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BANI MARKET - ESTABLISHMENTS Rini mto et 13 Nwta� Sr�fPf universal oneTm www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA I kL i Commonwealth of Massachusetts s s City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2011 ESTABLISHMENT NAME: Bani Market File Number:BHF-2004-000006 73 Harbor Street Salem MA 01970 LOCATED AT:. 0073 HARBOR STREET SALEM, MA 01970 Permit Type Permit No., Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-20121-0195 Jan 1,2012 Dec 31,2012 $70.00 TOBACCO VENDOR BHP-2012-0205 Jan 1,2012 . Der31,2012 $135.00 Total Fees: $205.00 PERMIT EXPIRES December 31,2012 Board of Health This Permit is not 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 fonsuch must be submitted to and approved by the Salem Board of Health. Page 1 i CITY OF SALEM, MASSACHUSETTS BOARD OF HF-ALTH 120 WASHINGTON STRF_',T,4...FLOOR TEL. (978)741.1800 III41BFRLEY DRISC0z'.. EIV ED F.\x{)78)745-0343 NLwOR �.Ym�rr"�/ n �l t Iramdinja snlcm.ct m LARRY RANIDIN,RSJRI HS,CHO,Cevv 21 La 1i HFAIA1I AGI NT CttY OF SNLEMIVA BOPRD OF 201�),APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I- �1� (fC P t. TEL# q 7 6- 7-V `3 ADDRESS OF ESTABLISHMENT -7 3 - 1:�A d2 bo Q 7�St FAX# �2za- - 7414/ - 333 MAILING ADDRESS(if different) Z R A k b o R Cf EMAIL-Business: Website: OWNER'S NAME1��4Nr�lSC� QAtI� TEE#�7 ' 3/rx—/ OPS` ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON f'JqA x.1 , rS C 5 &_,11:5 HOME TEL# DAIS OF:OPERATION -=I Mondg) ` Juesday I Wedr esday.,h: Thursday,' I Friday °Saturday Sunday HOURS OF OPERATION / Please write in We of day. `"7 C�` - for ezampia Liam-itpm ip ' PMi �vt7; T. IRl T / v l TYPE OF ESTABLISHMENT FEE (check only) �y RETAIL STORE YE NO less than 1000sq.ft. 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 -------------------------------------------------------------------------------------------------------------------------------------------------------- BEDIBREAKFASTt YES NO $100 CHILDCARE SERVICE$/NURSING HOME - -------------------------------------------- ------------_ ------- ----------... '... ADDITIONAL PERMITS MAKE(not just serve)ICE CREAM,YOGURT/SOFT SERVE YES NO 25 TOBACCO VENDOR YES NO $135 ALL MOf 4PROFIT(such as church kitchens) YES NO "$`L5 "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 lax. returns and paid all state taxes required under a law. Signature I Date Social Security or Federal Identification Number Updated 523/11 FOODAP201 Lariat Check#&Date��r� l-� ' � ✓�__...��..�.____...__ Commonwealth of Massachusetts a City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2011 ESTABLISHMENT NAME: Bani Market File Number:BHF-200"00006 73 Harbor Street Salem. MA 01970 LOCATED AT: 0073 HARBOR STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD SHP-2010-0605 Jan 1,2011 Dec 31,2011 $70.00 TOBACCO VENDOR OHP-2010-0606 Jan 1,2011 Dec 31,2011 $135.00 Total Fees: $205.00 PERMIT EXPIRES December 31, 2011 ——� Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS Y - BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRErNBAUM&SALP.M.COM DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Q a N i VA-R k e r TEL# V 7-'�--- 741171 - M ADDRESS OF ESTABLISHMENT- - �3 ./ -14 d, loo k ,S't FAX# 7 - 74/4 33 ? .G MAILING ADDRESS(if different) 7-.3 ' 1-1 l4 Z d&-1, S t EMAIL- Business': Website: OWNER'S NAME_ - T 1Ga ill/C l S C C> P-e TEL ADDRESS E/A,11 5� JDeF4-&ed y/ M,4 �'7 a6 6 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# " YS ..TION No.. Td-&d"' VlleAriesd ITh rsda?'.,. Aida"` y Satiirda"* iunA HOURS OF OPERATION I 7 y Please write in time of day,. -7-0 /I *C / �_tG / �''�� For example 11 am-11 pm TYPE OF ESTABLISHMENT FEE (check only) �- RETAIL STORE YES NO less than 1000sq.ft. W-0-) 1000-10,000sq.ft. =$280 more than I 0,000sq.ft. =$420 -..... - ---i-a --------------------------------- - RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/-B-RE •-----------------••Y-ES.-----146------...---...----------.-.........-----------------------------------------------$-1--0-0-- ----- CHILDCARE SERVICES/NURSING HOM--------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO � 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 teddy under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. t Signature V Date Social Security or Federal Identification Number Revised I0IU11 FOODAP201 Ladm Check#&Date7-4 I SORV�' f4 OrZEXAM FORM NO. 4502 CERTIFICATE NO. 6703942 SebrvSafea Certailffrolko%ao%tiffon w, TO NELSON SA!\I��CH�E Z N for successfully completing the standards set forth for the SeNSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)-Conference for Food Protection CFP), l 10/8/2009 DATE OF EXAMINATION 10/8/2014 DATE OF EXPIRATION Local laws apply..Check with your local regulatory agency for recertification requirements. Vila' NATIONAL RESTAURANT ® David Gilbert ASSOCIATIONg Chief Operating Officer,National Restaurant Association #0655 Executive Director, National Restaurant Association Solutions (92009 Nai am"Restaurant Association Educational Foundation.All rights reserved.ServSafo and the ServSafo logo are registered trademarks of the National Restaurant Association Educational Foundation. end used under license by Rumored Restaurant Association Solutions,LLC,a wholly owned subsidiary of the National Restaurant Association. This dosumont cannot be reproduced a,altered. `08121102 V0908 r r Commonwealth of Massachusetts s City of Salem Board of Health IQMbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/13/2010 ESTABLISHMENT NAME: Band Market File Number:BHF-2004-000006 159 Boston Street Salem MA 019.70 LOCATED AT: 0073 HARBOR STREET SALEM, MA 01470 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions t Notes RETAIL FOOD BHP-2009-0370 Jan 13,2010 Dec 3l,2010 $70.00 TOBACCO VENDOR BHP-2009-0371 Jan l3,2010 Dec 31,2010 $135.00 Total Fees: $205.00 i PERMIT EXPIRES Decem�2010 a Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • _ , BOARD OF HEALTH 120 WASHINGTON STREET,4°i FLOOR TEL. (978) 741-1800 I{RvfBERLEY DRISCOL- FAX(978) 745-0343 MAYOR DGREENBAUM&ALEM CONf DAVID GREENBAum, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT S4e TEL# 74W-333/ ADDRESS OF ESTABLISHMENT 7 3 , S )FAX# MAILING ADDRESS(if different) 7,,3- h ff� oX S 2 A /z M /LY4 6,)170 EMAIL-Business': /y128N1t°//P/�7CJ R �Y - fY�9�o Website: OWNER'S NAME ;EX'411JIAKSro Pe Aa TEL# 97Y' ' 3 /� ADDRESS— f14- Srr �P_4A0 /y _7J /_? STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# `DAYS OF OPERATION I Monday Tuesda Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION 1 Please write in time of day. I --7 �a For example 11 am-11 m t D / — /o 7- /0 1 7- r 7 - /0 - /o 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 less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS ------ 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 slate lax returns and paid all state taxes required under the law. 77T_:o_ � I & J� :� /— 13 —C7,0/0 Si tune Date Social Security or Federal Identification Number ----------------------------------------��- - -------------------- Revised 424/07 FOODAP2008.adm Check#&Date /1-&`25 / L_ Commonwealth of Massachusetts f City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/12/2009 ESTABLISHMENT NAME: Bani Market File Number:BHF-2004-000006 159 Boston Street Salem MA 01970 LOCATED AT: 0073 HARBOR STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2009-0370 Jan 12,2009 _ Dec 31,2009 $70.00 TOBACCO VENDOR BHP-2009-0371 Jan 12,2009 Dec 31,2009 $135.00 Total Fees: $205.00 PERMIT EXPIRES IDecember3l, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. ----In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • s CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIN[BERLEY DRISCOLL FAX(978)745-0343 MAYOR IDIONNE SALEM1I.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Lia ri I . MARK .v TEL# 4' 7if- ADDRESS OF ESTABLISHMENT 9�h- -73 11nAAb R• 5t, FAX# MAILING ADDRESS(if different) -,F- 73- HA4e bA- . - ?'t EMAIL- Business': Website: OWNER'S NAME (� 1: 4 ANC(scl7 �/UA / TEL# yy- ADDRESS /' �M S� PO 14 13cy Mil STREET •-� CITY STATE ZIP Y- CERTIFIED FOOD MANAGER'SNAME(S) IPANCtISCO P— A A CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON F0,t9- r d HOMETEL# .DAYS OF OPERATION-' Monday .Tliesda Wednesda ;Thursda .:: 'I - - '-Edda Saturday: Sunda HOURS OF OPERATION M t9/t Please write in time of day. 7—Y'O 10 j 7-Yo /O i ?'rbl0' �M'rb to+ To/DM !-D d'� $ Zo/DM For example Ilam-11 pm ! TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YE NO less than 1000sq.ft. 61141o.470 . 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/B-REAFA--S--T --------------------Y-ES------146---------------------------------------------------------------------------------$-1--0-0-- ------ CHILDCARE SERVICES -------- - - - -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YEa NO $25 TOBACCO'vENDOR YE 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 un r the law. 2b /P��8' o 13 -6 N 74 Signature Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date $ CITY OF SALEM BOARD OF HEALTH r s Establishment Name: ��C�111 \�Q( t�P t Date: r`� I Li Inc' Page: C of r I , Rem Code C—Cdttcat Item" r DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date r No. Reference R-Red Item - `' Verified PLEASE PRINT CLEARLY °^ v' I aS . , ars I nP flnn F)n alal r+ tt i^�� Itc otf�,rnc� 11c1 ti r 5-� � hlislnvvte� t/ t als f i G t -'t`e �" o_ i ied of oowVW,r/s t n lM 0 1)P.( __C1 [A 1 i'C,I.l (�i� ' OctI� 0 P < h I I.S I �V1 CY S P etn +uf)1 Alc %lY4nIiiox 4Ac OWheir fr ,f5 -{', c, se III- o, IlAo J f - At �CCr,ts r!IID erre >r Qty t o:A+ r�F r j 0 !S tint Ap 'Vo f � Y r i1( f Discussion With Person in Charge: Corrective Action Required: ❑ No7Suspension y $. ,y,, t have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ EmpExclviolations before the next inspection, to observe all conditions as described, and t0 ❑ Re-inspection Scheduled ❑ Emecomply with all mandates of the Mass/Federal Food Code. I understand thatnoncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emeyour food permit. �- �-� ❑ Voluntary Disposal ❑ Othe n t� r 0 1 14(C) PHFs,Received at I fares Violations Related to Foodborne fitness interventions and Risk According to Lay. Cooled to Factors(fterfat I-V) (tont) 4 1�F/45"F Within.' Hows PROTECTION FROM CHEMICALS — m Cool �,=?Aethods for PHFs Food or Color Additives 19 PHF Hot and Cold Holding 1=4 5- 1-50116(B) Cr, d�PHF�Maifitaincd at or bAmv I 732 12 i2 Additive, 590,00d(F) 41°145° F' Proaction ironLiLia��ycq, L 3-501 16(,A) I lot PHI,Maintained at or above Poisonous or Toxic Substances '.-(01.11 —1denfifying_tnfonnaiion -Original Contain 3-501 16(4) Boosts Held at or above 13091 erc,* a — 1-102.1 1 Coualson Name, Wl)rk;p,,Oavarnerx* Ljo —Time as Public Health Control--—! 7-201,11 Seacaukak 3-i01 19 Time,as a Publh;I leald)Control, 7 ResHctiori -PoBence us] Uscr 7-202.12 Conditions�op,of U se REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11— Toxic C ontame r,-Prol a In'tion,* POPULATIONS 7 _ -204.11 Sanalzei,,'Fritmia Cheioic:ds* 7-2(9.12 Chellue"6 for Washlllc llrodltccCdterW ti 1-80 1,11(A) Uripavtcurizcd Pre-lact.aged Joicts and 7 404 1- MR' I 1eflM Criteria" Reveraaels, with WaluillLubols" Lubt 3.80 1.11(B) Use of patrlliE� 3-801.11(1)) Raw or Paroalli CookedAturntd Food and 7-206.11 kcsiricied,"St Pe trades-C' iter ti" Raw Seed Spro' ac;Not Served. 1 7-406.12 Rodent Boa SuitirTks` Fnicking Powdem Pest Control and 2", '"oftitorin', CONSUMER ADVISORY 272 - 6031 Cons F_F_1;u.l1r_Ad1rsol1 (��T_quelp_twn of TIMEITEMPERATURE CONTROLS Animal F,:Klds'Ililnarc RdW, (hatercol)ked v; 16 Proper Cooking Temperatures for Not Othei H ise Pros cssed to Eliminate PHF6ilh,,1.1-M, Fgg - 1,55-F 15 02.13 145,1_-15sec, 1,3 Pasteurized F geSuNtinnv for Raw Shell 3-401.11(7.)(2) Comminuted Fish, Mea"N&Game ___-Animals- 155"F l5 sec " — SPECIAL REQUIREMENTS _734FLI l(B)d){2) Poik and Beef Roast - IWF 1 � 21 rni0 k I— 590,0i)9(Arj)) Violations tar"Section 590SX)9(A)-(D) in 3-401.11 -1) Rathes,lrjft,��d WaR,- 155�F 15 catering, mobile fes)d,temporary and residential kitchen operations shou Id be 3-401.1liAVI) prathn, Wild(Janrc, Stuffed PHFs, Sauffinv Cant filling Fish,Nfeai. dcbiled under the appropriate.sections Poultry or Radtos-165,9,15 sec. above if relined to folAborne ith,css 3-40 1�I I t_0(3, Wheile mu.da,Irraci Beef Steaks interventions and risk factors. Oflwr 1, 145,)F* 590.009 violations relating to go(al retail 3-401,12 Raw Aninial Fol)&Cookcd in a rn achres, should Be debited under#29 - Mlclowav,. W,F Slocual Requirements. ,--40 Ll I('A)(1)(b) Ali Other PIfFs-- 145`F 15 sec 1=7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRA CTWES _T!03,1 l(A)T(D)_ PHP, 16511- 15 sec. (Items 23-30) 3-40111(H) Microv 165°F 2 Minuic Standini, i9ttiral rind non-critical villialmm, which do at); reiate iolhc Firre, foodborne illness interventions and riA factors lilt above can be 3-403.11(C) Commercially Proccsaed RTFFcxA- finind in the ftWourngsectioro of dzi.Food Code zwd 105(.WR 140'FxI .,90.000, —---- -0 ---- -- 34(1�3,111(17) RcaarvnnCoo�Unsliced Portions of Beef item I Good Retail PrqeLttcts----=="T FC590,0 poasf�� 23� Management and Per sonnel 1 FC -2 1 �003 per ling of PHFs w 2 Food and FeProlection FC- 3 1 00,1 ry pro 25 EliJipment and Utensils 005 3-501.14(A) 0x4ing Cooke PHFs from 140`17 to -------- i'------- -2 006 70'1;Within 2 llrlurs rind From 701, 27Phys,cai Faulily FO-6 i 007 to 4 J'F145'F Within 4 fiow�, 2�7_'Poisonous or Toxic Materials FC-7 I DO8 -7-501,14(b) Crxlhn�,PHFs Made From Ambler) -2 -------- 009 9, ___��p - _ Temperawre Ingredions,In 41OF/45'F 30, Other Within 41 Iom P"WIle,ridexHtem ill lhe lolm! I t�9 Food C,Xja,r 105(AIR 59.;1970, CITY OF SALEM t BOARD OF HEALTH EstablishmentName: P)Gnl kc-'( �_-Pt Date: /n(: i Page of ttem x Code : C-Critical item `: f T #i,' z� z':DESCRIPTION OF VIOLATION/PLAN OF CORRECTION '" x, Date ;;a: I 'No Referenced R=Red Item "� '"„;' y ,',x � r, wk �r' aa'; - = . 'n s:,.�z.srx ,:,�i,'.'.`-tt�}. � ,- '` '';� f ` x ; ". : § Venfied ..x v_,.=. .. .f- "'X_""'( AfaY „ .[A,r.4'5^s:F'i°✓r�.. !` ::e/, -. ' ,.e +a-.:PLEASE PRINT CLEARLYrvr?. �,,.Jsmkt.+a a<. + �, 4 cS Av��4) no in-_su,e-c+(igp r,)t)Jur'1� c� eP.�nJ� ct ' v 4b oo<.<i hie Snlvl�')000cr r fo rnlnr-r hbrn ' `` �t e lcti_ll�Li �f c,r e. s (1; le_I(I'+0 � \h t` Vla l0 �a 1 CJA 0 In 1 �c�(1.t�� l ca tSZ��" 1�(�c ! n 1Uir i71I. GiV�Q � 1 `dC (x_'i0rl `on 10Y7h-'e ��Ui(�iLCON� �✓It1 A \+n ' 1 r, t��1 . Is t 's (�c�� wrm, "no+ s e. i Avm- )ni-t I 4 t 1 , Au n -------------- i r l Discussion With Person in Charge: Corrective Action Required ❑ No p�; , ❑ Yes rr �n5`<",;f,.. .� ,R; 3.<M.>.,e�+ Ln- /,.. �fi �' �:, , 1• ,� fr th I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. \ ` ❑ Voluntary Disposal LlOther: V F 7� . T 4(C) PlIFs Received mTem Niratures Violations Related to Foodborne Illness Interventions and Risk According to LzuCooled to Factors(items 1-22) (COPA 41°R45-F Within,!Hours, PROTECTION FROM CHEMICALS 3,,5 1,15 coofina Methods for llflt`s L14_ Food or Calor Ajd-uives 19 -- PHF Hot and Cold Holding 3-50116B) Cold PHF�M"hiconed at or bth),w 72—t,2 41°A5'F* 3-302,F4 I protection T6tA—) clot PFIB %faman near at or abov", I5 Poisonous or Toxic Substances kw%vs Field oz above 130— Containers, Time as twPublicideatflriC t I LN0— "'anno 7 W211 Common Nanne - Workonj Cowainer", 0'1.i 9 'Full,-as, a Public I lr�ahh Controll I 1�201.11 --§�u a,-:annr5j I�,ate" 7 590.004(H) Variance Reg ter -—enrew �Sk rice And Ulse� -— -— 1-20111 Rc,�i;icoonpro- 7-20112 Condnions of I-jso* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 iol II Toxic contairi-protnfdtron,, POPULATIONS HSP) 7-20,L 11 Saniii7tri,Criteria - ChenricaK- 2i 3-801.11(A) Unpastcurizcd Pre-pachagcd Jurces add 7-2(4.12 ChumncaN for Wnthj rodvcc, OhG601 7_20_4.14 -in, eeniw freveraiies with Warnii%Lat vfa, of ria' 7-205,11 liwid-val RA Contact.LubmanW --7— 3-ii(rl�11(D) Raw or Pailid1v Cvok��.([Amrrnfl Food and 7-206A-1--oscric"cd Vsc crncna� Raw St:(,d Vert 7-206A2 1 Rtxiew Bmt Smtions 3-g(JANC) UniFix X _j T,i 7-206,11 cking Po��Jere. Control and mnd- CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS22 3603-Li Consumer Auisoi v PiAted Pic Consumption of .r... Aniucid FxOIliat are R,kw, Under"x)kcd cr 16 Proper Cooking Temperatures to Not Otherwise Processed in FIhninace PHFS 3 401 1 IA(l)(2) Fgg:- 155'F 15 S�,,c. Patfiri-gens; Z,s-inaDecd acc, 145'F]5sec, —47-n2.i �I)Sthui,for[Law Sheri F 'e 3-40LIT(A)(2) conullm,.-r Animals poik and Btef Rixoa 1301, 121 min, ?-40i.1 1(B)(IT,2 SPECIAL REQUIREMENTS 590.009(A)-(f)) Vial Mons or Section 590.(X)9(A)-(D)Jn 1.11(A)t,') Rawe�, Nlvka�- 155'F IS catering. mobih, firocl. cempkKa4v and 3,01.II(An3) residential kitchen operations should be sluffmc Containing Fisl ref at, deboed under the appropriate sekronis -±(LultryLRatites-163`1 LT, [5 ed abiwe.if related it)foodhorne illness -7-40LIJKX33 '41,wk-ninscle, Intact T3�14 SUAkS— Other 590.009 violations rolatho, to poi retin! 340L 12 RawArnmAl FrNxk Cooked in practices should be debited under#29- _ Nlicwwave 1651, Sficcial Requirements- 11 All Orlicr Pi-Ifs-- 14T 15 Sec, LL7Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES -3-403.I1(A)&{D) PHI,, 165'F 15 we,. I (items 23-30) 3-403.11(b) Nficlowave F'2 Minute Standing CiWeal and non-(shoal violalioiii, which do nai rebate io the __ Posits toodborne illness iwei ventions aril rNkfin:lors lived above ton be 3-403.1 E(C) Commercially Pe(wessed RTE Kwid- found in,the following sections of the brood Code mad 105 C.UR 14WF' I J900(m, -F --T-qoqa-qv7w-1`Pr� ...I--�?---- --- -: ir te;� 3-403J 1(F) fh.niwnrirn,U:0iced Portions,ofiicqjn i Roa,10 23, 1 Management and Personnel FC -2 1 003 Protection FC- 3 W4 I Proper Cooling of p"Fs .......-------f- 6—— — ---I 25 ...... E iprnLn_twjq ewLtis �Lc 5 3-501,14(A) Cool ing Cwkcd PFIF's irom 140'F 14) --- qu L--------- 26, W�! 70�1Within 2 flour�and From 70"T 1 to I FG-5 006 07 FC-6 007 o,4 1 01/45�1-1 W"ithin 4 HcvKs, 2& �'hy5iral oisonous or TOXIC Materials I FC -7 003 3..501.14{}$) (oohin,f1flFs Made From Ambient Teirpe"ratort isteredieuts to 41�FAScF 30 Othe Within 4 floui-0 Den"Iesmbeal On)is rhe l',irat NOt)F(....1 Code i,r 105 CIVIR 590 000 r Commonwealth 416s81achusetts City-ofSalem-. Board of Health Iftbefley DftcolL. 120L Washington Streeti-4th-Floor- Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/24/2009 ESTABLISHMENT NAME: Barri-Market- File Number:BHF-2004-000006 159 Boston Street Salem- MA OW70- LOCATED AT, 0073 HARBOR STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2009-0370 Jan 12,2009 . Dec 31,2009 $70.00 TOBACCO VENDOR BHP-2009-0371 Jan 12,2009 Dec 31,2009 $135.00 Total Fees; $205.00 PERMIT EXPIRES December 312009 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 aeeordaneewith-the-State SanttargCode,beofre any revonations,improvements>ocegidpment changesaremade,all plans-for such-must-be submitted to___rl�prn.e�-Rj the cstem Board-of Health— Page t a Commonwealth of Massachusetts a City of Salem Board of Health IGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/17/2008 ESTABLISHMENT NAME: Bani Market File Number:BHF-2004-000006 159 Boston Street Salem MA 01970 LOCATED AT: 0073 HARBOR STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2008-0366 Jan 17,2008 Dec 31,2008 $70.00 TOBACCO VENDOR BHP-2008-0367 Jan 17,2008 Dec 31,2008 $135.00 Total Fees: $205.00 PERMIT EXPIRES December 31, 2008 Board of HealthQOILx L 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 of 1 • QTY OF SALEM, MASSACHUSETTS } irc' BOARD OF HEALTH 120 WASHINGTON STREET,4' FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR fsopTrasALEM.OOM JOANNE SOOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TOOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT g .; 117I.AXp.c�� TEL# ADDRESS OF ESTABLISHMENT 73 - HaRdck S'r' FAX# MAILING ADDRESS(if different) ® R r )( t�/ 3 4/eIA ' ImF}' EMAIL-Business': Website: OWNER'S NAME .�C ��'-N I� TEL# �l f� - v5_3a ADDRESS ./ E7/m • boleQ 9abla`"PM I¢ oP?465 STREET ® CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION I Monday Tuesday Wedneiday 1 Thursday ' Friday Saturday Sunda HOURS OFOPERATION M _ 4 M RM 10 pL Please write in time of day. 7 To (d STD For example i larn1 1 m TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE NO less than 1000sq.ft. 1000-10,000sq.ft. more than 10,000sq.ft. =$420 --------------------------.... .----------------------- ...... .... ...... � RESTAURANT YES NO less..than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES--------.-. ..._. . ----------------------------------------------------- ---------------- ADDITIONAL ----- ------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE PEEEJW L- NO 5 TOBACCO VENDOR NO $13 ALL NON-PROFIT(such as church kitchens) YES NO $ "Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to anWapproved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. A &4t a' ' 1 - t(P - V9 (943-0 $0711 Signalure IF Date Social Security or Federal Identification Number -- -------_ --------------—----------- ----------------------- -------------75Ta-------------------------- Re,ised 4/24/07 FOODAP2008.adm Chcckk R Date COURT DOCKET NO. CITY CITATION NO. OF SALEM PD L+(� VIOLATION NOTICE U 00 NAME(LAST,1FIRST,INITIAL) � ( • � � STREET'AJDDRESS - CITY/rOVj(NTE ZIP els 56 LICENSE NO. LIG EXP.DATE DATE OF BIRT 4� OWNER'S NAME(LAST,FIRST,INITIAL) S " rel A. STREETADDRESSOWN S E ZI _ S l ! , 6 REGIS RATION NO. EXP.DA MAK YEAR COLOR ( I DA E OF VIO TION TIME DA I EN PERSONAL INJURY APM ❑YES [I NO ILATI F IOLATI NFORCING DEPT I 'OFFENSE ' +'✓ ESR! I CHAPI J eobGJ-l� 5 Y , ;OFFICER I.D.NO. TOTAL FINE C DUE 7FICER CERTIFIES COPY GIVEN TOVIOLATOR �- IN HAND I X �BV MAIL ( DODO NO�-PAY ONLY BY POSTAL NOTE,MONEY !(}) ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 r TEL.(508)745-9595 X 251 r 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 9073,Harbor Street Bani Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-744-4569 PIC Assigned/Knowledgeable/Duties PASS d❑ RED Owner: Non-compliance with: Francisco Pena Anti-Choking PASS PIC: Francisco Pena Tobacco PASS Inspector: Janet Dionne Reporting HEALTH Reporting of Diseases by Food Employee and PIC PASS 0 RED [Date inspected: Correct By: 1/17/2008 Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0426 Receiving/Condition PASS ❑ RED Status: NEW Tags/Records/Accuracy of Ingredient Statements PASSN❑ RED �.#of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASSd❑ RED 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) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 23,2008 ) Page 1 of Item Status Violation Critical Urgency -- ' PROTECTION FROM CONTAMINATION Violations Related to � . Separation/Segregation/Protection PASSd❑ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED immediate corrective action) Proper Adequate Handwashing PASSJ❑ RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS 0 RED Handwash Facilities PASS 0 RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS 0 RED Toxic Chemicals PASS 0 RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS 0 RED Reheating PASS 0 RED Cooling PASS V] RED Hot and Cold Holding PASS Q RED Time As a Public Health Control PASS ❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS Q RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 23,2008 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Physical Facility PASS BLUE Comments: Provide door sweep for back exterior door. Basement: if going to use basement for food storage ceiling must be made of smooth as to be easily cleanable and impervious. Water, Plumbing and Waste PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: This is a retail establishment that serves all prepackaged foods. There is no food preparation at this establishment. This Establishment is set to open. f i I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 23,2008 ) Page 3 of I' m CITY OF SALEM, MASSACHUSETTS 1 BOARD OF HFALT11 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR I,RAMDIN QQSAI.F.M.COM LARRY 1L1MDUN,RS/RE1IS,CHO,CP-FS I-IEAI TH AGENT REMODELING PLAN REVIEW APPLICATION FOR CURRENTLY LICENSED ESTABLISHMENTS _REMODEL _CONVERSION Application fee :$90.00 Category: Restaurant_, Institution_, Daycare_, Retail Market Zother Name of Establishment: _ 3 ��✓� JV Z A-A Kc)L- Address: 73 • P AR 6,04- S?- Z2 0 fe W . 4445-S. d/tel 7D Phone, email if availablet',02 79- G 51-80 76 MA-94et- 97& -7yy 3 ai Name of Owner: TAe:;evei gt� foQNA Mailing Address: 17 E7/44 • 57` PpAbac[y OS--y Telephone: !? 79 C- 5-Y- 8070 Applicant's Name: F7RjV0(SCO Renl4 Title (owner, manager, architect, etc.): I'S L JN er Mailing Address: 611,V • �� 1 eA y• &4SS tO Telephone/e-mail: y7 9 -4 S��-53'0 'x`0 PpA)aOQ l/ q AAA} 4M I have submitted plans/applications to the following authorities on the following dates: Plumbing Building Fire Planning Electrical Conservation Engineering Licensing Historical Commission City Clerk Public Services Water Assessors Ad p Hours of Operation: Sun 4ac.g Mon as° j1�Tues 7A�'*6�� Wed ��ta A r Thur)iFRI L/11-A1q Sat F - 100�r^ Number of Seats: Number of Staff: (Maximum per shift) Maximum Meals to be Served: (approximate number): Breakfast Lunch Dinner Type of Service: (check all that apply): Sit Down Meals Other Take Out Caterer Mobile Vendor Project Start date: Completion date Please enclose the following documents: Application Fee $90.00 ( Check or Money Order made out to " City of Salem" ) Proposed Menu (including seasonal, off-site and banquet menus) Manufacturer Specification sheets for each piece of equipment shown on the plan Site plan showing location of business in building; location of building on site including alleys, streets; and location of any outside equipment (dumpsters, well, septic system - if applicable) Plan drawn to scale of food establishment showing location of equipment, plumbing, electrical services and mechanical ventilation ( color coded) Equipment schedule FOR OFFICIAL USE ONLY DATE RECEIVED FEE AMOUNT RECEIVED BY DATE APPROVED: APROVED BY: ;ate 39� - tC�• cK4 ' b av Z R,y Qo � w ti�s� rn�T NA-1 d 1 y P qv+ moa n d v,p�ap - b7 O0 W n+ I ' - yaN�b itt �. rrlj�Z:p 4Z Ik/ 1 } e � w 4 1 � A _�. �+ - � �' ..o � cw co.F'� m �; �. :I '. %t _. f'9 sBr9 � ivw"w.- �, _- „.._ i a� Sl 40 j ��% �" �a 1 � y;, Y�� v. � � - ��+jVA(�''++��'A\� �� .y d "h .�_ 1w' 'y^ Y s�.'1 .ei. 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