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STREGA - ESTABLISHMENTSSTREGA \- 94 LAFAYETTE STREET IMPORTANT MESSAGE FOR - b ) A. DATE / b TIME M ('(�5�InLL9=� OF � PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN. WANTS TO SEE YOU RUSH' RETURNED YOUR'. CALL WILL FAX TO YOU MESSAGE SIGNED iy Icn [DATE- - P.M Ai .neo V7 t Ll: PHONE AREA CODE NUMBER EXTENSION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN' WANTS TO SEE YOU RUSi-1�� RETURNED YOUR CALL WILL FAX TO YOU: / dITaft-OWNWIMA SIGNED z cn I f, ', _.._ ;{ i; _ - Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: File Number: BHF -2003-000015 LOCATED AT: Kimberley Driscoll Mayor Strega 94 Lafayette Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2011-0267 Jan 1, 2011 Dec 31, 2011 $280.00 ESTABLISMIENT PERMIT EXPIRES Total Fees: $280.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, at[ plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KI1vff3ERLEY DRISCOLL MAYOR DAVID GREENBAUM,RS ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET. 4" FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 DGRE2NIIAUbInUe.SALI,M. COM 2011 APPLICATION FOR nPERMIT 'TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Sf RE/G�1AL A Jn"1�1{fL*L/`i��t TEL# q��tP�, ��Itil 60�q ADDREvo Cr-- LST DLIGHNIL V I • / � -� - � C /, \ - 6� FAX H'-�(_ � y 1 LAil— MAI i,_y,(yp _ 00 - r— MAILING ADDRESS (if different) I EMAIL - Business': .et ADDRESS (0�Website: W QAA e C 'd TEL # C11� alp `i lalir CITY STATE CERTIFIED FOOD MANAGER'S NAME(S) RCsS CERTIFICATE#(S) 5`1 3 1 1 I (Required in an establishment where potentially hazardous food is prepared) I EMERGENCY RESPONSE PERSON �—1 VZ --P, di U " 0 HOME TEL #"I r) Io� tQJ 'DAYS,OFOPERA710N_ Monda - :,Tuesday ! <Wednesda T I `#Thursda :i Y .; `' y Y Y ... y: Saturday: ° ',Sunday. ;. Frida'' HOURS OF OPERATION Please write in time of day, For example 11 am -11 pm TYPE OF ESTABLISHMENT RETAIL STORE YES NO RESTAURANT l (Outdnor Stationar! Fend Cart R?1 NO FEE (checkonly) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 less than 25 seats 25-99 teats 5280 more than 99 seats 420 --------------------------ES ----------------------------------------------------------— ---------------------------------- $---10-------- BED/BREAKFAST/ YNO 0 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT (such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursant to MGL Chapter 629 ion 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax return and paid all slat¢ taxo requirbd under the law. 0C)L) 171LIP, , 5101() 03\43(10n75q Date Social Security or Federal Identification Number Revised 10/7/11 FOODAP2011.adm Check# & CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 120 WASHINGTON STREET 3RD FLOOR \�1 h}rryl.i�l i SALEM, MA 01970 TEL. 978-745-9595 EXT. 5648 FAX 978-7446775 or 978-740-9846 KIMBERLEY DRISCOLL MAYOR 0 LCEIVED FEB 10 2010 tU ALTfi HEARING NOTICE ROBERT M. Sr. PIERRE, CHAIRMAN JOHN H. CASEY RICHARD C. LEE MELISSA PAGLIARO, CLERK OF THE BOARD Notice is hereby given in accordance with Chapter 29, Section 23A of the Massachusetts General Laws, that a Special Meeting of the Salem Licensing Board will be held on Thursday February 11, 2010 at 6:00 p.m. in the third floor conference room, at City Hall Annex, 120 Washington Street. AGENDA 1. Strega — 94 Lafayette Street Request to stay suspension of Liquor License. Melissa Pagliaro Clerk of the Board t 03/04/2010 08:06 7812310407 PAULAKOSMAS PAGE 01 STrlga FAX TRANSM YTAL March 4, 2010 Total # of pages: 3 f'O: Salem 1-lealth Department FAX 978.745-0343 Re: rernlinex Service & Inspection Report Dated: 2/1.1./10 Strega Fntcrlalnment, Inc. 94 Lafayette Street Salcm, MA 01970 (97a) 741.0004 FAX (976)741.0X04 1 03/04/2010 08:06 7812310407 PALILAKOSMAS PAGE 02 V W;1 A 0, " � , " PrJllt.C,�cl, , : .1. 4?,', "_5 OY1 :1 1. 7 U INITIAL SERVICE 10 REGULAR SERVICE C) EXTRA SERVICE Ix TERA 4 11 MI Anse 1JDj6o, Ames 0 P,&Wphq A415 0P4.NiRoomi , f3exwIcips"Imi 0 LaWoo*W NOR' Q L*Wft 13"WOWSOW DD nl,euenaanaeenrn maY aro Cofflb'A�ij as am, MONR A.A..01 09.SNAGan F,ULV N I X 13NAL.- GT IR 1:1 (..'10 110 00 A In't vo lou1pli"OR10 1,zix Chargc... NEWTON 'M41 02,166 IMA ()"n (67.7)9617. 00 B SUPERVI R NAME TIFICATION NUMBER OPERATOR NAME E T FicAnON NUMBS F1, SL L R U R H JOHN I' 4w Inilom •BPO W6 Torgot _mRn CRakmAcnos 19Q P"tj W.Ir, n ArpqM n Is 4W MOO MO Roll Gig -TIN orim 3 IaarlUe Diner 13 0� wwo "a so, 640 Md "age "Im Post Control Materials Used EPA 41.0.0 ' TIC CIC A0190RI am 14 Anse 1JDj6o, Ames 0 P,&Wphq A415 0P4.NiRoomi , f3exwIcips"Imi 0 LaWoo*W NOR' Q L*Wft 13"WOWSOW DD nl,euenaanaeenrn maY aro PAID r 0 t o:r 1:1 u L . . . . . o . "'k UNRESOLVED PROBLEMS? 6I CALL 1-860-TERMINIX (1.800-837-6464) 11.1 1"ARAINW42 P.ADV Cofflb'A�ij as am, MONR A.A..01 09.SNAGan F,ULV Poonosomkommkort E3v- OR. 110 00 A In't 1,zix Chargc... PAID r 0 t o:r 1:1 u L . . . . . o . "'k UNRESOLVED PROBLEMS? 6I CALL 1-860-TERMINIX (1.800-837-6464) 11.1 1"ARAINW42 P.ADV 03/04/2010 08:06 ••r'r'ca�c 7812310407 }F InterlorAressPeste 4 Om O Offices _- L tobby/PubllcAroaP '^ G tl OoceelonelInlroderouDt�`r •". '''1&.Rote' .E. Wet Mese. M Cloak, O'EnhyWays IrlP A` 7 PeVollmollt ansa ��''. t}Aeaf/Coeker Rooma � .37_ O Janitor Closets '�,=�L" O Laundry' 1e. Stated Product r 0 Eloller/Furneco Room P Aipenttno Ante ' r,.,, ` UBtorage utility 1 apo! - 20." `a �`�' O Wareho0ee ' 10Ante 9esetnont }.`• `ClPatientRooms ` O ICU w...:Ylh..... elw. . O Linen S6mgs Rooms', O Kitchenett . O Nurses Stattohe y$, U Most Rooms ... , O Benquat/Mee %*Roof' PAULAKDSMAS %..,., .. _ .. 13 Other O 011ier ''I •.,( ' 001heP 51 KEN" K'Map Iplproperry Staet 9PHfvnoti Anti tl OoceelonelInlroderouDt�`r •". '''1&.Rote' .E. Wet Mese. M Cloak, 1'. Oeiirian Codkrooehoa' 2. Amenean Cockroaches 7 PeVollmollt ansa ��''. 12 Fiurding 9plilM Y 7 �' 1. ," `., G: Crease 0000"9115 on EqulDmonl 9. Oriental Cockroechea B. Mfe Mtb ta. Web-Bulkling 9p ly�y 1e. Stated Product r d. OutdoCockroaches w P Aipenttno Ante ' r,.,, 1a.13 R'od0ee 9pld era �'. 1 apo! - 20." `a 5.911vemeh 10Ante d5 Steck Wldowi SPftlaf {1. w...:Ylh..... elw. . A. DraU CbgpatllDlny - i riPepalUtlwA : B' feed Dabda lhklat Table p J kNeielbah C. Food Debrta On Sholf, - " K'Map Iplproperry Staet D. Food Debris Under Appliance'` L tlaeti Conteltuve.Need .E. Wet Mese. M Cloak, k4, HMvy:Du&VDIh Depoe, ,Orge"'+ik' , F-Gniosn Dopeslls on Floor N I%Wi mue Cobwe Pr G: Crease 0000"9115 on EqulDmonl 0 Repek`FlooryT M II.' Somd,,04as Leh Over MgM R Seel HoiasfCrec!d((n W COrnrtlenb : {1. I � N Ip ..� Yl tlti r , 2. 3 Seelf,derlol.Crne ales M. Mbrouri%MPW Lights WNde uil T him Buk7iab5 nchaa �esp�� Koop Doors Cloaetl u Romow Pllef of r s ; CC,. Repair.DooUUMSr1l . d V Cut Tell Gra.,4M'eedo 'DD. R lace'goorWep}flereblPPm9 np °imp%ve,0uiaida Druinelp EE.` P Outdoor 9tocogo Prabt;cas ,,;, X In.,tpil OraJel Folnitlnllbn;Bem.A, FF'„ ghat At rh t ytte �, d r wrY�n', V try Iw. r(' 7111''fr^� n 1 r 1"„F 1 - yi y . f:errrr gtA-4 1 t Ily i't.Wtrl�1� i t 145A., !rye rl w 41 'MRJ4"F�aJ6:I e. Jiiw °I Y L. 1 r' � WT. G II��... I Commonwealth of Massachusetts •r City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: File Number: BHF -2003-000015 LOCATED AT: Strega 94 Lafayette Street Salem. MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0085 Jan 4, 2010 Dec 31, 2010 $280.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $280.00 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR DAVID GREENBAum, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 FAX (978)745-0343 DGREENBAUM&ALEM. CONI 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Presu--A E417exni/",67NT 7AIc TEL # P79-751/--000 �l ADDRESS OF ESTABLISHMENT 951 LAF.4 d&r_ y��__afM FAX# 9'P- 7y/-OPoy MAILING ADDRESS (if different) EMAIL - Business': L/NDA (* DXE69 r&ft6 , L1-11 Website: Ue OWNER'S NAME ^Zz&l C�k//dCG�O TEL# ADDRESS GDLL// rT r,91m %%B 0/P90 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE TEL #. DA1 SggFkOPERAT.IQN, t tvlonday !; 'Tuesday,,, m ki�Wedbesday „ rn'"G'Th *rs W, "daNSaturday�t�Sundaje ' HOURS OF OPERATION Please write in time of day. j f . For example Ilam -11 pm i ! TYPE OF ESTABLISHMENT RETAIL STORE YES NO (Outdoor Stationary Food Cart BED/BREAKFAST/ FEE (checkonly) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 less than 25 seats $100 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT (such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be sub fitted to and approved by the Salem Board of Health. Pu uant to MGL apter 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 retults and plaid allat required under the law. n pa�� td -t�/_ o�P Ot-OG7sPdf Date Revised 424/01 FOODAP2008.adm Check# or city of ,Salem, Massachusetts Fire Department vavirC4N Cod 48 Laffayette Street Cody Fire 2revention Bureau Chief SaCem, Wassachusetts 01970-3695 29 Tort Avenue 978-744-6990 Te(978-744-1235 Te[978-745-7777 dcody@safem.com Ta.7C978-745-4646 T'ax978-745-9402 VIOLATION NOTICE Strega Restaurant 094 Lafayette Street Salem, MA 01970 Monday October 19, 2009 An inspection of your facility on Friday October 16, 2009 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on TO BE DETERMINED at / / If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code _ -_ Article Division Page Count 10.17.1 occupancy load posting 10.17 1 0 0 1 - Certificate of Inspection not posted as required. 2 - Maximum Occupancy per Certificate 98 persons. Actual count 184 persons. General. (a) Scope. The decoration, operation or use of places of assembly and education shall comply with the applicable requirements of 527 CMR 10.00 and 21.00 and 780 CMR. (b) Permit required. A place of assembly or one for educational use shall not be maintained, operated or used as such without a Certificate of Inspection from the building code official. (c) Posting of occupant load. Each place of assembly or education shall be posted with an approved legible sign in contrasting colors conspicuously located near the main exit from the room or space stating the number of occupants permitted within such space. The number of occupants permitted shall be determined by 780 CMR. Assembly rooms or spaces which have multiple use capability shall be posted for all such uses. The�1� jp�-�psponsible for installing and maintaining such signs. �� t U 10/19/2009 16:25 OCT 2 2 2009 -SEM Page 1 BOARD OF HEALTH city of Salsa Massachusetts 2t � £ Fire Department David W. cod 48 Gaffayette Street y Salem, 911assachusetts 01970-3695 Fire 9 'Forttion Bureau chief29 Fort Avenue 978-744-6990 Te[978-744-1235 TeC978-745-7777 dcody@saiem.com 'FaX978-745-9402 Fax 978-745-4646 VIOLATION NOTICE Strega Restaurant 094 Lafayette Street Salem, Bea 01970 Monday October 19, 2009 (d) Overcrowding. No person shall permit overcrowding or admittance of any person beyond the established posted occupant load of any place of assembly or education. The head of the fire department, upon finding overcrowded conditions or obstruction in aisles, passageways or other means of egress, or finding any condition which constitutes a hazard to life and safety shall cause the performance, presentation, spectacle or entertainment to be stopped until the area posted occupant load is re established or the obstruction or hazardous condition is removed. lloran, Jr., Charles R nspector CC: Chief David Cody Salem Building Dept. Licensing Board Salem Board of Health File Occupant/Owner 10/19/2009 16:25 Page 2 Commonwealth of Massachusetts ` City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/12/2009 , ESTABLISHMENT NAME: File Number: BHF -2003-000015 LOCATED AT: Strega 94 Lafayette Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0373 Jan 12, 2009 . Dec 31, 2009 $280.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $280.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. --In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 J � t -Jan'08:09 083 st, ,u1 , KWWULEY DWSCOLL MAYOR ijANu DIONNE, A&M HEALTH AGENT t:O . �IIr a1� rr} x�'rf AT i.. ��;�i75i1"'€inn: ADDRESS OF ESTABLISHMI MAIUNG ADDRESS (ifdiftenint) EMAIL -Bu OWNER'S Scott BOH t 978 745 0343 CITY OF SALEM, MASSACH.USFITS BOARD OF HEALTH 120 WASHINGTON SMI in', 4c' FLO()R I EL. (978) 741-1800 FAx (978) 745-0343 1010NNe a <.al.rinr. COM 9'y tAr- P. 3 k:1 PER11AhT�TQ OPERATE A� FOOD ESTABLISHMENT E n".'1 ,. TF �� 714I �Q . �, � �►. FAX 09It -�q 1 cog o� J,.v,s: CERTIFIED FOOD MANAGER'S NAMES) CERTI FICATE#(S) _ (Required in an establishment where ppte *dy hazardous food's prepared) EMERGENCY RESPONSE PERSON L BGG Lei HOME TEL # g DAYS OFOPBtA' ON M T W ThFrldavSaWalryStn •F�rj"UFt§OFOpERATION -- I Please wde IntMe of day. Foreaan nam-npm r 5 .�C TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES0 less than 1000sq.ft =$70 1000-10.000bq,ft. =$280 marc than 10,000oq.tt. =$420 RESTAURANT YES I NO less than 25 seats r4liz (Outdoor'ii Stallonary Food Cart 521 25-99 seats 280 more than 99 seats ............--------------------- -------------------------------.................---------�--------•---------------------------------- BEDBREAFCFASTI YE5 NO $100 ~Wig N1HIL r9rm"l1y MAKE (notjust serve) ICE CREAM, YOGURTISOFT SERVE YES $25 TOBACCO VENDOR YES $135 AU NON-PRORT (such as church kitdtens) YES O $25 *Please pay total with one check payable to the City of Salem. This Permit Is not transferable and must be reissued upon change of ownership, The Permit must be posted in a prominent location In the Establishment In accordance with the State Sanitary Code, before any renovadons, Improvements, or equipment changes are made, all plans for Su h must be sutan ed to aria approved by the selene Board of Health. P rsuant to MGL C er 6 AIK I certify under the pairs and penalties of perjury that I, to my beat knowledge and belief, have tiled all State tax rete *and 'd all t required oder the law. ►-8-07 03 q,3,6615L Signal=, IDate Social Security or Federal Identification Number aevised 4/14/07 F00VAP7*9.sdm Ch,ske&Dum—U.(AILO 1 /bGU 1 s Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4t" Floor Salem, Iv1A 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Datd Type of Operation(s) Type of Inspection / ( El Food Service ❑Retail ❑Routine El Re -inspection Address i" Ri _ El 13. Handwash Facilities Level ❑ Residential Kitchen Previous Inspection Telephone )` ""�' ! 15. Toxic Chemicals ❑Mobile '❑ Temporary Date: ❑ Pre-operation OwnerHACCP Y/N V CCca El16. Cooking Temperatures ❑ Caterer r ❑ Bed 1, Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time In�j Inspector out. - S Permit No. El wall .Laa.lull cnecneu requires an expiananon 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. t FOOD PROTECTION MANAGEMENT -, - _ 142. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties _ ' EMPLOYEE HEALTH _ El 13. Handwash Facilities ., 'F-:. ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS' El 14. Approved Food or Color Additives ❑ 3. Pefsonnel with Infections Restricted/Excluded ` " ' "_`" ` ' ""�' ! 15. Toxic Chemicals FOOD FROM APPROVED SOURCE ° - ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) E]5. Receiving/Condition El16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans `PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection :29. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate H hing ❑ 11. Good Hygienic 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. , N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils ' (FC -4)(590.005). 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S: 59JInspecfFO I4. d. Inspector's Signature: PIC's Signature: Print: Print: ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) .e 21. Food and Food Preparation for HSP NSUMERADVISORY.. 22. Posting of Consumer Advisories Number of Violated Provisions Related ,,Yo Foodborne Illnesses Interventions Y 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"Q,_ �0i of a Violations Related to Foodborne Illness Interventions and Risk Factors (items 9-22) FOOD PROTECTION MANAGEMENT 1 590.(J03tA) Assignment of Responsibility* i 790.003(B__) DemanstrationofKnowledve*_ -1 ?.-103. t 1 Person mcharge -duties EMPLOYEE HEALTH IN in 590,003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-20113 fluid Milk and Milk Producis* a �licants* Shell 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinkin * Water* Applicant To Report To The Person in Drinkin Water from an A roved S stem` Bottled Drinkin Water* 590.006(B) Charge* 590.00.3(G) Re orcin b Person in Char e* 3 590.003(D) Exclusions and Restrictions, T,590 -003(17,) Removal of Exclusions and Restrictions IN in * Denotes critical item in the federal 1999 Fox] Cocteor 165 CMR 590 000- ,+" PROTECTION FROM CONTAMINATION 13 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetical) Sealed Container* 3-20113 fluid Milk and Milk Producis* 3-202.13 Shell 3_202.14 Fogs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinkin * Water* 5-101.1.1 590.006(A) Drinkin Water from an A roved S stem` Bottled Drinkin Water* 590.006(B) Water Meets Srandards in 310 CMR 22.0" Shellfish and Fish From an Approved Source 3-201.14 3-201.15 Fish and Recreationally Caught Molluscan Shellfish* Molluscan Shellfish from NSSP Ui tod Sources* Game and Wild Mushrooms Approved by Reaulatort, Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms" 3-201.17 Game Animals* Receiving/Condition 3=202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Inte grit ; 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification 3-203.12 Shellstock Identification Maintained' TagslRecords: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records- Creation and Retention* 590904(7) Labeling of Ingredients' Conformance with Approved Procedures IHACCP Plans 3-502.11 S ecialized Processing Methods* 3-502.12 Reduced ox'�an acka'in�, criteria'" 5-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Fox] Cocteor 165 CMR 590 000- ,+" PROTECTION FROM CONTAMINATION 13 Cross -contamination 3-302.11(A)0) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animd Foods Separated from Each Other' Contamination from the Environment 3302.11(%) Food Protection* 3-302.15 Washing Fruits and Ve stables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(.B) Returned Food and Rescmcc of Food" Disposition of Adulterated or Contaminated Food 3-701-11 Discarflng or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.111 Manual Warewashine - Hot Water Sanitization Temperatures * 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures*- 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-60 L 11(A) Equipment Food Contact Surfaces and Utensils Cleao* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils't 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of E ni ment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anus* 2-301.-1.2 Cleatune Procedure* 2-301.14.-_ When to Wash* L1 " ,Good Hygienic Practices ' 4 2-40f 1I I "Eating, Drinkinlg or Usin Tobacco* 2-401.12„ ) Discharges From the Eyes, Nose and -`., Mouth* 3-301.12 Preventin Contamination tVhen Tustin" ]2 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 Ca aekies* 5-204.11 Location and Placement* 5-205.11 Accessibility. 0 aeration and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 Handwaqhing Cleanser, Availability 6-301.1.2 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: / Date: � j— Page:of tem Code c- Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Irate IN Reference R —Red Item - _ Verified c rry ,ami /: � -r-j n r a 1 A f n L r, _ h/_ I h/ A/o Lj_ �l��,.. , I ��-ELI SQlViIIIZ ®9=01�� J Discussion With Person in Charge: have read this report, have had the opportunity to ask questions and agree to correct all Corrective Action Required: ❑ No Yes o voluntary Compliance o Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to P �� G ^c -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo o Emergency Closure your food permit. e .( I ❑ Voluntary Disposal ❑ Other: V Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) ' PROTECTION FROM CHEMICALS 14 0 '' Denotos critical nein'n the federal 1999 Food Code or 105 CbIR 592000, Food or Color Additives r _ 3-202,12 Additives'' 3-302.10. Protection from U -- ,,--a Additives* 19 Poisonous or Toxic Substances 7-101.11 Identitving Information - Original Containers' 7-102.11 Common Name - Working* Containers* 7-201.11 Separation - SmraRc* 7-202.11 Restriction - Presence aid Use* 7-202.12 Conditions of Use* 7-20311 Toxic Containers - Prohibitions"` 7-204.11 7-204.12 Sanitizers. Criteria - Chenucals* Chemicals for Washing Produce,Criteria" 7-204.14 Drvina A cuts. Criteria" 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides Criteria* 7-206.12 7-206.13 Rodent Bait Stations" Tracking Powders. Pest Control and Monitoring* '' Denotos critical nein'n the federal 1999 Food Code or 105 CbIR 592000, Proper Cooking Temperatures for PHFs Received at Temperatures According to Law Cooled to 41" F)45'F Within 4 Hours. PHFs 3-401.11A(l)(2) Eggs -.._1.55°F 1.5 Sec. 19 E , - hrmaediate Service 1457-15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(B) 590.004(F) Animals - 155'F 15 sec. * 3-401.1 l(B)(1)(2) Pork'. and Beef Roast -130'F 121 min* 3-401.1l(A)(2) Ratites, Injected Meats- 155'F 15 3-501.16(A) sec. * 3-401.1.1(A)(3) Poultry, Wild Game, Stuffed PRFs, Time as a Public Health Control Stuffing Containing Fish, Meat, 3-501.19 Poultry or Ratites -165'F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks Variance Re viretttent 145-F * 3=401.12 Raw Animal Foods Cooked in a Microwave 165'5 3-401-11(A)(1)(b) All Other PHFs -145°F15sec- ' Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 su. 3-403.11(H) Microwave- 165° F2 Minute Standing Timex, 3-403.11(C) Commercially Processed RTEFood - 140°F* 3-40311(E) Remaining Umliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHF& from 140'5 to 707 Within 2 Hours and From 70°F to 41'F145'F Within 4 Hours. 3-501.14(B) Cooling PI-IFs Made From Ambient Temperature Ingredients to 41'F145'F Within 4 Hours* '' Denotos critical nein'n the federal 1999 Food Code or 105 CbIR 592000, 21 3-501.14((5) PHFs Received at Temperatures According to Law Cooled to 41" F)45'F Within 4 Hours. 590.000 3-501.15 Castile, Methods for PHFs 19 3-801.11(D) PHF Hot and Cold Holding Food and Food Protection 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41%45°F* 25 26. 3-501.1 (A) Hot PHF, Maintained at or above 14WE'. 005 3-501.16(A) Roasts Held at or above 130'F. 20 .007 Time as a Public Health Control Poisonous or Toxic MaterialsFC 3-501.19 Time as a Public Health Control* 29. 590.004(H) Variance Re viretttent 21 3-801.11(A) Unpastcanzed Pre: -packaged Juices and Beverages with WnrninelAbel, 590.000 -3-801,11(B) Use of Pasteurized'Eg1*s* FC - 2 3-801.11(D) Raw or Path ally Cooked Animal Food and Raw Seed S gouts Not Served. 'x Food and Food Protection 3-$01.1 l (C) Unopened Food Package Not Re -serves(. CONSUMER ADVISORY 22 3-603.1 I Consumer Advisory Posted for Consumption of 590.000 23. Anitual Foods That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate - Food and Food Protection FC - 3 PathnRens.* 25 26. 3302.13 Pasteurized Eggs Substitute for Raw Shell 005 27. Eggs* 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 ff.19 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Critical and non-critical violations, which do not relate m the ,foodborne, illness interventions and riskf actors listed above, can be. foerad in the J611mhhtg sections cif the Food Code and 1045 CMR .590.000 Item Good Retail Practices_ FC 590.000 23. Mans ement and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25 26. Equipment and Utensils Water, Plumbin and Waste FC 4 FC -5___006__ 005 27. Physical Facility FC -6 .007 28. Poisonous or Toxic MaterialsFC - 7 .008 29. S ectal Re uiroments - .009 30. _ _ Other I ooNrh,a ;63.Jrm CITY OF SALE � { BOARD OF HEALTH J Establishment Name: 1 lQ�YJ Date 19 Pager of Item No. Code C - Critical Item Reference R — Red Item V DESCRIPTION OF VIOLATION / PL4N OF CORRECTION PLE SE PRINT CLEARLY Date Verified J oo -kmhy 3 •ioa.i r 7ro U. i 1A/ l i GNl M'd • t>rrr Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions.and agree to correct all violations before the next inspection, to observe all conditions as described, and to P comply with all mandates of the Mass/Federal Food Code. I understand that .noncompliance may result in daily fines of twepty-five dollars or suspension/revocation of your food permit. /// /� i Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Rdstriction / Exclusion o� e -inspection Scheduled ❑ Emergency Suspension ❑ Embargo L] Emergency closure ❑ Voluntary Disposal ❑ 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 Additives` FC -2 3-342.14 Protection from Unairoved Additives* 15 7-101.11 Poisonous or Toxic Substances Identifying Information - Otigural Containers" 3-401.11(B)(1)(2) 7-102.11 CommonName- Workin-,Containers' Raines, Injected Meats -155°F 15 7-201.11 Sc aration-Storage* 3-461.11(A)(3) 7-20111 Restriction - Presence mod Use` Stuffing Containing Fish, Meat, 7-202.12 Conditions of Use, 3-401.11(,C)(3) 7-203.11 Toxic Containers - Prohibidons;* 145'F * 7-204.11 7-204.12 7-204.11 Sanitizers.Criteria - Chemicals* Chemicals for Washin¢ Produce, Criteria* Dtvin A tots. Criteria" 7-205-11 Incidental Food Contact. Lubricants* A(1 Other PHFs -- 145'F 15 sec. 7 246-7 1 Restricted Use Pesticides. Criteria* 3-403.11(A)&(ll) 7-206.72 1 Rodent Bait Stations* Microwave- 165'F 2 Minnte Standing 7-206,13 Cracking Powders, Pest Control and Monitoring^ 16 17 18 r Denotes critical item to the Ueral 1999 Focal Code or 105 C61R 590.000. Proper Cooking Temperatures for PHFs Received at Te rperatnras According to 1.aw Cooled to 41'F145'F Within 4 Hous. Coaling Methods for PHFs PHFs _3-401.11A(1)(2) Eggs- 155`F 15 Sec. FC -2 E ges- Imntediate Service 145°Pl5see* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Annuals - 155'F 15 sec. s 3-401.11(B)(1)(2) Pork and Beef Roast - 13WF 121 min* 3-401.11(A)(2) Raines, Injected Meats -155°F 15 - sec. 3-461.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control* Stuffing Containing Fish, Meat, 590.004(H) 22u�s-165°.F IS sec. 3-401.11(,C)(3) Whole -muscle, Intact BaefSterAs 145'F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401.11(A)(1)(b) A(1 Other PHFs -- 145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(ll) PHFs 165'F 15 sec. ;_ 3-403.11(B) Microwave- 165'F 2 Minnte Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F 3-403.1,1(E) RennabtingUnslicedPorton"IfBeef Roans' Proper Cooling of PRFs 3-501.14(A) Cooling Cooked PHFs front 140'F tp 70'F Within 2 Hours and From 70'F to 41'F145'F Within 4 Hours. 3-501.'14(3) Cooling PHFs Made From Ambient Temperature Ingredients to 41'5'45'F Within 4 Hours* r Denotes critical item to the Ueral 1999 Focal Code or 105 C61R 590.000. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 '1-50 L 14(C) 3-501,15 PHFs Received at Te rperatnras According to 1.aw Cooled to 41'F145'F Within 4 Hous. Coaling Methods for PHFs ly 3-801.11(B) PHF Hot and Cold Holding FC -2 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41V450 F" Food and Food Protection 3-501.16(A) Ilot PHFs Maintained at or above 140'F. * 25. 3-501.16(A) Roasts Held at or above 130'F. 2g 26. 27. Time as a Public Health Control FC - S FC - 6 3-501.'(9 Time as a Public Health Control* _ _ Poisonous or Toxic Materials 590.004(H) Variance Requirement_ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Bevel aaes with Warning Labels* 590.000 3-801.11(B) Use of Pasteurized Eggs* FC -2 3-801.11(D) Raw or Partially Cooked Animal Fond and Raw Seed Sprouts Not Served. ,x Food and Food Protection 3-8o1.11(C) Uno.enedFoaiPackageNotRe-served:" aragURMADDEMEM 22 1 3-603.11 Consurner Advisory Posted for Consumption of 590.000 23. Animal Faods `that are Raw, Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC -3 Path O "ens.* Eff"'.+niena1 25. 3-302.13 Pasteurized Eggs Substitute For Raw Shell .005 26. 27. E s* 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 retait practices should be debited under /J29 - SpecialRequirements. (items 23-30) Cnil(al and non-critical violations, which do not relate to the foodborne illness interventions and risk faders listed above, can be found in the following sections of the Food Code and 105 Ctfi? 590.000 Item Goad Retail Practices rFC 590.000 23. Mena emenq rand Personnel,..__._ FC -2 .003 24. Food and Food Protection FC -3 .004 25. Ecluiment and Utensils FC - 4 .005 26. 27. Water, P_lumbin and W erre Ph sical Facility_ FC - S FC - 6 006__ _ .007 28. _ _ Poisonous or Toxic Materials FC -7 '! .008 29. Re uirements 1 .009 30 _Strial _ Other isy,n[:,m,nons.z.�m� Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED. 01/08/2008 ESTABLISHMENT NAME: File Number: BHF -2003-000015 LOCATED AT: IGmberley Driscoll Mayor Strega 94 Lafayette Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2008-0317 Jan 7, 2008 Dec 31, 2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2008 Board of Health �f 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 8 of 14 KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4'1 FLOOR 'ISL. (978) 741-1800 FAX (978) 745-0343 Fa E C ;®, a D ISCOTTaSALEM. COM DEC 7 -2007 CI I Y Ot= SALEM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT St W(:54 C�� (s .✓tom r+�� TE°l # �t 'W(:5 ADDRESS OF ESTABLISHMENT - r pTyl FAX # G l 7 � ]�J( - 0Op6 q MAILING ADDRESS (if different) 1 EMAIL - Business': 1 If 1 ozn ax OWNER'S NAME h ADDRESS STREET CERTIFIED FOOD MANAGER'S NAM (Required in an establishment where potent EMERGENCY RESPONSE PERSON_ DAYS OF OPERATION Monday HOURS OF OPERATION Please write in tme of day. 5 . Ll TYPE OF ESTABLISHMENT RETAIL STORE YES NO - - ........... RESTAAN URT YES NO (O-utdoor S+aticnary Food Cart $21 1 Y�1 ---"--'-------------- ----' -------------------- ----. -....... BED/BREAKFAST/ YES NO CHILDCARE SERVICES -------------------- --- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) CITY WWW TEL # STATE (� ZIP CERTIFICATE#(S) -OME TEL #9 Friday Saturday Sunday FEE (check on] less than I000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------ ------------------------ less than seats =$ 25-99 seatsis 7"873 -to more than 99 seats = 420 $100 ------------------------------------------- YES NO $25 YES NO $135 YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pu suant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have fled all state tax retuand id all stat gmred under the law. Is � lI-7.g 0 0& 2,6 Date Security or Federal Identification Number -----------------------------------------j--7----------------- ------ Revised 4/24/07 FOODAP2008.adm CheM & Date S;e(:p/8 04/02/07 MON 17:24 FAX g J i 4 F COVER SHEET,' Yo`O A.C.O. DONALD FAMICO 6A SALEM POLICE DEPARTMENT f. P.O. BOX 390. SALEM, MASSACI40SETTS (978) 744-0171 X121 FAX(978)744-5325 .w NOTICE OF CONFIDENTIALLY THE DOCUMENT ACCOMPANYING THIS FACSIMILE CONTAINS INFORMATION FROM THE SALEM POLICE DEPARTMENT WHICH MAY BE CONFIDENTIAL AND/OR PRIVILEGED. THE INFORMATION IS INTENDED FOR USE BY THE INDIVIDUAL OR ENTITY NAMED ON THIS COVER SHEET. IF YOU ARE NOT THE INTENDED RECIPIENT, BE AWARE THAT DISCLOSURE ,COPYING OR DISTRIBUTION OR USE OF THE CONTENTS OF THIS TRANSMISSIONS IS PROHIBITED, IF YOU HAVE RECEIVED THIS FACSIMILE IN ERROR, PLEASE NOTIFY US BY TELEPHONE IMMEDIATELY. AGES SENT INCLUDING THIS COVER SHEET DATE FROM %je .J TO SUBJECT .2 Alae Ar 7-w PA 8vT" �'�• �1, /1cTi:.. ��.l7tq R l wdk�f C to /J�9� �� I/0FTrif /.ii VK S i%vi R1 NOTICE OF CONFIDENTIALLY THE DOCUMENT ACCOMPANYING THIS FACSIMILE CONTAINS INFORMATION FROM THE SALEM POLICE DEPARTMENT WHICH MAY BE CONFIDENTIAL AND/OR PRIVILEGED. THE INFORMATION IS INTENDED FOR USE BY THE INDIVIDUAL OR ENTITY NAMED ON THIS COVER SHEET. IF YOU ARE NOT THE INTENDED RECIPIENT, BE AWARE THAT DISCLOSURE ,COPYING OR DISTRIBUTION OR USE OF THE CONTENTS OF THIS TRANSMISSIONS IS PROHIBITED, IF YOU HAVE RECEIVED THIS FACSIMILE IN ERROR, PLEASE NOTIFY US BY TELEPHONE IMMEDIATELY. AGES SENT INCLUDING THIS COVER SHEET CHIEF OF POLICE ROBERT M. ST. PIERRE April 2, 2007 Ms. Linda Cappuccio 6 Holly Street Salem, MA 01970 Dear Ms. Cappuccia: After careful review of police reports 4444693 and #470963 regarding incidents on June 4, 2006 and March 13, 2007 involving your dog named "Gina Bear" (a chow/chow) being kept by you at 6 Holly St. and 94 Lafayette St. Strega Restraunt, and having knowledge of the dog's disposition, in accordance with City Ordinance Chapter 8, Section 8-66/8-77, I must at this time declare the dog as being "dangerous" to the general public. Therefore; you must comply -with the attached city ordinance as it relates to dangerous dogs immediately; specifically, your property must be posted and the dog must be muzzled at all -times when off your property or when unattached on your property also when and if your dog accompanies you to work at the Strega Restraunt you must comply with all regulations of the Salem Board of Health regarding animals in a food establishment, If any additional time is necessary, please contact me at (978) 744-0171, ext. 121, so we may discuss the matter. Donald R. Famico (/ Animal Control Officer DRF:cc Attachment CC: Joanne Scott, Salem Board of Health SALEM POUCE DEPARTMENT • 95 MARGIN STREET • SALEM. MASSACHUSETTS 01970 • 978/744-2204 MON 12:29 FAX CHIEF OF POLICE ROBERT M. ST. PIERRE (fitp of 6atem, Volire 3epartrrte Ms. Linda Cappuccio 6 Holly Street Salem, MA 01970 Dear Ms. Cappuccio: After careful review of police reports #444693 and #470963 regarding incidents on June 4, 2006 and March 13, 2007 involving your dog named "Gina Bear" (a chow/chow) being kept by you at 6 Holly St. and 94 Lafayette St. Strega Restraunt, and having knowledge of the dog's disposition, in accordance with City Ordinance Chapter 8, Section 8-66/8-77, I must at this time declare the dog as being "dangerous" to the general public. Therefore, you must comply with the attached city ordinance as it relates to dangerous dogs immediately; specifically, your property must be posted and the dog must be muzzled at all times when off your property or when unattached on your property also when and iryour dog accompanies you to work at the Strega Restraunt you must comply with -all regulations of the Salem Board of Health regarding animals in a food establishment. If any additional time is necessary, please contact me at (978) 744-0171, ext. 121, so we may discuss the matter. Donald R. Famico Animal Control Officer DRF:cc Attachment CC: Joanne Scott, Salem Board of Hearth, SALEM POLICE DEPARTMENT • 95 MARGIN STREET • SALEM, MASSACHU5ETT5 01970 • 978/744-2204 002 04/09/07 MON 12:29 FAX Z001 0"OV R SHEET �t ; A.C.O. DONALD FAMICO SALEM POLICE DEPARTMENT P.O. BOX 3905. SALEM, MASSACRUSETTS (978)744-0171X121 FAX(978)744-5325 DATE 7.1 FROM JDA TO �AIoi SUBJECT 150 NOTICE OF CONFIDENTIALLY fHE DOCUMENT ACCOMPANYING THIS FACSIMILE CONTAINS INFORMATION FROM THE SALEM 'OLICE DEPARTMENT WHICH MAY BE CONFIDENTIAL AND/OR PRIVILEGED. THE INFORMATION S INTENDED FOR USE BY THE INDIVIDUAL OR ENTITY NAMED ON THIS COVER SHEET. IF YOU_ SRE NOT THE INTENDED RECIPIENT, BE AWARE THAT DISCLOSURE ,COPYING OR DISTRIBUTION OR USE OF THE CONTENTS OF THIS TRANSMISSIONS -IS PROHIBITED. IF YOU- - iAVE RECEIVED THIS FACSIMILE IN ERROR, PLEASE NOTIFY US BY TELEPHONE IMMEDIATELY, AGES SENT INCLUDING THIS COVER SHEET 09/09/07 MON 12:30 FAX 04/09/07 12:30 v5.5n shift. B SALPM POLICE DEPARTMENT INCIDENT REPORT date: 04/09!07 MONDAY ,t••s-Fta+ +`azar .. C 440 ANIMAL CONTROL -DOG COMPLAINT 1=:08 * 94 LA'FAYETTE ST SAL *iDr: 1: 443 2. 4411 473191 * PAST" DOG ELITE az. ID #: 2i407 ALARM #: 21407 Invo: CAPPUC'CIO, LINDA J B HOLLY SALEM,MA 0197ki Vic: HA7.ELL, COREY 8 LINDEN ST MARBLEHEAD.NA 01949 2003 ,AGE: 1 T'"TYRO53 -70`' org/1st ##rev*clr* 440.-4,40 l 705-705 05ii4/56 034-36751- 05/22/79 officer's signal;ure---___dyte_.-.__ L call-back# (978) 741-0004 l+r COMMENTS �r## 20 SAL MARCH 18, 2007 MARBLEHEAD ANIMAL INSPECTIONAL.. SERVICE 705- 20 SAL RECEIVED IN ERROR A DOG BITE: REPORT FROM NORTH SHORE 705- 2:0 SAL MEDICAL FOR THE ABOVE COREY HAZELL, SEVERAL DAYS PASSED 705- 20 SAL AND THE REPORT" WAS FORWARDED TO SALEM FOR FOLLOW UP. 705- 2.0 SAL I SPOKE WITH MR COREY-HAZELL AND HE RELATED THE F=OLLOWING 705- "x'0 SAL INFORMATION. AFTER WORK HOURS HE: WAS SITTING CUT FRONT AT 705- 2.0 SAL THE BAR AND GOT OFF THE STOOL -NOT -KNOWING THE DOG WAS 705- 20 SAL- LAYING DOWN ON [HE FLOOR AT HIS REAR HE STARTLED THE DOG 705- _0 SAL IN SOME WAY AND ,THE DOC BIT HIM ON THERIGHTCALF. 705-- r.20 SAL. MR HAZELL STATED THE DOG IS OFTEN LOOSE INSIDE THE STRF60, 705--- 2 0 SAL RESTAURAUNT Af'IER HOURS -AND -HAS BITTEN OTHER EMPLOYEES !N 705-, 2041 SAL I"HE PAST BUT NOT REPORTED. 705- 20 SAL THIS DOG"LINA BEAR"A-CHOW WAS UNDER A 10 DAY QUARANTINE. AT 705-705 c0 SAL THE TIME OF THIS BITE :SEE: CASE: 47096.3. 705--705- 20 SAL EASED ON THIS LATEST I-NCIDENT I ISSUED A ORDER DECLARING 705- 20 SAL_ THE DOG AS DANGEROUS TO THE' PUBL.T.C. 70:x - officer's signal;ure---___dyte_.-.__ L Kimberley Driscoll Mayor April 17, 2007 Linda Cappuccio 6 Holly Street Salem, MA 01970 Dear Ms. Cappuccio, 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 In accordance with the Massachusetts State Food Code 105 CMR 590.6-501.115 Prohibiting Animals in a food establishment paragraph (A) "live animals may not be allowed on the premises of a food establishment." Therefore you are not allowed to have a dog on the Strega premises at any time whether the establishment is open for business or not. During an October 2005 inspection you were cited for violation of this Code. In addition, the Board of Health has received a report from Salem's Animal Control Officer that an employee states that you allow a dog on the premises after hours. Please be advised that continuation of this violation will result in a monetary fine and/or suspension of your permit to operate a food establishment. If you have any questions please call me at 978-741-1800. Thank you for your cooperation in this matter. ioanne Scott Health Agent Massachusetts. Department of P Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Heath Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name 33�Pr /1 ^ Date (C(-( T of O eration s T e ofins ection © outi a ❑ Re -inspection Previous Inspection Date: ElPro-operation ❑ Suspect Illness ❑❑ HGeneral ACCP Complaint ❑ Other Food Service EIRetail ❑ Residential Kitchen ❑ Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. AddressP Risk Level Telephone �/ _) [ L �O 1 t OwnerLi l Z)M �� ,r) p �,e i0 HACCP YIN Person in'Charge (PIC)' 1 Tim In: 0 Inspector �,A _P Each violation checked requires an Violations marked may pose an imminent he action as determined by the Board of Health. on the narrative page(s) and a citation (specific provision(s) violated. Non-compliance with: ntions and Risk Factors Anti -Choking Tobacco izard and require immediate corrective 590.009( E) ©590.009 (F) U� I FOOD PROTECTION MANAGEMENT '„i;r"".��" K 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 'FJFOOD FROM APPROVED ❑ 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 CONTAMINATIONI ❑ 8. Separation/ Segregation/ Protection ®' 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing [111. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection -"(FC-3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other - s, S. 5001nsp tFom 14.da ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities ';PROTECTION FROM CHEMICALS �E" ' ' � '' + � ,`� r i � g „�t n,. F.." ^i Ii F ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE CONTROLS (potentially Hazardous Foods) 711 'ii -o. -...f ��: .. .m ✓�...� da�, a.�_.._,-ate, :. , ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control r REQUIREMENTS FOR HIGHLY sUSCEPTieu POPULATIONS (MSP)" ❑ 21. Food and Food Preparation for HSP ECONSUMERADVISORY' . y,t,r i„1 ❑ 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,� -e. ,�A5� cnVl w 11 Inspector's Signatuf:�"a7>< .:k /1 ^ Print: �G� C G(�, �. PIC's Signature: Print: L I 1 N�� C _� Pagj of ?Pages r 1 Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 596.003(A) I Assignment of Res 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge duties�� EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require repotting by food employees and 3-20113 Fluid Milk and Milk Products* applicants* Shell Eggs* 590-003(F) Responsibility Of A Food Employee Or Art 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved S stem* 590.006(A) Charge, 590.006(B) 590.003(G) Re ordn b Pzrs m in Charee* 3 1 590.003(D) Exclusions and Restrictions* 7201.15 590.003(E) Removal of Exclusions and Restrictions 4 IN LE FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Ford Code or 105 CNIR 590.000. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-20113 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Fags and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved S stem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Was in Fruits and Ve etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 7201.15 Molluscan Shellfish from NSSP lasted Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shelistock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11. Food Safe and Unadulterated Tags/Records: Sheilstock 3-202.18 Shellstoek Identification 3-203.12 Shellstoek Identification Maintained* - Tags/Records: Fish Products 3-40111 Parasite Destruction* 3-402.12 Records, Creation and Retention" 590M04(J) Labeling of ingredients' Frequency of Sanitization of Utensils and Ford Contact Surfaces of Equipment* Conformance with Approved Procedures tHACCP Pians - 3-50111 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with ApRroved Procedures* * Denotes critical item in the federal 1999 Ford Code or 105 CNIR 590.000. PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302-11(A)(2) Raw Annul Foixls Separated from Each Other - Contamination from the Environment 3302.11(A) Food Protection* 3-302.15 Was in Fruits and Ve etables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice, of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Fond* y Food Contact Surfaces 4-501..111 Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashing- I-hx Water Sanitization Temperatures* 4-501..11.4 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) &luipmentFood Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 7702.11 Frequency of Sanitization of Utensils and Ford Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - HotWaterand Chemical* 10 Proper, Adequate Handwashing 2-301.11. Clean Condition - Hands and Anns4` 2-301.12 Cleaning Procedure* 2-30114 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2.401.12 Discharges From the Eyes, Nose and Mouth* 3-301,12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.0(4(F;) Preventing Contamination from En Flo ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-2174.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11. Hindwashing Cleanser, Availability 6-301.12 Hand Drying Provision C, Establishment BOARD OF HEAL Date: _-�>- \ C� -0 9 Page: cg-� of _'_�_ Item No. Code .Reference C -Critical Item R — Red Item :� DESCRIPTION OF VIOLATION / PLAN OF CORRECTION J, .. ;: .; �. ° �. - '^ PLEASES PB(HT CLEARLY s, a e '._ .Y - . Date Verified rnn C-_� ki� r AA )\ D \ Aln, - a v�k& \ rA t r - �' r P2 e- 165 c' c - �, - t rl3C, D 4zJ \D,-- Discussion Discussion With Person in Chargeaj) L Corrective Action4Required: L1 No es ❑ ❑ ❑ Voluntary Compliance Re -inspection Scheduled Embargo Voluntary Disposal ❑ ❑ ❑ ❑ Employee Restriction / Exclusion Emergency Suspension Emergency Closure Other FORM 7348 (REV. 7/2000) HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 TIME/TEMPERATURE CONTROLS 16 Food or Color Additives__ 3-202,12 Additives* 3-202.14 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 Se aration - 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 16 PHFs Received at Temperatures According to Law Cooled to 41*F/45°F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(B) PHFs 3-501.16(B) 590.004(F) 3-401.11 A(l)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°F* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(8)(1)(2) Pork and Beef Roast - 130°F 121 Min.* Physical Facility 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 Sec.* 28. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .008 29. Stuffing Containing Fish, Meat, .009 Poultry or Ratites - 165*F 15 Sec.* Other 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs -145°F15Sec.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave - 165*F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 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 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 20 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 PHFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41*F/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 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(B) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 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 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* ERecri- 11112101 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* neuutnemery t b 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 (Blue Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 CMR 590.00. Item Good Retail Practices FC 590.00 23. Management and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25. Equipment and Utensils FC - 4 .005 26. Water, Plumbing and Waste FC - 5 .006 27. Physical Facility FC - 6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. Special Requirements .009 30. Other BOARD OF HEALTH Establishment Name: Date: d Page: of nem Code C-Cancel Item s & DESCRIPTIpN OF VIOLATION / PLAN OFCORRECTION Date Nom =4Refererce R=Red Item - '• '.'' ` = ` ' - %?. z-Verified 2. PLfASE PAINT MEARLV� I rJ 0 c' 7_77-C, Discussion With Person in Charge: corrective Action Required:❑ No ❑ Yes a^ ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ^ ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other F(1RM 7i6R /RFV .+. r J� n lj. !o. -O..- .!. >., Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name C 3 \ _ IDate� c 1 U".V -0 T e of 0 erasion s Tvoe of Inspection &Routine ❑`Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness ❑ General Complaint ❑ Other WFood Service ❑ Retail ❑ Residential Kitchen ❑ Mobile ElTemporary ❑ Caterer ❑ Bed & Breakfast Permit No.0� Address -A �; _ e � u w li P Risk Level, Telephone !, , Y ,\ OwnerV 1 �' rf✓-; t7�{ (GAJ HACCP Y/N Person in Charge (PIC) Time In:❑HACCP Out: Inspector �Jb �t f7 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) ❑i action as determined by the Board of Health. ty FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned / Knowledgeable / Duties ❑ 13 Handwash Facilities 8 W W A`U{w9LLUM CvtiN'° "9,F m9'9 "EMPLOYEE HEALTH ' � P .k? .i';-:, . �. ..,-. a ! t..,;;,.zn 4' `PROTECTION FROM , x ❑�2. Reporting of Diseases by Fo+od Employee and PIC •>AQr� ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded a FOOD FROM APPROYEb SOURCEm, ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition �X 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION"" "; p Y ,❑ Separatioh/ Segregation/ Protection Ly\ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C. ,N. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) ❑ 15. Toxic Chemicals TIME/TEMPRATURE CONTROLS (Pbterdraiiy Haiardous Foods)"' ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control 'REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIDNS (HSP)"" ❑ 21. Food and Food Preparation for HSP :.CONSUMEIADYISORY,'»»,,.�{;,'a��,,.`.".,t,a„w„"`y„,®` El 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 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE -INSPECTION: sssoio� fFoo-ia.eoo U__� . Inspector's Signature: V Print: v _ PIC's Signature: (` Print: '� 1 Page of Rages' s.i ��tri.^.�. v,.r 1 /) Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) _ FOOD PROTECTION MANAGEMENT 1 596.003(A) Assignment of ResTonsibility* 590.003(B) Demonstration of Knowledge* 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* _ 3-201.12 require reporting by fool employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell F -s* 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 Drinkin Water from an A roved S stem* 590.006(A) Char e* 590.006(B) 590.(X)3(G) Reporting by Person in Charge* 31 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(F.) Removal of Exclusions and Restrictions C 6 ♦rat'• 'r Denotes critical item in the federal 1999 mood Code or 105 CMR 59(L000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* _ 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell F -s* 3-202.14 Fg <s and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinkin Water from an A roved S stem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.01` Washing Fruits and Vegetables Shelffish 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 Fi2guratory Authorit 3-202.18 Shellstock IdentificationPresem* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202,15 Package Integrity* 3-101.11 Fool Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained" Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(f) Labeling of Ingredients* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced os en packagmg, criteria* 8-103.12 Conformance with A. roved Procedures* 'r Denotes critical item in the federal 1999 mood Code or 105 CMR 59(L000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.1 I(A)(1) _ Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Annul Foods Separated from Each Other' Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501..111 Manual Warewashing -Hot Water Sani6zationTem eratures* - 4-501.112 Mechanical Warewashino Hot Water Sanitization Temperatures* 4-501.11.4 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301..12 Cleanin. Procedure - 2 -301.14 When to Wash* 1.1 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-201.12 Discharges From the Eyes, Nose and - Mouth* 3-301.12 Preventing Contamination When Tasting*_ 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacifies* 5-204.11 location and Placement* 5-205.17 - Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin Cleanser, Avid biIt 6-301.1.2 Hand Drying Provision Establishment Name: CITY OF SALEM 7 - r)(,Q`` �ab_s BOARD OF HEALTH J' m bY, Date:1L---)SZ—i Page:_ of Item Code C - Critical Item DESCRIPTION OF, VIOLATION / PLAN OF CORRECTION Date No. -- Reference' - R - Red Item , i., PLEASE PRINT CLEARLY' Verified % (1 . ✓n, rAi /s 7P:'r�t� ,/ Awl —'" YI It Y'1�i eAl in,- b', (-Inn /'•ne�rA�i�� i�l Y_AnAY/a' lA� �AJ D,I!/_ l i'�.�_—�Lri� On /1 �,'�. �h �� o.. �l -D �Alne v %�/1 N r.� i '' n � / n c m,64- syRA _ W 1 1 n ,1 O' D ) n a o /n o .(l (f V,1. eA rn-, ,1 12 .7'k�(� Y1Al-D, n,, ,Or V ,/9 tJ Q -"'70. j„„n.>r n l' At/1 fl,)(10 (10 A n 1 4 f?1 n . " I M /N .— (-Ir- ?. S: tl j T-- �I�l 1 i, /ems n ( - 11 n I lit 0 n A.L /),\; rUo,11 .-i 9A fT-4 it OAnn:ne,tiy I A(7 ('1A "' I l 0fl Discussion With Person in Charge:' Corrective Action Required: ❑ No lu des a✓Voluntary Compliance ❑ Employee Restriction / Emersion 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 Ll Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure r your food permit. ❑ Voluntary Disposal LI Other: 1� A -501.14(C) PRFs Ree6wd at Temperatures Violations Related to Foodbarne fitness interventions and Risk � According to Taw Cooled to Factors (item 1-22) (Cont) -11°I 45°FWiFhin41{otus. � 3-501.7.5 Ctmi n--Ibods for PHFs PROTECTION FROM CHEMICALS _ _ t9 I _ PHF Hot and Cold Holding _ 14 - �-- `Food or Gator Additives 3-5011Z(B) Cotta PHl s Mauvaine.d at or below 3.202,12 '590.004(F) 330114 IProtccfanCrainU+ta>�e?'�rlddttzve4"�� ,;..St;3ttri:';j � I3ntE'Ii2 1ftintatneduiai•above l5 1 Poisonous or Toxic Substances _I ! 40"F . 101.1 f : cont ers lnfirr m + on i3r ina3-5o I,16(A)Roasts Held at or above 194"F. -- Ih— Coaiahrrt rs r 7-102.11 1-common1Veme W �r6m - C crnt,artcrs- � 1--�g Time as a Public Health Control .__. ----- 3-501 !9 Sone as a Public I-lealth Control, 7-20t.11 -.tea adoa Stotap. ' - _�� ------ — '— 7-2{72.27 Re,inut,on-Pr senc�oand t'se'r - '�40JIOdfH)`arrancrRu4tatrGosuat- 7-262.12 Conditions of Usor` — REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-36312 Tc rcCcitainer- I'rohih2ttonsa` POPULATIONS�HSP 7-204.11 sant rxerk Criteria Cheltucah - 7=303 12 C}runnc'+2s for v ashen > I tuEnu, t iatcrta 21 -1'5`11 f i --I Lnp oteuriu.d Pre-packaged 3wwc wid --�'-- -- £;ever r es with Warnumg tab Ps - I i 204.14 �.- Dr rn7 km n€ria,-� 1 ; RO' ll(At 2nc of Pastennred Ft. * _ 245_I7 In:md ntal Fcxxl f untZ t lah cants°' 3-801.11(1)1 ; Raw or Patiialtt Cwked Animal Red and 7-206.11 _.__ Re,u ict a Use Pe, to ode+. Cr ter i a`- -I----- -----. �R iu 4r.rd Spnuta Nar See vca `, 7 206.1 ._R:t4xuat intorBinid _a uon�m:i:$Cl ;3TcktPuudcIrC-06.[ 'mirol and --- CONSUMER __CONSUMER t aned Ftxtn Pacla e _tL�oi Re.-..s_e..r._v-e_d_. __. ADVISORY TIMFI7EMPERATURE CONTROLS 22 3G0 I I Conmintr Vtvisoiv Posted forCons mzption o 1G Proper Cooking Temperatures for iur tl F x ds That s c Raw. k'ndercaaked or _ PHts Nor Otherwise Pr<,,;tvsedtoLamunate 3--bOt.1 ] kl11(zj 1.� 1,55'F14 S a _#�,._____� Pttht,uns __ (F vas loinw, ate S .trill 1465"T 1 4sec, 13 K.qtcuriiad Fgp; Subsr{tule fol Raw Shell 3-401.1tEa)t2) � Comminuted Fish, ilei t, k Gams:�— A eilo. L lS.v.r .r 3 403A1tAM(D) PHFs165°F15se;.I 3-403,11(13) Acrowave 165 F2%finur 4a'anding Tone, e, _ 3-403.11fC} t omen zciailvProe--ssedRTEFetj- __ 14f} F x 3-403.11(F) Remaining Un�lieed Portions of fie&&f 1g i 401.1l(6)(Itf2) 1 Pork u:d Bet Roast - 1301' 121 m I Proper Cooling at PHFs 411.11(A}{':} Rhtltt. Inrctt d Wi;tS 7 5 F 15 z-50L1dfAj e ry-- 3-401.11(Ay 3) j Poultry, Wild Game, Sniffed PRFs, ` 70"F Witton 2 Ffoars and Fron "WF ` St ttfSnftCo mr Fish Me i, nnt 3 -SOL WW Pon Ittvoi Raotts 165'1 15sot ` j 3-=i6t.t3.tCj(3) Whc,te.-rank le.twnaa&-efSteyks T mpztaurreln retientsro47°Fi45`F j 145 F."_ 3401.12 . - Raw Amoral Fuxfa Cixxketl m a� ' Unn tet,rawat uem in L MtGrvwavr I6"2r * 4h Okher PHm, 145"==i5 se . x 17 iReheating for Hot Holding 3 403A1tAM(D) PHFs165°F15se;.I 3-403,11(13) Acrowave 165 F2%finur 4a'anding Tone, e, _ 3-403.11fC} t omen zciailvProe--ssedRTEFetj- __ 14f} F x 3-403.11(F) Remaining Un�lieed Portions of fie&&f 1g I Proper Cooling at PHFs z-50L1dfAj C:a,liug Caxakeaf PFt1's foam 14(1 F hl ` 70"F Witton 2 Ffoars and Fron "WF 3 -SOL WW w41 F145 Fkkgthm4Honrs.' Cmlivv PHFs Made From Ambient T mpztaurreln retientsro47°Fi45`F �withat 4 flexors* ' Unn tet,rawat uem in the ialeral 19199 Vooci Cwf yr 105 CrAlt 590 000. _ SPECIAL REQUIREMENTS 590.E 7O( 1 m)-TV710uu vt- of Section 590.tX at Ai-tIl) in catering mollilc taxi tenipurwyand remda nt at kitchen operations sh©a(d be I dehuei ander the alaproprtat ;eetiaizs ob ve if related to 1lxxllxwrne illness inletvent,ons and risk factors. Other 590.1709 violations relating to food retail pear trees should he debited under #F29 - Speeull Requirements. VtOLATlOIVS LATED TO GOOD RETAIL PRACTICES (items 23-30) (3riurat and neon criocal molt rums, which down reiate to the foodborne illness Enerr:ntiomy and est jimlorc 2:sled above om be found in the iat;.itsing sernEaru o; the Food Code and )05 CA4R 94 Lafayette Street Strega City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-741-0004 Equipment and Utensils FAIL BLUE Owner: Linda Cappuccio PIC: Linda Cappuccio Inspector: John Gehan Date Inspected: Correct By: 1/25/2007 Risk Level Permit Number: BHP -2007-0207 Status: SIGNED OFF At of Critical Violations: 0 Time IN: Time OUT: , Urgency Description(s): BLUE: Violations Related to Good i Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Comment: Walk in freezer walls require general cleaning. Walls behind slicer/freezer require general cleaning. Walk in floor requires 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. Jan 25,2007) Page 1 oft w Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 25,2007) Page 2 oft COURT DOCKET NO.. CITATION NO. CITYOF SALEM A VIOLATION NOTICE PD 6 O 6 4 NAM FIRST, INITIAL) j(LAST, U /0 STREEIr ADDRESS CI ?OWN STATE ZIP La197e CQmI/ 1 LIC. EXP. DA E DATE OF BIRTH LW-le0- 207 / 3 -07 -�' OW ER'S NAME (LAST, FIRST, INITIAL STRE T D SS CIT OWN STATE ZIP pi REG S RATS) STATE I EXP. DATE I MAKE/TYPE YEAR COLOR rNO. DATE OF CATION TIME DATE CITATION WRITTEN PERMNAL wuNy.� AM u YES ❑NO LOCATION OF VIOLATION ENFORCING DEPT OFFENSE CHAP. SECT. FINES A B C OFFICER I.D. NO. TOTAL 00 \ t�E�l CE Y GIVEN TO VI�LATEl OR \v1 ❑ IN HAND X ❑ BY MAIL DO NOT MAIL CASH - PAY ONLY BY POSTAL NATE, MONEY ORDER OR BY CHECK MADE PAYABI- 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT EXERCISE THE FIRST OP ION AS STATED ON REVERSE, CONFES TO THE OFFENSE CHA GED, AND ENCLOSE PAYMENT IN THE AMO T OF $ CASE # SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL ). CITATION NC CITY OF SALEM L+ n Ila VIOLATION NOTICE PD6 aJ 4 NA g(LAST, FIRST, INITIAL) (Aepucc/o , Jj�,(��n/f p(y —/y// /� J STREE7 pp//RyS Tom! "`"'C/C.//// !i/%/ e/Ivqi�)- L ENSE NO. IAft 1 uNt°-,Wo -D20-f LIC, EXP. DATE ISI -07 DATE OF BIRT .--" OWJJER'S NAME (LAST, FIRST, INITIAL CITY. OWN STATE ZIP TRE SV VN/Lv! k!/ z//:b REGISTRATI�ON•NO. 5J_ATh EXP. DATE MAKERY�E �R COQR DATE OF OLATION TIME --�- 0 DATE CITATION WRITTEN PERS AJ INJURY ❑YES ❑ NO LOCATION OF VIOLATION ENFORCING DEPT OFFENSE CHAP. SECT. FINES A B C OFFICER I.D. NO. TOTAL 00 FI s/D©r E OFF EER CE EI€s'COFY GIVEN TOV�OLATOR [I IN HAND X ❑ BY MAIL DO NOT MAIL CASH - PAY ONLY BY POSTAL N TE, MONEY DER OR BY CHECK MADE PAYAB CfL �6ER CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 EC TTEL. (S(S) 745-9595 % 251 1 HEREBY ELO EXERCISE THE FIRST 9PTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHH RGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ Z CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL COURT DOCKET NO. CITATION NO. CTY"SALM ev"OLATIONNOT"cEPD6064 NA E(!T,LAST FIRSTINITIAL) �7/} uccio I /i.11� � (..GL LAP STREET ADDRESS CITY/TOWN STATE ZIP LIC SE NO. i '?V!/Lf LIC. EXP DATE DATE OF BIRTH OWNERS NAME (LAST, FIRST, INITIAL), STREETADDRESS r 7 �.,CITY/TOWN STATE ZIP U REGISTRATION NO. STATE, EXP. DATE MAKEfYPE YEAR . COLOR DATE 0FYlOLATI0 TIME (] AM DATE CITATION WRITTEN PERSONAL iwuav ❑YES ONO LOCATION OF VIOLATION ENFORCING DEPT. OFFENSE / '` CHAP. SECT. FINES A B C OFFICER t �Z I, D. NO. TONEL $ / GG JA OFFICER CERTIFI _ .G0PYZ-lVEN TO x DO NOT MAIL CASH - PAY ONLY BY POSTAL ORDER OR BY CHECK MADE PAYABLE TC: ❑ IN HAND ❑ BY MAIL MONEY 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELE T TO EXERCISE THE FIRST 9 TION AS STATED ON REVERSE, CONFhI S TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AM7 OF $ \\\ /CASE N SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL COURT DOCKET NO. CITATION NO. laCITY OF SALEM y VIOLATION NOTICE PSL 4 NAME (LAST, FIRST, INITIAL) / i • STREETADDRESS CITY/TOWN STATE ZIP LICENSE Nb. (, t ... LIC. EXP. DATE DATE OFF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL)/ STREETADDRESS CITY/TOWN STATE ZIP REGISTRATION NO. STATE EXP. DATE I MAKE/TYPE YEAR COLOR j DATEOFVI TION TIME DATE CITATION WRITTEN PERSONAL ❑ AM wUR PM ❑YES ❑ NO LOCATION OF VIOLATION "' ---- FORCING DEPT. OFFENSE CHAP. SECT. FINES A f y e B 1� C OFFICER. I.D. NO. TOTAL I Gca /J OFFICER CERTIFI >Y=GIVENN TO VIOLATOR ❑ IN HAND X }ll ❑ BY MAIL DO NOT MAIL CASH - P OSTAL;NOTE, MONEY . ORDER OR BY CH AYABL TO: I ALEM, MA 01970 El. (508)745-9595X251: I HEREBY ELECT TO ERCISE THE FIRST PTION AS STATED ON REVERSE,CONFESS THE OFFENSE C ARGED, AND ENCLOSE PAYMENT IN THE AMOUN F CASE # SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL ' 3A01/431A'3AI83H3V 3SOa X3 )L TO EXP)SE AOHESiVE, REMOVE Uv$ REMOVE UN ---i LINO 3AOW:3JAIS18JV 33'OdX3 01 T7 EXPOSE Violation Notice ----------------------------city of Salem To Offender: You have the following alternatives with regard to disposition 'of this matter (1) You may elect to pay by check, money order or postal note either in person Monday through Wednesday 'from 8AM to 4 PM (Thursday 8AM to 7 PM) Friday 8AM to 12PM at the Board of Health 120 Washington Street; or by mail to the Board of Health within 21 days of the date of this notice. This will operate as a final disposition of the matter, with no resulting criminal record. (2) If you fail to pay the fine, you will be summoned to appear at a hearing at Salem District Court. The hearing will operate as a final disposition, with no resulting criminal record, provided any fine by the hearing officer is paid within the time specified. (3) If you fail to pay the imposed fine or appear as specified, a criminal complaint will be issued against you. Place Stamp Here Post Office will not deliver without stamp City of Salem Board of Health 120 Washington Street —4th Floor Salem, MA 01970-3523 CITY OF SALEM, MASSACHUSETTS o BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC - 8 2006 TEL. 978-741-1800 FAx 978-745-0343 CI1Y OF SALEM Kimberley Driscoll WWW.SALEM.COM BOARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT TABLISHMEN�T NAME OF ESTABLISHMENT S�'REGIs SZ�� lP�h �'I �1%�I%( TEL # :'.,)L�(-oC% ADDRESS OF ESTABLISHMENT �) t -A P 4T FAX # -C(-IT ILA / ' D 2O MAILING ADDRESS (if different) ( EMAIL --Business': in (/�`t\ Snt,Qtly+ O er's1pip U-u<L) OWNER'S NAME TEL # Q 1 $ -16-1 laps ADDRESS �aL('V� �( S/�t'� iyw, 017-40 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) L 1 1,1 k1�J I (� �� CERTIFICATE#(S) M5,3 / -I 0 (Required in an establishment where potentially hazardous food its prepared) EMERGENCY RESPONSE PERSON LINDA G1 PPVk lO HOME TEL # DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION _ Please write inthine ofday. 5Pf1-�_IAft`, �-� Jr-� J Y -I (For example tlamttyml r TYPE OF ESTABLISHMENT RETAIL STORE YES NO - - - -------------------- ----- ------------- RESTAURANT NO - ------ --- ----- -- ------- --- ----- - -- --- ----- --- -- - -- -- BED/BREAKFAST YES NO ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only) less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - -- - ---- - ------ --------------------- --- --- -- -- -- --- -- -- le han 25 seats 2 99 eats =$15 more than 99 seats =$200 $100 YES NO $5 YES NO $50 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. to M L Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, all st to t re ms and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ----------------------------------------- - '�n Revised 11/13/06 FOODAP2007. adm Check# 8 Date L�Q' T U $ r0O Board ofHealth 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: File Number: BHF -2003-000015 LOCATED AT: Strega 94 Lafayette Street Salem NIA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0207 Dec 20, 2006 Dec 31, 2007 $150.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $150.00 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 5 of 11 94 Lafayette Street Telephone: 978-741-0004 Owner: Linda Cappuccio PIC: Linda Cappuccio Inspector: John Gehan Date Inspected: Correct By: 10/5/2006 Risk Level Permit Number: BHP -2006-0221 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) Strega City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Physical Facility FAIL Comment: Back storage room has a hole in the wall. Seal hole to prevent entrance of rodents. Back storage floor floor has chipping paint. Floor to be repainted by next routine inspction. Chemical room has holes in ceiling. Ceiling to be repaired by next routine inspection. GENERAL COMMENTS: 895:Chef to be certifieb by next routine inspection. All violations unless noted have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 BLUE GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 16,2006 ) Page I oft RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 16,2006 ) Page 2 oft Address: Telephone: 978-741-0004 Owner: Linda Cappuccio PIC: Linda Cappuccio Inspector: John Gehan Date: 10/5/06 Risk Level: HACCP: No Correct By: Permit Number: BHP -2006-0221 Status: Open # of Critical Violations: 3 Time IN: 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 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency PROTECTION FROM CONTAMINATION Bar hand wash sink has no paper towels or soap at time of inspection. Provide soap and paper towels. ✓ Kitchen hand wash sink requires hand wash only sign. Provide sign. Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE i CC MMENTS: Raw meat laying on dish wash surface. being preped on ware wash machine. Prepare food in designated areas. Discard meat. --I;;INalk in unit has uncovered foods. All foods must be covered. Mored direcrtly on floor in walk ins. floor. All foods to be stored 6-8 inches off of the ,aw chicken being stored on top of ready to eat foods. All potentially hazardous foods to be stored correctly as mandated. City of Salem Board of Health 120 Washington street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2005 Des Leaders Munkioal Solutions, Inc. COMMONWEALTH OF MASSACHUSETTS Page I corrected immediately or within 90 days) RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Equipment and Utensils FAIL Critical BLUE ,-,COMMENTS: Ice machine inside panel has accumulatiion of grime. Thoroughly clean and sanitize ice machine. C/alk ins loth missing thermometers. Provide visible and accurate thermometers.' ./Meat slicer has accumulation of food on it. Thoroughly clean and sanitize slicer. all white freezer in back by hand wash sink requires thorough cleaning. ,,S�me unit missing thermometer. Provide visible and accurate thermometer. gill station refrigerators missing thermometers. Provide visible and accurate thermometers. utting boards stained and scared. Resurface or replace boards. ontague oven requires thorough cleaning. Z i��freezer in storage room requires thorough cleaning. /iLnitbzing log not available at time of inspection. Log to be maintained daily. /No test strips available at time of inspection. Provide test strips. City of Salem Board of Heaeh 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS(9 2005 Des Laurlers Munkipai Solutions, Inc. COMMONWEALTH OF MASSACHUSETTS Page 2 City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Physical Facility FAIL BLUE COMMENTS: Back storage room has a hole in the wall. Seal hole to prevent entrance of rodents. Back storage floor floor has chipping paint. Floor to be repainted by next routine inspction. Chemical room has holes in ceiling. Ceiling to be repaired by next routine inspection. hind ice machine requires thorough cleaning. L ( hen ceiling has accumulation of dust on it. Clean ceiling. GENERAL COMMENTS: 877: Inspector Signature PIC Signature City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 OeoTMS® 2005 Des tauders Municipal Solations, Inc. COMMONWEALTH OF MASSACHUSETTS Page 3 i CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 120 WASHINGTON STREET 978-745-9595 ext. 421 NOTIFICATION FORM IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form W' ST be signed and returned with your application). NAME OF BUSINESS Corporate name: d/b/a: . LOCATION: TELE.# TYPE OF LICENSE ' "A, LX - 'A LL C% 6 VN 0 APPLICANTS INFO TI a w' 0. Name �1r-11+P.0-c��v� - Horn address:'k stiloLt yu.S City:. L (�yr� State: Zip: Home terle. #, f 14 t ' . v 4d,q . ..; ..., HEALTH AGENTANSPECTOR'SCOMMENTS: -.ri_. , -. /'%. -.r' . aL a !/r.L=Clpopw�AWKMIA F` lirC%�va((s✓s ltlCeXS--0. 4 d-'(�ajt a - i - nofifimtion fom- gE�r� Sf2�0� UdS /LC 7Z /,v ?i7B s Odyn nT /2 - aCD� �jd/o �/ Cd � �,j e, fGliKfr L ivau� �CJFiNNC (5a/,D /SS U e, rr"", f /td i- 77C,& qve� a®(i1oL/2k rr tf C STANLEY J. USOVICZ, JR. MAYOR CITY -OF SALEM, MASSACHUSETTS I 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: FOOD SERVICE Name of Establishment: Strega Address of Establishment: 94 Lafayette Street Owner's Name: Linda Cappuccio Restrictions: Application Date: 6/23/2004 Permit for Food Establishment 311-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT u o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH •s 120 WASHINGTON STREET, 4TH FLOOR /// a SALEM, MA 01970 TEL. 978-741-1800 '6 FAX 978-745-0343 �II STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT P(CUND JUN 2 3 2004 CITY OF SALEM BOARD OF HEALTH 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTAISHMENT NAME OF ESTABLISHMENT 157 REd p TEL # — 6OO ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) F9 r►� OWNER'S NAME �—1 Nb Iii Cf' 1717 Lk,CCt TEL CITY CERTIFIED FOOD STA (required in an establishment where potentially hazardous food is p`repared.) T EMERGENCY RESPONSE PERSON LI rtra� I tkQ0'-0 HOME TEL #IG� t 3 tL- 136y HOURS OF OPERATION: Mon.Tue. — S—Wed._)(_Thu. x Fri. x Sat. x Sun. TYPE OF ESTABLISHMENT RETAIL STORE YES NO FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,0.0,Osq.ft. =$250 RESTAURANT YES NO ,less than 25 seats =$100 25-99 seats X50 more than 99 seats--$2Ap_:> BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT (such as church kitchens) YES `�O $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State 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. Lestjow nt to Qan er 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my le ef shave filed all state tax returns and paid all state taxes requir` under the law. Signature Date Social Selcurity or Federal Iderltification Number Revised 11/03/03 FOODAP2.adm Check# 8 Date /.,i o20 ai — ,?(a&V,00 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 NameDate So-- �C 8 T of O eration s Tvoe of Insoection Food Service ❑ Retail ElResidential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑ Routine ©-Reinspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint El El O Other Address a 140rKrrX SY7 Risk Level Telephone %y�^DAA Owner L/ %.� CrilrAii!!A&o HACCP YM Person in Charge (PIC) 1 Time t: Inspector (0rOu,Ctjb 'OKI Each vioiarion checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT:, ` ❑ 1. PIC Assigned / Knowledgeable / Duties �. "EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION " ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C., N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 5MnSp cffom 14.d ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) - ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTSFOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY - ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signatur • " Print: , PIC's Signature: Print: / �4 /� f I Page-/ of ZPages Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignmentof'Responsibility* 590.003(B)_ _DemonstrationofKnowledge'� '2-103.11. Person in charge -- duties EMPLOYEE HEALTH 2 590.003(C_j Responsibility cif the person iu charge to 3-302.11(A)(1) Raw Annual Foods Separated from 590.004(8-B) require reporting by food employees and 3-201.12 applicants* 3-302.11(A)(2) Raw Anima! Foods Separated from finch 590.003(F) Responsibility Of A Food Employee Or An 3-202.13 Applicant To Report To The Person in 3-302.1I(A) I FoodProtection- 3-202.14 Char *e" 590.003(6) Reporting by Person in Chamc* 3 590.003(1)) Exclusions and Restrictions* 590.003(E) Removal of Exclusions and Restrictions E Cross -contamination IFood and Water From Regulated Sources 3-302.11(A)(1) Raw Annual Foods Separated from 590.004(8-B) Com )lane with Food Law" 3-201.12 Food in a Hermetically Sealed Containers` 3-302.11(A)(2) Raw Anima! Foods Separated from finch 3-201..13 Fluid Milk and Milk Products" 3-202.13 Shell Eras" 3-302.1I(A) I FoodProtection- 3-202.14 fi, rs and Mifk Pmdncts. Pasteurized' 3-202.16 Ice Made From Potable Drinking Water* Utensils* 5-101.11 Drinkin Water fttzm an A .roved S titem* 590.006(A) 590.006(B) Bottled Drinking Water* Water Meets Standards in 310 CMR 22.04` Disposition of Adulterated or Contaminated Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* Foods 3-201.15 Molluscan Shellfish from NSSP Listed Sources* 3-20118 - Game and Wild Mushrooms Approved by Frmqularvy Authority Shetlstock Idsntiftcation Present* Sanitiz.ation'rem eratures' 590.004rC) Wild Mushwma 3-201.17 Game Animals* 4-501.114 Chemical Sanitization- temp., pH, Receiving/Condition 3-202.11 PHFs Received at Pro ter Ternficral ures* Utensils Clean - 3-202.15 Pucka e'line it* 3-101.11. Fatd Safe and Unadulterated 6 Tags/Records: Sheilstock 3-202.18 Shellstt>Lk Identification * Chemical* 3-203-12 Shellstock Identification Maintained* Tags/Records: Fish Products 2-301.12 Cleanhr, Procedure* 3-402.'11 3-402.12 Parasite Destruction* v Records, Creation and Retention* 2-401.11 Eatin , Drinkin or UsingTobacco* 590.0040) Labeling of Ingredients" 7 12 Prevention of Contamination from Hands Conformance with Approved Procedures 1HACCP Plans Em �lovees" 3-50111 1 Specialized Processing,Methods* 5-203.11 Numbers and Capacities* 3-502.12 1 Reduced oxygen packaging, criteria* Supplied with Soap and Nand Drying L8-103 Confortnance with A) roved Procedures'` "De�lbtec critical item in the federal 1999 Food Code m' 105 0MR 590000. PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)(1) Raw Annual Foods Separated from Cooked and RTI: Foods* Contamination from Raw ingredients 3-302.11(A)(2) Raw Anima! Foods Separated from finch other' Contamination from the Environment 3-302.1I(A) I FoodProtection- 3-302.15 Washing Fr�etables 3-304.1 i. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Foods 9 Food Contact Surfaces 4-501.111 !Manual Warewashine - Hot Water Sanitiz.ation'rem eratures' 4-501.112 Mechanical Warewashing- IlotWater Saniti Lation Tem eratures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601-1'I(A) Equipment Food Contact Surfaces and Utensils Clean - 4 -602.11 Cleaning, Frequency of Equipment Food - Contact Surfaces and Utensils* 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Arms* 2-301.12 Cleanhr, Procedure* 2-301.14 When toWash* 11 Good Hygienic Practices 2-401.11 Eatin , Drinkin or UsingTobacco* 2-401.12 Discharges From the Eyes, Now and Mouth - outh*3-301.12 3 301,12Preventing Contaminutioa When Tustin'4` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination front Em �lovees" 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 location and Placement* 5-205.11 Accessibility.Oteration and ?t4 ainteounce Supplied with Soap and Nand Drying Devices 6-301.11 Handwashin Cleanser, Availabiht, 6-30112 Hand DrvinR Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: Jv—gg (9-4 Date: g��OY Page: 2-- of Item Code -C — Critical nem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R — Red Item. - Verified PLEASE PRINT CLEARLY ALL /U L44r7 &V Cl cs P/ A_ 10V I1 -MW eof /ht"'F � x yv Ll 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 / violations before the next inspection, to observe a1 condition as described, and to Exclusion P ❑ Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federate Qd�al�'e. understand that noncompliance may result in daily fines of twe t -fe,, olJldrs or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. //%/J/, ❑ Voluntary Disposal ❑ Other: i Violations Related to Foodborne illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS I4 16 18 `Deuoles' critical item in the federal 1999 Food Code or 105 CMR 590.000. Food or Color Addifives 3-202.12 Additives* 3-302.14 _ Protection from Unapproved Additives* 19 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containcns' 7-[02.11 Common Name - Working Containers* 7-261.1.1 Separation -Stora c* 7-202.1.1 Restriction - Presence and Use* 7-202.12 Conditions of Use' 7-20311 'Poxic Containers - Prohibitions" 7-204.11. Sanitizers, Criteria -Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Dr vino Agents. Criteria' 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 1 Restricted Use Pesticides, Criteria* 7-206.12 1 Rodent Bait' Stations' 7-206-13 Tracking Powders, Pest Control and Monitoring** - `Deuoles' critical item in the federal 1999 Food Code or 105 CMR 590.000. Proper Cooking Temperatures for Received at Temperatures According to Law Cooled to t 41°FI45°F Within 4 Hours.' PHFs 3-401.11A(1)(2) Eggs- 155-F 'IS Sec. 19 Encs- immediate Service 145°Fl5sec* 3-401,11(A)(2) Corruninoted Fish, Meats & Game 3-501A6(B) 590.004(F) Animals - 155°F 15 sec. * 3-401.71(14)(1)(2) Pork and Beef Roast - 130-F 121 min* 3-401.11(A)(2) Rntites, Injected Meats- 155°E 1.5 3-501.16(A) see. * 3-401.11(A}(3) Poultry, Wild Game, StuffedPHFs, Time as a Public Health Control Stuffing Containing Fish, Meat, 3-50419 Poultry or Ratites -165°F 15 sec. a' 3-401A 1.(C)(3) Whole -muscle, Intact Beef Steaks Variance Requirement 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401..11(A)(1)(b) All Other PHFs- 145°F '15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 sec. 3-403.11(B) Microwave -165° F 2 Minute Standing Time* 3-103.11(C) Commercially Processed RTE Food - 1.40°F' 3-403.11(E) Remaining Unsliced Portions or 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/45F Within 4 Hours. 3-501.14(13) Cooling PI{Fs Made From Ambient Temperature Ingredients to 41 °17145°F Within 4 Hours'" `Deuoles' critical item in the federal 1999 Food Code or 105 CMR 590.000. e • t 3-801.1 ] (A) 3-501.14{t:}�PHFs Received at Temperatures According to Law Cooled to t 41°FI45°F Within 4 Hours.' Use of Pasteurized E mss* 3-501.'15 Cooling, Methods for PRFs 19 Uno>ened Food Pucka �e Not Re -served. PHF Hot and Cold Holding 25 Equipment and Utensils 3-501A6(B) 590.004(F) Cold PI-1Fs Maintained at or below 41 °x45° F- 26. Water, Piumbin and Waste 3 -501.16(A) Hot PRFs Maintained at or above 14WR * 27. Physical Facility _ 3-501.16(A) Roasts Held at or above 7 30°F. 24 FC - 7 Time as a Public Health Control 29. S eciai Re uiremants 3-50419 Time as a Public Health Control* 30. Other 590.004(H) Variance Requirement e • t 3-801.1 ] (A) Unpasteurized Pre-packaged Juices and _Beveraites will, Warning Labels* 3-801.11(B) Use of Pasteurized E mss* 3-801.11(D) Raw or Patuaily Cooked Animal Food and Raw Seed S xonts Noe Served. ,a 3-801.11(0) Uno>ened Food Pucka �e Not Re -served. 22 3-603.11 Consumer Advisory Posted for Consumption of 23. Maria ement and Personnel_ FC - 2 Animal Foocls''hat are Raw. Undercooked or 24. Food and Food Protection - FC - 3 Not Otherwise Processed to Eliminate 25 Equipment and Utensils FC -:4- Pathogens.' eeFemd ,,,coot 26. Water, Piumbin and Waste 3-302.13 Pasteurized Eggs Substitute for Raw Shell 27. Physical Facility _ _FC __5 FC -6 Ee s* Kt:UU1tiCMtN 15 596.009(A) -(D) I 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 - Speeial Requirements. !.'I#/ifs (Itetns 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and ri.skjactors listed above, can be ,found in the following sections of the Food Code and 10.5 CNIR 590.000. Item Good Retail Practices FC 580.0o0 23. Maria ement and Personnel_ FC - 2 .003 24. Food and Food Protection - FC - 3 .004 25 Equipment and Utensils FC -:4- .005 26. Water, Piumbin and Waste .006 27. Physical Facility _ _FC __5 FC -6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. S eciai Re uiremants .009 30. Other �. _ _ 4599(enxbuk6-31oc Massachusetts Department of Rublic 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 S1-kerpili- Date T e f 0 eration s T of Ins ection oodService ❑ Retail outine ❑ Re -inspection u Address /T q 14 r M 7 Risk Level ❑ Residential Kitchen Previous Inspection TelephoneW .. y El Mobile ❑ Temporary Date: ❑ Pre-operation Owner HACCP Y/N /fp UGto ❑ Caterer EIBed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC)Time In: Out: Permit No. [-IHACCP El Other Inspector OAVt Q /j Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8Separation/ Segregation/ Protection VFood 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. R7 N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S 5901nsp &Fom614 dx n ❑ 12.Prevention of Contamination from Hands L].1eHandwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) [116. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY. SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP rCONSUMER 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-INSPECTIONAv` Ig -t n o-il Inspector's Signature• Print: PIC's Signature: Print:7 f LGrg yo l Wit. Pagel of Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) A�s+gument of Res onsibility* 590.003(B) I Demonstration of'Knowledpze_` 2-103.11 Pe+son in charge - duties EMPLOYEE HEALTH 2 590.003(0) i Responsibility of the person in charge to 590.004(A -B) require reporting by food employees and 3-201.12 applicants' 590-003(F) Responsibility Of A form Employee Or An 3-202.13 Applicant To Report To The Person In 3-202.14 Charge* 590.003(G) Reportieg, by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 590.003(.2) Removal of Exclusions and Restrictions s 4 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Scaled Container' 3-201.13 Fluid Milkand MilkProducts* 3-202.13 Shell Eggs* 3-202.14 Ears and Milk Pioducts. Pasteurized* 3-202.,16 Ice Made From Potable Drinking Water* 5-1.01.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinkma'Wtiter* 590.006(B) Water Meets Standards in 310 CMR 210* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan 3-306.14(A)(B) Shellfish* 3-201-15 Molluscan Shellfish from NSSP Lasted Sources* 3-701.11 Game and Wild Mushrooms Approved by Re ufato � Aerthorit 9 3-20118 Shellstock.' Identification Present* 590.004(C) Wild Mushrooms - '01.17 Game Animals` g 4-501.112 ReceivinglCondition 3-202.1 t PRFs Received at Pro ter Tem eratures* 3-20215 Pucka e'htte rit �* 3-101.11 Food Safe and Unadulterated 6 4-601.11(A) Tags/Records: Shellstock 3-202.18 Shellstock Identification 3-203.12 Shellstock Identification Maintained'" Tags/Records: Fish Products + 3-402.11 Parasite Destruction* 3-402.12 _ Records. Creation and Retentions' 590.004(!) Labeling of Ingredients" 7 Conformance with Approved Procedures 10 lHACCP Plans 3-502.11 S ecializedProeessineMethais* 3-502.12 Reduced ox • en )acka,im., criteria*. 8-103.12 Confonuance with A. raved Procedure: Denotes critical item in the L-de+.'d 1999 Food Code or 105 CMR 590.000. R Cross -contamination v 3-302.1l(AXl) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Haw ingredients 3-302.11(A)t2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-3021 t(A) Food Protection* - 3-30215 Washiniz Fruits Lind Vegetables 3-304.11 Food Coritaa, with Equiptnent and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reserviee of Fuad* + Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning unsafe Foods' 9 Food Contact Surfaces 4-501-1.11. Manual Warewashing- HotWater Sanitization Tem eratures* 4-501.112 Mechanical Warewishino Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. " 4-601.11(A) Ecfuipment Food Contact Surfaces and Utensils Clean* 4-602.11. Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anus'` 2-301,12 Cleaning Procedure* 2-301.14 When to Washx 11 Good Hygienic Practices 2-401-11 Eatia ,Drinking or L'sing Tobaccos` 2401.12 Discharges From the Eyes, inose and Mouth' 3-301.t2 Preventin>Contamination When Tasting" 12 Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Em to ees* 33 Handwash Facilities Conveniently Located and Accessible 5-203,11 Numbers and Capacities* 5-204.11 1ax:atiotr and Placement* 5-205.11 Accessibility. Operation and il+lainfenance Supphed with Soap and Nand Drying Devices 6-301.11 Handwashin Cleanser, AvailabIlity 6-301.12 Hand Dr in<�Pzovision CITY OF SALEM BOARD OF HEALTH rf Establishment Name: S'tT'/tc_f 4 Date: 61 IyU Page: of 2— Item No. Code Reference C — Critical Item DESCRIPTION OF VIOLATION? PLAN OF CORRECTION R — Red Item - PLEASE PRINT CLEARLY Date Verified Jr1_1 ME 9 A,00440r Z C A T i e ,[P't- s — asv - F$ e*4 r C re"mr o ,& &A C444AA u r eA6vtiergy f Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to conebtall . violations before the next inspection, to observe all conditions as described, and to ;'=? comply with all mandates of the Mass/Federal F C&de. I understand that noncompliance may result in daily fines of tw cif ✓e oll rs or suspension/revocation-of ' your food permit. v / Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ VoluntaIA�ry Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (items 1-22) (Cont.) l4 .� Food or Color Additives W3-501.15 3-202.12 Additives'' 19 3-302.14 Protu'tion from Una( raved Additives'". 15 7-101.11 Poisonous or Toxic Substances Identifying Information - Orivnal Containers* 26. 7-102.11 Conunon Name-Workiva Containers` 27. 7-201.11 Se.aration-Staa e'er 20 7-202.11 Restriction - Presence and tae` 29. ',-20212 Conditions oi'Use' 30. 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.1.2 Chemicals for Washing Produce, Criteria* 7-204.14 7-205.11 Drvine Agents. Criteria* Incidental Food Contact, Lubricants* 7-206.11 j Restricted Use Pesticides, Criteria" 7-206.1.2 Rodent Bait Sia ions'r' 7-206.13 Tracking Powders, Pest Control and Monitor ine" 16 3-501.'14(C") _ Proper Cooking Temperatures for W3-501.15 Mona ement and Personnel '.. FC - 2 PHFs 19 3-401.11A(1)(2) Eggs- 1557 15 Sec. 25. 3-501.16(8) 590.004(1`) Eegi-Immediate Service 145'F15sec:1 26. 3-401.1 I (A)(2) Comminuted Fish. Moats B. Game 27. 3-501.16(A) Animals - 155'F 15 sec. * 20 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121. tnin* 29. 3-401.11(A)(2) Ratites, Injected Meats- 1.55'F 15 30. 590.004(11) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Pouch y or Ratites -165'F 15 sec. 3-4011I(C).(3) Whole -muscle. Intact Beef Steaks 145`F* 3-401.12 Raw Annual Foals Cooked in a Microwave 165'F * 3-401.11(A)(1)(b) All Other PHFs -- 1454' 15 see. 17 Reheating for Hot Holding 3-403.11(A)&(D) PF -I's 165'F 15 sec. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Time' 3-403.1.1(C.'.) Commercially Processed RTF. Food - 140'F 3-40311(E) Rsmainine. Unsiiced Portions of Beef Roasts* 1g Proper Cooling of PHFs 3-501.14t,A) Cooling Cooked PHFs from 14WF to 70'F Within 2Hours and From 70'F to 41 °'145'1- Within 4 Hours. ` 3-501.14(6) UwlingPHFsMadeI-routAmbient Temperature Ingredients to 41'F/45''17 Within 4 Hours* * Denotes Critical itein in the federal 1999 Foal Code or 10J Cv1R i90.000. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnir, Labels' 3-801.11 tB) 'Use of Pasteurized L+'�t�s* 3-801.11(1)) Raw or Partially Cooked Animal Food and Raw Seed Scrota, Not Served. * Not Re -,served. 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Food; Tlad are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* 3-302.1.3 1 Pasteurized Eggs Substitute for Raw She]] 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. f.T7/111111 FT-GSITN41 (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and iiskfiactor's listed aboee, can be :Pound in the following sertions elf the Food Code and 105 CAIR 590.0(10. Item 3-501.'14(C") _ PRFs Received at Temperatures According to Law Coaled to 41'F/45'F Within 4 Hours. W3-501.15 Mona ement and Personnel '.. FC - 2 Cowling Methods for PFFFs 19 Food and Food Protection FC -3 PHF Hot and Cold Holding 25. 3-501.16(8) 590.004(1`) Cold PHFs Maintained at or below 41°/45' F* 26. 3-501.16(A) Hot PHFs Maintained at or above 140°' .a 27. 3-501.16(A) Roasts Held at or above 130'F. 20 1 Time as a Public Health Control 29. 3-507.19 Time as a Public Health Control'" 30. 590.004(11) Variance Rec niremenY REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnir, Labels' 3-801.11 tB) 'Use of Pasteurized L+'�t�s* 3-801.11(1)) Raw or Partially Cooked Animal Food and Raw Seed Scrota, Not Served. * Not Re -,served. 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Food; Tlad are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* 3-302.1.3 1 Pasteurized Eggs Substitute for Raw She]] 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. f.T7/111111 FT-GSITN41 (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and iiskfiactor's listed aboee, can be :Pound in the following sertions elf the Food Code and 105 CAIR 590.0(10. Item Good Retail Practices FC 590.000 23. Mona ement and Personnel '.. FC - 2 .003 24 Food and Food Protection FC -3 .004 25. Equipment and _Utensils_ FC - 4 _ .005 1 26. ' Water. Plumbing and Waste Q_FC S 006 27. Physical Facility '.. FC -6 .007 128. Poisonous or Toxic Materials FC -7 .008 29. S ecial Re quiremenis_ _ _ _ .0.09 30. Other f s:;.,rt,K ,,: z r,. 94 Lafayette Street HACCP: ❑ Telephone: 978-741-0004 Owner Linda Cappuccio PIC: - Linda Cappuccio Inspector: David Greenbaum Date Inspected: Correc 3/10/2005 Risk Level Permit Number: BHP -2005-0181 :Ctafi is SIGNED OFF # of Critical Violations: Strega City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Not Done "w ,. Anti -Choking PASS ❑ Time IN: Time OUT: Votes: Tobacco PASS ❑ RED RED RED RED PASSd❑ FOOD PROTECTION MANAGEMENT Not Done Not Done RED PIC Assigned / Knowledgeable / Duties PASS ❑V RED = EMPLOYEE HEALTH Not Done By. $ Reporting of Diseases by Food Employee and PIC Personnel with Infections Restricted/Excluded PASS./❑ PASS RED RED FOOD FROM APPROVED SOURCE Not Done Food and Water from Approved Source PASS Q RED - Time IN: Time OUT: Votes: Proper Adequate Handwashing Urgency Description(s) L Good Hygienic Practices BLUE - Violations Related to Good Prevention of Contamination from Hands Retail Practices (Critical Handwash Facilities violations must be corrected immediately or within 10 days)(Non-critical violations= PASS Receiving/Condition Tags/Records/Accuracy of Ingredient Statements Conformance with Approved Procedures/HACCP Plans PASSJ❑ PASSd❑ PASS PASS RED RED RED RED PASSd❑ PROTECTION FROM CONTAMINATION Not Done RED Separation/ Segregation/ Protection Food Contact Surfaces Cleaning and Sanitizing PASSd❑ FAIL Criticald❑ RED RED Cutting boards stained and scored. Resurface or replace cutting boards. Proper Adequate Handwashing Urgency Description(s) L Good Hygienic Practices BLUE - Violations Related to Good Prevention of Contamination from Hands Retail Practices (Critical Handwash Facilities violations must be corrected immediately or within 10 days)(Non-critical violations= PASS RED PASS D RED PASSd❑ RED PASSd❑ RED Provide a sign stating "Employees must wash hands." in mens room. GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005 ) PaQe 1 of 94 Lafayette Street must be corrected immediately or within 90 days) RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) PROTECTION FROM CHEMICALS Approved Food or Color Additives Toxic Chemicals Not Done PASS PASS VCM ❑J RED TIMEITEMPERATURE CONTROLS (Potentially Haz Not Done 8 inches of the floor. Cooking Temperatures PASS ❑Q RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS BLUE RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done BLUE Food and Food Preparation for HSP PASS ❑/ RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE Walkins and dry storage have food stored Equipment and Utensils Water, Plumbing and Waste Physical Facility Poisonous or Toxic Materials Special Requirements Other- See Notes on the floor. All food to be stored at least 6- GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005) Page 2 of 8 inches of the floor. FAIL Non -Critical ❑ BLUE Small white freezer, and two beverage air cooling units need visible, accurate thermometers. PASS ❑ BLUE PASS ❑ BLUE PASS ❑ BLUE PASS ❑ BLUE PASS ❑ BLUE GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005) Page 2 of 94 Lafayette Street Strega GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005) Page 3 of 0,0 PV FROM: SALEM POLICE DEPARTMENT �— P.O. BOX 3005 SALEM, MA 01970 504 TO: STREGA ENTERTAINMENT 94 LAFAYETTE ST. SALEM MA 01970 ALARM RESPONSE INVOICE date/inv description -------- ---------------------------------------- 11/30/05 KITCHEN MOTION 55404 addr: 94 LAFAYETTE ST loc#: 21407 case#: 429323 alarm#: 21407 Make all checks payable to "City of Salem." invoice with your payment. D JAN 0 3 2006 CITY OF SALEM BOARD OF HEALTH Due date: 01/13/06 total paid hal -------------------------- 2'5.00 25.00 TOTAL: 25.00 Enclose one copy of this All invoices will be bill at the rate of $25.00 for each false alarm. Failure to pay two invoices within sixty days will result in all alarms after the two outstanding invoices being billed at the rate of $50.00 for the balance of the current year. All overdue invoices will be accessed a $5.00 late fee. If you have any questions about this billing invoice, contact the Salem Police Traffic/Alarm Office at 978-744-0171 x115. DanverssSavings^Bank 15634 STREGA ENTERTAINMENT, INC. ONE 94 LAFAYETTE STREET SALEM, MA 01970 53-7116/2113 978-741-0004 12/28/2005 AY O THE ORDER OF City of Salem •#25.00 Twenty -Five and OO/IOU############R#itit##ititsttattiis#iixi##ist#i##t#Citi#aittstiiitii#######iR##tttt•##s##tii%#####i DOLLARS IEMO City of Salem Board of Health 120 Washington Street Salem, MA 01970 55404 v AUTHORIZED SIGNATURE 11'01563411' 42ii3711624 35 10619811' iTREGA ENTERTAINMENT, INC. City of Salem 12/28/2005 Date Type Reference Original Amt. Balance Due Discount 11/30/2005 Bill 55404 25.00 25.00 Check Amount 15634 Payment 25.00 25.00 amu or M L -rig Cash -Checking 35106198 55404 25.00 n 0 r 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: FOOD SERVICE Name of Establishment: Strega Address of Establishment: 94 Lafayette Street Owner's Name: Linda Cappuccio Restrictions: Application Date: 12/01/2004 Permit for Food Establishment 102-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. -> 19 1 i ✓HEALTH AGENT CITY OF SALEM, MASSACHUS (C 4i0�yy }j"`""'VVVVo j�", BOARD OF HEALTH c120 WASHINGTONSALEM, MA 01970TH FLOO NOV 3 0 2004 .� TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT `, NAME OF ESTABLISHMENT 5'fi? ECS E.NTE.RPIt�N�� 1 I t # I� 7 �f �' Odd "1 ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME L-►N&)fi V V ADDRES _ 46 L-1� CITY" LG ,{Y\I STATE -p zip i CERTIFIED FOOD MANAGER'S NAME(S V% w "NCA4a CERTII TEL #��l -C60 Y X -L36 (required in an establishment where potentially hazardous food is prepared.) 1 q EMERGENCY RESPONSE PERSON LL PSM PPu cL1 b HOME TEL #"�1LR" HOURS OF OPERATION: Mon. Tue. X Wed. x Thu. k Fri. k Sat. k Sun. X TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANTYES NO /6 c2 --0-6 less than 25 seats =$100 25-99 seats more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. to Mq C p e 2C, Section 49A, I certify under the pains and penalties of perjury that I, to my /ledg a belief, have tiled all state tax returns and paid all state taxes regyired under the law. Social Security or Federal Identification Number Revised 11/03/03 FOODAP2.adm Check# & Date / icy &Zk Z/. IMPOR,TnAN.TO- MESSAGE FOF - DATE TIMEr�i.5 Mys,--�N.lrx2 PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBILE AREA CODE N�IMBER TIME TD CALL TELEPHONED PLEASE CALL CAME TO SEE YOU '.. WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE M SIGNED sFORM 4009 MADE IN u. 09 NOTES 5- as-� T d i -euj6d ei +ued i e+Clam -e o'i=eu166 ei -uedi 6*68 i -e I i doi 6n 6. Clod ei +ued i e i i 6oi do d>u¢ d ei =ued i e i ui e6 -e =i w�&i i'1 =i e66 i ui e6+6 -i Eat i "i -i e06 i ui 66 6+uo i u6 e d ei =ued i 6+a33+6ed,n=e+ui i i ui e6 +e +i wt i'1 +i e06 d+aO > oe di n> 6-u i i Lt& 10 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Facsimile Transmittal To: V-1eF 11 ��stta��Rdirlf Fax # 9 78- %1//- © P 1r/' RE: `SAiyi�i �iti/� LD (;- Date : Page(s): including this cover # 2— Board of Health News----------------------------------------------------------------For Your Information OFFICE HOURS: Monday, Tuesday, & Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 Noon Do Salem Residents Know ? — Applications for a permit to remove exterior paint are required by the Salem Board of Health. No fee for permit and electric sanding is not permitted. Regulations for home owners and painting contractors are available. CITY OF SALEM HEALTH DEPARTMENT r Nine North Street Salem, Massachusetts 01970 Sanitizer Concentration Log Sheet zoos - 11 Date I Time I Conic. I Init. 11 Date I Time Conic. Init. 11 Date I Time I Conc. I Init. Date : the day and month Conic: concentration of sanitizer according to test Kit Time: the time of day Init: the initial of the person making up and testing the sanitizer Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4t" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 a Name Date )) T e of O eration s Type of Inspection f / Food Service ElRetail ❑Routine El-Be-inspection AddressRik Level El Residential Kitchen ❑ Mobile Previous Inspection Date: � Telephone / / El ElPre-operation Owner ) ^ 1 HACCP YM El Caterer ❑ Bed & Breakfast ElSuspect Illness ❑ General Complaint Person in Charge (PIC) Time In:ElHACCP Out J� Permit No. ❑ Other Inspector Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. I . FOOD PROTECTION IMAN AGEMENT, ; ;;;, m; ❑ 1. PIC Assigned/ Knowledgeable/ Duties s a'E ., F iem3Y I s.. _.iea,� d.:i-t;,. All tl ❑g2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE F u, �T--`"�,,,,�,,,,�, . ,y,i<;r".� u"., a" ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION`-� 0 ❑ 8 Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (Fc -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.0011) 29. Special Requirements (590.009) 30. Other 5: 59JIns{rec(PomF14.tla' ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM12 L ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals -._;TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) ` , ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling [:119. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGH LY SUSCEO, TIaLE POPULATIONS (HSPj ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: I / Print: G PIC's Signature: / Print:Page. 0f Pages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 596.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Foal Employee Or An 3-202.16 ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C C IN * Denotes critical item in the federal 1999 Foal Cate or 109 04 R 990.000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed S'ciurces* Contamination from the Consumer Game and Wild Mushrooms Approved by Re Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 - PI-TFs Received at Proper Tem eratureO 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(1) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* Conformance with Approved Procedures /HACCP Plans - 3-502.11 S ecialized Pxocessin Methods* 3-502.12 Reduced ox en acka 'ng, criteria* 8-103.12 Conformance with A roved Procedures* * Denotes critical item in the federal 1999 Foal Cate or 109 04 R 990.000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Annnal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) ,Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.1 J 1. Manual Warewashing - Hot Water Sanitization 'rent ratures* 4-501.112 Mechanical Warewashino Hot Water Sanitization Temperatures* 4-501.114 Chemical. Sanitization- temp., pH, concentration and hardness.' 4-601.t1(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11Clean Condition - Hands and Antis* 2-301.12 Cleanin Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2401.1.2 Discharges From the Eyes, Nose and - Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility. O•ration and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin , Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM d j BOARD OF HEALTH 5 Establishment Name: �4� Date: Al/ ?")Ibc� Page:_ of Q Item No. Code Reference C - Critical nem R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION e PLEASE PRINT CLEARLY t' C I' A , Date Verified fl C> 7 Co I — - cI Y&CIPAA o uo 441 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 R comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five ollars=oi .suspension/revocation of your food permit. j��J Corrective Action Required:❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ion Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1.22) (Cont.) PROTECTION FROM CHEMICALS 13 17 ' Denotes critical item in die @decal 1999 Food Code or 105 CMR 590.000. 20 3-501.14(C) Food or Color Additives 3-202.1.2 Additives* 3-302.14 Protection from (311at roved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers* 7-1.02-11 CommonName-WorkinaContamers* 7-201.11 Separation - Stora e* 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use" 7-203.11 Toxic Containers - Prohibitions* 7-204.17. Sanitizers,Criteria- Chemicals* 7-204.1.2 Chemicals for Washin� Produce, Criteria* 7-204.14 Drying Agents. Criteria' 7-205.1 I 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* ' Denotes critical item in die @decal 1999 Food Code or 105 CMR 590.000. 20 3-501.14(C) '! Proper Cooking Temperatures for 3-501.15 PHFs 3-401.IIA(1)(2) Eggs_ 155'F 15 Sec. 3-501.16(B) 590.004(F) E =gs-'Inwtediate Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Animals- 155'17 15 sec. 'r 3- 401.1.l(B)(1)(2) Pork and Beef Roast- 130'F Ll min* 3-401.11(A)(2) Rattles. Injected Meats -155'F1.5 590.004(H) see. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165°.F 15 see. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks FC - 7 1450F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3.401.11(A)(1)(b) All Other PHFs -- 1,45'F 15 sec, Reheatingfor Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 sec. * 3-403.11(B) Microwave -165' F 2 Minute Standing Times' 3403. H (C) Commercially Processed RTF Food - 14WF* 3-403.11 (E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501..14(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 hours and From 70°F to 41.'F/45'F Within 4 Hours. * 3-50114(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41017745'13 Within 4 flours* ' Denotes critical item in die @decal 1999 Food Code or 105 CMR 590.000. 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. 3-501.15 Cooling M1lethods for PHFs 3-801..11(B) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PIIFs Maintained at or below, 41°145°F* 3-501.16(A) Riot PHFs Maintained at or above 14WF. * 3-501.16(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Re qUirefflent REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 CONSUMER ADVISORY 22 3-801.116A) Unpasteurized Pre-packaged Rices and Beverages with Warnine Lttbels* 580.000 3-801..11(B) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. _ Food and Food Protection 3-801.11(C) Unopened Foci Package Not Re -served. CONSUMER ADVISORY 22 3-60111 Consumer Advisory Posted for Consumption of 580.000 23. Animal Foods That are Raw. Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate _ Food and Food Protection FC -- 3 Pathogens.* I I'v", ""001 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell ! .005 _ 26 _ E s'" SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(ll) 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 71-29 - Special Requirements. (Items 23-30) Critical and non-eritical violations, which do not relate to the foodborne illness interventions and risk Jacrors listed above, can be found in the followfag se(. tions of the Food Code and 105 CMR 590.000. Item Coad Retail Practices FC 580.000 23. Management and Personnel FC - 2 .003 24. _ Food and Food Protection FC -- 3 .004 25. E uipment and Utensils FC -4 ! .005 _ 26 _ _Water, Plumbin and Waste FC -5 .006 27. Phsical Facility_ FC -6 .007 28. Poisonous or Toxic Materials FC - 7 .008 2- 9. S ecial R uirements .009 30. Other ssvnr��mn,c�c.z.:x,� Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT I SPECTION REPORT Salem Board of Health 120 Washington Street, 4'h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 NameDat [ �- Tvpe of Operation(s) Tvpe of Inspection /HFood Service Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑Routine 9] Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint _ El HACCP ElO herr Address Risk Level Telephone Owner r r CPu CC I 11 HACCP Y/N Person in Ctfairge (PIG) Time Ind -43 Out:�� Inspector � oacn vioianon cnecKea 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) Q action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 12. Prevention of Contamination from Hands /I/; ) F-1 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 El 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices t 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 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)(594.008) 29. Special Requirements (590.009) 30. Other (//y/ �� S. 590,nsP dForm 14do / ! ❑ 13. Handwash Facilities PROTECTION FROM. CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE. CONTROLS (Potentially Haiairdous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY. SUSCEPTIBLE POPULATIONS (HSP),, ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY _ ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions ' and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: Print: PIC's Signature: Print: I Page of( Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) C 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowled e' "'-103.11 t Person in charge .-. duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to 590,004(A -B) require reporting by foal employees and 3-201,12 applicants" 3-201.13 590.003(F) Responsibility Of A Food Employee Or An 3-202.13 Applicant To Report' To The Person In 3-202.1.4 Charge* 3-202.16 590.003(0) Re ortinab Persatrn Char e* 3 590.003(1)) Exclusions and Restrictions* 590.006(A)Bottled 590.003(E) Removal of Exclusions and Restriction, N Fe C I 'P Denotes critical item in the federal '1999 Food Code or 105 CbIR 590,000. RI 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 E�gs* 3-202.1.4 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking W fitter from an Approved Svstem* 590.006(A)Bottled Drinking Water* 590.006(B) Water Meets Standards to 310 CMR 220* Washine Fruits and Vegetabies 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 Came and Wild Mushrooms Approved by Rp,notatort, Authodt 3-202.18 Shellstock Identification Present* 590.044(C) Wild Mushrooms - 3 -201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Pr�� 3=202,15 Package Integrity* 3-107-1.1 Food Safe and Unadulterated'" Tags/Records; Shellstock 3-202.18 Shetlstock Identification * 3-203.12 She7lstock Identification Maintained" Tags/Records: Fish Products 3-402.11 Parasite Destruction,. 3402.12 Records. Creation and Retention"` 590.004(1) Labeling eT Ingredients' Frequency of Sanitization of Utensils and Food Contact Swi'aces of Et ui ment* Conformance with Approved Procedures IHACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen oack�teria* 8-103.12 Conformance with Approved Procedures* 'P Denotes critical item in the federal '1999 Food Code or 105 CbIR 590,000. RI Cross-cdntamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1 1(A)(2) Raw Animas Foods Separated from Each Ocher* Contamination from the Environment 3-302A I(A) iFood Protection" 3730215 Washine Fruits and Vegetabies 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-304..14(Ai(B) Returned Food and Resefvice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 DiscardingorReconditioningUitsafe Foci" 9 Food Contact Surfaces 4-501,111 Manual Warewashing- [lotWater Sanitization"Pam eratures* 4-501.112 Mechanical Wmrewashing- Hot Water Sanitization Tem eratm-es" 4-501.114 Chemical Sanitization- temp., pH, concentration and hm'dness, * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11. Cleaning Frequency of Equipment Food - Contact Surfaces mad Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Swi'aces of Et ui ment* 4-703 . I I Methods of Sanitization -Hot Water and Chemical* to Proper, Adequate Handwashing 2-301.11. Clean Condition- Hands and Anns4` 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 12 Good Hygienic Practices 2-401.11 Eating, Drinkin r or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Month* 3-301.12 PreventingContaminatiotWhenTastin,a. 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em * 13 Handwash Facilities dwash Conveniently Located and Accessible 5-203.1.1 Numbers and Ca acitles* 5-204.11 Location and Placement` 5-205.11 Accessibilit �, O enation and Maintenmtce Supplied with Soap and Hand Drying Devices (i=301.11 Ilandwashing Cleanser. Availabilitv 6-301.12 Eland D in Proarsion 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 sAm Date Type of Operation(s) Type of Inspection Ck I() Iz gl x- 2 Food Service ❑ Retail ❑ Routine e -inspection Address L Risk G Q o` Level ❑ Residential Kitchen El PrZFvious Inspection Date: J>[,qj, Telephone2 (_ _/ of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board [-1 [IPre-operation > today, the items checked indicate violations of 105 CMR Owner 1 CC ( HACCP WIN[-1Temporary ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time C N In:3.1 ,O by a Board of Health member or its agent constitutes an ❑ HACCP Inspector v Out: -7 Permit No. ❑ Other Each violation checked'regiuires 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 • a ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection 14 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities (PROTECTION FROM CHEMICALS [114. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18, Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control .. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)',.',, ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices j 5 NSUMER ADVISORY. ,' ".• _, , , , 4 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Qv ° rl Page ofL, Pages immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection of Health. > today, the items checked indicate violations of 105 CMR ; 590.000/federal Food Code. This report, when signed below' C N 23. Management and Personnel (FC -2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC -3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso.00s) Cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC -5)(590.006) establishment operations. If aggrieved by this order, you ' 27. Physical Facility (FC -6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC -7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order.` 30. Other DATE OF RE -INSPECTION: Cly S : ssornspecrForms w.ex/ ) n n z �Q '0'% - . \I x Inspector's Signature: Print:\jU / PIC's Signature: \ Print: Qv ° rl Page ofL, Pages 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 ofKnowledse* 2103.1I Pe; son incharge -- duties 2 590.0 )3(C.) Responsibility of the person in charge to 590.004(A -B) require reporting by fiord employees and 3-201.12 a ilicamts* 590.003(F) Responsibility Of A Foci Employee Or An 3-202.13 3-202,, W 3-202.16 Applicant To ReportTo The Person ht 5 -101.11 Charge* 590.003(G) Re ortin, by Person in Charge" 3 590.003(D) Exclusions and Restrictions* 590.003(F) Removal of Fxchisions and Restrictions 4 V lusTauffilIT,i 9071041 ' Denotas criti ail item inII)c fedeial 1999 Food Cork or 105 CMR 590.000- w y. g Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Scided Container* 3-201.13 Fluid Milkand Milk Products* 3-202.13 3-202,, W 3-202.16 Shelli p- Eggs and Milk Products. Pasteurized* Ice Made From Potable Drinking Water - 5 -101.11 Drinking Water from an A roved S stem* 590.006(A) Bottled Drinkln Water* 590.006(B) Water Meets Standards in 310 CMR 220f 3-302.f 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* 3-20218 Game and Wild Mushrooms Approved by Regulatory Authority Shellstock Identification Present* 590.004(0) Wild Mushrooms* t. 3-201_17 Game Animals* Receiving/Condition ;+ 3-202.11. PHFs Received at Proper Temperatures* 3-202. t5 Package Integrity- nte it -3-101.11 3-101,11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 3-203.12 Shellstock Identification * Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction` 3-402.12 Records- Creation and Retention* 590.004(1) Labeling of Ingredients' Conformance with Approved Procedures iHACCP Pians 3-502.17 3-502.12 _ SL7ecialized Processin�a,Meth<xis* Reduced as Qen iackagina- eritaria'" 5-103.12 Conformance with A. roved Procedures" ' Denotas criti ail item inII)c fedeial 1999 Food Cork or 105 CMR 590.000- w y. g Cross-contamination-,..� 3-302.1 I(A)(I) Raw Animal Foals Separated from Cooked and RTE Foods'* Contamination from Raw ingredients 3-302A I(A)l2) Raw Animal Foods Separated from Each Other - Contamination from the Environment 3-3021 t(A) Food Protection- 3-302.f wnshin Fruits andVeeetables 3-304.11 Ford Contact with Equipment and lite"Als* 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 Ftp* 9 Food Contact Surfaces 4-501.111 Manual Warewashine -Hot Water Sanitization Temperatures' 4-501.712 Mechanical Warewashin - Plot Water Sanitization Tem eratnres* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness.* 4-601-2 I (A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 _ Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of F w mem* 4-703.11 Methods of Sanitization - Hot water and Chenneai* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition- Hands and Arms" 2-301-1.2 Cleanimv Procedure` *' 2-301.14 When to Wash' 1.1 Good Hygienic Practices ' 2-401.11 Patin , Drinking or Using Tobacco" 2401.12 Discharges From the Byes, Nose and Mouth* 3-301..12 Preventinn Contamination When Tasting* 22 Prevention of Contamination from Hands 590.004(8) Preventinti Contamination from Em lovecs* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca acities^' 5-204.11 location and Placement* 5-205-11 Accessibilitf_,.O>crationand Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 ffrmdwashmg Cleanser, Availabila 6-301-12 vision CITY OF SALEM BOARD OF HEALTH Establishment Name: 51� Date: 10 / °Ze2/05-- Page: of Item No. Code c - critical Rem Reference R — Red Item DESCRIPTION OF VIOLATION / PL N OF CORRECTION 'PLEASE.PR T CLE RLV Date Verified i O � , L� c/P G .w c iQ L -til r n5 l cM-r n e /2? A c a. ` re s o n (� N -/n o 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 FooVode. I understand that noncompliance may result in daily fines of twenty five doll r suspension/revocation of your food permit. Corrective Action Required: ❑ No -9 es ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion e -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 14 is 18 Food or Color Additives 3-202.12 Additives.°....._,..._.-,._ 3 302.14 Protection from Unimproved Additives* Poisonous or Toxic Substances 7-10 L I 1 Identifying Information - Original Containers* 7-102.11 Common Name - Working Containers* 7-201.11 Separation - Storage"` 7-20111 Restriction -Presence and Use* 7-202.12 Conditions of Use" 72011 Toxic Containers prohibitions* 720411. Saunnzers Criteria Chumcals' 7-204.1,2 Chemicals for Washing Produce. Criteria* 7-204.14 Dr mg i ents Criteria - 7 -205. 11 riteria7-205.11 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* s Proper Cooking Temperatures for PHFs 3-401.1IA(1)(2) Eggs- 1.55°F 1.5 Sec. E res- ftmnediate Service 145'Fl5sec* 3-401..11(A)(2) Comminuted Fish, Meals & Game Animals - 155'F 15 sec.'s 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 nein* 3-401 11(A)(2) Ratites, Imected Meats -155'F 1.5 sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. 41 3-401.11.(C)(3) Whole -muscle, 'Intact Beef Steaks 14501":;' 3-401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3401.11(A)(1)(b) All Other PHFs - 1.45'F 15 sec. Reheating for Hot Holding 3-4()3A1(A)&(D) PHFs 165'F 15 sec. ;: 3-103.11 (B) Microwave- 165'F 2 Minute Standing Timex` 3-403.11(C) Commercially Processed RTF Food - __ 14(NF* 3-403.11(6) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 1406F to 70°F Within 2 flours and From 70'F to 41.°F/45'F Within 4 Hours.' 3-501.14(13) Cooling PHFs Made From Ambient Temperature Ingredients to 410_450F Within 4l:lours'# I Denotes critical item in the federal 1999 Food Codc or 105 CMR 5907 UOQ. 3-S0L 14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Homs... 3-501.15 Cooling Methods for PHFs I9 PHF Hot and Cold Holding 3-501.16(B) Cold PFIFs Maintained at or below 590.004(F) 11`/-15: F* 3-501.16(A) Hat PHFs 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* 590.004(H) Variantt Re uirement 21 3-801 11(A) Unp tstem iced Pre-packaged Juices and Beverages with RarnmLLabels* 3-501.11(6) Use of Pastemized Ee s" � 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S xouts Not Settied. `" 3-801.11(C) Unopened Food Package Not Re -served. r- 22 3-60311 Consumer Advisory Posted for Consumption of Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* Er """" 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs' RRRaHffLTQW 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. 1_i��7/3_7•Fiii�(YT3�f (Items 23-30) Critical and non-critical violations. abich do not relate to the foodborne illness interventions and risk actors listed above, can be found in the following sections of the Food Code card 105 CMR 90.000. item Good Retail _Practices FC 59t2000--- 23. Mata ement and Personnel FC -2 .003 24. Food and Food Protection _ FC - 3 .004 25. Equipment and Utensils FC -4 i .005 26. Water, Plumbinq and Waste FC - 5 , .006 27. Physical Facility FC - 6 .007 28. Poisonous or Toxic Material 29__ Secial Re uirements -_ _ ___4 .009 30- _ Other -1110ro'= 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 A Date Tvoe of Ooeration(sl Tvoe of Insoection [�I-Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑,Routine 1❑ Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address // I rc Risk' Level Telephone it Owner _ HACCP Y/N Person in Ch rge (PI) f Time In: (r Out: Inspector , Each violation checked -tequirds 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 t 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. h"n ' w 'Yn"4 �_ti FOOb PROTECTION MANAGEMENT nl"!❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned / Knowledgeable / Duties ❑ 13 Handwash Facilities -: EMPLOYEE HEALTH ds,i PROTECTION FROM dHEMICALS" '0 41"3A ` �. El 2. Reporting of Diseases by Food Employee and PIC �� ' w�r- � _"- �� ar -a �,_ 0" ❑ 14. Approved Food or Color Additives ❑ 3.. Personnel with Infections Restricted/Excluded (i FOOD FROM APPROVED SOURCE!, !„ p; .» '?,""``.. 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 ❑N 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwash ❑ 1 T. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board . of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) ' .l 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other M� S5X10��14� F") AnM ❑ 15. Toxic Chemicals TIME%TEMPERATURE CONTROLS (Potentially Haiardbus Foodsj' fu -n ...,, •x ,�_rm'" `�. _a �m,�,.3.0 t,,.,,ae,�,.iw:.«........: ,a ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR -HIGHLY SIISCEPTIBLE'PUPIILATIONS (H&)tlr' ❑ 21. Food and Food Preparation for HSP t%CONSUMER ADVISORY" E ',„' -' x 'h,wra ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses. Interventions 4 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 J 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: r 1 1�/�'('/ G Inspector's Signatut: \ P/ Print: n PIC's Signature: I ; Print:W Page4of ages Violations Related to Foodborne illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1I 590.003(A) I Assignment of Responsibility* 590.003(B).. Demonstration of Knowledge" 2-103.11_ . Person in charge - duties ,TraveylifI�\y a 2 590.003(C) Responsibility of the person incharge to Compliance with Food Law* 3-201.12 require reporting by food employees and - 3-201.13 Fluid Milk and Milk Products* a i)licants* 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'rhe Person In Drinking Water from an.Arlroved S stent"` 590.006(A) Charge' 590.006(B) 590.003(6) Reporting by Person in Charge* F-31 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 L� C C •• i ' :. • I t1 * . • a Denotes critical Item in the Weral 1999 Food Code or 105 (:MR 590.000. PROTECTION FROM CONTAMINATION g Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Henneticall 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-tOI.I l Drinking Water from an.Arlroved S stent"` 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP tasted Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Peoulatory Authont 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity*. 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 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(J) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of uitnent* 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 A roved Procedures* a Denotes critical Item in the Weral 1999 Food Code or 105 (:MR 590.000. PROTECTION FROM CONTAMINATION g Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-3021.1(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Resenice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501..1.11. Mannas Warewashinn - Hot Water Sanitization "rent eratures* - 4-501.112 .Mechanical Warewashing- I%t Water Sanitization Temperatures* 4-501.114 Chemical Sanlfization- temp., pH, concentration and hardness. 4-601.l l(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 uitnent* 4-703.11 Methods of Sanitization - Hot Water and Chemical* IO Proper, Adequate Handwashing 2-301.11 1 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* .. l.i Good Hygienic Practices 2-401..11. Eating, Drinking or Usin Tobacco* 2-401.1.2 Discharges From the Eyes, Nose and - Mouth* 3-30112 PreventinE 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 LocationandPlacement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Hindwashi ng Cleanser, Availability 6-301.12 Hand Drying Provision ITY OF SALEM BOARD OF HEALTH Establishment Name: Page: '5 of 3: Item No. Code Reference C - Critical Item R - Red Item 71- DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY II Date Verified I ln� 'Urij ,, no f -,- Asic 4 1', 7 r A C, C'.' vew ci nrjmqj&r cAocojr iL lJor r ce C/ TO 16w "'441 I E)h �j k3A zQ_V__ Iy)-1 jJ0.4w 12 s1- (X /J..,/ fi ad, I )S' 0., V'' SIC, d'IeL -)J' ,-.T- Wq,delhLkd::_ 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 toRe-inspection comply with all mandates of the Mass/Federal Food Code. I understand that i noncompliance may result in daily fines of tw I my -five Q!l rs or suspension/revocation of your food permit. Corrective Action Required: Ej No Yes o Voluntary Compliance Ll Employee Restriction Exclusion Scheduled U Emergency Suspension '�) U Embargo U Emergency Closure ZI Voluntary Disposal cl Other: M M Violations Related to Poodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 1s * Denotes critical item in the. federal 1999 Foal Code or 105 CNIR 590 000- Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Una roved Additives* [[3-302 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original containers` 7-102.11 Common Name - Working Containers* 7-201-11 Separation - Stora e* 7-202,11 Restriction - Presence and Use* 7-202.,12 Conditions of ('set 7-203.1.1 Toxic Containers - Prohibitions* 7-204.11. Sanitizers,Criteria- Chemicals* 7-204.1.2 Chemicals for Washing Produce, Criteria* 7-204.14 Drvin& A eats. Criteria* 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 Restricted Use Pesticides. Criteria* 7-20612 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control an Monitoring* * Denotes critical item in the. federal 1999 Foal Code or 105 CNIR 590 000- Proper Cooking Temperatures for E3-501.15 1g PHFs 3-401.11A(l)(2) Gggs- 155`F 1.5 Sec. [[3-302 Eyes- Immediate Service 145'1715sec* 3-401.11.(A)(2) Comminuted Fish, Meats & Gante 20 Animals - 155'F 15 sec.' 3-401.11(1)(1.)(2) .Pork and Beet Roast - I30'13 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 1-55'F 15 S e6al Re uiremerts Other see. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165`1' 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401,11(A)(I)(b) All Other PHFs -145'F 15 sea Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165".F 15 sec. "` 3-403.11(B) Microwave- 165' F 2 Minute Standing Time, 3-403.11(C) Commercially Processed RTE Food - 1.40'F* 3-403.11(E) Remaining- Unslieed Portions of Beef Roasts* Proper Cooling of PHFs 3-501.1.4(A) Cooling Cooked PHFs from 140`F to 70'F Within 2 Flours and From 70'F to 41"F/45cF Within 4 Hours. 3-501.14(B) Cooling PIlFs Made From Ambient ` Temperature Ingredients to 41'F/45 -F Within 4 Hours* * Denotes critical item in the. federal 1999 Foal Code or 105 CNIR 590 000- 21 3-501-14(0) PFfFs Received at Temperatures According, to Law Cooled to 4I'F/45'F Within 4 Fears E3-501.15 1g cooling Methods for PHFs PHF Hot and Cold Holding 3 -801 -HIP) 3-501.16(13) Cold PHFs Maintained at or below 590.004(F) 41%45°F* [[3-302 3-501.16(A) Ihai PHFs Maintained at or above 140'R * Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 3-501.'16(A) Roasts Held at or above 130'F- 20 Time as a Public Health Control 28. 3-501.19 'Gime as a Public Health Council* 008 590.004(H) Variance Ra uirenrent 21 3-801, t I (A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* Animal FondsThat are Raw, Underawked or 3 -801 -HIP) _Use ol'Pasteuri zed Eggs* [[3-302 3-M1,1.1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. Pasteurized Gggs Substitute for Raw Shell 3-801.11(0) Uno coed Pcxtd Parka c NotRe-served. bt'=U aL rtt:UUlrttAA to t 5 590.009(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 prael ices should be debited under /129 - Specitd Requirements, (Items 23-30) Critical and non-critical violations, which do stat relate to the foodborne illness inrervenrions and riskfactors listed above, can be ,found in the following sections of the Food Code and 105 CMR 590.000. - Item 11Consumer Advrany Posted for Cousatnpdon of FC 590.000 Animal FondsThat are Raw, Underawked or Manu ement and Personnel ]Lot Otherwise Processed to Eliminate [[3-302 Patho*'E""1e`'".'rom.13 FC -- 1__L204 Pasteurized Gggs Substitute for Raw Shell _Equipment and Utensils W atec_Plumbing and Waste _Physical Facility _--__-_ E gs" bt'=U aL rtt:UUlrttAA to t 5 590.009(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 prael ices should be debited under /129 - Specitd Requirements, (Items 23-30) Critical and non-critical violations, which do stat relate to the foodborne illness inrervenrions and riskfactors listed above, can be ,found in the following sections of the Food Code and 105 CMR 590.000. - Item ----------------- Good Retail Practices FC 590.000 23. Manu ement and Personnel FC - 2 1 .003 24. Food and Food Protection FC -- 1__L204 Z5 26 27. _Equipment and Utensils W atec_Plumbing and Waste _Physical Facility _--__-_ FC -4 _.0_05 FC _5_ -� .006 FC -6 J .007 28. Poisonous or Toxic MaterialsFC-7 008 29 30 S e6al Re uiremerts Other R ,062 Ax k _ CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page:_ Of 3 `C Item Code c- Critical Item -DESCRIPTION OF VIOLATION? PLAN OF CORRECTION Date :J } No. Reference R — Red Item >;. PLEASE PRIN CLEAR :Y -- Verified 1ooc i' t t ! o r A n _ o� e n 2 - (e C� ' S r A icl` C - r m I 4 5 Discussion With Person in Charge: Corrective Action Required: U No e tif ❑ Voluntary Compliance L.) Employee Restriction / Exclusion I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next ins ection, to ob erve all conditions as described, and to P Re-inspection Scheduled ❑ Emergency Suspension A comply with all mandates of the Mass/Fed ral Food Code. I understand that noncompliance may result in daily fines ofenty-five ell.3rs or suspension/revocation of El Embargo ❑ Emergency Closure your food permit. � 'rl^ ^ ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 I7 18 TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives:` 3-302.14 Protection from Unapproved Additives* Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers* 7-1.02.11 Comrnon Name - Working Containers* 7-20't.II Separation - Storaee* 7-202.11 Restriction -Presence and Use* 7-202.12 Conditions of Use* 7-20.3.11 Toxic Containers - Prohibitions"` 7-204.11 Sanitizers,Criteria - Chemicals" 7-204.12 Chemicals for Washine Produce, Criteria" 7-204.14 Drying Agents, Criteria, 7-205.11 Incidental Food Contact, Lubricants* 7-20611 Restricted Use Pesticides, Cnteria* 24 Rodent Ba9t Suttigns" M Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS " Denotes critical ileo in the [Mend 1999 Food Cod,, or 105 Ch3R 590.000. Proper Cooking Temperatures for PRFs Received ra Ttmperamres PRFs 3-401.1.IA(1)(2) Eggs- 155'F 15 Sec. Eggs- humediate Service 145'F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Gane 3-801.11(D) Animals - 155'F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 nim* 3-401.11.(A)(2) Ratites, Injected Meats - 15,5'F 1,5 3-561.16(B) sec. 3-401.1.1(A,)(3) Poultry, Wild Game, Stuffed PRFs, 41 V45° F* Stuffing Containing Fish, Meat, 3-501,16(A) Youltr or Ratites -165°F 15 sec. ;' 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 140°F.* 1.45'F * 3-40112 Raw Animal Foods Cooked in a 24 Microwave 165'F * 3-401,11(Aul)(b) All Other PHFs - 145'F 15 sec. 3-501.19 Reheating for Hot Holding 3-403.11(A}Xr(I)} PHFs 165°.F 15 sec.:: 3-403.11(B) Microwave- 165' F 2 Minnie Standing Trine* 3-403.11(C) Commercially Processed RTE Food - 140'F' 3-403.11(F) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70`F Within 2 Hours and From 70'F to 41.'FI45'F Within 4 Hours. * 3-501 144(B) Cooling PHFs Made From Ambient Tempel attire Ingredients to 41'Fid5'F Within 4 Hours* " Denotes critical ileo in the [Mend 1999 Food Cod,, or 105 Ch3R 590.000. 2 3-501.14(C) PRFs Received ra Ttmperamres According to Law Cooled to _ 4FF145"F Within 4 Hours. k3-501.15 3-801.11(D) Cooling Methods for PRFs ]q 3-302.13 PHF Hot and Cold Holding 3-561.16(B) Cold P[-Ib's Maintained at or below 590.004(F) 41 V45° F* 3-501,16(A) Hot PHFs Milntained at or above 140°F.* 3-501. t6(A) Roasts Held at or above 130'F. ' 24 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(1-1) Variance Requirement 2 7 Onpasteurized Pre-packaged Juices artd Beverages with Wn "ing Labels* 3-901.11(B) Use of Pasteurized EPes* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-302.13 Raw Seed S rouis Not Served.* 3-f,0'1.11(C) Uno ened Food Packa e Not Re -served. * 22 3-603.'11 Consumer Advisory Posted for Consumption Of Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate .Pathogens,* F*oxve vri&Oqt 3-302.13 Pasteurized Eggs Substitute for Raw Shell 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 tisk factors. Other .590.009 violations relating to good retail practices should be debited under #29 -- Special Requirements. ( tete; 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, cnn be (mend in the fotloa-ing se rtions of the Food Code and 105 CXYR 590.000. so111& ,,baa 2.ax MaMcichusetts Department of Public Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Health � Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of Operations) Type of Inspection ,T5rFood Service Retail _Routine Re -inspection Address Risk'/❑ Level ❑ Residential Kitchen Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast I'revious In p ction Date: JG' ❑Pre -o ration ❑ Suspect Illness ❑ General Complaint Telephone❑- Owner „I \. G v C c 0 HACCP YM y Person in Charge (PIC) Time Inspectoron Pt Out:/� Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific pcovision(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 -..a„'" t� NR,..:.:, „�",„;w";';;,;, ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned / Knowledgeable [Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH n:rim, ,tii„ ;'PROTECTION FROM CHEMICALS" ❑ 2. Reporting of Diseases by Food Employee and PIC ... =v..t El14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded : A r ❑ 15. Toxic Chemicals !FOGDFROMAPPROVEDSOURCEp,..„ ❑ 4. Food and Water from Approved Source g TIME/FEMPERATURE CONTROLS (06termaf1 Hazardbua Foods) � 1, ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROMCONTAMINATION._: II ' " R.- 1 ' "�7v rT"- ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007)' 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other s: sso�nspecrFormsia.dac � / A I ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ;;REQUIREMENTS FOR HIGHLY SUSCEPTi9LE POPOLATIONS (f0j "�;( E321. Food and Food Preparation for HSP 'CONSUMER ADVISORw, , ,, ,_€ El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing' and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: / Print: T1 A PIC's Signature//� , / Print: �.. ' / �.� Page of Z -Pages u�- tri Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) _ FOOD PROTECTION MANAGEMENT '1 596.003(A) Assignment of Responsibility* ** 590.003(B) Demonstration of Knowledge" 2-103.11 Person in charge -duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-20't.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Thal Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System. 590.006(A) Charge* 590.006(B) 590-003(G) Reporting by Person in Charge* 3 590.003('D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions im 6 FOOD FROM APPROVED SOURCE * Denotes critical item in the ruderal 1999 Foal Cate or 105 CbiR 590.000. 8 Food and Water From Regulated Sources 590A04(A-B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Confamer* 3-20't.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 F, re and Milk Redacts. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.1.1 Drinking Water from an Approved System. 590.006(A) Bottled Drinkin Water* 590.006(B) Water Meets Standards in 31.0 CMR 22.0" Washing Fruits and Ve*stables Shellfish and Fish From an Approved Source 3-20114 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 Re ulato Authorit 3-20118 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11. PFIFs Received at Proper Temperatures* 3-202. t5 ,Parka e litre it * 3-101.11 Food Safe and Unadulterated Tags/Records: Sheiistock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Mamtained* - Tags/Records: Fish Products 3-402.1.1 Parasite Destruction' 3-402.12 Records. Creation and Retention* 590.0040) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-10112 1 Conformance with Approved Procedures* * Denotes critical item in the ruderal 1999 Foal Cate or 105 CbiR 590.000. 8 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Ve*stables 3-304.1.1. Food Contact with Equipment and utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Fear!* Disposition of Adulterated or Contaminated Food 3-701.11 I3iscarding or Reconditioning Unsafe Foods, y Food Contact Surfaces 4-501,111 Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(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 Metlm& of Sanitization - Her Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1t Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventing Contamination When Tasting* 1.2 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacifies* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Hardwashing Cleanser, Availability 6-301.1.2 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: <-16 Co Page:_ of Item No. Code Reference C - Critical Item R - Red Item V DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified Q151 P I be P _ -<' oma— n� ICIO Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all viotlations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understa at noncompliance may result in daily fines of twenty= i e dollars o e to /revocation of Vour food permit. Corrective Action Required: ❑ No es L3 Voluntary Compliance ❑ Employee Restriction / Exclusion �1 Re -inspection Scheduled ❑ Emergency Suspension Ll Embargo ❑ Emergency closure ❑ Voluntary Disposal ❑ Other: v �/ Violations Related to Foodborne fitness Interventions and Risk Factors (items 1.22) (Cont) PROTECTION FROM CHEMICALS Id 16 17 18 w Denotes critical item in the. Pedend 1999 Food Code or 105 CMR 590-000. I- 3-50) - F3-501.15 Food or Color Additives 3-202.12 Additives ti 3-302.14 Protection from Unapproved roved Additives* 3-801.11(C} Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers - ontainers-7-102.11 7 -102 11 Common Name - Working Containers* 7-201.11 Se aration-Storage* 7-202.11 1 Restriction - Presence and Usew, 7-202.12 Conditions of Use* f 7-203.11 'toxic Containers -Prohibitions'' 7-204.11 Sanitizers.Criteria -Chenucals�t1l 7-204.12 Chemicals for Walburg Prodnce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-20611 Restricted Use Pesticides, Critena* 7-206.12 1 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* w Denotes critical item in the. Pedend 1999 Food Code or 105 CMR 590-000. I- 3-50) - F3-501.15 Proper Cooking Temperatures for 19 PHFs 3-401.1.IA(1)(2) Eggs- 1.55`F 15 Sec. 3-801.11(C} E =gs- lnmrediate Service 145".F1Ssec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 20 Animals - 155°F 15 sec. 3-401.1 l(B)(1)(2) Pork: and Beef Roast - l')WF 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 sec. x- 3 -401.11(C)(3) Wholemuscle, Intact Beef Steaks 145°F 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401_11(A)(1)(b) All OtherPHFs- 145'F 15 sec Reheating for Hot Holding ,403.11 (A)&, (D) PFIFs 165'F 15 sec. 3-403.11(B) Microwave 165' F 2 Mnmte Standing Time* 3-403.11(C) Commercially Processed RTE Food - 1.40°F* 3-4011.1(E) Remaining Unslieed 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 Hours. 3-501_14('B) Cooling PFIFs Made From Ambient Temperature ingredients to 41'rAY17 Within 4ours'F w Denotes critical item in the. Pedend 1999 Food Code or 105 CMR 590-000. I- 3-50) - F3-501.15 3-501.14(C) P11Fs Received at Temperatures According to Law Cooled to 41':F/4Y F Within 4 How's. Cooling, Methods for PHFs 19 PHF Hot and Cold Holding 3-801A 1(D) 3 -SOL 16 B) Cold PHFs Maintained at or below 590.004(F) 4.1'/45° F* 3-801.11(C} 3-50'7.I6(A) Hot PHFs Maintained at or above 14W * Not Otherwise Processed to Eliminate 3-501.16(A) Roasts Held at or above 130°F. " 20 Time as a Public Health Control 29. S ecial R uirements 3-50L I9 Time as a Public Health Control*0.004(H) Substitute for Raw Shell 59Variance Re uirement e 3-801.II(A) Unpasteurized Pre-packaged Juices and Beveraees with Warninel,abels* 3-801.11(B) Use of Pasteurized Bees* 3-801A 1(D) Raw or Patualiy Cooked Animal Food and Raw Seed S rzonts Not Served. �` 3-801.11(C} Uno cued Food Parka =e Not Re -served. * R 01'1= 1J tL MCUUI tCNi CIV t a 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. Irmilir111114wol (Items 23-30) Critical and non-critical violations, which do not relate to the ,foodborne illness titrervemions and riskfactors listed above, can be found in the following sections of the Food Code and 105 CMR .590.000. -tem '.. Good Retail Practices 3-603.11 Consumer Advisory Posted for Consumption of 23 Mann ,cement and Personn_el 24. Food and Fend Protection - FC-2 FC_ --3 Anima Foods That are Raw, Undercooked or ;ggs FC - 4 FC - 5 -I FC -6 Not Otherwise Processed to Eliminate _ 28. Poisonous or Toxic Materials FC _-7 Patha=ens. clv"ou3302t3PasteurizedE 29. S ecial R uirements Substitute for Raw Shell _ 30 ..... Other Eggs' 01'1= 1J tL MCUUI tCNi CIV t a 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. Irmilir111114wol (Items 23-30) Critical and non-critical violations, which do not relate to the ,foodborne illness titrervemions and riskfactors listed above, can be found in the following sections of the Food Code and 105 CMR .590.000. -tem '.. Good Retail Practices FC 590.000 23 Mann ,cement and Personn_el 24. Food and Fend Protection - FC-2 FC_ --3 .003 .00A 25. Equi anent and Utensils 26. Water_ grnbin and Waste 27 Ph sical Facili FC - 4 FC - 5 -I FC -6 .005 006 .007 _ 28. Poisonous or Toxic Materials FC _-7 .008 29. S ecial R uirements .009 _ 30 ..... Other s; svoro,,,�m�esaaoc IMP IRTANT MESSAGE FOR DATE TIME 1 M�-a n OF Li)�l�ii%nN�-1 �T AREA CODE NUMBER EXTENSION U FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU CALL AGAIN WANTS TO SEE YOU ;fRUSH:L RETURNED YOUR CALL L FAX TO YOU MESSAGE )U w, �r2< Nn rob SIGNED ops. NOTES _____- it c4to-i Cycluc4ed 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 -2003-0015 LOCATED AT: Strega 94 Lafayette Street Salem MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0221 Jan 3, 2006 Dec 31, 2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES' December 31, 2006 Board of Health ^ 0 This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 10 a3TR . STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741 -1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT y DEC 1 D 9 2005 CITY OF SALEM BOARD OF HEALTH 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 1 NAME OF ESTABLISHMENT S- REQ Rei1; /LL, PJ' EL #_ ADDRESS OF ESTABLISHMENT 5 `I 1P PAU<-I i't34 MAILING ADDRESS (if different) OWNER'S U, CITY s��-8xv CERTIFIED FOOD MANAGER'S Wf TEL #'116 "la( aObq (required in an establishment where potentially hazardous food is prepared.) 1 EMERGENCY RESPONSE PERSON (-P1OQLkC6v-b HOME TEL # R +l 1b1 11(0j, HOURS OF OPERATION: Mon. ` Tue. X Wed. A Thu. i' Fri. �I, Sat.__X_Sun.�K_ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sglft. =$100 more than 10,000sq.ft. =$250 ----------- ----------------------------------------------------------------------------------- _ ........... RESTAURANT YES IVO less than 25 seats 100 25-99 seats more than 99 seats = 200 BED/BREAKFAST YES NO -------------------------- --- 6......... $100 .. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Signature to MGL/Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best @ and Iief,>ave4iled all state tax returns and paid all state taxes required under the law. Date Social Security or Revised 11/03/05 FOODAP2.adm Check# & Date ago .1 94 Lafayette Street City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Strega Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-741-0004 1 PIC Assigned / Knowledgeable / Duties PASS RED Owner: Comments: New chef to be certified by next routine inspection. Linda Cappuccio Non-compliance with: PIC: Anti -Choking PASS Linda Cappuccio 1 Inspector: i I Tobacco PASS John Gehan Date Inspected: Correct By: EMPLOYEE HEALTH Reporting of Diseases by Food Employee and PIC PASSd❑ RED 10/5/2006 Risk Level: Personnel with Infections Restricted/Excluded PASS ❑d RED Permit Number: FOOD FROM APPROVED SOURCE Food and Water from Approved Source PASS RED BHP -2006-0221 Status: Receiving/Condition PASS RED Open # of Critical Violations: Tags/Records/Accuracy of Ingredient Statements PASS RED 3 Conformance with Approved Procedures/HACCP Plans PASS RED 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 05,2006) Page I of PROTECTION FROM CHEMICALS Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION RED RED TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Violations Related to Separation/ Segregation/ Protection PASS Q RED Foodborne Illness Interventions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED RED immediate corrective action) Posting of Consumer Advisories PASS Q Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL RED Comments: Bar hand wash sink has no paper towels or soap at time of inspection. Provide soap and paper towels. Kitchen hand wash sink requires hand wash only sign. Provide sign. PROTECTION FROM CHEMICALS Approved Food or Color Additives Toxic Chemicals PASS PASS 0 RED RED TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooking Temperatures Reheating Cooling Hot and Cold Holding Time As a Public Health Control PASS PASS PASS PASS PASS RED RED RED RED RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Posting of Consumer Advisories PASS Q 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. Oct 05,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE Comments: Raw meat laying on dish wash surface. being preped on ware wash machine. Prepare food in designated areas. Discard meat. Walk in unit has uncovered foods. All foods must be covered. Food stored direcrtly on floor in walk ins. All foods to be stored 6-8 inches off of the floor. Raw chicken being stored on top of ready to eat foods. All potentially hazardous foods to be stored correctly as mandated. Equipment and Utensils FAIL Critical Comments: Ice machine inside panel has accumulatiion of grime. Thoroughly clean and sanitize ice machine. Walk ins both missing thermometers. Provide visible and accurate thermometers.' Meat slicer has accumulation of food on it. Thoroughly clean and sanitize slicer. Small white freezer in back by hand wash sink requires thorough cleaning. Same unit missing thermometer. Provide visible and accurate thermometer. Grill station refrigerators missing thermometers. Provide visible and accurate thermometers. Cutting boards stained and scored. Resurface or replace boards. Montague oven requires thorough cleaning. White freezer in storage room requires thorough cleaning. Sanitizing log not available at time of inspection. Log to be maintained daily. No test strips available at time of inspection. Provide test strips. Water, Plumbing and Waste Physical Facility - PASS FAIL Comments: Back storage room has a hole in the wall. Seal hole to prevent entrance of rodents. Back storage floor floor has chipping paint. Floor to be repainted by next routine inspction. Chemical room has holes in ceiling. Ceiling to be repaired by next routine inspection. Behind ice machine requires thorough cleaning. Kitchen ceiling has accumulation of dust on it. Clean ceiling. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 BLUE BLUE BLUE GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 05,2006 ) Page 3 of Item Status Violation Critical Urgency Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes PASS BLUE GENERAL COMMENTS: 877: 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 05,2006 ) Page 4 of FOODSERVIC E EQ UI PMENT SCHEDULE MK. On DESCRIPTION ELECTRICAL a J¢ 3 d 4. Y x COLD WATER J Q W Z) O= J > a o a WATER WASTE GAS s F- W W O 0 O N m U x O ? N M STEAM MANUFACTURER = CJ W m V7 J W J W ? MODEL REMARKS MK. 1 1 DOOR TYPE DISHMACHINE 42.1 13.1 4 208 3 X 4" 1-1 4z JACKSON PROD. TEMPSTAR W UILT-IN BOOSTER, 140 DEGREE H.W. REQUIRED FROM BUILDING SUPPLY 1 2 1 CONDENSATE HOOD B.T.U. BRITISH THERMAL UNIT B.T.C. CONSTRUCTION CAPTIVE AIRE CUSTOM 2 2A 1 CONDENSATE FAN S. STEAM INLET m� 42 1 �r NOT IN CONTRACT - 2A 3 1 SOILED DISHTABLE W LANDING ;: O Irl 2" EAGLE GROUP CUSTOM 3 4 1 PRE -RINSE FAUCET - -SPARE NUMBER- 11T 1 T& S, INC. B-0133/109 4 5 1 DOUBLE SIDED RACK SHELF od -SPARE NUMBER- - EAGLE GROUP 605383 5 6 1 TRASH RECEPTACLE NOT IN CONTRACT - 6 7 1 CLEAN DISHTABLE T3060SB 44 45 EAGLE GROUP CDTR-42 7 8 1 RACK SHELF X UJI EAGLE GROUP 605380 8 9 1 POT SINK 45 46 1 WORK TABLE W SINK 21 2)1 1213) 2 EAGLE GROUP 414-22-3-18R 9 _l 10 1 POT RACK 2" EAGLE GROUP EAGLE GROUP WM84PR 10 11 1 MOBILE SHELVING UNIT WALL SHELF EAGLE GROUP EAGLEGARD 11 12 - -SPARE NUMBER- EAGLE GROUP WS1272-16 4 -SPARE NUMBER- - 12' 13 - -SPARE NUMBER- 1 X -SPARE NUMBER- - 13_ 14 1 HAND SINK 48 49 IIT 1 1-11T KROWNE HS -2 14 15 1 WALK IN COOLER FREEZER 2)5.01 2)120 1 X W. A. BROWN CUSTOM 11'-7" x 5-10" x 7'-6" 15 . 15A 1 COOLER EVAPORATOR 20L0 1 120 1 X 4' W. A. BROWN CUSTOM 15A 1!B 1 FREEZER EVAPORATER 200 206 1 X 31e W. A. BROWN CUSTOM 15B 15C 1 COOLER CONDENSING UNIT 2Q0 120 1 X W. A. BROWN CUSTOM 15C 1°D 1 FREEZER CONDENSING UNIT 200 WS1260-16 4 20B 3 X 51 W. A. BROWN CUSTOM 15D 16 LOT, SHELVING UNIT METAL MASTERS EAGLEGARD 16 17 1 TRAY REST 52 53 - -SPARE NUMBER- RANDELL CUSTOM 17 17A 3 SHELVING UNIT METAL MASTERS EAGLEBRITE 17A 18 1 CONNEC HON'_ESS STEAMER 43.3 9.0 206 3 X 112- VULCAN -HART VPX3 18 19 1 MOBILE STEAMER STAND E.L MUSTEE 1 VULCAN -HART STAND 19 2D 1 REFRIGERATED PREP TABLE 9.0 1 120 1 X RANDELL MFG CO 8260N 20 21 1 UTILITY STAND W SINK 240 55 1A 1 1-1 Az RANDELL MFG CO 11260 0 22 1 DOUBLE OVERSHELF RANDELL MFG CO CUSTOM 22 23 - -SPARE NUMBER- 56 57 11 24" COCKTAIL STATION -SPARE NUMBER- 23 24 - -SPARE NUMBER- 1 SUPREME METAL -SPARE NUMBER- - 24 25 1 (3)HOT FOOD TABLE 14.4 3.0 120 1 X 11T RANDELL MFG CO 3313 25 z 1 HEAT LAMP 0.92 12D 1 X HATCO CORP. GRAH-36 26 27 1 MICROWAVE OVEN 14.6 1.0 12D 1 X PANASONIC NE -1056 27 28 1 TOASTER, FOUR -SLICE 11.51 2.4 206 1 X 1 WELLS MFG CO T -4C 28 29 1 1 1 ICE STORAGE BIN X 31e MANITOWOC, INC S-570 29 30 1 ICE MAKER 12.1 1-1A 208 1 X 1 MANITOWOC, INC QY-804A 30. 31 1 WATER FILTER S:!PREME METAL I CR -HS -15 MANITOWOC, INC TRI -L -20N 31 • 32 1 EXHAUST HOOD 10.0 120 120 1 X 1XII34" CAPTIVE AIRE CUSTOM 32 32A 1 EXHAUST FAN BEVERAGE AIR IDD94 SELF CONTAINED 62 NOT IN CONTRACT - 32A 32B 1 MAKE-UP AIR FAN NOT IN CONTRACT - 32B 33 1 FIRE SUPPRESSION SYSTEM 63 64 1 UNDERCOUNTER DISHWASHER ANSUL OR EQUAL R-102 SYSTEM 33 34 1 S S WALL PANEL 1 1 CAPTIVE AIRE CUSTOM 34 35 - -SPARE NUMBER- 66 2 BACK BAR COOLER 7.2 1 120 -SPARE NUMBER- - 35 35 1 POT FILLER I 1 T & S, INC. B-605/WALL BRACKET 36 37 1 10 BURNER RANGE a 4" 270 VULCAN -HART 60L 37 38 1 SALAMANDER BROILER S.fREME METAL CRI -12-36-7 !W /SPEED RAIL & 7 CIRCUIT COLD PLATE 1 34" 66 VULCAN -HART 36SB 39 1 SINGLE CONVECTION OVEN 9.0 1 120 1 X 4" 1 60 VULCAN -HART SG4C 39 40 1 FLOOR MODEL FRYER 111T 120 VULCAN -HART GRS45 40 * DENOTES EQUIPMENT NOT IN KITCHEN EQUIPMENT CONTRACT. * * DENOTES EXISTING EQUIPMENT NOT IN KITCHEN EQUIPMENT CONTRACT. * * * DENOTES EXISTING EQUIPMENT TO BE RELOCATED. * u �1 F00DD SER VDCC ELEVATION- CHEF'S LINE ELEVATION- COOKING LINE E U P ME NI'T 8 C HE DD U L E MK. On DESCRIPTION ELECTRICAL a < Q Ci Y = COLD WATER N _j< JQQ'O > Wt- a w o a WATER 0 0 OU S WASTE GAS r w x w w O N STEAM = c� p� to a w x "j W MANUFACTURER MODEL REMARKS FUNNEL FLOOR DRAIN MK. 41 1 COUNTERTOP CHARBROILER B.G. BOTTLE GAS A.F.F. B.T.U. BRITISH THERMAL UNIT B.T.C. CONSTRUCTION 444w 87 VOLTS CENTER LINE VULCAN -HART VCCB36 W S S STAND S. STEAM INLET m� 42 1 �r 12.0 1 1 OOI u �1 F00DD SER VDCC ELEVATION- CHEF'S LINE ELEVATION- COOKING LINE E U P ME NI'T 8 C HE DD U L E MK. On DESCRIPTION ELECTRICAL a < Q Ci Y = COLD WATER N _j< JQQ'O > Wt- a w o a WATER 0 0 OU S WASTE GAS r w x w w O N STEAM = c� p� to a w x "j W MANUFACTURER MODEL REMARKS FUNNEL FLOOR DRAIN MK. 41 1 COUNTERTOP CHARBROILER B.G. BOTTLE GAS A.F.F. B.T.U. BRITISH THERMAL UNIT B.T.C. CONSTRUCTION 444w 87 VOLTS CENTER LINE VULCAN -HART VCCB36 W S S STAND S. STEAM INLET 41 42 1 REFRIGERATOR FREEZER 12.0 1 1 120 1 O X1 ;: O Irl !�So� 'RUE FOOD SERV T-23DT 42 43 - -SPARE NUMBER- U O ww t od -SPARE NUMBER- - 43 44 1 MOBILE WORK TABLE 0 00 EAGLE GROUP T3060SB 44 45 1 20 QUART MIXER 9.8 1A 120 rn 1 X UJI BERKEL B20 45 46 1 WORK TABLE W SINK lg 2" EAGLE GROUP T3072SB-BS W/20" x16" SINK 46 47 1 WALL SHELF EAGLE GROUP WS1272-16 4 47 48 1 IFOOD PROCESSOR 7.0 1A IX 1 X ROBOT COUPE R2N 48 49 1 FOOD SLICER 4.5 112 120 1 X BERKEL 909E 49 50 1 WORK TABLE EAGLE GROUP T3060SB-BS 50 51 1 WALL SHELF EAGLE GROUP WS1260-16 4 51 52 - -SPARE NUMBER- --SPARE NUMBER- - 52 53 - -SPARE NUMBER- --SPARE NUMBER- - 53 54 1 MOP SINK1 1 11 E.L MUSTEE 19F y} 55 1 1 ICE BIN 1" DELFIELD 240 55 56 3 SODA SYSTEM W 3 GUNS NOT IN CONTRACT BY VENDOR 56 57 11 24" COCKTAIL STATION 1 SUPREME METAL CRI -12-24-7 W SPEED RAIL & 7 CIRCUIT COLD PLATE 57 58 2 BLENDER STATION 15.0 12D 1 X 1 1 1-1 SUPREME METAL CR -RS -15 58 59 2 BLENDER 10.0 1 12D 1 X WARING BB900S 59 60 1 UNDERCOUNTER REFRIGERATOR 4.0 1A 12D 1 X TPUE FOOD SERV TUC -27 SELF CONTAINED, NEMA 5-15 60 61 1 BAR HAND SINK 1 1 11T 1-1 S:!PREME METAL I CR -HS -15 61 62 1 DRAFT BEER COOLER 7.2 1A 120 11 1XII34" BEVERAGE AIR IDD94 SELF CONTAINED 62 63 1 15" COCKTAIL STATION 1' SUPREME METAL CRJ-15 63 64 1 UNDERCOUNTER DISHWASHER 33.0 6.7 4 27B 1 X 1 1 J,A�KSON PROD. JP-24BF _ CRCR-24 _ 64 65 65 1 GLASS RACK-SU-'REME METAL 66 2 BACK BAR COOLER 7.2 1 120 1 1 X1 EVERAGE AIR BB -78 SELF CONTAINED W 2 GLASS DOORS, 1 SOLID 66 67 1 36" COCKTAIL STATION a S.fREME METAL CRI -12-36-7 !W /SPEED RAIL & 7 CIRCUIT COLD PLATE 1 67 k DENOTES EQUIPMENT NOT IN KITCHEN EQUIPMENT CONTRACT. * * DENOTES EXISTING EQUIPMENT NOT IN KITCHEN EQUIPMENT CONTRACT. * * * DENOTES EXISTING EQUIPMENT TO BE RELOCATED. NOTE: ALL PLUMBING AND ELECTRICAL CONNECTIONS FOR EXISTING EQUIPMENT AND EQUIPMENT NOT IN KITCHEN EQUIPMENT CONTRACT TO BE VERIFIED BY THE OWNER AND OR GENERAL CONTRACTOR. NOTE: TRIMARK UNITED EAST IS NOT RESPONSIBLE FOR ANY MECHANICAL REQUIREMENTS FOR EXISTING EQUIPMENT TO BE REUSED. IT IS THE RESPONSIBILITY OF THE GENERAL CONTRACTOR, PLUMBING CONTRACTOR AND ELECTRICAL CONTRACTOR TO VERIFY ALL REQUIREMENTS WITH OWNER TO ENSURE PROPER CONNECTIONS ARE MADE NOTE. ALL PLUMBING AND ELECTRICAL UTILITY REQUIREMENTS SHOWN. ON THIS SCHEDULE ARE SUBJECT TO CHANGE BASED ON FINAL EQUIPMENT PROPOSAL SELECTED BY THE OWNER AND/OR CONTRACTOR. H.W. HOT, WATER V. C.W. COLD WATER H.P. W. DIRECT WASTE K.W. I.W. INDIRECT. WASTE AMP. F.D. FLOOR DRAIN S.R. F.F.D. FUNNEL FLOOR DRAIN D.R. G. GAS PH. B.G. BOTTLE GAS A.F.F. B.T.U. BRITISH THERMAL UNIT B.T.C. ABOVE FINISHED FLOOR C.P. CORD AND PLUG BRANCH TO CONNECTION THIS PLAN IS PRELFANARY, REFERENCE ONLY, NOT FOR CONSTRUCTION. ALL MECHANICAL INFORMATION SHOWN IS (� SUBJECT TO CHANGE BASED ON FINAL PROPOSAL SELECTED BY OWNER. GENERAL CONTRACTOR TO VERIFY WITH OWNER BEFORE ANY CONSTRUCTION CAN BEGIN. TRIIMARK UNITED EAST CAN NOT BE HELD E-4 RESPONSIBLE E THIS PLAN IS USED FOR CONSTRUCTION. O THIS DOCUMENT IS �"" PRELIMINARY, REFERENCE �p ONLY, NOT FOR «+ CONSTRUCTION 01/13/03 VOLTS CENTER LINE HORSEPOWER D.F.A. DROP FROM ABOVE KILOWATT S. STEAM INLET AMPERE R. STEAM RETURN SINGLE RECEPTACLE C.F.M. CUBIC FEET/MINUTE DUPLEX RECEPTACLE COL. COLUMN PHASE J.B. JUNCTION BOX ABOVE FINISHED FLOOR C.P. CORD AND PLUG BRANCH TO CONNECTION DATE I DESCRIPTION z 0 rn 1u M DATE, 01-16-2003 DRAWN BY- B.J.D. SCALE, 1/4"=1'-0" W (� U O E-4 r5 O int �"" S �p U «+ d o, -, to— O O Oin ;: O Irl !�So� �z U O ww t od wa 0 00 i 0— rn DATE I DESCRIPTION z 0 rn 1u M DATE, 01-16-2003 DRAWN BY- B.J.D. SCALE, 1/4"=1'-0" CAD FILE NAME- STREGA These Drawings are the sole property of TriMark United East and are not to be used in whole or in part without the written consent of TriMark United East. Owner and all Contractors to check and verify existing dimensions and conditions in the field before starting construction and to notify TriMark United East of any material or detail changes. CHECKED BY- SHEETN0- W (� a E-4 r5 W W <�co �z ww � wa 00 i 0— UJI Cc CAD FILE NAME- STREGA These Drawings are the sole property of TriMark United East and are not to be used in whole or in part without the written consent of TriMark United East. Owner and all Contractors to check and verify existing dimensions and conditions in the field before starting construction and to notify TriMark United East of any material or detail changes. CHECKED BY- SHEETN0- Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name5_� pate T e of Operation(s) T f Inspection PIC's Signature: ` _ Food Service Retail outine Ke -inspection Address Risk Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: ElTemporary ❑ Pre-operation OwnerHACCP YM ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time El HACCIP Inspector Ou :: Permit No. ❑ Other each violation cnecKea requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. U ' Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 590.009 (F) action as determined by the Board of Health. l FOOD PROTECTION -MAN *• a -_.., „a.. W 11. 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 N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other " S. 5nlnsedFPo 14.tl V El12. Prevention of Contamination from Han dS ❑ 13. Handwash Facilities [PROTECTION FROM CHEMICALS v , � ,... _ I ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods). ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control _- REQUIREMENTS FOR HIGHLY_ SUSCEPTIBLE POP.ULATIONS_(HSP)I ❑ 21. Food and Food Preparation for HSP 0 SUMER 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 ofthis order DATE OF RE -INSPECTION: Inspector's Signatul: Print: PIC's Signature: Print: __) � 1 - Pagel ofYages ggqpilpg�i IP 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` 2-1.03.1.1. Person in charge - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law" 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From PotableDrinkingWater* Applicant To Report To The Person in Drinking Water from an Approved S stem* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrict ons Lm C C FOOD FROM APPROVED SOURCE * Denotes ennead item in the federal 1999 food Code or 10 CMR 590.000. 111111117T11f:Wier$r :ouff 9-.r _u Tke Vi $k $ Food and Water From Regulated Sources 590.004(A B) Compliance with Food Law" 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 EMs and Milk Products, Pasteurized* 3-202.16 Ice Made From PotableDrinkingWater* 5-101.11 Drinking Water from an Approved S stem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0"' Washing Fruits and Ve.getables 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* Contaminabon from the Consumer Game and Wild Mushrooms Approved by Regulahcry Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Came Animals* 3-701..11 Receiving/Condition 3-202.1.1 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records:'Fish Products 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients' Cleaning Frequency of Equipment Food -- Contact Surfaces and Utensils* Conformance with Approved Procedures /HACCP Plans 3-502.1] Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes ennead item in the federal 1999 food Code or 10 CMR 590.000. 111111117T11f:Wier$r :ouff 9-.r _u Tke Vi $k $ Cross -contamination 3-302.1.1(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302-11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) -I Food Protection* 3-302.15 Washing Fruits and Ve.getables 3-304.11 Food Contact with Equipment and Utensils* Contaminabon 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 Temperaturee 4-501.112 _ Mechanical Warewashing- Hot Water Sanitization Tem eratures*- 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. 4-601..11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food -- Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Foal Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* .2-401.12 Discharges. From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contaminationfrom Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. . Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 - Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.1.2 Hand D m Provision y 4, Massachusetts Department of Public Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Health S Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name S_�A D _ ✓vy Address a p ` n n `l v, ._A t ateType I - Risk Level PIC's Signature: - l of Ooeratlon(s) Type of Inspection [NRoutine ❑\Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint El HACCP ❑ Other Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Telephone _ J Owner HACCP YM Person in Charge (PIC) inspector nn � Time In:\ J' QUC Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. J Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Antl-Chokin 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. rL I I FOOD PROTECTION MANAGEMENT ;1. PIC Assigned / Knowledgeable / Duties - EMPLOYEE HEALTH_ _ _ n h -71 ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE --0.-4 Food and Water from Approved Source ❑•5. Receiving/Condition ❑. 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION. , ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations. must be corrected immediately or within 90 days as determined by the Board of Health. .C. N.... 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 5901nspectPo 14.E ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ' ` ` " [114. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMElrEMPERATURE CONTROLS (Potentially Hazardous Foods) a ❑ 16. Cooking Temperatures ❑ 17. Reheating r ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control 21. Food and Food Preparation O lationfor HSP E -POPULATIONS El [CONSUMER ADVISORY " 2 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: RAZ Y r/A-1 cru a,fi C Inspector's Signature: PIC's Signature: - l Print: �� G� Pagel of4a7Yages Pn_q,''/i10{-��LPIt �G�o'�e.�k � � /2. c,�-ems Iit•MS�I�w �kG'�u.�.I �,,,c-¢� v� -Vimr�C�� t (�I 5 1� Pn I �CQ �� s�Q��I °C�e 2-e2Q C' hcV cc -,t r Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(.0) Assig men( of Res tonsibility* 590.003(B) Demonstration of Knowledge" _ 2-103.11 Person in charge -- duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202,16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved S stem" 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3 590.0(13(D) Exclusions and Restrictions* 3-20LI5 590.003(E) Removal of Exclusions and Restrictions Im C Fa - F, C FOOD FROM APPROVED SOURCE * Denotes critical acre in Phe Federal 1999 Food Code or 105 CMR 590800. La PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.1.4 Eggs and Milk Products. Pasteurized* 3-202,16 Ice Made From Potable Drinking Water* 5-101.1.1 Drinking Water from an Approved S stem" 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Sheldish and Fish From an Approved Source 3-201.1.4 Fish and Recreationally Caught Molluscan Shellfish* 3-20LI5 Molluscan Shellfish from NSSP Listed Sources* Proper, Adequate Handwashing Game and Witd ;Ylushrooms Approved by Regulatory Authorfi 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 2-301.14 ReceivingiCondition 3-202.1.1. PHFs Received at Proper Temperatures* 3-202.15 Package Inte rite* 3-101,.11. Food Safe and Unadulterated Tags/Records; Shellstock 3-202.18 Shellstock Identification * 3-203.1.2 Shellstock Identification Maintained* 12 Tags/Records: Fish Products 3-402.11 Parasite Desbvctiou* 3-402.12 Records. Creation and Retention' 590.004(1) Labeling of Ingredients' Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.1.2 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical acre in Phe Federal 1999 Food Code or 105 CMR 590800. La PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302. If (A)(]) Raw Animal Foods Separated from Cooked and RTE Focais* 4-501.111. Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Temperatures* Contamination from the Environment 3-302.1I(A) Food Protection* 3-302.15 1 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* 4-602.11 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3-701..11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces - 4-501.111. Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical. Sanitization- temp., pH; concentration and hardness. * 4-601..11(A) Equipment Food Contact Surfaces and - Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Fond - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2.301.11 Clean Condition - Hands and Atms* 2-301..12 Clearting Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2401.1.2 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tast 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacities* 5-204.11 Location and Placement* 5-205,11 - Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.1-1 Handwashing Cleanser, .Availability 6-301..1.2 Hand Drying Provision CITY OF SALEM (� BOARD OF HEALTH Establishment Name:_�X1t o -4,0— Date: l- (O- D Page: of Item No. Roue Reference C - Critical nem R -Red Item J DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY .U/Vl'7 '—'eDj Date Verifled f ( -00 C�Ir'd -o u'I o /_y)(j S6,1 "n - S I kd /1 -AU V0F,�a, Y)PtI�A P . a YY 4- 1 J(A"7 � Q.t! �1� __)A rll a )AAXJ✓�._. 'R00/1,� V_. 'R - v ,t i��nP KI U 4 IriQ- �- �� '�� < Al, p telO 11n �tb �'�) A�i/�r_� ✓e t�,u ( l,19/__vA1P.rf-A U,,. ?/ l 0 0 n� U Pa Al �» U Qtie Q ter I � > /V1 oaQ 'V1)'r/L/vi�e nV/v� U_7755 1 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/ comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of t enty five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ .Yes '9/ Voluntary Compliance ❑ Employee Restriction / Exclusion lel' Re -inspection Scheduled ❑ Emergency Suspension Q, ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne Ilinesainterventions and Risk Factors (Hems 1-221 (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIMEMEMPERATURE 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 - Storae* 7-202.11 Restriction -presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizera,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 1 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMEMEMPERATURE CONTROLS * Denotes critical item in the federal 1999 Food Code a,105 CMR 590.000. C 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFS 3-40i.11A(1)(2) Eggs- I55°F 15 Sec. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145'F15sec* 3401.11(A)(2) - Comminuted Fish. Meats & Game 3501. t 6(A) Animals - 155°F 15 sec. * 3401.1I(B)(1)(2) Pork and Beef Roast - 130'F 121 min* 3401.11(A)(2) Ratites, Injected Meats -155-F 15 590.004 H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFS, 27. Stuffing Containing Fish, A4eat, FC -6 Poultry or Ratites -165'F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 1 FC -7 145'F " 3401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3-401:11(A)(1)(b) All Other PHPs -145°F 15 sec. Reheating for Hot Holding 3403A 1(A)&(D) MIN 165-F 15 sec. * 3.403.11(B) Microwave -965° F 2 Minute Standing Time* 3-403.11(0) 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 70'F to 41'F/45'F A ithin 4 Hours. '- 3-501.14(B) 3-501.14(B) Cooling PHFS Made From Ambient Temperature Ingredients to 41°F/45'F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code a,105 CMR 590.000. C 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 4l F/45'F Within 4 Hours. 3-501.15 Cooling Methods for PHFS 3-801.11(B) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFS Maintained at or below 4101450 F* 3-501.16(A) Hot PHFS Maintained at or above 140'F. * 3501. t 6(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004 H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* - 5.90.000 3-801.11(B) Use of Pasteurized E °s* _ FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served, * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served - CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 5.90.000 23. Animal Foods That are Raw. Undercooked or _ FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Patho ens.* exK"ve ,nRoa, 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell .0055 26. 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. (Items 23.30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sectionsofthe Food Code and 105 CMR 590.000. Nem Good Retail Practices .FC 5.90.000 23. Manastement and Personnel _ _ FC -2 .003 i 24. Food and Food Protection FC - 3 .004 25. Equipment and Utensils I FC -4 .0055 26. Water Plumbinq and WasteFC-5 008 I 27. Physical Facility FC -6 .007 28. Poisonous or Toxic Materials 1 FC -7 .008 29. Special Requirements ,009 30. 1 Other s:rm:c-a ax. Mad'sachusetts Department of Public Health Division of Food and Drugs ' FOOD ESTABLISHMENT INSPECTION REPORT <'11r.. 01... J" Ott h(. ...,M-. t: [:-,:4^v _A7, IF i Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Print: Dat lel Z) T of Operations) Tvoe of Inspection '®Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. �]r Routine ❑ Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other ` y Address Q �1 C\1 _ 4 QQ rr• Risk Level Telephone Owner ( tnc �r 0 JCc.l o HACCP Y/N Person in Charge (PIC) Time Out: / Q Inspector '� 1 Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. 'FOOD PROTECTION MANAGEMENT' �`„�;- ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH"g¢.� 7,.moi ,,.1,1 vi i"�" 1{U"� ❑ 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 ry meq, Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C! N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S, 5001nsIdFor 14. o I ono �. ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities L PROTECTION FROM CHEMICALS a ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals i TIMEITEMPERATURE CONTROLS (Fkliemtally H2lzardous Foods) r, ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control .*.•".:REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)2 ❑ 21. Food and Food Preparation for HSP :OCONSUMEF 5 n 4, E] 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: _ 0✓�S a�(� Inspector's Signature: ) L Print: PIC's Signature: " - Print: (j y�e f Page ofages u 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 Knowled e* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by foal employees and 3-201.13 Fluid Milk and Milk Products* a >lil cants* Shell Eggs* 590003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Aplyoved System* 590.006(A) Char e* 590.006(B) 590.003(6) Reporting by Person in Charge* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Re trio ons 4 6 C -Denotes critical item in the federal 1999 Food Code or 10; CMR 590.000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.1.3 Shell Eggs* 3-202.14 EMs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101..1.1 Drinking Water from an Aplyoved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Reoulatow Authorit 3-20118 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11. PHFs Received at Pro er Temperatures* 3-202.15 Package lriteit y 3-101.11 Food Safe and Unadulterated Tags/Records: Shellslock 3-202.18 Shellstock Identtiflcation * 3-203.12 Shellstock Identification Maintained- Tags/Records: Fish Products 3-40111 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(.f) 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 acka hg, criteria* 8-1(13.1.2 Conformance with Approved Procedures* -Denotes critical item in the federal 1999 Food Code or 10; CMR 590.000. PROTECTION FROM CONTAMINATION $ Gross -contamination - 7302.11 (-At( 1) Raw Animal Foods Separated from Cooked and RTE Foals* Contamination from Raw Ingredients 3-302.1. (A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-30211(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and ReserviceofFood* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.1 t2 Mechanical Warewashing- Hot Water SatritizationTemperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11. Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eatinii, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tastin * 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Ca achies* 5-204.1.1. Location and Placement* 5-205.tl Accessibility, Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.I1 Handwasin ng Cleanser, Availability 6-301.12 Hand Drying Provision C CITY OF SALEM 1 BOARD OF HEALTH Establishment Name:Date: a LkoPage: of Item Code No. Reference C - Crk(cal nem R -Red Item DESCRIPTION OF VIOLATION / PIZAN OF CORRECTION PLEASE PRINT CLEARLY t Verified ff I // 110 �.. >.Aa r Inl, o I U . in s Cen J 0AAM avew. 7 I r r✓ �I ., r - s— I- Ko/) 1 �Qr 136v G -� tC,17—j i 46 c4 f3 G n re ► o4 l -t.1 QY142CAdA�It/Fr✓ G14 Ar ya, 4- in C 'T h> `SCWW/ r11 1201 fr/ Ike I-�G `I// � ✓ i '�I-.tom P f T —-+,/,, 70 a - Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty0-ive-dollars or suspension/revocation of your food permit.„ /Y Corrective Action Required: ❑ No < ,i7-. Yes, ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion - Re -inspection Scheduled LI Emergency Suspension ❑ Embargo _ ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: Violations Rowed to Foodborne Illness Interventions and Risk Factors (Itehas 1-22) (Cont) PROTECTION FROM CHEMICALS 14 ;K Cf))R: Food or Color Additives II 1�145'F Within -1 Hours. 3-202.12 Additives'* II�BtO� ?f 3-302.14 protection front 1Fnapprovet) Additives"- j is 3 if) I 16(A) 1 3-501. 16(A) Po sonous or Toxic Substances ,2t3 o_501 lr7 11D)4 i 101.11 i Identifying Infi.: million - 061-inal. 11H Fs, FC 00 pawl im- 7_101 11 1 GirdlaOT1 Nam, 'A,frikirti-, L2p FaiCf 1-20t.1 I 'S"pai.worl - SI t I waliLl -- - - ------- 7 7-20111 RelIHc6op 30 Ofhf,- 7702-12 Colidjutfir, of USvl 7 W. [I TOlit: (-'( 3 1 ita ine i f1coli, b): on,' "-')04.11 Salliolels. (1r, ilcri;l - cheitlic:ds A 103.11 ri) -204,11. W clmaicali, fbi: ahwt.od c C liicliol 1-204,14 DitinAveov. Criwlia 205.11 Iplr&nwI (vnfm Lobi nn( s, 7(16.11 R" it i2tl Usc Ile,1% ideF, Roilcal &w NI:!lioas, 06 1 11,,C ii 0011"i 'Mil 16 j I Proper cocking Temperatures 1401_11' ;K Cf))R: II 1�145'F Within -1 Hours. 3-501.1.5 PHFs II�BtO� ?f F`;O �,nd Hf r(o;ii 1 W) j pall, 3-50 lb(Bf 590 004(F 1 Cold PHFs Maintained at or bebiw 410145" F" 3 if) I 16(A) 1 3-501. 16(A) I -lot PHI't lifaintairred at or above 14(0-*, Rujsos Held at or abtl% e 130,'T, ; ,2t3 o_501 lr7 11D)4 Time as a Public Health Control Firitt, �is a Public, dt l rifip,.,e 1 3 40 1 (A)(It 11H Fs, FC 00 iIj _zsie. I FG - 5 L2p FaiCf K _. 6 X17 -4- ----- - - -- - - ------- 7 naf Spec 001ti 30 Ofhf,- p0leatin- for Writ i-icrIf1.lip" 3- -f03. !I A),i l) I N If- t 6. i. I A 103.11 ri) \fioo,,!of 165' 1� 2 I.Omwc Sifin(am, 1 t0 1 kF I Ra;;aa U"'jied pvt(tktns of llct I L8 NIIA4(A) {"o,'jing Cooffj_d PHF, ima" 14P'i-Io floul: 501. lff;; t iv,fStig, III IF, Nli:dc Rom Avkheiti lolaO REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA_TIONS-(HSP) �Isteucd flrc-pacl�agcd Juices and T w llev'ni!2es with Wii1111L UIWI�l I 1 (131 its- ot I , is , at I zed I S01.110)1 I, St ed "'proar" Nor sfi lvd. if{; Ull,q,;led 1_"oixi PatkavCNo J CONSUMER ADVISORY - - ---------- 22 1 1 CI,Aisuoje( o;ilz v Post "'tr Ccamwiptiopi of I od� lba+: Raw, U111jem")k<d Prat sf,,d I,) -limmativ 5i0,si;ro,r to! R;m shall SPLOIAL REOUIREViAENTS (ji lieflictiz A", I f A) ;ti),rt Cawrljfg. lnokjl� ttl,x,L "Clopwaly atid be If VIOLA DO, R_'7;_A TED '10 R'F_ TkC PRAC PHF& Reuived at Teuritteratures According to Law' Cooled to II 1�145'F Within -1 Hours. 3-501.1.5 PHFs 19 PHF Hot and Cold Holding 3-50 lb(Bf 590 004(F 1 Cold PHFs Maintained at or bebiw 410145" F" 3 if) I 16(A) 1 3-501. 16(A) I -lot PHI't lifaintairred at or above 14(0-*, Rujsos Held at or abtl% e 130,'T, ; ,2t3 o_501 lr7 11D)4 Time as a Public Health Control Firitt, �is a Public, dt l rifip,.,e REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA_TIONS-(HSP) �Isteucd flrc-pacl�agcd Juices and T w llev'ni!2es with Wii1111L UIWI�l I 1 (131 its- ot I , is , at I zed I S01.110)1 I, St ed "'proar" Nor sfi lvd. if{; Ull,q,;led 1_"oixi PatkavCNo J CONSUMER ADVISORY - - ---------- 22 1 1 CI,Aisuoje( o;ilz v Post "'tr Ccamwiptiopi of I od� lba+: Raw, U111jem")k<d Prat sf,,d I,) -limmativ 5i0,si;ro,r to! R;m shall SPLOIAL REOUIREViAENTS (ji lieflictiz A", I f A) ;ti),rt Cawrljfg. lnokjl� ttl,x,L "Clopwaly atid be If VIOLA DO, R_'7;_A TED '10 R'F_ TkC PRAC r tudfii, Tit" dl,,e�ll lt iz life wr, 1:t cd wol f�. folir", fc,ort" ;tt 0 11w, itflOd C,_f rN! 19 9"'). ilii U. I �vt, v welt lTanz ieracri 7 F 23tlailageritoA a 1 P�f FC 00 iIj _zsie. I FG - 5 L2p FaiCf K _. 6 X17 -- - - ------- 7 naf Spec 001ti 30 Ofhf,- III Establishment Na CITY OF SALEM BOARD OF HEALTH Date: 1 .ol Pager_ of ) Item Code C -Critical nem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date, No. Reference R - Red Item � PLEASE PRINT CLEARLY . Verlfiecl r iI n B Apdfr • 6 l / n l 1 1.Qrt../J iI a t'/A 0 o/ n �i✓ ��r t� I Z� L C1:20 / cly 41 o' fro �r nC GCr .f.nG _ 1� ,eA s�l Eeccde �" ),/V iscussion With Person in Charge: f Corrective Action Required: ❑ No O Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to p Exclusion Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or.suspension/revocation ofG o Embargo ❑ Emergency Closure 'yrour food permit. ��N �Pf ❑ Voluntary Disposal ❑ Other: t i 3� t 1 Violations Related to Foodborne Illness Interventions and Risk Factors (1(ohis, 1-22) (Cont) EC"nON FROM CHEMICALS I Food or Color Additives 3-202,12 'dLfifiw'* 3-3021 14 Protection from Unap I Poisonous or Toxic sastances Inalion - 01i"ina" 7 W2,11 50I 14.(-,) 7 20T 14 fie t n Pr sLnc Af;cordiug to Lit ix C'00W to of 1!5u -206.1 I t.". -MA t' 7-'(4 12 50I 14.(-,) 7 20T 14 Af;cordiug to Lit ix C'00W to -206.1 I R"ill—Ifill 5' "x if!q1'ifjci' (n'},il .'7 5Q1 T, CtKifin,-, Wffiods for IIHFs '106 I.f r. I,ej PHF Hot and Cold Holding 3-501.16(B) 590 004W1 Cold PHFs Maintainut at or below a REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPUL4TlO-r4,s-_(HS?)----.-- -- _ — --- - — - - — - i. 31 "W, l'i'v, `i,z' A a{ t ,'tt}}Gil o; S "Ild PRA 1, d, clure .Of t Clii"Im. wIil Iot f!fd ;wz bi, II .... diid A ------ ----- - 117' �qlc' Fc 5 104�ifm PU mt` F.0 6 K)7 tvl'-tef <Im FC 50I 14.(-,) Pfll-s Reixiwd n[ I-eniNratures Af;cordiug to Lit ix C'00W to I I F/45'17 Witbin 4 Hotus, 5Q1 T, CtKifin,-, Wffiods for IIHFs 19 PHF Hot and Cold Holding 3-501.16(B) 590 004W1 Cold PHFs Maintainut at or below 1, 16 A, His I"HFI; IMaintained t or above '113A J� A�';00i 11 -- -------- 26 N N jIfIll' S1 4ZJd1al' Time as .1 public Cmirol — - ---- ------- 501 VA) f-fii'ljiw coop d [Ii -IFS I!om I W, to T Within 2 Hour, i,!id From 15 F ',t iti'm 4 3 -50 1, 14 b) Cioiiui, P11F, MiAc If1;!re.0:CI1i' T ' "15 1 1a ;titin d 11,4110 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPUL4TlO-r4,s-_(HS?)----.-- -- _ — --- - — - - — - i. 31 "W, l'i'v, `i,z' A a{ t ,'tt}}Gil o; S "Ild PRA 1, d, clure .Of t Clii"Im. wIil Iot f!fd ;wz bi, II .... diid A ------ ----- - 117' �qlc' Fc 5 104�ifm PU mt` F.0 6 K)7 tvl'-tef <Im FC 50I 14.(-,) Pfll-s Reixiwd n[ I-eniNratures Af;cordiug to Lit ix C'00W to I I F/45'17 Witbin 4 Hotus, 5Q1 T, CtKifin,-, Wffiods for IIHFs 19 PHF Hot and Cold Holding 3-501.16(B) 590 004W1 Cold PHFs Maintainut at or below 1, 16 A, His I"HFI; IMaintained t or above -WiJbi,A) f kwsts I Jdd ai or abo%e 130IT. 26 N N Time as .1 public Cmirol — - ---- ------- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPUL4TlO-r4,s-_(HS?)----.-- -- _ — --- - — - - — - i. 31 "W, l'i'v, `i,z' A a{ t ,'tt}}Gil o; S "Ild PRA 1, d, clure .Of t Clii"Im. wIil Iot f!fd ;wz bi, II .... diid A ------ ----- - 117' �qlc' Fc 5 104�ifm PU mt` F.0 6 K)7 tvl'-tef <Im FC Massachusetts Department of Public Health ,Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT 1 Salem Board of Health 120 Washington Street, 4" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date- / 1/5 / 0 Tvoe of 0 eration(s) Tvoe of Inspection ❑Routine (24Re-inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness [I General Complaint ❑HACCP El Other M -Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile [-ITemporary ❑ Caterer ElBed & Breakfast El Permit No. Address c) �,�` , Risk ' Level Telephone �, Owner i � ,. HACCP Y/N Person in Charge (PIC) Time _ In: /� %� Out: . Inspector -� j .: 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. r FOOD PROTECTION MANAGEMENT- 1. ANAGEMENT 1. PIC Assigned / Knowledgeable / Duties c ` vTM-s j EMPLOYEE HEALTH ""7 � s. 1-"� 7�, g , 1 , -, t"""-e""� ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded a, FOOD FROM APPROVED SOURCE �W'I�'-' El 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 10 ❑ 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. Cgi 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) 1>4-27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.0011) 29. Special Requirements (590.009) 30. Other S. 501nspx(Fofi 14,E ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION PROM CHEMICALS -s ,(a+" El14. Approved Food or Color Additives ❑ 15. Toxic Chemicals r:TIMFJTEM0EFIATURECONT00L§(PoteittlallyHazarituu-8'-F'-' a) "r`I it r,..�i"" .d,: av, "Pr.�,a„•:z U. &I di y@6,:.@J�q_ A g..P' ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREM$NTs,ORHIGHLY$IISOEPTIBLC.POPULATIONS(HSP} ❑ 21. Food and Food Preparation for HSP FCONSUME'RADVISORYr „ "` Iar4R'�u �'��-`T:kma�»� �a � ❑ 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: 7UL � Inspector's Signature: �/ Print: , %PIC's Signature: 4- Print: �� C )0jjPage HZI of -Pages Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) I Assignment of Respbnsibilitt 590.003(B) Demonstration of Knowledge" 2-103.11 Person in charge --duties rl f4- K*yj:j;g.1;r,jiiij 2 590A03(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.7.2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* _ Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Chsu *e* 590.006(B) 590.003(0) Ke ordn b Person in Charge' 3 590.003(D) Exclusions and Retdctions* 3-201-15 590.003(E) Removal of Exclusions and Restrictions im FOOD FROM APPROVED SOURCE * Denoie� critical item in the fedend 1999 Food Code or 105 CMR 590.000. • i ♦ 1k O ?. t! 4 1 S Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.7.2 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 Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.17* WashiriR Fruits and Va etubles Shellfish and Fish From an Approved Source 3-207.14 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 Re ulato Authorit 3-202.15 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 ondition 9 HFs Received at Pro er Tem eratures* Food Contact Surfaces acka a Irate it IffReceiving/Condition ood Safe and Unadulterated agsfRecords: Sheiistock Mechanical Warewashina Hot Water Sanitization Temperatures* hellstookIdentification 4501.114 hellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention*. 590.004(J) Labeling of Ingredients* Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui mene Conformance with Approved Procedures IHACCP Plans 3-502.11 Specialized Processin Methods* 3-502.12 1 Reduced oxygen packaging, criteria* 8-103.12 1 Conformance with A roved Procedures* * Denoie� critical item in the fedend 1999 Food Code or 105 CMR 590.000. • i ♦ 1k O ?. t! 4 1 S Cross -contamination 3-302.1l(A)(1) Raw Animal Foods Separated from Coked and RTE Frxds* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 WashiriR Fruits and Va etubles 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 Fiord* 9 Food Contact Surfaces 4-501.111. Manual Warewashing - Hot Water Sanitization Ten eratures* 4-501.112 Mechanical Warewashina Hot Water Sanitization Temperatures* 4501.114 Chemical Sam iration- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Foal Contact Surfaces and Utensils Clean" 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui mene 4-703.11 Methods of Sanitization -Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms'; 2-301. t2 Cleanin Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401.11 Eating, Drinking- or Using Tobacco* 2-401.'12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Eirto Nees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices fi-301.1 t Handwashing Cleanser, Availabilit 6301..12 Hand Drvirn, Provision - -CITY OF SALEM. <BOARD OF HEALTH � I , i Establishment Name:,( Date://1 Page:_ of Item Ccwe Reference C - CrlUcal Item (/ DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date Verified No. T R - Red Item -. ,` PLEASE PRINT CLEARLY C dO G 61'7f (A)6( 'JI)FUCC IM 15 p -- r 4 "LL � F . _ 4 � T Discussion With Person in Charge: CtirPecti Action Required:, a No ` Yes I have read this report, have had the opportunity to ask questions and agree to correct all o'er oiuntary compliance p Employee Restriction / violations before the next inspection, to observe all conditions as described, and to _ '> P Exclusion ❑ Re-inspectior._Scheduled ❑: Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fine's of twenty' five .dollars.or suspension/revocation of O Embargo, '' ❑ Emergency Closure your food permit. f Voluntary Disposal. ❑ ❑ _-Other: F t -501 id(C) PHFs Heutived at Temperatures Violations Related to Foodborne Illness Interventions and Risk Anording to Law Cooled to Factors (IteMs 1-22) (Cont) 1 -; I `1=l4S"}= Within .l Ri... r, s 1 14 1 1 Food or Color Additives 1 T3-Stl,.l 5 Cooling Method, for PHFs PHF Hot and Cold Holding '. ,K �o; IOY n) ,:out ere s maintained at or ticlow 596.1[)4{1=; 4l /45` f _ Goin UnapprovedAdd,tities q t;l—i tat;) tintPHhcMaintainedatoi-above a or Toxic Substances --1 Identifging intimnatoon - -.---, i u u + .. Presence and t W E :_02.12�!`otoit Lit of Ufa' _------ -- I -26'4. i ! Samuzert Criteria 171u,1ic. tc' -- 7-70i I iiiof Wust'w t!ndl ILC ! -_(11Ull 7 164 1.4 12p_r�m,, A tents_ t nt , Y' 0} i I In;1d ata't<xvl tulle IAYbl1(an 17 -sob_ i 1 --!t T{cn, u ! .d t ii, Pe be 1 ies. CnteY rl —I {.air ngR.W t,tY Ce,od and 11MEin'EMPERATURE CONTROLS _ 14 .._.. .. Nrotrer f'eakYr ld np: atw es fe: _-- Pk}F 5 L ,: 5 1,-t. � , m d1. Ur uo- ! e t 2it1* J.-, quo_. ;).1 + Lt„ Fisd1.'tle rt. ofd -1l _.___ .�._., __ ... 1,�i.i !,Y _ . ! « .Stili!' 4'ri6 (<<'irt (_1!_!q i-) btit lH PYu, r Cooing at PNFS ..Stli- law .. , l.o,,C,64 PHA Win1 t-ii'F1n 174 F Wenn 2 hhury and Win TCt' Allan 1 1d . 7 H.m:_ pi!ils ,lad, C:inaic tn_r ieiRs If, I r'w3'F ". S;HJti(A} _ R, fists Held `at or above 13t1'E. <"_ Time as a Puhiic Hcafth Contro# i ! 4 'fir., as a Public ll.altll ontltll' _ IJAp.'(H) 1 vfniallCuFc, Un .scot .� REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 0801-.11Q) 1 Unpaq,runzal f1spackaged Miers"J CC7;'vS0tAER AID IS0RY 721319! it 1 CAS,nomor son"; ',.i, ii.k ( lit,4tt7 ;ttVn ' Y QtiC c Y.i^ -on 1..11G,ti: n i P. g> In Cct ;i, 4 to, l" l the Kitt St�'i - Vj Ka wA. ANA _ — E' fir?:.: "".j;: ail as1d� r t.hT,C1,<4O AVE` .,,')<:. _FAA r'-# iTrz"'f::.. boom "}_3ti) _Y 4nh .r? no, K ._it .a_t- _,_ won.won& ,lei. on vin C,t^.cdne,a, n; so.,;c•as F't: S.dS.d:n 4.. : Y r'tiX' 1d t.�d PA62 ,tT` r-kl t t� i ` 2 „ c y !ny 00' 21 Oti;Ft