'hoecl niton cl the 1F 1 COpII21tf. Sf,� 11011S ;...t, vt and ri";k qh"r I,,, RM Ji,.red d VIOLA FiONS RELA T -ED TO GOOD RETAIL PRACTZ0,; (Item4 23-30) Cin 'walw'd ww(1 do'gol ! 6ao11 f,f;dh,,'7, b,t,i v !We; 1,01fwno eand ? iAfiu fors Ii; ed above, (an I,(' !�wfnd i;?:N p,;i ","g sef s,, f,q, iiw food Code and 105 ("AIR Item cood Retail Practices FC 530,000 23, Manacen-rA a. ri Ponnpl Io 1-(: - 4 FC -6 W7 Fogs�'ar x1s or -,wfu tierfia ! FC -7 002 I 3-501,14(C) PHFs Received at Temperatures According to Lau Cooled to 41 `F/45'F Within 4 Homs. 3-501A 5 Ccxdm.� Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16B) Cold PHFs Maintained at or below 590,W4(F,1 41`/45° F* 1 591 16(A) I lot PHF� Maintained at or above 40 F. * i kuaims Held at or )bo%e 130"F, 20_ Time as a Public Health Control rrv� a� a Public I IciI t I cont) 01, Varo; Requircluent REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) it -T POt I LT IU8 � I I"'ll) 11, f P winized Eegs, L - �11 .a� — I I(D) Kz.�or Paomllv Cool,�,d Arimil Foid d;id F,Xu4 pae,!,ac, No! CONSUMER ADVISORY 22 4)03 1 1 1 (on tk;mzi A(o isots' Poted tar Conmimptiun of Anini'll Undere oktd oi ganare fur p6w Shelf SPECiAL REQUIREMENTS f,pa,,rine. nwbik, f".10d, t,'Inporwv and 1:ilchcn op,; tions sIioiljd be kli'hoecl niton cl the 1F 1 COpII21tf. Sf,� 11011S ;...t, vt and ri";k qh"r I,,, RM Ji,.red d VIOLA FiONS RELA T -ED TO GOOD RETAIL PRACTZ0,; (Item4 23-30) Cin 'walw'd ww(1 do'gol ! 6ao11 f,f;dh,,'7, b,t,i v !We; 1,01fwno eand ? iAfiu fors Ii; ed above, (an I,(' !�wfnd i;?:N p,;i ","g sef s,, f,q, iiw food Code and 105 ("AIR Item cood Retail Practices FC 530,000 23, Manacen-rA a. ri Ponnpl Io 1-(: - 4 FC -6 W7 Fogs�'ar x1s or -,wfu tierfia ! FC -7 002 I i Commonwealth of Massachusetts i City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment. Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: File Number: BHF -2004-000291 LOCATED AT: Steve's Quality Market 36 Margin Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2009-0175 Dec 23, 2008 Dec 31, 2009 $280.00 TOBACCO VENDOR BHP -2009-0176 Dec 23, 2008 Dec 31, 2009 $135.00 PERMIT EXPIRES Total Fees: $415.00 31, 2009 , Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR JANET DIONNE, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' TEL. (978) 741-1800��4® FAx (978) 745-0343 IDIONNE&ALEM. COM DEC 112008 &VWYD lu, b,yy 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT %PU-0/hO,lnArPlt�IL YYLt1-b—I- TEL# ADDRESS OF ESTABLISHMENT2n u y w1� Vd YM1�V/lvt FAX 401L 4tL MAILING ADDRESS (if different) EMAIL- Business': Website: (�/ OWNER'S NAME 5ktA2yL it _ TAGevn., TEL# ,'tib 'Iqq Mil ADDRESS CERTIFIED FOOD MANAGER'S (Required in an establishment where EMERGENCY RESPONSE hazardous food is prepared) Please write in time of day. I tFor examnle 11 am -11 Dmf It bO K- l ti, TYPE OF ESTABLISHMENT RETAILSTORE YES NO CITY CERTIFICATE#(S) TEL#qlI - q -A CIA-(Q�0aActa.� FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 ✓ more than 1 0,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart $210) 25-99 seats =$280 more than 99 seats =$420 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 / TOBACCO VENDOR (� _.NO $135✓ ALL NON-PROFIT (such as church kitchens) -7E—S— 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. Pu' nt 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 return paid all statey>Iaxes required under the law. . Date Social Security or Federal Revised 424/07 FOODAP2008.adm Check# & Datea����-4�e�B� $ 36 Margin Street 'Telephone: 744-4220 'Owner: Stephen Ingemi PIC: Peter Ingemi Inspector: David Greenbaum Date Inspected: Correct By: 1/23/200 Risk Level: Permit Number: BHP -2008-0066 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 RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Steve's Quality Market Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: The scale at the bakery prep area needs a thorough cleaning. The flooring at the bakery prep area needs a thorough cleaning including undeer and around all equipment. The bread slicer has an accumulation of food debris. Thoroughly clean the bread slicer. GENERAL COMMENTS: All other violations cited in the 1/10/08 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 24,2008) Page I oft 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® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 24,2008) Page 2 oft 36 Margin Street ,Telephone: 744-4220 Owner: Stephen Ingemi PIC: Peter Ingemi Inspector: David Greenbaum Date Inspected: Correct By: 1/101200 8 Risk Level: Permit Number: BHP -2008-0066 -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 RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Steve's Quality Market Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Separation/ Se gation/ Protection FAIL Critical ❑� RED C mment: Dirty knife and spoon found stored in a container of raw meat. Properly clean and sanitize all utensils and store in ppropriate area. Do not store dirty utensils with raw meat to prevent cross contamination. Food CisreadiAl Surfaces Cleaning and Sanitizing FAIL Critical RED ment: The sanitizing solution throughout the establishment found too week. Sanitizing solution of proper concentration must available at all work stations at all times. Th meat grinder was not properly cleaned and sanitized after the prior days usage. The meat grinder must be properly cleaned d sanitized after each use. Th meat slicer in the meat room has an accumulation of food debris and grime. Properly clean and sanitize the meat slicer after ch us T meat saw has an accumulation of food debris inside the saw housing. The meat saw must be properly cleaned and sanitized fter each use. KpKes found stored in water in many areas of the establishment. Clean and sanitize all knives, knives may be stored in sanitizing olution of proper concentration between usage. T inside panel on the ice machine has an accumulation of grime. Thoroughly clean and sanitize the ice machine. Good Hygienic Practices FAIL Cd' I ❑d RED mment: Employee drinks observed in the meat room, the bakery and in the del alk in. Employees must eat and drink in a designated area and store food and drinks in a designated employee refrigerator to prevent cross contamination. Handwash Facilities FAIL Critical 2 RED &,c"omment: The hand wash sink in the meat is missing paper towels. Provide disposable paper towels at this hand wash sink at all times. Te hot water temperatures at all hand wash sinks was approximately 89°F to 106°F. Provide hot water at all hand wash sinks at a mimum temperature of 110°F. water pressure in the mens room is extremely low. Restore water pressure to this hand wash sink. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 14,2008 ) Page I of Item Status Violation Critical Urgency RED: . T - —_ _ Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Foo rotection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require mment: There are price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price labels. immediate Corrective action) ! Cpdckage of marinated chicken wings removed outdated. Closely monitor all expiration dates. Equipment and Utensils FAIL Non -Critical BLUE Cc ment: The flooring in the meat room has an accumulation of food debris. Thoroughly clean the flooring including under and ound all equipment. T'wr Aping machine in the meat room needs a thorough cleaning. T walls in the meat room have an accumulation of food spills and splatter. Thoroughly clean all walls. T wrapping machine in produce prep area needs a thorough cleaning. The oreing in the produce prep area has an accumulation of food debris. Thoroughly clean the flooring including under and a 11 equipment. T fand sand refrigerator unit in the produce walk in have an accumulation of mold and dust. Thoroughly clean this unit. T oven in the prepared foods area has an accumulation of grease and grime. Thoroughly clean the oven inside and out. Th elves above the prepared foods prep area have an accumulation of food spills and splatter. Thoroughly clean and repaint LAffee shelves. T flooring in the prepared foods prep areas has an accumulation pf food debris. Thoroughly clean the floor including under and all equipment. ;T/dr9y,,;1gredIent shelves need a thorough cleaning and replace the aluminum foil. loong of the Lang oven needs a thorough cleaning. in client barrels need a thorough cleaning. e f'at the bakery prep area needs to be cleaned and repainted. �7hh prep table at the bakery prep area needs a thorough cleaning. --The scale at the bakery prep area needs a thorough cleaning. –The flooring at the bakery prep area needs a thorough cleaning including undeer and around all equipment. The bread slicer has an accumulation of food debris. Thoroughly clean the bread sliceThe bakery walk in freezer has an accu lation of frost and ice. Clean and remove all frost and ice. e�back room area needs a thorough cleaning. . Tye basement freezer ceiling is in disrepair. Repair or replace the ceiling to be nonporuos and easily cleanable. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 14,2008) Page 2 of Item Status Violation Critical Urgency T wall reach in freezer case has an accumulation of food debris and grime. Thoroughly clean the wall freezer case. - Physical Facility FAIL Non -Critical BLUE C ment: There are water stained ceiling tiles throughout this establishment. Investigate the source of the leak and repair. eplace all water stained ceiling tiles. GENERAL COMMENTS: A reinspection will be conducted on Wednesday, January 23, 2008, all violations to be corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 14,2008) Page 3 of Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/29/2010 ESTABLISHMENT NAME: File Number: BHF -2004-000291 LOCATED AT: Steve's Quality Market 36 Margin Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2010-0199 Jan 4, 2010 Dec 31, 2010 $280.00 TOBACCO VENDOR BHP -2010-0207 Jan 4, 2010 Dec 31, 2010 $135.00 Total Fees: $415.00 PERMIT EXPIRES December 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Paye 1 4'W KIMBERLEY DRISCOLL MAYOR DAVID GREENBAum, ACTING HEALTH AGENT NAME OF ADDRESS MAILING ADDRESS (if different) EMAIL - Business': OWNER'S NAME ADDRESS 2010 APPLICATION CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4m FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGRFENOAUM@SALEM. COM FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT f TEL # La / ,�/ q�Ay;0 FAX# LiiT'1 Website: TEL # q), � e) 7 `f b d -q STATE CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE Please write in time of (For exari 11 am -11 TYPE OF ESTABLISHMENT RETAIL STORE ES NO TEL ' i. t-I.om if It FEE (check only) less than 1000sq.ft. 1000-10,000sq.ft. more than I0,000sq.ft. =$ 70 =$280✓ =$420 RESTAURANT YES (NO f less than 25 seats =$140 (Outdoor Stationary Food Cart $210) 25-99 seats =$280 more than 99 seats =$420 .......... ------------------------------------------------- -............................... - BED/BREAKFAST/ YES NO $100 QHILDCARESERVICESMURSINGHOME - ......................................................................... ................... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR NO $135✓ ALL NON-PROFIT (such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to andapproved by the Salem Board of Health. - , 1 . Pursuant to MGL Chapter 62C, Sect I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have flled�all state tax returns an aid all state tax required vnder the law: °' ` Date ' ' r IF Social Security or Federal Identification Revised 424/07 FOODAP2008.adm Check# & DateFS F. + 4'+ s rw +"} 4• 'd"i yy��,',r<y,t a'�fi' +Y �a!p—rap +� k+ k, 1sJv2+. s* > ✓.5 ..!w +L aii=f^'Y""' kn.M'.r�A o��kNi 1 fY.... S; Y •"IP .: A ra A Commonwealth of Massachusetts r City of Salem --Board of Health I(jm(� y DtISC011 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 - Food/Retail Establishment Permit DATE PRINTED: 01/03/2008 - - ESTABLISHMENT NAME: File Number. BHF -2004-000291 LOCATED AT: Steve's Quality Market 36 Margin Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued. Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2006-0066 Jan 3, 2008 Dec 31, 2008 $280.00 TOBACCO VENDOR BHP -2008-0105 Jan 3, 2008 Dec 31, 2008 $135.00 Total Fees: $415.00 PERMIT EXPIRES December 31,.2008 Board of Health This Permit is not transferable and must be -reissued upon change of ownership. or location. The permit must be posted in - a prominent location in the Establishment -- -- - --- - In accordance with the State Sanitary Code, beofre any revonations, improvements; or equipment changes are made, all - plans for such must be submitted to and approved by the Salem Board of Health. Page 35 of 46 KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' FLOOR 'ISL. (978) 741-1800 FAX (978) 745-0343 ISCOTTC&SALENL COM RECEIVED DEC 6 - 2007 CITY Gc= SA!_EM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT, �dTO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ISP l I Ul TEL # � /ff l �t"1 ob-A ADDRESS OF ESTABLISHMENT 34 ri> ry- FAX # q,� lq�g3 1, 1 MAILING ADDRESS (if different) EMAIL - Business': l OWNER'S NAME ADDRESS Website: TEL # "( 18 1'I, "f DA A .M /A Ql�ily CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE HOURS OF OPE Please write in time y'_ Lt TEL# P- I1-1 -ltl Wb TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE ES NO & less than I000sq.ft. =$ 70 1000-10,000sq.ft. =$280✓ more than 10,000sq.ft. =$420 --- -------------------------YES ---------------------------------------I RESTAURANT NO less -- than-- -.25....se- a-- ts ------------=$J-40 --- (Outdoor Stationary Food Cart $210) 25-99 seats =$280 more than 99 seats =$420 ----- ---------_------------------- .. BED/BREAKFASTI YES NO $100 CHILDCARE ----_-------------_- — ------------------------------------------------------ ---------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR NO $135V --'ALL NON-PROFIT (such as church kitchens) ES 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. Pursua 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 returnsAn ,paid all state taxes required under the law. t Signature Date or Federal Identification Number ---'------'---�------------- ---'---------------' ----- ------ .,T� ---------- Revised 4/24/07 FOODAP2008.adm Checkq & Date j .Z $ '9Ik/7aR S1 --a Gd 3 2d es P"?oC,1161c rS 6vq s /, /vv X C/,v/L` '1 TO ''1T 1 DATE,/ -- TIME �o� AM P,` I ''1 V 6-7_ 6 :06 PM H FROM O �O�S �� AREA CODE EO+i OF N NO. fi N EXT. E ' M ; FAX 0 tfi�r:" e v47-1 A 2 7- IVf= g �iJri�r�ro 51.77 lN� OIiEf} E A 41cE 0 A s�-1—b M E C46�rnJ,rv& O.' SIGNED '', PHONED ❑ BACK ❑ CALLED ❑ S EVOU ❑ WAS IN ❑ Amu�GNN LL ❑ UNGFNT ❑ p TO _I / V V DATE-�r 0��-9 TIMOE AM G •J S PM FROM AREA CODE 0 NO. OF N ,• E ', EXT. FAX # M aLz /Z12 tu- zL E %�Lmn Opo - M s E, A G E SIGNE PHONEDEl TO WAS N Ell UIIGENT ❑ BACK _]CALORNEU SEANTS E YOU GNNALL • • ` FaMol Will �/ .riLrII AREA CODE .I, �- • .rte/i�� Ii. < ��L/: TO U —,„ n . F L� AREA CODE NO. EXT. FAX # PHONEDRAY I. BACK 1 CLORNED El SWANTS EVOUO ❑ I WAS IN E] I WILL CALL ❑ WMA". F-Mll . w.rdo _. AREA CODE NO. EXT. FAX # PHONEDRAY I. BACK 1 CLORNED El SWANTS EVOUO ❑ I WAS IN E] I WILL CALL ❑ `.�. �� �� ��, -; � ...�J DAT • , .. .O.EXT GISom /� . �✓.,�.'_., ,ice /: • • MEN= I.. • 1�� TO DATE �y TIME AM H 0 FROM AREA CODE NO. OF _ EXT. E M FAX u M s s E A M; G E o SIGNED PHONED BACK CALL SEE S EYOUO WAS IN Ell AGNNALL ❑ UPGENT❑ Glwo � m-rr�s C�a�'%2 SeX� �� a Pc/eQ/goy NORTH SHORE PEST CONTROL •— --- -- x 270 4USETTS 02151 (617) 289.9449 DATE TYPE OF SERVICE - TIME ✓ ❑ REGULAR -ONE TIME IN5 OUT � NAME S Tc /1ES ADDRESS -vazr- cx sT- u�u ata ac0� CITY PHONE SALE/ti. �Nll- S4+R-7g4e- 21220 O'Pest Control ©'Inspection ❑ Termites ❑rp[ reatment ❑ Rodents O'Spraying . r ct�lS 0 /eTE S CHEMICALS USED Wo "' QUANTITY USED SPECIAL INSTRUCTIONS/REMARKS AMOUNT TE�iT l�PT oL Pu�3Uc Gr%cz✓-s4ac ,:.C�t E.S _5 T- .$'ALt /�/ -�•fi 7r3�Of=i.2 i 0 rT.?GATFJ /fL�L /2UGGE .D q,PFVS . ;`v2 fLEA AvcTiur 47 T.viS SERVICED EY. 2v4 ��`j uCILG ( TOTAL /pry '� CUSTOMER SIGNATURE SERVICE REPORTNQ 082 r 14 AUG 2 o 1991 VV CITY OF SALEM 'rALTH DEPT t u 36 Margin Street HACCP: ❑ Steve's Quality Market City of Salem RETAIL FOOD - Food Establishment Inspection Item Telephone: PROTECTION FROM CONTAMINATION 744-4220 1 Separation/ Segregation/ Protection Owner:Com ent: There is poultry stored in the bakery walk in Stephen Ingemi PIC: Peter Ingemi Inspector: John Gehan Date Inspected: Correct By: 4/12/2007 Risk Level: Permit Number: BHP -2007-0012 Status: Open # of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Food Contact Surfaces Cleaning and Sanitizing Status Violation FAIL Critical Poultry to be stored in proper designated areas. FAIL —Co ment: Deli has cutting boards that are stained and scored. Resurface or replace boards. ,'Mear room has cutting boards that are stained and scored. Resurface or replace boards. Critical Urgency INga1 d❑ RED Cityof 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. Apr 13,2007) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions C�pm/m and Risk Factors (Require ent: Deli meat/cheese unit has uncovered foods. All foods must be covered. immediate corrective action) ere were personal drinks in the baking area. All personal items must be stored in designated areas. roo has personal drinks on food prep areas. All personal items must be stored in designated areas. The following items were twaking off the shelves for being outdated or damaged: 2 Mixed grain baby cereal 1 rice single grain 4 Bush original baked beans 1 B+M Vegitarian Baked beans 1 B+M maple baked beans 1 Campbell baked beans 4 Hellmans reduced fat mayonaise Equipment and Utensils FAIL BLUE .Oomment: Henry Penny unit in deli requires general cleaning. �Delfield unit in deli requires general cleaning. elves upstairs next to oven require general cleaning. /en requires thorough cleaning. /bait mixer requires thorough cleaning. masoning shelves require general cleaninng. ,.Baking area upstairs shelves require general cleaning. _, Baking area walk in freezer has accumulation of ice. Find source of leak and repair. Remove ice. ,Dai �ry walk in floor requires general cleaning. .-IMeat walk in floor requires general cleaning. ,_p_co�duce walk in floor requires general cleaning. Pi roduce wrapper requires general cleaning. Ice-o-matic ice machine inside panel requires general cleaning. vTyler reach in units from ice cream to the vegtable section requires cleaning of door tracks, vents and the bottom. '-,Alhlkljuice unit bottom areas and vents require general cleaning. 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. Apr 13,2007) Page 2 of Item Status Violation Critical Urgency There are knives throughout the uspstairs that are stored incorrectly. All knives to be stored in designated rack or container. Physical Facility,- FAIL BLUE ment: There is a large crack in the baking area wall. Seal hole to prevent entrance of rodents. .Employee restrooms require general cleaning. —There is a hole in the floor outside the mens bathroom. Seal hole. iFloor beneath the bread shelves require thorough cleaning. ,-;,here �ar'e water stained ceiling tiles above the baking area upstairs. Find source of leak and repair. Replace tiles. —Th rre are water stained ceiling tiles above the ice cream reach in. Find source of leak and repair. Replace tiles. 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. Apr 13,2007 ) Page 3 of 36 Margin Street Telephone: 744-4220 Owner: Stephen Ingemi PIC: Peter Ingemi Inspector: John Gehan Date Inspected: Correct By: 4/19/2007 Risk Level: Permit Number: BHP -2007-0012 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 RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Steve's Quality Market Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Separation/ Segregation/ Protection PASS Critical ❑d RED Comments: There is poultry stored in the bakery walk in. Poultry to be stored in proper designated areas. Food Contact Surfaces Cleaning and Sanitizing PASS Comments: Deli has cutting boards that are stained and scored. Resurface or replace boards. Mear room has cutting boards that are stained and scored. Resurface or replace boards. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 0 RED GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 19,2007 ) Page 1 of RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS Critical BLUE Comments: Deli meat/cheese unit has uncovered foods. All foods must be covered. There were personal drinks in the baking area. All personal items must be stored in designated areas. Meat room has personal drinks on food prep areas. All personal items must be stored in designated areas. The following items were twaking off the shelves for being outdated or damaged: 2 Mixed grain baby cereal 1 rice single grain 4 Bush original baked beans 1 B+M Vegitarian Baked beans 1 B+M maple baked beans 1 Campbell baked beans 4 Hellmans reduced fat mayonaise Equipment and Utensils PASS Comments: Henry Penny unit in deli requires general cleaning. Delfield unit in deli requires general cleaning. Shelves upstairs next to oven require general cleaning. Oven requires thorough cleaning. Hobart mixer requires thorough cleaning. Seasoning shelves require general cleaninng. Baking area upstairs shelves require general cleaning. Baking area walk in freezer has accumulation of ice. Find source of leak and repair. Remove ice. Dairy walk in floor requires general cleaning. Meat walk in floor requires general cleaning. Produce walk in Floor requires general cleaning. Produce wrapper requires general cleaning. Iceo-matic ice machine inside panel requires general cleaning. Tyler reach in units from ice cream to the vegtable section requires cleaning of door tracks, vents and the bottom. Milk/juice unit bottom areas and vents require general cleaning. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 BLUE GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 19,2007 ) Page 2 of Item Status Violation Critical Urgency There are knives throughout the uspstairs that are stored incorrectly. All knives to be stored in designated rack or container. Physical Facility PASS Comments: There is a large crack in the baking area wall. Seal hole to prevent entrance of rodents. Employee restrooms require general cleaning. There is a hole in the floor outside the mens bathroom. Seal hole. Floor beneath the bread shelves require thorough cleaning. There are water stained ceiling tiles above the baking area upstairs. Find source of leak and repair. Replace tiles. There are water stained ceiling tiles above the ice cream reach in. Find source of leak and repair. Replace tiles. GENERAL COMMENTS: All violations from 4/12/07 have been corrected. Thank you. - LL�7L�L City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 BLUE GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 19,2007 ) Page 3 of 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT cll LUP� Q� ee11r k TEL # v1711 '1gq.gA/ V ADDRESS OF ESTABLISHMENTYlA7k YVIGQ nlg�,a FAX # q1A MAILING ADDRESS (if different) EMAIL -- Business': Owner's: OWNER'S NAMEt?l�`l'ir �OYPVI I TEL#911f ✓)�1kqJ ADDRESS 'I 6r/w& S� ! A1em ma-. 61TIO STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) Q EMERGENCY RESPONSE PERSON�Q�C11AL HOME TEL #q1 b �� DAYS OF Monday Tuesday Wednesday Thursday Friday Saturday SmdaY NOURSOFOPERATION 41'1'1 (Q Q" Please write In in ofaall (For exampletlam-tlaml IV 9(A 1 11 tl Ul YVt 1ti ti '1�1 TYPE OF ESTABLISH T FEE (check only) RETAIL STOREES NO less than 1000sq.ft. -$50 1000-10,000sq.ft. =$1009 more than 10,000sq.ft. =$250 - - ---- ------ RESTAURANT YES NO --- ---------------- --- less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 -- -------- - - $100 ----- ----------- BEDIBREAKFAST YES N -------------------- ----- - - - - --- - ------ ..._------- - ----------- ----- - - - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR � / NO $501 ALL NON-PROFIT (such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have sled all state tax returns and paid all state taxes required under the law. e 6 Ltaa 3 Signature V I Date Social Security or Federal Identification Number --------------------------------------- ------------------------------------------------------ ---------------- ----------------- ----- Revised 11/13/06 FOODAP2007.adm J Checkii & Date �3L _t 6_I�Q6$ _1- 70± Cb CITY OF SALEM, MASSACHUSETTS o BOARD OF HEALTH RECEIVED ^111------��� E _EIVED 120 WASHINGTON STREET, 4TH FLOOR 0 9 Y SALEM, MA 01970 DEC - 4 2006 TEL. 978-741-1800 . FAx 978-745-0343 CITY OF SAL0A Kimberley Driscoll WWW'SALEM.COM BOARD OF HEALTH ,JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT cll LUP� Q� ee11r k TEL # v1711 '1gq.gA/ V ADDRESS OF ESTABLISHMENTYlA7k YVIGQ nlg�,a FAX # q1A MAILING ADDRESS (if different) EMAIL -- Business': Owner's: OWNER'S NAMEt?l�`l'ir �OYPVI I TEL#911f ✓)�1kqJ ADDRESS 'I 6r/w& S� ! A1em ma-. 61TIO STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) Q EMERGENCY RESPONSE PERSON�Q�C11AL HOME TEL #q1 b �� DAYS OF Monday Tuesday Wednesday Thursday Friday Saturday SmdaY NOURSOFOPERATION 41'1'1 (Q Q" Please write In in ofaall (For exampletlam-tlaml IV 9(A 1 11 tl Ul YVt 1ti ti '1�1 TYPE OF ESTABLISH T FEE (check only) RETAIL STOREES NO less than 1000sq.ft. -$50 1000-10,000sq.ft. =$1009 more than 10,000sq.ft. =$250 - - ---- ------ RESTAURANT YES NO --- ---------------- --- less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 -- -------- - - $100 ----- ----------- BEDIBREAKFAST YES N -------------------- ----- - - - - --- - ------ ..._------- - ----------- ----- - - - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR � / NO $501 ALL NON-PROFIT (such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have sled all state tax returns and paid all state taxes required under the law. e 6 Ltaa 3 Signature V I Date Social Security or Federal Identification Number --------------------------------------- ------------------------------------------------------ ---------------- ----------------- ----- Revised 11/13/06 FOODAP2007.adm J Checkii & Date �3L _t 6_I�Q6$ _1- 70± Cb 77 $_TUF Board of alth'"`°`s 3f'"ti" tye:t i°«ib" i r He_ IGmbetiey Dnscoll cy 1^ 120 Washington Street, 4th Floor{ M t1 MByOf,=; SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/19/2006 ESTABLISHMENT NAME: File Number: B14F-2004-000291 LOCATED AT: Steve's Quality Market 36 Margin Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2007-0012 Dec 19, 2006 Dec 31, 2007 $100.00 TOBACCO VENDOR BHP -2007-0035 Dec 19, 2006 Dec 31, 2007 $50.00 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 22 of 29 '36 Margin Street Telephone: 744-4220 Owner: Stephen Ingemi PIC: Peteringemi Inspector: John Gehan Date Inspected: Correct By: 10/30/2006 Risk Level: Permit Number: BHP -2006-0214 Status: SIGNED OFF # of Critical Violations: Time IN: I Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Steve's Quality Market Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Handwash Facilities FAIL Comment: Back handwash sink by bathroom at bottom of stairs requires thorough cleaning. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 RED GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 06,2006 ) Page 1 of RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Comment: Baby food isle has used paper towels on top of baby food. Remove paper towels. The following items were taken off of the shelves for being outdated: 10 Pillsbury Chocolate Moiste surprise boxes. 1 Betty Crocker angel food box 1 Ritz peanut Butter sandwich box. Damaged: Carolina Enriched rice. Deli had uncovered foods. All foods must be covered. 1:7417 Deli meat cases had personal drinks being stored in it. Personal items are to be stored in designated employee areas. Equipment and Utensils FAIL BLUE Comment: Tlyler reach in freezer (ice cream) requires thorough cleaning of bottom shelves. egg case has spills and splatter. Thoroughly clean case. Milk case requires general cleaning. Poultry case requires thorough cleaning of bottom shelves. Sanitizing logs not up to date either upstairs in meat room or downstairs in deli. Log to be maintained daily. Cutting boards stained and scored in deli. Resurface or replace cutting boards. Delfield unit in deli requires general cleaning. Deli meat display case requires general cleaning on outside base. There were many knives stored on shelves and in other various places. Knives are to be stored in designated container or in container of sanitizer. Oven upstairs requires general cleaning. Shelves by the oven require general cleaning. Ovens and warmers upstairs require cleaning around handles. Walk in bakery freezer has accumulation of ice build up. Remove ice. Repair unit. Same unit requires organization. Same unit has no visible thermometer inside. Provide visible and accurate thermometer. 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. Nov 06,2006) Page 2 of Item Status Violation Critical Urgency Dairy walk inrequires general cleaning benetah shelving. Same unit has no visible thermometer inside. Provide visible and accurate thermometer. Meat walk in requires thorough cleaning of shelves. Same unit has no visible thermometer. Provide visible and accurate thermometer. Meat room has stained and scored cutting boards. Resurface or replace cutting boards. Produce prep area upstairs requires general cleaning beneath shelves and equipment. Physical Facility FAIL BLUE Comment: There is a water stained ceiling tile above the ice cream freezer. Find source of leak and repair. Replace ceiling tile. GENERAL COMMENTS: All violations 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. Nov 06,2006 ) Page 3 of 36 Margin Street HACCP: ❑ City of Salem RETAIL FOOD - Food Establishment Inspection Steve's Quality Market Item Status Violation Critical Urgency Telephone: j PROTECTION FROM CONTAMINATION 744-4220 Handwash Facilities FAIL ❑d RED Owner: �Comment: Back handwash sink by bathroom at bottom of stairs requires thorough cleaning. Stephen Ingemi PIC: Peter Ingemi Inspector: John Gehan Date Inspected: Correct By: 1 10/30/2006 Risk Level: Permit Number: BHP -2006-0214 Status: Open # of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 30,2006 ) Page 1 of RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Comment: Baby food isle has used paper towels on top of baby food. Remove paper towels. �Thwfollowing items were taken off of the shelves for being outdated: ✓ 10 Pillsbury Chocolate Moiste surprise boxes. 1 Betty Crocker angel food box 1 Ritz peanut Butter sandwich box. Damaged: Carolina Enriched rice. ;:deli ISad uncovered foods. All foods must be covered. BLUE L,Deli�meat cases had personal drinks being stored in it. Personal items are to be stored in designated employee areas. Equipment and Utensils FAIL BLUE ,,,Comment: Tlyler reach in freezer (ice cream) requires thorough cleaning of bottom shelves. L-!.gg.case`has spills and splatter. Thoroughly clean case. Milk case requires general cleaning. I,Poi ltry case requires thorough cleaning of bottom shelves. Sanitizing logs not up to date either upstairs in meat room or downstairs in deli. Log to be maintained daily. Cutting boards stained and scored in deli. Resurface or replace cutting boards. Delfield unit in deli requires general cleaning. VBpli-meat display case requires general cleaning on outside base. Thrcre were many knives stored on shelves and in other various places. Knives are to be stored in designated container or in container of sanitizer. ✓Oven upstairs requires general cleaning. ,Shelves by the oven require general cleaning. ✓yen's and warmers upstairs require cleaning around handles. ,,,Walk'in bakery freezer has accumulation of ice build up. Remove ice. Repair unit. Same unit requires organization. r' Same unit has no visible thermometer inside. Provide visible and accurate thermometer. 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 30,2006 ) Page 2 of Item Status Violation 'Critical Urgency Dairy walk inrequires general cleaning benetah shelving. iSame unit has no visible thermometer inside. Provide visible and accurate thermometer. ,.M a walk in requires thorough cleaning of shelves. ..,.Same unit has no visible thermometer. Provide visible and accurate thermometer. Meat'room has stained and scored cutting boards. Resurface or replace cutting boards. (L,Rrdduce prep area upstairs requires general cleaning beneath shelves and equipment. Physical Facility FAIL BLUE ,--�Mment: There is a water stained ceiling tile above the ice cream freezer. Find source of leak and repair. Replace ceiling tile. 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 30,2006 ) Page 3 of 36 Margin Street Telephone: 744-4220 Owner: Stephen Ingemi PIC: s Peter ingemi Inspector: David Greenbaum Date & :- Correct By: i 66 „d r Risk Level: Permit Number: BHP4006-0214 AN, Status: SIGNED OFF # of Critical Violations: 1 Time IN:'. 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) � x City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Steve's Quality Market Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Handwash Facilities PASS ❑J RED Comments: Handwash sink in deli area has leak. Repair leak or replace faucet. 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. Jun 15,2006 ) Page 1 of 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: Employee drinks being stored on open refrigeration units at front of store. All employee food and drinks to be stored immediate corrective action) in designated employee area. Persoanl drink stored inside deli unit. All employee drinks and food to be stored in designated employee area. Employee drink in upstairs bakery area. All employee srinks and food to be stored in designated employee areas. Uncovered poultry trays in produce walk in. All foods in storage must be covered. The following items were pulled off of the shelves: 7 Nestle Til House Fudge Brownies 3 Gogurts 1 Hood fat free buttermilk 1 Duncan Hines Angel Food (open) 2 Apple Cider dated May 16 Equipment and Utensils Comments: Yogurt/beverage unit in front requires thorough cleaning. All open refrigeration units in front of store require general cleaning. Physical Facility FAIL Critical BLUE PASS BLUE Comments: Light shields missing in downstairs. Provide protective covers or light shields. Stairs going to the upstairs require thorough cleaning. Various water stained ceiling tiles upstairs. Find source of leak and repair. Replace all stained ceiling tiles. Screen by produce area upstairs has a tear in it. Repair or replace screen to prevent entrance of rodents. Womens employee restroom has falling ceiling tile. Repair tile. GENERAL COMMENTS: 655:All other violations cited in the 6/7/06 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. Jun 15,2006 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 15,2006 ) Page 3 of ' 36 Margin Street Telephone: 744-4220 Owner Stephen Ingemi PIC: Peter Ingemi Inspector John Gehan Date Correct By: 1135661 RED Risk Level: ` Permit Number: BHP -2006-0214 Status: Open # of Critical Violations: 3 Time IN Time OUT Urgency Description(s). BLUE: d' Violations Related toGood Retail Practices (Critical,": violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Steve's Quality Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency FOOD PROTECTION MANAGEMENT PIC Assigned / Knowledgeable / Duties PASS ❑o RED Anti -Choking PASS Tobacco PASS EMPLOYEE HEALTH Reporting of Diseases by Food Employee and PIC PASS ❑d RED Personnel with Infections Restricted/Excluded PASS RED FOOD FROM APPROVED SOURCE Food and Water from Approved Source PASS ❑d RED Rpnpiving/Cnnrlitinn PASS n RED Tags/Records/Accuracy of Ingredient Statements PASS 91 RED Conformance with Approved Procedures/HACCP Plans PASS Se RED City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeOTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2006) Page 7 of • Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑d RED Handwash/�Facilities FAIL RED Handwash in deli has leak. Repair leak faucet. � mments: sink area or replace PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑d RED TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooking Temperatures PASS ❑d RED Reheating PASS ❑d RED Cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2006) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE 50 nts: Employee drinks being stored on open refrigeration units at front of store. All employee food and drinks to be stored in designated employee area. Pprsoanl drink stored inside deli unit. All employee drinks and food to be stored in designated employee area. L.E Pployee drink in upstairs bakery area. All employee srinks and food to be stored in designated employee areas. covered poultry trays in produce walk in. All foods in storage must be covered. The following items were pulled off of the shelves: 7 Nestle Tit House Fudge Brownies 3 Gogurts 1 Hood fat free buttermilk 1 Duncan Hines Angel Food (open) 2 Apple Cider dated May 16 Equipment and Utensils FAIL Critical BLUE Comments: Yogurt beverage unit in front requires thorough cleaning. Open refrigeration units in front of store require general cleaning. b4 i11peOpen freezer in isle disorganized. Organize so that items are stored correctly. �h sanitizer bottles in deli had lower ppm than code mandates. Maintain sanitizer to proper ppm as mandated. ars-a` tizer log in deli not up to date. Log to be filled out daily. VGValk in refrigerator downstairs requires general cleaning. alk in freezer downstairs had accumulation of ice throughout. Remove ice and clean freezer. ,_,00,fling in walk in freezer in disrepair. Repair ceiling to be smooth, impervious and easily cleanable. stairs stove requires thorough cleaning. ent hood above stove has accumulation of grime. Ansul system shoul be cleaned by professional cleaning company. �S' el next to stove requires thorough cleaning. No sanitizer located in upstairs in stove area. All food prep areas to have sanitizer in labeled container at proper ppm. JNafl'next to and behind stove require thorough cleaning. i I-T-Toor around and beneath shelevs next to stove requires cleaning. /Shelf system and walls by dry storage area upstairs requires thorough cleaning. 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. Jun 09,2006 ) Page 3 of Item , in freezer upstairs floor requires general cleaning. bl h ves near window upstairs requires thorough cleaning. t,�aairy/Deli walk in floor requires cleaning. Status Violation Critical Urgency heck thermometer in dairy/deli walk in to ensure holding proper temperature. .: Sac�nitizing solution in butcher area weak. Sanitizer to be at proper ppm as mandated. t, butcher shop sanitizing log is not up to date. Log to be maintained daily as mandated. Water, Plumbing and Waste Physical Facility PASS BLUE FAIL BLUE (. o(ments: Light shields missing in downstairs. Provide protective covers or light shields. ,,Stairs going to the upstairs require thorough cleaning. ,Various water stained ceiling tiles upstairs. Find source of leak and repair. Replace all stained ceiling tiles. 1 -5"een by produce area upstairs has a tear in it. Repair or replace screen to prevent entrance of rodents. 1--'Womens employee restroom has falling ceiling tile. Repair tile. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes PASS BLUE GENERAL COMMENTS: 647:Upon inspection of the main floor bathroom, the smell of cigarette smoke lingered, ashes were found on the aback of the toilet, and a wet cigarette was sitting on top of the trash. V No employee is allowed to smoke within the establishment at anytime. Owner is given a monetary fine of $100.00 for violation. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2006 ) Page 4 of Item Status Violation Critical Urgency LLL Z0712(h City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2006 ) Page 5 of .� OOURTDOCKETNO-.—_____- -__ CRATInON NO. . VIOLATION NOTICE CITY OF SALEM PD OS36 NAME ( LAST,FlRST; INRIAL). em' S enh c- STRE DRESS CITYROWN STATE ZIP 7 fir S� c/ Sa+�m 970 LICENSE NO. .; LIC. BIRTH 07 NNxER'S NAME (LAST, FIRST, INITIAL) f �� �- STRE ADDRESS If CITY/TOWN STATE ZIP % G !r � %n, M4 c/1 70 REGISTRATION NO. STATE EXP DATE MAKEITYPE DATE OF VIOI;ATION TIME EJAM DATE CITATION WRTTTEN/ TPER�N� 7tl❑PM LOCATION10F VIOLATION ENF s�eyos 4 1, ;���r i RCING D PT. '06 4N OFFENSE i A fO�C<C6 PS CHAP. 2 SECT. l FINES r =(jII$(;-riuA !! Jag. B C OFFICER /JyVjI I.D. ND. TOTALFINE $ /&,i DUE T uF H GLHI IFIES COPY GIVEN TO VIOLATOR X \x ) � l Y L"J W HAND /���❑ BY MAIL �T MAIL CASH - PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL 0 CITATION NO. CITY IO SALEM FD 0536 VIOLATION NOTICE r NAME (LAST, FIRST, INITIAL) C n q efii St, e ee) • STREET DDRESS ' CITY/TOWN STATE21P 7 *11-4ekl sl- S�-Iem NA tY7o LICENSE NO. LIC. EXP. DATE DATE OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) Mole n , S1/'I Ltl�7 (' STREETADDRESS % CITY/TOWN STATE ZIP 7 l 4 ",pl JA4 0/1 7d , REGISTRATION NO. STATE EXP. DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIMEEl AM DATE CITATION WRITTEN PERSONAL OFY ❑PM I ❑VES ❑NO LOCATIONAF VIOLATION ENFORCING X 95aw bb, s'}?u rk.4- DEPT. A fU /piA OFFENSE r/+ CHAP. SECT. FINES B' C OFFICER-^ j I.D. NO. TOTAL FINE $ U DUE C OFFICER CERTIFIES COPY GIVEN TO VIOLATOR / IN HAND ❑ BY MAIL DO,NOT MAIL CASH - PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET . SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE # SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL 36 Margin Street Telephone: 744-4220 Owner: Stephen Ingemi PIC: Peter Ingemi Inspector. r° David Greenbaum Date Inspected: Correct By: 1/17/2006 Risk Level: Permit Number: BHP -2006-0214 Status: VIOLATION # of Critical Violations: 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 RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Steve's Quality Market Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Handwash Facilities FAIL Critical ❑d RED Comment: The produce handwash sink has only warm water. Restore hot water to this handwash sink immediately. Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: Thoroughly clean the wall freezer where the ice cream is. Physical Facility FAIL Non -Critical BLUE Comment: The back basement stair case needs a thorough cleaning. GENERAL COMMENTS: 432:AII other violations cited in the 1/9/06 inpection 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. Jan 17,2006 ) 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 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2006 ) Page 2 oft IMPORTANT MESSAGE FOR nP DATE —TIME ,—y TIME Z P.M. y Maw OF NOW =80 I AREA CODE NUMBER EXTENSION O FAX 3 MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU 'I WILL CALL AGAIN WANTS TO SEE YOU ;RUSH RETURNED YOUR CALL '.. LL FAM TO YOU ' �;I I ' . i' ■:�' • � ! 1.111 ' SIGNED FORM 4009 qmOp& MADE IN U.S.A. NOTES __ Y 36 Margin Street Steve's Quality Market Telephone: 744-4220 Owner: Stephen Ingemi PIC: Peter Ingemi Inspector: David Greenbaum Date Inspected: Correct By: 1/9/2006 Risk Level: Permit Number: BHP -.2006-0214 Status:. p 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) . City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Separation/ Segregation/ Protection FAIL Critical ❑? RED i/ Comment: There is a pair of dirty sneakers stored on a shelf with bread trays. Do not store any personal items with bread trays to prevent cross contamination. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED V'Comment: The cutting board in the produce prep area is badly stained and scored. Resurface or replace the cutting board. Handwash Facilities FAIL Critical 0 RED ^_T Comment: The produce handwash sink has no hot water. Restore hot water to this handwash sink immediately. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2006 ) 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 dairy walkin upstairs has uncovered food. All food in storage must be covered. immediate corrective action) There are some price labels covering expiration/sell by dates. Do not cover any expiration/sell by dates with price labels. Equipment and Utensils �1 Comment: The deli case needs a thorough cleaning. FAIL Non -Critical BLUE The flooring and walls in the deli have an accumulation of food spills and splatter. Thoroughly clean all floors and wall including under and around all equipment. �J The deli wrapping machine needs a thorough cleaning. Both basement walkins need a thorough cleaning. ti The oven in the bakery prep area upstairs needs a thorough cleaning inside and out. )/Clean all tables and work surfaces in the upstairs bakery prep area. VThe mixer on top of the table has an accumulation of food debris. Thoroughly clean mixer. (/The Unisource oven needs a thorough cleaning. ,V All dry ingredient barrels have an accumulation of food spills and splatter. Thoroughly clean all dry ingredient barrels. / All shelving in the bakery prep area and the back hall needs to be repainted. V The walkin freezer upstairs has an accumulation of food debris and grime. Thoroughly clean the floor. VThe produce walkin walls, floor and shelving have an accumulation of food debris and grime. Thoroughly clean walkin including floors, walls, all racks and under all racks. Ll All bread and roll trays have an accumulation of grime. Thoroughly clean and sanitize all trays after each use. )j The bottom of the meat case has an accumulation spills and splatter. Thoroughly clean meat case. `TS Thoroughly clean the wall freezer. Physical Facility FAIL Non -Critical BLUE Comment: Both backs a cases need thorough cleaning. 16,1AII flooring in back and upstairs needs a thorough cleaning including under and around all equipment. V The walls in the produce prep area have an accumulation of food spills and splatter. Thoroughly clean walls. t/There are many water stained ceiling tiles upstairs. Investigate the source of the leak and repair. Replace all stained ceiling tiles. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2006 ) Page of Item> Status Violation Critical Urgency `j The upstairs is in need of a thorough cleaning and organizing. GENERAL COMMENTS: 417:Reinspection will be on 1/17/06, all violations to be corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2006) Page 3 of Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: File Number: BHF -2004-0291 LOCATED AT: Steve's Quality Market 36 Margin Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2006-0214 Jan 3, 2006 Dec 31, 2006 $100.00 TOBACCO VENDOR BHP -2006-0215 Jan 3, 2006 Dec 31, 2006 $50.00 Total Fees: $150.00 PERMIT EXPIRES (December 31, 2006 - I Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 10 of 10 STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 Fax 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT DEC 052005 2005 CITY OF SALEM BOARD OF HEALTH 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT OeS' UA,(I14 I Y Yaik TEL # 'f'1 gLWoa,() --rf1n I lnn ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) IJ OWNER'S NAME 51GtUtA L ;!�%EVt'4t TEL q l�'I'1100Nj ADDRESS 1 �a.df kW J V CITY 5 AAL M STATE 111". ZIP U I,'11 U CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON'74C f 1,;n-peyt HOME TEL # 1� I'Zk HOURS OF OPERATION: Mon. ✓Tue. :,Wed. ✓ Thu. Fri. ✓ Sat. cor Sun.—LI—Am_ wivk TYPE OF ESTABLISHM (1744 — i(to it1 rr FEE (check only) [RETAIL STORE) ES NO O,I less than 1000sq.ft. =$ 50 (Q 1000-10,000sq.ft.=$100vlo� more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 - ..-....... - - ---------- VIES ------ NO -- ---------.-..--.......------------........................--------.-------------$ ---100-- BED/BREAKFAST YE $ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAIVi, YOGURT, S T SERVE YES NO $5 ' / TOBACCO VENDOR C�O:a � NO $50t/ 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, hWe filed all state tax returns and paid all state taxes required under the law. Signature V ° Date Social Security or Federal Identification Number ----------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check# & Date i-4 y !l 30 -3 /so ( IMPORTANT MESSAGE FOR ► is /1. a, A ILI u wZwrQTkTr AREA CODE NUMBER EXTENSION O 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 4009 1 U.S.A. NOTES 5?olt u 1b 7Q Nein 14+isv�^� N c, SS'diTc�i� CvwaelC,0 aet> %b%,iew 1-x,..j o� J. �c OF a gL�l 9_ PHONE 1 / ?f %4A NU ER! 02l"� h AR NSION U FAX U 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 YQU: SIGNED FORM, MADE IN V Iq� fi /IJG _vii fii .(i i Q4?s_��; --r— s s 9 STANLEY J. USOVICZ, JR. MAYOR October 19, 2005 Steve's Quality Market 36 Margin Street Salem, MA 01970 Dear Owner: 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 On Monday October 3, 2005 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17 -year-old male purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Steve's Quality Market is in violation of Section III(A) of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section, the sale of cigarettes, chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of (Three Hundred Dollar fine) for the Third offense. FOLLOWING THE THIRD (3RD) OFFENSE, THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore, you are ordered to pay a fine of $300.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4th floor, within ten days of receipt of this notice. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 741-1800. ja cerely yours, nn�e Scott Health Agent JS/mfp CERTIFIED MAIL: 7003 3110 0005 1992 2216 cc: North Shore Tobacco Control Program Christina Harrington, Board of Health Chairman and Members CENTURY BANK AND TRUST COMPANY 11001 StavesQualitySt Market r a�on.Ma.oz113-2329 - - - - 38 Margin Street . �*' � ... -. , Salem,Ma.01970 53139/113 (978)744-4220 10/25/2005 ORDER OFE City Of Salem - $ "300.00 Three Hundred Only..»...».,«,,......«»..,...»......»«.....................«....».....,.,.....«..,.,...,.,...,..... DOLLARS 8 11.017831118 1:0113013901: 11805 30206 4n' �E STANLEY J. USOVICZ, JR. MAYOR June 22, 2005 Steve's Quality Market 36 Margin Street Salem, MA 01970 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 ` w 1 Dear Owner: On Wednesday June 15, 2005 personnel from the Tobacco Control Program conducted a compliance check to ne l a tobacco nor. A female purchased I ed c garettte from establishment clerk in your store e1product Docume taton is now on file at he Board ofld Health regarding that sale. Steve's Quality Market is in violation of Section III(A) of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section, the sale of cigarettes, chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of (Two Hundred Dollar fine) for the�SF�G4E,?1B�offense. FOLLOWING THE THIRD (3RD) OFFENSE, THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation ,,yc�rrc 4 r the violation stated abo`l�e. check or money Therefore, you are ordered to pay a fine ofS�99'99"ts order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4th floor, within ten days of receipt of this notice. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 741-1800. Serely yours, ir, i6anne Scott Health Agent JS/mtp CERTIFIED MAIL: 7003 3110 0005 1992 1554 cc: North Shore Tobacco Control Program Christina Harrington, Board of Health Chairman and Members 36 Margin Street HACCP: ❑ Telephone: 744-4220 a Owner Stephen Ingemi PIC: Peter Ingemi Inspector: David Greenbaum VM2005 ` Status Violation Risk Level: Nature of problem or correction Non-compliance with: Permit Number. EMPLOYEE HEALTH BHP -2005-0120 _ -' Status V VIOLATION # of Critical Violations I R `' s" g Time IN Time OUT ❑ 4 s gotes PASS Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations Steve's Quality Market City of Salem RETAIL FOOD - Food Establishment Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Not Done EMPLOYEE HEALTH Not Done Anti -Choking PASS ❑ RED Tobacco FAIL Critical ❑ Employee found smoking in the backroom. Conformance with Approved Procedures/HACCP PASS ❑Q Smoking is prohibited in any retail food Plans store. FOOD PROTECTION MANAGEMENT Not Done PIC Assigned / Knowledgeable / Duties PASS ❑d RED EMPLOYEE HEALTH Not Done Receiving/Condition Reporting of Diseases by Food Employee and PIC PASS Personnel with Infections Restricted/Excluded PASS ❑d RED ❑J RED FOOD FROM APPROVED SOURCE Not Done Food and Water from Approved Source PASSd❑ RED Receiving/Condition PASS RED Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED Conformance with Approved Procedures/HACCP PASS ❑Q RED Plans GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc ( Rev. Aug 01,2005 ) Page I o{4 36 Margin Street must be corrected immediately or within'90 days) RED. Violations Related to. Foodborne Illness Intervention: and Risk Factors (Require immediate corrective action) Steve's Quality Market PROTECTION FROM CONTAMINATION Not Done 0 RED The bakery handwash sink used to wash Separation/ Segregation/ Protection PASS ❑J RED dirty dishes. Handwash sinks are to be Food Contact Surfaces Cleaning and Sanitizing FAIL 0 RED Dirty knives stored in the rack in the PROTECTION FROM CHEMICALS Not Done produce prep area nd in the meat room. Approved Food or Color Additives PASS ❑d RED All knives to be cleaned and sanitized prior Toxic Chemicals PASS RED to storage. Proper Adequate Handwashing PASS 0 RED Good Hygienic Practices PASS ❑J RED Prevention of Contamination from Hands PASS 0 RED Handwash Facilities FAIL Critical 0 RED The bakery handwash sink used to wash dirty dishes. Handwash sinks are to be used for handwashing ONLY. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures PASS ❑—/ RED Reheating PASS ❑Q RED Cooling PASS ❑d RED Hot and Cold Holding FAIL Critical RED The self serve deli case has a temperature Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A ❑d RED of 50°F. Repair unit to maintain a temperature of 41"F or below. Wall dairy case has a temperature of 50°F. Repair unit to maintain a temperature of 417 or below. Produce cooling unit has a temperature of 48'F. Repair unit to maintain a temperature of 41 °F or below. GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 01,2005) Page 2 of 36 Margin Street Steve's Quality Market Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE 7 boxes of baby cereal found outdated. Closely monitor all expiration/sell by dates. Some products have price labels obscuring expiration/sell by dates. Do not cover expiration/sell by dates with price labels. Equipment and Utensils FAIL Non -Critical ❑ BLUE The floors and walls in the deli have an accumulation of food spills and splatter. Thoroughly clean all floors and walls. The deli meat slicers need a thorough cleaning. The bottom of the front deli case needs a thorough cleaning. Wrapping machine needs a thorough cleaning. The interior panel of the ice machine has an accumulation of grime. Thoroughly clean entire ice machine. The first floor bathroom sink needs a thorough cleaning. Both back stair cases need a thorough cleaning. All walkin freezers and refrigerators need visible, accurate thermometers. The meat room walls and floors have an accumulation of food spills and splatter. Thoroughly clean all floors and walls in meat room. The produce walkin walls need a thorough cleaning. the bottom of ice cream freezer need a thorough cleaning. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non -Critical ❑ BLUE The windows in the bakery and produce prep areas are open with no screens. All openings to the outside must be sealed. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements - PASS ❑ BLUE Other- See Notes PASS ❑ BLUE GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 01,2005) Page 3 oto 36 Margin Street Steve's Quality Market GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 01,2005) Page 4 of IMPORTANT MESSAGE FOR,:.."< ,rT., ,..t2✓L� .. DATE - g' D .� ATIME •NI lwv PHONE AREA CODE NUMBER EXTENSION O FAX O 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 SIGNED FORM 4009 MADE IN U.S.A. NOTES "'4 CITY OF SAL en �/!P �i,U/3L� `� BOARD OF HEALTH Estalilisfiment Name:9 0 �IQyK P� Date: a�"ak " O Page: of Item No. Code Reference C - Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified. f l n /p. SPS Cclr msaqrr m nk l 71�;/ d)4j S D /rt G %c. 7S�// Q/1� alL` [l- f V / \ r e a 1,14 .. , �� o . � � ' 1 miaJs `l hP kk2X 7/V,!!IP 4 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 I comply with all mandates of the Mass/Federal Food Oode. I understand that. _E-.. __ noncompliance may result in daily fines of twe y- ive dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance Ll Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency closure ❑ Voluntary Disposal ❑ Other: el Violations Related to Foodborne fitness Interventions and Risk Factors (Items 1.22) (Cont,) PROSECTION FROM CHEMICALS I4 16 I8 * Denotes critical item in the Rslesa) 7999 Pbod Code or 705 CMlt 590A00. i3-501.15 Food or Calor Additives 3-202.12 Additives*_ 3-302,74 Protection from Unapproved Additives* 3-801.11 {C) Poisonous or Toxic Substances 7-101..11 Identifying Information - 01 gVii rl Containers" 7-102.11 Common Name - Work_9m* Containers* 7-201.11Se aration-Storage' 7-202.11 _ Restriction - Presence and Use" 7-202.12 Conditions of Use* 7-203.1.1 'toxic Containers -Prohibitions' 7-204.11 Sm»tizers, Criteria - Cheneicals* 7-204.12 Chemicals for lk'ashine. Produce, Criteria* 7-204.14 Di vino Aents. Criteria* 7-205.11 Incidental Food Contact, Lubricants` 7-206.11 Restricted Use Pesticides. Criteria* 7-206.12 1 Rodent Bait Stations" 7-206.13 Tracking Powders, Pest Control and Monitoring* * Denotes critical item in the Rslesa) 7999 Pbod Code or 705 CMlt 590A00. i3-501.15 Proper Cooking Temperatures for PHFs Raceived at Teivperatures According to Law Cooled fo 41`P145'F Within 4 Hours. -Cooling Methods for PHFs PHFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-801.11 {C) E> LhLl ediate Sen -ice 145°FSSsec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Animals- 155'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast - 130`F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 155'F 15 26. sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PRFs, Time as a Public Health Control* Stuffing Captaining Fish, Meat, 590.004(8) Poultry orRatites-165'F15 sec. 3=101,11.(,C)(3) Whole-muscle,Intact Beef Steaks FC -7 145-F * 3401.12 Raw Animal Foods Cooked in a ' Microwave 165+* 3-401_11(A)(1)(6) All Other PHFs- 1.45'F 15 sec. Reheating for Hot Holding 3 403.11(A)&(D) PHFs 165°F 15 sec. * 3-403.11(B) Microwave- 165° F2 Minute Standing Time* 3-403.11(C) Commercially Processed RTF Foa1- 140'F* 3-<103.1.1(E) Remaining Unsliced Portions of Beef Roasts" ; Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`17 to 70`F Within 2 flours and From 70'F to 41'F145'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 OF/4)'F Within 4 1loars'x * Denotes critical item in the Rslesa) 7999 Pbod Code or 705 CMlt 590A00. i3-501.15 3-501.14(0 PHFs Raceived at Teivperatures According to Law Cooled fo 41`P145'F Within 4 Hours. -Cooling Methods for PHFs 14 3-801.1 t(D) PHF Hot and Cold Holding 3-801.11 {C) 3-501.16(B) 590.004(F) Cold PPIFs Maintained at or below 41`745'F" Food and Food Protection 3-501.16(A) Hot PRFs Maintained at or above 140°F.* 25; 3-501,16(A) Roasts Held at or above 13WT. 20 26. Time as a Public Health Control - FC - 5 3-501.19 Time as a Public Health Control* Physical Facility- 590.004(8) Variance Re ulrement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801.1](A) 1 np isteurized Pre-packaged Juices and Besermies with L3 rningl ib is* 3-801.11(B) Use of Pasteurized Encs" 3-801.1 t(D) Raw or Partially Cooked Animal Foal and Raw Seed S roots Not Served. 'r 3-801.11 {C) i7no ened Fcx>d Package Not Reserved - 22 3-603.11 Consumer Advisory Posted for Consumption of 590-606 23. Animal Foods That are Raw. Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FG -3 I'athozens." e`r�°'=,;,;o, 25; 3-302.13 Pasteurized Eggs Substitute for Raw Shell 26. E gs* SPECIAL 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 /129 - Special Requirements. W (Items 23-30) Ci iticral and non-critical violations, which do not relate to the foodborne illness interventions and rist-fctors listed above, can be found in the following soi-iions of the Food Code and 105 CMR 590 000. Item Good Retail Practices FC 590-606 23. Mann ement and Personnel FC - 2 .003 _24. Food and Food Protection FG -3 .004 25; _ Equipment and Utensils FC, = 4_ 26. W ater, Plumbing and W aste - FC - 5 j .006 ?7. Physical Facility- _ FC - 6 .007 28. _ Poisonous or Toxic Materials FC -7 .008 29. S ecial Re uirements ' 0pg 90 _ Other -_-- -- t---___... gcwHnrn,Aekfi2dac s s STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM9 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 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Steve's Quality Market Address of Establishment: 36 Margin Street Owner's Name: Stephen Ingemi Restrictions: Application Date: 11/22/2004 Permit for Food Establishment 46-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 013-05 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. Vim - HEALTH AGENT CITY OF SALEM, MASSACHUSETTS �L BOARD OF HEALTH / 2 120 WASHINGTON STREET, 4TH FLOOR �r'�' ✓ O SALEM, MA 01970 0 TEL. 978-741-1800 FAX 978-745-0343 NOV 19 2004 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CITY OF SALEM 2005 APPLICATION FOR PERMIT, TO OPERATE A FOOD ESTABLF$® dTJF HEALTH NAME OF ESTABLISHMENT '�+eUUeS Qua(l'FN IYI�- I TEL # qi� qqq g o o Mf ADDRESS OF ESTABLISHMENT �(J jy1 St- 'Y/�1�(O.Vtn rna' od go MAILING ADDRESS (if different) OWNER'S NAME S I elk A TEL # ADDRESS ,tit` &r CITYSTATE V 6k- 71P 019,70 CERTIFIED FOOD ANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON °�✓ "ilk 2W41 HOME TEL # HOURS OF OPERATION: Mon. N Tue. 'Wed. Thu. Fri. Sat. ^/ Sun &A t,— �(IVIti TYPE OF ESTABLISHMENT,I 1 V90A RETAIL STORE YES NO RESTAURANT YES NO q6—o5 BED/BREAKFAST YES NO ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as chinch kitchens) )j—b5 FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100-1 more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 $100 YES NO $5 ES NO $50 S NO $,5 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 bgs _wledg nd belief, have filed all state tax returns and paid all state tpfe. required under the law. 1 R _ .. n 1 7. n . / I A. � / �l 1 A% n i -... Signature U ' I Date Social Security or Federal Identification Number --------- -------- - ------ -- ----- - --- -- --------------------------------------- Revised 11/03/03 FOODAP2.adm Check# & Date s s 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 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Steve's Quality Market Address of Establishment: 36 Margin Street Owner's Name: Stephen Ingemi Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 109-04 Frozen Desserts/Ice Cream Permit for the Sale of'robacco Products 29-04 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 � a CITY OF SALEM, MASSACHUSETTS t BOARD OF HEALTH e 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 NOV 18 2063 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. CI1"Y OF SALEM JOANNE T, MPH, Rs, cHo BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT <Ieucos QUO, IJP O(L�T TEL# j Q IVYgad U ADDRESS OF ESTABLISHMENT 3b 1(Y10,r CL1 VL cS"1 Sa ► I M MOt_ 0191.6 MAILING ADDRESS (if different) APdt01IA:Y. TEL # al r 1 ?)-q CITY CERTIFIED F (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON ?1 2.�er 37Vl�eYhl HOME TEL # 11 d ld l �44 �Q HOURS OF OPERATION: Mon. ✓ Tue. --Wed. _v Thu. `-- Fri. `' Sat. ^� Sun. UQm— IPWX TYPE OF ESTABLISHMENT �� I (p EE check only RETAIL STORE YES NO less than 1000sq.ft. -$50 1000-10,000sq.ft. =$10011--1- more $100fmore 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 (notjust serve) ICE CREAM, YOGURT, SOFTSERVE YES NO $5 TOBACCO VENDOR AJ -0 ® 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 be ke�y� ledge_ a belief, have filed all state tV3ax returns and paid all state taxes re wired under the law. J t0 Date Social Security or Federal Identification Number Revised 11/03/03 FOODAP2.adm Check# & Date /3 L!u% - ,// Pf AS - — Massachusetts'Department of Public Health f Division of Fobd 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 / / Date Tvpe of Operation's) Tr of Inspection ❑Food Service 0 Retail t i 1 r D J ❑Routine 9'Re-inspection Address,M,7 Risk V & Level ElResidential Kitchen Previous Inspection Telephone El Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Date: l0/S-/d ❑ Pre-operation! ❑ Suspect Illness ❑ General Complaint Owner /) Q > HACCP Y/N Person in Charge (PIC) Time Out: O Permit No. El HACCP [I Other Inspector > u Each violation checked requi s 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 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTIONFROMCONTAMINATION"` - _y ❑ 19. Hot and Cold Holding ❑ 8. Separation/ Segregation/ Protection ❑ 20. Time As a Public Health Control ❑ 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 3500MVp fFom I4.dw n El 21. and REME OR HIGHLY a SUSCEPTIBLE POPULATIONS (HSP) J Foodp tion for HSP CONSUMER ADVISORY- °„ - :` ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions Q 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: In'sp ¢ 's $i / n Print: �t PIC's Signature: / Print: 3:1-Le,T - Page of L Pages 1 �q Q� Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 59(]003(A) Assignment of Responsibility* 590 003(B) Demonstration of Knowledge* ^-103.1.1 Person in charge -duties 2 590.003(C) Responsibility of the, person in charge to Cont liance with Food Law* 3-201..12 require reporting by Mood employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell F -ss 590.003(F) _ Responsibility OfAFood EmployeeOrAn 3202,16 Ice Made From Potable Drinking W atcr* Applicant To Report To The Person In Drinkimg Water from an Approved Systern'k 590.006(A) Charge* 590.006(8) 590.003(G) Reporting by Person in Charge' 3 590.003(f)) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 10 '" Denotes critical item in the federal 1999 Fad Cade or 195 CMR 590,060. E8-- Food and Water From Regulated Sources 590.004(A -B) Cont liance with Food Law* 3-201..12 Food in a Hermetically Sealed Container, 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell F -ss 3-202.14 hep and Milk Products. pasteurized- asteurized*3202.16 3202,16 Ice Made From Potable Drinking W atcr* 5-101.11 Drinkimg Water from an Approved Systern'k 590.006(A) Bottled Drinking Water* 590.006(8) _ Water Meets Standards in 310 CMR X22.0* Wxshin Frn1tR and Veoembles Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish front NSSP Listed Sources` Contamination from the Consumer Game and Wild Mushrooms Approved by Reguiafory Alithority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrcx�tns* 3-201.17 Game Animals* 3-701.11. Receiving/Condition 3-202.11 PRFs Received at I'ro ter Tem )erasures* 3-202.15 Package [tire, dv* 3-101.11 'Food Safe and Unadultetated Tags/Records: Shellstock 3-202.13 ShOlsto k Identification 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-002.11 Parasite Destruction* 3-402.12 Recorda. Creation stud Retention" 590.004@ Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui )meat* Conformance with Approved Procedures lHACCP Plans 3-502.11 S ecialized Processin g Methods* 3-502,12 Reduced oxygen packagirill, criteria" 8-103.12 Conformance with A t )roved Procedures* '" Denotes critical item in the federal 1999 Fad Cade or 195 CMR 590,060. E8-- Cross-contarnnatian 3-11 '02.11(A)(1) Raw Animal FoodcSeparated from Cooked and RIE Foods", Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.1 ] (A) Food Protection* -T',02 15 Wxshin Frn1tR and Veoembles 1-304.11 Food Contact with Equipment and utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food anti Reservice of Food" Disposition of Adulterated or Contaminated Food 3-701.11. Discarding or Reconditioning Ensafe. Foal* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem erasures* 4-501.1.12 Mechanical Warewashing-Hot Water Sanitization Ternfaratur:es' 4-501.114 Chemical Sanitmajon- temp., pH, concentration and hardness, s` 4-601A 1(A) Equipment Ford 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 )meat* 4-703.11 Methods of Sanitization -- Hot Water and Chernical* LEL Proper, Adequate Handwashing 2-301.11 Clean ConditionHandsand Arne;* 2-301.12 Clemrina Pxocedme* 2-301.14 W7ren to Washy` 21 Good Hygienic Practices 2-401.11 Eatin , Drinkin � or Using 7`obacat* 2-401.12 Discharges From the Eyes. 'Nose and Month* 3-301.12 Preventing Contamination Alien Tastin gs` p2 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to-ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities 5-204.11 Location and Placemcarv, 5-205.11 Accessibiltt', G eration and Maintename Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin g Cleanser. Availability 6-301.12 HandDrvin>Provision Ir CITY OF SALEM BOARD OF HEALTH Establishment Name: Seye S O V W Date: IDI { 3I b i/ Page: �- of— Item Code C - Critical item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �uT/7Ytl GQ S GS _/2 /fLP -n S Cl/- 6Yi erdeR - ]tet L� 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 obseFrnt(y-five/dollars all conditions as described, and to ❑ Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federaod Code. I understand that noncgmpliance may result in daily fines oft w or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. KfLGfo�Xlf// r_.... ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-801.11(0) Poisonous or Toxic Substances 7-101.11 Identib ing Information - Original Containers" 7-102.11 Common Name - Working Containers* 7-201.11 Separation - Stca aeg s• 7-202.11 Restriction - Presence mud Use* 7-202.12 Conditions of (_Ise" 7-20311 Toxic Containers -Prohibitions` 7-204.11 Sanrdzers,Criteria - Chemicals^ 7-204.12 Cheuacah for Washing Produce, Criteria" 7-204.14 Dr ging 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* TIMEITEMPERATURE CONTROLS * Denotes critical item in ilia federal 1999 Food Code or 105 CMR 590.000. Proper Cooking Temperatures for PHFs Received at'fcniperature+ PHFs 3-401.11A(1)(2) Eggs- 1.55'F15See. 3-801.11(0) E =gs- hrvnediate Service 145"R15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game FC _-3 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 15 3-501.1fi(B) see. 3-401_11(A)(3) Poultry, Wild Game, Stuffed PHFs, 41%45°F* Staffing Containing Fish, Meat, 3-501-16(A) Poultry or Ratites -165°17 15 sea. 3-401.11(0(3) Whole -muscle, intact Beef Steak's 140IF. " 145`17 * 3-401.12 Raw Aninul Foods Cooked in a 20 Microwave. 165°F * 3-401.11(A)(1)(b) All Other PHFs -145'F'15see, 3-501.19 Reheating for Hot Holding 3-403.11(.x)&(D) PHFs 165'F 15 sea 3: 3-403.11(B) Microwave- 165° F 2 Minute Standing Time" 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-403.11(F) Remaining Unslieed Portions of Beef Roasts*' Proper Cooling of PHFs 3-501. i4(A) Cooling Cooked PHFs from 140'F to 70°F Within 2 Hours and From 70'F to 41"F1450F Within 4 Hours. * 3-501.14(13) Cooling PHFs Made From Ambient Temperature ingredients to 41°F145°17 Within 4 Hours" * Denotes critical item in ilia federal 1999 Food Code or 105 CMR 590.000. 0` ' z 1 11(A) 3-501.1 VC) PHFs Received at'fcniperature+ Use of Pasteurized Eggs* 3-80L l I (D) According to Law Cooled to 3-801.11(0) - 41`�F145`F Within 4 Hous. f3-501.15 FC _-3 Cgoiim, Methods for PHFs 19 3-302.13 PHF Hot and Cold Holding .005 ,006__ 3-501.1fi(B) PH Coid Fs Maintained A or below FG-6 FC -7 590.004(F) 41%45°F* S ecial Re uirements 3-501-16(A) Hot PHFs Maintained at or above 30 ___ Other 140IF. " 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 Re uireirm, 0` ' z 1 11(A) Unpasteurized Pre-packaged Juices and Beverages with Warningl.abcls* 3-801.11(B) Use of Pasteurized Eggs* 3-80L l I (D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801.11(0) Una pied Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 530.060 23. Animal Foods 'That are Raw, Undercooked of FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC _-3 Pathogans * rr�"•` "x'01 25. 26. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 ,006__ 27. 28. Ph sical Facility Poisonous or Toxic Materials 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 Disk factors. Other 590.009 violations relating to good retail. practices should be debited under #29 - Special Requirements. (Itemts 23-30) Ct-ilial and non -Critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sec tions of the Food Code and 10,5 CMR 590.000. Item Good Retail Practices FC 530.060 23. _ Manx ement and Personnel FC - 2 .003 24. Food and Food Protection FC _-3 ,00,1 25. 26. _ __ Equi memand Utensils Water. Plumbin and NJaste FC -4 FC -5 .005 ,006__ 27. 28. Ph sical Facility Poisonous or Toxic Materials FG-6 FC -7 .007 008 29. _ S ecial Re uirements .009 30 ___ Other ___ swom�mn,�eo.ze.,� Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4l" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name / C ; I t Date /U�$�G�� T e of 0 eratian s Type of Inspection Food Service 0 Retail (�"Routine ❑ Re -inspection Address J Risk Telephone n I1 Level El Residential Kitchen Previous Inspection - d ❑ Mobile El Temporary Date: ElPre-operationOwner HACCP Y/N Z ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness Q General Complaint Person in Charge ( IC) Time O Out: Permit No. r. ElO her Inspector / I I Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. ". FOOD PROTECTION MANAGEMENT _ ` ' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. -'Personnel with Infections Restricted/Excluded ,. FOOD FROM APPROVED SOURCE A ❑ 4. Food and Water from Approved Source J ❑ 5. Receiving/Condition , t "4 i ❑ 6. Tags/Records/Accuracy of Ingredient,Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION "i 8. Separation/ Segregation/ Protection.(D) m �] 9. Food Contact Surfaces Cleaning and Sanitizing (to) ❑ 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.asd6termined by the Board of Health. c _-K- 23. Management and Personnel (FC -2)(590.003) (31 24. Food and Food Protection (FC -3)(590.004) a (t5. Equipment and Utensils (FC -4)(590.005) 6. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility ( 5) (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S, 59010$p cfFo m-14.doc /ll ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS v ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals --,t TIME/IEMPERATURE CONTROLS (Potentially. Hazardous Foods) [116. Cooking Temperatures ❑ 17. Reheating ❑ 16. Cooling 19. Hot and Cold Holding(a) ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY; _ :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: bitictor;'s.S-gn tRqre: ' Print: \ 11'1 9. ✓.m PICIWsignaturk: L Print: a7 -117 a of�JPages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT I 590.003(A) Assignment ofRosponslfihty* 590.003(B) Demonstration of Knowledge* 2-103.11 � Perxo in6aarge--dutns EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Fond Iaw* 3-201_12 require reporting by fund emplovees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell EagS* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Vvater" Applicant To Report To The Person In Driukino Water from al �vstem* 590.006(A) Charge'" 590.006(.B) 590.003(6) Reporting- by Person in Charge* 3 590.003(1)) Exclusions and Restrictions'" 3-201.15 590.003(E) Removal of Exclusions and Restrictions 0 C C 'k Denotes critical lien in the fedrral 1999 Food Code or 105 CNiR 590,000. I'a;Yilrii I"Mttl :fitiG[ ±3rTifLr►i1i'iGT $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Fond Iaw* 3-201_12 Food in a Hermetically Sealed Cornainer* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell EagS* 3-202.14 E *s and Milk Products. Pastem tied' 3-202.16 Ice Made From Potable Drinking Vvater" 5-101.1 I Driukino Water from al �vstem* 590.006(A) Bottled Drinking Water" 590.006(.B) Water Meets 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 Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Returned Food and Reservice of Food* Game and Wild Mushrooms Approved by Reaustow Authority 3-202.18 Shellstock Identification Present* 590.004(0) Wild Mushraxns* 3-201.17 Game Animals* Receiving/Condition 3-202.11 PRFs Received at Proper Temperatures* 3-202.15 Package hiteggityg' 3-101.11 Food Safe and unadulterated Tags/Records: Shellstock 3-202.13 Shellstock Identification 3-203.12 Shellsu>ck Identification Maintained* Tags/Records: Fish P,rdducts 3-402.11. Parasite Destruction* 3402.12 Rccords. Creation and Retention* -90.0040) Laheling of ingredients' Methods of Sanifization - Hot Water and Chemical* Conformance with Approved Procedures fHACCP Plans 3-502.11 Specialized Processing McibkAs* 3-502.12 Reduced ox igen Packaging, criteria'" 8-103.12 Conformance with Approved Procedures* 'k Denotes critical lien in the fedrral 1999 Food Code or 105 CNiR 590,000. I'a;Yilrii I"Mttl :fitiG[ ±3rTifLr►i1i'iGT $ 3-3022.1 l(A)t1) Cross -contaminating Raw Animal Foods Separated from CUvkcd and RTE Foods* Contamination from Raw ingredients 3-302111(A)(2) Raw Animal Foods Separated from Each Other Contamination from the Environment 3-302.1 HA) 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)(11) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.I1 Discarding or Reconditioning Unsafe Food' 9 Food Contact Surfaces 4-501.11 t Manual Warewashing - Hot Water Sanitization Tem emuttes" 4-501.112 Mechanical Warewashina [lot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and. kindness. * 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 F tri ment* 4-703.11 Methods of Sanifization - Hot Water and Chemical* 10 Proper, Adequate Handwashing -301.11. Clean Condition-Hands_and Arms" 2-301.12 Cleaning Procedure* 2-301.14 Whca to Wash* II Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes. Nose and Mouth* I2 3-301.12 Preventive Contaminatiou When Tastin ="` Prevention of Contamination from Hands 590.00-1(E), l Preventing Contamination from Ernplovees* I3 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca aeitics'w 5-204.11. Location and Placement"' 5-205.11 Accessibility, ()erafion and Maintena<rce 6-301.1.,1 Supplied with Soap and Hand Drying Devices lfandwashine Cleanser. Availabilit 6-301.12 Hand Drvi!I Provision CITY OF SALEM BOARD OF HEALTH Establishment Name:]/ //1�/ t7l / //T// N 0 f Date: /a/S /o Page: of Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R — Red Item PLEASE PRINT CLEARLY Date• Verified h c bf >JAAS n u oW n tueYe g G Me / v I hei OvIdur&l e ou/do fed u A o G &moveele a icon : Ch O }3 ao 0 evh-ei2 M i Xe 2 Oet-,OQ/ y Ko% C701d Cheri Twp /s '9104-Z'041 ✓ ep 2r�Cl e c"n le�fn/hi / afian aao a'1 NaTt Remo-ecl OJ YTMe or' /n eeben - ✓ (/9) o e/fS (:7ree 6l 9 /d o-/ t /o a o / ✓ S �" it /3 S fU Q / LI_//9 CE Of %�S C�7oY1. // dAf u f'ISjg& of all rneS Pr o I /g M0'?-oU oleo-wo/ all u f 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/F1od�¢ode. I understand that noncompliance may result in daily fines of tw /frt'y fl e dollars or suspension/revocation of your food permit. Corrective Action Required: " ❑ No ❑ Yes LI voluntary compliance L3 Employee Restriction Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 0 Violations Related to Foodborne illness interventions and Risk Factors (items 1-22) (Cont) PROTECTION FROM CHEMICALS L14 t6 17 18 4 Food or Color Additives 3-202.12 Additives" 3-302.14 7-101..11 _ Protection from l?na roved Addi ves' Poisonous or Toxic Substances Identifying Information -Original Containers s 7-102.11 Common Name -Working Containers* 7-201.11 Se ara6on-Stow=e3` 7-202.1.1 Restriction - Presence - and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions" 7-204.11 Sanitizens, Criteria -Chemicals* 7-204.12 Chemicals for Washme Produce, Criteria" 7-204.11 Devin Arents. Criteria` 7-205.11 7-206.11 7-206.12 7-206.13 Incidental Food Contact. Ltilincants* Restricted Use Pesticides. Criteria* Rodent Bait Stations" Tracking Powders, Pest Control and Monttonn- 4 Denotes eTaical item In the luicral 19991=ood Code or 105 CNIR 590.000. 3-501 14(C) _ E3-501.15 Proper Cooking Temperatures for 19 PHFs 3-4011LA( l)(2) Eggs- 155'F 15 Sec. 3-50116(A) Etas-hmnedia[eService 145°FiSsec* 1401.11 (A}(2) Comminuted Fish, Meats & Game 2Q Antauds - 155'F 15 sec. 's 3-40111(8)(1)(2) Pork and Beef Roast - 13U F 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155°F 1.5 26. sec. * 3-401.1 I(A)(3) Poultry, Wild Game, Stinted PI3Fs, 27. Stuffing Containing Fish, Meat, Poultry or Ratites -165°17 15 sec. " 3=401.11.(C)(3) Whole muscle, Intact Beef Steaks FC - 7 145°F * 3401.12 Raw Animal Foods Cooked in a Microwave 165°F" 3A01 A I (A)(1)(b) All Other PHFs - 145'F 15 sec. _ _ Reheating for Hof Holding 3-40111(A)&(D) PHFs 165°F 15 sec. 3-403.11(B) Microwave-165'F2Minnie Standing Time'` 3-403.11(C) Commercially Pi xessed RTE Food - 14WIrs 3-403.11(E) Retnainim„ Unslieed Pw"sars of ,Beef Roasts*" Proper Cooling of PHFs 3-501..1.4(A) Cooling Cooked PRFs from 140°F to 70'F Within 2 Hours and From 70'F to 4 t'F145°F Within 4 Hours. 3- SOL 14(B) CoolimgPHFsMade From Ambient Temperature ingredients to 41°F145°F Within 4 Hours'., Denotes eTaical item In the luicral 19991=ood Code or 105 CNIR 590.000. 3-501 14(C) _ E3-501.15 PRFsI2eceived it Temperatures According to I.aw Cooled to 4FF145°F Within 4 Hones. Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501_16(8) 590.004(F) Cold PIIFs Maintained at or below 41V45° F" 3-50116(A) Mot PRFs Maintained at or above 14WK * 3-501.16(A,) Roasts Held at or above 130°F. 2Q Time as a Public Health Control 3-501.19 Time as a Public Health Control* 51)0.004(1-{) Valiance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSPS 2l3-801.17 (A) TUnpasteurized Pre-packaged Juices and Beventees with Warning Labels* 590.6_0_0__ 3-$01.11(5) Use of PasteurizedEeas* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S )routs Not Served.* Food and Food Protection 3-901.11(C) Unopened Food Packa =e tint Re -served. CONSUMER ADVISORY 22 3-60311 Consumer Advisory Posted for Consumption of 590.6_0_0__ 23. Animal Raids That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.'' B9o" ,nrmo� 25 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Lees* 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. (Iteuvs 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risd- fhciors listed above, can be found in the following sections q('the Food Code and 105 CMR 590.000. Sem Good Retall Practices FC - 590.6_0_0__ 23. _ Marracientent and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .O04 25 Equipment and Utensils .005 26. Water Plumbin and Waste FC 27. Ph sical FacilityFC-6 67 28. Poisonous or Toxic Materials FC - 7 •.008 29. Special Requirements o09 30. _ Other _ _ S.= 31lmeaa6zd- I CITY OF SALEM / BOARD OF HEALTH Establishment Name:, f p � Date: l0l '5� `y�0 Page: of Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date, No. Reference R —Red Item Verified .. DLEASE PRINT CLEARLY Y or 6)a U5't WAR Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe,Yall conditions as described, and, to ❑ Re -inspection Scheduled CIEmergency Suspension comply with all mandates of the Mass/Federaloo ,ode. I understand that noncompliance may result in daily fines of t� my -five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ���^ ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 Proper Cooking Temperatures for Food or Color Additives PHFs 3-202.12 Additives* 3-SO'1.11(C) 3-302.14 Protection from Unapproved Additives* 15 - Poisonous or Toxic Substances 3-401.11(B)(1)(2) 7-101.11 ldenfifying Information - Original Containers* 'Ratites, Injected Meats -155°F 15 7-102.11 7-201.11 7-202.'11 Common Name - Working Containers' Separation - Storage* Restriction -Presence and Use* 3-401-11(A)(3) 7-202.12 Conditions of Use* Stuffing Containing Fish, Meat, 7-203.11 'toxic Containers-Prohibitians* 3-401A 1(C)(3) 7-204.11 Sanitizers, Criteria - Chemicals" 145°F * 7-204.1.2 Chemicals for Washing Produce, Criteria* 7-204.14 7-20511 Doing ents, Criteria* Incidental Food Contact. Lubricants* All Other PHFs -145'F 15 sec. 7-206,11 Restricted Use Pessdcides. Criteria* 340111 (A)&([)) 7-206.12 Rodent Bai{Sfatiortss` Microwave- 165° F2 Minute Standing, 7-206.13 'Pracking Powders, Pest Control and Monitoring* 18 Y I I h4#'i111 f�iGt:3.1 �� i E15l�CMI. ' Denotes critical item in tiv rederal 1999 FoodCode or 105 C NIR 590.000. Proper Cooking Temperatures for PRFs Received at Temperatures .According to taw Cooled to 41'F/45"F Within 4 Hours - Cooling Methods for PHFs PHFs 3-401.1 IA(1)(2) Eggs- 155'F 15 Sec. 3-SO'1.11(C) E =gs- Lrmtediarc Sereicc 1.15`FlSsec* 3-401.11(A)(2) Comminuted Fish, Meats & Game - Animals - 155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 nun* 3-401.11(A)(2) - 'Ratites, Injected Meats -155°F 15 26. see. * 3-401-11(A)(3) Poultry, Wild Game. Staffed PHFs, Time as a Public Health Control* Stuffing Containing Fish, Meat, _ Poultry or Ratites-16VF 15 sec 3-401A 1(C)(3) Whole -muscle, Intact Beef Steaks FC - 1 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165F * 3-401.11 (A)(10)) All Other PHFs -145'F 15 sec. Reheating for Hot Holding 340111 (A)&([)) PHFs 165'P 15 sec. ,403.11 (B) Microwave- 165° F2 Minute Standing, Time" 3-403. I I (C) Commercially Processed RTE Food - 14WF* 3-403A 1(E) Remaining Unshced 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',F/45°F Within 4 Homs. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature htgredients to 41 `F/45`F Within 4 Hours'' ' Denotes critical item in tiv rederal 1999 FoodCode or 105 C NIR 590.000. 21 ORION •. tax a O 3-801.1 1(A) 3-501.14(C} 3 -501.15 PRFs Received at Temperatures .According to taw Cooled to 41'F/45"F Within 4 Hours - Cooling Methods for PHFs 19 3-801A 1(D) PHF Hot and Cold Holding 3-SO'1.11(C) 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 410/45`'F- _ Food and Food Protection - 3 -501.16(.A) Hot PHP; Maintained at or above 1401E * 25. 3-501.16(A) Roasts Held at or above 130'F.` 20 26. 1 Time as a Public Health Control FC -_5 3-501.19 Time as a Public Health Control* physical Facile... 590.004(H) Variance Requirement 21 ORION •. tax a O 3-801.1 1(A) Unpasteurized Pre-packaged Juices and Beverages with Warning, Labels* 3-801.11(B) Use ofPasteurizedEggs* 3-801A 1(D) Raw or Partially Cooked Animal Food and Raw Seed S routs Not Sertied. '9 3-SO'1.11(C) Unopened Food Packa =c Not Re -served. CONSUMER ADVISORY 22 3-60111 Consumer Advisory Posted for Consumption of 90 000 23. Animal Foods That are Raw, Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate _ Food and Food Protection - FC- 3 Pathogens.* 01l,e 111r2001 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Egg;* bt'tUAL FittdUlfitMtN1J _ 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 foodborrte illness interventions and tisk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. f TZWIyyiiYf#eTrFilf +lam (items 23-30) Critical and nein-critical violations, which do not relate to the foodborne- illness interventions and risk faetors listed above, can he ,found in the following sections of the Food Code and ,105 CUR 590.000. item Good Retail Practices FC 90 000 23. Manaciernent and Person nel FC -2 .003 24. _ Food and Food Protection - FC- 3 .004 25. Equipment and Utensils FC -4 .005 26. W a_ter. Plumbing and Waste FC -_5 _ .00_6 27. physical Facile... FC - 6 -- .007 28. Poisonous or Toxic Materials_ FC - 1 _--- .008 29. _ S ecial Re uiremenis .009 30, Other ssua,,,h,ro6a4,, Establishment Item Codo No. Reference R — Red Item G nd CITY OF SALEM BOARD OF HEALTH 4041 Page: of OF CORRECTION 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"F od'Gode. I understand that noncompliance may result in daily fines of twe qty-iv,� d Ilars or suspension/revocation of your food permit. t On zn �/o�R t Gna � x s�ored- ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal Is Verified O No I❑ Yes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure . ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) 14 Proper Cooking Temperatures for Food or Color Additives PHFs_ 3-202.12 Additkes* 3-801..17 (C) 3-302.14 Protection from [ nay roved Additives* 15 FC -3 ..004 Poisonous or Toxic Substances 3-401.11(B)(1)(2) 7-101.11 Identifying Inforntati<nn-Orignral Ratites, Injected Meats - 155°F 15 26. Containers - ontainer*7-102-I1 3-401.11(A)(3) 7 -102 11 Common Narne - Working Containers"` Stuffing Containing Fish, Meat, 7-201,11 SL . aratrOR - SLOCa1'e* 3-401.11(C)(3) 7-202.1.1 Restriction -Presence and Use'k 145°F * _ 7-242.12 Conditions of Use, 7-203.1.1 Toxic Containers - Prohibitions` All Other PHFs-145"F15see. 7-204.11 Sanitlzeis,Criteria-Chemicals^ 3-403.11(A)&(D) 7-201-1.2 Chemicals for Washing Produce, Criteria'' Microwave- 165° F 2 ,Minute Standing 7-204.14 Drving A cut's. Criteria* 3-403.11(C) 7-205.11 -206 Incidental Food Contact, Lubricants - ubricants*7-206.11 14WF* T 11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations' Proper Cooling of PRFs 7-206.13 Tracking Powders, Pest Control and 70°F Within 2 Hours and From 70°F Mon$oring* 17 18 ° Denotrs critical item in the [regal 1999 Food Code or 105 CNIR 590.004. Proper Cooking Temperatures for 3-801_I1(B) PHFs_ 3-401.11A(1)(2) Eggs- 155°F 1.5 Sec. 3-801..17 (C) E=¢s-htnnediauSe.rcice 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game FC -3 ..004 Animals - 155°F 15 sec. '' 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 155°F 15 26. See. '" 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, V. Stuffing Containing Fish, Meat, ' )oultr , or Ratites -1657 15 sec. s' 3-401.11(C)(3) Whole -muscle, Intact' Beef Steals FC - 7.008 145°F * _ 3-401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3-401,11(A)(1)(b) All Other PHFs-145"F15see. -- Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165"F 15 sec. * 3-403.11(B) Microwave- 165° F 2 ,Minute Standing Times' 3-403.11(C) Commercially Processed I2TE Food - 14WF* 3-103.11(E) Remaining Unsliced Portions of Reef Roasts* Proper Cooling of PRFs 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 41 017145°F Within .f Hours* ° Denotrs critical item in the [regal 1999 Food Code or 105 CNIR 590.004. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.1 1(A) 3-501.14(C) PFIFs Received at Temperatures According to taw Cooled to 4 F F/45°F Within 4 Hours. 3-801_I1(B) 3-541.15 Coolino. Methods for PHFs 19 PHF Hot and Cold Holding 3-801..17 (C) 3-501.16(B) Cold PEIFs Maintained at or below 590.004(F) 41V45° F* Not Otherwise Processed to Eliminate 3-501.10(A) Hot PHFs Maintained at or above WO"K * FC -3 ..004 3-501.16(A) Roasts Held at or above 1300F." 20 Time as a Public Health Control Pasteurized Fggs Substitute for Raw Shell 3-501-19 Time as a Public Health Control* 26. 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.1 1(A) Unpastecuized Pre-packaged Juices and Beverages with Warnina labels* 3-801_I1(B) Use of Pasteurized Eves* 3-801A 1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801..17 (C) Unopened Food Package Not Re -served. �T�PItii1dl4 G s s t 22 3-60111 Consumer Advisory Posted for Consumption of -- 530.000 23. Animal Foods That are Raw, Undercooked or FC - 2 1 .003 Not Otherwise Processed to Eliminate ___.... Food and Food Protection FC -3 ..004 Pathogens.* er�ma voaoor 25. 3-302.13 Pasteurized Fggs Substitute for Raw Shell 26. E es* AWMAAL Ht_UUEKr Mt:N I 590.009(A) -(D) Violations of Section 590.009(A) -(D) in caterin& 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 1129 - Special Requirements. f73t/- JMJ2 + J1F/TiV_'C9 (Items 23-30) Critical and non-critical violations, which do not relate to the fimdborne illness inno ventions and risk factors listed above, Can he found in the follon'ing sections of the Food Code and 105 CMR 590.000. - Hem Good Retail practices FC -- 530.000 23. Mannesmann and Fersonne_I FC - 2 1 .003 24. ___.... Food and Food Protection FC -3 ..004 25. Equipment and Utensils _ FC ---4 -1..005 26. Plumbing and Waste FC -S 1 .006______ V. _Water, Physical FacilityFC--6 .007 28. Poisonous or Toxic Materials FC - 7.008 29 Special Requirements .009 30, Other -___--- -- I ,'W "1 11 I,, CITY OF SALEM BOARD OF HEALTH Establishment Name: (tP S �l )(t J ( -- 7j f,( L i G t Date: lU 15 f U f i Page: J� of Jr Item No. Code Reference - C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R - Red Item PLEASE PRINT CLEARLY Date. Verified Qi+ 'V/7T11 S Ote t SC6P.0d - P sf r had ctecornu/ 75a» of va6u e f al -2d I S Gnirre ore oloolno [h /fie ract. n 4 h ?-c k a /)/I- no" -127M t)aii eu- ✓, n t 5CorPd - f4 bel—Hes and bo c �x ha e ke t2 " - 11'IaLe Svre- -fo have Sahf fi n /014A d! a/ 6uo�lC s fih v o v l �s hl/shine zf. 6f Sfore a accum�/a75o�, '07e nd darts - -7homtjokuCly f- Saluh2z- CtrhCCI /Oa zce ` /-1 h LZ'Il7Cc 4 C 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 i Comply with all mandates of the Mass/Federal'Foj Code. I understand that noncompliance may result in daily fines of twen{y-flve-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 Foodborne Illness Interventions and Risk Factors (Items 1-22) fConf.) 14 Food or CE T 3-20112 C Additivzs'r 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 7-101.11 identitynsg 1nRrrtnation - Original Containers* 7-102.11 Common Name - R'orking Cant 7-201.1 t Sep a anon - Storage" 7-202.1.1 Restriction- Presence and Use 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizets,Criteria- Chemicals* 7-204.12 _Chemicals for Washing Produce, Crit 7-204.14 Drvin*A=ents,Crireria" 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Rrrstricted Use Pesticides. Criteria* 7-206.13 1 Tracking Powders, Pest Control and 3-401.11 A(I)(2) 1 Eggs- 155`F 15 Sec. 3-401.11(A)('2) I Commanded Fish, Meat's' & Game 3-403.11(A)&(D) Annuals- 155°F 15 sec. * 3-401.11(13)(1)(2) _ Pork and deaf Roast - ,130°F 121 ny 3-401.11(A)(2) Ratites, Injected Meats- 155`F 15 --sec. 1, 3-401..1.1(A)(3) Poultry, Wild Game, Stuffed PlIFs, 3-501.16(13) Stuffing Containing Fish, Meat, 590.004(F) Youitr > of Ratites -165°F 15 ,sec. $` T401 11 (C)(3) Whole-mnsele, Intact Beet Stacks FC -6 145°F * 3-401. f2 Raw Animal Foods Cooked in a 2p Mlcnowave 165°F=" 3-40£.11fA)(1)(b) All Other PHFs- 145°F 15 sec 3-403.11(A)&(D) PHF, 1657 15 sec. 3-403.11.(B) Microwave- 165° F 2 Minute Standing 3-SO1.I 1(D) Time" 3-403.1 I (C) Commercially Processed RTE Food 3-403.11(E) ( Remaining Unsliced Portions ofl3eef [3:'5:01 I41AI Cooling Cooked PRFs from 140°F to 70°F Within 2 (fours and From 76°Fto 41°FAYF Within 4 Homs. * 14(13) Cooling PIIFs Made From Ambient Temperaane Ingredients to 41 `F/45°F 'Within 4 Hours_* - Denotes rubra] incur in the federal 1999 Pool Code or 105 CFni 590.000. 1. 3-501.1/,(C) PHFs Received at Temperatures 3-801.11(B) According to Law Cooled to 3-SO1.I 1(D) 41"F/45°F Within 4 Hours. 3-501.11(C) Coolinn Methods for PHFs E3-501.15 I9 PHF Hot and Cold Holding 3-501.16(13) Cold PRFs Maintained at or below 590.004(F) 41°145°F- *3-501.1fr(A) 3-501.16(A) Hot PHFs ;Maintained at or above. FC -6 140°F. 3-50'1,16(A) Roasts Held at or above 130°F. 2p Time as a Public Health Control 3-501.'19 Time as a Public Health Control* 590.004(H) VarianceRequirement 21 3 -SOI II(A) Unpasteurized Pre-packaged Juices and Beverages with Warnine Labels* 3-801.11(B) Us. of Pastemizedrl�s, 3-SO1.I 1(D) Raw or Partially Cooked Animal Ycmd and Raw Seed Sprouts Not Served. 3-501.11(C) Llno eased Food Package Not Re -served, �° 22 3-603.11 Consumer Advisory Posted for Consumption of 590 "" Annual Foods That, are Raw, Undercooked or FC - 2 Not Otherwise Processed to Eliminate 24, Food and Food Protection Pathogens.* era°ore=.ax�or 3-302.13 Pasteurized Eggs Substitute for Raw Shell FC - 4 .005 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 foodtaorne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (items 23-30) Critteafi mad awn-rriticat viotntimes•, which do not retate ao the foodborne illness interventions and risk factors listed above. can he ,found in the following sections of the Fqod Code and 105 CMR 590.000. ' Item -I Good Retail Practices r 590 "" 23. Marra ament and Personnel - ---------- FC - 2 .003 24, Food and Food Protection FC__3_ .004 Equipment and Utensils FC - 4 .005 _ 26. Water. Plumbing and Weste FC -5 .Co8 27. Ph sisal FC -6 .007 ToxFacilit}__ 28. Poisonouor s ic Materials FC -7 1 .008 29 S E grim Requirements .009 .. 30 (_.Other � ___.. _.. 1oVOfenuCzkE2.dac --ices Inc. ... pIM TICKET General Sere * PICK TICKET ** P.O. Hox 60 page: 1 Medford. MA 02155'0001 *+ Any Question Call 1-s0o-233-1033 *' JYder #: 164547 Order Date: 10/08/04 T Ship To: STEVE'S RUAIITY M 9o1d-To' STEVE`S QUALITY MARKET 36 MARGT1I.STRNET , 0 36 MARGIN 501970 bALEM1970 SALEM, la Ter: COLLECT v Rep: 61 19357 P.O.#: PETER Coat #: ate Shipped;.---- �' ate t ship: ASO Ship Via: OUR TRUC t Qty Unit Qty Shipped r To Ship Loc Item # Ordered .Seq# Description -1 Description -2 4 gACa 4-- 10 CUT3/4WHITE P3/4" 23 6/80X B AP5/8" , 1 Lise Items Comments : COLLECT $400.00 ATTN:PETER Total Quantity' Rec- by 4 CITATION NO. s CITY OF SALEM . VIOLATION NOTICE A 1921 NAME (LAST, FIRST, INITIAL) �,, a +� ..S�ef� S��✓�s r STREET`ADDRESS 3 / CITY/TOWN STATE yj ZIPPY /y a T: c m ani of I Y LICENSE NO. ,/ LIC. EXP. DATE DATE OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) STREETA DRESS ITY/TOWN STATE ZIP 31 1 lcm i'i�argtn fns of REGISTRATION NOS STAT I EXP. DATE MAKE/FY YEA COLOR DATEOF VIOLATION TIME �y oAM DATE CITATION WRITTEN. fo f_ PERSONAL INJURY ❑YES V 0// ! / jfJ D ❑NO LOCATION OF VV/IOLATION. ENFORCING DEP . SA Itt11 j i -Y%� iIFS U QTZf J y _iT OFFENSE j CHAP. SECT. FINES A a I'eQ2c4 vlob i B C -ane AGod 0 -ode 9G C OFFICER I.D. NO. TOTAL FINE / r DUE G/LSJ.•M1V•/T OFFICER CERTIFIES COPY GIVEN TO VIOLATOR _ / ❑ IN HAND X LTi xT. y( L"' -'7- 5 ❑ BY MAIL DO,I OT MAIL CASH - PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK < CITY HALL 93 WASHINGTON STREET 0 SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE a SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE, PEEL AND SEAL CITATION NO. CITY OF SALEM e} VIOLATION NOTICE A G 14 NAME (LAST, BRAT, INITIAL}) / f1 PSLIll y -b4 STREETADDRESS CI STATE ZIP &P t�+ ,//TOWN y�/� ,. I S ,. / L�.1}fieN, LICENSE NO. .. ( LIC. EXP. DATE DATE OF BIRTH OWNERS NAME (LAST, FIRST, INITIAL) S-heohen in i m STREETAD RESS CITY/TOWN STATE ZIP aN 'ee f&? N1 0 REGISTRATION NO. STATE I EXP DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION (/ TIME El AECJITA DIE 101 WRITTEN r ll PERSONAL irvduRO YES E=.Pfv� %,4'y NO LOCATION OF VIOLATIONEf�IF�/7O�eRLI�NG DPT. Y) Si'f7e OFFENSE CHAP. SECT. FINES A t�ar2 n 5y'. 1l8 B C OFFICER ` LD. NO. TOTAL FINE n,.. DUE OFFICE rbERT7Fl. 'CIOPY GIVEN TO VIOLATOR ❑ IN HAND X �11 ❑-OY'MAIL DO NOTlWIL ASH - ONLY BY POSTAL NOTE, MONEY ORDER, ORGY CHECK MADE PAYABLE TO: (.�/ CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL _ _ 1 'COURT DOCKET NO--�----f--��. CITY OF SALEM �------�-CITATION NO �C- �' VIOLATION NOTICE A 2914 NAME (LAST, FIRST, INITIAL) y. 2003 INTUIT INC. 0 728 1430Q433.8810 fi0/ v «:- 3 OWNER'S NAME (LAST, FIRST, INITIAL) O To ee If Q2 ) o/qi REGISTRATION NO.. ITI EXP. DATE MAKE/TYPE Do DATE OF VIOLATION ^) TIME 3 O PEflsONAL INJUflY ❑YES H o< 9�0 U El NO LOCATION OFFVIOLATION EVfOCIN077 PT y nO 4 OFFENSE . CHAP. SECT. FINES S. Ay x B c r) m OFFICER j I.D. NO. N ^ —� _ A DUE Wd1�J, Vl O F.Y fA amp r r « « Ni} q�G « « d � • 7C w w w :• O r « r r « « r � LU p « r « " iLl « .li w O « « « i O « y U7 w 0 « « m Lu « C p i A p • 0 N s « N y « mop « « NN Wo m0 * O « i « I R « { I « « « • m ' v � O O N O O � D W ♦J i c 'COURT DOCKET NO--�----f--��. CITY OF SALEM �------�-CITATION NO �C- �' VIOLATION NOTICE A 2914 NAME (LAST, FIRST, INITIAL) I / 7 STREETADDRESS cfryftoWN STATE ZIP fi0/ LICENSE NO.LIC. E%P. DATE GATE OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) STREETA RESS CITY/TOWN STATE ZIP ee If Q2 ) o/qi REGISTRATION NO.. STATE EXP. DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION ^) TIME DATE CITATION WRITTEN QQ /I PEflsONAL INJUflY ❑YES ' )� �.A�'O"J' U El NO LOCATION OFFVIOLATION EVfOCIN077 PT y nO 4 OFFENSE . CHAP. SECT. FINES A , _ JI. �.r-; r B C OFFICER j I.D. NO. TOTAL FINE ^ —� _ A DUE Wd1�J, OFFICE CERTMtES-COPY GIVEN TO VIOLATOR .� , ❑ IN HAND i DO NOVMAIL ASH -YA ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED; AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL wM A i • .+r v DATE -TfME PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBILE AREA CODE >41SER 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 SIGNED i IVP& TELEPHDNED 7W.Vr4. MAUE" (jM0&ATAPJT .- CAME TO SFE YOU DATE -TIM ■PHONE WANTS TO SEE YOU RUSH AREA CODE . FAX MOBILE.. E ��ER TIME TO CALL WILL FAX TO YOU MESSAGE -- Lgr�ft = TELEPHDNED 7W.Vr4. MAUE" PLEASE.CALL CAME TO SFE YOU '. WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU IN U.S.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 r EVAleff ()r91r q 41ey- Date / ILO) T e of O eration s FpM Service etail Type of Inspection ❑ Routine 01 -inspection Address Risk 51- e _36MA46u Telephone Level ❑ Residential Kitchen Previous Inspection %Y _ ` 2Z,0 ❑ Mobile ❑ Temporary ❑ Caterer EJ Bed & Breakfast Date: 6 pN ❑ Pre -o eration ❑ Suspect Illness El General Complaint Owner Svs{iI*W IN 6AJI HACCP YM Person in Charge (PIC)4-��- /t Com' Time u !S Out: Permit No. ❑ Other Inspector Qr4 y IQ il &/ (3 V COGII vlvlauvn cnecleea requires an explanation on me 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 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 i N : 23. Management and Personnel (FC -2)(590.003) ✓ A 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) FE130. Other & 59ol VMForm 14 do Inspector's PIC's Siang Print: ❑!Prevention of Contamination from Hands 12 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating [118. 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: C T J 4 G v 1 Page -1 of Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590-003(A) Assi gnment of Responsibility" 590.003(B) Demonstration of Kno!,.e" 2-103.11 Person in charge -- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to 590.004(A -B) require reporting by food employees and 3-201,12 applicants* 590.003(F) Responsibilht Of A Foal Employee Or An 3-202.13 Applicant To ReportTo The Person In 3-202.14 Chat' "e* $90.003{G) Reporting by Person inChar e* 3 590.003(D) Exclusions and Restrictions* 590.003(F.) Removal of Exclusions and Restrictions L© 5 C C '" Denote, critical item in the fed¢ral 1999 Food Code or 105 CMR 590-060. 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food La"* 3-201,12 Food in a I3ermeticall Sealed Container" 3-201,13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs- s*3-202.14 3-202.14 E s and Milk products. Pasteurized - 3 -202.16 Ice Made Frorn Potable Drinking Water" 5-101,11 Drinking Water from an A roved SvstenYe 590.006(A) Bottled Drinking Water* 590.006(8) Water Meets Standards in 310 CMR 22.0* Washing Fruits acrd VeL*etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan 3-201.15 _Shellfish* Molluscan Shellfish from NSSP Listed Sources* Contamination trom the Consumer Game and Wild Mushrooms Approved d y RegulatoryReguiatory Authorit 3-202.15 Shellstock Identification Present* 590.004(C) Wild Mashnioms` 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3202.11 . PRFs Received at Pro erTem ierl atures'" 3-202.15 Package Lutcerity* ._.. 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.15 Shellstock Identification 3-203.12 Shellstock Identification Maintained* TagsiRecards: Fish Products 3-402.11 Parasite Destruction* 3-102.12 Records. Creation and Retention" 590.0040) Labeling of Ingredients" Frequency of Sanitization of Utensils and Fond Contact Surfaces of fqtrf meat* Conformance with Approved Procedures lHACCP Plans 3-502.71 Specialized Processing Methods* 3-$02.12 Reduced oxygen ackavin , criteria" 8-103.12 Conformance with Approved Procedures* '" Denote, critical item in the fed¢ral 1999 Food Code or 105 CMR 590-060. 8 Cross -contamination 3-302.11(A)(1) Raw Arnmal Foals Separated from Cooked and RTE Foods" Contamination from Raw Ingredients 3-302- l 1(A)(2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-302A I(A) Food Protection" 3-302.15 Washing Fruits acrd VeL*etables 3-304.11 Food Contact with Equipment and Utensils* Contamination trom 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- Plot Water Sanitization Tem. erattres* 4-501112 Mechanical Warewashing-Hat' Water Sanitization Tem erasures* 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* 4-70211 Frequency of Sanitization of Utensils and Fond Contact Surfaces of fqtrf meat* 4-703.11 Methods of SanitizationHotWater and Chemical* Iff Proper, Adequate Handwashing 2301.11 Clean Condition - Hands and Arms"` 2-307.12 Clearing Procedure" 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401-11 Eating, Drinking orUsineTobacco* 2-401.12 Discharges From the Eycs. Nose and Month* 3-301.12 Preventing Coni'unlnation When Tastin^` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em ehnees* I3 Handwash Facilities Conveniently Located and Accessible 5-203.1.1 Numbers and Capacities* 5-204.11 location and Placement= _5-205.11 Accessibility, 0 errtion and Maintenance Supplied with Soap and Hand Drying Devices 6-301_1.1 Handwashin Cleanser. Availability 6-301.12 1Iand Drina Prov cion CITY OF SALEM BOARD OF HEALTH r Establishment Name: 7F-9 VS r atUcir�l M/ri Date: 'Ss/,y Page: 2— of s— Item No. Code Reference C — Critical nem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R - Red item " '---PLEASE.PflINT CLEARLY Date Verified K0Ile 0Mi!F_ K'aw zetf_C"01r n/oM#>: G Me 9 6 v-: -R-o,_'r C-o..Aw tMod 4VW ✓f'S+Gtr 4�M NOP" �i'�vCtAtN W+au-s' ofL 5'vrt-�v4Ct�9 I � r► G L d��- A (,�- !-�iA N�vt/y4 S N S^a N!si ' vi�s'i"rQ f � • • la A�►rJ wtq s. w � N Z s 6e"5 (1�F2 o-6�q«h r4r" e) Bt-kidtr G(r5' PLS � Ale -5— a r is s A-- v ra EA" O N S c & O /.N I O q ,Jsem- e /eta ,d4dt5 � K cJi�c�st� 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 obsery II conditions as described, and to P comply with all mandates of the Mass/Feder od Code. I understand that noncompliance may result in daily fines of twe ty-fi a 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 Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 16 17 : Denotes critical item is the federal 1999 Food Code or 105 CMR 590-000. 3-501.14(C) F3-501.15 Food or Color Additives 3-202.12 Additives' 3-302.14 Protection from Unat>roved Additives* 3-501.16(.A) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Natne- Workin^ Containers* 7-201.11. Separation - Stora e* 7-202.11 Restriction -Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitionsi` 7-204.11. Sta itizers. Criteria - Chemicals* 7-204.12 Chemicals for Washine Produce- Criteria* 7-204.1-1 Dr Ling Agents. Criteria* 7-205.1 l Incidental Food Contact. Lubricants* 7-206.11 Restricted 1.1se Pesticides. Criteria* 7-2176.12 Rodent Bait Stations* 7-206.'13 Tracking Powders, Pest Control and Monitoring : Denotes critical item is the federal 1999 Food Code or 105 CMR 590-000. 3-501.14(C) F3-501.15 Proper Cooking Temperatures for 19 PHFs 3-401.1 IA(1)(2) Eggs- 155'F 13 See. 3-501.16(.A) E es-htvnnedtatcSen'ice 145°F15sec# 3-401..11(A)(2) Comminuted Fish, Meats & Game 20 Animals - 155°F 15 see. * 3-401.11 (B)(1)(2) Pork'. and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 29_ _ sec. 3-401 JI I(A)(3) Poultry, Wild Game, Stuffed PRFs, Stuffing Containing Fish, Meat, __- Poultry or Ratites -165°17 15 sec. 3-401.1 1(C)(3) Whole -muscle, tract Beef Steaks 145`F 4' 3401.12 Raw Animal Foods Cooked in a 165'F"i 3401AI(A)(1)(b) _Microwave All Other PHFs -145'F'15sec. Reheating for Hot Holding ,403.11 (A)&(D) PHFs 165'F .15 sec. 4z 3-403.11(B) Microwave -165° F 2 ,Minute. Standing Tinnc* 3-403.11(C) Commercially Processed RTE Food - t40'F 3-403,1.1(E) Remaining Unsliced Portions orBcef Roasts' Proper Cooling of PHFs 3-501. W(A) Coaling Cooked PF'1Fs 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 PIFS Made From Ambient Temperature hun edients to 41 °F)45`F Within 4 floor., : Denotes critical item is the federal 1999 Food Code or 105 CMR 590-000. 3-501.14(C) F3-501.15 PHFs Received at'I'emperatures According to Law Cooled to 41'FI45°F Within 4 Hours. Coolim, Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold Mitts Maintained at or below _41V45' F* 3-501.16(.A) Hot PflFs Maintained at or above 140'F. * 3-501.1.6(A) Roasts Held at or above 130'F- 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 190,004tH} Variance Re ulrement * •r 2:( 3-801.11(A) Unpasteurized Pre-packaged Juices and Bevetaaes with Wamina I aabell- 590.000 3-SO1.11(B) Use of Pasteurized Bags* FC - 2 FC - 3 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 'k _ Equipment and Utensils W a_terPumbnd Waste Pg Facility.... 3-801.1](C) Uno ened Food Pucka e Not Re -served. • r � 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. _ 24. Annual Foods That are Raw. Undercooked or FC - 2 FC - 3 .003 .004 Not Otherwise Processed to Eliminate _ Equipment and Utensils W a_terPumbnd Waste Pg Facility.... FC - 4 FC-5 FC -6! Path * 17611,111 r -i.;_0" 28. _3-302.13 Pasteurized Eggs Substitute for Raw Shell .008 29_ _ Eggs* _ s9rca0ta1_ MMVUtncrwcrvra 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should he debited under the appropriate sections alcove if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail praeticas should be debited under #29 - Special Requirements. (Items 23-30) Ctiaaat and non-critical violatrono Which do sot relate to the ,foodborne illness interventions and risk fat tore listed above, can be found in rhe following sections of the Food Code and 105 CMR 590.000. item Good Retail Practices FC 590.000 23. _ 24. ona a Mmeet and Personnel Food and Food Protection FC - 2 FC - 3 .003 .004 25. 26. 2 _ Equipment and Utensils W a_terPumbnd Waste Pg Facility.... FC - 4 FC-5 FC -6! _ .005 006 .007 28. Poisonous or Toxic Materials FC - 7 .008 29_ _ S ecial Re uirements .009 _ __- ssvom,nm,�n-zsw 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 S' 2F✓� r QVALr 14/t/C Date / s /o'/ TVDe of ODerationi s) Type of Inspection ❑Food Service detail El Residential Kitchen ❑ Mobile ❑❑ Caterer ❑ Bed & Breakfast Permit No. outine E3Re-inspection Previous Inspection Date: ElPre-operation❑ Suspect Illness El ❑ General Complaint ❑HACCP El Other AddressRisk 3l° M7 61r/ i� Level M Telephone f7 &I -A/q- V? -go OwnerST pN�N , r HACCP YIN Person in Charge (PIC)Pg� NQt3Yt Time In: Out: Inspector C9MdtzArm'moo-1 rf/eS 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 v.. _ 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, 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) V.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, 501nVnlFo�-14.d� ❑ 122.. Prevention of Contamination from Hands @16 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 r 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 Qrder. DATE OF RE -INSPECTION: 3 s ctorfi Sig - re: of �� U Prink �i PIC a ngature: Print: e\ Z n g e M Page-/ ?pages Pages 00 Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT I 590.003(A) Assignment of Responsibility* 590.003(B) UrmonsrrrtionofKnowledge* _ 2-LO.i11 Person in siar e-dunrs EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to 590.004(A -B) require tepoiting byfood employees and 3-201-12 applicants* 590.003(F) Responsibility Of AFood Employee Or An 3-202.13 Applicant To RepotTo The Person In 3-20214 Charge't 590.003(03) Re ordng b Personrn Char e" 3 590.003(D) Exclusions and Restrictions* 590.003(F;) Removal of Exclusions and Restricticnns 4 5 C I * Denotes critical item in the federal 1999 Fmd Code or 105 CN4k 59(1000. g 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* 3-20214 E¢es and Milk Products, Pasteurized' 3-202,16 Ice Made From Potable Drinkine Water' 5-101.11. Di inkine Water front an Approved Svstem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0`" Washin>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 3202.18 Shellsrock Identification Present* 590.004(C) Wild Mushrooms" 3-201.17 Game Animak" 3-701..11 Receiving/Condition 3-20111 PI"IFs Received at Pru per Temperatures* 3-202-15 Packaaelnte i,tv` 3-101.11 Food Safe and Unadulterated * TagstRecords: Shellstmit 3-202.18 Shellstock Identification 3-203.12 Shellsrock Identification Maintained* Tags/Records: Fish Products 3 402.11 Parasite Desti notion* 3402.12 Records. Creation and Retention* 590.004(.1) Labeling of Ingredients' Frequency of Sanitization of Utensils and Foci Contact Surfaces of Equipment" Conformance with Approved Procedures /HACCP Plans 3-502.11 1 Specialized Processing Meth(As* 3-50272 Reduced oxygen Packaging, criteria* 8-103.12 Conformance with A roved Procedures" * Denotes critical item in the federal 1999 Fmd Code or 105 CN4k 59(1000. g Cross-cor.mminatron 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE F Fooshs , Contamination tram 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 Washin>Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils` Contamination from the Consumer 3-306.14(A)(B) Returned Food find Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701..11 Discarding or Reconditioning Unsafe FoorP" 9 Food Contact Surfaces 4-501.111 Manual Warewasbing - Hot Water Sanitization Tent eratares* 4-501.112 Mechanical Warewashina Hot Water Sanitization Tem peratures* 4-501.114 Chemical Sanitization- temp., pH, concentration andhatdness. * 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 Foci Contact Surfaces of Equipment" 4-703.11 Methods of Sanitization - Hot Water and Chemical" to Proper, Adequate Handwashing 2-301.11 Clean Condition- Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* i 1 Good Hygienic Practices 2-401.11 Fitting, Drinking orUsing Tobacco* 2-401.1.2 Discharges Front the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Testin ts, 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Eau lovees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.1.1 Numbers and Calpacities, 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 Eland Drving Provision I CITY OF SALEM BOARD OF HEALTH .r/ Establishment Name: 5'F49'/4&) -©1"m -I tri /NA rleaV— Date: S/d /r Page: 2 of 3 Item No. Code Reference c -Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R — Red Item - PLEASE PRINT CLEARLY Date Verified F014OW/Ns aw 4 Z P/DOt"'r 11x&.-wavaLn r- l-04dc N S MC'_t. r 0"-' -% CGOtip /O 04L4040- 9(,z /. At.ovev'r-af cftailii SURA A (3&9TY c!/oCK v r4sw 2 aOA&7 C4&AM Or 1114 2-7 v-Vt6e_ cc_ f8e4C# ,rJ WG4SDJr c t/1c CW(Aot oN EZ-WXGSe6. 1Vr 2 MQk Oil d:'14I1`VV d rrn 14.409 fo•n OQScW� N e�aP�frelf vs6 Ov at�'e Or4t'ff6P. mvf/D 09ttew t..a.q'gs X0 wor t21 o/S3ccwwnMs� / � r716 rtfA/'�OWNShIrrrlE' 17►rK- rr/ ait 1�6Li t? 1dA+`rOv✓As,V/NG Orcy:' 2 sSc�trr G r cot,�,r - nr - 061,4 64T6 l.Ps%41 ftT — ZL f3 tr d P M (l r r<T�4 , t/p3, N/Atc T Of, S-trtf 64 c&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 food permit. /� (�' _ Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: MA Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS I4 16 18 `Denotes critical item in the tadezl 1999 Food Code or 105 CMR 590,000. Food or Color Additives 3-202.12 Additivos* 3-302.14 _ Protection fmm Unar roved Additives* __.Management and Personnel Poisonous or Toxic Substances 7-10t.1 l Identifying Information - Original Containers* 7-302.11 CommmnName- Workin- Ctrntainers* 7-201.11 Se aradou - Storaac'` 7-20211 Restriction -Presence and Use* 7-20212 Conditions of User 7-203.1.1 Toxic Containers - Prohibi.tions' 7-204.11 Sanitizers, Criteria -Chemicals* 7-204.12 Chemicals for Washin Produce, Criteria* 7-204.14 Drvin Agents, Criteria* 7-205.1 I Incidental Food Contact. Lubricants- ubricants-7-206.'11 7-206.11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations,` 7-206.13 Tracking Powders, Pest Control and Monitoring-* `Denotes critical item in the tadezl 1999 Food Code or 105 CMR 590,000. Proper Cooking Temperatures for 19 PHFs 3401. HA(1)(2) Eggs-155°F15Sec. __.Management and Personnel E res-Invtcdiate Service 145°.F15sec*' 3-401.11(.4)(2) Comminuted Fish, Meats & Game 20 Animals - 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 tin 3-401.11(A)(2) Ratites, Injected Meals -155"F15 and Utensils see. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PFfFs, 26. Stuffing Containing Fish, Meat, FC Poultry or Ratites -165'F 15 sec. " 3-401.11.(C)(3) Whole -muscle, Intact 'Beef Steaks Ph sical Facility 145°F * 3401.12 Raw Animal Foods Cooked in a 28. Microwave 165°F 3401.11(A)(1)(b) All lather PHFs - 145°F 15 sec. .008 Reheating for Hot Holding 3-40111(A)&(D) PHFs 165°F 15 sec. * 3-403.11(B) Microwave- 165° F 2 Minute Standing _ 30. Time* 3-403.11(C) Commercially Processed RTE Faad - 140°F 3-103,11 (E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 14VF to 70`F Within 2 Hours and From 70°F to 41°F145°F Within 4 Hours. 3-501.14(B) Coolirn, IsI s Made Front Ambient Temperature Ingredients m 41 TV45'17 Within 4 Hours" `Denotes critical item in the tadezl 1999 Food Code or 105 CMR 590,000. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.14(0) _ PHFs Received at Temperatures According to Law Cooled to 41'F45'F Within 4 Hours. M 75171.15 Cwlin,Methodsfor PHFs 19 PHF Hot and Cold Holding 3-801,11(B) 3-501.16(B) Cold P1113s Maintained at or below .590.004(F) 41"145°F" __.Management and Personnel 3-50116(A) I lot PHFs Maintained at or above 140°F. Raw or Partially Cooked Animal Food and Raw Seed S nronts Not Served. ,F 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 Connni* Pasteurized Eggs Substitute for Raw Shell 590.004(H} Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpastetnizcd Pre-packaged Juices and Beveiates with Warnintr f abels* 3-801,11(B) Use of Pasteurized Ei? s* __.Management and Personnel 3-30111(?)) Raw or Partially Cooked Animal Food and Raw Seed S nronts Not Served. ,F .003 3-801.11(C) Unopened Food Package Not Re -served. " 22 3-603.11 Consumer Advisory Posted for Consumption of 590.0oo Animal Foods `That are Raw. Undercooked or __.Management and Personnel FC Not Otherwise Processed to Eliminate .003 24. Pathorens.* ee„ce:a ,moor 3-302.13 Pasteurized Eggs Substitute for Raw Shell 25. _ and Utensils E es` SPECIAL REQUIREMENTS 590.004(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 tisk factors. Cather 590.009 violations relating to good retail practices should be debited under 1129 - Special Requirements. Mi{X+�ifis�lZlt7�lT3�+ (Itefns 23-30) Critical and non-erifical violations, which do not relate to the foodborne illness interventions and risk J'ivctors lasted above, can be found in the follonoing sections of the Food Code and 105 CMIt 59(1000. Item Good Retail Prac_ trees FC 590.0oo 23. __.Management and Personnel FC - 2 .003 24. _ Food and Food Protection 25. _ and Utensils FC - 4 .005 26. _Equipment Water, Plumbin and lNaste FC -5 .006 27. Ph sical Facility FC -6 _ .007 28. Poisonous or Toxic Materials... FC - 7 .008 29. _ _ Special Requirements .C)o9 _ 30. Other -- - _-- Sasorcj,m„ 6-2n.,, CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: 3 of Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION R — Red Item PLEASE PRINT CLEARLY Date Verified +t -- /3 t 4A4 ALI- 1da><0Wf"A1 SiNX'!` " tdrlt�wAsAt�errr ctN ,�, 2s! w64PP 040 "va Ate- tJ Atm N r9 eLs' A R F �b ots z K144_, /tJ PAR&.6 #t&XAr 4K JtAY-I &'= F . d v l v✓ Shy %% /�i Lt INu -aeg ft&, "rt/wim d Dro 'f ANS f4 r r R6e� /� rgClrs. C&Krl r-, fb^ It N A rN6- W'94 N ct.� k N ctsv PunA s JAfrft, iM r. Pf W aMr t+uAr tSd t�6tuo� iN lLt�r�tfC66 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. n ' 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 15 16 17 .F Denotes critical item in I ha to der al 1999 Food Coda or 105 OMR 590 000. r %50L14(C) 3-501.15 Food or Color Additives 3-202.12 Adchtives`r 3-302.14 Protection from Ura t roved Additives''` 3-501.16(A) Poisonous or Toxic Substances 7-101.11 Identifying Information - CnOn d Containers" 7-102.11 Common Name - Working Containers" 7-201.11 Separation - Stoiaze", 7-20111 Restriction - Presence and Use" 7-202.12 Conditions of Urs,* 7-203,11 'Toxic Containers - Prohibitions* 7-204.11 _ Sanitizets.Criteria- Chenticalss' 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.1.1 Incidental Food contact. Lubricants* 7-206.1 t Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations* 7-206-'13 Tracking Powders, Pest Control and Monitorim** .F Denotes critical item in I ha to der al 1999 Food Coda or 105 OMR 590 000. r %50L14(C) 3-501.15 Proper Cooking Temperatures for 19 PHFs 3-401.11A(1)(2) Eggs- 1.55°F 1.5 See. 3-501.16(A) E res-Lnmediate S,rvice 145"FiSsec* 3-401.11.(A)(2) Comminuted Fish, Meats & Game Animals - 155°F 15 sec. n 3-401.11(B)( I)(2) Pork and Beef Roast - 13WF 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 sec. * 3-401_1.1(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, poultry or Ratites -165°17 15 see. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F T' 3401.12 Raw Animal Foals Cooked in a Microwave 165°F-* 3401A 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) Comrnercially,Processed RTE Food - 14WF" 3-403.11(F) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PRFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and From 70'l- 0`Fto to41°'.F145°F Within 4 Homs. 3-501.14(11) Cooling Mips Made From Ambient Temperature Ingredients to 41 °F/457 Within 4llours* .F Denotes critical item in I ha to der al 1999 Food Coda or 105 OMR 590 000. r %50L14(C) 3-501.15 PRFs Received at Temperatures According to L.aw Cooled to 41°F745°F Within 4 Hours. Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501.Io(B) 590,004(F) Cold PHFs Maintained at or below 41`!45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 3-501.16(A) Roasts Held at or above 13WR Time as a Public Health Control 3-501.19 Time as a Public Health Controls` 590.004(H} Variance Re uirement I 21 3-&0L I I(A) Unpasteurized Pie -packaged Juices and � Beveraees with Warning, 1-abels* 3-901._11(B) _ Use of Pasteurized Hees' 3-8011 i(D) Raw or Partially Cooked Annual Food and Raw Seed Sprouts Not Sets ed. 3-$01.11(0) Uno encd Food Packa e Not Re -served. 22 3-60311 Consumer Advisory Posted for Consumption of Animal Fads Fhat are Raw. Undercooked or Not Otherwise Processed to Eliminate Path 1. ern�n,E v*rzocr 3-302.13 Pasteurized Eggs Substitute forRaw Shell E " gs`r 5t'rU AL Kt:U tIKt:Mt:N 15 590 -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 #29 - Special Requirements. vrzffrrrNxy (Items 23-30) Critical acrd non-critical violations. which do Prot relate to tiee foodborne illness interventions and risk factors listed above, can be; found in the following sections of the Food Code and 105 GUR swnmie,W:YS-zm<