The URL can be used to link to this page

SUSHI GARDEN - ESTABLISHMENTS (2)Commonwealth of Massachusetts s � City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED:. 12/15/2010 ESTABLISHMENT NAME: File Number: BHF -2010-000065 LOCATED AT: Sushi Garden 99 North Street SALEM MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0601 Dec 15, 2010 Dec 31, 2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT jug! r r!rcA rte- TEL # 9 U - :i�4 - 919 8 ADDRESS OF ESTABLISHMENT qQ S c,6FAX # r MAILING ADDRESS (if different) EMAIL - Business': OWNER'S NAME t ADDRESS aO STREI t. Website: CITY TEL# 64- &61-1S'Vz M CERTIFIED FOOD MANAGER'S NAME(S) ;Vtc� I Gt/lra CERTIFICATE#(S) (Required in an establishment where potentially hazardo s food is p);epared) EMERGENCY RESPONSE TEL # ZIP HOURS OF OPERATION Please write in time of day.T!-' ` (Forexamplellam-1lpm) 11 i lx N. -Rawl -ILp+-) IP- TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YES NO ----------------------------------------------- less than 25 seats =$140 CITY OF SALEM, MASSACHUSETTS 25-99 seats =$280 BOARD OF HEALTH -� 120 WASHINGTON STREET, 47 FLOOR KIMBERLEY DRISCOLL Vw(978) 741-1800 �jE �Y'(8) 745-0343 MAYORMOv D 6NBAUM a SALEM. COM 1 DAVID GREENBAUM, c Gt O� SALEM ACTING HEALTH AGENT DgAFi® OF HEALTH 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT jug! r r!rcA rte- TEL # 9 U - :i�4 - 919 8 ADDRESS OF ESTABLISHMENT qQ S c,6FAX # r MAILING ADDRESS (if different) EMAIL - Business': OWNER'S NAME t ADDRESS aO STREI t. Website: CITY TEL# 64- &61-1S'Vz M CERTIFIED FOOD MANAGER'S NAME(S) ;Vtc� I Gt/lra CERTIFICATE#(S) (Required in an establishment where potentially hazardo s food is p);epared) EMERGENCY RESPONSE TEL # ZIP HOURS OF OPERATION Please write in time of day.T!-' ` (Forexamplellam-1lpm) 11 i lx N. -Rawl -ILp+-) IP- TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 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 SERVICESM U RS ING. HOME -------------------------------------- ---------- ADDITIONAL PERMITS - -- - -- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT (such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code; before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. 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 tax returns and paid all state taxes required under the law. (t(tIII tz> .2-7 s41 Date Security or Federal Identification Number /.-b.. EXIST DMUSING WALL TO REMAIN OVEN. I I I I O W/ST HOOD ABO O EXIST STOREFRONTKITCHEN _... woRK T WORK TABLE UNff WORKTABLE - z z OOOLER ------------ EXIST I I pp DDDR NEW COUNTER- \ i I' EXIST - .' `• 81�tlLcaS�* J S'1 STOREFRONT 1I A HIE I H AOA ACCESSIBLE COUNTER B Dsx No .I SINK � SI SME C EXIST DIMISING WALL TO REMAIN LIMIT OF WORK 4ROPOSED FLOOR PLAN SUSHI GARDEN SCALE: 1/4" = 1'-0" 99 North Street Salem' MA WALK IN 12'-1" J EXIST 7 OBATHROOM REP 31 OVEN EXIST LDI"OR EXISTSTORE SCALE: 3/8" = 1'-0" 49' 25' EXIST DRAISING WALL TO REMAIN 0 BBO 8T OVE W/ HOOD AB O GRILLE KITCHEN RK TABLE ` TABLE UNR i WORKTABLE it• -g' r r i � I I i ��(�N�E��W �C�O��U-�N��-E/+R/�--��J�FIi�� A HIE �' H IADA ACCESSIBLE COUNTER A-� B DISH h NG SINK PSI -----LIMIT OF WORK (",-,�ROPOSED FLOOR PLAN r -- EXIST DIMISING WALL TO REMAIN WALK IN I EXIST DOOR J EXIST 7 OBATHROOM R Lim & Associates, P.C. Attorney at Law November 8, 2010 David Greenbaum Acting Health Agent Board of Health City of Salem 120 Washington Street Salem, MA 01970 RE: 99 North Street, Salem, MA Sushi Garden, Inc. Dear Mr. Greenbaum: 65 Harrison Avenue, Suite 407, Boston, MA 02111 Tel (617) 451-3441 Fax: (617) 451-1899 Enclosed for processing please find the application for permit to operate a food establishment and the filing fee of $140.00. If you have any questions, please call me at the telephone number above. Thank you for your assistance in this matter. VIA NOVA 1-- 2010 C3 FY aa- 6,4LE-M BOARD OF HEALTH Very truly yours, Peter Lim, Esq. CITY OF SALEM BOARD OF HEALTH Date: November 16, 2010 Name of Establishment: Sushi Garden Address: 99 North Street Owner: Ping Chen and employee De Zhong Zheng Phone: 617-818-6407 The proposed new owner of this establishment Ping Chen and Certified Food Manager De Zhong Zheng and Attorney Peter Lim, presented a Floor Plan and Menu for review in accordance with the State Food Code. Both are approved as presented. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. A "Person in Charge" or "PIC' must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. Please forward copies of all Certificates to the Board of Health FLOOR PLAN A Hand Sink must be located in each food prep and service area. The hand sink must have a wall hung soap and paper towel dispenser. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the basement. Storage must be at least 6 inches off the floor. A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes are available. There will be no food prep in the back storage area. If food prep is to be done in this area a hand wash sink will need to be added. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. Fruits and vegetables must be washed prior to preparation. All food must be held at 41'F or lower, or 140°F or higher, at all times. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready -to -eat foods. Gloves, tongs, or tissues must be used when handling such food. CONSUMER ADVISORIES The consumer advisory regarding the consumption of raw or under cooked foods is posted on the menu. The new Allergen Awareness information was given to the owner. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3rtl bay of the 3 -bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. These must be clearly marked "sanitizer". Outside area of premises, including the dumpster area must be kept clean and sanitary. TRASH Trash will be held in an outside dumpster. A grease barrel will be located in the same area. The dumpster must remain closed and the area must be kept clean. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. A change of ownership inspection is scheduled for Wednesday, November 17, 2010 @ 2:OOPM. An applicatipn anW'- have been received. David Greenbaum I Actith Agent \(3 Date //— jD —/0 Peter Lim Date •.•��~_— h+ h C -p,k S� v"4eP �yaakgka4"�mfv ,� SP S+a m YnY l�fotlfieatlon of Test Result 6s1"`¢., eQp000 Nana,el Registry grFeod Safety Professionals) `$$',(9 ry �eZaa�g VQ` € § CERTIFIED FOOD SAFETY MANAGER 'aft ,d ,iia nfa'�t�' -'g I-. `r -?4"' _ t�.° r,�g-r"�.§ �3 ID#: xxx-xx-3206 Scaled Test Score: 87 DE ZHONG ZHENG Candidate Status: Pass Toftpate: June 21, 2010 k" 1, x� Certificate No: ZC20517400 Issue Date: June 21, 2010 :Congratulations! Attached is your cgrt)ficate and,wallet card .Please notify DE ZIIQ Ci ZII NG 3QA4,tional Registry of name o[ a l} asi�rt;lipes at the addres's [Zelow. X59 M'. `� .thT0 S'I,,s, . "'NfELiROSE, NIA O�;f`"776 Ensure Food Protection (You scored 73% correct). Competent Purchase and Receive Food (Y¢u pcored=73 /e et rrecl) Compaton( ,, n z, �, Food and Supplies Storage (You sordtl 80/q eotrecQ Compgtent�r I ` "yfi � Footls Preparation, Service & Display (You 'scared g4% coirect). `Mastered Equipment & Facilities Maintenance and Cleanliness (You scored 75% correct). Competent Personnel Hygiene, Training and Behaviors Related to Food Safety (You scored 77% correct). Competent Legal Compliance (You scored 100% correct). Mastered ;,ug, '%, Registry of Cood 6arfe yo�fbssio naj$D jj 5728 gr Blvd.$te 750 ,� Orlando FL � p004 � , Phone 407 523830 1 Fax: 407.352.360}. a °„- `$$',(9 ry �eZaa�g VQ` € § 4::.. 'aft ,d ,iia nfa'�t�' -'g I-. `r -?4"' _ t�.° r,�g-r"�.§ �3 c - t SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 HACCP PLAN FOR THE PRODUCTION OF SUSHI RICE TABLE OF CONTENTS Page 1 - Signature Sheet (HACCP cover sheet) Page 2 - HACCP Plan for the Production of Sushi Rice (narrative summary) Page 3 - Flow Diagram for the Production of Sushi Rice Page 4 - HACCP Master Plan Sheet for the Production of Sushi Rice Page 5 - Standard Operating Procedure for pH Measurement Page 6 / 7 - pH Log (master sheet & sample sheet) Page 8 - Summary of Employee Training Elements for the Production of Sushi Rice Page 9 / 10 - Employee Training Log (master sheet & signed sheets) Page I1- Laboratory Results Supplement — Guidelines for the Safe Preparation of Sushi SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 1, Qing Xiong Pang, in the position of owner, initially present and implement this HACCP PLAN FOR THE ACIDIFICATION OF RICE FOR SUSHI. SIGNATURE; Q106 " 1 X10 0 DATE: REVIEW/ REVISION TO SIGNED BY. I DATE This sheet must be signed and dated by a PIC after any reassessment or change to the program or a minimum of once per year. SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 HACCP PLAN FOR THE PRODUCTION OF SUSHI RICE PURPOSE: Cooked rice maintained in the temperature danger zone (41- 140°F) is susceptible to the outgrowth of spore -forming bacteria such as Bacillus cereus. Because the functionality of sushi rice requires its use at room temperature, the rice must be acidified to a pH value below 4.6 to inhibit the growth of these spore -forming bacteria. This HACCP plan addresses proper acidification of rice for room temperature storage and use. RECIPE Equipment: 5 -gallon plastic container for vinegar mixture, measuring cups, rice cooker, shallow container for cooked rice, spoon or paddle to spread rice, rice warmer Ingredients: dry rice, water, vinegar, sugar, salt 1. Combine 3,200 grams of dry rice with 3 liters of water in the rice cooker and cook until done (approximately 30 minutes). One recipe measures approximately 200 cups of cooked rice. 2. A vinegar mixture using 12 liters Fuji Rice Vinegar (4.2% acidity), 4 liters sugar, and 16 ounces of salt is made and stored under refrigeration in a covered, plastic container. Subsamples may be removed from the container and stored at room temperature for usage during the day. 3. Cooked rice (hot) is removed from cooker and placed in a shallow container. Using a spoon or paddle, the rice is spread to a depth of 4 inches or less. 4.32 fluid ounces of vinegar mixture is added to one batch of cooked rice. 5. The mixture is thoroughly stirred to distribute the vinegar mixture and facilitate cooling. 6. The pH is measured immediately according to established procedures. (See: HACCP Master Plan, Standard Operating Procedures for pH Measurement of Sushi Rice, Manufacturer's pH Instruction Manual (Hanna Instruments), Summary of Training Elements for the Production of Sushi Rice) 7. Shelf -life: Same Day Use (maintained at room temperature.) Discard unused rice at the end of the day. 8. The equilibrium pH value of sushi rice, formulated according to the above listed formulation and procedures, was validated by an independent laboratory and found to be 4.1 or less (see attached). Sushi rice acidification shall be verified according to the HACCP Master Plan. 8. This HACCP plan shall be reviewed a minimum of once per year or as needed by the PIC and shall be signed and dated to document this review. (see cover sheet). SUSHI GARDEN 99 NORTH STREET, SALEM, MA 01970 FLOWcDlA`GRA11f'OFTHEPROD'i1C770N�OFSZISHI°RICE Vinegar 4.2%AciditySalt Vinegar Mixture for Sushi Rice Refrigerated Storage of Mixture Sugar Combining of Dry Rice with Cold Water Cooking of Rice (Rice Cooker) Transfer of Rice to a Shallow Container pH Measurement of Slurry ------ - - - - - - I I -- - - - - - - - - - - - - - - - - - - - - - -- pH Value >4.6 I I ------------ PH Value < 4.6 Rice Warmer Holding of Acidified Rice Discarding of Rice at End of Day Acidification of ------------ Cooked Rice I CCP I I Sub -sampling of SOP FORpH MEASUREMENT I I Sushi Rice I Cooling of I Sub -sample i Sample Preparation Calibration of pH (Slurry of Tap Meter Water and Tap Water Sub -sample) pH Measurement of Slurry ------ - - - - - - I I -- - - - - - - - - - - - - - - - - - - - - - -- pH Value >4.6 I I ------------ PH Value < 4.6 Rice Warmer Holding of Acidified Rice Discarding of Rice at End of Day SUSHI GARDEN, 99 NORTH STREET, SALEM, MA 01970 HACCP PLAN MASTER SHEET FOR THE PRODUCTION OF SUSHI RICE Critical Control Point Hazard Controlled Critical Linsit(s) Monitoring Corrective Action Records Verification PRODUCTION Growth of Pathogens pH value of finished What — sushi rice For rice made within 2 pH log 1. Calibration OF SUSHI (spore -formers sushi rice < 4.3 @ 25°C hours, if pH value is greater of pH meter RICE including if measured within 2 How - A calibrated pH than 4.3 and < 4.6, add more Corrective daily prior to Bacillus cereus) hours < 4.6 if tested meter as per Standard vinegar until a value below Action to be use. (Acidification to after 2 hours of Operating Procedures for 4.3 is achieved - Record new recorded on exempt rice as a preparation pH measurement value pH Log 2. Record PHF using a Review by validated Recipe validated at a Freauencv — each batch For rice with a pH value > PIC recipe) targeted pH < 4.1. 4.6, if made greater than Records shall performed Who — sushi chef or one hour from measurement, be daily. designated employee discard rice. maintained for 30 Days 3. pH of rice To prevent recurrence: tested by a Verify use of correct recipe. food Verify proper use of pH laboratory meter, including buffer annually or integrity, electrode integrity, when daily pH and a fully charged battery levels are Verify adherence to SOP for consistently PH measurement. higher than the laboratory validated pH measurement. 4. HACCP plan reviewed a minimum of annually or as needed by PIC (Signed and dated by PIC SUSHI GARDEN, 99 NORTH STREET, SALEM, MA 01970 kmrormation based upon the use of OAKTON PART l - CALIBRATIONPROCEDURE 1. Switch unit on (ON/OFF button). 2. Dip electrode into chosen buffer (pH buffer 4 is suggested). DO NOT immerse above color band. 3. Press the CAL button to enter calibration mode. The "CA" flashes on the display. Then, a pH value close to the buffer value will flash. 4. After at least 30 seconds (about 30 flashes) press the HOLD/CON button to confirm calibration. The display will show "CO" and then switch to the buffer value reading. 5. Press the "CAL" button to exit. 6. Rinse the electrode in tap water. BUFFER NOTE: Make sure buffer has not passed expiration date. Keep the buffer covered and properly stored when not in use. Maintain buffer at room temperature. Keep away from bright light. Do not immerse probe into main container of buffer. Sub -sample buffer. Do not return sub -sample (used) buffer into main container. F2teaspoons ASUREMENT OF SAMPLE oons of finished sushi rice (as per formulation) into a clean container m temperature. of room temperature tap water. 3. Mash the rice and water mixture with a clean spoon until a slung is created. 4. Using a calibrated pH meter (see procedure above), measure the sample by dipping the electrode about 2 to 3 cm into the liquid portion of the slung. Stir and let the reading stabilize. 5. Press HOLD/CON to freeze the reading. This is the equilibrium pH. Record this value on the pH log. (NOTE: The complete record should include the date, time, pH value and initials of the person measuring the pH). 6. Rinse the probe in tap water and blot dry with a clean, dry cloth or paper towel. 7. Turn off the meter and replace the cap on the probe tip. Store properly. NOTE: Refer to Manufacturer's instruction for troubleshooting and replacing the batteries. SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 pH Log / Calibration Log The pH meter shall be calibrated according to established procedures and at a frequency established in the HACCP Master Plan. Follow the Standard Operating Procedure for pH Measurement Date/ Time / Initials for the performance of pH calibration Date Time pH of Sushi Rice Corrective Action (if required) Initials of person taking pH PIC Daily Record Review (Verification) Date / Initials 1 (Is iv l �U NOTES: SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 pH Log / Calibration Log The pH meter shall be calibrated according to established procedures and at a frequency established in the HACCP Master Plan. Follow the Standard Operating Procedure for pHMeasurement Date/ Time / Initials for the performance of pH calibration Date Time pH of Sushi Rice Corrective Action (if required) Initials of person taking pH PIC Daily Record Review (Verification) Date / Initials Iffellocki SUSHIGARDEN 99 NORTH STREET SALEM. MA 01970 SUMMARY OF EMPLOYEE TRAINING ELEMENTS FOR THE PRODUCTION OF SUSHI RICE 1. All employees involved in the production of sushi rice shall be trained in proper personal hygiene including: • proper hand -washing (procedures and frequency) • proper hair restraints, clothing (uniform and/or use of apron) • removal of jewelry during production • proper use of gloves and no bare hand contact of ready -to -eat products 2. All employees involved in the production of sushi rice shall be informed of their responsibility to report to the PIC when they are experiencing symptoms such as nausea, vomiting, diarrhea, fever, sores, or any other symptoms that may affect the safety of food. 3. All employees involved in the production of sushi rice shall be trained in the proper use of applicable food contact surfaces including: • proper cleaning and sanitizing procedures • proper storage procedures of equipment / ingredients • proper handling procedures of equipment / ingredients • proper procedures for preventing cross -contamination • proper use and storage of wiping cloths 4. All employees involved in the production of sushi rice shall be trained on the elements of the HACCP Plan for the Production of Sushi Rice including: • proper cooking procedures • proper formulation of sushi vinegar mixture • proper acidification of sushi rice through cooked rice to vinegar mixture ratio control and mixture distribution • proper sub -sampling procedures of sushi rice for pH measurement • proper preparation of sushi rice for pH measurement • proper storage and use of sushi rice • proper shelf -life of sushi rice 5. All employees involved in the production of sushi rice shall be trained on the Standard Operating Procedure for pH Measurement including: • proper calibration procedures • proper pH measurement of sample • proper handling procedures of buffer / pH meter • proper storage procedures of buffer / pH meter • current HACCP critical limits established in the plan • current HACCP monitoring frequency established in the plan • proper HACCP corrective actions when a deviation for a critical limit occurs • proper HACCP verification procedures / frequency • proper retention of records for 30 days (Refer to the U.S. FDA Food Code or local regulations, as applicable.) SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 EMPLOYEE TRAINING LOG The employees listed below have been properly trained in correct procedures for the production of sushi rice as per the SUMMARY OF EMPLOYEE TRAINING ELEMENTS FOR THE PRODUCTION OF SUSHI RICE (in the HACCP PLAN) EMPLOYEES NAME EMPLOYEE SIGNATURE TRAINING DA TE 0 �ev1 � !� Zfh This sheet must be signed and dated by the employee upon completion of training. SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 EMPLOYEE TRAINING LOG The employees listed below have been properly trained in correct procedures for the production of sushi rice as per the SUMMARY OF EMPLOYEE TRAINING ELEMENTS FOR THE PRODUCTION OF SUSHI RICE (in the HA CCP PLAN) EMPLOYEES NAME EMPLOYEE SIGNATURE TRAINING DATE This sheet must be signed and dated by the employee upon completion of training. FoodsResearch LABORATORIES, INC. 130 NEWMARKET SQUARE - BOSTON, MA 02118 Report Date: November 2, 2010 Lab Code: 10299-19 Date Submitted: 10-26-10 Sushi Garden 99 North Street Salem, MA 01970 SUBJECT: Equilibrium pH Analysis of Sushi Rice validation / verification of established recipe RESULTS pH (@ 250C): 3.95 METHODS: 21CFR114.90 A.O.A.C., 17th edition, 2000. Respectfully submitted, Andrea J. the Laborato Director Over 50 years--DeduatedtoQuaCity andService (617)442-3322 (617) 427-3322 FAX (617)442-2013 SUSHIGARDEN 99 NORTH STREET SALEM, MA 01970 SUPPLEMENT (NOT PART OF HACCP PLAN) GUIDELINES FOR THE SAFE PREPARATION OF SUSHI The HACCP Plan for the production of Sushi Rice shall be followed. (see HACCP plan including Training Elements for the Production of Sushi Rice). Proper records shall be maintained for a minimum of thirty days. 2. All food shall be obtained from an identifiable, approved sourc. All seafood shall come from a source that operates under a HACCP plan. 3. Documentation from fish supplier shall be on file regarding proper freezing of parasitic species of fish. FDA requires that fish be frozen at —4°C for 7 days or at —35°C until solid and stored at -31 °F for 15hours or -4°F for 24 hours in order to ensure parasitic destruction. 4. Proper temperature control of fish and potentially hazardous ingredients during receipt and storage shall be maintained. All potentially hazardous foods shall be received at or below 41'F. Refrigeration units shall operate to ensure food can be maintained at or below 41 °F. Frozen products shall be thawed under refrigeration at or below 41'F. 4. All sushi and related ingredients shall be properly handled as per the "No bare hand contact with ready -to -eat foods" policy established in the Food Code. Sushi chefs shall employ the use of gloves. 5. Cross -contamination shall be prevented through separation of raw and cooked ingredients, cleaning and sanitizing of equipment and utensils between uses, and the proper covering of the bamboo mat. Plastic wrap should be changed at least every four hours or after use on raw fish if the mat is to be used again on cooked product. Ideally, a separate set-up (bamboo mat, knife and cutting board) is suggested for raw versus cooked sushi. 6. Each ingredient should be kept in a separate container and held at proper temperatures. Additionally, ensure that all ingredients and utensils are properly stored in designated locations and protected during storage. 6. Consumer Advisory statements required as per the Food Code 3-603.11 shall be properly posted to advise the consumer of increased risk of foodborne illness due to the consumption of raw fish. A PIC (Person -in -Charge) shall be present during all hours of operation during which sushi is produced. CITY OF SALEM BOARD OF HEALTH Establishment Name: 5075 i CC,rj'90 Date: (aJ16I1O Page: of Item No. Code Reference C - Critical Item R - Red Rem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date. Verified O -P L / !t ;_� CC' 1 S 6v ct U'z c1c))/ _11 (t 1cPiI .`.O( dr C( �P[_S Ge In2QY1 7 lPYv -M o YiQ.0 C� r r7rr �ll tri cl -ll�r �il'1 �o �� cJ%1 Q) j Off) a .max nko l) .'f: I) o rqvvs.5 -PHI 7)t P. UI 01 n41:riC Inn rP 7 11 C-0 (-re r4(=(/. ,=7 `X 0 Pv P a 4Sr viC (�Si h,S vt,'YN� 7Cf .cam rt f�nii.,h 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. /' i -.A \� , 11 1 Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other. Violations Related to Foodborne Illness. Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIMEITEMPERATURE CONTROLS -- Food or Color Additives 3-202A2 Additives* 3-302.14 Protection from Unapproved Additives* 3-50L16(B) 590.004(1-) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.1.1 Separation - Storage* 7-202.11 Restriction -Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizes. Criteria - Chemicals* 7-204.12 Chemicals fru Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS -- Propel' Cooking Temperatures for 3-501.15 PHFs 3-401.11A(i)(2) Eggs- 1557 15 Sec. 3-50L16(B) 590.004(1-) Eggs- Immediate Service 145°F15sec* 3.401.1 1(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155°F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast - 130°F 121 mitt* 3.401.11(A)(2) Ratites, Injected Meats -155'F 15 590.004(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHPs, 27. - Stuffing Containing Fish, Meat, 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 Foods Cooked in a { Microwave 165°F * 3401.11(A)(1)(6) All Other PHFs - 145'F 15 sec. Reheating for Hot Holding 3-403AI(A)&(D) PHFs 165OF 15 sec. * 3403.11(B) Microwave- 165° F 2 Minute Standing Titre* 3-403.11(C) Commercially Processed RTE Food - 140'F* 3403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 Hous and From 7WF to 41°F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made Finat Ambient Temperature Ingredients to 41'F/45'F Within 4 Hours* "' Dema s critical item in the federal 1999 Fax1 Cade a 105 CMR 590.000. m 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45°F Within 4 Hours. 3-501.15 -Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-50L16(B) 590.004(1-) Cold PHFs Maintained at or below 41'/45° F* 3-501.16(A) Hot PHFs Maintained at or above 140°1. * 3-501.16(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance R uiretoem REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA71ONS(HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* $80.E 3-801.11(B) Use of Pasteurized Eggs - *3-801,11(D) FC - 2 3 -801, 11 (D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Food and For Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.I1 Consumer Advisory Posted for Consumption of $80.E j 23. Animal Foods That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and For Protection IFC - 3 pathogens.* F"°`°"` v*rmat 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell _004 Ong-� 26. E 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 ilhtess interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical.. and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 10S CMR 590.000. Hem 1 Good Retail Practices I FC $80.E j 23. { Manatiettuent and Personnel FC - 2 .003 24. Food and For Protection IFC - 3 25. Equipment and Utensils FC - 4 _004 Ong-� 26. Water. Plumbing and Waste ' FC -5 .006 27. - Physical FacilityFG-6 .007 28. Poisonous or Toxic Materials FC _ 7 .008 29. - Special Requirements { ,003 30. I Other s:5fettrt rco CITY OF SALEM BOARD OF HEALTH + Establishment Name: 11�n i GO)r �11 Date: I S I Page: of / Rem Pio. Code Reference C - Critical Item R -Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date -. Verified to � I .� i Q -n OF s f� 6'_H i. A' u o� )- j ow , -,4 to nYl A 7 y - 04 <I k c:,-IcAi±eL rooN ep(-/ II .'s eSf `jos W'Iy" ✓ o sz (cA In 5i karrvf r ta i 5 _ T , CIL+ d ci (t n/l Y CP'r�P ,-5m6) _S I all !f ('Q o i_ �t a_ Vila t V • T I [ r SjicC/. Pfi(- A ( 5e. tP15 r .� o tcdCO tY rrc I _i(6 Ir, '--'3 rerA -j rr)n (i +z) , C. )Ihet.TP 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 twentyive dollars or suspension/revocation of your food permit. / - Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness interventions and Risk Factors (hams 1-2P) (Cant.) PROTECTION FROM CHEMICALS 14 15 16 17 I8 TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.1.1 Separation - Storae* 7-202A I Restriction -Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying encs. 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 Monitorin * TIMEITEMPERATURE CONTROLS * Denotes critical item in the federal 1999 Food Cale or 105 CMR 590.000. 20 3-501.14(C) Proper Cooking Temperatures for 750 t.15 PRFs 5 401.11A(i)(2) Eggs- 155°F 15 See. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145'F15see* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155°F 15 sec. 3401.11(3)(1)(2) Pori, and Beef Roast - 130'F 121 min* 3401.11(A)(2) Ratites, Injected Meats -155'F 15 590.004 H) sec. * 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FG -6 Poultry or Ratites -165'F 15 sec. 3-401.11(C)(3) Whole -muscle, intact Beef Steaks FC-= 7 145'F * 3401.12 Raw Animal Foods Cooked in a Microwave 165F * 3-401.11(A)(1)(b) All Other PHFs -145'F 15 sec. ° Reheating for Hot Holding 3-403AI(A)&(1)) PHFs 165-F 15 sec. * 3-403.11(B) Microwave -965' F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 Hours and From 70'F to 41'F/45'F Within 4 Hours. * 3-501.14(3) Cooling PHFs Made From Ambient - Temperamre Ingredients to 41'F/45'F Within 4 Hours* * Denotes critical item in the federal 1999 Food Cale or 105 CMR 590.000. 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. 750 t.15 Cooling Methods for PHFs 3-801.11(B) PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41.0/45' F* 3-501.16(A) Hot PHFs Maintained at or above l40°F. * 3-501.16(A) Roasts Held at or above 1300F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004 H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (MSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with R arnina Labels* 000 3-801.11(B) Use of Pasteurized Ea s* 'FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 000 23. Animal Foods That are Raw. Undercooked or 'FC -2 _590.7 .003 Not Otherwise Processed to Eliminate Food and Food Protection Patho ns.• ER" "e rn,za i 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Eggs* Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical. and non-critical violations, which do not relate to the foodborne illness interventions and tisk factors listed above, can be found in the following sections_of the Food Code mid 105 CMR 590.000. Item I Good Retail Practices I .FC 000 23. Man lementand Personnel 'FC -2 _590.7 .003 24. Food and Food Protection .004 25. Equipment and Utensils �FC-3 l FC -4 .005 26. Water. Plumbing and Waste • FC -5 .006 27. Physical Facia FG -6 .007 26. Poisonous or Toxic Materials FC-= 7 .008 29. - Special Requirements .009 30. Other s:sxr t.2a F SALEM BOARD OF HEALTH Establishment Name: 41 Date: �� I i IIU Page: Of Item No. Code Reference C - Critical nem R - Red nem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - PLEASE PRINT CLEARLY Date, Vermeil --)-PO !!�� )r wkj fl )�,, / r I (_.F`C a);id U lsh17Ytp c t L EV CF(_ Ch lu -1'l� !h /r , a(,e . CYU I'd CK .A )Ice gback OJ -f-b 1 r U S -I C r v J �1� Icy r o f 0-, e w kj orl 67, C h eC a LA a, 15 `,i _ UNn .) 3tehC. r, OkzrI ill " -o Cn ot flo foe --I' o nr!nQ ce .he-^, FF , `1 eUSe � < 4 IS Pr" coni , el) Iillc, illi -fin lit d)ri Ci I1 vi-),(lnb5 t it 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 s�u-s-�p7ension/revocation of your food permit. e /` Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ElRe-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne !lines& Interventlons and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 17 18 TIMEMEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101..11 Identifying Information - Original Containers* 7-102-11. Common Mame - Working Containers* 7-201.11 Separation - Storage* 7-202.11 .Restriction -Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizes. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce- Criteria* 7-204.14 Drying Agents. Criteria' 7-205.11 Incidental Food Contact, Lubricants* 7-206-11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMEMEMPERATURE CONTROLS * Nnow critical iaem in the federal 1999 Food Cale " 105 CMR 590.000.: 0 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3401.11A(I)(2) Eggs- 155°F 15 Sec. 3-501.16(B) 590.004(F) Eggs- hamediate Service 145'Fl5sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501-16(A) Animals - 155°F 15 sec. * 3401.11(B)(1)(2) Pork and Beef Roast -130°F 121 non* 3.401.11(A)(2) Ratites, Injected Meats -155'F 15 590.004(H) see. * 3-401.1 I(A)(3) Poultry, Wild Game, Stuffed PRFs, 27. - Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165'F 15 sec. 3.401.11(0)(3) Whole -muscle, intact Beef Steaks FC _ 7 145°F *' 3401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401:11(A)(1)(b) All Other PHFs - 145°F IS sec. Reheating for Hot Holding 3-403AI(A)&(1)) PHFs 165°F 15 sec. * 3.403.11(B) Microwave- 1650 F 2 Minute Standing Time* 3-403.11(0) Commercially Processed RTE Food - 140'F* 3403-II(B) Remaining ()nslicedPortions ofBeef Roasts* Proper Cooling of PHF9 3501.14(A) Cowling Cooked PHFs from 140°F to 70°,F Within 2 Hours and From 70'F to 41`F/45'F Within 4 Hours. * 3-501,14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45'F Within 4 Hours* * Nnow critical iaem in the federal 1999 Food Cale " 105 CMR 590.000.: 0 3-501.14(C) PHFs Received at Temperatures According to. Law Cooled to 41'F/45'F Within 4 Hous. 3-501.15 Cooling Methods for PRFs 3-801.11E PHF Not and Cold Holding 3-501.16(B) 590.004(F) Gold PHFs Maintained at or below 41'/45° F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 3-501-16(A) Roasm Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control' 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Wamina Labels* 590590 3-801.11E Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served, * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.I1 Consumer Advisory Posted for Consumption of 590590 23. Animal Foods That are Raw. Undercooked or FC - 2 _003 .I Not Otherwise Processed to Eliminate Food and Food Protection FC -3 Pathogens.' ` .. "'t 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell _005 26. E * SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary• and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Iterns 23-30) Critical.. and tors -critical violations, which do not relate to the - foodborne illness itnerventions and risk factors listed above, can be found in the following sections of the Food Code and 10S CMR 590.000, Hem I Good Retail Practices j FC 590590 23. 1 Man t and Personnel FC - 2 _003 .I 24. Food and Food Protection FC -3 .004 25. _ Equipment and Utensils -i FC -4 _005 26. Water. Plumbingand Waste FC -5 906- 1 27. - Physical Facility FC -6 .007 26. Poisonous or Toxic Materials FC _ 7 008 29. Special Requirements ,009 30. Other 5:,901 a 2ax, JAPANESE APPETIZERS A1. GYOZA............................................................... 3.50 Meat and vegetable dumpling served steam or pan fried A 2. Kani Shumai......................................................... 3.50 Crab meat dumpling served steam or pan hied A3. Edamame.............................................................3.50 Boiled green soybeans, lightly salted A4. Spicy Naruto .......................................................4.50 5 piece o! crabstickdshrimp tobiko, avocado & spicy may. mlkkdd',thinly slice cucumber SALAD SAI. Ika Salad.............................................................. 3.75 Blended squid with seaweed SA2. Avocado Salad ...................................................... 3.75 Avocado salad with flyin Fish roe, cucumber and crabstick in Japanese style mayonnaise SA3. Seaweed Salad ..................................................... 3.75 Fresh seaweed seasoned in sesame SA4. House Salad ..........................................::............4.50 Ika salad with fresh seaweed, garden greens, and crab sticks " SA5. Seaweed Salad ..................................................... 4.50- w. spicy tuna fresh seaweed w. spicy crispy tuna SA6. Seaweed w. Spic Salmon .................................... Fresh seaweed w spicy crispy salmon 4.50 SA7. Seaweed with SpicyHamachi .............................. ; Fresh seaweed with sperispy yellow tail , 4.50 SA7. Side Salad ..........................................*. ............ ...omemade 1.95 Green garden salad with specialgingersauce JAPANESE NOODLE' JR1. Chicken, Beef or Vegtable Udon Soup ................ 7.75 " Thick udon noodle serve in a light fish soup wi , select of meat chicken, beef, or vegetable JR2. Seafood Udon Soup............ ...... o ........ _ ............... 7.95 Thick udon noodle serv6d in a light fish soup with mix seafood KATSU ENTREES All served with soup, salad, White rice Fresh seafood and tender meats dipped in a light bread crumbbatter, and then deep fried to perfection. Your choice of the following E 1. Tonkatsu (Pork) .................................................... 9.95 E 2. Chicken Katsu ......................................................9.95 JAPANESE TERIYAKI Healthy Dishes Fresh tender meats grilled to perfection, then smothered in our own special teriyaki sauce. Your choice of the following: All served with soup, salad, while rice - JT 1. Teriyaki Chicken..........:..:.....................................9.95 IT 2. Teriyaki Beef (New York Sirloin)...........................11.95 VEGETABLE ROLL Asparagus Roll (seaweed outside) ......................... 2.75, Avocado Roll (seaweed outside) ............................ 2.75 Kappa (cucumber) Roll (seaweed outside) ............ AAC Roll (avocado, asparagus, cucumber) ............. 2.75 3.50 Avocado& cream cheese Roll .............................. 2.95 Avocado & cucumber Roll ................................... 2.95 Sweet Potato Roll (tempura sweet potato) ............. 2.75 Vegetable Draggon Roll ......................................... 5.75 Asparagus cucumCrr and yamagoba, topped with avocado, spicy mam and sesame seed V etable Tempura Roll ....................................... .. 3.95 (5p�s) deep fried vleegetable - NARUTO • Wrapped with cucumber outside (NO RICE, diet & healthy sushi) Spicy Yellowtail Naruto .....................................4.75 Spicy Salmon Naruto*......................................... 4.75 SpicyTuna Naruto *............................................. 4.75 California Naruto................................................. 4.75 Eel Lover Naruto (eel & avocado).........................4.75 h. MAKI .' Maki cut in 6pa Hand roll is like ice cream cone shape Add cucumber 50¢ * Add avocado Wit Add flying fish roe 50¢ Price Maki or Hand Roll 4&NiSpicy Salmon Maki k .......4.50 Spicy Yellowtail Maki *. ....4.50 Crab Roll * ........................................................... 3.50 Negihama Maki * (yellowtail with scallion) ............ 3.95 Spicy Scallop Maki *.......................................... 4.50 Salmon Tempura (cucumber, avocado, tobiko)....... 4.50 Mider Maki (soft shell crab tobiko, avocado) ......... 5.95 azy Maki (shrimp tempura tobiko, avocado) ....... 4.50 Spiccyy Tuna Maki* .................................................4.50 Cabfornia Maki (crabstick, cucumber, avocado)..... 3.50 California Maki with Tobiko * .............................. 3.95 Una -Avocado Maki (eel & avocado) ...................... 4.25 Una-Kyu Maki (eel & cucumber) ........................... 4.25 ' Tekka Maki * (tuna roll) ......................................... 3.95 Sake Maki * (salmon roll) ...................................... 3.95 FutoMaki............................................................ 3.95 - P Cucumber, avocado, kam, tamago, spinach, tobiko OW � Boston Maki ......................................................... 4.50 .,, Fbi, cucumber, lettuce, asparagus, mayo and avocado '. ; --.. Philly Maki........................................................... 4.50 -Smokedsalmm, avocado, cream cheese TunaMango Maki * ..............................................4.25 Mango Shrimp Maki ............................................. 3.95 Shrimp with Avocado Maki .................................. 3.95 "'- Shrimp Tempura Maki..........................................4.50 Alaskan Maki (cooked salmon & avocado) ............. 3.95 California Deluxe * (tuna, cucumber, avo, tobiko)..... 4.50 SPECIAL MAKI ' Dragon Maki (cal. maki w. eel, avo. on top) ........... 6.95 ... Rainbow Maki *(kani, ebi, tobiko with fish on top)...... 6.95 Caterpillar Maki (eel, cuc, tobiko w. avo on top).... 6.95 ScorpionMaki ...................................................... 6.95 - - eel, orc., avo, tobhko shrimp on top VolcanoMaki *.................................................... 6.95 Crab Meat avocado, caviar, eel, spicy mayo and Spicy Tuna on Top 51 Crispy Eel Roll ...................................................... 7.75 eel, avocado cucumber, tobko and tempura bits - with mayo. r( Boston Favorite All Substitutions are acceptable with additional charge Consuming raw or under cooked fish, seafood, or meat may increase risk of food borne illness. SUSHI LIST Table Number 2 Pieces Nigiri * Sashimi 3 pieces add $1.50 Item Prices Sushi Sashimi Tamago(egg) ..........................2.95 Maguro (tuna).........................3.50 Sake (salmon) ..............:..........3.50 Hamachi (yellow tail)...............3.50 Suzuki (white ..................3.50 Kanikama (crabb stick) ...............2.95 Ebi (shrimp).............................2.95 Unagi(eel) .............................2.95 Ika (squid)...............................2.95 Tako (octopus).........................2.95 Smoked Salmon .......................2.95 Tobiko (flying fish roe) ..............2.95 Ikura (salmon roe)....................2.95 Uni (sea urchin).......................3.95 White Tuna .............................3.95 Tai(red snapper) ••••• .................2.95 Mackerel (saba).......................2.50 Inari (tofu skin)........................2.50 • SUSHI SASHIMI COMBINATION Served with Miso Soup SU 1. Sushi Regular *...................................................15.00 8 piece of i giri sushi and 6 pieces of tuna roll SU2. Sushi Deluxe * ....................................................18.00 10 pieces of nigii sushi and 6 pieces of tuna roll SU 3. Sushi Super * ...................................................... 20.00 12 pieces of nigiri sushi and 6 pieces of tuna roll SU 4. Chirashi*........................................................... 14.95 Assorted fillets of fish over a bed of rice SU 5. Tekka Don * .......................................................14.95 Tuna fillets of fish over a bed of rice SU 6. Makmono Combination *................................... 12.95 Chef s' choice of 3 rolled sushi, 18 pieces SU7 Salmon Don * .....................................................11.95 Salmon over a bed of rice SU 8. Unagi Don...........................................................9.95 Eel over a bed of rice SU 9. Sushi Vegetarian Platter .....................................13.95 8pes sushi: 4pcs avo 4pc Inari & cream cheese anll Sul 0. Salmon Combo * .................................................. 7.95 3pcs salmon sushi & salmon am roll SU11. Tuna Combo *...................................................... 7.95 3pcs Tuna sushi & tuna cucumber rd1.7.95 SU12. Sashimi Combo * ..................................................9.95 8pcs assorted raw fish SUI 3. Sashimi Regular * ...............................................14.95 15pcsassorte rawfnsh SU14. Sushi and Sashimi Combo * ................................14.95 5pcs assorted sushi, 6pcs assorted raw fish & tali roll ** All Substitutions are acceptable with additional charge** *Consuming raw or under cooked fish, seafood, or meat may increase risk of food borne illness JAPANESE LUNCH SPECIAL 7 days a week 11:30 am - 3:00 pm Except Christmas eve, i Christmas, New Year eve, and New year day , Served with soup and salad ` LSI. Veget arian Maki .................................................. 6.951 8 pieces of assorted vegetable in a big roll LS2. Makimono Combo ............................................... 6.95. Kappa, California, and oshinko maki LS3. Makimono Combo #2 .......................................... 6.95 Spicy salmon and California LS4. Sushi Lunch.......................................................... 6.95 4 pieces of nigiri sushi and 6 pcs of California maki { LS5. Sushi Lunch#2..................................................... 6.95 4 pcs of nigiri sushi and 6 pcs of spicy Duna LS6. Sashimi Lunch ...................................................... 7.95 chefs choice, 7 pcs of assorted fresh fish fillet LS7. Sashimi Salad ....................................................... 6.95 Seaweed salad mixed with assorted vegetables and our fresh fish All Substitutions are acceptable with additional charge *Consuming raw or under cooked fish, seafood, or meat may increase risk of food borne illness t Open Daily Sunday: 12:00 Noon to 9:45 P.M. Monday - Thursday: 11:30 A.M. to 9:45 P.M. Friday - Saturday: 11:30 A.M. to 10:30 P.M. h! Mor 'r ';;;7Apanese Deliverg Availahle All Day Salem - Peabody ($1 Delivery Charge) Take Out & Delivery Please Call Tel: 978-744-9998 / 978-744-9995 99 North Street, Salem, MA 01970 v c v ��a o� CHINESE APPETIZERS CHICKEN MOO SHI STYLE sm Lg CK 1. IF M IRChicken w. Broccoli........... 5.25 8.75 Served with 5 Pancakes to roll up the Moo Shi CA 1. 4 4 Egg Roll..............................1.95 3.75 CK 2. * X N Chicken w. Mix Vegetable.. 5.25 8.75 with house special sauce, CA 2. -)-- 4 4 4 Spring Roll .........................1.95 3.75 CK 3. X Ek IM Chicken w Mushroom....... 5.25 8.75 C extra Pancakes are 2Scent each CA 3. JR M Chicken Wings................... 4.95 7.95 CK 4. 29 A JR Chicken w Snow Peas........ 5.25 8.75 * 5R 1-1 Moo Shi Pork, Chicken, CA 4. 99 4h Chicken Fingers .................4.25 6.95 CK 5. ® 4E S Id Chicken w. String Bean ..... 5.50 9.00 * 4� -MBeef or Vegetable ......................... 7.95 CA S. 1* W Fried Shrimp4.25 7.95 5A WA Moo Shi Shrim 8.25 CK 6. (� � � Spicy Chicken in Garlic Sauce...... 9.25 � p•••••••••••••••••••••••••••• """""e..........••" " CK 7. 116 IN Chicken w. Cashew Nuts .............9.95 CA 6. A * Scallion Pan Cake............... 3.95 7.25 CA 8. At * ChickenTer'ryaki.................4.25 795 CK 8 f�: '� FA """"""""""" Gen Gao Chicken 10.95 EGG F00 YOUNG CA 9. n 6 4t French Fries .......................1.95 3..25 CK 9. ; :-It Mango Chicken .......................... 10.95 41 > W *r Egg Foo Young............................... 6.25 CK10. (42 JX Orange Flavored Chicken .......... 10.95 Choice of Pork, Chicken, Beef, or vegetable .............. CA70. ? 41t Boneless Spareribs............. 4.25 6.95 CK71. X 4 14 Chicken w. Sesame...... 10.95 I WX # T Shrimp Egg Foo Young ..................6.95 CA11. iA kW W Barbecued Spareribs .......... 4.25 7.25 CA72. M !1k Peking Ravioli (steam or Pan fried)...... 6.25 CK12. at Chicken w. Black Bean Sauce ......9.25 CURRIES FROM BOMBAY CA13. JV 14 Crab Rangoon ............................... 6.95 q¢ PU PILI Platter BEEF Savory Curry Sauce, Sauteed with Onions, Green Pepper For one......................................... 8.95 BE 1. * M -T- Beef w. Broccoli ................ 5.25 8.75 f 9Nimm+Chicken or Beef............................ 8.75 BE 2. � X � Beef w. Mixed Vegetable 5.25 8.75 f D -P Wx Shrimp.......................................... 8.95 For Two....................................... 16.95 g Na ^m A >B Tofu with Mixed Vegetable ........... 7.50 BE 3. 3� � Beef w. Mushroom ............5.25 8.75 TIDBITS BE 4. a A -'+� Beef w. Snow Peas ............5.25 8.75 E FRIED RICE BE 5. ® # s 4- Beef w. String Bean ........... 5.50 9.00 Each Substitution $1.00 Extra BE 6. f41i JX --F, Orange Flavored Beef.................10.95 NO ^1 zy 04 Curry Fried Rice ................. 3.95 5.95 T 1. Egg Roll, Chicken Fingers, Chicken Wings ...... 7.25 BE 7. i6 #tom ffi Black Pepper Steak w. Onion ..... . 10.95 Choice of Chicken, beef, pork, vegetable T 2. Spring Roll, Fired Shrimp, Chicken Fingers..... 7.50 M a ti, 11 Pineapple Fried Rice...... 3.50 5.75 T 3. Beef Teriyaki, Boneless Spareribs, PORK 4;. {# ry a House Fried Rice ............. 4.75 6.95 Chicken Wings & Crab Rangoon.................. 8.25 P 1. * M Pit Pork w. Broccoli ............ 5.25 8.75 tiff Steamed White Rice........ 1.00 2.00 T 4. Beef Teri ki Chicken Wins Chicken Finger. """ m � Wings, � P 2. * X FI Pork w. Mixed Vegetable ...5.25 8.75 � 4�t Steamed Brown Rice ......1.00 2.00 T 5. Chicken Teriyaki, Crab Rangoon, Boneless P 3. a irk Al Pork w. Mushroom ............5.25 8.75 E � j tk Sushi Rice ....................... 1.50 2.75 Spareribs, Chicken Fingers ........................... 8.25 P 4. St N. Al Pork w. Snow Peas ............5.25 8.75 KIDS MEAL P 5. ® � A PM1 NOODLES Pork w. String Bean ...........5.50 9.00 No oP 4.95 6.95 Served with One can of Soda SEAFOOD Choice of Chicken, beet, pork, Vegetable and shrimp is additional $1 RM 1. Mini Pork Dumplings w. Chicken SE 1. * M #2 Shrimp w. Broccoli ........... 5.50 9.00 0 tX to Mein ............................. 4.25 6.50 Wings, French Fries......................................... 5.00 SE 2. 0 3Fe C Shrimp w Mixed Vegetable 5.25 8.75 choice of chicken, beef, pork Vegetable RM 2. Chicken Fingers, Chicken Wings, SE 3. � 3i; Shrimp w Mushroom ....... 5.25 8.75 and shrimp is additional I French Fries .................... ............... 5.00 SE 4. s Shrimp w Snow Peas ........5.25 8.75 Xt 49 om Chow Mein ........................ 3.75 5.95 ••••••••••••••••• P Choice of Chicken, beef, pork, Vegetable RM 3. Crab Rangoons, Boneless Spareribs, SE 7. ® * A Q Shrimp w. String Bean ...... 5.70 9.25 and shrimp is additional gt French Fries................................................... 5.00 SE 8. P11 WR N Lobster Sauce ................... 4.25 6.50 ? ? ? Subgum Chow Mein .......... 3.75 5.95 SE 9. tR JM N Shrimp w. Lobster Sauce .............. 6.25 Choice of chicken, beef, pork Vegetable SE10. � � >� Mango Shrimp 10.95 and shrimp is additional 1 SOUP • g p ""."""rlic """uce." .. Xno-*ryM Chicago Chow Mein.......... 3.75 5.95 SE71. ( Spicy Shrimp in Garlic Sauce........ 9.25 Choice of Chicken, beef, pork, Vegetable Sm Lg SE12. A a M Shrimp w Black Bean Sauce......... 9.25 and shrimp is additional g1 S 1. ;ti V-3w S* Mini Dumpling Soup ......... 2.50 4.00 I *•44 0 0 House Lo Mein ..................5.25 7.95 S 2. Tr Te Egg Drop Soup ................. 1.95 3.75 VEGETABLES (4L ® PwPadThai ....................................... 7.95 S 3. :$ WOnton Soup ....................l.95 3.75 Choice of Chicken, beef, pork, Vegetable VE 1. kJ' ei� X Mixed Vegetable ............... 4.50 6.50 and shrimp is additional $I) S 4. CFA ;9 Hot and Sour Soup ...........1.95 3.75 VE 2. 1zP.s.>f B+X Tofu with Mixed Vegetable ........... 7.50 'Thai Bat noodle work-vied with choice of S 5. Its 0a Chicken Noodle soup ........1.95 3.75 VE 3. Pk * M Broccoli with Brown Sauce.. 4.50 6.50 S meat, egg, , peanuts, egg & bean sprouts S 6. fik Chicken Rice Sou 1.95 3.75 =� Sa Shia Chicken Lo Mein ............. 7.95 P ......•••••• VE 4. CA -* 3,5 + Egg plant in Gallic Sauce.............. 8.50 Sliced chicken pea pods, mushroom S 7. 0* ^N ;* Miso Soup .........................1.95 3.75 VE 5. ® * A Dry Sauteed String Bean w. Tofu ..... 8.50 & bambcoshoot work tossed in a Chinese S 8. ;*W%49=* Seafood Miso Soup ........... 3.95 6.95 bbq sauce & to mafood ein STEAMED HEALTHY DISH f ° IX shrimp & Scallops .. Noodles w. 8.25 MANDARIN DISHES Special Sauce on the Side ( * iii Singapore Rice Noodle................. 7.50 M 1. f ® Al )IR Szechuan Spicy Chicken .............. 8.50 ST 1, s* Xt3t *-N Steamed Chicken w. Mixed Veg.... 8.25 wok tried shrimps, pork, and chicken, M 2.(E9 Al 4r- Szechuan Spicy Beef..................... 8.50 ST 2. -3t 39 X Steamed Mixed Vegetable............. 9.95 thin rice noodle with curry sauce M 3. f ® Al C Szechuan Spicy Shrimp................. 8.50 ST 3. :*3k4-'r Steamed lumbo Shrimp w. Mixed Veg.. 9.95 LO MEIN COMBINATION M 4. f'9 il+* I Kung Pao Chicken ........................ 8.50 ST 4. �*X* JM Steamed Chicken w. Broccoli ...... 9.95 M 5. f'8' t* -'I� Kung Pao Beef ............................... 8.50 ST S. s*Xt%rM'Rr Steamed Shrimp w. Broccoli......... 9.95 A. Chicken wings, Boneless Spareribs, M 6. C'g' t* Wx KungPao Shrimp 8.50 Crab Rangoon, Shrimp Lo Mein ................... 7.95 P""""""'""'""""' " E B. Beef Teriyaki, Chicken Fingers, Crab M 7. f m Al A M Szechuan Spicy Tofu .................... 7.50 SWEET & SOUR Rangoon, Pork to Mein ................................ 7.95 All Items in Menu Subject 7% Mass Meal Tax €0 99 19 Sweet & Sour Chicken ................. 7.95 C. Chicken Wings, Boneless Spareribs, Not Responsible for Lost Articles. W Ek t9 Sweet & Sour Shrimp ................... 8.95 Crab Rangoon, Chicken Lo Mein ................. 7.95 1I HOUSE SPECIALTIES H 1. 9#ft-AMP1 Sweet& Sour Pineapple Chicken..9.95 All white chicken meat onion, green, pepper & pineapple in a light sweet &sour stir fry H 2. 1-: 31€ i Chicken Lettuce Cup ...................6.95 Stir fried chicken and diced green bean, mushrooms, served with lettuce on the side with house special sauce H 3.3 V tg # Kung Pao Three Delights ............10.95 Shrimp, chicken, beef sauteed with peanuts in hot spicy sauce. H 4. 3i; 19 %r Moo Goo Gai Pan ......................13.95 Sliced Chicken meat with white mushroom, pea pods & choice of Chinese vegetable H 5. 4dE Jumbo Shrimp w. Walnuts .......... 14.95 Crispy jumbo shrimp in creamy sauce. a Must Try. H 6. *-4% House Special Crispy Chicken ...10.95 Crispy fried sliced of chicken work tossed with ginger & garlic in a spicy sweet & sour sauce. H 7. Yu - Hsiang String Bean ...............7.95 Fresh String Bean, minced pork red bell peppers & scallion stir fried in a tangy garlic sauce CHINESE LUNCH MENU All dishes served with choice of ONE appetizer, and one can of soda: Add an appetizer from below for an additional $1, two appetizers max.(Lunch Time Only) Egg roll, Chicken Wing, Chicken Fingers, Beef Teriyaki, Boneless Spareribs, Crab Rangoon, Chicken Teriyaki, Spring Roll Choice of Pork Fried Rice or White rice or brown rice. (7 days a week 11:30 am - 3:00 pm Except Christmas eve, Christmas, New Year eve, and New year day) All Special after 3:00 pm, Extra $2.50 Choice of Chicken, pork, beef, vegetable, and shrimp is additional $1 1. I s"Yi=FW" Lo Mein, Chicken or Beef ............ 5.95 2. 1Z-L--F-9y'N Chow Mein, Chicken or Beef....... 5.95 3. faro^XW`i--t� Curry, Chicken or Beef ...............5.95 4. 4& 4A tRWalnut Shrimp.............................6.95 5. 9 *. et2 Cashew Shrimp with Pineapple ...6.95 6. W Ag N Lobster Sauce with Shrimp .......... 6.25 7.(.Y _^-- IM General Gau's Chicken................6.25 8. *MA4= Beef or Chicken with Broccoli ....5.95 9. XA4 Mixed Vegetable, Chicken or Beef.. 5.95 0. c .9 99 Chicken with Sesame ..................6.25 1. . ii* t'f-Moo Goo Gai Pan ......................5.95 2. f421 1N0L-T- Orange Flavored Beef or Chicken....6.25 3. 1-1 r9 & Pork Fried Rice with 2 Appetizer Choices ............6.25 4. 3E91110Li-t� Szechuan Spiced Chicken or Beef 5.95 f Hoot N til ic�� s . Permit Type - Permit No. ..,Permit Issued '.-Permit Expires - Fee Restrictions / Notes FOOD SERVICE BHP -2013-0001 Jan`1, 2013 -Dec 31, 2013 $140.00 ; I '1, CITY OF SALEM, wWASSACHUSETTS ■ ECEIVE1�Ov,111IINGTON SOARD OF HII L'111 e�4"'FLOOR. KIMBERLEY DRISCOLL y p12 Ti a1- (978) 741-1800 F kN (978) 745-0343 MAYOR 101 Z I Iramdin(a)salem.com CITY OFF 6��LTIr1 V PublicHeatth LARRY RAM1)1N, ILS/R1:I IS, (1110, CP -FS H I., ALT1 j AGENT BOAAfood Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: a 2) Establishment Address: Q{� f P19 O 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: 978- Z'j�� 7 `— l G L C�O/Q 8 5) Applicant Name & Title: e ( Q 6) Applicant Address Y3 �u �d� �Ve pp A p� lo+�(�p&•�1(r`f &W1, CA .d pOc 1 7) Applicant Telephone No: ( —982 `3f 99 24 Hour Emergency No: 6 -M—Ikl Emaillp�l E/Od l 'rill 1 8) Owner Name & Title (if different from applicant):J� e A dC iY0�1E 9) Owner Address (if different from applicant): 10) Establishment Owned by: � n association •V A corporation An individual A partnership Other legal entity 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Title Home Address �7I, @! Je4 t?VI Z46 " i �l�, IOB D/ 12 Person Directly Responsible FFor Dailyy0 eer�ations Person in CCharge, Supervisor, Manager, etc. Name & Title: gweer, //'e '� I bu l g+�. of Address: g2� I .0�n eloo ` , �1D%1 MA Telephone No: �Hw —� O o Fax: b - OOpp -J 0— U Email: 8 — a rt` Emergency Telephone No: np 13) District or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: Fax: Email: Check #: L/ Date: Amount: O] "I Food Establishment Information 14) Water Source:ly J 15) Sewage Disposal: CJ No: DEP Public Water Supp applliJicable) 16) Days and Hours of Operation: 0 J Cl, !Af}1 1`JD 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti -Choking Procedures ( if 25 seats or more): ❑ Yes I 20) Location: 22) Establishment Type (check all that apply) (check one) O.Retail ( Sq. Ft) O Caterer O Frozen Dessert Manufacturer Permanent Structure Food Service -( a Seats) Mobile Food Service - Takeout O Residential Kitchen for Retail Sale O Food Service - Institution O Residential Kitchen for Bed and Meals/Day) Breakfast Home Food Delivery O Residential Kitchen for Bed and --.--AIL.--T-----E- ------------ RETAIL STORE Breakfast Establishments ------------------------ RESTAURANT 21 Length Of Permit: ) g // (check one) O Less than 1000sq.ft. $ 70 ess than 25 seats $140 1�/Seaso O 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 Seasonal/Dates: O More than 10,000sq.ft. $420 O 25-99 seats $280 O More than 99 seats - $420 --- -- --- --- -- --- -- ---- - --- - ---- - - - ❑ Bed & Breakfast/Childcare Seryices /Nursing Home $100 Temporary/Dates/Time: -------------- ---------------------------------------- ------------ ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE ------------------------------------------------------- $25 O PASTURIZATION $25 ❑ TOBACCO VENDOR $135 ❑ ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare & private clubs) 23) Food Operations: Definitions: PHF -potentially hazardous food(time/temperature controls required) Non-PHFs - non -potentially hazardous food (no time/temperature controls required) Check all that apply): RTE - ready -to -eat foods (Ex. sandwiches, salads, muffins which need no further processing Sale of Commercially PHF Cooked, to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs V for More Than a Single Meal Service V Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill V/ Prepared by Consumer Reheating of Commercially Customer Self -Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service Within 4 hours contact alternative, time �s public health control. V Customer Self -Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only V Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in i3ulk Quantities ' To be completed by the Board of Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1, the undersigned, attest to the accur comply with 105 CMR 590.000 and all 590.000 and the Federal Food Code. 24) Signature of Applicant: of the information provided in this application and I affirm that the food establishment operation will 31 applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR Pursuant to MGL Ch. 62C, sec. 49A, I Have filed all state tax returns and pz 25) Social Security Number or Federal ID: under the penalties of perjury that I, to my best knowledge and belief, taxes required under law. Iz�-3�8�a�3 26) Signature of Individual or Corporate Name: (a j�c Lay ba SALEM BOARD OF HEALTH Establishment Name: S,> Date: -1 -til Page: of Rem No. Code Reference C - Critical Item R - Red Rem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date - Verified `La P ir� ss ) to (l T \1_rLAC tom. �' �,v• � �i Y 1 Cl, -1 ��, L v� 1 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to 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 at as ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion LlRe-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne fitness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 71ME(TEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives*' 3-302.14 Protection from Unapproved Additives" 3-501.16(B) 590.004(M Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Storage* 7-202.11 . Restriction -Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Cdteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* 71ME(TEMPERATURE CONTROLS * Denotes critical item in the federal 1999 Foci Cale a' 105 CMR 590.000. mm - 20 3-501,t4(C) Proper Cooking Temperatures for 3-501,15 PHF9 3-401.11A(1)(2) _ Eggs- 155°F 15 Sec. 3-501.16(B) 590.004(M Eggs- Immediate Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3501.16(A) Animals - 155°F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast - 130'F 121 min* 3401.11(&)(2) Ratites, Injected Meats --155'F 15 590.004 H) sec. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, A4eat, FC -6 Poultry or Ratites -165°F 1.5 sec. 3401.11('C)(3) Whole -muscle, Intact Beef Steaks i FC - 7 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401:11(A)(1)(b) All Other PHPs -145°F 15 sec. ° Reheating for Hot Holding 3403AI(A)&(D) PHFs 165°F 15 sec. * 3-403.11(B) Microwave -965' F 2 Minute Standing Time* 3-403.11(0) Commercially Processed RTEFood- 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and From 70'F to 41'F/45'F Within 4 Hours. * 3-501.14(B) Cooling PRFs Made From Ambient Temperature Ingredients to 41'F/45°F Within 4 Homs* * Denotes critical item in the federal 1999 Foci Cale a' 105 CMR 590.000. mm - 20 3-501,t4(C) PHFsReceived atTemperatures According to Law Cooled to 41°F/45°F Within 4 Hours. 3-501,15 Cooling Methods for PHFs 3-801.11(BL PHF Hot and Cold Holding 3-501.16(B) 590.004(M Cold PHFs Maintained at or below 41,0/450 F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 3501.16(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004 H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged luices and Beverages with Warning Labels* 690.0QD 3-801.11(BL Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Food and Food Protection 3-801-II(C) Unopened Food PackaW. Not Re -served. " CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 690.0QD 23. Animal Foods That are Raw, Undercooked or FC - 2 .003 .I Not Otherwise Processed to Eliminate Food and Food Protection FC- 3 Pathogens.* E"°`"°° a"za"i 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. 1 E s* 590.009(A) -(D) I Violations of Section catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical, and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, tribe found in the following sectionsofthe Food Code and 105 CMR 590.000. Rem Good Retail Practices .FC 690.0QD 23. Manatioment and Personnel FC - 2 .003 .I 24. Food and Food Protection FC- 3 .004 25. E ui mem and Utensils FC -4 .005 26. Water. Plumbing and Waste ' FC -5 .006 27. Physical Facility FC -6 .007 28. Poisonous or Toxic Matariats i FC - 7 .008 29. Special Requirements .003 30. Other .,- sacro.mm�tr x ax. Commonwealth of Massachusetts ' r City of Salem Board of Health Kimberiey Driscoll 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 06/16/2011 ESTABLISHMENT NAME: File Number: BHF -2010-000065 LOCATED AT: Sushi Garden/Wenwell Lucky, Inc. 99 North Street SALEM MA 01970 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2011-0475 Jun 16, 2011 Dec 31, 2011 $140.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $140.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM BOARD OF HEALTH Establishment Name: S-'tC'1 }) _OAC27 l -k Date: („ - 2,1) Page: I of Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Veritied C1 -)i 6jt'r. OF- ova 61 (1 ) t� �'GO'� 11 G'+ (oda-1 J ii t'i� t lam, '-G{...l.C\W`�t �L t�k31�-}�• -r 1 ( r�v� 1T 11-r,n F'Wvj oJS V NI . n `b(v - f�ll With Person in Charge: this report, have had the opportunity to ask questions and agree to correct all efore the next inspection, to observe ail conditions as described, and to h all mandates of the Mass/Federal Food Code. I understa Iii at nce may result in daily fines of twent�a d�rs_or u� evocation of Fnoncompliance ermit. 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 111ness Interventions and Risk Factors(ltems 1-22) (Cont) lm 2 Foodves* Color Additives 3-202.1 Additives' 3-302.14 _ Protection from Un roved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 identif}inglnformation- Original Containers* 7-102.11. Comman Name - Working Containers* 7-201.11 Separation - Storage* 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Samrizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 05.11 Incidental Food Contact. Lubricants* 06.11 Restricted Use Pesticides, Criteria* 06.12 P Rodent Bait Stations* 06.13 Tracking Powders, Pest Control and Monitarin * IN law 18 Dem)v% critical heern in the f de-ral 1999 Foal Cade 01 105 CMR M.OK m 3-501.1.4(0 Proper Cooking Temperatures for 3-50 t. 15 PHFs 3-401.11A(l)(2) Eggs- 155°F 15 See. 3-501.16(B) 590.004(F) Eg - immediate Service 145'Fi5see* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-.501.16(Al .Animals - 155'F 15 sec. " 3-401.11(11)(1)(2) Pork and Beef Roast -130'F121 min* 3-40IJ I(A)(2) Ratites, injected Meats - 155`F 15 590.004(H) sec. * 3.401.1 t(A)(3) Poultry, Wild Game, Stuffed PHFs, i 27. Stuffing Containing Raft, Meat, FC -6 Poultry or Ratites -1650F t.5 sec. 3-401_11(C)(3) Whole-muscle,Intact Beef Steaks FC-- 7 145°F * 3-401.12 Raw Animal Farris Cooked in a Microwave 165'F * 3-401 I UM(1)(b) All Other PHFs -- 145°F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165F 15 sec. * 3-403.11(B) Microwave- 165` F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 700F Within 2 Hours and From 70`F to 41'F/45'F Within 4 Hours. 3-501.14(B) Cooling PHFs Made FromAmbient Temperature Ingredients to 41'Ff456F Within 4 Hours* Dem)v% critical heern in the f de-ral 1999 Foal Cade 01 105 CMR M.OK m 3-501.1.4(0 PHFs Received at Temperatures - .According to Law Cooled to 41'13/4537 Within 4 Hours. 3-50 t. 15 Cooling Methods for PHFs _ PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PRFs Maintamed at or below 410745" F* 3-501.16(A) Hot PRFs Maintained at or above 140°F. * 3-.501.16(Al Roasts Heid at or above 130'F. 125. Time as a Public HMO Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Re nirement REQUIREMENTS FOR HIGHLY SUSCEF`TIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and Beverages with WantingLabels* _ 590.0w j a" -801.11(B) Use of Pasteurized Eggs* '- FC -2 3-801.11(D) Raw or Partially Cooked Animal FoW and Raw Seed Sprouts Not Served. * j Food and Food Protectioni 3-801.11 C Unopened Food Package Not Re -served. ^` CONSUMER ADVISORY 22 3-603.11Consumer Advisory Posted fru Consumption of 590.0w j 23. Animal Foods That are Raw. Undercooked or '- FC -2 .003 Not Otherwise Processed to Eliminate j Food and Food Protectioni FC - 3 Patbo*ens.*`p"'" 0 n 125. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Eggs* lii�+tsllil�iisl�ilf C•^] 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. (Itettts 23-30) Criticaland non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, carr be found in the following sectionsof the Food Code and 105 CMR 590.000. it Nemi Good Retail Practices FC 590.0w j 23. Ma anent and Personnel '- FC -2 .003 4. j Food and Food Protectioni FC - 3 .004 125. 1 Equipment and Utensils FC - 4 .005 26. Water. Plumunqand Waste _! FC -5 .006 i 27. 1-PhYslcai Factiity FC -6 .007 26. ' Poisonous or Toxic Materials FC-- 7 .008 X26. SpecW Requirements ' 30 ! Other CITY OF SALEM BOARD OF HEALTH Date: June 15, 2011 Name of Establishment: Sushi Garden Address: 99 North Street Owner: Peng Xu Phone: 978-744-9998 The proposed new owner of this establishment Peng Xu presented a Floor Plan and Menu for review in accordance with the State Food Code. Both are approved as presented. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. A "Person in Charge" or "PIC' must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. Please forward copies of all Certificates to the Board of Health FLOOR PLAN A Hand Sink must be located in each food prep and service area. The hand sink must have a wall hung soap and paper towel dispenser. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes any storage of these items in the basement. Storage must be at least 6 inches off the floor. A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes are available. There will be no food prep in the back storage area. If food prep is to be done in this area a hand wash sink will need to be added. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. Fruits and vegetables must be washed prior to preparation. All food must be held at 41 °F or lower, or 140°F or higher, at all times. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready -to -eat foods. Gloves, tongs, or tissues must be used when handling such food. CONSUMER ADVISORIES The consumer advisory regarding the consumption of raw or under cooked foods is posted on the menu. The new Allergen Awareness information was given to the owner. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3rtl bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. These must be clearly marked "sanitizer". Outside area of premises, including the dumpster area must be kept clean and sanitary. TRASH Trash will be held in an outside dumpster. A grease barrel will be located in the same area. The dumpster must remain closed and the area must be kept clean. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. An application a check have been received. David Greenbaum Date Senior Sanitarian a y:. Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvoe of Operationfsl Tvoe of Inspection Food and Food Protection -i ❑Food Service ❑ Retail [� E1aGine ❑ Re -inspection Address 26. Risk (FC=5)(590.006) Level ❑ Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone Ci n (� b [ITemporary ElPro-operation❑ Owner HACCP YM Caterer ❑ Bed & Breakfast ❑Suspect Illness ❑ General Complaint Person In Charge (PIC) Time v In:ElHACCP Inspector 0, Out Permit No. ❑ Other Each violation checked requite§ an explanation on the narrative page(s) and a citation of specific provision(s) violated. C 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) b� 590.009 (F) [a action as determined by the Board of Health.' rFOOf) PROTECTION MANAGEMENT -� i ❑ 12. Prevention of Contamination from Hands I o ❑ 1. PIC Assigned/ Knowledgeable / Duties _ _, 13. Handwash Facilities j EMPLOYEE HEALTH ' LPROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ° CH ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded - �. 1,F000 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 I PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [:110. 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. IT1 . 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils t (FC -4)(590.005) 26. Water, Plumbing and Waste (FC=5)(590.006) Z7. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S 5WIns,Fo � \ cam- ❑ 15. Toxic Chemicals Ej-E/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures 4 ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)! ❑ 21. Food and Food Preparation for HSP .__.._ .. CONSUMER ADVISORY; _ ❑ 22. Posting of Consumer Advisories I 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 aggriev d by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: b _ a q -C Inspector's Signature: Print: G Page -A of__�kges PIC's Signature: Print: kelbe,04011 6d�-t hc- Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(AjAssn tment of Responsibility* . 590.003(B) Demonstration of Knowledge* 2-103.11. Person in chargee - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and _ 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Char>e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(F,) Removal of Exclusions and Restrict ons [i© C C I FOOD FROM APPROVED SOURCE * Denotes critical nem in the Federal 1999 Food Cale or 105 CMR 590.000. FUM PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermeticall • Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101..11 Drinking Water from an Approved System* 590.006(A) Bottled Drinkin Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Shellfish and Fish From an Approved Source 3-201.1.4 Fish and Reereadonally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Proper; Adequate Handwasning Game and Wild Mushrooms Approved by Regulatofy Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrwms* 3-201.17 Game Animals* 2-301.14 _ Receiving/Condition 3-202.11. PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11. Food Safe and Unadulterated TagstRecords: Shellstock 3-202.18 Shellstock Identification 3-203.1.2 Shellstock Identification Maintained* 12 Tags/Records:'Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(7) Labeling of.ingredients° Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Metbods* 3--502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical nem in the Federal 1999 Food Cale or 105 CMR 590.000. FUM PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(1) Raw Animal. Foods Separated from Cooked and RTE Foods* 4-501.111 Contamination from Raw Ingredients 3-302.11(A)(2) Raw Aminal Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Tem eratures* 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* 4-602.11 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3-701.1'1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501.114 Chemical Sanitization- temp.; pH, concentration and hardness. * 4-601._11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot. Water and Chemical* 10 Proper; Adequate Handwasning 2-301.11 Clean Condition -Hands and Arms* 2-301..1.2 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11. Eating, Drinking or Using Tobacco* 2-401.'1.2 . Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from. Employees* 13 Handwash Facilities Conveniently Located and Accessible 5.203.11 Numbers and Capacities* 5-204.11 _ Location and Placement* 5-205.11 Accessibility, Operation and _Maintenance Supplied with Soap and Hand Drying Devices 6-301.1E Handwasbing Cleanser, Availability 6-301.1.2 HandD 'ngProvision aI\A BOARD OF HEALTH Establishment Name: � U / -AV 2, -,an X GnA. DateA0-- ILI .,0 F SALEM Page: 9— of -a Item No. Code Reference C - Critical itemDESCRIPTION R -Red Item OF VIOLATION / PLAN OF CORRECTION r)/! � y _ PLEASE PRINT LEARLV Date - Verified j2n Al a ViasAan2,4\9'v IVA:_ nzv `y49 0 Ah AV Ct�.-�3 i\At, '_SJR "I PL- '1 4 ._ 7 t S' ) l i r'� inn .3 buy -A- yea, + - _ - A f� . 4-10 U - OA IJ O�IAS J Discussion With Person in Charge:0 11 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 Cod . I understand that noncompliance may result in daily fines of twenty-f've-cl - to s or sus ensiQn revocation of your food permit. �I Corrective Action Required: ❑ No Yes Voluntary Compliance ❑ Employee Restriction / Exclusion e -inspection Scheduled ❑ Emergency Suspension :0 �I Embargo Li Emergency Closure 0 Voluntary Disposal ❑ Other: Viotaslons Rebated to Foodborne Illness Interventions and Risk Factors {Items }-22) (Gant.) im Food or Gator Additives 3-202.12 Additives* ~_....__ 3-302.14 Protection from Una roved .kdditives" 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.1 I Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Storad; 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 'Tonic Containers - Prohibitions* 7-204.11. Sanitize". Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14in eats. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stan -s* 7-206.13 Tracking Powders, Pest Control and Momuxin * lam M -notal critical mm in tate federal 1999 Foal Craft or 105 CNIR 590.000. 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs _ 3401.IIA(l)(2) Eggs- i5S''F 15 Sec. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145'Fl5sw 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155'F 15 sec. * 3-40IJI(B)(l)(2) Pork and Beef Roast -130'F121 min* 3-401.11(A)(2) Ratites, Injected Meats - 155`F 15 590.004(H) see. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, ' Phvstcal Facilitv Stuffing Containing Fish, Meat. 007 Poultry or Ratites-16YF 1.5 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks .008 j 145OF r. 3401.12 Raw Animal Foods Cooked in a .009 Microwave 165'F * 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) Plilas 165'F 15 sec. * 3-403.11(B) Microwave- 165= F 2 Minute Standing Time* 3403.11(C) Commercially Processed RTE Food - 140°F"' 1 3403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked Piers from 140`F to 70`F Within 2 Hours and From 70'F to 4I`F145'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45 -F Within 4 Hours* M -notal critical mm in tate federal 1999 Foal Craft or 105 CNIR 590.000. 3-501.14(C) PHFs Received at Temperatures According to l aw Cooled to 41'r145°F Within 4 Hoots. *_ 3-501.15 Cooling Methods for PHFs 3-801,11(B) PHP Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41°145°F* 3-50L16(A) Hot PHFsMaintained atorabove 140T. * 3-501.16(A) Roasts Held at or above 130'F. ° 1 Equipment and Utensi}s Time as a Public Health Control 3-501.19 Time as a Public Health Contrci 590.004(H) Variance Require 21 3-801.11(A) Unpasteurized Pre-packaged Iuiees and Beverages with Warning labels" 23_ 3-801,11(B) _ Use of_PasteuritedEm* 003 3-801.11(D) Raw or Partially Cooked Animal Food and Ran Seed Sprains Not Served. * FC - 3 3-801.11 LQ Unopened Food Package Not Re -served. 22 3-603.11 Consumer Advisory Posted for Consumption of 23_ i i,AanaSlement and Personnel Animal Foods That are Raw. Undercooked or 003 1 R. Not Otherwise-Proecssed to Eliminate FC - 3 .004 Pathogens.* tYkenveli;lAfl 1 Equipment and Utensi}s 3-302.13 Pasteurised Eggs Substitute for Raw Shell ! 26. _ 1 Water. Piurnbinq and Waste' E * 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness inden entians 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 1 .FC T9Dxw 23_ i i,AanaSlement and Personnel FC -2 003 1 R. 1 Food and Food Pratactson FC - 3 .004 25. 1 Equipment and Utensi}s (FC - 4 .005 ! 26. _ 1 Water. Piurnbinq and Waste' FC -5 .006 27. ' Phvstcal Facilitv FC16 007 128. Polsoncus or Toxic Materials ' FC - 7 .008 j 23S�eciat Requirements i .009 ' 30 I Other Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name -. k5 t1- d /� � cv_ -D ci l Date I'2__ I- It Tvoe of Ooeration(s) ❑Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile El Caterer ❑ Bed & Breakfast Permit No. Tvoe of Inspection . ❑ Routine ❑ Re-inspection Previous Inspection Date: i�Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address q o o e ,- �� Risk Level c Telephone 9-7 S _7 _ 1 9 q <� Owner V _ L1 HACC M❑ Person in Charge (PIC) S E`' 2 NES Time In: y:2t6_ Out: Inspector (_ p i Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. .:FOOD PROTECTION MANAGEMENTii C] 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 NI 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. 5901Wp Fa 14Ao ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities (PROTECTION FROM CHEMICALS " ' 4 � - •*+� ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals I. TIMW I EMPERATU_RE CONTROLS (Potentially Hazardous Fooda) ..j [116. Cooking Temperatures ❑ 17. Reheating ❑ 16. 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 ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: [..1 Print: L.AiLiL h1 n I k-:, PIC's Signature: Print: ✓ l Page -L orZ Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A)Assigumem of Responsibility* 590.003(B) Demsm , tion 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* tem* 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 11M C LE I FOOD FROM APPROVED SOURCE *Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. C PRnTFCTInN FRAM CnNTAU1K1ATIn1J Food and Water From Regulated Sources 590.004(A -B) Compliance with Food law* 3-201.12 Foal in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.33 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.1.1 Drinking Water from an Approved System* tem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0" Frequency of Sanitization of Utensilsand Food Contact Surfaces of Equipment" ShelBish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Iisted Sources* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authork 3-202.18 Shellsto ck Identification Present* 590.004(C) Wild Mushrooms* 3-201..1.7 Game Animals* 2-301.14 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Sheiistock 3-202.18 Shellstock Identification * 3-203.12 Sheltstock Identification Maintained* 12 Tags/Records:Fish Products 3402.11 Parasite Destruction* 3402.12 Records, Creation and Retention* 590.004(1) Labeling of Ingredients* Handwash Facilities Conformance with Approved Procedures /HACCP Plans " 3-502.11 S cialized Processin Methods* 3-502.12 Reduced oxygen packaging. criteria* 8-103.12 Conformance with. Approved Procedures* *Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. C PRnTFCTInN FRAM CnNTAU1K1ATIn1J 9 Cross -contamination 3-302.11(A)0) Raw Animal Foods Separated from Cooked and RTE Fads* 4-501.1.11 Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Temperatures* Contamination from the Environment 3-302.11(A) Food Protection* " 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* ' 4602.11 Contamination from the Consumer 3-306.14(A)(. Returned Food and Reservice of Food* Frequency of Sanitization of Utensilsand Food Contact Surfaces of Equipment" Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.1.11 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_ I I(A) Equipment Food Contact Surfaces and Utensils Clean* 4602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* - 4-702.11. Frequency of Sanitization of Utensilsand Food Contact Surfaces of Equipment" 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401..11. Eating, Drinking or Using Tobacco* 2401.1.2 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(F,) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 " Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Hand waZing Cleanser,.Availabilit y 6-3D1.1.2 Hand D 'n Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: D C=� Date: 12 —1 — I I Page: Z of Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified 9-1 T a •¢_ 'LCl Vim. C4 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 lOnesa Interventions and Risk Factors (Items 1-221 (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIMETIEMPERATURE CONTROLS Food or Color Additives - 3-202.12 Additives*' 3-302.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers* 7-102.11, Common Name - Working Containers* 7201.11 Separation -Stora * - 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers.Critetia- Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 - Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMETIEMPERATURE CONTROLS * 0.notn critical item in the federal 1999 Food Cale a,105 CMR 590 0. EMM C 3-501.14(C) Proper Cooking Temperatures for 3-501'.15 PHFs 3-401.11A(1)(2) Eggs- 155°F 15 Sea. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145'F15see- 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501,16(A) Animals - 155°F 15 sec. " 1-401.11(B)(1)(2) Pork and Beef Roast -130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 590.004(H) sec. a 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Staffing 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 Foods Cooked in a .i Microwave 165'F * 3-401:11(A)(1)(b) All Other PHFs -145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 sec. * ' 3-403.11(B) Microwave- 165' F 2 Minute Standing Time* 3-003.11(0) Commercially Processed RTE Food - 14001* 3403.11(E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Homs and From 70'F to 41'F/45'F Within 4'Hou rs. *. 3-501.14(,B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F/45°F Within 4 Hours* * 0.notn critical item in the federal 1999 Food Cale a,105 CMR 590 0. EMM C 3-501.14(C) PHFs Received at Temperatures . According to Law Cooled to 4 t'F/45'F Within 4 Hours. 3-501'.15 Cuolin Methods for PHFs. . PHF Not and Com Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 410/45' F* 3-501.16(A) Hot PRFs Maintained at or above 140'F. * 3-501,16(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and .Bemis with Warning Labels* 590.000 3-801.11(8) Use of Pasteurized Eggs* - FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Serve& * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw. Undercooked or - FC -2 .003 .I Not Otherwise Processed to Eliminate Food and Food Protection IFC -3 Pathogens.* 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Eggs* srrUAL HCVUIHCMCIY 1, 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in rhe following sections of the Food Code and 105 CMR 590.007. i Hem I Good Retail PraodcesFC 590.000 23. Man' el mentandPersonnel - FC -2 .003 .I 24.. Food and Food Protection IFC -3 .004 25. Equipment and Utensils I IFC -4 .005 26. Water, Plumbing and Waste _ I FC -5 .006 .. P'ical Facility FC -6 .007 28. Poisonous or Toxic Materials ! FC-- 7 .008 29. Special Requirements .i ,t)O9 30. j Other s:sum;amm.�e�z e: Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health .120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Print: L- pR I>5 Date TYDe of Ooeration(sl Tvoe of Inspection � k L l> I( -24s- t1 ❑ ❑ Food Service Retail ❑Routine ❑ Re -inspection Address9 9 2T H -=J? m6e�-T Risk Level ❑ Residential Kitchen Previous Inspection Telephone ,_ -7 K , -7 g El ❑ Mobile Temporary Date: fRPre-operation. Owner-P7f0imW HACCP &N Etyfr td 'Lww+ `a A. Vt.(, Z ❑ ❑ Caterer Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) PCU Time in. 2-T- ❑ HACCP Inspector L q e -A w o t N Out: Permit No. ® Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - 1. PIC Assigned / Knowledgeable / Duties LEMPLOYEEHEALTH= _ _._> ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded i FOOD FROM APPROVED SOURCE _ a, ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements [ k 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION N,8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate 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)(590.0011) 29. Special Requirements (590.009) 30. Other 5:5eolnspeafFo 14.11 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities I PROTECTION FROM CHEMICALS '" `V_ - I ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE P_OPULATIONS_(HSP_)i ❑ 21. Food and Food Preparation for HSP .CONSUMER ADVISORY-_ r °�," ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: - Inspector's Signature: e Print: L- pR I>5 PIC's Signature: Print: Pagel of -a Pages If %:2-1) �4n 1 j Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT '1 590.003(A) Assignment of Responsibility* 590.003(6) Demonstration of Knowledge* 2-103.11. Person in charge- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.1.2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590003(17) Responsibility Of A Fonts 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(8) 590.003((G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions' 3-201.15' 590.003(E) Removal of Exclusions and Restrict ons C C C C FOOD FROM APPROVED SOURCE PROTECTION. FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.OkA-B) Compliance with Food Law* 3-201.1.2 Food in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14, Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11', ` Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(8) Water Meets Standards in 31.0 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.141 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15' Molluscan Shellfish from NSSP lasted Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Re u/ato Authodt 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-20211 PHFs Received at Proper Temperatures* 3-202.15 Package Inte 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 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients' Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* Conformance with Approved Procedures /HACCP Pians 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* PROTECTION. FROM CONTAMINATION 8 .......... Cross -contamination 3-302.1l(A)(1,) Raw Animal. Foods Separated from Cooked and RTE .Fads* 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) I 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 Warewashing - Hot Water Sanitization Te eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. 4-601..11(A) - Equipment Food Contact Surfaces and Utensils Clean* - 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* to Proper, Adequate Handwasning 2-301.11. Clean Condition -Hands and Arms* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11. Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to ees* 13 Handwash Facilities Conveniently Located andAccessib/e 5-203.11. Numbers and Capacities* 5-20411 Location and Placement* 5-205.11 Accessibility, O eration and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin Clean@er, Availabilit 6-301.1.2 Hand D Provision ' Denotes critiwl item in the federal 1999 Food Cade or 105 CMR 590.000. �r t CITY OF SALEM n BOARD OF HEALTH Establishment Name: S u5 R i o Date: \k -2-S- 0 Paqe: 2 No. I Reference I R—Rraditemem Iz DESCRIPTION 0 &kbY 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 ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo 0 Voluntary Disposal of 3 Verified ❑ No I,0 Yes ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: y.....:..�..t.,+:r.4«.... OM1. � � -..� . }..r..:.6r=, .-._-..-.t"F..-. -.. ... ..» ......y. Violations Related to Foodborne Illness Interventions and Risk Factors (item 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIME(TEMPERATURE CONTROLS Food or Color Additives - 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* I FC -2 Poisonous or Toxic Substances 7-101..11 Identifying Information - Original Containers* 7-102.11, Common Name - Working Containers* 7 201.1 I 1 Separation - Storage* - 7-202.11 .Restriction - PresenceandUse* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIME(TEMPERATURE CONTROLS * iknotes critical twin in the federal 1999 Food Code or 105 CMR 590.000.' r 3-501:14(C) H s Received at Temperatures According to: Law Cooled to 41°FfdS°F Within .4 t-Trvtrc Proper Cooking Temperatures for . 19 -1 PRFs 3-401.11A(1)(2) Eggs- 155°F 15 Sec. I FC -2 Eggs- Immediate Service 145'F15sec* . 3-401.11(A)(2) Comminuted Fish, Meats & Game 590.004(H) - Animals - 155'F 15 sec. * 3401.11(B)(1)(2) Pork and Beef Roast -130-F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 26. sec. 3-401.11(A)(3) Poultry, Wild Game, Staffed PM, 27. 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 * 3401.12 Raw Animal Foods Cooked in a I Microwave 165'F * 3401:11(A)(1)() All Other PHFs - 145'F 15 sec. _-�-�-- Reheating for Hot Holding 3-403.11(A)&(D) PHFs 1657 15 sec. * 3403.11(B) Microwave- 1650 F 2 Minute Standing Time* 3403.11(C) Commercially Processed RTE Food - 140'F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PRFs from 1407F to 70'F Within 2 Hours and From 70T to 41'F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F/45°F Within 4 Hours* * iknotes critical twin in the federal 1999 Food Code or 105 CMR 590.000.' r 3-501:14(C) H s Received at Temperatures According to: Law Cooled to 41°FfdS°F Within .4 t-Trvtrc 3-50L16(B) 590.004(F) 3-501:15 Cooling Methods for PHFs 19 -1 PHF Hot and Cold Holding 3-50L16(B) 590.004(F) Cold PRFs Maintained at or below 41'/45° F* 3-501.16(A) Hot PRFs Maintained at or above 140'F. * 3-501.16(A) Roasts Held at or above 130°F. I FC -2 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and [Beverages with Warning Labels* 590. 0 3-801.11(B) Use of Pasteurized Eggs* I FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served * _ Food and Food Protection 3-801.11 C) I Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590. 0 23. Animal Foods That are Raw, Undercooked or I FC -2 _003_ Not Otherwise Processed to Eliminate _ Food and Food Protection FC - 3 Pathogens.* 25. ' 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Eggs* _ ne*evtnemem a Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical, and non-critical violations, which do not relate to the - foodborne illness interventions and risk factors listed above, can found in the following sections of the Food Code and 105 CMR 590 fM - - item I Good Retail Practices .FC 590. 0 23. 1 Manarximent and Personnel I FC -2 _003_ 24. _ Food and Food Protection FC - 3 .004 I 25. ' Equipment and Utensils FC -4 .005 26. Water. Plumbing and Waste I FC -5 .006 I 27. P ical Fac!U , FC -.6 .007 28. Poisonous or Toxic Materials FC -7 .008 29. S ial Rixsuirernants I .009 30. Other - _-�-�-- S:y*CtmmtrlYr2 dx CITY OF SALEM BOARD OF HEALTH Establishment Name: L t} G-acko— - Date: il— z $— t I Page: _'J of Item No. Code Reference C — Critical Item R -Red nem DESCRIPTION OF VIOLATION /PLAN OF CORRECTION PLEASE PRINT CLEARLY Dete-- Verified CA P i41 Discussion With Person in Charge: have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal 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 Foodbome Illness Interventions and Risk Factors fttems I -2Y) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 TIMEMEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101..1.1 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201-11 Se aration - Storage* 7-20111 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 1 Rodent Bait Stations* 7-2A6.13 Tracking Powders, Pest Control and Monitoring* TIMEMEMPERATURE CONTROLS * Denotes critical hemi in the federal 1999 Foal Code % 105 CMR 590.000. C a 3-501.14(C) " Proper Cooking Temperatures for 3-501.15 PHFs 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-SO1.16(A) Animals - 155°F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155-F 15 . 590.U04 H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Staffed PHFs, 27. Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165°F 15 sec. 3-401.11('C)(3) Whole -muscle, Intact Beef Steaks i FC = 7.008 145°F * 3-401.12 Raw Animal Foods Cooked in a ; Microwave 165'F * 3-401:11(A)(1)(b) All Other PHFs -145'F 15 see. Reheating for Hot Holding 3403.11(A)&(D) PHFs 165T 15 sec. * 3403.11(B) Microwave -165' F 2 Minute Standing - Time* 3-303.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 Hours and From 70'F to 41°F/45'F Within 4 Hours. * 3-501.14(13) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/456F Within 4 Hours* * Denotes critical hemi in the federal 1999 Foal Code % 105 CMR 590.000. C a 3-501.14(C) " PHFs Received at Temperatures According to-[aw Cooled to 41'F/45°F Within 4 Ron rs. 3-501.15 Cooling Methods for PHFs Unpastemued Pre-packaged Iuices and .Beverarres with Wanting Labels* PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PRFs Maintained at or below 410/450 F* 3-501.16(A) Hot PRFs Maintained at or above 3-SO1.16(A) Roasts Held at or above 130°F. 3-801.11(C) Time as a Public Health Control 3 50119 Time as a Public Health Control* 590.U04 H) Variance Requirement FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP 21 3-80L IA (A) Unpastemued Pre-packaged Iuices and .Beverarres with Wanting Labels* Animal Foods That are Raw, Undercooked or 3-801.118) Use of Pasteurized E*as* Not Otherwise Processed to Eliminate 3-80L I I (D) Raw or Partially Cooked Animal Fold and Raw Seed Sprouts Not Served. * Pathogens.' 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw, Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate Food and Food_ ProtectionFI C - 3 Pathogens.' 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell .005 E .'Arr A6 rtCVUIttCMt1V15 _ 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (hetes 23-30) Critical. and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sectionsofthe Food Code and 105 CMR 59(1(M Mem_ I Good Retail Practices .FC 590.000 23. i Man einem and Personnel FC -2 .003 i 24. Food and Food_ ProtectionFI C - 3 004 25. Equipment and Utensils FC -4 .005 Water. PlUmbing and Waste FC --5 .006 27. Physical FaCl6 FC -6 .007 28. Poisonous or Toxic Materials i FC = 7.008 29. S pial R uirements ; ,009 30. i Other Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4t Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpe of Operations) Type of inspection S Ing 1 D E I� I1 --ZS- I% ❑Food Service ❑ Retail ❑ Routine ❑ Re -inspection Address 9 9 6-5, T Risk Level ❑ Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone , -7 qy 9 g - _ El Temporary ❑ Caterer E3Bed & Breakfast RPre-operation ❑ Suspect Illness E3General Complaint Owner_ t" u08 -W t✓ulr u 'ow�ti ala CE L Zhe HACCP VJN Person in Charge (PIC)Time P6N 6 In: 2,: z 0 Out: Permit No. ❑ HACCP © Others Inspector L ,A µ p t >, Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision($) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an inkninent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board bf•Health. FOOD PROTECTION MANAGEMENT '�_� d a [fit], 1. PIC Assigned/ Knowledgeable/ Duties FEMPLOYEE HEALTH _ -��^7 ❑ 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 N 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION , (q8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S: SHOIre IF m614 tl ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEMEMPERATURE 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-(HSPj E]21. Food and Food Preparation for HSP [CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: e Print: L R e - e 'F'R" O u . PIC's Signature: n Print: Pagel of 3 Pages I%Z�t1 Violations Related to Foodborne Illness Interventions and Risk Factors (Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 590.003(A) I Assignment of Responsibility* _ 590.003(B) _Demonstration of Knowledge* 2-1.03.1 I. 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.(103(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.UO3(E) Removal of Exclusions and Restr et ons C 5 C C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Foci Code or 105 CMR 590.000. 8 Food and Water From Regulated Soarces 590.004(A -B) Compliance with Food Law* 3-201.12 _ Food in a Herutetically Sealed Container* 3-201.13 Fluid Milk and Milk. Products* 3-202.13 Shell Eggs* 3-202.1.4 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5=101.'11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 31.0 CNIR 22.0" Washin Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Cinight Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed .Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by qggulatn Authority 3-202.18 Shellsta:k Identification Present"-` 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.1.1 PHFs Received at Proper Temperatures* 3-202.15 Packa e bite rit* 3-101.11 Food Safe and Unadulterated Togs/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* Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* Conformance with Approved Procedures 7HACCP Plans 3-502.1 J. Specialized Processing Methods* 3-502.12 Reduced oxygen packagin,% criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Foci Code or 105 CMR 590.000. 8 Cross -contamination 3-302.11(A)(1) Raw Animal. Foals Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washin Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* ' Contamination from the Consumer 3-306.14(A)(B) Rearmed Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe F'aod* 9 Food Contact Surfaces 4-501.111 Manual Warewashing- HotWater Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Food Contact Surfaces and - Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Foal Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and 10 -Chemical* Proper, Adequate Handwashing 2-301.11 - Clean Condition -Hands and Arms* 2-301..1.2 -Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, Dfinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacifies* 5-204.11 Location and Placement* 5-20511 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Haralwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: S v.5 H S cl_ oC, J Date:—N l- SS - ' I Page: 2 _ of 3 Rem No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date,. Vermed $ • e , L*, "% i (76 C r S " N S 2 to ai o a%dL, b Wit. ai S LL Y_�. c) I- l9tr a 3.302 1UkA leL C I _ p A. 12, 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 ElRe-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 17 TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-30214 Protection from Unapproved Additives* 3-501A6(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201. 11 Separation - Stor-a 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions° 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 ring Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-246.13 Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS * Denotes critical item in the federal 1999 pond Cod:; % 105 CMR 590.000. mm- IKE 31-501,14(C) Proper Cooking Temperatures for .3-501.15 PRFs 3-401.I1A(1)(2) Eggs- 155 F 15 See. 3-501A6(B) 590.004(F) Eggs- Immediate Service 145'Fi5sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155F 15 sec. 3.401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 590.004(H) sec. * 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, _27.- Staffing Containing Fish, Meat, JFC-6 Poul or Ratites -1650F 15 sec. 340LIl(C)(3) Whole -muscle, intact Beef Steaks i FC -7 145'F 3401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3.401:11(A)(1)(b) All Other PHFs -145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165T 15 sec. * 3.403.11(8) Microwave- 165= F 2 Minute Standing Titre* 3-403.11(C) Commercially Processed RTE Food - 140'F 3-403.11(E) - Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PRFs 3-501.14(A) Cooling Cooked PRFs from 140'F to 70`F Within 2 Hours and From 7WF to 41`F/45'F Within 4 Hours. * 3-501.14(B) Cooling PRFs Made From Ambient Temperature Ingredients to 41'F/450F Within 4 Hours* * Denotes critical item in the federal 1999 pond Cod:; % 105 CMR 590.000. mm- IKE 31-501,14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. .3-501.15 Cooling Methods for PHFs Unpasteurized Pre-packaged Juices and Beverages with R arning Labels* PHF Hot and Cold Holding 3-501A6(B) 590.004(F) Cold PRFs Maintained at or below 410145' F* 3-501.16(A) Hot PHFs Maintained at or above 140'F. * 3-501.16(A) Roasts Held at or above 130'F. 3-801AI(C) 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 R arning Labels* Animal Foods That are Raw. Undercooked or 3-801.11(B) _ Use of Pasteurized Eggs* Not Otherwise Processed to Eliminate 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Patho ens.* Efn `rnrmot 3-801AI(C) Unopened rood PackaNot Re-seryed. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 5900 . ( 23. Animal Foods That are Raw. Undercooked or FC -2 .003 ' Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Patho ens.* Efn `rnrmot 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell .005 I 26. E SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (items 2-1-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 CMR 590.000. Hem I Good Retail Practices I FC 5900 . ( 23. j .Management and Personnel FC -2 .003 ' ' 24. Food and Food Protection FC - 3 .004 I 25. Equipment and Utensils I FC -4 .005 I 26. Water. Plumbing and Waste I FC -5 .006 _27.- Physical Facility JFC-6 .0077 -28. Pdsonous or Toxic Materials _ i FC -7 008 29. Snecial RanuirAments ,009 30. I Other 3i'tt!Ian�hslGzax CITY OF SALEM BOARD OF HEALTH Establishment Name: S Lks G_a- &11� Date: tt--7-93— t 1 Page: 3 of 3, Item No. Code Reference C - CriticalItem R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION J PRINT CLEARLY Date VerifiedPLEASE V� .2A In k� li / �~ OC4.lwQK/tCL 1241 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ . No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne Illness, Interventions and Risk Factors (dems-1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 N 17 18 TIMEITEMPERATIIRF t'nPiTont a - Food or Color Additives 3,202.12 Additives* 3-302.14 Protection from Una rovedAdditives* 3-50L16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original , Containers* 7-102.11. Common ?4ame-Workin Containers* 7-201.1.1 S aration - Stora -. 7-202.11 . Restriction - Presence and - 7 -20212 Conditions of Use* 7-203.11 Toxic Containers -Prohibitions* 7-204.11 Sattitizers• Criteria - Chetnicats* 7-204.12 Clienticals for Washin Produce, Criteria* 7-204.14 Drvin eats, Criteria* 7-205.11 Incidental Food Contact, Lubuicams* 7-206.11 - Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control. and Monittuin TIMEITEMPERATIIRF t'nPiTont a - _ Proper Cooking Temperatures for 3-501.15 PHFs 3 401.11A(i)(2) Eggs- 155°F 15 Sec. 3-50L16(B) 590.004(F) B es- Immediate Service 145-FI5sec* 3401.11(A)(2) Comminuted Fish. Meats & Game 3 501.16(A} Animals - 155°F 15 sec. 3-401.11(B)(1)(2) Pork. and Beef Roast - 130°F 121 min* 3401.] I(A)(2) Ratites, Injected Meats -155°F 15 590.U04(H) Sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, : FG , 6 Poultry or Ratites-I65°F 15 see, 3-401.1.1(C)(,3) Whole -muscle, Intact Beef Steaks 1 FC- 7 145OF 3401.12 Raw Animal Foods Cooked in a Microwave 165`F 3-401;11( "'11)(b) All Other PHPs -145°F 15 sea. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F IS sec. 3.403.11(B) Microwave- I65° F 2 Minute Standing, Time* 3403.11(C) Commercially Processed RTE Foal - 140eF* Remaining Unshced Portions of Beef Roasts* Proper Cooling of PAFs Cooling Cooked PHFs from 140°F to P3-501.14(B) 70°F Within 2 Homs and From 7d -P to 41`F/4.5°F Within 4 Hours. * Cooling PHFs Made Froth Ambient . Temperature Ingredients to 41°F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 FWd Code or 105 CMR 590.000, N M, 3.501:1.4(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Vditlun 4 Honrs, 3-501.15 Cuolin Methods for PHFs i 23. PHF Hot and Cold Holding 3-50L16(B) 590.004(F) Coid PHFs Maintained at or below 41°/45°F* 3-501.16(A) Hot PRFs Maintained at or above 140°F. 3 501.16(A} Roastc Held at or above 130°F. 25. Time as a Public Health Control 3-501.19 Time as a Pub leHealth Control* 590.U04(H) Variance Re uixetnent .. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP 21 3-801.11(A) Unpasteurized Pre-packa2Juicesa)id3-801.11(B) 590.000--i i 23. Use of3-801.1I(D) FC - 2 A03 ---j Raw or Partially Cooked RawSeedS opts Not Se3-801. 1 Food and Food Protection t1(C) Unoped Food Packa CONSUMER nnymnuv 22 3-603.71 Consumer Advisory Posted for Consumption of 590.000--i i 23. Animal Foods That are Raw. Undercooked or FC - 2 A03 ---j Not Otherwise Processed to Eliminate 1 Food and Food Protection FC - 3 Paulo IMS•* ER_ ive 1/1$ r 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell _ .005 i 26.- E SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590,009(A}(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590,009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PR4CTICES trretns �s-.w) Critical and non-cri#cal violations, which da not relate to the foodborne illrtess inierventions and risk factors listed above, can be found in the following sections of the Food Code mid 105 CMR 590. (W. - item Gocid Retail Pracdces FC 590.000--i i 23. Management and Personnel FC - 2 A03 ---j " 24. - 1 Food and Food Protection FC - 3 .004 25. E ui ent and Utensils FC -4 _ .005 i 26.- Water. Plumbin and Waste FC -5 .006 27. 1hvs1.. Faciiit : FG , 6 �28. Poisonous or Toxic Materials _ 1 FC- 7 .007 A06 28. Special Requirements �y 30.__ 1 other S:5W:E rth 2tl Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name S Itis it L lsr�% DG IJ Date 12 - )- (( Tvpe of ODeration(s) Tvpe of Inspection ❑Routine ❑ Re -inspection Previous Inspection Date: (BPre-operation ❑ Suspect Illness E3 General Complaint ❑ HACCP ❑ Other ❑Food Service ❑Retail ❑ Residential Kitchen El Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Address q o QT H c Risk Level Telephone 9-7 - 7 - 1 c q q eS / Owner (� _ r C E.t 3 E (- hEl HACCPL M Person in Charge (PIC)- 5 A C - (- Z iiE J ( Time In: 1-: ifS Out: Inspector L,, e,#-,1 M O t h Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT_ ` ❑ 1. PIC Assigned / Knowledgeable / Duties [_EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded LFOOD 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 PROTECTIONFROM 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.o03) 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:501�Wm�14.d. ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities EPRIOTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Fooda) -° ❑ 16. Cooking Temperatures ❑ 17. Reheating [118. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ---- - - AREOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS_{HSP); ❑ 21. Food and Food Preparation for HSP � ,CONSUMER ADVISORY�_ ,_.m;.�,�. +�, ❑ 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. Inspector's Signature: C_ � �,,.__ Print: L-ACa- 1< M 1� PIC'sSignature: / Print: GLC ✓ Q / �, L� Pageof,97Pages] Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(.0) Assig tment of Res tonsibilit 590.003(B) Demonstration of Knowledge* 2-1.03.11. 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 repotting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 lee Made From Potable Drinking Water* Applicant To Report To The Person In Dri liking Water from an Approved System* tem* 590,006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge' 31 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions im C 6 C FOOD FROM APPROVED SOURCE * Denotes critical Teem in the federal 1999 Pond Code or t0i CMR 590.000. C PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetical)_Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202. l4 Eggs and Milk Products. Pasteurized* 3-202.16 lee Made From Potable Drinking Water* 5-101. I i Dri liking Water from an Approved System* tem* 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* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by fLegiAaLoT Authority 3-202.18 Sthellstocl,,Identification Present-' 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 2-301.14 Receiving/Condition 3-202.1.1 PHFs Received at Proper Temperatures* 3-202.15 Package Inte rit * 3-101.11 Food Safe and Unadulterated Tags/Records; Shelistock 3-202.18 Shelistock Identification 3-203.1.2 Shellstock Identification Maintained* 12 Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.0040) Labeling of Ing. edlents* Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502.12 Reduced oxygen packaging. criteria* 8-103.12 Conformance wi! A roved Procedures* * Denotes critical Teem in the federal 1999 Pond Code or t0i CMR 590.000. C PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.1.1(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* A-501..1.11 Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Anirnal Foals Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Tent eratures* Contamination from the Environment 3-302.,11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* 4-602.11 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice, of Food* _ Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Foal* 9 Food Contact Surfaces A-501..1.11 Manual Warewashing - Hot Water - Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tent eratures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.A 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 Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 1 Proper, Adequate Handwashing 2-301.11. Clean Condition - Hands and Arms* 2-301..1.2 Cleanin Procedure* 2-301.14 When to Wash* It Good Hygienic Practices 2401.11. Eatin , Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em hr ees* 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 Dr Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: C) C, Date: I -Z - I - k l Pane: Z Of Item NO. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date, verified 4) 0 C.'j'-' 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: LI No LI 70�8 o Voluntary Compliance 0 Employee Restriction Exclusion L) Re -inspection Scheduled Lj Emergency Suspension 0 Embargo El Emergency Closure L3 Voluntary Disposal U Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Man 1-22) (Cont) PROTECTION FROM CHEMICALS 14 15 17 18 TIME/TEMPERATURE CONTROLS Food or Calor Additives 3,202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-)01.11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 - Separation - Stora * 7-20111 . Restriction - Presence and Use* 7-202.12 1 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce. Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIME/TEMPERATURE CONTROLS * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.. mm - FEE 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PRFs 340i.I IA(i)(2) Eggs- 155F 15 See. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145°F15sec* 3401.11(A)(2) Comminuted Fish. Meats &. Game 3501.16(A) Animals - 155'F 15 sec. * 340111(B)(1)(2) Pork and Beef Roast -130'F 121 nun* 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 590.004{Hj sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PRFs, 27. Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165'F 15 sec. 3-401.11('CX3) Whole -muscle, Intact Beef Steaks FG- 7. 14.5 OF * 3401.12 Raw Animal Foods Cooked in a Microwave 165`F * 3401AI(A)(1)(b) All Other PHFs - 145'F 15 sec. Reheating for Hot Holding 3403A1(A)&(D) PHFs 165OF 15 sec. * 3403.11(B) Microwave- 165° F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70*F Within 2 Homs and From 70'F to 410171450F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'Fl45'F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.. mm - FEE 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F145F Within 4 Hours. 3-501.15 Methods for PHFs 3-801.11(8) _Coolinig PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41°145°F* 3-501..16(A) Hot PHFs Maintained at or above 140°F. * 3501.16(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3-501.1.9 Time as a Public Health Control* 590.004{Hj Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and :Beverages with Warning Labels* 690.000 3-801.11(8) Use of Pasteurized Eggs - . *3-801.11(D) - 2 3 -801,11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 690.000 i 23. Animal Foods That are Raw. Undercooked or - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection -FC FC - 3 Pathogens.* F'"' ",surf 25. 3-302. l3Pasteurized Eggs Substitute for Raw Shell .005 i 26. E * Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical, and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, carr he found in the following sections of the Food Code and 105 CMR 590.000, Item Good Retail Practices .FC 690.000 i 23. l Management and Personnel - 2 .003 22 Food and Food Protection -FC FC - 3 A04 I 25. Equipment and Utensils f FC -4 .005 i 26. Water. Plumbing and Waste FC -5 .006 I 27. Physical Facility FC -6 .007 28. Poisonous or Toxic Materials FG- 7. 008 29. Special Requirements ,003 30. I Other Y±�M::am6c:42 Cx Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date !l-�S- t1 Type of Operation(s) T f Inspection Routine ❑ Re -inspection Previous Inspection Date: I7 Pre-operation -❑ Suspect Illness ❑ General Complaint ❑HACCP ® Others jt ❑Food Service [I Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Address C �� y�� Risk Level Telephone '-7 r , -7 qq Owner _ F+n�+ress{ EP& HACCP t Person in Charge (PIC) LA Time In: �:zt> Out: InspectorL M p t �, Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision($) violated. Non-compiiance 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 i EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOODFR6M7APPROVEDSOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements t�917. Conformance with Approved Procedures/HACCP Plans 1' PRS OV�+TECTION�FROM CONTAMINATION mm 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. M 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: 501nsyxfFom 14.Eoc ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals �TIMEREMPERATURE CONTROLS_(PoteMlally Ha=erdoua Foo_da) [116. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling [119. Hot and Cold Holding ❑ 20 Time As a Public Health Control LREOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATiONS_(HSP); ❑ 21. Food and Food Preparation for HSP M >. �CONSUMERADVISORY�.;;,,,, ❑ 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: CITY OF SALEM BOARD OF HEALTH Establishment Name: `s\.k-s01 C aZt>r- --, _3 Date: fit- z4s- , Page: _ -2— of 3 Rem No. Code Reference C - Critical Rem R -Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE CLEARLY Date Verified 'PRINT S �� P G.r�--�. ._irx^�..1-. 8iL— 4$Q� �'L(��.J(}. �C•L.d_.C^l"'�. ry�� u 4S 2 C 1pb c� -A �•..-Ct� 0.J.�k �!♦.. � sn: v .^-K (9V� Y`i Q•^+�/` �_NYl °^" i7 9 U J � ' GU.'/^ro`� 1w../ Y��CS [lv�ViJ� `ALT i7 REt ➢-.r. �. /7 q I t U - y" t'�„'"�. �� (} nr..-.A.t+...r..X t -vim. ` 6...e_¢..Y'• z..�. li I-:�..tn-C.C:5 ��..�:1A- p 112,1 l (� .Sol i2 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: u . No ❑ Yes. ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: CITY OF SALEM BOARD OF HEALTH Establishment Name: us 1} l G- Date: t l—'-L'C5 t I Page: 3 of i Rem Code C - Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION - Pate - Verified NO. Reference R - Red Item - - PLEASE PRINT CLEARLY , . 4 . LA r A-. AA -%-4 Vt^ w -_ t y. r2,1 c- ° i n 3 , -0iscussion With Person in Charge: Corrective Action Required: ❑ No ❑: 'Yes I have read this report,' have had the opportunity to ask questions and agree to correct all ' ❑ Voluntary Compliance , ❑ 'Employee Restriction / Exclusion m violations ,bef ore the next inspection observe all conditions as described, and to ❑ Re -inspection Scheduled p ❑ Emergency Suspension comply with all mandates of.the Mass/Federal Food Code. I understand that 4 i noncompliance may result in daily fines of,twenty-five dollars or suspension/revocation of, ❑ ' Embargo ❑ ' Emergency Closure permit' food ooperm 0 ` Voluntary Disposal - ❑ Other: l+ Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name t+ v t l _sr? -!r- D ;, Date d2 - i- t 1 a of O eration s Tvoe of Inspection ❑Routine ElRe-inspection0 Previous Inspection Date: [Z El suspect Illness O General Complaint HACCP ❑ Other Food Service El Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary El Caterer F1 Bed & Breakfast Permit No. Address'A q=, o 4-, H Risk Level Telephone �- _7 �jC/ t c Owner_ F �r> Cr X ti « 4 *� - e F ,_ , HACCP(M /N Person in Charge (PIC)- -Ifa ti F =-' c lE.r :� Timed In: 2: Out: Inspector (_, L'_n t t,,; O i t_.a Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. (,FOOD PROTECTION MANAGEMENT _'`771 I ❑ 1. PIC Assigned / Knowledgeable / Duties o EMPLOYEE HEALTH ° . � i ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded I FOODCFROM 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 �-` x � ❑ 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 Df Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C,, N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other 3:5WIn5Pe Fom 14.tl ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities .PROTECTION _FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATUREOONTROLS (Potentially Hazar_d_ous Foods),.._1 ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control `REGUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP). ❑ 21. Food and Food Preparation for HSP CONSUMER.ADYISORY ;� v_. .,,,_._v�' 0 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'sSignature: �/,..j'� Print: PIC's Signature: k, Print: I/ ,� } { .. Page -L of 1 Pages CITY OF SALEM BOARD OF HEALTH Establishment Name: t"`, T K- �ti ? '' Date: 1 - Page: of Item Code C -Critical item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION pme. No. Reference R - Red Item . . - - —.1 Verified LaOE r s -I Discussion With Person in Charge: rCorrectiven Required: ❑ . No ❑ yes 1 have read this report, have had the opportunity to ask questions and agree to correct all mpliance ❑ Employee RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to n Scheduled ❑ Emergency Suspension comply 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 Emergency Closure your food permit. isposal ❑ other: Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name ate T e eration s Type section l ood Service ElRetail ❑ Residential Kitchen ❑ Mobile utine Re -inspection Previous Inspection Date: AddressRq Telephone / ( Risk Level 1 11 Temporary ❑ Caterer El & Breakfast Permit No. [3Pre-operation ❑ Suspect Illness El General Complaint ❑ HACCP El Other Owner HACCP YM Person in C arge Ti �� In rr,, Out: I Inspector Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MAXAGEMENT _ _ _ _ _ _ _ [:112. Prevention of Contamination from Hands ❑ 1 PIC Assigned / Knowledgeable / Duties _ 13. Handwash Facilities EMPHELOYEE A_HLT ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE -_ ` r from A TIME/rEMPERATURE CONTROLS (Potemlelty Hazardous Foods) ❑ 4 Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION t ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing [111. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other o !/�J r`�' s 1�1 A rl 5h dw3 0.4 CSL. 4) ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control _H_1®s REQUIREMENTS FOR HIGHLY SUSCEPTI-BL E POPULATIONS.( P -. ❑ 21. Food and Food Preparation for HSP C SUMER ADVISORY M22. 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: Y Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT- 1 590.003(A) Assig tment of Responsibility • i 590.003(6) Demonstration of Knowledge* 2-103.11 1 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law`k 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 lee Made From Potable Drinking Water* Applicant To Report To The Person In tem* Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) - Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* - 3-201.15 590.003(F) Removal of Exclusions and Restrictions 4 In - In fn FOOD FROM APPROVED SOURCE 4 Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. PROTFCTION FROM CONTAMINATIr1N 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law`k 3-201.12 Food in a Hermeticail Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell E s* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 lee Made From Potable Drinking Water* 5-101.1.1 tem* 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 - Sheltish 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 Re ulato Authort 3-202.18 Sbellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.1.1. PHFs Received at Proper Temperatures* 3-202.15 Package Ince it * 3-101.11. Food Safe and Unadulterated TagstRecords: Shellstock 3-202.18 Shellstock Identification 3-203.1.2 Shellstock Identification Maintained* ' Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3402.12 Records, Creation and Retention* 590.004(1) Labeling of Ingredients* Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils" - Conformance with Approved Procedures tHACCP Plans 3-502.11- Specialized Processing Methods* 3-502.1.2 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures*� 4 Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. PROTFCTION FROM CONTAMINATIr1N 8 Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other" - Contamination from the Environment 3-302.11(A) I Food Protection* 3-302.15 Washing Fruits and 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 Recondititming:Unsafe Food* 9 Food Contact Surfaces 4-501..111. Manual Warewashing - Hot Water Sanitization Ten. eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp.; pH; concentration and hardness. 4-60 L 11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils" - 4 -702.11 Frequency of Sanitization of Utensils and - Food Contact Surfaces of E ui p ment* 4-103.11 Methods of Sanitization - Hot Water and - Chemical* 10 Proper, Adequate Handwashing - 2-301.1.1 - Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* Il Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 . Discharges. From the Eyes, Nose and Mouth*. - - - ..• . 3-301.12 Preventing Contatnination When Tasting" t2 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacities* 5-204.11 - Location and Placement* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying Devices 6 301.11 Handwashin , Cleanser, Availability 6301. 1.2 2HandD Provision MM CITY OF BOARD OF HEALTH Lffl'r- DM AnA&,,,_ Date: r}jC5:j4 Page: 9L, of N N DESCRIPTIONOF VIOLATION / PLAN -OF CORRECTION PLEASE PRINT CLEARLY e.�. •-� - -•WNW& ��E Iffliffil �'f 1p --��/� J_-//_•�.: v_C •� ''�� . Com. � � 1 .r��—�.:� your ... . v Volu taryCompliance El Employee Exclusion e-inspe Scheduled 0 Emergency Suspension Cl Voluntary Disposal U Other: N N Violations Relater! to Foodborne illness interventions and Risk Factors (Hems; 1-22) (Cont.) 15 16 -.-- Food Color Additives 3-202.12._. __.d_...-._...-_. Additives* 3-302.14 _ _ Protection from Unapproved Additives* 3-501.16(6) 590.004(F) Poisonous or Toxic Substances 7-102,11 Identi6ing Information - Original Containers* 7-102.11, Common Name - Working Containers* 7-201.11 Separation - Stora * 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* I7 - 18 Dinouz critical win in the f:-deral 7999 Food CWe or lW CMR 590.000. WE 3 -SOI. t4(0 Proper Cooking Temperatures for 3-501..15 PHFs 3-401.11A(1)(2) _ Eggs- 155F 15 Sec. 3-501.16(6) 590.004(F) Eggs- Immediate Servi e 145'Fl5sec* 3-401.11(A)(2) - Comminuted Fish. Meats & Game 3-501.16(A) Animals -155'F 15 sec. * 3.401.11(0)(1)(2) Port: and Beef Roost -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, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, Poultry or Ratites -765°F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks ' FC --7 145'F y' 3-401.12 Raw Animal Fords Cooked in a : Microwave 165T * 3-401.11(A)(1)(b) All Other PHFs -145°F 15 sec. - .,I Reheating for Hot Holding 3-403.11(A)&(D) PRFs 1657 15 sec. * 3-403.11(B) Microwave- I65` F 2 Minute Standing Titter* 3-403.11(C) Commercially Processed RTE Food - l4o°F�* 34),21I(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PRFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 70'F Within 2 Hours and From 70'F to 41`F/45'F Within 4 Hours. * 3-501.14(,6) Cooliag'PHFs Made From Ambient Temperature Ingredients to 4I'F/456F Within 4 Hours* Dinouz critical win in the f:-deral 7999 Food CWe or lW CMR 590.000. WE 3 -SOI. t4(0 PHFs Received at Temperatures According to Law Cooled to 417145°F Within 4 Hours. 3-501..15 Cooling Methods for PHFs �-A01.11(6 PHF Not and Cold Holding 3-501.16(6) 590.004(F) Cold PHFs Maintained at or below 410/45° F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. 3-501.16(A) Roasts Held at or above 130'F. i 25. Time as a Public Health Control 3-501:19 Time as a Public Health Coutrcd* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 1 690.00014 �-A01.11(6 Use of Past * euriz_edEggs* - FC - 2 3-80I.21(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * and Food Protection i 3-801.11(C) Unopened.Food Package Not Re -served. CONSUMER ADVISORY 22 36113.11Con tuner .Advisory Posted fro Consumption of 1 690.00014 i 23. Animal Foods That are Raw. Undercooked or - FC - 2 .003 - .1 Not Otherwise -Processed to Elfatuatur and Food Protection i ( FC -3 Pathogens.' i 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 j j 26. Eggs* *rM;JP.L K=U0lH=mrR1 1 b 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Spectal Requirements. (Items 23-30) Critical, and non-critical violations, which do not relate to the foodborne illness inten'entionr and risk factors listed above, can be found in the following sectionsofthe Food Code and 105 CMR 590.000. Eltetit i Good Retail Practices FC 1 690.00014 i 23. i Mama gement and Persc>nne! - FC - 2 .003 - .1 i 24.iFood and Food Protection i ( FC -3 1 .604 ! i 25. Equipment and Utensils FC - 4 .005 j j 26. Water. Plumbing and Wastes 'i}_F_C - 5 .006 27. Physical FacilityFC-5 '.007 i 28. Poisonous or Toxic Materials ' FC --7 129 _grasciaJ Requirements rementss : .003 ;. 30. i_other - .,I 5.yVA mtl G:.