THE DAILY BAGEL CAFE - ESTABLISHMENTSF;
Commonwealth of Massachusetts
City of Salem
Board of Health Kimberley Driscoll
120 Washington Stireet, 4th Floor Mayor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/04/2012
ESTABLISHMENT NAME: Dailly Bagel
File Number: BHF -20044)00265 - 6 Ea it India Square
Salem MA 01970
LOCATED AT: 0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2012-0301 ,Jan 1, 2012 Dec 21, 2012 $280.00 Old owner Ansbela & Fernando
ESTABLISHMENT Valentin/The Daily bagel Cafe
Total Fees: $280.00
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made,
all plans for such must be submitted to and approved by the Salem Board of Health. Page 1
KIi HIERLF_Y DRISCOU
MAYOR
LARRY RA NIDIN, RS/RI:[ IS, Cf IO, CP -FS
14FAla'I I AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4"' FLOOR
TEL. (978) 741-1800
FAX (978) 745-0343
Iramdin@salem.com
201_ APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT. / 6*L, 4�e TEL # VVYOr Dab /
ADDRESS OF ESTABLISHMENT -2 L /6 CSI ( iMee, FAX #
MAILING ADDRESS (if different)
EMAIL - Business':
OWNER'S
ADDRESS
Website:
TEL
NJ
STREET///'"�Gt/� V CITY
� � STATE _ ZIP
CERTIFIED FOOD MANAGER'S NAME(S),Glot// /%'j�)7vi / �I D CERTIFICATE#(S) b / 7
(Required in an establishment where potential) qhjazardous food is prepared
�� / �� � / (�
EMERGENCY RESPONSE PERSON //�f%//�/%r // ,ail—/y1/�L� HOME TEL# � 3- �G 0
DAYS OF OPERATION :. Monday Tuesday Wetlnesda Thursda • `d f Fdda SaturdaySunda
HOURS OF OPERATION
Please writein time of day. / �-- �� %.�� Y---. Z
(For example l7am-tlpm I / /
RETAIL
RESTAURANT
(Outdoor Stationary Food Cart
YES NO
less than I000sq.ft.
=$ 70
TOBACCO VENDOR
1000-10,000sq.ft.
=$280
--- ------------------
NU
DES
more than 10,000sq.ft.
--------------=--------------------- -
T=s`s tFan 25 seats
=$420
-
:7$140
25-99 seats
=$280
more than 99 seats
=$420
-------- - ----- -----
—
$100
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE
YES
$25
TOBACCO VENDOR
YES
$135
ALL NON-PROFIT (such as church kitchens)
YES
If
$25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax
returns and paid all state taxeg,required under the law.
Signature
Date
Updated 523/11 FOODAP2b-1 l.adm Y Check# & Date
Federal 1
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: ( 1`i p ( Date: �4 1 a I I Page: of
Item
No.
Code
Reference
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
PLEASE PRINT CLEARLY
Date -
VerItled
�
C HRY, t o � ( a Q,S o ()r`.
O cx b I s!(4
/ o G I Ft�
I. () d 4DQa 76(",S 61
-
l . ;P.r lV1 B rf kif S I
t
vied SF be C�
Vs vY
bg. has Grorp+ eft e -nu("
of
U
t-er V_U 5 -I( (Y) ICO C7' Farc�
�e ( bnC,tA:&I C h 4 i `i01l- t- Sc1�2 Ch - reSc ,
irr.
of- L9 cic e
U
hP c7KyAs nl (_s ry-PUpd.
v v -
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 Illness. Interventions and Risk
Factors (Items 1-22) (Cont.)
PROTECTION FROM CHEMICALS
14
15
16
17
18
TIMEITEMPERATURE CONTROLS
Food or Color Additives
3-202.12
Additives*
3-302.14
Protection froiWUnappruvod Additives*
FC -2
Poisonous or Toxic Substances
7-101..11
Identifying Information - Original
Containers*
7-102.11,
Common Name - Working Containers*
7201.1.1
1 Separation - Storae`
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*
7-2(4.12
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 Stadons*
7-206.13
Tracking Powders, Pest Control and
Momtorin
TIMEITEMPERATURE CONTROLS
* Denotes critical item in the federal 1999 Foal Code or 105 CMR 590.000.
3-501.14(C) PHFs Received at Temperatures
According to Law Cooled to
41'F/4517 Within 4 Hours. *
Proper Cooking Temperatures for
19
PHFs
3-401.)IA(1)(2)-
Eggs- 155°F15See,
FC -2
Eggs -Immediate Service 145'F15sec*
3-401.11(A)(2)
Comminuted Fish. Meats & Game
3-801,11(C)
Animals - 155°F 15 sec. *
3-401.11(B)(1)(2)
Pork and Beef Roast -130'F 121 min*
3401.11(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 -165017 15 sec.
3-401,11(0)(3)
Whole -muscle, Intact Beef Steaks
! FC - 7
1450F *
3401.12
Raw Animal Foods Cooked in a
!
Microwave 165'F *
3-40131(A)(I)(b)
All Other PHFs - 145-F 15 sec.
!
Reheating for clot Holding
3403AI(A)&(D)
PHFs 1650F 15 sec. *
3403.11(B)
Microwave -165° F 2 Minute Standing
Time*
3403.11(C)
Commermatly Processed RTE Food -
1400F*
3-403.11(E) -
Remaining Unsliced Portions of Beef
Roasts"
Proper Cooling of PHFs
3-501.14(A)
Cooling Cooked PHFs from 14(r° [o
70'F Within 2 Hours and From 7WF
to 41°F/45'F Within 4 Hours. *
3-501.14(B)
Cooling PHFs Made From Ambient
Temperature Ingredients to 41 OF/45g17
Within 4 Hours*
* Denotes critical item in the federal 1999 Foal Code or 105 CMR 590.000.
3-501.14(C) PHFs Received at Temperatures
According to Law Cooled to
41'F/4517 Within 4 Hours. *
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 41'/45° F*
3-501.16(A) Hot PRFs Maintained at or above
Time as a
Variance
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP)
21
3-501.15 Cooling Methods for PHFs
19
PHF Hot and Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 41'/45° F*
3-501.16(A) Hot PRFs Maintained at or above
Time as a
Variance
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP)
21
3-801.11(A)
Unpasteurized Pre-packaged Juices and
Beverages with Warning labels*
590.000
3-801.11(B)
Use of Pasteurized Eggs*
FC -2
3-801..I I (D)
Raw or Partially Cooked Animal Food and
Raw Seed Sprouts Not Served. *
1 Food and Food Protection
3-801,11(C)
Unopened Food age Not Re -served.
CONSUMER ADVISORY
22
3-603. i 1
Consumer Advisory Posted for Consumption of
590.000
1 23.
Animal Foods That are Raw. Undercooked or
FC -2
.003 " i
Not Otherwise Processed to Eliminate
1 Food and Food Protection
FC -3
Pathogens.' E"b""a ",root
25.
3-302. t3
Pasteurized Eggs Substitute for Raw Shea
_.004
.00- 5 1
26.
Eggs*
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, can be
found in the following sections of the Food Code and 105 CHR
590.000,
Rem
I Good Retail Practices
.FC
590.000
1 23.
1 Management and Personnel
FC -2
.003 " i
24.
1 Food and Food Protection
FC -3
1
25.
Equipment and lRensils
I FG -4
_.004
.00- 5 1
26.
Water, Plurnbinq and WasteFC
- 5
.006 !
27.
Physical Facility:
FC -6
W7
28.
Poisonous or Toxic Materials
! FC - 7
.008
29.
Special Requirements
!
.009
30..
I Other
!
.:sw:umv„�tr 2 s
CITY OF SALEM
`� I /
Establishment Name: ��Q LJCe t� BOARD OF HEALTH
X �GQ`p Date: 4 A a I I I Page: a of a
Item
No.
Code
Reference
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN 00 CORRECTION
PLEASE PRINT CLEARLY
Date,.
Verified
Sum ee :5ta i VLPI (t - .C.v_r (i,1 k u, o C,
�-cQ
�U--j-
' {C CQ�` JC «.�, 'Ci CG I l l k2ff f I // 1�p 7-
v
VeL,u ol,�I�,SL. uS-f- iJ Zvi dp � �F m' cxli�rl C�vrt-rc�c-f-
etc tl ck� Sor i -
CD C((a mo 0 1
0 r) Y1 c1 ivr
ntievtu fl d,-�lQase ck(5� �,/ r�ie ce c� Ke< -� PIC"s
cdsuc e {t a� �ex�ane 5s -i riniv cec is f -
21n_'Imc { on -1K3 tcKe U O'ce wi`I {t, ons K 4 // uiol A/x
V � iczfl
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
yourfood permit. ct/t" /�� �,,
Corrective Action Required,,-❑__.
No ❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
❑ Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
L.1Voluntary Disposal ❑ Other:
Violations Related to Foodborne Illness. Interventions and Risk
Factors (Items 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*
3-501.16($)
590.004(F)
Poisonous or Toxic Substances
7-101,11
Identifying Information - Original
Containers*
7-102.11.
Cummnn Name - Working Containers*
7-201.11
Separation - Stotae*
7-202.11
. Restriction - Presence and Use*
7-202.12
Conditions of Use*
7-203.11
Toxic Containers - Prohibitions*
7-204.11
Sanitizers. Criteria - Chemicals*
7-204.12
Chemicals for Washing Produce, Criteria*
7-204.14
Drying Agents. Criteria*
7-205.11
Incidental Food Contact, Lubricants*
7-206.11
Restricted Use Pesticides, Criteria*
7-206.12
Rodent Bait Stations*
7-206.13
Tracking Powders, Pest Control and
Monitoring*
TIME/TEMPERATURE CONTROLS
* Nnotes crifical item in the federal 1999 Food Code or 105 CMR 590.000.
KNO
F=_
3-501.14(C)
Proper Cooking Temperatures for
3-501.15
PRFs
3-401.11A(t)(2)
Eggs- 155°F 15 Sec.
3-501.16($)
590.004(F)
Eggs- Immediate Service 145'Fl5sec*
3401.11(A)(2)
Comminuted Fish. Meats & Game
3501.16(A)
Animals - 155°F 15 sec. *
3.401.11(3)(1)(2)
Pork and Beef Roast -130°F 121 min*
3-401.11(A)(2)
Ratites, Injected Meats -155°F 15
590.U0d(H)
sec. *
3-401.11(A)(3)
Poultry, Wild Game, Stuffed PHFs,
27. -
Stuffing Containing Fish, Meat,
FC -6
Poultry or Ratites -165'F 15 sec.
3-401.110(3)
Whole -muscle, Intact Beef Steaks
i FC = 7
145°F *
3-401.12
Raw Animal Foods Cooked in a
Microwave 165°F *
3-40111(A)(1)(b)
All Other PHFs -145°F 15 sec.
!
Reheating for Hot Holding
3403.11(A)&(D)
PHFs 165°F 15 sec. *
3.403.11(B)
Microwave- 165° F 2 Minute Standing
Time*
3Ak3.I I(C)
Conmlerdally Processed RTE Food -
140°F*
3-403.11(E)
Remaining Unsliced Portions of Beef
Roasts*
Proper Cooling of PRFs
3-501.14(A)
Cooling Cooked PRFs from 140°F to
70'F Within 2 Hours and From 70°F
to 410F/45'F Within 4 Hours. *
3-501.14(B)
Cooling PHFs Made From Ambient
Temperature Ingredients to4l°F/45°F
Within 4 Hours*
* Nnotes crifical item in the federal 1999 Food Code or 105 CMR 590.000.
KNO
F=_
3-501.14(C)
PHFs Received at Temperatures
According to Law Cooled to -
41°F/45`F Within 4 Hours.
3-501.15
Cooling Methods for,PHFs
3-801.11(B)
PHF Hot and Cold Holding
3-501.16($)
590.004(F)
Cold PHFs Maintained at or below
41.0/450 F*
3-501.16(A)
Hot PHFs Maintained at or above
l40'F, *
3501.16(A)
Roasts Held at or above 130°F.
25.
Time as a Public Health Control
3-501. t9
Time as a Public Health Control*
590.U0d(H)
Variance Rectuirement
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP)
21
3-801.11(A)
Unpasteurized Pre-packaged Juices and
Beverages with Warning Labels*
590.000
3-801.11(B)
Use of Pasteurized E *
I FC -2
3-801.11(D)
Raw or Parially Cooked Animal Food and
Rax Seed Sprouts Not Served. r
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
C 23.
Animal Foods That are Raw. Undercooked or
I FC -2
Not Otherwise Processed to Eliminate
Food and Food Protection
I FC -3
Patho ens.* Ef* fl1HI100t
25.
3-302.13
Pasteurized Eggs Substitute for Raw Shea
_00�
-Equipment
26.
1 Egg
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 riskfactors listed above, can be
found in the following sections of the Food Code and 105 CMR
seanrnl.
1 Hem
I Good Retail Practices
I FC
590.000
C 23.
Management and Personnel
I FC -2
24.
Food and Food Protection
I FC -3
__003
.004 I
25.
and Utensils
, FC -4
_00�
-Equipment
26.
_
Water. Piumbi and Waste
- 1 FC -5
006
27. -
Physical Facility
FC -6
.007
28.
Poisonous or Toxic Materials
i FC = 7
.008
29.
S ecia! Requirements
,009
30.
1 Other
!
>'� Commonwealth of Massachusetts
s � City of Salem
Board of Health Kimberley Driscoll
0
120 Washington Street, 4th Floor Mayor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/06/2011
ESTABLISHMENT NAME:
File Number: BHF -2004-000265
The -Daily Bagel=Cifer,
6 East India Square
Salem MA 01970
LOCATED AT: 0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2011-0272 Jan 1, 2011 Dec 31, 2011 $280.00 Old owner Gary Nadeau/The bagel
ESTABLISHMENT Place
PERMIT EXPIRES
Total Fees: $280.00
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted
in prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made,
all plans for such must be submitted to and approved by the Salem Board of Health. Page 1
E CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STLEET, 4T" FLOOR
TEL. (978) 741=1800_
KIIABERLEY DRISCOLL FAX (978) 745=0343 :-.-
NLkYOR DG I`,ENn,wm1(@nI,L*,61. CONE.
DAVID GREENBAum, RS
ACTING HEALTH AGENT
2011 APP ICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT '
NAME OF ESTABLISHMENT / TEL # �
ADDRESS OF ESTABLISHMENT FAX # 9 ,,d" / U ZQ
MAILING ADDRESS (if different)
EMAIL - Business':
Website:
Q/
�-'
OWNER'S NAME AQEfQY4(0
/alem
r✓\
TEL #
/11(QeS ,: C��_3
pp
ADDRESS—_ Oc@\ QLKl ICN
Ln i
((�������� pp
A l/�C/,
MC 1 do-% (93
STREET
CITY
STATE ZIP
CERTIFIED FOOD MANAGER'S NAMES)
U�P)
CERTIFICATE#(S)
(Required in an establishment where potentially food is prepared)
�hazardous
EMERGENCY RESPONSE PERSON 11I�QiIV.
UI CI�
Yh
HOME TEL #__
DAYStOFQPERATION �, Monday j`s.sTuesday''>' Wednesday ti, -Thursday.' I . 'Friday; 1} 7;Saturda ,., Suntlay
HOURS OF OPERATION
Please write in time of days _ 'j, i _ "2 '"l _ —I - (� - C_ 2
(Forexamplellam-11pm) / J _ / J / / CS Etc
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$ 70
1000-10,000sq.ft. =$280
more than 10,000sq.ft. =$420
RESTAURANT W€SJ NO
(Outdoor Stationary Food Cart $210)
less than 25 seats = 140
9 sets =$280
more than 9 sea s =$420
----- ------ -.--- ....
BED/BREAKFAST/ YES NO $100
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25
TOBACCO VENDOR YES NO $135
ALL NON-PROFIT (such as church kitchens) YES NO $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, Improvements,- or equipment changes are made, all plans for
such must be submitted to ind approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax
returns and paid all state taxes required under the law.
Date
Revised I Onli l FOODAP201 Ladm Check# & Date
Social Security or Federal Identification Number
�� S �'�
Commonwealth of Massachusetts
City of Salem
Board of Health
120 Washington Street, 4th Floor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 04/13/2011
ESTABLISHMENT NAME:
File Number: BHF -2004-000265
LOCATED AT:
Kimberley Driscoll
Mayor
Daily Bagel
6 East India Square
Salem MA 01970
0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2011-0422 Apr 13, 2011 Dec 31, 2011 $280.00
ESTABLISHMENT
Total Fees: $280.00
PERMIT EXPIRES IDecember3l,2011
Board of Health I
F
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made,
all plans for such must be submitted to and approved by the Salem Board of Health. Page 1
KUvIBERLEY DRISCOLL
MAYOR
DAVID GRFENBAUM, RS
ACTING HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4.. FLOOR
TFL. (978) 741-1800
FAX (978) 745-0343
DGREENBAUMQ5ffi.Ent. COM
2011 APPLICATION FOR PERMIT TO OPERATE A FOOD
NAME OF ESTABLISHMENT L
ADDRESS OF ESTABLISHMENT.
MAI LING ADDRESS (if different) _
EMAIL -Business:
OWNER'S NAME Fl^1
�Rl9.0
ADDRESS 13b A W
CERTIFIED FOOD MANAGER'S
(Required in an establishment where
EMERGENCY RESPONSE
Ge
Vhk miq 0199D C
Website:
F,�D IR_ �i v) �rhr
TEL#'1'16— I'IU-
15— r7e—Qoo a -
ZIP
3 aa�
TEL# 60�43 I" IIS
DAYS.OFOPERAIION tint "
T
lda;
'
Sun;W
HOURS OF OPERATION
Please verdeituneofday. L\i/�
`v�1"
�% I�p3
7j TI
�/_ 3
Zjys
•�
(Forezamdellam-11pn)
TYPE OF ESTABLISHMENT
RETAIL STORE YES NO
RESTAURANT
(Outdoor Stationary Foal Cart
BED/BREAKFAST/ YES
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE
TOBACCO VENDOR
ALL NON-PROFIT (such as church kitchens)
FEE (check only)
less than 1000sq.ft. =$ 70
1000.10.000sq.ft =$280
more than I0,000sq.fL =$420
less than 25 seats =$140
seats X280
more than 99 seats =$420
YES $25
YES $135
YES NO $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
In the Establishment
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, 1 certify under the pains and penalties of perjury that 1, to my hest knowledge and belief, have filed all state tax
rums d paid all axes required under the law.
SrPnature Date . Social SecuaitvorFederal Identification Number
Revised l0n11 I FOODAP201 Laden Chec]O & Date n'10 : l lo'b l It S
v
The Daily Bagel Caft
Location: Church Street MA, 1970
Area: 2246 SF
MIMT
•ate
U Ormw WAS me
fps= 9M UNOWU As
If I
OWN _
C �
THE DAILY BAGEL CAFE
6 East India Square
Museum place Mall
Salem NIA, 01970
WSRO nt
S1
ON
DAILY BAGEL
6 EAST INDIAN MALL
SUITE 139
SALEM, MA 01970
(978) 740-0001
,`.
"Pee"..
'O
OPEN 7 DAYS A WEEK
8AM - 4PM
EARLY EDITION
BREAKFAST SANDWICHES
EGG SANDWICH
FRIED EGG, CHEESE, BACON, SAUSAGE OR HAM ON YOUR
CHOICE OF TOAST, ENGLISH MUFFIN OR BAGEL.
SUPER DELUXE
2 FRIED EGGS, POTATO, HICKORY SMOKED BACON AND
CHEESE ON A GRILLED ROLL
BLT SANDWICH
2 FRIED EGGS, BACON, LETTUCE, TOMATO AND CHEESE ON
YOUR CHOICE OF TOAST, ENGLISH MUFFIN OR BAGEL
VEGETARIAN
2 FRIED EGGS, SPINACH, MUSHROOM, CARMELIZED
ONION AND CHEESE ON YOUR CHOICE OF TOAST, ENGLISH
MUFFIN OR BAGEL
SWEET AND WARM BREAKFAST IDEA
PEANUT BUTTER, SLICED BANANA SERVED ON YOUR
CHOICE OF TOAST, ENGLISH MUFFING OR BAGEL
STEAK AND EGG
GRILLED STEAK, 2 FRIED EGGS AND CHEESE SERVED ON
YOUR CHOICE OF CIABIATTA, ROLL OR BAGEL
THE BAYOU
ANDOUILLE SAUSAGE, 2 FRIED EGGS AND CHEESE
SERVED ON YOUR CHOICE OF BAGEL OR ROLL
HUMAN INTERESTS
FRESH BAKED GOODS
ASSORTED MUFFINS
BAGELS
BREADS
SCONES
BROWNIES
COOKIES
*ALLERGY ALERT - WE USE NUTS IN AND AROUND MOST OF OUR
PRODUCTS
*CONSUMPTION OF RAW OR UNDERCOOKED FOODS MAY RESULT
IN FOOD BOURN ILLNESS
HIGHLIGHTING
TRIPLE DECKER CLUB SANDWICHES
TURKEY
TURKEY, BACON, LETTUCE, TOMATO AND MAYO ON THREE
SLICES OF TOAST
HAM
HAM, BACON, LETTUCE, TOMATO AND MAYO ON THREE
SLICES OF TOAST
ROAST BEEF
ROAST BEEF, BACON, LETTUCE, TOMATO AND MAYO ON
THREE SLICES OF TOAST
TUNA
TUNA, BACON, LETTUCE, TOMATO AND MAYO ON
THREE SLICES OF TOAST
GRILLED CHICKEN
CHICKEN, BACON, LETTUCE, TOMATO AND MAYO ON THREE
SLICES OF TOAST
EXCLUSIVE
CHICKEN DEBBIE
GRILLED CHICKEN TENDERLOIN, CARMALIZED ONION,
APPLES, SWISS AND PARMESAN CHEESE ON CIABATTA
BREAD
CHICKEN MONIQUE
GRILLED CHICKEN, SPINACH, RICCOTTA CHEESE SAUTED
MUSHROOMS AND MOZZARELLA CHEESE ON CIABATTA
BREAD
CHICKEN AMANDA
GRILLED CHICKEN TENDERLOIN, ASPARAGAS,
MOZZERELLA AND SWISS CHEESE AND A GARLIC AIOLI
MAYONAISE ON CIABATTA BREAD
CITY DESK SALADS
TOSSED SALAD
LETTUCE, TOMATO, ONION, CUCUMBER AND BLACK OLIVES
CAESAR SALAD
ROMAINE LETTUCE, SHREDDED PARMESAN, CROUTONS,
BACON, TOMATO AND CAESAR DRESSING
MESCALIN SALAD (MIXED GREENS)
TOMATO, RED ONION, CUCUMBER, BLACK OLIVES,
SHREDDED PARMESAN CHEESE AND CROUTONS
ANTIPASTO
SALAMI, MORTADELLA, PROVOLONE AND SWISS CHEESE,
PROSCIUTO, ARTICHOCKE HEARTS, PEPPERONCINI, RED
ONION AND BLACK OLIVES
SPINACH SALAD
FRESH MUSHROOMS, BACON, TOMATO, RED ONION, HARD-
BOILED EGG AND BLACK OLIVES
CHICKEN SALAD
WHITE CHICKEN BREAST, CELERY, ONION AND MAYO
SERVED ON A TOSSED GARDEN SALAD
ALBACORE TUNA SALAD
ALBACORE TUNA, CELERY, ONION AND MAYO SERVED ON A
TOSSED GARDEN SALAD
GRILLED CHICKEN
CHICKEN TENDERS SERVED ON A TOSSED GARDEN SALAD
GRILLED SALMON FILLET
SERVED ON A TOSSED GARDEN SALAD
CHEF SALAD
HAM, TURKEY, SWISS AND PROVOLONE CHEESE,
HARD-BOILED EGG SERVED ON A TOSSED GARDEN SALAD
COBB SALAD
TURKEY, SWISS CHEESE, BACON AND HARD-BOILED EGG
SERVED ON A TOSSED GARDEN SALAD
CAJUN SALAD
GRILLED CHICKEN TENDERS; CAJUN SEASONED SERVED ON
A TOSSED GARDEN SALAD
GREEK SALAD
ROMAINE LETTUCE, FETA, KALMATA OLIVES,
PEPPERONCINI AND RED ONION
*CHOICE OF DRESSING ON ALL SALADS
DAILY EXPRESS SANDWICHES
HAM AND CHEESE
ROAST BEEF
TURKEY
CORNBEEF
TUNA
CHICKEN SALAD
*DELI EXPRESS SANDWICHES SERVED ON YOUR CHOICE OF
BREAD AND SAUCE OR DRESSING
BREADS
WHITE, WHEAT, RYE, MULTIGRAIN, BAGEL, SOUR DOUGH,
CIABATTA, FOCASHIA, SUB ROLL, BULKIE ROLL, BAGGETT
SAUCES/SPREADS
MAYO, MUSTARD, CHIPOLE MAYO, HONEY MUSTARD, PESTO,
SUNDRIED PESTO, ROASTED RED PEPPER, BBQ SAUCE, BUFFALO
SAUCE
SIDES
COLESLAW
PASTA SALAD OF THE DAY
HALF SOUR PICKLE (WHOLE)
SOUP OF THE DAY CUP
BOWL
CLAM CHOWDER CUP
BOWL
CHILI CUP
BOWL
*VEGAN/VEGETARIAN SOUPS SERVED DAILY
*LOOK FOR DAILY SPECIALS
SPECIAL EDITION
MOM'S FAVORITE
TURKEY, FRESH BASIL, ROAST PEPPERS, MOZZARELLA CHEESE
AND VINEGARETT
DAD'S FAVORITE
ROAST BEEF, SWISS CHEESE AND BBQ SAUCE SERVED ON A
GRILLED ROLL
PORK CARNITAS
SLOW BRAISED PULLED PORK WITH A RUB OF CHILI, CUMIN AND
GARLIC; TOPPED WITH PICO DIGALLO SALSA AND COLE SLAW
HOT LINKS
TURKEY MELT
TURKEY, TOMATO, CHEESE AND RUSSIAN DRESSING ON YOUR
CHOICE OF BREAD
TUNA MELT
TUNA, TOMATO AND CHEESE ON YOUR CHOICE OF BREAD
JUMBO FRANK
/, LB PEARL COUNTRY CLUB GRILLED AND SERVED ON A
TOASTED NEW ENGLAND STYLE HOT DOG ROLL WITH YOUR
CHOICE OF TOPPINGS
LOBSTER ROLL
KNUCKLE AND CLAW LOBSTER SALAD, CELERY, ONION AND
MAYO SERVED ON A TOASTED NEW ENGLAND STYLE HOT DOG
ROLL
CHILDREN'S MENU
." O e
HOT DOG
$3.50
PATRICK
HAM AND CHEESE
$3.50
AIDEN
GRILLED CHEESE
$3.50
BRUCE
PEANUT BUTTER AND JELLY
$3.50
OSCAR
FLUFF -A -NUTTER
$3.50
*SERVED WITH CHIPS AND BOX DRINK
RUN PRESS
PANINI SANDWICHES
CUBANO
ROASTED SLICED PORK, HAM, SWISS CHEESE, PICKLE AND
DIJON MUSTARD
THE MILANO
ITALIAN SAUSAGE, SPINACH, PROVOLONE CHEESE, GARLIC
AIOLI MAYONNAISE AND ITALIAN SEASONING
VEGETARIAN
MIXED GREENS, TOMATO, CUCUMBERS, CARAMELIZED
ONION, MUSHROOMS AND CHEESE
CHICKEN BASIL PESTO
CHICKEN TENDERLOIN, MIXED GREENS, SWISS OR
MOZZARELLA AND PESTO SAUCE
CHICKEN & SUN DRIED TOMATO
CHICKEN TENDERLOIN, SUN DRIED TOMATO, MIXED GREENS,
RED ONION, MOZZARELLA AND PEPPERCORN DRESSING
CHICKEN OR TUNA SALAD PANINI
YOUR CHOICE OF CHICKEN OR TUNA WITH GREEN ONION,
TOMATO AND JARLSBERG CHEESE
MONTE CRISTO
HAM, TURKEY, SWISS CHEESE AND HONEY DIJON
DRESSING, SIDE OF MAPLE SYRUP
RUBEN
CORN BEEF, SWISS CHEESE, SAUERKRAUT, RUSSIAN DRESSING
ROAST BEEF
MIXED GREENS, TOMATO VERMONT CHEDDAR CHEESE AND
HORSERADISH AIOLI MAYO
CORDON BLEU
CHICKEN TENDERLOIN, BAKED VIRGINIA HAM, SWISS CHEESE
AND HONEY MUSTARD
MUFFALETTA
HAM, SALAMI, MORTADELLA, PROVOLONE CHEESE, OLIVE
VEGETABLE SPREAD, CAPERS, OIL AND VINEGAR
TURKEY ARTICHOKE
SPINACH, ARTICHOKE SPREAD, ASIAGO AND PARMESAN CHEESE,
TOMATO, CARAMELIZED ONION SERVED ON FOCCACIA
WRAP IT UP
WRAPS
ROAST BEEF
LETTUCE, TOMATO, FETA CHEESE AND ROASTED GARLIC
AIOLI
SOPRANO
ITALIAN GRILLED CHICKEN, TOMATO, ROASTED PEPPERS,
MOZZARELLA CHEESE AND MARINARA SAUCE
AVOCADO WRAP
CUCUMBERS, SHREDDED CARROTS, MUSHROOMS,
CARAMELIZED ONION, TOMATO, MONTEREY JACK CHEESE
AND ITALIAN DRESSING
SPICY BUFFALO
CHICKEN TENDER, LETTUCE, TOMATO, ONION, WITH OUR
HOUSE BUFFALO SAUCE
CARIBBEAN
CHICKEN TENDER, LETTUCE, TOMATO, CHEDDAR CHEESE,
CARIBBEAN JERK SAUCE ON A WHOLE WHEAT WRAP
CAPE COD LOBSTER WRAP
KNUCKLE AND CLAW LOBSTER SALAD, CELERY, ONION AND
MAYO
SALMON CUSABI WRAP
GRILLED SALMON, LETTUCE, SHREDDED CARROTS,
CUCUMBERS, ONIONS WITH OUR HOUSE CUSABI SAUCE
NOVEMBER'S HOLIDAY
TURKEY, STUFFING, CRANBERRY SAUCE, AMERICAN
CHEESE AND MAYO
TURKEY
LETTUCE, TOMATO, CUCUMBER, CHEESE AND GARLIC HERB
SPREAD
SMOOTHIES
Imo, m,
F
Wld
EXAM FORM NO. 4440
CERTIFICATE NO. 6322379
#0655
TO EDWARD I N FANTIN O
for successfully completing the standards set forth by the National Restaurant Association Educational Foundation
for the ServSafe® Food Protection Manager Certification Examination, which is accredited by the American National
Standards Institute (ANSI)—Conference for Food Protection (CFP(.
2/20/2009
DATE OF EXAMINATION
2/20/2014
DATE OF EXPIRATION
Local laws apply, Check with your local regulatory agency for recertification requirements.
National Restaurant Association David Gilbert
`� Executive Vice President, Products and Services Group
EG'UCATIONAL FOUNDATION National Restaurant Association Solutions
CM National Restaurant Association Educational Foundation. All rights reserved. ServSafe°and the ServSafe logo are registered trademarks of the National Restaurant Association Educetianal Foundation,
and used under license by National Restaurant Association Solutions, LLC, a wholly owned subsidiary of the National Restaurant Associefion.
This document cannot be reproduced or altered.
11917110, v.11817
NATIONAL c
RESTAURANT
ASSOCIATION
S 0 L U T 1 0 N S TM
CITY OF SALEM
BOARD OF HEALTH
Date: April 5, 2011
Name of Establishment: The Daily Bagel Cafe
Address: 6 East India Mall
Owner: Edward Infantino
Phone: 978-740-0001
The proposed new owner of this establishment Edward Infantino presented a Floor Plan and
Menu for review in accordance with the State Food Code. The floor plan and menu 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.
FLOOR PLAN
A Hand Sink must be located in each food prep and service area. Hand wash sinks are centrally
located in the prep areas. The hand sinks must have wall hung soap and paper towel dispenses.
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.
A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes is available. If
a dishwasher is going to be used it must have a final rinse temperature of 180 degrees in the final
rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm.
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.
UNDERCOOKED FOODS
The advisory was given to the owner. An advisory must be added to the menu
FOOD ALLERGEN AWARENESS
The food allergen awareness advisory must be added to all menus and menu boards.
Information was given to the owner.
CHOKE SAVING
A person trained in choke saving techniques must be available whenever this establishment is
open for business.
EXTERMINATION
Monthly services of a Licensed Pest Control Operator are required. Owner must have an initial
inspection and show documentation of monthly extermination contract prior to opening. 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 3r° 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 must be kept in appropriate trash receptacles and a grease barrel must be used to hold
discarded food grease. The trash area must be kept in a clean and sanitary manner.
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 and check have been received.
A change of ownership inspection will be conducted the week of April 4, 2011.
' -4b,1
David Greenbaum
Acting Health Agent
Owner
The Daily Bagel Cafe THE DAILY BAGEL CAFE
Location: Church Street MA, 1970 6 East India Square
Area: 2246 SF Museum Place Mall
Salem MA, 01970
12 CXIEMM WAR ASO
TARn 1NIN UNGINUAS
dr
♦ /
x
Juice Bar
4.79
All Smoothies include one free boost!
Wheat Germ • Oat Bran • Protein
Additional Boost 79 cents
The Blue Banana • Berry Bliss
Raspberry Rickey • Tropical Cocktail
Sunshine Sipper • Banana Berry
This menu was printed by
Professional
Convenient
Courteous
Service
Your Source For
Copies
Color Copies
Printing
Trade Show & Promotional Items
Direct Mailing
Much More!
Stop by today to get your
FREE personalized Note Pads
100 Cummings Center • Suite 210D
(978) 232-3552
Sandwiches
Served on Bagel, Pita, White, Wheat,
Rye, Pumpernickel, or 5 -Grain.
Sub Roll, Bulkie Roll or Wrap
Toppings and Condiments
Fresh Lettuce • Tomato • Pickles
Onions • Cucumber • Hots
American • Swiss • Muenster • Provolone
Mayo • Low Fat Mayo
Horseradish Sauce
Dijon Mustard • Spicy Brown Mustard
Yellow Mustard • Honey Mustard
Tuna Salad
5.99
Chicken Salad
5.99
Curry Chicken Salad
5.99
Lowfat Lemon Tarragon Chicken Salad
5.99
Egg Salad
5.29
Seafood Salad
5.99
Smoked Turkey Breast
5.89
Honey Baked Ham
5.79
Prime Roast Beef
5.79
Bacon, Lettuce & Tomato (BLT)
5.49
Vegetarian with Hummus
5.99
Grilled Chicken
5.99
Peanut Butter & Jelly
3.25
Veggie Burger
5.99
All sandwiches served with chips and a pickle
Signature Sandwiches
The New Girl - smoked turkey, muenster cheese,
romaine lettuce, tomato and homemade cranberry
orange mayo on 5 grain bread 5.99
The New Boy - smoked turkey, cheddar cheese,
granny smith apple, romaine, tomato and honey
mustard on hearty harvest grain bread 5.99
The Turkey Metaxas - smoked turkey, swiss
cheese, bacon, cucumber, romaine lettuce, onion and
tzatziki sauce (creamy cucumber) 5.99
Hot Meatloaf Sandwich - hearty country white
toast with american cheese, romaine, tgmato, red
onion, ketchup & mayo 6.50
Specialty Wraps
Tuscany Wrap - smoked mozzarella, romaine let-
tuce, roasted red pepper, cucumber, bermuda onion
& creamy balsamic vinaigrette 5.99
with Italian Chicken 6.50
Greek Salad Wrap - romaine lettuce, tomato,
onion, feta cheese, cucumber, & creamy greek
dressing 5.99
with Italian Chicken 6.50
The Milano - Italian grilled chicken with pesto
mayo, provolone, black olives, cucumber, red onion
& romaine lettuce 6.50
The Soprano - grilled chicken and ham with melted
provolone, romaine, roasted red pepper, black olives
& creamy red pepper sauce 6.75
The Foo King Wrap - grilled chicken, shredded
carrot, cucumber, red onion, romaine lettuce,
crunchy peanuts, & spicy Thai peanut sauce 6.50
The Larry Pidgeon - roast beef with swiss cheese,
romaine lettuce, cucumber, tomato, onion & creamy
roasted red pepper sauce 6.50
Chicken Caesar Wrap - Italian grilled chicken, gar-
lic
arlic herb croutons, shredded carrots, romaine lettuce,
parmesan cheese & creamy Ceaser dressing 6.50
Salads
All salads served with pita bread
Garden
4.99
Chef
5.50
Tuna
6.49
Chicken
6.49
Seafood -
6.49
Egg
5.99
Greek
5.99
Grilled Chicken
6.75
Oriental
6.79
Choice of Dressings
Blue Cheese • Greek • Caesar • Creamy Italian
Parmesan Peppercorn • Buttermilk Ranch
Thousand island • Lite Olive Oil
Fat Free Italian • Greek Balsamic Vinaigrette
Fat Free Red Raspberry Vinaigrette
Extra dressing add 25 cents
Chicken Salad
Menu Changes Daily
Curry Chicken Salad 5.99
Bacon Ranch Chicken Salad 5.99
Waldorf Chicken Salad - with grapes,
apples & Walnuts 5.99
Grill Dp7ft:!�t- 1ter
'. -Thur. • Fn.
Ham5. 9�--,
Chee5.
TunaBaco ` 5.99
Tuna99
G eese 5.99
Grill3.99
Cahfo Reuben 5.99
Steak and C e Sub .99
Soup Z'liiIi
Cup 3.49 Cup 3.69
Bowl 4.49 Bowl 4.99
Bread Bowl - Soup or Chili - 5.25
Veganl Vegetarian Soups Served Daily
Pasta Salad of the Day
Menu Changes Daily
Small 3.25 • Large 6.50
Thai Noodle Saladwithvegetables & peanut sauce
Cheese Tortellini Salad -with black olives, red
peppers and a creamy balsamic dressing
Caesar Tortellini Salad -with chicken in a creamy
caesar dressing
BLT Pasta Salad -gemelli pasta with shredded
lettuce, chopped tomato, crumbled bacon,
mayo & seasonings
Tuna Pasta Salad -gemelli pasta blended with
garden vegetables, tuna, mayo & seasonings
Look for Daily Specials
Homestyle Macaroni and Cheese
Cheeseburgers • Wrap Sandwiches
Quiche
Pot Pie • Calzone
Homemade Beef Stew
Meatball Subs • American Chop Suey
Vegetarian Chili
Let The Daily Bagel C
Your Next
Office Meeting
Morning Menu
Fresh Brewed Coffee
Fresh Squeezed OJ
Homemade Muffins • Danish
Fresh Baked Scones • Croissants
Bagels & Cream Cheese
Fresh Fruit Available
Lunch Menu
Our most popular wraps or sandwiches
served on a platter accompanied with homemade
pasta salad, chips, pickles, cookies and soda.
Call (978) 922-2964 or Fax (978) 922-2964
To place your order
Ask far Bela
24 Hour Notice Please
Delivery Available
� vlwe ®
100 Cummings Center • Suite 210D
(978) 232-3552
Stop by today to get your
FREE personalized Note Pads*
We offer pick-up and delivery
at no extra charge!
'Limit 1 set of free
pads per company
4 .c1
•
`q4o-"
We have two locations!
Suite 107P
Phone (978) 922-2964
Fax (978) 232-1267
Open Monday - Friday
6:30am to 6:00pm
"The Daily Bagel Too"
Suite 151J
(978) 922-3501
Open Monday - Friday
7:30am to 2:30pm
100 Cummings Center
Beverly, MA 01915
Phone Orders Welcome
Daily Drinks
Homemade Baked Goods
Muffins
Small Mrdi.m
Lune
Fresh Brewed Coffee
1.48 1.77
1.99
Chat
1.95 2.50
2.99
Assorted Tea
1.48 1.77
1.99
Hot Chocolate
1.52 1.85
2.38
Fresh Brewed Iced Tea
1.60 1.85
2.09
Fountain Soda
1.19 1.45
1.69
Iced Coffee
1.95 2.09
2.38
Milk
1.89
Prices subject to change without notice.
Fresh Squeezed Orange Juice 1.99
Allergy Alert: We use nuts in and around
Coffee sold by
the pound,
2.19
whole bean or ground.
2.19
Specialty
Drinks
Low Fat Strawberry
2.19
5mgk
Double
Espresso
1.45
1.75
Caramel Macchiato
2.80
3.40
Cappuccino
2.55
3.10
Cafe latte
2.70
3.25
Cafe Americano
1.75
2.05
Cafe Mocha
2.70
3.30
Cafe Steamer
1.99
2.25
Iced Latte
2.70
3.25
Extra Shot Espresso
.55
Frozen Chat
3.25
Espresso Bean -Frozen Coffee Drink
4.79
Homemade Baked Goods
Muffins
1.50
Turnovers
1.99
Cookies
1.25
Danish
1.99
Scones
1.99
Crumb Cake
1.99
Biscotti
1.25
Donuts
.99
Cinnamon Coffee Rolls
1.99
Cream Cheese Coffee Rolls
1.99
Brownie
1.99
Low Fat Muffins
1.75
5% Massachusetts meal tax added to all purchases.
2.19
Prices subject to change without notice.
2.19
Allergy Alert: We use nuts in and around
2.19
most of our products.
2.19
Breakfast
Bagels
Plain
1.00
With
1.00
Butter or margarine
1.25
Jam or Jelly
1.59
Peanut Butter and Jelly
2.99
Hummus
2.19
Cream Cheese
2.99
Plain
2.19
Garden Veggie
2.19
Chive
2.19
Bacon Scallion
2.19
Honey Walnut
2.19
Strawberry
2.19
Cheddar Jalapeno
2.19
Garlic Herb
2.19
Olive Pimiento
2.19
Smoked Salmon
2.19
Low Fat
2.19
Low Fat Strawberry
2.19
New York Bagel and Lox
Smoked Salmon with Cream Cheese, Tomato,
Red Onion and Capers on a Toasted Bagel
5.99
Buttered English Muffins
1.00
Toast
1.00
With Jelly
1.39
Cereal
1.69
Yogurt
1.50
Fresh Fruit -
1.00
Fruit Cup
2.99
Breakfast Sandwich
Egg & Cheese with Ham,
Bacon or Sausage on a Toasted Bagel
or English Muffin
2.99
On a Croissant add 50 cents
CITY OF SALEM
BOARD OF HEALTH
Date: September 10, 2007
Name of Establishment: Daily Bagel Cafe
Address: 2 East India Square
Owner(s): Anabela & Fernando Valentim
Phone:
Mr. & Ms. Valentim, accompanied by their attorney, Michelle Carrier -Trial,
presented a Floor Plan and Menu for review in accordance with the State Food
Code.
CERTIFICATION
Ms. Valentim is a Certified Food Manager (CFM). Her son plans to
become certified as well. There must be at least one full time CFM at this
location.
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.
CHOKE -SAVING
There must be someone trained in choke -saving techniques at the
establishment any time it is open for business.
FLOOR PLAN
A Hand Sink is located in both the front counter and rear prep areas.
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. +itis
A three -bay sink will be used to wash, rinse and sanitize all utensils,
equipment and dishware.
MENU/FOOD PREP
Reviewed preparation of soups and sandwiches.
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.
Food must be cooled and heated quickly.
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.
UNDERCOOKED FOODS
No undercooked food will be served at this establishment. This must be
stated on the menu..
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.
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.
The new owner plans to open around September 24, 2007. A change of
ownership inspection will be conducted this week. The opening inspection for
the new owner will be conducted on SePl. AV 14 a+ qAM.
An application and check was not submitted for the permit.
poanne ocan
Health Agent
-/0-07
Date
Notification of Test Result
r s meOpD+y National Registry of Food Safety Professionals
Scat d Test Score @ s;r CERTIFIED FOOD SAFETY MANAGER
Scaled Test Score: 82 j >l
I
Candidate Status: Pass ANABELA VALENTIM
Test Date: April 11, 2007 '"�-T
w � lei
, Certificate No: XE20103915
`rM Issue Date: April 11, 2007
,y
CongratulationsI Attached is your certificate and wallet card. Please notify
....,.-..._.._ ---------------- ..._.-
ANABELA VALENTIM
the National Registry of name or address changes at the address below.
100 CUN MNGS CENTER
Apt: 107P
BEVERLY, MA 01915
Ensure Food Protection (You scored 82% correct). Competent
Purchase. and Receive Food (You scored 91% correct). Mastered -
Food and supplies storage (You scored 50% correct). Needs review
•'
Foods Preparation, Service & Display (You scored 89% correct). Mastered
Equipment & Facilities Maintenance and Cleanliness (You scored 69% correct). Competent
Personnel Hygiene, Training and Behaviors Related to Food Safety (You scored 85% correct). Mastered
Legal Compliance (You scored 0% correct). Needs review
National Registry of Food Safety Professionals® 1 5728 Major Blvd Ste 750 1 Orlando, FL 32819-0000 Phone: 407.352.3830 Fax: 407.352.3603
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 %� (�
Q l �4 d/�Q_
A
Date
(0 -16
TVDa of Operation(s)
C ].Food Service
[I Retail
❑ Residential Kitchen
El Mobile
El Temporary
❑ Caterer
❑ Bed & Breakfast
Permit No.
Tvpe of Inspection
.❑ Routine
[]'Re -inspection
Previous Inspection
Date:
❑ Pre-operation
❑ Suspect Illness
❑ General Complaint
❑ HACCP
El Other
Address.��,,JJ /\
(n hk"L c"YY�SI(�}},( S �r1 r 114--'
Risk
Level
Telephone n 7k n �o 000 Q
I
Owner C n
9101 -A -17
-1AA �i n 0 X1l0te 1h
HACCP Y/N
Person in Char e, PIC /�
g ,(.JII�( fi1,l i Qn.0 A /d.Qon AX
Time
In:(Q �( �
Out:
Inspector (J ->k p nLA
Each violation checked requires an
Violations marked may pose an imminent he
action as determined by the Board of Health.
on the narrative page(s) and a citation of specific provision(s) violated.
Non-compliance with:
ntions and Risk Factors Anti -Choking Tobacco
izard and require immediate corrective 590.009( E) P/ 590.009 (F)
` FOOD PROTECTION MANAGEMENT,. ====711-1
1
❑ 1. PIC Assigned / Knowledgeable / Duties
EMPLOYEE HEALTH
a 8. 7. ,�...-,n a-..�aei Tt«.« ✓6:4.m�ea.e a .,...-. ' ..t a..-.. s r.a,? tlaw.�w�,m ?:.w, 4 - .?
❑ 2. Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
❑ 4. Food and Water from
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCP Plans
I PRbTECTION FROMCONTAMINAnON
❑ 8. Separation/ Segregation/ Protection
9. Food Contact Surfaces Cleaning and Sanitizing
v
❑ 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices
m,.
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
7�C i .N-,
23. Management and Personnel (FC -2)(590.003)
24. Food and Food Protection (FC -3)(590.004)
J 25. Equipment and Utensils I(FC-4)(590.005)
26. Water, Plumbing and Waste (FC -5)(590.006)
27. Physical Facility (FC -6)(590.007)'
28. Poisonous or Toxic Materials (FC -7)(590.006)
29. Special Requirements (590.009)
30. Other
❑ 12. Prevention of Contamination from Hands
[x'13. Handwash Facilities
14. Approved Food or
15. Toxic Chemicals
LJ 16. Cooking Temperatures
[117. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
¢,`,REQUIREMENTs FOR HIGHLY sl1sciEPTIBLE POPULATION$ (HSP)'"",(
El 21. Food and Food Preparation for HSP
JwCONSUMERADVISORY'.,,_,�,.
❑ 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:' -( _ ( u
S. 5901n5 IFOm 14.d /)-),3-10
) (rA a� (/YID �u 'VU,CX �L� _'g
Inspector's Signature: �ac �4^ - Print: C) l�ry
PIC's Signature -f ''^ - - - Print i G � Page of✓ Pages
,
V �v
FQ, i v K e eDv
Violations Related to Foodborne Illness
Interventions and Risk Factors (items 1-22)
FOOD PROTECTION MANAGEMENT
1 590.003(A) Assignment of Responsibility"
590.003(B) Demonstration of Knowledge"
2-103.11 Person in charge - duties
EMPLOYEE HEALTH
2
590.003(C)
Responsibility of the person in charge to
Compliance with Food Law*
3-201.1.2
require reporting, by foal 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(0)
Re orcin by Person in Charge*
3
1 590.003(D)
Exclusions and Restrictions*
3-201.15
590.003(E}
Removal of Exclusions and Restrictions
4
6
.6 10 -.
I Denotes, critical item in the federal 1999 Foal Code or 105 CMR 590.000.
PROTECTION FROM CONTAMINATION
$
Food and Water From Regulated Sources
590.004(A -B)
Compliance with Food Law*
3-201.1.2
Food in a Hermetically Seated Container*
3-201.13
Fluid Milk and Milk Products*
3-202.13
Shell Eggs*
3-202.1.4
t��P ucts. Pasteurized*
3-202.16
Ice Made From Potable Drinking Water*
5-1.01.11
Drinking Water from an Approved System*
590.006(A)
Bottled Drinking Water*
590.006(,B)
Water Meets Standards in 310 CMR 22.0*
Washing Fruits and Vegetables
Shellfish and Fish From an Approved Source
3-201.14
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
Requiatory 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 Pro er Temperatures*
3-202.15
Package Lite it 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
3-402.11
Parasite Destruction*
3-402.12
Records, Creation and Retention*
590.004(1)
Labeling of Ingredients'
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Conformance with Approved Procedures
/HACCP Plans
3-502.11
Specialized Processing Methods*
3-502.12
Reduced oxygen packaging, criteria*
8-103.12
Conformance with A. roved Procedures*
I Denotes, critical item in the federal 1999 Foal Code or 105 CMR 590.000.
PROTECTION FROM CONTAMINATION
$
Cross -contamination
3-302.1 ](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
3-302.1I(A)
Food Protection*
3-302.15
Washing Fruits and Vegetables
3-304.11
Food Contact with Equipment and
Utensils*
Contamination from the Consumer
3-306.14(A)(B)
Returned Food and Reservice of Food*
Disposition of Adulterated or Contaminated
Food
3-701.11
Discarding or Reconditioning Unsafe
Food*
9
Food Contact Surfaces
4-501.111
Manual Warewashing - Hot Water
Sanitization Temperatures* - .
4-501.112
Mechanical Warewashing- HotWater
Sanitization Temperatures*
4501.114
Chemical Sanitization- temp., pH,
concentration and hardness.*
4-601.11(A)
Equipment Food Contact Surfaces and
Utensils Clean*
4-602.11
Cleaning Frequency of Equipment Food -
Contact Surfaces and Utensils*
4702.11
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
4-703.11
Methods of Sanitization - Hot Water and
Chemical*
t0
IProper, Adequate Handwashing
2-301.11
Clean Condition - Hands and Arms*
2-301._1.2
Cleaning Procedure*
2-301.14
When to Wash*
f
Good Hygienic Practices.
2401.11
Eatin , Drinkin 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
590.004(E)
Preventing Contamination from
Employees*
13
Handwash Facilities
Conveniently Located and Accessible
5-203.11
Numbers and Capacities*
5-204.1t
1,ocation and Placement*
5-20511
Accessibility, Operation and Maintenance
Supplied with Soap and Hand Drying
Devices
6-301.11
Handwashing Cleanser, Availability
6-301.12
Hand Drying Provision
Establishment
�v11
P BO0
A M6 F HEALTH -
Date- --hit - Page: of
Rem
Code C - Critical Item
`J
DESCRIPTION :OF:VIOLATION "/PLAN OF CORRECTION
-
Dale
No.
Reference R - Red Item
`PLEASE'PRIKT CLEARLY /? „It<
Verified
IRI
��� �,;`„
Al
a
a
q
`Y nA
h.,,10� A l..l
if (11
)
n.
.�
of
q
,
r
I
A
'Dn i_r, t 1:V, A
SL A.
i
n b ,n 1 ,
A
to L
(p�_ - �f .t
_
\ /^ ,na_ A n
_ _
1
n.1a
O r 1 't n
^v
fly'
,yJ
,
•��
y
/A�v
n
/ee^^ Pi
A
D /
n
_
I
n
(>
< n
n r�D
1 7p�/7
/ n
A A
.e i:QZ e
t 1r
/41z
/fin A ,.
1 n e
Discussion With Person in Charge:
Corre e Action Required:
❑ No
Yes
Voluntary Compliance
❑
Employee Restriction /
z
Exclusion
nV6
Re -inspection Scheduled
❑
Emergency Suspension
❑ Embargo `�
❑
Emergency Closure
RX
Disposal
❑
Other
s
p,..Voluntary
�10A
V dd,
, /!
l
EN, -BOSTON This Form Approved by the Department of Public Health �
�l �V..er�- �- I l t
FORM 7348 (REV. 7/20001 HOBBB & W�RR �
t � �
Violations Related to Foodborne Illness Interventions and Risk
Factors (Red Items 1-22) (Cont.)
PROTECTION FROM CHEMICALS
14
Food or Color Additives
3-202.12
Additives*
3-202.14
Protection from Unapproved Additives*
15
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, Criteria*
7-204.14
DryIng DryingAgents, Cnteoa*
7-205.11
Incidental Food Contact, Lubricants*
7-206.11
Restricted Use Pesticides, Criteria*
7-206.12
Rodent Bait Stations*
7-206.13
Tracking Powders, Pest Control and
Monitoring*
TIME/TEMPERATURE CONTROLS
16
PHFs Received at Temperatures
According to Law Cooled to
4I °F/45"F Within 4 Hours.*
Proper Cooking Temperatures for
Cooling Methods for PHFs
3-801.1 J (D)
PHFs
3-501.16(6)
590.004(F)
3-401.11A(I)(2)
Eggs- 155°F 15 Sec.
Hot PHFs Maintained at or above
140°F*
3-501.16(A)
Eggs - Immediate Service 145°F 15 Sec.*
25.
3-401.11(A)(2)
Comminuted Fish, Meats & Game
Time as a Public Health Control*
590.004(H)
Animals - 155°F Sec.*
FC - 5
3-401.11(B)(1)(2)
Pork and Beef Roast- 130°F 121 Min.*
Physical Facility
3-401.11(A)(2)
Ratites, Injected Meats -155°F 15 Sec.*
28.
3-401.11(A)(3)
Poultry, Wild Game, Stuffed PHFs,
.008
29.S
Stuffing Containing Fish, Meat,
.009
Poultry or Ratites - 165*F 15 Sec.*
Other
3-401.11(C)(3)
Whole -muscle, Intact Beef Steaks
145°F*
3-401.12
Raw Animal Foods Cooked in a
Microwave 165°F*
3-401.11(A)(1)(b)
All Other PHFs- 145°F 15 Sec.*
17
Reheating for Hot Holding
3-403.11(A)&(D)
PHFs 165*F 15 Sec.*
3-403.11(6)
Microwave- 165°F 2 Minute Standing
Time*
3-403.11(C)
Commercially Processed RTE Food -
140°F*
3-403.11(E)
Remaining Unsliced Portions of Beef
Roasts*
18
Proper Cooling of PHFs
3-501.14(A)
Cooling Cooked PHFs from 140°F to
70°F Within 2 Hours and from 70°F
to 41°F/45*F Within 4 Hours.*
3-501.14(B)
Cooling PHFs Made From Ambient
Temperature Ingredients to 41 °F/45°F
Within 4 Hours*
* Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
19
3-501.14(C)
PHFs Received at Temperatures
According to Law Cooled to
4I °F/45"F Within 4 Hours.*
3-501.15
Cooling Methods for PHFs
3-801.1 J (D)
PHF Hot and Cold Holding
3-501.16(6)
590.004(F)
Cold PHFs Maintained at or below
41°F/45°F*
3-501.16(A)
Hot PHFs Maintained at or above
140°F*
3-501.16(A)
Roasts Held at or above 130°F.*
25.
Time as a Public Health Control
3-501.19
Time as a Public Health Control*
590.004(H)
Variance Requirement
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP)
21 3-801.1I(A)
Unpasteurized Pre-packaged Juices and
Beverages with Warning Labels*
3-801.1l(B)
Use of Pasteurized Eggs*
3-801.1 J (D)
Raw or Partially Cooked Animal Food and
Raw Seed Sprouts Not Served.*
3-801.11(C)
Unopened Food Package Not Re -served.*
CONSUMER ADVISORY
22
3-603.11
Consumer Advisory Posted for Consumption of
590.00
23.
Animal Foods that are Raw, Undercooked or
FC - 2
.003
not Otherwise Processed to Eliminate
Food and Food Protection
FC - 3
Pathogens.* ENectiv 11112001
25.
3-302.13
1 Pasteurized Eggs Substitute for Raw Shell Eggs*
SPECIAL REQUIREMENTS
590.009(A) -(D) I Violations of Section 590.009(A) -(D) in
catering, mobile food, temporary and
residential kitchen operations should be
debited under the appropriate sections
above if related to foodborne illness
interventions and risk factors. Other
590.009 violations relating to good retail
practices should be debited under 1129 -
Special Requirements.
VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
(Blue Items 23-30)
Critical and non-critical violations, which do not relate to the
foodborne illness interventions and risk factors listed above, can be
found in the following sections of the Food Code and /05 CMR
590.00.
Item
Good Retail Practices
FC
590.00
23.
Management and Personnel
FC - 2
.003
24.
Food and Food Protection
FC - 3
.004
25.
Equipment and Utensils
FC - 4
.005
26.
Water, Plumbing and Waste
FC - 5
.006
27.
Physical Facility
FC - 6
.007
28.
Poisonous or Toxic Materials
FC - 7
.008
29.S
ecial Requirements
.009
30.
Other
IMPORTANT MESSAGE
FOR V ISS c%Jvr
DATE i I V TIME
PHONE
AREA CODE NUMBER EXTENSION
0 FAX
❑ MOBILE
AREA CODE NUMBER TIME TO CALL
TELEPHONED
PLEASE CALL
CAME TO SEE YOU
. WILL CALL AGAIN
WANTS TO SEE YOU
RUSHb
RETURNED YOUR CALL
WILL FAX TO YOU
nnMcc Ar=
SIGNED
413005 MADE IN U.S.A.
NIOTES
+CGt'73:) Tj L -I I - (� CDC CITY OF SALEM
BOARD OF HEALTH
Establishment
Date: � 7 Page: of
Item
No.
Code
Reference
C - Critical Item
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
i .PLEASE PRINT CLEARLY
Date -.
Verified
���
J S`� V V�TSY GC C -j CClll kCC'C
l� F
v1d o Ce t r h etv--t t l`n1j`IV1)l C� i i� e c f t� �c�
W�"
� r /
V
lfKQ,� (Do (e ms USrnq
C.V1a
nio 5 tli
f_t
k'Q_`hgirlf'P i' i 1 W
1 ' i VI't. Ck0 (-vec I r
_Jct
In v t �� t� s l 1 �.(1 t�.eC 1 C.� �( i %l'i-Q� • �
+t( to ct' -rk i 5 4,r- .
q
\
i
I � I
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
violations before the next inspection, to observe all conditions as described, and to
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspe sion/revocation of
your food permit. j/
Corrective Action Required:
❑ . No
❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction /
Emersion
❑ 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
17
18
TIMEMEMPERATURE CONTROLS
Food or Color Addhives
3120112
Additives*
3-302.14
Protection from Una roved Additives*
3-50L16(B)
590.004(F)
Poisonous or Toxic Substances
7-101.11.
Identifying Information - Original
Containers*
7-102.11.
Common Name - Working Containers*
7-201. L 1
Separation - Stora
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
Dryin ents. Criteria*
7-205.11
Incidental Foorl 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
* Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
19
Im-
3-501.14(C)
Proper Cooking Temperatures for
3-501..15
PRFs
3-401.11A(i)(2)
Eggs- )55'F 15 Sea
3-50L16(B)
590.004(F)
Eggs- Immediate Service 145'Fl5see*
3401.11(A)(2)
Comminuted Fish. Meats & Game
3-50L16(A)
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
590.004(nl
sec. *
3-401A I(A)(3)
Poultry, Wild Game, Stuffed PHPs,
27.
Stuffing Containing Fish, Meat,
I FC -6
Poul or Ratites -165'F 15 sec.
3-401.11(C)(3)
Whole -muscle, Intact Beef Steaks
' FC - 7.008
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
3403.11(A)&(D)
PHFs 165'F 15 sec. *
3403.11(B)
Microwave- 165° F 2 Minute Standing
Tine*
3403.11(C)
Commercially Processed RTE Food -
140°F*
3403.11(E)
Remaining Unsiiced Portions of Beef
Roasts*
Proper Cooling of PHFs
3-501.14(A)
Cooling Cooked PHFs from 140`F to
70'F Within 2 Hours and From 707
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 Hours*
* Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
19
Im-
3-501.14(C)
PRFs Received at Temperatures
According to law Cooled to
41'F/45F Within 4 Hours.
3-501..15
Cooling Methods for PHFs
3-801.11(B)
PHF Hot and,Coid Holding
3-50L16(B)
590.004(F)
Cold PHFs Maintained at or below
410145' F*
3-501.16(A)
Hot PHFs Maintained at or above
140'F. *
3-50L16(A)
Roosts Held at or above 130°F.
25.
Time as a Public Health Control
3-501.19
Time as a Public Health Control*
590.004(nl
Variance Requirement
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP)
21
3-801.11(A)
Unpasteurized Pre-packaged Juices and
Bevera es_with Warning labels*.
590.000
3-801.11(B)
Use of Pasteurized Eggs -
gs*3-801.11(D)
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 PackW 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 Protection
I FC - 3
Pathogens,' >m `rnrzar
25.
3-302.13
Pasteurized Eggs Substitute for Raw Shell
.005
26.
Eggs*
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, carr be
found in the following sections of the Food Code and 105 CMR
590.000.
- Item
Good Retail Practices
.FC
590.000
23_
Management and Personnel!
FC - 2
.003
i 24.
Food and Food Protection
I FC - 3
.004
25.
Equipment Utensils
1 FC -4
.005
26.
_ _and
Wa[er. Plumbingand Wasta
FC -5
.006
27.
Physical Facility
I FC -6
.007
28.
Poisonous or Toxic Materials
' FC - 7.008
29.
S ecial H uirements
.00 9
i 30.
1 Other
Commonwealth of Massachusetts
4 City of Salem
Board of Health Kimberley Driscoll
120 Washington Street, 4th Floor Mayor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED:. 01/04/2010
ESTABLISHMENT NAME:
File Number: BHF -2004-000265
The Daily Bagel Cafe
6 East India Square
Salem MA 01970
LOCATED AT: 0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2010-0088 Jan 4, 2010 Dec 31, 2010 $280.00 Old owner Gary Nadeau/The bagel
ESTABLISHMENT Place
PERMIT EXPIRES
Total Fees: $280.00
31, 2010
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
KIMBERLEY DRISCOLL
MAYOR
DAVID GREENBAUM,
ACTING HEALTH AGENT
CITY OF SALEM, MASSACHUSET"T"S
BOARD OF HEALTH
120 WASHINGTON STREET, 4`FLOOR
FLOOR
TEL. (978) 741-1800
FAx (978) 745-0343
DGREENBAUM@SALEM. COM
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT-- ftf-Ad/01 TEL # qXS-7qC—>, b0L
ADDRESS OF ESTABLISHMENT 7k CFlGv'Cf/ SFAX#
MAILING ADDRESS (if different)
EMAI L - Business':
Website:
OWNER'S NAME 1CF/rP�rS'tibr� L%%"¢TEL#�%T
ADDRESS i7,4 ac,
STREET
C-1
STATE
CERTIFIED FOOD MANAGER'S NAME(S) (/G9Le4,-ZY-4 -KCERTIFICATE#(S)
(Required in an establishment where potentially hazardous food is prepared)
62
ZIP
EMERGENCY RESPONSE PERSON OME TEL # C-00
,D,A,YS`:llF OPERATION , . `s >Monday, k�WTuesdbj;2 Wed"nesday Thurstlay 4 <."FBda ih ?> Saturdays 5 "Sunday
HOURS OF OPERATION 7— 3 -7 7 I 7_ ' 7- 3
Please write in time of day. l 7
Forexample I1am-11 m 1
TYPE OF ESTABLISHMENT
FEE (check only)
RETAIL STORE YES LNC).)
less than 1000sq.ft.
=$ 70
1000-10,000sq.ft.
=$280
more than 1 0,000sq.ft.
=$420
--------------------------- -- -------d-----------------....---------------------,le-s'
RESTAURANT E NO
---------------------------------------------
less than 25 seats
=$140
(Outdoor Stationary Food Cart $210)
25-99 seats
=$280
more than 99 seats
=$420
- ' --------------------Y-•-----ES ------------------------------------------------------
BED/BREAKFAST/ NO
-
-----------------------------------------------
$100
CHILDCARESERVICES/NURSING HOME - --------------------------------------------------------------------
ADDITIONAL PERMITS
MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE
YES NO
$25
TOBACCO VENDOR
YES NO
$135
ALL NON-PROFIT (such as church kitchens)
YES NO
$25
*Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax
returns and paid all state taxes required under the law.
Date
Security or Federal Identification Number
---------------"---- r------ -------------�—ems-- -----------------
Revised 424/07 FOODAP2008.adm Check#&Date$ �—a
0002 EAST INDIA SQUARE The Daily Bagel Cafe
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION
Separation/ Segregation/ Protection FAIL Critical ❑d RED
✓Comment: Walk-in had lunchmeat, cheese, salmon & chicken stored above pitas. Organize walk-in to properly separate PHFs from
RTE items. �—� C -O e %ed CLt -r'nte yr1,5D, /�
Food Contact Surfaces Cleaning and Sanitizing !r FAIL Critical ❑d RED
Comment: Sanitizer feed at 3bay sink strong at approx. 300ppm. Provide sanitizer of proper concentration (200ppm) at all times.
violations Related to Good Retail Practices (Blue Items)
Food and Food Protection
FAIL Critical
BLUE
Comment: Ice machine in kitchen had grime build up on inner panel. Thoroughly clean & sanitize inside of ice machine.
Equipment and Utensils FAIL Non -Critical BLUE
C/Comment: Right frigedaire freezer has broken thermometer. Provide new visible, accurate internal thermometer for this unit.
*3P cc� -hf1ta,O�11 he-in3�
Display case at front counter needs general cleaning in door tracks.
All other violations noted in the 5/26/09 inspection report have been corrected.
Please forward last 3 months' extermination recepits and service slip for refrigerator to the Board of Health within
one week.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeOTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2009) Page 1 oft
�eltx.- $,ew�i'at�e♦gaa-aqs�
978-740=0002
wne-
Or:nabela
A& Fernarido Valenti.`
PIC v
Ltz Covey
Elizabeth Salandrea_
Date
Inspected:Correct By
6/3/2009
Risk Level: t
Permit Nu1.mber
,
BHP 2009=0322 g
Status ''.;
SIGNED OFF _
# of Critical Violations
F
Time IN:
Time OUT "
S 4k
Urgency Description(s):
BLUE:
.Violations 'Related to Good
Retail Practices (Critical
violations must be corrected.;
immediately or within.1O'
days)(Non-critical violations.
hmust be corrected immediately`
r r.within 90 d,ays)�
Item Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION
Separation/ Segregation/ Protection FAIL Critical ❑d RED
✓Comment: Walk-in had lunchmeat, cheese, salmon & chicken stored above pitas. Organize walk-in to properly separate PHFs from
RTE items. �—� C -O e %ed CLt -r'nte yr1,5D, /�
Food Contact Surfaces Cleaning and Sanitizing !r FAIL Critical ❑d RED
Comment: Sanitizer feed at 3bay sink strong at approx. 300ppm. Provide sanitizer of proper concentration (200ppm) at all times.
violations Related to Good Retail Practices (Blue Items)
Food and Food Protection
FAIL Critical
BLUE
Comment: Ice machine in kitchen had grime build up on inner panel. Thoroughly clean & sanitize inside of ice machine.
Equipment and Utensils FAIL Non -Critical BLUE
C/Comment: Right frigedaire freezer has broken thermometer. Provide new visible, accurate internal thermometer for this unit.
*3P cc� -hf1ta,O�11 he-in3�
Display case at front counter needs general cleaning in door tracks.
All other violations noted in the 5/26/09 inspection report have been corrected.
Please forward last 3 months' extermination recepits and service slip for refrigerator to the Board of Health within
one week.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeOTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2009) Page 1 oft
�eltx.- $,ew�i'at�e♦gaa-aqs�
RED
Uiolatlons Related to 0
LLFoodborne Illness Interventions
!and Risk,Factors (Requlrep
immediateCorrective action)=�
Item
Status Violation Critical Urgency
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2009 ) Page 2 of
1 4 0002 EAST INDIA SQUARE
Telephone:'
978w740 -00027j,
'Anabela &Fernando Valenti -
PIC f,
Li z Coveys `
Inspect6r:,4 g A +
Ehzabeff Salandrea
Date Inspected. Correct By "
5/26/2009;
Level c .
�Rlsk
py
Permit Number, ,�
BHP -2009-0322 X:
Status:` -x1 a ar
VIOLATION w °
# of Critical Violations
5 t
Time IN:, "'"
Time OUT:
!Urgency Descriptiori(s).
!BLUE; f .
*'
'Violations Related to Good',.„
Retail Practices (Critical
,violations must be corrected
immediately or within r10
,days)(Non-critical violations
must be corrected immediately
or within 90 days),,
HACCP:
Item
The Daily Bagel Cafe
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
N
Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION
Separation/ Segregation/ Protection FAIL Critical RED
//Comment: Right frigedaire freezer had chicken & roast beef stored with muffins. Organize freezer to properly separate PHFs from
RTE items. p�{
5 14s v d L�Wi� vi�¢.
Walk-in had lunchmeat, cheese, a mon & c icken store abo a bread. Organize walk-in to properly separate PRFs from RTE items.
Food Contact Surfaces Cleaning and Sanitizing � e FAIL Critical WRED
omment: Sanitizer was not available in back or side°pr `jfareas. Sanitizer of proper concentration must be available at all
workstations at all times.
—Sanitizer feed at 3bay sink strong at approx. 300ppm. Provide sanitizer of proper concentration (200ppm) at all times.
ofsi gt
W<anitizer log not lilable; maintain daily log of sanitizer concentration.
pAbay sink had dirty dishes in sanitize bay, and employee was observed sanitizing knives in plastic container rather than in sanitize
bay. 3bay sink must be used properly in a system to wash, rinse & sanitize all equipment & utensils. Bays must only be used as
labeled.
�/Knives stored in kitchen observed to have some food debris on them. All knives must be fully washed, rinsed & sanitized prior to
storage.
V slicer has some food debris on it. Thoroughly clean & sanitize the slicer. W1 tI J{ p
Handwash Facilities FAIL Critical RED
V'eomment: Handwash sink in kitchen had lettuce in it. Handwash sinks to be used for handwashing only.
k.Aseoap dispenser refill in bathroom was not in dispenser. Soap dispenser must be stocked at all times.
Foods)
Hot and Cold Holding
FAIL Critical
RED
VComm'vv
ent: Delfield deli unit in kitchen was at a temperature of 51°F at time of inspection. Cream cheese in top of fridge measured
at 52.8°F, and sauerkraut measured at 50.5°F. PIC stated food had been in fridge sonce opening around 7am. Fridge must be
repaired to maintain temperature of 41°F or lower; all food discarded at time of inspection. Do not use fridge until repaired to be
417 or lowered , and please forward service invoice for fridge to the Board of Health.
LO -10('ep6CA s� Yvu� ihvo e
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 01,2009) Page I of
t
fL
1 Item Status Violation Critical Urgency
IREID-'+" ; '! Violations Related to Good Retail Practices (Blue Items)
Violations Related for h t, Food and Food Protection FAIL Critical BLUE
Foodborne Illness liiterventlons
,'a . - - �omment: Some drinks stored on floor in drink storage area, and more drinks stored on shelf too low to floor. Store all food at
nd Risk Factors (Require least 6-8" off the floor.
II mediate correcGve�actlon)
eft frigedaire freezer had uncovered slush, and a bag of bagels stored on top of an uncovered slush container. Cover all food in
WAX,�� ,,((��sttorage to prevent cross contamination.
SJ91Ldllce machine in kitchen had grime build up on inner panel. Thoroughly clean & sanitize inside of ice machine.
v4alk-in had some uncovered vegetables. Cover all food in storage to prevent cross contamination.
V/Both deli units in front had employee drinks in them. Store employee items separately to prevent cross contamination.
./ce machine at front counter left open and scoop was stored on soda machine. Close ice machine to prevent contamination, and
store scoop either in a clean sanitized container or in ive with handle extending out.
L./Fruit and yogurt cups in small snapple fridge must have proper labeling.
,.Amployee observed answering cell phone while preparing and serving food to customers. Personal items are not allowed in food
prep areas.
t/3 sugar free redbulls and 3 bags cape cod chips were removed, outdated. Owner to closely monitor all expiration dates.
Equipment and Utensils FAIL Non -Critical BLUE
(comment: Imperial freezer missing thermometer. Provide visible, accurate internal thermometer for this unit.
Right frigedaire freezer has broken thermometer. Provide new visible, accurate internal thermometer for this unit.
,,/Both frigedaire freezers need general cleaning & defrosting.
✓oth deli units in front need general cleaning inside and around edges in top.
x0aster needs general cleaning.
✓Microwave needs general cleaning.
� Display case at front counter needs general cleaning in door tracks.
Physical Facility FAIL Non -Critical BLUE
(/t<omment: Stained ceiling tiles observed in dining room. Investigate for leaks & replace any stained tiles throughout establishment.
Reinspection in one week, all violations to be corrected.
Please have last 3 months' extermination recepits available at reinspection.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeOTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 01,2009 ) Page 2 of
Item
Status Violation Critical Urgency
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 01,2009) Page 3 of
'J".il'ewe..-..+tve.ao+..y.1�i,F..A .>'.R#e. .�%1. .:3o�e.�r.1 �., e,v�"�.;,ls.;.+a'i;,rkk���7++.+y,-11�,�,++6�wJ6Yr.':S"�e?i:.-%'ts''"•'+.1 j1;...a't'a<'./X n.. .
Massachusetts Department of Public Health Salem Board of Health
120 Washington Sreet,
Division of Food and Drugs Salem, MA 019 0-35234" Floor
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Name
, () J
Date
F�_09FW1Food
Type of Operations)
Service
Retail
❑❑ Residential Kitchen
❑ Mobile
❑ Temporary
❑ Caterer
❑ Bed & Breakfast
Permit No.
Type of Inspection
Routine
Pr Re -inspection
Previous Inspection
Date:
❑ Pre-operation
❑ Suspect Illness
❑ General Complaint
❑ HACCP
❑Other
Address
.1
Risk
Level
Telephone a _ /
1
Owner 1 /� II �--
ENJOY it (I'�/ 90.4.-X,-'
HACCP YM
Person in Charge (PIC)
l� /V 2P
Inspector ( X� v )I s
Time
Time J
Out'.a
Each violation checked requires an_! xpl nation 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))ZO 590.009 (F)A
action as determined by the Board of Health.
FO D PROTECTION NIANAGEMENT_V` ""!u°99"__Tr IME"In
X43-vx .i,Nwb..+ A«
1. PIC Assigned / Knowledgeable / Duties
q EMPLOYEE HEALTHWk , °�".a, MrE{I� �_LU_
❑ 2. Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
.FOOD FROM APPROVED
❑ 4. Food and Water from Approved Source
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCP Plans
PROTECTION MOM CONTAMINATIONE-
❑ 8. Separation/ Segregation/ Protection
�9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
[111. Good Hygienic Practices
Violations Related to Good Retail Practices
Critical (C) violations marked must be corrected
immediately or within 10 days as determined by the Board
of Health. Non-critical (N) violations must be corrected
immediately or within 90 days as determined by the Board .
of Health.
23. Management and Personnel (FC -2)(590.003)
24. Food and Food Protection (FC -3)(590.004)
25. Equipment and Utensils (FC -4)(590.005)
26. Water, Plumbing and Waste (FC -5)(590.006)
27. Physical Facility (FC -6)(590.007)
28. Poisonous or Toxic Materials (FC -7)(590.008)
29. Special Requirements (590.009)
30. Other �I'P0
S, 5X[ns fFo. 14.dX l.i^pn:T Y�� f ��
U(u(db 4 �� lt-n�.. (34-"n
M
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
f'PROTECTION FROM GHEMICALs aW rr K r r `"� rh
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIMEREMPERATURE CONTROLS (4?otent1e11y Haiardousfoods)
[116. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
,J�19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
1"iiEOUiREIuIENTsFOR- IIGHLY sUsOEPT1al,E i'OPULATIQNS (HSP)T
❑ 21. Food and Food Preparation for HSP
.CONSUMED ADVISURYu,m �: "'_°" gi��"@°R 4
❑ 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: T11i V t ( 'a)�
PIC's Signature: t' } \ ` `,.�
Print:. �\ Cv r� V /�-1 I
Page of !Pages
0
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(0)
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 Foal Employee Or An
3-202.16
Ice Made From Potable Drinking Wafer*
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
1 590.(l03(D)
Exclusions and Restrictions*
3-201.15
590.003(F)
Removal of Exclusions and Restrictions
C
C
C
C
"Denotes critical item in the federal 1999 Pond Cade or 105 Cb1R 590.000.
KelflffMOT 1 f l T It \ i 0 I
Food and Water From Regulated Sources
590.004(A -B)
Compliance with Food Law*
3-201.12
Food in a Hermetically Sealed Container*
3-201.13
Fluid Milk and Milk Products*
3-202.13
Shell Eggs*
3-202.14
Eggs and Milk Products. Pasteurized*
3-202.16
Ice Made From Potable Drinking Wafer*
5-101.11
Drinking Water from an Approved System*
590.006 A)
Bottled Drinking Water*
590.006(B)
Water Meets Standards in 310 CMR 22.0"
Washin Fruits and Vegetables
Shegtish 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(0)
Wild Mushrooms*
3-201.1.7
Gam, Annuals-
3-701.11
Receiving/Condition
3-202.11
PHFs Received at Proper Temperatures*
3-202.'15
Package hiteit-* -
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
3-40211
Parasite Destruction*
3-402.1.2
Records. Creation and Retention*
590.004(1)
Labeling of Ingredients'
Frequency of Sanitization of Utensils and
Food Contact Surfaces ofEquipment*
Conformance with Approved Procedures
/HACCP Plans
3502.11
Specialized Processing Methods*
3-502.1.2
Reduced oxygen acka "ng. criteria*
8-103.12
Conformance with Approved Procedures*
"Denotes critical item in the federal 1999 Pond Cade or 105 Cb1R 590.000.
KelflffMOT 1 f l T It \ i 0 I
Cross -contamination
-
3-302.11(A)(])
Raw Animal Foods Separated from
Cooked and RTE Foods*
Contamination from Raw Ingredients
3-302.1.1(A)(2)
RawAnimalFoods 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
,-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..1.11
Manual Warewashing - Hot Water
Sanitization Temperatures*
4-501.112
Mechanical Warewashing- Hot Water
Sanitization Temperatures*
4-501.11,4
Chemical Sanitization- temp., pH,
concentration and hardness. 'r
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 ofEquipment*
4-703.11
Methods of Sanitization - Hot Water and
Chemical*
10
Proper, Adequate Handwashing
2-301.11
Clean Condition - Hands and Anus"
2-301.12
Cleaning Procedure*
2-301.14
When to Wash*
1.1
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(E)
Preventing Contamination from
Em to ees*
13
Handwash Facilities
Conveniently Located and Accessible
5-303.11
Numbers and Capacities*
5-204.11
Location and Placement*
5-205.11
Accessibility, Operation and Maintenance
Supplied with Soap and Hann Drying
Devices
6-301.11.
Handwashin Cleanser, Availability
6-301..12
Hand Drying Provision
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: -A'
C� P" Date: Page: of
Ile
Code
Critical It
IC7 MEMO
2,
ION/ PLAN OF CORRECTION Y
U. DESCRIPTION OF VIOLATION/ t % _' P�� I , 1P
;Date
erified
R-Redli
PLEASE"P njt�rr CLEARLY AMP,.
1 -47 11A
'/v i -/OQ
_11
-o
11A 1 0 A P
tj)
'0--) 4 0 'Y IA, (J�l rVA.1 :q I VA 9,1 P, 11..1/14P
.
VIM)X�-
+,OA A—/ 1J. in Xf —i,,;l
J,
_4(
MOA
Al 0
7
A
_-A
N -v
I,., RAP. n'),i�f4
Discussion With Person in Charge:
Corrective Action Required:
U No
u --Yes
I have read this report, have had the opportunity to ask questions and agre'e, to correct all
b� Voluntary Compliance U Employee Restriction
Exclusion .
violations before the next inspection, to observe all conditions as described, and to
Lj Re -inspection Scheduled Lj Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
may result in daily fines of twenty-five dollars or suspension/revocation of
0 Embargo L3 Emergency Closure
;noncompliance
Violations Related to Foodborne Illness interventions and Risk
Factors (item 1-=) (Cont')
PROTECTION FROM CHEMICALS
14 1 1 Food or Color Additives
3-302.14 Protcetion fro!Hj1n&pprVved Add[
Pol nous or Toxic Substances
7
7--t01.11 Identiffing Infia ination ---0 n;"
7 102,11
Covartioln Name -- Workia,, Court
77201.11
S�
7-202.11
Rcstriclion - Fros,,"-ce and Use*
7-20112
Conditions of Use,
7-203,11
Toxic, Connanco, - prof it bi: mpz*
1-204.1
e ",n'ts-
7-2()4. 12
Chen Gals for Washj��,PrL) Lhjce;
7-7-204.14
----
UmnaALenTCriteria"
7-206.12 1 R(Alew h4it Stations*
-206_'12 r1l, —rackmPowders. Pest control and
TIME/TEMPERATURE CONTROLS
T
Proper Cooking Temperatures for
3 401 . I I A,(l !(2; i Fin, 155 F IS S,,,
11)emsesmat ilhem 6ithee lockmal 1999
3-501.14{C) 1 PHFs Remwd at Teouperatures,
Ac:eording 10 Law conled to
Within Houm
Control'
n
590,004(11)
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
3-50!'160f Cold PHFs Maintained at or below
3 -SOI #6tAj iToflffi , Mba�namad in, above
140'F,
50J6(
IA) kwsts Heldat orabove 130"F,
Time as a Public Health Conu of
1-50i IQ I Timm as a Public Health
21 1; 3-&(11.t i(A) I
..... ed h'
—380TT—I(r),
Rav, Sero sprouia Not Served. 35
N-4 P- A-"' ?v"' U. --i
22 i 3 4)0 3, 11 Cowinner :Wk isor% Nowd for (Amintription of
Animal F,K>JK'Fhat arc Raw, Undmmikcd oi
Not ise Pr(cea%ed to l3limina(c
I
alho" 'm
--4 Pt-102.13 I'sTcm i icd E
Sobstinne ton Raw Shell
9w*Am
Violatjous of Section 590,(X)9(A)-(D) in
Catera )g mobilo fcaxL temporruy and
residentwt kitchen opelaflons akould lie
OcIaled tinder the
above, if iciated io tcsodlloore illness
interventions and rislk factors. Othcr
590.009 Violations rehltinw to glood retail
practices should be debited under 1129 -
Specfal Requirements,
VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
(I teinq 23-30)
C)Wra" and nonq ritwal vk)lav'ms, which do no, relate to the
foodborne dinets viterverui otza and mkperors 1svcd al,ore_ can be
ff"'4nd in seroonv 04 the Food Codand 105 Casa
fatl.()t
, .0
+Comminoted
3-401.11(A)(2)
Fish, Mears & Ganiv
AnimaLs 155'1715sec. '
34
3
Pork and llt�et kcsist - I 301F 121 nan,
3-410 1. i 1 (A)(2)
Ratnes. fnlCtcd fdats 155 T 15
sec.
(aare,
Stuffmtz Conaming Fish .'deaf,
Poultry oi Ratites -165`l IS wc�
—((0;—
—�'Nlhole -an-m'714", In! ac-tli-e—cf —Sleaks-
145117 i� ----- —
12
K1
Raw Aut;nai .Cooked1 Cooked ni a
Nficlowave 165'1'
'•401.I1tA}(I)tb3
111 Othei PHI-,, - 145`'17 15 sec,
—F)
R F efreating for Hot Holding
3, I '
;&
=
PIIFs Its"F Ii scot'"
3-t0m 1 (B)
-Microwave- 165' F 2 Minute Standing
Tom,
It(`)
Commercially Provesssd RTF, Kxd
4Q. F
3 0111(1_)
Rennuninc, (,nshced Pornons (if Beef
Roaw*
Proper Cooling of PHIFS
70'17 Within 2 Hours and Front 7(j'['
1 io 41`1`145i F'Within 4 Hour.
3 50#.14(13)
Cooling IIHFs Made From Ambient
Ingredients to 41'1,'/45'F
11)emsesmat ilhem 6ithee lockmal 1999
3-501.14{C) 1 PHFs Remwd at Teouperatures,
Ac:eording 10 Law conled to
Within Houm
Control'
n
590,004(11)
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
3-50!'160f Cold PHFs Maintained at or below
3 -SOI #6tAj iToflffi , Mba�namad in, above
140'F,
50J6(
IA) kwsts Heldat orabove 130"F,
Time as a Public Health Conu of
1-50i IQ I Timm as a Public Health
21 1; 3-&(11.t i(A) I
..... ed h'
—380TT—I(r),
Rav, Sero sprouia Not Served. 35
N-4 P- A-"' ?v"' U. --i
22 i 3 4)0 3, 11 Cowinner :Wk isor% Nowd for (Amintription of
Animal F,K>JK'Fhat arc Raw, Undmmikcd oi
Not ise Pr(cea%ed to l3limina(c
I
alho" 'm
--4 Pt-102.13 I'sTcm i icd E
Sobstinne ton Raw Shell
9w*Am
Violatjous of Section 590,(X)9(A)-(D) in
Catera )g mobilo fcaxL temporruy and
residentwt kitchen opelaflons akould lie
OcIaled tinder the
above, if iciated io tcsodlloore illness
interventions and rislk factors. Othcr
590.009 Violations rehltinw to glood retail
practices should be debited under 1129 -
Specfal Requirements,
VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
(I teinq 23-30)
C)Wra" and nonq ritwal vk)lav'ms, which do no, relate to the
foodborne dinets viterverui otza and mkperors 1svcd al,ore_ can be
ff"'4nd in seroonv 04 the Food Codand 105 Casa
fatl.()t
, .0
21 1; 3-&(11.t i(A) I
..... ed h'
—380TT—I(r),
Rav, Sero sprouia Not Served. 35
N-4 P- A-"' ?v"' U. --i
22 i 3 4)0 3, 11 Cowinner :Wk isor% Nowd for (Amintription of
Animal F,K>JK'Fhat arc Raw, Undmmikcd oi
Not ise Pr(cea%ed to l3limina(c
I
alho" 'm
--4 Pt-102.13 I'sTcm i icd E
Sobstinne ton Raw Shell
9w*Am
Violatjous of Section 590,(X)9(A)-(D) in
Catera )g mobilo fcaxL temporruy and
residentwt kitchen opelaflons akould lie
OcIaled tinder the
above, if iciated io tcsodlloore illness
interventions and rislk factors. Othcr
590.009 Violations rehltinw to glood retail
practices should be debited under 1129 -
Specfal Requirements,
VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
(I teinq 23-30)
C)Wra" and nonq ritwal vk)lav'ms, which do no, relate to the
foodborne dinets viterverui otza and mkperors 1svcd al,ore_ can be
ff"'4nd in seroonv 04 the Food Codand 105 Casa
fatl.()t
, .0
L`
0002 EAST INDIA SQUARE
Telephone:
978-740-0002
Owner:
Anabela & Fernando Valenti
PIC:
Blake Valentin
Inspector:
Elizabeth Salandrea
Date Inspected: Correct By:
6/5/2008
Risk Level:
Permit Number:
BHP -2008-0323
Status:
SIGNED OFF
# of Critical Violations:
2
Time IN: 'ITime
OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
HACCP:
The Daily Bagel Cafe
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
I•
Item Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION
Food Contact Surfaces Cleaning and Sanitizing FAIL Critical V. RED
Comment: Cutting board at the Delfield deli unit is stained and scored. Resurface or replace cutting board.
Sanitizer log not available - sanitizer log must be maintained daily. New log sheets have been given to PIC.
Violations Related to Good Retail Practices (Blue Items)
Food and Food Protection
FAIL Critical
BLUE
Comment: Walk-in fridge had some uncovered vegetables in it. All food in storage must be covered to prevent cross contamination.
All other violations noted in the 5/28/08 inspection report have been corrected.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2008) Page l oft
Item
RED:
Violations Related to
Foodborne Illness Interventions!
and Risk Factors (Require
immediate corrective action)
Status Violation Critical Urgency
01-�— ��4�
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 09,2008) Page 2 oj2
0002 EAST INDIA SQUARE
1�Icz�ffl
jTelephone:
978-740-0002
Owner:
Anabela & Fernando Valenti
/PIC:
Claudia Carvalho
iInspector.
) Elizabeth Salandrea
Date Inspected: Correct By:
15/28/2008
4Risk Level:
5 r
I
IPermit Number:
I BHP -2008-0323
Status:,
VIOLATION
I# of Critical Violations:
HACCP:
The Daily Bagel Cafe
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
11
Item Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION
Food Contact Surfaces Cleaning and Sanitizing
FAIL Critical
Comment: Cutting board at the Delfield deli unit is stained and scored. Resurface or replace cutting board.
RED
Sanitizer log not available - sanitizer log must be maintained daily. o�hn
Violations Related to Good Retail Practices (Blue Items)
Food and�ood Protection FAIL Critical BLUE
".O/Comment: Frigedaire freezer in back room had personal ice cream in it. Store all employee items in a separate designated area to
prevent cross contamination. UU
Walk-in fridge had some uncovered %>� All food in storage must be covered to prevent cross contamination.
✓Slush freezer had uncovered slush. All food in storage must be covered.
verage air deli unit had a personal drink stored in it. Store all employee items in a separate designated area.
splay case refrigerator at front holding at approximately 46°F. Turn up or provide a cover for the unit to maintain temperature of
41"F or below.
Equipment and Utensils FAIL Non -Critical
�mment: Frigedaire freezer in back room needs general cleaning.
2 W in fridge missing thermometer. Provide visible, accurate internal thermometer for this unit.
Time IN: Time OUT:,
Urgency Description(s): I YYY
BLUE:
Violations Related to Good 1
Retail Practices (Critical
violations must be corrected
immediately or within 10 j
days)(Non-critical violations !
must be corrected immediately !
or within 90 days) j
--- I
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 28,2008) Page / of
BLUE
M/of -stored in bucket in back room. Store mop hanging to air droca y.
I�te-Secure "hand sink only" sign to the wall at handsink in dishroom.
ush freezer needs general cleaning.
as r needs general cleaning of crumbs inside.
cola drink fridge needs general cleaning in the door tracks.
Physical Fac .ty FAIL Non -Critical BLUE
omment: There are stained ceiling tiles in the dining area and in the hallway to the restrooms. Investigate source of leak/staining
and replace all stained tiles.
Item
Status Violation Critical Urgency
'RED:
;Violations Related to Reinspection in one week, all violations to be corrected.
Foodborne Illness lriterventionsi 7
and Risk factors (Require, tMease have last 3 months of extermination invoices available at reinspection.
immediate corrective action) E
6�0 Q Q�Vvz�"k
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 28,2008 ) Page 2 oft
r -
M Commonwealth of Massachusetts
i City of Salem
Board of Health 10mberiey Driscoll
120 Washington Street, 4th Floor Mayor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 12/30/2008
ESTABLISHMENT NAME:
File Number: 13ttF-2004-000265
LOCATED AT
The Daily Bagel Caf6
6 East India Square
Salem MA 01970
0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type
Permit No. Permit Issued
Permit Expires
Fee Restrictions / Notes
FOOD SERVICE
BHP -2009-0322 Dec 30, 2008 .
Dec 31, 2009
$280.00 Old owner Gary Nadeau/The bagel
ESTABLISHMENT
Place
PERMIT EXPIRES
Total Fees: $280.00
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
KINIBERLEY DRISCOLL
MAYOR
,JANET DIONNE,
ACTING HEALTH AGENT
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4" FLOOR
TEL. (978) 741-1800
FAx (978) 745-0343
1DIONNE SALEM. COM
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT le -b". ,(G Q
HQ , TEL # / 6 k-6 5`0 "-OUc�—
ADDRESS OF
MAILING ADDRESS (if different)
EMAIL - Business':
OWNER'S
AD
Website:
TEL #0�1
STREET CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S)�c (( { U p/tU,rnr J CERTIFICATE#(S)
(Required in an establishment where potentially hazard-ousJJfood is prepared)
EMERGENCY RESPONSE PERSON 4.04 /J-0- tln Y HOME TEL #
DAY.S,OF.;OPERATION Monda Tuesd , '" i"*.Wednesda a .moi' Thursday l
s : Friday - ( Sunday'
HOURS OF OPERATION m
oSaturday
Please write in time of day.
(Forexamplellam-11pm) I Spm 3190--N 31Pm t
3vry,� 1 &fry) 3tph-t.
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES bJ less than 1000sq.ft. =$ 70
�J 1000-10,000sq.ft. =$280
more than I0,000sq.ft. =$420
RESTAURANT
(Outdoor Stationary Food Cart
INN
less than 25 seats =$140..
25-99 seats =$28
more than 99 seats 420
&
AJ6bifJf6RkD�EkMJT_§
--- ---------------------------------------------------------------------------------------------
BED/BREAKFAST/ YES NO $100
CHILDCARE SERVICES
------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 O $25
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
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 fled all state tax
returns and paid all state taxes required under the law.
Signature
Date
or
--------------------------------- --- - ---------------
Revised 424/07 FOODAP2008.adm Check# & Date / % i 2 �f7 $Q +{7V
DATE PRINTED:
Commonwealth of Massachusetts
City of Salem
Board of Health
120 Washington Street, 4th Floor
SALEM, MA 01970
Food/Retail Establishment Permit
01/08/2008
ESTABLISHMENT NAME:
File Number: BHF -2004-000265
1Gmbedey Drisooll
Mayor
The Daily Bagel Caf6
6 East India Square
Salem MA 01970
LOCATED AT: 0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2008-0323 Jan 7, 2008 Dec 31, 2008 $280.00 Old owner Gary Nadeau/The bagel
ESTABLISHMENT Place
Total Fees: $280.00
PERMIT EXPIRES December 31, 2008
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Page 11 of 14
Y
��W,yrrygcl
KIMBERLEY DRISCOLL
)MAYOR
JOANNE SCOTT,
HEALTH AGENT
CITY OF SALEM, MASSAC HUSEM
BOARD OF HEALTH
120 WASHINGTON STREET, 4"r FLOOR
'ISL. (978) 741-1800
FAX (978) 745-0343
)SCOTTaa SALEM. GOM
2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT ) e ` /ftp�J 154
` �� TEL # 9 I c6' Jy O " OOya
ADDRESS OF ESTABLISHMENT Ifd C t , (- St, Unik 139 _ FAX # 91$-1 10 - COO I
MAILING ADDRESS (if different)
EMAIL - Business':
Website:
OWNER'S NAMECo(-V......& A plitnc&dyichP-e \T \y TEL#_D�1Il�S"
ADDRESS WdStil ' '^'
STREET - CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S)� IPfy\ r CERTIFICATE#(S) X � �J,I��G 1-'
(Required in an establishment where potentially
,72
�hazardous
'food is prepared)
EMERGENCY RESPONSE PERSON 1716 KK UC1�Mktytn HOME TEL # `](7FS %616 3 730
Please write in time of day.
(ForezamDle llam-11pm)
TYPE OF ESTABLISHMENT
RETAIL STORE YES NO
RESTAURANT YES NO
(Outdoor Stationary Food Cart $210)
-----------------------
BED/BREAKFASTI YES NO
CHILDCARE SERVICES ----------------------.------------------- ---..-.
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE
TOBACCO VENDOR
ALL NON-PROFIT (such as church kitchens)
-1r*,-
FEE (check only)
less than I000sq.ft. =$ 70
1000-10,000sq.ft. =$280
more than 10,000sgA. =$420
-------------------------------------------
less than 25 seats
25-99 seats
more than 99 seats
YESNO
YES
YES
=$140
=$280
=$420
$
1 0 0
. 0 -
.-----
$25
$135
$25
-t 30PYn
'Please pay total with one check payable to the City of Salem.
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location
in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for
such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax
returns and paid all state taxes required under the law.
Date
Revised 4/24/07 FOODAP2008.adm Check# & Date
Security or Federal
$ asO,O O
Commonwealth of Massachusetts
City of Salem
Board of Health
120 Washington Street, 4th Floor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 11/01/2007
ESTABLISHMENT NAME:
File Number: BHF -2004-000265
Kimberley Driscoll
Mayor
The Daily Bagel Cafe
6 East India Square
Salem MA 01970
LOCATED AT: 0002 EAST INDIA SQUARE
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions /Notes
FOOD SERVICE BHP -2007-0660 Oct 16, 2007 Dec 31, 2007
ESTABLISHMENT
Total Fees:
PERMIT EXPIRES December 31, 2007
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Page t of 1
CITY OF SALEM, MASSACHUSETTS
o BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
W W W.SALEM.COM
Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO
Mayor HEALTH AGENT
2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT�I I TEL # 9 - 1 70-00Da\
ADDRESS OF ESTABLISHMENT FAX #9 7 - 710- 0001
MAILING ADDRESS (if different)
EMAIL -- Business':
OWNER'S
Owner's:
TEL
ADDRESS
STREET CITY
( STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) l I^^fl r,O hn ��(ydz;k CERTIFICATE#(S) /�Xj (A D -32L)
(Required in an establishment where potenliall hazardous food is Prepared)
EMERGENCY RESPONSE PERSONLILAQf-�X y^ Vi��OQAHOME TEL
---- - -- - - - --
BED/BREAKFAST YES NO
-- - . . . .... - -
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE
TOBACCO VENDOR
ALL NON-PROFIT (such as church kitchens)
--- ----- ---- ----- ------------
$100
YES NO $5
YES NO $50
YES (n $25
'Please pay total with one check payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a
prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are
made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief,
have filed all stle tax mtu ns and paid all state taxes required under the law.
n� nf7&, 3
nature Date Social Security or Federal Identification Number
Bevlsed 11/13/06 FOODAP2007.adm Check# & Date
7�0t/���
�t��
Please atnte in time of day'
lnPth Pm
P (o P Yh
4 F Y�'� L]
1 �m
(for example11am11pm1
TYPE OF ESTABLISHMENT
FEE (check only)
RETAIL STORE
YES O
less than 1000sq.ft.
1000-10,000sq.ft.
=$ 50
=$100
more than 10,000sq.ft.
=$250
------
RESTAURANT
-- -....- - -----------------
YES NO
----- ..... l - -------------
less than 25 seats
---- ---------
=$100
=$150
more than 99 seats
=
---- - -- - - - --
BED/BREAKFAST YES NO
-- - . . . .... - -
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE
TOBACCO VENDOR
ALL NON-PROFIT (such as church kitchens)
--- ----- ---- ----- ------------
$100
YES NO $5
YES NO $50
YES (n $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 stle tax mtu ns and paid all state taxes required under the law.
n� nf7&, 3
nature Date Social Security or Federal Identification Number
Bevlsed 11/13/06 FOODAP2007.adm Check# & Date
7�0t/���
Massachusetts Department of Public Health
Division of Food and Drugs
FOOD ESTABLISHMENT INSPECTION REPORT
_a
Salem Board of Health
120 Washington Street, 4'" Floor
Salem, MA 01970-3523
Tel. (978) 741-1800 Fax (978) 745-0343
Name t
1 1 �
Date
Date
o� D�
Type of ODeration(s1
Tvoe of Inspection
❑Routine
❑ Re -inspection
Previous Inspection
Date:
Pre-operation
A Suspect Illness
❑ General Complaint
❑ HACCP
❑ Other
Al Food Service
❑ Retail
❑ Residential Kitchen
El Mobile
❑ Temporary
❑ Caterer
❑ Bed & Breakfast
Permit No.
Address OI � 1
/ i
Risk
Level Q
r t
Telephonal, _ _ 660
1
Owner I _ `a 4
0_ /
v
HACCP Y/N
Person in C rge (PIC)
Time
In:
Inspector Wk�Out:
Each vNtbn checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated.
I Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑
action as determined by the Board of Health. I
❑ 1 PIC Assigned / Knowledgeable / Duties S
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°",""•'"""-''n"m`"'-"�"'""°"`""`�`
i
❑ 8. Separation/ Segregation/ Protection
.D'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.
1C," 1-N71
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)
/2'7. Physical Facility (FC -6)(590.007)
28. Poisonous or Toxic Materials (FC -7)(590.008)
29. Special Requirements (590.009)
,�0. Other
S'590Mu,OFar -14.dj °
R
❑ 122 prevention of Contamination from Hands
LaLt'3. Handwash Facilities
, PROTECTION FROM CHEMICALS =' ' ti ;=
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
ihTIMEITEMPERATURE CONTROLS (Potentially Haiardoua Fpods) _ �'
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 1B. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 21. Food and Food Preparation for HSP
;:CONSUMER ADVISORYi?� L' . h
❑ 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' r ' {u - 1
I v1 �" T IIF ]J__ �
Print:
/I W4 I k/)/.A/
PIC's Sigpa ure: 1, �\ l_ \ ..
_�
Print: 11 \ l
Page of� Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors (items 1-22)
FOOD PROTECTION MANAGEMENT
1 590.003(A) Assignment of Responsibility*
590.003(B) Demonstration of Knowledge"
2-103.11 Person in charge - duties
EMPLOYEE HEALTH
2
590k03(,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 Fail Employee Or An
3-202.16
_
Applicant To Report To The Person In
Drinking Water from an Approved System*
590.006(A)
Charge*
590.006(B)
590.003(G)
Reporting by Person in Charge'
3
590.0030
Exclusions and Restrictions*
3-201.15
590.003(F,)
Removal of Exclusions and Restrictions
im
7
FOOD FROM APPROVED SOURCE
.* Denotes critical item in the federat 1999 Food Code or 105 CMR 590.000.
a•i :#tr •, eu ,Ts •,
$
Food and Water From Regulated Sources
590.004(A -B)
Compliance with Food Law*
3-201.12
Food in a Hermetically Sealed Container*
3-201.13
Fluid Milk and Milk Products*
3-202.13
Shell Eggs*
3-202.14
Eggs and Milk Products. Pasteurized*
3-202.16
Ice Made From Potable Drinking Water*
5-101.11
Drinking Water from an Approved System*
590.006(A)
Bottled Drinking Water*
590.006(B)
Water Meets Standards in 310 CMR 22.0*
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
Reulato Authority
3-202.18
ShellstockIdentificationPresent*
590.004(0)
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 fntmit *
3-101.11
Food Safe and Unadulterated
Tags/Records; Shellstock
3-20118
Shellstook 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(7)
Labeling of Ingredients'
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Conformance with Approved Procedures
/HACCP Plans
3-502.11
Specialized Processing Methods*
3-502.1.2
Reduced oxygen packagrng, criteria*
8-103.12
Conformance with Approved Procedures*
.* Denotes critical item in the federat 1999 Food Code or 105 CMR 590.000.
a•i :#tr •, eu ,Ts •,
$
Cross -contamination
3-302.11(A)(1)
Raw Animal Foods Separated from
Cooked and RTE Foods*
Contamination from Raw Ingredients
3-302A I(A)(2)
Raw Animal Foals Separated from Each
Other*
Contamination from the Environment
3-302.1.1(A)
Food Protection*
3-302.15
Washing Fruits and Vegetables
3-304.11.
Food Contact with Equipment and
Utensils*
Contamination from the Consumer
3-306.14(A)(B)
Returned Food and Reservice of flood*
Disposition of Adulterated or Contaminated
Food
3-701.11
Discarding or Reconditioning Unsafe
Food*
9
Food Contact Surfaces
4-501..1.11.
Manual Warewasbing - Hot Water
Sanitization Tent eratures* -
4-501.112
Mechanical Warewashing- Hot Water
Sanitization Tem cratures*
4-501.114
Chemical Sanitiution- 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*
ID
Proper, Adequate Handwashing
2301.11
Clean Condition -Hands mid Arens*
2-301.12
Cleaning Procedure*
2-301.14
When to Wash*
11
Good Hygienic Practices
2401.11
Eating, Drinking or Using Tobacco*
2401.12
Discharges From the Eyes, Nese and -
Mouth*
3-30112
Preventing Contamination When Tastia
12
-
Prevention of Contamination from Hands
590k04(E)
Preventing Contamination from
Employees*
13
Handwash Facilities
Conveniently Located and Accessible
5-203.11
Numbers and Capacifies*
5-204.11
Location and Placement*
5-205.11
Accessibility, Oteration and -Maintenance
Supplied with Soap and Hand Drying
Devices
6-301.11
Handwashing Cleanser, Availability
6-301.1.2
Hand Drying Provision
CITY OF SALEM
Violations Related to Foodborne Illness Intertarritions and Risk
Factors (item 1-22) (Cont)
PROTECTION FROM CHEMICALS
1-4-
mood or Color Additives
1)-202,12
Additnes"i'
3-30114
Prouillion trail
is
r-161.11 —t=
Poisonous or Toxic Substances
Tracking Poiivders. Pest Control and
1 Containers*
71102.11
-12(ii)
Common Nanw Workin, Coalaincr,*
r7 - t ]I T'
3-4101.11(A)Q) limitc, Initocci Illetas 155 F 15
7-203,11 1 Toxic Containcil; -
7-204. 14 Dns_ L AM, -It �'fLe r 111
-205, IT
Incidents] 1-�>'xl { onlnct l.abrxants'
�-i—
-206
- 7�--j' -
�"Ticted sc pcricldes' Criteria
7-206.12
Rodent Bait Stalions�------
1206,13
Tracking Poiivders. Pest Control and
Animals
16
Proper Cooking Temperatures toir—
PHFs
?-'407.1.11(7 (2)F�,'gs- 15i'F 15 So%
3-401.14A)(2) Comwjjuo(�d Fi* Meats & Game
Animals
3-401.11(11)(1)(2) Pork and fl c1 Roam 1301 121 nti0
3-4101.11(A)Q) limitc, Initocci Illetas 155 F 15
Wild Stuffed PHF's'
soiffirleColuailling Fislit Meat,
Poultrt'ol- Ratite 165°7 15 sec,
3-40 ti Whale -inwltle, Intact ReJ Steaks
145`11
3-41) 1 IY ran I �, ;At U
ia�' , lin, 'o, ds
a
M iclowavc 165F
3-401 11 (A)(1)(b) isdi Other PIJFs -- 145"7 15 xec.
7.7
Reheating for Hot Helium 9
PRV, lo5'l1 15 sec,
(b) Microwave -165° F Mouve fiFinTin,
Tinter
3-403.11(C) Commercially Plvscei'$W�Rf Ir
140F
4-x2031 t(llit Rernanlint, Unsliced Portions «€ Reel
Roast o
18
Proper Cooling of PHF9
50-1.14(A) Cooling Cookcd PHF1 fi om 14(Ff- -ul
7001i Within 2 flouc;' and From 70`i''
to 4 !'F/45'F Within 4 houis,
inc PHFs Made Froin Ambient
TcmpQ! I attire lritscdionts n, 41�F/45'Fj
Within 4 Hours �
Fens ill tha fo'leral Nal) Food Cody or IOS CNIR590000
According to Law Cooled in
1 41 " F/45", F Within 4 Hours.
13-509.15 coolull, Methods for PHFS
19 1 PHF Hot and Gold Holding
1-1-51 at or bolow
590.004(2) 41`/45 F"
3-503 I WA) Mot PHI's Maintained at or above
140'F
-5171 16(A) Roasts hold at or above 136 P-'
Time as a Public Health Control
SOI 39 filrc as, a Public Health Control-
VjrjajacxRerement
REOUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS HSP
Unixk,scunied Fripackaged ]vices a td
Reties eev with Warnisi±t:t`
iOf Paqellac
I
Raw or Paoially Ccokrd Annual Food and
it M113); -
—1H "C'
L�L'19, 1 L�-' --) - --Li i=s vTI -IT
CONSUMER ADVISORY
22 3P,03 11 Consumer Art',isory flostuJ for Consumption of
Allim A I, WAS rhio arc Raw, Lindercooked of
Not Oihcrz ise Pox!ossed to Eliminate
T
3 Paqtek,rfzl>d Els ell
I g,, Substitute foi RAw Shell
A} (D) violati,cis of Section .590.0091x 4D) In
rituhric locld, temporat y and
fesidclu6al Ulchcri operations, should be
debt ed under the appropriate sections
above if rvltied to II-xAborne illness
interventions and risk factors. Otber
590.009 violations relating to gUod retail
pea: bees .>ltotdd !--,e debited under #29 -
t special
((teens 23-30)
ficidbortut ltbc: vs title? ventiow and ri.4-jactors hoed abwc, can be,
f0tord ol the fi(46ii trig, serlwro G/ the Food (bde and 10 CUR
.7'900()0,
S ..V -..u..
Establishment
CITY OF SALEM
BOARD OF HEALTH
Page: 3 of
Item
No.-?
Code
Reference
C - Critical Item
R - Red Item
'DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION, f
�'
L"� -z J"I JiA4kx"
'VPLEASEPRINT CLEARLY ,
D ate
Verified
0'
SLI
��Oglkr' 14 /J)/-tA Al -)7-e 9-
j.
ry')147-11n Q'I -a-A 'd
11401
In 12
//0-
'061a ori jgoj _
no, lioI)_bf ),,optn6 tlm_l117 COS - q7 Af47,;i7nj
1\,W (711 /1 'r12 R 1Ak (�O /0 1-k-27 Qj ��W
'-A( (j/-1 r'A 'C�10 J_h(�A 6L)lY21ha, bi a
t
h4ll)99/1 91kd_,V k 1 &l
w '100E. Pbkf j2 L ,7
,6
1)W k -2016Y) /13
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:
L) No
El Yes
❑ Voluntary Compliance El Employee Restriction
Exclusion
U Re -inspection Scheduled L) Emergency Suspension
C3 Embargo 0 Emergency Closure
El Voluntary Disposal L3 Other:
Violations Related to Foodborne Illness Interventions and Risk
Factors (Items 1-22) (Cont)
PROTECTION FROM CHEMICALS
14
Food or Color Additives "µ
3-202.12
Addtttti 0 ....-_.. .
.
3-302.'14
Protection frontU to drover( Additives"
IS
_ _ __
3 Poisonous or Toxic Substances 3
r FU1.II
+ Identifying Pilot m+*ion-OdYital -�
_
710211
Containers" _
Condom Nance W<rk", wt;tiner�T
720t.21
Se n+iuon Stet,
7-201
Restrict un - Pascncc aid t se
7-202.12
Conditions of Bao"
7-203.11
Toxic Coalamers- Prohibitions*
204111
salmi/Cts, Criteria Che.rniCds
�
204.12
Chwxricals for wti uh+ 1'+or'uu E.riteria"
7-2(g, I4
Dimon A ents.Crnc ia"
-.205.1 I
Ineid ntal F nxxl taw act Lahr icarrW
��7 106-I I
.
Retwicied lire Pe tfc ides. C7ateu+"
L7-206.12
Rodent Bart Stairce s'
_
Tia king Powdc s, Pest Control and
417
:7-2063.'13
—_
Momtorirt"
TIMEaEMPERATURE CONTROLS
16
Proper Cooking Temperatures for
PHFs
_
3-r40i. I I A(1)(2)
Eggs- 155'F I 55,x
_ _ __
Fla Fmmed+ «c Seri iu 145 F 15seo'
3-401.1 I(AV)
Comminuted F ith Meats h Cion
�
A;dt.rals-15-51 ! cec
i-i0i.11(D}{ i}f23
P(wk and Beet koast - 136 t 121 ruin
"s-401.1 t(Ajt�j
h rotes, lnfeo to Nlcats 1 5 F 15
3-401.11(A,l(3)
( Priapi%, Wild Game Stuli'od PHFs,
Stuffing Containing Fish. 'ileal,
Poultry or louncs- 165"T 15 sec.
3-401.I I (C)Q)
vVhole-nwscle, intact Beef Steaks
(45.F,
_
I s-401.12
Raw Aninwl K< xk Corked in a
'vtrooryve 16s F* _
Ali( herillf. 149`1 15 sec
417
Reheating for Hot Holding _-.N...-
3-403711(A)Kf0)
PHFs 16TT 15 sera"
.;-403.11(13)
Microwave -165' F 2 Minute: Standing
Time"
_
3-d03.11(C}
't-463.3 I(Fc}
_
C 3namcnriattvPia^sse,dRTPrxxul..
140'F* _
R nt tuimg I nsiieed Porncns nt Bc*ei
Roast, v _
10
Proper Cooling at PRFs
3-50��
Confine Coi& A PHPs Erten 1407 F to
70"F Within 2 Hours "rid From 70`'`F
---.---
uo 41 -FAY F Within 4 Hows.e
3-5' 01 i4f3)
Cooling PHFe hl rde From Ambien
Tampetaunre Int,redienis to41`Ft45`F
Wlthin'l Hours'__ -__-_--__--,__.----_-�
. Denotes critical item in the lotenil 1949 Food Cade or 105 (;tuft? 590 000
FM
3_5i1j,14('C- PRFs Received at Temperatures
-I According to Taus Coaled to
_ :I'R45'I' Within 4 Hews. r
3-5 )1.i5 Qxlfna Methrxis for'PRFS
1-501.16(B) Cold PHF rwlointa sed at or beiknv
S9fl,i){i-.i F; 41%45"F� _
3-501,16(A) I Int PHI s Istaintained at or above
_ 140'FF.
I Rcwis Held at or above F 30"1,. *-
Time as a Public Health Control
3-30 t is `f'.ime as a Public Health Conti -of,
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (EISE
-7T J Lhrpasieurrred Pro -packaged Juices and
3 -SW 14,13} F,u ee t�Puxieunred k ggs"_ ___
3-$(il 4 tm) , it } iw rot PartiaJu GKxked Aaimal Ftxid atfrd
to 5c. d ,; mats `!or Served.
3-$0111.F l!C! 3 L nmcned Fant Frt.l.acr horRe-served
CONSUME_P ADVISORY
2 -60. 11 Consntnrr Ad iso v Posted fur rAwscanption of
'animal F-tt& 1-har ire Raw, fnderctoked e -
Not f}th rH itt paxtried to l3iiminaw
1-302.13 I P, rte rrrrcd Ftk.. 5.9>sutut ffc- Rase shell
_ SPECIAL REQUIREMENTS
59J.ti70J(- 6D) Vialatrvn)a otSection 59(i.(X}9(A)-(D)iu
catering mobilo fixed, temporary and
residenl al kitchen operations shvndd he
dehit d tinder the appropriate, set�iions
Axwr if rel ued to foodborne illness
interventions and risk factors. Other
590.009 violations relating to raid retail
pr (rioter . ahotild be debited under x/29 -
Special Requircin°ttts.
ItICCATFONS RELATED -rO GOOD RETAIL PRACTICES
(items 23-30)
Crizie i and non-rriaicat vioutoon,e aitich do not rebate to the
foodborne ial ness frzfarvenlians and rfaA factor r hwc d above. con be
.found in the following secrionc ofthe Food Code. and 10,5 CUR
5.90_(100.
s roto: "M v L0'.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Date: Page: of
to
re.
Code,
Refer ��C'
ra
C.7 Critical lterr�W.,
RI-Reditern,
_N' It A'4 1�15' I el�vl DESCRIPTION OF.VIOLATION PLAN OF CORRECTION Date
r Verified
PLEASE PRINT CLEARLY �_
va
"-�c`Lo d 0- fp a
FTC Plp4 1inyu na -AI'Dn I n r. alt'd (Y/Zap/ 1?a Imllo C oy?
2
Aa, 6�z 77- / ca k -/w (-af 1AQ-d'X1
1DzkV, :Zhis Woay n C if 1 rIVIt
CAlh (11 o
US UJB '/ t '
—IV
C( ljp ,7f ah,)A8 W1 r ),00
j_) V-11791
IGS a'III r(_k, /67_S zo-( 4h1s eul alt
In ao- ak_d 1z)61e7h&41
L/
K
nc/ cy) Wpt\o (Z- rl
Wltffiel 4-6 WN&VA a0d Amlaoe 20 22---2
V
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.
II
Corrective Action Required:
Ei No
Q Yes
0 Voluntary Compliance Lj Employee Restriction
Exclusion
0 Re -inspection Scheduled Ll Emergency Suspension
El Embargo Ll Emergency Closure
Q Voluntary Disposal 0 Other:
Violations Related to Foodborne Inness Interventions and Risk
Factors (ttenre 1-22) ff`ont)
14 i i Food or Color Additives
3-302,14 ( Prot«ciionfront Una rovedAddinyes*
15 {. Poisonous or Toxic Substances _
',-10(.11 S ldentifyintzSnfotmatton--Ontnai
7.102.11 ' Common Name Workim, C(aaainers`
7-2071.11 Ste" 1,10art_Stora e"_____
7-202.17. E Reatsiction - Pmuncc and li se"
7-203.11 ' Tox'tc f`onfainer, - Vrohibitiunss:
0 dE a i<e.Crimtia
7-206.12 Rcxlent B'atStatioas"
?06.13 _.__. r '1 racking Powders. Pest Control and
7 -?.04.11 Sannizers, Criteria - Chenticai&*
7-'JJ1.12 Chenucais for Wachit:;r ProUuce. Cris
7-204.14 � T3rvitt��r�ents._Criteria"_���-�
7-205.1 i Incidental F.xxl Contact,
TIMEREMPERATURE CONTROLS _
15 Proper Cooking Temperatures tot
PNFs
3�IOt.liA(1)(2) Eggs- 155`F 15 S_c
_ fps- httmcdiate SSer vicc 145"Y15!
3 401.1 t(A)F2) Comtrtnwed FiSh,, Meats & Game
Animals - 1 5°F 15 sec, ;'
3-401.11(B)ll3Q)
Pork
Pork d Beat Roast -S 0I'121w
3-401.11(A)(2)
Injured Ltrats 155"F 15
__
3-401.11(AH 3)
Labr7eantsh`
7-2 6.i1�
Reztnct. t�e.P=.+:
TIMEREMPERATURE CONTROLS _
15 Proper Cooking Temperatures tot
PNFs
3�IOt.liA(1)(2) Eggs- 155`F 15 S_c
_ fps- httmcdiate SSer vicc 145"Y15!
3 401.1 t(A)F2) Comtrtnwed FiSh,, Meats & Game
Animals - 1 5°F 15 sec, ;'
3-401.11(B)ll3Q)
Pork
Pork d Beat Roast -S 0I'121w
3-401.11(A)(2)
Injured Ltrats 155"F 15
__
3-401.11(AH 3)
Ptd aftry Wild Crame, Siutfea l'FIFs,
Sudf ni Cont rlant Fish, Meat,
Pouiltry ur kfetes d65`t 35 sec. "
s -401,114C1!3)
Whdp-rawele„InuictBeef Steaks
N59; '
401.I2
R i0. Amnral F s -L (:cok.ed nt a
4Fi roxmve to F
i sifnicucni
I allcnhei Pia 145'1 Is.cc
3-403.1](A)&('D) #1-P--FIF--I-b--5TI sec. _
3-407.11(8)Yiiurl ov,avc 16-1" F 2lulinute Standing,
arts"
3-403.111(`1 Commercially Processed RT'F. Fcxxt -
of Beef
?-501.14(!1) (Carling Cookrd PHV" from l4o'F to
701, Within 2 Hours and From 79"F
kl _ to 41 F145` F Within 4 Hour
3 __SO1.14 11) 1 Coolmy PHF Made. From Ambient
Temperature Ingredients k>410F/45` F
L Within 4 Ft xr ` �--
" Denotes Critical cern is Ih, fotcral 1909 Puny Qxie or 105 ('MR 590 000,
w
-'-TP yget;cived tc' Temperatures
Accrording to 3avv Cooled to
_ 4luv M°F(45`h Witirin d Homs.
Coctficthc£ds for PS3Fs
3 1 Coad PHF s Maintained at or below
590.1)4) (FFi 1 41°145° F _ _
3-5(tt 16: A} 31st PI -11 'stamtamecl at or above
I Mo'v x
e 501-16{A) Pwsts field at or above 130`F. *`
Z1B v y Time as a Public Health Control
t 35013 9--l--
i Time as a Public f teaith Com roP
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
_ POPULATIONS {HSPS
21(A) [ L'np rsteudzed Pru packafcd Jokes and
3-801.11(D) Raw orPazviell Cucrked Aminal Food and
in sroc S ru3uts Not Served.
3-801.11(0 Urlovened Pood Packase Not i2e-served_ +.
_CONSUMER ADVISORY
22 3 b0� 11 Conmi to AdKisory Fasted for Consmuption of
' Animal F x>ds That are Raw. Underaxtked or
"lot Otherwise Pasa sse i m Elrmnam
__ 1516140...4 tt`, x a._yvn t?On
'-3tt'_.r 3 Yasteunr d F }.g:: Subs.7tutr for Raw Shc14 �-
590.009(A)(17) Vidationaoi- Section 590.01}9(A)-(D)in
catcring. rriohil(7 fcxxi, teurporwv and
resid ntral kitchen operations should tie
debited under the Appropriate ;ections
abuvc if related to iixAborne illness
interventions and risk factors. Other
590.009 violations relatinn to good retai?
1. 1' aaicv s ,hould he debited under #29 -
Sprcral Revlairern nts,
G OUTtONS RELATED TO GOOD RETAIL PRACTICES
(items 23-30)
criocal aru+non crah'at iotttkons, which do nol Mebane to Me
foodborne itlr e, r imervr niioro and r i, t fix rorr listentabove. <an be
found in t3te)att�n-nrw.r£ �horva o/';he Faed Code asst )05 (,'Mk
59QtXiU.
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: Date: Page: of
Item Code C Critical Item " 'r�
7 ON OF VIOLATION PLAN OF CORRECTION V Date
-�,DESCRIPTl
C V� re 6,2 Verified
No. Reference R - Red Item' W ... ..
plo,'
PLEASE PRINT CLEARLY
94, nzr, 11?�Zl�c*d)j H ljadrs n4z�-,-1 -MaV W2 /y
at7b//j/) /I J- /s &?P 700 A 10d-/',- _
-rlir -�P(r , -)aJ # O IM-Aae At. ,
II)Al _/,� , - V
I�Q 7. Av) ZIK,7e-'
o vvvP I 6L('d 17-Y) rs
r.1514;M7 4 7,1' /5 . (p, 16 -el -0-7
Lq(l C1,i1;-?,r717 �,n 17?% of Ma i
hhll, CIO�e C10VkeC-be03 hejlls 112oa,'9
t -U aAe, .1D tV L,() , -a 0_121;)11rr(7Z0_n alld f cry L
Jkal So. -fl?cd 1 We (O-AS!314��- t (2y
re InE / q/1 (y al , �:6
e�"
haw ba --A ar7��(-4el%
Discussion With Person in Charge: Corrective Action Required: Ll No Q Yes
I have read this report, have had the opportunity to ask questions and agree to correct all Ej Voluntary Compliance 0 Employee Restriction
Exclusion
violations before the next inspection, to observe all conditions as described, and to El Re -inspection Scheduled Ll Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Ll Embargo 0 Emergency Closure
yourfood permit. 11 C3 Voluntary Disposal 0 Other:
Violations Related to Foodborne Illness Interventions and Risk
Factors (items 1-22) {Cont) _
FIN
12
_ Poisonous or Toxic Substances
7t01.Y1 t itieniifym�fnformutirva �E)r3ginai
t L 1,�k Ulu Hi INmuz, IF,
226L1i Srsaietiou-SCuzsg
Restriction - Presence and Use*
7 2CP3AI PoxiConourielz - P
7-204.IT Sanirizerv. Criteria -
7-204,14 Dtttnh Atents_ C rit�rsa
1-205 11 Incidental I xxl Con act Lvin eanfs"
7 206. IT _ ReaucS d 1, e Pe ticide.s- Crnteu r*
i'-206.13 j Tracking Powders, Psi Control and
I llcnoles cruwal nem is i* IeMia IT)J)Food CAor 105 Cbttd 590€00.
3 iC) PKFs Re,. ived an Tempevnnres
ic,cordit g to I v Cooled to
_ ' I :F145 F Wiffizn 4 Hours-
--t-1,1
x
t 1 QFF55 CooIImr ;4meth;Y& for PHFs
19 i -. PHF Hot and Cold bolding
3S16(g) Cf PHI^ Meintaineil at or bslrn
590.004(f) 41-/45° F _
3-59 L ICriA) PHFPHFs ,%fiinrafued at or above
t IdG'F.'
3-5u1.16(A) Rests Held at or abat=e 130"F'.
20 _u.. Time as a Public Health Control
3 SO i 1 09 1 Time as a Public health ConnroV
90.00401) Variance Reau remail
21 Still itAj Uirp t rcurizcd Pre pasta*ed lances and
13c vet ides with Sh armi
PolCONSUMER ADVISORY _
226 3 1
61 nstuner Aoosory f'oszed Star C misuniption o{'
tt
mien I R,cds Ib i c Raw Undercooked q
Ot'
111 Not ierw oie Prez e sised to El nnate
i 3.302.1.1 P.aenn...^d F.gg> S.ehs'stntz €cg, Raw Shell
! � Sabats*
gill IIiR) 1g, 44 its Pa'teltnlzd i l S"
F ,Ric, ur, len! i Lark �d Annual Food and
t-801.1 I (D}
_
Raw
TIMEfTEMPERATURE CONTROLS
16
Proper Cooking Temperatures for
_
1657F2R4=i Standing
PHFa
_
3-4ql-IIA(ll(2; If,gs-155'-1sSx;.
3-�tY . 13 rC �
Fie-,Itsuusditte Service [451-17s
�t C ommercistly Pru�.es:,eti. RTE Food -
3 Dl.11tA)f2; Fm lninut d 1 ash Meats t Ciannc
Animals -15 F.15,wc.'
-4pi.i S.(H}l 3 (27 Po6 and Ei et Rkwst -130"f'121 a
.-401.11(A}t a; Kttifes,lnicc a%.4ents�l 5115
3-4173.1 ICE)
Remaining Umoced Portions of 13a of
3441 11(A}(3I ( Poitltty, WildGarne,Stuffed PliFn,
Roasts,.
Stuffing,; Cuniaiiun Fish Meet,
I 1 oui� Ug, Rames 165 r
Li-,
3-40LI102)(3) Yli k mu=. lc. Intact Beef Steaks
Cooling Cook�dPHFsicomld(PFto
3-401.12 R as Anirnat I'ools Cooked lin a
e �iic,x7R'3ye 165'F
to 13'3•/45 F W'ifl n 4 Hoars. "
Cooling PHFt Made From ambient
_
3_4tl1.t1(A(i)!b) Alt(hheiPHFs 1451
I
Tctn1X'FatOTe hsvrediewii, to 41�F/45°F
IT
Reheating for Hot Holding
I llcnoles cruwal nem is i* IeMia IT)J)Food CAor 105 Cbttd 590€00.
3 iC) PKFs Re,. ived an Tempevnnres
ic,cordit g to I v Cooled to
_ ' I :F145 F Wiffizn 4 Hours-
--t-1,1
x
t 1 QFF55 CooIImr ;4meth;Y& for PHFs
19 i -. PHF Hot and Cold bolding
3S16(g) Cf PHI^ Meintaineil at or bslrn
590.004(f) 41-/45° F _
3-59 L ICriA) PHFPHFs ,%fiinrafued at or above
t IdG'F.'
3-5u1.16(A) Rests Held at or abat=e 130"F'.
20 _u.. Time as a Public Health Control
3 SO i 1 09 1 Time as a Public health ConnroV
90.00401) Variance Reau remail
21 Still itAj Uirp t rcurizcd Pre pasta*ed lances and
13c vet ides with Sh armi
PolCONSUMER ADVISORY _
226 3 1
61 nstuner Aoosory f'oszed Star C misuniption o{'
tt
mien I R,cds Ib i c Raw Undercooked q
Ot'
111 Not ierw oie Prez e sised to El nnate
i 3.302.1.1 P.aenn...^d F.gg> S.ehs'stntz €cg, Raw Shell
! � Sabats*
gill IIiR) 1g, 44 its Pa'teltnlzd i l S"
F ,Ric, ur, len! i Lark �d Annual Food and
t-801.1 I (D}
_
Raw
2403.1 i (A)ge.(D) PI IP s 165"1 15 vcc. *
3-403.11(F,
_
1657F2R4=i Standing
S d Shitty Not Sely«I ':
�)ri<s
3-�tY . 13 rC �
3 403.11{C)
�t C ommercistly Pru�.es:,eti. RTE Food -
3-4173.1 ICE)
Remaining Umoced Portions of 13a of
Roasts,.
18
Proper Cooling of PHFs
x_501.id(A)
Cooling Cook�dPHFsicomld(PFto
70 I Wiihin 2 Hour< and Froin 70-F
____
3-5U1.1d(Ft)
to 13'3•/45 F W'ifl n 4 Hoars. "
Cooling PHFt Made From ambient
I
Tctn1X'FatOTe hsvrediewii, to 41�F/45°F
I llcnoles cruwal nem is i* IeMia IT)J)Food CAor 105 Cbttd 590€00.
3 iC) PKFs Re,. ived an Tempevnnres
ic,cordit g to I v Cooled to
_ ' I :F145 F Wiffizn 4 Hours-
--t-1,1
x
t 1 QFF55 CooIImr ;4meth;Y& for PHFs
19 i -. PHF Hot and Cold bolding
3S16(g) Cf PHI^ Meintaineil at or bslrn
590.004(f) 41-/45° F _
3-59 L ICriA) PHFPHFs ,%fiinrafued at or above
t IdG'F.'
3-5u1.16(A) Rests Held at or abat=e 130"F'.
20 _u.. Time as a Public Health Control
3 SO i 1 09 1 Time as a Public health ConnroV
90.00401) Variance Reau remail
21 Still itAj Uirp t rcurizcd Pre pasta*ed lances and
13c vet ides with Sh armi
PolCONSUMER ADVISORY _
226 3 1
61 nstuner Aoosory f'oszed Star C misuniption o{'
tt
mien I R,cds Ib i c Raw Undercooked q
Ot'
111 Not ierw oie Prez e sised to El nnate
i 3.302.1.1 P.aenn...^d F.gg> S.ehs'stntz €cg, Raw Shell
! � Sabats*
gill IIiR) 1g, 44 its Pa'teltnlzd i l S"
F ,Ric, ur, len! i Lark �d Annual Food and
t-801.1 I (D}
_
Raw
SPECIAL REQUIREMENTS _ __
4)-,C? Viclation� of Section .590A09(A)-(D) in
I catering- mobrir food, temporat v and
Iicsidcul al kilchell operations should be
s
debited under the appropriate iCCttUiiS
above if related to fiiodhorne illlioss
ntelventzonsandei ktacror� Other
'90.009 violations relating to ;bird retail
piactic s htsuld iv debited under //29 -
Specral RegoiremetiYs.
(Items 23-30)
Crbi at and ru n crilwal viofaliuni, ivierch do nor rebate m die
rood
horne dlness intervent arts ezrtd r sk jactots Iictcefabow, cat be a
(osnd bi !fid oilo}ring sen ons of the torr) (bele and IGS CUR
590LO00.
S.��n:4cctet: �ay_
S d Shitty Not Sely«I ':
�)ri<s
3-�tY . 13 rC �
c ncd Fcxnt Paclia rr hof Resensed.
SPECIAL REQUIREMENTS _ __
4)-,C? Viclation� of Section .590A09(A)-(D) in
I catering- mobrir food, temporat v and
Iicsidcul al kilchell operations should be
s
debited under the appropriate iCCttUiiS
above if related to fiiodhorne illlioss
ntelventzonsandei ktacror� Other
'90.009 violations relating to ;bird retail
piactic s htsuld iv debited under //29 -
Specral RegoiremetiYs.
(Items 23-30)
Crbi at and ru n crilwal viofaliuni, ivierch do nor rebate m die
rood
horne dlness intervent arts ezrtd r sk jactots Iictcefabow, cat be a
(osnd bi !fid oilo}ring sen ons of the torr) (bele and IGS CUR
590LO00.
S.��n:4cctet: �ay_
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
1 °�
Date
/ -)
T of 0 eration(s)
21 Food Service
❑Retail
❑ Residential Kitchen
❑ Mobile
El Temporary
❑ Caterer
El Bed & Breakfast
Permit No.
Tvoe of Inspection
❑Routine
,D7 Re -inspection
Previous Inspection
Date:
❑ Pre-operation
❑ Suspect Illness
E] General Complaint
E]HACCP
❑ Other
Address i/
I ` f
n
Risk
Level
Telephone _0131) 1
Owner
t YG v
YM
Charge
Person in Ch' '
Time
In:
Out:
Inspector
Each vlolatlon 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.
" FOODPROTECTION MANAGEMENT ;a..„y„_,,.,,,,„,,,,�.p
❑ 1. PIC Assigned / Knowledgeable / Duties
R
r EMPLOYEE HEALTH � c
❑ 2 Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
FOOD FROM APPROVED SOURCE`:gd
❑ 4. Food and Water from Approved Source
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCP Plans
,4PROTECTION FROM CONTAMINATION
E] 8. Separation/ Segregation/ Protection
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10. Proper Adequate Handwashing
❑ 11. Good Hygienic Practices
Violations Related to Good Retail Practices
Critical (C) violations marked must be corrected
immediately or within 10 days as determined by the Board
of Health. Non-critical (N) violations must be corrected
immediately or within 90 days as determined by the Board
of Health.
23. Management and Personnel (FC -2)(590.003)
24. Food and Food Protection (FC -3)(590.004)
25. Equipment and Utensils (FC -4)(590.005)
26. Water, Plumbing and Waste (FC -5)(590.006)
27. Physical Facility (FC -6)(590.007)'
28. Poisonous or Toxic Materials (FC -7)(590.008)
29. Special Requirements (590.009)
30. Other
�l
5: SHOlnspecfFormB-14 Cx
, ll
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
PROTECTION FROM CtLMICAI 6 r `
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIMEREMPERATURE CUNTRijLS (PctanUefly Flzerdous Foods) "
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
REQUIREMENTS FOR HI, HLY SUSCEPTIBLE PCPULATfONS.(HSPI g: a
❑ 21. Food and Food Preparation for HSP
¢.CONSUMER ADVIS„
El 22. Posting of Consumer Advisories
Number of Violated Provisions Related
To Foodborne Illnesses Interventions C
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:
Aspec� is latuce:
Print: I /�� dd i
a-
PIC_'sSignature: 1 . A . 0 ,n
.1.`
/.J-' 1 h'
Page
of Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors (items 1-22)
FOOD PROTECTION MANAGEMENT
596.003(A) Assignment of Responsibility*
590.003(B) Demonstration of Know] edge*
�
2-103.11 Person in charge -duties I
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(,13)
590,003(G)
Reporting by Person in Charge*
3
590.003(D)
Exclusions and Restrictions*
3-201.15
590,003(E)
Removal of Exclusions and Restrictions
C
I®
in
I
• s a ; � �� ; �7:T�Ft��>F•TiT[1Is79
* Denotes critical item in the federal 1999 food Code or 105 CMR 590.000.
PROTECTION FROM CONTAMINATION
S
Food and Water From Regulated Sources
590.004(A -B)
Compliance with Food Law*
3-201.12
Food in it 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 DrmkJ nE Water*
590.006(,13)
Water Meets Standards in 3 10 CMR 22.0*
Washing Fruits and Vegetables
Shetitish and Fish From an Approved Source
3-201.14
Fish and Recreationally Caught Molluscan
Shellfish*
3-201.15
Molluscan Shellfish from NSSP fisted
Sources*
Contamination from the Consumer
Game and Wild Mushrooms Approved by
Regulatory Authorit
3-202.18
Shellsnhck Identification Present*
590.004(C)
Wild Mushrooms*
3-201.17
Game Animals*
3-701,1.'1
Receiving/Condition
3-202.11.
- PHFs Received at Proper Tem eratureO
3-202.15
Package Integrity*
3-101.11
Food Safe and Unadulterated
Tags/Records: Sheiistock
3-202.18
Shellstoek Identification *
3-203.12
Shelistock Identification Maintained*
TagetRecords: Fish Products
3-402.11
Parasite Destruction* "
3-402.12
Records. Creation and Retention*
590.004(.1)
Labeling of Ingredients
Frequency of Sanitisation of Utensils and
Food Contact Surfaces of Equipment*
Conformance with Approved Procedures
iHACCP Plans
3-502.11
Specialized Processing Methods*
3-502.12
Reduced oxygen packagmg. criteria*
8-103.12
Conformance with A. zoved Irroeedures'
* Denotes critical item in the federal 1999 food Code or 105 CMR 590.000.
PROTECTION FROM CONTAMINATION
S
Cross -contamination
3-302.11(A}(1)
Raw Animal Foods Separated from
Cooked and RTE Ftxxls*
Contamination from Raw Ingredients
3-3(12.11(4)(2)
Raw Anir ul 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 Resemice of Food*
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 Temperatures* -
4-501.114
Chemical Sanitization- temp., pH, -
concentration and hardness. *
4-601.11(A)
Equipment Foal Contact Surfaces and
Utensils Clean*
4-602.11
Cleaning Frequency of Equipment Food -
Contact Surfaces and Utensils*
4-702.11
Frequency of Sanitisation of Utensils and
Food Contact Surfaces of Equipment*
4703.11
Methods of Sanitization - Hot Water and
Chemical*
14
Proper, Adequate Handwashing
2-301.11
Clean Condition - Hands and Arms*
2-301.12
Cleating Procedure*
2-301.14
When to Wash*
1.1I
Good Hygienic Practices
2-401.11
Eating, Drinking or Using Tobacco*
2401.12
Discharges From the Eyes, Nose and
Mouth*
3-301.12
PreventingContamination When Tastin *
12
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*
5-204.1.1
Location and Placement*
5-205.11
Accessibility, Operation and Maintenance
Supplied with Soap and Rand Drying
Devices
6-301.11
Handwashing Cleanser, Availability
6-301..1.2
Hand_D 'ng Provision
Establishment Name:
CITY OF SALEM
BOARD OF HEALTH
Date: /6 -q 0 Page: a— of
Item
No. -
No.
Code
References
C - Critical Item
R — Red Item
OF VIOLATION /PLAN OF CORRECTION
-
PRINT CLEARLY ,. . JI�//'L'�/-/N//-
Date
Verified
�
I
/PLEASE
Y1ill✓
/ /' INS^� / /`i Lam/ �',
l- ,,
fZ I i. )l w
V
()fAn�ho Wdino a IVOF o
S
+ 14
h
Q. of 00E oy Maui (5 /0 M 'a:UiT �x (X/'d Z&
or
A
3a
QDJJ-Q-, orwt &L C D -I
- Ice -
U U
Leizoe Coy).( jr D
J
�L
6-14 6-40 r (,(7 r
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-fivte dollars or suspension/revocation of
your food permit.
,/n -a � ti r SLP
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
0
17
Is
T
Food or Color Additives
3-202.12
Additives`
3-302.14
_
Protection from U_naroved Additives*
F3-507.15
Poisonous or Toxic Substances
7-101.11
Identifying Information -Original
Containers'I
7-102.11
Common Name - Working* Containers"
7-201.11
Separation - Stora e*
7-202- i. t
Restriction - Presence and Use*
7-202.12
Conditions of Use*
7-203.1.1
'toxic Containers - ProhibiLions"
7-204.11
Sanitizers. Criteria - Chemicals"'
7-204.12
Chemicals for W'ashine Produce, Criteria*
7-204.14
7-205.11
Drvin r, encs, Criteria"
Incidental Food Contact. Lubricants"`
7-206.11.
Restricted Use Pesticides. Criteria*
7-20612
Rodent Bait Stations*
7-206.13
'IYacking Powders, Pest Control and
Monitarine*
T
Denotes critics( item in the faders} 1999 Food Code or 105 CNIR 590.100.
Proper Cooking Temperatures for
3-801_11(B)
PHFs
3-40'1 A I A(l)(2)
_
Eggs 155'F '1.5 Sec.
F3-507.15
&res- hnmediate Service 145'F'15sce*
3-401.11(A)(2)
Coauninuted Fish, Meats & Oantc
FC -6
Animals - 155'F 15 sec. 'r
3-401.1I(B)(1)(2)
Poik and Beef Roast - 130'F 121 min*
3-401.1 1(A)(L)
R idtes, Injected Meats- 155-F 15
see.
3-401.11(A)(3)
Poultry, Wild Game,Stuffed IIHFs,
20
St'uf'fing Containing Fish, Meat,
Poultr crr Ratites -165°17 l5 sec. r.
3-401 11 (C)(3)
Whole -muscle, Intact Beet Steaks
145'17 *
-T401.12
Raw Animal Foods Cooked in a
Microwave 16517 *
3-401.1 l(A)(1)(b)
All Other PHFs - 145'F 15 sec.
Reheating for Hot Holding
3-403,11(A)&Q))
PHFs 165'F 15 sec.
3-d03.11(B)
Microwave- 165' F 2 Minute Standing
Time*
3-403.11(C)
Commercially Processed RTF Food -
140"F*
3-403.11(E;)
Remaining UnslicedPortions ofBeef
Roasts*
Proper Cooling of PHFs
3-501.1.4(A)
Cooiing Cooked PHFs fiom 140'F to
70'F Within 2 Hours and From 70'F
to 41°F145°F Within 4 Hours. *
3-501.14(B)
Cooling PRFs Made From Ambient
Temperature Ingredients to 41'F/45'F
Within 4 Noun;
Denotes critics( item in the faders} 1999 Food Code or 105 CNIR 590.100.
21 3-801.II(A)
3-501.14(C) PRFs Received at Temperatures -
3-801_11(B)
According to Lint Cooled to
3-801.11(D)
4FF1451F Within 4 Hours.
F3-507.15
Cooling Methods for PHFs
14
PHF Hot and Cold Holding
FC -6
3-501.16(B) G>ld PIfFs Maintained at or below
28. Poisonous or Toxic Materials
29. S eciai R uiremonts
590.004(F) 41145' F*
.008
.009
";-501.16(A) Hot PHFs Maintained at or above
14WE *
3-501.16(A) Roasts Held at or above 130`F.
20
Time as a Public Health Control
3 X01.19 Time as a Public Health Control*
590.004(H) Varisncc Re uirement
21 3-801.II(A)
Unpasteurized Pre. -packaged Juices and
Beverages with Warnine Labels*
3-801_11(B)
Use of_Pasteunzed'Fean-
3-801.11(D)
Raw or Partially Cooked Animal Food and
Raw Seed S routs Not Served.
3-801 A I (C)
Uno tened Food Packs .e Not Re -served. *
CONSUMER ADVISORY
22
3-603.11 Consumer Advisory Posted for Consumption of
590.000
Animal Foods'1'hat are Raw. Undercooked or
FC - 2
FC -3
Not Otherwise Processed to Eliminate
25. Eguioment and Utensils
26. !Nater, Plumbin and Waste
Pathtwens.* Ers,,,2 vr.�ori
'..005
.006
3-302.13 1 Pasteunzed Eggs Substitute fon Raw Shell
FC -6
Eggs* -
CIV 1 5
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 foodborneitlness
interventions and risk factors. Other
590.009 violations relating to good retail
practices should be debited under ff29 -
Special. Requirements.
170111WAJIMI F
(Items 23-30)
Critical and non-critical violaorms, which do not relate to the
foodborne iliness interventions and risk factors listed above, can be
f Lund in the following sec'ttom of the Food Code and 105 CMR
.590.000.
item Good Refaif Practices
FC
590.000
-----------
23. Management and Personnel _
24. Foci and Food Protection
FC - 2
FC -3
.003
.004
25. Eguioment and Utensils
26. !Nater, Plumbin and Waste
FC - 4
FC -5
'..005
.006
27. Physical Faciliiv___
FC -6
____ _
I .007-
28. Poisonous or Toxic Materials
29. S eciai R uiremonts
FC -7
.008
.009
30 Other
S:,S�plmmb,GG2Acc
�o
3 a. CITY OF SALEM, MASSACHUSETTS
ELECTRICAL DEPARTMEN-I
44 LiFAYETTE STREET
TEL (978) 745-6300
KIMBERLEY DRISCOLL FAX (978) 745-4638
MAYOR JGIARDI@SALEM. COM
j<rIIN J. GIARDI
Crry ELECTRICIAN
TO: Bella Valentin
The Daily Bagel RECEIVE
7 Church Street Unit 139
Salem, Mass. 01970 OCT — 4 2007
CilY Or
BOARD OF HE=ALTH
FROM John J. Giardi, City Electrician
SUBJECT The Daily Bagel
DATE October, 02, 2007
Ms.Valentin be advised, City Electrician John J. Giardi was
asked to conduct an investigation by the City of Salem Board of Health. The
Health Department concern was with the use of excessive extention cords.
Upon Mr. Giardi's investigation he observed that there were extention cords
plugged into wall outlets on the East Wall of the room. The cords were run
across and over the ceiling serving equipment on the West side of the room.
I refer you to article 400.8, Uses not permitted for extention cords. This is
quoted from the 2005 National Electrical Code. Extention cords may not be
used for a substitute for the fixed wiring of a structure. This is an immediate
fire concern and should be immediately rectified upon receipt of this letter.
Please have a licensed Electrician obtain an Electrical permit to perform the
work outlined. Your cooperation in this matter will be duly appreciated.
Failure to comply will result in further action. If you need any further
assistance please do not hesitate to call me at 978-745-6300 — --
CC: Tom St. Pierre, Director of Inspectior}al Services
Janet Dionne, Health Department
Lieut. Erin Griffin, Fire Prevention
m_cereiy yours,
U`a
John J.. Giardi
City Electrician
RECEIVED
' OC�T 4 20007
CITY OP Se` LE(A
BOARD OF HEALTH
Massachusetts Department of (Public Health
Division of Food and Drugs
FOOD ESTABLISHMENT INSPECTION REPORT
P
Salem Board of Health
120 Washington Street, 4th Floor
Salem, MA 01970-3523
Tel. (978) 741-1800 Fax (978) 745-0343,
Name
-
Uicip r1 -1d-
Dat
T e of O erstion s
T e f Inspection
Routine
® Re -inspection
Inspection
Date:
❑ Pre-operation
❑ Suspect Illness
❑ General Complaint
❑ Other
Food Service
❑ Retail
El Residential Kitchen/Previous
❑ Mobile
❑ Temporary
❑ Caterer
❑ Bed & Breakfast
Permit No.
Address r
Telephone y
Risk
Level
Owner _
HACCP Y/N
Person in Charge (PIC)
Time
Out �S/
Inspector
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provis(on(s) violated.
Noncompliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑
action as determined by the Board of Health. I
FOOD PROTECTION MANAGEMENT
❑ 1. PIC Assigned / Knowledgeable / Duties
EMPLOYEE HEALTH-
El.,
EALTH-
❑., 2.' Reporting of Diseases by Food Employee and PIC
❑ 3. Personnel with Infections Restricted/Excluded
r4FOQD-FROM_APPROVED SOURCE
4. Food and Water from Approved Source f
❑ 5. Receiving/Condition
❑ 6. Tags/Records/Accuracy of Ingredient Statements
❑ 7. Conformance with Approved Procedures/HACCP Plans
PROTECTION FROM CONTAMINATION
0�'8: Separation/ Segregation/ Protection
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
❑ 10 Proper Adequate Handwashing
❑ 1 Good Hygienic Practices
Critiq l (C) violations marked must be corrected
immediately or within 10 days as determined by the Board
of Health. violations
(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)
6. 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 (560.009)
30. Other
S, 50ftW�Fmme 14 f I , /9
❑ 12. Prevention of Contamination from Hands
❑ 13. Handwash Facilities
(PROTECTION FROM CHEMICALS 7-,'
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods)
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
❑ 19. Hot and Cold Holding
❑ 20. Time As a Public Health Control
. _._
-REgUIREMEHTS FOR HIGHLY SUSCEPTIBLE POPULATIONS -(HSP)!
❑ 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
El22. 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:
EYE
ZZLIMMOSM1111, r110
AM JA 2
Violations Related to Foodborne Illness
Interventions and Risk Factors (items 1-22)
FOOD PROTECTION MANAGEMENT
7 590.003(A)Assia tment of Responsibility*
590.003(B) Demonstration of Knowledge':
2-103.11 Person in charge - duties
EMPLOYEE HEALTH
2
590.003(0)
Responsibility of the person in charge to
Compliance with Food Law*
3-201.12
require reporting by food employees and
3-201.13
Fluid Milk and Milk Products*
applicants*
Shell Eggs*
590.003(F)
Responsibility Of A Food Employee Or An
3-202.16
Ice Made From Potable Drinking Water*
Applicant To Report To The Person In
Drinking Water from an Approved S 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 Restrict ons
4
C
6
C
FOOD FROM APPROVED SOURCE
4 Denotes critical item in the tetleral 1999 Food Cotte or 10 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 ma Hermetically Sealed Container*
3-201.13
Fluid Milk and Milk Products*
3-202.)3
Shell Eggs*
3-202.1.4
Eggs and Milk Products, Pasteurized*
3-202.16
Ice Made From Potable Drinking Water*
5-101.1.1
Drinking Water from an Approved S tem*
590.006(A)
Bottled Drinking Water*
590.006(B)
Water Meets Standards in 310 CMR 22.0*
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Sheirsh 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
ReliulatofyAuthorfty
3-202.18
Shellstock Identification Present*
590.004(C)
Wild Mushrooms*
3-201.17
Game Animals*
2-301.14
Receiving/Condition
3-202.11,
PHFs Received at Proper Temperabies*
3-202.15
Package Inte it
3-101.11
Food Safe and Unadulterated
Tags/Records: Shellstock
3-202.18
Shellstock Identification *
3-203. t2
Shelistock Identification Maintained*
12
Tags/Records: Fish Products
3402.11
Parasite Destruction*
3-402.12
Records, Creation and Retention*
590.004(1}
Labeling of Ingredients"
Handwash Facilities
Conformance with Approved Procedures
/HACCP Pians
Specialized Processing Methods*
3-502.12
Reduced oxygen packaging, criteria*
8-103.12
Conformance with Approved Procedures*
4 Denotes critical item in the tetleral 1999 Food Cotte or 10 CMR 590.000.
C
PROTECTION FROM CONTAMINATION
9
Cross -contamination
3-302.1 ](A)(])
Raw Animal Foals Separated from
Cooked and RTE Foods*
4-501.111
Contamination from Raw ingredients
3-302.11(A)(2)
Raw Animal Foods Separated from Each
Other"
Mechanical Warewashing- Hot Water
Sanitization Temperatures*
Contamination from the Environment
3-302.11(A)
Food Protection*
3-302.15
1 Washing Fruits and Vegetables
3304.1.1.
Food Contact with Equipment and
Utensils*
4-602.11
Contamination from the Consumer
3-306.14(A)(B)
Returned Food and Reservice of Food*
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
Disposition of Adulterated or Contaminated
Food
3-701..11
Discarding or Reconditioning Unsafe
Food*
9
Food Contact Surfaces
4-501.111
Manual Warewashing - Hot Water
Sanitization Temperatures"
4-501.11.2
Mechanical Warewashing- Hot Water
Sanitization Temperatures*
4-501.114
Chemical Sanifization- temp., pH,
concentration and hardness. *
4-601.11(A)
Equipment Food Contact Surfaces and
Utensils Clean*
4-602.11
Cleaning Frequency of Equipment Fond --
Contact Surfaces and Utensils*
4-702.11
Frequency of Sanitization of Utensils and
Food Contact Surfaces of Equipment*
4-703.11
Methods of Sanitization - Hot Water and
Chemical*
10
Proper, Adequate Handwashing
2-301.11 -
Clean Condition =Hands and Arms*
2-301.12
Cleaning Procedure*
2-301.14
When to Wash*
11
Good Hygienic Practices
2401.11
Eating, Drinking or Using Tobacco*
27401.12
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*
5-204.1.1
Location and Placement*
5-°.05.11
Accessibility, Operation and Maintenance
Supplied with Soap and Hand Drying
Devices
6-301.11
Handwashing Cleanser, Availability
6-301.12
HandDryingProvision
j
Establishment Name:,,
CITY OF SALE
BOARD OF HEALTH
Date:
M ^.
Paola: of
ttem
No.
Code
Reference
C - Crttleal ttem
R —Red Nem
r DESCRIPTION OF VIOLATION / PLAN OF CORRECTION -
ASE PRINT CLEARLY
Date..
verifiedPL
o
n ,
3��
C ArJ L I S i s ce-
Cf CIA 14
G o
oy- �. r— cj�—
lD
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 twe ty-five d t r or susp ieRfrevocation 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 Mems 1-22) (Cont.)
PROTECTION FROM CHEMICALS
14
15
16
IM
18
-
Food or Color Additives
3-202.12
Additives*
3-30214
Protection from Unapproved Additives*
3-501A6(B)
590,004(),
Poisonous or Toxic Substances
7-101,11
Identifying 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
Dtvin°Agents. Criteria*
7-205.11
btcidental 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
* thnotes critical item in the federal 1999 Fund Cade or 105 CMR 590.000.
C
LEN
3-501,14(C)
Proper Cooking Temperatures for
3-501.15
PRFs
3-40i.11A(1)(2)
Eggs- 1557 15 Sec.
3-501A6(B)
590,004(),
E gs- Immediate Service 145'F15sec*
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. min*
3-401.11(A)(2)
Ratites, Injected Meats -155'F 15
590.004(H}
see. *
3401.1t(A)(3)
Poultry, Wild Game, Stuffed PHFs,
27.
Stuffing Containing Fish, Meat,
! FC -6
Pool or Ratites -165°F 15 sec.
3-401.11(0)(3)
Whole -muscle, Intact Beef Steaks
! FC- 7
145°F *
3-401.12
Raw Animal Foods Cooked in a
Microwave 165F *
3-401il1(A)(1)(V)
All Other PHFs -145'F /5 sec.
i_
Reheating for Hot Holding
3-403.11(A)&(D)
PHFs 165'F 15 sec. *
3403.11(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 PRFs 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*
* thnotes critical item in the federal 1999 Fund Cade or 105 CMR 590.000.
C
LEN
3-501,14(C)
PHFs Received at Temperatures
According t0 Uw Cooled to
41.'F/45"F Within 4 Hours.
3-501.15
Cooling Methods for PHFs
3-R01.11(B}
PHF Hot and Cold Holding
3-501A6(B)
590,004(),
Cold PHFs Maintained at or below
41.0/45' 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 R oirement
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS (HSP)
21
3-801.11(A)
Unpasteurized Pre-packaged Juices and
Beverages with Warning labels*
590,000
3-R01.11(B}
Use of Pasteurized EQs*
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 A I (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
I FC - 2
.003
Not Otherwise Processed to Eliminate
Food and Food Protection
i FC - 3
Pathogens.' Ea°""° "
25.
3-30113
Pasteurized Eggs Substitute for Raw Shell
GO5-!
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 risk factors listed above, can he
found in the following sections of the Food Code and 105 CMR
590.000.
Mem
Good Retail Practices
i FC
590,000
23.
I Management and Personnel
I FC - 2
.003
24.
Food and Food Protection
i FC - 3
.004
25.
Equipment and Utensils
GO5-!
26.
Water. Plumbing and Waste
I FC -5
.0066
27.
Physical Facility
! FC -6
.007
28.
Poisonous or Toxic Materials
! FC- 7
.008
29.
S ecW Requirements
.003
30
I Other
i_
•
4*9C!pmhc[{ l ex
4
Massachusetts Department of Public Health,-
Division of Food and Drugs t
FOOD ESTABLISHMENT INSPECTION REPORT
Saleq,, Board of Health
120 Washington Street, 4'" Floor
Salem, MA 01970-3523
Tel. (978) 741-1800 Fax (978) 745-0343
Name
Lj (A
/
I (
e
Tvpe of 0 eration s
Type of Inspection
mod Service
[IRetail
[IResidential Kitchen
❑Mobile
❑❑ Caterer ary
❑ Bed & Breakfast
Permit No.
Routine
ElRe-inspection
Previous Inspection
Date:
ElPre-operation
❑ Suspect Illness
❑ General Complaint
❑ HACCP
❑ Other
Address
R sk
Level
Telephone
Owner �) .--
HACCP YM
Person in Charge (PIC) '-
-1
Time
In: j+ 5-J
,' t7r
Inspector oep 01Out:
eacn vloiavon cnecKea 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 x"' -
❑ 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
t 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
c 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
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)
$7.
Physical Facility
(FC -6)(590.007)
28.
Poisonous or Toxic Materials
(FC -7)(590.006)
29.
Special Requirements
(590.009)
30.
Other
Inspector's Sigm
\ I PIC's Signature:
Print:
❑ 12. Prevention of Contamination -from Hands
❑ 13. Handwash Facilities
tPROTECTIONFROMCHEMICALS_ '
❑ 14. Approved Food or Color Additives
❑ 15. Toxic Chemicals
71MEITEMPERATURE CONTROLS (Potentially Hazardous Foods) -.
❑ 16. Cooking Temperatures
❑ 17. Reheating
❑ 18. Cooling
KoHot and Cold olding
Time As a Public Health Control
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)
❑ 21. Food and Food Preparation for HSP
+CONSUMER ADVISORY „ ,`.
❑ 22. Posting of Consumer Advisories
Number of Violated Provisions Related
To Foodborne Illnesses Interventions
and Risk Factors (Items 1-22):
Official Order for Correction: Based on an inspec ion
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:
Violations Related to Foodborne Illness
interventions and Risk Factors (items 1-22)
FOOD PROTECTION MANAGEMENT
1 590.003(A) Assignment of Resnsibilit *
590.003(B} Demonstration of Knowled e*
2-103.1 J I 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*
a licants's
Shell Eggs*
590.003(F)
Responsibility Of A Food Employee Or An
3-202.16
ice Made From Potable Drinking Water*
Applicant To Report To The Person In
Drinking Water from an Approved System*
590.006(A)
Charge*
590.006(B)
590.003(G)
Reporting by Person in Charge*
3
590.003(D)
Exclusions and Restrictions*
3-201.15
590.003(E)
Removal of Exclusions and Restrictions
C
C
6
C
FOOD FROM APPROVED SOURCE
- Denotes critical item in the federal 1999 Food CWeor 105 CMR 590.000.
C
PROTECTION FROM CONTAMINATION
Food and Water From Regulated Sources
590.004(A -B)
Compliance with Food Law"_
3-201.1.2
Foci 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, f I
Drinking Water from an Approved System*
590.006(A)
Bottled Drinking Water*
590.006(B)
Water Meets Standards in 310 CMR 22.0*
Frequency of Sanitization of Utensils and .
Food Contact Surfaces of Equipment*
SheAlish and Fish From an Approved Source
3-201.14
Fish and Recreationally Caught Molluscan
Shellfish*
3-201.15
Molluscan Shellfish from NSSP fisted
Sources*
Proper, Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority
3-202.18
Shellstock Identification Present*
590.004(C)
Wild Mushrooms`
3-201.1.7
Game Animals*
2301.14
Receiving/Condition
3-202.11
PHFs Received at Proper Temperatures*
3-202.15
Package lute it y
3-101.11
Food Safe and Unadulterated
Tags/Records: Shellstock
3-202.18
Shellstock Identification
3-203.12
Shellstock Identification Maintained*
12
Tags/Records:Fish Products
3402.11
Parasite Destruction*
3-402.12
Records. Creation and Retention*
590.004(J)
Labeling of Ingredients'
Handwash Facilities
Conformance with Approved Procedures
1HACCP Plans
3-502.11
Specialized Processing Methods*
3-502.12
Reduced oxygen packaging, criteria"
8-103.12
Conformance with Ap ved Procedures*
- Denotes critical item in the federal 1999 Food CWeor 105 CMR 590.000.
C
PROTECTION FROM CONTAMINATION
L9L
Cross -contamination
3-302.11(A)(])
Raw Animal Foods Separated from
Cooked and RTE Fotxis*
4-501.111
Contamination from Raw Ingredients
3-302A l(A)(2)
Raw Animal Foods Separated from Each
Other"
Mechanical Warewashing- Hot Water
Sanitization Tem eratures*-
Contamination from the Environment
3-302.11(A)
Food Protection*
3-302,.5
1 Washing Fruits and Vegetables
3-304.1 1.
Food Contact with Equipment and
Utensils*
4-602.11.
Contamination from the Consumer
3-306,14(011)
Returned Food and Reservice of Food*
Frequency of Sanitization of Utensils and .
Food Contact Surfaces of Equipment*
Disposition of Adulterated or Contaminated
Food
3-701.1t
Discarding or Reconditioning Unsafe
Foods:
L9L
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 Handwashing
2-301.11
Clean Condition -Hands and Arms*
2-301.1.2
Cleaning Procedure*
2301.14
When to Wash*
It
Good Hygienic Practices
2-401.11
Eating, Drinking or Using Tobacco*
2.401.12
Discharges .From the Eyes, Noseand
Mouth*
3-30 L. 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
6-301.1-1
Handwashi❑ y
Cleanser,.Availabilit
6-301.12
Hand Drying Provision
1
CITY OF SALEM
/ BOARD OF HEALTH
Establishment Name:` )1 IL / �p ( / (r Date: L6,j 2 Page: of _
Item
No.
Code
Reference
C — Critical Item
R — Red It meq
DESCRIPTION OF VIOLATION / PLAN OF CORRECTION
PLEASE PRINT CLEARLY
Daie`
Verlfled
,, fr rJI Q -I r.i r/L7 rpn
CQ,
, r,
a
(/ I I
S
d .t�
J7 j 4
I
In J4
r rkowl% t9j.14J ✓t
r
IU5 kF-
OC4
eJ.1AJ
.�
/u ka-9h, c T
�� ra, ✓ �n ry `-
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. / ��7P , ! \) 4�
Corrective Action Required:
❑ No
Yes
❑ Voluntary Compliance ❑ Employe astriction
Exclusion
Re -inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Violations Related to Foodborne fliness Interventions and Risk
Factors (Items 1-22) (Cont.)
14
Food or Color Additives
3-202.12
Additives*'
3-302.14
Protection from Una roved Additives*
15
Poisonous or Toxic Substances
7-101,11
identifying Information - Original
Containers*
7-102.11,
Common Name - Workiu Containers*
7-201.11
Separation - Stora ri'
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, Lubticants*
7-206.11
Restricted Use Pesticides, Criteria*
7-20& 12
Rodent Bait Stations*
7-206.13
Tracking Powders, Pest Control and
Monitoring*
ME
18
k 11,711111 411� W4 ;LA I NJ 94914r, I 11,TOM
Denotes critical kern in the fiederai 11,399 Fwd Code or 1W QvIR 390.Og0.
C
3-501.14(0)
Proper Cooking Temperatures for
3-501..15
PRFs
3401.11A(1)(2)
Eggs- )55`F 15 Sec.
3-501.16(B)
590.004(F)
]Eggs- Immediate Service 145°F15sec*
3401.11(A)(2)
Comminuted Fish. Meats & Game
3-501.I6(A)
Animals -155OF 15 set:. *
3.401.11(13)(1)(2)
Pori and Beef Rout -130OF 121 min*
3-401.11(A)(2)
Ratites, Injected Meats-'IW1515
590.004(H)
sec. *
3-401.11(A)(3)
Poultry, Wild Game, Staffed PHFs,
28.
Stuffing Containing Fish, Meat,
FC=7
Poultry or Ratites -1650F 15 sec.
3-401.11(C)(3)
Whole -muscle, Intact Beef Steaks
` .009
1450F *
3-40LI2
Raw Animal Foods Cooked in a
Mictvwave 165`F
3 401:11{A)(1)(b}
All Other PHFs-- 145v17 15 sec.
Reheating for Hot Holding
3-403.11(A)&(1))
PHFs 165°F 15 sec. *
3-4011](B)
Microwave- 165` F 2 Minute Standing
Tittle*
3-403.11(C)
Commercially Processed RTE Food -
1400P
3-402-11(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 700E
to 4FF1450F Within 4 Hours. *
3-501.14(B)
Cooling PHFs Made From Ambient
Temperature ingredients to 410171456F
Within 4 Hours*
Denotes critical kern in the fiederai 11,399 Fwd Code or 1W QvIR 390.Og0.
C
3-501.14(0)
PHFs Received at Temperatures
According to I.aw Cooled to
41'FJ450F Withia 4 Haus.
p
3-501..15
Colin Methods for PHFs
_
PHF Not and Cold Holding
3-501.16(B)
590.004(F)
Cold PHFs Maintained at or Mow
4101450 F*
3-501.16(A)
Hot PHFs Maintained at or above
1400F. *
3-501.I6(A)
Roasts Heid at or above 130°F.
! ?fifi-!Water.
Time as a Public Health Control
3-501. i9
Tina 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*
1 590.000 1
3-861.11(6)
Use of Pasteurized Eggs*
FC -2
FC -3
3-801.11(13)
-Raw or Partially Cooked Animal Food and
Raw Seed Sprouts Not Served. *
Equipment and Utensils
3-801.11(C)
Unopened Food Package Not Reserved.
CONSUMER ADVISORY
22
3.603.11
Consumer Advisory Posted fir Consumption of
1 590.000 1
23.J
1 24..
Animal Foods That are Raw. Undercooked or
FC -2
FC -3
1 .003 .i
.004
Not Otherwise Processed to Eliminate
Equipment and Utensils
FC - 4
Patho*sns.*>Yc'n;amt
! ?fifi-!Water.
3-302.13
Pasteurized Eggs Substitute for Raw Sheil
_.005
.006
27. -
E
41dq"1_1soil3*L111LR iI RV AN
590.009(A){D) Violations of Section 590.009(x:) -(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)
Criticat.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.
I item
! Good Retail Practices
FC
1 590.000 1
23.J
1 24..
i Management and Personnel
1 Food and Food Protection
FC -2
FC -3
1 .003 .i
.004
1 25.
Equipment and Utensils
FC - 4
! ?fifi-!Water.
Plumbing and Waste
FC -5
_.005
.006
27. -
i Physical Facility
i FC -6
.007
28.
Pasonuus or Tozc Materials
FC=7
.008
29. .� Special Requirements
' 30 I Other _
` .009
5 a�r,�m.K.xtc
31
CITY OF SALEM
'BOARD OFHEALTH '
INn ��
Establishment Name: 3/�f le, ��« I %,` !" o - Dater
Pager Of
Item
Code
C-Crmcal Item
G DESCRIPTION OF VIOLATION % PLAN OF CORRECTION
Date,
No.
Referenc"
R - Red item.
PLEASE PRINT CLEARLY
Verified
cfvm
r I S
O ❑/ `ui'- � li
-
6 �' P GQ
i=^ i
-
IN o
-,I-ILG� ,
It\
l -
I
W
4A
-,
I IV
-_-
Z-7.54,
pdcL
G I l Yl
(AJNI
v_
-
TLI w t./& /k-r�
-
t Af— c, Jc 6 r —
i - �-
a
Discussion With Person in Charge:
Corrective Action Required:
Cl No
es'
I have read this report, have had the opportunity to ask questions and agree to correct all
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
violations before the next inspection, to observe all conditions as described, and to
e -inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/Federal Food Code. I understand that
,
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of
❑ Embargo ❑ Emergency Closure _
your food permit. ,
f,'..... -
❑ Voluntary Disposal ❑ Other:
Violations Related to Foodborne Illness. Interventions and Risk
Factors(imms 1-22) (Cant.)
14
Food or Color Additives
3-202.12
Additives*'
3-302.14
Protection from Unapproved Additives"
15
Poisonous or Toxic Substances
7-101,11
identifying Information -Original
Containers*
7-102.11.
Comma t Name - Working Containers*
7-201.11
Separation - Stcrax' -
7-202.11
. Restriction - Presence and Use*
7-202.12
Conditions of Use"
7-203.11
Toxic Containers - Prohibitions*
7-204.11.
Saratizers. Criteria - Chemicals*
7-204.12
Chemicals for Washir Produce, Criteria*
7-204.14
yin g Agents. Criteria'
Dr
7-205.11
incidental Food Contact, Lubricants*
7-206.11
Restricted Use Pesticides, Criteria'
7-2206.12
Rodent Bait Stations*
7-206.13
Tracking Powders, Pest Control and
Monitoring*
16
Fm-
�
' Dental critical itmr in the federal 1499 Foci Case or 10 CMR 590,000.
F
3-501.14iC)
Proper Cooling Temperatures for
3-501..15
PHFs
3-40i.11A(1)(2)
Eggs- 155°F 15 Sec.
3-501.16($)
590.004(F)
Ems- immediate Service 145°Fl5sec*
3401.11(A)(2)
Comminuted Fish. Meats & Game
3.501.16(A)
Animals - 1550F 15 sec. *
3.40L11(B)(1)(2)
Pork and Beef Rcest-130°F 121mio*
3-401.11(A)(2)
Ratites, Injected Meats -155`F 15
590.004(H)
sec. *
3-401.11(,A)(3)
Poultry, Wild Game, Stuffed PHFs,
.048
Stuffing Containing Fish, !Meat,
! -
Poultry or Ratites -165'F 15 sec,
3401.11(C)(.3)
Whole -muscle, Intact Beef Steaks
145°F *
3-401.12
Raw Animal Fools Cooked in a
Microwave 1657 *
3-401 11 (A)(1)(b)
All Other PHFs -145*F 15 sec.
Reheating for Hot Holding
3-403A I(A)&(D)
j PHFs 165'YF 15 sec. * _
3-403.11(B)
Microwave- 16S F 2 Minute Standing
Time*
3-403.11(C)
Commercially Processed RTE Food -
140"P
3-403A I(E)
Remaining Unsiiced Poriions of Beef
Roasts*
�
Draper Cooling of PHFs
3-501.14(A)
CoolingCooked PHFs from .140`F to
70°17 Within 2 Hours and From 70'F
to 41 `FI45°F (Within 4 Hours. *
3-501.14(:B)
Cooling PHFs Made From Ambient
Temperature ingredients t'o 41°17!45'F
Within 4 Hours"
' Dental critical itmr in the federal 1499 Foci Case or 10 CMR 590,000.
F
3-501.14iC)
PHFs Received at Temperatures
According to Law Coated to
4171457 Within 4 Houm
3-501..15
Cooling Methods for PHFs
3-801.11(H)
FW Hot and Cold Holding
3-501.16($)
590.004(F)
Cold PUFs Maintained at or below
410/450 F*
3-501,16(A)
Hot PHFs Maintained at or above
140°17. *
3.501.16(A)
Roam Held at ar above U".
26. Water. Piumbino and Waste
Time as a Public Health Control
3-501.19
Time as a Public Health Control*
590.004(H)
Variance Requirement
it il* r •-
21
3-801.1.1(A)
Unpasteurized Pre-packaged Juices and
.Beverages with Warning labels*
' 23. Ma meat and Personnel
3-801.11(H)
u
Use of Pasteurized Eggs"
1' __._---°--
1 24 i Ford and Food Protection
3-801.11(D)
flaw or Partially Cooked Animal Food and
Raw Seed Sprouts Not Served.. *
1 25 1 Equi m_ent and Utensils
3-801A I(C)
Umo ened Food Package Not Re -ser ed.
Animal Foods That are Raw. Undercooked or
Not Otherwise. Processed to Eliminate
3-302.13 1 Pasteurized Eggs Substitute for Raw Shen
590.009(A) -(D) 'Violations of Section 590.( )9(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,axd 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 CAIR
590.000.
Item ! Good Retail Practices
IFC
540.oyo _
' 23. Ma meat and Personnel
I FC -2
.003
1' __._---°--
1 24 i Ford and Food Protection
IFC - 3
004
1 25 1 Equi m_ent and Utensils
i FG - 4
.W5 1
26. Water. Piumbino and Waste
FC -5
{ 906
1 27. 1 PhysicalFacili
{ FC -6
.007
L28. ' Poisonous or Toxic Materials
-�S
FC - 7
.048
29. ecial Requirements
! -
.009
30. Other
Establishment
Item Cafe
C1
fY OF SALEM
BOARD OF HEALTH �
Date: 1l
Page: of
No.
Reference
C - Critical Item f
R - Red Item
DESCRIPTION OF VIOLATION / PLAN OF, CORRECTION
- ,,-+.y,..��.-..
;t. PLEASE PRINT CLEARLY
Date
iVerMled
lUlolf 4 r
n J / (/ .4f
in
�5�
G GVC nJ
DA
A4
I00
1
j
4=
9 y
.
a..;
a
Discussion With Person in Charge:
I have read this report, have had the opportunity to ask questions and agree to correct all
violations before the next inspection, to observe all conditions as described, and to
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty4ive dollars or suspension/revocation of
your food permit.
rt. ifs,
Corrective Action Required:
❑ No �❑ Ye
L
❑ Voluntary Compliance ❑ Employee Restriction /
Exclusion
ul e -inspection scheduled C) Emergency Suspensioh
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Violations Related to Foodborne Illness interventions 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*
_
FC - 2
Poisonous or Toxic Substances
7-101,11
Identifying Information - Original
Containers*
7-102.11.
Common Name - Working Containers*
7-201. 11
Se aration-Storage*
7-202.11
. Restriction - Presence and Use*
7-202.12
Conditions of Use*
7-203.11
Toxic Containers - Prohibitions*
7-204.11
Sanitizers. Criteria - Chemicals*
7-204.12
Chemicals for Washing Produce, Criteria*
7-204.14
Drying Agents. Criteria*
1-205. i 1
incidental Food Contact. Lubricants*
7-206.11
Restricted Use Pesticides, Criteria*
7-206.!2
- Rodent Bait Stations*
7-206.13
Tracking Powders, Pest Control and
Monitoring*
TIMEMEMPERATURE CONTROLS
* Denotes critical item in the federal 1999 Food Code or 105 CMR 590.(M10.
3-501A4(C) PHFs Received at Temperatures
According to Law CTed to
4VF/45°F Within 4 Hours.
Proper Cooking Temperatures for
19
PHFs
3401.11A(1)(2)
_
Eggs- 155`F 15 Sec.
_
FC - 2
Eggs- Immediate Service 145°F15sec*
3401.11(A)(2)
Comminuted Fisb. Meats & Game
3-801.11(C)
Animals - 155°F 15 sec. *
3-401.11(B)(1x2)
Pork and Beef Roast - 130°F 121 thin*
3401.11(A)(2)
Ratites, Injected Meats -155°F 15
26.
sec. *
3-401.11(A)(3)
Poultry, Wild Game, Stuffed PHFs,
27.
Staffing Containing Fish, Meat,
i FC - 6
Poultry or Ratites -165°F 15 sec.
3-401AI(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 Not Holding
3-403,11(A)&(D)
PHFs 165°F 15 sec. *
3-403.11(B)
Microwave- 1650 F 2 Minute Standing
Time*
3-403.11(C)
Commercially Processed RTE Food -
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 70°F
to 41°F/45*F Within 4 Hours. *
3-501.14(B)
Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
* Denotes critical item in the federal 1999 Food Code or 105 CMR 590.(M10.
3-501A4(C) PHFs Received at Temperatures
According to Law CTed to
4VF/45°F Within 4 Hours.
3-501.16(B) j Cold PRFs Maintained at or below
3-501.16(A) f Hot PHFs Maintained at or
Roasts Held at or above
Time as a Public Health
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS HSP
21
3-501.15 Cvo1 n Methods for PHFs
19
1 d Cold Holding
3-501.16(B) j Cold PRFs Maintained at or below
3-501.16(A) f Hot PHFs Maintained at or
Roasts Held at or above
Time as a Public Health
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS HSP
21
3-801.1.1(A)
Unpasteurized Pre-packaged Juices and
Beverages with Waning, Labels*
590
3-801.I1(B)
Use of Pasteurized Eggs*
_
FC - 2
3-801.11(D)
Raw or Partially Cooked Animal Food and
Raw Seed Sprouts Not Served. *
Food and Food Protection
3-801.11(C)
Unopened Food Package Not Re -sensed.
CONSUMER ADVISORY
22
3-603.11
Consumer Advisory Posted for Consumption of
590
23.
Animal Foods That are Raw. Undercooked or
_
FC - 2
.003
Not Otherwise Processed to Eliminate
Food and Food Protection
FC -3
Patho as.
25.
3-302.13
Pasteurized Eggs Substitute for Raw Shell
.W5 1
26.
Eggs*
SPECIAL REQUIREMENTS
590.009(A) -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.
Iyf*X-,I li` %7 �It 3�S1�Zeiili t ; 7
(Items 23-30)
Critical and non-critical violations, which do not relate to the
foodborne illness interventions and risk factors listed above, can be
found in the following sections of the Food Code and 105 CMR
590.000.
ft�ern
J Good Retail Practices
.FC
590
23.
Manag_smeni and Personnel
_
FC - 2
.003
t 24.
Food and Food Protection
FC -3
.004 I
25.
Equipment and Utensils
I FC -4
.W5 1
26.
Water. Plumbing and Waste
I FC -5
.006 I
27.
Physical Facility
i FC - 6
.007
26.
Poisonous or Toxic Materials
FC -7
.008
29.
- Special Requirements
I
.009
1 30.
I Other
.5:5'K.anhsY Z he
A-1 Exterminators
P.O. Box 310
Lynn, MA 01903-0310
8OD-525-4825
Bill -To: 11279641
DAILY BAGEL PLACE
7 CHURCH STREET
SALEM, MA 01970
Work Data Time
1021/11 02:07 PM
Purchase Order
Service
101
Service Slip / Invoice
-------------
{ lTATEC'��'y-Sflp��Pdyy'9��yy7Qp11
Work [1279641 978-740-0001
Location: DAILY BAGEL PLACE
7 CHURCH STREET
SALEM, MA 01970
Target Pest Technician
005
Telma Last Service Map Code
04/19/12
Description
REGULAR PEST CONTROL SERVICE
OCCUPIED AREAS MUST BE VACATED FOR HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE
THEY ARE REOCCUPIED. DO NOT ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY.
CONTRACTING ENTRIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD 8 AGRICULTURES'S
PESTICIDE BUREAU CONSUMER SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO
NOTIFY
TENANTS 2-7 DAYS PRIOR TO APPLICATION
COUNTER AREAIBACK KITCHEWBREAKROOM/STORAGE
AREA
Time In
Time Out
Amount
$50.00
SUBTOTAL $50.00
_TAX _ $0.00
TOTAL $50.00
vVY\�
TECHNICIAN SIGNATURE
Chargee outstanding over 30 days from the date of service aro subject to a 1'b% FINANCE I hereby acknowledge the satisfactory completion of all
SeSe}/ Iws rendered,
and agree to pay the
CHARGE PER MONTH or annual percentage rate of 1e%. Customer agrees to pay accrued cost of services as specified above.
expenses in the event of collection.
PLEASE PAY FROM THIS INVOICE
CUSTOMER SIGNATURE
A-1 Exterminators
P.O. Box 310
Lynn, MA 01903-0310
800-525-4825
8111 -To: [1279641
DAILY BAGEL PLACE
7 CHURCH STREET
SALEM, MA 01970
Work Date Tlme
11/15111 01:48 PM
Purchase Order
Service
101
SNAP MS
Service Slip / Invoice
Y _T6915A
tALi
1 N— 1'FlFI6C11 `!
Work 11279641 978-740-0001
Location: DAILY BAGEL PLACE
7 CHURCH STREET
SALEM, MA 01970
Target Pest Technician
005
Terms Last Service Map Cede
04119112
Description
REGULAR PEST CONTROL SERVICE
5 MOUSE SNAP TRAPS @ $1.00 EACH
CONTRACTING ENTITIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD & AGRICULTURES'S
PESTICIDE BUREAU CONSUMER SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO
NOTIFY
TENANTS 2-7 DAYS PRIOR TO APPLICATION
THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED.
INS 5-1
COUNTER AREABACK KITCHENBREAKROOM/STORAGE
AREA
Time In
Time Out
Amount
$50.00
$5.00
SUBTOTAL �_, $55.00
TAX $0.31
TOTAL $66.31
TECHNICIAN SIGNATURE
Charges outstanding over 30 days from the date of service am subject to a 1%% FINANCE I hereby aoknovdedge the satisfactory completion of et tvicee en eg pay the
CHARGE PER MONTH cr amwel permntage mte of 19%. Customer agrees ro Pay a=ed coat of servkea as spedfled above.
expenses In the event of wlledton.
PLEASE PAY FROM THIS INVOICE
CUSTOMER SIGNATURE
A-1 Exterminators
P.O. Box 310 Service Slip/Invoice
Lynn, MA 01.903-0310WP
'1N.UK3ICP T65?4H. _ -oe
800-525-4825 LT}ATf. _. -_k8a[
BIR -To: [1279641 Work [127964] 975-740-0001
DAILY BAGEL PLACE Location: DAILY BAGEL PLACE
7 CHURCH STREET 7 CHURCH STREET
SALEM, MA 01970 SALEM, MA 01970
Work Date Tune Target Pest Technician Time In
12/15/11 03:14 PM 005
Purchase Order Terms Last Service Map Code Time Out
04/19/12
Service Description Amount
101 REGULAR PEST CONTROL SERVICE $50.00
CONTRACTING ENTITIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD & AGRICULTURES'S SUBTOTAL^ $50.00
PESTICIDE BUREAU CONSUMER SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO TAX $DAO
NOTIFY-----�_--- _ ---
TENANTS 2-7 DAYS PRIOR TO APPLICATION TOTAL W $50.00
j THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED.
INS 5-1
I COUNTER AREA/BACK KITCHEMBREAKROOM/STORAGE
AREA
I inspect a0 areas remove old or wet trait reba t as needed for mks reset snap traps replace
. / I
" Chargee outstanding over 30 days Prem the date or service are subject to a 1%% FINANCE I hereby acknowledge the satufactM completan of all aerviras rendered, a r to pey the
CHARGE PER MONTH or annual Percentage rated 1e%. Customer agrees to pay accrued cost of services as specified above.
expenses in the event of collection.
PLEASE PAY FROM THIS INVOICE `
i
CUSTOMERSIGNATURE
A-1Box31
nators
P.O.. Box 310 Service Slip/ Invoice
Lynn, MA 01903-0310 774459 W
800-525-4825 € gATL°ftp
Bill -To: (1279641 Work [1279641 978-740-0001
DAILY BAGEL PLACE Location. DAILY BAGEL PLACE
7 CHURCH STREET 7 CHURCH STREET
SALEM, MA 01970 SALEM, MA 01970
Work Date Tlme Target Peat Technician Time In
01/19/12 01:50 PM 005
Purchase Order Terms Last Service Map Code Time Out
04/19/12
Service Description Amount
101 REGULAR PEST CONTROL SERVICE $50.00
OCCUPIED AREAS MUST BE VACATED FOR HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE
THEY ARE REOCCUPIED. DO NOT ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY.
CONTRACTING ENTITIES HAVE RECIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD 8 AGRICULTURES'S
PESTICIDE BUREAU CONSUMER SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO
NOTIFY
TENANTS 2-7 DAYS PRIOR TO APPLICATION
COUNTER AREABACK KITCHENBREAXROOMBTORAGE
AREA
SUBTOTAL $50.00
TAX $0.00
TOTAL $50.00
TECHNICIAN SIGNATURE
• Charges outstanding over 30 days from the data of service are subject to a 1%% FINANCE I hereby acknowledge the satisfactory Completion ofall s rendered, and agree to pay the
CHARGE PER MONTH or annual percentage rets of 18%. Customer agrees to pay accrued ccatof services as specified above.
expanses in the event of collection.
PLEASE PAY FROM THIS INVOICE
CUSTOMER SIGNATURE
A-1 Exterminators
P.O. Box 310 Service Slip / Invoice
Lynn, MA 01903-0310 4
zf1
800-5254825 11AL O Bfi - i
Bill -To: [127964]
Work [127964) 978-740-0001
DAILY BAGEL PLACE
Location: DAILY BAGEL PLACE
7 CHURCH STREET
7 CHURCH STREET
SALEM, MA 01970
SALEM, MA 01970
Work Date Time Target Pest Technician Time In
02/16/12 02:55 PM 005
Purchase Order Terms Last Service Map Code Time Out
04119112
Service Description Amount
101 REGULAR PEST CONTROL SERVICE $50.00
OCCUPIED AREAS MUST BE VACATED FOR HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE SUBTOTAL $50.00
THEY ARE REOCCUPIED. DO NOT ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY. TAX $0.00
TOTAL $50.00
CONTRACTING ENTITIES HAVE RECIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD & AGRICULTURES'S
PESTICIDE BUREAU CONSUMER SHEETS, WR17TEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO
NOTIFY
TENANTS 2-7 DAYS PRIOR TO APPLICATION
COUNTER AREA/BACK KITCHENIBREAKROOM/STORAGE
AREA
M apr & P 0
E
Chargee OPER MONTH
over 30 dayannual
from Me date of service are subject to e s to FINANCE 1 hereby wines as sp the satisfactory completion of all services
/rendered,
_— pay Uie
CHARGE PER MONTH er ennu9l percentega rate of 18%. Customer agrees to pay eopued mat of services as apetlhetl above. �c� r �"" Y -
expenses in the evert of mileclbn.
PLEASE PAY FROM THIS INVOICE
CUSTOMER SIGNATURE
A-1 Exterminators
Service Slip / Invoice
P.O. Box 310
. ,,.... T�
Lynn, MA 01903-0310
jdNVAIG 7$2157
800-525-4825
IIIACE i28I1*�Ft� -_
k#L1EEL
.,,,'L82T53-_ _
BIII-To: [127964]
Work [127954[ 978-740-0001
DAILY BAGEL PLACE
Location. DAILY BAGEL PLACE
7 CHURCH STREET
7 CHURCH STREET
SALEM, MA 01970
SALEM, MA 01970
Work Data Time Target Past Technician Time In
03/15/12 01:47 PM 005
Purchase Order Tents Last Service Map Code Time Out
04119/12
Service Description Amount
101 REGULAR PEST CONTROL SERVICE $50.00
OCCUPIED AREAS MUST BE VACATED FOR _ HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE SUBTOTAL $50.00
THEY ARE REOCCUPIED. DO NOT ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY. TAX $0.00
TOTAL $50.00
CONTRACTING ENTITIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD 8 AGRICULTURES'S
PESTICIDE BUREAU CONSUMER SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO
NOTIFY
TENANTS 2-7 DAYS PRIOR TO APPLICATION
COUNTER AREA/BACK KITCHENBREAKROOM/STORAGE
AREA
Chargee outstandingMON over 30 days perm the data
ra of sanke are tomrsubject to s stop ayFINANCE
Gomm I hereby services
s s e the saaUecbrycompletion of I . entl pay tha
CHARGE PER MONTH or annual percentage rete of 16%. Cuetomar agrees b pay aodued wet of eentcea es specified above.
expenses in the event o1 cdlecdon_
PLEASE PAY FROM THIS INVOICE
CUSTOMER SIGNATURE .
A-1 Exterminators
P.O. Box 310 Service p Sli / Invoice
Lynn, MA 01903-0310 [14VQiGE
800-525-4825 C1A1B. _t 9' 1
��AqF
Bill -To: [1279641
Work 11279641 978-740-0001
- DAILY BAGEL PLACE
Location. DAILY BAGEL PLACE
7 CHURCH STREET
7 CHURCH STREET
SALEM, MA 01970
SALEM, MA 01970
Work Date Time Target Pest Technician Time In
04/19/12 02:05 PM 005
Purchase Order Terms Last Service Map Code Time Out
04/19/12
Service Description Amount
101 REGULAR PEST CONTROL SERVICE $50.00
OCCUPIED AREAS MUST BE VACATED FOR HOURS. THOROUGHLY VENTILATE TREATED AREAS BEFORE SUBTOTAL $50.00
THEY ARE REOCCUPIED, DO NOT ALLOW ADULTS, CHILDREN, OR PETS ON TREATED SURFACES UNTIL DRY. TAX $0.00
TOTAL $50.00
CONTRACTING ENTITIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD & AGRICULTURES`S
PESTICIDE BUREAU CONSUMER SHEETS, WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO
NOTIFY
TENANTS 2-7 DAYS PRIOR TO APPLICATION
COUNTER AREAIBACK KITCHEN/BREAKROOM/STORAGE
AREA
I TECHNICIAN SIGNATURE
`Charges outstanding over 30 days from the date of service era subject to a 11h% FINANCE I hereby acknowledge the satisfactory completion of aervlces nd and to pay the
CHARGE PER MONTH or annual percentage rate of to%. Customer agrees to pay accrued cost of servkes as specified above.
expenses in the event of collection.
PLEASE PAY FROM THIS INVOICE
CUSTOMER SIGNATURE