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SUN GARDEN - ESTABLISHMENTS0 SUN GARDEN 99 NORTH STREET .' "W r'+v�r�.�.'��M"^+:,h'1.��..�arrr.i`•+Nrka°'i_ .a.'dM'^„'+�...,j.:;b�. IGfassachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Salem, MA 01970-3523 4" Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name f 00/y\_- ate T e of 0 eration s Type of Inspection Food Service Retail [j Residential Kitchen El Temporary ❑ Caterer El Bed &Breakfast Permit No. Routine M Re -inspection Previous Inspection Date: ElPre-operationOwner ❑ Suspect Illness El General Complaint ❑HACCP ❑ Other Address VI � n p Risk Level TelephoneE]Mobile 1 M ( 0 � HACCP Y/N Person in Chaiye (PIC) \_J \J� A/AAt-1I ( An Time 16.3 d(A Out: 9 Inspector } P'� I-&, � < y 1 Each violation checked requires n 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) t1,_ 590.009 (FA1 action as determined by the Board of Health. . t „ FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH""' ❑ 2. Reporting of Diseases by Food Employee and PIC M ❑ 3. Personnel with Infections Restricted/Excluded ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities `PROTECTION FROM CHEMICALS ��' a . '`� a 4 ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE."`aa�and�. , 'n-6 . ❑ 4. Food and Water from Approved Source i TIMEITEMPERATURE CONTROLS (134tenuatly Hazardous Foods)` ;' )OK5. Receiving/Condition ❑ 16. Cooking Temperatures ' ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating a❑ 7. Conformance with Approved Procedures/HACCP Plans 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. t"N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) OIL 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) ('} 27. Physical Facility (FC -6)(590.007) v 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 5901nVecrFc m -ra.ea ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS El21. Food and Food Preparation for HSP N r2SUMER ADVISORY; 2. Posting of Consumer Advisories jIov� �,Ll-o 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--INSSPECTION: j - D Inspector's Signature:, f ,.,U,�. / Print: +e) I -J PIC's Signature:�^ (! u Print: I ' ` 'w �1 Pa� of ages violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.1.2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicamss ShellEg s* 590.003(F) Responsibility OPA 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) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3 590.603(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 6 7 FOOD FROM APPROVED SOURCE * Denotes. critical item in the federal 1999 Food Cate or 105 CMR 590.000. .R PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources - 590.004(A -B) Compliance with Food Law* 3-201.1.2 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 ShellEg s* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5401.11 Drinkin Water from an A roved S stem* 590.006(A) Bottled Drinkin Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* WashingFruits and Ve etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by ReElatory Authority 3-202.18 Shellstock Identification Present* _590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.1.1 Receiving/Condition 3-202.1.1 PHFs Received at Proper Temperatures* 3-202.15 Package hue it * 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained` Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590k04(J) Labeling of Ingredients' Frequency of Sanitization of Utensils and Foci Contact Surfaces of ui menC* Conformance with Approved Procedures MACCP Plans -3-502.11 Specialized ProcesgiuMethods* 3-502.1.2 Reduced oxygen pacKaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes. critical item in the federal 1999 Food Cate or 105 CMR 590.000. .R PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(I) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Anirnal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 WashingFruits and Ve etables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservicc of Food* Disposition of Adulterated or Contaminated Food 3-701.1.1 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501..114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.1'[(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.1 t Frequency of Sanitization of Utensils and Foci Contact Surfaces of ui menC* 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 Prrwedurc* 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 Tastin a` 1.2 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em rla ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca acities* 5-20412 Location and Placement* 5-20511 Accessibility. Operation and MaintenarrCe Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM K BOARD OF HEALTH Establishment Name: agAm 2Y in Date: 1I- 01 —d Pager of Item No. Code C - Critical Item Reference R -Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date- Verified PLEASE//PRINT CLEARLY �iMnAn�i (- J,�n(}.�'}i,_3.�,7 {t ,v (finA I_�r 4j L�� ,. 9,z, i t OL 1�0 n wn n I Jv Pi/�' 10,1.1_Meti P �7� n -' �/_I(-i- R0 X - `n.v: r. n_a_..nn.i _ 1 t 1 .li rn a A /1 // Yx _)'0A _A. 7� qZ�Z r I . AfN%h V A A en , � T-) O� -.I- 1 A a n_ s n D. �' h _ %r.�. p _O - Ae . 12 A`,, cf o ��_ �� _a b eines nimI, Air..', -_ nil' .'1L A._iw_ l 1 V ,e /Vr9 'lyd AAi 1\ K i Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that ,noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No Yes Voluntary Compliance El Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: I Violations Related to Foodborne Illness Interventions and Risk Factors (helots 1-22) (Cont) PROTECTION FROM CHEMICALS 14 Cin ,,�i:�ials shr><°ses 21t:itxici- Food Color Additives Ili! ii5 1�3 �eC, 3-202.32 Addrtrves.r iv 19 3-302.14 Protection from Unapproved Additives" 15 c ` :)01.1,4(A) Poisonous or Toxic Substances 1 '!(ILII identifying Infcunatton Ou mai containers, - •it uti; Crn II6 .' :�i Ei, t4 .moi _ t 102,11 +'.OL11 Common 'V aro: At orlun,-, Contain -y", S'fut>Lton Sit�a� 2p 7-2d2.11 _ ' 7-202.12 - �� ( ft e_t•xtion Pt, ac ncc m,d t. Conditions of User }1 itnrn't Hexn.. 7-303.11 Toxic Container— Prohibition;" 7-204.11 Sanitizers, Criteria — Chemicaks 7-2(N.12 Ch nae sic for W tchn k rrxju(.c CnrctLa'- a'7 t1 J3_t1 1)Ptilti 204.14 7-2{4 14 /2OS.iI Di ,in At ente Criteria' _ Inti nttltrxl Contact ladnicanls` __ � 7-206-11 7-W6.12 lRoilen Rz, nc Al tc Pe ri tde (lir i -.. -206,1 i-.. },cobs'. -Iver. (._..('tnxr.l aaw ._._.( ,�Vnitczp❑o• TIME/TEMPERATURE CONTROLS i 3 Proper Cooking Tempeatures tar PHFG 3-403.11fCj Cin ,,�i:�ials shr><°ses 21t:itxici- P}1Fs Received at Temperatures According to Law Cooled to 41"F/45"F_Within 4Hours. Ili! ii5 1�3 �eC, .'-4113.! 1(i_J 4nF and 13..., Rust - 1.1 1 niia'. 19 I PHF Hot and Cold Holding Proper Cooling of PHPs _ c ` :)01.1,4(A) ---------------- 1 [ i `,A"t(d Ertt e ftt ti Pt i •it uti; Crn II6 .' :�i Ei, t4 .moi ` Sol.i4m) i'f :•tan 2p Tt nipeiau re fn redient; lo'! JFt451,17 ....... }1 itnrn't Hexn.. ..� . iiir 6- i! „19 ro,%,iGA, ,r 16,ii -._. i sa:c i 1 T tl . l t ii for Hot Hofd€a g t1 J3_t1 1)Ptilti flt tf- 1j5_ Miclim av,'- 3-403.11fCj Cin ,,�i:�ials shr><°ses 21t:itxici- P}1Fs Received at Temperatures According to Law Cooled to 41"F/45"F_Within 4Hours. _._— � .'-4113.! 1(i_J � !�f 317 tl lln�; i3OFl.red Ptit att nS Oi Ii(ei 19 I PHF Hot and Cold Holding Proper Cooling of PHPs _ c ` :)01.1,4(A) f adore. Catk'd PHFs from 14Y Y F to 1 j a h Within 2 ttaur� tind From 10`i= Hot PHFs Maintained at or above 140-F t191iI$5`r 1`dllil4 HSik .." ` Sol.i4m) Codi g 11HRI 'vf sic From Ambient 2p Tt nipeiau re fn redient; lo'! JFt451,17 I Time as a Public Health Control -•--! cin, as a Public IPeaWi Control' }1 itnrn't Hexn.. 'Ji ..zitrz:alten.l iiir 6- i! „19 ro,%,iGA, ,r 16,ii -._. REOUIREMENTS FOR HiGHLY SUSCEPTIBLE 11 l 3-801.1 1(A) ling+ tturixed Pre-packaged ack:aged Juiets and 3-501,14(C) P}1Fs Received at Temperatures According to Law Cooled to 41"F/45"F_Within 4Hours. K 11 (13 _ 3-501.15 Crviing Methods for PHFs 19 I PHF Hot and Cold Holding 7.XU1 1.rti 3-501.16(B) 590,004(F) Cold PHFs Maintained at or below 41`!45` F'r 3-501.1 G{A) Hot PHFs Maintained at or above 140-F 3 1,16(A) Ru sr, Held at or above 140"1 2p 3-501 .19 I Time as a Public Health Control -•--! cin, as a Public IPeaWi Control' I 590,004(H)Variance R rcnunt REOUIREMENTS FOR HiGHLY SUSCEPTIBLE 11 l 3-801.1 1(A) ling+ tturixed Pre-packaged ack:aged Juiets and ` 'Beset e.witt Nat un,l_abels'` K 11 (13 I)c of Pa temizcd i <` .. SOi Ii(It) i<:wor1 irti:d, C.ktedAnitnalFas!and /ie t 5e d S smuts 1e 7.XU1 1.rti I r;--;e,xd Ftxxi Pai`..ar. N, Reserved. * 2 3 60 I 1 ' �'.ur,5ur �c: 51i;-isois Yt '. r tJ &fir { aistn',pGon o,' A ` ow,- to, S114 . i SPECIAL RE_OJt1 MMMT _ l} i tc. fl (D),i it ,ti hih, tsX.,, t+.-,X.t?, r11...,t-). i •:`t;Id h.. ` e_..hj4. i . ,it{er t1;e x e ,n.•:4 . _1'FUU3 ._.'.3 , . _ ,.t.._ i3 it'- . ti.ii)u .>t;ua rcEaut*t a i:3 r;•t,;;i � WOLATIOAS RELATED TO esc3t"l+J" RETAIL Fii,4CTJCES {,Iteniti 23-301 � +z etimrtxr s74 "sa tti-arvcnt .n„ ;rat ri;d rite -tor,( jig ctI .i,rvr.. cart ?Ji= Ier tr r the) tt x -iu sa r r ai 1;e: rod Code's el1110 f diR U C'itU fCanz Goad Retail Prachccs _FC � 590.OtXi ; _ K naa me t and P ncif FG 2 003 24 F()d sed Food Protertiu, PC s 004 r me n1 and Uten , s _ � FC n 005 j " at r Rii. (:inn ar+r .J, 3n + EC I nfiF � �.l.,or 'rillic Ml,. 'I n �I R t.t (wN1t at ` QihP .t .e. ^Srr 4w..-'r-'a./vii.r.,A,.r�a,,�.!•i;Y't�t*°-flrf'' .A«f ' •.' �n..%rw tw q'l:v'p'v'ex. sir ...,....,rn-4 „f .a. " Yi , �,,h,'r-c^n.. � Y �y 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 i\ Name n _P ILI D to l� Type of Operations) Type of Inspection u'Routine Re -inspection Previous Inspection Date: ElPre-operationOwner ElSuspect Illness El General Complaint El HACCP El Other. Food Service ❑Retail ❑ Residential Kitchen ❑ Mobile El Temporary ElCaterer ❑ Bed & Breakfast j/� Permit No. Address l }-n Q _.L V l yt JLC Risk Level Telephone (a f� t 1 (� C l I 11I \ / (1A W a OA . C', HACCP Y/N Person in Charge (PIC) \.I M "fA �(t/)ti . Time In .� � put;1 f Inspector �t� � ( 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 of specific provision(s) violated. Non-compliance with: ntions and Risk Factors Anti -Choking Tobacco �. Izard and require immediate corrective 590.009( E).0-� 590.009 (F) ❑ F O��JD PROTECTION MANAGEMENT;, fL - [� 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2 Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded JFOODFROM APPROVED SQURCE=11"I� OM -2i ❑ 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 C6NTA'MiN_ATJ_ ON 7,7 8 Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 5R�i0. Proper Adequate Handwashing [111. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked most 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. .0-r N. -r-. 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. 501ro IFVm 44. Ca ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities .PROTECTION FROM CHEMICALS ; .. ....�'�'` "g wus�01,w.w,r..r-,5 �❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals :aTIME/TEMPERArIIREOONTROLS(PQeemfagytf�aaraousPsidae) ..w ❑ 16 Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling [119. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOIE kidH, Ys USCEPTIBLE POPULATIpNS {HSP)1;,3; ❑ 21. Food and Food Preparation for HSP * CONSUME.[iADYISORY:i;„" �2�! U�yr�..,s,"li.,�.,*�...s3'',��We;-?' ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related' t 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: 3 _ 5-d Com} Inspector's Signature: - Print: l 5,9 �7 b 1 C �,(, 1 � PIC's Signature: x ( � Prink / v n 4 ' �u, Page I of ages T Violations Related to Foodborne Illness Interventions and Risk Factors (items 9-22) FOOD PROTECTION MANAGEMENT 1I 590.003(A)- .A-esignmentofResponsibility" 590.003(B) Demonstration of Knowledge_ 2-103.11. Personinchaue-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* Shelf Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 - Applicant To Report To The Person In Drinking Water from an Approved System, 590.006(A) Char *e* 590.006(B) 590.003(6) Re oxtina b Person in Chttr!e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 13 6 * Denotes critical item in the federal 1999 Fad Cale or 105 CMR 590000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590A04(A-B) Compliance with Food Law* 3-201.12 Food in a Hermetically2 Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.1.3 Shelf Eggs* 3-202.14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water' 5-1.01.11 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 3-20.1.14 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 RegufaLoj Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-20117 Game Animals* 3-701.11 ReceivingtCondition 3-202.11 PI-1Fs Received at Proper Temperatures* 3-202.15 Package Ihte i[ 3-101.11. Food Safe and Unadulterated Tags/Records: Sheiistock 3-20218 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* - Tags(Records: Fish Products 3-402.11. Parasite Destruction* 3-402.1.2 Records, Creation and Retention* 590,004(.1) Labeling of ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E ul ment' Conformance with Approved Procedures tHACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria` 8-10112 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Fad Cale or 105 CMR 590000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.1.1(A)(]) Raw Animal Foods Separated from Cooked and RTE F(x)ds* Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other' Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-3tk1.11 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 4-501.1.11 Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.112 Mechanical Warewashing- Hot Water Saivtization Temperatures* 4-501.11.4 Chemical Sanifiration- temp., pH, concentration and hardness.'" 4-601.I I(A) Equipment Food Contact Surfaces and Utensils Clean* - 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils' 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of E ul ment' 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2301.11 Clean Condition - Hands and Arius" 2-301.12 Cleaning Pn>cednrc* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventin Contamination When Tastin " 12 Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.1.1 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11. Handwashing Cleanser, Availability 6-301.1.2 Hand Drying Provision . l i : I'�( I,,,) - Establishment Name �/ It ➢ !li) r N_� O nA CITY OF SALEM BOARD OF HEALTH Date: 1- 1 G _ % Violations Related to Foodborne illness Interventions and Risk Factors {Moms 1.22) (Coal Ir Food or Cc 12 Additives* '1-205,11 Poisonous or Toxic Substances 7-206 1 i tttenthyinginformation- Oliginai __ � t:.ontazners* 7-102.11 Common Name -- Workin j(Contsi 7-20 L I l Se. ar<s8on - Sa)rage': i -202_t1 Restriction - Prt,scna; and Use* _ 7-202.12 Conditions of Use' 720--1 ToxiCCxadaincig—Prob ini6owiz 7-204.11 Sanitizes.Criteria - Chemicals* '1-205,11 incidental Food t onticr Lain caritas` 7-206 1 i Reinicled Use Peaicides. Criteria' 7-206.12 Rodent Butt Stations, 7 2(i6, i 3 `l'ra king Powder . Pesi Control and 3-401,11A(1)(2101 :z-407.11.fA)f2) 3-401.11.(73)(1)L 3-40 1.11 (A)!3) 3-401.IIt0Q) 3-401, I'1.(A ) 3-403A 1(A) 3-403.11(B) 3-403. t 1(C) 3-403. d 7 (E1 3-501-)4C} " PHFs Received at Temperatures I Proper Cooling of PRFs According to TLaw Cooled to -411-i45"'F Within 4 Hours. � 3-501.15 Carling Methods for PHFs Witton 2 Flours and From 70"T PHF Hot and Cold Holding 3-S(7' -16(B) Cold PHFs Maintained at or below 590 (k)4(1-) 41°1450' F" 3-501.16(A) _ 13M PHFs Maintimed at or above 146"F.` 3-501.16(A}� Roasts Hold at or ibiwe 1.30°F. Within 4 Auur � Time as a Public Hoetth Control 3-5(11.19 _____. Tsmo as a Puhfic 1iealtii Control* - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSS _ 21 -S01 i(A) Unp fsieurlaid Pre packaged Juices and Beaeaazec with lAaina l,ab ls* 3-SOt l 1t,R) t_" of Pasteunred t r * 3-801.! t(1J)Raw or Partially Ccx)k-d 4nlntal Food and _...__._] to Sud Sprouts Bei: Served i' nNnr.d TZ -4 V:.<L...... i. A.....n,..I iTURE CONTROLS 22 31iO3 1 i I Consumer Achiscay Posted for Consumption of Proper Cooling Temperatures for ( Aninwl Foo& `That arc Raw. Undercooked or PHFs Nut tOtlirrr. ise Prcxc 4sed to 131imtnate Pit I s.y 155'F 15 5 c. 21-1, „-- c..-,,-- t-..,... 3•'_s0'i 13 i p,!srem I d Ej&., Substitute for Rauf Shell Comminuted Fish, Meats k Gsme Anitnals. 155°F i7 sec. * _ Pork and Beef Roast - I 301 121 m Rattles, Inicclod Meats -155-F 15 set * Pouhry, wild Game, Stuffed PFI'Fs', StuffingContamm. Fish, bleat, Pordtr�r Raritan I 65 15 sec.' Whole -mu: r&. Intact Dee Swaics 145"F* _ Raw Animal Finis Corked w a 1651F * Ptif 165"F 15 sec.:" Micaowave- 165' F 2 Minula Standing Time" Comznerciaty Paxessed RTE Fnod 18 i I Proper Cooling of PRFs 3-Silt.l4(A) -- CarlingCaik.dPFIFs1`1111114(PIFto Witton 2 Flours and From 70"T € t i 4l' F)45 F Within 4 Honi s 3-501,14(B) Cooling PHFs Mado Flinn Arnbient Temperature Ingredients to 41°F14ST Within 4 Auur � *' 1)un')Ws critical iurin me Ve leraf 194y Fooii C&lo or 105 C IR 591i 066, SPECIAL REOUIREMENTS _ 590.009tA)--(L0 T Viotntions olSection 59( 009(A) -(I3) in catering. tnobtla $xxl, teinporaiy and. { residenliat kitchen operations.should be debited under tire appropriate sections alone ift.lratedit) foolborn illness interventions and risk factors, Other 1590004 violations relating to good retail practices should he debited under N29. - Sp Tial Requirements. (Items 23-30) Ciu`caf and non-crawal rwWiomi, which do nw reiate k+ the ,foodborne idhccse in et vennow card r cik factors fisted atone ran be found in dtw fol;ondre� seciiom at the (rood Code and 105 CSIR I n 13' ,.�a�Z «' CITY OF SALEM BOARD OF HEALTH n� Establishment Name: �an,\ 9�vDate_�2-kPage: of 2 Item No. a Code Reference P. C -Critical item„ y R -R ed Item �,..�, % „ DESCRIPTION OF VIOLATION / PLAN OF CORRECTION �. a,. �. ; - „ a n. ,. = -w.... , �,:� x• a^ '� ;„n J, - .res "`''r S a PLEASE? PRINT CLEARLY Date Verified ) _ _ -t rr Jn .7. '- Sl/.[,�A Ar, n_ e 10..� ) n n_ S O --%t X .r �1_ . _ _on �1 n_ q-nG ` L s� Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne fitness Interventions and Risk Factors (1fritim; 142) {Coni) Food or Color 40drlweis -:A 202 12 Ulilni;,' 3-30114 i Protection 15 Poisonous or Toxic Substrmc� 'T'Itriy .. e lafortnat"c 7-t{)224 ifI i Common Name - Work tl Kt St 1-202.1E R(��Ntrietion - Prestirce and Us0 1 202-12 Cunditiow, of ("So' r _71-071 inel;l - Prnbit>i lana 1 ,204� 11 Na mlize". criteria - cherlricriW 7-204. for Wa� ee, fan 404,14 _Di '1_205 17 Incidental C'oritact' 1011 i(qu1W Rosil icied I'llse, PeAcide�' Criteria* 7 - 2.0 6. 12 Rkxi�lnt It4it Stiuoa�' P,�lWlrntroliaid TIMErrEMPERATURE CONTROLS 16 Temperatures for -50 1 . I'l(C) IIHFs peciwd at Temp';Tatures Accorlbn� lo Lem CwlA to 1 " l'Fi4f'F Wilhin,4 flowsII . 3 Fllg,,- 1WF 15 Se, 1-40 1.11 (AW:; cumminuted Fi�h' Meats & Gatm 1-40 J - I I (Ait 21 i Ratitts, tiow-,d lWals 155 �F 15 3 -40 1.111 A)( 3) Poulirv. Wild (`iatte. $Puffell Pi -?Fs, �'Illffing Fisti, Nblaa, poifltry or Katiws-165�+' '5 sec. R-e—JSlu—k, I 1 3-401.12 Raw Arvirvil Frxii, Cixkcd in a Microwave 16,51'* All Ocher Ptll:� -- 145'F 15 eec. L7_ Hot —Holdmg 6,51T, t 5 su. 71409,1 J (IT) Nficrkywavc- lWF 2 khnui�. Nianding ('arierrerci 0y Privessed RTE'K�.ldl �3:T3,1 I fC) 3-403.11{F) litarailling 1"Irsix-ed pordorii or Baer IS Proper Cooling of PHF& 501,WA) C,Kl1iiag C(lokxi Pf-[Fs from 14W F to IMI)7;)OF Within 2 Howl; and From 701' w 4 PF14Y F Within 4 Hoag�', Claolitig PHFt Made Frclal'-%�Inbiellt Temperature literedienci kr,WF/41`F Within 41l,wO Dejwtes 'nucal imlil in N, [Aflntl I 1rtioa ( Kje of I os (MR "'9l) 3-,50!,16(B) Cold PUPS Maintained ater bAow 590,004(F� 41145' 3-50t —16 i —A) -II iot f4artalained at or shave:1 1,11"17 1 3-50 1. 16(A) I Rwi;ls field at or above 130'1% Time as a Public Health Control 3-50 1 D as pijldic Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA I 2 7— 1 1-801A KA? Vic, -pactaged Aki�s and Reverareli with War6n- 3.8W.Stili} I'S11 3-801A l(f)) Rew or Partialk ("YAed Awkint Raid and I Ury'riened T;,x)d PackaLc Not lle-sctwc& 22 3 b03 1 i '-'Onawwr A<Iiiawy Ple;red for CowilinpLion, I,Nid, Thar irt kww ' Uiaderl.',oi,ked wiw F'Rarillatt l ";ubsutut� for PUW Sh-11 "o2.13 11�,m�urized F21lt cr fat SPECIAL REQUIREMENTS TVk4ufions of Sectqai in temporaivand 1 rc.mewul:al kitchl:n tipeiations Should be twbired undar theapprorriatc. seetioll's alxive if leiated to fo(Xihoric ilin"SS int -I vrjlliolls aold i -i'91, factors. CA11cr 5+3Ii.{W viillad' ils rehaillo to cuod retail be debited under #29 - S ocial VIOLATIONS fiELI'YED T67GOOD RETAIL PRACTICES ([tetra 23-30) Cilii,,al f2pid non, mwal vw!Mbm,i;, wbich down relrete i(i lite filodborne iflne'" iWeri,entioro "lul I'Ved al-ov" f"m be fintnd in thcftdkarlt,t farceurs e w, seboreself, ria: Fi)od Code rrrid 105 CIVIR 3 Fllg,,- 1WF 15 Se, 1-40 1.11 (AW:; cumminuted Fi�h' Meats & Gatm 1-40 J - I I (Ait 21 i Ratitts, tiow-,d lWals 155 �F 15 3 -40 1.111 A)( 3) Poulirv. Wild (`iatte. $Puffell Pi -?Fs, �'Illffing Fisti, Nblaa, poifltry or Katiws-165�+' '5 sec. R-e—JSlu—k, I 1 3-401.12 Raw Arvirvil Frxii, Cixkcd in a Microwave 16,51'* All Ocher Ptll:� -- 145'F 15 eec. L7_ Hot —Holdmg 6,51T, t 5 su. 71409,1 J (IT) Nficrkywavc- lWF 2 khnui�. Nianding ('arierrerci 0y Privessed RTE'K�.ldl �3:T3,1 I fC) 3-403.11{F) litarailling 1"Irsix-ed pordorii or Baer IS Proper Cooling of PHF& 501,WA) C,Kl1iiag C(lokxi Pf-[Fs from 14W F to IMI)7;)OF Within 2 Howl; and From 701' w 4 PF14Y F Within 4 Hoag�', Claolitig PHFt Made Frclal'-%�Inbiellt Temperature literedienci kr,WF/41`F Within 41l,wO Dejwtes 'nucal imlil in N, [Aflntl I 1rtioa ( Kje of I os (MR "'9l) 3-,50!,16(B) Cold PUPS Maintained ater bAow 590,004(F� 41145' 3-50t —16 i —A) -II iot f4artalained at or shave:1 1,11"17 1 3-50 1. 16(A) I Rwi;ls field at or above 130'1% Time as a Public Health Control 3-50 1 D as pijldic Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA I 2 7— 1 1-801A KA? Vic, -pactaged Aki�s and Reverareli with War6n- 3.8W.Stili} I'S11 3-801A l(f)) Rew or Partialk ("YAed Awkint Raid and I Ury'riened T;,x)d PackaLc Not lle-sctwc& 22 3 b03 1 i '-'Onawwr A<Iiiawy Ple;red for CowilinpLion, I,Nid, Thar irt kww ' Uiaderl.',oi,ked wiw F'Rarillatt l ";ubsutut� for PUW Sh-11 "o2.13 11�,m�urized F21lt cr fat SPECIAL REQUIREMENTS TVk4ufions of Sectqai in temporaivand 1 rc.mewul:al kitchl:n tipeiations Should be twbired undar theapprorriatc. seetioll's alxive if leiated to fo(Xihoric ilin"SS int -I vrjlliolls aold i -i'91, factors. CA11cr 5+3Ii.{W viillad' ils rehaillo to cuod retail be debited under #29 - S ocial VIOLATIONS fiELI'YED T67GOOD RETAIL PRACTICES ([tetra 23-30) Cilii,,al f2pid non, mwal vw!Mbm,i;, wbich down relrete i(i lite filodborne iflne'" iWeri,entioro "lul I'Ved al-ov" f"m be fintnd in thcftdkarlt,t farceurs e w, seboreself, ria: Fi)od Code rrrid 105 CIVIR Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: File Number: BHF -2004-000279 LOCATED AT: Sun Garden 99 North Street Salem MA 01970 0099 NORTH STREET U 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0045 Jan 4, 2010 Dee 31, 2010 $140.00 ESTABLISHMENT Total Fees: $140.00 r PERMIT EXPIRES December 31, 2010 Board of Health l! —� 1 . This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR DAVID GREENBAUM, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 DGREENBAUM@SAI:EM. COM 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD EST NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT— (0�- IVI>YAL S FAX# MAILING ADDRESS (if different) _ EMAIL - Business': 5� OWNER'S NAME ADDRESS S6, E STREET Website: CITY TEL # 60- 14 J- -14,)-C) mA )-11,4 a STATE CERTIFIED FOOD MANAGER'S NAME(S) Yy H rn V, YCtU CERTIFICATE#(S) (Required in an establishment where potentially //oo if I,7 hazardou fs prepared) J - EMERGENCY RESPONSE PERSON Q1Y (rt a-. fl -ill HOME TEL # ri tf�' I yh v Please write in time o (For example I lam -1 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------- - -- RESTAURANT YES NO less than 25 seats- 14 (Outdoor Stationary Food Cart $210) 25-99 seats No iagf, more than 99 seats =$420 ---------------------Y-------ES ----(- ------------------------------------------------------------------------------- BED/BREAKFAST/ O - - $100 CHILDCARE SERVICES/NURSING HOME - ADDITIONAL PERMITS �,--------------------------------------------- V"� 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 submitted to and approved by the.Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties'of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. FtTIJ ou -3 s? & q? -7 ; .01V: oa3 -76 Gs�� Sigifiature —7 Date I i Social Security or Federal Identifica ion Number -----------------------2 —`------------ -------- Revised 4/24/07 FOODAP2008.adm Check# & Date /a�J �� y�%f $ 0099 North Street U 1 -- - --- : Telephone - 978-744-9998 Owner: Yong Quang Qiu - PIC: Yung King Yau Inspector: Elizabeth Salandrea Date Inspected: Correct By: 110/20/2008 Risk Level 9 Permit Number: a BHP -2008-0255 Status: VIOLATION # of Critical Violations: . 4 Time IN: Time OUT: 9 ;Urgency Description(s): BLUE: Violations Related tc Good Retail Practices (Critical violations mustbe corrected immediately or within 10 'days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Protection FAIL Critical - YJ RED Womment: 2door deli unit had meat and shrimp stored above vegetables and sauces. Organize fridge to properly separate potentially hazardous items from ready to eat items. Food Con t Surfaces Cleaning and Sanitizing .FAIL Critical ❑� RED }^ ment: Sanitizer was slightly weak. Provide sanitizer of proper concentration at all times. � n ure sanitizer is available at all workstations at all times; only one bottle was available at time of inspection at front counter. IiFlo current sanitizer log available - establishment must maintain daily log of sanitizer concentration. New sheet given to PIC. TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) Hot and Id Holding FAIL Critical ❑d RED nW/Comment: Containers of chicken fingers and wings were out at room temperature. PIC stated they were cooling - PHFs may not stay at room temperature and must be cooled in refrigeration. Items put in refrigeration at time of inspection. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 21,2008) Page 1 oj2 Item Status Violation Critical Urgency ,RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions Vomment: There were raw chicken wings in the sanitize bay of the 2bay sink. Food may not be prepared in this sink - sink to only .and Risk Factors (Require be used to wash, rinse and sanitize dishes and utensils. �^' immediate corrective action) Equipment d Utensils FAIL Non -Critical a "^ 7 l r'D, BLUE /fin b::vpcs 74Co menta Handwash sink next to grill must be labelled "handwash only". lators need general cleaning. L404 %,.alS general cleaning. deli unit needs general cleaning. Moke fridge has accumulation of food debris on bottom and in door tracks. Thoroughly clean this fridge. �W/uucket where knives are stored needs general cleaning. Vwhite Kenmore freezer needs general cleaning along bottom. II dry ingredient barrels need general cleaning. (/41rea along window next to handwash sink in the front needs thorough cleaning. Physical F/agility FAIL Non -Critical BLUE Comment: There is some staining on the ceiling above the vegetable sink. Investigate for leaks and repairfrepaint ceiling. Other -See otes FAIL BLUE om ment:: Rodent droppings noted behind Kenmore freezer. Clean up and sanitize any areas where droppings are found, and exterminate as often as necessary to eliminate or control problem. Reinspection will take place Tuesday 10/28/08, all violations to be corrected. ease have July, August and September extermination receipts faxed to the Board of Health within one week. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 21,2008 ) Page 2 oft 0099 North Street U 1 Telephone: - ' 978-744-9998 Owner: Yong Quang Qiu PIC: Yung King Yau Inspector: Elizabeth Salandrea Date Inspected-. of ct By: 110/28/2008 Risk Level: Permit Number: BHP -2008-0255 Status: SIGNED OFF # of Critical Violations: 1 tTime IN: ime TOUT: Urgency Description(s): { BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 bays)(Non-critical violations must be corrected immediately i or within 90 days) { I 0 Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection _ FAIL Critical BLUE Comment: Two of the dry ingredient barrels had bowls being used as scoops. Bowls may not be used as scoops; provide proper scoop with handle and store it in the product with the handle extending out. Bowls removed at time of inspection. All other violations noted in the 10/20/08 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 29,2008 ) Page I of REDS ; Violations Related to I Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 29,2008 ) Page 2 oft Commonwealth of Massachusetts 6 City of Salem Board of Health IGmberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISHMENT NAME: File Number. BHF -2004-000279 Sun Garden 99 North Street Salem MA 01970 LOCATED AT: 0099 NORTH STREET U 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0228 Dec 29, 2008 Dec 31, 2009 $140.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $140.00 This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS + a BOARD OF HEALTH 120 WASHINGTON STREET, 4` FLOOR TEL. (978) 741-1800 K MBERLEY DRISCOLL FAx (978) 745-0343 MAYOR ID10NNe Sr1LFM. COM A JANET DIONNE, p, ACTING HEALTH AGENT I rOY1' 2 6,200 cnY 8 SOARO OF AL h 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT C1 A) 0 A Yr,60 12.a, TEL # 011,4 - 7 q U J 99 3— ADDRESS ADDRESS OF ESTABLISHMENT q9 A)0 (4�bM .mil t/iYOFAx# MAILING ADDRESS (if different) EMAIL - Business': Website: OWNER'SNAME klonil 4lAn0 TEL# 617-3/9^2,72Z ADDRESS _ P l a h4a Yktiu 0'�ZZ T CITY q STAT CERTIFIED FOOD MANAGER'S NAME(S) �I(A %!4 k /11� `1p_I t CERTIFICATE#(S) �D�S—010 (Required in an establishment where potentially hazardous i prepared EMERGENCY RESPONSE I TEL# DAYS QF—OPERATION.,,,', Monda • '< ;-,;T iesda -' I -,Wednesd r,.` Thursda '- ,Frida = ! : , Saturday ;: Sunda ' HOURS OF OPERATION aTO �(; Q To ! 11$0 -To (1'3o TJ 11;3 0 7o 1 )2:30 70 j )Z 30 n Please verde in timeof day. For example Ilam -11 pm) .10, 30 117 13 0 (O , �j O h. (0', 3 0 :00 /4011 1 !0 0 Afr 7 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 _ more than 10,000sq.ft. =$420 RESTAURANT YES)NO (Outdoor Stationary Food Cart $210) more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES - - ------RMITS ----------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PE MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT (such as church kitchens). YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. --• In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. , Revised 424/07 FOODAP2008.adm Check#&Date-,4jtf2 �F6 )/-zV-08 $r4a l�� I CITY OF SALEM BOARD OF HEALTHj Establishment Name: 2 M �� Date: 3— c)--Page: t of Item code C - Critical Item w ,t ° DESCRIPTION OF VIOLATION / PLAN OF CORRECTION y' 7 nate No. Reference-, . R - Red Item x Y�, ,, ' ,� ,r. ,,,,x„ Al-; . ¢ s„-, Verified k .r. PLEASE PRINT CLEARLY CJs . m /\`r.4.,A _e,,94' �Aj'le.Ao.n0 0 YrI\^ 0 _A� 0 o Cir �)p� Discussion With Person in Charge: Corrective Action Required: Li No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twent-five-dollars or suspension/rev cation of o Embargo ❑ Emergency Closure your food permit. LI Other: L' Voluntary Disposal v i Violations Rotated to Foodborne illness interventions and Risk Factors (fter ds 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 � Food or Color Additives �_� 3-217312 i zldditiees'h _� "# .'lt)2.14 Pa tcctiou from linappazFreel Addth4es' IF Poisonous or Toxic Substances _ 1 3-a 4K) identdgnig, Fnti"Ination.0in-linad i Containers" 02.!3 Common Nati,!: W ork iqA <mt ein rs*- -` I> ix te�.nntal lteo; ht the i,-Ilcral 1 P'3Y.Fotxi f.:rxie ur 105 C .@t 541: 000, 7 21)1.13 7-21)2.11 (S�nO'ttiorz _ SYota c., �,� Rest tcuon -- Presenceeaaud l : c* 7202.i2� CondntonsofUsc' � i 21F72 3 i _ C t m. P nl i6iidnrre�' Fri �-2C)4. i t 1 Satntvers, Criteria chemicals" 7-2(.4.12 . Ch nuc k for 'Washit e Pr(a)nce. Ctite ut* 7 205.7' __-LF:adcntat } ;xxf C vntact..! -206.11 kn"rieta a G e pc,ficides. '7-206.33 i Tittckintt Powdcr- , Pest Cnutrol and 3-10 Ll IA(ll(w} fs,gs- 155 F 15 Sic. Fwsas- Fuuucdusc. Seruxx- i,5TJ5sec, 3-401.l t(•l)t2t I Comminuted Fish, Meats ak Gum Anttcsal:�15''F #? Wc, 3-401.5 i{H3a 1}(2) i Pork and Beet Roast -1 rid f, 121Tuin" V,)1.11(A)t2} Ht tics, bt}ctt d bicnts 155 F 15 - 3 4f37.1I(A)r3i foul(}, Wild Gane, Stuffed 1"IfFs, Sloffntp Coal atmns Fish Meat, Poultry orkatxue 1659 15 sce." 3-40i.11(C)(3) wlwbt -mus lc. IntactT3ccY5teaks 145°I't { � 3-4011 12 Raw Aniawt Fc.W, Cottkcd its a Microwave 3-401.11(_A)f1)(b) akit (fitter Pit s - 14T,F 15 sec. t` Reheating for Hot Holding 3-4(331i(A)&,(D1 PH!,,165Tl5sea�� _ 3-40,3.1 V8,; icrawavc ] 5S' F 2 M nute Standing 3-403.11(C) Commercially Prot^ssedWIE'Fieri.. _.._..._..7 1.4('F..> 3-403.1 t(E Retnaming Uruoc•ed portions of Fled ROe52R� 3-501.14(Cj Pl#Fs Reoms'd at 1"empvsatures 4cmmding 10 Laei- C<x11u1 a1 4 1'.F45°F Within 4 Mous. 3-501.15 Ccxrliu=> 14ethtx3s fcx #'HFs 1-5w,16(l1) Proper Cooling of PHFs 1 s-SC;LL,i(A) CooliofiCaFkvdPFiFsfront 1411''Fto �_j{) ih(Aj 70°Fa Within 2 Flours and From 70"F i to 4 t ^F145`P 142tltin =4 Room" _ 1 3-a 4K) _ Crmling FHFs Made- Front Arnbient i 7"entperazute tngreditnits io 4VF(45°F Within 4$oatrs' -` I> ix te�.nntal lteo; ht the i,-Ilcral 1 P'3Y.Fotxi f.:rxie ur 105 C .@t 541: 000, 3-501.14(Cj Pl#Fs Reoms'd at 1"empvsatures 4cmmding 10 Laei- C<x11u1 a1 4 1'.F45°F Within 4 Mous. 3-501.15 Ccxrliu=> 14ethtx3s fcx #'HFs 1-5w,16(l1) Coos' PHF, 'maintained at or below �_j{) ih(Aj tint 111-11s Maintained at or above i dF. F 3-601, l6(Roat;V, li id at or above 130" It- * —_ -. Time as a Public Health Control 37101 .19 Tuno as a puh&e Health C onn:ol' 21 ! 3 -SM A I (.Aj the-paci aged Juiceit and kc era cs with V,arair it, .atvts*" t -St) l LI (.Fl) Ust, of pa. tf,tU j d `t-$U111(D) ilrvor Pailiall Clurksd Animal Food and -t—avl Sc ed-Ssroeas`got Serkc1 ' i -#,i 06/14/2007 04:05 FAX 7815938333 DEE'S CORNER 1� 001 Sun Garden 99. North Street Salem, Ma 01970 To whom it may concern:_ I, Yung King Yau, had conducted a.meetingwith my.employees regard4to-heakhandsanwzing\ issues. The names of the employees who had attended were Young Qiu and Shek Wong. Both employees are.in chargeof.cookingand preps ftfnod.for our customers_Du ftthemeeting,l have, discussed the following issues: 1. Wear gloves at.alltimeswheapreparing .food 2.. Keep separate trousers for different meats. 3. eleartali-areas afte, side workssu&aswipingthetabtes, counters; and any supplies that may have contact with food. 4. Sweeping and moping the floor 5: KeepaWWwel;mthesarthizhigbucketattheendofea&mgh[ 6. Ensure each sink are only used for its purpose. such as washing vegetable in.sink Land others non food related in sink 2. This meetingwas conducted on March 14, 2009 at.3:00.pm. if thereare.aay questions regarding -to -tips meeting, please feel free to contact me at 978-744-9998. Thaak You. Yung King Yau Sun Garden Manager 04/08/2008 14:12 PAX 8177280839 TAT ON AUTO SUPPLY 001 PROTECTION CLEANING� INC. 551 'MASS AvE., #E BOSTON, MA 02118 a] t $Tel: 857-991-1181 +41 -Cell: Iz-Z� We cleaan ovens, oven sides cPc bottoms, smoke exhausts and fans Customer j4!&: NfaJ Ge406 —Ye rlaeaz� Adder it�,3A: , Tel - ,,r ;gz ii 17 3 % 9 - Z? z2 a $A Date: -4 / QVANTmt DESCRIPTION TOTAL v f ;t SUBTOTAL %TAX Zut w� an Aplvuvedby: ^,LALESS DEPOSIT Received by: ;$ % BALANCE DUE Massachusetts Department of Public Health Divislon 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 iFax (978) 745-0343 Name �1/,^ a/t� l o � Ami Date DM �� Type of Operation(s) im of Inspection ❑Routine ©Re -inspection Or'evious Inspection Date:/ % ❑ Pre -o oration ❑ Suspect Illness El General Complaint ❑HACCP,�i' ❑ Other r� M Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile El Temporary ❑ Caterer El Bed & Breakfast Permit No. Address vl l 1 �. ctl L q I l\J(J �] �� V �1 Telephone ^I LI .qq Q 9_/ f I Risk r Level Owner //;�� \ /� G � t U HACCP YIN Person in Charge (PIC)Time VI Y)/1l L({7 In: Out: Inspector 1 , ( JJ \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 ❑ 1. PIC Assigned / Knowledgeable / Duties p EMPLOYEE HEALTH °„ asst ry w ••=>,mt yw µ a+n ' `` '•• Y-1""""' r ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded „FOOD FROM APPROVED S©URGE.a, , E 'a„E`� ❑ 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 x ,_,.':'" ` °''7'q, ❑ 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. 5901 Vo tFom -14. o n ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities 13- ".PROTECTION FROM CHEMICALS i '" r �, ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals ('" TIM&EMPERATURE CONTROLS (Poilikially Hazardous Fo6di)_;11-1 [116. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling [119. Hot and Cold Holding ❑ 20. Time As a Public Health Control tREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPUL47IONS (HSP)' ! ❑ 21. Food and Food Preparation for HSP .CONSUMERADVISORY :;;!,'.m'�"`"„3�.�.,t.,; ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of ' the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: ;\ Inspector's ig '*tu' v Minta 7f+ -I �l PIC's Signature: / /A !'I �-/�'� ` / - Y U / I� �l A i Page_ of Pages %V .� ,Y I 1.'� / Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1I 590.003(A) Assignment of Responsibility* 590.003(6) Demonstration ofKnowledge* 2-103.11. Person in cttarge- duties EMPLOYEE HEALTH 2 590.003(C) 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 Fad Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Char *e* 590.006(B) 590.003(G) Reporting by Person in Charge' 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions IM In Denotes critical item in the federal 1999 Food Code or 105 CMR 590A00. PROTECTION FROM CONTAMINATION S 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 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 Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Prescnt* 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 inteit * 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' Frequency of Sanitization of Utensils and Fool Contact Surfaces of E ui memt Conformance with Approved Procedures iHACCP Plans 3-502.16 Specialized Processingjvtethods* 3-502.12 Reduced ox en packaging. criteria* 8-103.12 Conformance with Approved Procedures* Denotes critical item in the federal 1999 Food Code or 105 CMR 590A00. PROTECTION FROM CONTAMINATION S Cross -contamination 3-302.11(A)0) Raw Animal Foots 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* 3-302.1.5 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashine - Hot Water Sanitization Temperatures, r 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and buttress, ,k 41601.. 1.1(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils' 4702.1 t Frequency of Sanitization of Utensils and Fool Contact Surfaces of E ui memt 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2301.11. Clean Condition - Hands and Anns" 2-30(.1.2 Cleaning Procedure* 2-301.14 When to Wash* Il Good Hygienic Practices 2-401.11 Eatin , Drink'ina or Usin 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 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 'ig Provision CITY OF SALEM BOARD OF HEALTH L �. ` '7/C�/�% Pager of Name: �X�l l 1Q.4�f� _ Date: Item No. Code {' Reference C - Critical Item 44= R — Red Item _ :+ DESCRIPTION OF VIOLATION / PLAN 6F CORRECTION ' k:. _ - 1`+` H ` PRINT CLEARLY. Date Verified -; _EASE fo e �h Us/ hr ar',�o_1-?4 Gee D l/L() n2 / EW141-a f -2 a z1t k994 �'/ & -� ed avP �PcoYd - v �G11 �Q s ha rye hen /0��4-lf' _S PStahl�s6�rn��tf is S'�� e 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 corpply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your -Food permit.` /� n P A ! N / Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal. L)Other: Violations Rallitsid to Foodborne Illness Interventions and Risk Factors (Iftems 1-22) (Cont) L_14 Food or Color Additives 1-26)2.12 Additive'* 1--30114 Protection from Ila L Poisonous of Toxic Substances 7H.11 Iderdifying, Info; ininion - Original 701F Within 2 Hours and From'10'F 145�"F -'-k,,w 27--- Tnitnal Fo� xis Crairad 111 a 7-201.11 �Pacdion - su: 1 2{32.11 le,,trictirrr - Pre,'wriccalid Uses 7202. 2 Cuiuiruons of Use' 7-20111 Toxic Conlaintl" - Prollibilions* 2(24.11 Saniti7eri. Criteria - ChouicaWz Chenlicak for Washity cliteria 7-704.14 7-205 IT mcideatial Nxid Contact. Lunt icantij0 7-206,17- —7,smoed Use Pe,ticides, Cmena' Rodent Beat Senionss L7-206.12! 13 Tracking PowdersPest Control and TIMEITEMPERATURE CONTROLS I Proper Cooking Temperatures for 3401, 11 All)(--,) I Eg&s- 155'F 15 Sec. 3-401.111A)(2) I Comminuted Fish, Meals & Gana 3-401.11,(Bu l)(2) 3-401.11(A)(2) 135" F 151 -t Pork and Beef Roam -1373 1' 121 n, - --- Ralitec linco"d fAcits 155 F 15 i scc. * T -4-01-11(A)0) Pnuhry, Wild Gartle, Stuffed IliFs" RoaS0 sluffirlaCOntaining Fish, feleiri, Proper Cooling of PHFs joiltryor atiws-165'Fl5scc. >' 3-401.11{C)(3) i Aqw!e-rouscle. bract licof Steaks 701F Within 2 Hours and From'10'F 145�"F -'-k,,w 27--- Tnitnal Fo� xis Crairad 111 a Cooluitt PHFs Made Fro6i Ambient Microwave 101, * — TZI ll(Aulllal All other PHFc -- 1451 15 sec k 3-,l03J1(A)&iD`i PKI -s 1551 15 wet. 3403 1 K, Vicrowavc- 165' r 2 Minure Standing — 1-403.11 (() Connnerciaily Pfocessed RTE Forst - l4tt'Fr 3-463.3 I (I Remaining Unsirced Portions of fleef RoaS0 Proper Cooling of PHFs 3 50 1 . W(,N) Cooling Cooki PHFr from 1401' to Coil 701F Within 2 Hours and From'10'F to 41'f,,45'F V.-itbirt 4 Hours, Cooluitt PHFs Made Fro6i Ambient I Within 4 Hours* 'r Lenu:es eraeal seem In the foreml 1991) Foaxl (Wisor 105 CIVIR 5941 000, 0lA4(C) PHFs Rrr�-ived Acknrding to Lao Cooled to 419--45F Witlbin,l Hows, aturas 15 lrff� L9 PHF Has and Cold Holding 1 1 501 16(B) PlifisMaumifrod at or Ft -111w 5�0.fti)"(Fl 7#`145°: * 3 -50 1, 1 6(A) Hot Vlll�� Maintained at or above 1-501. 16(A) Roasts Held at or above 13VF, 20 Time as a Public Health Control -3--sol,19 Time as a Public Health Cornrol 190.904T) ancc Ratur, Meat — Lin— REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPS -- llre-pacEagcd Juices and 13-80L I 1 (11) -44' �e ` paste"rized 3-ru 1. k I r Di Raw or Patu all" 0`ok-d All Food and c Not CONSUMER ADVISORY 22 360- qConqumer Adsisory P(y.,'wd f�ir('ousumption of Animal t'��ds 'I'haz arr. Raw, Underc�,K4zvd of '�ol Otherwise Proce�qsed to E'linullate 3-3(12.13 1 Ft,teuriyed Fgli4: Substitute foo Raw SPECIAL REQUIREMENTS T90 --l�' dol'�) tt)�--r Viokjticxls ol'Sectron 590.fX)9(A)-(LdJn catering. trai0ak, frxxt, temporary and temdenl4al kitchen operations should he i defuled ander the appropriate sections aBove if rcfrr�,d it) frx)dIX)rne illness HILUM100eq and risk factors. Other 590.W9 violations relarin.c, to ,00d retail practices should be debited under #29 - Special Rerituicyrients, VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Clifiral and nlal-t rilical I wtoch do true � Clare io ilic foodborne iihwSS olrO VM1,0WOnd riYkIiictors listed above, rair ta, found in irrefollou ing, sectiom of ilre fiaid Code and 10,5 (141? 90� OR), Coil 13-80L I 1 (11) -44' �e ` paste"rized 3-ru 1. k I r Di Raw or Patu all" 0`ok-d All Food and c Not CONSUMER ADVISORY 22 360- qConqumer Adsisory P(y.,'wd f�ir('ousumption of Animal t'��ds 'I'haz arr. Raw, Underc�,K4zvd of '�ol Otherwise Proce�qsed to E'linullate 3-3(12.13 1 Ft,teuriyed Fgli4: Substitute foo Raw SPECIAL REQUIREMENTS T90 --l�' dol'�) tt)�--r Viokjticxls ol'Sectron 590.fX)9(A)-(LdJn catering. trai0ak, frxxt, temporary and temdenl4al kitchen operations should he i defuled ander the appropriate sections aBove if rcfrr�,d it) frx)dIX)rne illness HILUM100eq and risk factors. Other 590.W9 violations relarin.c, to ,00d retail practices should be debited under #29 - Special Rerituicyrients, VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Clifiral and nlal-t rilical I wtoch do true � Clare io ilic foodborne iihwSS olrO VM1,0WOnd riYkIiictors listed above, rair ta, found in irrefollou ing, sectiom of ilre fiaid Code and 10,5 (141? 90� OR), 4.1•. ,'F' :f."''F�'r'.- ^d"'i.Y'^{.yi�.-%'4ut .: ..,� Stf+li�ih.,. .�4. . t'.i .. y. 1.. i�+A ..,:Ih 4444 444gt MMY ^y��E�4 'FrwF- '1+ f+'F' � 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 i i q� Dae 1 R p, 7 Ua Type of Operation(s) Type of Inspection © Food Service Retail ❑ Residential Kitchen ElMobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑Routine ❑ Re -inspection Previous Inspection Date: [IPre-operationOwner ❑ Suspect Illness ❑ General Complaint ❑HACCP p Other Address o Risk I Level Telephone 4� �' _ g' O 1 �/U HACCP V/ -N- Person in Charge C) I/ Viii) �( po Time In: Out: Inspector, �, �' U Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) 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 IuIANAQEMENT, " m;-"�,j„,�. ,P„` 1,.,,, : ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH � � 'PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PICS ' l• i�au=F •- �a �a: s_ El 14. Approved Food or Color Additives ❑ 3.. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 'n'."; tr.� j�,�:..; .� ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Record5%Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans y PROTECTION FROM CONTAMINATION ,. k RT, t# , PF '_� . ❑ 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)(590.067) 28. Poisonous or Toxic Materials (FC -7)(590.001) 29. Special Requirements (590.009) 30. Other S. 501ns IFOm i<me n vii , [115. Toxic Chemicals €��,TIMEITEMPERATURE CONTROLS (Patent ally Hazardous Foods), ""A ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control y;:.REOUIREMENTS FOR HIGHLY SUSCEPTIBLE PQPULAATIONS (HSP);, ❑ 21. Food and Food Preparation for HSP COlJSUMEFj 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:, Inspec` or' igil re: Pril--v -1 1( ±, PIC'sr$n re: ' Print: h` Pag _ of_ Pages a Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) _ FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment ofResponsibility* 590.003(B) Demonstzation of Knowledge* 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590A03(,C) Responsibility of the person in charge to liance with Food Law* 3-201.12 require repotting by food employees and 3-20'1.13 Fluid Milk and Milk Products* applicants* Shell Fg s* 590.003(F) _ Responsibility Of A Food Employee Or r1n 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System- stem*590.006(A) 59U06(A) Charge* 590.006(73) 590.003(G) Re ordn b Person n Cha ge* 31 590.003(D) Exclusions and Restrictions* 201.15 L 590.00d{F) Removal of Exclusions and Restrictions C C C LN s Denotes, critical item in the federal 1999 Foal Cade or 105 CMR 590.000. "a • ! • .1 11 ll 0l S Food and Water From Regulated Sources 590.004(A-B)Com liance with Food Law* 3-201.12 Food in a Hermetically Scaled Container* 3-20'1.13 Fluid Milk and Milk Products* 3-202.13 Shell Fg s* 3-202.14 Fg>s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System- stem*590.006(A) 59U06(A) Bottled Drinkin Water* 590.006(73) Water Meets Standards in 310 CMR 22.04` WashmE Fruits and Ve.etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish - 201.15 M011nSCan Shellfish from NSSP:Iasted Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authorit 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201..17 Game Animals* 3-701.11 Receiving/Condition 3-202.1.1 PHFs Receiver! at Pro er Temperatures* 3-202.15 Package Irate it y* 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(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 S ecialized Processin Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103. L2 Conformance wuh_AEEE2ved Procedures* s Denotes, critical item in the federal 1999 Foal Cade or 105 CMR 590.000. "a • ! • .1 11 ll 0l S Cross -contamination 3-302.11(A)(1.) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302A I(A)(2) Raw Annual Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 WashmE Fruits and Ve.etables 3-304.11. Food Contact with Equipment and (Rensils* 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 4-501.1.11. Manual Warewashing - Hot Water Sanitization Tem eratures* - 4-501.11.2 Mechanical Warewashina Hot Water Sanitization Temperatures* 4-501.11.4 Chemical Sanitization- temp., pH, concentration and hardness. " 4-601.11(A) Equipment Food Contact Surfams 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 1 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-40111 Eating. Drinking or Using Tobacco* 2401,42 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventin> Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Fm to ee 13 Handwash Facilities Conveniently Located andAccessible 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 Handwashing Cleanser, Availability 6-3011.2 Hand Drying Provision CITY OF SALEM 7 �s BOARD OF HEALTH Establishment Name: Sun ( a' r4' Date: 7/ 7�� Pager of 3. Item Code C - Critical nem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No.Reference R —Red Item Verified PLEASE PRINT CLEARLY .......... [ + / a--atp7c r h ^s� Discussion With Person in Charger } have read this report, have had the opportunity to ask questions and agree to correct all Corrective Action Required: ❑ No = ❑ Y s ° voluntary compliance ❑ Employee Restriction / � violations before the next inspection, to observe all conditions as described, and to ❑ Re -inspection Scheduled Exclusion ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that' , n ncompliance may result in daily fines of twenty-five dollars or suspension/revocation of L3Embargo ❑ Emergency Closure ur food permit. 1 � ' f4 T V � i �Li / % � \- ❑ Voluntary Disposal ❑ Other: i a v 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 3-302.14 Addiuves's Protection from Unapproved Additives* 15 E as-humediate Service 145°171 Ssec* Poisonous or Toxic Substances Comminuted Fish, Meats & Came 7-101.11 Identifying lnforminion -Original Containers- ontainers*7-1OL11 3-401.11(3)(1)(2) 7-10111 7-201.11 Common Name -Working Containers* Se.araLion- Storage" Ratites, Injected Meats- 155`F 15 7-202.11 Restriction - Presence and Use* 3-401.11(A)(3) 7-202.12 Conditions of Ilse* Stuffing Containing Fish, Meat, 7-203.11 'toxic Containers - Profidu dons* 3-401.11(C)(3) 7-204.11 Sanitizers. Criteria - Chemicals* 145`17 * 7-204.12 Chemicals for Washins Produce, Criteria* 7-204.14 Chying A eats, Criteria* All Other PHFs -1,45°F '15 sec. 7-205.11 Incidental Food Contact. Lubricants* 3-40111(A)&(D) 7-206,11 Restricted Use Pesticides. Criteria* Microwave- 1650 F 2 Minute Standing 7-206,12 7 -206.'13 Rodent Bait Stations - Tracking Powders, Pest Control and Monitoring* 17 18 '" Denotes critical ilon m tho federal 1999 Food Code or 105 CNIk 590900. IN 20 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3-401,11A(1)(2) _ Egg:- 155'F 15 Sec. 3-501.16(B) 590.004(F) E as-humediate Service 145°171 Ssec* 3401.11(A)(2) Comminuted Fish, Meats & Came 3-501,16(A) Animals - 155°F 15 sec. 3-401.11(3)(1)(2) Pork and Beef Roast - 130`F 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155`F 15 590.004(H) sec. 3-401.11(A)(3) Poultry, Wild Game, StuffedPHF,s, Poisonous or Toxic Materials Stuffing Containing Fish, Meat, .008 Poultry or Radios-I65'F 15 sec. ` 3-401.11(C)(3) Whole -muscle, Intact BeafSteaks .009 145`17 * 3401.12 Raw Animal Foals Cooked in a Microwave 165°F * 3401..11(A)(1)(h) All Other PHFs -1,45°F '15 sec. Reheating for Hot Holding 3-40111(A)&(D) PHFs 165"F 15 sec. * 3-403.11(B) Microwave- 1650 F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 14WF* 3-403.11 (E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFc from 1400E to 704_'F Within 2 Flours and From 70°F to 41°F/45°F Within 4 Hours. * 3-501.148) Cooling PHFsMade From Ambient Temperature Ingredients to 410F/450F Within 4 Hours' '" Denotes critical ilon m tho federal 1999 Food Code or 105 CNIk 590900. IN 20 3-501.14(C) PHFs Received of Temperatures According to Iatw Cooled to 4l'F/45`F Within 4Hours. 3-501.15 Cooling Methods for PHFs 3-90LlI(B) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PRFs Maintained at or below 41"/45"'F* 3-50'1.16(A) .lint PHFs Maintained at or above 140'17 * 3-501,16(A) Roasts Held at or above IX F. Water, Plumbin and Waste 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 Warnine Labels* Amman Foods `litat are Raw. Undercooked or 3-90LlI(B) Use of Pasteurized Ea..s* .003 .004 3-801.1 t(D) Raw or Partially Cooked Animal Faxt and Raw Seed Sprouts Not Served. Pasteurized Eggs Substitute for Raw Shell 3$01. -II(C) Uno �ened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of - FC -1580 000 Amman Foods `litat are Raw. Undercooked or Mata ement and Personnel Food and Food Protection Not Otherwise Processed to Eliminate .003 .004 Pathogens.* r'ro ,vE rn,roa� 3-302.13 Pasteurized Eggs Substitute for Raw Shell :_ .005 EluzO arCr6d LL. 15CblUMCIV1GIV I J 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 f/29 - Special Requirements. (,Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and riskJactore listed above, can be found in the following sections q/ the Food Code and 103 CMR 590.000, Item Good Retail Practices - FC -1580 000 23. 24. Mata ement and Personnel Food and Food Protection FC - 2 FC -3 .003 .004 251 __ _ Equipment and Utensils FC 4 :_ .005 26. Water, Plumbin and Waste FC -5 .006 27. Physical Facility---- FC -6 .007 29. Poisonous or Toxic Materials FC - 7 .008 29. Special Requirements ---------- -�-- .009 30. Other S.Y�OPnnb1A6+ Ax i CITY OF SALEM /� BOARD OF HEALTH 1�u Establishment Name: n �arU�/� Date: 4//% �/� �' Page: of Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R — Red Item W` Verified — PLEASE PRINT CLEARLY Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all 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 poncompliance may result in daily fines of twenty-five dollars or suspension/revocation of :your food permit. J ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ No I ❑ Yes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension Cl Emergency Closure ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) 14 1 Proper Cooking Temperatures for Food or Color Additives PHFs.._._. 3-202.12 Additives', 3-50116(B) 5W00417) 3-302.14 Protection from Unapproved Additives* IS 3-501.1.6(A) Poisonous or Toxic Substances 3-401.11(.11)(1 j(2) 7-101.11 Identifying Information -Original Ratites, Injected Nleat's - 155°F 15 590.004(H) Csntainers' 3-401.11(A)(3) 7-102.11 Common Name - WorkingContasners* Stuffing Containing Fish, Meat, 7-201.11 Se ara6on-S� 3401.11(C)(3) 7-202-'11 Restriction -Presence and Use's 145`17 * 7-202.12 Conditions of Use" 7-203.1.1 Toxic Containers -Prohibitions* All Other PHFs - 145`F 15 sec. 7-204.11 Sanitizers,Criteria -Chemicals^` 3-403.11(A)c&(J)) 7-204. t2 C:lrenticals for Washiue Produce, Criteria" Microwave- 165` F 2 Minute Standing 7-204.14 Drying Agents, Criteria - 3-403.11(C) 7 -205.11 incidental Food Contact. Lubricants* 140"F* 7-206.1 R.estdcted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* Proper Cooling of PRFs 7-206.'13 'franking Powders, Pest Control and 70`F Within 21 -lours and From 70`F Monitory eg 17 IM TIMElfEMPERATURE CONTROLS '" Denotes enbcal item 3n um federal 1999 Food Code or 105 CNIX 590.000- N 20 3-50114(0) 1 Proper Cooking Temperatures for 3-501.15 PHFs.._._. 3-401.1.1All )(2) Eggs- 155'F 1.5 Sec. 3-50116(B) 5W00417) E gs-lmntediate Service 145°F15sec* 3-401.,11(A)(2) Commitmted Fish, Meats & Game 3-501.1.6(A) Animals - 155°F 15 sec. 3-401.11(.11)(1 j(2) Pork. and Beef Roast -130°17 121 gin* 3-401.11(A)(2) Ratites, Injected Nleat's - 155°F 15 590.004(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC -6 Youltr - or Ratites -165`17 15 sac. x' 3401.11(C)(3) Whole-nurscle.Inrnet Beef Steaks FC -7 145`17 * 3-401.12 Raw Animal Foods Calked in a Microwave 165"F * 3401.11(A)(O(b) All Other PHFs - 145`F 15 sec. Reheating for Hot Holding 3-403.11(A)c&(J)) PHFs 165`F 15 see. * 3-403.11(11) Microwave- 165` F 2 Minute Standing Time" 3-403.11(C) Comrnercially Prrxessed RTE Food - 140"F* 3-403.11(E) Remaining Unslieed Portions of Beef Roasts* Proper Cooling of PRFs 3-501.14(.A) Cooling Cooked PHFs from 140`F to 70`F Within 21 -lours and From 70`F to 41.`F745°F Within 4 Hours. * 3-501.14(11) Cooling PFIFs Made Front Ambient Temperature Ingredients to 41 °F145°F Within 4 flours* '" Denotes enbcal item 3n um federal 1999 Food Code or 105 CNIX 590.000- N 20 3-50114(0) PHFs Received at Temperatures According to L zw Cooled to 41"F745°.F Within 4Hours. 3-501.15 Coolim, Methods for PIIFs 3-901.11(,B) PHF Hot and Cold Holding 3-50116(B) 5W00417) Cold PIIFs Maintained at or below 4J V45` F* 3-501,16(A) Riot PHFs Maintained at or above 140`F. * 3-501.1.6(A) Roasts Held at or above 130"F." 25. _ Time as a Public Health Control 3-Soi-1> Time as a Public Health Control* 590.004(H) Variance Re uirein REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801A 1(A) Unpasteurized Pre-packaged Races and ;Beverages with Warriors Labels* s90.000 3-901.11(,B) Use of Pasteurized Fees* FC -2 3-80I A I (D) Raw or Partially Crxoked Animal Food and Raw Seed Sprouts Not Served. Food and Food Protection 3-901.11(C)Uno cited Food Package Not Re -served, CONSUMER ADVISORY 22 3-603.11 Consumer .Advisory Posted for Consumption of s90.000 23. Animal Fails That are Raw. Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* ear ....pool 25. _ 3-302. t3 Pasteurized Eggs Substitute for Raw Shell .005 28. Eggs, giI 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. 1:14if,l/-SMob lirdia an (items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed obove, can be found in the following sec lions of the Food Code and /05 CMR 590.000. Item Good Retail Practices_ FC s90.000 23. Mona ement and P_ersonne_I FC -2 .003 24. -- Food and Food Protection FC - 3 .004 25. _ - _ Epmeni and Utensils - FC - 4 .005 28. Water, Plumbin and Waste FC -5 .000 27. Ph sinal Facility FC -6 .007 28. Poisonous or Toxic Materials FC -7 .008 29. S eoialR uirements .009 30. _ Other cS�OP„uAsl42ds 0099 North Street Telephone: '978-744-9998 j Owner: Yong Quang Qiu iPIC: Yong Quang Qiu Inspector: Elizabeth Salandrea Date Inspected: Correct By: 3/6/2008 Risk Level: Permit Number: BHP -2008-0255 Status: r SIGNED OFF # of Critical Violations: 2 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) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item - Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Q RED Comment: Beverage air deli unit had two sets of tongs for all items. Provide separate serving utensils for all items in unit. Violations Related to Good Retail Practices (Blue Items) Special Requirements FAIL Critical BLUE Comment: Rodent droppings observed in establishment. Owner to contact licensed pest control operator and exterminate as often as necessary. GENERAL COMMENTS: All other violations noted in 3/6/08 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS@ 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page I oft Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) i Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 17,2008 ) Page 2 oft 0099 North Street Telephone: i 978-744-9998 ,,Owner: Yong Quang Qiu -PIC: 'Yung King Yau Inspector: Elizabeth Salandrea Date Inspected: Correct By: 3/6/2008 `Risk Level: 'Permit Number: BHP -2008-0255 Status: VIOLATION # of Critical Violations: 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Leomment: Spray bottle of sanitizing solution found too weak. Provide sanitizing solution of proper concentration at all times. Wcket used for storing knives has food spills and splatter. Thoroughly clean this bucket. Beverage air deli unit only had one set of tongs for all items. Provide separate serving utensils for all items in unit. Handwash Facilities FAIL Critical ❑d RED 8/Comment: Both handwash sinks found to be obstructed. Keep all handwash sinks clear and accessible at all times. 1 City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 07,2008 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE ,Foodborne Illness Interventions and Risk Factors (Require omme(t�Kenmora fr zer, small beverage -air fridge, and walk-in fridge had some uncovered food. Cover all food in storage to immediate corrective action) prevent cr amination. Equipment a d Utensils FAIL Non -Critical BLUE omment: Front window area had accumulation of food spills and splatter. Thoroughly clean this area. -L,Grill requires a thorough cleaning. IiEnt�ire cookline requires thorough cleaning, including under and around all equipment. 41ligall beverage air fridge requires general cleaning of shelves and bottom. door beverage air fridge requires general cleaning. UZo"�ca cola fridge requires general cleaning of bottom and door tracks. t,/ucket used for knife storage requires general cleaning. alk -in freezer requires general cleaning of the floor and food containers. Physical Facility FAIL Non -Critical BLUE Womment: Ceiling in kitchen stained and water damaged. Investigate source of leak and repair ceiling. Special Requirements FAIL Critical BLUE Comment: Rosent droppings observed in establishment. Owner to contact licensed pest control operator and exterminate as often as necessary. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. Owner must provide last 6 months of extermination reports upon reinspection. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 07,2008) Page 2 oft Commonwealth of Massachusetts ... x City of Salem s • Board of Health IGmberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: File Number: BFIF-2004-000279 Sun Garden 99 North Street Salem MA 01970 LOCATED AT: 0099 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2008-0255 Jan 4, 2008 Dec 31, 2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be 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 9 of 10 a KIMBERLEY DRISCOLL MAYOR JOANNE SOOTT, HEALTH AGENT QTY OF SALEM, MASSACHUSEM BOARD OF HEALTH 120 WASHINGTON STREET, 4'm FLO cPi TEL. (978) 741-1800 loll FOOTr(a SS)ALE4M. GOM 5-0343 NAV ---ft 130,4'4'0 pyo OFS&A/ l`/ ;� 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT !!504as (d16 %'1 ADDRESS OF ESTABLISHMENT q9 Nd K vt !�4 p MAILING ADDRESS (if different) EMAIL - Business': Website: TEL# c(78—2,114rq998 fg-r-w, OWNER'SNAMEVoVI�N5 Q1U TEL# ADDRESS FE N CERTIFIED FOOD MANAGER'S NAME(S) Va N �i h VA �7 CERTIFICATE#(S) 4-U g5 -U t 0 (Required in an establishment where potentially h ardou ood is prep ed EMERGENCY RESPONSE TEL# HOURS OF OPERAIIUN Please write in time of day. (Por examnle 11 am -11 PM) &:!' 6e7 ,VL TYPE OF ESTABLISHMENT RETAIL STORE YES NO ------------------------- - RESTAURANT YES NO (Outdoor Stationary Food Cart $210) ... -------------------- ES------ BEDIBREAKFAST/ YES NO CHILDCARE SERVICES ------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check onl less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ----------------------- -------------- less than 25 seats -- --- - =$140 25-99 seats =$280 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. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. 7 Social --------------------- '------"-----T - - ---- --- — Revised 4/24/07 FOODAP2008.adCheckq & Date I l �� 2% I S m -Z6 -- 0,0"! CSs0 ity or Federal Identification Number 0099 North Street Telephone: 978-744-9998 j Owner: �I Yong Quang Qiu PIC: Yung King Yau Inspector: David Greenbaum Date Inspected: Correct By: 711812007 Risk Level: Permit Number: BHP -2007-0159 Status: SIGNED OFF # of Critical Violations: 0 Time IN: Time OUT: I Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Good Hygienic Practices PASS Critical ❑d RED Comments: There are employee drinks throughout the prep areas of this establishment. Employees must eat and drink in a designated employee area to prevent cross contamination. The True coke unit has employees food and drinks stored in it. Employees food and drinks must be stored in a designated employee refrigerator to prevent cross contamination. TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Hot and Cold Holding PASS Critical Comments: The walk in freezer has a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts RED ( Rev. Jul 19,2007 ) Page 1 oft RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS Critical BLUE Comments: There was an uncovered bucket of chicken on the back floor. cover chicken and store in a refrigerator at 6-8 inches off the floor. The walk in has some uncovered food. All food in storage must be covered. The walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. Equipment and Utensils PASS Non -Critical BLUE Comments: The shelving in the walk in needs a thorough cleaning. The True unit in back not working. Repair unit to good working order or remove. The GE freezer not working. Repair unit to good working order or remove. The front True coke unit needs a general cleaning. The small Beverage air unit in the cookline needs a thorough cleaning including the door gaskets. The Southbend grill needs a thorough cleaning. There are food spills and splatter on many walls. Thoroughly clean all walls. The meat slicer and grinder must be properly cleaned and sanitized after each use. Physical Facility PASS Non -Critical BLUE Comments: There is a hole and water damage on the kitchen ceiling. Investigate the source of the leak and repair. Repair and repaint the ceiling. Special Requirements PASS cll9q Comments: There is an accumulation of mouse droppings under a rack in the back. Owner to contact the licensed pest control operator to exterminate as often as needed. GENERAL COMMENTS: All violations cited in the 7/11/07 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 19,2007 ) Page 2 oft 0099 North Street Telephone: 978-744-9998 Owner: Yong Quang Qiu PIC: Tonylp Inspector: David Greenbaum Date Inspected: Correct By: 711112007 Risk Level: Permit Number: BHP -2007-0159 Status: VIOLATION # of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Good Hygienic Practices FAIL Critical RED ment: There are employee drinks throughout the prep areas of this establishment. Employees must eat and drink in a designate employee area to prevent cross contamination. The rue coke unit has employees food and drinks stored in it. Employees food and drinks must be stored in a designated ployee refrigerator to prevent cross contamination. TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) Hot and Cold Holdi - FAIL Critical U RED menta The walk in freezer has a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 11,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Co floal oant: There was an uncovered bucket of chicken on the back floor. cover chicken and store in a refrigerator at 6.8 inches off r. immediate corrective action) e w ' has some uncovered food. All food in storage must be covered. e walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. Equipment and Utensils FAIL Non -Critical BLUE - Co ment: The shelving in the walk in needs a thorough cleaning. Th rue it in back not working. Repair unit to good working order or remove. The freezer not working. Repair unit to good working order or remove. e fro rue coke unit needs a general cleaning. T small verage air unit in the cookline needs a thorough cleaning including the door gaskets. Tbend grill needs a thorough cleaning. =rear od spills and splatter on many walls. Thoroughly clean all walls. T meat slicer and grinder must be properly cleaned and sanitized after each use. Physical Facility FAIL Non -Critical BLUE Co ment: There is a hole and water damage on the kitchen ceiling. Investigate the source of the leak and repair. Repair and paint the ceiling. Special Re irements FAIL BLUE Co ent: There is an accumulation of mouse droppings under a rack in the back. Owner to contact the licensed pest control Aerator to exterminate as often as needed. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 11,2007 ) Page 2 oft 0099 North Street Telephone: 978-744-9998 Owner: Yong Quang Qiu PIC: Yong Quang Qiu Inspector: David Greenbaum Date Inspected: Correct By: 1117/2007 Risk Level: Permit Number: BHP -2007-0159 Status: SIGNED OFF # of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Status Violation PASS Critical Sun Garden Critical Urgency GI3i' Comments: There are dirty knives in the knife holder. Properly clean and sanitize all knives prior to storage. Good Hygienic Practices PASS Critical ❑d RED Comments: Employees drinks observed in food prep areas. Employees must eat and drink in a designated employee area to prevent cross contamination. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS Critical RED Comments: There was food debris in the 2 bay sink used for washing, rinsing and sanitizing dishes. Food preparation must be done in designated sinks, not in the 2 bay. 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 17,2007 ) Page I oft U City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2007 ) Page 2 oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: The walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. immediate corrective action) The walk in freezer has food stored directly on the floor. Store all food at least 6-8 inches off the floor. Equipment and Utensils PASS Non -Critical BLUE Comments: The True refrigerator needs a thorough cleaning. The Beverage air unit needs a thorough cleaning. The same unit has a broken thermometer. Provide a new visible, accurate thermometer in this unit. The knife container has an accumulation of food debris. Thoroughly clean the knife holder. The GE freezer needs a thorough cleaning. The True refrigerator in back is not working. Repair to good workin ordee or remove. The walk in freezer needs a thorough cleaning. Physical Facility PASS Non -Critical BLUE Comments: There is a leak and a hole in the kitchen ceiling. Repair leak and seal the hole. There is trash left outside loose. Store all trash in an appropriate trash receptacle. The grease barrel is directly on the ground. Store grease barrel up off the ground. GENERAL COMMENTS: Akll violations cuited in the 1/9/07 inspection report have been corrected. U City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 17,2007 ) Page 2 oft 0099 North Street Telephone: 978-744-9998 Owner: Yong Quang Qiu PIC: Yong Quang Qiu Inspector: David Greenbaum Date Inspected: Correct By: 1/9/2007 Risk Level: Permit Number: BHP -2007-0159 Status: PARTIAL COMPLY # of Critical Violations: 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical LJ RED I ment: There are dirty knives in the knife holder. Properly clean and sanitize all knives prior to storage. Good Hygienic Pr ces FAIL Critical d❑ RED Co ant: Employees drinks observed in food prep areas. Employees must eat and drink in a designated employee area to prevent ss contamination. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Pre oration for HSP FAIL Critical J RED Com nt: There was food debris in the 2 bay sink used for washing, rinsing and sanitizing dishes. Food preparation must be do m designated sinks, not in the 2 bay. 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 10,2007) Page 1 oft Item - Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require C9�mm ent: The walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. immediate corrective action) T alk in freezer has food stored directly on the floor. Store all food at least 6-8 inches off the floor. Equipment and tensils FAIL Non -Critical BLUE mment: The True refrigerator needs a thorough cleaning. • TjW'Beverage air unit needs a thorough cleaning. same unit has a broken thermometer. Provide a new visible, accurate thermometer in this unit. e knife container has an accumulation of food debris. Thoroughly clean the knife holder. L/The GE freezer needs a thorough cleaning. T True refrigerator in back is not working. Repair to good workin ordee or remove. T e walk in freezer needs a thorough cleaning. Physical Facili FAIL Non -Critical BLUE ,comment: There is a leak and a hole in the kitchen ceiling. Repair leak and seal the hole. o,Tfiere is trash left outside loose. Store all trash in an appropriate trash receptacle. -The-grease barrel is directly on the ground. Store grease barrel up off the ground. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. / �/ t� I'l, � <�4x 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 10,2007) Page 2 oft 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �l NAME OF ESTABLISHMENT S G/ 1ar 0 I�/1 y rl L TEL #M-24-? 9q ADDRESS OF ESTABLISHMENT ON /V 0 I� h S I " S ok I 11 Yn Gj FAX # MAILING ADDRESS (if different) EMAIL -- Business': OWNER'S Owner's: TEL# 6�7^ (q-2722 ADDRESS g VOIR V e haY-45� wri /lii A 02/2'9 'STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) Ilia ✓l l a OI )Zn(A CERTIFICATE#(S) (Required in an establishment where potentially/hazardous food is prepared) 'V 2 EMERGENCY RESPONSE PERSON y 0 h �� n1 (a h Sr t -Y (U HOME TEL # DAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. (For example llam4loml TYPE OF ESTABLISHMENT RETAIL STORE YES NO ------------ - - - -- -------- ----- ------ ----- -- -- RESTAURANT YES 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) CITY OF SALEM, MASSACHUSETTS =$ 50 o BOARD HEALTH T� RECEIVED a 120 WASHINGTON STREET, 4TH FLOOR S 25-99 seats SALEM, MA 01970 DEC - 7 2006 =$200 TEL. 978-741-1800 --- FAX 978-745-0343 CITY OF SALEM Kimberley Driscoll W W W.SALEM.COM BOARD OF HEALTH JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �l NAME OF ESTABLISHMENT S G/ 1ar 0 I�/1 y rl L TEL #M-24-? 9q ADDRESS OF ESTABLISHMENT ON /V 0 I� h S I " S ok I 11 Yn Gj FAX # MAILING ADDRESS (if different) EMAIL -- Business': OWNER'S Owner's: TEL# 6�7^ (q-2722 ADDRESS g VOIR V e haY-45� wri /lii A 02/2'9 'STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) Ilia ✓l l a OI )Zn(A CERTIFICATE#(S) (Required in an establishment where potentially/hazardous food is prepared) 'V 2 EMERGENCY RESPONSE PERSON y 0 h �� n1 (a h Sr t -Y (U HOME TEL # DAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. (For example llam4loml TYPE OF ESTABLISHMENT RETAIL STORE YES NO ------------ - - - -- -------- ----- ------ ----- -- -- RESTAURANT YES NO ------- ------ BED/BREAKFAST YES NO ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only) less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 than 25seat =$10 25-99 seats - 0 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. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all stale tax returns and paid all state taxes required under the taw. a �II�.nI Mliv yn rD, , )2 /1,9 P %ti—��gl Gssl1' Social Security or Federal Identification Number Revised 11/.13/06 FOODAP2007.adm Check# & Date --!;r (0��flQbS / na A 0 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: . File Number: BHF -2004-000279 Sun Garden 99 North Street Salem MA 01970 LOCATED AT: 0099 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0159 Dec 20, 2006 Dec 31, 2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES (December 31, 2007 Board of Health ti l 01 wd 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 16 of 16 0099 North Street Telephone:., 11 978-744-9998 Owner: Yong Quang Qiu "PIC: Yong Quang Qiu Inspector: David Greenbaum Date Inspected: Correct By: 8/28/2006 Risk Level: Permit Number: BHP -2006-0224 Status: SIGNED OFF # of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Sun Garden Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: The cooling unit in the front window is not working. Repair this unit to good working order. The True cooling unit in back is not working. Repair unit to good working order. GENERAL COMMENTS: 768:AII other violations cited in the 8/16/06 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 28,2006) Page 1 oft RED: a g Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency K'� I LL 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. Aug 28,2006 ) Page 2 oft .j 0099 North Street Telephoner 978-744-9998 Owner: j Yong Quang Qiu PIC: Yong Quang Qiu Inspector: David Greenbaum Date Inspected: Correct By: 8/16/2006 RED Risk Level: Permit Number: BHP -2006-0224 Status: VIOLATION # of Critical Violations: 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Separation/ Segregation/ Protection FAIL Critical ❑d RED Com :There is only one set of tongs for all food in the top of the deli unit. Separate tongs must be used for each item to p ent cross contamination. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Comment: Keep sanitizing solution readily available at all work stations at all times. Not on the floor under the sinks. Good Hygienic Practices FAIL Critical E/1 RED Comm : Employees drinks observed in cooling units and being consumed in the food prep areas. Employees drinks to be store in a dicated employee refrigerator and consumed in a designated break room not in food prep areas to prevent cross tammation. 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. Aug 17,2006) Page I oft RED: Violations Related to`"i'8" Foodborne Illness Interventions and Risk Factors (Require ` immediate corrective action) ` Item Violations Related to Food and Foo roi Status Violation Critical Urgency FAIL Critical Coke True reach in has uncovered food. All food in storage must be covered. BLUE T small Beverage air cooling has uncovered food. All food in storage must be covered. Yand stls FAIL Non -Critical BLUE acontainer holding the knives has an accumulation of dirt and grime. Thoroughly clean and sanitize the knife Th oke True reach in has an accumulation of food debris. Thoroughly clean this unit. Th in Beverage air reach in has a leak. Repair the leak. Th same unit has an accumulation of food debris. Thoroughly clean this unit. The c oling unit in the front window is not working. Repair this unit to good working order. �T a white GE freezer needs a general cleaning. The True cooling unit in back is not working. Repair unit to good working order. The baskets holding egg rolls in the walk in freezer have an accumulation of grime. Thoroughly clean and sanitize these baskets aEment: e. Physical FFAIL Non -Critical BLUE here is peeling paint on the kitchen ceiling. Scrape and repaint all peeling paint. GENERAL COMMENTS: 749:Reinspection will be on 8/28/06 all violations to be corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 17,2006 ) Page 2 oft r 0099 North Street Telephone: 978-744-9998 Owner: Yong Quang Qiu PIC' Inspector. David Greenbaum` Date Inspected: Correct By: 2/2/2006 Risk Level: T Permit Number:,, BHP -2006-0224 Status: yOFF SIGNED # of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Comment: The rice scoop stored in water. Store scoop in a sanitized container labeled "Rice Scoop Only" Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: The grease barrels are directly on the ground. Grease barrels must be stored up off the ground. GENERAL COMMENTS: 457:Rodent droppings still observed in the back roomand basement. Inspector will speak to the exterminator to determine course of action. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 06,2006 ) Page 1 oft RED: Violations Related to Foodborne Illness Interventions' and Risk Factors (Require T immediate corrective action) Item Status Violation Critical Urgency t� L LIU City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 06,2006 ) Page 2 of IMPORTANT MESSAGE FOR )nA A6 DATE TIME Mal P, PHONE `'J�/t!�� 3�L�3 ARE�� NUMB R EXTENSION O FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL`:' WILL FAX TO YOU MESSAGE (fl�11,8d t i SIGNED 4009 1 U.S.A. NOTES f'f' 0099 North Street Telephone: 978-744-9998 s Owner. 'Yong Quang Qiu PIC - Yong Quang Qiu Inspector: " David Greenbaum Date Inspected: Correct By: 1/25/2006 Risk Level: Permit Number BHP -2006-0224 " Status: 4 1 1 „ VIOLATION # of Critical Violations: m 8 _; 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), Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency FOOD PROTECTION MANAGEMENT PIC Assigned / Knowledgeable / Duties FAIL Critical ❑d RED dComment: Upon arrival for inspection there was no knowledgeable person in charge designated. In the absence of the Certified Food Manager there must be knowledgeable Person in Charge designated at all times. PROTECTION FROM CONTAMINATION Separation/ Segregation/ Protection FAIL Critical U RED Comment: There was a pair of tongs in the deli unit used to serve raw chicken and steak. Separate tongs must be used for each food item to prevent cross contamination. �There were an employees keys on the meat slicer. Store employees personal items in an appropriate area to prevent cross contamination. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑ RED Comment: There was only one spray bottle of sanitizing solution for the entire establishment. Sanitizing solution of proper oncentration MUST be readily available at ALL work stations at ALL times. The meat slicer has an accumulation of grime. Thoroughly clean and sanitize the meat slicer after each use. The rice scoop stored in water. Store scoop in a sanitized container labeled "Rice Scoop Only" HHaandwash Facilities FAIL RED Comment: The handwash sink near the Coke cooling unit found obstructed. Handwash sinks MUST be kept clear and accessible at VVV all times. The bathroom handwash sink had no hot water at the time of inspection. Provide HOT water to this hand sink at ALL times. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2006 ) Page 1 of City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2006 ) Page 2 of Item Status Violation Critical Urgency RED: TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) Violations Related to Cooling FAIL Critical RED Foodborne Illness Interventions and Risk Factors (Require Comment: There were many potentially hazardous foods out cooling at room temperature. Food must be cooled to a temperature immediate corrective action) of 70°F within two hours and down to temperature of 41°F winthin an additional two hours for a total cooling time of 4 hours. Hot and Cold Holding FAIL Critical ❑d RED +� i Comment: Chicken found stored out at room temperature. Store all cold potentially hazardous foods at a temperature of 41" or v below. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE Comment: Sauce found stored under the cookline uncovered. Do not store any food products under the cookline, and all food in storage must be covered. Label all dry ingredient barrels. Buckets of sauce stored directly on the back room floor. All food must be stored at least 6-8 inches off the floor. \� vThe Beverage air cooling unit has uncovered food. All food in storage must be covered. \Equipment and Utensils FAIL Non -Critical BLUE \J Comment: The Beverage air cooling unit has a broken thermometer. Provide a new visible, accurate thermometer in this unit. The cooker has an accumulation of grease and grime on the side. Thoroughly clean the entire cooker. S\ The GE freezer has an accumulation of food debris. Thoroughly clean this freezer. `�/ The Coke True cooling unit has an accumulation of food debris and grime. Thoroughly clean this unit. '� �j The sugar and sauce barrels have an accumulation of food spills and splatter. Thoroughly clean these barrels. \\tel The platform holding the sugar and sauce barrels needs a thorough cleaning and must be painted. V The flooring in both walkins needs a thorough cleaning. �j The rolling metal rack in back has food spills and splatter. Thoroughly clean and sanitize this rack. The grease barrels are directly on the ground. Grease barrels must be stored up off the ground. \J There are food spills and splatter in the front window area. Thoroughly clean this area. Physical Facility FAIL Non -Critical BLUE Comment: There are unfinished shelves in the basement. All shelves must be made impervious and easily cleanable. v There is trash piled up in back of the establishment. All trash must be stored in an appropriate trash receptacle. There are stained ceiling tiles in the back room. Investigate the source of the leak and repair. Replace all stained ceiling tiles. Special Requirements FAIL Critical BLUE Comment: There were many rodent droppings observed in the back room and in the front window. Owner must have pest control operator exterminate as often as needed to abate the rodent problem. GENERAL COMMENTS: 447:Reinspection will be in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2006 ) Page 3 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 30,2006 ) Page 4 of HACCP Risk Assessment City/Town of: Salem, MA Pupu Platter: chicken fingers, teriyaki steak, boneless spare ribs, Chicken wings, crab rangoons and wanton soup Establishment Name Sun Garden Ingredients Source Address 99 North Street Chicken Fingers: chicken and batter Agar Supply Person -in -Charge Yong Qiang Qiu Teriyaki Beef: Steak and sauce Agar Supply Boneless Spareribs: Boneless pork and sauce Agar Supply Information for the Risk Assessment was obtained by: ❑ Observation of Suspect Food/Process ❑ Observation of General Food Handling and Sanitation Practices ❑ Interview with Food Employee Responsible for Preparing Implicated Food. ❑ Interview with Person -in -Charge or Other Employee Dates of Investigation: 1/25/06 Chicken Wings: Chicken wings Agar Supply Crab Rangoon: Cheese, vegetables, shell Lun Fat Produce Wanton Soup: Water, mushroom, water chestnut, City water and Lun Fat Produce bok choy Weight(Volume of Suspect Food Prepared or Served: The pupu platter has approximately 6-6 pieces of each item and is cooked to order. The wanton soup is served in a 16 or 32 ounce serving and is cooked to order. Page 1 of 3 [ACCP Rbk Assessment Report Form (Updated 09/05) Describe Product Flow Describe Environmental Data Collected to HAZARDS Describe Corrective and Preventive Date Verify Control or Lack of Control of Hazards -Contamination Measures Initiated Verified (Preparation Steps) -Survival -Proliferation (Include changes in food handling procedures, orders Who, What, Where, When for correction, embargoes/disposals, food employee restrictions, food safety training, emergency suspensions and closures, etc.) [—]CCP Wanton Soup— is prepared to order and Meat is delivered and processed upon delivery. It appears that C - Pork Pork must be placed in the walk in under refrigeration until (Critical serving sizes are 16oz. Or 32oz. Ingredients meat is out at room temperature until such time that it is such time the chef will process the pork. Control are water, roasted pork and vegetables. The processed. S — Pork Sanitizing of knives, cutting boards and other utensils mus[ Point) roasted pork is supplied by Agar and comes in approximately a 501b box. The pork is cut and There is a lack of sanitizing taking place during the processing P - pork be done before changing from one potentially hazardous cooked and placed into the walk in freezer at a of meat. It does not appear that knives, cutting boards and food to another. temperature of O°. The pork is thawed in the other utensils are being sanitized between used and changing of walk in refrigerator at 37 ° F. The pork is then meat products. placed in a cooing unit at the cook line at a temperature of 40° F. The vegetables are purchased from Lun Fat Produce and are stored in the walk in at a temperature of 370 F. Page 1 of 3 [ACCP Rbk Assessment Report Form (Updated 09/05) -- Page 2 of 3 RACCP Risk Assessment Report Form (Updated 09105) Boneless spam ribs are supplied by Agar. Meat is delivered and processed upon delivery. It appears that C - Pork Pork must be placed in the walk in under refrigeration until Order only one case at a time approximately meat is out at room temperature until such time that it is such time the chef will process the pork. 50lbs. The boneless pork is cut into large processed S — Pork Sanitizing of knives, cutting boards and other utensils must [:]CCPpieces and placed in sauce. Pork is cooked completely and cooled for approximately 20- p y pp y There is a lack of sanitizing taking place during the processing P -Pork be done before changing from one potentially hazardous - 30 minutes. Pork goes in the walk in at 37° F. of mea[. It does not appear that knives, cutting boards and food to another. The pork is cooked in grill for approximately other utensils are being sanitized between used and changing of 10 minutes to heat After the pork is cooked it meat products. cut and served to the customer. - Teriyaki steak is supplied by Agar in Meat is delivered and processed upon delivery. It appears that C - Steak Pork must be placed in the walk in under refrigeration until approximately 501b boxes. The steak is cut meat is out at room temperature until such time thatit is such time the chef will process the pork. into big pieces and marinated in sauce. The processed S — Steak Sanitizing of knives, cutting boards and other utensils must ❑CCP Steak is placed into the walk in freezer at 0° F. The steak is thawed in the walk in refrigerator There is a lack of sanitizing taking place during the processing P - Steak be done before changing from one potentially hazardous at 37° F. The steak is then cooked in the grill of meat. It does not appear that knives, cutting boards and food to another. for approximately 10-15 minutes and served to other utensils are being sanitized between used and changing of the customer. meat products. Chicken Wings are supplied by Agar. Meat is delivered and processed upon delivery. It appears that C - Chicken Chicken must be placed in the walk in under refrigeration Approximately 4-5 cases are delivered at a meat is out at room temperature until such time that it is until such time the chef will process the pork. time. Chicken wing are stored in the walk in processed S — Chicken Sanitizing of knives, cutting boards and other utensils mus[ ❑CCP freezer at 0° F and are thawed in the walk in g wings refrigerator at 37° F. the chicken win are There is a lack of sanitizing taking place during the processing P -Chicken be done before changing from one potentially hazardous made to order. They come out of the walk in of mea[. It does not appear that knives, cutting boards and food to another. and are fried for approximately 5 minutes and other utensils are being sanitized between used and changing of served to the curomer. meat products. -- Page 2 of 3 RACCP Risk Assessment Report Form (Updated 09105) Comments: There is a small amount of food pre cooked during the busy times, i.e. lunch and dinner. t1ACCP Risk Assessment Report Form (Updated 09/05) Page 3 of 3 Describe Product Flow Describe Environmental Data Collected to HAZARDS Describe Corrective and Preventive Date Verify Control or Lack of Control of Hazards. -Contamination Measures Initiated Verified (Preparation Steps) -Survival (Include changes in food handling procedures, orders Who, What, Where, When -Proliferation for correction, embargoes/disposals, food employee restrictions, food safety training, emergency suspensions and closures, etc.) Chicken fingers — Chicken is supplied by Meat is delivered and processed upon delivery. It appears that C - Chicken Chicken must be placed in the walk in under refrigeration Agar. One case is delivered at a time meat is out at room temperature until such time that it is until such time the chef will process the pork. approximately 50lbs. The chicken is cut upon processed Sanitizing of knives, cutting boards and other utensils must ❑CCP arrival and then placed in the walk in freezer a[ 0° F. The chicken is [hawed in the walk in There is a lack of sanitizing taking place during the processing be done before changing from one potentially hazardous refrigendor at 37 ° F. Once thawed the chicken of meat It does not appear that knives, cutting boards and food to another. is dipped in batter and fried in the fryolator for other utensils are being sanitized between used and changing of approximately 20 minutes and served to meat products. customer. Fried Shrimp— Shrimp is supplied by Agar. It C Sanitizing of knives, cutting boards and other utensils must is purchased one case at a time. The shrimp be done before changing from one potentially hazardous goes directly in to the walk in freezer at 0° F. food to another. ❑CCP It is then thawed in the walk in refrigerator at 37° F. Once thawed it is dipped in batter and fried fro approximately 20 minutes and served to the customer. Crab Rangoon — cream cheese is supplied by C Sanitizing of knives, cutting boards and other utensils must Agar, onions and shells supplied by Lim Fat be done before changing from one potentially hazardous Produce. The cream cheese and onions are food to another. ❑CCP mixed together and stuffed into the shells. The uncooked crab rangoons are placed in the walk in refrigerator at a temperature of 37° F. The crab rangoons are plain the fryolator for approximately 5 minutes and served to the customer. Comments: There is a small amount of food pre cooked during the busy times, i.e. lunch and dinner. t1ACCP Risk Assessment Report Form (Updated 09/05) Page 3 of 3 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: File Number: BHF -2004-0279 Sun Garden 99 North Street Salem MA 01970 LOCATED AT: 0099 NORTH STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0224 Jan 3, 2006 Dec 31, 2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 9 of 10 STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT DEC 12 2005 CITY OF SALEM BOARD OF HEALTH 2006 APPLICATION FOR PERMIT Ln TO OPERATE A FOOD ESTABLISHMENT �y NAME OF ESTABLISHMENT S (4/I q r IQui[ S TEL # q % S — 7� `Y/` - ( q ADDRESS OF ESTABLISHMENT d% D MAILING ADDRESS (if different) OWNER'SNAME Y01,70 (9100, (t4 TEL# U CITYA CERTIFIED FOOD STA (required in an establishment where potentially hazardous food is prepared.) ZIP EMERGENCY RESPONSE PERSON 1(2 19 ,1 (91&0J Lief o HOME TEL # (9/7' 292-42 0 HOURS OF OPERATION: Mon. l TOe. Wed. Thu. Fri. --- Sat. S TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ES NO ) ryl less than 25 seats $100 / / 7 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO --------00 ---------------- $1 - --...---------------------------------------------------------------------------------------------------- ACCITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge andbelief, haves filed all state tax returns and pyaid all sta22 te taxes tax/e�s( required under the law. n / Signatu Revised 11/03/05 FOODAP2.adm Check# & Date * Security or Federal K.J _w STANLEY J. USOVICZ, JR. MAYOR i CITY OF SALEMv MASSACHUSETTS` BOARDOF HEALTH 120 WASHINGTON STREET, 4TH FLOOR - t 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: Sun Garden Address of Establishment: 99 North Street Owner's Name: Yong Quang Qiu Restrictions: Application Date: 11/18/04 Permit for Food Establishment 17-05 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. Vim - HEALTH AGENT CITY OF SALEM, MASSACHUSETTS -• BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR & SALEM, MA 01970 TEL. 978-741-1800 / �^ FAX 978-745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PE MIT TOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �;Q Al a �/ 71-0/1`1 TEL #�' 7d — 24q ADDRESS OF ESTABLISHMENT 9� MAILING ADDRESS (if different) OWNER'S TEL #, �",V-1a0 CITY C lic CERTIFIED FOOD (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON %//J��/'AL. 7�f.�✓1 HOME TEL # 6� !1 9/d 6� HOURS OF OPERATION: Mon /J 3o 7 Tuem}6-0AWed.ir3o, 1-1Thu113o-la�Fri/��Sat.�Sun./4 y-/2 qT TYPE OF ESTABLISHMENT RETAIL STORE YES NO RESTAURANT YES NO % % -d `S BED/BREAKFAST YES NO FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 . e -ss than 25 seats =$100 15-99 seats =$150 more than 99 seats =$200 $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief. have.filed all state tax returnsrand paid all state taxes required under the law. Date Security or -------------------------------------------------------- -------------------------------- Revised 11/03/03 FOODAP2.adm Check# & Date (o a2 i //�/�5 �0 Z{ DENNIS THE MENNIS PEST CONTROL 1.800.6493028 TOLL FREE DATETIME = IN OUT ❑ REG. ❑ 1 -TIME ❑ RES. EkOMM. ❑ INDOOR ❑ OUTDOOR NAME AooHEss AMOUNT % ERA NUMBER CITY. STATE; ZIP .^l fj PHONE ;SERVICES PERFORMED TgRGETPESTS APPLICATION METHOD ❑INSPECTION ..TREATMENT .; CHEMICALS USED AMOUNT % ERA NUMBER In �.c �... � Z4�\�_-1 ". I REMARKS .. -AMOUNT lDESCRIPTION t 0 SER LIC. NO. TOTAL',`r. I�— FD)Pglvl�o OCT 2 6 2005 CITY OF SALEM BOARD OF HEALTH Ile El INSPECTION �D-TREATMENT El ShHVIW: KtFUK I DENNIS THE MENNIS PEST CONTROL 1-800-649-3028 TOLL FREE D4TJO/2 TIME I OUT 0 COMM. 0 INDOOR Od TOOOH, NAME El INSPECTION �D-TREATMENT El ShHVIW: KtFUK I SERVICES PER . MED 't T PES S j 1APPUCATION,METHOD] S' ,'T^AI'jGET PEST 5) APP 1T101INEciNO ❑ INSPECTION ❑ TREA MENT p •+ / CX// ... �''K'�> (J�-t_t� EMICALS USD !:""'AMOUNT :. i-EPANIIMBER C 7 Y /- I4 k"CHEMICALS US` ✓� u- v Z s. SERVICES PERFORMED ,'T^AI'jGET PEST 5) APP 1T101INEciNO ❑ INSPECTION ❑ TREAMENT p •+ / CX// ... �''K'�> (J�-t_t� k"CHEMICALS US` a.. OU 1 n- --. — ___:� a ...�...,.��T`-s.u•._�-. �!-3Sec unuur art;>4 i r{s I.G� TOTAL ZU I i CU SIGNATURE SERVICE REPORT SERVICE REPORT d HEM�jC�AJLS:USECs�`}�'.5+`i MO:: Nrx '`)� yij„u,/ ,EPXNUUM^§EpjH ,ap 4 t C 1 MATURE _ i SERVICE REPORT I I —_�amaauaFes� I i 5 ED'8 LIC: N TOI C 1 MATURE _ SERVICE REPORT 4, k DPIfVI$iif MENAIIS PEST CONTROL 1.800-09.3028 TOLL FREE SERVICE REPORT 4. IB 39tid 53XO9-lIVW 60S0TOLBL6 9b:bl 5002/61/01 0099 North Street Sun Garden City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: 978-744-9998 Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Done RED OWneC' ,Yong Quang.Qiu .-: ,._ Anti -Choking Tobacco PASS PASS ❑ ❑ PIC Yong QUang Qlu Yong Qu FOOD PROTECTION MANAGEMENT Done - PIC Assigned / Knowledgeable / Duties PASS ❑� RED InspeDavid Greenbaum '' ' A EMPLOYEE HEALTH Done PASS Date Inspected: I Correct By:, Reporting of Diseases by Food Employee and PIC PASSd❑ RED Risk Level:'_ Permit Number: - - BHP-2005-0082--- Status: HP-2005-0082-Status. i r SIGNED OFF' ,, 9 of Critical Violations: IN: 4 ly PROTECTION FROM CONTAMINATION Personnel with Infections Restricted/Excluded PASS ❑d RED RED Food Contact Surfaces Cleaning and Sanitizing FOOD FROM APPROVED SOURCE Done Proper Adequate Handwashing PASS RED PASS ❑d RED Food and Water from Approved Source * Receiving/Condition PASS RED Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED Conformance with Approved Procedures/HACCP PASS [!09 RED Plans 4 ly PROTECTION FROM CONTAMINATION Done Separation/ Segregation/ Protection PASSd❑ RED Food Contact Surfaces Cleaning and Sanitizing PASS ❑J RED Proper Adequate Handwashing PASS RED Urgency Description(s): _ Good Hygienic Practices PASS ❑d RED BLUE: W � ! ' Prevention of Contamination from Hands PASS ❑J RED Violations Related to Good Retail Practices (Criticalq Handwash Facilities PASSd❑ RED NOTE: Keep the kitchen handwash sink violations mustbe corrected immediately or within 10 days)(Non-critical violations GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. clear and accessible at all times. ( Rev. Oct 04,2005 ) Page 1 of 0099 North Street Done Sun Garden must be corrected Immediately, PROTECTION FROM CHEMICALS Done BLUE Or„Within 90 days) Approved Food or Color Additives PASS ❑J RED RED PASS ❑ BLUE Violations Related to, Toxic chemicals PASS BLUE RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS (Potentially Haz Done BLUE and Risk Factors (Require cooking Temperatures PASS BLUE RED immediate corrective action)- ;;, PASS ❑ BLUE Other- See Notes Reheating PASS BLUE RED Cooling PASS ❑J RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done All violations cited in the 9/26/05 inspection Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS 0 RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other- See Notes PASS ❑ BLUE Owner must have extermination at least once a week until rodent problem is abated. Provide extermination invoiced to the Board of Health. All violations cited in the 9/26/05 inspection report have been corrected. GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 04,2005 ) Pake 2 of 0099 North Street Sun Garden GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 04,2005 ) PaQe 3 of 0099 North Street Telephone: =978-744-9998 Owner: PIC: City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Sun Garden Yung King Yau - tt Inspector.' David Greenbaum Date_ Inspected: Correct By: 9/28/2005 m Risk Level: Permit Number: BHP -2005-0082 l Status. VIOLATION ,# of Critical Violations' 'Time IN: Time OUT: Notes. 322: Reinspection in one week. Urgency Description(s)' ^" BLUE: Violations Related to Good Retail Practices (Critical w violations must be corrected immediately or within 10 days)(Non-critical violations . FOOD PROTECTION MANAGEMENT Not Done PIC Assigned / Knowledgeable / Duties PASS ❑d RED EMPLOYEE HEALTH Not Done Reporting of Diseases by Food Employee and PIC PASSd❑ RED Personnel with Infections Restricted/Excluded PASS ❑Q RED FOOD FROM APPROVED SOURCE Item Status Violation Critical Urgency Nature of problem or correction Food and Water from Approved Source Non-compliance with: Not Done RED Receiving/Condition Anti -Choking PASS ❑ Tags/Records/Accuracy of Ingredient Statements PASS 0 RED Qlu - Tobacco PASS ❑ Plans Yung King Yau - tt Inspector.' David Greenbaum Date_ Inspected: Correct By: 9/28/2005 m Risk Level: Permit Number: BHP -2005-0082 l Status. VIOLATION ,# of Critical Violations' 'Time IN: Time OUT: Notes. 322: Reinspection in one week. Urgency Description(s)' ^" BLUE: Violations Related to Good Retail Practices (Critical w violations must be corrected immediately or within 10 days)(Non-critical violations . FOOD PROTECTION MANAGEMENT Not Done PIC Assigned / Knowledgeable / Duties PASS ❑d RED EMPLOYEE HEALTH Not Done Reporting of Diseases by Food Employee and PIC PASSd❑ RED Personnel with Infections Restricted/Excluded PASS ❑Q RED FOOD FROM APPROVED SOURCE Not Done Food and Water from Approved Source PASS ❑d RED Receiving/Condition PASS RED Tags/Records/Accuracy of Ingredient Statements PASS 0 RED Conformance with Approved Procedures/HACCP PASS ❑d RED Plans GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc ( Rev. Sep 26,2005 ) Page 1 of 0099 North Street must be corrected immediately or within 90 days) RED: 4 Violations Related to , Foodborne Illness Interventions and Risk Factors (Require Sun Garden PROTECTION FROM CONTAMINATION Not Done Separation/ Segregation/ Protection PASS ❑J RED Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED ;Ahe cutting board is stained and scored. Resurface or replace the cutting board. There was a knife stored between L/equipment. All knives must be cleaned and sanitized and stored in an appropriate rack. Proper Adequate Handwashing PASS ❑d RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑./ RED Handwash Facilities FAIL Critical RED — The kitchen hand wash sink found obstructed. Keep handwash sinks clear and accessible at ALL times. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASSd❑ RED Toxic Chemicals PASSd❑ RED TIME/TEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures PASSd❑ RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding FAIL Critical RED V The beverage air reach in had a temperature of 56°F. Repair unit to maintain a temperature of 41°F or below. \/The walkin freezer had a temperature of 34°F. Repair the walkin to maintain a temperature of 0°F or below. Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASSd❑ RED GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Page 2 of 0099 North Street Sun Garden Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Nan -Critical ❑ BLUE The sides of the deli unit has an V accumulation of food debris and grime. Thoroughly clean the sides of the deli unit. %The walkin needs a thorough cleaning. The walkin freezer floor has an accumulation of grime. Thoroughly clean the floor including under all racks. ✓ The GE freezer has an accumulation of food debris. Thoroughly clean the freezer. t/The cookline needs a thorough cleaning. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non -Critical ❑ BLUE ✓The baseboard in the bathroom has an accumulation of grime. Thoroughly clean and repaint the baseboard. There is chipping/peeling paint in the V bathroom. Scrape and repaint all chipping/peeling. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements FAIL Critical ❑ BLUE VThere are numerous rodent droppings in the backroom and basement. Owner will have the exterminator service the establishment as often as needed to abate the rodent problem. "Keep the basement door closed and remove the mattress in the basement. V Discard the untensils on the shelf near the rodent droppings. Other- See Notes PASS ❑ BLUE GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 26,2005 ) Paze 3 of r!Tw71T;v'Ti z U) I A s O 8 O m a cn 0 un a uT r- 0 O a O Er C.13 c0 O O O grW-or 5-40*,¢y;J OFFIrfR . /'I -NO. TOTAL FINE , 0 LJA�J(efL��. DUE i OFFICER CERTIFIES COPY GIVEN TO VIOLATOR N HAND x ❑ BY MAIL grW-or 5-40*,¢y;J OFFIrfR . /'I -NO. TOTAL FINE , 0 LJA�J(efL��. DUE DO NOT MAIL CASH - PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 ! I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE # SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION is ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name / Sv, / dMt)4-d Date / Q /' fie/ T of Operation(s) Type of Inspection Food Service ❑ Retail El Residential Kitchen ❑ Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑ Routine W -Reinspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness ❑ General Complaint El HACCP ElOther Address Risk Level.i /�'( Telephone 7yy- g9elf- Owner t/a �j/ (r / J HACCP Y/N Person in Charge (PIC) Time In: Out: Inspector f 0 /yt� !3 it MidSflfYif O �OVII vivMrwn cnuuKeu requires an explanation on me narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable /Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Ci w 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) FR 30. Other S 5901nVWFcrm 14 noc IrA1 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) E121. Food and Food Preparation for HSP CONSUMER ADVISORY„ I ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 0 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 Signatu Print:y-/ PIC's Signature: // 1 1) Y / f l �� Print: V / V Page! of 2Pages Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT I 590-003(A) Assi raiment of Responsibility" 590.003(6) Demonstration of Knowledge* 2-103.11 Person in charge -duties 2 590.003(0) Responsibility of the poison in charge to 590 -004(A -B) require reporting by food employees and 3-201-12 a:2licants* 590.003(F) Responsibility Of A Foci Employee Or An 3-202.13 Applicant To Report To The Person In 3-202.1 d Cha�,re: 590.003(G) Re ortina by Person in Charge* 3 590.003(1)) Exclusions and Restrictions* 590.003(E) I Removal of Exclusions and Restrictions 4 C C C f3sZa7S7y%7�Ii5il'S7C7+S+I�iI?I�SI1L�i s Food and Water From Regulated Sources 590 -004(A -B) Compliance with Food Law* 3-201-12 Food in a I3ermeticall y Sealed Container* 3-201,13 Fluid Milk and Milk Products* 3-202.13 Shell 3-202.1 d Ei gs and Milk Pro acts. Pasteurize i* 3-202.16 Ice Made From Potable Drinking Water" 5-10111 Drinking Water from an Approved Svstem* 590.006(A)Bottled Drinking Water- 590.006(B) Witter Meets Standards in 310 CMR 220* Washing Fruits and e,:etables Sheffish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSS.P Listed Sources', Contamination from the Consumer Game and Wild Mushrooms Approved by Re ulato Authorit 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures 3-202.19 Package Integrity, 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* 590.004(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures 1HACCP Plans 3-502.1.1 Processin>Methods* 3-502-12 _,Specialized Reduced oxv en aci:aRin ,criteria 8-103.12 Conformance with Approved Procedures* "Denote, craicai item is the federal 1999 Food Code or 105 CMR 590,000, g Cross -contamination 3-302.1 1(A)(1) Raw Animal Foocis Separated from Coked and RTC' Foods" Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each Others` Contamination from the Environment 3-302A 1(A) I Food Protection* 3-30115 Washing Fruits and e,: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 Foo(fr 9 Food Contact Surfaces 4 -501 -III Manual Warewashing- [IotWater Sanitization Tem. erattnes* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp.. pH, eoncentration and hardness. * 4-601..11(9) Equipment Food Contact Surfaces and Utensils Clean* 4-60111 Cleaning Frequency of Equipment Food - Contact Surfaces aid 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* In Proper, Adequate Handwashing 2-301.1 1 Clem Condition -- Hands and Arms" 2301.12 Cleaning Procedure'r 2-301.14 When to Wash* it Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco^' 2-401.12 Discharges Frour the Eyes, dose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* lg Handwash Facilities Conveniently Located and Accessible 5-20311 Numbers and Ca aeihes" 5-204.11 Location and Placement* 5-205-11 Accessibility, O erasion and Maintenance Supplied with Soap and Hand Drying Devices 6x301.11 Handwashin Cleanser.AvailabiliT 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name:Sy�t#,C Date:77 - Page: of Z Item No. Code Reference C -Critical nem R - Red Item DESCRIPTIONOF VIOLATION / PLAN OF CORRECTION - - PLEASE PRINT CLEARLY Date Verified U n lv ? n2 t C i/ Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ( / i l l / l I^ ''r/ " 0/- yC 3 V Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure L3 Voluntary Disposal ❑ Other: Violations Rotated to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 13 16 17 18 Denotes critical item in ilia Wei it 1999 Foal Code of 105 CMR 590.000. 19 w 3-501-14(C) Food or Color Additives 3-202.12 Addt(Vesk 3-302.14 Pro[ecti on front Unat roved Additives* 3-501.15 Poisonous or Toxic Substances 1-101.11 klentifying Intel mation - Original Containers* -7-102, 11 Common Name-- Working Containers - 7 -1-01.11 Separation - Stora*e* 7-292.1.1 Restriction - Presence mud User 7-202.12 Conditions of IJse* 7-293.1.1 Toxic Containers - Prohibitions* 7-204.11 Sanitizet's,Criteria -Chemicals` 7-204.12 Chemicals for Washing Produce. Criteria* 7-204.14 Dryirt 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* Denotes critical item in ilia Wei it 1999 Foal Code of 105 CMR 590.000. 19 w 3-501-14(C) Proper Cooking Temperatures for 3-801,11(B) PHFs ;_401.11A(i)(2) _ Eggs- 155'F 15 Sec. 3-501.15 E as-hrmtediatc Service 145"F15sec' 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(B) Annuals - 155'F 15 sec. 3-401.11(B)('1)(2) Pork and Beet Roast - 130-F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 155'F 15 Physical Facili sec.* 3-401.-11(A)(3) Poultry, Wild Game, Stuffed PRFs, FC -- 7 .008 Stuffing Containing Fish, Meat, 3-501.39 Poultr or Ratites -165°P 15 sec. 3-401.11(C)(3) Whole -muscle, intact Beef Sfcaks L------- 145"F * 3-401.12 Raw Aninnal Foods Cooked in a Microwave 165'F * 3-1.1 l(A)(1)(b) All Other PHFs-145"F15sec. Reheating for Hot Holding 3-403.11(AWD) PHFs 165".F I5 scc. °' 3-403.11(13) Microwave -165" F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 1.40°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts"` Proper Cooling of PHFs 3-501,14(A) Cooling Cooked PHFs from 1.40°F to 70`F Within 2 Hours and From 79'F to 41".F145'F Within 4 Hours. * 3-50L14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45"F Within 4 Hours'r Denotes critical item in ilia Wei it 1999 Foal Code of 105 CMR 590.000. 19 w 3-501-14(C) PHFs Received at Temperatures 3-801,11(B) According to Law Cooled to 3-301.11(D) 41'F145'F Within 4 Hans. " 3-501.15 Cooling* Methods for PHFs Not Otherwise Processed to Eliminate PHF Hat and Cold Holding 3-501.16(B) Cold P[IFS Maintained at or below 59fW04(F) 41°145°F* 3-501.16(?,) Ilot PHFs Maintained at or above Physical Facili 140'F. 3-501.16(A) Roasts Held at or above 130°F. FC -- 7 .008 Time as a Public Health Control 3-501.39 Time as a Public Health Control* 590.004(H) Variance Re augment e 3-801 A ] (A) Unpasteurized Pre-packaged Juices and with Warninglabels* 3-801,11(B) _Beverages Use of Pasteurized Eggs* 3-301.11(D) Raw orPartially Cooked Animal Food and Raw Seed Sprouts Not Served. ;-S01.11(c) Uno good Frrod Pscka e NoC Ra -served. " 22 3-603. I Consumer Advisory Posted for Consumption of 23. 7 Animal Foods That are Raw. Undercooked or 24. _ _ Food and Food Protection Not Otherwise Processed to Eliminate 25. E uipment and Utensils Patho«ens:* 26. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 27. Physical Facili E 6" -,W009(A)-(D) ( Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should he debited under die 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. WWATT (Items 23-30) Critical and non-critical vioiertion,s, 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 .590.000. Item Good Retail Practices �t FC 590.000 23. Marraiternere and Personnel FC -- 2 .008 24. _ _ Food and Food Protection FC - 3 .004 25. E uipment and Utensils FC - 4 .005 26. Water. Plumbing and Waste FC -5 .006 27. Physical Facili FC -6 .007 28. Poisonous or Toxic Materials FC -- 7 .008 29. S ecial R ulrements ,009 30, - _ Other Oth - L------- sswr,nmc-z�x,� Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 41h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name 2N G Date19 2 T e of 0 erasion s T e,of In ection Food Se vice ❑ Retail outing ❑ Re -inspection Q�N O Address Risk / Level El Residential Kitchen Previous Inspection Telephone 7 S Xf ❑ Mobile Date: ElPre-operation OwnerElTemporary HACCP Y/N jdL U ❑ Caterer ElBed & Breakfast ❑ Suspect Illness ElGeneral Complaint Person in Charge (PIC)Time (Ay (/J i7AU In: Out: Permit No. ❑ HACCP ❑ Other Inspector 7i u CaUii VIUMLIU11 cnecleea requires an expianatlon on ine narrative page(s) ano 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. ' F090 PROTECTION MANAGEMENT _. 4' 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ P. 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 PA. Food Contact Surfaces Cleaning and Sanitizint ❑ 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_ 2 . 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 5: 501nsp cfFo,m 14 dw ❑ 12 Prevention of Contamination from Hands V13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEfrEMPERATURE 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 ,i CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related / To Foodborne Illnesses Interventions and Risk Factors (items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: 2/7�04 Inspector's Signature• Print: PIC's Signature: / /-� `� Print: Page of I Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT '( 590.003(A) I Assignment Of ReSp(a18ibilit)f* _ 590 003(B) Demonstration of Knowledge* 2-103.11 � Person in chin - dutir.-s EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in chm:ge to Compliance with Fo«xl Law" 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants,* Shell E,,s* 590.003(F) Responsibility Of A Food Employee Or An 3-202,16 Ice Made Front Potable Drinking Water* Applicant To Report To The Person In Dri�from an A. roved System" 590.006(A) Char«e'" 590.006(B) 590.003(G) Re ortin- byPerson in Char e` 3 590.003(1)) Exclusions and Restrictions* 3-201.15 590.003(E') 1 Removal of Exclusions and Restrictions 4 '" Denotes critical item in the federal 1999 Fond ("ode or 105 CMR )90.000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Fo«xl Law" 3-201.12 Food in a Hermetically Sealed _Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell E,,s* 3-202.14 Segs and Milk Products. Pasteurized* 3-202,16 Ice Made Front Potable Drinking Water* 5-101.11 Dri�from an A. roved System" 590.006(A) printed Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 220* Washine Fruits and VejEtables Shellfish and Fish. From an Approved Source 3-20t.14 Fish ad Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Reouiatort, Authoot 3-202.15 Shellstock Identification Present* 590.004(C) Wild Mushr(loms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11. PHFs Received at Proper Tem eratures'" 3-202.1.5 Package Integrity* 3-101.11 Food Safe and unadulterated TagstRecords: Shellstock 3-202.13 Shelktuck Identification * 3-203.12 Shelh tock Identification Maintained* TagsfRecards: Fish Products 3-402.11 P_arasiteDestmction* 3-402.12 Records. Creation and Retention" 590.004(7) Labeling of Ingredients` Frequency of Sanitization of Utensils and Food Contact Surfaces of E q ui anent* Conformance with Approved Procedures lHACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced ox Len Packaging, criteria' 8-103.12 Confortnance with A n roved Procedures°' '" Denotes critical item in the federal 1999 Fond ("ode or 105 CMR )90.000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RPE Foods"' Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* ' Contamination from the Environment 3-3021 t(A) Food Protection* 3-302.15 Washine Fruits and VejEtables 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* <) Food Contact Surfaces 4-501-I11. --Manual Warewashing- HotWater Sanitization "Pent eratures* 4-501.112 Mechanical Warewashing-Hot Water Sanitization Temperatures* 4-501,114 Chemical Sanitization- temp., pit, concentration and hardness. '` 4-601,11(A) Equipment Frxxi 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 q ui anent* 4-703.11 Methods of Sanitization --- Hot Water and Chemical,* li) Proper, Adequate Handwashing 2-307.71 Clean Condition - Hands and Anm* 2-301.12 Cleanin, Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Statin , Drinkin or Using Tobacco* 2-401..12 Discharges From the Eye:. Nose and Mouth* 3-301.12 _ Preventing Contamination When Tastin r* i2 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Elnlovees* l3 Handwash Facilities Conveniently Located and Accessible 5-203-I1 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 RandwashineCleanser. Availability 6-301.12 Hand Drvin g Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: 5W _ Date: ; —r Page: of y kem Code l C -Critical Item / DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date ,,I No. Reference R —Red Item o Oe r Q Verified V 1 2 C I If/c 4 ' `PX rl CX- etw I I Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. `� G Corrective Action Required'. ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal 11111111111112 �-§� ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1.22) (Cont) 6 .� 14 Food or Color Additives 3-202.12 Addinve0' 3-302.74 Protect i.... fromUna r roved Additives* 15 Poisonous or Toxic Substances 7-10 t.I I Identifying Information - Original Containers* 7-102.11 Common Name- Working Containers* 7-201.11 Se.. ,ration - Stora let` 7-202.11 Restriction - Presence and Ilse" 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitionsa` 7-204.11. Sat»fizets, Criteria -Chemicals" 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drvin A encs, Criteria' 7-205.11 Incidental Food Contact. Lubricants' 7-206-Y 1. Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders. Pest Control and Monitorin-* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ya Proper Cooking Temperatures for 19 PHFs_ 3-40 Ll 1A(i)(2) Eggs- 155'F 15 Sec. FC - 2 F Yqs- hnmediate Service 145`Fi Sses* 3-401.11(A)(2) Comminuted Fish, Meats & Game 20 Anitntds - 155'F 15 sec. * 3-401.118)(1)(2) Pork. and Beef Roast - 130'F 121 min* 3-401.11(A)(2) Ratites, injected Meats -155''.F 15 26. see. * 3-401.1.1(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165'F 15 sec. ^" 3-401.11(C)(3) Whole -muscle, intact Beef Steaks FC -7 145'F " 3-401.12 Raw Animal Ponds Cooked in a Microwave 165F * 3401_7 l (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' F2 Minute Standine Time* 3-403.11(C) Commercially Processed RTE Fond - 14WF* 3-403,1.1(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 14WF to 70'F Within 2 ,Hours and From 70'F to 4t'F(45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature ingredients to 41 `'F145'17 Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ya 21 3-801.1](A) Unpasteurized Prc packaged Juices and Beverages with W umng Iabefi* 3-801.11(B) Uac of Pasteurized H es* 3-801,11(l)) Raw or Partially Cooked Animal Raw Seed Sprouts Not Served. * 3-801.1 l(C) Unopened Food Package Not Re CONSUMER ADVISORY 22 3-603.1.1 3 -SGL 14(C)� PHFs Received at Temperatures According to law Cooled to 41"F1451 F Within 4 Horns. 3-S01,15 CoolimT Methods for PHFs 19 PHF Hot and Cold Holding 23. 3-501.16(13) Cold PHFs Maintained at or below 590.004(F) 4JV45°F* FC - 2 3-501.16(A) Hot PHFs Maintained at or above 140"F. * 3-302.13 3-501,1.6(A) Roasts Held at or above 130'F 20 Time as a Public Health Control 25._____ 3-501,19 Time as a Public Health Control" FC - 4 590.004(H) Variance Requirement 21 3-801.1](A) Unpasteurized Prc packaged Juices and Beverages with W umng Iabefi* 3-801.11(B) Uac of Pasteurized H es* 3-801,11(l)) Raw or Partially Cooked Animal Raw Seed Sprouts Not Served. * 3-801.1 l(C) Unopened Food Package Not Re CONSUMER ADVISORY 22 3-603.1.1 Consumer Advisory Posted for Consumption of FC Animal Foods T'ktat are Raw, Undercooked or 23. Not Otherwise Processed to Eliminate FC - 2 Patho-cm "" "" 3-302.13 Pasteurized Eggs Substitute for Raw Shell FC -- 3 Eggs* 590.009W41)) Violations of Section 590.009(A) -(D) in catering. mobile food, temporary and residential kitchen operations .should be debited under the appropriate sections alcove if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 1129 - Speeuil Requirements. (Items 23-30) Critical and non-critical violations, which do nut relate to the foodborne illness interventions and risk factors fisted above, can be ,found in the folloeeing sections of the Food Code and 105 CMR 590.000. Item Codd Retail Practices FC 590.990 23. Management andPersonnel FC - 2 .003 _ 24. _ Food and F..... Protection FC -- 3 .004 25._____ Equipment and Utensils FC - 4 .005 26. Water. Plumbing and Waste FC -5 .0613- OOSPhsical PhysicalFac 14 FC -6 .007 26. Poisonous or Toxic Materials FC -7 .008 2B. ___ --30. S ecial Re uiromants .009 Other _--- --- 1.y110.,ma kb -2a,, CITY OF SALEM RoARII nr: WPAI TH Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 16 17 18 TIMElTEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives'" 3-302.14 Protection from j n roved Additives" 3-501-75 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 CommonName-WorkinOCartainers* 7-201.11 Se. oration - storagca: 7-262.11 Restriction -Presence and I)se* 7-202.12 Conditions of Use* 7-201.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria -Chemicals* 7-204.12 Chenucak for Washln 1'rodune. Criteria* 7-204.14 DryingA eats. Criteria* 7-205.11 Incidental Food Contact. Lubricants* 7-206.1 I Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations' 7-206.13 'tracking Powders, Pest Control and Monitoring* TIMElTEMPERATURE CONTROLS * 1)C114eS craicel item in file fatu'al 1999 Food Code or 105 CMP 590.000. 19 h 3-501-14(C) Proper Cooking Temperatures for . PHFs 3-401.11A(1)(2) _ Eggs 155TF 15 Sec. 3-501-75 E ipI-InunedimeService145'Fl5sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 7501_16(B) Animals - 1.550F 15 sec. '" 3-401.1l(B)(1)(2) Pork and Beef Roast - 130`F 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 29 _ sec. 3-401_11(A)(3) Poultry, Wild Game, Stuffed PHFs, 30 Stinting Containing Fish, Meat, 01.19 E59;0)',004(H) Ponit7' of Rattles -165°F 15 S� 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 1450F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401.11(01)(b) All Other PHFs- 145 T' 15 sec. * Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165'F IS sec. * 3-403.11(&) Microwave -1650 F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Fwd - 1.400F" 3-1-03.11(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 acid From 70'F to 41'F/450F Within 4 Hours.'* 'T501 14(B) Coolim , PHFs Made From Ambient Temperature Ingredients to 41'F/45`F Within 4 Hours 1` * 1)C114eS craicel item in file fatu'al 1999 Food Code or 105 CMP 590.000. 19 h 3-501-14(C) PHFs Received at Temperatures . Accoming to Law Cooled to 3-801.11(,B) 41'Ff45'F Within 4 Hours. *. 3-501-75 Conlin"Methodsforl'HFs Raw or Partially Cooked Anunal Food and Raw Seed Sprouts Not Served. PHF Hot and Cold Holding 7501_16(B) Cold PHFs Maintained at or below 590,064(F) 41'/45° F* 3-501.16(A) Hot PHFs Maintained at or abova 29 _ 140'F.* 1.1.6(A) Roasts Held at or above 130°42 30 Time as a Public Health Control 01.19 E59;0)',004(H) Time as a Politic Health Control* Variance Re airenrent REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Uepasecuri'red Pre-packaged Juices and :Beveraees with Warninc Labels* 59o.000 3-801.11(,B) Use of Pasteurized E ns* FC -2 FC - 3 3-801.11(To Raw or Partially Cooked Anunal Food and Raw Seed Sprouts Not Served. Equprneni and Utensils Water. Plumbinci and Waste 3-801.11(C) Uro tened Taxi Package Not Re -served. " • 22 3-603.11 Consumer Advisory Posted for Consumption of 59o.000 23. 24. Animal Foods )bat are Raw, Undorcooked or FC -2 FC - 3 .003 004 Not Otherwise Processed to Eliminate Equprneni and Utensils Water. Plumbinci and Waste FC - 4 FC 5 Pathogens.* enecrcva vvaooa 27. 28. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 007 _ 29 _ Ee ts= w 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 /129 - Speciai Requirements. If Hht'rXtAMPIP74''iti/1 (Items 23-30) Critical and non-critical violations, nirich do not relate to the foodborne illness interventions and risk factors listed above, can be found in rhefollowing sections q/ the Food Code and 165 CMR .590.0(X). Item Good Retail Practices FC 59o.000 23. 24. Manaclement and Personnel --- Food and Food Protection FC -2 FC - 3 .003 004 _25____ _ 26. Equprneni and Utensils Water. Plumbinci and Waste FC - 4 FC 5 .005 .006 27. 28. Physical Facility _ Poisonous or Took Materials FC -6 FCT 007 _ 29 _ -. -----_ -... Special Requirements __. 1 .009 30 Other CITY OF SALEM BOARD OF HEALTH Establishment Name: Sdr/ 4AX 4,60 Date: 2e* 4AF Page: y of _ Item No. Code Reference C - critical Item R — Red Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified 11 C. &,o, rm,M . r mA z r .w ,-., f F/ c/� Q ti,IC Y rN rii2r 6 �r�.f►reor vri tS teo Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that 'noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit: s 7` Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: U Violations Related to Foodborne illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 I7 18 u Food or Color Additives 3-202.12 Additives" 3-302.14 Protection from Unapproved Additives* FC -2 FC - 3 Poisonous or Toxic Substances 7-101..11 Identifying Information - Original Containers* 7-102.11 Common Name - Working Containers* 7-201.11 Separation - Storacc* 7-202.1.1 Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers -Prohibitions' 7-201.11. Sanitizets. Criteria - Chemicals - hemicals*7.204.12 7204, 12 Chenucals for Washine Produce, Cr teria" 7-204.14 DivingAgents. 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 Monitodna* ' I)2110teS critical item in the IMNA 1999 Food Code or 105 C61R 590,000. Proper Cooking Temperatures for PHFs Received at'I'emperamres According to Iaw Cooled to 41'F/45'F Within 4 Hours_ Coaling Methods for PHFs PHFs_ _'t-401.1IA(I)(2) Eggs- 155'F'15 Sec. FC -2 FC - 3 E>gs-htmtediatc Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Animals - 155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 nu 3-401.1't(A)(2) Ratites, Injected Meats - 155'F 15 26. Sec. * 3-401.11(0)(3) Poultry, Wild Game, Stuffed PRFs, Time as a Public HealthConlroil' Stuffing Containing Fish, Meat, 590.004(H) Poultry or Ratites -165'F 15 sec. ` 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks -�- 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165F * 3-401.11(A)(1)(b) All Other PRFs --1.45'F 15 sea Reheating for Hot Holding 3-403.1 I (A)&(D) PHFs 165`F 15 sec. a: 3-403.11(B) Microwave -165° F 2 Minute Standing Time" 3-403.11(C) Commercially Processed RTE Food - 140'F' 3-403.11(E) Remaining Undiced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from WIFE to 70`F Within 2 Hours and From 70'F to 4FF145°F Within 4 Hours. * 3-501.14(B) Cooling PFIFs Made From Ambient 'Temperature htgredients to 41'F/45'F Within 4 Hours* ' I)2110teS critical item in the IMNA 1999 Food Code or 105 C61R 590,000. 21 3-501.i4(C) PHFs Received at'I'emperamres According to Iaw Cooled to 41'F/45'F Within 4 Hours_ Coaling Methods for PHFs E3-501.15 19 3-801.11(B) PHF Hot and Cold Holding FC -2 FC - 3 3-501.16(B) 590.004(F) Cold PIIFs Maintained at or below 41'14_5' F* - E_ and Utensils _ Water. Plumbin and Waste 3-501.16(A) ,Hot PHFs Maintained at or above. 140'F." 27. 3-501.16(A) Roasts Held at or above 1300. 20 26. Time as a Public Health Control FC-7 3-50,19 Time as a Public HealthConlroil' - S ecial R uirements 590.004(H) Variance Re uirement 21 3-801.l l (A) Unpastetni7ed Pre-packaged Juices and Beverages with Watnine. Labels* 540.tHIP 3-801.11(B) Use of Pasteurized Estes^ FC -2 FC - 3 3-111.11(D) Raw or Pm2talty Cooked Animal Foul and Rau+ Seed S gouts Not Sewed. " - E_ and Utensils _ Water. Plumbin and Waste 3-801_ 1 I (C) Uno coed Food Package Not Re -served_ i; 22 3-603.11 Consumer Advisory Posted for Consumption of 540.tHIP 23. 24. Animal Foods Tied are Raw- Undercooked or FC -2 FC - 3 .003 .004 Not Otherwise Processed to'Fliminate - E_ and Utensils _ Water. Plumbin and Waste F6_-4 FC 5 Pathogens.* E're'rola"' 27. 3-302.13 Pasteurized Eggs St&dtute for Raw Shell .007 26. fi e6" Violations of Section 590.009(Af (D) in catering, mobile food, temporary and residential kitchen operations should be debited ander 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, r}y ri /K3*i (Items 23-30) Critical and non-critical violations, which do not relate, to lite ,foodborne, illness intoventions and ri.skfactors listed tabrme, can be ,found in the follown;g sections of the Food Code and 105 CMR 590.600, Item Good Retail Practices_ FC 540.tHIP 23. 24. Mang ement and Personnel Food and Food Protection FC -2 FC - 3 .003 .004 25, 26 - E_ and Utensils _ Water. Plumbin and Waste F6_-4 FC 5 005 .006 27. Physical Facility____ FC -6 .007 26. Poisonous or Toxic Materia_I_s__ FC-7 .008 29. - S ecial R uirements 009 30. _- Other -�- sswr�„ev+:e-z.:m� CITATION NO. CITY OF SALEM PD VIOLATION NOTICE r 11 NAME (I -AST, FIRST, INITIAL)) STREETADDRESS CITY/TOWN STATE ZIP � sf- SAt„401 er atg?v LICENSE N0, LIC. EXP. DATE GATE OF BIRTH OWNERS NAME (LAST, FIRST,INITIAL) If/a/ t! 4>011r* at U A STREETADDRESS CITY/TOWN STATE ZIP $9 MtWC jv REGISTRATION NO. STATE EXP. DATE MTWRiTrENPERSO LOR DATE OF VIOLATION TIME AM❑ DATE CITAT❑ PMYESNOLOCATION OFVIOLATION OFFENSE CAP.. SECT. FINES _ &4 /'� OFFI' R I.D. N_O. ' TOTAL FINE $@ �7�,,,� .p e DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR IN HAND X ❑ BY MAIL DO NOT MAIL CASH - PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE # SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL STANLEY J. LISOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Sun Garden Address of Establishment: 99 North Street Owner's Name: Yong Quang Qiu Restrictions: Application Date: 11/26/2003 Permit for Food Establishment 24-04 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 STANLEY USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT '; /A A/ ( a TEL # C? 72 -?4q- q 9 !9 ADDRESS OF ESTABLISHMENT qCl /V 0 �� 5�S41-e no % 0 MAILING ADDRESS (if different) 1 OWNER'S NAME Y0 11 ADDRESS CITY CERTIFIED FOOD 0. ST (required in an establishment where potentially hazardous food is prepared.) # 6'Z-_242, 4 W4 0 EMERGENCY RESPONSE PERSON 70 115 011a &I gi 61 HOME TEL # HOURS OF OPERATION: Mon.lh?d Tue; Ned.,'��Thu. Fri/ Sata,'30 Sun. 1 v tA'ounrl /'oGOA R004M (2;oo/aI TYPE OF ESTABLISHMENT " I FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 ",j ' more than 10,000sq.ft. =$250 RESTAURANT DESNO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledqe and belief, have filed all state tax returns and. paid all state taxes required under the law. Security or Fedefal Identification Number Revised 11/03/03 FOODAP2.adm Check# & Date )Q P - //—/ / 1/3 ;w/o •�_ IMPORTANT MESSAGE FOR SaVA(>fi DATE 2 TIME P.M. N,I i-IY� OFNA -�, IACUVI Z-i�.�gkat� ( Tai' PHONE 019 Z0 AREA CODE NUMBER EXTENSION O FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU ` WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALLFAXTO YOU MESSAGE _y"(l bait SIGNED SOPS+ M�DMNUDDA SOPS+ M�DMNUDDA NOTES THE COMMONWEALTH OF MASSACHUSETTS Cl'TYll SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel: (978) 741-1800 Fax: (978) 745-0343 Name SuK �ARd� Date%'/ -70 T r n i i Food Service [I Retail El Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer El Bed & Breakfast Permit No. Type of Inspection ❑ Rpatine Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness El General Complaint ❑ HACCP El Other Address9p o II Risk Level � Y " 1 Telephone 7 _ ,o Li OwnerHACCP '166, J 01a Y/N Person in Charge (PIC)Time In: Out: Inspecto0- If - /1 KMS. - J�//G Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. - Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. Local law ❑ FOOD PROTECTION MANAGEMENT ❑ 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 (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) / 26. Water, Plumbing and Waste (FC -5)(590.006) ✓ 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red 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: Peet is atu I / Print: PIC's ig ature: I � ! / (�` Print: L' 1 ) `LA Page ofPages FORM 734A HOBBB&WARREN \BOSTON / Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) I 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 a« 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) 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 5 C r FOOD FROM APPROVED SOURCE * Dentes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 C 10' 13 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 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* 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* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 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(J) Labeling of Ingredients* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Dentes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 C 10' 13 PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 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* 4-601.1 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 Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 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* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision ITY OF SALE BOARD OF HEALTH Establishment Name: SOW 49AMS14 Date: 7,,;2& '0 L/ Page: c9- of I_9__ Rem No. Code Reference C - Critical Item R - Red Rem "` DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION - PLE SE PRINT CLEARLY. Date Verified 471TY1 /1,)f /n C Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. w Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: J Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) 14 Food or Color Additives 3-202.12 Additives* . 3-302.14 15 - Protection from Una roved Additives* Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers* 7-10211 7-201.1 1 7-20111 Coalition Name_-Workinn�Containers* Seearation - Storage"` _ Restriction - Presence and Use 7-202.12 Conditions of Use - 7 -20111 'Toxic Containers -Prohibitions* 7-204.11 Sattitizers.Criteria -Chemicals'+ 7-204.1.2 Chemicals for Washing Produce, Criteria` 7-204.14 Drvim, Agents. Criteria* 7-205.1.1 7-206.11 Incidental Food Contact, Lubricants* Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitorine* 16 17 * Denotes critical itern in the federal 1999 Food Code or 105 CIMR 590.000. 19 20 3-501.14(C) Proper Cooking Temperatures for Advisory Posted for Consumption ofAnimal PRFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-501_15 Ee,n-Immediate Service 145' F15secc, 3 401-I I (A)(2) Comminuted Fish. Meats &. Game 3-501-16(B) - Animals - 155'F 15 see. * 3-401.11(13)(1)(2) Pa'k and Beef Roast -130'F 121 min* 3-401.,11(A)(2,) Ratites, Injected Meats - 155°F 15 sec.* 3-401.1 I(A)(3) Poultry, Wild Game. Staffed PHFs, Stuffing Containing Fish, Meat, 3-501.19 Poultry or Ratites -165°F 15 sec 3-401.1 I(C)(3) Whole -muscle, ,Intact Beef Steaks 145'F it 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401.1l(A)(1)(b) All Other PHFs -- 145°F 15 sec. Reheating for Hot Holding 3.403.1.1(A)&(D) PHFs 165'F 15 sec. * 3-403.11(B) Microwave- 165° F 2 Minute Slanting Time* 3-403.11(C) Commercial ly Processed RTE Food - 140°Ft 3-403.11(E) Remaining Unsiiced 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/45'1- Within 4 Hours. * 3-501.14(13) Cooling PHFs Made Front Ambient Temperature Ingredients to 41°F/45'F Within 4 Hours* * Denotes critical itern in the federal 1999 Food Code or 105 CIMR 590.000. 19 20 3-501.14(C) PRFs Received.at Temperatures Advisory Posted for Consumption ofAnimal According to Law Cooled to _ 41'17(45'F Within 4 Hours, 3-501_15 Cooling Methods for PHFs Not Otherwise Processed to Eliminate PHF Hot and Cold Holding 3-501-16(B) - Cold PH{Fs Maintained at or below 590.004{1;) 41°145° F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. 3-501.16(A) Roasts Heldat or above 130'F. Time as a Public Health Control 3-501.19 Time as aPublic l-leaith Contr&' 530.004(8) Variance Recuh'ement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) _ 21 3-801f I (.A) Unpasteurizul Pre-packaged Juices and Bevera_ee with Warnin" Labels* 3-801.1] (B) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Conked Annnal Food and Raw Seed Sorouts Not Served. r 3-801.11(C) I Unopened Food Packaee Not Re -served. £ CONSUMER ADVISORY 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 foodhorne illness interventions and risk factors. Other 590.009 violations relating to goat retail practices should be debited ander #29 - Special Requirements. L9Is� ii(rTk�3 (Items 23-30) Critical and non-crilieal violations, which do not relate to the jaodhorru illness inlernentionc and risk (actors listed abore, can he fownd in the following sections of the Food Code and 105 CaFIR 590.000. 6o3Consurner Advisory Posted for Consumption ofAnimal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate ;13-3102 Pathogens." F'r "' i""".13 Pasteurized Eggs Substitute for Raw Shelf 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 foodhorne illness interventions and risk factors. Other 590.009 violations relating to goat retail practices should be debited ander #29 - Special Requirements. L9Is� ii(rTk�3 (Items 23-30) Critical and non-crilieal violations, which do not relate to the jaodhorru illness inlernentionc and risk (actors listed abore, can he fownd in the following sections of the Food Code and 105 CaFIR 590.000. THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel: (978) 741-1800 Fax: (978) 745-0343 Name /� SUIT �ri�0��i Date "� � Q Tve/f Ooeration(s) ® Food Service ❑ Retail ❑ Residential Kitchen El Mobile El Temporary ❑ Caterer ❑ Bed 8 Breakfast Permit No. T In i n r�- outir�� L1Re-inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address 77 NoArAt Slr Risk Level Telephone 7qY- Q j9 7 Owner t ONG af- f tl HACCP Y/N Person In Charge (PIC) Time In: Out: Inspector rePr) Aqm l jbnne Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties [V13. Handwash Facilities (A EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted / Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving / Condition ❑ 6. Tags / Records / Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures / HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation / Segregation / Protection ✓❑- 9. Food Contact Surfaces Cleaning and Sanitizing (,3) ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) 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) (j, ✓ ✓ 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) (1) 26. Water, Plumbing and Waste (FC -5)(590.006) (a) ✓ ✓ 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) J -H29. Special Requirements (590.009) 30. Other PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ©"'l9. 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 1/ To Foodborne Illnesses Interventions and Risk Factors (Red 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: ' re: awl Print: - PIC's Signature: \ iq \/ Print: '�� Page l of 3Pages ( Yl i �� ` K_ FORM 734A HOeeS &WARREN - BOS ON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT `,U1 590.003(A) Assign ent 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 Food Employee or an 3-202.16 Ice Made from Potable Drinking Water* Applicant to Report to the Person in r Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 31'4 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C 5 6 r FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 C 10 13 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 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* 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* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 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* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 C 10 13 PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) I Food Protection* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 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* 4-601.1 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 Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 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* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH 2 Establishment Name: 5 tw cwos ,I Date: Page: of Item Code C -Critical Item DESCRIPTION OF VIOLATION / PLAN OFCORRECTION Date No. Reference I R -Red Item - Verified t��'r��uL",7191 • • ._ -_ I/ v _ • �u�1tS_ �i�.Tit�LfllriTa�e_�i�rsi_r»_ _®�sr�� a�MEMO i Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. l ❑ Voluntary Disposal ❑ j Other: U J Victorians Related to Foodborne fitness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color Additives 3-202.12 Ad_ditiwsa 3-302.14 _ Protection from U�d Add ❑ves* Df- Poisonous or Toxic Substances 7-161.11 Identifying Information - Original 3-861.11(C) Containers" 7-102.11 CommotName- Workau, Containers' 7.201.11 Separation - Storaee* 7-202.11 Restriction - Presence and Use* 7302.12 Conditions of Ilse" -- 7-203.11 Toxic Containers - Fit oliibitions* 7-204.11 saaiti2ers. Criteria - Chemicals* 7-204-12 Chemicals for Washlne Produce, Criteria^ 7-204.14 Drvin, A-ents. Criteria" 7-201.11 Incidental Food Contact, Lubricants" 7-206.11 Restricted Use PesGeides. Ciitcria* 7-20011 Rodent Bait Stations" 7-206,13 Tracking Powders, Pest Controt and Monitorine* TIME/TEMPERATURE CONTROLS 16 3-501.14(C) PHFs Received at Temperatm'es Proper Cooking Temperatures for According, to L,aw Cooled to 3-801.11(B) PHFs W3-501.15 3-401.11At 1)(2) Eggs- 155'F 15 Sec, PHF Hot and Cold Holding 3-861.11(C) Es -s- Immediate Service 145'1715sec* 27. Physical Facility 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Hot PHFs Maintained at of above FC -7 ;animals - 155`F 15 sec. ,, 29 S ectal R uirement 30 1 Otheri -- -... 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 min'' Time as a Public Health Control 3-401.1 l (A)(2) Ratites, Injceted Meats - 155°F 15 590.004(1-1) Variance Requirement sec. * 3-401.11(Ai(3) Potdtry, Wild Game. Stuffed PHFs, Stuffing Contauring Fish, Meat Pouitry or Ratites -165°F 15 sec, 3-10L l l (C)(3) Whole -muscle, Intact Beef Steaks 145'F It 3-401.12 . Raw Animal Foods Cooked in a Microwave I o'S 3-401.11(A)(1)(b) All Other PHFs -- 145'F t5 sec. 17 Reheating for Hot Holding 3-403 1 fi(P)k(D) PHFs 165'F 15 sec. It 3-403.11(B) Microwave 165' F 2 Minute Standing Tune* 3-403.11(C) Commercially Processed RTE Food - 140°F" 3-403.11(E) Remeinine,Unsliced3'oruensofBeef Roasts" 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs front 140`F to 7(.)'F Within 2 Hours and From 70°F to 41 'F/45+ Within 4 Hours, 3-501.14(8) Cooling PRFs Made From Ambient Tennperamre. Ingredienus to 41 °P145`17 Within 4 Hours* "p motes critical item in thcfederal 1999 Pood C(xle or 103 CMR 59o.000, It- 3-801,1 I(A) 3-501.14(C) PHFs Received at Temperatm'es Consumer Advisory Posted for Consumption of According, to L,aw Cooled to 3-801.11(B) 41°F145'le Within 4 Hours.'` W3-501.15 Cool hn�Met'hods'for PHFs ei'3 PHF Hot and Cold Holding 3-861.11(C) 3-501.16(B) Cold PHFs Maintained at or below 27. Physical Facility 590.004(F) 410(450 F` Pasteurized Eggs Substitute for Raw Shell 3-501.16(A) Hot PHFs Maintained at of above FC -7 140°F.* 29 S ectal R uirement 30 1 Otheri -- -... 3-50L WA) _ Roast; Held at or above 130`F 2Q Time as a Public Health Control 3-501.19 Thrie as a Public Health Control" 590.004(1-1) Variance Requirement 3-801,1 I(A) Unkastcurized Prc p ickaged Juices and Consumer Advisory Posted for Consumption of Benenae,es with Rnrmmai.aibels" 3-801.11(B) Use of Pasteurized Eggs* 3-801,11(D) Raw or Partially Cooked Animal Foal and Not Otherwise Processed to Eliminate Raw Seed Sproule Not Served. 3-861.11(C) Uno encti Food Package Not Re -served. 22 3-603.11 Consumer Advisory Posted for Consumption of 23. Managernent and Personnel i. FC_2 Animal Foals that are Raw. Undercooked or 24. Food and Food Protection FC- 3 Not Otherwise Processed to Eliminate 25. E20innient and Utensils 26. Water, Plumbigand Waste FC -4 FC -5 C+1-,, nv,^OC' Pathogens �` 27. Physical Facility 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 28 Poisonous or Toxic Materials FC -7 E<as- 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 4129 - Special Requirements. (Items 23-30) Critical and non-erarcui violations, which do not relate to the foodborne illness interventions and risk factors Listed above, can be found in the followbig sections of the Food Code and 105 CMR -590. 000. !r Item Good Retail Practices i I FC 590,000 23. Managernent and Personnel i. FC_2 .003 24. Food and Food Protection FC- 3 .004 25. E20innient and Utensils 26. Water, Plumbigand Waste FC -4 FC -5 .005 .006 27. Physical Facility FC - 6 .007 28 Poisonous or Toxic Materials FC -7 008-� 29 S ectal R uirement 30 1 Otheri -- -... __ _ 009 _ 1 1111nn1:a:nix OF CITY OF SALEM BOARD OF HEALTH Establishment Name: k: or) 66rolen Date: Page: of Item Code No. Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R — Red Item PLEASE PRINT CLEARLY Date Verified i i-PLi • 5 G i rP - 1e a ri Ike lack ok Sauu-h d i IAc ry lCr und had o 9 - ro Ce._ CICCur rL e a D� 44i of op- be G ndLc�asltc Ch e^6,-ner hado Sei • 2raalde APO fate(a 11 4/fitigs r6Ua itshwnd had aopmu) ,r ri s o,v-u h / [ _U ur cos. / G- Ps 1 m a h o r - use bl + 0-4 2G[ S. u Ger ca -!e, e,�Mef dr_lo if—W 6=m& tillot N Qsh/n Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. _ i w /t I C Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ElVoluntary Disposal 0 Other: Violations Related to Foodborne illness Interventions and Risk Factors (Ifems 1.22) (Cont.) Is 16 17 * D=otu critical ite,u in the redend 1999 Food Code or 105 CMR 590 000. 19 20 _t-501.14(0 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Una r meed Additives* 3-501.16(B) 590 004(17) Poisonous or Toxic Substances 7-1(11.11 Idemityia¢ information -Original Containers' 7-102.11 Common Nara Workin, Container,* 7-201.11 7-202.17-7 1 Separation - Sto3age* ' Restriction - Presence acid Use* 7-202.12 Conditions of Use" 7-203.1.1 Toxic Containers - Prohibil.ions* 7-204.11 Sanitizers, Criteria -Chemic ls* 7.204.12 Chemicals for Washine Produce, Criteri'a'= 7-204.14 7-205.11 Davin=Arents. Criteria'" Incidental Food Contact. Lubrietmts* 7-206.71 Restricted Use Pesticides, Criteria* 7-206.12 1 Rodent Bait Stations* ?-206.13 Tracking Powders, Pest Control and Momtorin3* * D=otu critical ite,u in the redend 1999 Food Code or 105 CMR 590 000. 19 20 _t-501.14(0 Proper Cooking Temperatures for 3-501.15 PHFs 3-401.1.1 A(1)(2) Eggs- 1.55`F 1.5 Sec. 3-501.16(B) 590 004(17) E res-I3rmrediate Service 145 F15sec* 3-401.,11(A)(2) Comminuted Fish, Meats & Ganle 3-501.1.6(A) Animals - 155T 15 sec. '' 3-401.1 I(.B)(1)(2) Pork and Beef Roast - 130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 155T 15 L590 004(H)Variance sec. 'r 3-401.1 I(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC -6 Poultr , or Ratites -165".17 15 sec. a' _ 3-401.11(C)(3) Whole -muscle, Intact Beef Steak -s FC --7 1450F * ... 3-401.12 Raw Animal Foods Cooked in a Microwave 165T* 3-401.,1 11(A)(1)(b) All Other PHFs - 145`F 15 see. ___ _ Reheating for Hot Holding 3-403.11(A)&(I)) PNFs 165'F 15 sec. 3-403.11(B) Microwave- 165° F2 Minute Standing Time' 3 403.11(C) Commercially Processed RTE Food - 140T 3-403.11(E) Remaining Unsliced Portions ofBeef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 70'F Within 2 ,Hours and From 7WF to 4I'F/45°F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F145'F Within 4 Hours* * D=otu critical ite,u in the redend 1999 Food Code or 105 CMR 590 000. 19 20 _t-501.14(0 PHFs Received'atTemperatures According to Law Cooled to 41`'F/45`'F `t-ithin 4 Haus. 3-501.15 Coal Methods for PHFs I _ 23. PHF Hot and Cold Holding 3-501.16(B) 590 004(17) Cold Pf-IFs Maintained at or below 41%45°F" 3-501.16(A) Hot PHFs Maintained at or above 140T.* 3-501.1.6(A) Roasts Held at or above 130°F. 25. _ Time as a Public Health Control 3-501.19 Time as a Public Health Control* L590 004(H)Variance Re uirement a 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Bevera es with Warning Libels* Consumer Advisory Posted for Consumption of 3-801,11(B) Use ol'PastetlrizedE68S* _ 23. 3-801.11(f)) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * FC - 2 3-801.11(C) Unopened Foo{ Packa,,e Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 _ 23. Animal Foods -lbat are Raw. Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC -- 3 Patho�fans.* ENFibve f.^U00? 25. _ 3-302.13 Pasteurized Eggs Substitute for Raw,Shell 26. Eggs' 590.009(A) -(U) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under tire 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. 1:7:11/TI/:3 71rriiffi€x5 (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and ri.skfdctors Listed above., can be found in the foUowaig serrions of the Food Code and 105 CMR 590.000 AM Good Retail Practices FC 590.000 _ 23. _ Mona ement and_ Personnel FC - 2 .003 24. Food and Food Protection FC -- 3 .004 25. _ _EquJPmem and Utensils - 4 26. Water, Plumbing and Waste _FC FC -5 - _.005 .006 27. Ph sisal Facilites_--- FC -6 .OW 28. Poisonous or Toxic Materials FC --7 .008 29. S euial Re uirements .009 30, __ Other ___ 3,SwlfmrbeckF2duc Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 41h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T e of 0 eration s TyRe of Inspection U Food Service Retail El, Routine I✓_I Re-inspectiond-l7- e Address N Iq Risk Telephone Level ❑ Residential Kitchen Previous Inspection.Z- y��_ 9498 ❑ Mobile ❑ Temporary Date: ❑ Pre-operation Owner HACCP Y/N ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Char(e1(PIC) %li %/ Time r ✓ 4 i //i r/ In: Out: Permit No. ❑ HACCP ❑Other Inspector n PPPm, 1/ rY/ /n rrPf i.0 VaN1 Ylvlat wil 4 1cunau 1eyulres an explanation on the narrative page(s) anti 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) EF130. Other S 50Ml ,UFo-m 14"dx ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals _ TIME/TEMPERATURE CONTROLS (Potentially Hazardous. Foods)" ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY " ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: fgn e: ,• v - Print: LGA r �%/. / �'t(•IX:�Y/.iFN-c1. � . PIC's Signature: 'I' ,� t/ l- Print: VP ( Page (of Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment ofResponsibility* 590.003(B) I Demonstration of Knowledge* 2-103.1'1 Person in charge -duties �� EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Food and Water From Regulated Sources require repotting by food employees and 590.004(A -B) applicants* 590.003(F) Responsibility Of'A Food Employee Or An Food in a Hermetically Scaied Container" Applicant To Report To The Person In 3-201.13 Charge` 590 003(0) Re actin h Person in Charas* 3 590.003(D) Exclusions and Restrictions* 590.003(E) Removal of Exclusions and Restrictions •• t E4 Food and Water From Regulated Sources 590.004(A -B) Com,iliance with Food L.aw" 3-201.12 Food in a Hermetically Scaied Container" 3-201.13 Fluid Milk ind Milk Products* 3-202.13 3-202.14 Shell Egg's* Eg s and 'Silk Flotillas. Pasteurized" 3-202.16 Ice Made From Potable Drinking Water' 5-101.11 Ihinkup> Water from an A roved System* 590.006(A) Bottled Drhtkinz Water* 590.006(B) Water Meets Standards in 310 CMR 22.0"` 3-304.11. SheRtish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan shellfish - _3 Molluscan Shellfish from NSSP Lsted Sources* 3-306.14(A)(B) Gains and Wild Mushrooms Approved by RetroiltorvAulhoritv 3-20218 Shellstock Identification Preseru* 590.004(0) Wild Mushrooms - 3 -201.17 Came Animals* 5 Receiving/Condition 9 3-202.11 PI4Fs Received at Proper Temperatures 3-202.15 Package Ince grit "` 3-101.11 Food Safe and Unadulterated 6 4-501.112 Tags/Records: Shellstock 3-202.18 3-203.12 Shellstock Identification Shellstock Identification Maintained" 4-501.114 Tags/Records: Fish Products 3--402.11 Parasite Destruction* 3402.12 590.004(.1) Records, Creation and Retention* Labeling of Ingredients' 7 - Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized ProcesSine Methods* 3-502.13 1 Reduced oxvl,,en packagaing, criteria* 8-103.12 _ Conformance with Anprove<1 Procedures" I Denotes critical item in the lederd 1999 Faxl Code or I OS CMR 590.000. g Cross -contamination 3-302-11(Au])Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anhnal Foods Separated from Each Other* Contamination from the Environment 3-30211(A) Food Protectiat" 3-302.15 WashingFrultsandVegatables 3-304.11. Food Contact with Equipment and Utensils* Contamination from tha Consumer 3-306.14(A)(B) Returned Food and Reservice of Food - Disposition o€Aduiterated or Contaminated Food 3-701.1.1 - Discarding or Reconditioning Unsafe Food"' 9 Food Contact Surfaces 4-501.111 Manual Warewashing- Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashing-Hot Water Sanitization Tem eratures* 4-501.114 Chemical Stvtiti7mbon-tamp., pH, concentration and hardness. 4-60 Ll I (A) Equipment Food Contact Surfaces and - Utensils Clean* 4-602.11 Cleaning Frequency of Equipment ' A - Contact Surfaces and Utensils* 4-702.11 Frequency of'Sanirization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - HotWaterand Chemical* li) Proper, Adequate Handwashing ^ 2-301.11 Clean Condition - Hands and Amus` 2-30112 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eatin ,Drinking or Usin Toba�xcp* 2-401.12 Discharge; From the Eyes, Vose and Mouth* 3-301.12 Preventing Contamination When Tasting* - 12 Prevention of Contamination from Hands 590.004(E) Preventing Contanunation from Ent ilo ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204,1.1 Location and Placement* 5-205.11 Accessibilit . O paration and Maitttenence Supplied with Soap and Nand Drying Devices 6-301.11 Handwashocia Cleanses, Availability 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: Sunk l"n rP,447 Date: Page: 02 of _691- Item 2 Item No. Code Reference C -Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - PLEASE PRINT CLEARLY Date Verified - U/ N/ /77w76 e/ -4-,d d ,yS>, �Z oh �ra� -i7—Gy ��r�� X5-e�, Discussion With Person in Charge: have read this report, have had the opportunity to ask questions and agree to correct all inspection, to observe all conditions as described, and to violations before the next ins p comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. L L/C. --7 r Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color Additives 3-202.12 3-302.14 15 ---� Additives* Protection froth Unat roved Additives'r Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers* 7-102.11 Cornnton Name - Working Containers'" 7-201.1.1 Se aration-Stora c" 7-20111 Restriction - Presence and 17s&' 7-202.12 Conditions of Use, 7-203.11 '1oxicContainers -Prohibitions* 7-204.11. Sanitimrs.Criteria- Chemicals* 7-2(4.12 Chemicals for Washing Produce. Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 htcidental 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" 9 1.6 17 is G st * Denote, critical itern in the federal 1999 Pood Cone or 105 CMR 590.000. 3-501.14(C) PHFs Recessed at Temperahures lccordin to Law Cooled to 41 F145 F Within 4 Hours. 3-.5 .15 C oolow Methods for PHF: 3-501.16(B) Cold PHFs iVlaint'ained at or below Proper Cooking Temperatures for 41'/45° F* 3-%1.16(A) PHFs 3-401.11A(1)(2) 14W F. * Eggs- 155'F 15 Sec Roasts Held at or above '13WR 3-801.1.1(C) Eggs- Immediate Service 14>`Fl5sec, 3-401A I(A)(2) Comminuted Fish. Meats & Game t 27 Physical FacilityFG �- 6 Animals - 155'F 15 see. * 3-401.11(B)(1)(2) FC - 7 pork and Beef Roast - 130'F 121. turn - aut*3-401.11(A)(2) 3 -40 1.11 (A)(2) Ratites, Injected Meats - 15YT 15 -__erSpecial 130 _) oth-------... --. .-..---- sec, + 3-401.11(A)(3) Poultry, Wild Game. Stuffed PHFs, Stuffing Containing Fish, Meat. Poulhy or Ratites -165'F 15 see. 3-401-I1(0(3) Whole -muscle, Intact Beef Steaks 14-5'F '. 3-401.12 Raw Annual Foods Crooked in a Microwave 165'F * 3-401.1](A)(1)(b) All Other PHFs - 145'F'15 sec Reheating for Hot Holding 3-403A I(A)&(D) P1-IFs 165'F 15 sec. 3-403. I1(B) Microwave- 165' F 2 Minute Standing Thee* 3-403.1..1(C) Commercially Proccs_sedRTE Food - 140°F 3-463.11(E) Remaining Unsliced PorCions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Conked PHFs from 14WF to 70'F Within 2 Homs and From 70'F to 411 P/450F Within 4 Hoar, * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F745°F Within 4 Hours* * Denote, critical itern in the federal 1999 Pood Cone or 105 CMR 590.000. 3-501.14(C) PHFs Recessed at Temperahures lccordin to Law Cooled to 41 F145 F Within 4 Hours. 3-.5 .15 C oolow Methods for PHF: 3-501.16(B) Cold PHFs iVlaint'ained at or below 590.004(F) 41'/45° F* 3-%1.16(A) _ Hot Pii'Fs Maintained at or above 1-. -- z I 44 ' Food and F-ood Protection 14W F. * 3-50I.16(A) Roasts Held at or above '13WR 3-801.1.1(C) Time as a Public Health Control 3-501.19 Time as a Public Health Control` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre p Paged Juices and Beverages with Warning Labels* 23.Management and Personnel 3-90L I I (B) Use of Pasteurised Eggs* 1-. -- z I 44 ' Food and F-ood Protection 3-S01.'I l(D) Raw or Partially Cooked Animal Food and Raw Seed 5 xonts Not' Served. "' 5 ers and Utensils 3-801.1.1(C) Uno e Faxi Paeka re Re served. CONSUMER ADVISORY 22 3-663.11 Consume,t i(stsort Posted for Consumption of Animal Foods Mat are Raw. Undercooked or Not O ficru.ise Processed to'Elhninate Padtoecns r 0ai 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 590.009(A) -(D) Violations of Section 590.009(A)-(1)) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above ifrelated to Foodborne illness interventions and risk factors. Other 590.009 violations relating to gond retail practices should be debited under#29 - Special Requirements. GOOD RETAIL (items 23-30) Critical mrd non-critical violations, which do not relnte to the -foodborne illness interventions and risk'facrms listed above, carr be found in the foHouing sections of the Food Code arrd 105 CAIR 5eo-noo. Item Good Retail Practices FC 590.000 23.Management and Personnel '': FC -2 .003 1-. -- z I 44 ' Food and F-ood Protection ! FC -3 .004 5 ers and Utensils FC -4 005 26 Water. Plumbing and Waste _ FC 5 006_ t 27 Physical FacilityFG �- 6 .00 128, _ Poisonous or Toxic Materials FC - 7 .00H it_29 Requirements____ -__erSpecial 130 _) oth-------... --. .-..---- ----- -_._7 ssum.-n„.: _.. 'THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel: (978) 741-1800 Fax: (978) 745-0343 Name -_ .SUN 6aIV66_19 Date 'atl Tvoe of Oneration(s) 2 Foodservice ❑ Retail Type of Insoection ��Ftoutine Xe -inspection Address 1" Nn,e Risk 9 7-A . ) f Level ❑ Residential Kitchen ❑ Mobile Previous Inspection /L Date: 0'7 Telephone �i�qJ tivy- 99? ❑ 9. 1:1 Temporary ❑ Caterer ❑ Bed & Breakfast a•/O- ElPre-operation ❑ Suspect Illness ❑ General Complaint Owner^ I-el";' 6d rl HACCP Y/N Person in'Charge (PIC) 0 1 Time - i/,r 9 {ii A/9 (,//l i In: Out: Permit No. ❑ HACCP ❑ 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 (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 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 a A.: 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 (Blue Items) 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) L -H29. Special Requirements (590.009) 30. Other ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) e ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 3 and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0.00/Federal Food Code. This report, when signed below by aboard 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: ,Jnspector's-Signdture: Print: PIC's Signature: / Print: \ l-' _•• ( Page/ of Pages J FORM 734A HOBBS&WARREN -BOSTON x Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT T1 590.003(A)Assignment nment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11I Person in Charge - Duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the Person in Charge to sxe 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 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 5 6 FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 9 ;10 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 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* 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* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 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(J) Labeling of Ingredients* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 9 ;10 PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 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 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 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* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision I L. l CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: `.- /"7-11!V Page: a-- of oL Item No. Code Reference C - Critical Item R - Red Item � DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - PLEASE PRINT CLEARLY "" Date Verified J aVr -,,v/ (i ..C'm 7A ot7 e -/-r C/ 1P C A ✓l Oji 17 ¢ /9 lJ�I'-� n 42 Z/2L, /✓ -P ,fin 1 r�li X / Vele/ P C- 9- P . L'f r e Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that . noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. �� —Z Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS Iq Food or Color Additives 3-202.12Adm diti> ves'k_ 3-302-14 Protection f'rotn Una roved Additives% I- Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers" 7-10211 Common Name- Working Containers* 7-201.1.1 7-202.11. Se.ar_atio_u- Storage "` Restriction- Presence and Use'l.� 7-202.12 Conditions of Use - 7 -20311 Toxic Containers - Prohibitions* 7-204.11 Sanitizets. Criteria - Chemicals* 7-204.12 7-204.14 Chemicals for Washer t Produce, Criteria" Drvinn Aacnts. Criteda* 7-205.1.1 7-206.11 Incidental Food Contact, Lubricants* Restricted Use Pesticides. Criteria'" 7-206.12 Rodent Bait Stations" 7-206.13 Tracking Powders, Pest Control and Monitoring* 16 17 TIME/TEMPERATURE CONTROLS * Iknol'e9 critical item in the federal 1999 Foci Code or 105 CIN4R 590.000. Proper Cooking Temperatures for 3-801.11(B) PRFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec. W3-501.15 E��diate Service 1450F]Ssec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 1 Ph sical Faclfi1 FC -6 Animals - 155'F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 min" 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 Special Reguirements 1 sec * 3-401.11(A)(3) Poultry, Wild Gama Stuffed PHFs, 20 Stuftim, Containitc, Fish, Meat, Poultry or Ratites -165'F 15 sec. 3-401.1.1(0)(3) Whole -muscle, Intact Beef Steaks 145'F 1` 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F -r 3-401.11(A)(1)(b) All Other PHFs 145'F 15 sec. Reheating for Hot Holding 7-401.11UMR(D) PtlFs 165"'F It sec. * 1-403.11(13) Microwave- 165' F 2 Minute Standing 3 inle'r 3-403.11(C) Commercially Processed RTE Food - 14WF* 3-403.11(E) Remaining Unslieed Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 7WF Within 2 Hours and From 70'F to 41 1-145'F Within 4 Hours. * 3-501 14(B) Cooling PHFsMade Froth Ambient Temperature Ingredients to 41'FA5'F Within 4 Hours* * Iknol'e9 critical item in the federal 1999 Foci Code or 105 CIN4R 590.000. 21 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 3-801,11(:A) 3-501.1.4(C) PHFs R.zceived at Temperatures 3-801.11(B) Aceolding to Law Cooled to 3-801 11(D) 411145'F Within 4 Hours. ' W3-501.15 Coolirw Methods for PHFs I9 PHF Hot and Cold Holding 1 Ph sical Faclfi1 FC -6 3-501-16(B) Cold PHFs Maintained al or below 23- 590.004(F) 41.`145` F°` .008 3-501.16(A) Hot PHFs Maintained at or above Special Reguirements 1 140°F.* 30 3-501.16(.A) Roasts Held at or above '130°F: 20 Time as a Public Health Control 3-501.19 Tune as a Public Health Control" 590.004(H) Valance Requiter cat 21 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 3-801,11(:A) Unp isicurized Pre pa,kaged hilae. and Beverwee with WanunaLabels* 3-801.11(B) Use of Pasteurized 1: -s* 3-801 11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. m 3-80' L) I(C) Uno )ened Food Packa e Not Re-senred. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 Animal Foods That are Raw. Undercooked or Management and Personnel FG -2 f Food and Food Protection FC_�- 3 Not Otherwise Processed to Eliminate --------- �6. ' 26. Pathogens.* c't`"c.E rruroo� 3-;:02.13 Pasteurized Eggs Substitute for Raw Shell 1 Ph sical Faclfi1 FC -6 El- =s` SPECIAL REQUIREMENTS 5%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 59(1.009 violations relating to good retail practices should be debited under #29 - Special Requirements, (Items 23-30) Critical and non-critical violations, whirs do not relole to the foodborne illness interventions and risk factors listed above, carr be found in the following sections of the hood Code and 105 CMR 5,90.000. ! Item 1 Good Retail Practices FC 590.000 _ 23 � 24 Management and Personnel FG -2 f Food and Food Protection FC_�- 3 .003 .004 --------- �6. ' 26. Ec ul anent and Utensils t..FC 4 Water.Fumbin and Waste FC -5 005 .006 27. 1 Ph sical Faclfi1 FC -6 .007 23- Poisonous or Toxic Materials FC - 7 .008 29. Special Reguirements 1 .009 30 _ Other THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel: (978) 741-1800 Falx: (978) 745-0343 Name / ✓N �PiAa�n Date -. ©_Dl f Tvoe,of Operation(s) Food Service ❑ Retail Type'f In i Routine ❑ Re -inspection Address Risk Level ❑ Residential Kitchen ❑Mobile ❑ Temporary Previous Inspection Dater• x/-03 ❑ Pre-operation Telep � ,@ f �y�` Y Owner HACCP Y/N LIA,1 p 0,/4"2 q ❑ Caterer ElBed & Breakfast ❑ Suspect Illness ElGeneral Complaint Person in Charge (PIC) Time In: Out: Permit No. ElHACCP [I Other Inspector G2P.PirI / yj'JaU6 Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 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 1'9. Food Contact Surfaces Cleaning and Sanitizing(ZZ ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) 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 X23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) t/ 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) v 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other ❑ 12. Prevention of Contamination from Hands V13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number ofViolated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red 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: ns ig Print: PIC's Signature: / 'Y� % I 1P^ -r Print: K I )lei Page _/ of e Pages I FORM 734A HOBBB &WARREN -BOSTON J Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in Charge - Duties EMPLOYEE HEALTH 2 " 590.003(C) Responsibility of the Person in Charge to Compliance with Food Law* 3-201.12 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 System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* `s-3` 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 5 6 r FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 9 12 I .�, PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 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* 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* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 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* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 9 12 I .�, PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 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 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 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* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: AL ✓ter_ Gl oms Date: _2 -/✓1-/544/ Page: a�_ of Item No. Code Reference C - Critical Item R - Red Item Y DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date Verified PLEASE PRINT CLEARLY 271707-7 /l D1 stcLil%95 nt.i - - � F"t% ar cric.t �li,�pif C' sir//v �! i`ii/✓J,/Ja�.PF.F'a.,//� = cit,�ifs GGYrYi,✓-elw r:P//ova fLPS V n %) ninn/ r, 0/ /7iy,.rn 'eE/i*YI l�rLi,vs rv7D; bs/.e 1K vPs�: -C'14e" t 7 O.Nl�'9 lv '>illrZ,r> 7i�/.✓ e — �`Gf7/-v rv,�/J SCIt'��5/iYiNP�—ke.C��frrP rlz wDlat'� f 4e_ uPMaw. r- ✓,rzd fir -/iA'-'1 r'✓ /L- d P -CX,- Z o hfi ve f. �fnu, c7 /ar r%� oP/5x- v CPrPf7t'1cnT'_ //6-e/n'-7- '/tS7rc7r Gecd �/4hs Discsussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all inspection, to observe all conditions as described, and to ,violations before the next ins p comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. YG , Y. � Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion Cl Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 1s Id 17 18 • �r Food or Color Additives 3-202.12 Additives'` '1-302.14 Protection from Una> loved Additives r 3-501.16(A) Poisonous or Toxic Substances 7-101.11 Identifying information -Original containers* 7-102.11 Common Name - Working Containers* 7-201.11 Se oration -Storage"` 7-202.11 Restriction - Presence a ad 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 Diving A,,ents, Criteria* 9-205.11 Inridentat Food Contact, Lubricants* 7-2(16.11 Restricted Use Pesticides, Criteria'% 7 2(16.12 Rodent Bait Stations` 7-20fi.13 Tracking Powders, Pest Control slid Monit rina, • �r 1 Denotes' critical item In the federal 1999 Fold Code or I Oi CNIR 590.000. 19 z0 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3-401.11A(I)(2) Eggs- 155'F 15 Sec. 3-501.16(A) Ee s- Immediate Service 145`F15sw 3-401. 11(A)(2) Comminuted Fish. Meats & Came 3-801.1 Animals - 155'F 15 sec. ,,, 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121. min* 3-401.11(A)(2) Ratites, Injected Meats - 1.55'F 15 or Toxic Materials sec. r 3-401.11(A)(3) Poultry, Wild Game. Stuffed PHFs, _Poisonous _Special Requirements Stuffing Containing Fish, Meat, .009 Poultry or Ratites -165'F 15 sea_ 3-401.1 1(C)(3) Whole -muscle, Intact Beef Steaks -- 145"F ac 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F 3-40 1.11 (A)(1)(b) All Other PHFs - 145'F '15 see. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165-F 15 sec. * 3-403.11(B) Microwave- 165° F 2 Minute Standing Tithe* 3-401.11(C) Commercially Processed I2TE Food - 140°F* 3-403,1.1(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs front 140°F to 70'F Within 2 Hours and From 70'F to 41 °F/450F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature ingredients fit 41 -F/45'F Within 4 Hours* 1 Denotes' critical item In the federal 1999 Fold Code or I Oi CNIR 590.000. 19 z0 3-501.14(C) PHFs-Recti a- Temperatures According to IAw Cooled to 41'Fi45'F Within 4 Homs, a 3-501.15 = Coolin Methods for PHFs PHF Hot and Cold Holding 3-501..16(B) 590.004(F) Cold PIIFs Maintained at or below 4045"F` 1°( 3-501.16(A) Hot PHFs Maintained at or above 140'F.* 3-501.16(A) Roasts Held at or above 1.30'F. 3-801.1 Time as a Public Health Control 3-501.19 Time as a Public Health Control" 59CW04(H) Variance Re'cuinnucre REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. 3-801.11(A) Unp rsteurizsd Pre packaged Juices and Beverages with Wanvnq Labels* 590.000 3-801.11(B) Use of Pasteurized Eggs* FC -2 3-801.1l(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. " FC -3 FC -6 4 3-801.1 ..1(C) Unoened Foci Package Not Re -server(. r 22 j Good Retail Practices Consumer Advisory Posted for Consumption of 590.000 1_23, Animal Foods That are Raw, Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate FC -3 FC -6 4 LO2 Pathos*ens.*e'ra`ovz rm,1ooi j Physical Facility i FC -6 Pasteurized Eggs Substitute for Raw Shell 28y or Toxic Materials FC - 7 arcL IAL rtmidu1RCIVIC14 I a 590009(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 gtmd retail practices should be debited under #29 - Special Requirements. l't/N7+rkYI�iI��•7'ifh (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and rokfaclors listed abore, canbe found in the foHou ing se(tiona of the Food Code and 105 CMR 590.000. Item j Good Retail Practices '.. FC 590.000 1_23, 1 Management and Personnel FC -2 .003 24 Food and Food ProterLon -I-Equipment P 25 Water, Plumbiidnq and Waste 26. FC -3 FC -6 4 004 .005 ....... .006 27. j Physical Facility i FC -6 .007 28y or Toxic Materials FC - 7 .008 29 _Poisonous _Special Requirements .009 30 Other --