THE CAFE AT THE HOUSE OF SEVEN GABLES - ESTABLISHMENTSUS--
Massachusetts Department of Public Health
Division of Food and Drugs
FOOD ESTABLISHMENT INSPECTION REPORT
Salem Board of Health
120 Washington Street, 4'" Floor
Salem, MA 01970-3523
Tel. (978) 741-1800 Fax (978) 745-0343
Name
D
Type of Operation(s)
Tyge ofLJ Inspection
Print:
Page_ of Pages
J& -Food Service
outine
Address - CF
RiskRetail
Level
❑ Residential Kitchen
❑ Mobile
Re -inspection
Previous Inspection
Date:
Telephone
❑ Caterer
El
❑ Bed & Breakfast
Permit No.
ElPre-operation
❑ Suspect Illness
❑ General Complaint
❑ HACCP
❑ Other
Owner
HACCP YM
Person in Charge (PIC)
Time
In: 43v
Out:
Inspector
Each violation c ecked 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. �` 11_ �� �,P� fA,-f .h A4e- d f (SIJ
FOOD PROTECTION MANAGEMENTZZe, ,,.,�..„_,M==T `:"%
❑ 1. PIC Assigned / Knowledgeable / Duties
EMPLOYEE HEALTH ,„ ,;, a us=,a: a �27r= `r'`A'
❑ 2. Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
' PROTECTION FROM CHEMICALS'S '�"�3";"Fu
❑ 14. Approved Food or Color Additives
❑ 15 Toxic Chemicals
g�FOOD, FROM APPROVED SOURCE .,j-s�..,,-"� 71,A.r�„,�;,Z �w..x,».�.: €!r f 1 mE/rEMPERATURE CONTROLS (Pmem�ally Haiardous Foods)
E]4. Food and Water from Approved Source
❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling
f PROTECTION FROM CONTAMINATION >_ iyzv �'""_' ❑ 19. Hot and Cold Holding
....:,...,w..,.��.....�...,„„4t...
El ration/ Separation/ Segregation/ Protection ❑ 20. Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices
Violations Related to Good Retail Practices
Critical (C) violations marked must be corrected
immediately or within 10 days as determined by the Board
of Health. Non-critical (N) violations must be corrected
immediately or within 90 days as determined by the Board
of Health.
eC< 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. 5801nspectFor i<.d
REQUfREMENTS FOR HIGHLY SUSCEPTIBLE POPU�0.TION$ (HSP)
❑ 21. Food and Food Preparation for HSP
''CONSOMERA VISbRY,""="`Y ! ffl ',Em'� _�'�'=a�'"""`
a:... P =m .w=�, .-G,.a€,m., �m.as..:a= �w. to
❑ 22. Posting of Consumer Advisories
Number of Violated Provisions Related
To Foodborne Illnesses Interventions
and Risk Factors (Items 1-22):
Official Order for Correction: Based on an inspection
today, the items checked indicate violations of 105 CMR
590.000/federal Food Code. This report, when signed below
by a Board of Health member or its agent constitutes an
order of the Board of Health. Failure to correct violations
cited in this report may result in suspension or revocation of
the food establishment permit and cessation of food
establishment operations. If aggrieved by this order, you
have a right to a hearing. Your request must be in writing
and submitted to the Board of Health at the above address
within 10 days of receipt of this order.
DATE OF RE -INSPECTION:
Inspector's Signature:
Print:
PIC's Signature:
Print:
Page_ of Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors (Hems 1-22)
FOOD PROTECTION MANAGEMENT
1 590.003(A) Assignment of Responsibihry*
590.003(B) Demonstration of KnoAIed e*
2-103.11 PersYm in charge - duties
EMPLOYEE HEALTH
2
590.003(0)
Responsibility of the person in charge to
Com tiance with Food Law*
3-201.1.2
require reporting, by foot] 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(13)
590003(0)
ReportinR by Person in Charge*
3
1 590,003(1))
Exclusions and Restrictions*
3-201.15
590.003(E)
Removal of Exclusions and Restrictions
4
C
C
C
FOOD FROM APPROVED SOURCE
R Denotes critical item in the federal 1999 Fox] Code or 105 CMR 590.000.
v
PROTECTION FROM CONTAMINATION
8
Food and Water From Regulated Sources
590.004(A -B)
Com tiance with Food Law*
3-201.1.2
Food in a Hermetical ly Sealed Container*
3-201.13
Fluid Milk and Milk Products*
3-202.13
Shell Eggs*
3-202.14
Eggs and Milk Products. Pasteurized*
3-202.16
Ice Made From Potable Drinking Water*
5-101.11
Drinking Water from an Approved System*
590.006(A)
Bottled Drinking Water*
590 006(13)
Water Meets Standards in 310 CMR 22.0*
Washing Fruits and Vegetables
Shellfish and Fish From an Approved Source
3-201.14
Fish and Recreationally Caught Molluscan
Shellfish*
3-201.15
Molluscan Shellfish from NSSP Listed
Sources*
Contamination from the Consumer
Game and Wild Mushrooms Approved by
Regulatory Authority
3-202.18
Shellstock Identification Present*
590.004(C)
Wild Mushrooms*
3-201.17
Game Animals*
3-701 11
Receiving/Condition
3-202.1.1.
PHFs Received at Proper Tent eratures*
3-202.15
Packa e 1ntegrit y*
3-101.11
Food Safe and Unadulterated
Tags/Records: Shellstock
3-202.18
Shellstock Identification *
3-203.12
Shellstock Identification Maintained*
Tags/Records: Fish Products
3402.11
Parasite Destruction*
3-402.12
Records, Creation and Retention*
590,004(1)
Labeling of ingredients'
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Conformance with Approved Procedures
/HACCP Plans
3-502.11
Specialized Processing Methods*
3-502.12
Reduced oxygen packaging, criteria*
F8-163 -12
Conformance with Approved Procedures*
R Denotes critical item in the federal 1999 Fox] Code or 105 CMR 590.000.
v
PROTECTION FROM CONTAMINATION
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)
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 Resetvice of Food*
Disposition of Adulterated or Contaminated
Food
3-701 11
Discarding or Reconditioning Unsafe
Food*
9
Food Contact Surfaces
4-501.111
Manual Warewashing - Hot Water
Sanitization Tem eratures*
4-501.112
Mechanical Warewashing- Hot Water
Sanitization Tem eramres*
4-50 L 114
Chemical. Sanitisation- temp., pH,
concentration and hardness. 'k
4-601.11(A)
Equipment Food Contact Surfaces and
Utensils Clean*
4-602.11
Cleaning Frequency of Equipment Food -
Contact Surfaces and Utensils*
4-702.11
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
4-703.11
Methods of Sanitization - Hot Water and
Chemical*
10
Proper, Adequate Handwashing
2-301.11
Clean Condition - Hands and Arms"
2-301.12
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*
3-301.12
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*
5-204.1.1
Location and Placement*
5-205.11
Accessibility, Operation and Maintenance
Supplied with Soap and Hand Drying
Devices
6-301.11
Handwashing Cleanser, Availability
6-301.1.2
Hand Drying Provision
�.•.r..- '>w..,.r1.. .. ��n�..-:�.f r. ..i�w°4=�..ro.'k._•.. ..-s. �..-.^t`. .. ti:.�w^...n�+�.-.r^L'.+�".*AY{¢�', �?
i•
Massachusetts Department of Public Health Salem Board of Health
Division of Food and Drugs 120 Washington Street, 416 Floor
9 Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
r� 114
Name
/
(G 2 �lxJ"v
Da
/vt6-Food
Type of Operation(s)
Service
Retail
❑ Residential Kitchen
❑ Mobile
El Temporary
❑ Caterer
❑ Bed & Breakfast
Permit No.
T e of Inspection
SKRoutine
C1 Re -inspection
Previous Inspection
Date:
[IPre-operation
❑ Suspect Illness
E] General Complaint
[I HACCP
El Other
Address S Cybl9n
Ris
Level
Telephone Ci u
Owner
HACCP YM
Person in Charge (PIC)
Time A
SZ
O
Out:
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 immedi to corrective 590.009( E) E]590.009 (F) ❑
action as determined by the Board of Health. cni r C)(94PA A, f- -(-t AA r- d -
[ FOOD PROTECTION MANAGEMENT
❑ 1. PIC Assigned / Knowledgeable / Duties
' EMPLOYEE HEALTH""'
❑ 2 Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
FOOD FROM APPROVED SOURCE
❑ 4. Food and Water from Approved Source
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCP Plans
i` PROTEvnm 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.
IC L 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, 5001nspe For 14.dw
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
PROTECTION FROM CHEMICAt,S
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
�.TIME/TEMPERATURE CONTROLS (Paterrtia0y Hazardous Foods)
..4
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
_REO UIREMENT$ FDR HIOHLYSUSCEPTIBLE POPULATIONS (HS 7:'',j
❑ 21. Food and Food Preparation for HSP
CONSUMEP ADVISORY c„„ „`$', „�.��„ ,,,,,._n„:, i, '•��„° ` 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:
Print: 7u_w
�1�✓
PIC's Signature:
Print:
Page_ of Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors (Items 1-22)
FOOD PROTECTION MANAGEMENT
1 590.003(A) Demonstration
of Responsof Krrowled ey
590.003(B) Demonstration of Knowledge*
2-103.11. Person in charge - duties
EMPLOYEE HEALTH
2
590.003(C)
Responsibility of. the person in charge to
with Food Law*
3-201.12
require repotting by food employees and
3-201.13
Fluid Milk and Milk Products*
applicants*
Shelf Eggs*
_
590.003(F)
Responsibility Of A Food Employee Or An
3-202.16
Ice Made From Potable Drinkin Water*
Applicant To Report To The Person In
Drinking Water from an Approved System -
stem*590.006(A)
590.006(A)
Charge*
590.006(B)
590.003(G)
Reporting by Person in Char e*
3
1 590.003(D)
Exclusions and Restrictions*
3-201.15
590.003(F)
Removal of Exclusions and Restrictions
4
M
C
C
FOOD FROM APPROVED SOURCE
* Denotes critical item in the federal 1999 Foal Cade or 105 CMR 590.000.
PROTECTION FROM CONTAMINATION
8
Food and Water From Regulated Sources
590.004(A B)
with Food Law*
3-201.12
_Compliance
Food in a Hermetically Sealed Container*
3-201.13
Fluid Milk and Milk Products*
3-202.13
Shelf Eggs*
3-202.1.4
Eggs and Milk Products, Pasteurized"
3-202.16
Ice Made From Potable Drinkin Water*
5-101.11
Drinking Water from an Approved System -
stem*590.006(A)
590.006(A)
Bottled Drinking Water*
590.006(B)
Water Meets Standards in 310 CMR 22.0*
Washing Fruits and Ve etables
Shellfish and Fish From an Approved Source
3-201.14
Fish and Recreationally Caught Molluscan
Shellfish*
3-201.15
Molluscan Shellfish from NSSP Listed
Sources*
Contamination from the Consumer
Game and Wild Mushrooms Approved by
RegulatoryR2gulatory Authority
3-202.18
Shellstock Identification Present"
590.004(C)
Wild Mushrooms*
3-201_17
Game Animals*
3-701,11
Receiving/Condition
3-202.11
PHFs Received at Proper Temperatures*
3-202.15
Package Integrity*
3-101.11.
Food Safe and Unadulterated
Tags/Records: Shellstock
3-202.18
Shellstock Identification *
3-203.12
Shellstock Identification Maintained*
Tags/Records: Fish Products
3-402.11
Parasite Destruction*
3-402.12
.Records. Creation and Retention*
590.0040)
Labeling of Ingredients'
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Conformance with Approved Procedures
IHACCP Plans
3-502.11
S ec-ialimd Processing Methods*
3-50212
Reduced ox en tackaeind; criteria*
8-103.12
Conformance with Approved Procedures*
* Denotes critical item in the federal 1999 Foal Cade or 105 CMR 590.000.
PROTECTION FROM CONTAMINATION
8
Cross -contamination
3-302.11(A)0)
Raw Animal Foods Separated from
Cooked and RTE Focxis*
Contamination from Raw Ingredients
3-302.4 f (A)(2)
Raw Animal Foods Separated from Each
Other*
Contamination from the Environment
3-302.11(A)
Food Protection*
3-302.15
Washing Fruits and Ve etables
3-304.1 t
Food Contact with Equipment and
Utensils*
Contamination from the Consumer
3-306.14(A)(B)
Returned Fwd and Reservice of Food*
Disposition of Adulterated or Contaminated
Food
3-701,11
Discarding or Reconditioning Unsafe
Food*
9
Food Contact Surfaces
4-50L] 11
Manual Warewashinv - Hot Water
Sanitization Temperatures* -
4-501.112
Mechanical Warewashing- Hot Water
Sanitization Temperatures*
4-501.114
Chemical Sanitization- temp., pH,
concentration and hardness. *
4-601.1't(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*
470311
Methods of Sanitization -Hot Water and
Chemical*
10
Proper, Adequate Handwashing
2-301.11.
Clean Condition - Hands and Arms"
2301..12
Cleanim, Procedure*
2-301.14
When to Wash*
tl
Good Hygienic Practices
2-401.11
Eating, Drinking 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
590.001(8)
Preventing Coutamination.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, Availabilit
b-301.12
HandDrvim*Provision
Massachusetts Department of Public Health
Division of Food and Drugs
FOOD ESTABLISHMENT INSPECTION REPORT 4
r
Salem Board of Health
120 Washington Street, 0 Floor
Salem, MA 01970-3523
Tel. (978) 741-1800 Fax (978) 745-0343
Name
C� (1( ( 0
Da
R d
Type of Operation(s)
Type of Inspection
1�1 Food Service
Ll Retail
El Residential Kitchen
❑ Mobile
❑ Temporary
❑ Caterer
❑ Bed & Breakfast
Permit No.
❑ Routine
El Re -inspection
Previous Inspection
Date:
❑ Pre-operation
El Suspect Illness
❑ HGeneral ACCP Complaint
[__1
❑ Other
Address a
(J
Rik
Level'
Telephone b
Owner
HACCP Y/N
Person in Charge (PIC) '
Tim-�
In:
Ou ;
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 MANAGEMENT
❑ 1. PIC Assigned / Knowledgeable / Duties
EMPLOYEE HEALTH"�`� ��'}q-'f e y `, '•`�""', ,r��`2
❑ 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
I PROTECTION FROM CONTAMINATION =,,, - -s
$. ,,,�
❑ 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.
Cx ,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: 59JlnspeclPomi614.tloc
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
Kw PROTECTION FROM CH_EMICALS"';i
i+v . ew _v m nw wz- aamme draw y � cu
0 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIM EITEMPERATURE CONTROLS (Potentially Hazardous Foods)
F❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
V; REQUIREMENTS FOR HIGHLY SUSOEPTIBLE POPULATIONS (HSP) "r
❑ 21. Food and Food Preparation for HSP
'CONSUMER ADVISORY`ffl"_, �a.y......'�.
❑ 22. Posting of Consumer Advisories
Number of Violated Provisions Related
To Foodborne Illnesses Interventions
and Risk Factors (Items 1-22):
Official Order for Correction: Based on an inspection
today, the items checked indicate violations of 105 CMR
590.000/federal Food Code. This report, when signed below
by a Board of Health member or its agent constitutes an
order of the Board of Health. Failure to correct violations
cited in this report may result in suspension or revocation of
the food establishment permit and cessation of food
establishment operations. If aggrieved by this order, you
have a right to a hearing. Your request must be in writing
and submitted to the Board of Health at the above address
within 10 days of receipt of this order.
DATE OF RE -INSPECTION:
Inspector's Signature:
Print:
PIC's Signature:
/
Print LV I
Paget of pages
14,
F
Violations Related to Foodborne Illness
Interventions and Risk Factors (Items 1-22)
FOOD PROTECTION MANAGEMENT
1I 596.003(A) Assignment of Responsibility*
590.003(B) Demonstration of Knowledge""
2-103.] 7. Person in charge -duties
EMPLOYEE HEALTH
2
590.003(C)
Responsibility of the person in charge to
Compliance with Food Law*
3-201.12
require reporting by foal employees and
3-20113
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)
Char *e*
590.006(B)
5%003(G)
Reporting by Person in Charge*
3
590.003(D)
Exclusions and Restrictions*
3-201.15
590.003(E)
Removal of Exclusions andRestrictions
FV -
5
* Denotes critical item in the federal 1999 Food Cale or 105 CMR 590 OW
PROTECTION FROM CONTAMINATION
S
Food and Water From Regulated Sources
590.004(A -B)
Compliance with Food Law*
3-201.12
Food in a Hertneficall y Sealed Container*
3-20113
Fluid Milk and Milk Products*
3-202.1.3
Shell Eggs*
3-202.14
Eggs and Milk Products. Pasteurized*
3-202.16
Ice Made From Potable Drinking Water*
5-101. t 1
Drinking Water from an Approved System*
590.006(A)
Bottled Drinking Water*
590.006(B)
Water Meets Standards in 310 CMR 22.0*
Washing Fruits and Vegetables
Shellfish and Fish From an Approved Source
3-201.14
Fish and Reereadonally Caught Molluscan
Shellfish*
3-201.15
Molluscan Shellfish from NSSP Listed
Sources*
Contamination from the Consumer
Game and Wild Mushrooms Approved by
Regulatory Authority
3-202-18
Shellstock Identification Present*
590.004(C)
Wild Mushrooms*
3-201.17
Game Animals*
3-701.11
Receiving/Condition
3-202.1.1
PRFs Received at Proper Temperatures*
3-202.15
Package Integrity*
3-101.11
Food Safe and Unadulterated
Tags/Records: Shellstock
3-202.18
Shellstock Identification *
3-203.12
Shellstock Identification Maintained*
Tags/Records: Fish Products
3402.11
Parasite Destruction*
3-402.12
Records, Creation and Retention*
590.004(J) -
Labeling of Ingredients*
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Conformance with Approved Procedures
/HACCP Plans
3-502.11
S ecialized Processm Mcthods*
3-502.12
Reduced oxygen packa 'ng, criteria*
8-103.12
Conformance with Approved Procedures'
* Denotes critical item in the federal 1999 Food Cale or 105 CMR 590 OW
PROTECTION FROM CONTAMINATION
S
Cross -contamination
3-302.1.1(A)(1)
Raw Animal Foods Separated from
Cooked and RTE Foods*
Contamination from Raw Ingredients
3-302.11(A)(2)
Raw Animal Foods Separated from Each
Other*
Contamination from the Environment
3-302.11(A)
Food Protection -
rotection*3-302.15
3 -302. 15
Washing Fruits and Vegetables
3-3()4.11
Food Contact with Equipment and
Utensils*
Contamination from the Consumer
3-306.14(A)(B)
Retumed Food and Reservice of Food*
Disposition of Adulterated or Contaminated
Food
3-701.11
Discarding or Reconditioning Unsafe
Food*
9
Food Contact Surfaces -
urfaces4-501.111
4 -501 . I I I
Manual Warewashing - Hot Water
Sanitization'reraeratures* -
4-501.11.2
Mechanical Warewashing- I -lot Water
Sanitization Temperatures*
4-501.114
Chemical Sanitivation- temp., pH,
concentration and hardness. *
4-601.11(A)
Equipment Food Contact Surfaces and
Utensils Clean*
4-602.11
Cleaning Frequency of Equipment Food -
Contact Surfaces and Utensils*
4-702.11
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
4-703.11
Methods of Sanitization - Hot Water and
Chemical*
10
Proper, Adequate Handwashing
2-301.11
Clean Condition - Hands and Arms*
2-301.1.2
Cleaning Procedure*
2-301.14
When to Wash*
Ii
Good Hygienic Practices
2-401.11
Eating, Drinking or Usin Tobacco*
2-401.12
Discharges From the Eyes, Nose and
Mouth*
3-301.12
Preventing Contamination When Tasting*
12
Prevention of Contamination from Hands
590.0(9(E)
Preventing Contamination from
Employees*
13
Handwash Facilities
Conveniently Located and Accessible
5-203.11
Numbers and Capacities*
5-204.11
Location and Placement*
5-205.11
Accessibility, Operation and Maintenance
Supplied with Soap and Hand Drying
Devices
6-301.11
Handwashing Cleanser, .Availability
6-301, f2
Hand Drying Provision
Establishment Na
CITY OF SALEM
BOARD, OF HEALTH
rZ L
Date:
Page:_ of -Z>
Item
No.
Code
Reference
C - Critical Item '
R — Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
PPL PRINT CLEARLY 1 ",
Date
Verified•
-EASE
�l
~ [_ f r G �•iJt ( A T l I r 1' .�i>!�+ r rl s�
C l / 51,4-1
I
+D-
I Inl d10 r.'! Q C141 yl JL_
/ [
-Y
a�
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
inspection, to observe all conditions as described, and to
violations before the next ins p
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of
your food permit.
/���r -J;— < A��� a�
Corrective Action Required:
❑ No
_Q Yea
oluntary Compliance ❑ Employee Restriction /
Exclusion
Cl Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
V
3
Violations Related to Foodborne Illness Interventions and Risk
Factors (Ilehts 1-22) (Cont.)
PROTECTION FROM CHEMICALS
F-14
1 Pot!ot It,
Food or Color Additives
?-20312
Adchtive"4
3-302.14
Pattection front lfnappro%ed Additives':
1.5
Poisonous or Toxic Substances
IWAI
I WontlCying, Infoi mation - Original
1-501.16(B)
i Containers,
10-1,11
j 0-juronNam;
- - ------------
3 5011 16(A)
Hot PRF, atorabove
-202,11
ii Rat rl�ciiort Pit,st-ncc an,! 1.<c'
.-40,.11{F)
Usf
L20
7-20111
Toxic Conl(mei t -
7
204.11
Saintiveo, ('riterit, -- Chemie N
',Va,hinr
LN -04 12
Clunnicak for Ptodmct,,
7 -07 114
fil-111-Tw Lve-I-)K
1 105.11
Lund vial I;x-,d Cvwtttt. 1-tiN icalt's,
'_06.11
R�,iri,:I�d Proi,ide�:. Cottt I
-
7 ' 12
I
R�xleni BjIi
Wid
17-1,
a; itt
TIMErrEMPERATURE CONTROLS
16 Prow Cooking Temp et atu? Ps !za
FHF5
"to ,(I r5 j-',
101-1 NBIN!,2� P,,ik ard Hef Ruttgi ,in,
, Rits,
40 L T 1 iA jIj
1 Pot!ot It,
PRFs Received at Temperatures
According to Uz ti Cooled to
4I "F/4.5'F Witbin 4 Hours, *
W97-501T-5—
-
Cooling Methods for �PHFs-
PHF 4 and Gold Holding
1-501.16(B)
Cold PRFs Maintained at or below
590 004 (F)
41%45"F>
- - ------------
3 5011 16(A)
Hot PRF, atorabove
R"[E ht,i
140'F
.-40,.11{F)
Roists �H�eldat or .thole.tholec 130°F_
I
L20
Proper Cooilng of PHF6
34 1 14(A) Cr x,I 111 t Ot,)k!.d PH FS 11 on I U
Within 2 1 fouws said Nom -k'!
11�—F WTtion A Hot,r!,
-501.14(!1) 1 CooliuvPHF kl:;dt Fwqk-lir &;-t�l i
fcatl',�MIL, IT C IIF IMEI%! 1 i°/45`P
� 1t%ithin
/45`f --
Within -, I k A I r�
!0, 1 k I 'o, 0 ( 'Ic IT, I
'1 1-,4111, 1 i (A) i Unpieurr/.Td Joicts an(I
—4- , ----
U,c 14 Pa,te,Uized F
I K,v, or Pall!aik CIK)K,,A An;Attal acrd
I SL t,d ';IL.r�nas Nk�,. StI w1
1:'I ted Kxxf Packag, Not Rserved.
CONSUME!R ADVISORY
I--- I -------- - -- --------
22 3-o I p4AId lor
owturlption o;
F iA, thal trr Raw underu ,ked ol
I Raw Shell
,:0,1.,V:, shctiotl
cater, w- tnokk, .xa, Tvnkpora, and
,mder flic, %Ic
j.1d nst 1�1,
S REL A ITEO TL GOOD RETAUPqACTW�. S
(hews 23-30�
Ig st, ,11�, Food 105 ( -MR
2f) 4Vit I PiL,mol), �Tnz
28, ot -nxI
+G Ot9'Ic
-9 ; 001-1
F —1;
14((,)
PRFs Received at Temperatures
According to Uz ti Cooled to
4I "F/4.5'F Witbin 4 Hours, *
W97-501T-5—
-
Cooling Methods for �PHFs-
PHF 4 and Gold Holding
1-501.16(B)
Cold PRFs Maintained at or below
590 004 (F)
41%45"F>
3 5011 16(A)
Hot PRF, atorabove
140'F
j6('t,)
Roists �H�eldat or .thole.tholec 130°F_
I
L20
1 Time as a Public Health Control
P) i
r n at, a Pabfie, health Cono ov
rnx•uutrc men*
'1 1-,4111, 1 i (A) i Unpieurr/.Td Joicts an(I
—4- , ----
U,c 14 Pa,te,Uized F
I K,v, or Pall!aik CIK)K,,A An;Attal acrd
I SL t,d ';IL.r�nas Nk�,. StI w1
1:'I ted Kxxf Packag, Not Rserved.
CONSUME!R ADVISORY
I--- I -------- - -- --------
22 3-o I p4AId lor
owturlption o;
F iA, thal trr Raw underu ,ked ol
I Raw Shell
,:0,1.,V:, shctiotl
cater, w- tnokk, .xa, Tvnkpora, and
,mder flic, %Ic
j.1d nst 1�1,
S REL A ITEO TL GOOD RETAUPqACTW�. S
(hews 23-30�
Ig st, ,11�, Food 105 ( -MR
2f) 4Vit I PiL,mol), �Tnz
28, ot -nxI
+G Ot9'Ic
-9 ; 001-1
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: V��USP ^�� �{ �i r 1 cr' !�I C r-r:f� Date: (()�I S I i 1G Page: of /
Item
No.
Code
Relerence
C - critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
..
PLEASE PRINT CLEARLY
Date
Verified
/
^`P -I n. (�r-1 f"l )T I ,< 1��_ (a ill l�n �'i df_� i.t r:/C_ �_�_l i.�� ,(' l✓rh Y'
n0+;l'1Dt „r,- ;A iV `
.5 l tai<i^� to -p, n ,d U i n ki o (n-)�) �Cr al,•r
C A 'ev t.P,VI CSf (( (-J,67) \0 cT7 r.-"7 (2a UI i, 1-�•Y ewr'�/0 SVn^[ )A
IVO
- - _ - - -
i'^s-tlA `7 l `> k -1 V H4- k rf -s ` , I ('\.PC> i / allohii n q I `1 'f?1 �'"`? r'r (\ 1y ` '
e
vino n� in14 r s lo 1 r D _.. , , .
i
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
violations before the next inspection, to observe all conditions as described, and to
p
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty ollor suspension/revocation of
your food permit. /
U
Corrective Action Required:
❑ No
❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
L) Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Violations Retailed to Foodborne Illness Interventions and Risk
Factors (llehis, 1-221 (Cont.)
PROTECTION FROM CHEMICALS
14
-SO f1 I [C)
Food or Color Additives
K3ehe3ting for ilof ii++telrag 1
_
202.12
Ad Loves _
Ytie imjv,' 16,91` F MtwlW Sulrlli.::
3-302.14
Protection front Unapproved Additives`
I
15
E8—
Poisonous or Toxic Substances
�l
7;JTF Within 2 ticwr «!nd Fn»n ,-7'Ft 7
101.111
Identifying lntdt matron (In,mai
1 t �npsaunc ht r c tcttYs ". iJ "Fi45'F
_
I 1.011t2tn rs 1
3 501.16(A)
I lot PHFs ;Maintained it or above
l 102,11
Cotnrunn 4ame_N ,rb i gout il�r'�
�S
140T.
501.16i(A) I
Rt t,ts Held at oi' above 130°F. >k
?p
1 —� !
i 201 i t
pai arl in Slow
ti int-, as t Pubfie Health Control'
7-20111 11
Rut iulon - Pr :c-occ-aud 1,r_
1
7-202. 12 C'o uirt on-. of Uso '
_
'n 20111
T�,ac C ont imei P o3i Slrio❑v
;-2(4.11
T Ssnmius. Criteria Chu tic dti
7-'04.12
C'h.,u,ir, for AAthit2 l.,dtc (itc
t"-
/ 204.14
Dr,i1 A mntc. C rnr t i
� -205 l I
hnui i t it t xxi (c act l.❑h! ,a tts�'
--i
7-21,)6.1,1—
R ,in.n Uw Pc r Li ie:z C, ti t a'
.__. -
06.12
Ra(n 13,;f t; uu,*
#
nl ig ,oH,,i2 ]"'St C031t Eta
i
TIMEn'EMPERATURE CONTROLS_
16 PraPar Conking Temper lures tot
PRFs
_ _
C, m ulc ' icn, ."
1401. H 61)111.211 PTOar,�.>c=_ - !.iiin'.
-�?.; 1.itc 5? rata• [;:jc. _. S_.';?'.
i
4aL1:}') it St r Wt a i r c r IT
r 1,
1 is t1 _ t rt I
-SO f1 I [C)
1. 17
K3ehe3ting for ilof ii++telrag 1
-03.11(1)(ll) 1 11-11 'C `F i
Ytie imjv,' 16,91` F MtwlW Sulrlli.::
41'F/45'F Within 4 Homs.'
_t ly, e,_
103.17fC')�-
3-501. I i
._�
Rc n: ming L,,uittd Por t< , of 1 r,1t
liasi,':
E8—
__ Proper Cooling of PHFs
:1 500 J4(A) Cwlirwcixikd PM's l' m, I +0 F fo i
PHF Hot and Cold Holding
7;JTF Within 2 ticwr «!nd Fn»n ,-7'Ft 7
3-501.1'6(B)
F74; F W thm _ Ht till-._'_ _
9-5071..I(B;-- t t,tivoPHF. N- is From imbitni
1 t �npsaunc ht r c tcttYs ". iJ "Fi45'F
41`145° F
Within s H,x3r<-
°1 .It. cnUCRetei -n thi !cup �9 rpM,'t .,-, i, til 9.(siG-
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
_ POPULATIONS {HSP}
21 3-801 i'tA)tin{ ! ilrl cd Pr .aclaged Juicas and
_�—B„. tie. with «a! i ro� J;ib_is
£0'• I I(Bt lsc of Pa temiz d ET...
I(1)) KkIwlirlia_6illiCtw,e„dAlaanalFcx;dand
i-- �l{a `, d itimv„ tilt N S,.itc-t
hC 1 L rC ! Ll; lac %td Nxxi 1 ai'_aL' tic A >Scr ed.
CONSUMER ADVISORY _
^2 -60 11 Ito ,icd iixr CoiNl4Hptioa lit
( [ � 3,int.11 ,ids fha 1,c Raw, lh,uctur. kcd,^ I
i
., lb�fi,tfl_ fiF d..w Sbclt
j {
SPECIAL REQUIREMENTS
;:, IH qj
j cat.�cn= tni�tile 1t>11(3, t�n�tK t�tiry and ,
i i
i
i C?'sf 1,;.evr lis aftnF�`;�[l Fitt ,,,H)nS
r Lo w,ll
VIOLA TIORS RELA TED; C> uCit?� FtEI'AiL d RAC i t{;,'�
(Items 23-30)
,lot nc ii , rant+ +,ui r; I Jrtr urs i==rc,t c..,,,1, eclat Le
?,utr�.9+tHcrt �,r {v1: ,r' fTwdCode aitd)"0('11R
-SO f1 I [C)
PHFs Received at Temperatures
.Au: )rding to Law Cooled to --
41'F/45'F Within 4 Homs.'
3-501. I i
Conlm4 Methods for PHFS
14
PHF Hot and Cold Holding
3-501.1'6(B)
Cold PHFs Maintained at or below
590 0(9(F)
41`145° F
3 501.16(A)
I lot PHFs ;Maintained it or above
140T.
501.16i(A) I
Rt t,ts Held at oi' above 130°F. >k
?p
1 —� !
Time as a Public Health Control
-----
ti int-, as t Pubfie Health Control'
NOW
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
_ POPULATIONS {HSP}
21 3-801 i'tA)tin{ ! ilrl cd Pr .aclaged Juicas and
_�—B„. tie. with «a! i ro� J;ib_is
£0'• I I(Bt lsc of Pa temiz d ET...
I(1)) KkIwlirlia_6illiCtw,e„dAlaanalFcx;dand
i-- �l{a `, d itimv„ tilt N S,.itc-t
hC 1 L rC ! Ll; lac %td Nxxi 1 ai'_aL' tic A >Scr ed.
CONSUMER ADVISORY _
^2 -60 11 Ito ,icd iixr CoiNl4Hptioa lit
( [ � 3,int.11 ,ids fha 1,c Raw, lh,uctur. kcd,^ I
i
., lb�fi,tfl_ fiF d..w Sbclt
j {
SPECIAL REQUIREMENTS
;:, IH qj
j cat.�cn= tni�tile 1t>11(3, t�n�tK t�tiry and ,
i i
i
i C?'sf 1,;.evr lis aftnF�`;�[l Fitt ,,,H)nS
r Lo w,ll
VIOLA TIORS RELA TED; C> uCit?� FtEI'AiL d RAC i t{;,'�
(Items 23-30)
,lot nc ii , rant+ +,ui r; I Jrtr urs i==rc,t c..,,,1, eclat Le
?,utr�.9+tHcrt �,r {v1: ,r' fTwdCode aitd)"0('11R
CITY OF SALEM
BOARD OF HEALTH
Establishment Name:4+-It 1�"� ,7F ':�p:rp n Date: -q•' 101IL4 Inn Page: of a
Item
No.
Code
Reference
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
n '
PLEASE PRINT CLEARLY
Date'
. Verified
—,--101' V) I k IiiSY3Pr4j-)n It � ��i�Ckh�r�.��Ibin/`7�
^• ri I / C• "��' Y `�.n �'lr "_.;f" a ,V`P,YI� r''T�S�
I I -t re. kf P )L -e cam( C 1'7
r r
Inn ` r , f -
��s d -s ; ii h I P , CC r rA Iv+t4-✓Irr I Ti: Vi,?:-) pyo4c,,
Irl `1&Q-. VY1Gr hivto as hv( Id C�kq' h (.i
i'Vt�11 Sih� _ (tom helecd "vv,�,� �InK o>t r 'l
�� rC � -1� '7 '1 ^F(X � 7`_� PtY-�- � Ilf � V1�., 1�/ I Tr �• n �ti' I r!r-:
� .
I Ylo n Lo' C (Ci r f 0 C 61 VAI'
�i� 0,('i Cf0
r \$0 Ct nlf't.'�✓ r�,i-4,_I
r
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
inspection, to observe all conditions as described, and to
violations before the next ins P
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of
your food permit.
U
Corrective Action Required:
❑ No
❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Violations Related to Foodborne fitness interventions and Risk
Factors (lifellitill-22) (Cont)
PROTECTION FROM CHEMICALS
14
vi it 1(" F , 4
Food or Color Additives
I
4-20212
Additive,'*
3-30114
Piotecrmn froni�aaVproaed Additives*
15
tA)f
1 Poisonous or Toxic Substances
19
7-(41.11
1 ItIewifyinI, tnfol illation - 011�,6nall
"t ild fmlc, Ohl
contailew
�7102.11
1 ?6L1l
Common Name - Warks fi.-, (owamr,'
T-50 1, 1 ba A)
at 16 ork - stfaagc*
'Within 4 lltw"
Pjexrtw, .wd Uc
12
-
C(aldili(tn, of US0,
-0111
2-
204.11
S,initizeis. Criierw - 0emic,ll%
IM7-10)
---,2
7 104%14 1
[i3 IRS, Ai!cnts. Crii�ria
t..765.11
In6(kuiwI kXxI (',!mam I ubnwaw
06.(I
'/-206 12 1
Roti(( II 6"t sl�,!,mt"
06 l"
-1 ntckmg P,mdti i' s, ( ofl"7j ;n;d
'nME/TEMP`ERATUI'i1'-',. COITFROLS
iW-F— I ter
,403.1 It A)M
.?-403.11(B)
vi it 1(" F , 4
PHFs Received of Temperatures
I
1 103.11 (C)F
tZ IF,
3A6311(EI
21 11,,-
w' koa�l 1 ),
Pv;l, ;w<! tc.
tA)f
Cooling jklethods for PIIF.q
19
3,
"t ild fmlc, Ohl
70 � f Wilh-n 2) llavc and From r'f'
4 '1 F WitinnA, f fi qu
ol —501 TZ('671—
T-50 1, 1 ba A)
La
'Within 4 lltw"
�jf -
3-501 16iAl
—
Rwos Held -at or above 1300F,*O�
ic
Time as a Public Health Control
,403.1 It A)M
.?-403.11(B)
vi it 1(" F , 4
PHFs Received of Temperatures
I
1 103.11 (C)F
tZ IF,
3A6311(EI
I Rcmamirt, unywvj Ptrtwllc ol'Bc,el
3-501,15
Cooling jklethods for PIIF.q
19
3.501. WA)
PFIFS ioul I iW 1: to
70 � f Wilh-n 2) llavc and From r'f'
4 '1 F WitinnA, f fi qu
ol —501 TZ('671—
T-50 1, 1 ba A)
I lot l4airrailled at of above
'Within 4 lltw"
v-r 11 lb'. I 14 I o ... 1 ("41s ,, 1'.1`. , "Itt , " i',
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
21 I ;-110TANA)
,,-Sol II(BI
i 3-1WQ, 110, is I Iv ri Paoiall,, Ctx)kc,d Animal Nxdaird
FiXxi Puma:.(!dol R0, ,Cned, �
CONSUMER ADVISORY
Tle�
22 3-(10, 1 '1 Ckamimor Advi lr �C—w
ISOI� hrm,-'d I 7kinipt ail.
SPECIAL REQUIREMENTS
violtl;o; Section
ir
ti) tfii (a 'v J, i S 'k I� .cw'q
tt zo•:a l0!, rl",la u .l o
VIOLAtiONS RELATED. -5 r6oDJqE-rAJL PRACTICCS
(Stents 23-30)
:rad f,J?11, `M,Ofwitich do wn outc!,�
!iVledabw, ,,,I he
f-wlnd;n filt ;ht lvoe"Codcawjj1;i ('AIR
1 and Pernna,,f j FC 2 003
and Ut&,,srs A 100�-
2' ': Water. Pi rein! 1 FC-
Faciltv FC -
I L—
3-501.14(0
PHFs Received of Temperatures
.According to Laws Cooled to
4 1 T/45'F Within 4 Hams.
3-501,15
Cooling jklethods for PIIF.q
19
PHF Hot and Cold Holding
(.old PHI Maintained at or below
590,()()4(F)
31!45°1*
T-50 1, 1 ba A)
I lot l4airrailled at of above
— -----------------
�jf -
3-501 16iAl
—
Rwos Held -at or above 1300F,*O�
I
Time as a Public Health Control
Tinac a Public jealthControP
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
21 I ;-110TANA)
,,-Sol II(BI
i 3-1WQ, 110, is I Iv ri Paoiall,, Ctx)kc,d Animal Nxdaird
FiXxi Puma:.(!dol R0, ,Cned, �
CONSUMER ADVISORY
Tle�
22 3-(10, 1 '1 Ckamimor Advi lr �C—w
ISOI� hrm,-'d I 7kinipt ail.
SPECIAL REQUIREMENTS
violtl;o; Section
ir
ti) tfii (a 'v J, i S 'k I� .cw'q
tt zo•:a l0!, rl",la u .l o
VIOLAtiONS RELATED. -5 r6oDJqE-rAJL PRACTICCS
(Stents 23-30)
:rad f,J?11, `M,Ofwitich do wn outc!,�
!iVledabw, ,,,I he
f-wlnd;n filt ;ht lvoe"Codcawjj1;i ('AIR
1 and Pernna,,f j FC 2 003
and Ut&,,srs A 100�-
2' ': Water. Pi rein! 1 FC-
Faciltv FC -
I L—
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Date: Page:o'Z of Q
Item
No.
Code
Reference
C -Critical nem
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
;-.
PRINT CLEARLY
Date:; .,
, Verified
/�PLEAASE
� `
C� S. 1 -d \ t A 1 Lt� f 1,1� i LICt I I r P C1n CI`ki
t
r't \1 I C_ E fl IJIS )F C 1 6 P( f J
n
/
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
inspection, to observe all conditions as described, and to
violations before the next ins P
comply with all mandates of the Mass/Federal Food Code. 1 understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of
your food permit. /fty4t —7 �_.,.—,
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 (IIeMs 1-22) (Cont.)
PROTECTION FROM CHEMICALS
14
Food r Color Additives
PRFs Remwd at Temperatures
3-202.12 Additives*
3-302.14 _Protection from Unapproved Additives*
15
Poisonous or Toxic Substances
41"F/45`F Within 4 Hours.
'-101 11 Idmi fyinc lnfcn mai ion - Onginal
_1 Contanten"
3-501.15
_
7-102.11 1 CommonNrmw 'A n6inq-� Cont.:riacr,*
-ll
_
3 r(IIJ 1 c )
J it) 1 BSc=o i tion -SA ia��__
i
2(Y211 f R t-tc1 on - Pr scece Itnt _t k
3-501.16(B)
------
7-202-12 of _
77 '0203,11 oxic
? ^03 t 1 Toxic f � x tinct Prole bl
Co eiz
204.It sarotVC11 lrilei+ clwkoicIl
3 i1
7 204,12 Clwmi 11n for Wsl
17
�7 Jt14_IJ Dtnl_nAvcotc. Criteria '
_
05.11 ljp to ni ll l XA C l al ct l !b I cnlh
ko,ts Held at or above 130'(
�r ?O6 11 Fta:.0 t I_tt t'se Pr 1 ude
— —'!
7-206.12 1 Ro da,u Bair Sintinar
Imt, a fa Pubic hrzltil ('onaxxt*
Tni k. ng Po.<ds l' s: Com lll ;at(! ,
�-V
t t14Pn trnJ to'
16
---- --- i- 5 r l l t r l cc
i
18
3-I03.11t1i&,,)1 I1til Ioi, F i Ic.• _
4Ci3.lilti) _ '41ac.luw. te� its 1 �'4A� a lard n1,
Itmc
i-•t�3.ii{:i 6'_rnmterefal}I4c.,a-;.t?-t[1 P�Nx'1
3403. 11 IF i a Remaining t:nsl iKvd Pry: Oona of lice1
3 501 14(A) I Wi F to
"' 1 F it'itMn 2 hour ::�ti1 irar t ?}"F
__5"- Within -1 i-lr>m
.3501. H4 H) ' Coclir;l; PHF: Midc From Ambient
Tamprature htgreuicw tool` -145`17
within,4 Menus*
J :'ti siocatl0r n in; G:i 19J=,,,1 .c'r i:it' 1(M,
�+-501.14(C)
PRFs Remwd at Temperatures
According to Law Cooled to
_
41"F/45`F Within 4 Hours.
3-501.15
Coolim= Methods for PHFS
_
3 r(IIJ 1 c )
i
t 1 „
3-501.16(B)
Cold PHFs Maintained at or below
540.{)p4{F)
3 i1
17
' Reheatirg for H H MII
18
3-I03.11t1i&,,)1 I1til Ioi, F i Ic.• _
4Ci3.lilti) _ '41ac.luw. te� its 1 �'4A� a lard n1,
Itmc
i-•t�3.ii{:i 6'_rnmterefal}I4c.,a-;.t?-t[1 P�Nx'1
3403. 11 IF i a Remaining t:nsl iKvd Pry: Oona of lice1
3 501 14(A) I Wi F to
"' 1 F it'itMn 2 hour ::�ti1 irar t ?}"F
__5"- Within -1 i-lr>m
.3501. H4 H) ' Coclir;l; PHF: Midc From Ambient
Tamprature htgreuicw tool` -145`17
within,4 Menus*
J :'ti siocatl0r n in; G:i 19J=,,,1 .c'r i:it' 1(M,
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP}
(11 j --$Oi �ItA}-,ofievteulict,dPr .arl�� edJotces;md��
of Pa. ii wi7cd
IID) 1 lta.t or Putiali Cix)n ? Antiilal FoKA and
j
kw,_ S...r1 1,,orlmt5 NotSrrvco. I
�X(ii.I!/C, 4 Ur+�cen:^d Raxi
CONSUMER ADVISORY
22 '+ )(Ci 11 , COa u r hdl isorc Povtc • ibr < c �t ❑1,t1?ion of
i.blt< 1 1 +alt Mita c k, - lknnFr,x e>keci c
I i .,t'3 nt i,?Prt>< v i t�:lilin.le
SPECIAL REQUIREMENTS
SYi�n�-1{,q j. E7� "ic,lvu tn_ t,Y Se i.,, :-x..=sE)iAt tDi it
I calcrii 111 hi3;. i wc. temt),.aryatld 1
I
-_sicr,:<_lr:.e6 �aluts;tiars Iuttdd=.7P
under the a nromr t%,
cctcxns
i
I
i
-In"C fir WES
I
v;G iT10R15 RELATED 10 GOOD RETAit PRACTICES
S
fiferus 23-38)
C 1 t t arl 1 r :a! r< a _.i. ni [h do - n "W':
r t'rr
_+1 Ct1rRC i11t S'r, .r !'vCrit.� E W111,rl 4 hlf.ar, t/`1 tc.i c. <r1 fanbe,
r r_<, El,tr:p,J: z. udi.k.JIIII,,"ClIR
u 011.
�+-501.14(C)
PRFs Remwd at Temperatures
According to Law Cooled to
_
41"F/45`F Within 4 Hours.
3-501.15
Coolim= Methods for PHFS
19
PHF Hot and fold Holding
3-501.16(B)
Cold PHFs Maintained at or below
540.{)p4{F)
410/45° F*
591.16(A)
I Iut PHFg Maintained at or above
_
3-501.16_(A) I
ko,ts Held at or above 130'(
20
Time as a Public Health Control
— �'
Imt, a fa Pubic hrzltil ('onaxxt*
�-V
_
r lrre Rt�cut .nl,:ia
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP}
(11 j --$Oi �ItA}-,ofievteulict,dPr .arl�� edJotces;md��
of Pa. ii wi7cd
IID) 1 lta.t or Putiali Cix)n ? Antiilal FoKA and
j
kw,_ S...r1 1,,orlmt5 NotSrrvco. I
�X(ii.I!/C, 4 Ur+�cen:^d Raxi
CONSUMER ADVISORY
22 '+ )(Ci 11 , COa u r hdl isorc Povtc • ibr < c �t ❑1,t1?ion of
i.blt< 1 1 +alt Mita c k, - lknnFr,x e>keci c
I i .,t'3 nt i,?Prt>< v i t�:lilin.le
SPECIAL REQUIREMENTS
SYi�n�-1{,q j. E7� "ic,lvu tn_ t,Y Se i.,, :-x..=sE)iAt tDi it
I calcrii 111 hi3;. i wc. temt),.aryatld 1
I
-_sicr,:<_lr:.e6 �aluts;tiars Iuttdd=.7P
under the a nromr t%,
cctcxns
i
I
i
-In"C fir WES
I
v;G iT10R15 RELATED 10 GOOD RETAit PRACTICES
S
fiferus 23-38)
C 1 t t arl 1 r :a! r< a _.i. ni [h do - n "W':
r t'rr
_+1 Ct1rRC i11t S'r, .r !'vCrit.� E W111,rl 4 hlf.ar, t/`1 tc.i c. <r1 fanbe,
r r_<, El,tr:p,J: z. udi.k.JIIII,,"ClIR
u 011.
DATE PRINTED:
Commonwealth of Massachusetts
City of Salem
Board of Health Kimberley Driscoll
120 Washington Street, 4th Floor Mayor
SALEM, MA 01970
Foo"etail Establishment Permit
10/14/2009
ESTABLISHMENT NAME:
File Number: BHF -2004-000292
House of Seven Gables -The Garden Cafe
115 Derby Street
Salem MA 01970
LOCATED AT: 0054 TURNER STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2009-0588 Oct 14, 2009 Dec 31, 2009 $140.00
ESTABLISHMENT
Total Fees: $140.00
PERMIT EXPIRES December 31, 2009
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Paye 1
I "r
M
KIMBERLEY DRISCOLL
MAYOR
JANET MANCINI,
ACTING HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4` FLOOR
TEL. (978) 741-1800
FAX (978) 745-0343
IMANCINII&SALEM. COM
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT t Nt ✓ CAFE„ �I HDU iEL # ��gL�s 11Y�7Li�-�
ADDRESS OF ESTABLISHMENT III T- FAX # q -A
MAILING ADDRESS (if different) \l /W
EMAIL - Business': WA Website:
OWNER'S NAME U\I1vto I r IC repro—) wa TEL# 1IS)—;5 1-6W
ADDRESS !A3D EYY AW U/tV9 r MA oI C
STREET 11\ hM,, �CITTYYy� a STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) MOLI A �' I LA(4 tl/ J CERTIFICATE#(S)
(Required in an establishment where potentially hazardous food is prepared)
EMERGENCY RESPONSE PERSON lAlu,�Yh I A6100 3 HOME TEL# / IJ�
Please write in time of day. I0''1
(For example l l am -1 l pm)
TYPE OF ESTABLISHMENT FEE (check ctnly)
RETAIL STORE CES)NO less than 1000sq.ft. (=:$: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 (N9 $100
CHILDCARE SERVICESINURSING HOME--------------------------------------------------------------------------------------------------------------------------------
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES 0 $25
TOBACCO VENDOR YES �Q' $135
ALL NON-PROFlT (such as church kitchens) YESJ�O $25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for
such must be submi d t n approved by the Salem and of Health.
Pursuant to��11GLJJ��hap 6 n , I certffy under t p , s and penalties of perjury that I, to my best
knowledge and belief, have filed all state tax
returns ares%� t q re red r the law.AN I
1 4 J
Signature
Date
Revised 424/07 FOODAP2008.Am Check# & Date
Social Security or Federal Identification Number
Establishment Name:
CITY OF SALEM
BOARD OF HEALTH
Date:
Page: of
Item
No.
Code
Reference
C — Critical Item
R — Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
:;
PLEASE PRINT CLEARLY
Date
Verified
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
0 Voluntary Disposal ❑ Other:
Violations Related to Foodborne Illness interventions and Risk
Factors (ifehJs 1-22) (Cont)
PROTECTION FROM CHEMICALS
14
PHFs Received at Temperatures
Food or Color Additives
According to:Law Cooled to
3-202.12
Additives*
3-501.7 5
3-302.14
_
Protection from Unapproved Additives'
15
-101.11
_
' 7-102,11
Poisonous or Toxic Substances
Idenilying lnfonnation - Otwinal
Containers,
C uTnnP1n Naa1B working,
540-0-4(F)
i 20l 1 I
ai 4tid n Stas tfc ��
�F
liot PHFs Maintained at or above
2-
7 2.11
i'.� t ic6lm Pr ince and
3-StiL (6(A)
7 -202.E --r
—
C'onditiomof Use'
Time as a Public Health Conti of j
4-°03. H
_----
.Toxic C)omaiaery— Pcohilm ons
90.fla141)
i-204.19
Sannvus Ctiten Chuntcds
7-204.12
Chemicals for �A d hitt t�<du c t ❑,zral"
7-204,14
Drvinv Ai enet (rn l i l
5 1 1
lilt in lith 1 >'Vt cunt�lcl. 1 Ib k -m I
C 7'06.!1
Rcii.irioiiid Us,. Pe a ide t r_.
L7 .'05.12
_Crt
�RocL t S�qr
_06.1
_- �
IITt kms, PotIdltt cilli 4 twit
btonnonn j
-9MElTEMPERATURE CONTROLS
11 Proper Cooking Temperatures tot
ft l PHFs
_.
='707.131(7 { 1 rt,-.?- 54'1 5.. :..
I8
3-40iFit II, �.m€ttF,£ia,ttt
' :initnal5 � liJ`x:.l;:iC.'
Y
40 t.7='l11(r;('23 'on ri i nliW t
S
Reheating for Her Hokfinq ,.
_ 1-3.11(A)& (I) i t ltl IntI-}= t c
+.403.11 (b) tl(s,(t-..vc- U it 2tr2i rut S_-adint,.l
I
3-403.11 (C) Cin mer lath Pit,, vs ,d W[F W[1F "1-
.:
40 3,1 1(1:) Rc n u tint, Lnq;ded Pt•rtx s �,i L
�zY 4'
Proper Cooling of PHFs�
4 ,5pi. WA) ((d>,d nr, Cdxlk d PHI -s from 7 ,fj T'tu
7()i77()iF Within 2 Pour, nd From
m; 7`P
§ f-` t, F tl iU;in 4 Houds�_�
51)7. i4l, flj Crrhd PHF F
M;dcnnn Ambient i
Ceml iar.rce (( fru' eutc to 49"1 145`F
Within 4 Htnit "
° Jlcnoiez ,rii csl deil :.i n.: !;-:!< r I .v �:, s•. ..c , r S Os C �Uk 5b .1 ii}i i.
IN
3-501.14(0
PHFs Received at Temperatures
According to:Law Cooled to
•_ _
41=F/45T Within a How's, x
3-501.7 5
_
Coolim A4ethods for PRFs
PHF Hot and Fold Holding
3:501.1b(B)
Cold PHFs Maintained at (it below
540-0-4(F)
41`/45° F"
3-501.1 (I, V;
liot PHFs Maintained at or above
140'F. *
3-StiL (6(A)
Kbrits Held at or abo 130°R. 'TM_
{ '
_
Time as a Public Health Conti of j
i vl 19
—
( tin .0 a Public Health ContrsV _
90.fla141)
F i rose Rc mrement
REOUIREMENTS FOR HIGHLY SUSCEPTIBLE
_ POPULATIONS
1 21 34S01 111A)Pi- lack aged Juices and
I3evet d e. with Pzrnm 1x4,,15'`
4G; I lfi3l '
Us"(11 Pa`ttu:iwd 1 ,_:_4
"t Sul t10)i Hen, or P rail CtK;K,.d Aou*ttl Fcrxl and
�� —Sc o �4yzodxt
Nit, Se.1w -- -
! I I (U 1 1(f 1lr rncneo ruxt Ttc' ai, ti<+ Rc 4eroed
22 1 3L0 .1 i Cons[on r i,visw}?ixtetS i�n'C:drlantnptionoP
? c ural the d fi to Ur 7eraxzked at,
J'J':. � 1 !!:ref!ai! ' r xt_:t }l)i 1UI1 i -C E`.ai•i.'
(,te i,.tch ll C }.. L11;01 r rtes In,
<.'hi` t J t14+ `hc IIlriJrC?5nN t �...., l
s i -
�'...i .r,ol
,+ rc `It_r i rel 0,X t:_,t.l
✓iOLA`fL NS RELATED tC GOOD RETAIL PRA CXtd'%S
(1teots23-30) .
Gr rrtr n -tire ?7� *. ultrf Zr�a drt�n-he
t �tlr rR ?lit r rrvolt rl r�r; z ar[Irctnat tolr.c- 'In "It
_filimd ti .7t��� rte �. set., r . file ru of C adr. wid 145 C,bf)t
b tY�t1.
r
Item qn
' am ' Good Retail Practices i Fr' ,tin nnn
1 00°
t 006
S 0o6
Establishment Name:
CITY OF SALEM
BOARD OF HEALTH
Date: Page: of
Item
No.
Code
Reference
C - Critical nem
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
-:.
PLEASE PRINT CLEARLY
-Date
V6 rifled
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
inspection, to observe all conditions as described, and to
violations before the next ins P
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of
your food permit.
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 (/tells 1-22) (Cont)
PROTECTION FROM CHEMICALS
24
Ile 1
Food or Color Additives-)
_
Coolio.l teffias for PHFs
202.)2
Allditit'GK'r
3-50116(B)
590 004(F)
3-302.14
Protection from Unapplo,,ed Additives*
15
-}
Poisonous or Toxic Substances
r+.am
101.1 t1c!
tent tying tnfoiination -On-incl
�
Containers'"
102-11
R , 6i (m)(a 7 rz" i
1 i 4f:L11(A)r3j
1, ., ,Vila C t. sni 1l'liFs, t
mal urun Si'ai tp 1
S nI'r le t'n iai.. Fis, 1,i_....
F' 202.0
1 st;-ct rnl tr s.nc -and L c
— -
j 7 102. i Z
Condmwl of Use
e
?? 'D3_lI
Toxic f untamei P nhiflnion,-- {{{
-27 04.11
.S'anii7er� Crileri Ctirrnic110�.��_
1 ,e.rel hi `
04.11,
C hejl lk for Aa Ilii L t Odt Ct (rHt lam
-- t
')3 11
7. `'04.14
'
Dnin1r cute. C etc 1
!
205-11
Llan i n al t xv1 f vntacl 1al).1
j3 s93. }'1iC)
} C on> wi.-ia 1,, IR'11 t�i4aol - I
dUw P nid Cl Ire,
' +G F"
206-12
S,
f
- .rG.'l3 1
?00.
r
Ir,chmnl a ie , } �, z,ttr. ai+d
1
\qon to m
TWEITEMPE_RATURE CONTROLS
Ile 1
-i Proper Cooking Tempsa atu+es for
_
Coolio.l teffias for PHFs
PHFs
PHF Hot and COW Holding
3-50116(B)
590 004(F)
Cold PHFs Maintained at or below
410/45` P"
! 3�a� Bnlcd nusc, i; r -i 5aec
Ai11.1 La e)t2.+
"1 51a1.Ifi(A)�
I Ra su Held at or above 130°F. a
r+.am
iGlilHt4.-',rP
is 3t3 ice-�.+)11�1min`,1
�
1 i 4f:L11(A)r3j
1, ., ,Vila C t. sni 1l'liFs, t
S nI'r le t'n iai.. Fis, 1,i_....
j
e
a.
i
„(.5 (,A ti)
1 ,e.rel hi `
i7 1
Fr heating tot Clot l iVfinq
-- t
')3 11
403.11 (H)
afioovtve i+ 'vliowe Swildin. j
j3 s93. }'1iC)
} C on> wi.-ia 1,, IR'11 t�i4aol - I
_
' +G F"
R"Ill ini(I'lL ,..ltd Pkr,uon of H,
ttl Proper Cooling of PHFS
! 5501.1RA) C`<,roling Caikcd PHl=s lram Llt7`[=to
i 7("17 Wilirn 2 1 fonrc and From 701
I �._� -}( —to"i Fhi5`rV thin Hour.
501.14(Bj -T coc-'Ini PHF Yt 1 t, Front Ambient
IIII I'tmperallne 11 retSlert; t.-11 Fr45`F
.i
Within 4 FiLnn '
1 u L criocai Item •r it, Irik ., s r c,, tGi ( vttz c9ii jt)p.
LSAT
__
PHFs Received at Temperatures
According to Law Cooled to '
41 `F/45`F Within 4 Hours. *
3-5111.15
_
Coolio.l teffias for PHFs
!
PHF Hot and COW Holding
3-50116(B)
590 004(F)
Cold PHFs Maintained at or below
410/45` P"
3-50t.I0(A)
I Int PHFg Nfaintained at or above
14(;'Fz
"1 51a1.Ifi(A)�
I Ra su Held at or above 130°F. a
-5o)
I Time as a Public Health Control
z, Yubhs Neakh Control*
ince Ai ttiuent f
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
21 51)i Ill i) UnP, icu ,md Pi p 4zged Jtnces and
� Rc Fera c. 3�ith w umn Ia! li`
Rtl! l 11 d}�L=c i I Pa tiulind—t ink_ __
¢ S iLI I(ip (j�:,,v or Pal, iall C+on-d Animal Fcx d and
7 Pa.+ St ' Sprout, Nol `aecc i.
-.8(i k 11 t(', 1 t;;. ,n,,. d Fcuu9 Pa<ca�c No R., Su ved. `
22 -Htf_ 1 i Conem u c Ac` icon prs tar, nr (-on..umptivn
i �\3i itiJ i i` YRI� t1l)ir Irl IC30.'. {J 3+'CV..X IAC :1. Lit
v etc, ru i Sha ogle f%, Raw Siw!!
ytA0 9(A)- F)t1111 LtiLf! 9f).1k
! C2ii'.R+ * ,Hul`,1.1 t0.:ty TeH�I?uCal � 3.iG
' shd r .f �uchr i o}rr.�-ot "_�trki Ire
10M,, , ::z¢t t._ honors 7th
z>#s(,u ,al Lilts i" .orxt
_..,.:tl .....
r
VIOLA DONS RELAXED ,O ROOD RETAIL PRACTIC 5
(Iltm""la 10)
(it t ?Mit nt!(ai >iit h de no:f itt tw
oc hr ti _i Ls"Pt,i,,ld, to ti n tair chi, eAi irr. a.rt i.r
r iutlrodema1(i (.111{
LIU
hu 4
0
�
I
I
I
W�ALI,
Til
S
s
Q
I'I
�IVA
LA -3f
,
1I
I
I
I
Go
1.
etc
fi
Vrr
FL�4
` jI
,
bpft
r�►
I
�-
= ul
IIII
I
__dw
F
�v
.kti� 1
(�
F' e?"
Rem eVlecr.
,�E11
L(X:j
�N
a
CITY OF SALEM
BOARD OF HEALTH
Date: October 1, 2009
Name of Establishment: The Cafe at the House of The Seven Gables
Address: 115 Derby Street
Owner(s): William Laganas
Phone: 978-744-0991 , CeU. IR l c - 16163
The proposed manager of this establishment, William Laganas, presented a
preliminary Floor Plan and Menu for review in accordance with the State Food
Code.
An updated Floor Plan must be submitted. Please include location of all
equipment.
CERTIFICATION
Mr. Laganas will be the Certified Food Manager (CFM).
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.
FLOOR PLAN
A Hand Sink is 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 if basement is used for
storage.
A three bay sink for washing, rinsing and sanitizing all utensils equipment,
dishes will be used. This establishment also has a dishwasher. Please ensure
that the three bay sink bays are labeled as Wash, Rinse and Sanitize and that
the dishwasher if high temp reaches 180'degrees in final rinse cycle or if
chemically fed that proper parts per million is being maintained for proper
sanitizing of all equipment and utensils.
.%
4
MENU/FOOD PREP
Reviewed preparation of Hawthorne chicken sandwich.
All food must be held at 41 °F or lower, or 140°F or higher, at all times.
Therefore, soup and other hot items should be brought to boiling before being
held hot.
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.
All refrigerator/freezer units must have internal thermometers.
All equipment in the establishment must be operating properly. Any
unused equipment must be removed.
,/UNDERCOOKED FOODS
The menu that was presented today does not have an advisory. Please
ensure that advisory is printed on menu.
,/EXTERMINATION
Monthly services of a Licensed Pest Control Operator are required.
Please keep receipts for inspections. A signed contract in the new owners name
must be submitted to the Board of Health for our records and an initial inspection
must be conducted by a Licensed Pest Control Operator prior to opening of this
establishment.
SANITIZING SOLUTION
Sanitizing Solution must be accessible at each prep station and for any
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 3rd 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.
Outside area of premises, including the dumpster area, must be kept clean and
sanitary.
Please call to submit the final floor plan
An application and check was not submitted for the permit at time of this review.
Before the new owner is to take over and be issued a permit by the Board of
Health, a pre -opening inspection will be conducted. Please call to schedule an
inspection.
IN TI tEgEcjINNING
Assorted freshLU bPIzed scowes, vin u f fav s, bagels
Fresh Fruit cup
Hteart� Soups
Fresh Brewed Coffee
fee
I tot Assorted Teas
cold Beverages
TFfC- tfISTDRIANS
Htuwthorwe — c,rULO Chickew, swu z d bacow, vv.eLted
Smss cheese, carP.v-mL'Lzed owbows, sLibced tovu.ato, .� fLeLd
g reeves
Pl�%ppevi.— Swt.o"rzed T�cr�e�, .4w�.er%caw cheese, Stu. f f�wg,
awd crawberr� horseradish nQ. owwaise 40.25
Emmertow- Howeu Helm, Smo�zO Tut{zeu, -Provo owe
cheese, roasted red peppers, Dhow vKustard, Lettuce, awd
to vN.ato
FederaUSt—rzoast beef, provoLowe cheese, roasted red
peppers, awd horseradibsh Dhow spread 46.25
SPECIALTY WRAPS
cKal ev,, salad — Howtvwtcde ChKcken saLad, lettuce,
towtato, avLd red OnLovu $0.25
TUK'a salad wrap- Dolphi,v Frienoi[U tuv,a, dill
w�a�uov v aLse, lettuce, tomato, '� red owiov, �.2s
Ter(u%la Ume Ch%c19-ew Wrap- c,rULed gov�,eLess ChCc[zeA
Breast lw our owv,, TectvbLci lLw,e ntPr'Made, jasvKLvue rice,
Lettuce, tomato, � red ovU,ov\. 40.25
Derby wrap — c,rULed boneLess cKac zevL breast, basil- feta
pesto, roasted red peppers, tow,.atoes, Lettuce, and jasw,.lv,,e
rice 40.25
Essex Wrap — swzed to rluu, swCss cheese, House Ju
vvu,tstard vKPUovwuaise, lettuce, tovKato, �S red onion
.$6.25
Harbor wrap- si4c-culent pieces of Lobster taCL �§ IznRc,rzLe,
baoon, tarragon, ntcia ov,v,aise, Lettuce, avid tomato ov"
toasted wheat bread 40.25
f-M>T OFF Tf- E 6IR.I LL
ALL burgers feature hoz of fresh ground sirloin and are sewed ov, a freshly gri.U.ed bun
with lettuce, tomato, g XU p%cf2les
Wharf-Fkrger- topped with Avn.eri,cav,, cheese, svworzed
bacon, bbq sauce, sntothered Ln oniovLs.
gec�et gu.rger — topped with roasted red
Peppers ,� chun{2� bleu cheese dress'bncq 0.25
WULow gu.rger - topped with swiss cheese, coleslaw, and
Thousand Island dressL,nrn 4,0.25
H-avv-burger
cheeseburger
gacow cheese gu.rger
ctr�l,I.ed f-totdog
Gr���ed cheese
c,rMed cheese w/tomulto
SALADS
ALL salads lmrLude pita bread avt.d Dour choLce of dressLmg
The Commms- l ceberro Lettuce, tonotoes, au cu tubers,
greevu peppers, and red owCow
Chavi.dl,er- Ms')(9,' creevLs, S-Kto�Zed POcovr, Bits, Apples
SUCes, SWiss cheese, Cav,dLed Wal,vUuts, drCed cranberries
12 n -RP LspmL,c Dress'mo -f 0.50
creele cable — Mixed c,reevLs, Feta cheese, tonotoes,
roasted red peppers, �ZaLavu.ata olives, � pepperoa'bvufbs
THE ftgOVE MENLt IS EOR PROPOSALPt�tRPOSES
ONLY. PRICES LISTED fERE A PROJECTION OF
WHICH l WOI-tLD LIKE TO BE AROLiND. WHEN THE
FINAL MENLt IS MOD LkCED WE WILL REELECT
ACCI.tR.4TE P2.ICINCI R.E61ARDINC1 FOOD COSTS.
%-ZL1 t - $63
Cam
er�sale�
EXAM FORM NO. 4343
CERTIFICATE NO. 5806316
SelvSafer Certirica.lir tion
oms
National Restaurant Association ;'\
EDUCATIONAL FOUNDATION C
for successfully completing the standards set forth by the National Restaurant Association Educational Foundation
for the ServSafee Food Protection Manager Certification Examination, which is accredited by the American National
Standards Institute (ANSI) -Conference for Food Protection (CFP).
3/18/2008
DATE OF EXAMINATION
3/18/2013
DATE OF EXPIRATION
Local laws apply Check with your local regulatory agency for recertification requirements.
t n' NATIONAL"
RESTAURANT
Mary M.Adolf ASSOCIATION
President &COO, Products. and Services Division
National Restaurant Association Solutions - S 0 l 0 T 1 0 N S
031001 National Ra urent Association Edmadanel FauWadw, AN rghtsnaerved. ServSafa°mWthe SorvSdetops are registeeduedemerksof the National Reateurent Associalan Educ,tonal PouMadon,
and used under licence by National Rarteumnr Aseoeiadon solutions, LLL, awholtyevmed mbsialoryof We Nadnnal aeaauram Anociation. -d
This document cannot be reproduced or altered.
07050/01 v.am
Pest Control Service Agreement
° NORTH SHORE PEST CONTROL
7 Macarthur Road
PEABODY, MASSACHUSETTS 01960
n n
(508) 532-3330 G G
(617) 596-2710
CUSTOMER
I f e
SERVICE LOCATION
._,./ ,
.A�� r I ne Novo �e�°rJ �9flc3�e5
S BEE^T/ ,/� 1 T
b�UV 1 -
CITY,STATEWZIP
s Alen^ INIf}.
PERSON TO BE CONTACTED
� I LA ANo s
SERVICE PHONE
P ONE
781) 28 t (� 63
OF PROPERttT ESPVICED
FF"� Ae
DATE SERVICE BEGINS
EXPIRATION DATE
RENEWAL
❑
SERVICE TO BE PERFORMED
WMONTHLY ❑ QUARTERLY ❑ OTHER
PESTSTO BE CONTROLLED
---
sB_6lsernerS`je''43.-_ e Se -r -..
de,vTr �esr Rc[T'vt
SPECIALINSTRUCTIONS:
esr ----- �v-r.-.
- -
qp
` Flc�a2c��-n« ra ''� Sri t rc u �v �S / 0"IC-C
TERMS ANDCONDITIONS: w' 1
SERVICE GUARANTEE: We agree to apply chemicals to control above-named pests in accordance with terms and conditions of this
Service Agreement. All labor and materials will be furnished to provide the most efficient pest control and maximum safety required by
federal, state and city regulations.
SERVICE RENEWAL: This agreement shall be for an initial period of one year, and will renew itself annually unless either party cancels
this agreement by giving thirty days written notice before any expiration date.
ANNUAL
AGREEMENT CHARGE $ BY aa 1 i
COMPA DATE %V ' 3 -
INITIAL SERVICE CHARGE $ (AUTHOR I`G—N�A/TUyfle
MONTHLYA&%RT£RtY PAYMENTS $y11� FOR`
CUSTOMER - DATE
—
(AUTHORIZED SIGNAWREY
__________________ $